Duration Of Complaints Research Articles

Magnitude of chronic osteomyelitis and its associated factors in children as diagnosed on X-ray visiting at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia: A cross-sectional study.

To assess the magnitude of chronic osteomyelitis and its associated factors in children at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia, in 2022. A hospital-based cross-sectional study was done between April 15, 2022 and August 15, 2022, in children with an age of 18 years or below, who visited Felege Hiwot Comprehensive Specialized Hospital. A total sample size of 168 participants was involved in the study. The random sampling technique was applied to select the study participants. The data were collected from the patients, their charts, and X-ray requests. The data were cleaned, stored, checked for completeness, and entered into EpiData Version 3.1, which were then exported to SPSS Version 23 for analysis. Descriptive analysis was done, and bivariable and multivariable logistic regression were used for analysis. The prevalence of chronic osteomyelitis was found to be 86.3%. The tibia and femur were the most commonly involved bones, and metaphyseal involvement was very common. The most common radiological findings were sequestrum (56%) and involucrum (53%). Of the total patients with radiological evidence of chronic osteomyelitis, 16.6% had complications, the most common of which was a pathologic fracture (12.4%). Being male (adjusted odds ratio = 6.162, 95% confidence interval: 1.12-34.147), being over 10 years old (adjusted odds ratio = 4.048, 95% confidence interval: 1.032-15.886), living in a rural area (adjusted odds ratio = 4.046, 95% confidence interval: 1.236-13.364), having a discharging sinus (adjusted odds ratio = 5.237, 95% confidence interval: 1.393-19.693), having a clinical complaint lasting more than 1 year (adjusted odds ratio = 5.189, 95% confidence interval: 1.247-21.588), and a preceding event of trauma (adjusted odds ratio = =10.363, 95% confidence interval: 1.101-97.509) were the factors associated with chronic osteomyelitis. The prevalence of chronic osteomyelitis is high. In this study, being male, being in the age group above 10 years, having rural residency, having a discharging sinus, having a clinical complaint duration of more than 1 year, and having a preceding event of trauma were the factors associated with chronic osteomyelitis. Therefore, healthcare providers should have a high index of suspicion of chronic osteomyelitis in older male children from rural areas with a chronic discharging sinus following trauma.

Relationship Between Laptop Use Behavior and Health in Midwifery Students at the University of West Sumatra

The use of laptops is generally to meet the needs of wireless communication and internet access. The use of laptops has increased very high in the world of education, both among school and college students. The majority of today's school children always bring laptops to school because of the demands of an increasingly sophisticated era. In the world of education, Australia is a pioneer country for the use of laptops in the school environment, laptops are in great demand because they can be used anywhere and also the use of laptops has a positive impact on the learning and teaching process. The data collection method was carried out by interviews using a research instrument in the form of a questionnaire. The results of this study showed that there was no significant relationship between laptop size and health complaints that were felt due to laptop use (Pvalue = 0.961), there was no significant relationship between the duration of laptop use and health complaints that were felt due to laptop use (Pvalue = 0.782), no there is a significant relationship between the frequency of laptop use and health complaints that are felt due to laptop use (Pvalue = 0.065), there is a significant relationship between body position when using a laptop and health complaints that are felt due to laptop use (Pvalue = 0.002).

Lumbar Canal Stenosis Decompression Using Bilateral Interlaminar Versus Classic Laminectomy Technique

Objective: The study compared the postoperative back pain VAS score in bilateral interlaminar and classic laminectomy techniques in patients with lumbar canal stenosis.
 Material and Methods: This randomized controlled experiment was carried out at Ayub Teaching Hospital's Neurosurgery Department. 30 patients were in the bilateral interlaminar (BIL) group (A) and 30 were in the traditional laminectomy group (B). The bilateral interlaminar decompression technique was carried out utilizing the operating microscope. Both groups employed facet joint undercutting to reduce the 61-facet joint excision. All patients had postoperative CT scans to assess how well the decompression went. Postoperative VAS score was stratified to age, gender, duration of complaints, and duration of the procedure.
 Results: In group A, the mean age of patients was 51.10 years while in group B, the mean age was 54.500 years. There was a male dominance of male patients in both groups. The baseline mean VAS score was 7.9 in group A and group B both. The duration of the procedure was 71.2 minutes in group A, and 104.7 minutes in group B. Mean postoperative VAS score was 5.4 in group A and 3.3 in group B. There existed a significant difference in mean postoperative VAS scores between groups concerning gender, the duration of complaints, and procedures.
 Conclusion: In patients with lumbar canal stenosis, bilateral interlaminar allows for safe and adequate spinal canal decompression.
 Keywords: Lumbar canal stenosis (LCS), Bilateral Interlaminar (BIL), Classic Laminectomy, Visual Analog Scale (VAS).

Factors Affecting Prognosis in the Course of Pediatric Celiac Disease.

Introduction Celiac disease (CD) is a rather frequent chronic autoimmune disease that causes impaired growth in children. The present study aims to evaluate patients' condition after diagnosis cross-sectionally and determine the factors affecting prognosis. Methods Control visits were performed at the end of the 13-month intervention period. The study was designed as a single-center retrospective study and included patients diagnosed with CD. The study cohort consisted of 211 patients aged 1 to 18 years. Statistical parameters include Helicobacter positivity, Marsh classification; economic status; and body mass index (BMI) z-score, weight z-score, and height z-score to observe the difference between admission and follow-up. Results Treatment adherence is one of the most critical factors influencing improvement in developmental parameters during control visits (p<0.033). It was observed that the weight z-scores at the control visit deteriorated significantly with a longer duration of complaints (p=0.033). Better improvement of control visit BMI z-scores among patients with complaints compared to asymptomatic patients (p=0.036) indicate the importance of early diagnosis in asymptomatic cases. Developmental parameters of patients with CD without growth retardation (GR) show faster improvement compared to patients with GR (p<0.001). Families with good socioeconomic status can easily adapt to the diet by reaching a greater variety of gluten-free products, so anthropometric measurements are observed to be significantly higher at the control visit (p<0.002). Conclusions Treatment adherence is the most critical factor for improvement in CD treatment, as in all treatments. In addition, the investigation of suspected, additional disease symptoms during the follow-up of a CD patient is also of great importance for early diagnosis. The importance of early diagnosis has been emphasized in terms of anthropometric improvement in asymptomatic CD cases.

Kinesiophobia in shoulder disorders : Validation of the German version of the Tampa scale for kinesiophobia (TSK-GV)

With aprevalence of 7-30%, shoulder disorders form the third largest group of musculoskeletal complaints. Their formation and development is influenced by, e.g. psychological factors. The Tampa scale for kinesiophobia (TSK) is the most common measure for quantifying fear of movement. To investigate the reliability and validity of the German version of the TSK (TSK-GV) in ashoulder pain population. Subjects with shoulder pain were included in amulticenter cross-sectional study. In addition to kinesiophobia, pain intensity, subjective impairment in daily life and fear-avoidance beliefs were recorded. Atotal of 49subjects (24women and 25men) with amean age of 41.8 (SD = 12.8) were included. The descriptive evaluation at item level showed good internal consistency (Cronbach's α = 0.81). The homogeneity of the scale is poor (Loevinger's H = 0.35). The correlations did not show any clear convergence of the TSK-GV with the fear-avoidance beliefs questionnaire (FABQ) (r = 0.3501; p = 0.0137). The divergent validity was confirmed for both the numerical rating scale (NRS) (r = 0.1216; p = 0.4052) and the shoulder pain and disability index (SPADI) (r = 0.2571; p = 0.0745). The hypothesis testing resulted in 28.57% accepted hypotheses. There was asignificant influence of the TSK-GV and the FABQ on the duration of complaints (R2 = 0.3652; p ≤ 0.0001), as well as an explained variance of the duration of complaints on the TSK-GV of R2 = 0.1834 (p = 0.0021). The subgroup analysis showed asignificantly higher degree of kinesiophobia in male subjects (t = 3.8084/df = 47; p = 0.0002). The TSK-GV is areliable measurement tool. The construct validity should be further investigated in future studies. This study shows comparable values to previous studies in other populations. The TSK-GV is to date the only validated German language measure for recording fear of movement in shoulder disorders and shows an acceptable fit for this population.

Malassezia Folliculitis (MF) Patient Profile in Mycology Division of Dermatovenereology Outpatient Clinic General Academic Hospital Dr. Soetomo Surabaya Period of 2018-2020

Malassezia folliculitis (MF) is a chronic infection of pilosebaceous follicles caused by Malassezia spp. Clinical features of MF may include perifollicular papules and itchy erythematous pustules. This study evaluating the profile of MF patients in the period 2018-2020 in the Mycology Division of Dermatovenereology Outpatient Clinic of Dr. Soetomo General Academic Hospital Surabaya. Retrospective descriptive study aimed at evaluating MF patients including the number of cases, patient baseline data, history taking, physical examination, supporting examinations, and therapy. Based on the tabulation of data obtained 154 new MF patients. The majority of patients were aged 17-25, were females, were students. The most clinical characteristics were red nodules accompanied by moderate itching, the longest duration of complaints were <1 months, the most endogenous predisposing factors were hyperhidrosis and exogenous was humidity and high temperature, the most localized status was in the thoracalis posterior, the most dermatological status was erythematous papules, the supporting examinations carried out were KOH 20% and showed blastospores with the predominance grade 4+, the most Woods lamp examination revealed bright green yellow color, dermoscope examination showed erythema. Most systemic therapies was ketoconazole 2x200 mg and topical was ketoconazole shampoo 2%. There was an increase in the number of MF patients. The diagnosis of MF is based on anamnesis, physical examination and then matched with supporting examinations.

Intestinal disorders after acute diarrhea in young children and their coprological predictors

Background. After acute diarrhea in young children, intestinal disturbances and even chronic functional intestinal diseases may occur. To date, no pathogenetically based criteria have been found that would indicate the probability of chronic intestinal disorders, just as the mechanisms of their occurrence after acute diarrhea have not been fully elucidated. The objective: to evaluate the frequency and nature of bowel disorders in children of the younger age group within 6 months after a stay in hospital for acute diarrhea and to establish their relationship with coprological indicators — fecal calprotectin (FCР), the content of carbohydrates (reducing substances, RS), lactic acid (LA) and short-chain fatty acids (SCFA) — acetic, propionic and fatty (butyric). Materials and methods. The study involved 47 children aged 6–24 months who were hospitalized for acute diarrhea. Acute enterocolitis (group I) was diagnosed in 18 patients and was caused by Campylobacter jejuni in 12 cases, Escherichia coli O-18 and Escherichia coli O-44 in 3, Salmonella enteritidis in 2 and Yersinia enterocolitica in one case. Rotaviral gastroenteritis (group II) was diagnosed in 11 patients. Another 11 children had acute symptomatic (parenteral) diarrhea (group III) against the background of intestinal infection — acute otitis, pneumonia, pyelonephritis. In 7 children, diarrhea was classified as functional digestive disorder (group IV). Routine clinical tests were supplemented with an examination of feces for the presence of intestinal parasites, Clostridium difficile A/B toxins, adenoviruses, human hemoglobin, RS, FCP, SCFA and LA. Results. Six-month follow-up established that 14 of 18 children in group I had permanent or temporary loose stools. These complaints in 13 cases were combined with episodes of abdominal pain similar to intestinal colic. The same complaints were much less frequent in children of group II (6 and 3 of 11, respectively), group III (4 and 2 of 11) and group IV (only in 2 of 7 children). The rank correlation analysis did not reveal any significant relationships between the intensity and duration of complaints and FCP, RS, LA, and SCFA in patients of groups I and II. On the contrary, in group III, there were multiple correlations of complaints with FCP, RS, LA, and SCFA. In group IV, the association of loose stools with an increase in LA and acetic acid has been found. Conclusions. According to the 6-month follow-up, 57 % of young children with acute diarrhea complained of loose stools and/or recurrent abdominal pain after discharge from the hospital. Most often, intestinal disorders were detected in children who had acute bacterial enterocolitis. There were no correlations between the intensity of post-infectious (bacterial or viral) disorders with FCP, RS, LA and SCFA during hospitalization. In contrast, such associations were numerous in children with symptomatic (parenteral) and functional diarrhea. It was suggested that the studied coprological parameters can be used to predict the state of the intestine after acute diarrhea.

Presentation and management of female breast cancer in Egypt.

There have been system inefficiencies in the profiling and management of female breast cancer in Alexandria, Egypt. To identify barriers to full implementation of international guidelines for the management of female breast cancer patients. Female breast cancer data were extracted from records of 3 public oncology services in Alexandria, Egypt, from 2007 to 2016 and analysed. A total of 5236 of the available 7125 records were usable. Median age of the patients was 54 years, and the median duration of pre-diagnosis complaint was 3.1 months. Some 522 (31.5%) of the patients had a family history of cancer. For tumour stage, 2527 (55.2%) were early, 1717 (37.6%) were locally advanced, and 331 (7.2%) were at stage IV. Estrogen receptor, progesterone receptor, and HER2 were positive in 3869 (85%), 3545 (78%), and 461 (15.3%) patients, respectively. Chemotherapy started after a median 1.03 months. Adjuvant chemotherapy was given to 3667 (91.7 %) patients and neoadjuvant chemotherapy to 333 (8.3%); 3686 (92.1%) received anthracycline-based combination chemotherapy, and 3613 (86%) received hormonal treatment. One hundred and eighty of 317 eligible patients received Trastuzumab. Local and/or distant recurrence was seen in 1109 (21.2%) patients. In nonmetastatic cases, median overall and disease-free survival were 149.1 and 77.1 months, respectively. In metastatic cases, median progression-free survival was 19.6 months. We observed defects in the record system, there was delay in diagnosis and treatment, and nonadherence to targeted therapy in many patients. Strengthening of national and hospital-based registries is needed in Alexandria, Egypt, with a robust patient navigation system and targeted information, education and communication strategies. Continuous outcomes monitoring and adaptation to implementation needs should be sustained.

Stromal Herpetic Keratitis with Ulceration Associated with Reactivation of Epstein–Barr Virus and Human Herpes Virus Type 6: Experience of Diagnosis and Therapy

Objective: to study the clinical manifestations of herpetic stromal keratitis with ulceration associated with EBV and HHV-6 reactivation.Patients and methods. 172 patients with anterior ophthalmic herpes were under observation, of which 43 patients had herpetic stromal keratitis with ulceration with an average duration of complaints of more than 60 days. Tear, saliva, blood and urine samples were used as a material for PCR (qualitative and quantitative) for the presence of HSV, VZV, CMV, EBV, HHV-6, HHV-7 DNA. Local therapy of the acute period included instillation of antiviral, anti-inflammatory agents and lubricants. Systemic antiherpetic therapy included oral use of selective nucleoside analogues: valacyclovir and famciclovir in increased daily dosages.Results. 87 cumulative positive results were obtained, of which the proportion of EBV and HHV-6 DNA detection was 23 % and 28 %. Complex local therapy with the inclusion of heparin-containing lubricant and a drug containing 5 % dexpanthenol (“Corneregel”) combined with systemic therapy with nucleoside analogues in increased daily dosages led to complete relief of objective symptoms within 14 to 28 days.Conclusions. EBV and HHV-6 were detected in more than 50 % of cases, which determines systemic antiviral therapy in increased daily dosages and a prolonged course. The pathogenesis of ulcerative defects may be associated with the direct reactivation of HHV-6 and EBV, which requires the use of active reparative therapy from the first days of curation. The phenomenon of a transient viral “surge” detected by PCR during disease course can be observed by adequate systemic therapy and is a normal laboratory pattern indicating the correct tactics.

Evaluation of Cervical Endurance by Craniocervical Flexion Test in Patients with Subacromial Impingement Syndrome: A Preliminary Study

Aim: The aim of the study is to evaluate deep cervical flexor endurance in patients with subacromial impingement syndrome (SIS) and compare it with norm values proven in the literature in asymptomatic individuals. &#x0D; Materials and Methods: The patients’ age, weight, height, duration of complaints and dominant side information were recorded. 35 patients (25 female, 10 male) diagnosed with SIS by physicians participated in the study. Pain intensity was evaluated by numerical rating scale at rest, during elevation and at night. Craniocervical flexion test (CFT) is used for evaluating cervical endurance. “Stabilizer Pressure Biofeedback” device is used for this test. Two types of points are obtained as a result of this test. One is the CFT activation score, which expresses the activation level of the deep cervical muscles, and the other is the CFT performance index, which expresses the endurance of the deep cervical muscles. &#x0D; Results: Both the activation score (3.9±1.9) and the performance index (31.4±14.2) of CFT were significantly different in patients with SIS when compared with those of asymptomatic individuals.&#x0D; Conclusion: Cervical endurance is reduced in patients with SIS. Treatments including cervical stabilization should be planned in these patients.

Clinical features in childhood herpes zoster and predisposing factors: a retrospective study

Amaç: Herpes Zoster, Varisella Zoster Virüsünün reaktivasyonu sonucunda meydana gelen, dermatomal dağılım gösteren veziküller ile karakterize bir hastalıktır. İleri yaşlarda ve immünosupresyonu olan çocuklarda daha sık görülmektedir. Bu çalışma Herpes Zoster tanılı çocukların klinik özelliklerini ve predispozan faktörleri değerlendirmek için tasarlanmıştır.&#x0D; Gereç ve Yöntem: Ocak 2015 Mart 2021 tarihleri arasında hastanemiz Dermatoloji Polikliniğine başvuran ve Herpes Zoster tanısı alan 16 yaş altı hastaların bilgileri retrospektif olarak değerlendirildi. Hastaların yaşı, cinsiyeti, şikâyetleri, şikâyetlerinin süresi, suçiçeği aşıları, suçiçeği öyküleri, ek sistemik hastalıkları, eşlik eden viral enfeksiyonlar ve diğer predispozan faktörler belirlendi. Ek olarak döküntünün dermatomal yayılımı, uygulanan tedaviler ve komplikasyonlar gözden geçirildi.&#x0D; Bulgular: Çalışmaya alınan 67 olgunun 44’ü (%65,7) erkek, 23’ü (%34,3) kadın idi. Hastaların yaş ortalaması 9,7 ± 2,9 yıl idi. En sık görülen şikâyet lezyon bölgesinde kaşıntı idi (%44,8). En sık tutulan dermatom torakal dermatom idi (%56,7). Hiçbir hastada immünosupresyon veya malignite saptanmadı. İki vakada konjonktivit ve üç vakada sekonder bakteryel enfeksiyon gelişmişti. En sık saptanan predispozan faktör: Stres (%38,8) faktörü idi.&#x0D; Sonuç: Herpes Zoster, çocuklarda altta yatan bir immünosupresyonun veya malignitenin kutanöz göstergesi olmayıp klinik olarak iyi bir seyir izlemektedir. Hastalık daha çok stres, viral enfeksiyonlar ve güneş maruziyeti gibi predispozan faktörler eşliğinde karşımıza çıkmaktadır.

SMALL-BOWEL OBSTRUCTION DUE TO CONSUMPTION OF OLEASTER-LEAFED PEAR: A RETROSPECTIVE STUDY

Objective: Small-bowel obstruction is a common emergency worldwide. Oleaster-leafed pear (Pyrus elaeagnifolia Pall.) is an endemic wild pear species in Anatolia. The wild pear fruits are consumed for the treatment of diarrhea in traditional medicine. Here, we describe adhesive small-bowel obstruction following consumption of wild pear.Material and Methods: The medical records of patients who were followed with a diagnosis of adhesion-related small-bowel obstruction between May 2018 and September 2019 were reviewed retrospectively. Patients were divided into two groups as wild pear-related small-bowel obstruction (Group 1) and patients with not wild pear-related small-bowel obstruction (Group 2). Patient characteristics, blood parameters and clinical features were compared between groups.Results: A total of 74 patients including 16 in Group 1 and 58 in Group 2 were included. The median age in Group 1 and Group 2 was 55 and 60.5, respectively. Increased levels of leukocyte, C-reactive protein, blood urea nitrogen were significantly more frequent in Group 2 (all p&amp;lt;0.05). Group 1 was associated with a shorter duration of complaints and faster recovery (all p&amp;lt;0.05). Surgical intervention was required in only Group 2.Conclusion: The potential adverse effects of over-consumed traditional medicines should be kept in mind. Questioning the last food consumed before the complaints started may be a clue for food-induced small-bowel obstruction.

Rubber Band Ligation (RBL) vs Standard Hemorrhoidectomy (SH) for Treatment of Haemorrhoids

Objective: To compare rubber band ligation (RBL) vs standard hemorrhoidectomy for the treatment of haemorrhoids.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Department of General Surgery, Pak Emirates Military Hospital Rawalpindi, from Feb 2020 to Jan 2021.&#x0D; Methodology: A total of 200 patients with 2nd and 3rd-degree haemorrhoids who met the inclusion and exclusion criteria were included in the study. Group-A patients underwent rubber band ligation, while in Group-B, Milligan Morgan hemorrhoid-dectomy was done.&#x0D; Results: There were 200 patients (100 in each Group). There were 135 males (67.5%) and 65 females (32.5%). The female to male ratio was 1:2.01. Mean age was 44.73 ± 8.36 years in Group-A and 43.48 ± 8.98 years in Group-B. Mean duration of complaints was 8.72 ± 4.32 months in Group-A and 10.89 ± 3.80 in Group-B. Post-procedure patients were called for follow up in a third and eighth week. The most common complication seen in Group-A was recurrence which was 18% (p-value 0.001), and pain in Group-B, 82% (p-value 0.001), which was statistically significant.&#x0D; Conclusion: We concluded that Rubber band ligation is a quick, safe and cost-effective procedure for the outpatient department for Grade II and III haemorrhoids. The recurrence rate is high compared to standard hemorrhoid-dectomy, but its advantages make it a first-line procedure for Grade II and III haemorrhoids in the outpatient departments.

Functional gastrointestinal disorders in children: Effectivity, safety, and tolerability of the herbal preparation STW-5 (Iberogast®) in general practice

BackgroundFunctional gastrointestinal disorders (FGIDs) of the upper and lower digestive system in children and adolescents present with heterogeneous gastrointestinal symptoms and are a common reason for specialist consultations. The herbal medicinal preparation STW-5 has already shown efficacy and safety in clinical studies with more than 7000 adult participants suffering from functional dyspepsia (FD) or irritable bowel syndrome (IBS). Here, we evaluate with a prospective observational study the effectivity and safety of STW-5 in children with FGID under real-life conditions and interpret these data versus the background of controlled clinical studies in a predominantly adult population. MethodsThis prospective observational study included 980 children (age 3–14 years) with FGID. For inclusion, Rome III criteria were recommended to apply. The inclusion of the patients for treatment with STW-5 followed routine clinical practice. Patients were treated for approximately 1 week. The presence and severity of symptoms was documented at the study start and at the end of treatment period utilizing the adapted gastrointestinal symptom score (GIS). Other target parameters included global effectivity and tolerability assessments as well as adverse events. ResultsThe average patient age was 7.6 ± 2.9 years. Most of the patients were treated for IBS (n = 418; 43 %) or FD (n = 259; 26 %), with a mean baseline GIS of 16.1 ± 8.9. During the treatment period, the GIS decreased 76 % to 3.8 ± 4.2. The decrease in symptoms was similar for different age groups, gender, and indications. Patients with a shorter duration of complaints had a lower GIS at study end (p < 0.0001. The global treatment effect was assessed as good or very good by 87–89 % of patients/parents and physicians. Physicians rated the global tolerability as good or very good for 95 % of the patients. Seven patients (0.7 %) reported adverse events. ConclusionsThe treatment effect of STW-5 in this study was in its range comparable to according data from controlled clinical trials with predominantly adult participants.Thus, supporting robustness of these data generated in an uncontrolled observational setting. The results of this observational study indicate that STW-5 may be an effective and well tolerated treatment option also for children with FGIDs.

Getting to the Emergency Department in time: Interviews with patients and their caregivers on the challenges to emergency care utilization in rural Uganda.

Karoli Lwanga Hospital and Global Emergency Care, a 501(c)(3) nongovernmental organization, operate an Emergency Department (ED) in Uganda's rural Rukungiri District. Despite available emergency care (EC), preventable death and disability persist due to delayed patient presentations. This study seeks to understand the emergency care seeking behavior of community members utilizing the established ED. We purposefully sampled and interviewed patients and caregivers presenting to the ED more than 12 hours after onset of chief complaint in January-March 2017 to include various ages, genders, and complaints. Semistructured interviews addressing actions taken before seeking EC and delays to presentation once the need for EC was recognized were conducted until a diverse sample and theoretical saturation were obtained. An interdisciplinary and multicultural research team conducted thematic analysis based on descriptive phenomenology. The 50 ED patients for whom care was sought (mean age 33) had approximately even distribution of gender, as well as occupation (none, subsistence farmers and small business owner). Interviews were conducted with 13 ED patients and 37 caregivers, on the behalf of patients when unavailable. The median duration of patients' chief complaint on ED presentation was 5.5 days. On average, participants identified severe symptoms necessitating EC 1 day before presentation. Four themes of treatment delay before and after severity were recognized were identified: 1) Cultural factors and limited knowledge of emergency signs and initial actions to take; 2) Use of local health facilities despite perception of inadequate services; 3) Lack of resources to cover the anticipated cost of obtaining EC; 4) Inadequate transportation options. Interventions are warranted to address each of the four major reasons for treatment delay. The next stage of formative research will generate intervention strategies and assess the opportunities and challenges to implementation with community and health system stakeholders.

Assessment of adverse pregnancy outcomes in women presenting with uterine fibroids at a tertiary care hospital.

Objective: To determine frequency of adverse pregnancy outcomes in women presenting with uterine fibroids at a tertiary care hospital. Study Design: Descriptive Case Series. Setting: Department of Obstetrics &amp; Gynaecology, Nishtar Hospital, Multan. Period: 25th November 2020 to 24th June 2021. Material &amp; Methods: The detailed history was taken and patients were examined thoroughly. Data was collected for basic demographics i.e. Age, parity, BMI, duration of complaints and pregnancy outcomes. Patients were booked and followed up for the pregnancy outcomes like preterm labour and post-partum hemorrhage. Results: Mean age of our study cases was noted to be 28.98 ± 3.68 years. Mean duration of fibroids was noted to be 26.46 ± 8.11 months and most of them i.e. 86 (53.8%) presented with duration of disease for more than 2 years. Mean body mass index of our study cases was noted to be 26.21 ± 2.14 kg/m2 and obesity was present in 47 (29.4 %) of our study cases. Mean gestational age was noted to be 37.11 ± 3.09 weeks and 100 (62.4%) had gestational age more than 34 weeks. Large fibroids were observed in 21 (13.1 %), small in 48 (30 %), single fibroids in 39 (24.4 %), multiple fibroids in 39 (24.4 %), intramural in 7 (4.4%) and submucosal in 6 (3.8%). Preterm labor was noted in 88 (55 %) and Postpartum hemorrhage was noted in 66 (41.3 %) of our study cases. Conclusion: Uterine fibroids are associated with significantly increased adverse pregnancy outcomes as the frequencies of preterm births and postpartum hemorrhage were very high in our study. Preterm births were significantly associated with age, parity, obesity and characteristics of fibroids. Postpartum hemorrhage was significantly associated with age, parity, residential status, obesity and characteristics of fibroids.

Voice Handicap Index in Iranian Rehabilitation Professors with and Without Vocal Complaints

Background: University professors are a group of professional voice users who report more voice problems than the general population, which may affect their quality of life. The World Health Organization defines health as a multidimensional concept: "A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." The Voice Handicap Index (VHI) can assess university professors' vocal health even before having a voice problem. Objectives: We aimed to study the Voice Handicap Index (VHI) in Iranian rehabilitation professors with and without vocal complaints. Methods: This cross-sectional online study enrolled 235 professors (100 men and 135 women) from Iranian rehabilitation colleges selected through stratified random sampling. The inclusion criterion was being a university professor. The assessment tools included VHI and a four-part questionnaire about vocal complaints. The Kolmogorov-Smirnov test checked the normality of quantitative data. The Mann-Whitney and chi-square tests compared the two groups. The data were analyzed by SPSS21 at a significance level of 0.05. Results: The rate of voice problems was significantly more in professors with vocal complaints (29.12%) than in those without complaints (9%), according to VHI30 (P &lt; 0.001). The mean VHI differences between the two groups, with and without vocal complaints, were significant in the scores of the total scale (P &lt; 0.000) and its subtests physical (P &lt; 0.000), emotional (P &lt; 0.000), and functional (P &lt; 0.002). Some information was also obtained about vocal complaints in professors, including the frequency of nine vocal complaints. The frequency of the complaints was 64.1% for vocal fatigue, 61.2% for hoarseness, 24.3% for pain, 16.5% for breathy voice, 15.5% for strain, 13.6% for monotone voice, 11.7% for pitch breaks, 5.8% for aphonia, 4.9% tremor in professors with vocal complaints, 78.64% for the effect of vocal complaints on communication, and 72.8% (acute) and 27.2% (chronic) for the duration of vocal complaints. Conclusions: Iranian university professors of rehabilitation science with vocal complaints had higher VHI scores than those without vocal complaints, which shows they may be apt to voice problems. Vocal fatigue was the most common voice complaint, and voice tremor was the least. Also, most reported complaints were acute that affected professors' communication. In future research, it seems necessary to design comprehensive prevention and treatment programs focusing on the vocal health of professors in rehabilitation colleges.

Frequency and Type of Ovarian Tumors in Gynecological Women presenting to DHQ Teaching Hospital Gujranwala

Background: Ovarian cancer (OC) average lifetime risk is 1 in 70(1.4%).Ovarian cancer is diagnosed in 7300 women every year in UK and 239,000 women world wide.There are variations in incidence with ethnicity, white women have the highest incidence approximately14/100,000 where as Asian women have a lower incidence at 10/100,000. Aim: To find the frequency and different types of ovarian carcinomas in women presenting with pain lower abdomen. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynecology, DHQ Hospital Gujranwala from1st May 2020 to 31st October 2020.A total of 282 women presenting with pain lower abdomen were included.All women underwent ultrasonography and ovarian tumors were noted as per operational definition. Patients with ovarian tumor underwent laparotomy, the specimen of tumors were collected with excision biopsies and sent for histopathological analysis. Results: The mean age of cases was 33.808±7.70 years, and the mean duration of complaint was 4.322±1.46 weeks and mean weight was 69.560±13.00 kg. Majority of the patients (82.3%) belonged to 20-40 years age groups. Ovarian Tumor was seen in 65(23%) patients. Among 65 patients with ovarian tumor, 72.3% were benign, 3.1% borderline and 24.6% were malignant. Conclusion: It was concluded that ovarian tumors were common between the 20 and 40 years of age. The frequency of Malignant neoplastic lesions was higher than the benign neoplastic lesions. Keywords: Women, Pain lower abdomen, Ovarian tumors

Predictors of complicated appendicitis among patients presented to public referral hospitals in Harari region, Eastern Ethiopia: a case-control study

Complicated appendicitis makes up a significant proportion of acute appendicitis. There are well established associated factors for the development of complications, but the magnitude varies between developed and developing countries. This study was aimed to look for possible incriminated factors for higher rate of complicated appendicitis among patients treated in public hospitals found in the Harari region, Eastern Ethiopia. Multi-center case-control study with 1:2 was conducted on adult complicated appendicitis patients. The sample size of 414 was determined using an Open Epi and a simple random sampling technique was used to select the samples. Kobo collect was used for data collection by trained medical doctors. Data analysis was made using a statistical package for social studies version 23. The findings were presented in tables and elaborated in texts. Binary logistic regression analysis was conducted to determine association between predictors and outcome variable with adjusted odds ratio at 95% confidence interval, p value less than 0.05. A total of 402 patients included in the study with 268(66.7%) simple appendicitis and 134(33.3%) complicated appendicitis. More patients with complicated appendicitis had a history of another health facility visit compared to the simple appendicitis groups. Duration of chief complaint, history of constipation, having history of visit to health facilities without surgical intervention for their current problem and fever has shown moderate to strong associations on binary logistic regression analysis. Delayed presentation, patients who had a history of a visit to primary health care facilities and private clinics where surgical intervention not available were also found to have an increased risk of developing complicated appendicitis.

Clinical and histopathological profile of primary caruncular lesions.

Purpose:To provide a retrospective analysis of lesions of the caruncle which have been very rarely reported in the literature.Methods:A retrospective review of all the caruncular lesions between January 2000 and January 2020 was done at a single tertiary eye care hospital. The lesions were classified as benign and malignant lesions. Clinicopathological correlation was done for the excised lesions.Results:A total of 87 caruncular lesions were included in the study. Males (59%) were affected more than females (41%). The mean age at presentation was 44 ± 20 years. The mean duration of complaint was 36 ± 62 months. A total of 36 patients underwent surgical excision whereas the rest opted for conservative management. Recurrence was noted in five patients. Fifteen different types of lesions were identified histopathologically. Benign lesions (78%) were far more common than malignant ones (22%). Epithelial inclusion cyst was the most common benign lesion and sebaceous gland carcinoma was the most common malignant lesion. Correct clinicopathological correlation was seen in 52.7% of the cases. Caruncular tuberculosis, oncocytoma, and basosquamous cell carcinoma were some of the rare lesions.Conclusion:Caruncular lesions are uncommon and very diverse, which makes clinical diagnosis challenging. Epithelial inclusion cyst and sebaceous gland carcinoma were the most common benign and malignant lesions respectively. Correct clinicopathological correlation was seen in more than half of the cases.