Evaluating Factors Influencing Memorization in Undergraduate Medical Students.

Objectives: To evaluate the techniques used by medical students for better memo-rization and identify factors that directly or indirectly influence the process of memorization.Method: This cross-sectional study included undergraduate medical students from four public/private medical schools of Karachi. Through stratified random sampling, 400 medical students were administered a questionnaire that had been developed through focused group discussions and pre-tested on a smaller population. Data was analyzed using SPSS version 26.0 by applying Pearson’s chi square test for cate-gorical variables and Mann Whitney U test for scale variables.Results: Passion for the medical field was the key motivating factor for most the students (n=133; 33.3%). The source of motivation to study in students was related to the phase of their training at medical school, with preclinical and clinical years showing a slightly significant difference (P=0.049). Silent reading (n=203; 50.8%), intermittent power naps (n=125; 31.2%) and making notes and flowcharts (n=169; 42.2%) were the preferred memorization techniques. 46.9% (n=188) students re-quired < 4 hours of study daily and no significant difference in the number of study hours required per week was observed between the two genders and the students of preclinical and clinical years. Majority of the students considered lack of sleep (n=232; 58%) and social media (n=146;36.5%) their biggest sources of distraction.Conclusion: Desire to help humanity is the main driving force for medical students. The extensive syllabus requires dedicated number of study hours and use of memo-rization techniques suited for oneself.Keywords: Learning preference, Memorization technique, Motivation factor, Memory aid, Academic performance

Respiratory pathogens in patients with acute exacerbation of non-cystic fibrosis bronchiectasis from a developing country

Bronchiectasis unrelated to cystic fibrosis (non-CF bronchiectasis) has become a major respiratory disease in developing nations. The dilated mucus filled airways promote bacterial overgrowth followed by chronic infection, bronchial inflammation, lung injury and re-infection Accurate pathogen identification and antimicrobial susceptibility allowing appropriate treatment, in turn, may break this vicious cycle. To study the spectrum and antimicrobial spectrum of pathogen yielded from respiratory specimens in adult patients with acute exacerbation of non-cystic fibrosis (CF) bronchiectasis. This cross-sectional study was performed at the pulmonology clinics of the Aga Khan University, Karachi, Pakistan from 2016-2019. Respiratory specimens were collected from adult patients with acute exacerbation of non-CF bronchiectasis presenting in pulmonology clinics. Microbial cultures were performed using standard methodology. Susceptibility testing was performed and interpreted using Clinical Laboratory Standard Institute criteria. A total of 345 positive cultures from 160 patients presenting with acute exacerbation were evaluated. The most frequent organisms were Pseudomonas aeruginosa (n=209) followed by Hemophilus influenzae (n=40) and Staphylococcus aureus (n=24). High rates of antimicrobial resistance were found in all these pathogens. Proportion of Pseudomonas aeruginosa strains resistant to ciprofloxacin, imipenem, ceftazidime and piperacillin-tazobactam were 27.1%, 16.8%, 14.8% and 13.1% respectively. 65% of Hemophilus influenzae strains were resistant to cotrimoxazole and ciprofloxacin and 66.7% of Staphylococcus aureus strains were resistant to methicillin. High antimicrobial resistance in non-CF bronchiectasis patients against commonly used antimicrobials is a concern and highlight need for urgent community level interventions to improve clinical outcome in these patients

5-FU induced acute toxic leukoencephalopathy: early recognition and reversibility on DWI-MRI

Acute toxic leukoencephalopathy (ATL) is a rare adverse effect of 5-Fluorouracil (5-FU) chemotherapeutic agent. It is imperative for the radiologist to confidently identify the white matter changes caused by this agent in case of toxicity. This will help in early detection and appropriate management of patient, as the condition is reversible both clinically and on imaging. We report a case of a 29 years old gentleman, known case of carcinoma of esophagus who suffered from acute toxic leukoencephalopathy secondary to leukotoxic therapeutic agent 5-FU, and illustrate the reversible imaging findings of this condition on withdrawal of the inciting agent

Ewing sarcoma of larynx: A rare case in a 5-year-old boy

Ewing Sarcoma of the head and neck region is an extremely rare entity. Treatment usually involves surgery, chemotherapy and radiotherapy in varying sequences. We present the third case to date of Ewing sarcoma of the larynx in a paediatric population. A 5-year-old boy presented to emergency room with acute respiratory distress. Computerized tomography scan showed a mass in the supraglottis; he was intubated using videolaryngoscope and tracheostomy was avoided, mass was removed by cold dissection. Final histopathologic examination revealed Ewing sarcoma. Further workup showed no systemic metastasis. Patient was advised adjuvant therapy which the family refused. Currently he is doing fine on 2 years of follow-up

Management of laryngotracheal trauma: A review of current trends and future directions

Laryngotracheal trauma is rare but can pose serious threats to one\u27s life. Presenting symptoms vary according to the severity of injury. Immediate Airway control is first step in the management, intubation should be considered by a senior member of the trauma team if the injury is minor while tracheostomy should be reserved for more severe injuries. Evaluation by a fibre-optic laryngoscopy and CT scan should be done whenever possible. Reconstruction is done according to the site involved using suture, titanium miniplates and stents. Tissue engineering has added a new horizon in this management but up till now complete laryngotracheal regeneration is very far-fetched, but tissue regeneration at individual sites have shown some positive results. More work needs to be done in this less explored field including laryngeal transplantation

Use of endoscope in teaching of otolaryngology residents about site and size of tympanic membrane perforation and its impact on degree of hearing loss in adult patients: A cross sectional study

Objective: To determine the association between site and size of perforation of the tympanic membrane and the level of conductive hearing.Methods: The cross-sectional study was conducted from November 2015 to October 2016 at Aga Khan University Hospital Karachi and comprised patients with tympanic membrane perforation without any other middle-ear disease. Karl-Storz Rigid Endoscope attached to a camera was used to take pictures of the tympanic membrane. Site of the perforation was determined using a vertical line to divide the membrane into two anterior and posterior halves. Size of the perforation was calculated as a percentage of the total membrane using Image J software. Data analysis was done using Stata 12.Results: Of the 55 patients, 29(53%) were males and 26(47%) were females. The overall mean age was 33+/-15 years. With every 5% increase in the size of perforation, the hearing loss increased by 1 decibel. A difference of 5.5 decibels was noted between anterior and posterior perforations of similar size.Conclusion: Hearing loss increased with increase in the size of perforation

Dental CLAIRES: Contrastive LAnguage Image REtrieval Search for Dental Research

Learning about diagnostic features and related clinical information from dental radiographs is important for dental research. However, the lack of expert-annotated data and convenient search tools poses challenges. Our primary objective is to design a search tool that uses a user's query for oral-related research. The proposed framework, Contrastive LAnguage Image REtrieval Search for dental research, Dental CLAIRES, utilizes periapical radiographs and associated clinical details such as periodontal diagnosis, demographic information to retrieve the best-matched images based on the text query. We applied a contrastive representation learning method to find images described by the user's text by maximizing the similarity score of positive pairs (true pairs) and minimizing the score of negative pairs (random pairs). Our model achieved a hit@3 ratio of 96% and a Mean Reciprocal Rank (MRR) of 0.82. We also designed a graphical user interface that allows researchers to verify the model's performance with interactions.Comment: 10 pages, 7 figures, 4 table

Diagnostic accuracy of different cut-off values of adenosine deaminase levels in tuberculous pleural effusion

Objective: To assess the diagnostic accuracy of different cut-off values of pleural fluid adenosine deaminase levels as a diagnostic method for tuberculous pleural effusion. Method: The prospective study was conducted from 2014 to 2016 at the Aga Khan University Hospital, Karachi, and comprised pleural fluid samples of adult patients with and without tuberculosis which were tested for adenosine deaminase levels, and divided into tuberculosis group A and non-tuberculosis group B. Sensitivity, specificity, negative predictive value and positive predictive value were calculated using different cut-offs. Data was analysed using IBM SPSS (Statistical Package for Social Sciences) version 21.0 (IBM Corp., Armonk, NY). Results: Of 155 patients, 46(29.7%) had tuberculosis; 30(65.2%) males and 16(34.8%) females. Those who did not have tuberculosis were 109(70.3%); 69(63.3%) males and 40(36.7%) females. The adenosine deaminase levels were elevated in group A compared to group B (p\u3c0.001). The cut-off of 30U/L showed the highest sensitivity (71.7%) and negative predictive value (87.4%), and a specificity of 82.6%. The cut-off of 50U/L showed the highest specificity (89.9%) with sensitivity 52.2%, and the cut-off of 40U/L showed the highest positive predictive value of 68.9% with sensitivity 67.4% and specificity 87.2%. Conclusion: Pleural fluid adenosine deaminase testing for diagnosing tuberculosis pleuritis revealed highest sensitivity and moderate specificity for cut-off value of 30U/

Training in temporal bone surgery: A review of current practices

The temporal bone consists of complex anatomy, and the presence of various vital structures in close proximity makes the surgery of temporal bone highly challenging. Such a surgery requires years of training under the direct observation of trainers. Over the course of history, different training models have been adopted by experts to help train the young surgeons in this complex procedure. Cadaveric dissections of the temporal bone remains the gold standard in training of residents as the cadavers present the actual anatomical details which the surgeons encounter while operating on patients. However, due to scarcity of available cadavers, their one-time-only usage and high cost of involved in such trainings, experts have developed newer techniques of training, including three-dimensional reconstruction models and virtual reality simulators. Most of the literature on simulation in training of residents focuses on anatomical understanding and development of the surgical technique. There has been significant improvement in these techniques over time. With the addition of haptic feedback in the newer virtual simulation models, simulation has edged closer to basic modules of temporal bone dissection. the current review article was planned to have an overview of the different techniques in detail that are currently being in used