abdominal pain
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2022 ◽  
Vol 8 ◽  
Junfeng Zhong ◽  
Junfeng Hu ◽  
Linling Mao ◽  
Gang Ye ◽  
Kai Qiu ◽  

ObjectiveTo compare the efficacy of intravenous (IV) lidocaine with standard analgesics (NSAIDS, opioids) for pain control due to any cause in the emergency department.MethodsThe electronic databases of PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar were explored from 1st January 2000 to 30th March 2021 and randomized controlled trials (RCTs) comparing IV lidocaine with a control group of standard analgesics were included.ResultsTwelve RCTs including 1,351 patients were included. The cause of pain included abdominal pain, renal or biliary colic, traumatic pain, radicular low back pain, critical limb ischemia, migraine, tension-type headache, and pain of unknown origin. On pooled analysis, we found no statistically significant difference in pain scores between IV lidocaine and control group at 15 min (MD: −0.24 95% CI: −1.08, 0.61 I2 = 81% p = 0.59), 30 min (MD: −0.24 95% CI: −1.03, 0.55 I2 = 86% p = 0.55), 45 min (MD: 0.31 95% CI: −0.66, 1.29 I2 = 66% p = 0.53), and 60 min (MD: 0.59 95% CI: −0.26, 1.44 I2 = 75% p = 0.18). There was no statistically significant difference in the need for rescue analgesics between the two groups (OR: 1.45 95% CI: 0.82, 2.56 I2 = 41% p = 0.20), but on subgroup analysis, the need for rescue analgesics was significantly higher with IV lidocaine in studies on abdominal pain but not for musculoskeletal pain. On meta-analysis, there was no statistically significant difference in the incidence of side-effects between the two study groups (OR: 1.09 95% CI: 0.59, 2.02 I2 = 48% p = 0.78).ConclusionIV lidocaine can be considered as an alternative analgesic for pain control in the ED. However, its efficacy may not be higher than standard analgesics. Further RCTs with a large sample size are needed to corroborate the current conclusions.

2022 ◽  
pp. jrheum.211167
Gang Wang ◽  
Ning Zhuo ◽  
Jingyang Li

We read the recent article by Sugawara et al with great interest.1 The authors described a 65-year-old patient with rheumatoid arthritis who had been treated with methotrexate for 14 years without any adverse effects, yet within the last 6 months had developed fever and abdominal pain when treated with 2 mg/day of tacrolimus and 4 mg of baricitinib.

2022 ◽  
Vol 22 (1) ◽  
Jesper Blinkenberg ◽  
Øystein Hetlevik ◽  
Hogne Sandvik ◽  
Valborg Baste ◽  
Steinar Hunskaar

Abstract Background General practitioners (GPs) and out-of-hours (OOH) doctors are gatekeepers to acute hospital admissions in many healthcare systems. The aim of the present study was to investigate the whole range of reasons for acute referrals to somatic hospitals from GPs and OOH doctors and referral rates for the most common reasons. We wanted to explore the relationship between some common referral diagnoses and the discharge diagnosis, and associations with patient’s gender, age, and GP or OOH doctor referral. Methods A registry-based study was performed by linking national data from primary care in the physicians’ claims database with hospital services data in the Norwegian Patient Registry (NPR). The referring GP or OOH doctor was defined as the physician who had sent a claim for the patient within 24 h prior to an acute hospital stay. The reason for referral was defined as the ICPC-2 diagnosis used in the claim; the discharge diagnoses (ICD-10) came from NPR. Results Of all 265,518 acute hospital referrals from GPs or OOH doctors in 2017, GPs accounted for 43% and OOH doctors 57%. The overall referral rate per contact was 0.01 from GPs and 0.11 from OOH doctors, with large variations by referral diagnosis. Abdominal pain (D01) (8%) and chest pain (A11) (5%) were the most frequent referral diagnoses. For abdominal pain and chest pain referrals the most frequent discharge diagnosis was the corresponding ICD-10 symptom diagnosis, whereas for pneumonia-, appendicitis-, acute myocardial infarction- and stroke referrals the corresponding disease diagnosis was most frequent. Women referred with chest pain were less likely to be discharged with ischemic heart disease than men. Conclusions The reasons for acute referral to somatic hospitals from GPs and OOH doctors comprise a wide range of reasons, and the referral rates vary according to the severity of the condition and the different nature between GP and OOH services. Referral rates for OOH contacts were much higher than for GP contacts. Patient age, gender and referring service influence the relationship between referral and discharge diagnosis.

Healthcare ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 150
Georgios Mavraganis ◽  
Sofia Ioannou ◽  
Anastasios Kallianos ◽  
Gianna Rentziou ◽  
Georgia Trakada

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with a high incidence of arterial and venous thrombotic complications. However, thromboembolic events in unusual sites such as limb and visceral arterial ischemia are reported rarely in the literature. Herein, we describe a rare case of a patient with severe coronavirus disease 2019 (COVID-19) infection who experienced severe abdominal pain during the hospitalization and presented simultaneously renal artery, splenic artery and vein as well as aortic thrombi despite prophylactic antithrombotic treatment. Information about his follow-up post discharge is also provided. This case report raises significant clinical implications regarding the correct dose of antithrombotic treatment during the acute phase of the severe COVID-19 infection and highlights the need for incessant vigilance in order to detect thrombosis at unusual sites as a possible diagnosis when severe abdominal pain is present in severe COVID-19 patients.

2022 ◽  
Vol 6 (3) ◽  
pp. 1455-1459
Widodo Adi Prasetyo ◽  
Armen Ahmad

Background. Ancylostomiasis is an infection caused by hookworms. It is estimated that hookworms infect 1.2 billion people worldwide and cause higher morbidity than other types, mainly due to iron deficiency anemia. Hookworm infection increases with age. The main clinical manifestations are abdominal pain, features of iron deficiency anemia and hypoproteinemia. Diagnosis is based on the finding of characteristic eggs in the stool. Case presentation. A 67-year-old female patient had been administered into the Internal Medicine Ward of Dr. M. Djamil Padang Hospital with the main complaint of weakness, fatigue, and lethargy which had increased since 3 days before being admitted to the hospital. The patient also had complaints of pale skin, fever, heartburn, decreased appetite and weight loss. The patient was admitted to the hospital with awareness of compost mentis, cooperative, and his general condition appeared to be moderately ill, blood pressure 130/90 mmHg, pulse rate 104 x/minute, regular pulse, adequate filling, respiratory rate 22 x/minute, temperature 37.8 C. On physical examination, the conjunctiva of the pantient’s eyes were anemic. Laboratory examination revealed Hemoglobin 4 g/dl, Hematocrit 16%, MCV/MCH/MCHC 62fl/15pg/25g/dL, Reticulocytes 0.5%, SI/TIBC 22/315 mg/dL, Ferritin 8.5 ng/mL, and peripheral blood smear showing severe hypochromic microcytic anemia and relative eosinofilia. Ancylostoma duodenale worm eggs were found on routine stool examination. Final diagnosis was Severe microcytic hypochromic anemia caused by an iron deficiency and Ancylostomiasis. Severe microcytic hypochromic anemia caused by iron deficiency and ancylostomiasis was established based on the patient’s history, physical examination and laboratory investigations. Conclusions. Hookworms infect many people worldwide and cause high morbidity, mainly due to iron deficiency anemia. The highest prevalence is found in the tropics and subtropics, including Indonesia. The main clinical manifestations are abdominal pain, features of iron deficiency anemia and hypoproteinemia. Diagnosis is based on the finding of characteristic eggs in the stool. Albendazole 400 mg single dose resulted in 80% cure and a dose of 200 mg/day for 3 days gave 100% cure. Treatment of anemia is by administering ferrous sulfate or ferrous gluconate orally 200 mg three times a day and continued for up to 3 months after normal hemoglobin levels are achieved to maintain iron stores.

2022 ◽  
Abdulmohsen Alahmad ◽  
Shady Abdulrahman Kamel

BACKGROUND On 10 September 2021, Al-Ahsa General Health Directorate reported unexpected number of patients had presented with gastrointestinal symptoms. All the patients gave a history of sharing a common meal as they ate from dinner was served at the mother's house the day before. OBJECTIVE We investigated to verify the outbreak, determine its magnitude, identify the source and implement control measures. METHODS A retrospective cohort design was conducted. Cases were defined as any person who ate dinner at the family gathering on the 9th of September 2021 and developed any or a combination of the following symptoms: diarrhea, vomiting, fever, or abdominal pain within 26 hours of food consumption. We collected information on demographics, symptoms, and food history using a semi-structured questionnaire. We reviewed hospital records for symptoms and Vital sings. We reviewed available laboratory results for cases, we conducted active case search to identify more cases. statistical analyses were performed using SPSS 21.0. RESULTS Twenty subjects were defined as cases (74%) and seven as non-cases (26%). among cases, 16 were females (80%), and 4 were males (20%). The ages ranged between 2–70 years. Among cases (59.3%) had vomiting, (59.3%) had a fever, (48.1%) developed diarrhea, (25%) abdominal pain. The incubation period ranged from 10-26 hours (mean 17.8). The relative risks and p- value were calculated for food items to assess the association between consumption of individual food items and subsequent illness. Among 8 food items consumed, red pasta with chicken (Relative Risk RR= 3.14, 95% CI = 3.2-424.6) and pizza (RR= 1.73, 95% CI = 1.74-42.2) were significantly associated with illness. CONCLUSIONS According to the epidemiological investigation, symptoms, incubation period, and laboratory results there might be some differential diagnosis, but we were unable to more definitively identify the source of the outbreak. We recommend more education to the households about food safety

2022 ◽  
Vol 4 ◽  
pp. 133-141
Bipin Sohanraj Jain ◽  
Akshata Damodar Nayak

Chronic relapsing pancreatitis in the paediatric age group is a challenging case, especially when presenting in its acute exacerbation. This case report highlights the management of chronic relapsing pancreatitis in a 9-year-old female patient with homoeopathic treatment. The patient reported a year-long history of recurrent fever, abdominal pain, and raising titres of lipase and amylase; she had been admitted to a higher centre twice. The totality was constructed on day 1 and a homoeopathic remedy was prescribed. Detailed case taking, done after a week, confirmed the same remedy. Later, when the patient had an acute exacerbation, the same remedy-frequently repeated, helped settle the acute episode in a couple of days. The patient has been following up regularly for 3 years; the frequency and intensity of relapses reduced considerably over time and there have been no episodes for more than a year.

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