Five-day Course Research Articles

Providing recovery support to wounded, injured, and sick UK military personnel throughout the COVID-19 pandemic

ABSTRACT Health precautions implemented by the United Kingdom (UK) government to limit the spread of the Coronavirus Disease 2019 (COVID-19) led to the closure of many well-being support services in 2020. This created a need to re-think how impactful recovery support courses can be provided. One such service was that of the five-day Multi Activity Course (MAC) which was redesigned in accordance with national health guidelines to allow continued access for Wounded, Injured and Sick (WIS) military personnel to the service; the positive impacts of which are well established. This study investigated the influence of the newly developed Reduced numbers MAC (R-MAC) on the WIS participants lives during and for 12 months after attending. The R-MAC led to comparable impacts for participants well-being, at a time in which people’s mental well-being was often being adversely affected. The positive mental well-being of the 261 participants improved by 33% throughout the course and remained 14% higher for the 37 participants who provided data six months after attending. Key facets of the experience that were most impactful for the participants were (i) shared experience with other veterans, (ii) discussing issues in a safe environment while receiving support from the staff and (iii) developing knowledge around self-help/personal development. Adapting to the challenging circumstances and developing the R-MAC mitigated against the already adverse impact of the COVID-19 pandemic for the WIS participants.

ACUTE DIGITAL GANGRENE TRIGGERED BY COVID-19 COAGULOPATHY

ACUTE DIGITAL GANGRENE TRIGGERED BY COVID-19 COAGULOPATHY

Efficacy of Single Dose of Fosfomycin Versus a Five-Day Course of Ciprofloxacin in Patients With Uncomplicated Urinary Tract Infection.

Introduction and objective: Treatment has become more challenging due to an aging population, polypharmacy and high prevalence of comorbid illness, antimicrobial antibiotic allergy or sensitivity, an increase in the number of individuals with underlying immunological or structural abnormalities, as well as the frequency of multidrug-resistant infections. Many multidrug-resistant bacteria are still susceptible to nitrofurantoin and fosfomycin, two ancient medicines. Their high urine concentrations and low toxicity give them an advantage over newer medications. This study aimed to compare the efficacy of a single dose of fosfomycin versus a five-day course of ciprofloxacin in patients with uncomplicated urinary tract infections.Methodology and data collection procedure: This randomized control trial was conducted in the Department of Medicine, Benazir Bhutto Hospital, Rawalpindi. A total of 46 patients were enrolled. Patients were divided randomly into two groups by using the lottery method. In group A, patients were given a single 3 g dose of oral fosfomycin. In group B, patients were given oral ciprofloxacin (500 mg) daily for five days. Then patients were followed-up in the Outpatient Department (OPD) for 28 days. After 28 days, patients were evaluated for resolution of symptoms (as per operational definition). Patients in whom symptoms would not be resolved were managed as per standard protocol. All this information was recorded on proforma.Results: The average age of the patients in group A was 39.41±9.80 years while in group B that was 41.32±17.76 years. In both groups, 23 females were equally divided. The mean duration of symptoms in group A was 4.78±1.98 days while in group B was 4.95±1.29 days. The minimum duration of symptoms was three days and the maximum was 10 days. In group A, there were 15 (65.21%) patients with efficacy achieved, and among eight (34.78%) patients, efficacy was not achieved while in group B, there were 15 (65.21%) patients in which efficacy was achieved, and among eight (34.78%) patients, efficacy was not achieved. There was no significant association between efficacy and study groups as the p-value was not significant (p=0.87). Conclusion: The conclusion of the study was that in the treatment of simple urinary infections, a single dose of fosfomycin had equal efficacy and tolerability as a five-day course of ciprofloxacin.

State and prospect of application immunocorrection therapy in castration of piglets and 5‐month‐old boars in pig breeding farm

One of the most widespread surgical interventions is the castration of piglets and 5‐month‐old boars without breeding selection being a criterion in conditions of intensive development of the pig breeding industry. This work aims to use immunocorrection therapy, methods and system of their use, technological simplicity, and efficiency in boars castration in the pig breeding industry.The research was done with the help of the pig breeding industrial complex and Kostroma State Agricultural Academy. 87 hybrid boars at the age of 5 months (F1) were used. In total, two cycles of experiments were carried out. For the first cycle, 49 animals were divided into 7 groups (n=7) to define the effectiveness of using different methods and schemes of immunocorrection therapy in post‐castration complications and its impact on product indicators. In the second cycle of the research, performance indicators of pig‐meat production were studied on the control group (n = 9) and experimental group (n = 29) of boars by using the best immunocorrection therapy according to the first cycle of the research.Thymogen injection is a synthetic immunomodulatory dipeptide, an analog of one of the thymus hormones. Ribav (mycovit) is a natural origin alcohol‐based drug for local use immunocorrectors. Both immunocorrectors were used for the research.Research results: decrease of complications with an open surgical way of castration in the experimental group on 28,57% (control group 57,14%) especially in the group treated with thymogen and Ribav in post castration time; similar results were received considering local reactions as hyperemia and less edema; the same indicators were higher than in the control group at the closed technique of castration. It can be caused by an immune reaction to suture material ‐ Polycon; Ribav was more effective at the open technique of castration than at closed, which is explained by the accessibility of local wound treatment; the average daily gain in live weight in the groups treated with thymogen and Ribav was 0.551 ± 0.13 and 0.618 ± 0.09 versus 0.406 ± 0.04 kg in control, meat yield rate 77.0 ± 0.58 and 76.40 ± 0, 29 versus 76.85 ± 0.14 in control with 85.71% safety in the experimental groups versus 81.43% in control.Thus, Thymogen is preferable according to its manufacturability and cost indicators.In the second cycle of experiments with its use, the gain in live weight exceeded the indicators of the control group by 18.6% without significant differences in meat on the bone and its yield. At the same time, it should be noted that the safety of the livestock, as in the first series of experiments, was 7.6% higher in the experimental group (96.55 versus 88.89%).Thus, thymogen post castration injections or Ribav (mukovit) local irrigation treatment with a five‐day course at a postoperative period reduce the risk of post castration complications on 14,28 ‒ 28,57% in the condition of pig breeding intensification, reduce emersion of local reactions, increases the safety among 5‐month‐old boars by 14.28 ‐ 28.57%.As a result, it is better to use treatment schemes based on using Ribave with the closed technique of castration on small pig farms when personal care is possible.

Effect of thymogen immunocorrected boar castration on biochemical indicators

The article presents the results of the dynamics of indicators of protein, nitrogen and carbohydrate metabolism during castration of boars in industrial production against the background of immunocorrection with thymogen. The studies were carried out on 14 boars (aged 5 months), selected by random sampling from 38 animals in compliance with the principle of paired analogues and divided into two groups ‒ control and experimental ones (n=7 in each). All boars were castrated by an open method with preoperative medical support according to the methodology adopted in the farm. Animals of the experimental group were additionally injected with thymogen for a five-day course. During the experiment, the content of C-reactive and total proteins, albumin, globulin, urea, creatinine, glucose was determined in the blood serum. Albumin-globulin ratio was determined by the calculation method. According to the results of the experiment, it was found that castration of boars was accompanied in both groups at all stages of the experiment by an increase in the content of C-reactive protein, changes in protein metabolism, mainly in the catabolic phase of the postoperative period ‒ a decrease in the concentration of total protein, globulin below the norm in the control group with similar dynamics of indicators in the experimental group, but within the reference intervals. Further dynamics were positive in the direction of normalization at the anabolic phase. The dynamics of urea and creatinine in both groups had a wave-like character, not going beyond the normative values, the level of urea increased with a subsequent decrease, creatinine – vice versa. Their final levels were lower than the original ones.The use of thymogen largely leveled the intensity of changes in the catabolic phase of the pathological process and contributed to the normalization of the biochemical profile at the final stage of the experiment.

Gender-Affirming Vaginoplasty: A Patient Perspective on Informational Needs

ABSTRACT Introduction Gender-affirming vaginoplasty lacks universally-adopted guidelines for perioperative management. The Standards of Care developed by the World Professional Association for Transgender Health recommend surgeons provide an extensive consultation with the patient; explaining the surgery itself as well as informing the patient on pre- and post-operative expectations. With the copious amount of information to know about this process, patients may also turn to friends, support groups, the internet, etc. to find the details for themselves. We believe it would be useful to develop an inclusive guidebook outlining the entire vaginoplasty journey. Objective With this study, we sought to determine what information patients seek throughout their process of gender-affirming vaginoplasty. We hope to use the results from this study to inform the development of patient resources. Methods This study consisted of an anonymous survey emailed to 30 patients who underwent gender-affirming vaginoplasty between September 2018 and September 2020 with our team. The survey was composed of Likert-scale items that explored the importance of various topics. Patients were also asked from whom and how did they receive information regarding perioperative considerations and where they would have preferred to get it from. Descriptive statistics were used to analyse these responses. Free-text boxes allowed patients to comment on any additional topics that may be missing, provide advice for future patients, and offer suggestions for alternative methods of education/information delivery. A thematic analysis was performed on the qualitative portion of the survey. Results Seventeen individuals completed the questionnaire (56.6% response rate). All topics received an average rating of moderately important or higher (≧ 3 out of 5 on the Likert scale). The topics which got the lowest scores were Fertility Preservation and Preventative Cancer Screening. Of the 30 pre-operative topics queried, participants preferred to receive information in written form for 29 of them (97%), and from the surgeon (rather than other health care providers, friends, or the internet) for 27 topics (90%). A document outlining the expected five-day hospital course and one with post-discharge instructions were rated as very or extremely helpful by 85% and 77% of participants, respectively. Thematic analysis revealed five main themes; recovery process, satisfaction, trust in healthcare providers, information delivery, and neovaginal dilation and depth. Conclusions Individuals undergoing gender-affirming vaginoplasty have extensive informational needs and these are likely best addressed by their surgical team with a combination of written resources and verbal discussion with the patient. Participants recognized the importance of all topics enquired about, however neovaginal dilation and pelvic floor physiotherapy were particularly hot topics as seen in the thematic analysis. The importance of cultural competence and being able to build a trustworthy relationship with their healthcare providers were prominent findings of this study, underscoring the challenges that transgender patients face in interacting with the health care system. We hope these findings will contribute to creating patient-centered resources for transgender women undergoing vaginoplasty. Disclosure No

Abstract P1-13-03: Radiotherapy vs. endocrine therapy for hormone receptor positive early stage breast cancer accounting for endocrine therapy adherence

Abstract Purpose/Objective(s):. Several trials have compared endocrine therapy (ET) alone vs. ET and radiotherapy (RT) in low risk early stage estrogen receptor (ER)-positive breast cancer and have shown that the addition of RT to ET modestly reduces the rate of loco-regional recurrence (LRR) without altering survival. ET may also yield modest reductions in contralateral breast events. ET alone has thus become a standard strategy in select patients. Data evaluating the efficacy of RT alone are scarce. However, the toxicity of ET is not trivial and its effectiveness is dependent upon treatment adherence. As RT courses become ever shorter and safer, a re-evaluation of the strategy of RT alone is warranted. This analysis reports on the treatment outcomes of ER-positive early stage breast cancer treated with adjuvant RT or ET alone at a multi-hospital health system. We hypothesized that adjuvant RT alone would yield loco-regional control comparable to that of ET alone and that ET adherence would influence outcomes. Materials/Methods:. The shared electronic health record of multiple facilities within a university health system was queried to identify women with pathologic T1-2 N0 breast cancer treated with breast-conserving surgery between 2007 and 2016. Data collection included demographic features, tumor characteristics, treatment type, and evidence of LRR. Analysis was restricted to those patients with ER positive disease who underwent either RT alone or ET alone. Five-year LRR were compared across groups using the Kaplan-Meier method. Results:. 240 patients met inclusion criteria. Of these, 86 were treated with RT alone and 154 with ET alone. Patient, tumor and ET variables are listed in the table below. ET adherence and duration information were available for 135 out of 154 patients who received ET alone. Patients who completed 5 years of ET or whose ET was discontinued due to the disease recurrence or death were categorized as ET-adherence (ET-A). Patients who discontinued ET before reaching 5 years due to other reasons were categorized as ET-non adherence (ET-NA). Median ET duration in ET-A was 60 months (range, 15-101 months) and in ET-NA was 13 months (range, 1-54 months). The 5-year rates of LRR for RT alone vs. ET alone were 4.1 % (95% CI 0-8.8) vs. 5.0 % (95% CI 1.1-8.9). The 5-year rates of LRR for ET-A vs. ET-NA were 2.0 % (95% CI 0-4.7) vs. 16.4 % (95% CI 1.1-31.7). While the difference in the LRR rates between RT alone vs. ET-A was not statistically significant (p= .481), ET-NA was associated with significantly higher LRR rate compared to RT alone or ET-A (p<.05). The rate of ET non-adherent rate was 21.4%. Conclusion:. RT yielded LRR equivalent to overall ET and superior to ET non-adherence. For patients with early stage ER+ breast cancer, a prospective randomized trial comparing RT to ET and evaluating quality of life (QoL) is needed. In light of emerging data, a five-day course of RT can be considered as an alternative to five years of ET, and RT should be strongly considered if ET adherence is in doubt. Table 1.Patient, tumor and treatment characteristicsRT alone (n=86)ET alone (n=154)Median follow-up (months)50.6 (1-135)48 (3-114)Age (median)63 (39-91)74 (50-87)StageT176 (88.4%)142 (92.2%)T210 (11.6%)12 (7.8%)HistologyGrade 38 (9.3%)9 (5.8%)+LVI5 (5.8%)3 (2.0%)Endocrine Therapy (ET)ET duration (median, months)-57 (1-101)ET-Adherent-102 (66.2%)ET-Non adherent-33 (21.4%)ET duration not available-19 (12.3%) Citation Format: Seung Won Seol, Travis Pflederer, Lauren Weller, Chelain Goodman, Eric D Donnelly, John P Hayes, Jonathan B Strauss. Radiotherapy vs. endocrine therapy for hormone receptor positive early stage breast cancer accounting for endocrine therapy adherence [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-13-03.

Building Physician-Scientist Skills in R Programming:A Short Workshop Report.

Introduction:Statistical analysis programs require coding experience and a basic understanding of programming, skills which are not taught as part of medical school or residency curricula.Methods:We conducted a five-day course for early-career Nigerian physician-scientists interested in learning common statistical tests and acquiring R programming skills. The workshop included didactic presentations, small group learning activities, and interactive discussions. A baseline questionnaire captured participant demographics and solicited participants’ level of confidence in understanding/performing common statistical tests. REDCap questionnaires were emailed to obtain feedback on educational format and content. A post-workshop assessment covered participants’ overall impression of the program.Results:A total of 23 participants attended the program. Most participants were male (n=14, 60.9%) and at an early stage in their career (assistant professor, n=20, 87.0%). Approximately 70% of respondents indicated having received some prior training in statistics. The proportion of participants without experience using R and SAS software (90% and 85%, respectively) was greater than the corresponding proportions for Stata (55%) and SPSS (20%). Prior to the workshop, most respondents expressed being “not at all confident” in performing one-way ANOVA (60%), logistic regression (68%), simple linear regression (60%), and McNemar’s test (80%). There was a statistically significant post-workshop improvement in the level of confidence in understanding and performing common statistical tests. The course was rated on a 0–100 scale as “moderately difficult” (mean ± SD: 51.7 ± 19.5). Most participants felt comfortable in putting the knowledge learned into practice (82.2 ± 17.1).Conclusion and Public Health Implications:Introductory R can be taught to junior physician-scientists in resource-limited settings and can inform the development and implementation of similar training initiatives in analogous settings.

Nasal Decolonization to Reduce Surgical Site Infections

Background: Surgical site infections is one of the most common healthcare-associated infections. Staphylococcus aureus remains the most common etiologic agent causing surgical site infections. Studies confirm Staphylococcus aureus carriage increases the risk of Staphylococcus aureus surgical site infections. The purpose of this paper is to review the strategies to reduce surgical site infections due to Staphylococcus aureus focusing on nasal decolonization. Results: Published studies indicate screening patients for Staphylococcus aureus nasal carriage and decolonizing carriers during the preoperative period decreases the risk of S aureus surgical site infections in cardiac and orthopedic surgery. Most studies use combined chlorhexidene bathing and mupirocin for patients colonized with Staphylococcus aureus since colonization of multiple body sites is common and combination chlorhexidene bathing and intranasal mupirocin has been shown to be more effective at eradicating Staphylococcus aureus colonization. Mupirocin remains the best topical agent at eradicating nasal Staphylococcus aureus. Mupirocin has been shown to eliminate nasal colonization by over 90% with a five-day course, however, concerns over resistance have led to development of alternative agents. Nasal povidone-iodine, alcohol-based nasal antiseptic, and photodynamic therapy are promising new interventions, but more studies are needed. Conclusions: Short term nasal mupirocin is still the most studied and effective topical agent in eradicating Staphylococcus aureus nasal colonization. However, increasing mupirocin resistance remains an ongoing concern and newer agents are needed. Keywords: nasal decolonization, surgical site infections, mupirocin, healthcare-associated infections

Pfizer COVID-19 antiviral paxlovid authorised by MHRA

A second oral antiviral for the early treatment of COVID-19 has been approved by the Medicines and Healthcare products Regulatory Agency (MHRA). Paxlovid — a combination of two active ingredients, PF-07321332 and ritonavir — was approved after final trial results suggested a five-day treatment course reduced the risk of COVID-19-related hospitalisation and death within 28 days […]

Dynamics of hematological parameters during castration of boars on the background of immunocorrection

Pig breeding is one of the leading farm industries for the production of meat products. Castration is one of the techniques that help to increase the productivity of animals and regulate the quality of meat (eliminating the “smell of boar meat”). Its disadvantage is the presence of post-castration complications. An effective method of reducing their number is the use of drugs that have an immunotropic effect.Therefore, we conducted an experiment to find out the effect of one of this drug group representatives (timogen) on the dynamics of hematological parameters during castration of boars.The data of hematological studies (during the experiment) signified a violation of homeostasis, manifested in the first fourteen days after castration by the development of anemia (a decrease in the number of erythrocytes and hemoglobin) and thrombocytopenia, which (like erythropenia) was recorded against the background of anisocytosis. At the same time, the results, reflecting the picture of white blood, indicated an inflammatory process accompanied by leukocytosis, due to both the absolute and the relative number of lymphocytes, as well as the absolute number of medium-sized cells (MID). On the 30th day of observation, an increase in the number of erythrocytes and hemoglobin relative to the 14th day was noted against the background of a decrease in platelets and leukopenia.Thus, immunocorrection with a five-day course of timogen made it possible to neutralize the negative effect of surgical intervention on hematopoiesis, which allowed us to avoid sharp fluctuations in the morphological composition of red and white blood.

The enduring well-being impacts of attending the Battle Back Multi Activity Course for the lives of recovering UK armed forces personnel

ABSTRACT Few adventurous training courses have been formally designed to assist military personnel in their recovery and/or transition into civilian life by supporting psychological health and well-being. This study examines, for the first time, the longitudinal effects of a five-day Multi Activity Course (MAC) on the mental well-being of serving but wounded, injured, and/or sick (WIS) UK armed forces personnel. The MAC is delivered using a participant-centered approach to encourage engagement in adaptive sports, adventurous activities, and personal development coaching sessions. This work extends previous research showing powerful short-term well-being benefits. Measures of positive well-being and psychological need satisfaction were provided by participants before and after attending the course, as well as two weeks, three months, six months and 12 months later. Self-reported well-being measures of psychological need satisfaction and positive mental well-being improved significantly throughout the course. These remained significantly higher at six and 12 months after the course, respectively.

Evaluating the Clinical Outcomes of Remdesivir Among Patients Admitted With COVID-19 in a Tertiary Care Hospital.

Introduction: This study was conducted to determine whether remdesivir administration for treatment of coronavirus disease 2019 (COVID-19) is associated with reducing deaths among COVID-19 hospitalized patients.Methodology: It was a retrospective study, and the data was acquired at Ziauddin Hospital in Karachi, Pakistan. All patients admitted between February and May 2021 with severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection confirmed by polymerase chain reaction testing from nasopharyngeal samples were included in the study, including those who received at least five-day treatment of remdesivir and who did not receive even a single dose of remdesivir.Results: Data of overall 174 patients were used, out of which 71 (40.80%) received remdesivir. After propensity score matching, 71 patients in the remdesivir group were successfully matched with the non-remdesivir patients on the basis of age, gender, and disease severity. Results of multivariable logistic regression showed that there is no significant difference in deaths between patients who received remdesivir and patients who did not receive remdesivir (p-value=0.122). However, the length of hospital stay was significantly lower in the remdesivir group than in the control group (p-value=0.001).Conclusion: Results of this study can provide evidence that remdesivir can be efficient in reducing the duration of COVID-19 illness, and a five-day course of treatment is sufficient for patients to get clinical benefits.

Snowshoeing and winter camping as an experiential programme for physical education

ABSTRACT Snowshoeing is a traditional winter movement activity, but it is not very often utilised in formal physical education. This research study investigates whether snowshoeing and winter camping are suitable for use in university physical education and how the experience of such activities can benefit students. Eight students (five men, three women) participated voluntarily in this qualitative research study, participating in a five-day snowshoeing course with four nights spent in tents in the mountains in winter. After semi-structured interviews and participatory observation, the data were subjected to interpretative phenomenological analysis. There are three main topics anchored in that data. First, the participants’ experience can become a form of meditation in motion with various mental states, such as deep concentration, or what they describe as ‘head off’ or ‘shutting down’ the mind. The second theme is the connection, the sense of belonging to the group. The last theme is the real experience of nature in winter, as opposed to the routine of everyday life. A programme of snowshoeing and camping in tents in a natural environment in winter can enrich physical education and can help students gain a better understanding of the holistic essence of the human way of being.

Effectiveness, relevance, and feasibility of an online neurocritical care course for African healthcare workers

The majority of neurological disorders exist in low- and middle-income countries, but these nations have the fewest neurologists and neurological training opportunities worldwide. The objective of this study was to assess the effectiveness, relevance, and feasibility of a five-day neurocritical care course delivered online to African healthcare workers and to understand participants' prior neurological and neurocritical care training experiences. We offered the Neurocritical Care Society's Emergency Neurological Life Support (ENLS) course covering 14 neurocritical conditions via Zoom to 403 African healthcare workers over a 4-day period. An additional day was devoted to management of neurological emergencies in resource-limited settings. Participants completed pre- and post-course surveys to assess the effectiveness, relevance, and feasibility of the overall course to their settings. 318 participants (46% female; 56% residents; 24% neurologists; 9.0 ± 6.7 years practicing medicine) from 11 African countries completed the pre-course self-assessment, and 232 completed the post-course self-assessment. 97% reported prior experience caring for patients with neurological emergencies but only 35% reported prior neurology training and 9% prior neurocritical care training. Pre-course and post-course comfort levels showed statistically significant improvements (p < 0.001) across all fourteen neurocritical topics. 95% of participants found the course relevant to their current practice setting, 94% agreed the Zoom online platform was easy to use, and 93% reported it facilitated their learning. Suggestions for course improvement included addition of non-critical neurological conditions and inclusion of locally available diagnostics and treatment modalities. Study results suggest virtual platforms may offer a way to improve neurology training in areas with reduced neurological workforce.

A Comparison of Outcomes in Early-Stage Breast Cancer After External Beam Radiotherapy, Endocrine Therapy, Both, or Neither: A Retrospective Cohort Study Across a Large Health System

Several trials have compared endocrine therapy (ET) alone vs. ET and radiotherapy (RT) in low-risk early-stage ER+ breast cancer and have shown that the addition of RT to ET modestly reduces the rate of loco-regional recurrence (LRR) without altering survival. ET alone has thus become a standard strategy in managing these patients. Data evaluating the efficacy of RT alone is scarce. However, the toxicity of ET is not trivial, so as RT courses become ever shorter and safer, a re-evaluation of the strategy of RT alone is warranted. This analysis reports on outcomes of early-stage node-negative breast cancer treated with RT, ET, both, or neither at a multi-hospital health system. We hypothesized that RT alone yields comparable LRR to ET alone in ER+ positive early-stage breast cancer.The shared electronic health record of multiple facilities within a university health system was queried to identify women with pathologic T1-2 N0 breast cancer treated with breast-conserving surgery between 2007 and 2016. Data collection included demographic features, tumor characteristics, treatment type, and evidence of LRR. Analysis was restricted to those patients with ER+ disease. Five-year LRR were compared across groups using the Kaplan-Meier method. A multivariate analysis was performed to identify factors associated with LRR.1340 patients met inclusion criteria. Of these, 84 were treated with RT alone, 155 with ET alone, 1042 with both RT and ET, and 59 received breast conserving surgery only. Demographic and tumor variables are listed below. The 5-year rates of LRR for RT, ET, both, and neither, respectively, were 4.2% (95% CI 1.4-12.7), 5.6% (95% CI 2.6-11.7), 0.6% (95% CI 0.2-1.4), and 31.9% (95% CI 19.8-48.6). While not receiving any adjuvant therapy was associated with significantly higher rate of LRR (P < 0.001), the difference between RT and ET alone was not significant (P = .395). On multivariate analysis, age < 50 (HR 3.3; 95% CI 1.5-7.1), high grade (HR 2.5; 95% CI 1.1-5.8), and observation (HR 9.8; 95% CI 3.2-29.6) were associated with higher LRR, whereas receipt of both RT and ET was associated with lower LRR (HR 0.2; 95% CI 0.1-0.5).RT yielded LRR equivalent to ET in this population, while the combination was superior to either treatment alone. For patients with early-stage ER+ breast cancer, a prospective randomized trial comparing RT to ET and evaluating quality of life (QoL) is needed. In light of new trial data, a five-day course of RT can be considered; this treatment may yield equivalent LRR and better QoL than a five-year course of ET.

The effectiveness of a monopreparation containing a combination of ciprofloxacin – ornidazole in the treatment of infectious-inflammatory and dysbiotic vagina diseases

Introduction. Infectious inflammatory and dysbiotic diseases of the vagina represent a major concern facing obstetric and gynecological science. Individually, the two most common specific diseases can be distinguished, namely: bacterial vaginosis (BV) and nonspecific vaginitis (NV). The therapeutic strategy for these diseases requires a word of clarification and adjustment.Objective. To conduct a comparative analysis of treatment with the combination drug Orcepol WM (ciprofloxacin (500 mg) and ornidazole (500 mg)) and a combination of monopreparations in a dosage form similar to Orcepol WM.Materials and methods. As a comparison object, we used the method of simultaneous administration by patients of tablet forms of ciprofloxacin and ornidazole as mono-preparations in a dosage of 500 mg similar to Orcepol. The study included 64 patients with diagnoses of “bacterial vaginosis” or “nonspecific vaginitis” or "decompensated mixed vaginal dysbiosis". The average age of the patients was 35.34 ± 5.95 years. The patients were divided into two groups: group 1 (n = 32) received the combination drug Orcepol WM, group 2 (n = 32) received ciprofloxacin and ornidazole with two mono-preparations. The drugs were prescribed as a five-day course, two times a day. The patients were followed up by a doctor during two visits and one remote interview on day 30–45 after the end of treatment (visit 2).Results. In both groups, all patients received a full course of antibacterial therapy. There were no adverse drug reactions. In both groups, there was an improvement in clinical symptoms from the first to the second visit: discomfort, itching, burning, dyspareunia, hyperemia of the mucous membrane against the background of normalization of laboratory findings of the vaginal microbiocenosis condition. At the same time, the best results were higher in group 1. Manifestation of mycotic vaginitis with the development of strong clinical symptomatology on days 3 and 4 of treatment respectively were recorded in 4 (12.5%) patients from group 1 and 7 (21.9%) from group 2. The results of comparative observation showed that the number of relapses after the end of therapy were the same in group 1 (8 out of 32 patients, 25%) and in group 2 (9 out of 32 patients, 28%). The relapse occurred on average day 12 and 17 after the end of therapy, respectively.Сonclusion. Thus, the use of Orcepol WM showed a greater therapeutic efficacy as compared to the use of tablet forms of ciprofloxacin and ornidazole in similar dosages as a single-drug administration, which can be explained by a stronger patients' adherence to the treatment.

S2776 A Rare Case of Pseudomonas Aeruginosa Colitis and Subsequent Bacteremia in the Setting of Alcohol-Induced Cirrhosis

Introduction: Pseudomonas aeruginosa is an opportunistic bacterium that commonly causes pneumonia and urinary tract infections. While cases of P. aeruginosa colitis have been infrequently reported, we identify a unique case of P. aeruginosa bacteremia occurring after antibiotic-treated P. aeruginosa colitis in a patient with alcohol-induced cirrhosis. Case Description/Methods: A 38-year-old male with class III obesity and alcohol use disorder presented with cramping abdominal pain, vomiting and dark stool. There was no recent hospitalization and no antibiotic or intravenous drug use. Last alcoholic drink was reported to be several days prior to presentation. Physical exam identified scleral icterus, abdominal distension without tenderness, and hepatomegaly. Laboratory test results are outlined in Table 1. Serum acetaminophen and alcohol levels were not detected. Urinalysis and chest x-ray were unremarkable. Ultrasound demonstrated cirrhotic liver morphology and ascites, but no cholelithiasis. Ceftriaxone was started due to concerns for an upper gastrointestinal bleed. On day 2, he developed watery diarrhea. Stool cultures were positive for P. aeruginosa, prompting antibiotic transition to cefepime. Clostridioides difficile testing was negative. He completed a five-day course of cefepime with resolution of diarrhea and leukocytosis. Subsequently, he was started on methylprednisolone for treatment of alcoholic hepatitis, and later discharged on a tapering dose. Eleven days later, he returned with vomiting and generalized weakness, and was admitted to the intensive care unit with pansusceptible P. aeruginosa bacteremia and septic shock. Unfortunately, clinical condition continued to deteriorate despite maximal medical therapy, and he ultimately expired. Discussion: P. aeruginosa has rarely been described in association with colitis. To our knowledge, this is the first reported case of P. aeruginosa colitis in a patient with alcohol-induced cirrhosis, and the first case of P. aeruginosa bacteremia after previously treated colitis. While the optimal duration of treatment for P. aeruginosa colitis is not well defined, this case supports extended antibiotic courses for the treatment of P. aeruginosa infections in decompensated cirrhosis and cautious post-treatment steroid utilization.Table 1.: This table depicts initial admission laboratory testing results for the patient’s two separate admissions.

Leptospirosis: A Rare Cause of Acute Hepatitis

Leptospirosis is a zoonotic infection caused by the pathogenic Leptospira interrogans. Humans acquire the infection either through direct contact with the urine of infected animals, commonly rats or indirect contact of contaminated water or soil. It is a rare cause of acute hepatitis in the UK with fewer than 100 reported cases a year and hence diagnosis is commonly delayed. A 51-year-old fit Caucasian gentleman was admitted with a one-week history of painless jaundice, dark urine and pale-coloured stools. This was associated with feeling unwell, anorexia, nausea and intermittent epigastric discomfort. He binges on alcohol on a weekend. He works as a telephone engineer which occasionally exposes him to sewage water. On clinical examination, he was icteric with mild right hypochondriac tenderness. Liver biopsy was performed and histologically it was suggestive of leptospirosis. He was started on a five-day course of intravenous ceftriaxone followed by two days course of oral doxycycline. His IgM leptospirosis result finally came back as positive. Due to the rarity of leptospirosis in the UK, the serological testing of leptospirosis is only performed in the Rare and Imported Pathogens Laboratory in Porton Down, Salisbury leading to a delay in getting the result. The patient underwent an invasive procedure which can be avoided if the leptospirosis serology was ordered early and result available quickly. Fortunately, the patient made a full recovery after two months. Leptospirosis should be considered in an individual with acute hepatitis and a history of exposure to sewage.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S22

Teaching disability using problem-based learning in the international context: utility for social work

ABSTRACT Through their anti-oppressive professional practice and commitment to social justice and human rights, social workers can ensure people with disability exercise voice and agency and claim full citizenship in society. Yet, international research shows that ‘disability’ is often inadequately included in social work education, and that students may not graduate with the skills and knowledge needed to engage appropriately with people with disability. This article evaluates the effectiveness of using a short five-day hybrid course that integrated problem-based learning (PBL) and traditional teaching methods to deliver disability content to 42 German social work students. A qualitative SWOT (strengths, weaknesses, opportunities, and threats) method was utilised. Written responses from students were collected and thematically analysed. The analysis indicated that the PBL format was well-liked by students, many of whom showed evidence of increased self-directed and deep learning, better communication skills, and synthesis of theory and practice. Importantly, students were able to internationally contextualise and challenge discourses that perpetrated stigma and discrimination, positioning them as effective advocates for people with disability. The social justice focus of social work justifies the inclusion of the critical examination of the lived experience of people with disability in social work curriculum. The research findings suggest that PBL short courses can provide an effective and flexible means of delivering disability content in social work education.