bluuebunny/crossref_metadata_2025 huggingface dataset:
The BernClim plant phenological data set from the canton of Bern (Switzerland) 1970–2018
Authors: Rutishauser This , Jeanneret François , Brügger Robert , Brugnara Yuri , Röthlisberger Christian , Bernasconi August , Bangerter Peter , Portenier Céline , Villiger Leonie , Lehmann Daria , Meyer Lukas , Messerli Bruno , Brönnimann Stefan
Published: November 2019

Abstract. In 1970, the Institute of Geography of the University of
Bern initiated the phenological observation network BernClim. Seasonality
information from plants, fog and snow was originally available for applications in
urban and regional planning and agricultural and touristic suitability and is
now a valuable data set for climate change impact studies. Covering the
growing season, volunteer observers record the dates of key development
stages of hazel (Corylus avellana), dandelion (Taraxacum officinale), apple
tree (Pyrus malus) and beech (Fagus sylvatica). All observations consist of
detailed site information, including location, altitude, exposition (aspect)
and inclination, that makes BernClim unique in its richness in detail on decadal
timescales. Quality control (QC) by experts and statistical analyses of the
data have been performed to flag impossible dates, dates outside the
biologically plausible range, repeated dates in the same year, stretches of
consecutive identical dates and statistically inconsistent dates (outliers
in time or in space). Here, we report BernClim data of 7414 plant
phenological observations from 1970 to 2018 from 1304 sites at 110 stations, the QC procedure and selected applications (Rutishauser et al., 2019: https://doi.org/10.1594/PANGAEA.900102). The QC points to very good
internal consistency (only 0.2 % were flagged as internally inconsistent) and likely high quality of the data. BernClim data indicate a trend towards an extended growing season. They also track the regime shift in the late 1980s well to pronounced earlier dates like numerous other phenological records across the Northern Hemisphere.
Spatio-temporal assessment of the PCB sediment contamination in the four main French River Basins (1945–2018)
Authors: Dendievel André-Marie , Mourier Brice , Coynel Alexandra , Evrard Olivier , Labadie Pierre , Ayrault Sophie , Debret Maxime , Koltalo Florence , Copard Yoann , Faivre Quentin , Gardes Thomas , Vauclin Sophia , Budzinski Hélène , Grosbois Cécile , Winiarski Thierry , Desmet Marc
Published: November 2019

Abstract. Environmental pollution by Polychlorinated Biphenyls (PCBs) is a key concern about river quality because of their low degradation rates leading to their accumulation in sediments or living organisms. This original interdisciplinary work was conducted at a large scale along the four main French rivers (Seine, Rhône, Loire and Garonne Rivers), which flow into major European seas. We completed a dataset based on sediment analyses provided by monitoring agencies, port authorities and research teams on different solid matrices (cores, bed and flood sediments, suspended particulate matters, dredged sediments). This dataset (n=1416) focused on the seven indicator PCBs and their sum (∑PCBi) from 1945 to 2018. Special effort was put on the quality control to provide robust spatio-temporal information. Taking into account hydrological and human drivers, we outlined two main pollution trends: (1) from 1945 to 1975, a quick increase of ∑PCBi (up to 4 mg.kg−1 dry weight, dw) and a sharp decrease in the 1980s on the Seine and Loire Rivers; (2) increasing but moderate ∑PCBi levels (50 to 150 µg.kg−1 dw) followed by a decline after the 1990s on the Rhône and Garonne Rivers. In addition to these patterns, PCBs emissions from urban and industrial areas or accidental events were significant on each river. Finally, when calculating specific fluxes, the Rhône River exhibited the biggest ∑PCBi load (up to 12 µg.m−2.year−1 in 1977–1987), at least 25 % higher than those of the Seine and Loire Rivers, while the Garonne River showed very low fluxes. French specific ∑PCBi fluxes are two orders of magnitude lower than those found in American or Asian Rivers. In Europe, we confirmed that the Rhone and Seine Rivers provide a major supply of PCBi to the Western Mediterranean and the English Channel, respectively. The dataset is available at https://doi.pangaea.de/10.1594/PANGAEA.904277.
A Python framework for efficient use of pre-computed Green's functions in seismological and other physical forward and inverse source problems
Authors: Heimann Sebastian , Vasyura-Bathke Hannes , Sudhaus Henriette , Isken Marius Paul , Kriegerowski Marius , Steinberg Andreas , Dahm Torsten
Published: November 2019

Abstract. The finite physical source problem is usually studied with the concept of volume and time integrals over Green's functions (GFs), representing delta-impulse solutions to the governing partial differential field equations. In seismology, the use of realistic Earth models requires the calculation of numerical or synthetic GFs, as analytical solutions are rarely available. The computation of such synthetic GFs is computationally and operationally demanding. As a consequence, the on-the-fly recalculation of synthetic GFs in each iteration of an optimisation is time-consuming and impractical. Therefore, the pre-calculation and efficient storage of synthetic GFs on a dense grid of source to receiver combinations enables the efficient lookup and utilisation of GFs in time-critical scenarios. We present a Python-based framework and toolkit – Pyrocko-GF – that enables the pre-calculation of synthetic GF stores, which are independent of their numerical calculation method and GF transfer function.
The framework aids in the creation of such GF stores by interfacing a suite of established numerical forward modelling codes in seismology (computational back ends). So far, interfaces to back ends for layered Earth model cases have been provided; however, the architecture of Pyrocko-GF is designed to cover back ends for other geometries (e.g. full 3-D heterogeneous media) and other physical quantities (e.g. gravity, pressure, tilt). Therefore, Pyrocko-GF defines an extensible GF storage format suitable for a wide range of GF types, especially handling elasticity and wave propagation problems. The framework assists with visualisations, quality control, and the exchange of GF stores, which is supported through an online platform that provides many pre-calculated GF stores for local, regional, and global studies. The Pyrocko-GF toolkit comes with a well-documented application programming interface (API) for the Python programming language to efficiently facilitate forward modelling of geophysical processes, e.g. synthetic waveforms or static displacements for a wide range of source models.
Abstracts of the Medical Academic Congress of Unicamp (CoMAU), 2018
Authors: Executive Committee of IJMS IJMS
Published: November 2019

Abstracts of the Medical Academic Congress of Unicamp (CoMAU), 2018.
Health Care Expenditure of Rural Households in Pondicherry, India
Authors: Varadarajan Poornima , Moharana Lopamudra , Venkatesan Murugan
Published: November 2019

Background: Shortcomings in healthcare delivery has led people to spend a substantial proportion of their incomes on medical treatment. World Health Organization (2005) estimates reveal that every year 25 million households are forced into poverty by illness and the stru­ggle to pay for healthcare. Thus we planned to calculate the health care expenditure of rural households and to assess the households incurring catastrophic health expenditure. Methods: A cross-sectional study was conducted in the service area of Sri Manakula Vinayagar Medical College and Hospital from May to August 2011. A total of 100 households from the 4 adjoining villages of our Institute were selec­ted for operational and logistic feasibility. The household’s capacity to pay, out of pocket expenditure and catastrophic health expenditure were calculated. Data collection was done using a pretested questionnaire by the principal investigator and the analysis was done using SPSS (version 16). Results: The average income in the highest income quintile was Rs 51,885 but the quintile ratio was 14.98. The median subsistence expenditure was Rs 4,520. About 18% of households got impoverished paying for health care. About 81% of households were incurring out of pocket expenditure and 66% were facing catastrophic health expenses of 40%. Conclusion: There was very high out of pocket spending and a high prevalence of catastrophic expenditure noted. Providing quality care at affordable cost and appropriate risk pooling mechanism are warranted to protect households from such economic threats.
Brugada ECG Sign & Chest Pain Mimicking ST Elevation Myocardial Infarction
Authors: Mousa Omar , Rashid Haroonur
Published: November 2019

Background: Management of patients with the brugada ECG sign who have no previous history of syncope is still negotiable. We present a case of a 57 year-old Caucasian lady who presented to the emergency department with substernal chest pain. Results: Her past medical history showed that she had two previous episodes of lightheadedness, but no syncope. She had a family history of sudden death secon­dary to unknown cause in her aunt at the age of 61. Physical exam was unremarkable except for diaphoresis. Electrocardiography (ECG) showed ST elevation in the right precordial leads (V1-V2) with T inversion, mimicking a STEMI. Emergent cardiac catheterization revealed normal coronary arteries. Echocardiogram was normal. Again, interpretation of ECG revealed a Brugada type 1 pattern, characterized by coved-type, gradually descending ST-T segment, elevated J point of more than 2 mm and T wave inversion. Electrophysiological (EPS) testing with a Sodium channel blocker challenge showed a persistent Brugada type 1 pattern with non-inducible ventricular tachycardia. This patient had Brugada type 1 ECG pattern with no previous history of syncope (asymptomatic). Thus she was considered at low risk of developing a serious arrhythmogenic event in the future. Conclusion: A history of syncope remains the best available predictor for arrhythmogenic events. EPS testing in such patients, to stratify the risk and predict for any future events, is still controversial. It is still unjustified to place an implantable cardioverter-defibrillator in asymptomatic non-inducible individuals with the Brugada pattern. These patients should follow up closely with a cardiologist and be aware of the risk of possible triggers of ventricular arrhythmias.
Patient Perception of Physician Attire Before and After Disclosure of the Risks of Microbial Contamination
Authors: So Enoch C. T. , Fung Faraday H. F. , Yeung Joshua K. H. , Chow Lilian H. Y. , Kwok Julio S. H. , Lam Ruby L. Y. , So Tommy C. Y. , Yu Faye S. M. , Vackova Dana , Leung Gilberto K. K.
Published: November 2019

Background: The white coat is traditionally considered to be the appropriate attire for physicians but it may also be contaminated with microbes and act as a potential source of infection. We aimed to study patients’ acceptance of physicians’ attire, their underlying reasons, and their reactions to an educational intervention with regards to the risks of contamination. Methods: We conducted a voluntary ques­tionnaire survey at a university teaching hospital in Hong Kong from February to July 2012. 262 patient-responses from adult inpatients and outpatients across various specialties were analysed. Results: White coats were highly favoured (90.8%) when compared with scrubs (22.1%), smart casual (7.6%) and formal (7.3%) wears. ’Professional image’ and ‘ease of identification’ were the main attributes of the white coat. Most patients (92.2%) would prefer doctors washing their white coats every few days, whilst 80.9% believed that doctors were actually doing so. After patients were informed of the potential risk of microbial contamination, white coats remained as the most favoured attire (66.4%), but with scrubs doubling in popularity (45.8%). Smart casual (9.2%) and formal attire (4.6%) remain the least accepted. Conclusion: Despite cross-infections being a significant concern within the healthcare environments, patients’ predominant acceptance and perceived attributes towards the white coat were maintained after an educational intervention on the risks of microbial contamination.
Fibroblast Growth Factor (FGF) Receptor Mutations: A Pathway to Understanding Multigenic Risk in Disease?
Authors: Mires Stuart J.
Published: November 2019

Fibroblast growth factor receptor (FGFR) gain-of-function mutations form the pathogenic basis of multiple congenital pathologies. A pioneering body of work over the past two decades has established that a unique mutation selection process within the testis likely underlies the paternal age effect characteristics of such diseases. This mechanism, analogous to positive selection of mutations promo­ting proliferation in tumorigenesis, sparked interest in mutation profiling of testicular and other cancers. The resulting discovery of FGFR gain-of-function mutations akin to those of congenital syndromes has enabled a novel hypothesis to be born: that mutations represent a spectrum of activation. As such, FGFR gain-of-function mutations could be pathogenic not solely in defined monogenic syndromes but within myriad disease processes with ‘low activation’ conferring increased disease risk. Do such mutations contribute to multigenic risk in multiple pathologies? This review evaluates this hypothesis, alluding to the plausible clinical implications that ensue.
Complete Congenital Heart Block in a Newborn Associated with Maternal Systemic Lupus Erythematosus: A Case Report
Authors: Kiblawi Mahmoud A. , Naeem Alina , Al Attrash Elham A. , Kar Subhranshu , Goud B. K. M.
Published: November 2019

Background: Complete Congenital Heart Block (CCHB) is a rare disease of the newborn that carries significant morbidity and mortality. CCHB can be diagnosed early or late in life. In newborns, it is usually associated with maternal autoantibodies or a congenital cardiac structural abnormality. The most common presentation of CCHB is bradycardia that can be diagnosed by an electrocardiogram. Results: This is a case report of a male infant born to a mother with an autoimmune disease, Systemic Lupus Erythematosus (SLE), who was found to have third degree heart block at birth. Conclusion: Early diagnosis and prompt management of the case is important for a better prog­nosis and prevention of associated complications. Neonates with CCHB should be managed at a tertiary care center and the only definite treatment is insertion of a pacemaker. Moreover, prenatal diagnosis and specific obstetric counseling of pregnant women with SLE along with careful monitoring with serial ultrasonography and echocardiography are of paramount importance in prevention of the disease in subsequent offspring.
International Journal of Medical Students - Year 2013 - Volume 1 - Supplement 2
Authors: IJMS Executive Committee of
Published: November 2019

International Journal of Medical Students - Year 2013 - Volume 1 - Supplement 2

Abstracts of the 18th Academic Medical Congress of Piauí
International Journal of Medical Students - Year 2013 - Volume 1 - Supplement 3
Authors: IJMS Executive Committee of
Published: November 2019

International Journal of Medical Students - Year 2013 - Volume 1 - Supplement 3

Abstracts of the 4th International Student Medical Congress in Košice
The Role of Chemotherapy and Radiotherapy in the Surgical Management of Muscle Invasive Bladder Cancer
Authors: Luck Joshua
Published: November 2019

The management of muscle invasive bladder cancer represents an unresolved clinical challenge. Invasive urothelial carcinomas are associated with high mortality rates and early metastatic disease. Radical cystectomy is a recognized standard of care, although disease-free survival outcomes remain suboptimal. The limitations of pre-operative clinical staging, as well as the complex natural history of the disease, precludes the introduction of simple management protocols. To what degree chemotherapy and radiotherapy may be useful in the surgical management of invasive bladder cancer remains contentious. This literature review critically examines the benefits, risks and difficulties of each approach, with an emphasis on individually tailored therapy.
International Journal of Medical Students - Year 2013 - Volume 2 - Supplement
Authors: IJMS Executive Committee of
Published: November 2019

Abstracts of the 20th Academic Medical Congress of Piaui, Brazil, COMAPI 2013Abstracts of the 15th International Congress for Medical Students and Young Health Professionals, Romania, Medicalis 2014Abstracts of the 25th Colombian Student Congress of Medical Research, Armenia, Colombia, CECIM 2014Abstracts of the 6th International Student Medical Congress in Košice, Slovak Republic, ISMCK 2014Abstracts of the 32nd National Medical Students' Conference, Spain, CNEM 2014
Transparency in the International Journal of Medical Students
Authors: Bonilla-Escobar Francisco J. , K. Gharaibeh Aisha , J. Mires Stuart , A. Abhishek Hulegar
Published: November 2019

N/A
Gender Differences in Response to Experimental Pain among Medical Students from a Western State of India
Authors: Akhani Pratik , Mendpara Samir , Palan Bhupendra
Published: November 2019

Background: Pain is one of the most common reasons for patients to seek medical attention and it causes considerable human suffering. Pain is a complex perception that differs enormously among individual patients. Gender plays an important role in how pain is experienced, coped with and treated. Even young healthy individuals often differ in how they perceive and cope with pain. This study was done to investigate gender differences in response to experimental pain among medical students from a western state in India. Methods: A total of 150 medical students (86 males and 64 females) participated in this interventional study. The Cold Pressor Test was used to exert experimental pain. To study the response, cardiovascular measures (radial pulse, systolic blood pressure and diastolic blood pressure) and pain sensitivity parameters (pain threshold, pain tolerance and pain rating) were assessed. Results: No significant difference was found in cardiovascular response to experimental pain between both the genders (p>0.05). Pain threshold and pain tolerance were found to be significantly higher in males whereas pain rating was found to be significantly higher in females (p<0.01). Pulse reactivity showed a negative relationship with pain threshold and pain tolerance whereas a positive relationship with pain rating, however no statistically significant relation was found between these measures. Conclusion: Females display greater pain sensitivity than males. Different pain perception might account for gender difference in pulse reactivity.
Sub-tenon Anaesthesia versus Intracameral Anaesthesia in Patients Undergoing Cataract Extraction: A Comparative Study of the Level of Pain, Visual Perception and Anxiety
Authors: Mustapha Mushawiahti , Hamzah Muhammad Hazzril , Chow Soon Ken , Zulkifli Nur Syuhada , Abdul Latiff Zalikha , Dualim Diana Melissa , Cheah Su Gaik , Bastion Mae Lynn Catherine
Published: November 2019

Background: Phacoemulsification is a modern method of cataract extraction. Sub-tenon anaesthesia used to be the preferred anaesthetic technique for this procedure before intracameral anaesthesia gained its popularity in recent years. Nevertheless, many surgeons still believe that sub-tenon anaesthesia is better than topical anaesthesia. This study aimed to evaluate and compare the experiences of patients who were treated for cataract by phacoemulsification surgery using either sub-tenon or intracameral anaesthesia. Methods: Cross-sectional study conducted at Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia. Participants were asked to complete a questionnaire within 1-2 hours following surgery. The questionnaires were designed to gather information on the patient’s level of anxiety, visual perception and amount of pain experienced during cataract surgery. Results: A total of 62 patients were included in the study. Thirty-one patients received anaesthesia by sub-tenon injection, whereas another 31 patients received anaesthesia by intracameral injection. There were no significant differences in the level of pain experienced by the two groups of patients during instillation of anaesthesia and during surgery (p=0.205 and p=0.592, respectively). There were also no significant differences in terms of visual perception and anxiety levels during surgery between the two groups (p=0.178 and p=0.731, respectively). Conclusion: Intracameral anaesthesia obviates the need for an injection during cataract surgery and is as comfortable for patients as sub-tenon anaesthesia in terms of visual perception, level of pain, and anxiety.
Writing a Case Report: A Work of Art
Authors: Ortega-Loubon Christian , Correa-Márquez Ricardo
Published: November 2019

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Mitochondria as a Target for Future Diabetes Treatments
Authors: Thimm Franziska , Szibor Marten
Published: November 2019

Diabetes mellitus is rapidly becoming the world’s most dangerous serial killer. Type 1 diabetes (T1D) is a currently incurable autoimmune disease marked by progressive, and eventually exhaustive, destruction of the insulin-producing pancreatic beta cells. Type 2 diabetes (T2D) describes the combination of insulin resistance in peripheral tissue, insufficient insulin secretion from the pancreatic beta cells, and excessive glucagon secretion from the pancreatic alpha cells. T1D as well as severe cases of T2D are treated with insulin replacement, which can merely be considered as life support for the acute phases of the disease. Islet replacement of insulin-producing pancreatic beta cells represents a potential treatment method for both insulin-depleted diabetes (T1D) and insulin-resistant diabetes (T2D) and may shift diabetes management from life saving measures to a cure. One of the key challenges in islet transplants is the generation of reactive oxygen species (ROS) and the associated oxidative stress, which restricts graft longevity. A major leak of ROS takes place during oxidative phosphorylation at mitochondrial electron transport chain (ETC). Additionally, hyperglycemia-induced superoxide (O2•-) production has been linked to the development and progression of diabetic complications, both macrovascular and microvascular. Decreasing ROS in diabetic patients may prevent the incidence of long term diabetes complications. This review provides an overview of the role of mitochondria in diabetes, introducing them as a possible target for future treatment of diabetes.
A Medical Student Experience: Adding Value and Emotional Support to Patient Interactions
Authors: DiSalvo Dale S.
Published: November 2019

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Multiple Keratoacanthomas, Philadelphia Chromosome+ Acute Lymphoblastic Leukemia, and Dasatinib: A Case Report
Authors: Thukral Siddhant , E. King Jr Lloyd , E. King Jr Lloyd , H. Horowitz David
Published: November 2019

Background: Treatment for adult Philadelphia chromosome+ acute lymphoblastic leukemia includes using dasatinib, a tyrosine kinase inhibitor. Cutaneous squamous cell carcinomas and keratoacanthomas are common findings in patients treated with BRAF inhibitors of tyrosine kinases. No documentation of dasatinib inducing multiple keratoacanthomas, squamous cell carcinomas type during treatment of Philadelphia chromosome+ acute lymphoblastic leukemia is currently available. Case: A 77-year-old Caucasian male presented to the dermatology clinic two months after starting treatment with dasatinib for Philadelphia chromosome positive+ acute lymphoblastic leukemia. Biopsies confirmed the lesions on the arms, chest, legs and back as keratoacanthoma (KA) type of squamous cell carcinomas (SCCs). The cutaneous lesions were surgically removed and no new or recurrent lesions were detected since their initial rapid onset despite continued dasatinib therapy. Conclusion: This report of the rapid onset of keratoacanthoma type squamous cell carcinomas in a patient with Philadelphia chromosome+ acute lymphoblastic leukemia treated with dasatinib is presumed to be the first due to the rarity of adult Philadelphia chromosome+ acute lymphoblastic leukemia. This report documents another tyrosine kinase inhibitor that is associated with the eruption of keratoacanthomas, and adds to the literature regarding the regularity of this relatively common side effect, which may have treatment other than surgery if only a few lesions are present.
Methylprednisolone-Responsive Leptospiral Acute Pulmonary Syndrome: A Case Report
Authors: D. Johan-Arief, Iman , H. Lee Shen , Y. Er Xin , Kasinathan Ganesh , Pillai Naganathan
Published: November 2019

Background: Leptospirosis is an infectious disease caused by the spirochete of the genus leptospira. It is thought to be the most common zoonosis globally and has a wide range of clinical presentations with pulmonary hemorrhage being one of its most severe manifestations. This entity known as acute pulmonary syndrome carries a high fatality rate. However, it can be effectively managed with methylprednisolone therapy. Case: We report a case of leptospirosis in a 26-year-old Bangladeshi male who was otherwise healthy. He presented with a 7-day history of fever with chills and rigors, and hemoptysis for a duration of 2 days. Physical examination revealed a febrile and lethargic man. Respiratory examination exhibited bilateral generalized crepitations over the lung fields. A chest radiograph performed showed bilateral alveolar shadowing. The diagnosis of leptospirosis was made based on positive Immunoglobulin M enzyme-linked immunosorbent assay serology, which was then confirmed by the microscopic agglutination test for leptospirosis. The patient was commenced on intravenous antibiotics and methylprednisolone at this time. He responded well clinically with resolution of fever and hemoptysis and a marked decrease in crepitations upon auscultation. This correlated with radiological improvement evidence by an obvious reduction in alveolar shadowing on subsequent chest radiograph 2 days later. Conclusion: This case is highly pertinent to the medical field as leptospirosis is an ever-growing problem and acute pulmonary syndrome is an emerging manifestation of it. Therefore, early recognition and intervention is required as this can be effectively treated with methylprednisolone therapy even in resource-limited settings
Reply to Letter to the Editor, “Response to Medical Students’ Attitudes towards Female Sex Workers
Authors: Nakagawa Jenna Toki , Akpinar-Elci Muge
Published: November 2019

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Is Hepatorenal Syndrome a Diagnosis for the Emergency Physician
Authors: F. W. Ho Andrew , P. Pek Pin , L. Ang Tiing
Published: November 2019

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Relevance of Qualitative Research Approach in Evaluating Mental Health Interventions among Victims of Violence
Authors: Pacichana-Quinayaz Sara G. , Osorio-Cuellar Gisel V. , Gonzalez Stephanie , Bonilla-Escobar Francisco Javier , Gutierrez-Martinez Maria I.
Published: November 2019

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Lifesaving Sonography Protocols: A Pilot Course Involving Undergraduate Medical Students
Authors: Wisniewski Jakub , Garnier Hanna
Published: November 2019

Background: Ultrasonography protocols are easy to learn, frequently used in emergency medicine, and could be useful for inexperienced doctors. Inthis field, only a few protocols are needed to give an initial diagnosis and to start fast and proper treatment. Until now, only Focused Assessmentwith Sonography for Trauma (FAST) protocol training studies have been reported in the medical literature. Our point-of-care course, comprisedof extended FAST, lung scan and ocular scan trainings. The students’ curriculum usually does not include such ultrasonography courses, thus,we wanted to check its utility for the undergraduate medical students. Methods: Training lasted six days and consisted of two parts: 22 hoursof theoretical classes and 18 hours of practical activities, all trained and evaluated by six experienced medical doctors. Eighty-five electedstudents completed pre- and post-study questionnaires about emergency ultrasonography and passed the practical final exam. Results: Eighty-fiveparticipants of the course were present in the pre- and final test. Final test scores of theoretical and practical exams were significantly higherafter the training (58% vs. 87%; n=85; p<0.01). Answers for the questions related to FAST and EFAST (extended FAST) were correct irrespectiveof completion of the course. A question regarding the sonographic evaluation of body fluid incontinence was found to be the most difficult forstudents. After the course, 96.5% of participants were able to complete an EFAST scan at an adequate level of performance in under two minutes.Conclusion: Results show that medical students significantly extended their knowledge about point-of-care emergency medicine ultrasonographyand acquired practical skills during the course. Emergency medicine ultrasonography courses could be included into medical students’ curricula.
Outbreak Medical Mapping and the U.S. Nickel Epidemic: It Is Time to Implement Control and Prevention Measures
Authors: Brankov Nikoleta , Bergman Daniel , Goldenberg Alina , Jacob Sharon
Published: November 2019

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Superior Mesenteric Artery Syndrome: A Worldwide Descriptive Study with Literature Review
Authors: Awaludin Ruhidayati , Ab Rahim Hazimah , Syazana Arivai Dg. , Refaie Elkeleny Mostafa
Published: November 2019

Background: Superior mesenteric artery syndrome is best described as compression of the third part of duodenum by the superior mesenteric artery, resulting in obstruction. This rare condition has been studied for decades yet remains obscure. This study aimed to analyze different clinical presentations, diagnostic modalities, treatment approaches and outcomes of this condition. Methods: Thirty-five superior mesenteric artery syndrome cases were collected retrospectively from a Facebook group called “Superior Mesenteric Artery Syndrome Awareness & Support”. A questionnaire was designed using Google Forms to obtain the demographics, presenting symptoms, risk factors and co-morbidities, investigations, means of treatment and the outcomes. Data was entered into Microsoft Office Excel for statistical analysis. Results: The median age at diagnosis was 22 years. The median body mass index was 20.8 kg/m2. The median time interval from symptom onset to initial diagnosis was 22 months. The major presenting symptoms were abdominal pain (82.9%), nausea (77.1%), and vomiting (65.7%). Abdominal computed tomography scan with contrast (82.9%) was commonly used for confirmation of diagnosis. Thirteen cases (37.1%) were congenital. Thirty patients (85.7%) had received treatment. The overall management success was only 13.3%. Surgical management (34.3%) was the most commonly used regimen. Conclusion: Diagnosis of superior mesenteric artery syndrome is established after a thorough assessment of the clinical presentations and confirmed with suitable imaging modalities. The choice of treatment should be dependent on the causes and severity as different patients respond differently to therapy. Recurrence is possible in all patients, and a long-term follow up is thus required.
The Importance of Rapid Consideration of Creutzfeldt- Jakob Disease in the Differential Diagnosis of Progressive Neurodegenerative Disease: A Case Report
Authors: Joseph Arthur , Core Jacob , Solano Daniel , Patton Marquand , Smart Shaun
Published: November 2019

Background: Creutzfeldt-Jakob disease (CJD) is a prion disease characterized by misfolded proteins that lead to neurodegeneration and inevitable death. Classic sporadic CJD presents primarily with cognitive symptoms and ataxia without visual impairment at the onset of the illness. Seizure activity is a rare presentation of patients with sporadic CJD. Case: We present a rare case of rapidly progressive encephalopathy in a 57-year-old female who presented to the emergency department with bizarre behavior and vision deterioration. Imaging was unrevealing, and infectious and organic causes were ruled out. Electroencephalogram showed evidence of encephalopathy and non-convulsive status epilepticus. Magnetic resonance imaging conducted later displayed high signal intensity in centrum ovale. The patient’s history, results from diagnostic analyses, and clinical presentation suggested the diagnosis of CJD (sporadic type). Conclusion: Due to the low incidence and varying clinical presentations, it is difficult to include CJD in a differential diagnosis without specific analytic measures. However, for the benefit of the patient and healthcare resources, CJD needs to be quickly considered when rapid neurological decline or non-convulsive status epilepticus is not suggestive of another entity
Attitudes to and Understanding of Placebo Use: A Cross- Sectional Exploratory Study in a Malaysian Hospital
Authors: Tuthill Amanda Villiers , Han Tay Zhuo , Chai Chang Xian , Chai Ai Wen , Wong Chun Yiing , Morgan Karen
Published: November 2019

Background: This study explored doctors’ understanding of ‘placebo’, mechanisms of action, perceptions about effectiveness and concerns about use in a Malaysian teaching hospital. Methods: A survey questionnaire. Results: Respondents were 76 doctors (response rate: 55%): 52% were female, mean age was 32 years, and 61% were physicians/medical officers. Most (66.2%) never used a placebo. The main reason for use of placebos was for a possible psychological effect. Placebo use was considered unacceptable due to endangering of doctor-patient trust (59.2%) or patient deception (47.4%). Conclusion: Developing specific and professional standards and guidance on placebo use could help doctors to leverage the benefits of placebo use without endangering the doctor-patient relationship.
Syrian Refugee Relief: A Recent Graduate’s Volunteer Experience
Authors: Al Deen Mohammad Saad , S. Mousa Yazan
Published: November 2019

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Reflections on the Need for More Training in Neuroethics for Future Physicians: An Interdisciplinary Approach
Authors: Soriano Oriol , Morales Isabel
Published: November 2019

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Sixth Class Students' Performance and Confidence Levels Before and After Training in Clinical Skills Laboratories
Authors: Mustafa Abualhayja'a Ali , Ankarali Handan , Alyacoub, Ramez , Abudayeh Ala' , Alsaoud, Sara , Majed Alsaeidi Omar , Alsmady Moaath , Massad Islam , Alimoglu Orhan
Published: November 2019

Background: Acquisition of basic clinical skills by undergraduate medical students is becoming of greater concern. Clinical skills laboratories may provide a comfortable environment for training and may allow students to gain adequate performance level. The aim of this study is to evaluate students' performance and confidence levels before and after training of selected procedural skills; also to explore students' expectation towards skills laboratory training. Methods: Two questionnaires were conducted before and after training sessions in the clinical skills laboratory, school of medicine, University of Jordan, Amman, Jordan. The skills selected for this study: suture practice, venous access, arterial access, intradermal and intramuscular injection, central venous cannulation, male and female urinary catheterization, nasogastric tube placement and rectal examination. Although fifty-seven 6th year medical students filled the first questionnaire at the beginning before training, only 29 students could attend all training sessions, and fill the second questionnaire. Results: For all trained clinical skills, the mean students' performance scores and confidence levels were significantly increased after training (P <0.001). Expectations of students for skills laboratory were high. Conclusions: The students' performance and confidence levels were significantly improved after training in the clinical skills laboratory.
Molecular Characterization of Staphylococcus aureus Isolates Obtained from Hemodialyzed Patients at the Hospital de Clínicas of Paraguay: A pilot study
Authors: Silvero Isidre, Rubén Arturo , Rodríguez Acosta Fátima , Cristaldo Vargas César Rodrigo , Velázquez Romero Genaro Américo , Plans Perrota José Félix , Guillén Fretes Rosa María
Published: November 2019

Background: Patients undergoing hemodialysis are susceptible to the nasal carriage of Staphylococcus aureus, increasing the risk of developing infections associated with higher morbidity and mortality. The objective of this study was to describe the frequency of S. aureus carriage in hemodialysis patients and to perform molecular analysis of isolates by applying multiple-locus variable analysis. Methods: We conducted a descriptive cross sectional study with non-probabilistic sampling that included 28 hemodialysis patients attending the Nephrology Department of Hospital de Clínicas in Asunción, Paraguay. We obtained clinical data from medical records and interviews with patients. Nasal swabs were collected and analyzed by microbiological and molecular methods. Results: The frequency of S. aureus carriage was 50% (14/28), 93% of which (13/14) were methicillin resistant, 57% (6/14) were gentamicin resistant and 36% (5/14) were resistant to more than 4 antibiotic classes. S. aureus carriers showed higher frequency of rhinitis (p=0.02 odds ratio [OR]=6.6 (1.2- 34.4)). Seven methicillin-resistant S. aureus isolates had been analyzed by multiple-locus variable analysis, two of them showed identical pattern bands. Conclusion: We found a high frequency of methicillin-resistant Staphylococcus aureus colonization and the presence of two isolates with identical profile in the multiple-locus variable analysis indicating the possibility of transmission between patients.
Double Inlet Left Ventricle with Eisenmenger Syndrome in an Adult – A Case Report
Authors: Regi Abraham Rahul , Regi Abraham Rahul
Published: November 2019

Background: Patient diagnosed with double inlet left ventricle (prevalent in 5 – 10 in 100,000 newborns) complicated with Eisenmenger syndrome had a median survival age of 14 years without corrective surgery. Congenital heart disease such as this is usually treated by multiple surgeries during early childhood. A surgically uncorrected case in adults is not of common occurrence. Further, generalized itching after coming in contact with water (aquagenic pruritis) presented an interesting conundrum to treat. Case: A 29-year-old patient in India presented at a primary health care center with a history of difficulty breathing and discoloration of extremities since birth. He also gave a history of itching which commonly occurred after taking bath, hemoptysis and history of turning blue in color after birth. Patient had received no treatment besides regular phlebotomies. On examination, there was grade IV clubbing and conjunctival congestion. Cardiovascular examination revealed an enlarged heart, heaving apex beat and a pan-systolic murmur. A provisional diagnosis of a congenital cyanotic heart disease was made. Investigations revealed hemoglobin of 16.8g/dl. X–ray and electrocardiogram showed hypertrophy of the ventricles. An echocardiogram showed double inlet left ventricle with L-malposed vessels but without pulmonary stenosis. A final diagnosis of congenital heart disease; double inlet left ventricle, L-malposed vessels without pulmonary stenosis, Eisenmenger Syndrome and absolute erythrocytosis was made. Patient was advised for further management with a cardiologist in a tertiary center but the patient did not follow up. Conclusion: Unlike in high-income countries where most congenital heart diseases are detected and dealt with at birth whereas low-and middle-income nations often have to deal with cases that present much later and should often be included in the differential diagnosis. Inability to follow up cases, centers that are poorly equipped and lack of facilities for investigations, patient’s lack of medical awareness, and financial restrictions are major barriers to providing optimal treatment.
Surprises in Applying and Interviewing at Residency Programs in the United States
Authors: Ta Robert
Published: November 2019

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Abstracts of the Academic Medical Congress of Piaui, COMAPI, 2017
Authors: IJMS Executive Board of
Published: November 2019

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Life Goes On – Death and Dying in the Medical Field
Authors: Hussain Sara
Published: November 2019

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Fighting blindness with a Guerrilla: The Guerrilla Eye Service of Pittsburgh
Authors: Bonilla-Escobar Francisco J.
Published: November 2019

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A Survey Based Feedback Analysis of the Current Medical Teaching Methodology and Trends in Medical Research Practice in a South Indian Medical Institute
Authors: Nekkanti Supreeth , Manjunath Sagarika , Mahtani Arun , Meka Archana , Rao Tanushree
Published: November 2019

Background: The spine of a good healthcare system is the medical education received by its doctors. As medicine is evolving, the same can be inferred regarding the delivery of medical education. This study was conducted among 541 students in a prestigious medical college in India. The aim of the study was to find out lapses in our current medical education system and steps to improve it. 
Methods: A total of 541 medical students were included in this study. The only inclusion criteria being that they should be in their 2nd year MBBS or above. A questionnaire of 20 questions was given to each student and they were asked to mark the answers they felt was most appropriate. The questionnaire dealt with issues faced in our current education system regarding teaching methodology, clinical postings, research, evidence based medicine and steps to improve the healthcare system. Data was collected, analysed and statistically evaluated using Microsoft Excel and SPS version 21.0. 
Results: Majority of the students felt that classroom strength should not be more than a hundred students. They felt that more innovative teaching methods and discussions should be included. Students laid emphasis on research, clinical skills training and evidence based medicine. They felt that the healthcare system also needs tweaking in terms of funding and practicing evidence based medicine to be on par with healthcare systems across the world. 
Conclusion: The results in this study, resonates with the results of various other studies regarding delivery of medical education. It also takes into account the holistic approach of improving medical education and healthcare rather than focusing on one single aspect.
Do Thai Medical Students Understand What Does ‘AEC’ Mean? A Cross-sectional Survey.
Authors: Kittrakulrat Jathurong , Jurjai Ravipol , Jongjatuporn Witthawin , Jarupanich Nicha , Bhamani Annabel , Pongpirul Krit
Published: November 2019

Background: Thai medical students are inevitably involved in the regional collaborative movement of 10 countries toward the ASEAN Economic Community (AEC), this study explored how well they understand the term.

Methods: Twelve students proposed an abbreviation list, which was then rated for their difficulty level by another 55 students using a 5-point Likert scale. Three easy, three medium and three difficult abbreviations were randomly chosen and randomly listed in the final questionnaire, along with ‘AEC’. Another randomly selected 60 students were asked to write the full term of the 10 abbreviations.

Results: Of 34 abbreviations in the initial list, the selected terms were: CMCTSD, SRL, LSC, SOS, AM, LOL, WHO, USA, UK. They were correctly answered in 0, 0, 0, 6.67, 13.33, 46.67, 81.67, 96.67, and 98.33 percent, respectively. AEC was deemed moderately difficult, as 30% correctly expanded the abbreviation.

Conclusion: Majority of medical students lacked an understanding of the current AEC movement.
Detachment of the Amplatzer Device after Interventional Closure of a Mitral Prosthesis Paravalvular Leak
Authors: Pavel Alexandra
Published: November 2019

Background: Paraprosthetic leak is a complication of mitral and aortic valve implantation interventions, that can be treated either through a surgical procedure (repair or replacement of the prosthesis) or by means of a less-invasive percutaneous transcatheter approach. Nevertheless, this percutaneous intervention carries complications on its own, one of them being displacement of the occluder device.

Results: This is the case of a 66-year-old patient, with a clinical history of two mitral valve replacement procedures, who presented with dyspnea, fatigue, and peripheral edema. Echocardiographic findings described severe mitral regurgitation due to the presence of a paravalvular leak. Considering the high perioperative mortality, renal and respiratory impairment, and the fact that this reoperation would have been the third cardiac surgery for the patient, percutaneous transcatheter closure of the leak was recommended. Four days after the successful procedure, a checkup echocardiogram revealed the migration of the occluder device to the left atrial cavity. Even though the operative risk was high and the prognosis poor, the only available treatment option was the surgical management that achieved the removal of the device and replacement of the diseased prosthesis.

Conclusion: Albeit less invasive, lower risks, and better outcomes, the percutaneous intervention for leak closure has some clinically relevant complications that must be addressed promptly. One of these complications – detachment of the occluder device – even if quite rare, is a significant event that requires immediate surgical or interventional approach. A careful postoperative checkup is therefore essential to detect any complication and to address it directly.
Case Report: 56-year-old Woman Presenting with Progressive Hearing Loss, Chronic Otitis Media and Pulsatile Tinnitus
Authors: Morejon-Troya Luis , Jimenez-Zambrano Joyce
Published: November 2019

Introduction: Glomus tumors are rare benign lesions of the middle ear that are often associated with symptoms of progressive hearing loss and pulsatile tinnitus. Diagnosis is often delayed due to the slow growth of the tumor, and surgical resections of the mass are the mainstay treatment.

Case Presentation: A 56-year-old Latin American female was admitted to the hospital with a year-long history of intermittent pulsatile buzzing noise, progressive hearing loss, pain and discharge of the left ear. High-resolution Computerized Tomography and Magnetic Resonance Imaging revealed evidence of an enhancing mass lesion, which extended into the external auditory canal. A tympanomastoidectomy was performed. Most of the mass was removed, but some remained because of massive bleeding. The patient received 3 months of radiation therapy after the tympanic paraganglioma was surgically removed.

Conclusion: This case exposed the audiological findings, the location, and the extent of the tumor. Management options consist of radiation therapy and surgical management, depending on the size of the tumor. Early detection of glomus tumors is essential to prevent non-reversible complications.
HR Managers’ Views on SHRM and Its Role in Influencing Organizational Performance
Authors: Bassem Mariam , El Badawy Tarek A. , Magdy Mariam M.
Published: November 2019

The resource-based view argues for the importance of creating a sustainable competitive advantage for organizations to survive and thrive. Through their people, organizations can create a strong diverse and immobile workforce. In this study, we explored the significance of strategic human resource management in Egyptian national organizations. We sought after the views of human resource managers on the activities organizations support to link their human resource management activities to long-term strategies and objectives. The qualitative semi-structured interviews highlighted common activities among the visited organizations. The findings demonstrated that strategic human resource management is still in its infancy stage. Egyptian organizations are losing dynamism because of the poor management of their people.