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 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.

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 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