08.02.2023

Winter 2021

Original Articles

The Effects of the Covid-19 Pandemic on the Mental Health and Learning Abilities of Medical Students: A Cross-Sectional Study

MPH Matan Peer, MD Mary Rudolf, PhD Jumanah Essa-Hadad, MD Lilach Malatskey 8-16
Background: Medical students suffer from high levels of psychological distress. Prior to the COVID-19 pandemic, a meta-analysis found global rates of 28% for depression and 34% for anxiety. The pandemic has impacted medical students. Of Australian medical students, 70% reported a decline in well-being, and 75% of American students reported their education had been significantly disrupted. The objectives of this research were to examine how the COVID-19 pandemic affected the mental health and learning abilities of Israeli medical students and report the key coping strategies they employed.
Objectives:
Methods: An anonymous online survey was distributed to medical students from Bar-Ilan University, Israel, one year into the pandemic. The survey included: sociodemographic information, health, lifestyle, learning abilities, and coping strategies, as well as validated questionnaires on well-being, depression, anxiety, stress, and resilience.
Results: 236 of 450 eligible students (52.4%) responded to the survey, among them 197 (43.8%) responded fully. 76 (38.6%) reported deterioration in mental health, 79 (40.0%) met the criteria for depression disorder, 50 (25.4%) for anxiety disorder, and 54 (27.4%) for stress disorder. Remarkably, 31 students (15.7%) met the criteria for at least one severe/extremely severe disorder and 41 (20.8%) sought psychological/psychiatric therapy. The students were studying less efficiently (83 (42.1%)), 70 students (35.6%) were moderately/severely concerned they would fail academically, and 49 (24.9%) reported lower academic achievement. Only 69 (35.0%) had adequate resilience. A well-being score <35.5 was associated with higher rates of depression, anxiety, stress, and low resilience. The most common coping strategies included movies/TV shows (61.9%), physical activity (59.9%), and closeness to family (58.4%).
Conclusions: To the best of our knowledge this is the first study which examined the effect of the COVID-19 pandemic on Israeli medical students’ mental health and learning abilities. There was an alarming impact on mental health and detrimental effects on learning abilities. Urgent action is needed in terms of identifying, preventing, and treating students experiencing distress.

The Effect of Empagliflozin and Spironolactone Treatment on Fibrosis Immediately After Induction of Myocardial Infarction in Rats

BEMS Nadav Bandel, MD Elias Daud, PhD Offir Ertracht, MD Shaul Atar 16-22
Background: Coronary heart disease is a leading western world cause of death. The adult mammalian heart has negligible regenerative capacity. Damaged myocardium is replaced by extracellular matrix (ECM) in a deleterious process named fibrosis, which involves the renin-angiotensin-aldosterone system (RAAS) activation. Aldosterone antagonists, such as spironolactone (SPIR), are cardiac anti-fibrotic agents. Sodium/glucose cotransporter 2 inhibitors (SGLT2i), with empagliflozin (EMPA) being a key player within this group, prevent renal glucose reabsorption. SGLT2i also inhibits sodium-hydrogen exchange in the heart, which may lead to cardiac fibrosis attenuation.
Objectives: We hypothesized that administering SPIR combined with EMPA would have a synergistic effect on the attenuation of collagen deposition post-MI in rats.
Methods: The 21 rats who underwent a myocardial infarction induction procedure were divided randomly into 3 groups. The first group was treated with EMPA (30 mg/kg/day per os (P.O.), the second with an EMPA and SPIR (20 mg/kg/day, subcutaneous, S.C.) combination, and the third was used as the control. After 4 weeks the rats were sacrificed, and the heart was excised and underwent histological analysis.
Results: EMPA alone and EMPA+SPIR therapy increased left ventricular cavity perimeter (23.8 ± 4.9 mm and 29.5 ± 2.8 mm for EMPA and EMPA+SPIR therapy, respectively). These results were attributed to the mechanisms of eccentric hypertrophy. In the remote area, EMPA+SPIR therapy decreased CVF (4.6 ± 1.6% for the control group, 2.5 ± 1.3% for EMPA, and 2.1 ± 1.5% for EMPA+SPIR therapy). At the scar, both treatments decreased CVF, with EMPA+SPIR therapy showing intensified effect (79.9 ± 6.2%, 53.5 ± 5.4%, and 41.6 ± 2.6% for the control group, EMPA and EMPA+SPIR therapy, respectively). To the best of our knowledge, this is the first study to show the synergistic effect of these two drugs on the level of cardiac fibrosis.
Conclusions:

Attention Mediates the Similarity Effect in Decision Making

Omri Maor, Moshe Glickman, Marius Usher 23-27
Background: Preference reversal effects are among the most puzzling phenomena that challenge our understanding of human decision-making, and its relationship with the principles of rationality.
Objectives: Our aims were to examine the attentional bias underlying the Preference reversal effects (similarity) as suggested by the selective integration model.
Methods: We used a Rapid Sequential Visual Presentation (RSVP) with triples of numerical values while monitoring the participants' attentional selection using the dot-probe paradigm.
Results: We first managed to replicate a similarity effect as seen in previous research. By measuring attentional selection using the dot-probe paradigm we showed that subjects gave more attention to higher values compared to lower values, a difference that increased when the dot probed the target compared to the competitors.
Conclusions: These results fully support our hypotheses and suggest that attention is drawn into information congruent with observer's goals, whereas incongruent information is discarded.

Case Articles

A 30-Year-Old Female with Postpartum Hypertension

BSc Ori Hadad, MD-PhD Ehud Grossman 29-31
Background: Postpartum hypertension is usually due to persistent gestational hypertension, preeclampsia, or pre-existing chronic hypertension. In about 10% of the cases, there is a secondary underlying cause. We describe a case of a 30- year old healthy women woman with a normal pregnancy that developed severe postpartum hypertension due to Page's kidney.
Objectives:
Methods:
Results:
Conclusions:

Review Articles

Preparing and coping strategies for medical students' experience with a patient's death: systematic narrative literature review

Yaara Lisai, MD Adir Shaulov 32-37
Background: The experience of a patient's death for medical students is emotionally powerful and may cause feelings of distress and anxiety. Over the last 15 years, a growing number of studies have been published, dealing with the student's perspective, addressing preparation through End-of-life education, the experience itself, coping strategies, and the importance of processing emotions. The purpose of this paper is to review this experience as perceived by medical students. Although time and resources are invested in preparation for a patient's death, some of the students feel inadequately prepared. On an emotional level, the experience of death mainly brings about feelings of sadness and anger. The patient's identity and the student's past exposure to death were found to influence the way students perceive the experience. Students can cope with the experience in a variety of different methods such as conversations, reflections, and turning to religion. Coping strategies that include emotional processing usually result in better communication with the patient and family and improve the treatment quality.
Objectives:
Methods:
Results:
Conclusions: The medical world is undergoing a change in perception towards the experience of a patient's death. Students may encounter several different approaches to deal with the loss of a patient during their clinical years. It is important that they know which approach is beneficial to their well-being and can contribute to their personal and professional development.

Non-Invasive Thermal Imaging to Detect and Monitor Various Diseases

Rafael Y. Brzezinski MSc, Neta Rabin PhD, Ehud Grossman MD, Zehava Ovadia-Blechman PhD, Jonathan Leor MD, and Oshrit Hoffer PhD 38-40
Background:
Objectives:
Methods:
Results:
Conclusions:

COVID-19 Re-infection: a Case-Series Review

Anna Papish, Dvir Fridman, Dana Venkert, Neta S.Zuckerman MD, Orna Mor MD and Eli Schwartz MD 41-52
Background: Reports concerning cases of re-infection with SARS-CoV-2 are increasing. In this review, we analyzed all the confirmed re-infection cases published in the scientific literature by the end of April 2021. According to our findings, the symptoms in both infections were mostly "mild" and no common profile between the cases was found. Of the patients, 9 had background diseases, and 2 patients died following the second infection. IgG antibodies developed in 70% of the patients following the first infection (16/23), of them 44% developed neutralizing antibodies. No clear correlation between the presence of antibodies and symptom severity was found. Our findings suggest that new emerging variants and new mutations in the spike protein could cause re-infection, despite the development of IgG and neutralizing antibodies. In the era of new emerging variants and vaccination, the re-infection phenomenon should not be underestimated and should be further investigated.
Objectives:
Methods:
Results:
Conclusions:

Letters To The Editor

Journal of Israeli Medical Students: A New Era for Medical Student Publishing in Israel

Nicky Dunn MSc and Sameer Bhat BSc 7
Background:
Objectives:
Methods:
Results:
Conclusions:

What Do Patients Want?

Roi Shternin, BEd-MA and Emine Nur Avci, MD 56-57
Background:
Objectives:
Methods:
Results:
Conclusions:

A Discussion About LGBTQ + health

Omer Rott and Roy Zucker MD 58-59
Background:
Objectives:
Methods:
Results:
Conclusions:

The Importance of Studying Artificial Intelligence and Data Science to Medical Students

Yoad Cohen 60-61
Background:
Objectives:
Methods:
Results:
Conclusions:

Feature Articles

Assessment of the Diagnostic Criteria of Osteonecrosis of the Jaw in Cancer Patients with a History of Radiation Therapy and Exposure to Bone-Modifying Agents

Yotam Ganor DMD 53-55
Background:
Objectives:
Methods:
Results:
Conclusions:

Science of Yoga by Ann Swanson

Shahar Barami 62-64
Background:
Objectives:
Methods:
Results:
Conclusions:

Discovering Destiny: A Researcher with Ichthyosis Dedicates her Career to Investigate her Own Disorder

Janan Mohamad BMSc 65-66
Background:
Objectives:
Methods:
Results:
Conclusions:

Epiphany

שיר של יום חולין

ד"ר ק 68
Background:
Objectives:
Methods:
Results:
Conclusions: