Internal Medicine Research Articles

Current treatment paradigms for triple-negative breast cancer.

Triple negative breast cancer (TNBC) accounts for 15% of all breast cancers and is characterized by more aggressive biology, significant disease heterogeneity, and worse clinical outcomes. In recent years, improved understanding of TNBC tumor biology and its heterogeneity have led to the identification of new molecular targets, opening avenues for novel treatment strategies. Clinical trials evaluating immunotherapy, poly-ADP ribose polymerase (PARP) inhibitors, and antibody drug conjugates have shown improvement in clinical outcomes, leading to their incorporation to the treatment options available for patients with TNBC. This review aimed to provide the internal medicine specialist and primary care provider with a comprehensive overview of the current systemic therapy approaches for TNBC and introduce clinicians to novel therapies that have recently been added to the treatment armamentarium against this disease.

The Impact of Comorbidities and Motor Impairment on the Quality of Life of Patients with Spinal Muscular Atrophy: A Case-Control Study.

Introduction: Spinal muscular atrophy (SMA) is a genetically determined disease primarily leading to muscle weakness, but now, it is considered a systemic disease with changes in various tissues and organs. In our study, we aimed to compare quality of life (QoL) outcomes in patients with SMA in relation to the degree of motor limitation and comorbidities, mainly internal medicine diseases. Methods: We included 35 adult patients with SMA and 36 healthy volunteers. Thorough medical histories were taken focusing on comorbidities, and neurological examinations incorporating assessments using functional motor scales were performed. QoL was assessed based on the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire. Results: SMA patients and controls were comparable in terms of scores in the questionnaire's main domains. SMA patients presented significantly higher levels of satisfaction with their medical care than controls. Patients with more advanced SMA had significantly better scores on certain questions, e.g., those related to health satisfaction or leisure activities. A total of 71.4% of SMA patients had comorbidities, ranging from one to three in individual patients. SMA patients with comorbidities did not show worse QoL. Negative correlations were found between the number of comorbidities in SMA patients and individual questions on the WHOQOL-BREF questionnaire. Conclusions: Patients with SMA were satisfied with their medical care. Better scores on some questions in more advanced SMA may have been due to better adaptation to disease-related limitations. The presence of single comorbidities did not affect QoL, but a higher number of comorbidities negatively correlated with QoL.

Beyond Boundaries Uniting Internal Medicine and Surgery in Patient Care - A Narrative Synthesis

Introduction:The evolving landscape of healthcare necessitates the integration of internal medicine and surgery to address complex patient needs comprehensively. Traditional boundaries between these disciplines are increasingly blurred, prompting a holistic approach to patient care.Objective:This narrative review aims to synthesize current literature on the integration of internal medicine and surgery, exploring collaborative models, integrated care pathways, technological advancements, and interdisciplinary initiatives to enhance patient outcomes.Methods:A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar using keywords and MeSH terms related to internal medicine, surgery, interdisciplinary collaboration, and patient outcomes. Inclusion criteria included 30 articles discussing integrated care models and their impact on patient outcomes, published in English between 2009 and 2024. Data extraction focused on study characteristics, key findings, and outcomes. Results:The review identified several collaborative frameworks, such as multidisciplinary teams and perioperative surgical homes, which improved diagnostic accuracy, treatment efficacy, and patient satisfaction. Integrated care pathways demonstrated effectiveness in managing chronic diseases and complex surgical cases. Technological advancements, including EHRs and telemedicine, facilitated seamless communication and data sharing. Challenges to integration included institutional silos, cultural differences, and time constraints, but these were mitigated through interdisciplinary training and policy incentives.Conclusions:Integrating internal medicine and surgery enhances patient care by leveraging the combined expertise of both fields. Overcoming barriers through technological innovations, education, and policy changes is crucial. Future research should focus on long-term outcomes, patient engagement, and the role of personalized medicine in integrated care

Current and future workforce of general internal medicine in Switzerland: a cross-sectional study

AIM OF THIS STUDY: General internal medicine is a crucial element in healthcare systems. Understanding how many people are and will be working in this field is important to maintain and improve quality for patients in healthcare systems. This can provide a basis for political decisions. METHODS: We conducted a cross-sectional study to analyse the current and future workforce of generalists (general practitioners and internists in hospitals) in Switzerland. The Swiss Society of General Internal Medicine (SSGIM) distributed a survey to all members. Respondents were asked about their current average workload in 2023 and planned workload in 2033. The responses were used to calculate full-time equivalent (FTE) for the current and future workforce of generalists and to extrapolate FTE for all active SSGIM members. To model the demand by 2033, we derived different scenarios. RESULTS: Of all 6,232 active SSGIM members, 2,030 (33%) participated: 46% female, 25% (largest age group) 56-65 years old, 19% still in postgraduate training. The average workload in 2023 was 78% for female and 87% for male generalists; the FTE extrapolated to all active SSGIM members in 2023 was 5,246. By 2033, 1,935 FTEs (36%) will retire, 502 FTEs (10%) will reduce their workload, 116 FTEs (2%) will increase their workload and 2,800 FTEs (53%) will remain in the workforce with the same workload as in 2023. To maintain the same workforce as in 2023, 2,321 new FTEs (44%) will be needed by 2033. To fill this gap of 232 FTE new generalists per year, we modelled different scenarios with assumptions of interest, workload, migration and dropouts. CONCLUSIONS: Within only one decade, 44% of the current workforce of generalists will disappear, mainly due to retirement and decreased workload. To fill this gap, various scenarios need to be incorporated. Politicians are called upon to create the political framework to create attractive training and working conditions for generalists to address the future demand for healthcare services.

Acute Medicine – Needs and Challenges: The Bangladesh Perspective

Bangladesh has an ageing population, with increased multi-morbidity and polypharmacy. Acute care is becoming more complex, with increased admission numbers and little alternative to hospital attendance and admission. Alternative models of care are discussed, that include new ways of working and use of novel training techniques including technology such as point of care testing including ultrasound. The use of ambulatory care is also proposed, with rapid access and even virtual outpatient clinics. The development of specialist acute generalists can enable other clinicians to develop more specialised skills including managing separate gastrointestinal bleeding rotas and heart attack or stroke units. Standardised care at the front door can reduce variability in practice and promote excellence in acute care for all patients. The potential pros and cons of developing an acute (internal) medicine model in Bangladesh are discussed. J MEDICINE 2024; 25: 159-165

Large Language Model–Based Responses to Patients’ In-Basket Messages

Virtual patient-physician communications have increased since 2020 and negatively impacted primary care physician (PCP) well-being. Generative artificial intelligence (GenAI) drafts of patient messages could potentially reduce health care professional (HCP) workload and improve communication quality, but only if the drafts are considered useful. To assess PCPs' perceptions of GenAI drafts and to examine linguistic characteristics associated with equity and perceived empathy. This cross-sectional quality improvement study tested the hypothesis that PCPs' ratings of GenAI drafts (created using the electronic health record [EHR] standard prompts) would be equivalent to HCP-generated responses on 3 dimensions. The study was conducted at NYU Langone Health using private patient-HCP communications at 3 internal medicine practices piloting GenAI. Randomly assigned patient messages coupled with either an HCP message or the draft GenAI response. PCPs rated responses' information content quality (eg, relevance), using a Likert scale, communication quality (eg, verbosity), using a Likert scale, and whether they would use the draft or start anew (usable vs unusable). Branching logic further probed for empathy, personalization, and professionalism of responses. Computational linguistics methods assessed content differences in HCP vs GenAI responses, focusing on equity and empathy. A total of 16 PCPs (8 [50.0%] female) reviewed 344 messages (175 GenAI drafted; 169 HCP drafted). Both GenAI and HCP responses were rated favorably. GenAI responses were rated higher for communication style than HCP responses (mean [SD], 3.70 [1.15] vs 3.38 [1.20]; P = .01, U = 12 568.5) but were similar to HCPs on information content (mean [SD], 3.53 [1.26] vs 3.41 [1.27]; P = .37; U = 13 981.0) and usable draft proportion (mean [SD], 0.69 [0.48] vs 0.65 [0.47], P = .49, t = -0.6842). Usable GenAI responses were considered more empathetic than usable HCP responses (32 of 86 [37.2%] vs 13 of 79 [16.5%]; difference, 125.5%), possibly attributable to more subjective (mean [SD], 0.54 [0.16] vs 0.31 [0.23]; P < .001; difference, 74.2%) and positive (mean [SD] polarity, 0.21 [0.14] vs 0.13 [0.25]; P = .02; difference, 61.5%) language; they were also numerically longer (mean [SD] word count, 90.5 [32.0] vs 65.4 [62.6]; difference, 38.4%), but the difference was not statistically significant (P = .07) and more linguistically complex (mean [SD] score, 125.2 [47.8] vs 95.4 [58.8]; P = .002; difference, 31.2%). In this cross-sectional study of PCP perceptions of an EHR-integrated GenAI chatbot, GenAI was found to communicate information better and with more empathy than HCPs, highlighting its potential to enhance patient-HCP communication. However, GenAI drafts were less readable than HCPs', a significant concern for patients with low health or English literacy.

Revisiting the "Timed Up and Go" test: a 12-s cut-off can predict Hospitalization Associated Functional Decline in older adults.

Early detection of functional decline, a major risk among hospitalized older adults, can facilitate interventions that could significantly reduce it. We aimed to examine the contribution of the Timed Up and Go (TUG) test in predicting Hospitalization Associated Functional Decline (HAFD) among older adults, able toindependently ambulate before admission. We used a cross-sectional study design; a total of 310 older adults (age ≥ 65) hospitalized in internal medicine wards between December 2018 and August 2020 were included; exclusion criteria were inability to ambulate, a diagnosis restricting mobility, hospitalization for end-of-life care, or impaired cognition. The Modified Barthel Index was used to assess HAFD; it was administered at admission to evaluate patients' independence in activities of daily living 2weeks prior hospitalization, and at discharge. The TUG test was performed on admission and to predict significant functional decline (defined by a reduction of three points or more in the Modified Barthel Index), while accounting for demographics, length of hospitalization, comorbidity burden (Charlson's comorbidity index), and cognitive function (ALFI-MMSE). Participants were divided into three groups according to their TUG score-under or over a cut-off score of 12s, or inability to complete the test. Adjusting for age, comorbidity, cognitive ability, and duration of hospitalization, the group that performed the test in less than 12s showed no statistically significant change in the Modified Barthel Index, therefore no significant HAFD. The other groups showed a statistically significant decline in function. Risk for significant HAFD is currently underestimated in clinical settings, limited to subjective assessment, and underused in the context of implementing early interventions to prevent HAFD. The TUG may support screening for those at risk of hospitalizing-associated functional decline and could help identify patients suitable for preventative interventions.

Head of Zebu cattle (Bos Taurus indicus): sectional anatomy and 3D computed tomography

The research was designed to use computed tomography (CT) with 3D-CT reconstruction imaging techniques and the various anatomical sections—plana transversalia, frontalis, and dorsalia—to describe the anatomical architecture of the Zebu cattle head. Our study used nine mature heads. The CT bone window created detailed images of cranial bones, mandibles, teeth, and hyoid bones. All of the head cavities were evaluated, including the cranial, orbital, oral, auricular, and nasal cavities with their paranasal and conchal sinuses. The septum nasi, attached to the vomer and maxillary bones, did not reach the nasal cavity floor caudally at the level of the second premolar teeth, resulting in a single median channel from the choanae to the nasopharynx. The positions, boundaries, and connections of the paranasal sinuses were clearly identified. There were four nasal conchal sinuses (that were named the dorsal, middle, ethmoidal, and ventral) and five paranasal sinuses that were described as the following: sinus frontalis, maxillaris, palatinorum, and lacrimalis, as defined in the different anatomical sections and computed tomographic images. The complicated sinus frontalis caused the pneumatization of all bones that surrounded the cranial cavity, with the exception of the ethmoidal and body of basisphenoid bones. The sinus maxillaris was connected to the sinus lacrimalis and palatinorum through the maxillolacrimal and palatomaxillary openings, and to the middle nasal meatus through the nasomaxillary opening. Our findings provide a detailed anatomical knowledge for disease diagnosis to internal medicine veterinarians and surgeons by offering a comprehensive atlas of the Zebu cattle anatomy.

Effect of digital tools to promote hospital quality and safety on adverse events after discharge.

Post-discharge adverse events (AEs) are common and heralded by new and worsening symptoms (NWS). We evaluated the effect of electronic health record (EHR)-integrated digital tools designed to promote quality and safety in hospitalized patients on NWS and AEs after discharge. Adult general medicine patients at a community hospital were enrolled. We implemented a dashboard which clinicians used to assess safety risks during interdisciplinary rounds. Post-implementation patients were randomized to complete a discharge checklist whose responses were incorporated into the dashboard. Outcomes were assessed using EHR review and 30-day call data adjudicated by 2 clinicians and analyzed using Poisson regression. We conducted comparisons of each exposure on post-discharge outcomes and used selected variables and NWS as independent predictors to model post-discharge AEs using multivariable logistic regression. A total of 260 patients (122 pre, 71 post [dashboard], 67 post [dashboard plus discharge checklist]) enrolled. The adjusted incidence rate ratios (aIRR) for NWS and AEs were unchanged in the post- compared to pre-implementation period. For patient-reported NWS, aIRR was non-significantly higher for dashboard plus discharge checklist compared to dashboard participants (1.23 [0.97,1.56], P = .08). For post-implementation patients with an AE, aIRR for duration of injury (>1 week) was significantly lower for dashboard plus discharge checklist compared to dashboard participants (0 [0,0.53], P < .01). In multivariable models, certain patient-reported NWS were associated with AEs (3.76 [1.89,7.82], P < .01). While significant reductions in post-discharge AEs were not observed, checklist participants experiencing a post-discharge AE were more likely to report NWS and had a shorter duration of injury. Interventions designed to prompt patients to report NWS may facilitate earlier detection of AEs after discharge. NCT05232656.

Drug Interactions between Traditional Chinese Medicines and Cardiovascular Drugs.

Cardiovascular disease (CVD) is one of the leading causes of death worldwide, and its internal medicine treatments are mostly single/few-target chemical drugs. Long-term use of cardiovascular drugs for complex chronic diseases may lead to serious adverse drug reactions. Traditional Chinese medicine (TCM) has been used to treat heart diseases for thousands of years, helping to ease symptoms and prolong patients' lifespan in ancient China. TCM has the pharmacological characteristics of being multi-component, multi-target and multi-pathway, and the combined application of TCM and western medicine can be an alternative treatment for chronic and intractable diseases with high safety levels. This article reviewed the interactions and synergistic effect of TCM and cardiovascular drugs. In the treatment of arrhythmia, TCM combined with western medicine can more effectively regulate patients' cardiac electrophysiological characteristics, reduce the onsets of premature beat and heart rate variability, lower the levels of QT interval dispersion and serum inflammatory factors, alleviate clinical symptoms and TCM syndromes, and improve cardiac function with good safety levels. In the treatment of hypertension, integrative medicine can more steadily reduce blood pressure and levels of serum inflammatory factors and improve hemodynamic indexes and exercise tolerance, and it has high safety levels, especially for pregnant women. As for coronary heart disease, the combination of TCM and antiplatelet drugs may promote the absorption of each other. However, the interaction risk of pharmacokinetic mechanism between them is low at the dose of efficacy. Integrative medicine can reduce the level of N-terminal pro-brain natriuretic peptide, delay cardiac remodeling and improve heart function and quality of life for patients with heart failure with high safety levels.

Stress and value: the student perspective on utilizing real vs. actor patients in objective structured clinical examinations

BackgroundStudies have shown objective structured clinical examinations (OSCEs) to be one of the most reliable tools in assessing clinical performance; however in Pediatrics they primarily use manikins, simulators or parent actors which limits the comprehensiveness of the assessment. In our Pediatric Clerkship, medical students are evaluated using a standardized rubric during a clinical evaluation exercise (CEX) with real patients. This study assessed medical students’ perceived stress levels and the educational value of the CEX compared an OSCE. We hypothesized there would be equal stress and value for students with the CEX experience compared to the OSCE.MethodsThird year students anonymously completed questionnaires after required Pediatric CEX and Internal Medicine OSCE evaluations from July 2016-June 2017. The questionnaire included questions from the Intrinsic Motivation Inventory, a validated tool used to assess feelings of stress and perceived value of an exercise.ResultsA total of 147 and 145 questionnaires were completed after the CEX and OSCE. There were no differences between groups regarding levels of “nervousness” (p = 0.543) and “relaxation” (p = 0.055); students felt more “at ease” (p = 0.002) and less “pressure” (p < 0.001) during the CEX. Students perceived the CEX to be more useful and important to improve skills compared to the OSCE for the history taking, physical exam and interpersonal skills.ConclusionsOur results indicate that the CEX was associated with lower stress levels and had higher perceived value when compared to the OSCE. This study supports the usefulness of incorporating real patients into the clinical evaluation of medical students.

The Role of Notch1 Pathway Regulating CD4+CD25+Foxp3+ T Cells in Renovascular Hypertension

Abstract OBJECTIVE To explore the role and mechanism of the Notch1 pathway in regulating CD4+CD25+Foxp3+ Treg cells in renal vascular hypertension (RVH). METHODS According to the diagnostic criteria of RVH in the 8th edition of Internal Medicine, 220 patients treated in the Department of Nephrology of Sichuan Provincial People’s Hospital from January 2019 to January 2022 were enrolled in RVH group, and 220 patients with essential hypertension (EH) in the same period were selected as EH group; another 220 healthy examinees were selected as control group (NC). The proportion of CD4+CD25+ Treg cells in peripheral blood mononuclear cells (PBMCs) and the expression levels of interleukin-10 (IL-10), transforming growth factor-β (TGF-β), and cell proliferation nuclear antigen-67 (Ki-67) in PBMC of the 3 groups were compared by real-time fluorescence quantitative PCR and western blotting; the relative expression levels of Notch1 receptor and ligand mRNA in PBMC of the 3 groups were compared by real-time fluorescence quantitative PCR; the expression of downstream proteins Hes1 and Hes5 of Notch1 signaling pathway, the proportion of CD4+CD25+Foxp3+ Treg cells, and the effect on TGF-β expression were compared by western blotting after adding Notch1 signaling pathway inhibitor (DAPT). Real-time quantitative PCR and western PCR were used. The proportion of CD4+CD25+ Treg cells in PBMCs and the expression levels of IL-10, TGF-β, and cell proliferating nuclear antigen-67 (Ki-67) in PBMC were compared between the 2 groups. Real-time quantitative PCR was used to compare the mRNA expression levels of the Notch1 receptor and ligand in PBMC between the 2 groups. RESULTS Flow cytometry results showed that compared with the NC group, the RVH group had a significantly lower proportion of CD4+CD25+Foxp3+ Treg cells, TGF-β and Ki-67 expression levels, and higher IL-10 expression levels, with significant differences (P &amp;lt; 0.001). Compared with the RVH group, the EH group had a significantly higher proportion of CD4+CD25+Foxp3+ Treg cells, TGF-β and Ki-67 expression levels, and lower IL-10 expression levels, with significant differences (P &amp;lt; 0.001). Real-time quantitative PCR results showed that the RVH group also had significantly higher relative expression levels of Notch receptor Notch1 mRNA, Notch ligand DLL1, DLL4, Jagged1, and Jagged2 mRNA in PBMC than the NC group and EH group, with significant differences (P &amp;lt; 0.001). Western blot results showed that after adding Notch1 signaling pathway inhibitor (DAPT), Hes1 and Hes5 expression in peripheral CD4+CD25+Foxp3+ Treg cells of patients decreased significantly (P &amp;lt; 0.001), while CD4+CD25+Foxp3+ Treg proportion and TGF-β expression level increased significantly (P &amp;lt; 0.001). CONCLUSIONS The Notch1 signaling pathway plays an immunoregulatory role in RVH regulated by CD4+CD25+Foxp3+ Treg cells. Regulation of the Notch1 signaling pathway can significantly promote the proliferation of CD4+CD25+Foxp3+ Treg cells and the ability to secrete anti-inflammatory factors.

Retrospective, Longitudinal, One-Group Study on the Implementation of Continuous Glucose Monitoring To Improve Quality of Care for Patients With Type I or II Diabetes Mellitus in an Internal Medicine Residency Continuity Community Clinic

Retrospective, Longitudinal, One-Group Study on the Implementation of Continuous Glucose Monitoring To Improve Quality of Care for Patients With Type I or II Diabetes Mellitus in an Internal Medicine Residency Continuity Community Clinic

Clinical Presentation and Outcome of Patients Presented with Acute Confusional State (ACS) in a Tertiary Care Hospital of Bangladesh

Background: Acute confusional state (ACS) or delirium is a clinical condition categorized by troubled consciousness, cognitive function, or perception. The key to the management of cases of ACS lies in recognizing a cause or other contributing illness and alleviating it. Objective: To evaluate the patients of ACS intending to identify the clinical presentation of the ACS along with the outcome evaluation of its prognostic importance. Materials and method: A total of 50 patients of ACS fulfilling the DSM-4 criteria were enrolled purposively. It was a hospital-based cross-sectional type of observational study conducted among adult patients of more than 18 years of age for nine months period in the medicine department of Dhaka Medical College Hospital. Results: The mean age of patients was 63.18±9.8 years. Majority of the patients (66%) were male. Hypertension was the most common (46%) associated condition followed by obesity (22%). Fever was common in the majority of cases (78%) followed by disorientation (64%). Among the patients with cerebrovascular accidents, 70.59% had multiple infarcts and 29.42% showed hemorrhage in CT scans of the brain. Most of the patient's (76%) recovery was without any sequelae. Only 6% of patients died during the hospital stay. Conclusion: Acute confusional state (ACS) is among the most common problems in general medicine. Hence, treatment and further workup should run parallel to avoid the morbidity and mortality related to these circumstances. Delta Med Col J. Jan 2021;9(2): 75-79

Developing culturally competent physicians: Empathy, inclusivity, moral distress training and ethical reflections during the Medicine Clerkship

Purpose We aimed to develop a tool that would allow assessment of ethics competency and moral distress during the Internal Medicine Clerkship and to introduce curricular changes that could empower students to better address ethical dilemmas and challenges encountered during the clerkship. Materials and Methods A structured ethics assignment was introduced where students could reflect on impactful stressful scenarios and address questions related to emotional responses, identified ethical issues, management themes, and professional obligations. A 4-tiered grading rubric and individual narrative feedback was provided for each assignment, and small-group debriefing sessions were introduced for reflective thought and future planning. De-identified assignments were analyzed and classified into subgroups according to 5 main ethical issue subgroups and 10 specific management themes. Assignments were also analyzed for the presence of moral distress. Results 357 students completed the reflective ethics activities. The most commonly identified ethical issues were related to Shared Medical Decision Making (>40%), Primary of Patient Welfare challenges, (>20%), and Social/Organizational dilemmas. Management themes often pertained to Patient Wishes/Legal Obligations, Professional Behaviors, and Limited Resources. 87% of assignments demonstrated moral distress. Conclusion Medical school is a stressful time and challenges are augmented during clinical years. Our reflective activity demonstrated significant exposures to ethical dilemmas, reviewed earlier principles of ethics training, and provided a safe forum in which to discuss these important aspects of healthcare. We captured powerful images of challenging situations eliciting moral distress, and students greatly appreciated the activity. We encourage future investigations that support student well-being and enable smooth transitions into residency training.

Pain management inequities by demographic and geriatric-related variables in older adult inpatients.

Pain is ubiquitous, yet understudied. The objective of this study was to analyze inequities in pain assessment and management for hospitalized older adults focusing on demographic and geriatric-related variables. This was a retrospective cohort study from January 2013 through September 2021 of all adults 65 years or older on the general medicine service at UCSF Medical Center. Primary exposures included (1) demographic variables including race/ethnicity and limited English proficiency (LEP) status and (2) geriatric-related variables including age, dementia or mild cognitive impairment diagnosis, hearing or visual impairment, end-of-life care, and geriatrics consult involvement. Primary outcomes included (1) adjusted odds of numeric pain assessment versus other assessments and (2) adjusted opioids administered, measured by morphine milligram equivalents (MME). A total of 15,809 patients were included across 27,857 hospitalizations with 1,378,215 pain assessments, with a mean age of 77.8 years old. Patients were 47.4% White, 26.3% with LEP, 49.6% male, and 50.4% female. Asian (OR 0.75, 95% CI 0.70-0.80), Latinx (OR 0.90, 95% CI 0.83-0.99), and Native Hawaiian or Pacific Islander (OR 0.77, 95% CI 0.64-0.93) patients had lower odds of a numeric assessment, compared with White patients. Patients with LEP (OR 0.70, 95% CI 0.66-0.74) had lower odds of a numeric assessment, compared with English-speaking patients. Patients with dementia, hearing impairment, patients 75+, and at end-of-life were all less likely to receive a numeric assessment. Compared with White patients (86 MME, 95% CI 77-96), Asian patients (55 MME, 95% CI 46-65) received fewer opioids. Patients with LEP, dementia, hearing impairment and those 75+ years old also received significantly fewer opioids. Older, hospitalized, general medicine patients from minoritized groups and with geriatric-related conditions are uniquely vulnerable to inequitable pain assessment and management. These findings raise concerns for pain underassessment and undertreatment.

In-depth assessment of steatotic liver disease awareness in high-risk groups.

This study aims to determine the awareness levels and factors affecting it, along with prevalent misconceptions about Steatotic Liver Disease (SLD) among participants with high-risk indicators. A questionnaire with open-ended questions was utilized. Participants were recruited from two general internal medicine outpatient clinics, focusing on those with high-risk indicators for SLD. Data collection involved a questionnaire covering demographic information, self-reported clinical conditions, and open-ended questions about SLD awareness. Key focus areas included misconceptions, thematic awareness, and the relationship between awareness and educational attainment. The study involved 228 participants, predominantly female (70.4%), with an average age of 53.8 years. Only 33.7% showed a comprehensive understanding of all aspects of SLD. However, 90.4% provided some accurate information, though often limited or incomplete. Higher education and awareness of SLD risks were key predictors of better understanding. The logistic regression model, with an accuracy of 0.76 and recall of 0.84, found higher education inversely related to low awareness. Common misconceptions highlighted included the belief that polypharmacy or certain medications cause SLD, fatigue as an effect, and increased water intake as a treatment. Notably, seven patients mentioned artichoke consumption as a potential treatment. The findings highlight the gap between comprehensive and partial awareness of SLD among high-risk individuals. Educational level and informed understanding of SLD risks are crucial for improving awareness, emphasizing the need for specialized educational efforts and risk communication to high-risk patients.

Biochemical study of ZNF76 rs10947540 and SCUBE3 rs1888822 single nucleotide polymorphisms in the Egyptian patients with systemic lupus Erythematosus

ABSTRACT Systemic lupus erythematosus (SLE) is a common autoimmune disease marked by the formation of apoptotic debris and the presence of autoantibodies that target nuclear components. At this moment, the actual cause of SLE is uncertain. Genetic variables have been well proven to have a significant role in the propensity of SLE. This study aimed to investigate the effect of (ZNF76) rs (10947540) and (SCUBE) rs (1888822) gene polymorphism in patients with systemic lupus erythematosus. A case control study has been carried out at Medical Biochemistry & Molecular biology and Rheumatology unit of Internal Medicine Departments, Faculty of Medicine, Menoufia University, Egypt, for 1-year duration between 1 June 2022 and 1 June 2023. Sixty patients were females (75%) and twenty patients were males (25%). Their ages ranged from 19 to 53 years. Their disease durations ranged from 7 months to 20 years. The findings indicated that the TC genotype of the ZNF76 rs10947540 gene increases the risk of SLE by 2.274-fold, while the dominant TC + CC increases the risk by 2.472-fold, and the C allele increases the risk by 2.115-fold. Additionally, the results showed that the TT genotype of the SCUBE3 rs1888822 gene increases the risk of SLE by 3.702-fold, the dominant GT + TT increases the risk by 2.304-fold, and the T allele increases the risk by 2.089-fold, while the GT genotype increases the risk by 1.918-fold. The study revealed significant associations between the genotypes of these polymorphisms and certain clinical parameters in SLE patients. These findings highlight the potential genetic contributions to SLE susceptibility and its clinical manifestations, providing valuable insights for future research and potential personalized approaches to the management of this complex autoimmune disease.

Modern Trends in Development of Educational and Scientific Discipline ‘Public Health and Healthcare’: Its Methodological Role and Integrative Function

INTRODUCTION: In modern conditions of social development, there is a change of emphasis in definitions concerning not only public, but also individual health. Preserving and strengthening the health of the population is a complex task that implies the interaction of various specialists. This integration, the complexity of interaction in issues concerning preserving and strengthening the health of the population, should undoubtedly be reflected in the training of specialists, and, first of all, in higher medical education. AIM: To determine the role of the discipline ‘Public Health and Healthcare’ (PHH) in teaching population health issues and in the integration of departments of various profiles in the study of individual, group and population health in modern conditions. The article presents a discussion about modern trends in the development of the educational and scientific PHH discipline based on the opinions of students, teachers and the experience of Sechenovskiy University. Thus, students of profiles ‘General Medicine’, ‘Pediatrics’, ‘Medical and Preventive Care’ think that studying public health issues is the task of doctors of all clinical specialties (69.4%–76.7%), of hygienists ( 60.0%), of epidemiologists ( 30.0%). Integration in the teaching of PHH issues, according to teachers of PHH departments, in such types of activities as academic work, educational work, general scientific projects, joint printed works, textbooks and teaching aids, joint innovative projects, is mainly carried out with teachers of preventive educational disciplines, to a much lesser extent with teachers of clinical and fundamental disciplines. CONCLUSION: An integrative approach to definitions, terms, and concepts is needed in the study of the health of individuals, population groups and population with a significant variety of disciplines and departments teaching them. The methodological role in teaching these issues is the prerogative of the PHH discipline.

A Siddha Management of Attai vidal with internal and external medicines for Naalavibatha Punn (Varicose Ulcer): A Case Report

A Siddha Management of Attai vidal with internal and external medicines for Naalavibatha Punn (Varicose Ulcer): A Case Report