The Relationship between Eating Disorders and Stress among Medical Undergraduate: A Cross-Sectional Study

Introduction: Eating disorders are compulsive behaviours that can consume a person’s life to the point of becoming life threatening. Medical college can be a very stressful time and previous studies had found that stress could be a main factor leading to higher risk of eating disorder. We aimed to determine the association between stress and eating disorders among undergraduate medical students. Methods: A cross-sectional study was conducted among 320 respondents comprises of Year 3, 4 and 5 medical students in private medical college in Malaysia, assessed using self-administered questionnaires which consist of social demographic data, EAT-26 and Cohen Perceived Stress Scale. The response rate of this study was 77.4%. Results: With regards to EAT-26, 11.0% of medical students were at risk of developing eating disorder and from this students who have obese BMI status (25%) had 3.9 times more likely to develop eating disorder (95% CI: 1.4 - 10.9). There was significant association between those with unsatisfactory social relationship with friends and peers (OR 2.5, 95% CI 1.0 - 5.9;p value 0.035) and risk of developing eating disorders (OR 3.9, 95% CI 1.4 - 10.9;p value 0.007). For Cohen Perceived Stress Scale (CPSS), 75.5% of the respondents were having high stress level. There was no significant association between stress and the risk of eating disorders with OR 1.0, 95% CI: 0.6 - 1.7;p value 0.887. Conclusion: Majority of medical undergraduates were under stressed and there was a risky trend toward eating disorders in medical. However, based on our results it did not portray any significant association between stress and risk of developing eating disorders. Nevertheless, it should not be completely neglected. It is important to increase the awareness of medical undergraduates regarding eating disorders and its complications.

Knowledge and Perception of Sexual Health among Medical Undergraduates: A Cross-Sectional Study

Introduction: Sexual health education is paramount in curbing the rising numbers of sexual transmitted diseases in Malaysia. Medical undergraduates which are the future frontier play an utmost role in educating and quell the social barrier in discussion on this taboo topic. We aimed to determine the knowledge, perception and factors affecting sexual health education among medical students in MMMC and to advocate sexual health education at primary level. Methods: A cross-sectional study was conducted among 309 respondents comprises of Year 3, 4 and 5. Results: There was significant association between age, gender, religion and ethnicity and sexual health knowledge and perception score. Pearson correlation coefficient shows there was positive correlation (r = 0.059) between total sexual health knowledge percentage score and total perception score but was not significant. Conclusion: Medical undergraduates should improve their knowledge and perception regarding sexual health education. It is recommended to implement sexual education in high school curriculum and institution of higher learning in Malaysia as it is not implemented yet here due to political and religion sensitivity. It is also important that students develop personalities that are ready to accept exchange and contribute sensitive issues such as sexual health.

Effect of Punica granatum peel extract on learning and memory in rats

Objective:To evaluate potential memory enhancing effect of Punica granatum peel extract on rats.Methods:Healthy adult male albino rats of Wistar strain were used.Each group of 6 rats were administered either distilled water or 50 mg/kg of extract or 100 mg/kg of extract for 15 days and subjected to passive avoidance test or T-maze test.In the next phase rats were administered distilled water or 100 mg/kg of extract for 15 days and the rats were given injection diazepam before subjecting them to the tests.Results:The overall performance was better in test groups compared to control groups.Among the test groups,100 mg/kg rats performed better than 50 mg/kg.The effect on spatial learning parameters like mean number of alternations and mean percentage bias was more marked compared to retention testing parameters like latency. 100 mg/kg Punica extract treated group also improved performance of diazepam treated rats. Conclusions:There is a definite trend of memory improvement by Punica granatum peel with effects being more marked on spatial learning tendency and long term memory than on retention capacity.

Continuing episodes of pain in recurrent acute pancreatitis: Prospective follow up on a standardised protocol with drugs and pancreatic endotherapy

AIM To assess the outcomes of drug therapy(DT)followed by pancreatic endotherapy for continuing painful episodes in recurrent acute pancreatitis.METHODS DT comprised of pancreatic enzymes and antioxidants failing which,endotherapy(ET;pancreatic sphincterotomy and stent placement)was done.The frequency of pain,its visual analogue score(VAS),quality of life(Qo L),serum C peptide and faecal elastase were compared between baseline and after 1 year of follow up in all patients and in the two subgroups on DT and ET.Response was defined as at least 50%reduction in the severity of pain to below a score of 5.RESULTS Of the thirty nine patients analysed,21(53.9%)responded to DT and 18(46.1%)underwent ET.The VAS for pain(7.0±2.0 vs 1.3±2.5,P<0.001)and the number of days with pain per month decreased[1.0(1.0,2.0)vs 1.0(0.0,1.0),P<0.001],and the Qo L scores[55.0(44.0,66.0)vs 38.0(32.00,51.00),P<0.01]improved significantly during follow up.Similar significant improvements were seen in patients in the subgroups of DT and ET except for Qo L in ET.The serum C-peptide(P=0.001)and FE(P<0.001)levels improved significantly in the entire group and in the two subgroups of patients except for the C peptide levels in patients on DT.CONCLUSION A standardised protocol of DT,followed by ET decreased the intensity and frequency of pain in recurrent acute pancreatitis,enhanced Qo L and improved pancreatic function.

Comparing acid steatocrit and faecal elastase estimations for use in M-ANNHEIM staging for pancreatitis

AIM To compare two tests for exocrine pancreatic function(EPF) for use in M-ANNHEIM staging for pancreatitis. METHODS One hundred and ninety four consecutive patients with acute pancreatitis(AP; n = 13), recurrent acute pancreatitis(RAP; n = 65) and chronic pancreatitis(CP; n = 116) were enrolled. EPF was assessed by faecal elastase-1(FE-1) estimation and stool fat excretion by the acid steatocrit method. Patients were classified as per M-ANNHEIM stages separately based on the results of the two tests for comparison. Independent Student's t-test, χ~2 test, Kruskal-Wallis test, Mann-Whitney U test and Mc Nemar's test were used as appropriate. RESULTS Sixty-one(52.5%) patients with CP had steatorrhoea when assessed by the acid steatocrit method; 79 (68.1%) with CP had exocrine insufficiency by the FE-1 test(χ~2 test, P < 0.001). The results of acid steatocrit and FE-1 showed a significant negative correlation(Spearman's rho =-0.376, P < 0.001). A statistically significant difference was seen between the M-ANNHEIM stages as classified separately by acid steatocrit and the FE-1. Thirteen(6.7%), 87(44.8%), 89(45.8%) and 5(2.5%) patients were placed in M-ANNHEIM stages 0,?Ⅰ, Ⅱ, and Ⅲ respectively, with the use of acid steatocrit as against 13(6.7%), 85(43.8%), 75(38.6%), and 21(10.8%) respectively by FE-1 in stages 0,?Ⅰ, Ⅱ, and Ⅲ thereby altering the stage in 28(14.4%) patients(P < 0.001, Mc Nemar's test). CONCLUSION FE-1 estimation performed better than the acid steatocrit test for use in the staging of pancreatitis by the M-ANNHEIM classification since it diagnosed a higher proportion of patients with exocrine insufficiency.

Depression, Anxiety and Stress among Undergraduate Students: A Cross Sectional Study

Background: The prevalence of moderate to extremely severe level of depression, anxiety and stress among undergraduate students in Malaysia was ranging from 13.9% to 29.3%, 51.5% to 55.0% and 12.9% to 21.6% respectively. Medical students have been shown to be more inclined to emotional disorders, especially stress and depression, as compared to their non-medical peers. Therefore, the objective of this cross-sectional study was to determine the prevalence of depression, anxiety and stress among undergraduate students in Melaka Manipal Medical College. Methods: Self-administered questionnaires consisted of 3 sections: demographic data, socioeconomic data and DASS 21 questions. Data processing was performed using Microsoft Excel 2010. The psychological status was categorized according to the presence or absence of depression, anxiety and stress. The data were analyzed using Epi InfoTM 7.1.4 and SPSS. Student’s t-test, Fisher Exact and Chi-square test were used to analyze the associations. P-value of <0.05 was considered as statistically significant. Multiple logistic regression was used to calculate the adjusted Odd Ratio. Results: A total of 397 undergraduates participated in this study. The prevalence of the depression, anxiety and stress, ranging from moderate to extremely severe, was 30.7%, 55.5%, and 16.6% respectively. Multiple logistic regression shows significant associations between relationship status, social life and total family income per month with depression. Only ethnicity has been shown to be significantly associated with anxiety. There are significant associations between ethnicity and total family income per month with stress. No other factors have been found to be significantly associated. Conclusion: Depression, anxiety and stress have a high detrimental effect to individual and society, which can lead to negative outcomes including medical dropouts, increased suicidal tendency, relationship and marital problems, impaired ability to work effectively, burnout and also existing problems of health care provision. With that, there is a need for greater attention to the psychological wellbeing of undergraduate students to improve their quality of life.

Monocyte chemoattractant protein-1, transforming growth factor-β1, nerve growth factor, resistin and hyaluronic acid as serum markers：comparison between recurrent acute and chronic pancreatitis

BACKGROUND： Diagnostic parameters that can predict the presence of chronic pancreatitis（CP） in patients with recurrent pain due to pancreatitis would help to direct appropriate therapy. This study aimed to compare the serum levels of monocyte chemoattractant protein-1（MCP-1）, transforming growth factor-β1（TGF-β1）, nerve growth factor（NGF）, resistin and hyaluronic acid（HA） in patients with recurrent acute pancreatitis（RAP） and CP to assess their ability to differentiate the two conditions.METHODS： Levels of serum markers assessed by enzymelinked immunosorbent assay（ELISA） were prospectively compared in consecutive patients with RAP, CP and in controls and stepwise discriminant analysis was performed to identify the markers differentiating RAP from CP.RESULTS： One hundred and thirteen consecutive patients（RAP=32, CP=81） and 78 healthy controls were prospectively enrolled. The mean（SD） age of the patients was 32.0（14.0）years; 89（78.8%） were male. All markers were significantly higher in CP patients than in the controls（P〈0.001）; MCP-1NGF and HA were significantly higher in RAP patients than in the controls（P〈0.001）. Stepwise discriminant analysis showed significant difference（P=0.002） between RAP and CP for resistin with an accuracy of 61.9%, discriminant scores of ≤-0.479 and ≥0.189 indicating RAP and CP, respectively. The other markers had no differential value between RAP and CP.CONCLUSION： Serum resistin is a promising marker to differentiate between RAP and CP and needs validation in future studies, especially in those with early CP.

Efferent limb of gastrojejunostomy obstruction by a whole okra phytobezoar:Case report and brief review

A phytobezoar is one of the intraluminal causes of gastric outlet obstruction,especially in patients with previous gastric surgery and/or gastric motility disorders.Before the proton pump inhibitor era,vagotomy,pyloroplasty,gastrectomy and gastrojejunostomy were commonly performed procedures in peptic ulcer patients.One of the sequelae of gastrojejunostomy is phytobezoar formation.However,a bezoar causing gastric outlet obstruction is rare even with giant gastric bezoars.We report a rare case of gastric outlet obstruction due to a phytobezoar obstructing the efferent limb of the gastrojejunostomy site.This phytobezoar which consisted of a whole piece of okra(lady finger vegetable) was successfully removed by endoscopic snare.To the best of our knowledge,this is the first case of okra bezoar-related gastrojejunostomy efferent limb obstruction reported in the literature.

Emerging Trends in the Etiology and Antimicrobial Susceptibility Pattern of Enteric Pathogens in Rural Coastal India

Introduction: Gastroenteritis is recognized as a serious public health problem in India. It is a syndrome that can be caused by different bacterial, viral and parasitic pathogens. Indiscriminate use of antibacterial agents has resulted in the development of multidrug resistant organisms. A retrospective study was done to analyze the etiological spectrum of diarrhoea and to determine the antimicrobial resistance pattern of bacterial pathogens. Methodology: Fecal specimens from patients with acute or chronic diarrhoea were received prior antibiotic administration and processed for routine microscopy of parasites;culture, antimicrobial susceptibility testing and polymerase chain reaction for bacterial pathogens and latex agglutination for rotavirus. Results: Out of the 6043 stool samples collected during the period of Jan 2005-Dec 2013, 678 (11.2%) enteric pathogens were isolated. The predominant isolates were Diarrheagenic Escherichia coli (DEC) (46.3%) followed by Salmonella, Shigella, Vibrio cholerae and parasites. Certain unusual pathogens were also isolated. Among age wise distribution, Diarrheagenic Escherichia coli (DEC) mainly Enteroaggregative Escherichia coli (EAEC) was isolated from <5 years of age. The majority of other enteric pathogens were isolated from the adult population. The enteric pathogens isolated showed resistance to multiple antibiotics. The resistance pattern observed during this period showed an overall increase in resistance to the antibiotics tested. Conclusion: The present study documents the overall role of etiological agents as causes of diarrhoea and indicates that the indiscriminate use of potent antibiotics can lead to acquisition of resistance to important therapeutic agents.

Effect of aqueous seed extract of Mucuna pruriens on arsenic-induced testicular toxicity in mice

Objective:To investigate the protective effects of Mucuna(M.)pruriens against arsenic-induced testicular impairment in albino mice.Methods:Thirty-six male albino mice were divided into six groups,with 6 mice in each group.Group 1 received drinking water as the normal control.Groups 2 to 6 received sodium arsenite(40 mg/L)in drinking water.Group 3 received sodium arsenite(40 mg/L)and 300 mg/kg body weight(b.w.)of N-acetylcysteine.Group 4 received sodium arsenite(40 mg/L)and 500 mg/kg b.w.of M.pruriens.Group 5 received sodium arsenite(40 mg/L)and 1000 mg/kg b.w.of M.pruriens.Group 6 received sodium arsenite(40 mg/L)and 2000 mg/kg b.w.of M.pruriens.N-acetylcysteine and M.pruriens were administered orally once a day.Animals were subjected to the above treatments for 45 days.Animals were sacrificed with overdose of ketamine 24 h following drug administration.The testis was used for biochemical estimations(lipid peroxidation and glutathione),and the epididymis was used to determine the sperm count and morphology.Results:Sodium arsenite significantly decreased(P<0.01)the sperm count and glutathione levels of the testis.It significantly increased(P<0.01)the abnormal architecture of the spermatozoa and lipid peroxidation levels.Treatment with M.pruriens significantly increased the sperm count and the glutathione levels[500 mg/kg b.w.and 1000 mg/kg b.w.(P<0.01)].A significant decrease in sperm abnormality and lipid peroxidation levels[500 mg/kg b.w.and 1000 mg/kg b.w.(P<0.01)]was also observed.Conclusions:The perturbed sperm parameters and antioxidant levels of the arsenic insulted testis are attenuated by 500 mg/kg b.w.and 1000 mg/kg b.w.M.pruriens.

Calorie Restriction the Fountain of Youth

Calorie restriction (CR) is as close to a real fountain of youth as any known technique is. Caloric restriction known to extend the human lifespan by up to five years has quietly become accepted among leading researchers. Even scientists who are cautious about anti-aging hype say it works. The formula is simple: Eat less. It could add years to your life. In the context of health and longevity, I analyzed data documenting proofs which suggest that the caloric restriction extends life span and retards age-related chronic diseases in a variety of species, including rats, mice, fish, flies, worms, and yeast as well as improve biomarkers of aging in humans. Research has shown that not only does it result in a longer lifespan, but it also lowers blood pressure, oxidative damage, cardiovascular disease, modifies insulin sensitivity, reduces loss of central nervous system cells, strengthens the immune system, lowers cholesterol, diminishes the rate of heart disease, reduces muscle oxygen loss, improves muscle function, reduces free radical damage to body tissue and helps stabilize blood sugar in adult-onset diabetes. Caloric restriction the most widely recognized life span-extending intervention has shown that it does indeed have age-slowing effects in humans like it has been shown to work in animals and Dr. Fontana has already made medical history in studying anti aging effects of caloric restriction.

Multiple tendons of the additional belly of flexor pollicis longus in the carpal tunnel: Embryological perspective and their clinical significance

Although the flexor pollicis longus is known to show the additional head of the origin, the occurrence of its additional tendons in the carpal tunnel are seldom reported. The presence of such additional tendons in the carpal tunnel cannot be overlooked during the radiological and surgical procedures in this region. Herein, we report a rare case of additional muscle belly of flexor pollicis longus. The additional muscle belly after a short course divided into three tendons. All three tendons entered the carpal tunnel along with flexor pollicis longus, passing deep to the flexor retinaculum. Within the carpal tunnel, two of these tendons fused and terminated by merging with the undersurface of the flexor retinaculum. The third tendon terminated by joining the flexor digitorum superficialis tendon for the index finger, in the palm. An additional slip of the first lumbrical muscle took origin from the third tendon of the additional muscle belly of flexor pollicis longus. Further, the embryological basis and clinical significance of current case is discussed.

Hypoplastic plexiform right anterior cerebral artery and absence of anterior communicating artery—A case report

Anterior cerebral artery is the smaller terminal branch of the internal carotid artery. It is one of the arteries involved in the formation of the arterial circle of Willis at the base of the brain. Its hypoplasia or absence can cause serious problems during neurosurgery or in the vascular dynamics of the brain. We found a rare variation of the right anterior cerebral artery during the dissection of the brain. The initial segment of the artery was hypoplastic and plexiform. The anterior communicating artery was absent. The right and left anterior cerebral arteries fused with each other for a distance of about 1 cm. The course, size and distribution of the distal part of the right anterior cerebral artery were normal. This case may be of special importance to neurosurgeonsand radiologists. Obstructionor rupture of the left anterior cerebral artery in such cases might result in infarct of the medial surfaces of both cerebral hemispheres.

Can Fresh Frozen Plasma Prevent Acute Kidney Injury after Hump-Nosed Viper Bite?

Hump-nosed viper bite is the commonest venomous snakebite in Sri Lanka. Acute kidney injury (AKI) in association with coagulopathy is an important cause of mortality. Immunomodulating effects of fresh frozen plasma (FFP) could block the nephrotoxic effects of venom;and by replenishing depleted clotting factors resulting from venom induced consumption coagulopathy could offer an additional benefit in offsetting renal injury triggered by haematological disturbances. In a non-randomised observational study carried out from 2005 to 2008 in adults at the National hospital of Sri Lanka, the mean time for resolution of coagulopathy among 42 patients treated with FFP at the inception of coagulopathy was 4.7 hours compared to 18 patients treated with isotonic Saline among whom the mean time for normalisation of coagulopathy was 6.2 hours. None of these 60 patients developed acute renal failure. A separate cohort of 32 patients with coagulopathy after hump-nosed viper bite who had not received FFP during this study period developed acute renal failure and required haemodialysis. In the absence of safe and effective antivenom for hump-nosed viper in Sri Lanka, FFP may be a therapeutic option. FFP if given early to selected patients at inception of coagulopathy may prevent AKI and serve to save lives after hump-nosed viper bites.

Unusual communication of profunda femoris vein with the popliteal vein in the middle of the popliteal fossa

Profunda femoris vein (PFV) rarely forms a direct communication with the lower end of the femoral vein (FV) or popliteal vein (PV). During regular dissections for medical undergraduates, we came across a rare anatomical variation of PFV in the right lower limb of an 80-year-old female cadaver. PFV commenced from the PV just above its formation by the union of anterior and posterior tibial veins. It traversed the popliteal fossa on the lateral side of the popliteal artery and entered into the adductor canal after piercing the adductor magnus muscle. Finally, it emptied into the FV in the lower part of the femoral triangle. Furthermore, the PV had a small caliber than that of PFV. Deep veins of leg are the common site for formation of thrombosis. In terms of diagnosis and operative procedures, the location of thrombosis in the deep veins of lower limb is clinically of great importance. Thus detailed knowledge of the anatomical variation reported here is useful during diagnosis and treatment of deep vein thrombosis.

Anomalous origin and vulnerable course of left colic artery in relation to the pancreas—A case report

We report here an anomalous origin and course of left colic artery in relation to pancreas during routine dissection of the abdominal region in a 70-year-old male cadaver in the department of anatomy. The anomalous left colic artery took its origin from the superior mesenteric artery and immediately divided into right and left branches. The right branch passed through the transverse mesocolon to supply the left one third of the transverse colon. The left branch traversed to the left along the inferior border of the body of the pancreas and crossed the left kidney before supplying the left colic flexure of colon and descending colon. This aberrant course of the left branch of the left colic artery can be considered as a “vulnerable” course as it is liable to injury during pancreatic and renal surgeries since the artery is not expected to run along the inferior border of the pancreas. The pancreas, a retroperitoneal organ, is related to major arteries such as abdominal aorta, inferior vena cava, coeliac trunk and its main branches, superior mesenteric vessels, splenic and portal veins. Surgery of the pancreas therefore, not only needs a thorough knowledge of the normal course of branches of these vessels but also demands a good knowledge of possible anomalous vessels arising in this region.

Deregulated miRNA clusters in ovarian cancer:Imperative implications in personalized medicine

Ovarian cancer(OC)is one of the most common and fatal types of gynecological cancer.OC is usually detected at the advanced stages of the disease,making it highly lethal.miRNAs are single-stranded,small non-coding RNAs with an approximate size ranging around 22 nt.Interestingly,a considerable proportion of miRNAs are organized in clusters with miRNA genes placed adjacent to one another,getting transcribed together to result in miRNA clusters(MCs).MCs comprise two or more miRNAs that follow the same orientation during transcription.Abnormal expression of the miRNA cluster has been identified as one of the key drivers in OC.MC exists both as tumor-suppressive and oncogenic clusters and has a significant role in OC pathogenesis by facilitating cancer cells to acquire various hallmarks.The present review summarizes the regulation and biological function of MCs in OC.The review also highlights the utility of abnormally expressed MCs in the clinical management of OC.