International Journal of Medical Students (IJMS)
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A Cross Sectional Study on Adherence to Medication among Patients with Hypertension and/or Diabetes Attending One of the Tertiary Care Institutes of Ahmedabad City, Gujarat, India
Full text linkBackground: The lifelong management of chronic diseases such as Hypertension and Diabetes Mellitus necessitates a comprehensive approach, including lifestyle modifications and consistent adherence to medication. Present study aimed to evaluate treatment adherence among patients with diabetes and /or hypertension attending a tertiary care institute in Ahmedabad city, India.
Methods: A cross-sectional study was conducted among 200 patients aged over 18 years, diagnosed with diabetes and/or hypertension. The sample population was selected from a tertiary care institute at Ahmedabad city using a consecutive sampling method. Data collection utilized a pretested and predesigned proforma along with the Morisky Medication Adherence Scale (MMAS-8).
Results: Hypertension was present in 43.0% of the participants, while 20.0% reported diabetes mellitus. Additionally, 37.0% had both conditions. Out of total 200 patients 53.5% exhibited low adherence to treatment. Lower adherence to treatment was found to be more among Diabetics (67.5%) as compared to hypertensive patients (51.2%). Among participants having comorbidities 48.6% had low adherence to treatment. The association between disease type and adherence levels was not significant (p-value = 0.305). Not having any symptoms and forgetfulness were common reasons for low adherence among 41.1% and 24.2% of participants, respectively.
Conclusion: This study highlights the need for targeted interventions aimed at enhancing medication adherence among individuals managing with chronic illnesses like hypertension and diabetes. The findings provide valuable insights for healthcare professionals and policymakers to develop effective strategies for improving treatment adherence and subsequently mitigating the progression of these chronic conditions
Public Health Longitudinal Integrated Foundation Training (LIFT) Program: A Junior Doctor’s Experience
Full text linkThis paper presents reflections on a one-year public health (PH) Longitudinal Integrated Foundation Training (LIFT) program at Betsi Cadwaladr University Health Board (BCUHB). The program, introduced by Health Education and Improvement Wales (HEIW), aims to expose junior doctors to preventative medicine and population health approaches. Key experiences included contributing to a preconception care draft strategy, participating in a nuclear power plant decommissioning consultation, attending a Cryptosporidium outbreak meeting, and witnessing the implementation of Wales\u27 20mph speed limit law. These experiences provided insights into the multifaceted nature of PH work, including health improvement, health protection, and healthcare PH. The placement highlighted the importance of interdisciplinary collaboration, evidence-based policymaking, and effective communication in addressing complex health issues. Challenges included balancing clinical responsibilities with PH learning opportunities and adapting to the broader scope of PH work. In conclusion, integrating PH training into medical education is crucial for addressing rising chronic diseases and encourages junior doctors to embrace such opportunities for professional growth and developing new perspectives on population health
Medical University Students Lifestyle and Value of Health
Full text linkBACKGROUND: The risk of cardiovascular diseases (CVD) can be reduced by non-pharmacological approaches. Lifestyle medicine involves evidence-based interventions in physical activity, nutrition, sleep, and stress management. The feasibility of studying CVD risk factors (RFs) in groups of medical students with the development of programmes for the modification of the RFs can improve the health and qualification of medical staff in the future.
Aim: To evaluate the CVD risk factors in students of different courses at Grodno State Medical University (GrSMU).
METHODS: An online survey was conducted of 82, 1st and 5th year GrSMU students with their own consent. The questionnaire was based on the 2021 ESC Guidelines on cardiovascular disease prevention. All respondents were divided into two groups: 1 (5th year) and 2 (1st year). The “STATISTICA 10.0” computer programme was applied for investigation (Mann-Whitney test and Pearson χ2). The p-value less than 0.05 was statistically noteworthy.
RESULTS. The prevalence of the main modifiable RFs in the groups is in Table 1. No significant differences were found in the BMI, target WC in the 2 groups; 7.3% had a non-target BMI and 11% non-target WC; 14.6% of females and 1.2% of males are not aware of CVD heredity (p = 0.03). 83% of both groups ate “fast-food” (burgers, fries, pizza) 2 times a week or daily, the number of 1st year students was 58.5%, and the number of 5th year students – 24.4% (p = 0.005). It was found that 3.7% of students (all respondents were in 5th year) did not consume “fast-food” at all (p = 0.03). 60 out of 82 people ate salty food 2 times a week or daily (73.4%). No differences were found depending on age (course) in the consumption of sweet-drinks. 68% of the surveyed groups of 1 and 5 courses did not drink sweet-drinks or drank them less than 1-2 times a week; on the contrary, 6.1% of respondents drank them daily. 90% of all the students did not eat fish at all; 9.8% ate fish 1-2 times a week. Daily consumption of vegetables/fruits was indicated by 13.4% of students of both courses; 1.2% did not consume vegetables/fruits at all (5th year); 25.6% of students of both courses noted consumption less than 1-2 times per week; no differences were found depending on gender between groups.
CONCLUSIONS. Medical students have an unhealthy diet: more than 20% of both groups consume "fast-food" everyday, and 90% do not eat fish at all or less than 1-2 times a week; only 13.4% of respondents indicate daily consumption of vegetables and fruits, of which majority are girls
Am I A Fraud? Occurrence and Factors Associated with Impostor Phenomenon among Medical Students of Khartoum University, 2022.
Full text linkBACKGROUND: The impostor phenomenon (IP) is the tendency to attribute success to external factors rather than to one’s abilities. It is frequent among medical students and has a negative impact on their wellbeing. . This study aimed to assess the occurrence and mental health factors associated with IP in medical students in Sudan.
METHODS: A cross-sectional analytical study was conducted among University of Khartoum faculty of medicine students from December 2021 to January 2022, utilizing non-probability convenience sampling. The data collection tool employed was a Google form containing the Clance Impostor Phenomenon Scale (CIPS), Anxiety and depression were assessed using the Patient Health Questionnaire-4 (PHQ-4), burnout using the 2-item Maslach B burnout Inventory (MBI), and self-esteem with the Single-Item Self-Esteem Scale (SISE), with ethical clearance obtained from the department of community medicine at the faculty of medicine. Data was analyzed using SPSS version 26 with correlation analyses and Chi-square tests.
RESULTS: In the study sample (n = 409), IP was found in 216 students (52.8%). Statistical association was found between IP and gender (p = 0.028) and academic year (0.008). A regression model found statistical association (p<0.001) between IP and self-esteem, parental over-protection, anxiety, depression, burnout, and perfectionism. Individual CIPS items corresponded with the total CIPS scores, and the responses to individual CIPS items differed based on gender.
CONCLUSIONS: IP is frequent among University of Khartoum medical students and is linked to various family dynamics, personality traits, and mental health issues Efforts to increase awareness and facilitate IP management should be implemented
To Test or Not to Test? How a Positive Rapid Strep Test May Perplex the Diagnosis of Serum-Sickness Like Reaction
Full text linkBACKGROUND: Serum sickness-like reaction (SSLR) represents a rare immunologic disorder. The original version is the serum sickness (SS), a type III hypersensitivity reaction caused by large protein molecules such as diphtheria antitoxin. However, SSLR is a delayed reaction of unknown etiology, triggered by small non-protein molecules. The clinical presentation of SSLR includes the classic triad of fever, rash, and arthralgia, which typically occurs 1-2 weeks after the exposure to drugs (especially β-lactams, e.g., amoxicillin and cefaclor) and infectious agents (especially viruses and Streptococcus). Some patients also present with angioedema or lymphadenopathy. The prognosis is excellent, but rare complications of liver involvement, renal involvement, coagulopathy, and pneumonitis have been reported. It is a challenging diagnosis because it mimics sepsis and other exanthematous diseases. Pharyngitis is an upper respiratory tract infection that is usually caused by viruses, but the most common bacterial cause is Streptococcus pyogenes. The Rapid Strep Test (RST) is a useful diagnostic test for detecting Streptococcus pyogenes in patients with pharyngitis and a Centor score of 3 or more guiding the administration of antibiotics.
THE CASE: We report a case of a 63- year-old female patient seen in the emergency department (ED) with diffuse rash, musculoskeletal pain, high-grade fever with rigors, malaise, and a positive RST in the absence of clinical signs of pharyngitis. The rash was neither painful nor pruritic and was diffusely spread, sparing the face, the palms, and the soles, with a maculopapular pattern and occasional urticarial-like plaques (Figure 1). Her past medical history was positive for a recent (12 days before) respiratory tract infection, which was treated with amoxicillin/clavulanate, acetaminophen, and ibuprofen. The patient was admitted to the hospital and she was initially treated with clindamycin, given the initial clinical suspicion of streptococcal sepsis, but it was discontinued due to diarrhea. After an extensive diagnostic workup of the patient and the exclusion of other common diseases, her final diagnosis was SSLR. The most likely trigger was amoxicillin, although clavulanate, acetaminophen, and ibuprofen have also been reported as causes of SSLR. Methylprednisolone 0.5 mg/kg per os was administered, resulting in the resolution of symptoms after 2 days, while the dose was gradually tapered over one week.
CONCLUSION: SSLR is an interesting clinical entity, and its pathogenesis is poorly understood. The clinical presentation can be variable. SSLR is a clinical diagnosis of exclusion due to the absence of confirmatory testing. Physicians should be familiar with this benign condition to avoid unnecessary diagnostic testing such as RST which may misguide diagnosis and lead to unnecessary diagnostic testing, hospitalization, and antibiotic treatment
Comparing Treatment Recommendations for Ten Dermatological Conditions Using ChatGPT, Claude, and PI AI Models
Full text linkBACKGROUND: Artificial Intelligence (AI) is being increasingly utilized in healthcare and offers a potential alternative for gathering medical information in the future. The gold standard for many physicians on guiding their approach to medical management has been UpToDate and PubMed. In this review we attempted to see how well three AI models (ChatGPT, Pi, and Claude) could perform in generating first line treatment recommendations when compared against UpToDate.
METHODS: To test the performance of these AI models, medical scenarios describing physical exam findings and patient histories, were sourced from the clinician generated medical education platform for ten dermatological diseases and inputted into the models. The models were then prompt with the query: “What is the first line treatment?”
RESULTS: The results were tabulated, and it was found that Claude could successfully generated first line treatment recommendations that corresponded to UpToDate for all ten of the diseases tested with the other models successfully predicting nine of the ten correct treatment regimes. However, ChatGPT and Pi mistakenly diagnosed the squamous cell carcinoma vignette as actinic keratosis and provided inaccurate treatment advice.
CONCLUSION: These AI models demonstrate that future developments in artificial intelligence may offer a free alternative to UpToDate as improvements in management recommendations are made as artificial intelligence models are further refined. However, the benefits of future utilization must be weighed against the risks of overreliance on this type of technology, especially if proper validation of information does not take place
Predicting Extended ICU Stay Following Coronary Artery Bypass Grafting and its Impact on Hospitalization and Mortality : ICU Stay Prediction After CABG: Impact on Hospitalization and Mortality
No full textBACKGROUND: Coronary artery bypass grafting (CABG) remains one of the most common surgical treatments for coronary artery disease (CAD), aimed at reducing symptoms and enhancing patient survival. A critical element of post-CABG care is the duration of the patient’s stay in the intensive care unit (ICU), with an ideal target of fewer than 24 hours. However, a range of preoperative, intraoperative, and postoperative factors can extend ICU stays, leading to increased strain on hospital resources, poorer patient outcomes, and higher healthcare costs. This study seeks to identify the key factors that contribute to ICU stays exceeding 48 hours following CABG and CABG combined with heart valve surgery, and to analyze their association with postoperative complications and mortality rates.
METHODS: We conducted a retrospective cohort study at King Abdullah University Hospital (KAUH), analyzing data from 1,395 patients who underwent isolated CABG or CABG combined with valve surgery between January 2004 and December 2022. The patients were categorized into two groups: Group 1, with ICU stays of 48 hours or less (n=1,082), and Group 2, with ICU stays longer than 48 hours (n=313). A comprehensive analysis of clinical, laboratory, and demographic data was performed to identify predictors of prolonged ICU stays. Statistical methods were applied to evaluate the relationship between these factors and the length of ICU stay.
RESULTS: Our analysis revealed that patients in Group 2, who had ICU stays longer than 48 hours, were significantly older, with a mean age of 61.5 years compared to 58.7 years in Group 1 (p<0.001). Several preoperative conditions were strongly associated with prolonged ICU stays, including recent myocardial infarction (OR=1.69, p=0.015), chronic obstructive pulmonary disease (COPD) or asthma (OR=1.49, p=0.003), and preoperative renal impairment (OR=1.89, p=0.002). Intraoperative factors also significantly influenced ICU stay duration, with emergency or urgent surgeries (OR=2.19, p<0.001) and extended ventilator support during surgery (OR=5.92, p<0.001) being the most critical predictors. Postoperative complications emerged as significant determinants of ICU stay length. The development of renal impairment post-surgery (OR=6.78, p<0.001) and the occurrence of pneumonia or sepsis (OR=8.92, p<0.001) were strongly correlated with prolonged ICU stays and were also linked to higher mortality rates.
CONCLUSION: This study highlights the significant role of preoperative comorbidities, intraoperative events, and postoperative complications in prolonging ICU stays after CABG. Extended ICU stays are associated with an increased risk of severe postoperative complications and higher mortality, emphasizing the need for improved surgical and postoperative care protocols. By targeting the identified risk factors, healthcare providers can potentially reduce ICU durations, enhance patient outcomes, and alleviate the burden on healthcare systems. These findings underscore the importance of optimizing ICU resource utilization in the context of cardiac surgery
Dihydroartemisinin-piperaquine for Malaria Prevention in HIV‐Positive Pregnant Women: Systematic Review and Meta-Analysis of Clinical Trials
Full text linkBACKGROUND: Dihydroartemisinin-piperaquine (DP) is a long-acting artemisinin combination treatment that provides effective chemoprevention and has been proposed as an alternative antimalarial drug for intermittent preventive therapy in pregnancy (IPTp). Prevention of malaria infection during pregnancy in HIV-negative women currently relies on the use of long-lasting insecticidal nets together with intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP). Increasing sulfadoxine-pyrimethamine resistance in Africa threatens the current prevention of malaria during pregnancy. Thus, a replacement for IPTp-SP is urgently needed, especially for locations with high sulfadoxine–pyrimethamine resistance. Dihydroartemisinin-piperaquine is a promising candidate. This systematic review aimed to assess the effectiveness and safety of IPTp-DP in HIV-positive pregnant women.
METHODS: This systematic review and meta-analysis followed Cochrane guidelines. Our inclusion criteria were clinical trials on HIV-positive pregnant women using dihydroartemisinin-piperaquine regimens compared to any control group. Primary outcomes included maternal, placental, and cord malaria incidence; secondary outcomes included maternal and neonatal health and adverse effects. We searched PubMed, the Cochrane Library, and Scopus for relevant articles. Two independent reviewers screened the articles. A third reviewer resolved the discrepancies. Meta-analysis was done using RevMan 5.3. Fixed- or random-effects models were used based on heterogeneity, with odds ratios comparing intervention and control groups.
RESULTS: Intermittent preventive treatment with dihydroartemisinin-piperaquine (IPT-DP) during pregnancy significantly reduces the risk of malaria-related outcomes. Specifically, IPT was associated with a 55% decrease in the odds of having malaria during pregnancy (OR = 0.45, 95% CI: 0.36, 11.18, P ≤ 0.001); a 39% decrease in the odds of placental malaria (OR = 0.61, 95% CI: 0.43, 0.85, P = 0.004); and a 46% decrease in the odds of malaria at delivery (OR = 0.54, 95% CI: 0.30, 0.98, P = 0.04) (Figure 1). However, there was no significant reduction in the risk of adverse events (OR = 0.94, 95% CI: 0.73, 1.20, P = 0.61); low birth weight (OR = 0.94, 95% CI: 0.73, 1.20, P = 0.61); foetal loss (OR = 1.14, 95% CI: 0.67, 1.94, P = 0.62); or stillbirth (OR = 1.03, 95% CI: 0.56, 1.89, P = 0.93). On the other hand, there was a statistically significant increase in the risk of miscarriage in the IPT group compared to the control (OR = 3.37, 95% CI: 1.08, 10.51, P ≤ 0.001). This is 3.37 times the odds of miscarriage with IPT use.
CONCLUSION: Dihydroartemisinin-piperaquine reduces the risk of malaria and placental malaria in HIV pregnant women. Also, it does not significantly impact adverse pregnancy outcomes such as low birth weight, foetal loss, or stillbirth. However, DP increases the risk of miscarriage. This indicates the need for careful prescriptions for HIV pregnant women
Perceptions and Expectations of First-Year Medical Students at the Beginning of their Studies for their Course in the Field of Medicine
Full text linkBACKGROUND: Studies conducted on first-year medical students around the world show that the common axis of their concerns is both finding the balance between workload and personal life, as well as the need to develop soft skills to interact with patients. This study explores the perceptions and expectations of first-year students at the School of Medicine of the Aristotle University of Thessaloniki regarding the course of their studies and their future careers at the beginning of their studies.
METHODS: This is a cross- sectional study. The data was collected through an anonymous online questionnaire and completed by first-year students during their first lecture in October 2023. Descriptive statistical methods were used to analyze qualitative and quantitative variables. Braun and Clarke\u27s method was used for the thematic analysis of the open questions by two independent researchers.
RESULTS: The questionnaire was answered by 157 people out of the 233 people who participated in the (response rate: 67.4%). The 51.6% of the participants were men. The School of Medicine of the Aristotle University of Thessaloniki was the first choice for 126 (80.3%) students. The majority of students reported that they are quite confident in choosing medicine for their studies and career [median: 9, interquartile range (IQR) 2], while a significant percentage of students consider it likely to practice medicine abroad (median: 6, IQR: 3). Their expectations include enrichment of their knowledge, achievement of professional success, completion of their studies in a fair time. Some students prioritize social contribution as the major aim of their career. The main concerns included insecurity about their employment, lack of free time, possible wrong choice of studies, and fear of long-term commitment to medicine. In addition, 41 (26.1%) participants consider it likely to work in primary health care units after their studies.
CONCLUSION: The majority of students feel confident in choosing medicine as a profession. Resolution of their fears and concerns through close communication between students and teaching staff is considered necessary
Effects of a Low-Dose Cardiac Rehabilitation Program on Cardiovascular Conditioning Parameters in Patients with Heart Disease
Full text linkBACKGROUND: Cardiac rehabilitation is a high-evidence ischemic heart disease. The optimal dose of rehabilitation is not well defined due to the heterogeneity of studies.
AIM: To evaluate the effects of low-dose cardiac rehabilitation on cardiovascular performance parameters in patients with heart disease.
METHODS: A longitudinal, retrospective, observational, and analytical study was conducted. Adult patients who enrolled in the cardiac rehabilitation program were included, excluding or removing those without a history of cardiovascular disease, those who did not complete at least 5 rehabilitation sessions, and those with less than 80% attendance at rehabilitation sessions. Results from the initial and final (comparative) conventional and/or cardiopulmonary exercise tests were obtained, which included functional capacity in METs, chronotropic response, pressor response, heart rate and blood pressure recovery, double product, presence or absence of ischemia, arrhythmias, determination of ischemic threshold, and ergospirometry parameters such as peak VO2, VE/VCO2, O2 pulse, and aerobic and anaerobic thresholds.
RESULTS: A total of 32 patients were included, of whom 65.6% were male. A significant increase was observed in peak VO2 achieved (20.7 vs. 24.2 ml/kg/min, p=<0.001) and the percentage of predicted VO2 achieved (76.3% vs. 94.5%, p=<0.001) when comparing initial and final maximal exercise tests. Improvement was found in ergometric performance indices, FC/W index (1.18 vs. 1.02, p=0.043) and DP/W index (1.78 vs. 1.39, p=0.041). No significant difference was found regarding pressor or chronotropic response parameters, heart rate and blood pressure recovery, or double product.
CONCLUSION: It was concluded that in patients with heart disease, a low-dose cardiac rehabilitation program is effective in improving cardiovascular conditioning parameters such as peak VO2 and reducing the ischemic threshol