Patient video cases in large-group medical student teaching: A qualitative study of learner and educator perspectives.

BACKGROUND: Patient video cases (PVCs) are short video recordings of real patients during clinical encounters or instructed activities. Although widely used in healthcare professionals' education, their use in large group teaching (LGT) remains relatively unexplored. This study aims to explore the perceptions of medical students and academic staff regarding the use of PVCs to support LGT. METHODS: A purposive sample of medical students and academic staff from Leicester Medical School was obtained. Data were collected through focus groups (students) and semi-structured interviews (staff) in which two sensitising PVCs were used as a stimulus to discussion. Data analysis was undertaken using grounded theory through a process of open, axial, and selective coding, leading to core categories and themes. RESULTS: Sixteen medical students and four academic staff members participated. Four overarching themes were identified covering the benefits of using PVCs, ways in which they are used in LGT, the challenges faced by and how to optimise PVCs for LGT. This final theme covered design, choice of clip and how it is then used by the educator within the teaching session. Key considerations were the need to align the PVC with other content and to consider the student experience. CONCLUSION: Our findings support the use of well-chosen and well-designed PVCs within LGT and offer practical insights to use them effectively. PVCs are a potentially powerful tool within medical undergraduate LGT (a widely used instructional method) and further research into its use is needed.

The applicability of Boston Carpal Tunnel Questionnaire as a screening tool for carpal tunnel syndrome among potential high-risk female population in the West Bank: a cross-sectional study.

Carpal tunnel syndrome (CTS) is an entrapment neuropathy with a high level of morbidity if neglected. Boston Carpal Tunnel Questionnaire (BCTQ) was designed to track patients' progress after diagnosis. However, few studies showed that this questionnaire might be applicable as a screening tool for CTS. Objective: This study aims to identify the ability of BCTQ to detect symptoms and functional limitations of CTS among the potential high-risk population. Materials and Methods: This study is a cross-sectional study involving 366 females, aged 30-60 years, residents of the West Bank, Palestine. Data was collected using BCTQ to assess participants' symptoms severity and functional limitations. Results: Symptoms were reported in 72.4% of participants, while functional limitations were reported in 64.2%. Very severe symptoms were found in 1.1% of the study population, and very severe functional limitations were reported in 1.4% only. BCTQ reliability testing via Cronbach alpha showed a score of 0.937 and 0.922 for symptom severity and functional limitations scales, respectively. The most common reported symptom was pain during the daytime, while the 'household chores' was the most common functional limitation. Conclusion: This study showed that many participants reported symptoms and functional limitations of CTS without a prior diagnosis. The BCTQ can potentially be used as a screening tool for middle-aged females in the West Bank, Palestine, as it showed strong applicability. However, this study could not compute the actual prevalence of CTS due to the lack of access to clinical and electrophysiological confirmation.

Risk factors associated with the reported scores on the symptoms severity and functional limitations scales of the Boston Carpal Tunnel Questionnaire: a cross-sectional study.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. It presents with numbness, paresthesias, and pain. Multiple risk factors are associated with CTS, such as pregnancy, oral contraceptive use, rheumatoid arthritis (RA), and diabetes mellitus (DM). The Boston Carpal Tunnel Questionnaire (BCTQ) is a self-administered questionnaire for assessing the severity of symptoms and functional status of those previously diagnosed with CTS. We aim to identify risk factors associated with higher scores of CTS symptoms severity and functional limitations scales on the BCTQ. Materials and methods: This cross-sectional study was conducted among 366 female participants. The data was mainly collected using the BCTQ. Demographics and risk factors of CTS were added to the study's complete questionnaire; risk factors included RA, DM, hypothyroidism, number of pregnancies, usage of oral contraceptive pills (OCPs), use of smartphones and keyboards. A P value of less than 0.05 was considered statistically significant. Results: Most participants were in their 30s (44%) and housewives. RA, DM, hypothyroidism, and pregnancy were associated with reporting symptoms and functional limitations on BCTQ. OCPs and smartphone use were associated with functional limitations only. Conclusion: Different risk factors are associated with reporting symptoms and functional limitations of CTS on the BCTQ. For example, RA, DM, hypothyroidism, pregnancy, OCPs, and smartphone use have all been found to statistically affect the outcome of the BCTQ in this study. Therefore, clinical confirmation of the CTS diagnosis is required in future studies to ensure that these symptoms and functional limitations are associated with the CTS pathology rather than other risk factors and pathologies for proper targeted treatment plans and outcomes.

Factor V deficiency with a unique genetic mutation presenting as post-circumcision bleeding in a neonate, A-case-report.

Introduction and importance: Factor V deficiency is a rare bleeding disorder with varying presentations from minor mucosal bleeding to a life-threatening postoperative bleed. Currently, treatment is mainly supportive with Fresh Frozen Plasma. Case presentation: A previously healthy 14-day-old male presented with an uncontrollable bleeding following a circumcision. Physical examination was normal. Investigations showed hemoglobin 15.5 g/dl, platelets 409000, Prothrombin Time 57 seconds, Partial-Thromboplastin-Time 120 seconds. Mixing study corrected the coagulation profile, and the factor assay showed factor V activity of 11%. Genetic testing showed a pathogenic frameshift mutation in the F5 gene p.(P927Lfs*7) causing premature termination after 7 codons thus the diagnosis of Factor V deficiency was made. Clinical discussion: In this case, factor V deficiency presented as post-circumcision bleeding. For diagnosis, increased PT and PTT with normal thrombin time increases the index of suspicion for a bleeding disorder. Further testing with coagulation factors assays is required to make the final diagnosis. Factor V deficient patients undergoing surgery should be adequately prepared, and factor V activity level should be maintained at least at 25% of the normal activity level. The patient level prior to the circumcision was unknown, which led to the life threatening bleed. Conclusions: One of the early presentations of factor V deficiency is a post-circumcision bleeding. Adequate preparation with laboratory tests before circumcision is therefore recommended, especially for high-risk individuals. More than 100 genetic mutations were detected; frameshift mutation involving F5 gene p.(P927Lfs*7) was seen in our case.

Postoperative Pain, Analgesic Choices, and Ileus: A Snapshot from a Teaching Hospital in a Developing Country.

Background Pain relief can be achieved by diversity of methods with analgesics being the basic form of treatment. Analgesic safety and clinical effectiveness are the core factors in determining the analgesic of choice. One adverse effect of concern with opioids is the postoperative ileus (POI). Objective In this study, we looked at the severity of postoperative pain, the type of analgesics used to control the pain, and the incidence of POI at Baghdad Teaching Hospital. We hypothesized that we would find an association between the type of analgesia used and POI. Methods This observational study was conducted among 100 patients who were residents at the general surgery wards of Baghdad Teaching Hospital. A structured questionnaire was employed focusing on types of analgesics, degree of pain control, and the presence of ileus. Results Sixty-nine percent of patients received a combination of opioids and nonopioids. Moderate-to-severe pain was the most commonly reported category on pain scales. More than half of the patients (57%) were found to have POI during their hospital stay and there was a statistically significant association between the type of analgesia and POI development ( p =0.001). Conclusions A mix of analgesics (opioids and nonopioids) was the most common regimen at our center. The majority of the surgical inpatients reported having moderate-to-severe pain on both pain scales used in this study. Ileus incidence following abdominal surgeries (61%) was significantly higher than the reported incidence worldwide (10-30%). Postoperative ileus has multifactorial causes, one of which is the use of opioids for pain control. Considering the high incidence of ileus in our center and the association we found between the use of opioids and ileus, further studies should look at the doses of opioids used and whether alternative analgesic methods might result in less ileus.

Right arm weakness and mouth deviation as a presentation of Primary Angiitis of the Central Nervous System treated with rituximab: A case-report.

Introduction: Primary Angiitis of the Central Nervous System (PACNS) is a rare form of vasculitis that solely affects the Central Nervous System (CNS). Its presentation varies widely from a simple headache to a stroke-like presentation. PACNS management is divided into an induction phase, which includes corticosteroids, cyclophosphamide and rituximab, and a maintenance phase which includes: methotrexate, mycophenolate mofetil, rituximab and azathioprine. Case presentation: A 31-year-old male presented to the emergency department due to an episode of right arm weakness and left-sided facial weakness. Brain Magnetic Resonance Imaging (MRI) would show an ischemic change in the frontal and parietal lobes. A biopsy was done, which showed inflammatory infiltrates consistent with Primary Angiitis of the Central Nervous System. The patient was started on rituximab and showed improvement. Clinical discussion: In this case, PACNS presented as episodic right arm weakness and left sided facial weakness. Gold standard for diagnosis is a biopsy from the inflamed region of the CNS that shows lymphocytic infiltration in a granulomatous pattern. Conclusion: Despite its rarity, PACNS is a cause of morbidity if not caught and managed early. Therefore, considering PACNS in the differential diagnosis of a young patient with a history of frequent episodic neurological dysfunction is appropriate. Ischemic patterns on MRI further increase the index of suspicion around PACNS Confirmation of the diagnosis via biopsy from the inflamed region is the most accurate method.

Comparison of pain and extent of anesthesia in digital blocks for isolated finger lacerations: A randomized controlled trial.

OBJECTIVES: Digital injuries are among the most common presentations to the emergency department. In order to sufficiently examine and manage these injuries, adequate, prompt, and predictable anesthesia is essential. In this trial, we aim to primarily compare the degree of pain and anesthesia onset time between the two-injection dorsal block technique (TD) and the single-injection volar subcutaneous block (SV) technique. Further, we describe the temporal and anatomical effects of both techniques for an accurate delineation of the anesthetized regions. METHODS: This is a single-center prospective randomized controlled trial involving patients presenting with isolated wounds to the fingers requiring primary repair under local anesthesia. Patients were randomized to either the SV or TD blocks. The primary outcome was procedure-related pain (Numerical Rating Scale). Further, we assessed the extent of anesthesia along with the anesthesia onset time. RESULTS: A total of 100 patients were included in the final analysis, 50 on each arm of the study. The median pain score during injection was significantly higher in patients who received TD block than patients who received SV block (median [interquartile range] = 4 [2.25, 5.00] vs. 3.00 [2.00, 4.00], respectively, P = 0.006). However, anesthesia onset time was not statistically different among the groups (P = 0.39). The extent of anesthesia was more predictable in the dorsal block compared to the volar block. CONCLUSION: The single-injection volar subcutaneous blocks are less painful with a similar anesthesia onset time. Injuries presenting in the proximal dorsal region may benefit from the two-injection dorsal blocks, given the anatomical differences and timely anesthesia of the region.

Oxford-AstraZeneca Coronavirus Disease-2019 Vaccine-Induced Immune Thrombocytopenia on Day Two.

INTRODUCTION: Vaccines have been one of the most impactful human discoveries that have significantly changed life expectancy. Immune thrombocytopenic purpura (ITP) is an autoimmune disease characterized by platelet damage, life-threatening thrombocytopenia, and haemorrhage when the platelet count reaches below 20 × 109/mcL. Its pathogenesis involves viral mimicry or T-cell-induced immune destruction in antibody-negative cases. The clinical manifestations of thrombocytopenia vary according to the severity (level of platelets) and range from being asymptomatic to severe haemorrhage. ITP is treated with immunosuppression. Case Presentation. A 26-year-old Iraqi male laboratory analyst with an unremarkable medical history presented with severe thrombocytopenia 2 days after receiving the Oxford-AstraZeneca coronavirus disease-2019 vaccine. The patient was asymptomatic with unremarkable examination findings. However, his low platelet count was discovered accidentally, and the patient did not exhibit the resistance pattern of ITP and recovered successfully with regular immunosuppressant treatment. CONCLUSION: Patients with a history of thrombocytopenia can develop vaccine-induced thrombocytopenia earlier than the expected onset. Close monitoring, through regular complete blood counts, is highly recommended for patients with previous thrombocytopenia because the immune modulation process of the vaccine can worsen preexisting thrombocytopenia.

Surgical Management of Gallstone Ileus in Low-Settings Hospital during COVID-19 Outbreak: A Case Report.

Introduction Gallstone ileus is a very infrequent complication of cholelithiasis in which single or multiple stones pass through an abnormal fistula to the lumen of the intestine leading to a true mechanical obstruction. We are reporting a case of a female who developed intestinal obstruction due to gallstones during the coronavirus disease 2019 (COVID-19) outbreak and was managed urgently surgically in a low-settings hospital. Case Presentation An 85-year-old white female with 40 years history of gallstone disease, hypertension, and type-2 diabetes presented to the accidents and emergency unit with upper central crampy abdominal pain for 5 days associated with green color vomiting and absolute constipation. On examination, she was barely stable, dehydrated, had a distended abdomen, and guarding in the epigastric region. Her electrolytes were disturbed and had elevated serum creatinine and blood urea. Imaging studies confirmed gallstone ileus. Management was surgical despite the lack of facilities and equipment including COVID-19 personal protective equipment. Conclusion Despite being an infrequent complication, gallstone ileus might present at the most unexpected time and in the least equipped hospital where the surgeon's suspicion, risk stratification, and improvisation by utilizing what is available are the keys for successful management and saving lives.

Attitudes and perceptions among Iraqi young adults towards organs donation and transplantation: A call for action.

Background: Organs transplantation is the only treatment for end-stage organ failure. However, the disparity between organs availability and the number of patients in the waiting lists is widening globally, especially in Iraq for many reasons. This study aims to assess the level of attitudes and perceptions among Iraqi young adults towards organs donation and transplantation as the first study to be conducted in Iraq for such purpose. Methods: This observational study was conducted among 912 Iraqi young adults through a structured questionnaire which was disseminated among social media platforms. Participants consented before filling the questionnaire and their responses were analyzed to test the hypothesis of the study. Results: Most of the participants were females, Muslims and in their undergraduate level. Overall, 84.2% of the participants were willing to donate their organs after death and (97.9%) of them actually agreed to sign for organs donation. Most of those who were not willing to donate have no idea whether their religion approves it or not. There was no statistically significant difference in willingness to donate between different socioeconomic classes or residency areas. Conclusions: Most of the participants are convinced with donating their organs after death and are willing to sign for organ donation programs, advocating for initiating an official governmental transplant agency with multiple local committees distributed among health directorates all over the country managing it. The hesitancy to donate organs was attributed mostly to religious and associated with lack of knowledge issues, thus education might be the key to positive attitudes.