Check out the link below to view the full article.

http://msrj.chm.msu.edu/wp-content/uploads/2022/11/223-epub-final.pdf

Abstract

Case: We present a case of acute idiopathic four-compartment syndrome of the leg, treated by four-compartment fasciotomy, and wounds left to heal by secondary intention due to persistent edema following surgery.

Conclusion: This case highlights the importance of maintaining a high level of clinical suspicion for idiopathic spontaneous compartment syndrome presentation. This case also illustrates the variability of compartment syndrome treatment and recovery. The standard treatment for compartment syndrome is fasciotomy with delayed primary wound closure, but the patient elected to heal by secondary intention. The patient’s long term follow-up results showed positive outcomes.

Check out the link below to view the full article!

https://msrj.chm.msu.edu/wp-content/uploads/2022/11/226-ePub-final.pdf

Background: In addition to the purposeful teaching of knowledge and skills to medical students, the “hidden curriculum” refers to the inadvertent – and often unrecognized – transmission of implicit ideas, attitudes, and behaviors. One way to raise student and teacher understanding of the hidden curriculum (HC) is to provide them concrete examples of how and when it occurs during medical school. The goal of this study was to investigate how the HC is depicted popular medical television (TV) shows.

Methods: A systematic content analysis of successive episodes of eight prime-time TV shows was completed using a standardized classification scheme. A complete season of each TV program was analyzed to identify and classify depictions of the HC as it pertains to medical students. Our classification scheme used four dominant themes: what students discovered about medicine, what students learned about becoming a physician, what students experienced, and what students realized about themselves. After coding, all incidents were classified as “negative” if a rule or normal procedure was broken, or “positive” if they followed established professional values or provided patient-centered care.

Results: A total of 137 episodes were viewed with 1160 depictions of the HC portrayed. The TV shows with the most depictions were Code Black and Scrubs. Within the four dominant themes, 45 subthemes were identified. Most depictions (66.7%) were described as positive and included conflict resolution, sensitivity, respect, empathy, accountability and role-modeling. However, 33.3% (386/1160) were negative and included unrealistic patient expectations, working in a chaotic environment, haphazard learning interactions, emotional detachment, loss of idealism, complex social situations, and dealing with uncertainty.

Conclusions: Television dramas contain many positive and negative examples of the hidden curriculum during undergraduate medical training. Short snippets from these incidents could be used in an educational setting to teach related issues including professionalism, ethics, role modeling, communication skills, and coping techniques.

Author: Haleigh Prather, MHS, Oregon Health & Science University

Here’s a reflection from our Fall 2021 journal that most of us could relate to:
https://msrj.chm.msu.edu/wp-content/uploads/2022/10/227-ePub.pdf

Abstract: This piece is a conversation and reflection of my ongoing relationship with toxic professionalism in medical school. Students are often at the whim of their evaluators to give them outstanding feedback in the name of having a strong residency application, but a great deal of the criteria we are evaluated on is subjective. One piece of feedback I’ve gotten more than once that I take issue with is the idea that being extroverted, enthusiastic, and cheery in medicine is seen as “unprofessional” and that I need to change myself. I am pushing back on this idea and advocating for medical students to feel more comfortable being themselves during patient encounters and asking those in evaluative positions of power to consider how feedback such as this contributing to phenomena like physician burn out.

Key Phrases: Medical School, Medical Professionalism, Student Burnout

Check out this interesting reflection!

https://msrj.chm.msu.edu/wp-content/uploads/2022/10/212-ePub.pdf

Author: Hettiarachchige  Diluksha  Prasad  Jayawardana, University of Colombo

Abstract: The crooked tree has been adopted as the universal symbol for the field of orthopedics. Each part of this tree has hidden meanings closely related to orthopedic surgery. The purpose of this article is to generate thoughts among medical professionals and stimulate discussion among them on concepts behind the crooked tree and orthopedic surgery.

Another new and interesting article from our Fall 2021 Issue!

https://msrj.chm.msu.edu/wp-content/uploads/2022/10/208-ePub.pdf

Authors: Luna Kinoshita¹*, Aya Goto, MD, PhD², Makoto Kashimura, PharmD, PhD³, Norihiko Watanabe, BS⁴, Kenneth E. Nollet, MD, PhD⁵

¹School of Medicine, Fukushima Medical University, Fukushima, Japan. ²Center for Integrated Science and Humanities, Fukushima Medical University, Fukushima, Japan. ³Education Evaluation Division, Fukushima Medical University, Fukushima, Japan. ⁴Medical Information and Supply Management Division, Fukushima Red Cross Blood Donor Center, Fukushima, Japan. ⁵Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan.

Background: As the number of young people in Japan decreases, the proportion of them who donate blood warrants urgent attention. The aims of this investigation were to test whether students’ motivation of “doing good for others” associated with their blood donation behavior and to explore factors associated with their motivation.

Methods: Fukushima Red Cross Blood Donor Center conducted a questionnaire survey in 2018 at 10 high schools in Fukushima Prefecture (N=4506). From the database, we analyzed the factors associated with motivation as assessed by the perception of “doing good for others” using chi-square tests and binomial logistic regression.

Results: The percentage of those answering “doing good for others” as “important” was 67.2%. Students who donated blood more often tended to cite “doing good for others” as important. The probability of regarding this perception as important was significantly higher among females, those with better subjective health, and those knowing their own blood type and donation eligibility criteria.

Conclusion: Health promotion activities that improve subjective perceptions of one’s health may reinforce students’ awareness of blood donation as “doing good for others” that might promote frequent donation. Our results also support greater outreach to male students and improving students’ knowledge related to blood donation.

Key words: blood donation, blood donors, donation behavior, students, Japan

Here is the abstract of our newest accepted publication, Please follow the link below!

https://msrj.chm.msu.edu/wp-content/uploads/2022/10/198-ePub.pdf

Authors:

Mark Sharobim BSc, MSc^1*, Peter A. Tsivis, MD, MBA^1,2

¹Saba University School of Medicine, The Bottom, Saba, The Caribbean Netherlands
²Rocky Vista University College of Osteopathic Medicine, Ivins, Utah, USA

Introduction:
Gliomas are neoplasms of the central nervous system (CNS). Despite aggressive treatment, median survival of malignant tumors remains poor at 12 – 18 months. Newer treatments allow delivery of therapeutic substances across the selectively permeable blood-brain barrier (BBB). This allows for chemotherapeutics to more easily reach their target location in the CNS. Drug eluting wafers made up of carmustine can be placed in the surgical resection cavity of a tumor and clinical trials to date have demonstrated their utility.

Hypothesis:
Bypassing the BBB to allow greater accumulation of chemotherapeutics in the CNS will improve clinical outcomes in glioma patients.

Methods:
Studies from medical literature databases describing trials using carmustine wafers implanted after glioma resection were obtained. To test our hypothesis, the available data using this therapy was compared to current first line treatment data for glioma as described by Stupp and colleagues. The inclusion criterion for efficacy analysis was histopathologically confirmed primary glioma. Exclusion criteria included presence of metastasis or pediatric tumors.

Results:
10 studies describing wafer therapy use were initially gathered, encompassing over 500 patients. 6 studies met criteria for treatment efficacy analysis. 4 of 6 (75%) trials exhibited significant survival advantage as compared to control treatment. Furthermore, 3 of the 4 (75%) studies showing significance also demonstrated equal or higher percent increase in overall survival from control as compared to data generated from current first line therapy.

Conclusion:
Treatments bypassing the BBB are not currently standard-of-care for patients with glioma. We uncovered that most trials using carmustine implants post tumor resection describe increased overall survival, however in specific cohorts. Diverting the BBB in general may also have fewer side effects in contrast to classical routes of therapy. Future work is needed to develop similar therapeutics that improve outcomes in all age, gender, and prognostic risk factor populations.

Key words: Glioblastoma, Glioblastoma Multiforme, Blood-Brain Barrier, Drug Delivery Systems, Carmustine, Carmustine Wafers, Blood-Brain Barrier Disruption.

Interested in the gut microbiome?  Read the abstract and click the link below for our newest accepted publication!

http://msrj.chm.msu.edu/wp-content/uploads/2022/10/218-ePub.pdf

Authors: Divya Lakshmi Yerramsetty, Dipendra R. Pandeya, Ph.D.
Medical University of the Americas, Devens, MA, USA

Hypothesis: Compared to the flawed antimicrobial interventions, fecal microbiota transplantation (FMT) is more efficacious and safer in offering a significant clinical resolution of recurrent Clostridioides difficile (rCDI) – the world’s leading hospital-acquired infection.

Methods: An electronic search using Medscape, PubMed, and Google Scholar databases, limited only to articles published in academic journals with full-text access within the past ten years (2010-2020). Selection criteria consisted of quality research studies with relevant findings from patient follow-up post-FMT, considering both primary and secondary endpoints of the investigations. An evidence table was created to organize and evaluate the notable features of each source.

Results: Three RCTs, two retrospective cohort studies, and two systematic reviews and meta-analyses have established that FMT is an effective alternative to standard care in treating rCDI. Multiple infusions of FMT as a monotherapy and rescue treatment demonstrated near-complete clinical resolution in patients with rCDI. Further management of rCDI with the recommended first-line agents (e.g., vancomycin and fidaxomicin) proved counterproductive to FMT in comparative studies.

Conclusions: With its unappealing aesthetics and under-researched long-term implications, there is increased reluctance to FMT’s regular use. Before declaring the novel procedure as the best form of medical practice, future studies should have a stronger emphasis on vancomycin and fidaxomicin to allow for the effective comparison of FMT to non-FMT treatments. Despite the existing limitations, including insufficient sample sizes, FMT has still shown overwhelming promise as a curative treatment for rCDI.

Keywords: Dysbiosis, gut microbiome, FMT, human feces, rCDI, treatment

Here is the abstract of our newest accepted publication, Please follow the link below!

http://msrj.chm.msu.edu/wp-content/uploads/2020/08/MSRJ2019187.pdf

Deborah Anuoluwapo Aina, Saba University School of Medicine, Devens, MA, USA, Dutch Caribbean

Objective: The aim of this literature review is to evaluate the hormonal relationship between polycystic ovary syndrome and hypothyroidism.

Methods: Electronic databases such as Ebscohost and PubMed were searched, using words and phrases specific to the topic. Journal articles were filtered for publications from no earlier than 2008 to ensure accuracy and relevance.

Results: Anti-thyroid peroxidase antibodies and thyroid-stimulating hormone were significantly higher in polycystic ovary syndrome patients compared to controls (P<0.05). Polycystic ovary syndrome patients also had a statistically significant higher prevalence of autoimmune thyroiditis (P=0.035) and subclinical hypothyroidism (P=0.0133) compared to controls. In polycystic ovarian syndrome patients with thyroid-stimulating hormone levels ≥2.5 mIU/L, a significantly increased insulin resistance (P=0.007) and a significantly decreased insulin sensitivity (P=0.003) were observed compared to same patients with thyroid-stimulating hormone levels <2.5 mIU/L. Serum triglycerides were significantly higher in polycystic ovary syndrome patients with subclinical hypothyroidism compared to same patients with normal thyroid function (P=0.013). A significant positive correlation was present between luteinizing hormone and thyroid volume (P=0.007) and between anti-thyroid peroxidase antibodies and thyroid volume (P<0.0001). With thyroid hormone replacement, there was a significant increase in insulin sensitivity and free T3 /T4 levels, with a corresponding decrease in serum thyroid-stimulating hormone, prolactin, estradiol, insulin resistance, and free testosterone in polycystic ovary syndrome patients with untreated hypothyroidism. The polycystic-appearing ovaries and ovarian volumes in these patients also significantly regressed (P<0.05).

Conclusion: Polycystic ovary syndrome is associated with hypothyroidism. Hence, achieving euthyroidism may improve the clinical and morphologic characteristics of polycystic ovary syndrome.

Keywords: PCOS, hypothyroidism, levothyroxine, polycystic ovary, hormone, thyroid, autoimmune, insulin resistance