Patient Complaints Research Articles

Functional disorders in chronic inflammatory bowel disease: the gut-brain axis

In patients with inflammatory bowel diseases (IBD), functional complaints frequently persist after the clearing of inflammation and are clinically difficult to distinguish from symptoms of inflammation. In recent years, the influence of bidirectional communication between the gut and brain on gut physiology, emotions, and behavior has been demonstrated. What mechanisms underlie the development of functional gastrointestinal complaints in patients with irritable bowel syndrome (IBS) and IBD? What therapeutic approaches arise from this? Narrative review. The pathogenesis of IBS involves interactions between psychosocial factors, genetics, and microbiota as well as the central and peripheral nervous systems. The interplay between stress and visceral hypersensitivity is of central importance. Therapeutically, lifestyle changes with stress reduction and exercise alongside dietary, pharmacological, and psychotherapeutic options are useful. The treatment of functional gastrointestinal disorders remains challenging, as pharmacological therapies are often ineffective and gut-directed psychotherapies are rarely available.

Differences in the structure and prevalence of oral mucosal diseases across age groups

Relevance. In the Russian Federation, the population is witnessing a notable increase in the absolute number and proportion of elderly and senile individuals. Aging is recognized as a complex process involving multiple functional transformations in tissues and organs, often accompanied by a decline in the body’s adaptive capacities. With the growing proportion of older adults, the demand for dental care has significantly increased. Internal organ pathologies can alter the presentation of existing dental diseases or serve as triggers for the onset of oral conditions. A steady rise in oral mucosal diseases has been observed, linked to aging, environmental issues in specific regions, harmful habits, occupational hazards, and a tendency toward malignant transformation. Despite existing literature, the structure and prevalence of oral diseases, particularly mucosal pathologies in individuals over 60 years of age, remain underexplored. A personalized approach to diagnosing oral mucosal diseases (OMD) requires a comprehensive assessment of the clinical progression of primary, comorbid, and past conditions, while accounting for the patient’s age and sex.Materials and Methods. A primary examination was conducted at the Department of Therapeutic Dentistry and Periodontology of Pavlov First Saint Petersburg State Medical University to identify oral mucosal lesions. The study included 512 patients aged 18 to 89 years, comprising 167 men and 345 women. The assessment involved gathering patient complaints, medical histories, and general health status based on consultations with medical specialists. Visual evaluation of the oral mucosa was performed, along with autofluorescent stomatoscopy using the "AFS-D" device (Politron, Russia).Results. The study revealed a high prevalence of oral mucosal lesions among the adult population. Lesions were observed in 40.8% of the 512 patients, with their frequency and types varying by age and sex. The most common conditions included denture-related stomatitis, traumatic lesions, periodontal diseases, and leukoplakia.Conclusion. The analysis of data from primary patient examinations demonstrated a significant increase in oral mucosal lesions with age. While periodontal diseases and traumatic lesions were more prevalent in younger individuals, older adults showed a rise in oral mucosal conditions associated with internal organ pathologies. Additionally, there was a notable increase in precancerous oral mucosal diseases among elderly and senile patients

Sleeve gastrectomy with antral resection provides more effective weight loss in patients with super obesity

BackgroundObesity is a growing health issue that contributes to numerous diseases and lowers quality of life. In patients with super obesity (BMI > 50 kg/m²), bariatric surgery, particularly laparoscopic sleeve gastrectomy (LSG), is a common treatment option. However, the role of antral resection (AR) in LSG remains unclear, especially in this high-risk population. This study aims to compare the effectiveness of LSG with antral resection (LSG-AR) and LSG with antrum preservation (LSG-AP) on weight loss and postoperative complaints in patients with super obesity.MethodsThe medical records of patients with a BMI > 50 kg/m² who underwent LSG between 2016 and 2022 were retrospectively reviewed. Weight data were collected at admission, and at the first, second, and fifth-year follow-up. Patients were divided into two groups based on LSG-AR or LSG-AP procedures.ResultsSeventy-two patients were included. No significant difference was found in postoperative vomiting complaints between the groups (p = 0.67). First-year outcomes showed no significant differences in weight, BMI, or % Total Weight Loss (%TWL). However, second and fifth-year %TWL values were significantly higher in the LSG-AR group (p = 0.003 for both).ConclusionLSG-AR provides more effective long-term weight loss in patients with super obesity. Early postoperative vomiting complaints diminish over time, suggesting LSG-AR as a viable one-stage procedure for this patient population.

Optimizing Intravenous Patient-Controlled Analgesia for Cancer Pain: A Randomized Controlled Trial on Adjusted Background Infusion Rates.

Patient-controlled analgesia (PCA) has been considered for managing cancer pain; however, limited research has been conducted on optimizing continuous infusion rates with PCA. This study aimed to evaluate the efficacy and safety of a method that optimizes background infusion (BI) alongside PCA for titrating intravenous (IV) morphine in managing cancer-related pain. Forty-four patients with solid tumors who could not manage pain with oral or transdermal opioid analgesics were randomly assigned in a 1:1 ratio to receive IV morphine through PCA or the conventional method. In the PCA group, the BI rate was automatically adjusted on the basis of the frequency and interval of bolus button presses; contrastingly, BI rate in the conventional group was adjusted at the discretion of the medical staff. The primary outcome was the daily number of patient complaints of breakthrough pain (numeric rating scale ≥4). The PCA group reported a significant decrease in breakthrough pain complaints at 24 hours (median, 0 v 3 times/d; P = .012) and a lower proportion of nonresponders at 24 hours (21% v 55%; P = .048) compared with the conventional group. The total daily IV dose of morphine increased in the PCA group and exhibited a significant difference between two groups within 48 hours (median, 76.80 v 44.42 mg/d; P = .036). No uncontrolled opioid-related adverse effects were observed in either group. PCA, with an optimized BI rate, facilitated faster titration of IV morphine than the conventional method, achieving tolerable and rapid pain relief.

ДИАГНОСТИКА И ТЕРАПИЯ МЕНИНГИОМЫ ОБЛАСТИ ТУРЕЦКОГО СЕДЛА

Currently, the number of oncological diseases among the population is growing significantly, accordingly, the practical significance of scientific works on the topic of oncology increases. It is a well-known fact that in the early stages of oncological diseases, most tumors respond much better to treatment, and the prognosis for the patient's life becomes many times more favorable. Based on this, it is necessary to consider a clinical case and analyze in our scientific articles tumors that often lead to patient disability and, in fact, are quite difficult to respond to various types of therapy. The issue of treating such neoplasms is one of the leading tasks of modern medicine. It is worth noting that among neoplasms, brain tumors occupy a fairly impressive position, and 10% of them are tumors of the arachnoid space of the meninges - meningiomas of the sella turcica. [1] The main problem associated with the diagnosis and treatment of meningiomas is their fairly deep localization and, most often, late detection. This is due to the symptoms characteristic of this tumor. It is worth noting the age features of the most frequent detection of meningiomas and tracking the correlation of this indicator with possible patient complaints, which will allow detecting a neoplasm at the earliest stage and significantly improving the prognosis of treatment and further rehabilitation of the patient. In this scientific work, a clinical case of meningioma in a 57-year-old patient was considered, the treatment she received was analyzed and a diagnostic technique for this pathology was proposed.

BIOMEDICAL RISK FACTORS FOR THE DEVELOPMENT OF PREECLAMPSIA OF VARYING SEVERITY IN PREGNANT WOMEN

The aim of this study was to identify biomedical risk factors for the development of preeclampsia of varying severity in the group of examined pregnant women. Material and methods. 70 women whose pregnancy was complicated by the development of preeclampsia were under observation. The first group included 46 (65.7%) patients with moderate preeclampsia; the second group included 24 (34.2%) women with severe preeclampsia. The diagnosis was established on the basis of the patient's complaints, clinical examination, somatic, obstetric and gynecological anamnesis, analysis of the course of the present pregnancy, ultrasound fetometry and Dopplerometry findings. The patients who participated in the study had an assessment of clinical and anamnestic parameters, somatic status, obstetric and gynecological anamnesis. Data from 45 pregnant women with an unencumbered obstetric and gynecological history and a physiologically occurring pregnancy were used as control values. Results. The prognostic risk factors for the development of moderate and severe preeclampsia were analyzed based on the calculation of relative risk indicators (RR) and 95% confidence interval (95% CI). In the group of pregnant women with both severe and moderate preeclampsia, strong prognostic risk factors were: place of residence in the regions, extragenital pathology in the anamnesis, gynecological diseases in the anamnesis, the number of pregnancies in the anamnesis, birth parity, and arterial hypertension. The early identification of risk factors for moderate and severe preeclampsia enables timely preventive measures, thereby improving patient outcomes and prognosis. Conclusion. The analysis revealed that preeclampsia was more prevalent among pregnant women with a history of various extragenital diseases, a complicated obstetric and gynecological history, and concomitant hypertension.

Through a Hazy Lens: A Teen’s Surprising Struggle with Juvenile Cataracts

A juvenile cataract is a condition in which the eye's lens gets cloudy, affecting children and teenagers and considerably impairing vision. It accounts for approximately 5% to 20% of childhood blindness worldwide. A 16-year-old male patient came with his parents to the Pediatric Ophthalmology and Strabismus Department of RSUD dr. Zainoel Abidin with complaints of blurred vision in both eyes. The patient admitted that his visual acuity was deteriorating, and he had difficulty seeing the blackboard when the teacher explained it at school. There were no factors that aggravated or relieved the patient's complaints. The ophthalmologic examination showed the visual acuity of both eyes was 6/30, and the bilateral lenses were opaque. The patient was diagnosed with juvenile cataract oculi dextra et sinistra. Subsequently, the patient was planned for aspiration irrigation with intraocular lens (IOL) insertion in both eyes, membranectomy, primary posterior capsulectomy (PPC), and anterior vitrectomy (AV). Following the surgery, the visual acuity of both his eyes was improved to 6/7 and 6/10. The patient was also prescribed oral and topical antibiotics and topical anti-inflammatories to prevent infection and persistent inflammation after surgery. After surgery, the patient was also planned for optical rehabilitation one month postoperatively by being prescribed glasses with the best correction of 6/6 in both eyes.

PREVALENCE OF PERIODONTAL DISEASES AMONG INDUSTRIAL WORKERS EXPOSED TO HARMFUL FACTORS

The purpose of this study was to investigate the prevalence and intensity of periodontal diseases among inductrial workers exposed to harmful factors. Subjects and methods. To achieve the goal, 263 employees from three industrial sectors in the Ivano-Frankivsk region were surveyed: chemical production, glass production, and the agro-industrial complex. Clinical examinations were conducted at the Department of Dentistry of the Faculty of Medical Sciences at IFNMU. The employees were divided into two groups: the main group, which included 185 workers directly involved in production, and the control group, which consisted of 78 individuals from administrative and support staff, matched for gender, age, and work experience. These control group members worked outside the main production areas. Clinical examinations for both groups followed a standard medical protocol, including the collection of anamnestic data and the assessment of patient complaints. Results and discussion. According to the obtained data, only 7,57% of 185 subjects in the main group had an intact periodontium, which is 1,7 times less common than the subjects of the control group, who did not have close contact with occupational pathogens. Periodontal diseases in the control group were found in 87,18% of people. This figure is close to the average population in the flat areas of the Ivano-Frankivsk region for age groups from 20 to 54 years. Among patients of the main group, the number of individuals with periodontal diseases was 5,25% higher, which is obviously due to the effect of unfavorable factors at enterprises. By studying the structure of periodontal diseases, it was established that among 171 individuals in the main groups that had periodontal diseases, gingivitis was diagnosed in 5,26% of patients, localized periodontitis in 3,51%, and periodontitis in 2,92%, and the rest – 88,31 % of people diagnosed with generalized periodontitis. Therefore, among patients of the main group who are exposed to occupational hazards, HP of the II and III degree is detected much more often - in 45,03% of patients, which is 12,67% more than in patients of the control group who are not in contact with harmful factors. The vast majority (67,64%) of employees of the administrative building had milder forms of periodontal disease: GP of the initial and first degree of development, gingivitis, localized periodontitis. Conclusions. Thus, a comparison of data from the study on the prevalence and condition of periodontal tissues in individuals exposed to occupational hazards in industrial production (main group) with the control group revealed the following: periodontal diseases develop much more rapidly in workers and are correlated with their work experience, leading to the presence of underlying conditions that contribute to the quick and intense progression of dystrophic-inflammatory processes in the periodontal tissues. Anamnestically, the majority of the subjects linked the initial manifestations of the disease to the onset of their work at the enterprise.

Case series of small bowel obstruction

Introduction: Small Bowel Obstruction remains a significant cause of morbidity and mortality, accounting for 12%-16% of hospital admissions for acute abdominal pain in the United States. Imaging typically provides insights into the degree of obstruction, its cause, and whether the case is severe or complicated. This study aimed to examine cases of small bowel obstruction, encompassing patient complaints, radiological findings, and prognosis. Case description: The first case involves a 51-year-old male patient presenting with complaints of abdominal bloating for the past week. Physical examination and additional diagnostic tests indicated the patient was experiencing either partial ileus obstruction or total ileus obstruction, with total bowel obstruction suspected to be of malignant origin. The patient was treated in the ICU for two days, and then transferred to a general ward for five days before passing away. The second case involves a 57-year-old female patient presenting with complaints of epigastric pain for the past three days. Physical examination and additional diagnostic tests revealed either partial ileus obstruction or total ileus obstruction, with total bowel obstruction suspected to be of malignant origin. The patient was treated in the ICU for three days, followed by six days in a general ward. The patient showed significant improvement and was discharged with a recommendation for outpatient follow-up care at the polyclinic. Conclusion: Both cases presented here demonstrated the presence of obstruction through clinical history, physical examination, laboratory findings, and radiology. Initial management was conservative, followed by laparotomy as the surgical approach.

New Comprehensive Clinical Classification of Dry Eye Syndrome Severity 2024. Part 1

Over the past ten years, the scientific ophthalmological community has shown a significant interest increase in studying dry eye syndrome (DES), as the number of such patients is steadily increasing every year. According to research conducted by the international DEWS working group, which studies DES, there is no single “gold standard” for diagnosing DES, as its manifestations are very diverse. A set of diagnostic tests is used to diagnose DES, reflecting both subjective and objective indicators of tear production. Subjective diagnostic criteria include questionnaires, the most widely used of which are the OSDI and SPEED questionnaires. It should be noted that these questionnaires characterize only subjective indicators and do not take into account objective criteria. In addition, the peculiarity of DES is that the presence of complaints is already a sign of this disease. However, the symptoms, namely the complaints of patients, do not always coincide with the clinical manifestations of dry eye syndrome — objective indicators of the state of tear production, such as the indicators of tear production tests. Based on modern concepts of the etiology and pathogenesis of dry eye syndrome, the state of the tear-producing system directly depends on the state of the tissues of the ocular surface — the conjunctiva, cornea and eyelids. Any inflammatory process affecting the tissues of the ocular surface leads to a violation of the stability of the tear film, its evaporation and an increase in osmolarity, which in turn causes an inflammatory process. Therefore, it is necessary in diagnosing dry eye syndrome to take into account a set of indicators characterizing the state of the tissues of the ocular surface, including the inflammatory process, in particular, conjunctival hyperemia, as well as the stability of the tear film, which depends primarily on its lipid component. The comprehensive clinical classification of dry eye syndrome presented in this article reflects not only objective indicators of impaired tear production and inflammation of the ocular surface, but also subjective indicators — quality of life according to the SPEED scale, characterizing the intensity and frequency of complaints of dryness and discomfort in the eyes. The above indicators allow to differentiate the severity of dry eye syndrome, which is of fundamental importance for choosing treatment methods and the volume of drug therapy, and assessing its effectiveness in dynamics. The developed diagnostic algorithm does not require special skills when carried out by a doctor, so it can be recommended for its use in wide ophthalmological practice.

Erythrosis pigmentosa peribuccalis Brocq

Pigmented peribuccal erythrosis of Brocq is a rare disease, with less than 50 cases reported in the literature, affecting mainly women. The dermatosis manifests itself as small follicular pigmented and slightly hyperkeratotic papules that are grouped centrofacially to form plaques with clear contours around the mouth and nose, sometimes with lesions in the forehead. The color intensity may change during the day, due to the presence of a vascular component. The dermatosis does not cause subjective symptoms and the main complaints of patients are reduced to aesthetic discomfort due to the sharp transition from orange-brown coloring around the mouth and nose to the normal color of the cheeks. The etiology of this condition is currently unknown, the features of the dermatoscopic picture have not been described, and standardized and effective methods of therapy have not been developed. This article describes the clinical manifestations and dermatoscopic picture of this rare dermatosis in a 23-year-old girl with a disease duration of 6 years and ineffectiveness of previous treatment, who had pronounced and persistent positive dynamics against the background of treatment of concomitant cystic ovarian formations, the use of external agents with a keratolytic effect and strict photoprotection.

Measuring Quality Performance ofPublic Hospitals in Somalia

Public hospitals are government-owned hospitals, but they’re not fully funded by the government. The UN provides the majority of funding for public healthcare; however, very little is known about the quality of public hospitals in Somalia.Purpose: This study aims to evaluate the quality performance of public hospitals by using nine indicators, namely, patient waiting time, patient complaints, patient satisfaction, employee job satisfaction, medical service cost, shortage of medical services, errors in medical services, waste in processes, and availability of quality medical equipment.Methodology: First, the research began by mapping referral public hospitals in federal states of Somalia. Second, using simple random sampling with a self-administered questionnaire targeted at 16 public hospitals with 30 respondents, for a total of 480; however, two hundred and ninety-seven respondents have accepted to participate in the study, these make in a response rate of 62 percent. Research data were analyzed based on descriptive analysis.Findings: The findings of this study indicate that the majority items of the quality performance mean values were less than the midpoint of the scale (mean = 2.909, the standard deviation = 0.867). This indicates that the majority of the respondents were either neutral or agreed with the negative scale about the quality performance of the public hospitals.Research limitations: This research focused solely on the quality performance of the Somali public hospitals; thus, the results might not be applicable to other countries.Originality/value: Present research findings provide guidelines for enhancing quality performance in the Somalia public healthcare sector.

Social participation in health – case studies from primary health care in Kosovo

BackgroundParticipation and inclusion of service users in health governance impact the quality of care and citizen well-being. In developing countries, such as Kosovo, disadvantaged groups are particularly important due to deep exclusionary structures and multiple systemic barriers to participation and care provision.PurposeTo investigate the effects of three interventions on social participation in decision-making in several primary healthcare sites among the population and particularly vulnerable groups, i.e. ethnic minorities of Roma, Ashkali, and Egyptian backgrounds, elderly citizens, and people with disabilities.MethodsThis study uses the consolidated framework of social participation and adapts it to Kosovo’s primary healthcare context. We analysed the degrees of inclusiveness, intensity, and influence across three interventions, i.e., social participation mechanisms implemented in four municipalities and related primary care networks in Kosovo. We applied an embedded multiple-case study design relying on qualitative data collection.ResultsDegrees of social participation within each case study ranged from low to moderate. Patient councils serve as representative mechanisms to consider patient complaints with an informative and liaising role. The community scorecard mechanism involves community representatives in decision-making processes, with varying levels of inclusiveness and participation intensity, effectively voicing their preferences and demands. The municipal health action plans process exhibits varying inclusiveness levels where community representatives wield decision-making influence.ConclusionThe participation mechanisms examined in this study could sustain moderate social participation across inclusiveness, intensity, influence and impact domains. These shared platforms between service users and providers produce the most meaningful influence. The use of these mechanisms has a promise of increasing social participation in primary care settings in Kosovo.

Role of surgical vaginoscopy through no-touch hysteroscope in the treatment of female reproductive polyps

BackgroundThe study aims to investigate the application of surgical vaginoscopy via a no-touch hysteroscopic approach for the management of female genital polyps. The primary objective is to assess the feasibility of this technique in treating intrauterine pathologies in both pregnant and non-pregnant women.MethodsA total of forty-six patients diagnosed with genital polyps underwent operative vaginoscopy at a university-affiliated hospital between April 1, 2017 and May 31, 2023. A retrospective analysis was conducted on the collected data, encompassing patient complaints, clinical presentations, surgical outcomes, and pathological diagnoses. Additionally, the success rate of the vaginoscopic procedures was determined.ResultsForty-six patients with an average age of 33.0 ± 8.8 years were included in this study. Among them, 25 were non-pregnant (3 with and 22 without a sexual history). The most common clinical manifestation was irregular vaginal bleeding (11/25, 44%) followed by conscious vaginal protrusion (10/25, 40%). Among the 21 pregnant patients, the main symptom was irregular vaginal bleeding during pregnancy (100%). The postoperative pathological diagnoses included 11 endometrial polyps, 33 cervical polyps, 1 multiple vaginal polyps, and 1 vaginal stump polyps. The coincidence rate between the intraoperative vaginoscopic diagnosis and postoperative pathological diagnosis was 100%. Among the non-pregnant patients, 11 were diagnosed with endometrial polyps, with an average length of 2.2 ± 1.2 cm, 1 patient had vaginal residual polyps after total hysterectomy, with a polyp length of 0.3–0.7 cm, and 1 had multiple vaginal polyps, with a length of 0.5–3 cm. Twelve patients had cervical polyps with an average length of 3.4 ± 1.2 cm. Twenty-one pregnant patients were diagnosed with cervical polyps, the average length of 2.4 ± 1.4 cm. All patients successfully underwent vaginoscopic surgery, for an average surgical duration of 23.5 ± 14.9 min, a bleeding volume of 1–10 mL(4.5 ± 3.4 mL), and an average hospitalisation of 2.7 ± 1.3 days. Throughout the surgical procedures, no complications were encountered, including water intoxication or uterine perforation. Postoperatively, no patients experienced discomforts such as fever or moderate to severe abdominal pain. Furthermore, all non-pregnant women were monitored for a two-month period following surgery, and throughout this interval, there were no reports of abnormal vaginal bleeding, unusual vaginal discharge, or abdominal pain. None of the 21 pregnant women experienced abnormal vaginal bleeding after the surgery. Nineteen of them delivered at full term, and one underwent caesarean delivery at 31 weeks owing to placental abruption. All the newborns had Apgar scores of 10, 10, and 10, and one had a miscarriage at 18 weeks of gestation.ConclusionVaginoscopic surgery through no-touch hysteroscope represents a minimally invasive and highly effective method for addressing female reproductive tract polyps. This approach holds significant clinical value, particularly in the management of cervical polyps during pregnancy.

Evidence-based approach to the shoulder examination for subacromial bursitis and rotator cuff tears: a systematic review and meta-analysis

IntroductionShoulder pain represents a common patient complaint evaluated in a primary care setting. Approximately two thirds of these patients have rotator cuff injuries, with rotator cuff tears (RCTs) and subacromial impingement syndrome (SIS) accounting for a majority of causes. An accurate and efficient diagnostic strategy focused on physical examination findings may lead to improved outcomes and less functional disability.ObjectiveTo identify the most accurate physical examination tests for the diagnosis of RCT and SIS, we performed a systematic review and meta-analysis.MethodsThe database for our systematic review was compiled by using keywords and common indexing strategies to search PubMed, Ovid MEDLINE, Embase and the Cochrane Library from January 1, 1980, to March 15, 2024. Included studies evaluated a physical examination being performed prior to a reference standard diagnostic test for either RCT or SIS. Data was extracted in dual fashion and meta-analyses were performed regarding physical examination tests identified in our included studies.ResultsA total of twenty studies, which include 3,438 patients, met our inclusion criteria and had data extracted for statistical analysis. Data was adequate to perform meta-analyses on ten physical examination tests for RCT and five physical examination tests for SIS. There were six physical examination tests which had significant diagnostic odds ratios (DORs) when used in the diagnostic evaluation of suspected RCT, with the External Rotation Lag Sign at 90 Degrees having the highest magnitude of significance (DOR, 12.70; 95% CI, 3.68 – 43.86; P < .0001). Four physical examination tests had significant DORs for physical examination tests when used in the diagnostic evaluation of SIS, with the Yergason’s Test having the highest magnitude of significance (DOR, 4.71; 95% CI; 2.16 – 10.32; P = .0001).ConclusionWe present a large body of low-quality evidence for the diagnostic accuracies of physical examination tests for the identification of both RCT and SIS. We have identified novel data for the accuracy of the External Rotation Lag Sign at 90 Degrees and the Internal Rotation Lag Sign that have high to moderate diagnostic accuracy for ruling in tears of the rotator cuff.

Influencing factors of ocular pain in dry eye disease patients at high altitude.

To quantify the severity and frequency of ocular pain in Tibetan plateau patients with dry eye, and to evaluate the related factors affecting ocular pain. A retrospective study included 160 cases of dry eye disease (DED) patients who were treated from July 2022 to June 2023. Age, gender, occupation, illness course, anxiety, plateau duration, plateau protection, ocular surface disease index scale (OSDI), break-up time (BUT), Schirmer I test (SIT), conjunctivitis, history of ophthalmic medication, autoimmune disease, the workload of daily near vision range, smoking and overnight stay were obtained via comprehensive ophthalmic assessment, and their duration was followed up. Logistic regression analysis was used to determine the related factors affecting ocular pain. Totally 77.5% (124/160) of DED patients had ocular pain, of which the severity of ocular pain was mild, moderate, and severe in 30.0%, 36.3%, and 11.3% of patients, respectively. Frequency of ocular pain was reported occasional, half the time, frequent, and persistent pain in 19.4%, 36.9%, 16.9%, and 4.4%. OSDI score was 19.67±5.70 (13 to 36), and the level of pain was lowly correlated with OSDI (rs =0.316, P<0.001). Logistic regression showed that in plateau DED patients, increased anxiety led to increased severity and frequency of ocular pain [odds ratio (OR)=3.662, 5.613, 2.387, and 4.870; all P<0.05], professional eye protection and improvement of daily sleep quantity decreased pain (OR=0.307, 0.572, 0.418, and 0.789; all P<0.05), while smoking and general protection of plateau did not affect the severity and frequency of ocular pain (all P>0.05). Ocular pain is a common complaint in high-altitude DED patients during the pandemic. Anxiety, eye protection, and adequate sleep during the epidemic period are significantly associated with the severity and frequency of ocular pain in patients with plateau DED, while symptoms of DED have relatively little influence on them.

Five-year analysis of hospital complaints at a Japanese tertiary teaching hospital.

Patient complaint taxonomies strongly support the use of healthcare complaints as a powerful tool to improve the quality and safety of patient care. Hospitals use complaint data at the organizational level to address quality variation across service lines and departments. We applied a validated typology method to identify where the complaints occured and gained deeper insights about how they can be more effectively utilized to drive and implement continuous quality and service improvement activities within a tertiary hospital. We included all complaints and opinions from patients and their families over a 5-year period at a large tertiary teaching hospital in Japan. Two analysts categorized the opinions into complaints and gratitude expressions, with complaints classified using Reader etal.'s taxonomy. We performed statistical tabulations and determined the number of complaints across hospital sectors using the chi-squared test, residual analysis, and Cramer's V tests to check for significant correlations between the variables. A total of 6607 complaints and comments were received. Of these, 5401 related to the Clinical, Administrative, and Human Relations domains, respectively (11.1%, 56.1%, and 32.8%). At the domain level, the most common complaints are related to the Relationships domain in both the Medical and Nursing departments. However, a detailed analysis of the category levels demonstrated that the Medicine department received the most complaints in the Communication and Patient Rights category, whereas in the Nursing department, the Humanness/Caring and Patient Rights categories were the most common sources for complaints. The Administrative department complaints were mostly related to the Management domain, with the largest number of complaints related to the Institutional Issues category. We used a validated taxonomy to identify and address trends in patient complaints and identified the key hospital departments that required remedial improvement actions. All hospital departments received direct and targeted feedback on how to effectively improve the quality, safety and services of their clinical service lines.

Spectral tussophonobarography as a method for monitoring the effectiveness of cough treatment in patients with COVID-19

Dry cough is one of the most common complaints of patients with COVID-19, so it must be treated with antitussives. The effectiveness of prescribed therapy can be controlled by using questionnaires and spectral analysis of cough sounds. The aim was to assess the use of spectral tussophonobarography for monitoring the effectiveness of cough treatment in patients with COVID-19. Methods. The main group consisted of 60 patients with COVID-19 (45% men, 55% women, average age 38.6 (30.1; 49.6) years) with mild or moderate severity and strong complaints of cough. The disease was treated in accordance with clinical recommendations, and antitussives were also used. Cough on the 1st and 8th days of therapy was studied using a visual analogue scale and spectral tussophonobarography, then compared with the induced cough of 30 healthy individuals making up the comparison group (43.3% men and 56.7% women; average age of 36.3 (28.4; 44.8) years). Cough recordings were subjected to a fast Fourier transform algorithm. The following cough characteristics were assessed: duration (ms), ratio of low and medium frequency energy (60 – 600 Hz) to high frequency energy (600 – 6000 Hz), and frequency of maximum sound energy (Hz). Not only of the coughing act as a whole was assessed, but also of each phase separately. Results. On the 8th day of treatment, significant changes in cough characteristics were seen compared to the 1st day, especially in the 2nd phase of the cough act. The duration of cough increased (T = 355.0 (276.0; 407.5) – on the 1st day; T(c) = 432.0 (386.0; 556.0) – on the 8th day; p = 0.0000), lower frequencies began to predominate (Q = 0.281 (0.2245; 0.408) – on the 1st day; Q(c) = 0.4535 (0.3725; 0.619) – on the 8th day; p = 0.0000), the frequency of maximum sound energy decreased (Fmax = 488.5 (282.0; 1220.5) – on the 1st day; Fmax = 347.0 (253.0; 488.0) – on the 8th day; p = 0.0064). No statistically significant differences were found in the studied parameters on the 8th day of treatment as compared with those in healthy individuals. Conclusion. Spectral tussophonobarography revealed that characteristics of cough sounds during treatment of COVID-19 were close to those of healthy individuals.

Time-Critical Emergencies in Suburban Parks and Outdoor Recreation Spaces.

Objective Prior studies have described the patterns of emergency medical service (EMS) activations in national parks in the United States. However, little data existsregarding EMSactivations in local and regional outdoor recreational locations. We performed a retrospective analysis of EMS activations originating from parks and recreational areas in suburban Howard County, Maryland, to characterize those activations determined to be time-critical emergencies. Methods EMS activations originating from outdoor recreational areas and parks in Howard County, Maryland, between December 2018 and December 2022, were extracted from the Howard County Department of Fire and Rescue Services (HCDFRS) electronic medical records database. Patient complaints were categorized into medical or traumatic etiologies and then determined to be "time-critical" or "non-time-critical" by two emergency physician reviewers with a tie-breaker reviewer to resolve discrepancies. Results A total of 396 EMS activations in county parks and recreational areas were recorded during the study period, with 61 (15.40%) determined to be time-critical. The most commonly occurring time-critical calls were cardiac arrest (7; 11.48%), drug/alcohol-related complaints (5; 8.20%), and altered mental status (5; 4.92%). Most EMS activations were for male patients (273; 68.94%). Pediatric patients (<18 years old) constituted 161 (40.66%) time-critical traumatic injury activations, and these numbers decreased as patient age increased. The most commonly occurring time-critical medical activations (11; 2.78%), occurred in 40-64-year-olds. The highest number of total EMS activations occurred in October, with 57 calls (14.39%), and the greatest volume of time-critical activations occurred during June, with nine calls (14.75%). Conclusion Within a suburban county's EMS system, 15.4% of the total EMS activations to parks and outdoor recreational locations were found to be time-critical, significantly higher than in other places. Patients aged 0-18 experienced the highest number of time-critical trauma-related activations, whereas those aged 40-64 had the highest number of time-critical medical activations. EMS agencies should review their activation rates in these locations to determine the need to enhance education and operational readiness for response to time-critical activations for pediatric trauma and adult medical emergencies.

Case report: Depression in an older patient with dysgeusia as the initial symptom

IntroductionDepression is the most common mental illness among older adults, with substantial and persistent mood depression as the main clinical feature, which is unfavorable for improvement. The clinical manifestations can range from melancholy to grief or even numbness. Approximately one-third of older adult patients exhibit physical discomfort as the first symptom; dysgeusia as the first symptom, is very rare in clinical practice. Dysgeusia is a clinical symptom with no specific objective indicator; thus, the likelihood of misdiagnosis and missed diagnosis is high.Case presentationIn this study, a 60-year-old female housewife with elementary school as her highest level of education, presented to the outpatient department with dysgeusia, poor sleep, and poor mood persisting for &amp;gt;1 year, which aggravated 2 weeks before hospital visit. Psychiatric examination showed clear consciousness; the patient was cleanly and timely dressed and demonstrated self-care but had a worrisome expression. Using the diagnostic criteria of the International Classification of Diseases (10th edition), a diagnosis of a major depressive episode with psychotic symptoms was made. Following pharmacological and psychological treatment, the patient’s condition improved. The patient was compliant to treatment (10 mg/day of escitalopram), had a stable mood, good sleep, and no dysgeusia at &amp;gt;2 years of follow-up as an outpatient. She was able to do housework and take care of her children normally and did not complain about any other issues.ConclusionPhysical discomfort is a very common complaint in older patients with depression. If persistent physical symptoms do not improve after repeated medical treatment, timely assessment of the patient’s mental state or psychiatric referral should be considered to diagnose geriatric depression. Timely pharmacological and psychological therapy are the preferred treatment for older adults.