Medical College Research Articles

Deciphering prognostic indicators in non-HIV cryptococcal meningitis: Constructing and validating a predictive Nomogram model.

Cryptococcal meningitis (CM) is a well-recognized fungal infection, with substantial mortality in individuals infected with the human immunodeficiency virus (HIV). However, the incidence, risk factors, and outcomes in non-HIV adults remain poorly understood. This study aims to investigate the characteristics and prognostic indicators of CM in non-HIV adult patients, integrating a novel predictive model to guide clinical decision-making. A retrospective cohort of 64 non-HIV adult CM patients, including 51 patients from previous studies and 13 from the First Hospital of Shanxi Medical University, was analyzed. We assessed demographic features, underlying diseases, intracranial pressure, cerebrospinal fluid characteristics, and brain imaging. Using the least absolute shrinkage and selection operator (LASSO) method, and multivariate logistic regression, we identified significant variables and constructed a Nomogram prediction model. The model's calibration, discrimination, and clinical value were evaluated using the Bootstrap method, calibration curve, C index, goodness-of-fit test, receiver operating characteristic (ROC) analysis, and decision curve analysis. Age, brain imaging showing parenchymal involvement, meningeal and ventricular involvement, and previous use of immunosuppressive agents were identified as significant variables. The Nomogram prediction model displayed satisfactory performance with an akaike information criterion (AIC) value of 72.326, C index of 0.723 (0.592-0.854), and area under the curve (AUC) of 0.723, goodness-of-fit test P = 0.995. This study summarizes the clinical and imaging features of adult non-HIV CM and introduces a tailored Nomogram prediction model to aid in patient management. The identification of predictive factors and the development of the nomogram enhance our understanding and capacity to treat this patient population. The insights derived have potential clinical implications, contributing to personalized care and improved patient outcomes.

Genomic characterization and cluster analysis of Carbapenem-resistant Klebsiella pneumoniae

To investigate the genomic features and perform cluster analysis of Carbapenem-resistant Klebsiella pneumoniae (CRKP) to provide an experimental basis for guiding the prevention and treatment of CRKP infections.A retrospective case-cohort study was conducted on 19 non-redundant CRKP strains isolated from the Tenth Affiliated Hospital of Southern Medical University between January and June 2023. Whole genome sequencing (WGS) and multilocus sequence typing (MLST) were performed to compare genomic features and analyze the resistance genes and homology of the strains.The results showed that the 19 CRKP strains were isolated from 8 different clinical departments, mainly from respiratory specimens. The whole genome sequencing revealed that the genomic lengths of CRKP ranged from 4.90 to 5.85 Mbp, with contigs N50 values>20 kb for each genome. The median overall GC content was 57.0% (50.4%-57.1%). Comparative genomic analysis identified three regions with high genomic variability. WGS detected 32 resistance genes across 11 categories. All 19 strains carried carbapenem resistance genes (blaKPC-2 and blaOXA-48), blaTEM-1B extended-spectrum β-lactamase resistance genes, qnrS1 quinolone resistance gene, and fosA fosfomycin resistance gene, with each strain carrying only one carbapenemase gene. The detection rate of blaKPC-2 was 94.7% (18/19). MLST identified three sequence types: ST11, ST437 and ST147, with ST11 being predominant (89.5%, 17/19). Clustering analysis based on acquired resistance genes revealed three clonal transmission patterns among strains 72 and 90, and strains 88, 84, 66 and 79.In conclusion, CRKP strains carry multiple resistance genes, and clustering analysis indicating that nosocomial clonal transmission is closely related to acquired resistance genes. The ST11-blaKPC-2 type strain is the predominant clone. Strengthened surveillance and effective control strategies are necessary to reduce nosocomial transmission of CRKP.

Exploring the link between chromosomal polymorphisms and reproductive abnormalities

ObjectiveThis work aimed to investigate the potential correlation between chromosomal polymorphisms and various reproductive abnormalities.MethodsWe examined 21,916 patients affected by infertility who sought care at the Department of Reproductive Medicine, Affiliated Hospital of Shandong Second Medical University between January 2018 and December 2022. A total of 2227 individuals identified as chromosomal polymorphism carriers constituted the polymorphism group, and 2245 individuals with normal chromosome karyotypes were randomly selected to form a control group. Clinical manifestations, histories of spontaneous miscarriage, abnormal reproductive developments, fetal abnormalities, and male sperm quality anomalies were statistically compared between these two groups.ResultsOf the 21,916 patients analyzed, 2227 displayed chromosomal polymorphism, representing a 10.16% detection rate. Amongst the male patients, 1622 out of 10,827 exhibited polymorphisms (14.98%), whereas 605 out of 11,089 females showed polymorphisms (5.46%). Female carriers in the polymorphism group, showed statistically significant increased rates of spontaneous abortion (29.75% vs. 18.54%), fetal anomalies (1.32% vs. 0.81%), and uterine abnormalities compared with the control group (1.32% vs. 0.81%). Male carriers in the polymorphism group had higher rates of spontaneous abortion in partners (22.87% vs. 10.37%), fetal anomalies (1.97% vs. 0.25%), compromised sperm quality (41.74% vs. 7.18%), testicular underdevelopment (2.28% vs. 0.92%), and hypogonadotropic hypogonadism (0.62% vs. 0.37%) compared with the control group.ConclusionChromosomal polymorphisms may have a certain negative effect on reproductive irregularities, including spontaneous abortions, fetal anomalies, and reduced sperm quality in males. Their clinical effects deserve further investigation.

Global research trends on the links between gut microbiota and radiotherapy: a bibliometric analysis (2004-2023).

There is a crosstalk between gut microbiota and radiotherapy. The aim of this study is to use bibliometric analysis to explore the research status and development trends of research on gut microbiota and radiotherapy. A literature search regarding publications on gut microbiota and radiotherapy from 2004 to 2023 was retrieved. CiteSpace and VOSviewer were used to conduct the bibliometric analysis. The growth rate of publications, leading countries and institutions, preferred journals, top authors and co-cited authors, top co-cited references, keywords and citation were analyzed in this study. A total of 2821 papers were extracted. The number of papers has increased rapidly over the past decade, especially after 2017. The USA and China had the most publications and made great contributions to this field. The Chinese Academy of Sciences stood out as the institution with the highest number of publications, followed by the Chinese Academy of Medical Sciences & Peking Union Medical College. The most influential authors were Fan Saijun and Li Yuan. PLoS One had the most publications and the most total citations. Highly cited papers and high-frequency keywords illustrated the current status and trends. Furthermore, analysis of keyword with burst revealed that immunotherapy, acid, intestinal barrier, therapy, immunotherapy, fecal microbiota transplantation, etc, are at the forefront of research in this area. This study provides an overview of research on gut microbiota and radiotherapy, highlighting influential contributors, impactful publications, and emerging trends. Our finding suggests avenues for further exploration to improve clinical outcomes.

Evaluation of prognostic risk factors of triple-negative breast cancer with 18F-FDG PET/CT parameters, clinical pathological features and biochemical indicators.

Breast cancer is a heterogeneous disease comprising various molecular subtypes, including Luminal A, Luminal B, human epidermal growth factor receptor-2 (HER2) positive, and triple negative types, each with distinct biological characteristics and behaviors. Triple negative breast cancer (TNBC) remains a particularly challenging subtype worldwide. Our study aims to evaluate whether Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) parameters, clinical pathological features, and biochemical indicators serve as prognostic risk factors for TNBC. Additionally, we explore correlations between biochemical indicators and 18F-FDG PET/CT parameters. We conducted a retrospective analysis of 95 TNBC patients who underwent preoperative 18F-FDG PET/CT examinations at Tianjin Medical University Cancer Institute and Hospital from 2013 to 2018. Collected data included 18F-FDG PET/CT parameters, clinical and pathological features, and biochemical indicators. We used Kaplan-Meier survival analysis and multivariate Cox regression analysis to evaluate associations between 18F-FDG PET/CT parameters/biochemical indicators and disease free survival (DFS)/overall survival (OS). The log-rank test determined significant differences in survival curves, and the Spearman correlation coefficient analyzed correlations between quantitative variables. Visualization and analysis were performed using R packages. Among 95 TNBC patients, mean standardized uptake value (SUVmean) was significantly correlated with DFS. Fasting blood glucose (FBG), α- L-fucosylase (AFU) and Creatine kinase (CK) were independent predictors of DFS, while Precursor albumin (PALB) and CK were independent predictors of OS. FBG showed correlations with SUVpeak and SUVmean, and CK was correlated with peak standardized uptake value (SUVpeak). Our results indicated that 18F-FDG PET/CT parameters and biochemical indicators may constitute a new prognostic model for TNBC patients post-surgery. We found that SUVmean, FBG, AFU and CK are predictive factors for DFS in TNBC patients post-surgery, while PALB and CK are predictive factors for OS, which prompts us to pay more attention to these indicators in clinical practice. Also 18F-FDG PET/CT parameters and biochemical indicators have potential utility in constituting a new prognostic model for TNBC patients post-surgery.

Correlation of hysteroscopic findings of chronic endometritis with CD138 immunohistochemistry and their correlation with pregnancy outcomes.

To investigate the correlation between hysteroscopic findings of chronic endometritis and CD138 immunohistochemistry positive in endometritis and to analyze the pregnancy outcomes and associated risk factors following embryo transfer in women diagnosed with chronic endometritis via hysteroscopy. A retrospective observational study carried out at the Reproductive Medicine Center of Tangdu Hospital of Air Force Medical University, from January 2021 to December 2021, was performed by obtaining data from 194 medical records of women who underwent hysteroscopies for infertility and were diagnosed with chronic endometritis based on Delphi criteria. Spearman correlation analysis was used to evaluate the correlation between hysteroscopic findings and endometrial CD138 immunohistochemistry. The study also observed the differences in relevant indexes between the CD138-positive and CD138-negative groups after embryo transfer and analyzed factors influencing implantation failure using logistic regression analysis. The correlation analysis between hysteroscopic findings and CD138 immunohistochemistry showed that micropolyps were correlated with CD138 immunohistochemistry positivity. The correlation coefficient was 0.32 (P < 0.01). After embryo transfer, the clinical pregnancy rate of the CD138-positive group was lower compared to that of the CD138-negative group [64.79% (46/71) vs. 81.30% (100/123), P < 0.05]. The results of the multivariate logistic regression analysis revealed that age (P = 0.43) and CD138 immunohistochemistry positivity (P = 0.008) were the independent risk factors for predicting whether or not embryo implantation was successful. Hysteroscopic findings do not correlate strongly with endometrial CD138 immunohistochemistry, and chronic endometritis cannot be diagnosed by hysteroscopy alone. CD138 immunohistochemistry positivity is an independent factor contributing to the decrease in clinical pregnancy rate following embryo transfer.

The use of air abrasion method to treat caries in autistic patients at the age of 6 years: A non-randomized controlled trial.

Autism Spectrum Disorders (ASD) encompass a range of conditions characterized by difficulties in social interaction and communication. Managing dental treatment for children with autism presents challenges due to their reluctance to interact with dentists, which can be as high as 65%. This prospective non-randomized study, conducted at the Kazakh-Russian Medical University from January 15, 2023, to June 20, 2023, aimed to assess the efficacy of air abrasion caries treatment (AAbCT) compared to the standard method. The intervention involved applying air abrasion (AAb) treatment without anesthesia using aluminum oxide powder in the AAbCT group, while the control group received cavity preparation with local anesthesia. In this study, it was noted that the AAb method of tooth preparation was not different in efficacy from the traditional method for a population of children with autism, and could be used without anesthesia. A greater willingness to cooperate was noted (p=.0372). The AAb is an effective and safe treatment for children with ASD. Further studies needed to investigate its efficacy and safety in combination with behavioral interventions.

Expanding clinical characteristics and genotypic profiling of Yao syndrome in Chinese patients.

Yao syndrome (YAOS, OMIM# 617321) is a kind of systemic autoinflammatory diseases (SAIDs) linked to the nucleotide-binding oligomerization domain containing 2 (NOD2). Clinical reports of YAOS in China are sparse. Herein, we reported the largest YAOS cohort of Chinese patients to expand the understanding of its phenotype, genotype, and therapeutic responses. This study enrolled 15 adult patients diagnosed with YAOS at Peking Union Medical College Hospital from April 2015 to May 2024. Whole-exome sequencing was performed on all patients. Clinical data, genetic variations, and treatment responses were documented and compared with a Caucasian cohort. The mean age of disease onset was 35 ± 17 years old. The most common clinical manifestations included recurrent high-grade fever (100%), gastrointestinal symptoms (73.3%), arthralgia/arthritis, fatigue, myalgia, and lower extremity swelling (46.7%). All patients exhibited elevated acute-phase reactants during episodes. 12 heterozygous NOD2 variants were identified, with Q902K in 4 patients, R471C in 3, and variants c.-14C>T, A110T, S127L, R311W, A432V, Y514H, R541P, A661P, K818Q, A886V each found in individual patients. 90% of the patients responded well to glucocorticoids, and 55.6% to sulfasalazine. 66.7% of patients who received TNF inhibitors achieved complete resolution of symptoms. Additionally, one patient each responded favorably to canakinumab and tocilizumab. Compared to the Caucasian cohort, our cohort exhibited a more balanced gender ratio and a higher proportion of recurrent fever, proteinuria/hematuria as well as more frequent leukocytosis, elevated acute phase reactants, and anemia. Lower proportions of arthralgia/arthritis, skin rashes, headaches, and sicca-like symptoms were noted in our cohort. Moreover, a higher proportion of patients in our cohort showed a good response to TNF inhibitors. Chinese patients with YAOS had more pronounced inflammatory manifestations compared to the Caucasian cohort. Variants c.-14C>T, A110T, S127L, A661P, K818Q, A886V, R471C, and A432V were identified as novel NOD2 variants in YAOS. TNF, IL-6, and IL-1 inhibitors are the promising treatment options. These findings expand the clinical spectrum, genetic profile, and treatment efficacy of YAOS, underscoring the need for heightened awareness of this disease in diverse populations.

Evaluation of peripheral blood inflammation indexes as prognostic markers for colorectal cancer metastasis

The aim of this study was to evaluate the prognostic value of peripheral blood inflammation indexes in patients with metastatic Colorectal Cancer (CRC) and to establish a predictive scoring system. A total of 324 CRC patients diagnosed through pathological examination from January 2017 to July 2022 at the Third Affiliated Hospital of Kunming Medical University were included. The prognosis of patients with metastatic CRC was examined, and the correlation between IL-10 expression in pathological tissues and IL-10 expression in serum was analyzed. The results showed that the prognosis of CRC was poorer when metastasis occurred (P < 0.001). Additionally, IL-10 was highly expressed in the metastatic CRC group (P = 0.018), and the expression of IL-10 in pathological tissues of patients with metastatic CRC was positively correlated with the expression of IL-10 in serum (P = 0.037). The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-white blood cell ratio (LWR), aggregate index of systemic inflammation (AISI), monocyte-to-lymphocyte ratio (MLR), systemic inflammatory response index (SIRI), prognostic nutritional index (PNI), advanced lung cancer inflammation index (ALI), and interleukin-10 (IL-10) were calculated and determined by ROC curve. The critical values were 2.135, 3.735, 353.745, 0.265, 1.025, 52.975, 353.635, and 11.25, respectively. Inflammatory indexes with an AUC of more than 0.6 were selected, and each colorectal cancer patient with any of these risk factors was assigned a score of one. The 324 patients were then divided into two groups: 0–4 for the low-risk group and 4–8 for the high-risk group. The occurrence of distant metastases in the two groups was statistically analyzed. The results showed that the OS and PFS of the low-risk group were significantly superior to those of the high-risk group (P < 0.05). These findings indicate that NLR, LWR, AISI, MLR, SIRI, PNI, ALI, and IL-10 are risk factors for distant metastasis in CRC patients. Therefore, the prediction scores of these indexes can be used to effectively evaluate the prognosis of patients with metastatic CRC.

Збудники інфекційних хвороб людини і тварин та їх розповсюдження в Європі іксодовим кліщем Dermacentor reticulatus

Due to climate change, the possibility of human infective diseases caused by pathogens from the genera Borelia, Anaplasma, Rickettsia, Babesia, Bartonella, Coxiella, etc. is increasing in Europe. Generally, these pathogens are directly related to arthropod vectors, in particular, to Ixodes ticks. The aim of the study was to determine the current trends in the spread of tick-borne infections transmitted by Dermacentor reticulatus ticks in some European countries, including Ukraine, based on the analysis of literature. Over the past 10 years, in the vast majority of countries, including Europe, the situation with the defeat of farm and wild animals, as well as humans, by pathogens of severe infectious diseases from the genera Borrelia, Anaplasma, Rickettsia, Babesia, Theileria, Coxiella, Bartonella, Francisella, etc. has been aggravated. Representatives of these genera lead to severe diseases, such as tick-borne borreliosis, which are accompanied by damage to the central nervous system, joints, skin, and cardiovascular system. Members of the Rickettsiales genus cause a variety of feverish conditions in animals and humans. Species of the genus Babesia cause babesiosis, a disease caused by damage to red blood cells and the appearance of anti-erythrocyte antibodies, and representatives of the genus Toxoplasma cause toxoplasmosis, accompanied by damage to the nervous, lymphatic, and cardiovascular systems. Q fever is caused by species of the genus Coxiella. Severe human diseases are caused by tick-borne encephalitis viruses. Various PCR test systems have been developed and used to detect these pathogens. For example, in Poland, PCR for Borrelia burgdorferi s.l. was performed using the B. burgdorferi s.l. PCR kit (GeneProof, Czech Republic) for in vitro diagnosis. Anaplasma PCR kits (Blirt-DNA Gdańsk, Poland) were used to detect Anaplasma phagocytophilum DNA. For the detection of Babesia spp., a fragment of the 18S rDNA gene encoding a small ribosomal subunit localized in the conserved region V4 was used. To detect Bartonella spp., the tests Hum PCR Bartonella, Hum PCR Coxiella burnetii, and Vet PCR Rickettsia kit (BioIngenTech, Chile), Coxiella burnetii and Rickettsia spp. were used. In the Laboratory for the Study of Ticks and Tick-Borne Infections of Ternopil National Medical University (Ukraine), pathogens were identified using several test systems, namely DNA A. phagocytophilum, / DNA E. muris, / DNA E. chaffeensis, DNA B. burgdorferi s.l., DNA B. myamotoi; DNA Babesia sp., and RNA Ticks borne of encephalitis viruses (MolGen, Italy), which allow real-time determination on anamplifier "ROTOR Gene 6000" by Corbett Research. Studies in many European countries have shown infection of the Dermacentor reticulatus tick with the pathogens B. burgdorferi s.l. in the range from 1.6 to 49.8 %; A. phagocytophilum – 0.1–2.2 %; Babesia sрp. – 9.8–43.8 %; Coxiella spр. – 0.1–0.2%; Francisella spp. – 0.7–95%; Toxoplasma spр. – 3.2–16.7 %; and ticks borne of encephalitis viruses 8.5–16.6 %. Some Ukrainian scientists presented data on D. reticulatus infection, in particular B. burgdorferi s. l. – 10.1–22.1 %; A. phagocytophilum – 3–25.36 %; Babesia spр. – 1–41.2 %; Rickettsia sp. – 28 %; Bartonella spp. – 5 %; Coxiella spр. – 5.1 %, and tick-borne f encephalitis viruses – 11.9–71 %. The spread of many infectious agents is largely correlated with the spread of their vectors, including ticks of the D. reticulatus species. According to many scientists, this species is widespread in Europe, in particular, two metapopulations are currently distinguished as the western one, which includes the territories of France, Belgium, Slovakia, the Czech Republic, the Netherlands, and Germany, and the eastern one, which covers Lithuania, Latvia, Belarus, eastern and central Poland, and west of the Vistula River up to the Ural Mountains. In the Czech Republic, this species is found in all regions, more often in the southeastern and northwestern regions. In the UK, ticks have been found in West Wales, Devon, and Essex. In Romania, D. reticulatus was found in 17 counties, and in Moldova – in the Lower Dniester region. In Ukraine, this species is widespread from the Carpathians and Prykarpattia, Polissya, and Forest-Steppe, to the southeastern regions and Crimea.

Virtual Education in Military Medical University: A Descriptive Study

Background: Evaluating the strengths and weaknesses of virtual education is essential today. Objectives: This study examines the satisfaction of professors and students with the learning management system and the quality of virtual education in a military university. Methods: This descriptive-correlational study was conducted between 2021 and 2022. The sample included 44 professors and 167 students from the Faculty of Nursing, Medicine, and Pharmacy at a university. Data were collected using a demographic form and three standardized questionnaires that assessed satisfaction with the quality of virtual education, system interface, evaluation of professors' performance, and professors' opinions about virtual teaching. The data were analyzed using SPSS software version 22, employing correlation tests, one-way analysis of variance, independent t-tests, and multivariate analysis. Results: The students' average age was 21.23 ± 2.78 years, and 81.8% of them were male. The overall satisfaction of students with the learning management system (LMS) had an average score of 497.21 ± 109.68. The professors' performance, as perceived by the students, had an average score of 43.18 ± 9.98. The quality of online education was rated at 58.81 ± 12.51, with 68% of students reporting a moderate level of satisfaction. Among the professors, 29.5% expressed dissatisfaction with the LMS system interface, while 81.8% were moderately satisfied with the virtual education approach. Conclusions: Given the significance of virtual education, it is imperative to devise solutions that enhance professor satisfaction, improve content quality, and optimize performance. These measures will contribute to the overall success and effectiveness of virtual education, benefiting both professors and students alike.

Surgical Site Infections: Prospective Study in a Medical College Teaching Hospital at Port Blair, India

Abstract Objectives: Surgical site infections (SSIs) continue to be a prevalent and pervasive issue, contributing to healthcare expenditures, extended hospital stays, and significantly increased morbidity and death. The purpose of the current study was to evaluate the risk factors and prevalence of SSIs amongst patients undergoing various surgical procedures at a tertiary care facility in Port Blair, India. Materials and Methods: This prospective study was conducted at a tertiary medical college hospital setting in Port Blair, India, within the Department of Microbiology. The study was conducted from January 2018 to June 2018. Results: During the study period, 776 individuals underwent various surgeries, including both elective and emergency procedures. The total prevalence of the SSI rate during the study period was 12.88% (n = 776) based on the documentation of approximately 100 SSIs. Amongst these, 44% were associated with obstetrics and gynaecology surgery. The category of post-lower segment caesarean section (LSCS) stitch line had the greatest prevalence rate of SSIs (34 patients out of 175 developed infections; LSCS approximately 19.42% of these patients developed SSIs). Conclusions: In Indian adult patients undergoing any form of surgical procedure, the SSI prevalence was 12.88%. SSIs occurred more frequently after obstetrics and gynaecology operations. Following any type of surgery, patients who are women, younger, had emergency surgery, have diabetes, and require a lengthy hospital stay are more likely to experience SSIs. The most commonly encountered pathogens were Staphylococcus aureus and coagulase negative Staphylococcus.

Association of FGF23 Levels and Development of Anemia in Patients with Non Dialysis Chronic Kidney Disease

Background: Anemia is one of the common complication of Chronic Kidney Disease that intensifies in grade and severity as eGFR decline which also increases the risks for cardiovascular mortality. The development of anemia and elevated fibroblast growth factor 23 levels are the earliest changes observed in chronic kidney disease. Objective: This study aims to understand the association of FGF23 levels development of anemia in chronic kidney disease patients prior to renal replacement therapy. Methods: This is an analytical type of cross sectional study carried out among 95 respondent'1ged between 18 and 75 years with CKD stage 1-5 before dialysis, divided into two groups- Group I­ comprised of 68 patients and Group 11- included 27 age and sex matched respondents not having CKD, enrolled from two te1tiary-care hospitals, namely- Sir Salimullah Medical College &amp; Mitford Hospital and National Institute of Kidney Diseases &amp; Urology (NIKDU). Socio-demographic status, disease profile and laboratory findings including serum iron, iron binding capacity, ferritin, transferrin saturation, calcium, phosphorus, intact parathormone, vitamin D, eGFR and FGF-23 levels were studied. Result: Mean age of the respondents was 50.1±10.74 (SD) years, mean estimated glomerular filtration rate was 35.92± 22.61 in group I and 91.66± 14.2 in group II. The mean FGF23 level in group I and II were 85.76± 207.54, 21.99± 12.12 pg/mL respectively, serum iron level was 81.61± 39.24 mcg/dL and 95.0± 32.38 mcg/dL in group I and II respectively, serum ferritin level was 225.59± 2 I 2.5 ng/mL and 157.85± 220.89 ng/ml. TIBC was 312.65± 95.83 mcg/dL and 418.85± 118.25 mcg/dL in group I and II respectively. In Group I and II, iron deficiency was found in 23% and 25%respectively when stratified according to serum ferritin level and 26.5% and 22.22% respectively, when stratified according to serum transferrin saturation level. This difference was significant among the group. Serum iron, ferritin, TIBC and TSAT were significantly associated with serum FGF23 levels. Conclusion: Disrupted iron metabolism and high FGF23 levels is commonly found in chronic kidney disease. Clinical laboratory findings have revealed the relation between FGF23 and anemia in no dialysis chronic kidney disease patients.

GnRH-a-based fertility-sparing treatment of atypical endometrial hyperplasia (AEH) and early endometrial carcinoma (EC) patients: a multicenter, open-label, randomized designed clinical trial protocol

BackgroundAround 4% of women receive an endometrial cancer diagnosis before turning 40, mainly those without prior childbirth experience and a strong desire to preserve their ability to conceive. Consequently, for young patients diagnosed with atypical endometrial hyperplasia (AEH) or early endometrial carcinoma (EC), a fertility-preserving approach employing high-dose oral progesterone has been adopted. However, previous research has shown a notable relapse rate. Furthermore, the extended use of substantial oral progesterone doses may hinder ovarian function and raise the risk of weight gain, liver issues, blood clotting, and breast cancer. We previously assessed the clinical effectiveness and pregnancy outcomes of gonadotropin-releasing hormone agonist (GnRH-a) based re-treatment for women with EC and AEH who did not respond to oral progestin therapy but achieved favorable treatment results and reproductive outcomes.MethodsThis study will be an open-label, two-armed, randomized, investigator-initiated multicenter trial evaluating the combination of GnRH-a with the levonorgestrel-releasing intrauterine system or the combination of GnRH-a with an aromatase inhibitor (comprising a subcutaneous GnRH-a injection every 4 weeks and daily oral letrozole 2.5 mg). A total of 226 participants will be randomly allocated to one of the two treatment groups in a 1:1 ratio. The primary objective is to determine the effectiveness of GnRH-a-based re-treatment in achieving a complete response (CR) at 24 weeks for patients with AEH or EC. Secondary objectives include assessing the pregnancy rate 12 weeks after treatment, as well as post-treatment pregnancy outcomes and the rate of recurrence.Ethics and disseminationThe protocol received approval from the Institutional Review Board of Peking Union Medical College Hospital and from boards at five other institutions. The trial will adhere to the principles outlined in the World Medical Association’s Declaration of Helsinki and follow Good Clinical Practice standards. The trial results will be disseminated through publication in a peer-reviewed journal.ConclusionsProspective evidence supporting conservative treatment for EC and AEH is limited. There is a need for new approaches that can achieve higher CR rates with fewer side effects. This trial will assess the effectiveness of GnRH-a-based fertility-sparing treatment in obese women and recurrent patients, offering a promising alternative for patients with EC and AEH.Trial registration numberChinese Clinical Trial Registry ChiCTR2200067099. Registered on December 27, 2022.

Successful Management of Waja’al-Rukba (Knee Osteoarthritis) with Unani Pharmacopeial Poultice: A Case Study

Knee osteoarthritis (Knee OA) is the most common Musculoskeletal disorder, which causes functional disability thus, increasing the economic burden in society. In Unani medicine knee Osteoarthritis is treated with various regimens and drugs. Among these regimens, Dimād (Poultice) is prepared with several single Unani pharmacopeial drugs that exert anti-inflammatory, analgesic and anti-arthritic actions. Keeping this in mind a case study was conducted to assess the efficacy of Dimād-i-jalinus a pharmacopeial Unani formulation in the management of Knee OA. A 63-year-old female patient with chief complaints of pain and swelling in the left knee joint, joint stiffness and mild tenderness feeling severe pain while performing daily activity for the last 6 months was treated at OPD of Hakim Syed Ziaul Hasan Govt. (Auto) Unani Medical College &amp; Hospital, Bhopal. Dimād-i-jalinus was given to the patient, in paste form and the patient was explained to use this paste over the anterior surface of the Left knee joint and the bandage was wrapped to keep the medicines in place overnight every day for 14 days. The patient was assessed at baseline, 7th day and 14th day based on changes in subjective and objective parameters with the help of Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). The present study reveals that Dimād-i-jalinus is safe and effective in treating Knee OA without any side effects. Therefore, further randomized clinical studies need to be carried out to validate the effectiveness of Dimād-i-jalinus in the management of Knee OA.

The role of students’ extracurricular independent work in the formation of general and professional competences in graduates of medical college

The article considers the forms and possibilities of extracurricular independent work, which is an important component of the modern pedagogical process and allows to mobilise students for creative activity. In modern conditions of medical education, the role of independent work of students, including extracurricular, which contributes to improving the quality of education, the formation of students’ desire for continuous self-education, the ability to independently acquire new knowledge and use them in their professional activities, is increasing. The task of teachers of professional modules is not only to teach students a profession, but also to teach students to acquire knowledge, process it and apply it in various activities. Gradually the skill to choose information of professional nature in the general information flow is formed. Independent work is one of the key factors that allows to transfer a student from a passive consumer of knowledge to an active participant. The main reasons for the increasing role of independent work in mastering educational programmes of medical profile are reflected in the general and professional competencies of a specialist’s ability to organise his/her own activities, to make decisions in standard and non-standard situations, to search for and use information, as well as to independently determine the tasks of professional and personal development. To develop students’ learning and cognitive activity we use various forms of extracurricular work. The main figure in the organisation of independent work is the teacher, who directly manages the independent work of students in his discipline both individually and in a group. The main tasks of the teacher in the management of independent work of students are: to assist students in organising independent work; to implement a differentiated approach to the organisation of independent work; to stimulate students’ interest in the in-depth study of the discipline; determine the scope of tasks for independent work in accordance with the programme; create methodological support for the discipline: teaching and methodical complex (TMC), control tasks (tests, problem tasks), topics of essays, term papers, etc.; to control independent work, evaluate and encourage students’ creative activity. Thus, independent work is an autonomous activity of students, characterized by their independence and cognitive interest, which can be considered as a teacher-controlled independent cognitive activity of students.

Comparative Study on Symptomatic Response and Toxicity of Concurrent Chemo-Radiotherapy and Radiotherapy Alone in the Treatment of Cervical Cancer

This prospective observational study was carried out to compare the symptomatic response and acceptable toxicity in concurrent chemo-radiotherapy and radiotherapy alone in the treatment of cervical cancer. A total of 60 patients (30 patients in arm A &amp; 30 patients in arm B) who have biopsy proven cervical carcinoma with no history of previous treatment were selected from the Department of radiotherapy Rajshahi Medical College Hospital, Rajshahi &amp; in the department of Radiation &amp; Oncology, National Institute of Cancer Research &amp; Hospital. All patients in both arms received external beam radiation with 50Gy in 25 daily fractions over five weeks. Followed by three insertions (one insertion per week) of Intracavitary brachytherapy each 700 cGy. Patients in arm-A received Inj. Cisplatin 40mg/m2 in IV infusion on the first day of each treatment per week in addition to radiotherapy. In this study it was observed that a significant symptomatic improvement was found in arm-A after treatment than arm-B and no severe unwanted reaction was noted in most of the patients. Systematic toxicity developed in both groups and comparatively more in arm-A (chemo radiation) but that was not statistically significant and well managed with conservative treatment. Regarding performance status patients treated with concurrent chemo radiation showed better performance status than the patient treated with radiotherapy alone. In this study it was observed that patients of carcinoma cervix treated with concurrent chemo radiotherapy was effective for symptomatic improvement and feasible with acceptable toxicity for advanced cancer of the uterine cervix than those with radiation alone.

Individualized prediction of non-sentinel lymph node metastasis in Chinese breast cancer patients with ≥ 3 positive sentinel lymph nodes based on machine-learning algorithms

BackgroundAxillary lymph node dissection (ALND) is a standard procedure for early-stage breast cancer (BC) patients with three or more positive sentinel lymph nodes (SLNs). However, ALND can lead to significant postoperative complications without always providing additional clinical benefits. This study aims to develop machine-learning (ML) models to predict non-sentinel lymph node (non-SLN) metastasis in Chinese BC patients with three or more positive SLNs, potentially allowing the omission of ALND.MethodsData from 2217 BC patients who underwent SLN biopsy at Shantou University Medical College were analyzed, with 634 having positive SLNs. Patients were categorized into those with ≤ 2 positive SLNs and those with ≥ 3 positive SLNs. We applied nine ML algorithms to predict non-SLN metastasis. Model performance was evaluated using ROC curves, precision-recall curves, and calibration curves. Decision Curve Analysis (DCA) assessed the clinical utility of the models.ResultsThe RF model showed superior predictive performance, achieving an AUC of 0.987 in the training set and 0.828 in the validation set. Key predictive features included size of positive SLNs, tumor size, number of SLNs, and ER status. In external validation, the RF model achieved an AUC of 0.870, demonstrating robust predictive capabilities.ConclusionThe developed RF model accurately predicts non-SLN metastasis in BC patients with ≥ 3 positive SLNs, suggesting that ALND might be avoided in selected patients by applying additional axillary radiotherapy. This approach could reduce the incidence of postoperative complications and improve patient quality of life. Further validation in prospective clinical trials is warranted.

Knowledge and Awareness About Breastfeeding Among Postnatal Mothers in a Private Medical College

Background: Breastfeeding is essential in any infant’s nutrition and growth. There are various misconceptions and cultural beliefs regarding breastfeeding which can hinder breastfeeding and its continuation by the mothers. Objective: To describe the current level of knowledge and awareness about breastfeeding among postnatal mothers in private medical college. Methods: A Clinic based cross-sectional review was completed in the post-pregnancy ward of Obstetric division of the Saveetha clinical school and medical clinic between June 2021 toAugust 2021. Information were gathered through interview utilizing a semi-organized poll. Datawere went into Microsoft succeed and engaging examination was finished. Results: A very small percentage of postpartum mothers are aware of the significance of avoiding prelacteal feeding, early breastfeeding, exclusive breastfeeding, burping, and breastfeeding on demand. However, more than half of postpartum mothers are aware of the health benefits of breastfeeding, the benefits of colostrum, and the bonding benefits of breastfeeding. Additionally, they are informed about whether mothers with HIV or tuberculosis can breastfeed.

A log odds of positive lymph nodes-based predictive model effectively forecasts prognosis and guides postoperative adjuvant chemotherapy duration in stage III colon cancer: a multi-center retrospective cohort study

BackgroundThe log odds of positive lymph nodes (LODDS) was considered a superior staging system to N stage in colon cancer, yet its value in determining the optimal duration of adjuvant chemotherapy for stage III colon cancer patients has not been evaluated. This study aims to assess the prognostic value of a model that combines LODDS with clinicopathological information for stage III colon cancer patients and aims to stratify these patients using the model, identifying individuals who could benefit from varying durations of adjuvant chemotherapy.MethodA total of 663 consecutive patients diagnosed with stage III colon cancer, who underwent colon tumor resection between November 2007 and June 2020 at Sun Yat-sen University Cancer Center and Longyan First Affiliated Hospital of Fujian Medical University, were enrolled in this study. Survival outcomes were analyzed using Kaplan–Meier, Cox regression. Nomograms were developed to forecast patient DFS, with the Area Under the Curve (AUC) values of time-dependent Receiver Operating Characteristic (timeROC) and calibration plots utilized to assess the accuracy and reliability of the nomograms.ResultsMultivariate analysis revealed that perineural invasion (HR = 1.776, 95% CI: 1.052–3.003, P = 0.032), poor tumor differentiation (HR = 1.638, 95% CI: 1.084–2.475, P = 0.019), and LODDS groupings of 2 and 1 (HR = 1.920, 95% CI: 1.297–2.842, P = 0.001) were independent predictors of disease-free survival (DFS) in the training cohort. Nomograms constructed from LODDS, perineural invasion, and poor tumor differentiation demonstrated robust predictive performance for 3-year and 5-year DFS in both training (3-year AUC = 0.706, 5-year AUC = 0.678) and validation cohorts (3-year AUC = 0.744, 5-year AUC = 0.762). Stratification according to this model showed that patients in the high-risk group derived significant benefit from completing 8 cycles of chemotherapy (training cohort, 82.97% vs 67.17%, P = 0.013; validation cohort, 89.49% vs 63.97%, P = 0.030).ConclusionThe prognostic model, integrating LODDS, pathological differentiation, and neural invasion, demonstrates strong predictive accuracy for stage III colon cancer prognosis. Moreover, stratification via this model offers valuable insights into optimal durations of postoperative adjuvant chemotherapy.