Local Medical Treatment Research Articles

Metastasis of small cell lung cancer to bilateral extraocular muscles: a case report

BackgroundOrbital metastasis is a possible complication of small cell lung cancer and a pattern of bilateral invasion of the extraocular muscles has rarely been reported in literature.Case presentationA 46-year-old white male with a past medical history of smoking and stage IV small cell lung carcinoma presented with loss of vision and pain in the left eye. Examination revealed bilateral proptosis and left afferent pupillary defect, and visual acuity was hand motion on the left eye and 4/10 on the right eye. An orbital computed tomography scan showed a compression of the left optic nerve between the extraocular muscles at the apex, and a lateral canthotomy was performed for a new-onset compressive optic neuropathy, with residual visual improvement. There was also significant enlargement of the extraocular muscles in the right orbit. The patient was maintained in palliative treatment with both chemotherapy and local medical and surgical (amniotic membrane cover for exposure keratopathy) ophthalmological treatments until he eventually died 5 months after.ConclusionBilateral metastasis to the extraocular muscles is a very rare manifestation of small cell lung cancer and the palliative treatment in these cases is challenging.

Real-world progression-free survival and overall survival of palbociclib plus endocrine therapy (ET) in Japanese patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative advanced breast cancer in the first-line or second-line setting: an observational study

BackgroundA recent large real-world study conducted in the United States reported the effectiveness of palbociclib plus aromatase inhibitor in HR+/HER2− advanced breast cancer (ABC). However, local clinical practice and available medical treatment can vary between Japan and Western countries. Thus, it is important to investigate Japanese real-world data. This observational, multicenter study (NCT05399329) reports the interim analysis of effectiveness of palbociclib plus ET as first-line or second-line treatment for HR+/HER2− ABC by estimating real-world progression-free survival (rwPFS) and overall survival (OS) in Japanese routine clinical practice.MethodsReal-world clinical outcomes and treatment patterns of palbociclib plus ET were captured using a medical record review of patients diagnosed with HR+/HER2− ABC who had received palbociclib plus ET in the first-line or second-line treatment across 20 sites in Japan. The primary endpoint was rwPFS; secondary endpoints were OS, real-world overall response rate, real-world clinical benefit rate, and chemotherapy-free survival.ResultsOf the 677 eligible patients, 420 and 257 patients, respectively, had received palbociclib with ET as first-line and second-line treatments. Median rwPFS (95% confidence interval) was 24.5 months (19.9–29.4) for first-line and 14.5 months (10.2–19.0) for second-line treatment groups. Median OS was not reached in the first-line group and was 46.7 months (38.8-not estimated) for the second-line group. The 36-month OS rates for de novo metastasis, treatment-free interval (TFI) ≥ 12 months, and TFI < 12 months were 80.2% (69.1–87.7), 82.0% (70.7–89.3), and 66.0% (57.9–72.9), respectively.ConclusionThe addition of palbociclib to ET was effective for treating HR+/HER2− ABC in Japanese routine clinical practice.

First-trimester cesarean scar pregnancy: a comparative analysis of treatment options from the international registry

BackgroundCesarean scar pregnancy (CSP) is an iatrogenic consequence of a prior cesarean delivery (CD). The gestational sac implants into a niche created by the incision of the previous CD carrying a substantial risk for major maternal complications. The aim of this study is to report, analyze and compare effectiveness and safety of different treatments options of CSP managed in the first trimester through a registry. ObjectivesTo study the ultrasound findings, disease behavior, and management of first trimester CSP. Study designWe created an international registry of CSP to study the ultrasound findings, disease behavior, and management of CSP. The CSP-registry collects anonymized ultrasound and clinical data of individual CSP patients on a secure digital information platform. Cases were uploaded by 31 participating centers in 19 countries. In this study we only included live and failing CSP (with or without positive fetal heart beat) who received active treatment (medical or surgical) before 12+6 weeks’ gestation in order to evaluate effectiveness and safety of the different management options. Patients managed expectantly were not included in this study and will be reported separately. Treatment was classified as successful if it led to a complete resolution of pregnancy without the need for any additional medical intervention. ResultsBetween 29 August 2018 and 28 February 2023, we recorded 460 patients with CSP (281 live, 179 failing CSP) who fulfilled the inclusion/exclusion and were registered. 270/460 (58.7%) patients were managed surgically, 123/460 (26.7%) underwent medical management, 46/460 (10%) underwent balloon management and 21/460 (4.6%) underwent other, less frequently used treatment options. Suction evacuation was very effective, with 202/221(91.5%, 95%CI 87.8-95.2) success rate whilst systemic methotrexate was least effective with only 38/64 (59.4%, 95% CI 48.4-70.4) patients not requiring additional treatment. Overall, surgical treatment of CSP was successful in 236/258 (91.5%, 95% CI 88.4-94.5) and the complication rate was 24/258 (9.3%, 95% CI 6.6-11.9). ConclusionCSP in the first trimester of pregnancy can be managed effectively in more than 90% of cases with either suction evacuation, balloon treatment or surgical excision. The effectiveness of all treatment options decreases with advancing gestational age CSP should be treated as early as possible after confirmation of the diagnosis. Local medical treatment with KCl or methotrexate is less efficient in and has higher rates of complications compared to the other treatment options. Systemic methotrexate has a substantial risk of failing and a higher complication rate and should not be recommended as first line treatment.

Surgery for chronic rhinosinusitis with nasal polyps: An update

This update aimed to evaluate surgical indications in the management of chronic rhinosinusitis with nasal polyps (CRSwNP). It was conducted and reported according to the criteria stipulated by the Synthesis Without Meta-analysis (SwiM) guidelines. From the PubMed-National Library of Medicine database, 1098 articles were identified for the period 2006–2021 using the key words “nasal polyps” and “surgery”. After screening and analysis, 39 publications were selected. The efficacy of surgery on functional improvement in CRSwNP, measured by the specific quality-of-life score SNOT-22, is established, and improvement in olfactory function is expected in 50% of patients. The rate of surgical revision is at least 10–15% at 4 years, but the disease can be controlled for several years, with the interval between primary surgery and symptomatic recurrence exceeding 10 years in some cases. The criteria for surgery are not clearly defined in the literature. However, several authors consider failure of ≥ 8 weeks’ well-conducted local medical treatment and use of more than 2 courses of systemic corticosteroids as a reliable indication. No studies or meta-analyses are currently available to determine the superiority of one surgical technique over another.

Undiagnosed Behçet Syndrome Presenting with Abdominal Wall Ulceration: A Case Report

Behçet syndrome (BS) is a chronic inflammatory disease that damages blood vessels and affects multiple systems, including the skin, mucosa, joints, eyes, nervous system, and gastrointestinal tract. The disease follows a relapsing course, characterized by recurrent episodes of inflammation. Cutaneous lesions are a common manifestation of BS, presenting as ulcerations exhibiting the pathergy response, posing a challenge for healing. We report an unusual case of abdominal wall ulceration in a female patient with previously undiagnosed BS. The atypical characteristics and course of the ulcerations, as well as the data obtained from the patient’s medical history and laboratory findings, prompted a multidisciplinary approach. The findings, in conjunction with the clinical suspicion, resulted in a diagnosis of BS. Following the diagnosis, the patient received appropriate management, including local wound care and medical treatment for BS, resulting in rapid wound epithelialization within a few days of treatment initiation. The patient was referred to a rheumatologist for further evaluation and long-term management of BS. This case underscores the significance of including BS in the differential diagnosis of unusual ulcerations.

Diabetic retinopathy in the pediatric population: Pathophysiology, screening, current and future treatments

Diabetic retinopathy (DR) is a sight threatening complication of diabetes mellitus (DM). The incidence of DR in the pediatric population has increased in the last two decades and it is expected to further rise in the future, following the increase in DM prevalence and obesity in youth. As early stages of the retinal disease are asymptomatic, screening programs are of extreme importance to guarantee a prompt diagnosis and avoid progression to more advanced, sight threatening stages. The management of DR comprises a wide range of actions starting from glycemic control, continuing with systemic and local medical treatments, up to para-surgical and surgical approaches to deal with the more aggressive complications. In this review we will describe the pathophysiology of DR trying to understand all the possible targets for currently available or future treatments. We will briefly consider the impact of screening techniques, screening strategies and their social and economic impact. Finally a large part of the review will be dedicated to medical and surgical treatments for DR including both currently available and under development therapies. Most of the available data in the literature on DR are focused on the adult population. The aim of our work is to provide clinicians and researchers with a comprehensive overview of the state of the art regarding DR in the pediatric population, considering the increasing numbers of this diseases in youth and the inevitable consequences that such a chronic disease could have if poorly managed in children.

A Retrospective Analysis of Internet-Based Sharing Nursing Service Appointment Data.

Aims To investigate the historical data of the “Internet+ Nursing” service platform and provide a theoretical basis to optimize the “Internet+ Nursing” service model by analyzing a population in need of nursing care services, service prices, services in demand, willingness to place orders, and feedback on use. Methods A retrospective analysis of data related to home care services on the “Jiuzhou Nursing Care” platform from April 2020 to August 2021, a total of 279 person-times, relevant information about the research subjects, and the status of home care services was conducted. SPSS 24.0 software was used for data analyses, such as calculating frequencies and percentages and conducting chi-square tests. Results The “Jiuzhou Online Nurse” primarily serves elderly patients, and the majority of these patients have lost their ability to care for themselves. The average cost of nursing services was ¥183.45, and the unit cost of services had no effect on the number of service items. This particular internet-based home nursing service has a high level of satisfaction. Patients aged 60 to 74 have the highest number of Internet-based home care service orders (χ2 = 11.791, P < 0.05). Patients who reuse the platform are more willing to assign people to provide services (χ2 = 238.078, P < 0.05). Patients who were unable to care for themselves had a higher rate of repeat order (χ2 = 10.877, P < 0.05). Conclusion The “Internet+ Nursing” service platform specifically meets the individual needs of elderly patients, provides them with home nursing services, and improves local medical treatment and door-to-door services. This platform also provides convenience for elderly individuals who cannot care for themselves so that they can receive prompt treatment and assistance to improve their quality of life.

СИСТЕМНАЯ И СТОМАТОЛОГИЧЕСКАЯ ПАТОЛОГИЯ ПАЦИЕНТА С РЕВМАТОИДНЫМ АРТРИТОМ НА ФОНЕ МЕТОТРЕКСАТ-ТЕРАПИИ (клинический случай)

Background. One of the urgent problems of modern medicine is the formation and development of an interprofessional approach to the complex therapy of patients with combined pathology. An interdisciplinary approach to the examination and treatment of patients with concomitant diseases is due to the interconnection of the oral mucosa with systemic diseases. Literature data indicate the pathogenetic commonality of systemic connective tissue diseases, including rheumatoid arthritis with periodontitis and oral mucosa diseases, which is based on a diffuse inflammatory process.&#x0D; Objectives ― study of a clinical case of combined lesion of the oral mucosa of a patient with rheumatoid arthritis during treatment with methotrexate.&#x0D; Methods. We examined patient R. — an elderly man of 72-year-old with ulcerative and necrotic lesions of the oral mucosa, simultaneously suffering from rheumatoid arthritis and receiving methotrexate as maintenance therapy. The patient was sent to the Department of Therapeutic Dentistry of Omsk State Medical University, to the clinical base of dental clinic № 1 in Omsk in order to clarify the diagnosis and prescribe complex treatment.&#x0D; Results. Patient R. revealed a combined ulcerative-necrotic lesion of the oral mucosa and gums with rheumatoid arthritis. Joint general and local medical treatment by a dentist of lesions of the oral mucosa, gums, examination, observation in dynamics and the advice of a physician-therapist in terms of prescribing maintenance therapy for rheumatoid arthritis by reducing the dose of the drug (methotrexate) gave a joint positive effect in a comprehensive interdisciplinary approach to the treatment of a patient with comorbid pathology.&#x0D; Conclusions. Our research has shown that it is necessary to increase activity in the development of an interdisciplinary collaboration between dentists and internists. The continuity and friendship of doctors of different specialties make it possible to get a positive result in the treatment and improve the quality of life of patients.

Facing COVID-19: Early Recognition and Triage Tool for Medical Treatment Facilities With Limited Resources.

ABSTRACTIntroductionCoronavirus Disease 2019 (COVID-19) is spreading all over the world. Health systems around the globe have to deal with decreased capabilities and exhausted resources because of the surge of patients. The need to identify COVID-19 patients to achieve a timely opportunity to treat and isolate them is an ongoing challenge for health care professionals everywhere. A lack of testing capabilities forces clinicians to make the crucial initial decision on the basis of clinical findings and routine diagnostic laboratory test. This article reviews the current literature and presents a new adapted protocol for diagnosing and triaging COVID-19 patients. A special emphasis lies on the stepwise approach guiding the medical provider to a triage decision that is suitable for the individual patient and the situation of the local medical treatment facility.Materials and MethodsOn March 30, 2020, a PubMed based literature research on COVID-19 following the preferred reporting items for systematic reviews and meta-analyses guidelines was performed. A diagnostic and triage tool for COVID-19 was designed based on the major findings in the reviewed literature.ResultsAfter a selection process, focusing on the topics “epidemiology,” “clinical characteristics,” and “diagnostic tools,” 119 out of a total amount of 1,241 publications were selected to get an overview of the growing evidence.ConclusionsThe designed Early Recognition and Triage Tool enables the medical provider to use the applicable modules of the protocol for capabilities of the local setting to get the most appropriate diagnostic and triage done. The tool should give guidance for the initial approach until specific testing for the COVID-19 virus is available.

Preliminary study on local medical treatment of aortic valve calcification: Drug delivery to aortic valve in rat

Preliminary study on local medical treatment of aortic valve calcification: Drug delivery to aortic valve in rat

Relationship Between Psychological Factors and Wound Occurrence in Patients With Peripheral Arterial Disease in the Leg

This prospective study investigated psychological factors affecting wound healing in patients with peripheral arterial disease (PAD). Fifty patients with PAD in a local hospital were enrolled. The Geriatric Depression Scale short version, Type-D scale 14, Medical Outcome Study 36-Item Short-Form Health Survey (SF-36), Functional Independence Measure, Self-efficacy for Managing Chronic Disease Scale, Barriers Self-Efficacy Scale, and Mini Nutritional Assessment were applied to assess physical and psychological factors. Wound occurrence and healing were evaluated at 6 months after discharge, and 34 and 30 patients could be followed, respectively. The patient group with wound occurrence showed poorer mental component score (MCS) and better role/social component score (RCS) category scores of SF-36, and a higher stage in the Fontaine classification, than those without wound occurrence. On comparing Fontaine classification-matched subgroups, patients with wound occurrence showed poorer general health factor and MCS and better RCS of SF-36 than those without wound occurrence. Logistic analysis showed that MCS and RCS predicted wound occurrence and needs for local medical treatment, respectively. Among the psychological factors tested, MCS was a major factor associated with wound occurrence in the present study, with wide variation in clinical conditions and factors associated with PAD. Psychological factors were important as biological, physical, and social factors for patients with PAD during the long-term follow-up period, and an appropriate battery to evaluate psychological factors focused on patients with PAD should be developed.

New methods of local medical treatment of purulent wounds

Purpose of the study. To study experimental model of purulent wounds efficiency of the combined effects of benzalkonium chloride and metronidazole immobilized on various bases.Materials and methods. The material was in vitro studies and experimental animals (Wistar rats), which was modeled a purulent wound and then divided into 3 groups according to the treatment method with the three studied combinations, each of which contained benzalkonium chloride and metronidazole, the combinations differed in bases, which were polyethylene oxide or sodium salt of carboxymethylcellulose, or polymethylsiloxane polyhydrate. Research methods: in an in vitro experiment, growth retardation zones were determined for the most common pathogens of wound infection using the standard disc method. In an in vivo experiment the healing process was evaluated by Popov's planimetric method, the contamination of the wounds was studied by sowing the biopsy of wounds on nutrient media with subsequent counting of the grown up colonies. The data were processed statistically, the reliability of the differences was assessed by the Kruskal-Wallis test.Results. All test combinations showed high growth retardation areas for all test strains of microorganisms. Objectively, the highest results were observed with a combination of polyethylene oxide (Staphylococcus aureus 30 (29; 30), Bacillus cereus 27 (27; 28), Escherichia coli 20.5 (20; 21), Proteus vulgaris 21.5 (20; 22), Pseudomonas aeruginosa 17 (16; 17), Candida albicans 25.5 (25; 26)). In determining the healing rate, it was noted that the maximum values in the groups when using combinations based on the sodium salt of carboxymethylcellulose and polymethylsiloxane polyhydrate occurred on day 1–3 (29.6 (27.6; 31) and 20.2 (18.8; 24.2) mm2/day, respectively), and in the group using a combination on polyethylene oxide — for 3–5 days (20.6 (17.3; 22.8) mm2/day).Conclusion. Our studies have shown the high antimicrobial activity of all the developed combinations for all the strains of microorganisms studied. It is also possible to recommend combinations on polyethylene oxide and sodium salt of carboxymethylcellulose for further preclinical studies at all times of treatment, and a combination based on polymethylsiloxane polyhydrate only in the first phase of the wound process.

Discrimination of Gentiana and Its Related Species Using IR Spectroscopy Combined with Feature Selection and Stacked Generalization.

Gentiana, which is one of the largest genera of Gentianoideae, most of which had potential pharmaceutical value, and applied to local traditional medical treatment. Because of the phytochemical diversity and difference of bioactive compounds among species, which makes it crucial to accurately identify authentic Gentiana species. In this paper, the feasibility of using the infrared spectroscopy technique combined with chemometrics analysis to identify Gentiana and its related species was studied. A total of 180 batches of raw spectral fingerprints were obtained from 18 species of Gentiana and Tripterospermum by near-infrared (NIR: 10,000–4000 cm−1) and Fourier transform mid-infrared (MIR: 4000–600 cm−1) spectrum. Firstly, principal component analysis (PCA) was utilized to explore the natural grouping of the 180 samples. Secondly, random forests (RF), support vector machine (SVM), and K-nearest neighbors (KNN) models were built while using full spectra (including 1487 NIR variables and 1214 FT-MIR variables, respectively). The MIR-SVM model had a higher classification accuracy rate than the other models that were based on the results of the calibration sets and prediction sets. The five feature selection strategies, VIP (variable importance in the projection), Boruta, GARF (genetic algorithm combined with random forest), GASVM (genetic algorithm combined with support vector machine), and Venn diagram calculation, were used to reduce the dimensions of the data variable in order to further reduce numbers of variables for modeling. Finally, 101 NIR and 73 FT-MIR bands were selected as the feature variables, respectively. Thirdly, stacking models were built based on the optimal spectral dataset. Most of the stacking models performed better than the full spectra-based models. RF and SVM (as base learners), combined with the SVM meta-classifier, was the optimal stacked generalization strategy. For the SG-Ven-MIR-SVM model, the accuracy (ACC) of the calibration set and validation set were both 100%. Sensitivity (SE), specificity (SP), efficiency (EFF), Matthews correlation coefficient (MCC), and Cohen’s kappa coefficient (K) were all 1, which showed that the model had the optimal authenticity identification performance. Those parameters indicated that stacked generalization combined with feature selection is probably an important technique for improving the classification model predictive accuracy and avoid overfitting. The study result can provide a valuable reference for the safety and effectiveness of the clinical application of medicinal Gentiana.

Developing a craniomaxillofacial and cervical equipment module for surgeons in the austere environment: a systematic review.

The treatment of craniomaxillofacial and cervical wounds in a disaster relief setting is done by clinicians from local medical treatment facilities, non-governmental organisations (NGO), or the military. Although each group and individual surgeon will need specific equipment, this will be restricted by weight, portability and interoperability. We systematically reviewed scientific and commercial publications according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The papers we identified described the portable equipment that is required to treat patients who need damage-control surgery (decompressive craniectomy, temporary stabilisation, and internal and external fixation of the facial bones) for craniomaxillofacial and cervical injuries in austere or military settings. Austere settings are those in which there is an inherent lack of infrastructure, such as facilities, roads, and power. A total of 35 papers or scientific articles recommended the equipment that is needed to manage these injuries, but we could find no module that was specifically designed for use in these environments. Multiple modules are currently required to provide comprehensive surgical care and many of the items in the existing maxillofacial and neurosurgical kits are rarely used, which increases the cost of initial procurement and resupply. Duplications in equipment between modules also increase the size, weight, and financial cost. We suggest the equipment that is required to make up a rationalised, lightweight, and compact module that can be used for all craniomaxillofacial and cervical operations in austere settings.

Towards new ways of assessing the impact of local medical journals: A proposal and call for change

The relevance of research output to the local community is critical to changing practice. Research relevance has to be determined using measurements that show that the knowledge that arose from that research has made an impact on society. This paper, based on a literature review and preliminary research results, advocates for research impact measurements which take account of local contexts when evaluating the relevance of a journal article or indeed any research output. It concludes that a journal should go beyond traditional measurement metrics of citation analysis and bibliometrics alone as a measure of research impact. Although it is important to standardise measurements, it is also important that local communities should be encouraged to choose measurements of research output that matter to them. The proposed ways of assessing research impact are: (a) change in policies in the health sector, (b) effect on local medical treatment guidelines, (c) effect on case management, (d) use in continuous professional development, and (e) impact on local knowledge production.

Restoration of normal occlusal relations in the complex treatment of patients with generalized periodontitis and bounded edentulous spaces

The aim of the work is to restore occlusal relations during the orthopedic stages of complex treatment in patients with chronic course of generalized periodontitis (GP) of the І and ІІ degree and bounded edentulous spaces using the “T-Scan” system to achieve stable disease. Materials and methods. A total of 55 patients aged from 20 to 44 years old were examined, including 20 persons with oral health and occlusal equilibration and 35 patients with GP in its chronic phase of the I and II degree presenting with Kennedy classes III and IV partially edentulous situation (1–3). After evaluation of the dental occlusion relationships, all patients were performed a complex treatment of GP by selective grinding or occlusal surface adjustment with a composite material under the control of the apparatus “T-Scan III”, achieving the most correct distribution of occlusal contacts. At the same time, the local instrumental and medical treatment using antimicrobial and anti-inflammatory drugs and medicines with systemic effect orally to correct metabolic disorders. This was followed by the orthopedic treatment, restoring the dentition defects with fixed metal-ceramic structures under the control of the “T-Scan III” system. The results of therapy were evaluated immediately, after 6 and 12 months. Results. We have confirmed that the normal masticating pressure between the left and right parts of the dentofacial system is distributed evenly. However, we have found out, that there are not always ideal occlusion relationships, and the variation range is (48.7 to 51.3) ± 0.24 % in healthy persons. At the stages of orthopedic treatment, and especially fitting denture with the help of the “T-Scan III” system, we have reached the norm determined by us, striving for perfection. The state of periodontium and occlusion achieved after the complex treatment, remained for more than 12 months, that was confirmed by clinico-radiological data. Conclusions. Restoration of normal occlusal relations under the control of the “T-Scan III” system contributed to rapid GP remission during the orthopedic stages of complex treatment in patients with GP and bounded edentulous spaces after initial and medicamentous periodontal therapy and provided prevention of various complications and long-term stabilization of the pathological process in the periodontium.

Marketing research and pharmacoeconomic aspects of medicinal cosmetic products containing azelaic acid

O. P. Kilieieva Goal. Analysis of the domestic market of pharmaceutical cosmetics containing azelaic acid, registered on the pharmaceutical market of Ukraine; determination of stability indicators of the range of drugs of this group, their competitiveness of solvency for further study of the availability of this list of drugs and the possibility of meeting the needs of the population in the treatment of the specified pathology. Materials and methods. The materials of the study became the legal basis: the orders of the Ministry of Health of Ukraine, the Protocol on the provision of medical care to patients with vulgar acne (Approved by the Order of the Ministry of Health of Ukraine of May 08, 2009, No. 312, with amendments № 670 dated 04.08.2016). Unified clinical protocol of primary, secondary (specialized), tertiary (highly specialized) medical care (acne). Methods of research - statistical, graphic, marketing, pharmacoeconomic, content analysis of official sources of information. Results . According to the unified clinical protocols of primary, secondary (specialized), tertiary (highly specialized) medical care (ACMD) about acne – this skin disease has the ICD-10 code: L70 in accordance with the International Statistical Classification of Diseases and Related Disorders of Health (Tenth Edition) - vulgar acne. In the occurrence of acne, four principal mechanisms are distinguished: increased production of sebum by sebaceous glands; increased keratinization of epidermis cells and the accumulation of horny cells in the ducts of the sebaceous glands (follicular hyperkeratinization); propionic acid bacteria (Propionibacterium acnes – microorganism, which normally lives in sebum without oxygen availability); inflammation. In analyzed literary sources, it is generally indicated that acne treatment should be of a complex nature. Except drug therapy should include such components as conversation with the patient and his psychological support, physiotherapy, daily skin care, local and systemic medical treatment. Conclusions. The assurance of the assortment's stability is carried out. It has been established that the assortment of azelaic acid-containing LCAs for the prevention and treatment of acne is stable (in pharmacies of Zaporizhzhia? Dnipro, Mykolaiv, Kryvyi Rih, Cherkasy) and is equal to 0.87. The coefficient of competitiveness is calculated. It has been established that the most competitive is AcneStop (Ukraine). The rate of liquidity of the price is calculated. Calculated values of K liq indicate that the maximum ratio of liquidity to the drug is Azogel PRAT (gel) (K liq = 0.49), and the minimum – on the LS Skinoren (cream) (K liq = 0.05) and is more available on the market among analogues. Solvency adequacy ratio is calculated. According to the calculations it is clear that the highest index of C a.s is Skinoren (gel, cream) – 5.7 %, lowest – Azogel PRAT (C a.s = 1.2 %).

Medical Scribe Impact on Patient and Provider Experience

The electronic health record (EHR) has created additional administrative burdens on providers to perform data entry while trying to engage with the patient during the health care visit. Providers have become frustrated and distracted with the documentation requirements which further hindered connectivity, and communication with the patient. The utilization of medical scribes in the outpatient clinical setting was a strategy shown to enhance patient and provider interaction, decrease clinician's administrative tasks, and promote satisfaction among providers and patients. This was an innovative quality improvement pilot project to improve the patient and provider experience using scribes in an outpatient setting. Two providers, to include one Family Medicine doctor and one Internal Medicine physician, and four hospital corpsmen participated in this pilot project. The four hospital corpsmen received a 2-week training of the fundamentals of the EHR and their role as scribes prior to the start of the project. Two corpsmen were designated for each provider and worked with their provider throughout the 12-week project period. The two primary aspects evaluated during the implementation of the scribes were the patient experience, and provider experience. Navy Medicine and the University of South Carolina Institutional Review Boards (IRB) considered this project exempt from full IRB review. The experience questionnaire results indicated a slight mean decrease, but did not negatively impact patient satisfaction or overall patient experience. The local Medical Treatment Facility patient satisfaction, obtained through the Interactive Customer Evaluation, and the Joint Outpatient Experience Survey, indicated that there was no decrease in patient satisfaction or overall experience during the project period. The providers' experience improved with an average 50% decrease in time spent after hours documenting in the EHR, enhanced engagement with patient, staff, and ancillary team members, and improved work life balance. Additional findings of improved clinic efficiencies, completion of notes for both providers and positive qualitative comments from the scribes were identified. In multiple settings, documentation requirements burden providers. The consideration of scribes could foster work life balance, retention, and wellness. The patient and provider experience was strengthened through the utilization of medical scribes, so future research centered on the provider and patient experience could be beneficial to organizations. Further study of the scribe's experience, especially considering the positive comments from the hospital corpsmen that participated as scribes during the project, could provide beneficial outcomes. Navy Medicine is advancing every opportunity to strengthen clinical and operational readiness, health and partnerships to provide the highest quality care and promote wellness for our patients. This type of quality improvement initiative could positively support readiness, quality and wellness for our organization, providers, and patients.

Human Rabies Still Exists in Urban and Peri-Urban Areas in Mali—National Data-Base Analysis of the Capital of Mali from 2007 to 2017

From 2007 to 2017 sixty-three (63) new cases of human rabies have been identified in Mali on an estimated total population in 2017 of 17,650,195 inhabitants. This is an incidence of 0.32 cases for 100,000 inhabitants. All these cases occurred in urban areas and involved the two sexes. The age group most affected was the one less than 20 years old. The majority of the victims (73.1%) were pre-schools, school-aged pupils and housewives. In 97% of the cases, the animal in question was a dog and the type of exposure of the bite. Eighty-two percent (82%) of the victims had received no local medical treatment or the post exposure quasi prophylaxis treatment. The median duration between the first symptoms and death among the cases of human rabies was 3 to 7 days. The median duration between the occurrence of the first signs and death was four (4) days. No virological confirmation had been conducted on the patients. The rage disease is retained as a priority disease, since the adoption of the strategy of “integrated monitoring of the disease and response” in 2008. However, in spite of the efforts made, progress still remains to be effected to assess the actual impact of rabies in Mali.

Rhinogenic Contact Point Headache: Surgical Treatment Versus Medical Treatment

Rhinogenic contact point headache (RCPH) is a headache syndrome secondary to mucosal contact points in the sinonasal cavities, in the absence of inflammatory signs, hyperplastic mucosa, purulent discharge, sinonasal polyps, or masses. It may result from pressure on the nasal mucosa due to anatomic variations among which the septal deviation, septal spur, and concha bullosa, are the most commonly observed. In recent years, RCPH has remained a subject of controversy regarding both its pathogenesis and treatment. This study aimed to investigate the effect of surgical and medical treatment of pain relief in patients with RCPH, evaluating the intensity, duration, and frequency of headaches, and the impact of different treatments on quality of life. Ninety-four patients with headache, no symptoms or signs of acute and chronic sinonasal inflammation and who present with intranasal mucosal contact points positive to the lidocaine test were randomized into 2 equal groups and given medical or surgical treatment. The authors used visual analog scale, number of hours, and days with pain to characterize the headache and Migraine Disability Assessment score (MIDAS) to assess the migraine disability score before and 3 to 6 months after treatment. After treatment the severity, duration, and frequency of the headache decreased significantly (P < 0.001, P < 0.001, and P = 0.031, respectively) as well as the MIDAS in the surgical group compared with medical group. Our results suggest that surgical removal of mucosal contact points is more effective than local medical treatment improving the therapeutic outcomes in patients with contact point headache.