Initial Complaint Research Articles

Evolução do processo terapêutico fonoaudiológico no Distúrbio Específico de Linguagem (DEL): relato de caso

O objetivo deste estudo foi descrever a evolução clínica de uma criança do gênero feminino, nove anos de idade, com diagnóstico de Distúrbio Específico da Linguagem atendida na Clínica de Linguagem Infantil da FOB-USP. Realizou-se acompanhamento longitudinal, por meio de análise de prontuário e filmagens. A intervenção fonoaudiológica iniciou quando a criança apresentava cinco anos com queixa de alterações fonológicas e prejuízos na inteligibilidade de fala. Constatou-se processos fonológicos não mais esperados para a idade, alterações semântico-lexicais, sintáticas, pragmáticas, e em processos perceptivos auditivos, estando a linguagem receptiva preservada. A intervenção teve como principal objetivo a organização dos subsistemas linguísticos principalmente da habilidade de processamento de informações. Após um ano, houve evolução dos aspectos trabalhados, exceto do aspecto fonológico, que teve evolução menos significante. Atividades direcionadas a linguagem escrita foram inseridas quando a criança iniciou o ensino fundamental. Após 42 meses de intervenção, houve evolução do aspecto fonológico. Entretanto, esta evolução ainda não é observada na fala espontânea. As alterações neste aspecto exercem grande influência no desempenho da linguagem escrita. A habilidade de consciência fonológica está adequada, entretanto, há dificuldade na conversão fonema/grafema, resultando em desempenho aquém do esperado na linguagem escrita. Ainda, há comprometimento no processamento da informação linguística, além de persistência nas alterações, que acarretam defasagens no processo de alfabetização. Acreditamos que para conduzir o processo terapêutico é necessário compreender a natureza das dificuldades linguísticas, desenvolvendo estratégias específicas voltadas principalmente ao processamento da informação linguística e a aprendizagem, proporcionando habilidades e capacitando o indivíduo para a participação ativa em ambientes sociais e escolares.

Systematic Review of Self-Reported Prognosis in Adults After Mild Traumatic Brain Injury

To update the MTBI prognosis review published by the WHO Task Force in 2004. Systematic review and best-evidence synthesis. MEDLINE, PsycINFO, Embase, CINAHL and SPORTDiscus were searched from 2001 to 2012. We included published, peer-reviewed studies. Controlled trials, cohort and case-control studies were selected according to predefined criteria. Studies were included with more than 30 adult MTBI cases. Not applicable. Self-reported outcomes in adults. Evidence from accepted studies was synthesized qualitatively into key findings, and prognostic information was prioritized according to design as exploratory or confirmatory. Of 299 reviewed studies, 101 (34%) were accepted and form our evidence base of prognostic studies. Of these, 23 addressed self-reported outcomes in adults, including two of the three original ICoMP research studies. These studies show that common post-concussion symptoms are not specific to MTBI/concussion and occur after other injuries as well. Poor recovery after MTBI is associated with poorer pre-morbid mental and physical health status and with more injury-related stress. Most recover over one year, but persistent symptoms are more likely in those with more acute symptoms and more emotional stress. Common subjective symptoms after MTBI are not necessarily caused by brain injury per se, but they can be persistent in some patients. Those with more initial complaints and psychological distress recover slower. We need more high-quality research on these issues.

Characteristics of Prolonged Concussion Recovery in a Pediatric Subspecialty Referral Population

To identify pre-existing characteristics associated with prolonged recovery from concussion in a sample of patients referred to a pediatric sports medicine clinic. This was a retrospective, exploratory cohort study of 247 patients age 5-18 years with concussion referred to a tertiary pediatric hospital-affiliated sports medicine clinic from July 1, 2010, through December 31, 2011. A random sample of all eligible patient visits (3740) was chosen for further review and abstraction. Statistical comparisons between subsets of patients were conducted using exact χ(2) tests, logistic regression, quantile regression, and Kaplan-Meier survival curves. The median time until returning to school part-time was 12 days (IQR 6-21); until returning to school full-time without accommodations was 35 days (IQR 11-105); until becoming symptom-free was 64 days (IQR 18-119); and until being fully cleared to return to sports was 75 days (IQR 30-153). Furthermore, 73% of all patients were symptomatic for >4 weeks, 73% were prescribed some form of school accommodation, and 61% reported a decline in grades. Characteristics associated with a prolonged recovery included a history of depression or anxiety; an initial complaint of dizziness; abnormal convergence or symptom provocation following oculomotor examination on physical examination; and history of prior concussion. Pediatric and adolescent patients with concussion may experience cognitive and emotional morbidity that can last for several months following injury. Clinicians should consider specific pre-existing characteristics and presenting symptoms that may be associated with a more complicated recovery for concussion patients.

Hyperacusis as the initial presentation of Creutzfeldt-Jakob disease.

Creutzfeldt-Jakob disease (CJD) is a rare and invariably fatal neurologic disorder caused by an abnormal prion protein. Perceptual disturbances, including visual and auditory agnosias, have been reported in the course of CJD but are not typically the initial complaint. We report a case of hyperacusis as the initial presentation of sporadic CJD.

The Withdrawal of the Initial Complaint and the Settlement by the Parties, Expressions of Christian Forgiveness

For offences that harm private interest or have a limited social impact, the Criminal Code of 1969 provided the withdrawal of the initial complaint and the settlement by the parties.The draft of the Romanian Criminal Code, submitted for approval to Parliament, tacitly repeals the institution of the settlement of parties, which, as the founder of Romanian criminal law argued, “may be more useful for restoring legal order and prevent other disturbances that may have stemmed from the lingering resentments of the two subjects of the litigation.”In most modern criminal laws we can no longer find the explicit settlement by parties, but rather the presumed settlement inferred from the withdrawal or abandonment of the criminal complaint. In Romanian criminal law, over time, offences for which settlement was possible have varied from one era to another. In the Sturdza Codex, settlement was possible and considered as mitigating. In the proposed Criminal Code bill of 2004, settlement by the parties also existed.The will to reach a settlement by the parties may be determined by Christian reasons. Forgiveness of one's fellow man is a commandment of the Lord Christ, which He himself fulfilled on the cross and preached.What is the contribution of Christian teaching to the emergence, development and application of the criminal law institutions of withdrawal of initial complaint and settlement by parties?

WHAT IS THE RETURN ON YOUR UNPLANNED RETURNS?

Objectives & BackgroundUnplanned emergency re-attendance within seven days is a national quality indicator set at 1–5% by the Department of Health. Newham University Hospital (NUH), one of three hospitals forming...

Initial memory deficit profiles in patients with a cerebrospinal fluid Alzheimer's disease signature.

Alzheimer's disease (AD) clinical onset is usually characterized by a memory complaint and a progressive memory deficit. The proportion of typical medial-temporal amnesia revealing AD remains unknown. The present study explores the episodic memory impairment profiles by the Free and Cued Selective Recall Reminding Test (FCSRT) in patients with initial memory complaint and a cerebrospinal fluid (CSF) biomarker signature of AD. Seventy-three patients referred for memory complaint to the Centers for Memory, Resource and Research of Lyon and Montpellier (France) were included consecutively. All patients underwent an extensive neuropsychological examination and had a Mini-Mental State Examination (MMSE) score ≥20 and a positive CSF AD signature. The patients were classified as having mild dementia or prodromal AD. Verbal episodic memory was assessed using the French version of the FCSRT exploring encoding, storage/consolidation, and cued delayed retrieval phases of memorization. Three different memory profiles were identified according to the results of FCSRT. The median age was 72 year-old [interquartiles: 65-76]. The median MMSE score was 23 [interquartiles: 21-25]. 88% of the patients (n = 64) presented with a medial temporal amnesia profile. The dysexecutive amnesia and normal verbal episodic memory profiles represented respectively 5% (n = 4) and 7% (n = 5). There were no significant differences in term of age, gender, and MMSE score between the three profile groups. In a population initially presenting with memory complaints and depicting a CSF AD signature, a high proportion of medial temporal amnesia is disclosed as expected, but also a proportion of dysexecutive amnesia and normal FCSRT.

Is retrograde flexible nephrolithotripsy feasible for calyceal diverticular stone?

The aim of this study is to manage the calyceal diverticular (CD) stone, several treatment options were applied but it is still a challenging condition of endourology. In this retrospective study, we aim to report the results of our patients with CD stones treated with retrograde flexible nephrolithotripsy (RFNL). A total of 47 patients (55 procedures) who underwent RFNL by a single surgeon for CD stones from January 2004 to March 2013 were evaluated retrospectively. The demographic properties and initial complaints of those patients have been recorded along with their comorbidities and previous history of stone management. Moreover, the size and number of the stones, the duration of the surgery, fluoroscopy time, stone-free rate (SFR) and postoperative complications of the patients have been evaluated. The mean age was 41.8 years (range 16-71). Of the study population, 31 (65.9%) were male. Mean stone size was 21.1 (7-52) mm whereas in 3 (6.4%) of the cases the stones could not be reached. Mean duration of the surgery was 92.8 (57-163) min whereas mean fluoroscopy time was 35.9 (14-103) s. After 3 months of follow-up period, the SFR was 85.1%. No major complications occurred. RFNL with holmium laser and nitinol basket catheter application is a feasible and successful procedure in the management of CD stones. With its high success rates, low incidence of complications and minimal morbidity when compared with other treatment options, RFNL has the potential of becoming the preferred treatment option in the minimally invasive management of patients with CD stones.

Effect of foot massage on postoperative pain and vital signs in breast cancer patient

Background : Pain is a common sequela of surgery and foot massage has been advocated as an effective and easy technique that can be applied independently by nurses to patients in postoperative period to relive pain intensity. It involves a simple technique, costs little and requires no special equipment. The aim of this study is to evaluate the effect of foot massage on postoperative pain and vital sign parameters in postoperative breast cancer patients. Methods: A quasiexperimental design was used to investigate any causality between foot massage and postoperative pain with a total of 60 breast cancer patients (n = 30 in the control group who received only analgesic treatment and n = 30 in the experimental group who received analgesic treatment plus foot massage). A structured questionnaire was developed by the researcher to collect data related to participants’ characteristics such as age, level of education, type of surgery and usage of Non-steroidal Anti Inflammatory Drugs [NSAIDs]. Following an initial complaint from patients that they were experiencing post-operative pain the pain intensity level was assessed by a Visual Analogue Scale [VAS] as a baseline and after 60 minutes and 120 minutes following foot massage. Vital signs were assessed using the same time intervals. Findings: When analyzing pain levels over time a significant difference was found between both groups with the mean pain level of the experimental group who had experienced foot massage as an adjunct to analgesia being noted to be lower than that of the control group. A statistically significant reduction of systolic and diastolic blood pressure in both groups was also observed but a higher reduction was observed in the experimental group ( P < .001) whilst the respiratory rate remained unchanged in both groups. Conclusion : Foot massage is an effective modality in helping to relieve postoperative pain among women who have been treated with surgery for breast surgery. To promote and improve the quality of foot massage in clinical settings, regular meeting should be held by health team members to discuss the potential positive clinical outcomes, patient benefits and methods of implementation and audit of this technique. Consideration should be given by schools of nursing to include this technique within their nursing curriculum, through the integration of the complementary therapy foot massage technique as part of the considerations on the fundamentals of surgical nursing theory and practice.

Comparison of rectal and axillary temperatures in dogs and cats.

To compare rectal versus axillary temperatures in dogs and cats. Prospective observational study. 94 dogs and 31 cats. Paired axillary and rectal temperatures were measured in random order with a standardized method. Animal signalment, initial complaint, blood pressure, blood lactate concentration, and variables associated with vascular perfusion and coat were evaluated for associations with axillary and rectal temperatures. Axillary temperature was positively correlated with rectal temperature (ρ = 0.75 in both species). Median axillary temperature (38.4°C [101.1°F] in dogs, and 38.4°C [101.2°F] in cats) was significantly different from median rectal temperature in dogs (38.9°C [102.0°F]) but not in cats (38.6°C [101.5°F]). Median rectal-axillary gradient (difference) was 0.4°C (0.7°F; range, -1.3° to 2.3°C [-2.4° to 4.1°F]) in dogs and 0.17°C (0.3°F; range -1.1° to 1.6°C [-1.9° to 3°F]) in cats. Sensitivity and specificity for detection of hyperthermia with axillary temperature were 57% and 100%, respectively, in dogs and 33% and 100%, respectively, in cats; sensitivity and specificity for detection of hypothermia were 86% and 87%, respectively, in dogs and 80% and 96%, respectively, in cats. Body weight (ρ = 0.514) and body condition score (ρ = 0.431) were correlated with rectal-axillary gradient in cats. Although axillary and rectal temperatures were correlated in dogs and cats, a large gradient was present between rectal temperature and axillary temperature, suggesting that axillary temperature should not be used as a substitute for rectal temperature.

Factors Affecting the Length of Stay of Patients in Emergency Department Observation Units at Teaching and Research Hospitals in Turkey

SUMMARYObjectivesThis study aimed to determine the reasons for long stays in monitoring units and to propose a solution.MethodsThe patients who were followed in monitoring units of emergency service and the factors affecting the length of their hospital stay were analyzed retrospectively. Demographic features, their initial complaint that lead to monitoring, diagnosis, their means of arrival to emergency service, their admittance date and hour, medical history, basic vital signs, length of stay in emergency service, invasive interventions, intubation, mortality rates, consultations, and clinical results were evaluated.ResultsThe study included 603 patients. Average emergency service stay in monitoring unit was found to be 6.5 hours. In addition, 15 patients (2.5%) stayed 24 hours or longer, and 78 patients (12.9%) stayed 12 to 24 hours. Of the 15 patients who stayed in emergency service for 24 hours or more, 8 (53.3%) stayed because there wasn't enough space in intensive care units. The most prevalent complaint for admission to the emergency service was chest pain (25.5%), followed by dyspnea (21.9%) and tachycardia (11.6%).ConclusionsFor real emergency conditions, monitoring units are necessary to follow patients closely and to perform immediate interventions. The fullness of the intensive care units primarily affects the emergency service and leads to long stays in emergency service as patients are waiting to be admitted to the intensive care unit. As the number of consultations increases, the monitoring period is prolonged.

Sinonasal Pure Yolk Sac Tumor: A Case Report and Literature Review

Extragonadal pure yolk sac tumor of sinonasal origin is very rare. We report herein a case with sinonasal yolk sac tumor in a 1 year and 3 months old girl. The initial complaint was persistent nasal bleeding for about 2 months. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a lobulated soft tissue mass in paranasal sinus that extended to oral cavity, nasopharynx, and oropharynx. The histology showed typical features of yolk sac tumor and the positive immunohistochemical staining of SALL4 and α-fetoprotein. After tumor excision, adjuvant chemotherapy of JEB regimen was prescribed. After the follow-up for 13-months, α-fetoprotein was normal and neither tumor progression nor metastasis was found. We review the previous literature and discuss the etiology, histology, treatment, and the prognosis of the rare sinonasal yolk sac tumor.

A Case of Successful Treatment for Obstructive Jaundice in Hepatocellular Carcinoma with A Biliary Invasion by Transcatheter Arterial Chemoembolization after Biliary Drainage

Biliary invasion by hepatocellular carcinoma (HCC) is much less common. Patients manifest obstructive jaundice as the initial complaint, but most of them are inoperable. We report a case of completely improved biliary invasion in HCC after transcatheter arterial chemoembolization (TACE). A 61-year-old woman was referred for evaluation of jaundice. A biliary invasion of huge HCC was confirmed by image of abdominal computerized tomography (CT) and biopsy specimen. After improvement of jaundice by endoscopic retrograde biliary drainage and percutaneous transhepatic biliary drainage, she underwent TACE as a palliative treatment. Follow-up CT showed partial lipiodol uptake in hepatic tumor and its bile duct invasion. In follow-up endoscopic retrograde cholangiopancreatography, occluded cholangiogram showed neither luminal obstruction nor filling defect after removal of biliary stent. Our case suggests that obstructive jaundice, caused by inoperable huge HCC with biliary invasion, may be expected to resolve successfully biliary obstruction by a choice of TACE. Korean J Pancreatobiliary 2014;19(1):31-36

A Case Report of Thrombotic Thrombocytopenic Purpura Associated with Systemic Lupus Erythematosus: Overlapping Features

The association between thrombotic thrombocytopenic purpura (TTP) and systemic lupus erythematosus (SLE) is rare. Herein, we present a case with overlapping features between TTP and SLE. A 17-year old girl admitted to our hospital with an initial complaint of high grade fever, persistent headache, and microangiopathic hemolytic anaemia (negative Coombs test with schistocytes), thrombocytopenia with thrombotic event with central nervous system involvement and probably renal involvement. Also, our patient fulfilled the criteria for SLE- fever, hair loss, oral ulcers, central nervous system involvement, renal involvement, positive ANA, positive dsDNA and normal C3 and C4. The patient was rescued by extensive plasma exchange started promptly after the diagnosis. After 8 months of treatment, TTP recurred, successfully managed with plasma exchange, steroids and cyclophosphamide. It was difficult to discriminate TTP from SLE. Our case presented simultaneous features of both SLE and TTP who reinforce the importance of early diagnosis of TTP by the observation of fragmented RBCs and the intensive therapy, including plasma exchange and careful follow-up, not only to ensure diagnosis and treatment of a relapsed episode of TTP, but also to ensure proper management of the patient’s physical and mental health due to its high morbidity.

Controlled Breathing With or Without Peppermint Aromatherapy for Postoperative Nausea and/or Vomiting Symptom Relief: A Randomized Controlled Trial

With little scientific evidence to support use of aromatherapy for postoperative nausea and/or vomiting (PONV) symptoms, this study evaluated controlled breathing with peppermint aromatherapy (AR) and controlled breathing alone (CB) for PONV relief. A single blind randomized control trial design was used. On initial PONV complaint, symptomatic subjects received either CB (n = 16) or AR (n = 26) intervention based on randomization at enrollment. A second treatment was repeated at 5 minutes if indicated. Final assessment occurred 10 minutes post initial treatment. Rescue medication was offered for persistent symptoms. Among eligible subjects, PONV incidence was 21.4% (42/196). Gender was the only risk factor contributing to PONV symptoms (P = .0024). Though not statistically significant, CB was more efficacious than AR, 62.5% versus 57.7%, respectively. CB can be initiated without delay as an alternative to prescribed antiemetics. Data also support use of peppermint AR in conjunction with CB for PONV relief.

Polycystic liver disease presenting as acute abdomen

A 65-year old gentleman came in with an initial complaint of abdominal pain for 2 days. His pain was on the left side at the level of the umbilicus, intermittent, sharp and non-radiating, 10/10. He associated the pain with deep coughing and deep breaths and was not relieved with ibuprofen. His past medical history includes hypertension, surgery was called for suspected acute abdomen and subsequently a computed tomography (CT) scan of abdomen was done with oral contrast which showed a cyst protruding from the liver juxtaposed to the abdominal viscera (Figure 1). Interventional radiology was called to drain the cyst and subsequent to the procedure the patient’s pain was relieved. The abdominal pain was explained by an impressive CT scan for a patient who had no diagnosis of polycystic kidney disease (PKD) with extra renal manifestations.

Comparisons of presentations and outcomes of cryptococcal meningitis between patients with and without hepatitis B virus infection

The clinical characteristics and outcomes in cryptococcal meningitis (CM) have been shown to vary depending on the underlying condition. The purpose of this study was to investigate these differences in patients with and without hepatitis B virus (HBV) infection. We performed a retrospective study at the Third Affiliated Hospital of Sun Yat-Sen University from January 2006 to June 2012. Thirty-two HBV-positive patients and 58 HBV-negative patients were included. Among the 90 patients with CM, 32 (35.6%) were HBV-infected. CM occurred in a younger population in the HBV-positive group, with a higher Charlson comorbidity score than the HBV-negative group. The HBV-positive group presented with lower initial complaints of visual symptoms, lower cerebrospinal fluid (CSF) white blood cell counts, lower percentages of the total protein in the CSF exceeding 0.45 g/l, higher glucose levels in the CSF, a higher percentage of positive results for Cryptococcus culture in the CSF, more extraneural involvement sites, and a higher proportion of normal brain images than the HBV-negative group. Factors for a poor prognosis in the HBV-positive group included liver cirrhosis and HBV DNA >10³ copies/ml. In the HBV-uninfected group, lower glucose in the CSF and hydrocephalus were the indicators of an unsatisfactory outcome. Certain clinical features of CM were found to be significantly different between HBV-infected and HBV-uninfected patients, including age and initial laboratory findings, as well as the indicators of an unsatisfactory outcome. Host defense defects in the HBV-infected group may lead to a lower intensity of inflammation in the pathogenesis of CM compared with the HBV-uninfected patients and may account for these divergences between the two groups.

Acute pancreatitis and obstructive jaundice as initial complaints of hepatocellular carcinoma: case report

BackgroundPatients with cirrhosis-associated hepatocellular carcinoma (HCC) rarely present with acute pancreatitis (AP) and obstructive jaundice as the main clinical features. AP with obstructive jaundice caused by common bile duct embolism (CBDE) is very rare.Case presentationA 54-year-old man with CBDE was misdiagnosed with common bile duct stones three times over a 7-month period. Investigations during this time did not identify CBDE. Surgical exploration was performed because of AP, obstructive jaundice, and a tumor in the left lobe of the liver. CBDE from the hepatic tumor was diagnosed by intraoperative biopsy and frozen section examination. The patient underwent left hemihepatectomy, cholecystectomy, and bile duct exploration.ConclusionPreoperative diagnosis of CBDE is difficult because of the rarity of the condition, lack of physician awareness, and easy misdiagnosis on imaging examinations. Early and accurate diagnosis of this condition is important.

Unhappy Meals: Sex Discrimination in Toy Choice at Mcdonald's

This essay reports on a commonplace form of sex discrimination that we unsuccessfully challenged in a lawsuit before the Connecticut Human Rights Commission. In a small-scale pilot study that we conducted 5 years ago (which was the basis of our initial complaint) and in a follow-up study conducted in 2013, we found that McDonald’s franchises, instead of asking drive-through customers ordering a Happy Meal about their preference, instead asked the customer for the sex of the customer’s child (Is it for a boy or a girl?) and then gave different types of for each sex. Moreover, our 2013 visits found that franchises treat unaccompanied children differently because of their sex. In 92.9% of the visits, the stores, without asking the child about her or his preference, just gave the that they had designated for that sex. Moreover, 42.8% of stores refused to offer opposite-sex even after the child re-approached the and affirmatively asked for an alternative. In the most egregious instance, a girl, after twice asking for a boy’s toy, was denied the offering (even though the store a moment later had the boy’s toy in stock). These fair counter tests indicate that stores use discriminatory default, altering, and mandatory rules. They constitute strong prima facie evidence of disparate treatment on the basis of sex in the terms and conditions of contracting for a public accommodation. We also use our Happy Meal empiricism as a motivating example to explore the proper limits of civil rights law. While newspapers describing job listing as male or female have been found to be a per se civil rights violation, describing Happy Meal offerings as boy’s toys or girl’s toys may, as a positive matter, not offend courts’ current notion of equality.

Assesment of the patients presenting with severe anemia to the emergency internal medicine clinic.

OBJECTIVE:Etiological evaluation of the patients who were hospitalized with the diagnosis of severe anemia (Hb<7 gr/dl) in the emergency internal medicine clinic between January and July, 2013.METHODS:In this study, 112 patients who were hospitalized in Dr. Lutfi Kirdar Kartal Education and Research Hospital emergency internal medicine clinic with severe anemia between January and July 2013 were retrospectively analyzed. Patients’ initial complaints, underlying causes of their anemia and prognosis of the patients were evaluated.RESULTS:The etiology of anemia was iron deficiency in 60 (53.6%), chronic kidney failure in 16 (14.2%), hematologic malignancies in 12 (10.7%), liver cirrhosis in 12 (10.7%) and other non-malignant hematologic disorders in 4 (3.6%) patients.CONCLUSION:The most common cause of anemia in patients who apply to emergency internal medicine clinic with severe anemia is iron deficiency. The most common complaints on admission are subjective ones such as weakness, fatigue and lassitude. Chronic disease anemia does not cause severe anemia as much as iron deficiency.