Clinical Setup Research Articles

Influence of Diabetes Mellitus and Nutritional Parameters on Clinical and Functional Aspects and Quality of Life in Patients Hospitalized Due to Exacerbation of Chronic Obstructive Pulmonary Disease.

Patients with chronic obstructive pulmonary disease (COPD) may experience exacerbations. During severe exacerbations, nutritional and endocrinological comorbidities can play an important role in the clinical and functional aspects of these patients. The aim of this study was to analyse the influence of the presence of diabetes mellitus (DM) and nutritional parameters on the deterioration of symptoms and quality of life during a severe exacerbation in patients with COPD. An observational study was conducted on COPD patients admitted due to an exacerbation. The COPD Assessment Test (CAT) questionnaire was administered, and clinical and functional parameters were compared based on the presence of nutritional and endocrinological alterations. A total of 50 patients were included, of whom 30 (60%) were male. The mean age was 70.5 years (standard deviation (SD) 9.6). The median CAT score during exacerbation was 25 (interquartile range (IQR) 17.5-30), and the baseline score was 13.5 (IQR 7-19), which represented a statistically significant difference (p < 0.001). Patients with iron deficiencies had a lower total CAT score (p = 0.041), specifically for items related to daily activity (p = 0.009) and energy (p = 0.007). Diabetic patients exhibited a greater decline in pulmonary function during exacerbation (p = 0.016), while patients with high thyroid-stimulating hormone (TSH) levels had a shorter hospital stay (p = 0.016). For COPD patients admitted due to an exacerbation, the metabolic assessment is useful and relevant in the clinical set-up, as endocrinological comorbidities negatively affect clinical and functional aspects of these patients.

Assessment of the presence of Acinetobacter spp. resistant to β-lactams in commercial ready-to-eat salad samples

Acinetobacter baumannii is a well-known nosocomial infection causing agent. However, other Acinetobacter spp. have also been implicated in cases of human infection. Additionally, these bacteria are known for the development of antibiotic resistance thus making the treatment of the infections they cause, challenging. Due to their relevance in clinical setups less attention has been paid to their presence in foods, and its relation with infection/dissemination routes. In the current study commercial Ready-To-Eat (RTE) salads were analyzed seeking for antibiotic resistant Acinetobacter spp. A preliminary screening allowed us to recover Gram-negative bacteria resistant to β – lactams using cefotaxime, third generation cephalosporins, as the selective agent, and this was followed by identification with CHROMagar™ Acinetobacter and 16S rDNA sequencing. Finally, the isolates identified as Acinetobacter spp. were reanalyzed by PCR to determine the presence of nine potential Extended Spectrum β Lactamases (ESBL). Two commercial RTE salad brands were included in the study (2 batches per brand and 8 samples of each batch making a total of 32 independent samples), and compared against an organic lettuce. High concentrations of β – lactam, resistant bacteria were found in all the samples tested (5 log CFU/g). Additionally, 209 isolates were phenotypically characterized on CHROMagar Acinetobacter. Finally, PCR analysis identified the presence of different ESBL genes, being positive for blaACC, blaSHV, blaDHA and blaVEB; out of these, blaACC was the most prevalent. None of the isolates screened were positive for more than one gene. To conclude, it is important to highlight the fact that pathogenic species within the genus Acinetobacter spp., other than A. baumannii, have been identified bearing resistance genes not typically associated to these microorganisms highlight the importance of continuous surveillance.

Bilateral absence of musculocutaneous nerve in a cadaveric specimen

Knowledge of the normal course and distribution of the nerves of the brachial plexus in the axilla and arm, and of its possible variations, is essential for the proper management of upper limb nerve injuries, which is a relatively common occurrence in the clinical setup. Bilateral absence of the musculocutaneous nerve was observed during routine dissection of a female cadaver. The muscles of the flexor compartment of the arm were supplied by the median nerve bilaterally.The present case report should elucidate this variation and should aid in applying this knowledge in the clinical setup.

Factors Impacting Participation of Small and Medium Enterprises in Construction on Public Procurement in South Africa

Introduction: Since Autorefractors nowadays have become mainstream and available in almost all clinical setups Autorefractors to make measurements swiftly. So in such a situation , it is necessary to compare the results of different refraction measurement devices including Autorefractors and retinoscopy with subjective corrections in Myopia and Hypermetropia. Methods : This is a descriptive study done among 100 patients visiting Ophthalmology OPD with Myopia and Hypermetropia in Saveetha medical college selected by convenience Sampling . The data collect ed will be tabulated and analyzed using SPSS. Results: Patients were divided into two age groups to find out age wise distribution of type of refractive errors and comparing the results from the subjective examination and results given by the Autorefractive meter it is clearly from this study that the difference between two methods was almost negligible and that Autorefractors are also a reliable method of measurement in a large clinical setup. But, on the other hand, manual retinoscopy still prove to be far better and efficacious technique yielding accurate results when it is used to check for refractive errors in individuals. Conclusion: In this study, we conclude that autorefractors are also reliable and can also be used to estimate refractive errors in a clinical setup, even though manual retinoscopy remains the most accurate and efficacious method..

Federated Deep Learning for Wireless Capsule Endoscopy Analysis: Enabling Collaboration Across Multiple Data Centers for Robust Learning of Diverse Pathologies

Wireless capsule endoscopy (WCE) is a revolutionary diagnostic method for small bowel pathology. The manual perusal of the resulting lengthy and redundant videos is cumbersome. Automated analysis of WCE video frames is an intricate data modeling task because of the diverse representations of anomalies caused by inappropriate capture conditions. Deep neural networks require training to learn diverse pathological manifestations utilizing heterogeneous data collected from multiple institutions. However, the accessibility of WCE data poses privacy concerns for multiple centers. The efficient learning of heterogeneous data distributed over multiple institutions in a privacy-preserving fashion has become a challenge hampering the adoption of AI-based diagnoses in clinical practice. Prior studies have contrived extensive data augmentation and the generation of synthetic images from the same center. However, models trained at one center are at risk of a lack of generalization for a global deployment. Federated learning (FL) is a novel paradigm in which models learn from distributed data and share knowledge without accessing the data themselves. This study proposes an FL framework for multiple anomaly classifications of WCE frames, elaborating on the potential of collaborative learning from multiple data centers on the edge. Our empirical results prove that the proposed decentralized approach can learn the generalized features of WCE frames. Validating heterogeneous test sets revealed a 10–12% improvement in performance for decentralized models based on FL compared to the best-case performance of centralized models, demonstrating the potential of the federated framework to support multiple anomaly classification of WCE frames while preserving data privacy across various clinical setups.

Evaluation of a head rest prototype for rotational corrections in three degrees of freedom.

Cranial stereotactic irradiations require accurate reproduction of the planning CT patient position at the time of treatment, including removal of rotational offsets. A device prototype was evaluated for potential clinical use to correct rotational positional offsets in image-guided radiotherapy workflow. Analysis was carried out with a prototype device "RPS head" by gKteso GmbH, rotatable up to 4° in three dimensions by hand wheels. A software tool accounts for the nonrectangular rotation axes and also indicates translational motions to be performed with the standard couch to correct the initial offset and translational shifts introduced by the rotational motion. The accuracy of angular corrections and positioning of an Alderson RANDO head phantom using the prototype device was evaluated for nine treatment plans for cranial targets. Corrections were obtained from cone beam computed tomography (CBCT) imaging. The phantom position was adjusted and the final position was then verified by another CBCT. The long-term stability of the prototype device was evaluated. Attenuation by the device along its three main axes was assessed. A planning study was performed to evaluate if regions of high-density material can be avoided during plan generation. The device enabled the accurate correction of rotational offsets in a clinical setup with a mean residual angular difference of (0.0±0.1)° and a maximum deviation of 0.2°. Translational offsets were less than 1mm. The device was stable over a period of 20 min, not changing the head support plate position by more than (0.7±0.6) mm. The device contains high-density material in the adjustment mechanism and slightly higher density in the support structures. These can be avoided during planning generation maintaining comparable plan quality. The head positioning device can be used to correct rotational offsets in a clinical setting.

Potential objective measures to assess the presence of hidden hearing loss in young adults with long-term exposure to loud music

Several objective measures for identifying individuals with “hidden hearing loss” (HHL), have been proposed based on cochlear synaptopathy and the resulting central changes in neural gain. While the loss of high-threshold auditory nerve fibres may result in weaker middle-ear muscle reflexes (MEMR) in HHL sufferers, binaural processing is likely disproportionately and deleteriously impacted by central gain changes in the same group of individuals. In this study, two groups of young adults (&amp;lt;35 years old) with normal audiometric thresholds were recruited, one of which consisted of students from a music conservatory who co-reported tinnitus and listening-in-noise difficulties, likely as a result of HHL. Participants completed a set of questionnaires as well as undergoing both multi-frequency MEMR testing (four ipsilateral elicitors), and an electrophysiological measure of IPD processing known as the ‘Interaural Phase Modulation-Following-Response(“IPM-FR”) (evoked using two IPD transitions using a clinical setup). Results show that the ‘HHL/Tinnitus’ group presents lower scores on the Speech, Spatial and Qualities of Hearing Scale questionnaire, less steep MEMR growth functions, and smaller IPM-FRs compared to the ‘control’ group. This suggests that both objective measures could be clinically useful to identify populations with HHL.

A Wireless and Wearable Body-Pressure-Monitoring System for the Prevention of Pressure-Induced Skin Injuries.

This article presents a wireless and wearable body-pressure-monitoring system for the on-site, real-time prevention of pressure injuries for immobilized patients. For the prevention of pressure-induced skin injuries, a wearable pressure sensor system is designed to monitor the pressure at multiple sites on the skin and to alert the danger of prolonged application of pressure on the skin with a pressure-time integral (PTI) algorithm. The wearable sensor unit is developed using a pressure sensor based on a liquid metal microchannel and integrated with a flexible printed circuit board that includes a thermistor-type temperature sensor. The wearable sensor unit array is connected to the readout system board for the transmission of measured signals to a mobile device or PC via Bluetooth communication. We evaluate the pressure-sensing performances of the sensor unit and the feasibility of the wireless and wearable body-pressure-monitoring system through an indoor test and a preliminary clinical test at the hospital. It is shown that the presented pressure sensor has high-quality performance with excellent sensitivity to detect both high and low pressure. The proposed system measures the pressure at bony sites on the skin for about six hours continuously without any disconnection or failure, and the PTI-based alarming system operates successfully in the clinical setup. The system measures the pressure applied to the patient and provides meaningful information from the measured data for early diagnosis and prevention of bedsores to doctors, nurses, and healthcare workers.

Multi-camera optical tracking and fringe pattern analysis for eye surface profilometry in ocular proton therapy

Background and purposeAn optical tracking system for high-precision measurement of eye position and orientation during proton irradiation of intraocular tumors was designed. The system performed three-dimensional (3D) topography of the anterior eye segment using fringe pattern analysis based on Fourier Transform Method (FTM). Materials and methodsThe system consisted of four optical cameras and two projectors. The design and modifications to the FTM pipeline were optimized for the realization of a reliable measurement system. Of note, phase-to-physical coordinate mapping was achieved through the combination of stereo triangulation and fringe pattern analysis. A comprehensive pre-clinical validation was carried out. Then, the system was set to acquire the eye surface of patients undergoing proton therapy. Topographies of the eye were compared to manual contouring on MRI. ResultsPre-clinical results demonstrated that 3D topography could achieve sub-millimetric accuracy (median:0.58 mm) and precision (RMSE:0.61 mm) in the clinical setup. The absolute median discrepancy between MRI and FTM-based anterior eye segment surface reconstruction was 0.43 mm (IQR:0.65 mm) ConclusionsThe system complied with the requirement of precision and accuracy for image guidance in ocular proton therapy radiation and is expected to be clinically tested soon to evaluate its performance against the current standard.

Clinical Outcomes and Setup Reproducibility in Patients Receiving Synchronous Bilateral Breast Radiation in the Prone Position

Standardized radiation therapy (RT) positioning and planning are vital to treat both breasts without excess toxicity in patients with synchronous bilateral breast cancer (SBBC). We studied clinical outcomes and setup reproducibility in patients with SBBC treated in the prone position. This is a retrospective study of patients receiving RT for SBBC from 2012-2022 treated in the prone position. Patient demographics, RT dose and field, toxicity, and outcomes were collected. RT planning used gantry and table shifts to avoid entrance/exit through contralateral breast and organs at risk. RT delivery was standardized, with left breast treated first. After 2014, radiographic films were placed during the first 5 fractions to evaluate field overlap. Consistent overlap required re-simulation or re-planning. Positional shifts during setup were collected for patients receiving bilateral whole breast irradiation (WBI) and bilateral partial breast irradiation (PBI). A total of 45 patients were treated for SBBC. Median age was 67 years. Median follow-up was 28 months. 35 patients were treated with WBI (1 with low axilla on one side) and 5 with PBI. 5 patients were treated with WBI in one breast and PBI in the other. The most common whole breast dose was 40.5Gy, with a simultaneous integrated boost to the lumpectomy cavity to 48Gy. PBI patients were treated with 30Gy (n = 4) or 40.05Gy (n = 1). 8 patients (17.7%) had acute grade 2 and 1 patient (2%) had acute grade 3 dermatitis. This patient was treated WBI bilaterally and was known to have overlap on GaF. Physician and patient accepted higher toxicity for adequate coverage of bilateral upper inner quadrant tumors. Patients with grade > = 2 dermatitis had bilateral WBI (+/- low axilla) except 1. 6 patients had acute dermatitis in the sternal area (5 were WBI and 1 PBI). Only 2 of these patients had overlap on GaF. Of 20 patients with late toxicity follow-up (> 6 months), 5 (25%) had late grade 1-2 dermatitis. 4 (20%) were treated with WBI (+/-low axilla). 1 patient had both a local and distant recurrence. For setup and treatment delivery, couch shifts recorded for patients treated with bilateral WBI (n = 33) and bilateral PBI (n = 5) were minimal. Mean shifts in nearly all dimensions were limited to sub-centimeter or sub-degree changes, with 2D and cone beam CT (CBCT) imaging. Analysis of GaF showed that only 3 patients (10%) had field overlap. A new plan was created for 1 patient to increase the gap between fields, and for the others, patient and physician accepted overlap for adequate coverage. To our knowledge, this is the first study examining clinical outcomes and setup reproducibility in patients treated with SBBC in the prone position. This study indicates the feasibility of prone bilateral breast treatment with minimal shifts and overlap on daily treatments. However, we do see a higher number of acute dermatitis in patients treated with bilateral WBI (vs. PBI) and that overlap was not seen on GaF in all patients who developed sternal dermatitis.

Enhancing Clinical Accuracy in DIBH Pattern Detection with a Combined Ultrasonic and IR Sensor System

This study aimed to develop a DIBH monitoring system using IR (Infrared- VL6180X Time of Flight) distance sensors and a microcontroller, and to demonstrate its functionality and performance in various irregular free and DIBH breathings from the left breast and lung patients. A total of ten patients who performed DIBH breathing for treatment planning and optimized treatment delivery were randomly selected for the study. The breathing motion of the system was tested using an RPM (Real-Time Positioning Management) phantom. The IR sensors were interfaced with an Arduino microcontroller, and a body phantom was used to mimic the DIBH pattern on a CT scan. The detector holder was mounted perpendicularly between the xiphoid and umbilicus, with the ability to compensate for various patient body habitus and adapt to clinical setups. The plastic devices were 3D printed, and the sensors were mounted approximately 100mm apart to receive directed echo signals and prevent unwanted signals from scattering. The IR sensor DIBH system was able to detect and record the patient's breathing pattern in real-time. The IR sensor showed better visualization of breathing rhythm with fewer fluctuations and reduced noise than the previous ultrasonic sensor system. The breathing amplitude and duration for the patients were compared to our treatment planning of Varian Eclipse and verified in TrueBeam's Breath-Hold Gating mode. The amplitude and duration from the primary study were measured to ±5mm, including 3mm sensor noise level and ±1.5 second. The IR sensor DIBH system demonstrated better performance compared to the ultrasonic sensor, with a better visualization of breathing rhythm and reduced fluctuations and noise. It provided a clinically acceptable DIBH pattern for monitoring chest and abdominal motion in patients with irregular breathing. The findings of this study have the potential to enhance clinical accuracy in radiation therapy treatment planning and delivery for patients undergoing DIBH.

Children’s Attitude and Preferences of Paediatric Dentist’s Attire and Dental Clinic Set up in Paediatric Dental Practice

Background: The biggest issue for any paediatric dentist, despite the many advancements in the field of paediatric dentistry, is to reduce patient anxiety associated with dental visits and encourage them to accept the necessary care. In order to establish a good relationship with the child, the dentist's presentation is crucial.&#x0D; Aim: To assess the children’s perception and preference towards the dentist’s appearance, dental clinic set-up.&#x0D; Materials and Methods: A questionnaire designed to evaluate children’s attitudes and preferences towards dentists was distributed in public schools and was completed by 1012 children (459 males, 553 females) aged between 7–13 years. Data collected was entered into a computer and analyzed using SPSS software. Descriptive and inferential analysis was carried out.&#x0D; Results: For about 526 children (52%) it was their first visit while 486 children (48%) had been to the dentist before. Children’s preferred attire for receptionists was casual clothes (50.2%) while for the dentist, most of them (42.7%) preferred scrubs. Most (69.1%) of the children were not scared with the use of PPE kit.&#x0D; Conclusion: The findings of this study can assist dentists in determining what to wear when working with kids to lessen their anxiety and enhance healthcare delivery.

Factors Influencing the Emergence of Antimicrobial Drug Resistance in Clinical Dental Practice

OBJECTIVE: To investigate the perception of general dentists regarding the over-prescription of antibiotics leading to Antimicrobial drug resistance in their clinical practice. METHODOLOGY: A cross-sectional study encompassing a personalized Likert scale questionnaire on factors influencing anti-microbial resistance in dental general practices was conducted on 196 practitioners. The questionnaire inquired about different factors which tend to affect the over-prescription of antibiotics and influence anti-microbial resistance. It was piloted on 30 participants before dissemination. RESULTS: Factors showing the highest level of agreement were "lack of patient awareness regarding use of antibiotics" (96.9%), "over-the-counter availability" (95.4%), and self-medication" (95.4%). General dental practitioners were overprescribing in their clinical setup due to improper guidelines (24.4%), for their patient's satisfaction (21.2%), and lack of knowledge (19.2%).33.5% of them stated that patients reporting to them were self-medicating and 27.2% found that their patients had a lack of awareness. CONCLUSIONS: This study concluded that all the factors were responsible for the Antimicrobial Drug Resistance phenomenon in clinical dental practice. However, the majority of the dentists were over-prescribing antibiotics due to improper guidelines, lack of knowledge, and for the patient's satisfaction. KEYWORDS: Antimicrobial Drug Resistance; Awareness; Antibiotics; Dental General Practices; Over-the-Counter Drugs.

Neutrophil-lymphocyte ratio among preeclampsia patients in India – A systematic review and meta-analysis

Preeclampsia is one of the major causes of morbidity and mortality in pregnant females in India. Early detection of preeclampsia can be of clinical utility. Neutrophil Lymphocyte Ratio (NLR) is a simple hepatological biomarker that has been used for diagnosis of preeclampsia. With this perspective in mind, the present meta-analysis was planned to evaluate NLR among preeclampsia in the Indian setting. Databases systematically searched were PubMed, MEDLINE, and Google Scholar were systematically searched till July 2023. The studies selected were all Indian published articles NLR evaluated in females of age ≥18 years and &lt; 40 years with preeclampsia and normal health pregnant females. Data extraction was guided by a predetermined checklist. Using RevMan 5 software, the mean and standard deviation were evaluated and analyzed. The initial search yielded 103 records of which 54 articles underwent evaluation, which identified 8 articles and a total 1381 study population. Of these, 534 cases of preeclampsia and 847 normal healthy pregnant females investigated the significance of evaluation of NLR for identification of preeclampsia. The meta-analysis showed an overall significant effect in favor of the importance of NLR investigation in predicting preeclampsia (SMR = 1.04, 95% CI 0.91–1.16, p &lt; 0.001). A significant Q statistic (p &lt; 0.001) indicated the presence of heterogeneity (I2 = 96%). This systematic review and meta-analysis proved that NLR can be employed for detecting early preeclampsia. Further prospective studies are needed to validate the potential applicability of NLR as a diagnostic marker in clinical setup.

Highlighting Speech and Language Characteristics in Angelman Syndrome: A Case Study

Introduction Angelman syndrome is a rare genetic neuro-developmental disorder diagnosed in one in 12000-20000 live births (NORD, 2018). Individuals with Angelman syndrome typically present with global developmental delay, learning difficulties, intellectual disability, seizures, ataxia, and a distinctive behavioral phenotype (Williams, 2010). One of the hallmark features of Angelman syndrome is severe speech and language impairment. Aim The study aimed to highlight speech and language characteristics in a case with Angelman syndrome. Methodology A case aged four- year Hindi speaking female child who reported with chief complaint of unable to speak clearly. Comprehensive Speech and language evaluation included administration of Receptive-Expressive Emergent Language Scales (REELS) (Kenneth R Bzoch), Communication Developmental Eclectic Approach to Language Learning (Com-DEALL developmental profile) (Pratibha Karanth, The Com-DEALL Trust), Speech intelligibility rating scale (AYJNIHH-7 point rating scale), Photo Articulation Test -Hindi (UNICEF project) , Com-DEALL Oro-motor Checklist (Pratibha Karanth, The Com-DEALL Trust) from a SLP perspective. The test scores were collected from the child’s behavior observation during clinical set-up and parental responses from daily life. Result and discussion: The preset study result indicated delayed developmental scores in receptive and expressive language, fine motor skills and cognition. Speech errors are noted in the domain of articulation. Post therapeutics findings indicated significant change in the developmental scores of all the domain. Conclusion: Research on assessment and intervention protocol of Angelman syndrome can be a stepping stone in terms of exploring information to provide adequate awareness and counseling of parents.

Ludwig’s Angina in a Parturient: A Case Report

Introduction: Ludwig’s angina is a rare but life threatening cellulitis of the soft tissue involving the floor of the mouth. Although Ludwig’s angina is a rare condition, it must be kept as a differential in the clinical setup when a patient presents with a neck swelling. Case Report: A 28 year old multigravida with 31 weeks 4 days gestational age presented with a swelling over the right side of the neck since 8 days. Patient also complains of toothache since past 5 days. The swelling was sudden in onset and progressed to attain the present size. It was associated with breathing difficulty since past 1 day. It was also associated with pain over the region. She had difficulty in eating solid food due the restriction in mouth opening due to the swelling. She was on liquid diet since past 7 days. She was diagnosed with hypothyroidism and was on Tab. Thyroxine 50 mcg. On physical examination, she is a moderately built and nourished female, vitals were stable. Examination of the head and neck revealed a diffuse swelling of size 10x10 cm over the right side of face extending from the right mastoid till the right oral commissure. Superiorly it extended up to 1 cm below right eye and inferiorly till the sternocleidomastoid origin. Total leucocyte count of 5.59 thousand/mm3. After admission, antibiotics were started. Incision and drainage was planned for the patient. Intraoperatively, patient was tracheostomized due to restricted mouth opening and difficult intubation. After induction, vertical incision was made and about 100 ml of pus was drained from the swelling on the right side. Post-operative period was uneventful. The patient was discharged on antibiotics and tracheostomy care. Conclusion: Ludwig’s angina should be kept in mind with this type of presentation. It can be life threatening if the treatment is improper, but intervention and subsequent correction can clear the symptoms completely.

Identification of appropriate tools to gauge brain functions in a clinical setup of a developing country: A pilot study.

To identify the most appropriate tools to measure functions of the brain that can be utilized in the clinical setups of developing countries. This qualitative research with a three-step approach was carried out from January 2022 to May 2022 at the Institute of Basic Medical Sciences, Khyber Medical University, Pakistan. Firstly, literature was searched to identify main brain faculties, then interviews were conducted with regional field experts to identify appropriate scales for the selected functions. Lastly a rubric was filled using interview transcripts and literature. The identified functions were vision, hearing, cognition, motor and emotions. Based on the rubric the best tests were visual fields (17/24), pure tone audiometry (16/24), Mini-Mental State Exam (20/24), Trait Emotional Intelligence Questionnaire (18/24), Romberg's test (19/24) and Manual Muscle Testing (18/24). The clinicians in developing countries can utilize the visual fields, pure tone audiometry, Mini-Mental State Exam, Trait Emotional Intelligence Questionnaire, Romberg's test and Manual Muscle Testing for most efficient, feasible, accurate and cost-effective measurement of brain functions.

OS12.6.A PRELIMINARY RESULTS FROM COPENHAGEN STUDY ON QUALITY OF LIFE IN YOUNG ADULTS WITH GLIOMAS

Abstract BACKGROUND Young patients diagnosed with gliomas face a life-changing disease, with a limited life length. They face challenges participating in daily social life and educational/work life. While the therapy for this patient group has the goal of prolonging life-length, little is known of their quality of life (QoL). A potential lower QoL due to diagnosis and the side effects of the treatment needs to be continuously assessed by health professionals. This study aimed to assess the QoL over time in young patients diagnosed with gliomas and to elucidate if these patients may need additional help and support. A second aim was to test the feasibility of repeated use of two validated online questionnaires to guide the clinicians working with this patient group. A third aim was to calculate a clinical cut-off score for the Functional Assessment of Cancer Treatment-Brain (FACT-Br). MATERIAL AND METHODS The design was a longitudinal, prospective study with a continuous inclusion during a 3-year period (2020-2023). Patients included were 18-35 years old suspected with a low-grade glioma at their first consultation in the clinic. The QoL was evaluated using FACT-Br and WHO-5 (WHO-5 Well-Being Index). The patients received the online questionnaires at pre-selected time points (pre-operation, 3-month, 6-month, 12-month) followed by a 3-month break and then repeated. The feasibility was evaluated in terms of compliance over time, defined as a completion of the first consecutive four questionnaires. A linear Generalized Estimating Equation (GEE) analysis was used to identify changes in FACT-Br total score. RESULTS A total of 33 patients were included in the study (Mdn=26y; 60% men; drop-out/exclusion n=3). At 3-month follow-up (n=30) four patients (13,3%) had a WHO-5 score below cut-off value (50/100 points) and five patients (16,7%) had a FACT-Br score below calculated cut-off (144/200 points) (M=160). The cut off-score for FACT-Br was calculated using a ROC-curve based on the WHO-5 cut-off value (n=30). The quality was deemed good (AUC=0,895). The Fact-Br total score showed no significant change over time (n=30). One subscale regarding functional wellbeing did show a significant change (p=0.021) (180 days change = 0,74; 95%-CI: 0,39-1,09). In March 2023 11 of 13 (84,6%) patients had a complete set of the first four consecutive questionnaires. CONCLUSION There was no significant change in the overall QoL (FACT-Br), but one subscale improved significantly. Five patients had a FACT-Br score below the calculated cut-off at 3 month-follow-up which might indicate a need for further support. Our study suggests that online QoL questionnaires are feasible in a clinical setup with this patient group. These results may give health professionals better insight in the need of support thus securing the best quality of life possible in young patients waiting for disease progression.

Integrating osteopathic manipulative treatment into prenatal care visits in a family medicine resident clinic.

Literature describing the integration of osteopathic manipulative treatment (OMT) during prenatal care visits in a resident clinic setting are scarce. Concise and readily accessible resources reviewing OMT in pregnancy are limited. We sought to integrate OMT into routine prenatal care appointments in a family medicine resident clinic setting and create a concise resource for those performing OMT in pregnancy. Musculoskeletal (MSK) pain in pregnancy is common. Specifically, low back pain (LBP) often accompanies pregnancy and may negatively impact sleep, the ability to work, and the ability to complete daily tasks. Treatment options for LBP in pregnancy are limited due to the concern for fetal or maternal harm associated with pharmacologic options or invasive procedures. OMT is a low-risk intervention that has been demonstrated to improve back pain and reduce deterioration of back-specific function in pregnancy. Over a 12-month period, one resident physician offered OMT during routine prenatal care visits in a family medicine resident clinic. During the study period, we identified barriers to integrating OMT along with solutions. Barriers to integrating OMT were noted in three areas: clinic setup and logistics, attending physician awareness of OMT in pregnancy, and treating physician knowledge of OMT in pregnancy. OMT provides pregnant patients withadditional treatment options and relief from MSK pain. This may reduce the number of patients with untreated MSKpain and benefit those who are unable to attend additional appointments outside of prenatal care due to financial or logistic barriers. OMT can be integrated intoroutine prenatal care visits in a training setting by providing complaint-specific OMT and determining how treatments can be performed for each unique examination room and table. Reviewing OMT in pregnancy with the attending physician prior to treatment, contraindications to OMT in pregnancy, and visualizing how treatments will be altered in pregnancy allows for smooth integration.

Comparison of Antibiofilm Activity of Pseudomonas aeruginosa Phages on Isolates from Wounds of Diabetic and Non-Diabetic Patients.

The persistence of organisms as biofilms and the increase in antimicrobial resistance has raised the need for alternative strategies. The study objective was to compare the ability of isolated bacteriophages to remove in vitro biofilms formed by Pseudomonas aeruginosa isolated from the environment with those isolated from diabetic and non-diabetic wounds. P. aeruginosa were isolated from clinical and environmental sites, and antimicrobial susceptibility was tested. Bacteriophages were isolated and characterized based on plaque morphology and host range. A reduction in the viable count assayed the lytic ability of candidate phages. The crystal violet method was used to determine the residual biofilm after 24 h of phage treatment on 72-h-old biofilms. The statistical significance of phage treatment was tested by one-way ANOVA. Of 35 clinical isolates, 17 showed resistance to 1 antibiotic at least, and 7 were multidrug resistant. Nineteen environmental isolates and 11 clinical isolates were drug-sensitive. Nine phages showed 91.2% host coverage, including multidrug-resistant isolates. Phages eradicated 85% of biofilms formed by environmental isolates compared to 58% of biofilms of diabetic isolates and 56% of biofilms of non-diabetic isolates. Clinical isolates are susceptible to phage infection in planktonic form. Biofilms of P. aeruginosa isolated from diabetic wounds and non-diabetic wounds resist removal by phages compared to biofilms formed by environmental isolates. All phages were efficient in dispersing PAO1 biofilms. However, there was a significant difference in their ability to disperse PAO1 biofilms across the different surfaces tested. Partial eradication of biofilm by phages can aid in complementing antibiotics that are unable to penetrate biofilms in a clinical set-up.