2023 Western Medical Research Conference

The proceedings contain 549 papers. The topics discussed include: interleukin-2 kinase-mediated T-cell receptor signaling is critical in the development of type 1 diabetes by OT-1 T-cells;the effect of the COVID-19 pandemic on anxiety and depression in adolescents in the military population;dollars sense: a school-based effort to increase financial literacy in high school students;fostering the next generation of healthcare leaders in a pandemic world;walkability of San Bernardino county?s elementary schools in relation to various school characteristics;placebo-controlled trial in tanner 2-3 males with Klinefelter syndrome: effect of testosterone gel versus placebo in motor skills outcomes;my implant is expiring: a national secret shopper study of extended use of the contraceptive implant;comparing the effects of aerobic exercise and yoga on stress levels in college students;and are patients with a history of chest radiation therapy at higher risk for sternal wound problems after heart transplant?.

Postauricular Incision Keloid: An Unintended Consequence of COVID-19 Mask Precautions

Introduction: Keloids of the head and neck can result in significant disfigurement and psychological stress. Here we report a novel case of keloid formation at a well-healed postauricular incision presenting after a year of daily ear loop mask use and discuss unique considerations for management. Method(s): This is a retrospective case review of a 35-year-old African American man with Klinefelter syndrome, type 2 diabetes mellitus, and a history of hypertrophic scar formation who presented to otology clinic in 2015 with chronic left otitis media and cholesteatoma. He underwent left tympanoplasty and mastoidectomy in 2016 through a postauricular incision 1 cm posterior to retroauricular sulcus in a standard fashion. In 2018, the patient was noted to have a hypertrophic scar without extension beyond the borders of the incision that was stable until 2021. Result(s): In 2021, the patient was noted to develop a 12A 7-cm postauricular keloid in the setting of mechanical irritation from his mask worn throughout the COVID-19 pandemic. Given the disfiguring cosmesis and resulting challenges securing an ear loop mask, he elected to undergo complete excision of the postauricular keloid with tension-free primary closure of the wound, intralesional corticosteroid injection (triamcinolone acetonide 40 mg/mL), and pressure dressing. The patient was counseled on options for mask wearing to avoid contact with the postauricular incision. Conclusion(s): When designing postauricular incisions in patients prone to hypertrophic scar or keloid formation, the point of postauricular contact of ear loop masks is a novel consideration to minimize risk of future pressure-related injury. Counseling on alternative face masks that tie behind the head or anchoring ear loops to buttons sewn onto a hat or headband are other preventative pressures.

The first year of a national-access adult Klinefelter's Syndrome multi-disciplinary team (KSMDT) clinic: patient and clinician reported outcomes

Klinefelter's syndrome is the most common chromosomal abnormality seen in men, affecting 1 in 650 men. It is a group of chromosomal disorders with at least one extra X chromosome (47, XXY) occurring due to non-disjunction at the time of gametogenesis. Most adult men are diagnosed at the time of fertility investigations. However, the syndrome has an array of clinical presentations which patients require input from numerous medical specialities during their lifetime. The setting up of a national-access Klinefelter Syndrome multidisciplinary clinic (KSMDT) approach comprising Urology, Endocrinology, Genetics, Reproductive medicine, Radiology, Psychosexual medicine, a specialist pharmacist as well as a patient representative has led to improvements in fertility and long- term management and waiting times. Here we describe the patient-reported outcomes and clinician perspectives of the clinic as it approached its 1st year. Between 2019 and 2020, 72 patients were seen in the adult KS MDT clinic. To assess the quality of care received in the clinic, an 8 -point feedback questionnaire was given to each patient attending the clinic to fill out at the end of the clinic. The form included a space for feedback for each speciality involved. The feedback forms were reviewed by 2 individual researchers and entries were assessed using an adapted Likert scale (0 – 5). Clinicians involved in the clinic were also encouraged to attend and rate the other specialties, the effectiveness of the pre and post clinic MDTs and to describe achievements derived from KSMDT clinic team-working. All the patients (n = 72) took the questionnaire reported that the clinic was beneficial to their understanding of KS & its management and had enough time during consultations. In terms of scoring 86% were very satisfied (score = 5) about genetic consultation compared to 92%, 82%, 82% and 88% in endocrine, fertility, psychosexual and urology consultation, respectively. Key factors influencing these positive results included the presence of an MDT, the access to a patient liaison and knowledge of support groups during the consult, digitized patient information sheets and a cohesive approach between endocrine and fertility teams. Clinician feedback was positive with all members agreeing that the pre and post clinic MDTs allowed effective pinpointing of often missed issues (e.g. hormone induction, social issues). Key milestones for the clinic included the reduction in waiting times by almost 80%, securing funding for costly hormone medication and assisted reproduction, improving sperm retrieval rates (from 11 – 29%) and a thrombo-embolism awareness programme. The overall patient and clinician feedback for the adult KSMDT clinic was uniformly positive, with the multispecialty approach allowing communication with and between all relevant specialities on the same day, avoiding the need to come for multiple separate appointments across different sites (especially relevant during the COVID-19 era). The feedback has also been useful in developing patient information tools such as digital resources and has led to the development of a supportive community group for newly diagnosed KS men. More research is underway to investigate the complex issues affecting KS men long term, after fertility management. Work supported by industry: no. [ FROM AUTHOR] Copyright of Journal of Sexual Medicine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

A pilot national-access young person's Klinefelter Syndrome multidisciplinary team clinic: patient and clinician reported outcomes

Most children are diagnosed with Klinefelter's as part of investigating learning and behavioural difficulties or during prenatal screening. Klinefelter's is the most common chromosomal abnormality affecting men (1 in 650) and is associated with a large spectrum of clinical manifestations including learning, behavioural and developmental delays. The optimal management of this condition involves many different specialties, as seen in the development of adult Klinefelter multidisciplinary team (KSMDT) clinics. Unfortunately, young patients are often outside the remit of these adult clinics, and often experience major gaps and delays to the patient pathway, with a lack of coordination in areas such as hormone replacement therapy, psychological & educational support and fertility counselling. Based on this, a national survey was carried out to assess the needs of young (16-20) Klinefelter Syndrome patients which led to the setting up a young person's KSMDT clinic model for KS. We report on the patient and clinician reported feedback in the first 6 months of this clinic. The structure of the pilot young person's KSMDT clinic included input from endocrinologists, a fertility team of urologists & reproductive medicine doctors, a psychology team involving both clinical and educational psychology, a neurodisability team, genetics specialists as well as a specialist pharmacist and a patient liaison. Each consult was specifically structured to the patient's priorities, with both the patient and parent invited to attend and to separately indicate these priorities. Ten patients (mean age 17, range 16 – 20) were seen in the first clinic. To assess the quality of care received in the clinic, an 8 -point feedback questionnaire was given to each patient & parent attending the clinic to fill out at the end of the clinic. The form included a space for feedback for each speciality involved. The feedback forms were reviewed by 2 individual researchers and entries were assessed using an adapted Likert scale (0 – 5). Clinicians involved in the clinic were also encouraged to attend and rate the other specialties, the effectiveness of MDT clinic. All patients & parents were satisfied about the structure of clinic, the provision and management plans. 94% of patients indicated they were very satisfied (score = 5) about endocrine consultation compared to 100%, 90% and 88% in genetic, neurodisability/psychology and fertility consultations respectively. Key factors influencing these positive results included the presence of detailed fertility counseling, access to patient support groups and having a transition plan to the adult KSMDT clinic. Clinician feedback was positive with all members agreeing that the pre and post clinic MDTs allowed effective discussion of complex issues such as hormone initiation, future fertility as well as socio-educational factors affecting the well-being of the patient. The overall patient and clinician feedback for the young person's KSMDT clinic was uniformly positive, with the multispecialty approach allowing communication with and between all relevant specialities on the same day, avoiding the need to come for multiple separate appointments across different sites (especially relevant during the Covid era). A fully fledged clinic is now running based on the feedback and insight provided from the pilot process, with a seamless transition of these young patients to our adult KSMDT clinic to continue to support them. Work supported by industry: no. [ FROM AUTHOR] Copyright of Journal of Sexual Medicine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Investigation of COVID-19 infection in subjects with Klinefelter syndrome.

PURPOSE: COVID-19 has worse clinical outcomes in males compared with females and testosterone may determine gender differences. Hypogonadism and supernumerary X chromosome may have a role in the SARS-CoV-2 infection in Klinefelter syndrome (KS). Aim of the study was evaluating COVID-19 frequency and severity in KS. METHODS: Participants were invited to complete a retrospective self-administered questionnaire containing multiple choice and open-ended answers. RESULTS: COVID-19 was detected in 10% of the evaluated KS subjects; none was hospitalized. 44.4% of COVID-19 patients had one cohabitant-infected versus 3% of non-infected (p < 0.01). Testosterone levels in infected patients were lower compared to those of non-infected subjects (3.1 ± 1.2 ng/ml vs. 5.2 ± 2 ng/ml, p < 0.05). CONCLUSIONS: The frequency of SARS-CoV-2 infection among KS subjects was 10%. All infected patients showed mild symptoms. The presence of one affected cohabitant significantly associated with SARS-CoV-2 infection. An association between SARS-CoV-2 and hypogonadism was confirmed.

Respiratory distress in a patient with Klinefelter syndrome: a suspicion of COVID-19 hiding severe pulmonary embolism.

Klinefelter syndrome is the most common congenital abnormality causing primary hypogonadism and predisposing to a state of hypercoagulability. We report the case of a 37-year-old man, of Algerian nationality, diagnosed with Klinefelter syndrome admitted to the hospital via the emergency room for acute chest pain and dyspnea. The patient arrived in Tunisia 36 hours ago. On admission, body temperature was 38.2°C, blood pressure, pulse and respiratory rate were 130/70 mmHg, 120/minute and 26/minute, respectively. He had an oxygen saturation of 87% in room air. His electrocardiography revealed a complete right bundle-branch block, chest X-Ray was normal. In front of the clinical presentation and the origin of the patient coming from an endemic country, COVID-19 infection was suspected but ruled out by pharyngeal swabs testing negative by real-time reverse-transcription polymerase chain reaction test and massive pulmonary embolism was diagnosed from his chest computed tomography images. The symptoms improved with anticoagulation treatment.