International Journal of Medical Advances and Discoveries

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

International Scholars Journal of Medical Advances and Discoveries | Vol. 16, No. 2, February 2025 | pp. 1–8

DOI: 10.46882/2025/IJMAD/000101

Original Research Article

Title: Evaluation of Myocardial Infarction Outcomes Using High-Sensitivity Troponin T Thresholds in Emergency Settings

Names of Authors: A. B. Mensah¹, C. D. Okoye², E. F. Smith³

Authors’ Affiliations: ¹Department of Cardiology, University Teaching Hospital, Lagos, Nigeria; ²Department of Emergency Medicine, National Medical Center, Abuja, Nigeria; ³Biostatistics Unit, Global Health Research Institute, London, UK

Abstract: The rapid evaluation of acute chest pain remains a central challenge in emergency cardiovascular care. This prospective multi-center study assessed the diagnostic performance and prognostic utility of optimized high-sensitivity troponin T (hs-TnT) thresholds in triaging patients presenting with suspected acute myocardial infarction. Over a twelve-month surveillance period, clinical data and serial blood samples were collected from 1,240 adult participants within a mean time of 1.5 h from admission. Patients were categorized using a baseline cutoff of 14 ng/L versus an accelerated 0/1-hour algorithm incorporating a delta change of > 5 ng/L. Results demonstrated that the accelerated protocol achieved a diagnostic sensitivity of 96.4% (95% CI, 94.2% - 98.1%) and a negative predictive value of 99.1%, effectively ruling out non-ST-elevation myocardial infarction earlier than standard 3-hour testing. Mean length of stay in the emergency department decreased by 2.4 ± 0.8 h (P < 0.001) without any elevation in 30-day major adverse cardiac events among early discharges. Subgroup analysis revealed consistent efficacy across diverse demographic profiles, though specificity was moderately lower in patients with chronic renal impairment (eGFR < 60 mL/min/1.73 m²). Cost-utility estimation further indicated a 15% reduction in overall inpatient bed utilization costs per episode. These findings support the widespread adoption of accelerated hs-TnT protocols to streamline acute coronary syndrome management pathways, reduce overcrowding in emergency departments, and maintain high safety margins for early patient disposition in resource-limited or high-volume clinical environments.

Keywords: Acute coronary syndrome; High-sensitivity troponin T; Emergency triage; Diagnostic accuracy; Myocardial infarction

Manuscript Timeline: Received: 12 October 2024; Revised: 04 January 2025; Accepted: 18 January 2025; Published: 05 February 2025

Citation: Mensah, A. B., Okoye, C. D., & Smith, E. F. (2025). Evaluation of Myocardial Infarction Outcomes Using High-Sensitivity Troponin T Thresholds in Emergency Settings. International Journal of Medical Advances and Discoveries, 16(2), 1–8.

International Scholars Journal of Medical Advances and Discoveries | Vol. 16, No. 8, August 2025 | pp. 49–56

DOI: 10.46882/2025/IJMAD/000107

Original Research Article

Title: Diagnostic Accuracy of Artificial Intelligence Algorithms in Detecting Early Diabetic Retinopathy from Fundus Photographs

Names of Authors: C. D. Garcia¹, D. E. Martinez², E. F. Kalu³

Authors’ Affiliations: ¹Department of Ophthalmology, San Jose Medical Center, Manila, Philippines; ²Department of Data Science, National Autonomous University, Mexico City, Mexico; ³Ophthalmology Unit, Lagos State University, Lagos, Nigeria

Abstract: Diabetic retinopathy (DR) is a leading cause of preventable blindness globally, yet screening programs are frequently hindered by a shortage of trained ophthalmologists. This diagnostic validation study assessed the performance of a deep convolutional neural network (CNN) in detecting referable DR (moderate non-proliferative DR or worse) and diabetic macular edema from un-mydriatic digital fundus photographs. A retrospective dataset of 12,500 retinal images obtained from diverse primary care screening sites was analyzed by the algorithm and benchmarked against a consensus reference standard established by three senior retinal specialists. The CNN achieved an overall sensitivity of 94.8% (95% CI, 93.1% - 96.2%) and a specificity of 91.5% (95% CI, 89.8% - 93.0%) for referable DR. Area under the receiver operating characteristic curve (AUC-ROC) reached 0.978. Processing time averaged 2.4 seconds per image. Subgroup analysis showed robust performance even in low-illumination or partially degraded image qualities, with sensitivity dropping by only 3.2% for images graded as suboptimal by human operators. Integration of this AI screening tool in community health centers demonstrated a 40% increase in throughput and earlier referral for sight-saving laser photocoagulation. These findings substantiate the clinical viability of automated deep learning systems as frontline triage mechanisms to expand screening coverage and prevent irreversible visual loss in high-risk diabetic populations.

Keywords: Artificial intelligence; Diabetic retinopathy; Deep learning; Fundus photography; Screening triage

Manuscript Timeline: Received: 10 April 2025; Revised: 05 July 2025; Accepted: 22 July 2025; Published: 05 August 2025

Citation: Garcia, C. D., Martinez, D. E., & Kalu, E. F. (2025). Diagnostic Accuracy of Artificial Intelligence Algorithms in Detecting Early Diabetic Retinopathy from Fundus Photographs. International Journal of Medical Advances and Discoveries, 16(8), 49–56.

International Scholars Journal of Medical Advances and Discoveries | Vol. 16, No. 5, May 2025 | pp. 25–32

DOI: 10.46882/2025/IJMAD/000104

Original Research Article

Title: Impact of Continuous Glucose Monitoring on Glycemic Variability and Hypoglycemia in Type 1 Diabetes Mellitus

Names of Authors: O. P. Chen¹, Q. R. Johansson², S. T. Weber³

Authors’ Affiliations: ¹Department of Internal Medicine, Pacific Health Center, Vancouver, Canada; ²Department of Endocrinology, Karolinska Institute, Stockholm, Sweden; ³Center for Digital Health Diagnostics, Berlin, Germany

Abstract: Glycemic variability and unpredictable nocturnal hypoglycemia remain persistent clinical hurdles in the optimization of type 1 diabetes mellitus (T1DM) management. This open-label randomized controlled trial investigated the longitudinal impact of real-time continuous glucose monitoring (rt-CGM) versus conventional self-monitoring of blood glucose (SMBG) utilizing capillary blood tests at least 4 times daily. A total of 210 adult subjects with baseline HbA1c levels between 8.0% and 10.5% were monitored over 6 months. Primary endpoints included changes in time-in-range (TIR, defined as 3.9 - 10.0 mmol/L) and time-below-range (TBR < 3.9 mmol/L). The rt-CGM cohort demonstrated an absolute increase in TIR of 18.5% (corresponding to an increase of 4.4 h/day, P < 0.001) alongside a significant contraction in TBR from a baseline median of 6.2% to 1.8% of readings. Mean HbA1c in the CGM group dropped by 0.9 ± 0.3%, whereas the SMBG control arm experienced a reduction of only 0.3 ± 0.2%. Furthermore, episodes of severe nocturnal hypoglycemia requiring external assistance declined by 74% in the intervention group. Psychometric evaluation via the Diabetes Distress Scale indicated marked improvements in emotional burden and fear of hypoglycemia. These robust empirical outcomes reinforce clinical practice guidelines advocating for real-time sensor technology as a standard of care in T1DM, highlighting its capacity to transform behavioral self-management and curtail acute metabolic emergencies.

Keywords: Type 1 diabetes; Continuous glucose monitoring; Glycemic variability; Hypoglycemia; HbA1c reduction

Manuscript Timeline: Received: 10 January 2025; Revised: 08 April 2025; Accepted: 20 April 2025; Published: 05 May 2025

Citation: Chen, O. P., Johansson, Q. R., & Weber, S. T. (2025). Impact of Continuous Glucose Monitoring on Glycemic Variability and Hypoglycemia in Type 1 Diabetes Mellitus. International Journal of Medical Advances and Discoveries, 16(5), 25–32.

International Scholars Journal of Medical Advances and Discoveries | Vol. 16, No. 9, September 2025 | pp. 57–64

DOI: 10.46882/2025/IJMAD/000108

Clinical Review

Title: Targeted Microbiota Modulation via Fecal Microbiota Transplantation in Inflammatory Bowel Disease Management

Names of Authors: F. G. O'Connor¹, G. H. Kim²

Authors’ Affiliations: ¹Department of Gastroenterology, St. Jude Medical Institute, Dublin, Ireland; ²Department of Internal Medicine, Seoul National University, Seoul, South Korea

Abstract: Dysbiosis of the gastrointestinal microbiome is a central pathogenetic hallmark of inflammatory bowel disease (IBD), encompassing both Crohn's disease and ulcerative colitis. This review evaluates the evolving role of fecal microbiota transplantation (FMT) as a targeted biologic intervention designed to restore microbial diversity and induce clinical remission in refractory IBD cases. We examine the physiological mechanisms through which donor microbial consortia re-establish short-chain fatty acid (acetate, propionate, and butyrate) production, suppress mucosal pro-inflammatory cytokine expression (TNF-alpha, IL-1beta, and IL-6), and reinforce intestinal epithelial tight junction integrity. Clinical trial data indicate varying efficacy: while FMT demonstrates robust induction of steroid-free remission in mild-to-moderate ulcerative colitis (pooled remission rates approximating 45% to 52% following multi-donor preparations), efficacy in Crohn's disease remains less consistent, likely due to transmural inflammation and complex phenotypic heterogeneity. Critical parameters influencing success include donor screening rigor, delivery modality (colonoscopic infusion vs oral lyophilized capsules), and pre-FMT antibiotic conditioning regimens. Safety profiles remain manageable, with self-limiting abdominal cramping and low-grade fever occurring transiently in under 15% of recipients. Optimizing patient selection criteria and characterizing specific "super-donor" microbial signatures will be vital for transforming FMT from an experimental rescue therapy into a standardized, personalized treatment modality in IBD care pathways.

Keywords: Fecal microbiota transplantation; Inflammatory bowel disease; Ulcerative colitis; Microbiome dysbiosis; Remission induction

Manuscript Timeline: Received: 05 May 2025; Revised: 02 August 2025; Accepted: 19 August 2025; Published: 05 September 2025

Citation: O'Connor, F. G., & Kim, G. H. (2025). Targeted Microbiota Modulation via Fecal Microbiota Transplantation in Inflammatory Bowel Disease Management. International Journal of Medical Advances and Discoveries, 16(9), 57–64.

International Scholars Journal of Medical Advances and Discoveries | Vol. 16, No. 6, June 2025 | pp. 33–40

DOI: 10.46882/2025/IJMAD/000105

Systematic Review

Title: Pharmacological Interventions for Long COVID Fatigue and Cognitive Dysfunction: A Systematic Review and Meta-Analysis

Names of Authors: U. V. Nair¹, W. X. Novak², Y. Z. Tanaka³

Authors’ Affiliations: ¹Department of Neuro-Infectious Diseases, Continental University, Melbourne, Australia; ²Department of Internal Medicine, Vienna General Hospital, Vienna, Austria; ³Department of Rehabilitation Medicine, Kyoto University, Kyoto, Japan

Abstract: Post-acute sequelae of SARS-CoV-2 infection, commonly termed long COVID, frequently manifest as debilitating chronic fatigue and persistent cognitive impairment ("brain fog"). This systematic review and meta-analysis evaluated randomized and quasi-experimental trials examining pharmacological treatments intended to alleviate long COVID fatigue and neurocognitive deficits. Following rigorous PRISMA guidelines, a comprehensive search of major databases retrieved 18 eligible studies encompassing 2,150 adult patients treated with interventions including low-dose naltrexone, anti-histamines, mitochondrial supplements, and targeted anti-inflammatory agents. Pooled random-effects meta-analysis revealed a modest but statistically significant improvement in standardized fatigue severity scores (standardized mean difference, -0.58; 95% CI, -0.81 to -0.35; P < 0.001) among patients receiving low-dose naltrexone or combined antihistamine therapy compared to placebo controls. Cognitive performance metrics, assessed via the Trail Making Test and digit span assessments, showed directional gains but high heterogeneity across trials (I² = 74%). Adverse events were reported as mild, predominantly gastrointestinal discomfort or transient headache. Subgroup analyses indicated that interventions initiated within 3 months of symptom onset yielded superior functional recovery compared to late-stage administration. While current pharmacological approaches offer tangible symptomatic relief, the high heterogeneity and limited sample sizes of existing studies underscore the urgent necessity for large-scale, well-powered multi-center trials to establish definitive therapeutic algorithms for this complex syndrome.

Keywords: Long COVID; Chronic fatigue; Cognitive dysfunction; Low-dose naltrexone; Meta-analysis

Manuscript Timeline: Received: 14 February 2025; Revised: 05 May 2025; Accepted: 19 May 2025; Published: 05 June 2025

Citation: Nair, U. V., Novak, W. X., & Tanaka, Y. Z. (2025). Pharmacological Interventions for Long COVID Fatigue and Cognitive Dysfunction: A Systematic Review and Meta-Analysis. International Journal of Medical Advances and Discoveries, 16(6), 33–40.