International Journal of Medical Students (IJMS)
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A Reflective Case Study: Complex Presentation of a Veteran Patient with Cardiomyopathy and a History of Facial Reconstruction
Full text linkTrauma-informed care (TIC) reframes complex patient encounters by recognizing the lasting impact of trauma on health behaviors. I describe the case of a male veteran in his sixties who presented with apparent gastrointestinal illness, yet further evaluation revealed untreated cardiomyopathy and a history of combat-related facial reconstruction. Despite clear evidence, the patient denied his cardiac condition, reflecting mistrust of healthcare and the psychological burden of trauma. This denial complicated diagnostic reasoning and care planning but underscored the critical role of TIC in uncovering hidden narratives behind clinical presentations. By shifting focus from symptoms to context, this case highlights how trauma, resilience, and denial intersect in medical practice. It calls for reflective approaches that integrate psychosocial insight into clinical decision-making, particularly when caring for veterans and patients with complex life histories
Effectiveness of Haptic Feedback Devices in Reducing Pain Perception During Intra-Articular Corticosteroid Injections in Rural Guatemala and Kenya – A Randomized Controlled Trial
No full textworldwide and a leading cause of disability, affecting most individuals by age 65 due to cartilage degradation, eburnation, osteophyte formation, and inflammation. Intra-articular corticosteroid injections (IACIs) are widely used for moderate to severe OA and are especially beneficial in low-resource areas where long-term medications and physical therapy may be inaccessible. However, IACIs can induce substantial pain and anxiety, particularly when anesthetics or imaging guidance are unavailable. Haptic feedback, such as tactile stimulation through handheld vibration devices, has demonstrated the ability to modulate pain perception in clinical settings. As a simple, low-cost method, it may offer a non-pharmacologic option to reduce procedural discomfort in environments where pain control measures are limited. This study evaluates the effectiveness of handheld vibration devices in reducing pain perception during IACIs in rural Guatemala and Kenya.
Aim: To assess whether handheld vibration devices reduce pain perception during intra-articular corticosteroid injections in patients with osteoarthritis in resource-limited health settings.
Methods: A randomized controlled study was conducted during Kansas City University\u27s Global Health Outreach programs in Guatemala and Kenya. 37 adult patients with OA of the knee (89%), hand (8%), or shoulder (3%) scheduled for IACIs were enrolled; four were excluded due to protocol deviations or incomplete data, resulting in a final sample of 33 participants. Subjects were randomized 1:1 into a control group (standard care) or a haptic group that held a vibration device (Beurer MG10) in the contralateral hand during the injection. Pain perception was assessed using the Wong-Baker FACES Pain Rating Scale before and after the procedure. Statistical analysis was performed using Mann-Whitney and Wilcoxon Signed Rank tests.
Results: No statistically significant difference was found between the control and haptic feedback groups in post-injection pain scores (p = 0.058). However, the majority of participants experienced significantly lower actual pain than expected (Haptic = 76.5%, Control = 62.5%), with only two reporting increased pain and seven reporting no change. Pain scores decreased by an average of 4.047 points overall (p < .001), with reductions of 3.217 in the control group (p = .001) and 2.727 in the haptic group (p = .006). The average post-injection pain score was 1.44 for the control group and 2.35 for the haptic group.
Conclusion: Although handheld vibration devices did not significantly reduce pain perception compared to standard care during IACIs, a higher proportion of patients in the haptic group reported less pain than expected. Participants experienced significantly less pain than anticipated, suggesting that factors such as patient reassurance, procedural familiarity, or clinical environment may play a larger role in pain modulation. Limitations included communication barriers despite translator and language support, procedural variability among injectors, and an imbalance in joint types treated, with most injections administered to the knee. Nonetheless, this study highlights the feasibility of implementing low-cost, non-pharmacologic strategies like haptic feedback in resource-limited settings. Further investigation with a larger sample size and standardized technique is warranted to explore the role of haptic feedback in reducing procedural pain in low-resource environments.
Students\u27 Perspectives on the Educational Environment at the University of Khartoum, Faculty of Medicine (2023-2024)
No full textBackground: Educational Environment (EE) is a broad category of settings that engage students in learning activities and its plays a central role in shaping students’ learning, attitudes, and academic success..A positive EE promotes intellectual growth, cooperation, satisfaction, and achievement, while students’ perceptions guide improvement effort. In Sudan, however, medical education faces unique challenges, including limited resources, political instability and ongoing conflict, all of which negatively affect training, infrastructure, and student well-being, highlighting the urgent need for systematic evaluation. At the University of Khartoum’s Faculty of Medicine, understanding students’ views is vital for identifying strengths and areas requiring improvement. Despite the institution’s leading role, little research has examined how academic performance, motivation, and living conditions influence these perceptions.
Methods: A cross-sectional study was conducted using a self-administered, online questionnaire. The Dundee Ready Educational Environment Measure (DREEM) was applied to assess the perceptions of 377 medical students across six academic batches. Stratified random sampling ensured adequate representation by gender and batch. Data were analyzed using SPSS version 22 to examine the influence of demographic and academic factors on five key domains of the educational environment: perceptions of teaching, perceptions of teachers, academic self-perception, perceptions of atmosphere, and social self-perception.
Results: The overall DREEM score was 113.1 ± 19.62, indicating a generally positive perception of the educational environment. However, subgroup analyses revealed notable disparities. Male students reported lower perceptions of teaching quality (p = 0.036), while dormitory residents had a significantly lower perception of teachers (p = 0.011). Students with intrinsic motivation exhibited higher scores in teaching (p = 0.002) and social self-perception (p = 0.002), whereas students experiencing academic difficulties had significantly lower scores in teaching (p = 0.016) and atmosphere (p = 0.029).
Conclusion: The findings indicate a generally favorable perception of the educational environment, yet subgroup differences highlight areas requiring targeted improvement. Male students’ lower ratings of teaching suggest the importance of incorporating gender-sensitive instructional strategies. Similarly, dormitory residents’ less favorable views of faculty may point to environmental or institutional barriers limiting student–faculty interaction. The higher scores among intrinsically motivated students underscore the value of fostering self-directed learning, while lower scores among academically struggling students emphasize the strong link between performance and perceptions of the learning environment. Together, these results call for evidence-based curricular reforms, strengthened student support services, and faculty development initiatives to create a more inclusive and effective environment that supports both academic achievement and professional growth. Student perceptions thus provide critical insights, with targeted interventions in teaching approaches, motivational support, and institutional systems offering pathways to enhance learning outcomes and student well-being.
From Anatomy to Intervention: Coil Embolization of a Post-Cholecystectomy Hepatic Artery Pseudo aneurysm: A Case Report and Anatomical Insights for Medical Student
Full text linkBackground: Post-cholecystectomy vascular complications are rare, but serious. The surgical anatomy of the hepatic arteries is notoriously variable and increases the potential risk of injury during hepatobiliary surgery. Normally the hepatic artery proper bifurcates into right and left hepatic arteries. But, in one third of cases the aberrant right hepatic aretery (aRHA) may originate from the superior mesenteric, gastroduodenal, right gastric artery or the coeliac trunk. Trauma from surgical clips or electrocautry can damage the aRHA during dissection at the Calot\u27s triangle, with subsequent formation of pseudoaneurysm. This presents late after surgery, mostly as GI bleed, right upper quadrant pain and jaundice—the Quincke\u27s triad. This case report presents pseudoaneurysm formation after injury to aRHA during cholecystectomy which was subsequently managed with coil embolization.
The Case: A 65-years-old gentleman presented with right hypochondrial pain of 5-months duration which was confirmed to be due to gallstones on ultrasonography. He was admitted for cholecystectomy. Intraoperatively, during laparoscopiccholecystectomy Calot\u27s triangle was identified and cystic artery and duct were clipped under vision and cut. While removing the gallbladder massive bleeding was observed for which the procedure had to be converted to open cholecystectomy. Upon inspection an aberrant right hepatic artery was found which was ligated, while 02 pints of blood were transfused. After hemostatic control, bile leak was observed, for which T-tube was placed in the common bile duct. Postoperatively, there was a gradual decrease of his t-tube output. On the 10th post-operative day, patient became apprehensive and there was massive bleeding from T-tube site and in the sub hepatic drain. He developed shock, for which he was resuscitated. Over next week bleeding progressively decreased. Meanwhile, ultrasound showed no intra-abdominal collection but a hypo-echoic area at the porta hepatis. CT angiogram showed a pseudo-aneurysm of RHA and it was aberrantly arising directly from the celiac trunk. The case was discussed in multi-disciplinary meeting, and it was decided that patient needed coil embolization of the pseudo-aneurysm. Procedure was performed by interventional radiologist through right femoral access with 4 Fr C2 catheter. Wire was advanced into the distal right hepatic artery and embolization done with a long 6 mm coils. Coiling was done distal and proximal to the neck of the pseudo-aneurysm. No complications were observed. Post embolization patient remained stable with no bleeding episode. Hemoglobin and liver functions showed improving trend after the intervention. T-tube was removed after an unremarkable cholangiogram. Patient was discharged and follow-up after 2 and 4 weeks showed clinical improvement and no further episode of bleeding. Post-embolization angiogram at 2-week follow-up showed no filling of the pseudo-aneurysm with filling of the distal right hepatic artery branches via collaterals.
Conclusion: This case underscores the importance of knowledge of hepatobiliary vascular anatomy in clinical practice, which enables a surgeon to anticipate challenges and tailor operative strategies accordingly. When an unexplained hemorrhage occurs in the post-cholecystectomy period, CT angiography should be used promptly to detect the causeincluding pseudo-aneurysm of aRHA and endovascular coil embolization is an effective minimally invasive intervention with good results
Evaluation of Anxiolytic Effect of Pantoprazole on Swiss Albino Mice – An Experimental Study
Full text linkBackground: Anxiety disorders, affecting over 7% of the global population, are among the most common psychiatric disorders significantly impairing daily life, productivity, and social functioning. Current treatments, such as SSRIs and benzodiazepines, provide only partial relief and are often limited by side effects including sedation, sexual dysfunction, and dependence. This has created a pressing need for safer and more effective therapeutic options. Pantoprazole, a commonly used proton pump inhibitor, has demonstrated neuroprotective and anti-inflammatory properties in preclinical studies. These findings raise the possibility that pantoprazole may also exert anxiolytic effects, which have not yet been systematically explored.
Methods: Thirty female Swiss albino mice were divided into five groups, each consisting of 6 animals each- control (saline), standard (diazepam 5 mg/kg i.p.), and pantoprazole-treated groups (10, 15, 20 mg/kg orally). Drugs were administered daily for 14 days. Mice were then assessed using the Elevated Plus Maze (EPM) which measures time spent and entries into open arms, and Actophotometer which records locomotor activity to determine whether pantoprazole produced sedative effects.
Results: Pantoprazole treatment significantly reduced anxiety-like behavior in a dose-dependent manner. In the EPM, mice treated with pantoprazole spent more time and made more entries into open arms compared to controls, with the 20 mg/kg dose producing the strongest effect (p<0.001), comparable to diazepam. Importantly, locomotor activity remained unchanged across pantoprazole groups, indicating that its anxiolytic effect was not confounded by sedation. Statistical analysis confirmed that the 20 mg/kg dose of pantoprazole produced significant improvements in anxiety-related measures without altering overall activity levels.
Conclusion: This experimental study provides the first evidence that pantoprazole, at higher doses, exerts significant anxiolytic effects in Swiss albino mice. Unlike diazepam, pantoprazole did not reduce locomotor activity, suggesting a favorable safety profile without sedative side effects. These results highlight pantoprazole’s potential as a novel or adjunctive therapeutic agent for anxiety disorders. While further mechanistic studies and clinical trials are required, the findings open an exciting avenue for repurposing an established and well-tolerated drug in the management of anxiety.
Group
EPM: Time in Open Arms (sec)
EPM: Open Arm Entries
Locomotor Activity (Counts)
Control (Saline)
89.00 ± 14.07
3.67 ± 1.15
241.67 ± 35.13
Diazepam 5 mg/kg (i.p.)
213.17 ± 29.93
10.33 ± 2.08
295.17 ± 28.07**
Pantoprazole 10 mg/kg (p.o.)
121.83 ± 16.53
5.83 ± 1.47*
228.33 ± 25.75 (ns)
Pantoprazole 15 mg/kg (p.o.)
131.67 ± 13.79
7.50 ± 1.87
216.17 ± 28.28 (ns)
Pantoprazole 20 mg/kg (p.o.)
155.67 ± 22.44
8.17 ± 1.60
225.83 ± 29.45 (ns)
Table 1. Effects of Pantoprazole on Anxiety-Like Behavior in the Elevated Plus Maze and Locomotor Activity
Legend: Values are expressed as mean ± SEM (n = 6 per group). Statistical significance was analyzed against control group: *p < 0.05, **p < 0.01, **p < 0.001; ns = not significant
Assessment of doctor\u27s satisfaction with governmental hospital after the war 2024 in Sudan
No full textBACKGROUND: 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\u27t 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
The Pupil’s P’s: An Alliterative Tool and Practical Framework for Managing Older Patients
Full text linkGeriatrics encompasses all specialties of medicine. Therefore, medical students must be aware of many factors during their geriatrics rotation. Herein, we distil our reflections from medical school into employment to create a practical framework using an novel alliteration in: The Pupil’s P’s. We acknowledge and complement existing mnemonics devices, which are largely based on diagnosis, to introduce medical students to major geriatric topics to assist management whilst they round on their patients – Peculiar Presentations, Psychological Pertubations, Peristaltic Products, Profound Pain, Polypharmacy, Pressure Sores, Physiological De-conditioning, Poor Perception, Partner Practitioners, Post-Hospital Plan, Palliative Care, and Parsimony. For students of geriatric medicine, The Pupil’s P’s literary device creates a succinct, educative tool with the added utility as a reference to generate the multi-factorial reasoning required to care for older patients. Ultimately, through our experience in aged care, we wish to convey the important lesson of holistic, patient-centered care to students . Accordingly, despite the numerous issues that may be encountered with older patients, we emphasize treating the patient holistically, and not the individual problems which may be discovered
Real World Experience of Bedaquiline-Based Anti-Tubercular Regime in Multi-Drug Resistant Tuberculosis.
Full text linkBACKGROUND: 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