Signs and syndromes in acute appendicitis:A pathophysiologic approach

Physical examination signs have not been well studied,and their accuracy and reliability in diagnosis remain unknown.The few studies available are limited in that the method of performing the sign was not stated,the technique used was not standardized,and the position of the appendix was not correlated with imaging or surgical findings.Some appendiceal signs were written in a non-English language and may not have been appropriately translated(e.g.,Blumberg-Shchetkin and Rovsing).In other cases,the sign described differs from the original report(e.g.,Rovsing,Blumberg-Shchetkin,and Cope sign,Murphy syndrome).Because of these studies limitations,gaps remain regarding the signs’utility in the bedside diagnosis of acute appendicitis.Based on the few studies available with these limitations in mind,the results suggest that a positive test is more likely to be found in acute appendicitis.However,a negative test does not exclude the diagnosis.Hence,these tests increase the likelihood of ruling in acute appendicitis when positive but are less helpful in ruling out disease when negative.Knowledge about the correct method of performing the sign may be a valuable adjunct to the surgeon in further increasing their pretest probability of disease.Furthermore,it may allow surgeons to study these signs further to better understand their role in clinical practice.In the interim,these signs should continue to be used as a tool to supplement the clinical diagnosis.

Identifying barriers to early diagnosis of breast cancer and perception of women in Malwa region of Punjab,India

Objective:The aim of present study is to identify the breast cancer screening barriers among the women with breast cancer of Malwa region of Punjab,India.The study was conducted at three government hospitals representing almost all districts of Malwa region.Methods:The quantitative research design was followed using empirical research methods.Study was carried out by one-to-one interview by the field investigator and research assistant.Total of 363 breast cancer patient has been interviewed through the scheduled questionnaire and results has been recorded for further analysis.In this study,five barriers are described namely as personal barriers,socio-cultural barriers,economic barriers,health­system barriers,and treatment barriers which contains various questions regarding barriers to breast cancer screening.Univariate analysis methods have been used for the analysis to access the socio-demographic profile of women.Data has been obtained with the help of 5-point liker scale.Binary logistic model was chosen.Results:Majority of participants were in the age groups 50-<60 years(3&6%,140/363)and>60 years(31.1%,112/363).Majority of these women(47.4%,171/363)were illiterate and most of them were housewives.The major barriers to breast cancer screening faced by most of the women were having no knowledge about screening services(90.9%,329/363),the importance of early diagnosis(90.9%,329/363),different screening methods(95.5%,347/363)and place of availing screening services(91.2%,330/363)misguided belief in God and fate(81.5%,295/363)and preferring duties than taking care of health(70.2%,254/363).Education qualification(odds ratio[OR]0.74,β'=-0.309,t=-5.357,P=0.000)and socioeconomic class(OR 1.43,β’=0.354,t=3.399,P=0.001)were found to be significant determinant of the barriers among women.Conclusion:The survey was conducted in the women between the age 40-60 years and as an outcome,the unawareness about screening services,fatalistic attitude,fear of being diagnosed with the cancer,low per capita income was found out significant factors that restricted the women for early check-up for the breast cancer.

Symptom distress and interference among cancer patients with osteoradionecrosis of jaw: A cross-sectional study

Objective:Osteoradionecrosis of the jaws(ORNJ)is among the most serious oral complications of head and neck cancer treatment with radiation therapy.This study aimed to examine the level of symptom distress and interference of ORNJ in head and neck cancer patients in China.Methods:A cross-sectional study was conducted to profile patient reported symptom severity.Ninetyfive hospitalized ORNJ patients were recruited.Participants completed the MD Anderson Symptom Inventory-Head and Neck Module-Chinese version.Results:The percentage of participants who reported that they experienced at least one type of symptom was 97.9%,and 85.2%patients reported interference.The 10 most severe symptoms were as follows:limited mouth opening,problem with teeth/gums,difficulty swallowing/chewing,dry mouth,oral malodor,difficulty with voice/speech,dental ulcer,tinnitus/ear obstruction,skin pain/burning/rash,and difficulty hearing.The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy.The interference of patients positively correlated with core symptoms(r=0.612),head and neck symptoms(r=0.709),and ORNJ symptoms(r=0.440)(P<0.01).The longer time to the onset of ORNJ after radiotherapy was positively and significantly correlated with symptom distress(r=0.479,P<0.001),and mouth opening correlated negatively with symptom distress(r=-0.298,P=0.003).Conclusions:ORNJ patients suffered mainly from limited mouth opening and other maxillofacial symptoms.The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy.ORNJ patients commonly had symptom distress,which influenced their quality of life.

Sheehan’s syndrome and anterior hypopituitarism

A case of Sheehan’s syndrome and anterior hypopituitarism was collected in Geriatric department of the third clinical college of Inner Mongolia medical university.Due to atypical clinical symptoms,it is easy to be delayed in its diagnosis and treatment.The paper aims to investigate the difference of clinical characteristics and treatment outcome of anterior hypopituitarism through case analysis.

Effectiveness and safety of Jinshuibao capsules(金水宝胶囊)in treatment of residual cardiopulmonary symptoms in convalescent patients of coronavirus disease 2019:a pilot randomized,double-blind,placebo-controlled clinical trial

OBJECTIVE:To evaluate the effectiveness and safety of Jinshuibao capsules(金水宝胶囊),a Traditional Chinese Medicine(TCM),in the treatment of residual cardiopulmonary symptoms in convalescent corona virus disease 2019(COVID-19)patients.METHODS:A total of 200 participants with COVID-19 in convalescence phase were randomly assigned into two groups at a 1:1 ratio in this multicenter randomized,double-blind,placebo-controlled trial.One group received Jinshuibao capsules,and the other received placebo.The patients were followed up at one and two weeks of treatment.Five symptoms(dry cough,shortness of breath,sweating,chest tightness and palpitation)improvement rates and full recovery rates were compared.RESULTS:All baseline characteristics were comparable between the two groups.After two weeks of treatment,symptom improvement rates for dry cough(74.00%vs 50.00%,P=0.015),shortness of breath(78.95%vs 46.15%,P<0.001),sweating(80.00%vs 57.75%,P=0.004),chest tightness(87.06%vs 60.47%,P<0.001)and palpitation(82.50%vs 64.56%,P=0.010)were significantly higher in the Jinshuibao group compared with the control group.Meanwhile,Jinshuibao capsules treatment also displayed more satisfactory full recovery rates of all five symptoms(dry cough 58.00%vs 19.57%,shortness of breath 18.95%vs 7.69%,sweating 36.00%vs 19.72%,chest tightness 32.94%vs 13.95%,and palpitation 48.75%vs 29.11%)in participants with COVID-19 in convalescence phase compared with the control group(P<0.05).No severe adverse events were reported in either group.CONCLUSIONS:Jinshuibao capsules have the potential to improve residual cardiopulmonary symptoms in convalescent COVID-19 patients,with few adverse events.

17例耳硬化症患者的临床与影像学分析

目的分析17例耳硬化症患者的临床特征、影像学表现及手术治疗效果。方法收集2020年5月~2023年5月在湖州市中心医院接受手术治疗的17例(17耳)耳硬化症患者临床、影像学资料,分析其临床表现、颞骨CT影像学表现及手术前后纯音测听结果变化。结果17例(17耳)患者中,11耳(64.71%)为前庭窗型,表现为进行性传导性听力损失,其中9耳有耳鸣,3耳有轻微平衡问题;混合型6耳(35.29%)显示混合性听力损失,5耳有耳鸣,3耳有偶发性平衡障碍。影像学上,前庭窗型显示镫骨底板区域骨质增厚、前庭窗密度增加;混合型则显示镫骨底板增厚及耳蜗周围密度减低,1耳可见“双环征”,两种类型耳硬化症患者骨密度差异无统计学意义(P>0.05)。术后均未见耳鸣加重或其他严重并发症,仅2例(11.76%)出现暂时性头晕,术后随访显示术区恢复良好,无感染或其他迟发性并发症;术后听力测试显示气导阈值、气骨导差较术前显著改善(P均<0.05)。结论前庭窗型和混合型耳硬化症的影像学和临床表现各有特点,镫骨成形术可显著改善听力,降低气导阈值和气骨导差,且手术安全、并发症少。