A Common Condition with an Uncommon Presentation

​BY ARJUN BHARAD​WAJ​ &AHMED RAZIUDDIN, MD​A 41-year-old man who recently immigrated from Africa came to the ED with abdominal pain. The patient primarily spoke Tigrinya, and an interpreter was used in taking a history. The patient's abdominal pain had started four hours earlier, which he described as squeezing or cramping mid-epigastric and umbilical pain. The pain did not change or radiate.He had also had three episodes of nonbloody emesis. This was a new problem for him, and he hadn't encountered anyone sick or with similar symptoms. His last bowel movement was the previous night, and no changes in bowel or urination were noted. He had no fever, chills, chest pain, shortness of breath, weakness, or fatigue. He had leftover food the night before, and he drank lemon juice to calm his stomach that morning. He had no past medical or surgical history but a family history of hypertension on his father's side.Mild tenderness in the epigastric and umbilical regions, normoactive bowel sounds, fullness in the epigastric region, and no abdominal guarding or rigidity were noted on exam. There was no McBurney's point tenderness, rebound tenderness (Blumberg's sign), Murphy's sign, Rovsing's sign, Dunphy's sign, psoas sign, no percussive tenderness, or obturator sign. The history and physical exam indicated a likelihood of viral gastritis, but other possibilities such as gastroesophageal reflux disease, gastric/intestinal ulcers, pancreatitis, gall bladder-associated disease...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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ConclusionsThis study provides information about Aβ plaque burden, tau tangle burden, and neurodegeneration in cognitively unimpaired persons at three levels of genetic risk for AD. Unimpaired APOE ϵ4 HMs can be studied before their 70s to evaluate the understanding of factors, processes, and interventions involved in the predisposition to and prevention of AD, and after their 70s, to discover factors, processes, and interventions involved in the resilience or resistance to and prevention of AD.
Source: Alzheimer's and Dementia: The Journal of the Alzheimer's Association - Category: Geriatrics Source Type: research
Publication date: Available online 9 December 2019Source: Journal of ColoproctologyAuthor(s): Seyedeh Elham Norollahi, Seyed Mohammad Taghi Hamidian, Zeynab Khazaee Kohpar, Rezvan Azadi, Pooya Rostami, Sogand Vahidi, Sahar Ghazanfari, Farnaz Azar Shabe, Roya Khaksar, Ali Akbar SamadaniAbstractColorectal cancer is one of the most important malignancies in the classification of gastrointestinal cancers. One of the predisposing factors at molecular level for this cancer is via WNT signaling which is associated with the vast numbers of different genes. Thus, in this study, we aimed to investigate whether Adenomatous Polyposis ...
Source: Journal of Coloproctology - Category: Gastroenterology Source Type: research
ConclusionsThe data regarding ketamine use in mechanically ventilated patients is limited in terms of quantity, methodological quality, and demonstrated clinical benefit. Ketamine may play a role as a sedative-sparing agent, but may be associated with harm. High-quality studies are needed before widespread adoption of ketamine earlier in the sedation pathway.
Source: Journal of Critical Care - Category: Gastroenterology Source Type: research
We present a case of GCA in a patient who presented with jaw claudication and occlusal pain. A 78-year-old man visited our department with left-sided facial pain associated with mastication. He also reported spontaneous left-sided facial pain and diminished vision. Based on his age, his new-onset left-sided headache, and a high erythrocyte sedimentation rate, he was diagnosed with GCA with immediate initiation of prednisolone (PSL) therapy. His fever subsided the following day. A temporal artery biopsy (TAB) was performed 7 days after hospitalization and showed a false-negative result. His left-sided facial pain and headac...
Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology - Category: ENT & OMF Source Type: research
ConclusionThe expression of matrix metalloproteinases-2 and 9 in hypopharyngeal carcinoma was significantly higher than that in pericarcinoma tissue, and it was enhanced with the increase of clinical stage. The expression level was related to lymph node metastasis and tumor pathological stage. Thus, matrix metalloproteinases-2 and 9 may be involved in the occurrence, development, invasion and metastasis of hypopharyngeal carcinoma through a variety of mechanisms.ResumoIntroduçãoA função da metaloproteinase da matriz 2 e9 nas metástases e no desenvolvimento de carcinoma hipofaríngeo...
Source: Brazilian Journal of Otorhinolaryngology - Category: ENT & OMF Source Type: research
ConclusionsThyroidectomy may only be required during total laryngectomy for selected cases of advanced transglottic tumors and tumors with subglottic extension more than 10 mm.ResumoIntroduçãoEm geral, a invasão da glândula tireoide não é uma característica do carcinoma laríngeo avançado, não sendo necessário realizar tireoidectomia em todos os casos de laringectomia total.ObjetivosAvaliar a frequência da invasão da glândula tireoide em pacientes com carcinoma espinocelular avançado de laringe submetidos à laringe...
Source: Brazilian Journal of Otorhinolaryngology - Category: ENT & OMF Source Type: research
Publication date: Available online 10 December 2019Source: American Journal of OtolaryngologyAuthor(s): Evette Ronner, Razan Basonbul, Rupal Bhakta, Leila Mankarious, Daniel J. Lee, Michael S. CohenAbstractObjectiveEvaluate the impact of cochlear anomalies on hearing outcomes for pediatric patients with cochlear implants.Study designRetrospective chart review.SettingTertiary care center.Subjects and methodsCharts were retrospectively reviewed for cases where pediatric cochlear implant surgery was performed between 2002 and 2018 at a single, tertiary care institution. Patients were divided into groups based on the presence ...
Source: American Journal of Otolaryngology - Category: Endocrinology Source Type: research
Abstract Background: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder with recurrent abdominal pain and altered defecation habits. We here attempted to determine the effect of acupuncture on IBS. Methods: Randomized controlled trials (RCTs) published in CNKI, VIP, Wanfang, PubMed, Cochrane Library, EMBASE, Web of science, and ClinicalTrials.gov till July 17, 2019 were searched. Outcomes were total efficacy rates, overall IBS symptom scores, or global quality of life scores. Standardized mean difference (SMD) with 95% confidence intervals (CI) and risk ratio (RR) with 95% CI were calcul...
Source: Pain Research and Management - Category: Anesthesiology Authors: Tags: Pain Res Manag Source Type: research
Publication date: Available online 19 November 2019Source: Pharmacology &TherapeuticsAuthor(s): Giovanni Grignani, Alessandra Merlini, Dario Sangiolo, Lorenzo D'Ambrosio, Ymera PignochinoAbstractWith the ever-expanding therapeutic indications and ongoing clinical trials with Poly(adenosine diphosphate-ribose) Polymerase (PARP) inhibitors, it is of outmost importance to stop and rethink what we know and still do not know concerning one of the major revolutions in target therapies in the last decades. Indeed, many PARP inhibitors (PARPi) are able to bind multiple targets, with a plethora of potential interactions with ca...
Source: Pharmacology and Therapeutics - Category: Drugs & Pharmacology Source Type: research
Publication date: Available online 9 December 2019Source: Pharmacological ResearchAuthor(s): Stefania Koutsilieri, Foteini Tzioufa, Despoina-Christina Sismanoglou, George P. PatrinosAbstractPharmacogenomics and personalized medicine interventions hold promise to optimize drug treatment modalities and hence, improve the quality of life of the patients by minimizing the occurrence of adverse drug reactions and/or maximizing drug treatment efficacy. To this end, proper guidance for accurately prescribing the correct drug at the right dose is empowered by major regulatory bodies, namely the U.S. Food and Drug Administration (F...
Source: Pharmacological Research - Category: Drugs & Pharmacology Source Type: research
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