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The Journal receives contributions and unpublished manuscripts of Original Articles, Short Communications, Reviews, Case Reports, Interviews, Experiences, and Letters, which are reviewed by experts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. There are no article processing charges, submissions fees, or any other costs required of authors to submit, review, or publish articles in the <em>IJMS</em>.</p> University Library System, University of Pittsburgh en-US International Journal of Medical Students 2076-6327 <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> Cover, Credits, & Content Executive Board of IJMS Copyright (c) 2020 Executive Committee of IJMS 2020-04-30 2020-04-30 8 1 1 8 10.5195/ijms.2020.543 Leadership and Health: The Scientific Journal’s Mission of Spreading Science in Times of Pandemic Francisco J. Bonilla-Escobar Copyright (c) 2020 Francisco J. Bonilla-Escobar 2020-04-30 2020-04-30 8 1 9 10 10.5195/ijms.2020.544 Clinical Presentation and Therapy of Primary Immune Thrombocytopenia Resistant to Splenectomy <p><strong>Background:</strong> A satisfactory therapeutic response is achieved with splenectomy in 60–80% of the patients diagnosed with immune thrombocytopenic purpura (ITP). There is an ongoing consensus on the short-term efficacy of splenectomy, however, its long-term efficacy remains controversial. Our aim was to establish the frequency of resistance and relapse after splenectomy, the occurrence of complications, the therapeutic strategies and the drug efficacy in splenectomy-resistant ITP.</p> <p><strong>Methods: </strong>We retrospectively analyzed 138 adult ITP patients who had been previously diagnosed and treated at the Clinic of Hematology, Clinical Center of Serbia, and who underwent splenectomy between 1987 and 2018.</p> <p><strong>Results:</strong> Of the 138 ITP patients, 20.3% (n=28/138) were refractory to splenectomy, 11.6% (n=16/138) relapsed and 8.7% (n=12/138) were primarily resistant. The average post-splenectomy follow-up period was 117 months (range 3-474). The average follow-up period of the patients resistant to splenectomy was 147 months (range 23-474). Of the patients refractory to splenectomy, 67.8% (n=19/28) showed a good therapeutic response: 49% (n=14/28) complete remission and 18.8% (n=5/28) partial remission. The response was usually achieved using the following drugs: romiplostim (100%), eltrombopag (75%), cyclosporine (66.67%), mycophenolate mofetil (50%), danazol (50%) and corticosteroids (40.9%). Hemorrhagic and non-hemorrhagic complications occurred in 78.6% (n=22/28) and 28.6% (n=8/28) of the patients, respectively.</p> <p><strong>Conclusion:</strong> Splenectomy remains a very efficient therapeutic modality for the treatment of ITP patients with a high percentage of splenectomy-resistant patients achieving remission. Thrombopoietin receptor agonists have shown exceptional results so far in the treatment of refractory ITP patients.</p> Aleksandar Kara-Jovanović Nada Suvajdžić-Vuković Copyright (c) 2020 Aleksandar Kara-Jovanović, Nada Suvajdžić-Vuković 2020-04-30 2020-04-30 8 1 11 14 10.5195/ijms.2020.436 Teaching Cultural Competency through Global Health Education at Weill Cornell Medicine <p><strong>Background:</strong> Educating medical students to better understand the complexities of cultural competence, the social determinants and environmental determinants of health that are important and integral components of the medical school curriculum.</p> <p><strong>Methods:</strong> In 2014, Weill Cornell Medicine (WCM) implemented a new curriculum, the adoption of which provided the means to enhance an existing global health program, informally introduced in 2009, and to address the issues of cultural competency. In this article, we share WCM’s experience in building and expanding its global health curriculum.</p> <p><strong>Results:</strong> A hallmark of our program is the successful collaboration between students and faculty to create a multi-disciplinary global health program that incorporates electives, clinical field placement, and collaborative research.</p> <p><strong>Conclusion:</strong> Key lessons learned through our experience include the necessity for strong faculty-student collaboration, full support from the administration, and building global partnerships. Our example could be a useful guide for other medical schools seeking to establish a global health education curriculum.&nbsp;</p> Katharine-Grace Norris Caitlin Noonan Roger Ying Claire T. Kenney Jennifer Huang Brienne Lubor Rohini Kopparam Elena Beideck Priyanka Patel Madelon L. Finkel Copyright (c) 2020 Katharine-Grace Norris, Caitlin Noonan, Roger Ying, Claire T. Kenney, Jennifer Huang, Brienne Lubor, Rohini Kopparam, Elena Beideck, Priyanka Patel, Madelon L. Finkel 2020-04-30 2020-04-30 8 1 15 19 10.5195/ijms.2020.440 Determinants of Residency Program Choice in Two Central African Countries: An Internet Survey of Senior Medical Students <p><strong>Background:</strong> Central African countries have an increasing burden of disease, low specialist workforce densities, and under-resourced postgraduate medical education. The residency program choice of today’s medical students will determine specialist workforce density in the near future. This study aims to elucidate the factors that influence the choice of residency programs among medical students of two Central African countries.</p> <p><strong>Methods:</strong> We designed an online questionnaire in French and English with closed-ended, open-ended, and Likert scale questions. Links to both forms were shared via the international messaging application, WhatsApp, and data were collected anonymously for one month. Respondents were sixth- and seventh-year medical students enrolled in nine Cameroonian and Congolese schools. The threshold of significance was set at 0.05 for bivariate analysis.</p> <p><strong>Results:</strong> There were 149 respondents in our study, 51.7% were female, and 79.2% were from Cameroon. Almost every student (98%) expressed the wish to specialize, and a majority (77.2%) reported an interest in a residency program abroad. Preferred destinations were France (13.7%), Canada (13.2%), and the U.S.A. (11.9%). The most popular specialties were cardiology (9.4%), pediatrics (9.4%) and obstetrics and gynecology (8.7%). The choice of specialty was made based on the respondent’s perceived skills (85.9%), anticipated pay after residency (79.2%), and patient contact (79.2%).</p> <p><strong>Conclusion:</strong> Understanding which specialties interest Cameroonian and Congolese medical students and the reasons for these choices can help develop better local programs.</p> Ulrick S. Kanmounye Mazou Temgoua Francky T. Endomba Copyright (c) 2020 Ulrick Sidney Kanmounye, Mazou Temgoua, Francky Teddy Endomba 2020-04-30 2020-04-30 8 1 20 25 10.5195/ijms.2020.470 Next Generation of Advanced Non-Small Cell Lung Cancer Therapy: Targeted and Immuno-Therapies <p>Lung cancer is one of the deadliest cancers in the world. Current clinical trials are focused on developing the next generation of therapies that target novel anti-cancer mechanisms. One approach is to prime the immune system, as the cancer has been known to suppress immune cells in the tumour microenvironment. Using pharmacotherapy, the immune system can be unleashed and suppress the cancer’s growth. Another pathway is targeting known oncogenic genes that are important for the cancer’s growth and survival. In lung cancer, the epidermal growth factor receptor and several other mutated proteins are targets of small-molecule inhibitors that have been shown to drastically improve patient survival and quality of life. Discussed in this review are broad highlights of the different immunotherapies and small molecule targeted therapies that have been studied in the latest clinical trials for lung cancer.</p> Sze Wah Samuel Chan Elliot Smith Copyright (c) 2020 Sze Wah Samuel Chan, Elliot Smith 2020-04-30 2020-04-30 8 1 26 32 10.5195/ijms.2020.446 ST-Segment Elevation and Normokalemia in Acute Diabetic Ketoacidosis: Case Report and Brief Literature Review <p><strong>Background:</strong> Diabetic Ketoacidosis (DKA) is a life-threatening complication of Diabetes Mellitus Type 1 (DM1) and requires prompt management; however, benign transient electrocardiographic (ECG) abnormalities with normal serum potassium levels can be seen in diabetic patients secondary to metabolic changes. Understanding the varying presentation among patients provides valuable insight into the management of this seemingly uncommon and benign diagnosis.</p> <p><strong>The Case:</strong> A 24-year-old male with a history of DM1 presented to the Emergency Department (ED) with ST-segment elevation, normal potassium levels and metabolic acidosis. The patient was found to be in DKA with benign cardiac manifestations.</p> <p><strong>Conclusion:</strong> The correction of underlying metabolic abnormalities in DKA and the awareness of the benign cardiac pseudo pathology on ECG allows for effective management and personalized patient care.</p> S. Bryn Dhir Abbas Husain Copyright (c) 2020 S. Bryn Dhir, Abbas Husain 2020-04-30 2020-04-30 8 1 33 35 10.5195/ijms.2020.432 Polymyositis as a Rare Musculoskeletal Manifestation of Chronic Graft-Versus-Host Disease: A Case Report of a 33-Year-Old Patient <p><strong>Background:</strong> Musculoskeletal manifestations of chronic Graft-Versus-Host Disease (GVHD) are rare and unfamiliar to most clinicians. Here we discuss the pathophysiology of chronic GVHD, current treatments and direction of research for improved therapy and prophylaxis and focus on the common and less common musculoskeletal complications of this unfortunately prevalent and burdensome disease.</p> <p><strong>The Case:</strong> This is a case report of a 33-year-old male with a past medical history of Acute Myeloid Leukemia (AML) who presented with a 1-month history of generalized, proximal weakness and was found to have polymyositis secondary to chronic GVHD. Elicitation of further history showed that the patient had had multiple manifestations of both acute and chronic graft-versus-host disease in the two years following hematopoietic stem cell transplantation (HSCT).</p> <p><strong>Conclusion:</strong> It is important for clinicians to be familiar with polymyositis secondary to chronic GHVD, which may appear in patients more than 100 days following allogenic HSCT and typically presents as diffuse, generalized myopathy with preserved sensation and elevated CPK and aldolase. The current mainstay of treatment is glucocorticoids with or without a calcineurin inhibitor, however due to the side effects associated with long term treatment, more effective prophylactic and therapeutic treatments are needed to address this and other manifestations of chronic GVHD.</p> David Ben-Nun Copyright (c) 2020 David Ben-Nun 2020-04-30 2020-04-30 8 1 36 40 10.5195/ijms.2020.487 Encephalopathy an Atypical Presentation of Intussusception: A Case Report <p><strong>Background:</strong> Intussusception Encephalopathy is a pediatric emergency where a stuporous child presents with or without abdominal symptoms. Neurological manifestations of intussusception are an atypical presentation of this condition. It often misleads clinicians to other differential diagnoses of encephalopathy.</p> <p><strong>The Case:</strong> We present to you a case of an 11-month-old child presented with encephalopathy, acute in onset with underlying intussusception.</p> <p><strong>Conclusion:</strong> Intussusception encephalopathy is a pediatric emergency. It should be kept as a differential diagnosis when a child presents with complaints of acute onset of drowsiness with or without abdominal symptoms. Early diagnosis could save grave complications and improve the prognosis.</p> Venma Mampilly Sasikumar Manalumukkil Sankaran Ramaraj Subbiah Copyright (c) 2020 Venma Mampilly, Sasikumar Manalumukkil Sankaran, Ramaraj Subbiah 2020-04-30 2020-04-30 8 1 41 44 10.5195/ijms.2020.360 Fostering Europe’s Future Physician-Scientists: An Interview with European MD/PhD Association Chairman Dr. André dos Santos Rocha <p>Dr. André dos Santos Rocha is a Resident Physician in Intensive Care Medicine &amp; Anaesthesiology and a current MD-PhD student in the Department of Acute Medicine at the University of Geneva.&nbsp;In parallel, he is also the current Chairman of the European MD/PhD Association (EMPA), a role in which he coordinates a diverse group of highly-driven MD-PhD students. EMPA is a not-for-profit organisation which was founded with the central aims of bringing together MD-PhDs from across Europe, fostering a comfortable setting for networking, promotion of European scientific&nbsp;collaborations and support for research and mobility of European MD-PhD students. One of the main medium through which EMPA achieves a number of these lofty goals is their annual conference, which is typically held in conjunction with one of the national associations. I met with André after the recent European and Swiss MD-PhD Conference in Geneva to discuss his experience in this role and what the future holds for EMPA.</p> Paul M. Ryan André dos Santos Rocha Copyright (c) 2020 Paul MacDaragh Ryan, André dos Santos Rocha 2020-04-30 2020-04-30 8 1 45 48 10.5195/ijms.2020.468 Being an Italian Medical Student During the COVID-19 Outbreak <p>Many students around the world have been wondering how their life will change since the very first outbreak of Covid-19. In my experience article I have tried to give a flavor of how has the academic world changed in quarantine. Difficulties and opportunities have been analyzed. Questions regarding the validity of e-learning have been posed. In an arduous period as the one we are experiencing, having an idea of what life could be in worst case scenario could be helpful.</p> Nicolo G. Biavardi Copyright (c) 2020 Nicolo Giuseppe Biavardi 2020-04-02 2020-04-02 8 1 49 50 10.5195/ijms.2020.489 Medical Education in Naples, Italy, at the Time of SARS-CoV-2 <p>SARS-CoV-2 pandemic dramatically changed our daytime routine. Our university world was deeply affected by this emergency situation and had to guarantee the teaching activity with online lessons and exams. While it is true that even in non-emergency conditions online teching is an integral part of many universities, the same cannot be said for graduation ceremonies. And what about students' clinical practice and research activity?&nbsp;<span lang="EN-GB">In the present article, we will discuss about the experiences of a final-year medical student and of a young assistant professor of Surgery.</span></p> Gianluca Pagano Gaetano Luglio Copyright (c) 2020 Gianluca Pagano, Gaetano Luglio 2020-04-30 2020-04-30 8 1 51 53 10.5195/ijms.2020.496 Uncertainty in the Air: In the Emergency Room with COVID-19 in Pakistan Abuzar Siraj Muhammad Waleed Khan Copyright (c) 2020 Abuzar Siraj, Muhammad Waleed Khan 2020-04-30 2020-04-30 8 1 54 55 10.5195/ijms.2020.497 COVID-19 amongst the Pandemic of Medical Student Mental Health <p>The medical community has been greatly impacted by the COVID-19 pandemic.&nbsp; As medical students, we face unique challenges and uncertainty during this time.&nbsp; While the world gears up to fight the battle with this physical illness, our battle with mental health should not be forgotten.&nbsp; Medical students are disproportionately affected by mental health issues and psychological distress.&nbsp; This experience piece aims to shed light on these challenges and provoke a discussion around mental health in medical students during these trying times.</p> Leah Komer Copyright (c) 2020 Leah Komer 2020-04-30 2020-04-30 8 1 56 57 10.5195/ijms.2020.501 The Utility of Online Resources in Times of COVID-19: A Mexican Medical Student Point of View <p>We live in an unprecedented time, the covid19 outbreak has paralyzed the world including medical students. They remain in quarantine in the hope that the pandemic will end. The Latin America countries are particularly affected by their lack of resources and the time when medical students return to the universities is lengthening. Meanwhile the use of online platforms to resume the classes and the variety of online courses to complement the learning seems promising and should be more widely disseminated.<br><br></p> Aldo Mijail Pacheco Carrillo Copyright (c) 2020 Aldo Mijail Pacheco Carrillo 2020-04-30 2020-04-30 8 1 58 59 10.5195/ijms.2020.502 Studying Medicine in Barcelona During the COVID-19 Pandemic Enrique López-Ruiz Copyright (c) 2020 Enrique López-Ruiz 2020-04-30 2020-04-30 8 1 60 61 10.5195/ijms.2020.504 COVID-19: Experience from Vietnam Medical Students Duc Nguyen Tran Minh Tung Pham Huy Dung Nguyen Hoang Minh Quach Thieu Copyright (c) 2020 Duc Nguyen Tran Minh, Tung Pham Huy, Dung Nguyen Hoang, Minh Quach Thieu 2020-04-30 2020-04-30 8 1 62 63 10.5195/ijms.2020.505 COVID-19 Pandemic: Other Perspective. Saudi Arabia <p>The emerging COVID-19 pandemic has affected most aspects of life all over the world. In addition, it has promoted fear and uncertainty and initiated several ethical challenges. In this brief experience account, I will try to shed the light on the mediocre aspects of our circumstances and assert the protective measures for our wellbeing during current widespread contagion.</p> Osama A. Zitoun Copyright (c) 2020 Osama A. Zitoun 2020-04-30 2020-04-30 8 1 64 65 10.5195/ijms.2020.506 COVID-19: Where Do We Go from Here? An Experience from Medical Students in India <p>We’ve all read about the repercussions of pandemics in the past centuries, but COVID-19 is the first one we’ve struggled through! As uncertainty prevails in this unprecedented lockdown, we have deliberated over our perspective of our country’s preparedness and evolving protocols, along with the brunt taken by the academic courses. Nevertheless, there’s always a silver lining to look for, as we escape from our overbearing deadlines!</p> Tanisha Kalra Nikhita Kalra Copyright (c) 2020 Tanisha Kalra, Nikhita Kalra 2020-04-30 2020-04-30 8 1 66 67 10.5195/ijms.2020.509 A New Reality: Experiences from Canadian Clerkship Medical Students during COVID-19 <p>Medical students across the globe are being impacted by COVID-19. We are Canadian third year medical students who offer our experience as to how COVID-19 has impacted our medical training. We offer insight as to what medical students are doing despite being away from clinical duties. Questions regarding medical student responsibility during COVID-19 are raised. Our lived experience during this time will be beneficial to learn how the role of medical students during a pandemic evolve over time.</p> Jeffrey Leong Gurkaran S. Sarohia Copyright (c) 2020 Jeffrey Leong, Gurkaran S. Sarohia 2020-04-30 2020-04-30 8 1 68 69 10.5195/ijms.2020.516 Medical Students Have a Powerful Role in Addressing Community Needs in the COVID-19 Pandemic: An Experience from the US Carly O'Connor-Terry Tejasvi Gowda Ben Zuchelkowski Sarah Minney Jane Kwon Copyright (c) 2020 Carly O'Connor-Terry, Tejasvi Gowda, Ben Zuchelkowski, Sarah Minney, Jane Kwon 2020-04-30 2020-04-30 8 1 70 72 10.5195/ijms.2020.517 The Voice of a Psychiatry Resident Doctor During COVID-19 Outbreak in Mumbai, India Pooja Kapri Pawan Gadgile Copyright (c) 2020 Pooja Kapri, Pawan Gadgile 2020-04-30 2020-04-30 8 1 73 74 10.5195/ijms.2020.523 Lessons from COVID-19: The Perspective of an International Medical Student Back in the United States <p>As current medical students, we are in a unique position. Although we possess some medical knowledge, our hometowns may require a medical diploma to provide clinical aid in the fight against COVID-19. However, upon arrival from my medical school in Ireland to my home state of California, multiple community-based opportunities to assist patients were discovered. While medical students provide community care, we can also observe our surroundings, learn from the current situation, and deduce methods of improving patient care and healthcare systems, with hopes of preventing such repercussions if a similar pandemic were to occur in the future. This experience piece aims to express shifts in a medical student’s perspective amidst COVID-19 and explicate potential ways in which the American healthcare system can improve.</p> Avnee Nulkar Copyright (c) 2020 Avnee Nulkar 2020-04-30 2020-04-30 8 1 75 76 10.5195/ijms.2020.527 Being an American 2nd Year Medical Student in the COVID-19 Pandemic Benjamin D. Liu Copyright (c) 2020 Benjamin D. Liu 2020-04-30 2020-04-30 8 1 77 78 10.5195/ijms.2020.528 Medical Students in Low- and Middle-Income Countries and COVID-19 Pandemic Chatpol Samuthpongtorn Krit Pongpirul Copyright (c) 2020 Chatpol Samuthpongtorn, Krit Pongpirul 2020-04-30 2020-04-30 8 1 79 81 10.5195/ijms.2020.533 The COVID-19 Pandemic Through the Lens of a Medical Student in India <p>Online education in the pandemic era is a necessity for some and a substitute for others. Like any other form of communication, online education too has its fair share of constraints. Though, it has tried to address the lag of access during the time of pandemic but its universal access is still a matter of deep concern. As the pandemic progresses, so will our dependence on online education which needs to be tailored for students, educators and institutions.</p> <p>&nbsp;</p> Surobhi Chatterjee Copyright (c) 2020 Surobhi Chatterjee 2020-04-30 2020-04-30 8 1 82 83 10.5195/ijms.2020.537