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Jensen B, Vardinghus-Nielsen H, Mills EHA, Møller AL, Gnesin F, Zylyftari N, Kragholm K, Folke F, Christensen HC, Blomberg SN, Torp-Pedersen C, Bøggild H. "I just haven't experienced anything like this before": A qualitative exploration of callers' interpretation of experienced conditions in telephone consultations preceding a myocardial infarction. Patient Educ Couns 2023; 109:107643. [PMID: 36716564 DOI: 10.1016/j.pec.2023.107643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Callers with myocardial infarction presenting atypical symptoms in telephone consultations when calling out-of-hours medical services risk misrecognition. We investigated characteristics in callers' interpretation of experienced conditions through communication with call-takers. METHODS Recording of calls resulting in not having an ambulance dispatched for 21 callers who contacted a non-emergency medical helpline, Copenhagen (Denmark), up to one week before they were diagnosed with myocardial infarction. Qualitative content analysis was applied. RESULTS Awareness of illness, remedial actions and previous experiences contributed to callers' interpretation of the experienced condition. Unclear symptoms resulted in callers reacting to their interpretation by being unsure and worried. Negotiation of the interpretation was seen when callers tested the call-taker's interpretation of the condition and when either caller or call-taker suggested: "wait and see". CONCLUSION Callers sought to interpret the experienced conditions but faced challenges when the conditions appeared unclear and did not correspond to the health system's understanding of symptoms associated with myocardial infarction. It affected the communicative interaction with the call-taker and influenced the call-taker's choice of response. PRACTICE IMPLICATIONS Call-takers, as part of the decision-making process, could ask further questions about the caller's insecurity and worry. It might facilitate faster recognition of conditions warranting hospital referral.
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Affiliation(s)
- Britta Jensen
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
| | - Henrik Vardinghus-Nielsen
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | | | - Filip Gnesin
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Nertila Zylyftari
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Kristian Kragholm
- Unit of Clinical Biostatistics and Epidemiology, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark; Copenhagen Emergency Medical Services, University of Copenhagen, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, University of Copenhagen, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Danish Clinical Quality Program (RKKP), National Clinical Registries, Denmark
| | | | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Setyawati AN, Tjahjono DK K, Chionardes MA, Arkhaesi N. Acute acalculous cholecystitis in a pediatric dengue hemorrhagic fever patient: A case report, lesson learned from limited resource setting. Ann Med Surg (Lond) 2022; 81:104437. [PMID: 36147073 PMCID: PMC9486663 DOI: 10.1016/j.amsu.2022.104437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/04/2022] [Accepted: 08/12/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Dengue fever (DF) is endemic in numerous regions of Indonesia with primary clinical features such as high fever as well as pullout of intravascular fluid and albumin leakage, which provokes pleural effusion, hypoproteinemia, and blood hemoconcentration. However, the incidence of abdominal pain as a clinical manifestation of DF, which refers to acalculous cholecystitis, is rare. CASE PRESENTATION An 11-year-old female was admitted to the to hospital with fever, headache, and myalgia. Blood examination resulted in low platelet coua nt and positive IgM Dengue antibody test. On the third day, the patient felt sharp abdominal pain. Abdominal ultrasound showed cholecystitis, cholestasis, pleural effusion, ascites, and laboratory finding showed increased C-reactive protein. The management was conservative and discharged at the 7th day. DISCUSSION The acalculous cholecystitis in Dengue Fever/Dengue Hemorrhagic fever (DF/DHF) is challenging in diagnose due to atypical presentations. Several proposed mechanisms are critical illness, including direct invasion of the gallbladder epithelial cells, vasculitis, stasis of biliary flow, obstruction of the biliary tree, ischemia, and sequestration. The actual mechanism of the dengue virus has been proposed that direct viral incursion of the gallbladder may yield edema and exudation. Abdominal ultrasonography is considered to diagnose acute acalculous cholecystitis (AAC) in children. CONCLUSION Understanding pathophysiology of the acalculous cholecystitis in DF/DHF patients and atypical presentation of sharp abdominal pain help physicians for early diagnosis and management both in monitoring and patient care management. Abdominal ultrasonography can help physicians to diagnose AAC.
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Affiliation(s)
- Amallia Nuggetsiana Setyawati
- Department of Medical Biology and Biochemistry, Faculty of Medicine Diponegoro University, Semarang, Indonesia
- Department of Pediatrics, National Diponegoro Hospital, Semarang, Indonesia
- Division of Pediatrics, Williambooth General Hospital, Semarang, Indonesia
- Corresponding author. Department of Medical Biology and Biochemistry, Faculty of Medicine Diponegoro University, Semarang, Indonesia.
| | - Kusmiyati Tjahjono DK
- Department of Medical Biology and Biochemistry, Faculty of Medicine Diponegoro University, Semarang, Indonesia
| | - Melissa Angela Chionardes
- Department of Medical Biology and Biochemistry, Faculty of Medicine Diponegoro University, Semarang, Indonesia
| | - Nahwa Arkhaesi
- Department of Pediatrics, National Diponegoro Hospital, Semarang, Indonesia
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Yuan H, Ye F, Zhou Q, Feng X, Zheng L, You T, Cao R, Feng D. The Relationship between Atypical Symptoms of Degenerative Cervical Myelopathy and the Segments of Spinal Cord Compression: A Retrospective Observational Study. World Neurosurg 2022; 161:e154-e161. [PMID: 35092814 DOI: 10.1016/j.wneu.2022.01.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with degenerative cervical myelopathy(DCM) often present with atypical symptoms such as vertigo, headache, palpitations, tinnitus, blurred vision, memory loss and abdominal discomfort. This study aims to investigate the relationship between atypical symptoms of DCM and the segments of spinal cord compression. METHODS 166 DCM patients with atypical symptoms admitted to our institution from 2019 to 2020 were divided into vertigo, headache, blurred vision, tinnitus and palpitations groups according to their atypical symptoms; while the typical group was 214 DCM patients with typical symptoms only. Differences in segments of compression were compared between each group. And the results of over one-year follow-up were further summarized for non-surgical and surgical treatment of DCM patients with atypical symptoms. RESULT The incidence of vertigo, headache, blurred vision, tinnitus and palpitations of all DCM patients was 37%, 18%, 15%, 11% and 11% respectively. Compared to the typical group, patients in the blurred vision and tinnitus group were older (P < 0.05) and the incidence of spinal cord compression at C3-5 in the vertigo group, C4-5 in the headache group and C6-7 in the palpitation group was higher (P < 0.05). The scores of vertigo, headache and palpitations decreased after surgical decompression (P < 0.05), whereas only vertigo and headache scores decreased after non-surgical treatment (P < 0.05). CONCLUSION Atypical symptoms were common in patients with DCM and the segments of spinal cord compression might be associated with specific atypical symptoms. Surgical treatment is effective in relieving some of the atypical symptoms.
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Affiliation(s)
- Hao Yuan
- Spinal Surgery Department, The Affiliated Hospital of Southwest Medical University, 646000, Luzhou, China
| | - Fei Ye
- Spinal Surgery Department, The Affiliated Hospital of Southwest Medical University, 646000, Luzhou, China
| | - Qinzhong Zhou
- Spinal Surgery Department, The Affiliated Hospital of Southwest Medical University, 646000, Luzhou, China
| | - Xiaolan Feng
- Department of Imaging, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan province, China
| | - Lipeng Zheng
- Spinal Surgery Department, The Affiliated Hospital of Southwest Medical University, 646000, Luzhou, China
| | - Ting You
- Spinal Surgery Department, The Affiliated Hospital of Southwest Medical University, 646000, Luzhou, China
| | - Renping Cao
- Spinal Surgery Department, The Affiliated Hospital of Southwest Medical University, 646000, Luzhou, China
| | - Daxiong Feng
- Spinal Surgery Department, The Affiliated Hospital of Southwest Medical University, 646000, Luzhou, China.
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Garg K, Aggarwal A. Effect of Cervical Decompression on Atypical Symptoms Cervical Spondylosis-A Narrative Review and Meta-Analysis. World Neurosurg 2021; 157:207-217.e1. [PMID: 34655819 DOI: 10.1016/j.wneu.2021.09.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Atypical symptoms of cervical spondylosis refer to symptoms other than the typical symptoms of cervical spondylosis and include headache, nausea, gastrointestinal discomfort, blurred vision, tinnitus, hypomnesia, and palpitations. The role of cervical decompression in mitigating atypical symptoms of cervical spondylosis is still unclear. METHODS A comprehensive search of different databases was performed to retrieve articles that studied the effect of cervical decompression on associated atypical symptoms. The data were analyzed to obtain pooled improvement in the various atypical symptoms after cervical decompression. RESULTS Twenty-seven studies were included in the meta-analysis. Our analysis showed that cervical decompression was associated with significant improvement in Neck Disability Index-Headache Component (standardized mean difference [SMD], -0.84; 95% confidence interval [CI], -0.94 to -0.74; P < 0.0001), visual analog scale (SMD, -1.47; 95% CI, -1.73 to -1.21; P = 0.0004) and cervicogenic headache (odds ratio [OR], 0.19; 95% CI, 0.06-0.63; P = 0.01). Significant improvement was also observed in vertigo (OR, 0.27; 95% CI, 0.10-0.77; P = 0.02), tinnitus (OR, 0.54; 95% CI, 0.35-0.83; P = 0.02), and nausea (OR, 0.25; 95% CI, 0.13-0.47; P = 0.006) after cervical decompression. Nonsignificant improvement was noticed in the rates of blurred vision, hypomnesia, giddiness, gastrointestinal discomfort, palpitations, and hypertension. CONCLUSIONS Our analysis showed that cervicogenic headache, tinnitus, and nausea were significantly relieved after cervical decompression. There was no significant effect of cervical decompression on blurred vision, hypomnesia, giddiness gastrointestinal discomfort, palpitations, and hypertension.
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Affiliation(s)
- Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Ankita Aggarwal
- Department of Radiodiagnosis, VMMC and Safdarjung Hospital, New Delhi, India
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Isshi K, Furuhashi H, Koizumi A, Nakada K. Effects of coexisting upper gastrointestinal symptoms on daily life and quality of life in patients with gastroesophageal reflux disease symptoms. Esophagus 2021; 18:684-692. [PMID: 33389239 DOI: 10.1007/s10388-020-00801-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/12/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIM Gastroesophageal reflux disease (GERD) is a common disease encountered in daily medical care and clinical problem which hampers daily life and reduces quality of life (QOL). The coexistence of GERD-related symptoms with the typical GERD symptoms, such as heartburn or acid regurgitation, and various upper abdominal symptoms is frequently observed in patients with GERD. However, the effect of these coexisting symptoms on the daily life and QOL of patients with GERD has not been clarified. Therefore, the effects of the various upper abdominal symptoms coexisting with GERD on the daily life and QOL of such patients were compared. METHODS A total of 113 newly diagnosed patients who visited our hospital with typical GERD symptoms were assessed using the modified frequency scale for the symptoms of GERD (MFSSG), gastroesophageal reflux and dyspepsia therapeutic efficacy and satisfaction test (GERD-TEST), and short-form 8-item health survey (SF-8) questionnaires. The "gastroesophageal reflux symptom" (7 items) and "dyspepsia symptom" (7 items) groups were divided into two "typical symptoms" and two "atypical symptoms" for a total of four categories. The Pearson's correlation coefficient and multiple regression analysis were used to evaluate the correlations between each symptom category and dissatisfaction for daily life [eating, sleeping, daily activities, mood, as well as dissatisfaction for daily life-symptom subscale (SS), which is the average of the four items in the GERD-TEST, the physical component summary [PCS] and mental component summary [MCS] of the SF-8, and the influence of each symptom category on the daily life and QOL. RESULTS The incidences of each symptom category in patients with GERD were high: typical GERD (100%), atypical GERD symptoms (67.3%), typical functional dyspepsia (FD) (71.7%), and atypical FD (75.2%). Pearson's correlation analysis demonstrated significant correlations between each symptom category and living status (dissatisfactions of eating, sleeping, daily activities, daily life-SS) and almost all items in SF-8 (PCS, MCS) (P < 0.05). Multiple regression analysis indicated the largest influences of each symptom category on living status and QOL in descending order: dissatisfaction for eating (atypical FD, typical FD), daily activities (atypical FD, typical FD, typical GERD), mood (atypical FD), daily life-SS (atypical FD, typical FD), PCS (typical FD), and MCS (atypical FD) (P < 0.05). CONCLUSION Coexisting FD symptoms, particularly atypical FD symptoms, had a large influence on the impairments of daily life and decreases in QOL. Daily medical care of GERD requires attention to coexisting symptoms and their treatment instead of just focusing on the chief complaints by patients.
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Affiliation(s)
- Kimio Isshi
- Isshi Gastro-Intestinal Clinic, 2-15-21, Shinozaki-cho, Edogawa-ku, Tokyo, 133-0061, Japan. .,Department of Endoscopy, The Jikei University School of Medicine, 3-15-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan.
| | - Hiroto Furuhashi
- Isshi Gastro-Intestinal Clinic, 2-15-21, Shinozaki-cho, Edogawa-ku, Tokyo, 133-0061, Japan.,Department of Endoscopy, The Jikei University School of Medicine, 3-15-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Akio Koizumi
- Isshi Gastro-Intestinal Clinic, 2-15-21, Shinozaki-cho, Edogawa-ku, Tokyo, 133-0061, Japan.,Department of Endoscopy, The Jikei University School of Medicine, 3-15-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Koji Nakada
- Isshi Gastro-Intestinal Clinic, 2-15-21, Shinozaki-cho, Edogawa-ku, Tokyo, 133-0061, Japan.,Department of Laboratory Medicine, The Jikei University School of Medicine, 3-15-8 Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan
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6
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Abstract
Delirium is an acute neuropsychiatric syndrome and one of the most common presenting symptoms of acute medical illnesses in older people. Delirium can be triggered by a single cause, but in most cases, it is multifactorial as it depends on the interaction between predisposing and precipitating factors. Delirium is highly prevalent in older patients across various settings of care and correlates with an increased risk of adverse clinical outcomes. Several pathophysiological mechanisms may contribute to its onset, including neurotransmitter imbalance, neuroinflammation, altered brain metabolism, and impaired neuronal network connectivity. Several screening and diagnostic tools for delirium exist, but they are unfortunately underutilized. Additionally, the diagnosis of delirium superimposed on dementia poses a formidable challenge – especially if dementia is severe. Non-pharmacological approaches for the prevention and multidomain interventions for the treatment of delirium are recommended, given that there is currently no robust evidence of drugs that can prevent or resolve delirium. This article aims to review the current understanding about delirium in older people. To achieve this goal, we will describe the epidemiology and outcomes of the syndrome, the pathophysiological mechanisms that are supposed to be involved, the most commonly used tools for screening and diagnosis, and prevention strategies and treatments recommended. This review is intended as a brief guide for clinicians in hospital wards to improve their knowledge and practice. At the end of the article, we propose an approach to improve the quality of care provided to older patients throughout a systematic detection of delirium.
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Affiliation(s)
- Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Justin S Brathwaite
- Department of Emergency Medicine, Boston University, Boston, MA, United States
| | - Paolo Mazzola
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
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Abstract
When older adults experience acute coronary syndrome (ACS), they often present with what are considered "atypical" symptoms. Because their symptoms less often match the expected presentation of ACS, older patients can have delayed time to assessment, to performance of an electrocardiogram, to diagnosis, and to definitive management. Unfortunately, it is this very group of patients who are at the highest risk for having ACS and for complications from ACS. This article aims to outline presentation, outcomes, and potential solutions of underrecognition of ACS in the older adult population.
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George NM, Ramamoorthy L, Satheesh S, Jayapragasam KM. Gender divides in the clinical profiles of patients with acute myocardial infarction at a tertiary care center in South India. J Family Community Med 2021; 28:42-47. [PMID: 33679188 PMCID: PMC7927970 DOI: 10.4103/jfcm.jfcm_443_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/19/2020] [Accepted: 12/20/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: Early identification of myocardial infarction (MI) is a determinant in the provision of appropriate treatment modalities. The focus of the present study is on the identification of gender-based differences in risk factors, clinical manifestations, and coronary angiography findings in patients presenting with MI. MATERIALS AND METHODS: A cross-sectional study was conducted among patients admitted with MI at a tertiary care center in South India during March 2016 to June 2017. Selected 120 male and 120 female consecutive patients admitted with acute MI, who had survived and been stabilized. Data was collected using a pre-tested structure data sheet. Appropriate parametric and nonparametric tests were used to analyze the data. RESULTS: Participants were homogenous as regards age (P < 0.107); majority of men and women were from the rural areas. About 32.5% of the men interpreted the pain as due to a cardiac problem or indigestion, whereas 60.8% of the women thought it was fatigue/muscle pain. The self-interpretation or perception of pain in both genders was statistically significant (P < 0.001). Compared to the men, the females increasingly presented with atypical symptoms (P = 0.005). Regarding ST-elevated MI, male preponderance was noted (P = 0.004)). Considering the anatomical location of MI, the presentation of Inferior Wall Myocardial Infarction (IWMI) was predominant in females compared to men (P = 0.003). The majority of men had increased presentation of single-vessel disease compared to women (P = 0.02), whereas normal coronaries and double-vessel disease were found statistically significantly higher in females (P = 0.03 and P = 0.008, respectively). CONCLUSION: Public education is needed on the atypical presentations which are common with women than in men. The public should, therefore, be informed of those symptoms and how to recognize them so that they may seek medical care promptly.
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Affiliation(s)
- Neethu M George
- Department of of Nursing and, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Lakshmi Ramamoorthy
- Department of of Nursing and, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Santhosh Satheesh
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Kumari M Jayapragasam
- Department of of Nursing and, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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9
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Yin XB, Wang XK, Xu S, He CY. Type A aortic dissection developed after type B dissection with the presentation of shoulder pain: A case report. World J Clin Cases 2021; 9:232-235. [PMID: 33511190 PMCID: PMC7809677 DOI: 10.12998/wjcc.v9.i1.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/05/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Aortic dissection (AD) is a life-threatening condition with a high mortality rate without immediate medical attention. Early diagnosis and appropriate treatment are critical in treating patients with AD. In the emergency department, patients with AD commonly present with classic symptoms of unanticipated severe chest or back pain. However, it is worth noting that atypical symptoms of AD are easily misdiagnosed.
CASE SUMMARY A 51-year-old woman was first diagnosed with scapulohumeral periarthritis due to left shoulder pain. After careful examination of her previous medical history and contrast-enhanced computed tomography angiography, the patient was diagnosed with a new type A AD after chronic type B dissection in the ascending aorta. The patient was successfully treated with surgical replacement of the dissected aortic arch and remains in good health.
CONCLUSION New retrograde type A AD after chronic type B dissection is relatively rare. It is worth noting that a physician who has a patient with suspected AD should be vigilant. Both patient medical history and imaging tests are crucial for a more precise diagnosis.
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Affiliation(s)
- Xin-Bo Yin
- Clinical Nursing Teaching and Research Section, Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
- Department of Emergency, Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Xiao-Kai Wang
- Department of Emergency, Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Su Xu
- Melbourne Dental School, University of Melbourne, Melbourne 3000, Australia
| | - Cai-Yun He
- Faculty of Nursing, School of Medicine, Hunan Normal University, Changsha 410013, Hunan Province, China
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10
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Gan JM, Kho J, Akhunbay-Fudge M, Choo HM, Wright M, Batt F, Mandal AKJ, Chauhan R, Missouris CG. Atypical presentation of COVID-19 in hospitalised older adults. Ir J Med Sci 2020; 190:469-474. [PMID: 32959219 PMCID: PMC7505490 DOI: 10.1007/s11845-020-02372-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/17/2020] [Indexed: 01/08/2023]
Abstract
Background It is increasingly recognised that older patients may not present with typical symptoms of COVID-19. Aims This study aims to evaluate the incidence, characteristics and clinical outcome of older adults with atypical presentations of COVID-19. Methods A retrospective analysis of adults ≥ 65 years with confirmed COVID-19 admitted to our institution between 1 March and 24 April 2020 was performed. Patients were categorised into typical or atypical groups based on primary presenting complaint in the community. Results One hundred twenty-two patients (mean age 81 ± 8 years; 62 male) were included. Seventy-three (60%) were categorised into the typical group and 49 (40%) into the atypical group. In the atypical group, common presenting complaints were fall in 18 (36%), reduced mobility or generalised weakness in 18 (36%) and delirium in 11 (22%). Further assessment by paramedics and on admission found 32 (65%) to have typical features of COVID-19, fever being the most common, and 22 (44%) were hypoxic. This subset had worse outcomes than those in the typical group with a mortality rate of 50% versus 38%, respectively, although this was not statistically significant (P = 0.27). No significant difference in mortality or length of hospital stay between the groups was demonstrated. Conclusion Older patients with atypical presentation of COVID-19 in the community are equally susceptible to poor outcomes. Early detection may improve outcomes and limit community transmission. Primary care practitioners should be vigilant and consider prompt onward referral.
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Affiliation(s)
- Jasmine Ming Gan
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, UK
| | - Jason Kho
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, UK
| | - Michelle Akhunbay-Fudge
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, UK
| | - Hwei Ming Choo
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, UK
| | - Melanie Wright
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, UK
| | - Farzana Batt
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, UK
| | - Amit K J Mandal
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, UK.
| | - Rahul Chauhan
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, UK
| | - Constantinos G Missouris
- Department of Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, UK.,University of Cyprus Medical School, Nicosia, Cyprus
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Weltz AS, Addo A, Broda A, Connors K, Zahiri HR, Park A. The impact of laparoscopic anti-reflux surgery on quality of life: do patients with atypical symptoms benefit? Surg Endosc 2020; 35:2515-2522. [PMID: 32468262 DOI: 10.1007/s00464-020-07665-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/20/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Gastroesophageal reflux disease (GERD) may manifest atypically as cough, hoarseness or difficulty breathing. However, it is difficult to diagnostically establish a cause-and-effect between atypical symptoms and GERD. In addition, the benefit of laparoscopic anti-reflux surgery (LARS) in patients with laryngopharyngeal manifestations of GERD are not well characterized. We report the largest series reported to date assessing operative and quality of life (QOL) outcomes after LARS in patients experiencing extraesophageal manifestations of GERD and discuss recommendations for this patient population. METHODS A retrospective review of patients with extraesophageal symptoms and pathologic reflux that underwent LARS between February 2012 and July 2019 was conducted. Inclusion criteria consisted of patients with atypical manifestations of GERD as defined by preoperative survey in addition to physiological diagnosis of pathological reflux. Patient QOL outcomes was analyzed using four validated instruments: the Reflux Symptom Index (RSI), Laryngopharyngeal Reflux QOL, Swallowing QOL (SWAL), and Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQOL) surveys. RESULTS 420 patients (24% male, 76% female) with a mean age of 61.7 ± 13.0 years and BMI of 28.6 ± 5.0 kg/m2 were included in this study. Thirty-day wound (0.2%) and non-wound (6.74%) related complication rates were recorded in addition to thirty-day readmission rate (2.6%). Patients reported significant improvements in laryngopharyngeal symptoms at mean follow-up of 18.9 ± 16.6 months post LARS reflected by results of four QOL instruments (RSI - 64%, LPR - 75%, GERD-HRQOL - 80%, SWAL + 18%). The majority of patients demonstrated complete resolution of symptoms upon subsequent encounters with 68% of patients reporting no atypical extraesophageal manifestations during follow-up survey (difficulty breathing - 86%, chronic cough - 81%, hoarseness - 66%, globus sensation - 68%) and 68% of patients no longer taking anti-reflux medication. Seventy-two percent of patients reported being satisfied with their symptom control at latest follow-up. CONCLUSIONS In appropriately selected candidates with atypical GERD symptomatology and objective diagnosis of GERD LARS may afford significant QOL improvements with minimal operative or long-term morbidity.
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Affiliation(s)
- Adam S Weltz
- Department of Surgery, Anne Arundel Medical Center, School of Medicine, Johns Hopkins University, 2000 Medical Parkway, Belcher Pavilion, Suite 106, Annapolis, MD, 21401, USA
| | - Alex Addo
- Department of Surgery, Anne Arundel Medical Center, School of Medicine, Johns Hopkins University, 2000 Medical Parkway, Belcher Pavilion, Suite 106, Annapolis, MD, 21401, USA
| | - Andrew Broda
- Department of Surgery, Anne Arundel Medical Center, School of Medicine, Johns Hopkins University, 2000 Medical Parkway, Belcher Pavilion, Suite 106, Annapolis, MD, 21401, USA
| | - Kevin Connors
- Department of Surgery, Anne Arundel Medical Center, School of Medicine, Johns Hopkins University, 2000 Medical Parkway, Belcher Pavilion, Suite 106, Annapolis, MD, 21401, USA
| | - H Reza Zahiri
- Department of Surgery, Anne Arundel Medical Center, School of Medicine, Johns Hopkins University, 2000 Medical Parkway, Belcher Pavilion, Suite 106, Annapolis, MD, 21401, USA
| | - Adrian Park
- Department of Surgery, Anne Arundel Medical Center, School of Medicine, Johns Hopkins University, 2000 Medical Parkway, Belcher Pavilion, Suite 106, Annapolis, MD, 21401, USA.
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Li RL, Chu SG, Luo Y, Huang ZH, Hao Y, Fan CH. Atypical presentation of SARS-CoV-2 infection: A case report. World J Clin Cases 2020; 8:1265-1270. [PMID: 32337201 PMCID: PMC7176616 DOI: 10.12998/wjcc.v8.i7.1265] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/06/2020] [Accepted: 03/27/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The first case of pneumonia subsequently attributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in Wuhan, Hubei Province on December 8, 2019. The symptoms included fever, coughing, and breathing difficulties. A few patients with this infection may only have atypical symptoms, which could lead to a misdiagnosis and subsequently further facilitate the spread of the virus. CASE SUMMARY A 74-year-old female patient complained of severe diarrhea. She did not have fever, coughing, or breathing difficulties. A physical examination revealed no obvious positive signs. The patient had been hypertensive for more than 10 years. Her blood pressure was well controlled. On January 9, 2020, the patient's son visited a colleague who was later confirmed positive for SARS-CoV-2 and his first close contact with our patient was on January 17. The patient was first diagnosed with gastrointestinal dysfunction. However, considering her indirect contact with a SARS-CoV-2-infected individual, we suggested that an atypical pneumonia virus infection should be ruled out. A computed tomography scan was performed on January 26, and showed ground-glass nodules scattered along the two lungs, suggestive of viral pneumonia. Given the clinical characteristics, epidemiological history, and examination, the patient was diagnosed with coronavirus disease-2019 (COVID-19). CONCLUSION Our patient had atypical symptoms of COVID-19. Careful acquisition of an epidemiological history is necessary to make a correct diagnosis and strategize a treatment plan.
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Affiliation(s)
- Rui-Lin Li
- Department of Cardiology, Shanghai East Hospital (East Hospital affiliated to Tongji University), Tongji University, Shanghai 200123, China
| | - Shu-Guang Chu
- Department of Medical Imaging, Shanghai East Hospital (East Hospital affiliated to Tongji University), Tongji University, Shanghai 200123, China
| | - Yu Luo
- Department of Cardiology, Shanghai East Hospital (East Hospital affiliated to Tongji University), Tongji University, Shanghai 200123, China
| | - Zhen-Hao Huang
- Department of Cardiology, Shanghai East Hospital (East Hospital affiliated to Tongji University), Tongji University, Shanghai 200123, China
| | - Ying Hao
- Department of Cardiology, Shanghai East Hospital (East Hospital affiliated to Tongji University), Tongji University, Shanghai 200123, China
| | - Cheng-Hui Fan
- Department of Cardiology, Shanghai East Hospital (East Hospital affiliated to Tongji University), Tongji University, Shanghai 200123, China
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Shi F, Yu Q, Huang W, Tan C. 2019 Novel Coronavirus (COVID-19) Pneumonia with Hemoptysis as the Initial Symptom: CT and Clinical Features. Korean J Radiol 2020; 21:537-540. [PMID: 32174057 PMCID: PMC7183833 DOI: 10.3348/kjr.2020.0181] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 01/08/2023] Open
Abstract
Recently, some global cases of 2019 novel coronavirus (COVID-19) pneumonia have been caused by second- or third-generation transmission of the viral infection, resulting in no traceable epidemiological history. Owing to the complications of COVID-19 pneumonia, the first symptom and imaging features of patients can be very atypical and early diagnosis of COVID-19 infections remains a challenge. It would aid radiologists and clinicians to be aware of the early atypical symptom and imaging features of the disease and contribute to the prevention of infected patients being missed.
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Affiliation(s)
- Fengxia Shi
- Department of Radiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, China
| | - Quanbo Yu
- Department of Radiology, Yueyang Second People's Hospital, Yueyang, China
| | - Wei Huang
- Department of Radiology, Changsha First Hospital, Changsha, Hunan, China
| | - Chaochao Tan
- Department of Clinical Laboratory, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, China.
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Díaz Vico T, Elli EF. Clinical outcomes of gastroesophageal reflux disease-related chronic cough following antireflux fundoplication. Esophagus 2020; 17:92-8. [PMID: 31617046 DOI: 10.1007/s10388-019-00701-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/08/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite the effectiveness of antireflux fundoplication for typical gastroesophageal reflux disease, outcomes regarding surgical therapy for patients with gastroesophageal reflux disease-related chronic cough are currently unclear. The purpose of this study was to evaluate whether antireflux surgery for patients with chronic cough is effective, and to assess the correlation between indexes, such as symptom index and symptom association probability, and response to surgery. METHODS We performed a retrospective review of a prospectively collected database from a 3-site institution from 2013 to 2017. Of 1149 patients who underwent antireflux surgery, 41 presented with chronic cough as a main symptom related to gastroesophageal reflux disease. Preoperatively, patients underwent a symptom assessment, esophagogastroduodenoscopy, esophageal 24-h pH monitoring, and manometry. Patients were followed up at 6 weeks and 12 months post-surgery. RESULTS Thirty-three (80.5%) patients underwent Nissen fundoplication, while 8 (19.5%) underwent Toupet fundoplication. Isolated chronic cough was present in 8 (19.5%) patients, and median (range) DeMeester score was 28.9 (0.3-96.7). After 12-month follow-up, chronic cough was absent in 28 (68.3%) patients (P = .02). Typical reflux symptoms responded well to surgery, but response was not optimal. Postoperative dysphagia and atypical reflux symptoms were slightly worse on long-term follow-up; however, differences were not significant (P ≥ .2). When examining how the different symptom indexes correlated with complete, partial, or no response in patients with gastroesophageal reflux disease-related cough, there was no notable agreement on predicted response to surgery. CONCLUSIONS Antireflux surgery, although less predictable, is effective for the treatment of gastroesophageal reflux disease-related chronic cough.
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Ward MA, Ebrahim A, Kopita J, Arviso L, Ogola GO, Buckmaster B, Leeds SG. Magnetic sphincter augmentation is an effective treatment for atypical symptoms caused by gastroesophageal reflux disease. Surg Endosc 2020; 34:4909-15. [PMID: 31792691 DOI: 10.1007/s00464-019-07278-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/14/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND The purpose of this study was to determine whether magnetic sphincter augmentation (MSA) could effectively treat patients with gastroesophageal reflux disease (GERD) who suffer primarily from atypical symptoms due to laryngopharyngeal reflux (LPR). MSA has been shown to treat typical symptoms of GERD with good success, but its effect on atypical symptoms is unknown. METHODS A retrospective review of a prospectively maintained institutional review board-approved database was conducted for all patients who underwent MSA between January 2015 and December 2018. All patients had objective confirmation of GERD from ambulatory pH monitoring off anti-reflux medications (DeMeester score > 14.7). Symptoms were assessed preoperatively and at 1 year postoperatively using GERD Health-Related Quality of Life (GERD-HRQL) and Reflux Symptom Index (RSI) questionnaires. RESULTS There were 86 patients (38 males; 48 females) with a median age of 51.5 years. Total GERD HRQL scores improved from a mean of 38.79 to 6.53 (p < 0.01) and RSI scores improved from a mean of 20.9 to 8.1 (p < 0.01). Atypical symptoms evaluated from the RSI questionnaire include hoarseness, throat clearing, postnasal drip, breathing difficulties, and cough. All atypical symptoms were significantly improved at 1 year following MSA (p < 0.01). All three typical symptoms of heartburn, dysphagia, and regurgitation were significantly improved based on pre and postoperative GERD HRQL questionnaires (p < 0.02). Ninety-one percent of patients were off their PPI and dissatisfaction with their current therapy decreased from 95% preoperatively to 13% postoperatively. CONCLUSION MSA is an effective treatment for typical and atypical GERD symptoms.
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Abstract
We present a rare case report of a patient diagnosed with primary plasma cell leukemia (PCL) who presented with atypical signs and symptoms which acutely evolved into life-threatening multi-organ failure. This case raises questions regarding the latest diagnostic guidelines and therapeutic options in the management of acute PCL and reinforces the need for prompt treatment after diagnosis.
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Affiliation(s)
- Shaylika Chauhan
- Department of Internal Medicine, Saint Peter's University Hospital, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Priya Jaisinghani
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jaivir Rathore
- Department of Neurology, College of Medicine, University of Illinois, Chicago, Illinois, USA
| | - Hassan Tariq
- Department of Neurology, Marshall University, WV, USA
| | - Yesenia Galan
- Department of Internal Medicine, Saint Peter's University Hospital, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Arjun Madhavan
- Department of Pulmonary Medicine, Saint Peter's University Hospital, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Haris Rana
- Department of Pulmonary Medicine, Saint Peter's University Hospital, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Douglas Frenia
- Department of Pulmonary Medicine, Saint Peter's University Hospital, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Boskovic I, van der Heide D, Hope L, Merckelbach H, Jelicic M. Plausibility Judgments of Atypical Symptoms Across Cultures: an Explorative Study Among Western and Non-Western Experts. Psychol Inj Law 2017; 10:274-81. [PMID: 29057031 DOI: 10.1007/s12207-017-9294-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/18/2017] [Indexed: 11/23/2022]
Abstract
Symptom validity tests (SVTs) are predicated on the assumption that overendorsement of atypical symptoms flags symptom exaggeration (i.e., questionable symptom validity). However, few studies have explored how practitioners from different cultural backgrounds evaluate such symptoms. We asked professionals working in Western (n = 56) and non-Western countries (n = 37) to rate the plausibility of uncommon symptoms taken from the Structured Inventory of Malingered Symptomatology (SIMS), dissociative symptoms from the Dissociative Experience Scale (DES-T), and standard symptoms (e.g., anxiety, depression) from the Brief Symptom Inventory-18 (BSI-18). Western and non-Western experts gave similar plausibility ratings to atypical, dissociative, and standard symptoms: both groups judged BSI-18 symptoms as significantly more plausible than either dissociative or atypical symptoms, while the latter two categories did not differ. Our results suggest that the strategy to detect symptom exaggeration by exploring overendorsement of atypical items might work in a non-western context as well.
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18
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Khan S, Ali SA. Exploratory study into awareness of heart disease and health care seeking behavior among Emirati women (UAE) - Cross sectional descriptive study. BMC Womens Health 2017; 17:88. [PMID: 28950842 PMCID: PMC5615477 DOI: 10.1186/s12905-017-0445-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 09/20/2017] [Indexed: 12/31/2022]
Abstract
Background Cardiovascular disease was the leading cause of death among women in the United Arab Emirates (UAE) in 2010. Heart attacks usually happen in older women thus symptoms of heart disease may be masked by symptoms of chronic diseases, which could explain the delay in seeking health care and higher mortality following an ischaemic episode among women. This study seeks to a) highlight the awareness of heart diseases among Emirati women and b) to understand Emirati women’s health care seeking behaviour in UAE. Method A cross sectional, descriptive study was conducted using a survey instrument adapted from the American Heart Association National survey. A convenience sample of 676 Emirati women between the ages of 18–55 years completed the questionnaire. Results The study showed low levels of awareness of heart disease and associated risk factors in Emirati women; only 19.4% participants were found to be aware of heart diseases. Awareness levels were highest in Dubai (OR 2.18, p < 0.05) among all the other emirates and in the 18–45 years age group (OR 2.74, p < 0.05). Despite low awareness levels, women paradoxically perceived themselves to be self-efficacious in seeking health care. Interestingly, just 49.1% Emirati women believed that good quality and affordable health care was available in the UAE. Only 28.8% of the participants believed there were sufficient female doctors to respond to health needs of women in UAE. Furthermore, only 36.7% Emirati women chose to be treated in the UAE over treatment in other countries. Conclusion Emirati women clearly lack the knowledge on severity and vulnerability to heart disease in the region that is essential to improve cardiovascular related health outcomes. This study has identified the need for wider outreach that focuses on gender and age specific awareness on heart disease risks and symptoms. The study has also highlighted potential modifiable barriers in seeking health care that should be overcome to reduce morbidity and mortality due to heart disease among national women of UAE.
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Affiliation(s)
- Sarah Khan
- College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates.
| | - Syed Adnan Ali
- Government Degree Science and Commerce College, Landhi Korangi 6, Karachi, Pakistan
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Baheerathan A, Brownlee WJ, Chard DT, Shields K, Gregory R, Trip SA. Antecedent anti-NMDA receptor encephalitis in two patients with multiple sclerosis. Mult Scler Relat Disord 2016; 12:20-22. [PMID: 28283100 DOI: 10.1016/j.msard.2016.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
Abstract
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder characterised by psychiatric symptoms, movement disorder and seizures often evolving into a severe encephalopathy. An overlap has recently been recognised between anti-NMDAR encephalitis and inflammatory demyelinating disorders, particularly neuromyelitis optical spectrum disorder (NMOSD). In this case report, we describe two patients with an initial presentation consistent with anti-NMDAR encephalitis who have subsequently developed relapsing-remitting multiple sclerosis (MS) and discuss the literature pertaining to potential overlap between NMDAR encephalitis and inflammatory demyelinating disorders.
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Affiliation(s)
- A Baheerathan
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - W J Brownlee
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, United Kingdom
| | - D T Chard
- National Hospital for Neurology and Neurosurgery, London, United Kingdom; Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, United Kingdom
| | - K Shields
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - R Gregory
- Department of Neurology, Poole Hospital NHS Foundation Trust, Poole, United Kingdom
| | - S A Trip
- National Hospital for Neurology and Neurosurgery, London, United Kingdom; Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, United Kingdom.
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Khan S, Khoory A, Al Zaffin D, Al Suwaidi M. Exploratory study into the awareness of heart diseases among Emirati women (UAE) and their health seeking behaviour- a qualitative study. BMC Womens Health 2016; 16:71. [PMID: 27821100 PMCID: PMC5100226 DOI: 10.1186/s12905-016-0350-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 10/29/2016] [Indexed: 11/10/2022]
Abstract
Background Cardiovascular diseases were the leading cause of death in women in the United Arab Emirates (UAE) in 2010. The UAE is expected to experience a tripling of heart diseases in the next two decades as risk factors for heart diseases increase. Research shows that first year survival rates of younger women suffering from a heart attack are lower than in men. Women present with a wider range of symptoms for heart diseases than men; non-recognition of atypical symptoms may explain the delay in seeking treatment and poor prognosis following heart diseases in women. No known study on awareness of heart diseases among women has been carried out in the Middle Eastern region. Methods Social constructionist and interpretivist epistemological approaches have been considered in this qualitative study to explore the awareness of heart diseases and the health seeking behavior of Emirati women. Convenience sampling was used to recruit 41 Emirati women. Three focus groups and six in-depth semi-structured interviews were conducted to obtain data. Thematic content analysis was applied to the data following transcription and translation of recordings. Results Emirati women had limited knowledge on heart diseases. Women were generally unaware of the atypical symptoms, commonly experienced by women however they identified most risk factors associated with heart diseases. Lack of awareness of disease severity and symptoms, sociocultural influences and distrust in the healthcare system were considered the main barriers to seeking prompt treatment. Conclusions This study clearly identified gaps and inaccuracies in knowledge of heart diseases, which could contribute to delayed health seeking action and possibly poorer prognosis among Emirati women. Absence of initiatives to educate women on cardiovascular diseases in UAE has erroneously deemed it a less serious concern among Emirati women. The findings from this study provide clear indications of the need to increase accountability of the healthcare system and to develop culturally relevant, gender specific, age focused, heart diseases related public health awareness campaigns in UAE. Electronic supplementary material The online version of this article (doi:10.1186/s12905-016-0350-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Khan
- College of Natural and Health Sciences, Zayed University, P.O. Box 19282, Dubai, United Arab Emirates.
| | - Ayesha Khoory
- College of Natural and Health Sciences, Zayed University, P.O. Box 19282, Dubai, United Arab Emirates
| | - Dhabia Al Zaffin
- College of Natural and Health Sciences, Zayed University, P.O. Box 19282, Dubai, United Arab Emirates
| | - Meera Al Suwaidi
- College of Natural and Health Sciences, Zayed University, P.O. Box 19282, Dubai, United Arab Emirates
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Albarqouni L, Smenes K, Meinertz T, Schunkert H, Fang X, Ronel J, Ladwig KH. Patients' knowledge about symptoms and adequate behaviour during acute myocardial infarction and its impact on delay time: Findings from the multicentre MEDEA Study. Patient Educ Couns 2016; 99:1845-1851. [PMID: 27387122 DOI: 10.1016/j.pec.2016.06.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/12/2016] [Accepted: 06/12/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE We aimed to assess whether patients' knowledge about acute myocardial infarction (AMI) has an impact on the prehospital delay-time. METHODS This investigation was based on 486 AMI patients who participated in the cross-sectional Munich-Examination-of-Delay-in-Patients-Experiencing-Acute-Myocardial-Infarction (MEDEA) study. A modified German-version of the ACS-Response-Index Questionnaire was used. Multivariate logistic-regression models were used to identify factors associated with knowledge-level as well as the impact of knowledge-level on delay-time. RESULTS High AMI-knowledge shortened median delay-time in men (168[92-509] vs. 276[117-1519] mins, p=0.0069), and in women (189[101-601] vs. 262[107-951]mins, p=0.34). Almost half-of-patients (n=284,58%) demonstrated high AMI-knowledge. High-knowledge were independently associated with male-gender (OR=1.47[1.17-1.85]) and General-Practitioner as a knowledge-source (OR=1.42[1.14-1.77]). Old-age (OR=0.87[0.86-0.89]) and previous AMI-history/stent-placement (OR=0.65[0.46-0.93]) were significantly associated with lower-knowledge. Although the majority (476,98%) correctly recognized at least one AMI-symptom, 69(14.2%) patients correctly identified all AMI-symptoms. Additionally, one-in-three believed that heart-attack is always accompanied with severe chest-pain. Elderly-patients and women were more likely to be less-knowledgeable about atypical-symptoms (p=0.006), present with atypical AMI-presentation (p<0.001) and subsequently experience protracted delay-times (p<0.001). CONCLUSIONS Knowledge of AMI-symptoms remains to be substandard, especially knowledge of atypical-symptoms. Knowledge is essential to reduce delay-times, but it is not a panacea, since it is not sufficient alone to optimize prehospital delay-times.
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Affiliation(s)
- L Albarqouni
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - K Smenes
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Th Meinertz
- Department of Cardiology, University Heart Center Hamburg Eppendorf, and Klinikum Stephansplatz Hamburg, Germany
| | - H Schunkert
- Klinik für Herz-& Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Munich Heart Alliance, Germany
| | - X Fang
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - J Ronel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - K-H Ladwig
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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Trad KS, Fox MA, Simoni G, Shughoury AB, Mavrelis PG, Raza M, Heise JA, Barnes WE. Transoral fundoplication offers durable symptom control for chronic GERD: 3-year report from the TEMPO randomized trial with a crossover arm. Surg Endosc 2016; 31:2498-2508. [PMID: 27655380 PMCID: PMC5443856 DOI: 10.1007/s00464-016-5252-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 09/13/2016] [Indexed: 02/07/2023]
Abstract
Background Four randomized controlled trials have demonstrated the short-term efficacy and safety of transoral esophagogastric fundoplication (TF) performed with the EsophyX® device in eliminating troublesome gastroesophageal reflux disease (GERD) symptoms in well-selected patient populations. The aim of this study was to assess the durability of these outcomes at 3 years post-procedure. Methods The TF EsophyX versus Medical PPI Open Label trial was conducted in seven US sites. Between June and August 2012, we enrolled patients with small (<2 cm) or absent hiatal hernias who suffered from troublesome GERD symptoms while on PPI therapy for at least 6 months and had abnormal esophageal acid exposure (EAE). Randomization was to TF group (n = 40) or to PPI group (n = 23). Following evaluation at 6 months, all remaining PPI patients (n = 21) elected to undergo crossover to TF. Fifty-two patients were assessed at 3 years for (1) GERD symptom resolution using three GERD-specific quality of life questionnaires, (2) healing of esophagitis using endoscopy, (3) EAE using 48-h Bravo testing, and (4) discontinuation of PPI use. Two patients who underwent revisional procedures by year 3 were included in the final analysis. Results At 3-year follow-up, elimination of troublesome regurgitation and all atypical symptoms was reported by 90 % (37/41) and 88 % (42/48) of patients, respectively. The mean Reflux Symptom Index score improved from 22.2 (9.2) on PPIs at screening to 4 (7.1) off PPIs 3 years post-TF, p < 0.0001. The mean total % time pH <4 improved from 10.5 (3.5) to 7.8 (5.7), p = 0.0283. Esophagitis was healed in 86 % (19/22) of patients. At the end of study, 71 % (37/52) of patients had discontinued PPI therapy. All outcome measures remained stable between 1-, 2-, and 3-year follow-ups. Conclusion This study demonstrates that TF can be used to achieve long-term control of chronic GERD symptoms, healing of esophagitis, and improvement in EAE.
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Affiliation(s)
- Karim S Trad
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA. .,The George Washington University Medical Faculty Associates, 1800 Town Center Drive, #218, Reston, VA, 20190, USA.
| | - Mark A Fox
- Crossville Medical Group, Crossville, TN, USA.,Cumberland Medical Center, Crossville, TN, USA
| | | | - Ahmad B Shughoury
- Saint Mary Medical Center, Hobart, IN, USA.,Internal Medicine Associates, Merrillville, IN, USA
| | - Peter G Mavrelis
- Saint Mary Medical Center, Hobart, IN, USA.,Internal Medicine Associates, Merrillville, IN, USA
| | - Mamoon Raza
- Indiana Medical Research, Elkhart, IN, USA.,Unity Surgical Hospital, Mishawaka, IN, USA
| | - Jeffrey A Heise
- Heartburn Center/Rehabilitation Department, Hancock Regional Hospital, Greenfield, IN, USA
| | - William E Barnes
- Livingston Hospital and Healthcare Services, Inc., Salem, KY, USA
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Sun Y, Muheremu A, Yan K, Yu J, Zheng S, Tian W. Effect of double-door laminoplasty on atypical symptoms associated with cervical spondylotic myelopathy/radiculopathy. BMC Surg 2016; 16:31. [PMID: 27160834 DOI: 10.1186/s12893-016-0146-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 04/30/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Double-door laminoplasty is an effective method in treating patients with cervical spondylosis. Many patients with cervical spondylosis experience a set of atypical symptoms such as vertigo and tinnitus, and wish to know if the surgical treatment for cervical spondylosis can also alleviate those symptoms. The current research was carried out to investigate if atypical symptoms can be alleviated in patients who received laminoplasty for the treatment of cervical spondylosis. METHODS One hundred ninety patients who received laminoplasty to treat cervical spondylotic myelopathy/radiculopathy in our center and complained about one or more of the atypical symptoms before the surgery were followed for a mean of 61.9 months (from 39 to 87 months) after the surgery. Severity scores were retrospectively collected by follow up outpatient visits or phone interviews. The data was calculated based on patient feedback on the frequency and severity of those symptoms before the surgery and at last follow up, and were compared by paired sample t-tests. RESULTS Most patients reported that the atypical symptoms such as vertigo (P <0.001), nausea (P <0.001), headache (P <0.001), tinnitus (P = 0.001), blur vision (P = 0.005), palpitation (P <0.001) and gastrointestinal discomfort (P = 0.001) were significantly alleviated at the last follow up; there was no significant change in the severity of hypomnesia (P = 0.675). CONCLUSION Double-door laminoplasty can significantly alleviate most of the atypical symptoms in patients with cervical spondylosis. Further research is needed to explore mechanisms underlying this extra benefit of laminoplasty.
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Muheremu A, Sun Y. Atypical symptoms in patients with cervical spondylosis might be the result of stimulation on the dura mater and spinal cord. Med Hypotheses 2016; 91:44-46. [PMID: 27142142 DOI: 10.1016/j.mehy.2016.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/03/2016] [Accepted: 04/06/2016] [Indexed: 11/19/2022]
Abstract
Patients with cervical spondylosis often present with some atypical symptoms such as vertigo, headache, palpitation, nausea, abdominal discomfort, tinnitus and blurred vision and hypomnesia. Although there are a few hypotheses about the etiology of those symptoms, none of them have provided evidence convincing enough to explain the clinical, pathological and anatomic manifestation of those symptoms. One of the more acceptable explanations is that those symptoms are the results of stimulation of the sympathetic nerves in the posterior longitudinal ligament. The clinical fact that dissection of the posterior longitudinal ligament significantly alleviates the severity of those symptoms seems like an evidence for the validity of this hypothesis. However, recent clinical studies showed that laminoplasty, which has no effect on the posterior longitudinal ligament, can achieve the similar effect. In this paper, we hypothesize that stimulation of the dura mater and spinal cord might be the cause of atypical symptoms in patients with cervical spondylosis.
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Affiliation(s)
| | - Yuqing Sun
- Department of Spine Surgery, Beijing Ji Shui Tan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China.
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25
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Ozsari T, Bora G, Ozdemir ÖMA, Kiliç I. A Neonatal Septic Arthritis Case Caused by Klebsiella pneumoniae: A Case Report. J Clin Diagn Res 2016; 10:SD01-2. [PMID: 27042550 DOI: 10.7860/jcdr/2016/17651.7230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/20/2015] [Indexed: 11/24/2022]
Abstract
Septic arthritis is encountered very rarely during the neonatal period and its diagnosis can delay because of atypical symptoms, thus it may lead to serious sequelae. The sequale can be prevented by early diagnosis and concomitant treatment. In neonates, pain can be experienced as a result of pseudoparalysis and of movement of the effected joints. A 17-day-old neonatal patient was brought to our hospital with complaint of unrest and then diagnosed with septic arthritis due to propagation of Klebsiella pneumoniae in joint fluid culture was represented because of the rarity of such a case.
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Affiliation(s)
- Tamer Ozsari
- Department of Pediatrics, Igdır State Hospital , Igdır, Turkey
| | - Gülhan Bora
- Pharmacy, Department of Pharmaceutical Microbiology, YYU University , Turkey
| | - Özmert M A Ozdemir
- Faculity of Medicine, Department of Newborn, Pamukkale University, YYU University , Turkey
| | - Ilknur Kiliç
- Faculity of Medicine, Department of Newborn, Pamukkale University, YYU University , Turkey
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26
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Lam T, Burns K, Dennis M, Cheung NW, Gunton JE. Assessment of cardiovascular risk in diabetes: Risk scores and provocative testing. World J Diabetes 2015; 6:634-641. [PMID: 25987961 PMCID: PMC4434084 DOI: 10.4239/wjd.v6.i4.634] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 01/30/2015] [Accepted: 02/12/2015] [Indexed: 02/05/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among patients with diabetes mellitus, who have a risk of cardiovascular mortality two to four times that of people without diabetes. An individualised approach to cardiovascular risk estimation and management is needed. Over the past decades, many risk scores have been developed to predict CVD. However, few have been externally validated in a diabetic population and limited studies have examined the impact of applying a prediction model in clinical practice. Currently, guidelines are focused on testing for CVD in symptomatic patients. Atypical symptoms or silent ischemia are more common in the diabetic population, and with additional markers of vascular disease such as erectile dysfunction and autonomic neuropathy, these guidelines can be difficult to interpret. We propose an algorithm incorporating cardiovascular risk scores in combination with typical and atypical signs and symptoms to alert clinicians to consider further investigation with provocative testing. The modalities for investigation of CVD are discussed.
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27
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Yi CH, Liu TT, Chen CL. Atypical symptoms in patients with gastroesophageal reflux disease. J Neurogastroenterol Motil 2012; 18:278-83. [PMID: 22837875 PMCID: PMC3400815 DOI: 10.5056/jnm.2012.18.3.278] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 02/02/2012] [Accepted: 02/10/2012] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Atypical symptoms are common in gastroesophageal reflux disease (GERD). Patients with non-erosive reflux disease (NERD) and erosive reflux disease (ERD) exhibit different clinical characteristics and responses to acid suppression treatment. We aimed to compare atypical characteristics in patients with NERD and ERD. We also investigated the presence of histological esophagitis in patients with NERD and ERD. Methods Eligible patients completed a questionnaire regarding reflux symptoms and concomitant atypical symptoms. Endoscopic biopsies with histological examination were performed. Results Of the 210 patients with GERD, 90 patients with ERD and 120 patients with NERD were studied. ERD patients were characterized by higher prevalence of hiatal hernia (P = 0.001) and smoking (P = 0.047). The prevalence of GERD was greater in the age group between 41 and 60 years regardless of endoscopic finding. There was no difference in the prevalence of atypical symptoms or histological esophagitis between NERD and ERD. In all subjects, heartburn was associated with dysphagia (r = 0.16, P = 0.01), dyspepsia (r = 0.22, P = 0.008) and hiccup (r = 0.19, P = 0.003), whereas acid regurgitation was associated with dyspepsia (r = 0.21, P = 0.014), belching (r = 0.15, P = 0.018) and hiccup (r = 0.19, P = 0.002). Conclusions Atypical symptoms did not correlate with the presence of histological esophagitis. Atypical symptoms were equally prevalent in patients with NERD and ERD. The existence of atypical symptoms appears to be associated with the presence of typical reflux symptoms irrespective of endoscopic and histological reflux esophagitis.
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Affiliation(s)
- Chih-Hsun Yi
- Department of Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
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