Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)

Abstract Background: Induction of general anesthesia frequently induces hemodynamic instability characterized by hypotension, necessitating timely administration of vasopressors. The causal relationship between heart rate (HR) and blood pressure (BP) during this critical period remains incompletely understood, limiting the development of predictive models for vasopressor requirements.
Objective: This study employed dynamic causal modeling (DCM) to characterize the directional interactions between HR and BP during anesthetic induction and to develop a systems-based predictive framework for vasopressor needs.
Methods: We prospectively enrolled 120 adult patients undergoing elective major surgery under general anesthesia. Continuous HR and invasive arterial BP data were recorded from 5 minutes pre-induction to 10 minutes post-intubation. A time-varying Granger causality analysis was applied to quantify the feedforward (HR→BP) and feedback (BP→HR) causal pathways. A dynamic Bayesian network integrating hemodynamic, pharmacodynamic, and patient-specific parameters was constructed to predict vasopressor requirements.
Results: Propofol induction significantly attenuated the feedback pathway (BP→HR) from baseline (causal coefficient: 0.42±0.11 vs. 0.18±0.09, p<0.001) while preserving the feedforward pathway (HR→BP). The magnitude of feedback attenuation correlated strongly with subsequent vasopressor dose (r=0.73, p<0.001). The DCM-based prediction model achieved an AUC of 0.89 (95% CI: 0.83-0.94) for predicting vasopressor requirements >50 µg phenylephrine equivalent.
Conclusion: Dynamic causal modeling of HR-BP coupling during anesthetic induction provides mechanistic insights into hemodynamic instability and enables accurate, individualized prediction of vasopressor requirements, offering a promising framework for precision hemodynamic management.

Abstract Trauma remains one of the leading causes of death and disability worldwide, particularly among young adults. Uncontrolled hemorrhage is responsible for a substantial proportion of preventable trauma-related deaths and frequently occurs during the prehospital phase of care. Tranexamic acid (TXA), an antifibrinolytic agent that inhibits plasminogen activation and fibrinolysis, has emerged as a potentially life-saving intervention when administered early after traumatic injury. Several randomized controlled trials and observational studies have evaluated the efficacy and safety of prehospital TXA administration; however, uncertainty remains regarding its impact on mortality, neurological recovery, and long-term functional outcomes across diverse trauma populations. This systematic review and meta-analysis aimed to synthesize contemporary evidence regarding the effectiveness of prehospital TXA administration in trauma patients. A comprehensive search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library conducted for studies published between January 2010 and December 2025. Eligible studies included randomized controlled trials and observational cohorts evaluating prehospital TXA administration in trauma patients. Primary outcomes included all-cause mortality, hemorrhage-related mortality, and functional outcomes. Secondary outcomes included thromboembolic complications, blood transfusion requirements, and intensive care unit (ICU) length of stay. Random-effects meta-analysis models used to calculate pooled effect estimates. Twenty-eight studies involving 46,872 trauma patients met inclusion criteria. Prehospital TXA administration was associated with a significant reduction in overall mortality (pooled risk ratio [RR] = 0.84; 95% CI: 0.77–0.92) and hemorrhage-related mortality (RR = 0.78; 95% CI: 0.70–0.87). Functional outcomes at six months demonstrated modest but statistically significant improvement among TXA-treated patients. No significant increase in thromboembolic events observed. The findings suggest that early prehospital administration of TXA improves survival and functional recovery in trauma patients while maintaining an acceptable safety profile. These results support broader integration of TXA into prehospital trauma protocols and reinforce the importance of early hemorrhage control strategies in modern trauma care.

Abstract Acute coronary syndrome (ACS) remains one of the leading causes of morbidity and mortality worldwide, accounting for a substantial proportion of emergency department (ED) visits. Rapid and accurate identification of patients with ACS is essential to optimize clinical outcomes, reduce unnecessary hospital admissions, and improve healthcare efficiency. High-sensitivity cardiac troponin (hs-cTn) assays have revolutionized the diagnostic approach to myocardial injury by enabling earlier detection of myocardial necrosis with greater analytical precision than conventional troponin assays. In recent years, several accelerated diagnostic pathways (ADPs) incorporating hs-cTn measurements have been developed and validated for rapid rule-out and rule-in of ACS in emergency settings. This systematic review and meta-analysis aimed to evaluate the diagnostic performance, safety, and clinical utility of hs-cTn-based accelerated diagnostic pathways in patients presenting with suspected ACS.
A systematic search of PubMed, Embase, Web of Science, Scopus, and the Cochrane Library conducted for studies published between January 2015 and December 2025. Eligible studies assessed accelerated diagnostic protocols using hs-cTn assays and reported diagnostic accuracy outcomes. Pooled sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and diagnostic odds ratios calculated using random-effects meta-analysis models. Heterogeneity assessed using the I² statistic.
Thirty-two studies involving 78,456 patients met the inclusion criteria. The pooled sensitivity for ruling out acute myocardial infarction was 98.7% (95% CI: 98.1–99.2%), while pooled specificity was 82.4% (95% CI: 79.1–85.3%). The pooled NPV exceeded 99%, supporting the safety of early discharge strategies. Accelerated pathways significantly reduced emergency department length of stay and hospital admissions without increasing major adverse cardiac events.
The findings suggest that hs-cTn-based accelerated diagnostic pathways provide highly accurate and efficient strategies for evaluating suspected ACS in emergency departments. Their widespread implementation may improve patient flow, optimize resource utilization, and maintain patient safety while facilitating rapid clinical decision-making.

Abstract Background: Emergency care systems worldwide face increasing challenges due to overcrowding, limited specialist availability, geographic disparities, and the need for rapid clinical decision-making. Telemedicine has emerged as an innovative approach to improve access to expert consultation, optimize emergency department (ED) workflows, and enhance patient-centered care. This systematic review evaluates the effects of telemedicine integration in emergency care on clinical outcomes, workflow efficiency, and patient satisfaction.
Methods: A systematic review conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases including PubMed, Embase, Scopus, Web of Science, and Cochrane Library searched for studies evaluating telemedicine applications in emergency care. Eligible studies included randomized controlled trials, prospective and retrospective observational studies, and comparative studies reporting clinical outcomes, operational performance, or patient satisfaction measures. Data regarding study characteristics, telemedicine models, emergency conditions, outcomes, and quality indicators extracted and synthesized.
Results: 28 studies involving more than 120,000 emergency care encounters were included. Telemedicine implementation was associated with improved access to specialist consultation, reduced time-to-treatment, decreased emergency department length of stay, and enhanced diagnostic decision-making. The greatest benefits observed in stroke, trauma, cardiac emergencies, and rural emergency care settings. Meta-analysis demonstrated a significant reduction in treatment delays and improved workflow efficiency. Patient satisfaction was generally high, with users reporting improved communication, reduced travel burden, and increased confidence in medical decisions. However, challenges included technological limitations, provider training requirements, and integration with existing healthcare systems.
Conclusion: Telemedicine represents an effective strategy for improving emergency care delivery by enhancing clinical decision-making, accelerating treatment processes, and improving patient experiences. Successful implementation requires reliable technological infrastructure, standardized clinical protocols, and continuous evaluation of outcomes. Future research should focus on large-scale randomized studies and cost-effectiveness analyses to optimize telemedicine integration into emergency healthcare systems.

Abstract The increasing proportion of older adults presenting to emergency departments (EDs) has created significant challenges for healthcare systems worldwide. Older patients frequently present with complex multimorbidity, functional impairment, cognitive decline, and increased vulnerability to acute stressors. Frailty, defined as a state of decreased physiological reserve and increased susceptibility to adverse health outcomes, has emerged as an important predictor of hospitalization, mortality, and functional deterioration. Emergency department-based frailty assessment tools may provide rapid identification of high-risk older adults and support individualized clinical decision-making. This systematic review and meta-analysis aimed to evaluate the predictive performance of frailty assessment instruments applied in emergency departments for hospitalization, mortality, and other adverse outcomes among older adults. A comprehensive literature search performed in major biomedical databases to identify studies evaluating validated frailty assessment tools in ED populations aged ≥65 years. Eligible studies assessed the association between frailty measurements and clinical outcomes, including hospital admission, short- and long-term mortality, intensive care utilization, functional decline, and adverse events. Data regarding study characteristics, frailty instruments, predictive performance measures, and outcomes extracted and synthesized. The pooled evidence demonstrated that ED-based frailty assessment tools were significantly associated with increased risk of hospitalization and mortality. Instruments including the Clinical Frailty Scale (CFS), Identification of Seniors at Risk (ISAR), Emergency Department Frailty Index (ED-FI), and Frailty Phenotype demonstrated moderate-to-high predictive accuracy. Frailty assessment improved risk stratification beyond chronological age alone and provided clinically meaningful information regarding patient vulnerability. However, heterogeneity existed regarding assessment methods, outcome definitions, and follow-up periods. Frailty screening in emergency departments represents a valuable approach for identifying older adults at increased risk of adverse outcomes. Integration of rapid frailty assessment into routine emergency care may improve triage decisions, facilitate appropriate resource allocation, and support patient-centered management strategies.

Abstract Background: Intraoperative hypotension (IOH) is a prevalent and perilous complication during surgery, strongly associated with adverse postoperative outcomes including acute kidney injury, myocardial injury, and increased mortality. Current predictive strategies often rely on invasive arterial monitoring or singular hemodynamic parameters, limiting their widespread applicability. This study introduces and validates a novel Composite Systematic Instability Score (SIS), integrating multiple non-invasive hemodynamic parameters to predict IOH events up to 15 minutes before onset.
Methods: We conducted a prospective observational study across three tertiary care centers, enrolling 450 adult patients undergoing moderate-to-high risk non-cardiac surgery. Non-invasive hemodynamic data, including continuous blood pressure, heart rate variability, stroke volume variation, and systemic vascular resistance estimates, were collected using the ClearSight system. The SIS algorithm was developed using a machine learning approach combining five key physiological features: mean arterial pressure trend, hypotension prediction index (HPI), cardiac output variability, systemic vascular resistance index, and pulse pressure variation. The primary outcome was prediction accuracy for IOH (defined as MAP < 65 mmHg for ≥1 minute) within a 15-minute forecast window.
Results: The SIS demonstrated excellent predictive performance with an Area Under the Receiver Operating Characteristic Curve (AUC-ROC) of 0.94 (95% CI: 0.91-0.97), significantly outperforming individual parameters. At optimal threshold (SIS > 65), sensitivity was 89.2%, specificity 85.7%, positive predictive value 82.3%, and negative predictive value 91.4%. The score enabled a 52.3% reduction in IOH duration compared to standard monitoring.
Conclusion: The novel Composite Systematic Instability Score, derived entirely from non-invasive monitors, provides accurate, early prediction of IOH with excellent clinical utility. This approach offers a practical, accessible tool for proactive hemodynamic management across diverse surgical settings.

Abstract This study applies Failure Mode and Effects Analysis (FMEA) to assess and mitigate risks in key hospital departments, aiming to enhance patient safety and process reliability. Conducted in a 400-bed tertiary hospital over a six-month period, the research focused on three high-risk units: the Intensive Care Unit (ICU), Operating Room (OR), and Pharmacy. Data were collected through incident reports, structured interviews, and process observations. For each failure mode, the Risk Priority Number (RPN) was calculated based on severity, occurrence, and detectability scores. In the ICU, alarm fatigue had the highest RPN (336), signaling a critical need for smarter alarm systems. In the OR, incomplete time-out procedures posed the greatest risk (RPN: 315), highlighting communication gaps. In the Pharmacy, look-alike/sound-alike (LASA) medications were the most dangerous (RPN: 336), indicating the importance of system-based labeling and verification strategies. The study concludes that FMEA is a practical, data-driven approach for identifying latent hazards in hospital systems. Targeted interventions such as staff training, digital checklists, and barcode medication administration systems are recommended. Integrating FMEA with hospital information systems and routine quality audits can significantly improve patient safety outcomes and organizational resilience.

Abstract Dermal fillers have become a cornerstone in aesthetic medicine, offering minimally invasive solutions for facial rejuvenation, contour enhancement, and volume restoration. This review explores the various types of dermal fillers, their clinical indications, and potential complications associated with their use. Dermal fillers are broadly categorized into temporary, semi-permanent, and permanent types, with hyaluronic acid-based fillers being the most popular due to their biocompatibility and reversibility. Other commonly used materials include calcium hydroxylapatite, poly-L-lactic acid, and polymethylmethacrylate microspheres. Indications for dermal filler application encompass correction of age-related volume loss, soft tissue augmentation, wrinkle reduction, and facial contour remodeling. Proper patient selection and individualized treatment planning are essential to maximize aesthetic outcomes and minimize risks. Despite their safety profile, dermal fillers carry potential complications ranging from mild and transient, such as swelling, bruising, and erythema, to more serious adverse events including infection, vascular occlusion, and granuloma formation. The prevention and management of complications require a thorough understanding of facial anatomy, appropriate injection techniques, and prompt recognition of adverse signs. Advances in filler technology and imaging techniques have improved treatment precision and patient satisfaction; however, challenges remain in achieving consistent long-term results and managing rare but severe complications. This review underscores the importance of clinician expertise, patient education, and ongoing research to optimize the safety and efficacy of dermal filler treatments. Future developments may focus on novel biomaterials, personalized treatment protocols, and improved diagnostic tools to further enhance clinical outcomes.

Abstract The lower third of the face plays a critical role in facial harmony and aesthetic perception, often being one of the first regions to exhibit signs of aging such as volume loss, sagging skin, and reduced definition of the jawline. The "Contouring Plus" approach combines the synergistic use of Calcium Hydroxylapatite (CaHA) and Hyaluronic Acid (HA) to offer a comprehensive, minimally invasive solution for rejuvenation and contouring of this facial region. CaHA, known for its biostimulatory properties, not only provides immediate volumization but also induces neocollagenesis, leading to long-term dermal remodeling. HA fillers, on the other hand, deliver precise augmentation and hydration, particularly effective in fine contouring and surface-level corrections. This integrated technique involves strategic placement of both substances in targeted anatomical zones, enhancing mandibular angle, chin projection, and submental definition while maintaining a natural and harmonious appearance. The approach emphasizes individual assessment, customized product layering, and attention to facial dynamics, which collectively contribute to high patient satisfaction and safety. Clinical evidence demonstrates significant improvements in facial aesthetics with minimal adverse effects, making this method an ideal option for both men and women seeking facial rejuvenation without surgery. This paper reviews the anatomical rationale, product characteristics, injection techniques, and clinical outcomes associated with the Contouring Plus protocol, positioning it as an advanced standard in modern aesthetic dermatology.

Abstract The rate of muscle cell growth is also dependent on the activity of some hormones, including growth hormone (GH), insulin, insulin-like growth factor-1 (IGF-1), and steroid sex hormones, especially testosterone. Research results on the acute hormonal response to resistance training show that anabolic hormones such as growth hormone and testosterone, which are very important and vital in tissue growth and remodeling, increase during and after resistance training. These hormones play an important role in increasing protein synthesis. Therefore, the improvement of some physical fitness factors in adolescents is attributed to the increase in the level of these hormones. In this regard, Kramer (2004) stated that if the rest interval between resistance training periods performed at 80% of 1RM in 6 periods and 10 repetitions in each period is less than 1 minute, it can cause a significant increase in the secretion of growth hormone and testosterone. Testosterone is an anabolic hormone that stimulates protein synthesis and plays a very important role in the growth and maintenance of muscle tissue. Growth hormone is one of the most important hormones in the body that, along with a group of other hormones, affects metabolism and is necessary for maintaining body weight and protein synthesis in adults. It has been proven that normal growth is directly related to the plasma concentration of Somatomedin-C or insulin-like growth factor IGF-1.

Abstract Facial aesthetic treatment with injectable hyaluronic acid (HA) fillers has become a pivotal technique in modern non-surgical facial rejuvenation. This minimally invasive approach offers a safe, effective, and customizable solution to restore facial volume, improve contours, and reduce signs of aging. The methodological approach to HA filler treatments is comprehensive, involving a detailed understanding of facial anatomy, aging patterns, filler properties, and injection techniques. The selection of appropriate HA fillers depends on their rheological characteristics such as viscosity, elasticity, and cohesivity, which influence their suitability for different facial regions and depths. Treatment planning requires a thorough facial assessment to identify areas of volume loss, asymmetry, and dynamic movement, guiding tailored injection strategies to achieve harmonious and natural outcomes. Techniques including linear threading, bolus injections, fanning, and cross-hatching are employed based on specific aesthetic goals and anatomical considerations. Safety is paramount in all procedural steps, with knowledge of critical vascular and neural structures essential to minimize risks such as vascular occlusion or nerve injury. Additionally, the reversibility of HA fillers with hyaluronidase provides an important safety net, enhancing patient confidence. This methodological framework integrates both scientific rigor and artistic judgment, balancing objective anatomical corrections with subjective aesthetic desires. Continuous advances in filler technology and injection techniques, combined with growing clinical experience, contribute to improving treatment efficacy and patient satisfaction. Overall, a structured, evidence-based approach to injectable HA fillers is crucial for achieving optimal, reproducible, and safe facial aesthetic outcomes.

Abstract Introduction: Evaluating the comparative effects of ketamine and dexmedetomidine on adverse events following traumatic nasal surgeries is clinically significant. Clarifying their roles in reducing postoperative nausea, vomiting, shivering, hypotension, and bradycardia supports evidence-based anesthetic selection. This research enhances perioperative care by informing tailored anesthetic strategies, ultimately promoting patient safety, improving postoperative recovery, and optimizing outcomes in trauma patients undergoing nasal surgery.

Material and methods: This prospective, randomized, double-blind clinical trial will compare ketamine and dexmedetomidine regarding adverse event incidence in adults undergoing traumatic nasal surgery. Consecutive eligible patients will be randomized and both participants and clinical staff will be blinded. Data on postoperative complications will be systematically collected and statistically analyzed. The study is ethically approved and complies with the Declaration of Helsinki, ensuring rigorous methodology, patient safety, and reliable, generalizable results for evidence-based anesthetic management.

Results: The comparative analysis of ketamine and dexmedetomidine in patients undergoing traumatic nasal surgery revealed no significant differences in the incidence of postoperative adverse events, including nausea, vomiting, shivering, hypotension, and bradycardia requiring treatment. Both anesthetic agents demonstrated similar safety profiles, with low rates of hemodynamic complications and comparable risks for common postoperative events, supporting their use as equally viable options in this clinical context.

Conclusion: This study demonstrates that ketamine and dexmedetomidine provide comparable safety profiles for patients undergoing traumatic nasal surgery, with no significant difference in the incidence of nausea, vomiting, shivering, hypotension, or bradycardia requiring intervention.

Abstract Introduction: Understanding the role of gut microbiota in the pathogenesis of ankylosing spondylitis (AS) is of paramount clinical importance, as it offers novel insights into the systemic nature of this inflammatory disease beyond the axial skeleton. Elucidating the gut-joint axis may uncover microbial biomarkers and therapeutic targets, enabling earlier diagnosis, personalized treatment strategies, and potentially disease-modifying interventions that address underlying immune dysregulation rather than merely suppressing symptoms.

Material and methods: This systematic review rigorously synthesized current evidence on gut microbiota’s role in ankylosing spondylitis by screening multiple databases, applying strict inclusion criteria, and following PRISMA guidelines. Data extraction and risk of bias assessments were performed independently to ensure reliability. Clinical and methodological heterogeneity across studies was carefully evaluated, with statistical analyses and subgroup assessments employed to interpret variability, ultimately providing a comprehensive, high-quality appraisal of the gut-joint axis in AS pathogenesis.

Results: The results of this systematic review, synthesized from nine eligible studies, reveal consistent alterations in gut microbiota composition among patients with ankylosing spondylitis. Notable findings include increased abundance of Prevotella and Lactobacillus species and reduced levels of Faecalibacterium and Ruminococcus. These microbial changes were associated with elevated pro-inflammatory cytokines (IL-17, IL-23), increased zonulin levels, and reduced butyrate, suggesting a link between dysbiosis, impaired gut barrier function, and systemic inflammation in AS.

Conclusion: Based on the synthesized evidence, ankylosing spondylitis is associated with gut microbiota dysbiosis characterized by increased Prevotella and reduced Faecalibacterium, alongside elevated pro-inflammatory, intestinal permeability markers. These findings suggest a gut–immune axis contributing to disease pathogenesis.