Cross-Sectional Analysis of the Effect of Physical Activity, Nutrition, and Lifestyle Factors on Medical Students' Academic Achievement.

BACKGROUND: Unhealthy dietary habits, decreased physical activity, poor sleep quality, and increasing levels of stress and burnout have all been identified as major concerns of medical students. Due to the rigorous environment of medical school, maintaining a well-balanced and nutritious diet is often replaced by more convenient and nutrient-poor options. Improper dietary habits and a sedentary lifestyle both play an essential role in the development of type II diabetes, obesity, hypertension, and hyperlipidemia. These unhealthy trends commonly stem from the innate drive for medical students to achieve at the highest level, sacrificing healthy lifestyle choices to maximize studying. Unfortunately, this dynamic creates a paradox where students create an unhealthy lifestyle to increase academic achievement; however, these destructive living conditions lead to a diminished sense of well-being. As a result, greater rates of burnout, comorbidities, and other maladaptive tendencies diminish success in school. OBJECTIVE: The objective of this study is to investigate the effects of lifestyle habits such as nutrition, physical activity (PA), and stress on academic performance (grade point average: GPA) among first- and second-year students at Nova Southeastern University, Kiran C. Patel College of Osteopathic Medicine (KPCOM). METHODS: A cross-sectional study was conducted on medical students (n = 161) under institutional review board (IRB) approval. The students voluntarily completed a self-reported survey containing questions about diet, exercise (frequency and type), stress, and self-reported GPA. About 800 students were invited to complete the survey between June 15, 2022, and June 28, 2022. A simple lifestyle indicator questionnaire (SLIQ) score was determined for each student based on their diet, PA, and stress responses. RESULTS: The results showed a significant positive correlation between SLIQ score and high academic achievement. A significant positive association was found between the low academic-achieving (LAA)(2.00-2.99 GPA) vs the high (3.60-4.00 GPA) academic-achieving (HAA) cohorts for physical activity (p = 0.012) as well as diet (p = 0.043). Further, the HAA cohort reported higher satisfaction with their mental and physical health (74% and 54%, respectively) as compared to the LAA cohort (29% each). CONCLUSION: This study demonstrated positive correlations between diet and physical activity with high academic achievement. The HAA cohort recorded the highest rates of fruit/vegetable and home-cooked meal consumption and the greatest participation in light, moderate, and heavy exercise when compared to the middle academic-achieving (MAA) (3.00-3.59 GPA) and LAA cohorts. Interestingly, the HAA students also recorded the highest rates of satisfaction with their mental and physical health. As a result, there is a need to promote healthier lifestyle trends among medical students with a focus on diet and physical activity.

Survival of liver transplant patients coinfected with HIV and HCV is adversely impacted by recurrent hepatitis C.

Although liver transplantation (LTx) in HIV-positive patients receiving highly active antiretroviral therapy (HAART) has been successful, some have reported poorer outcomes in patients coinfected with hepatitis C virus (HCV). Here we discuss the impact of recurrent HCV on 27 HIV-positive patients who underwent LTx. HIV infection was well controlled post-transplantation. Survival in HIV-positive/HCV-positive patients was shorter compared to a cohort of HIV-negative/HCV-positive patients matched in age, model for end-stage liver disease (MELD) score, and time of transplant, with cumulative 1-, 3- and 5-year patient survival of 66.7%, 55.6% and 33.3% versus 75.7%, 71.6% and 71.6%, respectively, although not significantly (p = 0.07), and there was a higher likelihood of developing cirrhosis or dying from an HCV-related complication in coinfected subjects (RR = 2.6, 95% CI, 1.06-6.35; p = 0.03). Risk factors for poor survival included African-American race (p = 0.02), MELD score > 20 (p = 0.05), HAART intolerance postLTx (p = 0.01), and postLTx HCV RNA > 30000000 IU/mL (p = 0.00). Recurrent HCV in 18 patients was associated with eight deaths, including three from fibrosing cholestatic hepatitis. Among surviving coinfected recipients, five are alive at least 3 years after LTx, and of 15 patients treated with interferon-alpha/ribavirin, six (40%) are HCV RNA negative, including four with sustained virological response. Hepatitis C is a major cause of graft loss and patient mortality in coinfected patients undergoing LTx.

Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial.

BACKGROUND & AIMS: An earlier pilot study from our liver unit suggested benefit from treatment with pentoxifylline (PTX), an inhibitor of tumor necrosis factor (TNF), in severe acute alcoholic hepatitis. The aim of the present study was to evaluate this treatment in a larger cohort of patients. METHODS: One hundred one patients with severe alcoholic hepatitis (Maddrey discriminant factor > or = 32) entered a 4-week double-blind randomized trial of PTX (400 mg orally 3 times daily) vs. placebo. Primary endpoints of the study were the effect of PTX on (1) short-term survival and (2) progression to hepatorenal syndrome. On randomization, there were no differences in demographic and clinical characteristics or laboratory values (including TNF) between the 2 groups. RESULTS: Twelve (24.5%) of the 49 patients who received PTX and 24 (46.1%) of the 52 patients who received placebo died during the index hospitalization (P = 0.037; relative risk, 0.59; 95% confidence interval, 0.35-0.97). Hepatorenal syndrome was the cause of death in 6 (50%) and 22 (91.7%) patients (P = 0.009; relative risk, 0.29; 95% confidence interval, 0.13-0.65). Three variables (age, creatinine level on randomization, and treatment with PTX) were independently associated with survival. TNF values on randomization were not predictive of survival; however, during the study period they increased markedly in nonsurvivors compared with survivors in both groups. CONCLUSIONS: Treatment with PTX improves short-term survival in patients with severe alcoholic hepatitis. The benefit appears to be related to a significant decrease in the risk of developing hepatorenal syndrome. Increasing TNF levels during the hospital course are associated with an increase in mortality rate.

Delayed recurrence of hepatocellular carcinoma after liver transplantation: detection of origin by chromosomal analysis.

We report on a 41-year-old man undergoing liver transplantation for chronic hepatitis C who presented 26 months later with hepatocellular carcinoma. No evidence of hepatocellular carcinoma could be found in the native liver, although features of small cell dysplasia were prominent. Although he had recurrent hepatitis C, the transplanted liver was not cirrhotic. Chromosomal analysis was used to resolve whether this was a de novo tumor or a recurrence of an unsuspected tumor present at the time of transplantation. This male patient had received a liver from a female donor, and in situ hybridization for the Y chromosome showed reactivity in the tumor but not in surrounding nontumorous liver. Thus, this is an example of the use of chromosomal analysis to resolve the origin of a tumor occurring in the transplant setting.