The distinguishing of uterine leiomyosarcomas (ULMS) and uterine leiomyomas (ULM) before the operation and histopathological evaluation of tissue is one of the current challenges for clinicians and researchers. Recently, a few new and innovative methods have been developed. However, researchers are trying to create different scales analyzing available parameters and to combine them with imaging methods with the aim of ULMs and ULM preoperative differentiation ULMs and ULM. Moreover, it has been observed that the technology, meaning machine learning models and artificial intelligence (AI), is entering the world of medicine, including gynecology. Therefore, we can predict the diagnosis not only through symptoms, laboratory tests or imaging methods, but also, we can base it on AI. What is the best option to differentiate ULM and ULMS preoperatively? In our review, we focus on the possible methods to diagnose uterine lesions effectively, including clinical signs and symptoms, laboratory tests, imaging methods, molecular aspects, available scales, and AI. In addition, considering costs and availability, we list the most promising methods to be implemented and investigated on a larger scale.
Introduction and purpose. Due to the outbreak of Covid-19 pandemic polish government in March 2020 decided to directs students to remote learning. This condition last -with minor exceptions- one and half year.Material and method. The aim of the study was an evaluation of public experience and attitude towards online learning.Results. All the respondents between March and May 2020 learned via online devices. The average note for e-learning was 2,99 in a 5-grade scale, while a score for stationary learning was 3,84. Students motivation, engagement and stress level decreased during remote-learning. 43% students claimed, that their marks improved during that time. The main disadvantages of online school were too much time spent in front of the screen and monotony of the lessons. Among the advantages was for example time for additional hobbies. Realisation of practical activities was more difficult or impossible for 74,9% of the respondents. Almost one quarter of the people did not have adequate home conditions to study online. Practical activities were often difficult or impossible to realise.Conclusions. Online learning was a necessity during the pandemic, however this type or gaining knowledge has both advantages and disadvantages. It influenced not only scientific issues, but also students’ motivation and sociopsychological aspects. To conclude, twice as many students prefer stationary than online learning – respectively 39,7% vs 21,1%.
Preeclampsia (PE) is a pregnancy complication that affects 5% to 8% of all pregnancies. It is a leading cause of maternal mortality that contributes annually more than 60,000 maternal deaths all over the world. Data submitted so far by clinicians are still insufficient to completely understand the disease. Despite many researches, the prediction of patients suffering from PE remains difficult. Moreover therapeutic methods are also limited and concentrated on symptomatic treatment and early termination of pregnancy. The aim of the presented article is to review current research on the PE and its long-term effects on mother and child. PE is defined as a hypertension developing after 20 weeks of gestation with at least one of the following symptoms: proteinuria, maternal organ dysfunction or foetal growth restriction. Because initially patients may be completely asymptomatic, the diagnosis is usually difficult. Untreated PE may lead to the death of both mother and neonate. In later life it predisposes woman and child to cardiovascular and metabolic diseases. Maternal consequences are related to increased risk of hypertension, stroke, thrombosis or chronic kidney disease, whilst offspring implications are directly correlated with hypertension, increased body mass index, hormonal changes and reductions in cognitive functions. In the future there is a need to develop more effective diagnostic methods of PE. Comprehensive understanding of the pathophysiology would allow to avoid many negative long-term effects and reduce its mortality rate.
Lipoedema is a chronic progressive disorder of adipose tissue leading to an enlargement of lower extremities. It is considered to be rare; however, the prevalence of the disease is underestimated because it is commonly misdiagnosed as obesity or lymphedema and the general awareness is poor. The etiology of the disorder is considered to be multifarious, including genetic inheritance, hormonal imbalance and microcirculation alterations. Diagnosis is mainly based on medical history and physical examination. Management of lipoedema is focused on reducing the symptoms, improving the quality of life and preventing further progression of the disease. The aim of this paper is to raise the awareness of the disease and provide appropriate clinical guidance for the assessment of lipoedema. We searched through the PubMed/MEDLINE database and took into consideration all of the results available as of 6 September, 2020 and outlined the current evidence regarding lipoedema epidemiology, etiology, clinical presentation, differential diagnosis, and management. Better understanding of lipoedema is crucial for establishing an early diagnosis and a proper treatment, which in turn will reduce the psychological and physical implications associated with the disease.
Introduction: Acromegaly is a chronic disease resulting from increased secretion of growth hormone. The main reason of elevated GH concentration is pituitary adenoma that originates from somatotropic cells. As a consequence, several changes in the organism appear such as progressive deformation of the skeleton with enlargement of the skull, hands and feet, growth of soft tissues, bones and internal organs as well as many other systemic complications which are responsible for increased mortality in untreated patients. Case report: A 60-year-old patient was diagnosed with acromegaly due to the pituitary macroadenoma and associated hypopituitarism in the thyroid and gonadotropic axis 4 years ago. The disease was suspected in April 2016 by a rheumatologist, and then confirmed on the basis of hormonal tests in the Endocrinology Clinic (IGF1 - 754.7 ng/ml, N: 77-224; GH - 2.51 ng/ml, no inhibition in OGTT). The imaging examination revealed a pituitary macroadenoma with dimensions of 17x15x19 mm. The medical history revealed the characteristic symptoms of acromegaly like enlargement and deformation of the fingers, enlarged nose, excessive sweating and headaches for the last 12 years. There have been several studies investigating the complications of acromegaly that found abnormalities in the cardiovascular system, metabolic disorders (dyslipidemia, abnormal fasting glycaemia), arthropathies, sigmoid polyps and nodular goiter. Due to the patient's lack of consent to the surgical intervention, treatment with a somatostatin analogue was introduced. During 2-year therapy, the normalization of IGF-1 concentration was not achieved. In October 2018 patient completely abandoned therapy with somatostatin analogue. In 2019 the lack of control of acromegaly was confirmed. During hospitalization in 2020 the uncontrolled acromegaly was stated once again. The patient still does not consent to the surgical procedure to remove pituitary macroadenoma, however, he agreed for systematic re-treatment with a somatostatin analogue. Conclusions: Isolated pharmacological treatment doesn’t always allow for sufficient control of an illness. Effective treatment of acromegaly should consist of surgery as well as conservative treatment. The introductinon of both 2nd generation analogues and GH receptor antagonists in therapeutic programs makes effective pharmacological treatment possible.
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Objective: The study was aimed to analyze the diagnostic approach to a child with a non-traumatic musculoskeletal pain registered in the pediatric Hospital Emergency Department (HED). Since the pandemic COVID-19 affects patient health and the healthcare system, we also evaluated the impact of pandemic on type of musculoskeletal symptoms. Study design: A retrospective cross-sectional study was conducted by statistical analysis of data of patients with non-traumatic musculoskeletal pain registered in HED between January 2018 and December 2020. Data of patients referred and not referred to hospital ward and admitted to HED before and during COVID-19 pandemic have been compared. Results: Majority of patients presented acute, non-trauma related, single-site pain, usually localized in the hip, the knee and the spine. 21,49% of patients were referred to a hospital ward, usually rheumatological, neurological or orthopedic. Final diagnoses in almost ¾ patients belong to the group of musculoskeletal system and connective tissue disorders. During the pandemic significantly less patients with musculoskeletal pain reported to our HED. The duration of symptoms before admission was not significantly longer than in previous years, but the problem in children and the impact of the pandemic on the musculoskeletal system in children is complex. Conclusions: Our study provides detailed information on patterns of pediatric musculoskeletal consultations in HED. A positive history of trauma preceding musculoskeletal pain in a child may only be accidentally related to the final cause. Musculoskeletal pain can be also a symptom of a lot of various systemic conditions, not only diseases of the musculoskeletal system. The still ongoing COVID-19 pandemic may require changes in the organization of the HED. We believe that the presented results can help in organizing and planning care in pediatric HEDs, develop diagnostic algorithms and training for HED staff.
Introduction and objective: Prader-Willi syndrome (PWS) is a severe genetic disorder being manifested by several symptoms such as infantile hypotonia and poor thriving outcomes, low height, hyperphagia, endocrine, reproductive and internal malfunctions and malformations. In the disease treatment, growth hormone (GH)-replacement therapy is commonly carried on. In this article, we sum up the latest clinical trials' results concerning the effectiveness and safety of GH-replacement therapy. Abbreviated description of the state of knowledge: Taking into consideration six clinical trials performed in the years 2019-2020, most of them showed positive results of GHreplacement therapy in PWS patients, not only in case of better motor skills or body composition, but also concerning their social and adaptive functioning. Moreover, as for the cessation of GH treatment, some authors seem to highlight no deterioration in cognitive functioning in patients who attained adult height after GH-treatment. Summary: GH-replacement therapy seems to be a good therapeutic option for PWS-affected individuals. Nonetheless, in our research we did not come across on any clinical trials with more than one-year-long observations. Thus, on the long term, these results can not exclude a gradual deterioration of cognitive functioning.
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