International Journal of Medical Students 2021-09-20T16:36:28-04:00 Francisco Javier Bonilla-Escobar, MD, MSc, PhD(c) Open Journal Systems <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The Journal receives contributions and unpublished manuscripts of Original Articles, Short Communications, Reviews, Case Reports, Interviews, Experiences, and Letters, which are reviewed by experts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 quarterly by the University Library System, University of Pittsburgh. The Journal's main office is located in the United States of America (USA). Any publication, dissemination, or distribution of the information included in the Journal is permitted if the source is cited (Int J Med Students).</p> <p>This journal provides immediate <em>open access</em> to its content. Our Open Access follows a “<em>diamond model</em>”; the Journal is free to both readers and authors, there are no article processing charges, submissions fees, or any other costs required of authors to submit, review, or publish articles.</p> Cover, Credits, & Content 2021-09-11T12:28:31-04:00 Executive Board of IJMS 2021-09-06T00:00:00-04:00 Copyright (c) 2021 Executive Committee of IJMS A Call for Action—Empowering Medical Students to Facilitate Change 2021-09-15T09:26:40-04:00 Madeleine J. Cox Purva C. Shah Leah Komer Muhammad Romail Manan L V Simhachalam Kutikuppala Benjamin Liu 2021-08-30T17:10:17-04:00 Copyright (c) 2021 Madeleine J. Cox, Purva C. Shah, Leah Komer, Muhammad Romail Manan, L V Simhachalam Kutikuppala, Benjamin Liu Call for Emergency Action to Limit Global Temperature Increases, Restore Biodiversity, and Protect Health 2021-09-15T09:33:43-04:00 Lukoye Atwoli Abdullah H. Baqui Thomas Benfield Raffaella Bosurgi Fiona Godlee Stephen Hancocks Richard Horton Laurie Laybourn-Langton Carlos Augusto Monteiro Ian Norman Kirsten Patrick Nigel Praities Marcel GM Olde Rikkert Eric J. Rubin Peush Sahni Richard Smith Nicholas J. Talley Sue Turale Damián Vázquez 2021-08-26T00:00:00-04:00 Copyright (c) 2021 Laurie Laybourn-Langton, Lukoye Atwoli, Abdullah H. Baqui, Thomas Benfield, Raffaella Bosurgi, Fiona Godlee, Stephen Hancocks, Richard Horton, Carlos Augusto Monteiro, Ian Norman, Kirsten Patrick, Nigel Praities, Marcel GM Olde Rikkert, Eric J. Rubin, Peush Sahni, Richard Smith, Nicholas J. Talley, Sue Turale, Damián Vázquez Healthcare Students’ Perception of Social Distancing During the 2019 Coronavirus Pandemic: A Cross-Sectional Survey 2021-09-15T09:35:38-04:00 Devon L Barrett Katharine W Rainer Chao Zhang Travis W Blalock <p><strong>Background:</strong> Since the implementation of social distancing practices during the global coronavirus disease 2019 (COVID-19) pandemic there have been a myriad of definitions for ‘social distancing.’ The objective of this study was to determine students’ awareness of the various definitions of social distancing, how strictly they adhered to social distancing guidelines, and how they perceived the importance of various social distancing practices.&nbsp;</p> <p><strong>Methods:</strong> This cross-sectional survey was distributed via email to students at Emory-affiliated graduate schools, including the Medical, Nursing, and Public Health Schools.</p> <p><strong>Results</strong>:&nbsp;Of the 2,453 recipients of the survey, 415 students responded (16.9% response rate). The majority of respondents were medical students (n=225, 55.6%). Of the respondents, 357 noted that they “frequently” or “always” abided by social distancing. The most common definition of social distancing with which respondents were familiar was the Centers for Disease Control and Prevention (CDC)’s (n=276 of 369 responses, 74.8%). There were significant differences across groups&nbsp; when grouping students by the definition of social distancing that they were aware of, the social distancing guideline they most closely followed, and their school of attendance regarding the importance of specific social distancing examples (p&lt;0.05 for each).</p> <p><strong>Conclusions</strong>:&nbsp;A survey of healthcare students identified differences in the importance of social distancing practices based on the definition of social distancing that they were aware of. The results of this study underscore the importance of having unified definitions of public health messaging, which ultimately may impact disease spread.</p> 2021-05-18T00:00:00-04:00 Copyright (c) 2021 Devon L Barrett, Katharine W Rainer, Chao Zhang, Travis W Blalock Perception of Medical Students on the Effect of Covid-19 on Medical Education in Nigeria 2021-09-15T09:41:43-04:00 Adeleke Victor Fasiku Ibrahim Abdulsamad James Kolade Adegoke Adedeji Samson Afolabi Samson Olaniyi Adedayo Ayomide Olanipekun Temitope Olumuyiwa Ojo <p><strong>Background:</strong> The lockdown due to the COVID-19 pandemic disrupted normal activities including undergraduate medical education in Nigeria, similar to the rest of the world. Nigeria as a low- and middle-income country had peculiar challenges in adjusting to the new norm. This study aimed to assess Nigerian medical student’s perception of the effect of COVID-19 on their learning.</p> <p><strong>Methods:</strong> A semi-structured, pre-tested online questionnaire was administered to consenting medical students from thirty-three medical schools in Nigeria. Questions assessed the effect of COVID-19 on study and wellbeing, as well as the perception of interventions from institutions and student organizations to reduce the lockdown consequence on learning. Data was analyzed using (SPSS) version 25.</p> <p><strong>Results:</strong> A total of 623 students from 33 institutions participated. All private institutions and 25% of public institutions had commenced online lectures/tutorials, 92% of students in private institutions and 21% in public institutions had attended online lectures/tutorials. Of those who did not attend institution-organized classes, 30.5% were opposed to online lectures, the main reasons stated being internet cost/availability and inefficiency. About 65% of the participants were aware of student-organized online tutorials/seminars. Eighty percent did not feel motivated to study and perceived their personal study to be less effective.</p> <p><strong>Conclusion:</strong> Nigerian medical student’s perception of the effect of COVID-19 on their medical education was largely negative. Private institutions fared better in coping with the challenges of the pandemic. Proper planning will be needed to curb the effect of COVID-19 on students’ health and wellbeing.</p> 2021-08-25T00:00:00-04:00 Copyright (c) 2021 Adeleke Victor Fasiku, Ibrahim Abdulsamad, James Kolade Adegoke, Adedeji Samson Afolabi, Samson Olaniyi Adedayo, Ayomide Olanipekun, Temitope Olumuyiwa Ojo Trends and Factors Impacting Healthcare Charges and Length of Stay for Cholecystectomies: A New York State Population-based Analysis 2021-09-15T09:45:48-04:00 Aria Darbandi Christina Chopra <p><strong>Background:</strong> Gallbladder disease confers a significant economic toll on the United States healthcare system. This study aims to characterize current trends and features of the cholecystectomy population and identify factors that influence the length of stay and total charges.</p> <p><strong>Methods:</strong> Case information was extracted for laparoscopic and open cholecystectomies from 2013-2016 using the New York Statewide Planning and Research Cooperative System (SPARCS) database. Descriptive, comparative, and multivariable linear regression analysis was conducted on 58,141 cases assessing age group, race, gender, admission presentation, surgical technique, insurance status, year of operation and severity of illness by the length of stay and total charges.</p> <p><strong>Results:</strong> Of all procedures, 91.6% were laparoscopic, and 79.4% were emergent on admission. Total procedures trended down, while laparoscopic and emergent cases steadily increased (p&lt;0.0001). Total charges increased during the study period, while the length of stay decreased (p&lt;0.0001). Open and emergent procedures were associated with a higher cost and longer inpatient stays (p&lt;0.0001). Open procedures were proportionally more common among elderly, male patients, and in elective cases (p&lt;0.0001). Emergent presentation was more common in females, non-whites, and younger patients (p&lt;0.0001). Regression model showed that male gender, open operation, Black race, and emergent presentation were independent predictors for a longer stay and greater total charges (p&lt;0.0001). Medicare insurance predicted lower total charges but longer length of stay (p&lt;0.0001).</p> <p><strong>Conclusion:</strong> Race, insurance, procedure type, and patient presentation influence hospital charges and stays following cholecystectomy. Understanding these trends will allow policymakers and providers to limit the healthcare burden of cholecystectomy.</p> 2021-07-08T00:00:00-04:00 Copyright (c) 2021 Aria Darbandi, Christina Chopra The Impact of Previous Cardiology Electives on Canadian Medical Student Interest and Understanding of Cardiology 2021-09-15T09:51:06-04:00 Bright Huo Wyatt MacNevin Todd Dow Miroslaw Rajda <p><strong>Background:&nbsp;</strong>Most Canadian medical schools do not have mandatory cardiology rotations. Early exposure to clinical cardiology aids career navigation, but clerkship selectives are chosen during pre-clerkship. This study investigates whether prior elective experiences affect medical student interest as well as understanding of cardiology before clerkship selections.</p> <p><strong>Methods:&nbsp;</strong>A literature search was conducted using Google Scholar, Embase and PubMed to create an evidence-based cross-sectional survey. The anonymous questionnaire was administered to 53 second-year medical students at a Canadian medical school via <em>Opinio</em>, an online survey platform. Students were assessed on their interest and understanding of cardiology practice using a 5-point Likert Scale. Descriptive statistics and Chi-Square analysis were applied to assess the relationship between previous elective experience, medical student interest, and understanding of career-related factors pertaining to cardiology.</p> <p><strong>Results:&nbsp;</strong>Overall, 26 (49.1%) students reported cardiology interest, while it was a preferred specialty for 9 (17.0%). Medical students reported low understanding of community practice (n=20, 37.7%), duration of patient relationships (n=14, 26.4%), spectrum of disorders (n=13, 24.5%), and in-patient care (n=11, 20.8%) associated with cardiology practice. Students with prior cardiology electives had increased understanding of in-patient care (<em>χ<sup>2</sup> </em>= 4.688<em>, Cramer’s V </em>= 0.297<em>, p</em> = 0.030 and were more likely to select cardiology as a top specialty choice (<em>χ<sup>2</sup> </em>= 7.983<em>, Cramer’s V </em>= 0.388<em>, p</em> = 0.005).</p> <p><strong>Conclusions:&nbsp;</strong>Pre-clerkship medical students have a low understanding of cardiology practice. Increasing pre-clerkship exposure to cardiology may help students determine their interest in the specialty before clerkship selectives are chosen.</p> 2021-07-21T00:00:00-04:00 Copyright (c) 2021 Bright Huo, Wyatt MacNevin, Todd Dow, Miroslaw Rajda Predictors of Cerebral Arteriovenous Malformation Mortality: A Single-center, Five-year Retrospective Study 2021-09-15T09:56:12-04:00 Patricio Garcia-Espinosa Edgar Botello-Hernández Gabriela Torres-Hernández Clarissa Guerrero-Cavazos Estefania Villareal-Garza Andrea Flores-Rodriguez <p><strong>Background:</strong> Arteriovenous Malformations (AVMs) are abnormalities in intracranial vessels between the arterial and venous systems. This study aimed to identify the predictors of mortality in patients that presented to our hospital with AVMs, ruptured or unruptured, and correlate them to those available in the literature.</p> <p><strong>Methods:</strong> An analytical, observational, retrospective study was performed to review data of patients with cerebral AVMs in the University Hospital “Dr José Eleuterio González” from January 2016 to December 2020. Clinical files were reviewed based on AVMs diagnosis according to the &nbsp;International Classification of Diseases 10<sup>th</sup> Revision, ICD-10. Variables were subjected to a univariate analysis and those found significant (p-value &lt; 0.05) were subjected to a logistic regression.</p> <p><strong>Results:</strong> A total of 80 patients were included in our study. Most of the participants were females (56.3%) and three were pregnant. The most common presenting symptom was holocranial headache (34 cases) occurring between the hours of 22:00 to 7:00. The most significant predictors of mortality were a total bleeding volume greater than 9.18 cm<sup>3 </sup>(p = 0.010), the presence of more than one symptom (p = 0.041), and a history of previous cerebral intraparenchymal hemorrhage (p = 0.014).</p> <p><strong>Conclusion: </strong>Results demonstrated an important association between intracranial bleeding and mortality. Ultimately, more prospective studies are needed to determine predictor factors for mortality in AVMs patients.</p> 2021-08-31T00:00:00-04:00 Copyright (c) 2021 Patricio Garcia-Espinosa, Edgar Botello-Hernández, Gabriela Torres-Hernández, Clarissa Guerrero-Cavazos, Estefania Villareal-Garza, Andrea Flores-Rodriguez Splenic Rupture in a COVID-19 Patient – A Case Report 2021-09-15T09:58:00-04:00 Anna C. Crowley Raul R. Magadia Arianna B. Lanpher <p><strong>Background: </strong>It is well known that the Coronavirus disease 2019 (COVID-19) causes coagulation changes, requiring frequent monitoring for potential sequelae such as myocardial infarction and stroke. Non-traumatic splenic rupture is a rare and poorly understood occurrence in the clinical setting. Possible causes of nontraumatic splenic rupture include neoplasm, infection, inflammatory disease, iatrogenic and mechanical causes. Furthermore, increased intrasplenic tension, increased abdominal pressure, and thrombotic vascular occlusion are possible mechanisms.</p> <p><strong>The Case</strong>: We report a case of splenic rupture in a COVID-19 patient. Our patient was a 52-year-old black man, presenting with diarrhea and moderate dyspnea, who was found to be COVID-19 positive. He had a past medical history significant for end-stage renal disease, chronic anemia, and aortic valve replacement. In an otherwise uneventful, 7-day hospital course, the patient’s stay abruptly resulted in a nontraumatic splenic rupture and demise. In this report, we have evaluated the likelihood of COVID-19 causing splenic rupture in a patient with no prior splenic disease.</p> <p><strong>Conclusion</strong>: This case highlights the possibility of splenic rupture in otherwise normally recovering COVID-19 patients, particularly in the presence of comorbid conditions of renal failure and anticoagulation, with increased abdominal pressure during routine defecation. This information may assist in furthering the pathophysiology of COVID-19 and its life-threatening complications. In patients with COVID-19, non-traumatic splenic rupture should be considered as one of the differential diagnoses in patients who present with abdominal pain and early recognition of the same, owing to a high index of suspicion, can be lifesaving.</p> 2021-07-16T00:00:00-04:00 Copyright (c) 2021 Anna C. Crowley, Raul R. Magadia, Arianna B. Lanpher Pneumatocele-Induced Pneumothorax in a Patient with Post-COVID-19 Pneumonitis. A Case Report. 2021-09-15T10:00:54-04:00 Kevin O. Wortman II Kevin O. Wortman Sr. <p><strong>Background: </strong>The COVID-19 pandemic has been challenging medical professionals and facilities for over a year now. Much of the literature describes pathologic lung changes and complications associated with SARS-CoV-2, with pneumothorax and pneumatoceles not being uncommon.</p> <p><strong>The Case: </strong>We describe a case involving a patient that presented to the emergency department with a pneumothorax. Three weeks prior, the patient was hospitalized for 10 days in acute respiratory distress secondary to COVID-19 pneumonitis, which did not require ventilator support. Follow up imaging revealed a 7 cm (AP) x 4.6 cm (transverse) x 2.5 (cc) cm pneumatocele.</p> <p><strong>Conclusion: </strong>We speculate that antecedent rupture of an unrecognized pneumatocele likely caused lung collapse leading to the patient’s pneumothorax. This review delves into the etiology of both pneumothoraces and pneumatoceles along with their relation to COVID-19 pneumonia.</p> 2021-08-24T00:00:00-04:00 Copyright (c) 2021 Kevin O. Wortman II, Kevin O. Wortman Sr. A Case Report of Acute Severe Myelitis and Meningitis Secondary to Varicella Zoster Virus Reactivation in a Patient with Acquired Immunodeficiency Syndrome 2021-09-15T10:06:01-04:00 Victor A. Novelo-Hernández Marco Cárdenas Claudia Torres-González Patricio Garcia-Espinosa Rómulo Ramirez Marco Díaz-Torres Alejandro Marfil-Rivera <p><strong>Background:</strong> Myelitis post Herpes-Zoster is a rare condition that is typically associated with immunocompromised states. It usually starts as an acute loss of sensory and motor functions below the affected spinal cord level. The condition can range in severity from a mild to a fatal presentation. Other neurological complications include meningitis, atypical presentations should encourage the search for undiagnosed immunosuppression states.</p> <p><strong>The Case:</strong> We describe the case of a 42-year-old man, with previously undiagnosed HIV, who developed acute myelitis and meningitis after the appearance of the classic zoster lesions. On lumbar puncture and subsequent CSF analysis, the patient was found to have Froin's Syndrome. The patient was initiated with ceftriaxone, vancomycin, and acyclovir regimen and prophylactic antiphymic treatment was also added. After 14 days in the hospital, the fever, headache, and neck stiffness subsided while the sphincter function and lower limb paraplegia did not improve.</p> <p><strong>Conclusion:</strong> Varicella zoster virus reactivation suggests underlying immunosuppression. This case demonstrates the importance of being cognizant to the wide range of clinical manifestations that may suggest spinal cord involvement after clinical reactivation. Furthermore, physicians also need to be mindful that Acquired Immunodeficiency Syndrome (AIDS) and other immunodeficiency states could present with atypical clinical manifestations.</p> 2021-08-12T00:00:00-04:00 Copyright (c) 2021 Victor A Novelo-Hernández, Marco Cárdenas, Claudia Torres-González, Patricio Garcia-Espinosa, Rómulo Ramirez, Marco Díaz-Torres, Alejandro Marfil-Rivera Severe Esophagitis and Chemical Pneumonitis as a Consequence of Dilute Benzalkonium Chloride Ingestion: A Case Report 2021-09-15T10:09:15-04:00 Amit Kumar Rajesh Chetiwal Priyank Rastogi Shweta Tanwar Saurabh Gupta Rajesh Patnaik Maduri Vankayalapati Sudhish Gupta Alok Arya <p><strong>Background: </strong>Benzalkonium chloride (BAC) has been used as an active ingredient in a wide variety of compounds such as surface disinfectants, floor cleaners, pharmaceutical products and sanitizers. Solutions containing &lt;10% concentration of BACs typically do not cause serious injury. As the available data regarding acute BAC toxicity is limited, we report a case of dilute benzalkonium chloride ingestion resulting in bilateral chemical pneumonitis and significant gastrointestinal injury requiring mechanical ventilatory support.</p> <p><strong>The Case: </strong>A 42-year-old male presented with chief complaints of nausea, vomiting and excessive amount of blood- mixed oral secretions after accidental ingestion of approximately 100ml of BAC solution (&lt;10%). Later he developed respiratory distress with falling oxygen saturation for which he was intubated and mechanical ventilatory support was administered. Computed tomography (CT) chest was suggestive of bilateral chemical pneumonitis and upper gastrointestinal (GI) endoscopy revealed diffuse esophageal ulcerations. The patient was managed with intravenous fluids, corticosteroids, proton pump inhibitor, empiric antibiotics and total parenteral nutrition.</p> <p><strong>Conclusion: </strong>The present case report emphasizes that dilute BAC compounds can cause severe respiratory and gastrointestinal injuries. Immediate and aggressive medical treatment is crucial for improving patient outcomes and reducing the complication rates.</p> 2021-08-12T00:00:00-04:00 Copyright (c) 2021 Amit Kumar, Rajesh Chetiwal, Priyank Rastogi, Shweta Tanwar, Saurabh Gupta, Rajesh Patnaik, Maduri Vankayalapati, Sudhish Gupta, Alok Arya COVID-19 Volunteering Experience in Vietnam 2021-09-20T16:36:28-04:00 Tran Thi Lan Vo Trong Khanh Nguyen Tran Minh Duc 2021-07-08T00:00:00-04:00 Copyright (c) 2021 Tran Thi Lan, Vo Trong Khanh, Nguyen Tran Minh Duc Student Mobility and Research Capacity: A Global Health Experience 2021-09-16T09:25:24-04:00 Letícia Nunes Campos Sura Wanessa Santos Rocha <p>Global South countries struggle to train and retain researchers and practitioners to address local, regional, and global health challenges. Therefore, it is necessary to train a new generation of Global South scientists adequately, aiming to develop these low- and middle-income countries’ research capacity. In this regard, international student mobility fosters collaboration among institutions and promotes global health education while building capacity. The International Federation of Medical Students’ Associations (IFMSA) operates the largest student-run medical exchange program worldwide, providing research exchange programs since 1991. This article aims to report the experience of a Brazilian medical student, a Global South country, in Germany, a Global North country in an IFMSA research exchange.</p> <p>The 4-week research exchange occurred in February of 2020 at the Medical Faculty of Ruhr Universität Bochum in Bochum, Germany. The student assisted on various research projects at the institution's neurophysiology department. Educational activities also included journal clubs, lectures, workshops, and a conference. All activities were in English and under supervision. In terms of assessment, the student work was detailed in a logbook, which was shared with supervisors.</p> <p>During the exchange experience, the student learned through being exposed to different environments, people, and scientific methodologies. This resulted in the acquisition and improvement of research-related skills including research design and implementation, ethics, and professionalism, besides fostering intercultural learning. Additionally, this report demonstrates how student mobility fosters more collaborative environments and enhances scientific and networking possibilities.</p> 2021-07-08T00:00:00-04:00 Copyright (c) 2021 Letícia Nunes Campos, Sura Wanessa Santos Rocha Opportunistic Conversations about Eating Disorders: An Encounter from my Pediatrics Elective 2021-09-15T10:17:14-04:00 Brishti Debnath <p>My final year elective was starkly different to the one I had envisioned in my earlier years of medical school. Due to the ongoing global pandemic, those six-weeks were spent much closer to home. But I was fortunate in that I managed to secure it in the specialty of paediatrics, an area I wish to pursue as a postgraduate. There were many thought-provoking encounters to be had during my time in the paediatrics department. One encounter has given me much to reflect upon, as I shall discuss in this article.&nbsp;</p> 2021-08-24T00:00:00-04:00 Copyright (c) 2021 Brishti Debnath Lessons Learnt from Operationalising an International Collaborative Multi-Centre Study 2021-09-15T10:18:22-04:00 Rhea Raj Catherine Dominic Suraj Gandhi Elliott H. Taylor Marina Politis Syeda Namayah Fatima Hussain Divya Parwani Soham Bandyopadhyay Noel Peter Kokila Lakhoo <p>Many medical students are both skilled and experienced in healthcare research, statistical analysis and evidence synthesis; assets that can be deployed to great effect in order to conduct research and contribute to the body of evidence - particularly in outbreak situations where senior doctors may be redeployed to clinical duties, thus ensuring that the next generation of academic clinicians’ interest and knowledge does not go in vain.&nbsp;Here, we document the process by which a group of medical students across the world, with senior support, harnessed their enthusiasm and the power of technology to play leading roles in an international multi-centre study run by the Global Health Research Group on Children’s Non-Communicable Diseases (Global Children’s NCDs). Many lessons have been learnt from the successful operationalisation of this study, which we hope to impart in this article. Our operations team consisted of: a social media team who manage our various accounts; a graphic design team who produce visuals to illustrate milestones achieved or highlight countries from which we did not yet have representatives; a network team who constructed a database to manage our extensive collaborator network; a communications team who managed emails and maintained regular contact with collaborators as well as producing a guide of common issues; a researcher support team who worked to ensure that any issues faced were dealt with promptly by hosting drop-in sessions; and finally a research capacity building team. We found that medical students bring fresh perspectives and an open-minded approach which is useful in reframing challenges and generating innovative solutions; thus it is vital to give them the opportunity to collaborate with, and learn from senior academics and policy-makers.&nbsp;</p> 2021-08-30T00:00:00-04:00 Copyright (c) 2021 Rhea Raj, Catherine Dominic, Suraj Gandhi, Elliott H. Taylor, Marina Politis, Syeda Namayah Fatima Hussain, Divya Parwani, Soham Bandyopadhyay, Noel Peter, Kokila Lakhoo