Neuropsychiatric diseases account for the largest proportion of the global burden of non-communicable diseases with depression being the leading cause of disability worldwide (1) Depression and suicides occur at an alarming rate among healthcare professionals despite having adequate knowledge of mental health and relative access to psychiatrists (2).In this review, the aim was to identify the association between depression and suicidal ideation among medical students and its implication on their overall health and patient care. Also examined were the preventive strategies essential in curbing depression and suicidal ideation among medical students.Method: An electronic search was conducted on PubMed, Google Scholar, and Embase, to identify articles on depression and suicide among medical students. The prevalence of depression, the association between depression and suicidal ideation among health professionals, and the outcomes of depression on productivity and patient care were explored.Results: Many studies show an association between depression and suicidal ideation in medical students. Depression is commoner in female medical students, and it impairs learning which in turn affects patient care. Long hours of lectures, financial burdens, and insufficient sleep have been identified as risk factors for depression in medical students.Conclusion: There is a significant risk of depression and suicidal ideation among medical students worldwide. Integration of mental health services, provision of free and timely counseling services, and implementation of mental health policies are strategies that can be used for mitigating depression and promoting mental wellness.
BACKGROUND: The efficacy of anti-thyroid drugs in conjunction with radioactive iodine therapy in the management of Graves' disease is still controversial. OBJECTIVE: To compare the efficacy of pretreatment with methimazole before the administration of radioactive iodine for the treatment of Graves' disease. DESIGN AND SETTING: A systematic review and meta-analysis was conducted at a teaching/tertiary hospital in Ibadan, Nigeria. METHODS: A systematic search of the PubMed, Embase, Cochrane Library, and Web of Science databases was performed from inception to December, 2021. RESULTS: Five studies with 297 participants were included. There was no difference in the risk of persistent hyperthyroidism when radioactive iodine was used in conjunction with methimazole compared with when radioactive iodine was used alone (relative risk: 1.02, 95% confidence interval, CI: 0.62-1.66; P = 0.95, I 2 = 0%). Subgroup analysis based on the duration between discontinuation of methimazole and the administration of radioactive iodine showed a lower risk of persistent hyperthyroidism when methimazole was discontinued within 7 days before radioactive iodine use, although this did not reach statistical significance (risk ratio: 0.85, CI: 0.28-2.58). CONCLUSIONS: The use of methimazole before radioactive iodine administration was not associated with an increased risk of persistent hyperthyroidism. Concerns about medication toxicity and adverse effects should be considered when clinicians make decisions on combination therapies for the treatment of Graves' disease. PROSPERO REGISTRATION: CRD42020150013, https://www.crd.york.ac.uk/prospero/display_record. php?RecordID=150013.
The microvasculature (with vessels <100 μm in diameter) plays a crucial role in tissue oxygenation, perfusion and wound healing in the lower limb. While this holds clinical significance, microvasculature evaluation in the limbs is not a standard practice. Surgical interventions focus on reestablishing blood flow in larger vessels affected by the peripheral artery disease (PAD). Nevertheless, the impact of revascularization on tissue oxygenation and perfusion in severe microvascular disease (MVD) is still unknown. We present the cases of two patients who underwent surgical revascularization for peripheral blood flow with different outcomes. Patient A had PAD, while B had PAD, severe MVD and a non-healing wound. Although both showed improvements in ankle-brachial index post-op, spatial frequency domain imaging metrics (which measure microvascular oxygenation and perfusion) remained unchanged in B, indicating a potential gap in assessing the surgical efficacy in MVD using ankle brachial index and emphasizing microcirculation evaluation in optimizing wound healing outcomes.
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