Assessing medical student satisfaction and interestwith serious game

Introduction : Serious games are interactive and entertaining digital software with an educational purpose, and they are increasingly being used in undergraduate medical education. Effective serious games attempt to form positive mood in order to encourage players to continue the play, leading to increased interest in gameplay and satisfaction as well as better academic performances. Aim: To determine the medical students’ satisfaction, situational and individual interest during a serious game. Methods : This was a prospective study performed during a 2-year period (2018-2019 and 2019-2020). A total of 108 third-year medical students participated in this study. Students were asked to play a serious game on a computer for 20 minutes. A set of questionnaires containing evaluation grids to measure the satisfaction and interest was given to students. The effectiveness of the game was assessed using pre and post-tests. Results : Following the exclusion criteria of students due to missing data, complete data were available for 97 students. Satisfaction and interest experienced by the students were high. The median of the game performance of students was 418, 04 points. There was a positive relationship between ease of use and game performance.There was a negative correlation between the three scales of interest and game performance.There was a significant difference between the mean scores of pre-tests and post-tests (p<0.01). Conclusion: The results of this study suggest the potentials of serious game on medical student’s satisfaction, interest and learning achievement.     

Bacteraemia in sickle cell anaemia is associated with low haemoglobin: a report of 890 admissions to a tertiary hospital in Tanzania

Bacteraemia is a leading cause of morbidity in sickle cell anaemia (SCA), but information from studies in Africa is limited. We evaluated 890 admissions from 648 SCA patients at a tertiary hospital in Tanzania. Bacteraemia was present in 43 admissions (4·8%); isolates included Staphylococcus aureus (12/43; 28%), non‐Typhi Salmonella (9/43; 21%), Streptococcus pneumoniae (3/43; 7%) and Salmonella Typhi (2/43; 5%). Compared to SCA patients without bacteraemia, SCA patients with bacteraemia had significantly lower haemoglobin [71 g/l vs. 62 g/l, odds ratio 0·72 (95% confidence interval 0·56–0·91), P < 0·01]. Further exploration is needed of the relationship between anaemia and bacterial infections in SCA in Africa.     

Spectral Doppler of the Hepatic Veins in Noncardiac Diseases: What the Echocardiographer Should Know

In most instances, the flow profile in the hepatic veins (HVs) reflects the fluctuation of pressure within the right atrium. Thus, interrogation of blood flow in the HVs is highly useful for the evaluation of right heart hemodynamics and has become an integral part of any routine echocardiographic examination. However, flow in the HVs is also affected by the state of the liver parenchyma and by the fluctuation of pressure within the thoracic cavity. Therefore, liver and pulmonary pathologies influence the flow pattern in the HVs and may lead to its dissociation from right heart hemodynamics. Echocardiographers should familiarize themselves with the findings on HV Doppler in noncardiac diseases to avoid misinterpretation and incorrect diagnosis.     

Guillain-Barré syndrome following the first dose of Pfizer-BioNTech COVID-19 vaccine: case report and review of reported cases

Neurological Sciences - Since the SARS-CoV-2 pandemic has started in December 2019, millions of people have been infected all over the world. Vaccination is the most efficient tool to end this...     

Constitutively active ezrin increases membrane tension, slows migration, and impedes endothelial transmigration of lymphocytes in vivo in mice

ERM (ezrin, radixin moesin) proteins in lymphocytes link cortical actin to plasma membrane, which is regulated in part by ERM protein phosphorylation. To assess whether phosphorylation of ERM proteins regulates lymphocyte migration and membrane tension, we generated transgenic mice whose T-lymphocytes express low levels of ezrin phosphomimetic protein (T567E). In these mice, T-cell number in lymph nodes was reduced by 27%. Lymphocyte migration rate in vitro and in vivo in lymph nodes decreased by 18% to 47%. Lymphocyte membrane tension increased by 71%. Investigations of other possible underlying mechanisms revealed impaired chemokine-induced shape change/lamellipod extension and increased integrin-mediated adhesion. Notably, lymphocyte homing to lymph nodes was decreased by 30%. Unlike most described homing defects, there was not impaired rolling or sticking to lymph node vascular endothelium but rather decreased migration across that endothelium. Moreover, decreased numbers of transgenic T cells in efferent lymph suggested defective egress. These studies confirm the critical role of ERM dephosphorylation in regulating lymphocyte migration and transmigration. Of particular note, they identify phospho-ERM as the first described regulator of lymphocyte membrane tension, whose increase probably contributes to the multiple defects observed in the ezrin T567E transgenic mice.     

The predictive value of treatment response using FDG PET performed on day 21 of chemoradiotherapy in patients with oesophageal squamous cell carcinoma. A prospective, multicentre study (RTEP3)

Purpose

FDG PET has been suggested to have predictive value in the prognosis of oesophageal carcinoma. However, the retrospective studies reported in the literature have shown discordant results. Additionally, only four studies have evaluated FDG PET during chemoradiotherapy (CRT) in patients with different histological lesions. The purpose of this study was to investigate the predictive value of FDG PET performed early during CRT (on day 21) in a population of patients with oesophageal squamous cell carcinoma.

Methods

Included in this prospective study were 57 patients with a histological diagnosis of squamous cell carcinoma of the oesophagus. Of these 57 patients, 48 (84 %) were evaluated (aged 63?±?11 years; 44 men, 4 women). Each patient underwent FDG PET (4.5 MBq/kg) before CRT, according to the Herskovic protocol (t0; PET₁) and on day 21?±?3 from the start of CRT (d21; PET₂). The response assessment included a clinical examination, CT scan or FDG PET and histological analysis 3 months and 1 year after PET₁. The patients were classified as showing a complete response (CR) or a noncomplete response. A quantitative analysis was carried out for PET₁ and PET₂ using the following parameters: SUVmax, SUVmean (with SUVmean₄₀ as the 3-D volume at an SUVmax threshold of 40 % and SUVmean_p as that defined by a physician), tumour volume (TV, with TV₄₀ defined as the TV at 40 % of SUVmax, and TV_p as that defined by a physician); and the total lesion glycolysis (TLG, SUVmean × TV, with TLG₄₀ defined as the TLG at 40 % of SUVmax, and TLG_p as that defined by a physician). The differences in responses at 3 months and 1 year between PET₁ (t0) and PET₂ (d21) were assessed in terms of variations in SUV, TV and TLG using a repeated measures of variance (ANOVA).

Results

SUVmax, SUVmean and TLG decreased significantly between PET₁ (t0) and PET₂ (d21; p?<?0.0001). The TV significantly decreased only when assessed as TV_p (p?=?0.02); TV₄₀ did not decrease significantly. With respect to the predictive value of PET₁, only TV_{40_1} and TV_{p_1} values, and therefore TLG_{40_1} and TLG_{p_1}, but not the SUV values, were significantly lower in patients with CR at 3 months. SUVmax₁, TV_{p_1} and TLG_{p_1} were significantly lower in patients with CR at 1 year. With respect to the predictive value of PET₂, only TV_{40_2} and TV_{p_2} values, and therefore TLG_{40_2} and TLG_{p_2}, but not the SUV values, were significantly lower in patients with CR at 3 months. None of the PET₂ parameters had significant value in predicting patient outcome at 1 year. The changes in SUVmax, TV₄₀, TV_p, TLG₄₀ and TLG_p between PET₁ and PET₂ had no relationship to patient outcome at 3 months or 1 year.

Conclusion

This prospective, multicentre study performed in a selected population of patients with oesophageal squamous cell cancer demonstrates that the parameters derived from baseline PET₁ are good predictors of response to CRT. Specifically, a high TV and TLG are associated with a poor response to CRT at 3 months and 1 year, and a high SUVmax is associated with a poor response to CRT at 1 year. FDG PET performed during CRT on day 21 appears to have less clinical relevance. However, patients with a large functional TV on day 21 of CRT have a poor clinical outcome (ClinicalTrials.gov NCT 00934505).     

Low vision rehabilitation: An update

This article provides information concerning issues related to the care of individuals who are visually impaired. Issues reviewed include determining who should be referred for vision rehabilitation services, Charles Bonnet syndrome, visual acuity, contrast sensitivity and visual field testing along with Useful Field of View testing. This article also discusses technology advances that can enhance the visual functioning of individuals who are visually impaired, including how these advances can help drivers with visual impairments to continue to safely operate motor vehicles, at least on a limited basis. Finally, resources that are available to both encourage and motivate patients to take advantages of vision rehabilitation services are reviewed.     

A verrucous tumor of the leg: Atypical case of Syringocystadenoma Papilliferum

Syringocystadenoma Papilliferum (SCAP) is a benign adnexal tumor. Most of the cases present with a solitary lesion in the head and neck region at birth or in early childhood. In fact, only two cases of SCAP on the lower leg have been reported in the literature. We report an atypical case by its location and its clinical aspect.