Full Examination Research Articles

Improving the use of Nabers probes for furcation detection during periodontal assessment in dental curricula

INTRODUCTION Detection of furcation involvement (FI) is an integral part of full periodontal examination. The aims of this study were to: 1) investigate the extent to which furcation assessment was performed and recorded by undergraduate and postgraduate students on clinic; 2) evaluate the perceptions of teachers about possible problems in relation to furcation assessment among students; and 3) assess the impact of the dental school’s educational interventions on the improvement in furcation assessment among students. METHODS Students were interviewed after their periodontal assessment. This occurred in three different settings: undergraduate and postgraduate treatment clinics, and new patient assessment clinics. Teachers were also interviewed about their perceptions of the students’ quality of furcation assessment. Students were re-surveyed following educational interventions to improve their furcation detection. RESULTS The baseline questionnaire showed that only 44% of the undergraduate students checked for FI; this compared with 83% of postgraduate students. Of those undergraduate students who assessed FI, only 13% used a Nabers probe and 63% did not record their finding in the patient’s notes. Following educational interventions, 56% of the undergraduates performed furcation assessment, with 78% of these using a Nabers probe. CONCLUSIONS Furcation assessment is often missed during the full periodontal examination carried out by undergraduate dental students and Nabers probes are rarely used. However, teaching interventions have the potential to improve the students’ learning experience and therefore also patient care.

Professional and Psychological Influence of the COVID-19 Pandemic on the Training of Medical Residents.

Coronavirus disease 2019 (COVID-19) has profoundly impacted residency and fellowship training and education. However, how and to what extent the COVID-19 pandemic in Lebanon compromised the daily involvement of trainees on the clinical and ethical levels is currently unknown, which this study will shed light on. We conducted a cross-sectional survey (30 questions) targeting medical residents delivering healthcare services in Lebanon. Residents from different specialties were included in the study to assess the effect of the pandemic on their education and the ethical obstacles they faced when dealing with patients. A total of 221 postgraduate medical students participated in our study. Results showed that about half of the residents (52.1%) were only able to do a basic physical examination rather than a full examination as a mandatory requirement in the residency curriculum. The majority (60%) agreed that the doctor-patient relationship is contravened. In addition, almost all residents suffered from fear and emotional distress that affected their education (83.7%). The findings of this study identify the effect of COVID-19 on residents' training, which affects treatment outcomes and greatly impacts the mental well-being of both healthcare workers and patients.

Physical examination for the detection of sexually transmitted infections among transgender women and travestis in Brazil: acceptability and associated factors.

This study aimed to determine the acceptability and factors associated with uptake of a physical examination for the detection of symptomatic sexually transmitted infections (STIs) by transgender women and travestis in Brazil. TransOdara was a multi-centric, cross-sectional STI prevalence study conducted among transgender women and travestis in five capital cities (Campo Grande, Manaus, Porto Alegre, Salvador and São Paulo) representing all Brazilian regions, between December 2019 and July 2021. A total of 1,317 self-identified transgender women and travestis aged ≥18 years were recruited using respondent-driven sampling and responded to a standard questionnaire. A medical consultation was offered including a physical examination and collection of samples from multiple sites to detect various STIs. Factors associated with uptake were investigated by reviewing demographic characteristics of participants who gave permission for physical examination (general, genital, and anorectal). Most participants (65.4%, 95% confidence interval - 95%CI 62.7-68.0) gave permission for a general examination (including oropharyngeal), with fewer permitting genital (42.3%, 95%CI 39.6-46.0) or anorectal (42.1%, 95%CI 39.4-44.9) examinations. Overall, 34.4% (95%CI 31.8-37.0) of participants refused all examinations. Participants with STI symptoms were significantly more likely to give permission for full examination than asymptomatic participants (64.3 vs. 37.4%, adjusted odds ratio - AOR=3.6, 95%CI 2.4-5.5). Other factors significantly associated with uptake of a full examination in multivariate analysis included age (AOR=1.5 for ≥25 years), religion (AOR=1.7 for Afro-Brazilian, AOR=1.9 for other religions compared to no religion), and education (AOR=2.0 for higher-level). In the context of STI management, this study found limited acceptance of anogenital examinations among transgender women and travestis, with higher acceptance among those with STI symptoms.

Aflibercept or ranibizumab for diabetic macular edema.

Vascular endothelial growth factor (VEGF) is the primary substance involved in retinal barrier breach. VEGF overexpression may cause diabetic macular edema (DME). Laser photocoagulation of the macula is the standard treatment for DME; however, recently, intravitreal anti-VEGF injections have surpassed laser treatment. Our aim was to evaluate the efficacy of intravitreal injections of aflibercept or ranibizumab for managing treatment-naive DME. This single-center, retrospective, interventional, comparative study included eyes with visual impairment due to treatment-naive DME that underwent intravitreal injection of either aflibercept 2 mg/0.05 mL or ranibizumab 0.5 mg/0.05 mL at Al-Azhar University Hospitals, Egypt between March 2023 and January 2024. Demographic data and full ophthalmological examination results at baseline and 1, 3, and 6 months post-injection were collected, including the best-corrected distance visual acuity (BCDVA) in logarithm of the minimum angle of resolution (logMAR) notation, slit-lamp biomicroscopy, dilated fundoscopy, and central subfield thickness (CST) measured using spectral-domain optical coherence tomography. Overall, the 96 eyes of 96 patients with a median (interquartile range [IQR]) age of 57 (10) (range: 20-74) years and a male-to-female ratio of 1:2.7 were allocated to one of two groups with comparable age, sex, diabetes mellitus duration, and presence of other comorbidities (all P >0.05). There was no statistically significant difference in baseline diabetic retinopathy status or DME type between groups (both P >0.05). In both groups, the median (IQR) BCDVA significantly improved from 0.7 (0.8) logMAR at baseline to 0.4 (0.1) logMAR at 6 months post-injection (both P = 0.001), with no statistically significant difference between groups at all follow-up visits (all P >0.05). The median (IQR) CST significantly decreased in the aflibercept group from 347 (166) µm at baseline to 180 (233) µm at 6 months post-injection, and it decreased in the ranibizumab group from 360 (180) µm at baseline to 190 (224) µm at 6 months post-injection (both P = 0.001), with no statistically significant differences between groups at all follow-up visits (all P >0.05). No serious adverse effects were documented in either group. Ranibizumab and aflibercept were equally effective in achieving the desired anatomical and functional results in patients with treatment-naïve DME in short-term follow-up without significant differences in injection counts between both drugs. Larger prospective, randomized, double-blinded trials with longer follow-up periods are needed to confirm our preliminary results.

The prevalence of functional amblyopia and its related risk factors in preschool children in North-Eastern Iran.

Purpose was to determine the prevalence of amblyopia and its related risk factors in children aged 3-6 years in Bojnurd, north-eastern Iran. In this cross-sectional study, from 12,331 children aged 3-6 in Bojnurd, 6600 children participated in annual amblyopic screening program and among them, around 1100 suspected cases were referred for full ophthalmic examinations. Measurement of visual acuity, cycloplegic refraction, subjective refraction, and cover test were performed for all participants. Amblyopia was defined as CDVA of 0.2 LogMar or less in each eye or 2-line difference or more in best-corrected visual acuity between two eyes. The prevalence of amblyopia was estimated 0.95% (95% confidence interval [CI]: 0.73%-1.2%). There was no relationship between amblyopia with age and genders. Most amblyopic children were hyperopic (61.9%; 95% CI: 48.7-73.8). Strabismus was found in 17.4% of amblyopic patients (95% CI: 9.05%-29.09%). Approximately half of the amblyopic children were anisometropic (55.5%; 95% CI: 42.40%-68.08%). The most common type of amblyopia was anisohyperopic (55.56%; 95% CI: 42.5%-67.5%). The prevalence of bilateral amblyopia was more than unilateral amblyopia. The assessment of data showed that hyperopia, astigmatism, and anisometropia were the most common causes of amblyopia in this study. The prevalence of amblyopia was estimated about 1% in north-eastern Iran. Our study indicated a valuable information around the effect of refractive error and anisometropia on amblyopia which could be helpful in designing a comprehensive vision screening program for preschool children.

Corneal and epithelial thickness mapping in diabetic patients using optical coherence tomography

Purpose To evaluate corneal and epithelial thickness using the anterior segment optical coherence tomography and to correlate these changes with major disease parameters, that is duration of the disease, status of control (glycated hemoglobin level), and stage of diabetic retinopathy. Patients and methods Corneal and epithelial thickness profile of 25 patients diagnosed with diabetes mellitus and 25 healthy individuals were measured by anterior segment optical coherence tomography. Full ophthalmological examination of all patients was done. The disease duration and the glycated hemoglobin levels were recorded. Results In diabetic patients, there was nonsignificant thinning in mean central epithelial thickness (P=0.14). The mean central corneal thickness is slightly thicker, however, it did not reach significance (P=0.051). There was statistically significant thickening in central stromal thickness (P=0.015). There was a significant negative correlation between the severity of retinopathy and superior epithelial thickness (P=0.037). The duration of the disease showed significant correlation with most of epithelial thickness values, however, HA1c level was not found to have any statistically significant effect on corneal and epithelial parameters. Conclusion Chronic metabolic stress of diabetes has an impact on corneal epithelium and stroma. Severity of diabetic retinopathy should be considered as a risk factor during corneal surgeries to avoid epithelial and stromal-associated complications.

Clinical aspects of human Bocavirus 1 in a sample of Egyptian infants with acute lower respiratory tract infection: A pilot study

Background/aim The recent advance in molecular technology permitted a comprehensive range of novel viral etiological causes to be detected in respiratory tract specimens. The human Bocavirus 1 (HBoV1) as a virus of the Parvoviridae family recently was defined as a human pathogen mainly linked to acute respiratory infection in children. Our aim was to identify the rate and seasonal variation of Bocavirus 1 infection and their correlation with the different clinical presentations in Egyptian infants less than 2 years old with acute lower respiratory tract infection. Patients and methods This study enrolled 100 infants aged from 4 weeks to 2 years presenting with symptoms of acute respiratory infection from Materia Hospital and Alzahraa University Hospital. Full medical history, general and local examination of the chest focusing on respiratory rate and plain chest radiograph were collected from each infant. In addition, pharyngeal swabs were collected from participated infants and were subjected to DNA extraction followed by PCR using different viral protein-targeted primer sets. Results Bronchopneumonia was the prominent diagnosis in the enrolled infants (38%) followed by bronchiolitis (34%) and bronchitis (28%) subsequently. The presence of HBoV1 among studied patients was 8% and the peak of the infection was in January (37.5%) followed by April (25%) and July (25%). Most of patients with HBoV1 positive were presented with respiratory distress and refusal of feeding. Seven percent of all patients were presented with diarrhea. Conclusions HBoV1 infection may be considered as a risk factor for lower respiratory tract infections in Egyptian children less than 2 years old.

Understanding the Etiopathogenesis of Non-Arteritic Anterior Ischemic Optic Neuropathy with Laboratory Findings.

The role of inflammation and hemostasis in non-arteritic anterior ischemic optic neuropathy (NAION) was investigated by examining related blood tests. The predictive values of these laboratory indicators and their effects on prognosis were reviewed. In this study, 48 patients diagnosed with NAION and 50 healthy volunteers were included. All subjects underwent full ophthalmological examination. All patients were treated with oral corticosteroids (methylprednisolone 1 mg/kg/day) for 15 days after that corticosteroid medication was reduced and stopped. Each patient was monitored at least for 12 months. The mean platelet volume (MPV), platelet distribution width (PDW), neutrophil/lymphocyte ratio (NLR), and red cell distribution width (RDW) values were recorded. These findings were compared with control group. The mean MPV, RDW, and NLR values were significantly higher in NAION group (respectively, p<0.001, p=0.006, and p<0.001). There was no statistically significant difference between group 1 and group 2 in PDW values, but the mean PDW value was higher in the patient group compared to the control group (p=0.435). Based on the receiver operating characteristic (ROC) curve, the NLR had the strongest predictive value. This was followed by MPV, RDW, and PDW with lower diagnostic predictive values. MPV, NLR, and RDW were found to be elevated and have diagnostic predictive values in NAION patients. Easily accessible and simple laboratory methods could help us show systemic inflammation and ischemic events in NAION patients. As a result, inflammatory reactions besides ischemic changes may play a role in the etiopathogenesis of NAION. These biomarkers can be evaluated to ensure that patients with risk factors for the development of NAION.

Skin Barrier Parameters in Acne Vulgaris versus Normal Controls: A Cross-Sectional Analytic Study.

Data of objective skin barrier parameters in acne patients with and without therapy compared with normal controls are limited. This information could provide more insight into the pathogenesis of acne vulgaris and optimal acne treatment. To measure and compare skin barrier parameters in a large cohort of acne patients with and without therapy compared with normal controls. This cross-sectional analytic study was conducted on healthy Thai volunteers. After completing a questionnaire on their general information and skincare routine, volunteers received a full skin examination and were divided into subjects with and without acne. Skin barrier parameters, including the transepidermal water loss (TEWL), skin hydration and sebum production were measured and compared between the two groups. Factors that may affect each parameter were analysed and adjusted for in a multivariate regression analysis. In addition, data from acne patients with and without treatment were evaluated. The study included 316 volunteers (164 acne patients, 152 controls), mostly female (79% acne, 78% controls). The mean age of the acne group was considerably lower than that of the control group (34 vs 48.6 years (p < 0.001)). Acne patients showed significantly higher TEWL (13.16 vs 10.63 g/m²/day, p < 0.001), sebum production (median 3 vs 0 A.U, p = 0.002), and skin hydration (244.60 vs 222.60 uS, p = 0.001). These differences remained significant after adjusting for confounding factors. Additionally, significant differences were observed between controls, acne. Patients receiving and not receiving acne medications. The highest TEWL was observed in acne patients receiving treatment, followed by untreated acne patients and normal controls (p = 0.0003). Skin hydration exhibited a comparable pattern (p = 0.03). There were significantly higher TEWL, sebum production and hydration in acne patients. Acne treatment further impaired the skin barrier. These findings support the possible benefits of moisturisers with barrier-enhancing properties in patients receiving acne medications.

Chatgpt Revolutionizes Education: Improves Learning Through Conversational AI

The instructive atmosphere is assumed novel gears by artificial intelligence (AI), which takes the control to transform out-of-date education and knowledge approaches. This article delivers a full examination of artificial intelligence (AI) skills, their likely habits in teaching, and the encounters related with them. We dialog around chatbots and connected procedures that can impersonator human-human communications and generate script that seems humanoid when assumed natural language effort. Current chatbots, such as ChatGPT, have many aids, but their tender in the schoolroom grants important ethical and applied subjects as well. In adding to inspiring accountable and moral usage, the writers expect to proposal valued info on how AI may be positively combined into the instructive situation to advantage both teachers and scholars.

Optic disc morphology and interocular symmetry in children.

The purpose of the study was to obtain a pediatric reference database for optic disc parameters and interocular symmetry. To ascertain factors that modify these parameters (age, spherical equivalent [SE], and sex). This was a cross-sectional study. 90 patients aged 5-17 years fulfilled all the inclusion criteria. After a full examination including cycloplegic refraction, all patients underwent optical coherence tomography (OCT) of the papilla using the three-dimensional (3D) scan protocol of the Topcon 3D 2000 OCT device. We provide reference values for optic disc parameters in the pediatric population. We also retrieved interocular symmetry reference values for these parameters. The multivariate regression analysis did not reveal variations in any of the optic disc parameters associated with age, sex, or SE (all P ≥ 0.126). The 95th percentile limit for absolute interocular differences for the cup-to-disc area ratio was 0.24. The multivariate regression analysis revealed the absence of a correlation between asymmetry of the optic disc parameters and age, sex, and the interocular difference in SE (all P ≥ 0.105). Pediatric reference databases for optic disc parameters and ranges of normality for interocular symmetry provide key diagnostic support in diseases that affect the optic nerve.

Head and neck cancers: epidemiology, diagnosis and treatments

Introduction: Head and neck cancers (HNC) affect many subsites in the upper aero-digestive tract. The risk factors include tobacco smoking, chewing betel nut/paan, excessive alcohol consumption, hereditary factors and viruses such as human papillomavirus (HPV) and Epstein–Barr virus (EBV). Early diagnosis, lifestyle changes and HPV vaccination will improve survival. Epidemiology: Globally, recent estimates from GLOBOCAN shows there are 890,000 cases of head and neck cancers annually and 450,000 deaths annually (1). There is an increasing incidence of oral cavity, lip, buccal cancers in the developing world due to higher consumption of tobacco, alcohol and chewing areca nut. There has been an increasing incidence of some HNC due to high-risk strains of human papillomavirus (HPV) (2). Cancers caused by HPV include tonsil cancer, tongue base cancer and unknown primary cancers. The EBV causes nasopharyngeal cancers especially in the Far East. There is a decreasing incidence of some cancers caused by smoking such as laryngeal and hypopharyngeal cancers mainly due to the reduction in smoking rates in some developed countries. Overall, there is a predicted increase in HNC of up to 30% annually by 2030 (2). The HPV-associated cancers affect mainly younger males, who do not necessarily smoke or drink alcohol. The HPV is a strong prognostic factor so patients with HPV positive cancers respond better to treatment as there are less genetic mutations when compared to cancers driven by tobacco smoking. These trends are alarming with socioeconomic impacts. Diagnosis: Symptoms of HNC include difficulty swallowing, persistent sore throat, difficulty breathing, hoarseness, neck lumps, referred pain to the ear, weight loss, and systemic symptoms in advanced disease. A full ENT examination is performed of the oral cavity, oropharynx, neck and ideally flexible nasendoscopy. Ultrasound-guided FNAC or core biopsy of neck lumps are performed. Cross-sectional imaging with CT or MRI scans followed by tumour biopsies either under local or general anaesthetic. Tumour biopsies are assessed using H&amp;E stains, and tests for HPV detection (p. 16 immunohistochemistry, in situ hybridisation or polymerase chain reaction). A PETCT scan is useful for staging cancers, identifying the origin of unknown primary cancers and for surveillance. Treatments: The head and neck cancer multidisciplinary team reviews all investigations and recommends either curative or palliative treatment options that are in every patient’s best interests. Surgery can be open, endoscopic or with the use of a robot. Microvascular reconstruction with flaps is performed as necessary to improve function and quality of life. Oncologic treatments include intensity-modulated radiotherapy (IMRT), which can be combined with chemotherapy. Immunotherapy is a second-line treatment for recurrent HNC currently. Advanced cancers can be treated with palliative intent or best supportive care especially if the patients are frail and have significant comorbidities. There are ongoing clinical trials and research studies exploring better, less-toxic treatments. Multiomics approach and artificial intelligence are exciting developments. Conclusion: There is an increasing incidence of some HNC especially cancers driven by tobacco smoking, alcohol consumption and high-risk human papillomaviruses. Smoking cessation, HPV vaccination, early diagnosis and improvements in treatments are important factors in ensuring good outcomes.

Decreased bone mineral density is associated with an increased number of teeth with periodontitis progression: a 5-year retrospective cohort study

ObjectiveLongitudinal studies on the systemic bone loss-periodontitis relationship are limited with disparate results. The aim of this study was to investigate the association between bone mineral density (BMD) and periodontitis progression, controlling for other covariables in a Thai population.Materials and methodsIn 2,418 participants, BMD values of the lumbar spine, femoral neck, and total hip were measured with dual-energy X-ray absorptiometry at baseline. Each participant’s BMD status was classified as normal, osteopenia, or osteoporosis. Full mouth periodontal examinations on 6 sites/tooth were performed at baseline and 5-year follow-up visits. Periodontitis progression was defined as a tooth presenting an additional proximal CAL loss of ≥ 3 mm or an additional lost tooth with a baseline CAL ≥ 5 mm. The risk effects of BMD status on the number of teeth with periodontitis progression were analyzed using multivariate Poisson regression.ResultsBaseline BMD status of osteoporosis was associated with an increased number of teeth with periodontitis progression in the subgroups of postmenopausal women, non-smokers, and participants with periodontitis stage III/IV with adjusted risk ratios of 1.31 (95% CI = 1.09–1.58), 1.19 (95% CI = 1.04–1.36), and 1.13 (95% CI = 1.00–1.28), respectively.ConclusionBaseline BMD in the osteoporosis range increased the risk of having a greater number of teeth with periodontitis progression in specific participant subgroups.Clinical RelevanceDecreased BMD is a potential factor affecting periodontitis progression risk in some individuals. Multidisciplinary approaches in educating and maintaining patients’ bone-oral health may help improve their quality of life.

Pattern of Bacterial Infections in Paediatric Patients with Chemotherapy-Induced Neutropenia

Objectives: To determine the frequency of bacterial infections and their sensitivity to various antibiotics in paediatric cancer patients having chemotherapy-induced neutropenia. Study Design: Cross-sectional study Place and Duration of Study: Paediatric Oncology ward, Combined Military Hospital, Rawalpindi Pakistan, from Jul 2018 to Jan 2019. Methodology: A total of 205 children aged one year to 12 years undergoing chemotherapy and having neutropenic fever were included. Complete history, full physical examination and related blood, microbiological and radiological investigations were undertaken. Antibiotics were given as per protocol. Results: In our study, the bacterial infections in paediatric cancer patients with chemotherapy-induced neutropenia was found in 45(21.95%) patients. Of these, gram-positive organisms were found in 25(55.5%) patients and gram-negative in 20(44.4%). Conclusion: The frequency of bacterial infections in paediatric patients with chemotherapy-induced febrile neutropenia is quite high, with a high percentage of gram-positive bacteria.

QUANTITATIVE AUTOFLUORESCENCE IN CENTRAL SEROUS CHORIORETINOPATHY.

Central serous chorioretinopathy (CSC) is associated with pachychoroid and dysfunctional retinal pigment epithelium. Autofluorescence (AF) is typically altered. The authors performed this study to quantify these alterations using quantitative AF (qAF) in patients with CSC and in their fellow eye in comparison with a healthy control group. Patients with CSC and healthy controls were recruited prospectively. All patients received a full clinical examination including best-corrected visual acuity, enhanced depth imaging-optical coherence tomography, and qAF. Quantitative autofluorescence images were taken with a confocal scanning laser ophthalmoscope (Heidelberg Engineering). Quantitative autofluorescence values were assessed in specified regions of the inner eight and the middle ring of the Delori grid. In total, 141 eyes of 77 patients with CSC were included. Ninety eyes had a manifest CSC (group 1) while 51 fellow eyes (group 2) did not show signs of CSC. There were no significant differences of qAF values between these two groups: mean qAF values were 241.3 (inner eight) and 212.8 (middle ring) in group 1 and 235.9 (inner eight) and 210.0 (middle ring) in group 2 ( P = 1.0 and 1.0). We compared these eyes with healthy controls comprising 39 eyes. Quantitative autofluorescence signals (inner eight: 164.7; middle ring: 148.9) differed significantly compared with both CSC manifest ( P < 0.001) and fellow eyes ( P < 0.001). Our results show that patients with CSC have increased qAF values in both eyes with manifest CSC and asymptomatic, clinically unremarkable fellow eyes in comparison with healthy controls. This finding suggests that qAF alterations are present even before clinical signs can be observed.

Study on the Digital Reassembly of Yoni Monument Excavated from Cella of Hong Nang Sida, Lao PDR

During the dismantling of the cella of the Hong Nang Sida temple in Laos, 100 highly significant Yoni-monument members were recovered as fragmented individual stones. To restore the Hong Nang Sida temple to its former glory, it is necessary to restore the fragmented Yoni-monument members to their original positions. However, the high weight and low mobility of the stones make it difficult to physically reassemble the story members. Therefore, this study utilized three-dimensional (3D) scanning, modeling, and printing technologies to digitally reassemble the Yoni monument. To achieve this goal, optimization modeling was performed to connect the three-dimensional (3D) scanning data of individual fragmented stones, after which each story member was reduced to a 1/5 of its original size and printed by sand printing to evaluate the feasibility of physical assembly. Finally, 3D scans of the Yoni monument assembled using the sand-printing outputs were taken, and all the story members were virtually aligned based on the scan data to complete the digital reassembly. We believe that the results of this study will improve the feasibility and completeness of the physical reassembly by allowing for a full preliminary examination of stone blocks, which would otherwise be difficult to achieve because of the risk of secondary damage or weight limitation. In particular, it is possible to objectively and visually illustrate the geometric relationship between the members of each story, which can be extended to similar stone-based cultural heritage sites. To broaden the utility of the digital-reassembly model, it must be evolved into a historic building information model that links the unstructured data, including documents, photos, and images, obtained throughout the process life cycle.

Онлайн-обучение врачей неонкологических специальностей по профилактике и ранней диагностике злокачественных новообразований кожи.

One of the reasons for the late diagnosis of malignant skin neoplasms (hereinafter referred to as MNS) is the insufficient knowledge of doctors in non-oncology specialties [1], [2]. The sensitivity for recognizing cutaneous melanoma (hereinafter referred to as MNS) during a visual examination by primary care physicians is 40,2% [3]. The sensitivity of recognizing MNS for an inexperienced dermatologist is 69%, compared to the sensitivity of diagnosing MNS by an experienced dermatologist is 92% [4]. Also, the reason for the late diagnosis of MNS is an insufficiently complete examination of patients. Evidence suggests that doctors do not routinely offer full body mole screening. Up to 63% of patients diagnosed with MK visited their GP in the year before diagnosis. Only 30% of dermatologists perform a full body skin examination on all of their patients [5]. Thus, an important method is the education of doctors of non-oncology specialties in the form of training programs in the principles of early diagnosis of cancer, which in turn can help improve the oncological epidemiological situation [9]. The purpose of this study is to study the effectiveness of organizing an 8-hour online training aimed at raising the awareness of nononcology doctors on the prevention and early diagnosis of cancer. Material and methods. An 8-hour online course «Early diagnosis of skin tumors» was conducted for doctors, created by a group of authors on the platform «Personal Account of a Doctor at the Volga Research Medical University.» The training course included the following issues: risk factors for MK and other cancers, a description of the diagnostic algorithm using the ABCDE method with an illustration of each sign on photographic images, differential diagnosis of skin tumors, prevention with an emphasis on protection from ultraviolet radiation. The course used 82 photographs of MNS. The illustrated material consisted of 30 images of MK, 25 images of basal cell skin cancer (BCSC), 15 images of seborrheic keratoma of the skin, 12 images of skin hemangiomas. Conclusion. As a result of online training, one can note an improvement in the level of knowledge of doctors after completing an online course aimed at the prevention and early diagnosis of cervical cancer. Increasing the specificity of diagnosing nevi (0,846, 0,953) before and after, respectively, can help reduce costs in the “secondary level” of healthcare. The topic of prevention presented in the course also contributes to conducting preventive conversations with patients and correct patient routing. Thus, conducting online training has a number of advantages and shows good learning results. The diagnostic methods discussed in the course, aimed at clarifying the diagnosis of cancer, especially in the early stages of the disease, predetermine the choice of optimal treatment tactics and are the key to ensuring the best prognosis of the disease.

Hepatitis B immunization status and risk factors of people aged 1 to 69 in Huangpu District, Shanghai, China.

China has long been with high Hepatitis B Virus(HBV) prevalence in the world. The HBV prevalence of people aged 1-59 decreased to less than 8% in 2006, and by 2020, HBsAg positive rate of children aged <5 decreased to less than <1% which was due to the free three-dose hepatitis B(HepB) immunization for newborns nationwide since 2002. Huangpu district was selected as one of the pilot areas for free Hep B vaccination in newborns since 1986, which formed an early protection in the population from mother-to-child transmission. However, the existed HBV infected people were still needed to be discovered, evaluated whether to receive antiviral therapies and intervened with health education in order to reduce the incidence of viral hepatitis related hepatocellular carcinoma (HCC) and also reach the goal to eliminate public health hazards of viral hepatitis by 2030. To know HepB immunization status among people aged 1 to 69 in Huangpu district of Shanghai, and find out risk factors changes of HBV infection. Cross-sectional study was applied to analyze the HepB immunization status and related risk factors by carrying out survey among 706 participants aged 1 to 69 years old. Blood samples were collected for detection of serological HBV markers including hepatitis B surface antigen(HBsAg), hepatitis B surface antibody(HBsAb) and hepatitis B core antibody(HBcAb). Participants with HBsAg positive were required to complete additional examinations such as alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin, albumin, globulin, liver fibroscan and liver ultrasound. For participants aged 1 to 14, the positive rate of HBsAg, HBsAb and HBcAb was 0.00, 50.00 and 30.46%, respectively. The HBsAb positive rate reached a peak of 90.91% at 2 years old, and then showed a significant downward trend (χ2 = 55.612, p < 0.001). All the participants have completed three-dose Hep B vaccination, however for the second dose, those who vaccinated 30 days later than the appointed time(aged one month) got higher HBcAb prevalence than those who vaccinated on time(χ2 = 5.87, p = 0.015). Two mothers were found HBsAg positive, but there was no significant difference in children's HBcAb positive rates regardless of the mothers' HBsAg results. For participants aged 15 to 69, the positive rate of HBsAg, HBsAb and HBcAb was 4.21, 44.25 and 49.23%, respectively. Multivariate analysis for HBcAb positive among people aged 15 to 69 showed that age(50-69) and HBsAb positive were the risk factors for HBcAb positive(p < 0.05). Higher education was the protective factor for HBcAb positive(p < 0.05). After the screening for HBsAg, 22 participants were tested HBsAg positive and required additional examinations, and a total of 12 completed all the examinations. One participant was recognized as active HBV infection without antivirus treatment. Among the 12 participants, 2 have received antiviral treatment before and 4 had a history of HBV infection in family members. In this study, HBsAg positive rate of those who aged 1 to 14 was 0.00%, which indicated that the HepB immunization has achieved a lot in protecting children from being infected. However, failing to get timely Hep B vaccination could be an influencing factor for HBcAb positive in children. As a result, additional tests for HBV DNA could be done to specify an HBV infection and more attention should be paid to the timeliness of Hep B vaccination in the next step. The HBcAb positive rate of people aged 1 to 69 was relatively higher than that of other provinces. Despite of the limited participants with full examinations, we should still put emphasis on HBV treatment and the possibility of transmission within families.

Flipped Learning in Higher Education for the Development of Intrinsic Motivation: A Systematic Review

Background: Flipped learning (FL) is being considered, in terms of new educational trends, a beneficial pedagogical model in the classroom. In particular, FL and intrinsic motivation (IM) are key components to the model since they can be crucial to a high-quality education. FL for the development of IM in higher education, as well as searches for potential interventions have, thus improved over the past ten years. However, no reviews that analyze the findings and conclusions reached have been published. Consequently, the objectives of this paper were to analyze the relationship between the use of FL and the IM of students in higher education, and to identify the aspects that should be present in FL models to develop the IM that contributes to high-quality education. Methods: in accordance with PRISMA guidelines, a systematic review of PubMed, Web of Science, Scopus, and ProQuest was carried out. Results: Of the 407 studies that were initially discovered, 17 underwent a full examination in which all findings and conclusions were analyzed. After implementation, the majority of the FL interventions improved IM results. Conclusion: many key aspects have been identified that must be followed in order to intrinsically motivate students using the FL methodology.

Moisture chamber goggles for the treatment of postoperative dry eye in patients receiving SMILE and FS-LASIK surgery

BackgroundThe incidence of refractive surgery-related dry eye disease (DED) is rising due to the increasing popularity of corneal refractive surgery. The moisture chamber goggles (MCGs) have been shown to tear evaporation by increasing local humidity and minimizing airflow. The current study aims to evaluate the efficacy of moisture chamber goggles for refractive surgery-related DED.MethodsIn this nonrandomized open-label controlled study, 78 participants (156 eyes) receiving refractive surgery were enrolled between July 2021 and April 2022, and sequentially allocated to MGC and control groups. 39 participants were allocated to the MGC groups, of which 53.8% received small-incision lenticule extraction (SMILE) and 46.2% received femtosecond laser-assisted in situ keratomileusis (FS-LASIK), and were instructed to wear MCGs for the duration of 1 month postoperatively, in addition to the standard postoperative treatment received by the control groups (56.4% SMILE, 43.6% FS-LASIK). Participants underwent full ophthalmic examinations, including visual acuity, manifest refraction, DED evaluations, and higher-order aberrations (HOAs), both preoperatively and at routine follow-ups 1 day, 1 week, and 1 month after surgery. DED parameters included non-invasive tear film break-up time (NIBUT), tear meniscus height (TMH), conjunctival congestion, lipid layer thickness (LLT), and ocular surface disease index (OSDI) questionnaires. Student’s t-test was used for comparisons between control and MCG groups, and between preoperative and postoperative parameters within groups.ResultsPostoperative NIBUT decreased in both SMILE and FS-LASIK control groups 1 day after the surgery (SMILE, P = 0.001; FS-LASIK, P = 0.008), but not in the corresponding MCG groups (SMILE, P = 0.097; FS-LASIK, P = 0.331). TMH in the MCG group was significantly higher at 1 week (P = 0.039) and 1 month (P = 0.015) in SMILE, and 1 day (P = 0.003) in FS-LASIK groups. In FS-LASIK participants, significantly lower HOAs and coma levels in the MCG group were observed 1 day (total HOAs, P = 0.023; coma, P = 0.004) and 1 week (total HOAs, P = 0.010, coma, P = 0.004) after surgery. No consistent statistically significant intergroup difference was observed between MCG and control groups in conjunctival congestion, LLT, and OSDI.ConclusionsMCGs effectively slowed tear evaporation, increased tear film stability, and improved HOAs in patients receiving SMILE and FS-LASIK surgeries. MCG is an effective adjuvant therapy in the comprehensive management of refractive surgery-related DED.