Medical Profile Research Articles

Epidemiological Characteristics of Pediatric Supracondylar of Humerus Fractures in a Tertiary Hospital in Iran.

Supracondylar humerus fracture (SHF) is the most common fracture observed in children. The present study aimed to assess the characteristic parameters in one of the most extensive available pediatric SHF series referred to a tertiary hospital in Iran. The medical profiles of the SHF patients who were referred to our tertiary hospital between January 2017 and January 2022 were retrospectively reviewed. The inclusion criteria entailed age < 14 years and a radiographically confirmed diagnosis of SHF. The collected data included age, gender, side of injury, mechanism of injury, season of the injury, concurrent complications, type of fracture, and treatment. A total of 1,309 patients with a mean age of 7.7±2.7 years were included in this study. The incidence of SHF was 1.8-fold higher in males, while the mean age of incidence was significantly lower in female patients (7.2 vs. 8 years; P<0.001). Falling was the most frequent mechanism of injury (97%). Gartland type I was the most prevalent type of injury (n=482; 36.8%). Moreover, the majority of fractures were extension-type (n=1,249; 95.4%). Most patients were managed conservatively (n=785; 60%). Concurrent fractures as well as neuralgic, vascular, and muscular complications were present in 3%, 1.45%, 1.22%, and 0.5% of patients, respectively. As evidenced by the results of this study, SHF is prevalent among the Iranian pediatric population. Therefore, greater awareness is required regarding the high incidence of this fracture in this population and its adequate management with respect to concurrent complications, particularly neurovascular compromise.

FUNCTIONAL FEATURES OF COMPOSITIONAL CONJUNCTIONS USE IN A SCIENTIFIC MEDICAL TEXT

Background. The article is devoted to the use of means of compositional conjunctions in the field of scientific communication on the example of the a in a simple sentence. The authors refer to the semantic and functional features of the compositional conjunction a in the scientific medical text, where it is presented quite widely. The comparative meaning of the conjunction a, the specifics and rules of verbalization of this meaning are focused on the most accurate and specific characterization of the facts occurring in a living organism or in any part of it.&#x0D; The purpose of the study is to present a variety of options for the characteristics of the objects of comparison, a detailed examination of the functioning of various words-allied analogues used together with the conjunction a, i.e., a vmeste s tem (and at the same time), a sledovatel'no, a znachit (and therefore), which means and others, among which special attention is paid to sentences with a combination and also.&#x0D; Materials and methods. Textbooks served as the material for the study are as follows: N.V. Chebyshev Biology (2016), Human Physiology, ed. V.M. Smirnov (2019), G.V. Poriadin et al. Pathophysiology. General and Clinical Pathophysiology (2022). The article used methods of scientific description, observation and statistical analysis, which allowed us to obtain reliable information about the functioning of the composition conjunction a in a scientific text of a medical profile.&#x0D; Results. The article concludes that the compositional conjunction a is capable of creating diverse semantic relations in a scientific text of a medical profile and performing specific communicative tasks of text formation. The functioning of the conjunction a in a simple sentence is associated with the accentuation of one of the connected fragments, which, as a rule, finds expression in the more frequent connection of concertizers to the conjunction a. The informative and communicative status of adjunctive sentences with a-relations in scientific speech is aimed at a more accurate and adequate presentation of scientific information.&#x0D; Practical implications. The results may be used not only for following research of scientific (medical) text but are also important in the pedagogical practice of teaching foreign medical students.

Underlying motivations hampering Flemish primary care physicians from overcoming the barriers in osteoporosis care: an EMR-facilitated clinical reasoning study

BackgroundOver half of the European population aged minimum 65 years presents with at least two chronic diseases. Attention towards these diseases exhibits disparities, with limited primary care physician (PCP) attention for osteoporosis. This was confirmed in a previous integrated osteoporosis care (IOC) project in which notable difficulties to enlist PCPs arose. Consequently, this study was initiated in Flemish PCPs for in-depth analysis of underlying mechanisms hampering PCPs to fully commit to osteoporosis care.MethodsA qualitative Electronic Medical Record (EMR)-facilitated clinical reasoning study was conducted. A semi-structured interview guide was employed to guide PCPs from reflections on their own patients to broader views regarding osteoporosis care. An inductive thematic analysis was performed using NVivo 12.ResultsThirteen PCPs were interviewed. They stated that osteoporosis patients often had complex (medical) profiles. PCPs emphasised the ongoing necessity for prioritisation within this context. This leads to a competition for PCP attention during consultations at three levels: i. between acute versus preventive care; ii. between primary fracture prevention and other preventive services and iii. between secondary fracture prevention and other preventive services; spanning eight areas of competition: disease significance, perceived impact, PCP awareness, the patient agenda, PCP competence, PCP support, perceived patient burden, and efficiency of care provision. Applicability of these areas of competition differed between levels.ConclusionThe intricate context in which PCPs operate, creates a competition for PCP attention leading to a lack of attention for fracture prevention. To preserve efforts in fracture prevention, areas of competition should be systematically addressed.Trial registrationApproval for the study has been provided by the Ghent University Hospital Ethics Committee (BC-09797).

The evolution of the Caprini score

The article is a narrative review of the literature that addresses the issues of individual risk assessment of hospital-acquired VTE using the Caprini score. It provides modern epidemiological data confirming the high medical and social significance of the problem of hospital venous thrombosis. The questions of the natural evolution of the Caprini score since the publication of the initial version in 1991 are discussed, a comparative analysis of the modifications of 2005, 2010 and 2013 is carried out, and the features of validation studies that have proven the superiority of the classical version of 2005 are discussed. Attention is paid to the problem of integrating the Caprini score into medical documentation with automation of the process of risk assessment and the appointment of preventive measures. The issue of heterogeneity of approaches to dividing patients into risk groups for developing VTE in accordance with the assessed scores is discussed separately; data from modern studies are presented confirming the existence of very high (9–10 points) and extremely high (≥11 points) risk groups that require an individual approach to prevention of thrombotic complications. Summary data are provided on the frequency of registration of VTE in accordance with Caprini scores in patients of various medical profiles based on a meta-analysis of 68 validation studies. The possibility of using patient-oriented questionnaires based on the Caprini score is discussed, which demonstrate high consistency with the original scale, but have not yet been studied in prospective studies. Revised algorithms are proposed to individually assess the risk of VTE using the 2005 vers of the Caprini score and prescribe adequate prophylaxis. It is concluded that the Caprini score still continues to improve and evolve in accordance with general trends in the development of medicine and healthcare, while maintaining the status of the most studied and in demand system for individual assessment of the risk of developing hospital-acquired VTE.

The effect of cognitive-behavioral therapy and haptonomy on fear of childbirth in primigravida women: a randomized clinical trial

BackgroundConsidering the role of fear of childbirth (FOC) in the enhancement of unnecessary cesarean sections (CS), the present study aimed at evaluating the effect of Cognitive-Behavioral Therapy (CBT) and haptonomy on the FOC (as primary outcome) and intended birth method and final birth method (as secondary outcomes) among primigravida women.MethodsThis randomized clinical trial was conducted on 99 primigravida women in Tabriz, Iran 2022. Participants were assigned to three groups with a ratio of 1:1:1 using stratified block randomization based on the fear intensity. One of the intervention groups (n = 33) received eight group sessions of CBT from 24 to 28 weeks of gestation and the other intervention group (n = 33) received haptonomy during seven sessions once a week. The control group (n = 33) received routine prenatal care. The Wijma questionnaire was completed by the participants before the intervention, after the intervention at 35–37 weeks of gestation, and after birth. The intended birth method was investigated before and after the intervention at 35–37 weeks of gestation. The final birth method and the reasons for CS were recorded based on the mother’s medical profile. The one-way ANOVA was used before the intervention and RMANOVA after the intervention to compare the mean scores of FOC among the three groups. Further, chi-square test was applied to compare the intended and final birth method.ResultsThe mean (standard deviation: SD) of FOC in the CBT group changed from 74.09 (11.35) at 24–28 weeks of gestation to 46.50 (18.28) at 35–37 weeks and 48.78 (20.64) after birth (P < 0.001). The means (SDs) of FOC in the haptonomy group were 76.81 (13.09), 46.59 (15.81), and 45.09 (20.11), respectively (P < 0.001). The mean (SD) of FOC in the control group decreased from 70.31 (6.71) to 66.56 (18.92) and then, increased to 71.00 (21.14) after birth (P = 0.878). After the intervention, there was no statistically significant difference among the three groups in terms of the intended birth method (P = 0.278), and final birth method (P = 0.107).ConclusionThe findings of the present study revealed that both CBT and haptonomy interventions reduce FOC. Although the desire for vaginal birth and final vaginal birth in the haptonomy group was more than that in the other two groups, there was no statistically significant difference among the three groups.Trial registrationIranian Registry of Clinical Trials: IRCT20170506033834N9. Date of registration: 02.01.2022. URL: http://en.irct.ir.

Межведомственное взаимодействие при организации телемедицинских консультаций по схеме «врач – врач» с участием медицинских специалистов лечебных медицинских организаций Федерального медико-биологического агентства

Summary. The data are considered on conducting telemedicine consultations in 2021-2022 under “doctor – doctor” scheme with participation of attending physicians and consulting physicians of medical organizations (MO) of the Federal Medical and Biological Agency (FMBA of Russia). The division of telemedicine consultations by medical profiles, forms and types is given. The conclusion is made: ensuring the availability and quality of medical care with the use of telemedicine technologies in remote interaction between medical specialists is directly related to the possibility of conducting telemedicine consultations with the participation of medical specialists of MOs of different departmental affiliation in the presence of common information space, including under the conditions of liquidation of medical and sanitary consequences of emergency situations.

“I would constantly watch myself”: Individual Attitudes and Needs towards Dementia Risk Prediction and Risk Disclosure in Interviews (PreTAD)

AbstractBackgroundResearch on medical risk profiles and early detection progresses rapidly. With the early knowledge of individual health risks comes, so the hope, the possibility of tailored prevention. Potential users and healthcare providers are facing new challenges in terms of decision‐making for risk prediction, education and counselling, as well as dealing with the risk information obtained. If, as in the case of Alzheimer’s disease, there are hardly any therapy and no healing options so far, risk prediction has an existential relevance and social impact, the extent of which has been little investigated yet. Therefore, supporting a self‐determined decision for or against dementia risk prediction, taking into account individual attitudes, needs and expectations, is of major importance. As part of the PreTAD‐project (The Predictive Turn in Alzheimer’s Disease: Ethical, Clinical, Linguistic and Legal Aspects), we aim to explore the attitudes, needs and expectations regarding early dementia prediction and risk disclosure in the general population, first‐degree relatives of persons with Alzheimer’s dementia or APOE4 allele carriers, and individuals with subjective cognitive decline (SCD).MethodIn the work package ethics, we (1) conduct an online‐survey within the general population and (2) carry out 40 narrative interviews with a) individuals from the general population, b) individuals with AD family history, and individuals diagnosed with SCD (either c) ≤ 4 weeks or d) &gt; 4 weeks ago) to get an in‐depth view of individual attitudes and needs regarding early dementia prediction, the reasons for its approval or rejection, and to examine whether personal characteristics play a role in the decision‐making process. We analyze the interviews using type‐building qualitative content analysis (Kuckartz &amp; Rädiker 2022).ResultPreliminary results of the first interviews (n = 5), accompanying the quantitative study, showed that participants tended to confuse the terms prediction and diagnosis in the context of Alzheimer’s. The driving reasons for or against prediction were 1) the anticipated impact on self‐determination and 2) self‐awareness, and 3) the anticipated psychological burden of risk knowledge.ConclusionHealthcare providers should carefully consider individual attitudes and expectations regarding dementia risk prediction as risk disclosure may have serious implications on individuals’ self‐determination, self‐awareness and mental health.

ОСОБЕННОСТИ МОДЕЛИРОВАНИЯ НАУЧНЫХ ТЕКСТОВ НА ЗАНЯТИЯХ ПО РУССКОМУ ЯЗЫКУ КАК ИНОСТРАННОМУ

The article is devoted to one of the most important aspects of teaching Russian as a foreign language - the scientific style of speech. One of the approaches to the study of the scientific style of speech is considered. Special attention is paid to the modeling of professionally-oriented texts of the medical and biological profile. The article reveals the stages of modeling the reproductive scientific text, as well as the features of the modeling process itself. The article analyzes various types of abstracts, their effectiveness and peculiarities of perception by foreign students from far and near abroad.

Abstract A119: Unveiling disparities in clinical trial participation: Exploring socioeconomic barriers and access to insurance among diverse ethnic groups

Abstract Introduction: Diversity in clinical trials (CTs) is crucial for enhancing the ability to generalize research findings and promote equal health services for underserved populations. Researchers and companies seeking approval for late-stage CTs are now asked by the US Food and Drug Administration (FDA) to provide a diversity plan to ensure inclusivity among CT participants. To design such a plan, it is important to study the barriers leading to underrepresentation in CTs. While CTs interventions are mostly covered by trial sponsors, insurance coverage is still required for participation. We studied the impact of insurance coverage, as a potential factor impacting participation in CTs among underserved communities, while considering other key parameters such as age, sex, cancer type and disease status. Methods: Leal is an AI-based platform that matches cancer patients (pts) to CTs based on a self reported medical profile. The profile includes parameters essential for CT matching including disease status, stage, biomarker/mutational status, treatment history, comorbidities and demographics. This study included a multi-ethnic cohort of 4,525 pts who signed up to the platform in 2023. We analyzed potential barriers for CT enrollment among various ethnic groups. We implemented the non-parametric Pearson's Χ², the Welch's t-test and the Games-Howell pairwise comparisons tests, at significance level of 0.05. Results: Insurance coverage was significantly linked to ethnicity. Non-white pts comprised 37% of uninsured pts, which was markedly higher compared to their representation in the insured group (24%, p&amp;lt;0.0001). Medicaid had the most diverse subscriber base (33%) compared to other insurance providers (p&amp;lt;0.0001), independently from disease status and cancer type. In addition, when considering participation in CTs, 78% of non-white pts were willing to travel up to 50 miles, while a larger percentage of white pts (64%) were open to traveling between 100 and 200 miles (p&amp;lt;0.0001). Conclusions: We found a strong association between socioeconomic status and potential barriers for CTs participation including insurance coverage and willingness to travel. The higher proportion of uninsured non-whites highlights the disparity in access to insurance of underserved populations. This may stem from both financial constraints or limited education and community resources. Medicaid had the most diverse subscriber base, which is aligned with its aim to provide coverage to pts with low income. To increase diversity in CTs, financial support programs for uninsured patients should be considered. In addition, CT sites should consider incorporating insurance programs for pts with disadvantaged backgrounds. Our study also revealed reduced willingness among non-whites to travel long distances to trial sites. To ensuring representative outcomes across diverse populations, regardless of location or socioeconomic status, requires addressing accessibility limitations through financial support, localized trial sites, and community-targeted recruitment strategies. Citation Format: Ritta Jubran, Yelena Lapidot, Tzvia Bader, Avital Gaziel. Unveiling disparities in clinical trial participation: Exploring socioeconomic barriers and access to insurance among diverse ethnic groups [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A119.

Assessing the Efficacy of the Modified SEGA Frailty (mSEGA) Screening Tool in Predicting 12-Month Morbidity and Mortality among Elderly Emergency Department Visitors.

Rapid identification of frail elderly individuals upon admission to the emergency department is pivotal for enhancing their care and alleviating emergency room congestion. This pilot study aims to explore the relationship between morbidity, mortality, and frailty, as assessed by the mSEGA scale, among individuals aged 65 years or older in the emergency department. A retrospective cohort study was conducted at a single center. The pilot study included patients aged 65 and above who were admitted to Chaumont Hospital's emergency unit (Haute-Marne department) for medical and/or surgical reasons between 1 July 2017 and 31 January 2018. Data encompassed socio-demographic characteristics, medical profiles, and emergency department visit details. Outcomes for patients one year post-admission were obtained through consultation with their respective general practitioners. A total of 255 subjects participated, with a mean age of 82.1 ± 8.2 years. Primary admission reasons were falls (n = 51, 20.0%), digestive issues (excluding hemorrhage) (n = 30, 11.8%), and "other" causes (n = 61, 23.9%). Among participants, 78 (30.6%) scored ≤8 on the mSEGA frailty scale, 49 (19.2%) scored 9 to 11, and 125 (50.2%) scored ≥12. Concerning post-emergency department outcomes, 152 patients (59.6%) were hospitalized, while 103 (40.4%) were discharged. No deaths were reported during the study period, and vital status was known for all subjects at the one-year mark. At that point, 63 out of 255 patients had passed away, with 30 of them being readmitted to the emergency department either before or at the time of their one-year death. The 12-month survival rate analysis based on frailty status revealed a significant difference. Low-frailty patients exhibited a survival rate of 87.2% (95% CI; [77.5-92.9]), whereas frail/very frail patients had a survival rate of 70.0% (95% CI; [62.7-76.2]). Similarly, the 12-month readmission-free survival rate demonstrated statistically significant disparities. Low-frailty patients had a rate of 76.9% (95% CI; [65.9-84.8]), compared to 51.4% (95% CI; [43.8-58.5]) for very frail patients. Utilizing the mSEGA frailty scale in the Emergency Department could provide crucial prognostic insights, highlighting significant differences in 12-month survival and readmission-free survival rates based on frailty status.

Новые вызовы и запросы для национальной системы здравоохранения в цифровую эру

The authors emphasize that the quality of life of the population is a priority in the development of any state. Life expectancy at birth (LEB) is one of the important indicators. The paper reveals the statistical dependence of (LEB) on the value of gross domestic product in the country as a whole. Using statistical data, the authors demonstrate the strong fluctuations of the LEB indicator by regions and the lack of correlation between LEB and gross regional product per capita for the constituent entities of the Russian Federation. This problem re-quires a special approach when working with the life expectancy indicator in the healthcare system. The article considers the relevance of changing business processes and transition to a management model based on the patient’s medical profile in the healthcare system in order to achieve the national development goals of the state and improve the quality of population's life. The positive role of a patient-oriented approach in the devel-opment of the healthcare system is substantiated. The possibility of using medical marketing tools as part of social marketing is revealed in order to create communications, increase trust in the healthcare system, satis-faction with medical care, and increase the proportion of citizens leading a healthy lifestyle.

Effect of ABO blood group on postoperative overall survival and recurrence-free survival rate in patients with hepatocellular carcinoma after hepatectomy: a multi-center retrospective cohort study

BackgroundHepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. The survival rate after hepatectomy as the first line of treatment for HCC depends on various factors. This study evaluated the association of the ABO blood group and Rh with overall survival (OS) and Recurrence-free survival (RFS) rate after hepatectomy.MethodsThis multicenter retrospective cohort study reviewed the medical files of 639 HCC patients who underwent hepatectomy from 2010 to 2022 in three medical centers affiliated with the Iran University of Medical Sciences. Patient data, including demographic, clinical, tumor characteristics, and post-surgery outcomes, were collected by referring to the patient’s medical profiles. The Cox proportional hazard investigated the relationship between ABO blood group type and OS and RFS rate after hepatectomy.ResultsThe five-year OS and RFS rates were 25.4% and 18.7%, respectively. The five-year OS (Lok rank:40.89, P:0.001) and RFS rate in patients with blood type A were significantly lower than in non-A patients. (Lok rank:10.8, P:0.001) The multivariate Cox analysis showed that blood type A, age < 45 years, tumor size > 5 cm, Poor tumor differentiation, presence of metastasis, The number of involved lymph nodes ≤ 2, and serum Alpha-Fetoprotein)AFP( level ≥ 400 were significantly related to the decreased survival rate of HCC patients after hepatectomy (P < 0.05) There was no significant association between Rh with OS and RFS (P > 0.05).ConclusionBlood group type A, compared to non-A, can be associated with decreased OS and RFS rates in patients with HCC after hepatectomy.

The diagnosis of tuberculous meningitis: advancements in new technologies and machine learning algorithms.

Tuberculous meningitis (TBM) poses a diagnostic challenge, particularly impacting vulnerable populations such as infants and those with untreated HIV. Given the diagnostic intricacies of TBM, there's a pressing need for rapid and reliable diagnostic tools. This review scrutinizes the efficacy of up-and-coming technologies like machine learning in transforming TBM diagnostics and management. Advanced diagnostic technologies like targeted gene sequencing, real-time polymerase chain reaction (RT-PCR), miRNA assays, and metagenomic next-generation sequencing (mNGS) offer promising avenues for early TBM detection. The capabilities of these technologies are further augmented when paired with mass spectrometry, metabolomics, and proteomics, enriching the pool of disease-specific biomarkers. Machine learning algorithms, adept at sifting through voluminous datasets like medical imaging, genomic profiles, and patient histories, are increasingly revealing nuanced disease pathways, thereby elevating diagnostic accuracy and guiding treatment strategies. While these burgeoning technologies offer hope for more precise TBM diagnosis, hurdles remain in terms of their clinical implementation. Future endeavors should zero in on the validation of these tools through prospective studies, critically evaluating their limitations, and outlining protocols for seamless incorporation into established healthcare frameworks. Through this review, we aim to present an exhaustive snapshot of emerging diagnostic modalities in TBM, the current standing of machine learning in meningitis diagnostics, and the challenges and future prospects of converging these domains.

Using machine learning in the prediction of symptomatic venous thromboembolism following ankle fracture

BackgroundVenous thromboembolism (VTE) is a major cause of morbidity and mortality in the trauma setting, and both prediction and prevention of VTE have long been a concern for healthcare providers in orthopedic surgery. The purpose of this study was to evaluate the use of novel statistical analysis and machine-learning in predicting the risk of VTE and the usefulness of prophylaxis following ankle fractures. MethodsThe medical profiles of 16,421 patients with ankle fractures were screened retrospectively for symptomatic VTE. In total, 238 patients sustaining either surgical or nonsurgical treatment for ankle fracture with subsequently confirmed VTE within 180 days following the injury were placed in the case group. Alternatively, 937 patients who sustained ankle fractures managed similarly but had no documented evidence of VTE were randomly chosen as the control group. Individuals from both the case and control populations were also divided into those who had received VTE prophylaxis and those who had not. Over 110 variables were included. Conventional statistics and machine learning methods were used for data analysis. ResultsPatients who had a motor vehicle accident, surgical treatment, increased hospital stay, and were on warfarin were shown to have a higher incidence of VTE, whereas patients who were on statins had a lower incidence of VTE. The highest Area Under the Receiver Operating Characteristic Curves (AUROC) showing the performance of our machine learning approach was 0.88 with 0.94 sensitivity and 0.36 specificity. The most balanced performance was seen in a model that was trained using selected variables with 0.86 AUROC, 0.75 sensitivity, and 0.85 specificity. ConclusionBy using machine learning, this study successfully pinpointed several predictive factors linked to the occurrence or absence of VTE in patients who experienced an ankle fracture. Training these algorithms using larger, more granular, and multicentric data will further increase their validity and reliability and should be considered the standard for the development of such algorithms. Level of evidenceCase-Control study – 3

An Interdisciplinary Approach to Development of a New Combined Medicine for Musculoskeletal Disorders

Musculoskeletal disorders represent a significant global health concern, affecting millions and straining healthcare systems. Addressing the complex nature of musculoskeletal disorders necessitates a multifaceted approach, one that integrates various scientific disciplines. This paper delves into the collaborative efforts employed in the development of a new combined medication tailored for musculoskeletal disorders. Bringing together expertise from pharmacology, biomedicine, physiotherapy, and bioinformatics, the research has forged a holistic pathway to medication synthesis. Key focus areas include the evaluation of molecular targets, ensuring optimal drug-drug interactions, and tailoring the therapeutic approach based on the individual patient's needs and the specific disorder's pathology. Furthermore, insights from physical therapy informed the drug development process, ensuring that the new medication aligns with rehabilitative approaches and promotes functional recovery. Advanced computational methods also played a pivotal role, enabling the prediction of drug efficacy, potential side effects, and patient response variability. Preliminary results suggest that this interdisciplinary strategy not only enhances the drug's therapeutic potential but also minimizes adverse reactions, paving the way for a more comprehensive and effective approach to managing musculoskeletal disorders. This research underscores the power of interdisciplinary collaboration on the relevance, necessity, and timeliness of the pharmaceutical development of a new combined medicine for musculoskeletal disorders based on known active pharmaceutical ingredients. The characteristics of active pharmaceutical ingredients (ketamine, analgin, diazepam) were studied in order to substantiate the composition based on a combination of evidence-selected active pharmaceutical ingredients. The composition, clinical and pharmacological properties, control regime, availability, areas of medical application, quality and safety profile were substantiated.

Main Directions of Sustainable Development in Education

Objective: One of the important vectors of the strategic development of the EAEU countries (Member States of the Eurasian Economic Union) is the construction of a digital economy and digital education - the formation of a common market for educational services with norms that level the competitiveness of countries in the field of education, aimed at improving the quality of human capital. It should be noted that education was not included in the service sectors for which the EAEU common market is being formed. Only in relation to the common labor market, the EAEU countries agreed on the mutual recognition of documents on education without going through the procedure for recognizing diplomas (with the exception of papers on education in pedagogical, legal, medical, and pharmaceutical profiles), as well as on the right to receive education by children from families working in the country (Articles 97 and 98 of the Treaty on the EAEU). But five years before the creation of the EAEU, on December 11, 2009, the EAEU countries signed an agreement on cooperation in the field of education, according to which the parties «carry out coordinated measures to consistently expand the EAEU aimed at creating a common educational space». Research in the field of concerted action of the member countries of the EAEU, as a rule, is located in the area of higher education, and we do not find research in the field of general education in the public domain. Theoretical framework: This study aims to identify the main directions of sustainable development in education in modern conditions. The choice of the topic is due to the importance of understanding the differences in the potential for digitalization of school education in the post-Soviet republics within the framework of the Eurasian Union and the hypothetical request of the Azerbaijani and Russian education systems to develop a resource matrix for the digital educational environment, as signaled by the roadmaps of the National Projects of Azerbaijan and the Russian Federation in the field of education and economy in general. Method: To compare the preparedness of schools in different countries for the digitalization of education for subsequent testing in the educational system of Azerbaijan, an analysis of the state of affairs was carried out according to the criteria: (1) material and technical equipment; (2) preparedness of teaching staff; (3) opportunities for the formation of a digital educational environment and an analysis of digital practices in the projects of schools in the EAEU member countries. The logic of the empirical part includes identifying the respondents' ideas about the possibilities of digitalizing school education in the EAEU countries. The result of the practical part will be the formed matrix of the «potential of school digitalization» in the context of the EAEU countries. Results: The effect of the global digitalization of general education, triggered by the pandemic (COVID 19), is the reason for the emergence of research interest in the problem in the EAEU countries and the comparison of approaches and processes that accompany the phenomenon of digitalization of education. Moreover, advanced practices in digitalizing education have been identified among these countries, which can become the basis for further sustainable development. Originality/value: The digitalization of education is a multifaceted phenomenon covering all human activity spheres. A phenomenon that needs to be comprehended, developed, and actively applied in practice is its consequences and advanced learning technologies to fit into the new, emerging digital world system. With a broad interpretation of the concept of «digitalization of education», it can be noted that the authors are unanimous that digitalization forms an educational environment that ensures the «delivery» of information to participants in the educational process using digital technologies and tools (software + multimedia equipment).

C10 (Clinical Case) Precocious Puberty in Internationally Adopted Children: A Tale of Two Thelarches

Abstract Introduction/Background Internationally adopted (IA) children may commonly experience post-adoption medical issues in the infectious, nutritional, developmental and psychological domains. We present a rare endocrinologic case of 2 biologically unrelated children adopted into the same Canadian family with diagnoses of idiopathic central precocious puberty (CPP), years after adoption. Case Description A 13-month-old female was adopted from Kazakhstan with a past history of prematurity (29 weeks gestational age), grade II intraventricular hemorrhage, query hypoxic ischemic encephalopathy, perinatal CMV infection, and malnourishment. She demonstrated catch-up growth after adoption and was monitored for developmental concerns. She presented at 7 years 9 months with report of thelarche at 6 years 6 months, pubarche at 7 years 6 months and accelerated height velocity. Bone age was advanced by 3 years (+4 SD). By Endocrinology consultation at 8 years 1 month, gonadotropin-releasing hormone (GnRH) stimulation test confirmed CPP. There was no central nervous system (CNS) symptomatology. Leuprolide was initiated to minimize psychosocial impacts of CPP and not necessarily to improve final adult height. Seven years after their first adoption, the family welcomed a female child from Vietnam, aged 2 years 11 months. Medical profile included malnutrition and atopic dermatitis. Thelarche was noted at 5 years 4 months. By Endocrinology consultation at 5 years 5 months, she had isolated breast development with accelerated height velocity. Bone age was advanced by 2.5 years (+3 SD). GnRH stimulation test revealed CPP. Leuprolide was started. MRI brain showed no CNS lesion, which confirmed the diagnosis of idiopathic CPP. Discussion Whereas there is a rare, but documented, increased prevalence of CPP among IA children, etiology is unclear. Theories postulate that it may be related to rapid catch-up growth post-adoption or past exposure to endocrine disruptors. Awareness of this risk may vary. Initial post-adoption consults often focus on other medical and developmental screening. Depending on the age at adoption, counselling about puberty may seem remote. This may impact the timing at which pubertal concerns are identified. As early identification of CPP provides an opportunity to intervene to preserve adult height, as well as minimize psychosocial impact on the child, pubertal surveillance should not be overlooked. Based on caregiver feedback from our cases, we now include counselling on, and examination for, early pubertal changes in our IA clinic visits. Conclusion IA children are at increased risk of central precocious puberty. Paediatric clinicians and caregivers should be aware of this risk to allow for timely identification and treatment of this condition.

Evaluation of Acute Outcomes and Factors Influencing the Care of Chest Trauma in a District General Hospital in the United Kingdom.

Background The rate of chest trauma admissions under the Queen Hospital Burton Orthopedic team has been steadily increasing, surpassing other hospital trusts. Patients are managed locally by the Orthopedic department, unlike in major trauma centres. Understanding the management outcomes and patient factors in this setting is crucial for enhancing patient safety. Methodology A retrospective analysis of 139 patients with chest trauma referred to the QHB Orthopedic team from October 2017 to May 2021 was conducted using the Meditech-V6 electronic medical records system (Meditech, Westwood, US). This study aims to evaluate the outcomes of patients admitted with chest trauma and improve current practices. The objectives include assessing patient factors influencing outcomes, initiating discussions with a major trauma centre, and enhancing the quality of care for chest trauma patients. Results The mechanism of injury in all cases of chest injuries was blunt trauma, accounting for 100% of the cases. The specific mechanisms of injury observed in the study included falls from standing, falls from height, road traffic collisions, and assault. The study comprised 139 individuals, 128 of whom were diagnosed with rib fractures, and 11 who did not have any rib fractures. In addition, two patients were hospitalized with bilateral rib fractures, both of which were life-threatening. Tragically, one of these cases resulted in the death of the patient. With regardto outcomes,67% of the patients received a consultation at Royal Stoke Hospital (RSH). Eight individuals were transferred to RSH for further management, while the remaining 131 patients were not transferred.Eighty-seven individuals were discharged from the hospital, indicating successful recovery and readiness for discharge. However, it is noteworthy that nine patients experienced complications during their hospital stay, highlighting the potential challenges and risks associated with chest trauma management. Tragically, seven patients succumbed to their injuries and passed away. Conclusions The majority of patients in this study were aged 65 and over and presented with multiple comorbidities, indicating the complex medical profile of this population. However, despite the presence of life-threatening injuries and the associated risks, only a minority of patients in the study were transferred to a designated trauma centre. This raises concerns about the adequacy of the current transfer protocols and the potential impact on patient outcomes.

PREVALENCE AND DETERMINANTS OF DIABETES DISTRESS AMONG TYPE 2 DIABETES MELLITUS (T2DM) WITH INSULIN THERAPY IN A PRIMARY HEALTH CARE CENTRE

Individuals with diabetes mellitus experience psychological issues associated with their disease and involve multiple states related to diabetes management. Insulin distress is a significant contributor to diabetes distress. The objective of this study is to identify the prevalence and determinants of diabetes distress among type 2 Diabetes Mellitus (T2DM) with insulin therapy in the setting of primary health care. Methods: This cross-sectional study was conducted from 1st August 2022 to 30th December 2022 at Sungai Buloh Health Clinic, Selangor, Malaysia. 300 T2DM with insulin therapy were recruited and screened for diabetes distress status. Their sociodemographic and relevant medical profiles were recorded, and the Diabetes Distress Scale (DDS) was used to measure diabetes distress. Results: Diabetes distress was prevalent among insulin respondents at a rate of 24.3%, with 13.2% of patients experiencing emotion-related distress, 7.7% experiencing regimen-related distress, 2.3% experiencing interpersonal-related distress, and 1.1% experiencing physician-related diabetes distress.The significant determinants for diabetes distress among diabetic cases were education with (OR = 0.248, 95% CI: 0.116-2.101), diabetes duration (OR = 0.415, 95% CI: 0.235- 0.735), exercises (OR = 17.91, 95% CI: 2.337-137.32), FBS (OR = 0.517, 95% CI: 0.283- 0.945), HbA1c (OR = 2.774, 95% CI: 1.249-6.159).Conclusion: The present study shows that diabetes distress prevalence is present among T2DM with insulin therapy. Then, suggested components of diabetes distress should be implemented as screening strategies among T2DM with insulin therapy to prevent the late detection of psychiatric disorders. The study highlights comprehensive planning, holistic collaboration, and integrated strategies to improve patient adherence and health outcomes.

Medical profile of patients referred to an Australian postgraduate oral surgery clinic.

Thorough knowledge of a patient's medical history and medications is necessary for providing safe oral surgery care, and may be considered a form of risk management. This study investigated the prevalence of medical conditions and medication types in patients referred to an Australian postgraduate oral surgery clinic over 2 years. A retrospective cross-sectional study of the clinical records of 233 randomized patients referred to the Griffith University (Queensland, Australia) postgraduate oral surgery clinic in 2018 and 2019 was performed. Medical conditions and medications were counted and categorized, and descriptive statistics were generated. In all, 133 patients (57%) had at least one medical condition. 58% of them (77) had two or more categories of medical conditions, representing nearly a third (33.0%) of all sampled patients. The most prevalent category of medical conditions was psychiatric (25.3%), followed closely by cardiovascular (24.5%) diseases. Cardiovascular medications were the most prevalent, comprising 23.6% of all medications recorded, followed by psychotropics (18.3%). Over half of patients referred to the postgraduate oral surgery clinic had at least one systemic medical condition. Nearly a third of patients referred had at least two distinct systemic medical conditions. With an ageing population and the accompanying rise in multimorbidity globally, dental school curricula must adapt to prepare students to meet these challenges in their careers.