Notes

Risks with regard to infection-related a hospital stay within end-stage kidney condition individuals throughout peri-dialysis period.
cts of congenital anomalies which need immediate preventive actions such as iron folate supplementation during preconception and early pregnancy. Therefore, design strategies to create community awareness and prevention mechanism of congenital anomalies, and strengthening the care and rehabilitation services for affected patients are crucial.With the advent of the age of Artificial Intelligence (AI), we seek to consider how AI could shape clinical examinations, specifically Objective Structured Clinical Examinations (OSCEs). OSCEs, whilst having its own limitations, could be further enhanced with new technologies like AI to help better assess and prepare our future clinicians. With the everchanging requirements on the modern clinician, we deliberate the strengths and weaknesses of AI, and the need for emphasis on different skills to complement rather than resist the tides of change. In conclusion, we feel that AI has the potential to be a strong driving force in remodelling OSCEs to support future doctors and could serve as a new frontier in medical education and beyond. That being said, we recognize the technology and its applications are still in its infancy, and further study will be needed to eluciate the role of AI in medical education and in the greater landscape of medical practice.
Children with type 1 diabetes (T1D) at different stages of development have age-specific needs, which can influence their perception of quality of life (QoL). In our study, we aimed to emphasize these age-specific needs and assess the perception of QoL in Saudi children with T1D, as well as their parents correlating QoL scores with children's glycemic control.

This is a cross-sectional study in which children with T1D and their parents from 2 tertiary institutes in Saudi Arabia have answered a standard diabetes-specific QoL questionnaire (PedsQL™ 3.0 diabetes module, translated in Arabic). We also reported glycated hemoglobin (HbA1c) results for these children within a month of completing the questionnaire. The QoL total aggregate and domain scores for self (children) and proxy (parents') reports were compared and correlated with children's HbA1c.

A sample was 288 self and proxy reports from 144 children with T1D of 3 age groups 5 to 7 years (7%), 8 to 12 years (49%), and 13 to 18 years (44%), and their parents. QoL differed significantly between self and proxy reports in the total aggregate and domain scores (
-values range from .02 to <.001). The impact on QoL was significantly higher in female patients (
 = .043). Insulin pump users had better HbA1c (
 = .007), and HbA1c level was worse in those who intended to fast at Ramadan (
 = .005).

Children with T1D at different developmental age groups perceive QoL differently than their parents. Adjusting management as per age-specific challenges could potentially improve these children's QoL and glycemic control.
Children with T1D at different developmental age groups perceive QoL differently than their parents. Adjusting management as per age-specific challenges could potentially improve these children's QoL and glycemic control.The Continuum theory and the Levels of Health theory propound the idea that return of efficient acute inflammation (high fever) heralds true improvement in chronic inflammatory states. We present 6 cases of atopic dermatitis (AD), which had stability in their improvement for 1 year or more, under classical homeopathy. The cases were retrospectively assessed with selected based on the Hanifin Rajka atopic dermatitis diagnostic criteria and the follow ups evaluated according to changes on SCORing Atopic Dermatitis scale (SCORAD) scale. The pictures are presented as evidence. Modified Naranjo Criteria for assessing causal attribution of clinical outcome to homeopathic intervention was used to assess the effect of homeopathy in these cases. All the cases improved and stabilised with complete skin clearance (those that relapsed within 1 year were not included). These patients had not suffered high fevers/acute inflammatory diseases since onset/aggravation of AD. Five of the 6 cases developed acute inflammatory diseases as the chronic condition improved. The last case showed return of an old, lesser pathology. The control cases - which were selected for non-improvement under classical homeopathy also showed remarkable skin clearance when there was appearance of acute inflammatory states. In this study, there is a mutually exclusive relationship between efficient acute inflammation and chronic inflammation, which is in accordance with the 2 theories considered here. Further scientific studies are necessary to establish the phenomenon at tissue level.Chronic myelo-monocytic leukemia (CMML) is an aggressive myeloid neoplasm with some features of a myelodysplastic syndrome (MDS) and others of a myeloproliferative neoplasm (MPN). Rarely, patients with CMML have a co-existing lympho-proliferative disorder (LPD). In most cases, the lymphoid neoplasm is diagnosed first, and the CMML is considered to be a secondary therapy-induced form of leukemia. We report herein a unique case of de-novo CMML, with an underlying clonal T-cell population and describe its clinical presentation and laboratory findings. A 70-year old male presented with a 3-month history of cough, dsypnea, abdominal distension, and low-grade fever. Physical and radiological examination revealed hepatosplenomegaly but no lymphadenopathy. LDC203974 Peripheral blood had absolute monocytosis with marrow showing CMML with 10% blasts along with dysplasia in myeloid and erythroid lineages. Flow cytometry indicated possibility of chronic myelo-monocytic leukemia with 13% monocytic cells along with an additional clonal population of gamma/delta T cells (15%) with aberrant immunophenotype. Polymerase chain reaction (PCR) analysis was positive for clonal T-cell rearrangement. A diagnosis of CMML with an underlying clonal T-CLPD was made. The synchronous occurrence of CMML and T-cell neoplasm may be attributed to a genetic mutation common to both. Currently, there are no treatment guidelines for group of patients; hence individualized therapeutic strategies should be implemented to enable symptomatic improvement and provide optimum care.
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