Medical Practice Research Articles

Treatment of chronic kidney disease in older populations.

As the world population ages, an expected increase in the prevalence of chronic kidney disease (CKD) among older individuals will pose a considerable challenge for health care systems in terms of resource allocation for disease management. Treatment strategies for older patients with CKD should ideally align with those applied to the general population, focusing on minimizing cardiovascular events and reducing the risk of progression to kidney failure. Emerging therapies, such as SGLT-2 inhibitors and GLP-1 receptor agonists, hold promise for the effective management of CKD in older individuals. In addition, non-pharmacological interventions such as nutritional and exercise therapies have a crucial role. These interventions enhance the effects of pharmacotherapy and, importantly, contribute to the maintenance of cognitive function and overall quality of life. Various factors beyond age and cognitive function must be taken into account when considering kidney replacement therapy for patients with kidney failure. Importantly, all treatment options, including dialysis, transplantation and conservative management approaches, should be tailored to the individual through patient-centred decision-making. The dynamic integration of digital technologies into medical practice has the potential to transform the management of CKD in the aging population.

Attribute Prototype-guided Iterative Scene Graph for Explainable Radiology Report Generation.

The potential of automated radiology report generation in alleviating the time-consuming tasks of radiologists is increasingly being recognized in medical practice. Existing report generation methods have evolved from using image-level features to the latest approach of utilizing anatomical regions, significantly enhancing interpretability. However, directly and simplistically using region features for report generation compromises the capability of relation reasoning and overlooks the common attributes potentially shared across regions. To address these limitations, we propose a novel region-based Attribute Prototype-guided Iterative Scene Graph generation framework (AP-ISG) for report generation, utilizing scene graph generation as an auxiliary task to further enhance interpretability and relational reasoning capability. The core components of AP-ISG are the Iterative Scene Graph Generation (ISGG) module and the Attribute Prototype-guided Learning (APL) module. Specifically, ISSG employs an autoregressive scheme for structural edge reasoning and a contextualization mechanism for relational reasoning. APL enhances intra-prototype matching and reduces inter-prototype semantic overlap in the visual space to fully model the potential attribute commonalities among regions. Extensive experiments on the MIMIC-CXR with Chest ImaGenome datasets demonstrate the superiority of AP-ISG across multiple metrics.

A Cost-Affordable Methodology of 3D Printing of Bone Fractures Using DICOM Files in Traumatology

Three-dimensional (3D) printing has gained popularity across various domains but remains less integrated into medical surgery due to its complexity. Existing literature primarily discusses specific applications, with limited detailed guidance on the entire process. The methodological details of converting Computed Tomography (CT) images into 3D models are often found in amateur 3D printing forums rather than scientific literature. To address this gap, we present a comprehensive methodology for converting CT images of bone fractures into 3D-printed models. This involves transferring files in Digital Imaging and Communications in Medicine (DICOM) format to stereolithography format, processing the 3D model, and preparing it for printing. Our methodology outlines step-by-step guidelines, time estimates, and software recommendations, prioritizing free open-source tools. We also share our practical experience and outcomes, including the successful creation of 72 models for surgical planning, patient education, and teaching. Although there are challenges associated with utilizing 3D printing in surgery, such as the requirement for specialized expertise and equipment, the advantages in surgical planning, patient education, and improved outcomes are evident. Further studies are warranted to refine and standardize these methodologies for broader adoption in medical practice.

Treatment of chronic kidney disease in older populations.

As the world population ages, an expected increase in the prevalence of chronic kidney disease (CKD) among older individuals will pose a considerable challenge for health care systems in terms of resource allocation for disease management. Treatment strategies for older patients with CKD should ideally align with those applied to the general population, focusing on minimizing cardiovascular events and reducing the risk of progression to kidney failure. Emerging therapies, such as SGLT-2 inhibitors and GLP-1 receptor agonists, hold promise for the effective management of CKD in older individuals. In addition, non-pharmacological interventions such as nutritional and exercise therapies have a crucial role. These interventions enhance the effects of pharmacotherapy and, importantly, contribute to the maintenance of cognitive function and overall quality of life. Various factors beyond age and cognitive function must be taken into account when considering kidney replacement therapy for patients with kidney failure. Importantly, all treatment options, including dialysis, transplantation and conservative management approaches, should be tailored to the individual through patient-centred decision-making. The dynamic integration of digital technologies into medical practice has the potential to transform the management of CKD in the aging population.

Novel magnetic iron oxide-dextran sulphate nanocomposites as potential anticoagulants: Investigating interactions with blood components and assessing cytotoxicity

Examining the critical role of anticoagulants in medical practice, particularly their central function in preventing abnormal blood clotting, is of the utmost importance. However, the study of interactions between blood proteins and alternative anticoagulant nano-surfaces is still understood poorly. In this study, novel approach involving direct functionalisation of magnetic iron oxide nanoparticles (MNPs) as carriers with sulphated dextran (s-dext) is presented, with the aim of evaluating the potential of magnetically-responsive MNPs@s-dext as anticoagulants. The physicochemical characterisation of the synthesised MNPs@s-dext includes crystal structure analysis, morphology study, surface and electrokinetic properties, thermogravimetric analysis and magnetic properties` evaluation, which confirms the successful preparation of the nanocomposite with sulfonate groups. The anticoagulant potential of MNPs@s-dext was investigated using a standardised activated partial thromboplastin time (APTT) test and a modified APTT test with a quartz crystal microbalance with dissipation (QCM-D) which confirmed the anticoagulant effect. Time-resolved solid-liquid interactions between the MNPs@s-dext and model blood proteins bovine serum albumin and fibrinogen were also investigated, to gain insight into their hemocompatibility, and revealed protein-repellence of MNPs@s-dext against blood proteins. The study also addressed comprehensive cytotoxicity studies of prepared nanocomposites, and provided valuable insights into potential applicability of MNPs@s-dext as a promising magnetic anticoagulant in biomedical contexts.

Inequality and health: Can medical practice address the consequences of inequalities?

The extent to which governments provide socioeconomic supports has been highlighted by their spending during the COVID-19 pandemic. This has implications for patterns of inequality, in particular on exacerbating unequal health and well-being. Inequity has expanded due to neoliberalism, a market-based approach that has endured for more than four decades. Together with COVID-19, it has developed and exposed many structural governance differences. There are a number of examples presented of the effects of inequalities on health and well-being. The role of general practice in addressing these is discussed and challenges are highlighted, especially those relating to payment systems and workforce constraints.

Improving the approach to calculating shielding in computed tomography rooms

The study assessed the acceptability of the currently existing approach to calculating shielding in computed tomography rooms and formulated proposals for its improvement, taking into account the parameters of research in domestic medical practice. It is proposed to use the dose-length product as the main measured parameter in the new approach to calculating shielding. Typical tomograph workload values of dose-length product, typical for examinations in the Russian Federation, were assessed. Using thermoluminescent detectors, the experimental assessment of the distribution of absorbed dose in the air in a computed tomography room was carried out. The experimental results showed that the distribution of of X-ray exposure in the central plane is not isotropic. Due to the attenuation of exposure by the gantry design, “shadow” zones are observed, where the absorbed dose reduction in the air reaches 10-13 times compared to its level in the direction of couch movement. Based on the results of measurements of the distribution of absorbed dose in air, the relative scatter coefficients were calculated. The workload was determined for 7 tomographs (1 in St. Petersburg and 6 in Moscow). For each tomograph, the average weekly number of head and body examinations and the values of dose-length product for these areas were assessed, taking into account the number of multiphase examinations. The obtained workload values turned out to be one or two orders of magnitude higher than those currently used in calculating shielding. Based on the results of the study and literature data, the work proposes a new approach to calculating shielding in computed tomography rooms, based on the value of measured dose-length product during the examination and allowing to take into account the specifics of the operation of the device.

The use of artificial intelligence in radiology: new possibilities for diagnostic imaging. A literature review

Introduction and purpose: Rapid advances in technology enable innovative solutions to be implemented in modern medicine, relieving healthcare workers by speeding up diagnosis and improving the quality of treatment. The subject of this review is Artificial Intelligence (AI), an innovative form of help in the daily practice of doctors. It offers the opportunity to relieve healthcare workers by accelerating the diagnosis process and improving the quality and effectiveness of treatment. The aim of this paper is to present the current state of knowledge, assess the effectiveness of algorithms in the recognition and interpretation of abnormalities in medical images compared to specialists in radiology and discuss the challenges associated with the implementation of AI in various medical specialties. Brief description of the state of knowledge: Artificial intelligence, especially through machine learning and deep learning techniques, has found wide application in radiology. Many facilities around the world use advanced AI systems in the day-to-day work of radiologists, including the Mayo Clinic, Massachusetts General Hospital, and the University of Tokyo Hospital. Summary: Studies show that while AI algorithms can perform worse than radiologists in some areas, they are at the forefront of others, especially in detecting subtle abnormalities. The effective implementation of artificial intelligence requires addressing regulatory, ethical, and training issues. Despite these challenges, artificial intelligence has the potential to play a key role in the future of radiology and revolutionize medical practice, opening new perspectives and improving the quality of health care.

Improving the approach to calculating shielding in computed tomography rooms

The study assessed the acceptability of the currently existing approach to calculating shielding in computed tomography rooms and formulated proposals for its improvement, taking into account the parameters of research in domestic medical practice. It is proposed to use the dose-length product as the main measured parameter in the new approach to calculating shielding. Typical tomograph workload values of dose-length product, typical for examinations in the Russian Federation, were assessed. Using thermoluminescent detectors, the experimental assessment of the distribution of absorbed dose in the air in a computed tomography room was carried out. The experimental results showed that the distribution of of X-ray exposure in the central plane is not isotropic. Due to the attenuation of exposure by the gantry design, “shadow” zones are observed, where the absorbed dose reduction in the air reaches 10-13 times compared to its level in the direction of couch movement. Based on the results of measurements of the distribution of absorbed dose in air, the relative scatter coefficients were calculated. The workload was determined for 7 tomographs (1 in St. Petersburg and 6 in Moscow). For each tomograph, the average weekly number of head and body examinations and the values of dose-length product for these areas were assessed, taking into account the number of multiphase examinations. The obtained workload values turned out to be one or two orders of magnitude higher than those currently used in calculating shielding. Based on the results of the study and literature data, the work proposes a new approach to calculating shielding in computed tomography rooms, based on the value of measured dose-length product during the examination and allowing to take into account the specifics of the operation of the device.

ConKeD: multiview contrastive descriptor learning for keypoint-based retinal image registration.

Retinal image registration is of utmost importance due to its wide applications in medical practice. In this context, we propose ConKeD, a novel deep learning approach to learn descriptors for retinal image registration. In contrast to current registration methods, our approach employs a novel multi-positive multi-negative contrastive learning strategy that enables the utilization of additional information from the available training samples. This makes it possible to learn high-quality descriptors from limited training data. To train and evaluate ConKeD, we combine these descriptors with domain-specific keypoints, particularly blood vessel bifurcations and crossovers, that are detected using a deep neural network. Our experimental results demonstrate the benefits of the novel multi-positive multi-negative strategy, as it outperforms the widely used triplet loss technique (single-positive and single-negative) as well as the single-positive multi-negative alternative. Additionally, the combination of ConKeD with the domain-specific keypoints produces comparable results to the state-of-the-art methods for retinal image registration, while offering important advantages such as avoiding pre-processing, utilizing fewer training samples, and requiring fewer detected keypoints, among others. Therefore, ConKeD shows a promising potential towards facilitating the development and application of deep learning-based methods for retinal image registration.

МЕЖДУНАРОДНЫЙ ПРОФИЛЬ БЕЗОПАСНОСТИ ПРИМЕНЕНИЯ ОМАЛИЗУМАБА В КЛИНИЧЕСКОЙ ПРАКТИКЕ

The article provides an overview of information on cases of adverse reactions with the use of omalizumab, the reports of which are included in the database of the World Health Organization's international drug monitoring program in 6 years (selected period 01.01.2017-01.01.2024). An analysis of the safety indicators of omalizumab, which is the drug of choice in the treatment of a number of severe atopic diseases, was carried out. Despite the long-term use of the drug in medical practice (more than 15 years) and reports on its efficacy, there is insufficient information on adverse reactions during its use, especially in the Russian Federation, since long-term clinical monitoring has not been carried out. The obtained characteristics of the structure of adverse reactions to the use of omalizumab by gender, age of patients, nature of their complaints, severity of outcomes, geography and initiators of reports, constitute a theoretical basis for improving and fine-tuning the domestic system of pharmacovigilance and drug monitoring, and may also be of practical interest to doctors, researchers and health regulators. The first rank places in the structure of adverse reactions to omalizumab are occupied by: general disorders and reactions at the site of administration, disorders of the skin and subcutaneous tissue, disorders of the respiratory system, thoracic and mediastinal organs, injuries, intoxication and complications of procedures, disorders of the nervous system. In the overall structure of NR, serious adverse reactions to omalizumab accounted for 35,1%. The analysis showed that in the assessment of adverse reactions, a significant role is given to patients (their representatives), whose opinion is determined by subjective feelings and the level of awareness, so more attention should be paid to drug informing patients.

The Uniform Determination of Death Act is Not Changing. Will Physicians Continue to Misdiagnose Brain Death?

Efforts to revise the Uniform Determination of Death Act in order to align law with medical practice have failed. Medical practice must now align with the law. People who are not dead under the law that defines death should not be declared dead. There is no compelling reason to continue the practice of declaring legally living persons to be dead.

Abortion in Islam: A Fiqh Examination of Medical and Social Indications

This article aims to explore how principles of Islamic fiqh can be integrated with modern medical approaches in addressing abortion, particularly in countries with significant Muslim populations. Given the high rates of unwanted pregnancies and the grave consequences of unsafe abortions, this research is imperative to enhance understanding of the diverse fiqh perspectives regarding medical and social justifications for abortion. The methodology employed is a phenomenological qualitative approach with a constructivist paradigm, emphasising a deep comprehension of the subjective experiences and viewpoints of Islamic scholars. Data was collected through extensive literature review, including classical and contemporary fiqh texts as well as academic literature related to medical ethics in Islam. The findings reveal various interpretations of Quranic verses relevant to abortion, underscoring the importance of preserving life and human dignity. Within the context of Maqasid Shariah, it was found that abortion could be permitted in situations meeting the criteria of Darura, where the preservation of the mother's life is the paramount concern. Social phenomena related to abortion were also examined, highlighting the stigma and social consequences faced by women in Muslim communities who undergo or consider abortion. The discussion in this article includes the integration of religious law and medical practice, and the need for greater education and awareness about reproductive health within Muslim communities. This allows the research to provide clear guidelines that not only assist healthcare practitioners in making ethical decisions but also support the creation of more effective and empathetic policies that consider the health and well-being of women within a framework of human rights and social justice.

Therapeutic itineraries of snakebite victims and antivenom access in southern Mexico.

Access to antivenoms in cases of snakebite continues to be an important public health issue around the world, especially in rural areas with poorly developed health care systems. This study aims to evaluate therapeutic itineraries and antivenom accessibility following snakebites in the states of Oaxaca and Chiapas in southern Mexico. Employing an intercultural health approach that seeks to understand and bridge allopathic and traditional medical perceptions and practices, we conducted field interviews with 47 snakebite victims, documenting the therapeutic itineraries of 54 separate snakebite incidents that occurred between 1977 and 2023. Most victims used traditional remedies as a first line of treatment, often to withstand the rigors of a long journey to find antivenoms. The main obstacles to antivenom access were distance, poor antivenom availability, and cost. Standard antivenom treatment is highly valued and sought after, even as traditional beliefs and practices persist within a cultural framework known as the "hot-cold" system. The findings are crucial for informing future enhancements to antivenom distribution systems, health education initiatives, and other interventions aimed at mitigating the impact of snakebites in the region.

The application of blended teaching in medical practical course of clinical skills training

BackgroundBlended teaching is an effective approach that combines online and offline teaching methods, leading to improved outcomes in medical education compared to traditional offline teaching. In this study, we examined the impact of blended teaching in clinical skills training, a medical practice course.MethodsThis study involved forty-eight undergraduate students studying clinical medicine in the fifth semester at Wuhan University of Science and Technology. The students were divided into two groups: the control group, which received traditional offline teaching, and the experimental group, which received hybrid teaching. Following the completion of the 4-month course, both groups underwent the Objective Structured Clinical Examination (OSCE) to evaluate their proficiency in clinical skills. Furthermore, the experimental group was given a separate questionnaire to gauge their feedback on the Blended Teaching approach.ResultsBased on the OSCE scores, the experimental group outperformed the control group significantly (P<0.05). The questionnaire results indicated that a majority of students (54.2%, 3.71 ± 1.06) believed that blended teaching is superior to traditional offline teaching, and a significant number of students (58.3%, 3.79 ± 1.15) expressed their willingness to adopt blended teaching in other courses. Furthermore, students in the experimental group displayed varying levels of interest in different teaching contents, with emergency medicine (79.2%), internal medicine (70.8%), and surgery (66.7%) being the most popular among them.ConclusionsThis research demonstrates for the first time that blended teaching can achieve a good pedagogical effectiveness in the medical practice course, clinical skills training and practice. Moreover, in different teaching contents, the teaching effects are different. In the content of Emergency Medicine and Surgery, which is more attractive to students, the application of blended teaching could result in a better pedagogical outcome than other contents.

High-Dose versus Low-Dose Oxytocin for Labor Augmentation: A Meta-Analysis of Randomized Controlled Trials.

Background/Objectives: Although oxytocin administration is recommended for delayed labor progress, there is no consensus over the preferred optimal dose of oxytocin. We aimed to perform a meta-analysis of pregnancy outcomes comparing high-dose versus low-dose oxytocin regimens for augmentation of delayed labor. Methods: PubMed, Embase, and Cochrane databases were systematically searched for studies comparing high-dose with low-dose oxytocin for labor augmentation from inception up to May 2023. The outcomes assessed were cesarean rate, instrumental delivery rate, postpartum hemorrhage, neonatal death, and uterine tachysystole. Subgroup analysis was performed with randomized controlled trials (RCTs) and propensity-matched studies. Statistical analysis was performed using Rstudio. Heterogeneity was assessed with I2 statistics, and a random-risk effect was used if I2 > 50%. Results: Twenty-one studies met inclusion criteria, and eighteen were RCTs. A total of 14.834 patients were included, of whom 7.921 (53.3%) received high-dose and 6.913 (46.6%) received low-dose oxytocin during labor augmentation. No statistical differences were found in cesarean delivery, neonatal mortality, postpartum hemorrhage and vaginal instrumentation rate. However, uterine tachysystole incidence was significantly higher with high-dose oxytocin (95% Cl, 1.30-1.94, p = 0.3; 0.6; I2 = 9%). Conclusions: Labor augmentation with a low-dose oxytocin regimen is effective as with a high-dose regimen, but with significantly less uterine tachysystole events, which can lead to intrauterine and neonatal complications. Our findings suggest that a low-dose regimen may be safe and effective for labor augmentation in medical practice.

Artificial Intelligence in Urology: Application of a Machine Learning Model to Predict the Risk of Urolithiasis in a General Population.

This research presents our application of artificial intelligence (AI) in predicting urolithiasis risk. Previous applications, including AI for stone disease, have focused on stone composition and aiding diagnostic imaging. AI applications centered around patient-specific characteristics, lifestyle considerations, and diet have been limited. Our study comprised a robust sample size of 976 Chilean participants, with meticulously analyzed demographic, lifestyle, and health data through a comprehensive questionnaire. We developed a predictive model using various classifiers, including logistic regression, decision trees, random forests, and extra trees, reaching high accuracy (88%) in identifying individuals at risk of kidney stone formation. Key protective factors highlighted by the algorithm include the pivotal role of hydration, physical activity, and dietary patterns that played a crucial role, emphasizing the protective nature of higher fruit and vegetable intake, balanced dairy consumption, and the nuanced impact of specific protein sources on kidney stone risk. In contrast, identified risk factors encompassed gender disparities with males found to be 2.31 times more likely to develop kidney stones than females. Thirst and self-perceived dark urine color emerged as strong predictors, with a significant increase in the likelihood of stone formation. The development of predictive tools with AI, in urolithiasis management signifies a paradigm shift toward more precise and personalized health care. The algorithm's ability to process extensive datasets, including dietary habits, heralds a new era of data-driven medical practice. This research underscores the transformative impact of AI in medical diagnostics and prevention, paving the way for a future where health care interventions are not only more effective but also tailored to individual patient needs. In this case, AI is an important tool that can help patients stay healthy, prevent diseases, and make informed decisions about their overall well-being.

Prognostication: A fading Hippocratic art?

Over the past 75 years modern medicine has advanced in its ability to diagnose and treat many diseases. However, the medical profession's ability to prognosticate the course and outcome of an illness has not satisfied the needs of many patients. Physicians must not lose the ability, or desire, to consider the whole person in relation to a patient's disease. We need to ask ourselves what person has the disease, not what disease the person has. Here I endeavor to demonstrate why Hippocrates valued prognostication highly, how its importance may have faded from the consciousness of current medical practice, and how modern technology is attempting to reinvent or revise it.

O-288 Pro

Abstract Currently and globally, the majority of ART treatments are performed either fully in the private medical sector or are partially subsidized in the public sector but with common treatments spill-over to the private sector; countries where there is sufficient public coverage of ART are in fact rare. While private clinics and hospital have been the norm in ART for decades, in recent years the field has undergone significant consolidation, and this has resulted in an influx of large financial players such as private equity (PE) firms. The results are a series of mergers and acquisitions that are shaping the geography of ART provision. In this debate, I will take on the “pro” side and I will highlight the scholarship around the changes in care brought about by PE ownership of medical practices, bringing examples from branches of medicine such as dermatology, dentistry, long term care or Ob&amp;Gyn that have experienced market consolidation in the last decades. I will show that available evidence indicate that the change in ownership to PE of private medical practices is associated with an increase in the number of patients treated and a net increase in payments to clinicians. Moreover, PE ownership has been repeatedly associated with a perception of higher quality care by patients, while clinical KPIs have not gotten worse and, if anything, have improved. This is usually due to greater intentional focus on standardization and quality control, streamline and protocolization of treatments, and centralization of certain administrative areas. I will further argue that, in large PE owned networks, best practices tend to be enhanced by peer to peer sharing and central medical boards, while centralization and digitalization of patient data collection favors research and development in a field that sorely lacks public funding for reproductive research.

Practice of Low Flow Anaesthesia and Volatile Agents Choices among Anaesthesia Providers at Muhimbili National Hospital and Muhimbili Orthopaedic Institute

With the availability of modern workstations and heightened awareness of the Health services cost and environmental effects of waste anaesthesia gases, anaesthesia providers worldwide are practicing low flow anaesthesia. In most developing countries Low Flow Anaesthesia is still underutilized due to lack of monitoring equipments and sufficient knowledge. Tanzania appears to have a paucity of studies on the prevailing practice pattern of fresh gas flow. Objective; The study aimed at assessing the practice of low flow anaesthesia and volatile agents choices among anaesthesia providers at Muhimbili national hospital and Muhimbili orthopaedic institute. Methods: A descriptive cross-sectional study was carried out for a period of 8 months involving 158 anaesthesia providers. A Structured questionnaire was used to collect data which included demographic, practice setting of Low Flow Anaesthesia, Workstations, scavenging, monitoring equipments, Volatile agents routinely used and preferred Agent. Data were analysed using the IBM Statistical package for social science’s version 23.0. Result: Prevalence of Low flow anaesthesia was 27.2%, however, only 6% used the fresh gas flow of 1l/min – 500mls/min. All anaesthesia providers had workstations and only 2.3% displayed Minimum Alveolar concentration (MAC), 79.1% worked in theatre with functioning scavenging systems, 55.8% used capnography, 6.9% monitored inspiratory Oxygen and none of anaesthesia providers used Bispectral and Agent Analyzers. Isoflurane was the most routinely used inhalational agents (100%) followed by Sevoflurane (69%), then Halothane (32%). Desflurane still not available in these hospitals. Conclusion: Low flow anaesthesia is seldom practiced in our locality despite having strong evidence of attractive advantages in medical practice and ergonomics.