A Multi-attention Collaborative Deep Learning Approach for Blood Pressure Prediction

We develop a deep learning model based on Long Short-term Memory (LSTM) to predict blood pressure based on a unique data set collected from physical examination centers capturing comprehensive multi-year physical examination and lab results. In the Multi-attention Collaborative Deep Learning model (MAC-LSTM) we developed for this type of data, we incorporate three types of attention to generate more explainable and accurate results. In addition, we leverage information from similar users to enhance the predictive power of the model due to the challenges with short examination history. Our model significantly reduces predictive errors compared to several state-of-the-art baseline models. Experimental results not only demonstrate our model’s superiority but also provide us with new insights about factors influencing blood pressure. Our data is collected in a natural setting instead of a setting designed specifically to study blood pressure, and the physical examination items used to predict blood pressure are common items included in regular physical examinations for all the users. Therefore, our blood pressure prediction results can be easily used in an alert system for patients and doctors to plan prevention or intervention. The same approach can be used to predict other health-related indexes such as BMI.

Physical examination performed by general practitioners in 5 community health service institutions in Beijing: an observational study

Background Physical examination is a core component of consultation. Little is known about the status quo of physical examinations performed by general practitioners in community health service institutions in China. The aim of this study was to investigate general practitioners’ performance of physical examinations in consultations. Methods An observational study was conducted in 5 community health service institutions in Beijing between November 2019 and January 2020. Eleven general practitioners were observed for one workday. Information of consecutive consultations was recorded including patient characteristics, reasons for encounter, physical examinations performed by general practitioners, length of consultation time and time spent on specific activities in consultations. Results A total of 682 consultations of 11 general practitioners were recorded. Physical examinations were performed in 126 consultations (15.8%). Physical examination was more likely to be performed in patients visiting with symptoms (P < 0.001). Majority of the 126 physical examinations were distributed in “Head, face, and neck examination” (n = 54, 42.9%) and “Cardiovascular examination” (n = 55, 43.7%). No physical examination was performed on skin, male genitalia, female breasts and genitalia, and neurological systems. Total 2823 min of activities were observed and recorded. General practitioners only spent 3.1% of the recorded time on physical examination, which was less than the time spent on taking history (18.2%), test (4.9%), diagnosis (22.7%), therapy (38.4%), and health education (8.6%). The average time spent on physical examinations was 0.8±0.4 min per consultation. Conclusion Physical examination was insufficiently performed by general practitioners in community health service institutions in Beijing. More time and commitment should be advocated for improving the quality of physical examinations in primary care.

Iron-Deficiency Anemia Related to Ancylostoma duodenale Infection in 67 Years Old Female Patient

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.

Health care utilization following “digi-physical” assessment compared to physical assessment for infectious symptoms in primary care

Background The use of chat-based digital visits (eVisits) to assess infectious symptoms in primary care is rapidly increasing. The “digi-physical” model of care uses eVisits as the first line of assessment while assuming a certain proportion of patients will inevitably need to be further assessed through urgent physical examination within 48 h. It is unclear to what extent this approach can mitigate physical visits compared to assessing patients directly using office visits. Methods This pre-COVID-19-pandemic observational study followed up “digi-physical” eVisit patients (n = 1188) compared to office visit patients (n = 599) with respiratory or urinary symptoms. Index visits occurred between March 30th 2016 and March 29th 2019. The primary outcome was subsequent physical visits to physicians within two weeks using registry data from Skåne county, Sweden (Region Skånes Vårddatabas, RSVD). Results No significant differences in subsequent physical visits within two weeks (excluding the first 48 h) were noted following “digi-physical” care compared to office visits (179 (18.0%) vs. 102 (17.6%), P = .854). As part of the “digital-physical” concept, a significantly larger proportion of eVisit patients had a physical visit within 48 h compared to corresponding office visit patients (191 (16.1%) vs. 19 (3.2%), P < .001), with 150 (78.5%) of these eVisit patients recommended some form of follow-up by the eVisit physician. Conclusions Most eVisit patients (68.9%) with respiratory and urinary symptoms have no subsequent physical visits. Beyond an unavoidable portion of patients requiring urgent physical examination within 48 h, “digi-physical” management of respiratory and urinary symptoms results in comparable subsequent health care utilization compared to office visits. eVisit providers may need to optimize use of resources to minimize the proportion of patients being assessed both digitally and physically within 48 h as part of the “digi-physical” concept. Trial registration Clinicaltrials.gov identifier: NCT03474887.

The Effect of Parental Social Integration on the Physical Examination Utilization for Young Migrant Children: A National Cross-Sectional Study in China

Purpose: Physical examination is a key component of child health management. Migrant children are a vulnerable group with lower healthcare service utilization, and this study aims to explore the effect of parental social integration on the physical examination service utilization for young migrant children under 6 years old in China.Method: This study conducted a secondary data analysis of the 2014 National Internal Migrant Dynamic Monitoring Survey in China. A total of 2,620 participants were included in this study. A total of 22 indicators were selected to measure social integration. Multivariate logistic regression was used to explore the association between parental social integration and physical examination use of young migrant children.Results: More than half (66.4%) of the migrant children aged 0–6 years had used free physical examination. Parental social integration, especially structural integration, was associated with the physical examination utilization of migrant children. Specifically, those migrant children's parents who had medical insurance (P &lt; 0.05; OR = 1.29), who had participated in local activities (P &lt; 0.001; OR = 1.98), who had registered local residents as neighbors (P &lt; 0.05; OR = 1.34), and who had a deep sense of self-identity (P &lt; 0.05; OR = 1.09) were more likely to take children to use physical examination.Conclusions: This study provided evidence that parental social integration was associated with migrant children's physical examination utilization, and this association was multifaceted, lying in the dimensions of economic, structural, and psychological integration. Improving the social integration of migrant parents would be effective to enhance the migrant children's healthcare service utilization.

INVESTIGATIONS AND DIAGNOSIS OF GIANT PERIURETHRAL CONDYLOMA AND EFFICACY OF THE MANAGEMENT WITH CONVENTIONAL APPROACH: A CASE REPORT

Objective: This study aims to show our first case of female with periurethral condyloma and how we managed it. Case(s) Presentation: A 40-year-old female came with asymptomatic lesion in the genital area for 4 months, without any history of promiscuity. The physical examination showed a mass of 5 x 5 cm located in the periurethral area. The patient underwent mass excisions without any complication, further pathological examination confirmed the diagnosis of CA. Discussion: After operation and discharge there are no sign of recurrence after 6 months follow up. Conclusion: Despite the rare occurrence in periurethral region, clinicians should be aware of CA case in female and for our first case we used mass excision with satisfactory result.

Experience of using an integrated approach in the diagnosis of temporomandibular joint dysfunction

The article presents a clinical case of the diagnostics and treatment of the temporomandibular joint dysfunction (TMJ) in patient after orthodontic treatment. The hypertonia of masticatory muscles, limit of mouth opening and deviation of the jawbone to the right were observed during physical examination. Adhesion of the disk to the articular tubercle of the right temporal bone was detected on MRI. Hyperrotation of the articular head and the deviation of the jawbone to the right were observed on the charts during axiography. Disappearing of the feeling of heaviness in the right TMJ, free mouth opening, absence of deviation symptom, and the reduction of the rigidity of the masseter muscles were observed on the basis of diagnostic examinations after treatment. Presented clinical experience lets us make a conclusion that it is necessary to prescribe taking axiography and MRI during diagnosing and treating temporomandibular joint dysfunction.

A Case of Unrelenting Facial Swelling

Melkersson-Rosenthal syndrome (MRS) is an uncommon disorder with presenting symptoms that typically involve the face and orofacial structures. It is a difficult diagnosis to make, as it may present with a protracted course of seemingly unrelated dermatological, ocular, and neurological findings. This case report reviews the presentation, workup, and diagnosis of a 75-year-old woman who presented with orofacial swelling, facial palsy, and tongue fissuring that had intermittently recurred over 10 years without a unifying diagnosis. Extensive medical history, photography, laboratory workup, and radiographic imaging were performed to identify the diagnosis of MRS in this patient. Our case highlights the challenge and importance of critically evaluating and consolidating a patient’s history of their present illness, physical examination, and ancillary testing to successfully establish a unifying diagnosis, especially when the diagnosis is relatively rare and diverse in its range of affected populations and symptomatology.