Extracorporeal blood purification is associated with improvement in biochemical and clinical variables in the critically-ill COVID-19 patients.

This study tried to investigate the impact of oXiris filter on both clinical and laboratory parameters in critically-ill COVID-19 intensive care unit (ICU) patients receiving extracorporeal blood purification and the clinical setting for the initiation of therapy. A consecutive sample of 15 ICU patients with COVID-19 was treated with oXiris membrane for blood purification or for support of renal function due to acute kidney injury. We have included 19 non treated ICU COVID-19 patients as a control group. Two chest x-rays were analyzed for determining the chest x-ray severity score. We have found a significant decrease of SOFA score, respiratory status improved and the chest x-ray severity score was significantly decreased after 72 h of treatment. IL-6 significantly decreased after 72 h of treatment while other inflammatory markers did not. Respiratory status in the control group worsened as well as increase in SOFA score and chest x-ray severity score. Survived patients have shorter time from the onset of symptoms before starting with extracorporeal blood purification treatment and shorter time on vasoactive therapy and invasive respiratory support than deceased patients. Critically-ill patients with COVID-19 treated with extracorporeal blood purification survived significantly longer than other ICU COVID-19 patients. Treatment with oXiris membrane provides significant reduction of IL-6, leads to improvement in respiratory status, chest x-ray severity score, and reduction of SOFA score severity. Our results can suggest that ICU COVID-19 patients in an early course of a disease could be potentially a target group for earlier initiation of extracorporeal blood purification.

Ewing's sarcoma of the third metatarsal: a case report and review of the literature.

We report a rare case of Ewing's sarcoma involving the third metatarsal bone and spreading into adjacent bone in a 23-year-old man, with special emphasis on imaging characteristics. On radiographs the tumor presented as a permeative lytic lesion with aggressive periosteal reaction and cortical destruction. Computed tomography and magnetic resonance imaging delineated the osseous and soft tissue extent of the tumor. A large soft-tissue mass around the involved bone was highly indicative of Ewing's sarcoma. Cortical invasion of the neighboring second metatarsal was seen only on magnetic resonance imaging. Increased up-take of technetium 99m methylene diphosphonate was noticed on bone scintigraphy. An early diagnosis of Ewing's sarcoma, even when it occurs in unusual locations, is necessary for adequate treatment and is of particular importance in terms of prognosis. The optimal imaging modality for the diagnosis of Ewing's sarcoma is magnetic resonance imaging since it allows accurate analysis of the soft-tissue component and visualization of possible local invasion of adjacent structures.

Cross-sectional imaging of the pelvic tumors and tumor-like lesions in gynecologic patients-misinterpretation points and differential diagnosis.

Computed tomography and/or magnetic resonance imaging were performed in 42 female patients with suspected pelvic mass. Surgical and histopathological reports were compared to the imaging findings, yielding mismatch in five (17.8%) patients. One benign cyst and one case of postirradiation fibrosis were characterized as recurrent tumors, one surgically transposed ovary as metastasis, and an ovarian torsion as ovarian tumor, and a pelvic hematoma was mistaken for abscess. The most common false-positive finding on a per-lesion basis was that of enlarged lymph nodes.

Academic misconduct among medical students in a post-communist country.

AIM: To assess the prevalence of, attitudes towards and willingness to report different forms of academic dishonesty among medical students in a post-communist transitional country. METHODS: An anonymous, self-administered questionnaire was distributed to medical students in Years 2-6 at the Zagreb University School of Medicine; 827 (70%) valid questionnaires were returned and analysed. RESULTS: Most of the students (94%) admitted cheating at least once during their studies. The most frequent type of misconduct was 'signing in an absent student on a class attendance list' (89.1%), and the least frequent 'paying for passing an examination' (0.7%). The number of committed types of misconduct out of 11 listed types increased from Year 2 (median 2) to Year 6 (median 4). Cheating behaviours could be clustered into 4 groups based on self-reported cheating, perceived prevalence of cheating, attitude towards cheating, and willingness to report cheating. The clustered behaviours that most students admitted to were perceived as the most frequent, more approved of and less likely to be reported. The strongest predictors of dishonest behaviour were attitude, perception of peer group behaviour and study year. Almost half (44%) the students said they would never report any form of cheating. CONCLUSION: Academic misconduct is widespread among medical students at the largest medical school in Croatia and its prevalence is greater than that reported for developed countries. This may be related to social and cultural factors specific to a country in the midst of a post-communist transition to a market economy, and calls for measures to be instigated at an institutional level to educate against and prevent such behaviour.

Knowledge about and attitude towards science of first year medical students.

AIM: To assess the knowledge about and attitude towards science of students entering medical school, and to find out whether these parameters are influenced by their high school education, sex, place of residence, and rank achieved on the admission test. METHODS: A total of 193 (82%) students who enrolled at the Zagreb University School of Medicine in 2001 filled out an anonymous questionnaire at their first lecture. The questionnaire consisted of demographic data, 20 statements on science adapted to a 1-5 Likert scale, and 8 multiple-choice test questions on knowledge of scientific research. RESULTS: The students knowledge of scientific research was poor (out of 8 answers, 2.2 +/- 1.2 were correct) in spite of their positive attitude towards science (75 +/- 11 on a 20-100 scale). Higher ranking students at the admission test showed more positive attitude (Spearmans rho=-0.157, p=0.003). There was no interdependence between other personal data (sex, high school, and place of residence) and opinion/knowledge about science. CONCLUSION: In Croatia, first-year medical students are not familiar with basic facts about the scientific methods and communication in medicine, but they have positive attitude towards scientific research. The only factor associated with more positive attitude towards science is higher rank at the admission test.

Teaching research methodology in medical schools: students' attitudes towards and knowledge about science.

OBJECTIVE: To explore the relationship between teaching scientific methodology in Year 2 of the medical curriculum and student attitudes towards and knowledge about science and scientific methodology. DESIGN: Anonymous questionnaire survey developed for this purpose. SETTING: Zagreb University School of Medicine, Croatia. PARTICIPANTS: A total of 932 students (response rate 58%) from all 6 years were invited to participate. MAIN OUTCOME MEASURES: Score on attitude scale with 45 Likert-type statements and score on knowledge test consisting of 8 multiple choice questions. RESULTS: The average attitude score for all students was 166 +/- 22 out of a maximum of 225, indicating a positive attitude towards science and scientific research. The students' average score on the knowledge test was 3.2 +/- 1.7 on 8 questions. Students who had finished Year 2 had the highest mean attitude (173 +/- 24) and knowledge (4.7 +/- 1.7) scores compared with other year groups (P < 0.001, anova and Tukey posthoc test). For students who had attended a mandatory Year 2 course on the principles of scientific research in medicine (Years 3 to 6), multiple linear regression analysis showed that knowledge test score (B = 3.4; SE = 0.4; 95% confidence interval 2.5-4.2; P < 0.001) and average grades (B = 7.6; SE = 1.5; 95% CI 4.6-10.6; P < 0.001) were significant predictors of attitude towards science, but not sex or failure to pass a year (B = - 0.6; SE = 1.7; 95% CI - 3.9-2.6; P = 0.707; and B = - 3.1; SE = 1.9; 95% CI - 6.8-5.7; P = 0.097, respectively). CONCLUSION: Medical students have generally positive attitudes towards science and scientific research in medicine. Attendance of a course on research methodology is related to a positive attitude towards science.

Naive and memory B cells respond differentially to T-dependent signaling but display an equal potential for differentiation toward the centroblast-restricted CD77/globotriaosylceramide phenotype.

Resting (CD38(low)) tonsillar B cells differentiate to express the centroblast-restricted CD77/globotriaosylceramide antigen on high-level engagement of CD154. As the CD38(low) population comprises both naive and memory subsets, we wished to compare the propensity of each to develop this germinal center phenotype; particularly as the capacity of memory B cells to re-enter afollicular reaction remains unclear. Resting B lymphocytes were therefore separated into CD27(-)IgA(-)IgG(-) and IgD(-) fractions to generate subsets enriched for naive and memory cells, respectively. Following stimulation via BCR and/or CD40 - surrogate signals for B cells engaged in T-dependent signaling - differences between the two subsets were seen in the kinetics and/or magnitude of responses such as entry into DNA synthesis, induction of the costimulatory molecules CD80 and CD86; up-regulation of CD23, and changes in BCL-6 mRNA expression. Nevertheless, naive and memory cells revealed a nigh identical capacity for acquiring CD77: both appeared equally sensitive in this regard, with high-level CD40 engagement via cell-bound CD154 being required for both subsets to achieve the hallmark centroblast phenotype. These findings suggest that, provided with the opportunity to encounter cell membrane CD154 in abundance, both naive and memory B cells display the potential to be diverted towards a germinal center pathway of differentiation.