Breast cancer is the most common cancer among women worldwide, with germline mutations in high-penetrance genes like BRCA1 and BRCA2, and moderate-penetrance genes such as CHEK2 and ATM contributing majorly to the onset of the same.Universal germline genetic testing offers an avenue to improve early identification and develop appropriate management guidelines. Our retrospective cohort study analyzed data from 525 newly diagnosed breast cancer patients at Mercy Hospital Fort Smith from January 2020 to December 2023. Patients underwent germline genetic testing using next-generation sequencing panels irrespective of family history of cancer. Details on patient demographics, clinical characteristics, and genetic test results were collected and analyzed. The median age at diagnosis of patients was 66, with invasive ductal carcinoma (IDC) being the major subtype (66%). CHEK2 mutations were the most common pathogenic mutations (9 patients), followed by BRCA1 and MUTYH (6 each).Pathogenic mutations were more prevalent in patients over 60 years (63%). Germline mutations were identified more frequently in IDC than in ductal carcinoma in situ. Among patients with germline mutations, there was a significant drift toward mastectomy over breast-conserving surgery. Universal germline genetic testing identified pathogenic mutations in a significant proportion of breast cancer patients, especially among the older patient population. The findings further emphasize the importance of integrating universal genetic testing into routine care to guide surgical and risk-reduction management protocols effectively. Further research is needed to regularize genetic testing in similar patients.

Breast cancer is the most common cancer among women worldwide, with germline mutations in high-penetrance genes like BRCA1 and BRCA2, and moderate-penetrance genes such as CHEK2 and ATM contributing majorly to the onset of the same.Universal germline genetic testing offers an avenue to improve early identification and develop appropriate management guidelines. Our retrospective cohort study analyzed data from 525 newly diagnosed breast cancer patients at Mercy Hospital Fort Smith from January 2020 to December 2023. Patients underwent germline genetic testing using next-generation sequencing panels irrespective of family history of cancer. Details on patient demographics, clinical characteristics, and genetic test results were collected and analyzed. The median age at diagnosis of patients was 66, with invasive ductal carcinoma (IDC) being the major subtype (66%). CHEK2 mutations were the most common pathogenic mutations (9 patients), followed by BRCA1 and MUTYH (6 each).Pathogenic mutations were more prevalent in patients over 60 years (63%). Germline mutations were identified more frequently in IDC than in ductal carcinoma in situ. Among patients with germline mutations, there was a significant drift toward mastectomy over breast-conserving surgery. Universal germline genetic testing identified pathogenic mutations in a significant proportion of breast cancer patients, especially among the older patient population. The findings further emphasize the importance of integrating universal genetic testing into routine care to guide surgical and risk-reduction management protocols effectively. Further research is needed to regularize genetic testing in similar patients.

Breast cancer is the most common cancer among women worldwide, with germline mutations in high-penetrance genes like BRCA1 and BRCA2, and moderate-penetrance genes such as CHEK2 and ATM contributing majorly to the onset of the same.Universal germline genetic testing offers an avenue to improve early identification and develop appropriate management guidelines. Our retrospective cohort study analyzed data from 525 newly diagnosed breast cancer patients at Mercy Hospital Fort Smith from January 2020 to December 2023. Patients underwent germline genetic testing using next-generation sequencing panels irrespective of family history of cancer. Details on patient demographics, clinical characteristics, and genetic test results were collected and analyzed. The median age at diagnosis of patients was 66, with invasive ductal carcinoma (IDC) being the major subtype (66%). CHEK2 mutations were the most common pathogenic mutations (9 patients), followed by BRCA1 and MUTYH (6 each).Pathogenic mutations were more prevalent in patients over 60 years (63%). Germline mutations were identified more frequently in IDC than in ductal carcinoma in situ. Among patients with germline mutations, there was a significant drift toward mastectomy over breast-conserving surgery. Universal germline genetic testing identified pathogenic mutations in a significant proportion of breast cancer patients, especially among the older patient population. The findings further emphasize the importance of integrating universal genetic testing into routine care to guide surgical and risk-reduction management protocols effectively. Further research is needed to regularize genetic testing in similar patients.

BACKGROUND AND OBJECTIVE

Attrition in the medical training programs not only affects the specialty but also the hospital, the trainee’s career path, and the provision of care to patients. This study aims to determine the trends, annual rates, and reasons of attrition at the University of the Philippines-Philippine General Hospital (UP-PGH) from 2018-2022.

The study was carried out in two stages. A retrospective review of trainees’ records from the Office of the Deputy Director of Health Operations (ODDHO) and Human Resource Department (HRD) was initially done followed by a survey of the resident training officers (RTOs). Associations between physician and program attributes to attrition were analyzed using t-test and Chi-square at pRESULTS

There were 141 resignations recorded during the 5-year review (residents=113, fellows=28). The mean age for residents was 28.76 years ± 3.05, 55.75% were females, 59.29% graduated from non-UP College of Medicine (UPCM) schools, and 92.92% were single. Most left during their first year (53.98%); Ob-Gyne (n=20) and Anesthesiology (n=18) had the most number of drop-outs. For fellows, the mean age was 32.73 years ± 2.70, most were female (60.71%), single (71.43%), from non-UPCM schools (71.43%), left during their 1st year (78.57%) and not from PGH residency (78.57%). Pediatrics (n=13) and Internal Medicine (n=9) had the highest numbers of fellow resignations. The reasons cited were mental health, unmet expectation, change in specialty, and sickness. The mean resident attrition rate was 3.51% while for fellows it was 1.36%, an evident rise was seen during the COVID-19 years.

The decision to take postgraduate training is a personal journey for medical graduates. It is important to focus on strategies in identifying modifiable stressors during demanding times and be more receptive in addressing anxiety and mental health issues. Adjustments in the selection process must give applicants the real-world feel of the training environment, so a more realistic expectation will be met.

Introduction: For extensive osseous involvement of primary tumours in the distal femur and proximal tibia, knee resection arthrodesis (KRA) is an economic alternative to endoprosthetic reconstruction in developing countries. Enneking (1977) described the use of an intramedullary (IM) nail for KRA and is still regarded as the most reliable method for fusion. We sought to determine if dual plating or IM nailing for KRA would produce comparable outcomes. Materials and methods: This is a cross-sectional study of 30 patients who underwent KRA with either IM nail or dual plates for tumours about the knee. Demographic and surgical profile, functional scores using the Musculoskeletal Tumour Society (MSTS) score, and incidence of complications were determined. Results: Mean follow-up was 2.28 years (SD 20.4). IM nail was utilised in 12 (40%) and dual plating in 18 (60%). 21 complications occurred, with 11 (52.38%) and 10 (47.62%) occurring in the IM nail and dual plating group respectively. MSTS score was higher with the IM nail (23.5 vs 22.5). Mean operative time was longer with the IM nail compared to dual plating (8.29 vs 7.80 hours). Blood loss was higher with the IM nail (1309.09 vs 1138.89mL). Conclusion: Outcomes of IM nailing and dual plating KRA are comparable, including the incidence of complications. While blood loss and operative time were noted to be longer in the IM nailing group, and hospital admission was longer in the dual plating group, the difference was not significant. Larger, prospective studies are recommended to report outcomes for fusion done following tumour resection.

Introduction: This study aimed to find the association between the Knee Movement or KM method versus the traditional lateral knee radiograph positioning procedure and the incidence of true lateral knee radiographs achieved. Materials and methods: A cross-sectional study of patients with knee problems that underwent lateral knee radiograph using the knee movement method (KM method), starting from March 2022 until August 2022. Fifty knee radiograph results using the KM method (KM group) were compared to retrospective data from fifty knee radiograph from the patients before March 2022 using the traditional method of lateral knee radiograph as the control (TM group). The data were analysed using the Chi-Square test to see if the KM method is associated with more true lateral knee radiograph results achieved compared to the traditional procedure. Results: Fifty patients in the KM method group had 80% (n=40) true lateral knee radiographs and 20% (n=10) untrue lateral knee radiographs, while in the Traditional Procedure group from the retrospective data of 50 patients had 44% (n=22) true lateral knee radiographs and 56% (n=28) untrue lateral knee radiographs (P<0.05). There is no significant association between the type of procedure applied with the types of error (P=0.432). Nevertheless, it helps us as it gives a gross picture that most of the errors are under-rotation of the knee, either from the KM method Group 90% (n=9) or the Traditional procedure Group 79% (n=22). Conclusion: The KM method was associated with achievement of a more true and accurate lateral knee radiograph. Additional studies with a larger sample should be done to evaluate the reliability of this method.

The collision cross-sections(CCS)measurement using ion mobility spectrometry(IMS)in combination with mass spectrometry(MS)offers a great opportunity to increase confidence in metabolite identifi-cation.However,owing to the lack of sensitivity and resolution,IMS has an analytical challenge in studying the CCS values of very low-molecular-weight metabolites(VLMs ≤ 250 Da).Here,we describe an analytical method using ultrahigh-performance liquid chromatography(UPLC)coupled to a traveling wave ion mobility-quadrupole-time-of-flight mass spectrometer optimized for the measurement of VLMs in human urine samples.The experimental CCS values,along with mass spectral properties,were reported for the 174 metabolites.The experimental data included the mass-to-charge ratio(m/z),retention time(RT),tandem MS(MS/MS)spectra,and CCS values.Among the studied metabolites,263 traveling wave ion mobility spectrometry(TWIMS)-derived CCS values(TWCCSN2)were reported for the first time,and more than 70％of these were CCS values of VLMs.The TWCCSN2 values were highly repeatable,with inter-day variations of＜1％relative standard deviation(RSD).The developed method revealed excellent TWCCSN2 accuracy with a CCS difference(△CCS)within±2％of the reported drift tube IMS(DTIMS)and TWIMS CCS values.The complexity of the urine matrix did not affect the precision of the method,as evidenced by △CCS within±1.92％.According to the Metabolomics Standards Initiative,55 urinary metabolites were identified with a confidence level of 1.Among these 55 metabolites,53(96％)were VLMs.The larger number of confirmed compounds found in this study was a result of the addition of TWCCSN2 values,which clearly increased metabolite identification confidence.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has led to an association between COVID-19 and pediatric diabetes. Studies have indicated the increased likelihood of children with COVID-19 infection developing diabetes. Our objective was to assess not only the increase in pediatric diabetes at our hospital and identify possible risk factors, but also to correlate the psychosocial changes resulting from the pandemic with new-onset diabetes. Methods: We analyzed data from 58 children aged 1 to 18 years admitted to our hospital with new-onset diabetes between March 2020 and December 2021. The data included inflammatory biomarkers and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies (Abs), as well as the results of a lifestyle questionnaire. Results: The average number of hospital admissions per month for new-onset diabetes increased from 10 to 18 with the start of the pandemic. Of the 58 children in our analysis, 33% had positive SARS-CoV-2 IgG Ab, 31% had type 1 diabetes mellitus, and 62% had type 2 diabetes mellitus (T2DM). More than half (54%) were experiencing diabetic ketoacidosis. Those with T2DM were older, majority African American, had higher median body mass index (BMI) percentiles, and lower vitamin D levels. There were no significant correlations between any psychosocial risk factors and either diabetes type or SARS-CoV2 Ab status. Conclusion Despite the increased incidence of new-onset diabetes among children in Mississippi during the pandemic, this study was unable to demonstrate a significant correlation between COVID-19 infection and new-onset diabetes. The findings of this study highlighted the correlation between increased BMI and type 2 diabetes, underscoring the significant problems of obesity and diabetes in our study region. Further research is warranted.

OBJECTIVES: This study aimed to develop susceptible-exposed-infectious-recovered-vaccinated (SEIRV) models to examine the effects of vaccination on coronavirus disease 2019 (COVID-19) case trends in Malaysia during Phase 3 of the National COVID-19 Immunization Program amidst the Delta outbreak. METHODS: SEIRV models were developed and validated using COVID-19 case and vaccination data from the Ministry of Health, Malaysia, from June 21, 2021 to July 21, 2021 to generate forecasts of COVID-19 cases from July 22, 2021 to December 31, 2021. Three scenarios were examined to measure the effects of vaccination on COVID-19 case trends. Scenarios 1 and 2 represented the trends taking into account the earliest and latest possible times of achieving full vaccination for 80% of the adult population by October 31, 2021 and December 31, 2021, respectively. Scenario 3 described a scenario without vaccination for comparison. RESULTS: In scenario 1, forecasted cases peaked on August 28, 2021, which was close to the peak of observed cases on August 26, 2021. The observed peak was 20.27% higher than in scenario 1 and 10.37% lower than in scenario 2. The cumulative observed cases from July 22, 2021 to December 31, 2021 were 13.29% higher than in scenario 1 and 55.19% lower than in scenario 2. The daily COVID-19 case trends closely mirrored the forecast of COVID-19 cases in scenario 1 (best-case scenario). CONCLUSIONS Our study demonstrated that COVID-19 vaccination reduced COVID-19 case trends during the Delta outbreak. The compartmental models developed assisted in the management and control of the COVID-19 pandemic in Malaysia.

Nanoscale biomaterials have garnered immense interest in the scientific community in the recent decade. This review specifically focuses on the application of three nanomaterials, i.e., graphene and its derivatives (graphene oxide, reduced graphene oxide), carbon nanotubes (CNTs) and nanocellulose (cellulose nanocrystals or CNCs and cellulose nanofibers or CNFs), in regenerating different types of tissues, including skin, cartilage, nerve, muscle and bone. Their excellent inherent (and tunable) physical, chemical, mechanical, electrical, thermal and optical properties make them suitable for a wide range of biomedical applications, including but not limited to diagnostics, therapeutics, biosensing, bioimaging, drug and gene delivery, tissue engineering and regenerative medicine. A state-of-the-art literature review of composite tissue scaffolds fabricated using these nanomaterials is provided, including the unique physicochemical properties and mechanisms that induce cell adhesion, growth, and differentiation into specific tissues. In addition, in vitro and in vivo cytotoxic effects and biodegradation behavior of these nanomaterials are presented. We also discuss challenges and gaps that still exist and need to be addressed in future research before clinical translation of these promising nanomaterials can be realized in a safe, efficacious, and economical manner.