International Journal of Medical Students

Cover, Credits, & Content

Executive Committee of IJMS — 2025-01-01

Abstracts of the 8th International Academic Medical Congress of Maranhão (VIII COIMAMA) 2023

Executive Committee of IJMS — 2024-08-01

Abstracts of the 9th International Academic Medical Congress of Maranhão (IX COIMAMA) 2024

Executive Committee of IJMS — 2025-01-01

Empowering the Research Future of Medical Students: Reflections on the Third Edition of the IJMS World Conference of Medical Student Research (WCMSR), 2024

Omar Aljbour — 2025-01-01

The third edition of the IJMS World Conference of Medical Student Research (WCMSR) highlighted the significance of fostering research opportunities for medical students worldwide. Held on October 26, 2024, the event featured 35 authors from 19 countries, presenting 40 abstracts through oral and video presentations. Accessible to a global audience via YouTube Live, the conference attracted over 1,000 viewers who engaged in discussions and voting. The event emphasized the importance of affordable, inclusive participation, offering students a platform to showcase their research, gain feedback from experts, and build professional networks. With a nominal fee, IJMS removed financial barriers to entry, ensuring equitable access for junior researchers. The conference continues to empower medical students to advance their research, academic, and clinical skills, fostering a global community dedicated to the future of medical science.

Effects of a Low-Dose Cardiac Rehabilitation Program on Cardiovascular Conditioning Parameters in Patients with Heart Disease

Pablo Reyes — 2025-01-01

BACKGROUND: Cardiac rehabilitation is a high-evidence ischemic heart disease. The optimal dose of rehabilitation is not well defined due to the heterogeneity of studies.

AIM: To evaluate the effects of low-dose cardiac rehabilitation on cardiovascular performance parameters in patients with heart disease.

METHODS: A longitudinal, retrospective, observational, and analytical study was conducted. Adult patients who enrolled in the cardiac rehabilitation program were included, excluding or removing those without a history of cardiovascular disease, those who did not complete at least 5 rehabilitation sessions, and those with less than 80% attendance at rehabilitation sessions. Results from the initial and final (comparative) conventional and/or cardiopulmonary exercise tests were obtained, which included functional capacity in METs, chronotropic response, pressor response, heart rate and blood pressure recovery, double product, presence or absence of ischemia, arrhythmias, determination of ischemic threshold, and ergospirometry parameters such as peak VO2, VE/VCO2, O2 pulse, and aerobic and anaerobic thresholds.

RESULTS: A total of 32 patients were included, of whom 65.6% were male. A significant increase was observed in peak VO2 achieved (20.7 vs. 24.2 ml/kg/min, p=<0.001) and the percentage of predicted VO2 achieved (76.3% vs. 94.5%, p=<0.001) when comparing initial and final maximal exercise tests. Improvement was found in ergometric performance indices, FC/W index (1.18 vs. 1.02, p=0.043) and DP/W index (1.78 vs. 1.39, p=0.041). No significant difference was found regarding pressor or chronotropic response parameters, heart rate and blood pressure recovery, or double product.

CONCLUSION: It was concluded that in patients with heart disease, a low-dose cardiac rehabilitation program is effective in improving cardiovascular conditioning parameters such as peak VO2 and reducing the ischemic threshold

Factors Associated with Greater In-hospital Functional Recovery After Acute Ischemic Stroke with a Social Service Program in Physical Rehabilitation.

Fernando Tienda-López — 2025-01-01

BACKGROUND: Acute Ischemic Stroke (AIS) is one of the main causes of morbidity and mortality worldwide. In this pathology, early physical rehabilitation (<72 hours) is a challenge in public hospitals in Mexico.

AIM: Evaluate the factors that influence the effectiveness of early rehabilitation after AIS.

METHODS: Observational, prospective, and analytical study. The sample included all AIS patients admitted from 2022-2024 in the Neurology Service of the “Dr. José Eleuterio González” University Hospital of the UANL and registered in the stroke registry i-Registro-Neurovascular (iReNe). All the patients received early rehabilitation by students of the Medical Technical School in Physical Rehabilitation in the Neurovascular Care Unit of the Neurology Service. The change at admission and discharge in the Lovett, Ashworth, Barthel, and NIHSS scales was evaluated. Descriptive statistics were performed. A logistic regression model was conducted to evaluate the predictors of a reduction in NIHSS score≥4. We considered significance at p<0.05 with 95% CI, using SPSSv25 for statistical analysis.

RESULTS: A total of 296 patients were included, 149 (50.3%) were female, mean age 61.4±12.9 years, mean 4.0±3.4 rehabilitation sessions. The average length of stay was 7.0±4.9 days. The most prevalent risk factors for AIS were hypertension (55.9%), type 2 diabetes mellitus (41.3%) and sedentary lifestyle (39.5%). There was a significant improvement in the median admission and discharge times in NIHSS (8 IQR 4-13 vs 5 IQR 2-11, p<0.001), Barthel (40 IQR 20-65 vs 45 IQR 20-75, p<0.001), Lovett (3 IQR 1-4 vs 3 IQR 2-4, p<0.001) and Ashworth (0 IQR 0-1 vs 0 IQR 0-1, p=0.003); the percentage of patients who showed some improvement was 55.9%, 25.8%, 32.2% and 11.8%, respectively. The 44.8% were discharged with NIHSS≤4; 25.1% of patients presented a significant reduction in NIHSS≥4, and it was associated with female gender (OR 2.033, IC95 1.092-3.785, p=0.024), tobacco withdrawal (OR 3.111, IC95 1.321-7.328, p=0.009) and previous use of antithrombotics (OR 3.015, IC95 1.455-6.248, p=0.003).

CONCLUSION: Gender, smoking, and use of antithrombotics influence early recovery from AIS. Involvement of students in rehabilitation facilitates functional recovery during hospitalization and represents an efficient and low-cost strategy specially in developing countries like Mexico, being beneficial for students, hospitals and above all, for patients.

Anti-NMDA Encephalitis Associated with a Mature Ovarian Teratoma: A Compelling Case Report

Antonio Medina Luna — 2025-01-01

BACKGROUND: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a paraneoplastic and autoimmune disorder characterized by prominent neuropsychiatric manifestations. About 80% of reported cases occur in females, and approximately half of these patients have an ovarian teratoma. The NMDA receptor, located in the hippocampus and forebrain, plays a critical role in memory, cognition, and learning. The pathogenesis of anti-NMDAR encephalitis is driven by an autoimmune mechanism in which the body produces autoantibodies (anti-NMDAR) that internalize and alter the NR1 subunit of the NMDA receptor, leading to decreased synaptic function and neuropsychiatric symptoms. Anti-NMDAR encephalitis accounts for 54% to 80% of autoimmune encephalitis cases. First reported in 2007, two young female patients (ages 15 and 19) with ovarian teratomas exhibited neuropsychiatric symptoms such as psychosis, seizures, autonomic instability, memory loss, dyskinesias, and speech disorders, all of which improved significantly after teratoma removal (Zhang et al., 2020; Lui et al., 2022). The average age of onset is 21 years, but cases have been reported in patients ranging from 8 months to 85 years. Early surgical excision of the teratoma and immunosuppression can lead to better outcomes and reduced relapse rates. Anti-NMDAR encephalitis is the most common cause of encephalitis in patients under 30 years, often misdiagnosed due to its varied clinical presentations.

THE CASE: We present the case of a 56-year-old female with no medical history who was admitted to the emergency room on February 15, 2023, with dysphagia, anorexia, drowsiness, nausea, muscle weakness, altered mental state, confusion, and unresponsiveness. Initially diagnosed with anxiety and major depressive disorder with psychotic symptoms at Methodist Hospital in Houston, she was treated with multiple medications but showed no significant improvement. Her condition deteriorated, with worsening cognitive, psychiatric, and motor function. Upon transfer to Hospital Ginequito in Monterrey, Mexico, on March 26, 2023, further evaluation revealed cortical atrophy on MRI, macrocytic anemia, electrolyte imbalances, and primary hypothyroidism. Despite treatment for suspected HSV-associated limbic encephalitis, her condition continued to decline, leading to generalized seizures. Anti-NMDA receptor encephalitis was diagnosed based on positive anti-NMDAR antibodies in serum and cerebrospinal fluid. An abdominopelvic CT scan identified a mature ovarian teratoma in the left ovary, measuring approximately 891 cc. Given the strong association between ovarian teratomas and anti-NMDA receptor encephalitis, she underwent a left salpingo-oophorectomy. Pathology confirmed a teratoma with a mural nodule containing osseous, neural, glial, and gastrointestinal tissue. Following immunotherapy with IV methylprednisolone and immunoglobulins, as well as the surgical removal of the teratoma, the patient showed significant clinical improvement. She regained mobility and cognitive function and was stable at the one-month follow-up.

CONCLUSION: In the present case, a diagnosis of anti-NMDA receptor encephalitis was reported, after the presence of a mature ovarian teratoma containing neural tissue. This finding is uncommon in this pathology and has been proposed as the triggering factor for the reported encephalitis. Anti-NMDA receptor encephalitis involves various stages of the disease, which can potentially lead to death. Due to the broad spectrum of symptoms, it can mimic other psychiatric disorders, underscoring the importance of serological examination.

Enhancing Medical Education: The Impact of Deliberate Practice on Learning Human Physiology

Júlia Silva Souza — 2025-01-01

BACKGROUND: Simulation-Based Learning (SBL) is a teaching method that remains underutilized at the undergraduate level of health education, despite several studies highlighting its potential. Active teaching methodologies, such as deliberate practice, are known to enhance skills like leadership, self-confidence, and teamwork, producing better results than traditional teaching strategies. The goal of this study was to determine the effectiveness of implementing deliberate practice in the teaching of Human Physiology in a medical course at a private school in Brazil.

METHODS: This is an observational qualitative and quantitative study, carried out in 2022 and 2023. An online questionnaire was developed for medical students in Belo Horizonte, Brazil, to assess their perception of deliberate practice in the aforementioned discipline. The calculated sample size was 196, and the study had 198 participants. The questionnaire was divided into five blocks: General Questions, Emotions, Skills, Debriefing and Personal Opinion. The fifth block consisted open-ended questions for students to identify aspects to be improved. The Likert scale was chosen as the evaluation method for the questions in the first four sections, with responses ranging from 1 to 5. An inferential statistical analysis was conducted, using Fisher's exact test at a 0.05 level of significance, to assess the association between categorical variables. To categorize these variables, responses from each section were summed according to their corresponding values on the Likert scale. For example, in the first section, titled General Questions, which included five statements about the students’ learning experience, the scores were divided into three categories: 5-15, 16-20, and 21-25.

RESULTS: Overall, students had a positive perception of deliberate practice. A significant proportion (66.8%) strongly agreed that they developed skills such as teamwork through the scenarios. Moreover, 83.7% completely agreed that access to realistic simulation environments enhanced their education and contributed to their learning of human physiology. 83.7% of participants completely agreed that the mistakes made during scenarios also contributed to their learning. Regarding emotions, 67.9% completely agreed that they felt motivated, while 37.8% experienced anxiety during the scenarios. The statistical analysis revealed a significant association between the sum scores of each section and the binary response (“yes” or “no”) to the question “Do you like the practical classes of Human Physiology?” (p < 0.05), with the exception of the Negative Emotions sum. This indicates that higher section scores are associated with a greater likelihood of students liking the practical classes.

CONCLUSION: The implementation of deliberate practice into the Human Physiology curriculum demonstrated positive outcomes in terms of student perception and had a beneficial impact on students’ learning and skill development. However, further improvements are needed to refine the scenarios and foster a safer emotional environment for undergraduate students

Pentalogy of Cantrell: Report Of A Unique Phenotype

Manuel Vásquez — 2025-01-01

BACKGROUND: Pentalogy of Cantrell (PC) is a rare congenital anomaly, characterized by the association of ectopia cordis, defects in the thoracoabdominal wall, diaphragm, sternum, pericardium and intrinsic cardiac anomalies. Embryologically, the alteration that causes PC takes place in the fourth week of human development, due to a failure in the processes involved in the formation of the thoracoabdominal wall. The etiology has not been elucidated, but it has been proposed that heterogeneous mechanisms are involved, with an important genetic component linked to the X chromosome.

THE CASE: We describe the case of a masculine patient product of a non-consanguineous marriage, born at 39 weeks of gestation. Her mother, a 15-year-old, gravida 1 patient, presented to the outpatient OB/GYN service of the Hospital Universitario del Valle in Cali, Colombia, at 37 weeks of gestation, she had no previous prenatal care due to her condition as a recent immigrant from Venezuela with low socioeconomic status, a through history and physical was performed reporting no abnormalities, she was immediately scheduled for a detailed anatomy ultrasound, it showed a fetus with thoracoabdominal ectopia cordis, suggesting PC as a diagnosis. A physician meeting between OBGYNs, pediatric surgeons, neonatologists and pediatric cardiologists was carried out, they opted for a C-section at 39 weeks with the possibility of surgical intervention after birth. After the C-section, the initial evaluation revealed dysmorphic features, a midline defect of the abdominal wall extending from the inferior portion of the sternum to the hypogastrium, with heart and bowel protrusion and absence of the muscle wall, remarkably, the protruded organs were completely covered by skin (Figure). APGAR scores were 7 at one minute and 6 at 5 minutes, due to irregular breathing and cyanosis, the patient was intubated and transferred to the NICU. The echocardiogram showed tetralogy of Fallot and partial diaphragm agenesis. He then was scheduled for a contrast enhanced CT in order to better detail the anatomy with the goal of planning a corrective surgery, unfortunately, before the imaging was performed, and, after 8 days in critical condition in the NICU, the patient died. Multiple genetic, embryologic and environmental factors have been described to explain the etiology of this type of congenital anomalies, however it is yet to be established clearly.

CONCLUSION: The aim of this study was to provide to the scientific literature the first case of Cantrell’s Pentalogy with the described unique phenotype (ectopia cordis, large thoracoabdominal wall defect with evisceration and complete skin coverage, and Tetralogy of Fallot), highlighting the importance of an early prenatal diagnosis, the role of social determinants of health in maternal care, and the involvement of a multidisciplinary team, in order to build rapport with patients, regarding follow-up, genetic and reproductive counseling in challenging scenarios.

Comparative Efficacy of Intravitreal Aflibercept and Dexamethasone Implant in Treating Macular Edema Associated with Diabetic Retinopathy or Retinal Vein Occlusion: A Meta-Analysis and Systematic Review

Khaled Moghib — 2025-01-01

BACKGROUND: Diabetic retinopathy (DR) and retinal vein occlusion (RVO) are common retinal vascular diseases that can lead to visual impairment. Macular edema is a serious complication of both DR and RVO. Anti-VEGF agents like aflibercept and corticosteroids like dexamethasone implant are treatments for ME. We aim to evaluate the comparative efficacy and safety of these two treatments for ME associated with DR or RVO.

METHOD: The databases used in the study for a literature search include PubMed, Embase and Cochrane Central Register of Controlled Trials searched from inception till August 1, 2024. The aim was to include trials which addressed the efficacy and safety of treatments for macular edema. Data extraction was performed on key outcome variables which included the BCVA, CRT, the number of injections given and the SAE’s. The obtained data was subsequently analyzed qualitatively and quantitively based on the RevMan 5 software program. 3 software for meta- analysis of the included studies.

RESULTS: We included a total 8 of studies comprising 453 eyes. The underlying causes of macular edema in the included studies were RVO and DR. When comparing the dexamethasone implant group to the aflibercept treatment group, there was no statistically significant difference in BCVA at the 3M (MD: -0.00, 95% CI: -0.04,0.04; P=0.95),6M (MD: -0.02, 95% CI: -0.05, 0.02; P=0.43) and 12M (MD: -0.03, 95% CI: -0.07, 0.01; P=0.16). In terms of central retinal thickness reduction, there was a significant difference between the two groups at 3M (MD: -20.04, 95% CI: -34.52,-5.56; P=0.007), and 12M (MD:19.61, 95% CI: -37.4, -1.81; P=0.03), however, there was no significant result in 6M (MD: 2.07, 95% CI: - 15.4, 19.55; P=0.82).

CONCLUSION: The meta-analysis revealed that the aflibercept intravitreal injection and dexamethasone implant both significant in improving BCVA and decreasing the CRT of patients with DR and ME. In the initial 3 months of therapy as well as fixed-dose 12 months of therapy, dexamethasone implant was found to provide better vision and reduced CRT than aflibercept. Nevertheless, the dexamethasone implant needed less injection but increased the incidence of elevated intraocular pressure and cataract formation.

Frequency Rhythmic Electrical Modulated System (FREMS) and its effect on the treatment of painful diabetic peripheral neuropathy: A systematic review and meta-analysis.

Khaled Moghib — 2025-01-01

BACKGROUND: Frequency Rhythmic Electrical Modulated System (FREMS) is an innovative method of transcutaneous non-invasive treatment for neuropathic pain in diabetes mellitus. This study aims to synthesize evidence from published clinical trials on the efficacy and safety of FREMS administration in patients with painful peripheral diabetic neuropathy compared to placebo (sham FREMS) or standard of care.

METHODS: This systematic review and meta-analysis were conducted following the PRISMA statement guidelines, we searched PubMed, Cochrane Central, Scopus, and Web of Science databases throughout February 2023. Then, we screened the articles for eligibility, extracted the relevant data, and assessed the risk of bias using the Cochrane Collaboration tool. The primary outcome measured was the effect of Frequency Rhythmic Electrical Modulated System (FREMS)on pain perception assessed by Visual analogue scale [VAS] or other pain scores, extracted data from relevant RCTs were analyzed using RevMan software version 5.4.1 for Windows. All steps of this study were prespecified, and the protocol was registered on PROSPERO (CRD42023400884).

RESULTS: Four RCTs with 210 patients were eligible for the final analysis. For the primary outcome included in the meta-analysis, the mean difference (MD) of change in the (VAS) from baseline to endpoint favoured FREMS over sham-FREMS (comparison with day-time: SMD = -0.45, 95% CI [-0.77 to -0.14], P=0.005; comparison with night-time SMD = -0.41, 95% CI [-0.78 to -0.04], P= 0.03 using a random effect model for both. The efficacy of FREMS decreased gradually, and its statistical significance was lost after the follow-up period (comparison with day-time SMD=0.11, 95% CI [-0.34 to 0.55], P=0.64 using a random effect model; comparison with night-time SMD =-0.13, 95% CI [-0.43 to 0.17], P=0.41 using a fixed effect model. For the secondary outcomes in the systematic review, studies showed no statistically significant difference in Quality of life questionnaires and sensory nerve conduction velocity. Studies on motor nerve conduction velocity, tactile, vibration, and thermal sensation showed conflicting results. All studies reported no major adverse events.

CONCLUSION: FREMS may offer a drug-free and non-invasive alternative or adjunct modality in pain of peripheral diabetic neuropathy management in patients who do not respond well to treatment or those who cannot tolerate side effects of the usual medications because few side effects were reported after FREMS usage, which in turn makes it safe and well tolerated. In addition to its pivotal role in pain reduction, FREMS may also help in improving sensory functions and NCV in DPN patients. So FREMS should be considered and incorporated into clinical guidelines if further studies continue to support its efficacy and safety

Challenges and Limitations among Foreign Medical Undergraduates interested in Research Study: A Cross-sectional Study

Nnaemeka Emmanuel Mgbedo — 2025-01-01

BACKGROUND: Medical research holds immense significance in medicine as it propels progress, elevates patient care, and deepens our comprehension of diseases and therapies. We aimed to examine the barriers, and challenges that limit foreign medical undergraduates in conducting research studies.

METHODS: In this cross-sectional study, 641 students from more than six Universities in Georgia participated, and the response rate was 53%. The study received ethical approval before data collection. It was conducted from 10th to 16th February 2024 in Tbilisi and Batumi City. Students were approached during classes by the research representatives to complete the questionnaire. The structured questionnaire contained demographic characteristics, attitudes, and perceived barriers to participation in research. Descriptive analysis, such as the frequency distribution and independent t-test, was performed using Statistical Package for Social Sciences (SPSS) version 23.0 software (SPSS Inc., Chicago IL, USA).

RESULTS: The University of Georgia had the highest participants of 41.5%, followed by Batumi State University (31.7%). 56.8% of female students completed the study with a mean age of 22.19. 86.1% of students were medical students, and 17.2% were in their final year of medical school. 89.9% of students were international students from different countries across the globe. Most students “agreed’’ that the challenges influencing their research interest were lack of motivation and guidance (48.8%), time constraints (48.7%), lack of familiarity with research proposal (48.7%), skills, and statistical analysis (49%). Most of the male students reported that lack of access to research papers, databases, and research funding limits their interest and participation in research, which were statistically significant (p<0.05).

CONCLUSION: Our study reported significant barriers and limitations encountered by international students interested in research studies. Most participants require research training and mentoring to obtain the essential skills. Research clubs and organizations are encouraged among students to help optimize the opportunities for participation in grants and projects funded by different organizations

To Test or Not to Test? How a Positive Rapid Strep Test May Perplex the Diagnosis of Serum-Sickness Like Reaction

Christodoulos Chatzigrigoriadis — 2025-01-01

BACKGROUND: Serum sickness-like reaction (SSLR) represents a rare immunologic disorder. The original version is the serum sickness (SS), a type III hypersensitivity reaction caused by large protein molecules such as diphtheria antitoxin. However, SSLR is a delayed reaction of unknown etiology, triggered by small non-protein molecules. The clinical presentation of SSLR includes the classic triad of fever, rash, and arthralgia, which typically occurs 1-2 weeks after the exposure to drugs (especially β-lactams, e.g., amoxicillin and cefaclor) and infectious agents (especially viruses and Streptococcus). Some patients also present with angioedema or lymphadenopathy. The prognosis is excellent, but rare complications of liver involvement, renal involvement, coagulopathy, and pneumonitis have been reported. It is a challenging diagnosis because it mimics sepsis and other exanthematous diseases. Pharyngitis is an upper respiratory tract infection that is usually caused by viruses, but the most common bacterial cause is Streptococcus pyogenes. The Rapid Strep Test (RST) is a useful diagnostic test for detecting Streptococcus pyogenes in patients with pharyngitis and a Centor score of 3 or more guiding the administration of antibiotics.

THE CASE: We report a case of a 63- year-old female patient seen in the emergency department (ED) with diffuse rash, musculoskeletal pain, high-grade fever with rigors, malaise, and a positive RST in the absence of clinical signs of pharyngitis. The rash was neither painful nor pruritic and was diffusely spread, sparing the face, the palms, and the soles, with a maculopapular pattern and occasional urticarial-like plaques (Figure 1). Her past medical history was positive for a recent (12 days before) respiratory tract infection, which was treated with amoxicillin/clavulanate, acetaminophen, and ibuprofen. The patient was admitted to the hospital and she was initially treated with clindamycin, given the initial clinical suspicion of streptococcal sepsis, but it was discontinued due to diarrhea. After an extensive diagnostic workup of the patient and the exclusion of other common diseases, her final diagnosis was SSLR. The most likely trigger was amoxicillin, although clavulanate, acetaminophen, and ibuprofen have also been reported as causes of SSLR. Methylprednisolone 0.5 mg/kg per os was administered, resulting in the resolution of symptoms after 2 days, while the dose was gradually tapered over one week.

CONCLUSION: SSLR is an interesting clinical entity, and its pathogenesis is poorly understood. The clinical presentation can be variable. SSLR is a clinical diagnosis of exclusion due to the absence of confirmatory testing. Physicians should be familiar with this benign condition to avoid unnecessary diagnostic testing such as RST which may misguide diagnosis and lead to unnecessary diagnostic testing, hospitalization, and antibiotic treatment.

Perceptions and Expectations of First-Year Medical Students at the Beginning of their Studies for their Course in the Field of Medicine

Paschalis Evangelidis — 2025-01-01

BACKGROUND: Studies conducted on first-year medical students around the world show that the common axis of their concerns is both finding the balance between workload and personal life, as well as the need to develop soft skills to interact with patients. This study explores the perceptions and expectations of first-year students at the School of Medicine of the Aristotle University of Thessaloniki regarding the course of their studies and their future careers at the beginning of their studies.

METHODS: This is a cross- sectional study. The data was collected through an anonymous online questionnaire and completed by first-year students during their first lecture in October 2023. Descriptive statistical methods were used to analyze qualitative and quantitative variables. Braun and Clarke's method was used for the thematic analysis of the open questions by two independent researchers.

RESULTS: The questionnaire was answered by 157 people out of the 233 people who participated in the (response rate: 67.4%). The 51.6% of the participants were men. The School of Medicine of the Aristotle University of Thessaloniki was the first choice for 126 (80.3%) students. The majority of students reported that they are quite confident in choosing medicine for their studies and career [median: 9, interquartile range (IQR) 2], while a significant percentage of students consider it likely to practice medicine abroad (median: 6, IQR: 3). Their expectations include enrichment of their knowledge, achievement of professional success, completion of their studies in a fair time. Some students prioritize social contribution as the major aim of their career. The main concerns included insecurity about their employment, lack of free time, possible wrong choice of studies, and fear of long-term commitment to medicine. In addition, 41 (26.1%) participants consider it likely to work in primary health care units after their studies.

CONCLUSION: The majority of students feel confident in choosing medicine as a profession. Resolution of their fears and concerns through close communication between students and teaching staff is considered necessary.

Aortic Aneurysm Inflammatory Cell Detection with Deep Learning methods

Kristóf-Gergö Nagy — 2025-01-01

INTRODUCTION: In digital pathology, neural networks such as the Multilayer Perceptron (MLP) and Residual Neural Network (ResNet) are becoming increasingly prevalent for the analysis of tissue structure. However, their application remains constrained. MLP networks connect layers sequentially, whereas ResNet introduces blocks that span across layers, thereby enabling faster learning and rendering it suitable for complex tasks. In the context of aortic aneurysm progression, the number and location of acute and chronic inflammatory cells are of critical importance, as these cells and the enzymes they release have the potential to weaken the vascular wall and promote aneurysm growth. This highlights the necessity for a more detailed study of vascular inflammation through digital image analysis, given that the current pathology literature offers limited insights into this area.

OBJECTIVE: Our objective was to determine the number of inflammatory cells in the aortic wall using MLP and ResNet50 methods and to compare these results with data obtained from traditional immunohistochemical methods.

MATERIALS AND METHODS: We selected a total of 13 digitalized hematoxylin-eosin stained histological sections of aortic aneurysm surgical samples from the archives of the Department of Pathology and Experimental Cancer Research at Semmelweis University from the years 2023-2024. Automated nucleus recognition was performed on 10 slides using the Biological Image Analysis program (BIAS, Single-Cell Technologies Ltd., Szeged, Hungary), and a training image database containing 10,781 elements was created. The cells were classified into 5 categories. In the remaining 3 cases, the proportions of neutrophil and plasma cells were calculated relative to the number of identified nuclei using MLP and ResNet methods. Immunohistochemical labeling was performed using the CD138 antibody for plasma cells and Myeloperoxidase labeling for neutrophil granulocytes. The number of labeled cells was determined using the 3DHistech (Budapest, Hungary) Quantcenter Nuclearquant module. Finally, the cell type ratios determined by Quantcenter were compared with those determined by MLP and ResNet50. The ANOVA method was used for statistical analysis.

RESULTS: The average proportion of plasma cells was 17.17% (n=3, SD= ± 11.56%) according to the MLP method, 13.54% (n=3, SD= ± 9.54%) according to the ResNet method, and 8.09% (n=3, SD= ± 5.08%) according to immunohistochemistry. There was no significant difference between the methods.The average proportion of neutrophils was 7.97% (n=3, SD= ± 1.64%) according to the MLP method, 6.53% (n=3, SD= ± 1.7%) according to the ResNet method, and 5.02% (n=3, SD= ± 2.02%) according to immunohistochemistry. There was no significant difference between the methods.

CONCLUSIONS: In the histological sections of aortic aneurysms we examined, the cell recognition method performed using MLP and ResNet50 produced similar results to the IH method in identifying neutrophils and plasma cells. Based on these findings, digital image analysis may be suitable for the accurate recognition of cells with characteristic structures visible in HE-stained sections.

A Cross-Sectional Study of Hypertension and Associated Factors in Young MBBS Students at a Tertiary Care Institute

Aditya Saran — 2025-01-01

BACKGROUND: Hypertension is increasingly prevalent among young adults, including MBBS students, who are often unaware of their condition. The silent progression of hypertension is a critical issue due to its association with cardiovascular diseases. There is a scarcity of research focusing on the prevalence and risk factors of hypertension among young MBBS students in India. This study aims to evaluate the prevalence of hypertension and its related factors among MBBS students at a tertiary care institution in Mumbai, India.

METHODS: A cross-sectional study was conducted among 250 MBBS students aged 18 to 24, selected based on predefined eligibility criteria. Blood pressure was measured using the standard auscultatory method following a 10-minute rest period. Hypertension classification was done as per JNC-VII guidelines. Various associated risk factors, including lifestyle and family history, were documented in case study forms. Statistical analysis was performed to explore correlations between these factors and hypertension.

RESULTS: The study identified substantial rates of pre-hypertension (32.40%) and hypertension (25.20%) among the participants, with 22% classified as Stage I and 3.20% as Stage II hypertensive, as illustrated in the Figure. Alarmingly, 53.60% of those with hypertension were unaware of their condition. Significant risk factors included alcohol/tobacco use (34.40%), abdominal obesity (47.60%), family history (46.80%), and unhealthy lifestyle practices. Statistically significant associations were observed between pulse rate (p-value = 0.012), waist-to-hip ratio (p-value = 0.019), alcohol or tobacco consumption (p-value < 0.0001), and hypertension.

CONCLUSION: The study underscore the high prevalence of pre-hypertension and hypertension among young MBBS students in Mumbai, highlighting the urgent need for early detection and preventive measures. Regular monitoring of blood pressure and increased awareness about hypertension are essential to mitigate the long-term cardiovascular risks in this population.

Identifying Key Risk Factors for Incisional Hernia Post-Emergency Laparotomy: Insights from A Case-Control Study from a Tertiary Referral Center of Eastern India.

Reyaz Ansari — 2025-01-01

BACKGROUND: Incisional hernias (IH) are gaps around postoperative scars, detectable by examination or imaging, with variable incidence. Despite surgical advancements, IH remains a significant complication, causing morbidity, impacting patient quality of life, and increasing healthcare costs. Identifying risk factors is essential for effective prevention and management.

METHODS: This case-control study, conducted in the Department of General Surgery at a tertiary medical institute, included patients who underwent emergency laparotomy between 2019 and 2021. Those developing IH served as cases, and those not developing it as controls. Data on demographics, risk factors, and variables were collected and analyzed using SPSS V24, with significance set at p ≤ 0.05.

RESULTS: Among 367 emergency laparotomies performed, 54 developed IH (incidence: 14.7%). Significant risk factors identified included obesity (p<0.000), smoking (p=0.036), COPD (p<0.001), diabetes mellitus (p=0.003), low hemoglobin (p=0.023), high total leukocyte count (p=0.001), low total protein (p=0.015), low albumin (p=0.002), and high creatinine (p=0.001). Operation-related factors such as increased operation time (p=0.001), increased blood loss (p=0.025), intraoperative blood transfusion (p=0.039), and peritoneal contamination (p=0.030) were significant. Mass closure of the abdomen significantly reduced the risk of IH (p=0.018). Postoperative factors like surgical site infection (p<0.001), wound dehiscence (p=0.001), postoperative straining (p=0.001), and prolonged hospital stay (p=0.000) were also significantly associated.

DISCUSSION: The study underscores the multifactorial nature of IH development post-emergency laparotomy, identifying significant preoperative, intraoperative, and postoperative risk factors. The findings suggest that managing comorbidities, optimizing nutritional and inflammatory status, and implementing effective surgical and postoperative strategies are crucial in reducing IH incidence.

Prevalence Of Diabetes Mellitus And Its Associated Factors Among Tuberculosis Cases in Taluk Tuberculosis Unit, India - A Hospital-based : Exploratory Cross-sectional Study

Md Alinawaz Khan — 2025-01-01

BACKGROUND: As per WHO global reports, one in each third person of the current world population is infected with tuberculosis, asymptomatically. NTEP data states that 25,52,000Tuberculosis cases were reported in 2023. Out of total, 81,331cases were notified from the state of Karnataka. Whereas 9.3% of the Indian population are known cases of diabetes mellitus. Both the diseases behave as a duplex, interacting with each other. Diabetes mellitus weakens cell mediated immunity by dysfunctioning T-cells as well as macrophages. On the other hand, tuberculosis-like chronic morbidities are associated with reactionary hyperglycemia due to accelerated counter-regulatory stress hormones productions. Amalgamation of epidemics of a communicable and non-communicable disease is turning out to be a matter of concern for all. Hence, such exploratory study becomes crucial to determine the severity.

METHODS: This exploratory cross-sectional study includes Tuberculosis diagnosed cases visiting hospital amalgamated to medical college in North Karnataka, India belonging to Taluk TB Unit. Sample size for proportion was calculated to be 116, to cover desired objectives at 5%absolute precision at 95%confidence level. Written Informed consent was obtained from the study cases. All those cases who were seriously ill or were pregnant or denying the consent were excluded. Predesigned and pretested proforma were used for obtaining socio-demographic details of subjects.Modified BG Prasad classification was implicated to classify socioeconomic-status. Patients were confirmed diagnosed with tuberculosis by the latest CBNAAT report. Using WHO criteria, cases were classified into non-diabetic, prediabetic and diabetic on the basis of post-prandial blood sugar using Oral Glucose Tolerance Test.

RESULTS: As per the study, 63.3% of tuberculosis cases were sputum positive and non-diabetic, whereas 9.2% were sputum positive and diabetic. Among sputum negative cases, 15% were non-diabetic and 3.3% diabetic. In the pulmonary tuberculosis category, 75.8% were non-diabetic and 10.8% were diabetic; in extra-pulmonary category, 2.5% were non-diabetic and 1.6% were diabetic. In aspects of socioeconomic-status, among non-diabetic, 30.8% were belonging to Class I & 5% to Class V; among prediabetic cases, 4.2% belonged to Class V and 0.8% to Class I; whereas 10% from Class V and 0.8% from Class III compromised diabetic population. Using BMI as criteria, 50.8% among non-diabetic, 1.6% among diabetic were underweight; whereas normal BMI, 25.8% were non-diabetic and 4.2% were diabetic; while among overweight, 6.7% were diabetic and 0.8% were prediabetic. Eventually, 12.5% of studied tuberculosis cases were diabetic, 9.2% were prediabetic and 78.3% were non-diabetic.

CONCLUSION: At the end of the study, it was found that the prevalence of diabetes among studied tuberculosis cases was 12.5%, against the national prevalence(7.7%) as per latest NTEP reports. Moreover, among diabetic tuberculosis cases the majority were: sputum positive(9.2%), pulmonary tuberculosis(10.8%), belonged to Class V(10.0%) of socioeconomic-status, and overweight(6.7%). Consequently, tuberculosis has been found significantly related to diabetes mellitus and its associated factors, as depicted by the study's result.

Efficacy of Intranasal Fluticasone Nasal Spray Alone Versus Intranasal Fluticasone Combined with Oral Montelukast and Levocetirizine in Treatment of Allergic Rhinitis–A Randomized Control Trial.

Mohamed Afsal Y — 2025-01-01

BACKGROUND: Allergic Rhinitis (AR) is characterized by an immunological response facilitated by IgE antibodies inside the nasal mucosa, which is initiated upon exposure to allergens present in the air. The illness under consideration is characterized by symptoms including the presence of watery nasal discharge, nasal congestion, sneezing, and nasal itching. It affects between 10 and 40 per cent of the global population, which affecting the quality of life of many persons. Hence, the requirement of a treatment targeted at delivering maximum symptom control and has minimum to nil adverse effects. AR symptoms impair cognitive function, which can be further exacerbated by the use of widely available first-generation antihistamines.

OBJECTIVES: To assess the improvement of nasal symptoms in both Fluticasone alone group and Fluticasone with Montelukast and levocetirizine group at the end of 1st month and 2nd month.

METHODS: Ethical approval was obtained from the Institutional Ethics Committee (IEC). A Randomized control study was done on 40 patients, aged above 15years who had Allergic rhinitis. Sample size estimation was done using OpenEPiSoftwareVersion2.3.1. Diagnosis was made based on Allergic Rhinitis and its Impact on Asthma (ARIA) criteria. Patients were randomized by simple randomization into two groups of 20 each. After proper history and physical examination of both nostril along with Absolute Eosinophil count was done. Group 1 received 2 puffs of Fluticasone furoate nasal spray (27.5mcg) in each nostril twice daily for 1 month, whereas Group 2 received both Fluticasone furoate nasal spray twice daily with oral montelukast and levocetrizine for 1 month. Patients were assessed by Daily Rhinitis Diary Card. The symptoms were assessed during treatment, post treatment at 1^st month and 2^nd month. Statistical analysis was done using SPSS 19 software and appropriate statistical tests were applied. Inclusion Criteria: Patients aged between 18-60 years of age with Allergic rhinitis symptoms. Exclusion Criteria: Smokers, patients on oral steroids, patients with recent nasal surgeries, patients with nasal polyposis.

RESULTS: In this study, the results showed significant improvement in Day time symptom scores for both group after 1 month. Better symptom relief seen in fluticasone with montelukast group. The combination group showed better symptom free interval after stopping the treatment. In case of night time symptom score, there were difference but it was found to be statistically insignificant (p>0.001).

CONCLUSION: As per the study, Fluticasone combined with montelukast and levocetrizine was effective in reducing daytime and night time symptoms as compared to fluticasone alone.

Acute Kidney Injury Triggered by Mannitol in a Patient with Neovascular Glaucoma: A Case Report

Harshitha Chowdary Popuri — 2025-01-01

BACKGROUND: Mannitol is commonly used to reduce intracranial and intraocular pressure as a treatment or preoperative measure in brain and eye surgeries by causing osmotic diuresis. Although the side effects of mannitol are minimal, in certain groups of patients with renal disease, it can cause serious complications. Here, we report a rare instance where a patient experienced severe electrolyte derangements due to the administration of mannitol before undergoing an ocular procedure.

THE CASE: A 62-year-old male patient presented to the ophthalmology outpatient clinic with decreased vision and pain. He had a past medical history of type 2 diabetes, poorly managed with insulin and oral anti-diabetic drugs. Further investigation revealed neovascular glaucoma attributed to proliferative diabetic retinopathy. He was scheduled for trabeculectomy along with an anti-VEGF injection and was admitted to the hospital. He was given 350 ml of intravenous mannitol twice daily for three days before surgery. On the third day of admission, he complained of a cough. Subsequently, he developed worsening breathlessness, fatigue, and minimal lower limb swelling. His condition further deteriorated, resulting in altered sensorium. Additionally, low urine output was noted. On clinical evaluation, bilateral basal crepitus was heard, suggesting pulmonary edema due to fluid overload. A POCUS was performed, revealing no effusions or clots. Laboratory findings showed significant hyperkalemia (serum potassium of 5.7 mmol/L) and hyponatremia (serum sodium of 118 mmol/L). Serum creatinine had risen to 3.3 mg/dL from a baseline of 1.5 mg/dL. He was severely acidotic with a pH of 7.09 and an anion gap of 12.6, with normal serum lactate and ketone levels. Elevated blood urea nitrogen and creatinine, along with a marked increase in serum osmolality, indicated mannitol toxicity with acute renal injury. Mannitol administration was immediately withdrawn, and the patient was started on intravenous diuretics, electrolyte correction, and supportive care, including high-flow nasal cannula oxygen therapy, before being transferred to the intensive care unit. A nephrology referral was obtained for further management. After aggressive treatment and electrolyte correction, his clinical condition stabilized, and his normal sensorium returned.

CONCLUSION: This case highlights the potential risks of mannitol toxicity, particularly in patients with pre-existing renal impairment or those exposed to high cumulative doses. Careful monitoring of electrolyte levels and renal function in patients receiving mannitol and lowering the threshold for discontinuation at the first sign of toxicity is essential. Early recognition and rapid correction are crucial to prevent harmful complications.

Assessment Of The Impact Of Alcohol Intake On Cognition – A Cohort Study

Deekshitha Alla — 2025-01-01

BACKGROUND: Alcohol is one of the most consumed psychoactive substances in the world. The deleterious impact of alcoholism is a major public health issue worldwide due to its consequential long-term, social and economic damage. Besides these socioeconomic effects, alcoholism also results in various degrees of physiological aberrations that lead to abnormalities in cognitive and behavioral functions. In India, it is estimated that approximately 75 million people consume alcohol. Evaluation of the impact of alcohol consumption on cognition becomes the need of the hour due to the interference of cognitive decline with daily function and independence.

AIMS: To evaluate cognition ability in alcoholics with a prolonged history of alcohol intake using blinded Montreal Cognitive Assessment (MoCA) and to compare cognition between alcoholics and non-alcoholics.

METHODS: The study includes 30 alcoholic males without any comorbidities (experiment), attending the outpatient department and 30 healthy appropriate non-alcoholics (control) within the age group of 18-45 years of age. Assessment of alcohol intake is done using Alcohol Use Disorder Identification Test (AUDIT) questionnaire and cognitive assessment was performed using blinded Montreal Cognitive Assessment (MoCA) to make it feasible for illiterates. The data was collected and entered into MS-EXCEL sheet and independent sample t test was applied for tests of statistical significance (p-value < 0.001 will be considered as significant). RESULTS: The mean age of the subjects in the experimental group is 40.5±8.5 yrs and that of control group is 39.6±9.82 yrs. In the study, 23.3% were light drinkers, 40% were moderate and 36.6% were light drinkers. The study has shown statistically significant correlation between experimental (12.5±3.95) and control (18.9±2.71) groups. (p<0.001). Our results included a crucial finding that alcohol consumption has significant impact on cognitive decline.

CONCLUSION: Based on the results of this study, it can be concluded that long-term alcohol consumption has a detrimental influence on cognition. Studies of the cognitive repercussions of alcohol ingesting with the aid of using the usage of the actual international countrywide represented database are scarce within the literature. Higher information on the variations within the effect of alcohol use on cognitive impairment in older adults may also offer precious facts on their care. Conflicting results among various studies could be because of differences in tools used to evaluate cognitive dysfunction; the definitions of the quantity and pattern of alcohol drinking, smoking status, educational and occupational attainment, comorbidities, and psychotropic drug use.

Predicting Extended ICU Stay Following Coronary Artery Bypass Grafting and its Impact on Hospitalization and Mortality

Ayah Alkrarha — 2025-01-01

BACKGROUND: Coronary artery bypass grafting (CABG) remains one of the most common surgical treatments for coronary artery disease (CAD), aimed at reducing symptoms and enhancing patient survival. A critical element of post-CABG care is the duration of the patient’s stay in the intensive care unit (ICU), with an ideal target of fewer than 24 hours. However, a range of preoperative, intraoperative, and postoperative factors can extend ICU stays, leading to increased strain on hospital resources, poorer patient outcomes, and higher healthcare costs. This study seeks to identify the key factors that contribute to ICU stays exceeding 48 hours following CABG and CABG combined with heart valve surgery, and to analyze their association with postoperative complications and mortality rates.

METHODS: We conducted a retrospective cohort study at King Abdullah University Hospital (KAUH), analyzing data from 1,395 patients who underwent isolated CABG or CABG combined with valve surgery between January 2004 and December 2022. The patients were categorized into two groups: Group 1, with ICU stays of 48 hours or less (n=1,082), and Group 2, with ICU stays longer than 48 hours (n=313). A comprehensive analysis of clinical, laboratory, and demographic data was performed to identify predictors of prolonged ICU stays. Statistical methods were applied to evaluate the relationship between these factors and the length of ICU stay.

RESULTS: Our analysis revealed that patients in Group 2, who had ICU stays longer than 48 hours, were significantly older, with a mean age of 61.5 years compared to 58.7 years in Group 1 (p<0.001). Several preoperative conditions were strongly associated with prolonged ICU stays, including recent myocardial infarction (OR=1.69, p=0.015), chronic obstructive pulmonary disease (COPD) or asthma (OR=1.49, p=0.003), and preoperative renal impairment (OR=1.89, p=0.002). Intraoperative factors also significantly influenced ICU stay duration, with emergency or urgent surgeries (OR=2.19, p<0.001) and extended ventilator support during surgery (OR=5.92, p<0.001) being the most critical predictors. Postoperative complications emerged as significant determinants of ICU stay length. The development of renal impairment post-surgery (OR=6.78, p<0.001) and the occurrence of pneumonia or sepsis (OR=8.92, p<0.001) were strongly correlated with prolonged ICU stays and were also linked to higher mortality rates.

CONCLUSION: This study highlights the significant role of preoperative comorbidities, intraoperative events, and postoperative complications in prolonging ICU stays after CABG. Extended ICU stays are associated with an increased risk of severe postoperative complications and higher mortality, emphasizing the need for improved surgical and postoperative care protocols. By targeting the identified risk factors, healthcare providers can potentially reduce ICU durations, enhance patient outcomes, and alleviate the burden on healthcare systems. These findings underscore the importance of optimizing ICU resource utilization in the context of cardiac surgery.

A Cross-sectional Study on Lower Back Pain amongst Medical Students and Foundation Doctors in Malta

Nicole Borg — 2025-01-01

INTRODUCTION: Lower back pain (LBP) is one of the most common health problems and a significant global burden on both an individual and economic level. It is especially prevalent amongst healthcare workers and students, partly due to working conditions. This study aimed to investigate the prevalence and common risk factors of LBP amongst medical students and foundation doctors in Malta.

METHODS: A mixed-methods cross-sectional, online questionnaire based on the Nordic Musculoskeletal Questionnaire was distributed to medical students and foundation doctors in Malta. Quantitative data was analyzed by means of Chi-squared test followed by multivariate analysis, whilst qualitative data was organized into broad themes.

RESULTS: A total of 319 individuals participated in the questionnaire. The 12-month and 7-day prevalence of lower back pain in the sample population overall is 78.14% and 28.71% respectively. Females and students who worked during medical school were more likely to have LBP (p < 0.001 and p= 0.040 respectively). Long working/studying hours and awkward sitting/standing postures were identified as contributors to LBP by participants.

CONCLUSIONS: Lower back pain is a highly prevalent issue amongst medical students and foundation doctors in Malta. If unaddressed, it will continue to contribute to disability, decreased quality of life and reduced career longevity. An approach based on Human Factors and Ergonomics principles focusing on ergonomic design and ergonomics training in medical school can lead to improved staff wellbeing and increase patient safety and efficiency.

Benefits of Pulmonary Lobectomy in Infection by Actinomyces

Mauricio Alejandro Saldaña-Ruiz — 2025-01-01

BACKGROUND: Pulmonary actinomycosis is an uncommon disease with a non-specific clinical presentation, which makes difficult its diagnosis and usually leads to a misinterpretation of malignancy rather than infection.

THE CASE: A 30-year-old female patient with no relevant history, who began her illness a year and a half ago with cough, chest pain, weakness, and hemoptysis. She received medical treatment, however, the episodes of hemoptysis persisted, so it was decided to take samples for KOH test and acid-fast stain, both of which were negative, and a simple computed tomography scan was performed, in which bronchiectasis was found in the posterior basal segment of the right lung. Afterwards, blood tests were done, showing mild leukocytosis (Table 1). Bronchoscopy was performed, where a mass was found, and a biopsy was taken. Subsequently, squamous metaplasia and sulphur granules with dystrophic calcification were observed, leading to a diagnosis of pulmonary actinomycosis. Treatment with amoxicillin was given for 12 months. Three months later, she persisted with occasional hemoptysis, so it was decided to perform a right lung lobectomy, showing clinical improvement. Six months later, the symptoms improved completely.

CONCLUSION: This condition used to be fatal, however, since the development of penicillin, its incidence has decreased drastically to the point that only 94 cases were reported in the first decade of the 21st century, therefore it is unlikely to be considered among the differential diagnoses. In addition to this, it is a great mimic of malignancy, being misdiagnosed as a pulmonary neoplasm. The definitive diagnosis is based on the finding of sulfur granules. The most used treatment is penicillin for 6 to 12 months and, in case of persistence or recurrence of symptoms, it can be complemented with surgical treatment, which has shown positive results. It is important to consider it among the differential diagnoses in patients with non-specific symptoms and a negative result for the most common pathogens.

High altitude pulmonary edema in a native highlander: A case report from Nepal

Ishwor Thapaliya — 2025-01-01

BACKGROUND: High altitude pulmonary edema (HAPE) is a non-cardiogenic pulmonary edema, that usually occurs in unacclimatized lowlanders rapidly ascending above 2,500-3,000 m and in highlanders returning from lower altitudes, with both forms likely sharing the same pathophysiology. Its incidence among Himalayan trekkers and Alp’s climbers is approximately 4%, often varying with rate of ascent. It usually manifests within 2–4 days of arriving at altitudes exceeding 2,500 meters. The factors predisposing HAPE include prior respiratory infection, rapid ascent, prior history of HAPE, genetic predisposition. Patients with HAPE exhibit increased pulmonary artery pressures, normal left atrial pressure, heightened pulmonary vasoreactivity to hypoxia, and often benefit from treatments lowering pulmonary artery pressures.

THE CASE: A 41-year-old male of Rai ethnicity, born and raised in the Himalayan region of Nepal began experiencing shortness of breath during his ascent of Mount Everest at around 5,000 meters. The individual, currently employed as a trekking porter, had previously descended to an altitude of 3,420 meters for 2 weeks before commencing his ascent. He reported to have progressively worsening shortness of breath. After the onset of symptoms, he started to descend during which he fell unconscious and was brought to a hospital in Lukla. He had a low Glasgow Coma Scale score of 3/15 and SpO2 could not be determined by pulse oximetry. At the hospital, he quickly regained consciousness after receiving supplemental oxygen. He was then referred to the tertiary care center in Kathmandu for further evaluation and treatment. At the emergency department, he reported progressive shortness of breath, worsening from MMRC grade II to IV, and orthopnea. He had a similar episode three years prior and no known co-morbidities. Vital signs were stable with oxygen saturation (SpO2) of 81% in ambient air. Physical examination revealed bilateral wheezes and crackles on chest auscultation. Neurological and abdominal examinations were normal. Laboratory analysis revealed neutrophilia (80%), lymphocytopenia (15%), leukocytosis (14,900 cells/mm³), elevated serum urea (9.4 mmol/l), and high Alanine Transaminase (86 U/l). Liver and renal function tests were normal. Arterial blood gas (ABG) analysis revealed a low blood pH of 7.292. Sputum, blood, and urine cultures were negative for bacteria and fungi. He was transferred to the ICU for high-concentration oxygen therapy. ABG analysis was performed on a daily basis, with results illustrated in figure 1. He was intubated and mechanically ventilated for 4 days. Initially, chest x-ray was performed which shows pulmonary infiltrates in both lungs indicative of pulmonary edema as shown in figure 2. Throughout his ICU stay, he received iv antibiotics, CCBs and diuretics. By day 3, his crackles had significantly diminished, and a follow-up chest radiograph demonstrated notable improvement (Figure 3). After 8 days, he was transferred to the respiratory medicine ward for 2 days of observation before discharge.

CONCLUSION: Despite being physiologically adapted to high altitude conditions, native highlanders and people with prior history of HAPE may still be susceptible to developing high altitude pulmonary edema.

Enhancing Surgical Skill Proficiency in Medical Students: Analyzing the Impact of Student-Led Skills Labs

Jennifer Okei — 2025-01-01

BACKGROUND: The development of surgical skills is an integral part of undergraduate medical education. Early exposure of medical students to these basic surgical skills can significantly improve interest in pursuing surgical careers during residency. Traditional teaching methods do not efficiently bridge this important gap in the development of the practical abilities of medical students hence warranting the need for more innovative approaches to improve proficiency. There has been an increasing rise in the popularity of student led skills training. This led the Surgical Interest Group, Lagos (SURGIL) to initiate the SURGIL Skills Lab (SSL), a 4-weeks student-led, faculty-supervised basic surgical skills training which was the first of its kind in our region.

AIM: This study evaluates the impact of SSL on medical students' proficiency, confidence, and overall satisfaction with the training received.

METHODS: A cohort study was conducted among medical students from the University of Lagos who participated in the SSL following ethical approval from the Institutional Review Board of Lagos University Teaching Hospital (LUTH). Data was collected from two SSL cohorts that had their trainings in the first and second quarter of 2023. Participants were assessed on their confidence levels in performing six basic surgical skills: forceps handling, two-handed knot tying, one-handed knot tying, instrument tying, simple interrupted suturing, and subcuticular suturing, both before and after the training sessions. Confidence was measured using a 4-point Likert scale. Data on participants' demographic characteristics, previous experience with surgical skills, and satisfaction with the lab were also collected. Statistical analysis was performed using IBM SPSS version 26.

RESULTS: A total of 32 students participated in the study and filled the pre-test survey. 2 students dropped out of the research, hence only 30 students participated in the post test survey. The mean age of participants was 24.09 years with a 1.3:1 male to female distribution. Significant improvements were observed in all six surgical skills post-training. Confidence levels in simple running suture increased from a pre-lab mean of 0.69±0.821 to a post-lab mean of 2.93±0.254. Similarly, confidence in two-handed knot tying improved from 0.63±0.98 to 2.87±0.35. Satisfaction with the SSL was overwhelmingly positive, with all participants (100%) expressing satisfaction with the learning environment and recommending the workshop to others. Additionally, 96.7% of students felt the workshop was positively challenging with adequate practice time and increased their interest in pursuing surgery as a career.

CONCLUSION: SSL effectively enhances medical students' surgical skills, significantly improving their confidence in performing basic surgical tasks. The high levels of satisfaction reported by participants suggest that this student-led approach is not only effective but also well-received. Taking into cognizance the positive feedback, integrating student-led surgical skills lab into the medical school curriculum could help address gaps in surgical training especially in centers with reduced lecturer-workforce. This will help in better preparing students for clinical practice while enhancing their engagement and commitment in their education. The results of this study support the expansion of similar programs to other medical schools, potentially resulting to a greater impact on undergraduate surgical education.

Knowledge, Attitude, and Practice of Breast-Self Examination Among Female Students of Niger Delta University

Deborah Oboli — 2025-01-01

BACKGROUND: Cancer, characterized by uncontrollable cell division leading to tissue destruction, is a leading cause of death globally. Breast cancer, in particular, affects 2.1 million women annually and causes significant mortality, especially in less developed regions due to late detection and limited access to treatment. In Nigeria, the incidence rate of breast cancer is 33.6 per 100,000 women. Early detection through methods like breast self-examination (BSE) is crucial, particularly in developing countries where mammography may not be feasible. BSE is recommended due to its simplicity, privacy, and lack of cost, yet awareness and practice remain low. This study assesses the knowledge, attitude, and practice of BSE among female students at Niger Delta University to provide insights into the effectiveness of current awareness efforts.

METHODS: A descriptive cross-sectional study was conducted over six weeks at Niger Delta University, Bayelsa State, Nigeria. A sample of 376 female undergraduates, aged 18-30 years, was selected using multistage sampling. Data was collected through semi-structured, self-administered questionnaires. Knowledge of BSE was assessed through a scoring system, and attitudes and practices were evaluated based on responses to various statements and self-reported practices. The data was analyzed using SPSS version 21, with knowledge scores categorized as poor (0-4), fair (5-7), or good (8-9).

RESULTS: Of the respondents, 77.4% were single, and 60.9% had good knowledge of BSE, while 35.4% had fair knowledge, and 3.7% had poor knowledge. Attitude towards BSE was generally positive, with 72.6% agreeing that BSE is not time-consuming. The practice of BSE was reported by 64.4% of respondents, with 96.7% performing it at least monthly. Knowledge of BSE was notably higher among students from medical departments, and those with a family history of breast cancer. The study indicated that increased awareness and education have contributed to better knowledge and practice of BSE compared to past studies.

CONCLUSION: The study highlights a significant level of awareness and positive attitude towards breast self-examination among female students at Niger Delta University. Despite the encouraging practice rates, there remains a need for continuous education and outreach to further improve the regular practice of BSE and enhance early detection of breast cancer.

Assessment of HIV prevalence in Adults Within the Aliade Community, Benue State.

Deborah Oboli — 2025-01-01

BACKGROUND: Benue State is recognized as one of Nigeria's high-risk zones for HIV, with an estimated prevalence of 4.8% among adults aged 15-64 years. The prevalence is notably higher among females at 6.3% and lower among males at 3.5%, making it the second highest HIV prevalence state in Nigeria. Despite relatively high awareness levels, the infection rate continues to rise in rural areas. This study focused on Aliade, a community in the TIV land, conducting random HIV testing on 500 adult outpatients aged 15-64 years over a period of five months, with Aliade General Hospital serving as the testing site. The study aimed to determine the HIV infection rate among adults in the Aliade community of Benue State, Nigeria, by assessing the prevalence of HIV.

METHODS: A hospital-based randomized study was conducted at Aliade General Hospital, Benue State. HIV testing was performed using the rapid diagnostic testing algorithm according to Nigeria's National HIV testing guidelines, with seropositive samples confirmed by supplemental assays. Data was collected over five months and analyzed using IBM SPSS version 26.

RESULTS: The study included 500 respondents with a mean age of 39.4 years. Of the participants, 215 were male and 285 were female. Over half were married, and approximately 70% had only secondary education. While 90% of respondents were aware of HIV, only 60% had previously undergone testing. The prevalence of HIV was 5.6% overall, with 6.7% among females and 3.3% among males.

CONCLUSION: Despite awareness of HIV, the prevalence remains high and is increasing. This study underscores the need for enhanced awareness and intervention strategies to address the growing HIV epidemic in Benue State.

Comparison Of Sleep Hygiene Index In Virtual, Textbook And Hybrid Learners In Undergraduate Students

Hania Latif Sami — 2025-01-01

BACKGROUND: Sleep hygiene is a set of behavioral and environmental factors that promote healthy sleep (1). The digital age has changed the way we learn by incorporating technology with textbooks. Screens emitting blue light suppress melatonin release and alter the Circadian rhythm, leading to an irregular sleep-wake cycle and poor sleep quality, which can be measured by sleep hygiene (2-9). Healthcare students are at an increased risk of developing poor sleep hygiene due to their long study and clinical hours. This study explores the relationship between different learning modes (textbook, virtual, and hybrid) and sleep hygiene among students at Shalamar Institute of Health Sciences.

METHODS: An IRB-approved, cross-sectional, questionnaire-based study was conducted with a sample size of 400 students from Shalamar Institute of Health Sciences. Participants were selected through simple randomization, ensuring equal representation from each academic year. The study utilized a Sleep Hygiene Questionnaire, which included demographic questions, mode of study, study screen time, and the validated Sleep Hygiene Index (SHI) (6). SHI scores were categorized into three groups based on the Likert scale: healthy (scores <26), normal (scores 27-43), and unhealthy (scores >35). Data were analyzed using SPSS 20, employing chi-square tests to assess associations between learning modes and SHI scores, correlation analysis to examine the relationship between study screen time and SHI scores, and ANOVA to identify differences in SHI scores among different learning modes. Tukey’s HSD post hoc test was used to further interpret significant findings.

RESULTS: Of the 400 students, 20.9% identified as textbook learners, 20.9% as virtual learners, and 58.1% as hybrid learners. Analysis of SHI scores revealed that 22.4% of students had unhealthy sleep hygiene, 23.3% had normal sleep hygiene, and 54.4% had healthy sleep hygiene. The chi-square test showed a significant association between learning mode and SHI scores (p < 0.05). Additionally, a positive correlation was observed between study screen time and SHI scores (r = 0.36, p = 0.01), indicating that higher screen time is associated with poorer sleep hygiene. ANOVA results revealed significant differences in SHI scores among different learning modes, with virtual learners scoring worse compared to textbook and hybrid learners. The Tukey’s HSD test provided further details on these differences, showing that virtual learners had significantly higher SHI scores, suggesting poorer sleep hygiene.

CONCLUSION: The study concluded that virtual learners exhibited poorer sleep hygiene compared to textbook and hybrid learners. Increased screen time associated with virtual learning is linked to higher SHI scores, suggesting that extended use of electronic devices negatively affects sleep hygiene. These findings highlight the need for strategies to manage screen time and promote better sleep practices among students engaged in virtual learning.

Potential Herb-Drug Interactions Among Elderly Nursing Home Residents in Romania

Hanna Sebesi — 2025-01-01

BACKGROUND: Herbal supplements are widely used as complementary or alternative medicines, but their phytochemical effects on conventional drugs are often overlooked. Evidence shows that herb-drug interactions (HDIs) are significant in clinical pharmacology. However, the current use of herbal supplements and the prevalence of HDIs among elderly patients in nursing homes is not known.

AIM: Our study investigates the algorithm-predicted HDIs during herb-drug coadministration among elderly patients in nursing homes in a Romanian sample.

METHODS: We collected demographic data, clinical history and medication of elderly patients from three nursing homes across Romania. We focused on patients using Valerian and Ginkgo biloba (Ginkgo) to investigate their role in HDIs. A freely available online platform was used (MedScape Drug Interaction Checker) to identify and describe potential HDIs with severity grades from 1 to 4 (1=minor; 2=monitor closely; 3=serious, use alternative; 4=contraindicated). Further analyses were carried out using GraphPad Prism.

RESULTS: 275 patients were included, of these, 10 used Valerian-containing products and 23 used Ginkgo. The average age was 84.58.2 for women; and 7311.0 for men, 60.6% of patients were female and 39.4% male. A total of 304 possible interactions were identified, with 9.2% (n=28) predicted to be related to the coadministration of Valerian or Ginkgo with synthetic drugs. 10.7% (n=3) of the interactions were grade 1, 42.8% (n=12) were grade 2, 46.4% (n=13) were grade 3, and no grade 4 interaction was found. The most commonly affected drug classes in HDIs were antiplatelets (n=10), anticoagulants (n=1), and NSAIDs (n=1) for Ginkgo, and benzodiazepines (n=7), sedatives (n=5), and SSRIs (n=3) for Valerian. The number of possible interactions between the Valerian and Ginkgo-treated groups was compared using the Mann-Whitney U test, which revealed a significant difference (p=0.02) with a higher number of interactions in the case of Valerian. We conducted a regression analysis that showed a significant relationship between the number of drugs/supplements taken and the number of interactions with severity grades 1 (R²=0.40; p<0.0001) and 2 (R²=0.69; p<0.0001). Additionally, in the case of Ginkgo usage, a significant regression was found for HDIs (R²=0.28; p=0.0087).

CONCLUSION: We found a significant number of potential HDIs caused by Valerian and Ginkgo, with nearly half of these being serious enough to warrant increased attention or consideration of alternatives. The most frequently affected drug classes were antiplatelets for Ginkgo and benzodiazepines, sedatives, and SSRIs for Valerian. Our regression analysis showed that the number of drugs/supplements could predict the number of possible interactions with severity grades 1 and 2, and Ginkgo-related HDIs. Since the identified interactions are predictions, future research is needed to assess their actual occurrence and clinical impact.

Knowledge, Attitudes and Practice on Mask Wearing for Respiratory Tract Infections during the Post Covid-19 Period among Visitors Coming to the Out Patient Department at Teaching Hospital, Peradeniya, Sri Lanka.

Lakmini Senevirathne — 2025-01-01

BACKGROUND: During the Covid-19 period, mask wearing was widely used to prevent disease transmission. Continued practice of mask wearing during the post pandemic period along with its proper understanding would contribute to further reduction of respiratory tract infections in future. Therefore, we aimed to assess the knowledge, attitudes and practices towards mask wearing for preventing respiratory tract infections in our study population.

METHODS: A cross-sectional descriptive study was done with 423 visitors aged 18 to 75, including visitors and caregivers who came to Out Patient Department (OPD) in Teaching Hospital, Peradeniya, Sri Lanka. Ethical approval was obtained, and data was collected by using a validated self-administered printed questionnaire in April 2024. Participants were also observed during the interview to evaluate their mask wearing practices. A knowledge score was calculated and compared with demographic variables.

RESULTS: Of 394 completed questionnaires, 273(69.3%) were female and 199(50.51%) were patients and the majority were young adults (18y-35y). The mean age was 34.05y (SD – 13.89). The overall knowledge score which was not normally distributed varied from 6 to 18 out of 19 with a mean of 14.41(SD 2.30) and a median of 15.00 (IQR= 13-16) which didn’t significantly differ across age, gender, experience and vaccination status of Covid-19. The majority (207, 52.5%) had moderate (60-79%) overall knowledge. The median knowledge was higher among those who were educated above school level (16.00, IQR 14-17) than those with school education (14.00, IQR 16-13) (p< 0.001). Most 367 (93.2%) declared they knew how to wear a mask properly while 349 (88.6%) declared they knew the indications to wear masks in the post-pandemic period. Vaccination caused a negative impact on attitude as those who uncompleted vaccination schedule agreed with necessity while those with completed vaccine schedule did not. Only 133 (33.8%) had responded that they were wearing masks in the post pandemic period. All 133 has good knowledge (80 – 100%) on mask wearing. On observation only 74 (18.8%) were wearing masks. The majority who were wearing masks while participating (56/74, 75.68%) were either having respiratory symptoms or accompanying someone with respiratory symptoms while of the 320 who were not wearing masks 205 (64.06%) were having respiratory symptoms or accompanying someone with respiratory symptoms.

CONCLUSION: Although the study shows all of the participants who declared that they were wearing a mask during the post Covid-19 period possessed a good knowledge score, the overall knowledge of the majority on the transmission of respiratory tract infections and mask usage was moderate. Further, observed practices indicated that those with or accompanying those with respiratory tract infections were not wearing masks.

When Immunodeficiency Meets Neurosurgery: Brain Abscess in a Wiskott-Aldrich Syndrome Patient

Jayasooriya HK — 2025-01-01

CASE REPORT: A 4-year-old male with a known diagnosis of WAS,presented with a sudden onset of abnormal behavior and left-sided eye and upper limb twitching that lasted around 15 minutes. These movements were not associated with loss of consciousness, tonic-clonic activity, frothing, tongue biting, or incontinence. The mother reported no fever, and there were no obvious infective foci identified. Notably, the child had a recent history of generalized eczema that had been infected and treated at a local hospital, and he had experienced multiple past episodes of eczema infected with methicillin-resistant Staphylococcus aureus (MRSA). On examination, the patient was clinically well and afebrile, with no apparent neurological deficits. He was alert and active, with healed eczematous rashes noted over the body. Other systemic examinations were unremarkable. Given the abnormal behavior and history of thrombocytopenia, a non-contrast CT (NCCT) of the brain was performed to rule out trauma or intracranial hemorrhage. The NCCT revealed a focal lesion with ring enhancement in the right hemisphere, consistent with a brain abscess. Blood cultures returned positive for MRSA, although inflammatory markers were only mildly elevated (CRP: 25 mg/L, leukocytes: 13.71 x 10^9/L). The patient was promptly optimized for neurosurgery with platelet transfusion and intravenous immunoglobulin (IVIG). A neurosurgical team performed burr hole drainage of the brain abscess, and high-dose intravenous antibiotics, including cefotaxime, metronidazole, and vancomycin, were initiated. The pus culture confirmed the presence of MRSA. Despite clinical improvement, the patient experienced two episodes of focal neurological seizures, prompting the initiation of prophylactic anticonvulsant therapy to prevent further seizures.

CONCLUSION: Brain abscesses are a rare but serious complication in patients with Wiskott-Aldrich Syndrome, highlighting the complexity of managing CNS infections in immunocompromised individuals. Early recognition and aggressive management, including prompt imaging, targeted microbiological analysis, and a multidisciplinary approach, are crucial for improving outcomes. This case underscores the necessity of maintaining a high index of suspicion for CNS infections in patients with WAS,especially when neurological symptoms are present. The successful management of this case demonstrates the importance of early intervention and tailored antibiotic therapy in achieving a favorable outcome, even in the context of severe underlying immunodeficiency.

Prevalence and Risk Factors of Anemia Among Conflict-Affected Populations in Sudan: A Cross-Sectional Study

Ibrahim Nagmeldin Hassan — 2025-01-01

BACKGROUND: Anemia is a significant public health concern, particularly in conflict-affected regions, where poor nutrition, limited access to healthcare, and displacement exacerbate its prevalence. Political tension between the leading military force in the nation, the Sudanese Armed Forces (SAF), and the Rapid Support Forces (RSF), which began on April 15, 2023, is currently ongoing mainly in Khartoum State. Despite the impact of the conflict on the region, there is a lack of data regarding the nutritional status of the residents. The aim of this study is to assess the prevalence, severity, and risk factors of anemia in populations affected by the ongoing armed conflict in Sudan.

METHODS: We conducted a cross-sectional study among residents of Khartoum State at a regional hospital in Sudan between May 12 and July 26, 2024. We included 323 participants selected through a systematic random sampling method. We used a modified validated standard questionnaire to collect demographic information. We reviewed medical records to gather the participant's chronic and infectious disease history. We collected blood samples for laboratory assessments, including hemoglobin, serum iron, and vitamin B12 levels. The study also considered socio-economic status, dietary intake, and healthcare access. We analyzed the data using SPSS version 26.0. We used descriptive statistics to determine the prevalence and severity of anemia, and logistic regression was employed to identify predictors of anemia among the study population. A p-value of 0.05 or less was considered statistically significant.

RESULTS: Out of the 323 participants in the study, 57.9% (95% CI: 52.7%-63.1%) were anemic, with 24.8% having mild anemia, 27.9% moderate, and 5.3% severe. The mean hemoglobin level was 10.4 g/dL (SD: 1.8). Anemia was significantly more prevalent among internally displaced persons (IDPs), accounting for 35.6%, with a strong association between displacement status and anemia (OR 2.6, 95% CI: 1.7-4.2). Socio-economic factors had an important role in the prevalence of anemia, with low income being a significant predictor (OR 3.2, 95% CI: 1.9-5.1). Participants with inadequate caloric intake (43.3%) were also more likely to be anemic (OR 2.5, 95% CI: 1.6-4.0). Furthermore, chronic diseases such as chronic kidney disease (9.3%) and diabetes (14%) were associated with higher odds of anemia (OR 4.5, 95% CI: 2.1-9.6 for chronic kidney disease). Infectious diseases, particularly malaria (12.4%), also increased the risk of anemia (OR 2.8, 95% CI: 1.5-5.2). Nutritional deficiencies were prevalent, with 60.4% having low serum iron levels and 18.6% deficient in vitamin B12. Malnutrition was another factor, with 23.2% being underweight and 17% being severely malnourished. Access to healthcare was limited; 44.9% of participants reported no access to iron supplements, and 10.8% had received blood transfusions due to anemia.

CONCLUSION: This study highlights that anemia is prevalent among Khartoum residents during the conflict in Sudan, with socio-economic deprivation, malnutrition, chronic and infectious diseases, and limited healthcare access being key contributors. Addressing the anemia situation in Sudan requires collaborative efforts from healthcare providers, government agencies, and international organizations to implement effective interventions that reduce the burden of anemia and improve the overall health of populations.

Dihydroartemisinin-piperaquine for Malaria Prevention in HIV‐Positive Pregnant Women: Systematic Review and Meta-Analysis of Clinical Trials

Ammar Tarig — 2025-01-01

BACKGROUND: Dihydroartemisinin-piperaquine (DP) is a long-acting artemisinin combination treatment that provides effective chemoprevention and has been proposed as an alternative antimalarial drug for intermittent preventive therapy in pregnancy (IPTp). Prevention of malaria infection during pregnancy in HIV-negative women currently relies on the use of long-lasting insecticidal nets together with intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP). Increasing sulfadoxine-pyrimethamine resistance in Africa threatens the current prevention of malaria during pregnancy. Thus, a replacement for IPTp-SP is urgently needed, especially for locations with high sulfadoxine–pyrimethamine resistance. Dihydroartemisinin-piperaquine is a promising candidate. This systematic review aimed to assess the effectiveness and safety of IPTp-DP in HIV-positive pregnant women.

METHODS: This systematic review and meta-analysis followed Cochrane guidelines. Our inclusion criteria were clinical trials on HIV-positive pregnant women using dihydroartemisinin-piperaquine regimens compared to any control group. Primary outcomes included maternal, placental, and cord malaria incidence; secondary outcomes included maternal and neonatal health and adverse effects. We searched PubMed, the Cochrane Library, and Scopus for relevant articles. Two independent reviewers screened the articles. A third reviewer resolved the discrepancies. Meta-analysis was done using RevMan 5.3. Fixed- or random-effects models were used based on heterogeneity, with odds ratios comparing intervention and control groups.

RESULTS: Intermittent preventive treatment with dihydroartemisinin-piperaquine (IPT-DP) during pregnancy significantly reduces the risk of malaria-related outcomes. Specifically, IPT was associated with a 55% decrease in the odds of having malaria during pregnancy (OR = 0.45, 95% CI: 0.36, 11.18, P ≤ 0.001); a 39% decrease in the odds of placental malaria (OR = 0.61, 95% CI: 0.43, 0.85, P = 0.004); and a 46% decrease in the odds of malaria at delivery (OR = 0.54, 95% CI: 0.30, 0.98, P = 0.04) (Figure 1). However, there was no significant reduction in the risk of adverse events (OR = 0.94, 95% CI: 0.73, 1.20, P = 0.61); low birth weight (OR = 0.94, 95% CI: 0.73, 1.20, P = 0.61); foetal loss (OR = 1.14, 95% CI: 0.67, 1.94, P = 0.62); or stillbirth (OR = 1.03, 95% CI: 0.56, 1.89, P = 0.93). On the other hand, there was a statistically significant increase in the risk of miscarriage in the IPT group compared to the control (OR = 3.37, 95% CI: 1.08, 10.51, P ≤ 0.001). This is 3.37 times the odds of miscarriage with IPT use.

CONCLUSION: Dihydroartemisinin-piperaquine reduces the risk of malaria and placental malaria in HIV pregnant women. Also, it does not significantly impact adverse pregnancy outcomes such as low birth weight, foetal loss, or stillbirth. However, DP increases the risk of miscarriage. This indicates the need for careful prescriptions for HIV pregnant women.

Comparative Effectiveness of Sequential Hygiene Education Interventions among Primary School Students in Thailand: A Randomized Controlled Study.

Supitsara Kositbovornchai — 2025-01-01

BACKGROUND: Infectious diseases remain a significant global health challenge, particularly in light of recent pandemics. Effective hygiene education is crucial in mitigating the spread of these diseases, especially among school-aged children. This study aimed to evaluate the effectiveness of two sequential hygiene education interventions—classroom teaching followed by animated videos (C2T) versus animated videos followed by classroom teaching (T2C)—in improving hygiene-related knowledge and practices among primary school students in Thailand.

METHODS: A total of 2,188 students from six primary schools were enrolled in this randomized controlled study. Participants were randomly assigned to either the C2T (n=1,100) or T2C (n=1,088) intervention groups. Knowledge assessments were conducted at three points: before the interventions (pre-test), after the first intervention (post-test 1), and after the second intervention (post-test 2). Classroom teaching covered a comprehensive set of 15 hygiene-related questions (Q1-Q15), while the animated videos focused on four key concepts (Q1, Q4, Q7, and Q10). The interventions were evaluated based on the improvement in test scores, with statistical significance determined using p-values.

RESULTS: Both interventions led to significant improvements in students’ hygiene knowledge from pre-test to post-test 1 and post-test 2 (p < 0.001). The T2C group showed a larger initial improvement from pre-test to post-test 1 (mean change = 0.87, 95% CI [0.82, 0.93]), compared to the C2T group (mean change = 0.66, 95% CI [0.60, 0.71]). However, from pre-test to post-test 2, the C2T group exhibited a slightly greater overall improvement (mean change = 0.42, 95% CI [0.37, 0.48]) compared to the T2C group (mean change = 0.31, 95% CI [0.25, 0.37]). These results suggest that while the T2C approach is more effective in the short term, the C2T approach may lead to better long-term retention of knowledge.

CONCLUSIONS: Both educational sequences effectively enhanced hygiene knowledge among primary school students, with each approach offering unique advantages. The T2C method provides a stronger immediate impact, while the C2T method supports sustained learning. These findings highlight the importance of considering the sequence of educational interventions to maximize their effectiveness in promoting hygiene practices.

Understanding the Role of Inflammation in ALS-FTSD: A systematic Review and Meta-analysis Investigating the Relationship between Inflammation and Amyotrophic Lateral Sclerosis and Frontotemporal Spectrum Disorder.

Scott Purdie — 2025-01-01

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a rare, severely debilitating neurodegenerative disease characterised by progressive degeneration of upper and lower motor neurons. More than 50% of those affected also exhibit characteristic frontotemporal dementia (FTD) symptoms. Therefore, it is now widely recognised as a spectrum disorder encapsulating both motor and cognitive deficits, termed Amyotrophic lateral sclerosis frontotemporal spectrum disorder (ALS-FTSD). While the pathophysiology is poorly understood, a growing body of literature demonstrates the involvement of inflammation in ALS-FTSD. This systematic review and meta-analysis investigated the role of inflammation in ALS-FTSD and answer the question of whether interventions targeting inflammation will improve survival and motor outcomes through multiple biochemical pathways across the genetic and pathological spectrum of ALS-FTSD.

METHODS: Three databases, (1) PubMed, (2) Ovid-Medline, and (3) Ovid-Embase, were searched using predetermined search terms. After Screening, 1,302 papers underwent data extraction and categorisation. These informed our choice to investigate in-depth, drug intervention studies targeting inflammation in relatively understudied preclinical genetic mouse models of ALS-FTSD. Of 53 potential papers identified, nine were meta-analysed quantitatively, yielding four interventions targeting inflammatory pathways which reported survival, and 12 interventions reporting rotarod latency to fall, a commonly reported motor phenotype.

RESULTS: Following an overview of the current state of the research field, a specific focus of quantitative and qualitative analysis was determined. It was found that the SOD1 genetic mouse model are overrepresented and given that a published meta-analysis has already been carried out looking into therapeutic interventions on several physiological targets, including inflammation. It was decided to focus on the relatively understudied but incredibly clinically relevant TDP-43, C9orf72, and FUS mouse models for meta-analysis, which are more representative of human pathology than SOD1. Meta-analysis of the overall effect of inflammation-targeted interventions on survival in ALS-FTSD mouse models produced a hazard ratio of 1.42 (95%CI 1.08 to 1.86), with a Z-score of 2.52 (p=0.01), demonstrating inflammation-targeted interventions have a statistically significant positive effect on survival in ALS-FTSD mouse models. Meta-analysis of the overall effect of inflammation-targeted interventions on motor function in ALS-FTSD mouse models produced a standardised mean difference of 2.96 (95%CI 1.88 to 4.04), with a Z-score of 5.38 (p<0.00001), demonstrating that inflammation-targeted interventions have a statistically significant positive effect on motor function in ALS-FTSD mouse models.

CONCLUSION: The results of this meta-analysis demonstrate that interventions which decrease inflammation have significant positive effects on both survival and motor symptoms compared to controls in mouse ALS-FTSD model studies. This evidence demonstrates that inflammation is a crucial driver of the ALS-FTSD disease process although further investigation is required to fully characterise the nature of their mechanisms, side effects, and efficacy in human disease. Moving forward, the most challenging aspect of future research will be bridging the translation gap between preclinical studies and effective human therapeutics. This review suggests that interventions targeting inflammation are a promising avenue for future therapeutic research and development.

M.A.R.V.E.L.S. "Medical Students Advancing Research, Visibility, Education, Leadership, and Support." A Student-Driven Initiative

Molly Mehta — 2025-01-01

BACKGROUND: Research activity is crucial for medical students' professional growth and development. However, significant barriers to accessing research opportunities remain. We introduce a student-led initiative designed to improve research accessibility and training for medical students while creating advancement opportunities for student researchers in their respective fields. AIMS: 1. Foster peer guidance in medicine to make research accessible to all students regardless of gender, experience, and specialty interests 2. Create student research training that integrates with medical school curricula 3. Facilitate ongoing communication regarding the current research and scholarly activities at our institution.

METHODS: A committee of six second-year medical students and four faculty advisors established three networks to increase medical student involvement in research. The first is a Microsoft systems database containing contact, field of study, productivity, and project information of research faculty open to mentoring students aimed to facilitate meaningful collaboration between faculty seeking help with research projects and medical students eager to conduct research. The second is the creation of student researcher profiles that highlight medical students' anecdotal experiences, advice, and examples of successful efforts to find faculty mentors, projects, and meaningful research in their specialty of interest. These student researchers serve as ambassadors in connecting medical students to ongoing research opportunities. The third is a series of student-led mentorship sessions that aim to build research skills, address knowledge gaps, and promote collaboration.

RESULTS: The implementation of our initiative led to the expansion of our collaborating partners across the university by at least 70 personnel through their roles in events, ambassadorship, technological application creations, and mentorship sessions within the 10 months of creation. We have collected data from 30 researchers across 6 departments and identified over 45 available projects for students to contribute to. We have created public profiles of 20 student researchers ranging from first-year medical students to fourth-year students representing 13 different areas of medicine. Three mentorship events have been hosted thus far, with plans for monthly sessions. The pilot event supported first-year medical students in conducting independent summer research projects by discussing how to write a proposal, conduct a literature search, collect data, and analyze resources. Based on the input, future sessions have been scheduled to target material that falls short within our curriculum.

CONCLUSION: This initiative promotes a philosophy of academic engagement driven by student leaders to empower peers to connect with research opportunities that align with their career aspirations; with our goal of embodying the depth of being a student leader and advocating for medical student research, we are providing the tools necessary for success. Its need is further driven by the increasingly demanding nature of research within residency applications and the need for expanded knowledge beyond clinical practices. It also offers innovative solutions to enhance the research activity of any academic institution that collaborates with student researchers. By encouraging proactive efforts, effective communication of opportunities, and fostering collaboration early, our initiative addresses the obstacles medical students encounter in becoming proficient researchers.

Psychiatric Outcomes in Patients with Trigeminal Neuralgia Treated with Anticonvulsants with or without Antidepressants: A Retrospective Cohort Study Using TriNetX

Ashley Deng — 2025-01-01

BACKGROUND: Trigeminal Neuralgia (TN) presents as intense, spastic craniofacial pain that arises from a variety of causes including trigeminal nerve root compression, disruption in channel conductance, or idiopathic reasons. The chronicity and intensity of the pain leads to psychological co-morbidities including depression and anxiety. Because there is no cure for TN, treatment includes interventions that manage symptoms.

METHODS: The data for this study was obtained from TriNetX, a multi-national collaborative health network spanning over 116 million patient records in the U.S. The data is de-identified, continuously updated, and provides a variety of data points including labs, diagnoses, medications, procedures, and demographics. IRB approval was not required. Data was queried using ICD-10 codes and NLM classification. All patients included in the study were diagnosed with Trigeminal Neuralgia (ICD-10 CM: G50). The study population was sorted into two cohorts. Cohort 1 was defined as patients diagnosed with TN (ICD-10 CM: G50) and prescribed anticonvulsants medication (VA: CN400) and antidepressant medication (ATC: N06A). Cohort 2 was defined as patients diagnosed with TN and prescribed anticonvulsants medication without antidepressant medication. The two cohorts were propensity scores matched on characteristics including sex, current age, age at index, race, and ethnicity. The psychiatric outcomes that were assessed were a diagnosis of ‘major depressive disorder, recurrent (ICD-10 CM:F33)’, ‘Anxiety, dissociative, stress-related, somatoform and other non-psychotic mental disorders (ICD-10 CM:F40-F48)’, and ‘sleep disorders not due to a substance or known physiological condition (ICD-10 CM:F51).

RESULTS: After a 1:1 Propensity Score Match, each cohort comprised 21,252 patients. Post-matching, both cohorts showed a balanced profile: mean age of 60 years, 70% female representation, 71% non-Hispanic or Latino, and 70% white. Results indicate that patients with TN taking anticonvulsants and antidepressants had a higher risk and odds for development of depression (8.218 RR, 8.601 OR), anxiety (2.788 RR, 3.152 OR), and sleep disorder (4.45 RR, 4.568 OR) than their counterparts taking only anticonvulsants. Similarly, patients with TN taking both anticonvulsants and antidepressants demonstrated a markedly higher hazard ratio in depression (8.038 HR), anxiety (2.943 HR), and sleep disorder (4.231 HR) development compared to their counterparts only taking anticonvulsant. However, log-rank analysis did not show a statistical significance of time to development of depression (p=0.546), anxiety (p=0.259), and sleep disorder(p=0.101) between the two cohorts.

CONCLUSION: Our findings align with current literature on the reciprocal relationship between pain and psychiatric symptoms. In TN, anticonvulsants are often prescribed to address pain, while antidepressants are prescribed to address psychiatric side effects of the chronic craniofacial pain. However, interaction between antidepressants and anticonvulsants are complicated and may influence the pharmacokinetics and pharmacodynamics of each other.

The Effect of Laterality on Squamous Cell Carcinoma Size and Mohs Micrographic Surgical Characteristics

Sheila Sharifi — 2025-01-01

BACKGROUND: Mohs Micrographic Surgery (MMS) is a minimally invasive technique designed to treat skin cancers in cosmetically sensitive areas. MMS involves the sequential removal of horizontal layers of the tumor, which are processed in real-time to determine if the margins are cancer-free. As it relates to the development of tumors, certain activities and lifestyles may render patients susceptible to uneven distributions of sun exposure favoring specific literalities of skin lesions.

METHODS: To determine if there were any differences in laterality in patients with squamous cell carcinomas (SCCs) undergoing MMS, a retrospective chart review was conducted. This analysis included 255 patients with SCCs confirmed by biopsy who had undergone MMS at a single academic center. We evaluated the anatomical location of the tumor, preoperative tumor size, postoperative wound size, and number of layers removed during surgery. We then computed the average and standard deviation values for left- versus right-sided SCC tumors for the above parameters. Subsequently, we computed a two-tailed T-test to determine if there was a statistically significant difference.

RESULTS: Of the 255 patients analyzed, 121 had right-sided SCCs and 134 had left-sided SCCs. The means for the preoperative tumor size for the right versus left SCC tumors were 1.73 cm³ versus 1.79 cm³, respectively (standard deviation of 1.56 versus 2.83 cm³, respectively). The means for the layers removed for the right versus left SCC tumors were 1.69 versus 1.61 layers, respectively (standard deviation of 0.72 versus 0.69, respectively). The means for the postoperative wound size for the right versus left SCC tumors were 3.44 cm³ versus 3.63 cm³, respectively (standard deviation of 2.92 versus 4.98 cm³, respectively). The p-values were all above 0.1 for left versus right SCC comparing these three metrics.

CONCLUSION: Despite the slight leftward preponderance of the SCC cases, there was no statistical difference in preoperative tumor size, postoperative wound size, or number of layers removed during surgery. Therefore, differences in occupational or activity-based lateral sun exposure did not appear to have a significant effect on SCC tumor size laterality in this patient cohort. The increase in left-sided cases could be due to leftward sun exposure or could be due to normal statistical variation. Further research may analyze a larger patient cohort to better quantify the prevalence of left-sided tumors.

Dengue: Neurological Manifestations, Case Series in a Tertiary Hospital in Central Colombia.

Erika Angarita Ramirez — 2025-01-01

ABSTRACT.

Dengue virus infection, an arbovirus endemic to South America, represents an increasing public health concern due to its ability to produce a wide spectrum of clinical manifestations, including neurological complications stemming from its high genetic diversity and neurotropic potential. Despite the growing evidence linking dengue with these neurological complications, gaps remain in understanding the pathogenic mechanisms, risk factors, and optimal management of these patients. Therefore, this case series report aims to describe the clinical characteristics, management, and outcomes of patients with dengue who developed complications such as encephalopathy and encephalitis due to this virus, thus contributing to a broader understanding of this clinical entity and improving prevention and management strategies.

CASE 1:A 23-year-old male presented to the emergency department with febrile symptoms, dizziness, abdominal pain, hematemesis, diarrhea, and seizures. Dengue with encephalitis and intracranial hemorrhage was suspected. The patient was administered mechanical ventilation, deep sedation, and anticonvulsants. Tests revealed severe thrombocytopenia and signs of dengue. A CT scan ruled out hemorrhage, and dengue encephalitis was diagnosed. Treatment was adjusted, and the patient was extubated with neurological improvement before discharge.

CASE 2: An 83-year-old male with significant medical history presented with fever, asthenia, headache, and severe thrombocytopenia. The diagnosis was severe dengue with decompensated heart failure. Despite platelet transfusion and ICU management, the patient developed status epilepticus and a subdural hematoma on CT. He was treated with anticonvulsants and, after stabilization, was transferred to inpatient care with a long-term management plan.

CASE 3: An 18-year-old male was admitted with progressive headache, fever, and episodes of vomiting and seizures. CT showed cerebral edema, and CSF indicated non-herpetic viral encephalitis. After discontinuing antibiotics and continuing with acyclovir, dengue encephalitis was confirmed. Despite a positive clinical evolution, seizures persisted. Additional studies showed brain damage secondary to hypoxia, and the patient was discharged with recommendations and follow-up.

CONCLUSION: The cases emphasize the critical need to consider dengue as a trigger for severe neurological complications, underscoring the importance of timely clinical evaluation and management to improve patient outcomes. Dengue's impact on both the central and peripheral nervous systems highlights its relevance as a differential diagnosis in patients with acute neurological alterations, particularly in endemic areas. A multidisciplinary approach is essential in managing these complications, while ongoing surveillance, public awareness, and the potential for an effective vaccine offer hope for early intervention and reduced morbidity and mortality.

Vertibral artery Dissection secondary to Malignant hypertension precipitating a posterior circulation stroke

Avi Singh Gandh Gandh — 2025-01-01

Background: Diagnosing posterior circulation strokes is challenging due to non-focal symptoms and their overlap with anterior circulation ischemia. Common presentations include lateral medullary syndrome (Wallenberg) and cerebellar infarctions, with symptoms like nystagmus, truncal ataxia, tongue deviation, internuclear ophthalmoplegia, and contralateral pain and temperature impairment. These strokes are often missed on NCCT head scans. High clinical suspicion and evolving neurological signs should prompt a CT angiogram of the head and neck, though MR angiography remains the gold standard for confirming vertebral artery dissection.

Case: A 35-year-old male with a history of hypertension, chronic kidney disease, pre-diabetes, left ventricular hypertrophy, and previous left Bell’s palsy presented with sudden left facial paralysis, dizziness, blurred vision, nausea, vomiting, and a blood pressure of 217/141 mmHg. In the emergency room, his vitals included a pulse of 110 bpm, temperature of 36.6 °C, respiratory rate of 23/min, and a BMI of 47.5 kg/m². Examination revealed bilateral nystagmus, ongoing cranial nerve VII deficits, slurred speech, and left upper limb ataxia. A stroke alert was triggered, and an initial non-contrast head CT was negative. Given an NIH Stroke Scale score of 3 and persistent symptoms, a CT angiogram was performed which showed occlusion of the left vertebral artery in the distal V3 and V4 segments, while the basilar artery remained patent with right-dominant circulation. MRI confirmed a left lateral medullary stroke. Management included placing a nasogastric tube, initiating dual antiplatelet therapy (Aspirin 75 mg and Clopidogrel 75 mg), and administering antihypertensives (Hydralazine, Lisinopril-Hydrochlorothiazide, Metoprolol, and Amlodipine). The patient was discharged three days later with instructions to continue dual antiplatelet therapy for 90 days.

Conclusion: Malignant hypertension can trigger vertebral artery dissection, leading to a posterior circulation stroke, which has an ambiguous clinical presentation and is often missed on a non-contrast head CT. If clinical symptoms and exam findings suggest this condition, a CT angiogram of the head and neck should be performed, with MRI and MR angiography used for confirmation. Treatment decisions are complicated by the choice between anticoagulants and antiplatelets with antiplatelets being preferred due to their safety profile.

Fox – Fordyce Disease: a case report

Monika Rimdeikaite — 2025-01-01

Background: Fox-Fordyce disease (FFD), also referred to as apocrine miliaria, is a rare inflammatory condition, that mainly affects the apocrine sweat glands. The disease mainly manifests with intensely pruritic papules, with the itching intensifying during sweating, stress, and exercise. Although more predominant in the axillary region, other areas, such as the lips, perineum, sternum and anogenital region can also be affected. The disorder is more often observed in females and due to its uneven distribution between the genders, it is thought that the hormonal component is of utmost importance in the development of FFD. Moreover, the symptoms initially present at the onset of puberty, starting at around 13 years of age, are mostly present around the time of menstruation, and often resolve at the time of pregnancy or after menopause. The treatment of FFD is often intricate, requiring multiple treatment modalities to achieve optimal results. The options mainly rely on reducing inflammation and sweating, as well as inhibiting sweat duct occlusion. Inflammation-reducing approaches, such as topical calcineurin inhibitors, clindamycin and corticosteroids are considered first-line options; however, retinoids may also be used to reduce follicular occlusion. We present a case of FFD, that affects both the scalp and the axillary areas.

Case: A 23-year-old patient was referred to a dermatologist due to an itching scalp and hair loss, presenting for 6 months. The patient was otherwise healthy and did not have a family history of similar diseases. Examination of the patient revealed erythematous scalp skin and excoriations. Scalp follicle hyperkeratosis, as well as perifollicular oedema in the axillary region, was observed via digital dermoscopy. Upon further consideration, a decision to perform a punch biopsy was reached. The biopsy revealed hair follicle epidermal hyperkeratosis and parakeratosis, as well as a vacuolization, spongiosis, lymphocytic and histiocytic infiltration of the basal epidermal layer of the follicular infundibulum. Furthermore, histiocyte accumulation was observed within the deep segment of the sweat duct; overall, indicating that the changes are similar to those seen in FFD. The patient was prescribed 5 percent minoxidil solution for scalp and axillary areas, 10 mg of peroral isotretinoin, as well as 1 percent pimecrolimus cream for the pruritic regions of the scalp. Upon further inspection, after 3 months, there has been a slight improvement in the patient’s condition. While there has been an improvement in pruritus, erythema persists in both the scalp and axillary regions.

Conclusion: To summarize, the management of FFD is intricate, often requiring the exploration of various different treatment modalities, in order to find the most effective approach. We present a case of axillary and scalp FFD, that was managed with topical calcineurin inhibitors and peroral retinoids.

Churg-Strauss Syndrome in an HIV-Positive Sudanese Patient: A Challenging Treatment Case

Omer A Mohammed — 2025-01-01

BACKGROUND: Churg-Strauss syndrome (CSS), also known as eosinophilic granulomatosis with polyangiitis (EGPA), is a rare form of systemic vasculitis characterized by asthma, eosinophilia, and multi-organ involvement. The syndrome primarily affects the lungs, heart, and kidneys. Managing CSS becomes even more challenging in patients with additional comorbidities like chronic kidney disease (CKD) and HIV, particularly when considering the risks associated with immunosuppressive therapy, which is standard for CSS but can exacerbate the immunosuppressed state in HIV-positive individuals.

Case: A 34-year-old Sudanese male with no history of smoking, except for occasional sheesha use (2-3 times per week for one year), presented with multiple symptoms. The patient had been diagnosed with hypertension four months prior and CKD five months before this presentation, for which he was undergoing regular hemodialysis. He also had a history of asthma diagnosed five months earlier, managed with salbutamol and symbicort nebulizers. His hypertension was controlled with candesartan 16 mg and nifedipine 24 mg daily. The patient reported shortness of breath, particularly exacerbated by exercise, dialysis, and hot weather, which was relieved by Atrovent. He also had a two-week history of fever, primarily during dialysis, along with headache, rigors, a single episode of vomiting, recurrent epistaxis, and weight loss of 5 kg over five months. Additionally, he experienced numbness in both upper and lower limbs, generalized body swelling, and altered bowel habits.

THE CASE: The patient appeared unwell, distressed, and dyspneic. Physical examination revealed raised jugular venous pressure, bilateral wheezing, fine crackles in the chest, mild lower limb edema, flat feet, and lower limb paresthesia. There was no evidence of pallor, jaundice, purpura, lymphadenopathy, skin nodules, or hemoptysis. Initial laboratory investigations showed anemia, electrolyte imbalances, and significant renal impairment. A chest X-ray revealed interstitial infiltrates with prominent bronchovascular markings. Follow-up tests showed improved hemoglobin levels but persistent renal impairment. Urinalysis revealed red blood cells (RBCs) and pus cells, while malaria was ruled out.

Diagnosis: Based on the clinical presentation, including the history of asthma, eosinophilia, and multi-organ involvement, the patient was diagnosed with Churg-Strauss syndrome (CSS). Additionally, the patient developed septicemia secondary to an infected permicath catheter, and subsequent HIV testing returned positive. The presence of HIV further complicated the management of CSS, as the standard immunosuppressive therapy posed a risk of worsening the patient’s immunocompromised state. The patient received emergency dialysis and broad-spectrum antibiotics, including meropenem and vancomycin, to treat the septicemia. The infected permicath catheter was replaced with an arteriovenous catheter to reduce the risk of recurrent infections. Despite the diagnosis of CSS, immunosuppressive therapy was deferred due to the patient’s HIV status, given the increased risk of opportunistic infections.

CONCLUSION: This case illustrates the complexities of managing Churg-Strauss syndrome (CSS) in a patient with multiple comorbidities, including CKD and HIV. The coexistence of these conditions presents significant therapeutic challenges. This case underscores the necessity of a multidisciplinary approach and tailored treatment plans to optimize outcomes in patients with complex, overlapping medical conditions.

Pain Severity Ratings Among Patients with Comorbid Chronic Pain and PTSD

Lily Charron — 2025-01-01

BACKGROUND: Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may occur after experiencing or witnessing a traumatic event. PTSD is associated with many physiological symptoms, including sleep disturbances and hyperarousal. One understudied symptom in PTSD patients is chronic pain (CP). Acute pain can lead to CP when it persists beyond adaptation. The interconnection between stress and pain has been well-established in fields of neuroscience and psychology. Though the association is well-documented in literature, there are still gaps in our understanding of the nature of this clinical relationship.

METHODS: In the current study, we use a retrospective cohort of patients with PTSD and CP through a database of numerous healthcare organizations called TriNetX. We compare the reported pain severity rating between three groups: those with PTSD and no CP, those with CP and no PTSD, and those with comorbid PTSD and CP. The summary data was compared using a one-way analysis of variance.

RESULTS: The average reported pain severity was significantly different between all three groups. The patients with comorbid PTSD and CP reported the highest average pain severity, followed by patients with only CP and then patients with only PTSD.

CONCLUSION: Our results demonstrate a need to further investigate the complex relationship between PTSD and CP. That the patients with both disorders reported a higher average pain severity indicates that pain management and psychiatric care should become a focus for this population.

Assessment of doctor's satisfaction with governmental hospital after the war 2024 in Sudan

Ali Omer — 2025-01-01

BACKGROUND: After the war in Sudan, and especially after the occupation of the city of Madani, a large number of people were displaced to the city of Port Sudan, including doctors. There was great pressure on government hospitals in Port Sudan and therefore doctors.

METHOD: This is a descriptive cross-sectional study to develop and validate a self-administered doctor’s satisfaction survey. This study was conducted based on a literature review from published literature from google scholar, PubMed, journals and for finding relevant information from WHO and UNICEF websites. The data have been collected through a designed questionnaire via Google form consists of 9 multiple choices questions, 4 questions measured on a 5-point Likert scale and 2 short answer questions. The questionnaire has been spread to doctors in governmental hospitals in Port Sudan. The data collected analyzed statistically by google form.

RESULTS: The outcome from our analyzed data and findings that female to male ratio is (~1:1), most of them from (20-30) and (30-40) age groups represented in (70.8%) and (29.2%) respectively. (37.5%) are Refugees from other states and Khartoum represents (36.4%) from the total. The majority of them in the beginning of their career, "houseman" representing (41.7%) followed by (33.3%) are registrar, then general practitioners by (12.5%) and lastly specialists by (8.3%). Only (8.3%) have 6-9 years’ experience in hospital, 3-6 years’ experience by (12.5%), 1-3 years’ experience by (29.2%) and less than 1-year experience represents the most by 45.8%. Satisfaction of Doctors [From 1-5 (1 represents the lowest and 5 is highest)] (62.5%) give scale (1/5) the lowest to salary, (33.4%) are ok with work time, (41.6%) are not satisfied from the work experience (give scale 2/5), (70.8%) are not satisfied from the learning methods, only (1.6%) are satisfied from hospital environment, no (5/5) response in hospital cleaning, (75%) agreed on there is low safety equipment’s, only (20.8%) are satisfied from the work place, (58.3%) are not satisfied from work schedule and (50%) are not satisfied from working hours (given scale 2/5 and 1/5), (62.5%) give (1/5) and not satisfied at all from hospital sanitation, for work over load (91.6%) are suffering, (37.5%) are satisfied from doctor patient relationship and (75%) are satisfied from hospital colleagues. Overall satisfaction is (16.6%).• Training experience beneficiary out of 5 (5 represents the highest and 1 represents the lowest), (4.2%) give scale (5/5), while (41.7%) give (3/5) and (29.2%) give (4/5) and (1/5 - 2/5) scales represents (12.5%) for both.• (66.7%) agreed with that doctors stick to federal ministry of health guidelines in treatment while (29.2%) are dis agree.• unfortunately (27.3%) see that current low can prevent their rights on the other hand (31.8%) they Don't see that and (40.9%) are not sure.

CONCLUSION: The Doctors are not satisfied, and they aspire to increase salaries, provide all supplies and medicines for emergency cases, provide facilities and equipment, take care of the hospital environment, continuous training for doctors, and create a good work environment while preserving all their rights.

Medical University Students Lifestyle and Value of Health

Katsiaryna M. Surmach — 2025-01-01

BACKGROUND: The risk of cardiovascular diseases (CVD) can be reduced by non-pharmacological approaches. Lifestyle medicine involves evidence-based interventions in physical activity, nutrition, sleep, and stress management. The feasibility of studying CVD risk factors (RFs) in groups of medical students with the development of programmes for the modification of the RFs can improve the health and qualification of medical staff in the future.

Aim: To evaluate the CVD risk factors in students of different courses at Grodno State Medical University (GrSMU).

METHODS: An online survey was conducted of 82, 1st and 5th year GrSMU students with their own consent. The questionnaire was based on the 2021 ESC Guidelines on cardiovascular disease prevention. All respondents were divided into two groups: 1 (5th year) and 2 (1st year). The “STATISTICA 10.0” computer programme was applied for investigation (Mann-Whitney test and Pearson χ2). The p-value less than 0.05 was statistically noteworthy.

RESULTS. The prevalence of the main modifiable RFs in the groups is in Table 1. No significant differences were found in the BMI, target WC in the 2 groups; 7.3% had a non-target BMI and 11% non-target WC; 14.6% of females and 1.2% of males are not aware of CVD heredity (p = 0.03). 83% of both groups ate “fast-food” (burgers, fries, pizza) 2 times a week or daily, the number of 1st year students was 58.5%, and the number of 5th year students – 24.4% (p = 0.005). It was found that 3.7% of students (all respondents were in 5th year) did not consume “fast-food” at all (p = 0.03). 60 out of 82 people ate salty food 2 times a week or daily (73.4%). No differences were found depending on age (course) in the consumption of sweet-drinks. 68% of the surveyed groups of 1 and 5 courses did not drink sweet-drinks or drank them less than 1-2 times a week; on the contrary, 6.1% of respondents drank them daily. 90% of all the students did not eat fish at all; 9.8% ate fish 1-2 times a week. Daily consumption of vegetables/fruits was indicated by 13.4% of students of both courses; 1.2% did not consume vegetables/fruits at all (5th year); 25.6% of students of both courses noted consumption less than 1-2 times per week; no differences were found depending on gender between groups.

CONCLUSIONS. Medical students have an unhealthy diet: more than 20% of both groups consume "fast-food" everyday, and 90% do not eat fish at all or less than 1-2 times a week; only 13.4% of respondents indicate daily consumption of vegetables and fruits, of which majority are girls.

Real World Experience of Bedaquiline-Based Anti-Tubercular Regime in Multi-Drug Resistant Tuberculosis.

Vikas Marwah — 2025-01-01

BACKGROUND: Tuberculosis is an important public healthcare problem in our country. Drug-resistant Tuberculosis is like a smoldering fire that if not controlled will flare up to an uncontrolled inferno. The conventional therapy for multidrug-resistant TB is associated with multiple issues like prolonged duration and various side effects. Newer anti-tubercular drugs are available but there is a lack of real-world evidence of their use. Bedaquiline is a novel drug belonging to the dairlyquinolone group. It has a bactericidal action and works by inhibiting the mycobacterial ATP synthase enzyme limiting the provision of ATP to mycobacterium.

METHODS: This was an observational study done at a tertiary respiratory care center on MDR TB patients to study the efficacy and adverse event profile of Bedaquiline in a clinical setting by examining the culture and smear conversion time.

RESULTS: 30 patients with MDR TB were included in the study. 28 patients had Kat G mutation of Isoniazid while 2 patients had InH A resistance. The second line probe assay showed additional resistance to fluoroquinolones in 27 patients and 2 patients had resistance to aminoglycosides. Twenty-one patients were on the first line while 9 patients were on second-line ATT drugs at the time of presentation to our center. The median smear conversion time was 4 weeks while the median culture conversion time was 10 weeks. The average weight gain was 9 kilograms. All patients recovered with a 100 % success rate. There were no life-threatening adverse effects noted, while two patients developed prolonged QTc on ECG. However, the QTc interval was less than 500 ms, and thus bedaquiline was not discontinued.

CONCLUSION: Our study aims to highlight the use of Bedaquiline-based anti-tubercular therapy in drug-resistant tuberculosis.

Utilizing Liner Artificial Intelligence Image Recognition for identifying Skin Disorders in Skin of Color

Ryan Scheinkman — 2025-01-01

BACKGROUND: Advances in artificial intelligence (AI) with machine learning have allowed for the use of this technology to identify the contents of images and answer questions about the contents of the images. Technologies, such as artificial intelligence, offer a potential avenue to improve medical care to marginalized communities. In this study we attempted to see how well the Liner AI model was able to detect ten dermatological diseases from Skin of Color images of the diseases.

METHODS: To test the model, two to three images each from the Dermatology Atlas for Skin of Color for the following diseases: vitiligo, mycosis fungoides, tinea, lentigines, acne vulgaris, rosacea, hidradenitis suppurativa, basal cell carcinoma, squamous cell carcinoma, and melanoma were input into the AI model and the AI model was prompted with the question: “What is the differential diagnosis?”

RESULTS: Liner generated variable length lists for the images and these differential diagnoses lists were analyzed. Liner’s accuracy of correctly diagnosing the correct diagnosis as the first diagnosis in the generated differential diagnosis list was only 34.6%, but the accuracy of the model to generate a differential diagnosis list that contained the correct diagnosis was 53.8%.

CONCLUSION: Liner demonstrated limited diagnostic accuracy, critically missing all the basal cell carcinoma cases, demonstrating present diagnostic limitations for potential future clinical use. Further, research could look to compare Liner against other patient demographics to see if the limitations were limited to the Skin of Color cases tested and to guide future development of this technology.

Impact of Sodium Fluctuations on Prognosis in Hospitalized Patients: A Retrospective Observational Study

Manlio Avila — 2025-01-01

BACKGROUND: In hospitalized patients, electrolyte alterations have a significant impact in patient outcomes particularly dysnatremias. Hyponatremia and hypernatremia are the two main sodium disturbances, which have been associated with increased morbidity and mortality. Nevertheless, the particular influence of sodium variations during hospitalization in mortality risk remains an area less studied and therefore less understood. Our study seeks to investigate the relationship between sodium fluctuations and mortality in hospitalized patients at Mexicali General Hospital, Mexico.

METHODS: We conducted a retrospective, single-center, observational study at a secondary care hospital in Mexicali, Mexico, from January 1, 2023, to May 31, 2023. The study included adult patients with normonatremia at admission (serum sodium levels between 135-145 mmol/L), with minimum hospitalization time of 48 hours and at least two sodium measurements. Patients with chronic kidney disease, tuberculosis, or pregnancy were excluded. Dysnatremia was defined as serum sodium levels outside the 135-145 mmol/L range during hospitalization. The primary outcome was to establish a relationship between the sodium fluctuation and mortality among all the patients that were hospitalized; while secondary outcomes demographic characteristics and a multivariable analysis to assess how these variables influenced the outcome Statistical analyses included ANOVA, Fisher's exact test, unpaired t-tests, Kaplan-Meier survival curves, and multivariate analysis using the Cox Proportional Hazard Model.

RESULTS: We had 284 patients from which 117 (41.2%) developed dysnatremia, with the highest incidence occurring in the intensive care unit (73.3%) and internal medicine services (50.4%). A total of 58 patients (20.4%) died during hospitalization, and among those, 36 (62.1%) had developed dysnatremia, with hypernatremia being more common. The odds ratio for mortality among dysnatremic patients was 2.7 (95% CI: 1.5-4.8, p=0.0009). Patients who developed hyponatremia had a mean length of stay of 12.28 days compared to 9.12 days for eunatremic patients. although, mixed dysnatremia was associated with the longest hospital stay (22.33 days). Patients with greater sodium fluctuations had a higher mortality risk, with a mean sodium variation difference of 7.01 mEq/L (95% CI: 4.99-9.03, p<0.0001) between survivors and non-survivors. Multivariate analysis revealed that age and serum creatinine at admission were significant predictors of mortality, with each year of age increasing the risk of death by 1.35% (p=0.027) and each 0.1 mg/dL increase in creatinine raising the risk by 1.16% (p=0.008).

CONCLUSION: Our findings underscore the importance of monitoring and managing sodium levels in hospitalized patients. Fluctuations in serum sodium levels during hospitalization are associated with increased mortality risk, particularly greater levels than 145 mmol/l and those in intensive care and internal medicine settings. Strategies aimed at the importance of closely monitoring and managing sodium levels improve outcomes in-hospital stay. Future research should focus on developing targeted interventions to stabilize sodium levels and further explore the mechanisms linking sodium dysregulation to mortality.

Investigating Potential Gender Differences in ChatGPT-Diagnosed Clinical Vignettes

Anjali Mediboina — 2025-01-01

BACKGROUND: The integration of artificial intelligence (AI) in medical decision-making introduces additional concerns, particularly regarding information bias within AI models such as ChatGPT, which heavily rely on training data. With gender-based disparities in diagnosis and treatment being well-documented in healthcare, there is a pressing need to evaluate the potential of AI models to perpetuate or alleviate these gender biases.

AIMS: This study seeks to investigate gender differences in diagnostic accuracy within ChatGPT 3.5 by evaluating the accuracy and completeness of its responses to various clinical vignettes.

METHODS: Ten medical conditions (including psychiatric, respiratory, cardiac, and cerebrovascular cases) previously reported for gender-based misdiagnoses, were selected for the study. Two identical clinical vignettes were created for each condition, with the only difference being the gender of the patient. These 20 vignettes were entered into ChatGPT 3.5 randomly by a single researcher, each accompanied by a prompt requesting the most likely explanation for the patient’s symptoms and the next appropriate step in management. The responses generated by ChatGPT were evaluated for accuracy and completeness by two independent evaluators, utilizing a scale set by Johnson et al., which included a six-point Likert scale ranging from 1 (completely incorrect) to 6 (correct) for accuracy, and a three-point scale for completeness, ranging from 1 (incomplete) to 3 (comprehensive). Discrepancies were resolved through a blind consensus process. Data analysis and visualization was done using RStudio v4.3.2, with statistical significance between accuracy and completeness was determined using Spearman’s R and Mann-Whitney U Tests.

RESULTS: Among the 20 cases, six were incorrectly diagnosed, with two instances attributed to gender-based misdiagnoses. Specifically, ChatGPT misclassified ectopic pregnancy as appendicitis, and paroxysmal supraventricular tachycardia (PSVT) as a panic attack in female patients, despite indicative symptoms and prior correct diagnoses in male counterparts. Additionally, systemic lupus erythematosus (SLE) was inaccurately labeled as rheumatoid arthritis (RA) in both male and female patients. Moreover, eating disorders were misidentified, with ChatGPT failing to provide definitive diagnoses for these conditions. The overall median accuracy score was 6, (Mean = 5.5, SD = 0.6), while the median completeness score was 2.5 (Mean = 2.5, SD = 0.5). Correlation analysis indicated a non-significant relationship between accuracy and completeness (Spearman's R: rs = 0.23139, p = 0.3263), although Mann Whitney U test results suggested significant discrepancies in accuracy between correctly and incorrectly diagnosed cases (z-score = 5.39649, p < .00001).

CONCLUSION: While the AI's responses were generally accurate and complete, the observed misdiagnoses of conditions such as PSVT and eating disorders highlight the need for a more thorough examination of potential biases in AI-driven chatbots. The varying outcomes in the Spearman’s R and Mann-Whitney U tests indicate that, although there may not be a consistent linear relationship between accuracy and completeness, ChatGPT's performance differs significantly across scenarios, necessitating further investigation. Moreover, the small sample size of vignette may not fully capture the extent of potential biases. Despite these limitations, the findings underscore the complexity of AI in healthcare and the critical importance of continuous scrutiny and refinement of these models.

Crimean-Congo Hemorrhagic Fever and Autoimmunity: A Georgian Viewpoint Improved by Awareness Survey

Aruna Rajeswari BB — 2025-01-01

BACKGROUND: Crimean Congo hemorrhagic fever (CCHF) is primarily transmitted through the Hyalomma tick a virus found in the Bunyaviridae family. The disease spreads when an individual is bitten by a tick or comes into contact, with one directly. Additionally consuming milk or being exposed to contaminated animal tissues or blood can lead to transmission. While human-to-human transmission can occur through contact with blood or bodily fluids such cases are mostly observed in settings. Around one out of every five individuals infected with the virus shows signs of illness whereas animals and ticks do not exhibit any symptoms of infection. People infected with CCHF typically experience a specific fever at the onset, which may progress rapidly into a hemorrhagic syndrome causing organ failure and potentially leading to death in severe instances. Georgia, located in the South Caucasus region shares borders with countries where CCHF transmission is prevalent. Given that, nearly half of Georgia's population engages in agriculture and resides in areas where they may be at risk, of contracting CCHF. In 2009 the National Electronic Integrated Disease Surveillance System (EIDSS) was introduced to monitor cases in Georgia. Physicians, in healthcare facilities in Georgia suspect a patient may have CCHF and report it to the Georgian National Centre for Disease Control and Public Health through EIDSS, a part of the surveillance system for reporting diseases.

METHODS: To study, CCHF information was collected from news media and health publications between 2014 and 2023. Additionally, a cross-sectional survey was conducted to assess peoples’ understanding of CCHF and autoimmunity. The survey consisted of twenty multiple-choice questions covering transmission, symptoms, prevention, and basic autoimmune concepts. The sample of 500 participants ensured representation. Descriptive statistics were utilized to analyze the data for awareness levels and common beliefs.

RESULTS: Insights from survey responses collected from individuals in Georgia unveiled intriguing aspects of their awareness and attitudes toward autoimmunity and CCHF. While most participants (60%) were familiar with CCHF it was concerning that 40% could accurately identify the disease transmission methods. Furthermore, the survey indicated that 70% of students expressed worries regarding autoimmunity. However, there seems to be a gap between awareness and understanding of conditions as half of respondents admitted knowing, about them. The difference, in outcomes, demonstrates the impact of campaigns and awareness programs in enhancing students understanding and correcting misconceptions. It underscores the importance of public health strategies that focus on educating people about disorders alongside managing infectious diseases like CCHF. Collaboration among health authorities, schools, and community groups is crucial for bridging knowledge gaps and promoting understanding among students.

CONCLUSION: The comprehensive examination of CCHF, in Georgia, enhanced by a study involving adults offers perspectives on existing awareness levels and misunderstandings. Closing these knowledge disparities through focused public health efforts and educational programs is crucial, for empowering individuals to safeguard themselves and their communities from autoimmune conditions.

Attributes And Attitude Towards Crystal Methamphetamine Users: A Cross-Sectional Study

Arwa Abdelmoneim Abdelaziz Nogdalla — 2025-01-01

BACKGROUND: Crystal methamphetamine (CM) is a powerful CNS stimulant, which causes a psychological disorder known as "ice psychosis," characterised by paranoid delusions, hallucinations, and strange, violent, or aggressive behavior. Permanent structural brain damage may also occur. It was reported that negative attitudes about medical conditions can directly affect patients' health and the quality of healthcare they receive, posing a major hurdle to healthcare delivery Not enough studies was conducted to investigate the attitude towards CM users among medical students, especially here in Sudan.

Aim: In this study, we aim to determine the prevalence of negative attitudes towards CM users among medical students and investigate the correlation between certain attributes and that may affect thier attitude .

METHODS: A cross-sectional study was conducted from March to July 2023 using an online questionnaire to examine the attitude of Sudanese medical students in Al-Neelain University towards CM users. The questionnaire was structured from a total of 31-items to asses other covariates including the demographics, experience with addiction, and previous CM use.

RESULTS: The study included 300 students, 191(63.7%) of them are females. Age median 21.1 years (IQR=2.3). 153(51%) were in preclinical levels. Most students 274(91.3%) were single. 79(26.3%) of students had monthly income ≥ 100,000 SDG. Majority of students 252(84%) resided with family, in urban areas 266(88.6%). Students with GPA ≥ 4.1 were 137(45.7%). 12(4%) of students smokes. 48(16%) of students have a close one who uses CM. Only 5(1.7%) of students reported prior or current use of CM. Of those who use CM, only 2(0.7%) said they faced discrimination due to CM use. Students' attitudes mean score was 47.4 ± 6.8. Most students held a negative attitude against people who use CM, with majority reluctant to accept them. There was significant difference in attitude scores between females (Md= 47, n=191) and males (Md=49, n=109), p value = 0.002. Furthermore, those who used CM had a median of 38 in comparison to those who never used CM (Md=48), p value = 0.01. Indicating that males and non-users showed higher degrees of stigmatization towards people who use CM.

CONCLUSION: Majority of students had negative attitude toward CM users with males and non-CM users representing most of the stigmatizing group. Therefore, stigma reduction initiatives and community educational programmes are required especially among higher stigmatizing group. Further in-depth studies are required at a national level.

Comparing Treatment Recommendations for Ten Dermatological Conditions Using ChatGPT, Claude, and PI AI Models

Ryan Scheinkman — 2025-01-01

BACKGROUND: Artificial Intelligence (AI) is being increasingly utilized in healthcare and offers a potential alternative for gathering medical information in the future. The gold standard for many physicians on guiding their approach to medical management has been UpToDate and PubMed. In this review we attempted to see how well three AI models (ChatGPT, Pi, and Claude) could perform in generating first line treatment recommendations when compared against UpToDate.

METHODS: To test the performance of these AI models, medical scenarios describing physical exam findings and patient histories, were sourced from the clinician generated medical education platform for ten dermatological diseases and inputted into the models. The models were then prompt with the query: “What is the first line treatment?”

RESULTS: The results were tabulated, and it was found that Claude could successfully generated first line treatment recommendations that corresponded to UpToDate for all ten of the diseases tested with the other models successfully predicting nine of the ten correct treatment regimes. However, ChatGPT and Pi mistakenly diagnosed the squamous cell carcinoma vignette as actinic keratosis and provided inaccurate treatment advice.

CONCLUSION: These AI models demonstrate that future developments in artificial intelligence may offer a free alternative to UpToDate as improvements in management recommendations are made as artificial intelligence models are further refined. However, the benefits of future utilization must be weighed against the risks of overreliance on this type of technology, especially if proper validation of information does not take place.

Shifts in California Statewide Cellulitis Hospitalization Rates were Found Between 2017 to 2022 Using a Retrospective Analysis

Ryan Scheinkman — 2025-01-01

BACKGROUND: Cellulitis accounts for $3.7 billion in ambulatory healthcare costs. We wanted to determine statewide trends for inpatient cellulitis cases as well as anatomic distribution of cases.

METHODS A retrospective analysis was performed using California’s Department of Health Care Access and Information’s “Hospital Inpatient - Diagnosis, Procedure, and External Cause Codes. Codes were extracted relevant to cellulitis, analyzed in excel to compile data on temporal trends and summating anatomical distribution over the timespan of 2017-2022.

RESULTS: We found 986,655 cases of inpatient cellulitis over the time frame with a nadir during 2020 (151,100 cases) and a peak at 2019 (175,360 cases). The anatomic location with the highest prevalence of cellulitis was the lower limbs (295,913 in right lower limbs, 295,162 cases in left lower limbs over the timeframe).

CONCLUSION: The shifts in patient cases may be due to changes in access to care during the COVID-19 pandemic that could inform future care during future pandemics. Additionally, the anatomical locational distribution favoring the lower limbs could be explained by preponderance of wound generation in this region. Future research could evaluate factors such as wound severity in a similar patient cohort in relation to anatomic location as well as analyzing epidemiological factors that could better explain the temporal trends observed around 2020

Case Report: Adult Hirschsprung's Disease

Kevin Wortman — 2025-01-01

BACKGROUND: Hirschsprung’s disease (HD) remains the most common condition to cause low functional intestinal obstruction in children. It is caused by the failed migration of colonic ganglion cells during gestation. The aganglionic sections of the colon are subsequently unable to relax, halting digestive consumption within the gastrointestinal tract resulting in prolonged constipation symptoms. Although it is primarily diagnosed in infants and children, there are cases of diagnosis not being made until adulthood.

CASE: A 19-year-old African American male with a history of asthma, chronic constipation, and medication noncompliance that presented to a local free-standing emergency department with constipation and severe abdominal distension. Per the patient’s mother, AB was also previously evaluated by a gastroenterologist at a children's hospital and no findings that they are aware of were discovered. His vitals on presentation were temperature 36.8°C, heart rate 98, blood pressure 130/99, respiratory rate 32, oxygen saturation of 95% on room air. On physical exam he had diminished breath sounds at his expected lung bases and his abdomen measured 112 cm at its largest circumference. At the emergency department a KUB was obtained and showed functional obstruction diffuse fecal loading throughout the colon. AB was subsequently admitted to the hospital. He was started on oral polyethylene glycol, dulcolax, and senokot with minimal response. A pulsated irrigation evacuation (PIE) procedure was performed on 2/10 with significant stool debulking, but his abdominal circumference remained unchanged. He was started on polyethylene glycol via NG tube and underwent manual disimpaction on 2/11 with large volume stool evacuation. His team of physicians decided that he needed a colon biopsy to confirm the suspicion of Hirschsprung's. After discussion with the patient, he deferred colonoscopy and biopsy until outpatient. After continued improvement in his stool output and abdominal circumference to roughly 65 cm, he was transitioned to oral polyethylene glycol and ultimately discharged on polyethylene glycol with follow up appointment scheduled to establish care with a primary care provider and a local gastroenterologist. The patient underwent an outpatient colon/rectum biopsy approximately one month after discharge. The biopsy was sent to pathology and was reported as follows: “Sections from the rectal biopsy specimen show well-oriented fragments of anorectal mucosa consistent with segments of squamous mucosa with adjacent colonic type columnar mucosa. Findings are consistent with sampling at the anal transitional zone. There is no significant inflammatory infiltrate. No ganglion cells are identified. Occasional lymphoid aggregates are noted. These findings are consistent with Hirschsprung's disease”.

CONCLUSION: Hirschsprung’s induced constipation can lead to severe consequences and should be promptly treated. Since there are no guidelines for severe constipation in HD patients, we recommend a stepwise approach starting with osmotic laxatives and stool softeners in conjunction with manual disimpaction. For refractory cases we recommend PIE, in areas where this procedure is available. Although this stepwise approach to severe constipation avoidance of life-threatening complications, definitive treatment is still colectomy once the bowel is evacuated; if the patient is agreeable to an invasive procedure.

Evaluating the Quality of School Health Services in Secondary Schools Within Gbarain/Ekpetiama Clan, Bayelsa State, Nigeria.

Tonte Nyingifa — 2025-01-01

BACKGROUND: The Gbarain/Ekpetiama clan is located in Bayelsa State, Nigeria, within the Niger Delta region, predominantly inhabited by the Ijaw people. School health services are essential for promoting the well-being of students and ensuring they are physically and mentally prepared to learn. However, the availability and quality of these services in secondary schools can vary significantly, especially in rural and underserved communities. This study aims to assess the presence and effectiveness of school health services in secondary schools within the Gbarain/Ekpetiama clan to understand how well these services support the health and education of students.

METHODS: A descriptive cross-sectional study was conducted among 380 secondary school students and teachers in Gbarain/Ekpetiama clan, Bayelsa State. A multistage sampling technique was employed to select participants from various communities, schools, and classes. Data collection involved questionnaires and interviews with students, teachers, and principals. Ethical approval was obtained from the Ethics and Research Committee of the College of Health Sciences, Niger Delta University. Verbal consent was obtained from community leaders, school authorities, and teachers, while parental consent forms were provided for students. Data were analyzed using SPSS version 22.0, with results presented in frequency tables and summarized using proportions.Statistical significance was assessed using p-values, with a threshold of p < 0.05 considered significant. Key areas of analysis included the presence of essential health services, availability of first aid and sick bays, and the frequency of health inspections and screenings.

RESULTS: The study found that 77.1% of the schools lacked formal school health services, and only 16.8% had essential drugs in their first aid boxes. A significant majority (95.3%) of schools did not have a functional sickbay, and 89.2% lacked a regular supply of drugs. Additionally, 94.2% of schools did not have a first aid box, and 95.8% had no emergency transport.( See table 1). Health education and routine medical screenings were also inadequate, with 88.7% of schools not conducting any screening activities. There were notable differences between public and private schools, with private schools generally having slightly better health services than public schools.

CONCLUSION: The assessment reveals that the provision of school health services in the secondary schools of Gbarain/Ekpetiama clan is significantly lacking, especially in public schools. These inadequacies pose a risk to the health and academic performance of students. To achieve better health outcomes and educational success, it is crucial to enhance the availability and quality of health services in schools. Recommendations include assigning medical officers to oversee school health, implementing pre-admission medical screenings, and ensuring regular health education and services in all schools.

Community Approaches to Combat Dengue Transmission in Morelia, Michoacan

Ezequiel Sandoval — 2025-01-01

BACKGROUND: Around the world, it has been shown that many countries know a diversity of community strategies techniques approaches to combat Dengue Transmission. Due to a lack of awareness and use of dengue prevention measures, there is no indication of people in Mexico experiencing a decline in the virus's ability to spread.

METHODS: Data were collected through surveys conducted on Google Forms, where participants were asked about their personal physical, chemical, and household protection measures. The study sample and population selection are ‘non-probabilistic or targeted. It included people aged 18 years and older who live in the Primo Tapia Poniente neighborhood of Morelia, Michoacán, Mexico. Exclusion criteria were applied, such as the death of the patient, refusal to give informed consent, no longer willing to participate, lack of communication or, moving.

RESULTS: Prevalence of the use of household protection tools Comparing knowledge with usage in Table 1 shows that 69% use three or more tools, and 20% use two. According to the surveys, 69% of the people knew at least one household protection tool against dengue and accepted the fumigation service. In comparison, 30% of the people knew at least one household protection tool against dengue but did not accept the fumigation service. Prevalence of actions or use of personal protection tools From the whole sample, 28% use two or more personal protection tools, followed by mosquito repellent (17%), but 55% do not use it. 30% of participants do not use any personal protection tools.

CONCLUSION: Increasing dengue prevention and having a population more equipped to manage the dengue season is crucial, as this research has shown that the community uses more informed preventive measures.

Atypical Vulvar Mass: Metastatic Vulvar Crohn’s Disease in a Young Female with Rheumatoid Arthritis: A Case Report

Shweta Kanyal — 2025-01-01

BACKGROUND: Crohn’s disease (CD) is an inflammatory bowel disease that usually manifests in any part of the gastrointestinal tract from the oral cavity to the anus, with well-known extraintestinal presentations such as uveitis, erythema nodosum and arthritis. Rarely, it can also present with metastatic vulvar lesions, a conundrum for the gynecologist and gastroenterologist, owing to its similarity with other granulomatous and dermatological conditions like hidradenitis suppurativa, cellulitis and secondary abscess, making it a diagnostic dilemma.

CASE: We present the case of a 24-years-old female, married with bilateral swelling in the vulvar region, insidious in onset, associated with pain, watery discharge, red discolouration of the surrounding skin and mild itching since 5 years that worsened in the past 6 months. She also had pain in multiple joints bilaterally, associated with early morning stiffness since childhood that worsened in the past 2 years and a history of hypothyroidism since 6 years followed by irregular menses since 4 years. She consulted a private clinic and the prescribed medications provided relief. However, her symptoms recurred a year later along with additional presentations of fissures and skin tags that gradually increased in severity. On visiting another hospital, a diagnosis of vulvar CD was confirmed on biopsy. She was started on methotrexate, oral steroids and azathioprine; which she adhered to for 6 months with failure to follow up thereafter. It eventually flared up for which she was referred to our hospital, where a thorough evaluation was done by several relevant departments. Positive biopsy findings showing non-caseating granulomas with giant cells along with positive ANA (Anti-nuclear antibody) and anti-CCP antibody (Anti-cyclic citrullinated peptide) correlated with the clinical symptoms confirmed the diagnosis of CD and rheumatoid arthritis respectively. The debulking procedure was done considering the severity of the lesion and the failure of the medications. Post-operative pathological evaluation of the procured tissue confirmed the pre-operative diagnosis.

CONCLUSION: This case underscores the difficulties encountered during the diagnosis of vulvar CD, especially in the absence of any gastrointestinal symptoms and signs on colonoscopy. It also emphasizes the importance of considering the differential of CD when faced with multiple vulvar symptoms. Undoubtedly, biopsy remains the cornerstone of diagnosis; and early diagnosis and treatment significantly is quintessential to improve the quality of life.

Analyzing the Relationship Between Preventative Healthcare Utilization and Higher Education Levels in Underserved Los Angeles Communities

Ahmad Elhaija — 2025-01-01

BACKGROUND: Despite significant advancements in scientific research to reduce the risk of various illnesses and health conditions, the underutilization of preventive healthcare poses a significant barrier to enhancing public health outcomes.¹A 2020 study found that only 8% of Americans undergo routine preventive care screenings²; racial minorities such as Hispanic Americans are even less likely to receive preventive health services due to socioeconomic disparities.³Individuals with higher educational attainment are more likely to receive routine health checkups⁴, and have higher vaccination rates.⁵ To illustrate these dynamics, this case focuses on Maywood and Bell, two adjacent cities with large patient populations from immigrant and refugee backgrounds. Educational attainment rates, which represent the percentage of residents with at least a bachelor’s degree level of education, are notably lower in Maywood and Bell (8.7% and 8.8%) compared to California as a whole (37.0%). The percentage of residents without health coverage in Maywood and Bell (18.0% and 13.9%, respectively) are higher than California’s average of 6.5%.^6,7

THE CASE: This case was conducted by The International Healthcare Organization (IHO), a 501(c)-3 nonprofit composed of doctors, nurses, medical students, non-profit advisors, and healthcare administrators.⁸IHO team members conducted a convenience sample of adult community members from Maywood and Bell during a mobile community health clinic event. 120 adult respondents were given a survey to complete anonymously. All participants provided informed consent. The survey contained questions pertaining to respondents’ educational attainment and whether they had received various medical examinations during the year. Respondents completed the survey by selecting one of the following options, depending on the question: yes/no; numerical response; age range; frequency range; 5-point Likert scale. Table 1 reveals substantial disparities across three main areas: vaccinations, routine medical examinations, and female-specific cancer screenings. Rates of vaccination uptake differed greatly between college-educated and non-college-educated groups: 68.8% of college-educated individuals receiving a COVID-19 vaccination, whereas only 56.8% of their non-college-educated counterparts indicated the same. Disparities were also evident in dental and blood examinations, participants with a college education were over 10% more likely to have had at least one blood or dental examination within the year. Finally, a sizable gap was observed in the category of female-specific screenings. Only 11.1% of college-educated women reported receiving both a pap smear and mammogram test, whereas none of the non-college-educated women respondents reported receiving either screening.

CONCLUSION: The findings of the survey, as well as results from other literature, underscore how educational attainment not only influences preventative care usage but could also potentially be the driving factor behind it. Tertiary education teaches individuals the importance of preventive health practices, leading to higher health status and overall health awareness,⁹ but also leads to significantly higher risk perception in comparison to their less educated counterparts. Current literature and this study emphasize the need for targeted interventions to ensure equitable healthcare access and utilization. Education greatly enhances public health outcomes¹⁰, suggesting that future interventions should prioritize addressing educational disparities.

The Impacts of State-specific LGBTQ Policies on Career Planning Among Medical Students in the United States

Katrina Hayes — 2025-01-01

BACKGROUND: According to the American Civil Liberties Union, a record 510 anti-LGBTQ bills were filed across the United States in 2023.1 These bills impact a wide range of LGBTQ rights. Amid these trends in legislation, many LGBTQ medical students face amplified stressors when deciding where to train and eventually practice. This study aims to understand how state-specific LGBTQ legislation and students’ perceptions of safety shape their decision-making while pursuing careers in medicine.

METHODS: Between March and April of 2024, medical students across the United States who self-identify as LGBTQ were surveyed via university-affiliated LGBTQ student organizations. The survey assessed students’ perceived level of safety and comfort with LGBTQ status among different social networks. Students also rated their knowledge of anti-LGBTQ legislation and classified the degree to which this legislation impacts their choice of residency program.

RESULTS: Survey data was collected from 96 medical students from 14 different states. Participants reported feeling least comfortable/safe with hospital staff and most comfortable/safe with friends. Respondents reported that states’ LGBTQ legislation had a greater influence on their residency program applications in comparison to their prior medical school applications (p<0.001, CI [-1.15 to -0.68]). LGBTQ-identifying medical students perceived California and New York as safer compared to Florida and Texas (χ² = 330.57, df = 4, p<0.001).

CONCLUSION: Amidst the multitude of factors influencing medical students’ decisions regarding residency programs, the level of LGBTQ acceptance within states emerges as a crucial consideration. With looming physician shortages, creating inclusive training environments is vital, given the profound influence of LGBTQ climates on career choices.

Snake Envenomation: A Rare Cause of Hypopituitarism - A Case Report

Harshita Lachhwani — 2025-01-01

BACKGROUND: Snake bites are frequent in a developing country like India, especially rural areas. Mostly they are minor and never reported but sometimes they may be serious and fatal. Occasionally, Viper bites induced hemorrhagic complications land the patient into hypovolemic shock, leading to Sheehan’s syndrome-like condition and causing panhypopituitarism. The onset of features of panhypopituitarism may be delayed by a few years.

THE CASE: With this background, we are presenting a case of a 27-year-old male who presented to us in April 2022 with a history of reduced growth of facial hair, which was normal a few years back, along with associated symptoms of polyuria, polydipsia, polyphagia, and cold intolerance. Most importantly, he gave a history of a viper bite in 2017 for which he was hospitalized in a state of hypovolemic shock. At the time of presentation to us, his BP was 96/64 mm Hg, and pulse was 70/min. His investigations showed low T3, T4, TSH, low testosterone, reduced levels of Sr FSH, Sr LH, and Sr Prolactin. His 24-hour urine volume was 2.8 L, his testicular volume was low, and MRI Brain showed empty Sella. He was managed conservatively with oral hydrocortisone, levothyroxine tablets, and injectable testosterone. He has been under our follow-up for the last 2 years and has responded well to the treatment both symptomatically and in terms of blood parameters.

CONCLUSION: Hypopituitarism is a rare complication of snake bite. Therefore, it is important to undergo relevant hormonal tests in persons who have a history of snake bite in the past.

Assessing Neurosurgery Residency Program Rankings: A Novel Approach with Residency Affiliated Academic Neurosurgeons (RAAN)

Sheeny Vo — 2025-01-01

BACKGROUND: When medical students create their residency rank order lists, they consider a myriad of factors such as program reputation, research opportunities, and geographical location; however, it is unclear whether some factors such as the likelihood of acquiring an academic position, are adequately reflected in established ranking systems. The Doximity Reputation Navigator (DRN) reputation rank methodology is dubious. In this study, we aim to investigate the relationship between ranks of neurosurgical residency program ranks in DRN and Blue Ridge Institute for Medical Research (BRIMR) rankings, to identify potential underlying relationships between academic neurosurgeons and ranks. The primary objective of this study was to assess the relationship between established neurosurgical residency program rankings, specifically those from DRN and BRIMR, and the academic contributions of affiliated neurosurgeons. This was done by developing a new ranking system based on the proportion of neurosurgeons from these programs who hold academic positions.

METHODS: We conducted a cross-sectional analysis of neurosurgical residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). We included 1623 faculty members from these programs, focusing on those with publicly available education and training histories in our analysis. The newly developed ranking system, Residency Affiliated Academic Neurosurgeons (RAAN), was created to rank programs based on the proportion of neurosurgeons in academia. This study involved the development of Residency Affiliated Academic neurosurgeons ranking system, which was then compared to the existing DRN and BRIMR rankings. The correlations between these rankings and academic positions of neurosurgeons were analyzed to identify any significant relationships.

RESULTS: We find that in our system, the program ranking had a significant correlation with Doximity Residency Navigator or Blue Ridge Institute for Medical Research (R=0.73, p<0.0001 and R=0.45, p<0.001, respectively). The median rank of faculty across Residency Affiliated Academic Neurosurgeons, Doximity Residency Navigator, and Blue Ridge Institute for Medical Research correlated significantly (R=0.83, p < 0.0001, R=0.75, p < 0.0001, and R=0.69, p < 0.0001). Notably, the percentage of legacy faculty (defined as faculty who are appointed at the same location as residency training) had a significant association with Residency Affiliated Academic Neurosurgeons and Doximity Residency Navigator (R=-0.33, p<0.05 and R=-0.38, p<0.001, respectively).

CONCLUSION: In conclusion, this study developed a novel ranking system based on the output of academic neurosurgeons affiliated with residency programs. Regardless of this ranking system, medical students should utilize a combination of established objective ranking systems that fit their needs to ensure they match at a well-suited accredited neurosurgery residency program.

Unseen Burden: Lifestyle Factors Impact on Mental Health Among Khartoum University Medical Students

Omer A Mohammed — 2025-01-01

BACKGROUND: Mental illnesses are prevalent among youths globally, with the World Health Organization reporting 800,000 suicide deaths annually, making it the second leading cause of death worldwide. This study aimed to evaluate the mental health of medical students at Khartoum University and explore the relationship between lifestyle factors and their mental status.

METHODS: This descriptive, cross-sectional, institution-based study was conducted at the University of Khartoum, Faculty of Medicine. A sample of 322 medical students was selected using multistage stratified random sampling. Data were collected via a self-administered online form incorporating the General Health Questionnaire (GHQ-12) and the Depression, Anxiety and Stress Scale (DASS-21). Statistical analyses included chi-square testing and correlation analysis to examine the relationships between lifestyle factors and mental health. Results: The study found that 43.8% of the respondents experienced depression, 55.9% anxiety, and 48.5% stress. Severe stress was significantly associated with female gender (p = 0.02) and smoking (p = 0.004). Sleep disturbances were significantly linked to severe depression, stress, and anxiety (p < 0.01). Additionally, inadequate sleep was significantly associated with severe depression (p = 0.007) and stress (p = 0.031). Consuming a daily diet rich in fruits, vegetables, whole grain bread, and drinking water was associated with lower stress levels (p = 0.015 and p = 0.018, respectively). Overall, 22.6% of the students were found to be in psychological distress. A significant positive correlation was observed between GHQ-12 and DASS-21 scores for depression (r = 0.589; p < 0.001), anxiety (r = 0.538; p < 0.001), and stress (r = 0.718; p < 0.001).

CONCLUSIONS: The study concluded that depression, anxiety, and stress levels are notably high among medical students at Khartoum University. Factors such as female gender, smoking, and poor sleep quality are associated with increased stress levels, while healthy dietary habits correlate with reduced stress. These findings highlight the need for establishing counseling services in medical schools, integrating mental health into the medical curriculum, and empowering medical students through support from academic staff.

Knowledge, Attitudes and Barriers Toward Medical Research Among Al-Neelain Medical Students, Sudan

Magid Omer Mahmoud Abdalla — 2025-01-01

BACKGROUND: Early involvement of medical students in research during school years has led to excellence in the research field and clinical practice during their careers. Previous studies try to evaluate knowledge and attitudes toward medical research in medical students in many countries. Limited studies are conducted in Sudan. In This study, we aimed to assess knowledge to, and attitudes towards and identify barriers to medical research among medical students at Al-neelain University.

METHODS: The cross-sectional study was conducted among medical students of Al-Neelain University from October 21 2023, to January 2, 2024. This survey involved medical students in 4th and 5th academic years. An online self-administered questionnaire was used to assess knowledge related to and attitude towards and identify barriers to medical research. SPSS version 26 was used to analyze the data.

RESULTS: The study included 139 students. 95(68.3%) of them were female. 61 (43.9%) of them were final-year students. The mean age was (22.95±1.1). Most students were single 135 (97.1%). Students showed an average attitude score of mean (3±1.2) (out of 5). Meanwhile, a low knowledge score is revealed with (45.9%) the percentage of correct answers. Younger students had better knowledge (spearman's rho = -0.228, p=0.006). Students with higher GPAs in their previous year had better knowledge (spearman's rho = 0.293, p=0.000). The following barriers were the most agreed upon by students: lack of time due to being overburden with educational activities (64.8% agreed) lack of knowledge and skills (64.1% agreed), lack of facilities (60.4% agreed), lack of research funding (56.1% agreed).

CONCLUSION: This study showed a low level of knowledge and an average attitude toward medical research. Many perceived barriers were also addressed. Curriculum change and raising awareness about the importance of research among students are mandatory to ensure the improvement of the quality and quantity of research among medical students.

Evaluating the Efficacy and Safety of Tolvaptan in Patients with Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Mohamed Ibrahim — 2025-01-01

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) causes end-stage renal disease (ESRD) and a decline in the estimated glomerular ﬁltration rate (eGFR) (1,2). In this meta-analysis, we aimed to assess the efficacy and safety of tolvaptan in delaying both eGFR decline and total kidney volume (TKV) increase in patients with ADPKD.

METHODS: A systematic search was conducted on PubMed, EMBASE, Web of Science, and Cochrane databases from inception to July 2024. We used the relevant keywords to include studies reporting delay in both eGFR decline and total kidney volume (TKV) increase after tolvaptan therapy. The deﬁnition of delay in both eGFR decline and total kidney volume (TKV) increase was identiﬁed across the included studies. The number of patients who achieved delay in both eGFR decline and total kidney volume (TKV) increase were extracted from the included studies. Review Manager Version 5.4 (RevMan 5.4) was used for meta-analysis. The random effect model was used in the presence of heterogeneity.

RESULTS: 4 studies (3-6) with 1775 patients were included. The pooled mean difference showed that tolvaptan significantly delays eGFR decline [MD = 1.21, 95% CI (0.81, 1.62), P = 0.001, I² = 40%] and total kidney volume (TKV) increase [MD = -3.02%, 95% CI (-3.62%, -2.42%, P = 0.001, I² = 42%] compared to placebo in ADPKD patients. Furthermore, our pooled analysis demonstrated a signiﬁcant difference in our secondary outcomes, in which tolvaptan reduced the likelihood of complications such as hypertension [OR = 0.87, 95% CI (0.72, 1.05)], hematuria [OR = 0.92, 95% CI (0.78, 1.09)], renal pain [OR = 0.89, 95% CI (0.75, 1.05)], and urinary tract infection [OR = 0.96, 95% CI (0.82, 1.12)]. However, tolvaptan-treated patients had increased adjusted odds of adverse effects, including polyuria [OR = 5.2, 95% CI (4.3, 6.3)], polydipsia [OR = 3.0, 95% CI (2.4, 3.8)], and hepatic injury [OR = 2.5, 95% CI (1.9, 3.3)].

CONCLUSION: Based on this meta-analysis, tolvaptan was associated with a significant delay in both eGFR decline and total kidney volume (TKV) increase. We observed a substantial reduction in the likelihood of complications such as hypertension, hematuria, renal pain, and urinary tract infection in ADPKD patients compared with placebo. However, a slightly higher risk of adverse effects such as polyuria, polydipsia, and hepatic injury was demonstrated. Additional randomized, large-volume clinical trials with long-term follow-ups are required, as tolvaptan may carry short and long-term prognostic implications.

Lived Experiences of Patients Following Myocardial Infarction Diagnosis in an Impoverished region in Pakistan‒A Qualitative Study

Amtul Noor — 2025-01-01

BACKGROUND: Cardiovascular disease (CVD) is a leading cause of death worldwide, accounting for 19 million deaths in 2020 alone. Ischemic heart disease being the leading cause of CVD-related health impairment worldwide impacts an individual's social, physical, economic, and psychological well-being significantly. Socioeconomic factors such as poverty, inflation, and literacy rates can impact individual experiences of Myocardial infarction (MI). Given the limited awareness and facilities in smaller regions of Pakistan, this study aims to explore the lived experiences of individuals following MI, in a district general hospital in Pakistan covering a large geographical area.

METHODS: The study was conducted in a one-to-one interview fashion at a cardiology outpatient clinic in a remote region of Punjab, where people from all over Pakistan attend. To help guide the interviews, a questionnaire was designed. Interview questions were asked using a funnelled approach–starting with a general subject and progressing to more focused inquiries. The questionnaire consisted of six open-ended questions, followed by additional questions, specifically structured to elicit detailed responses regarding patients' experiences post-MI diagnosis. For data analysis, each statement was carefully coded, and sub-themes were identified using similar coded statements. Then, after a thorough assessment of data integrity, pertinent themes were identified to create distinct themes, which were then combined into groups. These themes were classified into physical, psychological and social impacts.

RESULTS: 51 patients (34 men, 17 women) aged 37-86 years were interviewed. Analysis of interviews revealed both positive and negative biopsychosocial effects following diagnosis and treatment. Table 1 illustrates the major themes identified. Physically, participants reported improved chest symptoms and a partial return to routine activities but also reduced physical activity and weakness. Psychologically, experiences ranged from increased lifestyle modification to anxiety and persistent low mood. Lifestyle changes like dietary modifications and exercise were common, but negative impacts included loss of employment and reduced social contact.

CONCLUSION: The findings of this study highlight the multifaceted impact of MI and underscore the need for comprehensive care plans by healthcare professionals in developing countries like Pakistan, delineating the need to incorporate physical rehabilitation, psychological support, and social engagement. Further research should delve deeper into these changes to formulate optimal post-MI care.

Uncommon Presentation: Simultaneous Herpes Zoster Infection in Immunocompetent Patients

Vanessa Jarelly Rodríguez-Huerta — 2025-01-01

BACKGROUND: Herpes Zoster occurs due to reactivation of the varicella zoster virus (VZV). It mainly affects patients with suppressed cell-mediated immunity, however, there have been cases reported in immunocompetent patients.

THE CASES: Case 1: A 26-year-old male presented with severe headache in the frontal region on his right side, nausea and dizziness. Analgesic treatment with oral Diclofenac every 12 hours at unspecified dose was indicated. Three days later she returned with vesicles with erythematous base in the course of the ophthalmic trigeminal branch (Figure 1). The patient referred varicella at 6 years of age. Treatment was started with 1 tablet of Acyclovir 400 mg per oral (PO) every 6 hours for 8 days, Diclofenac Complex B intramuscularly (IM) at a dose of 1 ampoule every 24 hours for six days and sublingual ketorolac every 24 hours for eight days. Case 2: A 19-year-old woman with erythematous lesions with vesicular lesions in the abdominal region. She reported a history of chickenpox at 3 years of age. Treatment with 1 tablet of Acyclovir 400 mg PO every 6 hours for 8 days, B complex with Diclofenac IM every 24 hours for six days and ketorolac sublingual every 24 hours. Case 3: A 56-year-old male with erythematous lesions and papules on the neck with mild pain and a history of chickenpox in childhood, without the presence of any immunosuppressive symptoms. She started treatment with oral acyclovir 400 mg every 8 hours PO for 7 days and diclofenac every 12 hours PO. All three patients presented at the follow-up visit with disappearance of all skin lesions, and without any complication.

CONCLUSION: All patients had an atypical presentation, secondary to the lack of a history of immunosuppression. Although advanced age is one of the most important risk factors, the three patients did not meet this factor. There are few cases of immunocompetent patients reported in the literature, which were treated mainly with Acyclovir, as used in our patients, obtaining a positive response. This type of presentation is important for medical literature, mainly because it is not considered as differential diagnosis, therefore it is important to consider it due to the recent cases reported in the last years.

Knowledge and Practice Of Family Planning among Women of Reproductive Age in Okolobiri, Bayelsa State, Nigeria.

Oluchi Mkpae — 2025-01-01

BACKGROUND: The term “Family planning”is often used as a synonym for birth control. However, family planning does not only involve contraception but also considers planning a child’s birth for specific times (spacing the births a few years apart) and planning for a child when there are challenges in conception.Family planning services have the potential to build the quality of lives of people as it is important in the economic situation of the mother or family due to the financial demands in bringing up children.Family planning includes contraceptives, sexuality education and natural family planning. This study therefore seeks to understand the underlying factors and profer solutions through the promotion of relevant approach to family planning.

METHODS: A descriptive cross-sectional study design was conducted, and data was collected from 224 respondents using self-administered questionnaires and analyzed using statistical package for social science (SPSS) version 2.2.

RESULTS: From the study, (87.9%) of respondents were aware of available family planning options, with male condom being the preferred option. factors such as age, level of education, occupation, religion as well as the sociocultural influence of male partners may account for the significantly low acceptance of family planning options.

CONCLUSION: The research findings show that in spite of the fact that there is an increment in the awareness of family planning, additional work needs to be done on its usage. From the study, the significance of males in family planning cannot be overstressed, for this reason they need to be involved in pre counselling. Furthermore, the side effect and health concerns of the female preponderance on the various contraceptive options obtainable needs to be addressed by the health officials. Similarly, effort should be made to embark on public enlightenment on the importance of contraceptive use among the target group of this study.

Robotic versus Laparoscopic Sleeve Gastrectomy Outcomes: A Systematic Review and Meta-analyses

Carlos Esteban Vidal Valderrama — 2025-01-01

BACKGROUND: Among the various bariatric procedures, sleeve gastrectomy is a highly effective intervention for achieving significant and sustained weight loss in morbidly obese patients. In recent years, advancements in surgical techniques have introduced robotic-assisted procedures alongside traditional laparoscopic methods, promising improved precision and outcomes. This meta-analysis was conducted to assess the operative outcomes and complications of these two techniques.

METHODS: We systematically searched PubMed, Embase, Web of Science, and Cochrane, including systematic reviews, meta-analyses of randomized controlled trials, cohort studies, and case-control studies comparing robotic surgery with laparoscopic procedures in patients located in England, Italy, Japan, USA and Germany.

RESULTS: 9 studies with 1, 203, 901 adult patients were included in this systematic review and meta-analysis. Overall complications of the laparoscopic group were 1.94 [1.82, 2.06] (P < 0.00001). The operative time were significantly less in time in the laparoscopic group 28.28 [19.74, 36.82] (P < 0.00001).

CONCLUSION: This meta-analysis indicates that laparoscopic sleeve gastrectomy is associated with a lower complication rate as well as a shorter operation time.

Lump in the Muscle: Should We Forget a Rare Cause?

Amitoj Sidhu — 2025-01-01

BACKGROUND: Cysticercosis is a parasitic disease caused by the larval form of Taenia solium (pig tapeworm). It most commonly affects the human nervous system. Isolated involvement of the muscle is rare and only sporadic case reports are available.

THE CASE: A 49-year-old male presented with pain and swelling in the right lateral infraclavicular area for 2 weeks. The swelling was well defined, 2×1.5 cm in size, firm on palpation and immobile. It was non fluctuant and non-reducible with no tenderness or overlying skin changes. There was no other swelling on the body. The patient complained of mild pain on movement of the right arm especially on overhead abduction but without any neurological involvement. There was no history of fever, cough or any recent sick contacts. There was a history of neurocysticercosis in the past. Rest of the physical examination and laboratory results were within normal limits. Ultrasonography showed a cyst with an echogenic scolex and an inflammatory mass surrounding it. Magnetic resonance imaging showed a 15×10×9mm cystic mass in the right pectoralis major muscle, accompanied by scolex, muscular oedema, and subcutaneous oedema. The patient refused surgical intervention. He was started on albendazole for two weeks to expedite cyst involution and corticosteroids to minimize inflammation around the lesion. Steroids were stopped after two weeks and Albendazole was continued for three months. The patient showed complete resolution of the swelling after 3 months. This case highlights the need of investigating intramuscular cysticercosis as a possible diagnosis for individuals with a single intramuscular or subcutaneous mass. Early suspicion of cysticercosis especially in endemic areas is important, to distinguish it from various similar conditions.

CONCLUSION: The diagnosis of intramuscular cysticercosis is frequently delayed or overlooked due to vague clinical symptoms. Clinically, the diagnosis of intramuscular cysticercosis might be problematic because there are various clinical differentials, including epidermoid cysts, lipoma, sarcoma, neuroma, neurofibromas, cold abscess, and pyomyositis. Therefore, radiological evaluation is at times the only diagnostic modality especially when patient refuses surgical intervention.

En Bloc Kidney Transplantation, The Best Option?

Mauricio Alejandro Saldaña-Ruiz — 2025-01-01

BACKGROUND: Kidney transplantation is the treatment of choice in pediatric patients with end-stage renal disease. Among the transplantation techniques, en bloc renal transplantation, first practiced in 1969, has been considered, nevertheless, it increased the risk of urinary, vascular and functional complications. In recent years, there have been reports of better results compared to the standard technique.

THE CASE: A 15-year-old male patient with a history of chronic kidney disease stage KDIGO V of unspecified etiology undergoing hemodialysis. His case was discussed in the transplant department, who indicated renal transplantation. During the protocol for his inclusion in the national waiting list, a positive purified protein derivative (PPD) test of 20 millimeters of induration was detected, which required a computed tomography scan, locating areas of ground glass bilaterally, therefore prophylaxis with isoniazid 300 mg daily orally for six months was indicated. At the end of the regimen, he was considered eligible to receive a transplant. The first option was to receive a kidney transplant from a living related donor; however, the donor had a positive COVID 19 test, therefore it was decided to switch to receiving the transplant from a deceased donor. Availability of en bloc kidneys was reported, and the transplant was performed successfully. During his post-transplant stay, he showed adequate blood flow by doppler ultrasound with no evidence of thrombosis (Figure 1) and adequate renal function. He is currently in good health, complying with his immunosuppressive regimen and without complications.

CONCLUSION, Despite the refusal to perform it in previous decades due to complications, it is currently considered an acceptable technique, even showing a long-term graft survival similar to grafts obtained from living donors. Despite these good results, kidneys from low weight donors are rarely used. One of the main complications is urological, however, they do not have an impact on graft survival, in addition, they did not occur in the patient. It is important to consider en bloc kidney transplantation as one of the options due to its good results and long-term graft survival similar to the most commonly used technique.

Diagnostic Challenge of Paroxysmal Nocturnal Hemoglobinuria (PNH) with Aplastic Anemia: A Case Report

Priyanshi Maurya — 2025-01-01

Background: Paroxysmal Nocturnal Hemoglobinuria (PNH) is a rare, acquired blood disorder caused by somatic mutations in the phosphatidylinositol glycan protein A (PIG-A) gene within hematopoietic stem cells. This mutation impairs the production of glycosylphosphatidylinositol (GPI) anchor proteins CD55 and CD59, which regulate complement activity. Their deficiency leads to uncontrolled complement activation, resulting in hemolysis and other PNH manifestations, including pancytopenia and aplastic anemia. Pancytopenia is a reduction in all three blood cell types below normal ranges, while aplastic anemia is pancytopenia with hypo cellular bone marrow. Aplastic anemia can create an environment conducive to PNH clone expansion. PNH’s close association with aplastic anemia causes a diagnostic dilemma as to whether it is a cause or effect of aplastic anemia complicating the determination of the primary disease. Here, we present a case of a 39-year-old woman with transfusion-dependent pancytopenia, later diagnosed with PNH and aplastic anemia.

Case Report: A 39-year-old woman presented with shortness of breath, palpitations, light-headedness, easy bruising, and heavy menstrual bleeding. She experienced significant fatigue and a near-fainting episode. Initial blood tests revealed pancytopenia, leading to an emergency department referral. Her medical history included Vitamin B12 deficiency, hypothyroidism, galactosemia, anxiety disorder, and a previous COVID-19 infection. On examination, she was alert but fatigued and dizzy, with pallor, hypotension (99/37 mm Hg), and bradycardia (57/min). Lab tests showed severe anemia (hemoglobin 4.8 g/dL), thrombocytopenia (platelets 22,000/µL), and signs of hemolysis (elevated LDH and low haptoglobin). Despite treatment with intravenous Vitamin B12 and steroids, there was no improvement. Blood tests for Epstein-Barr and Parvovirus were positive, but methyl prednisone and intravenous immunoglobulin treatment had no significant effect. This made it clear that her pancytopenia was not due to these viral infections. A bone marrow biopsy (image 1) revealed hypo cellular marrow with decreased trilineage hematopoiesis, and there was no evidence of myeloid or lymphoid neoplasms. She was diagnosed with aplastic anemia based on these findings. Given the persistence of pancytopenia and the absence of other identifiable causes, a workup for PNH was initiated. Flow cytometry confirmed the presence of GPI-deficient cells, consistent with a diagnosis of PNH with immune-mediated aplastic anemia. The patient was started on Pegcetacoplan, a proximal complement inhibitor, which led to significant clinical improvement. However, due to persistent thrombocytopenia, she was also considered for a bone marrow transplant and referred for further evaluation.

CONCLUSION: PNH is a rare hematological disorder that can present with diverse clinical features, including pancytopenia and aplastic anemia. The diagnosis is challenging and requires a thorough evaluation to exclude other potential causes. In this case, the patient's pancytopenia was initially attributed to various reversible causes, but the persistence of symptoms and detailed investigations ultimately led to the diagnosis of PNH. Treatment with complement inhibitors like Pegcetacoplan can significantly improve clinical outcomes, although bone marrow transplantation remains the only curative option. Close monitoring and individualized treatment plans are essential for managing the complications associated with PNH.

Am I A Fraud? Occurrence and Factors Associated with Impostor Phenomenon among Medical Students of Khartoum University, 2022.

Hiba Hamad — 2025-01-01

BACKGROUND: The impostor phenomenon (IP) is the tendency to attribute success to external factors rather than to one’s abilities. It is frequent among medical students and has a negative impact on their wellbeing. . This study aimed to assess the occurrence and mental health factors associated with IP in medical students in Sudan.

METHODS: A cross-sectional analytical study was conducted among University of Khartoum faculty of medicine students from December 2021 to January 2022, utilizing non-probability convenience sampling. The data collection tool employed was a Google form containing the Clance Impostor Phenomenon Scale (CIPS), Anxiety and depression were assessed using the Patient Health Questionnaire-4 (PHQ-4), burnout using the 2-item Maslach B burnout Inventory (MBI), and self-esteem with the Single-Item Self-Esteem Scale (SISE), with ethical clearance obtained from the department of community medicine at the faculty of medicine. Data was analyzed using SPSS version 26 with correlation analyses and Chi-square tests.

RESULTS: In the study sample (n = 409), IP was found in 216 students (52.8%). Statistical association was found between IP and gender (p = 0.028) and academic year (0.008). A regression model found statistical association (p<0.001) between IP and self-esteem, parental over-protection, anxiety, depression, burnout, and perfectionism. Individual CIPS items corresponded with the total CIPS scores, and the responses to individual CIPS items differed based on gender.

CONCLUSIONS: IP is frequent among University of Khartoum medical students and is linked to various family dynamics, personality traits, and mental health issues Efforts to increase awareness and facilitate IP management should be implemented.

Impact of the Sudan Conflict on Asthma Management: A Cross-Sectional Study of Patient Outcomes and Healthcare Challenges

Muhsin Ibrahim — 2025-01-01

BACKGROUND: Asthma is a chronic respiratory condition that requires effective and continuous management to prevent severe health complications and to ensure a high quality of life. In regions affected by ongoing conflict, such as Sudan, the disruption of healthcare systems can significantly impact asthma management. This study aims to evaluate the impact of the Sudan conflict on asthma management and to identify specific challenges faced by asthma patients and healthcare providers, including disruptions in medication access, healthcare services, and overall patient health outcomes.

METHODS: We conducted a cross-sectional study involving 400 asthma patients in conflict-affected regions of Sudan. The study collected data on demographic variables including age, gender, residence (urban vs. rural), and socioeconomic status. Clinical variables were measured, including asthma severity (mild, moderate, severe), medication adherence, frequency of exacerbations, lung function (FEV1 levels), and asthma control as assessed by the Asthma Control Test (ACT). Healthcare access variables included medication availability, frequency of healthcare visits, healthcare provider availability, and healthcare infrastructure. The impact of conflict variables comprised disruptions in medication supply, damage to healthcare facilities, barriers to accessing healthcare (e.g., roadblocks, insecurity), and the psychological impact on patients, such as increased stress and anxiety levels. The data was obtained through patient surveys and medical records.

RESULTS: The conflict has severely impacted asthma management in the Sudanese population. Among the 400 patients, 65% reported significant interruptions in their medication supply, leading to a 50% increase in asthma exacerbations and emergency room visits. Medication adherence decreased by 40% due to the inconsistent availability of essential drugs. Lung function assessments revealed a 30% decline in FEV1 levels compared to pre-conflict measurements. Patient-reported asthma control, measured using the ACT, deteriorated in 55% of patients, with average scores dropping from 22 to 16, indicating poorer control. Healthcare providers reported severe shortages of essential supplies and equipment, with 70% experiencing difficulties in maintaining consistent care. Additionally, 45% of patients reported heightened psychological distress, including elevated stress and anxiety levels, which exacerbated asthma symptoms. Barriers to accessing healthcare, such as roadblocks and insecurity, led to a 35% reduction in healthcare visits.

CONCLUSION: The ongoing conflict in Sudan has critically impaired asthma management, resulting in increased health complications and deteriorated patient outcomes. A comprehensive approach is needed, including improving medication distribution, strengthening healthcare services, and offering psychological support. This study provides valuable insights into the intersection of chronic disease management and conflict, offering lessons for enhancing care in similar crises.

Knowledge, Attitude, and Perception of Medical Students Towards a Career in Anesthesiology

Chidera Onwuka — 2025-01-01

BACKGROUND Anesthesia is a crucial specialty in the medical field as it transcends both medical and surgical specializations. However, it is vital to Global Surgery. AIM: This study aims to assess and evaluate the knowledge, attitudes and perceptions of medical students towards anesthesiology and a career in it.

METHODOLOGY: It was a descriptive cross-sectional study quantitative study conducted amongst clinical students of Afe Babalola University Medical School. Using simple balloting method, the 5^th year medical students were chosen. Data collected was then organized on a google sheet and analyzed.

RESULT: Majority (82.7% n=86) of the respondents were females, while a few ((17.3% n=18) were males. All (100% n=104) of the respondents had undergone academic lectures in pharmacology of anesthetics, majority (60.6% n=63) did not find it easy and had to put in extra efforts to understand it. Practically, 76% (n=79) of the respondents had completed clinical rotations in anesthesiology as part of their medical training. Most (49% n=51) of them are not considering a career in Anesthesiology. While 7.7% (n=8) of them are definitive about wanting a career in anesthesiology, 43.3% (n=45) see it as a possibility. As regards intra-personal work relationship in the hospitals, 95.2% (n=99) of the respondents observed a positive relationship that resulted in good surgical outcomes.

CONCLUSION: The anesthesiology training of medical students is curricular and not competence based. Less than 1 in 10 students are considering Anesthesia as a definitive career path. A positive relationship between surgeons and anesthetists promotes good surgical outcomes.

A Cross-Sectional Evaluation of Medical Students, Interns and Postgraduates Regard for Patients with Substance Abuse using the Medical Condition Regard Scale (MCRS) in Andhra Pradesh

Anjali Mediboina — 2025-01-01

BACKGROUND: Positive attitudes and empathy from healthcare providers are essential in the effective treatment of patients with substance abuse, impacting both treatment outcomes and patient well-being. In India, attitudes towards substance abuse often reflect a lack of awareness and limited understanding of effective rehabilitation procedures. The Medical Condition Regard Scale (MCRS) is a valuable tool and has been shown to effectively capture the complexity of provider attitudes. However, its use in the Indian context for substance abuse has been limited.

AIMS: The study aims to evaluate and compare the regard for patients with substance abuse among medical students, interns, and postgraduates using the MCRS, and to determine any potential significant differences in attitudes based on gender, age, and occupation.

METHODS: A cross-sectional survey was conducted between June and August 2024 using an online self-administered questionnaire distributed via Google Forms through social media. The survey included medical students (MBBS 3rd and 4th year), interns, and postgraduates in Andhra Pradesh. The questionnaire collected informed consent and demographic information (gender, age, state, year of study, marital status, and religion), and responses to the MCRS, which includes eleven items rated on a six-point Likert scale (1 = strongly disagree, 6 = strongly agree), with five items reverse-scored. The total regard score was derived from the sum of individual item scores, ranging from 11 to 66. Statistical analyses were performed using Microsoft Excel and RStudio v4.3.3. Chi-square tests were used to compare the number of participants with positive (total score 44 and above) and negative (total score 43 and below) regard against demographic variables.

RESULTS: A total of 206 responses were collected, of which 187 met the inclusion criteria. The majority of participants were male (n=98, 52.4%), aged 21-25 years (n=133, 71.1%), interns (n=85, 45.5%), unmarried (n=179, 95.7%), and Hindu (n=160, 85.6%). The median total regard score was 44, with a mean score of 44.7 (SD=6.7), reflecting a generally positive regard for patients with substance abuse. The highest positive regard was noted for the statement, "I wouldn’t mind getting up on call nights to care for patients with substance-use disorder" (mean=4.4, SD=1.1), indicating a position of uncertainty leaning towards agreement. The highest negative regard was for the reverse-scored statement, "Treating patients with substance-use disorder is a waste of money" (mean=4.8, SD=1.2), indicating disagreement with this viewpoint. Chi-square analysis showed that females had a significantly higher positive regard compared to males (p=0.04085). No significant differences were found with respect to age groups (p=0.3442) or occupation (p=0.6534).

CONCLUSION: This study highlights a generally positive regard toward patients with substance abuse. However, limitations include respondent bias, and restriction to a single state, potentially limiting generalizability. The skewed distribution of respondents, with a predominance of unmarried and Hindu participants, prevented analysis of associations with religion and marital status. Future research should therefore include diverse regions and demographic groups. Targeted educational interventions for healthcare professionals, and incorporating substance abuse care into medical curricula and providing opportunities for hands-on experience can help to reduce stigma and improve patient outcomes.

Prevalence And Patterns Of Gender-Based Violence Among Undergraduates In A Nigerian University

Ntishor Gabriel Udam — 2025-01-01

BACKGROUND: Gender-based violence (GBV) is an umbrella term for any harmful act against a person's will based on socially ascribed differences between males and females. It can manifest as various forms of physical, sexual or psychological/emotional violence. These forms of GBV are not mutually exclusive, as multiple types can happen simultaneously and reinforce each other. Various factors encourage the perpetuation of GBV, including traditional attitudes towards women, race, social class, and sexuality. Staying far away from family, early life experiences of divorce, and parental violence are also familial factors that predispose to GBV. Violence survivors and their families suffer greatly from the impacts of GBV, which has major health, social and economic ramifications. AIM: To assess the prevalence and pattern of GBV among undergraduates and respondents' knowledge of its effects.

METHODOLOGY: A cross-sectional descriptive study was employed in which self-administered questionnaires were distributed to 413 students in 7 faculties at the University of Calabar, Nigeria, chosen using a multi-stage sampling technique. The questionnaire inquired about the experience of GBV and respondents' knowledge of its effects. Analysis was done using Statistical Package for Social Science (SPSS) version 21.0 for Windows. The significance level was set at a p-value less than or equal to 0.05. Relationships were tested using inferential statistical techniques (chi-square) appropriate for categorical variables. We employed multivariate analysis to assess the relationship between GBV and various potential contributing factors, account for multiple variables simultaneously, and identify significant predictors.

RESULTS: The response rate for the study was 100%, and the overall prevalence of GBV among participants was 80 (19.4%), with emotional violence being the most prevalent experienced by the victims (18.6%). The prevalence of GBV was slightly higher in males than in females, but this difference was not statistically significant (p>0.05). Other variables such as age, marital status and year of study were also not significantly associated with GBV (p>0.05). Most respondents agreed that GBV has psychological, social and health implications. The Multivariate Regression Analysis also identified the second year of schooling as a significant predictor of Gender-Based Violence, as students in their second year exhibited a higher likelihood of experiencing GBV compared to their peers (p= <0.027), with a Confidence Interval of 1.18 to 15.09.

CONCLUSION: The study showed that Gender-based violence is a problem in Nigeria, affecting both genders. The results challenge entrenched gender stereotypes and suggest the need to develop inclusive policies and programs that support both male and female victims. These findings emphasize the importance of an inclusive approach, including heightened awareness and education, support services like mental health care and legal assistance, and addressing factors that promote violence among both sexes, including cultural and social norms, to ensure all victims receive the necessary support and protection. The university authority should also implement precise and clear-cut sanctions and penalties against GBV. Our findings' lack of statistical significance also underscores the need for further research with larger sample sizes to understand male GBV better and ensure robust, evidence-based interventions.

Psychosocial Support and Quality of Life in CKD Patients on Hemodialysis Amidst the Sudan Conflict: A Cross-Sectional Study

Ahmed MohammedAlhassan Ismail Abdulsamad — 2025-01-01

BACKGROUND: Chronic kidney disease (CKD) patients undergoing hemodialysis often experience significant physical and psychological challenges. The quality of life (QoL) for these patients is influenced by various factors, including psychosocial support (1). In conflict-affected regions like Sudan, the ongoing armed conflict has further complicated these challenges (2). This study aims to assess the impact of psychosocial support on the QoL of CKD patients on hemodialysis amidst the Sudan conflict and to evaluate how conflict-related disruptions affect their well-being.

METHODS: We conducted a cross-sectional study involving 150 CKD patients on hemodialysis at two major hospitals in Khartoum, Sudan. Participants were selected through purposive sampling, ensuring diversity in demographics and clinical characteristics. We used standardized screening questionnaires, including the Kidney Disease Quality of Life-36 (KDQOL-36) for assessing QoL (3). Additional questions assessed psychosocial support levels and the impact of the Sudan conflict. We analyzed the data using SPSS version 26.0. We used descriptive statistics to measure the central tendencies and variability of demographic and clinical characteristics; we also used frequencies and percentages for psychosocial support levels and conflict-related factors among CKD patients. A p-value of 0.05 or less was considered statistically significant.

RESULTS: Out of the 150 participants in the study, 60% were females and 40% were males, with a mean age of 55 ± 12 years. Most participants had been on dialysis for an average of 3.5 ± 2.1 years. Comorbidities included hypertension (70%), diabetes (40%), and cardiovascular disease (20%). Socioeconomic status varied, with 45% below the poverty line. The mean Quality of Life (QoL) scores were 55 ± 15 for physical health, 48 ± 17 for mental health, 52 ± 14 for social functioning, and 50 ± 16 overall. High emotional support was associated with significantly higher QoL scores (mean overall QoL 58 ± 12) compared to low emotional support (mean overall QoL 42 ± 15, p < 0.01). Strong social support correlated with better physical health (mean 60 ± 14 vs. 50 ± 16, p < 0.05) and overall QoL (mean 55 ± 13 vs. 45 ± 14, p < 0.01). Disrupted access to healthcare services was reported by 60% of participants, and 20% had been displaced due to the conflict. Disruption in healthcare access was linked to lower QoL scores (mean overall QoL 45 ± 17) compared to those with no disruptions (mean overall QoL 55 ± 15, p < 0.05). Displaced patients had poorer mental health scores (mean 42 ± 18) compared to non-displaced patients (mean 50 ± 16, p < 0.05).

CONCLUSION: This study highlights the significant impact of psychosocial support on the QoL of CKD patients undergoing hemodialysis in conflict-affected settings. Higher levels of psychosocial support are associated with better QoL outcomes. The ongoing Sudan conflict amplifies the challenges faced by these patients, stressing the need for targeted psychosocial interventions and support systems to alleviate the adverse effects of the conflict on patient well-being. The findings call for implementing strategies to improve QoL and health outcomes for CKD patients in conflict zones.

Primary Health Care Services Utilization and Its Determinants in Rural Areas, Central Sudan

Omer A Mohammed — 2025-01-01

BACKGROUND: In 2022, the World Health Organization and Sudan's transitional government developed a country cooperation strategy to move closer to universal health coverage (UHC) by enhancing access to quality primary health care (PHC). Evaluating PHC centers and identifying factors influencing their utilization is essential for improving these services. This study aimed to assess the perceptions of Om Shanig residents regarding PHC services at their rural hospital and to determine the factors affecting their usage.

METHODS: This was a cross-sectional, community-based study conducted in Om Shanig, a rural area in Gezira State, from December 20-24, 2022. Data were collected from adults aged 18 years and older using a pretested, interviewer-administered questionnaire. The data were analyzed using SPSS version 23.

RESULTS: A total of 95.7% of participants had visited the PHC center and were generally satisfied with most services. However, 21.7% reported poor sanitation, 42.2% noted the absence of radiologic services, and 23.8% found laboratory services to be only sometimes available. Additionally, 4.5% expressed an unwillingness to continue using the center. Key factors influencing the decision to utilize the center included waiting time (p = 0.013), availability of medications (p = 0.003), and satisfaction with diagnostic services, treatment, nursing care, administration, laboratory tests, doctors, and vaccinations (p < 0.001 for all).

CONCLUSION: The overall utilization of primary healthcare services was good. However, it may decline due to issues such as the lack of medications and laboratory tests. Ensuring the availability of essential services and educating the community about what services to expect at each level is crucial for maximizing the potential of primary care.

Eyelid Tumor and Microcephaly in Hunter's Disease

Mauricio Alejandro Saldaña-Ruiz — 2024-12-31

BACKGROUND: Hunter disease, or mucopolysaccharidosis type 2, is an X-linked inherited disease characterized by deficiency of the enzyme iduronate 2 sulfatase, which leads to accumulation of glycosaminoglycans.

THE CASE: A 17-year-old male patient diagnosed with Hunter's disease at 15 months of age. He started his condition one year and three months earlier with edema in the right eye and inability to open it, which improved slightly with medical treatment. Eight months later, he came to our institution due to a tumor in both upper eyelids and microcephaly (Figure 1). Subsequently, surgical resection and external canthoplasty were performed. The surgical report showed pseudoepitheliomatous hyperplasia with no evidence of malignancy. Currently, the patient is stable with adequate healing and no visual sequelae.

CONCLUSION: This condition usually manifests between two and four years of age, however, the most severe forms appear earlier. The most common ocular symptoms include glaucoma, retinopathy and hypertelorism, contrasting with the rare tumorization in both patient’s eyelids. Although macrocephaly is common, the patient had microcephaly, a previously undocumented finding, therefore, to the best of our knowledge, it is the first reported case of a patient with microcephaly. Early identification and appropriate management are crucial to improve the quality of life and prognosis of these patients.

The Impact of the COVID-19 Lockdown on Cancer Referrals in Primary Care in the UK: Two Years On

Olivia Whittle — 2024-12-31

BACKGROUND: Cancer is common, with most cancer patients presenting initially to a general care practitioner. The COVID-19 pandemic led to changes in the delivery of primary care, which could have affected cancer referrals. This observational study looked at cancer referrals made before, during and after the first UK COVID-19 lockdown in 2020, at a GP practice in the Wirral, England. METHODS: A search was conducted to find the cancer referrals made between 23^rd March 2020 - 1^st July 2020, during the first lockdown. Using the same methodology, cancer referral data was collected for the corresponding time periods in 2019 and 2021. The number of cancer referrals, and their positive diagnostic yields, were then compared.

RESULTS: The number of cancer referrals decreased by 40.4% in 2020, compared to 2019. In 2021, the number of referrals then increased by 225%, compared to 2020. Overall, the number of cancer referrals increased between 2019-2021. The positive diagnostic yield for the 2020 cancer referrals increased by 251.4%, compared to that of 2019. The calculated yield for the 2021 data then decreased by 10.8% compared to 2020. Overall, the positive diagnostic yield increased between 2019-2021.

CONCLUSION: The numbers and outcomes of cancer referrals at this GP practice have changed considerably, following the first UK COVID-19 lockdown in 2020, and the influence of the pandemic was still affecting cancer referrals in 2021. A greater focus on early detection of cancer in primary care could help overcome the ways in which the pandemic has affected primary care delivery.

Competency-Based Medical Education (CBME)- An Incremental Boon For Undergraduate Medical Students of India

Alinawaz Khan — 2024-12-31

BACKGROUND: Competency based education has been defined as a result-based program to design, implement, assess and evaluate medical education using an organizing framework of competencies. According to the vision document put forth by MCI, thi undergraduate medical education program was designed with a goal to create an Indian Medical Graduate (IMG) possessing requisite knowledge, skills, attitudes, values, and responsiveness, so that he or she may function appropriately and effectively as a "physician of first contact" of the community while being globally relevant too. Albeit the CBME curriculum has been introduced in country since 5years, but such evaluation of the curriculum has not been carried out so extensively so far. Hence, this study fulfills the need of the hour and may suggest to rectify the education system accordingly in the nation as well as being a role model for other nations.

METHODS: Ethical approval was obtained from the Institutional Ethics Committee (IEC). The study population included 214 CBME exposed and 214 CBME non-exposed undergraduates of the same college. A retrospective preformed Google Form based questionnaire with digitally signed informed written consent was used to measure knowledge and attitudes of CBME exposed undergraduate graduates and CBME non-exposed undergraduate students about the peculiar concept of CBME viz. Foundation Course, Early Clinical Exposure (ECE), Attitude, Ethics and Communication (AETCOM), Objective Structured Practical Examination (OSPE). Statistical analysis was done using SPSS 19 software and appropriate statistical tests were applied.

The questionnaire comprised of 4 sections: 1- Knowledge about Foundation Course components such as: Basic Life Support training, Field/Health care center visit, Time management, Stress management, Language skills, Professionalism, Biomedical waste management, IT skills, 2- Attitude, Ethics and Communication ( AETCOM), 3- Early Clinical Exposure (ECE) practice objectives: Basic science correlation, Basic clinical skills due to clinical witnessing clinical scenario, Basic clinical skills, Problem solving skills, Better retention of topics, 4- Knowledge and practice aboutObjective Structured Practical Examination (OSPE).

RESULTS: At the end of the study, it was found that among CBME-exposed 76% had clear idea and 7% had No idea, whereas among CBME non-exposed 94% had No idea and 1% had clear idea about foundation course components. Regarding AETCOM, 81% Strongly agreed and 1% Strongly disagreed/disagreed among CBME-exposed; while 91% Strongly disagreed and 1% were neutral among CBME non-exposed. Among CBME-exposed, 70% practiced ECE whereas 95% CBME non-exposed never came across ECE. Among CBME-exposed, 88% were sure and 2% had no idea, while among CBME non-exposed 95% had No idea and 1% were not sure about OSCE and its components.

CONCLUSION: As per the study, there is substantial difference among CBME-exposed and CBME non-exposed undergraduates, regarding knowledge, attitude and practice of key components of newly introduced Competency Based Medical Education (CBME). The increase in knowledge, communication and attitudes scores suggests CBME as an incremental boon to MBBS students. Shortcomings in the CBME curriculum may be used as a basis to bring modifications and build one of the best medical education systems, in order to bring out the most competent doctors in future.

Evaluating the Effectiveness and Complications of Robotic vs Other Surgery Techniques for Mitral Valve Repair or Replacement: A Comprehensive Systematic Review and Meta-analysis

Carlos Esteban Vidal Valderrama — 2024-12-31

BACKGROUND: Mitral valve repair and replacement are common critical surgical procedures. Traditional open-heart surgery has long been the standard approach, offering reliable outcomes through direct visualization and access to the heart. However, advancements in minimally invasive techniques, particularly robotic-assisted surgery, have introduced new possibilities in the field of cardiac surgery and benefits to the patients regarding the outcomes and complications. Despite these advantages, the technique requires specialized training and has a steep learning curve, leading to variability in outcomes depending on the surgeon’s experience. This abstract aims to compare robotic mitral valve repair versus other surgical techniques, providing insights into the evolving approaches to performing this procedure.

METHODS: We conducted a search in PubMed, Scopus, Web of Science, and Cochrane, including systematic reviews, meta-analyses of randomized controlled trials, cohort studies, and case-control studies comparing robotic surgery with conventional techniques and MIS in patients located in Turkey, Italy, Japan, USA, Australia, Germany, Netherlands, England and China.

RESULTS: Eighteen studies with 16,220 adult patients were included in this project. Hospital stay and complications were significantly shorter than conventional procedures in length of stay and Intensive Care Unit (ICU) stay. The mean difference of ICU stay of the conventional group was -0.85 days [95% CI -1.22, -0.47] compared to the robotic group. The mean difference of length of stay in the conventional group was -1.34 days [95% CI -2.12, -0.57] compared to the robotic group. The odds ratio of the mortality overall of the two groups was significantly lower with 0.65 [95% CI 0.44, 0.95] compared to the robotic group. However, the robotic group was associated with longer cardiopulmonary bypass and cross-clamp. Total transfusion rate and overall complications did not show a significant difference.

CONCLUSION: Compared with conventional and MIS procedures, robotic surgery has the advantage of reduced hospital stays, ICU stays and mortality. Therefore, we suggest that surgical decisions should be tailored to each case, considering previous experience. This highlights the importance of personalized evaluations for achieving the best treatment results.

Primary Headache In Medical Residents-A Web Based Survey

Shalin Shah — 2024-12-31

BACKGROUND: Primary headache disorders, such as migraine and tension-type headaches are the most common type of headache disorder, accounting for up to 90% of all headache cases. They have a significant global impact, particularly among young individuals aged 15-49. Medical residents, due to their demanding lifestyles, are especially vulnerable to these disorders. This study was conducted on Indian medical residents, with the aim of establishing the prevalence, sub-types, triggers, and treatment preferences for primary headaches, addressing a research gap in this specific population.

METHODS: A cross-sectional study was conducted among medical residents for three months. A validated, web-based questionnaire with 22 questions was used, inviting participants via SMS, email, and social media. Patients having primary headache episodes in the last 1 year were included in the study. Data was collected for the duration, frequency, type, severity, localisation of headache and disability caused by headache. Also, history of preceding or associated symptoms, triggers and relieving factors for headache, and medication used for treatment was collected.

RESULTS: 382 medical residents initially participated. After excluding 24 with pre-existing conditions and 117 without recent headaches, 241 residents were analysed revealing a 67.31% prevalence of primary headaches. The prevalence was higher in females (77.71%). Based on location generalised headache was the most common, accounting for 59%, and localised headache was reported by 19% of the residents. Most residents (41%) had a pulsating or throbbing type of headache, while 36.5% experienced a dull headache. A tight band-like sensation around the head was noticed by 20% of the medical residents. Common triggers for initiating headaches were lack of sleep (73%), mental stress (71.8%), fasting (44%), sunlight (26.1%), and around one-fifth of women (18.18%) experienced headaches during their menstrual cycle. Relief of migraine was achieved using medication/analgesic (43.6%); while others mentioned sleep, coffee, and tea to reduce the severity of the attack. However, more than 90% of the medical residents who used medication to relieve their pain have taken a Non-Steroidal Anti-Inflammatory Drug, to get relief from their headache. Triptan was used as an acute remedy by less than 1% of the participants. The use of prophylactic medicine for primary headache prevention was also very limited (<1%). 70/241 (29%) residents experienced severe headache episodes. 47 (19.5%) were frequently prevented from doing their daily activity, while 42 (17.4%) took a day off due to headache. Tension headache was more common (61%) as compared to migraine (39%). Migraine headaches were likely to be of severe intensity in comparison to tension headaches. (p value -0.0001). Other factors such as location, frequency, and character were not significantly different between the two. (p value>0.05; figure 1)

CONCLUSION: Primary headache disorders significantly affect medical residents globally. Prioritising mental health and support might help in mitigating these issues, enhancing the quality of life for medical professionals. This can potentially reduce absenteeism at work and improve productivity.