Pocket-sized Ultrasound versus Cardiac Auscultation in Diagnosing Cardiac Valve Pathologies: A Prospective Cohort Study

Background: Pocket-sized ultrasound devices are used to perform focused ultrasound studies (POCUS). We compared valve malfunction diagnosis rate by cardiac auscultation to POCUS (insonation), both conducted by medical students. Methods: A prospective cohort study was conducted among patients with and without clinically relevant valve dysfunction. Recruitment to the study group was based on the presence of at least one valve pathology of at least moderate severity identified on recent echocardiography study that was required for clinical reasons. Three final-year medical students examined the patients. Each patient underwent auscultation and a POCUS using a pocket-sized ultrasound machine. Sensitivity was defined as the percentage of patients correctly identified as having a valve disorder. Specificity was defined as correct identification of the absence of valve pathology. Results: The study included 56 patients. In 18 (32%), no valve pathology was found. Nineteen patients (34%) had at least two valvular pathologies. Sixty valve lesions were present in the whole cohort. Students' sensitivity for detecting any valve lesion was 32% and 64% for auscultation and insonation; respectively, specificity was similar. The sensitivity for diagnosing mitral regurgitation, mitral stenosis, and aortic regurgitation rose significantly by using POCUS compared to auscultation alone. When using POCUS, Students identified valve pathologies in 22 cases (39%) from the patients with at least two valve dysfunctions, and none when using auscultation. Conclusions: Final-year medical students' competency to detect valve dysfunction by performing cardiac auscultation is poor. Cardiac ultrasound-focused training significantly improved medical students' sensitivity for diagnosing a variety of valve pathologies.

The Pandemic Leadership Model: A Study of Medical Student Values During COVID-19

Background: Leadership training is of growing importance in medical education. The COVID-19 pandemic provides unique insight into the qualities and characteristics medical students value in leaders. Little standard information exists regarding best practices, competency-based leadership models or frameworks to guide leadership program development in undergraduate medical education. This study aims to determine what students value in leadership during a pandemic and what implicit leadership framework students use in order to inform medical education curricula. Methods: We developed a survey instrument aimed to uncover student perceptions of effective and ineffective leadership qualities and examples, both during the current COVID-19 pandemic and during crises in general. Results: Students identified the overarching themes of Communication, Other-Orientation, Personal Characteristics, Decisive Action, and Use of Information. These five themes were then built into the model of Pandemic Leadership within the context of complexity leadership theory and collective leadership theory. Conclusion: This study is unique in its focus on student perceptions of leadership qualities both in general, and during a time of challenge that can serve as a real-world laboratory for leadership. We hope that this information, along with the pandemic leadership model, can serve as the first step to useful and relevant leadership training programs in undergraduate medical education.

Predictors of Cerebral Arteriovenous Malformation Mortality: A Single-center, Five-year Retrospective Study

Background: Arteriovenous Malformations (AVMs) are abnormalities in intracranial vessels between the arterial and venous systems. This study aimed to identify the predictors of mortality in patients that presented to our hospital with AVMs, ruptured or unruptured, and correlate them to those available in the literature. Methods: An analytical, observational, retrospective study was performed to review data of patients with cerebral AVMs in the University Hospital “Dr José Eleuterio González” from January 2016 to December 2020. Clinical files were reviewed based on AVMs diagnosis according to the International Classification of Diseases 10th Revision, ICD-10. Variables were subjected to a univariate analysis and those found significant (p-value < 0.05) were subjected to a logistic regression. Results: A total of 80 patients were included in our study. Most of the participants were females (56.3%) and three were pregnant. The most common presenting symptom was holocranial headache (34 cases) occurring between the hours of 22:00 to 7:00. The most significant predictors of mortality were a total bleeding volume greater than 9.18 cm3 (p = 0.010), the presence of more than one symptom (p = 0.041), and a history of previous cerebral intraparenchymal hemorrhage (p = 0.014). Conclusion: Results demonstrated an important association between intracranial bleeding and mortality. Ultimately, more prospective studies are needed to determine predictor factors for mortality in AVMs patients.

Lessons Learnt from Operationalising an International Collaborative Multi-Centre Study

Many medical students are both skilled and experienced in healthcare research, statistical analysis and evidence synthesis; assets that can be deployed to great effect in order to conduct research and contribute to the body of evidence - particularly in outbreak situations where senior doctors may be redeployed to clinical duties, thus ensuring that the next generation of academic clinicians’ interest and knowledge does not go in vain. Here, we document the process by which a group of medical students across the world, with senior support, harnessed their enthusiasm and the power of technology to play leading roles in an international multi-centre study run by the Global Health Research Group on Children’s Non-Communicable Diseases (Global Children’s NCDs). Many lessons have been learnt from the successful operationalisation of this study, which we hope to impart in this article. Our operations team consisted of: a social media team who manage our various accounts; a graphic design team who produce visuals to illustrate milestones achieved or highlight countries from which we did not yet have representatives; a network team who constructed a database to manage our extensive collaborator network; a communications team who managed emails and maintained regular contact with collaborators as well as producing a guide of common issues; a researcher support team who worked to ensure that any issues faced were dealt with promptly by hosting drop-in sessions; and finally a research capacity building team. We found that medical students bring fresh perspectives and an open-minded approach which is useful in reframing challenges and generating innovative solutions; thus it is vital to give them the opportunity to collaborate with, and learn from senior academics and policy-makers.

Perception of Medical Students on the Effect of Covid-19 on Medical Education in Nigeria

Background: The lockdown due to the COVID-19 pandemic disrupted normal activities including undergraduate medical education in Nigeria, similar to the rest of the world. Nigeria as a low- and middle-income country had peculiar challenges in adjusting to the new norm. This study aimed to assess Nigerian medical student’s perception of the effect of COVID-19 on their learning. Methods: A semi-structured, pre-tested online questionnaire was administered to consenting medical students from thirty-three medical schools in Nigeria. Questions assessed the effect of COVID-19 on study and wellbeing, as well as the perception of interventions from institutions and student organizations to reduce the lockdown consequence on learning. Data was analyzed using (SPSS) version 25. Results: A total of 623 students from 33 institutions participated. All private institutions and 25% of public institutions had commenced online lectures/tutorials, 92% of students in private institutions and 21% in public institutions had attended online lectures/tutorials. Of those who did not attend institution-organized classes, 30.5% were opposed to online lectures, the main reasons stated being internet cost/availability and inefficiency. About 65% of the participants were aware of student-organized online tutorials/seminars. Eighty percent did not feel motivated to study and perceived their personal study to be less effective. Conclusion: Nigerian medical student’s perception of the effect of COVID-19 on their medical education was largely negative. Private institutions fared better in coping with the challenges of the pandemic. Proper planning will be needed to curb the effect of COVID-19 on students’ health and wellbeing.

Pneumatocele Induced Pneumothorax in a patient with Post-COVID-19 Pneumonitis. A Case Report

Background: The COVID-19 pandemic has been challenging medical professionals and facilities for over a year now. Much of the literature describes pathologic lung changes and complications associated with SARS-CoV-2, with pneumothorax and pneumatoceles not being uncommon. The Case: We describe a case involving a patient that presented to the emergency department with a pneumothorax. Three weeks prior, the patient was hospitalized for 10 days in acute respiratory distress secondary to COVID-19 pneumonitis, which did not require ventilator support. Follow up imaging revealed a 7 cm (AP) x 4.6 cm (transverse) x 2.5 (cc) cm pneumatocele. Conclusion: We speculate that antecedent rupture of an unrecognized pneumatocele likely caused lung collapse leading to the patient’s pneumothorax. This review delves into the etiology of both pneumothoraces and pneumatoceles along with their relation to COVID-19 pneumonia.