Natural course of AIDS following HIV-2 infection.

In a 21-year-old female, AIDS following infection with HIV-2 was diagnosed alongside an HIV-associated high-grade B cell lymphoma. Treatment of HIV-2 with dolutegravir, emtricitabine, and tenofovir resulted in viral suppression and slow recovery of CD4 cell counts. Treatment of lymphoma caused significant adverse effects but led to complete remission. The patient denied sexual activity and intravenous drug abuse. The patient had been born to an HIV-2-positive mother but appropriate perinatal testing based on national guidelines had remained negative. This case recapitulates the natural course of HIV-2 infection.

'Hold the course(s)!' - a qualitative interview study of the impact of pandemic-triggered contact restrictions on online instruction in community-based family medicine teaching.

The COVID-19 pandemic has been identified as a catalyst for the digitalization of medical education. Less is known about the specific impact of the pandemic on decentralized, community-based education, such as in General Practitioner practices. The aim of this study is to understand the impact of the digital transformation process, triggered by the COVID-19 pandemic. As, family medicine courses involve both university-based and community-based teaching, this study focuses the mode and quality of instruction and instructors in family medicine teaching. A qualitative interview study was conducted. The participants (N = 12) of a multi-perspective Quality Circle in family medicine teaching were interviewed twice: first, in 2019, about digitalization in family medicine teaching in Tübingen, Germany, not yet aware of the global changes and local transformation that would take place shortly thereafter. Second, in a follow-up interview in 2020 about the transition process and digitalization following the impact of contact restrictions during the pandemic. Grounded Theory was used as a qualitative research approach to analyze the complex processes surrounding this transformation. By analyzing the interviews with various stakeholders of community and university-based teaching, a model for the digital transformation process of family medicine teaching at the University of Tübingen in response to an external stimulus (the pandemic) was developed. It involves six chronological steps: "The calm before the storm," "The storm hits," "All hands on deck," "Adrift," "Reset course," and "The silver lining." This model seeks to understand the process of digital transformation and its impact on the teaching institution (medical faculty of the University of Tübingen, Institute for General Practice and Interprofessional Health Care) and instructors from an integrated perspective and thereby critically revisits prior concepts and opinions on the digitalization of medical teaching. Insights gained are presented as key messages.

A post-Flexner comparative case study of medical training responses to health system needs in Brazil and Germany.

Health systems need medical professionals who can and will work in outpatient settings, such as general practitioner practices or health centres. However, medical students complete only a small portion of their medical training there. Furthermore, this type of training is sometimes seen as inferior to training in academic medical centres and university hospitals. Hence, the healthcare system's demand and the execution of medical curricula do not match. Robust concepts for better alignment of both these parts are lacking. This study aims to (1) describe decentral learning environments in the context of traditional medical curricula and (2) derive ideas for implementing such scenarios further in existing curricula in response to particular medicosocietal needs.This study is designed as qualitative cross-national comparative education research. It comprises three steps: first, two author teams consisting of course managers from Brazil and Germany write a report on change management efforts in their respective faculty. Both teams then compare and comment on the other's report. Emerging similarities and discrepancies are categorised. Third, a cross-national analysis is conducted on the category system.Stakeholders of medical education (medical students, teaching faculty, teachers in decentral learning environments) have differing standards, ideals and goals that are influenced by their own socialisation-prominently, Flexner's view of university hospital training as optimal training. We reiterate that both central and decentral learning environments provide meaningful complementary learning opportunities. Medical students must be prepared to navigate social aspects of learning and accept responsibility for communities. They are uniquely positioned to serve as visionaries and university ambassadors to communities. As such, they can bridge the gap between university hospitals and decentral learning environments.

Impact of pancreatic cancer and subsequent resection on glycemic control in diabetic and nondiabetic patients.

The incidence of new onset or worsening diabetes is surprisingly low in patients after partial pancreatectomy for cancer, leading us to question what factors predict diminished glycemic control in those undergoing resection. All patients undergoing pancreatectomy for cancer at a large, rural university teaching hospital between 1996 and 2010 were identified. The incidence of new onset, or worsening, existing diabetes was determined based on pre and postoperative medication requirement. Univariate analysis was undertaken to identify factors that predict worsened glycemic control. One hundred and one (1 total, 79 Whipple, 21 distal) patients were identified, 41 per cent of which had preexisting diabetes. Nearly half of existing diabetics manifested an increased medication requirement prior to their cancer diagnosis. New onset diabetes occurred in 20 per cent of postoperative patients. Of established diabetics, 34 per cent had either improved glycemic control (9/41) or were cured (5/41) despite the reduction of islet cell mass that occurred with surgery. On univariate analysis, only prolonged hospitalization was associated with worsened glycemic control. Diminished glycemic control is a frequent presenting symptom of pancreatic cancer. Worsened or new onset diabetes is associated with length of stay, which can be influenced by a number of factors including complications and comorbidities.