Medical Screening Research Articles

MLP-RL-CRD: diagnosis of cardiovascular risk in athletes using a reinforcement learning-based multilayer perceptron

Objective. Pre-participation medical screening of athletes is necessary to pinpoint individuals susceptible to cardiovascular events. Approach. The article presents a reinforcement learning (RL)-based multilayer perceptron, termed MLP-RL-CRD, designed to detect cardiovascular risk among athletes. The model underwent training using a publicized dataset that included the anthropological measurements (such as height and weight) and biomedical metrics (covering blood pressure and pulse rate) of 26 002 athletes. To address the data imbalance, a novel RL-based technique was adopted. The problem was framed as a series of sequential decisions in which an agent classified a received instance and received a reward at each level. To resolve the insensitivity to the initialization of conventional gradient-based learning methods, a mutual learning-based artificial bee colony (ML-ABC) was proposed. Main Results. The model outcomes were validated against positive (P) and negative (N) ECG findings that had been labeled by experts to signify individuals ‘at risk’ and ‘not at risk,’ respectively. The MLP-RL-CRD approach achieves superior outcomes (F-measure 87.4%; geometric mean 89.6%) compared with other deep models and traditional machine learning techniques. Optimal values for crucial parameters, including the reward function, were identified for the model based on experiments on the study dataset. Ablation studies, which omitted elements of the suggested model, affirmed the autonomous, positive, stepwise influence of these components on performing the model. Significance. This study introduces a novel, effective method for early cardiovascular risk detection in athletes, merging reinforcement learning and multilayer perceptrons, advancing medical screening and predictive healthcare. The results could have far-reaching implications for athlete health management and the broader field of predictive healthcare analytics.

Analysis of Graphene Pythagoras Tree Fractal Antenna with Thin SiO2 Substrate in Terahertz Regime

Abstract The Pythagoras Tree Fractal patch is considered on a SiO2 substrate thickness of 1.5 µm to radiate at four frequencies of 4.975THz, 5.38THz, 6.73THz, and 7.61THz with Voltage Standing Wave Ratio (VSWR) ≤ 2. This is a very creative fractal design of a multiband THz antenna, based on a very thin graphene layer, the study proved a value in terms of high radiation efficiency and high gain, at the level of current research we made a comparison study where the design has evidently huge potential regarding applicability for telecommunication technology in the terahertz regime. The demand for high-performance terahertz (THz) antennas has increased significantly in recent years due to their potential applications in various fields such as medical imaging, security screening, and wireless communications. In this paper, the authors present an analysis of a graphene Pythagoras Tree Fractal (GPTF) antenna with a thin SiO2 substrate for THz regime. The GPTF antenna is designed using a fractal geometry approach, which provides multiple resonant frequencies and enhances the overall radiation efficiency. The thin SiO2 substrate is used to reduce the substrate losses and improve the radiation performance of the antenna. The authors use the Finite-Difference Time-Domain (FDTD) software to simulate the performance of the proposed antenna. The results show that the proposed antenna exhibits high gain, low return loss, and wide bandwidth, making it a promising candidate for THz applications.

Halogen-bonding boosting the high performance X-ray imaging of organic scintillators.

Organic scintillators with efficient X-ray excited luminescence are essential for medical diagnostics and security screening. However, achieving excellent organic scintillation materials is challenging due to low X-ray absorption coefficients and inferior radioluminescence (RL) intensity. Herein, supramolecular interactions are incorporated, particularly halogen bonding, into organic scintillators to enhance their radioluminescence properties. By introducing heavy atoms (X=Cl, Br, I) into 9,10-bis(4-pyridyl)anthracene (BPA), the formation of halogen bonding (BPA-X) enhances their X-ray absorption coefficient and restricts the molecular vibration and rotation, which boosts their RL intensity. The RL intensity of BPA-Cl and BPA-Br fluorochromes increased by over 2 and 6.3 times compared to BPA, respectively. Especially, BPA-Br exhibits an ultrafast decay time of 8.25ns and low detection limits of 25.95±2.49nGys-1. The flexible film constructed with BPA-Br exhibited excellent X-ray imaging capabilities. Furthermore, this approach is also applicable to organic phosphors. The formation of halogen bonding in bromophenyl-methylpyridinium iodide (PYI) led to a fourfold increase in RL intensity compared to bromophenyl-methyl-pyridinium (PY). It suggests that halogen bonding serves as a promising and effective molecular design strategy for the development of high-performance organic scintillator materials, presenting new opportunities for their applications in radiology and security screening.

Training for shorter ultra-trail races results in a higher injury rate, a more diverse injury profile, and more severe injuries: 2022 Mac ultra races

ObjectivesDetermine and compare the epidemiology, clinical characteristics, and injury severity among race entrants training towards different ultra-trail race distances. DesignRetrospective cross-sectional study. SettingThe six months training period before the 2022 Mac Ultra races (46 km, 80 km, 161 km and 322 km). ParticipantsOf the 245 race entrants, 162 (66% of Mac ultra-trail runners) consented to analyse their data. Outcome measuresInjury rate (injuries per 1000 h of running), point prevalence (% of currently injured participants), injury severity (time loss), and the frequency (n, %) of injuries reported during pre-race medical screening in the six months before the race. Using inferential statistics, we compared the injury rates between the different race distance categories (46 km, 80 km, 161 km, 322 km). All tests were performed at a 5% level of significance. ResultsWe reported a statistically significantly higher injury rate among 46 km study participants (3.09 injuries per 1000 h) compared to the injury rates reported among 80 km (0.68 injuries per 1000 h; p = 0.001) and 161 km (1.09 injuries per 1000 h; p = 0.028) participants. The lower limb (89%) was the most injured anatomical region, with only 46 km study participants reporting upper limb, trunk, and head injuries (11%). Muscle/tendon was the most reported injured tissue type (56%), with muscle injuries (31%) the most reported pathology type. Shorter distance ultra-trail runners reported the highest injury severity. ConclusionUltra-trail runners training towards shorter ultra-trail distance races presented with a higher injury rate, more diverse injury profile, and a higher injury severity.

Understanding Thrombosis and Hemorrhage in Myeloproliferative Neoplasms through a Nationwide Study

Introduction The incidence of Myeloproliferative Neoplasms (MPNs), including Essential Thrombocythemia (ET), Polycythemia Vera (PV), and Primary Myelofibrosis (PMF) are increased. Thrombosis and hemorrhage are major complications of ET and PV. Leukemic transformation is a rare but fatal complication of MPNs. However, their incidence and risk factors of thrombosis and hemorrhage in a nationwide population are not fully known. Methods This study used nationwide data from the Korean National Health Insurance System (NHIS). We assessed thrombosis, hemorrhage, and leukemic transformation events in a cohort of all 9,779 patients diagnosed with MPNs during 2011-2016. A Big data formed by the NHIS contains demographic, clinical characteristics (smoking, body mass index, dates of birth, last follow up date, gender), health care utilization, treatment medication and health screening for the whole Korean population (Table 1). Results Of total 9,779 patients with MPNs, 5,970 (61.04%) had ET, 2,655(27.2%) PV, 586 (5.9%) PMF, and 568 (5.8%) unspecified MPN (MPN-U). 2,187 (22.4%) patients were diagnosed arterial thromboembolism including cerebral infarction and other thromboembolism during follow-up. And 1,029 (10.5%) patients were diagnosed venous thrombus including pulmonary thromboembolism. 254 (2.6%) patients were diagnosed intracerebral hemorrhage. Secondary leukemia (acute myeloid leukemia (n=482, 4.9%), acute lymphocytic leukemia (n=38, 0.4%), chronic myeloid leukemia (n=423, 4.3%), and chronic lymphocytic leukemia (n=22, 0.2%)) arising from MPNs were noted. Secondary myelofibrosis was noted in 321 (3.3%) patients with MPNs. Multivariate analysis revealed several risk factors for thrombosis and hemorrhage in patients with PV and ET. In patients with PV, age over 60 years (hazard ratio [HR]=2.199, 95% confidence interval [CI]=1.863-2.596, p<0.001), hypertension (HR=1.519, 95% CI=1.269-1.818, p<0.001), and atrial fibrillation/flutter (HR=1.561, 95% CI=1.088-2.241, p=0.016) were identified as significant risk factors for thrombosis. Additionally, age over 60 years (HR=2.896, 95% CI=1.637-5.123, p<0.001) was associated with an increased risk of hemorrhage in patients with PV. In patients with ET, multivariate analysis identified age over 60 years (HR=2.495, 95% CI=2.217-2.809, p<0.001), male sex (HR=1.147, 95% CI=1.034-1.271, p=0.009), hypertension (HR=1.563, 95% CI=1.385-1.764, p<0.001), dyslipidemia (HR=1.216, 95% CI=1.084-1.364, p=0.001), atrial fibrillation/flutter (HR=1.537, 95% CI=1.091-2.165, p=0.014), and hematologic malignancy (HR=1.294, 95% CI=1.097-1.527, p=0.002) as significant risk factors for thrombosis. Moreover, age over 60 years (HR=2.657, 95% CI=1.744-4.048, p<0.001) and hypertension (HR=1.775, 95% CI=1.161-2.713, p=0.008) were found to be significant risk factors for hemorrhage in patients with ET. Conclusions This is the first Korean nationwide study to understand thrombosis and hemorrhage in patients with MPNs. This set of data can be utilized to compare the Asian patients with MPNs to international data and guidelines.

Health System for Exercise Rehabilitation Detection Retina Images and IoT Blockchain

Smart Healthcare which is based on deep learning is becoming increasingly popular because of its practical applications and has grown popular after its incorporation with IoT. Degenerative eye disease is the main factor of blindness in people of working age. Asian nations with large populations, like India and China, are on the edge of a diabetes epidemic. In terms of medical screening and diagnosis, a large number of diabetes patients posed a huge problem for skilled clinicians. The idea is to employ deep learning algorithms to detect blind spots in the eye and estimate the severity of the stage. We present an optimum approach for detecting blindness in retinal images based on recently released pre-trained EfficientNet models, as well as a comparative assessment of many innovative neural network models, in this study. On a benchmark dataset of retina images obtained by diagnostic imaging at various imaging phases, our EfficientNet-B5-based model assessment performs better than CNN and ResNet50 models.

The prevalence of anomalies in the lumbar spine in the Turkish male population

Aims: It was aimed to determine the prevalence of lumbosacral anomalies in young male population.
 Methods: 56.798 male patients, between 18-49 years old, were included in this study during their medical screening in Dışkapı Yıldırım Beyazıt Training and Research Hospital from July 2016-July 2020. The presence of spina bifida occulta (SBO) and transitional vertebrae (TV) anomalies were recorded in the candidates. SBO patients were evaluated according to their S1 and L5 origins, and TV patients were evaluated separately according to sacralization and lumbarization. We identified transitional vertebrae by counting down from the last thoracic vertebra on the AP X-rays, then if necessary looking at the lateral view for confirmation. If hypoplastic ribs were identified, the vertebra immediately beneath would be designated as L1. Castellvi types I, II, III, and IV were included as transitional states.
 Results: 56798 patients were evaluated retrospectively. The mean age of the patients was 23.28 (18-49 years). Radiological anomalies were detected in 2577 (4.5%) of 56798 cases. No radiological anomaly was observed in other cases. Spina bifida occulta was detected in 1478 (2,6%) patients. Lumbosacral transitional vertebrae were detected in 1099 cases (1.9%). 745 (1.3%) of these anomalies are sacralization and 354 (0.6%) of them are lumbalization.
 Conclusion: In the light of this information, we think that knowing the frequency of lumbosacral anomalies, especially LSVT, in our society should be considered in the evaluation before spinal surgery operations.

Osteoporosis Prediction Using Machine-Learned Optical Bone Densitometry Data.

Optical bone densitometry (OBD) has been developed for the early detection of osteoporosis. In recent years, machine learning (ML) techniques have been actively implemented for the areas of medical diagnosis and screening with the goal of improving diagnostic accuracy. The purpose of this study was to verify the feasibility of using the combination of OBD and ML techniques as a screening tool for osteoporosis. Dual energy X-ray absorptiometry (DXA) and OBD measurements were performed on 203 Thai subjects. From the OBD measurements and readily available demographic data, machine learning techniques were used to predict the T-score measured by the DXA. The T-score predicted using the Ridge regressor had a correlation of r = 0.512 with respect to the reference value. The predicted T-score also showed an AUC of 0.853 for discriminating individuals with osteoporosis. The results obtained suggest that the developed model is reliable enough to be used for screening for osteoporosis.

Willingness for Medical Screening in a Dental Setting-A Pilot Questionnaire Study.

An important way to manage noncommunicable diseases (NCDs) is to focus on prevention, early detection, and reducing associated risk factors. Risk factors can be detected with simple general health checks, which can also be performed in dental clinics. The purpose of this study was to investigate participants' willingness to participate in general health checks at the dentist, in particular the difference in opinion between medical patients and random healthy dental attendees. A total of 100 medical patients from an outpatient internal medicine clinic and 100 dental clinic attendees were included (total of 200 participants). The participants were asked for their opinion using six closed-ended questions. Overall, 91.0% of participants were receptive to information about the risk of diabetes mellitus (DM) and cardiovascular diseases (CVD). The majority (80-90%) was receptive to screening for DM and CVD risk, such as weight and height measurements, blood pressure measurement, saliva testing for CVD and to measure glucose and cholesterol via finger stick. No significant differences were found in the frequencies of the responses between the different groups based on health status, age, sex, or cultural background. This study shows that most participants are willing to undergo medical screening at the dentist for early detection and/or prevention of common NCDs.

Lampedusa Island hotspot is a crucial migrant health checkpoint. Is enough attention being paid?

Abstract Background The migrant reception system in Italy operates on two levels: first and second reception centers. The first reception is carried out in collective centers -called hotspots- where newly arrived migrants are identified. Approximately, ¾ of the landings take place on Lampedusa, a small Italian island 113 km away from the Tunisian coast, that has its own hotspot. Here migrants should receive the first medical care and the first health screening and identification. The aim of this study is to understand the quality of healthcare provided at the Lampedusa hotspot. Methods A survey was conducted in April 2023 on all the 80 doctors and nurses who worked in the Lampedusa hotspot clinic between 2020 and 2022. In the first part, questions concerning their work in hotspot, experience, training before starting the task, and the actual needs of the migrant population were asked. In the second part, the focus was on available medical tools and screening for infectious diseases. Results Thirty-nine (46%) of the healthcare professionals responded to the survey, with half of them in their first work experience. Less than 40% had previously worked in a migrant assistance context. 93% of them started the job without a training course. 80% of respondents have never had access to protocols or guidelines and 80% believe that the structure is unsuitable for screening infectious diseases. Four out of 10 migrants seek treatment and ⅔ of the respondents state that there was no health screening. Conclusions These results highlight the need for health screening and treatment implementation, to prevent the spreading of infectious diseases, the development of antibiotic resistance, and the good management of economic resources. The migrant reception system in Lampedusa is highly present in the political and journalistic debate, but not as much in the scientific, as the latest publication dates back to 2015. Key messages • Lampedusa hotspot is an essential checkpoint for infectious disease and migrants’ health screening. • Migrants’ health at arrival is a public health issue that must be better tackled by the scientific community.

Chronic disease management: Preventive care framework for migrant workers in Singapore

Abstract Chronic diseases, if unmanaged, can contribute to significant premature mortality and morbidity. Before the COVID-19 pandemic, there was limited data on chronic disease prevalence amongst migrant workers (MWs) in Singapore. The antecedent episodic and fragmented primary care for migrant workers also affected care continuity for common chronic diseases. In April 2022, a Primary Care Plan (PCP) was developed for migrant workers to improve access and affordability which included chronic disease detection and management and risk factor reduction. In addition, chronic disease screening was also enhanced in migrant workers’ pre-employment medical screening for those with risk factors or above 40 years old. Beyond disease management, interventions to address health gaps and strengthen the healthcare resilience of MWs are incorporated into a population-health based “Management of Oral and Chronic Conditions and Ailments - MOCCA” framework, anchored on three thrusts: 1. Address knowledge gaps and inculcate healthier habits - Improve health literacy via outreach programmes and culturally nuanced health materials 2. Mitigate risk factors - Build primary care providers’ capabilities to deliver alcohol/tobacco interventions 3. Treat and control disease progression - Set up referral pathways between primary and tertiary healthcare institutions including for post-discharge case management MOCCA was implemented in December 2022 through the collective efforts from the government, community, social service agencies and their employers. Key messages • Migrant workers have been receptive to interactive health programmes, regular health screening, follow up on chronic disease under the PCP and 324 workers attended basic dental screening. • The MOCCA framework is integral to the provision of care for MWs, through risk factor identification, empowerment of health ownership, and periodic assessment of health and behavioural outcomes.

Department ofDefense Medical Examination Review Board Audiogram Screening Comparative Analysis.

The Department of Defense Medical Examination Review Board (DoDMERB) plays a pivotal role in the assessment of medical fitness for aspiring military officers. A crucial component of this process is the screening audiogram, designed to evaluate hearing capabilities. However, recent observations of high disqualification rates following screening audiograms led to concerns about their accuracy. This quality improvement project, conducted between 2017 and 2019, aimed to assess the concordance between screening audiograms and reference-standard audiometry, as well as to investigate the relationship between disqualification status and hearing thresholds at different frequencies. A sample of 134 candidates, drawn from various locations across the United States, was analyzed. Results revealed that the screening audiogram mean thresholds were twice that of the reference-standard audiogram, particularly in the lower frequencies. Additionally, we found that 84% of candidates were incorrectly disqualified by the screening exam when followed up by the reference-standard. Overall, Bland-Altman analysis revealed significant disagreement between these two tests. This discrepancy prompted a fundamental policy shift in 2020, where candidates who fail screening audiograms now automatically undergo reference-standard audiometry before any disqualification decision. This policy change reflects the commitment of DoDMERB to refining the medical screening process. It reduces the burden on candidates, provides a more comprehensive assessment, and ensures that qualified individuals are not erroneously disqualified.In addition to policy changes, this quality improvement project explored potential courses of action to enhance the screening audiogram process. Among these, improving contract specifications for testing facilities to minimize ambient noise emerged as the most practical and cost-effective approach. In conclusion, the project underscores the importance of refining medical screening processes to accurately assess candidates' qualifications while retaining the utility of screening audiograms. These efforts not only benefit aspiring military officers but also contribute to maintaining the high standards required for military service.

3D phantom for image quality assessment of mammography systems

Objective. To present an innovative approach for the design of a 3D mammographic phantom for medical equipment quality assessment, estimation of the glandular tissue percentage in the patient’s breast, and emulation of microcalcification (μC) breast lesions. Approach. Contrast-to noise ratio (CNR) measurements, as well as spatial resolution and intensity-to-glandularity calibrations under mammography conditions were performed to assess the effectiveness of the phantom. CNR measurements were applied to different groups of calcium hydroxyapatite (HA) and aluminum oxide (AO) μCs ranging from 200 to 600 μm. Spatial resolution was characterized using an aluminum plate contained in the phantom and standard linear figures of merit, such as the line spread function and modulation transfer function (MTF). The intensity-to-glandularity calibration was developed using an x-ray attenuation matrix within the phantom to estimate the glandular tissue percentage in a breast with a compressed thickness of 4 cm. Main results. For the prototype studied, the minimum confidence level for detecting HA μCs is 95.4%, while for AO μCs is above 68.3%. It was also possible to determine that the MTF of the commercial mammography machine used for this study at the Nyquist frequency is 41%. Additionally, a one-to-one intensity-to-glandularity calibration was obtained and verified with Monte-Carlo simulation results. Significance. The phantom provides traditional arrangements presented in accreditation phantoms, which makes it competitive with available devices, but excelling in regarding affordability, modularity, and inlays distribution. Moreover, its design allows to be positioned in close proximity to the patient's breast during a medical screening for a simultaneous x-ray imaging, such that the features of the phantom can be used as reference values to specify characteristics of the real breast tissue, such as proportion of glandular/adipose composition and/or μC type and size lesions.

Reinvestigating the Perceptions of Annual Skin Cancer Screening Scale: a suitable measure for older adults.

The Perceptions of Annual Skin Cancer Screening Scale (PASCSS) explains significant variance in whether people undergo annual clinical skin cancer screening beyond other relevant predictors. When developing the PASCSS, the author only tested its psychometric properties and validity with participants representative of the general USA population, despite the particular relevance of annual clinical skin cancer screenings to at-risk populations, namely, older adults. We reanalyze the PASCSS using a sample of older adults. We conducted a three-wave survey study (n = 237) with each wave separated by one week. Demographic information was recorded at Time 1. The PASCSS was administered at Time 2. Outcomes were measured at Time 3. The model fit of our confirmatory factor analysis met or closely approached traditional cutoffs, and each item loaded very strongly onto its respective latent factor. These PASCSS's dimensions together explained an additional 38% of variance in dermatologist screening and 37% of variance in any medical professional screening beyond our control variables (both P < 0.01). The dimension of Unknowledgeable was statistically significant in predicting dermatologist screening ( P = 0.03), whereas the three dimensions of Forget, Recommended, and Unknowledgeable were statistically significant in predicting any medical professional screening (all P < 0.05). Our results supported the psychometric properties and validity of the PASCSS, and we showed that the dimensions significantly relate to whether participants received a clinical skin cancer screening in the past year. The current investigation supports that the PASCSS is appropriate to administer to older adults.

PosturAll: A Posture Assessment Software for Children.

From an early age, people are exposed to risk factors that can lead to musculoskeletal disorders like low back pain, neck pain and scoliosis. Medical screenings at an early age might minimize their incidence. The study intends to improve a software that processes images of patients, using specific anatomical sites to obtain risk indicators for possible musculoskeletal problems. This project was divided into four phases. First, markers and body metrics were selected for the postural assessment. Second, the software's capacity to detect the markers and run optimization tests was evaluated. Third, data were acquired from a population to validate the results using clinical software. Fourth, the classifiers' performance with the acquired data was analyzed. Green markers with diameters of 20 mm were used to optimize the software. The postural assessment using different types of cameras was conducted via the blob detection method. In the optimization tests, the angle parameters were the most influenced parameters. The data acquired showed that the postural analysis results were statistically equivalent. For the classifiers, the study population had 16 subjects with no evidence of postural problems, 25 with mild evidence and 16 with moderate-to-severe evidence. In general, using a binary classification with the train/test split validation method provided better results.

The role of nurses in the prevention of cervical cancer: Cervical screening, an unkept promise by the majority of women in Nigeria

ABSTRACT Cervical cancer remains a major public health problem accounting for continuous female death in developing countries. Cervical cancer is the second most common cancer in women globally with an estimated number of 500,000 new cases of cervical cancer and 273,000 mortalities annually. Cervical screening is the best cancer screening test in the history of medicine and most cost-effective of all medical screening tests. The study review aimed to highlight methods of cervical cancer prevention, identify the uptake of cervical screening among women, and explain the role of nurses in uptake of cervical screening. Cervical cancer is preventable and easily treatable if it is detected at early stages, but poor information on prevention and access to screening and treatment contributes to 90% of deaths. In the developing countries such as Nigeria, a large proportion of cervical cancers are diagnosed in advanced stages, with poor rates of survival. The three main methods for preventing cervical cancer are through primary prevention (human papillomavirus vaccination and health education), secondary prevention (cervical screening, early detection of precancerous lesions, and treatment), and tertiary prevention (measures to slow the progression or recurrence, surgical removal, radiotherapy, and chemotherapy). Nurses can help improve the acceptability of this neglected promise by focusing on health education on cervical screening and vaccination in prenatal clinics and infant welfare clinics where there are more women. Inclusion of cyberspace could also serve as a successful and popular platform for this health teaching. All nurses/midwives must preach and fervently work toward the WHO 90–70–90 plan for eradicating cervical cancer.

Prevalence of Various Forms of Active Tuberculosis in Patients with Diabetes

A diabetic foot ulcer (DFU) is a persistent complication of diabetes mellitus. Diabetes is linked to a two to four-fold higher likelihood of developing peripheral arterial disease (PAD) when compared to individuals without diabetes. Objective: To determine the incidence of various forms of active tuberculosis in patients with diabetes. Methods: It was a cross-sectional study conducted at the Department of General Medicine from August 2022 to February 2023. 175 patients, including both males and females, participated in this study. Comprehensive demographic information was meticulously documented for each patient following the appropriate consent procedures. These patients had symptoms such as cough with or without phlegm, hemoptysis, persistent fever, and unexplained weight loss, and their ages ranged from 10 to 85 years. Comprehensive medical history, clinical examination, and TB screening tests were conducted and data analysis were done by SPSS version-24 for further analysis. Results: The mean age was 51.34 years with a standard deviation of 3.61. Among the patients, 107 (61.14%) were male, and 68 (38.85%) were female. The overall prevalence of active TB was 38 cases, accounting for 21.71% of the total. Among these cases, 18 were pulmonary TB, making up 47.36% of the active TB cases, while 13 were extra-pulmonary TB, constituting 34.21% of the total. Additionally, 5 cases were identified as multidrug-resistant TB, representing 13.15% of the active TB cases. Conclusions: In conclusion, our study reveals a higher prevalence of various forms of active tuberculosis in patients with diabetes with pulmonary tuberculosis accounting for 47.35% and extra pulmonary tuberculosis for 34.21% of cases.

Evaluation of Patients aged over 65 years who applied to Ankara Training and Research Hospital Family Medicine Outpatient Clinics: Comparison Before and After Covid-19 Pandemic

Aim: Taking into account the importance and priority of the geriatric age group, the aim of our study was to examine the reasons for and the number of visits to primary health care institutions, to compare them before and after the Covid-19 pandemic, and to draw attention to the importance of geriatric sciences in family medicine specialty training in the light of this evaluation.&#x0D; &#x0D; Materials and Methods: Patients who applied to the Ankara Training and Research Hospital (EAH) Family Medicine Outpatient Clinics between 01.03.2020-31.12.2022 constitute the population of the study. Patients were retrospectively evaluated before and after the Covid-19 pandemic according to their admission rates and diagnoses. The outpatient clinics they applied to were analyzed. Musculoskeletal system problems were analyzed under a separate heading according to diagnoses.&#x0D; Results: Out of 47014 diagnoses above the age of 65 during the pandemic period, I10 - Essential (Primary) Hypertension was the most common diagnosis, except for general medical examinations and screening examinations. In the post-Covid-19 period, 45928 diagnoses were made in 14398 patients over the age of 65. After general medical and laboratory examinations, the most common diagnose was I10 Essential Hypertension in both period. Musculoskeletal complaint during the pandemic period was the second most common with the diagnosis of M79.1 Myalgia in both period. Musculoskeletal complaints especially myalgia was more common in the pandemic period than the post-covid period (p

Sexual dysfunction in women with PCOS: a case control study.

What is the relationship of sex steroid levels with sexual function in women with and without polycystic ovary syndrome (PCOS)? Women with PCOS reported more sexual dysfunction and more sexual distress compared to those without PCOS, but only few and weak associations between androgen levels and sexual function were observed. The literature shows that women with PCOS report lower levels of sexual function and sexual satisfactionand more sexual distress. Contributing factors seem to be obesity, alopecia, hirsutism, acne, infertility, anxiety, depression, and low self-esteem. In women with PCOS clinical and/or biochemical hyperandrogenism is common; its relationship with sexualfunction is, however, inconclusive. This observational prospective case control study with 135 women (68 PCOS, 67 control) was conductedfrom March 2017 until March 2020. Heterosexual women with and without PCOS, aged 18-40 years, in a steady relationshipand without any comorbidities, underwent an extensive medical and endocrine screening using liquid chromatography-tandem mass spectrometry and validated sexual function questionnaires. Women with PCOS reported significantly lower sexual function (Female Sexual Function Index (FSFI) P < 0.001, partial η2 = 0.104), higher levels of sexual distress (Female Sexual Distress Scale-Revised P < 0.001, partial η2 = 0.090), and they more often complied with the definition of sexual dysfunction (41.2% vs 11.9%, P < 0.001, Phi V = 0.331) and clinical sexual distress (51.5% vs 19.4%, P < 0.001, Phi V = 0.335). Regression analysis adjusted for confounders showed only few and weak associations between androgen levels and sexual function, with each model explaining a maximum of 15% sexual function. Following significant Group × Hormone interactions, analyses for both groups separately showed no significant associations in the PCOS group. The control group showed only weak negative associations between testosterone and FSFI pain (β = -6.022, P = 0.044, Adj R2 = 0.050), between FAI and FSFI orgasm (β = -3.360, P = 0.023, Adj R2 = 0.049) and between androstenedione and clinical sexual distress (β = -7.293, P = 0.036, exp(β) = 0.001). The focus of the study on sexual functioning potentially creates selection bias. Possibly women with more severe sexual disturbances did or did not choose to participate. Differences between women with PCOS and controls in relationship duration and hormonal contraceptive use might have skewed the sexual function outcomes. Sexual function is impaired in women with PCOS. However, endocrine perturbations seem to have minimal direct impact on sexual function. Addressing sexuality and offering psychosexual counseling is important in the clinical care for women with PCOS. This study was funded by the departments of the participating centers: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Psychosomatic OBGYN and Sexology, Leiden University Medical Center, Leiden, the Netherlands; and Department of Sexology and Psychosomatic OBGYN, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands. J.S.E.L. received unrestricted research grants from the following companies (in alphabetical order): Ansh Labs, Ferring, Merck Serono and Roche Diagnostics. He also received consultancy fees from Ansh Labs, Ferring, Titus Healthcare and Roche Diagnostics. The other authors have no conflicts of interest. CCMO register, registration number: NL55484.078.16, 10 March 2016. https://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform?OpenForm.

Design and application of a medical protective face screen

Design and application of a medical protective face screen