Typical Complaints Research Articles

Rank correlation between atopic comorbidity and laboratory parameters in allergic rhinitis

One of the current cutting-edge problems in allergy and ENT is the study of comorbidity in allergic rhinitis, which is the most common atopic disease among all other atopies. Two decades ago, a new endotype of the disease, local allergic rhinitis, was discovered. In the past, some patients with typical complaints of chronic nasal congestion, persistent runny nose, and other similar symptoms, did not display such characteristic diagnostic criteria as positive allergy skin tests and an increased value of serum total IgE and specific IgE antibodies. They were qualified by allergists and ENT specialists as individualists with non-allergic rhinitis and, accordingly, did not receive adequate treatment. However, their symptoms remained, prompting them to abuse decongestants and resulting in an increased burden on the cardiovascular system. This, along with the burden of concomitant pathology, including other atopies, can be considered a significant medical and social problem. With the purpose to study rank correlation between comorbidity and three laboratory biomarkers, 46 patients with allergic rhinitis were examined. The list of parameters included two routine items such as serum total IgE and eosinophilic cationic protein, and rarely studied IL-4 in skin exudate. Clinical analysis showed that significantly more often allergic rhinitis in patients was combined with bronchial asthma (in 39.1%, p 0.05), less often with food allergy (in 19.6%), atopic dermatitis (in 10.9%), insect allergy (in 8.7%), and allergic urticaria (in 4.5%). In one case, local perennial rhinitis was identified, accompanied by conventional seasonal rhinitis with a high content of serum total IgE and positive allergic skin tests with pollen allergens. Skin tests with household allergens, including house dust mite products, showed a negative result. This case was regarded as a manifestation of the so-called “double” allergic rhinitis. The Spearman correlation demonstrated a negative mean strength relationship between comorbidity and serum IgE and eosinophilic cationic protein (p 0.05). The seemingly paradoxical result can be interpreted quite logically, taking into account immunopathogenetic mechanisms of allergic inflammation. In particular, with an increase in the frequency of atopic comorbidity, the migration of eosinophils from the blood to sites of eosinophilic inflammation increases.

Central Hypothyroidism Associated With Empty Sella: Literature Review and Case Report

Empty Sella Syndrome (ESS) is a rare case of sella turcica malformation, resulting in pituitary gland decrease. It may reveal itself through neurological symptoms, endocrine disorders, visual disturbances or incidental findings during imaging. The urgency of this problem has increased with the widespread use in the diagnosis of the non-invasive method of magnetic resonance imaging (MRI). It can be discovered as part of the investigation of the pituitary disorders, or as an incidental finding when imaging the brain. Practice shows that such patients rarely come with typical complaints thus an extended review of this case is needed to prompt suspicion and aid in the diagnosis of ESS. Few cases of empty sella associated with isolated thyroid-stimulating hormone (TSH) deficiency were published. We report a case of a 46 year-old woman with complaints: edema, dizziness, low blood pressure, hair loss, dry skin. Examinations were performed: ultrasound of the thyroid gland, TSH, FT4 (free thyroxine), FT3 (free triiodothyronine), anti TPO (Antibodies to thyroid peroxidase). Conclusion: patients with TSH, FT4, and FT3 deficiency, should undergo examinations to exclude empty sella as one of the reason of central hypothyroidism. According to the above mentioned the recommendation is to examine all the tropic hormones of the pituitary gland after diagnosing empty sella. Diagnosing central hypothyroidism associated with empty sella helps improving the knowledge and points to different clinical manifestation of empty sella syndrome.

Pneumatosis cystoides intestinalis in granulomatosis with polyangiitis: a case report.

This study aims to investigate the clinical manifestations, imaging features, and treatment considerations in the rare occurrence of pneumatosis cystoides intestinalis (PCI) within the context of granulomatosis with polyangiitis (GPA). We present the case of a 71-year-old Chinese woman diagnosed with GPA, who, despite exhibiting fatigue, knee pain, and nasosinusitis, remained asymptomatic for PCI. Regular follow-up revealed laboratory and imaging evidence indicative of clinical relapse. The patient received GPA treatment but was not specifically managed for PCI. Serial abdominal CT scans were performed to monitor the progression of PCI. Radiological diagnosis confirmed the presence of gas within the colon wall, indicating pneumatosis cystoides intestinalis. Notably, the patient remained asymptomatic for abdominal complaints. Despite ongoing GPA treatment, a follow-up CT scan 2months later revealed persistent gas within the colon wall, suggesting a persistent state of PCI. Patient consent was obtained for the publication of this case report, and ethical approval was not obtained as this study constitutes a retrospective review. This case underscores the importance of recognizing pneumatosis cystoides intestinalis as a potential complication in GPA patients, even in the absence of typical abdominal symptoms. Further research is warranted to elucidate the underlying mechanisms and optimal management strategies for this rare association. Key points • Rare association: This case report sheds light on the uncommon occurrence of pneumatosis cystoides intestinalis (PCI) within the context of granulomatosis with polyangiitis (GPA), adding to the understanding of the spectrum of manifestations of GPA. • Clinical manifestations: Despite being diagnosed with GPA and experiencing symptoms such as fatigue, knee pain, and nasosinusitis, the patient remained asymptomatic for PCI, emphasizing the importance of vigilant clinical monitoring in GPA patients. • Imaging features: Radiological imaging, including serial abdominal CT scans, played a crucial role in diagnosing and monitoring the progression of PCI in the absence of typical abdominal complaints, highlighting the utility of imaging modalities in detecting silent manifestations of gastrointestinal complications in GPA. • Treatment considerations: The case highlights the challenge of managing PCI in GPA patients, especially when asymptomatic, and raises questions about the optimal management strategies for such rare associations, underscoring the need for further research in this area.

Morton's Metatarsalgia: The Current State of the Issue

A typical complaint with Morton's neuroma is a burning paroxysmal pain in the area of the plantar surface of the metatarsal bones with irradiation into the III interdigital space, which forces the patient to take off his shoes and massage the foot in the most inappropriate situations. Given that women are mostly ill, clinical manifestations reduce the quality of life of patients, limit their daily professional and work activities. The paper presents the etiology, pathogenesis and clinical picture of this disease, diagnostic features. A radical method of treatment is surgery, which is relatively simple in technique and consists in dissecting the tissues that compress the nerve and creating optimal conditions for the nerve trunk, preventing its subsequent traumatization.

Prevalence of neck pain in higher secondary students (8th to 12th standard) due to e-learning during the COVID-19 pandemic period: An online survey

IntroductionNeck pain is a typical complaint among people who spend a lot of time on their devices. Due to the pandemic situation, students have recently shifted their studies from the classroom to e-learning, causing them to spend excessive hours on gadgets. Thus, it is of utmost importance to study the prevalence of neck pain in students using gadgets for e-learning. The purpose of this research was to study the prevalence of neck pain in higher secondary students using electronic gadgets for e-learning during the COVID-19 (coronavirus disease 2019) pandemic period. MethodA survey-based study was carried out on 1007 students from 8th to 12th grade. Data was collected via Google Form and analyzed using SPSS software. Mann Whitney-U test and the Kruskal Wallis test were used for a comparative analysis. ResultsIn this study, a total of 1007 students participated, out of whom 615 reported experiencing neck pain. Of those experiencing neck pain, 268 were males and 347 were females, with mean pain intensities of 4.64 and 4.77 respectively. ConclusionThe findings of the present study suggest that the prevalence of neck pain is higher in students using gadgets for e-learning.

Sigmoid volvulus during pregnancy: A case report and literature review

Background: Sigmoid during in pregnancy is the most common cause of intestinal obstruction. Despitethis, diagnosis remains the largest challenge. The diagnosis of sigmoid volvulus in pregnancy is oftendelayed because the symptoms mimic typical pregnancy-associated complaints. Clinical examination isusually limited because of the gravid uterus, and radiological evaluation presents another challengebecause of the risks of teratogenicity to the fetus, especially in the first trimester. Delays in diagnosisinvariably lead to ischemia, necrosis, and colon perforation, and prompt surgical intervention isnecessary to minimize maternal morbidity and fetal mortality.Case presentation: A 36-year-old para 4+0 gravida 5 presented initially at 29+1 weeks of gestation withabdominal symptoms. A diagnosis of acute gastritis and pyelonephritis was made, and the patient wasallowed home. She later presented with severe abdominal pain and vomiting, after which a diagnosis ofsigmoid volvulus was made at 30+5 weeks of gestation. The patient underwent laparotomy where thevolvulus was detorted. However, she experienced fetal demise in utero two days after the laparotomy.She was induced into labor and expelled the fetus.Conclusion: Sigmoid volvulus complicating pregnancy is rare. However, when it occurs, it may lead toconsiderable maternal and fetal morbidity and mortality. In patients who present with abdominal pain,distension, and absolute constipation, a high index of clinical suspicion is required for prompt diagnosis.Early diagnosis and appropriate surgical intervention are crucial to improve maternal and fetal outcomes,as shown in this case.

The The Effect of Benson Relaxation on the Chest Pain Scale of Unstable Angina Pectoris (UAP) Patients in the HCU Ward of Bali Royal General Hospital

ABSTRACT
 Unstable angina pectoris has a typical chest pain complaint caused by a blockage of the coronary arteries which cause oxygen cannot be supplied to the myocardial cells resulting in anaerobic metabolism causing an accumulation of lactic acid which causes chest pain. One of the non-pharmacological therapies as supportive therapy can help the performance of gold standard therapy to reduce pain felt by Benson relaxation patients. The purpose of this study was to determine the effect of benson relaxation.This study used a quasy experimental design with a pre-post test design with control group design. This study involved 30 respondents, namely 15 respondents in the intervention group who were given Benson medication and relaxation and 15 respondents in the control group who were given medication only using a purposive sampling technique and measuring instruments used the Visual Analogue Scale before and after the intervention.The results showed that the pain scale in the intervention group before being given Benson relaxation was mostly moderate pain (60%), in the control group (73.3%) experienced moderate pain. The pain scale in the intervention group after being given Benson relaxation was mostly mild pain (93.3%), whereas in the control group (73.3%) experienced moderate pain. There was an effect of Benson's relaxation on the chest pain scale of Unstable Angina Pectoris patients with a p value = 0.001 <0.05. It is recommended that giving Benson relaxation be used as a standard for non-pharmacological pain management for patients with unstable angina pectoris.

Assessment of Prevalence and Causative Factors for Replacement of Composite and Amalgam Restorations: An Observational Study

ABSTRACT Aim: This study intends to evaluate the frequency and causes of replacement for failed amalgam and composite dental restorations. Methodology: A cross-sectional study comprising female patients with failed permanent composite and amalgam restorations aged 15–60 years old was carried out at the dental clinics of Qassim University. Using a self-structured proforma, demographic data and causes for restoration failure were recorded. The effectiveness of the restorations was assessed by using the Ryge criteria after performing clinical and radiographic examinations. The Statistical Package for Social Science was used for the statistical analysis. Results: It is found that 84.6% of the 299 unsuccessful restorations examined were composite, and 15.4% were amalgam. The main reason for dental failure for both amalgam (95.6%) and composite (93.28%) restorations was secondary caries. Failure of amalgam restoration was largely caused by poor marginal adaptation. With varied incidences between amalgam and composite restorations, typical complaints included discomfort, sensitivity, pain, and food impaction with soreness. The main justification for replacement in amalgam restorations was sensitivity. Repair and replacement rates were similar for amalgam, composite, and mandibular/maxillary restorations. Moreover, 21.1% of individuals overall reported no symptoms, with 8.7% in the amalgam group and 23.3% in the composite group with significant differences (χ 2 = 34.28, P = 0.001). Conclusion: According to the current study, secondary caries was found to be the main reason for both amalgam and composite restoration failure. The main problems reported were sensitivity, discomfort, and pain with amalgam showing more sensitivity-related failures.

P-36 Hidden cause of decreased fertility rate during Grave's disease

Abstract Introduction Thyroid autoimmune disorders interfere with the physiology of reproduction, cause premature ovarianfailure, and mimic the early stage of menopause. Recently, no specific research was made to measure Grave's disease and infertility rates in young patients. Clinical Case Due to an inability to conceive for two years, a 24-year-old Caucasian female was referred to the clinic with typical symptoms and complaints of Grave's disease. She has a family history of Grave's disease and Diabetes mellitus. Ultrasound confirmed the presence of a highly vascularized non-homogeneous hyperplastic thyroid gland. A thyroid scan with Tc99m revealed generalized increased uptake. Laboratory investigations showed a decrease in TSH-!0.005mIU/ml (n.0.4mIU/ml - 4.0mIU/ml), elevated FT4-31.8 pmol/l (n.8.0pmol/l-22.0pmol/l), FT3- 9.69pmol/l (n3.4 pmol/l-6.76pmol/l) and positive Anti-TG -190.05 AU/ml (n>150), Anti-TPO - 75.7 IU/ml (n>75) Anti-TSHR-27.3 IU/l (n>1,5). Prolactin and gonadal hormones were within normal limits AMH - 1.8 ng/ml(n1.52ng/ml-9.95ng/ml), Fsh- 6mIU/ml(n3.9mIU/ml-12.4mIU/ml). The patient was started on Methimazole and Beta-blocker. While decreasing the Methimazole dosage for further discontinuation, disease recurrence developed, and a total thyroidectomy was performed. Post- operatively, the patient was maintained on Levothyroxine. After 6 months of follow-up due to irregular Levothyroxine intake, the patient reached a hypothyroid status, during which, the patient had 2 consecutive spontaneous pregnancies, from which, one ended with spontaneous miscarriage in the early weeks of pregnancy and another, ectopic pregnancy treated with right salpingectomy. HSG confirmed weak left fallopian tube patency. After several months of keeping TSH below 2.5 mIU/ml, IVF treatment was scheduled. The results of the infertility workup showed a decrease in ovarian reserve AMH - 0.163ng/ml (n1.52ng/ml-9.95ng/ml), Fsh-16.23 mIU/ml(n3.9mIU/ml- 12.4mIU/ml), due to it, modified natural cycle IVF was performed. She received 2 oocytes and 2 embryos. One high-grade blastocyst was transferred in a fresh cycle that ended with pregnancy and delivery. The child was born without a genetic disorder but with natal teeth. Conclusion This is a rare case of infertility with diminished ovarian reserve due to Grave's disease. A pregnancy was reached by proper correction of thyroid hormonal parameters and modified natural cycle IVF. It indicates a possible need for close monitoring of the functional ovarian reserve in patients planning pregnancy even at the young age group.

An unusual case of tubercular liver abscess presenting as pericardial effusion

Tropical nations like India frequently have liver abscess. They are typically amoebic or pyogenic abscesses. It can sporadically be a sign of hepatic tuberculosis (TB). Hepatic tuberculosis should be suspected in cases where the patient doesn’t present with typical complaints of pyogenic/amoebic abscess without response to commonly used antibiotics. Pyogenic/amoebic liver abscesses show the rare complication of rupture into the pericardium, especially if the abscess is left sided. However, a tubercular pericardial effusion presenting with rupture into the pericardium has rarely been reported. We present to you a case of tubercular pericardial effusion in a known diabetic patient secondary to ruptured liver abscess presenting to the emergency department with chief complaints of breathlessness, chest pain and bilateral pedal edema.

Impact of cognitive stimulation on the autonomy of a patient with early‐onset AD

AbstractThe relevance of non‐pharmacological cognitive stimulation treatments in patients with MCI and AD is increasingly recognized as tools for slowing the progression of the disease and preserving autonomy. However, the registration and quantification of the impact is diffcult to consign.The objective of the present work is to present the case of a 59 year old woman, with early onset AD who is undergoing cognitive stimulation treatment and its evolution in cognitive and functional performance.Initially he presented with typical subjective memory complaint, he obtained a score of 25/30 in MMSE and a CDR of 1. An 18F‐FDG study was performed that showed the typical hypometabolism pattern and a positive 11C‐PIB PET/CT for cortical amyloid deposits. On functionality scales, he scored 100 on the Barthel index and 8 on the Lawton and Brody scale. He underwent cognitive stimulation treatment, from that moment and uninterruptedly, through biweekly sessions of 45‐60 minutes each. It currently has a CDR of 2 and an MMSE of 15/30. In relation to its functionality, it presents a Barthel Index of 100/100 and a Lawton and Brody scale of 4/8.Although the inevitable progression of the disease has an evident impact on cognitive functions, which is clearly reflected in the neuropsychological tests, the functionality of the patient has been fully maintained for basic activities of daily living, and partially for activities instrumentals. This demonstrates the relevance of personalized cognitive stimulation treatments in patients with Alzheimer’s disease, especially in forms of early presentation, when the disease is more aggressive and when patients are very active at the time of diagnosis.

Сучасне розуміння етіопатогенезу гастроезофагеальної рефлюксної хвороби: висвітлення ключових аспектів та перспектив

Gastroesophageal reflux disease (GERD) is one of the most common diseases among gastroenterological pathologies. The relevance of GERD is due not only to medical aspects, but also to economic ones, since the vast majority of patients are young working-age people. The prevalence of GERD ranges from 20% to 30% of the adult population. GERD is associated with a significant decrease in quality of life and the development of Baretta’s esophagus and esophageal adenocarcinoma. GERD is a chronic disease with spontaneous repetitive spillage of gastric or duodenal-gastric contents into the esophagus, with typical complaints of heartburn and regurgitation. The pathogenesis is complex and includes the following aspects: decreased tone of the lower esophageal sphincter, diaphragmatic hernia, impaired protective function of the esophageal mucosa and esophageal motility, and increased intra-abdominal pressure. Obesity plays a significant pathogenetic role in the development of GERD. Weight loss is associated with symptom relief and a reduced risk of complications. Diagnosis of GERD is based primarily on typical clinical symptoms and empirical trial therapy with PPI. Treatment includes lifestyle changes, medications, and surgery. Еndoscopy and pH monitoring additionally contribute to the correct diagnosis. Further research on pathogenetic mechanisms is needed to implement effective strategies for diagnosis, treatment and prevention of complications.

Elastofibroma: a literature review and clinical case

Elastofibroma is a rare, slow growing, benign soft tissue tumor characterized by a typical location in the subscapularis. It has a mesenchymal origin and consists of proliferating fibrous and adipose tissue with elastic and collagen fibers in its composition. Pain and discomfort in the subscapular region, restriction on movement are typical complaints for patients with elastofibroma, however, the absence of clinical symptoms and difficult differential diagnosis make it difficult to choose treatment tactics. A 70-year-old patient applied to a surgeon at the Clinical Diagnostic Center of the Central Clinical Hospital of St Alexis with complaints of a painless tumor-like subcutaneous mass in the region of the lower angle of the right scapula. She noted the presence of this formation 5 years ago, during this time the tumor gradually grew. When viewed on the back along the lower edge of the right shoulder blade, a volumetric tumor-like formation in the form of a ball measuring 7.5 × 6.0 × 2.0 cm, soft-elastic consistency is determined. On palpation, painless, not soldered to the skin. The skin over the formation is not changed. A preliminary diagnosis was established lipoma of the back. The diagnosis of elastofibroma was established after ultrasound of the posterior chest wall, MSCT of the chest. For differential diagnosis, the puncture biopsy material was sent for histological examination, the result of which confirmed the diagnosis of elastofibroma. Observational tactics in this case is preferable, since elastofibroma is not accompanied by pain, limitation of mobility, and does not bring discomfort when moving. Thus, at the moment, imaging methods allow establishing an accurate diagnosis, but histological examination is necessary for differential diagnosis. However, a histologically confirmed diagnosis will not always be an indication for surgery. In most cases, in the absence of clinical manifestations, observational tactics are followed in the treatment.

Quality of life in lumbar spinal stenosis: Does it correlate with magnetic resonance imaging and spinopelvic parameters?

PurposeDegenerative lumbar spinal stenosis (LSS) is a common degenerative spinal disorder with debilitating symptoms that can impact quality of life (QoL). However, the anatomical basis for typical complaints has been poorly quantified. This study aims to correlate QoL assessments of patients with LSS with radiographic spinopelvic parameters and magnetic resonance imaging (MRI) measurements. MethodsWe screened 371 patients hospitalized for LSS and excluded those with a history of spine surgery. Ultimately, we analyzed the data of 34 patients retrospectively. Two independent members of our research group evaluated the alignment parameters on preoperative spinal radiographs, MRI, and classified the images according to the Pfirrmann grading. The spinopelvic alignment was then compared with the clinical QoL scores Core Outcome Measures Index (COMI) and the Oswestry Disability Index (ODI) as collected by the Spine Tango registry. In addition, the interobserver reliability was analyzed. ResultsThe individual MRI measurements correlated significantly. This correlation could not be found when compared with the spinopelvic parameters on radiographs. Neither the COMI nor the ODI scores showed a significant correlation with the MRI or radiographic imaging. ConclusionsThe severity of LSS related disability according to QoL questionnaires could not be quantified by any MRI or spinopelvic parameter that was measured. There was also no correlation of the MRI and spinopelvic parameters among themselves. Consequently, treatment recommendations for symptomatic LSS should never be based on radiological data only.

FRI558 Hidden Cause Of Decreased Fertility Rate During Grave’s Disease

Abstract Disclosure: T. Kutchukhidze: None. T. Khurodze: None. Introduction: Thyroid autoimmune disorders interfere with the physiology of reproduction, cause premature ovarian aging, and mimic the early stage of menopause. Recently, no specific research was made to measure Grave’s disease and infertility rates in young patients. Case Report: Due to an inability to conceive for two years, a 24-year-old Caucasian female was referred to the clinic with typical symptoms and complaints of Grave's disease. She has a family history of Grave’s disease and Diabetes mellitus. Ultrasound confirmed the presence of a highly vascularized non-homogeneous hyperplastic thyroid gland. A thyroid scan with Tc99m revealed generalized increased uptake. Laboratory investigations showed a decrease in TSH-<0.005mIU/ml (n.0.4mIU/ml - 4.0mIU/ml), elevated FT4-31.8 pmol/l (n.8.0pmol/l-22.0pmol/l), FT3- 9.69pmol/l (n3.4 pmol/l-6.76pmol/l) and positive Anti-TG -190.05 AU/ml (n>150), Anti-TPO -75.7 IU/ml (n>75) Anti-TSHR-27.3 IU/l (n>1,5). Prolactin and gonadal hormones were within normal limits AMH - 1.8 ng/ml(n1.52ng/ml-9.95ng/ml), FSH- 6mIU/ml(n3.9mIU/ml-12.4mIU/ml). The patient was started on Methimazole and Beta-blocker. While decreasing the Methimazole dosage for further discontinuation, disease recurrence developed, and a total thyroidectomy was performed. Postoperatively, the patient was maintained on Levothyroxine. After 6 months of follow-up due to irregular Levothyroxine intake, the patient reached a hypothyroid status, during which, the patient had 2 consecutive spontaneous pregnancies, from which, one ended with spontaneous miscarriage in the early weeks of pregnancy and another, ectopic pregnancy treated with right salpingectomy. HSG confirmed weak left fallopian tube patency. After several months of keeping TSH below 2.5 mIU/ml, IVF treatment was scheduled. The results of the infertility workup showed a decrease in ovarian reserve AMH - 0.163ng/ml (n1.52ng/ml-9.95ng/ml), FSH-16.23 mIU/ml(n3.9mIU/ml-12.4mIU/ml), due to it, modified natural cycle IVF was performed. She received 2 oocytes and 2 embryos. One high-grade blastocyst was transferred in a fresh cycle that ended with pregnancy and delivery. The child was born without a genetic disorder but with natal teeth. Conclusion: This is a rare case of infertility with diminished ovarian reserve due to Grave’s disease. A pregnancy was reached by proper correction of thyroid hormonal parameters and modified natural cycle IVF. It indicates a possible need for close monitoring of the functional ovarian reserve in patients planning pregnancy even in the young age group. Presentation: Friday, June 16, 2023

Drug advertising in the German free-of-charge health magazine Apotheken Umschau (Pharmacy review): a critical analysis

In Germany, the Apotheken Umschau (Pharmacy review) is a very popular health magazine for lay people, which is available free of charge in pharmacies. In this study, drug advertising in the Apotheken Umschau was critically analyzed. To our knowledge, studies on drug advertisements in such magazines are scarce. For the analyses, a total of 123 different advertisements from all 48 issues of Apotheken Umschau in 2020 and 2021 were compared. Since 2021 is the first year that was completely characterized by the COVID-19 pandemic, it was thus also possible to work out pandemic effects. More preparations from the categories immune system, eyes and sleep were advertised in 2021. Accordingly, typical complaints home office workers were addressed. Advertisements provided only very modest scientific information, if at all. The Therapeutic Products Advertising Act (Medicines Advertising Law; Heilmittelwerbegesetz (HWG)) provides regulations regarding the handling of drug advertising. However, in various categories, we noted substantial deficiencies of the advertisements to comply to regulations, e.g. the disclosure of adverse effects and omission of the mandatory statement “For risks and adverse effects, read the package insert and ask your doctor or pharmacist (Für Risiken und Nebenwirkungen fragen Sie Ihren Arzt oder Apotheker oder lesen Sie die Packungsbeilage)”. Fifty-one of the 123 advertisements featured females to appeal particularly to this target group. Furthermore, a homogeneous ethnic (Caucasian) picture and a traditional image of German society were presented although this clearly deviates from reality. In conclusion, this study provides insights into the yet poorly studied mechanisms of drug advertisement for lay people. Pharmacological evidence plays a much smaller role than psychology, marketing and traditional societal models. It appears that drug companies intentionally use the “grey area” of the Medicines Advertising Law to optimally promote their products and ignore mandatory statements. This practice must be stopped by stricter legal control to protect the consumer from misinformation. In this way, drug safety will be increased.

Clinical Study of Maricha Kshaudra Yoga in the Management of Vataja kasa (dry cough)

One of the oldest holistic medicinal systems in the world is Ayurveda, which has explained comprehensive pathophysiology of different diseases along with its management. One of the most significant and typical respiratory conditions listed in Ayurveda is Vataja kasa. It is mainly characterized by shushka kasa (dry cough), swarabheda (hoarseness in voice), kshinabala (weakness), hritshoola (pain in the chest), parshwashoola (pain in flanks), udarashoola (pain in abdomen), shirashoola (headache), etc. Due to outside factors including population growth, contamination of the environment, industrialization, and urbanisation, it has a growing prevalence throughout time. It is one of the typical complaints and is also a symptom of many Pranvah strotasa (respiratory system) disorders. Classics of Ayurveda, has elaborately Kasa as a distinct disease with its diagnostic details and plan of management. Even though multiple options are there for its management, Maricha kshaudra yoga, prescribed by Sushruta Samhita was not yet tested. Therefore, an effort was made to research the effectiveness of Maricha kshaudra yoga, a trial medicine, in the treatment of Vataja Kasa. Data was collected on the first, seventh, and fourteenth days after the medicine was administered, and it was determined to have significant efficacy.

Giant myxoma of the right sections of the heart obstructing the inferior vena cava: A case report

Objective: We present a rare case of surgical management of giant myxoma of the right heart with obstruction of the orifice of the inferior vena cava (IVC), obstruction of the right atrioventricular orifice, with the development of high pulmonary hypertension, and severe heart failure. Case presentation: A 39 years old male patients applied to the consultative polyclinic with typical complaints of severe shortness of breath, palpitations, severe weakness, almost bed rest, severe swelling of the lower extremities, with a transition to the anterior abdominal wall (edema). On physical examination signs of severe heart failure NYHA class IV were revealed. Imaging demonstrated giant right atrial myxoma obstructing IVC with base originated in fossa ovalis, obstructing tricuspid valve and protruding in the right ventricle occupying 50% of its cavity. The surgical removal of the giant RA myxoma protruding the right ventricle and obstructing IVC and tricuspid valve was performed under cardiopulmonary bypass and hemodynamic support. The patient was discharged on the 10th day after surgery and only residual minimal tricuspid regurgitation was revealed on follow-up examination. Conclusion: The described case from our practice proves the possibility of a severe course of giant myxomas of the right heart, with the development of deep hemodynamic complications of systemic and pulmonary circulation. The chosen correct tactics of surgical treatment provided a favorable result, despite the severity of the initial condition and the degree of hemodynamic disturbance. Intraoperative tactics and technique for performing the stages of urgent surgery were chosen based on the situation, the features of the anatomical structure of the tumor, and the severe complications that arose. Our case proves the possibility of adequate implementation of such interventions, when choosing the right tactics of surgical treatment. Take home message: If clinical signs of circulatory failure, heart failure are detected, it is necessary to perform echocardiography. If mass formations of the heart chambers are detected, immediately refer the patient to specialized cardiac surgery clinics to resolve the issue of surgical correction of pathology.

Features of Vestibular Changes in Patients with Vestibular Schwannoma. Historical Background and the Current State of the Problem.

The problem of vestibular disorders is one of the most urgent in the practice of a neurologist and otorhinolaryngologist. Dizziness patients can also ask for help specialists of any profile. Typical complaints require to conduct an appropriate examination and prescribe treatment. Due to the acute manifestation and rapid progression of symptoms, the patient's quality of life is significantly decreased and the ability to work is impaired. Vestibular disorders are even increased with age. Among the elderly, such complaints presented in about 48% of patients, almost every second one. Depends on the cause, vertigo can be of peripheral (otological), central and functional (psychological) origin. Often, the patient's condition assessed as serious and required immediate medical manipulations. For this reason, any specialist, to whom patient complains of dizziness, must be able to competently conduct an examination and perform the most complete examination. However, the lack of uniform standards for vestibular testing can lead to diagnostic errors and the choice of incorrect medical tactics. The article provides an overview of the literature data on the examination of patients with complaints of dizziness. An integral part of the diagnostic search for dizziness is the collection of complaints and anamnesis, a standard otorhinolaryngological examination, as well as audiometric and vestibular otoneurological tests. There is not much literature about vestibular testes in patients with vestibular schwannomas, here in this paper we present the literature dats and our experience in this topic.

Prevalence of Nonspecific Low Back Pain Among the Long Route Bus Drivers in Peshawar, Khyber Pakhtunkhwa, Pakistan

Low back pain (LBP) causes significant socioeconomic loss due to work-related musculoskeletal disorders (WMSDs). Prolonged sitting and vehicle vibration cause back pain, a typical complaint among long-route bus drivers. This study aimed to determine the frequency of job-related nonspecific LBP among long-route bus drivers in Peshawar, Pakistan. A descriptive cross-sectional study was conducted on 348 bus drivers working at three bus terminals (Haji Camp, Lahore, and Daewoo Bus Terminals). Data were gathered from January 2022 to June 2022 using a uniform, modified Nordic questionnaire. The mean age of drivers was 44. The results show a high prevalence of LBP at 93.4%. The most frequently impacted age group was in their fourth decade of life, and the least affected were the septuagenarians. According to the current study, job-related LBP was common among bus drivers. The study findings showed that long-route bus drivers are at continuous risk of developing nonspecific LBP due to long driving hours, with the driver's weight and age as additional risk factors.