International Journal of Medical Students

Antibiotic Use Awareness and Practices in the Indian Community During Later Stages of COVID-19 Pandemic: A Cross-Sectional Survey

Hiyanoor Ghosh — 2024-07-09

Background: An increased overuse of antibiotics coupled with dearth of newer alternatives has worsened antibiotic resistance in LMIC’s like India. The prescription of antibiotics for symptoms similar to COVID-19 infection has aggravated the problem of antibiotic overuse, further worsening antibiotic resistance. This study aims at understanding not only the extent of overuse, but also the social patterns and causes of over-prescription or self medication of antibiotics in India.

Methods: A cross-sectional survey of the knowledge, attitude and practices on antibiotic use was conducted from September to October, 2022, using a Google form questionnaire. A virtual snowball technique was used to recruit respondents.

Results: A total of 309 responses were received (56% female and 44% male). 59.5% of the respondents were between 15 to 30 years. Surprisingly, in spite of a majority of respondents (around 70%) having a health sciences background, 67.8% of respondents falsely believe that antibiotics speed up recovery from most coughs and colds. 94.8% of respondents had used antibiotics in the last one year. 17.2% of respondents had taken antibiotics without the prescription of a doctor. The most common antibiotic used on prescription and self-medication was Azithromycin. Only 20.7% of respondents took antibiotics on suspicion of having COVID-19, with the most common one being Azithromycin.

Conclusion: The study highlights that a greater knowledge on antibiotic use does not necessitate better attitude towards their cautious and rational use. The use of antibiotics for self-limiting indications like cough, cold and sore throat needs to be restricted through stricter regulations.

Blindness Disparities Between Racial/Ethnic Groups in the State of Texas

Angelica Garcia — 2024-07-09

Background: There are disparities in health outcomes between races. Blindness is associated with decreased quality of life and negative health outcomes. There is little published data investigating the difference in the prevalence of blindness between races/ethnicities nationally and in Texas.

Methods: This retrospective observational study investigates the differences in crude prevalence of blindness between different race/ethnicities in Texas. Data was gathered from the Centers for Disease Control and Prevention (CDC) website Vision and Eye Health Surveillance System (VEHSS) using the most recently available Compositive Estimate data from the state of Texas. The variables compared were age groups and race/ethnicity categories of Black, non-Hispanic, Hispanic, any race and White, non-Hispanic, referred to as “Black,” “Hispanic,” and “White” respectively. The logs of the relative ratios and Z scores were used to compare each age group.

Results: The Black group consistently had the highest crude prevalence of blindness across age groups; The White group had the lowest prevalence. The Hispanic group consistently had prevalence rates that were between the Black and White groups. No differences were found to be statistically significant.

Conclusion: This data shows that, despite ongoing diversity and inclusion efforts, ongoing inequalities exist in healthcare outcomes. In the state of Texas, this is made apparent by the difference in blindness prevalence between Black, Hispanic, and White populations. These data can be used to bring about change that needs to be addressed at the state and institutional level.

A Cross-Sectional Survey of Instagram to Assess Quality and Reliability of Information Regarding Tuberculosis

Rohan Singhal — 2024-07-09

Background: Tuberculosis is one of the oldest diseases known to affect humans and a major cause of death worldwide. The National Strategic Plan 2017-2025 aims to eliminate tuberculosis by 2025. Appraising knowledge and awareness of tuberculosis are essential for successful tuberculosis control, given the significance of social and psychological variables in determining health outcomes.

Methods: A cross-sectional observational study was conducted wherein, the top six hashtags related to “Tuberculosis” on Instagram, identified by the maximum number of posts were taken. A questionnaire was made for assessment of these posts based on various pre-determined categories- type of post, type of information circulated and to assess if it is “true”, “false” or “cannot be determined” using the WHO Factsheet on Tuberculosis & CDC.

Result: A total of 370 posts were found to be relevant according to the inclusion criteria and had vast user interaction These posts created and uploaded by the health and wellness industry comprised of 27.02%, followed by doctors at 20.27% and news agencies at 5.96%. 50.54% of the posts analyzed contained a description of tuberculosis and 20% about prevalence and diagnosis The posts by doctors and health and wellness industry had a statistically significant higher number of posts that contained “true” information and scored statistically significantly higher on the mean of Global Quality Scores and Reliability Scores.

Conclusion: Social media is a powerful medium for disseminating scientific facts on TB. The government and policymakers need to develop internet-based programs and interventions to improve knowledge, attitudes, and practices towards TB.

Determining the Prevalence and Severity of Menopausal Symptoms in Post-Menopausal Women of Eluru, Andhra Pradesh, India, using the Menopause Rating Scale (MRS)

Anjali Mediboina — 2024-07-09

Background: This study aimed to assess the prevalence and severity of menopausal symptoms among women in Eluru, Andhra Pradesh, India, to better comprehend the specific challenges faced by rural women during this transitional phase.

Methods: Post-menopausal women who visited the Rural Health and Training Center in Eluru between September-November 2021 and had one year of amenorrhea were included. A face-to-face interview administered a questionnaire to collect socio-demographic details and the Menopause Rating Scale (MRS) which contained 11 questions using a 4-point Likert scale. Microsoft Excel and SPSS-20, with one-way ANOVA test were used for data and statistical analysis.

Results: A total of 100 respondents were included, aged between 45-60 years. Majority of the respondents (37%) were aged 45-50 years and were unskilled workers (53%) with a monthly income falling under the upper middle-class category (53%). Additionally, 61% belonged to nuclear families. Using the MRS, joint and muscle pains were the most prevalent symptoms (82%), followed by sleep problems (64%) and anxiety (57%). Heat discomfort was reported least frequently (25%). Age groups and symptom severity were found to be significantly associated, indicating that women between 45-50 years were more likely to experience mild-severe symptoms.

Conclusion: This study identified a notable prevalence of menopausal symptoms among women in Eluru; however, limitations included the limited sample size and geographic scope. Retrospective data collection might have introduced recall bias. The study highlights the need for increased awareness and education on menopause. Community-based programs and health centers should be established to address these needs.

Learning of Intimate Area Examination Amongst Pakistani Medical Students: Knowledge, Attitudes, and Practices Study

Masooma Bakhtiari — 2024-07-09

Background: Intimate area examination (IAE) is an integral part of clinical examination skills and must be mastered by medical students before they start their careers. This study explores the experiences of Pakistani medical students regarding learning of IAE, the associated barriers and their effects on students’ learning.

Methods: This cross-sectional study, based on a self-designed questionnaire, was conducted at two Pakistani medical colleges, which included final year students and postgraduate trainees.

Results: During their undergraduate training, 74.9% of the respondents had not conducted a female pelvic examination, 51.9% had not examined a female groin, 79.7% had not examined a female rectum, and 72.7% had not examined a male rectum. From the 65 postgraduate doctors, 48.4% reported that they were not prepared to perform an IAE at the start of their clinical career. Regarding barriers to IAE learning, more than half of the respondents felt that the opposite gender of the patient (64.7%) and patient’s refusal (63.1%) had a strong negative effect on IAE learning. A high percentage of respondents reports that they were not taught IAE during their undergraduate years. Among the currently used pedagogical techniques, 71.1% of the respondents opted for real patient-based learning, followed by clinical simulations (21.9%), and videos (7.0%). No one thought examination should be taught theoretically. A significant difference between male and female experience in IAE learning was also observed.

Conclusion: Learning of IAE remains unsatisfactory and poses a major challenge for the Pakistani Medical Students in the institutes included in this study.

Leveraging a Podcast Series for Nutrition Education in Medical Curriculum

John Vellek — 2024-07-09

Background: Malnutrition is a worldwide problem. Despite the paradoxical global prevalence of both an obese and underfed population, physicians have historically fallen short in their efforts to combat this epidemic. Unfortunately, medical education has only recently prioritized nutrition curriculum, and its incorporation has been slow. The Culinary Medicine Interest Group (CMIG) at New York Medical College (NYMC) aims to expand access to nutrition education in medical school.

Methods: The CMIG podcast was conceived as an adjunct to the preclinical curriculum. Podcasts were distributed via the NYMC learning-management system in parallel with pre-clinical curriculum and made widely available via Spotify, YouTube, and Google Podcasts. A pre-podcast survey was conducted to establish a baseline of nutrition knowledge in the NYMC student population, and a post-podcast survey was also distributed.

Results: During 2022-2023, twelve episodes covering various nutrition-related subspecialty topics were released. We received 76 pre-podcast survey responses which made the need for nutrition curriculum clear: 37% reported no experience with nutrition, less than half took coursework that covered nutrition, 59% were uncomfortable discussing eating disorders, and only 21.5% reported feeling comfortable discussing diet in relation to menopause. Post-podcast survey responses could not be analyzed due to low participation.

Conclusion: Limited survey responses hinder conclusions about the podcast's potential impact; we believe this is related to the lack of value conferred upon content beyond the scope of mandated material. Nevertheless, baseline data support the need for more nutrition curriculum; we present a novel approach to expanding access to nutrition curriculum in medical education.

Skipping Breakfast is Associated with Shorter Sleep Duration in Medical Students

Harsh Bhoopatkar — 2024-07-09

Background: Breakfast skipping is common in young adults, including medical students. Poor sleep quality is also common in medical students. Sleep quality and duration are important determinants of health and wellbeing. The aim of the study is to explore the novel association between medical students’ frequency of breakfast consumption with sleep quality and duration.

Methods: Year 3 medical students completed a survey at the end of 2018. Data collection included demographic information, the Pittsburgh Sleep Quality Index (PSQI) and breakfast consumption in the month before their end-of-year clinical assessment.

Results: The response rate for the survey was 76.6% (216/282). Forty-five percent of medical students skipped breakfast at least once in an average week and 56.9% of students had poor sleep quality (as defined by PSQI scores > 5). There was a statistically significant association between a higher frequency of breakfast skipping and shorter sleep duration (Kendall’s tau-b, P = 0.012). Regression analysis also showed that breakfast frequency had a statistically significant impact on sleep duration (P = 0.048).

Conclusion: Breakfast skipping is common in medical students. Furthermore, breakfast skipping is significantly associated with a shorter sleep duration. This knowledge could empower medical students to optimize their routines for better sleep and general health.

Transforming Toxic Research Cultures: Protecting the Future of Medical Students and Early Career Researchers – Part I

Hamrish Kumar Rajakumar — 2024-07-09

Have you ever felt your passion for research slowly erode under the weight of unfair practices and relentless pressure to publish? Or been denied authorship credit for work you tirelessly contributed to? If so, you are not alone. This is the harsh reality for many medical students and early career researchers trapped in a “toxic research culture.” This hidden crisis undermines the integrity of medical research and jeopardizes the well-being and career prospects of those eager to advance science. Despite its prevalence, this issue remains shrouded in silence, propagating cycles of harm and hampering scientific progress.

This editorial explores the evolution of medical research culture, defines the harmful practices that constitute a toxic environment, and highlights the vulnerability of junior researchers to such practices. Manifestations of toxicity, including bullying, harassment, and unethical authorship practices, are analyzed along with their detrimental impacts on mental health. Current policies and strategies for promoting a healthier research environment are discussed. We highlight the urgent need for reforms, including the promotion of whistleblowing without fear, diversifying leadership, revising evaluation criteria, and implementing educational interventions on research ethics as a preventive measure. Additionally, we explore the impact of fake mentors within academia, advising vigilance against individuals who exploit their roles for personal agendas rather than genuine mentorship.

Through a call to action, we urge stakeholders and institutions to safeguard junior researchers and uphold the integrity of scientific research. IJMS plays a crucial role in this transformation by promoting mentorship, ethical practices, and accessible research.

A Medical Student Experience as an Acting Intern in Colorectal Surgery

Sidharth Misra — 2024-07-09

Gaining hands on clinical experience in the US as a medical student is an important prerequisite for securing a residency spot in the US. These clinical electives in surgery enable the medical student to witness the process of providing healthcare to patients from the time of the first clinic visit to the post operative recovery phase of the patient after surgery. This is especially crucial for international medical students who are used to a different type of medical system back in their home country. Getting an opportunity to rotate in the department of Colorectal surgery at the Cleveland Clinic is an opportunity of a lifetime. This is my experience at the Cleveland Clinic as an acting intern.

Conducting Research as a Medical Student: A Need for Change

José Rodrigues Gomes — 2024-07-09

This article is a short opinion piece addressing the personal and professional importance of performing research, while also highlighting some of the difficulties we might face while doing so. With this said, a historical perspective on research conducted by medical students is given, which exemplifies the significance of this component in students' lives and future careers. Alongside this, the statistics also exemplify the student's desire to do more research and how universities have failed to meet students’ expectations. Finally, some examples of small but immediate measures are offered that can help reform medical curricula through new mentorship regimes, better communication, more financial support, and better overall opportunities that will be key in motivating more students to conduct research.

Silent Suffering: Recognizing and Addressing the Emotional Impact of Patient Loss on Medical Students

Grace Kim — 2024-07-09

Experiencing patient loss is emotionally challenging for many medical students. This narrative reflects on the author's encounter with sudden patient loss and the complex emotions it evoked. The commentary underscores the need to prioritize emotional support for medical students dealing with patient loss. The author proposes ways to accomplish this, including equipping students with effective coping mechanisms, creating a supportive environment that encourages students to seek debriefing sessions, and incorporating debriefing sessions into clerkship curricula. By normalizing the emotional complexities of patient loss and fostering a culture of support, medical education can better prepare students to navigate the challenges of patient care with compassion and resilience.

Cover, Credits, & Content

Executive Committee of IJMS — 2024-07-09

Exploring the Impact of COVID-19 on the Healthcare System and Vulnerable Populations in the United States

Rachel Williams — 2024-07-09

Beginning in early 2020, SARS-CoV-2, the virus responsible for COVID-19, spread across the world, giving rise to a global pandemic that impacted billions of people. Surprisingly, the United States was among one of the worst affected countries with over a million deaths. The purpose of this review is to discuss the impact of COVID-19 in the United States from the perspectives of government policies and the U.S. healthcare system. The emergence of multiple viral variants was at the center of sequential waves of infection in the U.S., resulting in increased number of cases, hospitalizations, and deaths along with associated mental health sequelae in the population. Lack of uniform policies at the local, state, and federal levels exacerbated the situation. These factors contributed to significant healthcare worker burnout. Furthermore, the disease caused higher morbidity and mortality rates in specific groups such as lower average socioeconomic status, rural and underserved communities, Native Americans and African Americans, and older age groups (65+ years). The lessons learned from this broad analysis highlight many inadequacies and challenges experienced in the U.S. during the pandemic. Here we propose several suggestions for healthcare and government responses in the event of future unanticipated healthcare crises.

The Factors Causing Stress in Medical Students and their Impact on Academic Outcomes: A Narrative Qualitative Systematic Review

Thensiniya Jeyapalan — 2024-07-09

Background: This study investigated the causes of stress in medical students and the impact of stress on their academic outcomes. Much is known about the impact of stress on medical students but there is a gap in knowledge regarding the collated overview of literature in this area. This study sought to pull together disparate research to gain a clearer overview of the core drivers of stress.

Methods: Taking a meta-level approach, a narrative qualitative systematic review of previous systematic reviews was undertaken, following the PRISMA guidelines. This systematic review covered literature published from 2009-2023 where the focus was stress in students studying at medical schools in the United Kingdom. Findings were then assessed for commonly emerging themes.

Results: From an initial tranche of 3394 articles, a final set of eight systematic reviews was identified. The eight reviews drew on over 309 separate research projects and involved over 500,000 participants. A review of the key findings from each of the eight studies identified five themes: academic pressure, the impact of the institution, students’ personality traits, social relationships, and financial stress. The analysis provided clear evidence that stress amongst medical students results in negative academic outcomes.

Conclusion: The findings suggest a need to reduce stress to help medical students prevent a decline in their academic outcomes and health. From these findings it is recommended that medical schools examine their curriculum to identify areas where they feel they put undue academic pressure on their students and work on ways to remediate this situation.

A Case Report of Bardet Biedl Syndrome in a Patient from Pakistan who Presented with Osmotic Symptoms associated with Diabetes Mellitus

Bakht Babar — 2024-07-09

Background: The primary features of Bardet Biedl syndrome (BBS) are characterized by retinal degeneration, central obesity, post-axial polydactyly, intellectual impairment, hypogonadism, and renal anomalies. The secondary clinical features are syndactyly, delay in the achievement of developmental milestones, diabetes insipidus, diabetes mellitus, congenital heart disease and liver involvement. It is diagnosed when a patient has either four primary or three primary and two secondary clinical features and the management depends upon those predominant features.

Case presentation: A 12-year-old boy presented with polyuria, polydipsia and polyphagia. His developmental milestones were delayed and had syndromic features on physical exmination. Ultrasound of the abdomen and pelvis showed mild right-side hydronephrosis. His BMI was 28 and HbA1c was 18.3%, and values of LH and FSH were decreased. As a result, he was diagnosed with a case of BBS. He was commenced on insulin therapy with Insulin Regular (Human Insulin)and Insulin NPH (Human Insulin).

Conclusion: Patients presenting with polyuria, polydipsia, polyphagia along with the presence of syndromic features, should be assessed for BBS as osmotic symptoms associated with diabetes mellitus can be initial clinical presentation of BBS. Its management depends upon the signs and symptoms of the patient. Various options including weight loss, exercise, oral hypoglycemic drugs, and insulin are available to treat diabetes mellitus in BBS. Some cases can have very high levels of HbA1c on initial presentation, which may require insulin without trying oral hypoglycemic drugs to treat diabetes mellitus in BBS.

Disseminated Tuberculosis with Testes Involvement: An Intriguing Case Report

Arnab Kundu — 2024-07-09

Background: Disseminated tuberculosis (TB) is the presence of two or more noncontiguous sites resulting from hematogenous dissemination of Mycobacterium tuberculosis. We report a case of disseminated TB with testicular involvement.

Case: A 21-year-old male patient presented to the outpatient department with bilateral testicular enlargement and tenderness for last six months. It was suspected to be a case of epididymo-orchitis and empirical antimicrobial therapy was initiated. However, ultrasonography findings were inconsistent with epididymo-orchitis. Two weeks later the patient again presented with increased nodularity in the right testes. Non-seminomatous germ cell tumor was suspected. However, tumor markers came back normal. Magnetic resonance imaging revealed enlarged lymph nodes in the right inguinal and retroperitoneal region raising a suspicion of testicular lymphoma. Positron emission tomography with computed tomography showed multiple lymphadenopathies. Histopathology of the left axillary lymph node finally confirmed the diagnosis to be tuberculosis. No drug resistance were found and the patient responded well to anti-tubercular drugs.

Conclusion: Diagnosing disseminated TB is difficult as it mimics conditions, such as infarction, cancer, torsion, etc. Attention to small details is necessary. We faced a similar situation in our patient. The patient went through a myriad of tests before finally being diagnosed with TB. Histopathological study was able to get it whereas cytology could not. Similar and totally opposite cases were found in the literature. This highlights the difficulty and importance of these type of cases.

Continuous Rifampicin Therapy Induced Acute Kidney Injury in a Tuberculous Patient: A Case Report

Muqsit Ali Shaukat — 2024-07-09

Background: Tuberculosis (TB) presents with productive cough, hemoptysis, chest pain, fever, weight loss, and night sweats. Anti-tuberculosis treatment (ATT) can affect various organs, including the liver and kidneys. ATT-induced acute kidney injury (AKI) presents with fever, rash, nausea, vomiting, diarrhea, and abdominal pain. It occurs due to type 2 or 3 hypersensitivity and affects individuals who have previously used rifampicin or are currently using it intermittently.

Case: An 60-year-old lady was diagnosed with TB and started on ATT. After a few days, she complained of reduced food intake and vomiting, yellow discoloration of the skin, abdominal pain and distention, and limb swelling. She was diagnosed as a case of ATT-induced AKI. She didn't have past exposure to rifampicin and was continuously using it this time.

Conclusion: The key learning point from this case is that ATT-induced AKI can develop even when used in a continuous dosing regime and upon first time exposure despite no history of past exposure. This prompts vigilance in monitoring renal function in patients being started on ATT regimen. This is becasuse, ATT-induced AKI poses risk to patient’s life and there is a possibility of developing resistance to anti-tuberculous therapy as a result of discontinuation of treatment. Furthermore, our case suggests that, in addition to immune-mediated mechanisms described in literature for ATT-induced AKI, other pathophysiological mechanisms might also be linked to this pathology and need further research for better understanding and optimization of treatment strategies.