International Journal of Medical Students

Prevalence of Generalized Anxiety Disorder and Associated Risk Factors Among Medical Students in Sudan: A Cross-Sectional Study at Omdurman Islamic University

Fri, 12 Apr 2024 00:00:00 -0400

Background: Generalized Anxiety Disorder (GAD) is a mental illness that significantly affects various domains of daily functioning. Limited research has been conducted on GAD among medical students in Sudan, particularly during the socio-political and economic crises. This study aimed to assess the prevalence of GAD, identify risk factors, and evaluate its impact on academic performance and daily activities among Sudanese medical students.

Methods: A cross-sectional study was conducted among undergraduate medical students at Omdurman Islamic University. Data were collected using a self-administered online questionnaire via Google Forms, consisting of two parts: socio-demographic information and the Generalized Anxiety Disorder Questionnaire (GAD-7), a validated tool for screening and measuring the severity of GAD.

Results: A total of 374 medical students participated, with 64.7% being female. The GAD-7 scores were high (above 9), suggesting GAD among 33.7% of participants, with severity levels of 41.2% for mild anxiety, 21.4% for moderate anxiety, and 12.3% for severe anxiety. Comparison of means showed significant associations between GAD and female students (p<0.001) and students with chronic diseases (p=0.034). GAD significantly impacted daily activities (p<0.001). Multiple logistic regression analysis found that students in the final year had significantly higher GAD-7 scores (Adjusted Odds Ratio=4.25, 95% Confidence Interval=1.27-14.22).

Conclusions: The higher scores on the GAD-7 measure among Sudanese medical students are concerning. This emphasizes the urgent need to raise awareness, normalize mental health discussions, and provide accessible counseling services tailored to the students' needs.

Prioritizing Mental Health: A Cross-Sectional Investigation of Depression Prevalence and Risk Factors among Medical Students in Peshawar, Pakistan

Fri, 12 Apr 2024 00:00:00 -0400

Background: Depression is a significant problem among medical students worldwide, affecting their well-being and potentially compromising patient care. This study aimed to determine the prevalence of depression among medical students in Peshawar, Pakistan, and to identify the associated risk factors.

Methods: A cross-sectional study was conducted from April to June 2023, involving medical students from seven colleges in Peshawar. We employed stratified sampling to distribute surveys to students. We collected data on socio-demographic characteristics, prevalence of depression using the Hospital Anxiety and Depression Scale (HADS), and depression risk factors. We used multivariate logistic regression, clustered by university, to assess factors associated with depression.

Results: Out of 400 distributed questionnaires, 324 were returned (response rate: 81%). The participants' mean age was 21.70 ± 1.65 years, with 53.1% being females. The prevalence of depression was 19.4% and 26.2% were borderline cases. No variables were found to be significantly linked to depression in our multivariate regression model. However, male gender, year of study, experiencing discrimination or harassment in medical school, and having negative perceptions of medical school's impact on mental health had odds ratios above 1, with confidence intervals including the null value.

Conclusion: This study reveals a high prevalence of depression among medical students in Peshawar, Pakistan. It emphasizes the need to address risk factors and establish support systems to minimize the impact of depression on students' well-being and academic performance. Further studies are necessary to identify modifiable factors associated with depression in medical students.

Antibiotic Appropriateness on Mondays vs. Fridays: Empiric Treatment of Simple Cystitis in the Emergency Department

Fri, 12 Apr 2024 00:00:00 -0400

Background: The treatment of urinary tract infections (UTIs) has contributed to the rise of antibiotic resistance. Antibiotic appropriateness in the outpatient setting is lower than expected. We hypothesized that prescribing practices may vary based on the day of the week. We sought to determine the percentage of antibiotic prescriptions that met criteria for antibiotic appropriateness on Mondays vs. Fridays.

Methods: This is a retrospective cohort study of adult females with simple cystitis presenting to the Emergency Department (ED) between 2019 and 2021. We defined antibiotic appropriateness based on the Infectious Diseases Society of America guidelines in conjunction with a regional outpatient UTI antibiogram. Each prescription was assessed for drug selection, dose, frequency, and duration. Categorical data is reported as counts (%) and compared with chi-square. Nonparametric continuous data is reported as median (range) and compared with Mann-Whitney.

Results: 160 subjects were included: 80 came to the ED on a Monday and 80 on a Friday. Demographics were similar; except, more subjects had antibiotic allergies on Mondays. The number of appropriate antibiotic prescriptions was similar between Mondays and Fridays: 54 (68%) and 60 (75%), respectively (p=0.3). Overall, 44 subjects had an inappropriate duration of antibiotics and 14 subjects had an inappropriate antimicrobial prescribed, with no differences between Mondays and Fridays. Dose and frequency were always correct. In total, there were 46 (29%) antibiotics that failed to meet appropriateness criteria.

Conclusions: There was no difference in antibiotic appropriateness between Mondays and Fridays; however, 29% of prescriptions did not meet criteria for appropriateness.

The Influence of Pre-Trip Medical Spanish Education on a US-Based, Medical Student Service Trip: A Cohort Study

Fri, 12 Apr 2024 00:00:00 -0400

Background: International service trips are increasingly common in medical school curricula. Medical Spanish is an essential tool in healthcare interactions with Spanish-speaking patients globally. Medical Spanish classes are offered at many medical schools, but it is not known whether they increase confidence for medical students on Spanish-speaking service trips.

Methods: A prospective cohort study of medical students attending one of two sister campuses who completed pre- and post-international medical service trip questionnaires. Data collected includes demographics, confidence, and perceived experiences. Data analyses involved a multivariable regression assuming an ordered multinomial response, FREQ procedure, and the GLIMMIX procedure on SAS STAT v.9.4.

Results: Demographics significantly associated with confidence categories are female sex, length of Spanish education, previously having lived in a Spanish country, and experience speaking Spanish with patients. Confidence communicating in Spanish shows the highest gain in significant categories post-trip while confidence working with interpreters and feeling adequately trained to treat Hispanics showed the lowest. Participants having taken Medical Spanish before did not improve their confidence. However, participants with prior Medical Spanish experience reported significantly higher benefit from this education in that it gave them an advantage and helped them connect better with patients.

Conclusion: Our findings reinforce the importance of language-concordance and confidence in patient interactions while demonstrating that prior Medical Spanish experience may not significantly improve confidence on a Spanish-speaking international trip, especially among non-fluent students. Spanish experience and proficiency should not be a deterring factor for students looking to go on a medical trip.

Prevalence and Burden of Disorders of Gut-Brain Interaction Among UK Medical Students

Lydia C. Brown, Imran Aziz — Fri, 12 Apr 2024 00:00:00 -0400

Background: Disorders of Gut-Brain Interaction (DGBI) affect 40% of the general population and are associated with substantial health impairment. Medical students reportedly have among the highest rates of DGBI, although data is mainly from Asia and Africa. We addressed this issue within a UK-based university.

Methods: An online survey was completed by 378 of 1621 medical students. Demographics, medical history, and gastrointestinal symptoms were collected, the latter using a modified Rome IV questionnaire to determine the presence of DGBI symptoms over the last 3 months. Additional validated questionnaires screened for somatization, psychological distress, eating disorders, quality of life, and burnout.

Results: DGBI were present in 76% (n=289/378), of which two-of-three had multiple affected sites. The most frequent DGBI were gastroduodenal (57%), followed by bowel (49%), esophageal (29%), and anorectal (26%) disorders. Approximately 50% of students with DGBI experienced painful gastrointestinal symptoms at least one day/week. Students with DGBI, compared to those without, had significantly higher anxiety and depression scores, increased somatic symptom reporting, reduced mental and physical quality of life, poorer eating habits, and more frequent medication use (p-values, all<0.05). They were also at significantly higher risk of burnout, through study exhaustion and disengagement. The greatest health impairment was seen in those with multiple, painful, DGBI. Only 23% and 5% of students with DGBI had consulted a primary care provider and gastroenterologist, respectively.

Conclusion: Medical students commonly experience DGBI and associated health burden, yet infrequently seek help. Greater awareness may lead to increased support, improved health, and better study engagement.

Medical Students’ Stress Levels Are Correlated with Their Sleep Quality and Life Satisfaction

Ervin Ozdemir, Yigit Yazarkan, Bilge Pehlivanoglu — Fri, 12 Apr 2024 00:00:00 -0400

Background: Stress and sleep disturbances associated with low life satisfaction is frequently reported during medical education, intervening with the academic achievements and general well-being of medical students. We aimed to investigate the effects of stress levels on sleep quality (SQ) and life satisfaction (LS) of the students in Hacettepe University Medical Faculty (HUMF).

Methods: This cross-sectional study was conducted at HUMF between May and September 2022 after ethical approval. The participants (39 women and 48 men) completed a personal information form, State- Trait Anxiety Index (STAI)-I and II, Pittsburgh SQ Index (PSQI) and Satisfaction with Life Scale (SWLS). Their blood pressure, heart rate, and salivary cortisol levels were measured.

Results: The men and women were comparable for age, body mass index (BMI), stress parameters and PSQI scores, except the higher LS in women (P=0.045). Gender-based analysis revealed positively correlated BMI and STAI-I (r=0.357) and II (r=0.501) scores in women (P<0.05), and a similar but a weaker correlation for STAI-II scores in men (r=0.291) (P<0.05). The study group exhibited poor SQ (>5). The higher STAI-II scores, cortisol concentration and caffeine consumption were significantly associated with poorer SQ and LS in both genders, however, the state scores and alcohol consumption exhibited a significant relation in men, only. Higher scores for trait inventory and cortisol concentrations correlated negatively with LS in all participants.

Conclusion: Awareness, a proactive approach, and sufficient support can help the relieve and/or manage the stress of medical students and improve SQ and LS.

Residency Program Website Content May Not Meet Applicant Needs

Fri, 12 Apr 2024 00:00:00 -0400

Background: Residency program applicants use a variety of resources during the application cycle. Program websites can vary substantially, and it is unclear how the website information is used by applicants. We aimed to determine the most popular information source used by applicants. We also sought to identify specific online content that was deemed important in the decision-making process.

Methods: A survey was distributed to fourth-year medical students at an academic institution. Demographic information was collected, and the importance of various online resources was gauged using a Likert scale. Subgroup analysis was performed for procedural versus non-procedural specialty applicants.

Results: 91 of the 169 fourth-year medical students (54%) completed the survey. The most utilized sources for the students were residency program websites (41%), the Fellowship and Residency Electronic Interactive Database (FREIDA) website (36%), and the Doximity website (14%). The most valued (Likert scale of 4 and 5) website content for the students included information on resident wellness (86%), resident fellowship acquisition (85%), faculty data (84%), residency location and resident lifestyle (81%), and application point of contact (79%). There were significant differences between what procedural specialty applicants deemed important versus what those applying to non-procedural specialties deemed important.

Conclusion: Residency program websites are commonly used among applicants during the residency match process. Content on resident wellness was highly valued irrespective of specialty choice; however, this information was often not present on residency websites. These findings may help guide website content development initiatives for residency programs to reflect applicant needs more adequately.

A Review of Psychosocial Factors on Birth Outcomes in Women with Substance Use Disorder in the United States: The Importance of Preventing Relapse During Sustained Remission

Alexandra R. Dailey — Fri, 12 Apr 2024 00:00:00 -0400

Infant mortality rate has been an area of concern for the United States for years. Many attributing factors, including psychosocial influences, have been identified. Pregnant patients with substance use disorder have also been shown to experience poor birth outcomes. This study examines trends related to socioeconomic hurdles and mental health in pregnant women with substance use disorder. Databases were searched to find resources that outlined these relationships. After assessing the study designs and associations of fifty-five resources, several patterns were observed, including an increased risk of adverse birth outcomes with higher maternal stress and lower socioeconomic status. In pregnant women with substance use disorder, post-traumatic stress and social stigma resulted in negative effects on mental health. Substance use-related pregnancy anxiety was amplified by triggers that resulted in feelings of fetal detachment and substance cravings. Most literature focused on pregnant patients with active addiction; however, these triggers may have an especially powerful effect on women who become pregnant while in substance use recovery. Studies on remission trajectories indicated a higher mortality risk in people with a history of substance use but have not yet calculated the proportion of women capable of bearing children in this category. This highlights the necessity to develop personalized treatment for pregnant women in sustained remission from substance use disorder to prevent relapse during this crucial time. This population would benefit from a screening tool that assesses for high-risk events like PTSD, psychological stress, and substance use triggers and intervention that includes evidence-based mental health resources.

Medical Students’ Study Habits Through a Sociocultural Lens: A Systematic Literature Review

Hamzah Shahid Rafiq, Erik Blair — Fri, 12 Apr 2024 00:00:00 -0400

This study investigates the literature on medical students' study habits and the surrounding sociocultural factors. A systematic literature review was undertaken, aiming to establish what is known, identify gaps in the literature and suggest what further research needs to be done. The review followed the PRISMA guidelines and identified 13 papers that were within the inclusion criteria. These papers were analyzed and discussed through a sociocultural lens, dividing the results into four sociocultural groupings: Personal, Behavioral, Environmental and Cognitive. The findings suggest that while sociocultural factors influence medical students' study habits, individual behaviors and attitudes predominantly guide their study decisions. The findings also suggest that there is little research into the intersection of these factors. It is recommended that the factors drawn from this systematic review be used to formulate more direct research into study habits with a magnified approach to help provide medical institutions, policymakers, and students with information to better inform their decisions and produce efficient, healthy study habits.

Cover, Credits, & Content

Executive Committee of IJMS — Fri, 12 Apr 2024 00:00:00 -0400

Public Health Outreach in Impoverished Areas of Cambodia: Addressing the Issues Related to Prescription Practices

Chisato Iba, Mira Namba, Yudai Kaneda, Takayuki Ando — Fri, 12 Apr 2024 00:00:00 -0400

During a two-week public health internship organized by Projects Abroad in impoverished areas in Cambodia, the authors participated in health check-ups and outreach activities. We identified issues such as polypharmacy and medication misuse. These problems stem from symptom-based prescriptions without considering individual patient conditions due to limited diagnostic equipments and medications. Our solution involved suggesting a documentation akin to Japan's prescription record books, and Drug Information Leaflets (DILs). Prescription record books would enable patients to record the medications they purchased at the pharmacy, so that physicians would know what medications patients are taking during their health checkups, and thus prevent polypharmacy. In addition, the DILs included medication details and illustrations, considering the low literacy rates in the areas. We emphasized the need for sustained non-communicable diseases (NCDs) treatment and the potential of external perspectives to introduce innovative healthcare approaches and improvements within local communities.

Grassroots HPV Vaccine Education in Phnom Penh, Cambodia: A Personal Reflection

Mira Namba, Miyu Shinohara, Samrith Sela, Ken Khouch, Yudai Kaneda, Rei Haruyama — Fri, 12 Apr 2024 00:00:00 -0400

I visited two primary schools, and concerningly, more than half of the teachers had never heard of HPV or HPV vaccine. Furthermore, the students demonstrated limited knowledge of HPV or the vaccine to the extent that they struggled to comprehend the questionnaire. However, after I delivered a 15-minute lecture about HPV and the vaccine, it was encouraging to note an increase in the number of students expressing an intention to get vaccinated. It became clear that until now, health education, including sexual health, has not been sufficiently implemented in primary schools, and thus, knowledge about HPV has not been provided by teachers sufficiently. Therefore, expanding this type of educational intervention to deliver reliable information is necessary, prioritizing teachers and parents as targets, since the intention of teachers and parents is considered to have a significant influence on the vaccination of children. A world free of cervical cancer can only be achieved through continuous education and awareness initiatives especially at the grassroots level, such as I practiced in Cambodia, to facilitate informed decision-making.

From Theory to Practice: Reflections of a Medical Student's Rural Posting in a Leprosy Hospital

Glorious Kate Akpegah — Fri, 12 Apr 2024 00:00:00 -0400

This article reflects on a medical student's rural posting at a Nigerian Leprosy Hospital. Despite Nigeria's 1998 Leprosy elimination achievement, the disease has persisted in marginalized communities. Leprosy, a Neglected Tropical Disease (NTD), is associated with poverty and social stigma. The rural posting offered insight into the clinical and psychosocial aspects of Leprosy. The article also emphasized the role of medical students in eradicating diseases via awareness campaigns, collaboration with health organizations, early case identification, and improved rural healthcare.

The Importance of Understanding Social Determinants of Health as Medical Students: My Experience with the Cincinnati Homeless Coalition

Shivatej Dubbaka, Taylor Lentz — Fri, 12 Apr 2024 00:00:00 -0400

Medical education traditionally emphasizes academic rigor, often at the expense of practical community engagement. This experience article describes my journey beyond the confines of a medical school's preclinical curriculum to engage with the social determinants of health through a partnership with the Cincinnati Homeless Coalition. My narrative begins with my initial foray into the community, detailing the inception and execution of a project aligned with the organization's mission to combat homelessness. I discuss the challenges encountered, propose enhancements to overcome these limitations, and reflect on the project's implications for future medical cohorts. The article underscores the value of understanding social determinants of health, such as socioeconomic status and education, and their influence on health outcomes. It advocates for the integration of community-based experiences in medical training, asserting that such involvement can enrich the educational journey of medical students by providing a broader perspective on healthcare needs and patient advocacy.

Becoming a Physician: A 40-year Retrospective on Medical Socialization

Michael McGee — Fri, 12 Apr 2024 00:00:00 -0400

The medical training and socialization process can be stressful and at times even traumatic. Medical students must develop ways to nurture their vitality, refine their values, be true to theirselves, and develop their capacities as healers in the face of the difficult medical socialization processes. This article outlines the challenges of medical training and socialization, and then reviews well-established principles and practices for becoming a vital, skillful, and healing physician.

Artificial Intelligence in Medicine and Medical Education: Current Applications, Challenges, and Future Directions

Fri, 12 Apr 2024 00:00:00 -0400

AI's rise in medicine promises personalized care, better diagnoses, and innovative training. It analyzes images, predicts diseases, and tailors treatments. However, ethical concerns loom. Biased data can lead to unfair diagnoses, and some AI systems lack transparency, raising trust issues. The editorial proposes solutions: ethical frameworks, transparent AI, and legal regulations. It envisions a future where AI complements doctors, requiring collaboration across fields. To prepare future physicians, medical schools need to integrate AI and ethics into their curriculum. AI holds immense potential, but challenges must be addressed. Through collaboration and responsible development, AI can revolutionize medicine alongside human expertise.

Fulminant Hepatic Failure as the Initial Presentation of Hodgkin's Disease and Liver Transplantation: A Case Report

Fri, 12 Apr 2024 00:00:00 -0400

Background: Hodgkin's disease, a B-cell neoplasm, primarily impacts lymph nodes or extranodal lymphoid tissue. It includes two distinct entities: classical (95%) and lymphocyte-predominant nodular. While the disease commonly manifests as the growth of cervical and intrathoracic lymph nodes in 60-90% of cases, there are rare instances where Hodgkin’s disease has been linked to fulminant liver failure, carrying a very poor prognosis.

The Case: We present the case of a 13-year-old Hispanic female, who started with an insidious condition that evolved to fulminant hepatic failure of unknown etiology with an AST of 770 mg/dl. It was decided to perform an orthotopic liver transplant, the histopathological analysis of the explant and a lymph node reported mixed cellularity Hodgkin's disease. Subsequently, the hematology service requested a lumbar puncture, with no evidence of infiltration. It was decided to initiate six cycles of chemotherapy (CTX) with BEACOPP (bleomycin, etoposide, adriamycine, cyclophosphamide, vincristine, procarbazine, and prednisone) scheme, evolving without complications and achieving a complete response eleven months later; currently, she has been free of disease for three years.

Conclusion: The etiology of Hodgkin's disease in our 13-year-old patient remains elusive, emphasizing the importance of early diagnosis and diverse treatment approaches. Despite limited hospital resources, the decision to proceed with the transplant was driven by the potentially fatal outcome if left untreated. Future considerations may necessitate individualizing each case, and carefully assessing the risks and benefits associated with transplantation.

Severe Hyperkalemia: Electrocardiographic Tips for Early Recognition Based on a Case Report

Fri, 12 Apr 2024 00:00:00 -0400

Background: Rapid correction of severe hyperkalemia is mandatory to survival due to its induction of fatal cardiac arrhythmias. The electrocardiogram serves as the diagnostic tool that can provide insight into such fatal arrhythmias. We present two relevant alterations seen in an 84-year-old female patient with previous anterior myocardial infarction, angioplasty of the circumflex coronary artery, left ventricular ejection fraction of 35%, hypertension, dyslipidemia, paroxysmal atrial fibrillation, and diabetes.

The Case: The patient had 4-days with asthenia, adynamia and dyspnea. Lung auscultation showed bilateral base rales with cardiomegaly and interstitial edema identified on chest x-ray. Lab work revealed severe metabolic acidosis, increased plasma urea, creatinine, and severe hyperkalemia (7.9 mEq/liter) considered secondary to acute renal failure. Treatment was initiated with 0.9% sodium chloride, bicarbonate, ASA diuretics and polarizing solution (insulin), resulting in a reduction of hyperkalemia to 6.1 mEq/liter. The patient suffered a cardiorespiratory arrest with recovery and needed intubation and dopamine for hemodynamic support but died 15 hours after admission.

Conclusion: The electrocardiographic findings characteristic of severe hyperkalemia were: (i) regular rhythm (cycle length 920-950 ms) without discernible P-waves, which may have a junctional or ventricular origin and less probably could be a manifestation of sinoventricular conduction (preferential conduction from the sinus node to the AV node through specialized tracts without activation of the atrial cardiomyocytes), and (ii) sine wave morphology (markedly wide QRS, absence of ST-segment and broadly based T-waves). These electrocardiographic features, typical of hyperkalemia exceeding 7.0 mEq/liter, are harbingers of malignant arrhythmias and should prompt immediate therapy.