Problem In Management Of Patients Research Articles

Towards a better treatment of patients with vascular malformations: certified interdisciplinary centers are mandatory

BackgroundVascular anomalies are orphan diseases that occur in all age groups and range from purely aesthetic to potentially life-threatening conditions. This thesis paper outlines the typical conferring problems in patient management and possible structural solutions for a better patient treatment in the future. MethodsA multi-perspective author panel consisting of key stakeholders from the German Interdisciplinary Society of Vascular Anomalies and the German Society for Surgery defined problem areas and possible solutions including quality indicators as criteria for certified interdisciplinary Vascular Anomalies Centers (VAC). ResultsAccording to the literature available, clearly defined nomenclature and nosological entities often remain unused in this field, and consented diagnostic and therapeutic evidence is rare. Expert opinions dominate and in some cases lead to disparate recommendations. Typical patient problems arise from this situation, exemplified in patient vignettes. Centralized and standardized patient treatment in interdisciplinary VAC may be a solution to this problem. These centers should agree on a set of general principles and quality indicators with an additional minimum set of structural and procedural criteria. DiscussionThe present position paper outlines perspectives for implementing certified interdisciplinary VAC. There is a need for a comprehensive nomenclature, access to interdisciplinary treatment centers, more scientific evidence, and further education in this rare group of diseases. ConclusionUse of scientifically sound and patient-relevant criteria for certifying the interdisciplinary quality of VAC is expected to improve health care in Germany.

Mogamulizumab efficacy is underscored by its associated rash that mimics cutaneous T-cell lymphoma: a retrospective single-centre case series.

Mogamulizumab is a humanized antibody against chemokine receptor type 4. It was recently approved by the US Food and Drug Administration for relapsed or refractory mycosis fungoides (MF) and Sézary syndrome (SS). The most commonly reported adverse event in the phase III licensing trial was drug eruption (28%), now termed mogamulizumab-associated rash (MAR). Clinical recommendations about MAR and its treatment differ between the current package insert and postapproval insights reported from two single-centre studies that focused on its characterization, but less so on outcomes and clinicopathological differentiation from cutaneous T-cell lymphoma (CTCL). To describe our experience in the diagnosis of MAR and treatment of patients with CTCL with mogamulizumab. This is a single-centre retrospective case series study. We found a higher incidence of MAR in patients with CTCL (17 of 24, 68%) than previously reported. MAR development is associated with complete (11 of 17) or partial (four of 17) responses, with an overall response rate of 88%, compared with 29% (two of seven) in patients without MAR. Diagnosis of MAR may be obscured by its ability to mimic key CTCL features both clinically and histologically, but an absence of T-cell-receptor clonality and relatively decreased CD4 : CD8 ratio compared with baseline lesions strongly favour MAR over recurrent disease. MAR has the potential to create a significant management problem for patients on mogamulizumab. Misidentification of MAR as recurrent CTCL may detrimentally result in the premature discontinuation of mogamulizumab in patients whose disease is historically hard to treat. Thorough clinicopathological investigation of new lesions during treatment with mogamulizumab is required to inform ideal treatment decisions and achieve better outcomes.

Sleep Medicine Evaluation in the Annual Patient Management Problem (PMP) Exam for Otolaryngology Residents.

The sleep medicine has not been previously included in the patient management problem (PMP) exam for otolaryngology residents at Tehran University of Medical Sciences. The aim of this study, is to evaluate the results of this first implementation. This was a cross-sectional study. The examinees included all 62 residents from the 1st to 4th years of the Tehran University of Medical Sciences otolaryngology department. The resident scores obtained in this exam were evaluated and compared by residency year. The overall participant score was low for this part of the PMP. There was no score difference between years 1 and 3, but there was a significant positive change in year 4 (p = 0.007). This score pattern was not evident in other parts of the exam. Otolaryngology residents have insufficient knowledge toward the sleep medicine. The reasons for such scoring patterns may be due to the structure of sleep medicine training within the department which may lead to undesirable consequences.

Integrating patient management, reflective practice, and ethical decision-making in an emergency medicine intern boot camp

BackgroundIntegration of clinical skills, ethical decision-making, and reflection skills have emerged as cornerstones of clinical teaching in medical schools. This study aimed to detect whether a multimodal learning environment approach consisting of lectures, a drill, post-drill video debriefing, and written reflection in an emergency medicine rotation boot camp improves interns’ patient management skills, ethical decision-making, and reflection skills.MethodsA multimodal learning environment was created by the collaboration of emergency medicine, ethics, and medical education specialists. Multiple educational techniques involving lectures, case discussions, and role-playing a crisis scenario were applied. Pre-test and post-test, debriefing on performances on video records, video-recorded performance assessment, and reflective essays about their own and group’s performances were used to assess various aspects of the student performances. Additionally, a meeting was organized with the presence of the authors to create qualitative data obtained through the program evaluation meeting conducted on three themes: influences of teaching methods, students’ performances, and common achievements and mistakes of students.Results133 students participated. Post-test multiple-choice question (MCQ) test scores were slightly higher than pre-test. A low and medium correlation was detected among pre-test and post-test patient management problem (PMP) and reflection scores, which was more prominent for female students. Multiple linear regression showed that pre-test and post-test PMP scores significantly contributed to reflection scores. These results might support that better patient management predicts more robust reflective practice. Teachers observed that students appreciated being inspired by well-performing peers, particularly noting the empathic needs of patients, companions, and other health professionals. However, students overlooked summoning forensic or social services and were inhibited by the pressure of the contextual traits of the drill.ConclusionThe multimodal learning environment created by multidisciplinary collaboration contributed to the improvement of components of situational awareness of the interns: patient management skills, ethical decision-making, and reflective practice. During this research, we created a toolbox better to capture the richness and diversity of student interactions. Considering the scarcity of context-specific assessment methods and widespread use of MCQs or generic scales for higher-order thinking skills in medicine, this study might be regarded as a step forward in that context.

Greater Nursing Role for Enhanced Post-Percutaneous Coronary Intervention Management.

Percutaneous coronary intervention (PCI) has increasingly been used in management of coronary artery diseases (CAD). Coupled that with an increasing incidence rate of CAD has augmented the hospital burden with consequential post-PCI patient management problems and dissatisfaction. Nursing care has a key role to play in upgrading the healthcare services and raising patients’ satisfaction through enhanced patient education and engagement. In this regard, nursing-led intervention has shown some success in three main domains: risk reduction; psychological improvement; and quality of life. Urgent efforts are needed to formulize a structured follow-up with enhanced nursing role in post-PCI management to raise quality of healthcare.

Clinical and anamnestic characteristics of patients with an implanted cardioverter-defibrillator in real clinical practice (data from the Kuzbass register)

Aim To study the consistency of the practice of management, selection and routing of patients at high risk of sudden cardiac death (SCD) selected for cardioverter-defibrillator implantation (CDI) with current clinical guidelines and to evaluate the quality of subsequent outpatient follow-up and treatment based on a retrospective analysis of clinical amnestic data from the Kuzbass Registry of Patients with CDI.Material and methods The study was based on the Registry of Patients with Implanted Cardioverter Defibrillator and included successive data of 28 patients hospitalized to the Kizbass Cardiological Center from 2015 through 2019. Social and clinical amnestic characteristics, indications for CVI, and concomitant drug therapy were analyzed retrospectively. Statistical analyses were performed with the Statistica 10.0 software (Statsoft, USA).Results Median age of patients was 59 (53; 66) years; 239 (83.6 %) men were included; 29 (10.1%) people were employed, CHI was performed in 182 (63.6 %) patients for prevention of SCC, and for secondary prevention in 104 (36.4 %) patients. 208 (72.7 %) patients were diagnosed with ischemic heart disease (IHD), and 145 (67.9 %) of them underwent myocardial revascularization. Noncoronarogenic diseases were found in 78 (27.3 %) patients, and most of them were diagnosed with dilated cardiomyopathy. All patients had chronic heart failure (CHF); half of them had stage IIA CHF. Median left ventricular ejection fraction was 30 (25; 36,5) % according to echocardiography using the Simpson method. Comorbidity was found in 151 (52.8 %) patients. 128 (44.8%) patients received a triple neurohormonal blockade for CHF treatment; titration to target doses was not performed in any of them. Antiarrhythmics were administered to 150 (52.4 %) patients.Conclusion According to the data from the Kuzbass Registry of CVI, the main patient cohort consisted of men of pension age with IHD and CHF. Before CVI, more than a half of them had not received an optimum drug therapy and not all of them had received target lesion revascularization. Creating and analysis of Registries of CHI patients is an effective method for identifying existing problems in patient management before CVI and for optimizing their subsequent follow-up and treatment.

Problems in patient management and the impact of osteoporosis therapy on the incidence of clinical infection

The global diversion of health resources during the COVID-19 pandemic from the provision of routine medical care, and the more frequent and severe course of this infection in older patients justify the need to study the impact of the pandemic on the management of patients with osteoporosis.Aim – to assess the impact of the COVID-19 pandemic on the management of patients with osteoporosis, as well as the impact of anti-osteoporotic drugs on the incidence of COVID-19.Material and methods. A cross-sectional study was conducted, including a telephone survey and analysis of outpatient records of 304 patients with osteoporosis, who were recommended therapy with anti-osteoporotic medications. The average age was 70.8±8.8 years. The vast majority of patients took bisphosphonates in oral or parenteral forms.Results. Problems with the timely conduct of laboratory tests were noted by 91 (30.4%) subjects, DXA testing – 98 (32.8%). 65 (22.1%) were unable to receive the drug in a timely manner. Problems were more common when taking parenteral drugs (p=0.002). The cumulative incidence of COVID-19 was 12.2%, which is twice as high as in the population. There was a tendency to a lower incidence of confirmed SARS-CoV-2 infection when treated with denosumab or zoledronic acid. COVID-19 cases were not associated with either a vitamin D dose or a 25(OH)D level.Conclusions. During the COVID-19 pandemic, there is a significant decline in the quality of medical care for patients with osteoporosis, which cannot but lead to a new epidemic in the future – an epidemic of low-energy fractures. Our data confirmed the predisposition of older age groups to a higher incidence of COVID-19. However, there is no clear association of osteoporosis therapy with the risk of developing clinical manifestations of COVID-19.

Comparison of electronic versus conventional assessment methods in ophthalmology residents; a learner assessment scholarship study

BackgroundAssessment is a necessary part of training postgraduate medical residents. The implementation of methods located at the “shows how” level of Miller’s pyramid is believed to be more effective than previous conventional tools. In this study, we quantitatively compared electronic and conventional methods in assessing ophthalmology residents.MethodsIn this retrospective study, eight different conventional methods of assessment including residents’ attendance, logbook, scholarship and research skills, journal club, outpatient department participation, Multiple Choice Question (MCQ), Objective Structured Clinical Examination (OSCE), and professionalism/360-degree (as one complex) were used to assess 24 ophthalmology residents of all grades. Electronic media consisting of an online Patient Management Problem (e-PMP), and modified electronic OSCE (me-OSCE) tests performed 3 weeks later were also evaluated for each of the 24 residents. Quantitative analysis was then performed comparing the conventional and electronic assessment tools, statistically assessing the correlation between the two approaches.ResultsTwenty-four ophthalmology residents of different grades were included in this study. In the electronic assessment, average e-PMP scores (48.01 ± 12.40) were much lower than me-OSCE (65.34 ± 17.11). The total average electronic score was 56.67 ± 11.28, while the total average conventional score was 80.74 ± 5.99. Female and male residents’ average scores in the electronic and conventional method were (59.15 ± 12.32 versus 83.01 ± 4.95) and (55.19 ± 10.77 versus 79.38 ± 6.29), respectively. The correlation between modified electronic OSCE and all conventional methods was not statistically significant (P-value >0.05). Correlation between e-PMP and six conventional methods, consisting of professionalism/360-degree assessment tool, logbook, research skills, Multiple Choice Questions, Outpatient department participation, and Journal club active participation was statistically significant (P-value < 0.05). The overall correlation between conventional and electronic methods was significant (P-value = 0.017).ConclusionIn this study, we conclude that electronic PMP can be used alongside all conventional tools, and overall, e-assessment methods could replace currently used conventional methods. Combined electronic PMP and me-OSCE can be used as a replacement for currently used gold-standard assessment methods, including 360-degree assessment.

95 Evaluating The Rate, The Predictors And The Outcomes Of Patients With Negative Appendectomy(NAR)

Abstract Introduction Appendectomy is associated with complications and negative appendicectomy. We evaluated the rate and predictors of NAR in a cohort. Method Patients' data who underwent emergency appendicectomies over a year was analysed. A definition of NA; absence of inflammatory cells in the appendix. The NAR was calculated using (NAR-SDC) and (NAR-STC). Leucocytosis was a total WBC &amp;gt;11000/mm3, elevated CPR &amp;gt;5 mg/L. Results 372 patients were included. Median durations of symptoms 2 days. The mean admission WBC, CRP and serum bilirubin levels were 12,600 (3000-38000)/mm3, 66.9 (1-323) mg/L and 12.7 (4-38) µmol/L respectively. Laparoscopic appendectomy was performed in 93.5% with a conversion rate of 4.6%.NAR-SDC was 10.2% and NAR-STC was 25.8%. NAR was higher in females than males (39.4% versus 11.1%; p-value 0.0001). Patients with NA were younger (p-value 0.0001), had lower WBC (p-value 0.014), CRP (p-value 0.0001) levels on admission. Female gender, duration of symptoms more than 3 days, lower WBC were found to be predictors of NAR. Conclusions NA is a problem in management of patients with acute right lower abdominal pain. Our NAR compared favourably with reported rates. Female gender, symptoms more than 3 days, lower WBC were predictors of NA.

Diabetes and Tuberculosis: Challenge of Modern Medicine

The world medical community is strongly concentrated on the fight COVD-19, HIV/AIDS, tuberculosis. The combination of two or more concurrent nosologies is a major problem in patient management. Thus considering the abovementioned facts, we would like to focus your attention on such comorbidities as diabetes and tuberculosis. Patient M., 49 y.o., type 2 diabetes during 10 years. In July 2018, she consulted her physician and complained of non-productive mild cough, low-grade fever, fatigue, reduced workability. After the follow-up examination which involved chest X-ray and complete blood cell count, she was diagnosed with an abscess forming pneumonia in the right lower lobe and prescribed treatment with the use of broad-spectrum antibiotics according to the protocol. After the treatment, the patient’s condition has slightly improved, though the labile diabetes with frequent episodes of hypoglycemia and hyperglycemia, and cough still persisted. The level of HbA1C was 7.8%. At the patient’s request, she continued to receive: glimepiride 6 mg/day, metformin 1000 mg/day. Considering the patient’s general condition as gradual recovery the doctor has discharged the patient. In January 2019, the patient consulted a tuberculotherapist, because the cough persisted, the body temperature markers sometimes attained feverish indices, the general weakness increased. After the follow-up examination: complete blood cell count, chest X-ray, sputum smear microscopy, genetic-molecular study with GeneXpert-test and culture test on the BACTEC system, the patient was diagnosed with disseminated tuberculosis with bacterial excretion, susceptible. The patient received treatment according to the 2HRZE 4HR scheme. Results: the treatment was completed, whereas the cavern was preserved, the patient refused to undergo surgical treatment. After 7 months, the previous symptoms reappeared, after additional examination the patient was diagnosed with multi-drug resistant tuberculosis and was prescribed treatment with second-line agents for 20 months, and the patient was given insulin degludec/aspart at a daily dose of 64 IU. The therapy resulted in patient’s recovery, the cavern was closed, and compensation of diabetes was achieved: no episodes of hypoglycemia were recorded; the HbA1C - 6.5%. Analyzing the previous data it is necessary to note the mistakes that were made. The mismatch of clinical symptoms with the established diagnosis, the absence of a sputum smear for acid-resistant bacteria, apical localization of tuberculosis which is typical for patients with diabetes was not characteristic in this case, all these factors have led to an incorrect diagnosis at the primary level. At the beginning of tuberculosis treatment, the patient should be transferred to the correction of blood glucose levels with insulin and, if the cavern preserves, the patient should be prepared for its surgical removal.

Rocuronium reversed with sugammadex for thymectomy in myasthenia gravis: A retrospective analysis of complications from Japan.

Postoperative respiratory failure is a serious problem in the anaesthetic management of patients with myasthenia gravis who undergo thymectomy. Although the classical recommendation is to avoid neuromuscular blockers, there is no strong evidence to support it. To evaluate the postoperative outcomes in patients with myasthenia gravis after thymectomy when anaesthetic management included rocuronium reversed with sugammadex. A retrospective cohort study. Nationwide acute in-patient care database. A total of 1143 patients with myasthenia gravis who underwent thymectomy were included. Data were collected from the medical insurance claims data of acute care in-patient hospitals. The postoperative complications when rocuronium reversed with sugammadex was compared against no muscle relaxant use using propensity score matching. The primary outcomes were the rates of in-hospital mortality, plasma exchange following thymectomy and the use of immunoglobulins. The secondary outcomes were the length of stay in the high dependency/ICUs, the total length of hospital stay and the duration and type of respiratory support following thymectomy. There were no significant differences between the propensity score matched groups in terms of plasma exchange [relative risk, 0.96; 95% confidence interval (CI), 0.64 to 1.43] and use of immunoglobulins (relative risk, 1.09; 95% CI, 0.60 to 1.97). The length of hospital stay was significantly shorter in patients in whom rocuronium and sugammadex were used: 29.0 vs. 35.4 days, P = 0.035. Anaesthetic management with rocuronium reversed by sugammadex was not associated with increased risk of respiratory complications. These findings could help in the anaesthetic management of patients with myasthenia gravis.

Evaluation of Some Salivary Parameters in a Group of Children Suffering From Rampant Caries in Ismailia City

Introduction: Rampant caries (RC) is a severe form of dental decay with multifactorial origin. RC poses a challenging management problem for dentists and patients. Aim: the aim of the study was to evaluate and compare between some salivary parameters: pH, buffering capacity, total protein, flow rate and zinc concentration in a group of children suffering from rampant caries and others with normal caries activity in Ismailia city. Material and methods: sixty apparently healthy children aged from 3-5 years of both sexes. According to dmfs index the selected children were divided into three groups. Saliva samples were examined for salivary pH changes, measured by pH meter, Buffering capacity by titratable acidity, Total protein by colorimetric method, Flow rate by drooling method and Zinc concentration using an atomic absorption spectrophotometer. Results: there was no statistically significant difference between mean salivary pH values in three groups. Salivary buffering capacity results showed, group I had a statistically significantly highest mean buffering capacity, There was no statistically significant difference between group II and group III, salivary total proteins showed no statically significant difference between group I and group II; both showed the statistically significant highest mean total protein, but group III showed the statistically significant lowest mean salivary total protein. There was no statistically significant difference between the three groups in salivary flow rate and Zn concentration. Conclusion: salivary pH, flow rate and Zn conc. can’t be used as an indicator for occurrence of rampant caries but salivary total protein and salivary buffering capacity may be used. Introduction: Rampant caries (RC) is a severe form of dental decay with multifactorial origin. RC poses a challenging management problem for dentists and patients. Aim: the aim of the study was to evaluate and compare between some salivary parameters: pH, buffering capacity, total protein, flow rate and zinc concentration in a group of children suffering from rampant caries and others with normal caries activity in Ismailia city. Material and methods: sixty apparently healthy children aged from 3-5 years of both sexes. According to dmfs index the selected children were divided into three groups. Saliva samples were examined for salivary pH changes, measured by pH meter, Buffering capacity by titratable acidity, Total protein by colorimetric method, Flow rate by drooling method and Zinc concentration using an atomic absorption spectrophotometer. Results: there was no statistically significant difference between mean salivary pH values in three groups. Salivary buffering capacity results showed, group I had a statistically significantly highest mean buffering capacity, There was no statistically significant difference between group II and group III, salivary total proteins showed no statically significant difference between group I and group II; both showed the statistically significant highest mean total protein, but group III showed the statistically significant lowest mean salivary total protein. There was no statistically significant difference between the three groups in salivary flow rate and Zn concentration. Conclusion: salivary pH, flow rate and Zn conc. can’t be used as an indicator for occurrence of rampant caries but salivary total protein and salivary buffering capacity may be used.

Abstract PS17-43: Sco-101 is a novel oral drug that reverses antiestrogen resistance in breast cancer cells

Abstract Breast cancer is the most frequent cancer diagnosed in women and 80% of all cases of breast cancer patients present with estrogen receptor (ER)-positive disease. Treatment with antiestrogens most notable tamoxifen and faslodex are effective for a large proportion of ER-positive breast cancer. However, antiestrogen resistance eventually arises in all patients with advanced disease. Thus, antiestrogen resistance represents a major problem in the clinical management of breast cancer patients and there is currently no treatment to overcome resistance to antiestrogens. SCO-101 is an oral drug currently being tested in a Phase II clinical trial enrolling metastatic colorectal cancer patients with drug resistant disease (ClinicalTrials.gov Identifier: NCT04247256). In the current work, we investigated the potential of SCO-101 to act in combination with the antiestrogens tamoxifen or fulvestrant (faslodex) in antiestrogen resistant breast cancer cell lines (MCF-7/LCC-2, MCF-7/LCC-9, T47D/TR1) and - as a negative control - the ER negative MDA-MB-231. Treatment effects were investigated by MTT cell viability assays, siRNA knock-down experiments and western blots. SCO-101 only had minor inhibitory effects on cell viability when administered alone. Interestingly, when combining SCO-101 with tamoxifen or fulvestrant in MCF-7 or T47D antiestrogen resistant breast cancer cells, an additive to synergistic effect on cell viability was observed. In contrast to these results, SCO-101 in combination with antiestrogens had no effects on the triple negative MDA-MB-231 cell line, indicating the ER and or PR (progesterone receptor) is important for the effect of SCO-101 in antiestrogen resistant breast cancer cells. As SCO-101 has been described to targets the volume-regulated anion channel (VRAC), in which LRRC8A is the essential subunit, we investigated whether knockdown of LRRC8A would impact the treatment outcome. No apparent changes in response to SCO-101 and antiestrogens were observed upon the knockdown. Additionally, the protein level of LRRC8A was examined upon treatment with anti-estrogens +/- SCO-101 and the treatment did not alter LRRC8A protein expression. Our findings strongly suggest that SCO-101 interferes with antiestrogen resistance in breast cancer and we have recently received an EURECA Eurostars grant to further investigate the molecular mechanisms of action for SCO-101 in reversing antiestrogen resistance, to investigate drug response in 3D breast cancer models, and to conduct a Phase Ib dose escalation clinical trial with SCO-101 and faslodex in patients with antiestrogen resistant ER positive breast cancer. Citation Format: Jan Stenvang, Ida CB Madsen, Katrine Hartfelt, Haatisha Jandu, Signe L Nielsen, Palle Christophersen, Nils Brünner. Sco-101 is a novel oral drug that reverses antiestrogen resistance in breast cancer cells [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS17-43.

Human Immunodeficiency Virus type 1 Drug Resistance Mutations in Patients Failing Antiretroviral Therapy in Lebanon from 2009 to 2013

Background: Antiretroviral drug resistance remains a significant problem in the clinical management of patients infected with the Human Immunodeficiency Virus type-1. Aim: This study investigates and reports data on the molecular characterization of HIV-1 isolates from patients who are in a state of therapy failure. Methods: This is a retrospective study conducted on 65 patients in therapy failure. Inclusion criteria included patients diagnosed as being in therapy failure between the years 2009 and 2013. We defined ART failure as either a failure to achieve viral suppression or a failure to detect viral loads below 500 copies/mL after virological suppression in at least two plasma samples. We used the published WHO list for surveillance of transmitted resistance and the Stanford HIV Drug Resistance Database to identify drug resistance mutations. Results: 65% of the participants had at least one drug resistance mutation (DRM). 12% of the population sampled had resistance to only one ART class, 32% presented with resistance to two classes of antiretroviral drugs, and 20% had resistance to all three classes of drugs. The prevalence of nucleoside transcriptase inhibitor (NRTI) mutations was 55%, the most common DRM being M184V. The prevalence of non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations was 58%, with the most common mutation being the K103N mutation. The prevalence of protease inhibitors drug resistance mutations was 23%, with mutations V82A and I47V being present in 10% of the study population. Conclusion: Our study is the first molecular characterization of DRM emergence in HIV-1 strains from patients failing antiretroviral therapy in Lebanon. Continuous monitoring of resistance patterns for HIV in the country is necessary to tackle the emergent drug resistance.

A comparative evaluation of role of gender, age and socioeconomic status on perceived dental anxiety of 4-8 years old children using two scales

Dental anxiety is a common problem that affects people of all ages and appears to develop mostly in childhood and adolescence. Dental anxiety in children has been recognized as a problem in patient management for many years. It is important that dentists are able to assess dental anxiety in child patients as early as possible so that they may identify patients who are in special need with regards to their fear. Age, gender and socioeconomic status play an important role as determining factors in dental anxiety, hence should be considered while measuring dental anxiety. A randomized control study was conducted in 4 to 8 years old children using two scales. A list of children from 14 schools in Gautam Budh Nagar district (U.P.) was collected and 1025 children were randomly selected. The children were asked about how they feel when they visit a dentist, by VPT and FIS separately their role with gender, age and socioeconomic was evaluated.To do comparative evaluation of role of gender, age and socioeconomic status on perceived dental anxiety of 4 to 8 years old children using two scales. Among 1025 children, 532(51.9%) were males and 493 (48.1%) were females. Age wise comparison of both scales score revealed that mean FIS score was statistically significant and higher than mean VPT scale among 7 and 8 year age groups. Among 4, 5 and 6 year age group, no statistically significant difference was found between two scales. Dental anxiety is found to increase with increasing age. Females had a similar level of anxiety as compared to males and Children from low SES had a high level of dental anxiety than children from high SES.

Organization of Urological and Oncourological Care for Patients in a Pandemic of COVID-19: Overcoming Existing Limitations

The new coronavirus infection pandemic has certainly changed all spheres of human activity, the healthcare system was completely transformed and reassignment in a short time. The built model of a personalized approach to each patient was replaced by the provision of health services to groups of patients with similar symptoms of the disease and severity, and conditions not associated with coronavirus infection, anyway, took a back seat. Since the announcement of the COVID-19 pandemic, the main human and material resources have been directed at combating the new infection. To date, almost every country has cases of coronavirus infection. The planned surgical care was temporarily stopped, what could not but affect the outcomes of diseases. A special category of patients is represented by patients with diagnosed malignant neoplasms, the delay in treatment of which can significantly reduce the life expectancy and/or quality of life. The current state of the problem served as a catalyst for the development of telemedicine technologies, which simplified communication in the patient-physician and physician-physician relationship. Urinary tract infections are one of the most common reasons for visiting a urologist, which implies the prescription of antibacterial drugs. However, in a pandemic, remote prescription of these drugs is limited by the lack of face-to-face specialist consultations. This enabled make it possible to use drugs based on bacteriophages. Patient management problems were solved by using distance counseling techniques. In this article we present an algorithm for providing urological and oncourological care to patients in the context of the COVID-19 pandemic, as well as an overview of the existing world practice in the implementation of telemedicine consultations in the current epidemiological situation.

A Population-Based Analysis of Distant Metastasis in Stage IV Gastric Cancer.

BackgroundDistant metastasis (DM) is a crucial problem in management of patients with gastric cancer. Identification of the risk factors for development of DM and the prognostic factors for patients with DM is essential in development of individualized treatment of patients at the advanced stage with specific metastasis.Material/MethodsRecords of patients with gastric cancer were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Survival duration of patients with specific DM was estimated, and the prognostic factors were investigated using the Cox proportional hazard regression model. The logistic regression model was used to reveal the inherent risk factors for development of DM.ResultsEventually, 32.6% (11,918 out of 36,588) of gastric cancer patients were diagnosed with DM between 2010 and 2015, among whom 5,361, 1,778, 1,495, and 231 patients were diagnosed with liver, lung, bone, and brain metastasis, respectively. The median overall survival for patients with DM was 5.0 (95% CI: 4.8–5.2) months, with a 5-year survival rate of 3.9%. Primary tumor site, histology types, tumor grade, T stage, N stage, surgery, chemotherapy, and the number of metastases were associated with worse survival. Younger age and higher tumor grade were positively associated with the development of DM.ConclusionsInitial DM was found in 32.6% of patients with gastric cancer. Homogenous and heterogenous predictive factors were identified for patients with a specific metastatic site, which can be used in targeted screening and individualized treatment.

Research progress on clinical management of elderly patients with type 2 diabetes complicated by weakness

Frailty has gradually become a new important complication for elderly patients with type 2 diabetes, which has been widely concerned. This paper expounds the occurrence, development mechanism and influencing factors of elderly patients with type 2 diabetes complicated by weakness, discusses the existing problems in the clinical management of elderly patients with type 2 diabetes complicated by weakness in China, and makes recommendations. Key words: Review; Aged; Diabetes, type 2; Weakness

Non-responsiveness and tachyphylaxis to anti-vascular endothelial growth factor treatment in naive patients with exudative age-related macular degeneration.

Age-related macular degeneration (AMD) is a leading cause of central visual loss in people aged over 50 years in well developed countries. Although the anti-vascular endothelial growth factor (VEGF) therapy has become a standard treatment for exudative AMD, its effectiveness may be limited in some cases. We aimed to assess the prevalence of non-responsiveness and tachyphylaxis to anti-VEGF drugs in patients with exudative AMD. The study included 63 initially treatment-naive AMD patients who were analyzed for non-responsiveness and tachyphylaxis to intravitreal injections (IVI) of ranibizumab and aflibercept. The participants were enrolled in a National Healthcare Fund (NHF) Therapeutic Program for the Treatment of Exudative AMD. Best-corrected visual acuity (BCVA) and morphological features of a disease activity assessed in optical coherence tomography (OCT) were evaluated during a 12-month follow-up. The percentage of non-responders achieved 22.2% (14 eyes). No significant correlation was found between the type of VEGF inhibitor and a negative response to therapy. Eight patients (12.7%) developed early tachyphylaxis, which was more common in eyes treated with aflibercept (P = 0.04). The presence of serous pigment epithelium detachment (sPED) at baseline was associated with non-responsiveness as determined by both BCVA (OR 18.2, 95% CI 2.86 - 248; P = 0.021) and OCT features (OR 23.0, 95% CI 1.80 - 321; P = 0.030). Eyes treated with aflibercept showed statistically significant greater BCVA improvement (P = 0.0034) and central retinal thickness (CRT) reduction (P = 0.0129) as compared to ranibizumab group during a loading phase of therapy. In a maintain phase of treatment the differences in BCVA and CRT between these two groups were not statistically significant, however eyes treated with aflibercept still showed better functional and anatomical results. Anti-VEGF therapy is an effective method of treatment for exudative AMD, however some patients may show week or no positive reaction or may develop tachyphylaxis. Awareness of these possible negative effects is an important clinical problem in the long-term management of AMD patients with VEGF inhibitors.

Idiopathic Intracranial Hypertension: The Monster Within.

Idiopathic intracranial hypertension (IIH) is defined as a syndrome of raised intracranial pressure with normal imaging of the brain and cerebrospinal fluid (CSF) composition. There are many controversies and myths that surround IIH. Although patients of IIH may present “typical” symptoms and signs of raised intracranial pressure, clinical scenarios often vary. A typical clinical and radiological finding poses significant problems in diagnosis and management of patients with IIH. We have tried to resolve these controversies and provide a comprehensive update on different aspects of IIH. In this article, we review the common problems encountered while dealing with patients of IIH.