Response to Medical Students' Attitudes towards Female Sex Workers

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Lifesaving Sonography Protocols: A Pilot Course Involving Undergraduate Medical Students

Background: Ultrasonography protocols are easy to learn, frequently used in emergency medicine, and could be useful for inexperienced doctors. Inthis field, only a few protocols are needed to give an initial diagnosis and to start fast and proper treatment. Until now, only Focused Assessmentwith Sonography for Trauma (FAST) protocol training studies have been reported in the medical literature. Our point-of-care course, comprisedof extended FAST, lung scan and ocular scan trainings. The students’ curriculum usually does not include such ultrasonography courses, thus,we wanted to check its utility for the undergraduate medical students. Methods: Training lasted six days and consisted of two parts: 22 hoursof theoretical classes and 18 hours of practical activities, all trained and evaluated by six experienced medical doctors. Eighty-five electedstudents completed pre- and post-study questionnaires about emergency ultrasonography and passed the practical final exam. Results: Eighty-fiveparticipants of the course were present in the pre- and final test. Final test scores of theoretical and practical exams were significantly higherafter the training (58% vs. 87%; n=85; p<0.01). Answers for the questions related to FAST and EFAST (extended FAST) were correct irrespectiveof completion of the course. A question regarding the sonographic evaluation of body fluid incontinence was found to be the most difficult forstudents. After the course, 96.5% of participants were able to complete an EFAST scan at an adequate level of performance in under two minutes.Conclusion: Results show that medical students significantly extended their knowledge about point-of-care emergency medicine...

Ultrasonography as a Modern Teaching Support to the Anatomy Course: Is It Beneficial for Medical Students

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Romantic Name for a Deadly Condition: Kissing Aneurysms of the Pericallosal Artery – A Case Report

Background: Kissing aneurysms are two independent but adjacent aneurysms protruding from two contralateral arterial locations. This report describes a successfully treated case of kissing aneurysms at the Department of Neurosurgery, Medical University of Gdansk. Case: A 45-year-old asymptomatic woman was diagnosed with unruptured bilateral aneurysms located in the pericallosal-callosomarginal division. Her medical history included a previous intracranial aneurysm and arterial hypertension. The patient underwent a successful treatment by surgical clipping and was discharged in good condition; neither disability nor neurologic deficit was noticed upon discharge. Surgical wound healing was complicated by an infection and resulted in a reoperation for the patient. Conclusion: The etiology of kissing aneurysms is still unknown and the best treatment method stills remains unclear. Thus, every case has to be carefully and individually assessed by an interdisciplinaryteam. As a result, patient transfer to an experienced neurosurgical center could be beneficial

Spinal Cord Stimulation in Failed Back Surgery Syndrome: Review of Clinical Use, Quality of Life and Cost-Effectiveness

Failed back surgery syndrome (FBSS) is complex and recurrent chronic pain after spinal surgery. Several important patient and surgery related risk factors play roles in development of FBSS. Inadequate selection of the candidates for the spinal surgeries is one of the most crucial causes. The guidelines suggest that conservative management featuring pharmacologic approaches and rehabilitation should be introduced first. For therapy-refractory FBSS, spinal cord stimulation (SCS) is recommended in selected patients. Treatment efficacy for FBSS has increased over the years with the majority of patients experiencing pain relief and reduced medicinal load. Improved quality of life can also be achieved using SCS. Cost-effectiveness of SCS still remains unclear. However evidence for SCS role in FBSS is controversial, SCS can be beneficial for carefully classified patients

Beyond series expansions: mathematical structures for the susceptibility of the square lattice Ising model

We first study the properties of the Fuchsian ordinary differential equations for the three and four-particle contributions $\chi^{(3)}$ and $\chi^{(4)}$ of the square lattice Ising model susceptibility. An analysis of some mathematical properties of these Fuchsian differential equations is sketched. For instance, we study the factorization properties of the corresponding linear differential operators, and consider the singularities of the three and four-particle contributions $\chi^{(3)}$ and $\chi^{(4)}$, versus the singularities of the associated Fuchsian ordinary differential equations, which actually exhibit new ``Landau-like'' singularities. We sketch the analysis of the corresponding differential Galois groups. In particular we provide a simple, but efficient, method to calculate the so-called ``connection matrices'' (between two neighboring singularities) and deduce the singular behaviors of $\chi^{(3)}$ and $\chi^{(4)}$. We provide a set of comments and speculations on the Fuchsian ordinary differential equations associated with the $n$-particle contributions $\chi^{(n)}$ and address the problem of the apparent discrepancy between such a holonomic approach and some scaling results deduced from a Painlev\'e oriented approach.Comment: 21 pages Proceedings of the Counting Complexity conferenc

Increased Number of Cerebellar Granule Cells and Astrocytes in the Internal Granule Layer in Sheep Following Prenatal Intra-amniotic Injection of Lipopolysaccharide

Chorioamnionitis is an important problem in perinatology today, leading to brain injury and neurological handicaps. However, there are almost no data available regarding chorioamnionitis and a specific damage of the cerebellum. Therefore, this study aimed at determining if chorioamnionitis causes cerebellar morphological alterations. Chorioamnionitis was induced in sheep by the intra-amniotic injection of lipopolysaccharide (LPS) at a gestational age (GA) of 110 days. At a GA of 140 days, we assessed the mean total and layer-specific volume and the mean total granule cell (GCs) and Purkinje cell (PC) number in the cerebelli of LPS-exposed and control animals using high-precision design-based stereology. Astrogliosis was assessed in the gray and white matter (WM) using a glial fibrillary acidic protein staining combined with gray value image analysis. The present study showed an unchanged volume of the total cerebellum as well as the molecular layer, outer and inner granular cell layers (OGL and IGL, respectively), and WM. Interestingly, compared with controls, the LPS-exposed brains showed a statistically significant increase (+20.4%) in the mean total number of GCs, whereas the number of PCs did not show any difference between the two groups. In addition, LPS-exposed animals showed signs of astrogliosis specifically affecting the IGL. Intra-amniotic injection of LPS causes morphological changes in the cerebellum of fetal sheep still detectable at full-term birth. In this study, changes were restricted to the inner granule layer. These cerebellar changes might correspond to some of the motor or non-motor deficits seen in neonates from compromised pregnancies

The Comet Interceptor Mission

Here we describe the novel, multi-point Comet Interceptor mission. It is dedicated to the exploration of a little-processed long-period comet, possibly entering the inner Solar System for the first time, or to encounter an interstellar object originating at another star. The objectives of the mission are to address the following questions: What are the surface composition, shape, morphology, and structure of the target object? What is the composition of the gas and dust in the coma, its connection to the nucleus, and the nature of its interaction with the solar wind? The mission was proposed to the European Space Agency in 2018, and formally adopted by the agency in June 2022, for launch in 2029 together with the Ariel mission. Comet Interceptor will take advantage of the opportunity presented by ESA’s F-Class call for fast, flexible, low-cost missions to which it was proposed. The call required a launch to a halo orbit around the Sun-Earth L2 point. The mission can take advantage of this placement to wait for the discovery of a suitable comet reachable with its minimum ΔV capability of 600 ms−1. Comet Interceptor will be unique in encountering and studying, at a nominal closest approach distance of 1000 km, a comet that represents a near-pristine sample of material from the formation of the Solar System. It will also add a capability that no previous cometary mission has had, which is to deploy two sub-probes – B1, provided by the Japanese space agency, JAXA, and B2 – that will follow different trajectories through the coma. While the main probe passes at a nominal 1000 km distance, probes B1 and B2 will follow different chords through the coma at distances of 850 km and 400 km, respectively. The result will be unique, simultaneous, spatially resolved information of the 3-dimensional properties of the target comet and its interaction with the space environment. We present the mission’s science background leading to these objectives, as well as an overview of the scientific instruments, mission design, and schedule

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030