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 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The Journal receives contributions and unpublished manuscripts of Original Articles, Short Communications, Reviews, Case Reports, Interviews, Experiences, and Letters, which are reviewed by experts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 International Journal of Medical Students is published online triannually on behalf of the Executive Committee of the International Journal of Medical Students which 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. There are no article processing charges, submissions fees, or any other costs required of authors to submit, review or publish articles in the International Journal of Medical Students.</p> International Journal of Medical Students Publisher en-US International Journal of Medical Students 2076-6327 <p>Authors who publish with this journal agree to the following terms:</p> <ul> <li class="show">Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a href="" rel="license">Creative Commons Attribution 4.0 International License</a>&nbsp;that allows others to share the work with an acknowledgement of the work’s authorship and initial publication in this journal.</li> <li class="show">Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal’s published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li class="show">Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.</li> </ul> <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> Cover, Credits, & Content Executive Board of IJMS Copyright (c) 2019 Executive Board of IJMS 2019-08-31 2019-08-31 7 2 24 28 10.5195/ijms.2019.428 The Weight of Schoolbags and Musculoskeletal Pain in Children of Selected Schools in Thimphu, Bhutan: A Cross-sectional Study <p><strong>Background:</strong> The carriage of loads on the back in children, &gt;10% of one’s body weight (BW), induces postural change and morbidity related to spinal pain. We studied the weight of schoolbags and the prevalence of musculoskeletal pain related to carrying schoolbags among children in Thimphu, Bhutan.</p> <p><strong>Methods:</strong> This was a cross-sectional study, with a multistage cluster sampling, conducted amongst grade 8 and 10 students. Data were collected using a standardized self-administered questionnaire and weights of students and schoolbags were measured. Descriptive statistics were used to present the findings. Means were compared using t test and risk factors were identified using logistic regression.</p> <p><strong>Results:</strong> There were 131 students whose schoolbags weighed &gt;10% body weight (BW). The mean weight of schoolbags was 4.6 ±1.5 kg for grade 8 students and 4.0 ±1.5 kg for grade 10 students. Musculoskeletal pain in at least one body region was reported by 411 students. Schoolbags weighing &gt;10% BW and carrying the bags over only one shoulder were significant risk factors for reporting musculoskeletal pain. There were 197 students whose schoolbags did not have any safety feature; students did not use them consistently even if they were present.</p> <p><strong>Conclusions:</strong> The weight of school bags that were more than the recommended ≤10% BW was a strong factor in reporting musculoskeletal pain. Parents and students may be educated on the use of schoolbags with safety features. Measures such as providing storage facilities in schools may reduce the weight of bags.</p> Thinley Dorji Saran Tenzin Tamang Sonam Yoezer Kuenzang Wangdi Copyright (c) 2019 Thinley Dorji, Saran Tenzin Tamang, Sonam Yoezer, Kuenzang Wangdi 2019-08-31 2019-08-31 7 2 29 32 10.5195/ijms.2019.355 Spine ABC, A Multidimensional Case Report from A to Z: Aneurysmal Bone Cyst of the Spine <p><strong>Background:</strong> Aneurysmal bone cysts (ABC) are uncommon entities which cause expansile and destructive bone lesions and are characterized by reactive proliferation of connective tissue. They usually grow rapidly with hypervascularity. ABC’s incidence on the spine is 1.5 in 10 million. Most cases present with pain of unexplained origin.</p> <p><strong>The Case: </strong>Presented in this paper is an ABC case in the spinous process of the L2 vertebra of a 20-year-old Greek female patient. The main symptom was persistent back pain, without neurological symptoms, of four years’ duration. Treatment consisted of surgical curettage of the lesion. In this case report, we tried to describe not only the pathology of this disease but also the subsequent psychosocial symptoms that accompany it. We managed to accomplish that by exploiting the knowledge of an experienced pathologist, the help of the physicians responsible for this case, the interest of some sensitized medical students, and of course, the experience of the patient herself since the patient is also the lead author.</p> <p><strong>Conclusion:</strong> The focal point of this article is that even though ABCs might lead to excruciating pain, this pain can be alleviated with the proper treatment, especially if the communication between physician and patient is optimal.</p> Eliza (Eleni-Zacharoula) Georgiou Savvina Prapiadou Helen Kourea Copyright (c) 2019 Eliza (Eleni-Zacharoula) Georgiou, Savvina Prapiadou, Helen Kourea 2019-08-31 2019-08-31 7 2 33 37 10.5195/ijms.2019.407 Recurrent Subacute Subdural Hematoma in a 67-Year-Old Female with Late Alzheimer’s Disease: A Case Report <p><strong>Background:</strong> Chronic Subdural Hematoma (CSDH) is becoming an urgent public health issue due to an increase of incidence in aging populations like Taiwan. Though trauma still stands as the primary mechanism of CSDH, it is often overlooked in the elderly, especially those with mid-to-late stage Alzheimer’s Disease (AD). Coincidentally, the clinical presentation of mid-to-late stage AD shares significant overlap with CSDH. AD creates an immense challenge for physicians and family members to identify early signs of CSDH.</p> <p><strong>The Case</strong><strong>:</strong> We report a peculiar case of a 67-year-old female with a history of AD who presents to the Emergency room in Belmopan City, Belize, with recurrent CSDH. On admission her consciousness was disturbed and late stage dementia presented an enormous challenge for logical and meaningful history taking. Axial non-contrast computed tomography showed a crescent-shaped isodense subdural hematoma in the left hemisphere of the parietal lobe. She was stabilized and treated conservatively with corticosteroids, beta blockers, angiotensin-converting enzyme (ACE) inhibitors and diuretics.</p> <p><strong>Conclusion:</strong> It is important for physicians to recognize and develop protocols to identify early signs of CSDH in patients with late stage AD. Early management is a key factor in minimizing more serious complications like recurrence, seizures, and tension pneumocephalus.</p> Paul Marcel Morgan Copyright (c) 2019 Paul Marcel Morgan 2019-08-31 2019-08-31 7 2 38 40 10.5195/ijms.2019.371 Pulmonary Embolism Secondary to Silicone Injection <p><strong>Background:</strong> The use of silicone for synthetic enhancement in cosmetic procedures has been established for decades but is questionable in safety as it is associated with a range of possible complications. Incidental injection of this polymer into the venous system is not uncommon and can result in the formation of microemboli, which can travel to the lungs. This occurrence can result in a rapid decline of respiratory function and send a patient into severe acute distress.</p> <p><strong>The Case:</strong> This report details a female patient presenting with hemoptysis, presumed to have severe pneumonia until her history of cosmetic treatment was revealed and correlated. Her rapid respiratory decline is followed in inflammatory response markers and radiograph imaging.</p> <p><strong>Conclusion:</strong> A unique treatment approach with prone positioning was used and may play a key role in decreasing mortality in these patients. This report draws attention to the dangers of cosmetic enhancement and raises clinical awareness for associated complications.</p> Carolyn Frances Molina Zachary Paul Retalis Copyright (c) 2019 Carolyn Frances Molina, Zachary Paul Retalis 2019-08-31 2019-08-31 7 2 41 44 10.5195/ijms.2019.367 Aneurysmal Subarachnoid Hemorrhage in a 68-Year-old Hyperglycemic Female Patient: Case Report and Literature Review <p><strong>Background: </strong>While hyperglycemia is intimately associated with uncontrolled diabetes mellitus (DM), recent clinical studies have demonstrated that hyperglycemia is also present in the early acute phase of stroke and is associated with poor prognosis and increased long-term mortality. About half of patients with acute hemorrhagic stroke also present with hyperglycemia upon admission. But more than 50% of patients with acute hemorrhagic stroke develop hyperglycemia even without a previous history of DM. This sheds new light on the relationship between DM, hyperglycemia, and hemorrhagic stroke, with a pathophysiology that is perhaps more profound than is conventionally understood.</p> <p><strong>The Case: </strong>We report a case of a 68-year-old female, with a history of DM Type 2 and stage 3 hypertension who presents to the emergency room (ER) at the Western Regional Hospital in Belmopan City, Belize, with hemorrhagic stroke and hyperglycemia. Diffuse subarachnoid hemorrhage was found in the frontal, temporal, and parietal regions. Mild intraventricular hemorrhage was also observed in the frontal horns and basal cisterns. And small areas of intraparenchymal hemorrhage were present in the frontal lobes. The patient was stabilized and treated conservatively with calcium channel blockers, and diuretics.</p> <p><strong>Conclusion:</strong> Despite a unifying consensus that is still pending, maintaining glucose levels between 110-120 mg/dl by using continuous insulin infusions after traumatic brain injury or aneurysmal subarachnoid hemorrhage may carry some clinical benefit with slightly improved outcome.</p> Paul Marcel Morgan Copyright (c) 2019 Paul Marcel Morgan 2019-08-31 2019-08-31 7 2 45 49 10.5195/ijms.2019.393 What Was the Name of That Drug? How Medical Students can Make the Most Out of Their Education <p>Consolidating all of the knowledge that medical students are expected to learn in their first two years of education can be challenging. Strategies for committing concepts to memory are explored. The importance of making the most out of case-based learning is emphasized. In contrast with passive-styled learning in lectures, CBL takes an active approach requiring students to apply critical thinking. The power of active recall in committing information to memory is also delved into. In particular, one effective and popular form of active recall known as the testing effect is highly recommended. Applying these strategies will help medical students develop a strong foundation for clerkship.</p> Aryan Riahi David Jung Copyright (c) 2019 Aryan Riahi, David Jung 2019-08-31 2019-08-31 7 2 50 51 10.5195/ijms.2019.398