Impacts and challenges of United States medical students during the COVID-19 pandemic

The delivery of medical student education has changed rapidly during the coronavirus disease 2019(COVID-19)pandemic.Students in their pre-clinical years have transitioned to online courses and examinations.Students in their clinical years are not permitted on clinical rotations,and face uncertainties in career exploration and the residency application process.Medical students in all stages of training are volunteering and helping their communities.The future presence of COVID-19 throughout the United States is unknown,and medical students are eager to return to their training.This paper outlines current challenges in medical student education and the various responses that have been adopted.We also discuss possible future directions for students through involvement in telemedicine,outpatient clinic visits,and non-respiratory inpatient care tasks as adequate personal protective equipment,COVID-19 testing,and resources become more widely available.

Teenage pregnancy and the sociodemographic attributes as a major contributor: Findings from an urban referral center in Nepal

BACKGROUND Teenage pregnancy is a challenging issue worldwide.Yet,despite the increased health risk and socioeconomic impact of teenage pregnancy,the numbers remain high in Nepal.AIM To determine the prevalence and sociodemographic factors associated with teenage pregnancy in Nepal.METHODS A hospital-based cross-sectional study was conducted in the Paropakar Maternity and Women’s Hospital from April to August 2017.A total of 1359 mothers were assessed and interviewed regarding their reproductive history and sociodemographic attributes.Ethical approval from the Nepal Health Research Council,permission from the concerned hospital,and consent from study subjects were obtained.RESULTS Of the 5526 deliveries,679(12.3%)were teenage pregnancy deliveries.The majority(85.1%)of mothers(out of 1359)were married at<20 years of age,with a mean age of marriage of 17.57 years(±1.994,range:12-25 years).Marriage age was a significant determinant of teenage pregnancy(odds ratio[OR]2.423[2.262-2.596];P<0.001).Likewise,a love marriage(OR:2.018[1.585-2.570];P<0.001)and first teenage pregnancy(OR:3.622[3.265-4.017];P<0.001)were significant determinants for subsequent teen pregnancies.Knowledge of family planning methods(OR:0.474;0.288-0.779;P=0.003)and use of any methods of family planning utilization(OR:0.345;0.248-0.479;P=0.000)significantly lowered the chance of teenage pregnancy.CONCLUSION Teenage pregnancy occupies a substantial proportion of total deliveries in the Nepalese maternity hospital.In addition,early pregnancy was significantly associated with age and type of marriage,education level,knowledge,and practice of contraceptive methods.

Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures

Purpose:Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage.There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis(MIPPO)technique and intramedullary interlocking(IMIL)nailing for extra-articular distal tibia fractures.The aim of our study is to compare the functional outcome between the two treatment methods.Methods:This was the prospective comparative study of 100 patients with distal third tibia fractures divided into two groups.The first group of patients were treated with MIPPO technique while the second group of patients were managed by IMIL nailing.Patients were followed up in outpatient department to assess the functional outcomes,malunion,delayed union,nonunion,superficial and deep infection between the two groups.Statistical analyses were performed using the SPSS software(version 16.0).Results:Average malunion(degrees)in the MIPPO group was 5(3—7)±1.41 vs.10.22(8—14)±2.04 in the IMIL group(p=0.001).Similarly postoperative knee pain in the IMIL group was 10%vs.2%in the MIPPO group(p=0.001).In terms of superficial infection and nonunion,the results were 8%vs.4%and 2%vs.6%for the MIPPO and IMIL group,respectively(p=0.001).Conclusion:Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue,bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing.Considering the results of the study,we have slightly more preference for the MIPPO technique.