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.

Pemenuhan Kebutuhan Oksigenasi Pasien Asthma Bronchiale dengan Teknik Relaksasi Batuk Efektif

Bronchial asthma is a disease of respiratory tract obstruction caused by muscle contraction, inflammation, and accumulation of secretions around the bronchi. Meeting the need for oxygenation is part of the management of asthmatic bronchial patients. This case study aims to describe the fulfillment of oxygenation needs. The case study method uses a descriptive design with a nursing care approach in the same two cases, namely respondents with bronchial asthma. The case study was conducted at the Putri Hijau Kindergarten II Hospital from October to December 2018. The data collection method was through interviews, physical examinations, supporting examinations, using the assessment format as an instrument in data collection. After intervention with effective cough relaxation techniques as well as collaboration in the administration of drug and oxygen therapy, during four days of treatment, both respondents were able to meet their oxygenation needs optimally. It was concluded that the intervention had an effect on the effectiveness of airway clearance so as to eliminate shortness of breath, based on this study, it is hoped that it can be applied by health workforce.

Conservative Management of the Duodenal Injury during Percutaneous Nephrostomy Placement: A Few and Far between Complications of the Urological Literature

Herein, we reported a duodenal perforation case as an intestinal injury during a percutaneous nephrostomy procedure. A 73-year-old woman with bilateral nephrostomy catheters was applied to the emergency service with right flank pain. Early in the day, her bilateral nephrostomy catheters had been changed. On physical examination, she had a defense and rebound at her right quadrant, and costovertebral angle tenderness was also positive. In the contrast-enhanced abdominal computed tomography scan, the right nephrostomy catheter was located in the second part of the duodenum, and the contrast agent did not leak into the peritoneum from the injury area. We decided on conservative management of the case with active surveillance using daily blood tests and physical examinations. The nephrostomy catheter in the duodenum was left to prevent fistula between the duodenum and the skin, and a new one was placed in the right kidney. The broad spectrum antibiotherapy regime was applied, and the patient was followed up closely. The catheter in the duodenum was removed on the 20th day, uneventfully, and the patient was discharged successfully on the 24th day with her permanent bilateral nephrostomy tubes. On the first follow-up, one month later, the patient had no active medical complaint.

Association of Sarcopenia with Osteopenia and Osteoporosis in Community-Dwelling Older Korean Adults: A Cross-Sectional Study

Sarcopenia and bone disorders, such as osteopenia and osteoporosis, are common musculoskeletal disorders in older adults. Therefore, this study aimed to establish the association between sarcopenia and bone disorders such as osteoporosis and osteopenia according to sex. We analyzed 3077 participants from the 2008–2011 Korean National Health and Nutrition Examination Survey aged 65 years or older. After adjusting for all covariates, such as physical examinations, exercise, and nutrient intake (model 4), the odds ratios for the association between sarcopenia and bone disorders were 2.051 (95% confidence interval [CI]: 1.498–2.808) in osteopenia and 2.258 (95% CI: 1.584–3.218) in osteoporosis. However, when sex was analyzed separately, the odds ratio was significantly different in men (osteopenia—2.068, 95% CI: 1.462–2.924; osteoporosis—3.247, 95% CI: 1.953–5.399), but not in women. Therefore, the results of this study show an association between sarcopenia and bone disorders in older Korean adults. Sarcopenia is significantly related to osteopenia and osteoporosis, especially in men, when stratified by sex.

Blood Concentrations and Dietary Intake of Cd among the General Population in South Korea

This study aimed to identify the time trends of blood Cd concentrations and their correlation with the Cd-B and the intakes of food groups as an influencing factor for Cd exposure among the general population in South Korea. During seven Korea National Health and Nutrition Examination Surveys from 2005 to 2017, a total of 9578 individuals (4317 men and 5261 women) participated in a 24 h recall test for a dietary survey and a blood-metal survey using physical examinations performed in the same survey year. The blood Cd concentration was observed to decrease significantly (p < 0.05) from 1.51 µg/L in 2005 to 0.76 µg/L in 2017. In terms of the food groups, grains and cereals, potatoes and starch, and fruits were significantly correlated with the corresponding Cd concentrations and also showed decreased intakes. For Koreans, the observed decrease in blood Cd concentrations was probably caused by a decrease in the intake of food groups of plant origin.

Clinical Features and Ultrasound Findings of a Rare Musculoskeletal System Disease--neuromuscular Choristomas

Background: Neuromuscular choristomas (NMCs) as exquisitely rare developmental lesions have previously been established associated with recurrent fibromatosis after surgery, led to multiple operations, or even amputation. Yet, the report about ultrasound imaging features and clinical conditions of NMCs was rare. The purpose of this study was to describe the ultrasound features and clinical analysis of NMCs to provide suggestions to the optimal management strategy.Methods: From 2020 September to 2021 September, 7 patients with a confirmed diagnosis of NMC who underwent ultrasound examination in our department were enrolled into our study. Physical examinations were performed to detect motor deficit, sensory deficit, neuropathic pain, limb undergrowth, muscular atrophy, cavus foot and bone dysplasia. Ultrasound imaging were performed and investigated in both involved nerve and neuromuscular choristomas associated desmoid-type fibromatosis (NMC-DTF). All patients had a definite history and regular follow up. The clinical course, physical examinations, ultrasound features and pathologic results of NMC patients were analyzed.Results: Seven patients with an average age of 7.0±7.2 years (range: 2-22 years) were enrolled into our study. Nerves involved included the sciatic nerve (6 cases) and the brachial plexus (1 case). 6 patients (85.7%) presented with manifestations of limb undergrowth, 6 (85.7%) with muscular atrophy, and 5 (71.4%) with cavus foot deformity. Based upon ultrasound findings, all visible involved nerve segments presented with hypoechoic and fusiform enlargement with intraneural skeletal muscle elements. Five patients (71.4%) had NMC-DTFs at the site of the affected nerve. All NMC-DTFs were shown as hypoechoic solid lesion adjacent to the nerve and well-circumscribed. In the subset of surgery group, all 5 patients presented with progression to NMC-DTFs at the site of the NMCs. No fibromatosis was detected in the other two non-surgery patients. Conclusions: Understanding of the typical ultrasound features and clinical associated conditions would help to early diagnose the rare disease. When a potential diagnosis is made, invasive procedure like biopsy or resection might be not a good choice given frequent complication by aggressive recurrence.

The association between educational level and multimorbidity among adults in Southeast Asia: A systematic review

Background In Southeast Asia, the prevalence of multimorbidity is gradually increasing. This paper aimed to investigate the association between educational level and multimorbidity among over 15-years old adults in Southeast Asia. Methods We conducted a systematic review of published observational studies. Studies were selected according to eligibility criteria of addressing definition and prevalence of multimorbidity and associations between level of education and multimorbidity in Southeast Asia. The Newcastle-Ottawa Scale (NOS) was used to measure the quality and risk of bias. The methodology has been published in PROSPERO with registered number ID: CRD42021259311. Results Eighteen studies were included in the data synthesis. The results are presented using narrative synthesis due to the heterogeneity of differences in exposures, outcomes, and methodology. The prevalence of multimorbidity ranged from 1.7% to 72.6% among over 18 years-old adults and from 1.5% to 51.5% among older people (≥ 60 years). There were three association patterns linking between multimorbidity and education in these studies: (1) higher education reducing odds of multimorbidity, (2) higher education increasing odds of multimorbidity and (3) education having no association with multimorbidity. The association between educational attainment and multimorbidity also varies widely across countries. In Singapore, three cross-sectional studies showed that education had no association with multimorbidity among adults. However, in Indonesia, four cross-sectional studies found higher educated persons to have higher odds of multimorbidity among over 40-years-old persons. Conclusions Published studies have shown inconsistent associations between education and multimorbidity because of different national contexts and the lack of relevant research in the region concerned. Enhancing objective data collection such as physical examinations would be necessary for studies of the connection between multimorbidity and education. It can be hypothesised that more empirical research would reveal that a sound educational system can help people prevent multimorbidity.

Assessment of Thoracic Abnormalities in Premature Infants

Background: There is a large incidence of congenital thoracic abnormalities that manifest as deformities and or defects of anterior chest walls. Thoracic abnormalities in preterm infants may also be associated with malpositioning in the incubator in the presence of respiratory disease and prolonged mechanical ventilation. Immaturity of respiratory and musculoskeletal system need to compromise biomechanical function of thorax. Thus, the purpose of the study is to access the thoracic alteration and the factors associated with its abnormalities in the infants born prematurely. Objective: Assess thoracic alteration in premature infants. Methods: This was an observational study with infants in first year of age, born prematurely with birth weight < 2000g. Exclusion criteria were: major congenital malformations as defined by the centers for disease contol and prevention, grade III/IV intraventricular hemorrhage or preventricular leucomalacia. Physical examinations were performed independently to assess shoulder elevation and thoracic alterations. Results: 34 infants born prematurely were included for the study according to the inclusion criteria from which 20 infants (58.8%) showed thoracic abnormalities and remaining 14 infants (41.1%) were without abnormalities. Conclusion: The prevalence of thoracic abnormalities was high in infants born prematurely, and was associated with pulmonary disease, and may also have compromised the growth rate of these infants during the first year of life.

Persistent Headache Caused by Post-Traumatic External Nasal Neuralgia: A Case Report

A 50-year-old female patient presented with a severe headache characterized by sharp pain localized in the right frontal area above the right eye. The patient’s right nostril was cauterized to stop a nosebleed one year prior to the start of the pain. Physical examinations revealed that the pain was aggravated by touch of the right lateral side of the nose and in severe attacks radiated to the maxillary frontal teeth. Blood tests, magnetic resonance image (MRI) and computer scanning (CT) scan images were all normal. The patient was diagnosed with post-traumatic external nasal neuralgia and symptoms were relieved and nearly resolved completely using a nasal cleanse and lubrication of the nose.

Electrolyte Abnormalities in Children Presenting with Acute Gastroenteritis

Objective: To find out the frequency of electrolyte abnormalities among children with acute gastroenteritis. Study Design: A cross-sectional study. Place and Duration of the Study: The Department of Pediatrics, Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawlakot from July 2020 to December 2020. Material and Methods: A total of 159 children of both genders aged between 1 month to 5 years and presenting with acute gastroenteritis at outpatient or emergency department were included. At the time of enrolment, clinical and physical examinations were performed while medical history and presenting complaints were recorded. Frequency of electrolyte abnormalities like hyponatremia, hypernatremia, hypokalemia and hyperkalemia were noted on a predesigned proforma. Results: In a total of 159 children, 86 (54.1%) were male. Mean age was noted to be 2.1+1.7 years while 69 (43.4%) children were aged between 1 to 3 years. Majority of the children, 104 (65.4%) belonged to rural areas of residence. Abdominal pain, vomiting and lethargy were the other most frequently observed presenting complaints noted among 91(57.2%), 60 (37.7%) and 51 (32.1%) children respectively. Among all children, mean serum sodium was noted to be 140+11.3 meq/L. Hyponatremia was found to be among 45 (28.3%) children while hypernatremia was present in 28 (17.6%) children with AGE. Mean serum potassium was calculated to be 4.2+3.7 mmol/L. Hypokalemia was found to be present among 28 (17.6%) children while hyperkalemia was noted to be among 10 (6.3%) children. Conclusion: Frequency of electrolyte abnormalities was found to be high among children with acute gastroenteritis. Timely identification and treatment of children presenting with acute gastroenteritis coupled with electrolyte abnormalities needs to be done to reduce the morbidity and mortality associated with these diseases. Keywords: Acute gastroenteritis, hypokalemia, hyperkalemia, hypernatremia, hyponatremia