A video of a 55-year-old man with a history of hypertension, tobacco use, hepatitis B and C, hepatic cirrhosis, and cocaine abuse.

ASVIDE ◽  
2021 ◽  
Vol 8 ◽  
pp. 363-363
Author(s):  
Rishabh Kothari ◽  
Scott A. Weldon ◽  
Cuneyt Koksoy ◽  
Joseph S. Coselli
Keyword(s):  
Hepatitis B ◽  
Tobacco Use ◽  
Cocaine Abuse ◽  
Hepatic Cirrhosis ◽  
History Of

scholarly journals A 46-year-Oldman with Gynaecomastia and Cirrhosis Hepatis Child Plug A. A case Report

2021 ◽  
Vol 3 (2) ◽  
pp. 66-71
Author(s):  
Syarifah Dian Rosa Lubis ◽  
Melati Silvani
Keyword(s):  
Hepatitis B ◽  
Hepatic Cirrhosis ◽  
Varicose Veins ◽  
Previous History ◽  
Abdominal Ultrasound ◽  
Case Presentation ◽  
Sexual Drive ◽  
History Of ◽  
Cirrhosis Hepatis ◽  
Bilateral Breast Enlargement

Background:  Gynecomastia is defined as the presence of excessive breast tissue in males, which can appear unilateral or bilateral. Bilateral prepubertal gynecomastia in the absence of endocrine abnormalities is extremely rare, with only a few cases in literature. Case Presentation: A  46-year-old man  presented with a  2 years history of bilateral breast enlargement and pain. There is heartburn, shrinking testicles,  and  decreased sexual drive. Vital  examination showed  normal. BMI  : 24. 0 kg/m².  Head  dan neck: normal. On the chest both breasts are enlarged as avocados, palpable time around areola, chewy contingency, press pain, galactorrhea  negative. Lung and cast are  normal. In  the abdominal: hepar, lien and renal are not palpable, and ascites are not found. There is an atrophy of testicles.  Previous history of hepatic cirrhosis with Esophageal Varicose Veins caused by Hepatitis B. Laboratory examination  Estradiol 98.71 pg/mL (range: <62), Testosterone: 8.66 ng/mL (range: 3.0-10.6), LH5.53 mlU/mL, FSH 6.49 mlU/mL, Prolactin 5.08 ng/mL; Total T4 5.57 ng/dL , TSH 1.84 μIU/mL. SGOT U/L 53, SGPT 71 U/L,  Hepatitis B (+), HBsAg Reactive S/CO 414.46; HBeAg: Non Reactive, HBV DNA Undetectable and Albumin 3.6 g/dL. Fibroscan:  Cirrhosis Hepatis. Abdominal ultrasound:  Cirrhosis Hepatis. Gastroscopy:  Esophageal Varicose Veins (F1, LI, CB) + Pan Gastropathy. Conclusion: Reportedly A 46-year-old man presented with  gynaecomastia bilateral with  Cirrhosis Hepatis Child Plug A, given conservative treatment with tamoxiphen for 1 month

scholarly journals Cross-sectional retrospective analysis of clinical characteristics of chronic hepatitis B patients with oral antiviral treatment in eastern China

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Jueqing Gu ◽  
Guodong Yu ◽  
Xiaoli Zhang ◽  
Shanyan Zhang ◽  
Huan Cai ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Chronic Hepatitis ◽  
Kidney Disease ◽  
Hepatitis B ◽  
Chronic Hepatitis B ◽  
Hepatic Cirrhosis ◽  
Antiviral Treatment ◽  
Eastern China ◽  
History Of

Abstract Background In China, more than 20 million patients with chronic hepatitis B need antiviral treatment. Side effects of antiviral treatment such as renal complications can be problematic, particularly in an aging population. Methods The data were retrospectively extracted from the hospital medical charts of five centers in eastern China from January 1 to December 31, 2018. Results A total of 8309 patients with CHB was enrolled in this study. The median age of the patients was 46 years. The prevalence of diabetes mellitus, hypertension, and hepatic cirrhosis was respectively 3.49%, 4.42%, and 23.72%. The prevalence of these comorbidities increased with age (P < 0.001). Of the patients with CHB, 5332 had complete renal function results. Among them, patients with an estimated glomerular filtration rate of < 60 mL/min/1.73m2 accounted for 4.14%, and those with proteinuria for 8.33%. According to the definition of chronic kidney disease, the proportion of patients with chronic kidney disease was 11.37%. The prevalence of chronic kidney disease increased with age (P < 0.001). In a multivariate analysis, age group [odds ratio (OR) = 2.387], diabetes mellitus (OR = 1.486), hypertension (OR = 2.557), hepatic cirrhosis (OR = 1.295), and a history of exposure to adefovir dipivoxil (OR = 1.644) were significantly associated with CKD (P < 0.05). Among patients with CKD, 17.66% (107/606) had a history of lamivudine exposure, and 34.65% (210/606) had a history of nucleotide analogue exposure Conclusion The management of Chinese patients with CHB should take into consideration age, previous medication history, and renal impairment.

scholarly journals Occupational Sharp Injury and Splash Exposure among Healthcare Workers in a Tertiary Hospital

2021 ◽  
Author(s):  
Roshan Mathew ◽  
Ritin Mohindra ◽  
Ankit Sahu ◽  
Rachana Bhat ◽  
Akshaya Ramaswami ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hepatitis B ◽  
Healthcare Workers ◽  
Hepatitis B Surface Antigen ◽  
Tertiary Hospital ◽  
Needle Stick Injury ◽  
Medical Procedures ◽  
Immunodeficiency Virus ◽  
History Of ◽  
Hepatitis C Virus Antibody

Abstract Background Occupational hazards like sharp injury and splash exposure (SISE) are frequently encountered in health-care settings. The adoption of standard precautions by healthcare workers (HCWs) has led to significant reduction in the incidence of such injuries, still SISE continues to pose a serious threat to certain groups of HCWs. Materials and Methods This was a retrospective study which examined the available records of all patients from January 2015 to August 2019 who self-reported to our emergency department with history of sharp injury and/or splash exposure. Details of the patients, mechanism of injury, the circumstances leading to the injury, status of the source (hepatitis B surface antigen, human immunodeficiency virus, and hepatitis C virus antibody status), and the postexposure prophylaxis given were recorded and analyzed. Data were represented in frequency and percentages. Results During the defined period, a total of 834 HCWs reported with SISE, out of which 44.6% were doctors. Majority of the patients have SISE while performing medical procedures on patients (49.5%), while 19.2% were exposed during segregation of waste. The frequency of needle stick injury during cannulation, sampling, and recapping of needle were higher in emergency department than in wards. More than 80% of HCWs received hepatitis B vaccine and immunoglobulin postexposure. Conclusion There is need for periodical briefings on practices of sharp handling as well as re-emphasizing the use of personal protective equipment while performing procedures.

scholarly journals Clinical judgement in chest pain: a case report 

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Mishita Goel ◽  
Shubhkarman Dhillon ◽  
Sarwan Kumar ◽  
Vesna Tegeltija
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Tobacco Use ◽  
Stress Test ◽  
Artery Bypass ◽  
Pretest Probability ◽  
Clinical Judgement ◽  
Test Results ◽  
Cardiac Stress ◽  
History Of

Abstract Background Cardiac stress testing is a validated diagnostic tool to assess symptomatic patients with intermediate pretest probability of coronary artery disease (CAD). However, in some cases, the cardiac stress test may provide inconclusive results and the decision for further workup typically depends on the clinical judgement of the physician. These decisions can greatly affect patient outcomes. Case presentation We present an interesting case of a 54-year-old Caucasian male with history of tobacco use and gastroesophageal reflux disease (GERD) who presented with atypical chest pain. He had an asymptomatic electrocardiogram (EKG) stress test with intermediate probability of ischemia. Further workup with coronary computed tomography angiography (CCTA) and cardiac catheterization revealed multivessel CAD requiring a bypass surgery. In this case, the patient only had a history of tobacco use but no other significant comorbidities. He was clinically stable during his hospital stay and his testing was anticipated to be negative. However to complete workup, cardiology recommended anatomical testing with CCTA given the indeterminate EKG stress test results but the results of significant stenosis were surprising with the patient eventually requiring coronary artery bypass grafting (CABG). Conclusion As a result of the availability of multiple noninvasive diagnostic tests with almost similar sensitivities for CAD, physicians often face this dilemma of choosing the right test for optimal evaluation of chest pain in patients with intermediate pretest probability of CAD. Optimal test selection requires an individualized patient approach. Our experience with this case emphasizes the role of history taking, clinical judgement, and the risk/benefit ratio in deciding further workup when faced with inconclusive stress test results. Physicians should have a lower threshold for further workup of patients with inconclusive or even negative stress test results because of the diagnostic limitations of the test. Instead, utilizing a different, anatomical test may be more valuable. Specifically, the case established the usefulness of CCTA in cases such as this where other CAD diagnostic testing is indeterminate.

scholarly journals Hepatitis B virus infection and its associated factors among medical waste collectors at public health facilities in eastern Ethiopia: a facility-based cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Degu Abate Mengiste ◽  
Abebe Tolera Dirbsa ◽  
Behailu Hawulte Ayele ◽  
Tewodros Tesfa Hailegiyorgis
Keyword(s):  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Cross Sectional Study ◽  
Medical Waste ◽  
Health Facilities ◽  
Sectional Study ◽  
Cross Sectional ◽  
Eastern Ethiopia ◽  
B Virus ◽  
History Of

Abstract Background The risk of hepatitis B virus infection among medical waste handlers who undergo collection, transportation, and disposal of medical wastes in the health institutions is higher due to frequent exposure to contaminated blood and other body fluids. There is limited evidence on the seroprevalence of hepatitis B among medical waste handlers in eastern Ethiopia. The study was aimed at studying the seroprevalence of Hepatitis B Virus and associated risk factors among medical waste collectors at health facilities of eastern Ethiopia. Methods A facility-based cross-sectional study was conducted among randomly selected medical waste collectors from public health facilities in eastern Ethiopia from March to June 2018. A pre-tested and well-structured questionnaire was used to collect data on socio-demographic characteristics and hepatitis B infection risk factors. A2.5ml venous blood was also collected, centrifuged and the serum was analyzed for hepatitis B surface antigen using the instant hepatitis B surface antigen kit. Descriptive summary measures were done. Chi-square and Fisher exact tests were used to assess the risk of association. Multivariate logistic regression was conducted with 95% CI and all value at P-value < 0.05 was declared statistically significant. Results From a total of 260 (97.38%) medical waste collectors participated, HBV was detected in 53 (20.4%) of the participants [95%CI; 15.8, 25.6]. No significant differences were observed in the detection rates of HBV with respect to socio-demographic characteristics. In both bivariate and multivariable logistic regression analysis, being unvaccinated (AOR = 6.35; 95%CI = [2.53–15.96], P = 0.001), history of blood transfusion (receiving) (AOR; 3.54; 95%CI; [1.02–12.24], P = 0.046), history of tattooing (AOR = 2.86; 95%CI = [1.12–7.27], p = 0.03), and history of multiple sexual partner (AOR = 10.28; 95%CI = [4.16–25.38], P = 0.001) remained statistically significantly associated with HBsAg positivity. Conclusion This cross-sectional study identified that HBV infection is high among medical waste collectors in eastern Ethiopia. Immunization and on job health promotion and disease prevention measures should be considered in order to control the risk of HBV infection among medical waste collectors in eastern Ethiopia.

Cocaine use, abuse and dependence in a population-based sample of female twins

1998 ◽  
Vol 173 (4) ◽  
pp. 345-350 ◽  
Author(s):  
Kenneth S. Kendler ◽  
Carol A. Prescott
Keyword(s):  
Cocaine Abuse ◽  
Genetic Factors ◽  
Model Fitting ◽  
Population Based ◽  
Cocaine Use ◽  
Past Half Century ◽  
History Of ◽  
Population Based Registry ◽  
Twin Resemblance

BackgroundAlthough cocaine use in women has increased substantially over the past half-century, we understand little about the aetiology in women of cocaine use and abuse, and know almost nothing about the role of genetic factors.MethodWe obtained by telephone interview a history of lifetime cocaine use, abuse and dependence from 1934 individual twins from female–female pairs ascertained through a population-based registry, including both members of 485 monozygotic (MZ) and 335 dizygotic (DZ) pairs.ResultsThe prevalence of lifetime cocaine use, abuse and dependence were 14.0%, 3.3% and 2.3%. Probandwise concordance rates, in MZ and DZ twins, respectively, were: cocaine use 54% and 42%; cocaine abuse 47% and 8% and cocaine dependence 35% and 0%. In MZ and DZ twins, odds ratios were: cocaine use 14.2 and 6.7 and cocaine abuse 40.8 and 2.7. Biometrical model-fitting suggested that twin resemblance for liability to cocaine use was due to both genetic and familial–environmental factors while twin resemblance for cocaine abuse and symptoms of dependence was due solely to genetic factors. Estimated heritabilities were: cocaine use 0.39, cocaine abuse 0.79 and symptoms of dependence 0.65.ConclusionsThe vulnerability to cocaine use and particularly cocaine abuse and dependence in women is substantially influenced by genetic factors.

Natural history of hepatitis B

2003 ◽  
Vol 39 ◽  
pp. 50-58 ◽  
Author(s):  
Giovanna Fattovich
Keyword(s):  
Natural History ◽  
Hepatitis B ◽  
History Of
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