International Journal of Medical Students

A Blueprint for High Altitude Acclimatization Prior to High Altitude Competition for Professional Athletes

Tue, 03 Dec 2024 00:00:00 -0500

Introduction: Among professional athletes, high altitude training is a popular technique due to its documented success on improving cardiovascular health and athletic performance. Nevertheless, there is little consensus on the guidelines for high altitude training and competition. This review sought to summarize existing literature for acclimatization recommendations for competing at high altitudes and suggests a blueprint that could be followed by athletes and trainers.

Methods: This paper is part of the Altitude Nondifferentiated ECG Study (ANDES) project. A non-systematic search was conducted using Pubmed, EMBASE and MEDLINE databases.

Results: Six studies were included, all of which recommended a gradual ascent before competition. The duration of acclimatization ranged from 4 days to 2 weeks depending on the magnitude of ascent. Athletes are encouraged to have pre-ascent assessments of ferritin, transferrin, hemoglobin mass, ECG, and weight with close monitoring of adverse altitude-induced complications.

Conclusion: This study provides insight on key recommendations for athletes and trainers to consider when training and competing at high altitudes. These strategies can optimize athletic performance and mitigate deleterious altitude effects that can hinder functionality and training.

A Narrative Review on the FSTL-1 Protein and its Current Known Impact on Cardiovascular Ischaemic Disease

José Rodrigues Gomes — Tue, 17 Dec 2024 00:00:00 -0500

This narrative review investigates the potential therapeutic role of FSTL-1 in addressing severe cardiac issues following myocardial infarctions (MI). Despite advances in modern medicine, MI persist as a leading global cause of death, with stem cell therapy falling short of expectations since the early 2000s. In contrast, FSTL-1, an emerging bone morphogenetic protein, demonstrates promise based on successful studies. We conducted a qualitative narrative synthesis of studies published in PubMed, Scopus, and Web of Science between January 2000 and May 2022. This research explores the intricate scientific aspects of FSTL-1's contribution to myocardial regeneration, utilizing a chronological approach to trace its progression from biological pathways to broader scenarios. It examines the mechanisms regulated by FSTL-1 and its effects on cardiac tissue and cells, highlighting its potential as a therapeutic agent emphasizing its multifaceted role in cardiac regeneration. By deepening our comprehension of FSTL-1, this study significantly contributes to knowledge advancement, offering insights into its role in addressing severe cardiac issues post-MI. By consolidating current knowledge and proposing new avenues for investigation, this work offers valuable insights into FSTL-1's significance in advancing cardiovascular health and post-MI recovery.

Cover, Credits, & Content

Executive Committee of IJMS — Tue, 17 Dec 2024 00:00:00 -0500

Complex Regional Pain Syndrome, an Important Differential Diagnosis in Sports Injuries: a Case Report

Carlos Cabrera-Ubilla, Germán Cueto, Christian Lucas — Tue, 17 Dec 2024 00:00:00 -0500

Background: Complex regional pain syndrome (CRPS) is a disproportionate and persistent, regional pain related to a minor trauma. Although CRPS is not an infrequent condition its pathophysiology remains unknown and leading to underdiagnosis or late diagnosis. The diagnosis is clinical, according to Budapest criteria of the International Association for the Study of Pain. Bone scintigram is the most effective test to support the diagnosis. The aim of this article is to discuss the importance of clinical suspicion for an early CRPS diagnosis in a sprain’s young athlete clinical case.

The Case: We present the case of a sixteen-year-old male patient with no medical history who suffered two minor ankle injuries in the right foot. The patient developed severe and persistent pain associated with vasomotor, sudomotor and trophic abnormalities. He remained undiagnosed for 10 months until CRPS diagnosis confirmation supported by a bone scintigram. He received multiple treatments until spontaneous remission in the fourth year of evolution.

Discussion: CRPS poses a diagnostic challenge that requires early suspicion to improve treatment outcomes and prognosis. Maintaining a high index of clinical suspicion is crucial, and CRPS should be considered in the evaluation of any persistent pain sport-related injury. Despite extensive research on CRPS conducted in recent decades, this condition may still be unfamiliar to many healthcare providers. Increasing awareness of CRPS among medical professionals can facilitate timely and accurate diagnosis, which is essential for effective management.

Bronchiectasis with Transmediastinal Herniation of the Left Upper Lobe in a 3-Year-Old Child: A Case Report

Anuva Dasgupta, Dibyendu Raychaudhuri — Tue, 17 Dec 2024 00:00:00 -0500

Background: Bronchiectasis is a disorder marked by the destruction of smooth muscle and elastic tissue caused by inflammation, resulting in the permanent expansion of bronchi and bronchioles. It can occur following a single severe episode or repeated episodes of pneumonia, as well as exposure to tuberculosis.

The Case: A child reported with cough and cold for 7 days, with mild fever. He was admitted to the hospital due to breathing difficulties and facial swelling. The clinical exam showed crepitation, wheezing, and pectus carinatum. Patient has history of multiple hospital admissions due to pneumonia and respiratory distress and exposure to tuberculosis. His mother was diagnosed and treated for tuberculosis when he was 3 months old. Condition of the patient was evaluated using ultrasonographic examination, chest radiograph and High-Resolution Computed Tomography of thorax.

Conclusion: High-resolution Computed Tomography (HRCT) scanning is the preferred diagnostic test as it helps to identify the pathologic changes and the exact extent through which it has taken place. Early intervention plays a critical role in reducing severe complications like hemoptysis and cor pulmonale. The current treatment options consist of antibiotics, bronchodilators, anti-inflammatory medications, and physical therapy. The patient was treated using steroids, anti-microbials and inhalational bronchodilators. Complete symptom resolution was noted in two weeks from date of admission. He also seemed to be doing well in the follow-up visit, one week post discharge. Severe cases may require injectable antibiotics. As a widespread condition in India, early diagnosis and treatment with suitable antimicrobials is critical for a positive outcome.

Navigating Barriers: Healthcare Anchor Institutions and Population Health Advancement

Daniel Wagner, Tara Lagu, Carol Haywood, Carolyn Schafer, Ronald Ackermann — Tue, 17 Dec 2024 00:00:00 -0500

Background: Many United States hospitals explicitly pursue “anchor missions” by committing to intentionally apply place-based economic power and human capital in partnership with the community. Little is known about how hospital-community partnerships are implemented or whether they impact social determinants of health (SDOH) and population health. We qualitatively analyzed healthcare institutions from a national network to understand barriers and facilitators while implementing hospital-community partnerships that aim to improve population health.

Methods: We used qualitative analysis of responses to open-ended items on a cross-sectional survey to explore how hospitals with anchor missions address SDOH. We administered the survey to healthcare systems participating in the Healthcare Anchor Network (HAN), a national network of hospitals with explicit goals to address SDOH and improve population health.

Results: Responses were from 16 organizations. Two themes emerged: 1) healthcare systems faced many demands (i.e., COVID-19, financial stability), which competed with prioritization of the anchor mission, and 2) senior leadership engagement was critical for impact of the anchor mission and efforts to address SDOH and population health. Strategies to engage leadership included peer networking and providing repetitive education on community health inequities to hospital leaders.

Conclusions: Although health systems show enthusiasm for population health, competing priorities often constrain anchor mission efforts to improve SDOH and population health outcomes. With external encouragement, such as changes to federal or state quality metrics reporting, payment incentives to address community health, or other policy changes, health systems will engage more with communities and be able to address SDOH.

Enhancing Medical Education: The Impact of Deliberate Practice on Learning Human Physiology

Mon, 16 Dec 2024 00:00:00 -0500

Background: Simulation-Based Learning (SBL) has potential in health education, yet it remains underutilized at the undergraduate level. Active teaching methodologies, such as deliberate practice, are known to enhance skills like leadership, self-confidence, and teamwork. This study aimed to evaluate the medical students’ perception of deliberate practice in learning Human Physiology at a private medical school in Brazil.

Methods: An observational qualitative and quantitative study was conducted in 2022 and 2023 using an online questionnaire, including 198 participants. An inferential statistical analysis was conducted, using Fisher's exact test at a 0.05 level of significance, to assess the association between categorical variables.

Results: Overall, students had a positive perception of deliberate practice. A significant proportion (66.8%) strongly agreed that they developed teamwork skills through the scenarios. Additionally, 83.7% strongly agreed that access to realistic simulation environments enhanced their learning. In terms of emotions, 67.9% felt motivated, while 37.8% experienced anxiety during the scenarios. The statistical analysis revealed a significant association between the sum scores of each section and the binary response (“yes” or “no”) to the question “Do you like the practical classes of Human Physiology?” (p < 0.05), with the exception of the Negative Emotions sum. This indicates that higher section scores are associated with a greater likelihood of students liking the practical classes.

Conclusion: The integration of deliberate practice into the Human Physiology curriculum has positively impacted students’ learning and skill development. However, enhancements are needed to create a safer emotional environment for students.

A Cross-Sectional Institutional Survey of Depression, Suicidal Ideation, and Stigma in Medical Students

Fiona Gruzmark, Alexis Reinders, Yanzhi Wang, Ryan Finkenbine — Tue, 17 Dec 2024 00:00:00 -0500

Background: Due to high rates of depression and suicidal ideation among medical students, interventions, such as Pass/Fail grading systems and peer-mentorship, have been implemented, but their effects not reported. The purpose of this study was to explore variations in depression severity among medical students and to better understand the related stigma in healthcare over the past decade, with the aim of enhancing medical education.

Methods: A cross-sectional survey was conducted on REDCap across students at the University of Illinois College of Medicine. The severity of depression was measured by the PHQ-9. Stigma was assessed utilizing Likert scale responses. Demographics of students who are most likely to experience depression were collected. Additionally, clinical diagnoses of depression, treatment modalities, and alcohol use were compared.

Results: There were 178 respondents with a 15% response rate. Thirty-nine (22%) respondents were classified in the moderate-to-severe depression group. Thirteen students, all female, endorsed suicidal ideation. A majority of respondents reported that depressed medical students would provide inferior patient care (n=71, 58%), their application to residency would be less competitive (n=76, 54%), they would feel embarrassed (n=88, 61%), and that it would be risky to reveal they have depression on a residency application (n=153, 94%).

Conclusions: Depression, suicidal ideation, and stigmatization remain prevalent in medical students and may have worsened since 2010. New, multi-faceted approaches such as giving medical students the choice of mental health providers, providing clear information about documentation, and implementing personal, well-being goals are needed to reduce depression and stigma experienced by medical students.

Magnitude of Psychological Distress Among Medical and Non-Medical Students During the Late Phase of the COVID-19 Pandemic in West Bengal: A Cross-Sectional Study

Udisa Das, Arunima Ganguly , Dibakar Haldar, Asish Mukhopadhyay — Tue, 17 Dec 2024 00:00:00 -0500

Background: COVID-19 pandemic led to drastic changes worldwide affecting mental health of students. This study aimed to assess psychological distress due to COVID-19 in students during the late phase of pandemic and to establish correlation of academic course, socio-demographics, and knowledge-attitude-practices (KAP) with depression and anxiety.

Methods: A cross-sectional study was conducted in Kolkata, from March to April 2022 among undergraduate medical students and undergraduate students from engineering and general science colleges, via purposive and snowball sampling. Survey questionnaire was circulated via Google forms through social media. It included Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Fear of COVID-19 scale 2020, KAP regarding COVID-19 and socio-demographics. Data were analyzed using SPSS(Version 22.0) by estimating mean, standard deviation, median, interquartile range, and displayed by charts and tables. Mann-Whitney U test/non-parametric ANOVA and Chi-square tests were used for drawing statistical inferences. P-value of <0.05 was considered significant.

Results: A total of 421 responses were included: 219 medical and 202 non-medical students. Most participants were male (58.67%). Prevalence of depression was 58.42% among non-medical students and 81.73% among medical students. Prevalence of anxiety was 50.99% among non-medical students and 76.25% among medical students. Medical students had significantly better scores for knowledge and attitude (p=0.001 in both). Anxiety was influenced by residence (p=0.018), mode of travel (p=0.012), and having relatives or friends affected by COVID-19 (p=0.03).

Conclusion: High prevalence of depression and anxiety among college students, especially medical students, highlights the need for student wellness activities and better mental health services in colleges across India.

Prevalence and Associated Factors of Psychological Distress of Patients with Stroke Attending a Neurology Clinic — An Analytical Cross-sectional Study

Pumudu Weerasekara, Chalitha Warshawithana, Nelushi Weerasinghe, Irshad Mashood — Tue, 17 Dec 2024 00:00:00 -0500

Background: A vast range of factors lead to psychological distress among stroke patients, causing poor outcomes. This study aimed to assess the prevalence of psychological distress and identify the associated factors among stroke patients attending the Neurology Clinics of the National Hospital of Sri Lanka (NHSL), Colombo.

Methods: A descriptive cross-sectional study with an analytical component was conducted among 177 patients with stroke attending the Neurology Clinics of the NHSL, Colombo, who were sampled by multistage random sampling. Psychological distress was assessed using the Kessler Psychological Distress Scale (K-10). Data collected under 6 domains underwent initial bivariate analysis using Chi-square and Fisher's Exact Tests, followed by multivariate analysis via binary logistic regression.

Results: The mean age of the participants with stroke was 59.7 (SD:12.3) years. The prevalence of psychological distress among stroke patients was found to be 23.3% (95% CI:16.1–31.9). During bivariate analysis, six factors (p<0.05) were significant. The regression analysis identified five independent predictors: younger age (OR =0.87, 95% CI=0.79–0.97, p<0.05), female gender (OR=70.94, 95% CI=3.73–1348.89, p=0.05), patient being the sole source of income (OR=24.71, 95% CI=1.67–362.01, p<0.05), increased level of disability (OR=13.05, 95% CI=3.59–47.36, p<0.001), and past personal history of psychiatric disorders (OR=172.59, 95% CI=3.64–8174.42, p<0.05) with a R² of 0.772.

Conclusion: The prevalence of psychological distress among patients with stroke attending the Neurology Clinics of the NHSL, Colombo, is considerably high and is associated with multiple health and non-health related factors.

Healthcare Workers’ Perceptions of Patient Safety Culture in United States Hospitals: A Systematic Review and Meta-Analysis

Ganesh Chilukuri, S. Thomas Westerman — Tue, 17 Dec 2024 00:00:00 -0500

Background: Despite leading in healthcare spending, the United States sees only marginal improvements in patient outcomes among developed nations. Assessing patient safety culture (PSC) through the Hospital Survey on Patient Safety Culture (HSOPSC) provides insights into overall patient safety and attitudes toward medical errors. This study aims to examine PSC in U.S. hospitals across professional categories via a systematic review and meta-analysis of published literature.

Methods: Embase, PubMed (Medline), Web of Science, Scopus, and AHRQ’s Bibliography were consulted for identifying studies. A total of 31 articles met the eligibility criteria for inclusion, which garnered 608,443 survey participants in a national population of hospital healthcare professionals. For each professional category of PSC, a fixed and random-effects meta-analysis was performed, and a subgroup analysis was also conducted to measure differences in perceptions of PSC based on type of healthcare professional.

Results: The HSOPSC composite average across all the studies was 61.3% positive responsiveness, indicating a need for improvement in patient safety. “Teamwork within units” had the highest positive PSC perception while “nonpunitive response to error” and “handoffs and transitions” scored the lowest. Furthermore, healthcare trainees and physicians seemed to have overall worse perceptions of patient safety culture compared to other professional subgroups, indicating the potential impacts of inexperience and a culpability culture on patient safety and medical error in hospitals.

Discussion: To strengthen weak aspects of patient safety culture, hospitals should implement interventions such as teamwork training and error-reporting systems, thereby enhancing patient safety measures and reducing medical errors.

Breastfeeding Policies of Otolaryngology Residency Programs

Tue, 17 Dec 2024 00:00:00 -0500

Background: Women entering surgical residencies must determine which programs best fit their career and family goals. The purpose of this study was to determine if breastfeeding policies are available on otolaryngology residency program websites.

Methods: A total of 122 publicly available otolaryngology residency program websites were reviewed for the presence of a breastfeeding policy and lactation information. The percentage of residents and faculty that are women in each program as well as the program’s region, size, and affiliation with a top 50 hospital for ear, nose, and throat care were determined. Frequencies and nonparametric analyses were calculated when appropriate.

Results: None of the otolaryngology residency programs had a breastfeeding policy posted directly on their website. A link to a Graduate Medical Education (GME) website that contained a breastfeeding policy was present on 20 (16.4%) program websites, and 31 websites (25.4%) had information about lactation facilities on the GME website or another page that could be found through the search bar; 17 (23.0%) of the large residency programs contained the link to the GME website, whereas only 3 (6.25%) of the small programs did (p = 0.015). Residency programs that were affiliated with a top 50 hospital for ear, nose, and throat care were more likely to have a link to the GME website with a breastfeeding policy than those not affiliated (13 [29.5%] vs. 7 [8.9%], respectively; p = 0.003).

Conclusion: Otolaryngology residency programs do not provide breastfeeding policies directly on their websites.

Gender Trends in Dermatology Research: Shifting Authorship Landscape in Indian Journals

Anjali Mediboina, Meghana Bhupathi, Keerthana Janapareddy — Tue, 17 Dec 2024 00:00:00 -0500

Background: Historically, research authorship has been male dominated, particularly in dermatology. Gender equity in medical research is vital for diverse perspectives and rigorous science. In India, gender trends in dermatology research among first authors remain understudied, limiting our understanding of gender inequalities in the field.

Methods: This study analyzed Original Articles, Review Articles, and Case Reports in three prominent Indian Dermatology journals from January 2017 to May 2023. The first authors' genders were determined using Namsor V.2, cross-verified with social media profiles, and authors with undetermined genders were excluded. The authors' countries were identified based on their affiliated institutions. The data was analyzed using Microsoft Excel, with a predictive analysis using the FORECAST function.

Results: Among 1,600 authors, 840 were female and 760 male. Male authors outnumbered female authors only in 2017. Female authors surpassed male authors in original articles and case reports, while fewer appeared in review articles. Predictive analysis revealed an increasing trend in female authors from 2023 to 2028, indicating evolving gender dynamics in dermatology research.

Conclusion: While the rise in female representation in medical research is promising, concerns arise when fields become predominantly female, raising questions about their perceived value. Gender disparities in compensation further underscore these concerns, as male dermatologists earn more. Addressing such disparities is crucial and recognizing these issues and actively pursuing gender equality is essential for a more inclusive and equitable future in medicine.

Empowering Global Collaborative Research

Tue, 17 Dec 2024 00:00:00 -0500

The increasing prevalence of toxic research cultures poses a significant challenge for early-career researchers, driven by the pressure to publish and systemic issues in academia. This editorial explores strategies to mitigate these challenges through global collaborative research. Key recommendations include fostering standardized workshops on research ethics, ensuring equitable authorship practices, and leveraging virtual mentoring to support early-career researchers. The article highlights the benefits of international research collaborations, including talent exchange, resource sharing, and capacity building in low- and middle-income countries. Despite these opportunities, barriers such as inadequate infrastructure, time zone management, and accountability in virtual projects persist. The International Journal of Medical Students (IJMS) serves as a model for promoting diversity, equity, and inclusion, providing a global platform for student researchers. By embracing virtual conferences, exchange programs, and student-friendly organizations, the research community can advance health equity and innovation. This editorial calls for a collective effort to rethink traditional research mentoring and foster inclusive global partnerships.

Impact of “Aegeus” - A Novel Research-Based Quiz for and by the Medical Undergraduate Students in India

Shirish Rao, Devansh Lalwani, Amey Ambike, Yashika Zadage — Tue, 17 Dec 2024 00:00:00 -0500

“Aegeus” is India’s first undergraduate research-based quiz, conceptualized and organized by medical students under the A.S.P.I.R.E council of Seth GS Medical College, Mumbai, as part of the annual “Confluence” conference. Launched in 2021, the quiz evolved from an online format during the pandemic to an in-person event over three years, incorporating innovative rounds on ethics, biostatistics, study design, and manuscript writing. With 125 teams (250 participants) across its editions, “Aegeus” fostered research interest and deeper understanding among undergraduates, with 73% of non-participants reporting increased motivation to engage in research. By refining its format annually based on participant feedback, the quiz enhanced engagement, competitiveness, and practical application of research concepts, paving the way for broader national and international participation in future editions.

Lessons Learned from Being Involved with Organized Medicine as a First-year Medical Student

Tai Metzger — Tue, 17 Dec 2024 00:00:00 -0500

Attending the Michigan State Medical Society House of Delegates (MSMS HOD) meeting was a transformative experience that deepened my understanding of the vital role organized medicine plays in shaping healthcare. The meeting's diverse and passionate discussions on critical issues highlighted the profound impact of collective advocacy. Networking with experienced physicians underscored the value of involvement in medical societies for career enrichment and mentorship. This experience inspired me to actively participate in organized medicine to advocate for meaningful changes in healthcare. I urge fellow medical students to engage in similar experiences to gain insights into healthcare policy, develop leadership skills, and contribute to the future of our profession.

Predatory Publishing: A Medical Student Author’s Perspective

Diego Arriaga Izabal — Tue, 03 Dec 2024 00:00:00 -0500

Predatory publishers are, generally, dishonest, lack transparency and center in publishing counterfeit journals to exploit the open-access model in which the author pays, and through this, obtain their self-interest profits. Unfortunately, these types of journals are on the rise and may easily deceive inexperienced researchers such as medical students who aspire to venture into research. In this context, the purpose of the present work is to offer a generalized view of 'predatory' magazines, how to identify them and avoid them; as well as raise awareness about its existence and discern its deceptive emails through my personal experience.

From Hope to Hardship: Understanding the Impact of Hierarchies and Violence in Medicine

Ximena Cors Cepeda — Tue, 17 Dec 2024 00:00:00 -0500

This article is an experience piece reflecting on my journey through medical school rotations, highlighting the pervasive nature of workplace violence (WPV) and its impact on students' motivation and mental health. I discuss the high incidence of mistreatment and its correlation with burnout, imposter syndrome, and decreased academic performance among trainees. I emphasize the importance of recognizing and addressing subtle forms of WPV, including microaggressions and systemic issues, and advocate for proactive measures such as education, training, and fostering cultural change within healthcare institutions. Through reflecting on my experiences and observations, I aim to inspire systemic change and empower individuals to contribute to a healthier, more empathetic medical culture.

Moersch-Woltman Syndrome - An Uncommon Conundrum

Vitorino M. Dos Santos, Laura C. Modesto, Julia C. Modesto — Tue, 17 Dec 2024 00:00:00 -0500

Recently, this Journal published an interesting case study about the Moersch-Woltman syndrome that affected a middle-aged female, who had not an early diagnosis of this uncommon condition and was longtime submitted to polypharmacy without any improvement of the relentless course of this disease. The authors commented on the importance of a high index of suspicion to get an early correct diagnosis and prompt effective management that is indispensable to result in the best outcomes. The additional short comments on novel literature data aim to emphasize the exemplifying role of reported cases, mainly by enhancing the awareness of non-specialists and primary healthcare workers.