International Journal of Medical Students (IJMS)
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Effectiveness of Trimethoprim-Sulfamethoxazole in Cyclosporiasis: A Meta-analysis of Randomized Clinical Trials
Full text linkIntroduction: Cyclosporiasis, caused by Cyclospora cayetanensis, is an intestinal infection transmitted via contaminated food and water and is responsible for at least 10% of diarrheal episodes in children aged 0-4 years in endemic regions. Clinically, it manifests as watery diarrhea, fever, and fatigue, posing significant public health challenges because of its association with foodborne outbreaks and the resultant healthcare costs. The primary treatment regimen involves trimethoprim-sulfamethoxazole (TMP/SMX); however, no meta-analysis has validated its use.
Objective: We performed a meta-analysis to evaluate the efficacy of TMP/SMX compared to placebo for the eradication of oocysts and clinical resolution of cyclospora, drawing on data from randomized controlled trials (RCTs).
Methods: A comprehensive search was performed in PubMed, Scopus, and Google Scholar until May 2025. The studies deemed eligible were randomized controlled trials (RCTs) that included confirmed diagnoses and clinical or laboratory assessments conducted seven days following treatment. The methodological quality of the studies was evaluated using Cochrane\u27s Risk of Bias 2 (RoB 2) tool. Risk differences (RD) with 95% confidence intervals (CI) were calculated using a random-effects model.
Results: Among the 19 studies identified, only three were randomized controlled trials, encompassing 88 patients. The oocyst eradication rates with TMP/SMX ranged from 83% to 100%, in contrast to the persistent infection observed in the placebo group. The reported risk difference (RD) values were −1.00 (Madico et al.), −0.78 (Hoge et al.), and −0.82 (Shim et al) The heterogeneity was moderate, with an I² value of 40%. The risk of bias was low for Hoge et al., moderate for Shim et al., and high for Madico et al.
Conclusion: The present meta-analysis demonstrated that TMP/SMX exhibits significant efficacy in eradicating Cyclospora cayetanensis and improving clinical outcomes compared to placebo, thereby supporting its designation as the preferred treatment for Cyclosporainfection. However, the evidence is constrained by the limited number and variable quality of existing trials, underscoring the necessity for larger, high-quality randomized controlled trials (RCTs) to reinforce the therapeutic recommendations.
Green Synthesis of Streptomycin-Conjugated Silver Nanoparticles and their Efficacy Against Multi Drug-Resistant Staphylococcus aureus
Full text linkBackground: The emergence of multidrug resistant (MDR) pathogenic microbes against typical antibiotics is a global problem. Novel and effective strategies are being explored to treat various disease causing MDR pathogens. In this study, we prepared and tested the efficacy of antibiotic-conjugated silver nanoparticles against MDR-pathogens.
Methods: We used the plant extract for the green-synthesis of Silver nanoparticles (AgNPs) as well as Streptomycin-conjugated AgNPs. The aqueous Azadirachta indica (Neem) leaf extract was used for the synthesis of AgNPs. The synthesized nanoparticles were characterized by various techniques and the antimicrobial activity was determined by agar-well plate method.
Results: The green synthesized Streptomycin-conjugated AgNPs were characterized by different analytical techniques to establish the nanoparticle formation, size, shape and the presence of functional groups. The UV-visible spectra indicating absorbance at 450 and 440nm confirmed the formation of AgNPs and St-AgNPs, respectively. The scanning electron microscopic images showed that AgNPs and St-AgNPs are spherical in shape and the size in the range of 21-30 nm and 29-43 nm, respectively. The X-ray diffraction pattern of AgNPs and St-AgNPs showed peaks establishing the crystalline nature of the particles with characteristic peaks of 2θ for (111), (200), (220) and (311) planes. The Fourier Transform Infrared spectrum of St-AgNPs shows distinct peaks at 2980.47 (C-H bond), 1723.37(C=O bond), 1606.89 (C=C bond), 1507.63 (N-O group), 1445.33 (C-H), 1269.02 (C-O bond),1019.19 (C-O bond), and 812.43 cm (C-C bond) which corresponds to the functional groups present in both AgNPs and the conjugated antibiotic streptomycin. Further, the antimicrobial activity of AgNPs and St-AgNPs was examined by using the agar-well plate method against MDR Staphylococcus aureus. The antimicrobial activity analysis showed that St-AgNPs exhibited ~50% higher activity as compared to streptomycin alone.
Conclusion: The results of our study indicate that the green synthesized antibiotic conjugated AgNPs could be used to treat MDR Staphylococcus aureus and potentially other MDR pathogens as well. Further detailed studies are in progress to confirm the utility of these antibiotic conjugated AgNPs
Successful Microsurgical Replantation After Multiple Traumatic Amputations Caused by an Electric Grinder: A Case Report
Full text linkTraumatic digital amputations are uncommon but carry significant functional, aesthetic, and occupational consequences, particularly in young adults. Microsurgical replantation has been shown to restore hand function and improve quality of life; however, success depends on factors such as ischemia time, injury mechanism, tissue viability, and surgical technique. Machinery-related injuries are especially challenging due to extensive crush and avulsion damage, often limiting replantation possibilities. Recent evidence suggests that even in the absence of suitable veins for anastomosis, venous congestion techniques can sustain digital viability, with reported survival rates up to 78.5%.
We report the case of a 24-year-old woman who suffered total traumatic amputation of the second (D2) and third (D3) digits, and partial amputation of the fourth (D4) digit of her right hand after an accident with an electric mill. She arrived at the emergency unit 1.5 hours post-injury. D3 was deemed non-replantable and underwent stump remodeling. Successful microvascular replantation of D2 was achieved, including bone fixation with Kirschner wires, terminal-to-terminal arterial anastomosis, nerve repair, and tenorrhaphy. Postoperative management included anticoagulation and antiplatelet therapy. At six weeks, fixation material was removed, and the patient continues rehabilitation with favorable outcomes and no major complications.
This case demonstrates that meticulous microvascular reconstruction of digits, integrating bone, vascular, nerve, and tendon repair, can restore function and aesthetics in complex traumatic amputations. Early intervention, careful patient selection, technical precision, and comprehensive rehabilitative care are critical for success. Multidisciplinary management is essential, providing clinical evidence to guide surgical decision-making in similar high-complexity cases
Publication Rate of Students and Graduates of the Program of Combined Studies in Medicine (PECEM), an MD/PhD Program of Mexico
Full text linkBackground: Clinician-scientists play a critical role in bridging biomedical research and clinical practice, offering innovative solutions to the complexity of health challenges worldwide. MD/PhD programs provide a structured pathway for students to simultaneously develop clinical expertise and research skills. While these programs are common in North America and Europe, there are a few in Latin America, like the Program of Combined Studies in Medicine (PECEM) of the National Autonomous University of Mexico (UNAM) that was established in 2011 as one of the first initiatives of its kind in Mexico to integrate undergraduate medical education with rigorous research training, aiming to graduate physicians with both clinical competence and doctoral-level expertise. Evaluating the scientific productivity of PECEM students is essential to understand its contribution to academic medicine and the development of physician-scientists in Mexico.
Methods: A cross-sectional study was conducted, including all articles published by PECEM students and graduates between 2013 and the first half of 2025. The search was performed in the Scopus database to identify publications authored by program participants. Each publication was examined individually to extract the publication year, journal type (international or national), impact factor of the journal, number of citations, and research topic. Additional demographic data from PECEM enrollment and graduation records were also reviewed. A database was built using Microsoft Excel 2010, and descriptive analyses were conducted to determine publication trends, productivity by generation, thematic distribution, and average citations.
Results: Between 2013 and 2025, PECEM students produced 790 original articles. Of these, 749 (94.8%) were published in international journals, while 41 (5.2%) appeared in national journals. The second generation of PECEM students contributed the largest proportion of publications (33.54%). Research topics were diverse, although endocrinology (13.42%) and applied statistics (12.28%) were the most frequent, followed by oncology, infectious diseases, and epidemiology. The average impact factor of journals where PECEM students published was 4.26, with an average of 17.92 citations per article, underscoring the visibility and academic relevance of their work.
As of 2025, PECEM includes 110 students distributed across 14 cohorts, with 30 graduates who sum up 542 (68.57%) of the articles published. Among them, 9 women (8.18%) and 21 men (19.09%) have successfully obtained both degrees. The program has demonstrated steady growth in student enrollment, accompanied by an increase in research output, particularly notable after 2021, coinciding with the global scientific response to the COVID-19 pandemic.
Conclusion: PECEM at UNAM represents an innovative model for integrating clinical training with scientific research at the undergraduate level in Mexico. Its experience demonstrates that it is possible to train physician-scientists capable of making significant contributions to biomedical knowledge and clinical practice. By promoting early scientific productivity, the program helps to reduce the gap in medical publications in Latin America and strengthens the training of professionals with national and international impact. PECEM serves as a reference model for other institutions seeking to expand the role of physician-scientists in Latin America, fostering a stronger future for healthcare systems and the advancement of modern medicine
Single Center Experience of the Impact of the COVID-19 Pandemic on Education and Career Outlook of Radiologists
Full text linkBackground: The COVID-19 pandemic mandated social distancing and contact isolation. There is limited data on the impact of such changes on the clinical and educational experience of radiologists. This study aims to understand how the pandemic affected the education, careers, and mental well-being of resident and attending radiologists.
Methods: A 17-item questionnaire was distributed to resident and attending radiologists at a single academic center. Responses were collected from October 2020 to January 2021 and a follow-up survey was distributed in December 2021. Outcome measures were analyzed using measures of central tendency in Microsoft Excel.
Results: There were 26 responses, 20 from attending physicians and 6 from residents. Of these, 70% of attendings and 66.7% of residents perceived a negative impact on educational experiences. Among those who completed the depression questionnaire, 85% denied symptoms in themselves or colleagues. In the follow-up survey, all participants reported increased imaging volume, and 57% were working remotely. While 57% saw no impact on mentorship from remote interactions, 29% reported a negative effect. A sense of being overworked was noted by 86%, and 43% reported reduced job satisfaction. Depressive symptoms related to the pandemic were endorsed by 71%.
Discussion: While schedule flexibility was a notable benefit to remote work, a significant negative impact on educational experiences was reported. Career dissatisfaction was also significant in the follow-up questionnaire, likely due to sustained increased volume and remote education. Future studies should explore workload, mental health, and career satisfaction to improve structuring of radiology workflows
Insomnia Prevalence and Risk Factors Among Hispanic University Staff in Ecuador: A Cross-Sectional Study
Full text linkBackground: Insomnia, characterized by difficulty initiating or maintaining sleep, is a common condition that adversely affects health, productivity, and overall well-being. This study aimed to determine the prevalence and associated risk factors of insomnia among Hispanic university staff at a higher education institution in Ecuador.
Methods: A cross-sectional study was conducted between August 2023 and February 2024, including 385 university employees. Participants completed an anonymous survey collecting demographic, lifestyle, occupational, and sleep-related data. Sleep quality and insomnia severity were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). Data were analyzed using descriptive statistics, Spearman correlations, logistic regression, and Receiver Operating Characteristic (ROC) curve analysis to identify predictors of clinically significant insomnia (ISI > 14).
Results: The prevalence of insomnia was 65.2%, with mean PSQI and ISI scores of 8.8 ± 5 and 11.5 ± 7, respectively. Severe insomnia affected 2.9% of participants. Higher insomnia scores were significantly correlated with workplace stress, workload, ethnicity, light exposure during sleep, and use of insomnia medication. Logistic regression identified workplace stress and light exposure as the strongest predictors of insomnia. ROC analysis indicated workplace stress had the greatest discriminative ability (AUC = 0.864), followed by light exposure (AUC = 0.789).
Conclusion: A high prevalence of clinically significant insomnia was observed among university staff, primarily linked to workplace stress and nighttime light exposure. Targeted interventions addressing these factors could improve sleep health and overall well-being. Further studies in diverse populations are needed to validate these findings
Using an Interactive Self-Directed Module to Teach Nicotine Use Disorder Management
Full text linkBackground: Tobacco use is the largest and most preventable cause of morbidity and mortality. Though cessation counseling is an effective treatment, its priority is lowered in overcrowded medical curricula, reducing students’ confidence in clinical counseling. Self-directed e-modules help with didactic lectures and could be used to teach nicotine cessation practices. This study evaluated an interactive self-directed module on students’ knowledge acquisition and confidence in nicotine use disorder management.
Methods: This pre-post interventional study had 155 medical students complete the module between January and December 2022. Students were given knowledge-based pre- and post-module tests, and later a post-module survey to evaluate their learning experience and comfort with nicotine use disorder management. Paired differences between pre- and post-module tests were assessed for the overall- and question-specific scores. The survey data was qualitatively analyzed.
Results: The module significantly improved students\u27 overall test scores with a mean difference of 13.4 (95% CI: 10.5-16.3) between the pre- and post-module tests. There was a significant increase in understanding of electronic nicotine devices\u27 role in smoking cessation (difference: 29.7; CI: 21.2-38.2), evidence-based pharmacology therapy (difference:15.5; CI: 9.2-21.8), and combination treatment plans (difference: 16.1; CI: 8.8-16.1). Topics related to nicotine use disorder diagnosis and the harms of electronic nicotine devices showed no significant change. Additionally, students self-reported a significant improvement in comfort with nicotine use disorder management (difference: 0.75; CI: 0.58-0.93).
Conclusion: Medical students developed knowledge of and confidence in nicotine use disorder management with this interactive self-directed e-module
Aging Patients, Changing Substances: Unexpected Demographic Shifts in Turkey’s Drug Treatment Admissions Over a Decade
Full text linkBackground: Substance use disorders (SUD) have undergone significant demographic and epidemiological shifts worldwide, with emerging substances and evolving patterns of use presenting new challenges for healthcare systems. In Türkiye, the past decade has been marked by increased policy efforts to expand treatment access and reduce drug-related harms. However, systematic evaluations of national-level data remain limited. This study retrospectively examines Türkiye’s national drug reports between 2013 and 2023 to identify critical trends in treatment admissions, substance prevalence, and health outcomes among individuals with SUD.
Methods: We conducted a retrospective analysis of official data from the Turkish Ministry of Interior covering the period 2013–2023. A total of 362,560 documented cases were included. Key indicators assessed were annual treatment admissions, direct drug-related mortality, seized illicit substances, and infectious disease markers (including HIV) among people who inject drugs (PWID). Trends were further stratified by demographic variables such as age, sex, and primary substance of use.
Results: Over the study period, treatment admissions for SUD rose by 60%, reflecting both increased prevalence and broader treatment availability. Direct drug-related mortality declined by 39.6% between 2017 and 2023, coinciding with the implementation of harm reduction policies. Notably, methamphetamine emerged as the dominant substance, with an average annual prevalence increase of 46.2%. This trend displaced opioids as the leading primary substance, with opioid-related admissions declining from 76.3% to 4.2%. Mortality patterns revealed that 75.2% of drug-related deaths in 2022 were linked to polydrug use.
Demographic analysis highlighted substantial changes in the treatment population. The proportion of female participants increased from 5.6% to 9.7%, indicating a narrowing gender gap in treatment access. The mean age of treatment entrants rose from 24.3 to 27.6 years, demonstrating a gradual ageing trend. Educational profiles also shifted, with broader representation across different academic backgrounds.
Despite gains in treatment expansion, infectious disease surveillance raised concerns. HIV seropositivity among PWID increased 6.7-fold, predominantly associated with methamphetamine injection, underscoring emerging public health risks tied to changing patterns of substance use.
Conclusion: This analysis reveals profound demographic and epidemiological shifts in Türkiye’s substance use landscape over the past decade. Rising treatment admissions, declining opioid prevalence, and the rapid dominance of methamphetamine use highlight evolving drug-related challenges. Positive outcomes include reduced drug-related mortality and increased female engagement in treatment, suggesting partial success of harm reduction policies. However, the surge in methamphetamine-related harms, polydrug mortality, and HIV incidence among PWID signal urgent areas for intervention. These findings underscore the need for adaptive, evidence-based strategies that integrate harm reduction, infectious disease prevention, and targeted support for vulnerable populations
Reconstruction of a Large Lumbar Carcinoma Defect Using a Subtype III Keystone Flap: Case Report
Full text linkBackground. Systemic inflammation is theorized to alter lipid metabolism through cytokine-driven suppression of hepatic synthesis, changes in lipoprotein clearance, and impaired reverse cholesterol transport. These theoretical changes include reductions in low-density lipoprotein (LDL), high-density lipoprotein (HDL), and total cholesterol (TC) with elevations in triglycerides (TG). While these mechanisms are biologically plausible and supported in experimental settings, large-scale inpatient data confirming these patterns remain limited. Clarifying how lipid profiles shift during acute inflammation is essential for accurate cardiovascular risk assessment and interpretation of lipid panels during illness.
Methods. We conducted a retrospective analysis of electronic medical record data from a tertiary academic medical center between 2020 and 2024. A total of 5,060 hospitalized adult patients with C-reactive protein (CRP) >5 mg/L and at least one lipid panel were included. Patients were stratified into CRP categories: 5–20, 20–50, 50–100, and >100 mg/L. Mean values for TG, LDL, HDL, and TC were compared across groups using one-way ANOVA. Tukey HSD post-hoc testing was performed to evaluate between-group differences.
Results. Among the 5,060 patients included, th mean age was 50.5 years, and 53.4% were female. As CRP increased, LDL declined from 105.53 mg/dL in the 5-20 mg/L group to 87.94 mg/dL in the >100 mg/L group, and TC declined from 187.04 to 157.28 mg/dL. HDL also showed a consistent inverse relationship with CRP, decreasing from 48.89 to 38.68 mg/dL across categories. ANOVA revealed significant group differences for LDL (F = 68.53, p < 0.0001), HDL (F = 94.83, p < 0.0001), TC (F = 99.39, p < 0.0001), and TG (F = 5.39, p = 0.0011). Tukey post-hoc tests showed significant LDL reductions between the 5-20 and >100 mg/L groups (mean difference = –17.60 mg/dL, p < 0.0001) and the 20-50 and >100 mg/L groups (mean difference = –9.72 mg/dL, p < 0.0001). For TC, the 5-20 and >100 mg/L comparison showed a statistically significant reduction (mean difference = –29.77 mg/dL, p < 0.0001). For HDL, significant reductions were observed between the 5-20 and >100 mg/L groups (mean difference = –10.21 mg/dL, p < 0.0001), 20-50 and >100 (mean difference = –7.58 mg/dL, p < 0.0001), and 50-100 and >100 (mean difference = –3.09 mg/dL, p = 0.0023).
Conclusion. This study demonstrates a clear inverse association between CRP levels and lipid values, particularly LDL, HDL, and TC, in hospitalized patients. These patterns reflect inflammation-induced suppression of lipoprotein synthesis and metabolic remodeling. Lipid profiles obtained during inflammatory states may underestimate baseline atherosclerotic cardiovascular risk, highlighting the importance of contextual interpretation to avoid delayed or missed preventive interventions.
Figure 1. Mean Lipid Levels by CRP Category in Hospitalized Patients (N = 5,060)
CRP Category (mg/L)
Triglycerides (mg/dL)
LDL (mg/dL)
HDL (mg/dL)
Total Cholesterol (mg/dL)
5–20
174.31
105.53
48.89
187.04
20–50
163.55
97.66
46.26
174.11
50–100
169.16
89.57
41.78
160.45
>100
186.74
87.94
38.68
157.28
ANOVA F-value
5.39
68.53
94.83
99.39
ANOVA P-value
0.0011
<0.0001
<0.0001
<0.0001
Primary Intestinal Lymphangiectasia Presenting as Chylous Ascites in a Young Female: A Rare Case
Full text linkBackground: Primary intestinal lymphangiectasia (PIL) is a rare condition that occurs due to the pathological dilation of intestinal lymphatics, characterized by protein losing enteropathy, and occurs more commonly in children. Adults’ occurrence is less common, and misdiagnoses with other gastrointestinal disease is prevalent because of the overlapping and nonspecific features.
The Case: A 28-year-old female presented with recurrent abdominal distension and chylous ascites requiring therapeutic paracentesis over the past three years. Medical history was notable for 7 years of diffuse recurrent intermittent crampy abdominal pain more prominent periumbilical and at the right lower quadrant, bloating, loose stools, and weight loss, raising suspicion for Crohn’s disease, however, no supportive findings were noted on colonoscopy or histopathology, despite this, she was treated as a case of Crohn’s for a short period, but the absence of progression and the new-onset chylous ascites prompted reconsideration of the diagnosis and further investigation into alternative causes of protein-losing enteropathy and ascites.
At presentation, the patient denied fever, night sweats, diarrhea, or overt gastrointestinal bleeding. An abdominal examination showed distention with shifting dullness, consistent with ascites. Without peripheral edema, lymphadenopathy, or hepatosplenomegaly. Laboratory investigations were significant for low serum albumin level of 2.3 g/dL. Ascitic fluid was sterile, and negative for malignant cells. A PET-CT scan was ordered to exclude occult malignancy, autoimmune, inflammatory, or metabolically active conditions. Abdominal CT imaging revealed diffuse thickening of the hepatic flexure of the colon, associated mesenteric fat stranding, and lymphadenopathy (largest node 1.5 cm), in addition to moderate-volume ascites, these findings alongside the clinical picture have raised suspicion for a lymphatic telangiectasia; the patient was started on budesonide and long-acting octreotide (Sandostatin LAR 20 mg intramuscularly every 28 days). She showed clinical improvement following therapy, with reduction in abdominal distension and decreased need for paracentesis. Endoscopic evaluation (Figure 1) demonstrated multiple white plaques in the duodenum on upper endoscopy. Histopathologic examination of the duodenum and ileum was most consistent with primary intestinal lymphangiectasia and revealed lymphatic dilation with preserved villous architecture. No parasites, granulomas, dysplasia, or malignancy were noted.
Conclusion: PIL is rare in adults and can mimic other gastrointestinal disorders, leading to delayed diagnosis. Diagnosis relies on histopathologic confirmation and exclusion of secondary causes. Dietary management is the cornerstone of treatment, with adjunctive therapies reserved for refractory cases. Our patient’s diagnostic journey underscored several critical knowledge gaps that continue to challenge clinicians managing intestinal lymphangiectasia. Despite presenting clinical and biochemical features suggestive of the disease, the absence of standardized approaches to quantify lymphatic dysfunction made it difficult to objectively assess disease burden or monitor response to therapy. This case reflects broader gaps in our understanding of the disease’s natural history, particularly in adult-onset presentations, which remain poorly characterized. The clinical heterogeneity observed across patients suggests that individualized diagnostic and therapeutic strategies are urgently needed. Continued research is essential to uncover the underlying mechanisms driving variability in presentation and treatment response and ultimately guide the development of more targeted, personalized care