Open Access Short Research Article

Scoring Short Answer Questions of Five Borderline Medical Students

Monique Trigg, John Barnard, Hannah Pham, Peter Devitt

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/10.9734/BJMMR/2016/29295

Background: The assessment of medical knowledge is integral to becoming a medical practitioner in Australia, and Short Answer Questions (SAQs) are frequently used in this process. This paper compares the use of Classical Test Theory (CTT) and the Rasch rating scale measurement framework in scoring SAQs to evaluate the competence of borderline candidates in Australian medical students.

Aims: The aim of this study was to utilise two scoring paradigms to compare the results of borderline medical students on SAQs.

Methods: Forty SAQs were administered to 140, fifth year medical students at an Australian university in an online practice examination. Aligned with CTT, each student’s performance was expressed as the sum of the question scores. The data was then also analysed within the Rasch rating scale measurement framework and measures of performance were obtained. The two sets of results were compared across borderline students.

Results: According to CTT, five students were identified as being exactly at the pass mark of 50 per cent. Rasch analysis indicated however that although the students had the same ability estimates, their approach to answering SAQs were vastly different, altering the interpretation of their overall performance. 

Conclusion: The sole use of CTT in the analysis of examination data may result in issues of validity and reliability when measuring clinical competence. The Rasch rating scale measurement framework may be invaluable in informing the analysis of performance in high stakes scenarios to ensure fair decisions of clinical competence.

Open Access Original Research Article

Distribution of Six Polymorphisms in Two Communities with a Historical High Incidence of Diabetes and Obesity in Yucatan, Mexico

Miriam Givisay Domínguez-Cruz, María de Lourdes Muñoz, Armando Totomoch-Serra, María Guadalupe García-Escalante, Nina Valadez-González, Doris Pinto-Escalante, Álvaro Díaz-Badillo

Journal of Advances in Medicine and Medical Research, Page 1-12
DOI: 10.9734/BJMMR/2016/28660

Aims: Maya ancestry populations from Yucatan have exhibited a high prevalence of diabetes and obesity; consequently, the aim of this study was to determine the allelic and genotype frequencies of six polymorphisms associated with diabetes and obesity in two Maya populations.

Place and Duration of Study: Department of Genetics and Molecular Biology, Centro de Investigación y de Estudios Avanzados del IPN; Laboratorios de Genética y Hematología, Centro de Investigaciones Regionales “Dr. Hideyo Noguchi”, Universidad Autónoma de Yucatán between September 2014 and March 2016.

Methodology: Healthy individuals with Maya ancestry were recruited in small rural and urban communities from Yucatan. Six polymorphisms present in five genes (PPARGC1A, NRF1, SLC30A8, ADRA2A and UCP3) were genotyped using TaqMan assays. Linkage disequilibrium analysis was performed for rs13266634 and rs11558471 (SLC30A8).

Results: The observed frequencies in the small rural community (SRC) and Merida were in Hardy Weinberg equilibrium. Frequencies of five polymorphisms (rs8192678, rs1882095, rs13266634, rs11558471 and rs3781907) correlated with 1000 genomes project data, furthermore, statistical analysis did not reveal a significant difference between genotype frequencies of the SRC and Merida populations. Contrary, frequencies from Mexicans living in Los Angeles compared with frequencies obtained in Yucatan (SRC and Merida) indicated significant difference on genotype frequencies in the ADRA2A gene (P-value= .017). The polymorphisms rs13266634 and rs11558471 in the SLC30A8 gene displayed strong linkage disequilibrium (D’= 0.96), displaying frequencies of 0.725, 0.255, and 0.015 for haplotypes C-A, T-G, and C-G respectively.

Conclusion: Distribution of A allele in rs553668 (ADRA2A) in the Yucatan populations was higher than the frequency reported for Mexicans from LA, Americans, Europeans, and Africans. This finding could be related to blood pressure levels in the Maya populations. Additionally, a high frequency of C-A haplotype (rs13266634 and rs11558471) in the SLC30A8 gene could be associated with an increased risk of diabetes and obesity in these populations.

Open Access Original Research Article

Assessment of Changes in Sex Hormones, Cortisol and White Blood Cells during Menstrual Cycle in Female Asthmatic Students at NAU, Nnewi, Nigeria

R. Ukibe Nkiruka, N. Ukibe Solomon, C. Onyenekwe Charles, E. Ahaneku Joseph, N. Monago Ifeoma

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/BJMMR/2016/27400

Background: Asthma is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms due to triggers to which the patients are sensitive. Due to the hormonal variations in monthly cycles, women are at risk of increased asthma exacerbations which require close monitoring of those patients to ensure better control and management of the condition.

Aims of Study: This study was designed to assess the changes in sex hormones (progesterone and estradiol), cortisol and white blood cells in asthma female students in Nnamdi Azikiwe University, Nnewi Campus Nigeria.

Materials and Methods: A total of 120 female students with regular menstrual cycle, within the age bracket of 18-35 were randomly recruited for the study. 60 female participants were students who have been diagnosed of asthma exacerbations and use synthetic therapy (Inhaled corticosteroid therapy), while the remaining 60 female participants were apparently healthy control females students. The eligible female students were classified based on menstrual phases as: (i) Follicular asthma females (n=60), (ii) Luteal asthma females (n=60), (iii) Follicular control females (n=60) and (iv) Luteal control females (n=60). Blood samples were collected consecutively from each of the participant at the mid-follicular (4th-13th) and mid-luteal (14-23rd) phases of their menstrual cycle for determination of progesterone, estradiol and cortisol, using ELISA kit method and white blood cell indices using Sysmex K21N Hematology analyzer.

Results: 40 (66.7%) of the Asthma students reported increased exacerbations with reduced activities at mid-luteal phase of their menstrual cycle while 20 (33.3%) reported increased exacerbations with reduced activities at mid-follicular phase of menstrual cycle. The mean serum progesterone, and cortisol in asthma female subjects at follicular phase were significantly lower compared with the values at luteal phase of menstrual cycle (P=.05). Progesterone level was lower in asthma females compared with control females at luteal phase of menstrual cycle (P=0.05). Estradiol level was significantly higher at follicular phase compared with the value at luteal phase of menstrual cycle in asthmatic females (P=0.05). Estradiol level was significantly lower in asthma females compared with control females at both phases of menstrual cycle (P=0.05 respectively). The percentage neutrophils was significantly lower in asthma female subjects when compared with the value in control female subjects at both follicular and luteal phases of menstrual cycle (P=.05 respectively).

Conclusion: The changes noted in this study vary according to the phases of the menstrual cycle which may be indicative of a link between respiratory symptoms and hormonal changes through the menstrual cycle. This may be attributed to inhibitory effects of the synthetic glucocorticoids on hypothalamo-pituitary-adrenal axis and on the proliferation, growth and migration of white blood cells in asthma female students.

Open Access Original Research Article

Patient Satisfaction with Treatment Method: A Determinant of the Efficacy of Cognitive Behaviour Therapy Compared with Psycho-pharmacological Intervention Therapy

Abdollah Alizadeh, Maryam Mokhtarzade, Parastoo Damercheli

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/BJMMR/2016/10765

The first aim of the research was to compare the Cognitive Behavior Therapy (CBT) with psychopharmacological intervention (PI) and to find out its effectiveness on Iranian women with Anxiety disorders (general anxiety disorder GAD, obsessive compulsive disorder OCD, social anxiety disorder SAD). The second one was to investigate which treatment satisfies the patients more. The sample consisted of 300 women from 18 to 45 who referred to counseling and mental health centers and private offices in Islamshahr city (Tehran state). They were divided into two groups: 1) One group with three disorders (GAD, OCD and SAD) referred to CBT. 2) The other group with the same disorders received PI. PI course lasted for at least 6 months and the total number of sessions for the CBT group was 12 to 16 (held every week). Primary diagnosis interview was on the basis of DSM-4-TR 2000. Then the Symptom Checklist-90-Revised (SCL90-R) test and the Jones’ irrational beliefs test (IBT) were performed in separate sessions. Research method was the quasi-experimental one with pre-test and post-test. The present study findings points out that the patients obtain more satisfaction from CBT than the other treatment. The patient’ satisfaction on was measured by an inventory at the end of treatment course. As we saw in this research, those patients who received CBT tended to introduce this method of treatment to others more than the other group and they were very satisfied with this method.

Open Access Original Research Article

Does Circadian Preference Determine Risk for Developing Alcohol Use Disorder amongst Undergraduate and Pre-University Students? A Cross-Sectional Study

Chong Kar Hon, Tan Yee Hau, Thong Tze Ying, Ganesh Kumar A/L Vasantha Kumar, Dina Kumaran

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/28269

Aims: To determine the relationship between circadian preference and risk for developing alcohol use disorder among medical students and pre-university students.

Study Design: An analytical cross sectional study was conducted among non-Muslim undergraduate students of a private medical institution in Melaka, Malaysia.

Place and Duration of Study: Melaka, Malaysia from September to October 2014.

Methodology: 250 participants were selected by using multistage sampling method, 223 students participated (89.2% resposnse rate). Sociodemographical data, assessment of circadian preference by International Journal Chronobiology (IJC) and WHO Alcohol Use Disorder Identification Test were collected using a structured questionnaire. Bivariate analysis, chi-square test, Fisher Exact test and multiple logistic regression analysis were calculated.

Results: Out of 223 non-Muslim undergraduate students, 60.09% were having intermediate type, 21.97% were having evening type and 17.94% were having morning type of circadian preference. Only 17.04% of the participants were having moderate, high and addictive alcohol consumption risk; among them 7.9% were addictive and 10.5% were high risk.  Participants with evening type of circadian preference were 4.5 times more likely to be associated with a higher risk for developing alcohol use disorder as compared to participants with morning type of circadian preference (OR 4.5, 95% CI 1.2-17.0, P=0.02). After adjusted for age, gender, ethnicity, hostel and monthly allowance, evening type of circadian preference and risk for developing alcohol use disorder were not significantly associated to each other.

Conclusion: Circadian preference was significantly associated to the risk for developing alcohol use disorder among the undergraduate and pre-university students in bi-variate analysis without considering other factors such as age, gender, ethnicity and monthly allowance. However, no significant association were found among each of the factors that were being compared. This was because there was a confounding variable which was gender affecting the result. In our study, male students had a higher risk in developing AUD and male students were more likely to have evening type of cicadian preference. We should provide adequate counseling about sleep hygiene, healthy sleep-wake cycle and encourage students to develop morning type of circadian preference in order to reduce the risk of developing alcohol use disorder.

Open Access Original Research Article

Early Detection of Cardiac Affection in Acute Carbon Monoxide Intoxicated Patients

Samia S. Barghash, Hala N. El Sherif, Rawya M. Salah El-Din, Azza M. Hassan, Salwa Selim Abougalambou, Nahid Abbas

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/25824

Background and Objective: Cardiovascular sequelae of Carbon monoxide (CO) poisoning may be clinically occult and remains undiagnosed due to lack of overt symptoms as acute chest pain and ischemic changes in the ECG. The advent of more sensitive and specific markers capable of detecting minor degree of cardiac damage may enable the clinicians to detect patients suffering from acute CO cardiotoxicity. The main objective of this study is to detect the cardiac effects of carbon monoxide toxicity through the estimation of cardiac biomarkers.                           

Subjects and Methods: An observational prospective study design was used in the data collection process. Cardiovascular system examination and Electrocardiography (ECG) were performed for eighty CO poisoned patients who reported to Poison Control Center (PCC), Ain Shams university Hospital, Egypt over six months. Patients with coronary artery disease or other known heart disease, patients with renal failure as well as smoker subjects were excluded. Carboxyhemoglobin level (COHb), serial cardiac markers (serum of aspartate aminotransferase (AST), creatine kinase-MB (CPK-MB), lactate dehydrogenase (LDH), and cardiac troponin-I (cTnI) quantitative determination) have been assessed.                                                                               

Results: ECG changes were present in 67.7% of patients. cTnI was 100% sensitive and 73.2% specific, CPK-MB was 79.5% sensitive and 92.7% specific, LDH was 69.2% sensitive and 92.6% specific while AST was 71.8% sensitive and 73.2% specific. cTnI was found elevated in 43 out of 80 cases. There was no statistical significant difference between cardiac markers in patients with normal and changed ECG. There was no statistical significant difference between COHb in patients with normal and elevated cTnI.                                                                                              

Conclusion: Although CO poisoned patients may present to the PCC, fully conscious, with low COHb level, even with free ECG recordings, yet the possibility of cardiac affection should not be excluded. This highlights the importance of cTnI detection in the serum of CO poisoned patients even those with normal ECG recordings to detect any minute cardiac injury.

Open Access Original Research Article

Evaluation of Bupivacaine Co-administration with Midazolam or Neostigmine in Pediatric Inguinal Hernia Surgery-A Randomized Clinical Trial Study

Jarahzadeh Mohammad Hossein, Vaziribozorg Sedighe, Heiranizadeh Najmeh, Dehghani Mohammad Hossein

Journal of Advances in Medicine and Medical Research, Page 1-6
DOI: 10.9734/BJMMR/2016/27029

Aims: The aim of this study was to evaluate the analgesic effects of midazolam and neostigmine co-administration with bupivacaine in pediatric inguinal hernia surgery.

Study Design: Randomized, double-blinded clinical study.

Place and Duration of Study: Departments of Anesthesiology, Head and Neck Surgery, Shahid Sadoughi University of Medical  Sciences, Yazd, Iran, between 2012 and 2014.

Methodology: In this double blinded randomized clinical trial study, 90 pediatric patients aged 1-5 years undergoing inguinal hernia surgery were randomly assigned in to 3 groups. Group A received bupivacaine with placebo. Group B received caudal block with bupivacaine co-administrated with 50 µgr/kg midazolam. Group C received bupivacaine co-administered with neostigmine 2 µgr/kg. The hemodynamic variables were recorded at the baseline and interoperation. The pain score, sedation score, nausea/vomiting and analgesic use were recorded in the recovery phase and after 24 hours too.

Results: Baseline and intraoperative hemodynamic variables such as heart rate and blood pressure were compared between three groups. After 24 hours the pain score and sedation were not different. The anesthesia side effects like nausea and vomiting were the same between the   three groups. In recovery room pain and sedation were significantly better in midazolam group (B). Also the analgesic use between group A and B, was different during 24 hours after operation. The most analgesic dose were used in Bupivacaine with Placebo (A) and the least in midazolam    group (B).

Our findings demonstrated that pain score in midazolam and neostigmine group was less than bupivacaine group and sedation score was higher in midazolam and neostigmine group. After 24 hours the pain score and sedation were not different. The anesthesia side effects like nausea and vomiting were the same in three groups. Analgesic use was significantly higher in bupivacaine group compare with other two groups.

Conclusion: From the results, midazolam and neostigmine would be appropriate adjuncts to bupivacaine in caudal block during pediatric surgeries.

Open Access Original Research Article

An Innovative Crossword Puzzle Tool to Evaluate the Undergraduate Medical Student’s Knowledge in Forensic Medicine

K. M. Rajyaguru, M. N. Mohd Azhar, A. R. Nadiawati, S. C. Reddy

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/BJMMR/2016/28957

Aims: The main aim is to expose the medical student after completion of their forensic medicine posting to the crossword puzzle and to study their responses given in feedback questionnaire with an effort to introduce an innovative short answer question for the end of posting examination.

Study Design: A Prospective 'survey based questionnaire' study.

Methodology: In this study, 56 students of forensic medicine were given a crossword puzzle exercise to solve individually. They were given 45 minutes to solve a puzzle having 32 words to fill in with the help of appropriate keys given. The students were allowed to sit far apart and use of the internet, mobile, books etc. was not allowed. They were asked to fill in the feedback questionnaire. Crossword puzzle contains 16 horizontals and 16 vertical words and 32 keys.

Results: After completion of the crossword puzzle, all the data was analyzed in SPSS program. In this result, we considered a total of grade 5 and 4 only. Out of 56 students, only 16 students could not score passing marks. Out of total 56 students, 91.1% (n=51) students agreed that they enjoyed this puzzle and 94.7% (n=53) agreed that this improves their forensic vocabulary and comprehensive knowledge. Out of total students 64.2% (n=36), students liked to have such puzzle as an examination question. Lastly, 92.8% (n=52) of the students agreed that it is a useful tool to learn forensic medicine.

Conclusion: Majority of participants liked the crossword as an examination questions. It improves memory power, performance and critical thinking of student with fun. This can be tried as examination question in end posting examination.

Open Access Original Research Article

Effect of Ramipril Treatment on Proteinuria and Advanced Glycation End Products in Type 2 Diabetes Mellitus Patients with Nephropathy: One Year Follow up Study

Pawan Kumar Kare, Neerja Aggrawal, Om Prakash Kalra, Basu Dev Banerjee, Parul Varshney, Rishila Ghosh, Neeru Singh, Vinod Kumar Arora, Sri Venkata Madhu, Ashok Kumar Tripathi

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/BJMMR/2016/28555

Aims: The present study was carried out to evaluate the effect of angiotensin converting enzyme inhibitor (ACEI) therapy on proteinuria and serum advanced glycation end products (AGEs) level in type 2 diabetes mellitus (T2DM) patients with nephropathy.

Study Design: Single-arm prospective longitudinal study.

Duration and Place of Study: The study subjects were enrolled from Diabetic and Nephrology clinic at University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India, between September 2013 and July 2014.

Methodology: The study subjects comprised of clinically diagnosed T2DM patients (n = 75) with evidence of persistent micro-albuminuria (ACR; 30-299 mg/g creatinine) or overt albuminuria (ACR; ≥300 mg/g creatinine) tested on two separate occasions. These patients were treated with ACE inhibitor; ramipril (5 mg to 20 mg /day) for 12 months. Effectiveness was assessed based on change in urinary albumin/creatinine ratio (ACR) and serum AGEs level.

Results: Ramipril treatment produced significant fall in log urinary ACR (P<0.001) and significant reduction in serum AGEs level (P<0.001) during 12 months follow up period as compared to baseline values. Also significant positive correlation between serum AGEs level and urinary ACR was observed at baseline. However, after one year follow up the serum AGEs level and urinary ACR did not correlate significantly. No significant change in serum creatinine and estimated glomerular filtration rate (eGFR) were observed after one year follow up.

Conclusions: Apart from antiproteinuric action, ramipril treatment has been found to lower serum AGEs level that may eventually arrest vascular complications in T2DM patients with nephropathy.

Open Access Review Article

The Art and Science of the Medical Auscultation: Respiratory Sounds

Alcibey Alvarado, Isabel Arce

Journal of Advances in Medicine and Medical Research, Page 1-10
DOI: 10.9734/BJMMR/2016/28642

Auscultation of the chest is a very old diagnostic method. Originally, it was performed by the examiner directly hearing into the patient's chest, and this practice dates back to the time of Hippocrates. The original description of lung sounds was based on comparing acoustic phenomena that was heard in the chest with gross lesions autopsy. Subsequently, the interpretation of these findings is based on functional rather than anatomical analysis. Auscultation became an invaluable diagnostic method. With the advent of radiological images, increasingly sophisticated, computerized tests of lung function, rapid arterial blood gas analysis, endoscopic studies airway and percutaneous biopsies of pleura and lung; the practice, with method and timing of chest auscultation, has lost presence. In addition, the nomenclature of respiratory sounds is sometimes confusing and the terminology proposed by international committees, little known. One objective of the article is to give a pathophysiological basis of noise based on modern computer-assisted studies which have enabled accurate recording and sound analysis techniques. The other objective is to provide a practical and useful tool to understand and correlate what you hear, with the pathophysiological basis, the underlying condition that generates the phenomena and streamline the diagnostic work.