Asian Journal of Medical Research and Case Reports

Noradrenaline based Hemodynamic Rescue in Cardiogenic Shock: A Case Series

A. Julliyan Dilleban — 2026-03-20

Cardiogenic shock (CS) is a state of critical end-organ hypoperfusion due to severe cardiac dysfunction and remains associated with high mortality despite advances in pharmacologic and device-based support. This case series describes four male patients (aged 50–72 years) with CS complicated by extensive comorbidity, including coronary artery disease, dilated cardiomyopathy, Type 2 diabetes mellitus, and chronic kidney disease, and markedly reduced left ventricular ejection fraction (28–30% in two cases). All patients presented with profound hypotension (blood pressure as low as 80/50 mmHg) and clinical evidence of hemodynamic collapse, necessitating urgent vasoactive support. Noradrenaline was employed as the primary vasopressor in all cases, with careful titration of continuous intravenous infusion to restore mean arterial pressure and improve perfusion, consistent with contemporary recommendations that favour norepinephrine over dopamine as first-line therapy in CS. In two patients, noradrenaline was combined with dopamine to augment inotropy in the setting of refractory hypotension. Management was further complicated by renal dysfunction, heart failure, and coagulation abnormalities, requiring repeated optimisation of background therapies, including de-escalation of dual antiplatelet therapy, adjustment of renin–angiotensin system blockade, and active correction of anaemia. Across cases, haemodynamic stabilisation was achieved through individualized titration of vasopressors alongside multidisciplinary optimisation of cardiovascular, renal, and metabolic status. These findings suggest that noradrenaline can serve as an effective first-line vasopressor for initial hemodynamic stabilization in complex cardiogenic shock, particularly when integrated with multidisciplinary and individualized patient management strategies. This series highlights the central role of goal-directed noradrenaline therapy in the acute resuscitation of complex CS and underscores the importance of pharmacist-supported, patient-specific adjustments to chronic cardiovascular and nephroprotective regimens in improving clinical trajectories in this high-risk population.

Management of Retinal Macroaneurysms: A Case Series and Treatment Approaches

Boutayna Azarkan — 2026-04-11

Retinal arterial macroaneurysms (RMAs) are uncommon vascular lesions that can lead to visual impairment through exudation or hemorrhage. We report a retrospective case series of four patients with symptomatic RMAs evaluated using multimodal imaging and managed with different therapeutic approaches.

All patients presented with decreased visual acuity and a history of systemic hypertension. Initial best-corrected visual acuity (BCVA) ranged from 1/10 to 5/10. Multimodal imaging—including optical coherence tomography (OCT), fluorescein angiography (FA), and OCT angiography—enabled accurate characterization of lesion type (exudative versus hemorrhagic) and guided treatment decisions.

Three patients with exudative macroaneurysms received intravitreal anti-VEGF therapy (bevacizumab), resulting in macular edema reduction and BCVA improvement by 1–3 lines. One patient with combined focal laser achieved additional lesion stabilization. One patient with multilayered macular hemorrhage underwent pars plana vitrectomy with internal limiting membrane peeling, leading to anatomical resolution but limited functional recovery (BCVA improved from 2/10 to 4/10).

These findings highlight the importance of multimodal imaging in differentiating exudative and hemorrhagic RMAs and tailoring treatment strategies. Intravitreal anti-VEGF therapy appears effective as a first-line approach in most symptomatic cases, with adjunctive laser or surgical intervention reserved for selected presentations.

Correlation Between Auditory Steady-State Responses and Pure-Tone Audiometry in Hearing Threshold Assessment

H. Boudhar — 2026-04-03

Introduction: Accurate assessment of hearing thresholds is a fundamental component of the diagnosis and management of hearing disorders. Although pure-tone audiometry remains the gold standard, its application may be limited in non-cooperative patients or in certain complex clinical situations. Auditory Steady-State Responses (ASSR) provide an objective, frequency-specific method for estimating hearing thresholds.

Aim: This study aimed to evaluate the correlation between ASSR-derived thresholds and behavioural pure-tone audiometry thresholds, and to assess the clinical contribution of ASSR in audiological evaluation.

Materials and Methods: This observational study, conducted in the Department of Otorhinolaryngology and Cervico-Facial Surgery at the 20 August Hospital, Ibn Rochd University Hospital Centre in Casablanca, over ten months from September 2023 to July 2024, included fifty-three patients evaluated for suspected hearing impairment who underwent both pure-tone audiometry and ASSR testing. Hearing thresholds were analysed at standard frequencies (500, 1000, 2000, and 4000 Hz). ASSR thresholds were compared with behavioural audiometric thresholds to assess correlation, mean differences, and agreement in audiometric configuration. Statistical analysis was performed to determine the strength and significance of correlations and to evaluate the influence of clinical parameters on test performance.

Results: A statistically significant correlation was found between ASSR-derived thresholds and pure-tone audiometry thresholds, particularly at speech frequencies. Mean differences between the two methods were generally small and clinically acceptable. ASSR accurately reproduced the audiometric configuration in most cases, with greater precision observed in severe to profound hearing loss. Slightly reduced reliability was noted at lower frequencies; however, this did not compromise the overall diagnostic value of the method.

Conclusion: These findings confirm the reliability of ASSR as an objective tool for estimating hearing thresholds and its strong agreement with pure-tone audiometry. ASSR is particularly valuable in non-cooperative patients, in cases of severe to profound hearing loss, and in situations requiring objective confirmation of auditory thresholds. While ASSR does not replace behavioural audiometry, it represents an essential complementary tool within an integrated audiological assessment, contributing to improved diagnostic accuracy and therapeutic decision-making in otorhinolaryngology.

Poisson Autoregressive and Poisson Exponential Weighted Moving Average Models for Infectious Disease Prevalence among Farmers in Benue State, Nigeria

David Adugh Kuhe — 2026-04-11

Aims: This study aims to model and analyze the infection rates of Human Immunodeficiency Virus (HIV), Tuberculosis (TB), and Viral Hepatitis (VHP) among farmers in Benue State, Nigeria, and to examine their temporal dynamics and co-infection patterns using Poisson-based time series models.

Study Design: The study adopts a quantitative, retrospective time series design utilizing count data models, specifically the Poisson Autoregressive (PAR(1)) and Poisson Exponential Weighted Moving Average (PEWMA) models.

Place and Duration of Study: The study was conducted in Benue State, Nigeria, using monthly secondary data on serologically confirmed cases of HIV, TB, and VHP from January 2010 to December 2022.

Methodology: Descriptive statistics, time plots, bar charts, and the Anderson-Darling normality test were employed to explore the data characteristics. The PAR(1) model was used to assess persistence in infection rates, while the PEWMA model captured dynamic changes and co-infection relationships. Model performance was evaluated using coefficients of determination and diagnostic checks for dispersion and predictive accuracy.

Results: The findings revealed increasing trends in HIV, TB, and VHP infections with clear non-Gaussian distributions. Peak infection rates occurred between 2017 and 2019, while the lowest rates were observed in 2010. The PAR(1) model indicated strong persistence with lag coefficients of 0.7362 (HIV), 0.7036 (TB), and 0.6718 (VHP). Monthly increases were estimated at 2.25% for HIV, 1.22% for TB, and 12.08% for VHP. The models demonstrated strong goodness-of-fit with R² values of 83.3%, 78.8%, and 80.8% for HIV, TB, and VHP, respectively. The PEWMA model highlighted significant co-infection dynamics, particularly between HIV and TB, and showed that VHP incidence is closely associated with both infections. Diagnostic results confirmed minimal over-dispersion and strong predictive capability.

Conclusion: The study concludes that infection rates of HIV, TB, and VHP among farmers in Benue State are increasing and exhibit strong temporal dependence and co-infection interactions. The findings underscore the need for continuous surveillance, targeted interventions, and integrated public health strategies. Further research is recommended to investigate the underlying drivers of these trends and the observed non-normality in the data.

Discriminant Analysis of Craniometric Traits for Sex Classification in Southern Nigerians Using Computed Tomography

Okoro Ogheneyebrorue Godswill — 2026-06-02

Determination of biological sex from skeletal remains an important component of forensic human identification, particularly where conventional means of identification are unavailable. The cranial base, owing to its structural durability and resistance to postmortem damage, provides dependable anatomical landmarks for metric assessment. This investigation explored the usefulness of mastoid length, foramen magnum length, and foramen magnum breadth as discriminative cranial indicators for sex classification among adults in Southern Nigeria through computed tomography-based evaluation. This retrospective analytical study utilized cranial CT scans obtained from adult subjects within Southern Nigeria. Measurements of the selected cranial parameters were obtained directly from reconstructed digital images using standardized radiological protocols. Statistical processing was performed using the Statistical Package for the Social Sciences (SPSS) version 27. Descriptive analysis was used to summarize cranial measurements, while independent sample t-tests assessed sex-based differences. Discriminant function analysis was employed to establish the predictive strength of the measured variables for sex differentiation. The analysis demonstrated consistent enlargement of all assessed parameters in males relative to females, reflecting marked sexual dimorphism within the studied population. Significant statistical differences were observed between both sexes across the measured variables. Among the parameters examined, foramen magnum length and breadth emerged as the strongest discriminator, while mastoid length also showed substantial classification utility. The discriminant model generated from these variables demonstrated high reliability for sex assignment, confirming the diagnostic relevance of cranial base metrics in population-specific forensic applications. The findings underscore the value of CT-derived mastoid and foramen magnum measurements as objective and reproducible indicators for sex estimation. Their integration into forensic anthropological practice offers a precise, non-destructive, and population-relevant approach for sex classification in Southern Nigerian adults.

Craniofacial Superimposition (CFS) in Forensic Identification: Integrating Anatomy, Technology, and Ethics

George Kelvin Nkem — 2026-06-11

Background: Craniofacial superimposition (CFS) is an important forensic identification technique that compares cranial remains with ante-mortem facial photographs to establish human identity. Recent advancements in 3D imaging, CBCT, and artificial intelligence have significantly improved the accuracy, objectivity, and reliability of CFS in forensic investigations.

Aims: This review aims to evaluate craniofacial superimposition (CFS) as a multidisciplinary forensic technique by examining its anatomical foundations, technological innovations, and ethical implications. The goal is to assess its reliability, reproducibility, and humanizing role in forensic identification.

Study Design: A narrative review synthesizing published literature from 1980 to 2025, focusing on anatomical landmark stability, soft tissue correlations, imaging technologies, artificial intelligence applications, and ethical frameworks in forensic practice.

Methodology: Peer‑reviewed articles, forensic case reports, and book chapters were systematically analyzed. Emphasis was placed on cranial morphology, soft tissue thickness data, cone‑beam computed tomography (CBCT), three‑dimensional imaging, AI‑driven overlays, and digital reconstruction technologies. Ethical considerations such as informed consent, privacy, cultural sensitivity, and evidentiary admissibility were also critically examined.

Results: Findings highlight that cranial landmarks such as orbital rims, nasal apertures, and mandibular angles provide durable anchors for superimposition, though variability across age, sex, and ancestry complicates interpretation. Technological advances, including CBCT, 3D imaging, and AI algorithms, have significantly improved precision, reproducibility, and evidentiary value. Digital reconstruction enables restoration of damaged cranial features, while cloud‑based ICT platforms foster global collaboration and population‑specific datasets. Ethical analysis underscores the importance of transparency, cultural sensitivity, and human dignity, ensuring that overlays restore identity without overstating certainty.

Conclusion: Craniofacial superimposition has evolved from a qualitative art into a quantitative science, integrating anatomy, technology, and ethics. Its strengths lie in its ability to humanize skeletal remains and provide closure, while its limitations highlight the need for caution and collaboration. Future progress depends on international standardization, diverse anatomical databases, and interdisciplinary partnerships that unite forensic scientists, technologists, and ethicists.

Dermatoglyphics as Anatomical Markers in Medical Diagnostics, ICT and Forensic Applications: A Narrative Review with Ethical Perspectives

George Nkem Kelvin — 2026-06-20

Dermatoglyphics refers to the study of epidermal ridge patterns on the fingers, palms, toes and soles. This narrative review examines dermatoglyphics as a potential anatomical marker in medical diagnostics, information and communication technology (ICT) and forensic applications, while considering associated ethical issues. Literature published between 2015 and 2025 was reviewed through searches of PubMed, Scopus and Web of Science, with emphasis on peer-reviewed studies, systematic reviews and primary research addressing medical, psychological or forensic outcomes. The reviewed evidence indicates that ridge counts, pattern types and palmar configurations have been associated with selected congenital, neurodevelopmental, systemic and metabolic conditions, including Down syndrome, Turner syndrome, autism spectrum disorder, schizophrenia and diabetes mellitus. These associations support the possible use of dermatoglyphics as a low-cost and non-invasive adjunct in screening and risk assessment, particularly in settings where advanced diagnostic tools are limited. ICT-based approaches, including high-resolution digital scanning, automated fingerprint identification systems, artificial intelligence, mobile health applications, multimodal biometrics, 3D imaging and blockchain-supported data protection, have improved the capture, classification and interpretation of ridge patterns. Forensic applications remain important because fingerprints provide stable and individualising biometric information for human identification. However, current evidence is limited by methodological heterogeneity, small sample sizes, population-specific findings, limited longitudinal data and concerns about algorithmic bias. Dermatoglyphics should therefore be interpreted as a supportive marker rather than a stand-alone diagnostic or predictive tool. Future research should prioritise standardised ridge analysis protocols, larger and more diverse cohorts, responsible ICT integration and clear ethical safeguards for privacy, consent and biometric data governance.

Vaccine-Preventable Livestock Diseases and the Antimicrobial Resistance Burden in Low- and Middle-income Countries: Towards a One Health Modelling Framework

Md. Rimon Bhuiyan — 2026-07-11

Background: Antimicrobial resistance (AMR) constitutes one of the most formidable public health threats of the 21st century, with low- and middle-income countries (LMICs) bearing a disproportionate burden. Livestock systems in these settings are both major consumers of antimicrobials and critical reservoirs for resistant pathogens, yet the quantitative contribution of vaccine-preventable livestock diseases to AMR burden remains poorly characterised within a One Health framework.

Objectives: This review synthesises available evidence on the burden of AMR attributable to vaccine-preventable livestock diseases in LMICs, evaluates existing modelling methodologies and their limitations, identifies critical data gaps, and proposes an integrated One Health modelling framework to guide future research and policy.

Methods: A narrative synthesis was conducted using evidence from PubMed, Scopus, Web of Science, and grey literature (WHO, FAO, WOAH, GRAM) published from 2015 to 2026. Studies examining AMR burden quantification, veterinary antimicrobial use (AMU), livestock vaccination, and One Health modelling approaches were included, with priority given to LMIC-focused evidence.

Results: Global AMU in food-producing animals was estimated at approximately 99,502 tonnes in 2020 and is projected to rise by 8% by 2030, with Asia and emerging economies disproportionately driving this trend. Vaccine-preventable diseases, including Foot-and-Mouth Disease, Newcastle Disease, Contagious Bovine Pleuropneumonia, and Brucellosis, collectively drive substantial antibiotic prophylaxis in LMICs. However, only 10% of LMICs systematically track AMR in animals, and no validated cross-sectoral modelling framework currently quantifies the AMR burden averted by livestock vaccination programmes. Existing approaches utilising Disability-Adjusted Life Years, the Animal Health Loss Envelope, and compartmental transmission models reveal significant methodological gaps.

Conclusions: A robust, LMIC-adapted One Health modelling framework that integrates animal AMU data, zoonotic spillover pathways, vaccination coverage metrics, and human AMR outcomes is urgently needed. Addressing surveillance fragmentation, cold-chain barriers, and data harmonisation will be pivotal to realising the potential of livestock vaccination as a cost-effective AMR mitigation strategy.

Juvenile Xanthogranuloma on the Eyelid: A Case Report

Pinzón Gonzaléz Maira Alejandra — 2026-02-18

We present the case of a 4-year-old male with a painless, firm, smooth, yellow-orange, rounded papule approximately 6 mm in diameter located on his right upper eyelid. The lesion caused functional limitation in eye opening. Due to the risk of visual impairment, an ophthalmological evaluation was performed, followed by complete surgical excision.

The diagnosis was confirmed by histopathological examination, establishing the nature of juvenile xanthogranuloma, a non-Langerhans cell histiocytosis.

No recurrence was observed during follow-up. This case highlights the importance of recognizing eyelid presentations of this condition and promoting a multidisciplinary approach to prevent visual sequelae in the pediatric population.

Unravelling the Genetic Traits Linked to a Refractory Vasculitis: A Case Study on Adenosine Deaminase 2 Deficiency

C. Kaddouri — 2026-02-23

Adenosine deaminase 2 deficiency (DADA2) is a rare genetic disorder that follows an autosomal recessive pattern, stemming from mutations in both copies of the ADA2 gene. This condition leads to reduced enzyme activity and can cause a wide range of issues related to blood vessels, inflammation, and the immune system. We present the case of a 19-year-old male from a family with a history of consanguinity, who has experienced recurrent fevers, mouth sores resembling aphthous ulcers, hives, joint pain due to inflammation, and neurological symptoms that appeared early in life. Imaging of the brain showed several small areas of damage from a lack of blood flow. Lab tests indicated ongoing inflammation without signs of low blood cell counts or deficiencies in immunoglobulins, and tests for infections and immune responses came back negative. Because systemic inflammation can lead to early strokes, we suspected DADA2. Genetic testing confirmed he had a homozygous variant in the ADA2 gene (NM_001282225.2: c.1069G>A). After starting treatment with weekly etanercept, he quickly saw a reduction in fever, stability in his neurological condition, and normalisation of inflammatory markers. This case underscores the importance of considering DADA2 in young patients who show signs of systemic vasculitis, unexplained fevers, or early strokes. Early diagnosis is vital, as prompt anti–TNF-α treatment can help prevent serious complications and greatly enhance patient outcomes.

Multiple Drugs Interaction with Warfarin in a Single Patient: The Role of Rifampicin and Trimethoprim-Sulfamethoxazole (TMP-SMX)

Mohd Fadzli Maspan — 2026-03-12

Introduction: Warfarin is the only anticoagulant proven for use after mechanical heart valve surgery. Rifampicin has been reported to increase the warfarin requirement, while the use of Trimethoprim–Sulfamethoxazole (TMP-SMX) may increase the risk of bleeding when used together with warfarin. Due to its narrow therapeutic index and numerous interactions with drugs and foods, it is crucial to closely monitor INR levels in patients taking warfarin with both rifampicin and TMP-SMX.

Case Presentation: We reported a case of a 58-year-old gentleman with severe aortic stenosis who underwent mechanical aortic valve surgery. The patient was discharged with a stable dose of warfarin (5mg daily) and INR levels. However, due to poor hygiene, limited ambulation, and poorly controlled diabetes, he was readmitted with an infected sacral sore, requiring the initiation of both rifampicin and TMP-SMX alongside warfarin.

Results: The commencement of both TMP-SMX and rifampicin in the patient caused a sudden increase in INR levels to 6 on day 4 of antibiotics, necessitating transfusion of fresh frozen plasma (FFP). Subsequently, the INR level became sub-therapeutic, requiring escalation of the warfarin dose to three times the baseline (15mg compared with the usual 5mg daily). The patient required treatment with TMP-SMX and rifampicin for a prolonged period of three weeks. However, the enzyme induction effect of rifampicin on warfarin metabolism persisted for up to three months after its discontinuation with the final warfarin dose being 7mg daily.

Conclusion: This case highlights the critical need for awareness of drug interactions with warfarin. The opposing effects of TMP-SMX and rifampicin on warfarin make it crucial to closely monitor INR levels to prevent both bleeding and thromboembolic events in patients after mechanical valve surgery.

Type 2 Torpedo Maculopathy with Distinct Multimodal Imaging Features: A Case Report

Boutayna Azarkan — 2026-06-05

Background: Torpedo maculopathy (TM) is an uncommon congenital abnormality of the retinal pigment epithelium (RPE), characterised by a distinctive torpedo-shaped lesion that is typically situated temporal to the fovea. The condition is most frequently identified incidentally in asymptomatic individuals and may be categorised into various subtypes according to optical coherence tomography (OCT) characteristics.

Case Presentation: A 45-year-old asymptomatic male underwent routine ophthalmic evaluation. Best-corrected visual acuity was 20/20 in both eyes. Fundus examination of the right eye revealed a well-defined torpedo-shaped hypopigmented lesion located approximately two disc diameters temporal to the fovea. Multimodal imaging demonstrated characteristic features of Type 2 torpedo maculopathy. Fundus autofluorescence showed predominantly hypoautofluorescence with a focal hyperautofluorescent temporal tip. OCT revealed preservation of the inner retinal layers, thinning of the outer nuclear layer, outer retinal cavitation, and increased choroidal transmission. OCT angiography showed no evidence of choroidal neovascularisation and demonstrated preserved choriocapillaris architecture surrounding the lesion. The left eye was normal.

Conclusion: This case highlights the diagnostic value of multimodal imaging in the identification and characterisation of Type 2 torpedo maculopathy. The presence of a hyperautofluorescent lesion tip, preserved inner retina with outer retinal cavitation, and intact surrounding choriocapillaris on OCTA provides additional imaging insights that may facilitate differentiation from other hypopigmented macular lesions. Although generally benign, periodic follow-up remains advisable to monitor for rare complications such as choroidal neovascularisation.