Department Of Medicine Research Articles

Medical interns' training in family medicine at a district hospital and primary health care clinics in Middelburg, Mpumalanga.

Training of medical interns at the Middelburg district hospital has been introduced as part of the mandatory 6 months' rotation in Family Medicine department since 2021. This report provides an overview of what has been attained in 2021 and 2022. It covers various aspects of the activities medical interns have been exposed to in the Middelburg hospital and the surrounding primary health care clinics.Contribution:Sharing experiences of family medicine training for medical interns in district hospitals is essential because the 6 months' rotation is new for most family physician trainers, especially those in small hospitals and primary health care clinics. Taking into account the paucity of evidence on the topic, the report brings current information that supports that training medical interns in district hospitals and primary health care clinics prepares them to be comfortable and competent clinicians for the generalist work during the community service year ahead.

Type 2 Diabetes Revealing a Mixed GH (Acromegaly) and Prolactin Adenoma: A Case Report of the Internal Medicine Department of the Gabriel Touré University Hospital, Bamako, Mali

Type 2 Diabetes Revealing a Mixed GH (Acromegaly) and Prolactin Adenoma: A Case Report of the Internal Medicine Department of the Gabriel Touré University Hospital, Bamako, Mali

Dosimetry during iodine-131 therapy - a technical point of view from a single centre's own experience.

Nuclear medicine uses radionuclides in medicine for diagnosis, staging, therapy, and monitoring the response to therapy. The application of radiopharmaceutical therapy for the treatment of certain diseases is well-established, and the field is expanding. Internal dosimetry is multifaceted and includes different workflows, as well as various calculations based on patient- specific dosimetry. The objective of this study was to introduce the technical issues which might occur during iodine-131 (¹³¹I) dosimetry performed in nuclear medicine departments. Retrospective analysis was performed on a group of 44 patients with papillary thyroid cancer who between May 2021 and October 2021 underwent a 131I treatment: 80-100 mCi (2200-3700 MBq, based on the previous medical history and stage of the disease). Patients underwent a series of ¹³¹I therapy scans using gamma camera Discovery NM 670 CT. Whole body scan (WBS) was performed 2, 4, 24 and 48 hours after ¹³¹I administration. Additionally, after 24 hours of single photon emission computed tomography/ computed tomography, two fields of view (SPECT/CT 2-FOV) were performed from the mid-head to the bladder. During the dosimetry procedure, several issues arise. Firstly, after receiving therapeutic doses of ¹³¹I, patients should remain in their rooms until the appropriate activity is achieved before being transported to the diagnostic room. Secondly, the walls between examination rooms meet the requirements for accurate diagnosis but not for therapy, leading to the occurrence of artefacts in patients examined behind the wall, potentially influencing the examination results. Thirdly, personnel in the control room also experience additional exposure (10 times greater than in the case of standard diagnostic procedure). The dosimetry in patients in whom therapeutic procedures are performed with the use of isotopes is mandatory according to Polish and European law, technical issues which occur during the dosimetry procedures might influence the organization of the work in departments.

Demographic Profile, Respiratory Presentation and Outcome Analysis of Acute Encephalitis Syndrome in a Tertiary Hospital in Bangladesh

Acute encephalitis syndrome has been a major health problem worldwide due to its high morbidity and mortality. The aim of this study was to find out the demographic profile of acute encephalitis syndrome and to determine the association of the outcome of the disease with the demographic factors and respiratory symptoms at presentation. This observational analytic cross-sectional study was conducted in the departments of Medicine, Paediatrics, and Neurology in Bangabandhu Sheikh Mujib Medical College Hospital in Bangladesh from September 2013 to August 2014. People of all ages who fulfilled the inclusion criteria of acute encephalitis syndrome were included in the study. In this study, 270 cases were diagnosed with acute encephalitis syndrome. Most cases were clustered around the age groups of 0-5 year (24.1%), 6-17 year (24.8%), and 18 -45 year (28.5%). Death was higher among the 18-45 age groups (33.3%) as well as in males (59.3%). Apart from neurological symptoms, respiratory symptoms on presentation were present in 66.9% cases with 89.6% death and this association was found statistically significant (p value < 0.001, AOR 6.96, COR 5.3 with 95% CI). Influence of socio-demographic factors and delay in seeking hospital admission on adverse outcome was not statistically significant. Most cases occurred in January-February (12.6% and 11.1%) and in July (14.4%). Overall mortality was 17.8%. Encephalitis presenting with respiratory symptoms in association carries higher mortality. Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):22-26

Association of Admission CRP Level with Short Term Outcome in Patients with Acute Ischemic Stroke

Acute ischemic stroke is very common in Bangladesh and one of the most common causes of physical disability and death. This study was performed to determine the prognostic value of CRP measured in the very early phase of ischemic stroke for short term functional outcome of patients with acute ischemic stroke. This observational study was carried out in the departments of Medicine and Neurology of Faridpur Medical College Hospital, Faridpur from July 2012 to December 2012. Total 100 patients of acute ischemic stroke were recruited in this study. Blood sample was collected for CRP level during the time of admission. In this study 26% of patients were in low CRP group (CRP <3 mg/L), 34% of patients were in medium CRP group (CRP 3-9.9 mg/L), 40% of patients were in high CRP group (CRP ≥10 mg/L). According to modified Rankin Scale (mRS) scoring system the high CRP group having a 44% risk for a poor outcome (mRS ≥3 ) vs 27% for the low CRP group ( p = 0.01). According to Barthel Index (BI) scoring system the high CRP group having a 45% risk for a poor outcome (BI <95) vs. 25% for the low CRP group (p = 0.002). Z test of proportion revealed significant association between high CRP level and poor short-term outcome of patients with acute ischemic stroke. Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):12-15

A target English needs analysis on ESP course: Exploring medical students’ perceptions of necessities at a Yemeni university

This research focuses on the needs analysis and perspectives in evaluating English for Specific Purposes (ESP) courses designed for medical students. The study intends to identify the medical students’ perceptions of the frequency and importance of using English language skills. Two different instruments, questionnaires and semi-structured interviews, were used to collect data. Respondents included 186 medical students, 4 ESP lecturers, and 10 Department of Medicine (DM) Subject Matter lecturers at Ibb University in Yemen. In this study, quantitative data were collected from three different subject groups (n=200) by means of three versions of the questionnaire. Correspondingly, some follow-up interviews, which were organised with a group of these three informants (n=29), complemented the data collection procedure. The collected data was analysed via the SPSS software package, followed by a qualitative data thematic analysis of semi-structured interviews. The findings showed some differences in which medical students believed the most frequent skills used are Listening and Reading, while their ESP and DM Subject Matter lecturers believed that medical students use Writing and Listening. The results revealed that although most of the English language skills and sub-skills in target needs were considered important or very important by all the participants, there were discrepancies in the preferences and priorities. The findings of this study are expected to be used as reference material for further research and give valuable considerations which may provide useful information for the ESP course designers to meet the target English needs of medical students in Yemen.

Cleidocranial dysplasia associated with dentigerous cyst-review of literature and case report of two siblings.

Cleidocranial dysplasia (CCD) is a developmental anomaly of the skeleton and teeth which may be inherited, be transmitted as dominant characteristics in either male or female or even appear spontaneously. A case was reported in the department of oral medicine and radiology of two sisters age 17 and 19 years old with a chief complaint of milk teeth not falling since childhood. They presented specific physical and oral findings in common which suggested the idea of an undiagnosed syndrome. The sisters showed CCD characteristics including short stature (4 feet) and frontal bone resorption indicating delayed closure of fontanels. The stature is moderately shortened with the neck appearing long and narrow and the shoulders markedly dropped. Dental abnormalities such as retention of primary dentition, multiple supernumerary teeth, and delayed eruption of permanent dentition. OPG showed the presence of multiple impacted permanent and supernumerary teeth with radiolucency involving the crowns of impacted teeth revealing a cystic lesion. Lateral cephalogram also revealed the presence of multiple impacted teeth. The provisional diagnosis of CCD with dentigerous cyst was given. The enucleation of cyst was done and submitted for histopathological examination. Histopathologically, the soft tissue section suggested the features of dentigerous cyst. The final diagnosis of CCD associated with dentigerous cyst was confirmed.

Clinical characteristics of hospitalized children with respiratory syncytial virus infection and risk prediction of severe illness during the post-COVID-19 era in Kunming

Objective: To compare the epidemiological and clinical characteristics of hospitalized children with respiratory syncytial virus (RSV) infection in Kunming among the pre-and post-COVID-19 era, and to establish a prediction model for severe RSV infection in children during the post-COVID-19 period. Methods: This was a retrospective study. Clinical and laboratory data were collected from 959 children hospitalized with RSV infection in the Department of Pulmonary and Critical Care Medicine at Kunming Children's Hospital during January to December 2019 and January to December 2023. Patients admitted in 2019 were defined as the pre-COVID-19 group, while those admitted in 2023 were classified as the post-COVID-19 group. Epidemiological and clinical characteristics were compared between the two groups. Subsequently, comparison of the clinical severity among the two groups was performed based on propensity score matching (PSM). Furthermore, the subjects in the post-COVID-19 group were divided into severe and non-severe groups based on clinical severity. Chi-square test and Mann-Whitney U test were used for pairwise comparison between groups, and multivariate Logistic regression was applied for the identification of independent risk factors and construction of the prediction model. The receiver operating characteristic (ROC) curve and calibration curve were employed to evaluate the predictive performance of this model. Results: Among the 959 children hospitalized with RSV infection, there were 555 males and 404 females, with an onset age of 15.4 (7.3, 28.5) months. Of which, there were 331 cases in the pre-COVID-19 group and 628 cases in the post-COVID-19 group. The peak period of RSV hospitalization in the post-COVID-19 group were from May to October 2023, and the monthly number of inpatients for each of these months were as follows: 72 cases (11.5%), 98 cases (15.6%), 128 cases (20.4%), 101 cases (16.1%), 65 cases (10.4%), and 61 cases (9.7%), respectively. After PSM for general data, 267 cases were matched in each group. The proportion of wheezing in the post-COVID-19 group was lower than that in the pre-COVID-19 group (109 cases (40.8%) vs. 161 cases (60.3%), χ2=20.26, P<0.001), while the incidences of fever, tachypnea, seizures, severe case, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein and interleukin-6 levels were all higher than those in the pre-COVID-19 group (146 cases (54.7%) vs. 119 cases (44.6%), 117 cases (43.8%) vs. 89 cases (33.3%), 37 cases (13.9%) vs. 14 cases (5.2%), 69 cases (25.8%) vs. 45 cases (16.9%), 3.6 (1.9, 6.4) vs. 2.3 (1.8, 4.6), 9.9 (7.1, 15.2) vs. 7.8 (4.5, 13.9) mg/L, 20.5 (15.7, 30.4) vs. 17.2 (11.0, 26.9) ng/L, χ2=5.46, 6.36, 11.47, 6.42, Z=4.13, 3.06, 2.96, all P<0.05). There were 252 cases and 107 cases with co-infection in the post-and pre-COVID-19 groups, respectively. The proportion of triple and quadruple infection in the post-COVID-19 group was higher than that in the pre-COVID-19 group (59 cases (23.4%) vs. 13 cases (12.1%), 30 cases (11.9%) vs. 5 cases (4.7%), χ2=5.94, 4.46, both P<0.05). Among the 252 cases with co-infection in post-COVID-19 group, the most prevalent pathogens involving in co-infections, in order, were Mycoplasma pneumoniae 56 cases (22.2%), Influenza A virus 53 cases (21.0%), Rhinovirus 48 cases (19.0%), Parainfluenza virus 35 cases (13.9%), and Adenovirus 28 cases (11.1%).The result of multivariate Logistic regression showed that age (OR=0.70, 95%CI 0.62-0.78, P<0.001), underlying diseases (OR=10.03, 95%CI 4.10-24.55, P<0.001), premature birth (OR=6.78, 95%CI 3.53-13.04, P<0.001), NLR (OR=1.85, 95%CI 1.09-3.15, P=0.023), and co-infection (OR=1.28, 95%CI 1.18-1.38, P<0.001) were independently associated with the development of severe RSV infection in the post-COVID-19 group. The ROC curve of the prediction model integrating the above five factors indicated an area under the curve of 0.85 (95%CI 0.80-0.89, P<0.001), with an optimal cutoff of 0.21, a sensitivity of 0.83 and a specificity of 0.80. The calibration curve showed that the predicted probability in this model did not differ significantly from the actual probability (P=0.319). Conclusions: In the post-COVID-19 era in Kunming, the peak in pediatric hospitalizations for RSV infection was from May to October, with declined incidence of wheezing and increased incidence of fever, tachypnea, seizures, severe cases, and rates of triple and quadruple co-infections. Age, underlying diseases, premature birth, NLR, and co-infection were identified as independent risk factors for severe RSV infection in the post-COVID-19 period. In this study, a risk prediction model for severe pediatric RSV infection was established, which had a good predictive performance.

"They were very very nice but just not very good": The interplay between resident-supervisor relationships and assessment in the emergency setting.

Clinical supervisors hesitate to report learner weaknesses, a widely documented phenomenon referred to as "failure to fail." They also struggle to discuss weaknesses with learners themselves. Their reluctance to report and discuss learner weaknesses threatens the validity of assessment-of-learning decisions and the effectiveness of assessment for learning. Personal and interpersonal factors have been found to act as barriers to reporting learners' difficulties, but the precise role of the resident-supervisor relationship remains underexplored, specifically in the emergency setting. This study aims to better understand if and how factors related to the resident-supervisor relationship are involved in assessment of and for learning in the emergency setting. We conducted a qualitative study, using semistructured interviews of 15 clinical supervisors in emergency medicine departments affiliated with our institution. Transcripts were independently coded by three members of the team using an iterative mixed deductive-inductive thematic analysis approach. The team then synthesized the coding and discussed analysis following guidelines for thematic analysis. Participating emergency medicine supervisors valued resident-supervisor relationships built on collaboration and trust and believed that such relationships support learning. They described how these relationships influenced assessment of and for learning and how in turn assessment influenced the relationship. Almost all profiles of resident-supervisor relationships in our study could hinder the disclosing of resident weaknesses, through a variety of mechanisms. To protect residents and themselves from the discomfort of disclosing weaknesses and to avoid deteriorating the resident-supervisor relationship, many downplayed or even masked residents' difficulties. Supervisors who described themselves as able to provide negative assessment of and for learning often adopted a more distant or professional stance. This study contributes to a growing literature on failure to fail by confirming the critical impact that the resident-supervisor relationship has on the willingness and ability of emergency medicine supervisors to play their part as assessors.

Type 2 Diabetes Revealing a Mixed GH (Acromegaly) and Prolactin Adenoma: A Case Report of the Internal Medicine Department of the Gabriel Touré University Hospital, Bamako, Mali

Introduction: Pituitary adenomas are benign, well-differentiated tumours that usually grow slowly over several years and are developed monoclonally from anteropituitary endocrine cells. We report a case of mixed GH and prolactin adenoma diagnosed in the Internal Medicine Department of the Gabriel Touré University Hospital, Bamako, Mali. Observation: The patient was a 36-year-old man with a 4-year history of type 2 diabetes mellitus who had consulted a specialist for headache, polyuro-polydipsic syndrome, decreased libido and erectile dysfunction. On clinical examination, a tumour syndrome was noted with headache and visual blur. The biology revealed a GH hypersecretion syndrome (IGF1) which was elevated to 561.9 µg/ml (VN=116-353) and prolactin elevated to 463.3 µIU/ml (VN: 24-324) and diabetes. Pituitary MRI revealed a pituitary macroadenoma. Our patient was treated with Dostinex 0.5mg/week with a gradual increase in dose and insulin. He was also referred to neurosurgery, where he is awaiting removal of the adenoma after glycaemic control and hormone normalisation. The evolution was marked by the disappearance of headaches, improvement in vision, GH and prolactin hypersecretion syndrome and glycaemic control. Conclusion: In sub-Saharan Africa, the problems posed by pituitary adenomatous pathologies are complex, due to the limited biological and morphological investigation facilities and the rarity of specialised surgical facilities.

Abstract 4664: Therapeutic targeting of TP53-mutated acute myeloid leukemia by inhibiting cell cycle checkpoint

Abstract Acute myeloid leukemia (AML) is a hematological malignancy characterized by various somatic mutations leading to abnormal proliferation and differentiation of hematopoietic cells. Mutations on the TP53 gene occur in 5% to 10% of patients with de novo AML, with higher frequency in patients with relapsed and refractory (R/R) AML. Patients with TP53-mutated AML typically exhibit a poor response to conventional induction therapy and have a short overall survival (OS) rate, with a median duration of 5-9 months. Although various target agents have been developed for the treatment of AML, treatment options for TP53-mutated AML remain limited. Here, we have discovered a novel drug combination that can enhance the efficacy of the conventional therapeutic regimen for TP53-mutated AML patients. For in vitro analysis, we used the human AML cell line Kasumi-1(AML-M2), which harbors a homozygous TP53 R248Q mutation. We treated kasumi-1 cells with a combination of cytarabine and Idarubicin to produce drug tolerant persisters (DTPs) which is a minor population that survived the drug treatment. The Kasumi-1 DTPs displayed temporal G2/M phase cell cycle arrest and significant resistance to further repeated drug treatment. To discover drug candidates targeting TP53-mutated DTPs, we first examined the differentially expressed genes (DEGs) of TP53-mutated AML patients using patients’ RNA expression data deposited in the cancer genome atlas (TCGA) database. Using selected DEGs, drug candidates potentially affecting TP53-mutated AML cells were extracted from the connectivity map (CMap build 02) database. In addition, through a literature search, drugs with the ability to reactivate mutant p53, drugs that directly target mutant p53, synthetic lethal partners with mutant p53, and drugs that target leukemia stem cells were selected as candidate groups. As a result, we selected 46 drug candidates that would be effective for TP53-mutated AML through in silico analysis and therapy strategies targeting p53. Using in vitro cytotoxicity assay, we screened 46 candidate compounds at multiple doses and confirmed several drugs that effectively eliminate DTPs. The drug screening showed that cell cycle checkpoint inhibitors not only resulted in a significant reduction of G2/M phase arrested cells but also induction of apoptotic cells at the subG1 phase. Furthermore, the zero interaction potency (ZIP) model of SynergyFinder (https://synergyfinder.fimm.fi) analysis showed that cell cycle checkpoint inhibitors synergistically enhanced the cytotoxic effect of cytarabine on Kasumi-1 DTPs. Collectively, this study suggests that novel combination treatment of cell cycle checkpoint inhibitors with conventional drugs selectively inhibits TP53-mutated AML DTPs. Citation Format: Daehyeon Gwak, Dongchan Kim, Heejun Jang, Jun Liu, Suji Min, Ja Min Byun, Youngil Koh, Junshik Hong, Sung-soo Yoon, Dong-Yeop Shin, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea, Republic of. Therapeutic targeting of TP53-mutated acute myeloid leukemia by inhibiting cell cycle checkpoint [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 4664.

¿Cómo detectar a los pacientes mayores no institucionalizados en riesgo de malnutrición durante su hospitalización? Comparación de 8 herramientas de cribado de malnutrición o de riesgo nutricional

BackgroundThe prevalence of malnutrition is high among the elderly population. Hospital admission is a window of opportunity for its detection. ObjectiveTo assess the concordance of different nutritional scales in hospitalized patients. MethodsProspective study in non-institutionalized patients over 65years of age admitted to an internal medicine department. Five malnutrition screening surveys (MNA, MST, MUST, NRS-2000 and CONUT) and three nutritional risk screening surveys (SCREEN3, 8 and 14) were compared. As gold standard we use the Global Leadership Initiative for Malnutrition (GLIM) definition of malnutrition. ResultsEighty-five patients (37% female, median age 83years) were included. Forty-eight percent (95%CI: 38-59%) of patients were classified as malnourished according to GLIM criteria. The SCREEN3 scale was the most sensitive (93%; 95%CI: 87-98) and MUST the most specific (91%; 95%CI: 85-99). The most effective scale for excluding suspected malnutrition was SCREEN3 (LR− 0.17; 95%CI: 0.05-0.53) and the best for confirming it was MST (LR+ 7.08; 95%CI: 3.06-16.39). Concordance between the different scales was low or very low with kappa indices between 0.082 and 0.465. ConclusionsA comprehensive approach is needed to detect malnutrition in hospitalized patients. More sensitive scales are more useful in initial screening. Nutritional risk tools could be effective at this stage. In a second step, malnutrition should be confirmed according to established criteria such as GLIM.

Stressors, emotions, and social support systems among respiratory nurses during the Omicron outbreak in China: a qualitative study

BackgroundRespiratory nurses faced tremendous challenges when the Omicron variant spread rapidly in China from late 2022 to early 2023. An in-depth understanding of respiratory nurses’ experiences during challenging times can help to develop better management and support strategies. The present study was conducted to explore and describe the work experiences of nurses working in the Department of Pulmonary and Critical Care Medicine (PCCM) during the Omicron outbreak in China.MethodsThis study utilized a descriptive phenomenological method. Between January 9 and 22, 2023, semistructured and individual in-depth interviews were conducted with 11 respiratory nurses at a tertiary hospital in Wuhan, Hubei Province. A purposive sampling method was used to select the participants, and the sample size was determined based on data saturation. The data analysis was carried out using Colaizzi’s method.ResultsThree themes with ten subthemes emerged: (a) multiple stressors (intense workload due to high variability in COVID patients; worry about not having enough ability and energy to care for critically ill patients; fighting for anxious clients, colleagues, and selves); (b) mixed emotions (feelings of loss and responsibility; feelings of frustration and achievement; feelings of nervousness and security); and (c) a perceived social support system (team cohesion; family support; head nurse leadership; and the impact of social media).ConclusionNursing managers should be attentive to frontline nurses’ needs and occupational stress during novel coronavirus disease 2019 (COVID-19) outbreaks. Management should strengthen psychological and social support systems, optimize nursing leadership styles, and proactively consider the application of artificial intelligence (AI) technologies and products in clinical care to improve the ability of nurses to effectively respond to future public health crises.

Comparision between 3% Hypertonic Saline and 20% Mannitol in the Management of Raised Intracranial Pressure in Children

Background Osmotic agents like mannitol and hypertonic saline are the mainstay of management of raised intracranial pressure (ICP) along with non-pharmacological measures like head elevation, hyperventilation, and hypothermia and CSF drainage. Several recent studies have shown hypertonic saline relatively superior to mannitol however, both are being used commonly. So, this study was done to compare the efficacy of mannitol and hypertonic saline in management of raised ICP in children. Methods This was a prospective randomized comparative study done among 40 children aged 1-5 years admitted in department of Pediatrics and Adolescent Medicine, BPKIHS, Dharan with clinical signs and symptoms of raised ICP They were divided into two groups based on consecutive sampling with group 1 receiving 20% mannitol and group 2 receiving 3% hypertonic saline. Results Both the groups were comparable for age distribution, gender and baseline characteristics. Pretreatment mean MAP was higher in group 2 as compared to group 1 while decrease in MAP was present in both groups at 24, 36-, 48-, 56- and 60-hours post-treatment; however, this was not statistically significant. 78.9% cases improved with mannitol while 90.5% improved with 3% hypertonic saline but this was not statistically significant. Conclusion Hypertonic saline can be an equally effective agent for management of raised ICP in children but larger and multi-centric study may help in determining which one is better.

Benign Lipomatous Soft Tissue Tumors in Nigerians: An Analysis of the Clinical and Morphological Features of a Common but Important Entity.

Introduction Benign lipomatous tumors are soft tissue tumors that exhibit a predominant adipocytic phenotype. Lipomas are the archetype and are the most common benign soft tissue tumors in adults but relatively uncommon in children. Their sex incidence is equivocal. They sometimes occur in combination with other mesenchymal elements, giving rise to variants including fibrolipoma, angiolipoma, myolipoma, spindle cell lipoma, chondroid lipoma, osteolipoma, and chondrolipoma. Their clinical significance is mainly due to the cosmetic disfigurement of patients and the differential diagnosis of malignant soft tissue tumors. Occasionally, due to their large size or presence near vital organs, they may cause life-threatening and/or excruciating pressure symptoms. This study was purposed to address the dearth of local studies on the clinical and morphological characteristics of benign lipomatous tumors in Nigerians, to compare these with those of other populations, and to establish baseline data. Materials and methods This was a retrospective study of all benign lipomatous tumors seen in the anatomic pathology and forensic medicine department of Asokoro District Hospital, Abuja, Federal Capital Territory, Nigeria, over an eight-year period. Surgical pathology reports were retrieved for patients' biodata and clinical information. The appropriate slides were retrieved, and reviewed, and new sections were cut where necessary. The tumors were classified according to the 2020 World Health Organization (WHO) guidelines and categorized based on size as small, medium, or giant. The data obtained were analyzed, and the results were presented as tables, bar charts, ratios, and percentages. Results Four hundred and eighteen cases met the inclusion criteria. Of these, 58.4% (244/418), occurred in females, while 41.6% (174/418) occurred in males. The age range was six to 91 years, while the median age was 42 years. The least number of cases, 0.5% (2/418), were seen in patients aged less than 10 years, while the majority, 35.4% (148/418), occurred in the fifth decade, followed by 27.8% (116/418) in the fourth. Size-wise, the majority of tumors, 60% (253/418), were medium, followed by small, 22.8% (95/418). Giant-sized tumors significantly accounted for 16.7% (70/418) of the cases. The diagnostic spectrum comprised conventional lipoma and variants such as fibrolipoma, spindle cell lipoma, pleomorphic lipoma, angiolipoma, chondrolipoma, intramuscular lipoma, and osteolipoma. Lipoma and fibrolipoma dominated with 87.1% (364/418) and 10.0% (42/418), respectively, while the rest accounted for <3%. The majority, 31.8% (133/418), occurred in the back/shoulder region, followed by the lower limb with 18.2% (76/418). Only two cases occurred in the abdominal/pelvic region. More tumors occurred in females in all the regions except the head and neck, which had a male-to-female ratio of 1.5:1. Multiple site tumors were more common in males in a ratio of 2.5:1. Most, 41.1% (39/95), of the small-sized tumors, occurred in the head/neck region, largely involving the face, 48.7% (19/39). Conclusion Our study showed many similarities in the clinical and morphological features of benign lipomatous tumors between Nigerians and other regions of the world. A notable finding, however, was the significantly higher proportion of giant benign lipomatous tumors when compared tostudies from other regions, a finding that warrants further studies.

Distribution of internal medicine rotations among resident physicians in Japan: a nationwide, multicenter, cross-sectional study

BackgroundIn Japan, postgraduate clinical training encompasses a 2-year residency program, including at least 24 weeks of internal medicine (IM) rotations. However, the fragmented structure of these rotations can compromise the training’s quality and depth. For example, a resident might spend only a few weeks in cardiology before moving to endocrinology, without sufficient time to deepen their understanding or have clinical experience. This study examined current patterns and lengths of IM rotations within the Japanese postgraduate medical system. It scrutinized the piecemeal approach—whereby residents may engage in multiple short-term stints across various subspecialties without an overarching, integrated experience—and explored potential consequences for their clinical education.MethodsThis nationwide, multicenter, cross-sectional study used data from self-reported questionnaires completed by participants in the 2022 General Medicine In-Training Examination (GM-ITE). Data of 1,393 postgraduate year (PGY) one and two resident physicians who participated in the GM-ITE were included. We examined the IM rotation duration and number of IM subspecialties chosen by resident physicians during a 2-year rotation.ResultsApproximately half of the participants chose IM rotation periods of 32–40 weeks. A significant proportion of participants rotated in 5–7 internal medicine departments throughout the observation period. Notable variations in the distribution of rotations were observed, characterized by a common pattern where resident physicians typically spend 4 weeks in each department before moving to the next. This 4-week rotation is incrementally repeated across different subspecialties without a longer, continuous period in any single area. Notably, 39.7% of participants did not undertake general internal medicine rotations. These results suggest a narrowed exposure to medical conditions and patient care practices.ConclusionsOur study highlights the need to address the fragmented structure of IM rotations in Japan. We suggest that short, specialized learning periods may limit the opportunity to gain broad in-depth knowledge and practical experience. To improve the efficacy of postgraduate clinical education, we recommend fostering more sustained and comprehensive learning experiences.

Case Report: Inflammatory orbital pseudotumor revealing Behçet's disease: an original observation

Objective To provide an original observation of Behçet’s disease, revealed by an inflammatory pseudotumor of the orbit. Methods We reported an observation of an inflammatory pseudotumor of the orbit that revealed Behçet’s disease. Results Twenty-Eight years old patient was admitted to the internal medicine department for painful edema in the right eye with headache and loss of visual acuity. Ophthalmologic examination revealed eye protrusion with conjunctival hyperemia. Orbital MRI resonance imaging revealed periorbital inflammatory thickening associated with inflammatory myositis. Behçet’s was diagnosed based on a history of recurrent oral aphthous since childhood, pseudofolliculitis, pathergy test positivity, and negativity of the rest of the etiological investigations. The evolution was spectacular with boli methylprednisolone and colchicine prescriptions. Conclusion Although the association is rare, Behçet’s disease should be included in the workup of inflammatory pseudotumors of the orbit.

Value of follow-up diagnostic radioiodine scans in differentiated thyroid cancer.

The most important part of the follow-up of differentiated thyroid carcinoma (DTC) is the measurement of serum thyroglobulin (Tg). An increase of Tg levels indicates likely tumor recurrence. According to the guidelines of the European Society of Medical Oncology (ESMO), the follow-up should consist of serum Tg assays and a neck ultrasound, while the American Thyroid Association (ATA) recommends serum Tg assays, neck ultrasounds, and a diagnostic radioiodine whole-body scan (WBS) if non-stimulated Tg is greater than 10 ng/mL or if Tg is rising. This study questions the necessity of a diagnostic WBS in patients with low stimulated Tg levels during the initial follow-up. This study is a retrospective data analysis. The data of 185 patients, who were in regular treatment and aftercare between 2015 and 2018 at the Department of Nuclear Medicine in Vienna, as well as the data of 185 patients who were treated in Tbilisi between 2015 and 2019, were analyzed. There was a highly significant relationship between low stimulated Tg levels (<0.5 ng/mL) and the outcome of the diagnostic WBS at the first follow-up (χ 2 = 14.7, P < 0.001). In total, 31 out of 370 patients (8.4%) had positive findings in the diagnostic WBS. Seventy-five of 370 patients (19.74%) had stimulated Tg levels >0.5 ng/mL. Our data suggest that the first follow-up, 4-12 months after the initial therapy of DTC, including the measurement of basal and stimulated Tg levels and Tg antibody levels, does not mandate a diagnostic WBS on all patients. In this study, we examined the still commonly used routine diagnostic radioiodine whole-body scan in the first follow-up of patients with differentiated thyroid carcinoma. We questioned the necessity of the scan in patients with low stimulated thyroglobulin levels. Therefore, we combined retrospective data from the University Hospital in Vienna and in Tbilisi to analyze 370 patients. We were able to demostrate a highly significant relationship between low stimulated thyroglobulin levels (<0.5 ng/mL) and the outcome of the diagnostic scan at the first follow-up (χ = 14.7, P < 0.001).

About the work of the XVII Scientific and Practical Conference of Young Scientists and Specialists “Forensic medical science and practice”

On December 7, 2023, the Department of Forensic Medicine and Medical Law Russian University of Medicine of the Ministry of Health of the Russian Federation jointly with the Forensic Medical Expertise Bureau of the Moscow Health Department held the XVII Scientific and Practical Conference of young scientists and specialists "Forensic Science and Practice". The conference was attended by future forensic physicians ― students, residents and postgraduates, teachers of forensic medicine departments of medical universities of the Russian Federation, as well as novice forensic experts and their experienced supervisors.&#x0D; Professor E.Kh. Barinov in his welcoming speech to the participants of the conference told about the history of such events in Moscow, noted their scientific and practical significance, which contributes both to the formation of interest of the young generation of specialists in scientific research, and the acquisition of experience in public speaking and versatile discussions.&#x0D; In the main part of the day the reports of the conference participants were delivered followed by discussion of the topics raised.&#x0D; At the closing of the event, the high level of preparation of the speakers was noted and a detailed analysis of the speeches was presented. The Organising Committee wished the young scientists, specialists and their supervisors success in continuing their work on the selected topics.

Possibilities of using topical retinoids and azelaic acid in acne therapy

Background. Acne is a common, complex and multifactorial inflammatory disease that results from a variety of causes. Acne therapy is an urgent problem of dermatocosmetology. The clinical manifestations of dermatosis can be alleviated, and its long-term consequences can be prevented by early diagnosis and timely initiation of treatment, affecting multifaceted all parts of the pathogenesis.&#x0D; Aims. To evaluate the clinical efficacy and safety of the use of monotherapy of 0.1% adapalene cream (Adaclean) with combined external therapy of 0.1% adapalene cream (Adaclean) with 20% azelaic acid cream (Azix-Derm) in the treatment of mild to moderate acne.&#x0D; Methods. Under our supervision at the Department of Plastic Reconstructive Surgery, Cosmetology and Regenerative Medicine of the State Budgetary Educational Institution of Higher Professional Education Rost of the State Medical University of the Ministry of Health of Russia, the clinics “Ekaterininskaya” and “MIR-O-MED” there were 50 patients aged 12 to 50 years (18 (36%) men and 32 (64%) women) with mild and moderate acne. Patients with comedonal acne, in the absence of multiple inflammatory elements, which made up group 1 of observation (n = 16), were prescribed Adaclean cream, 1 time per day (evening) against the background of skin care. In the group with mild to moderate papulo-pustular acne and post-inflammatory changes (group 2, n = 34), patients were prescribed a combination of 0.1% adapalene cream and 20% azelaic acid cream (Adaclean (evening) and Azix-Derm (morning)). The follow-up period was 6 months.&#x0D; Results. Total clinical remission after 6 months therapy was achieved in 70% of cases, a significant improvement — in 28%, improvement — in 2%. In patients with a comedonal form of acne against the background of monotherapy with Adaclean cream, clinical recovery was obtained in 44% of patients, a significant improvement — in 50%, and an improvement — in 6%. In patients from the group of papulo-pustular acne of mild to moderate severity, after 3 months the use of complex therapy Adaclean and Azix-Derm noted almost complete relief of the inflammatory process; after 6 months therapy clinical recovery was recorded in 58%, significant improvement — in 36%; 6% showed partial improvement, which is associated with irregular use of drugs and skin care products. After 6 months combined treatment was able to achieve regression of dyschromia in 18–46% of patients, atrophic scars — in 5–22%, which significantly improved the results of therapy and made it possible to achieve a good cosmetic effect.&#x0D; Conclusion. The combined use of drugs for external use of adapalene (Adaclean) and AK (Azix-Derm) in the treatment of papulo-pustular acne of mild and AK (Azix-Derm) in the treatment of papulo-pustular acne of mild and moderate severity can significantly increase the effectiveness of treatment, achieve a stable clinical effect and remission of the disease, as well as improve the quality of life of patients.