International Journal of Medical Students <p>The International Journal of Medical Students (IJMS) is a peer-reviewed open-access journal (ISSN 2076-6327) created to share the scientific production and experiences of medical students and recently graduated physicians worldwide. Our objective is to be the primary diffusion platform for medical students, using standards that follow the process of scientific publication.</p> <p>The Journal receives contributions and unpublished manuscripts of Original Articles, Short Communications, Reviews, Case Reports, Interviews, Experiences, and Letters, which are reviewed by experts (Peer-Reviewers). This supports the quality and validity of the publications.</p> <p>The <em>IJMS</em> is published online triannually by the University Library System, University of Pittsburgh. The Journal's main office is located in the United States of America (USA). Any publication, dissemination, or distribution of the information included in the Journal is permitted if the source is cited (Int J Med Students).</p> <p>This journal provides immediate <em>open access</em> to its content. Our Open Access follows a “<em>diamond model</em>”; the Journal is free to both readers and authors, there are no article processing charges, submissions fees, or any other costs required of authors to submit, review, or publish articles.</p> en-US <p id="copyright">Authors who publish with this journal agree to the following terms:</p> <ol> <li class="show">The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.</li> <li class="show">Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.</li> <li class="show">The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a&nbsp;<a href="" target="_blank" rel="noopener">Creative Commons Attribution 4.0 International License</a>&nbsp;or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions: <ol> <li class="show">Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.</li> <li class="show">The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.</li> <li class="show">Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.</li> <li class="show">Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.</li> <li class="show">The Author represents and warrants that:<br> <ol> <li class="show">the Work is the Author’s original work;</li> <li class="show">the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;</li> <li class="show">the Work is not pending review or under consideration by another publisher;</li> <li class="show">the Work has not previously been published;</li> <li class="show">the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and</li> <li class="show">the Work contains no libel, invasion of privacy, or other unlawful matter.</li> </ol> </li> <li class="show">The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.</li> </ol> </li> </ol> <p><em>Enforcement of copyright</em></p> <p>The IJMS takes the protection of copyright very seriously.</p> <p>If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.</p> <p>If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to <a href=""></a></p> <p>&nbsp;</p> <p><em>Infringing material</em></p> <p>If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to&nbsp;<a href=""></a></p> (Francisco Javier Bonilla-Escobar, MD, MSc, PhD(c)) (IJMS Contact) Fri, 18 Dec 2020 13:09:39 -0500 OJS 60 Cover, Credits, & Content Copyright (c) 2020 Executive Committee of IJMS Thu, 17 Dec 2020 14:12:14 -0500 A Grain of Sand in the Ocean: Training New Generations of Editors, Reviewers, and Medical Scientists Francisco J. Bonilla-Escobar, Annora A. Kumar, Georgiana Farrugia-Bonnici, Paul MacDaragh Ryan, Mihnea-Alexandru Găman Copyright (c) 2020 Executive Committee of IJMS Fri, 18 Dec 2020 00:00:00 -0500 Pre-Existing Social Conditions: A Call to Prevent the Perpetuation of Gender Inequalities in Research Production during COVID-19 <p>The global COVID-19 pandemic has increased the demand for systematic studies on our changing society and medical students are responding accordingly. However, emerging evidence indicates that there are changing patterns in research production since the initial COVID-19 outbreak in early 2020, with an exponential increase in the number of manuscripts submitted to academic journals for peer review, but with women producing significantly less research compared to men. In an effort to contemplate what academic journals’ responsibilities are to counteract these trends among medical students, we consider three “pre-existing social conditions” that have the potential to negatively affect female medical students’ careers long-term: 1) the unequal division of labor both at home and work; 2) women’s lower well-being compared to men’s; and 3) men’s greater representation in science, technology, engineering, and mathematics (STEM) fields. As a society, we need to offset these trends that threaten women’s careers, as we are at risk of reversing the diligent work achieved to improve gender equality in the fields of science and medicine. While “pre-existing conditions”—the social, economic, political, and historical forces discussed here— have led to, and exacerbated, gender disparities in research production during the pandemic, <em>The International Journal of Medical Students </em>(IJMS) is committed to acknowledging these gender inequalities and preventing their perpetuation among the next generation of future doctors and physician-scientists.</p> Kelly Rhea MacArthur, Madeleine J. Cox, Ciara Egan, Leah Komer Copyright (c) 2020 Kelly Rhea MacArthur, Madeleine J. Cox, Ciara Egan, Leah Komer Thu, 17 Dec 2020 00:00:00 -0500 SARS-CoV-2 Infection Among Healthcare Workers in Tijuana, Mexico: A Cross-Sectional Study <p><strong>Background:</strong> Healthcare workers (HCW) are a high-risk group for contraction of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of this study was to estimate the effect size of being a HCW and acquiring coronavirus disease 2019 (COVID-19) at the Mexican Institute of Social Security (IMSS) in Tijuana, Mexico.</p> <p><strong>Methods:</strong> A cross-sectional study of the Epidemiologic Surveillance Online Notification System database was conducted, including entries from Tijuana City between March 11, 2020 to May 1, 2020. Multiple imputation was performed for SARS-CoV-2 RT-PCR result where data was missing. Prevalence odds ratios (POR) were calculated to estimate the effect size of HCWs contracting COVID-19 compared to the general population (GP).</p> <p><strong>Results:</strong> From a total of 10,216 entries, 6,256 patients were included for analysis. HCW status was significantly associated with higher odds of acquiring COVID-19, (POR=1.730, Confidence Interval 95% [CI95%]=1.459;2.050). Nurses had double odds (POR=2.339, CI95%=1.804;3.032) than the GP. Physicians had a POR=1.828 (CI95%=0.766;1.380). Resident physician status was double the likelihood of the GP (POR=2.166, CI95%=0.933;5.025). Meanwhile, being an intern had a protective factor (POR=0.253, CI95%=0.085;0.758). Among medical specialties, emergency medicine had the highest exposure-effect association, followed by anesthesiologists.</p> <p><strong>Conclusion:</strong> HCW had up to 73% increased odds of acquiring COVID-19 than the GP in Tijuana, Mexico. Nurses were the group with the highest likelihood out of all HCW, as a result of prolonged and close contact with patients. Emergency medicine and anesthesiology were the medical specialties with highest odds of infection because they frequently perform aerosol-generating procedures.</p> José Adrián Yamamoto-Moreno, Cecilia Pineda-Aguilar, Samuel Ruiz-Pérez, Gloria Liliana Gortarez-Quintana, Marco Antonio Ruiz-Dorado Copyright (c) 2020 José Adrián Yamamoto-Moreno, Cecilia Pineda-Aguilar, Samuel Ruiz-Pérez, Gloria Liliana Gortarez-Quintana, Marco Antonio Ruiz-Dorado Wed, 09 Dec 2020 00:00:00 -0500 Knowledge, Attitude, and Practices Associated with COVID-19 Among School Students in Bharatpur, Chitwan District of Nepal <p><strong>Background:</strong> The virus causing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has reached pandemic proportions. Understanding people’s perceptions of the disease will provide tools to improve strategies to limit its transmission. This study aims to assess the knowledge, attitude, and practices (KAP) associated with the disease among high school students.</p> <p><strong>Methods:</strong> Cross-sectional study conducted among secondary level students (grade 8<sup>th</sup> and 9<sup>th</sup>) in an urban high-school at Bharatpur, Chitwan, Nepal to assess KAP using a pre-tested questionnaire. Data were analyzed using Epi Info</p> <p><strong>Results:</strong> We collected 101 surveys (response rate 100%). Most of the students were found to be knowledgeable about the timeline of the first outbreak (92.08%), and nearly three-fourths of participants knew about hand-washing for 20 seconds (73.27%). Information about the presence of the disease in Nepal (50.50%), its causative agent (65.53%), and symptoms (57.43%) showed that there is a knowledge gap among participants. Most of the participants were found to have a positive attitude towards the prevention and control of the disease. The majority of the respondents reported using face mask (77.23%) and adopting hand-washing measures (79.21%) as preventive strategies. The majority of the students were highly concerned about the disease.</p> <p><strong>Conclusion:</strong> Secondary level students of Chitwan, Nepal were found to have fair knowledge and understanding of the disease, showed a moderately positive attitude towards preventive measures, and reported appropriate preventive practices against the disease. It is recommended that a similar study with a wider population be conducted to assess KAP of Nepalese people towards SARS-CoV-2.</p> Deepak Subedi, Suman Bhandari, Asmita Gaire, Milan Kandel, Sanju Subedi, Surendra Karki Copyright (c) 2020 Deepak Subedi, Suman Bhandari, Asmita Gaire, Milan Kandel, Sanju Subedi, Surendra Karki Wed, 09 Dec 2020 00:00:00 -0500 The Negative Correlation of Spice Intake and Colorectal Cancer: A Statistical Analysis of Global Health Databases <p><strong>Background:</strong> Colorectal Cancer (CRC) has multiple risk factors and depends highly on diet. Positive associations of red meat and processed meat intake and CRC have been proven, but no research has been conducted on the relation of spice intake and CRC risk. Various in-vitro studies have demonstrated the anticancer activity of chemicals present in spices, which is the main driving force for our statistical analysis.</p> <p><strong>Methods:</strong> We analyzed Global Burden of Disease (GBD) database, Food and Agricultural Organization of United Nations (FAO) database, and Global Dietary Database (GDD) using Pearson correlation statistics to find any significant correlation, mainly between spice intake and CRC risk. Data from 1990 to 2013 of 100 countries was collected for the analysis. Twenty-three-year average values (±SD) were calculated for CRC risk, spice, red meat, processed meat, vegetable, and fruit intake. CRC risk is taken as dependent variable whereas all other were independent variables. All variables were analyzed using Pearson correlation analysis. Results with p&lt;0.05 were further analyzed using regression analysis.</p> <p><strong>Results:</strong> Pearson correlation showed that spice intake had a significant negative correlation (r= -0.301, p=0.002) whereas red meat (r= 0.722, p&lt;0.001) and processed meat (r= 0.339, p&lt;0.001) had a significant positive correlation with CRC risk.</p> <p><strong>Conclusion:</strong> Significant negative correlation between spice intake and CRC risk indicates that higher spice intake can be preventive against cancer and possibly decrease the risk of colorectal cancer in populations with higher CRC risk.</p> Shinjit Mani, Nathan Pramanik, Deeksha Rao, Stuti Sharma, Timur Akhmetov Copyright (c) 2020 Shinjit Mani, Nathan Pramanik, Deeksha Rao, Stuti Sharma, Timur Akhmetov Thu, 17 Dec 2020 00:00:00 -0500 From Student to Teacher: Medical Student Perceptions of Teaching Children and a Novel Application of the One Minute Preceptor <p><strong>Background: </strong>As students progress through medical school, the student assumes teaching roles, but without formal training regarding how to teach.</p> <p><strong>Methods: </strong>We administered surveys to 1<sup>st</sup>, 2<sup>nd</sup> and 4<sup>th</sup> year medical students asking about perceptions of teaching. The surveys were completed in the Fall (2019) and again in late Spring (2020). In the interim, students were given the opportunity to teach 5<sup>th</sup> graders during an outreach program. We gave the medical student volunteers a brief interactive session about the One Minute Preceptor (OMP) as a tool to teach the children. In the Spring survey, medical students who used the OMP were also asked about its utility in the pediatric setting.</p> <p><strong>Results: </strong>Seventy-four students completed survey 1 and, of these, 51 completed the follow-up survey. Mean age was 24-27; 57% were female. Across both surveys, ≥70% were comfortable with and felt they understood their role as a teacher of trainees, peers, and patients. However, &lt;50% felt they knew any teaching method or had a plan for improving teaching skills. All felt that teaching was an important medical skill. Six students completed OMP training and the outreach program. All felt the OMP was useful to teach key points, provide feedback, and involve the learner. They also all felt the OMP should be taught in medical school.</p> <p><strong>Conclusion: </strong>Medical students believe it is important to learn teaching skills. The OMP may be a useful addition to the medical school curriculum to help medical students teach in doctor-patient settings across ages and group sizes.</p> Laura Cline, Muna Canales Copyright (c) 2020 Laura Cline, Muna Canales Wed, 09 Dec 2020 00:00:00 -0500 Internet Addiction and Its Relationship with Depression and Academic Performance: A Cross-Sectional Study at a Medical School in Pakistan <p><strong>Background: </strong>Excessive Internet use may induce depression, influence relationships, and decrease academic performance. There is scarce information about Internet addiction in Pakistan. This study aimed to determine prevalence of Internet addiction and its relationship with depression and academic performance.</p> <p><strong>Methods:</strong> A study based on a self-administered survey was carried out at a medical school in Peshawar, Pakistan. Participants were medical students (MBBS) and a non-randomized convenience sampling technique was utilized for data collection. We collected demographic information, last professional exam score, Internet addiction, and depression scores using the Young’s Internet Addiction Test (YIAT) and the Beck’s Depression Inventory (BDI), respectively. The analysis included binomial 95% confidence intervals (95% CI) estimations and linear and logistic regressions to assess variables relations.</p> <p><strong>Results:</strong> We analyzed responses from 231 participants (380 students approached and 250 responded: response rate=65.79%, 19 excluded), 64.07% were male and the age average was 21±2 years. Profound and slight addiction to the Internet was found in 9.09% (95%CI=5.71-13.56) and 41.99% (95%CI=35.55-48.64) of students, respectively. Frequency of depression (mild-severe) was 59.74% (95%CI=53.11-66.12). Levels of Internet addiction and depression were found associated after adjusting by sex and age (β=0.27, R<sup>2</sup>=0.03, p-value=0.009). Internet addiction (OR=0.54, 95%CI=0.2-1.49, p-value=0.23) and depression (OR=0.62, 95%CI=0.36-1.09, p-value=0.10) were not significantly associated with low grades after adjusting by sex and age.</p> <p><strong>Conclusion:</strong> More than half of the students are having excessive Internet usage which could result in despondency and academic performance deterioration. Internet addiction should be considered an emerging challenge and appropriate mitigation measures should be taken opportunely.</p> Farrukh Ansar, Waqar Ali, Adil Zareef, Noman Masud, Sawar Zahab, Huma Iftikhar Copyright (c) 2020 Farrukh Ansar, Waqar Ali, Adil Zareef, Noman Masud, Sawarul Zahab, Huma Iftikhar Thu, 17 Dec 2020 00:00:00 -0500 Pap Smear Readability on Google: An Analysis of Online Articles Regarding One of the Most Routine Medical Screening Tests <p><strong>Background: </strong>The Papanicolaou smear (Pap smear, Pap test) is one of the most routine screening tests performed in medicine. The development and widespread use of this test has brought a considerable decrease in the incidence of cervical cancer. Unfortunately, this disease process continues to convey significant morbidity and mortality. These persistent phenomena may be the result of inadequate compliance with routine Pap smear screening, in which limited education is thought to play a role, particularly among ethnic minority groups.</p> <p><strong>Methods: </strong>A Google search using the phrase “pap smear” was performed and the first fourteen web addresses were analyzed using four standardized readability indices: the Flesh-Kinkaid Grade Level, the Simple Measure of Gobbledygook, the Gunning Fog Index and the Automated Readability Index. The average grade level readability was then compared to the American Medical Association recommendation that health care information should be written at a 5th or 6th-grade reading level (i.e., ages 10-12 years).</p> <p><strong>Results: </strong>The average grade-level readability values of the fourteen analyzed sites using the four aforementioned indices were 8.9, 8.8, 11.9, and 8.4, respectively. The mean readability of all four indices was 9.5.</p> <p><strong>Conclusion: </strong>The grade-level readability of commonly accessed internet information regarding Pap smears is above the recommendation of the American Medical Association. Health care providers and website authors should be cognizant of this, as it may impact compliance. This is particularly important given that this routine healthcare test is recommended for nearly fifty percent of the world’s population at various points throughout their lifetime.</p> Mark J. Parry, Travis S. Dowdle, Jesse N. Steadman, Tiffany R. Guerra, Kim L. Cox Copyright (c) 2020 Mark J. Parry, Travis S. Dowdle, Jesse N. Steadman, Tiffany R. Guerra, Kim L. Cox Wed, 09 Dec 2020 00:00:00 -0500 Hypertension Awareness, Treatment, and Control in Mexico: An Opportunistic Medical Student-led Blood Pressure Screening Campaign – A Cross-Sectional Study <p><strong>Background:</strong> Hypertension is still a growing public health problem in Mexico. An estimated 151% increase in the number of individuals with hypertension is expected for 2050 if actions are not taken in the country. The aim of this study is to describe hypertension awareness, treatment, control and its associated factors in participants of an opportunistic medical student-led blood pressure screening campaign in Mexico.</p> <p><strong>Methods:</strong> A cross-sectional study, using convenience sampling was performed, including participants aged 18 years and older from 15 Mexican states. Each participant completed a questionnaire about risk factors and had three BP measurements taken. Hypertension was defined as ≥140/90 mmHg. Multiple imputation with linear regression was performed where data was missing.</p> <p><strong>Results:</strong> From a population of 2 545 participants, 623 (24.5%) participants had hypertension. Of those with hypertension, 81.9% had a previous diagnosis of hypertension and only 16.1% were not on medication at the time of screening; 61% were controlled, 121% were uncontrolled patients and 18% were not aware they had hypertension. High marginalization was found to have the biggest proportion of uncontrolled cases (33%), while the number of unaware hypertensives in very low marginalization states doubled the national figure. More than half the participants taking antihypertensive agents were on a single medication, achieving control in almost 8 in 10 patients.</p> <p><strong>Conclusion:</strong> It is important to continue making and supporting awareness raising campaigns in different settings across the country to generate more evidence and lead to better programs for improving hypertension detection in Mexico.</p> José Adrián Yamamoto-Moreno, Suzzette Anaís Navarro-Rodríguez, Samuel Ruiz-Pérez, Juan Carlos Godínez-Reyes, Marvin Mendoza-Rojo Copyright (c) 2020 José Adrián Yamamoto-Moreno, Suzzette Anaís Navarro-Rodríguez, Samuel Ruiz-Pérez, Juan Carlos Godínez-Reyes, Marvin Mendoza-Rojo Wed, 09 Dec 2020 00:00:00 -0500 Novel Combination Strategies to Enhance Immune Checkpoint Inhibition in Cancer Immunotherapy: A Narrative Review <p>Programmed cell death protein-1 (PD-1) is an immune checkpoint receptor that induces and maintains tolerance of T cells, invariant natural killer T (iNKT) cells, and natural killer (NK) cells, among other lymphocytes. Immune checkpoint inhibition by PD-1 blockade restores the lymphocytic immunostimulatory phenotype and has been successful in the treatment of various malignancies. However, while immune checkpoint blockade has been shown to provide robust antitumor treatment outcomes, its overall response rate remains low in a significant portion of cancer patients. An essential unmet need in cancer therapy is the development of novel pharmacologic strategies designed to lower rates of resistance associated with immune checkpoint blockade. Therefore, efforts that seek to enhance the efficacy of PD-1 inhibition possess profound immunotherapeutic potential. Here, three promising combination strategies that harness the antitumor effects of immune checkpoint inhibitors (ICIs) together with non-ICI antitumor therapeutic agents are reviewed. These agents include (1) ABX196, a potent inducer of iNKT cells, (2) chimeric antigen receptor (CAR)-T cell therapy, and (3) NK cell therapy. A comprehensive literature search was conducted using the PubMed and databases for scientific articles and active trials, respectively, pertaining to immune checkpoint inhibition, iNKT cells, CAR-T cells, and NK cell immunotherapy. Preliminary clinical and preclinical data suggest that these combination treatment regimens greatly suppress tumor growth and may serve as innovative methods to enhance and optimize anticancer immunotherapy.</p> Jonathan A. Hermel, Cassi M. Bruni, Darren S. Sigal Copyright (c) 2020 Jonathan A. Hermel, Cassi M. Bruni, Darren S. Sigal Thu, 17 Dec 2020 00:00:00 -0500 Glucose-6-phosphate Dehydrogenase Deficiency: A Review <p>Deficiency of glucose-6-phosphate dehydrogenase enzyme is a common X-linked disorder that affects humans globally. It was first identified in the 1950s as a disorder that primarily affects the red blood cells causing a myriad of symptoms including acute haemolytic anaemia, neonatal jaundice and chronic nonspherocytic haemolytic anaemia. The deficiency has been extensively studied and especially in the last 5 years there have been improvements in the diagnosis and management. Various methods of diagnosis exist, however recent research focusses on the use of biosensors for more accurate and less time-consuming diagnosis. Guidelines suggest on controlling symptomology as there exists no specific treatment. Neonatal jaundice is a common complication of the disease and research on phototherapy has proved to show some effect in managing this condition. In the last year, protein-protein interactions have been studied and are used as a target to enhance enzyme stability and activity. AG1 is a small molecule activator that has demonstrated effectiveness in treating G6PD deficiency in models. The purpose of this review is to summarize existing literature and potential areas of research on glucose-6-phosphate dehydrogenase deficiency including clinical characteristics, diagnosis and management.</p> Nidhruv Ravikumar, Graeme Greenfield Copyright (c) 2020 Nidhruv Ravikumar, Graeme Greenfield Thu, 17 Dec 2020 00:00:00 -0500 Case Report: General Anesthetic Management for Laparoscopic Cholecystectomy in Paramyotonia Congenita <p><strong>Background:</strong> Paramyotonia congenita (PC) is a rare disorder affecting skeletal muscle. Patients with this non-progressive condition experience intermittent episodes of sustained myotonia. Due to the predisposition for prolonged muscle contraction, special attention must be given to anesthetic management during operative procedures to prevent complications similar to those experienced in patients with malignant hyperthermia. To date, however, limited reports of anesthetic management in paramyotonia congenita are available.</p> <p><strong>The Case:</strong> The present report describes successful general anesthetic management given to a patient with paramyotonia congenita using propofol and ketamine for induction, non-depolarizing rocuronium for muscle paralysis, and continuous nitrous oxide and IV propofol infusion for sedation. The patient remained stable throughout the case without myotonic episodes or other complications.</p> <p><strong>Conclusion:</strong> Our report describes successful anesthetic management in a patient with paramyotonia congenita. This provides a potential management plan that may be applied to PC patients undergoing a variety of surgical procedures and eliminates risk associated with succinylcholine and possibly volatile anesthetics. Further research is needed to determine whether this approach is superior to previously reported techniques and should also identify which agents may be effectively utilized to reverse an intra-operative myotonic episode in PC.</p> Analise McGreal, Daniel Slagle, Andrew Dickens Copyright (c) 2020 Analise McGreal, Daniel Slagle, Andrew Dickens Wed, 09 Dec 2020 00:00:00 -0500 Fixed Drug Eruption: A Rare Case of Polysensitivity between Two Unrelated Fixed Dose Combination Preparations - A Case Report <p><strong>Background:</strong> A fixed drug eruption is a type IV hypersensitivity reaction to a medication that characteristically re-emerges on the same site each time the specific drug is taken. Antimicrobials (including fixed dose combinations) are frequently implicated in fixed drug eruption while gliptins (as separate drugs or as combined preparations) on the other hand are infrequent triggers. Drugs belonging to similar classification and having similar chemical structures can show cross reactivity, but here we describe a case of cross reactivity between unrelated drug classes, also known as polysensitivity.</p> <p><strong>The Case:</strong> A 58-year-old man presented with painful, burning, and pruritic blisters with ulcerations on the oral mucosa of lips, hard palate, and tip of the tongue. The patient had been on vildagliptin - metformin fixed dose combination tablets for one year. He was asked to stop the drug and lesions started improving thereafter. A week later he suffered from gastroenteritis for which he took a combined preparation of ofloxacin and ornidazole and lesions re-appeared at the same site as before with severe itching and burning.</p> <p><strong>Conclusion:</strong> This case highlights polysensitivity amongst chemically unrelated drugs, especially available in fixed-dose combination. It is an extremely rare occurrence (less than 0.2%). Moreover, there have only been a few cases of such delayed reactions occurring to gliptins, especially vildagliptin. A clinician must keep a high index of suspicion to identify this phenomenon.</p> Jessica Kaushal, Abhimanyu Rakesh Copyright (c) 2020 Jessica Kaushal, Abhimanyu Rakesh Wed, 09 Dec 2020 00:00:00 -0500 Aberrant Lymphatic Drainage of Primary Invasive Lobular Carcinoma with Concurrent Primary Lung Adenocarcinoma: A Case Report <p><strong>Background:&nbsp;</strong>Lymphatic spread of breast cancer is currently well understood and can be assessed in breast cancer patients through the use of lymphatic mapping with sentinel node biopsy, CT, PET.</p> <p><strong>The Case:&nbsp;</strong>Here we present a case report of a 73-year-old female with two distinct primary carcinomas, right-sided invasive lobular carcinoma of the breast and left-sided adenocarcinoma of the lung. We also discuss the predictable and unpredictable lymphatic drainage of the lobular carcinoma, including ipsilateral drainage to the axillary chain and suspected contralateral hilar and mediastinal lymph node metastasis.</p> <p><strong>Conclusion:&nbsp;</strong>The unique lymphatic spread of breast cancer, in this case, emphasizes the use of lymphatic mapping for the staging of disease and staining biopsied tissue samples for tumor markers to guide treatment. Additional anatomic research in this patient or supporting reported cases are needed to determine the frequency and cause of aberrant lymphatic drainage of primary invasive lobular carcinoma of the breast.</p> Rina Won Lee, Emily Denney Copyright (c) 2020 Rina Won Lee, Emily Denney Thu, 17 Dec 2020 00:00:00 -0500 A First Year Medical Student’s Perspective on Working in ICU during the COVID-19 Pandemic <p>The COVID-19 pandemic has brought forth unprecedented times. Due to this, medical students of all abilities and competencies can play a meaningful part in patient’s treatment.&nbsp; &nbsp;Throughout medical school, teaching is focussed on the overarching clinical care needed – from medication to surgery. However, there are many other aspects of care required for patient’s recovery, such as personal care. Working as a healthcare assistant brings this to the forefront, particularly in an intensive care unit, during a pandemic. This allowed me to experience a different side of medicine and patient care, something I believe all medical students should see.</p> Erin McCabe Copyright (c) 2020 Erin McCabe Wed, 09 Dec 2020 00:00:00 -0500 National Health Service Bury and Rochdale Doctors on Call (NHS BARDOC): Medical Students Working on the Frontline at the Greater Manchester COVID-19 Death Service <p>We were third year medical students preparing for our clinical examinations to take place. What felt like a few moments later, on the 23<sup>rd</sup> of March 2020 Greater Manchester went into lockdown and we were told to stay home to protect the NHS and prevent the spread of the COVID-19 virus. Like many students across the UK, we seeked a job within the NHS to decrease the demand for staff during the pandemic. We worked on the frontline for an Emergency Community Death Service set up in response to the rapid increase in deaths occurring in the community due to the pandemic. Here we arranged for timely and efficient verification of the deaths alongside handling the legalities of the Medical Certificate of Cause of Death and cremation papers. It was a psychologically challenging, but massively rewarding journey.</p> Imania Yaqub, Bilaal Ghafoor Copyright (c) 2020 Imania Yaqub, Bilaal Ghafoor Wed, 09 Dec 2020 00:00:00 -0500 Students Leading a Free Clinic: Lessons Learned About Digital Health in the Age of COVID-19 Marina E. Shatskikh, Anna Kirillova, Lucy Z. Shi Copyright (c) 2020 Marina E. Shatskikh, Anna Kirillova, Lucy Z. Shi Thu, 17 Dec 2020 00:00:00 -0500 COVID-19: Using Social Media to Promote Mental Health in Medical School During the Pandemic <p>The Asian Pacific American Medical Student Association (APAMSA) is a national student organization that advocates for the health of the Asian American Pacific Islanders. In May 2020, our APAMSA chapter at Oakland University William Beaumont (OUWB) School of Medicine located in Michigan, USA hosted a virtual mental health campaign titled, “Socially Distant but Emotionally Connected: 6ft Closer During Quarantine.” We reached out to medical students and faculty within the OUWB community to share their experiences during the initial phases of quarantine. Our goal was to create a space for everyone at OUWB to engage in meaningful conversations about mental health and support each other during the pandemic. The responses we received varied across numerous topics, including xenophobia, loneliness, and lack of motivation. Participants also followed up with words of encouragement for their peers and guidance on how to cope with social isolation. Our virtual campaign was very feasible and successful under the constraints of social distancing, and we urge other medical schools to implement their own mental health awareness initiatives to destigmatize the topic in their communities. General steps on how to start your own campaign include: collaborating with interest groups, deciding on social media platforms, and sharing with your community.&nbsp;</p> Han G. Ngo, Brianna L. Gibney, Paul Patel, Jennifer L. Nguyen Copyright (c) 2020 Han G. Ngo, Brianna L. Gibney, Paul Patel, Jennifer L. Nguyen Wed, 09 Dec 2020 00:00:00 -0500 COVID-19: Turning a Pandemic into a Learning Opportunity for Senior Medical Students <p>Normally, the 4th year of medical school in the United States is when students narrow down their clinical experiences to reflect their interests, and prepare for applying to residency programs. The COVID-19 pandemic has made this process difficult, forcing many senior students from the frontlines to the sidelines. Policy changes have forbidden students from attending some in-person rotations and participating in operational procedures. The impact that COVID-19 has had on medical curricula varies between institutions, with many being hindered significantly by the event. However, my institution is using novel approaches to patient care, allowing senior students to help. Senior students are using telecommunication to connect with patients and assist them with their medical questions and needs. They are acting as Transitional Care Providers and Patient Navigation Assistants, allowing them to use their knowledge and skills to help both the patients and the healthcare system. Other students are acting as “COVID-19 case-trackers,” attempting to mitigate the spread of infections. By allowing students to take on these roles during the pandemic, institutions like mine are making this time one of valuable experience and learning. For some senior medical students, the COVID-19 pandemic, with all of its hardships, has become an invaluable learning opportunity and a chance to serve their community.</p> John C. Garman Copyright (c) 2020 John C. Garman Wed, 09 Dec 2020 00:00:00 -0500 Eyes Wide Open - To Cornea, to Medical School, to Life <p><span class="tagit-label">Sharing memories of a medical student who is also a corneal harvester for transplantation. The text will describe and share stories and experiences he went through and what lessons he learned</span></p> Aviad Sapir Copyright (c) 2020 Aviad Sapir Thu, 29 Oct 2020 00:00:00 -0400 Recurrence of COVID-19: Treading the Fine Line Between Relapse and Re-infection <p>The ongoing outbreak of COVID-19 that began in Wuhan, China, has constituted a Public Health Emergency of International Concern, with cases confirmed in more than 200 countries. Currently, infected individuals are the primary source of infection and multiple cases of relapse are also reported following the recovery. It is highly concerning the nature of relapse which may be caused due to reactivation or reinfection. While the present testing scenario of using different molecular techniques has several loopholes that can report false results and hamper the process of effectively preventing the transmission of the virus. Various recommendations need modifications to effectively stop the horizontal transmission of the virus and look deeply into the links with relapse cases to prevent a second wave during a pandemic.</p> Ritwick Mondal, Shramana Deb, Durjoy Lahiri, Gourav Shome Copyright (c) 2020 Ritwick Mondal, Shramana Deb, Durjoy Lahiri, Gourav Shome Wed, 09 Dec 2020 00:00:00 -0500 Letter to the Editor Regarding "Survey among Medical Students during COVID-19 Lockdown: The Online Class Dilemma" <p class="p1">Neither students nor teachers were prepared for a sudden shift from traditional classroom learning to e-learning without any extensive planning and faculty training. In countries like India, the vast majority of students are underprivileged to access e-learning facilities. To overcome this, special schemes that provide free data daily to attend online classes may be considered. Medical students are also concerned about acquiring practical clinical skills that cannot be provided through e-learning. The drastic reduction in their patient contact time, time spent in wards learning clinical skills, and bedside teaching may have a negative impact on the confidence of medical students with regard to their future career skills. The indefinite extension of their courses is also a concern, as universities have failed to provide appropriate clarity in their communications. Immediate measures need to be instituted so that the efforts of online education may bear fruit.&nbsp;Medical students are a natural reservoir of volunteers and they offer a vast wealth of potential which can be put to use in times of crisis. To harness this potential, medical students should be prepared adequately. The inclusion of “pandemic/crisis specific” content in the medical curriculum may prove to be helpful in tackling these situations in future. This will also help the students to complete their transition from a ‘student’ to a ‘doctor’.</p> Akshara Mavunkal Thampan, Davis Thomas Pulimoottil, Angel Cham Philip Copyright (c) 2020 Akshara Mavunkal Thampan, Davis Thomas Pulimoottil, Angel Cham Philip Thu, 17 Dec 2020 00:00:00 -0500 Response to the Letter to the Editor Regarding "Survey among Medical Students during COVID-19 Lockdown: The Online Class Dilemma" <p>We thank the editor for allowing us to respond to the comments by Akshara et al. The authors concur with us on unpreparedness and goes on to highlight how female doctors are over-worked during the pandemic. In this response, we also discuss why providing free data will not bring about significant change in students’ perception of online classes. We then advise how students can learn basic examination skills during the pandemic. Finally, we express our views on government and universities and finish with a recommendation that would help future doctors in times like the COVID-19 pandemic. &nbsp;</p> Andrew Thomas, Mohan. T Shenoy, Kottacherry T. Shenoy Copyright (c) 2020 Andrew Thomas, Mohan. T Shenoy, Kottacherry T. Shenoy Mon, 14 Dec 2020 00:00:00 -0500 Benefits and Drawbacks of Online Open-Book Examinations for Medical Students in the COVID-19 Pandemic Shuja Yaqub, Hannah Suh, Hozafa Ali Copyright (c) 2020 Shuja Yaqub, Hannah Suh, Hozafa Ali Thu, 17 Dec 2020 00:00:00 -0500 Putting Our First Responders First: A Call for Health Insurance in Retirement for Palm Beach Gardens Fire Rescue Joseph Varney, Kimberly Murry, Natalie Humphrey Copyright (c) 2020 Joseph Varney, Kimberly Murry, Natalie Humphrey Wed, 09 Dec 2020 00:00:00 -0500 Carotid Intima-Media Thickness and Cardiovascular Risk Factors <p>Albers SS et al. reviewed carotid artery variation in the development of atherosclerotic carotid artery disease (Int J Med Students. 2019 Sep-Dec;7(3):82-91) commenting on changes from birth to older ages that can contribute to disorders of intramural elastin even in absence of disease. Considering the coexistence of traditional risk factors of atherosclerosis, additional comments are posed about measurements of carotid intima-media thickness in patients with obesity, chronic renal failure, and secondary hyperparathyroidism. The authors emphasized the need for further research to validate preventive procedures initiating since prenatal.</p> Vitorino Modesto dos Santos, Laura Campos Modesto Copyright (c) 2020 Vitorino Modesto dos Santos, Laura Campos Modesto Mon, 14 Dec 2020 00:00:00 -0500 Acknowledgement of Reviewers Vol 8 (2020), IJMS Sushil Dahal Copyright (c) 2020 Executive Committee of IJMS Fri, 18 Dec 2020 00:00:00 -0500