International Journal of Medical Students (IJMS)
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Knowledge, Attitude, and Perception of Medical Students Towards a Career in Anesthesiology
Full text linkBACKGROUND 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 5th 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
Pentalogy of Cantrell: Report Of A Unique Phenotype
Full text linkBACKGROUND: 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
Sculpting the Science: Teaching Anatomy of the Facial Muscles to Medical Students
Full text linkBackground: Clay-modeling in anatomy education is an engaging activity that complements cadaveric dissections. The post-COVID-19 cadaver shortage further necessitates alternative practical modalities.
Methods: A student-centred clay-modeling practical activity was developed towards the study of the muscles of facial expression due to a shortage of cadaveric material. Student feedback in the form of a questionnaire with closed- and open-ended questions.
Results: Thematic analysis was manually performed to generate the primary and secondary themes associated with the open-ended questions. Four themes were generated: fun, collaboration, active learning, and bittersweet. Closed-ended questions revealed that respondents found the activity motivational and enjoyable. Feeling around the disassembly of students\u27 anatomical models was of particular interest. Some students expressed emotions of sadness and others stated that they felt devastated.
Conclusion: The outcome of this study presents the opportunity for further work to link discussions around the humanistic considerations of anatomy and the study of human remains, utilizing clay modelling as a crucial resource
Psychiatric Outcomes in Patients with Trigeminal Neuralgia Treated with Anticonvulsants and Antidepressants: A Retrospective Cohort Study Using a National Database
Full text linkBackground: Trigeminal Neuralgia (TN) is a chronic craniofacial condition characterized by intense, sporadic shocks of pain through the trigeminal nerve. The unpredictable and severe nature of these episodes can be physically and mentally debilitating, significantly affecting the quality of life and often leading to anxiety, depression, and sleep disorders. This study investigated the psychiatric outcomes of anxiety, depression, and sleep disorders in TN patients who were treated with both anticonvulsants and antidepressants, compared to those who were treated only with anticonvulsants, to explore a multi-modal approach for addressing both pain and psychiatric symptoms.
Methods: A retrospective analysis of electronic health records was conducted using TriNetX, a collaborative health network encompassing over 250 million patient records worldwide. The analysis included 15,129 patient records, comparing two cohorts of TN patients.
Results: After adjusting for demographic factors, both cohorts were predominately female (73%), white (70%), and about 59 years of age. The results indicated that patients taking both anticonvulsants and antidepressants had higher risk, odds, and hazard ratios for developing depression (RR 10.448, OR 10.906, HR 10.763), anxiety (RR 2.680, OR 3.210, HR 3.013), and sleep disorders (RR 3.595, OR 3.696, HR 3.697) compared to those taking only anticonvulsants.
Conclusion: Despite limitations including inability to assess dosage and severity of pain, these findings suggest that concurrent use of anticonvulsants and antidepressants may exacerbate psychiatric symptoms in TN patients. However, these effects might improve with appropriate dosage adjustments, highlighting the need for including dosage adjustments and monitoring
Challenges and Limitations among Foreign Medical Undergraduates interested in Research Study: A Cross-sectional Study
Full text linkBACKGROUND: 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 organization
M.A.R.V.E.L.S. "Medical Students Advancing Research, Visibility, Education, Leadership, and Support." A Student-Driven Initiative
Full text linkBACKGROUND: Research activity is crucial for medical students\u27 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\u27 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
The Impacts of State-specific LGBTQ Policies on Career Planning Among Medical Students in the United States
Full text linkBACKGROUND: 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
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.
Full text linkBACKGROUND: 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 1st month and 2nd 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
Churg-Strauss Syndrome in an HIV-Positive Sudanese Patient: A Challenging Treatment Case
Full text linkBACKGROUND: 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
High altitude pulmonary edema in a native highlander: A case report from Nepal
Full text linkBACKGROUND: 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