Neurophobia among medical students

Objective:

To assess the attitude of medical students and junior physicians toward neurology.

Methods:

A self-administered, previously validated, questionnaire was distributed among 422 students and junior physicians at King Abdulaziz University, Jeddah, Saudi Arabia from September to December 2012. In this cross-sectional study, the questionnaire included demographic data and 12 statements to examine attitudes toward neurology using a Likert scale.

Results:

The response rate among participants was 70.3%. The mean age was 22.35 (SD+/-1.28) years. Males comprised 46.2%. While 31.3% of students had not decided regarding their future career, 11.8% selected neurology as their first possible choice. Whereas 29.6% of students were not satisfied with their neurology teaching experience, 84.4% found neurology difficult, and 42.7% of the whole group thought that their neuroscience knowledge was insufficient. Advanced clinical year students (namely, interns) were less likely to consider neurology as a career choice (p=0.001).

Conclusion:

Most of the students had an unfavorable attitude toward neurology on the Likert scale. New strategies are needed to change students’ attitude toward this demanding specialty.Neurological disorders comprise 6.4% of the global health burden, and contribute to 12% of global mortality.1 A large proportion of these disorders are chronic, outpatient based, and typically cared for in the community by general medical staff.2-6 Hence, it is important that medical students, and eventually medical doctors of different specialties, become more familiar and comfortable with dealing with these common diseases. Neurophobia, or the fear of neuroscience and clinical neurology, is well known among medical students and junior physicians.2 Neurology is considered, throughout the world, as the most difficult and the least understood medical specialty.2-5 Students, residents, and general practitioners display less confidence when dealing with neurological cases compared with other medical conditions.5,7 This has been attributed to limited patient exposure, difficult neuroanatomy, complex clinical examination, insufficient teaching, and diagnostic complexity.3,5,6,8 In Saudi Arabia, the attitude of medical students toward neurology and the extent of neurophobia is not well explored. Our study aimed to examine this issue and its extent among Saudi medical students.     

Pathologic changes in breast cancer after anti-estrogen therapy

Breast cancer patients do not commonly receive anti-estrogens prior to surgical excision. We reviewed a cohort of patients who received preoperative anti-estrogen therapy after baseline biopsy and then had a repeat biopsy after several weeks on treatment. Patients with estrogen receptor positive tumors received anastrozole and fulvestrant in combination with gefitinib. Core needle biopsies were performed at day 1 and 21, and tumors were completely excised if operable at day 112. All patients were postmenopausal. Following treatment, tumors had degenerative changes including smudged nuclei, decreased nuclear size, intranuclear vacuoles, vacuolated cytoplasm, and increased cellular discohesion. In addition, increased tubule formation and intracytoplasmic lumina were seen in 6/9 cases (66.7%) and decreased mitotic rate was demonstrated in 7/9 cases (77.8%). These findings indicate increased differentiation of the tumor cells in response to anti-estrogen therapy and that may correlate with clinical response.     

IgA nephropathy in Malaysia

A total of 164 patients with IgA nephropathy were diagnosed at the Department of Medicine, Universiti Kebangsaan Malaysia and the Department of Nephrology, General Hospital, Kuala Lumpur between 1981-1988. This represented an incidence of 20.1% of all primary glomerulopathies seen in both units. The 3 major ethnic groups were equally affected with 59.7% occurring between the ages of 20-36 years. It was not uncommon in females. The high prevalence of hypertension, renal failure, heavy proteinuria at presentation and the increased chronicity index in the biopsy, suggest that IgA nephropathy is progressive disease leading to chronic renal failure.     

Photodynamic inactivation of biofilms formed by Candida spp., Trichosporon mucoides, and Kodamaea ohmeri by cationic nanoemulsion of zinc 2,9,16,23-tetrakis(phenylthio)-29H, 31H-phthalocyanine (ZnPc)

The biofilms formed by opportunistic yeasts serve as a persistent reservoir of infection and impair the treatment of fungal diseases. The aim of this study was to evaluate photodynamic inactivation (PDI) of biofilms formed by Candida spp. and the emerging pathogens Trichosporon mucoides and Kodamaea ohmeri by a cationic nanoemulsion of zinc 2,9,16,23-tetrakis(phenylthio)-29H,31H-phthalocyanine (ZnPc). Biofilms formed by yeasts after 48?h in the bottom of 96-well microtiter plates were treated with the photosensitizer (ZnPc) and a GaAlAs laser (26.3?J?cm(-2)). The biofilm cells were scraped off the well wall, homogenized, and seeded onto Sabouraud dextrose agar plates that were then incubated at 37°C for 48?h. Efficient PDI of biofilms was verified by counting colony-forming units (CFU/ml), and the data were submitted to analysis of variance and the Tukey test (p?相似文献   

Percutaneous balloon mitral valvuloplasty in patients with severe mitral stenosis and low transmitral diastolic pressure gradient

An elevated left atrial pressure and high diastolic pressure gradient (DPG) across the mitral valve are the major hemodynamic abnormalities in mitral stenosis (MS). However, a subgroup of patients with severe MS is characterized by low initial DPG. The authors reviewed the clinical, echocardiographic and hemodynamic data as well as procedural results in 180 patients who underwent percutaneous balloon mitral valvuloplasty (PBMV). An initial mean DPG?>?10?mmHg was found in 144 patients (80%) (group A) and mean DPG?≤?10?mmHg in 36 patients (20%) (group B). Patients in group A had higher left ventricular ejection fraction (LVEF) than in group B (61?±?5% versus 42?±?6%, respectively) and higher cardiac index (2.8?±?0.4 versus 2.0?±?0.3?l/min/m ² ). In group B 12 patients (33%) had normal LVEF, whereas 24/36 (67%) had reduced LVEF. All the latter had wall motion abnormalities on ventriculography. Unlike group A, intraprocedural echocardiography was essential for monitoring and evaluating immediate results of PBMV in group B. On follow‐up of three years, 75% of group A patients and 55% in group B were in functional class I (p?<?0.05). PBMV did not significantly improve symptoms in patients in group B who had preprocedure LVEF?≤?35%. (Int J Cardiac Intervent 2003; 5: 200–205)     

Association between betamethasone levels and respiratory distress syndrome in preterm births: A prospective cohort study

The recommended fixed dosage of betamethasone for pregnancies at risk of preterm birth was determined in the 1970s, regardless of gestational age (GA), number of fetuses, and maternal weight. We aimed to examine the association between maternal and neonatal betamethasone serum levels and neonatal respiratory distress syndrome (RDS) and to examine whether levels correlate with maternal weight, GA, or number of fetuses. A prospective study was conducted at a single academic medical center between August 2016 and February 2019. Women received betamethasone and delivered between 28⁺⁰ and 34⁺⁶ weeks were included. Maternal serum levels (MSLs), and neonatal serum levels (NSLs) of betamethasone at delivery were analyzed using Corticosteroid enzyme‐linked immunosorbent assay kit. RDS was diagnosed according to clinical and radiographic findings. We assumed that the sensitivity of NSLs to detect RDS is 95%; hence, 150 neonates were needed (power 80%, alpha 0.05). Overall, 124 women were included; including 96 (77.4%) singletons, 26 (21.0%) twins, and 2 (1.6%) triplets, corresponding to 154 neonates. RDS was diagnosed in 35 neonates (22.7%). After adjusting for GA, time elapsed from the last dose, and number of doses, NSLs were associated with RDS (relative risk: 0.97, 95% confidence interval: 0.94–0.99, p = 0.011). A level of 6.00 ng/ml predicted RDS with a sensitivity of 80.0% and specificity of 64.7%. Adjusted MSLs were not associated with RDS. Both maternal and neonatal serum levels were not associated with the number of fetuses and maternal weight. In conclusion, NSLs are associated with RDS whereas MSLs are not.

Study Highlights

• WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC?

The currently recommended betamethasone dosage for fetal lungs’ maturity was determined in the 1970s, regardless of gestational age, maternal body mass index, and number of fetuses. This fixed dosage that is administered to all pregnant women at risk of preterm birth is associated with nonpersistent and an unequal effect on neonatal morbidity and mortality.

• WHAT QUESTION DID THIS STUDY ADDRESS?

Is there an association between maternal or fetal betamethasone levels and neonatal outcome, and whether levels differ according to maternal weight, gestational age, or number of fetuses?

• WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE?

Adjusted neonatal betamethasone serum levels were associated with respiratory distress syndrome, whereas adjusted maternal serum levels were not. Both were not associated with maternal weight or number of fetuses, and only weakly associated with gestational age at delivery.

• HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE?

The results derived from this study suggest that simply adjusting betamethasone dosage according to maternal serum levels, gestational age, number of fetuses, or maternal weight at delivery is unlikely to lead to better determining the optimum betamethasone dosage.