Independent Predictors of In-Hospital Mortality in Elderly and Non-elderly Adult Patients Undergoing Emergency Admission for Hemorrhoids

Background The study explored determinants of mortality of admitted emergently patients with the primary diagnosis of hemorrhoids, during the years 2005-2014. Methods Demographics, clinical data, and outcomes were obtained from the National Inpatient Sample, 2005-2014, in elderly (65+ years) and non-elderly adult patients (18-64 years) with hemorrhoids who underwent emergency admission. Multivariable logistic regression model with backward elimination was used to identify predictors of mortality. Results 25 808 adult and 26 978 elderly patients were included. Female patients consisted of 42.5% and 59.3% in adult and elderly, respectively. 42 (.2%) adults died, of which 50% were female and 125 (.5%) elderly patients died, of which 60% were female. Mean (SD) age of the adult patients was 47.8 (11) years and in elderly patients was 78.7 (8) years. 82.2% and 85.7% had internal hemorrhoids in adult and elderly patients, respectively. 9326 (36.1%) adult and 7282 (27%) elderly patients underwent an operation. In the final multivariable logistic regression model for adult patients with operation, delayed operation and invasive diagnostic procedures increased the odds of mortality, whereas in elderly patients, delayed operation and frailty index were the risk factors of mortality. In both adults and elderly with no operation, increased hospital length of stay (HLOS) significantly increased the odds of mortality, and undergoing an invasive diagnostic procedure significantly decreased the odds of mortality. Conclusion In all operated patients, increased time to operation and undergoing an invasive diagnostic procedure were the risk factors for mortality. On the other hand, in non-operated emergency hemorrhoids patients, increased age and increased HLOS were the risk factors for mortality while undergoing an invasive diagnostic procedure decreased the odds of mortality.

Risk Factors of Mortality in Patients Hospitalized With Chronic Duodenal Ulcers

Background We aimed to identify risk factors of mortality in patients hospitalized with duodenal ulcers (DUs). Methods A National Inpatient Sample–based retrospective cohort study from 2005 to 2014 was conducted on patients undergoing emergency admission for chronic DUs. Demographics, clinical data, and outcomes were collected. Multivariable logistic regression model was applied to find the risk factors of mortality. Results 70 641 patients were included in this study, of which 30 525 (43%) were non-elderly (< 65 years) and 40 116 (57%) were elderly (65+ years) patients. 72% of non-elderly and 57% of elderly patients were males. Mortality rate of men vs women was similar in non-elderly group (1.9% vs 2%, respectively), whereas it significantly differed in elderly patients (4.5% vs 5.3%, respectively, P<.0001). Time to operation was 1.15 (1.83) days in survived vs 1.55 (3.86) days in deceased non-elderly patients ( P < .001). Time to operation was .85 (1.73) days in survived vs 1.79 (7.28) days in deceased elderly patients ( P < .001). In patients with operation, age, delayed operation, frailty, and presence of perforation were the main risk factors of mortality in both elderly and non-elderly patients. Invasive diagnostic procedure was shown as a protective factor in elderly patients. In the final model for patients with no operation, age, hospital length of stay, and frailty were the main risk factors of mortality in both elderly and non-elderly patients. Invasive diagnostic procedure was revealed as a protective factor in all patients as well. Conclusion Early operation in patients with DU requiring surgical intervention is essential to improve the outcomes.

Diagnozowanie logopedyczne uczniów w czasie pandemiiDiagnozowanie logopedyczne uczniów w czasie pandemii

Speech plays an extremely important role in interpersonal communication. Often times, speech does not develop according to the norm. The time of the pandemic is a very difficult time for specialists. Not an easy moment for a quick, reliable diagnosis. The article clarifies the issues of diagnosis and speech therapy. It talks about a reliable diagnosis, which is determined by many factors, opinions, and specialist research. The article focuses on specific conceptual terminology in the field of speech therapy diagnostics. It allows for the emergence of a consistent diagnostic procedure. He brings us closer to the difficult time of therapeutic work during remote learning. It shows us the difficult access to medical specialists such as a neurologist, ENT specialist, phoniatrist and others. Speech therapy care is designed to preventive and diagnostic measures. The work of a speech therapist is taking preventive measures to prevent speech defects and disorders. Supporting preventive activities, including in the field of teachers. Speech therapist Conducts screening tests to determine the speech of students. Organizing speech therapy assistance. These are activities in the field of living word culture. First of all, it shows us how many students use speech therapy in educational institutions. The aim of this article is to show the difficult work of a speech therapist in times of a pandemic. With what obstacles on the way to beautiful Polish pronunciation a modern specialist. Under what conditions do therapists work, wanting to further fulfill themselves as therapists who want to help.

Multilocus Sequence Typing of Non-JP2 Serotype b Aggregatibacter actinomycetemcomitans Strains of Ghanaian and Swedish Origin

Objective and MethodsThe Gram-negative bacterium, Aggregatibacter actinomycetemcomitans is associated with periodontitis affecting young individuals. The geographic dissemination of the highly leukotoxic JP2 genotype of serotype b of this species was previously studied by multilocus sequence typing (MLST). Here, we have used MLST to genetically characterize non-JP2 genotype strains of serotype b, isolated from individuals living in Ghana (n=41), and in Sweden (n=13), respectively.ResultsThe MLST analysis revealed a total of nine sequence types (ST). Both Ghanaian and Swedish isolates were distributed in ST 1-3. ST 5 and 6 were only identified among the Ghanaian strains, whereas ST 4, 7, 8 and 9 were uniquely represented among the Swedish strains. Previously, we characterized these non-JP2 genotype strains of A. actinomycetemcomitans serotype b by arbitrarily-primed (AP)-PCR, which distributed them into three groups, AP-PCR type 1, 2, and 3, respectively. AP-PCR type 1 strains are generally highly leukotoxic, and are associated with progression of periodontal attachment loss. As AP-PCR type 1 includes both JP2 genotype strains and a proportion of non-JP2 genotype strains of serotype b, a straightforward diagnostic procedure has been sought. This has revealed a gene, cagE, which appears to be conserved only in this AP-PCR type. According to our results, MLST was not a highly discriminatory method to identify AP-PCR type 1, as strains of this AP-PCR type could be found within three different ST: ST 2, ST 3 and ST 8.ConclusionAccording to MLST, a geographic dissemination of non-JP2 genotype A. actinomycetemcomitans serotype b appears to exist. However, aiming to identify carriers of AP-PCR type 1, non-JP2 genotype serotype b, PCR with cagE-specific primers is likely the most efficient diagnostic procedure known today.

What an Interventionalist Needs to Know About INOCA

Ischaemia with non-obstructed coronary artery disease (INOCA) remains a diagnostic and therapeutic challenge. An anatomical investigation-based approach to ischaemic heart disease fails to account for disorders of vasomotion. The main INOCA endotypes are microvascular angina, vasospastic angina, mixed (both) or non-cardiac symptoms. The interventional diagnostic procedure (IDP) enables differentiation between clinical endotypes, with linked stratified medical therapy leading to a reduced symptom burden and a better quality of life. Interventionists are therefore well placed to make a positive impact with more personalised care. Despite adjunctive tests of coronary function being supported by contemporary guidelines, IDP use in daily practice remains limited. More widespread adoption should be encouraged. This article reviews a stratified approach to INOCA, describes a streamlined approach to the IDP and highlights some practical and safety considerations.

Serial Inhibin B Measurements in Boys with Congenital Monorchism Indicate Compensatory Testicular Hypertrophy in Early Infancy

Aim Congenital monorchism is considered a condition in which an initially normal testis has existed but subsequently atrophied and disappeared due to a third trimester catastrophe (presumably torsion). Since inhibin B concentrations appear related to Sertoli and germ cells number, we evaluated pre- and postoperative inhibin B of boys with congenital monorchism to determine whether the well-known hypertrophy of the contralateral testis was reflected in inhibin B concentrations. Materials and Methods Twenty-seven boys consecutively diagnosed with congenital monorchism (median age 12 months) underwent follow-up with reproductive hormones 1 year postoperatively (median age 25 months). The results were compared with inhibin B of 225 boys with congenital nonsyndromic unilateral cryptorchidism, by converting values to multiple of the median (MoM) for age in normal boys. Results Ten boys (37%) had blind-ending vessels and ductus deferens (vanished testis) and the remaining (63%) had testicular remnants. At the time of diagnostic procedure, monorchid boys did not have significantly lower inhibin B (median 114, range 20–208) than unilateral cryptorchid boys (136, 47–393) (p = 0.27). During follow-up, MoM values of inhibin B increased in monorchid boys (median 0.59 to 0.98) and in unilateral cryptorchid boys (0.69 to 0.89) (both p < 0.0001). Compared with the concentration at surgery, an additional 44% monorchid boys had inhibin B MoM values higher than 1.0, whereas only additional 23% of unilateral cryptorchid boys exhibited such values (p = 0.04). Conclusion Generally, inhibin B MoM values were normalized during follow-up in boys with congenital monorchism, reflecting compensatory hypertrophy within the first 2.5 years of life. The compensatory capacity to increase was better in monorchism than in unilateral cryptorchidism.

Role of Vascular Ultrasonography in Patients with Leg Swelling

There are many causes of leg swelling or edema. Leg edema due to systemic condition or disease demonstrates chronic, bilateral features, whereas leg edema caused by vascular disease shows more complex clinical features including secondary skin changes and ulcerative lesion, resulting in more complicated clinical outcomes with less frequent early diagnosis and appropriate management. Definite differential diagnosis might not be possible by medical history, clinical features, and physical findings. Vascular ultrasonography (Duplex ultrasound) can be used easily as a bedside diagnostic procedure and is a recommended diagnostic tool for differentiation of a non-vascular from vascular etiology in patients with leg swelling.

Pain and discomfort in violation of bowel movements in children – an actual problem

Pain and discomfort during bowel movements in children are among the most common symptoms in the modern civilized world. The most common cause of these symptoms is chronic constipation, which is often treated by a pediatrician or pediatric gastroenterologist. In differen­tial diagnosis, it is very important to distinguish between chronic symptomatic constipation and functional (without an organic basis), which are most common in childhood. Organic causes of constipation are usually dealt with in cooperation with specialized specialists. The main patho­physiological mechanisms of functional constipation are stress, pain during emptying, and fear of further painful bowel movements. The clinical picture is dominated by in­frequent and difficult defecation of a large amount of hard stools. If the history, laboratory and other additional stud­ies indicate functional constipation, and there are no warn­ing signs of chronic symptomatic constipation, complex treatment can be started. Therapy includes psychological preparation of the patient and his family, working with the correct technique of defecation, dietary and regimen mea­sures, sufficient physical activity, the use of osmotic lax­atives. The presence of warning signs requires a rational differential diagnostic procedure, which varies depending on the age of the child.