International Journal of Medical Students (IJMS)
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A Rare Case of Extensive Bilateral Fibroadenomas in a Young Woman
Full text linkBackground Fibroadenomas are benign, solid nodules in the breast commonly found in women less than 35 years of age. Typically, fibroadenomas do not exceed 3-4 per breast, and the occurrence of five or more is uncommon. Case We present a case of an 18-year-old female, initially diagnosed with bilateral fibroadenomas, progressing to an extensive presentation of over 25 fibroadenomas per breast by age 26, a rarity in the medical literature. Despite recommendations for a mastectomy due to the lesion burden, the patient, after consulting with the physician and understanding the risk of progression, opted for watchful waiting, citing concerns about future breastfeeding. Conclusion This case underscores the importance of shared decision-making in managing extensive fibroadenomas in young women, considering their impact on future reproductive choices. We aim to raise awareness of such uncommon presentations and encourage further reporting to broaden understanding and management strategies
The Power of Perseverance: My 31-Year Journey to Finish Medical School
Full text linkThis experience-based narrative recounts the author’s return to medical school after a 31-year hiatus, highlighting the unique challenges and personal growth associated with completing a medical degree later in life. The aim of this reflection was to illustrate how nontraditional pathways can still lead to meaningful academic achievement and professional development. The author withdrew from medical school due to financial hardship and a family tragedy. Over the following decades, they built a successful global career in the pharmaceutical industry, eventually leading a professional organization dedicated to the Medical Science Liaison profession. The onset of the COVID-19 pandemic created an unprecedented opportunity to resume medical education through virtual instruction. At the age of 48, the author re-enrolled and began medical school from the beginning, all while continuing to manage their responsibilities as a Chief Executive Officer. The narrative follows the integration of academic demands with ongoing executive leadership, the emotional and intellectual challenges of returning to school at a later stage in life, and the insights gained from unique clinical rotations, including those at internationally recognized institutions. The story culminates in graduation at age 51 with top academic honors. This account aims to inspire readers by demonstrating that persistence, adaptability, and discipline can overcome nontraditional barriers to completing a medical degree
A Case of Successful Surgical Resection of Locally Advanced (T4) Lung Cancer Utilizing a Multi-Disciplinary Approach Involving Previously Unresectable Structures
Full text linkBackground:
Lung cancer is the leading cause of cancer death worldwide and the second most prevalent cancer in the world.(1) Tumor node metastasis (TNM) staging continues to serve as the primary prognostic factor for survival in lung cancer.
TNM classification (8th edition) characterizes T4 disease as a tumor exceeding 7 cm in its largest dimension or one that invades structures such as the mediastinum, diaphragm, heart, great vessels, recurrent laryngeal nerve, carina, trachea, esophagus, spine or represents a separate tumor in a different lobe of ipsilateral lung.(2) These structures are typically deemed “unresectable”.(3)
Case:
We present the case of an asymptomatic 66-year-old gentleman with an incidental lung nodule found on routine pre-operative chest x ray. In this case, imaging revealed local extension, involving the stomach (excluded from TNM classification), diaphragm and pericardium. Consequently, the disease was initially considered incurable. Nevertheless, through collaborative multi-disciplinary surgical approach, successful resection was achieved.
Conclusion:
T4 disease exhibits heterogeneity, and although it is typically deemed unresectable, recent developments in surgery are challenging this conventional belief and demonstrating the potential benefits of surgical resection, particularly where a radical dissection is anticipated
Diagnostic Performance of Western Blot for Congenital Toxoplasmosis: A Systematic Review and Meta-Analysis
Full text linkBackground: Congenital toxoplasmosis results from infection with the parasite Toxoplasma gondii, which is transmitted from mother to child during pregnancy. Although Western blot is considered the most sensitive diagnostic tool for congenital toxoplasmosis, its diagnostic performance has not been subjected to meta-analysis. Methods: We conducted a systematic review and meta-analysis by performing literature searches across PubMed, Scopus, and Web of Science. The search strategy included the terms "western blot OR immunoblot" AND "congenital toxoplasmosis." The selected studies were required to meet specific inclusion criteria, which involved comparing the performance of the western blot test against the gold standard criteria for permanence of IgG after 10 months of age. These studies had to be case and control studies. The data obtained from the studies were then organized into an evidence synthesis table and the sensitivity, specificity, and Diagnostic Odds Ratio (DOR) index were calculated. This meta-analysis was performed in compliance with the recommendations of PRISMA guidelines. Results: After evaluating the selection criteria, we identified 44 articles; however, only 10 were selected for the meta-analysis. Western blot assay demonstrated a pooled sensitivity of 93.8% (95% CI: 79.2-98.4) and a pooled specificity of 96.6% (95% CI: 89.8-98.9) for the diagnosis of congenital toxoplasmosis. Six of the 10 studies had a DOR higher than 300, whereas the in-house method yielded a lower DOR of 1.2. Conclusions: This meta-analysis confirmed the utility of well-standardized western blot tests as a dependable diagnostic approach for congenital toxoplasmosis in terms of both sensitivity and specificity
Clinical Audits in Medical Education: Barriers and Opportunities Among Jordanian Medical Students
Full text linkBackground: Clinical audits are crucial for enhancing healthcare quality, but various obstacles can restrict their implementation. This study aims to examine barriers to the implementation of clinical audits among medical students and interns.
Methods: We conducted a cross-sectional online survey involving 727 clinical-year medical students (4th–6th year) and interns in Jordan from six Jordanian universities between August and November 2023. Participants completed a self-administered online questionnaire covering demographics, knowledge of clinical audits, perspectives on clinical audits, and barriers to conducting them.
Results: Of the 727 participants (58.2% male; 35.5% in their 6th year), only 7.3% had engaged in clinical audits, despite 69.5% identifying personal development and 64.8% recognizing healthcare improvement as motivations. Key barriers included time constraints (78%), academic pressure (79%), and a lack of institutional support (80%), while 59.2% felt their curriculum left them underprepared. Awareness of audit objectives was limited, with 48.4% disagreeing that they understood audit objectives. Fear of criticism was commonly reported, with 70.7% agreeing or strongly agreeing that this discouraged their participation. Multivariable logistic regression adjusted for university, academic year, GPA, and gender showed that prior research involvement strongly predicted audit knowledge (1–2 projects: aOR = 6.30; 3–4 projects: aOR = 4.92; p < 0.001).
Conclusions: Students expressed positive attitudes toward clinical audits but showed limited knowledge and very low participation. These findings highlight the need for structured, hands-on audit training within undergraduate medical curricula and improved institutional support to facilitate student engagement in quality improvement activities
Efficacy of Narrowband UVB Phototherapy in Mild to Moderate Psoriasis: A Case Series from Kharkiv, Ukraine
Full text linkBackground. Psoriasis is a genetically determined, chronic autoimmune disease of the skin and joints with a complex immunopathogenesis. Although topical corticosteroids remain the first-line treatment for mild to moderate forms, narrowband UVB (NB-UVB) phototherapy has emerged as an effective non-systemic alternative.
AIM: To evaluate the clinical efficacy of NB-UVB phototherapy in patients with mild to moderate psoriasis using PASI and DLQI scores.
Methods: Five patients were treated with NB-UVB phototherapy at the Dermatologic Centre “Chista shkira” (Kharkiv, Ukraine) between February and May 2025. PASI and DLQI were assessed before and after the course of treatment. All patients received adjunctive topical corticosteroids and antihistamines. Statistical analysis was performed using the Wilcoxon signed-rank test.
Results: The mean PASI score decreased from 4.8 ± 3.78 to 0.56 ± 0.54 (p = 0.0625), and DLQI scores also improved, though statistical significance was not achieved (p = 0.0544). Clinical improvement, PASI75, was observed in 4 of 5 patients. All patients reported a reduction in pruritus.
Conclusion: NB-UVB phototherapy combined with topical corticosteroids and antihistamines demonstrated clinical improvement in most patients with mild to moderate psoriasis. Although the results did not reach statistical significance due to the small sample size, the findings support further investigation of this therapeutic approach
Health Anxiety Among Clinical Medical Students: A Cross-Sectional Study at Uludağ University Faculty of Medicine
Full text linkBackground: Health anxiety, characterized by persistent worry about having or developing serious illness due misinterpretation of bodily sensations, represents a significant concern in medical education. Medical Student Syndrome (MSS), a unique manifestation of health anxiety specific to medical trainees, involves the tendency to misinterpret benign bodily sensations as symptoms of diseases being studied. Turkish medical students demonstrate higher rates of anxiety and depression compared to non-medical peers due to academic pressures, emotional exposure to illness, and prolonged training demands. The heightened awareness of disease pathology, combined with educational stressors, may increase susceptibility to health anxiety among medical students. This study aimed to evaluate and compare health anxiety levels among clinical-year medical students across different academic stages.
Methods: A cross-sectional study was conducted among 288 clinical medical students (4th, 5th, and 6th years) at Uludağ University Faculty of Medicine. The sample exceeded the minimum required size of 272 participants calculated using Cochran\u27s finite population correction formula. Data collection utilized a two-part online survey following informed voluntary consent. Part one assessed sociodemographic variables and health anxiety-related factors, while part two employed the validated Turkish version of the Short Health Anxiety Inventory (SHAI), an 18-item self-report instrument evaluating current mental states and emotional responses to illness scenarios. Statistical analysis was performed using SPSS version 23, employing descriptive statistics, Chi-square tests, Student\u27s t-tests, and multiple linear regression analysis to identify significant predictors of health anxiety. Ethics approval was obtained from Uludağ University Faculty of Medicine Clinical Research Ethics Committee.
Results: The study population comprised 136 (47.2%) female and 152 (52.8%) male students, with proportional distribution across academic years: 92 (31.9%) fourth-year, 95 (33.0%) fifth-year, and 101 (35.1%) sixth-year students. The overall mean SHAI score was 19.2±9.3. Female students exhibited significantly higher health anxiety levels compared to males (21.3±9.0 vs. 16.8±9.0; t=4.20, p<0.05). Among participants, 64.2% reported experiencing distress and anxiety due to self-perceived illness attributed to medical education knowledge, with significantly higher SHAI scores (21.1±8.7 vs. 15.7±9.2; t=4.80, p<0.05). Notably, 54.2% sought medical consultation based on self-diagnosis from medical knowledge, showing significantly elevated anxiety scores (22.6±8.1 vs. 15.2±8.9; t=7.30, p<0.05). Among those seeking consultation, 53.8% received confirmation of their suspected diagnosis. Multiple linear regression analysis revealed female gender as a significant predictor of health anxiety (B=4.15, 95% CI [2.34, 5.96]). No significant differences were observed in health anxiety scores based on residence location or academic year level (p>0.05).
Conclusions: This study demonstrates significant health anxiety prevalence among clinical medical students, with female gender and medical education-induced health concerns serving as primary risk factors. The finding that over half of students sought medical consultation based on self-diagnosis highlights the practical impact of health anxiety on healthcare utilization behaviors. The absence of significant differences across academic years suggests that health anxiety remains consistently elevated throughout clinical training phases. These findings emphasize the need for targeted mental health support and educational interventions addressing health anxiety in medical curricula. Early identification and management of health anxiety could improve student wellbeing and reduce inappropriate healthcare-seeking behaviors.
When Antibiotics Leave a Mark: Understanding Minocycline-Related Pigmentation
Full text linkBackground: Minocycline, a broad-spectrum tetracycline antibiotic, is frequently prescribed for chronic dermatologic or infectious conditions. While generally well-tolerated, long-term or high-dose use can lead to a rare side effect: minocycline-induced hyperpigmentation (MIH). MIH is categorized into four types based on clinical presentation and histopathology, with Type I causing blue-black macules affecting sites of inflammation, Type II causing blue-gray pigmentation on areas of normal skin, Type III involving diffuse muddy-brown discoloration in sun-exposed areas, and Type IV affecting scars on the back. With the growing use of minocycline for resistant infections, recognition of this side effect is important.
The Case: A 68-year-old male with a medical history of hypertension, congestive heart failure, type II diabetes, dyslipidemia, colon cancer, and prior aortic valve replacement was admitted to the hospital following a syncopal event. He was found to be febrile (104°F), delirious, and diagnosed with sepsis caused by Acinetobacter baumannii with no clear infection source. He was prescribed oral minocycline 100 mg twice daily for long-term suppression for approximately 5 years. Approximately 12 months after initiation, the patient developed bilateral hyperpigmentation on the dorsal surfaces of his feet, which gradually spread up to his bilateral lower extremities, forearms, cheeks, and sclera. The pigmentation persists and continues to expand at a slow rate. The clinical features suggest Type III MIH.
Conclusion: The case illustrates a severe and unusually widespread manifestation of Type III MIH resulting from long-term minocycline use. While some pigmentation cases resolve after drug discontinuation, Type III often persists indefinitely and with increasing total cumulative dose. This disfiguring adverse effect highlights the importance of ongoing skin assessments in patients on long-term, high-dose minocycline regimens. Early recognition and timely intervention may help prevent irreversible cosmetic changes and improve long-term patient outcomes
Bilateral Fasciocutaneous V-Y Advancement Flaps for Reconstruction of a Stage IV Sacral Pressure Injury in a Burn Patient: A Case Report and Literature Review
Full text linkBackground: Pressure injuries (PIs) in the sacral region are a major reconstructive challenge, particularly in critically ill patients or those with a history of extensive burns. Healing capacity is often impaired, and the availability of healthy tissue is limited. Surgical coverage using fasciocutaneous flaps, such as the V-Y advancement design, provides durable reconstruction and effective redistribution of tension. This case illustrates the effectiveness of bilateral V-Y fasciocutaneous flaps in managing a large sacral PI in a burn patient.
The Case A 47-year-old male with a history of extensive burns developed a stage IV sacral pressure injury during a prolonged stay in the intensive care unit. Clinical evaluation confirmed deep tissue involvement. After nutritional optimization, infection control, and wound bed preparation, surgical coverage was planned. Reconstruction was achieved with bilateral V-Y fasciocutaneous advancement flaps, which allowed tension-free closure and adequate vascularized coverage. The postoperative course was uneventful. At twelve-month follow-up, the wound remained fully closed, with no recurrence, dehiscence, or functional compromise. Recent evidence suggests fasciocutaneous flaps may provide superior resistance to pressure compared with muscle flaps, while minimizing donor-site morbidity. Bilateral V-Y advancement flaps allow tension-free closure and remain reliable even in patients with challenging comorbidities, as illustrated in this case.
Conclusion: Bilateral V-Y fasciocutaneous flaps represent a safe, reliable, and effective strategy for reconstructing extensive sacral pressure injuries in patients with complex backgrounds such as burns. Integration of surgical treatment into a multidisciplinary and preventive care plan is critical to optimize outcomes and reduce recurrence risk
Leishmaniasis in a Patient with Congenital Neutropenia - A Rare Case Report
Full text linkBackground: Visceral leishmaniasis is a parasitic disease caused by Leishmania species and transmitted by sandflies. It typically presents with fever, hepatosplenomegaly, and cytopenias. Congenital neutropenia is a rare primary immunodeficiency characterized by recurrent infections due to persistently low neutrophil counts. To our knowledge, the coexistence of congenital neutropenia and visceral leishmaniasis has not previously been reported.
The case: We describe an eight-year-old child with congenital neutropenia who presented with pallor and hepatosplenomegaly, notably in the absence of fever. Laboratory studies showed pancytopenia with severe neutropenia. Given this constellation of findings, several differential diagnoses were initially considered, with leukemia being strongly suspected. Bone marrow aspiration was performed to confirm the diagnosis. Unexpectedly, the marrow examination revealed numerous Leishmania amastigotes, establishing the diagnosis of visceral leishmaniasis. The patient was treated with liposomal amphotericin B, resulting in a gradual clinical recovery and normalization of blood counts.
Conclusion: This report represents the first documented case of concurrent congenital neutropenia and visceral leishmaniasis. It highlights the importance of maintaining a broad differential diagnosis in immunocompromised patients presenting with cytopenias and organomegaly, even in the absence of fever. Early recognition of visceral leishmaniasis remains critical, as timely treatment can substantially improve outcomes.