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Journal of Medical Internet Research Sep 2023Sexually transmitted infection (STI) rates continue to rise in Australia, and timely access to testing and treatment is crucial to reduce transmission. Web-based... (Review)
Review
BACKGROUND
Sexually transmitted infection (STI) rates continue to rise in Australia, and timely access to testing and treatment is crucial to reduce transmission. Web-based services have been viewed as a way to improve timely access to STI/HIV testing and have proliferated in recent years. However, the regulation of these services in Australia is minimal, leading to concerns about their quality. The purpose of this review was to systematically identify web-based STI/HIV testing services available in Australia and assess them on aspects of quality, reliability, and accessibility.
OBJECTIVE
We aim to systematically identify and assess web-based STI/HIV testing services available in Australia.
METHODS
A Google search of Australian web-based services was conducted in March 2022 and repeated in September 2022 using Boolean operators and search terms related to test services (eg, on the internet or home), STIs (eg, chlamydia or gonorrhea), and test type (eg, self-test). The first 10 pages were assessed, and services were categorized as self-testing (ST; test at home), self-sampling (SS; sample at home and return to laboratory), or self-navigated pathology (SNP; specimens collected at pathology center). Website reliability was assessed against the Health on the Net Foundation code of conduct, and service quality was assessed using a scorecard that was developed based on similar reviews, Australian guidelines for in-person services, and UK standards. Additionally, we looked at measures of accessibility including cost, rural access, and time to test results.
RESULTS
Seventeen services were identified (8 ST, 2 SS, and 7 SNP). Only 4 services offered recommended testing for all 4 infections (chlamydia, gonorrhea, syphilis, and HIV) including genital, anorectal, and oropharyngeal sites, and 5 offered tests other than those recommended by Australian testing guidelines (eg, Ureaplasma). Nine services (1 SNP, 8 self-test) had no minimum age requirements for access. Reliability scores (scale 0-8) were similar between all services (range 4.75-8.0). Quality weighted scores (scale 0-58) were similar between SNP and SS services (average 44.89, SD 5.56 and 44.75, SD 1.77, respectively) but lower for ST services (22.66, SD 8.93; P=.002). Government-funded services were of higher quality than private services (43.54, SD 6.71 vs 29.43, SD 13.55; P=.03). The cost for services varied between SNP (Aus $0-$595; ie, US $0-$381.96), self-sample (Aus $0; ie, US $0), and ST (Aus $0-$135; ie, US $0-$86.66). The time to test results was much shorter for SNP services (~4 days) than for SS (~12 days) and ST (~14 days).
CONCLUSIONS
This review identified considerable variability in the quality and reliability of the web-based STI/HIV testing services in Australia. Given the proliferation and use of these services will likely increase, it is imperative that Australia develops national standards to ensure the standard-of-care offered by web-based STI/HIV testing services is appropriate to protect Australian users from the impact of poorly performing and inappropriate tests.
Topics: Humans; Gonorrhea; Australia; Reproducibility of Results; Sexually Transmitted Diseases; HIV Testing; Internet
PubMed: 37738083
DOI: 10.2196/45695 -
Journal of Medical Case Reports Sep 2023Hemorrhoidal disease is a common anorectal pathology. Complications post hemorrhoidectomy are rare. Postoperative complications following hemorrhoidectomy include...
BACKGROUND
Hemorrhoidal disease is a common anorectal pathology. Complications post hemorrhoidectomy are rare. Postoperative complications following hemorrhoidectomy include bleeding (2%), infection (0.4-8%), urinary retention (15%), and constipation (15-30%).
CASE PRESENTATION
A 40-year-old of Asian background female presented to a tertiary colorectal service with large bowel obstruction post hemorrhoidectomy. This is the first case in the surgical literature describing large bowel obstruction secondary to extrinsic compression from urinary retention following hemorrhoidectomy. The patient developed urinary retention and obstructed defecation in setting of inadequate analgesia post hemorrhoidectomy. The patient required indwelling catheter insertion and aggressive constipation management to resolve symptoms. Histopathology from the hemorrhoidectomy did not reveal a malignancy.
CONCLUSION
Anesthetic choice and postoperative analgesia are important factors to avoid the development of complications. A missed malignancy diagnosis must always be excluded with patients presenting post hemorroidectomy with bowel obstruction.
Topics: Humans; Female; Adult; Hemorrhoidectomy; Urinary Retention; Intestinal Obstruction; Aggression; Constipation
PubMed: 37717034
DOI: 10.1186/s13256-023-04125-3 -
BMC Geriatrics Sep 2023In the early stages of the coronavirus disease 2019 (COVID-19) outbreak, the most widely recognised symptoms of the disease were fever, cough, shortness of breath,...
BACKGROUND
In the early stages of the coronavirus disease 2019 (COVID-19) outbreak, the most widely recognised symptoms of the disease were fever, cough, shortness of breath, myalgia, and fatigue. However, in addition to these symptoms, COVID-19 can cause systemic symptoms outside the lungs. Older patients with severe COVID-19 often require admission to the intensive care unit (ICU). Acute rectal ulcer bleeding, characterised by painless, profuse haematochezia, caused by solitary or multiple rectal ulcers, is one of the main causes of severe haematochezia in patients with COVID-19 in the ICU. However, recurrent duodenal ulcer bleeding followed by rectal ulcer bleeding has not previously been reported in older patients during ICU treatment for severe COVID-19.
CASES PRESENTATION
Herein, we report the case of an 81-year-old woman admitted to the emergency department due to severe COVID-19 and transferred to the ICU 2 days later for treatment. During treatment in the ICU, the patient developed recurrent duodenal ulcer bleeding and underwent endoscopic electrocoagulation haemostasis and gastroduodenal artery embolisation. However, the night after the final haemostatic operation, due to rectal ulcer bleeding, the patient discharged bloody stools intermittently, which was effectively controlled using endoscopic electrocoagulation, topical medication, blood transfusion, and haemostatic drugs.
CONCLUSIONS
To the best of our knowledge, this is the first report of duodenal ulcer bleeding followed by rectal ulcer bleeding in an older patient with severe COVID-19 infection. This report creates awareness for clinicians about the multiple and complex gastrointestinal symptoms that may occur during COVID-19 treatment.
Topics: Female; Humans; Aged; Aged, 80 and over; Ulcer; Duodenal Ulcer; COVID-19 Drug Treatment; COVID-19; Cough
PubMed: 37710168
DOI: 10.1186/s12877-023-04283-5 -
Acta Obstetricia Et Gynecologica... Oct 2023Women with an abnormally high pelvic floor muscle tone may have a clinical presentation that is complex, involving urinary, anorectal and/or sexual dysfunction,... (Review)
Review
Amsterdam complex pelvic pain symptom scale with subscales: Based on a Norwegian translation, psychometric assessment and modification of the Amsterdam hyperactive pelvic floor scale.
INTRODUCTION
Women with an abnormally high pelvic floor muscle tone may have a clinical presentation that is complex, involving urinary, anorectal and/or sexual dysfunction, genital/pelvic pain and psychological distress. The Amsterdam Hyperactive Pelvic Floor Scale (AHPFS) is a Dutch 30-item condition-specific self-report questionnaire developed to measure these complex pelvic pain symptoms. The aim of this study was to translate the Dutch version into Norwegian, to assess the psychometric properties, and to present a valid factor structure.
MATERIAL AND METHODS
Translation, back-translation and a review of the back-translated version were performed. Thereafter, a pilot test including feedback from six clinical experts and cognitive interviews with 11 patients from the target group was conducted. Next, a field test was performed among women who were (1) patients at the gynecological outpatient clinic/pelvic floor physiotherapist at St. Olav's Hospital, (2) members of the Vulvodynia or the Endometriosis Patient Associations or (3) female students and employees from the Faculty of Medicine and Health Science, the Norwegian University of Science and Technology, in a web-based survey. To ensure a sample with symptomatic women, only women who scored ≥11 according to the Dutch prespecified factor structure were included in the statistical analyses (n = 232).
RESULTS
Content/face validity demonstrated that the questionnaire was perceived as relevant, comprehensive and understandable. Some adjustments in the instructions of the questionnaire and the response categories were made, which lead to the Norwegian translation ACPPS-30. Assessment of the questionnaire's dimensionality revealed a five-factor structure similar to the original Dutch Amsterdam Hyperactive Pelvic Floor Scale (AHPFS) but without the Urinary tract infection factor and seven other items. The translated and modified ACPPS-16 total score and subscales correlated as expected with scales measuring similar conditions. Test-retest reliability demonstrated good stability for scales (intraclass correlation coefficient 0.85-0.93) and single items (weighted kappa values from 0.34 to 0.90).
CONCLUSIONS
A modified Norwegian version ACPPS-30 was presented, in addition to a shorter version with only 16 of the translated items distributed among five factors similar to the original Dutch version (ACPPS-16). Both versions proved to be valid, stable and reliable tools to investigate complex pelvic pain symptoms possibly due to an abnormally high-toned pelvic floor muscle.
Topics: Humans; Female; Psychometrics; Pelvic Floor; Reproducibility of Results; Pelvic Pain; Surveys and Questionnaires; Norway
PubMed: 37675780
DOI: 10.1111/aogs.14665 -
The American Journal of Case Reports Sep 2023BACKGROUND A recently described zoonotic viral infection, mpox (monkeypox), is an Orthopoxvirus transmitted by close contact, which causes symptoms similar to smallpox,...
BACKGROUND A recently described zoonotic viral infection, mpox (monkeypox), is an Orthopoxvirus transmitted by close contact, which causes symptoms similar to smallpox, although less severe. This report presents the case of a 40-year-old man with anemia, proctitis, rectal bleeding, and a perianal rash due to mpox infection. CASE REPORT A 40-year-old man with a medical history of human immunodeficiency virus (HIV) and syphilis presented multiple times with progressive and painful perianal lesions. On initial presentation, swabbing of the lesions and polymerase chain reaction (PCR) testing confirmed a diagnosis of mpox infection, and treatment with a 14-day course of Tecovirimat was started. Nine days after initiating Tecovirimat, the patient presented again with worsening perianal pain and associated hematochezia resulting in acute symptomatic anemia. Despite a blood transfusion to treat his anemia, the patient's status declined as his viral symptoms progressed. Computed tomography (CT) investigation demonstrated significant proctitis with interval development of small perianal abscesses. A multidisciplinary approach for medical management and treatment was instituted. The resolution of the patient's anemia and mpox proctitis was confirmed on follow-up. CONCLUSIONS Despite treatment with antiviral agents, mpox infection can progress quickly; thus, swift management with a multidisciplinary approach and close follow-up is needed to treat and prevent secondary complications such as anemia and proctitis. Further data collection regarding the sexual practices of those with diagnoses of mpox as well as seminal, anorectal, and genital swabbing would be valuable to confirm the mode of transmission and cause of mpox proctitis.
Topics: Male; Humans; Adult; Mpox (monkeypox); Proctitis; Dermatitis; Gastrointestinal Hemorrhage; Anemia; Benzamides; Exanthema
PubMed: 37660250
DOI: 10.12659/AJCR.940177 -
Techniques in Coloproctology Oct 2023Approximately 15-50% of patients with an anorectal abscess will develop an anal fistula, but the true incidence of this entity is currently unknown. The aim of the study... (Observational Study)
Observational Study
PURPOSE
Approximately 15-50% of patients with an anorectal abscess will develop an anal fistula, but the true incidence of this entity is currently unknown. The aim of the study was to determine the incidence of anorectal abscess and development of a fistula in a specific population area and to identify potential risk factors associated with demographic, socioeconomic and pre-existing disease (e.g. diabetes and inflammatory bowel disease).
METHODS
A longitudinal observational study was designed including a large cohort study in an area with 7,553,650 inhabitants in Spain 1st january 2014 to 31st december 2019. Adults who attended for the first time with an anorectal abscess and had a minimum of 1-year follow-up were included. The diagnosis was made using ICD-10 codes for anorectal abscess and anal fistula.
RESULTS
During the study period, we included 27,821 patients with anorectal abscess. There was a predominance of men (70%) and an overall incidence of 596 per million population. The overall incidence of anal fistula developing from abscesses was 20%, with predominance in men, and a lower incidence in the lowest income level. The cumulative incidence of fistula was higher in men and in younger patients (p < 0.0001). On multivariate analysis, patients aged 60-69 years (hazard ratio 2.0) and those with inflammatory bowel disease (hazard ratio 1.8-2.0) had a strong association with fistula development (hazard ratio 2.0).
CONCLUSIONS
One in five patients with an anorectal abscess will develop a fistula, with a higher likelihood in men. Fistula formation was strongly associated with inflammatory bowel disease.
Topics: Adult; Male; Humans; Female; Abscess; Cohort Studies; Follow-Up Studies; Anus Diseases; Rectal Fistula; Inflammatory Bowel Diseases
PubMed: 37548781
DOI: 10.1007/s10151-023-02840-z -
Medicine Aug 2023Signet-ring cell carcinoma, which is an infrequent type of colorectal cancer. Abdominal pain is the primary presenting complaint of patients with acute appendicitis. It...
RATIONALE
Signet-ring cell carcinoma, which is an infrequent type of colorectal cancer. Abdominal pain is the primary presenting complaint of patients with acute appendicitis. It is difficult to diagnose patients with appendiceal carcinomas accompanying with symptoms of acute appendicitis.
PATIENT CONCERNS
A 33-year-old female patient was admitted to our hospital, with chief complaints of "bilateral pelvic space-occupying lesions for 1 month, aggravated abdominal distension, and she accompanied with diarrhea for 3 days."
DIAGNOSIS
The patient was with primary signet ring cell carcinoma of the appendix, presented with acute appendicitis, as well as bilateral ovarian metastasis and peritoneal implantation metastasis.
INTERVENTIONS
She was then treated with irinotecan, oxaliplatin, calcium folinate, 5-FU combined with bevacizumab, surgical treatment, and postoperative adjuvant treatment with oxaliplatin, capecitabine regimen to consolidate the efficacy.
OUTCOMES
The patient is in good conditions, and postoperative adjuvant chemotherapy is in progress as well.
CONCLUSION
The outcomes highlighted the importance of strict histopathologic assessment for appendiceal adenocarcinoma, and provided new ideas for the diagnosis and treatment of advanced-stage signet ring cell carcinoma of the appendix.
Topics: Female; Humans; Adult; Appendix; Bevacizumab; Oxaliplatin; Appendicitis; Carcinoma, Signet Ring Cell; Appendiceal Neoplasms
PubMed: 37543827
DOI: 10.1097/MD.0000000000034412 -
International Journal of Surgery Case... Aug 2023Haemophilia A (HA) is a hereditary X-linked recessive hemorrhagic disorder that results from a deficiency or dysfunction of coagulation factor VIII (FVIII) caused by...
INTRODUCTION AND IMPORTANCE
Haemophilia A (HA) is a hereditary X-linked recessive hemorrhagic disorder that results from a deficiency or dysfunction of coagulation factor VIII (FVIII) caused by gene mutations.
CASE PRESENTATION
This case report presents the challenging management of a 37-year-old man who developed perianal necrotizing fasciitis accompanied by severe infection, necrosis, and septic shock. The patient underwent emergency surgery. However, significant bleeding occurred during and after the surgery.
CLINICAL DISCUSSION
Despite initial treatment with fresh frozen blood plasma infusion satisfactory efficacy was not achieved. Investigation into the patient's family history revealed a haemophiliac niece, prompting further testing for haemophilia. Ultimately, the patient was diagnosed with haemophilia A. Hemorrhage controlled was obtained through coagulation factor VIII infusion. With subsequent treatment, the patient experienced significant recovery, and normal anal function was restored.
CONCLUSION
In summary, routine coagulation examination may not effectively evaluate coagulation dysfunction in patients with severe infectious diseases. Comprehensive preoperative evaluations are necessary for acute anorectal surgeries, with emphasis on screening for haemophilia.
PubMed: 37441981
DOI: 10.1016/j.ijscr.2023.108470