Clinical Examination Methods Research Articles

Priority areas for the formation of specialized care for children with congenital cleft of the maxillofacial region, complicated by anomalies of other organs and systems

Topicality. The specialized literature does not sufficiently present the systematization of concomitant malformations additional to congenital cleft of the maxillofacial region, the frequency of their occurrence and the species correlativity of relationships. There is no program for concretizing the interaction of specialists in different fields that ensure the unity of the processes of diagnosis and rehabilitation of patients with complex disorders of embryogenesis. Purpose. To present the main directions of specialized care for children with congenital cleft of the maxillofacial region in combination with malformations of other organs and systems. Materials and methods. A group of patients (823 people) who received treatment at the Center «Bonum» (Yekaterinburg) for a period of 25 years (1998–2022) with cleft maxillofacial region and concomitant malformations was studied. In the course of the study, the data of malformations were systematized, and correlations between congenital concomitant defects were identified. Clinical and special methods of patient examination were used in the study. Results. An innovative methodology for systematic monitoring and treatment of patients with maxillofacial cleft in combination with concomitant malformations has been developed based on a staged algorithm of therapeutic and corrective interactions of rehabilitation specialists of various profiles. The optimal tactics of the interacting advantages of the treatment process of concomitant congenital malformations are presented, taking into account the sequence of rehabilitation measures, the volume and duration of surgical elimination of the cleft against the background of concomitantanomalies. Conclusions. The proposed methodological algorithm for the dynamic observation of 823 patients with cleft of the maxillofacial region, complicated by malformations of other organs and systems, has absorbed the fundamental directions of therapeutic and corrective interactions of specialists in various fields, concentrating knowledge and experience on this issue for a period of 25 years (1998–2022) and made it possible to minimize postoperative complications (the indicator of residual deformities of the upper lip and nose after the primary cheilorhinoplasty amounted to 16,16 %, and after velourinoplasty – 2,46 %), to successfully complete (in 73,63 % of cases) the main stages of surgical treatment of the maxillofacial region, as well as the main processes of restoring the health of this group of patients in accordance with the age periods of rehabilitation.

Diagnosis and Treatment of Vertebrobasilar Insufficiency and Pain Syndrome in Patients with Kimmerle anomaly

Patients with vertebrobasilar insufficiency and pain syndrome, which are quite common in the practice of a neurologist and neurosurgeon, require a comprehensive examination to clarify the etiological factor of the development of vertebrobasilar insufficiency and differential diagnosis. One of the reasons for it is Kimmerle's anomaly—this is a variant of the development of the C1 vertebra, which has an additional bone arch growing from the posterolateral part of the lateral mass of the Atlas above the furrow of the vertebral artery to the posterior arch, as well as ossification of part of the Atlanto-occipital ligament. In addition to the clinical and neurological examination method, the diagnostic complex includes spondylography, computed tomography, and magnetic resonance imaging of the cervical spine, ultrasound Dopplerography, and direct angiography. The dependence of the frequency of neurological syndromes and their severity on the severity of the anomaly and the age of patients has been established. An algorithm for the complex diagnosis and treatment of this pathology has been developed.

ОСТРЫЙ ГЕНЕРАЛИЗОВАННЫЙ ЭКЗАНТЕМАТОЗНЫЙ ПУСТУЛЕЗ: КРАТКИЙ ОБЗОР ЛИТЕРАТУРЫ И СОБСТВЕННОЕ НАБЛЮДЕНИЕ

Abstract. Introduction. Acute generalized exanthematous pustulosis is a rare cutaneous adverse drug reaction. The disease has a complex development mechanism, involving various subpopulations of T cells and monocytes, characterized by a genetically determined imbalance in IL-36 signaling. This reaction has an acute onset, a variety of clinical manifestations, and a self-limited course after drug discontinuation. Aim: Exemplifying by our own clinical observation, to present an algorithm for diagnosing and managing acute generalized exanthematous pustulosis. Material and Methods. Patient Kh., 55 years old, was hospitalized in the vascular neurology department due to ischemic stroke in the posterior circulation system, in the form of vestibulopathy, and left hemiataxia, unspecified pathogenetic subtype. Abundant itchy pustules appeared on the skin of the trunk, upper and lower extremities, weakness, lethargy, and body temperature increase up to 38–38.5ºС on the 4th day of treatment. General clinical, laboratory, and instrumental examination methods were used. Results and Discussion. Examination revealed extensive foci of edematous erythema, multiple non-follicular small pustules, an increase in the absolute number of neutrophils to 18,500 cells/μl and eosinophils to 1,250 cells/μl in the general blood test, a moderate increase in the levels of liver transaminases in the biochemical analysis, and a slight pleural effusion on the right in ultrasound. The use of the EuroSCAR scale, based on the assessment of clinical symptoms, morphology of skin lesions, and histological picture of the disease, helped set a correct diagnosis and choose a patient management approach. The patient received treatment with systemic and local glucocorticosteroids, manifesting with good positive changes. Conclusions. Using the EuroSCAR scale developed by a team of international experts helps set the diagnosis of acute generalized exanthematous pustulosis. Immediate discontinuation of the causally significant drug is a prerequisite for successful patient management. Local therapy using disinfectant solutions, topical glucocorticosteroids, and moisturizing lotions is the initial approach to managing a patient with acute generalized exanthematous pustulosis.

Plasma Extracellular Vesicle-Associated Proteins as Promising Diagnostic Biomarkers of Age-Related Macular Degeneration.

Age-related macular degeneration (AMD) is a significant factor causing blindness in adults. However, the clinical diagnosis of AMD is relatively challenging, due to the shortcomings of the existing clinical examination methods and the latent period of retinal damage before macular degeneration becomes apparent. This study aims to explore the potential of extracellular vesicles (EVs) protein chips for early diagnosis of AMD using patients' plasma samples. To achieve early diagnosis of AMD, this study utilized a high-throughput platform for liquid biopsy based on EVs protein chips. Forty AMD patients and 41 normal individuals were recruited. Through machine learning methods, we identified that ATP-binding cassette transporter A1 (ABCA1) is an EVs protein marker for diagnosing AMD. Additionally, a validation set was constructed using the random forest method for verification. The results of the study indicated that ABCA1 is a reliable biomarker for diagnosing AMD. The validation using the random forest method confirmed the robustness and reliability of ABCA1 as a diagnostic marker. This finding suggested that ABCA1 can serve as a new promising liquid biopsy-based marker for diagnosing macular degeneration. The utilization of EVs protein chips, combined with machine learning methods, can effectively identify ABCA1 as a biomarker for the early diagnosis of AMD. This approach offers a promising new method for liquid biopsy diagnostics, potentially improving the clinical diagnosis and management of macular degeneration.

Nursing students’ experiences of professional competence evaluation by Objective Structured Clinical examination method: a qualitative content analysis study

BackgroundClinical education is a significant part of medical education, and paying attention to clinical evaluation is important. One of the challenges in the teaching-learning process is evaluating students’ performance. Learners, as the main stakeholders of the educational system, may have different experiences of evaluation quality. Awareness of these experiences is effective in improving the quality of clinical evaluation. Therefore, this study was conducted to “explore the experiences of nursing students for evaluation of professional competence by using the objective structured clinical examination (OSCE)”.MethodThis study was conducted with a qualitative descriptive research approach and conventional content analysis method in 2022–2024. The participants included 12 undergraduate nursing students at Maragheh University of Medical Sciences, who were selected by purposeful sampling, and their experiences were collected using semi-structured and in-depth interviews until reaching data saturation.ResultsThe data analysis of the interviews led to the extraction of 268 primary codes, 7 subcategories, 2 categories, and 1 theme: “Credibility and stability”. The category “Exam’s accuracy in measuring competence " included 3 sub-categories: “Challenges in objective adaptation “, " Communication and organizational challenges for exam preparation " and " Inadequate simulation of stations and exam environment “, and the category " Exam power for repeatability” included 4 sub-categories: " Characteristics of the students “, " Lack of evaluators’ skills and mastery “, " Inefficiency of the evaluation tool " and " Disturbance in executive affairs”.ConclusionsOSCE can be used in self-evaluation, creating motivation and strengthening different dimensions of students’ learning, as well as discovering weaknesses and strengths for planning by managers and faculties. According to the results of this study, many factors such as management before and during the exam, characteristics of the evaluators, prevailing educational conditions in the faculty, and the method of clinical training are effective in achieving the “reliability and sustainability” required in the OSCE.

Clinical experience of the carboxytherapy method in the treatment of patients with temporomandibular joint pain dysfunction syndrome (К07.60)

Objective. Improving the effectiveness of treatment of patients with TMJ PDS myogenic origin. Material and methods. According to the purpose of the study, a group of 10 patients (8 women and 2 men aged 14 to 60 years) was formed with the coincidence of a triad of signs: pain during movements of the lower jaw, a feeling of heaviness and tension in the chewing and facial muscles, restriction of mouth opening. A set of diagnostic measures has been implemented in the following scope: clinical and radiological examination methods, TMJ MRI, ultrasound and surface EMG of the chewing muscles, digital axiography. In the treatment of patients in the study group, the method of invasive carboxytherapy was used, based on dosed injections of CO2 in the projection of trigger points of the masticatory muscles. The research examines the therapeutic value of using of CO2 in the protocol of functional rehabilitation of patients with TMJ diseases of myogenic origin. Results. The analysis of the effectiveness of treatment of patients in the study group was carried out to assess the dynamics of key parameters: the severity of the pain syndrome according to VAS, the magnitude of the IMPACT index values and the magnitude of mouth opening. The severity of pain in patients in the study group, according to average values, decreased by 86% from the initial values, an increase in the amplitude of mouth opening by 28.5%, a decrease in the IMPACT index values by 42.5% from the initial values of hypertonicity of the masticatory muscles, an increase in blood flow speed of superficial temporal artery at 52.5%. Conclusion. The results of the clinical application of the carboxytherapy method in the treatment of patients with TMJ PDS allow us to recommend this method for implementation in the rehabilitation protocols of patients with TMJ PDS of myogenic origin, trismus and hypertonus of the masticatory muscles. Carboxytherapy as a method of etiopathogenetic rehabilitation contributes to the early relief of pain syndrome, normalization of the bioelectric activity of the chewing muscles and restoration the physiological kinematics of the lower jaw’s movements.

Lipoleiomyoma of the uterus in a woman of reproductive age (clinical case)

Uterine lipoleiomyoma is one of the variants of uterine leiomyoma, which is histologically represented by the presence of mature fat and smooth muscle cells. The relevance of the coverage of this clinical case is determined by the extreme rarity of the development of uterine lipoleiomyoma in women of reproductive age. The purpose of this work was to record this clinical case in the world statistics of lipoleiomyoma, to evaluate methods of diagnosis and differential diagnosis, to determine the role of early diagnosis of uterine lipoleioma in the subsequent tactics and scope of surgical treatment. Data from the medical records of a 41-year-old inpatient were analyzed. In addition to the generally accepted clinical and biochemical methods of blood and urine examination, electrocardiogram, ultrasound examination of the pelvic organs, the level of ovarian tumor markers in the blood (CA 125, HE4 and the ROMA index) was determined. The diagnosis of the disease was based on the data of pathohistological and immunohistochemical studies. Based on the results of a review of the medical literature, analysis of articles obtained as a result of a search of PubMed, SCOPUS, Web of Science, MedScape databases, the current state of the problem is highlighted, literary data related to the incidence, features of the clinical course, diagnosis and treatment of uterine lipoleiomyoma are summarized. The clinical case presented in the article demonstrates an incidental finding of a uterine lipoleiomyoma in a woman of reproductive age, measuring 30x25x20 cm, originated subserously from the body and cervix of the uterus, in the area of its isthmus. Under this condition, it occupied the entire Douglas space, the area of the sacro-uterine ligaments and the parietal peritoneum, intimately adjacent to the sigmoid and rectum, to the ureters and iliac vessels. The peculiarity of this clinical case is that sonographically uterine lipoleiomyoma was hidden under the "mask" of a dermoid cyst of the right ovary. Macroscopically, it differed from a typical lipoleiomyoma by the purple-bluish color of its outer surface and soot-colored, fine-lobed spongy structure on the section. The diagnosis of uterine lipoleiomyoma was verified only on the basis of pathohistological and immuno­histochemical research. Microscopically, the lipoleiomyoma had a mesenchymal structure with a pronounced vascular component and consisted of mitotically inactive bundles of smooth muscle cells and mature adipocytes. Im­munohistochemically, a positive reaction for caldesmon, desmin, smooth muscle actin alpha of tumor cells and for S.100 (DAKO, polyclonal) fatty cells was detected, which confirmed the hypothesis of direct transformation of smooth muscle cells existing in the leiomyoma of the uterus into fatty cells. This clinical case should complement the global statistical indicators of diagnosis of uterine lipoleiomyoma in women of reproductive age. Lipoleiomyoma should be considered as the primary diagnosis in case of detection of a large uterine tumor in women with excess body weight and be removed immediately after diagnosis, otherwise it is impossible to exclude its malignancy. For the planned diagnosis of neoplasms of the female genital organs, preference should be given to non-invasive research methods: magnetic resonance or computer tomography with contrast enhancement. The problem of these tumors lies in their unpredictable histogenesis, the unexpected presence of fat in the microscopic structure, and in the visual similarity to sarcomas. Verification of the diagnosis is carried out on the basis of pathohistological and immunohistochemical studies of the tumor preparation. Uterine lipoleioma can have a purplie-bluish color and develop by a broad base from the body and cervix of the uterus, as a result of "lipomatous" metaplasia of the uterine leiomyoma existing in a woman. Regular preventive examinations of women of all ages are crucial for timely detection of this rare neoplasm.

Clinicopathological analysis of small intestinal metastasis from extra-abdominal/extra-pelvic malignancy.

The metastatic tumors in the small intestine secondary to extra-abdominal/extra-pelvic malignancy are extremely rare. However, the small intestine metastases are extremely prone to misdiagnosis and missed diagnosis due to the lack of specific clinical manifestations and examination methods, thus delaying its treatment. Therefore, in order to improve clinical diagnosis and treatment capabilities, it is necessary to summarize its clinical pathological characteristics and prognosis. To summarize the clinicopathological characteristics of patients with small intestinal metastases from extra-abdominal/extra-pelvic malignancy, and to improve the clinical capability of diagnosis and treatment for rare metastatic tumors in the small intestine. The clinical data of patients with small intestinal metastases from extra-abdominal/extra-pelvic malignancy were retrieved and summarized, who admitted to and treated in the Air Force Medical Center, Chinese People's Liberation Army. Then descriptive statistics were performed on the general conditions, primary tumors, secondary tumors in the small intestine, diagnosis and treatment processes, and prognosis. Totally 11 patients (9 males and 2 females) were enrolled in this study, including 8 cases (72.3%) of primary lung cancer, 1 case (9.1%) of malignant lymphoma of the thyroid, 1 case (9.1%) of cutaneous malignant melanoma, and 1 case (9.1%) of testicular cancer. The median age at the diagnosis of primary tumors was 57.9 years old, the median age at the diagnosis of metastatic tumors in the small intestine was 58.81 years old, and the average duration from initial diagnosis of primary tumors to definite diagnosis of small intestinal metastases was 9 months (0-36 months). Moreover, small intestinal metastases was identified at the diagnosis of primary tumors in 4 cases. The small intestinal metastases were distributed in the jejunum and ileum, with such clinical manifestations as hematochezia (5, 45.4%) and abdominal pain, vomiting and other obstruction (4, 36.4%). In addition, 2 patients had no obvious symptoms at the diagnosis of small intestinal metastases, and 5 patients underwent radical resection of small intestinal malignancies and recovered well after surgery. A total of 3 patients did not receive subsequent treatment due to advanced conditions. Small intestinal metastases of extra-abdominal/extra-pelvic malignancy is rare with high malignancy and great difficulty in diagnosis and treatment. Clinically, patients with extra-abdominal/extra-pelvic malignancy should be alert to the occurrence of this disease, and their prognosis may be improved through active surgery combined with standard targeted therapy.

The value of IL-6 in cerebrospinal fluid for determining the development of cerebral vasospasm after subarachnoid hemorrhage

An inflammatory response following aneurysmal SubArachnoid Hemorrhage (aSAH) plays a significant role in the development of cerebral vasospasm. This study analyzes the correlation between the level of InterLeukin-6 (IL-6) in CerebroSpinal Fluid (CSF) after aSAH and the occurrence of cerebral vasospasm. We analyzed clinical manifestations, laboratory data, and instrumental examination methods in 45 patients who were treated for intracranial aSAH within 21 days, studying the relationship between the development of cerebral angiospasm and the concentration of the inflammatory factor. We found the potential significance of IL-6 in predicting vasospasm, confirmed by cerebral angiography. As a control, we analyzed the CSF samples of 15 patients treated for unruptured cerebral aneurysms. According to the study results, vasospasm developed in 44% of patients, on average on the 6th day from the onset of the disease. Patients with aSAH demonstrated statistically significant (p<0.05) higher mean IL-6 values in CSF on the 3rd, 7th, and 10th days compared to the control group. Patients with vasospasm showed statistically significant (p<0.05) higher mean IL-6 values in CSF on the 3rd day, while the differences on the 7th and 10th days (p<0.05) were not statistically significant. The threshold value for predicting the formation of cerebral vasospasm was determined to be 325 pg/ml on the 3rd day from the onset of the disease. We concluded that IL-6 in cerebrospinal fluid is a potential early marker for predicting vascular spasm after subarachnoid hemorrhage on the 3rd day of the disease, before the onset of clinical manifestations. We concluded that monitoring the value of IL-6 in the cerebrospinal fluid on the third day after aneurysm rupture is potentially significant for the early diagnosis of vasospasm. Keywords: intracranial aneurysm, vasospasm, stroke, cytokines.

Assessment of Mamsa Sara in Pandu Rogi with special reference to Mild to Moderate Anaemia - An Observational Study

Ayurveda is a science of life that offers meaning of health and better living. Assessment of health, disease and assortment of treatment are done mainly by clinical observation by the physician. Sara Pareeksha obliges as a vital diagnostic tool and is one among the method of clinical examination under Dashavidha Atura Pareeksha to evaluate the status of Dhatus. Mamsa Dhatu, provides nourishment to other Dhatus, provide strength, health, happiness and tranquility. Aim and Objective: To evaluate the status of Mamsa Sarata in Pandu Rogi with special reference to mild and moderate anaemia. Materials and Methods: The present study is a cross sectional observational study, conducted in 153 patients of each mild and moderate anaemia categorized based on diagnostic and inclusion criteria. Detailed history taken with a specially designed case proforma and Charakoktha Mamsa Sara Purusha Lakshanas assessed with a validated questionnaire. Result: On analysis of Mamsa Sara Purusha Lakshanas in Pandu Rogi with special reference to mild anaemia and moderate anaemia showed considerable change in the status of above mentioned Sara Purusha Lakshanas within and between two groups of mild anaemia and moderate anaemia. Discussion: In this study, 91.52% and 84.013% of Charakoktha Mamsa Sara Purusha Lakshanas estimated in mild anaemia patients and moderate anaemia patients respectively thus changes in Mamsa Sarata more appreciable in moderate anaemia patients.

Oral hygiene status and oral care motivation in children aged 7–9 years in a Vietnam primary school: A cross-sectional study

IntroductionOral hygiene is a crucial factor in oral health, especially in children. To increase the awareness of oral care behaviour among children, oral care motivation plays a critical role in daily dental practices. Therefore, this cross-sectional study was conducted to investigate the current oral hygiene status and evaluate the association between oral care motivation and oral hygiene index in 7–9-year-old children at Primary School in Hanoi, Vietnam. MethodsClinical examinations were performed on 200 randomly selected children to assess the Simplified Oral Hygiene Index (OHI-S). Face-to-face interviews were applied to record students' intrinsic and extrinsic motivation for oral care through a questionnaire, which consisted of questions regarding demographic characteristics and oral care motivation. Data were analyzed using STATA 15.0 software and a p-value < 0.05 was statistically significant. ResultsThe mean OHI-S score was 2.48 ± 0.72. Good and fair oral hygiene were observed in 7.5 % and 66 % of participants, respectively. Students' motivation for dental care was predominantly extrinsic, with a mean score of 15.87 ± 1.322. Higher motivation in dental care is statistically significantly associated with oral hygiene index score (Coef=-0.27). ConclusionThese results indicate that students with intrinsic motivation exhibit better oral hygiene practices. Consequently, strengthening oral health educational programs in primary schools based on intrinsic motivation could be helped improve the oral hygiene status and oral care behaviours of children.

Candidiasis and Oral Health

Candidiasis, primarily caused by Candida albicans, poses significant oral health concerns. This review highlights its clinical manifestations, diagnostics, and management strategies. Predisposing factors include poor oral hygiene and systemic conditions like HIV/AIDS and diabetes. Clinical presentation varies from asymptomatic colonization to symptomatic mucosal infections, with complications such as denture stomatitis. Diagnostics encompass clinical examination and various laboratory methods, guiding tailored treatment with topical or systemic antifungals. Prevention strategies targeting modifiable risk factors are crucial. Despite challenges like antifungal resistance, interdisciplinary collaboration among healthcare providers is essential for the effective management of oral candidiasis and its impact on overall health. Keywords: Candidiasis; Candida albicans; Oral health; Diagnostics; Antifungals; Prevention strategies

The painful knee in children

Knee pain is one of the most common reasons for medical consultation for musculoskeletal problems in the paediatric population. The aetiology is of very variable origin and necessitates aprecise assessment. In addition to athorough anamnesis, clinical and imaging examination methods, as well as laboratory diagnostics are of utmost importance to establish aproper diagnosis and an adequate treatment regimen. This chapter summarises the current diagnostic algorithm for dealing with knee pain in children and adolescents.

ANALYSIS OF VARIANCE SPERMOGRAM INDICATORS OF MEN DIFFERENT AGE GROUPS WITH ASTENOZOOSPERMIA, TERATOZOOSPERMIA AND AZOOSPERMIA

In recent decades, a decline in male fertility due to deterioration in sperm quality hasbeen noted around the world. This is probably explained by the tendency to increase the diseasesof the male genital organs and, as a result, the increase in the percentage of male infertility.In addition, there is a deterioration of the quantitative and qualitative indicators of spermogramsin practically healthy men. The average number of sperm in the ejaculate of a healthy man hashalved over the past 50 years, and the average volume of ejaculate has decreased by one third. Itis known that the multicomponent composition of the internal male genital organs is in constantrestructuring due to age changes, functional activity and the influence of various factors. That iswhy it is important to take into account both physiological and age-related changes in a man'sability to conceive.Diagnosis of male infertility includes clinical research methods and methods of laboratory-instrumental examination. Among the latter, the most important for finding out the functionalstate of the gonads and the fertilizing ability of sperm is the study of ejaculate. The object ofour research was spermograms obtained during the examination of patients at the "AlternativeClinic" reproductive medicine clinic.The purpose of the work was using biometric analysis to the different indicators of menspermograms of younger, middle and older age groups with normozoospermia (N), asthenozoospermia(AZS), teratozoospermia (T) and azoospermia (A). The task of the research wasto analyze the main indicators of spermograms of men of different age groups in normal andpathological conditions, to conduct a one-factor and two-factor variance analysis of the influenceof the studied diseases and age factor.After analyzing the main indicators of spermograms of men of younger, middle andolder age groups with asthenozoospermia, azoospermia, and teratozoospermia, it was establishedthat the indicators that undergo the greatest deviations in the studied diseases are themobility of spermatozoa according to categories A and B, the morphology of spermatozoa, theFarris fertility index, and the activity of spermatozoa.After conducting a one-factor variance analysis, we established that the share of theinfluence of the studied diseases on the overall variability of such indicators of spermograms asthe mobility of spermatozoa according to category A and B and the morphology of spermatozoain the spermograms of men of the studied age groups is within 63–98% of the total contribution(younger age group), 60–96% (middle age group) and 75–96% (older age group). The shareof influence of unaccounted factors is within 2–40% of the total contribution. The share of theinfluence of the studied diseases in the overall variability of such indicators as the Farris index and sperm activity in the spermograms of men of all studied groups is significantly reducedand is within 22–44% of the total contribution. Instead, the influence of unaccounted factors(56–78% of the total contribution) is growing significantly. This may indicate the presence ofconcomitant diseases and other pathologies in the men who took part in the research.After conducting a two-factor variance analysis, we established that the shares of theinfluence of the studied diseases on the overall variability of such indicators of spermogramsas motility of spermatozoa according to category A and B, morphology of spermatozoa, Farrisfertility index and activity of spermatozoa are decisive and are within the range of 90.7–99.9%of the total contribution, the share of the influence of the age factor on the variability of spermogramindicators of men of different age groups is insignificant.

Gambaran Tingkat Stres, Kecemasan, dan Depresi Mahasiswa dalam Persiapan Menghadapi Ujian Osce (Objective Structured Clinical Examination)

The competency test is an assessment of the abilities of Indonesian nurse graduates using written test methods via Computer Based Test (CBT) and Paper Based Test (PBT) as well as the Objective Structured Clinical Examination (OSCE) method. The results of researchers' interviews with D3 Nursing and Nursing students found that almost 86% experienced anxiety and stress. The aim of this research is to identify the level of stress, anxiety and depression of students when facing the OSCE. The research design uses a descriptive method, the sample is 85 people (56 D3 Nursing students, 26 Nursing students). Scale. Results of analysis of student stress levels were 31.76% normal, 17.65% mild, 21.18% moderate, 12.94% severe, and 16.47% very severe. Analysis of student anxiety levels 38.82% normal .12% mild, 24.71% moderate, 10.59% severe, and 11.76 very severe. Meanwhile, analysis of depression levels was 56.47% normal students, 15.29% mild, 11.76% moderate, 3.53. % by weight, and 12.94% by weight. The conclusion of this research is that the level of stress, anxiety and depression among students is mostly at normal levels, but there are still students at severe and very severe levels. It is recommended that educational institutions carry out stress, anxiety and depression management to eliminate negative influences as a relaxation effort that can change the situation to neutral.

The results of clinical monitoring of phytotherapeutic correction in the presence of benign breast diseases

Benign breast diseases (BBDs) are the most common group of diseases among women that negatively affect their quality of life. In fact, these pathological conditions are diagnosed at least 10 times more often than breast cancer. Up to 30% of women with BBDs will need treatment at some point in their lives. A triple assessment which is performed using imaging methods of clinical examination (ultrasound examination, mammography) and histopathological examination after a puncture biopsy during the initial consultation allows to exclude breast cancer in the majority of patients. `The main clinical manifestation of BBDs is mastalgia. In recent years, a variety of natural herbal remedies have played a significant role in the symptom-modifying therapy of mastalgia.The objective: to study the possibility of using an innovative phytocomplex as a symptom-modifying agent in the presence of BBDs, which is manifested by mastalgia.Materials and methods. Clinical monitoring of 60 patients between the ages of 22 and 46 years old with BBDs of various genesis was carried out. The study group included 30 women who used a phytocomplex containing 3,3`-diindolylmethane (200 mg), vitex extract (100 mg), epigallocatechin (45 mg), broccoli extract (0.4 mg), 1 tablet twice daily for 90 days. The reference group included 30 women who used a dietary supplement with indole-3-carbinol (200 mg) according to a similar scheme.Assessment of clinical symptoms of BBDs, measurement of interleukin-6 level in blood serum, fine-needle aspiration biopsy of pathological foci and immunocytochemical analysis of biopsies, assessment of patients’ quality of life were performed before and after treatment.Results. The innovative phytocomplex (diindolylmethane – DIM, Agni casti fructus) compared to the indole-3-carbinol monopreparation demonstrated a higher efficiency in creating conditions for the elimination of clinical manifestations of BBDs: discomfort, swelling, pain at rest and during palpation.A pronounced regression of clinical symptoms was observed in the study group: a decreased frequency of patients with chest discomfort from 100 to 36.7%, a decrease in pain at rest and during pressure – from 53.3 to 13.3% and from 33.3 to 13.3%, respectively, swelling – from 46.7 to 16.7%. The index of the quality of life of patients, which was determined by the sum of the scores of the questionnaire filled out by the patients themselves, showed a more pronounced tendency to increase in the study group.Conclusions. The innovative phytocomplex can be recommended as a preparation for phytotherapeutic correction in order to help reduce the intensity and eliminate mastalgia and other symptoms of BBDs.

Interrater Agreement of Height Assessment by Rigid Proctoscopy/Rectoscopy for Rectal Carcinoma.

Some guidelines for rectal carcinoma consider 12 cm, measured by rigid endoscopy, to be the cutoff tumor height for optional neoadjuvant chemoradiation therapy. Measuring differences of only a few centimeters may predetermine the choice of further therapy. However, rigid endoscopy may exhibit similar operator dependence to most other clinical examination methods. Evaluation of concordance of rigid rectoscopic tumor height measurements performed by 4 experienced examiners, 2 measuring with patients in the lithotomy position and 2 in the left lateral position. Assessment of tumor palpability and distance of the anal verge to the anocutaneous line were also evaluated. This study used a prospective observational design. This study was conducted at an academic teaching hospital that is a referral center for colorectal surgery. There were 50 patients, of whom 35 were men (70%). The median age was 72.5 years (53-88 years). Interrater agreement of tumor height assessment and tumor height of less than or greater than the 12-cm height limit. With an intraclass correlation coefficient of 0.947 (95% CI, 0.918-0.967, p < 0.001), interrater reliability of tumor height assessment was statistically rated "excellent." Despite this, in 26% of patients, there was no agreement regarding the allocation of the tumor <12- or >12-cm height limit. Furthermore, there was also considerable disagreement concerning tumor palpability and the distance of the anal verge to the anocutaneous line. Patient positioning was not found to influence results. Single-center study. Rigid rectal endoscopy may not be a sound pivotal basis for the consideration of optional chemoradiation therapy in rectal carcinoma. Application of a universally valid height limit ignores biological variability in body frame, gender, and acquired pelvic descent. Eligibility for neoadjuvant therapy should not rely on height measurements alone. Uniform MRI or CT imaging protocols, based on agreed upon terminology, including factors such as tumor height relative to the pelvic frame and peritoneal reflection, may be an important diagnostic addition to such a decision. See Video Abstract .Clinical trial registration: DRKS00012758 (German National Study Registry), ST-D 406 (German Cancer Society). ANTECEDENTES:Algunas guías para el carcinoma de recto consideran que 12 cm, medidos mediante endoscopia rígida, es la altura de corte del tumor para la quimiorradiación neoadyuvante opcional. Por lo tanto, una diferencia de medición de sólo unos pocos centímetros puede predeterminar la elección de una terapia adicional. Sin embargo, la endoscopia rígida puede presentar una dependencia del operador similar a la de la mayoría de los demás métodos de examen clínico.OBJETIVOS:Evaluación de la concordancia de las mediciones de la altura del tumor rectoscópico rígido realizadas por cuatro examinadores experimentados, dos en litotomía y dos en posición lateral izquierda. También se evaluó la evaluación de la palpabilidad del tumor y la distancia del borde anal a la línea anocutánea.DISEÑO:Estudio observacional prospectivo.LUGAR:Hospital universitario, centro de referencia para cirugía colorrectal.PACIENTES:50 pacientes, 35 varones (70%), mediana de edad 72,5 años (53-88 años).PRINCIPALES MEDIDAS DE RESULTADOS:Acuerdo entre evaluadores en la evaluación de la altura del tumor y la asignación del tumor por debajo o más allá del límite de altura de 12 cm.RESULTADOS:Con un coeficiente de correlación intraclase de 0,947 (IC del 95%: 0,918-0,967, p < 0,001), la confiabilidad entre evaluadores de la evaluación de la altura del tumor se calificó estadísticamente como "excelente". A pesar de esto, en el 26% de los pacientes no hubo acuerdo sobre la asignación del tumor por debajo o por encima del límite de 12 cm de altura. Además, también hubo un considerable desacuerdo con respecto a la palpabilidad del tumor y la distancia del borde anal a la línea anocutánea. No se encontró que la posición del paciente influyera en los resultados.LIMITACIONES:Estudio unicéntrico.CONCLUSIONES:La endoscopia rectal rígida puede no ser una base sólida y fundamental para considerar la quimiorradiación opcional en el carcinoma de recto. La aplicación de un límite de altura universalmente válido obviamente ignora la variabilidad biológica en la constitución corporal, el género y el descenso pélvico adquirido. La elegibilidad para la terapia neoadyuvante no debe depender únicamente de las mediciones de altura. Los protocolos uniformes de imágenes por resonancia magnética o tomografía computarizada, basados en una terminología acordada, incluidos factores como la altura del tumor en relación con la estructura pélvica y la reflexión peritoneal, pueden ser una adición diagnóstica importante para tal decisión. (Traducción-Yesenia Rojas-Khalil )Clinical trial registration: DRKS00012758 (German National Study Registry), ST-D 406 (German Cancer Society).

ерсонифицированный подход к диагностике и лечению рецидивирующих форм бактериального вагиноза

According to world statistics, bacterial vaginosis (BV) occupies one of the first places among vaginal diseases. The frequency of its distribution in the population ranges from 12% to 80% and depends on the contingent of women examined. BV develops mainly in women of reproductive age: in 80–87% of women with pathological vaginal discharge and 37–40% of pregnant women. Aim. To evaluate the effectiveness of three-stage therapy for recurrent and combined forms of BV based on the characteristics of the microbiome of the genital tract in women of early reproductive age. Materials and methods. We observed 445 women, who were divided into the following clinical groups. The IP group included 174 (39.10±2.31%) women with a confirmed diagnosis of recurrent BV. The IIP group included 153 (34.38±2.25%) women in whom BV was combined with cervicitis of nonspecific etiology. Group IIIP included 85 (19.10±1.86%) patients with a verified diagnosis of recurrent BV in combination with vulvovaginal candidiasis. The comparison group included 33 (7.42±1.24%) women, whose examination results corresponded to the reference values. Verification of the diagnosis in patients was carried out when contacting the antenatal clinic, based on the anamnesis, the nature of the complaints, and the results of clinical and laboratory examination methods. Laboratory examination included: pH – measurement of vaginal fluid using colpotest; bacterioscopic (urethra, cervical canal, vagina, rectum), bacteriological examination and polymerase chain reaction method in real time characterized the vaginal biotope. Patients with recurrent BV were offered three-stage therapy according to a personalized algorithm we developed, taking into account concomitant vaginal pathology. Results. The data obtained indicated an improvement in the quality of life of patients who underwent a course of three-stage therapy. The clinical effect showed that there were no relapses of the disease in patients of the IIIP group in 83% of cases, in the IIP and IP groups – in 90% and 91% of women, respectively. The highest frequency of relapses after therapy after 6 and 12 months was observed in patients of group IIIP, which amounted to 6% and 8% of Clinical cases (p&lt;0.05). Conclusion. Our data indicate that the use of the proposed diagnostic algorithm and three-stage therapy for recurrent and combined forms of BV made it possible to reduce the frequency of reproductive losses in patients in the prospective study groups: spontaneous miscarriages in early and late gestation – in 6.29, ectopic pregnancies – by 5.54 times, premature births by 3.65 times. The frequency of normal term births in women in the prospective study groups after three-stage therapy increased by 1.4 times.

ASSESSMENT OF CLINICAL FEATURES AND TREATMENT OPTIMIZATION OF ACUTE VARICELLA-ZOSTER VIRUS MYOCARDITIS: AN OBSERVATIONAL STUDY

The purpose of the study: to explore the frequency of development, features of the clinical course and treatment of acute myocarditis in adults with chickenpox. Materials and methods. This study included 240 patients with chickenpox between the ages of 18 and 40 years. Clinical, biochemical, molecular genetics and instrumental examination methods were used for assessment. Examination of selected patients was carried out in the acute period, after normalization of body temperature and before being discharged from the hospital. Student’s t test was used for statistical evaluation. Results and discussion. Acute myocarditis was diagnosed in 16.6% of patients with chickenpox caused by Varicella-zoster virus. A high correlation has been revealed between the severity of chickenpox and the frequency of development, as well as the severity of acute myocarditis in adults. Conclusions. An increase in CRP, sialic acid and fibrinogen in the blood serum of chickenpox patients reflects the severity of the disease, but is not specific for myocarditis. Treatment of acute myocarditis in patients with chickenpox should be early and comprehensive.

The Current Status of Partial Rupture of Anterior Cruciate Ligaments in Sport Players Coming for Examination and Treatment at Tan Son Nhat Hospital, An Sinh Hospital and Gia An Hospital in Ho Chi Minh City, Viet Nam

The study employed methods of clinical and paraclinical medical examination and statistical mathematics to investigate the current status of partial rupture of anterior cruciate ligament (ACL) in sports players examined at An Sinh Hospital, Tan Son Nhat Hospital and Gia An Hospital (n = 33). The results of both clinical and paraclinical tests clearly showed that partial rupture of the ACL had a significant impact on the patients’ knee joint function. However, signs such as pain level were not too large (only average) making the patients easy to get subjective. If not treated promptly, the ACL could be completely ruptured. Therefore, it is necessary to pay attention to the screening of ACL to avoid missing lesions. Furthermore, if treated early, the remaining ACL should be a good foundation for the support and orientation of collagen fiber proliferation. As a result, it is necessary to have early intervention measures to improve and restore knee function helping patients return to sports activities soon.