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Author(s): R Girish Menon (corresponding author) [1] Neurosciences perhaps is one of the fortunate branches of medicines to have made quantum leaps in the last century. This exponential progress was [...]

Arjun Menon, Rahul Menon, Vishnou MourougavelouFaculty of Medicine, Imperial College London, London, UKWe read with great interest the research by Shields et al,1 evaluating the most effective ways of teaching the clinical abdominal examination to medical students. As medical students ourselves, we too have noticed how variability in cohort size, teaching style, and levels of practice can affect competency when performing a clinical examination.At Imperial College, London, students are taught to perform examinations on real and simulated patients from an early stage. It is natural that students would like to examine real patients with clinical signs as without this experience early on in their medical career, it would put them at a disadvantage when they are required to recognize pathology. A randomized experiment found that what students valued most was the “authenticity” of real patient encounters.2 We do however acknowledge that simulated patients have their benefits, especially during the early learning stage. Furthermore, finding real patients who are willing to volunteer their time for the teaching of medical students can be challenging.1Another important factor to the successful teaching of the clinical examination is the size of the group. In a study of 48 medical students studying the musculoskeletal examination, it was found that through small-group interactive examination skills teaching, the students improved their skills immediately after the teaching but also maintained these acquired skills several months on.3 The controls on the other hand, who only carried out regular clerkship activities, such as hospital placements, were unable to improve their examination skills.3Authors' replyHelen M Shields,1 Nielsen Q Fernandez-Becker,2 Sarah N Flier,2 Byron P Vaughn,2 Melissa H Tukey,2 Stephen R Pelletier,3 Douglas A Horst21Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, 2Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 3Center for Evaluation, Harvard Medical School, Boston, MA, USAWe are happy to respond to the excellent comments in the Letter to the Editor by Arjun Menon, Rahul Menon, and Vishnou Mourougavelou, medical students at Imperial College, London, regarding our recently published article entitled “Volunteer Patients and Small Groups Contribute to Abdominal Examination’s Success”.1We completely agree with Imperial College London’s routine practice of using “real patients” from the beginning of medical school for students to practice their physical examination skills. We would like to clarify and confirm that it is also our practice to use “real patients” for our Abdominal Examination Exercise. Our ability to recruit sufficient “real” volunteer patients each year for 43–46 small groups for the Abdominal Examination is the result of the popularity of this exercise with these patients.1 We have not had the difficulty in recruiting patients as noted by Bokken et al2 perhaps because all the patients came from the practices of the two Directors of the Abdominal Examination (HS and DH) who were committed to utilizing “real” patients.View the original article by Shields et al

Rahul Menon, Vishnou Mourougavelou, Arjun MenonFaculty of Medicine, Imperial College London, London, UKWe read with great interest the review by Siddaiah-Subramanya et al1 regarding the difficulty for medical students to participate in research, in developing countries. From our own experience as medical students, we agree that organizational factors, adequacy of knowledge, and variability in “attitudes” may all contribute to difficulty in participating in research. Nevertheless, we propose that the introduction of research projects, which may be part of an intercalated degree, could help improve medical students’ involvement in research.Author's replyManjunath Siddaiah-Subramanya,1,2 Harveen Singh,3 Kor Woi Tiang1,21Department of Surgery, Logan Hospital, Meadowbrook, 2Department of Medicine, Griffith University, Nathan, 3Department of Gastroenterology, Lady Cilento Children’s Hospital, Brisbane, QLD, Australia We would like to thank Menon et al for the letter in response to our article.1 We note that an overarching theme in the letter is the situation in countries where research at medical school could be improved. In the letter, Menon et al have brought out a couple of important issues: one is that the problem is multifactorial, and the other is the fact that opportunities and encouragement need to be provided to the students so that they could get more involved in research.View the original paper by Siddaiah-Subramanya and colleagues.

Byline: R. Menon Use of prophylactic antiepileptic drugs (AED) following aneurysmal subarachnoid hemorrhage (aSAH) is a matter of considerable debate. Cerebrovascular surgeons, generally prefer to err on the side of [...]

Roshni Menon, Brinda G David Department of Dermatology, Venereology and Leprosy, Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, Pondicherry, India Abstract: Management of psoriasis is a challenge to the treating physician. The chronic inflammatory state of psoriasis with exacerbations and remissions necessitate “on-and-off” treatment schedules. The safety profiles of drugs and tolerability issues for patients are important factors to be considered during treatment. Various biological agents targeting T-cells and the inflammatory cytokines are available for systemic treatment of psoriasis. However, major causes of concern while using these drugs are risk of susceptibility to infection and development of anti-drug antibodies, which will affect the pharmacokinetic properties, efficacy, and safety profile of the drug. Itolizumab, a humanized anti-CD6 monoclonal antibody, is a new molecule that acts by immunomodulating the CD6 molecule. CD6 is a co-stimulatory molecule required for optimal T-cell stimulation by the antigen-presenting cells. This step is crucial in T-cell proliferation to form Th1 and Th17 cells, which play a major role in the pathogenesis of psoriasis. This article deals with the properties of Itolizumab and its role in the treatment of psoriasis. Based on the available published data, Itolizumab seems to have a better adverse effects profile and at the same time comparatively less efficacy when compared to other biological agents available for treating psoriasis. Larger studies with longer duration are required to clearly depict the long-term side effects profile. Keywords: Itolizumab, CD6, psoriasis, monoclonal antibody, biologicals

An e-mail marketing experiment based on the behavioral perspective model was conducted to investigate consumer choice. Conversion e-mails were sent to two groups from the same marketing database of registered consumers interested in children's books. The experiment was based on A-B-A-C-A and A-C-A-B-A withdrawal designs and consisted of sending B = utilitarian (economic/functional) and C = informational (social) advertising stimuli with a clear call for action. Key measurements consisted of individuals receiving the e-mail, opening it, clicking on a link, and buying the target books. Aggregated results showed that the informational stimuli were more successful in inducing consumers to open the e-mails whereas the utilitarian stimuli were beneficial in increasing buying behavior. Data for individual consumer behavior indicate possible stimulus control in the case of particular consumers and potentials for functional analysis. The results show different appropriateness of stimuli for shaping consumer responses online and possibilities for translational work in behavior analysis.