Series: Volume 10, Issue 2 2021

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Editorials

Editor’s Welcome

Dr Mabel Leow MD, PhD | Editor-in-Chief, AMSJ

Welcome to Volume 10, Issue 2 of the Australian Medical Student Journal.
This has been and unprecedented year with Covid-19.

In this issue, we have included a Covid-19 section for medical students to share their thoughts on issues associated with the pandemic. This is in addition to our usual wide range of medical and surgical topics. Of mention are two papers which will be relevant to all medical students. One is a case-based discussion on oxygen delivery, as it is commonly prescribed therapy. The second is a research study on microbial contamination in medical students, a problem which all of us face with in our everyday work.

Over the last 12 months, the AMSJ has taken steps to raise the standards of our editorial team to ensure that we publish quality studies. We have started an Understudy team to provide a platform to train pre-clinical medical students with minimal research experience, but aspire to be editors. As part of being a student journal, it is our mission to train medical students. Hence, if you have an interest in being an editor but lack the experience, please do join our team!

Last but not least, I would like to express my gratitude to various parties who have made this issue possible. First, the editorial team is grateful to the authors who have chosen to publish their work to AMSJ. We are privileged to be part of your research journey, in which you have put in many hours and months of hard work. At a personal level, I am thankful to my entire editorial and proofreading team who have been the backstage workers making this issue possible. To acknowledge their work this year,
we have included the names of the editors and proofreaders who have been working on the manuscripts.

Moving forward, we want to increase the visibility of AMSJ. This would take in the form of advertising our manuscripts on Facebook and Twitter. We would greatly appreciate if authors and readers could also share your articles with your friends and colleagues.

Correspondence: mabelleowqihe@yahoo.com

Categories
Case Reports

A multidisciplinary approach in diagnosing children with autistic traits and multiple behavioural issues: a case report

diagnosing children with autism
diagnosing children with autism

The diagnosis of Autism Spectrum Disorder (ASD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria is based on a constellation of symptoms overarching social and communication deficits, behavioural issues, and stereotyped motor and sensory abnormalities. Some studies have raised concerns about overdiagnosis and misdiagnosis of ASD, likely due to the overlapping symptoms of ASD and other psychological and behavioural disorders. This case emphasises the importance of an integrated multidisciplinary diagnostic approach for ASD diagnosis as a single consultation is usually insufficient for paediatricians to reach to the conclusion of ASD. With valuable inputs from different disciplines, including psychology and speech therapy, paediatricians can have a better picture of a child’s underlying issues and provide a more effective management plan for the family. 

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Categories
Case Reports

Continuous positive airway pressure for obstructive sleep apnoea improved oculogyric crises as well as psychotic symptoms in a woman with schizophrenia and developmental disability

Happy and healthy senior woman sleeping deeply on her back with CPAP machine mask and hose.

Abstract

Introduction: This report highlights the risk factors and complexities of schizophrenia as well as the adverse effects of treatment. Obstructive sleep apnoea (OSA) has a notorious history of under-diagnosis in both the general population as well as those suffering from mental health disorders, particularly schizophrenia. Antipsychotics have life altering side effects contributing both to a decrease in quality of life as well as increasing morbidity and mortality.

Case overview: This case report presents a 61-year-old female with diagnoses of schizophrenia, frontal lobe epilepsy, a developmental disability, oculogyric crises (OGC), and obstructive sleep apnoea.

Discussion overview: Early intervention with continuous positive airway pressure (CPAP) in those suffering from OSA can have dramatic effects decreasing the burden of concurrent disease. This report showcases that treatment of OSA with CPAP increased patient wellbeing, allowing down-titration of risperidone, and thereby ameliorating the drug-induced OGC in this patient. 

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Categories
Case Reports

A case of postoperative pericardial effusion progressing to tamponade

Introduction: Pericardial effusions often occur after cardiac surgery, usually asymptomatically. However, large postoperative effusions may cause cardiac tamponade, which is a medical emergency. Case overview: We report a case of a 62-year-old businessman who presented with worsening paroxysmal nocturnal dyspnoea, orthopnoea, and an episode of near-syncope. Echocardiography revealed evidence of cardiac tamponade, most likely due to recent coronary artery bypass graft and aortic valve replacement surgery. He was treated with pericardiocentesis and ongoing review revealed no recurrence of the effusion. Discussion overview: We discuss the incidence and risk factors for postoperative pericardial effusion and the possibility of tamponade after cardiac surgery. Though rare, recognising tamponade after cardiac surgery is vital and a thorough understanding of the treatment of tamponade is necessary.

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Categories
Case Reports

Aicardi-Goutières Syndrome: A Case Report

Background: Aicardi-Goutières Syndrome (AGS) is a rare genetic neurological disorder that presents as pseudo-TORCH syndrome. There are 350 confirmed cases worldwide. This case report describes a 22-month-old male with Aicardi-Goutières Syndrome who was diagnosed at four months of age. This paper seeks to highlight AGS as a differential for TORCH Syndrome, and to build on the limited knowledge from previous cases to identify key concepts and management strategies that may be of benefit to the medical community.

Case overview: A four-month-old male was admitted to a New Zealand Hospital in status epilepticus.A history of inconsolable crying, subjective fevers and abnormal posturing was elicited. Examination found a spastic quadriplegic cerebral palsy. Investigation excluded infective causes. MRI and CT scans demonstrated atrophy of the cerebral cortex with calcification of the basal ganglia. CSF analysis showed elevated white cells and neopterin, and genetic analysis identified variants of unknown significance in the ADAR1 gene. A diagnosis of AGS was made. Treatment focused on managing complications including seizures, spasticity, and airway clearance.

Discussion overview: This case highlights AGS as a differential for TORCH syndrome. Complication management forms the basis of care. Current literature is limited, and future research is needed to understand the pathophysiology of the disease to develop treatments and management strategies.

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Categories
Case Reports

Oxygen delivery: a case-based approach

This article explains and emphasises the importance of oxygen delivery for medical students to apply to clinical practice through the usage of several common clinical cases. 

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Categories
Feature Articles

Exchange Experiences: Exploring Chinese Healthcare as Australian Medical Students

This feature article explores the similarities and differences in the medical education and health care systems of modern China compared with those of the Western world. It explores how a system interacts with, and adapts to, the political and social structure of its population and the challenges that can arise from this. 

The authors were part of a medical school exchange program to the First Affiliated Hospital, Sun Yat-sen University Guangzhou where they observed the inner workings of the hospital. The authors have drawn their observations from their experiences attending lectures, taking patient histories and observing cases during their rotations through each department of the First Affiliated Hospital. The experience gave the authors insight into how healthcare and education can vary between each country and the factors controlling this. 

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Categories
Uncategorized Review Articles

Musculoskeletal Disorders in Surgeons

Background

Musculoskeletal disorders (MSDs) are an occupational hazard amongst surgeons, causing detrimental effects in up to 20% of surgeons in their lifetime. However, there is a paucity of data examining solutions for the problem. There is also a lack of research comparing MSDs in surgeons who perform open surgery compared with those who perform newer methods of surgery such as laparoscopic and robotic surgery.

Aims

We aim to explore existing literature about the various risk factors and the consequences of MSDs. We believe that by raising awareness of such risk factors to medical students from early on in their medical careers, they can develop an appreciation of the potential long-term impacts and take an early approach to prevention. We discuss preventative strategies in the categories of individual, occupational, institutional, and intra-operative techniques.

Materials and Methods

Ovid Medline, Cochrane Library, and PubMed databases were used to identify articles. Studies reporting on work-related MSDs in surgeons were included. Articles relevant to medical fields with a high level of surgical involvement, such as gynaecology, were also included. This information was used to construct a narrative review of the literature (see Appendix 1 for full methodology). Within each database search, only a few articles relevant to this review were generated. Therefore, the citations were also screened to find additional articles that fit within the scope of this review.

Results

Multiple factors were found to contribute to the development of MSDs, including individual and occupational factors. MSDs have resulted in a high percentage of surgeons performing fewer surgeries or taking more time off work. Similar risk factors applied to laparoscopic and robotic surgery. Few studies examined strategies to combat MSDs, but techniques such as intraoperative exercise and ergonomic training have shown to be promising.

Conclusion

There is a need for ongoing research into strategies to prevent MSDs in surgeons. Currently there are no evidence-based guidelines for management of work-related MSDs. Medical students should be aware that this occupational hazard has deleterious effects on the body and should be encouraged to employ some of the currently available strategies to prevent MSDs. The authors of this review advocate for ergonomics education to be integrated into surgical training programs via collaboration between ergonomists and surgical program directors.

Main Learning Points

  1. MSDs in surgeons are under-researched but are still an important occupational hazard that can be potentially debilitating.
  2. There are no guidelines to manage MSDs – current best strategies involve having a well-balanced lifestyle, seeking help early, and being ergonomically aware of mechanisms of injury.
  3. Greater awareness of ergonomics among surgeons could possibly reduce the incidence of MSDs among high risk groups.

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Categories
Original Research Articles

Welcome to the wards: Pilot study on microbial contamination of medical students during initial clinical rotations

Background: Pathogenic bacteria can colonise the hands, medical equipment, and personal belongings of healthcare workers (HCW) exposed to clinical environments. Healthcare-associated infections (HAI) arising from the transmission of these pathogens to patients causes morbidity, mortality, and an economic burden. Despite widespread healthcare worker education and policy change, the incidence of HAI remains high in Australia.

Aim: To identify potentially pathogenic bacterial contamination of clinically unexposed medical students’ hands and items upon entry into the clinical environment and subsequent design of a definitive study.

Materials and methods: A pilot prospective cohort study was performed at a large tertiary hospital in Melbourne, Victoria. Eight medical students had two- to six-week samples taken from their dominant hand, mobile phones, and stethoscopes in the first six months of entering the clinical environment.

Results: Pathogenic bacteria were detected throughout the six-month testing period on five of the eight students’ hands, mobile phones, or stethoscopes. Pathogenic bacteria grown included methicillin-sensitive Staphylococcus aureus, Enterococcus faecalis, and Gram-negative pathogens, such as Serratia marcescens, Pseudomonas spp. and Acinetobacter baumanii. No multi-resistant organisms were detected. Low decontamination rates of items, universal use of phones while on the toilet, and recent hand hygiene credentialing were reported by participants.

Conclusion: Colonisation by nosocomial pathogens on medical students’ hands, mobile phones, and stethoscopes was identified during the first six months of clinical study. Further research to characterise bacterial contamination of new HCW, risk factors, and strategies to improve infection control practices has the potential to reduce HAI.

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Categories
Review Articles

Do medical students practice what they preach? A review of their dietary patterns over the last decade.

Abstract

Background

While many studies have been performed to evaluate different indicators of psychological distress among medical students, the amount of published data evaluating their dietary habits is limited. Therefore, the purpose of this scoping review was to provide an overview of medical students’ dietary behavior. This is the first review paper to summarise the information available about dietary practices among medical students.

Materials and Methods

A scoping review was performed in 2018 using the PRISMA-ScR framework and the MEDLINE database was searched by combining the terms ‘eat’, ‘diet’, ‘meals’, ‘nutrition’ with the word ‘medical student’ by using the ‘AND’ function. Some additional papers were also selected from the citations of relevant publications. Data was independently extracted by two authors using pretested forms.

Results

A total of 739 articles were found by using the search terms. Thirty-three articles fulfilled the eligibility criteria and four further articles were found from the citations of relevant publications. Medical students showed an increasing tendency to exhibit conventionally unhealthy eating patterns, both as a whole and within different dietary categories. In particular, decreased fruit and vegetable intake, overindulgence of fast food, and a tendency to skip meals. Gender discrepancies were also noted in some categories.

Conclusion

Medical students, while for the most part displaying a full understanding of the nutritional science behind dietary recommendations, did not always meet the advised levels for most of the categories explored. Lapses in personal dietary choices may affect patient counselling, in addition to the many direct consequences of improper nutrition on the health and wellbeing of the student themselves.

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