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   Table of Contents - Current issue
Coverpage
July-September 2020
Volume 6 | Issue 3
Page Nos. 163-281

Online since Saturday, September 26, 2020

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EDITORIAL  

What's new in Academic International Medicine? International health security agenda – Expanded and re-defined p. 163
Nicole K Le, Manish Garg, Ricardo Izurieta, Sona M Garg, Thomas J Papadimos, Bonnie Arquilla, Andrew C Miller, Abbas M Khan, Tamara Worlton, Michael S Firstenberg, Sagar C Galwankar, Sunil Raina, Harry L Anderson III, Rebecca Jeanmonod, Kristiana Kaufmann, Donald Jeanmonod, Annelies De Wulf, Dianne McCallister, Christina Bloem, Ijeoma Nnodim Opara, Niels D Martin, Juan A Asensio, Stanislaw P Stawicki
DOI:10.4103/IJAM.IJAM_113_20  
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REVIEW ARTICLES Top

Impacts and challenges to education in academic international medicine during a global pandemic p. 179
Annelies De Wulf, Christina Bloem, Marian P Mcdonald, Lorenzo Paladino, Donald Jeanmonod, Nicole Kaban, Veronica Tucci, Manish Garg, Sona Garg, Stanislaw P Stawicki, Vesta Anilus, Edgar Miranda, Rebecca Jeanmonod
DOI:10.4103/IJAM.IJAM_108_20  
The novel coronavirus (COVID-19) pandemic of 2020 has had profound impacts on medical education, both domestic and abroad. In this consensus paper from the American College of Academic International Medicine, we systematically discuss the impact of the pandemic both immediately and long term on international medical education, bedside teaching, procedural teaching, didactics and curriculum, accreditation, and mental health of medical teachers and learners. We discuss some strategies that have been implemented to mitigate the negative impact of the pandemic while providing reasons for hope in the future. The following core competencies are addressed in this article: Practice-based learning, Patient care, Interpersonal and communication skills, Systems-based practice
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The role of infections in infertility: A review p. 189
Manju Ohri Pai, S Venkatesh, Pratima Gupta
DOI:10.4103/IJAM.IJAM_44_19  
Reproduction is an essential part of a human life and being unable to conceive marks a great impact on mind and body of both males and females. Infertility being on a rise among the couples, urogenital infections are considered to be one of the major causes. A broad range of organisms including bacteria, fungi, virus, and parasites are well documented to interfere with the reproductive function in both the sexes. They affect different sites, in males, sperm morphology, its motility and eventually its function can be affected at different levels of their development, maturation, and mobility. In females, cervical areas, tubal obstruction, and peritoneal damage are the common sites that are affected by infections, thus, interfering with human fertility. Other than direct infections, co-infections are also nowadays suspected to be responsible for impairment of sperm quality, motility, and mobility. In light of these facts, this review aims to report the complex relation between infection and fertility. The following core competencies are addressed in this article: Medical knowledge, Patient care.
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ORIGINAL ARTICLES Top

A cross-sectional study to assess the psychosocial impact of COVID-19 pandemic on health-care workers at a tertiary care hospital in India Highly accessed article p. 197
Alka Bansal, Smita Jain, Lokendra Sharma, Munesh Kumar, Anil Sharma
DOI:10.4103/IJAM.IJAM_89_20  
Introduction: Corona virus disease 2019 (COVID-19) has been declared a notified disaster and public health emergency of international concern. Health-care workers (HCWs) who are involved in the care of these COVID patients are at additional risk of developing mental illness themselves due to direct exposure associated with the disease in them leading to this study. Aim: This study aims to assess the psychosocial impact of COVID-19 pandemic on HCW using Screening Questionnaire for Disaster Mental Health (SQD). Materials and Methods: A cross-sectional study was done on 112 HCW in SMS Hospital, Jaipur from June 1, 2020, to June 15, 2020. SQD was used to assess the magnitude of posttraumatic stress disorder and depression in these HCWs who were directly involved in care of COVID-19 patients at some point of time and had no previous history of mental illness. Results: 5.67% HCW were suffering from severe posttraumatic stress disorder and similar 5.67% had severe depression due to COVID-19. Results analyzed by t-test found that, overall, HCWs were mildly affected by COVID-19 in terms of posttraumatic stress disorder (mean value 2.16; 95% confidence interval [CI] = 1.80–2.53, P = 0.000) and depression (mean value 1.27; 95% CI = 0.97–1.57, P = 0.000) as per SQD scale. Conclusion: The study highlighted that the majority of the HCW were slightly affected by corona pandemic in terms of posttraumatic stress disorder and depression but as corona is still persisting, the need of constant vigilance for its psychosocial impact on them continues. The following core competencies are addressed in this article: Medical knowledge, Professionalism, Practice-based learning and improvement, Systems-based practice.
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Prevalence of self-medication of antibiotics among 2nd-year medical students and their knowledge about antibiotic resistance p. 203
Neha Sharma, Monica Jain, Preksha Sharma, Charu Jain, Alka Bansal, Lokendra Sharma, Uma Advani
DOI:10.4103/IJAM.IJAM_13_20  
Aims and Objectives: The objective of the study was to determine the prevalence of self-medication practices of antibiotics among medical students and to evaluate the knowledge of medical students about antibiotic resistance at SMS Medical College, Jaipur, India. Methodology: In this descriptive type of cross-sectional study, a 31-item prevalidated questionnaire was prepared, which comprised both open-ended and closed-ended questions. The response was obtained, and the students were sensitized about the rational use of antimicrobials and antimicrobial resistance and about advantages and disadvantages of self-medication. Results: The response rate in our study was 83.3%. The mean age of respondents was 20.09 ± 1.34 (mean ± standard deviation). While 63.2% of participants were found to be self-medicators, the most common source of knowledge about self-administration of antibiotic was information from parents as reported by 40.6% of respondents. The majority of students (35.8%) consumed amoxicillin. Gender-based significance of the difference of knowledge regarding self-medication was found nonsignificant as the value of P > 0.05. The majority of students (91.4%) knew about antibiotic resistance. There was no gender-based significant knowledge regarding antibiotic resistance. Overall knowledge of students was satisfactory. A postsession lecture on antibiotic resistance and its association with self-medication was arranged to reinforce the knowledge of students. Conclusion: The awareness about the increasing incidence of antibiotic resistance is one of the needs of the moment. The following Graduate Medical Education core competencies were addressed: Medical knowledge, Practice-based learning and improvement, Interpersonal and communication skills.
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ACADEMIC PROGRAMS AND DEVELOPMENT Top

A distance clinical research training course in Ghana p. 209
Rockefeller Oteng, Bernard Arhin, Jonathan Boakye-Yiadom, Jason Goldstick, Marisa R Eastman, Ronald Frank Maio
DOI:10.4103/IJAM.IJAM_62_20  
Clinical research training in low- and middle-income countries (LMICs) has not been adequately incorporated into local physicians' education. The lack of trained physician–scientists in LMICs is due in part to poor research infrastructure in these areas including limited funding support and scarcity of senior-level physician–scientists to provide training in research methodology. This article describes the structure, content, and evaluation of a combined synchronous/asynchronous distance and onsite learning program implemented in Kumasi, Ghana, to train physicians in clinical research. The course was delivered over 18 months and was associated with a clinical research study for which the participants were coinvestigators. A substantial increase in clinical research self-efficacy, as measured by the Clinical Research Appraisal Inventory, was found at the end of the course compared to baseline. This course could serve as a model for the delivery of clinical research training in other LMICs. The following core competencies are addressed in this article: Medcal knowledge, Practice-based learning and improvement.
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Technology and tools for easy writing of the medical dissertation and original articles p. 215
Ketan Garg, Bhawna Garg
DOI:10.4103/IJAM.IJAM_8_20  
Medical writing has become an unaccountable alternate subject in the curriculum of doctors. It starts from the undergraduate level where a medical student has to write some projects in the Preventive and Social medicine department. Apart from that, case summaries in the various clinical subjects begin in the final year of undergraduation. At the postgraduate level, Indian medical students have a big task in front of them in the form of a thesis. The protocol writing in the initial 3 months of the tenure seems such a daunting subject and it puts so much of pressure on the naïve mind who is mastering a particular medical field. The focus starts deviating from the learning of the clinical skills to completing the protocol writing without any specific tutorial-based guidance on the technology to write a protocol for the thesis or a complete thesis itself. Nonetheless, this is superseded by one/two compulsory research publications in the postgraduation. The increasing population in our country, increasing workload in the departments, especially surgical fields in the government hospitals, has led to an undue burden on medical students for medical writing. The complete digitalization of the dissertations has warranted a complete knowledge of the computers and writing softwares such as Microsoft word, Excel, and PowerPoint and the various plagiarism tools for an easy and errorless completion of the dissertation during the medical tenure. The following core competencies are addressed in this article: Interpersonal and communication skills, Professionalism, Systems-based practice.
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CASE REPORTS Top

A case of spontaneous uterine rupture in a nongravid uterus p. 220
N M Abdul Waris, S Manu Ayyan, K Vimal Rohan, Suresh G Nair
DOI:10.4103/IJAM.IJAM_3_20  
Uterine rupture is defined as separation of the wall of the uterus. Spontaneous rupture is a rare catastrophic complication in pregnant uterus and rarest in nongravid uterus. The diagnosis is not always obvious, and morbidity and maternal and fetal mortality is still high in gravid uterus. We report the case of a 37-year-old nongravid multipara with spontaneous uterine rupture, with a previous history of lower segment cesarean section and myomectomy. There are only a few published literatures, and the present case is an exceptional case that we observe for the first time in our emergency department. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care, Medical knowledge.
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Hurdles to managing a case of methicillin-susceptible Staphylococcus aureus: A clinical nightmare p. 224
Siddharth Bhattacharjee, Geetha Philips
DOI:10.4103/IJAM.IJAM_24_19  
Staphylococcus aureus (SA), the most virulent of the many staphylococcal species, has been rightly described to be a cause of aggressive infections. Its versatility in evading host immune mechanisms and its ability to invade any human tissue make it a major cause for morbidity and mortality worldwide. With the current focus being on methicillin-resistant SA, the hurdles to the management of methicillin-susceptible SA (MSSA) are often underestimated. Here, we present a case of MSSA that was a skin colonizer, which gained entry inside the host following a fall. Although timely and adequate treatment for bacteremia was given, he progressed to sepsis with multiorgan dysfunction syndrome (MODS) and succumbed to the infection. A 79-year-old male, with a history of a recent fall which was treated, presented 2 weeks later, with complaints of fever and altered sensorium. The initial culture from the knee was negative. He was currently admitted for altered sensorium, which turned out to be MSSA bacteremia. He progressed to sepsis with MODS-septic arthritis, lobar pneumonia, and possible infective endocarditis (IE). He was on daptomycin and cefazolin. However, the patient did not respond to the treatment, progressed to septic shock, and unfortunately succumbed to infection. In our scenario, heavy skin colonization, followed by the breach in the skin following fall, possibly was the cause for septic arthritis weeks later. The lack of clinical response to daptomycin and the rapid clinical decline raised the suspicion of another source of SA invasion. Keeping in mind the aggressiveness of SA, a diagnosis of possible IE was also considered, and treatment was initiated. The management guidelines for treating MSSA are clearly defined by the Infectious Diseases Society of America and the National Health Service. We report this case to reflect on possible causes for nonresponse to treatment and to remind physicians of the devastating infectiveness of MSSA. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and improvement.
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Use of lifesaving extracorporeal membrane oxygenation in a case of massive hydroxychloroquine overdose p. 229
Asma Rashid, Mehboob A Rehan, Brian Sneck, Edwards Jennifer, Douglas Whatmore
DOI:10.4103/IJAM.IJAM_39_19  
Hydroxychloroquine (HCQ), approved by the Food and Drug Administration in 1955, has high potential for overdose due to its increasing use related to mortality and morbidity benefit in many autoimmune diseases. Lack in the current available data regarding standardized management and practical approach needed in overdose cases necessitates a discussion on this topic. The purpose of this case presentation is to add to the current medical literature on HCQ overdose and management, to determine possible guidelines for guiding therapy in future for HCQ toxicity, and to present recommendations for more efficient and timely management that may reduce the morbidity and mortality of patients with intentional or accidental HCQ overdose. The following core competencies are addressed in this article: Medical knowledge, Patient care, Interpersonal and communication skills, Practice-based learning and improvement
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CONFERENCE ABSTRACTS AND REPORTS Top

The 2020 St. Luke's University Health Network Annual Research Symposium: Event highlights and scientific abstracts p. 234
Anna Ng Pellegrino, Rachel Birk, Parampreet Kaur, Stanislaw P Stawicki
DOI:10.4103/IJAM.IJAM_115_20  
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LETTERS TO EDITOR Top

Containment of the coronavirus disease 2019 outbreak by imposing travel restrictions: Worthy approach? p. 278
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/IJAM.IJAM_16_20  
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Narrative medicine in India: Let more medical journals be “vocal for local” voices p. 280
Ganesh Singh Dharmshaktu
DOI:10.4103/IJAM.IJAM_101_20  
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