Physicians Of Different Specialties Research Articles

Concepts of lines of therapy in cancer treatment: findings from an expert interview-based study

ObjectiveThe concept of lines of therapy (LOT) in cancer treatment is often considered for decision making in tumor boards and clinical management, but lacks a common definition across medical specialties. The complexity and heterogeneity of malignancies and treatment modalities contribute to an inconsistent understanding of LOT among physicians. This study assesses the heterogeneity of understandings of the LOT concept, its major dimensions, and criteria from the perspective of physicians of different specialties with an oncological focus in Germany. Semi-structured expert interviews with nine physicians were conducted and evaluated using qualitative content analysis.ResultsMost interviewees agreed that there is no single definition for LOT and found it difficult to explicate their understanding. A majority of experts stated that they had already encountered misunderstandings with colleagues regarding LOT and that they had problems with deciphering LOT from the medical records of their patients. Disagreement emerged about the roles of the following within the LOT concept: maintenance therapy, treatment intention, different therapy modalities, changing pharmaceutical agents, and therapy breaks. Respondents predominantly considered the same criteria as decisive for the definition of LOT as for a change in LOT (e.g., the occurrence of a progression event or tumor recurrence).

Smoking cessation counselling patterns in cancer patients - survey of Lebanese physicians.

Tobacco smoking is a known risk factor for cancer development and smoking cessation can lower this risk and improve outcomes in some cancer patients. Despite that, many cancer patients do not quit smoking after a cancer diagnosis, and smoking cessation counselling is still not routinely provided in cancer care. The aim of this study is to examine patterns in smoking cessation counselling to cancer patients by their treating physicians. A self-administered, web-based (mobile-friendly), anonymous questionnaire was developed on LimeSurvey and sent by e-mail to Lebanese physicians of different specialties between June 2020 and January 2022. Data were analysed using SPSS and associations between the different items were determined using the χ2 test. A total of 146 physicians filled out the questionnaire. Almost all physicians ask cancer patients about their smoking status, but only 45.9% provide smoking cessation counselling, and only 24% refer patients to smoking cessation counselling programs. Only 27.4% of all respondents have received formal smoking cessation training, and only 27.4% feel capable of providing smoking cessation counselling in their clinic. Specifically, family medicine physicians were more likely to provide smoking cessation counselling in the clinic (69%), more likely to refer patients to a smoking cessation counselling program (44%), and more likely to have received formal smoking cessation counselling training (67%) and more likely to feel capable of providing smoking cessation counselling (93%). Lack of training, lack of knowledge of available programs and the lack of availability of enough programs are leading obstacles contributing to low rates of smoking cessation counselling in cancer patients as reported by the physicians. Our data reveals a deficiency in smoking cessation counselling and referral of cancer patients to smoking cessation counselling programs in our region. This highlights the need for dedicated smoking cessation counselling training for practicing physicians and physicians in training.

Potentially fatal complications of new systemic anticancer therapies: pearls and pitfalls in their initial management.

Various types of immunotherapy (i.e. immune checkpoint inhibitors [ICIs], chimeric antigen receptor [CAR] T-cells and bispecific T-cell engagers [BiTEs]) and antibody drug conjugates (ADCs) have been used increasingly to treat solid cancers, lymphomas and leukaemias. Patients with serious complications of these therapies can be presented to physicians of different specialties. In this narrative review we discuss potentially fatal complications of new systemic anticancer therapies and some practical considerations for their diagnosis and initial treatment. Clinical presentation of toxicities of new anticancer therapies may be unpredictable and nonspecific. They can mimic other more common medical conditions such as infection or stroke. If not recognized and properly treated these toxicities can progress rapidly into life-threatening conditions. ICIs can cause immune-related inflammatory disorders of various organ systems (e.g. pneumonitis or colitis), and a cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) may develop after treatment with CAR T-cells or BiTEs. The cornerstones of management of these hyper-inflammatory disorders are supportive care and systemic immunosuppressive therapy. The latter should start as soon as symptoms are mild-moderate. Similarly, some severe toxicities of ADCs also require immunosuppressive therapy. A multidisciplinary team including an oncologist/haematologist and a corresponding organ-site specialist (e.g. gastroenterologist in the case of colitis) should be involved in the diagnosis and treatment of these toxicities. Health professionals should be aware of potential serious complications of new systemic anticancer therapies. Early diagnosis and treatment with adequate supportive care and immunosuppressive therapy are crucial for the optimal outcome of patients with these complications.

Physicians' Knowledge of the Systematic ABCDE Approach in Riyadh, Saudi Arabia.

To evaluate physicians' knowledge of the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach components. A cross-sectional study was conducted in 2023 using an online questionnaire in order to collect data about the knowledge of the ABCDE approach's components among physicians in different specialties in Riyadh, Saudi Arabia. The number of participants were 165 in total and the median knowledge score for all participants was 15.0, with an associated interquartile range (IQR) of 10.0 to 20.0. Intensive Care Medicine had the highest median knowledge score of 19.0 (IQR: 12.0-21.0), followed by Internal Medicine at 17.0 (IQR: 13.0-20.0). Conversely, Cardiology and Anesthesiology showed lower scores, with medians of 8.0 (IQR: 4.0-10.0) and 7.5 (IQR: 4.0-13.5), respectively (p = 0.011). Senior Registrars demonstrated the highest median knowledge score of 20.0 (IQR: 14.0-22.0), while Fellows had the lowest at 8.5 (IQR: 7.0-13.0) (p < 0.001). Practicing for 10 to 15 years and more than 15 years having medians of 20.0 (IQR: 16.0-23.0) and 19.0 (IQR: 17.0-22.0), respectively. However, participants with less experience, working for less than 5 years, had a median score of 12.0 (IQR: 8.5-16.5) (p < 0.001). Knowledge scores of physicians representing various medical specialties found diverse levels regarding the ABCDE approach. Knowledge scores were significantly influenced by the primary area of practice, level of experience, and duration worked in the profession, highlighting the need for tailored training and education across different specialties and career stages. On the other hand, future studies should concentrate on finding new factors that influence practice adherence to the ABCDE approach and tying theoretical knowledge to clinical practice.

Beliefs and practices of physicians in Lebanon regarding promotional gifts and interactions with pharmaceutical companies.

Pharmaceutical companies invest greatly in promotional gifts to influence prescription of medications by physicians, yet there is limited published information evaluating its impact on healthcare. This study aimed to assess the beliefs and practices of physicians in Lebanon regarding promotional gifts and their interactions with representatives of pharmaceutical companies. This cross-sectional study was conducted between December 2019 and January 2020 through an email-based questionnaire sent to 5936 physicians of different specialties registered in the Lebanese Order of Physicians. Assessment was done using a validated tool and data analysis was conducted using SPSS version 26.0. Of the 268 respondents, 188 (70.4%) reported that physicians in Lebanon accepted gifts from representatives of pharmaceutical companies. Most of the physicians (31.7%) interacted with company representatives more than once a week. Medication samples (251 respondents) and stationary items (222 respondents) were the most common gifts accepted by physicians who admitted accepting gifts. Overall, 225 (84.9%) respondents believed that prescriptions by physicians in Lebanon were influenced by the gifts. Only 74 (40.0%) of those who accepted gifts from pharmaceutical companies believed that it was unethical, and around half did not know if the Lebanese Code of Medical Ethics allowed them to accept gifts from pharmaceutical companies. Although physicians in Lebanon were aware of the effect that gifts from pharmaceutical companies could have on their prescription behaviours, many of them still accepted the gifts. This study provides evidence to policymakers for decision-making regarding ethical guidance on interactions between physicians and pharmaceutical companies in Lebanon.

Polypragmasy and the basics of personalized rational pharmacotherapy selection in older patients with obesity and type 2 diabetes mellitus

Increasing life expectancy and, as a consequence, a large number of comorbidities lead to a multitude of medications prescribed by physicians of different specialties. Patients with obesity and carbohydrate metabolism disorders, especially with type 2 diabetes mellitus (DM2), are at particular risk of polypragmasy, which is associated with the use of potentially nonrecommended medications. Prescribing errors can cause significant harm to the patient’s health and increase the risk of rehospitalization and healthcare costs. Identification of probably not recommended drugs in this category of patients will improve understanding of prevalence and risk factors of their use, develop strategies to prevent and limit the burden of taking inappropriate drugs and promote development of personalized and patient-oriented treatment options. Tools exist to assess potentially inappropriate therapy (PIT) in the elderly and new tools and criteria are often created. However, they are not specifically aimed at people with obesity and carbohydrate metabolism disorders. Thus, these criteria usually include only a few items related to DM2. Consequently, there is a clear need for a modern tool that can be used to address PIT specifically in older adults with obesity and carbohydrate metabolism disorders.

DNA-based diagnostics of hereditary diseases of the respiratory tract

The diagnosis of orphan lung diseases often requires specific tests, and treatment is difficult due to problems in understanding the mechanisms of disease development and low incidence. When a therapy is developed, it is very expensive.The aim of the article was to present modern approaches for the genetic diagnosis of hereditary respiratory diseases.Conclusion. A physician of any specialty can encounter an orphan disease in clinical practice. The emergence of new methods for the maintenance and targeted therapy of orphan lung diseases necessitates allertness of both pediatric and adult pulmonologists. Competent management of such patients requires knowledge of the basics of genetics and the modern possibilities of DNA diagnostics, as well as close interdisciplinary cooperation between physicians of different specialties and laboratories.

Point-of-Care Cardiac Ultrasound Training Programme: Experience from the University Hospital Hradec Králové.

Point-of-care ultrasound examinations performed by physicians of different specialties are a rapidly growing phenomenon, which has led to a worldwide effort to create a standardised approach to ultrasound examination training. The implementation of emergency echocardiography by noncardiologists is mainly aimed at the standardisation of the procedure, a structured training system, and an agreement on competencies. This article summarises the current training programmes for nonechocardiographers at the University Hospital in Hradec Králové. In cooperation with cardiologists specialised in cardiac ultrasound (ECHO), an extended acute echo protocol dedicated to emergency department physicians was developed and validated in daily practice. According to our retrospective evaluation, after one year of clinical practice, we can confirm that point-of-care ultrasound examinations performed using the standardised limited echo protocol are safe and accurate. The observed concordance with comprehensive ECHO was 78%. This trial is registered with NCT05306730.

Comorbidity: alobar holoprosencephaly and pulmonary tuberculosis in a child (a case report)

Aim: to demonstrate the features of detection and management of a child with simultaneous alobar holoprosencephaly and pulmonary tuberculosis (TB) by the example from our own clinical observation. Materials and methods. A clinical case of our own observation of the simultaneous course of pulmonary TB and alobar holoprosencephaly in the child who was treated in the pediatric department of the clinical base of the Department of Phthysiatry and Pulmonology of Zaporizhzhia State Medical and Pharmaceutical University on Public Non-Profit Enterprise “Zaporizhzhia Regional Clinical and Diagnostic Center of Phthysiatry and Pulmonology” of Zaporizhzhia Regional Council. Results. The 4-year-old child diagnosed with pulmonary TB was admitted to the Pediatric Department. Previously, the child was diagnosed with alobar holoprosencephaly in a children’s hospital. His condition was severe due to the main disease. Family members, who had contact with the child, were examined to rule out TB. The index patient was a grandmother, who had recurrent drug-sensitive TB and was looking after the child living apart from the family. The treatment for TB was successful, but the child developed drug-induced hepatotoxicity. Also, the child had episodic convulsions when admitted to the department, which did not repeat after the prescribed treatment by a neurologist. Conclusions. Alobar holoprosencephaly is a severe and rare structural brain abnormality with complex and multifactorial causes. This condition can be identified at the first screening examination of a pregnant woman, so prenatal diagnosis is quite important. The disease leads to severe disability and requires assistance of physicians in different specialties. Treatment for tuberculosis is successful but demands more monitoring of side effects during antimycobacterial therapy.

The role of different educational programs in specialty preference among Chinese medical students: a cross-sectional study

BackgroundThe imbalanced supply of physicians in different specialties and the decreasing number of young doctors in China have made it important to understand specialty preference and influencing factors and to evaluate the role of different programs in specialty choice and career planning among Chinese medical students to help shape the social healthcare system and ensure adequate medical practitioners in each specialty.MethodA cross-sectional study comprising medical students from 5-year and 8-year program was conducted online. Demographics, specialty preferences and influencing factors, and career planning situations were collected and analysed by the chi-square test. Binary logistic regression analysis was performed in each program to identify the association between influencing factors and each specialty.ResultsA total of 128 students (57.03% 5-year, 42.97% 8-year) responded to our survey. More 8-year students had a doctor in their household than 5-year students (25.45% vs. 10.96%, p < 0.05). The most preferred specialty among 5-year students was surgery, followed by others and internal medicine, while that most preferred by 8-year students was surgery, followed by internal medicine, obstetrics/gynecology and anesthesiology. Compared with 5-year students, more 8-year students considered ‘personal competencies’ (66.67% vs. 40.85%, p < 0.05), ‘the reputation of the specialty’ (18.52% vs. 7.04%, p ≤ 0.05), ‘fewer doctor‒patient disputes’ (27.78% vs. 11.27%, p < 0.05) and ‘advice from family members’ (24.07% vs. 7.04%, p < 0.05) influential. Among 5-year students, ‘personal competencies’ was positively associated with preference for surgery and ‘work-life balance’ was negatively associated. Among 8-year students, ‘personal competencies’ and ‘work-life balance’ were positively associated with internal medicine, while ‘interests in the specialty’ and ‘broad career prospects’ were negatively related. Many students need further career guidance, and personalized tutoring was the most wanted method.ConclusionsThere was no difference between 5-year and 8-year students regarding specialty preference, but bias existed, possibly due to the influence of the real-world situation. Improving the working environment and welfare might be beneficial for developing a balanced distribution of the workforce among different medical departments. It is necessary for medical schools to develop programs accordingly to help them better plan their future careers.

GEMA 5.3. Spanish Guideline on the Management of Asthma

The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide.Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists.Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).

LEVEL OF BURNOUT AND ITS DETERMINANTS AMONG PROGRAM PHYSICIANS OF DIFFERENT SPECIALTIES IN MAKKAH CITY2023

Introduction: Burnout is a major problem that affect most of the residents and health care providers silently resulting in low level of satisfaction. Prior studies done in Saudi Arabia for the prevalence of burnout among programs residents in different regions, none of them was done in Makkah city. This study focuses on burnout among residents in postgraduate training Among different specialties, which can be stressful both physically and psychologically. Methodology: It is an analytical cross-sectional study data was collected by questionnaire. Calculation of sample size was done by Raosoft website. SPSS version 26 is used for data analysis. Results: The study included 282 program physicians in Makkah City. Results showed that 52.8% were female. Working hours per week varied, with 26.6% working less than 48 hours and 8.2% working more than 144 hours. 21.6% expressed a neutral opinion about their specialty, while 65.6% reported being satisfied. Among the participants, 29.8% had a low level of burnout, 27.7% had a moderate level, and 42.6% had a high level of burnout based on the total MBI scores. Factors associated with high-level burnout included maintaining an unhealthy lifestyle, being neutral or satisfied with the specialty, desiring to change the specialty, having fewer shifts per month, and working longer hours per week. Age, gender, marital status, and years of practice as a GP did not show significant associations with high-level burnout. Conclusion: This study sheds light on the prevalence of burnout and its determinants among program physicians in Makkah City. The findings underscore the significance of addressing burnout as a pressing concern within the healthcare profession. Interventions targeting workload management, career satisfaction, healthy lifestyle promotion, and specialty-specific support may be crucial in mitigating burnout and enhancing the well-being of physicians. Further research is warranted to explore additional factors contributing to burnout and to develop comprehensive interventions tailored to the specific needs of physicians in different specialties and stages of their careers.

Academic satisfaction in residents of the north zone, Mexico City

Resident academic satisfaction has been linked to academic performance and quality of care. To analyze the perception of academic satisfaction in medical residents of the North Decentralized Administrative Operation Body 2 of the Instituto Mexicano del Seguro Social (IMSS), north of Mexico City. Cross-sectional analytical study. A total of 346 resident physicians of different specialties and academic degrees were found, enrolled in the residence halls in the northern zone of the IMSS, Mexico City from January to February 2022. The dependent variable was the level of academic satisfaction. Descriptive and inferential statistics and p ≤ 0.05 were produced for statistical significance. The level of high satisfaction was 80.6% and the level of poor or low satisfaction was 1.7%. The dimension most affected in the negative bases was that of "Perception of teaching" in which 13% of the doctors surveyed refer to the need for some retraining of teachers. The best qualified dimension was "Perception of the role of autonomies" where 35.3% have an excellent perception of their personal work. The highest degree of satisfaction decreased during the second year. There is a high degree of satisfaction among resident doctors, however it is necessary to work to improve satisfaction in the remaining 20%.

Personal, social and behavioral components of emotional burnout among physicians (based on the example of a study of physicians in the Primorsky Territory)

The subject of the study is the personal, social and behavioral components of emotional burnout among medical specialists. The empirical object of the study was 340 physicians of different specialties, ages and work experience. Based on theoretical analysis, the authors of the study identify the main internal components of emotional burnout among medical specialists: the personal component (a range of certain personal characteristics and states), the social component (relationships with other people, including colleagues and patients), and the behavioral component (professional and motivational orientation of the individual and stress resistance). The methodological basis of the study is the component model of internal manifestations of emotional burnout, which consists of three components. The study used the testing method and the projective method. It was found that emotional burnout is typical (from moderate to extremely high levels) for 309 people (90.9%). The scientific novelty of the study should be considered the use of a three-component model of emotional burnout internal factors. The study determined that overall work experience has no correlation with the manifestations of emotional burnout, but young and mature age contribute to it. Target points were identified for the prevention and psychological correction of emotional burnout among medical specialists of various specialties. Programs can be drawn up based on the manifestations of each component in doctors with a high level of emotional burnout.

Knowledge and Perception of Physicians of Different Specialties in Saudi Arabia Toward Helicobacter pylori.

Helicobacter pylori (H. pylori) is a key pathogen causing several gastrointestinal diseases. Fortunately, H. pylori infection is treatable, which can lower its comorbidities. However, data assessing physicians' awareness of H. pylori is lacking in Saudi Arabia. To assess the knowledge and awareness of physicians of different specialties who practice in Saudi Arabia about H. pylori infection. This is a cross-sectional study conducted between May and September 2022 on physicians across all regions in Saudi Arabia using a validated online questionnaire covering their knowledge and awareness of H. pylori infection. An independent t-test, one-way ANOVA, and Games-Howell as a post hoc test were used to analyze the data. A General Linear Model was also employed to determine significant predictors among the variables reliant on H. pylori awareness. The results showed that the mean awareness score of 474 physicians was 76.99± 6.9, indicating that participants had sufficient knowledge about H. pylori infection. In general, the internal medicine specialists (28.3%) had better awareness of H. pylori infection than the other specialties. Moreover, the university hospital sector performed the best, scoring 80.68±13.3, and the southern region had the highest-ranked physicians with a score of 81.56 ±13.7 in terms of H. pylori awareness. Furthermore, the general linear model revealed a statistical significance (p<0.05) for the following demographic aspects concerning H. pylori awareness: the physicians' age group of 30-39 years, duration of experience of 11-15 years, the hospital sectors of Nation Guards (NGH) and Security Forces (SFH), and the southern and central regions of practice in Saudi Arabia. Physicians in Saudi Arabia have relatively sufficient awareness of H. pylori; however, they are highly influenced by age, years of experience, the hospital sector involved, and the region where the physicians practice.

Microwave Radiothermometry in Evaluating Brain Temperature Changes (Review)

Aim. This review aims to inform physicians of different specialties (anesthesiologists, intensivists, neurologists, neurosurgeons, oncologists) about the diagnostic capabilities of microwave radiothermometry, which enables to identify and analyze features of alterations of cerebral temperature in brain damage.The review displays a critical analysis of 80 recent Russian and foreign open access publications found by keywords.The review presents major clinical features and pathophysiological mechanisms of cerebral thermal balance disruptions in brain lesions. Slow responsiveness and vulnerability of cerebral thermal homeostasis regulation mechanisms that underlie development of different temperature heterogeneity levels in the cerebral cortex in healthy brain and brain lesions are highlighted. The authors postulate their concept about the critical role of hyperthermia in the pathogenesis of brain damage and disruption of interconnections in the global central regulation system. A body of evidence explaining direct association between the depth of consciousness impairment and degree of cerebral cortex temperature heterogeneity manifestation is presented. It is emphasized that a significant increase in temperature heterogeneity with areas of focal hyperthermia accompanies an acute period of ischemic stroke, while in post-comatose state usually associated with prolonged impairment of consciousness, the temperature heterogeneity significantly subsides. It has been suggested that lowering of an increased and rising of the reduced temperature heterogeneity, for example by using temperature exposure, can improve altered level of consciousness in patients with brain damage. The diagnostic capabilities of various technologies used for cerebral temperature measurement, including microwave radiothermometry (MWR), are evaluated. Data on high accuracy of MWR in measurement of the cerebral cortex temperature in comparison with invasive methods are presented.Conclusion. In healthy individuals MWR revealed a distinct daily rhythmic changes of the cerebral cortex temperature, and badly violated circadian rhythms in patients with brain lesions. Since MWR is an easy-toperform, non-invasive and objective diagnostic tool, it is feasible to use this technology to detect latent cerebral hyperthermia and assess the level of temperature heterogeneity disruption, as well as to study the circadian rhythm of temperature changes.

'Ultrasound Examination' of the Musculoskeletal System: Bibliometric/Visualized Analyses on the Terminology (Change).

Ultrasound imaging of the musculoskeletal system is paramount for physicians of different specialties. In recent years, its use has become the extension of physical examinations like using a "magnifying glass". Likewise, the eventual concept has naturally and spontaneously evolved to a "fusion" of classical physical examination and static/dynamic ultrasound imaging of the musculoskeletal system. In this regard, we deem it important to explore the current use/awareness regarding 'ultrasound examination', and to better provide insight into understanding future research spots in this field. Accordingly, this study aimed to search the global/research status of 'ultrasound examination' of the musculoskeletal system based on bibliometric and visualized analysis.

Chronic mesenteric ischemia: A review of current diagnostic and terminology issues

Introduction. Chronic mesenterial ischemia (CMI) is a group of extremely dangerous diseases, considered to be rare, clinically manifested by persistent abdominal pain syndrome, stool disorders, weight loss. CMI can develop both as a result of direct lesion of the unpaired branches of the abdominal aorta and as a result of compression from outside under the influence of extravasal factors. Up to 80 % of patients with diagnosed cardiovascular diseases have clinical manifestations of CMI.The aim of the work was to determine the etiological structure, risk factors, principles of classification and diagnosis of chronic ischemia of the digestive organs.Materials and Methods This review includes 47 papers on techniques, techniques, and outcomes of treatment interventions, selected from 835 publications found by keyword in PubMed, Google Scholar, and elibrary.ru databases with a search depth from 1990 to 2021.Results and Discussion There is no generally accepted terminology and classification of CMI. More than 90 % of CMI cases are related to atherosclerotic vascular lesion. The high-risk population includes women over 60 years of age. The classic triad of CMI symptoms includes food-related abdominal pain, weight loss, abdominal aortic auscultation murmur, but due to the nonspecific nature of the complaints, diagnosis is difficult. Clinical suspicion of CMI and re-analysis of the data increase the informative value of radial diagnostic methods.Conclusion Diagnosis of chronic mesenteric ischemia is an interdisciplinary problem, requires interaction of physicians of different specialties: general practitioner or general practitioner, abdominal and vascular surgeon, gastroenterologist, radiologist, endoscopist. The presence of clinical suspicion of CMI increases the informativeness, timeliness and adequacy interpretation of the results of high-tech methods of radiological diagnostics.

Transfusion thresholds in cardiac surgery: Commentary on Bracey et al., 1999.

Transfusion thresholds in cardiac surgery: Commentary on Bracey et al., 1999.

PSAT022 A Rare Case of Androgen Secreting Adrenal Cortical Carcinoma in a Young Woman

Abstract Introduction/Background Adrenal cortical carcinoma (ACC) is a rare disease occurring in 1 to 2 per million per year. (1) The pure androgen secreting carcinomas are even more rare and occur in only 6% of the cases of ACC. (2) These tumors have an occurrence of age which is usually bimodal either in the first or fifth decade of life. (3) Herein, we report an unusual case of malignant pure androgen secreting adrenal tumor in a woman in her second decade. Clinical Case A 19 year old female presented to the ED with abdominal pain and was found to have incidental adrenal tumor and therefore referred to endocrinology. She complained of hirsutism in the upper lip, chest and abdomen, weight gain and amenorrhea for 18 months?. Hormonal work-up revealed elevated DHEAS 755 mcg/dL (normal 27-240), serum testosterone level 306 ng/dL (normal 10-75), whereas cortisol and metanephrines levels were within normal limits. A diagnostic MRI showed a large left 10.5cm adrenal tumor and patient subsequently underwent laparoscopic left total adrenalectomy. Final pathological report revealed low grade adrenocortical carcinoma confined to the adrenal cortex. Oncology was consulted and the patient was started on adjuvant cytotoxic chemotherapy with cisplatin and etoposide followed by radiation, and mitotane therapy. Postoperatively at two months testosterone and DHEAS levels were normalized. Conclusion This case illustrates how ACC may present with atypical symptoms of hirsutism, amenorrhea, and hyperandrogenic state. Hypersecretion of both androgen and cortisol is more common occurring approximately 46% of patients with ACC but the presence of hypersecretion of isolated androgens in adrenal tumors has been associated with an increased likelihood of malignancy. (3) Physicians of different specialties should have a high degree of suspicion for adrenal involvement in the evaluation of patients with hirsutism and hyperandrogenism. Work-up should include laboratory testing along with radiographical images to help establish the diagnosis. References Angelousi A, Kassi E, Kaltsas GA. Adrenocortical Carcinoma. [Updated 2018 Oct 2]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278924/ Abiven G, Coste J, Groussin L, Anract P, Tissier F, Legmann P, Dousset B, Bertagna X, Bertherat J. Clinical and biological features in the prognosis of adrenocortical cancer: poor outcome of cortisol-secreting tumors in a series of 202 consecutive patients. J Clin Endocrinol Metab. 2006 Jul;91(7): 2650-5. doi: 10.1210/jc.2005-2730. Epub 2006 May 2. PMID: 16670169. Cavlan D, Bharwani N, Grossman A. Androgen- and estrogen-secreting adrenal cancers. Semin Oncol. 2010 Dec;37(6): 638-48. doi: 10.1053/j.seminoncol.2010.10.016. PMID: 21167382. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.