Medicine and Therapeutics Reviews (MTR) is an open access, peer-reviewed medical journal dedicated to the dissemination of high-quality research articles, authoritative reviews and novel ideas. Unlike many traditional medical journals, MTR recognizes the importance of negative reports, providing a unique platform for the publication of studies that yield negative or inconclusive results. The journal aims to promote transparency, scientific rigor, and the advancement of medical knowledge by showcasing a comprehensive range of research findings. MTR stands out from other medical journals by actively encouraging the submission and publication of negative reports. Negative reports are studies that produce results that do not support the original hypothesis or fail to demonstrate a significant effect of a treatment or intervention. These reports often face challenges in finding publication avenues due to biases towards positive findings, which can lead to an incomplete and biased scientific literature. This journal accepts such manuscripts for publication provided that the genesis of the failed hypothesis is described and justified rationally and possibles reasons for the failure of hypothesis is adequately dealt with in the discussion section along with detailed methodology of the study
Is medical science the tipping point of AI?
Copyright (c) 2025 Medicine and Therapeutics Reviews
Acetazolamide for the prevention of acute mountain sickness: a systematic review and meta-analysis
Background: Acute mountain sickness (AMS) is a frequent complication among individuals ascending rapidly to high altitude and, if unrecognised or untreated, may progress to life-threatening high-altitude cerebral or pulmonary edema. Prophylactic pharmacotherapy is recommended for high-risk travellers, and acetazolamide is the most widely used agent. However, variability in trial designs and dosing regimens has led to ongoing uncertainty about the magnitude of benefit. Objectives: To evaluate the effectiveness of acetazolamide, compared with placebo, in preventing AMS in individuals ascending to high altitude. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing acetazolamide with placebo for AMS prevention. Electronic databases (PubMed, Ovid, Cochrane Library, Scopus and MEDLINE) were searched from inception to 2024 using the terms “acetazolamide”, “acute mountain sickness” and “prevention”. Studies enrolling participants at risk of AMS and reporting AMS incidence as a primary outcome were eligible. Duplicate publications and studies assessing only outcomes other than AMS prevention were excluded. Data were pooled as risk ratios (RRs) with 95% confidence intervals (CIs) using RevMan 5.4. Heterogeneity was quantified with the I² statistic. Risk of bias was assessed with theCochrane Risk of Bias (RoB-1) tool and visualised using robvis. Results: From 184 records identified, 25 RCTs, including 2,433 participants, met eligibility criteria. Compared with placebo, acetazolamide significantly increased the proportion of participants who remained free of AMS (pooled RR for being AMS-free 1.20; 95% CI 1.12–1.29; p < 0.00001). Moderate statistical heterogeneity was observed (I² = 54%; p for heterogeneity = 0.0008), indicating variability in effect estimates across trials, but the direction of effect consistently favoured acetazolamide. Conclusions: This meta-analysis of 25 randomized trials demonstrates that acetazolamide prophylaxis is effective in reducing the risk of AMS in individuals ascending to high altitude. In the absence of contraindications, acetazolamide should be considered as a key pharmacological strategy for AMS prevention in at-risk travellers, alongside gradual ascent and other non-pharmacological measures.
Teratogenic Effect of Levetiracetam on Albino Mice Placentae
Background: Levetiracetam is widely used as a newer antiepileptic drug in women of reproductive age, but data on its teratogenic effects, particularly on the placenta, are limited. This experimental study evaluated dose-related placental changes following prenatal exposure to levetiracetam in albino mice. Methods: Forty F1-generation pregnant Swiss albino mice were randomly allocated to four groups (n=10 each). Group I received intraperitoneal distilled water (control). Groups II–IV received levetiracetam 600, 1200 and 1800 mg/kg body weight, respectively, from gestational day (GD) 5–11. All dams were sacrificed on GD19. Placentae were weighed, examined grosslyand processed for histology (H&E). Trophoblastic, mucoid and fibrinoid degeneration and presence of dilated vessels were recorded. Data were analysed using one-way ANOVA and chi-square tests. Results: Mean placental weight differed significantly among groups (F=5.300, p<0.001), being lower in Group II and higher in Groups III and IV compared with controls. Levetiracetam exposure produced marked, dose-related histopathological changes. Trophoblastic degeneration was present in 10% of control placentae versus 93.3%, 84% and 86.96% in Groups II–IV, respectively (p<0.00001). Mucoid degeneration occurred in 1.8% of controls vs 40%, 62% and 91.3% in Groups II–IV. Fibrinoid degeneration was found in 5.5% of controls vs 44.4%, 64%and 87% in Groups II–IV, while dilated vessels were seen in 1.8% of controls vs 2.2%, 20% and 93.5% in Groups II–IV (all p<0.00001). Conclusion: Prenatal exposure to levetiracetam during organogenesis produced significant, dose-related placental degenerative changes in albino mice. These findings suggest potential teratogenic risk at the placental level and underline the need for cautious use and further mechanistic and clinical studies in pregnancy.
Case Report of Anaemic Retinopathy in a 25 year old Male
Anemic retinopathy, characterized by retinal hemorrhages and other vascular abnormalities, is a rare ocular manifestation associated with systemic conditions such as anemia (1). The report presents case of a 25-year-old male diagnosed with anemic retinopathy presenting with Roth spots, flame-shaped hemorrhages, and pre-retinal hemorrhage. This report underscores the importance of recognizing ocular manifestations of systemic diseases and highlights the significance of prompt ophthalmologic evaluation in patients with anemia.
Misoprostol induced Hyperpyrexia mimicking Sepsis: A Case Report
Background: Misoprostol, a prostaglandin E1 analogue widely used for cervical ripening and labor induction, is known to cause transient pyrexia and shivering. However, high-gradehyperpyrexia mimicking sepsis is uncommon and may lead to unnecessary investigations and antibiotic exposure. Awareness of this adverse effect is essential to avoid misdiagnosis andovertreatment. Case Presentation: A 28-year-old primigravida at 41+2 weeks of gestation underwent induction of labor for post-datism. Following an uneventful antenatal course, she received 25 μgintravaginal misoprostol. A second identical dose was administered after four hours. Ninety minutes later, she developed sudden high-grade fever (104.5°F), chills, rigors, tachycardia (132bpm), and mild tachypnea. Blood pressure remained stable (110/70 mmHg) and fetal heart rate was reassuring (150 bpm). There were no signs of uterine tenderness or foul-smellingdischarge. In view of suspected sepsis, complete blood counts, urine analysis, and blood and urine cultures were obtained and broad-spectrum intravenous antibiotics were initiated. The feverresolved spontaneously within seven hours without hemodynamic compromise. Labor progressed normally and she delivered a healthy neonate vaginally. All cultures remained negative at 48hours; antibiotics were discontinued and the postpartum period was uneventful. Conclusion: Misoprostol-induced hyperpyrexia is a rare but benign adverse effect that may closely resemble sepsis. Clinicians should recognize this presentation, particularly in the absenceof other infectious features, to prevent unwarranted interventions. Vigilance, timely assessment, and expectant observation can minimize maternal morbidity and avoid unnecessary antibioticuse while ensuring maternal-fetal safety.
Partial Atlanto-Occipital Assimilation in a Dry Human Skull: An Osteological Case Report and Clinical Implication
Background: Atlanto-occipital assimilation, also termed occipitalization of the atlas, is a congenital craniovertebral junction anomaly characterized by partial or complete bony fusion of the atlas (C1) with the occipital bone. Although many individuals remain asymptomatic, such fusion can alter the anatomy of the foramen magnum and predispose to atlantoaxial instability and neurovascular compromise in some patients. Case description: During routine osteology teaching in the Department of Anatomy, AIIMS Guwahati, a dry adult human skull with an attached atlas vertebra was found to exhibit partial fusion between the atlas and the occipital bone. Fusion involved the anterior arch of the atlas and the anterior and lateral margins of the foramen magnum, while the posterior margin remained unfused. The anteroposterior and transverse diameters of the foramen magnum measured 3.2 cm and 3.0 cm respectively, lying toward the lower end of reported normal adult ranges. Three distinct foramina were observed: a right posterior condylar foramen, an accessory anterior tunnel-like foramen between the fused anterior arch and the anterior margin of the foramen magnum, and bilateral intervertebral foramina for the first cervical nerve. Conclusion: This specimen represents a combined anterior and lateral partial occipitalization. Despite near-normal linear dimensions of the foramen magnum, the altered bony configuration around the craniovertebral junction could have important clinical implications in vivo, particularly for radiological interpretation and surgical planning.