Traumatic Diaphragmatic Hernia: Management and Review

Traumatic diaphragmatic injury (TDI) is a fairly uncommon with incidence of 0.8 and 1.6 %, commonest fallowing blunt trauma abdomen. Right-side have higher mortality rate compared to left side and penetrating injuries. It present as occult to obvious. Laparoscopy offers diagnostic and therapeutic tool of care. Lack of awareness of the condition may delay in diagnosis, results life threatening complications. Missed hernia is a known complication of blunt trauma as acute diagnosis can be difficult to ascertain. An early diagnosis and treatment lead to better outcome. In present study CECT revealed acute diaphragmatic hernia, bilateral pleural effusion and hair line fracture of right tibia on skiagram limb. Because of uncertainty in diagnosis of acute diaphragmatic hernia or rupture surgeons faces challenges for the management, high suspicion index required to diagnose the cases. An early diagnosis and treatment lead to better outcome

Content and analysis of a knowledge translation activity for an elder abuse detection tool: a descriptive study

Background Knowledge translation (KT) is challenging to carry out and assess. The content of a program developed to foster KT activities pertaining to the Elder Abuse Suspicion Index (EASI)©, a tool to help identify elder abuse, is described, along with reporting and analysis of some of its outcomes. Methods Enquiries about the use of the EASI were encouraged through completion of a structured questionnaire available on an EASI website. These were submitted by email and guided individualized responses. Descriptive data collated anonymously from the questionnaires described in aggregate corresponders’ occupations, countries of work, information needs about the tool, and intent of use. The processes that generated this data were evaluated as to whether they conformed to established elements of KT. Results One hundred thirty-eight queries were received over 6 years coming from enquirers with 12 different professional backgrounds, working in 25 countries. The information sought aimed to facilitate EASI use in clinical, quality improvement, public health, research, teaching, KT, and commercial ventures. Conclusions This activity, incorporating recognized elements of a KT undertaking, documents specific global interests in elder abuse detection. It suggests a model for researchers to gauge interest in their findings and to promote exchange around them.

Development of a suspicion index for secondary schizophrenia using the Delphi method

Aim: The aim of this study was to develop a suspicion index that aids diagnosis of secondary schizophrenia spectrum disorders in regular clinical practice. Method: We used the Delphi method to rate and refine questionnaire items in consecutive rounds. Differences in mean expert responses for schizophrenia spectrum disorders and secondary schizophrenia spectrum disorders populations allowed to define low/middle/high predictive items, which received different weights. Algorithm performance was tested in 198 disease profiles by means of sensitivity and specificity. Results: Twelve experts completed the Delphi process, and consensus was reached in 19/24 (79.2%) items for schizophrenia spectrum disorders and 17/24 (70.8%) for secondary schizophrenia spectrum disorders. We assigned rounded values to each item category according to their predictive potential. A differential distribution of scores was observed between schizophrenia spectrum disorders and secondary schizophrenia spectrum disorders when applying the suspicion index for validation to 198 disease profiles. Sensitivity and specificity analyses allowed to set a >8/10/16 risk prediction score as a threshold to consider medium/high/very high suspicion of secondary schizophrenia spectrum disorders. Conclusion: Our final outcome was the Secondary Schizophrenia Suspicion Index, the first paper-based and reliable algorithm to discriminate secondary schizophrenia spectrum disorders from schizophrenia spectrum disorders with the potential to help improve the detection of secondary schizophrenia spectrum disorder cases in clinical practice.

Intramucosal duodenal adenocarcinoma concomitant with Saint’s triad

Duodenal tubulovillous adenomas are rare and have malignant potential. Their successful management depends on the preoperative diagnosis and adequate excision. Endoscopic mucosal resection or submucosal dissection can control superficial tumors. Adenocarcinoma of the duodenum may originate in tubular or tubulovillous adenoma, and possible diagnostic challenges occur concerning the endoscopic biopsy findings. We report a 62-year-old female with chronic epigastric burning and a bolus sensation. Upper gastrointestinal endoscopy showed a non-ampullary duodenal tumor, and the biopsy study diagnosed a tubulovillous adenoma. Further mucosectomy revealed an intramucosal adenocarcinoma in a tubulovillous adenoma with a tumor-free pedicle. Besides the intestinal neoplasms, the patient had the diagnosis of classical Saint’s triad; and the manifestations were hiatus hernia, gallbladder disorder, and colonic diverticula. The objective is to report two scarcely described conditions and comment on controversial points of view about the concomitance of Saint’s triad and malignancy. Case reports can reduce late diagnosis, enhancing the suspicion index on rare diseases.

Una storia che zoppica

The paper reports the case of a 5-year-old boy who presented with Perthes’ Disease with a long and underhand history of persistent coxalgia, which later became bilateral. Therefore, the main clinical data were reviewed with a particular focus on the diagnostic process and on those elements of pathogenesis and epidemiology that constitute suspicion index. While it is not a matter of urgency, early diagnosis is a priority. Magnetic resonance imaging represents the diagnostic test, since the radiography in the initial stages of the disease could be negative and the ultrasound can be confusing because it often looks like benign coxalgia. Therapeutic intervention based on severity varies from the use of orthopedic braces to surgery.

Content and Analysis of a Knowledge Translation Activity for an Elder Abuse Detection Tool: A Descriptive Study

Background: Knowledge translation (KT) is challenging to carry out and assess. The content of a program developed to foster KT activities pertaining to the Elder Abuse Suspicion Index (EASI) ©, a tool to help identify elder abuse, is described, along with reporting and analysis of some of its outcomes. Methods: Enquiries about the use of the EASI were encouraged through completion of a structured questionnaire available on an EASI website. These were submitted by email and guided individualized responses. Descriptive data collated anonymously from the questionnaires described in aggregate corresponders’ occupations, countries of work, information needs about the tool, and intent of use. The processes that generated this data were evaluated as to whether they conformed to established elements of KT.Results: 138 queries were received over 6 years coming from enquirers with 12 different professional backgrounds, working in 25 countries. The information sought aimed to facilitate EASI use in clinical, quality improvement, public health, research, teaching, KT, and commercial ventures..Conclusions: This activity, incorporating recognized elements of a KT undertaking, documents specific global interests in elder abuse detection. It suggests a model for researchers to guage interest in their findings and to promote exchange around them.

Validation of imaging reporting and data system of coronavirus disease 2019 lexicons CO-RADS and COVID-RADS with radiologists’ preference: a multicentric study

Background A retrospective multicentric study gathered 1439 CT chest studies with suspected coronavirus disease 2019 (COVID-19) affection. Three radiologists, blinded to other results, interpreted all studies using both lexicons with documentation of applicability and preferred score in assessing every case. The purpose of the study is to assess COVID-19 standardized assessment schemes’ (CO-RADS and COVID-RADS lexicons) applicability and diagnostic efficacy. Results This study included 991 RT-PCR-confirmed CT studies. An almost perfect agreement was found in COVID-RADS among the three observers (Fleiss Kappa = 0.82), opposed by a substantial agreement in CO-RADS (Κ = 0.78). The preference records favor COVID-RADS/CO-RADS in 78.5%/12.5%, 75.5%/24.5%, and 73.4%/24.5% regarding the three radiologists’ records, respectively. The distinguishability between positive and negative RT-PCR cases was 0.92 for COVID-RADS, while it was 0.85 for CO-RADS. On the other hand, both lexicons’ performance regarding clinical diagnosis and clinical suspicion index was 0.93 for COVID-RADS and 0.94 for CO-RADS. A very high to excellent agreement between the three observers for COVID-RADS/CO-RADS preference was concluded (Fleiss Kappa = 0.80 to 0.94). These results were statistically significant (p < 0.001). Conclusion Both lexicon scores (CO-RADS and COVID-RADS) were found to be applicable in the COVID-19 structured report with the preference of COVID-RADS in more than 50% of cases. The diagnostic accuracy of COVID-RADS against RT-PCR was higher than that of CO-RADS.

A Surprising Cause of Contained Aortic Rupture: Perforation from a Lumbar Osteophyte

We describe a patient with contained aortic rupture due to perforation from a protruding lumbar osteophyte, who was treated by open surgery. This case underlines that less common aortic pathologies are possible, which require a high suspicion index to be diagnosed.

Tuberculosis of the Left Calcaneum and Collapsed Right Femoral Head: A Case Report

Introduction: Tuberculosis (TB), one of the oldest diseases known to affect humans, is caused by the bacteria Mycobacterium tuberculosis. The disease usually affects the lungs, although, in up to one-third of cases, other organs are involved. TB of the bone mimics other clinical conditions such as chronic osteomyelitis, Madura mycosis and actinomycosis. Case Report: A fifth child and last-born girl, in a family of living four children, aged 9 years, consulted Kigali University Teaching Hospital (CHUK) on December 7, 2017, from Kibuye Referral Hospital (Western of Rwanda) for ulcerated, infected left heel with swollen foot 4 months before our consultation. Physical examination revealed a patient with swollen and tender foot discharging serous bloody fluids accompanied by inability to stand with a painful right hip. Small left inguinal lymph nodes were present. Blood work-up, computed tomography scan of the left foot, and an incisional biopsy at the level of the left calcaneus were performed and revealed extrapulmonary TB. The histopathological features for TB were scanty, but the high index suspicion of possible extrapulmonary TB led to the confirmation of the diagnosis using auramine-rhodamine special stain. Anti-TB therapy for 12 months course was initiated and the monthly follow-up for 11 months was done. Conclusion: Although calcaneal TB is very rare, in countries with high incidence of TB, clinicians must have a high suspicion index and skeletal TB must be included in differential diagnosis of bone masses whenever possible bone mass biopsy and special staining technique in addition to most common diagnosis means should be done to rule out the possibility of bone TB. Keywords: Calcaneus, tuberculosis, Rwanda.

Detection of Zoonotic Yersinia Infection in Symptomatic and Asymptomatic Dogs in Sokoto State Nigeria

Background: Zoonotic Yersinia infection has been previously reported in humans and animal hosts in Nigeria, occasionally with fulminant disease. Despite earlier evidence of Yersinia pathogen circulating in human and animal populations in Nigeria, studies and suspicion index to Yersinia is below an acceptable average amongst clinicians, diagnosticians, academics and health policy officers. Methods: The deoxycholate Citrate Agar (DCA) was used as a selective media to culture Yersinia, preceded by inoculation in MacConkay agar. Plates with evident growth in the differential media consistent with reported accounts for Yersinia were picked and inoculated in selective medium and left for 48 hours until growth was seen, other samples were left until five days before being discarded as negative. Pure cultures were subjected to a comprehensive biochemical test standard and previously applied for diagnosis and discrimination of Yersinia species. Result: This research recorded an overall microbial prevalence of 30%. Prevalence of Yersinia enterocolitica was 18.3% and Y. pseudotuberculosis 11.7%. Male dogs presented a relative prevalence of Y. enterocolitica 40.9% compared with 59.1% recorded for female dogs. Symptomatic dogs presented a relative prevalence of Y. enterocolitica of 86.4% and Y. pseudotuberculosis of 71.4%