Adolescent Chest Pain

In Reply.— We did not conduct urine testing for cannabinoids but did inquire about the use of marijuana. Adolescents were questioned about use of all street drugs, including manjuana. Patients with chest pain did not admit to using drugs (5%) any more frequently than patients in our control groups with abdominal pain (8%) or without pain (4%). The above letters highlight the importance of considering the importance of psychologic, situational and environmental conditions when evaluating an adolescent with chest pain.

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Symptomatic manifestations of the disease caused by coronavirus (COVID-19) in adults: systematic review

Revista Gaúcha de Enfermagem ◽

10.1590/1983-1447.2021.20200205 ◽

2021 ◽

Vol 42 (spe) ◽

Author(s):

Antonio Rosa de Sousa Neto ◽

Ana Raquel Batista de Carvalho ◽

Erika Morganna Neves de Oliveira ◽

Rosilane de Lima Brito Magalhães ◽

Maria Eliete Batista Moura ◽

...

Keyword(s):

Systematic Review ◽

Abdominal Pain ◽

Chest Pain ◽

Web Of Science ◽

Scientific Literature ◽

Nasal Congestion ◽

Research Question ◽

Clinical Manifestations ◽

Runny Nose ◽

Cough Headache

ABSTRACT Objective To identify symptoms of COVID-19 in adults in the scientific literature. Method Systematic review of studies published from December 1, 2019 to April 21, 2020 from the Scopus, Web of Science and PubMed databases, in order to answer the following research question: “What are the symptoms caused by COVID-19 in adults?” using the keywords “Symptoms”, “Clinical Manifestations”, “Coronavirus”, “COVID-19”. Results Of the total 105 references, 13 references that addressed the symptoms of COVID-19 were selected. Fever and normal or dry cough were symptoms present in all studies. Conclusion The symptoms identified in adult patients were fever, normal or dry cough, headache, pharyngalgia, dyspnea, diarrhea, myalgia, vomiting, sputum or expectoration, anxiety or chest pain, fatigue, nausea, anorexia, abdominal pain, rhinorrhea, runny nose or nasal congestion, dizziness, chills, systemic pain, mental confusion, hemoptysis, asthma, taste disorder, smell disorder, belching and tachycardia.

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Сolloidal silicon dioxide use (Polisorb MP) at food allergy skin and gastrointestinal manifestations

Pediatrics (Suppl Consilium Medicum) ◽

10.26442/26586630.2021.2.200967 ◽

2021 ◽

pp. 158-164

Author(s):

Vera P. Vavilova ◽

Alexander M. Vavilov ◽

Sofia A. Tsarkova ◽

Irina A. Nechaeva ◽

Ekaterina Iu. Burmistrova ◽

...

Keyword(s):

Atopic Dermatitis ◽

Food Allergy ◽

Abdominal Pain ◽

Silicon Dioxide ◽

Life Quality ◽

Allergic Diseases ◽

Food Allergies ◽

Control Groups ◽

Gastrointestinal Manifestations ◽

Skin Manifestations

Background. At present, due to high prevalence of allergic diseases which start in early childhood, the search for new prevention and treatment methods is in great demand. Aim. To study the effectiveness of the Russian-produced enterosorbent colloidal silicon dioxide in the treatment of patients with food allergies combined with atopic dermatitis and gastrointestinal manifestations. Materials and methods. An open, randomized, comparative clinical study of the enterosorbent (colloidal silicon dioxide) effectiveness has been conducted in parallel groups of infants and preschool children with food allergy skin and gastrointestinal manifestations. The main groups (1 67 children with food allergies and atopic dermatitis skin manifestations, 3 60 children with food allergies and gastrointestinal manifestations) received, along with basic medication, colloidal silicon dioxide enterosorbent day at an age-specific dosage twice a for 1014 days. Control groups (2 60 children with food allergies and atopic dermatitis skin manifestations, 4 60 children with food allergies and gastrointestinal manifestations) did not receive enterosorbent. All children underwent a clinical, functional and laboratory status assessment, including medical records analysis, a pediatrician clinical examination, narrow specialists (allergist-immunologist) examination, laboratory and instrumental research. The treatment effectiveness was being evaluated on the 14th day after the initiation of therapy and after 30 days. The therapy effectiveness was assessed based on regression of skin syndrome clinical and gastrointestinal manifestations, intoxication syndrome and laboratory parameters (IgE, hemogram eosinophilia duration). The study was conducted from 2017 to 2019. On the basis of LLC Modern Medical Technologies Clinics (Kemerovo). Results. Therapy with colloidal silicon dioxide increases the significance of food allergy skin manifestations positive dynamics, which makes it possible to reduce the volume of medication and the duration of topical glucocorticosteroids use to 5.340.35 days, in the compared group 10.520.85 days (p=0.002). All patients with food allergy combined with atopic dermatitis in the main and control groups noted positive clinical dynamics, appearing as decrease in the skin inflammatory reaction area and intensity. However, the of colloidal silicon dioxide use accelerates skin syndrome condition normalization significantly (group 1 skin syndrome persisted in 2.92.0% after 14 days, in group 2 18.34.9%; p=0.003). Colloidal silicon dioxide use accelerates humoral immunity state normalization (IgE) and peripheral blood parameters (hemogram eosinophilia). Colloidal silicon dioxide therapy accelerates food allergy gastrointestinal manifestations positive dynamics in children. Two weeks after the sorbent therapy started, gastrointestinal tract lesions symptoms frequency is less than in patients in the compared group. Diarrhea frequency before treatment started was 48.36.5%, 45.06.4% in the compared groups. After two weeks it decreased to 6.73.2% with the Polisorb therapy and to 16.64.8% in the compared group (p=0.003). Abdominal pain was noted by patients of both groups equally often before the study began. After 2 weeks, abdominal pain was noted by ten percent 10.03.9% of patients taking colloidal silicon dioxide and 25.05.6% of the compared group (p=0.009). Conclusion. Taking into account the composition of the colloidal silicon dioxide, it makes sense to include this medication in childrens food allergies complex treatment starting from infancy, which contributes to a more rapid relief of gastrointestinal system damage symptoms, life quality improvement for children and their parents, and decrease in medication load. When using colloidal silicon dioxide in children with food allergies, a faster dynamics of disease symptoms relief (p=0.003) was noted, which allows us to conclude that it is highly effective in the treatment of allergic diseases associated with food sensitization.

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Adolescent Chest Pain

PEDIATRICS ◽

10.1542/peds.72.6.916 ◽

1983 ◽

Vol 72 (6) ◽

pp. 916-916

Author(s):

INGRID L. LANTNER

Keyword(s):

Chest Pain ◽

Chronic Cough ◽

Laboratory Tests ◽

Skin Tests ◽

Routine Laboratory ◽

Pediatric Practice ◽

Respiratory Allergies ◽

Urine Testing

To the Editor.— I have some questions about Pantell and Goodman's article on adolescent chest pain. Was there any urine testing for cannabinoids? Were there inquiries regarding the use of marijuana? It's not unusual for teenagers to smoke this drug exclusively. In my pediatric practice, I have seen several adolescents with left-sided or substernal pain, in some instances not accompanied with chronic cough. The roentgenograms of the chest, EGG, tuberculosis tests, and other routine laboratory tests were negative, including some skin tests for respiratory allergies in a few.

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Differential diagnosis of common presentations

Oxford Handbook of Acute Medicine ◽

10.1093/med/9780198797425.003.0016 ◽

2019 ◽

pp. 863-890

Author(s):

Punit S. Ramrakha ◽

Kevin P. Moore ◽

Amir H. Sam

Keyword(s):

Differential Diagnosis ◽

Abdominal Pain ◽

Back Pain ◽

Chest Pain ◽

Muscle Weakness ◽

Joint Pain ◽

Nausea And Vomiting ◽

Cutaneous Manifestations ◽

Internal Malignancy

This chapter explores the differential diagnosis of common presentations, including abdominal pain and distension, back pain, blackouts and collapse, breathlessness and dyspnoea, chest pain, confusion, constipation, cough, cutaneous manifestations of internal malignancy, diarrhoea, dysphagia, falls, fever, fits and seizures, haematemesis and melaena, haematuria, haemoptysis, headache, hemiparesis, hoarseness, itching and pruritus, joint pain and swelling, leg swelling, muscle weakness, nausea and vomiting, palpitations, tremor, unconsciousness and reduced consciousness, weak legs, and wheeze.

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Does Ambulance Crew Size Affect On-Scene Time or Number of Prehospital Interventions?

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00042977 ◽

1996 ◽

Vol 11 (3) ◽

pp. 214-217 ◽

Cited By ~ 7

Author(s):

Lawrence H. Brown ◽

Charles F. Owens ◽

Juan A. March ◽

Elizabeth A. Archino

Keyword(s):

North Carolina ◽

Chest Pain ◽

Life Support ◽

Advanced Life Support ◽

Fire Department ◽

Control Groups ◽

Hospital Emergency ◽

Large Cities ◽

Patient Groups ◽

Ambulance Crew

AbstractIntroduction:While large cities typically staff ambulances with two emergency medical services (EMS) professionals, some EMS agencies use three people for ambulance crews. The Greenville, North Carolina, EMS agency converted from three-person to two-person EMS crews in July 1993. There are no published reports investigating the best crew size for out-of-hospital emergency care.Hypothesis:Two-person EMS crews perform the same number and types of interventions as three-person EMS crews. Two-person EMS crews do not have longer on-scene times than do three-person EMS crews.Methods:Data for the two most common advanced life support calls in this system—seizures and chest pains—were collected for the months of June and August 1993. Three-person EMS crews responded to both types of calls in June. In August, two-person EMS crews responded to seizure calls; two-person EMS crews accompanied by a fire department engine (pumper) with additional manpower responded to chest pain calk. The frequency of specific interventions, number of total interventions, and scene times for the August calls were compared to their historical control groups, the June calls.Results:One hundred twenty-six patient contacts were included in the study. There were no significant differences in total number or types of procedures performed for the two patient groups. Mean on-scene time for patients with seizures was 11.0±4.2 minutes for three-person crews and 19.4±8.3 minutes for two-person crews (p <0.001). Mean on-scene time for patients with chest pain was 13.6±4.9 minutes for three-person crews, and 15.4±3.2 minutes for two-person crews assisted by fire department personnel (p >0.05).Conclusion:Two-person EMS crews perform the same number of procedures as do three-person EMS crews. However, without the assistance of additional responders, two-person EMS crews may have statistically significantly longer onscene times than three-person EMS crews.

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A Giant Intradiaphragmatic Bronchogenic Cyst: Case Report and Literature Review

Tumori Journal ◽

10.5301/tj.5000669 ◽

2017 ◽

Vol 103 (1_suppl) ◽

pp. S25-S27 ◽

Cited By ~ 1

Author(s):

Xin Gao ◽

Min Zhai ◽

Haitao Zhang ◽

Yunliang Wang ◽

Jin Zhou

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Chest Pain ◽

Literature Review ◽

Bronchogenic Cyst ◽

Early Embryogenesis ◽

Congenital Lesions ◽

Left Diaphragm ◽

The Right ◽

Bronchogenic Cysts

Bronchogenic cysts are congenital lesions developing during early embryogenesis. The intradiaphragmatic location is extremely rare. We present a giant bronchogenic cyst arising from the left crus of diaphragm. Based on our literature review results, intradiaphragmatic bronchogenic cysts have the following characteristics: 1) they are more common in female patients; 2) the patients are usually asymptomatic, or present with symptoms of chest pain, abdominal pain, and hiccups; 3) the cysts located in the left diaphragm are more than those in the right diaphragm, most of which are located in the area of the left diaphragm crus.

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Anticoagulation-induced unilateral adrenal haemorrhage and pseudoaneurysm

BMJ Case Reports ◽

10.1136/bcr-2019-232539 ◽

2019 ◽

Vol 12 (12) ◽

pp. e232539 ◽

Cited By ~ 1

Author(s):

Yi Th'ng Seow ◽

Zi Qin Ng ◽

Sze Ling Wong

Keyword(s):

Myocardial Infarction ◽

Abdominal Pain ◽

Chest Pain ◽

High Morbidity ◽

Digital Subtraction ◽

Adrenal Haemorrhage ◽

Previously Treated ◽

St Elevation ◽

High Degree ◽

Significant Size

Spontaneous unilateral adrenal haemorrhage (AH) is extremely rare. Its presentation is usually non-specific and requires a high degree of suspicion as it is associated with high morbidity and mortality if diagnosis is delayed. Hereby, we present a case of 67-year-old man with significant cardiac history presented with right-sided chest pain and non-specific abdominal pain. He was previously treated for non-ST elevation myocardial infarction 5 days ago prior to the current presentation. CT scan of abdomen and pelvis demonstrated a right-sided active AH. The patient subsequently underwent digital subtraction angiography. Angio-embolisation was attempted for the pseudoaneurysm but failed due to spasm of the vessel. He was managed conservatively and discharged after clinical improvement. Clinic review 6 months later showed significant size reduction of the pseudoaneurysm.

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Diagnostic anticipation to reduce emergency department length of stay: a cohort study in Ferrara University Hospital, Italy

10.21203/rs.3.rs-20219/v1 ◽

2020 ◽

Author(s):

Andrea Strada ◽

Niccolò Bolognesi ◽

Lamberto Manzoli ◽

Giorgia Valpiani ◽

Chiara Morotti ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Abdominal Pain ◽

Chest Pain ◽

Length Of Stay ◽

Diagnostic Algorithm ◽

University Hospital ◽

Blood Tests ◽

Traumatic Bleeding ◽

Ed Crowding

Abstract Background : Emergency Department (ED) crowding reduces staff satisfaction and healthcare quality and safety, which in turn increase costs. Despite a number of proposed solutions, ED length of stay (LOS) - a main cause of overcrowding - remains a major issue worldwide. This cohort study was aimed at evaluating the effectiveness on ED LOS of a procedure called “diagnostic anticipation”, which consisted in anticipating the ordering of blood tests by nurses, at triage, following a diagnostic algorithm approved by physicians. Methods : In the second half of 2019, the ED of the University Hospital of Ferrara, Italy, adopted the diagnostic anticipation protocol on alternate weeks for all patients with chest pain, abdominal pain, and non-traumatic bleeding. Using ED electronic data, LOS independent predictors were evaluated through multiple regression. Results : During the weeks when diagnostic anticipation was adopted, as compared to control weeks, the mean LOS was shorter by 18.2 minutes for chest pain, but longer by 15.7 minutes for abdominal pain, and 33.3 for non-traumatic bleeding. At multivariate analysis, adjusting for age, gender, triage priority and ED crowding, the difference in visit time was significant for chest pain only (p<0.001). Conclusions : The effectiveness of the anticipation of blood testing by nurses varied by patients' condition, being significant for chest pain only. Further research is needed before the implementation, estimating the potential proportion of inappropriate blood tests and ED crowding status

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A High Urinary Urobilinogen / Serum Total Bilirubin Ratio Reported in Abdominal Pain Patients Can Indicate Acute Hepatic Porphyria

10.21203/rs.3.rs-587707/v2 ◽

2021 ◽

Author(s):

Chengyuan Song ◽

Shaowei Sang ◽

Yuan Liu

Keyword(s):

Abdominal Pain ◽

Roc Curve ◽

Total Bilirubin ◽

Correct Diagnosis ◽

Clinical Manifestations ◽

Total Bilirubin Level ◽

Serum Total Bilirubin ◽

Control Groups ◽

Diagnostic Dilemma ◽

Laboratory Test Results

Abstract Background: Due to its variable symptoms and nonspecific laboratory test results during routine examinations, acute hepatic porphyria (AHP) has always been a diagnostic dilemma for physicians. Correct diagnosis mainly depends on the elevated urinary porphobilinogen (PBG) level, which is not a routine test performed in the emergency department. Therefore, identifying a more convenient indicator during routine examinations is important to improve the diagnosis of AHP.Methods: In this retrospective study, we enrolled 12 AHP patients and 100 patients with abdominal pain of other causes as the control groups in Qilu hospital of Shandong University between 2015 and 2021. The clinical manifestations and laboratory result data including urinary urobilinogen/serum total bilirubin ratio were compared between these two groups. The diagnostic performance of urinary urobilinogen/serum total bilirubin ratio was measured as sensitivity, specificity, and accuracy. The cut-off for optimal clinical performance was determined by the receiver operator characteristic (ROC) curve. Results were considered significant at a P < 0.05.Results: Compared with the control groups, AHP patients showed a significantly higher urinary urobilinogen level (P < 0.05). However, we showed that the higher urobilinogen level was caused by a false-positive result due to elevated urine PBG. Hence, we used serum total bilirubin, an upstream substance of urinary urobilinogen synthesis, for calibration. A remarkable increase in the urinary urobilinogen/serum total bilirubin ratio was observed in AHP patients. The area under the ROC curve of this ratio for AHP was 1.000 (95% confidence interval, 1.000–1.000, P < 0.01). A cutoff value of 3.22 for the urinary urobilinogen/serum total bilirubin ratio yielded a sensitivity of 100% and a specificity of 100% to distinguish AHP patients from the controls.Conclusion: A reported high urinary urobilinogen level that was adjusted by the serum total bilirubin level (urinary urobilinogen/serum total bilirubin ratio) could be used as a sensitive and specific indicator for AHP in patients with abdominal pain.

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Doxycycline-Induced Gastric Perforation

The American Surgeon ◽

10.1177/00031348211047494 ◽

2021 ◽

pp. 000313482110474

Author(s):

Yeahwa Hong ◽

Christopher Staniorski ◽

Dean Pollack ◽

Steven Evans

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Chest Pain ◽

Adverse Effects ◽

Diagnostic Criteria ◽

Gastric Perforation ◽

Mucosal Injury ◽

First Case ◽

Life Threatening

Esophageal and gastric mucosal injuries are well-documented adverse effects of doxycycline leading to odynophagia, chest pain, and abdominal pain. There are no clear diagnostic criteria for such adverse effects; hence, the diagnosis depends heavily on thorough history. There is a paucity of literature describing life-threatening complications from doxycycline-induced mucosal injury, such as hemorrhage and perforation. We present the first case report describing a gastric perforation from doxycycline use.

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