Psychological and emotional experiences of participants in a medical school, early assurance admissions program targeting students from groups underrepresented in medicine

BACKGROUND

There are growing number of pathway programs, with an early assurance of admission, that target undergraduate students from groups underrepresented in medicine (URiM) to enable their competitiveness for and matriculation to medical school, including the Penn Access Summer Scholars (PASS) program. The psychological and emotional experiences of students in these programs, however, have not been previously described.

METHODS

Students from the summer 2021 cohort of the PASS program were interviewed using a structured set of questions that explored four specific areas: (i) the application process; (ii) the benefits and value of being in the PASS program; (iii) the emotional and psychological challenges and stresses of being in the PASS program; (iv) feelings and emotions about not taking the MCAT or having to interview at multiple schools. The transcribed, de-identified interviews were then subjected to a qualitative analysis.

RESULTS

Students in PASS reported that the program was valuable to them in that it reduced the stress of the pre-medical process; relieved worry and anxiety surrounding the MCAT; enabled development of supportive relationships and provided meaningful exposures to the medical profession and biomedical research. Despite this, students reported feelings of imposterism, guilt, and fear of disappointing, along with varying degrees of regret over not taking the MCAT and not interviewing at more than one medical school.

CONCLUSIONS

URiM and other marginalized students participating in early assurance admissions programs likely enter medical school with a range of positive and negative emotions as a result of their participation in these programs. These data can be used to inform the development of programing and other initiatives that further support the transition and success of these students in medical school.

Evolution of total hip arthroplasty in patients younger than 30 years of age: A systematic review and meta-analysis

INTRODUCTION

While surgical technique and implant technology for total hip arthroplasty (THA) has improved over the years, it is unclear whether recent progress has translated to improved clinical outcomes for young patients. The goal of this study is to determine trends in (1) indications, (2) surgical technique (3) clinical and radiographic outcomes, and (4) survivorship for THA in patients younger than 30 years of age.

METHODS

MedLine, Cochrane, EMBASE, and Google Scholar were searched using several key phrases for articles focusing on THA performed on patients younger than 30 years of age between 1971 and 2020. A total of 34 qualifying articles were identified and stratified into three groups according to operative years and compared to one another on the basis of (1) indications; (2) fixation technique; (3) implant design; (4) clinical and radiographic outcomes; and (7) survivorship.

RESULTS

The mean patient age at index THA were 20.5 (9-30), 22.1 (11-30) and 21.5 (10-30) years, respectively, for each study group. Over time, patients underwent fewer THAs for JRA (Juvenile Rheumatoid Arthritis) (p < 0.001) but more for post-treatment and iatrogenic avascular necrosis (p < 0.001; p < 0.001). Early THAs primarily used metal on UHMWPE (Ultra high molecular weight polyethylene) (71.7%, p < 0.001), modern THA predominantly use ceramic on HXLPE (Highly cross-linked polyethylene) (42.5%, p < 0.001). Early fixation methods used cement (60.4%, p < 0.001), and modern fixation primarily use press fit technology (95.9%, p < 0.001). Prevalence of radiographic loosening decreased significantly (p < 0.001) over time. There was no significant difference in clinical improvement on HHS. Lastly, fewer patients required THA revision in recent decades (p < 0.001).

CONCLUSIONS

Advances in surgical technique and technology have served to improve implant longevity. Surprisingly, subjective clinical scores showed no significant improvement over time, suggesting that early iterations of THA were extremely successful.

401 Squamous Cell Carcinoma Surgery During a Global Pandemic – a Single UK Tertiary Centre Experience

Aim

Method

Results

Conclusions

Penn Access Summer Scholars program: a mixed method analysis of a virtual offering of a premedical diversity summer enrichment program

In the USA, numerous summer programs are available for undergraduate students that seek to increase the number of individuals from groups underrepresented in medicine (URM) that matriculate to medical school. These programs have typically been conducted at research-focused institutions, involving hands-on-research and various enrichment experiences. For 2020, the COVID-19 pandemic resulted in the suspension of on-campus student activities at American universities, necessitating a switch to a virtual format for these URM-focused programs. Outcomes, however, from these programs conducted virtually, necessitated by the COVID-19 pandemic, have not been reported. The Penn Access Summer Scholars (PASS) program at the Perelman School of Medicine (PSOM) targets URM undergraduates, providing two consecutive summers of mentored research and enrichment experiences, with the goal of enabling participants' matriculation to PSOM. PASS has been an 8 week on-campus experience, but during summer 2020, virtual programming of 6 weeks was provided due to the COVID-19 pandemic. Participants in the 2020 virtual offering of PASS completed pre- and post-program surveys that included 5-point Likert-style and open-ended questions to determine the impact of the programing on self-assessments of research skills, familiarity with the physician identity, and preparedness to be a PSOM student. Post-program, participants also assessed program administration and content. With respect to program objectives, participants reported significant increases in their self-reported confidence in conducting research, understanding of physician identity, and sense of preparedness for medical school. The educational value of the program content, their level of engagement in the program and the overall quality of the program were rated as excellent or outstanding by large majorities of respondents. Content analyses of participant comments were consistent with these quantitative results. Therefore, a premedical summer enrichment program targeting URM undergraduates can be successfully conducted virtually to achieve program objectives and may increase the availability to these initiatives.

The potential of solar photovoltaic systems for residential homes in Lagos city of Nigeria

The development and use of solar photovoltaic (PV) technologies worldwide is considered crucial towards fulfilling an increasing global energy demand and mitigating climate change. However, the potential of a solar PV-system is location specific, influenced by the local solar resource, energy demand and cost among other factors. The main aim of this study is to conduct a detailed assessment of the potential of solar PV-systems in residential buildings in Lagos Metropolitan Area, Nigeria. Nigeria has enormous solar energy potential, it is the most populous country in Africa and occupies a significant place in the development of Africa. Yet, it is a country with one of the lowest per capita electricity consumption in the world - at 149 kWh per capita for a population of about 170 million, about 7% of Brazil's and 3% of South Africa's. To achieve this goal, this study employed the survey of 150 residential buildings in three local government areas (LGAs) in Lagos State, Nigeria to obtain electric load data. HOMER Pro was used to size the PV-systems and to determine the levelized cost of electricity (LCOE). The computed energy results of the study for the base case scenario revealed the PV array, lead acid battery and the converter (inverter) of the PV-systems to be in the following range: 0.3-76 kW; 2 to 176  kWh; and 0.1-13.2 kW respectively. Economic analysis revealed a LCOE of the systems in the range of 0.398 USD/kWh to 0.743 USD/kWh. The use of PV-system generated electricity in the dwellings has potential for an annual reduction of greenhouse gas emissions in the range of 31.24 kgCO₂eq to 7456.44 kgCO₂eq. Clearly, the use of solar PV systems in residential buildings possesses potentials for enabling Nigeria to attain its climate change mitigation targets indicated in her Nationally Determined Contributions (NDCs).

Fatty Acids in Some Cooking Oils as Agents of Hormonal Manipulation in a Rat Model of Benign Prostate Cancer

Anti-androgenic substances, mainly prostate 5α-reductase inhibitors, used in the treatment of benign prostatic hyperplasia (BPH) have been associated with side effects in man and animals. To reduce these side effects as well as suppress BPH development, the management of the condition has come to include dietary interventions. This study investigated the effect of some cooking oils on testosterone-induced hyperplasia of the prostate in rats. Male Sprague-dawley rats were distributed into eighteen groups (n=6) as A-R. A negative control group was injected subcutaneously with soya oil; while prostatic hyperplasia was induced subcutaneously in groups B-R with 3mg/kg testosterone daily for 14days. Group B was the positive control (BPH group) while groups C-R were also administered orally 800mg/kg of coconut, castor, canola, cottonseed, pomegranate, blackseed, sheabutter, olive oil, codliver, sardine, palm, repeatedly heated palm (RHPO), vegetable, repeatedly-heated vegetable (RHVO), sesame, and groundnut oils respectively, daily, for 14 days. Blood sample was drawn via retro-orbital sinus for the estimation of serum testosterone(T) and dihydrotestosterone (DHT) level and rats were thereafter euthanized to obtain the prostates for T and DHT determination as well as tissue weights. Data are mean ± SEM, compared by ANOVA. The oils significantly reduced the increase in prostate weight (PW) to body weight (BW) ratio induced by testosterone. Apart from the fact that all the oils reduced the PW:BW ratio, the blackseed, sheabutter, sardine, vegetable and groundnut oils suppressed the DHT level in the serum, while pomegranate, olive, RHPO reduced DHT level in the prostate compared to the BPH rats. This study suggests that blackseed, sheabutter, sardine, vegetable, groundnut, pomegranate, olive, and RHPO oils could inhibit testosterone-induced hyperplasia of the prostate and therefore may be beneficial in the management of BPH.

Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa

BACKGROUND

Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk.

METHODS

We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cut-points for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC.

RESULTS

The optimal WC cut-point was 81.2 cm (95% CI 78.5-83.8 cm) and 81.0 cm (95% CI 79.2-82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63-65) than in men (53%, 95% CI 51-55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4-2.9, for men and 2.2, 95% CI 2.0-2.3, for women).

CONCLUSION

The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.International Journal of Obesity advance online publication, 31 October 2017; doi:10.1038/ijo.2017.240.

Impact of some low-cost interventions on students' performance in a Nigerian medical school

BACKGROUND

Students' poor performance in physiology examinations has been worrisome to the university community. Reported preference of peer-tutoring to didactic lectures at the University of Nigeria Medical School has not been investigated.

AIM

The aim of this work is to design/implement low-cost interventions to improve teaching and learning of physiology.

MATERIALS AND METHODS

This is a postintervention retrospective review of medical Student's performance in 2 nd Bachelor of Medicine and Bachelor of Surgery examinations physiology. Data were collected and analyzed by descriptive and inferential statistics using the MedCalc Statistical software (Turkey). The odds ratio (OR) was used to determine the chances of passing before and after the intervention. The level of significance was set at P < 0.05.

RESULTS

A total of 2152 students sat for the professional examination over the study period, and 1485 students passed the examination at first attempt giving an overall pass rate of 69%. The pass rate from 2008 when our interventions started was significantly higher than the pass rate before this reform (OR: 0.53; 95% confidence interval: 0.43-0.64; P < 0.0001).

CONCLUSION

Results support the engagement of teachers with strong translational interests and clinicians to augment existing faculty in basic sciences, innovative alternatives to passive lecture formats and students involvement in program evaluation.

The frequency of various indications for plain chest radiography in Nnamdi Azikiwe University Teaching Hospital, Nnewi (NAUTH)

BACKGROUND

With soaring advances in the field of medicine, the place of older radiologic imaging modalities is being reduced to basic screening tools. Yet the modern imaging modalities like computerized tomography (CT), magnetic resonance imaging (MRI), ultrasound and nuclear medicine are hardly available.

STUDY OBJECTIVES

To study the frequency of various indications of plain chest radiography, remind us of its uses and to enhance the preparedness of the department to maximally accomplish the ideals of this investigation.

METHODOLOGY

A total of 1476 consecutive patients for chest radiography in the department of radiology, NAUTH, Nnewi from the period of February 2009 and whose request form contain adequate data were recruited for this study. These data were analyzed using SSPS.

RESULTS

A total of 1476 patient were included in this study. There was female preponderance with male to female ratio of 1.3:1. Mean Age of the patients is 39.32 years (std19.56). The most frequent indication for chest radiography is certain infections and parasitic diseases (40.9% and the greatest source of referral for this study is General outpatient (GOPD)/family medicine department.

CONCLUSION

The most frequent indications for chest radiography in the study are certain infection and parasitic diseases. Chest Radiography is the most frequent plain radiography study in our environment where infectious diseases are still very rampant. This makes chest radiography an important study for screening patient for possible diagnosis and classifying the need for further radiographic investigation of our patients.

Diabetes mellitus in pregnancy: an update on the current classification and management

BACKGROUND

Diabetes mellitus is a common medical disorder in pregnancy. It contributes particularly to perinatal morbidity/mortality, and maternal morbidity. This review aims at improving maternal and neonatal health care especially in Sub-Saharan Africa by improving the knowledge of health practitioners on current evidences in the classification and management of diabetes mellitus in pregnancy.

METHODS

Relevant texts as well as online data bases including Pubmed, Google scholar, and African journal online, were searched for literatures related to the subject.

RESULTS

Classification of diabetes in pregnancy has been revised to reflect the various aetiological factors. Also, the diagnostic value of fasting plasma glucose has been lowered to mark the point at which dramatic increase in the microvascular complications of diabetes mellitus occurs. Morbidity and mortality associated with the condition would be reduced through proper management that involves preconception care, early antenatal booking, dedicated multidisciplinary antenatal care, and delivery in a center with neonatal facility. Furthermore, some oral glucose lowering agents have shown some safety after the first trimester and they have been found to give comparable result to insulin therapy.

CONCLUSION

The classification of diabetes mellitus in pregnancy has been revised. Its optimal management should involve multi-disciplinary inputs and may include oral hypoglycaemic agents. Knowledge of these by clinicians would improve maternal and neonatal health.

Women's involvement in the decision to be delivered by caesarean section in Sub Saharan Africa

The aim of this study is to determine the degree and nature of women's involvement in the decision to deliver by Caesarean section.

METHODOLOGY

A cross sectional descriptive multi-centre study on post partum women who were delivered by Caesarean section in the three study centres.

RESULTS

The five most common indicators for Caesarean section include cephalo-pelvic disproportion, prolonged labour, malpresentation, pregnancy induced hypertension and ante partum haemorrhage, which accounted for 70% of the indications for Caesarean section. The commonest influence on respondents' decision to have Caesarean section was physician factors, followed by religious and cultural factors. Husbands influenced majority of the respondents during decision for Caesarean section. The respondents' agreement with decision for Caesarean section varied significantly as the number of previous Caesarean section, being highest among women with 4 previous Caesarean section. In conclusion, the majority of women were found to be involved in the decision to have Caesarean section, and the most influential factors on them during the decision process were physician factors and husband's presence. In this environment, the greater the number of previous Caesarean section a woman has had in the past the more likely would she accept Caesarean section in subsequent deliveries as a better option.

RECOMMENDATION

There is need for further studies to determine the effect of socio-demographic factors on decision to have caesarean section as well as satisfaction of the outcome.

Depletion of cellular glutathione by conditions used for the passaging of adherent cultured cells

Cultured cells are commonly exposed to trypsin-containing solutions in order to prepare cell suspensions suitable for subculture. Conditions used to release and disperse monolayers of cultured murine hepatoma 1c1c7 and human breast epithelial MCF10A cells caused the loss (40-95%) of cellular glutathione (GSH), but did not affect viability. Glutathione contents returned to pretrypsinization values within 24 h of replating. In contrast, the GSH contents of cultured rat hepatoma 5L cells were not affected by trypsinization. Exposure of 1c1c7 cultures to H(2)O(2) or etoposide 1 or 24 h after replating resulted in concentration-dependent cytostatic and cytotoxic effects. The concentration-response curves defining the cytostatic and cytotoxic effects of etoposide, and the cytostatic effects of H(2)O(2) were not influenced by the timing of toxicant addition. However, 1c1c7 cultures treated with H(2)O(2) 1 h after replating were more susceptible to the cytotoxic actions of the peroxide than cultures treated 24 h after plating. These studies show that conditions commonly used for the passaging of cultured cells can lead to a transient, but profound loss of GSH in some cell lines. Furthermore, the outcome of cytotoxicity analyses can be influenced by the time elapsed between the plating of cultures and the addition of toxicant.

Chloramphenicol-induced mitochondrial dysfunction is associated with decreased transferrin receptor expression and ferritin synthesis in K562 cells and is unrelated to IRE-IRP interactions

Chloramphenicol is an antibiotic that consistently suppresses the bone marrow and induces sideroblastic anemia. It is also a rare cause of aplastic anemia. These toxicities are thought to be related to mitochondrial dysfunction, since chloramphenicol inhibits mitochondrial protein synthesis. We hypothesized that chloramphenicol-induced mitochondrial impairment alters the synthesis of ferritin and the transferrin receptor. After treating K562 erythroleukemia cells with a therapeutic dose of chloramphenicol (10 microg/ml) for 4 days, there was a marked decrease in cell surface transferrin receptor expression and de novo ferritin synthesis associated with significant decreases in cytochrome c oxidase activity, ATP levels, respiratory activity, and cell growth. Decreases in the transferrin receptor and ferritin were associated with reduced and unchanged message levels, respectively. The mechanism by which mitochondrial dysfunction alters these important proteins in iron homeostasis is not clear. A global decrease in synthetic processes seems unlikely, since the expression of the cellular adhesion proteins VLA4 and CD58 was not significantly decreased by chloramphenicol, nor were the message levels of beta-actin or ferritin. The alterations were not accompanied by changes in binding of the iron response protein (IRP) to the iron-responsive element (IRE), although cytosolic aconitase activity was reduced by 27% in chloramphenicol-treated cells. A disturbance in iron homeostasis due to alterations in the transferrin receptor and ferritin may explain the hypochromic-microcytic anemia and the accumulation of nonferritin iron in the mitochondria in some individuals after chloramphenicol therapy. Also, these studies provide evidence of a link between mitochondrial impairment and iron metabolism in K562 cells.

Criteria for the selection of experiences and content in midwifery education

Selection of content and learning experiences for any educational endeavor is based on the aim and objectives for setting up the program, and the competencies required of graduates of the school. To exclude those experiences that will lead to skill in the management of obstetric emergencies, and at the same time expect midwives to function independently in rural communities is a negation of basic curriculum planning principles. The range of experiences available to the contemporary curriculum planner in the health field is infinite. However, due to the changing nature of societal needs in the health field, and the rapid obsolescence of previously held assumptions about health care services and the role of midwives, selection of experiences requires creativity and well defined criteria for judgment. Those suggested in this paper are validity, comprehensiveness, pattern, balance, relevance, and continuity. The six criteria are discussed to show the relevance of each to some of the current weaknesses in midwifery education in Nigeria.

A supplement of Dikanut (Irvingia gabonesis) improves treatment of type II diabetics

The effects of Dikanut (Irvingia gabonensis), an African viscous preparation, as supplement (4g/day) in the diet of eleven Type II diabetics were studied. Levels of plasma lipids, glucose and erythrocyte ATPases were monitored for one month. The dikanut supplement elicited hypolipidemic activity. The reduction in plasma lipids was primarily due to a decrease in LDL + VLDL-cholesterol and triglycerides levels. HDL-cholesterol was increased. The three ATPases of the erythrocyte membrane of the diabetic patients were significantly lower than in normal subjects. When dikanut was consumed by the diabetics for four weeks, the activities of the enzymes increased significantly. The increases correlated well with significant reduction of plasma glucose levels. These desirable biochemical effects mediated by ingestion of a naturally-occurring dietary fibre were accompanied by improved clinical states.

Erythrocyte membrane ATPases in diabetes: effect of dikanut (Irvingia gabonensis)

The levels of the three ATPases found in the erythrocyte membrane of diabetic patients were significantly lower than normal subjects. The distribution of the enzymes was also different. Na+,K+-ATPase and Mg2+-ATPase reflected the status of blood glucose more than Ca2+-ATPase. The ratio between two of the ATPases was sensitive to glycemic response. When dikanut, a viscous preparation, was fed to diabetics for 4 weeks, blood glucose became normal and the activities of the three ATPases increased significantly. The ratio among the enzymes also approached that of normal subjects. A relationship was found between the blood glucose level and erythrocyte membrane ATPases which, if linked to insulin binding or level, may provide a rapid inexpensive assay in diabetes research.