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Vascular and Endovascular Surgery May 2024This case report documents the management of a 66-year old man with atrial fibrillation with recent placement of a WATCHMAN Flex atrial appendage occlusion device. The...
This case report documents the management of a 66-year old man with atrial fibrillation with recent placement of a WATCHMAN Flex atrial appendage occlusion device. The patient presented with renal failure, abdominal pain, and difficulty walking 2 months after placement. The WATCHMAN Flex device was found to have embolized to his abdominal aorta at the level of the renal arteries with associated thrombus. Extensive workup revealed reduced left ventricular cardiac function and decreased renal function, both of which were felt to be potentially reversible with device removal. The patient then underwent retrieval of the device and all associated thrombus via an open retroperitoneal approach. This case demonstrates a potential consequence of implanting devices such as an atrial appendage occlusion device and describes a technique for removal.
PubMed: 38747057
DOI: 10.1177/15385744241251657 -
Research Square Apr 2024Despite the large number of children in India, there is little information on the impact of children's disability on school enrolment, and how this differs by...
Despite the large number of children in India, there is little information on the impact of children's disability on school enrolment, and how this differs by population. We estimated the prevalence of childhood disability in two sites in Tamil Nadu, southern India, and the effect of functional difficulty on school enrolment. We used a parent-reported survey containing the UNICEF-Washington Group questions to identify children aged 5 to 17 years with functional difficulty during a census conducted for an ongoing trial. We estimated pooled- and gender-specific prevalence of functional difficulty among 29,044 children. We fitted regression models to identify subgroups with higher rates of functional difficulty and the effect of functional difficulty on reported school enrolment. We estimated the modification of the effect of functional difficulty by age, gender, socioeconomic status, household education, and sub-site, on additive and multiplicative scales. We found of 29,044 children, 299 (1.0%) had any functional difficulty, equal among boys and girls. Being understood (0.5%) and walking (0.4%) were the most common difficulties. Functional difficulty was strongly associated with non-enrolment in school (Prevalence ratio [PR] 4.59, 95% CI: 3.87, 5.43) after adjusting for age, gender, and site. We show scale-dependent differences between age and socioeconomic groups in the effect of functional difficulty on enrolment. This study shows that at least one in a hundred children in this region have severe functional difficulties and nearly half of these children are not enrolled in school, highlighting the need for further efforts and evidence-based interventions to increase school enrolment among these groups.
PubMed: 38746354
DOI: 10.21203/rs.3.rs-4154190/v1 -
Radiology Case Reports Aug 2024Presented here is a compelling case of a patient with a history of untreated hypertension, highlighting symptoms indicative of Wallenberg syndrome, including acute-onset...
Presented here is a compelling case of a patient with a history of untreated hypertension, highlighting symptoms indicative of Wallenberg syndrome, including acute-onset dizziness, visual disturbances, continuous vomiting, difficulty walking, and an altered level of consciousness. This case's significance lies in its clinical presentation and in the diagnostic journey undertaken to elucidate its underlying pathology. Throughout the patient's hospitalization, a comprehensive assessment incorporating clinical, laboratory, and imaging techniques was conducted to delineate the extent of their condition. Of particular significance were the findings derived from MRI and MRA examinations of the endocranium, which provided crucial insights into the underlying pathophysiology. The MRI revealed multifocal ischemic lesions, pointing towards basilar artery thrombosis affecting both vertebral branches and displaying characteristic features associated with Wallenberg syndrome. Notably, the patient's lack of antihypertensive, anticoagulant, or antiplatelet therapy underscores the importance of addressing modifiable risk factors early in the disease course. This case serves as a poignant reminder of the complexities inherent in cerebrovascular diseases, highlighting the imperative of prompt recognition and management of predisposing factors. By presenting this case, we aim to underscore the clinical significance of timely intervention in mitigating potential complications of hypertension, such as cerebral artery thrombosis, thereby emphasizing the importance of proactive patient care and risk factor modification in clinical practice.
PubMed: 38745978
DOI: 10.1016/j.radcr.2024.03.043 -
BMC Public Health May 2024Although COVID-19 has entered the endemic phase, individuals infected with COVID-19 are required to adhere to home quarantine measures. By exploring the public's...
INTRODUCTION
Although COVID-19 has entered the endemic phase, individuals infected with COVID-19 are required to adhere to home quarantine measures. By exploring the public's knowledge and attitude towards recommended home quarantine measures, their readiness in containing potential COVID-19 outbreak can be determined. This study aimed to assess the public knowledge and attitude towards home quarantine instructions and their association with history of COVID-19 infections.
METHODS
This was a web-based cross-sectional study conducted among the public in Malaysia between August to October 2022. All Malaysian adults over 18 years of age were included. Knowledge on home quarantine instructions and COVID-19 warning signs were measured using "True," "False," or "I'm not sure", while attitude towards home quarantine instructions was measured using a five-point Likert Scale. The questionnaire was initially constructed in English and then translated into the national language, Bahasa Malaysia. Face and content validation were performed. The internal consistency of the questionnaire was found to be satisfactory.
RESULTS
1,036 respondents were analyzed, comprised mostly of females (743, 71.6%) with a history of COVID-19 (673, 64.9%). In the knowledge domain, more than 80% of the respondents answered 9 out of 11 home quarantine instructions statements correctly. 457 (44.1%) were unaware or unsure about the minimum distance of the infected individual's bed from the rest of the occupants in a shared bedroom. The respondents reported relatively weaker knowledge in identifying uncommon warning signs of COVID-19 deterioration, including anuria (162, 44.5%), ingestion problems (191, 52.5%), and immobility (195, 53.6%). In the attitude domain, more than 90% of respondents answered correctly in 8 out of 9 questions. Respondents with a previous history of COVID-19 infections had better knowledge than COVID-19 infection-naïve individuals towards both home quarantine instructions and COVID-19 warning signs.
CONCLUSION
Most respondents had good knowledge and attitude towards home quarantine instructions, with those previously infected with COVID-19 showing greater awareness of uncommon warning signs. However, there was a notable lack of awareness regarding physical distancing within shared rooms, appropriate disinfectant use and mobility limitation within the household. This study highlights the knowledge gaps to be improved in future educational campaigns.
Topics: Humans; COVID-19; Malaysia; Male; Female; Health Knowledge, Attitudes, Practice; Quarantine; Cross-Sectional Studies; Adult; Middle Aged; Surveys and Questionnaires; Young Adult; Adolescent; SARS-CoV-2
PubMed: 38745185
DOI: 10.1186/s12889-024-18739-9 -
Cureus Apr 2024Lymphatic filariasis, caused by filarial worms such as , , and , represents a significant public health burden in endemic regions. The disease primarily affects the...
Lymphatic filariasis, caused by filarial worms such as , , and , represents a significant public health burden in endemic regions. The disease primarily affects the lymphatic system, leading to lymphatic dysfunction and chronic morbidity. This abstract provides a comprehensive overview of lymphatic filariasis, including its transmission dynamics, pathogenesis, clinical manifestations, diagnostic approaches, and treatment options. Special attention is given to the socioeconomic impact of the disease and the challenges associated with its control and elimination. The patient in this particular case is a 58-year-old man who had lower limb swelling and pain, characteristic of chronic lymphatic obstruction. Additionally, the swelling tends to worsen during the evening hours often resulting in difficulty in walking and discomfort. Lymphatic filariasis was diagnosed based on clinical presentation.
PubMed: 38741824
DOI: 10.7759/cureus.58167 -
Cureus Apr 2024Parinaud syndrome, which most commonly involves the dorsal midbrain, has classical features of upward gaze paralysis, convergence-retraction nystagmus, and pupillary...
Parinaud syndrome, which most commonly involves the dorsal midbrain, has classical features of upward gaze paralysis, convergence-retraction nystagmus, and pupillary light near dissociation. A 62-year-old male presented to the Eye department with diminution of vision and symptoms of dry eye with associated difficulty in walking. Examination revealed nystagmus while performing convergence test. An MRI revealed lesions in the thalamic and gangliocapsular regions. Microangiopathies involving the thalamus and gangliocapsular region can lead to Parinaud syndrome. In our case, microangiopathies were most probably hypertensive.
PubMed: 38738087
DOI: 10.7759/cureus.58120 -
Oxford Open Immunology 2024Health care workers (HCWs) are primary health providers therefore ensuring their protection and recovery from Covid-19 is of high interest. We investigated post-acute...
Health care workers (HCWs) are primary health providers therefore ensuring their protection and recovery from Covid-19 is of high interest. We investigated post-acute sequelae of SARS-CoV-2 infection (PASC) in HCWs who had previously been infected with SARS-CoV-2. Overall, 68 HCWs were classified as PASC according to duration of persisting symptoms. The 68 HCWs with PASC were split into two groups according to the mean duration of their symptoms, which were (8 PASC) 122 and (60 PASC) 641 days. The frequencies of common symptoms reported by HWCs with PASC were continuous headaches (45), mild cough (41), fatigue (37), myalgia (25) and shortness of breath (14). When using the Medical Research Council (MRC) dyspnoea scale to examine the degree of breathlessness in relations to activity we found that 4 reported having difficulty breathing after strenuous exercise, 19 were identified with shortness of breath when walking fast or when walking up a slight hill, 2 reported walking slower than most people on level or stopping after 15 minutes walking at own pace, 1 reported stopping to breath after walking 91 meters, or after a few minutes on level ground and 1 reported being too breathless to leave the house, or breathless when dressing/undressing. Our results highlight concern for HCWs with long-term persisting symptoms which may negatively impact their health this represents an emerging public health priority. HCWs with prolonged Covid-19 symptoms especially breathing difficulties need better diagnostic tests and treatments.
PubMed: 38737940
DOI: 10.1093/oxfimm/iqae001 -
BMC Musculoskeletal Disorders May 2024The onset of locomotive syndrome (LS) precedes that of frailty. Therefore, the first step in extending healthy life expectancy is to implement measures against LS in...
BACKGROUND
The onset of locomotive syndrome (LS) precedes that of frailty. Therefore, the first step in extending healthy life expectancy is to implement measures against LS in young adults. The aim of this study was to investigate the prevalence of LS and its associated factors in young adults for early detection and prevention of LS.
METHODS
The participants of this study comprised 413 university students specializing in health sciences (192 males and 221 females) with an average age of 19.1 ± 1.2 years. All participants voluntarily participated in the study and reported no serious health problems. The presence or absence of LS was evaluated using the stand-up test, two-step test, and the 25-question Geriatric Locomotive Function Scale. Additionally, musculoskeletal assessment (one-leg standing, squatting, shoulder elevation, and standing forward bend), body composition analysis (weight, body mass index, body fat mass, body fat percentage, skeletal muscle mass index (SMI), and phase angle), handgrip strength test, physical activity assessment, and nutritional assessment were conducted. Sex-stratified analyses were performed, comparing groups with and without LS. Factors associated with LS were explored using binomial logistic regression.
RESULTS
Of the 413 young adults studied, 86 individuals (20.8%) were found to have LS. When stratified by sex, LS was observed to have a considerably higher prevalence in females (55, 24.9%) than in males (31, 16.1%). In males, the notable differences between the groups with and without LS were observed in one-leg standing and phase angle, whereas in females, differences were identified in body fat mass, body fat percentage, SMI, musculoskeletal pain, and handgrip strength. Two types of binomial logistic regression analysis revealed that the inability to perform one-leg standing was associated with LS in males, while the presence of musculoskeletal pain and a high body fat percentage were identified as factors associated with LS in females.
CONCLUSIONS
One in five young adults were found to have LS in this study, underscoring the necessity for early intervention and LS health education. Furthermore, effective management of musculoskeletal pain is also crucial.
Topics: Humans; Male; Female; Cross-Sectional Studies; Prevalence; Young Adult; Japan; Locomotion; Body Composition; Adolescent; Syndrome; Risk Factors; Adult; Hand Strength; Mobility Limitation; East Asian People
PubMed: 38730399
DOI: 10.1186/s12891-024-07493-z -
Joint Diseases and Related Surgery Mar 2024Case reports of plexopathy after prostate cancer are usually neoplastic. Radiation-induced lumbosacral plexopathy and insufficiency fractures have clinical significance...
Case reports of plexopathy after prostate cancer are usually neoplastic. Radiation-induced lumbosacral plexopathy and insufficiency fractures have clinical significance due to the need to differentiate them from tumoral invasions, metastases, and spinal pathologies. Certain nuances, including clinical presentation and screening methods, help distinguish radiation-induced plexopathy from tumoral plexopathy. This case report highlights the coexistence of these two rare clinical conditions. Herein, we present a 78-year-old male with a history of radiotherapy for prostate cancer who developed right foot drop, severe lower back and right groin pain, difficulty in standing up and walking, and tingling in both legs over the past month during remission. The diagnosis of lumbosacral plexopathy and pelvic insufficiency fracture was made based on magnetic resonance imaging, positron emission tomography, and electroneuromyography. The patient received conservative symptomatic treatment and was discharged with the use of a cane for mobility. Radiation-induced lumbosacral plexopathy following prostate cancer should be kept in mind in patients with neurological disorders of the lower limbs. Pelvic insufficiency fracture should also be considered if the pain does not correspond to the clinical findings of plexopathy. These two pathologies, which can be challenging to diagnose, may require surgical or complex management approaches. However, in this patient, conservative therapies led to an improvement in quality of life and a reduction in the burden of illness.
Topics: Humans; Male; Prostatic Neoplasms; Aged; Lumbosacral Plexus; Fractures, Stress; Radiation Injuries; Pelvic Bones; Peripheral Nervous System Diseases; Magnetic Resonance Imaging; Radiotherapy
PubMed: 38727129
DOI: 10.52312/jdrs.2024.1551 -
Archives of Physical Medicine and... May 2024To determine, in patients undergoing total knee arthroplasty (TKA), whether increasing context specificity of selected items of the shortened version of the Western...
OBJECTIVE
To determine, in patients undergoing total knee arthroplasty (TKA), whether increasing context specificity of selected items of the shortened version of the Western Ontario and McMaster Universities Osteoarthritis Index function (WOMAC-F) scale (ShortMAC-F) (1) enhanced the convergent validity of the ShortMAC-F with performance-based mobility measures (ii) affected mean scale score, structural validity, reliability, and interpretability.
DESIGN
Secondary analysis of randomized clinical trial data.
SETTING
A tertiary teaching hospital.
PARTICIPANTS
Patients undergoing TKA (N=114).
INTERVENTIONS
Not applicable.
MAIN OUTCOME MEASURES
The ShortMAC-F was modified by specifying the "ascending stairs" and "rising from sitting" items to enquire about difficulty in performing the tasks without reliance on compensatory strategies, whereas the modified "level walking" item enquired about difficulty in walking 400 m. Before and 12 weeks after TKA, patients completed the WOMAC-F questionnaire, modified ShortMAC-F questionnaire, knee pain scale questionnaire, sit-to-stand test, fast gait speed test, and stair climb test. Interpretability was evaluated by calculating anchor-based substantial clinical benefit estimates.
RESULTS
The modified ShortMAC-F correlated significantly more strongly than ShortMAC-F or WOMAC-F with pooled performance measures (differences in correlation values, 0.12-0.14). Increasing item context specificity of the ShortMAC-F did not influence its psychometric properties of unidimensionality (comparative fit and Tucker-Lewis indices, >0.95; root mean square error of approximation, 0.05-0.08), reliability (Cronbach's α, 0.75-0.83), correlation with pain intensity (correlation values, 0.48-0.52), and substantial clinical benefit estimates (16 percentage points); however, it resulted in lower mean score (4.5-4.8 points lower).
CONCLUSIONS
The modified ShortMAC-F showed sufficient measurement properties for clinical application, and it seemed more adept than WOMAC-F at correlating with performance-based measures in TKA.
PubMed: 38723858
DOI: 10.1016/j.apmr.2024.05.005