Emotional responses and coping strategies of medical students during the COVID-19 pandemic.

OBJECTIVES: To assess the emotional responses and coping strategies of medical students during the lockdown and social distancing measures implemented during the coronavirus disease -19 (COVID-19) pandemic. METHODS: This cross­sectional study is based on data collected from undergraduate medical students at the College of Medicine, Alfaisal University Riyadh, Saudi Arabia, during the fall semester of academic year 2020-2021. All the participants completed a self-administered online questionnaire consisting of 3 parts: demographic information, emotional response scale, and 14-item, adapted brief coping orientation to problems experienced inventory to determine the use of avoidant or approach coping strategies. Coping and emotional response scores were compared using t-test. Linear regression analysis was also performed. RESULTS: A total of 261 students from all years were included. Overall scores were higher for avoidant coping strategies. The use of avoidant coping strategies was significantly higher in females (p=0.03) and in preclinical students (p<0.001). Preclinical students had a higher mean score for anger (p=0.002). Conversely, students in the clinical phase had higher scores for anxiety (p=0.005) and sadness (p=0.027). The regression analysis of emotional responses and coping strategies suggests that avoidant coping is a predictor of anger (p=0.003) and sadness (p=0.005). CONCLUSION: Interventions to train medical students in the use of more productive and effective coping strategies may reduce negative emotional responses linked to the present COVID-19 pandemic and in the future.

Evaluation of Genetic Polymorphisms of N-acetyltransferase 2 and Relation with Chronic Myeloid Leukemia.

OBJECTIVES: The N-Acetyltransferase 2 (NAT2) gene encodes a key enzyme involved in xenobiotic metabolism, which contributes to the detoxification of numerous cancer therapy-induced products. However, the NAT2 genotype/phenotype is not fully understood and few studies have reported its relationship with CML. The aim of this study was to determine whether its polymorphisms (C481T, G590A, 803A>G and 857G>A) have a role in chronic myeloid leukemia susceptibility (CML) in Sudanese population. METHODS: We performed a case- control study. DNA from 200 CML patients and 100 controls was analyzed for the NAT2 polymorphisms using PCR-RFLP assay. RESULTS: The study showed NAT2 polymorphisms 803AG are associated with CML protection by a factor of 2.3, (OR = 0.044, 95% CI: 0.020-0.095, p = 0. 000). The study indicated that the heterozygous (GA) and mutant (AA) variants of the G857A genotype also offer protection, (OR = 0.002, 95% CI: 0.002-0.019, p = 0. 000) and (OR = 0.018, 95% CI: 0.002-0.133, p = 0. 000), respectively. CONCLUSION: There was no significant difference in CML diagnosis among Sudanese cases with the 481C→T and 590G→A polymorphisms. But patients with the compound NAT2 genotypes 481CT/803 AG, 590AG/ 803AG, 590AG/ 803GG, 590AA/ 803AG and 590GG/ 803AG were found to have a reduced risk. The current study demonstrates that polymorphisms of NAT2 A803G and G857A might also act as protective factors against developing the disease.

Higher b-values improve the correlation between diffusion MRI and the cortical microarchitecture.

PURPOSE: In diffusion MRI (dMRI), it remains unclear to know how much increase of b-value is conveying additional biological meaning. We tested the correlations between cortical microarchitecture and diffusion metrics computed from standard (1000 s/mm2), high (3000 s/mm2), to very high (5000 s/mm2) b-value dMRI. METHODS: Healthy volunteers were scanned with a dMRI pulse sequence that was first optimized together with a T1-WI and T2-WI. Averaged cortical surface map of estimated myelin (T1-WI/T2-WI) was compared with surface maps of mean diffusivity (MD) computed from each b-value (MD1000, MD3000, and MD5000) and to surface map of mean kurtosis (MK computed from the 0-, 1000-, to 3000-s/mm2 shells) in 360 cortical parcels using Spearman correlations, multiple linear regressions, and Akaike information criteria (AIC). RESULTS: Surface map from MD1000 showed variations not related to myelin but the MD3000 and MD5000 maps inversely mirrored estimated myelin map; lower MD values being observed in more myelinated cortical areas. MK mirrored myelinated cortical areas. Quantitatively, Spearman correlations between myelin and MD became more and more negative as long as b-values increased while the correlation was positive between myelin and MK. Multiple regression models confirmed negative associations between myelin and MD that were significantly better from MD1000 to MD3000 and MD5000 (R2 = 0.33, p < 0.001; R2 = 0.43, p < 0.001; and R2 = 0.50, p < 0.001) and positive association between myelin and MK (R2 = 0.53, p < 0.001). Comparisons of the 3 statistical models showed the best performances with MK and MD5000 (AICMK < AICMD5000 < AICMD3000 < AICMD1000). CONCLUSION: Higher b-values are more closely related to subtle cellular variations of the cortical microarchitecture.

CYP1A1 and CYP2D6 Polymorphisms and Susceptibility to Chronic Myelocytic Leukaemia.

BACKGROUND: CYP1A1 and CYP2D6 are both xenobiotic metabolizing enzymes belonging to the CYP450 enzyme family. Polymorphisms in these genes vary between individuals, resulting in dissimilar patterns of susceptibility to the effects of carcinogenic substances and drugs. OBJECTIVE: In a prospective study, the influence of CYP1A1*2C and CYP2D6*4 gene polymorphisms on the susceptibility to chronic myelocytic leukaemia (CML) were investigated. METHODS: Prevalence of CYP1A1*2C and CYP2D6*4 was detected in blood specimens from three hundred participants - two hundred patients and a hundred healthy individuals as a control group, using PCR-RFLP. RESULTS: CYP1A1 Ile/Val and Val/Val genotype frequency in our study population was 82% & 15% in CML patients and 55% & 8% in controls, respectively. This suggests that carriers had an elevated risk (OR=18.38, 95% CI=7.364-45.913, p value; =0.000 and OR=23.125,95 % CI=7.228-73.980, p value=0.000, respectively). Individuals carrying the CYP2D6 heterozygous genotype (IM) were notably fewer in number within the CML group at 43.5%, as opposed to 93% of the controls. This suggests that the IM genotype may have a prophylactic function in lowering CML risk (OR=0.036, 95% CI=0.005-0.271, p value =0.001). In spite of the distribution of the homozygous mutant (PM) genotype being higher in cases with CML (87% as opposed to 6% in the control), this difference was deemed non-significant (OR=0.558, 95% CI=0.064-4.845, p value =0.597). CONCLUSION: These findings indicate that polymorphic CYP1A1 and CYP2D6 genes affect the susceptibility to CML.

Genetic Polymorphism of GSTP1, GSTM1 and GSTT1 Genes and Susceptibility to Chronic Myeloid Leukaemia.

BACKGROUND: The development of cancer results from an imbalance between exposure to carcinogens and the capacity of various enzyme systems engaged in activation or in the detoxification of xenobiotics. The aim of the present study is to investigate the association of GSTP1, GSTM1 and GSTT1 gene polymorphisms in susceptibility to Chronic Myeloid Leukaemia (CML). METHODS: A total of 200 CML patients and 100 controls were enrolled in a case-control study with GSTM1 and GSTT1 analysis with PCR and GSTP1 analysis with PCR-RFLP. RESULTS: The GSTT1 null genotype was significantly higher among CML patients suggesting that this genotype is associated with an increased risk of CML. It was found in 42% of cases as compared with 21% of the controls, (OR =2.78, 95% CI: 1.59 - 4.85; p-value =0.000). The presence of the GSTT1 genotype may thus be considered a protective factor for CML. The frequency of individuals carrying GSTM1 null genotype was slightly higher in the control group but this difference was not statistically significant. The GSTM1 null genotype was present in 35% of control cases and 34% of the CML patients, (OR=0.975, 95%CI: 0.58-1.58;p-value=0.863). Individuals with a combined GSTM1 null/GSTT1null genotype had an estimated 2.85-fold increased risk of CML, but no associated risk between GSTP1 Ile 105 Val polymorphism and CML was found (OR=1.99, 95% CI: 0.40 - 9.32; p-value = 0.417). CONCLUSIONS: No association between GSTP1 and GSTM1 with susceptibility to CML was found. GSTT1 genotype may be a protective factor for CML, while the null genotype shows association with developing CML.
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Leininger's Theory of Culture Care Diversity and Universality: An Overview With a Historical Retrospective and a View Toward the Future.

An historical overview of Leininger's Theory of Culture Care Diversity and Universality also known as the Culture Care Theory (CCT) and evolution of the Sunrise Enabler are presented along with descriptions of the theory purpose, goal, tenets, basic assumptions, major core constructs, and orientational definitions. Recent articles, books, and book chapters provide relevant exemplars to enhance scholarly understanding and application of theory constructs. Proposed future directions encompass using the CCT to guide research of discovery and translational research projects for evidenced-based nursing practice; develop nursing courses and curricula to prepare culturally competent nurses; guide future culturally competent administrative and leadership policies and procedures; inform public policy related to cultural diversity and underserved populations; promote grant writing initiatives to enhance cultural diversity in hiring nursing staff, supervisors, and faculty; and promote admission of nursing students from underserved and/or diverse backgrounds.

Cervical Spinal Cord DTI Is Improved by Reduced FOV with Specific Balance between the Number of Diffusion Gradient Directions and Averages.

BACKGROUND AND PURPOSE: Reduced-FOV DTI is promising for exploring the cervical spinal cord, but the optimal set of parameters needs to be clarified. We hypothesized that the number of excitations should be favored over the number of diffusion gradient directions regarding the strong orientation of the cord in a single rostrocaudal axis. MATERIALS AND METHODS: Fifteen healthy individuals underwent cervical spinal cord MR imaging at 3T, including an anatomic 3D-Multi-Echo Recombined Gradient Echo, high-resolution full-FOV DTI with a NEX of 3 and 20 diffusion gradient directions and 5 sets of reduced-FOV DTIs differently balanced in terms of NEX/number of diffusion gradient directions: (NEX/number of diffusion gradient directions = 3/20, 5/16, 7/12, 9/9, and 12/6). Each DTI sequence lasted 4 minutes 30 seconds, an acceptable duration, to cover C1-C4 in the axial plane. Fractional anisotropy maps and tractograms were reconstructed. Qualitatively, 2 radiologists rated the DTI sets blinded to the sequence. Quantitatively, we compared distortions, SNR, variance of fractional anisotropy values, and numbers of detected fibers. RESULTS: Qualitatively, reduced-FOV DTI sequences with a NEX of ≥5 were significantly better rated than the full-FOV DTI and the reduced-FOV DTI with low NEX (N = 3) and a high number of diffusion gradient directions (D = 20). Quantitatively, the best trade-off was reached by the reduced-FOV DTI with a NEX of 9 and 9 diffusion gradient directions, which provided significantly fewer artifacts, higher SNR on trace at b = 750 s/mm2 and an increased number of fibers tracked while maintaining similar fractional anisotropy values and dispersion. CONCLUSIONS: Optimized reduced-FOV DTI improves spinal cord imaging. The best compromise was obtained with a NEX of 9 and 9 diffusion gradient directions, which emphasizes the need for increasing the NEX at the expense of the number of diffusion gradient directions for spinal cord DTI contrary to brain DTI.