Clinical characteristics and evaluation of the incidence of cryptococcosis in Finland 2004-2018

Background Cryptococcosis is one of the major causes of mortality among HIV patients worldwide. Though most often associated with late stage HIV infection/AIDS, a significant number of cases occur in other immunocompromised patients such as solid organ transplant recipients and patients with hematological malignancies. Immunocompromised patients are a heterogeneous group and their number increases constantly. Since little is known about the incidence and the clinical features of cryptococcosis in Northern Europe, our aim was to investigate the clinical characteristics of cryptococcosis patients in Finland. Methods We retrospectively reviewed the laboratory confirmed cryptococcosis cases in Finland during 2004-2018. Only those who were treated for cryptococcosis were included in the study. Initial laboratory findings and medical records were also collected. Results A total of 22 patients with cryptococcosis were included in our study. The annual incidence of cryptococcosis was 0.03 cases per 100,000 population. Ten patients were HIV-positive and 12 out of 22 were HIV-negative. Hematological malignancy was the most common underlying condition among HIV-negative patients. Conclusions To our knowledge, this is the first study of the clinical presentation and incidence of cryptococcosis in Finland. We demonstrate that invasive cryptococcal infection occurs not only in HIV/AIDS patients or otherwise immunocompromised patients but also in immunocompetent individuals. Even though cryptococcosis is extremely rare in Finland, its recognition is important since the prognosis depends on rapid diagnostics and early antifungal therapy.Peer reviewe

Clinical characteristics and evaluation of the incidence of cryptococcosis in Finland 2004-2018

Background: Cryptococcosis is one of the major causes of mortality among HIV patients worldwide. Though most often associated with late stage HIV infection/AIDS, a significant number of cases occur in other immunocompromised patients such as solid organ transplant recipients and patients with hematological malignancies. Immunocompromised patients are a heterogeneous group and their number increases constantly. Since little is known about the incidence and the clinical features of cryptococcosis in Northern Europe, our aim was to investigate the clinical characteristics of cryptococcosis patients in Finland.Methods: We retrospectively reviewed the laboratory confirmed cryptococcosis cases in Finland during 2004-2018. Only those who were treated for cryptococcosis were included in the study. Initial laboratory findings and medical records were also collected.Results: A total of 22 patients with cryptococcosis were included in our study. The annual incidence of cryptococcosis was 0.03 cases per 100,000 population. Ten patients were HIV-positive and 12 out of 22 were HIV-negative. Hematological malignancy was the most common underlying condition among HIV-negative patients.Conclusions: To our knowledge, this is the first study of the clinical presentation and incidence of cryptococcosis in Finland. We demonstrate that invasive cryptococcal infection occurs not only in HIV/AIDS patients or otherwise immunocompromised patients but also in immunocompetent individuals. Even though cryptococcosis is extremely rare in Finland, its recognition is important since the prognosis depends on rapid diagnostics and early antifungal therapy.</p

Lääketieteen opiskelijoiden työelämälähtöinen näkemys perusopetuksen kehityskohteista

Tiivistelmä Entistäkin parempia kesäkandeja Lääketieteen perusopetuksen tärkeä tavoite on antaa opiskelijalle hyvät käytännön valmiudet toimia lääkärin tehtävissä. Suurin osa ylimpien vuosikurssien opiskelijoista työskentelee kesäaikana lääkärinä. Pyysimme kesätöissä olleita kahden ylimmän vuosikurssin opiskelijoita arvioimaan työelämävalmiuksiaan ja antamaan ehdotuksia perusopetuksen kehittämiseksi. Onnistumisia oli koettu ammattihenkilöstön välisen yhteistyön, potilas-lääkärivuorovaikutuksen ja potilaan haastattelemisen osa-alueilla. Heikoimmin oli onnistuttu toimenpiteissä, diagnoosin löytämisessä ja potilaan tutkimisessa. Perusopetusta toivottiin tapauslähtöisemmäksi ja enemmän perusterveydenhuollossa tarvittavaa osaamista painottavaksi. Ohjaavaa yksilöllistä palautetta ja toimenpideopetusta haluttiin lisää. Toivelistalla oli myös lausuntojen laatimisen opetusta, lääkehoidon erityiskysymysten huomiointia, moniammatillisen yhteistyön harjoittelua ja lääkäriksi kasvamisen tukemista.Abstract Work-based view of medical students on the development targets of basic education In Finland, medical students can work temporarily as a doctor after completing the first four years’ studies. We asked students to assess their working life skills and to suggest ideas to further improve education. The perceived strengths were professional collaboration, patient-physician interaction, and interviewing the patient. More challenging were performing procedures and diagnosing and examining the patient. Students requested more case-based education, emphasis on primary health care skills, individual feedback, and teaching of procedures. Students suggested also that medical education should focus more on writing medical documents, polypharmacy, interprofessional co-operation, and professional development

National MEDigi project:systematic implementation of digitalization to undergraduate medical and dental education in Finland

Abstract MEDigi is a nationwide Finnish project that aims to develop and implement digital teaching, learning and assessment solutions and to provide possibilities for national harmonization of undergraduate medical and dental education in Finland. The MEDigi project will investigate the options and feasibility of a common national digital online platform and produce digital content and solutions for medical education. Furthermore, tools and support system for digital pedagogy training will be created to ensure that the teaching staff will achieve and retain appropriate digipedagogical skills. The project aims also to increase the competence related to the digital tools used in clinical practice (eHealth, digital health) of physicians and dentists. Furthermore, academic research will be carried out on various aspects of the project. All the universities in Finland that offer the Licentiate Degree in Medicine and Dentist programmes are involved: Universities of Eastern Finland, Helsinki, Oulu, Tampere and Turku. The project is coordinated by the University of Oulu. The project is carried out in close collaboration with the Finnish Medical Society Duodecim and the Finnish Dental Society Apollonia. The project lifespan is until the end of May 2021. MEDigi project is financed by the Finnish Ministry of Culture and Education and its total budget is over 4 million euros

Variable Length Instruction Compression on Transport Triggered Architectures

The memories used for embedded microprocessor devices consume a large portion of the system’s power. The power dissipation of the instruction memory can be reduced by using code compression methods, which may require the use of variable length instruction formats in the processor. The power-efficient design of variable length instruction fetch and decode is challenging for static multiple-issue processors, which aim for low power consumption on embedded platforms. The memory-side power savings using compression are easily lost on inefficient fetch unit design. We propose an implementation for instruction template-based compression and two instruction fetch alternatives for variable length instruction encoding on transport triggered architecture, a static multiple-issue exposed data path architecture. With applications from the CHStone benchmark suite, the compression approach reaches an average compression ratio of 44% at best. We show that the variable length fetch designs reduce the number of memory accesses and often allow the use of a smaller memory component. The proposed compression scheme reduced the energy consumption of synthesized benchmark processors by 15% and area by 33% on average.Peer reviewe

Detection of novel gene variants associated with congenital hypothyroidism in a Finnish patient cohort

Abstract Background: Congenital hypothyroidism (CH) is defined as the lack of thyroid hormones at birth. Mutations in at least 15 different genes have been associated with this disease. While up to 20% of CH cases are hereditary, the majority of cases are sporadic with unknown etiology. Apart from a monogenic pattern of inheritance, multigenic mechanisms have been suggested to play a role in CH. The genetics of CH has not been studied in Finland so far. Therefore, multigenic sequencing of CH candidate genes was performed in a Finnish patient cohort with both familial and sporadic CH. Methods: A targeted next-generation sequencing (NGS) panel, covering all exons of the major CH genes, was applied for 15 patients with sporadic and 11 index cases with familial CH. Results: Among the familial cases, six pathogenic mutations were found in the TPO, PAX8, and TSHR genes. Furthermore, pathogenic NKX2.1 and TG mutations were identified from sporadic cases, together with likely pathogenic variants in the TG, NKX2.5, SLC26A4, and DUOX2 genes. All identified novel pathogenic mutations were confirmed by Sanger-sequencing and characterized in silico and/or in vitro. Conclusion: In summary, the CH panel provides an efficient, cost-effective, and multigenic screening tool for both known and novel CH gene mutations. Hence, it may be a useful method to identify accurately the genetic etiology for dyshormogenic, familial, or syndromic forms of CH