Factors Affecting Clinical Performance among Pakistani Dental Students: A Cross-Sectional Study

Objective: To identify the factors affecting clinical performance among dental students and to help addressing these problems. Material and Methods: A cross-sectional study in which students of third and final year of dentistry participated. Data was collected from June 2022 till September 2022. Data was collected from the third and final year dental students of both public and private dental colleges within the Pakistan using a purposive sampling technique. Results: A total of 372 dental students participated in this study. Thirty eight (31.9%) students belonged to third year while 81 (68.1%) were final year students from government college. For the private dental college, 121 (47.8%) were third year students while 132 (52.2%) were final year students. Majority of the participants were males from both the colleges. 42.9% of government dental students and 26.5% of private dental students agreed on well-preparedness of clinical instructors. 5.5% from private and 21.0% from government dental colleges agreed that adequate personal protective equipment were present in clinical departments. Conclusion: From this study, it is concluded that there should be focus more focus on the factors to enhance clinical skills, supervision of students in clinical practice to help addressing the problems faced during learning and performance in a clinical environment, to produce self-confident, motivated, knowledgeable, skillful and a professional dental graduates

MINOCA - A Rarity Of It\u27s Own And The Importance Of Cardiac MRI

Myocardial infarction with non-obstructive coronary arteries (MINOCA) disease is a diagnostic dilemma with clinical evidence of acute myocardial infarction (AMI) with normal coronary arteries. MINOCA is a complex issue; the management of the patients needs to be focused on identifying the core problem. Cardiac magnetic resonance (CMR) imaging is a non-invasive diagnostic tool that can play an important role in enabling clinicians to build a differential diagnosis in patients with MINOCA and also identify other non-ischemic aetiologies of myocardial injury. We present a challenging case of a patient with MINOCA with MI in small proximal septal artery distribution revealed on cardiac magnetic resonance imaging

Cystic Fibrosis - An Ever Evolving Challenge

Cystic fibrosis (CF) is a genetic disease that results from mutations in a large single gene located on chromosome 7. More than 2000 different mutations in the gene have been identified to have caused the disease. Most of these mutations are exceedingly rare and therefore not a part of CF screening or all testing panels. This case discusses an adult female with a history of asthma, bronchiectasis, pseudomonas colonization, and respiratory failure on chronic oxygen who presented to the ED with sudden onset shortness of breath, fever, chills, body aches, nonproductive cough, and headache. The patient\u27s condition clinically improved with treatment and was discharged on day three. The patient had previously undergone a laboratory evaluation of bronchiectasis. Due to the patient\u27s history of bronchiectasis and pseudomonas colonization, there was a decision to reconsider the possibility of CF. The patient underwent a routine cystic fibrosis genetic testing panel which subsequently confirmed a CFTR mutation. The discussion highlights the importance of remaining vigilant for signs of CF, to remain open to the possibility of CF or CFTR related disorders, when patients have had evaluations for such that predate current testing standards or capabilities

Student Involvement in Curriculum Development Enhances Medical Education

Background: During the 2014 annual review of the curriculum for first year medical students at the Medical College of Georgia, the public health module was noted as an area that needed improvement. To address this concern, a Public Health Curriculum Workgroup was formed for the purpose of identifying specific areas to improve and developing a more robust and integrative curriculum. A small cohort of medical students with public health backgrounds were invited to be members of this workgroup and participate in the development and delivery of public health content to the next cohort of first year medical students. We hypothesized that having this type of student participation results in a more clinically relevant and engaging curriculum. Methods: The curriculum workgroup met weekly to establish learning objectives, prioritize topics, and design interactive activities. The student members contributed to both curricular planning and content delivery. First year medical students completed course evaluations following the public health curriculum. These evaluations included five Likert scale questions and three narrative feedback response questions. Evaluation data before and after student involvement in the curriculum was examined. Results: Student evaluations of the overall quality of the public health curriculum increased 38% from 2014-2016. The measure of how well the content contributed to development as a future physician increased 36%. There was a 33% increase in how well the instructional materials aided understanding of topics. Theming of narrative evaluation comments showed that student involvement in the curriculum was well received. In 2016, 28.4% of narrative comments cited student presentations as the most valuable aspect of their public health experience. Conclusions: Involving medical students with public health backgrounds in curriculum development and content delivery of a public health module for first year medical students led to improvements in overall quality, clinical relevance, and instructional materials

The Frequency of Asymptomatic Sacroiliitis in Jordanian Patients with Crohn’s Disease. Assessment by Magnetic Resonance Enterography

Background: our aim was to assess frequency of asymptomatic sacroiliitis (SI) in patients with Crohns disease referred for magnetic resonant enterography (MRE) as a part of small bowel evaluation. Methods: this was a retrospective study of all patients with Crohns disease who were referred for MRE between January of 2016 to October of 2017 to Jordan University Hospital. All MRE were reviewed by an experienced radiologist and SI was diagnosed and graded based on predefined MRI criteria. All patients were contacted and assessed for symptomatic SI based on Assessment of SpondyloArthritis international Society (ASAS) criteria of 2009 for axial spondyloarthropathy. All patients were included in the final analysis.Results: a total of 60 patients were included, overall 18 (30%) showed evidence of SI, two patients were symptomatic and another two were diagnosed with ankylosing spondylitis as assessed by ASAS criteria. Those were excluded. Fourteen (23%) patients were included in the final analysis, with an average age of 36.7 years, 71% males. The average disease duration was 7.25 years. The percentage of ASA used by patients was 50%, Azathioprine 71%, Biologic agents in 36% in combination and single drug was used in 36% of patients.Conclusion: The prevalence of asymptomatic SI based on predefined MRI criteria was 23%, the importance of this finding and future course progression needs further studies

Interdisciplinary Strategies for Treating Oral Aversions in Children.

Oral aversion is a frequent diagnosis in the pediatric population. For a minority of children, feeding challenges rise to the level of requiring clinical evaluation and intervention. Determining the best evaluation and treatment plan can be challenging, but there is a consensus that treatment for children with a severe oral aversion involves an interdisciplinary approach. Within the team model, multiple strategies have demonstrated effectiveness, including sensorimotor skill building, behavioral modification, hunger provocation, and sensory integration therapy. This tutorial reviews the diagnostic and treatment process for a child with oral aversion, including identification of an underlying etiology, the medical and behavioral evaluation, and formulation of a treatment plan

A Randomized Controlled Trial of an Outpatient Protocol for Transitioning Children from Tube to Oral Feeding: No Need for Amitriptyline.

ObjectiveTo assess the role of amitriptyline in the effectiveness of an outpatient protocol for weaning medically complicated children from tube to oral feeding.Study designTwenty-one children seen in multidisciplinary outpatient feeding teams across 4 sites were recruited to a randomized placebo-controlled trial of a 6-month outpatient treatment protocol with behavioral, oral-motor, nutrition, and medication components.ResultsAll of the children who completed the 6-month program (73%) were weaned to receive only oral feeding, regardless of group assignment. The transition from tube to oral feeding resulted in decreases in body mass index percentile and pain, some improvements in quality of life, and no statistically significant changes in cost.ConclusionsAmitriptyline is not a key component of this otherwise effective outpatient, interdisciplinary protocol for weaning children from tube to oral feeding.Trial registrationClinicalTrials.gov: NCT01206478