Physical Diagnostic Tests Research Articles

Antenatal care quality and detection of risk among pregnant women: An observational study in Ethiopia, India, Kenya, and South Africa.

Antenatal care (ANC) is an essential platform to improve maternal and newborn health (MNH). While several articles have described the content of ANC in low- and middle-income countries (LMICs), few have investigated the quality of detection and management of pregnancy risk factors during ANC. It remains unclear whether women with pregnancy risk factors receive targeted management and additional ANC. This observational study uses baseline data from the MNH eCohort study conducted in 8 sites in Ethiopia, India, Kenya, and South Africa from April 2023 to January 2024. A total of 4,068 pregnant women seeking ANC for the first time in their pregnancy were surveyed. We built country-specific ANC completeness indices that measured provision of 16 to 22 recommended clinical actions in 5 domains: physical examinations, diagnostic tests, history taking and screening, counselling, and treatment and prevention. We investigated whether women with pregnancy risks tended to receive higher quality care and we assessed the quality of detection and management of 7 concurrent illnesses and pregnancy risk factors (anemia, undernutrition, obesity, chronic illnesses, depression, prior obstetric complications, and danger signs). ANC completeness ranged from 43% in Ethiopia, 66% in Kenya, 73% in India, and 76% in South Africa, with large gaps in history taking, screening, and counselling. Most women in Ethiopia, Kenya, and South Africa initiated ANC in second or third trimesters. We used country-specific multivariable mixed-effects linear regression models to investigate factors associated with ANC completeness. Models included individual demographics, health status, presence of risk factors, health facility characteristics, and fixed effects for the study site. We found that some facility characteristics (staffing, patient volume, structural readiness) were associated with variation in ANC completeness. In contrast, pregnancy risk factors were only associated with a 1.7 percentage points increase in ANC completeness (95% confidence interval 0.3, 3.0, p-value 0.014) in Kenya only. Poor self-reported health was associated with higher ANC completeness in India and South Africa and with lower ANC completeness in Ethiopia. Some concurrent illnesses and risk factors were overlooked during the ANC visit. Between 0% and 6% of undernourished women were prescribed food supplementation and only 1% to 3% of women with depression were referred to a mental health provider or prescribed antidepressants. Only 36% to 73% of women who had previously experienced an obstetric complication (a miscarriage, preterm birth, stillbirth, or newborn death) discussed their obstetric history with the provider during the first ANC visit. Although we aimed to validate self-reported information on health status and content of care with data from health cards, our findings may be affected by recall or other information biases. In this study, we observed gaps in adherence to ANC standards, particularly for women in need of specialized management. Strategies to maximize the potential health benefits of ANC should target women at risk of poor pregnancy outcomes and improve early initiation of ANC in the first trimester.

Acute Optic Neuritis: An Update on Approach and Management.

This review discusses the physical examination and diagnostic tests necessary to diagnose optic neuritis (ON) and provides an update on the approach and management of acute ON. A comprehensive search of the PubMed database was conducted, limited to English-language journals and recent publications. A total of 160 articles were initially screened by title, of which 73 articles were included in the narrative synthesis. ON is an inflammation of the optic nerve that can be caused by different systemic and neurological disorders. It is commonly presented as a subacute unilateral painful vision loss, and based on its clinical manifestation, it can be classified as typical or atypical. Atypical ON is bilateral with visual acuity of worse than 20/200 or has an atypical demographic presentation for demyelination, such as a non-Caucasian male with optic disc swelling, for which neuromyelitis optica spectrum disorder (NMOSD), myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD), or other etiologies should be considered. Steroids and immunosuppressants are the main treatment options for ON, and timely treatment initiation is critical to preventing irreversible vision loss, especially in atypical cases.

Utility of telemedicine for providing Obstetrics and Gynecology services during the COVID-19 pandemic—A single center experience from a tertiary care teaching hospital located in South India

BACKGROUND: The COVID-19 pandemic greatly impeded the provision of public healthcare within a healthcare system that was already under considerable strain. Routine patient care services were impacted during that time, leading to the promotion of telemedicine as a means of maintaining uninterrupted healthcare services. Telemedicine involves the utilization of electronic technology and communication to provide health-related information and medical care to individuals who are physically separated from healthcare professionals. MATERIALS AND METHODS: To assess the feasibility of utilizing telemedicine for providing women's health services, we conducted a six-month analysis of data collected from the Department of Obstetrics and Gynecology's teleconsultation application at AIIMS, Mangalagiri. Our objective was to evaluate the practicality of telemedicine in delivering diverse healthcare services to women. Our institution offered two types of telehealth services: a “call-based”approach and an “app-based”approach. We examined several parameters within the data, including the distribution of ages, the geographic locations of teleconsultation registrations, whether the registrations were new or follow-up cases, the various presenting complaints, the recommended treatments, the number of consultations (single or multiple), and whether cases required in-person or hospital visits. Additionally, we also compared patient responses between these two modalities. RESULTS: The “call-based”consultation method was preferred by the majority of our patients (94%). The registered cases included both related to obstetrics and gynecology, with a higher proportion of complaints relating to gynecological issues (82.5%). We were able to make a diagnosis in 77% of cases, while in 20% of cases, additional physical examinations and diagnostic tests were necessary. Follow-up appointments were recommended for 53% of patients. The success rate of consultations for patients seeking obstetrics and gynecology services showed a statistically significant difference (P value < 0.001). The vast majority of patients (99%) expressed high satisfaction with the consultation process. CONCLUSION: During the COVID-19 pandemic, telemedicine proved to be an effective approach in mitigating the overcrowding of hospitals and preventing the spread of infection. Its success suggests that telemedicine can be a viable option for managing elective gynecology matters and low-risk obstetric cases in the future, thereby alleviating the strain on healthcare systems.

Can a Computational Model Predict the Effect of Lesion Location on Cam-type Hip Impingement?

The Warwick consensus defined femoroacetabular impingement syndrome as a motion-related clinical disorder of the hip with a triad of symptoms, clinical signs, and imaging findings representing symptomatic premature contact between the proximal femur and acetabulum. Several factors appear to cause labral and cartilage damage, including joint shape and orientation and patient activities. There is a lack of tools to predict impingement patterns in a patient across activities. Current computational modeling tools either measure pure ROM of the joint or include complexity that reduces reliability and increases time to achieve a solution. The purpose of this study was to examine the efficacy of a low computational cost approach to combining cam-type hip shape and multiple hip motions for predicting impingement. Specifically, we sought to determine (1) the potential to distinguish impingement in individual hip shapes by analyzing the difference between a cam lesion at the anterior femoral neck and one located at the superior femoral neck; (2) sensitivity to three aspects of hip alignment, namely femoral neck-shaft angle, femoral version angle, and pelvic tilt; and (3) the difference in impingement measures between the individual activities in our hip motion dataset. A model of the shape and alignment of a cam-type impinging hip was created and used to describe two locations of a cam lesion on the femoral head-neck junction (superior and anterior) based on joint shape information available in prior studies. Sensitivity to hip alignment was assessed by varying three aspects from a baseline (typical alignment described in prior studies), namely, femoral neck-shaft angle, femoral version, and pelvic tilt. Hip movements were selected from an existing database of 18 volunteers performing 13 activities (10 male, eight female; mean age 44 ± 19 years). A subset was selected to maximize variation in the range of joint angles and maintain a consistent number of people performing each activity, which resulted in nine people per activity, including at least three of each sex. Activities included pivoting during walking, squatting, and golf swing. All selected hip motion cases were applied to each hip shape model. For the first part of the study, the number of motion cases in which impingement was predicted was recorded. Quantitative analyses of the depth of penetration of the cam lesion into the acetabular socket and qualitative observations of impingement location were made for each lesion location (anterior and superior). In the second part of the study, in which we aimed to test the sensitivity of the findings to hip joint orientation, full analysis of both cam lesion locations was repeated for three modified joint orientations. Finally, the results from the first part of the analysis were divided by activity to understand how the composition of the activity dataset affected the results. The two locations of cam lesion generated impingement in a different percentage of motion cases (anterior cam: 56% of motion cases; superior cam: 13% of motion cases) and different areas of impingement in the acetabulum, but there were qualitatively similar penetration depths (anterior cam: 6.8° ± 5.4°; superior cam: 7.9° ± 5.8°). The most substantial effects of changing the joint orientation were a lower femoral version angle for the anterior cam, which increased the percentage of motion cases generating impingement to 67%, and lower neck-shaft angle for the superior cam, which increased the percentage of motion cases generating impingement to 37%. Flexion-dominated activities (for example, squatting) only generated impingement with the anterior cam. The superior cam generated impingement during activities with high internal-external rotation of the joint (for example, the golf swing). This work demonstrated the capability of a simple, rapid computational tool to assess impingement of a specific cam-type hip shape (under 5 minutes for more than 100 motion cases). To our knowledge, this study is the first to do so for a large set of motion cases representing a range of activities affecting the hip, and could be used in planning surgical bone removal. The results of this study imply that patients with femoroacetabular impingement syndrome with cam lesions on the superior femoral head-neck junction may experience impinging during motions that are not strongly represented by current physical diagnostic tests. The use of this tool for surgical planning will require streamlined patient-specific hip shape extraction from imaging, model sensitivity testing, evaluation of the hip activity database, and validation of impingement predictions at an individual patient level.

Prevalence and Characterisation of Patients with Asthma According to Disease Severity in Portugal: Findings from the EPI-ASTHMA Pilot Study.

ObjectiveTo assess the feasibility of the procedures of EPI-ASTHMA. EPI-ASTHMA is a population-based multicentre stepwise study about the prevalence and characterisation of patients with asthma based on disease severity in Portugal.MethodsA pilot study of EPI-ASTHMA was conducted with adults from three primary care centres. We followed a stepwise approach comprising 4 stages: stage 0—invitation phone call (n ~1316); stage 1—telephone interview (n ~658); stage 2—clinical assessment with physical examination, diagnostic tests, and patient-reported outcome measures, to confirm the diagnosis of those with possible asthma at stage 1 (n ~160); stage 3—characterization of a subgroup of asthma patients by collecting data through a telephone interview, patient file review and CARATm app (n ~40), after 3-months. The frequency of asthma was calculated in relation to the entire study population (stage 1) and the frequency of difficult-to-treat/severe asthma in relation to the number of asthma patients (stage 3).ResultsFrom 1305 adults invited, 892 (68%) accepted to participate (stage 0) and 574 (64%; 53[42–67] y; 43% male) were interviewed (stage 1). From those, 148 (26%; 60[46–68] y; 43% male) were assessed at stage 2, and 46 (31%; 51[39–67] y; 44% male) were diagnosed with asthma. Half of these patients (n = 23) accepted to install the app. Stage 3 was completed by 41 (93%) patients, of whom 31 (83%) had asthma confirmed by their file review. A total of 8% of participants had asthma, of those 17% had difficult-to-treat and 5% severe asthma.ConclusionAttained recruitment rates and the quality of the results confirmed the feasibility of the EPI-ASTHMA stepwise approach. This pilot study provided insight into the improvement of the procedures to be generalized across the country.

EPI-ASTHMA study protocol: a population-based multicentre stepwise study on the prevalence and characterisation of patients with asthma according to disease severity in Portugal

IntroductionIn Portugal as in other countries, data on the epidemiology of asthma are mainly grounded in questionnaire studies. Additionally, the detailed characterisation of asthma in terms of disease severity, control...

Risk Factors of Serious Bacterial Infection in Previously Healthy Children Older Than 90 Days Old With Fever and Neutropenia.

The main objective was to determine the clinical or analytical factors that independently predict risk of serious bacterial infection (RSBI) in immunocompetent patients older than 90 days given a diagnosis of fever and for whom neutropenia was an incidental finding. The secondary objective was to describe the prevalence of serious bacterial infections (SBIs). This is a 3-year-long, multicenter, prospective analytical and observational study carried out at 6 pediatric emergency departments. Data for epidemiological, clinical, and analytical variables were collected. One hundred forty patients with febrile neutropenia (60.7% mild, 39.3% moderate to severe) were recruited. Serious bacterial infection incidence was 15.0% (95% confidence interval [CI], 9-21): 1 Invasive Bacterial Infection (Staphylococcus epidermidis bacteremia), 10 urinary tract infections, 8 pneumonias, and 2 cellulitis. Median total neutrophil counts per microliter showed no statistically significant differences (P = 0.512; 1000 [750-1200] in SBI patients vs 1100 [800-1300] in non-SBI patients). Higher RSBI was observed in patients with neutrophils less than 20% relative to total leukocytes (SBI, 15, 26.3%) than in those with neutrophils of 20% or greater (SBI, 6, 7.2%) (odds ratio, 4.6; 95% CI, 1.7-12.7). In patients with greater than 5000 leukocytes/μL, a percentage of neutrophils less than 20% was related to a greater RSBI with a trend toward statistical significance (odds ratio, 6.1; 95% CI, 0.7-51.1; P = 0.066). The clinical variables did not show a significant association with RSBI. None of the clinical or analytical variables assessed were associated with the RSBI. However, according to a post hoc analysis, in patients with greater than 5000 leukocytes/μL, a neutrophil percentage less than 20% could be an independent risk factor for SBI. A thorough physical examination and basic diagnostic tests (urinalysis and chest x-ray) may help to establish a diagnosis of SBI in the vast majority of cases.

Review and Comparison of Four-Tier Multiple Choice and Five-Tier Multiple Choice Diagnostic Tests to Identify Mastery of Physics Concepts

Misconceptions of a concept in a lesson will have an influence in understanding the next concept. Having misconceptions that exist in learning can understand the nature of the misconceptions and consequently can help student learning progress. Therefore, a diagnostic test for misconceptions is needed, including the newest four-tier multiple choice and five-tier multiple choice. This research is a literature review that provides information systematically using the PRISMA method which often occurs in students' misconceptions in high school physics subjects. The data for this research are 60 selected articles from 2017-2021. The purpose of this study is to reveal the use of four-tier multiple choice and five-tier multiple choice diagnostic tests in physics and also provide a comparison of each instrument with the strengths and weaknesses of the four-tier multiple choice and five-tier multiple choice diagnostic tests. Furthermore, the use of multiple choice four levels (83.33%) and multiple choice five levels (16.67). %). In the use of the four-tier multiple choice physical material diagnostic test, which are often used in identifying misconceptions, are optical devices (12%) and energy businesses (10%). And the use of an additional five-tier multiple choice instrument diagnostic test that is often used is to present an overview or conclusion at the fifth level. However, each type of four-tier multiple choice and five-tier multiple choice tests has its own advantages and disadvantages in assessing students' conceptions

Symposium Title: The Contribution of Neurophysiology to Migraine: From Basic Mechanisms to the Effects of Novel Treatments

Pediatric dizziness is an uncommon complaint presenting to the Otolaryngology clinic. While the term dizziness may be used to describe any altered sensation of orientation to the environment which includes presyncope, light-headedness and ataxia, vertigo refers to a false sensation of motion of self or surroundings. Although a variety of etiologies are known to cause dizziness and vertigo, evaluation of this symptom becomes challenging in children who are unable to clearly explain what they experience, the provoking factors, associated symptoms and the duration of attacks. Vestibular tests are also difficult to conduct in the pediatric age group leading to apathy from the clinician.To ascertain the prevalence of pediatric vertigo in children under 18 years of age, presenting to the Otolaryngology Clinic of a tertiary care hospital, and to describe the clinical profile, investigations and diagnosis in these children.A prospective cross-sectional, descriptive clinical study was undertaken from January 1, 2018 to April 30, 2019. All children below the age of 18 years presenting to our department with primary complaints of dizziness were included in the study. After a thorough history and physical examination, screening methods and diagnostic tests were conducted to make a diagnosis. Referrals were sought from other specialties when necessary.The number of children visiting the Department for various ENT ailments during the study period was 10,950. Among these 89 children presented with a primary complaint of dizziness. Their ages ranged from 3 to 18 years; mean age was 11.42 years (SD 3.45). A diagnosis was made in all except two children. The most common cause of dizziness in the age group less than 6 years was benign paroxysmal vertigo of childhood (BPVC) and in the older children was migraine associated vertigo, which was also the commonest overall diagnosis made (28.1%). This was followed by circulation related dizziness like orthostatic hypotension and vasovagal syncope (15.7%).The prevalence of pediatric dizziness in children presenting to the Otolaryngology clinic was 0.8%. The diagnosis of pediatric vertigo may be challenging, but careful history and examination along with guided investigations and referrals results in correct diagnosis in almost all patients.

STUDY TO EVALUATE THE ROLE OF LAPAROSCOPY IN CHRONIC ABDOMINAL PAIN

INTRODUCTION : Chronic abdominal pain can be diagnostic challenge. Chronic abdominal pain is a signicant clinical problem that often leads to repeated laparotomies. Laparoscopy has a signicant diagnostic and therapeutic role in patients with chronic abdominal pain. In case of diagnostic uncertainty, laparoscopy may help to avoid unnecessary laparotomy, provide accurate diagnosis and helps to plan surgical treatment. The main function of laparoscopic evaluation is to detect the presence or absence of intra abdominal organic lesion. AIMS AND OBJECTIVES : To determine the diagnostic and therapeutic role of laparoscopy in chronic abdominal pain. MATERIALS AND METHODS : All patients undergoing laparoscopy for chronic abdominal pain were included in the study for a period of 1 year from Nov. 2018 to Oct. 2019 in SHANTIRAM Medical College and General Hospital. The patient's demographic data, length of time with pain, diagnostic studies, intraoperative ndings, interventions and follow-up were determined. INCLUSION CRITERIA: Patients with history of abdominal pain for 3months or more, if physical examination and diagnostic tests are unrevealing. Patients with previous history of abdominal operation are included. RESULTS : A total of 25 patients (19 women and 6 men) with an average age of 34.64yrs underwent diagnostic laparoscopy for the evaluation and treatment of chronic abdominal pain. The average length of time with pain was 32.96 weeks (range 12-96). 2 cases required conversion to an open procedure and no complications occurred. Findings included abdominal Koch's in 9, appendicitis in 8, cholecystitis in 1, cirrhosis in 1; ovarian cyst in 1, bilateral mbrial cyst in 1 and 4 patients had no obvious pathology. 82.6% of patients had pain relief at the time of follow up. CONCLUSION : Laparoscopy has a diagnostic and therapeutic role in patients with chronic pain abdomen

Lower Gastrointestinal Bleeding

Of patients who present with major gastrointestinal (GI) bleeding, 20 to 30% will ultimately be diagnosed with bleeding originating from a lower GI source. Lower GI bleeding has traditionally been defined as bleeding originating from a source distal to the ligament of Treitz; however, with the advent of capsule endoscopy and deep enteroscopy allowing for visualization of the entire small bowel, the definition has been updated to GI bleeding originating from a source distal to the ileocecal valve. Lower GI bleeding can range from occult blood loss to massive bleeding with hemodynamic instability and predominantly affects older individuals, with a mean age at presentation of 63 to 77 years. Comorbid illness, which is a risk factor for mortality from GI bleeding, is also more common with increasing age. Most deaths related to GI bleeding are not due to uncontrolled hemorrhage but exacerbation of underlying comorbidities or nosocomial complications. This review covers the following areas: evaluation of lower GI bleeding (including physical examination and diagnostic tests), initial management, and differential diagnosis. Disorders addressed in the differential diagnosis include diverticulosis, arteriovenous malformations (AVMs), ischemic colitis, anorectal disorders, radiation proctitis, postpolypectomy bleeding, and colorectal neoplasms. Figures show an algorithm for management of patients with suspected lower GI bleeding, tagged red blood cell scans, diverticular bleeding, colonic AVM, ischemic colitis, bleeding hemorrhoid, chronic radiation proctitis, and ileocolonic valve polyp. Tables list descriptive terms for rectal bleeding and suggested location of bleeding, imaging modalities and differential diagnosis for lower GI bleeding, endoscopic techniques for hemostasis, and an internal hemorrhoids grading system. This review contains 8 highly rendered figures, 5 tables, and 100 references.

Feline cutaneous lymphoma: an evaluation of disease presentation and factors affecting response to treatment.

The primary goal of this study was to characterize the clinical presentation of feline cutaneous lymphoma. The secondary aims included determining if treatment or initial response to treatment affected the overall survival of patients, and understanding if disease characteristics such as immunophenotype, cell size or the presence of epitheliotropism influenced response to treatment. Veterinary medical oncologists at four academic veterinary teaching hospitals submitted cases of feline patients with cutaneous lymphoma diagnosed by histopathology or cytology. Signalment, feline leukemia virus (FeLV)/feline immunodeficiency virus (FIV) status, physical examination findings, clinical signs, diagnostic tests, therapy, response and outcome, and necropsy findings, when available, were recorded. Forty-one patients were identified and described. The majority of patients were domestic shorthair cats (n = 29). The median age at diagnosis was 12.3 years. Males were over-represented in the population (n = 30). In the majority of patients (n = 33), the FIV/FeLV status was unknown. Twenty patients were fully staged. Thirty-four patients were treated with a variety of modalities, including surgery, radiation, single-agent or combination chemotherapy, or prednisolone only. In multiple patients, surgery or radiation was combined with a systemic therapy. Of 34 patients treated with some form of therapy, 20 responded (achieving either a partial response or complete remission). Clinical signs and physical examination findings varied among patients. Response to therapy appeared to be associated with survival (P = 0.0025); however, this population was highly censored. Immunophenotype, cell size and the presence of epitheliotropism did not influence treatment response. Results were limited by small numbers of patients, heterogeneous disease manifestations and treatment protocols. Further studies are necessary to evaluate the effect of specific treatment modalities and disease subtype on prognosis.

Synthesis of Environmentally Friendly Silver Nanoparticles

The nanoparticles synthesized by plants and micro-organisms are environmentally safe and do not leave residues or long-term toxic effects in ecosystems or accumulate in the environment and transfer through the food chain. Therefore, the aim of the research is to synthesize silver nanoparticles from the leaves of the oleander plant, where they are environmentally friendly when used for various purposes such as controlling agricultural pests. The results showed that the leaves of this plant have the ability to synthesize silver nanoparticles and this is confirmed by the tests of color change of the plant extract the reaction solution, the color of the solution changed from colorless to pink. Physical diagnostic tests such as absorption using a UV-Visible spectrophotometer at a wavelength of 340 nm, transmission electron microscope (TEM) and X-ray diffraction (XRD) technique have confirmed the formation of AgNPs in the leaves of a plant oleander. Keywords: silver nanoparticles, synthesis, environmentally friendly, physical diagnosis

Prevalence, clinical profile, and diagnosis of pediatric dizziness in a tertiary care hospital

IntroductionPediatric dizziness is an uncommon complaint presenting to the Otolaryngology clinic. While the term dizziness may be used to describe any altered sensation of orientation to the environment which includes presyncope, light-headedness and ataxia, vertigo refers to a false sensation of motion of self or surroundings. Although a variety of etiologies are known to cause dizziness and vertigo, evaluation of this symptom becomes challenging in children who are unable to clearly explain what they experience, the provoking factors, associated symptoms and the duration of attacks. Vestibular tests are also difficult to conduct in the pediatric age group leading to apathy from the clinician. ObjectivesTo ascertain the prevalence of pediatric vertigo in children under 18 years of age, presenting to the Otolaryngology Clinic of a tertiary care hospital, and to describe the clinical profile, investigations and diagnosis in these children. MethodsA prospective cross-sectional, descriptive clinical study was undertaken from January 1, 2018 to April 30, 2019. All children below the age of 18 years presenting to our department with primary complaints of dizziness were included in the study. After a thorough history and physical examination, screening methods and diagnostic tests were conducted to make a diagnosis. Referrals were sought from other specialties when necessary. ResultsThe number of children visiting the Department for various ENT ailments during the study period was 10,950. Among these 89 children presented with a primary complaint of dizziness. Their ages ranged from 3 to 18 years; mean age was 11.42 years (SD 3.45). A diagnosis was made in all except two children. The most common cause of dizziness in the age group less than 6 years was benign paroxysmal vertigo of childhood (BPVC) and in the older children was migraine associated vertigo, which was also the commonest overall diagnosis made (28.1%). This was followed by circulation related dizziness like orthostatic hypotension and vasovagal syncope (15.7%). ConclusionsThe prevalence of pediatric dizziness in children presenting to the Otolaryngology clinic was 0.8%. The diagnosis of pediatric vertigo may be challenging, but careful history and examination along with guided investigations and referrals results in correct diagnosis in almost all patients.

Surgical Management for a Broken Delivery Shaft in <i>Vivo</i> during PCI Following Acute Myocardial Infarction in a Complex LAD Artery Lesion: A Case Report and Literature Review

Stuck up and fracture of coronary angioplasty hardware are unwonted complications of percutaneous coronary interventions (PCI) for which surgical retrieval and management is once in a while required. We present one case of a 59-year-old diabetic, a hypertensive gentleman who attended the emergency room (ER) with central chest pain for 2 hours. After evaluation of the patient by physical and noninvasive diagnostic tests, he was diagnosed as a case of acute myocardial infarction (AMI) with stable hemodynamic. For the aforementioned findings, the patient was treated first with a thrombolytic agent in ER and then shifted to Cardiology Department for monitoring and further coronary evaluation by coronary angiography (CAG). CAG revealed essentially single vessel disease (SVD) with complex left anterior descending (LAD) artery lesion, so PCI was attempted but failed with an unfortunate incidence of the broken delivery shaft and left in vivo. Immediate decision making and surgical management for retrieval of lost angioplasty device and correction coronary lesion with revascularization save the patient from grave complication. All the series of events and management approaches of this very complex coronary artery lesion are discussed in this article.

Lower Gastrointestinal Bleeding

Of patients who present with major gastrointestinal (GI) bleeding, 20 to 30% will ultimately be diagnosed with bleeding originating from a lower GI source. Lower GI bleeding has traditionally been defined as bleeding originating from a source distal to the ligament of Treitz; however, with the advent of capsule endoscopy and deep enteroscopy allowing for visualization of the entire small bowel, the definition has been updated to GI bleeding originating from a source distal to the ileocecal valve. Lower GI bleeding can range from occult blood loss to massive bleeding with hemodynamic instability and predominantly affects older individuals, with a mean age at presentation of 63 to 77 years. Comorbid illness, which is a risk factor for mortality from GI bleeding, is also more common with increasing age. Most deaths related to GI bleeding are not due to uncontrolled hemorrhage but exacerbation of underlying comorbidities or nosocomial complications. This review covers the following areas: evaluation of lower GI bleeding (including physical examination and diagnostic tests), initial management, and differential diagnosis. Disorders addressed in the differential diagnosis include diverticulosis, arteriovenous malformations (AVMs), ischemic colitis, anorectal disorders, radiation proctitis, postpolypectomy bleeding, and colorectal neoplasms. Figures show an algorithm for management of patients with suspected lower GI bleeding, tagged red blood cell scans, diverticular bleeding, colonic AVM, ischemic colitis, bleeding hemorrhoid, chronic radiation proctitis, and ileocolonic valve polyp. Tables list descriptive terms for rectal bleeding and suggested location of bleeding, imaging modalities and differential diagnosis for lower GI bleeding, endoscopic techniques for hemostasis, and an internal hemorrhoids grading system. This review contains 9 figures, 8 tables, and 103 references.

Lower Gastrointestinal Bleeding

Of patients who present with major gastrointestinal (GI) bleeding, 20 to 30% will ultimately be diagnosed with bleeding originating from a lower GI source. Lower GI bleeding has traditionally been defined as bleeding originating from a source distal to the ligament of Treitz; however, with the advent of capsule endoscopy and deep enteroscopy allowing for visualization of the entire small bowel, the definition has been updated to GI bleeding originating from a source distal to the ileocecal valve. Lower GI bleeding can range from occult blood loss to massive bleeding with hemodynamic instability and predominantly affects older individuals, with a mean age at presentation of 63 to 77 years. Comorbid illness, which is a risk factor for mortality from GI bleeding, is also more common with increasing age. Most deaths related to GI bleeding are not due to uncontrolled hemorrhage but exacerbation of underlying comorbidities or nosocomial complications. This review covers the following areas: evaluation of lower GI bleeding (including physical examination and diagnostic tests), initial management, and differential diagnosis. Disorders addressed in the differential diagnosis include diverticulosis, arteriovenous malformations (AVMs), ischemic colitis, anorectal disorders, radiation proctitis, postpolypectomy bleeding, and colorectal neoplasms. Figures show an algorithm for management of patients with suspected lower GI bleeding, tagged red blood cell scans, diverticular bleeding, colonic AVM, ischemic colitis, bleeding hemorrhoid, chronic radiation proctitis, and ileocolonic valve polyp. Tables list descriptive terms for rectal bleeding and suggested location of bleeding, imaging modalities and differential diagnosis for lower GI bleeding, endoscopic techniques for hemostasis, and an internal hemorrhoids grading system. This review contains 9 figures, 8 tables, and 103 references.

Lower Gastrointestinal Bleeding

Of patients who present with major gastrointestinal (GI) bleeding, 20 to 30% will ultimately be diagnosed with bleeding originating from a lower GI source. Lower GI bleeding has traditionally been defined as bleeding originating from a source distal to the ligament of Treitz; however, with the advent of capsule endoscopy and deep enteroscopy allowing for visualization of the entire small bowel, the definition has been updated to GI bleeding originating from a source distal to the ileocecal valve. Lower GI bleeding can range from occult blood loss to massive bleeding with hemodynamic instability and predominantly affects older individuals, with a mean age at presentation of 63 to 77 years. Comorbid illness, which is a risk factor for mortality from GI bleeding, is also more common with increasing age. Most deaths related to GI bleeding are not due to uncontrolled hemorrhage but exacerbation of underlying comorbidities or nosocomial complications. This review covers the following areas: evaluation of lower GI bleeding (including physical examination and diagnostic tests), initial management, and differential diagnosis. Disorders addressed in the differential diagnosis include diverticulosis, arteriovenous malformations (AVMs), ischemic colitis, anorectal disorders, radiation proctitis, postpolypectomy bleeding, and colorectal neoplasms. Figures show an algorithm for management of patients with suspected lower GI bleeding, tagged red blood cell scans, diverticular bleeding, colonic AVM, ischemic colitis, bleeding hemorrhoid, chronic radiation proctitis, and ileocolonic valve polyp. Tables list descriptive terms for rectal bleeding and suggested location of bleeding, imaging modalities and differential diagnosis for lower GI bleeding, endoscopic techniques for hemostasis, and an internal hemorrhoids grading system. This review contains 9 figures, 8 tables, and 103 references.

Anosmia, hyposmia, and dysgeusia as indicators for positive SARS-CoV-2 infection.

Anosmia, hyposmia, and dysgeusia as indicators for positive SARS-CoV-2 infection.

Post-travel screening of symptomatic and asymptomatic travelers.

Until last year, terrorism, economic instability, poverty and natural disasters were considered the major threats to humans globally. Infectious diseases were seen as a minor problem. This, however, changed in 2020 when the global COVID-19 pandemic broke out and a new danger emerged. The latest events generated a lot of discussion on health hazards associated with international tourism and uncontrolled spread of pathogens across the borders. The major health problems of travelers to developing countries with harsh environmental conditions and endemic infectious diseases include gastrointestinal disorders, dermatoses, respiratory infections and fevers of unknown origin. A medical interview by an experienced physician is the foundation of the post-travel screening process both in symptomatic and asymptomatic travelers; the interview should focus on identifying exposure to risk factors (endemic infectious diseases, failure to adopt disease prevention measures, consumption of food or water from unsafe sources, insect bites, animal bites, travelling in large groups, unsafe sex with casual partners). While physical examination (identification of abnormalities) and diagnostic tests (identification of pathogens) can be useful for detecting illnesses and asymptomatic infections as well as assessing the general health condition of a patient, including his immune system. The aim of the article is to provide information on the post-travel screening process in symptomatic and asymptomatic travelers who have returned from areas with harsh climate conditions and low sanitation standards.