Private Medical Center Research Articles

Hypersensitivity pneumonitis against the background of the use of organic substances, probably mustard powder (clinical case)

We describe a clinical case of hypersensitivity pneumonitis against the background of the use of organic substances, probably mustard powder.Patient K. is 18 years old and lives in the city. The disease began on 01.11.2022, with complaints of cough with difficult secretion of thick sputum, shortness of breath with slight physical exertion, an increase in body temperature to 37.5 °C, a feeling of palpitations. Complaints were observed for about three weeks and increased in dynamics. Consulted a pulmonologist at a private medical center, where a diagnosis of allergic bronchitis was made and treatment was prescribed, which did not have a positive effect. On 21.11.2022, the family doctor referred him for an X-ray examination, where pathological changes in the lungs were detected. The patient was referred to a pulmonologist for consultation, and a computed tomography (CT) of the chest was also performed. Changes characteristic of hypersensitivity pneumonitis were detected, hospitalized in the pulmonology department of the Ternopil Regional Phthisiopulmonological Medical Center. It is known from the anamnesis that for about three months he worked in the production of food products where mustard powder was used, he did not use respiratory protection means.Additional examination methods were carried out. Bronchoscopy, conclusion — Catarrhal laryngitis, diffuse bilateral catarrhal tracheobronchitis. Computed tomography of the chest organs dated 22.11.2022, the conclusion is that the picture of the dissemination syndrome in the lungs is more characteristic of acute hypersensitivity pneumonitis. The patient was consulted by a cardiologist. The clinical diagnosis «Hyper­sensitive pneumonitis against the background of the use of organic substances, probably mustard powder, subacute form, diagnosed for the first time. Pulmonary insufficiency of the 2nd degree. Idiopathic mitral valve prolapse. Metabolic cardiomyopathy. Heart failure of the 0th stage». Treatment is prescribed. 09.12.2022 discharged for outpatient treatment with improvement. According to the data of the control examination (CT dated 09.01.2023) dynamics of partial resorption of hypersensitivity pneumonitis.

Assessment of Serum 25-Hydroxyvitamin D and Its Association in Type 2 Diabetes Mellitus Elderly Patients with Kidney Disease: A Retrospective Cross Sectional Study

The overall aim of this study is to determine the prevalence of vitamin D deficiency and its association with diabetic nephropathy in elderly patients with type 2 diabetes mellitus. This study is a single center retrospective cross-sectional design conducted at private medical center. The study group included all patients (18 years or older) suffering from type 2 diabetes mellitus that attended the diabetic clinic from September 2019 to January 2021. The main outcome variable is a trough level of (<20 ng/mL) for 25OHD. The patients were categorized as having diabetic nephropathy based on estimated glomerular filtration rate (eGFR). Total glycated hemoglobin (HbA1c), creatinine serum, Alb: Cr ratio, total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were compared between vitamin D deficiency groups. Univariate and multivariate logistic regression was used to investigate the association between vitamin D deficiency and other significant anthropometric and biochemical factors. A p value < 0.05 was chosen as the criterion to make decisions regarding statistical significance. Among the 453 diabetic patients included in study, 48.6% (n = 220) were male and 51.4% (n = 233) were female. The mean age ± S.D of the patients was 54.5 ± 10.6 years old. Out of 453 diabetic patients, 71.1% (95% CI: 66.9%-75.3%) had vitamin D deficiency (25OHD < 20 ng/mL). There was a statistically significant association between 25OHD level and diabetic nephropathy in elderly patients with type 2 diabetes mellitus. Diabetic patients with e-GFR < 60 mL/min more likely to have vitamin D deficiency (p < 0.001). Similarly, individuals with Alb: Cr ratio > 30 mg/g were more likely to have vitamin D deficiency (p < 0.001). Moreover, diabetic patients with serum creatinine > 1.8 mg/dL were more likely to have vitamin D deficiency (p < 0.001). The study revealed a high prevalence of vitamin D deficiency in elderly patients with type 2 diabetes mellitus. A significant association was reported between 25-hydroxyvitamin D, e-GFR and Alb: Cr ratio.

The role of marketing strategy in the activities of medical institutions under the conditions of COVID-19

The article is devoted to the topical issues of analyzing the impact of COVID-19 on the marketing activities of medical institutions. Attention is paid to the analysis of the main innovations in the field of medical marketing that arose in response to the challenges caused by the coronavirus pandemic. Changes in society's priorities were analyzed, as well as ways of adapting the marketing activities of business entities in the health care sector were investigated. Determinants of the micro- and macro-environment of medical institutions, which significantly affect the functioning of such institutions in the conditions of challenges of a different nature, in particular in the conditions of epidemics, are determined. An analysis of the competitiveness of a separate medical institution in the region of Ukraine was carried out. The authors proposed an innovative version of Maslow's matrix, which in its essence is more about safe behavior and physiological needs of the consumer. The authors paid attention to the peculiarities of maintaining pages in social networks, setting up targeted advertising, development of health care sites, partnership between medical institutions, virtual assistance of doctors and other important parameters of marketing activity. Three main interrelated topics were chosen for social media posts: COVID-19, hospital, laboratory. Based on the results of the research, recommendations were developed for improving the marketing activities of a private medical center in the context of a pandemic. The authors developed a media plan for the popularization of a comprehensive examination of the human body after suffering from the coronavirus disease. Using the example of a medical center, the implementation of new marketing trends in the work of a medical institution is described (digitalization, updating pages in social networks, implementation of online patient records, maintenance of expert accounts). Outcomes were assessed by monitoring the number of patient records. The effectiveness of the implementation of marketing innovations in the activities of these business entities in the conditions of pandemic challenges has been proven. The advantages of introducing such innovations into the activities of medical institutions and the prospects for their improvement have been studied

Providing gender affirming and inclusive care to transgender men experiencing pregnancy

Objectives and designInformation about providing professional and appropriate perinatal care to transgender men in the perinatal setting is scarce, and healthcare providers often have insufficient knowledge or skills to provide this care. In response, a quality improvement educational program for nursing staff was developed and implemented, with the goal of evaluating the impact of this intervention on nurses’ knowledge, skills, and attitudes when caring for pregnant transgender men. Setting and participantsThe training was offered to nursing staff of a 24-bed inpatient perinatal unit at a large, private academic medical center in a major East Coast city during the unit's quarterly staff meeting in March 2020. InterventionThe training covered the provision of affirming and inclusive perinatal care for transgender men. The content of the training was based on recommendations in the literature and reviewed by content experts. MeasurementsPre-test (N = 55) and post-test (N = 23) online self-administered surveys assessed nursing staff's knowledge of, comfort, and interest in providing gender affirming care for transgender men. Mann-Whitney U and Fischer's exact tests were used to determine significant changes in knowledge and attitudes over time. FindingsFindings suggest the training improved nursing staff's self-reported knowledge and skills in providing gender affirming care to pregnant transgender men over time, with participants demonstrating improved knowledge about communication around pronouns, gender identity, reproductive systems, and obstetric history. Awareness of resources for both professional development and to refer transgender patients also improved. However, persistent deficits in other knowledge, skills, and attitudes remained, suggesting that nurses would likely benefit from further support and training in transgender-specific health issues. Key conclusions and implications for practiceFindings support the utility of unit-based training in improving affirming and inclusive care in the perinatal setting. This highlights opportunities for supporting nurses’ professional practice of caring for transgender patients experiencing pregnancy and may be adapted for use in other specialty units.

Telerehabilitation as a Method for Achieving Competencies in Physical and Rehabilitation Medicine Residency Training in a Developing Country: A Protocol for a Pilot Mixed-Methods Study.

BackgroundIn the second year of the COVID-19 pandemic, Physical and Rehabilitation Medicine (PRM) residents in a developing country continue to face a lack of in-person clinical exposure and learning opportunities. With the unprecedented shift to virtual care, it remains uncertain whether residents can achieve PRM competencies using telerehabilitation as a method of instruction.ObjectiveTo determine the PRM residents' ability to achieve competencies through telerehabilitation, as perceived by different stakeholders (residents, chief residents, training officers, and department heads).MethodsThis will be a pilot mixed-methods study, employing concurrent triangulation, in the Department of Rehabilitation Medicine in one large private medical center and one large government hospital in Manila, Philippines. There will be two phases of online data collection upon approval by their respective research ethics board. The first phase will involve an online Likert-scale questionnaire to obtain the residents' self-perceived attainment of competencies and learning of PRM topics and skills specified by the International Society of Physical and Rehabilitation Medicine and the Philippine Board of Rehabilitation Medicine. The results of the survey will then be summarized and presented in a focus group discussion (FGD) with the department heads, training officers, and chief residents of the two institutions in an attempt to explain the residents' perceptions on their competencies achieved through virtual care. Afterwards, the qualitative data obtained from the FGD will then be thematically analyzed, and mixed methods integration will be employed to generate knowledge and recommendations.DiscussionIt is hypothesized that the majority of the residents had little to no experience with telerehabilitation pre-pandemic. Suddenly telerehabilitation was used to augment clinical training during the pandemic. It is uncertain whether telerehabilitation can help residents achieve competencies in the different domains of training, namely: patient safety and quality patient care; medical knowledge and procedural skills; interpersonal and communication skills; practice- and systems-based learning and improvement; reintegration of people with disabilities into the society; medical ethics and public health; quality assurance; policies of care and prevention for disabled people; and professionalism. The study results can provide insights on the aspects of a PRM curriculum that may have to be modified to ensure the training program is sensitive and appropriate to the changing training needs of the residents amid the pandemic and similar crises that may disrupt in-person clinical encounters in the future.

The Effects of Acupressure on Menopausal Symptoms: A Randomized Controlled Study

Objectives: The aim of this study was to see how weight cycling affected women's nutritional health and their risk of developing Type 2 diabetes (T2DM). Materials and Methods: Between November 2018 and May 2019, 80 women aged 18 to 65 years old applied to the Nutrition and Diet Department of a Private Medical Center and consented to participate in the study. A questionnaire form was applied to the participants, anthropometric measurements and biochemical blood parameters were evaluated. The Finnish Diabetes Risk Score (FINDRISK) was used to determine the risk of T2DM. Results: 55 of the 80 women included in the study (68.8%) entered the weight cycle, while 25 (31.2%) did not enter the weight cycle. In terms of body weight, BMI, waist circumference, body fat mass, and HOMA-IR values, there was a statistically significant difference between the groups (p0.05). While the amount of total energy, protein, fat, cholesterol, and omega-6 fatty acids in the daily diet of women who entered the weight cycle was higher than those who did not enter the weight cycle, it was observed that the intake of carbohydrates and omega-3 fatty acids were lower (p&gt;0.05). There was no significant difference between the groups regarding the FINDRISK score (p&gt;0.05). Conclusion: Weight cycling is particularly frequent among women nowadays, and it is a significant risk factor for chronic illnesses in the coming years. Although this study's duration and sample number are limited, the data obtained emphasizes the effects of weight cycling on health.

The Effect of an Education Module to Reduce Weight Bias among Medical Centers Employees: A Randomized Controlled Trial

Introduction: Weight bias, stigma, and discrimination are common among healthcare professionals. We aimed to evaluate whether an online education module affects weight bias and knowledge about obesity in a private medical center setting. Methods: An open-label randomized controlled trial was conducted among all employees of a chain of private medical centers in Israel (n = 3,290). Employees who confirmed their consent to participate in the study were randomized into intervention or control (i.e., “no intervention”) arms. The study intervention was an online 15-min educational module that included obesity, weight bias, stigma, and discrimination information. Questionnaires on Anti-Fat Attitudes (AFA), fat-phobia scale (F-scale), and beliefs about the causes of obesity were answered at baseline (i.e., right before the intervention), 7 days, and 30 days post-intervention. Results: A total of 506, 230, and 145 employees responded to the baseline, 7-day, and 30-day post-intervention questionnaires, respectively. Mean participant age was 43.3 ± 11.6 years, 84.6% were women, and 67.4% held an academic degree. Mean F-scale scores and percentage of participants with above-average fat-phobic attitudes (≥3.6) significantly decreased only within the intervention group over time (p ≤ 0.042). However, no significant differences between groups over time were observed for AFA scores or factors beliefs to cause obesity. Conclusions: A single exposure to an online education module on weight bias and knowledge about obesity may confer only a modest short-term improvement in medical center employees’ fat-phobic attitudes toward people with obesity. Future studies should examine if reexposure to such intervention could impact weight bias, stigma, and discrimination among medical center staff in the long-term.

Experience in using the service design in the development of nursing services in the republic of Kazakhstan

Background. Service design is the activity of planning and implementing changes in medical organizations to improve the quality of medical services. In Europe and the USA, service design is widespread in many large multidisciplinary medical centers. Study design. This article is a description of the experience. Methods. The authors described their own experience of using service design in the field of nursing in a private medical center in Astana. Results. The team from the Astana Medical University chose the topic: “increasing the level of satisfaction of patients with chronic diseases with the quality of nursing care in the organization of primary health care.” We used ready-made tools, reflecting their ideas on paper, flipcharts, posters and stickers. Direct data collection (interviewing and observation) by our team was carried out within one month. The planned number of patients and nurses was 10 people each. The interview focused on the subjective experience of the interviewed patients and nurses, revealing their beliefs, attitudes, level of trust and quality of communication with each other. Then the facilitators collected the completed forms and summed up the results. Thus, the focus of attention was shifted towards the low level of communication skills of nurses, taking into account the repeated complaints of patients about the lack of information about upcoming manipulations (tests, operations, diet, etc.), diseases in general, methods of self-care; lack of empathy and medical ethics. The new goal was aimed at increasing patient satisfaction with the communication skills of polyclinic nurses. To solve this problem, it was decided to conduct a two-hour express training among the nurses of the polyclinic to improve the communication skills of nurses by implementing the NURSE protocol. Conclusions. Service design has been applied for the first time in the healthcare industry of Kazakhstan as an innovative tool for improving patient-centered nursing care.

TYPE 2 DIABETES MELLITUS PREVALENCE IN PATIENTS WITH CARDIOVASCULAR DIEASES

The aim: To estimate type 2 diabetes mellitus (T2DM) prevalence in patients who came for a consultation to the private practice cardiologist. Materials and methods: 97 patients with cardiovascular diseases (СVD), visited a cardiologist in private medical center, were included (mean age 49,5 (42,8; 58,3) years, 43 (44.3 %) males) and T2DM prevalence was estimated. Results: 84 (86.6 %) patients had arterial hypertension, 19 patients (19.6 %) had coronary artery disease. Mean body mass index was 29,4 (25,2; 33,4) kg/m2. Waist circumference above recommended was observed in 78.4 %. 30 рatients (30.9 %) were overweight, 44.3 % had abdominal obesity. Almost all patients had atherogenic dyslipidemia. Total T2DM prevalence was 19.6 %, including cases of first-diagnosed diabetes (17.5 %). Conclusions: T2DM and prediabetes prevalence in our sample of patients with CVD was higer than described for the general population. Рatients with cardiovascular diseases require careful assessment of diabetes risk factors for its timely detection and for possiblу improving the outcomes.

Prevalence of depression, anxiety and stress among private medical college students in South India: A cross-sectional study

Medical education is competitive across the globe. The long duration of the medical and paramedical courses and exposure to clinical settings potentially causes mental health issues. The aim of this study was to estimate the prevalence of depression, anxiety and stress among undergraduate students in a private medical college in South India. This cross-sectional study was conducted among paramedical and medical students at a private medical college hospital and research center in South India in the year 2021. The required sample size was calculated as 783 with an expected prevalence of 53%, 95% confidence interval (CI), design effect 2.0, and non-response of 10%. The study participants were selected based on simple random sampling. After obtaining informed consent, the data was collected using an email questionnaire. Standard data collection tools such as the Perceived Stress Scale (PSS); and the Depression, Anxiety and Stress Scale - 21 (DASS-21) questionnaire were used. The investigator computed the odds ratio (OR) and adjusted odds ratio (aOR) with a 95% CI. Out of 1200 students, 1015 (85%) responded to the email questionnaire. Among them, 639 were females (63%), and 925 were paramedics (91%). Prevalence of depression, anxiety and stress were 59%, 43% and 11%, respectively. Almost 95% of students experienced moderate-to-severe stress in the last one month. Prevalence was higher among females and students of medical courses. Students of final year of college (aOR = 2.0; 95% CI = 1.2-3.5) and students of medical course (aOR = 1.5; 95% CI = 1.1-2.4) were independently associated with stress among the study participants. There is high prevalence of depression, anxiety and stress among medical college students in south India. The final year of study and medical course were independently associated with higher stress than others. We recommend periodic assessment of mental health status and additional mental health care for final year students and medical students.

Assessment of Vitamin D Level in a Sample of Iraqi Obese Women

Background: High prevalence of both vitamin D (vit. D) deficiency and obesity in world population as reported by many studies drown attention to establish the association and its direction between these two modifiable risk factors and their impact on health status which are still uncertain. Objective: To measure vit. D levels among a sample of obese women, describing some factors that may contribute for vit. D values in this sample and assess the correlation between vit. D levels and body mass index (BMI). Methods: A cross-sectional study was carried out among 100 obese women. Their age ranged between (20-50) years, during the period from 1st February to 1st August 2019. The sample was gathered from laboratory of private medical center at Palestine Street in Baghdad. vit. D was measured by (Ichroma vit D), which is a fluorescence immunoassay. Results: The mean±SD of vit. D values of the participants were found to be (16.05±6.9) ng/ml. Only two women from the sample had sufficient vit. D level of more than 30 ng/ml, (72%) of the participants found to have insufficient vit. D level 10-29.9 ng/ml and the remaining had deficiency in vit. D level &lt;10 ng/ml. A significant association was found between vit. D levels and the age participants and beverages drinking (P≤0.01). Indirect correlation was found between vit. D values of the participants, their BMI values, and waist/ hip ratios and was significant with the last P≤0.012. Conclusion: No association was found between vit. D and BMI, but there is indirect correlation between vit. D and waist/hip ratio. Highest deficiency of vit. D among age group (30-39) years old and among those who were drinking carbonated beverage. Keywords: Obese, women, vitamin D, body mass index Citation: Abdulkader HD, Al-Saffar AJ. Assessment of vitamin D level in a sample of Iraqi obese women. Iraqi JMS. 2021; 19(2): 172-181. doi: 10.22578/IJMS.19.2.6

Determination of "indeterminate score" measurements in lean nonalcoholic fatty liver disease patients from western Saudi Arabia.

BACKGROUNDNoninvasive measures to estimate liver fibrosis in lieu of biopsy in nonalcoholic liver disease (NAFLD) can broadly differentiate high vs low degrees of condition extent. However, an “indeterminate score” necessitates further clinical investigation and biopsy becomes essential, highlighting the need for identification of other noninvasive factors with accuracy for this midlevel extent and its prognosis. Lean NAFLD cases are of particular interest regarding this issue, as they present as otherwise healthy, and will benefit greatly from the less invasive assessment.AIMTo estimate the agreement of two noninvasive assessment tools in lean NAFLD patients, and assess factors related to indeterminate scores.METHODSUltrasound-diagnosed NAFLD patients, without sign of other chronic liver disease (n = 1262), were enrolled from a tertiary private medical centre between 2016-2019. After grouping by body mass index (obese, overweight, and lean), each participant underwent FibroScan. NAFLD fibrosis score (NFS) was used for subclassification (lower, higher, and indeterminate). No patient underwent liver biopsy. The kappa statistic was used to assess inter-rater agreement between the three groups on liver fibrosis degree assessed via FibroScan and NFS. Indeterminate score among the three groups was assessed to identify factors that predict its determination. RESULTSThe NAFLD study cohort was composed of lean (159/1262, 12.6%), overweight (365/1262, 29%) and obese (737/1262, 58.4%) individuals. The lean patients were significantly younger (49.95 ± 15.3 years, P < 0.05), with higher serum high density lipoprotein (52.56 ± 16.27 mg/dL, P < 0.001) and lower prevalences of type 2 diabetes mellitus, hypertension and hyperlipidaemia. All groups showed a predominance of lower fibrosis degree. The lean NAFLD patients showed a significantly lower NFS (P < 0.001). Degree of agreement between FibroScan and NFS was fair between the lean and obese NAFLD categories, and moderate in the overweight category. NFS was predictive of indeterminate score. Age was a factor among all the body mass index (BMI) categories; other associated factors, but with less strength, were serum alanine aminotransferase in the overweight category and BMI in the obese category.CONCLUSIONLean NAFLD patients showed lower degree and prevalence of liver fibrosis by NFS; however, follow-up biopsy is still needed.

Clinical and epidemiological characteristics of patients seeking COVID-19 testing in a private centre in Malaysia: Is there a role for private healthcare in battling the outbreak?

ObjectiveThis cross-sectional observational study summarized the baseline characteristics of subjects who underwent COVID-19 molecular testing in a private medical centre located in the state of Selangor in Malaysia between 1 Oct 2020 and 31 Jan 2021. We compared the baseline characteristics between subjects who were tested positive and negative of SARS-CoV-2 infection, and identified risk factors which may be predictive of SARS-CoV-2 positivity.Methods and findingsA total of 36603 subjects who were tested for COVID-19 infection via molecular assays at Sunway Medical Centre between Oct 1, 2020 and Jan 31, 2021, and consented to participate in this observation study were included for analysis. Descriptive statistics was used to summarize the study cohort, whereas logistic regression analysis was used to identify risk factors associated with SARS-CoV-2 positivity. Among the reasons listed for COVID-19 screening were those who needed clearance for travelling, clearance to return to work, or clearance prior to hospital admission. They accounted for 67.7% of tested subjects, followed by the self-referred group (27.3%). Most of the confirmed cases were asymptomatic (62.6%), had no travel history (99.6%), and had neither exposure to SARS-CoV-2 confirmed cases (61.9%) nor exposure to patients under investigation (82.7%) and disease clusters (89.2%). Those who presented with loss of smell or taste (OR: 26.91; 95% CI: 14.81–48.92, p<0.001), fever (OR:3.97; 95% CI: 2.54–6.20, p<0.001), running nose (OR: 1.75; 95% CI:1.10–2.79, p = 0.019) or other symptoms (OR: 5.63; 95% CI:1.68–18.91, p = 0.005) were significantly associated with SARS-CoV-2 positivity in the multivariate logistic regression analysis.ConclusionOur study showed that majority of patients seeking COVID-19 testing in a private healthcare setting were mainly asymptomatic with low epidemiological risk. Consequently, the average positivity rate was 1.2% compared to the national cumulative positivity rate of 4.65%. Consistent with other studies, we found that loss of smell or taste, fever and running nose were associated with SARS-CoV-2 positivity. We believe that strengthening the capacity of private health institutions is important in the national battle against the COVID-19 pandemic, emphasizing the importance of public-private partnership to improve the quality of clinical care.

The effect of central corneal thickness on Goldmann tonometry: a retrospective study.

To determine the relation between central corneal thickness and intraocular pressure. This retrospective study investigated 112 eyes from 56 individuals who underwent photorefractive keratectomy in a single private medical center between May 2018 and September 2019. Intraocular pressure readings were obtained with Goldmann applanation tonometry, and central corneal thickness measurements were evaluated preoperatively. All the examinations were repeated at 3 and 6months postoperative. At 3 and 6months postoperative, the mean intraocular pressure was only slightly reduced from baseline (mean reduction of 0.6 ± 2.0mmHg, P < 0.001 and 0.73 ± 2.14mmHg, P < 0.001, respectively). The change in intraocular pressure following photorefractive keratectomy was not clinically significant, and this change was not correlated with postoperative central corneal thickness at 3months (p = 0.620, r = 0.047). This study showed that the change in intraocular pressure following photorefractive keratectomy was not clinically significant, and ruled out a correlation in this context between the change in central corneal thickness and the delta intraocular pressure. Our results might question the axiom between central corneal thickness and intraocular pressure and may thus challenge the current clinical setting for evaluating glaucoma.

Individualized luteal phase support normalizes live birth rate in women with low progesterone levels on the day of embryo transfer in artificial endometrial preparation cycles

To analyze the impact on live birth rates (LBRs) of the individualized luteal phase support (termed iLPS) in patients with low serum progesterone (P) levels compared with patients without iLPS. Retrospective cohort study, December 1, 2018, to May 30,2019. Private medical center. A total of 2,275 patients checked for serum P on the day of blastocyst transfer were analyzed. During the study period, 1,299 patients showed serum P levels of ≥9.2 ng/mL, whereas 550 showed serum P levels of <9.2 ng/mL and received iLPS. Additionally, a historical group of 426 patients with serum P levels of <9.2 ng/mL but no iLPS were used for comparison. Eligible patients were aged ≤50 years with adequate endometrium morphology after receiving estrogens. Luteal phase support was provided with micronized vaginal P (MVP) to all women. Patients with personalized initiation of exogenous P according to the endometrial receptivity assay test, polyps, fibroids distorting the cavity, or hydrosalpinx were not included in the analysis. As routine practice since December 2018, patients with low serum P levels received an iLPS with a daily injection of 25 mg of subcutaneous P from the day of embryo transfer (ET) in addition to standard LPS (400 mg of MVP twice a day). Live birth rate. The LBR was 44.9% in the iLPS cases vs. 45.0% in patients with normal serum P levels (crude odds ratio [OR], 1.0; 95% confidence interval [CI], 0.82-1.22). By regression analysis, low serum P levels did not affect the LBR after adjusting for possible confounders (age, oocyte origin, fresh vs. frozen, day of ET, embryo quality, number of embryos transferred) (adjusted OR, 0.99; 95% CI, 0.79-1.25). Similarly, no differences were observed in other pregnancy outcomes between groups. The LBR was significantly higher in the group of patients who received additional subcutaneous P (iLPS) compared with the historical group with low serum P levels and no iLPS (44.9% vs. 37.3%; OR, 1.37; 95% CI, 1.06-1.78). In the overall population, patients showing P levels of <9.2 ng/mL on the day of ET were slightly younger and had higher body mass index and lower estradiol and P levels during the proliferative phase compared with patients with P levels of ≥9.2 ng/mL. No differences were observed with regard to the time in between the last dose of MVP and the serum P determination. After a multivariable logistic regression analysis, only body mass index and estradiol levels in the proliferative phase reminded statistically significant. Significant differences in the LBR were observed between patients with serum P levels of <9.2 ng/mL without iLPS and patients with serum P levels of ≥9.2 ng/mL when using either own or donated oocytes. Individualized LPS for patients with low serum P levels produces LBRs similar to those of patients with adequate serum P levels.

Intragastric balloon outcomes in obese patients attending Al Madar Private Medical Center

Intragastric balloon outcomes in obese patients attending Al Madar Private Medical Center

Evaluation of Newborn Screening Test for Critical Congenital Heart Disease (Cchd) in a Private Medical Center in Mexico and its Implications for being at 2550 Meters above Sea Level

Pulse oximetry screening test (POT) has been shown to be useful for in early detection of critical congenital heart disease (CCHD). The precise oxygen saturation expected at altitudes above 1500 meters above sea level is unknown, and its usefulness in children born above this height is also unknown. The target is to describe the results obtained from the POT in 100 apparently healthy newborns in a private hospital at 2550 meters above sea level where most of them were evaluated by one or more fetal-stage ultrasounds for the detection of CCHD among other things. Sex, resuscitation and weeks of gestation did not alter the results. 95 patients had “normal” prenatal ultrasound, of which 32% tested positive POT, and CCHD was also ruled out after clinical follow-up. It was concluded that all the patients with a positive test were healthy. We suggest possibility of modifying the POT parameters in order to avoid false positives is also discussed.

ATRIAL SEPTAL ANEURYSM IN ADULTS – IS IT A DEGENERATIVE HEART DISEASE?

Objective: Atrial septal aneurysm (ASA) is a localised “saccular” deformity of the interatrial septum, generally at the level of the fossa ovalis, which protrudes to the right or the left atrium or on both sides. It is a well recognised cardiac abnormality that was previously diagnosed on autopsy only, but it is now frequently picked up on routine echocardiography or during evaluation of ischemic stroke. There is a dearth of data on atrial septal aneurysm in our environment, and the authors set out to find the common cardiac abnormalities associated with atrial septal aneurysm in adults who had transthoracic echocardiographic examination in Enugu, South-East Nigeria Design and method: Conquest Medical Imaging is a private medical diagnostic centre in Enugu, South-East Nigeria. The centre offers radiologic and ultrasonography diagnostic services. The echocardiographic records of 1390 patients done over a 4-year period were retrospectively reviewed. The examinations were done with a Logic 500MD Echocardiographic machine made by General Electric. Data obtained from the echocardiography register included presence of atrial septal aneurysm, age, gender, other cardiac abnormalities present. Results: A total of 1174 adults had echocardiographic examination during the period under review, and consisted of 667 males and 507 females. The mean age of the males was 43.1 ± 6.2 years, while the mean age of the females was 45.9 ± 7.1 years. Atrial septal aneurysm was present in 28 patients representing 0.2% of the total adult population, and made up of 11 males and 17 females. 25 patients had one or more additional cardiac abnormalities, representing 89.3% of all patients with atrial septal aneurysm. Degenerative aortic valve disease, degenerative mitral valve disease, and left ventricular diastolic dysfunction were the cardiac abnormalities noted in addition. Conclusions: The frequent association of degenerative valvular heart diseases with atrial septal aneurysm in adults may suggest that atrial septal aneurysm has a degenerative aetiology in adults.

ReCiter: An open source, identity-driven, authorship prediction algorithm optimized for academic institutions.

Academic institutions need to maintain publication lists for thousands of faculty and other scholars. Automated tools are essential to minimize the need for direct feedback from the scholars themselves who are practically unable to commit necessary effort to keep the data accurate. In relying exclusively on clustering techniques, author disambiguation applications fail to satisfy key use cases of academic institutions. Algorithms can perfectly group together a set of publications authored by a common individual, but, for them to be useful to an academic institution, they need to programmatically and recurrently map articles to thousands of scholars of interest en masse. Consistent with a savvy librarian’s approach for generating a scholar’s list of publications, identity-driven authorship prediction is the process of using information about a scholar to quantify the likelihood that person wrote certain articles. ReCiter is an application that attempts to do exactly that. ReCiter uses institutionally-maintained identity data such as name of department and year of terminal degree to predict which articles a given scholar has authored. To compute the overall score for a given candidate article from PubMed (and, optionally, Scopus), ReCiter uses: up to 12 types of commonly available, identity data; whether other members of a cluster have been accepted or rejected by a user; and the average score of a cluster. In addition, ReCiter provides scoring and qualitative evidence supporting why particular articles are suggested. This context and confidence scoring allows curators to more accurately provide feedback on behalf of scholars. To help users to more efficiently curate publication lists, we used a support vector machine analysis to optimize the scoring of the ReCiter algorithm. In our analysis of a diverse test group of 500 scholars at an academic private medical center, ReCiter correctly predicted 98% of their publications in PubMed.

The Potential of Prenatal Diagnosis in the Early Detection of Congenital Malformations

We present a unique association of fetal malformations very early diagnosed by ultrasoundexamination, at 14 weeks of gestation. A 28-year-old pregnant female, was addressed in a privatemedical center from Bucharest, Romania, for a routine ultrasound screening. A detailed ultrasoundevaluation of the fetus showed numerous and significant cephalic and heart malformations. Theultrasound examination of the fetal head suggest the diagnosis of fetal lobar hydrocephalus, and theultrasound examination of the fetal heart suggest the transposition of the great vessels. The parentswere informed about the severity of the fetal malformations and decided to terminate the pregnancydue to medical reasons. Anatomopathological examination confirmed the prenatal diagnosis. Firsttrimester ultrasonography was crucial in the early prenatal diagnosis and management of themalformed fetus with a unique association of fetal malformations.