Medical Practice Research Articles

Horace Wells: A Pioneer in Modern Anesthesia and Pain-Free Medical Practices

Horace Wells: A Pioneer in Modern Anesthesia and Pain-Free Medical Practices

Primed for Discovery.

Antibiotics are essential components of current medical practice, but their effectiveness is being eroded by the increasing emergence of antimicrobial-resistant infections. At the same time, the rate of antibiotic discovery has slowed, and our future ability to treat infections is threatened. Among Christopher T. Walsh's many contributions to science was his early recognition of this threat and the potential of biosynthesis─genes and mechanisms─to contribute solutions. Here, we revisit a 2006 review by Walsh and co-workers that highlighted a major challenge in antibiotic natural product discovery: the daunting odds for identifying new naturally occurring antibiotics. The review described strategies to mitigate the odds challenge. These strategies have been used extensively by the natural product discovery community in the years since and have resulted in some promising discoveries. Despite these advances, the rarity of novel antibiotic natural products remains a barrier to discovery. We compare the challenge of discovering natural product antibiotics to the process of identifying new prime numbers, which are also challenging to find and an essential, if underappreciated, element of modern life. We propose that inclusion of filters for functional compounds early in the discovery pipeline is key to natural product antibiotic discovery, review some recent advances that enable this, and discuss some remaining challenges that need to be addressed to make antibiotic discovery sustainable in the future.

German medical students’ views regarding Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): a cross-sectional survey

BackgroundMyalgic encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a challenging disease pattern and has gained increasing scientific and public interest in recent years due to the Corona pandemic and Long-Covid. The aim of this study was to investigate (1) medical students’ health-related control beliefs, (2) students’ awareness and views about ME/CFS at the beginning of their medical education, and (3) to examine whether there are correlations between students’ health-related control beliefs and their views about ME/CFS.MethodsA cross-sectional online-survey was conducted in October 2020 with all new medical students at the Ludwig Maximilian University of Munich and the Technical University Munich.ResultsA total of 251 students completed the survey, representing a response rate of 27.0% (251/929). The examined health related locus of control of the students was predominantly internal oriented. Students’ awareness about ME/CFS at the beginning of their medical education were found to be low: 46,8% (117/250) of the students surveyed disagreed that they have heard or read about ME/CFS and 81,6% (204/250) disagreed that they feel sufficiently well informed about the disease. A possible correlation between students’ health-related locus of control and their views regarding ME/CFS-specific issues was found: The higher the students’ internal locus of control, the less they favored a strict separation of mental and physical suffering in medical practice, the less they believed that psychological causes for an illness should only be sought when no physically objective causes could be found, and the less they agreed that there is no indication for therapy if a disease is not objectively detectable.ConclusionsAs ME/CFS is a medical challenge and increasingly relevant in medical practice, the fact that 50% of medical students have never heard of this disease underscores the need for awareness and education. We found that the majority students in the sample largely have an internal health related locus of control. They rate their own influence on their health higher than those with an externally oriented control conviction.

The "Green Doctor" Initiative: Ethical Healthcare in the Age of Medical Commercialization

The "Green Doctor" initiative represents a groundbreaking shift in global healthcare systems, aiming to prioritize ethical, compassionate, and patient-centered care in an era of increasing commercialization. Proposed by Professor Reza Ghalamghash, the "Green Doctor" concept focuses on the moral obligations of healthcare professionals to provide care that transcends financial considerations and commercial pressures. This innovative model emphasizes the humanistic aspects of medicine, where physicians are encouraged to focus on patients' holistic well-being, mental and emotional health, and equitable access to care. In the face of rising healthcare costs, systemic inequities, and ethical dilemmas posed by profit-driven models, the "Green Doctor" approach is particularly timely. This article explores the philosophical foundation of the "Green Doctor" concept, its implications for healthcare systems around the globe, and its potential to drive meaningful change in public health policy and medical practices. Through a detailed exploration of real-world case studies, the article delves into how this model is being adopted in different healthcare settings, examining its efficacy in enhancing patient outcomes, promoting healthcare equity, and reshaping the relationship between doctors and their patients. Additionally, the article discusses the structural challenges faced by healthcare providers in implementing this approach, including financial constraints, regulatory hurdles, and the need for institutional support. It also highlights the role of technology in facilitating the "Green Doctor" model, particularly through the use of telemedicine, digital health platforms, and AI-driven diagnostics, which allow doctors to extend care to underserved populations while maintaining a patient-centered focus. Finally, the article assesses the future of the "Green Doctor" initiative in the context of evolving global healthcare challenges, offering insights into how it could serve as a sustainable model for ethical healthcare in the 21st century.

State of art on evaluation of three- to six-dimensional novel additive manufacturing technology for biomedical applications

Additive manufacturing has evolved over the last few decades. Three-dimensional printing is a digital manufacturing technology that provides nearly endless options for the creation of an accessible instrument for all parts of various medical practices, including tissue engineering, through meticulous optimization of material, processing, and geometry for every point in an object. Three-dimensional printing has opened up a new, faster, and safer manufacturing process, despite its incapability to fabricate complex structures and objects. Recently, novel four-dimensional printing techniques have been developed for the transformation of typical stable three-dimensional printed parts into smart objects. The limitations of three-dimensional printing could be remedied with four-dimensional printing, by applying time as the fourth dimension. Self-repairing and speedy printing are two additional benefits of this technology's by using smart materials. By adapting this technology, numerous medical domains could be profited. Four-dimensional printing does not have the ability to produce curved complicated forms. However, five-dimensional printing overcomes the flaws seems in four-dimensional printing. Five-dimensional additive manufacturing relies on the rotation of both the print bed and the extruder head. Five-dimensional printing outlasts in terms of durability than three- and four-dimensional printing. Currently, a combination of the principles of four- and five-dimensional printing into a single process is called six-dimensional printing. In six-dimensional printing, the form changes over time due to the reaction of environmental factors, which is primarily used in biomedical applications. This paper summarizes extensive research on biomaterials in the field of biomedical science and discusses the present implications of three-, four-, five-, and six-dimensional printing techniques.

The Physician King Buddhadasa: A Mine of Virtues, as the Sea is of Jewels.

King Buddhadasa was a monarch of the Kingdom of Anuradhapura, Sri Lanka, in the 4th century A.D. He was a unique king with sound knowledge and skill in medicine according to the traditional medical system. The primary source of Sri Lankan history describes him as "a mine of virtues, as the sea is of jewels." This is due to his virtue of being a righteous king and a compassionate physician, whose healing extended to both humans and animals. His contributions went beyond curative medicine to include preventative care, medical administration, and scholarly work such as the Sarartha Sangrahaya. Similar to Charaka and Sushruta in the South Asian region, his life and work are exemplary and inspirational to modern-day physicians. This review provides an account of the life of King Buddhadasa as recorded in the primary chronicle of Sri Lankan history. Some of his healing accounts may seem mystical to the reader. The article also endeavours to find plausible explanations for those occurrences based on allopathy and science. These records serve as important lessons for modern-day physicians, encouraging the inculcation of good conscience and morality in medical practice.

Carotid sinus massage in clinical practice: the Six-Step-Method.

Carotid sinus massage (CSM) as integral part of cardiovascular autonomic testing is indicated in all patients > 40 years with syncope of unknown origin and suspected reflex mechanism. However, large practice variation exists in performing CSM that inevitably affects the positivity rate of the test and may result in an inaccurate diagnosis in patients with unexplained syncope. Even though CSM was introduced into medical practice more than 100 years ago, the method of performing CSM is still largely operator- and centre-dependent, while in many places, the test has been entirely abandoned. Here, we describe a standardized protocol on how to perform CSM, which basic monitoring equipment is necessary and why CSM is a safe procedure to perform. Our aim is to create a uniform approach to perform CSM. The new proposed algorithm, the Six-Step-Method, includes: (i) check history for exclusion CSM; (ii) turn head slightly contralaterally and posterior (see also explanatory video and poster provided as Supplementary material; (iii) palpation to identify carotid sinus location; (iv) massage for 10 s; (v) monitoring of blood pressure and heart rate to assess of the haemodynamic response type; and (vi) include time intervals between subsequent massages. Carotid sinus massage should be performed on both the left and right and in the supine and upright position. The recommended equipment to perform CSM consists of: (i) a tilt table in order to perform CSM in supine and standing position, (ii) a continuous blood pressure monitor or cardiac monitor, and (iii) at least two persons.

Effects of Citizenship Status on International Medical Graduate Specialty Choice and Practice Location.

The number of both US citizen and noncitizen international medical graduates (IMGs) practicing in the United States has grown substantially over the last two decades, but little is known about how these groups differ in clinical specialty and practice location. To evaluate the effects of citizenship status on IMG specialty choice (primary care vs nonprimary care) and practice location (rural and health professional shortage areas [HPSAs]). To analyze the retrospective, cross sectional data between 2010 and 2019, we estimated a series of multivariate logistic regressions with year fixed effects after assessing trends in new physician specialty choice and practice location. Survey of Residents Completing Training in New York, the largest publicly available annual survey of graduating residents and fellows in the US. 15,133 new physicians who accepted a job offer in our study period, including 8,177 US medical graduates (USMGs), 2,753 US citizen IMGs, 1,057 permanent resident IMGs, and 3,146 noncitizen non-permanent resident (NCNP) IMGs. IMG and Citizenship status. Whether a new physician chose to practice primary care; whether a new primary care physician chose to work in a rural area; whether a new primary care physician chose to work in a HPSA. Compared to 2010, there were 20% fewer NCNP IMGs entering primary care in 2019. Our logistic analysis found that US citizen IMGs were five times, permanent resident IMGs seven times, and NCNP IMGs nine times more likely to enter primary care compared to USMGs. Among new primary care physicians, NCNP IMGs were more likely to work in a rural area compared to USMGs while US citizen IMGs and permanent resident IMGs acted similarly to USMGs. NCNP IMGs were five times more likely to work in a HPSA while US citizen IMGs and permanent resident IMGs were less likely, compared to USMGs. There was a declining proportion of NCNP IMGs entering primary care; citizenship status affected IMGs' specialty and practice location choices with NCNP IMGs more likely to choose primary care and work in rural areas and HPSAs.

Burnout Syndrome among Emergency Physicians and Residents: A Systematic Review

Objectives: To study the risk factors and prevalence of burnout and its dimensions among emergency physicians in Saudi Arabia. Methods: PubMed, SCOPUS, Web of Science, and Science Direct were systematically searched for relevant literature. Rayyan QRCI was employed throughout this comprehensive process. Results: We included fourteen studies with a total of 1810 patients, and 1068 (59%) were males. The MBI-HSS was the scale used to assess burnout. The prevalence of burnout ranged from 15.57% to 76%. The following factors were associated with higher burnout risk: smokers, people using medication for sleep disorders, number of vacation days annually, number of workdays per week, female sex, single status, early medical practice participants, resident physician/surgeon employment category participants, people whose current job negatively impacted their family life, and people with back pain. Conclusion: Saudi physicians in emergency medicine have the highest burnout rates of any profession, making them particularly vulnerable to burnout. Nonetheless, there remains a high level of job satisfaction among emergency physicians, and further research is necessary to fully understand the intricate relationship between burnout and job satisfaction. Because burnout is linked to particular personality traits and particularly coping mechanisms, doctors who are at high risk of experiencing burnout should be recognized early on and appropriately consulted. In order to make progress toward the goal of effectively treating burnout syndrome in the future, more case-control studies pertaining to behavioural intervention and the promotion of healthy lifestyles are required.

Genetic testing, a challenge to kidney biopsy? A case report

The field of genetic testing has experienced significant growth in medical practice since 1956, when the first genetic analysis was introduced. Persistent proteinuria has long been considered a strong risk factor for the progression of chronic renal failure, though, paradoxically, it can also be a benign process, as seen in individuals with mutations in the cubilin (CUBN) protein, specifically the C-terminal. CUBN is a peripheral protein that plays a crucial role in the receptor-mediated endocytotic reabsorption of albumin in the proximal tubule. In the past, there have been misinterpretations of CUBN variants with isolated proteinuria as glomerular injury, leading to unnecessary kidney biopsies and ineffective treatments. This paper discusses two siblings with a homozygous variant of (p.Tyr3018Ser) in the C-terminal of the CUBN protein, inherited from both heterozygous carrier parents. This case presents an opportunity to question our typical approach to proteinuria in an effort to avoid unnecessary kidney biopsies and the subsequent side effects of treatments, particularly for those with proteinuria.

Tuberculosis its Prevalence, Complications and Clinical Aspects among the Population of Northern Part of Bihar

Introduction: It is commonly known as death causing disease of reproductive age group people. It is one of the top five death causing disease. It effects upon every age group people. But dangerous impact of tuberculosis occurs on immunocompetent people. There are a number of complications occur only due to one disease that is tuberculosis. it effects almost all organs and impaired their vital functions. Even if we leave death, even after tuberculosis proved to be most dangerous disease. In this study our main aim to explore the aspects, complications and prevalence of genital tuberculosis. In this study we also explore the ancient technics as well as the modern technics and their methods to ruled out the disease and improvement of treatment from ancient time to modern time. Method: This study was carried out between January 22 to April 23. 342 subjects are selected by inclusion and exclusion method. Subjects are classified in to 3 groups according to their physical appearance clinical symptoms and family history. Further patients are again classified in to negative, positive and doubtful negative patients after conducting routine and special investigations. Results: After all pathological investigation we found that 45 (13.1%) subjects have found positive in which 5.8% were male and 7.2 % were female. Conclusion: Tuberculosis is present in different forms and should be ruled out in early stage to safe from tissue damages. But unfortunately, we haven’t any tools which can detect the disease in its early stage accurately. All the investigation has their own limitations and contamination errors. There are a number of patients in which some can easily identified by their clinical symptoms and related routine examination, some are asymptomatic and identified by advanced diagnostic tools where are some such patient are also found who were strong symptomatic but even not only routine but also advance investigations are fail to detect. In our study we found the root cause of the disease, which are high population density, economically lower standard, poor hygiene life style, compromise food habits, illiteracy, marriage in early stage, multiple marriage, multiple children, non- skilled medical practices are causing and enhancing the incident of tuberculosis.

Artificial Intelligence Revolutionizes Esophageal Squamous Cell Carcinoma Management

<span lang="ES">The application of artificial intelligence in esophageal tumor pathology highlights the ongoing and significant transformative impact AI has in medicine. This article provides a comprehensive overview of AI technologies' current use in diagnosing and treating esophageal squamous cell carcinoma (ESCC). Through our research, we identified and meticulously analyzed 33 relevant academic papers and studies that contribute to this field. These papers encompass a broad spectrum of AI applications related to the management of esophageal squamous cell carcinoma. AI integration and deployment in both the diagnosis process and therapeutic interventions for tumors offer highly promising prospects, for example, in endoscopic procedures AI algorithm can process endoscopic images in real-time to identify abnormalities that may be missed by the human eye, it can highlight subtle changes such as color variations, small growths or tissue anomalies, which might go unnoticed due to fatigue, distraction or human limitations in perceiving fine details. AI technologies enhance medical practice precision and effectiveness by significantly reducing the likelihood of human errors and offering practical, innovative solutions. Consequently, AI confluence with medical practice not only increases diagnosis accuracy but also improves the overall efficiency of treating esophageal squamous cell carcinoma.</span>

CYTOLOGICAL DIAGNOSTICS OF THYROID DISEASES: BASIC PRINCIPLES AND FEATURES OF APPLICATION IN MODERN CONDITIONS

Introduction. Cytological diagnostics of thyroid diseases widely used in medical practice today. The standards and guidelines used in this examination ensure close cooperation between doctors of different specialties. Aim of research: To determine the methodological and organizational features of cytological examination of the thyroid gland, which can improve the use of this diagnostic method in Ukraine. The effectiveness of cytological examination depends on many factors. First of all, it is important to use this method in cases where the test result can be sufficiently informative and help identify thyroid diseases, choose further diagnostic and appropriate treatment tactics. Important stages in the actual cytological examination of thyroid diseases are: sampling, fixation and staining of cytological specimens, evaluation of microscopic changes, formulation of a cytological conclusion, and, if necessary, the use of immunocytochemical and molecular genetic methods. Compared to other countries, Ukraine has a higher incidence of uninformative reports in cytological diagnostics of thyroid diseases. The reasons for this are most likely more frequent violations of the technique of puncture, fixation and transportation of the material. It should be noted that cytologic examination in Ukraine is performed by a laboratory doctors, while in most countries of the world this examination is performed by a pathologist. Conclusions. In order to improve the effectiveness of the method of cytological diagnostics of thyroid diseases in Ukraine, it is necessary to ensure proper compliance with the relevant norms, standards and rules at all stages of its implementation. Taking into account the current regulatory norms and rules for cytological examinations in Ukraine, it is necessary to improve the qualifications of laboratory doctors in the field of cytological diagnostics of thyroid diseases, officially to include the method of cytological diagnostics into the work of a pathologist and to actively implement in medical practice The Bethesda System for Reporting Thyroid Cytopathology, 2023.

Effects of the coronavirus 2019 pandemic on medical publishing: The sacrifice of quality for quantity?

AbstractFacing the coronavirus disease 2019 (COVID‐19) pandemic, medical publishers rose to the occasion, moving to make their full portfolio of COVID‐19–related research available to read for free and expediting peer review and production processes. With such a rapid transition from paper submission to publication, however, concerns also arose regarding whether the quality of the research publication process was being affected. This article seeks to document the transformation of medical publishers' practices in response to the COVID‐19 pandemic and briefly discuss where they may go from here. For this goal, a literature search was performed in PubMed at several points to identify papers that reported early trends in how medical publishers handled COVID‐19 research.

Hunting for Early Melanomas With a Maximum Clinical Surface Diameter up to 6 mm: A Prospective Study of Reflectance Confocal Microscopy Features in 68 Consecutive Cases.

Early diagnosis of melanoma and prompt effective therapy optimizes prognosis. Reflectance confocal microscopy (RCM) facilitates diagnosis by providing immediate 3D single cell resolution down into the papillary dermis. Consecutive cases were examined using a Vivascope 1500 confocal microscope at a single referral medical practice in Sydney, Australia 2019-2023. Melanoma clinical surface diameters were recorded by 0.1 mm increments up to 6.0 mm. The RCM features recorded were: pagetoid single cells or nests, pleomorphic cell shape, atypical dendritic cells, non-edged papillae, variation in melanocyte size and confluent sheets of cells. All cases required diagnostic agreement by two dermatohistopathologists using hematoxylin and eosin staining followed by SOX 10 and/or PRAME stains if required. Total cases were 68: 38 males (mean age 57) and 30 females (mean age 64). Melanoma in situ (n = 65) compared to invasive melanoma (n = 3), all males, invasion depth (0.4-0.5 mm). Most frequent RCM features found in 50% or more of cases within all diameter increments were: pagetoid single cells n = 64/68 (94%), pleomorphic cell shape n = 63/68 (93%), epidermal disarray n = 58/68 (85%), and atypical dendritic cells n = 45/68 (66%). Non-edged dermal papillae were n = 42/68 (62%). Melanoma RCM features were found throughout the diameter ranges. Confocal examination may facilitate early melanoma recognition in these ranges.

Literacy in the Scope of Radiation Protection for Healthcare Professionals Exposed to Ionizing Radiation: A Systematic Review.

Background: The use of radiation is important in different medical procedures, and to ensure a high level of good medical practice, radiation protection (RP) should be seen as a very important subject. This review shows information about the knowledge in the scope of radiation protection among healthcare professionals exposed to ionizing radiation. There are not many studies that evaluate the radiation exposure of healthcare professionals. Methods: A systematic search was performed, using PRISMA guidelines, in Pubmed and Scopus databases and manually to identify relevant articles to answer the PICOS question, "Is there an adequate level of literacy in the scope of radiation protection among healthcare professionals exposed to ionizing radiation?". This systematic review included cross-sectional studies with the following inclusion criteria: (i) in Portuguese, Spanish, or English; (ii) about literacy in the scope of radiation protection; (iii) published between 2017 and 2024; and (iv) participants must be dentists, radiographers, doctors, and nurses. The JBI critical assessment tool was used to assess the risk of bias. Results: The search identified 566 potentially relevant references, which, after applying inclusion/exclusion criteria, resulted in 12 articles. Studies found that the overall knowledge of these healthcare workers was unsatisfactory, and a lack of knowledge in radiation protection negatively affects health services' quality. Training is essential and must emphasize how radiation exposure can be minimized, safeguarding health professionals' trust and sense of security. Results showed that more years of experience make workers more attentive to protection measures, suggesting that training strategies focused on basic radiological risks and radiation safety are needed. Conclusions: Key findings recommend implementing a standardized national training program on the basic principles and safety of ionizing radiation for all healthcare professionals.

Endovascular thrombectomy for childhood stroke (Save ChildS Pro): an international, multicentre, prospective registry study.

Emerging evidence suggests that endovascular thrombectomy is beneficial for treatment of childhood stroke, but the safety and effectiveness of endovascular thrombectomy has not been compared with best medical treatment. We aimed to prospectively analyse functional outcomes of endovascular thrombectomy versus best medical treatment in children with intracranial arterial occlusion stroke. In this prospective registry study, 45 centres in 12 countries across Asia and Australia, Europe, North America, and South America reported functional outcomes for children aged between 28 days and 18 years presenting with arterial ischaemic stroke caused by a large-vessel or medium-vessel occlusion who received either endovascular thrombectomy plus best medical practice or best medical treatment alone. Intravenous thrombolysis was considered part of best medical treatment and therefore permitted in both groups. The primary outcome was the difference in median modified Rankin Scale (mRS) score between baseline (pre-stroke) and 90 days (±10 days) post-stroke, assessed by the Wilcoxon rank test (α=0·05). Efficacy outcomes in the endovascular thrombectomy and best medical treatment groups were compared in sensitivity analyses using propensity score matching. The Save ChildS Pro study is registered at the German Clinical Trials Registry, DRKS00018960. Between Jan 1, 2020, and Aug 31, 2023, of the 241 patients in the Save ChildS Pro registry, 208 were included in the analysis (115 [55%] boys and 93 [45%] girls). 117 patients underwent endovascular thrombectomy (median age 11 years [IQR 6-14]), and 91 patients received best medical treatment (6 years [3-12]; p<0·0001). The median Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score on admission was 14 (IQR 10-19) in the endovascular thrombectomy group and 9 (5-13) in the best medical treatment group (p<0·0001). Both treatment groups had a median pre-stroke mRS score of 0 (IQR 0-0) at baseline. The change in median mRS score between baseline and 90 days was 1 (IQR 0-2) in the endovascular thrombectomy group and 2 (1-3) in the best medical treatment group (p=0·020). One (1%) patient developed a symptomatic intracranial haemorrhage (this patient was in the endovascular thrombectomy group). Six (5%) patients in the endovascular thrombectomy group and four (5%) patients in the best medical treatment group had died by day 90 (p=0·89). After propensity score matching for age, sex, and PedNIHSS score at hospital admission (n=79 from each group), the change in median mRS score between baseline and 90 days was 1 (IQR 0-2) in the endovascular thrombectomy group and 2 (1-3) in the best medical treatment group (p=0·029). Regarding the primary outcome for patients with suspected focal cerebral arteriopathy, endovascular thrombectomy (n=18) and best medical treatment (n=33) showed no difference in 90-day median mRS scores (2 [IQR 1-3] vs 2 [1-4]; p=0·074). Clinical centres tended to select children with more severe strokes (higher PedNIHSS score) for endovascular thrombectomy. Nevertheless, endovascular thrombectomy was associated with improved functional outcomes in paediatric patients with large-vessel or medium-vessel occlusions compared with best medical treatment. Future studies need to investigate whether the positive effect of endovascular thrombectomy is confined to older and more severely affected children. None.

STI Rates Among High-Risk Youth Undeterred During Early COVID-19 In A HIV Care Clinic

Abstract Background In recent years, the United States has observed increasing rates of sexually transmitted infections (STIs). Rates are highest amongst the teen and young adult age groups. In addition to the immense healthcare costs associated with STIs, long-term sequelae can be severe on the individual level. The risk of infertility is particularly high for those with repeated or prolonged infection. Upon entering the COVID-19 pandemic, it was unclear if the widespread behavioral changes and disruptions in routine care practices to minimize the further spread of COVID-19 would cause an increase or decrease in the United States’ STI rates. This study sought to determine if there was a change in the incidence of STIs during the first year of the COVID-19 pandemic compared to the year prior in a population at high risk for STIs. Methods A retrospective chart review was performed for 330 patients aged 12 to 41 years (mean 20.2 years, median 20 years, standard deviation 3.75 years) with human immunodeficiency virus (HIV) or on pre-exposure prophylaxis (PrEP) to prevent the acquisition of HIV, who presented for preventative and acute care appointments at a multidisciplinary pediatric and young adult HIV Clinic in the year prior to and during the first year of the COVID-19 pandemic (March 22, 2019-March 21, 2021). Utilizing telehealth, rapid COVID-19 screening, and multimodal patient communication, increased efforts were made in this clinic during the pandemic to maintain appropriate STI screening, testing, treatment, and rescheduling of routine visits when appropriate to minimize COVID-19 exposure and spread. Comparisons were made between the two time periods, which evaluated the incidences of individual and overall STIs diagnosed per person-years, STIs per total tests performed, and time to treatment initiation. Results Between one year prior to and the first year during the COVID-19 pandemic, this clinic experienced no statistically significant rate changes of sexually transmitted infections. A non-significant decreased incidence of chlamydia (22 cases per 100 person-years and 18 cases per 100 person-years, respectively) and unchanged rates of gonorrhea (22 cases per 100 person-years and 22 cases per 100 person-years, respectively) and syphilis (16 cases per 100 person-years and 15 cases per 100 person-years, respectively) were observed. The median times to treatment remained largely unchanged. Conclusion This HIV care clinic experienced a decreased chlamydia infection rate, a trend similar to the CDC United States STI data during this time period. In contrast to the nationally reported increased rates of gonorrhea and syphilis, this clinic experienced unchanged rates. The lack of change in our cohort could reflect that the benefits of a multidisciplinary HIV care model persist despite a pandemic that disrupted routine medical care and behavior practices.

Clinical research perspective on moxibustion treatment for urinary incontinence: A perspective review.

This study provides an in-depth perspective of moxibustion as a treatment option for urinary incontinence (UI), focusing on its clinical efficacy, underlying mechanisms, and potential integration into standard care practices. Moxibustion, rooted in traditional Chinese medicine, involves the targeted application of heat from burning moxa at specific acupoints. Analyzing data from randomized controlled trials and retrospective studies, the study suggests that moxibustion effectively reduces UI symptoms and improves quality of life with minimal adverse effects. The therapeutic benefits are attributed to enhanced blood circulation, improved neurological functions, and hormonal balance, facilitating tissue repair, and urinary system functionality. Despite encouraging outcomes, existing research exhibits limitations, including small sample sizes, and inconsistent methodologies. Future research should aim to address these gaps by conducting larger, standardized multicenter trials to provide more definitive evidence of moxibustion's effectiveness. Additionally, integrating moxibustion into comprehensive treatment strategies for UI and promoting its inclusion in clinical guidelines could enhance its acceptance and application in modern medical practice. This study underscores the potential of moxibustion as a non-alternative in the management of UI, warranting further exploration and validation in clinical settings.

Comprehensive approach to clinical decision-making strategy, illustrated by the Gulf War.

Throughout the history of medicine, clinical decision-making strategies have largely been dependent on the implementation of novel technologies. Artificial intelligence (AI) has not only made a leap into a new dimension of medical measures & decisions' shaping but has also served as a strategic backup of medical practice. Due to its nature, and military technologies in use, the Gulf War (1990-1991) is considered to be the verge of the contemporary warfare era. Soldiers had been engaged into a highly complex military operation theatre contaminated with both chemical and radiological noxious agents, and burdened with side-effects of prophylactic measurements. The aim of this review is to present a comprehensive approach to clinical decision-making strategy using theGulf War veterans' syndrome as an example. The model is based on the processing of all data coming from the military operation theatre and their unification with medical data, so as to obtain the final product, i.e.,the decision needed for a personalised therapeutic approach. Due to the complexity and a huge amount of data gathered at a given location in a given time, the functioning of this model unanimously calls for the interlace between military system AI and that of the medical sector.