Patient Physical Examination Research Articles

Headache production during physical examination in patients with and without headache attributed to a whiplash injury: A case-control study

BackgroundProvocation of headache on physical examination of the neck may reflect a role of cervical structures in the presence of acute whiplash-associated headache (WAH). ObjectiveTo determine differences in headache provocation during physical tests in people with and without WAH after a whiplash injury. DesignCase-control study. MethodsForty-seven people with acute whiplash-associated disorders participated, 28 with WAH. Passive accessory intervertebral movement over the tubercle of C1, the spinous processes of C2-C3 and facet joints of C0-C4, the flexion-rotation test (FRT), manual palpation of cranio-cervical muscles and the upper limb neurodynamic test + cranio-cervical flexion were assessed bilaterally twice by a blinded examiner; headache provocation was determined. Cohen's kappa and Chi-squared were determined to evaluate the intra-rater reliability of test results and differences between groups, respectively. A logistic regression model was also performed. ResultsIntra-rater reliability of headache provocation was good or excellent for most tests. Significant differences between groups were found with higher positive tests in WAH for the assessment of C2 (68%), the most painful side of C0-C1 (57%), C1-C2 (75%) and C2-C3 (53%), most (79%) and least (25%) restricted sides of the FRT, and manual palpation of the most painful side for the trapezius (53%), masseter (50%) and temporalis (46%) muscles. Provocation of headache during the assessment of C2 and C1-C2 on the most painful side demonstrated the highest association with WAH. ConclusionMechanical provocation of headache is more frequent in people with WAH than in those without headache soon after a whiplash injury.

Factors Important to Patients when Making Treatment Decisions for Knee Osteoarthritis.

Patient treatment decisions for knee osteoarthritis (OA) are driven largely by the patient's physical examination and radiograph findings. Because multiple treatment options may be medically appropriate, it is imperative that the patient's voice be considered to better facilitate patient-centered treatment decisions. Concordance between physicians and patients on optimal treatment can vary, with few studies identifying the factors important to patients when making treatment decisions for knee OA. The goal of this analysis is to identify and synthesize subjective factors in the literature found to influence patient decision-making in a presurgical knee OA population, such that physicians and health care teams can become better equipped to help patients realize their specific treatment goals. This review was registered with PROSPERO and conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. A systematic search was completed in four databases for search terms related to knee OA and decision-making. Articles were eligible for inclusion when they discussed (1) patients' thoughts, feelings, goals, and perceptions that factored into treatment deliberation and decision-making; and (2) related to knee OA. Twenty-four articles were identified, 11 qualitative studies and 13 quantitative studies. Synthesis of the included articles revealed three main themes that drive patient treatment decisions: (1) individual catalysts to pursue treatment including pain and mobility limitations, (2) interpersonal factors including social networks and clinician trust, and (3) risks versus benefits assessment including patients' beliefs and expectations. Only a few studies looked at nonoperative treatment decisions, and no studies looked at cohorts considering knee preservation surgeries. This study was completed to synthesize literature related to patient treatment decisions for nonoperative and surgical management of knee OA, finding that patients consider multiple subjective factors when choosing whether to move forward with treatment. Understanding how patients' beliefs determine their preferences for treatment can improve shared decision-making.

Gemcitabine-associated DRESS syndrome: A case report.

Gemcitabine is a well-tolerated pyrimidine antimetabolite chemotherapeutic that is increasingly utilized to treat non-small cell lung carcinoma, breast, pancreatic, and urogenital cancers. Myelosuppression is a common side effect and skin rashes can be observed. We discuss a case of the exceedingly rare DRESS syndrome, which appeared following Gemcitabine treatment. A 60-year-old patient with pancreatic cancer and liver metastases received therapy with Gemcitabine as a single agent. Fever, itching, and redness started to be reported on the third day of receiving Gemcitabine treatment. The patient's diffuse maculopapular rash steadily got worse, leading to hospitalization. In the patient's physical examination, a high fever, hepatomegaly, and a diffuse macular papular rash were detected, an increase in eosinophils in the complete blood count and peripheral blood. A skin biopsy was performed. It was determined that the patient had Gemcitabine-associated DRESS syndrome. Antihistamines and local steroids were administered. On the fifth day following treatment, skin lesions and eosinophilia decreased. The most common cause of DRESS syndrome, a disorder marked by extensive skin eruption, fever, eosinophilia, and systemic symptoms, is medication use. Infections including HHV-6, EBV, and CMV can occasionally be the reason. Gemcitabine is one of the medications that is frequently used in cancer, and a case was provided because the literature review did not mention Gemcitabine-related DRESS syndrome.

The Pros and Cons of Use of Handheld Electronic Devices During Ward Rounds and the Impact of the COVID-19 Pandemic.

The exponential use of handheld electronic devices (HEDs) among healthcare providers has shown the potential to enhance clinical workflows and improve patient care. However, the challenges and risks of carrying these devices during ward rounds and their impact on postgraduate trainees' (PGTs') training in general and more specifically during the COVID-19 pandemic need to be explored. A cross-sectional mixed-methods online survey was conducted to evaluate the perceptions of trainees and faculty at Accreditation Council for Graduate Medical Education International accredited residency and fellowships programs in Qatar on the use of HEDs on clinical workflow, trainees' education, and the impact of the COVID-19 pandemic. One hundred and fifty-eight participants were enrolled in the study (87 postgraduate trainees and 71 faculty). Exploratory data analysis and descriptive statistics were performed using STATA version 12 and thematic analysis of 301 qualitative responses to the survey open-ended questions using Atlas. ti qualitative software, version 9.4.0. Almost all PGTs, 83 (95.4%), and faculty 43 (62.3%) use HEDs during ward rounds. Accessibility of patient information by PGTs 73 (94.8%) and faculty 46 (84.4%) and work efficiency were the main perceived benefits. Hindering communication between team members, disruption of interaction with patients, increased risk of infection and breach of patient confidentiality were among the challenges associated with their use. Carrying devices reduced the frequency of hand hygiene practices and physical examinations of patients by trainees. The COVID-19 pandemic led to a decrease in the use of HEDs by both faculty [38(64%)] and PGTs [42(60%)]. HEDs' use is valued by both faculty and PGTs in enhancing workflow, trainees' education, patient experience, and patient care during the COVID-19 pandemic. Graduate medical education leaders should adopt measures to monitor their use during ward rounds as they can negatively impact trainees' education, reduce interaction with patients, increase the risk of infection, and breach patient confidentiality.

Интерфероны I типа, потребность в глюкокортикостероидах и коморбидность у пациентов с системной красной волчанкой

Background: сomorbidity is one of the factors which considerably reduce life expectancy and affect quality of life of patients with systemic lupus erythematosus (SLE). Interferons (IFNs) are molecules whose changing concentrations may induce the active clinical manifestations of SLE and the increase in risk of comorbidities and their higher severity. The involvement of IFN-α in the development of comorbidities in the adult population of SLE patients may have distinguishing characteristics in cases of childhood-onset SLE and will need further research for better understanding its role. Aim: to assess the relationship between the level of IFN-α and the need for glucocorticosteriods (GCs) and the prevalence of comorbidities in adult SLE patients with different onset ages. Patients and Methods: this non-interventional study included SLE patients (n=71) (SLICC (2012) / EULAR (2019) Criteria) who did not receive genetically engineered biological agents: 43 (60%) patients with SLE onset under the age of 18 years comprised the group of juvenile SLE (jSLE) and 28 (40%) patients with SLE onset at 18 years or older age were included in the group of adult SLE (aSLE). For determining SLE activity during physical examination of patients, the SLEDAI-2K index was used. Serum IFN-α levels were measured by enzyme-linked immunosorbent assay (ELISA). The Charlson comorbidity index (CCI) and the CIRS-G scale were used for assessing comorbidities. Results: in patients with aSLE, serum IFN-α levels were higher and associated with higher GC doses. Also, aSLE patients had higher CCI and CIRS-G scores. As regards comorbid diseases, a statistically significant higher prevalence of peptic (stomach and duodenal) ulcers and menstrual disorders in women was observed. These comorbidities correlated with IFN-α levels. Conclusion: serum IFN-α levels are associated with the use of high GS doses and high CCI and CIRS-G scores, as well as the prevalence of GI diseases and menstrual disorders in women. The anti-interferon therapy seems to be a promising option for reducing "steroid addiction" and related comorbidities. KEYWORDS: systemic lupus erythematosus, interferon, anifrolumab, glucocorticosteroids, comorbidity. FOR CITATION: Aliev D.B., Inamova O.V., Maslyansky A.L. et al. Type I interferon, the need for glucocorticosteroids and comorbidities in patients with systemic lupus erythematosus. Russian Medical Inquiry. 2023;7(3):118–123 (in Russ.). DOI: 10.32364/2587-6821- 2023-7-3-118-123.

A Telephone Triage System for Patients Calling with Symptoms of a Posterior Vitreous Detachment

The purpose of the study was to develop a simple telephone questionnaire, without physical examination input, that predicts which patients calling with symptoms of a posterior vitreous detachment (PVD) have a retinal tear (RT) or rhegmatogenous retinal detachment (RD). Prospective cohort (quality improvement) study. All patients with symptoms consistent with a PVD calling a major academic ophthalmology department over a 4-month period in 2020 and who were seen on follow-up within 1.5 months (211 screened and 193 included). A comprehensive telephone questionnaire assessing for RT/RD risk factors was administered by telephone triage staff to all patients calling with symptoms of flashes, floaters, or curtain/veil in their vision. Multivariable logistic regression was used to determine risk factors most predictive of having an RT/RD during the add-on visit. Risk factor odds ratios were used to develop an RT/RD risk score. Development of a clinical risk score for having an RT/RD at the add-on visit after telephone triage. Approximately 55% of patients were previously established in the retina clinic, 26% were new to the department, 19% were previously established in the comprehensive clinic, and 7% had an RT/RD at the add-on visit. Out of 23 questions and 70 prespecified possible answers from the telephone questionnaire, the final clinical risk score for RT/RDs was derived from 7 questions and 15 possible answers. The simplified questionnaire can be administered quickly by telephone operators without any reference to physical examination or the patient's chart. The receive-operator curve for our final multivariable logistic regression and clinical risk score models have an area under the curve of > 0.90. Using a conservative clinical risk score, approximately 50% of all patients without an RT/RD can be safely seen nonurgently. Progressively higher scores can be used to determine relative urgency of an appointment. To our knowledge, this is the first study to predict risk of an RT/RD in a patient calling with symptoms consistent with a PVD without reference to the patient's physical examination or chart. Our clinical risk scoring system can be used to determine urgency of an add-on appointment and increase the number of low-risk patients with symptomatic PVDs who are scheduled routinely. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Understanding the Female Physical Examination in Patients with Chronic Pelvic and Perineal Pain.

(1) Background: The objective was to compare the exploration of chronic pelvic pain syndrome (CPPS) patients in different locations and establish the role of physical examination in CPPS patients. (2) Methods: We reviewed clinical data from 107 female patients with CPPS unresponsive to conventional therapies at Puerta de Hierro University Hospital Madrid, Spain, from May 2018 to June 2022. Patients were classified into three groups: (a) pelvic pain; (b) anorectal pain; or (c) vulvar/perineal pain. (3) Results: Although the demographics of patients with CPPS were different, their physical examinations were strikingly similar. Our study observed a comorbidity rate of 36% and 79% of central sensitization of pain. Seventy-one percent of patients had vulvar allodynia/hyperalgesia. Pain on examination was identified in any pelvic floor muscle, in any pelvic girdle structure, and neuropathic pain in 98%, 96%, and 89%, respectively. Patients with vulvar and perineal pain were more different from the other groups; these patients were younger and had fewer comorbidities and less central sensitization, less anorectal pain, more pain during intercourse, and greater nulliparity (p = 0.022; p = 0.040; p = 0.048; p = 0.000; p = 0.006; p = 0.005). (4) Conclusions: The findings of this study are related to the understanding of the pathophysiology of CPPS. The physical examination confirms the central sensitization of female patients with CPPS, helps us to determine the therapeutic management of the patient, and can be considered as a prognostic factor of the disease.

Nursing role in early detection of cardiac amyloidosis: a case report

Cardiac amyloidosis (CA) is a rare health condition that occurs due to amyloid deposits in the heart's tissues, it causes restrictive cardiomy-opathy, which leads to heart failure and death. This report discusses a case of 72-year-old Saudi male known case of hypertension, diabetes mullets, left ventricular dysfunction, and chronic kidney dysfunction presented to hospital with shortness of breath, paroxysmal nocturnal dyspnea, and orthopnea. Patient's physical examination revealed jugular vein distention, generalized pitting edema and abdominal distension. Echo image exhibited abnormal myocardial texture with moderate global hypokinesia, left ventricular D shape, and thickened interatrial sep-tum. CA diagnosis is complex, and its diagnostic accuracy is relatively limited. Delay in CA diagnosis continues to challenge clinicians, which has adverse effects on patient's quality of life, and mortality rate. Underdiagnosis mainly because disease has nonspecific symptoms which often associated with poor prognosis. To aid in early diagnosis and treatment, nurses should be aware about symptoms, diagnostic approach, and disease progression of CA.

In Patients Admitted to a Home Rehabilitation Service, Is Remote Completion of the Patient-Generated Subjective Global Assessment Physical Examination Using Still Images Captured by Allied Health Assistants a Valid Alternative to an In-Person Physical Examination?

There is increasing provision of telehealth services, including nutrition services. However, remote nutrition assessments are challenging due to difficulties in conducting physical assessments remotely, a crucial component of assessing nutritional status. The aim of this study was to evaluate whether remote completion of the Patient-Generated Subjective Global Assessment physical examination using still images captured by allied health assistants (AHAs) is a valid alternative to an in-person physical examination in patients admitted to a home rehabilitation service. This study was cross-sectional in design. This study involved 104 adults admitted to the home rehabilitation service at Southern Adelaide Local Health Network, Adelaide, Australia, over 2 sampling periods in 2019 and 2020 who were receiving home visits by an AHA and were engaged in rehabilitation activities. Validity of the still image-based physical assessment was determined using still images collected by an AHA and an in-person physical assessment completed by a dietitian from each participant. A dietitian blinded to the in-person results later assessed the de-identified still images to determine the presence and extent of deficit at each anatomical site and overall physical examination component of the Patient-Generated Subjective Global Assessment. Percentage agreement, weighted κ, sensitivity, and specificity between the still image based and in-person physical examinations were determined to assess agreement between the 2 methods of assessment. The still image based physical examination achieved a percentage agreement of 75% against the in-person examination, with a weighted κ of 0.662 (95% confidence interval 0.516-0.808) and a sensitivity-specificity pair of 76.6% and 89.1%. Physical examination using still images collected by AHAs achieved percentage agreement, κ, and sensitivity and specificity compared with an in-person physical examination that is consistent with or superior to commonly adopted nutrition screening and assessment tools. There is potential for implementation of this method to facilitate remote nutritional assessments by dietitians; however, further work is needed to ensure dietitians are able to assess still images reliably.

Comparison of hip strength in football players with hip and/or groin-related pain and healthy controls

Introduction: Muscle weakness and atrophy have been associated with longstanding joint pathology, and strength testing is often recommended during the physical examination of patients with hip/groin pain. The aim of this study was to compare peak strength in football players (soccer and Australian football) presenting with hip and/or groin-related pain with healthy controls. Methods: Male and female football players were recruited across Melbourne and Brisbane, Australia. Demographic information and two questionnaires; the Copenhagen Hip and Groin Outcome Score (HAGOS) and the International Hip Outcome Tool 33 (iHOT) were collected. Hand-held dynamometry was utilised to test isometric hip muscle strength across flexion, extension, abduction, adduction, internal and external rotation planes. Peak strength (N) and torque (Nm) were normalised to body mass and linear mixed effects models were used to investigate the relationship between strength and symptomatic hips. Results: 191 football players with hip and/or groin-related pain (mean [+/- SD] age, 27.8 ± 6.3 years) and 69 controls (mean [+/- SD] age, 27.3 ± 5.6 years) were include in this study. Of this, 293 symptomatic hips and 138 control hips were used for analyses. Results demonstrated peak adduction (-0.18 Nm/kg: 95% CI -0.27 to -0.08, P 0.001), external rotation (-0.06 Nm/kg: 95% CI -0.09 to -0.02, P 0.003) and internal rotation strength (-0.06 Nm/kg: 95% CI -0.10 to -0.03, P 0.001) were lower in symptomatic hips than control hips. Abduction strength was lower in symptomatic Australian football players hips than controls (-0.20 Nm/kg: 95% CI -0.33 to -0.06, P 0.004) but this was not observed in symptomatic soccer players hips (-0.05 Nm/kg: 95% CI -0.15 to 0.06, P 0.382). No difference was found between peak flexion strength (0.07 Nm/kg: 95% CI -0.15 to 0.01, P 0.103) or peak extension strength (-0.07 Nm/kg: 95% CI -0.18 to 0.05, P 0.249) in symptomatic hips and control hips. Discussion: The findings from this research suggest that hip adduction, internal and external rotation are lower in footballers with hip and/or groin related pain than controls irrespective of the sport played. Hip abduction strength was lower in symptomatic Australian Rules football players but not observed in soccer. Impact:•Findings from this research suggest common impairments are found in hip adduction, internal and external rotation in football players with hip and/or groin related pain than controls regardless of sport played.•Hip abduction strength was lower in symptomatic Australian Rules football players but not observed in soccer. My co-authors and I acknowledge this research was supported by an Australian National Health and Medical Research Council (NHMRC) project grant 1088683.

Point-of-Care Ultrasound (POCUS) as an Extension of the Physical Examination in Patients with Bacteremia or Candidemia.

Background: In general, transthoracic echocardiography (TTE) is the first diagnostic test used for patients with bacteremia or candidemia and clinical signs of Infective Endocarditis (IE). Point-of-care ultrasound (POCUS) may be used in addition to physical examination for the detection of structural heart disease and valve abnormalities. Objective: To determine the diagnostic accuracy of POCUS for the detection of signs suggestive of IE, including vegetation, valvular regurgitation, structural heart disease, hepatomegaly, splenomegaly and septic embolisms, in patients with bacteremia or candidemia. Design: Observational, cross-sectional, multicenter study using convenience sampling. Setting: Six Spanish academic hospitals. Patients: Adult patients with bacteremia or candidemia between 1 February 2018 and 31 December 2020. Measurements: The reference test, to evaluate vegetation, valvular regurgitation and structural heart disease, was transesophageal echocardiography (TEE). For patients who did not undergo TEE, transthoracic echocardiography (TTE) was considered the reference test. POCUS was performed by internists, while conventional echocardiography procedures were performed by cardiologists. Results: In 258 patients, for the detection of valvular vegetation, POCUS had sensitivity, specificity, and positive and negative predictive values of 77%, 94%, 82% and 92%, respectively. For valvular regurgitation (more than mild), sensitivity was ≥76% and specificity ≥85%. Sensitivity values for the detection of hepatomegaly and splenomegaly were 92% and 92%, respectively, while those for specificity were 96% and 98%. Conclusion: POCUS could be a valuable tool, as a complement to physical examination, at the hospital bedside for patients with bacteremia or candidemia, helping to identify signs suggestive of IE.

Acute Kidney Injury in a Patient with Darifenacine Overdose

Introduction:Darifenacin is a medication that has anticholinergic and antimuscarinic effects and is used in the treatment of overactive bladder.Adverse and overdose effects of the medication such as dry mouth and eyes,headache,nausea, constipation, urinary retention, and dyspepsia have been reported .An overdose effect on AKI has not been reported in the literature, and no dose adjustment is recommended in patients with renal impairment
 Case:A 24-year-old male patient applied to the emergency department with a declaration of taking 25 drugs containing darifenacin active ingredient for suicidal purposes.The patient had complaints of nausea and difficulty urinating.The patient's physical examination was normal.In laboratory, creatinine was 2.09mg/dL, and hemoglobi (+++) and protein(++) were found in urine test.Renal USG revealed a grade 1-2 increase in echogenicity of both kidneys.The patient was followed up with intravenous fluid replacement therapy, and the patient whose creatinine levels regressed was discharged with the recommendation of nephrology outpatient control.
 Conclusion:Any molecule taken in overdose can cause AKI via ATN should not be ignored by emergency physicians.The fact that such a side effect or undesirable situation has not been reported with Darifenacin so far doesn’t mean that the molecule is safe for this situation.An overdose of Darifenacin may cause AKI in patients.

Double Trouble – Synchronous Primary Malignant Neoplasms: A Case Report

Synchronous primary malignancy (SPM) is rare. We herein present a case of gastric carcinoma (GC) and renal cell carcinoma (RCC) to highlight the fact that the occurrence of RCC as a synchronous tumor along with GC is rare and that a high index of suspicion of SPM should be considered before declaring it as a metastasis. A 60-year-old male presented with abdominal pain and vomiting for 4 months, and a mass was incidentally found in the lumbar region. The patient was diagnosed with SPM of the GC and RCC. Chemotherapy was given, followed by total gastrectomy; radical nephrectomy was performed. The patient is currently on follow-up. Complete history taking and thorough physical examination of patients with malignancy is instrumental in ruling out metastasis and other synchronous lesions, especially in GC. Synchronous malignancies should be treated with the multidisciplinary team, as there is no consensus in the treatment protocol

Maximizing Opportunities for Anatomy Learning: Use of Authentic OSPE as Part of Assessment in Anatomy

In the care of patients, a practicing physician performs a selected and integrated set of individually skillful acts that are pertinent to each patient encounter. These include, for example, engaging the patient in a professional relationship, taking a clinical history, performing a mental and physical examination, performing, or initiating clinical tests or procedures, and undertaking diagnostic and therapeutic interventions. From an analytic perspective, these component acts of medical care reflect the generic competencies which comprise the practitioner’s basic clinical method1.Skill learning requires the demonstration of skill proficiency that must be observable. This observation is necessary to evaluate performance. Moreover, learners need repeated and deliberate practice followed by constructive feedback to continually refine and improve their performance of the skill. Therefore, the evaluation of skill proficiency requires the direct involvement of a trained observer, such as a supervising expert or an experienced patient2.The utility or value of assessment items (question used in an examination) depends on; their validity, reliability, educational impact, cost, and acceptability3. For instance, a written examination item had good value and utility if it tests learning in the knowledge domain. In the same way, a written examination item has poor utility if used for testing psychomotor skills.The so‐called OSPE (Objective Structured Practical Examination) has its origins in physiology4 where competence in performing physiological tests (e.g. Rinne’s test) are examined through observation by an examiner using a structured checklist (similar to Objective Structured Clinical Examination, OSCE). Within the context of medical education, an activity could be regarded as a clinical skill if it satisfies three conditions namely, the activity must be demonstrable, observable, and employs using knowledge, psychomotor and attitude components of learning (Fig 1).Anatomy learning in medical education underpins the development of clinical reasoning, understanding of medical imaging, the basis of clinical procedures, and physical examination of patients. An authentic utilization of the concept of OSPE in anatomy education should be in the context of evaluating a true skill competence. This will include evaluating competence in physical examination and/or clinical procedural skill (Fig 2). In current undergraduate medical education, these skills and more are now part of a comprehensive and integrated clinical skills curriculum.References AAMC, (2005). Recommendations for Clinical Skills Curricula for Undergraduate Medical Education. Association of American Medical Colleges. Duvivier et al. (2011) BMC Medical Education 11:101 Van der Vleuten CPM, (1996). Advances in Health Sciences Education 1 (1), 41‐67 Nayar U et al. (1986). Med Educ 20 (3):204‐9

An Unusual Cause of Sudden Bilateral Lower Extremity Weakness.

Acute bilateral quadriceps tendon rupture is a musculoskeletal injury that requires urgent orthopedic surgical evaluation. Bilateral quadriceps tendon rupture is exceptionally rare, yet a missed diagnosis can result in long-term disability for the patient. This article presents a patient's case including the history, physical examination, key imaging findings, and management. This article emphasizes the importance of a detailed physical examination in patients presenting with musculoskeletal complaints as well as maintaining a broad differential diagnosis, which will assist the advanced practice provider in recognizing both the common and rare diagnoses in the emergency department.

Senses of Touch: The Absence and Presence of Touch in Health Care Encounters of Patients with Mental Illness.

Touch is a fundamental sense and the most unexplored of the five senses, despite its significance for everything we do in relation to ourselves and others. Studies have shown that touch generates trust, care and comfort and is essential for constituting the body. Based on ethnographic fieldwork, this study explores the absence and presence of touch in interactions between people with mental illness and professionals, in health care encounters with general practitioners, neurologists and physiotherapists, as well as masseurs. We found that touch and physical examination of patients with mental illness is absent in health care encounters, leaving the patients with feelings of being out of place, misunderstood, less socially approved and less worthy of trust. Drawing on Honneth and Guenther, we conclude that touch and being touched is an essential dimension of recognition-both of the patients' bodily sensations and symptoms and of them as human beings, detached from the psychiatric label-as well as contributing to the constitution of self and personhood. These findings confirm that touch works as an existential hinge that affirms a connection between the patient, the body and others and gives a sense of time, space and existence.

Fontan-associated liver disease.

Fontan-associated liver disease.

Echocardiographic assessment of pulse wave velocity in psoriatic patients with and without psoriatic arthritis

Abstract Funding Acknowledgements Type of funding sources: None. Background Psoriasis (PSO) is an inflammatory disorder which in its more severe form affects cardiovascular system (CVS) leading to more rapid atherosclerosis progression. Moreover, some data suggested that the presence of psoriatic arthritis (PSA) may further increase CVS deterioration. Purpose Our aim was to compare the pulse wave velocity (PWV) between psoriatic patients without and with psoriatic arthritis (PSA 0 and 1 group, respectively). Methods We examined 31 consecutive patients (20 males and 11 females) with moderate to severe PSO taking systemic anti-inflammatory medications (TNF-alpha inhibitor, IL-17 inhibitor, IL-23 inhibitor or IL12/23 inhibitor) with transthoracic echocardiography with the evaluation of PWV The group was divided into two 17 patients without PSA (PSA 0) and 14 with concomitant PSA (PSA 1). To achieve PWV value the time from R wave in ECG to the onset of arterial flow was measured respectively in carotid (T1) and femoral artery (T2) with further calculation of time difference (delta T). The distance between supraclavicular area and groin was measured during physical examination of patient. PVW was expressed as the ratio between assessed distance (in meters) and time difference (in seconds). Results Patients with psoriatic arthritis (PSA 1) had more frequently hypertension and higher BMI but did not differ significantly from the group without joints involvement regarding other demographics, risk factors and basic echocardiographic data. They also showed similar PSO severity as assessed with PASI score, see Table. The PWV assessment was feasible in all patients and the respective mean values achieved 9.2 ± 3.7 m/s in PSA 0 vs 10 ± 2.8 m/s in PSA 1 group, p = ns. Both T1 and T2 correlated significantly with duration of PSO, see Figure, and even better with patient’s age r = -0.61, p = 0.0003 for T1 and r = -0.77, p < 0.0001 for T2, whereas PWV correlated significantly only with patient’s age. In the model of 12 variables only older age was the independent predictor of PWV >10 m/s in multivariate logistic analysis, OR 1.08 95% CI 1.003- 1.165. Conclusions Patients with PSA showed tendency to the higher prevalence of obesity and hypertension when compared with patients with skin PSO only. Measurement of PWV during echocardiography or even more simple times to flow spectrum onset in carotid or femoral arteries provided quantitative parameters reflecting cardiovascular impairment in PSO and PSA. Abstract Table. Group comparison. Abstract Figure. PSO duration, T1, T2 and PVW.

Similar but different: A comparison of rare site ectopic pregnancies.

A comparative examination of the clinical, laboratory, ultrasound findings, and operative characteristics of rare site located ectopic pregnancies. Retrospective analysis of all department cases of rare site located ectopic pregnancies diagnosed and treated from December 2006 to December 2019. Thirty rare ectopic pregnancies were identified. Of these, 11 were ovarian, 10 were interstitial and 9 were tubal stump. The patients treated for ovarian pregnancy had significantly lower human chorionic gonadotropin (hCG) levels than patients treated for interstitial or stump pregnancies (2025±1105 mIU/ml, 18,424±2579 mIU/ml and 11,204±9221 mIU/ml, respectively, p=0.003). The main presenting symptom in patients with an ovarian pregnancy was abdominal pain (90.9%, 60.0% and 44.4%, respectively, p=0.031). Signs of abdominal peritoneal irritation (i.e., rebound tenderness and guarding) were more frequent upon physical examination in patients with an ovarian pregnancy (72.2%, 30.0% and 22.2%, respectively, p=0.044) who also exhibited the highest rates of syncope and hypovolemic shock upon admission compared to patients with an interstitial or stump pregnancy (54.5%, 10.0% and 11.1%, respectively, p=0.031). Ovarian pregnancies were associated with the lowest sonographic detection rates (9.1%, 80.0% and 100%, respectively, p=0.0001) and with free fluid in the pouch of Douglas (72.7%, 20.0% and 22.2%, respectively, p=0.02). Ovarian pregnancies experienced the highest rupture rate during surgery compared to interstitial or stump pregnancies (66.9%, 16.7% and 44.4%, respectively, p=0.028), had a significantly higher estimated blood loss (1081±647ml, 760±597ml and 343±318ml, respectively, p=0.003) and required blood transfusions in the perioperative period (63.6%, 20.0% and 11.1%, respectively, p=0.025) significantly more often. Ovarian pregnancy remains the most challenging diagnosis compared to interstitial and tubal stump ectopic's. Health care providers should recognize these rare site ectopic pregnancies and to handle these gynecological emergencies promptly.

The prevalence of scapular dyskinesia in patients with back, neck, and shoulder pain and the effect of this combination on pain and muscle shortness.

The aim of the study was to evaluate the prevalence of scapular dyskinesia in patients with neck, back, and shoul-der pain and examine the variations in clinical parameters cause by this combination. A total of 121 patients with neck, back, or shoulder pain were included in this prospective cross-sectional study. De-mographic and clinical data of the patients were recorded. It was evaluated the intensity of pain with the visual analog scale (VAS), the presence of muscle shortness with muscle shortness tests, and scapular dyskinesia with the Lateral Scapular Slide Test. The prevalence of scapular dyskinesia was 41.9% in the study population. Patients were divided into groups, with or without scapular dyskinesia for evaluation, and compared. The presence of scapular dyskinesia was significantly higher in pa-tients with back and shoulder pain (p<0.05). When the distribution of scapular dyskinesia pathological types was evaluated, it was found that Type 1 was the most common in the study population. No significant difference was observed in pain intensity at rest and during activity between the groups (p>0.05), but the VAS score at night was significantly higher in patients with scapular dyskinesia (p<0.05). The pectoral, latissimus dorsi, and rhomboids muscle shortness were significantly higher in the group with scapular dyskinesia (p<0.05). The evaluation of the presence of scapular dyskinesia in a physical examination in patients with neck, back, and/or shoulder pain will be a guide for the diagnosis and treatment of pain-related problems.