Medical Consultation Research Articles

Impact of the coronavirus pandemic on the diagnosis and treatment of head and neck cancer

After the first appearance of COVID-19cases, the virus spread worldwide within afew months. This led to adecrease in medical consultations. The present study investigates whether this effect had an impact on the diagnosis and treatment of head and neck cancer during the period from 2018 to 2022. Data from the clinical cancer registration center (KKR) of Mecklenburg-Vorpommern from the 2020-2022 period were compared to those from the two previous years (2018, 2019). Demographic data, case numbers, diagnosis data, International Classification of Diseases (ICD) codes, and TNM classifications were recorded. COVID-19case numbers were obtained from the Robert Koch Institute (RKI). Data were analyzed using the Mann-Whitney Utest and Pearson's correlation. Atotal of 2332 patient cases could be included in this study. During the lockdown there was neither asignificant reduction in tumor diagnoses registered at the KKR nor acorrelation between COVID-19case numbers and tumor diagnoses. Significant differences were found in terms of Tcategory in the year 2022 compared to the pre-COVID years 2018 and 2019. Furthermore, there was ashift in the relative frequencies of some ICD-10codes. During the COVID-19 pandemic, no significant differences in tumor diagnoses were observed upon comparing the years 2018 to 2022. Contrary to the expectation of adecrease in case numbers during the pandemic due to the lockdown with an increase in tumor stages, areduction of the Tcategory could be found in 2022, and ashift in the relative frequencies of some ICD-10codes in the pandemic period was observed.

Blood Loss in Women of Childbearing Potential Taking Oral Anticoagulants for Venous Thromboembolism (The BLEED Study).

Oral anticoagulants (OAC) may exacerbate menstrual bleeding in women of childbearing age; however, the existing literature on this issue has several limitations. This study investigates abnormal uterine bleeding (AUB) in women of childbearing age taking oral anticoagulants-Vitamin K antagonists (VKA) or Direct Oral Anticoagulants (DOAC)-for venous thromboembolism through a retrospective analysis of prospectively collected data. Uterine bleeding was assessed using the Pictorial Blood Assessment Chart (PBAC) and hemoglobin (Hb) values during anticoagulation compared to prior therapy. The number of unplanned medical visits for bleeding complications was also calculated. From June 2014 to November 2023, 110 women were recruited (median age, 36 years). PBAC scores correlated with Hb values at baseline and during therapy (ANOVA, p<0.01), with a significant difference in Hb values before and during anticoagulant therapy (Δ Hb) among groups (ANOVA, p=0.034). Seventeen women (15.4%) reported fibroids, experiencing a greater reduction in Hb values during anticoagulant administration than women without fibroids (Δ 0.3, IQR -0.8, 2.9 vs -0.5, IQR -1.2, 0.3; p=0.012). Women with fibroids required more frequent unplanned medical consultations for bleeding (mean visits 5 vs 4 respectively; Poisson regression, p<0.05). Among women with fibroids, those taking apixaban showed smaller Hb changes than those on other oral anticoagulants (ANOVA, p=0.047). This difference persisted even after adjusting for potential confounders (MANOVA, p=0.004). Women of childbearing potential taking OAC frequently experience changes in Hb values and PBAC scores during treatment, with fibroids playing a significant role.

Prevalence of anxiety and depression disorders in patients with inflammatory bowel disease in a city in southern Brazil

Inflammatory bowel disease is a chronic disease with symptoms and possible complications that can bring disability to the patient and trigger impairment in mental health such as depression and anxiety disorder. Objective: To evaluate the prevalence of Anxiety and Depression Disorder in patients with IBD in the Inflammatory Bowel Disease outpatient clinic of UFPEL. Methodology: Applied socio-economic questionnaire, M.I.N.I. instrument and collection of data from the medical record during the medical consultation. In patients attending the FAMED-UFPEL outpatient clinic with a diagnosis of Inflammatory bowel disease and over 16 years of age in the period from 06/01/2021 to 02/28/2022. Results: During the exposed period, 59 patients diagnosed with IBD were evaluated, being 37 (62.7%) with Crohn's Disease and 22 (37.3%) with Ulcerative Colitis, the average age was 46 years. In the current study, disease activity was evaluated using the Mayo Score for patients with ulcerative colitis with a result with no statistical significance for depression (p:0,494) and anxiety disorder (p:0,484). The Harvey Bradshaw Score was used in patients with Crohn's Disease that also has no statistical relevance for depression (p:0.969) and anxiety disorder (p:0.380). In the present study, 29.4% of patients had Ulcerative Colitis and recurrent depressive episode and 54.2% of patients had generalized anxiety disorder. Conclusion: there is a high prevalence of mood disorders in the population studied, it is emphasized the need for the active search of these diagnoses in this population, offering adequate treatment of the pathologies found with a view to better quality of life.

Determinants of Doctor–Patient Communication in Terms of Patient Rights During the COVID-19 Pandemic

Background. Today, the public does not want to be just a passive consumer of health services. Patients often expect to be informed and involved in decisions about their health. Objective. With better doctor–patient communication, patients are more likely to follow treatment recommendations. Material and methods. The study was conducted using a face-to-face survey method on a group of 203 adult, independent patients from 2021 to 2022 at a medical facility, i.e., a rehabilitation clinic. The purpose of this study was to assess the determinants of doctor–patient communication in terms of patient rights. One of patients’ rights is the right to information about their health condition and treatment methods and the right to ask questions when the doctor does not provide details about the treatment or diagnosis or when it is not understandable. Doctors providing information to the patient and the opportunity for the patient to ask questions are key elements in the process of making informed decisions regarding further medical treatment. Therefore, patients were divided into two groups: active (+) and passive in communication (−) with doctors. Results. Patients who were active in communication (33%) wanted to ask questions or had the opportunity to ask the doctor questions, and thus, they were able to take an active part in the discussion with the doctor. In contrast, patients who were passive in communication (67%) did not want to ask questions or did not have the opportunity to ask the doctor questions, and therefore, their active participation in the discussion and thus their right to ask questions may have been limited. The authors’ survey shows that respondents with active communication were significantly more likely than patients with passive communication (almost 100% vs. 86%) to obtain information about their condition (p = 0.002), diagnostic methods (p = 0.003), therapeutic methods (p = 0.00007), treatment results, and prognosis (p = 0.0008). Moreover, almost all respondents with active communication as opposed to respondents with passive communication (95% vs. 52%) rated communication with doctors highest (on a scale from 0 to 5), including credible and professional approach to patients (p &lt; 0.0001), providing information in clear and simple language (p &lt; 0.0001), answering questions asked by patients (p &lt; 0.0001), openness and kindness (p &lt; 0.0001), maintaining professional confidentiality (p &lt; 0.0001), or emotional support (p &lt; 0.0001). Conclusions. Hence, the primary key element of the medical consultation is appropriate amount and content of information given to the patient, providing explanations and answering questions. Also importantly, according to the results, active communication between patients and doctors was significantly influenced by female gender, higher education, and a positive evaluation of communication with doctors.

Accuracy of Prospective Assessments of 4 Large Language Model Chatbot Responses to Patient Questions About Emergency Care: Experimental Comparative Study.

Recent surveys indicate that 48% of consumers actively use generative artificial intelligence (AI) for health-related inquiries. Despite widespread adoption and the potential to improve health care access, scant research examines the performance of AI chatbot responses regarding emergency care advice. We assessed the quality of AI chatbot responses to common emergency care questions. We sought to determine qualitative differences in responses from 4 free-access AI chatbots, for 10 different serious and benign emergency conditions. We created 10 emergency care questions that we fed into the free-access versions of ChatGPT 3.5 (OpenAI), Google Bard, Bing AI Chat (Microsoft), and Claude AI (Anthropic) on November 26, 2023. Each response was graded by 5 board-certified emergency medicine (EM) faculty for 8 domains of percentage accuracy, presence of dangerous information, factual accuracy, clarity, completeness, understandability, source reliability, and source relevancy. We determined the correct, complete response to the 10 questions from reputable and scholarly emergency medical references. These were compiled by an EM resident physician. For the readability of the chatbot responses, we used the Flesch-Kincaid Grade Level of each response from readability statistics embedded in Microsoft Word. Differences between chatbots were determined by the chi-square test. Each of the 4 chatbots' responses to the 10 clinical questions were scored across 8 domains by 5 EM faculty, for 400 assessments for each chatbot. Together, the 4 chatbots had the best performance in clarity and understandability (both 85%), intermediate performance in accuracy and completeness (both 50%), and poor performance (10%) for source relevance and reliability (mostly unreported). Chatbots contained dangerous information in 5% to 35% of responses, with no statistical difference between chatbots on this metric (P=.24). ChatGPT, Google Bard, and Claud AI had similar performances across 6 out of 8 domains. Only Bing AI performed better with more identified or relevant sources (40%; the others had 0%-10%). Flesch-Kincaid Reading level was 7.7-8.9 grade for all chatbots, except ChatGPT at 10.8, which were all too advanced for average emergency patients. Responses included both dangerous (eg, starting cardiopulmonary resuscitation with no pulse check) and generally inappropriate advice (eg, loosening the collar to improve breathing without evidence of airway compromise). AI chatbots, though ubiquitous, have significant deficiencies in EM patient advice, despite relatively consistent performance. Information for when to seek urgent or emergent care is frequently incomplete and inaccurate, and patients may be unaware of misinformation. Sources are not generally provided. Patients who use AI to guide health care decisions assume potential risks. AI chatbots for health should be subject to further research, refinement, and regulation. We strongly recommend proper medical consultation to prevent potential adverse outcomes.

Differential diagnosis of dizziness: what's the contribution of Artificial Intelligence?

Dizziness is one of the most common reasons for medical consultations. The interdisciplinary range of differential diagnoses often leads to difficulties in proper classification. Artificial Intelligence and machine learning can assist through data-driven algorithms and facilitate the collection of important clinical signs as digital biomarkers. The article will present and critically discuss the current evidence on the topic.

Family planning after transplantation: sex- and organ-related differences in the perception of medical counseling and social challenges

Abstract Purpose Transplant patients are increasingly of childbearing age. Organ-related health as well as pregnancy-related risks require a standardized approach to family planning counseling. The aim of this study was to explore sex- and organ-related counseling differences and expectations in family planning to improve counseling services and reduce risks after transplantation. Methods The study was designed as a cross-sectional, multi-center cohort study. A total of 251 participants aged between 18 and 45 years with a visceral or thoracic transplant completed a questionnaire on their attitude toward family planning and experience with medical consultation. Results More female than male participants had a desire to have children. Males believed their transplantation-related medication had an influence on their fertility, while women worried it could harm their child. Contraceptive counseling was negated by 43.6% of the women and 73.4% of the men. Medical advice regarding family planning was highly requested by both sexes. Women felt more influenced in their family planning than men. Female thoracic organ recipients worried about a pregnancy more than visceral organ recipients. Women showed great awareness for pregnancy-related risks with the majority wanting to plan a pregnancy beforehand. Conclusion The findings revealed a lack of contraceptive counseling and a lack of family planning advice by physicians.

Perception of fatphobia and pesocentrism within medical consultation

Abstract Background About 42% of adults living with overweight or obesity suffer a marked pattern of stigmatization and thanks to this discrimination the risk of death has increased up to 60%. Objectives To identify the factors that contribute to the perception of fatphobia and pesocentrism within the first level of medical care. Methods A prospective cross-sectional study was carried out. Statistical analysis was performed with X2 test and 95% confidence interval (OR/CI95%). Results 104 participants with obesity and overweight were included. The factors associated with the perception of pesocentrism were, started eating plans before the age of 10 years (3.38/1.12-10.7); being denied consultation for being a fat person (0.27/-0.16-0.46); perceiving mistreatment by the physician regarding weight (0. 2/0.13-0.3); perceiving physical harassment by the physician (0.23/0.16-0.82); perceiving discomfort on physical examination (0.44/0.23-0.82); perceiving fat-phobic behaviors by the physician (5.45/3.24-9.16). Factors associated with perceived fatphobia were, started eating plans before the age of 10 years (4.89/1.71-14.01); being denied consultation for being a fat person (0.19/-0.08-0.44); perceiving mistreatment by the physician regarding weight (0. 07/0.04-0.15); perceiving physical harassment by the physician (0.11/0.06-0.19); perceiving discomfort on physical examination (0.28/0.11-0.67); perceiving weight-centered behaviors by the physician (0.05/0.01-0.23). All with p value &amp;lt;0.05. Conclusions Factors such as the beginning of eating plans in childhood, refusal of consultation for being a fat person, mistreatment regarding weight, physical harassment by the physician, discomfort during physical examination are associated with and favor the perception of both fat-phobia and weight-centeredness in the medical consultation. Key messages • It is of vital importance to know more about the concepts of fatphobia and pesocentrism, in order to promote non-discrimination around them. • Fatphobia and pesocentrism are still little known issues within the medical community, the perception of them is due to discriminatory behaviors that have been normalized.

Development of a tool for generating comprehensible, individualized and digitalized outpatient letter

Abstract Background Patients often remember little from a medical consultation or a conversation with a doctor. A comprehensible, individual patient letter summarizing the consultation can support, as a German project which successfully implemented a digital tool to generate such a letter in inpatient care showed. Based on this, our aim is to develop a tool for letters in outpatient care in Switzerland, to support understanding of the consultation and increase patient’s health literacy (HL). Methods The development of the tool was conducted participatively with targeted health professionals (HP) and patients with a chronic disease to 1) identify specific patient groups and situations, 2) confirm eligibility and receive concrete input regarding structure and content, and 3) to ensure the technical practicality and usability by the target groups. Concretely, several expert and patient interviews, a focus group and consultation observations were performed. Further workshops and usability tests are planned. Results We first defined 8 criteria to identify situations suitable for the development of the letter (e.g. high information need) and interviewed 5 experts on selected topics. Based on this, chronic back pain was chosen for a deeper feasibility analysis: A focus group interview (n = 4 HP) and 5 telephone interviews with patients confirmed the eligibility and provided information on the structure and content of the letter. Observations of 5 consultations provided further insights. Then, a first concept for the letter’s content was developed and is currently being finalized. It consists of: 1) summary; 2) background; 3) diagnosis; 4) treatment; and 5) next steps and includes infoboxes and a glossary. Conclusions The tool for patient letters can be adapted to other diseases (e.g. chronic back pain) and settings (outpatient care). In a next phase, the letter will be piloted in an outpatient clinic and evaluated with HP and patients. The effect on HL will also be assessed. Key messages • Comprehensible, individualized, and digitalized patient letters can help patients to deal with health information and take better decisions for their health and well-being. • The developed patient letter and the corresponding tool should be easily adaptable for other diseases and settings.

A Multicenter Physician Survey Evaluating the Use of Ki-67 in Breast Cancer Management in Canada

Background: Ki-67’s response to pre-operative endocrine therapy (ET) in early breast cancer is an evidence-based tool to guide adjuvant treatment decisions. Physicians across Canada were surveyed to explore current practice patterns and perceived barriers to the use of Ki-67 in practice. Methods: Physicians were invited to participate in an anonymous survey and were eligible if they prescribed systemic therapy for breast cancer in Canada. Respondents were asked to describe their usage of Ki-67, perceptions of the evidence surrounding Ki-67 ET response, and interest in future trials using this approach. Results: The survey received 48/163 responses (29.4%). The majority of respondents (97.6%) reported access to Ki-67 testing upon request. Treatment decisions for adjuvant Abemaciclib was the most common reason (97.6%), followed by adjuvant chemotherapy decisions (16.7%). Only 19.0% had used Ki-67’s response to pre-operative ET in practice. Common barriers to this approach that were identified included a lack of awareness from other providers (54.8%), an increased resource requirement (54.8%), and a lack of timely medical oncology consultation (52.4%). The majority of physicians (85.3%) reported that they would participate in future trials using the Ki-67 endocrine response, and that rate of treatment decision change (95.2%) and cost analysis (42.3%) were important endpoints. Conclusions: Despite the widespread availability of Ki-67 testing, few physicians in Canada currently use it to assess endocrine response, predominantly due to logistical and resource constraints. There is a high level of interest in participating in future trials using this strategy, which should focus on disease related outcomes, feasibility, and the financial impact on the public healthcare system.

Productivity and consultation times in Portuguese primary care: trends and payment model variations

Abstract Background Portugal faces a shortage of primary care workforce resulting in an increase in patients without Family Physician (FP). While expanding the patient list per FP may help, it could also result in excessive workloads, compromising Consultation Times (CT) and quality of care. Furthermore, it is important to study the role of the primary healthcare (PHC) financing model in incentivizing their productivity. This study aims to analyse the productivity and CT in PHC units in Portugal, variation over time, and differences across PHC unit payment models. Methods 6,563 PHC units with different payment models (salary at UCSP, salary and group pay-for-performance at USF-A, and salary, capitation, and individual pay-for-performance at USF-B) from 2015 to 2022 were analysed, including the annual numbers of medical and nursing consultations and full-time equivalents (FTE) of physicians and nurses. Weekly productivity (WP) was calculated using the consultations per FTE physician and nurse. CT were determined by dividing each FTE’s weekly workload by WP. Multivariate analysis explored differences in CT between PHC units, temporal variations, and the influence of the patient population characteristics. Results FTE physicians had a mean WP of 117 consultations (SD 39) lasting 22.4 minutes (SD 7.0). FTE nurses had a mean WP of 56 consultations (SD 18) lasting 41.0 minutes (SD 14.3). Compared to UCSPs, USF-A and USF-B had shorter CT (p &amp;lt; 0.05) by 2.48 to 4.05 minutes for medical consultations and by 5.51 to 8.04 minutes for nursing consultations. CT increased over time, decreased with higher PHC age and favorable socio-demographic context, and increased with higher population density and elderly patients’ proportion (p &amp;lt; 0.05). Conclusions USF-B professionals showed higher productivity and shorter CT, suggesting that financial incentives are effective in enhancing productivity but that gains may be obtained with losses in visit duration. Key messages • Effective workforce management is crucial given the current primary care professionals shortages. • Physicians and nurses in PHC units pay-for-performance exhibit higher productivity and shorter consultation time.

Factors associated with actinic keratoses in people with albinism in the Albivoire program

Abstract Background People with albinism (PWA) face health inequalities partly due to barriers in accessing health care, consequently delaying the diagnosis of skin precancerous and cancerous lesions. Actinic keratoses (AK), are common precancerous lesions, indicating a high risk of skin cancer. Given the scarcity of research on skin cancer prevention among PWA in Africa, this study aimed to determine the prevalence and factors associated with AK in PWA followed in the Albivoire program. Methods This cross-sectional analytical study was conducted within the ongoing Albivoire program in Ivory Cost. Initiated in Ivory Coast in 2021, Albivoire is the largest comprehensive preventive and care initiative with and for PWA, offering medical consultation campaigns in dermatology, ophthalmology, and psychology. Dermatological records of consenting patients were analyzed. The prevalence (95%CI) of AK was estimated, and the associated factors assessed using logistic model. Results To date, a total of 1978 PWA received care across four regions (Abidjan, Bouaké, Korhogo and Man). Available data from 475 PWA were analyzed, among whom 247 (52%) were women. The median age was 14 years (interquartile range [IQR]: 7-25). Of these, 181 individuals (38.1%, 95% CI [33.7 - 42.6]) presented with actinic keratoses (AK). The median age of PWA with AK was 22 years (vs 11 years for without AK (p &amp;lt; 0.001). Among PWA with AK, 87.8% were daily exposed to sun (vs 12.2% for those exposed occasionally, p = 0.026). In the multivariate analysis, factors significantly associated with AK included age 22 years or older (vs age &amp;lt; 22 years, aOR=4.83, p &amp;lt; 0.001), the presence of ephelides (vs absence; aOR=2.08, p = 0.003) and presence of xerosis (vs absence aOR=4.88, p &amp;lt; 0.001). Conclusions This study highlights the high prevalence of AK in PWA in Ivory Cost, and identifies specific modifiable associated factors which should be targeted in global health strategies to prevent skin cancer among this vulnerable population. Key messages • Prevalence of skin precancerous lesions (actinic keratoses) in people with albinism in Ivory Cost is high (38%) and associated with modifiable risk factors. • Tailored public health interventions needed to prevent skin cancers in vulnerable populations, targeting lesions like xerosis, ephelides, and actinic keratoses through skin protection.

Application of Artificial Intelligence Models to Predict the Onset or Recurrence of Neovascular Age-Related Macular Degeneration

Neovascular age-related macular degeneration (nAMD) is one of the major causes of vision impairment that affect millions of people worldwide. Early detection of nAMD is crucial because, if untreated, it can lead to blindness. Software and algorithms that utilize artificial intelligence (AI) have become valuable tools for early detection, assisting doctors in diagnosing and facilitating differential diagnosis. AI is particularly important for remote or isolated communities, as it allows patients to endure tests and receive rapid initial diagnoses without the necessity of extensive travel and long wait times for medical consultations. Similarly, AI is notable also in big hubs because cutting-edge technologies and networking help and speed processes such as detection, diagnosis, and follow-up times. The automatic detection of retinal changes might be optimized by AI, allowing one to choose the most effective treatment for nAMD. The complex retinal tissue is well-suited for scanning and easily accessible by modern AI-assisted multi-imaging techniques. AI enables us to enhance patient management by effectively evaluating extensive data, facilitating timely diagnosis and long-term prognosis. Novel applications of AI to nAMD have focused on image analysis, specifically for the automated segmentation, extraction, and quantification of imaging-based features included within optical coherence tomography (OCT) pictures. To date, we cannot state that AI could accurately forecast the therapy that would be necessary for a single patient to achieve the best visual outcome. A small number of large datasets with high-quality OCT, lack of data about alternative treatment strategies, and absence of OCT standards are the challenges for the development of AI models for nAMD.

Beyond telehealth in heart failure, how a nurse-led mobile team unit improves management and reduces re-admission in elderly patients living in a rural area

Abstract Introduction Telehealth plays a crucial role in improving access to healthcare for elderly patients with heart failure (HF), particularly those who live in under-resourced geographic areas, have physical disabilities, or have difficulties with transportation. However, extending and improving telehealth faces significant obstacles, primarily due to its inadequacy to fully assess a patient's clinical status. While some components of HF can be measured remotely, others, such as cardiac and lung examinations, require in-person clinical evaluation. This leads to imprecise assessments of HF severity, excessive medical consultations, and inappropriate emergency transfers or hospitalization. We conducted an evaluation of a specialized mobile team unit (MTU) for HF care in a rural area. The team consisted of nurses trained in performing electrocardiograms (ECGs) and point-of-care ultrasound (POCUS) to extend telemonitoring services to elderly patients with HF in the comfort of their homes. This approach offers a direct and optimal evaluation of the patient's condition. Purpose This study aimed to evaluate the added value of an MTU in assessing and optimizing treatment for HF in elderly patients, ultimately leading to decreased hospitalization or medical request rates. Materials and methods This retrospective analysis examined data from elderly patients diagnosed with HF, who participated in a 6-month telemonitoring program, and received MTU visits. MTU was activated by the telemonitoring team, in patients presenting signs of decompensation, with an imprecise assessment of severity based on digital data only. Results During six months, 165 elderly patients were included in the telemonitoring platform after index HF hospitalization. The mobile team traveled over 3,040 kilometers in a rural area with limited cardiological care. They visited 84 patients (50.9%), offering personalized education and physical assessments to all of the patients, 45% received additional imaging (EKG, POCUS). This resulted in 30% therapeutic adjustments, 90% fewer General practitioner (GP) /Cardiologist consultations and 54% avoided readmissions: 20% of hospitalizations were avoided immediately and 34% likely avoided in the near future, demonstrating the intervention's 80% effectiveness. Conclusion Monitoring heart failure (HF) in elderly patients can be challenging, especially in rural areas with limited access to care, few caregivers, cognitive impairments, or difficulty using e-health platforms. This study emphasizes the benefits of a nurse-led mobile team unit in providing a reliable direct assessment of HF severity. This home intervention provides education, strengthens the decision-making capacity of the remote monitoring platform, assists with patient management, and significantly reduces the readmission rate.

Can ChatGPT affect health literacy?

Abstract Background ChatGPT is a large language model based on artificial intelligence, which nowadays finds application in various fields, including medicine. Objectives To investigate the usefulness of ChatGPT related to health literacy and to highlight its potential limitations. Methods We searched PubMed/MEDLINE for published research and articles that reviewed ChatGPT in the context of health literacy, written in English over the past five years with free full text access. All original articles were screened. Results A total of 53 publications were found. Twenty-five publications met the inclusion criteria and were included in the review. Most of the works presented a positive opinion towards the use of ChatGPT. The authors of six articles believe that ChatGPT generates more readable papers, while four of them believe the opposite. In four articles authors found out possibility to simplify text. The negative sides relate to the possibly insufficient education of users, the accuracy of the information, potential bias, dependence on the outdated data, and the ethical problem of the real authors not being cited, and therefore not recognized for their work. Conclusions According to the conducted research, ChatGPT represents an opportunity to improve health literacy by generating accessible and comprehensible information about health. It has also been shown to improve the readability and accessibility of public education materials on selected health topics. Furthermore, while AI models like ChatGPT can serve as a reliable source of health information, they should be used as an addition to professional medical consultation, and not as a standalone advice service. Key messages • ChatGPT represents an opportunity to improve health literacy. • AI models like ChatGPT can serve as a reliable source of health information, but they should be used as an addition to professional medical consultation, and not as a standalone advice service.

Testicular Torsion Following MMR Vaccination in an 18-Month-old Infant: A Case Report

Introduction: The measles, mumps, and rubella (MMR) vaccine is associated with known complications, such as salivary gland involvement and aseptic meningitis. Isolated reports of epididymal orchitis following MMR vaccination have also been reported, but no reported case of testicular torsion in infancy has been explicitly attributed to the MMR vaccine. Objective: Here, we report an 18-month-old male infant presented with a history of gradually worsening painful left scrotal swelling following a booster dose of MMR that finally led to orchiectomy with the diagnosis of testicular torsion. Case Presentation: An 18-month-old male infant presented with a one-day history of gradually worsening painful left scrotal swelling following a booster dose of MMR. No evidence of blood flow was detected in the left testicle in color Doppler sonography, which was compatible with testicular torsion. In surgical exploration, the left testicle seemed firm and dark in color. The spermatic cord vessels were thrombotic in appearance, and the testicular appendix seemed completely necrotic. The nonviable left testicle was removed. Conclusions: Although testicular torsion after MMR vaccination is rare, in the case of any pain, swelling, and redness of the scrotum, the patient should seek an urgent medical consultation. Physicians should be aware that testicular swelling after the MMR vaccine might not be just epididymal-orchitis but really a medical emergency.

Characterizing clinical and hormonal profiles of acne in north African women with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is the leading endocrine disorder in young women of childbearing age. Dermatological issues, particularly acne, are a major reason for medical consultations. The aim of this study is to determine the prevalence of PCOS in patients presenting with acne as their main dermatological complaint and to compare the metabolic and hormonal clinical characteristics of acne patients with PCOS to those with isolated acne. This was a prospective study with analytical aims, carried out in the Endocrinology Department and the Dermatology Department of Farhat Hached University Hospital in Sousse. The study included patients seeking treatment for acne from January 2023 to January 2024, divided into two groups: those with confirmed PCOS (G1) and those with isolated acne (G2). All patients underwent hormonal assessment and ovarian ultrasound. We conducted a study involving 212 patients. We found that 65.6% of acne patients had been diagnosed with PCOS. Nodular lesions were significantly more frequent in 'PCOS' (p = 0.02). Acne was linked with hirsutism, which was more prevalent in 'PCOS' (94.2% 'PCOS' vs. 67.1% 'isolated acne'), as well as androgenic alopecia (51% 'PCOS' vs. 21.9% 'isolated acne') (p < 10- 3). 'PCOS' showed evidence of biological hyperandrogenism, with a mean testosterone level of 0.72 ± 0.27 ng/mL, significantly higher than in 'isolated acne'. The LH/FSH ratio was greater than 1 in 72.7% of cases in 'PCOS', demonstrating a significant difference compared to 'isolated acne', where it was greater than 1 in 24.7% of cases (p < 10- 3). In our study, acne in 'PCOS' appeared to be more severe and was associated with hypertestosteronemia (p = 0.041) and hyperprolactinemia (p = 0.008). According to our results, phenotype A was the most likely to cause severe acne (p = 0.043). Our work is unique in that it brings to light this hidden aspect of the dermatological impact of PCOS, prompting physicians to screen for this endocrine disorder in all adult women seeking acne treatment.

Distraction osteogenesis in the treatment of transverse malocclusions in children

Relevance. Malocclusions accounts for 37% to 89% of all maxillofacial conditions in children aged 3 to 18 across various regions of Russia. These malocclusions can present as isolated issues in a single plane or as combined anomalies across multiple planes. Jaw narrowing or underdevelopment is influenced by various endogenous and exogenous factors. The choice of treatment depends on the severity of the malocclusion. While literature indicates several effective methods for treating transverse malocclusions, some aspects remain insufficiently explored.Materials and methods. A statistical analysis was conducted on 271 patient records of individuals with transverse malocclusions who received treatment in the Department of Pediatric Maxillofacial Surgery at A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of the Russian Federation, between 2013 and 2023.Results. There was an almost equal distribution of patients by gender, with a noticeable increase in medical consultations from 2013 to 2023. The majority of surgically treated patients were between 15 and 17 years old. Isolated transverse malocclusions were significantly less common than cases combined with other pathologies, with mesial occlusion being the most frequent comorbidity.Conclusion. The findings demonstrate a significant need for surgical treatment in pediatric patients with transverse malocclusions through distraction osteogenesis. This underscores the importance of continually improving treatment methods for children, including enhancing diagnostics, refining treatment indications, optimizing distraction protocols, and adjusting treatment courses. These efforts aim to improve the quality of rehabilitation for children, ensuring better outcomes into adulthood and facilitating their social adaptation.

81 mRNA COVID-19 vaccine safety among children and adolescents from the Canadian National Vaccine Safety Network

Abstract Background The Canadian National Vaccine Safety Network (CANVAS) expanded its active safety surveillance for COVID-19 vaccines among children and adolescents during the COVID-19 pandemic. Objectives This analysis aimed to determine whether the first or second dose of mRNA COVID-19 vaccination is associated with health events in children and adolescents. Design/Methods Adolescents 15-19 years of age or parents/guardians of children 5-14 years of age were recruited from seven Canadian provinces/territories and followed for the occurrence of health events seven days after doses 1 and 2 or for a seven-day period for unvaccinated participants. The primary outcome was a health event that prevented daily activities, resulted in school absenteeism, and/or required a medical consultation, including emergency department visits or hospitalization. Aged-stratified multivariable logistic regression examined health events associated with mRNA COVID-19 vaccines (BNT162b2, mRNA1273, and mixed [different products for doses 1 and 2]) for children aged 5 to 11 years and adolescents aged 12 to 19 years. Results Between January 2021 and February 2023, a total of 249,418 (Children BNT162b2: 205,744, mRNA-1273: 36, and Adolescent BNT162b2: 39,628, mRNA-1273: 4,010) completed the first dose survey and 128,599 (Children BNT162b2: 109,625, mRNA-1273: 3, mixed: 235, and Adolescent BNT162b2: 17,202, mRNA-1273: 1,155, mixed: 474) had completed the second dose survey. A total of 668 unvaccinated participants (Children 431 and Adolescent 237) completed the control survey. In the week following dose 1, health event rates among vaccinated children and adolescents were &amp;lt;4% and lower than in unvaccinated counterparts (6.9%), and neither BNT162b2 nor mRNA-1273 were associated with health events in either age group. Following dose 2, among vaccinated adolescents health events rates (BNT162b2 4.6%, mRNA-1273 8.5%, mixed 10.4%) were higher than unvaccinated adolescents (3.4%), but were self-limiting and resolved within 7 days. Among children, there was no difference in health event rates between vaccinated and unvaccinated groups. Conclusion For children, mRNA COVID-19 vaccines were not associated with health events preventing daily activities, resulting in school absenteeism and/or requiring medical consultation. Similar to vaccinated adults our findings found vaccinated adolescents reported higher rates of health events after dose 2 mRNA COVID-19 vaccines, but these were self-limiting and resolved quickly. Our findings can be used to inform adolescents and their parents of what to expect following COVID-19 vaccination.

Women's self-reported symptoms of reproductive tract infection, medical consultations, and factors influencing them in less developed regions: perimenopausal and older women in need of urgent attention.

Reproductive tract infections (RTIs) represent a critical public health concern impacting women's health, particularly pronounced in developing countries. We aim to investigates the prevalence of self-reported RTI symptoms in women aged 18 to 65 and the factors influencing gynecological examination behavior and associated risks are explored. From May 6, 2022, to September 20, 2022, a comprehensive survey engaged 20,864 women aged 18 to 65 in 19 townships in Lueyang, Shaanxi. Each survey team, comprising a gynecologist, two female health center staff, and a master's student, conducted face-to-face questionnaire surveys in villages and households. The questionnaire featured three sections: prevalence of self-reported RTI symptoms, gynecological examination history, and factors influencing examination behavior. The high response rate of 98.69% yielded 20,590 valid questionnaires. Among surveyed women, 42.04% reported RTI symptoms, with a higher prevalence in those aged 30 and above, peaking at 44.88% in the 50-59 age group. Vulvar itching (24.73%), abnormal vaginal discharge (17.41%), and urinary tract irritation signs (11.73%) were most common. Older adult women (≥60) reported higher frequency and longer duration of symptoms. Only 9.88% of symptomatic women underwent gynecological examinations in 2022. Examination likelihood decreased with age, presenting a critical gap in healthcare utilization among older women. Reasons for checkups included routine checkups (47.02%), symptom concerns (41.29%), and the availability of free medical checkup programs (9.82%). Barriers included perceived lack of serious symptoms (23.7%), lack of necessity (4.41%) and lack of time (3.98%). Among those examined, 40.58% had a diagnosis of gynecological disorders, including pelvic inflammatory disease, human papilloma virus infection and cervical cancer. Widespread RTI symptoms, particularly in perimenopausal and older women, underscore the need for enhanced healthcare. Barriers to gynecological examinations include awareness, education, and accessibility issues. Strategies must prioritize health education, routine examinations, and improved healthcare infrastructure in underdeveloped regions.