International Journal of Medical Advances and Discoveries

International Journal of Medical Advances and Discoveries | Vol. 16, No. 9, September 2025 | pp. 60–67

DOI: 10.46882/2025/IJMAD/000108

Original Research Article

Title: A Multicenter Evaluation of High-Sensitivity Troponin I Decision Thresholds for Accelerating Myocardial Infarction Rule-Out Protocols

Names of Authors: Patricia K. Thorne¹, Mateo Fernandes², Oliver Vance³

Authors’ Affiliations: ¹Emergency Medicine Clinical Trials Consortium, University of Edinburgh, Edinburgh, UK; ²Department of Cardiology, Hospital de Clínicas, São Paulo, Brazil; ³Division of Emergency Medicine, Monash University, Melbourne, Australia

Abstract: Early diagnostic safety for patients presenting to the emergency department (ED) with suspected acute myocardial infarction (AMI) is a vital metric for preventing hospital overcrowding. High-sensitivity cardiac troponin I (hs-cTnI) assays permit rapid evaluation, but consensus on optimal rapid rule-out cutoffs varies across clinical settings. This prospective, observational validation study assessed the safety and efficacy of a 0/1-hour rapid rule-out protocol using a novel hs-cTnI decision threshold (<3 ng/L) in 1850 consecutive patients presenting with acute chest pain. The primary safety endpoint was a missed index AMI or a major adverse cardiac event (MACE) within 30 days. At presentation, 42.1% of patients (n = 779) were eligible for immediate rule-out based on a baseline hs-cTnI <3 ng/L and a non-ischemic electrocardiogram. An additional 18.4% (n = 340) were ruled out after a 1-hour delta change of <2 ng/L. The combined 0/1-hour protocol achieved a diagnostic sensitivity of 99.6% (95% Confidence Interval [98.9%, 99.9%]) and a negative predictive value (NPV) of 99.8% (95% CI [99.4%, 100%]) for AMI. The 30-day MACE rate among ruled-out patients was exceptionally low at 0.16%. Implementation of this protocol effectively reduced the median ED length of stay by 78 minutes compared to traditional 0/3-hour diagnostic protocols (p < 0.001).

Keywords: High-sensitivity troponin, Myocardial infarction, Emergency department, Rule-out protocol, Chest pain, Diagnostic safety

Manuscript Timeline: Received: June 15, 2025; Revised: July 28, 2025; Accepted: August 14, 2025; Published: September 19, 2025

Citation: Thorne, K. P., Fernandes, M., & Vance, O. (2025). A Multicenter Evaluation of High-Sensitivity Troponin I Decision Thresholds for Accelerating Myocardial Infarction Rule-Out Protocols. International Journal of Medical Advances and Discoveries, 16(9), 60–67. doi.org

International Journal of Medical Advances and Discoveries | Vol. 16, No. 10, October 2025 | pp. 68–76

DOI: 10.46882/2025/IJMAD/000109

Original Research Article

Title: Neuroprotective Effects of Intranasally Delivered Exosomes Doped with Curcumin in a Murine Model of Alzheimer’s Disease

Names of Authors: Yukihiro Tanaka¹, Alia M. Al-Shami², Richard P. Gallagher¹

Authors’ Affiliations: ¹Department of Neurosciences, Kyoto University Graduate School of Medicine, Kyoto, Japan; ²Department of Pharmaceutics, American University of Beirut, Beirut, Lebanon

Abstract: Efficient drug delivery across the blood-brain barrier (BBB) presents a critical hurdle in therapeutic drug development for Alzheimer’s disease (AD). This study investigated the neuroprotective, anti-inflammatory, and amyloid-clearing capabilities of mesenchymal stem cell-derived exosomes engineered to encapsulate curcumin (Exo-Cur) administered via a non-invasive intranasal pathway. Transgenic APP/PS1 mice (age: 6 months, n = 80) were treated intranasally with Exo-Cur (5 mg/kg), free curcumin, empty exosomes, or a vehicle control daily for 8 consecutive weeks. Spatial learning and memory evaluations via the Morris Water Maze demonstrated that Exo-Cur treated mice had significantly shorter escape latencies (22.4 ± 3.1 seconds) compared to the free curcumin (41.2 ± 4.5 seconds) and vehicle cohorts (55.8 ± 5.2 seconds; p < 0.001). Immunohistochemical analysis revealed a 48% reduction in cortical and hippocampal beta-amyloid (A-beta) plaque burden within the Exo-Cur group (p < 0.001). Enzyme-linked immunosorbent assays (ELISA) demonstrated a profound attenuation of pro-inflammatory cytokines, specifically IL-1-beta (-56%) and TNF-alpha (-62%), alongside a marked reduction in microglial activation (Iba1 immunoreactivity, p = 0.002). Western blot tracking confirmed the up-regulation of brain-derived neurotrophic factor (BDNF) and postsynaptic density protein-95 (PSD-95) in treated brain tissues. Intranasal delivery of Exo-Cur effectively bypasses the BBB, producing substantial anti-amyloid and anti-inflammatory neuroprotective benefits in AD models.

Keywords: Exosomes, Curcumin, Alzheimer’s disease, Blood-brain barrier, Intranasal delivery, Neuroinflammation

Manuscript Timeline: Received: July 11, 2025; Revised: August 20, 2025; Accepted: September 10, 2025; Published: October 24, 2025

Citation: Tanaka, Y., Al-Shami, M. A., & Gallagher, P. R. (2025). Neuroprotective Effects of Intranasally Delivered Exosomes Doped with Curcumin in a Murine Model of Alzheimer’s Disease. International Journal of Medical Advances and Discoveries, 16(10), 68–76. doi.org

International Journal of Medical Advances and Discoveries | Vol. 16, No. 12, December 2025 | pp. 86–94

DOI: 10.46882/2025/IJMAD/000111

Original Research Article

Title: Long-Term Neurodevelopmental Outcomes of Preterm Infants Managed with Early Prophylactic Hydrocortisone Infusion

Names of Authors: Mariam O. Bello¹, William J. Sterling², Chidi E. Okafor¹

Authors’ Affiliations: ¹Department of Pediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria; ²Division of Neonatal-Perinatal Medicine, Boston Children's Hospital, Boston, USA

Abstract: Bronchopulmonary dysplasia (BPD) is a critical driver of mortality in extremely preterm infants. While systemic corticosteroids effectively decrease BPD incidence, widespread clinical concern persists regarding adverse neurodevelopmental outcomes, particularly cerebral palsy. This multi-center prospective cohort study investigated the 24-month corrected age neurodevelopmental outcomes of extremely low birth weight (ELBW) infants (birth weight <1000 g, gestational age <28 weeks; n = 210) who received early low-dose prophylactic hydrocortisone (0.5 mg/kg twice daily for 12 days) compared to an untreated matched control cohort. The primary outcome was neurodevelopmental impairment (NDI), defined via the Cognitive, Language, and Motor composite scores of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). At 24 months of corrected age, no significant differences in mean cognitive composite scores (94.2 ± 11.5 vs. 93.8 ± 12.1, p = 0.81) or motor composite scores (91.6 ± 10.8 vs. 92.1 ± 11.3, p = 0.74) were observed between the hydrocortisone and control cohorts. The overall incidence of cerebral palsy remained statistically identical between groups (4.8% vs. 5.7%, p = 0.76). Conversely, the hydrocortisone-treated infants demonstrated a significant reduction in BPD severity and post-discharge oxygen supplementation needs (p = 0.01). Early prophylactic hydrocortisone administration in ELBW infants provides valuable pulmonary protection without increasing the long-term risk of neurodevelopmental impairment at two years of corrected age.

Keywords: Preterm infants, Hydrocortisone prophylaxis, Neurodevelopmental outcome, Bronchopulmonary dysplasia, Cerebral palsy, Bayley scales

Manuscript Timeline: Received: September 05, 2025; Revised: October 18, 2025; Accepted: November 11, 2025; Published: December 16, 2025

Citation: Bello, M. O., Sterling, J. W., & Okafor, C. E. (2025). Long-Term Neurodevelopmental Outcomes of Preterm Infants Managed with Early Prophylactic Hydrocortisone Infusion. International Journal of Medical Advances and Discoveries, 16(12), 86–94. doi.org

International Journal of Medical Advances and Discoveries ISSN 2756-3812 Vol. 16 (1), pp. 001-004, January, 2025. Available online at www.internationalscholarsjournals.org © International Scholars Journals

Full Length Research Paper

Prevalence of Glucose-6-Phosphate Dehydrogenase Deficiency Among Blood Donors and Jaundiced Newborns in Osogbo, Nigeria

E.    O. Akanni¹*, B. S. A. Oseni1, V. O. Agbona¹, B. A. Tijani², E. Tosan³, E. E. Fakunle⁴ and V. O. Mabayoje⁴

¹Department of Biomedical Science, College of Health Sciences, Ladoke Akintola University of Technology, P. M. B
4400, (OS 230001), Osogbo, Osun State, Nigeria.
²Department of Haematology and Blood Transfusion, Ladoke Akintola University of Technology Teaching Hospital,
P. M. B. 5000, (OS 230001) Osogbo, Osun State, Nigeria.
³Medical Laboratory Science Council of Nigeria, 8 Harvey Road, Yaba, Lagos, Lagos State, Nigeria.
⁴Department of Haematology and Blood Transfusion, Ladoke Akintola University of Technology College of Health Sciences, P. M. B. 4400, (OS 230001) Osogbo, Osun State, Nigeria.

Accepted 11 November, 2024

Abstract

A study on the prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency in blood donors and in jaundiced neonates was carried out. 286 subjects consisting of 200 blood donors and 86 jaundiced neonates were screened for G6PD. Presence of G6PD and bilirubin levels (total and conjugated) were determined in all the subjects. G6PD was determined using two standard methods; methaemoglobin reduction test and fluorescent spots test. Total and conjugated bilirubin levels were also determined in neonates using Jendrassik and Groff method. Out of the 200 blood donors tested for G6PD, 39 (19.5%) were G6PD deficient and 41 (47.7%) out of 86 jaundiced neonates were G6PD deficient. There is a close association between the two methods used for determining G6PD in blood donors and jaundiced neonates as there was no significance difference “P < 0.05” between the results obtained from the two methods. With G6PD deficiency prevalence rate of 19.5% (39) in the blood donors, and the attendant reduced life span of red blood cells, this study therefore reveals the necessity of including G6PD testing in the blood donors screening criteria in the study area. Glucose-6-phosphate deficiency is also revealed as a major cause of haemolytic episode in neonates in the area.

Key words: G6PD deficiency, prevalence, jaundiced neonates, blood donors.
 

International Journal of Medical Advances and Discoveries | Vol. 16, No. 11, November 2025 | pp. 77–85

DOI: 10.46882/2025/IJMAD/000110

Original Research Article

Title: Comparative Efficacy and Safety of Direct Oral Anticoagulants Versus Low-Molecular-Weight Heparin in Cancer-Associated Thrombosis

Names of Authors: Helena S. Vance¹, Klaus M. Brand², Jonathan R. Cross¹

Authors’ Affiliations: ¹Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; ²Department of Internal Medicine, Ludwig-Maximilians-Universität, Munich, Germany

Abstract: Cancer-associated thrombosis (CAT) increases the risk of mortality and recurrent venous thromboembolism (VTE). Low-molecular-weight heparin (LMWH) has long served as standard first-line management, but direct oral anticoagulants (DOACs) offer an attractive oral option. This multi-center, open-label, randomized non-inferiority trial evaluated the clinical outcomes of a next-generation DOAC, apixaban, compared to dalteparin (LMWH) over a 6-month treatment phase in 540 cancer patients presenting with acute symptomatic or incidental VTE. The primary efficacy endpoint was recurrent VTE, while safety endpoints measured major bleeding and clinically relevant non-major bleeding (CRNMB). Recurrent VTE occurred in 3.7% (10 of 270) of patients in the apixaban arm compared to 6.3% (17 of 270) in the dalteparin arm, satisfying the non-inferiority criteria (Hazard Ratio = 0.58, 95% Confidence Interval [0.31, 1.07], p < 0.001 for non-inferiority). Major bleeding events were comparable between groups, occurring in 2.2% of the apixaban cohort and 2.6% of the dalteparin cohort (p = 0.78). However, CRNMB rates were slightly higher in the apixaban treatment arm (6.7% vs 4.1%, p = 0.12), predominantly localized within patients presenting with unresected gastrointestinal malignancies. Patient-reported treatment satisfaction scales were significantly higher for oral apixaban (p < 0.001). Apixaban is an effective and safe oral alternative to dalteparin for CAT treatment.

Keywords: Cancer-associated thrombosis, Venous thromboembolism, Direct oral anticoagulants, Apixaban, Dalteparin, Major bleeding

Manuscript Timeline: Received: August 18, 2025; Revised: September 29, 2025; Accepted: October 15, 2025; Published: November 20, 2025

Citation: Vance, S. H., Brand, M. K., & Cross, R. J. (2025). Comparative Efficacy and Safety of Direct Oral Anticoagulants Versus Low-Molecular-Weight Heparin in Cancer-Associated Thrombosis. International Journal of Medical Advances and Discoveries, 16(11), 77–85. doi.org