Analysis Of Clinical Cases Research Articles

Comorbidity Depression and Self-destructive Behavior in Adolescence: Comparative Sex Analysis of Clinical Cases

Today, there is a trend of intentional self-harm, suicide and injury among teenagers. Doctors pay attention that among the reasons for this situation are the depressed state of society, cruelty and indifference in the family, maladjustment in the educational institution, low neuropsychological stability of children and young people, inability to constructively solve personal problems, lack of sustainable interests and interesting organized leisure time, impossibility self-expression and self-realization, etc. The comorbid combination of depressive disorders (DD) and self-destructive behavior (SDB) in adolescence is one of the most important and global problems of modern clinical psychiatry. The gender specifics of such an aggravating variant of DD in boys and girls requires additional research. The objective: to analyze the sexual characteristics of DD in a comorbid combination with SDB in youth. Materials and methods. In the pilot study 48 boys and girls aged 15–18 years with DD (according to ICD-10) and manifestations of SDB were examined in outpatient clinic, namely: 11 (22.91%) boys and 37 (77.08%) girls. The patient health questionnaire (PHQ-9) was used in the study. Results. According to the results of the study, patients were diagnosed with different variants of clinical syndromes of DD. The level of severity of DD had no gender characteristics. Such syndromes as hysterical-depressive, depressive-hypochondriac, depressive-dysphoric syndrome were found only in girls. At the same time, hysterical-depressive syndrome occurred most often – in 29.2% of all cases in both groups. The results of the study indicate a tendency towards the predominance of bisexual identification among girls (21.6%) compared to 9.1% among boys. Conclusions. It has been proven that in youth DD have 100% comorbidity with SDB. The presented clinical cases demonstrated severe DD in youth, taking into account gender characteristics. The significant predominance of depressive-obsessive and anxiety-depressive syndromes in young men is an important factor in the comorbid development of SDB (suicidal activity) in these patients.

Differential diagnostic search in dermatologic practice and its effect on quality of medical care: Clinical cases

Introduction. A differential diagnostic search is a crucial method for making a final clinical diagnosis. Lack of clinical thinking leads to tactical errors, both in making a diagnosis and in choosing a therapy algorithm. The problem of iatrogeneses especially often arises at the initial stages of patient management.Case descriptions. The paper demonstrates the difficulties of verifying the diagnosis of patients with dermatological pathology on the example of clinical cases. The stages of differential diagnostic search are covered in detail. Practicing physicians stress the importance of timely correct diagnosis and, consequently, the choice of therapy. The study involved a detailed analysis of clinical cases and mistakes causing a delay in diagnosis and wrong choice of therapeutic tactics at the outpatient stage. A clinical case with designated diagnosis is presented and analyzed as an illustrative example. Special attention was given to a complex evaluation of subjective, objective and diagnostic data, the significance of analyzing the development of dermatoses.Conclusion. Careful adherence to diagnostic algorithms will avoid iatrogenic errors and thereby improve the quality of medical care and the quality of life of dermatological patients.

Definition and Diagnostic Criteria for Pediatric Blepharokeratoconjunctivitis

Pediatric blepharokeratoconjunctivitis (PBKC) is a chronic, sight-threatening inflammatory ocular surface disease. Due to the lack of unified terminology and diagnostic criteria, nonspecific symptoms and signs, and the challenge of differentiation from similar ocular surface disorders, PBKC may be frequently unrecognized or diagnosed late. To establish a consensus on the nomenclature, definition, and diagnostic criteria of PBKC. This quality improvement study used expert panel and agreement applying the non-RAND modified Delphi method and open discussions to identify unified nomenclature, definition, and definitive diagnostic criteria for PBKC. The study was conducted between September 1, 2021, and August 14, 2022. Consensus activities were carried out through electronic surveys via email and online virtual meetings. Of 16 expert international panelists (pediatric ophthalmologists or cornea and external diseases specialists) chosen by specific inclusion criteria, including their contribution to scientific leadership and research in PBKC, 14 (87.5%) participated in the consensus. The name proposed was "pediatric blepharokeratoconjunctivitis," and the agreed-on definition was "Pediatric blepharokeratoconjunctivitis is a frequently underdiagnosed, sight-threatening, chronic, and recurrent inflammatory eyelid margin disease associated with ocular surface involvement affecting children and adolescents. Its clinical spectrum includes chronic blepharitis, meibomitis, conjunctivitis, and corneal involvement ranging from superficial punctate keratitis to corneal infiltrates with vascularization and scarring." The diagnostic criteria included 1 or more suggestive symptoms accompanied by clinical signs from 3 anatomical regions: the eyelid margin, conjunctiva, and cornea. For PBKC suspect, the same criteria were included except for corneal involvement. The agreements on the name, definition, and proposed diagnostic criteria of PBKC may help ophthalmologists avoid diagnostic confusion and recognize the disease early to establish adequate therapy and avoid sight-threatening complications. The diagnostic criteria rely on published evidence, analysis of simulated clinical cases, and the expert panel's clinical experience, requiring further validation with real patient data analysis.

Interpretation of fatty acids and adrenal function in Ald-X patients using PRISMA 2020 methodology

X-linked Adrenoleukodystrophy is a hereditary metabolic disorder that causes the accumulation of very long-chain fatty acids in various tissues, primarily affecting the nervous system and adrenal glands. The aim of the study was to interpret very long-chain fatty acids and adrenal function in patients with X-linked Adrenoleukodystrophy using PRISMA 2020 methodology. A systematic literature review and an analysis of a specific clinical case were conducted. A total of 135 records were reviewed, of which 16 relevant articles were selected after applying inclusion and exclusion criteria. The results highlight the complex relationship between VLCFA levels and adrenal function, and the importance of an integrated approach to treatment. It is concluded that further research is essential to better understand this correlation and develop effective therapeutic strategies

Comorbidity of cerebral amyloid angiopathy and Alzheimer's disease. Clinical case analysis

The development of cognitive impairment in old age is often caused by overlapping neurodegenerative and cerebrovascular changes which have a mutually aggravating clinical effect. In recent years, the problem of cerebral amyloid angiopathy (CAA), which is one of the variants of such an interaction, has gained importance. Despite the frequent occurrence of this pathology in the elderly, a unified approach to the treatment of these patients has not yet been developed, especially taking into account the frequent combination with other nosological forms. CAA is a disease associated with both Alzheimer's type neurodegeneration and cerebrovascular pathology. The article presents a clinical case illustrating this situation and discusses the diagnostic algorithm in detail. The characteristics of the pathogenesis and clinical manifestations of CAA and the link between neurodegenerative and cerebrovascular pathologies are discussed.

Digenic CHD7 and SMCHD1 inheritance Unveils phenotypic variability in a family mainly presenting with hypogonadotropic hypogonadism

ObjectivesCHARGE syndrome is a congenital hereditary condition involving multiple systems. Patients are easily misdiagnosed with idiopathic hypogonadotropic hypogonadism (IHH) due to the overlap of clinical manifestations. An accurate clinical diagnosis remains challenging when the predominant clinical manifestation resembles hypogonadotropic hypogonadism. MethodsThis original research is conducted based on the genetic finding and analysis of clinical cases. Whole-exome sequencing (WES) and in-silico analyse were performed on two sisters to investigate the pathogenesis in this family. Homology modelling was conducted to evaluate structural changes in the variants. ResultsWES and Sanger sequencing revealed two siblings carrying a nonsense mutation (NM_017780.4: c.115C > T) in exon 2 of CHD7 inherited from a mildly affected mother and a missense mutation (NM_015295.3: c.2582T > C) in exon 20 of SMCHD1 inherited from an asymptomatic father. The nonsense mutation in CHD7 was predicted to generate nonsense-mediated decay, whereas the missense mutation in SMCHD1 decreased protein stability. ConclusionsWe identified digenic CHD7 and SMCHD1 mutations in IHH-associated diseases for the first time and verified the synergistic role of oligogenic inheritance. It was also determined that WES is an effective tool for distinguishing diseases with overlapping features and establishing a molecular diagnosis for cases with digenic or oligogenic hereditary disorders, which is beneficial for timely treatment, and family genetic counseling.

Clinical case analysis of 32 children aged 0-6 years with lead poisoning in Nanning, China.

Lead is one of the heavy metals that is toxic and widely distributed in the environment, and children are more sensitive to the toxic effects of lead because the blood-brain barrier and immune system are not yet well developed. The objective of the study was to investigate the clinical characteristics of lead poisoning in children aged 0∼6 years in a hospital in Guangxi, and to provide scientific basis for the prevention and treatment of lead poisoning. We collected and analyzed the clinical data of 32 children with lead poisoning admitted to a hospital in Guangxi from 2010 to 2018. The results showed that most of the 32 cases presented with hyperactivity, irritability, poor appetite, abdominal pain, diarrhea, or constipation. The hemoglobin (HGB), mean corpusular volume (MCV), mean corpuscular hemoglobin (MCH), and hematocrit (HCT) of the lead-poisoned children were all decreased to different degrees and were below normal acceptable levels. Urinary β2-microglobulin was increased. Blood lead levels (BLL) decreased significantly after intravenous injection of the lead chelator, calcium disodium edetate (CaNa2-EDTA). In addition, HGB returned to normal levels, while MCV, MCH, and HCT increased but remained below normal levels. Urinary β2-microglobulin was reduced to normal levels. Therefore, in this cohort of children, the high-risk factors for lead poisoning are mainly Chinese medicines, such as baby powder. In conclusion, lead poisoning caused neurological damage and behavioral changes in children and decreased erythrocyte parameters, leading to digestive symptoms and renal impairment, which can be attenuated by CaNa2-EDTA treatment.

Biopsy-proven acute tubulointerstitial nephritis in patients treated with immune checkpoint inhibitors: a pooled analysis of case reports.

Acute kidney injury (AKI) in cancer patients receiving immune checkpoint inhibitors (ICIs) may recognize multiple causes. Here, we reviewed cases of biopsy-proven acute tubulointerstitial nephritis (ATIN) to describe the clinical characteristics and outcomes of this condition. We conducted a pooled analysis of clinical cases of ICI-related biopsy-proven ATIN up to 1 May 2022. We collected data on clinical characteristics, AKI, biopsy findings, laboratory examinations, and renal outcomes. Eighty-five patients (61.4 ± 19 years, 56 male) were evaluated. Melanoma was the most prevalent diagnosis (51%), followed by non-small cell lung cancer (30%). ICI treatment consisted of PD-1, PDL-1 (nivolumab, pembrolizumab, atezolizumab), and CTLA-4 inhibitors (i) (ipilimumab) or combination PD-1i+CTLA4i. Renal toxicity developed after a median of four cycles of therapy. Fifty-one patients (65.5%) developed the most severe form of AKI- stage 3, including five patients requiring dialysis. All the 19 patients treated with dual ICI blockade developed AKI-stage 3, compared with 29 patients out of the 60 receiving a single agent (p<0.001). Most events were managed with corticosteroids associated with ICI withdrawal. In 15 patients ICI was restarted, but in six (40%) AKI recurred. Overall, 32 patients (40%) presented a complete renal recovery, which chance was inversely associated with dual ICI blockade (OR 0.15, 95CI 0.03-0.7, p=0.01). ICI-related ATIN may develop late after the therapy initiation, presenting as severe AKI, particularly in patients with dual ICI blockade. Although this complication may be partially reversible, concerns remain about the renal function sequelae and the possibility of restarting ICI treatment.

Practical Lesson in a New Discussion Format – Clinical Case Discussion

The exceptional availability of high-tech simulators is not enough to ensure the high quality of practical training of the future medical specialists. The main condition is the use of certain pedagogical technologies that ensure the continuity of the system of practice and improvement of practical skills and preparation for competent professional activity at all stages of the future doctor training.&#x0D; In recent years, there has been a clear trend to improve the methods of simulation technologies in medical education at the undergraduate stage of the future doctors’ training. At the same time, an important direction is the step-by-step analysis of clinical cases followed by an extended discussion (with the elements of debriefing) and the use of additional information in the form of separate information blocks with visualization. Only at this stage it is possible to practice communication skills, to understand the clinical route of the patient, as well as to discuss possible rehabilitation and preventive measures.&#x0D; The aim of this article is to share own experience of the implementation of a highly effective teaching method – the discussion of clinical cases, Clinical Case Discussion (CCD), which promotes the development of deep clinical thinking in students, the ability to practically apply knowledge in various fields of medicine, the performance of the applied differential diagnosis, and the formation of the real tactics of the diagnostic search and/or treatment of a specific patient on the example of this clinical case.&#x0D; Performance of a practical session in the new Clinical Case Discussion (CCD) format promotes the development of clinical thinking, allows students to systematize the material obtained and separate dominant signs (symptoms) from secondary ones, justify the appointment of laboratory and instrumental examination methods, verify the diagnosis and develop a number of rehabilitation measures. Active participation in the discussion of specialists of related specialties (depending on the topic of the clinical case and the primary manifestation of the disease) demonstrates the importance of interdisciplinary interaction and the ability to work in a team. The use in the process of clinical discussion of separate information blocks (with visualization) regarding important symptoms, as well as diseases with which it is necessary to perform differential diagnosis, contributes to analytical thinking, a syndromological systematized approach and the formation of a final diagnosis.

Effects of psychological characteristics of patients with hypertension on their adherence to treatment. Analysis of clinical cases

Objective — to acquaint cardiologists and family medicine doctors with modern treatment approaches that take into account the psychological characteristics of patients. The professional activity of therapeutic doctors is to a large extent (especially in comparison with surgical and anesthesiology specialties) related to the need to develop communication skills, since patients differ not only in clinical features, but also in psychological traits that are revealed in the process of diagnosis and treatment. The authors performed the analysis of four clinical cases with a detailed description of socio‑demographic and behavioral characteristics of patients who ask for a cardiologist’s consultation for the purpose of correcting drug treatment. In addition to the analysis of complaints, anamnesis and data from laboratory and instrumental examinations, typical problems of communication with «difficult» patients have been described and practical recommendations were provided. Four variants of the possible behavior of patients are presented, determined by their psychological characteristics and manifested during communication with doctors of a therapeutic profile. The following psychotypes were chosen as «classical»: «expressive», «directive», «analytical» and «friendly». For the first two, a characteristic feature is the presence of a high level of authority in the process of communicating with interlocutors, and for the last two — a low level. Also, «analytical» and «directive» personalities are marked by a significantly higher degree of self‑control compared to «expressive» and «friendly». Doctors mostly come into contact with patients who combine the features of two psychotypes with the dominance of one of them. Physicians’ understanding of the therapeutic profile of patients’ psychological characteristics will allow understanding their expectations and improving adherence to pharmacotherapy.

Nephrotic syndrome secondary to Sjögren syndrome in an older adult: a clinical case analysis

Nephrotic syndrome secondary to Sjögren syndrome in an older adult: a clinical case analysis

CENPN suppresses autophagy and increases paclitaxel resistance in nasopharyngeal carcinoma cells by inhibiting the CREB-VAMP8 signaling axis

ABSTRACT Chemotherapeutic resistance is one of the most common reasons for poor prognosis of patients with nasopharyngeal carcinoma (NPC). We found that CENPN can promote the growth, proliferation and apoptosis resistance of NPC cells, but its relationship with chemotherapeutic resistance in NPC is unclear. Here we verified that the CENPN expression level in NPC patients was positively correlated with the degree of paclitaxel (PTX) resistance and a poor prognosis through analysis of clinical cases. VAMP8 expression was significantly increased after knockdown of CENPN by transcriptome sequencing. We found in cell experiments that CENPN inhibited macroautophagy/autophagy and VAMP8 expression and significantly increased PTX resistance. Overexpression of CENPN reduced the inhibitory effects of PTX on survival, cell proliferation, cell cycle progression and apoptosis resistance in NPC cells by inhibiting autophagy. In turn, knockdown of CENPN can affect the phenotype of NPC cells by increasing autophagy to achieve PTX sensitization. Sequential knockdown of CENPN and VAMP8 reversed the PTX-sensitizing effect of CENPN knockdown alone. Experiments in nude mice confirmed that knockdown of CENPN can increase VAMP8 expression, enhance autophagy and increase the sensitivity of NPC cells to PTX. Mechanistic studies showed that CENPN inhibited the translocation of p-CREB into the nucleus of NPC cells, resulting in the decreased binding of p-CREB to the VAMP8 promoter, thereby inhibiting the transcription of VAMP8. These results demonstrate that CENPN may be a marker for predicting chemotherapeutic efficacy and a potential target for inducing chemosensitization to agents such as PTX. Abbreviations: 3-MA: 3-methyladenine; ATG5: autophagy related 5; CENPN: centromere protein N; CQ: chloroquine; CREB: cAMP responsive element binding protein; ChIP: chromatin immunoprecipitation assay; IC50: half-maximal inhibitory concentration; LAMP2A: lysosomal associated membrane protein 2A; MAP1LC3/LC3: microtubule associated protein 1 light chain 3; NPC: nasopharyngeal carcinoma; NPG: nasopharyngitis; oeCENPN: overexpressed CENPN; PTX: paclitaxel; RAPA: rapamycin; RNA-seq: transcriptome sequencing; shCENPN: small hairpin RNA expression vector targeting the human CENPN gene; shCENPN-shVAMP8: sequential knockdown targeting the human CENPN gene and VAMP8 gene; shVAMP8: small hairpin RNA expression vector targeting the human VAMP8 gene; TEM: transmission electron microscopy; TIR: tumor inhibitory rate; VAMP8: vesicle associated membrane protein 8.

Судомний синдром у підлітка як прояв синдрому делеції 22q11.2

22q11.2 deletion syndrome (DiGeorge syndrome) is one of the most common chromosomal abnormalities, which is characterized by multiplicity and variability of damage to various organs and systems: cardiovascular, immune, nervous, endocrine, skeletal. Purpose - to increase doctors' awareness regarding the diagnosis of 22q11.2 deletion syndrome in patients with seizure disorder based on a clinical case analysis. Here we report a clinical case of DiGeorge syndrome (22q11.2 deletion syndrome) in a boy with seizures diagnosed at the age of 14 years by genetic testing because of suspected epileptic encephalopathy. Diagnosed hypofunction of the parathyroid gland and hypocalcemia are obviously the cause of seizures and required a change in treatment. Despite the presence of T- and B-lymphopenia, the boy did not have a frequent infectious syndrome. The absence of defining signs of the 22q11.2 deletion syndrome at an early age, namely the absence of data for a congenital heart defect, pronounced facial dysmorphias, frequent infections, did not give an opportunity to suspect this syndrome at an early age. Taking into account the prevalence, multiplicity and variability of the lesion and the varying degree of severity of clinical manifestations in 22q11.2 deletion syndrome, patients with this syndrome can be found in the practice of every doctor. With seizures in combination with developmental disorders, it is necessary to rule out 22q11.2 deletion syndrome at any age. Wider awareness of the dysmorphic and clinical manifestations of this syndrome will allow better diagnosis of this disease, which requires a multidisciplinary approach to management. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

Assessment of risk factors for the vertebral body kyphotic deformity progression in patients with type A1 injuries of the thoracolumbar junction

More than 60% of traumatic injuries of the spine occur in the zone of the thoracolumbar junction (TLJ), and 60–75% of these fractures are of a compression nature. Type A1 injuries are characterized by the least osteo-destructive changes compared to other injuries. Traditionally, they are treated conservatively. A number of studies conducted in the last 10 years, shows a high rate of failure of conservative treatment, as evidenced by the progression of kyphotic deformity of the compressed vertebral body. Most of these publications are devoted to osteoporotic lesions in aged patients, while this aspect has been little studied in patients of working age with normal bone density. Objective: to evaluate the factors influencing the risk of kyphotic deformity progression in patients of working age with type A1 traumatic injuries of the thoracolumbar junction. Materials and methods. The analysis of clinical cases of patients who visited the outpatient department of Romodanov Neurosurgery Institute of National Academy of Medical Sciences of Ukraine in the period from 2019 to 2022 with traumatic damage to the TLJ zone. Forty-seven victims who met the selection criteria were selected. Gender, age, body mass index, level of damage, location of the damaged endplate (caudal or cranial), bone tissue radiodensity, angular kyphotic deformity of the vertebral body, and pain intensity were considered as predictors. Depending on the presence or absence of deformity progression 2 months after the injury, the patients were divided into two clinical groups. The most clinically significant predictors were identified using the LASSO (Least Absolute Shrinkage and Selection Operator) regression method. Results. LASSO screening identified five potential predictors. The final logistic regression model after regularization demonstrated high predictive performance: the area under the ROC curve (AUC) was 0.907, and the predictive accuracy was 85%. When assessing the risk of kyphotic deformity progression in traumatic injuries of type A1 of the TLJ zone, age, bone density, angular kyphotic deformity of the vertebral body, and pain intensity are of the greatest importance, demonstrating a directly proportional relationship. A compressed caudal endplate is also associated with a higher risk of post-traumatic progression of angular kyphosis. The nomogram developed using the mentioned factors makes it possible to quantify the degree of risk when choosing a therapy strategy. Conclusions. The performed analysis made it possible to create a nomogram for predicting the increase in kyphotic deformity of the vertebral body in A1 fractures of TLJ region. The proposed model can be used for a rational assessment of the risk degree when choosing the optimal tactics for treating patients.

Heparin-induced thrombocytopenia associated with low-molecular-weight heparin: clinical feature analysis of cases and pharmacovigilance assessment of the FAERS database.

Background: Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) are commonly used anticoagulants for the management of arterial and venous thromboses. However, it is crucial to be aware that LMWH can, in rare cases, lead to a dangerous complication known as heparin-induced thrombocytopenia (HIT). The objective of this study was to evaluate the pharmacovigilance and clinical features of HIT associated with LMWH, as well as identify treatment strategies and risk factors to facilitate prompt management. Methods: We extracted adverse event report data from the FDA Adverse Event Reporting System (FAERS) database for pharmacovigilance assessment. Case reports on LMWH-induced thrombocytopenia dated up to 20 March 2023 were collected for retrospective analysis. Results: Significantly elevated reporting rates of HIT were shown in adverse event (AE) data of LMWHs in the FAERS database, while tinzaparin had a higher proportional reporting ratio (PRR) and reporting odds ratio (ROR) than other LMWHs, indicating a greater likelihood of HIT. Case report analysis indicated that a total of 43 patients showed evidence of LMWH-induced thrombocytopenia with a median onset time of 8days. Almost half of the events were caused by enoxaparin. LMWHs were mainly prescribed for the treatment of embolism and thromboprophylaxis of joint operation. Patients with a history of diabetes or surgery appeared to be more susceptible to HIT. Clinical symptoms were mostly presented as thrombus, skin lesion, and dyspnea. Almost 90% of the patients experienced a platelet reduction of more than 50% and had a Warkentin 4T score of more than 6, indicating a high likelihood of HIT. In all patients, LMWHs that were determined to be the cause were promptly withdrawn. Following the discontinuation of LMWHs, almost all patients were given alternative anticoagulants and eventually achieved recovery. Conclusion: LMWH-induced thrombocytopenia is rare but serious, with increased risk in patients with diabetes or a surgical history. Prompt recognition and management are crucial for the safe use of LMWHs.

Analysis of amelogenesis imperfecta with abnormal tooth eruption caused by FAM83H mutation

Objective: FAM83H is one of the major pathogenic genes of amelogenesis imperfecta (AI). Previous studies focused on the abnormal enamel development and mineralization caused by the mutations in FAM83H. Here we aimed to observe other effects of FAM83H mutations on tooth eruption besides AI through clinical case analysis. Methods: Published AI cases with FAM83H mutations were searched through PubMed database, and the characteristics of tooth eruption of each cases were counted and analyzed. The literature search range was from January 1, 2008 to February 28, 2023, using the keywords FAM83H and amelogenesis imperfecta. The included literature must provide the detailed radiographic imaging or dental eruption information of AI patients, as well as FAM83H gene mutation information. The basic clinical information, tooth phenotypes, and mutations of all the enrolled cases were collected and analyzed in order to find the characteristics of abnormal tooth eruption. Results: Among 45 papers about FAM83H related to AI, twenty meeting the inclusion criteria were selected, involving 50 AI patients carrying FAM83H mutations who had radiographic image data or the detailed description of tooth eruption. A total of 34 abnormal erupted teeth were from 12 patients (12/50, 24%), among which 85% (29/34) had clear eruption path without any eruption obstructions, either embedded (25/34, 74%) or partially erupted (4/34, 12%). Tooth position analysis found that abnormal eruption of canines and second molars accounted for the highest proportion, accounting for 38% (13/34) respectively. Conclusions: The mutations in FAM83H may lead to amelogenesis imperfecta as well as abnormal tooth eruption at specific tooth positions.

A cytodiagnosis of adenoid cystic carcinoma of the tracheobronchial tree through a systematic clinical case comparison and analysis

BackgroundPrimary adenoid cystic carcinoma (AdCC) of the tracheobronchial tree is very rare with a high risk for recurrence and metastasis. The diagnosis of AdCC by histologic and immunohistochemical means has been well studied clinically. However, the identification of AdCC by cytologic features remains elusive due to the atypical features the cancer presents. This study aimed to describe the cytologic features of AdCC by using bronchial brushing, which could aid in distinguishing AdCC from other pulmonary carcinomas.MethodsThe cytopathological features of bronchial brushing smears collected from seven cases were histologically diagnosed as AdCC. The defined cytologic features, which could potentially be diagnostic, were systemically analyzed.ResultsFour out of the seven cytologic cases were inconcordance with the histologic diagnosis and cytologically classified as positive for malignant cells, small cell carcinoma, or atypical cells. Three cases showed a characteristic adenoid structure and magenta stroma forming globule, which was distinguished from the four cases. Cytologically, the above mentioned three cases were uniform with relatively small bland nuclei and little cytoplasm. In this study, only one case showed atypical polygonal medium-sized cells with conspicuous nucleoli.ConclusionsUnlike fine-needle aspiration cytology, magenta stroma globules might offer an alternate clue for cytodiagnosis of AdCC clinically. Bronchial brushings cytology was more present in bland uniform cells with high nuclear to cytoplasmic ratios and background mucoid substance. More cases should be collected and confirmed using histopathology with careful film reading to reduce the rate of misdiagnosis.

Metacognition through an Iterative Anatomy AI Chatbot: An Innovative Playing Field for Educating the Future Generation of Medical Students

Medical educators face many challenges instructing future medical students, specifically in the integration of learning technologies. To overcome these challenges, educators must implement learner-centered and interactive teaching strategies. Anatomical sciences are the cornerstone of medical education and provide the bedrock to layer conceptual understanding of the human body. With the “medical knowledge boom”, most medical schools have reduced the curricular time for anatomy instruction, resulting in a paucity of knowledge and issues incorporating anatomical knowledge in clinical scenarios. Modern pedagogical techniques combining AI chatbots with concurrent metacognitive frameworks can foster a deeper understanding of anatomical knowledge and analysis of clinical cases. Student reflection on the learning process allows for monitoring their progress and tailoring of learning strategies to their specific capabilities and needs. A.I. technology can aid in scaffolding knowledge with practical applications via iterative and immediate feedback in case- or problem-based learning formats. The use of textual conversations actively engages students and simulates conversations with instructors. In this communication, we advocate for the incorporation of AI technologies fused with a metacognitive framework as a medium to foster increased critical thinking and skill development that enhances comprehension. These skills are important for medical students’ lifelong learning process.

Cloud Computing based Influenza Virus Prevention and Control for Bio-Medical Applications

Aims: To improve the flexibility and efficiency of measurement of influenza virus prevention and control, and realize the combination of modern Internet technology and medical technology, in this article, the cases of influenza virus outbreaks in the past five years will be retrieved from various websites. Background: A total of 5087 articles including clinical case analysis literature, individual infection case reports, review literature, Chinese and English literature, outbreak cases, and duplicate literature of non-human infection cases should be excluded Method: Natural Development of Influenza Virus Infection in Individuals Result: The results show that in the influenza virus epidemic database, the longest course of influenza virus infection is 10 days, the shortest is 2 days, the average course is 5.6 (5.6 ± 1.7) days, and the proportion of cases with the course of 5 days is the largest, and the proportion of cases with the course of 8 days is the smallest. Conclusion: In the international common mathematical modelling research, it is found that the latency of influenza viruses is 1-7 days, most of them are 2-4 days, the average latency is 1.9 days, and the course of the disease is 3-6 days. In this study, through the medical information sensor system based on cloud computing, the SEIAR model of the influenza virus outbreak database is built, and the average latency of all outbreaks is calculated. The average latency of the influenza virus is 2.0 days, which is very close to the international research data, and the difference between the two is only 0.1 days. Compared with non-interventional outbreaks, influenza virus control measures push the peak period from 145 days (no intervention) to 169 days (i.e. 24 days later). The infection rate of the influenza virus decreases from 74.75% untreated to 26.41%, that is to say, 48.34

Morphological characteristics and diagnostic criteria of traditional serrated adenoma

Traditional serrated adenomas (TSAs) are extremely rare polyps from the group of serrated polyps of the colon. TSAs is no more than 5 % of all colon polyps. A relatively small number of studies have been devoted to this histological variant, at the same time, some aspects of the morphological diagnosis of TSA still remain undisclosed. Purpose: to conduct a clinical and morphological analysis of cases of TSAs.Materials and methods. The study included 57 cases of TSAs diagnosed in the period from 2021 to 2023. In the cases detected during this period, the results of histological and endoscopic studies were analyzed.Results. The age of patients ranged from 44 to 78 years and averaged 61.7 years. The ratio of men and women is 1:1.8. Most TSAs were found in the rectum (n = 28) and sigmoid colon (n = 20). In 8 cases, the tumor was localized in the descending part and the splenic flexure of the colon. In 1 observation, a tumor was found in the cecum. The sizes of the polyps ranged from 0.5 cm to 3.5 cm. In 22 cases, the composition of the polyp included tubulovillous adenomas (16 cases) and hyperplastic polyps (6 cases) in addition to TSAs. In 5 cases, foci of highly differentiated adenocarcinoma were detected in the TSAs material.Conclusion. TSAs has characteristic morphological features with a serrated exophytic growth pattern, cytoplasmic eosinophilia and the presence of ectopic crypts. Due to the difficulties of morphological diagnosis, TSAs in some cases remains undiagnosed. At the same time, due to the increased malignant potential, TSAs requires special vigilance on the part of pathologists and clinicians.