Multiple Complaints Research Articles

Digital health literacy and well-being in university students in Germany

Abstract Background Digital communication technologies had a crucial role during the COVID-19 pandemic, with the internet and Social Media as highly frequented sources for retrieving health information. University student's health and well-being were highly affected and most interaction with peers and professionals migrated to the digital realm, which made digital health literacy (DHL) a key competence to navigate digital health environments. The main goal of the study was to explore DHL of students in Germany. Methods A cross-sectional online survey among students (N = 14916) from 130 universities in Germany was implemented as part of the global Covid-HL Network, collecting data on DHL, physical and mental health, SoC and sociodemographics. Data was analyzed using univariate, bivariate and regression analyses. Results Assessing the reliability of information (5964/14,103, 42.3%) and determining commercial interest of information posed the most difficult tasks (5489/14,097, 38.9%). Difficulties were revealed for finding information (4282/14,098, 30.4%). Female students reported lower DHL and social media use was associated with lower judgment skills. 38% of all students reported low and very low well-being and 29% reported at least two health complaints weekly, while health outcomes follow a social gradient (lower SES and gender). Regression analysis showed significant association between SoC and well-being (OR: 1.2-2.03) and health complaints (OR: 1.58-1.71). Higher future worries were with low well-being (OR: 2.83) and multiple health complaints (OR: 2.84). Conclusions There is an urgent need to enhance DHL and SoC of students and implement health promotion strategies, using target group specific intervention. Gender and socioeconomic differences must be taken into account and interventions could be delivered within the university. Measures should also address student mental health.

Yield of pelvic CT in emergency department patients undergoing CT torso for generalized or multiple complaints.

To evaluate the utility of pelvic computed tomography (CT) in emergency department (ED) patients undergoing chest CT angiogram (CTA) for chest pain or suspected pulmonary embolism (PE) followed by abdominopelvic CT in the same session for additional multisystem or generalized complaints. This retrospective study included consecutive adult ED patients from January 2017 to December 2019 who underwent CTA for suspected PE followed by portovenous abdominopelvic CT for multisystem or generalized complaints. Patient demographics, vitals, laboratory values, exam indication, malignancy history, and recent surgery/intervention were recorded. CT reports were reviewed for acute chest, abdomen, and/or pelvic pathology. There were 400 patients with 243 (61%) women and mean age of 59.8years. Acute pelvic findings were seen in 11% (45/400). In 53% (24/45) of these, pelvic pathology could be diagnosed based on the abdominal portion of the CT. Five percent (21/400) of patients demonstrated isolated acute pelvic findings with 86% of these (18/21) clinically suspected prior to imaging. Acute pelvic pathology was associated with female gender (p = 0.015) and elevated white blood cell count (WBC) (p = 0.03). Specific pelvic CT indications and female gender were significantly associated with (p = 0.02 each) and independent predictors of isolated acute pelvic pathology. In ED patients undergoing chest CTA for chest pain or suspected PE combined with abdominopelvic CT, the presence of acute pelvic-related pathology not visualized on abdominal CT is low. For this ED patient cohort, pelvic CT may not be necessary in men with normal WBC and a low pre-imaging clinical suspicion for acute pelvic pathology.

Multiple health complaints in preadolescence and hospital contacts during adolescence: a prospective cohort study.

Multiple health complaints (MHC) is increasing among preadolescents in many countries, but their prognostic effect for individual thriving or societal resource use is scarcely studied. This makes interpreting the significance of this increase challenging. We contribute by examining whether MHC in preadolescence predicts hospital contacts in adolescence by doing a nation-wide population-based cohort-study following preadolescents from the Danish National Birth-Cohort from 2010 to 2018. 96,382 children were invited at age 11. Responses to a modified version of the Health Behaviour in School Children Symptom Checklist (headache, dizziness, stomachache, irritability, feeling nervous, difficulty in getting to sleep and feeling low) was dichotomized into MHC (≥ 2 concurrent symptoms, each with a frequency of at least weekly, yes/no). Hospital contacts were derived from Danish registers from the date of answering the questionnaire to December 31st 2018. Negative binomial regression estimated incidence rate ratios (IRRs) comparing children with MHC to children without. Analyses were further broken down by hospital sector (psychiatric/somatic) and contact type (in-patient/out-patient/emergency room). 47,365 (49.1%) responded. Mean age was 11.2 years, 52% girls. 10.3% of responders reported MHC. For hospital contacts, the unadjusted IRR was 1.74 [95% CI 1.65, 1.83]. Results were robust to adjustment for sociodemographic variables and somatic/psychiatric morbidity diagnosed before baseline, IRR 1.62 [95% CI 1.54–1.71]. In conclusion, MHC in preadolescents are prognostic of hospital contacts. This shows that we cannot ignore MHC, and to prevent potentially unhelpful healthcare use, we must act. Future research should focus on the underlying causes of MHC to understand which changes will be most helpful and thus how to act.

Association of mast-cell-related conditions with hypermobile syndromes: a review of the literature.

Ehlers–Danlos syndrome (EDS) is a group of related connective tissue disorders consisting of 13 subtypes, each with its own unique phenotypic and genetic variation. The overlap of symptoms and multitude of EDS variations makes it difficult for patients to achieve a diagnosis early in the course of their disease. The most common form, hypermobile type EDS (hEDS) and its variant, hypermobile spectrum disorder (HSD), are correlated with rheumatologic and inflammatory conditions. Evidence is still needed to determine the pathophysiology of hEDS; however, the association among these conditions and their prevalence in hEDS/HSD may be explained through consideration of persistent chronic inflammation contributing to a disruption of the connective tissue. Aberrant mast cell activation has been shown to play a role in disruption of connective tissue integrity through activity of its mediators including histamine and tryptase which affects multiple organ systems resulting in mast cell activation disorders (MCAD). The overlap of findings associated with MCAD and the immune-mediated and rheumatologic conditions in patients with hEDS/HSD may provide an explanation for the relationship among these conditions and the presence of chronic inflammatory processes in these patients. It is clear that a multidisciplinary approach is required for the treatment of patients with EDS. However, it is also important for clinicians to consider the summarized symptoms and MCAD-associated characteristics in patients with multiple complaints as possible manifestations of connective tissue disorders, in order to potentially aid in establishing an early diagnosis of EDS.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12026-022-09280-1.

“Pattern of Sexually Transmitted Infections: Treated in A Private Clinic at Dhaka, Bangladesh”

Background: Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), continue to present major health, social, and economic problems in the developing world, leading to considerable morbidity, mortality, stigma and long-term disability, economic loss and death throughout the world. Despite the availability of effective treatment and preventive measures, incidence of STIs is increasing even in developed countries. Objectives: To determine the pattern of sexually transmitted infections in patients presenting with genital symptoms. Material and Methods: A cross sectional, descriptive study was carried in the Dermatology-Venereology Clinic of Holy Lab Diagnostic & Consultation Centre, Uttara, Dhaka, Bangladesh from January to December 2019. During one year period, a total of 140 consecutive cases were enrolled in this study. The diagnosis of infections was made clinically with relevant laboratory investigations and they were interviewed for their sexual behaviour after taking consent and assuring confidentiality. Results: A total of one hundred forty (140) patients who presented with genital symptoms were studied. The average age of this population was 28.84 years (±9.15) and it ranged from 18-58 years. 3.7% belonged to age group 18-27 years, followed by 28-37 years (22.1%); 38-47 yrs (52.8%); 48-57 yrs (18.5%) and > 57 yrs (2.8%). Majority patients of 38-47 yrs 74 cases 52.8%. Males outnumbered females, constituting 76.2% of the total patients, with male to female ratio of 3.37:1. Out of the total 140, some had multiple complaints while others were asymptomatic. Majority cases of burning micturition in both male and female patients 39(24%). Burning micturition and discharge from genitalia was also observed in both sexes. The most frequently encountered infection in both male and female was Gonococcal Urethritis (GU) 42 (30%). The infections were common among both married and unmarried people. Other group of people who had no STI (23.5%) was suffering from venereophobia, pearly penile papules and some form of dermatitis. No case of HIV infection was encountered in this study. Gonococcal Urethritis was common mainly among businessman, transportation worker, security personnel and housewives. Other infections were equally dispersed in all other occupation groups. Conclusions: The prevention and control of STI is based on health education, appropriate diagnosis and treatment. Sexually active people adolescents and young adults should be provided with proper sex education about delaying sex debut and protective measures (correct and consistent use of barrier method during every sexual act) to prevent these infections with especial focus on monogamous relationship.

Successful Debulking of Tricuspid Valve Vegetation Using Suction Filtration and Veno-Venous Bypass

Tricuspid valve endocarditis with recurrent septic pulmonary emboli is an indication for surgery. In this report, we present a case of right-sided infective endocarditis (RSIE) in a female patient with a history of intravenous drug use (IVDU). The patient was admitted with multiple chief complaints of fatigue, chills, fever, cough, chest pain, and shortness of breath. She was found to have a large 1.8 cm (W) x 2.4 cm (L) mobile tricuspid valve vegetation on transthoracic echocardiogram (TTE). Despite being on appropriate antibiotics, the patient failed to improve clinically. Cardiothoracic surgery (CTS) evaluated the patient for surgical management of infective endocarditis (IE) given the size of vegetation, persistent bacteremia, and clinical deterioration. However, the risk/benefit ratio for open-heart surgery was high, given the history of active IVDU and hemodynamic instability. The patient underwent percutaneous extraction of the vegetation using suction filtration and veno-venous bypass and her condition significantly improved clinically afterward. We discuss the importance of suction filtration and veno-venous bypass in managing tricuspid valve endocarditis as an alternative in patients who are not ideal candidates for surgery and the need for more evidence regarding its effectiveness compared to surgery.

Gastrointestinal problems and non‐Oral feeding in children evaluated for medical child abuse (fabricated and induced illness)

AbstractVictims of medical child abuse (MCA) often have gastrointestinal (GI) complaints and nutritional difficulties, leading to non‐oral feeding methods. We documented the frequency of GI complaints, non‐oral feeding methods, medical complaints leading to them and difficulties experienced. They were compared with children evaluated preoperatively by a G‐tube protocol.Children with possible MCA at Children's Hospital, 2011–2015, were retrospectively reviewed. They were compared with a 5 per cent random sample of G‐tube protocol children, 2013–2015.Sixty‐five of 143 (45.5%) children evaluated for MCA were determined to be MCA victims. Twenty‐four out of 65 children with MCA (39.6%) had GI complaints compared to nine out of 60 G‐tube protocol children (15.0%). Gastroesophageal reflux and oral‐motor dysfunction were the most frequent GI problems in both groups. Fewer MCA children had prior non‐oral feeding methods than G‐tube protocol children. However, MCA victims had more prior GI investigations, non‐oral feeding types and complications thereof. MCA children were less likely to have feeding tubes placed, but caretakers took 30 per cent who did not receive a tube elsewhere for tube insertion. Interventions in MCA children restored many to oral feeding and resolved nutritional and developmental complaints.MCA victims had frequent GI complaints, numerous investigations and frequent complications. They had more uncommon GI complaints. MCA interventions improved feeding and nutrition.Key Practitioner Messages Gastrointestinal (GI) problems and non‐oral feeding methods are common in medical child abuse (MCA). MCA victims undergo many investigations and tend to have multiple GI complaints. Non‐oral feeding methods are common and often fail or are fraught with complications. Consider MCA in children with unusual primary and/or GI diagnoses. Intervention can relieve feeding and developmental problems and failure to thrive.

Management of Psychiatric Disorders with HIV and Dermatological Disorders.

Management of Psychiatric Disorders with HIV and Dermatological Disorders.

Association between Multiple Oral Complaints and Menopausal Symptoms: An Observational Study

Association between Multiple Oral Complaints and Menopausal Symptoms: An Observational Study

User-friendly mindfulness-based interventions (MBI) for children and adolescents with childhood cancer

A 14-year-old male with a brain tumor who underwent proton radiation has multiple complaints of headaches with pain radiating to the neck and left side weakness. Also, he is experiencing stress, anxiety, and sleep interruption associated with his illness. He learned and practiced mindfulness techniques with the Apple Mindfulness app and used them to cope with stressors related to his medical condition. His perception of pain had marginally boosted during the preliminary session. However, after three weeks of implementing mindfulness practices, he reduced his experiences of stress and subsequently coped well with his pain and anxiety.

Prevalence of Vitamin D Deficiency in Lalitpur Nepal

Introduction: Sunlight exposure is the most important source of vitamin D for human beings. We can get vitamin D from other sources such as diet and dietary supplements as well. Human body synthesizes most of the vitamin D from exposure to direct ultraviolet sunlight. The deficiency of vitamin D is a major public health problem worldwide. It is deficiency of vitamin D level when blood serum which is below 30ng/ml. The deficiency is associated with various musculoskeletal diseases and autoimmune diseases. The early detection of deficiency plays an important role to prevent those diseases. The aim of the study is to find the prevalence of vitamin D deficiency.
 Method: A retrospective study was conducted in Star Hospital Sanepa, Lalitpur, Nepal, from first January 2018 to 31 December 2018. All patients attended outpatient door with multiple complaints like; backache, muscle pain, leg pain was tested for Vit D3.
 Result: A total of 786 patients had tested vitamin D levels, where 717 (91.2%) had deficiency and 69 had normal levels. Adult females were found to be vitamin D deficient than the adult male population.
 Conclusion: Vitamin D deficiency was found to be higher in females than males in Lalitpur district Nepal.

Clinical characteristics and treatment of treatment-resistant bipolar depression

Depression represents the predominant mood pole in bipolar disorder. Bipolar depression typically has a poor response to antidepressant medication, and also involves the risk of polarity shifts, induction of mixed states, and / or rapid cycle induction. The diagnosis of bipolar depression can be delayed by 8 to 10 years. The reason for this delay is mainly the fact that both manic and hypomanic episodes appear lately in the course of the disorder. It is therefore necessary to diagnose this clinical entity as early as possible versus monopolar depression in order to treat it more effectively. This differential diagnosis is based on certain clinical features of bipolar depression, which are often difficult to be distinguished from those of monopolar depression and therefore it is necessary to know specific criteria that differentiate them to some extent qualitatively and / or quantitatively. Such characteristics are daily mood swings, multiple physical complaints, psychomotor retardation, psychotic elements (delusions and perceptual disorders mood congruent or noncongruent), the disturbance of certain bodily functions, including circadian rhythms, sexual desire, appetite, and disorders of sleep architecture. The treatment of bipolar depression is based on the options known from monopolar depression (such as the use of antidepressants, antipsychotics, and certain antiepileptic agents) and their combinations, while in recent years it has been enriched with new pharmaceutical agents and non-pharmacological approaches. New glutaminergic regulators dominate the new pharmacological agents' research, and among them the antidepressant effect of ketamine and esketamine at sub-anesthetic doses is being extensively investigated during recent years. Non-pharmacological approaches include methods such as electroconvulsive therapy, repetitive transcranial magnetic stimulation (rTMS), sleep deprivation, and phototherapy.

After a Post-Heterosexual Mormon Theology: A Ten-Year Retrospective

After a Post-Heterosexual Mormon Theology: A Ten-Year Retrospective

Sustainable fishing in Ghana: Lessons from indigenous Akan fishing ethics

For many individuals in the Ghanaian culture, fishing is one of the activities that provide a source of income and nutrition. A lot has been written about fishing and its economic worth. Recently, there have been multiple complaints made by both the industry insiders and outsiders about various abuses and issues affecting the business. This has made many to wonder whether the fishing industry in Ghana is sustainable. Sustainable fishing has been a big issue of concern in Ghana. But what is sustainable fishing? Sustainable fishing, in this sense, is leaving enough fish in the ocean and other water bodies while simultaneously protecting ecosystems and endangered species. If the oceans and rivers are preserved, those who rely on fishing will be able to maintain their employment. This study investigates the phenomenon of Akan fishing ethicsas well as some of the lessons that may be learned from it in order to improve Ghana‟s fishing industry. Because some of the abuses and issues identified in the fishing sector are caused by domestic factors, this study believes that indigenous knowledge and practices on fishing can be used together with the modern means of fishing to address the apparent challenges in the fishing industry in Ghana.

Frequency of Seropositivity of Helicobacter Pylori Among Patients Presented with Dyspepsia

Objective: To determine the frequency of seropositive helicobacter pylori (H. pylori) among patients presented at outpatient department (OPD) with dyspepsia at tertiary care Hospital. Methodology: This descriptive case-control study was conducted at medicine department of Peoples University of Medical and Health Sciences for women Nawabshah (SBA). Study duration was six months from October 2018 to March 2019. All the patients of age 18-70 years, presented with complaint of dyspepsia, either of gender were included in the study. After taking informed consent all the patients underwent serological assessment for H. pylori. From each study participant a 5ml blood sample was taken and sent to the laboratory for the diagnosis of H. pylori. After collection of the laboratory reports, all the data was collected via self-made study proforma. Data analysis was done by using SPSS version 20. Results: Total 78 patients of dyspepsia were enrolled, their mean age was34.23+6.22 years and average duration of symptoms was 15.23+7.14 months. Males were 43(55.1%) and females were 35(44.9%). Feeling of abdominal distension after meal was among 21(26.9%) cases, epigastrium pain was in 14(17.9%) cases, heart burn was among 32(41.0%) patients, 07(09.0%) had belching and 19(24.4%) had multiple complaints. Seropositivity rate of H. pylori was 33.30% among patients of dyspepsia and it was statistically insignificant according to gender and socioeconomic status (p->0.05). Conclusion: As per study conclusion the seropositivity of H. pylori was observed to be higher among patients of dyspepsia and seropositivity of H. pylori was insignificantly linked to gender and socioeconomic status. Keywords: Dyspepsia, H. pylori, seropositive

Trends in multiple health complaints in Polish adolescents in light of data from 30 European countries and Canada (2002-2018).

BackgroundAdolescence is a sensitive period accompanied by rapid developmental changes that can result in health complaints. The aim of the study was to describe the trend of subjective health complaints (HBSC-SCL) of Polish adolescents compared to their peers from 30 other countries and to rank all countries based on a proposed standardised measure.Material and MethodsData from the Health Behaviour in School-Aged Children (HBSC) study collected from 2002 to 2018 were used. The overall number of respondents from 30 countries in the combined sample from five quadrennial rounds was 773,356, including 49.2% boys and 50.8% girls. The HBSC-SCL is a non-clinical measure consisting of eight health complaints, usually analysed in two dimensions of psychological and somatic symptoms. Linear regression analysis was applied to assess the significance of trends of the total index and two subindices in the combined sample and individual countries.ResultsA significant increasing trend for the eight-item index appeared in Poland only in 13- and 15-year-olds, while only among 15-year-olds in the combined sample from 30 countries. Standardised country rank varied between -1.85 and 2.48 (worst). The countries that achieved extreme negative values (>=1) are France, Hungary, Italy, and Sweden, and the rank for Italy is considerably higher than for other countries. In Poland, the standardised rank for psychological symptoms exceeded the threshold of +1 in 2018.ConclusionsThe HBSC-SCL index could be useful for monitoring change in adolescent mental health. The proposed method of ranking may allow a broader view of the differences and similarities between countries and help to identify those performing unfavourably against cross-country patterns.

Vibrio alginolyticus Tympanostomy Tube Otorrhea in a Child Newly Diagnosed with Primary Ciliary Dyskinesia with no Seawater Exposure

Vibrio alginolyticus is a rare pathogenic organism that has been associated with seawater contact causing gastrointestinal disease in most cases and in a narrower spectrum, otitis media, and externa. Here, we report an 8-year-old male child who presented with tympanostomy tube otorrhea caused by V. alginolyticus although his family reported strict water precaution adherence without any exposure to swimming pools nor seawater. Before this presentation, he had multiple otological and respiratory complaints since his birth, and he was investigated for primary ciliary dyskinesia (PCD), for which nasal biopsy was done and returned negative. However, genetic panel testing was positive and confirmed PCD.

Remember that patient you saw last week: characteristics and frequency of patients experiencing anticipated and unanticipated death following ED discharge.

The emergency department (ED) is an at-risk area for medical error. We determined the characteristics of patients with unanticipated and anticipated death within 7days of ED discharge and whether medical error contributed. We performed a single-centre health records review of 200 consecutive cases during a 3-year period from 2014 to 2017 in two urban, academic, tertiary care EDs. We included patients evaluated by an emergency physician who were discharged and died within 7days. Three trained and blinded reviewers determined if deaths were related to the index visit, anticipated or unanticipated, and/or due to potential medical error. Reviewers performed content analysis to identify themes. Of 200 cases, 129 had sufficient information for analysis, translating to 44 deaths per 100,000 ED discharges (200/458,634). 13 cases per 100,000 ED discharges (58/458,634) were related and unanticipated deaths. 4 cases per 100,000 were due to potential medical errors (18/458,634). Over half (52.7%) of 129 patients displayed abnormal vital signs at discharge. Pneumonia (27.1%) was the most common cause of death. Patient themes were: difficult historian, multiple complaints, multiple comorbidities, acute progression of chronic disease, and recurrent falls. Provider themes were: failure to consider infectious etiology, failure to admit high-risk elderly patient, and missed diagnosis. System themes were: multiple ED visits or recent admission, and no repeat vital signs recorded. Though the frequency of related and unanticipated deaths and those due to medical error was low, clinicians should carefully consider the highlighted common patient, provider, and system themes to facilitate safe discharge from the ED.

Cuscuta reflexa Roxb. Poisoning: A Case Report

Cuscuta reflexa (C. reflexa Roxb.), is an endogenous parasitic plant found in Nepal and has been used by various ethnic communities of Nepal. However, there has been cases of toxicity in humans which needs attention. Here we discuss a case of C. reflexa Roxb. Accidental self-poisoning while being used for liver ailments that presented with gastrointestinal symptoms initially and local health facility and visited two health facilities before presenting to Tribhuvan University Teaching Hospital with multiple complaints. Appropriate risk assessment was done and the patient was managed conservatively at our center for three days following which he was discharged.

Pre-adolescents with multiple health complaints redeem more prescriptions: A follow-up study in the Danish National Birth Cohort.

Aims: This study aimed to examine the association between multiple health complaints (MHC) in pre-adolescence and prescription redemption in adolescence. Methods: This was a nationwide population-based study based on the Danish National Birth Cohort for an average of 6.9 years (2010-2018). A total of 96,382 children were invited at the age of 11. A modified version of the Health Behaviour in School Children Symptom Checklist was dichotomised into the World Health Organization's definition of MHC (⩾2 complaints, each with a frequency of at least weekly, yes/no). The number of prescriptions was retrieved from Danish registries. Negative binomial regression estimated incidence rate ratios (IRRs) comparing children with MHC to children without. Prescription redemption was further stratified by psychiatric/somatic medication and into subtypes of prescriptions. Results: A total of 47,365 (49.1%) children participated (Mage=11.2 years, 52% girls). MHC were reported by 10.3%. The unadjusted IRR (MHC vs. no MHC) of all types of redemptions was 1.57 (95% confidence interval (CI) 1.49-1.64). Results were robust to adjustment for socio-demographic variables and somatic/psychiatric morbidity at baseline (IRR=1.47; 95% CI 1.40-1.54). Associations were especially strong for psychiatric medication (adjusted IRR=3.88; 95% CI 3.43-4.40) and were modified by neither sex nor maternal education. Conclusions: MHC in pre-adolescents predict prescription redemption. This implies that changes in MHC might be indicative of changes in public health. This requires further study, as the cause of a change in reporting of symptoms might also cause a change in treatment response. The latter determines whether prescriptions are treating ill-being or needlessly medicalising subjective symptoms.