Medical History Collection Research Articles

Варіанти перебігу гастроезофагеальної рефлюксної хвороби залежно від виду рефлюксу

The purpose of the work was to study the clinical course of gastroesophageal reflux disease with acid and alkaline refluxes, to investigate the psychosomatic state, the features of endoscopic changes in the esophageal mucosa, changes in pH-measurement and gastric motility in patients with gastroesophageal reflux disease depending on the type of reflux. Materials and methods. A study of 60 patients with gastroesophageal reflux disease aged 24-65 years (mean age 44.5±5.3 years) was carried out. The main group consisted of 35 patients with gastroesophageal reflux disease with concomitant acid reflux, and the comparison group included 25 patients with verified alkaline reflux. Control group consisted of 20 practically healthy people. The groups were representative by age and sex. All patients underwent a comprehensive diagnostic program, which included a careful collection of life and medical history, questionnaires, clinical examinations, anthropometric studies, laboratory and instrumental studies. Results and discussion. Among the examined patients with gastroesophageal reflux disease with acid reflux, men predominated (60%). In contrast, the patients with alkaline reflux were dominated by female patients –76%. Most patients with alkaline reflux were overweight and had obesity of I and II degree. Тhe abdominal type of the obesity prevailed in the patients with alkaline reflux (64%). In the main group of the patients there was an increase in the number of acid reflux per day – 125±2.6, alkaline – 60±2.1 in the comparison group – 113±44.2 (p <0.01). In the control group, weakly acidic reflux, which coincided with clinical manifestations, was registered less frequently – the average daily rate was 155±24.3. The average daily number of refluxes over 5 minutes in patients with acid reflux was 19.7±3.5, with alkaline – 16.8±3.3. The erosive form of gastroesophageal reflux disease was observed more often with alkaline refluxes in 14 (66.7%) people: reflux esophagitis grade A (38.1%), grade B (19.1%), grade C (9.5%) patients. However, the non-erosive form was more observed in patients with acid reflux (59.3%). Delayed gastric evacuation is more pronounced in patients with gastroesophageal reflux disease with alkaline reflux, which can be explained by slowing of motility of the stomach and the presence of duodenostasis. In the vast majority of patients in this group, complete evacuation of contrast from the stomach occurred in a period of 3 hours or more. This allows us to conclude that the violation of the contractile ability of the stomach is one of the main factors that slows gastric evacuation, increases intragastric pressure and contributes to the development of pathological dumping of gastric contents into the esophagus. Conclusion. The combined course of gastroesophageal reflux disease with acid and alkaline reflux is characterized by specific etiopathogenetic mechanisms of development, polymorphism of clinical symptoms, which worsens the psychosomatic state and quality of life of patients. In patients with gastroesophageal reflux disease with alkaline refluxes, concomitant lesions of the pancreato-biliary system were more often diagnosed. The erosive form of gastroesophageal reflux disease was observed more often with alkaline refluxes (66.7%) patients. However, the non-erosive form was more observed in patients with acid reflux (59.3%). A hiatal hernia was found in patients with acidic (22.9%) and alkaline reflux (28.1%). Insufficiency of the lower esophageal sphincter was observed in 40% of patients with alkaline reflux, in 34.2% of patients with acid reflux with normal body weight. In gastroesophageal reflux disease with acid reflux, persistent delay in gastric evacuation is caused by persistent pylorospasm

Percussion test: description and diagnostic accuracy of a new manual test for bone marrow edema of the knee

BackgroundPrompt diagnosis of bone marrow lesion (BML) is difficult but critical for correct treatment. Magnetic resonance imaging is the gold standard, although expensive and time consuming. Simple and reliable clinical test for BML detection is lacking. Aim of the study is to describe a new manual clinical test called Percussion Test (PT) and to statistically determine its diagnostic accuracy in BML, compared to MRI imaging.MethodsAfter evaluation of the inclusion and exclusion criteria, 218 consecutive patients with unilateral knee pain and age comprised between 18 and 80 years old were enrolled in our observational prospective study. Informed consent was obtained for each patient. After medical history collection, PT was performed by a single operator as described. MRI was performed in the affected knee to detect the presence of BML. Coherence in PT and MRI assessment was evaluated in each quadrant of the knee via contingency tables, as sensitivity, specificity, NPV, PPV and diagnostic accuracy were calculated.ResultsNo correlation with a positive PT was demonstrated for the covariables gender (p = 0.156), age (p = 0.272) and BMI (p = 0.639).PT showed a sensitivity ranging from 60.6 (40.6–80.6) to 79.5 (63.0–96.0) and a specificity ranging from 85.7 (80.0–91.5) to 96.0 (93.1–98.9) depending on knee quadrant. Diagnostic accuracy ranged from 81.6 (75.9–86.6) to 89.4 (84.6–93.2), and p-value was < 0.00001 in a chi-squared analysis for all quadrants.ConclusionsPT showed sensitivity and specificity values that are comparable with other clinical tests routinely adopted in clinical practice. In the absence of other reliable clinical test, PT has the potential to become a useful bedside tool in the diagnosis and management of BMLs.

The study of blood serum trace elements in comparison with the structural and functional characteristics of goiter and the carriage of antithyroid antibodies in some regions of Russia

The study of the sufficiency with essential trace elements in the context of thyroid pathology is especially relevant, since the development and progression of thyroid diseases have various pathogenetic mechanisms, which largest proportion is provoked by insufficient intake of key trace elements, primarily iodine. The aim of the research was obtaining primary data on the sufficiency with essential trace elements of the population in the some regions of the Russian Federation, comparing the data obtained with the prevalence of goiter and the carriage of antibodies to thyroid peroxidase (AT-TPO). Material and methods. The Cross-Sectional Population Study was conducted in medical institutions of the Republics of Crimea, Republics of Tuva and Bryansk region (persons applied for outpatient consultations). The scope of the study was 387 people aged 18 to 65 years (the average age was 40±5 years). All of them underwent: collection of medical history, endocrinologist examination with palpation of the thyroid gland (TG), ultrasound examination of TG, blood sampling to assess the levels of thyroid-stimulating hormone (TSH), AT-TPO, iodine, selenium, zinc. Ultrasound of the TG was performed in the supine position using a portable ultrasound machine LOGIQe (China) with a multi-frequency linear probe 10-15 MHz. During the study, the volume of the thyroid gland, the presence of nodular formations and their characteristics according to the TIRADS classification, TG structure and its echogenicity were assessed. Iodine, selenium and zinc level were measured using tandem mass spectrometry with ionization in inductively coupled plasma (Agilent 8900 ICP-MS Triple Quad). TSH and Ab-TPO were determined by chemiluminescent immunoassay on the Architect i2000 automatic analyzer. Results. All regions are comparable in terms of iodine availability, but differ in the severity of natural iodine deficiency. The median concentration of iodine in blood serum practically coincided in all three regions, amounting to 39.8 μg/l in the Republic of Crimea; 38.8 μg/l in the Republic of Tyva and 43.4 μg/l in the Bryansk region. Comparing these results with foreign data, as well as with our results on urinary iodine level, obtained by routine cerium-arsenite method, we can assume that iodine content in blood serum corresponded to the lower limit of the normal target values. The median concentration of selenium in blood serum also practically coincided in all three regions, amounting to 68.2, 72.1 and 62.8 μg/l, respectively, and probably meets the criteria for optimality. The median serum concentration of zinc in Bryansk region residents corresponded to a deficiency (491.3 μg/l) and was significantly lower compared to the indicator in the Republics of Crimea and Tyva (1633.2 and 1667.6 μg/l, respectively, values above optimal). Among the examined, the proportion of people with AB-TPO carriership was 23.5% (Republic of Crimea - 20.9%, Republic of Tuva - 26.4%, Bryansk region - 20.7%), with impaired thyroid function - 9.6% (6.2% - hypothyroidism, 3.4% - thyrotoxicosis). The frequency of goiter varied from 10 to 13.8%. There were no significant differences in the frequency of occurrence, ultrasonic characteristics of goiter and thyroid nodules by regions. Conclusion. However, the results obtained do not allow to unequivocally judge the absence of micronutrient deficiency in the population of the regions of the Russian Federation, since used the ICP-MS method requires the development of our own reference values of trace elements; in the absence of the latter, data from similar foreign studies were taken as standards. In addition, in further studies it will be important to take into account additional criteria for assessing trace element deficiency, for example, activity of superoxide dismutase and alkaline phosphatase as indirect markers of zinc deficiency, etc. Correlation between blood serum concentration of trace elements and the frequency and structural characteristics of goiter, the carriage of Ab-TPO, and dysfunction of the TG was not revealed.

Identifications of the novel mutants on MYO7A in a family with non-syndromic hereditary deafness

Objective:To identify the deaf-causing mutation by the genetic analysis in a family with non-syndromic hereditary deafness. Methods:Medical history collection, hearing, vision, and genome whole-exome sequencing were performed on the members of the deaf family. Results:Two mutation sites were identified in the MYO7A gene, namely c.1183C>T and 1496T>C, of which c.1183C>T has a small number of foreign literature reports, and 1496T>C is a newly discovered mutation site. According to ACMG mutation guideline showed that these two mutations were pathogenic mutations of the proband. Sanger sequencing verified that c.1183C>T was derived from the father, and 1496T>C was derived from the mother. These two mutation sites were not found in the healthy population in the Exome Sequencing Project（ESP6500） database, 1000 Genomes Project database, and the Gnomad database. Moreover, the second child in this family included a heterozygous mutation of c.1183C>T and 1496T>C and was confirmed to become severe sensorineural deaf. Conclusion:A new pathogenic compound heterozygous mutation in the MYO7A gene has been discovered, which provides more diagnostic evidence for the autosomal recessive non-syndromic deafness caused by the MYO7A gene mutation and improves the prenatal gene diagnosis in high-risk families for mutation carriers to reduce congenital disabilities.

Инородные тела в желудке у ребенка 5 лет: особенности клинической симптоматики (клиническое наблюдение)

Gastrointestinal foreign bodies (FB) are a relevant issue of present-day pediatrics due to non-specific clinical presentations, difficulties in collecting medical history because of child’s age, and low awareness of parents and practitioners. The authors describe a 5-year girl with multiple gastric FBs (a conglomeration of hundred 0.3-cm magnetic balls). The girl was twice admitted to different hospitals with different incoming diagnoses. Non-specific clinical symptoms and complaints resulted in late diagnosis, primary exclusion of other infectious (acute gastroenteritis) and inflammatory (ulcerative colitis) GI disorders, and unreasonable prescription of medications including antibiotics. The authors address the management strategy for gastric magnetic FBs in this child and difficulties with their endoscopic removal. More than three weeks (24 days) had passed from the first symptoms to the final diagnosis. This case report illustrates the need for the accurate collection of medical history and timely diagnostic search using X-ray and endoscopic imaging irrespective of a child’s age. KEYWORDS: foreign bodies, gastrointestinal tract, children, magnetic balls, endoscopy, X-ray. FOR CITATION: Bevz A.S., Bokova T.A., Elin L.M. Gastric foreign bodies in a 5-year child: pattern of clinical presentations (case report). Russian Journal of Woman and Child Health. 2022;5(2):173–177 (in Russ.). DOI: 10.32364/2618-8430-2022-5-2-173-177.

КЛІНІЧНИЙ ВИПАДОК ГОСПІТАЛЬНОЇ ПНЕВМОНІЇ, ВИКЛИКАНОЇ KLEBSIELLA PNEUMONIA, ВНАСЛІДОК КОНТАКТУ ІЗ ЧЛЕНОМ РОДИНИ

The problem of morbidity and mortality due to infectious lesions of the respiratory tract, in particular nosocomial pneumonia, remain one of the most pressing problems of modern medicine. Nosocomial pneumonia ranks 3rd among all infectious diseases that a patient can contract at a medical institution after urinary and wound inflammation and it is characterized by high mortality. Nosocomial pneumonia is provoked by antibiotic-resistant microorganisms; in the intensive care patients, it is complicated by the re-aspiration of bacteria that accumulate above the cuff of the intubation tube. Identification of nosocomial and community-acquired pneumonia involves a particular flora of pathogens and, accordingly, involves empiric therapy. Routine analysis of sputum according to Gram gives approximate data, which is a clarification for empiric treatment. We present a clinical case, which demonstrates that infection is also possible due to contact of a family member with another one, working at a medical institution. Therefore, in our clinical case, we emphasize that it is very important to collect a thorough history. Careful collection of medical history can provide additional information: working in a team, being a medical professional, relatives working at a medical institution. It should be noted that in this category of patients, the causative agent of infection, including nosocomial pneumonia, may be the strains of nosocomial microorganisms. Regardless of age, we recommend the use of preventive measures (lifestyle modification, acclimatization training, sports, etc.) to increase the non-specific resistance of the body. As a preventive measure, medical personnel should follow the regimes of ventilation and wet cleaning in the premises, wash their hands and rinse their nasal passages as often as possible with saline solutions, use a mask to protect the respiratory organs, disinfect hands with alcohol.

Asian cohort for Alzheimer’s disease (ACAD) data collection: Rationale, design and validation

AbstractBackgroundAs the first large Alzheimer’s Disease (AD) genetics cohort for Asians in the United States and Canada, the Asian Cohort for Alzheimer’s Disease (ACAD) has adapted existing instruments to collect data on sex, genetics, medical history, and lifestyle risk factors. We hypothesize that any and all of these factors impact AD risk differently for Asians. Initially ACAD focuses on US and Canadian participants of Chinese, Korean, and Vietnamese ancestry.MethodACAD’s Clinical Workgroup reviewed commonly used dementia research questionnaires, including the NACC Uniform Data Set, Religious Order Study, and NIA‐Late‐Onset AD to select, and in some cases adapt, questions that are most appropriate for ACAD. A combination of AD clinical researchers and community outreach specialists reviewed the data collection packet, administration procedures, and consensus diagnosis process for cultural sensitivity without sacrificing scientific rigor to gather non‐genetic and lifestyle risk factor data.ResultWe designed the ACAD Data Collection Packet (DCP) to create a friendly dialogue with participants through a socio‐culturally and linguistically sensitive 3‐part process. The DCP consists of some instruments already validated in Chinese, Vietnamese and Korean languages to screen for cognitive impairment (Cognitive Abilities Screening Instrument (CASI) and Modified Mini‐Mental State (3MS)). Part A collects origins, Mediterranean diet compliance, and Clinical Dementia Rating scores. The self‐administered Part B uses an adaptation of the Rush Cognitive Activity Questionnaire on early‐life enrichment. Part C structures the collection of medical history and cognitive testing with CASI vs 3MS, the Common Objects Memory Test, Category (not Letter) Fluency, and the 15‐item Clock Drawing Task. This assessment is designed to be administered either remotely or face to face.ConclusionOver the next year, we will pilot the ACAD Data Collection Packet, to set a community standard for dementia screening among Asian Americans and Canadians that can support data harmonization across epidemiological studies. While ACAD translation accommodates Chinese, Korean, and Vietnamese at this stage, we look forward to implementing additional major Asian languages.

Clinical, laboratory and psychological aspects of moderate COVID-19 in cardiovascular patients one month after discharge from the hospital

Aim. To study clinical, laboratory and psychological aspects of moderate coronavirus disease 2019 (COVID-19) in cardiovascular patients one month after discharge from the hospital.Material and methods. The study included 88 patients with cardiovascular diseases hospitalized for COVID-19. After 1 month, 72 respondents continued the participation in the study. Medical history collection, physical examination, and diagnostic investigations were performed. We used the Hospital Anxiety and Depression Scale (HADS) by Zigmond A. S., Snaith R. P., Beck Anxiety Inventory scale, Mini-mental State Examination (MMSE) scale for assessing mental status.Results. One month after discharge, there was a decrease in the number of patients with signs of impaired respiratory system, such as cough, shortness of breath, chest congestion, while a decrease in exercise tolerance persists was revealed in 80,5% (out of 95,5% during hospiatalization), generalized weakness and increased sweating — in 69,5%. In addition, 38,9% of patients noted a noticeable, newly reported, hair loss. Attention is drawn to the high prevalence of neurological symptoms during hospiatalization, including dizziness, severe headaches not relieved by analgesics and non-steroidal anti-inflammatory drugs, lethargy, disorientation of place and time, and in some cases even hallucinations. Some of the symptoms persist after 1 month: 55,5% note a decrease in memory, 36% — feelings of fear and anxiety, 63,9% — sleep disorders in the form of frequent nocturnal awakenings (19,4%), insomnia (16,6%), long falling asleep (11,1%). Some of the respondents revealed unfavorable events over the past month as follows: blood pressure (BP) destabilization in the form of episodes of BP increase and decrease during the day — 36,0%, hypertensive crisis — 14,0%. There was an increase in the number of patients with subclinical and clinical depression (p&lt;0,05). There was also an increase in the number of patients with hypercholesterolemia compared with inhospital data by 15,5%.Conclusion. One month after discharge, the respiratory symptoms naturally decrease, but new symptoms appear, such as shortness of breath during exercise, fatigue, unsteady gait, hair loss, and increased sweating. There was an increase in the number of patients with subclinical and clinical depression on the HADS scale. Among laboratory parameters, an increase in the number of patients with increased level of total cholesterol and low-density lipoproteins was revealed.

Applying Virtual Reality Assisted Critical Thinking Training Programs Among Nurse Practitioners

The three-dimensional virtual world generated in virtual reality (VR) environments involves vision, hearing, touch, and potentially other user senses. VR environments are designed to closely simulate real situations/scenarios, allowing users to observe and engage in experiences free of time and space restrictions. Virtual patients are an extension of virtual reality. In recent years, virtual reality exercises have been widely used in various medical education and training programs to promote professional competence. The clinical practice of nurse practitioners is similar to physicians in some institutions. Nurse practitioners perform supplementary medical services such as physical assessment, medical history collection and consultation, problem detection, test result assessment, differential diagnosis, and patient health problem decision-making under the supervision of physicians. The critical thinking component in nurse practitioner education is largely similar to that taught in medical education. VR is often used in medical education to train medical students. Also, VR may be applied in critical thinking training for nurse practitioners to promote competence in reasoning and differential diagnosis. However, few studies in the literature have evaluated the effectiveness of VR-based training for nurse practitioners in Taiwan. In the future, this issue needs to be studied further.

Archivists' Information Work Lines: Affective, Information Management, and Hybrid Onsite‐Remote Work Performance

AbstractThis paper is among the first to investigate information work concepts in the archival context. A qualitative case study, it relies on two rounds of semi‐structured interviews with information professionals at medical history collections in Philadelphia. These interviews bracketed the six months before and after COVID‐19's onset. We analyze three lines of information work that evolved as these archivists shifted the work context to their home environments: affective effort, information management, and hybrid onsite‐remote work performance. Findings suggest that tasks such as processing, digitizing, and curating resources (invisible pre‐pandemic) and reference services (visible pre‐pandemic) overlap in archivists' hybrid onsite‐remote work performance during the pandemic. In recognizing the links between archivists' information work and work performance as a holistic approach to studies of the information‐intensive archival context, this research has implications for the centrality of work context, purpose, and value in the archival context.

Study on Effectiveness Analysis of Multi-Media Combined with PBL Teaching in Breast Surgery

To explore the effectiveness of multi-media combined with PBL teaching in breast surgery. Methods: 56 interns who came to our hospital for breast surgery from January 2019 to December 2020 were randomly divided into two groups: traditional teaching control group (n = 28) and multi-media PBL teaching observation group (n = 28). Two groups’ theoretical knowledge, skill operation, teaching quality, student’s evaluation and satisfaction with the teaching model were compared before ending the internship. Results: The total scores of breast examination, differential diagnosis, imaging reading, diagnosis and treatment scheme and total scores of the students in the observation group were higher than those of the students in the control group, and the total scores of body position, surgical site selection, disinfection and local anesthesia, surgical operation, postoperative treatment and clinical operation skills were also higher than those of the students in the control group (P &lt; 0.05), but there was no significant difference between the two groups in medical history collection, professional knowledge and preoperative preparation (P &gt; 0.05). The teaching quality of the students in the observation group was also significantly higher than that in the control group (P &lt; 0.05). In addition, the students’ satisfaction with the teaching method, the teaching effect and the overall satisfaction in the observation group were significantly higher than those in the control group (P &lt; 0.05). Conclusion: Multi-media combined with PBL teaching can effectively improve students’ professional knowledge theory level, operation skills, enhance students’ enthusiasm and initiative, develop good clinical thinking habits, and have high teaching satisfaction. It is worthy of being popularized in the clinical teaching of breast surgery.

Exploration and Thinking in Mixed Flipping-Classroom Teaching Approach on Clinical Endocrinolgy during the Coronavirus Disease 2019 Period

ABSTRACTBackground and Objectives:To explore the superiority of flipping-classroom lended learning in which the stay-home e-learning and traditional internship complements each other in resident training of endcorinology during coronavirus disease 2019 restriction period.Materials and Methods:A total of 44 residents were randomized as the study population. In the endocrine-rotation training, we reformed the clinical learning by unified online-teaching led by teachers' combination with individual guidance by residents. Moreover, the final implementation assessment was conducted by standard double-blind examinations.Results:After 4–8 weeks training, the 44 residents were assessed for clinical skills from six dimensions, including medical history collection, physical examination, history report and inpatient record writing, case analysis, and overviewing capability. Compared with the mean scores of 68 residents rotated in internal medicine in 2019, the mean scores on physical examination, inpatient record writing, and overviewing capability in 2020 group were higher with significance ([85.72 ± 8.33] vs.[79.22 ± 10.12], P = 0.0006), ([90.28 ± 10.70] vs. [81.82 ± 8.03], P < 0.0001), ([80.31 ± 8.70] vs. [73.04 ± 12.74], P = 0.0012), whereas scores on skills of medical history collection and history report were slightly lower ([82.11 ± 9.02] vs. [85.06 ± 7.23], P = 0.0586), ([79.30 ± 8.17] vs. [83.21 ± 5.01], P = 0.0022), while scores on case analysis did not show huge gap but with polarized performance in 2020 group ([74.38 ± 10.29] vs. [78.13 ± 8.53], P = 0.0386).Conclusions:Providing the novel pattern of unified online-teaching combined with individual-guidance at the bedside to the front-line residents can reduce the risk of cluster epidemics and effectively ensure the training effect on them but still with shortcomings. The future online teaching reform is better for focus more on how to make up for or reduce the actual problem of disconnection between theory and practice in the process of online clinical skills training for residents and teachers.

Клинический случай и литературный обзор патогенетических аспектов комбинированной инфекции вируса Эпштейна — Барр и кандидоза полости рта

Актуальность. Лечение пациентов с рецидивирующей инфекцией, которая устойчива к традиционной терапии, является сложной клинической задачей в педиатрии. Цель работы: проанализировать существующую литературу о клинических особенностях кандидоза полости рта и инфекционного мононуклеоза. Материалы и методы. Представлен случай комбинированной вирусной инфекции Эпштейна — Барр в форме инфекционного мононуклеоза и кандидоза ротовой полости рта у 4-летнего мальчика. Результаты. Исследована бактериальная флора горла и рта, в культурах из горла были изолированы Str.viridans 103 КОЕ/мл, S.aureus 105 КОЕ/мл, Candida albicans 106 КОЕ/мл. Иммуноферментный анализ показал, что индекс антител EBV VCA IgM составлял 2,63 (более 0,8 — положительный результат). Выводы. При инфекционном мононуклеозе в сочетании с кандидозом полости рта наблюдаются следующие общие симптомы: длительная лихорадка, лимфаденопатия и синдром экзантемы. Обычно они возникают после приема антибактериальных средств широкого спектра действия. В случае заболевания с такими симптомами, как длительная лихорадка, лимфаденопатия, тонзиллит и синдром экзантемы, которые являются общими для кандидоза полости рта и инфекционного мононуклеоза, требуется дифференциальная диагностика. Необходимо изучить микробиоту ротоглотки у пациентов с инфекционным мононуклеозом для выявления флоры, которая может обусловливать осложненное течение заболевания и трудности диагностики. В таком случае данный вид исследования является важным диагностическим методом обнаружения кандидоза.

Early Elevation of Thioredoxin-1 Serum Levels Predicts 28-Day Mortality in Patients with Sepsis.

BackgroundSepsis is the leading cause of death in critically ill patients, and the prevention of which requires precise outcome prediction and early intervention. We evaluated the prognostic prediction value of serum thioredoxin-1 (Trx-1) as an anti-inflammatory factor in patients with sepsis.MethodsAs a prospective study, patients with sepsis admitted to the intensive care unit (ICU) of our hospital during 2020 were recruited. Medical history collection, sequential organ failure assessment (ΔSOFA), and laboratory tests were performed within 24 h of admission. Serum levels of Trx-1 and other inflammatory biomarkers were detected with samples dynamically collected before, during, and after septic shock. Patients were categorized as survivors and non-survivors according to survival status on day 28. Correlation between Trx-1 and other sepsis-associated parameters as well as the correlation of Trx-1 and other sepsis-associated parameters with 28-day mortality were evaluated. Prognostic factors were identified by Cox regression analyses.ResultsA total of 187 patients were recruited. Serum Trx-1 level was positively correlated with inflammatory factors (interleukin-6, C-reactive protein, procalcitonin) and index of sepsis severity (ΔSOFA score, partial pressure of oxygen/fraction of inspired oxygen), all of which were significantly higher in non-survivors than survivors. While Trx-1 level at different timepoints and its evolution over time significantly differed between survivors and non-survivors, the initial Trx-1 level outperformed the other parameters in predicting 28-day survival. With 38.27 ng/mL as the cutoff value, serum Trx-1 predicted 28-day survival with optimal sensitivity and specificity.ConclusionEarly increases in serum levels of Trx-1 can predict 28-day mortality in sepsis patients in the ICU.

Genotype and phenotype analysis of a family with Waardenburg syndrome type Ⅰcaused by a novel mutation in PAX3 gene

Objective:To identify gene mutation and analysis the association between clinical characterizes and the mutations in a family of Waardenburg syndrome （WS） type I in Yunnan, China. Methods:With informed consent, the proband with WS phenotype and his family members were given medical history collection, physical examination and audiological evaluation. Peripheral blood was obtained, genomic DNA was extracted, and deafness related genes were detected by high-throughput sequencing. Sanger sequencing was used to verify the mutation sites of proband and his family members. Results:C. 602C>G mutation in exon 5 of PAX3 gene was identified, which is nonsense mutation and may cause a truncated protein. The mutation cause 201 amino acid of the protein changed from serine to stop codon. According to the American College of Medical Genetics and Genomics （ACMG）, it is considered as Pathogenicity（PVS1+PM2+PP3）. This mutation has not been included in the database also not been reported in the literature. Conclusion:Combined with the results of clinical diagnosis and gene diagnosis, this mutation was considered as the cause of the disease. This study enriched mutation spectrum of PAX3 gene.

Drug-induced liver injury associated with the use of nonsteroidal antiinflammatory drugs

Nonsteroidal antiinflammatory drugs (NSAIDs) are effective drugs used widely in clinical practice. NSAIDs are reversible inhibitors of cyclo-oxygenase, mainly used for the symptomatic relief of pain, whether rheumatologic, traumatic, infectious or episodic. However, the appointment of NSAIDs must be considered risk factors for side effects.Drug-induced liver injury associated with the use of NSAIDs does not have any specific manifestations and covers the symptoms that occur in a variety of liver lesions, from asymptomatic increase in transaminases to the development of fulminant liver failure. The need for early diagnosis, a difficult differential diagnostic search, and the absence of specific laboratory tests make this pathology quite difficult for a practicing physician. Treatment is based on the abolition of NSAIDs, which caused liver damage, and the appointment of symptomatic therapy. Preventive measures are reduced to compliance with the dose, multiplicity, ways of drug administration, the absence of polypragmasia, careful collection of medical history, analysis of risk factors before prescribing a drug and monitoring the patient in the dynamics.

Disparities Limit the Effect and Benefit of a Web-Based Clinic Intake System.

With increasing value being placed on patient-centered care and the focus on efficiency and workflow in health care delivery, the authors have implemented a web-based system for demographic, medical history, and patient-reported outcomes data collection for every clinical visit at their specialty upper-extremity center. They evaluated initial success and disparities in use after 12 months. The authors evaluated questionnaire parameters from 2018 patients, focusing primarily on the new patient intake form. They analyzed form-completion time relative to appointment time and form-completion percentage at various times before the appointment. The authors grouped patients by age, sex, race, income, education, employment status, transportation access, self-reported pain, and quality-of-life scores. Waiting room time was evaluated. Of new patients, 94% used the web-based platform to complete the intake form. Of the 4898 completed forms, 69.7% were done more than 1 hour before appointment time, indicating that a personal device was used. When grouped by patient characteristics and controlling for all demographic factors, patients who were male, non-White, and older than 40 years; had lower family income; and had a high school education or less were significantly associated with later form completion. Of the 1136 patients for whom the authors had adequate waiting room time data, late form completion significantly increased odds of waiting more than 15 minutes to be placed into an examination room. These data indicate that the authors are reliably capturing important patient information before appointment time. This could improve clinical workflow and overall quality of care and also identify limits in access and online system use, providing opportunities to improve capture by developing targeted interventions for specific patient populations. [Orthopedics. 2021;44(3):e434-e439.].

Identifying Potential High-Risk Medication Errors Using Telepharmacy and a Web-Based Survey Tool.

Obtaining patient medication histories during emergency department (ED) admissions is an important step towards identifying potential errors that could otherwise remain in the patient's active medication list. This is a descriptive report of a standardized, electronic data collection tool created to document potential medication errors in patients receiving high-risk medications during ED admissions. Trained pharmacy technicians completed a survey following medication history collection using a secure web platform called REDCap®. Data collected included patient-specific information, the number and type of high-risk medications, and potential medication errors identified in the collection process. During a pilot period of April 2019 to October 2020, 191 patient records were completed using the survey tool. Out of a total of 1088 medications recorded, 41% were considered high-risk medications. 42% of potential medication errors were classified as high-risk medication errors. Results from this survey tool demonstrated that 58% of high-risk medication orders could potentially result in a medication error that can be carried through patient admission and discharge. Accurate medication history and transitions of care can significantly impact patient quality of life. The cost of addressing a medication related-adverse event is also substantial. Based on published reports, annual gross savings to a hospital is estimated to be $4532 per harmful error in 2020, after adjusting for inflation. This equated to approximately $1,182,852 in estimated savings for Ascension Texas in 18 months. Nationwide, preventing potential medication errors in an outpatient setting can save on average $3.5 billion per year. This web-based survey tool has improved the quality and efficiency of potential error identification during medication history collection by pharmacy technicians. This information can be easily retrieved and aid in discussions regarding medication reconciliation at the leadership level and impact patient treatment outcomes by developing virtual processes that may result in fewer medication related events.

Neurodevelopmental Disorders, Psychiatric Comorbidities and Associated Pathologies in Patients with Childhood-Onset Schizophrenia and Premorbid Autistic Symptoms.

Childhood-Onset Schizophrenia (COS) is a rare (1/40000), severe and neurodevelopmental form of schizophrenia beginning before 13 years of age. Little is known about comorbidities and specific COS-related disorders. Thus, the objective of our study was to evaluate them from a psychiatric, neurodevelopmental and somatic perspective. This is an ancillary study of the GenAuDiss protocol. A standardized psychiatric interview (K-SADS-PL DSM5) and a neuropsychological assessment (WISC-V/WAIS-IV) were carried out in outpatients with COS as well as a medical history collection concerning pregnancy, perinatal period, development, biography and medical and psychiatric, personal, and family history. 20 outpatients were included. The mean age of onset of COS was 8.90 years (+/- 2.30). Psychiatric comorbidities (DSM5) were Attention Deficit Hyperactivity Disorder (15/20 patients), Anxiety Disorders (14/20) and Autism Spectrum Disorder (13/20). The average IQ was 70.26 (+/- 18.09). A language delay and a break in school career were noted in 18/20 patients. Finally, the main associated somatic disorder was asthma (15/20 patients). We highlighted in our patients with COS a high frequency of comorbidities including at least one systematic psychiatric disorder. However, although COS is a severe condition impacting the patient, his family and society, its management remains essentially symptomatic. In clinical practice, it is necessary to look for all these comorbidities and to manage them in order to improve the overall quality of care.

Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) study: Rationale, design and baseline characteristics of a randomized control trial of the MIND diet on cognitive decline

Alzheimer's dementia (AD) is the sixth leading cause of death in the U.S., with an estimated $305 billion cost of care in 2020. Currently there are no cures or therapies to ameliorate the disease progression and symptoms. Growing evidence links a diet characterized by high antioxidant components with benefits to cognitive function, which is indicative of the preventative potential of dietary inteventions.The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) study is a 3-year, multicenter, randomized controlled trial to test the effects of the MIND diet on cognitive function in 604 individuals at risk for AD.Men and women ages 65 to 84 years were recruited. Eligible participants were randomized to either the MIND diet with mild caloric restriction or their usual diet with mild caloric restriction. Cognitive assessments, medical history, blood pressure, anthropometric measurements, and blood and urine sample collections will be taken at baseline and follow-up visits. MRI scans will be completed on approximately half of the enrolled participants at the start and end of the study.Unique features of the MIND study include: 1) a dietary pattern, rather than single nutrient or food, tested in an at-risk population; 2) foods featured as key components of the MIND diet (i.e. extra-virgin olive oil, blueberries, and nuts) provided for participants; and 3) MRI scans of brain structure and volume that may provide potential mechanistic evidence on the effects of the diet. Results from the study will be crucial to the development of dietary guidelines for the prevention of AD.