Pairing medical students on the wards: A multi-site analysis of pairing effect on clerkship performance.

BACKGROUND: Medical students are often paired together on clinical teams during their clerkships. While this practice has multiple potential positive effects, evidence suggests that most students feel that their evaluation is impacted by the other student. This perception negatively impacts the learning environment. We set out to determine whether paired students had a measurable effect on each other's clerkship grade during the medicine sub-internship. METHOD: We examined 186 4th year student-pairs during the required medicine sub-internship at 3 hospital sites of Harvard Medical School from 2013-2017. Chi-square tests were used to determine whether pairing impacted the final clerkship grade. Subsequently we examined whether pairing impacted the sub-internship performance stratified by students' 3rd year core medicine clerkship grade to account for prior performance. FINDINGS: We found no significant deviation between the expected and observed distribution of student grades (chi-square 1.9, p = 0.39) among 186 student pairs, suggesting that pairing had no meaningful effect on the sub-internship grade. We also saw no significant effect of pairing when controlling for prior internal medicine clerkship performance (chi-square 10.9, p = 0.53). CONCLUSIONS: Despite concerns that students on the same medical team may impact each other's performance evaluation, our exploratory study demonstrated no significant effect of student pairing on grades in a medicine sub-internship. Further study of the complex relationship between students on a medical team are warranted to optimize this common practice and enhance the learning environment.

Bone Within Bone as a Calcified Subdural Hematoma.

Calcified subdural hematoma (CSDH) is a very rare presentation but a known and reported entity in literature. Most of the case reports have been described in children and the elderly. Surgical treatment for CSDH is still considered controversial. We report here a case of calcified subdural hematoma in a middle-aged male that was successfully operated on. A 45-year-old male presented with complaints of right-sided weakness and seizures with a history of head trauma three years ago. Non-contrast computerized tomography (NCCT) head showed calcified subdural hematoma associated with mass effect and midline shift. A frontotemporoparietal craniotomy was done to remove the CSDH. Intra-operatively the brain was pulsating well. He was discharged on the 12th postoperative day and doing well on a follow-up visit.

Mobile technology: A tool for healthcare and a boon in pandemic.

Healthcare systems deal with disease prevention, early detection, diagnosis, investigation, and timely, affordable, and safe treatment. For the delivery of services in the health sector, communication is the key to linking the service provider and the patients. Mobile technology in the recent past has rendered various platforms of communications for the healthcare system. Thus, in health, mobile technology has greatly contributed to time management and cost reduction for healthcare at every level including hospital visits to individual appointments with doctors, hence the convenience. With advancements in mobile technologies and the growing number of mobile users, newer opportunities have opened up for the use of mobiles for patient care. Emerging information and communication technologies with the help of the Internet of Things (IoT) have been instrumental in integrating different domains of the health sector with mobile technology. Thus, the technology may have the potential to become powerful medical tools to support the health sector at all levels of care. In this review, the concept, applications, and advantages of mobile technology for health and the present pandemic have been discussed. It also discusses mobile health technology, as a support system for convenient and safer healthcare for public health, and the opportunities to improve its applications for unseen future health crises.

Pairing students on the wards: The effect on the clerkship learning environment.

BACKGROUND: Medical students are often paired together on clinical teams during their clerkships, but the effect of this practice is unknown. We conducted a survey study to determine student perceptions and attitudes regarding being paired on the same team with a classmate. METHODS: We conducted semi-structured interviews and utilized thematic analysis to develop themes for survey design. We then designed and administered a survey to the graduating class of 2018 at Harvard Medical School. RESULTS: One hundred students participated in the survey (60% response). The majority of students perceived that pairing impacted their clerkship evaluations. Pairing was perceived to positively impact learning, adjustment to the clerkship, enjoyment, wellness and the overall clerkship experience. However, stress related to grading and evaluation as well as competition for patients were cited as negative impacts. Students in our sample were split on their preferences for working alone or with another student on a clinical team. CONCLUSION: Student pairing is a common practice that affects the learning environment in clinical clerkships. Further study of interactions between students on medical teams as well as interventions to raise the positive value of pairing while limiting its negative impact may enhance the clerkship learning environment.

Synthesis, Crystallography, and Anti-Leukemic Activity of the Amino Adducts of Dehydroleucodine.

Dehydroleucodine is a bioactive sesquiterpene lactone. Herein, four dehydroleucodine amino derivatives were synthesized using the amines proline, piperidine, morpholine, and tyramine, and spectroscopic methods and single-crystal X-ray diffraction unambiguously established their structures. The cytotoxic activity of these compounds was evaluated against eight acute myeloid leukemia cell lines, and their toxicity to peripheral blood mononuclear cells was also determined. The proline adduct was the most active compound, it showed anti-leukemic activity, upregulated heme oxygenase 1 (HMOX1) and the primary stress-inducible isoform of the heath shock 70 kDa protein 1 (HSPA1A), and downregulated NFkB1 transcription, it was also found to be about 270 times more water soluble than dehydroleucodine.

Dehydroleucodine, a Sesquiterpene Lactone from Gynoxys verrucosa, Demonstrates Cytotoxic Activity against Human Leukemia Cells.

The sesquiterpene lactones dehydroleucodine (1) and leucodine (2) were isolated from Gynoxys verrucosa, a species used in traditional medicine in southern Ecuador. The activity of these compounds was determined against eight acute myeloid leukemia (AML) cell lines and compared with their activity against normal peripheral blood mononuclear cells. Compound 1 showed cytotoxic activity against the tested cell lines, with LD50 values between 5.0 and 18.9 µM. Compound 2 was inactive against all of the tested cell lines, demonstrating that the exocyclic methylene in the lactone ring is required for cytotoxic activity. Importantly, compound 1 induced less toxicity to normal blood cells than to AML cell lines and was active against human AML cell samples from five patients, with an average LD50 of 9.4 µM. Mechanistic assays suggest that compound 1 has a similar mechanism of action to parthenolide (3). Although these compounds have significant structural differences, their lipophilic surface signatures show striking similarities.

Selective activity of the histone deacetylase inhibitor AR-42 against leukemia stem cells: a novel potential strategy in acute myelogenous leukemia.

Most patients with acute myelogenous leukemia (AML) relapse and die of their disease. Increasing evidence indicates that AML relapse is driven by the inability to eradicate leukemia stem cells (LSC). Thus, it is imperative to identify novel therapies that can ablate LSCs. Using an in silico gene expression-based screen for compounds evoking transcriptional effects similar to the previously described anti-LSC agent parthenolide, we identified AR-42 (OSU-HDAC42), a novel histone deacetylase inhibitor that is structurally similar to phenylbutyrate, but with improved activity at submicromolar concentrations. Here, we report that AR-42 induces NF-κB inhibition, disrupts the ability of Hsp90 to stabilize its oncogenic clients, and causes potent and specific cell death of LSCs but not normal hematopoietic stem and progenitor cells. Unlike parthenolide, the caspase-dependent apoptosis caused by AR-42 occurs without activation of Nrf-2-driven cytoprotective pathways. As AR-42 is already being tested in early clinical trials, we expect that our results can be extended to the clinic.

Extensively drug resistance (XDR) tb is not always fatal.

The chance of incidence of XDR TB is on the rise due to improper use of second line anti-tubercular drugs. XDR-TB is very difficult to treat successfully and is often referred to as "virtually untreatable form of TB". We herein report a case of XDR TB confirmed by bacteriological examination in a WHO recognised laboratory who after 12 months of regular treatment improved both clinically and radiologically with sputum smear conversion. To the best of our knowledge, there has been no previous report of any similar case in literature.

Primary neuroectodermal tumor of penis (PNET)--a case report.

Primary neuroectodermal tumor (PNET) is a rare entity with high malignant potential. It usually affects the skeletal system and primary extraskeletal involvement is uncommon. Because of rarity of tumor in the penis, only a few cases have been reported. A 17-year-old male adolescent presented with painless penile swelling of 4 weeks' duration. Clinical examination revealed multiple, 1 cm hard nodules palpable on penile shaft. Open incisional biopsy of the penile nodule revealed an undifferentiated malignant round cell tumor and on immunohistochemistry a diagnosis of PNET was made. Metastatic workup was negative. Total penectomy and perineal urethrostomy was performed, and subsequently adjuvant chemotherapy was given.

Totally endoscopic coronary artery bypass surgery.

Robotically enhanced surgery is a fast-developing technique that allows totally endoscopic cardiac surgery on both the beating and arrested heart. Between December 2002 and May 2005, 13 patients underwent totally endoscopic coronary bypass using the da Vinci system; 11 operations were on a beating heart and 2 on arrested hearts. The mean time for internal mammary artery mobilization was 42 min. The time for left internal mammary artery-to-left anterior descending artery anastomosis was 20-36 min for totally endoscopic cases. In one patient, the right internal mammary artery was anastomosed to the diagonal artery. No patient required conversion to a median sternotomy. Mean intensive care unit stay was 1.2 days and mean hospital stay was 4.5 days. There was no hospital mortality. All 13 patients had coronary angiography at 3-month intervals, which showed 100% patency in 12 patients while one had 50% anastomotic narrowing for which coronary angioplasty was performed. Using robotic technology, completely endoscopic anastomosis is possible in patients with single-vessel disease. Use of robotics is now extended to achieve complete myocardial revascularization by harvesting both internal mammary arteries in addition to making a small thoracotomy for direct anastomosis.

Determination of active ingredient in synthetic pyrethroid formulations by high-performance thin-layer chromatography/densitometry.

A new, simple, precise, and rapid high-performance thin-layer chromatography (HPTLC) method was developed for the analysis of commercial emulsifiable concentrate (EC) formulations of cypermethrin, alpha-cypermethrin, and lambda-cyhalothrin. A known amount of reference grade synthetic pyrethroid and its EC formulation was subjected to TLC, and the amount of pesticide present in the active ingredient spot was estimated by densitometry in a single beam, single wavelength reflectance mode. Calibration curves of the synthetic pyrethroid was linear in the range of 8-24 microg, and the correlation coefficient for the calibration equation ranged between 0.97 and 0.99. Recoveries from laboratory-prepared test samples of the EC formulation were in the range of 95-99%. Pesticide formulations were further analyzed by gas liquid chromatography using flame ionization detector, and results were comparable. The proposed HPTLC method has application for quality control and determination of the shelf life of EC formulations.