Clinical Departments Research Articles

Care of post-placenta praevia patients in the post anesthesia recovery department of a private clinic, 2021

Cesarean section is a surgical procedure performed on the mother's abdomen and uterus to remove the pregnancy product. Placenta previa is a major obstetric complication that occurs in the second half of pregnancy and endangers the life of both the mother and the fetus; cesarean section is the treatment of choice. Timely nursing care helps patients recover quickly and avoid serious complications. The objective is to identify the needs of the patient and manage the nursing treatment for the resolution of the registered problems. Qualitative study, single clinical case type, included a 37-year-old patient. The stages of the nursing care process were followed: assessment, with a framework validated by professionals in the area, formulation of diagnoses and planning of nursing care according to the NANDA, NOC, NIC taxonomy. The evaluation of the results was obtained by the difference in final and baseline scores. Nine altered patterns were found; Three patterns were prioritized: sexuality, reproduction, cognitive perceptual, adaptation, tolerance to the situation and stress. Seven nursing diagnoses were identified, the diagnoses were prioritized: risk of bleeding, acute pain and anxiety based on the SSPFR format (signs and symptoms, problem and related factor); the change score was +1, +2, +2, +2, +3. It is concluded that according to the needs attended to in the patient, the nursing care process was developed in its five stages, allowing to provide quality care to the patient; therefore, it is explained that timely care and adequate treatment would shorten the recovery process.

PLASMA CELL LEUKEMIA: AN AGGRESSIVE DISEASE, A CAUSE OF DIAGNOSTIC ERROR

Plasma cell leukemia (LP) is a rare and aggressive plasma cell tumor that manifests as significant clonal expansion of plasma cells in the bone marrow and peripheral blood. It is considered primary when it presents at initial diagnosis and secondary when it occurs in patients with pre-existing multiple myeloma (MM). Because of the high frequency of extramedullary injuries, plasma cell leukemia is a major source of diagnostic error that can lead to fatality. We report a case of plasma cell leukemia diagnosed at the clinical haematology department of the CNTS in Dakar (Senegal).

Perceived Utility of Jan Aushadhi Outlets and Awareness of Generic Medicines at the Andaman and Nicobar Islands: A Cross-Sectional Study.

Despite being the leading exporter of generic medicines to the world, affordable medicines are still beyond the reach of most patients in India.Analysis of the National Sample Survey data showed that in one year, more than 55 million Indians became poor only because they had to spend their own money to purchase medicines. The Jan Aushadhi Scheme launched by the Government of India is an ambitious step to make quality generic drugs affordable to the common man of the country. This study aimed to assess the knowledge, attitude, and perceptions of patients at a tertiary care teaching hospital in the Andaman and Nicobar Islands about Jan Aushadhi Kendras and generic medicines. The study was a questionnaire-based cross-sectional study. A prevalidated self-made questionnaire was distributed to 200 patients visiting the OPD of different clinical departments in the hospital. Participants' knowledge, attitude, and perception of Jan Aushadhi Kendras and generic medicines were evaluated. Analysis of collected data was done using descriptive statistical measures such as mean and percentages. It was found that most of the participants were not fully aware of the Jan Aushadhi Scheme and the facts about generic medicines. The majority of the participants were under the notion that generics were not similar in quality to the branded ones. The study observed that the patients had a very poor understanding of the Jan Aushadhi Scheme and generic medicines with the majority being ignorant and having incorrect information. To fill this gap, a more proactive approach by the healthcare workers and authorities is needed to disseminate the scheme-related facts, dispel the myths regarding generics, and accept the program wholeheartedly by the common man.

Android-Based Patient Healthcare Tracker with Appointment Booking Capability

Managing the healthcare system presents various challenges that healthcare professionals must be well-prepared to address. Additionally, in times of pandemics, reducing human contact in crowded locations like clinics becomes crucial. Currently, many clinic departments spend a considerable amount of time manually entering and searching for patient data within their systems. This process is not only time-consuming but also notably ineffective. Hence, the development of a mobile application has become an imperative solution to overcome these issues. This project has been implemented using Android Studio with the primary aim of tracking patient health and efficiently recording patient data. This, enables doctors to effectively monitor their patients. The developed application serves as a two-way communication bridge between patients and healthcare departments. Patients can effortlessly schedule appointments with their doctors for consultations and update their health status through the app. Simultaneously, doctors can conveniently issue prescriptions via the same application. We conducted a survey involving 120 participants, comprising 20 doctors and 100 patients. The results unequivocally demonstrate that the designed application has significantly improved healthcare management and fostered efficient communication between doctors and patients.

Ангелина Константиновна Гуськова (к 100-летию со дня рождения)

Angelina Konstantinovna Guskova, Doctor of Medical Sciences, Professor, Corresponding Member of the Russian Academy of Medical Sciences, Laureate of the Lenin Prize, Honoured Scientist of the RSFSR, Laureate of the Sievert Prize, worked for 50 years at the A.I. Burnazyan FMBC. She was born on 29 March 1924 in the family of doctor Konstantin Vasilievich and pianist Zoya Vasilievna Guskov. In 1941, she entered the Sverdlovsk State Medical Institute, Faculty of Medicine, and successfully graduated in 1946. A.K. Guskova did her residency at the Clinic of Nervous Diseases and Neurosurgery. After her graduation, Angelina Konstantinovna was sent to Chelyabinsk-40 (Ozersk), where she started working in medical institutions serving the operating personnel of Plutonium Combine No. 817. There she gained her first experience in treating patients with acute and chronic radiation sickness. In 1957, A.K. Guskova became a senior researcher at the Institute of Biophysics in Moscow, from 1961 she headed the Radiology Department of the Institute of Occupational Hygiene and Occupational Diseases of the USSR Academy of Medical Sciences. In 1974 she returned to the Institute of Biophysics of the Ministry of Health of the USSR as Head of the Clinical Department. Under the leadership of A.K. Guskova in the Clinical Department of the Institute of Biophysics a number of methods of diagnostics and prediction of severity of radiation syndromes, as well as their treatment were developed and introduced into practice. This allowed the staff of the Department to successfully cope with the most difficult task of treating a large group of victims of the Chornobyl accident in 1986. A.K. Guskova is the author of more than 200 publications, 11 monographs (co-authored), and sections in monographs and manuals (independent). The most important of them are: «Human Radiation Disease» (1971), «Medical Assistance given to personnel of the Chernobyl N.P., after 1986 Accident». (1996). (editor and co-author), «Guidelines for Organisation of Medical Care for Persons Exposed to Radiation» (1986), «Guidelines for Radiation Medicine» (2001).

IJCM_88A: Perception of the medical college faculty on new competency-based medical education curriculum for MBBS students

Background: Medical education needs to be adjusted to meet the fast- changing expectations of society and the resulting demands on daily medical practice. The Medical Council of India (MCI) has updated the Medical Curriculum based on CBME. Objectives: 1. To assess the perceptions of the faculty members of the Medical college on the competency-based medical education curriculum for the MBBS course 2. To assess the readiness to incorporate competency-based medical education in the medical education curriculum among faculty members Methodology: This cross-sectional study was set in Kasturba Medical College, Mangalore, among teaching staff of pre-clinical, para-clinical, and clinical departments. A total of 93 (pre-clinical-29, para-clinical-31, clinical=33) faculty members were requested to fill out the questionnaire. Results: Our study highlights inter-department coordination, time demands, and lack of faculty training as the major barriers to the implementation of CBME. Among all participants around 60% were females. Most of the participants had teaching experiences between 0-5 years. Almost 95% of the participants were aware of the new MCI 2019 curriculum. The majority of the participants rated their knowledge about CMBE as moderate level (38.7%). 61.3% of the faculty members consider themselves to be ready to incorporate CBМЕ. According to most faculty members, a moderate amount (50%) of training is required and sessions and workshops (68.8%) are the most preferred type of training. Conclusion: Most of the faculty members found that the CBME pattern will be effective in imparting skills to undergraduates. Most of the participants identified inter-department coordination, demands of time, and lack of training in evaluation and feedback to be the major barriers to implementing the CBME pattern. Most of the faculty members consider themselves to be ready for this change even though a lot of them find the implementation of CBME to be a difficult task.

Osmotic demyelination syndrome (ODS), and psychiatric manifestations

IntroductionHyponatriemia can be potentially fatal if it is not corrected immediately. The rapid correction of chronic hyponatriemia can cause demyelinating brain lesions.ObjectivesA fifty-six year old female was brought to the emergency department of the psychiatric clinic by her daughter, with incomprehensible speech and psycomotor agitation. She was diagnosed several years ago with bipolar disorder, with valproic acid and quetiapine being her current medication. She has been living alone, in a small suburban city. Approximately twenty four hours before her admission to the hospital she visited her daughter, which aligns with the onset of symptoms.MethodsAfter both the brain CT scan and the lab results came back normal, the patient was admitted to the psychiatric clinic of the General Hospital of Corfu. On the fourth day of the patient’s hospitalization - when both her speech and the psycomotor agitation showed signs of improvement- we were informed that three days before her admission to the clinic she visited the emergency department of another hospital where she was treated for hyponatriemia. The patient’s hyponatriemia was corrected over the span of twelve hours by 35 mEq.ResultsAfter receiving this information, we ordered a brain MRI scan which revealed a central pontine myelinolysis. The result can explain the clinical symptoms that our patient showcased before her admission and could have been caused by the rapid correction of hyponatriemia.ConclusionsThe patient’s speech was fully restored after four weeks and there were no symptoms consistent with any psycho emotional disorder.Disclosure of InterestNone Declared

Influence of genetic background on the clinical picture of bipolar affective disorder in a population of children and adolescents

IntroductionBipolar disorder in children is characterized by a different course than in adults, which is a diagnostic difficulty. DAT-1 is a dopamine transporter gene that regulates dopaminergic neurotransmission through the mechanism of active reuptake of this neurotransmitter from the synapse. Polymorphisms within the described gene can result in changes in dopamine levels, which may have implications for the development of bipolar disorder.Objectives The aim of the project was to analyze the relationship between single nucleotide polymorphisms (SNPs) within the dopamine transporter gene DAT-1 and the risk of development of bipolar disorder in a population of children and adolescents.Methods21 healthy controls (12 females, 9 males) have been recruited into the study and 13 patients (9 girls, 4 boys) with bipolar disorder diagnosis from Department of Psychiatry and outpatient clinic, were recruited for the study group. Questionnaires such as the KSADS-PL were carried out and blood was taken for laboratory tests of four SNPs within the DAT-1 transporter. PQStat, Microsoft Excel 2013 and StatSoft STATISTICA were used to perform the statistical analysis.ResultsSNPs within the dopamine transporter gene and environmental risk factors influenced the risk of developing bipolar disorder in the population of children and adolescents.ConclusionsThe ambiguity in results emphasizes the necessity for further investigations into correlation between genetic factors in bipolar disorder etiology. Future research should involve more participants. The results of this project are likely to make a significant and valuable contribution to the current knowledge of bipolar disorder and to the development of innovative diagnostic methods, making a significant contribution to the advancement of science.Disclosure of InterestNone Declared

Genomic multidisciplinary teams: A model for navigating genetic mainstreaming and precision medicine.

Recent rapid advances in genomics are revolutionising patient diagnosis and management of genetic conditions. However, this has led to many challenges in service provision, education and upskilling requirements for non-genetics health-care professionals and remuneration for genomic testing. In Australia, Medicare funding with a Paediatric genomic testing item for patients with intellectual disability or syndromic features has attempted to address this latter issue. The Sydney Children's Hospitals Network - Westmead (SCHN-W) Clinical Genetics Department established Paediatric and Neurology genomic multidisciplinary team (MDT) meetings to address the Medicare-specified requirement for discussion with clinical genetics, and increasing genomic testing advice requests. This SCHN-W genomic MDT was evaluated with two implementation science frameworks - the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and GMIR - Genomic Medicine Integrative Research frameworks. Data from June 2020 to July 2022 were synthesised and evaluated, as well as process mapping of the MDT service. A total of 205 patients were discussed in 34 MDT meetings, facilitating 148 genomic tests, of which 73 were Medicare eligible. This was equivalent to 26% of SCHN-W genetics outpatient activity, and 13% of all Medicare-funded paediatric genomic testing in NSW. 39% of patients received a genetic diagnosis. The genomic MDT facilitated increased genomic testing at a tertiary paediatric centre and is an effective model for mainstreaming and facilitating precision medicine. However, significant implementation issues were identified including cost and sustainability, as well as the high level of resourcing that will be required to scale up this approach to other areas of medicine.

Human Papillomaviruses Genotype Distribution and Replacement by Year from 2014 to 2020 in Beijing, China.

Cervical cancer is one of the most common gynecological malignancies worldwide. The incidence of cervical cancer ranks second for female malignancies in China. However, human papillomavirus (HPV) prevalence and genotype replacement for a long time in Beijing were not yet evaluated. Women patients who visited clinical departments, especially the gynecology department, were included in this study from 2014 to 2020. They suffered from different kinds of cervical abnormalities even cervical cancer. Thirteen types of HPV were detected in cervical samples by using multiple fluorescence polymerase chain reactions. All patients were divided into four groups according to age (15-30, 31-45, 46-60, and >60 years old). The study included data from four certain years (2014, 2016, 2018, and 2020). Overall HPV prevalence was 18.0%, 16.7%, 21.9%, and 19.1%, respectively. Of the 13 genotypes, the top one infection type was HPV52, followed by HPV58 and HPV16 or HPV16 and HPV58 in different years. HPV56 prevalence raised from 2018, which replaced HPV39 into the top five list. Only HPV prevalence of 46-60 years age group declined, mainly resulting from the reduced prevalence of HPV39 and HPV58 (p < 0.001 and p = 0.020). The proportions of HPV dual-infection across the four years varied significantly in statistics (p = 0.001), whereas the most common dual-infection HPV39/68 disappeared after 2018. The prevalence of two HPV genotypes (HPV39 and HPV58) and dual-infection HPV39/68 showed a declining trend, especially in the 46-60 years age group. The trends need to be observed continuously.

Correlations between Clinic Preferences and Alcohol Use Disorder: an Alcohol Cohort Study in Northern Taiwan in 2022

IntroductionChronic alcoholism can result in severe liver conditions such as fatty liver disease and cirrhosis, potentially leading to life-threatening complications and premature death.ObjectivesThis study investigated the age-sex distribution of patients with alcohol addiction and aimed to identify differences in clinic department preferences based on their principal and additional diagnoses in Taiwan, in 2022.MethodsWe conducted a comprehensive analysis of the diagnostic patterns of 334 patients with alcohol addiction from the Taoyuan General Hospital, Ministry of Health and Welfare.ResultsFigure 1 depicts patient demographics, highlighting 297 male and 37 female patients with alcohol-related disorders. Males aged 41-60 years were particularly dominant, as shown in Figure 2. Principal diagnoses, including alcoholic liver disease and acute pancreatitis, are detailed in Table 1. Additional diagnoses, such as chronic pancreatitis and esophageal varices, are presented in Table 2. For departmental preferences, Table 3 reveals the Gastrointestinal (GI) department as the top choice, followed by Kidney, Neurological, and Cardiovascular/Chest.Table 1.Top 5 Principal Diagnoses of Alcohol Addiction Patients.ICD-10-CMPrinciple diagnosisTimesRankK70Alcoholic liver disease431K85Acute pancreatitis272F10Alcohol related disorders183A41Other sepsis144K86Other chronic pancreatits115Table 2.Top 5 Additional Diagnoses of Alcohol Addiction Patients. ICD-10-CMAdditional diagnosisTimesRankF10Alcohol related disorders401K86Other chronic pancreatits182I85Esophageal varices163K70Other sepsis16E87Other disorders of fluid, electrolyte and acid-base balance154R65Symptoms and signs specifically associated with systemic inflammation and infection105Table 3.Top 5 Departments for Alcoholism Patient Presentation.DepartmentTimesRankGastrointestinal1621Kidney392Neurological253Cardiovascular Chest154Image:Image 2:Conclusions The study revealed that patients with alcohol addiction often delay seeking psychiatric help instead of presenting for medical care only after liver or gastrointestinal complications occur. This underscores the crucial need for better health education regarding the relationship between alcohol addiction and liver disease. Prompt recognition and early intervention for substance addiction can significantly reduce these risks and improve patient outcomes.Disclosure of InterestNone Declared

임상실습을 경험한 간호대학생의 의사소통능력, 문제해결능력, 임상수행능력, 비판적사고능력과 인간중심돌봄역량의 관계

Purpose: This study is a descriptive research study conducted to identify the relationship and influencing factors between communication competence, critical thinking competence, problem-solving ability, clinical performance competence and person-centered care competence of nursing students who have experienced clinical practice.&#x0D; Method: The subjects of this study were students enrolled in the nursing departments of two four-year universities located in 2 areas, and the 3rd and 4th graders who had more than 1 semester of clinical practice were conveniently extracted. Data were collected from September to December 2023. Data analysis was analyzed using the SPSS 21.0 program by t-test, one-way ANOVA, and Pearson's correlation coefficient.&#x0D; Results: As a result of the study, There were significant differences in communication competence in gender (p=.029), age (p=.039), grade (p=.030), satisfaction with nursing department (p&lt;.001), satisfaction with clinical practice (p&lt;.001), number of participation in personality-related education (p=.012), volunteer time (p=.011), the need for person-centered care at the nursing site (p&lt;.001), and the degree of interpersonal relationships (p&lt;.001). In terms of problem-solving skill, there were significant differences in grade (p=.011), religion (p&lt;.001), clinical practice satisfaction (p=.003), volunteer time (p=.003), clinical practice experience department (p=.041), the need for person-centered care at the nursing site (p&lt;.001), and interpersonal relations (p&lt;.001). In terms of clinical performance competence, there were significant differences in religion (p=.005), satisfaction with clinical practice (p&lt;.005), number of participation in personality-related education (p=.030), volunteer time (p=.002), clinical practice experience department (p=.005), the need for person-centered care at the nursing site (p&lt;.001), and interpersonal relationship (p&lt;.001). In terms of person-centered care competence of nursing, there were significant differences in gender (p=.008), religion (p=.002), satisfaction with clinical practice (p&lt;.001), volunteer time (p=.002), the need for person-centered care at the nursing site (p&lt;.001), and interpersonal relationship (p&lt;.001). Subject's communication competence averaged 4.04 out of 5, problem-solving skill was 3.87 points, clinical performance competence was 4.09, critical thinking competence was 3.87 points, and person-centered care competence was 4.21 points. Person-centered care competence was found to have a significant positive correlation with communication competence (r=.511, p&lt;.001), problem-solving skill (r=.601, p&lt;.001), clinical performance competence (r=.813, p&lt;.001), and critical thinking competence (r=.423, p&lt;.001). The more time nursing students spent volunteering, the better their interpersonal relationships, and the more they felt the need for person-centered care at the nursing site, the higher their person-centered care competence.&#x0D; Conclusion: Based on the results of this study, it is necessary to induce nursing students to use a lot of volunteer programs in order to increase their person-centered care competence, and it is necessary to develop and actively guide convergence extracurricular activities linked to subjects. In the clinical field, it is necessary to develop and apply an effective clinical practice program based on a person-centered nursing model in which students analyze subjects and solve problems through the reasoning process of critical thinking.

Characteristics of Factors Influencing the Occurrence of Cleft Lip and/or Palate: A Case Analysis and Literature Review.

Cleft lip with or without cleft palate (CL/P) stands as the most common congenital facial anomaly, stemming from multifactorial causes. Our study aimed to ascertain the prevalence and characteristics of cleft palates, identify associated risk factors to inform prevention and prenatal detection for early intervention, and assess postoperative rehabilitation protocols for cleft palates. This study employs a retrospective descriptive and clinical approach. The study includes 103 children with cleft palates treated at the Department of Head and Neck Surgery Clinic for Children and Young Adults, Department of Clinical Pediatrics, University of Warmia and Mazury. We conducted a thorough evaluation of records, considering variables such as sex, cleft type, maternal occupation, parental education, and family history of clefts. Data analysis was carried out using R software version GPL-3 and ordinal logistic regression analyses. Notably, children born to mothers who experienced significant stress during pregnancy exhibited a 9.4-fold increase in the odds of having bilateral cleft palates. Conversely, no substantial evidence was found to support the influence of the child's sex, birth order, body mass, maternal exposure to workplace toxins, infections, or drug toxicity on the dependent variable. Our findings suggest that children with parents who have a history of clefts and those with less educated mothers are more likely to develop bilateral cleft palates. Additionally, children born to mothers experiencing stress during pregnancy face an increased risk of bilateral cleft palates. It is important to note that there is a paucity of literature on rehabilitation following various cleft palate surgical techniques in children.

Family case of cystic fibrosis

Cystic fibrosis is an autosomal recessively inherited monogenic disease caused by a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, located on the long arm of chromosome 7 (7q31.2). This mutation results in a disruption in the transport of sodium and chloride ions between intercellular fluid and the epithelial cells of the excretory ducts of the exocrine glands. This paper presents the description of a family case of cystic fibrosis involving two patients who have been under observation since birth and are sisters (patient A – 4 years 10 months, patient B – 1 year 11 months). In both patients, neonatal screening and sequential diagnosis of cystic fibrosis identified the DF508/CFTRdele2.3(21kb) mutation, the most prevalent among the Caucasian population in the Russian Federation. The primary concern in managing both patients is the correction of nutritional status and minimization of exacerbations of chronic bronchopulmonary inflammation. To determine the management strategy for these patients, a consultation was held with Dr. E.I. Kondratyeva, a leading cystic fibrosis expert and professor at the MGSC Institute, who serves as the head of the Scientific and Clinical Department of Cystic Fibrosis and the Department of Genetics of Respiratory System Diseases, an expert of the European Society for Cystic Fibrosis Committee on Diagnostics and Registry, and Deputy Chief for Scientific Work of Research Clinical Institute of Childhood of the Ministry of Health of the Moscow Region. The peculiarity of the presented clinical cases lies in the fact that within one family, with an interval of 3 years, two girls with severe disease were born. Early diagnosis was performed for both, which has allowed for the slowing down of the pathology's progression.

Abstract 4806: The potential impact of a Von Hippel-Lindau clinical care center for patients at the University of Illinois Chicago

Abstract Introduction: Von Hippel-Lindau (VHL) is an inherited autosomal dominant cancer syndrome causing early-onset tumors in various organs. It poses high risks of renal cell carcinoma, hemangioblastomas, pheochromocytomas, and paragangliomas among others. VHL can be clinically diagnosed based on the Danish, international, or Dutch guidelines, or through molecular diagnosis by identifying a pathogenic variant in the VHL gene. There is now an FDA-approved HIF-2 alpha inhibitor that is effective for the treatment of VHL-related manifestations, and the identification of eligible patients is paramount to receive this benefit. In addition, the screening recommendations for VHL are extensive and result in significant burden on patients. We suspect that VHL is under-diagnosed in the clinical setting, and we further hypothesize that this burden may contribute to care gaps and disparities in access to VHL-related care. Methods: This is a single-institution, retrospective study conducted at the University of Illinois Health and Hospitals System (UIH). We assessed the prevalence of patients with VHL-related tumors by examining ICD diagnosis codes from 2010 to 2023. Additionally, we analyzed the subset of these patients who underwent germ-line genetic testing. Furthermore, we examined our cohort of VHL patients more closely to explore the burden of VHL-related care. We examined the time to germ-line genetic and cascade testing from first clinical touchpoint at UIH, as well as the total number of clinical departments accessed at UIH. Demographics, clinical characteristics, germ-line genetic testing results, and information on clinical visits were also collected from those with a molecular or clinical diagnosis of VHL. Results: We found 9,875 patients with at least one VHL-associated tumor. Among them, 1,379 had two or more VHL-associated tumors, with &amp;lt;2% undergoing germline genetic testing. We identified 10 individuals diagnosed with VHL. Of the ten patients, 30% were black, 30% were white, and 40% self-identified as other. Age of onset for VHL-related screening ranged from 10 to 37 years. All patients diagnosed with VHL underwent germ-line genetic testing, with 60% opting for cascade testing of at-risk family members. Patient care was fragmented, with on average, each VHL patient seeking care from five different UIC clinical departments (range 1-11) and receiving care from multiple separate institutions (range 1-4). Conclusion: Our data revealed that most patients with VHL-associated tumors did not receive genetic testing, demonstrating a potential missed opportunity for early diagnosis and interventions to improve outcomes for VHL-related disease. Furthermore, our data highlights the clinical burden of VHL, and supports the potential impact of a coordinated care program for these patients. Citation Format: Neha Hippalgaonkar, Kirsten Drabek, Aseem Aseem, Tara Maga, Lara Balay, Vivian Pan, Pamela Ganschow, Karine Tawagi, Neha Awati, Natalie Reizine. The potential impact of a Von Hippel-Lindau clinical care center for patients at the University of Illinois Chicago [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4806.

USING OF THE MODELS IN PRACTICE-ORIENTED EDUCATION DURING LEARNING OF PEDIATRIC DENTISTRY

Teachers of clinical departments of establishments of higher medical education are faced with the problem of practical training of students, and many methods have been proposed for its improvement.&#x0D; The purpose of the study was to consider the models of practice-oriented education that can be used&#x0D; during the teaching of pediatric therapeutic dentistry.&#x0D; One Minute Preceptor model is used by the teacher during a 1-5-minute conversation with the student to guide diagnostic and treatment processes; initially a student examines a patient, then presents the clinical case, after which the teacher manages his behavioral reactions.&#x0D; SNAPPS model (Summarize + Narrow + Analyze + Probe + Plan + Select) describes 6 stages of the clinical training. The model includes analysis of the medical history and examination methods, choice of the diagnoses for differential diagnostic, proper differential diagnosis, questions to the teacher about uncertainties, discussion of patient’s treatment plan and questions and sources related to the clinical case for independent processing.&#x0D; Within the framework of pattern recognition and reproduction model (standard cases), student talks about the main problem that worries the patient and offers his diagnosis based on key symptoms during 30 seconds. Teacher personally examines patient, makes a diagnosis or discusses why it cannot be made with certainty, and evaluates the student’s actions.&#x0D; All described models of practice-oriented learning improve the expression of reasoning without much impact on the time spent for case presentation. Pattern recognition and reproduction model is especially useful in dentistry to recognize widespread clinical cases. One Minute Preceptor model, which involves the initiative and mentoring role of the teacher, fits well for beginners, while SNAPPS model, that focused on independent work of students, for strong students.

Pregnancy and delivery in an advanced cancer survivor with immune checkpoint inhibitor-induced type 1 diabetes: a case report

PurposeGiven the rarity and elderly onset of immune checkpoint inhibitor (ICI)-induced type 1 diabetes (ICI-T1DM), cases leading to delivery are rare.MethodTo our knowledge, this is the first case report of childbirth in a patient with ICI-T1DM after cancer survival. A 32-year-old woman was started on Nivolumab for metastatic parotid cancers one year after total parotidectomy.ResultThe patient developed ICI-T1DM after 43 cycles and started multiple daily insulin therapy and self-monitoring of blood glucose. Complete response was maintained for 2 years by nivolumab, and she finished nivolumab in 77 cycles to attempt pregnancy. During the follow-up period, she began using a sensor-augmented pump (SAP). She had undetectable serum and urinary C-peptide when she started SAP. Her HbA1c level decreased from 7.8 to 6.6% without increasing hypoglycemia in one year. The patient remained in complete response after ICI discontinuation, and embryo transfer was initiated. Pregnancy was confirmed after a second embryo transfer (21 months after ICI discontinuation). At 36 weeks and 6 days, an emergency cesarean section was performed due to the onset of preeclampsia. The baby had hypospadias and bifid scrotum but no other complications or neonatal intensive care unit admission.ConclusionBecause ICI discontinuation and ICI-T1DM carry risks for the patient and child, the decision regarding pregnancy warrants careful consideration. Diabetologists should collaborate with patients and other clinical departments to develop a treatment plan for childbirth.

ECMS-NET:A multi-task model for early endometrial cancer MRI sequences classification and segmentation of key tumor structures

Endometrial cancer, one of the three major malignant tumors of the female genitalia, has seen an increase in incidence in recent years. The 5-year survival rate for early endometrial cancer is approximately 80% to 90%. In clinical practice, the accurate segmentation of endometrial cancer tumors is crucial for assessing the extent of hyperplasia and guiding treatment decisions. Developing a deep learning (DL)-based tumor segmentation method for Magnetic Resonance Imaging (MRI) sequences in cases of Endometrial Cancer (EC) can significantly improve the accuracy and efficiency of this process. We proposed an multi-task framework: ECMS-Net. We established a classification model based on the Transformer algorithm to discern images containing tumors within the sequence and U2-Net segmentation model was trained to perform automated and precise segmentation of early endometrial cancer tumor regions. Our results show that we have firstly proposed a sequence classification method and achieved an accuracy of 0.985 and this is the best result of the study so far, followed by a tumor segmentation maxF1 value of 0.970, which highlights the excellent performance of our proposed method. The entire experimental process aligns closely with the demands of the clinical imaging department, promising to enhance the efficiency of medical professionals, alleviate workload stress, and better cater to the requirements of the medical field.

Differences in the treatment needs of patients with dementia with Lewy bodies and their caregivers and differences in their physicians’ awareness of those treatment needs according to the clinical department visited by the patients: a subanalysis of an observational survey study

BackgroundWe investigated whether the treatment needs of patients with dementia with Lewy bodies (DLB) and their caregivers, along with their attending physicians’ perception of those treatment needs, differ according to the clinical department visited by the patients.MethodsThis was a subanalysis of a multicenter, cross-sectional, observational survey study. Data from the main study were classified according to the clinical department visited by the patient: psychiatric group (P-group), geriatric internal medicine group (G-group), and neurology group (N-group). The treatment needs of patients and caregivers were defined as “the symptom that causes them the most distress”, and the frequency of each answer was tabulated.ResultsThis subanalysis included 134, 65, and 49 patient–caregiver pairs in the P-, G-, and N-groups, respectively. Statistically significant differences in patient background characteristics such as patient age; initial symptom domains; use of cholinesterase inhibitors, levodopa, antipsychotics, and Yokukansan; and total scores of the Mini-Mental State Examination, Neuropsychiatric Inventory-12, and Movement Disorder Society-Unified Parkinson’s Disease Rating Scale Parts II and III were shown among the three subgroups. While there were no differences in patients’ treatment needs among the subgroups, residual analysis showed that in the N-group, parkinsonism was more of a problem than other symptom domains (p = 0.001). There were significant differences in caregivers’ treatment needs among the three subgroups (p < 0.001). The patient–physician concordance rates for the symptom domains that caused patients the most distress were: P-group, 42.9% (kappa coefficient [κ] = 0.264); G-group, 33.3% (κ = 0.135), and N-group, 67.6% (κ = 0.484). The caregiver–physician concordance rates for the symptom domains that caused the caregivers the most distress were: P-group, 54.8% (κ = 0.351), G-group, 50.0% (κ = 0.244), and N-group, 47.4% (κ = 0.170).ConclusionThis subanalysis revealed differences in the treatment needs of patients with DLB and their caregivers according to the clinical department they attended. There might be a lack of awareness of those treatment needs by the attending physicians, regardless of their specialty.Trial registrationUMIN Clinical Trials Registry UMIN000041844.

New Genetic Markers of Skin T-Cell Lymphoma Treatment.

Cutaneous T-cell lymphomas (CTCL) can be described as chronic skin inflammation lesions with the content of malignant T cells and they are considered to be T-cell-mediated skin diseases. CD147 is recognized as a 58-kDa cell surface glycoprotein of the immunoglobulin superfamily; it can induce the synthesis of MMPs (matrix metalloproteinases) on the surface of tumor cells where it was originally identified. It can also function in adjacent tumor fibroblasts using CD147-CD147 interactions. The polymorphism rs8259 T/A is situated in the untranslated region (3'UTR) of the CD147 gene. HLA DRB1*1501 takes part in the process of presentation and recognition of different antigens to T cells. It can be expressed by antigen-presenting cells-macrophages, dendritic cells, and B cells. The aim of the study is to test genotype-phenotype associations of both polymorphisms including therapy in a large cohort of CTCL patients. A final total of 104 CTCL patients were enrolled in the study. For the first remission at the clinic department, they were treated by means of local skin-directed therapy, phototherapy, and systemic therapy. Genomic DNA was isolated from peripheral blood leukocytes. A standard technique using proteinase K was applied. The polymorphisms rs8259 T/A (CD147 gene) and rs3135388 (HLA DRB1*1501) were detected through standard PCR-restriction fragment length polymorphism methods. The severity of the disease (patients with parapsoriasis, stages IA and IB, vs patients with stages IIB, IIIA, and IIIB) was associated with the CD147 genotype: the AA variant was 3.38 times more frequent in more severe cases, which reflects the decision on systemic therapy (p = 0.02, specificity 0.965). The AA genotype in the CD147 polymorphism was 12 times more frequent in patients who underwent systemic therapy of CTCL compared to those not treated with this therapy (p = 0.009, specificity 0.976). The same genotype was also associated with radiotherapy-it was observed 14 times more frequently in patients treated with radiotherapy (p = 0.009, specificity 0.959). In patients treated with interferon α therapy, the AA genotype was observed to be 5.85 times more frequent compared to the patients not treated with interferon therapy (p = 0.03, specificity 0.963). The HLA DRB1*1501 polymorphism was associated with local skin-directed therapy of CTCL. The CC genotype of the polymorphism was observed to be 3.57 times more frequent in patients treated with local therapy (p = 0.008, specificity 0.948). When both polymorphisms had been calculated together, even better results were obtained: the AACC double genotype was 11 times more frequent in patients with severe CTCL (p = 0.009, specificity 0.977). The TACT double genotype was associated with local skin-directed therapy (0.09 times lower frequency, p = 0.007, sensitivity 0.982). The AACC genotype was 8.9 times more frequent in patients treated by means of systemic therapy (p = 0.02, specificity 0.976) and as many as 18.8 times more frequent in patients treated with radiotherapy (p = 0.005, specificity 0.969). Thus, the AACC double genotype of CD147 and DRB1*1501 polymorphisms seems to be a clinically highly specific marker of severity, systemic therapy and radiotherapy of patients with T-cell lymphoma. Although genotyping results were not known during the treatment decision and could not modify it, the clinical decision on severity and therapy reflected some aspects of the genetic background of this complicated T-cell-associated disease very well.