Complaints Of Symptoms Research Articles

Predictors of treatment initiation and mapping the cancer diagnostic pathway: A retrospective observational cohort study of patients with metastatic non-small cell lung cancer

BackgroundHealth-care providers in the US revealed that a substantial proportion of mNSCLC patients do not receive any first-line therapy and the biggest gaps in care are time inefficiencies in the diagnostic process. The goal of this study was to determine whether such gaps are found in Israel where healthcare is universal and participation in a medical insurance plan is free and compulsory. MethodsWe conducted a retrospective, observational cohort study using the computerized data of Maccabi Healthcare Services, a 2.5 million-member state-mandated health-service. Patients with mNSCLC diagnosed between 2017 and 2018 were followed until December 2019. ResultsAmong 434 patients (62% male, mean age 68 y, 74% adenocarcinoma), 345 (79%) initiated first-line treatment. Compared to treated, untreated patients (n = 89) were more likely to be older (mean [SD]=71 years [10] vs. 67 [10], p < 0.001), have a higher co-morbidity index (5.6 ([4.4] vs. 4.0 [3.4], p < 0.001), smokers (84% vs. 66%, p = 0.001), and require hospitalization in the year prior to diagnosis (80% vs 61%, p = 0.002). There was no difference in socioeconomic status. Time from first symptom to imaging was longer for untreated than treated patients (6.51 months [4.24, 7.33] vs 3.48 months [2.76, 4.34] respectively, p = 0.22). Predictors of treatment initiation included age< 70 years, non-smokers, EGFR testing performed, ECOG performance status 0–1 and shorter wait from first symptom to imaging. Median time from first symptom to initiation of 1 L, was 7.76 months (6.51–8.75). ConclusionThe proportion of untreated mNSCLC patients are comparable to those reported in the US; we did not find health disparities between socioeconomic levels. Our data suggest that the main barrier to effective diagnostic process is the wait between symptom complaint and imaging.

Effect of Electrode Montage on 500-Hz Tone Burst Evoked Masseter Vestibular Evoked Myogenic Potential.

Masseter vestibular evoked myogenic potentials (VEMPs) are short-latency myogenic responses obtained in response to electric or acoustic stimulation. It is a relatively newer test that helps assess the vestibulo-trigeminal pathway, thereby gaining more interest in brainstem pathologies like Parkinsonism, multiple sclerosis, and idiopathic random eye movement disorders. The purpose of the study was to compare the effect of zygomatic versus mandibular reference montage on the latency and amplitude of masseter VEMP (mVEMP) using a 500-Hz tone burst stimulus. Twenty healthy participants in the age range of 18-29 years, with no complaints of vestibular signs and symptoms, were recruited for the study. VEMP was recorded for all the participants using 500-Hz tone burst stimuli in zygomatic electrode montage and mandibular electrode montage. mVEMP was recorded in both ipsilateral and contralateral modes. The Wilcoxon signed-ranks test revealed no significant difference between the zygomatic and mandibular montage for both the latency and amplitude parameters (p > .05). This study revealed no significant difference in p11 and n21 latencies as well as p11-n21 rectified amplitude between zygomatic and mandibular montage using a 500-Hz tone burst stimulus in young adults. Hence, utilizing a 500-Hz tone burst, mVEMP can be recorded in zygomatic and mandibular electrode montage.

180-W GreenLight laser photoselective vaporization with multiple triamcinolone acetonide injections for the treatment of bladder neck contractures.

Bladder neck contracture (BNC), one of the most challenging complications after transurethral resection of the prostate (TURP) and photoselective vaporization of the prostate (PVP), lacks effective treatment. In the present study, our experience in treating BNC using GreenLight laser vaporization with triamcinolone acetonide (TA) injections was shared. This is a retrospective cohort study that included 46 patients with BNC after TURP and PVP in our center. GreenLight laser surgeries (180W) were carried out and TA was administrated simultaneously. TA injections were repeated every week for three times after surgeries. The perioperative and postoperative parameters were reviewed and compared. Bladder neck tissues were examined by immunohistochemical staining to explore the expressions of collagen I, matrix metalloproteinase-3 (MMP-3), and transforming growth factor-β (TGF-β) after treatments. The chief complaint symptoms of all patients were significantly relieved after our treatments. None of them showed BNC recurrence during the follow-up. Complications were rare and mild. Postoperative assessments including maximal urinary flow rate (P < 0.01), International Prostate Symptom Score (P < 0.01), quality of life index (P < 0.01), and post-void residual volume (P < 0.001) were significantly better than baseline values, respectively. Immunohistochemical staining showed significantly lower expressions of collagen I (P < 0.001), MMP-3 (P < 0.001), and TGF-β (P < 0.001) after treatments. In conclusion, 180-W GreenLight laser with repeated TA injections demonstrated the safety and long-term efficacy in treating BNC, by inhibiting the expressions of fibrotic factors. Our procedure was a promising treatment for BNC after PVP and TURP.

The brachial-ankle pulse wave velocity is a predictive factor for erectile dysfunction in patients with benign prostate hyperplasia

ABSTRACT Introduction Phosphodiesterase (PDE) 5 inhibitors induce relaxation of endothelial cells. Tadalafil, one of PDE 5 inhibitors, has been applied for the treatments of erectile dysfunction (ED) and benign prostate hyperplasia (BPH). Under continuous treatments with PDE 5 inhibitor for BPH, it is significant to investigate the relationship between endothelial and sexual functions by comparing the brachial-ankle pulse wave velocity (baPWV).and the sexual health inventory for men (SHIM) score. Objectives Total 89 BPH patients who consulted our clinic with a complaint of urinary symptoms were enrolled in this prospective study. They were treated with a daily dose of 5mg tadalafil. Methods The Institutional Review Board (IRB) approved this clinical study and informed consents had been obtained from 89 BPH patients. Their vessels endothelial function was assessed by baPWV and erectile function was evaluated by SHIM score. International prostate symptom score (IPSS) was obtained as male lower urinary symptoms (LUTS) parameters. However, we focused on the relationship between vessels endothelial and erectile function in this sub-analysis report. Therefore, the SHIM scores were compared with baPWV and IPSS at 0, 3, 6, 12, 24, 36, 48, 60, 72 and 84 months after PDE5 inhibitor treatment. Results The mean age of 89 patients was 66.7 +/- 11.1 years old. Their prostate size was 29.8 +/- 21.2 ml. Initial SHIM, baPWV and IPSS score were 7.4 +/- 5.6, 1742.5 +/- 393.0 cm/sec and 17.5+/- 7.5, respectively. Before tadalafil treatment, baPWV and SHIM were significantly correlated (p=0.0025) which indicated patients with low vessels endothelial function vessels endothelial function suffered from erectile dysfunction. F4rthere06re, all the data of baPWV and SHIM including after tadalafil treatment from 3 to 84 months (n=472) were significantly co-related each other (p&amp;lt;0.0001). On the other hand, baPWV were significantly improved from 3 to12 months after tadalafil administration, however baPWV levels returned to the baseline levels after 24 to 84 months. SHIM score was significantly improved from 3 to24 months after tadalafil administration, however SHIM levels returned to the baseline levels after 36 to 84 months. Conclusions Our previous paper (Aging Male 21, 2018) reported that PDE5 inhibitors improved ED, male LUTS and baPWV from 3 to 12 months. The present data also suggested that endothelial function and male LUTS strongly related to ED in BPH patients. However, baPWV and SHM score levels returned to the baseline levels after 24 and 36 months, respectively. Thus, tadalafil can delay vessels endothelial and erectile dysfunction in BPH patients. In addition, erectile dysfunction seems to be occurred after vessels endothelial dysfunction. Hence, baPWV might be a predictive factor for ED in BPH patients with tadalafil treatments. Disclosure Work supported by industry: no.

Relationship between self- image of penile size and erectile function in Japanese men

ABSTRACT Background Many studies on penile size have been conducted in other countries, but very few in Japan. Furthermore, there are no reports about men's self-image of penile size or the effect of self-image on erectile function. Objectives We investigated penile size in male urology outpatients and examined the difference between subjective and objective penile size and the relationship between self-image and erectile function. Materials and Methods 186 patients who visited our clinic between April 2007 and March 2015 with the chief complaint of late-onset hypogonadism symptoms were enrolled. Patients were asked to complete a questionnaire that included their self-assessed flaccid and erect penile length, self-image of their penile size, SHIM (Sexual Health Inventory for Men) score, and time to ejaculation. All objective penile measurements including stretched length and circumference were performed by the same physician (s). Results The mean self-assessed flaccid and erect penile lengths were 6.8 cm and 12.5 cm, respectively. The mean objectively measured flaccid and stretched penile lengths were 8.3 cm and 12.6 cm, respectively. Most of the patients (71.0%) rated their penis as normal, 27.9% as small, and only 1.1% as large. 28.5% of the patients described their penis as short, and 17.2% as thin. The mean SHIM score of patients who rated their penis as small (7.9) was significantly lower than that of patients who rated their penis as normal (10.5) (p&amp;lt;0.05). The mean time to ejaculation of all patients was 8.7 minutes, and that of the patients with premature ejaculation was 4.6 minutes. Fewer cases (8.6%) desired treatment for penile length, compared to those desiring treatment for ED (31.7%) or premature ejaculation (18.3%). Conclusion Compared with reports from other countries, a high percentage of Japanese patients are dissatisfied with their penile size, and these patients may have a lower self-esteem with respect to their erectile function. Disclosure Work supported by industry: no.

Pengaruh Konsumsi Puding Bayam Merah terhadap Keluhan Dismenore dan Gejala Sindrom Premenstrual pada Remaja Putri

Premenstrual syndrome (PMS) is a collection of symptoms caused by hormonal changes that last about two weeks before menstruation until the start. In addition to hormonal changes (an increased estrogen hormone), several other contributing factors include vitamin and mineral deficiencies such as vitamin B, calcium, magnesium, lack of physical activity, and stress. This study aimed to find out more clearly the effect of consuming red spinach pudding on complaints of dysmenorrhea and symptoms of premenstrual syndrome in adolescent girls. This study used a Quasy Experiment with a two-group pretest-posttest design with a total sample of 60 people. Based on the linear regression analysis results after controlling for the confounding variables BMI and HB levels, the mean reduction in PMS scores in the intervention group was 2.44 and in the control group was 0.54. The mean difference between groups was 2.98, with a p-value = 0.009. The results showed a decrease in the mean premenstrual syndrome score in the group of young women who consumed red spinach pudding.

Опыт лечения депрессии у пациента, перенесшего коронавирусную инфекцию

A sharp rise in the prevalence of mixed anxiety-depressive disorder is observed during the pandemic. Along with symptoms of anxiety, asthenic complaints and cognitive impairment predominate among clinical manifestations of post-COVID-19 depression [4-7]. This drives the patients to first contact general practitioners and neurologists. In the reported clinical case a female patient, who had recently survived coronavirus infection, developed a moderate depressive episode. Antidepressant monotherapy with vortioxetine (Brintellix) as initial treatment was selected based on the polymorphic clinical picture of mood disorder that included not only clear cognitive and asthenic symptom clusters, but also anxiety symptom cluster. Furthermore, vortioxetine is compatible with anticoagulants still taken by the patient due to recommendations of general practitioner. Taking into account the patient's hypochondriacal fixation on her physical health, it is important to note that vortioxetine has no adverse effects on the function of cardiovascular system. In real clinical practice, vortioxetine (Brintellix) shows high efficacy and good tolerability when used for treatment of depressions developing after coronavirus infection.

Real-World Experience with First FDA-Approved Oral Testosterone Undecanoate Formulation

ABSTRACT Introduction The diagnosis of hypogonadism (HG) in men requires both consistently low testosterone (T) levels and signs and symptoms of T deficiency. Management of HG with T replacement therapy (TRT) aims to improve both low serum T levels and patients’ symptomatic complaints. The first oral softgel formulation of testosterone undecanoate (TU) was recently approved by FDA (JATENZO®) for TRT in men with specific hypogonadal conditions and is available in 3 capsule strengths and 5 dosage combinations for necessary dose adjustments. However, dose titration may not be necessary in many patients treated with this new oral TU formulation given the wide eugonadal range. Objective Assess the ability of any given daily dosage of oral TU to restore T to eugonadal levels without dose adjustment at steady state (Css); and determine real-world dose titration experience of patients treated with oral TU. Methods Pharmacokinetic (PK) simulations were performed using a robust population PK model developed for T in 474 hypogonadal men who were treated with oral TU in prior PK studies. The model consisted of a 1-compartment model with absorption lag time and an allometric function on key allometric parameters to account for differences in body weight. This final population PK model was coded in Trial Simulator v2.3.0.6 software. T levels were simulated following oral TU BID dosing on Day 55 (i.e., at steady state) with no dose adjustments. Average T concentrations (Cavg) were derived from multiple serial blood samples collected over 24 hrs for oral TU doses of 237, 316, and 396 mg TU, BID (without dose modification). The percent of subjects with T levels within the eugonadal range (serum Cavg between 304 ng/dL-1030 ng/dL) at each of these TU dose levels was calculated. Prescription data was also accessed in the Symphony PatientSource Patient Transactional Dataset to evaluate the frequency of real-world dose titration. Results The percentage of subjects with Css T Cavg within the eugonadal range for 237, 316, and 396 mg TU, BID were 61%, 74% and 74%, respectively. These corresponded to mean [5%, 95% CI] serum T levels (ng/dL) of 398 [389, 406], 560 [549, 572] and 728 [715, 741] ng/dL, respectively. Early assessment of real-world prescribing data for JATENZO indicated 35% of patients underwent dose titration by month 5. Conclusions Simulated daily BID dosing of oral TU without dose adjustment yielded eugonadal T levels in most subjects at all 3 dose levels examined. These data are consistent with initial early real-world experience with oral TU that indicates dose titration has not been required in most patients. However, because the desired outcome of TRT therapy focuses on both T Cavg and symptomatic response, this oral TU formulation enables necessary dose adjustment when needed. Disclosure Yes, this is sponsored by industry/sponsor: Clarus Therapeutics, Inc. Clarification Industry initiated, executed and funded study Any of the authors act as a consultant, employee or shareholder of an industry for: Clarus Therapeutics, Inc.

Clinical and histological work-up of vitreoretinal metastases from cutaneous malignant melanoma

We report a rare case of vitreoretinal metastases from cutaneous malignant melanoma (CMM). A 76-year-old patient with CMM presented at our clinic complaining of floaters and blurred vision in his right eye. After conducting an exploratory vitrectomy, the diagnosis of vitreoretinal metastases from CMM was made. Histopathology of the enucleated eye demonstrated residual clusters of malignant cells in the vitreous and focal invasion of the inner retina. CMM metastatic to the retina and vitreous is very rare. A detailed ophthalmological examination in all patients with metastatic CMM and complaints of ocular symptoms is highly recommended.

Prevalence of Sexual Dysfunction in Parkinsonian Men: A Literature Review

ABSTRACT Introduction Parkinson's disease (PD) is one of the most common age-related progressive neurodegeneration disorders with incidence increasing 5-10-fold between the sixth to ninth decade of life. Aside from aging, the male sex is also a significant factor in developing PD. Men are twice as likely to develop PD, have an earlier age of disease onset, and an increased rate of disease progression than that of women. Recently, greater attention has been placed towards the quality of life in PD patients, of which non-motor symptoms play a significant role. Sexual dysfunction is an often-overlooked non-motor symptom, which requires patients to reinvent their sexuality thus forcing their partners to cope with these changes in addition to the consequences of Parkinson's disease. Although sexual dysfunction correlates with a reduced marital and life satisfaction, the dysfunction is neglected due to the sensitivity of the topic, prioritizing motor symptom complaints, and attitudes of patients. Objective The purpose of the study is to conduct a systemic review to evaluate the prevalence of the dominant sexual dysfunction characteristics in parkinsonian men to optimize their quality of life. Methods A systemic review was conducted according to the methodology following the PRISMA guidelines. A search was carried out across PubMed, CINAHL, Academic Search Complete, and PsychInfo using the term “Parkinson's disease” and “Sexual Dysfunction” with the latter expanded to include related terms such as “libido,” “low libido,” “impotence,” “erectile dysfunction,” “ejaculation,” and “orgasmic disorder.” There were no temporal or demographic restriction. Results A total of 956 references were identified, 428 were directed for reading titles and abstracts. A total of 81 articles were excluded for full-text reading. Based on inclusion and exclusion criteria, 15 studies met the criteria and were included into the review. The studies were published between 1990 and 2020. It was not possible to perform a meta-analysis due to the heterogeneity present in the studies. In the selected studies, six scales were used to measure sexual dysfunction: Arizona Sexual Experience Scale (ASEX), Brief Index for Sexual Function (BISF), International Index for Erectile Dysfunction (IIEF), Israeli Sexual Behavior Inventory (ISBI), Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction (SCOPA-AUT), and in-house questionnaires. Across the six sexual dysfunction scales, the average reported impaired libido was 40.93% (range = 2%-83%), erectile dysfunction was 54.27% (range = 21.05%-79%), ejaculatory dysfunction was 37.83% (range = 3.16%-79%), and orgasmic dysfunction was 47.88% (range = 0%-87%). Conclusions The review indicates a high prevalence of sexual dysfunction in parkinsonian men; however, insufficient evidence to support or refute the significance of the sexual dysfunction parameters in parkinsonian men. A link between Parkinson's disease and sexual dysfunction via dopamine deficiency and psychosocial deficits has been hypothesized. Increasing awareness and addressing the usually overlooked sexual dysfunction in parkinsonian men can potentially improve their quality of life significantly. Health care providers may consider initiating a conversation regarding sexual function or refer to a sexual medicine specialist thus optimizing the non-motor aspect of parkinsonian men's quality of life. Disclosure No

Management of Sexually Transmitted Infections by Community Pharmacists in Lagos, Nigeria: a Cross-sectional Study

Background: Sexually Transmitted Infections (STIs) are of public health importance in Nigeria.&nbsp;Timely interventions could alleviate STI-associated symptoms, and delay transmission. This study investigated how Community Pharmacists responded to complaints of STI-associated symptoms and&nbsp;explored factors that hinder these efffforts. Methods: A cross-sectional, descriptive study was carried out among 48 Community Pharmacists in Surulere Local Government Area of Lagos. Data were collected using a pretested self-administered,&nbsp;semi-structured questionnaire that comprised demographic characteristics of the pharmacists and the&nbsp;patients, STI symptoms, and services provided by the community pharmacists. Descriptive and&nbsp;inferential statistics were used to summarize the data using SPSS version 20.0. AP-value of &lt;0.05 was&nbsp;considered signifificant. Results: More than half of the Community Pharmacists (58.3%) were females, with 56.3 % having &lt; 5years of practice experience. An average of 10 patients presented to the pharmacies daily with STI&nbsp;associated symptoms. Most patients (97.9%) were aged 18 to 49 years, and are mainly females&nbsp;(70.8%). The most common STI-associated complaints in females were vaginal discharge (93.8%)&nbsp;and urethral discharge (70%) in men. On any STI-related visit, the pharmacist elicited information on&nbsp;the history of present symptoms (92%), medications taken before the pharmacies' visit (88%), onset&nbsp;and duration of symptoms (85%). They suggested medications (94%), counseled patients on&nbsp;medication use (89%), offffered preventive care (Condom use (83.3%); abstinence (31.3%), and&nbsp;referred patients to hospital (79%). Un-resolving symptoms (86.8%) were the main reason for&nbsp;referrals. The Pharmacists failed to confifirm patients' identities and did not follow up with the patients&nbsp;in 45.8% of the visits. They suggested metronidazole (89.6%) most, followed by Azithromycin (85%&nbsp;and Ciproflfloxacin (79%). Patients' reluctance to open up was the main obstacle to the provision of STI&nbsp;management services in the community. Conclusion: Community pharmacists provided a wide range of STI management services of which&nbsp;treatment, medication counseling, and preventive care are the most common. There is a need for&nbsp;pharmacists to improve on referrals and follow-ups to ensure continuity in care.&nbsp

Dysfunctional coronavirus anxiety in nonpsychotic psychiatric outpatients during the COVID-19 pandemic: A network analysis.

BackgroundThe 2019 coronavirus disease (COVID‐19) pandemic has had a profound impact on the mental health of people worldwide. This study examined dysfunctional coronavirus anxiety in nonpsychotic psychiatric outpatients during the pandemic using the coronavirus anxiety scale (CAS) and examined the relationship between coronavirus anxiety and clinical symptoms using network analysis.MethodsIn this cross‐sectional study, 192 patients who first visited the psychiatric outpatient clinic of Severance Hospital during the COVID‐19 pandemic with chief complaints of depressed mood, anxiety, somatic symptoms, or insomnia were included. We compared the clinical characteristics of patients with and without dysfunctional coronavirus anxiety. Network analysis was conducted to estimate the network of coronavirus anxiety and depressive, anxious, and hypochondriacal psychopathology.ResultsThe results showed that 7.8% of patients exhibited dysfunctional coronavirus anxiety (CAS ≥ 5). Patients with dysfunctional coronavirus anxiety showed higher levels of health worry, somatic preoccupation, and subjective anxiety compared to patients without dysfunctional coronavirus anxiety. In the network analysis, the health worry node (Item 6 of the WI) showed the greatest number of connections with coronavirus anxiety nodes.ConclusionsThese findings suggest that health worry may be an important bridge symptom that connects coronavirus anxiety and other clinical psychopathology. Patients with elevated health worries should be carefully monitored during the COVID‐19 pandemic for exacerbation of previous symptoms and COVID‐19‐related psychopathology. Understanding the psychological factors in the face of the pandemic and their relationships with clinical psychiatric symptoms would help people prevent and overcome mental health problems during the pandemic.

Effectiveness of vitex agnus castus extract in the treatment of primary dysmenorrhea

Background. Primary dysmenorrhea (PD) is one of the most common types of gynecological pathology and is observed in 31–52% of young women, in 10% of them the pain is so intense that leads to disability. In the pathogenesis of PD consider a representative of eicosanoids— thromboxane A2 with a pronounced vasoconstrictor effect. The article presents the results of clinical and hormonal examination of women with PD and developed on this basis a method of treatment. The purpose was to develop and evaluate the effectiveness of treatment of PD, taking into account the multicomponent pathogenesis of the disease. Materials and methods. There were 60 women observation, randomly divided into two groups: 30 women with PD (main group) and 30healthy women (control group). PD was diagnosed on the basis of patients’ complaints of painful menstruation and related symptoms, excluding organic gynecological pathology and diseases of the internal organs in consultation with a physician and endocrinologist. Treatment of patients with PD was performed with a combined drug, which includes a standardized extract of Vitex agnus castus L., indole-3-carbinol, 3,3-diindolyl-methane, passionflower extract, California escholzia extract. Results. As a result of treatment in patients with PD significantly reduced the intensity of pain, and 60% completely disappeared pain, all disappeared fear of waiting for the next menstruation, significantly reduced the manifestations of autonomic vascular (from 17% of patients to 3%), autonomic (from 10% of patients to 0%), metabolic and endocrine (from 13% of patients to 0%) disorders and disorders of the emotional and mental sphere (from 23% of patients to 7%), no patient had a combination of symptoms. Conclusions. Given the safety, high therapeutic efficacy, the drug based on Vitex agnus castus extract can be recommended for the treatment of young patients with PD lasting at least 3 months.

Cystitis glandularis- rare cause of urinary bladder mass: case report and literature review

BackgroundCystitis glandularis a rare benign proliferative disease of the urinary bladder mucosa is usually a microscopic finding and manifests rarely as a large visible macroscopic lesion of urinary bladder. Only few cases of cystitis glandularis presenting as urinary bladder mass in female patients have been reported in the literature. We are reporting a case of cystitis glandularis presenting as a urinary bladder mass in a very young female patient.Case presentation.Our patient, a young female 25 years of age presented in the Urology OPD with complaints of irritative lower urinary tract symptoms for two years and intermittent hematuria for one year. On evaluation, she was found to have a urinary bladder mass. Transurethral resection of her urinary bladder mass was done and on histopathological examination, it came out to be cystitis glandularis.ConclusionClinical presentation of cystitis glandularis is variable. It may remain asymptomatic or could present as irritative lower urinary tract symptoms, hematuria, or mucus in the urine. It is normally a microscopic finding but could also present as an overt urinary bladder mass however this has been reported rarely in the literature.

Lung Ultrasound Findings in COVID-19: A Descriptive Retrospective Study.

BackgroundPoint-of-care ultrasound (POCUS) is an indispensable tool in emergency medicine. With the emergence of the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a need for improved diagnostic capabilities and prognostic indicators for patients who are symptomatic for COVID-19 has become apparent. POCUS has been demonstrated to be a useful diagnostic and prognostic tool in the emergency department (ED) in assessing other lung complications. Still, limited data regarding its utility in assessing COVID-19 are available. This study sought to evaluate whether POCUS findings in the ED were correlated with vital signs or laboratory abnormalities typically seen among patients with COVID-19.MethodsA retrospective study was conducted that included 39 patients who presented with COVID-19 and systemic inflammatory response syndrome (SIRS) to a large, urban tertiary care ED. The study population was limited to adults aged 18 and above who came to the ED with the primary complaint of respiratory symptoms, met SIRS criteria on admission, and had images of at least one anterior and one posterior intercostal space per lung and a minimum of four intercostal spaces. POCUS images were obtained by trained operators in the ED using portable ultrasound machines, recorded in an image database, and reviewed by ultrasound fellowship-trained emergency physicians. Clinical data (e.g., acute phase reactants and vital signs) were obtained through a chart review of patients’ electronic medical records.Results Both the percentage of intercostal spaces with B-lines and the percentage of merging B-lines were correlated with decreased oxygen saturation on presentation. No other statistically significant correlations were observed between these sonographic findings and other vital signs or acute phase reactants, nor between these clinical data and the percentage of intercostal spaces that were positive for the shred sign.ConclusionsWith the emergence of the COVID-19 pandemic, emergency medicine physicians are on the frontline of identifying and caring for patients affected by the virus. This study found that sonographic findings associated with interstitial pneumonitis, notably merging B-lines, and the overall percentage of intercostal spaces with B-lines, were clearly associated with worsening oxygen saturation, now thought to be one of the driving causes of morbidity and mortality in COVID-19. As ultrasound has become a ubiquitous and indispensable tool in the ED, this study demonstrated its utility in assessing and managing patients with COVID-19. Bedside ultrasound is a cheap, fast, and non-invasive tool that healthcare providers can use as an essential adjunct in addition to laboratory markers and other imaging modalities for the diagnosis and prognosis of COVID-19.

Pelvic mass resection at time of laparoscopic sacrocolpopexy

In this video, we demonstrate the laparoscopic removal of a large pelvic mass that was found intra-operatively and proceed to perform an efficient laparoscopic sacrocolpopexy to address the patient's primary complaint of prolapse symptoms.

Adolescent gender diversity: sociodemographic correlates and mental health outcomes in the general population.

Gender diversity in young adolescents is understudied outside of referral clinics. We investigated gender diversity in an urban, ethnically diverse sample of adolescents from the general population and examined predictors and associated mental health outcomes. The study was embedded in Generation R, a population-based cohort of children born between 2002 and 2006 in Rotterdam, the Netherlands (n = 5727). At ages 9-11 and 13-15 years, adolescents and/or their parents responded to two questions addressing children's contentedness with their assigned gender, whether they (a) 'wished to be the opposite sex' and (b) 'would rather be treated as someone from the opposite sex'. We defined 'gender-variant experience' when either the parent or child responded with 'somewhat or sometimes true' or 'very or often true'. Mental health was assessed at 13-15 years, using the Achenbach System of Empirically Based Assessment. Less than 1% of the parents reported that their child had gender-variant experience, with poor stability between 9-11 and 13-15 years. In contrast, 4% of children reported gender-variant experience at 13-15 years. Adolescents who were assigned female at birth reported more gender-variant experience than those assigned male. Parents with low/medium educational levels reported more gender-variant experience in their children than those with higher education. There were positive associations between gender-variant experience and symptoms of anxiety, depression, somatic complaints, rule-breaking, and aggressive behavior as well as attention, social, and thought problems. Similar associations were observed for autistic traits, independent of other mental difficulties. These associations did not differ by assigned sex at birth. Within this population-based study, adolescents assigned females were more likely to have gender-variant experience than males. Our data suggest that parents may not be aware of gender diversity feelings in their adolescents. Associations between gender diversity and mental health symptoms were present in adolescents.

Should COVID-19 symptoms be used to cohort patients in the emergency department? A retrospective analysis

ObjectiveTo determine how cohorting patients based on presenting complaints affects risk of nosocomial infection in crowded Emergency Departments (EDs) under conditions of high and low prevalence of COVID-19. MethodsThis was a retrospective analysis of presenting complaints and PCR tests collected during the COVID-19 epidemic from 4 EDs from a large hospital system in Bronx County, NY, from May 1, 2020 to April 30, 2021. Sensitivity, specificity, positive and negative predictive value (PPV, NPV) were calculated for a symptom screen based on the CDC list of COVID-19 symptoms: fever/chills, shortness of breath/dyspnea, cough, muscle or body ache, fatigue, headache, loss of taste or smell, sore throat, nasal congestion/runny nose, nausea, vomiting, and diarrhea. PPV was calculated for varying values of prevalence. ResultsThere were 80,078 visits with PCR tests. The sensitivity of the symptom screen was 64.7% (95% CI: 63.6, 65.8), specificity 65.4% (65.1, 65.8). PPV was 16.8% (16.5, 17.0) and NPV was 94.5% (94.4, 94.7) when the observed prevalence of COVID-19 in the ED over the year was 9.7%. The PPV of fever/chills, cough, body and muscle aches and nasal congestion/runny nose were each approximately 25% across the year, while diarrhea, nausea, vomiting and headache were less predictive, (PPV 4.7%–9.6%) The combinations of fever/chills, cough, muscle/body aches, and shortness of breath had PPVs of 40–50%. The PPV of the screen varied from 3.7% (3.6, 3.8) at 2% prevalence of COVID-19 to 44.3% (44.0, 44.7) at 30% prevalence. ConclusionThe proportion of patients with a chief complaint of COVID-19 symptoms and confirmed COVID-19 infection was exceeded by the proportion without actual infection. This was true when prevalence in the ED was as high as 30%. Cohorting of patients based on the CDC's list of COVID-19 symptoms will expose many patients who do not have COVID-19 to risk of nosocomially acquired COVID-19. EDs should not use the CDC list of COVID-19 symptoms as the only strategy to minimize exposure.

Analisis Keluhan Gejala Neurotoksik pada Pekerja Industri Percetakan XYZ

&lt;p&gt;&lt;em&gt;Indonesia has quite a number of business or industrial branches, one of which is a business that never subsides, namely the printing business. Currently technology is growing, the printing business in Indonesia that uses digital or offset machines continues to grow. The printing business is a type of business that is starting to be taken into account, especially in recent years the printing business has grown rapidly, seen from the small-scale printing industry that has recently emerged. Central nervous system damage can occur due to exposure to chemicals, especially those that are neurotoxic. Such as the use of neurotoxic drugs, as well as people who have metabolic disorders such as diabetes or uremia. Meanwhile, the focus of public health is the relationship between neurotoxic damage and toxic substances (toxins) found in the workplace. This research was conducted by means of field observations which aim to dig up information on complaints of neurotoxic symptoms in workers who work in the spatter industry. This research was conducted in one of the XYZ printing industries. XYZ printing company has 25 workers who are respondents in this study. Based on table 1 and table 2 regarding the distribution of answers to complaints of neurotoxic symptoms in respondents to XYZ printing workers, it is found that there are 5 (20%) positive respondents experiencing neurotoxic symptoms..&lt;/em&gt;&lt;/p&gt;

Clinical manifestations of diffuse large B-cell lymphoma that exhibits initial symptoms in the maxilla and mandible: a single-center retrospective study

BackgroundDiffuse large B-cell lymphoma (DLBCL) is the most common type of lymphatic tumor; however, extranodal DLBCLs that exhibit initial symptoms in the maxilla and mandible are rare. Moreover, DLBCL is clinically classified as a moderate to highly malignant lymphatic tumor that can progress rapidly; therefore, early diagnosis is crucial. However, diagnosis is difficult as the disease causes a diverse range of clinical symptoms with no characteristic imaging findings. We conducted a clinical investigation to clarify the clinical characteristics of DLBCL that exhibits initial manifestation in the maxilla and mandible.MethodsOf the 2748 patients with malignant tumors of the oral and maxillofacial region examined at our hospital during a period of 11 years between January 2006 and December 2016, 27 primary cases diagnosed with DLBCL based on the chief complaint of symptoms in the gingiva and bone of the maxilla and mandible were enrolled in this study. Evaluations were based on sex, age, whether treatment was provided by a previous physician, symptoms, duration of disease until treatment was sought, clinical diagnosis, laboratory findings, and imaging results.ResultsThere were 15 cases that involved the maxilla and 12 that involved the mandible. The median duration of disease until treatment was sought was 60 d (3–450 d). All cases exhibited a tumor or a mass, and hypoesthesia of the chin was confirmed in eight cases wherein the mandible was involved. The clinical stages were stage I in eight cases, stage II in ten cases, and stage IV in nine cases. Serum lactate dehydrogenase (LDH) levels were elevated in 13 of 22 patients. The overall survival rate was 63%.ConclusionsSymptoms associated with nontender swelling and numbness of the lip or chin in the absence of other findings such as dental infections should raise suspicions about DLBCL. Patients should be provided appropriate imaging and accurate biopsy assessments to improve prognosis.