Main Complaint Research Articles

Active surveillance versus immediate surgery: A comparison of clinical and quality of life outcomes among patients with highly suspicious thyroid nodules 1 cm or smaller in China

IntroductionActive surveillance (AS) is considered an alternative to immediate surgery (IS) for low-risk papillary thyroid microcarcinoma (PTMC) patients. However, it is difficult to decide between AS and IS due to limited evidence regarding risks and benefits for patients in China. MethodsThis study prospectively enrolled 485 patients with highly suspicious thyroid nodules </= 1 cm who chose AS and 331 patients who underwent IS during the same period. The oncological outcomes, adverse events and quality of life, were compared between the two groups. ResultsThe oncological outcomes of the IS and AS groups were similarly excellent. The IS group had significantly higher rates of temporary vocal cord paralysis (VCP) and temporary hypoparathyroidism than the AS group (2.7% vs. 0.2%, p = 0.002; 13.6% vs.1.9%, p < 0.001, respectively). The IS group had significantly more patients on hormone replacement therapy (98.4% vs. 10.9%, p < 0.001) and a significantly higher incidence of neck scarring (94.3% vs. 9.1%, p < 0.001) compared to the AS group. In the early stages, the quality of life questionnaire showed significant differences with respect to three items: voice, throat/mouth, and surgical scarring, with more complaints in the IS group. However, one year or more after surgery, the main complaint was surgical scarring. ConclusionIn China, AS can achieve similar short-term therapeutic effects as IS. As this approach can reduce the occurrence of unfavorable events, achieve better quality of life, it is a feasible option for patients with highly suspicious thyroid nodules.

Headache in acute ischemic stroke. Results from two Mexican databases. (P11-12.012)

<h3>Objective:</h3> To describe the clinical characteristics of headaches in ischemic cerebral infarction <h3>Background:</h3> Our group has previously reported findings on this topic. The present study is an update of these results. To our knowledge, this is the only study of headache in ischemic cerebral infarction (ICI) in México <h3>Design/Methods:</h3> All hospitalized patients with diagnosis of acute ICI confirmed with neuroimaging studies and registered in the iReNe (i-Registro Neurovascular, <i>iNeurovascular Registry</i>)) and PREMECEF (First Mexican Headache Registry) databases, from January 2018 to June 2022, were included. All underwent neurovascular examination, neuroimaging studies, evaluation of etiology (TOAST), in addition to a focused history on headache characteristics. The results are presented with descriptive and comparative statistics. <h3>Results:</h3> A total of 1106 patients were included, of whom 157 (14%) had headache; 80 (51%) were male and the mean age was 57± 12.4 years. Headache was the initial symptom in 44 (28%) and the main complaint in 16 (10%). Previous headache was found in 8 (5%). The characteristics found included: throbbing (38%), oppressive (13%); average intensity of 7.1; holocranial, 27%, frontal, 11%; most frequent accompanying symptoms: nausea and/or vomiting in 21%, dizziness and/or vertigo in 20%. ICI etiology: atherothrombotic 40 (26%), lacunar 36 (23%), cardioembolic 15 (10%) and undetermined 37 (24%). Location of the ICI, 85 (54%) were anterior circulation and 42 (26%) posterior. No correlation was found between headache characteristics and ICI location (p=0.36). <h3>Conclusions:</h3> The pathophysiology of headache in ICI remains a controversial topic. Our results provide similar information to that already reported; no correlation was found between the clinical characteristics of headache with the location of the ICI. <b>Disclosure:</b> Dr. Marfil-Rivera has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for lilly. Dr. Riojas has nothing to disclose. Dr. Gongora Rivera has nothing to disclose.

Klinefelter syndrome: The characterization of the clinical and sociological features of 51 patients

IntroductionKlinefelter syndrome is the most frequently found aneuploidy among male patients. Its clinical presentation is very heterogeneous, and thus poses a challenge for a timely diagnosis. MethodsA retrospective study was carried out with 51 consecutively selected patients diagnosed with Klinefelter Syndrome from Jan/2010 to Dec/2019. The karyotypes were identified using high resolution GTL banding at the Genetics Department. Multiple clinical and sociological parameters were studied by collecting data from the clinical records. Results44 (86%) of the 51 patients presented a classical karyotype (47,XXY) and 7 (14%) showed evidence of mosaicism. The mean age at diagnosis was 30.2±14.3 years old. Regarding the level of education (N=44), 26 patients (59.1%) had no secondary education, with 5 (11.4%) patients having concluded university studies. Almost two thirds of the sample revealed learning difficulties (25/38) and some degree of intellectual disability was present in 13.6% (6/44). Half of the patients were either non-qualified workers (19.6%) or workers in industry, construction, and trades (30.4%), which are jobs that characteristically require a low level of education. The proportion of unemployed patients was 6.5%. The main complaints were infertility (54.2%), followed by hypogonadism-related issues (18.7%) and gynecomastia (8.3%). 10 patients (23.8%, N=42) were biological parents. With regards the question of fertility, assisted reproductive techniques were used in 39.6% of the studied subjects (N=48), with a success rate (a take home baby) of 57.9% (11/19), 2 with donor sperm and 9 with the patients’ own gametes. Only 41% of the patients (17/41) were treated with testosterone. ConclusionThis study identifies the most important clinical and sociological findings of Klinefelter syndrome patients that should be considered when deciding workout and disease management.

Effect of Combinations of Quadriceps Exercise and Hip Abductor Exercise on Pain in Knee Osteoarthritis Patients in Orthopedic and Traumatology Outpatient Care

Background: Osteoarthritis is a disorder of the moving joints. Pain functioning are the main complaints of the disease osteoarthritis of the knee. The purpose of the study was to analyze the effect of a combination of quadricep exercise and hip abductor exercise on pain in knee among osteoarthritis patients.Subjects and Method: The study was carried out at the East Java Regional Hospital for the period of December 2022 to March 2023. The study population was knee joint osteoarthritis patients of degree 1 to degree 2. The sampling technique used in this study was purposive sampling, with inclusion and exclusion criteria. The number of samples in quantitative research was 60 respondents. The dependent variable is pain, while the independent variable is quadriceps exercise and hip abductor exercise. The instrument used is the WOMAC questionnaire. Analysis of the study was using the Wilcoxon test and the Mann Whitney test.Results: There was a significant difference in pain between the control and intervention groups after conducting a combination of quadriceps exercises and hip abductor exercises (p=0.043)Conclusion: The combination of quadriceps exercise and hip abductor exercise is effective on pain reduction in knee osteoarthritis patients.Keywords: quadriceps, hip abductor, osteoarthritis.Correspondence: Dia Metasari. Master of Nursing, Universitas Airlangga, Indonesia. Jl. Dr. Ir. H. Soekarno, Mulyorejo, Surabaya, East Java 60115. Email: dia.metasari-2021@fkp.unair.ac.id. Mobile: +628563040303.Indonesian Journal of Medicine (2023), 08(02): 186-193https://doi.org/10.26911/theijmed.2023.08.02.08

Clinico-pathological profile of schistosomal appendicitis detected in surgically resected appendices: A retrospective study

BackgroundAppendicular schistosomiasis (AS) is an uncommon cause of acute appendicitis that can only be diagnosed histopathologically. There are few reports of AS and its histopathological profile is unclear in Egypt. Therefore, we aimed to evaluate the prevalence and clinicopathological, profile of AS among patients presented with acute appendicitis for proper management and to reduce the health burden of the disease. MethodsThis is a retrospective study performed at a university hospital comprising all patients with pathological confirmation of appendiceal Schistosomiasis after appendectomies between 2017 and 2021. All data were extracted from patient's files including age, sex, residence, main patient's complaint, Alvarado scores, and laboratory data. The histopathological specimens were reviewed by the histopathologist in this study and special stains were done when indicated. ResultsThe prevalence of AS was 1.07% (20/1870), all of them were adults or old age with a mean age of 39.25, 80% of cases were males. The most frequent clinical presentation in our patients was abdominal pain in the right iliac fossa (96%) with a mean duration of symptoms of 2.5 days. At the time of the operation, two patients had perforations, with no recorded mortality. Only 20% showed gross unusual foci, and lymphoplasmacytic infiltration was seen in 90% of cases. All patients were advised to postoperative praziquantel therapy. ConclusionHistopathological evaluation for schistosomiasis in all surgically removed appendix is recommended in endemic areas for middle and old ages and comprehensive postoperative follow-up with praziquantel therapy is required to ensure disease eradication and prevent further complications.

Profil clinique et étiologique des onychomycoses à Lomé (Togo)

Objective: The aim of this study was to describe the clinical and etiological profile of onychomycosis at Lomé (Togo). Patients and Method: This is a descriptive prospective study, carry out from September 2020 to September 2021, on patients seen for onychomycosis in the public dermatology services of Lomé (Togo). Results: During the study period, 108 (1.7%) of the 6230 new patients had mycologically confirmed onychomycosis. The patients mean age was 43.03±14.5 with a female predominance (sex ratio: 0.2). Diabetes was the most frequent past medical history. Aesthetic discomfort was the main complaint, and hyperkeratosis the main physical sign, respectively at 86.1% and 75.9%. Distolateral onychomycosis (52.8%) clinical form was the most frequent. Yests (60.2%) were the most isolated group of fungi followed by dermatophytes and moulds respectively 26.9% and 12.9%. Candida albicans with a preferential location on the hands (p&lt;0.01) and Trichophyton rubrum on the feet (p=0.03) were the main pathogens. Conclusion: Our study showed a low hospital based prevalence of onychomycosis with a predominance of Candida albicans complex in the hands and Trichophyton rubrum in the feet. Key words: onychomycosis, Candida albicans, Trichophyton rubrum, Lomé (Togo)

PD45-10 A MULTICENTER PROPENSITY SCORE MATCHED PAIR STUDY IN 313 PATIENTS COMPARING PERCUTANEOUS NEPHROLITHOTOMY VERSUS RETROGRADE INTRA RENAL SURGERY FOR MANAGEMENT OF UROLITHIASIS IN CALYCEAL DIVERTICULUM

PD45-10 A MULTICENTER PROPENSITY SCORE MATCHED PAIR STUDY IN 313 PATIENTS COMPARING PERCUTANEOUS NEPHROLITHOTOMY VERSUS RETROGRADE INTRA RENAL SURGERY FOR MANAGEMENT OF UROLITHIASIS IN CALYCEAL DIVERTICULUM

Atraumatic myositis ossificans of mentalis muscle

Rationale: Atraumatic myositis ossificans circumscripta is a benign condition characterized by the aberrant formation of bone in extraskeletal soft tissues without a usual connection to trauma. Patient Concern: A female patient of around 17 years of age reported with the main complaint of pain and swelling over the chin area for 6 months with no history of trauma. Diagnosis: Clinical, radiographic, and histopathological examinations were performed and all signs and symptoms pointed to a diagnosis of Atraumatic Myositis Ossificans in the Mentalis muscle. Intervention: Surgical exploration of the area concerned was done under (L.A) local anesthesia with adrenaline (1:1,00,000), where the nodes were extracted from the lower surface of the Mentalis muscle. The wound was sutured back to its normal physiologic anatomy, and the patient then was advised of postoperative instructions. Results: The patient recovered with a good prognosis and returned to a normal routine with good functional capacity. Lessons Learned: The practitioner must consider Atraumatic Myositis ossificans as a viable diagnosis for painful soft tissue calcification when a history of trauma is not present.

495 Impact of Postoperative Fatigue Following Minimally-Invasive Lumbar Spine Surgery

INTRODUCTION: Postoperative fatigue, a feeling of debilitating tiredness and loss of energy, is a distressing symptom and can have a major impact on the patient’s quality of life after surgery. Fatigue may be one of the main complaints after surgery and may last much longer than pain, preventing return to normal function and activity. METHODS: We surveyed patients that underwent minimally-invasive lumbar spine surgery under general anesthesia (laminectomy with or without fusion) within the past year. A five-point Likert scale (very much, quite a bit, somewhat, a little bit, not at all) was used to assess the extent of fatigue during the first postoperative month, its impact on QOL, and ADLs. RESULTS: The survey was completed by 100 patients, 61% were male, with mean age 64.6 ± 12.5 years (range 28-87), 31% underwent an MIS-TLIF, 69% a lumbar laminectomy. During the first postoperative month 45% of patients referred significant fatigue (very much or quite a bit); for 31% of patients fatigue significantly impacted their QOL; and significantly limited their ADLs in 43% of patients. MIS-TLIF was associated with higher rate of postoperative fatigue compared to laminectomy, 61.3% versus 37.7%, p=0.02. Patients 65 years old or older had higher rates of fatigue compared to younger patients, 55.6% versus 32.6%, p = 0.02. We did not observe a statistically significant difference in postoperative fatigue between male and female patients. CONCLUSIONS: Our study revealed a substantial incidence of postoperative fatigue in patients that underwent minimally-invasive lumbar spine surgery under general anesthesia, with a significant impact on their QOL and ADLS. There is a need to research new strategies to reduce fatigue after spine surgery.

Chemical Peeling in Skin-Aging Patients: A Retrospective Study

Background: Skin aging is a degenerative process that involves a decrease in the structure and function of skin cells and theextracellular matrix due to intrinsic and extrinsic factors. Chemical peeling is one of the skin aging treatments that involvesskin ablation using chemical agents. Purpose: To evaluate the profile of skin-aging patients treated with chemical peeling atthe Dermatology and Venereology Outpatient Unit of Dr. Soetomo General Hospital Surabaya from January throughDecember 2019. Methods: The data were obtained from patients’ medical records through a total sampling technique, whichconsisted of age, gender, occupation, history taking, physical examination, diagnosis, therapeutic agents, follow-up frequency,and therapeutic result. Result: The study included 37 patients, the majority of whom were between the ages of 46 and 55(35.1%), female (100%), and private employees (32.4%). In history taking, patients’ main complaint is dull skin (94.6%), withthe risk factor of sun exposure (97.3%) and the history of sunscreen usage (81.1%). Pigmentary changes were found in allpatients (100%). The most common diagnoses are photoaging Glogau II and Glogau III, found in 15 patients (40.5%),respectively. The common priming agents were sunscreen (97.3%), cleanser (94.6%), and 8% glycolic acid (75.7%). Themajority of patients (62.2%) received 20% glycolic acid as a peeling agent and sunscreen (86.5%) as a post-peeling agent.The majority of patients (43.2%) did not follow up. Glogau II photoaging (57.1%) was the main therapeutic result.Conclusion: Proper chemical peeling procedures and patients compliance are important factors to improve therapeuticoutcomes.

Individualised Homoeopathic Treatment in Plantar Callosities: An Evidence-Based Case Report

AbstractCallosities are circumscribed areas of hyperkeratosis due to intermittent pressure or friction over a bony prominence. They are often present on the soles and toes due to physical activity, poorly fitting shoes and foot deformities. Its prevalence is more in the above 65 age group, and primarily females are affected. Scalpel debridement and regular application of topical keratolytics like caustic and acidic compounds are the treatment options in conventional medicine, but it is impractical for older people with diabetes mellitus. A case of plantar callosities cured with Sulphur without topical application, recurrence or adverse effects is presented here. The main complaints and overall well-being were assessed using the Measure Yourself Medical Outcome Profile (MYMOP2) and Outcome Related to Impact in Daily Living (ORIDL) scale (+4). The causal relationship attributed to modified Naranjo criteria for homoeopathy (MONARCH) score (+9) suggested clinical improvement through homoeopathic intervention only. This evidence-based case report exhibits the importance of individualised homoeopathic treatment in plantar callosities.

Pengaruh Pemberian Quadriceps isometric exercise terhadap perubahan nyeri osteoarthritis knee pada pasien Rumah Sakit Wijaya Kusuma Lumajang

Knee osteoarthritis is a disorder of the knee joint that is progressive, for example in the joint cartilage, synovial fluid and subchondral bone, and causes furs, ulcerations, and becomes thin. The main complaints that are often felt by sufferers of Knee Osteoarthritis are pain, limited range of joint motion, mechanical abnormalities, and limitations in carrying out daily functional activities. Complaints felt by sufferers of Knee Osteoarthritis can cause a decrease in the quality of life in the elderly. This study aims to identify the effect of quadriceps isometric exercise on changes in pain in osteoarthritis patients. This research has 21 respondents. The research design uses a pre-experimental type with a one group pretest and posttest approach. Bivariate analysis in this study used Wilcoxon. The results of this study were that the mean pain scale before quadriceps isometric exercise was 5.761, the mean pain scale after quadriceps isometric exercise in knee osteoarthritis patients was 2.857, and there was an effect of isometric quadriceps exercise on reducing pain in osteoarthritis patients at Wijaya Kusuma Hospital Lumajang with a p-value = 0.000 (p&lt;0.05). It is hoped that this research can provide additional information based on data and theory to improve the quality of physiotherapy services by establishing a standard procedure for performing the quadriceps isometric exercise, especially in osteoarthritis patients.

Peripheral Neuropathy Outbreaks in Bhutan, 2020–2021

Thiamine (vitamin B1) deficiency can cause beriberi leading to cardiac involvement or, more commonly, peripheral neuropathy. Common causes of thiamine deficiency are alcohol use, maternal thiamine deficiency, poor dietary diversity, unhygienic food preparation, and unsafe cooking practices. This report presents an analysis of suspected peripheral neuropathy outbreaks recorded at the Royal Centre for Disease Control between 2020 and 2021. The suspected outbreaks were reported from schools and monastic institutes with the main complaints of numbness and swelling of lower limbs. Three of the four events were confirmed due to thiamine deficiency by laboratory analysis. Of 34 samples tested, 27 (79%) had thiamine deficiency, defined as a thiamine diphosphate (ThDP) level &lt;75.0 nmol/L. The mean ThDP level was 56.5 nmol/L. There were no statistically significant differences in the average ThDP level among the patients of different age groups. Given the fact that micronutrient deficiency was established as the cause of the current peripheral neuropathy outbreaks, we recommend that the supply of fortified rice across both government and private institutes in the country be initiated. Holistic approaches should be implemented to reduce the burden of micronutrient deficiencies in the country.

DESKRIPSI FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KELUHAN COMPUTER VISION SYNDROME (CVS) (Studi pada Karyawan Universitas Siliwangi)

CVS is a complex work-related eye and vision disorder experienced as a result of computer users' use of computers. CVS is influenced by individual factors, work environment factors, and computer factors which are felt to reduce daily work productivity. The purpose of this study was to determine the factors associated with CVS complaints. This research is a descriptive study with a cross sectional approach. A sample of 75 people was taken in total sampling with the criteria of respondents aged 45 years. The results showed that the main complaints of CVS were strained or tired eyes, dry and irritated eyes, blurred vision, and headaches. Eye strain or fatigue is a type of complaint that many respondents feel. Female respondents are more at risk of complaining of CVS than male respondents. Respondents who have worked 3 years, worked for 4 hours a day are more at risk of complaining about CVS. Respondents with monitor displays of bright colored characters and dark colored backgrounds are risk factors for complaining of CVS. Respondents who have a distance of vision 50 cm are more at risk of complaining of CVS compared to respondents who have a distance of vision ≥ 50 cm. Respondents with the position of the top of the monitor against horizontal eye level that is not parallel are more at risk of experiencing CVS than those with an aligned position. Most of the respondents' workspaces have low lighting levels ( 300 lux) which is a risk factor for complaining of CVS. It is recommended that respondents pay attention to the conditions and situations when working with computers, especially improving lighting and sitting in an parallel position

Pemberian Sari Kacang Hijau Untuk Meningkatkan Kadar Hemoglobin Ibu Hamil Dengan Anemia Ringan

Anemia is a condition of reduced red blood cells or commonly referred to as erythrocytes in blood circulation or hemoglobin so that they are unable to fulfill their function as oxygen carriers to all tissues (Astuti &amp; Ertiana, 2018). Anemia can indirectly cause complications such as abortion (1.6%), premature labor (10%), infection (5.5%), causing his disorder (4%), the first stage lasts a long time (1.8%), the second stage lasts a long time (4.9%), postpartum hemorrhage (30.1%), low birth weight (62%), (Kemenkes RI, 2017). In addition to standard care, there is also care that can be given as an additional effort to increase hemoglobin levels in pregnant women, namely by consuming Ambon banana, spinach juice, honey, chicken liver, guava juice and green bean juice. According to the results of research by Dewi, et al (2017), consuming mung bean juice 2x/250ml for 14 days is very effective in increasing hemoglobin levels in pregnant women with anemia. Case Presentation: Mrs. E, 23 years old, G1P0A0Ah0, 35 weeks and 3 days of gestation, came to the health center wanting to check her condition with the main complaint recently feeling dizzy, weak and easily tired when doing daily activities. On general examination, it was found that BP: 100/60 mmHg, N: 82 x/minute, S: 36.5, R: 22 x/minute. Special examination found that the eyes and conjunctiva were slightly pale, the rest were within normal limits. In the supporting examination, the result of Hb was less than the normal limit of 10.2g/dl. Conclusion: After midwifery care was performed by providing complementary care of green bean extract 2x/250ml for 7 days, Mrs E's Hb increased from 10.2g/dl to 11.1 g/dl, eyes and conjunctiva were no longer pale.

Application of the infrared thermography method in diagnosis of Raynaud`s phenomenon

The development of modern diagnostic medicine, the important task of which is the use of non-invasive methods for detecting a disease without impact of radiation exposure, has led to the spread of the method of infrared thermography, which allows to quickly and informatively identify pathological conditions of a person within a single examination. The main complaints characteristic of Raynaud's phenomenon are associated with cold, hyperemia, edema, and a feeling of paresthesia in the limbs. A significant number of scientific works have been devoted to the study of the Raynaud's phenomenon, where basically, examples of manifestations of Raynaud's phenomenon are given in the form of a violation of the microcirculation of the distal parts of limbs. Comprehensive studies of the combination of Raynaud's phenomenon with concomitant diseases, according to the authors, are insufficiently covered. The application of sophisticated modern laboratory diagnostic methods to detect this disease is nonspecific and burdensome for the patient. Thermographic diagnostics within one examination reveals both the presence of signs of Raynaud's phenomenon and concomitant somatic diseases. This paper presents the results of many years’ thermographic research, demonstrating the variety of manifestations of the Raynaud's phenomenon. For the first time, it has been shown that patients with signs of Raynaud's phenomenon, as a rule, have concomitant somatic diseases, which should be the subject of research of specialists in different medical fields to determine the relationship of Raynaud's phenomenon with the identified diseases. The results of visualization of thermoasymmetries of the skin of various pathological conditions during a complex thermographic examination were obtained, which greatly simplify the diagnostic search and understanding the complexity and danger of Raynaud's phenomenon. Of particular importance are the results of work for the differential diagnosis of complications of diabetes mellitus – diabetic foot syndrome. The paper presents some results of thermographic examinations of patients with signs of Raynaud's phenomenon and identified pathological changes in the body.

Віддалені наслідки пілороміотомії в дітей

Hypertrophic pylorostenosis is one of the most frequent causes of vomiting in newborns requiring surgical intervention. While the intraoperative complications and immediate results of pyloromyotomy are widely reported in the literature, the remote consequences of this intervention, especially depending on the method of correction, are not well understood and contain contradictory results. Purpose - to study the remote consequences of pyloromyotomy depending on the method of surgical correction - open (OMPT) or laparoscopic pyloromyotomy (LMPT). Materials and methods. The primary assessment of long-term outcomes was performed by analysing the answers to the questions of the Diagnostic Questionnaire for Paediatric Functional Gastrointestinal Disorders, which was sent to 246 patients and their parents; responses were received from 169 (68.7%) respondents, who were included in the study. Re-hospitalisation was required in 57 (33.7%) children who underwent X-ray examination, fibrogastroscopy and ultrasonography. Statistical processing of the study results was performed using the software StatPlus: mac, AnalystSoft Inc. (version v8). Results. The average age of patients involved in the study was 8.5±0.3 years (range of fluctuations - from 2 to 18 years old). Among the respondents, 132 (78.1%) children underwent OPMT, and 37 (21.9%) children underwent LPMT. No complaints were expressed by 102 (60.4%) children, including 81 (61.4%) children after OPMT and 21 (56.8%) after LPMT (p=0.6152). The main complaint in children after pyloromyotomy, which required re-hospitalisation, was chronic abdominal pain, as indicated by 38 (22.5%) of the respondents. There was no correlation between the occurrence of chronic abdominal pain and the age at which hypertrophic pylorostenosis was diagnosed (R=0.183, p=0.2588), the duration of the disease (R=0.079, p=0.6275) and the child's body weight at the time of the intervention (R=0.048, p=0.768). Functional disorders of the digestive tract were diagnosed in 15 (8.9%) children. In 24 (14.2%) children, a slowdown in barium passage through the intestine was detected, which, in combination with periodic pain, indicated chronic adhesive disease. Fibrogastroscopy revealed duodenogastric reflux in 18 (10.7%) children, which in 5 (2.96%) patients was combined with pylorus insufficiency and in 12 (7.1%) with gastritis, and in 17 (10.1%) children gastroesophageal reflux was diagnosed. Conclusions. Thus, in the long term after pyloromyotomy, 33.7% of children required re-hospitalisation due to various pathologies of the gastrointestinal tract. Duodenogastric and gastroesophageal reflux and chronic adhesive disease were most often detected in the long term after pyloromyotomy, and the frequency of their occurrence did not depend on the method of surgical intervention. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Does the Kantian state dominate?: Freedom and majoritarian rule

Recently, scholars have criticized what they call the “Kantian-Republican” thesis of freedom as non-domination. The main complaint is that domination is unavoidable. This concern can be separated into the problem of state domination, which suggests that the state's intervening powers necessarily dominate its citizens, and the problem of majority domination, which suggests that the People necessarily dominate individual citizen as a result of the potential to form dominating majorities.

A Rare Clinical Entity of Krukenberg Tumor: A Case Report in Margono Soekarjo Hospital of Purwokerto

Introduction: Krukenberg Tumor is an ovarian tumor that originated from other organ metastases such as gastric, colorectal, pylorus, appendix, colorectal, or breasts. This study aims to report an incidence of a Krukenberg tumor found in a-36year- old woman who has finished her therapy at Margono Soekarjo Hospital.Case Presentation: This case reports the incidence of a Krukenberg tumor found in a-36-year old woman with the main complaint of a burning sensation in her stomach and the existence of a mass in the right and under the Arcus Costae. The patient underwent metastasectomy and biopsy. Histopathological examinations show that the features of Krukenberg tumor originated from a gaster. The patient then underwent chemotherapy for 6 cycles, radiotherapy 20 times, and some evaluation. This case had been observed for 12 months since the first time the patient came to the hospital.Conclusions: Krukenberg tumor is a rare tumor of the ovary which is characterized by poor prognosis. This case depicts the finding of Krukenberg tumor with gastric clinical features. The combination of metastasectomy and chemotherapy can be done in such a case to improve patient survival rates.

Тhe problem of comorbidity in diseases of the gastrointestinal tract in women: solutions

The article presents a review of the literature related to the problems of the gastrointestinal tract in gynecological practice.Complaints from the digestive organs are interrelated with vaginal dysbiosis, a violation of the formation of the menstrual cycle. The main complaints presented by women with diseases of the female genital sphere, the causes of their occurrence and measures to eliminate these complaints are considered.