Clinical Departments Research Articles

A Complex Interplay of Tumor Microenvironment Could Enhance Cholangiocarcinoma Progression Even After Surgery: A Prospective Study.

The current study was conducted to explore the impact of macrophages and programmed cell death protein 1 (PD-1) expression on tumor-infiltrating lymphocytes (TILs) on treatment outcomes and to define the interaction between these factors and the clinicopathologic features of advanced cholangiocarcinoma (CCA) patients. Twenty-five patients with metastatic CCA were recruited for the current study from El-Rajhi Hospital and the Clinical Oncology Department of Assiut University. Additionally, 19 healthy controls were included. Before the flow cytometric detection of immune cells, the diagnosis and staging of CCA were performed based on surgical intervention, imaging, carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA) determinations. This was followed by flow cytometric detection of CD4+, CD8+, CD4+PD-1+, CD8+PD-1+, and CD11b+CD68+ macrophages in the peripheral blood of both patients and controls. The current results revealed higher levels of CD4+, CD8+, and CD11b+CD68+ macrophages in controls compared to patients. At the same time, PD-1 expression was significantly higher in patients compared to controls. CD4+ was correlated with improved progression-free survival (PFS), while CD8+PD-1 was associated with shorter PFS. In general, CD4+ and CD8+ levels progressively increased with improved response to treatments, differentiation, single organ site metastasis, and surgical interventions. On the contrary, PD-1 expression and macrophages progressively increased with worsening response, dedifferentiation, multiple organ sites, and surgical interventions. The median PFS was 12 months, and the mean ± standard error (SE) was 13.1 ± 1.3. CCA has a desmoplastic microenvironment with complex immunologic topography and tumor-reactive stroma. The immune landscape of the peripheral blood mononuclear cells (PBMCs) in CCA patients before treatment could reflect the state of systemic immune function and response to treatments. Our results revealed that T-lymphocytes correlated with better prognosis while macrophages and PD-1+ expression were associated with poor outcomes.

Social Needs Screening in Academic Health Systems: A Landscape Assessment.

Screening for social needs has gained traction as an approach to addressing social determinants of health, but it faces challenges regarding standardization, resource allocation, and follow-up care. The year-long study, conducted by the Association of American Medical Colleges, integrated data from conferences, surveys, and key informant interviews to examine the integration of social needs screening into health care services within Academic Health Systems (AHS). The authors' analysis unveiled eight key themes, showcasing AHS's active involvement in targeted social needs screening alongside persistent resource allocation obstacles. AHS are dedicated to efficiently identifying high-risk populations, fostering partnerships with community-based organizations, and embracing technology for closed-loop referrals. However, concerns endure about the utilization of reimbursement codes for social needs and regulatory compliance. AHS confront staffing issues, resource allocation intricacies, and the imperative for seamless integration across clinical and nonclinical departments. Notably, opportunities arise in standardized training, alignment of AHS priorities, exploration of social investment models, and engagement with state-level health information exchanges. Aligning clinical care, research pursuits, and community engagement endeavors holds promise for AHS in effectively addressing social needs.

Prevalence and Antimicrobial Susceptibility Pattern of MRSA amongst Patients from an Indian Tertiary Care Hospital: An Eye Opener

Staphylococcus aureus (S. aureus) is a very common human pathogenic microorganism that can cause a variety of infectious diseases, including skin and soft tissue infections, endocarditis, osteomyelitis, bacteremia, and lethal pneumonia. About one-third of the common population is colonized with S. aureus. MRSA is a formidable pathogen known to cause high mortality & morbidity, that poses a significant threat to public health worldwide. Presence of MRSA strains, resistant to multiple antibiotics especially in hospital stay, has complicated the management of infections caused by this bacterium. The aim of this study was to shed light on the prevalence and antimicrobial sensitivity pattern of MRSA among patients in a tertiary care center located in Faridabad, Haryana. This cross-sectional observational study was conducted in the Department of Microbiology, ESIC Medical College & Hospital, a 510 bedded tertiary care teaching hospital in Faridabad, Haryana, India. All wound samples including pus, exudates, wound swab and tissue samples received for aerobic culture and antimicrobial sensitivity from various clinical departments from January 2019 to July 2019 were included in this study. A total of 747 samples were received from January 2019-July 2019. Mean age of this study population was found to be 50.7 ± 14.8 years. Out of 747 samples, 226 (30.25%) were culture positive. Among the S. aureus isolates, methicillin resistance was seen amongst 39 (58.2%). Antibiotic Susceptibility results of S. aureus showed 100% resistance to Penicillin along with 100% resistance to Fluoroquinolones in both MRSA and MSSA. High prevalence of MRSA amongst patients highlights the importance of continued surveillance and implementation of antimicrobial stewardship program to control the menace of antimicrobial resistance. Strict adherence to Infection Control practices its regular follow up to assess the effectiveness of any hospital infection control measures taken is the key.

Rapid initiation of bictegravir/emtricitabine/tenofovir alafenamide as first-line therapy in HIV infection. A prospective study.

Rapid initiation of ART after HIV diagnosis is recommended for individual and public health benefits. However, certain clinical and ART-related considerations hinder immediate initiation of therapy. An open-label, single-arm, single-centre 48-week prospective clinical trial involving ART-naïve HIV-diagnosed adults who started bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) within a week from the first hospital visit, before the availability of baseline laboratory and genotype results. The primary aim was to determine the proportion of people with at least one condition that would hinder immediate initiation of any recommended ART regimen other than BIC/FTC/TAF. Clinicaltrials.gov: NCT04416906. We included 100 participants: 79% men, 64% from Latin America, median age 32 years. According to European AIDS Clinical Society (EACS) and US Department of Health and Human Services 2023 guidelines, 11% (95%CI 6; 19) of participants had at least one condition that made any ART different from BIC/FTC/TAF less appropriate for a rapid ART strategy. Seventy-nine percent of the people started BIC/FTC/TAF within the first 48 hours of their first hospital visit. There were 16 early discontinuations (11 lost to follow-up). By week 48, 92% (95%CI 86; 98) of the participants of the ITT population with observed data achieved viral suppression. Eight grade 3-4 adverse events (AEs), five serious AEs and six ART-related AEs were identified. Adherence remained high. BIC/FTC/TAF is an optimal treatment for rapid initiation of ART. However, additional strategies to improve retention in care must be implemented.

Efficacy analysis of the empathy-based attribution analysis-cognitive restructuring-pharmacological treatment model in the management of globus syndrome

ObjectiveThe aim of this study is to investigate the clinical efficacy of the empathy-based attribution analysis-cognitive restructuring-pharmacological treatment model for the management of globus syndrome. MethodSixty-nine newly diagnosed patients with globus syndrome at the Wenzhou People's Hospital Department of Gastroenterology outpatient clinic were enrolled in this study. After obtaining informed consent, patients were randomly assigned to either the observation group (attribution analysis-cognitive restructuring-classical pharmacotherapy; n = 35) or the control group (pharmacotherapy alone; n = 34), with a treatment course of 4 weeks. Efficacy assessments were conducted before and during treatment using the 9-item Patient Health Questionnaire-9 (PHQ-9), the 7-item Generalized Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-15 (PHQ-15). ResultsAfter four weeks of treatment, the total efficacy rate was 100 % in the observation group and 27.6 % in the control group, with a statistically significant difference between the groups (P < 0.05). Scores on the PHQ-9, GAD-7, and PHQ-15 significantly improved in the observation group compared to before treatment and were better than those in the control group, with statistically significant differences (P < 0.05). ConclusionThe empathy-based attribution analysis-cognitive restructuring-pharmacological treatment model for the management of globus syndrome demonstrated good clinical efficacy, providing strong evidence for further clinical promotion.

Magnesium matters: unveiling hidden risks in kidney transplant patients through total and ionized magnesium profiling.

In kidney transplant (KT) patients, magnesium (Mg2+) deficiency is widespread. It is often encountered early after KT, may persist longer, and is frequently promoted by calcineurin inhibitors (CNIs) and tubular leakage. Studies demonstrated an association between post-KT hypomagnesemia and allograft dysfunction. The concentration of the active form, the ionized Mg2+ (iMg2+), is not measured clinically, and total Mg2+ (tMg2+) and iMg2+ correlations are conflicting. We assess the cross-sectional prevalence of hypomagnesemia in KT patients. The correlation of demographic and anthropometric parameters was also studied. A prospective, single-center analysis of KT patients was conducted at the University Hospital of Bern, Switzerland (March 2023-August 2023). Blood samples were collected at least twice for the majority of patients. tMg2+ has been quantified from a plasma sample at the Clinical Chemistry Department of the University Hospital of Bern. The PRIME® ES analyzer (Nova Biomedical, USA) provided results for iMg2+. The following co-variables were considered: age, comorbidities, kidney disease, KT history, estimated glomerular filtration rate (eGFR), and treatment (including Mg2+ supplementation and immunosuppression). A total of 208 measurements in 104 patients were performed [once in 9/104 patients (8.7%), twice in 86/104 (82.7%), and three times in 9/104 (8.7%)]. Compared to that in healthy volunteers (51 measurements in 51 participants), mean iMg2+ was significantly lower in KT patients {KT: 0.46 mmol/L [interquartile range (IQR): 0.40-0.50], volunteers: 0.57 mmol/L (IQR 0.54-0.61), p < 0.01}. Overall, iMg2+ and tMg2+ showed strong category agreement (r2 = 0.93, p < 0.01). In linear regression, low iMg2+ correlated with CNI exposure. For 110/208 measurements (52.9%), a reduced iMg2+ (cutoff: 0.42 mmol/L) was shown. In 58/208 (27.9%), both values were reduced, and 52/208 (25%) had isolated reduced iMg2+. In principal component analysis, patients with isolated low iMg2+ clustered with patients with low iMg2+ and tMg2+. iMg2+ and tMg2+ were strongly correlated. A substantial proportion of patients show isolated low iMg2+. Currently, it is unclear if these patients suffer from Mg2+ deficiency.

Development of a Train-the-Trainer Quality Improvement Curriculum.

Quality improvement (QI) curricula are required for clinical disciplines at all training levels. Despite this, faculty educators often feel inadequately prepared to perform QI functions and thus lack the skills necessary to teach QI to learners. We aimed to improve faculty QI skills so they could oversee didactic curricula and experiential QI projects. We developed a train-the-trainer curriculum for faculty within medicine, nursing, and allied health that was delivered as a 2-hour interactive workshop. Core concepts included QI methodologies, measurement, implementation, and scholarship. Prior to the workshop, attendees completed a baseline knowledge test and a self-assessment of their confidence in teaching QI. Both assessments were repeated 1 month and 6 months postworkshop. Participants also completed a course evaluation. We report on our experience after two workshops with 23 participants total. Baseline median knowledge test percentage correct was 36%. This increased to 77% at 1 month and remained at 57% at 6 months. Self-assessment ratings of QI teaching skills increased consistently from baseline to 1 month to 6 months, with all respondents reporting feeling some confidence or very confident by the end of the study period. The course overall was rated very good or excellent by 91% of attendees. A focused QI train-the-trainer curriculum can sustainably improve faculty knowledge and self-ratings of QI teaching skills. Participants rated the interactive 2-hour workshop highly. Its materials can be easily adapted across disciplines and clinical departments to increase the number of faculty competent to facilitate didactic and experiential QI training.

Factors affecting the course and prognosis of implant-associated infection caused by &lt;i&gt;Klebsiella&lt;/i&gt; spp.

Background. The outcome of complex treatment of implant-associated infection (IAI) depends on various factors, but one of the most important is the etiology of the inflammatory process. Treatment of orthopedic infection caused by Gram-negative microorganisms in general and representatives of the family Enterobacteriaceae in particular causes many difficulties, one of which is the rapid growth of antibiotic resistance. Aim of the study — to evaluate the factors affecting the course and prognosis of implant-associated infection caused by Klebsiella spp. Methods. We performed a retrospective analysis of case histories of 85 patients who underwent treatment of IAI caused by Klebsiella spp. in the clinical departments of the center from January 1, 2017 to December 31, 2021. According to the results of the telephone survey, the patients were divided into 2 main groups depending on the outcome of the 2-year follow-up period determined in accordance with the Delphi criteria. Results. It was found that the prognosis was significantly worsened by the number of sanitizing surgical interventions in the anamnesis (p = 0.022), the need for sanitizing intervention in the early postoperative period (p0.001) and the presence of Klebsiella spp. growth in postoperative culture tests (p = 0.002), hypoalbuminemia on 7-14 days after the surgery (p = 0.008). The administration of trimethoprim-sulfamethoxazole for the outpatient treament stage significantly improved the outcome (p = 0.038), which is most likely due to a high proportion of polymicrobial associations — 69.5%. Conclusions. There is a statistically significant direct relationship between the probability of an unfavorable treatment outcome of patients with IAI caused by Klebsiella spp. and the number of sanitizing surgical interventions in the anamnesis, low serum albumin (g/l) on 7-14 days after the operation, revision intervention in the early postoperative period, positive growth of Klebsiella spp. in postoperative culture tests. The probability of a favorable outcome was increased by the prescription of trimethoprim-sulfamethoxazole for oral administration at the outpatient stage.

The Clinicoepidemiological Features and Treatment Outcomes in Cervical Carcinoma at Clinical Oncology Department of Ain Shams University Hospital: Retrospective Analysis

Abstract Background Through Increased education, access to care, and the expansion of screening and vaccination programs, reductions in cervical cancer incidence and mortality may be achieved. Aim and Objectives the aim of the study was to determine the clinicoepidemiological features and treatment outcome in cancer cervix at clinical oncology department of Ain Shams University Hospital. Subjects and Methods This retrospective analytical study included consecutive adult female patients ≥ 18 years with pathologically confirmed cervical cancer presented to the Clinical Oncology Department, Ain Shams Faculty of Medicine, Cairo, Egypt from January 2016 to December 2020. Results Most of the patients (71.3%) were under 60years, andthe median age at diagnosis was 53 years. In our cohort, about 54.5 % of patients were postmenopausal, with the median age of menopause around 51.0 years. In most cases, the age of menarche was between 9 and 12 years. 94.1.0 % of the patients were married, and most of them got married after reaching the age of 18 years (74.2%). In our cohort, CCRTH improved both DFS and OS for adjuvant groups as well as PFS and OS for patients who received definitive treatment. Univariate analysis including age, menopausal status, sociodemograhic data, tumor characteristsics, FIGO sataging and treatment received showed that significantrisk factors for reduced PFS and OS of patients who received palliative treatment was Diabetus mellitus as a comorbidity. Conclusion This data emphasizes that patient in rural setting present at later stages which could be improved by creating awareness in rural women, and help accessing adequate screening measures.

The Role of Chitinase-3-like Protein 1 (YKL-40) as a Marker of Disease Activity in Ankylosing Spondylitis Patients

Abstract Background Ankylosing spondylitis is a prototype of spondyloarthritides that primarily affects the axial skeleton. Sacroiliitis is the hallmark and accompanied by inflammation of the entheses and formation of syndesmophytes, leading to spinal ankylosis in later stages. Prevalence estimates vary between 0.1% and 2% in different populations.The most utilized peripheral blood biomarkers of ankylosing spondylitis activity in clinical practice and clinical trials are ESR and CRP. However, they have low sensitivity and specificity. Objective To detect the role of YKL-40 as an objective Marker of disease activity in ankylosing Spondylitis Patients. Patient and Methods This study was a case control study, included fifteen ankylosing spondylitis patients were recruited from the outpatient clinic and inpatient department of Physical Medicine, Rheumatoloy and Rehabilitation of Ain Shams university hospitals and fifteen adult healthy volunteers as a control group. Approval of the Ain shams university research and ethical committee was obtained. Results There was no statistically significant difference between patient and control group as regard age and sex. YKL-40 showed 100% sensitivity and 100% specificity. large scale studies with follow up of patients in response to drug treatment are needed to be done to assess its uses as a disease activity marker. large scale prospective studies are needed with the assessment of comorbidities and their time of development in correlation to YKL-40 as it has an excellent potential for prediction of these comorbidities. Conclusion YKL-40 marker is a good predictor for ankylosing spondylitis disease.

Assessment of Serum Autophagy Related Protein Beclin1 in Egyptian Adult Beta Thalathemic Patients

Abstract Background Beta-thalassemia is a chronic hemolytic anemia that is inherited in an autosomal recessive manner. It is characterized by reduced hemoglobin levels and red blood cell production. Aim of the Work Assessment of serum autophagy related protein beclin1 in Egyptian adult beta thalathemic patients and Its relation to ineffective erythropoiesis, transfusion requirements, iron overload. Subjects and Methods This is a case control study which was carried out at Ain Shams university hospitals. Internal medicine department, Clinical hematology and stem cell transplantation unit, outpatient clinic and inpatient department, during the period between January 2022 and August 2022. Results Our study revealed significant decreased fertility between patients group and control group (P = 0.011). Transfusion-dependent beta-thalassemia males have a high proportion of fertility impairment and iron overload might contribute to disturbed sperm quality and testicular tissue injury. Such findings might explain the high prevalence of impaired fertility in transfusion-dependent beta- thalassemia patients which agrees with our results. Also our study revealed significant differences between non-transfusion dependent group and transfusion-dependent group regarding spleen size (cm) below costal margin which was increased in (TD group), transfusion per year (ml/yr)(which was increased in (TD group), virology (HIV, HCV,HBV) revealed that percentage of HCV+ve higher in (TD group) with (P &amp;lt; 0.001): Our study revealed significant difference between non-transfusion- dependent group and Transfusion-dependent group regarding percentage of patients of with positive HCV which was increased in Transfusion-dependent group (P = 0.021): In our study Iron chelation therapy was found to be given in a higher percentage of TD patients compared to non TD patients (P &amp;lt; 0.001). Also our study revealed significant difference regarding cardic function(EF%) between patients group and control group (EF found to be lower in patients group than controls) (P &amp;lt; 0.001): Also our study showed that Beclin-1 level is significantly higher in patients group compared to control group (P &amp;lt; 0.001). We couldn’t find previous studies of Beclin-1 level in thalassemia patients. We postulate that Beclin 1 could be used as a marker of worsening cardiac functions in thalassemia patients, but further studies should measure serial levels of Beclin 1 and correlate it with cardiac parameters over longer periods of follow up. Conclusion Beclin 1 level increased in Adult Beta Thalasemia patients and it can be used as a prognostic marker for Adult Beta Thalasemia patients.

227 Retrospective Study to Assess Axillary Management and Oncological Outcome After Neoadjuvant Chemotherapy for Patients with Breast Cancer

Abstract Aim Evaluation of the effect of neoadjuvant chemotherapy on axillary nodal status. The secondary objective was to evaluate the percentage of patients who are eligible for SLNB after neoadjuvant chemotherapy. Method This retrospective study was conducted by collecting data during the period from October 2019 to July 2021. The study included 64 patients who had biopsy-proven locally advanced breast cancer with clinically or radiologically positive axillary LNs, had been receiving neoadjuvant chemotherapy at the Clinical Oncology Department, and underwent surgery after neoadjuvant therapy at the surgical oncology unit of Alexandria Main University Hospital. Exclusion criteria were as follows: Patients with early-stage breast cancer, metastatic stage IV breast cancer, unfit/refusing neoadjuvant therapy, aged less than 18 years or more than 75 years or clinically and radiologically negative axilla. Data were collected retrospectively to assess the oncological and surgical outcomes after completing NAC. The files of 450 patients were reviewed, and only 64 patients were eligible patients to be included in our study. Results Complete pathological response (ypT0ypN0) was found in six of the 64 patients in our study. Four patients were triple-negative, and two patients were HER2-enriched biological subtype. One patient was T1, one patient was T2, one patient was T3, and three patients were T4. One patient was N1, four patients were N2, and one patient was N3. Conclusions Post-neoadjuvant ultrasound is essential for assessment of axillary response. Approximately 44.4% of patients with negative post-neoadjuvant axillary ultrasound can avoid unnecessary ALN clearance. Accurate axillary staging is the cornerstone for omission of axillary clearance after neoadjuvant among patients.

Role of Optical Coherence Tomography (OCT), Fundus Photography, and Amsler Grid in Detection of Macular Disorders Associated with High Myopia

Abstract Background High myopia refers to ametropia characterized by elongation of optic axis and retinal and choroidal degeneration in the fundus, and high myopic patients present with various degrees of structural and functional retinal changes and thinning of the retinal thickness. Active screening for high myopic patients with imaging techniques by OCT, Fundus photography and amsler grid and providing patients with corresponding treatment on this basis may effectively reduce the risk of irreversible visual function damage. Objective To point to the importance of combining OCT, fundus photography with amsler grid testing in patients with high myopia. Methods This study was conducted on 40 eyes from EI-Demerdash Hospital outpatient clinic and ophthalmology department investigations unit in the period from June 2021 till May 2022; the patients were 24 females (60.0%) and 16 males (40.0%) with age ranged from 16 to 50 years. Results Our investigations gave us an idea about the macular diseases associated with high myopia and the importance of combining use of OCT, fundus imaging and amsler grid with patients with high myopia. These findings consist of chorioretinal atrophy, foveoschisis, choroidal neovascularization, dehiscence of retinal layers known as retinoschisis (foveoschisis or extre foveoschisis), macular holes (lamellar and full thickness), posterior retinal detachment. We can early detect theses changes in macula of highly myopic patients by Amsler grid testing as daily self monitoring and this can be useful in directing the patient to more sophisticated investigation tool like OCT and fundus photography and therefore give the patient the optimal chance to save the vision. Conclusion OCT combined with fundus photography and amsler grid testing are helpful tools that allow detailed evaluation of the macula in eyes with pathological myopia and easily anticipate, diagnose and follow up diseases associated with high myopia.

1021 Accuracy of Clinical Coding in General Surgery and Its Financial Impact

Abstract Aim To analyse the clinical coding performed at a tertiary centre after patient discharge and compare it with the clinical summary to identify any inconsistency and its financial implications. Method Fifty patient episodes were selected randomly between June 2023 and August 2023 under the general surgery department. Clinical notes, discharge summaries and existing clinical codes were scrutinized by liaison with the clinical coding department. Financial losses were noted, and the summary was later presented at the local clinical governance meeting. Results A total of £38,760 was lost in 50 patients. Loss incurred was primarily due to incomplete information in the discharge summary, related to the patient’s comorbidities, incomplete diagnosis, and procedure/investigations. These results were discussed in a clinical governance meeting and a poster was made to disseminate the conclusion and improve the quality of the discharge summary. Conclusions A total of £38,760 of funding was lost due to discrepancies in the clinical coding. An intervention in the form of a poster and teaching session was conducted for junior doctors and a repeat cycle is planned in the due course of time to improve the quality and minimise the loss of funding.

Faculty Experiences: Virtual versus Traditional Problem-based Learning during COVID-19 in a Saudi Medical College

Abstract Background: The COVID-19 pandemic has forced a fast change to new teaching approaches based on online education. Problem-based learning (PBL) was one of the modified teaching strategies. The current study sought to examine faculty perceptions of virtual versus traditional PBL during the COVID-19 pandemic at a Saudi medical college. Methods: This is a retrospective cross-sectional study conducted at King Saud University’s College of Medicine. We compared the perceptions of faculty members who facilitated traditional face-to-face PBL in 2019–2020 and virtual PBL in 2020–2021. An online survey with demographic and practice data was distributed. The faculty’s perception of PBL facilitation, student learning, and overall satisfaction was investigated using a 5-degree Likert scale: 15 items grouped into three main areas. All of the questions were written in a way that compares traditional and virtual PBL. Mean scores were determined for all parts, and the findings were reported as mean standard deviation, with scores of 3 and above considered positive, and scores of &lt;3 considered negative. The data were analyzed with SPSS version 25.0. Results: In the study period, 57 faculty members facilitating PBL replied to the survey (response rate 67.85%). There were no gender variations in the representation of participants (male 56.1%, female 43.9%), and they come from a variety of basic and clinical departments. The majority of participants (91.3%) have more than 2 years of PBL facilitation experience, and 64.2% have received training in both virtual and traditional PBL facilitation. The faculty assessment of facilitating virtual PBL was favorable as overall satisfaction, with the mean of the components in the satisfaction section being 3.67. In terms of facilitation preferences, we discovered that despite the amount of effort involved in facilitating traditional PBL sessions (mean = 3.47), their motivation to facilitate traditional PBL was higher than that of virtual PBL (mean = 3.33). Faculty perceptions of students’ learning in PBL were more traditional, with the mean of the items in this section (such as students’ motivation, participation, and group dynamics) being higher (3.616). Conclusions: The faculty’s satisfaction with their abilities to properly facilitate virtual PBL sessions did not detract from their motivation to be in direct personal interaction with students during PBL sessions. To ensure faculty care about students’ learning in virtual PBL, their perception had to be correlated to their learning outcomes.

Assessment of Professionalism among Postgraduate Medical Students: A Cross-Sectional Study from Patna, Bihar.

Professionalism is a core quality which has to be developed and imbibed by medical students. However, training in professionalism was not a part of the medical curriculum until recently when the Competency-Based Medical Education system was introduced for undergraduate medical students in India, by the National Medical Commission. However, there has been no formal training on professionalism, in the curriculum of postgraduate (PG) medical students in India. Therefore, in this study, we have done a quantitative assessment of the attitude towards professionalism among PG medical students. A cross-sectional study was conducted among 200 PG medical students of an autonomous institute in Patna, Bihar over a period of six months using the Learners' Attitudes on Medical Professionalism Scale (LAMPS) questionnaire. Data entry was done on Microsft Excel 2015 (Microsoft Corporation, Redmond, Washington, United States) and data analysis was done using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). Out of 200 study subjects, 55% (n=110) were PG students from clinical departments and 45% (n=90) were from pre-clinical and para-clinical departments; 25.5% (n=51) of them were from first year, 57% (n=114) of them were from second year, and 17.5% (n=35) were from third year PG training. The overall mean score for the LAMPS scale across all domains was found to be 2.78±0.178(mean±S.D). Clinical PG students (2.99 ± 0.217) received significantly higher scores than pre/paraclinical PG students (2.68 ± 0.176) (T-test value = 10.9262, p < 0.0001). This study highlights the disparity in professionalism scores between clinical and pre/para-clinical students, suggesting a tailored approach might be beneficial. In order to improve the attitude towards professionalism, structured courses/workshops should be inculcated into the PG training curriculum. Continuous evaluation of professionalism throughout medical training can lead to better preparedness for future professional roles.

Effects of different treatment modalities on cardiovascular disease in ARR-positive hypertensive patients.

Data on the prognosis of clinically undiagnosed hypertensive patients who are aldosterone-to-renin ratio (ARR) positive are still scarce. Therefore, we investigated the clinical characteristics of clinically undiagnosed hypertensive patients who were ARR-positive and the influence of their different treatments on the occurrence and development of complications. A total of 285 hypertensive patients data with ARR ≥ 3.8 in the Second People's Hospital of Huai'an from January 2019 to December 2021 were collected, and 135 undiagnosed hypertensive patients were ultimately included in the analysis. According to their treatment strategy in various clinical departments, 135 patients were divided into the operation, spironolactone and control groups. Then, the clinical characteristics and the occurrence and development of complications in the three groups were compared. The results suggested that: (1) Only 34 (11.9%) of 285 hypertensive patients with ARR ≥ 3.8 were clearly diagnosed with Primary aldosteronism (PA) through functional tests, and the blood pressure (BP) compliance rate was only 50.30% during follow-up. (2) Based on exclusion criteria, 135 undiagnosed hypertensive patients were eventually included in the analysis. Patients in the surgery group had lower blood potassium levels and higher aldosterone levels than those in the other two groups, and their risk of new cerebrovascular complications was lower than that of the patients in the spironolactone group. (3) The risk of new cerebrovascular complications in the spironolactone group was 9.520 times higher than that of the control group, and this risk mainly occurred in patients with ARR values of 3.8-5.7. On the whole, surgery remains a good option for hypertensive patients with severe hyperaldosteronism and hypokalemia and those unable to undergo confirmatory tests; however, spironolactone therapy in patients with clinically undiagnosed hypertension, especially those with 3.8 ≤ ARR < 5.7, confered a higher risk of new cerebrovascular complications.

Pain Detect as A Tool for The Screening of Neuropathic Pain in Patients with Diabetes Mellitus

Background: Diabetic neuropathy (DN) is a prevalent long-term complication of diabetes mellitus (DM), affecting more than 50% of patients. In addition, several studies also showed that distal symmetric polyneuropathy (DSPN) accounts for 75% of all DN cases. To facilitate the treatment of DN, painDETECT questionnaire, a self-reported tool with 85% sensitivity and 80% specificity, has been recommended for detecting neuropathic component in pain. Objective: This study aimed to promptly diagnose DN using painDETECT questionnaire in DM patients. Methods: The study procedures were carried out using a descriptive, cross-sectional design with 67 DM patients from Cibabat Regional Hospital Department of Internal Medicine outpatient clinic through consecutive sampling in October–November 2022. Primary data were obtained using the adapted and validated Indonesian painDETECT questionnaire. Results: Among the 67 patients, 32.9% experienced neuropathic pain with a score of 19–38, indicating the involvement of &gt;90% of neuropathic pain components. Sensory deficits, such as numbness, burning sensation, pins-and-needles, and allodynia, were observed in 86.3%, 90.1%, and 72.7% of patients with neuropathic pain, respectively. In addition, a total of 59.7% of participants (n=40) reported the presence of mild pain (NRS 3). Conclusion: Based on the results, the majority of patients had complaints of neuropathic or mild pain (40 subjects; 59.7%). Among the 22 patients experiencing neuropathic pain, 54.5% reported mild intensity.

Outpatient Factors Implicated in Timing of Delayed Elective Inguinal Hernia Repair in Premature Neonates: Single Center Analysis Brings Up a Touchy Issue and Balancing Metric

IntroductionAmong premature infants, the incidence of inguinal hernias (IH) has been reported to be as high as 10–30%. We performed this study to characterize the association between individual and systemic variables that may affect diagnosis to definitive operative repair of the premature neonatal IH in the outpatient setting. MethodsA single center cohort retrospective review analyzing IH repair in the premature neonatal (<37 GA) population was performed. Data was collected between 2013 and 2022. The cohort was defined as patients who underwent repair before the age of 1 and excluded patients with major medical comorbidities or underwent simultaneous major abdominal surgeries. ResultsOf the 836 premature neonates who underwent IH repair, the majority (73%) were repaired electively. Patients were characterized into risk cohorts a-priori. High-risk patients (HR, n = 43) were more likely to have Government insurance (67%). There was a significant difference in HR patient time to surgery between Government versus Commercial insurance, 10.6 versus 4.7 days, respectively (95% CI -11.09 to −0.4396, p = 0.0345). HR patients were also seen more frequently (clinic or emergency department) prior to operative repair (2.51 vs 1.72 95% CI –1.296% to −0.289%, p = 0.0021). A multivariate linear regression model demonstrated that risk class (p = 0.0244), touches (p < 0.0001), GA (p < 0.001), and prior authorization (p < 0.0001) were significantly associated with time to hernia repair. ConclusionsSystemic variables such as insurance type may increase average wait time for elective outpatient IH repair. This increase in wait time is associated with an increased number of healthcare visits. Therefore, timely access to surgical care prevents potential harm and may decrease health system burden. Type of StudyRetrospective comparative study/cohort study. Level of EvidenceIII.

Practice Transformation in the Transforming Clinical Practice Initiative and Emergency Department Use.

To provide insight on how ambulatory care practices can reduce emergency department (ED) visits, we studied changes in Medicare ED visits for primary and specialty care practices in the Transforming Clinical Practice Initiative. We compared practices that transformed more vs less during the 6-year period ending in 2021 (3,773 practices). Using data from a practice transformation assessment tool completed at multiple intervals, we found improvement in the transformation score was associated with reduced ED visits by 6% and 4% for primary and specialty care practices, respectively, 3 to 4 years after first assessment. Transformation in 5 of 8 domains contributed to reduced ED visits.