International Journal of Medical Students
type: channel
description: The International Journal of Medical Students (IJMS) is an open-access, peer-reviewed scientific journal (ISSN 2076-6327) that publishes original research and experiences in all fields of medicine. The IJMS was created in 2009 to share scientific production and experiences where there is at least one author enrolled as a medical student (including MBBS students, MD students, DO students, MD/MSc students, and MD/PhD students) in any medical school in the world or a recently graduated physician. These early-career scientists must be accompanied by a senior researcher that must be also responsible for the research, guaranteeing the quality of the work. The IJMS aims to be the leading publication platform for early-career scientists' medical research. Read more in the About the Journal section.
publisher: University Library System, University of Pittsburgh
language: en-US
publication name: International Journal of Medical Students
issn: 2076-6327
copyright: Authors who publish with this journal agree to the following terms: The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution. Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work. The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions: Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license. The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal. Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a l…
items: Abstracts of the Student's Scientific Society of Tbilisi State Medical University
items: Abstracts of the 10th International Academic Medical Congress of Maranhão (X COIMAMA) 2025
items: Abstracts of the International Students’ Congress of Bucharest (2024)
items: Abstracts of the Medical Academical Conferece of Piauí (COMAPI) 2023
items: Cover, Credits, & Content
items: Ease of Nasogastric Intubation using a Frozen Nasogastric Tube by a Novice Intern in Anaesthetized, Intubated Adult Patients. A Randomized, Controlled Parallel Assignment Study
items: Evaluation of Anxiolytic Effect of Pantoprazole on Swiss Albino Mice – An Experimental Study
items: Assessing the Precision of AI-Generated Medical Answers: An Evaluation of LLaMA-3 Powered Meta AI
items: National Trends Reveal Hypertension as the Dominant Driver of Cardiovascular Readmissions
items: Sleep Solutions or Sleepless Nights? Adverse Events in Mandibular Adjustment Devices and Hypoglossal Nerve Stimulator Treatment of Obstructive Sleep Apnea
items: Exploring Careers in Healthcare & Onward (ECHO): A Community Outreach Program to Promote Healthcare Career Interest in K-8 Students Surrounding the CU Anschutz Medical Campus
items: Sleep Quality in First- to Third-Year Medical Students at Universidad de San Carlos de Guatemala: Prevalence and Associations with Daytime Sleepiness and Perceived Stress
items: Mobile Phone Use and Hand Grip and Pinch Strength in the SCAMP Study
items: Cognitive Impairment and Its Influencing Factors Among Elderly at Residential Homes in Western Tamil Nadu -A Cross-sectional Study
items: Association Between Diabetes Mellitus and Intraoperative Awareness During General Anesthesia: A Retrospective Cohort Study
items: The Effects of Community-Based Mental Health Interventions on Resettled Adult Refugees from Muslim-Majority Countries
items: Emotional and Psychological Dependence of Medical Students on Artificial Intelligence Chatbots: A Cross-Sectional Study
items: Vagus Nerve Neuropathy in SARS-CoV-2 Infection: An Ultrasound Study
items: Occupational Exposure to Blood / Body Fluid and Anxiety Among Final-Year Medical Students: The Result of the Curricular Gaps in Medical Education
items: Evaluation of HMBG1 serum levels and its involvement in depressive symptoms in Obstructive Sleep Apnea Patients (OSA)
items: Characterisation of Morphological Changes and Retinal Decay in a Retinal Degeneration Murine Model of Retinitis Pigmentosa
items: Handgrip Strength Asymmetry in Middle-aged and Older Adults: Clinical Aspects
items: From Observation to Participation: Gender Differences and Surgical Exposure among Medical Students
items: Antimicrobial Resistance Awareness and Antibiotic Prescribing Behavior Among Healthcare Workers
items: Publication Rate of Students and Graduates of the Program of Combined Studies in Medicine (PECEM), an MD/PhD Program of Mexico
items: The Intersection of Rheumatology and Cardiology: Cardiac Disease in Rheumatic Disorders within Palestinian patients between 2022-2024, A Retrospective Cohort Study
items: Effectiveness of Haptic Feedback Devices in Reducing Pain Perception During Intra-Articular Corticosteroid Injections in Rural Guatemala and Kenya – A Randomized Controlled Trial
items: Effectiveness of Trimethoprim-Sulfamethoxazole in Cyclosporiasis: A Meta-analysis of Randomized Clinical Trials
items: Amyloidosis – A Rare Complication of Long-Evolving Rheumatoid Arthritis. A Case Report
items: Left Colo-renal Fistula in an Elderly Female: Case Report
items: Primary Intestinal Lymphangiectasia Presenting as Chylous Ascites in a Young Female: A Rare Case
items: A Case of Rosai-Dorfman Disease
items: One Step Forward, Two Steps Back: Functional Decline following Lisfranc Fracture-Dislocation
items: Aggressive Gallbladder Carcinoma in Down Syndrome Patient: A Rare Presentation
items: Avoiding Pacemaker: Resolution of Sinus Node Dysfunction through CPAP Therapy
items: Silent Splenic Crisis in an Immunocompetent Adolescent: A Case Report of Multifocal Splenic Abscess with Subcapsular Extension and Paradoxical Leukopenia Managed Conservatively
items: Subcutaneous Panniculitis-like T-cell Non-Hodgkin Lymphoma Associated with Cushing Syndrome: An Introspection
items: Opportunities for Climate-Sensitive Work in the Health Sector - Kenya and Germany in Focus
items: Near-Peer Teaching of Laparoscopic Skills among Medical Students – A Randomized Feasibility Study
items: Managing Hyperphagia, Obesity, and Hyperglycemia in Prader-Willi Syndrome: A Meta-Analysis of GLP-1 Agonists and SGLT2 Inhibitors
items: What Medical Students Can Learn from the 2024 Dengue Outbreak in Pakistan: Clinical Spectrum, Biochemical Abnormalities and Predictors of Severity
items: Risk of Recurrence of Congenital Ocular Toxoplasmosis in Children: A Meta-Analysis Review of Studies With Long-Term Clinical Follow-up.
items: Aging Patients, Changing Substances: Unexpected Demographic Shifts in Turkey’s Drug Treatment Admissions Over a Decade
items: Cross Sectional Study on Air Pollution and its Influence on Health Related Quality of Life in Coimbatore
items: MALAT1 and MIAT as Emerging Biomarkers for Diabetic Retinopathy: A Systematic Review and Meta-Analysis
items: Health Anxiety Among Clinical Medical Students: A Cross-Sectional Study at Uludağ University Faculty of Medicine
items: Association Between the Presence of Palmaris Longus Muscle and Handwriting Performance in Medical Students: A Cross-Sectional Study
items: Survival Factors in Lung Cancer Patients with Mutations in the PROS1, SERPINC1, F2, and F5 Genes
items: Leishmaniasis in a Patient with Congenital Neutropenia - A Rare Case Report
items: Diabetic Striatopathy: A Forgotten Diagnosis in Clinical Neurology
items: Efficacy of Narrowband UVB Phototherapy in Mild to Moderate Psoriasis: A Case Series from Kharkiv, Ukraine
items: Reconstruction of a Large Lumbar Carcinoma Defect Using a Subtype III Keystone Flap: Case Report
items: The Lipid Paradox in 5,060 Hospitalized Patients: An Inverse Association Between C-Reactive Protein and Cholesterol in a Tertiary Care Cohort from 2020 to 2024
items: Is Mental Health Contagious? Depression, Anxiety, Stress and Burnout among Mental health professionals in Sudan
items: Healthcare Access Dimensions among ESRD Patients on Dialysis in Northern Sudan during Wartime 2024
items: Malnutrition among Patients with End-Stage Renal Disease in War 2024: The Role of Healthcare Access, Dialysis, Gender, and Economic Disparities
items: Cross-Sectional Descriptive Study of Comparative Accuracy of ChatGPT, Google Gemini, And Microsoft Copilot in Solving NEET PG Medical Entrance Test
items: Enhancing wash Practices and Health Outcomes in a Remote Community in the Peruvian Amazon: a Community-Based Intervention
items: Human Immunodeficiency Virus Infection Among Women with Cervical Cancer: A Cross-Sectional Study
items: Exploring the Relationship Between Students’ Academic Performance and Jungian Psychological Types: A Correlational Study
items: Prevalence of Anxiety Among Medical Students in River Nile Universities: A Cross-Sectional Study
items: The Impact of Lifestyle on Cardiovascular Health Among Medical Students at 6 October University
items: Emotional Well-Being, Anxiety, Depression, and Burnout Among First-Year Hospital Medical Students in Guatemala: A Pilot Study
items: Assessment Of Vision Impairments Among Licensed Drivers In Mathura: A Pilot Study
items: Factors Influencing Varicose Vein Amongst the Local Population of Namakkal - A Cross-Sectional Study
items: Knowledge, Attitude, and Practice on Over-the-Counter Drugs among Medical Students University of Khartoum, 2022-2023
items: Students' Perspectives on the Educational Environment at the University of Khartoum, Faculty of Medicine (2023-2024)
items: Myeloid-Derived Suppressor Cells in HIV: A Marker Beyond CD4 Count?
items: Early Clues, Early Cure: Evaluating the Utility of the Hematological Scoring System in the Early Diagnosis of Neonatal Sepsis.
items: Perceived Knowledge, Perception and Readiness of University Students regarding Sustainability Education and Practice
items: Cross Sectional Study On Prevalence Of Insomnia And Factors Contributing To Insomnia In Adolescent School Students
items: Impact of War on Burnout among Medical Students at Al-Neelain University in Sudan, 2024

Abstracts of the Student's Scientific Society of Tbilisi State Medical University
type: item
creator: Executive Committee of IJMS
rights: Copyright (c) 2025 Executive Committee of the IJMS https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-08-12
publication date: 2025-08-12
starting page: S14
ending page: S28
doi: 10.5195/ijms.2025.3753

Abstracts of the 10th International Academic Medical Congress of Maranhão (X COIMAMA) 2025
type: item
description: The 10th International Congress of Maranhão (X COIMAMA) brought together medical students, early-career researchers, and academic mentors to present and discuss emerging scientific contributions across the biomedical and clinical sciences. This conference book compiles the accepted abstracts from a diverse range of disciplines, including basic science, clinical research, public health, and medical innovation. The event aimed to promote scientific inquiry, strengthen research competencies among trainees, and encourage interdisciplinary dialogue within the global medical student community. The abstracts contained herein represent the collective academic output of participants and serve as a reference for ongoing research development and future collaborative opportunities.
creator: Executive Committee of IJMS
rights: Copyright (c) 2025 Daniela Collazos https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-11-26
publication date: 2025-11-26
starting page: S29
ending page: S100
doi: 10.5195/ijms.2025.4239

Abstracts of the International Students’ Congress of Bucharest (2024)
type: item
creator: Executive Committee of IJMS
rights: Copyright (c) 2025 Executive Committee of IJMS https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-05-12
publication date: 2025-05-12
starting page: S101
ending page: S150
doi: 10.5195/ijms.2025.3459

Abstracts of the Medical Academical Conferece of Piauí (COMAPI) 2023
type: item
creator: Executive Committee of IJMS
rights: Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-01-18
publication date: 2025-01-18
starting page: S151
ending page: S173
doi: 10.5195/ijms.2025.3227

Cover, Credits, & Content
type: item
creator: Executive Committee of IJMS
rights: Copyright (c) 2025 Daniela Collazos https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
doi: 10.5195/ijms.2025.4311

Ease of Nasogastric Intubation using a Frozen Nasogastric Tube by a Novice Intern in Anaesthetized, Intubated Adult Patients. A Randomized, Controlled Parallel Assignment Study
type: item
description: Ease of Nasogastric Intubation using a Frozen Nasogastric Tube by a Novice Intern in Anaesthetized, Intubated Adult Patients. A Randomized, Controlled Parallel Assignment Study Background: Frozen nasogastric tube insertion has a higher first attempt success rate compared to normal nasogastric tube insertion in many previous clinical trials. However, the insertion in these studies were done by an expert or the familiarity with nasogastric intubation is not commented about. Success rate of the skilled techniques differ based on the expertise level. We observed that the primary contact physician to be the first responder to nasogastric intubation call in majority of the hospitals is a novice intern. AIM: Our study aims to determine the success rate and associated complications when a novice intern attempt to introduce a frozen or a conventional nasogastric tube under supervision. Methods: A total of 200 anesthetized, tracheally intubated patients were randomized to receive either a frozen nasogastric tube (n=100) or a normal nasogastric tube (n=100) as a part of routine care. The first attempt success, overall success, duration of insertion, number of attempts and complications were noted. Results: Frozen nasogastric tube group had higher first attempt success (74 versus 51) and overall success (82 versus 57). It also had fewer attempts for successful nasogastric tube insertion as well as lesser time for the successful procedure (35.8 s versus 42.1 s). Overall complications were fewer with Frozen nasogastric tube (34 versus 61) compared to conventional nasogastric tube except bleeding (21 in both) and kinking (5 and 1). Conclusion: Our study demonstrated that in the hand of novice intern a frozen nasogastric tube results in higher first attempt success rate, overall success rate, reduced number of attempts, reduced coiling and shorten intubation time with a comparable mucosal bleeding in comparison to conventional nasogastric tube intubation.
creator: Madhuri Dommaraju
creator: Shameem s
creator: Aloka Samantaray
rights: Copyright (c) 2025 MADHURI DOMMARAJU, Shameem s, Aloka Samantaray https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S175
ending page: S175
doi: 10.5195/ijms.2025.4025

Evaluation of Anxiolytic Effect of Pantoprazole on Swiss Albino Mice – An Experimental Study
type: item
description: Background: Anxiety disorders, affecting over 7% of the global population, are among the most common psychiatric disorders significantly impairing daily life, productivity, and social functioning. Current treatments, such as SSRIs and benzodiazepines, provide only partial relief and are often limited by side effects including sedation, sexual dysfunction, and dependence. This has created a pressing need for safer and more effective therapeutic options. Pantoprazole, a commonly used proton pump inhibitor, has demonstrated neuroprotective and anti-inflammatory properties in preclinical studies. These findings raise the possibility that pantoprazole may also exert anxiolytic effects, which have not yet been systematically explored. Methods: Thirty female Swiss albino mice were divided into five groups, each consisting of 6 animals each- control (saline), standard (diazepam 5 mg/kg i.p.), and pantoprazole-treated groups (10, 15, 20 mg/kg orally). Drugs were administered daily for 14 days. Mice were then assessed using the Elevated Plus Maze (EPM) which measures time spent and entries into open arms, and Actophotometer which records locomotor activity to determine whether pantoprazole produced sedative effects. Results: Pantoprazole treatment significantly reduced anxiety-like behavior in a dose-dependent manner. In the EPM, mice treated with pantoprazole spent more time and made more entries into open arms compared to controls, with the 20 mg/kg dose producing the strongest effect (p<0.001), comparable to diazepam. Importantly, locomotor activity remained unchanged across pantoprazole groups, indicating that its anxiolytic effect was not confounded by sedation. Statistical analysis confirmed that the 20 mg/kg dose of pantoprazole produced significant improvements in anxiety-related measures without altering overall activity levels. Conclusion: This experimental study provides the first evidence that pantoprazole, at higher doses, exerts significant anxiolytic effects in…
creator: Farheen Kooliyattayil
creator: Shwetha Oommen
creator: Jacob Abraham
rights: Copyright (c) 2025 Farheen Kooliyattayil, Shwetha Oommen, Jacob Abraham https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S176
ending page: S176
doi: 10.5195/ijms.2025.4103

Assessing the Precision of AI-Generated Medical Answers: An Evaluation of LLaMA-3 Powered Meta AI
type: item
description: Background & Objective: Meta AI is being used frequently by medical students to clear the queries or to solve the questions, due to its easy availability. The purpose of this study is to assess the correctness of the Meta AI-generated answers to medical questions, and the reproducibility of the results. Method: The study employs an Evaluation Research Design aimed to assess the quality and effectiveness of Meta AI. A total of 240 MCQs were included in the questionnaire, 30 MCQs from each subject. Out of these, 108 were case-based (Category: A), whereas 132 were fact-based (Category: B). Meta AI was re-queried with the previously failed questions 14 days later. Results were analyzed manually and accuracies were evaluated using IBM SPSS version 27. Results: In initial analysis, Meta AI correctly answered 187 out of 240 questions (average accuracy = 77.9%). The most accurately responded category was Category-A with an average accuracy of 82.4%. The accuracy of Category-B was noted to be 74.2%. In re-scored analysis, Meta AI reproduced correct answers for only 12 out of 53 previously failed questions leading to an average reproducibility of 22.6%. The accuracy of Category A was 47.3% and that of Category B was 8.8%. Conclusion: The integration of AI in the field of medicine is advancing rapidly, and models like Meta AI represent significant strides in making medical information more accessible and accurate. Despite these promising results, there are notable limitations, such as the scope of questions, the subjects covered, and potential selection biases. Table 1. Overview of Total and Categorical Validation from Initial Analysis Subject Correct Answers Wrong Answers Category – A n (total) Category – B n (total) Accuracy % Anatomy 20 10 1 (8) 9 (22) 66.6 Biochemistry 26 4 3 (16) 1 (14) 86.6 Community Medicine 20 10 5 (10) 5 (20) 66.6 Forensic Medicine 18 12 0 (0) 12 (30) 60.0 Microbiology 27 3 1 (16) 2 (14) 90.0 Pathology 29 1 1 (29) 0 (1) 96.6 Pharmacology 26 4 3 (15) 1…
creator: Areeba Khan
creator: Muhammad Talha Khan
rights: Copyright (c) 2025 Areeba Khan, Muhammad Talha Khan https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S177
ending page: S177
doi: 10.5195/ijms.2025.3887

National Trends Reveal Hypertension as the Dominant Driver of Cardiovascular Readmissions
type: item
description: Introduction: Cardiovascular (CV) hospital readmissions significantly burden the U.S. healthcare system, particularly among patients with heart failure. While previous studies have evaluated all-cause readmission, there is limited understanding of the specific CV diagnoses responsible for short- and long-term hospital returns. This study aimed to identify the leading CV-specific diagnoses contributing to 30-day and 1-year readmissions following an index hospitalization for heart failure to inform targeted interventions and reduce repeat hospitalizations. Methods: We conducted a retrospective cohort analysis using the Nationwide Readmissions Database (NRD) from 2016 to 2022. A total of 31,886,859 weighted hospitalizations were included. Adult patients (≥18 years) admitted with a primary diagnosis of heart failure were included. The primary outcome was CV-specific readmission within 30 days and 1 year, based on ICD-10 codes for heart failure/pulmonary edema, hypertension and hypertensive crisis, myocardial infarction, arrhythmias/conduction disorders, stroke, pulmonary circulation disorders, and venous thromboembolism. Survey-weighted descriptive statistics, stratified by 30-day and 1-year CV-specific readmission status, identified leading diagnoses. Adjusted models accounted for demographics, comorbidity burden (Charlson Comorbidity Index), and hospital characteristics. Chi-square tests and phi-coefficients (φ) quantified associations, with statistical significance set at p < 0.001. Results: Among patients initially hospitalized for heart failure, hypertension or hypertensive crisis accounted for the majority of CV-specific readmissions at both 30 days (64.8%) and 1 year (65.1%). Recurrent heart failure or pulmonary edema was the second most common cause, followed by arrhythmias, acute myocardial infarction, and stroke. All comparisons versus hypertension or hypertensive crisis were statistically significant (p < 0.001; φ = 0.53–0.69). These diagnostic patterns remai…
creator: Kyle Thurmann
creator: Trisha Mukherjee
creator: Joe Dantin
creator: Paul Kang
creator: Michael White
rights: Copyright (c) 2025 Kyle E. Thurmann, MS, Trisha G. Mukherjee, Joseph G. Dantin, MS, JD, Paul T. Kang, PhD, Michael D. White, MD https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S178
ending page: S178
doi: 10.5195/ijms.2025.3605

Sleep Solutions or Sleepless Nights? Adverse Events in Mandibular Adjustment Devices and Hypoglossal Nerve Stimulator Treatment of Obstructive Sleep Apnea
type: item
description: Background: Novel therapies for patients with obstructive sleep apnea (OSA) are gaining popularity as many turn away from traditional continuous positive airway pressure (CPAP) treatment. This study aims to analyze and compare the adverse events (AEs) associated with two alternative therapies to CPAP, mandibular adjustment devices (MADs) and hypoglossal nerve stimulators (HGNs). Methods: A retrospective database analysis was conducted of the adverse event (AE) reports extracted from The Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database. Devices included MADs (SomnoMed Herbst Advance, Sydney, Australia, product codes DYJ, LRK, ECN, and EJF) and HGNs (Inspire Implant, Golden Valley, Minnesota, USA, product code MNQ) for all years reported. Duplicate entries and reports related to device malfunction were excluded. AEs were analyzed for severity of the adverse event and classified using the Clavien-Dindo scale. AEs were classified based on the severity of harm, type of harm (Allergic Reaction, Choking, Numbness, Pain, Trauma, Paralysis, Dystonia, Hemorrhage, Dysphagia/Odynophagia), and patient outcomes (Hospitalization, Surgical Management). Results: A total of 24 MADs and 60 HGNs met the inclusion criteria for analysis. Trauma was the most frequently reported AE for MADs (n=8, 33.333%) while pain was most frequently reported for HGNs (n=29, 48.333%). Allergic reactions were significantly more prevalent in MADs compared to HGNs (n=6, 25.000% vs n=1, 1.667%, p=0.002). On the other hand, pain was significantly more prevalent with the use of HGNs compared to MADs (n=4, 16.667% vs n=29, 48.33%, p=0.012). The mean severity of the AE was higher in HGNs compared to MADs (3.000 vs 2.375, p=0.005) indicating a higher level of intervention was required and increased risk of life-threatening outcomes. No statistically significant difference in association was observed between MADs and HGNs for hospitalization, surgical management, cho…
creator: Jacob Bauer
creator: Chloe Carrington
creator: Sana Khan
rights: Copyright (c) 2025 Jacob Bauer, Chloe Carrington, Sana Khan https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S179
ending page: S179
doi: 10.5195/ijms.2025.4002

Exploring Careers in Healthcare & Onward (ECHO): A Community Outreach Program to Promote Healthcare Career Interest in K-8 Students Surrounding the CU Anschutz Medical Campus
type: item
description: Background: Early exploration can strongly influence children’s career development. Past research suggests that children of low socioeconomic status (SES) have a relative lack of exposure to the healthcare environment, which has been adversely associated with healthcare career interest. Many have examined the importance of promoting early interest in healthcare careers, particularly as a strategy to address shortages of healthcare professionals practicing in low socioeconomic areas. While most research examines career interventions in teenage adolescents, there is a relative lack of such interventions geared towards the elementary and middle-aged population. Our community outreach program is designed to introduce basic physiological concepts and explore careers in healthcare through hands-on experiments. The aim is to increase exposure and interest in healthcare careers in elementary- and middle-aged students. Methods: From December 2024 to October 2025, ECHO organized four career fairs at libraries and elementary schools in Aurora County. Participants were recruited through advertising at partnering schools and libraries, most of which have a large population of students who qualify for free or reduced-price lunches. The event offered four activities: “Build Your Own Stethoscope” (Cardiology), “Learn About Lungs” (Pulmonology), “Make a Surgeon’s Bracelet” (Surgery), and “All About Reflexes” (Neurology). Each activity was led by 2-4 volunteer medical students or physicians from the CU Anschutz medical campus. Following completion of the fair, participants completed anonymous post-event surveys that evaluated interest in the activities offered and medical professions before and after the career fair. Results: Between December 2024 and October 2025, 71 elementary and middle school students participated and completed post-event surveys at three ECHO career fairs. There was a 175% increase in “Yes” responses to the question “I am interested in a career where I grow up t…
creator: Ariel Davydov
creator: Rebecca Altshuler
creator: Zoe Van De Voorde
creator: Aimme Pugh Bernard
rights: Copyright (c) 2025 Ariel Davydov, Rebecca Altshuler, Zoe Van De Voorde, Aimme Pugh Bernard https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S180
ending page: S180
doi: 10.5195/ijms.2025.4014

Sleep Quality in First- to Third-Year Medical Students at Universidad de San Carlos de Guatemala: Prevalence and Associations with Daytime Sleepiness and Perceived Stress
type: item
description: Background: Sleep quality is fundamental for learning, emotional regulation, and long-term health. Medical students often face heavy workloads and irregular schedules that can disrupt sleep and increase stress and daytime sleepiness. Based on our literature search, we found no previous reports examining sleep quality and its associations with daytime sleepiness and perceived stress among Guatemalan medical students; therefore, this study represents an initial contribution to this field. Establishing the magnitude of sleep problems in this context is essential to guide student well-being initiatives and institutional policies. Aim: To determine the prevalence of poor sleep quality among first- to third-year medical students at the Universidad de San Carlos de Guatemala and to evaluate its association with daytime sleepiness and perceived stress. Methods: We conducted a cross-sectional survey of first- to third-year medical students at the Universidad de San Carlos de Guatemala during June-July 2024. Participants filled out an online questionnaire that included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and the Spanish Perceived Stress Scale (EEP). Poor sleep was defined as PSQI > 5. Demographic data included sex, age, and academic year. Categorical variables were compared with chi-square tests, and associations among PSQI, ESS, and EEP scores were assessed with Spearman correlations. Analyses were performed in R with α = 0.05. Results: A total of 100 students participated (mean age 21.7 ± 1.6 years; 61% women), who reported an average nightly sleep duration of 4.9 ± 1.05 hours (mode = 5 hours) over the previous month. The mean PSQI score was 9.2 ± 2.8, with 90.0% (95% CI 83.5–94.6) classified as having poor sleep quality (PSQI > 5). Excessive daytime sleepiness (ESS ≥ 10) was found in 49% of students (mean ESS 8.8 ± 3.6). High perceived stress was present in 87% of participants, with a mean score 32.1 ± 6.8 which corresponds to the hig…
creator: Victor Rivero
creator: Ana Palomo
rights: Copyright (c) 2025 Victor Rivero, Ana Palomo https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S181
ending page: S181
doi: 10.5195/ijms.2025.3984

Mobile Phone Use and Hand Grip and Pinch Strength in the SCAMP Study
type: item
description: Background: Use of smartphones demands small, repetitive movements of the thumb and digits on small screens with prolonged hand grip and awkward wrist movement, which may result in fatigue, discomfort, weakness or musculoskeletal impairment. The relationship between phone use and grip and pinch strength in adolescents is poorly understood. Existing research is limited to small, cross-sectional studies predominantly in young adults with little adjustment for confounders, limiting causal inference. Yet hand and wrist injuries pose a huge economic burden to the NHS, costing c£1.3 billion annually with an average 2.8 days of workdays lost. High quality, longitudinal research with appropriate adjustment of confounders is required to resolve this research question, given the high levels of smartphone use in UK adolescents. Methods: The aim of this study is to investigate the longitudinal association between smartphone use and hand grip and pinch strength, and to explore if any observed associations differ between dominant and non-dominant hands, or between biological sexes, in the Study of Cognition, Adolescents and Mobile Phones (SCAMP), a prospective school-based cohort in Greater London, UK. 647 SCAMP participants with baseline (11-12 years) and follow-up (13-15 years) data were included in the analysis. Hand grip strength was measured for both hands, using standardised technique, with a hand-held Jamar dynamometer (kg), and tip pinch, key pinch and palmar pinch with a Jamar pinch gauge (kg). Mobile phone use variables were daily duration of calls, daily duration of social network use, daily duration of internet use, daily frequency of text messaging and daily frequency of instant messaging. Self-reporting via questionnaire at baseline and follow-up were undertaken. Analyses were adjusted a priori for potential confounders (age, sex, socioeconomic status, ethnicity, other device use, time difference between baseline and follow-up, and school cluster effects). Results: …
creator: Rachel B. Smith
creator: Lan Cheng
creator: Catherine James
creator: Chen Shen
creator: Mireille B. Toledano
rights: Copyright (c) 2025 Rachel B. Smith, Lan Cheng, Catherine James, Chen Shen, Mireille B. Toledano https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S182
ending page: S182
doi: 10.5195/ijms.2025.3961

Cognitive Impairment and Its Influencing Factors Among Elderly at Residential Homes in Western Tamil Nadu -A Cross-sectional Study
type: item
description: Background: The global population is experiencing rapid aging, with projections indicating that the number of older adults will double by 2050. In India, it is anticipated that one in every five individuals will be aged 60 years or above in the near future. This demographic transition brings with it an increasing prevalence of cognitive impairment (CI), characterized by declines in memory, attention, or executive functioning that are more severe than typical age-related changes but do not meet criteria for dementia. Elderly individuals living in old age homes face additional vulnerabilities due to social isolation, weakened family support, and adjustments to institutional care. Despite these challenges, cognitive health within residential care settings has received limited attention in the Indian context. Identifying the prevalence and contributing factors of CI is essential for promoting appropriate healthcare interventions and safeguarding the autonomy and well-being of older adults. Aim: The present study was designed to evaluate the prevalence of cognitive impairment and to examine the factors associated with it among elderly residents of old age homes in Coimbatore. Methods: A cross-sectional study was carried out between November 2024 and February 2025 across selected old age homes in Coimbatore. Using multistage random sampling, 200 individuals aged ≥60 years were recruited. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA). A pretested semi-structured questionnaire collected data on demographic and socioeconomic characteristics, financial dependence, and past occupations, as well as health conditions and lifestyle factors. Anthropometric measurements and clinical parameters such as blood pressure and pulse were recorded. Data were analysed using SPSS v25.0, and associations were tested at a significance level of p<0.05. Results: Among 200 elderly participants (mean (± SD) age 69.8 ± 9.8 years; 57% men, 43% women), one-third were i…
creator: Sri Thabasni S K
creator: Muthathal S.
creator: Dhaarani Dharmaraj
creator: S. Supriya Sri
rights: Copyright (c) 2025 Sri Thabasni S K https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S183
ending page: S183
doi: 10.5195/ijms.2025.4074

Association Between Diabetes Mellitus and Intraoperative Awareness During General Anesthesia: A Retrospective Cohort Study
type: item
description: Background: Despite advancements in anesthetic techniques, specific patient populations remain vulnerable to intraoperative awareness. Diabetes mellitus (DM), increasingly prevalent and often accompanied by significant comorbidities, may complicate anesthetic management and mask signs of inadequate anesthetic depth. This study investigates whether DM is independently associated with an increased risk of unintended intraoperative awareness. Methods: A retrospective cohort analysis was conducted using the TriNetX research platform, a federated health database. Two cohorts were identified: patients with DM and a control group without DM undergoing surgery under general anesthesia. Propensity-score matching (1:1) was used to control for confounders, including cognitive impairment, chronic obstructive pulmonary disease, substance use, cardiovascular disease, and anesthesia type. The incidence of intraoperative awareness was compared between groups. Results: After matching, 193,868 patients were included in each cohort (total n=387,736). The incidence of intraoperative awareness was significantly higher in the DM group (0.027%, n=52) compared to the non-DM group (0.015%, n=29). DM was associated with a statistically significant increased risk (absolute risk difference: 0.012%, 95% CI: 0.003–0.021%, p=0.0106). Diabetic patients had nearly twice the risk of intraoperative awareness (RR=1.793, 95% CI: 1.139–2.824; OR=1.793, 95% CI: 1.139–2.825). Conclusion: DM significantly increases the risk of intraoperative awareness during general anesthesia. These findings underscore the importance of heightened anesthetic vigilance and personalized monitoring strategies in diabetic patients to mitigate this risk. Table 1. Comparison of Intraoperative Awareness Incidence Between Diabetic and non-Diabetic Cohorts. Cohort Patients in Cohort Patients with Outcome Risk Diabetes Cohort 193,868 52 0.027% Non-Diabetic Control Cohort 193,868 29 0.015% Risk Difference 95% CI (Risk Diff) z p Risk…
creator: Zhenghao Wang
creator: Ngoc Bich Nguyen
creator: Eduardo Espiridion
rights: Copyright (c) 2025 Zhenghao Wang, Ngoc Bich Nguyen, Eduardo Espiridion https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S184
ending page: S184
doi: 10.5195/ijms.2025.3781

The Effects of Community-Based Mental Health Interventions on Resettled Adult Refugees from Muslim-Majority Countries
type: item
description: Background: Although refugees from Muslim-majority countries represent a vast percentage of displaced populations globally, limited data exists on their resettlement into high-income nations. This gap has resulted in an inadequate and inequitable method of care when addressing their mental health needs, often overlooking relevant cultural and religious frameworks. The religious beliefs of these individuals, paired with the sociocultural assumptions placed upon them both internally and externally, affect help-seeking behavior and psychosocial resilience which ultimately manifests in poorer health outcomes. These issues are compounded because refugees often face significant stressors through discrimination, societal stigma, and trauma from forced migration which exacerbate disparities. Furthermore, the COVID-19 pandemic disproportionately affected refugee populations that struggled with limited access to treatment and healthcare information. The pandemic amplified epidemic hysteria fueled stigmatization of refugee populations which further increased their distrust in Western medicine and decreased compliance with healthcare systems. Aim: To identify the effects of community-based mental health interventions in resolving this population's unmet mental health disparities. Methods: We conducted an integrative review of the literature on this topic to illuminate the effectiveness of this healthcare model for resettled adult refugees from Muslim-majority countries. Data extracted from the literature included information on interrelated environmental systems that affect mental health, descriptions of the measures taken at each of the four ecological levels of influence, and reported outcomes in regards to effectiveness and challenges. Results: Interventions for depression, anxiety, and psychological distress were most prevalent, addressed most commonly through strengthened social-bondedness and interpersonal relationships among refugees and their communities. Programs which…
creator: Ahmad Elhaija
creator: Ilia Talebi Dolouei
rights: Copyright (c) 2025 Ahmad Elhaija, Ilia Talebi Dolouei https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S185
ending page: S185
doi: 10.5195/ijms.2025.3947

Emotional and Psychological Dependence of Medical Students on Artificial Intelligence Chatbots: A Cross-Sectional Study
type: item
description: Background: Artificial Intelligence (AI) chatbots are programs designed to simulate human-like conversations to provide information and parasocial interaction. Even though these tools may provide a sense of companionship-like bonds, overreliance risks conflating support with dependence. This raises critical questions regarding whether the very features that enhance chatbot engagement may, through repeated or emotionally charged interactions, inadvertently promote emotional dependence. Our study aimed to evaluate the emotional and psychological dependence on AI chatbots among medical students, a population group at higher risk of adopting such coping strategies due to intense stress and limited avenues for emotional support. Methods: A national cross-sectional survey was conducted among medical students enrolled in various public and private institutions across Pakistan over a period from July to August 2025 through an online questionnaire with assured anonymity. The survey was voluntary, and all participants provided informed consent prior to enrollment. Ethical approval was obtained from Ethical Committee of Ameer-ud-Din Medical College. Data collectors were recruited from different provinces to ensure broad geographic representation, and the survey link was disseminated through institutional and student networks. The questionnaire comprised the following sections: demographics, chatbot usage patterns, emotional expression, psychological help, emotional and psychological dependence, relationship-style dependency, and satisfaction. Reverse coded items were included to minimize acquiescence bias. Dependence was classified as low, moderate, or high using mean ± SD thresholds. Data were analyzed in SPSS 27 using descriptive and inferential statistics, multivariable regression, and mediation–moderation analyses to address confounding and interaction effects, with significance set at p ≤ 0.05. The study complied with STROBE guidelines. Results: Of 1063 responses, 1045 we…
creator: Sheraz Qasim
creator: Ali Hassan
creator: Fatima Saleemi
creator: Mirza Shaheer Haider
creator: Muhammad Ibrahim Khalil
creator: Adeenah Irshad
creator: Safia Bibi
creator: Ali Sher
creator: Ahsan Ali
rights: Copyright (c) 2025 Sheraz Qasim, Ali Hassan, Fatima Saleemi , Shaheer, Ibrahim , Adeenah , Safia Bibi, Ali Sher, Ahsan https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S186
ending page: S186
doi: 10.5195/ijms.2025.4057

Vagus Nerve Neuropathy in SARS-CoV-2 Infection: An Ultrasound Study
type: item
description: Background: The vagus nerve regulates systemic inflammation through the inflammatory reflex arc. Afferent fibers detect cytokines and relay signals to the brainstem, which activates parasympathetic pathways to suppress inflammation via acetylcholine release in the spleen. Disruption of this “brake system” can lead to cytokine storm, a driver of severe COVID-19. Beyond COVID-19, vagal dysfunction is also implicated in atherosclerosis, asthma, diabetes, Crohn’s disease, ulcerative colitis, and autoimmune thyroiditis. Aim: To determine whether vagus nerve neuropathy can be detected in SARS-CoV-2–infected patients using ultrasound, and to assess its contribution to COVID-19 pathophysiology and related inflammatory conditions. Methods: A prospective study was conducted between October 2021 and April 2022, including 68 patients (mean age 53.1 ± 14.3 years) with PCR-confirmed Delta variant infection and 50 healthy controls (mean age 22.7 ± 2.4 years). Exclusion criteria for controls included chronic illness or medication affecting autonomic function. Ultrasound was performed with a 10–18 MHz linear probe, with patients supine or in lateral decubitus position. The vagus nerve was examined bilaterally at two levels: X1 (carotid bifurcation) and X2 (cricoid cartilage). Cross-sectional area (CSA) was traced just outside the hyperechoic rim. Each measurement was repeated by two independent operators. Data were analyzed using Mann–Whitney U tests (IBM SPSS v26). Results: On the left side, X1 values did not differ, while X2 showed a borderline increase in the COVID group (p=0.05). On the right side, both X1 and X2 were nearly doubled in COVID-19 patients compared to controls (p<0.001). Median CSA values were consistently higher in patients (Left X1: 0.77 vs 0.70 mm²; Left X2: 0.87 vs 0.70 mm²; Right X1: 1.20 vs 0.60 mm²; Right X2: 1.30 vs 0.70 mm²). Importantly, this enlargement was observed despite the older age of the patient group, where smaller nerve dimensions would normally…
creator: Jelena Mićić
rights: Copyright (c) 2025 Jelena Mićić https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S187
ending page: S187
doi: 10.5195/ijms.2025.4085

Occupational Exposure to Blood / Body Fluid and Anxiety Among Final-Year Medical Students: The Result of the Curricular Gaps in Medical Education
type: item
description: Background: Occupational exposure to blood and body fluids (BBF) remains a significant hazard globally, with medical students being particularly vulnerable during clinical training. These exposures pose direct blood-borne pathogen transmission risk and considerable psychological sequelae, including anxiety. This study aimed to determine BBF exposure prevalence and characteristics among final-year medical students and investigate their association with anxiety levels, while identifying key contributing factors. Methods: A cross-sectional study was conducted among 271 final-year medical students at Bursa Uludağ University Faculty of Medicine between January and February 2025, achieving a response rate of 74.9% (n=203). Data were collected via a structured online questionnaire comprising three sections: sociodemographic characteristics, a detailed assessment of occupational BBF exposure history (including frequency, route, procedure, clinical department, and contributing factors), and the Turkish version of the Generalized Anxiety Disorder-7 (GAD-7) scale, a validated self-report tool for anxiety screening. Statistical analysis involved descriptive statistics, bivariate comparisons (Chi-square, t-test), and multivariate Negative Binomial Regression. Results: More than half of the participants (56.2%, n=114) reported at least one BBF exposure during their clinical internships, with the majority (67.5%, n=77) experiencing multiple (≥2) incidents. Among the reported exposure routes, cutaneous contact was the most frequent (23.6%), followed by percutaneous injuries (12.8%). Exposures occurred most frequently during venous blood draws (50.0%) and arterial punctures (33.3%). Rotations in the Emergency Department were associated with the highest proportion of exposures (66.7%). While glove usage was universal during reported exposures (100%), adherence to other personal protective equipment (PPE) was low (masks: 58.8%, gowns: 16.7%). The leading self-reported contributing fac…
creator: Levent Özdemir
creator: Sena Sude Özyar
creator: Sabrina İsrafilzade
creator: Behrokh Khorasani
rights: Copyright (c) 2025 Levent Özdemir, Sena Sude Özyar, Sabrina İsrafilzade, Behrokh Khorasani https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S188
ending page: S188
doi: 10.5195/ijms.2025.3828

Evaluation of HMBG1 serum levels and its involvement in depressive symptoms in Obstructive Sleep Apnea Patients (OSA)
type: item
description: Obstructive sleep apnea (OSA) is a chronic disorder marked by recurrent airway obstruction, leading to sleep fragmentation and intermittent hypoxia. It is associated with neuropsychiatric comorbidities, particularly depression. Both OSA and depression involve systemic inflammation. High-mobility group box 1 (HMGB1), a ligand of TLR4, promotes proinflammatory cytokine secretion and has been linked to depression. Its secretion can be induced by reactive oxygen species. This study aimed to assess HMGB1 concentrations in OSA patients and examine their relationships with polysomnography (PSG) parameters, hypoxia-inducible factor 1α (HIF-1α), and depressive symptoms. The study included 152 participants undergoing PSG. Based on apnea-hypopnea index (AHI), they were divided into OSA (AHI≥5; n=102) and non-OSA (n=50) groups. Depression was assessed with the Montgomery–Åsberg Depression Rating Scale (MADRS), and insomnia with the Insomnia Severity Index (ISI). Serum HMGB1 and HIF-1α levels were measured using ELISA. Participants were further categorized into control (n=21), depression only (n=29), OSA only (n=57), and OSA with depression (n=45) subgroups. HMGB1 levels differed between groups (p=0.014). Controls had lower concentrations (40.0 pg/ml) compared to depression (45.6 pg/ml, p=0.013) and OSA+depression (44.9 pg/ml, p=0.049). Across all participants, HMGB1 correlated with MADRS scores (R=0.178, p=0.028), but not within subgroups. HMGB1 and HIF-1α were correlated in the whole sample (R=0.278, p=0.011) and particularly in depression and OSA subgroups. No association was observed between OSA severity and HMGB1 levels. In conclusion, elevated HMGB1 is linked to depression, independent of OSA presence, and relates to depressive symptom severity. HMGB1 dysregulation may contribute to depression development, warranting further investigation.
creator: Julia Jaromirska
creator: Agata Gabryelska
creator: Marcin Sochal
creator: Szymon Turkiewicz
rights: Copyright (c) 2025 Julia Jaromirska, Agata Gabryelska, Marcin Sochal, Szymon Turkiewicz https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S189
ending page: S189
doi: 10.5195/ijms.2025.4084

Characterisation of Morphological Changes and Retinal Decay in a Retinal Degeneration Murine Model of Retinitis Pigmentosa
type: item
description: Retinitis pigmentosa (RP) is a complex, incurable, polygenic retinal dystrophy that initially presents as loss of night vision in childhood, and progresses to severe, irreversible loss of vision in adult patients. The Pde6rd10mouse models a progressive retinal degeneration akin to RP seen in humans. These mice carry a spontaneous mutation in the rod-phosphodiesterase gene that leads to photoreceptor degeneration peaking between (P)20-25 postnatal days, with degenerative plastic changes of second- and third- order neurones becoming increasingly severe following this. RP is currently without cure, however one such idea for successful vision restoration relies on the intraocular injection of haematopoietic stem cells as rod and cone photoreceptor precursor cells. There is a requirement to determine at which points there is sufficient retinal degeneration to for there to be a treatment need, without compromising the integrity of the scaffolding neurones in the remaining retina as retinal disorganisation worsens. Early transplantation of differentiated photoreceptors could delay or even prevent remodelling of the second-order neurones and cell death by providing synaptic input to those circuits. The study aim was to determine the peak range of photoreceptor cell death and evaluate the structural modifications to retinal neurones following photoreceptor degeneration in the Pde6rd10 mouse model, documenting the sequence of changes of second- and third-order retinal cells and their synaptic terminals to an advanced stage of degeneration. This data can be used to inform the timespan within which transplanted photoreceptor precursor stem cells could effectively integrate with the retinal cells in the rd10 retina and function as normal, restoring normal vision. Immunohistochemistry and qualitative immunofluorescence microscopy were performed on retinal cryosections of rd10mice to detect and assess the presence of specific cellular markers across of wild-type and postnatal days…
creator: Harriet Fallon
rights: Copyright (c) 2025 Harriet Fallon https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S190
ending page: S190
doi: 10.5195/ijms.2025.4058

Handgrip Strength Asymmetry in Middle-aged and Older Adults: Clinical Aspects
type: item
description: Background: Identifying early markers of neurodegeneration remains a key challenge. Recent studies (Zammit AR, 2021; Chen Z. et al., 2022; Wang et al., 2023) suggest an association between handgrip strength (HGS) asymmetry and cognitive decline. This study explores clinical characteristics of HGS asymmetry in middle-aged and elderly patients. Methods: Ninety patients (mean age 63.7±1.2 years; 58.9% men) were enrolled. Inclusion criteria: age >45, preserved hand function. HGS was measured using a KERN MAP 130K1 dynamometer. Asymmetry coefficient was defined as the ratio of non-dominant to dominant hand strength; values <0.9 or >1.1 indicated asymmetry. Cognitive function was assessed via the MoCA test; anxiety and depression via the HADS scale. Results: Mean HGS: dominant hand – 28.5±1.8 kg, non-dominant – 25.9±1.3 kg. HGS asymmetry was found in 54.4% of patients (dominant hand – 38 cases; non-dominant – 11). MoCA scores were lower in the asymmetry group (22.8±0.6) vs. the non-asymmetry group (24.8±0.4; p<0.05). Significant declines were observed in visuoconstructive skills (1.67±0.24 vs 2.58±0.30) and memory (1.61±0.39 vs 2.11±0.40). MoCA negatively correlated with age (r = -0.39) and anxiety (r = -0.32). In the asymmetry group, strong correlations were found between gender and muscle strength (r = -0.70), and between muscle strength and MoCA scores (r = 0.34). Conclusion: HGS asymmetry was present in over half of patients and was associated with lower cognitive scores. The asymmetry coefficient may serve as a clinical marker of early cognitive decline.
creator: Anastasiia Kolesnykova
creator: Maksym Parii
creator: Zoia Salii
rights: Copyright (c) 2025 Anastasiia Kolesnykova, Maksym Parii, Zoia Salii https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S191
ending page: S191
doi: 10.5195/ijms.2025.3934

From Observation to Participation: Gender Differences and Surgical Exposure among Medical Students
type: item
description: Introduction: Surgical rotations are critical to the clinical education of medical students, bridging theoretical knowledge with practical experience. In many medical institutions, the transition from passive observation to active participation in surgical settings remains inconsistent and may be influenced by gender disparities. This study aimed to assess the extent of surgical exposure among clinical medical students in Georgia, with a particular focus on gender-based differences in opportunities to participate actively during general surgery rotations. Methods: A cross-sectional survey was conducted among undergraduate medical students from the University of Georgia, Ilia State University, European University, Caucasus University, and Caucasus International University in Tbilisi, following ethical approval. The survey was carried out from June 27 to July 18, 2025. Participants were asked about the duration of their general surgery rotation, the number and types of procedures they observed and assisted with, and their involvement in basic surgical tasks. Perceptions of supervisory support, feedback, and overall satisfaction were measured using a Likert scale. Gender-based comparisons were analyzed using independent sample t-tests, with statistical significance at p < 0.05. Results: Of the 96 respondents (mean age: 24.05 ± 2.65 years), 52 were female (54.2%) and 44 male (45.8%). Most students (58.3%) spent 2–4 weeks in general surgery rotations. Only 70.8% had the chance to perform basic surgical skills under supervision. Male students were more likely to have scrubbed in during surgeries compared to females. Males also reported significantly more opportunities to perform basic surgical tasks (p = 0.007) and assist in operations (p = 0.017). While both genders reported similar perceptions of supervisor approachability, female students rated their overall learning experience lower on average. 43.8% of all students strongly disagreed they had sufficient hands-on prac…
creator: Nnaemeka Emmanuel Mgbedo
creator: Jametta Ukpong
creator: Alvin Turay
creator: Orugbaoghene Mba
creator: Oritsemimajemite Lori
rights: Copyright (c) 2025 Nnaemeka Emmanuel Mgbedo, Jametta Ukpong, Alvin Turay , Orugbaoghene Mba , Oritsemimajemite Lori https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S192
ending page: S192
doi: 10.5195/ijms.2025.3843

Antimicrobial Resistance Awareness and Antibiotic Prescribing Behavior Among Healthcare Workers
type: item
description: Background: Antimicrobial resistance (AMR) is on the rise worldwide and presents a significant threat in Iraq, where ongoing conflict and fragile health systems contribute to elevated levels of multi-drug-resistant (MDR) organisms. It is increasingly recognized as a public health challenge in Iraq, largely due to the prevalent misuse and over-prescription of antibiotics. Research indicates that numerous physicians in public hospitals often prescribe antibiotics based on empirical evidence while community pharmacists commonly dispense antibiotics without prescriptions, which exacerbates self-medication and misuse. Although national AMR control plans are in place, their implementation is still limited. Surveillance initiatives have uncovered high levels of multidrug-resistant bacteria, including Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus, in both adult and pediatric populations. It is essential to raise awareness about AMR in Iraq. This necessitates coordinated efforts across healthcare, agriculture, and environmental sectors consistent with the One Health approach to encourage responsible antibiotic usage, enhance surveillance, and enforce regulatory measures. Objective: The current study conducted to evaluate healthcare workers’ (HCWs) awareness, practices, and institutional barriers to AMR control in a sample of Baghdad hospitals. Methods: A cross-sectional survey from July to September 2025 was designed. About 196 HCWs across five hospitals in Baghdad City were involved to assess perceptions of AMR, infection control practices, and stewardship awareness. Results: The largest proportion of participants were from Baghdad Medical City (64.3%), followed by Al-Yarmouk Teaching Hospital (16.8%), Al-Kindy Teaching Hospital (10.7%), Madain Hospital (7.7%), and Zafaraniyah General Hospital (0.5%). Most respondents were residents (39.8%) or pharmacists (35.7%); 86.2% considered AMR a major problem. Gram-negative (43.2%) and Gram-positive (42.1%) were…
creator: Abdalrhman Salah Yasser
creator: Jaafar Muhanad Saheb
creator: Yahya Mohanad Abdul Jabbar
creator: Rand R. Hafidh
rights: Copyright (c) 2025 Abdalrhman Salah https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S193
ending page: S193
doi: 10.5195/ijms.2025.4043

Publication Rate of Students and Graduates of the Program of Combined Studies in Medicine (PECEM), an MD/PhD Program of Mexico
type: item
description: Background: Clinician-scientists play a critical role in bridging biomedical research and clinical practice, offering innovative solutions to the complexity of health challenges worldwide. MD/PhD programs provide a structured pathway for students to simultaneously develop clinical expertise and research skills. While these programs are common in North America and Europe, there are a few in Latin America, like the Program of Combined Studies in Medicine (PECEM) of the National Autonomous University of Mexico (UNAM) that was established in 2011 as one of the first initiatives of its kind in Mexico to integrate undergraduate medical education with rigorous research training, aiming to graduate physicians with both clinical competence and doctoral-level expertise. Evaluating the scientific productivity of PECEM students is essential to understand its contribution to academic medicine and the development of physician-scientists in Mexico. Methods: A cross-sectional study was conducted, including all articles published by PECEM students and graduates between 2013 and the first half of 2025. The search was performed in the Scopus database to identify publications authored by program participants. Each publication was examined individually to extract the publication year, journal type (international or national), impact factor of the journal, number of citations, and research topic. Additional demographic data from PECEM enrollment and graduation records were also reviewed. A database was built using Microsoft Excel 2010, and descriptive analyses were conducted to determine publication trends, productivity by generation, thematic distribution, and average citations. Results: Between 2013 and 2025, PECEM students produced 790 original articles. Of these, 749 (94.8%) were published in international journals, while 41 (5.2%) appeared in national journals. The second generation of PECEM students contributed the largest proportion of publications (33.54%). Research topics were d…
creator: Jennifer Eble Gaytán
creator: Ana Flisser
creator: Tanya Plett-Torres
rights: Copyright (c) 2025 Jennifer Eble Gaytán, Ana Flisser, Tanya Plett-Torres https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S194
ending page: S194
doi: 10.5195/ijms.2025.4068

The Intersection of Rheumatology and Cardiology: Cardiac Disease in Rheumatic Disorders within Palestinian patients between 2022-2024, A Retrospective Cohort Study
type: item
description: Background: Rheumatologic and cardiovascular conditions are major causes of morbidity and mortality. Recent research has shown a close association between them. As cardiac manifestations in the Palestinian population remain uncharacterized, the current study aims to investigate the proportion of cardiac manifestations in rheumatologic disease patients from Palestine and to determine the factors associated with these manifestations. Methods: A retrospective cohort was conducted on rheumatology patients, at Al-Makassed Hospital from 2022 to 2024. Data was collected from electronic records for 296 patients. Cardiovascular manifestations were recognized through echocardiography and consultation reports. Analysis using SPSS version 26 was performed to determine the association between patients' characteristics and the cardiac manifestations. Data included demographics (age, gender), previous chronic diseases; especially regarding rheumatologic condition; age at diagnosis; cardiac manifestations; imaging reports, laboratory information, lipid profile, comorbidities and risk factors. Results: Of the 296 patients, 71.6% were females, with an average age of 49.2 ± 15.5 years. The most common rheumatic diseases were seronegative spondyloarthropathy (25.1%), rheumatoid arthritis (RA) (18.1%), and systemic lupus erythematosus (SLE) (11.1%). The proportion of clinically recognized cardiac disease was 17.9%; whereas 16.6 percent of participants had obesity and 9.8 percent had an addiction to cigarettes. Among comorbidities other than rheumatologic diseases, hypertension (30.4%) and diabetes mellitus (19.9%) were the most common. Cardiac disease was significantly associated with older age, diabetes mellitus, hypertension, coronary artery disease, positive troponin, and positive CK-MB (p < 0.05). Meanwhile, no significant associations with gender, specific rheumatic conditions, or lipid profile were observed. Conclusion: This is the first research from Palestine that studies cardia…
creator: Malak R. Hroub
rights: Copyright (c) 2025 Malak R. Hroub https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S195
ending page: S195
doi: 10.5195/ijms.2025.3965

Effectiveness of Haptic Feedback Devices in Reducing Pain Perception During Intra-Articular Corticosteroid Injections in Rural Guatemala and Kenya – A Randomized Controlled Trial
type: item
description: worldwide and a leading cause of disability, affecting most individuals by age 65 due to cartilage degradation, eburnation, osteophyte formation, and inflammation. Intra-articular corticosteroid injections (IACIs) are widely used for moderate to severe OA and are especially beneficial in low-resource areas where long-term medications and physical therapy may be inaccessible. However, IACIs can induce substantial pain and anxiety, particularly when anesthetics or imaging guidance are unavailable. Haptic feedback, such as tactile stimulation through handheld vibration devices, has demonstrated the ability to modulate pain perception in clinical settings. As a simple, low-cost method, it may offer a non-pharmacologic option to reduce procedural discomfort in environments where pain control measures are limited. This study evaluates the effectiveness of handheld vibration devices in reducing pain perception during IACIs in rural Guatemala and Kenya. Aim: To assess whether handheld vibration devices reduce pain perception during intra-articular corticosteroid injections in patients with osteoarthritis in resource-limited health settings. Methods: A randomized controlled study was conducted during Kansas City University's Global Health Outreach programs in Guatemala and Kenya. 37 adult patients with OA of the knee (89%), hand (8%), or shoulder (3%) scheduled for IACIs were enrolled; four were excluded due to protocol deviations or incomplete data, resulting in a final sample of 33 participants. Subjects were randomized 1:1 into a control group (standard care) or a haptic group that held a vibration device (Beurer MG10) in the contralateral hand during the injection. Pain perception was assessed using the Wong-Baker FACES Pain Rating Scale before and after the procedure. Statistical analysis was performed using Mann-Whitney and Wilcoxon Signed Rank tests. Results: No statistically significant difference was found between the control and haptic feedback groups in post-injec…
creator: Tyler Perleberg
creator: Alfeil Felipe
creator: Carmen Tong
creator: Jordan Konstanty
creator: Gautam Desai
rights: Copyright (c) 2025 Tyler Perleberg, Alfeil Felipe, Carmen Tong, Jordan Konstanty, Gautam Desai https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S196
ending page: S196
doi: 10.5195/ijms.2025.3657

Effectiveness of Trimethoprim-Sulfamethoxazole in Cyclosporiasis: A Meta-analysis of Randomized Clinical Trials
type: item
description: Introduction: Cyclosporiasis, caused by Cyclospora cayetanensis, is an intestinal infection transmitted via contaminated food and water and is responsible for at least 10% of diarrheal episodes in children aged 0-4 years in endemic regions. Clinically, it manifests as watery diarrhea, fever, and fatigue, posing significant public health challenges because of its association with foodborne outbreaks and the resultant healthcare costs. The primary treatment regimen involves trimethoprim-sulfamethoxazole (TMP/SMX); however, no meta-analysis has validated its use. Objective: We performed a meta-analysis to evaluate the efficacy of TMP/SMX compared to placebo for the eradication of oocysts and clinical resolution of cyclospora, drawing on data from randomized controlled trials (RCTs). Methods: A comprehensive search was performed in PubMed, Scopus, and Google Scholar until May 2025. The studies deemed eligible were randomized controlled trials (RCTs) that included confirmed diagnoses and clinical or laboratory assessments conducted seven days following treatment. The methodological quality of the studies was evaluated using Cochrane's Risk of Bias 2 (RoB 2) tool. Risk differences (RD) with 95% confidence intervals (CI) were calculated using a random-effects model. Results: Among the 19 studies identified, only three were randomized controlled trials, encompassing 88 patients. The oocyst eradication rates with TMP/SMX ranged from 83% to 100%, in contrast to the persistent infection observed in the placebo group. The reported risk difference (RD) values were −1.00 (Madico et al.), −0.78 (Hoge et al.), and −0.82 (Shim et al) The heterogeneity was moderate, with an I² value of 40%. The risk of bias was low for Hoge et al., moderate for Shim et al., and high for Madico et al. Conclusion: The present meta-analysis demonstrated that TMP/SMX exhibits significant efficacy in eradicating Cyclospora cayetanensis and improving clinical outcomes compared to placebo, thereby supportin…
creator: Sofía Bermúdez Rodríguez
creator: Luis Felipe Mosquera Solano
creator: Daniela Agudelo Torres
creator: Filippo Furlanetto
creator: Jorge Enrique Gomez Marin
rights: Copyright (c) 2025 Sofía Bermúdez Rodríguez, Luis Felipe Mosquera Solano, Daniela Agudelo Torres, Filippo Furlanetto, Jorge Enrique Gomez Marin https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S197
ending page: S197
doi: 10.5195/ijms.2025.3960

Amyloidosis – A Rare Complication of Long-Evolving Rheumatoid Arthritis. A Case Report
type: item
description: Background: Amyloidosis consists of a diverse spectrum of medical conditions, defined by the accumulation of fibrillar proteins in a beta-sheet configuration in different tissues. Reactive amyloidosis (AA), previously known as secondary amyloidosis, can appear as a complication of chronic inflammatory diseases, such as rheumatoid arthritis. In present times, the use of biological therapies has decreased its prevalence, but it remains a considerable threat for patients, as its main target is the kidney, with progression towards renal failure. Light chain amyloidosis (AL) is a primary form of the disease, involving plasma cell clones in the bone marrow, and has been reported in patients with rheumatoid arthritis, constituting an important differential diagnosis. Herein, we present the case of AA amyloidosis in a patient with a long evolution of rheumatoid arthritis, highlighting its diagnostic difficulties. The Case: A 55-year-old woman presented to our clinic with mild arthritic pain in the hands, fatigue and hyperpigmentation on the dorsal side of her forearms, associated with itching. Rheumatoid arthritis is present in her medical history, having been diagnosed 15 years prior. Her medication included Metotrexate for three years, interrupted due to digestive intolerance, followed by Sulfasalazine to the current presentation. Physical exam highlighted obesity, the skin lesions on the forearms and a positive Gaenslen sign bilaterally. Biologically, an important inflammatory syndrome was discovered, alongside a very high rheumatoid factor (FR). These have been persisting for a number of years, prompting several past investigations to identify its cause. A serum protein electrophoresis with immunofixation was negative for monoclonal bands, but serum light chains kappa and lambda were slightly elevated. Histopathological analysis of a biopsy from abdominal fat revealed apple-green birefringence in polarized light with Congo red staining, leading to the diagnosis of amylo…
creator: Irina Maria Rusu
creator: Rebeca-Ioana Rus
creator: Maria-Cristina Simian
creator: Daria Șerbănescu
creator: Laura Muntean
rights: Copyright (c) 2025 Irina Maria Rusu, Rebeca-Ioana Rus, Maria-Cristina Simian, Daria Șerbănescu, Laura Muntean https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S198
ending page: S198
doi: 10.5195/ijms.2025.4038

Left Colo-renal Fistula in an Elderly Female: Case Report
type: item
description: Background: Colo-renal fistulas are rare entities, with very few cases reported worldwide and no established prevalence. Left-sided fistulas are the most frequent reno-intestinal communications. They usually result from chronic inflammation, diverticular disease, or necrotic processes. However, colo-renal fistulas caused by an abscessed renal cyst are exceptionally uncommon. This case highlights a rare presentation in an elderly female and underscores the importance of considering fistulous complications in patients with complicated renal cysts. The Case: An 82-year-old female, history of high blood pressure, diverticulitis, left renal cyst classified as Bosniak II F–III was admitted for a scheduled cystectomy. She presented with progressive low back pain, asthenia, unintentional weight loss, pneumaturia, fecaluria and sustained a fall from standing height during hospitalization. No additional medical history was noted. Follow-up abdominal CT revealed findings suggestive of emphysematous pyelonephritis, an infected left renal cyst, and a small communicating tract between the left kidney and the splenic flexure of the colon. Exploratory left lumbotomy confirmed the colo-renal fistula. The patient was managed by a fistulectomy, and drainage of the abscessed renal cyst was performed, followed by placement of a Jackson-Pratt drain. Postoperative recovery was favorable, with resolution of pain and no recurrence at 6 months-follow-up. Conclusion: This case illustrates an unusual cause of colo-renal fistula, secondary to rupture and infection of a renal cyst after trauma. Given its rarity and nonspecific presentation, early suspicion based on imaging and clinical findings is critical. Management requires a multidisciplinary surgical approach in a tertiary care setting. To our knowledge, this is one of the few reported cases of a colo-renal fistula associated with an abscessed renal cyst, contributing to the limited body of literature on this rare condition.
creator: Sebastian Penafiel
creator: Juan Velez-Posada
rights: Copyright (c) 2025 Sebastian Penafiel, Juan Velez-Posada https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S199
ending page: S199
doi: 10.5195/ijms.2025.3879

Primary Intestinal Lymphangiectasia Presenting as Chylous Ascites in a Young Female: A Rare Case
type: item
description: Background: Primary intestinal lymphangiectasia (PIL) is a rare condition that occurs due to the pathological dilation of intestinal lymphatics, characterized by protein losing enteropathy, and occurs more commonly in children. Adults’ occurrence is less common, and misdiagnoses with other gastrointestinal disease is prevalent because of the overlapping and nonspecific features. The Case: A 28-year-old female presented with recurrent abdominal distension and chylous ascites requiring therapeutic paracentesis over the past three years. Medical history was notable for 7 years of diffuse recurrent intermittent crampy abdominal pain more prominent periumbilical and at the right lower quadrant, bloating, loose stools, and weight loss, raising suspicion for Crohn’s disease, however, no supportive findings were noted on colonoscopy or histopathology, despite this, she was treated as a case of Crohn’s for a short period, but the absence of progression and the new-onset chylous ascites prompted reconsideration of the diagnosis and further investigation into alternative causes of protein-losing enteropathy and ascites. At presentation, the patient denied fever, night sweats, diarrhea, or overt gastrointestinal bleeding. An abdominal examination showed distention with shifting dullness, consistent with ascites. Without peripheral edema, lymphadenopathy, or hepatosplenomegaly. Laboratory investigations were significant for low serum albumin level of 2.3 g/dL. Ascitic fluid was sterile, and negative for malignant cells. A PET-CT scan was ordered to exclude occult malignancy, autoimmune, inflammatory, or metabolically active conditions. Abdominal CT imaging revealed diffuse thickening of the hepatic flexure of the colon, associated mesenteric fat stranding, and lymphadenopathy (largest node 1.5 cm), in addition to moderate-volume ascites, these findings alongside the clinical picture have raised suspicion for a lymphatic telangiectasia; the patient was started on budesonide and l…
creator: Basheer Babaa
creator: Malak R. Hroub
creator: Yousef Habes
creator: Maha Ramzi
creator: Omar H. Salloum
rights: Copyright (c) 2025 Basheer Babaa, Malak R. Hroub, Yousef Habes, Maha Ramzi, Omar H. Salloum https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S200
ending page: S200
doi: 10.5195/ijms.2025.3968

A Case of Rosai-Dorfman Disease
type: item
description: Background: Rosai-Dorfman Disease (RDD) is a rare form of histiocytosis. We have observed extralymphatic involvement in about 43% of RDD cases in the literature, while dermatological symptoms manifest in only about 10% of cases. We present a case of RDD characterized by both nodal and extranodal involvement, initially presenting with bilateral ear nodules and dyspnea that closely resembled the clinical features of relapsing polychondritis; unfortunately, the diagnosis was missed at first. This case highlights the necessity for greater awareness and education among healthcare professionals regarding RDD to do diagnosis and treatment. Case Report: A 25-year-old lady had a one-year history of discomfort and swelling in the cartilaginous part of the ears, accompanied by dyspnea (MRC dyspnea scale 2). A clinical diagnosis of relapsing polychondritis was made by an ENT surgeon, and oral steroids and NSAIDs were given. An inhaler containing salbutamol was also prescribed. The symptoms progressively worsened, her left ear became more swollen, dyspnea worsened (MRC dyspnea scale 3), she also developed bilateral cervical lymphadenopathy, and she presented to the medicine OPD. The examination revealed bilateral enlargement of the ear helices, resembling a cauliflower-like appearance (Figure 1). This time, FNAC from the left ear and a biopsy of the cervical lymph node were done, and they showed proliferation of histiocytes. Most of the histiocytes have abundant foamy cytoplasm and prominent nucleoli. These cells were found admixed with plasma cells with Russell bodies, lymphocytes, and neutrophils. Histiocytes showed features of emperipolesis. Fibrosis with a vague storiform pattern is present. These morphologic features are compatible with RDD. Routine laboratory investigations were normal. Serologies for antinuclear antibody (ANA) were positive (16.5 U/mL), and anti-dsDNA was negative. Spirometry revealed an obstructive pattern with a forced expiratory volume in one second (F…
creator: Montasir Ahmed
creator: Karma Sherpa
creator: Forhad Hossain
creator: Parvat Chhetri
creator: Nuyama Rai
creator: Anushila Rai
rights: Copyright (c) 2025 Montasir Ahmed, Karma, Forhad, Parvat, Nuyama Rai, Anushila https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S201
ending page: S201
doi: 10.5195/ijms.2025.3774

One Step Forward, Two Steps Back: Functional Decline following Lisfranc Fracture-Dislocation
type: item
description: Background: What once was managed through foot amputations has now evolved from a surgical sentence to a joint-sparing breakthrough in modern orthopaedics. Though rare, Lisfranc injuries pose devastating consequences as they are associated with poor functional outcomes and high rates of disability. Lisfranc injuries continue to test clinicians with its subtlety and complex biomechanics. The Case 24-year-old male sustained a Lisfranc fracture-dislocation during Brazilian jiu-jitsu training when his left foot was held in plantarflexion and abruptly subjected to axial-load. Initial weight-bearing radiographs demonstrated classic widening between the 1stand 2nd metatarsal bases (“fleck sign”), lateral displacement of the 2nd metatarsal, and subluxation of the tarsometatarsal joints, confirming ligamentous disruption. CT scans further detailed the fracture-dislocation. The surgical team debated between primary arthrodesis versus open reduction and internal fixation (ORIF). Given the patient’s age and fitness, he underwent urgent closed reduction followed by ORIF using multiple cannulated screws and a dorsal bridge plate. A follow-up X-ray showed improved alignment, but the patient reported ongoing pain despite 12 months of physiotherapy. Everyday activities like walking and standing for extended periods became difficult, impacting his mental health. He later opted for a second surgery to remove the hardware. Though this offered partial relief, he continues to suffer from stiffness and pain. Conclusion: Even with timely surgical repair, Lisfranc injuries are physically taxing to recover from, often leading to life-altering functional limitations as they are associated with arch collapse and posttraumatic arthritis. Improving access to specialist care is essential to promote midfoot stability and prevent long-term disability.
creator: Nasrin Ahmed
rights: Copyright (c) 2025 Nasrin Ahmed https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S202
ending page: S202
doi: 10.5195/ijms.2025.3773

Aggressive Gallbladder Carcinoma in Down Syndrome Patient: A Rare Presentation
type: item
description: Background: Gallbladder carcinoma in individuals with Down syndrome (DS) is exceedingly rare, literature reports only a handful of cases. Risk factors include cholelithiasis, chronic inflammation, biliary helicobacter pylori colonization, chromosomal instability and cytogenetic abnormalities of chromosome 21. The Case : A 45-year-old male with a history of Down syndrome, presented to the emergency department complaining of moderate epigastric pain for 3 days, 5 days of yellowish skin discoloration, and 2-weeks of postprandial nausea and vomiting of undigested food. There was no history of dysphagia, anorexia, bowel habit changes, or gastrointestinal bleeding. Family and drug history is unremarkable. On examination, the patient had a distended abdomen, jaundice, mild epigastric tenderness, and a palpable bulge in the right upper quadrant. Laboratory findings over repeated evaluations revealed persistently elevated inflammatory markers, direct hyperbilirubinemia, hypocalcemia, mild anemia with decreased hematocrit level, and hypoalbuminemia. Liver and pancreatic enzymes were unremarkable. On ultrasound, moderate-to-severe ascites were noted. MRI abdomen showed a large exophytic hepatic mass (9 × 7.5 × 7.3 cm) in segment VI encasing and compressing the gallbladder, with multiple smaller hepatic lesions (0.2–2.3 cm) and enlarged multilobular speculated periportal/mesenteric lymph nodes measuring up to 4.3 cm in diameter, 3.3 cm right adrenal lesion and asymmetric thickening of the ascending colon. Findings were suspicious for metastatic malignancy with gallbladder involvement. Colonoscopy was performed and revealed grossly normal mucosa; histopathology was unremarkable. A triphasic CT scan confirmed metastatic disease; and hyperbilirubinemia was explained by hepatocellular invasion rather than obstructive cholestasis. Echocardiography was significant for moderate pulmonary hypertension. Histopathological exam of a core biopsy of the liver lesion revealed moderately diff…
creator: Basheer Babaa
creator: Malak R. Hroub
creator: Lana M.A Jamal
creator: Salahaldeen Deeb
creator: Khaled Alhashlamon
creator: Izzeddin A. Bakri
rights: Copyright (c) 2025 Basheer Babaa, Malak R. Hroub, Lana M.A Jamal, Salahaldeen Deeb, Khaled Alhashlamon, Izzeddin A. Bakri https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S203
ending page: S203
doi: 10.5195/ijms.2025.3967

Avoiding Pacemaker: Resolution of Sinus Node Dysfunction through CPAP Therapy
type: item
description: yet underdiagnosed sleep-related breathing disorder with significant cardiovascular implications. Besides hypertension, heart failure, and ischemic disease, SAHS has been increasingly associated with arrhythmias and conduction abnormalities. Sinus node dysfunction (SND) is among the rhythm disturbances most frequently reported, with clinical manifestations ranging from bradycardia to prolonged sinus pauses. The pathophysiology involves recurrent nocturnal hypoxemia, sympathetic-vagal imbalance, and intrathoracic pressure fluctuations, which together promote electrical instability. Traditionally, pacemaker implantation has been considered the treatment of choice for symptomatic or severe SND. However, growing evidence suggests that adequate management of SAHS with continuous positive airway pressure (CPAP) may reverse rhythm disorders, highlighting the importance of identifying reversible causes before committing to invasive procedures. The Case: We report the case of a 34-year-old man with morbid obesity (BMI 43.6) and no cardiovascular history, who presented with severe daytime sleepiness (Epworth score 17). Physical examination was unremarkable, with no structural heart disease. Baseline electrocardiogram showed sinus bradycardia at 56 bpm. Holter monitoring revealed sinus node dysfunction with nocturnal pauses up to 6.8 seconds. Based on these findings, dual-chamber pacemaker implantation was initially considered. Simultaneous overnight polysomnography confirmed severe SAHS, with an apnea-hypopnea index (AHI) of 70 events/hour, oxygen desaturation index of 52/hour, and a nadir oxygen saturation of 56%. Given the temporal overlap between apneic events and sinus pauses, an alternative strategy was pursued. The patient was started on CPAP therapy and received weight loss counseling. At one-month follow-up, he reported complete resolution of daytime symptoms. Repeat polysomnography demonstrated significant improvement, with AHI reduced to 38/hour, desaturation index …
creator: Rebeca-Ioana Rus
creator: Irina-Maria Rusu
creator: Maria Cristina Simian
creator: Bogdan Valentin Roznovan
creator: Paula Cornelia Varga
rights: Copyright (c) 2025 Rebeca-Ioana Rus, Irina-Maria Rusu, Maria Cristina Simian, Bogdan Valentin Roznovan, Paula Cornelia Varga https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S204
ending page: S204
doi: 10.5195/ijms.2025.4037

Silent Splenic Crisis in an Immunocompetent Adolescent: A Case Report of Multifocal Splenic Abscess with Subcapsular Extension and Paradoxical Leukopenia Managed Conservatively
type: item
description: Background: Primary splenic abscess is a rare clinical entity, with a reported incidence ranging from 0.05% to 0.70%, and is especially uncommon in immunocompetent individuals. The spleen’s robust phagocytic and immunological functions generally confer protection against microbial invasion. Most splenic abscesses are secondary to hematogenous seeding, frequently in the setting of infective endocarditis, immunosuppression, diabetes, trauma, or intravenous drug use. The clinical presentation is often vague, with the classic triad of fever, left upper quadrant (LUQ) pain, and leukocytosis present in only a minority of cases. The diagnostic challenge is compounded by nonspecific symptoms and frequently sterile blood cultures. Imaging modalities, particularly computed tomography, play a central role in diagnosis. Surgery has long been the main treatment for splenic abscesses, but there’s now a growing preference for less invasive options like targeted antibiotics and image-guided percutaneous drainage. However, the optimal treatment approach remains uncertain. Percutaneous drainage can be a useful option in selected cases, but studies have reported high failure rates, ranging from 14.3% to 75%. Moreover, even with advances in imaging and treatment, delayed diagnosis or inadequate treatment carries a high mortality risk. We report a rare case of primary multifocal splenic abscess in a previously healthy 15-year-old immunocompetent female. The Case: A previously healthy 15-year-old female presented with a 10-day history of high-grade fever and abdominal pain, which localized to the LUQ and became sharp and positional in nature. She had no history of recent infection, immunosuppression, trauma, or chronic illness. Notably, she experienced transient arthralgias and displayed no gastrointestinal or respiratory symptoms. Clinical examination revealed LUQ tenderness and splenomegaly. Laboratory investigations showed profound leukopenia (WBC 2,100/mm³) with neutropenia (ANC 800/…
creator: Amit Kumar
creator: Shweta Tanwar
creator: Yogeshwaran Mohan
creator: Aman Dubey
rights: Copyright (c) 2025 Amit Kumar, Shweta Tanwar, Yogeshwaran Mohan, Aman Dubey https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S205
ending page: S205
doi: 10.5195/ijms.2025.4026

Subcutaneous Panniculitis-like T-cell Non-Hodgkin Lymphoma Associated with Cushing Syndrome: An Introspection
type: item
description: Background: Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) accounts for less than 1% of non-Hodgkin lymphoma cases and is characterized by malignant lymphocyte infiltration into adipose tissues. The term “panniculitis-like T -cells” refers to the histological similarity of the lymphoma cells to the T-cells found in chronic or granulomatous panniculitis. This type of lymphoma is responsible for an ectopic ACTH secretion which leads to excessive cortisol secretion causing Cushing syndrome. Case: A 45-year-old patient diagnosed with SPTCL in 2022 underwent six cycles of cyclophosphamide, epirubicin, vincristine, and prednisone (CHOP regimen). Due to iatrogenic Cushing syndrome, CHOP was discontinued, and two cycles of rituximab-ifosphamide-carboplatin-etoposide (R-ICE) were administered. In 2023, the patient presented with scleral jaundice and dark urine. Laboratory findings revealed a total bilirubin of 11.2 mg/dL, leukopenia, thrombocytopenia, hyperfibrinogenemia, and elevated D-dimers. A CT scan showed hepatic and iliopsoas muscle lesions, indicating systemic dissemination and relapse of the lymphoma. Conclusion: Corticosteroid-based regimens are standard treatment options for SPTCL. However, paraneoplastic syndromes such as ectopic ACTH secretion by malignant cells may lead to excessive cortisol levels, exacerbated by corticosteroids. Due to iatrogenic Cushing syndrome induced by the first-line therapy and relapse following second-line options, off-label venetoclax, an apoptosis inducer, was initiated in combination with ropeginterferon alfa-2b. The patient achieved complete remission. No SPTCL cases treated with venetoclax have been published in the literature. We report high efficacy of off-label venetoclax in a relapsed SPTCL with no other available therapeutic option.
creator: Maria Palfi
creator: Alexandra Zirbo
creator: Cristina Simian
creator: Dávid Kegyes
creator: Anamaria Bancoș
creator: Ciprian Tomuleasa
rights: Copyright (c) 2025 Maria Palfi, Alexandra Zirbo, Cristina Simian, Dávid Kegyes, Anamaria Bancoș, Ciprian Tomuleasa https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S206
ending page: S206
doi: 10.5195/ijms.2025.4087

Opportunities for Climate-Sensitive Work in the Health Sector - Kenya and Germany in Focus
type: item
description: Background: Healthcare systems around the world are facing unprecedented challenges as concerns about climate change and its widespread effects intensify. The healthcare sector has two big problems: it is very vulnerable to the health effects of climate change and yet it contributes significantly to greenhouse gas emissions. Therefore, transitioning to climate-sensitive healthcare is a top concern for the whole world. However, implementation differs significantly across various economic and geographical contexts. This study aimed to identify and compare opportunities for climate-sensitive work in the health sectors of Kenya and Germany. Methods: The study employed a qualitative approach, using a combination of field observations and expert interviews between July and September 2025. Data was collected over four-week periods at Kenyatta National Hospital (KNH) in Nairobi, Kenya, and Charité – Universitätsmedizin in Berlin, Germany. Methods included structured field observations across six key categories (energy, mobility, nutrition, supply chains, waste management, and digitalization) and in-depth, semi-structured expert interviews with medical students and hospital staff. Interview transcripts and observational notes were analyzed using thematic analysis. Results: KNH demonstrated inherent low-carbon practices like passive cooling, local food sourcing with minimal packaging, and high reuse of materials including food waste. It however, faced systemic barriers including heavy reliance on fossil fuels, budget constraints, and inadequate waste recycling. Charité utilized energy-efficient infrastructure and efficient public transport but struggled with high food waste from individual packaging and perceived inefficiencies in waste sorting. Both institutions were making efforts towards digitalization especially in patient records. A significant knowledge-attitude-practice gap was identified; healthcare professionals and students in both countries expressed strong interes…
creator: Cyrus Kimanthi
creator: Juliette Clara Schreiber
creator: Pamela Miloya Godia
creator: Andrea Budnick
rights: Copyright (c) 2025 Cyrus Kimanthi, Juliette Clara Schreiber, Pamela Miloya Godia; Andrea Budnick https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S207
ending page: S207
doi: 10.5195/ijms.2025.4055

Near-Peer Teaching of Laparoscopic Skills among Medical Students – A Randomized Feasibility Study
type: item
description: Background: Laparoscopic surgery is integral to modern surgical practice, with proficiency increasingly required across a range of specialties. However, many medical students graduate with limited exposure to essential skills. To address this, university surgical societies have adopted the “Near-peer” model to teach surgical skills. That is, senior or experienced medical students teach junior students basic surgical skills. However, the objective impact of this intervention remains under-evaluated. Furthermore, objective evaluation requires a comprehensive and validated assessment tool, which is currently lacking. The aims of this study were to develop a novel objective assessment tool, assess changes in students’ confidence and objective performance in laparoscopic tasks following near-peer versus self-directed training, and explore factors associated with performance outcomes. Methods: This single-blinded, randomised feasibility study enrolled 42 medical students without prior laparoscopic experience. Participants were assigned via computer randomisation to peer-taught (Group 1) or self-taught group (Group 2) and completed six weekly sessions across four laparoscopic stations: Ball Transfer, Circle Cutting, Peg Transfer, and String. Each of the peer-teachers had at least six months of peer-teaching experience and had completed an online teaching module. Performance was scored using a novel objective assessment tool developed through a Modified Delphi Method. In contrast to a traditional Delphi approach, a draft assessment tool was developed by the first author based on a literature review and preliminary framework. This was distributed to three experts in laparoscopic surgery and surgical education who provided structured feedback until unanimous consensus was achieved. The assessment domains of the novel assessment tool were unique for each station. Points were allocated for specific task anchors based on the performance quality of each step, alongside bonuses, d…
creator: Martin Ho
rights: Copyright (c) 2025 Martin Ho https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S208
ending page: S208
doi: 10.5195/ijms.2025.4015

Managing Hyperphagia, Obesity, and Hyperglycemia in Prader-Willi Syndrome: A Meta-Analysis of GLP-1 Agonists and SGLT2 Inhibitors
type: item
description: Background: Prader-Willi Syndrome (PWS) is a genetic disorder caused by a deletion, mutation, or imprinting error of the paternal 15q11-13 region or by maternal uniparental disomy of chromosome 15. One of the disorder's most noticeable characteristics is the development of a constant insatiable appetite, which often results in hyperphagia, hyperglycemia and severe obesity. Hyperphagia related incidents and obesity complications are the leading cause of death for individuals with PWS. Effective treatments for hyperphagia, obesity, and hyperglycemia are needed to improve the quality of life and life expectancy for patients with PWS. Methods: This meta-analysis aims to assess changes in weight, HbA1c, and hyperphagia after the commencement of GLP-1 agonists and SGLT2 inhibitors in individuals with PWS. A review of the literature was conducted by searching Scopus, PubMed, clinicaltrials.gov, and Cochrane to identify relevant case studies, case series, retrospective studies, non-randomized clinical trials, and randomized clinical trials that involved treating PWS patients with any GLP-1 agonists or SGLT2 inhibitors. A total of 224 records were screened with 45 studies meeting inclusion criteria. Studies involving monotherapy and combination therapy regimens were included, and studies of all ages were included. Case and retrospective studies must have quantitative data on changes in weight, hyperphagia, BMI, or HbA1c to be included in the meta-analysis, and a meta-analysis of raw data extracted from these studies was conducted. For the studies involving trials, a fixed-effect meta-analytic model was used. Results: Preliminary analysis of the studies showed promising results that indicated that GLP-1 agonists and SGLT2 inhibitors could help PWS patients with weight management, reduction of hyperphagia, and glycemic control. However, most of the studies were retrospective case reviews rather than trials, and the trials had less favorable results. The two clinical trials, wh…
creator: Saumika Mulluri
rights: Copyright (c) 2025 Saumika Mulluri https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S209
ending page: S209
doi: 10.5195/ijms.2025.3992

What Medical Students Can Learn from the 2024 Dengue Outbreak in Pakistan: Clinical Spectrum, Biochemical Abnormalities and Predictors of Severity
type: item
description: Background: To provide insights into the demographic profile, clinical manifestations, biochemical abnormalities, and outcomes of patients admitted with dengue fever (DF) during the 2024 outbreak in Pakistan. Methods: This prospective cohort hospital-based study was carried out at Fauji Foundation Hospital Rawalpindi from August to November 2024. DF was diagnosed on the basis of positive Dengue NS-1 antigen or IgM antibody or both. Patients under 12 years, having other causes of fever or chronic co-morbid diseases were excluded. Demographic data, symptoms, clinical examination signs and laboratory parameters were recorded on a proforma. Severity of dengue was based on WHO revised classification of 2009. Data were analyzed using SPSS, version 21.0. Results: A total of 198 patients were included and majority of them (83.8%) were from the Pothohar Plateau of Punjab comprising of Rawalpindi, Chakwal, Jhelum and Attock districts.Diagnosis was based on positive Dengue NS-1 antigen in 132 (66.6%), positive IgM antibody in 21 (10.6%) and both NS-1 and IgM positive in 45 (22.7%) patients. Mean age was 39.14±17.6 years and 173 (87.4%) were females. The mean duration of hospital stay was 4.98±2.42 days. Twenty six (13.1%) patients were categorized as “Dengue without warning signs” (DWoWS), 150 (76%) patients as “Dengue with warning sign”s (DWWS), and 22 (11%) patients as “Severe Dengue” (SD). Among this study cohort, 184 (92.9%) survived and improved clinically to be discharged, however, there were 14 (7.1%) mortalities. All these 14 patients had Severe Dengue. Compared with survivors the non-survivors&#39; age did not differ significantly; 38.6±17.7 vs 45.8±14.3 years respectively, p= 0.139. The proportion of non-survivors was significantly higher among males (24%) as compared to females (4.6%), p= 0.00. The OR (odds ratio) of a male dying was 10.8 time that of a female. All patients of both groups had a history of fever. The proportion of patients with myalgia, rash, vaginal…
creator: Mahnoor Ahmed
creator: Shahan Ahmed
creator: Faizan Ahmed
creator: Hamayun Ashraf
rights: Copyright (c) 2025 Mahnoor Ahmed, Shahan Ahmed, Faizan Ahmed, Hamayun Ashraf https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S210
ending page: S210
doi: 10.5195/ijms.2025.4012

Risk of Recurrence of Congenital Ocular Toxoplasmosis in Children: A Meta-Analysis Review of Studies With Long-Term Clinical Follow-up.
type: item
description: Background. Congenital toxoplasmosis, a vertical infection caused by Toxoplasma gondii, can result in neurological and ocular sequelae that may manifest even years postnatally. Although standardized postnatal treatments have been implemented, clinical recurrences, particularly ocular ones, are anticipated to persist during extended follow-up periods. Consequently, prenatal treatment may potentially mitigate these recurrences; however, the evidence supporting this is currently limited and dispersed. Aim: To conduct a meta-analysis on the recurrence rate in children with congenital toxoplasmosis, considering their history of prenatal and postnatal treatment (spanning at least one year), and incorporating long-term clinical follow-up (extending for a minimum of two years). Methods. The databases utilized for the study selection process included PubMed, Web of Science, and Google Scholar. The Medical Subject Headings (MeSH) terms employed were “Toxoplasmosis AND Congenital” and "Toxoplasmosis AND Ocular.” The search was refined using the filters “clinical trial” and “randomized controlled trial.” Additionally, the references of the identified articles were scrutinized to identify other pertinent studies, employing the snowball technique. Experts in the field were consulted to provide relevant published or unpublished data. Studies were included if they reported a minimum of two years of follow-up and presented the results of ophthalmological follow-up. Data concerning prenatal treatment were extracted and systematically organized in an Excel database. The recurrence rate was determined by dividing the number of relapses among untreated patients over the follow-up period by 100. Results. Following revision, only three studies documented the incidence of new retinochoroiditis episodes during extended ophthalmological follow-up. All children in these cohorts received a minimum of one year, with some receiving up to two years of postnatal anti-Toxoplasma treatment. The adju…
creator: Juan David Duarte Arias
creator: Geraldine Mesa Londoño
creator: Nicolás León Parra
creator: Jorge Enrique Gómez Marín
rights: Copyright (c) 2025 Juan David Duarte Arias, Geraldine Mesa Londoño, Nicolás León Parra, Jorge Enrique Gómez Marín https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S211
ending page: S211
doi: 10.5195/ijms.2025.3926

Aging Patients, Changing Substances: Unexpected Demographic Shifts in Turkey’s Drug Treatment Admissions Over a Decade
type: item
description: Background: Substance use disorders (SUD) have undergone significant demographic and epidemiological shifts worldwide, with emerging substances and evolving patterns of use presenting new challenges for healthcare systems. In Türkiye, the past decade has been marked by increased policy efforts to expand treatment access and reduce drug-related harms. However, systematic evaluations of national-level data remain limited. This study retrospectively examines Türkiye’s national drug reports between 2013 and 2023 to identify critical trends in treatment admissions, substance prevalence, and health outcomes among individuals with SUD. Methods: We conducted a retrospective analysis of official data from the Turkish Ministry of Interior covering the period 2013–2023. A total of 362,560 documented cases were included. Key indicators assessed were annual treatment admissions, direct drug-related mortality, seized illicit substances, and infectious disease markers (including HIV) among people who inject drugs (PWID). Trends were further stratified by demographic variables such as age, sex, and primary substance of use. Results: Over the study period, treatment admissions for SUD rose by 60%, reflecting both increased prevalence and broader treatment availability. Direct drug-related mortality declined by 39.6% between 2017 and 2023, coinciding with the implementation of harm reduction policies. Notably, methamphetamine emerged as the dominant substance, with an average annual prevalence increase of 46.2%. This trend displaced opioids as the leading primary substance, with opioid-related admissions declining from 76.3% to 4.2%. Mortality patterns revealed that 75.2% of drug-related deaths in 2022 were linked to polydrug use. Demographic analysis highlighted substantial changes in the treatment population. The proportion of female participants increased from 5.6% to 9.7%, indicating a narrowing gender gap in treatment access. The mean age of treatment entrants rose from 24.3 to …
creator: Ayça Sıla Kumtepe
creator: Levent Özdemir
creator: Serranur Sığındere
creator: Derya Çağlayan
rights: Copyright (c) 2025 Ayça Sıla Kumtepe, Levent Özdemir, Serranur Sığındere, Derya Çağlayan https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S212
ending page: S212
doi: 10.5195/ijms.2025.3807

Cross Sectional Study on Air Pollution and its Influence on Health Related Quality of Life in Coimbatore
type: item
description: Background: The air quality inside and outside of buildings and structures is referred to as indoor air quality (IAQ), particularly as it pertains to the comfort and health of building occupants. Since most individuals spend 90% of their time indoors, mostly at home or at work, indoor environment conditions have a significant impact on human wellbeing. Air quality is closely linked to global ecosystems and climate, and the impact of indoor air pollution on people's quality of life is an iceberg. Objectives: The study aim to assess the indoor air pollution and its influence on Health Related Quality of Life (HRQoL) in an urban population. Methods: A cross sectional study was conducted among 400 adults under an urban field practice area of a private college using systematic random sampling. The semi-structured questionnaire was designed for indoor air pollution along with EuroQol 5-Dimension 5-level (EQ-5D-5L); EuroQol Visual Analogue Scale (EQ VAS) was used. The data collected was entered in Microsoft Excel and analysed using SPSS software v.25. Descriptive statistics such as mean (SD), proportion has been done accordingly with inferential statistics chi-square test was used to see association between categorical variables. Cox proportional hazard model – hazard ratio and Kaplan Meier Curve – visualize life expectancy deterioration (LED) was done accordingly. Results: The prevalence of indoor air pollution was 72.5% in our study area. Based on EQ 5D 5L, the mean (±SD) score is 0.86 (±0.17), and the EQ VAS score is 76.3 (±11.1) of satisfactory life. There was a significant association between the presence of indoor air pollution and poor health based on EQ-5D-5L score (0.041) type of family (0.002), overcrowding (0.009), second-hand smoking (<0.01), and comorbidities (<0.01). Conclusion: The study highlighted that indoor air pollution negatively affects the quality of life in the study population, with a 4.56 years loss in Quality-Adjusted Life Expectancy (QALE). To i…
creator: Dhaarani Dharmaraj
creator: Fredrick Stephen
creator: Nawin Jai Vignesh
creator: Naveen Prabhu Jayaraj
creator: Sugunadevi G
rights: Copyright (c) 2025 Dhaarani Dharmaraj https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S213
ending page: S213
doi: 10.5195/ijms.2025.3980

MALAT1 and MIAT as Emerging Biomarkers for Diabetic Retinopathy: A Systematic Review and Meta-Analysis
type: item
description: Background: Diabetic retinopathy (DR) is a leading cause of preventable blindness, affecting nearly one-fourth of diabetic patients worldwide. Early diagnosis remains a major challenge due to reliance on labour-intensive, clinician-dependent fundoscopy. Long non-coding RNAs (lncRNAs), particularly MALAT1 (Metastasis-Associated Lung Adenocarcinoma Transcript 1) and MIAT (Myocardial Infarction-Associated Transcript), have been implicated in the pathogenesis of DR through regulation of angiogenesis, inflammation, oxidative stress, and vascular dysfunction. Their measurable expression in accessible biofluids such as serum and tears make them promising candidates for non-invasive biomarkers. The objective of this systematic review and meta-analysis was to assess the utility of MALAT1 and MIAT as diagnostic biomarkers for diabetic retinopathy. Methods: The study methodology complied with PRISMA 2020 standards and was documented in the PROSPERO registry (CRD420250650000). Databases including PubMed, Embase, Scopus, and PubMed Central were systematically searched, without date restrictions. Eligible studies included original, full-length research articles, case-control studies, and clinical studies evaluating MALAT1 or MIAT as biomarkers in patients with DR compared to diabetics without DR or healthy controls. Data on sensitivity, specificity, and area under the curve (AUC) were extracted. Quality assessment employed the Newcastle-Ottawa Scale, and pooled diagnostic performance was derived using a random-effects model. Results: Out of 52 records screened, 5 studies (n = 795 participants) were included, comprising 3 studies on MALAT1, 2 on MIAT, and 1 assessing both. Study populations were drawn from China, Egypt, and Canada, with serum or plasma as the primary biological matrix. MALAT1 demonstrated AUC values ranging from 0.62 to 0.84, with a pooled AUC of 0.737 (95% CI: 0.607–0.868). MIAT showed AUC values between 0.75 and 0.82, with a pooled AUC of 0.786 (95% CI: 0.732–0.…
creator: Saransh Gupta
creator: Seerat Kular
creator: Vandana Sharma
creator: Anuradha Raj
creator: Harmanpreet Singh Kapoor
creator: Aklank Jain
rights: Copyright (c) 2025 Saransh Gupta, Seerat Kular, Vandana Sharma, Anuradha Raj, Harmanpreet Singh Kapoor, Aklank Jain https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S214
ending page: S214
doi: 10.5195/ijms.2025.4071

Health Anxiety Among Clinical Medical Students: A Cross-Sectional Study at Uludağ University Faculty of Medicine
type: item
description: Background: Health anxiety, characterized by persistent worry about having or developing serious illness due misinterpretation of bodily sensations, represents a significant concern in medical education. Medical Student Syndrome (MSS), a unique manifestation of health anxiety specific to medical trainees, involves the tendency to misinterpret benign bodily sensations as symptoms of diseases being studied. Turkish medical students demonstrate higher rates of anxiety and depression compared to non-medical peers due to academic pressures, emotional exposure to illness, and prolonged training demands. The heightened awareness of disease pathology, combined with educational stressors, may increase susceptibility to health anxiety among medical students. This study aimed to evaluate and compare health anxiety levels among clinical-year medical students across different academic stages. Methods: A cross-sectional study was conducted among 288 clinical medical students (4th, 5th, and 6th years) at Uludağ University Faculty of Medicine. The sample exceeded the minimum required size of 272 participants calculated using Cochran's finite population correction formula. Data collection utilized a two-part online survey following informed voluntary consent. Part one assessed sociodemographic variables and health anxiety-related factors, while part two employed the validated Turkish version of the Short Health Anxiety Inventory (SHAI), an 18-item self-report instrument evaluating current mental states and emotional responses to illness scenarios. Statistical analysis was performed using SPSS version 23, employing descriptive statistics, Chi-square tests, Student's t-tests, and multiple linear regression analysis to identify significant predictors of health anxiety. Ethics approval was obtained from Uludağ University Faculty of Medicine Clinical Research Ethics Committee. Results: The study population comprised 136 (47.2%) female and 152 (52.8%) male students, with proportional dist…
creator: Levent Özdemir
creator: Ezgi Mühürcü
creator: Oğuzhan Çalışkan
rights: Copyright (c) 2025 Levent Özdemir, Ezgi Mühürcü, Oğuzhan Çalışkan https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S215
ending page: S215
doi: 10.5195/ijms.2025.3833

Association Between the Presence of Palmaris Longus Muscle and Handwriting Performance in Medical Students: A Cross-Sectional Study
type: item
description: Background: The Palmaris Longus (PL) is a superficial muscle of the anterior compartment of forearm, contributing to wrist flexion but considered functionally dispensable. Anatomically, it shows significant variability, with agenesis reported in 1.5–63.9% of individuals worldwide. The functional significance of the PL has been studied primarily in sports; however, limited research has examined the role of PL in fine motor tasks, particularly handwriting, which demands both wrist stability and precise motor control. Given the PL’s contribution to wrist flexion and hand stabilisation, its absence may influence handwriting. With this background, this study was focused to assess the prevalence of the PL in North Indian medical students, analyze its variation with respect to laterality and gender and determine any possible association between the presence of the PL and handwriting performance. Understanding these relationships could provide insight into the functional relevance of the PL in fine motor activities and contribute to anatomical and clinical knowledge in the population studied. Methods: A cross-sectional observational study was conducted over two months among 200 first- and second-year MBBS students aged 18–25 years at AIIMS Bathinda. The presence of the PL muscle was assessed using Schaeffer’s, Pushpakumar’s, and Mishra’s tests. Handwriting performance was evaluated with the validated Handwriting Assessment Battery for Adults, which included dot writing, horizontal line drawing, and numeral writing, scored for speed, accuracy, and legibility. Descriptive statistics were computed, and associations were analyzed using regression models (negative-binomial, Poisson, and linear), adjusting for sex, handedness, and PL laterality. A p-value <0.05 was considered statistically significant. Results: Most participants were right-handed (189/200, 94.5%). PL absence was uncommon (11/200, 5.5%) and more frequent in females (7/73, 9.6%) than males (4/127, 3.1%). Dominant-h…
creator: Seerat Kular
creator: Anshika Gandhi
creator: Anirudh
creator: Saransh Gupta
creator: Dr. Apurba Patra
creator: Dr Priti Chaudhary
rights: Copyright (c) 2025 Seerat Kular, Anshika Gandhi, Anirudh, Saransh Gupta, Dr. Apurba Patra, Dr Priti Chaudhary https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S216
ending page: S216
doi: 10.5195/ijms.2025.4072

Survival Factors in Lung Cancer Patients with Mutations in the PROS1, SERPINC1, F2, and F5 Genes
type: item
description: Background: Lung cancer remains a leading cause of cancer mortality globally, with poor 5-year survival rates largely due to late-stage detection. Small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) are distinguished by distinct growth patterns, metastatic potential, and genetic profiles. Genetic markers in coagulation pathways, including F2, F5, PROS1, and SERPINC1, are implicated in tumor progression, metastasis, and hypercoagulable states. This study investigates the association of these gene mutations with clinical outcomes, tumor location, stage, and demographic factors in lung cancer patients. Aim: The objective of this study was to characterize the prognostic significance of F2, F5, PROS1, and SERPINC1 mutations in lung cancer by analyzing clinical outcomes and survival patterns. Using TCGA-LUAD and TCGA-LUSC cohorts, we assessed how these mutations interact with patient age, race, tumor laterality, anatomic site, stage, and treatment strategies. The overarching aim was to determine whether thrombophilia mutations represent independent factors influencing survival and to explore their potential role in guiding personalized therapy. Methods: Primary lung cancer patients with mutations in F2, F5, PROS1, or SERPINC1 were identified from TCGA-LUAD and TCGA-LUSC datasets. STAR RNA gene expression quantification was obtained for each gene. Patients were divided into mutation (n = 569) and comparison (n = 850) groups. Univariate and multivariate Cox proportional hazards analyses were conducted to evaluate associations between overall survival and patient age, race, AJCC pathologic stage, tumor primary site, laterality, and treatment type (chemotherapy, ancillary, immunotherapy, pleurodesis, radiation, targeted therapy). Hazard ratios (HR) with 95% confidence intervals (CI) were calculated. Results: Across all mutations, higher pathologic stage and right-sided tumor location were consistently associated with worse survival. F5 mutations were signific…
creator: Raniya Ahmad
creator: Ryan Brownlee
creator: Aditya Birla
creator: Dongyu Zhang
creator: Hung Bui
creator: Mashoor Al Ahammed
creator: Girindra Raval
rights: Copyright (c) 2025 Raniya Ahmad https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S217
ending page: S217
doi: 10.5195/ijms.2025.4095

Leishmaniasis in a Patient with Congenital Neutropenia - A Rare Case Report
type: item
description: Background: Visceral leishmaniasis is a parasitic disease caused by Leishmania species and transmitted by sandflies. It typically presents with fever, hepatosplenomegaly, and cytopenias. Congenital neutropenia is a rare primary immunodeficiency characterized by recurrent infections due to persistently low neutrophil counts. To our knowledge, the coexistence of congenital neutropenia and visceral leishmaniasis has not previously been reported. The case: We describe an eight-year-old child with congenital neutropenia who presented with pallor and hepatosplenomegaly, notably in the absence of fever. Laboratory studies showed pancytopenia with severe neutropenia. Given this constellation of findings, several differential diagnoses were initially considered, with leukemia being strongly suspected. Bone marrow aspiration was performed to confirm the diagnosis. Unexpectedly, the marrow examination revealed numerous Leishmania amastigotes, establishing the diagnosis of visceral leishmaniasis. The patient was treated with liposomal amphotericin B, resulting in a gradual clinical recovery and normalization of blood counts. Conclusion: This report represents the first documented case of concurrent congenital neutropenia and visceral leishmaniasis. It highlights the importance of maintaining a broad differential diagnosis in immunocompromised patients presenting with cytopenias and organomegaly, even in the absence of fever. Early recognition of visceral leishmaniasis remains critical, as timely treatment can substantially improve outcomes.
creator: Karima Boughambouz
creator: Sana Bouimout
creator: Yasmine Bouferkas
creator: Meriem Boueri
rights: Copyright (c) 2025 Karima Boughambouz, Sana Bouimout, Yasmine Bouferkas, Meriem Boueri https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S218
ending page: S218
doi: 10.5195/ijms.2025.3930

Diabetic Striatopathy: A Forgotten Diagnosis in Clinical Neurology
type: item
description: Background: Diabetic striatopathy primarily affects individuals with type 2 DM, often controlled, and is more common in females from Asian regions; cases have been reported across diverse populations.1,2 The incidence is approximately 1/100,000.3 Biopsy of the striatum shows vasculopathy with reactive gliosis. Diabetic striatopathy, a rare complication of Diabetes Mellitus (DM), presents a clinical challenge due to its variable manifestations. It is primarily characterized by abnormal involuntary movements, such as chorea or ballismus, which may affect limbs and, as in our case, the oromandibular region.4 This atypical presentation highlights the need to include diabetic striatopathy in the differential diagnosis of unexplained movements in patients with diabetes. The Case A 73-year-old man presented to the emergency department with a 15-day history of involuntary movements involving his left leg and oromandibular region. The symptoms began with mild pain, followed by irregular jaw movements and later choreiform movements of the left leg. He had recently been diagnosed with type 2 diabetes and was on metformin, glyburide, and sitagliptin, with no family history of movement disorders, prior head or neck injuries, or fever. On examination, he was alert, oriented, and hemodynamically stable, with no focal neurological deficits. Laboratory evaluation revealed fasting glucose of 132 mg%, postprandial 148 mg%, HbA1c 7.3%, mild anemia, and elevated thyroid function (0.3 µIU/mL); renal and liver function tests were normal. Initial suspicion of right basal ganglia or subthalamic stroke was revised after MRI revealed right putaminal hyperintensity with preservation of the internal capsule (Figure 1). Endocrinology consultation and anti-chorea therapy with tetrabenazine and clonazepam led to complete resolution, and the patient remained well on follow-up while continuing oral hypoglycemic therapy. Conclusions: The pathophysiology remains incompletely understood. Evidence sugge…
creator: Sajjad Ahmed Khan
creator: Anish Luitel
creator: Rasmita Poudel
creator: Huma Kausar
creator: Vivek K. Rauniyar
rights: Copyright (c) 2025 Sajjad Ahmed Khan, Anish Luitel, Rasmita Poudel, Huma Kausar, Vivek K. Rauniyar https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S219
ending page: S219
doi: 10.5195/ijms.2025.3981

Efficacy of Narrowband UVB Phototherapy in Mild to Moderate Psoriasis: A Case Series from Kharkiv, Ukraine
type: item
description: Background. Psoriasis is a genetically determined, chronic autoimmune disease of the skin and joints with a complex immunopathogenesis. Although topical corticosteroids remain the first-line treatment for mild to moderate forms, narrowband UVB (NB-UVB) phototherapy has emerged as an effective non-systemic alternative. AIM: To evaluate the clinical efficacy of NB-UVB phototherapy in patients with mild to moderate psoriasis using PASI and DLQI scores. Methods: Five patients were treated with NB-UVB phototherapy at the Dermatologic Centre “Chista shkira” (Kharkiv, Ukraine) between February and May 2025. PASI and DLQI were assessed before and after the course of treatment. All patients received adjunctive topical corticosteroids and antihistamines. Statistical analysis was performed using the Wilcoxon signed-rank test. Results: The mean PASI score decreased from 4.8 ± 3.78 to 0.56 ± 0.54 (p = 0.0625), and DLQI scores also improved, though statistical significance was not achieved (p = 0.0544). Clinical improvement, PASI75, was observed in 4 of 5 patients. All patients reported a reduction in pruritus. Conclusion: NB-UVB phototherapy combined with topical corticosteroids and antihistamines demonstrated clinical improvement in most patients with mild to moderate psoriasis. Although the results did not reach statistical significance due to the small sample size, the findings support further investigation of this therapeutic approach.
creator: Marharyta Khaustova
creator: Andrii Dashchuk
rights: Copyright (c) 2025 Marharyta Khaustova, 2. Andrii Dashchuk https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S220
ending page: S220
doi: 10.5195/ijms.2025.3792

Reconstruction of a Large Lumbar Carcinoma Defect Using a Subtype III Keystone Flap: Case Report
type: item
description: Background. Systemic inflammation is theorized to alter lipid metabolism through cytokine-driven suppression of hepatic synthesis, changes in lipoprotein clearance, and impaired reverse cholesterol transport. These theoretical changes include reductions in low-density lipoprotein (LDL), high-density lipoprotein (HDL), and total cholesterol (TC) with elevations in triglycerides (TG). While these mechanisms are biologically plausible and supported in experimental settings, large-scale inpatient data confirming these patterns remain limited. Clarifying how lipid profiles shift during acute inflammation is essential for accurate cardiovascular risk assessment and interpretation of lipid panels during illness. Methods. We conducted a retrospective analysis of electronic medical record data from a tertiary academic medical center between 2020 and 2024. A total of 5,060 hospitalized adult patients with C-reactive protein (CRP) >5 mg/L and at least one lipid panel were included. Patients were stratified into CRP categories: 5–20, 20–50, 50–100, and >100 mg/L. Mean values for TG, LDL, HDL, and TC were compared across groups using one-way ANOVA. Tukey HSD post-hoc testing was performed to evaluate between-group differences. Results. Among the 5,060 patients included, th mean age was 50.5 years, and 53.4% were female. As CRP increased, LDL declined from 105.53 mg/dL in the 5-20 mg/L group to 87.94 mg/dL in the >100 mg/L group, and TC declined from 187.04 to 157.28 mg/dL. HDL also showed a consistent inverse relationship with CRP, decreasing from 48.89 to 38.68 mg/dL across categories. ANOVA revealed significant group differences for LDL (F = 68.53, p < 0.0001), HDL (F = 94.83, p < 0.0001), TC (F = 99.39, p < 0.0001), and TG (F = 5.39, p = 0.0011). Tukey post-hoc tests showed significant LDL reductions between the 5-20 and >100 mg/L groups (mean difference = –17.60 mg/dL, p < 0.0001) and the 20-50 and >100 mg/L groups (mean difference = –9.72 mg/dL, p < 0.0001). For TC, the 5-2…
creator: Wilson Sebastian Peñafiel-Pallares
creator: Camila Brito-Balanzategui
creator: Juan Velez-Posada
creator: Jonathan Velasco
rights: Copyright (c) 2025 Wilson Sebastian Peñafiel-Pallares, Camila Brito-Balanzategui, Juan Velez-Posada, Jonathan Velasco https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S221
ending page: S221
doi: 10.5195/ijms.2025.3909

The Lipid Paradox in 5,060 Hospitalized Patients: An Inverse Association Between C-Reactive Protein and Cholesterol in a Tertiary Care Cohort from 2020 to 2024
type: item
description: Background. Systemic inflammation is theorized to alter lipid metabolism through cytokine-driven suppression of hepatic synthesis, changes in lipoprotein clearance, and impaired reverse cholesterol transport. These theoretical changes include reductions in low-density lipoprotein (LDL), high-density lipoprotein (HDL), and total cholesterol (TC) with elevations in triglycerides (TG). While these mechanisms are biologically plausible and supported in experimental settings, large-scale inpatient data confirming these patterns remain limited. Clarifying how lipid profiles shift during acute inflammation is essential for accurate cardiovascular risk assessment and interpretation of lipid panels during illness. Methods. We conducted a retrospective analysis of electronic medical record data from a tertiary academic medical center between 2020 and 2024. A total of 5,060 hospitalized adult patients with C-reactive protein (CRP) >5 mg/L and at least one lipid panel were included. Patients were stratified into CRP categories: 5–20, 20–50, 50–100, and >100 mg/L. Mean values for TG, LDL, HDL, and TC were compared across groups using one-way ANOVA. Tukey HSD post-hoc testing was performed to evaluate between-group differences. Results. Among the 5,060 patients included, the mean age was 50.5 years, and 53.4% were female. As CRP increased, LDL declined from 105.53 mg/dL in the 5-20 mg/L group to 87.94 mg/dL in the >100 mg/L group, and TC declined from 187.04 to 157.28 mg/dL. HDL also showed a consistent inverse relationship with CRP, decreasing from 48.89 to 38.68 mg/dL across categories. ANOVA revealed significant group differences for LDL (F = 68.53, p < 0.0001), HDL (F = 94.83, p < 0.0001), TC (F = 99.39, p < 0.0001), and TG (F = 5.39, p = 0.0011). Tukey post-hoc tests showed significant LDL reductions between the 5-20 and >100 mg/L groups (mean difference = –17.60 mg/dL, p < 0.0001) and the 20-50 and >100 mg/L groups (mean difference = –9.72 mg/dL, p < 0.0001). For TC, the 5-…
creator: Kyle Thurmann
creator: Trisha Mukherjee
creator: Michael White
rights: Copyright (c) 2025 Kyle Thurmann, Trisha G. Mukherjee, Michael D. White, MD https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S222
ending page: S222
doi: 10.5195/ijms.2025.3656

Is Mental Health Contagious? Depression, Anxiety, Stress and Burnout among Mental health professionals in Sudan
type: item
description: Background: Mental health professionals are more likely to experience mental health problems due to their work environment, Poor management of this can lead to job dissatisfaction, low organizational commitment and high turnover. The goal of this cross-sectional study is to evaluate the mental health of health care professionals working in Khartoum state psychiatric hospitals in order to comprehend effective coping strategies. Methods: Data was collected through both online and paper questionnaires, and analyzed using SPSS version 25, using descriptive statistics for categorical and continuous data, and inferential tests like Mann Whitney U, Kruskal-Walllis, and Sperman’s correlation. P value < 0.05 was considered significant. Results: A total of 164 mental health workers participated, majority of participants were female, single, and worked in private institutions for an average of 36-48 hours per week. The study found that participants experienced high levels of stress and personal burnout, with depression and anxiety being negatively correlated with the age of respondents and work-related burnout. Conclusion: The study suggests that mental health professionals in Sudan are experiencing relatively high levels of depression, stress, anxiety, and burnout. This highlights the need for effective strategies to support the mental well-being of healthcare professionals in this setting. Table 1. Demographic and Occupational Profile of the Study Sample. Variable Total N % Gender Male 68 41.5 Female 96 58.5 Social status Single 77 47.0 Married 78 47.6 Divorced 7 4.3 Widowed 2 1.2
creator: Iyas Abdelhadi Ahmed Abdelhadi
rights: Copyright (c) 2025 Iyas Abdelhadi Ahmed Abdelhadi https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S223
ending page: S223
doi: 10.5195/ijms.2025.3761

Healthcare Access Dimensions among ESRD Patients on Dialysis in Northern Sudan during Wartime 2024
type: item
description: Background: Patients with end-stage renal disease (ESRD) undergoing hemodialysis are among the most vulnerable groups in low-income and conflict-affected settings. Adequate access to healthcare is crucial for maintaining treatment continuity, preventing complications, and supporting nutritional health in this population. This study assesses healthcare access and its determinants among end-stage renal disease (ESRD) patients on hemodialysis in Northern Sudan and examines the relationship between access and malnutrition. Methods: This cross-sectional study involved secondary data analysis from 137 ESRD patients in four dialysis centers in Northern Sudan using cluster sampling. Healthcare access was measured using a structured questionnaire based on the modified Penchansky and Thomas model. Nutritional status was assessed usingthe Subjective Global Assessment (SGA). Descriptive statistics, bivariate analysis, and logistic regression were used to identify determinants and predictors of healthcare access using the Statistical Package for Social Science (SPSS) v21. Statistical significance was set at p-value < 0.05. Results: Overall, all patients showed moderate to high levels of healthcare access (mean index: 3.87 ± 0.51). Affordability scored the lowest among access dimensions. Higher income and age were significant predictors of better access (AOR=9.99 and AOR=3.87, respectively; p<0.05), while gender, displacement, and health insurance showed no significant contribution. Malnourished patients showed significantly lower scores on the affordability and awareness domains (p-value < 0.05). Conclusion: While patients in Northern Sudan had moderate to high access to healthcare, affordability was the most prominent barrier, being more prominent in malnourished patients, besides the low awareness. We recommend socioeconomic support, facilitating healthcare access for vulnerable patients, and nutritional educational programs.
creator: Iyas Abdelhadi Ahmed Abdelhadi
rights: Copyright (c) 2025 Iyas Abdelhadi https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S224
ending page: S224
doi: 10.5195/ijms.2025.3764

Malnutrition among Patients with End-Stage Renal Disease in War 2024: The Role of Healthcare Access, Dialysis, Gender, and Economic Disparities
type: item
description: Background: Chronic kidney disease (CKD) involves a decline in kidney function for at least three months, often requiring renal replacement therapy at the end stage. Ende-stage renal disease (ESRD)patients on haemodialysis are at risk of malnutrition, leading to poor clinical outcomes. This complex and multifaceted issue, influenced by socioeconomic and clinical care, is expected to worsen due to the ongoing war and high displacement rates. This study aimed to provide evidence on the prevalence of and factors contributing to malnutrition among haemodialysis patients in northern Sudan. Methods: This cross-sectional study recruited 141 patients from four public haemodialysis centres in the northern state through cluster sampling. Socioeconomic and clinical data were collected via interviews with patients, caregivers, and healthcare providers. Nutritional status was assessed using Subjective Global Assessment, and healthcare access was evaluated using the Penchansky and Thomas model. Descriptive, bivariate, and multivariate analyses were performed using SPSS v21, with statistical significance set at P < 0.05. Results: Most patients were males (68.1%), and the mean age was 52 ± 14.5 years. Hypertensive renal damage was the most common aetiology of ESRD (36.9%), followed by hereditary kidney diseases (20.6%). Approximately one-fourth of patients were hospitalized in the last 6 months, primarily due to electrolyte disturbances. Mild to moderate malnutrition was observed in 44% of patients, and severe malnutrition in 4.3%. Female gender (OR=2.292, 95% CI= 1.037-5.066) and dialysis duration over 5 years (OR=2.945, 95% CI= 1.155-7.505) predicted malnutrition. Better healthcare access correlated with improved nutritional status (p<0.05). Lower income, urban residence, hypertension, and cardiopathy were linked to higher SGA scores. Conclusion: The study reveals a high prevalence of malnutrition in haemodialysis patients, with a significant contribution of iatrogenic factors, s…
creator: Iyas Abdelhadi Ahmed Abdelhadi
rights: Copyright (c) 2025 Iyas Abdelhadi Ahmed Abdelhadi https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S225
ending page: S225
doi: 10.5195/ijms.2025.3763

Cross-Sectional Descriptive Study of Comparative Accuracy of ChatGPT, Google Gemini, And Microsoft Copilot in Solving NEET PG Medical Entrance Test
type: item
description: Background: Artificial Intelligence (AI) is increasingly applied in healthcare and medical education, with tools capable of assisting in diagnosis, treatment planning, and exam preparation. The NEET-PG is India’s national entrance examination for postgraduate medical training, with case vignettes forming a major component of assessment. AI chatbots therefore hold potential as aids in exam preparation. Previous studies have reported variable accuracy of AI tools in medical licensing exams, but head-to-head comparisons across question types, subjects, and platforms are scarce. Given their rapidly growing use by students and educators, establishing the reliability of these tools is critical. This study directly compares three leading AI chatbots. The objective was to assess and compare the accuracy of ChatGPT-4, Google Gemini, and Microsoft Copilot in solving the NEET-PG 2023 examination and evaluate their performance across different question types and medical subjects. Methods: This cross-sectional descriptive study evaluated the performance of three AI chatbots using a validated set of 200 NEET-PG 2023 questions sourced from PrepLadder and verified against standard textbooks. These questions were presented verbatim to ChatGPT-4, Google Gemini, and Microsoft Copilot. Each chatbot received the questions independently in separate sessions to minimize memory bias. Responses were recorded correct or incorrect using the validated answer key, and accuracy was expressed the percentage of correct responses. Comparative analysis was performed for overall accuracy, subject distribution, and question type (recall, analytical, image-based, case-based). Differences were assessed using the chi-square test with p < 0.05 considered statistically significant. Results: Microsoft Copilot achieved the highest overall accuracy with 165/200 correct responses (82.5%), followed by ChatGPT-4 with 161/200 (80.5%) and Google Gemini with 155/200 (77.5%). The difference in overall performance wa…
creator: Manik Bhise
creator: Sachin Kale
creator: Anuradha Patil
creator: Nandita Jali
rights: Copyright (c) 2025 Manik Bhise, Kale Sachin Sadanand, Patil Anuradha Vishwanath, Jali Nandita Vivekanand https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S226
ending page: S226
doi: 10.5195/ijms.2025.3989

Enhancing wash Practices and Health Outcomes in a Remote Community in the Peruvian Amazon: a Community-Based Intervention
type: item
description: Background: Florida International University Herbert Wertheim College of Medicine (FIU HWCOM) students initiated a community health and Water, Sanitation, and Hygiene (WASH) initiative in San Juan de Yanayaku, a remote Peruvian Amazon village of 105 individuals, from November 28 to December 2, 2024. The purpose of this project was to provide essential healthcare services and address critical WASH issues. The project was conducted in collaboration with Nevada Building Hope Foundation, which has provided support to the community for over a decade. Methods The team established and operated a temporary health clinic in a central community space to evaluate the overall health status of community members. Screenings included common acute and chronic health conditions, nutritional assessments, and vital sign monitoring. Each participant underwent a basic health assessment, with brief interviews to collect self-reported hygiene practices, water consumption, and prior illness history. Data were used to identify hygiene-related illness trends and inform future WASH interventions. New clothing was also distributed to community members. In addition, WASH education at the local primary school emphasized proper handwashing techniques and hygiene practices to reduce communicable disease spread. Results: The clinic provided health screenings for 40 individuals. Of these, sixty percent were female and most were between 20 and 60 years old. Eighty percent reported direct exposure to Amazon River water. While 65% reported no known medical conditions and 92.5% were not on medications, this may reflect limited healthcare access rather than absence of disease. Diarrhea was more common in river water consumers (50% vs. 12.5%). Stomachaches were also more frequent in river water users (37.5% vs. 25%). Higher glucose levels were observed in individuals drinking river water, suggesting a possible nutritional or metabolic impact linked to chronic infection or lack of food and care. Headaches …
creator: Rosemary Wright
creator: Sakhi Shah
creator: Venus Liu
rights: Copyright (c) 2025 Rosemary Wright, Sakhi Shah, Venus Liu https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S227
ending page: S227
doi: 10.5195/ijms.2025.4083

Human Immunodeficiency Virus Infection Among Women with Cervical Cancer: A Cross-Sectional Study
type: item
description: Background: Cervical Cancer remains a major public health concern worldwide, particularly in low- and middle-income countries. Women living with Human Immunodeficiency Virus (HIV) are at significantly higher risk for persistent Human Papilloma Virus (HPV) infection and progression to invasive cervical cancer due to immune suppression. This study aimed to determine the prevalence of HIV infection among women with cervical cancer and to assess demographic and clinical factors associated with HIV positivity. Methods: A prospective cross-sectional study was conducted among histologically confirmed cervical cancer patients after the approval of ethics committee. Demographic details, clinical history, HIV status, and treatment history were collected using a pre-validated structured questionnaire after obtaining informed consent. Data were analyzed using descriptive statistics, and subgroup analysis was performed for age, menopausal status, and place of residence. Results: Eighty patients were included, with a mean age of 47.86 ± 20.94 years; most were aged 45–64 years (51.25%) and presented with stage IIb disease (67.5%). Sixteen patients (20%) were HIV-positive. HIV prevalence was highest among women aged 45–64 years (41.17%) and among urban residents (62.5%). A majority of patients (65%) were premenopausal. Conclusion: A substantial proportion of cervical cancer patients were HIV-positive, underscoring the need for routine HIV screening, early diagnosis, and integrated management of HIV and cervical cancer to improve clinical outcomes. Table 1. HIV Status Distribution Among Cervical Cancer Patients HIV Status No.of cervical cancer patients Percentage Positive 16 20% Negative 64 80%
creator: Sai Sadhvika Kommuru
rights: Copyright (c) 2025 Sai Sadhvika Kommuru https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S228
ending page: S228
doi: 10.5195/ijms.2025.3936

Exploring the Relationship Between Students’ Academic Performance and Jungian Psychological Types: A Correlational Study
type: item
description: Introduction: The aim of this study is to explore the potential relationship between students' academic performance and their psychological types, as defined by Carl Jung's theory. The study also aims to highlight the relevance of Jung's theory of psychological types in understanding individual differences in academic performance. The key question is whether a person's psychological type influences their learning process, goal setting, and achievement. Methods: For theoretical information C. G. JUNG “THE COLLECTED WORKS” Edited by Sir Herbert Read was used. 50 students participated in the correlation study based on informed consent. The inclusion criteria are people with active student status aged 18 to 24 years. Questionnaires were used to collect data. The Myers-Briggs Type Indicator (MBTI) was used to determine the psychological types. SPSS Statistics Program was used to process the data. Four major variables were identified: 1. Gender, 2. University (Tbilisi State Medical University or other), 3. Psychological types, 4. Academic performance for the last 2 semesters (A, B, C, D). A correlation analysis was performed between these variables to determine the Pearson Correlation coefficient. Results: As a result of the pilot study the correlation between academic performance with student’s psychological type was not confirmed (Pearson Correlation -.132. Table1.). Given the small cohort, the results cannot be generalized of the general population. Conclusion: Aforementioned pilot correlation research shows that a person’s professional success, academic performance and the scale of the use of knowledge is not dependent on the psychological type. This calls for further studies with bigger and more diverse cohorts. Table 1. Pearson correlation coefficient Academic performance psychological type Academic performance 1 -.132 psychological type -.132 1
creator: Lizi Sarjveladze
rights: Copyright (c) 2025 Lizi Sarjveladze https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S229
ending page: S229
doi: 10.5195/ijms.2025.3834

Prevalence of Anxiety Among Medical Students in River Nile Universities: A Cross-Sectional Study
type: item
description: Background: Despite the social prestige the medical profession gives, it is not without taxation. Because of the rigorous training curriculum and long-term clinical practice medical school is stressful and onerous for mental health. We aim to measure prevalence of anxiety among medical students in the River Nile state and its association with sociodemographic characteristics. Methods: A descriptive cross-sectional facility-based study involving 335 students from first to fifth academic years at River Nile State medical schools. conducted using the Hospital Anxiety and Depression Scale (HADS) in addition to questions about a demographic. Data analysis was done on STATA program. Results: In our study wefound a high prevalence of anxiety 71.4% (Anxiety 47.8% and borderline anxiety 23.6%). There was no significant association between different colleges and anxiety (p=0.85), and no significant association in different academic years (p=0.23), Nationality (p=0.64), smoking (p=0.59) and drug (p=0.3). There was a significant association between anxiety and gender (p=0.001) female has more anxious than male. Conclusions: The Level of anxiety among medical students at River Nile state was high (71.4%), there is an urgent need to focus on awareness about mental well-being and provide the necessary support services to reduce anxiety.
creator: Tarteel Abazer Musa
creator: Alwathig Yahia
rights: Copyright (c) 2025 Tarteel Abazer Musa, Alwathig Yahia https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S230
ending page: S230
doi: 10.5195/ijms.2025.3699

The Impact of Lifestyle on Cardiovascular Health Among Medical Students at 6 October University
type: item
description: Background: Life-threatening cardiovascular conditions (CVDs) are one of the most important factors that affect peoples’ appetites and life expectancy on a global scale. Lifestyle factors such as diet, physical activity, sleep, and stress levels are important determinants of cardiovascular health. This research examines medical students’ lifestyle habits in relation to cardiovascular health indicators at 6 October University. Methods: This is a cross-sectional study of 100 medical students, and it was conducted via an online questionnaire in English and Arabic. The questionnaire contained demographic data, information about leisure activity, diet, smoking, sleep patterns, stress levels, and self-measured heart rate and blood pressure. Results: Of the participants, 62% were physically active more than 3 times weekly, only 28% of students reported eating fast food more than twice a week and 35% reported eating fruits and vegetables daily. 64% said they sleep for 6-8 hours a day. 42% reported feeling stressed. Among the responding students, 16% reported having elevated blood pressure and the majority of these students who reported poor lifestyle scores. Conclusion: These findings suggest that lifestyle behaviours including physical activity and dietary habits are associated with cardiovascular health indicators among medical students. It is necessary to promote healthy lifestyle changes to improve the wellbeing of future health professionals. Table 1. Summary of Health Behaviors Among Students Variable % of Students Physically active ≥3 times/week 62% Fast food consumption >2/week 28% Daily fruit/vegetable intake 35% Sleep duration 6–8 hours/night 64% Reported moderate/high stress 42% Elevated blood pressure reported 16%
creator: Naif A. Jaafari
rights: Copyright (c) 2025 Naif A. Jaafari https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S231
ending page: S231
doi: 10.5195/ijms.2025.3893

Emotional Well-Being, Anxiety, Depression, and Burnout Among First-Year Hospital Medical Students in Guatemala: A Pilot Study
type: item
description: Background: The transition into the first hospital year is a critical period in medical education, exposing students to new responsibilities, academic demands, and emotional stressors that increase vulnerability to anxiety, depression, and burnout. In Guatemala, evidence on students’ mental health at this stage is scarce. This pilot study examined emotional well-being, anxiety, depression, and burnout among Guatemalan medical students. Methods: A cross-sectional survey was conducted among 50 first-year hospital medical students from public and private universities in Guatemala using non-probabilistic convenience sampling. Data collection employed a Google Forms questionnaire with validated instruments: Patient Health Questionnaire (PHQ-9) for depression, Generalized Anxiety Disorder scale (GAD-7) for anxiety, and Oldenburg Burnout Inventory (OLBI) for exhaustion and disengagement. Sociodemographic data were also obtained. Descriptive statistics, Pearson correlations, and chi-square tests were performed with significance set at p < 0.05. Results: Mean OLBI scores were 16.3 ± 4.2 for exhaustion and 19.5 ± 2.9 for disengagement, with high levels in 40% and 84% of students, respectively. The mean PHQ-9 score was 6.0 ± 3.9, with 22% meeting criteria for moderate-to-severe depression. The mean GAD-7 score was 9.4 ± 5.5, with 42% screening positive for moderate or higher anxiety. Depression and anxiety were strongly correlated (r = 0.71, p < 0.001). Burnout was not significantly associated with depression or anxiety (p > 0.5). Conclusions: This pilot study revealed high rates of anxiety, depression, and burnout among Guatemalan medical students, underscoring the urgent need for institutional interventions to protect mental health.
creator: ANA PALOMO
creator: Victor Rivero
creator: Luis Torres
rights: Copyright (c) 2025 Ana Palomo, Victor Rivero, Luis Torres, MD https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S232
ending page: S232
doi: 10.5195/ijms.2025.4101

Assessment Of Vision Impairments Among Licensed Drivers In Mathura: A Pilot Study
type: item
description: Background: Driving is a visually intensive task that requires the integration of multiple visual functions to ensure road safety. In India, vision screening protocols for obtaining a driving license are often inadequate or inconsistently enforced. This pilot study was conducted to assess the prevalence and types of vision impairments among licensed drivers in Mathura district. Objective: To evaluate key visual parameters—glare recovery, night vision, color vision, visual acuity, phoria, and horizontal visual field—among licensed male drivers and determine their potential impact on driving performance. Methods: A cross-sectional pilot study was conducted at Spexwear Optical & Physiotherapy Centre, Mandi chauraha, Sonkh Road, Mathura. A total of 198 male drivers aged 18–56 years participated. Standardized tests were conducted to assess visual acuity (Snellen chart), color vision (Ishihara plates), glare recovery, night vision, phoria, and horizontal field of vision. Data were analyzed using descriptive statistics and chi-square tests; p-values < 0.05 were considered statistically significant. Results: Visual acuity deficits were noted in 29% of participants (binocular), 33% (right eye), and 25% (left eye). Impairments in glare recovery and night vision were present in 15% and 12% of drivers, respectively. Color vision deficiency was found in 23% of participants, with an additional 13% requiring retesting. Phoria was abnormal in 24%, and 19–20% of drivers showed subnormal horizontal field vision in at least one eye. Most impairments showed statistically significant associations (p < 0.05) with driving fitness. Conclusion: A significant proportion of licensed drivers in Mathura have unrecognized visual impairments. Comprehensive vision screening should be made mandatory in the driver licensing process to enhance road safety and reduce accident risks. Table 1. Distribution of Visual Function Test Results Among Drivers Glare Recovery Test Grade Number of Drivers Percenta…
creator: Dr Ragni Kumari
creator: Jagdish Singh
rights: Copyright (c) 2025 Dr Ragni Kumari, Jagdish Singh https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S233
ending page: S233
doi: 10.5195/ijms.2025.3758

Factors Influencing Varicose Vein Amongst the Local Population of Namakkal - A Cross-Sectional Study
type: item
description: Background: Varicose veins are a part of the spectrum of chronic venous disease. Varicosity might be due to obstruction, valvular insufficiency and calf muscle pump malfunction. They are not only a cosmetic concern but can also lead to significant morbidity, including pain, edema, skin changes, and ulceration if left untreated. Globally, the prevalence of varicose veins varies between 10% and 30%, influenced by genetic, occupational, and lifestyle factors. Prolonged standing, elevated body mass index (BMI), and hereditary predisposition are among the most widely reported risk factors. Aim: To assess the estimation of factor that influence the occurrence of varicose veins. Methods:: This study will be conducted in the Department of General Surgery at Swamy Vivekanandha Medical CollegeHospital and Research Institute. Patients who are coming to the Out Patient Department(OPD) and are willing to be examined for research purposes will be a part of the study. A minimum of 50 cases will be included in this study. Patients with severe pain and complications like: DVT/associated atherosclerotic arterial diseases will be excluded from the study. Patients with varicose will be examined and interviewed physically. The parameters of the study Age,Gender,Hours of Standing (Occupation),BMI,Pregnancy,Hereditary} will be noted down and the findings will be analyzed statistically using Chi-Squared test, SPSS software to understand the prevalence of varicose vein depending on the factors influencing them. Conclusions: The study is conducted to analyze the risk factors associated with varicose vein among the local population of Namakkal. Further counselling will be given to reduce the prevalence of varicose vein among the general public
creator: vivek krishnaa
rights: Copyright (c) 2025 vivek krishnaa https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S234
ending page: S234
doi: 10.5195/ijms.2025.3957

Knowledge, Attitude, and Practice on Over-the-Counter Drugs among Medical Students University of Khartoum, 2022-2023
type: item
description: Background: Self-medication with over-the-counter (OTC) medications is common among medical students. It is influenced by many factors, such as age, sex, income, self-care orientation, and medical knowledge. A high level of education and professional status are predictive factors for self-medication. Unfortunately, especially in developing countries, professional health care is relatively expensive and in some cases not readily available making self-medication an obvious choice of healthcare service. Furthermore, it has been noted that purchase of drugs that can only be purchased with a doctor's prescription in developed countries are OTC in developing countries. Students are expected to have proper knowledge, attitude, and practice (KAP) towards OTC medications and subsequent adverse drug reactions (ADRs). Objective: This study aimed to assess the KAP of OTC medication use and related factors among medical students, Uofk 2022. Methods: A cross-sectional study was conducted. Data were collected using a self-administered questionnaire from 377 students from year 1 to year 6 University of Khartoum, Faculty of Medicine.Then the data was analyzed using Statistical Package for Social Sciences (SPSS) version 24. Chi-square analysis was conducted and multivariable logistic regression analysis was used to determine the association between KAP and OTC use and its related adverse effects. Result: A total of 393 students participated in the study. The majority of the respondents (75.2%) reported that they practice self-medication. Fever & headache (76%), cough & common cold (48.5%), and abdominal cramps (45.7%)) were the most common conditions for which the students go for self-medication while analgesics (85.2%) followed by antispasmodics (72.4%) were the most commonly used classes of drugs. Minor illnesses (55.9%) and a desire for quick relief 171 (25%) were the main reasons for the self-medication practice with OTC medications. Conclusion: Self-medication is widely practice…
creator: Iyas Abdelhadi Ahmed Abdelhadi
rights: Copyright (c) 2025 Iyas Abdelhadi Ahmed Abdelhadi https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S235
ending page: S235
doi: 10.5195/ijms.2025.3762

Students' Perspectives on the Educational Environment at the University of Khartoum, Faculty of Medicine (2023-2024)
type: item
description: Background: Educational Environment (EE) is a broad category of settings that engage students in learning activities and its plays a central role in shaping students’ learning, attitudes, and academic success..A positive EE promotes intellectual growth, cooperation, satisfaction, and achievement, while students’ perceptions guide improvement effort. In Sudan, however, medical education faces unique challenges, including limited resources, political instability and ongoing conflict, all of which negatively affect training, infrastructure, and student well-being, highlighting the urgent need for systematic evaluation. At the University of Khartoum’s Faculty of Medicine, understanding students’ views is vital for identifying strengths and areas requiring improvement. Despite the institution’s leading role, little research has examined how academic performance, motivation, and living conditions influence these perceptions. Methods: A cross-sectional study was conducted using a self-administered, online questionnaire. The Dundee Ready Educational Environment Measure (DREEM) was applied to assess the perceptions of 377 medical students across six academic batches. Stratified random sampling ensured adequate representation by gender and batch. Data were analyzed using SPSS version 22 to examine the influence of demographic and academic factors on five key domains of the educational environment: perceptions of teaching, perceptions of teachers, academic self-perception, perceptions of atmosphere, and social self-perception. Results: The overall DREEM score was 113.1 ± 19.62, indicating a generally positive perception of the educational environment. However, subgroup analyses revealed notable disparities. Male students reported lower perceptions of teaching quality (p = 0.036), while dormitory residents had a significantly lower perception of teachers (p = 0.011). Students with intrinsic motivation exhibited higher scores in teaching (p = 0.002) and social self-perception (p…
creator: Malaz M. Abdalmotalib
creator: Nihal Elmubarak A. Hussien
creator: Eyad Kashif
creator: Muaiad Adil A. Abdelmotalab
creator: Hadiea Mosaab Ahmedelbashir Hassan
rights: Copyright (c) 2025 Malaz M. Abdalmotalib, Nihal Elmubarak A. Hussien, Eyad Kashif, Muaiad Adil A. Abdelmotalab, Hadiea Mosaab Ahmedelbashir Hassan https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S236
ending page: S236
doi: 10.5195/ijms.2025.4027

Myeloid-Derived Suppressor Cells in HIV: A Marker Beyond CD4 Count?
type: item
description: Background: HIV infection causes profound immune dysregulation, primarily through CD4⁺ T lymphocyte depletion and persistent immune activation. Myeloid-derived suppressor cells (MDSCs) have recently been recognized as key immunoregulatory cells. They represent a heterogeneous population of immature myeloid cells with strong capacity to suppress T cell proliferation and cytokine production, often mediated via PD-L1 expression and arginase activity. While their role has been described in cancer and other chronic infections, their contribution to HIV pathogenesis, clinical manifestations, and therapy response remains insufficiently defined. Aim: The aim of this study was to investigate the role of MDSCs and PD-L1 expression in HIV-positive patients, in relation to clinical symptoms, CD4⁺ T cell count, and type of antiretroviral therapy (ART). Methods: Peripheral blood samples from 41 HIV-positive patients and 10 healthy controls were collected. Flow cytometry was performed to quantify MDSCs (absolute counts and percentage of CD45⁺ cells), PD-L1 expression on MDSCs, and CD4⁺ T cell counts. Patients were stratified by clinical status (symptomatic vs. asymptomatic), CD4⁺ stage (<200/µl, 200–500/µl, >500/µl), and ART regimen (PI+NRTI, PI+NNRTI, NRTI+NNRTI, or no therapy). Statistical analysis was carried out using IBM SPSS v26. Normality of data was evaluated with the Shapiro–Wilk test. Depending on distribution, comparisons were made using t-test, ANOVA, Mann–Whitney U, or Kruskal–Wallis test. Correlations between continuous variables were assessed using Spearman’s rho. Results: MDSC percentages were significantly higher in HIV patients compared to healthy controls (p = 0.007). Within the HIV group, symptomatic patients showed elevated MDSC levels (p = 0.045) and lower CD4⁺ counts (p = 0.032) than asymptomatic individuals. Stratification by CD4⁺ stage revealed a trend toward increasing MDSC percentages with advancing disease, though this did not reach significance (p = 0.…
creator: Jelena Mićić
creator: Nikola Trifunović
creator: Ivan Stanojević
creator: Vesna Begović Kuprešanin
creator: Danilo Vojvodić
rights: Copyright (c) 2025 Jelena Mićić, Nikola Trifunović, Ivan Stanojević, Vesna Begović Kuprešanin, Danilo Vojvodić https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S237
ending page: S237
doi: 10.5195/ijms.2025.4065

Early Clues, Early Cure: Evaluating the Utility of the Hematological Scoring System in the Early Diagnosis of Neonatal Sepsis.
type: item
description: Background: Neonatal sepsis is a clinical syndrome characterised by signs of circulatory compromise due to microbial invasion of the bloodstream in the first month of life. It is a leading cause of neonatal mortality and is a global health concern. Early identification is crucial. The “gold-standard”- blood culture - has low sensitivity and is time-consuming. In resource-limited settings, these factors frequently lead to empirical antibiotic use, contributing to antimicrobial resistance. Rodwell et al. introduced a Hematological Scoring System (HSS) as an adjunctive tool for early diagnosis of neonatal sepsis using various hematological parameters. This observational diagnostic accuracy study aims to establish the reliability of HSS as a diagnostic marker, with potential for global use in the early identification of neonatal sepsis. Methods: This study is set in a tertiary care centre in Kerala, India. 60 neonates admitted to the NICU were included. The Hematological Scoring proposed by Rodwell et al is given in the table. Sepsis likelihood was interpreted as follows: ≤2 (less likely), 3–5 (probable), and >5 (very likely). Sensitivity, Specificity, PPV and NPV of each HSS parameter as well as CRP was assessed using IBM SPSS Statistics, ver. 30. Results: The study included 60 cases divided into three groups. Definite sepsis (5/60): Blood culture is positive for sepsis. Probable sepsis (25/60): Blood culture is negative but signs or elevated CRP suggestive of infection. No sepsis (30/60): Negative blood culture, normal CRP levels and absence of any signs of infection. The most common organisms isolated from the definite sepsis group were Staphylococcus Aureus and Acinetobacter Baumanni. Performance of the hematological parameters were analysed by two different approaches: Definite sepsis group vs. No definite sepsis group (Probable sepsis and No sepsis). Definite and Probable sepsis groups vs. No sepsis group. In both the approaches, total neutrophil count was the mos…
creator: Fahed Mohammed
creator: Farin Ashraf
creator: Gayathri G Nair
rights: Copyright (c) 2025 Fahed Mohammed, Farin Ashraf, Gayathri G Nair https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S238
ending page: S238
doi: 10.5195/ijms.2025.4066

Perceived Knowledge, Perception and Readiness of University Students regarding Sustainability Education and Practice
type: item
description: Background: Education for Sustainable Development (ESD) empowers individuals to acquire the knowledge, skills, attitudes, and values necessary for fostering a sustainable future. As global concerns regarding climate change, resource depletion, and environmental degradation intensify, higher education institutions play a vital role in preparing students to adopt and champion sustainable practices. This study aims to assess perceived knowledge, perception, and readiness toward sustainability education and practice among IMU University students, with the goal of informing institutional strategies and designing impactful educational interventions. Methods: A cross-sectional study was conducted among students enrolled in foundation, undergraduate, and postgraduate programs in IMU University. Data were collected using a validated, self-administered online questionnaire disseminated through institutional emails and social media platforms. The online survey included a combination of closed-ended multiple-choice questions, Likert scale ratings, and open-ended questions. A minimum sample size of 426 students was calculated to ensure representativeness, factoring in a 20% non-response or attrition rate. The survey assessed students’ demographic characteristics, prior exposure to sustainability content, perceived knowledge of sustainability concepts, attitudes toward environmental and planetary health, and readiness to engage in sustainability initiatives. Data were analyzed descriptively to summarize trends and identify potential gaps in knowledge and participation. Results: A total of 427 respondents participated in the study; 328 were female, and 351 were Malaysian. The majority (83.6%) were enrolled in undergraduate programs, and 81% had not attended any course related to sustainability. In terms of environmental and planetary health, 92.3% and 87.2% of respondents, respectively, rated their knowledge as fair or good. Climate change, pollution, and deforestation were identi…
creator: Pui Ee Seow
creator: Ke Shuen Yeo
rights: Copyright (c) 2025 Pui Ee Seow, Ke Shuen Yeo https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S239
ending page: S239
doi: 10.5195/ijms.2025.4061

Cross Sectional Study On Prevalence Of Insomnia And Factors Contributing To Insomnia In Adolescent School Students
type: item
description: Background: Insomnia- the unwelcome experience of difficulty in falling asleep, difficulty in maintaining sleep or early morning awakening with inability to resume sleep is common in all age groups and impairs quality of life. Untreated insomnia has severe impact on health and socioeconomy.These include subjective and objective daytime consequences like fatigue or malaise, poor attention and concentration, social and vocational dysfunction, mood disturbances, daytime sleepiness, reduced energy, tension etc. Insomnia is highly related to advancing age, family history of insomnia, female sex, lifestyle, emotional background, worry and stress; each of which is important to assess among the community, especially centering the adolescent age group. Since there are no known existing studies on the same topic in the authors setting and the available studies show wide variations in the prevalence of insomnia, they would like to investigate that. Objective: Primary objective: To study the prevalence of Insomnia in adolescent school children in Thiruvananthapuram Corporation, Kerala, India. Secondary objective: To find out the factors contributing to insomnia among the study population- Methodology: Study design: Cross sectional study. Study setting: Higher secondary schools of Thiruvananthapuram Corporation, Kerala, India. Study population: Adolescent students of two schools of Thiruvananthapuram Corporation. Data collection and analysis: Schools were approached through proper channels. Permissions were taken from school authorities before study. Questionnaires based on Insomnia Severity Index were distributed among the study population. The questionnaire consists of two sections, one based on a standard Insomnia severity assessment question and second one includes questions that are directed towards the establishment of relation between insomnia and certain factors, in which the researchers are interested in. A score based on all of this is determined and the demographic da…
creator: Athul. A
creator: Athira K Raveendran
creator: Athira Mangalan
creator: Athira Manoj
creator: Athira Sudhakaran
rights: Copyright (c) 2025 Athul. A https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S240
ending page: S240
doi: 10.5195/ijms.2025.3976

Impact of War on Burnout among Medical Students at Al-Neelain University in Sudan, 2024
type: item
description: Background: Burnout, characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment, is relatively frequent among medical students due to the demanding nature of medical education. In conflict zones, such as Sudan, the challenges are exacerbated by war, which disrupts training and increases psychological stress. Despite its potential long-term consequences on individuals and healthcare systems, burnout among medical students in these settings remains underexplored. Aim: This study aimed to assess the prevalence of burnout among medical students at Al-Neelain University in Sudan, with a focus on the impact of war on burnout levels. Additionally, it evaluated the students' coping mechanisms and resilience in overcoming the challenges posed by conflict and academic disruptions. Methods: A cross-sectional study was conducted among 259 medical students at Al-Neelain University, selected using a stratified sampling technique. Data were collected through an online, close-ended questionnaire comprising three sections: sociodemographic and training-related questions, a burnout assessment using the Maslach Burnout Inventory-Student Survey (MBI-SS), and an evaluation of resilience using the Brief Resilient Coping Scale (BRCS). The data collected were analyzed using Microsoft Excel and the Statistical Package for the Social Sciences (SPSS). Results: Of the total of 259 medical students at Al-Neelain University, the prevalence of burnout using the two-dimensional definition was 18.5%, while 8.1% met the criteria for three-dimensional burnout. High emotional exhaustion and cynicism were observed in 31.7% and 32.8% of students, respectively, whereas 30.1% had low academic efficacy. Burnout was significantly associated with poor academic performance, inadequate social support, and limited internet access (p < 0.001). The Brief Resilient Coping Scale (BRCS) showed that only 19.3% of students had high resilience coping, while 45.9% had low re…
creator: Enas Seyed
creator: Mohammed Yhya
creator: Ruaa El.Walid
creator: Assma Gamie
creator: Noha Sofyan
rights: Copyright (c) 2025 Enas Seyed, Mohammed Yhya, Ruaa El.Walid, Assma Gamie, Noha Sofyan https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S241
ending page: S241
doi: 10.5195/ijms.2025.4034

Ochratoxin A and Citrinin Contamination in Rice, Oats and Wheat Flour in Michoacán, Mexico: an External Biomonitoring Study
type: item
description: Background: Ochratoxin A (OTA) and citrinin (CIT) are classified as nephrotoxic mycotoxins, compounds naturally produced by some saprophytic filamentous fungi of the Aspergillus and Penicillium genera. These two mycotoxins are of particular concern because of both their ability to contaminate a vast spectrum of foods and their thermal stability of up to 250º C, thus representing a concrete threat for human health. Progressive decline in kidney function, chronic kidney disease, interstitial nephritis and Balkan Endemic Nephropathy are listed as long-term health risks. Aim: Since Mexico does not have regulations on OTA and CIT contamination limits in food, an external biomonitoring study is needed. The main objective of this study is to determine whether and to which extent selected food matrices are contaminated with ochratoxin A and citrinin. Methods: Commercial rice, oats and wheat flour, purchased from large-scale retail stores in Morelia (Michoacán), were selected as food matrices. In order to assess mycotoxins’ concentration, extracts of these cereals were needed. The process of extraction began by finely grinding and sieving the cereals until a homogeneous powder was obtained. Three replicates of each cereal were prepared by mixing 20 grams of powder with 100 mL of 80% acetonitrile. To optimize extraction, samples were placed on a rotatory magnetic plate for 15 minutes, centrifuged at 1980 g for 5 minutes. The supernatant was then collected, concentrated by rotary evaporation, and stored at 4°C until analysis. For detection, sensitive and highly specific techniques were applied: thin-layer chromatography (TLC) and enzyme-linked immunosorbent assay (ELISA). TLC was employed for qualitative analysis, while ELISA was used for quantitative analysis. Results:TLC results showed considerable ochratoxin A and citrinin contamination in all the analyzed samples (rice, oats and wheat flour), as well as potential occurrence of other toxins. Further investigation is needed …
creator: Maria Elena Asdrubali
creator: Alessandro Perera
creator: José Ángel Patricio Abarca Figueroa
rights: Copyright (c) 2025 Maria Elena Asdrubali, Alessandro Perera, José Ángel Patricio Abarca Figueroa https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S242
ending page: S242
doi: 10.5195/ijms.2025.4089

Green Synthesis of Streptomycin-Conjugated Silver Nanoparticles and their Efficacy Against Multi Drug-Resistant Staphylococcus aureus
type: item
description: Background: The emergence of multidrug resistant (MDR) pathogenic microbes against typical antibiotics is a global problem. Novel and effective strategies are being explored to treat various disease causing MDR pathogens. In this study, we prepared and tested the efficacy of antibiotic-conjugated silver nanoparticles against MDR-pathogens. Methods: We used the plant extract for the green-synthesis of Silver nanoparticles (AgNPs) as well as Streptomycin-conjugated AgNPs. The aqueous Azadirachta indica (Neem) leaf extract was used for the synthesis of AgNPs. The synthesized nanoparticles were characterized by various techniques and the antimicrobial activity was determined by agar-well plate method. Results: The green synthesized Streptomycin-conjugated AgNPs were characterized by different analytical techniques to establish the nanoparticle formation, size, shape and the presence of functional groups. The UV-visible spectra indicating absorbance at 450 and 440nm confirmed the formation of AgNPs and St-AgNPs, respectively. The scanning electron microscopic images showed that AgNPs and St-AgNPs are spherical in shape and the size in the range of 21-30 nm and 29-43 nm, respectively. The X-ray diffraction pattern of AgNPs and St-AgNPs showed peaks establishing the crystalline nature of the particles with characteristic peaks of 2θ for (111), (200), (220) and (311) planes. The Fourier Transform Infrared spectrum of St-AgNPs shows distinct peaks at 2980.47 (C-H bond), 1723.37(C=O bond), 1606.89 (C=C bond), 1507.63 (N-O group), 1445.33 (C-H), 1269.02 (C-O bond),1019.19 (C-O bond), and 812.43 cm (C-C bond) which corresponds to the functional groups present in both AgNPs and the conjugated antibiotic streptomycin. Further, the antimicrobial activity of AgNPs and St-AgNPs was examined by using the agar-well plate method against MDR Staphylococcus aureus. The antimicrobial activity analysis showed that St-AgNPs exhibited ~50% higher activity as compared to streptomycin alone. C…
creator: Soura Rajeshwara
creator: Raghu Holalkere
creator: Raghavendra Nagaraju
creator: Rajeshwara Achur
creator: Halesh
rights: Copyright (c) 2025 Soura Rajeshwara, Raghu S. Holalkere, Raghavendra S. Nagaraju, Rajeshwara Achur, Halesh L.H. https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S243
ending page: S243
doi: 10.5195/ijms.2025.3977

Modulatory Role of Pre-orthostatic Cold-Water Ingestions on the Electroencephalogram
type: item
description: Background: Literature is replete with the adverse outcomes of the cold impacts of climate change. The aim of the study was to investigate the effect of pre-orthostatic cold water ingestions on the electroencephalogram in male individuals. Methods: 35 apparently healthy young males averaging 19.5years satisfied the inclusion criteria and were selected for the study. Participants ingested 500militers of portable commercial water at 250c and 100c five minutes prior to sitting or orthostasis. Orthostasis lasted for minutes. Electroencephalogram (EEG) was recorded using PowerLab 26T with eye opened. On assumption of erect position, EEG recording was started and continued for 20 minutes during which the standing lasted. Results: Ingestion of 250c or 100c water prior to orthostasis has no significant effect on alpha wave frequency when compared to baseline. Beta wave frequency and alpha/beta ratio were significantly higher and lower in participants who ingested 250c prior to orthostasis when compared to those who ingested 250c prior to sitting respectively. Beta wave frequency and alpha/beta ratio also increased and decreased respectively in participants who ingested 100c prior to orthostasis when compared to those who ingested 100c prior to sitting. Ingestion of 250c prior to orthostasis caused higher beta wave frequency and lower alpha/beta ratio when compared to participants who ingested 100c prior to orthostasis. Conclusion: The findings of the study demonstrated that ingestion of 250c water prior to orthostasis was associated with relatively greater cortical activation.
creator: Mayowa Adeniyi
creator: Ayoola Awosika
rights: Copyright (c) 2025 Mayowa Adeniyi, Ayoola Awosika https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S244
ending page: S244
doi: 10.5195/ijms.2025.4009

Effects of Non-Nutritive Sweetener Mixers compared to Carbohydrate Mixers on Alcohol Pharmacokinetics and Patient-Reported Outcomes: A Systematic Review and Meta-Analysis
type: item
description: Background: Alcohol-associated accidents pose a major global health burden, accounting for 4.7% of all deaths and 4.6% of total disability-adjusted life years. Alcohol impairs psychomotor performance, driving ability, and risk perception. These acute outcomes are largely determined by alcohol absorption and metabolism, which in turn is influenced by gender, body composition, enzyme polymorphisms, drinking state, and co-consumed mixers. While carbonation and caffeinated mixers have shown to alter the pharmacodynamics of alcohol, the effects of non-nutritive sweetener (NNS) mixers remain underexplored. Given the increasing prevalence in the use of NNS mixers, clarifying their impact on alcohol pharmacokinetics and subjective intoxication and related outcomes is critical. Methods: A systematic review and meta-analysis of studies obtained from three databases (PubMed, EMBASE, Scopus) was conducted in accordance with PRISMA guidelines. Primary outcomes assessed were breath or blood alcohol concentration (BrAC/BAC) and gastric emptying (t1/2, tlag). Secondary outcomes included subjective ratings of intoxication and related psychomotor tests. Risk of bias was assessed using the RoB2 tool. Standardized mean differences (SMD) was calculated for BrAC Cmax. Subgroup analysis were performed separately for the breathalyzer used, standardized ethanol dosing, and non-nutritive sweetener composition. Heterogeneity was quantified using I² statistic, and sensitivity and publication bias analyses were performed when required adjusting for the small sample size. Results: Five studies were reviewed, of which four (34 NNS vs. 34 carbohydrate (CHO)) contributed to meta-analysis. All included studies were rated as having an overall risk of bias of “some concerns”. NNS mixers were associated with higher not statistically significant peak BrAC (SMD = +1.01, 95% CI = -0.44 to 2.46, p = 0.097; I² = 53%). Subgroup analyses done for the type of breathalyzer used (p=0.1), standardized ethanol dos…
creator: Shwetha Shenod
creator: Dhanikha SV
creator: Hari Sudhan S
rights: Copyright (c) 2025 Shwetha Shenod, Dhanikha SV, Hari Sudhan S https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S245
ending page: S245
doi: 10.5195/ijms.2025.4011

Evaluating SLC11A2 Expression in Stage III Colon Adenocarcinoma: No Prognostic Signal but Coordinated Expression with SLC40A1
type: item
description: Background: Colon cancer is characterized by the uncontrollable growth of abnormal epithelial cells and is a leading cause of cancer-related mortality worldwide. Stage 3 colon adenocarcinoma involves local lymph nodes and has a 5 year survival rate of about 65-75%. In diseases associated with marked inflammation, expression of iron regulating genes has been shown to experience significant alterations and predict worse prognosis in some patients. Notable genes involved in this pathway include SLC11A2, HAMP, FTH1, and SLC40A1. Aim: This study assessed SLC11A2’s significance for predicting overall survival in stage 3 colon adenocarcinoma followed by a gene expression correlational analysis with other iron regulating genes in patients from The Cancer Genomic Atlas COAD database. Methods: TCGA was queried for clinical and STAR counts RNA gene expression data within the TCGA-COAD project. 362 patients with AJCC stage 3 primary colon adenocarcinoma were selected. STAR RNA data was normalized using variance stabilizing transformation and patients were stratified by quartiles of expression into Q1, Q2, Q3, or Q4 groups. Additionally, patients were classified as early onset (EO) or late onset (LO) if age at diagnosis was before or after 50 years old, respectively. A Kaplan-Meier overall survival (OS) curve was created comparing survival across quartiles of SLC11A2 expression with log rank analysis assessing significance. Univariate and multivariate Cox Proportional Hazards Analysis was completed for SLC11A2 expression quartile, age, gender, and race. Linear regression testing was completed to assess colinearity of SLC11A2 expression with HAMP, FTH1, and SLC40A1. Results: On Kaplan-Meier analysis, SLC11A2 expression was not a significant predictor of survival at any quartile. Q2 experienced the worst survival, with all other quartiles displaying similar survival. On univariate analysis, quartiles of SLC11A2 expression were nonsignificant for OS. LO patients experienced signifi…
creator: Ryan Brownlee
creator: Shagun Dolakia
creator: Mashoor Al Ahammed
creator: Aditya Birla
creator: Raniya Ahmad
creator: Girindra Raval
rights: Copyright (c) 2025 Ryan Brownlee, Shagun Dolakia, Mashoor Al Ahammed, Aditya Birla, Raniya Ahmad, Girindra Raval https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S246
ending page: S246
doi: 10.5195/ijms.2025.4098

Using pretreatment MRI perfusion to inform subsequent MRI perfusion
type: item
description: Purpose: Patients with brain metastases frequently require stereotactic radiosurgery (SRS), which offers effective local control while avoiding the neurocognitive toxicities of whole brain radiation therapy. Increasing enhancing lesions after SRS may represent recurrent metastasis or radiation necrosis. MR perfusion is commonly used to distinguish between these entities, with recent meta-analyses showing good correlations between hyperperfusion and recurrent metastasis. However, some metastases do not show hyperperfusion before SRS due to innate tumor properties rather than technical limitations. We hypothesize that pretreatment MR perfusion can improve perfusion interpretation at suspected progression, where absent hyperperfusion before treatment suggests perfusion is an unreliable marker for recurrent metastasis. Materials and Methods : We retrospectively reviewed patients with systemic cancers and brain metastases who underwent SRS, had MR perfusion scans ≤30 days before SRS, and later developed suspected progression (>30 days post-SRS) with repeat MR perfusion ≤30 days before surgical resection. Histopathology served as the reference standard for determining recurrent metastasis versus necrosis. One metastasis was evaluated per patient. We analyzed dynamic contrast enhanced T1-weighted MR perfusion images with automated arterial input function to calculate Ktrans maps (transfer constant coefficient) and VP maps (plasma volume). The entire enhancing lesion was segmented using a semi-automated tool, propagated onto Ktrans and VP maps, and used to calculate normalized ratios (rKtrans, rVP). Absent hyperperfusion was defined as ratio <1.5. Statistical analysis used t-test where p=0.05. Results: Initial perfusion results before SRS across the entire cohort showed median rKtrans=1.7 (range: 0.20-29.56) and median rVP=2.1 (range: 0.275-7.536). Median metastasis size was 3.0 cc (range: 0.369-10.431). We identified 22 patients with growing enhancing lesions and repeat pe…
creator: Adebola Ademola
rights: Copyright (c) 2025 Adebola Ademola https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S247
ending page: S247
doi: 10.5195/ijms.2025.4054

How is Hypertension Associated with the Risk of Dementia among Adults living in High-Income Countries: A Systematic Literature Review
type: item
description: Background: Dementia is a major public health challenge in high-income countries (HICs). Hypertension is a modifiable risk factor for dementia, yet the timing of exposure and dementia subtype-specific associations remain uncertain. This meta-analysis quantifies the association between hypertension and dementia risk in HICs and examines life-course timing (midlife and late-life) and dementia subtypes. Methods: Systematic searches on OVID Medline, Embase, PsycINFO, Scopus and Web of Science (from inception to July 2025) identified 21 cohort studies. Four studies were meta- analyzed to quantify the association of midlife hypertension and all-cause dementia risk. The remaining studies were narratively synthesized using the SWiM guidelines. Screening and data extraction and analysis were done in accordance with PRISMA guidelines. Study quality was appraised with the JBI checklist; risk of bias was assessed with ROBINS-E and visualized using ROBVIS. Additionally, a Directed Acyclic Graph was constructed to map hypothesized causal pathways between hypertension and dementia, and to identify key confounders, particularly given the complex life-course interactions between these conditions. Results: Twenty-one cohort studies, with sample size ranging from 1,462 to 848,505, follow-up between 8 to 37 years, and participant mean ages from 30-95 years. Study populations were largely homogeneous, consisting predominantly of white participants in Europe, the USA, and Australia, and Asian participants from Japan and Korea. Ethnic minority and socioeconomic status were not reported in the included studies. Single-country studies were conducted in the United Kingdom, USA, Finland, Norway, Sweden, Japan, South Korea, Included2-16 and Australia. One multi-cohort study included seven cohorts across five countries (United States, Sweden, Germany, Netherlands, and Spain), and another study included two cohorts from two countries (Netherlands and Sweden). Meta-analysis of four studies showed…
creator: Feyi Ayanlowo
creator: Faithful Miebaka x Daniel
creator: Erika Kispeter
rights: Copyright (c) 2025 Feyi Ayanlowo, Dr. Daniel https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S248
ending page: S248
doi: 10.5195/ijms.2025.4090

Prevalence and prognostic significance of sodium levels in adults with traumatic brain injury: A meta-analysis
type: item
description: Background: Traumatic Brain Injury (TBI) is one of the leading causes of morbidity and mortality worldwide. Sodium disturbances occur commonly after traumatic brain injury and causes many complications. This study is aimed at determining prevalence and prognosis of sodium levels in adult with traumatic brain injury. Methods: A meta-analysis was performed following PRISMA guidelines. A systematic search was conducted at PubMed and Google Scholar from 2009 to 2025 for studies reporting sodium disturbances in adults with traumatic brain injury. Risk of bias was assessed using Newcastle-Ottawa Scale (NOS). Results: A total of 8 studies with 94,874 patients were involved. Data was analyzed using R software (version 4.5.1). The studies suggest that hypernatremia was associated with increased risk of mortality (OR 2.9 [95% CI 1.939-4.332] p-value <0.0001, I^2 = 85.05%) and worsened outcomes. Limited data on hyponatremia is not sufficient to make pooled analysis but few studies suggests that it is associated with increased severity and worsened outcomes. Conclusion: Hypernatremia is associated with increased risk of mortality and poorer outcomes. This study emphasizes the importance of incorporating sodium monitoring into standardized management protocols.
creator: NagaVenkata Priya Sri Harshitha Somarouthu
rights: Copyright (c) 2025 NagaVenkata Priya Sri Harshitha Somarouthu https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S249
ending page: S249
doi: 10.5195/ijms.2025.3997

Polypharmacy and Outcomes in Elderly Patients with Heart Failure: A Meta-Analysis
type: item
description: Background: Polypharmacy, commonly defined as the use of five or more medications, is highly prevalent among elderly patients with heart failure. While guideline-directed therapy improves survival, excessive or inappropriate medication use may increase mortality, hospitalization, and treatment burden. Aim: This study aimed to evaluate the association between polypharmacy and clinical outcomes in elderly patients with heart failure, including mortality, hospitalization, and quality of life. Methods: We conducted a systematic literature search in PubMed, Cochrane, and Scopus to identify observational studies assessing the impact of polypharmacy (defined as ≥5 medications) on elderly patients (≥65 years) with heart failure. Search strategies combined keywords (e.g., "heart failure", "polypharmacy") and subject headings (e.g., MeSH). The initial search yielded a total of 1,082 records. Studies were excluded if they were narrative reviews, case reports, or did not report quantitative outcomes of interest, such as mortality or hospitalization rates. After removing duplicates, titles and abstracts were screened based on predefined inclusion criteria. Following a full-text review of potentially eligible articles, 38 studies were included in the final systematic review, representing a pooled population of >250,000 participants. Of these, 11 studies provided sufficient quantitative data as Hazard Ratios with 95% Confidence Intervals and were included in the final meta-analysis for mortality and hospitalization. Findings from the remaining studies were synthesized narratively. Two reviewers independently screened, extracted data, and assessed study quality. A random-effects model was used to pool hazard ratios (HRs) and 95% confidence intervals (CIs). Statistical heterogeneity was assessed using the I2 statistic. Subgroup analyses were performed by medication type (heart failure–specific vs. non-cardiovascular), setting (community vs. hospital), and frailty status. Results: Po…
creator: Minahil Akbar
creator: Sandi Assaf
rights: Copyright (c) 2025 Minahil Akbar, Sandi Assaf https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S250
ending page: S250
doi: 10.5195/ijms.2025.4046

Meta Analytic Review on The Effect of Repetitive Transcranial Magnetic Stimulation on Post-COVID 19 Memory Impairment and Related Cognitive Disorders
type: item
description: Background: After the emergence of SARS-CoV-2 (covid-19) there have been reported cases of cognitive impairment in patients after recovering. The symptoms may persist for months and significantly impair quality of life. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive procedure that has shown promise in improving cognitive function in existing psychiatric and neurologic conditions. It is hypothesised that by stimulating targeted regions of the brain, rTMS may improve memory by enhancing synaptic plasticity, modulating cortical excitability, and promoting neurogenesis. Due to its non-invasive nature and its potential for improving quality of life, rTMS could be a neofrontier in treating memory impairment following covid-19 but remains underexplored. Objective: To evaluate the effect of rTMS on memory outcomes in individuals with cognitive impairment after SARS-CoV-2 infection and related neurological conditions. Methods: Two meta analytic studies were identified by searching reputable electronic databases using predefined keywords: “rTMS”, “memory impairment”, “COVID-19”, “MCI”. All searches were conducted on September 10, 2025. The included meta analyses had performed a comprehensive search from eight databases (PubMed, Embase, Cochrane library, Web of Science, CNKI, Wanfang, Sinomed, and VIP). Inclusion criteria: (1) randomised controlled trials (RCTs), (2) studies using rTMS intervention, regardless of wave type (Theta, beta, etc), (3) studies which had standardised memory outcomes reported, (4) cases with memory/cognitive impairment after infection with COVID-19 or patients with mild cognitive impairment (MCI). A qualitative inclusion was made for a case report of rTMS in a post covid patient. The data extracted included sample size, stimulation parameters, memory outcome measures, standardized mean differences, and reported adverse effects. Data synthesis involved no new statistics and was purely descriptive based on the pooled effect sizes.…
creator: Hassan Khalid
rights: Copyright (c) 2025 Hassan Khalid https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S251
ending page: S251
doi: 10.5195/ijms.2025.4051

Ekterly (Sebetralstat): A First in Class Oral On Demand Treatment for Hereditary Angioedema
type: item
description: Background: Hereditary angioedema (HAE) is a rare, potentially life-threatening genetic disorder characterized by recurrent episodes of edema affecting the skin, gastrointestinal tract, and airway. With a prevalence of only about 0.0012% globally (range 0.0007–0.01%), its rarity contributes to frequent delays in diagnosis and treatment, increasing risk of severe complications. Until recently, on-demand therapies for HAE required intravenous or subcutaneous administration, limiting accessibility and adherence. Objective: This study evaluates the clinical significance, therapeutic efficacy, and potential impact of Sebetralstat (Ekterly), the first FDA-approved oral on-demand therapy for HAE. Methodology: A review of recent clinical trials was conducted, assessing efficacy and safety with key parameters including symptom relief time and bradykinin levels. Discussion: Sebetralstat is a selective plasma kallikrein inhibitor that blocks bradykinin production, the central mediator of swelling in HAE. By reducing bradykinin, it prevents excessive vascular leakage responsible for symptoms. Clinical trials demonstrated rapid relief, with a median improvement time of 1.6 hours and some patients responding within 10 minutes. In laryngeal attacks, pooled analysis showed symptom relief within a median of 1.07 hours and complete resolution within 24 hours in 64.3% of cases, especially critical outcome to prevent airway obstruction. The oral formulation provides a practical alternative to injectables, enabling timely, unobtrusive treatment and improved quality of life. Conclusion: Sebetralstat marks a breakthrough in HAE therapy, combining convenience, rapid action, and favorable safety. Its availability is expected to enhance compliance, empower patients, and redefine standards of care.
creator: Hitanshi Nareshkumar Panchal
creator: Srijamya
rights: Copyright (c) 2025 Hitanshi Nareshkumar Panchal, Srijamya https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S252
ending page: S252
doi: 10.5195/ijms.2025.4032

The Impact Of Nightshifts On Doctors’ Cognitive Performance At Kosti Teaching Hospital During War, Sudan, 2024
type: item
description: Background: Nightshifts are an integral part of healthcare delivery but are strongly associated with disrupted circadian rhythms, sleep deprivation, and cognitive decline. These challenges may be exacerbated in conflict-affected regions such as Sudan, where physicians face increased workload and stress. This study aimed to evaluate the impact of nightshifts on doctors’ cognitive performance at Kosti Teaching Hospital during the ongoing war in Sudan. Methods: A hospital-based cross-sectional analytic study was conducted at Kosti Teaching Hospital between September 2024 and January 2025. A total of 54 doctors from medicine, pediatrics, surgery, and obstetrics and gynecology departments were enrolled. Data were collected using a self-administered structured questionnaire incorporating the Fatigue Assessment Scale (FAS), Perceived Stress Scale (PSS), and a cognitive performance assessment tool. Analysis was performed using SPSS v22 . Results: Most participants were males (63%), single (91%), and house officers (63%), with the predominant age group being 25–29 years (69%). The majority reported no regular sleep schedule (70%) and attended fewer than two nightshifts per week (66%), sleeping less than 6 hours during shifts (96%). Overall, 59.3% of doctors demonstrated cognitive impairment. Moderate stress was reported by 77.8% and mild to moderate fatigue by 37%. No significant association was found between cognitive performance and number of nightshifts per week (p=0.106), stress level (p=0.381), or fatigue level (p=0.284). Most doctors coped with nightshifts by consuming caffeine (72.2%) and taking short breaks (57.4%), while structured sleep schedules were the most common long-term coping strategy (57.4%). Conclusion: The majority of doctors reported cognitive impairment, moderate stress, and fatigue during nightshifts, though no significant associations were observed between cognitive outcomes and workload, stress, or fatigue levels. Coping strategies such as structure…
creator: Sarah Yousif
creator: Tebyan Suliman
creator: Reem Gaafar
creator: Rayan Almogera
creator: Shahd Ibrahim
rights: Copyright (c) 2025 Sarah Yousif, Tebyan Suliman, Reem Hatim Gaafar, Rayan Nasir Almogera, Shahd Babekir Ibrahim https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S253
ending page: S253
doi: 10.5195/ijms.2025.4067

Psychiatric Comorbidities and Mortality After Heart Failure Hospitalization: Evidence of a Survival Paradox From a Nationwide Cohort
type: item
description: Introduction: Psychiatric comorbidities may influence survival outcomes among patients hospitalized for heart failure (HF), yet their individual effects on short- and long-term mortality remain underexplored. Conditions such as depression, bipolar disorder, PTSD, and schizophrenia often coexist with HF and may affect outcomes through mechanisms like poor self-care, reduced treatment adherence, and neurohormonal dysregulation. Psychiatric illness is also associated with increased healthcare utilization, delayed care-seeking, and fragmented follow-up, factors that may compound cardiovascular risk. These comorbidities are frequently underdiagnosed or undertreated in cardiovascular populations, making it critical to understand their prognostic significance. Despite the high prevalence of these comorbidities, limited research has evaluated their direct contribution to mortality following HF hospitalization at a national level. Clarifying how specific psychiatric diagnoses impact mortality may guide risk stratification and inform more tailored post-discharge interventions. Methods: We conducted a retrospective cohort study using the Nationwide Readmissions Database (NRD), spanning 2016 to 2022. Adult patients (≥18 years) hospitalized with a primary diagnosis of HF were included. Psychiatric comorbidities were identified via ICD-10 codes for depression, anxiety, bipolar disorder, schizophrenia/psychotic disorders, PTSD, and substance abuse disorder. Outcomes included 30-day and 1-year mortality, evaluated using multivariable logistic regression models adjusted for demographic, socioeconomic, and hospital-level characteristics. Among 31,886,859 weighted hospitalizations, several psychiatric comorbidities were significantly associated with lower mortality. Results: Compared to patients without these conditions, those with bipolar disorder had reduced odds of 30-day mortality (OR 0.70, 95% CI: 0.67–0.73, p<0.001) and 1-year mortality (OR 0.72, 95% CI: 0.69–0.74, p<0.001). Sim…
creator: Joseph Dantin
creator: Kyle Thurman
creator: Trisha Mukherjee
creator: Paul Kang
creator: Michael White
rights: Copyright (c) 2025 Joseph Dantin, Kyle Thurman, Trisha Mukherjee, Dr. Paul Kang, Dr. Michael White https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S254
ending page: S254
doi: 10.5195/ijms.2025.3617

Cardiovascular Readmissions After Heart Failure: Substance Use Disorder as a Potential Risk Factor Among Psychiatric Comorbidities
type: item
description: Background. Psychiatric comorbidities are known to adversely affect cardiovascular (CV) outcomes, but their specific influence on CV-related hospital readmissions remains unclear. While prior research has focused on all-cause 30-day readmissions, few studies have evaluated psychiatric conditions in relation to CV-specific readmissions over both short- and long-term periods. This study aims to assess how individual psychiatric diagnoses impact 30-day and 1-year CV-specific readmission risk in patients initially hospitalized for heart failure (HF). Methods. We conducted a retrospective cohort analysis using the Nationwide Readmissions Database (NRD) from 2016 to 2022. A total of 31,886,859 weighted hospitalizations were included. Adult patients (≥18 years) hospitalized for HF were stratified by psychiatric comorbidity, including depression, anxiety, bipolar disorder, post-traumatic stress disorder (PTSD), schizophrenia/psychotic disorders, and substance use disorder (SUD). The primary outcomes were CV-specific readmissions within 30-days and 1-year, identified using ICD-10 codes. Multivariable Cox regression models adjusted for age, sex, Charlson Comorbidity Index, income quartile, hospital characteristics, and discharge disposition were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Results. SUD was the only condition associated with a clinically significant increased risk of CV-specific readmission at both 30-days (HR 1.03, 95% CI 1.02-1.03, p < 0.001) and 1-year (HR 1.02, 95% CI 1.02-1.03, p < 0.001). In contrast, statistically significant but clinically modest reductions in CV-specific readmission at both were observed at both time points for depression (30-day HR 0.85, 95% CI 0.84-0.85, p < 0.001; 1-year HR 0.85, 95% CI 0.84-0.85, p < 0.001), bipolar disorder (30-day HR 0.82, 95% CI 0.81-0.84, p < 0.001; 1-year HR 0.81, 95% CI 0.80-0.82, p < 0.001), PTSD (30-day HR 0.84, 95% CI 0.82-0.86, p < 0.001; 1-year HR 0.84, 95% CI 0.83-0.86, p …
creator: Trisha Mukherjee
creator: Kyle E. Thurmann
creator: Joseph G. Dantin
creator: Paul T. Kang
creator: Michael D. White
rights: Copyright (c) 2025 Trisha Mukherjee, Kyle E. Thurmann, MS, Joe G. Dantin, JD, MS, Paul T. Kang, PhD, Michael D. White, MD https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S255
ending page: S255
doi: 10.5195/ijms.2025.3567

Tuberculous Aortitis Masquerading as Takayasu Arteritis: A Diagnostic Tightrope in a TB-Endemic Region
type: item
description: Background: Tuberculous aortitis is an exceptionally rare extrapulmonary manifestation of Mycobacterium tuberculosis, most often seen in TB-endemic areas. It typically presents with nonspecific symptoms and may closely mimic primary large-vessel vasculitis, particularly Takayasu arteritis. Differentiating between infectious and autoimmune causes of aortitis is critical, as the management pathways diverge significantly namely, anti-tubercular therapy (ATT) versus immunosuppression. This case illustrates the diagnostic complexity and clinical decision-making involved in distinguishing between the two in a high-risk patient. Case Presentation: A 50-year-old woman with a background of hypertension, type 2 diabetes mellitus, chronic atherosclerotic disease, and bilateral renal artery stenosis presented with a two-day history of vomiting and blurring of vision. She had no history of fever, claudication, stroke, postprandial pain, or chest discomfort. On examination, she had a striking discrepancy in blood pressure: 160/80 mmHg in the upper limbs and 80/50 mmHg in the lower limbs. Neurological and systemic examinations were otherwise unremarkable. Initial investigations revealed serum sodium of 119 mmol/L, creatinine of 1.5 mg/dL, and CRP of 21.6 mg/L. ANA was positive, while cANCA and pANCA were negative. CT brain showed chronic right parietal lacunar infarct. A CT aortogram revealed severe narrowing of the descending thoracic and abdominal aorta with >90% stenosis of the coeliac artery, moderate superior mesenteric artery stenosis, and one-third occlusion of the left posterior tibial artery. These findings raised strong suspicion for Takayasu arteritis. However, PET-CT demonstrated metabolically active supraclavicular lymphadenopathy, and Mantoux testing was strongly positive. ESR and CRP showed a rising trend. While a lymph node biopsy was planned, general surgery deemed it inaccessible for sampling at the time. The patient had no systemic features suggestive of autoimm…
creator: Tooba Fatima Iram
creator: Yusra Fatima Anam
creator: Haroon Abdullah Shaheed
creator: Rahul Kumar Agarwal
creator: Naazira Begum
rights: Copyright (c) 2025 Tooba Fatima Iram, Yusra Fatima Anam, Haroon Abdullah Shaheed https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S256
ending page: S256
doi: 10.5195/ijms.2025.3747

Pregnancy Outcomes Following Elective Fetal Reduction from Dichorionic Twins to Singleton: Analysis of 30 Consecutive Cases Performed at 11-14 Weeks
type: item
description: Background: Requests for reduction from twins to singleton are being faced more frequently in the recent times. This study aims to assess the outcomes of fetal reduction from DCDA twins to singleton where both fetuses looked anatomically normal for gestation. Methods: This is a case series carried out in a single fetal medicine unit in Kolkata over a period of 36 months. Internal ethics committee approval was obtained for this retrospective review. Women carrying dichorionic diamniotic twins where there were no obvious medical indications were included in the study. The only reason for performing these procedures was maternal request. All cases were performed trans-abdominally at 11-14 weeks gestation by a single operator with considerable experience. The primary objective of this study was to assess the risk of procedure related pregnancy loss. The secondary objective was to assess the overall pregnancy outcome for these cases. Results: 31 cases were performed in this study period but one was lost to follow up. Hence 30 cases were analysed retrospectively. We did not have any pregnancy loss before 24 weeks in this series. Three underwent premature delivery before 34 weeks but all other pregnancies could be continued till term and delivered after 37 weeks with good perinatal outcome. Conclusion: Our study results, when compared with published literature appeared comparable in terms of the risk of miscarriage, gestational age at delivery and birth weight. Fetal reduction remains an effective option in cases to DCDA twins to those who prefer to give birth to one child only.
creator: Brojesh Rishi Mukherjee
rights: Copyright (c) 2025 Brojesh Rishi Mukherjee https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S257
ending page: S257
doi: 10.5195/ijms.2025.4104

Successful Microsurgical Replantation After Multiple Traumatic Amputations Caused by an Electric Grinder: A Case Report
type: item
description: Traumatic digital amputations are uncommon but carry significant functional, aesthetic, and occupational consequences, particularly in young adults. Microsurgical replantation has been shown to restore hand function and improve quality of life; however, success depends on factors such as ischemia time, injury mechanism, tissue viability, and surgical technique. Machinery-related injuries are especially challenging due to extensive crush and avulsion damage, often limiting replantation possibilities. Recent evidence suggests that even in the absence of suitable veins for anastomosis, venous congestion techniques can sustain digital viability, with reported survival rates up to 78.5%. We report the case of a 24-year-old woman who suffered total traumatic amputation of the second (D2) and third (D3) digits, and partial amputation of the fourth (D4) digit of her right hand after an accident with an electric mill. She arrived at the emergency unit 1.5 hours post-injury. D3 was deemed non-replantable and underwent stump remodeling. Successful microvascular replantation of D2 was achieved, including bone fixation with Kirschner wires, terminal-to-terminal arterial anastomosis, nerve repair, and tenorrhaphy. Postoperative management included anticoagulation and antiplatelet therapy. At six weeks, fixation material was removed, and the patient continues rehabilitation with favorable outcomes and no major complications. This case demonstrates that meticulous microvascular reconstruction of digits, integrating bone, vascular, nerve, and tendon repair, can restore function and aesthetics in complex traumatic amputations. Early intervention, careful patient selection, technical precision, and comprehensive rehabilitative care are critical for success. Multidisciplinary management is essential, providing clinical evidence to guide surgical decision-making in similar high-complexity cases.
creator: Martin Rodriguez Alvarado
creator: Mariana Fraga Duarte
creator: Sofia Rubiralta Adame
creator: Alba Mayra Padilla
creator: Celina Veronica Kishi Sutto
creator: Jorge Luis Perez Ruiz
rights: Copyright (c) 2025 Martin Rodriguez Alvarado, Mariana Fraga Duarte, Sofia Rubiralta Adame, Alba Mayra Padilla, Celina Veronica Kishi Sutto, Jorge Luis Perez Ruiz https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S258
ending page: S258
doi: 10.5195/ijms.2025.4029

Challenging the Paradigm: Emphysematous Pyelonephritis in a Culture-Negative, Non-Diabetic Patient
type: item
description: Background: Emphysematous pyelonephritis (EPN) is a necrotizing infection characterized by gas within the renal parenchyma and perirenal tissues. It is highly fatal, particularly in patients with diabetes mellitus or ureteral obstruction and has predilection for the left kidney. The Huang and Tseng classification is most typically applied to stratify severity. This case is remarkable because of the extremely rare reports of EPN in non-diabetic patients with negative urine cultures, occurring in up to 30% of reported cases. The Case: A 41-year-old female with history of bilateral nephrolithiasis, presented with severe left flank pain, radiating to the lumbar and inguinal regions, in association with dysuria, oliguria, and vesical tenesmus. Physical examination revealed significant tenderness of the left flank. Laboratory findings indicated profound leukocytosis, and urinalysis showed signs of infection but no urine culture growth. Non-contrast uro-Computed Tomography demonstrated bilateral nephrolithiasis, left-sided hydronephrosis, emphysematous changes in the renal parenchyma, and inflammatory involvement of Gerota’s, Lateroconal, and Zuckerkandl’s fascia. Based on radiological criteria, the case was classified as Huang and Tseng grade IIIB. The patient was managed with broad-spectrum intravenous antibiotics and supportive measures, with subsequent clinical improvement and no symptoms recurrence at 6 months-follow-up. Conclusion: Emphysematous pyelonephritis is a life-threatening infection most commonly associated with diabetes, yet it may also occur in non-diabetic patients with obstructive uropathy. Negative urine cultures do not exclude the diagnosis. Radiologic findings play a fundamental role in classification and management decisions. Early diagnosis and prompt treatment are critical for a favorable outcome.
creator: Sebastian Penafiel
creator: Juan Velez-Posada
rights: Copyright (c) 2025 Sebastian Penafiel, Juan Velez-Posada https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S259
ending page: S259
doi: 10.5195/ijms.2025.3875

Early Recognition of Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome): a Case Report of Successful Diagnosis and Treatment
type: item
description: Background: EGPA is a rare, multi-system, autoimmune disease characterized by vasculitis along with asthma and elevated eosinophils in the blood and tissues, affecting 1 to 3 in 1 million people annually, primarily middle-aged population [1]. It is well known that a large proportion of EGPA patients have had asthma and/or have had or currently have nasal polyps [2]. EGPA is associated with increased mortality compared to the general population. Due to variable clinical presentations, diagnosis is often delayed, leading to various physical deficits and life-threatening conditions. Therefore, it is important to detect and treat the syndrome in a timely manner. The Case: We present a case of successful diagnosis and treatment Churg-Strauss syndrome, emphasizing the importance of early recognition and intervention. A 56-year-old man with bronchial asthma and a history of sinus surgery presented with rhinitis, cough, low-grade fever, wrist pain and digital paresthesia. Initial imaging revealed sinusitis and right lung infiltrates and treatment for presumed pneumonia was started. During hospitalisation he developed anaemia, respiratory failure, haemoptysis, persistent inflammation and urinary problems. Further evaluation revealed a haemorrhagic rash, eosinophilic leukocytosis, haematuria, proteinuria and positive p-ANCA antibodies. Renal biopsy confirmed focal necrotizing and crescentic glomerulonephritis with eosinophilic infiltration consistent with EGPA. The patient's clinical condition improved rapidly with the introduction of high-dose methylprednisolone pulse therapy. Conclusion: This case demonstrates the complexity of diagnosing EGPA, which can be diverse and similar to more common diseases such as asthma, sinusitis and pneumonia. A multidisciplinary approach, including histological confirmation, was necessary to establish an accurate diagnosis. Early recognition and prompt initiation of corticosteroid treatment led to favourable short-term outcomes. Given the ris…
creator: Viktorija Domrina
creator: Beatričė Linkauskaitė
creator: Liucija Mazaliauskaitė
rights: Copyright (c) 2025 Viktorija Domrina, Beatričė Linkauskaitė, Liucija Mazaliauskaitė https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S261
ending page: S261
doi: 10.5195/ijms.2025.3895

Bilateral Fasciocutaneous V-Y Advancement Flaps for Reconstruction of a Stage IV Sacral Pressure Injury in a Burn Patient: A Case Report and Literature Review
type: item
description: Background: Pressure injuries (PIs) in the sacral region are a major reconstructive challenge, particularly in critically ill patients or those with a history of extensive burns. Healing capacity is often impaired, and the availability of healthy tissue is limited. Surgical coverage using fasciocutaneous flaps, such as the V-Y advancement design, provides durable reconstruction and effective redistribution of tension. This case illustrates the effectiveness of bilateral V-Y fasciocutaneous flaps in managing a large sacral PI in a burn patient. The Case A 47-year-old male with a history of extensive burns developed a stage IV sacral pressure injury during a prolonged stay in the intensive care unit. Clinical evaluation confirmed deep tissue involvement. After nutritional optimization, infection control, and wound bed preparation, surgical coverage was planned. Reconstruction was achieved with bilateral V-Y fasciocutaneous advancement flaps, which allowed tension-free closure and adequate vascularized coverage. The postoperative course was uneventful. At twelve-month follow-up, the wound remained fully closed, with no recurrence, dehiscence, or functional compromise. Recent evidence suggests fasciocutaneous flaps may provide superior resistance to pressure compared with muscle flaps, while minimizing donor-site morbidity. Bilateral V-Y advancement flaps allow tension-free closure and remain reliable even in patients with challenging comorbidities, as illustrated in this case. Conclusion: Bilateral V-Y fasciocutaneous flaps represent a safe, reliable, and effective strategy for reconstructing extensive sacral pressure injuries in patients with complex backgrounds such as burns. Integration of surgical treatment into a multidisciplinary and preventive care plan is critical to optimize outcomes and reduce recurrence risk.
creator: Sebastian Colina
creator: Wilson Sebastian Peñafiel-Pallares
creator: Javier Campoverde-Sanchez
creator: Jonathan Velasco-Bustamante
rights: Copyright (c) 2025 Sebastian Colina, Wilson Sebastian Peñafiel-Pallares, Javier Campoverde-Sanchez, Jonathan Velasco-Bustamante https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S260
ending page: S260
doi: 10.5195/ijms.2025.3916

Reversible Hypocalcaemic Dilated Cardiomyopathy causing Decompensated Heart Failure- A Case Report
type: item
description: Background: Hypocalcaemia induced heart failure, commonly seen in children due to Vitamin D deficiency, is a rare clinical syndrome in adults. These patients are refractory to routine treatment, but the timely diagnosis of the underlying etiology and correction of calcium promptly restores myocardial function. The Case A 55-year-old non-alcoholic and non-smoker female, previously diagnosed as a case of dilated cardiomyopathy, presented with complaints of progressive dyspnoea on exertion from NYHA-II to NYHA-IV over a span of 1 week. At admission the patient was conscious, afebrile; having respiratory distress, peripheral oxygen saturation of 93% at room air, blood pressure of 92/56 mmHg equal in both arms, regular pulse rate of 100 beats per minute, audible left ventricular S3, mild peripheral edema, and bilateral basal crepitations. She was diagnosed to have decompensated heart failure. Chest X-Ray revealed cardiomegaly. Electrocardiogram showed sinus tachycardia (90 beats/minute), QRS axis of -20o, prolonged QTc of 574 milliseconds. Laboratory analysis at admission revealed minimally deranged liver and renal functions, and highly elevated BNP. Relevant biochemical parameters are shown in the given table. Transthoracic echocardiogram revealed dilated left chambers (left ventricle end-diastolic diameter: 61 mm, left ventricle end-systolic diameter: 52 mm), left ventricle (LV) severe global systolic dysfunction (LVEF=22%) due to diffuse hypokinesia, restrictive type of diastolic dysfunction with elevated filling pressure indexes (E/E’=19), mild functional mitral regurgitation, mild tricuspid regurgitation, moderate pulmonary hypertension (systolic pulmonary artery pressure of 50 mmHg). Normal coronary angiography ruled out underlying ischemia. Patient was initially started on furosemide as decongestive therapy. Subsequent investigations conducted due to prolonged QTc revealed severe hypocalcaemia (corrected calcium of 4.38 mg/dL), inappropriately normal PTH, and pres…
creator: Shlok Bhardwaj
creator: Bhupinder Singh
rights: Copyright (c) 2025 Shlok Bhardwaj, Prof. Dr. Bhupinder Singh https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S262
ending page: S262
doi: 10.5195/ijms.2025.4003

When Antibiotics Leave a Mark: Understanding Minocycline-Related Pigmentation
type: item
description: Background: Minocycline, a broad-spectrum tetracycline antibiotic, is frequently prescribed for chronic dermatologic or infectious conditions. While generally well-tolerated, long-term or high-dose use can lead to a rare side effect: minocycline-induced hyperpigmentation (MIH). MIH is categorized into four types based on clinical presentation and histopathology, with Type I causing blue-black macules affecting sites of inflammation, Type II causing blue-gray pigmentation on areas of normal skin, Type III involving diffuse muddy-brown discoloration in sun-exposed areas, and Type IV affecting scars on the back. With the growing use of minocycline for resistant infections, recognition of this side effect is important. The Case: A 68-year-old male with a medical history of hypertension, congestive heart failure, type II diabetes, dyslipidemia, colon cancer, and prior aortic valve replacement was admitted to the hospital following a syncopal event. He was found to be febrile (104°F), delirious, and diagnosed with sepsis caused by Acinetobacter baumannii with no clear infection source. He was prescribed oral minocycline 100 mg twice daily for long-term suppression for approximately 5 years. Approximately 12 months after initiation, the patient developed bilateral hyperpigmentation on the dorsal surfaces of his feet, which gradually spread up to his bilateral lower extremities, forearms, cheeks, and sclera. The pigmentation persists and continues to expand at a slow rate. The clinical features suggest Type III MIH. Conclusion: The case illustrates a severe and unusually widespread manifestation of Type III MIH resulting from long-term minocycline use. While some pigmentation cases resolve after drug discontinuation, Type III often persists indefinitely and with increasing total cumulative dose. This disfiguring adverse effect highlights the importance of ongoing skin assessments in patients on long-term, high-dose minocycline regimens. Early recognition and timely interven…
creator: Roma Desai
creator: Jacqueline Leon
creator: Alicia Fields
creator: Jarrod Plank
rights: Copyright (c) 2025 Roma Desai, Jacqueline Leon, Alicia Fields , Jarrod Plank https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S263
ending page: S263
doi: 10.5195/ijms.2025.3905

Beyond Genetics: Clinico-Pathological Recognition of Ullrich Muscular Dystrophy in a Resource-Limited Setting
type: item
description: Background: Ullrich congenital muscular dystrophy (UCMD) is a rare collagen VI–related myopathy caused by mutations in COL6A1, COL6A2, or COL6A3 genes. Although traditionally considered an autosomal recessive disorder, recent reports have identified autosomal dominant variants that cause the UCMD phenotype. Clinically, it is characterized by early‐onset muscle weakness, proximal joint contractures, and distal joint hyperlaxity. This condition frequently progresses to restrictive respiratory involvement, while typically sparing cognitive, sensory, and autonomic functions. Given this predictable trajectory, early integration of palliative care is increasingly emphasised to optimize quality of life and reduce crisis-driven interventions. UCMD is extremely rare, with an estimated prevalence of fewer than 1 in 1,000,000 births worldwide, though the exact frequency remains unknown. A definitive diagnosis requires genetic confirmation and immunohistochemistry, but such resources are often limited in low- and middle-income countries. Case summary: A 15-year-old male, born of a third-degree consanguineous marriage, presented to the internal medicine department with recurrent lower respiratory tract infections and respiratory distress. He was first evaluated at age 4 for progressive motor regression, difficulty ambulating, and multiple joint contractures. Over the next decade, he had progressive motor decline and restrictive pulmonary disease, while cognitive, sensory, autonomic, and cardiac functions remained preserved. Physical examination revealed proximal muscle weakness, contractures of elbows and ankles, lumbar lordosis, café-au-lait spots, and a waddling gait. Muscle biopsy demonstrated features consistent with a dystrophic process and mild non-specific myopathic changes. A clinical diagnosis of UCMD was established based on characteristic clinical findings and histopathological correlation due to the unavailability of genetic testing and collagen VI immunohistochemist…
creator: Parvathi Sudha Hari
creator: Ranjit Sanu Watson
creator: Sudha P
rights: Copyright (c) 2025 PARVATHI SUDHA HARI, Dr Ranjit Sanu Watson, Dr Sudha P https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S264
ending page: S264
doi: 10.5195/ijms.2025.3958

Circulating Tumor DNA as a Tool of Surveillance and Early Indicator of Relapse in Sarcoma Patients
type: item
description: Background: The use of circulating tumor DNA (ctDNA) has been increasingly explored to monitor treatment response and recurrence surveillance in sarcoma patients. Given the minimally invasive method of measurement via blood samples, and its accuracy and early prediction compared to traditional imaging studies, this method holds promise for implementation as part of patient monitoring following primary treatment. We report our experience in a retrospective series of sarcoma patients where ctDNA was measured in the context of clinical care. Methods: Retrospective review of five sarcoma patients who were monitored with a tumor-informed ctDNA assay and conventional imaging studies after completing primary treatment was completed. Results: Patient A: A 36-year-old female was diagnosed with left breast angiosarcoma with liver metastasis. Patient was on pazopanib after initial successful treatment with surgery and chemotherapy. Patient was followed with ctDNA, and 37 days later, ctDNA measurements yielded a positive result (1.25 MTM/mL). Abdomen MRI two months later revealed liver metastasis. Patient B: A 43-year-old female was diagnosed with metastatic undifferentiated pleomorphic sarcoma. Patient was disease-free for one year after lung metastasectomy but then became positive on ctDNA surveillance (1.31 MTM/mL plasma). Patient had CT imaging two weeks later which showed no disease recurrence. Positive ctDNA levels with negative CT scans led to an additional PET study, confirming recurrence and enabling earlier redirection. Patient C: A 49-year-old female in remission after treatment for left breast angiosarcoma was followed with ctDNA assays, which yielded a positive result (1.69 MTM/mL). Imaging studies were normal. Subsequent ctDNA showed further ctDNA increase (8.9 MTM/mL). CtDNA increase and negative CT scans led us to order a PET scan, revealing new lesions in the sternum, right sacrum/ilium, and left femur, resulting in early detection of metastatic disease. Patien…
creator: Esha Sankhala
creator: Jordan Ziegler
creator: Allan Silberman
creator: Rebecca Godin
creator: Earl Brien
rights: Copyright (c) 2025 Esha Sankhala, Earl Brien, Jaya Gill, Leo Mascarenhas https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S265
ending page: S265
doi: 10.5195/ijms.2025.4023

From Thirst to Hormonal Collapse: A Case of Pituitary Stalk Enlargement Presenting with Central Diabetes Insipidus and Panhypopituitarism
type: item
description: Background: Pathologies involving the pituitary stalk (PS) are typically identified by the presence of central diabetes insipidus. The prevalence of central diabetes insipidus (CDI) is less than 1 per 25,000 population. Up to 25% of individuals affected by CDI have cranial neoplasms or have undergone post-pituitary surgery, highlighting its association with these conditions. However, CDI rarely manifests because of pituitary stalk enlargement. We share the case of a 51-year-old female patient with pituitary stalk enlargement presenting as CDI with panhypopituitarism. The Case: A 51-year-old female with a history of cervical cancer with lung metastasis, chronic myeloid leukemia (CML) and type 2 diabetes mellitus presented with septic shock from Clostridium difficle colitis. During hospitalization, she developed symptoms of polyuria, polydipsia. On examination her urine appeared clear in color and her output was 4.2 l/day. Laboratory tests showed elevated serum osmolality (325 mosm/kg) and low urine osmolality (82 mosm/kg), with high serum sodium (156 mEq/L) and urine specific gravity at 1.003.MRI findings revealed pituitary stalk enlargement (5 mm) with diffuse enhancement of the pituitary gland and lack of T1 hyperintensity in the posterior pituitary, suggesting a pituitary pathology. Hypernatremia was managed with intravenous Dextrose 5% in water fluid. Treatment with subcutaneous desmopressin (2 mcg), resulted in significant improvement in urine output (1.2 l/day) serum osmolality (287 mosm/kg) , urine osmolality (420 mosm/kg) and urine osmolality (1.013). This confirmed the diagnosis of Secondary CDI. Concomitantly, the finding of panhypopituitarism was made, necessitating hormone replacement therapy to address deficiencies in TSH, LH, FSH, and ACTH. However, the decision to transfer the patient to hospice care was made considering her overall prognosis and quality of life given her advanced malignancies and poor hospital course. Conclusion: In this case, clinica…
creator: Tyler Ohler
creator: Jacqueline Leon
creator: Kusuma Ravulapali
creator: Rakesh Inturi
rights: Copyright (c) 2025 Tyler Ohler, Jacqueline, Kusuma Ravulapali, Rakesh Inturi https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S266
ending page: S266
doi: 10.5195/ijms.2025.4092

Kratom Khaos: Tracing the Medical and Societal Toll of Kratom Use in Kentucky
type: item
description: Background: Kratom, derived from a tree species native to Southeast Asia and used in traditional medicine, is gaining popularity within the United States. While at low doses it is intended for stimulant use, higher doses of kratom can achieve analgesic effects similar to opiates. It’s use and misuse continues to be an area of interest given its unregulated status and propensity for addiction and abuse. Here we present four cases of kratom abuse observed in the inpatient and outpatient settings in southcentral Kentucky. The Case: First, 20-year-old female with medical history of anxiety and major depressive disorder presented to the emergency department due to symptoms of restlessness, body aches, chills, nausea, palpitations and loose stools. Patient revealed she has been taking 7-8 kratom tablets daily and had attempted immediate cessation but relapsed due to her symptoms. In clinic follow up, she was started on Atarax and methyl salicylate patches for symptom control and is currently in process of tapering off Kratom. Next, 49-year-old male with history of hypertension, chronic kidney disease, hyperlipidemia, and chronic pain presented to clinic with recurrent hypertensive episodes. He disclosed chronic use of kratom following MVC 5 years prior, currently taking 10 g every 4-5 hours. With a desire to cut back, the patient and his physician through shared-decision making created a tapering plan. With a slow taper, he has not reported any withdrawal symptoms. As his kratom use trends down, he will be referred to pain management specialist for chronic pain. Additionally, 18-year-old male with no significant medical history was brought to the ED being found unresponsive and foaming at the mouth. He was tachypneic, tachycardic, and hypotensive with a mildly elevated troponin. After receiving Narcan and IV fluids, the patient became responsive. Patient disclosed he was taking two 50 mg packages of kratom alongside marijuana and alcohol for recreation. After returning to…
creator: Jacqueline Leon
creator: Tyler Ohler
creator: Joseph Beckman
creator: Mallory Vaughn
rights: Copyright (c) 2025 Jacqueline Leon, Tyler Ohler, Joseph Beckman, Mallory Vaughn https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S267
ending page: S267
doi: 10.5195/ijms.2025.4093

Subacute Sclerosing Panencephalitis Presenting as a Stroke Mimic: A Case Report
type: item
description: Background: Subacute sclerosing panencephalitis (SSPE) is a rare, progressive neurodegenerative disorder caused by persistent measles virus infection in the central nervous system. In SSPE, mutant forms of measles virus persist within neurons and glial cells, evading immune clearance. This results in chronic inflammation and progressive neuronal degeneration. The condition typically presents 6–8 years after the initial measles infection with cognitive decline, behavioral changes, and myoclonus, and later progresses to motor decline, seizures, and a vegetative state. The estimated incidence of SSPE is 4–11 cases per 100,000 measles infections, though higher rates have been reported in lower- and middle-income regions, particularly when measles occurs at a young age. Although the global incidence has decreased with vaccination, SSPE continues to occur in areas with suboptimal measles immunization. We present a case of SSPE in an unvaccinated young adult, initially suspected to have ischemic stroke. The Case: A 22-year-old male, unvaccinated against measles, presented with acute neurological deficits, characterized by sudden-onset Right-sided Hemiplegia. Initial MRI showed acute cortical infarcts in the left fronto-parietal region. He received stroke-directed therapy, but there was no neurological improvement. Over the following days, the patient developed progressive behavioral disturbances, irritability, and memory impairment, followed by myoclonic jerks. A repeat MRI one month later revealed diffuse T2/FLAIR hyperintensities involving the bilateral posterior parietal lobes, left frontal and temporal lobes, and left centrum semiovale, extending beyond the initial infarct-like lesions. These findings were more suggestive of an evolving encephalitic process rather than a vascular event. Electroencephalography (EEG) demonstrated periodic epileptiform discharges (Figure 1). Cerebrospinal fluid (CSF) analysis showed markedly elevated measles-specific IgG antibodies (29.51…
creator: Nandita Jali
creator: Avinash Alashetty
rights: Copyright (c) 2025 Nandita Jali, Dr. Avinash Alashetty https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S268
ending page: S268
doi: 10.5195/ijms.2025.4099

From Anatomy to Intervention: Coil Embolization of a Post-Cholecystectomy Hepatic Artery Pseudo aneurysm: A Case Report and Anatomical Insights for Medical Student
type: item
description: Background: Post-cholecystectomy vascular complications are rare, but serious. The surgical anatomy of the hepatic arteries is notoriously variable and increases the potential risk of injury during hepatobiliary surgery. Normally the hepatic artery proper bifurcates into right and left hepatic arteries. But, in one third of cases the aberrant right hepatic aretery (aRHA) may originate from the superior mesenteric, gastroduodenal, right gastric artery or the coeliac trunk. Trauma from surgical clips or electrocautry can damage the aRHA during dissection at the Calot's triangle, with subsequent formation of pseudoaneurysm. This presents late after surgery, mostly as GI bleed, right upper quadrant pain and jaundice—the Quincke's triad. This case report presents pseudoaneurysm formation after injury to aRHA during cholecystectomy which was subsequently managed with coil embolization. The Case: A 65-years-old gentleman presented with right hypochondrial pain of 5-months duration which was confirmed to be due to gallstones on ultrasonography. He was admitted for cholecystectomy. Intraoperatively, during laparoscopiccholecystectomy Calot's triangle was identified and cystic artery and duct were clipped under vision and cut. While removing the gallbladder massive bleeding was observed for which the procedure had to be converted to open cholecystectomy. Upon inspection an aberrant right hepatic artery was found which was ligated, while 02 pints of blood were transfused. After hemostatic control, bile leak was observed, for which T-tube was placed in the common bile duct. Postoperatively, there was a gradual decrease of his t-tube output. On the 10th post-operative day, patient became apprehensive and there was massive bleeding from T-tube site and in the sub hepatic drain. He developed shock, for which he was resuscitated. Over next week bleeding progressively decreased. Meanwhile, ultrasound showed no intra-abdominal collection but a hypo-echoic area at the porta hepatis. C…
creator: Shahan Ahmed
creator: Faizan Ahmed
creator: Ehsan Masud Kiani
creator: Mahnoor Ahmed
creator: Anis Ahmed
creator: Syeda Qumreen Ahmad
creator: Fatima Nazir
creator: Kamil Ahmad Kamil
rights: Copyright (c) 2025 Shahan Ahmed, Faizan Ahmed, Ehsan Masud Kiani, Mahnoor Ahmed, Anis Ahmed, Syeda Qumreen Ahmad, Fatima Nazir, Kamil Ahmad Kamil https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S269
ending page: S269
doi: 10.5195/ijms.2025.4033

Genetically Confirmed Schwartz–Jampel Syndrome: An Ultra-Rare Case of Congenital Myotonia with Osteochondrodysplasia from India
type: item
description: Background: Schwartz–Jampel syndrome is a rare autosomal recessive disorder caused by mutations in the HSPG2 gene, leading to perlecan deficiency. Perlecan is a heparan sulfate proteoglycan critical for cartilage integrity, basement membrane stability, and neuromuscular transmission. The disorder manifests with skeletal dysplasia and persistent myotonia, while cognition and lifespan are usually preserved. Only about 150 cases have been reported worldwide. We report a four year old child with severe osteochondrodysplasia and generalized myotonia, highlighting the therapeutic benefit of botulinum toxin A in managing both blepharospasm and perioral myotonia. The Case: A male neonate, born full term to consanguineous parents, was referred on day one of life with suspected skeletal dysplasia. Birth weight was 3.0 kg (−0 to +1 SD), with macrocephaly (>+2 SD) and short length (<−3 SD). Dysmorphic features included a narrow thorax, bent femora and tibiae, retrognathia, long philtrum, and ichthyosis. Infantogram revealed rhizomesomelia with irregular metaphyses of long bones. At four years, he presented with gross motor delay due to sustained skeletal muscle contractions, failure to thrive, and gait difficulty. Anthropometry remained <−3 SD for height, weight, and head circumference. Examination showed generalized myotonia of facial and skeletal muscles, pursed lips, micrognathia, thoracic kyphosis, hip abduction deformities, and hypertrophied muscles. Neurological assessment revealed hypertonia with areflexia, while speech and cognition were preserved. The differential diagnosis includes muscular dystrophies, skeletal dysplasias, myotonic disorders, congenital myopathies, and cramp–stiffness syndromes such as stiff person syndrome and Isaac’s syndrome. However, the coexistence of osteochondrodysplasia with persistent myotonia, supported by whole exome sequencing which revealed a homozygous likely pathogenic variant in the HSPG2 gene (c.5014+2T>C), confirmed the diagnosis. P…
creator: Nandita Jali
creator: Suvarna Magar
creator: Tanya Trikha
creator: Varsha Vaidya
creator: Viranchi Vaidya
rights: Copyright (c) 2025 Nandita Vivekanand Jali, Suvarna Magar, Tanya Trikha, Varsha Vaidya, Viranchi Vaidya https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S270
ending page: S270
doi: 10.5195/ijms.2025.4063

Critical Role of Multiplex PCR in Diagnosing Legionella–SARS-CoV-2 Co-infection in a Severely Immunosuppressed Pregnant Patient: A Case Report
type: item
description: Background: The pregnancy period is characterized by significant immunological shifts, creating a window of vulnerability to severe infections. This susceptibility is profoundly amplified in patients with iatrogenic immunosuppression, such as those receiving biologic therapy for inflammatory bowel disease. Sepsis in these patients presents important diagnostic and therapeutic challenges, as both common pathogens and atypical co-infections must be considered. Co-infection with Legionella pneumophila, a potent intracellular bacterium, and SARS-CoV-2, a virus known for inducing immune dysregulation, is exceptionally rare and can precipitate a life-threatening hyperinflammatory state. The Case: We present a case of severe septic shock and acute respiratory failure resulting from this unusual dual infection in a uniquely compromised host. A 31-year-old female, 35 weeks pregnant, presented in ER with fever, dyspnea and altered general state, rapidly progressing to septic shock despite the broad spectrum antibiotic therapy initiated at admission. Her medical history was significant for ulcerative colitis treated with biologic therapy (Adalimumab) for the past two years. The investigations revealed septic shock, respiratory failure due to severe pneumonia. The obstetrical risk assessment conducted to emergency C section delivery due to high risk of complications and even death for both mother and child. A healthy premature baby was admitted to neonatal unit and the next day, the mother was transferred to infectious diseases intensive care unit. On admission to the intensive care unit, she was tachypneic (24 breaths/min) with an oxygen saturation of 88% on room air, desaturating on minimal exertion. Laboratory investigations revealed a systemic inflammatory response, with a procalcitonin of 33.9 ng/mL (ref: <0.5), C-reactive protein 21.15 mg/dL (ref: <0.5) and marked neutrophilic leukocytosis. Arterial blood gas analysis confirmed severe acute hypoxemic respiratory failure. …
creator: Anda Sabou
rights: Copyright (c) 2025 Anda Lup https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S271
ending page: S271
doi: 10.5195/ijms.2025.4069

Pituitary Carcinoma with Secondary Intracranial Involvement: A Case Report
type: item
description: Background: Pituitary carcinoma is an exceptionally rare and aggressive malignancy, accounting for less than 0.5% of all pituitary tumors. Diagnosis requires evidence of cerebrospinal or systemic metastases, as histological features alone cannot reliably distinguish carcinoma from aggressive adenomas. Malignant prolactinomas are particularly uncommon and associated with poor prognosis, with most patients surviving less than one year after diagnosis. The Case: We present a 28-year-old male with metastatic lactotroph pituitary carcinoma. His initial pituitary mass was resected in 2002 after presenting with neurological symptoms. He subsequently developed multiple recurrences requiring additional surgeries and Gamma Knife radiosurgery. In 2022, a posterior fossa lesion resection confirmed metastatic pituitary carcinoma, lactotroph subtype, with immunopositivity for PIT-1 and prolactin. By 2024, imaging revealed stable lesions in the sella turcica, frontal horn, and cerebellum without new metastases. The patient developed hypopituitarism and epileptic seizures requiring a vagus nerve stimulator. He is currently on cycle 5 of Temozolomide chemotherapy with dose adjustment for thrombocytopenia. Despite the typical poor prognosis of pituitary carcinoma, this patient remains clinically stable over 12 years since the appearance of intracranial spread and over 20 years since the initial diagnosis. Conclusion: This case highlights the unpredictable clinical course of malignant prolactinomas and the potential for long-term survival with consistent multimodal therapy. The patient’s unusually prolonged survival suggests that aggressive surveillance combined with repeated surgical interventions, radiotherapy, and Temozolomide chemotherapy may improve outcomes in select cases. Further study of such rare presentations may help inform future management strategies for pituitary carcinoma.
creator: Mashoor Al Ahammed
creator: Haifa Haris
creator: Ryan Brownlee
creator: Raniya Ahmed
creator: Aditya Birla
creator: Gerald Wallace
rights: Copyright (c) 2025 Mashoor Al Ahammed, Haifa Haris, Ryan Brownlee, Raniya Ahmed, Aditya Birla, Gerald Wallace https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S272
ending page: S272
doi: 10.5195/ijms.2025.4097

The Lupus You Didn't See Coming: Secondary Evans Syndrome with Fulminant Autoimmune Myocarditis in a Young Woman
type: item
description: Background: Some cases in medicine feel like a thriller, where every test, every symptom, and every intervention builds suspense. We present a young woman whose illness unfolded like a high-stakes medical drama: chest pain, cardiogenic shock, hemolysis, and mystery antibodies all converging in a race against time. The Case: A 25-year-old female arrived at the emergency room with seven days of dragging left-sided chest pain radiating to the neck, back, and arms, accompanied by shortness of breath (NYHA II–III), palpitations, sweating, orthopnea, and facial puffiness. One day prior, she developed black stools and non-bilious vomiting. On arrival, she was in cardiogenic shock, requiring noradrenaline infusion. ECG revealed ST-elevation in aVR with global ST-depression, and echocardiography demonstrated global hypokinesia with moderate left ventricular dysfunction. Labs were dramatic: hemoglobin 6 g/dL, highly elevated troponin I, deranged liver function tests, unconjugated hyperbilirubinemia, positive direct Coombs test, and low complement levels (C3 and C4). Immediate management included intravenous steroids, multiple blood transfusions, and plasma exchange. Serology revealed strong anti-histone antibody positivity with a completely negative ANA profile (anti-dsDNA, anti-Sm, anti-RNP). Coronary angiography was normal, confirming myocarditis as the source of troponin elevation. Ultrasound showed hepatosplenomegaly, and history uncovered a recent mismatched blood transfusion, complicating the hemolytic picture. Through rapid multidisciplinary coordination including critical care, cardiology, hematology, rheumatology, and nephrology, the patient stabilized, hemoglobin improved, and she was discharged on a carefully tailored immunosuppressive regimen. Conclusion: This case is a diagnostic rollercoaster. Anti-histone positivity initially suggested drug-induced lupus, yet hypocomplementemia, secondary Evans syndrome, and fulminant myocarditis pointed toward an atypical or e…
creator: Tooba Fatima Iram
creator: Yusra Fatima Anam
creator: Haroon Abdullah Shaheed
creator: Rahul Kumar Agarwal
creator: Raksha Kapali
rights: Copyright (c) 2025 Tooba Fatima Iram, Yusra Fatima Anam, Haroon Abdullah Shaheed, Rahul Kumar Agarwal, Raksha Kapali https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S273
ending page: S273
doi: 10.5195/ijms.2025.4040

An Uncommon Presentation of Systemic Sclerosis with Pulmonary Hypertension: A Case Report
type: item
description: Ba Background: Systemic sclerosis is a rare autoimmune condition that carries high mortality rates due to its varied and often hidden presentations. It is broadly classified into limited and diffuse systemic sclerosis, with the latter associated with a poorer prognosis because of its pulmonary, cardiac, and renal complications. Pulmonary hypertension and interstitial lung disease in diffuse systemic sclerosis (dcSSc) are serious complications that are difficult to diagnose due to their occult and insidious course. These manifestations not only increase morbidity and mortality but also result in significant out-of-pocket healthcare expenditure, especially among individuals with limited access to specialized care. We present a rare case of dcSSc complicated by pulmonary hypertension and interstitial lung disease, emphasizing the need for screening, early detection, and multidisciplinary treatment, especially among high-risk individuals. The Case: A 53-year-old Caucasian female presented with a six-month history of progressive dyspnea, dysphagia, Raynaud’s phenomenon, and fatigue. She also had proximal interphalangeal joint swelling, unintentional weight loss, and cutaneous changes such as sclerodactyly, calcinosis cutis, and telangiectasias. The skin thickening was diffuse, extending to the trunk, suggesting a diagnosis of diffuse cutaneous systemic sclerosis (dcSSc). Nailfold capillaroscopy revealed dilated capillaries, further supporting the diagnosis of dcSSc. Laboratory findings were significant for positive ANA with centromere patterns with elevated anti-Scl-70 antibodies. Persistent and progressive dyspnea prompted imaging, which revealed mild interstitial lung disease (ILD) on high-resolution CT and pulmonary hypertension (PH) on echocardiogram, with right ventricular hypertrophy. Pulmonary function tests confirmed reduced diffusing capacity (DLCO). This constellation of findings met the ACR/EULAR 2013 criteria for dcSSc with pulmonary involvement. A multidisci…
creator: Kedar Kulkarni
creator: Himanshu Jog
creator: Hemanth D
creator: Pranav Sakaleshpur
rights: Copyright (c) 2025 Kedar Kulkarni https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S274
ending page: S274
doi: 10.5195/ijms.2025.4008

Cat Scratch Disease in a Low-Prevalence Region: A Case Report from Bangladesh
type: item
description: Background: Cat Scratch Disease (CSD), caused by gram-negative bacillus Bartonella henselae, is transmitted through cat scratches or bites, leading to regional lymphadenopathy, fever, and malaise. It is self-limiting but can result in severe complications in immunocompromised patients, including bacillary angiomatosis or encephalitis. In South Asia, including Bangladesh, the prevalence of CSD is not well-understood due to scarce data, and it is often misdiagnosed because of its similarities to other illnesses, such as tuberculosis. Diagnostic tools like fine-needle aspiration cytology (FNAC), serologic tests (IFA and ELISA), and imaging are essential for accurate identification. A study in Bangladesh between 2018 and 2020 revealed that 15.1% of healthy cats carry Bartonella spp., confirming the risk of CSD in the area. This report discusses a previously healthy 38-year-old female with persistent axillary swelling following a recent cat scratch. The Case: A 38-year-old female with no significant past medical history and no prior history of tuberculosis or malignancies presented to the medicine outpatient department (OPD) with complaints of swelling in the left axillary region. The swelling was accompanied by mild pain localized to the left axilla, malaise, and a low-grade fever persisting intermittently for about one week, ranging from 101 to 102°F. Upon history taking, the patient reported an incident of being scratched by a cat on her left wrist and forearm six weeks back. The cat was non vaccinated, and showed features of diminished appetite before and after the scratching episode. Two weeks after the scratch, she began to notice swelling in her left axilla, which progressively increased in size over the next four weeks. The patient denied any complaints of cough, shortness of breath, or weight loss. She reported maintaining a good appetite throughout the illness. Primary care physician made a differential diagnosis of lymphoma and tuberculosis and carried out rel…
creator: Mahnoor Fatima
creator: Forhad Hossain
creator: Karma Sherpa
creator: Ahmed Al Montasir
creator: Md. Zakir Hossain
rights: Copyright (c) 2025 Mahnoor Fatima, Forhad Hossain, Karma Dicky Sherpa, Ahmed Al Montasir, Md. Zakir Hossain https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S275
ending page: S275
doi: 10.5195/ijms.2025.4018

A Diagnostic Gray Zone: Isolated Left Oculomotor Nerve Palsy in the Setting of Hyperhomocysteinemia, Sphenoid Sinusitis, and Rathke’s Cleft Cyst
type: item
description: Rathke’s Cleft Cyst (RCC) is a benign, epithelium-lined cyst arising from remnants of Rathke’s pouch, typically located in the sellar or suprasellar region, and is a documented cause of oculomotor nerve palsy via compressive mechanisms. The sphenoid sinus lies adjacent to the cavernous sinus, through which the oculomotor nerve passes, making inflammatory spread from sphenoidal sinusitis a potential but uncommon cause of cranial nerve involvement. Hyperhomocysteinemia, defined as elevated plasma homocysteine levels, is an established independent risk factor for endothelial dysfunction, prothrombotic states, and small-vessel ischemia, and has been implicated in cranial neuropathies. We report a case involving all three of these factors contributing to isolated oculomotor nerve palsy. A 26-year-old right-handed woman presented with progressive left-eye diplopia for two months, worse on near and right gaze, along with recurrent headaches and blurring of vision in the right eye. She denied trauma, slurred speech, limb weakness, or dysphagia. Neurological examination revealed isolated left oculomotor nerve palsy: restricted adduction, elevation, and depression, with ptosis and pupil sparing. Visual acuity was 5/6 bilaterally; other cranial nerves, motor, and sensory systems were normal. Labs showed elevated homocysteine (83.9 µmol/L) and low vitamin B12 (205 pg/mL). MRI revealed a Rathke’s cleft cyst in the sellar region and left sphenoidal sinusitis. The patient responded well to a short course of corticosteroids, with resolution of diplopia and ptosis. This improvement supports an inflammatory or microvascular ischemic etiology rather than a purely compressive one. Previous studies associate hyperhomocysteinemia with microvascular cranial neuropathies, RCCs with compressive oculomotor palsy, and sphenoidal sinusitis with inflammatory extension to cranial nerves. Our case is unique in presenting all three concurrently, contributing to a diagnostic grey zone. Steroid resp…
creator: S Anton Charles
creator: Shaun Nevil
creator: Umesh G
creator: Sofia Mondal
creator: Chaitra C S
rights: Copyright (c) 2025 Shaun Nevil, Umesh G, S Anton Charles, Sofia Mondal, Chaitra C S https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S276
ending page: S276
doi: 10.5195/ijms.2025.4048

Acute Myeloid Leukemia in A Young Adult: Diagnostic Insights from a Case Report
type: item
description: Background: Acute myeloid leukemia (AML) is a clonal hematopoietic stem cell disorder. It predominantly affects older adults and is characterized by the proliferation of immature myeloid cells and bone marrow failure. Diagnosis can be made using peripheral smear, cytochemistry, immunophenotyping, and cytogenetics, as early recognition is crucial for management and prognosis. The Case: 21 year old male presented with fever, leukocytosis, mild anemia, and 75% of the blasts were medium-to-large size, with an irregular nuclear membrane, finely granular chromatin, nucleoli in peripheral blood smear with the presence of Auer rods, normocytic normochromic RBCs, and reduced platelets. Special stains such as myeloperoxidase (MPO) positivity, Sudan Black stain positivity, Periodic Acid-Schiff (PAS) negativity, and multicolor flow cytometry using CD45 vs. side scatter gating confirmed the diagnosis of Acute Myeloid Leukemia. Moreover, cytogenetic and molecular studies are recommended to improve prognosis and guide targeted therapy. Conclusion: This case demonstrates how a thorough morphological evaluation and specific cytochemical tests can swiftly guide the diagnostic considerations for AML. Multicolor flow cytometry confirms lineage and facilitates the classification necessary for treatment planning. In young adults, where early intervention can significantly impact outcomes, combining traditional and modern diagnostic methods reduces the time to diagnosis and expedites referrals to the hematology/oncology department. This case underscores the ongoing educational and practical importance of peripheral smears and cytochemistry, especially in environments where immediate access to cytogenetic or molecular testing is limited. Table 1. Immunophenotyping showing Myeloid Monocytic Markers Maturation Markers CD34 Bright Positive CD13 Bright Positive CD33 Moderate Positive CD117 Moderate Positive CD64 Dim Positive HLA-DR Dim Positive CD45 Dim Positive
creator: Jainishkumar Morker
creator: Dr. Pinal Shah
creator: Dr. Mubin Patel
creator: Dr. Rahul Modi
creator: Dr. Deepshikha Dave
creator: Dr. Krutika Patel
rights: Copyright (c) 2025 Jainishkumar Morker, Dr. Pinal Shah, Dr. Mubin Patel, Dr. Rahul Modi, Dr. Deepshikha Dave, Dr. Krutika Patel https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S277
ending page: S277
doi: 10.5195/ijms.2025.4062

Guillain–Barré Syndrome in the Setting of Acute Biliary Pancreatitis: A Rare Clinical Association
type: item
description: Guillain–Barré syndrome (GBS) is an acute polyneuropathy often triggered by an antecedent infection. Common etiologies of GBS include C. jejuni, cytomegalovirus, HIV, influenza, and SARS-CoV-2. Antibodies to these infections can cross-react with shared epitopes on peripheral nerves, causing demyelination or axonal loss. Patients with GBS typically present with bilateral ascending flaccid paralysis, distal paraesthesias, and hyporeflexia. Acute pancreatitis is an inflammatory condition of the pancreas, often caused by gallstones. Patients classically present with epigastric pain radiating to the back with nausea and vomiting. Pancreatitis is associated with a wide range of systemic complications. Shock, disseminated intravascular coagulation (DIC), sepsis, acute respiratory distress syndrome (ARDS), and renal failure are extensively described in the literature and commonly encountered in critical care settings. Despite the substantial body of work done on pancreatitis complications, one that remains absent from the literature GBS. The Case: We report the case of a 67-year-old female with ischemic heart disease, hypertension, and megaloblastic anemia. She presented to the ER of local hospital with epigastric pain radiating to the back and multiple episodes of vomiting. Ultrasound revealed a bulky pancreas and gallbladder mucocele. She was diagnosed with acute biliary pancreatitis (BISAP score 4) and admitted to the surgical ward. After developing persistent increased work of breathing, she was shifted to the ICU, where she was intubated. Contrast-enhanced CT abdomen demonstrated pancreatic swelling, peripancreatic fat stranding, inflammatory extension to the transverse colon, and a 4.2 × 2.3 cm hypoperfused area suggestive of early necrosis. Her clinical course was further complicated by the development of ARDS and acute kidney injury requiring hemodialysis. She remained on mechanical ventilation for 8 days. After extubation, it was noted that she was unable to lift h…
creator: Shaehzeen Arshad
creator: Haider Iftikhar
creator: Maidah Ilyas
rights: Copyright (c) 2025 Dr. Shaehzeen Arshad, Dr. Haider Iftikhar, Maidah Ilyas https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S278
ending page: S278
doi: 10.5195/ijms.2025.3896

Diagnostic Challenges in Maxillary Telangiectatic Osteosarcoma: A Rare Case
type: item
description: Histologically, telangiectatic osteosarcoma is defined by blood-filled cystic spaces lined by high-grade malignant cells. This appearance leads to frequent diagnostic confusion with an aneurysmal bone cyst on both imaging and pathological examination. Owing to its infrequency, aggressive behavior, and nonspecific clinical features, this variant poses significant diagnostic difficulties. The Case: A 37-year-old woman presented with a rapidly enlarging right cheek swelling of 1 month's duration. It is associated with fresh blood coming out of the mouth. Later she reported a further increase in the swelling size, eventually impairing eating and speech. There is no history of trauma, systemic diseases, prior malignancies, or previous surgeries apart from dental prosthetic implants. On physical examination, there was a large, firm, right cheek swelling, non-pulsatile, non-compressible, without skin changes. Computed Tomography (CT) scan showed a heterogeneously enhancing mass lesion occupying most of the right maxillary sinus, measuring about 7x5 cm, showing few foci of calcifications compatible with detached teeth, demonstrating aggressive features such as adjacent bone erosions and destruction of the alveolar maxillary ridge inferiorly and maxillary sinus wall posteriorly. In addition to exerting mass effect upon masticator muscles, it also has medial extension into the nasal and oral cavities, displacing the tongue into the contralateral side, causing airway narrowing. The patient was assessed by the maxillo-facial surgeons, who recommended tracheostomy to secure the airways. An initial biopsy result revealed an inconclusive, poorly differentiated malignant neoplasm, given the aggressive clinical course and inconclusive results; repeat histopathological examination and immunohistochemistry was done and revealed a highly cellular malignant neoplasm predominantly composed of atypical spindle cells, with prominent vascularity and scattered areas of lace-like osteoid matr…
creator: Malak R. Hroub
creator: Mohanad Abuzahra
creator: Alhareth M. Amro
creator: Mohammed A. Barakat
creator: Maha Ramzi
creator: Basheer Babaa
creator: Mohannad Abulihya
creator: Abdallah Altell
rights: Copyright (c) 2025 Malak R. Hroub, Mohanad Abuzahra, Alhareth M. Amro, Mohammed A. Barakat, Maha Ramzi, Basheer Babaa https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S279
ending page: S279
doi: 10.5195/ijms.2025.3966

Surviving The Odds: A Rare Case of Untreated Transposition Of The Great Arteries In Adulthood With Neurological Manifestations
type: item
description: Background: Dextro- transposition of the great arteries (dTGA) is a very rare congenital cardiac anomaly with an incidence of 0.02-0.05% that usually results in 90% infantile mortality, without surgical correction. Simultaneous interposition with other anomalies like atrial septal defect (ASD), ventricular septal defect (VSD), can enable survival beyond infancy, in some instances. However, long-term survival into adulthood remains exceptionally uncommon, especially when complicated with brain abscess- a known but serious complication of cyanotic CHD. The Case: We present a case of Cyanotic congenital heart disease with d-TGA, VSD, ASD, dextro-cardia, complicated by a cerebral abscess. A 28-year-old male presented with two episodes of focal seizures and one episode of loss of consciousness. The patient was previously diagnosed with cyanotic congenital heart disease at age 7 months, but chose not to opt for surgical intervention as there was no delay in developmental & intellectual milestones. Since then, he had multiple episodes of deepening of cyanosis with palpitations & giddiness, which were subsequently managed by blood letting & incomplete staged surgery. Upon arrival at our hospital, he developed weakness over left-half of his body, which resolved spontaneously. On examination he was conscious and oriented. He also had, prominent bilateral EJV with central cyanosis and Grade 2 clubbing. CVS examination revealed Grade III mid-systolic murmur all over the precordium and apex beat at right sixth intercostal space along mid-clavicular line. CNS examination revealed no focal neurological deficit. All other systems were unremarkable. Echocardiography and cardiac catheterization confirmed: Situs solitus with dextrocardia Large ASD and VSD with common atrium Pulmonary artery & aorta arising parallelly (dTGA) Severe valvular and infundibular pulmonary stenosis (PS) Hypoplastic right ventricle and normal left ventricular function MRI brain revealed a right parietal lobe …
creator: Sristi Chakraborty
creator: Monika P Jawanjal
rights: Copyright (c) 2025 Sristi Chakraborty, Monika P Jawanjal https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S280
ending page: S280
doi: 10.5195/ijms.2025.4022

Giant Left Diaphragmatic Hernia Complicated With Intrathoracic Gastric Volvulus and Total Gastric Necrosis: An Uncommon Case Report
type: item
description: Background: Diaphragmatic hernia in adults is an uncommon but potentially fatal condition. Diagnosis is often delayed because of nonspecific symptoms, predisposing patients to severe complications. Among these, intrathoracic gastric volvulus with necrosis is one of the most catastrophic, carrying a high risk of septic shock, multiorgan failure, and postoperative mortality exceeding 30–50% in critical settings. This case is notable for the size of the hernia, the extent of gastric necrosis, and the complexity of reconstruction required, while also underscoring the need for access to specialized critical care. The Case: A 66-year-old male with cirrhosis, hypertension, and diabetes presented in extremis with severe abdominal pain, distension, and acute dyspnea progressing to refractory shock. He required mechanical ventilation and vasopressor support. Examination revealed abdominal distension, tracheal deviation, and absent left breath sounds. Chest radiography showed a massively distended stomach in the left hemithorax, with mediastinal shift and contralateral lung collapse. Emergency laparotomy demonstrated a 10 × 5 cm diaphragmatic defect containing a volvulated stomach with complete necrosis. Procedures included adhesiolysis, hernia reduction, diaphragmatic repair, total gastrectomy, and Roux-en-Y reconstruction with esophagojejunal and jejunojejunal anastomoses. A left chest tube and drains were placed. The surgery lasted nine hours with blood loss of 1500 mL. Postoperatively, the patient remained critically ill with hypovolemic and septic shock requiring dual vasopressors and ventilatory support. Conclusion: Giant diaphragmatic hernia with intrathoracic gastric volvulus and total gastric necrosis is an exceptional, life-threatening condition. Successful management requires rapid diagnosis, immediate surgical intervention, multidisciplinary collaboration, and advanced critical care infrastructure.
creator: Sofia Rubiralta Adame
creator: Martin Rodriguez Alvarado
creator: Mariana Fraga Duarte
creator: Jack Abadi Chiriti
creator: Jair Ariel Nava Vazquez
creator: Emanuel Osmar Diaz Vega
rights: Copyright (c) 2025 Sofia Rubiralta Adame, Martin Rodriguez Alvarado, Mariana Fraga Duarte, Jack Abadi Chiriti, Jair Ariel Nava Vazquez, Emanuel Osmar Diaz Vega https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S281
ending page: S281
doi: 10.5195/ijms.2025.4031

The Hidden Rhythm: A Rare Case of Isoarrhythmic Sick Sinus Syndrome Defying Chronotropic Expectations
type: item
description: Background: Isoarrhythmic sick sinus syndrome (SSS) is a rare and often under-recognized variant of sinus node dysfunction, where the sinus and junctional rates are nearly identical, masquerading as a normal rhythm. Typically, SSS is associated with chronotropic incompetence (the inability of the heart to appropriately increase its rate during exertion), leading to symptoms such as fatigue, syncope, or exercise intolerance. It remains a common indication for permanent pacemaker implantation. However, cases demonstrating preserved chronotropic response are extremely uncommon, and recognizing these can directly influence management strategies. The Case: We present a 72-year-old male with longstanding hypertension and chronic tobacco use, who presented with progressive dyspnea over one month, bilateral leg swelling, palpitations, and productive cough. On examination, he was in sinus bradycardia (57 bpm), hypertensive (200/100 mmHg), and had signs of fluid overload. Initial ECG suggested second-degree AV block; however, careful analysis revealed junctional rhythm with intermittent sinus capture, consistent with isoarrhythmic AV dissociation, confirming SSS. A 24-hour Holter monitor demonstrated a maximum sinus pause of 1.8 seconds, confirming sinus node dysfunction. To evaluate SA node function under physiological stress, a treadmill exercise test using the Bruce protocol was performed. Surprisingly, the patient exhibited a robust chronotropic response, with heart rate rising from 52 bpm to 133 bpm, without ischaemic changes or arrhythmias. Management focused on controlling hypertensive emergency with intravenous antihypertensives and alleviating heart failure symptoms with diuretics. Given the preserved chronotropic competence, absence of syncope, and no severe bradycardia, permanent pacemaker implantation was deemed unnecessary. The patient was discharged in stable condition with close cardiology follow-up. Conclusion: This case highlights isoarrhythmic SSS as a subtl…
creator: Tooba Fatima Iram
creator: Haroon Abdullah Shaheed
creator: Yusra Fatima Anam
creator: Rahul Kumar Agarwal
creator: Naazira Begum
rights: Copyright (c) 2025 Tooba Fatima Iram, Haroon Abdullah Shaheed, Yusra Fatima Anam, Rahul Kumar Agarwal, Naazira Begum https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S282
ending page: S282
doi: 10.5195/ijms.2025.4045

When RASopathies Collide: A Case Highlighting the Continuum between Noonan and LEOPARD Syndromes
type: item
description: LEOPARD syndrome and Noonan syndrome are clinically overlapping RASopathies, both frequently associated with pathogenic variants in the PTPN11 gene, which encodes the SHP-2 tyrosine phosphatase. Typically, Noonan syndrome arises from gain-of-function variants, while LEOPARD syndrome results from loss-of-function alterations, most often distinguished by the presence of lentigines and cardiac anomalies. We report a diagnostically challenging case of a 17-year-old male who presented with behavioural disturbances, seizure disorder, visual and auditory hallucinations, and history of right orchidectomy and left-eye cataract. Physical examination revealed hypertelorism, low-set ears, high-arched palate, and dental overcrowding, but notably lacked lentigines or cardiac findings. Genetic analysis identified a heterozygous PTPN11 variant, p.Phe285Ser in exon 8, previously described in both LEOPARD syndrome 1 and Noonan syndrome 1. Ancillary investigations confirmed seizure activity on EEG but showed no abnormalities on ECG or MRI. This case highlights the diagnostic ambiguity inherent to RASopathies, where identical PTPN11 variants may underlie divergent phenotypes. The absence of cutaneous and cardiac manifestations traditionally considered pathognomonic for LEOPARD syndrome underscores the limitations of relying solely on phenotype for classification. Instead, this case supports a genotype-first diagnostic framework, where molecular findings refine and sometimes challenge clinical labels. Recognition of such overlap is critical for genetic counselling, prognostic assessment, and surveillance planning, as patients may deviate from usually documented syndrome descriptions. Our report adds to the growing body of evidence that PTPN11 p.Phe285Ser represents a mutational hotspot bridging Noonan and LEOPARD syndromes, reinforcing the continuum model of RASopathies.
creator: Umesh G
creator: Sofia Mondal
creator: Shaun Nevil
creator: S Anton Charles
creator: Mansi Kumarswamy
rights: Copyright (c) 2025 Umesh G, Sofia Mondal, Shaun Nevil, S Anton Charles, Mansi Kumarswamy https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S283
ending page: S283
doi: 10.5195/ijms.2025.4056

Management Challenges Encountered in a Borderline Personality Disorder with Multiple Somatic Diagnosis: A Case Report
type: item
description: Background: Borderline personality disorder (BPD) is a complex psychiatric condition characterized by pervasive instability in affect regulation, impulse control, interpersonal relationships, and self-image. Patients often present with comorbidities such as mood disorders, substance use, or somatic illnesses, which complicate diagnosis and treatment. The Case: We present the case of a 26-year-old female with a history of major depression, known with borderline personality disorder, and multiple prior suicide attempts. The aim of this case report is to underline the therapeutic challenges in managing severe psychiatric illness in the context of complex somatic comorbidities. Psychiatric evaluation of the patient revealed depressive symptomatology with anhedonia, suicidal ideation, fatigability and social withdrawal. Somatically, the patient had a recent diagnosis of Child-Pugh A liver cirrhosis, ulcerative colitis, and primary sclerosing cholangitis, requiring careful therapeutic adjustments. The extent of hepatic damage suggested the potential need for future liver transplantation. Pharmacological management included antidepressants, antipsychotics, and benzodiazepines. Conclusion: This case underscores the ethical and clinical challenges of considering liver transplantation in a patient with a personality disorder. Although prior suicide attempts complicate prognostic assessment, the patient remained adherent to both pharmacological treatment and medical rehabilitation, underscoring that psychiatric illness alone should not preclude access to life-saving interventions, which must be considered through individualized, multidisciplinary evaluation.
creator: Alexandra Zirbo
creator: Maria Palfi
creator: Cristina Maria Simian
creator: Bianca Crecan-Suciu
rights: Copyright (c) 2025 Alexandra Zirbo, Maria Palfi, Cristina Maria Simian, Bianca Crecan-Suciu https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S284
ending page: S284
doi: 10.5195/ijms.2025.4086

Atypical presentation of a hypopharyngeal leiomyoma: Case Report
type: item
description: Leiomyomas are benign tumors of smooth muscle origin, most frequently located in the uterus and gastrointestinal tract. Their presence in the hypopharynx is extremely rare due to the limited amount of smooth muscle in this region, and clinical manifestations are often nonspecific, including dysphagia, globus sensation, and pharyngeal discomfort, which may mimic malignant disease. We report the case of a 63-year-old male with a history of gastroesophageal reflux disease (GERD) and Barrett’s esophagus who presented with a one-year history of dyspepsia, globus sensation, and progressive dysphagia. Endoscopic evaluation revealed a small lesion on the posterior hypopharyngeal wall, further confirmed by contrast-enhanced computed tomography as a 7 × 6 × 4 mm homogeneous, hypervascular, pedunculated mass without cervical lymphadenopathy. The patient underwent endoscopic cold-cut resection, which led to complete symptom resolution. Histopathological analysis demonstrated a well-circumscribed neoplasm composed of spindle-shaped cells arranged in fascicles, with no atypia, necrosis, or abnormal mitoses. Immunohistochemistry revealed diffuse positivity for smooth muscle actin, confirming the diagnosis of hypopharyngeal leiomyoma. The postoperative course was uneventful, with continued GERD management. This case illustrates an exceptionally rare benign tumor of the hypopharynx, emphasizing the importance of including such entities in the differential diagnosis of patients with nonspecific pharyngeal symptoms. Accurate diagnosis requires thorough endoscopic and radiological evaluation combined with histopathological confirmation. Complete surgical excision remains curative, providing excellent prognosis with minimal risk of recurrence. This report contributes to the limited literature on hypopharyngeal leiomyomas and highlights the value of a multidisciplinary approach in their management.
creator: Jair Ariel Nava Vazquez
creator: Martin Rodriguez Alvarado
creator: Alessandro Nava Torres
creator: David Rui-Jing Guo
creator: Neil Parikh
creator: Ramon Adrian Magaña Davalos
rights: Copyright (c) 2025 Jair Ariel Nava Vazquez, Martin Rodriguez Alvarado, Alessandro Nava Torres, David Rui-Jing Guo , Neil Parikh, Ramon Adrian Magaña Davalos https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S285
ending page: S285
doi: 10.5195/ijms.2025.4094

When Bone Forms in the Endometrium: A Case of Osseous Metaplasia Presenting with Chronic Pelvic Pain and Abnormal Uterine Bleeding
type: item
description: Background: Endometrial osseous metaplasia is a rare condition characterized by the transformation of endometrial stromal cells into osteoblast-like cells. Its etiology remains uncertain, but proposed risk factors include a history of abortion and chronic intrauterine inflammation. This condition is clinically relevant because it can cause infertility, abnormal uterine bleeding, and pelvic pain, particularly in young women. Early recognition and management are crucial to avoid long-term sequelae. Case: A 20-year-old woman with past medical history of spontaneous abortion six months ago, presented with pelvic pain and abnormal uterine bleeding. Transvaginal ultrasonography revealed echogenic structures suggestive of intrauterine calcifications. Hysteroscopy confirmed the presence of osseous tissue within the endometrial cavity, which was completely resected. Histopathology confirmed the diagnosis of endometrial osseous metaplasia. The postoperative course was uneventful, and symptoms resolved following treatment. Conclusion: Endometrial osseous metaplasia, though rare, should be considered in young women with recent abortions presenting with abnormal uterine bleeding, pelvic pain, or infertility. Ultrasonography serves as a valuable initial diagnostic tool, while hysteroscopy remains the gold standard for both diagnosis and treatment. This case highlights the importance of clinical awareness to ensure timely recognition and management of this uncommon entity.
creator: Camila Brito-Balanzategui
creator: Wilson Sebastian Peñafiel-Pallares
creator: Oscar Venegas-Baca
rights: Copyright (c) 2025 Camila Brito-Balanzategui, Wilson Sebastian Peñafiel-Pallares, Oscar Venegas-Baca https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S286
ending page: S286
doi: 10.5195/ijms.2025.3907

Early Detection of alpha-synuclein deposition within Two Years Diagnosis of REM Sleep Behavior Disorder and Consequential Prevention of Parkinson’s
type: item
description: Background: Early diagnosis of REM sleep behavior disorder (RBD) offers a valuable prognostic indicator for individuals at risk of neurodegeneration through their progression into Parkinson's disease. The prognosis of RBD in relation to worsening symptoms can be determined using epidermal nerve punch biopsies and immunohistochemistry to assess the degree of alpha-synuclein aggregation. The Case: A 72-year-old white woman with a two-year history of REM sleep behavior disorder (RBD) is present with the neurologist for a follow-up appointment for evaluation of Parkinson’s disease. She was diagnosed with RBD through an evaluation in the ER for her injured hip from falling out of bed after acting out her dreams. She has a familial connection to Parkinson’s disease through her sister. She has been educated on RBD and its correlation to the risk of Parkinson’s disease. Being educated on upcoming research to prevent progression of synucleinopathy, she agreed to be a part of this study; therefore, we decided to obtain epidermal nerve biopsies to look for possible alpha-synuclein proteins. The posterior cervical epidermal nerve biopsy was found to be positive for alpha-synuclein proteins. The patient is told of the prognosis, that research suggests she could present with PD symptoms with dysautonomia a decade from now. Clonazepam is effectively managing her RBD symptoms; however, she is aware of research being conducted for preventing synucleinopathy progression. Conclusion: Investigating the underlying causes of Parkinson’s disease is essential for both advancing preventive strategies and providing patients with clearer expectations regarding disease progression. Epidermal nerve biopsies have been found to have a high sensitivity rate of detecting the relationship between Parkinson’s disease and RBD. Progression of synucleinopathy is suggested to cause neurodegeneration in those with RBD who later progress to PD.
creator: Hiba Khan
rights: Copyright (c) 2025 Hiba Khan https://creativecommons.org/licenses/by/4.0
license: https://creativecommons.org/licenses/by/4.0
date: 2025-12-31
publication date: 2025-12-31
starting page: S287
ending page: S287
doi: 10.5195/ijms.2025.3830