Department Of Medicine Research Articles

Comparative Analysis of Drowning Index: Relevance in Drowning Deaths versus Non-Drowning Asphyxial Deaths

Drowning remains a significant cause of mortality worldwide, necessitating accurate diagnostic tools for forensic investigation. This paper conducts a comparative analysis of the Drowning Index (DI) to ascertain its relevance in distinguishing drowning deaths from non-drowning asphyxial deaths. Drowning deaths present a challenge for forensic pathologists, because the autopsy findings may occur in many non-drowning scenarios. Previous studies have attempted to identify patterns in organ weights that may be specific for drowning. The drowning index has been defined as the weight ratio of the lungs and pleural effusion fluid to the spleen. We compared the lung and pleural effusion weight, spleen weight, and DI from 124 autopsies of asphyxia deaths including both drowning deaths and non-drowning asphyxia deaths such as hanging, strangulation, suffocation and mechanical asphyxia at the department of Forensic Medicine and Toxicology at the Gandhi Medical College, Bhopal from January 2021 to August 2022. Findings highlight the potential utility of the DI as a valuable adjunctive tool in forensic investigations, providing insights into its comparative efficacy in differentiating drowning from other modes of asphyxial deaths. Such insights are critical for enhancing accuracy in forensic diagnoses and contributing to advancements in medicolegal death investigations.

Profiling cytokines in peritoneal effluent through a targeted multiplex cytokine panel provides novel insight into the localized proinflammatory processes in patients undergoing peritoneal dialysis.

The number of relevant markers indicating local intraperitoneal inflammation in patients undergoing peritoneal dialysis (PD) is limited. Therefore, this study aimed to evaluate the compatibility of peritoneal effluent (PE) for proteomic analysis and assess its potential utility in immunoprofiling studies. This pilot study included six PD patients from the Peritoneal Dialysis Center, Department of Nephrology, Transplantology, and Internal Medicine in Szczecin, Poland. All patients were clinically stable, with no signs of infections or malignancy at the time of study. PE samples were collected during routine surveillance visits at the Peritoneal Dialysis Center. Proteomic analysis of the samples was conducted using the Olink® (Olink Proteomics AB, Uppsala, Sweden) Target 48 Cytokine panel. PE samples were successfully analyzed, with 28 out of 45 proteins found within the limit of quantitation (LOQ) and 32 out of 45 proteins detected above the limit of detection (LOD). No significant interference from the matrix was observed in the assay. Biomarkers associated with low-grade inflammation showed varied levels, and the observed patterns were comparable across all patients. This study suggests that utilizing a cytokine panel with relative quantification is a promising method for PE immunoprofiling.

The effect of severe COVID-19 infection on biochemical markers (FBS, HbA1C, FA, INS, C-Pep) in diabetic patients

Background & objective: Several studies have been conducted around the world on the impact of COVID-19 on people with diabetes mellitus (DM). Any acute illness can cause stress and increased inflammatory reactions, which increase sympathetic outflow and produce catecholamines, growth hormones, cortisol, and cytokines, all of which raise the risk and severity of complications from diabetes. Diabetes is a significant risk factor for the severity of COVID-19. We conducted this study to identify whether severe COVID-19 infection has any effect on the biomarkers, including fasting blood sugar (FBS), HbA1C, FA, INS, C-Pep, in individuals with DM. Methodology: This study was simultaneously conducted at Department of Chemistry and Biochemistry, College of Medicine of Al-Nahrain University, and Department of Medicine of Mustansiriyah University College of Medicine, Baghdad, Iraq. During the months of February and March 2022, 50 COVID-19 patients with diabetes and 50 COVID-19 patients without diabetes were included in the study. The control group included 100 healthy, sexually identical people (age 50-80), collected under the supervision of the second supervisor from relatives and students of Mustansiriyah University, College of Medicine. Venous blood samples of 5 mL were taken from all participants and subjected to laboratory tests to detect the levels of the biomarkers. Results: Average FBS level in DM patients was 304.9 mg/dL, (range 132-545.9 mg/dL), which was remarkably higher than in non-DM patient groups (193.3 mg/dL), range (of 66.2–458). The DM patients' group had a significantly higher concentration of HbA1C (median = 6.70 mg/dL, range 5.2-8.1) than the non-DM patient group (median = 5.8, range 4.2–7.6) with a significant difference. Although The group of DM patients had significantly greater FA concentrations than the group of non-DM patients. In contrast, the median and range for insulin and c-peptide Displays non-significant differences for covid-19 patients (DM and non-DM), but it's significant with a control group. Conclusion: According to this study, COVID-19 patients with diabetes had greater biochemical indicator levels than non-diabetic people. Pre- and postprandial hyperglycemia and diabetic ketoacidosis were more common in COVID-19 DM patients than in non-infected DM patients. We found that COVID-19 increased the severity risk for T2DM patients and glucose level is raised and progresses in a vicious cycle exacerbated by insulin resistance (IR) and decreased pancreatic b-cell function. Keywords: COVID-19, Diabetes mellitus, FBS, HbA1C, FA, INS, C-Pep Citation: Yones MS, Al-Wasiti E, Al Qaseer AH, Al-Rubaiawi HK. The effect of severe COVID-19 infection on biochemical markers (FBS, HbA1C, FA, INS, C-Pep) in diabetic patients. Anaesth. pain intensive care 2024;28(5):804−808; DOI: 10.35975/apic.v28i5.2553 Received: June 01, 2024; Reviewed: June 19, 2024; Accepted: June 19, 2024

PRESCRIPTION PATTERN OF ANTI-HYPERTENSIVE MEDICATIONS IN PATIENTS WITH HYPERTENSION AT A TERTIARY CARE HOSPITAL, ASSAM

Objective: The aim of our study is to analyze the pattern of prescription of medications used for managing hypertension (HTN) at a tertiary care hospital and assess the comorbidities associated with HTN. Methods: This prospective study has been conducted for duration of 6 months in the Department of Medicine of Silchar Medical College and Hospital. Prescriptions of both genders diagnosed with primary essential HTN and patients receiving or advised to start antihypertensive medications were included in the study. Results: One hundred and fifty prescriptions have been evaluated in the study duration, 42% are female and 58% male. Monotherapy (69%) followed by dual therapy (26%) and multidrug therapy (5%) have been prescribed to the patients. Calcium channel blockers (CCBs) (48%) are the most widely used drugs, along with angiotensin receptor blockers (ARBs) (29%), beta-blockers (BBs) (11%), diuretics (6%), and angiotensin-converting enzyme inhibitors (6%) in single drug therapy. ARB+CCB followed by ARB+diuretic and ARB+BB were used in dual therapy. In triple therapy, the most preferred therapy was ARB+CCB+diuretic, and then ARB+CCB+BB. Dyslipidemia (38%), followed by Type 2 diabetes mellitus (DM) (34%), and chronic kidney disease (CKD) (19%) were the most common associated comorbidities. Conclusion: Monotherapy was frequently prescribed regimen followed by dual therapy and multidrug therapy. In single-drug therapy, CCB was mostly used, and then ARB. In dual therapy CCB+ARB was the most preferred treatment. Dyslipidemia was most frequently associated with HTN, followed by DM and CKD. Prescription patterns of anti-hypertensive moderately followed the World Health Organization recommendations for HTN.

Prescribing sustainability: should UN sustainable development goals be part of the medical, pharmacy, and biomedical education?

How to adapt the curriculum of medicine, pharmacy, and biomedical sciences to prepare future health professionals to meet the challenge of maintaining quality care in a period of socio-ecological crisis? Addressing connections between humanity and sustainable environment should include an analysis of the reciprocal influence of various ecosystems, since it is now clear that healthcare systems have an impact on ecosystems and vice versa. Here, we propose that integrating the United Nations Sustainable Development Goals (SDGs) into the curriculum could be a first step in such a transversal education. Members of the faculty of medicine at the University of Namur, Belgium, including teaching staff of the department of medicine, pharmacy, biomedical sciences and psychology, were invited to respond anonymously to a questionnaire about their views on the feasibility of integrating the SDGs into their teaching. A subsequent survey on students' perceptions of such teaching was conducted by student representatives. Seventy-nine percent of surveyed members of the medical faculty believe that it is possible to integrate SDGs into their lectures. However, 44-86% of them did not know how to integrate each individual goal. 94.4% of students would like SDGs to play a greater role in their education; 64.4% of them would integrate them into existing modules; 23.9% would create an optional module, and 11.9% would create a mandatory module. Sustainable Development Goals integration into the curriculum of medicine, pharmacy, and biomedical sciences is perceived as challenging in a dense teaching program. To clarify how SDGs can translate into traditional lectures, we provide for each SDG targeted applications for bachelor's, master's and continuing education.

A PROSPECTIVE OBSERVATIONAL STUDY OF MONITORING AND REPORTING OF ANTIMICROBIAL DRUGS ASSOCIATED ADVERSE DRUG REACTIONS AND THEIR SIGNIFICANCE ON PATIENTS SAFETY AND HEALTH-CARE OUTCOMES

Objective: Adverse drug reaction (ADR) surveillance and reporting practices are at an early stage of development within the Indian context. The pharmacovigilance rate in India falls below 1%, which is notably lower compared to the global average of 5%. India holds the position of being the fourth most significant contributor to the pharmaceutical industry worldwide. Therefore, there exists a pressing demand to enhance the pharmacovigilance framework for safeguarding the health of the Indian population. ADR is defined as the unintended, obnoxious, and unwanted reaction due to the use of a drug. The administration of antimicrobial agents causes various ADR that has been analyzed throughout the study. The main objective of the research is to monitor and report the adverse drug reaction caused by antimicrobial drugs Methods: A prospective observational study was carried out in the various departments of the hospital with duration of 3 months including 100 patients using patient profile form and ADR reporting forms and analyzing with the scales for causality, severity, and preventability assessment. Results: During the study, 29 ADRs were found among 100 patients, with an incidence rate of 9.6%, more common in females (52%) than in males (48%). ADRs were most frequently reported in the age group of 35–51 years (34%), then 18–34 years (28%), and 1–17 years (24%). The general medicine department reported the highest number of ADRs (66%), followed by the pediatric department (24%). Cephalosporins caused the most ADRs (35%). Common ADRs included constipation, diarrhea (34%) and rashes, nausea, and vomiting (34%). Naranjo scale indicated that the causality of ADRs was probable (52%). Hartwig severity scale showed 55% ADRS to be mild. Schumock and Thornton method found that 76% of ADRs were preventable.Management of most of ADRs included drug withdrawal (52%). Conclusion: The majority of cephalosporin-related side effects, which included constipation, diarrhoea, and rashes, were observed. Most of the patients got better with the help of ADR monitoring and management. Finding and treating drug-related problems early make patients feel better and keep them safe. This study shows health-care system why it is important to monitor and report ADR caused by drugs.

Analysis of the radiation accidents prevalence in nuclear medicine in the Russian Federation

Radiation events (accidents) appearance is an integral part of the use of ionizing radiation sources in medicine in general and nuclear medicine in particular. To minimize the negative impact on patients, workers, and public due to such events, it is necessary to have reliable information about real prevalence of the radiation events (accidents). The current work presents the analysis of the radiation accidents with medical ionizing radiation sources registered in the “Data bank of radiation accidents and incidents” of the Rospotrebnadzor Information and Analytical Centre for Radiation Safety and the results of workers questionnaires conducted in 25 nuclear medicine departments (about 30% of all nuclear medicine departments in the Russian Federation). The results of the analysis showed that the most common registered radiation accidents in the “Data bank of radiation accidents and incidents” are identification of passengers with high external dose rate as well as identification of waste contaminated by medical radionuclides. The results of the questionnaire showed that the most common radiation accidents (events) in nuclear medicine are contamination of work clothes or work surfaces with radionuclides, or patient fluids containing radionuclides; conducting examination without proper referral; extravasation of radiopharmaceutical. Existing systems of identification and registration of radiation accidents do not allow to identify radiation events (accidents) specific to nuclear medicine. The further research aimed at developing a classification of radiation events (accidents) in medicine and methods for responding to such events are feasible.

8006 Feedback For Fellows: Opening The Pandora's Box Of "Confidence" In Feedback

Abstract Disclosure: S. Ananthakrishnan: None. C. Noronha: None. Background: Feedback is a key component of training at any level. Sub-specialty fellowship training has unique goals and barriers to feedback exchange, such as faculty tension with giving negative feedback to potential future colleagues, that are uncommon in other training environments. A common characteristic that may be discussed in feedback exchanges is a supervisor’s perception of a trainee’s confidence. Concerns have been raised both at the local and national level regarding the potential negative effects of the word “confidence” in medical education, due to cultural, gendered, and racial biases, which can be harmful to the learning environment in endocrinology where many trainees hail from diverse geographic and cultural backgrounds. Methods: Within our institution, ACGME annual survey data between 2015-2019 indicated that a large portion of internal medicine specialty fellows were not satisfied with the feedback they received. Pilot data from a survey administered to trainees in the Department of Medicine at our institution indicated that 66.67% (n=31) of trainees had received feedback about their confidence level as observed in the clinical setting. Over 70% of those trainees felt the feedback was actionable less than half the time. The themes of frustration and ambiguity in interpreting the feedback around “confidence” emerged from the trainee data. To address perceived deficiencies in supervisor knowledge, skills and attitudes around fellowship-specific feedback exchange, we implemented departmental workshops focused on highlighting tools related to giving feedback to fellow trainees and case-based discussions to understand how and why the word “confidence” is used in feedback and how it may be interpreted by trainees. Results: This feedback workshop has been instituted within our Department of Medicine and was piloted with a focus on fellowship education in the Endocrinology section by the time of this abstract (further data forthcoming). Following the workshop, attendees (n=13) were surveyed. 76.9% of respondents had experience delivering feedback with the word or theme of “confidence”, despite 69.2% of respondents being aware of the varied meanings of the word. Following the workshops, data from faculty attendees indicated 92% of respondents were aware of the varied meaning and 99% felt more comfortable using behavioral-based, as opposed to personality-based, language to support actionable changes in fellow skills. Conclusions: This workshop curriculum suggests further need to explore the impact of the word “confidence” in feedback exchanges. Our pilot data is a call to action for further research on the development of effective strategies on how to move past use of the word “confidence” in feedback, with the goal of providing more specific, bias-free and behavioral-based feedback that can support a more inclusive learning environment for fellowship trainees. Presentation: 6/3/2024

8192 A Two-Cycle Clinical Audit Testing Inpatient Management Of Hypophosphatemia In A UK District Hospital

Abstract Disclosure: J. Porto: None. E. Ssemmondo: None. N. Obike: None. A. Abobaker: None. R. March: None. N. Tun: None. T. Pawlak: None. Objective: A clinical audit was conducted to assess if there was any improvement in management of hypophosphatemia among patients admitted to the medical wards using the local Trust protocol, following structured edcational sessions to the junior doctors covering medical wards. Design and methodology: The 2 cycles of the audit were conducted between March 2020 and September 2021 in Scarborough district Hospital. The clinical notes of 52 patients (20 in the first cycle and 32 in the re-audit) with hypophosphatemia were reviewed. These were identified using the electronic laboratory results of patients within the study period. The aspects of the trust protocol for management of hypophosphatemia that were audited; documentation of symptoms associated with low phosphate levels, cardiac monitoring in severe hypophosphatemia, identification of the likely cause of hypophosphatemia, the presence or absence of associated acute kidney injury (AKI) and initiation of phosphate replacement. The results of the first audit were presented at the local hospital clinical governance meeting (August 2020). Following this, 2 teaching sessions and 2-case based discussion on hypophosphatemia were organised for all the doctors in the department of medicine. The re-audit was subsequently conducted after the fourth teaching session. The proportions of each audited item were compared between the first audit and the re-audit using Fisher exact probability test. Results:25% of patients in the first audit had severe hypophosphatemia compared to 28% in the re-audit. In patients with severe hypophosphataemia, only 33.3% had cardiac monitoring during the re-audit cycle compared to 60% in the first cycle, and the difference was not statistically significant (p=0.58). There was significant improvement in the documentation of symptoms of hypophosphataemia amongst inpatients during the re-audit cycle compared with the initial cycle; 62.5% vs only 10% (P 0.002). Most patients had an underlying cause of the hypophosphatemia identified (80% and 62.5%-first and second cycle respectively). AKI was associated with hypophosphataemia in 15% & 34.4% (P 0.2) in the first and second cycles respectively. Despite low phosphate levels, 25% and 28.1% at the initial audit and the second cycle respectively did not receive any form of phosphate replacement. Conclusion: The two-cycle clinical audit showed that the teaching sessions on management of hypophosphatemia increased the awareness of the importance to document whether the patients were symptomatic or asymptomatic following the drop in their phosphate levels, which can help to identify patients at risk of developing complications, such as cardiac arrythmias. However, these sessions were not sufficient to improve overall management of patients with low phosphate levels. Presentation: 6/1/2024

12353 Differential Gene Expression And Pathway Analysis In Growth Hormone Secreting Pituitary Tumors According To Granulation Pattern

Abstract Disclosure: H. Shin: None. Differential gene expression and pathway analysis in growth hormone-secreting pituitary tumors according to granulation pattern. Hye Ju Shin [1], Kyung Won Kim[2], Chan Woo Kang[2], Eun Jig Lee[2], Cheol Ryong Ku[2]. [1]Department of Clinical Drug Discovery & Development, Yonsei University College of Medicine, Seoul, Republic of Korea, [2]Endocrinology, Institute of Endocrine Research, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea Objective: The purpose of this research is to explain clinical variations in patients with acromegaly by exploring gene expression differences according to granulation patterns in growth hormone (GH)-secreting pituitary tumors. Materials & methods: Transcriptome analysis was conducted on 6 normal pituitary tissues and 15 GH-secreting pituitary tumors, including 9 densely granulated somatotroph tumors (DGSTs) and 6 sparsely granulated somatotroph tumors (SGSTs). Results: The median age at diagnosis was 50 years, with a predominance of female patients (60%). We identified 3111 differentially expressed genes (DEGs) in tumors compared to normal pituitaries, with 1117 DEGs unique to a specific granulation within tumors. SGST showed enriched the pathways involved in neuronal development (axon development, axonogenesis, axon guidance, synapse and presynapse organization, gliogenesis, glial cell differentiation, nerve development, synaptic membrane adhesion, semaphorin-plexin signaling pathway involved in neuron projection guidance) and acute inflammatory response. No pathways were significantly downregulated in SGST compared with those in DGST. Three signaling pathways (JAK-STAT, phosphatidylinositol 3-kinase, and MAP cascade) and three neuronal development processes (generation of neurons, nerve development, and neurogenesis) were significantly enriched in both GO and GSEA analysis. The PPI networks constructed with the up- and downregulated DEGs consisted of 128 and 132 PPI pairs, respectively. There were 10 hub proteins, top highly connected DEGs: ANLN, TLE3, TLE2, DMD, ADRA1A, RBFOX1, MMP2, LMO1, RUNX1T1, and NPPA. Conclusion: The results indicate that granulation-specific gene expression may underpin diverse clinical characteristics in acromegaly. Overall, this study emphasizes the potential for further investigation into these transcriptomic variations and their roles in disease pathology, particularly the involvement of genes linked to neuronal development, inflammatory response, and JAK-STAT signaling in SGST. Presentation: 6/3/2024

12480 REMS Technology For The Bone Health Assessment After Hormonal Therapy In Transgender Subjects

Abstract Disclosure: F.A. Lombardi*: None. A. Russo: None. P. Pisani*: None. C. Stomaci*: None. F. Conversano*: None. R. Franchini*: None. M. Di Paola*: None. V. Racanelli*: None. S. Casciaro: None. Introduction: Sex steroid hormones play crucial roles in bone metabolism and the musculoskeletal system. These hormones interact with specific nuclear receptors, such as estrogen and androgen receptors, which are expressed in bone tissue. This interaction regulates the ongoing process of bone remodeling and induces positive effects on bone health.In this regard, it is crucial to examine the long-term impact of gender affirming hormone therapy (GAHT) on bone metabolism. Radiofrequency Echographic Multi-spectrometry (REMS) is a radiation-free technology for assessing bone mineral density (BMD) and fracture risk prediction by the analysis of the reference axial sites: lumbar spine (LS) and femoral neck (FN). REMS has been widely validated in comparison with Dual Energy X-ray Absorptiometry (DXA), showing good accuracy and precision (>90%), thereby representing a valid technology to monitor bone health status (BHS) in a short-term period. In this context, the goal of this preliminary clinical study was to track the bone health of transgender subjects for one year after starting treatment, using REMS, in order to comprehend the effects of GAHT on BHS. Methods: 7 transgender patients were recruited at Endocrinology Unit of Internal Medicine Department of Santa Chiara Hospital Trento (Italy). Among them were 4 individuals assigned male at birth (AMAB) undergoing therapy with oestradiol valerate 2 g/day and cyproterone acetate 25 mg/day, as well as 3 individuals assigned female at birth (AFAB) undergoing therapy with testosterone 25 mg/day. Before starting GAHT, patients underwent LS-DXA scan, followed by monitoring of BHS by REMS technology after 12 months from the start of treatment. Results: The results show an increase of T-score values in AMAB (-0,3 ± 0,3 REMS vs -1,8 ± 1,8 DXA) after estrogen treatment starting, and no effect on bone in AFAB subjects after GAHT (0.5 ± 0.4 REMS vs 0.9 ± 0.4 DXA); this is due to:-the protective effect of estrogen therapy in AMAB subjects against bone loss;-the combined effect of the decrease of estrogen together with the increase of testosterone in AFAB ones. Conclusions In summary, these initial findings indicate that REMS could be appropriate for monitoring the bone health status of these individuals, confirming the anticipated beneficial effects of estrogen therapy on bone loss in AMAB individuals. The limitation of the study is the lack of REMS data at the beginning of the treatment, but the possibility of carrying out the technique in subsequent evaluation times will allow us to evaluate the change in bone mass during hormonal reaffirmation therapy and compare it with the progress of the measurements obtained with DXA data ones. Presentation: 6/2/2024

Assessment of renal response in Tunisian patients with proliferative lupus nephritis under three different induction immunosuppressive agents: A prognostic retrospective study.

The aim of our study was to evaluate the renal response (RR) of three immunosuppressive protocols in the induction treatment of proliferative lupus nephritis (PLN) in a Tunisian population. We performed a retrospective prognostic cohort study in the Internal Medicine Department of the Habib Thameur University Hospital in Tunis from January 2000 to December 2023, and included kidney biopsy proven proliferative lupus nephritis patients. Three induction treatments were compared: High CYP regimen: glucocorticoids (GC) + IV cyclophosphamide (CYP) in monthly pulses of 0.7g/m2 for 6 months; Low CYP regimen: GC + IV CYP in biweekly pulses of 500mg for 3 months; and MMF regimen: GC + oral MMF 1.5g twice daily for 6 months. The primary endpoint was the incidence of RR (complete and partial remission) at one year post-diagnosis. The additional outcomes were end-stage kidney disease (ESKD), severe adverse events (AEs) and death. Our study included 78 PLN patients (High CYP: 17, Low CYP: 40, MMF: 21). The study found that 94.1% of patients receiving High CYP achieved the primary endpoint, RR, compared to 67.5% of those receiving Low CYP and 61.9% in the MMF group. For the additional outcomes, there were 3 cases of ESKD, all in the Low CYP group, 5 cases of death (4 in the Low CYP group and 1 in the MMF group), and 20 cases of severe AEs, all of which were severe infections (5 in the High CYP group, 12 in the Low CYP group, and 3 in the MMF group). Multivariate analysis showed that the High CYP regimen was more associated with RR than the MMF regimen, with an adjusted OR of 9.846 (95% CI: 1.087-98.210); p = 0.042. Multivariate analysis did not show statistically significant differences between the High CYP regimen and the Low CYP regimen in terms of RR. As an induction treatment for PLN, the High CYP regimen was strongly associated with a higher rate of RR than the MMF regimen. There were no statistically significant differences between the High CYP regimen and the Low CYP regimen in terms of RR.

Special Issue on Informatics Education A Longitudinal Graduate Medical Education Curriculum in Clinical Informatics: Function, Structure, and Evaluation.

There is a need to integrate informatics education into medical training programs given the rise in demand for health informaticians and the call on the Accreditation Council for Graduate Medical Education (ACGME) and the body of undergraduate medical education (UGME) for implementation of informatics curricula. This report outlines a 2-year longitudinal informatics curriculum now currently in its seventh year of implementation. This report is intended to inform United States (US) Graduate Medical Education (GME) program leaders of the necessary requirements for implementation of a similar program at their institution. The curriculum aligns with the core content for the subspecialty of clinical informatics (CI) and is led by a multidisciplinary team with both informatics and clinical expertise. This educational pathway has a low direct cost and is a practical example of the academic learning health system (aLHS) in action. The pathway is housed within an internal medicine department at a large tertiary academic medical center. The curriculum has yielded 13 graduates from both internal medicine (11, 85%) and pediatrics (2, 15%) whose projects have spanned acute and ambulatory care and multiple specialties. Projects have included Clinical Decision Support (CDS) tools, of which some will be leveraged as substrate in applications seeking extramural funding. Graduates have gone on to CI board certification and fellowship, as well as several other specialties, creating a distributed network of clinicians with specialized experience in applied CI. An informatics curriculum at the GME level may increase matriculation to CI fellowship and more broadly increase development of the CI workforce through building a cadre of physicians with HIT expertise across specialties without formal CI board certification. We offer an example of a longitudinal pathway which is rooted in aLHS principles. The pathway requires a dedicated multidisciplinary team and departmental and IT leadership support.

Outcomes of pediatric in-hospital cardiac arrest in the emergency department of a tertiary referral hospital in Tanzania: a retrospective cohort study

BackgroundCardiopulmonary resuscitation (CPR) is an emergency procedure performed to restore heart function to minimize anoxic injury to the brain following cardiac arrest.Despite the establishment of emergency department and training on Pediatric Advanced Life Support (PALS) at Muhimbili National Hospital (MNH) the outcomes of pediatric in-hospital cardiac arrest have not been documented. We ought to determine the outcomes and factors associated with 24-h survival after pediatric in-hospital cardiac arrests at MNH in Tanzania.MethodsWe conducted a retrospective study of all patients aged 1 month to 18 years who had in-hospital cardiac arrests (IHCA) prompting CPR in the Emergency Medicine Department (EMD) at MNH, Tanzania from January 2016 to December 2019. Data was collected from electronic medical record (Wellsoft) system using a standardized and pretested data collection form that recorded clinical baseline, pre-arrest, arrest, and post-arrest parameters. Bivariate and multivariable logistic regression analyses were performed to assess the influence of each factor on 24-h survival.ResultsA total of 11,951 critically ill patients were screened, and 257 (2.1%) had cardiac arrest at EMD. Among 136 patients enrolled, the median age was 1.5 years (interquartile range: 0.5–3 years) years, and the majority 108 (79.4%) aged ≤ 5 years, and 101 (74.3%) had been referred from peripheral hospitals. Overall stained return of spontaneous circulation was achieved in 70 (51.5%) patients, 24-h survival was attained in 43 (31.3%) of patients, and only 7 patients (5.2%) survived to hospital discharge. Factors independently associated with 24-h survival were CPR event during the day/evening (p = 0.033), duration of CPR ≤ 20 min (p = 0.000), reversible causes of cardiac arrest being identified (p = 0.001), and having assisted/mechanical ventilation after CPR (p = 0.002).ConclusionIn our cohort of children with cardiac arrest, survival to hospital discharge was only 5%. Factors associated with 24-h survival were CPR events during the daytime, short duration of CPR, recognition of reversible causes of cardiac arrest, and receiving mechanical ventilation. Future studies should explore the detection of decompensation, the quality of CPR, and post-cardiac arrest care on the outcomes of IHCA.

Prevalence of Adhesive Capsulitis in Patients With Type 2 Diabetes Mellitus: A Single-Center Cross-Sectional Study From Pakistan.

Background An inflammatory condition leading to stiffness and pain in the shoulder joint, adhesive capsulitis is associated with conditions such as diabetes mellitus, cervical spondylosis, thyroid dysfunction, autoimmune rheumatic diseases, and shoulder injury due to trauma, fracture, rotator cuff tear, surgery, or immobilization. Adhesive capsulitis may affect a notable proportion of the diabetic population. There are numerous studies that show that patients with type 2 diabetes mellitus are not only at higher risk of developing adhesive capsulitis but also suffer poor outcomes despite treatment, especially in patients with long-standing diabetes mellitus. Furthermore, there is significant variation in data regarding the prevalence of adhesive capsulitis in Pakistani patients with type 2 diabetes mellitus. Objective To determine the prevalence of adhesive capsulitis among patients with type 2 diabetes mellitus presenting to a tertiary care hospital in Bahawalpur, Pakistan. Methods The present observational cross-sectional study was carried out at the Department of Medicine, Bahawal Victoria Hospital, Quaid-e-Azam Medical College, Bahawalpur, Pakistan, from February 2024 to August 2024. Type 2 diabetes mellitus was labeled by HbA1c of more than 7.0%, or two random blood glucose levels of 200 mg/dL or more, or an existing diagnosis of diabetes mellitus, and/or use of anti-hyperglycemic therapy. Adhesive capsulitis was diagnosed clinically on the basis of history (gradual onset shoulder pain with limitation of movements) and examination (reduction in active and passive range of motion (ROM) of the shoulder, especially abduction, internal rotation, and external rotation) in the absence of significant abnormalities on shoulder X-ray. After ethical approval and obtaining informed consent, 430 patients with type 2 diabetes mellitus were included in the study using a non-probability consecutive sampling technique. Demographic information, diabetes control, and HbA1c levels were noted, and the patients were assessed for adhesive capsulitis. All the data was recorded and entered into IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, NY, USA), for analysis. Results Having a female preponderance (266, or 61.9%), the mean age of the participants was 54.0 ± 13.1 years. With regard to occupational status, 126 (29.3%) had a sedentary occupation, 45 (10.5%) were unemployed, and 259 (60.2%) had a non-sedentary occupation. The mean diabetes duration was 6.4 ± 5.3 years, and the majority of patients had poor diabetes control (322, or 74.9%). Adhesive capsulitis was present in 61 (14.2%) patients with type 2 diabetes mellitus. On stratification, no significant statistical association of adhesive capsulitis was seen with gender (p-value: 0.075), age (p-value: 0.465), occupation (p-value: 0.056), diabetes duration (p-value: 0.118), or diabetes control (p-value: 0.090). Conclusion Adhesive capsulitis was not an uncommon finding in our study, reported in almost one-fifth of the 430 patients enrolled. We recommend that treating physicians screen diabetic patients for adhesive capsulitis so that proper pain relief, physiotherapy, and rehabilitation may be provided timely and efficiently, thereby reducing morbidity and improving the quality of life for such patients.

Intracranial injuries in the autopsy material of the Department of Forensic Medicine of the Medical University of Lodz with analysis of anatomical lesions caused by traumatic brain injuries

BackgroundIn 2022, 408 autopsies were performed in the Department of Forensic Medicine of the Lodz Medical University, of which as many as 82 concerned deaths with intracranial injuries, which represents about 20 % of all performed autopsies. AimThe article presents a comparative analysis of deaths of people with intracranial injuries in terms of frequency, the structure of victims (gender, age, sobriety), type of injury (intracranial bleeding, bruises of nerve tissue, nerve tissue tears, posttraumatic brain oedema, etc.), causes and circumstances of death, place of death (house, hospital, street) survival time, type of tool/object used, and the obtained data were compared with publications from other departments of forensic medicine. ResultsThe victims were definitely male. Regarding age, deaths mainly concerned people between 31 and 70. The most common cause of death was multi-organ injuries, craniocerebral, intracranial and the least other injuries. Regarding the circumstances of the deaths, most of the cases were accidents; the fewest were homicides.

Paul Farmer: A Pioneer of Global Health, Health Equity, and Health Advocacy.

Paul Farmer, a distinguished physician and anthropologist known by many as a pioneer in global health endeavors, made a profound impact on the landscape of healthcare. Through his innovative approaches to healthcare delivery and his unwavering commitment to social justice and health equity, he changed the landscape of healthcare on a global scale. He was a Kolokotrones University Professor, Chair of the Department of Global Health and Social Medicine at Harvard Medical School, Chief of the Division of Global Health Equity at Brigham and Women's Hospital in Boston, Chancellor of the University of Global Health Equity in Rwanda, and Chief Strategist and Co-founder of Partners In Health (PIH). PIH is an international non-profit organization that embarked on research and healthcare advocacy initiatives, providing direct healthcare services for those in resource-limited communities worldwide. Farmer, through his development of innovative and heartfelt approaches to healthcare delivery and social justice medicine, exemplified how integrating community engagement and social determinants of health can lead to transformative healthcare solutions and ultimately improve patient experiences. This vignette explores Farmer's early life, educational journey, and major contributions to medicine and social justice in healthcare, emphasizing the enduring impact of his work on public health and future generations of medical professionals.

Association between serum albumin and disease severity of non-cystic fibrosis bronchiectasis

Background Bronchiectasis is a chronic debilitating but neglected pulmonary disease. It is associated with substantial health related burden and health care costs. However, the biochemical parameters related to disease severity have not been sufficiently assessed. Objective: Aim of the present study to find out any association between serum albumin and disease severity of non-cystic fibrosis bronchiectasis. Methods This was a cross-sectional observational study of 33 subjects with non-cystic fibrosis bronchiectasis at department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital (NIDCH) from December 2019 to March 2021. After taking informed written consent BSI score be calculated and blood was taken for to measure serum albumin. Data was collected through questionnaire. After completion of the data collection, analysis was done with the help of Statistical Package for Social Science (SPSS) version 22. Results Mean age of the study subjects was 43.36 ± 15.65 years with a range of 21 -76 years and more likely to be men (60.6%). History of previous pulmonary tuberculosis found in 48.5% subjects as associated conditions and pseudomonas aeruginosa (21.2%) was the most common organisms in sputum culture. 87.9% of the study subjects had history of exacerbation within last 12 months and 60.6% were hospitalized within last 2 years. More than half (54.6%) of the study subjects had severe, 33.3% had moderate and 12.1% had mild bronchiectasis with the mean BSI score of 9.00 ± 3.05. Mean serum albumin was 3.22 ± 0.84 g/dl. Albumin had a significant negative correlation with BSI score (r = -0.457 and p = 0.008). Conclusion The serum albumin had moderate correlation with disease severity of non-cystic fibrosis bronchiectasis. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1104-1111

Learning Networks: How Family Medicine Departments Are Meeting the Requirement.

In 2023, the Accreditation Council for Graduate Medical Education added participation within a "learning collaborative" or "learning network" (LN)as a requirement for family medicine residencies. The structure and scope of what makes an acceptable LN was only vaguely defined. The purpose of this study was to learn how many family medicine residencies associated with departments already belong to LNs, the purpose and funding of these existing LNs, and barriers to entering LNs. An online survey was sent to family medicine department chairs through a Council of Academic Family Medicine Educational Research Alliance omnibus study from August to September 2023. Survey questions explored the purpose, structure, and funding of LNs that associated residency programs already belonged to as well as the chairs' beliefs and knowledge about LNs. Of the 227 chairs, 119 completed the survey (50.2%). About 53% reported that their department was part of an LN, with more than one-third belonging for 5 years or less; 47% had a low understanding of what an LN is; and 71% had little to no concern that collaborating in an LN would negatively affect residency recruitment. The purpose of most LNs was a mix of research, education, and clinical activities. Faculty's lack of knowledge about LNs and lack of time were the top barriers identified to joining an LN. Funding was varied, and departmental funding was positively associated with administrative control of the LN. About half of the residency programs associated with family medicine departments already belong to LNs. Wide variation among existing LNs may lead to significantly disparate outcomes for residents and residencies as they navigate this new requirement.

Vitamin D Insufficiency In Type 2 Diabetics: AHospitalBased Evaluation Of Incidence And Severity

Objective: The objective of the study was to determine the frequency and intensity of vitamin D insufficiency in individuals with type 2 diabetes mellitus (DM). Methods: This retrospective investigation was carried out in the Department of Medicine over a one-year period. After receiving the consent of the patients and approval from the Ethical committee, a total of 200 participants were recruited for the study. Out of them, 100 healthy individuals were included as the case group (Group-A) and 100 patients with type-2 diabetes mellitus were enrolled as the control group (Group-B). Results: A total of 120 individuals (60% males and 40% females) were included in the study. Our study revealed that 38% of the participants fell within the age range of 40-50, while 32% were between 50-60 years old. Additionally, 16% were below the age of 40, and 14% were above the age of 60. Out of the total sample, 35 individuals (35%) had been diagnosed with diabetes for a duration of 1-5 years, 45 individuals (45%) for 6-10years, and 20 individuals (20%) for more than 10 years. Out of the total sample, 6 individuals (6%) werediagnosed with ischemic heart disease, whereas 18 individuals (18%) had hypertension as a result of vitamin D insufficiency. Diabetes patients with well-managed HbA1C levels had 10 instances of adequate, inadequate, and insufficient levels of Vitamin D, while uncontrolled diabetes patients had 8 instances, 34 instances, and 18 instances respectively. Conclusion: Diabetic patients have a higher prevalence of vitamin D insufficiency compared to the general healthy population. The majority of afflicted patients were male, and the deficit was most commonly identified in the uncontrolled group