Outpatient Clinic Of Department Research Articles

Evaluation Nurses' Intervention toward Potential Complication for Patient after Gastrointestinal Surgery

Background: gastrointestinal surgery complication one cause of death worldwide. Objective: To determine the nurse's intervention toward potential complication for patient after gastrointestinal surgery. Methodology: A descriptive study was carried out throughout the present study to evaluation of nurses' intervention toward potential complication for patients after gastrointestinal surgery In Diwaniyah Teaching Hospital who attended the outpatient clinic department of hospitals in Al-Dewaniya governorate. The study was carried out during the period extended from the 10th of January 2024 to 1th June 2024. Results: The study showed that all ten axes are associated with the overall goal (evaluation of nurse's intervention). A statistical correlation is very strong because the mean level is less than 0.01. (And the level of indication shows that the relationship is true and stronger. Conclusion: Findings of the study indicated that there is the duration of training the findings of the present study show that highest percentage while the relationship between the all of items of questioner's depending on the coefficient of high correlation because attention to this axis will result in increased nursing care, which is the general goal. Recommendations: Carrying out strategies for nursing intervention within a context of comprehensive follow- up care, and Carrying out nursing care programmed on patients with produce of caring during treatment. Also Emphasis on the communication between the educational hospitals in relation to the exchange of clinical and surgical practical experiences through the establishment of seminars, courses and seminars, organized by the experts. In regarding about the role of health care worker should be give instruction to maintain the weight and exposure to the sunlight and identify the signs and symptoms of disease.

The use of interleukin-10 (IL-10) and phosphorus levels as predictors of the time to improvement in COVID-19 patients: a prospective study

Early detection of COVID-19 improves the chance of recovery and helps identify high-risk patients. Our study aimed to statistically predict the time to improvement with the admission data of COVID-19 patients.Methods: Our prospective cohort study occurred between January and September 2022 at Alexandria University Hospital’s outpatient clinic and isolation department. We enrolled 43 patients after assessing their eligibility and collecting their baseline data.Results: The mean age was 34.8 years (± 12.3). Most of them were females (65.1%). The mean of oxygen saturation was 95.2% (± 2.8). We used linear regression to predict how long it would take to improve [time to improvement (days) = 1.186*P (mmol/L) + 0.010*IL-10 (pg/mL)]. Its diagnostic performance was 0.723 (95% CI: 0.552–0.894), and it was accurate at predicting improvement within a week but not at longer delays; additionally, its positive and negative predictive values were 56.3% and 85.2%, respectively.Conclusion: We recommend monitoring phosphorus and interleukin-10 levels. The time-to-improvement delay negatively correlated with a reduction in baseline oxygen saturation upon admission. Additionally, for every 0.84 meq/L increase in phosphorus or 100 pg/mL increase in interleukin-10, there was a 1-day delay provided that the other was constant, with a coefficient of determination of 85.9%.

Sexual Dysfunction in Women with Asthma and Associated Factors

Background: Asthma is a common chronic inflammatory airway disease. Female sexual dysfunction (FSD) is frequently seen in asthmatics but often unnoticed in clinical practice. This study evaluated the associations between asthma disease characteristics and (FSD). Methods: A total of 73 female asthma patients who visited the chest department outpatient clinic and age-matched 73 healthy controls were enrolled. All the participants completed the questionnaires: female sexual function index (FSFI), BECK depression, and BECK anxiety inventory, and underwent pulmonary function tests. Patients with asthma completed an asthma quality of life questionnaire (AQLQ) and asthma control test (ACT). FSD risk factors were analyzed using logistic regression analysis. Results: About 68.8% of asthmatics had female sexual dysfunction. BECK anxiety and FSFI scores with all six subsets were statistically significantly lower than healthy individuals in asthmatics (p < 0.001). CRP levels, BECK anxiety, and depression scores had inverse (r = -0.386 r = -0.343 r = -0.286), and FEV1% had a positive correlation with FSFI total scores. About 37.5% of asthma patients with FSD were current smokers, the most compromised domain of the FSFI scale was sexual arousal with a mean of 2.94 ± 0.56 and their FEV1% was lower, and CRP was higher than the asthma patients without FSD (p < 0.001, p < 0.021). Smoking, high levels of CRP and BECK anxiety scores, and low FEV1% were found to be risk factors for FSD in regression analysis. Conclusions: Female sexual dysfunction is frequently present in asthma patients. Smokers, patients who have anxiety, lower FEV1% predicted values, and higher CRP levels tend to be susceptible to sexual dysfunction, which implicates inflammation as an underlying mechanism.

Comparison of effectiveness indicators before and during the COVID-19 pandemic in a university hospital

Objective: Our aim in this study is to reveal to what extent hospital efficiency indicators changed in a University Hospital between the period before the Covid 19 pandemic (2018-2019) and the period when the pandemic started and continued (2020-2021). Method: The study planned as a retrospective and descriptive type, data belongs to a 4-year period (2018-2021). The number of personnel for the years examined in the study, the number of applications to the outpatient clinic and emergency department calculated monthly and the number of deceased patients. Bed occupancy rate, inpatient rate, average patient stay days, bed turnover rate and bed turnover interval were used as hospital bed utilization efficiency indicators. Result: Among all years, April 2020 had the lowest number of emergency applications (n=1287) and total number of outpatient clinic applications (n=7530). The year with the highest bed occupancy rate was 2020 with 77.2±6.7. The highest inpatient rate was in 2020 with 6.7±2.1, the highest average day of stay was in 2021 with 10.8±2.2, the highest bed turnover rate was in 2018 and 2019 with 4.7±0.3 and the highest bed turnover interval was observed in 2021 with 5.2±2.2. April 2020 was the month with the highest inpatient rate at 11.8% and the highest bed turnover interval at 16.8. Conclusion: The number of patients applying to emergency departments and outpatient clinics decreased, the inpatient rate increased, the bed turnover rate decreased, the bed turnover interval extended and the average day of stay increased during the pandemic period.

Role of ultrasound and magnetic resonance neurography in the detection of median nerve abnormalities in carpal tunnel syndrome

BackgroundThe most prevalent cause of peripheral nerve entrapment is carpal tunnel syndrome, which is characterized by compression of the median nerve at the wrist as a result of nearby or localized microvascular interference as well as structural alterations to the median nerve or adjacent tissues. However, no special information regarding the median nerve or its surroundings is provided by clinical examination or electrophysiological testing. The purpose of this study is to evaluate the effectiveness of magnetic resonance neurography (MRN) and ultrasound in identifying changes and abnormalities of the median nerve in carpal tunnel syndrome.MethodsThe twenty-five patients in this study ranged in age from 27 to 63 years old, with a mean age of 47. There were 18 female patients and seven male patients. All patients were sent to the radiology department from the orthopedics, neurology, outpatient clinic, and neurology department, at Ain Shams Hospital, Faculty of Medicine, Ain Shams University. All of the patients had clinically manifested pain along the median nerve distribution, each of the sixteen patients had hand paresthesia, and four had thenar muscle atrophy.ResultsIn the current study, Ultrasound exhibits low negative predictive value of 67% and specificity of 67%, but high positive predictive value of 95%, sensitivity of 95%, and overall accuracy of 92%. On the other hand, (MRN) exhibits a low negative predictive value of 60% and a high specificity of 75% in the diagnosis of nerve entrapment, but it also displays a high positive predictive value of 95%, sensitivity of 90%, and overall accuracy of 88%. Regarding the assessment of the recurrence cause and post-surgical evaluation is more reliable by Magnetic Resonance Neurography examination.ConclusionsMagnetic resonance neurography and high-resolution ultrasonography can be utilized to diagnose patients with median nerve entrapment and patients who cannot be diagnosed electrophysiologically.MRN is a more accurate method for detecting the exact location of nerve entrapment and evaluating nerve recovery after surgical intervention than nerve conduction studies and electromyography. Additionally, MRN can be used to identify causes that were not previously recognized based on physical examination and electrophysiological tests.

P055 ELECTROCARDIOGRAPHIC ABNORMALITIES AND ASSOCIATED FACTORS IN NORMOTENSIVE TYPE II DIABETIC PATIENTS

Background/Objective: Type II diabetes mellitus (T2DM) is a coronary heart disease (CHD) equivalent in the presence of target organ damage or at least three cardiovascular disease (CVD) risk factors. Resting electrocardiography (ECG) is recommended in T2DM patients only in the presence of hypertension or on suspicion of CVD. ECG abnormalities occur early in T2DM, are associated with future cardiovascular events/mortality after adjustment for traditional CVD risk factors. Early screening and detection may improve long term survival in T2DM patients hence, aim of study- to assess the patterns and factors associated with ECG abnormalities in T2DM patients without co-existing hypertension. Methods: One hundred normotensive (BP<130/80mmHg, not on any antihypertensive agent) T2DM patients were recruited consecutively, from the Endocrinology and Diabetes clinics of the Medical Outpatient Clinic and Family Medicine department of the University of Nigeria Teaching Hospital. Consents were obtained, before interviewers, administered questionnaire to get the biodata, T2DM history, complications and treatment. Anthropometric and blood pressure readings were taken using standard methods. A 12-hour overnight fasting blood sample was taken for biochemical assessment of blood glucose, glycated haemoglobin, lipids, urea and creatinine. A 12 lead ECG was performed and interpreted by one cardiologist using the Minnesota ECG code criteria. Descriptive statistics was used for patterns of ECG abnormalities while association between categorical variables were cross tabulated and tested using chi square. Results: Participants were majorly females 68(68.0%), overweight/obese 52(52.0%) with a mean age of 55.56±9.89 years. Duration of T2DM illness post diagnosis was 6.57±6.26years. T2DM was poorly controlled in 92(92.0%) while 93(93.0%) had dyslipidaemia. ECG was abnormal in 56(56.0%) with multiple abnormality in 12(21.4)%. Left atrial abnormality was the commonest 14(25.0%) ECG abnormality. No factor was associated with ECG abnormality. Conclusions: ECG abnormalities are common in T2DM, occurring early in the absence of co-existing hypertension. ECG should be done at diagnosis of T2DM irrespective of CVD risk factors, with frequent monitoring than recommended by guidelines. Table. Pattern of electrocardiographic abnormalities in normotensive type II diabetic patients.

Prevalence of cervical cancer and associated factors among women attending gynecological clinic outpatient department at tumbi regional referral hospital, Tanzania

Prevalence of cervical cancer and associated factors among women attending gynecological clinic outpatient department at tumbi regional referral hospital, Tanzania

The Role of Chitinase-3-like Protein 1 (YKL-40) as a Marker of Disease Activity in Ankylosing Spondylitis Patients

Abstract Background Ankylosing spondylitis is a prototype of spondyloarthritides that primarily affects the axial skeleton. Sacroiliitis is the hallmark and accompanied by inflammation of the entheses and formation of syndesmophytes, leading to spinal ankylosis in later stages. Prevalence estimates vary between 0.1% and 2% in different populations.The most utilized peripheral blood biomarkers of ankylosing spondylitis activity in clinical practice and clinical trials are ESR and CRP. However, they have low sensitivity and specificity. Objective To detect the role of YKL-40 as an objective Marker of disease activity in ankylosing Spondylitis Patients. Patient and Methods This study was a case control study, included fifteen ankylosing spondylitis patients were recruited from the outpatient clinic and inpatient department of Physical Medicine, Rheumatoloy and Rehabilitation of Ain Shams university hospitals and fifteen adult healthy volunteers as a control group. Approval of the Ain shams university research and ethical committee was obtained. Results There was no statistically significant difference between patient and control group as regard age and sex. YKL-40 showed 100% sensitivity and 100% specificity. large scale studies with follow up of patients in response to drug treatment are needed to be done to assess its uses as a disease activity marker. large scale prospective studies are needed with the assessment of comorbidities and their time of development in correlation to YKL-40 as it has an excellent potential for prediction of these comorbidities. Conclusion YKL-40 marker is a good predictor for ankylosing spondylitis disease.

Assessment of Serum Autophagy Related Protein Beclin1 in Egyptian Adult Beta Thalathemic Patients

Abstract Background Beta-thalassemia is a chronic hemolytic anemia that is inherited in an autosomal recessive manner. It is characterized by reduced hemoglobin levels and red blood cell production. Aim of the Work Assessment of serum autophagy related protein beclin1 in Egyptian adult beta thalathemic patients and Its relation to ineffective erythropoiesis, transfusion requirements, iron overload. Subjects and Methods This is a case control study which was carried out at Ain Shams university hospitals. Internal medicine department, Clinical hematology and stem cell transplantation unit, outpatient clinic and inpatient department, during the period between January 2022 and August 2022. Results Our study revealed significant decreased fertility between patients group and control group (P = 0.011). Transfusion-dependent beta-thalassemia males have a high proportion of fertility impairment and iron overload might contribute to disturbed sperm quality and testicular tissue injury. Such findings might explain the high prevalence of impaired fertility in transfusion-dependent beta- thalassemia patients which agrees with our results. Also our study revealed significant differences between non-transfusion dependent group and transfusion-dependent group regarding spleen size (cm) below costal margin which was increased in (TD group), transfusion per year (ml/yr)(which was increased in (TD group), virology (HIV, HCV,HBV) revealed that percentage of HCV+ve higher in (TD group) with (P < 0.001): Our study revealed significant difference between non-transfusion- dependent group and Transfusion-dependent group regarding percentage of patients of with positive HCV which was increased in Transfusion-dependent group (P = 0.021): In our study Iron chelation therapy was found to be given in a higher percentage of TD patients compared to non TD patients (P < 0.001). Also our study revealed significant difference regarding cardic function(EF%) between patients group and control group (EF found to be lower in patients group than controls) (P < 0.001): Also our study showed that Beclin-1 level is significantly higher in patients group compared to control group (P < 0.001). We couldn’t find previous studies of Beclin-1 level in thalassemia patients. We postulate that Beclin 1 could be used as a marker of worsening cardiac functions in thalassemia patients, but further studies should measure serial levels of Beclin 1 and correlate it with cardiac parameters over longer periods of follow up. Conclusion Beclin 1 level increased in Adult Beta Thalasemia patients and it can be used as a prognostic marker for Adult Beta Thalasemia patients.

Role of Optical Coherence Tomography (OCT), Fundus Photography, and Amsler Grid in Detection of Macular Disorders Associated with High Myopia

Abstract Background High myopia refers to ametropia characterized by elongation of optic axis and retinal and choroidal degeneration in the fundus, and high myopic patients present with various degrees of structural and functional retinal changes and thinning of the retinal thickness. Active screening for high myopic patients with imaging techniques by OCT, Fundus photography and amsler grid and providing patients with corresponding treatment on this basis may effectively reduce the risk of irreversible visual function damage. Objective To point to the importance of combining OCT, fundus photography with amsler grid testing in patients with high myopia. Methods This study was conducted on 40 eyes from EI-Demerdash Hospital outpatient clinic and ophthalmology department investigations unit in the period from June 2021 till May 2022; the patients were 24 females (60.0%) and 16 males (40.0%) with age ranged from 16 to 50 years. Results Our investigations gave us an idea about the macular diseases associated with high myopia and the importance of combining use of OCT, fundus imaging and amsler grid with patients with high myopia. These findings consist of chorioretinal atrophy, foveoschisis, choroidal neovascularization, dehiscence of retinal layers known as retinoschisis (foveoschisis or extre foveoschisis), macular holes (lamellar and full thickness), posterior retinal detachment. We can early detect theses changes in macula of highly myopic patients by Amsler grid testing as daily self monitoring and this can be useful in directing the patient to more sophisticated investigation tool like OCT and fundus photography and therefore give the patient the optimal chance to save the vision. Conclusion OCT combined with fundus photography and amsler grid testing are helpful tools that allow detailed evaluation of the macula in eyes with pathological myopia and easily anticipate, diagnose and follow up diseases associated with high myopia.

Immunogenicity and Adverse Events after Covid-19 Vaccination in Patients with Systemic Inflammatory Autoimmune Diseases

Abstract Background The first cases of COVID-19 began in Wuhan, Hubei Province china, in December 2019. Since then, this disease caused by a highly pathogenic virus, severe acute respiratory syndrome coronavirus (SARS-COV-2), has been labelled as a global pandemic. It is believed that the primary means of viral spread is via respiratory droplets during close-range, human-to-human contact. Aim of the Work To assess immunogenicity and to compare adverse effect following COVID-19 vaccinations in patients with systemic inflammatory autoimmune diseases vs matched healthy controls. Patients and Methods This is a cross sectional study. Two groups of subjects were enrolled in the study after consideration of both inclusion and exclusion criteria. Group A: patients with systemic inflammatory auto immune disease (60 subjects) including (30 patients with systemic lupus erythematosus, 30 patients with rheumatoid arthritis) who received two doses of COVID-19 vaccine. Group B: age-matched healthy controls who received two doses of COVID-19 vaccine (30 Subjects). All patients were recruited from the outpatient clinic of department of Internal Medicine – Rheumatology division at Ain Shams University Hospital. Control group were recruited from medical and non-medical staff working at Ain Shams University Hospital. Results There was no statistically significant difference in the titre of anti-spikes antibodies with the use of different immune suppressive drugs in RA group such as methotrexate and leflunomide with p-value =0.935,0.257, respectively,also in SLE patients there was no statistically significant difference in the titre of anti-spikes antibodies with the use of different immune suppressive drugs in SLE group such as azathioprine, mycophenolate mofetil and cyclophosphamide with p-value = 0.317, 1.000 and 0.513 respectively,(all patients in our study were on corticosteroids and hydroxychloroquine). There was statistically significant difference as regarding disease activity in RA patients before and after covid-19 vaccine with p-value = 0.001,with a total percentage of 26.70% of patients developed mild disease activity,13.30% developed moderate disease activity while 3.3% of patients developed severe activity and as regarding SLE patients there was statistically significant difference as regarding disease activity in SLE patients before and after covid-19 vaccine with p-value = 0.002,with a total percentage of 23.3% of patients developed mild disease activity,6.7% developed moderate disease activity while 10% of patients developed severe activity. Conclusion Comparable side effects in both control and patients group with only minor side effects were reported. The Sinopharm BIBP COVID-19 vaccine was immunogenic in the majority of patients in comparison to control group, with an acceptable safety profile. The use of different immune suppressive therapies (methotrexate, azathioprine, mycophenolate mofetil,cyclophosphamide) didn’t affect humoral response after two doses of the vaccine. Apparent impact on disease activity of both SLE and RA patients but mainly in the form of mild disease activity.

Immunogenicity and Adverse Events after Covid-19 Vaccination in Patients with Systemic Inflammatory Autoimmune Diseases

Abstract Background The first cases of COVID-19 began in Wuhan, Hubei Province china, in December 2019. Since then, this disease caused by a highly pathogenic virus, severe acute respiratory syndrome coronavirus (SARS-COV-2), has been labelled as a global pandemic. It is believed that the primary means of viral spread is via respiratory droplets during close-range, human-to-human contact. Aim of the Work To assess immunogenicity and to compare adverse effect following COVID-19 vaccinations in patients with systemic inflammatory autoimmune diseases vs matched healthy controls. Patients and Methods This is a cross sectional study. Two groups of subjects were enrolled in the study after consideration of both inclusion and exclusion criteria. Group A: patients with systemic inflammatory auto immune disease (60 subjects) including (30 patients with systemic lupus erythematosus, 30 patients with rheumatoid arthritis) who received two doses of COVID-19 vaccine. Group B: age-matched healthy controls who received two doses of COVID-19 vaccine (30 Subjects). All patients were recruited from the outpatient clinic of department of Internal Medicine – Rheumatology division at Ain Shams University Hospital. Control group were recruited from medical and non-medical staff working at Ain Shams University Hospital. Results There was no statistically significant difference in the titre of anti-spikes antibodies with the use of different immune suppressive drugs in RA group such as methotrexate and leflunomide with p- value = 0.935,0.257, respectively,also in SLE patients there was no statistically significant difference in the titre of anti-spikes antibodies with the use of different immune suppressive drugs in SLE group such as azathioprine, mycophenolate mofetil and cyclophosphamide with p-value = 0.317, 1.000 and 0.513 respectively,(all patients in our study were on corticosteroids and hydroxychloroquine). There was statistically significant difference as regarding disease activity in RA patients before and after covid-19 vaccine with p-value = 0.001,with a total percentage of 26.70% of patients developed mild disease activity,13.30% developed moderate disease activity while 3.3% of patients developed severe activity and as regarding SLE patients there was statistically significant difference as regarding disease activity in SLE patients before and after covid-19 vaccine with p-value = 0.002,with a total percentage of 23.3% of patients developed mild disease activity, 6.7% developed moderate disease activity while 10% of patients developed severe activity. Conclusion Comparable side effects in both control and patients group with only minor side effects were reported. The Sinopharm BIBP COVID-19 vaccine was immunogenic in the majority of patients in comparison to control group, with an acceptable safety profile. The use of different immune suppressive therapies (methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide) didn’t affect humoral response after two doses of the vaccine. Apparent impact on disease activity of both SLE and RA patients but mainly in the form of mild disease activity.

Application of a natural language processing artificial intelligence tool in psoriasis: A cross-sectional comparative study on identifying affected areas in patients’ data

Psoriasis is an immune-mediated skin disease affecting approximately 3% of the global population. Proper management of this condition necessitates the assessment of the body surface area and the involvement of nails and joints. The integration of natural language processing with electronic medical records (EMRs) has recently shown promise in advancing disease classification and research. This study evaluates the performance of ChatGPT-4, a commercial artificial intelligence platform, in analyzing unstructured EMR data of psoriasis patients, particularly in identifying affected body areas. The study analyzed EMR data from 94 patients treated at the Dermatology Department and Psoriasis Outpatient Clinic of Sheba Medical Center between 2008 and 2022. The data were processed using the ChatGPT-4 interface to identify and report the body areas affected by psoriasis. These identified areas were then categorized, and the accuracy of ChatGPT-4’s analysis was compared with that of a senior dermatologist. The results revealed that the dermatologist identified 477 psoriasis-affected body areas. ChatGPT-4 accurately recognized 443 (92.8%) of these areas, missed 34, and incorrectly identified 30 areas as affected. From 94 cases, nail involvement was detected in 32 cases (34.0%), with ChatGPT-4 correctly identifying 29 cases. Joint involvement was noted in 25 cases (26.6%), with 24 correctly identified using ChatGPT-4. Complete accuracy was achieved in 54 cases (57.4%), although inaccuracies were observed in 40 cases (42.6%). We found that cases with more characters, words, or identified body areas were more prone to errors, suggesting that increased data complexity heightens the likelihood of inaccuracies in artificial intelligence analysis. ChatGPT-4 demonstrated high performance in analyzing detailed and complex unstructured EMR data from patients with psoriasis, effectively identifying involved body areas, including nails and joints. This highlights the potential of NLP algorithms to enhance the analysis of unstructured EMR data for both clinical follow-up and research purposes.

Evaluation of patients presenting with headache to the emergency outpatient clinic

Aims: This study aimed to explore the factors contributing to headache presentation in patients by recognizing headache as a symptom of various potential ailments. It is crucial to understand these factors for appropriate assessment and treatment planning in patients with headaches. Additionally, this study investigated patients' preferences for headache management, which is an understudied aspect in the field. Methods: In 2012, a two-month study was conducted at an emergency department outpatient clinic to assess the general characteristics, severity, frequency, duration, and location of headache episodes among patients presenting with headache complaints. The study analyzed various parameters, including the different types of pain, such as throbbing, stabbing, and burning, as well as the impact of headaches on daily performance, medication use, specific medications taken, and alternative treatment methods via a headache questionnaire. Results: The survey results revealed that 21.7% of the patients described their pain as extremely severe, 52.2% as severe, and 26.1% as distressing. Pain descriptions were predominantly throbbing (79.4%) and pain (62.2%), with sensations of pressure (20%), stabbing (18.3%), pulsating (13.3%), burning (10.6%), and constriction-like a band (2.8%). The localization of pain was bilateral in 15.0% of patients, unilateral in 18.3%, around or behind the eyes in 28.3%, and in the neck or back of the head in 38.3%. Headaches were found to affect the work life of 40.6% of patients, 20% reported no impact, and 39.4% experienced occasional interference. No significant statistical difference was observed regarding the intensity, frequency, and duration of pain, and its impact on work life with respect to sex. The usage of non-prescription medication was high (92.8 %), whereas prescription medication usage was 57.8%. Regarding alternative treatment methods, massage therapy was used by 53.6% of the patients and herbal treatments by 17.8%. Conclusion: This study examined the frequency and handling of headaches among patients visiting an emergency department. The results indicate that headaches affect both sexes equally, with a marginal prevalence in females. To provide better care, addressing patients’ preferences and experiences is important. As patients rely on non-prescription medications and alternative therapies, concerns regarding healthcare accessibility arise. A combination of medication management, patient education, and non-pharmacological therapies is necessary to achieve better outcomes and decrease the burden on healthcare systems.

#535 Roxadustat as a treatment of anemia after kidney transplantation

Abstract Background and Aims Roxadustat is a recently approved hypoxia-inducible factor prolyl hydroxylase inhibitor that has demonstrated favourable safety and efficacy in the treatment of renal anaemia. The goal of this study is to analyse the effect of roxadustat on the level of hemoglobin in a group of patient with chronic kidney disease with or without kidney transplantation. Method This is a monocentric study conducted on the patients of Transplant-nephrology department and/or Transplant-nephrology out-patient clinic of University Hospital Martin, Slovakia who have been treated with roxadusat since August 1st, 2022. Results 33 patients were included in the study. The average follow up of treatment with roxadustat was 4.2 months. The following parameters were recorded at the baseline: age, gender, estimated glomerular filtration rate—eGFR (CKD-EPI), treatment with iron and level of iron in serum, level of C-reactive protein, level of hemoglobin, starting dose of Roxadustat. We discovered a significant improvement in the levels of hemoglobin after one month of roxadustat treatment (P < 0.0001) and another significant improvement in follow-up (P ‚0,0373). There was no significant difference in eGFR, CRP or iron levels during follow up, so hemoglobin levels were not affected by inflammation or kidney function. In the next step the group of patients was divided based on history of kidney transplantation. Again, we confirmed significant improvement in hemoglobin levels in kidney transplantation group in first month of treatment (P < 0.0001) as well as in follow up (P < 0.0001). There was a significant improvement in hemoglobin levels in the first month of roxadustat treatment in the group of patients who did not undergo kidney transplantation (P = 0.0261). However, there was no significant difference between hemoglobin levels in month 1 and follow up in this group. Conclusion Roxadustat—as a new treatment option of anaemia for patients with chronic kidney diseases. Our first analysis confirmed that roxadustat is very effective not only in patients with CKD, but also in patients with anaemia after kidney transplantation.

#191 An unusual cause of hypocalcemia in a young patient

Abstract Background and Aims A 33-year-old man visited the Nephrology Department outpatient clinic with abnormal laboratory findings: his serum calcium level was 5.9 mg/dL in a recent health examination. He denied any underlying disease and was on no medications. He complained of a tingling sensation in his hands and of eyelid twitching. On physical examination, he showed Chvostek's sign. His laboratory findings including serum calcium level are shown in Table 1. He did not have any morphological abnormalities, such as a round face, brachydactyly, or dental anomalies. Method Since he showed hypocalcemia, normal 25-hydroxyvitamin D, and elevated parathyroid hormone (PTH) levels, the presence of PTH resistance was presumed. Under strong suspicion of pseudohypoparathyroidism (PHP) in this patient, DNA sequence analysis and methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) of GNAS and STX16, genetic regions that are often affected by mutations or imprinting changes in PHP, was performed. No pathogenic mutations in GNAS and STX16 were detected by sequencing. Results Results of MS-MLPA of the GNAS locus demonstrated abnormal methylation patterns in the patient after HhaI restriction enzyme treatment. The methylation ratio showed a gain of methylation in the NESP55 region and loss of methylation in the AS, XL, and A/B differentially methylated regions (DMRs) in the patient as compared to a healthy control (Fig. 1). The patient was diagnosed with PHP type 1B (PHP1B) due to the methylation abnormalities in multiple DMRs. His parents both showed normal serum calcium levels; thus, no further genetic testing was conducted. He is on outpatient follow-up with adequate calcium replacement and no specific symptoms. Conclusion PHP is a rare disorder of unknown prevalence. It is characterized by hypocalcemia, hyperphosphatemia, and increased PTH levels. PHP1B is a subtype of PHP characterized by isolated renal PTH resistance, usually without physical abnormalities such as Albright hereditary osteodystrophy or other endocrine abnormalities. PHP1B can be sporadic or familial. The genetic characteristics of most sporadic PHP1B remains unclear, but GNAS imprinting abnormalities and hypomethylation at the A/B DMRs have been reported. Symptoms of PHP1B usually begin in childhood due to low calcium levels and may include numbness, seizures, tetany, cataracts, and dental problems. However, as in our case, specific symptoms may not occur until adulthood. Therefore, when evaluating the cause of hypocalcemia, it is necessary to differentiate PHP1B, even in adults, and particularly in cases with hyperphosphatemia and high PTH levels.

A giant primary ovarian fibrosarcoma in a South Sudanese patient

Ovarian fibrosarcomas account for less than 1% of all ovarian malignancies. Clinical diagnosis is extremely difficult. A 20-year-old, illiterate, married nulliparous woman presented to our Outpatient Department Clinic (OPD) with chronic abdominal distension. Ultrasound and CT scan revealed a very large intra-abdominal mass, 23.8x27.8x35.7cm. She underwent a laparotomy and left salpingo-oophorectomy with her uterus and right adenexum conserved. After surgery, the mass weighed 11.1kg and measured 43x38x35cm. Histological findings were in line with a giant primary ovarian fibrosarcoma. To date, as far as we are aware, this is the largest ever recorded primary ovarian fibrosarcoma.

Experience with Gore’s Block in Patients with Lower Lumbar Radiculopathy

Abstract Lower lumbar radiculopathy is one of the most common presentations in the pain clinic outpatient department (OPD). A thorough history, physical examination, neurological assessment, and imaging help in the diagnosis and management. The inability to identify the correct pain generator often causes a failure of treatment. Dr. Satishchandra Gore has proposed a new method for the diagnosis of affected lower lumbar nerve root (L5 and S1) at a peripheral level. His hypothesis is that in an inflamed nerve root, sodium channels are upregulated at both proximal and distal ends (central and peripheral). This results in tenderness at the distal peripheral end of the nerve on palpation. We can block the sodium channels at the distal portion of the same inflamed nerve, which may be able to abolish pain. This procedure is called “Gore’s Block” and the result is called “Gore’s sign.” We used this technique in 10 patients with suspected L5-S1 radiculopathy. Out of 10 patients, seven patients had pain relief after Gore’s block. These seven patients also responded well to a Caudal epidural steroid injection. Two patients did not have significant pain relief with Gore’s block and had poor responses to epidural steroid injections. One patient got therapeutic pain relief after Gore’s block, probably due to the natural resolution of the disease. Gore’s block is a simple, OPD procedure, helpful in diagnosing the level of nerve affection in lower lumbar radiculopathy. It is diagnostic and has a good correlation with epidural blocks. Whether it is therapeutic in nature needs to be further investigated.

A Case Series of Round Block Techniques for Large, Recurrent, and Multicentric Benign Breast Diseases.

Benign breast diseases are a common presentation in the breast clinic outpatient department. These diseases, including giant fibroadenoma, multiple fibroadenoma in different quadrants, and large or recurrent phyllodes tumors, pose challenges in surgical management. We present a case series of 16 patients aged 19 to 63 years (average age, 41.5 years) who presented with breast lumps and underwent surgery using the round block technique for benign breast diseases at our institute between November 2019 and March 2024. Prior to surgery, all patients had clinical, radiological, and pathological assessments. Age, duration of lump, and detailed menstrual, obstetric, and family history of each patient were recorded. Eight (50%) of the patients had phyllodes tumor, four (31.25%) had fibroadenoma, three (18.75%) had both fibroadenoma and phyllodes tumor, and one (6.25%) had adenolipoma. The average size of tumors was 7.5 cm in our study. During postsurgical follow-up, none of the patients had nipple areola necrosis, and they reported that nipple sensation was acceptable. A mastectomy was avoided in all circumstances. Good cosmetic outcomes and clear margin status are achievable using the round block technique.

Lung Cancer in Women-Sociodemographic, Clinical and Psychological Characteristics with Comparison to Men.

(1) Background: There is a difference in the course of lung cancer between women and men. Therefore, there is a need to evaluate various factors in the patient population treated in daily practice. The purpose of this study was to analyze the clinical, sociodemographic and psychological aspects of female lung cancer. To better express the results, we compared women and men. (2) Methods: Consecutive patients with a history of lung cancer treatment admitted to the outpatient oncology clinic (Department of Lung Cancer and Chest Tumours, Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw) and the Department of Internal Medicine, Pulmonary Diseases and Allergy, were enrolled. We conducted analyses of the clinical, psychological and socioeconomic factors of women with lung cancer treated in everyday practice, including a comparison with a group of men. Demographic data were collected from a self-administered questionnaire. We used the Perceived Stress Scale (PSS-10) and Acceptance of Illness Scale (AIS) questionnaires for psychological evaluation. (3) Results: A total of 100 patients with confirmed primary lung cancer with a history of treatment were enrolled in the study (50 women and 50 men). We found a significantly shorter history of smoking in the group of women; at the same time, there were no differences in the reported incidence of COPD. Despite comparable results to men on the psychological questionnaire (PSS-10, AIS), women more often reported a willingness to be supported by a psychologist or psychiatrist due to lung cancer. However, they did not decide to consult them more often than men. Immunotherapy was a significantly less frequently used method in women. (4) Conclusions: We should be more active in finding out the willingness to consult a psychologist or psychiatrist among women with lung cancer. The diagnosis of COPD should be considered more often among women due to the lack of differences in the reported incidence of COPD between men and women, despite a clear contrast in the number of pack-years.