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   2013| July-August  | Volume 5 | Issue 4  
    Online since July 13, 2017

 
 
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ARTICLES
Perceived stress and burnout among medical students during the clinical period of their education
Ragaa El-Masry, Seba M Ghreiz, Randah Mohamad Helal, Ahmed M Audeh, Tarek Shams
July-August 2013, 5(4):179-188
DOI:10.4103/1947-489X.210543  
Background: Transition from pre-clinical to clinical training has been identified as a crucial stage of medical education regarding student stress. When entering the clinical environs, students may become more prone to burnout. Aims: This study aimed to determine the prevalence, sources and predictors of high stress levels and burnout among medical students at King Faisal University, Saudi Arabia, during the clinical phase of medical education. Subjects and Methods: A cross-sectional survey of medical students in years four through six at Al-Ahsa Medical College during the academic year 2011-12 was performed. All 324 regular course attendants were invited to participate in the study and 233 participated (response rate of 71.9%). A self-reported questionnaire was used which covered three categories, including 18 sources of stress. Short Perceived Stress Scale and Emotional Exhaustion Subscale of Maslach Burnout Inventory were used to measure stress and burnout. Result: Sixth year students were more likely to cite relationship, hospital, and professional issues as stressors. Top stressors cited by final year students were concern about the future, defective clinical practice skills, fear of harming patients, and high parental expectations. Whereas first year students cited stressors such as transportation problems to hospital, fear of infection, and time limitations for training. The prevalence of emotional exhaustion and high levels of perceived stress was 76.8 and 71.7% respectively. Year of study was the only single independent risk factor for burnout and high levels of stress among students of clinical years. Conclusions: Clinical phase of medical education is a necessary area of intervention in order to provide an improved transition between pre-clinical and clinical periods. In addition, adoption of a new curriculum that integrates pre-clinical and clinical training of students from an early stage of education may reduce the stress.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  1,003 144 3
Upper trapezius activation during upper limb neural tension test-1 in karate players
Jince T Mathew, Thakur Kunal, Sadhana Meena, Jasmine Kaur Chawla, Lakshman Sethu
July-August 2013, 5(4):173-178
DOI:10.4103/1947-489X.210542  
Background: Manual examinations and subsequent manual therapy became the mainstream options for treatment of mechanical musculoskeletal disorders. Neurodynamics deals with the mechanics and pathomechanics of the nervous system as it moves relative to its adjacent tissues. Objectives: We determined upper trapezius activity during upper limb neural tension test-1 (ULTT-1) in asymptomatic National level Karate players of Madhya Pradesh State of India and correlated its activity with sensory responses during neural test. Subjects and Methods: Fifty national-level karate players (26 males) aged 20 to 25 years (mean age 22.0±1.4 SD) with no history of musculoskeletal or neurological injury were studied. Sensory response intensity was recorded on visual analogue scale (VAS). Electromyography (EMG) activity of upper trapezius muscle was recorded from the muscle belly. Results: All subjects showed ‘positive’ sensory responses on VAS with the mean value of 6.5±1.1 and EMG activity in upper trapezius muscle with mean of 93±19 microvolts. They all had “positive” sensory responses during upper limb tension test-1. They were described mainly as stretch, pain, pull and, tightness. Majority of the sensory responses was reported during the stages of wrist and elbow extension and all subjects showed increased EMG activity in upper trapezius muscle during ULTT-1, which correlated directly with the perceived sensory response. Conclusion: Upper trapezius muscle activity is evident during ULTT-1 which is directly correlated with the perceived intensity of sensory responses during the test. Sensory responses to ULTT 1 can be elicited in a large proportion of asymptomatic active young players.
[ABSTRACT]   Full text not available  [PDF]
  591 80 -
Phytochemical screening, antibacterial and cytotoxic activity of different fractions of xylocarpus mekongensis bark
Arif Ahmed, Zubair Khalid Labu, Shubhra Kanti Dey, Arpona Hira, Mohamed Sariful Islam Howlader, Mohamed Hemayet Hossain, Jimuty Roy
July-August 2013, 5(4):206-213
DOI:10.4103/1947-489X.210546  
Background: In Bangladesh, the tree Xylocarpus mekongensis (Lamk.) M. Roem. is used as the traditional medicine for the treatment of a number of ailments. Objectives: The present study was undertaken for antibacterial activity and cytotoxicity study of the methanol, ethyl acetate and chloroform extract of X. mekongensis bark. Materials and methods: Antimicrobial activity has been investigated against Vibrio cholera, Shigella flexneri, Shigella boydii, Salmonella typhi, Salmonella paratyphi and Staphylococcus aureus by disc diffusion and broth macro- dilution assay. For cytotoxicity test, methanol, acetate and chloroform extract of bark of X. mekongensis were subjected to brine shrimp lethality bioassay. Results: The zone of inhibition has been observed with almost all bacteria with some exceptions. Minimum inhibitory concentrations (MIC) of the extracts were found to be significant. The LC50 values of these three extracts were found to be 1280, 320 and 320 μg/ml, respectively. Conclusions: Findings of the study justify the use of the plant in traditional medicine and suggests further investigation.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  565 104 1
REVIEW
Emerging concepts in metformin therapy: Hyperglycaemia and beyond
Tarek M Fiad, Fatema H Al Hammadi, Asma A Al Nuaimi, Jamila S Al Dhuhouri
July-August 2013, 5(4):227-239
DOI:10.4103/1947-489X.210550  
Metformin has been extensively used in the management of type 2 diabetes mellitus (T2DM). A number of properties combined, including cost effectiveness, safety, weight neutrality, low risk of Hypoglycemia and cardiovascular protection moved metformin to the forefront of diabetes management and is now accepted as the standard first line therapy. Although other classes of glucose lowering medications were introduced to clinical practice in the recent times, none of such therapies has as yet demonstrated superiority to metformin to justify being considered as a first line therapeutic option. The use of metformin has extended in the last 2 decades to include diabetes prevention, gestational diabetes mellitus (GDM) and polycystic ovary syndrome (PCOS). There is accumulating evidence from observational studies to suggest a possible role for metformin in cancer prevention and in the management of non-alcoholic fatty liver disease. We reviewed the role of metformin in the prevention and treatment of T2DM and allied metabolic disorders and examined the non- glycaemic effects of metformin. In addition, we reviewed safety aspects pertinent to the usage of metformin in special clinical settings.
[ABSTRACT]   Full text not available  [PDF]
  548 77 -
ARTICLES
Prediction of dermatophyte culture by clinical features: Saving time and cost in resource-poor settings
Adeolu Oladayo Akinboro, Olayinka A Olasode, Olaniyi Onayemi, Adebanke Oguntola, Aderibigbe Isaac Ajibola
July-August 2013, 5(4):189-195
DOI:10.4103/1947-489X.210544  
Background: Tinea capitis is common among children worldwide. Confirmation of diagnosis for early commencement of therapy and control has continued to be a major challenge in resource-poor settings. Patients and Methods: This cross-sectional study recruited 185 children in the rural community of Osogbo, Nigeria. Two thirds of the study population were children aged 5 to 8 years. Clinical history was documented and scalp scrapping of scales and hairs was obtained for microscopy and culture. Two sided fisher exact test was employed in the bivariate analysis. Results: The mean ± SD age for the culture positive and the negative children were 7.2 ± 2.2 years and 7.8 ± 2.7 years respectively. Dermatophyte culture positivity was found in 123 (66.5%) of the children. For the culture-positive children, the positive predictive values were high at 95%, 91%, 88%, and 87% and negative predictive values were low at 16%, 24%, 18% and 0% respectively for adenopathy, alopecia, pruritus, and scalp scaling as single symptom and sign respectively. For various combinations of any two symptoms, positive predictive values ranged from 73-82%, for three symptoms 81% and for four symptoms 77%. The combinations also demonstrated higher negative predictive values 67 – 86% for two, 64% for three and 78% for four symptoms, the absence of which diagnosis could be held in doubt. Similarly, positive likelihood ratios were 2.7, 1.5,1.1, and 1.0 for adenopathy, alopecia, pruritus, and scalp scaling respectively. The positive likelihood ratios ranges from 1.6 – 2.8 for various combinations of two cardinal symptoms; highest for adenopathy and alopecia, and 2.0 for three symptoms and 1.8 for all the four symptoms. Conclusions: Among pre adolescent children, culture positivity is well predicted when adenopathy and alopecia are present or in combination with scalp scaling. Consequently, control of infection may be further enhanced with omission of culture and early commencement of treatment.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  539 69 1
COMMENTARY
Metformin, the remarkable and unique antidiabetic agent
Abdulfattah Ali Lakhdar
July-August 2013, 5(4):240-242
DOI:10.4103/1947-489X.210551  
In the current issue of this Journal, Fiad and colleagues thoughtfully reviewed in detail the role of metformin in current clinical practice and highlighted the additional effects of metformin independent of the glycemic action of the drug. The review is comprehensive, up to date and is extensively supported by the literature. Metformin remains the first drug of choice in patients diagnosed with type 2 diabetes. Its vascular protection actions are particularly interesting though not yet fully understood. Its antineoplastic actions are very exciting. The authors clarify the issues of gastrointestinal side effects and renal limitations of its use and give practical ways of minimizing the potential loss of benefit to all treated patients.
[ABSTRACT]   Full text not available  [PDF]
  508 66 -
VIEW POINT
Regulating healthcare professions in Libya: A viewpoint
Salaheddin M Mahmud, Fathi I Ali, Amna Salhin, Fellani Mohamed, Elmahdi A Elkhammas, For the Libyan Healthcare Society-USA
July-August 2013, 5(4):214-217
DOI:10.4103/1947-489X.210547  
Regulating the licensing and practice of healthcare professions is an essential first step for reforming the Libyan healthcare system. In this article, we identify the overarching principles that should guide any efforts targeted at reforming the regulation of healthcare professions in Libya, and to summarize the perspective of the Libyan Healthcare Society-USA (LHS-USA) on these issues. Our aim is not to advocate for the adoption of a specific regulatory model. Instead, we hope to stimulate debate about the principles of professional regulation, and over the process needed to develop consensus on the final shape of the Libyan regulatory model.
[ABSTRACT]   Full text not available  [PDF]
  510 52 -
ARTICLES
The role of angiogenic biomarkers in gastrointestinal cancer
Sahar EM El-Deek, Naglaa K Idriss, Randa S Hana, Madleen AA Abdou, Doaa W Maksemose, Madeha M Zakhary
July-August 2013, 5(4):196-205
DOI:10.4103/1947-489X.210545  
Background: Angiogenesis is a key issue in the carcinogenesis progression. Gastrointestinal tract (GIT) cancer is a multi-stage disease, multifaceted, concerning convention of different signaling cascades. Abnormal angiogenesis have been related to pathogenesis of tumor. Objectives: We hypothesized inter-relationships between indices of angiogenesis biomarkers across the spectrum of GIT cancer and its relation to the pathogenesis and prognosis of the diseases. We also evaluated the consequence of estimating these indices in untimely tumor recognition. Methods: Forty patients were studied and divided into two groups: Group 1 (n=30) with GIT cancer and group 2 (n=10) with benign lesion. The cancer group subdivided into patients with gastric cancer (n= 12) and patients with colorectal cancer (n=18). 20 healthy controls (C) were involved in the study. Serum levels of all biochemical indices were estimated. Results: Significantly high serum levels of studied angiogenic biomarkers were detected in patients with GIT cancer compared to C and benign group (p<0.000l and p<0.001 for each respectively). Their levels being significantly higher in late stage of the disease versus early stage and in patients with high tumor burden versus patients with low tumor burden with the exception of Cathpsin-B and HA that showing no significant difference. Positive Significant correlations was present between all indices in cancer groups (p<0.001). Also, there was significant positive correlations between these biomarkers and stage of the tumor (p<0.01). Conclusions: There was a gradation in angiogenesis biomarkers in patients with GIT cancer which related to stage and size of the tumors. This may reflect the relative roles of these biomarkers in the biology of GIT cancer. Their estimation may have implications for our understanding of the pathphysiology of tumor, play a novel beneficial roles in early tumor detection and targeted tumor therapy by using antangiogenic therapy
[ABSTRACT]   Full text not available  [PDF]
  497 60 -
CASE REPORTS
Atypical pheochromcytoma: Haemorrhagic cyst and abdominal pain in a normotensive patient
Fathima P Kunjumohammed
July-August 2013, 5(4):218-222
DOI:10.4103/1947-489X.210548  
Pheochromocytomas are catecholamine-secreting tumors. They show a considerable variation in clinical presentation ranging from adrenal incidentaloma in a normotensive individual to a patient in hypertensive crisis or with cerebrovascular or cardiac decompensation. We report here a case of fifty years old Omani female patient was referred to the endocrine clinic from a regional hospital, for further investigation of a an incidental left adrenal cyst that was detected on US abdomen being performed for evaluation of abdominal pain. Pheochromocytoma was eventually confirmed and an abdominal CT showed a large haemorrhagic cyst. The course and management is described and a focused review of the pitfalls of diagnosis and management is provided.
[ABSTRACT]   Full text not available  [PDF]
  448 59 -
QUIZ
A nine month old boy with hemolytic anemia
Shweta Patel, Jessica A Hemminger, Samir B Kahwash
July-August 2013, 5(4):223-226
DOI:10.4103/1947-489X.210549  
Full text not available  [PDF]
  294 75 -