The COVID-19 pandemic: doom to international medical electives? Results from two German elective databases

Abstract: Objective: International medical electives are an essential part of medical education and popular among medical students. During the COVID-19 pandemic, however, many students had assistantship placements postponed and electives cancelled. Educational institutions switched face-to-face campus-based teaching to virtual platforms. Although it is conceivable that international medical electives were particularly affected by this development, numerical data on this phenomenon is yet scarce. To investigate how the COVID-19 pandemic influenced the clinical elective behavior of German-speaking medical students, we systematically analyzed two large German online databases (Famulatur-Ranking and PJ-Ranking) cataloging medical elective experience testimonies. Results: The COVID-19 pandemic substantially reduced the number of German medical students undertaking abroad medical electives. Between 2018 and 2020, a total of 10,976 reports were uploaded to both databases. We observed a notable decline in abroad elective reports in 2020. Prior to the COVID-19 pandemic, almost 5% of reports uploaded to “PJ-ranking” covered an international medical elective. This number dropped to 1.68% in 2020. Analyzing “Famulaturranking”, we observed a comparable phenomenon. While 4.74% of reports in 2019 covered an international elective, the number dropped to 2.02% in 2020. The long-term consequences of this phenomenon will be subject to future research

The impact of surgical resection and adjuvant therapy on survival in paediatric patients with Atypical Teratoid Rhabdoid Tumour: Systematic review and pooled survival analysis

Background Atypical teratoid/rhabdoid tumours (AT/RT) is a rare malignant neoplasm in the paediatric population. AT/RT is characterised by rhabdoid cells combined with the loss of either the INI1 or BRG1 protein. Objective To systematically review and analyse patient and tumour characteristics, prognosis, and impact of treatment on survival in paediatric patients with AT/RT confirmed by alterations in INI1 or BRG1. This systematic review is the first only to include paediatric cases of AT/RT confirmed with either INI1 or BRG1 alterations. Methods MEDLINE was searched using the terms "atypical teratoid/rhabdoid tumour" AND "paediatric/pediatric". Cases were included if confirmed by loss of INI1 or BRG1. The extracted dataset was analysed using descriptive statistics, log-rank test, and Kaplan-Meier survival analysis via SPSS. Results A total of 38 articles were included in this study. The average age at diagnosis was three years. The most common locations reported are the supratentorial region and cerebral hemispheres. Ninety-three patients were reported to show evidence of dissemination. The average overall survival was 29 months. A significant difference in survival was noted between the tumour location groups, particularly worst outcomes for patients with spinal AT/RT (p = <0.001). Extent of resection and adjuvant therapy were significant for survival (Chi-square = 10.107, p = 0.018) and (Chi-square = 20.38, p = < 0.0001), respectively. Conclusion AT/RT of the central nervous system in paediatric populations is a rare neoplasm associated with a poor prognosis in most patients. Future studies should be directed to find a standardised treatment protocol

Epithelioid Variant of Pleomorphic Liposarcoma: A Rare Challenging Diagnosis Causing Severe Medial Thigh Pain

We present the case of pleiomorphic liposarcoma in the medial compartment of the thigh of a 59-year-old female patient. The lump was noticed eight months prior to presentation and had gradually increased in size, leading to pressure symptoms in her thigh. Although painless initially, the lump eventually became tender prompting her to seek surgical attention. At the plastic surgery clinic, she was advised to get an MRI, which revealed an irregular but well-defined mass lesion measuring 8.2 x 6.6 x 4.3 cm. The mass did not have any manifestations in the surrounding structures. A wide excisional biopsy was then performed, and multiple sections were processed for histopathological analysis, confirming a diagnosis of epithelioid variant of pleomorphic liposarcoma

The Potential Applicability of Melatonin as an Immunosuppressive Agent for COVID-19: Review

COVID-19 is an emerging pathogen that has recently caused a global pandemic. It is an RNA virus that causes a respiratory tract infection. The pathogenesis of this virus involves an over aggressive immune reaction leading to inflammation and in certain cases acute respiratory distress syndrome (ARDS) and various neurological manifestations. Melatonin, a mitochondrially targeted antioxidant with anti-inflammatory properties, is being tested in trials as a potential adjuvant therapeutic agent that can help reduce oxidative stress damage caused by viral infections as well as optimizing the innate immune response. In addition, melatonin is an extremely safe drug and reports show its usefulness in treating other respiratory viral infections. The role of melatonin as an adjuvant in managing COVID-19 cases as well as the delirious states that are often encountered in these patients is being discussed

Pre-publication abstract-only reports compared to full-text manuscripts for randomised controlled trials in inflammatory bowel disease: a systematic review

Introduction: RCTs of key therapies in IBD are often presented and available as abstracts for significant periods of time prior to full publication, often being employed to make strategic and clinical prescribing decisions. We compared the concordance of pre-publication abstract-only reports and their respective full-text manuscripts. Methods: Pairs of full-text manuscripts and their respective pre-publication abstract-only reports for the same RCT outcomes, at the same timepoint of analysis were included. The RCTs were on treatments for IBD with full-text manuscripts published between 2010-2023. Results: We found 77 pairs of full-text manuscripts and their pre-publication abstract-only reports. There were significant mis-matches in the reporting of; stated planned outcomes (65/77 matched, p<0.001), and primary outcomes reported in their results sections (67/77, p<0.001); trial registrations (34/65, p<0.001); numbers of randomised participants (49/77, p=0.18); participants reaching end of study (21/71, p<0.001); and primary outcome data (40/73, p<0.001). Authors conclusions matched (75/77, p=0.157). Authors did not provide explicit or implied justifications for the absence or non-concordance for any of the above items. Conclusions: Abstract-only reports have consistent issues with both limited reporting of key information and significant differences in data when compared with their later full-text publications. These are not related to further recruitment of patients or word count limitations, and are never explained. As abstracts are often used in guidelines, reviews and stakeholder decision making on prescribing, caution in their use is strongly suggested. Further work is needed to enhance minimum reporting standards in abstract-only works and ensure consistency with final published papers. What is already known on this topic – Data from abstract-only reports of RCTs are often used as evidence sources for clinical and strategic decision-making in IBD. It is not known whether they are up to par for this purpose. What this study adds – Our findings suggest that abstract-only reports are often inconsistent in their reporting, compared with their respective full-text manuscripts, especially in areas such as flow of participants and primary outcome data. These are not related to further recruitment of patients or word count limitations, and are never explained. How this study might affect research, practice or policy – Caution is advised when abstract-only reports are used as evidence sources. Enhanced minimum reporting standards for abstract-only reports need to be employe

Management and outcomes of traumatic paediatric spinal cord injuries in low- and middle-income countries: a scoping review protocol

Background Traumatic spinal cord injury (TSCI) accounts for a significant proportion of deaths and disability worldwide and this is largely concentrated in low- and middle-income countries (LMICs). Though rare, a subset of TSCIs occurs in children, which can lead to long-term comorbidities if not managed within the optimal time frame. However, the lack of pre-hospital care, infrastructure and specialist manpower in LMICs may pose a challenge for health practitioners to provide quality and consistent standard of care to the children. The variety in practice and lack of clarity on management and outcomes of TSCIs in LMICs necessitates an evaluation of the literature. This scoping review protocol outlines how the authors will address the said topic of interest. Methods MEDLINE, Embase and Global Index Medicus will be searched from database inception to date in order to identify the relevant studies. Paediatric patients (ages 18 or below) with a TSCI managed in an LMIC country will be included. Surgical and conservative management of TSCIs will be considered. Original research, reviews, commentaries, editorials and case reports will be included. Results Primary outcomes will include TSCI epidemiology, presentation, management, morbidity, mortality and long-term complications. Secondary outcomes will include delays in receiving care. Discussion This scoping review will be the first to evaluate the current landscape of paediatric TSCI management and outcomes in LMICs, highlighting pertinent themes that may be used to guide further research as well as health system strengthening efforts by policymakers and stakeholders