Wrist Arthritis

Arthritis means inflammation of the joint. Symptoms of arthritis includes pain, swelling, redness, stiffness and loss of motion of the involved joint. Wrist arthritis can affect multiple functions of daily life and hence acknowledging its causes, seeking proper diagnosis, and finding effective long-term treatments are necessary to avoid disability

Perceptions Towards the Discharge Process in a Community Teaching Hospital

Background: Discharge process in the hospital is lengthy and with low efficiency, especially in teaching facilities. Our objective was to identify perceptions towards the current discharge process and possible ways to improve it in a community teaching hospital in Las Vegas, NV. Methods: Quality improvement with cross-sectional survey questionnaire. Participants: 200 hospital staff (total possible participants) who were involved in the discharge process. 149 (actual participants) completed the surveys (response rate of 75[percent]) which included multiple choices as well as open ended questions; 95 nurses, 43 residents, and 11 case managers. Results were analyzed using the Chi-Square test. Results: 44[percent] of respondents believed that the hospital discharge process is efficient while 56[percent] did not. Frequent delays in discharge process from hospital were estimated often by 57.7[percent]. Easiest placements were home health (51.7[percent]) followed by hospice (19.5[percent]). The most time-consuming placements were skilled nursing facility (43[percent]) followed by acute rehab (22.8[percent]). The preferred method of contact regarding discharge process differed among roles. 41[percent] of nurse respondents listed voice calls while 54.5 [percent] of case managers and 44[percent] of residents documented text messaging (P-value [less than] 0.001). While most (61 [percent]) believed that multidisciplinary rounds are of value, the percentage of those who preferred it, differed among roles. 69.4[percent] of nurses favored multidisciplinary round versus 4.2[percent] who did not. This was 54.5[percent] vs. 27.2[percent] for case managers and 44.1[percent] vs. 30.2[percent] for the residents (P-value = 0.002). Conclusion: Discharge process in teaching facilities is considered fragmented, inefficient and different groups of health care personnel perceive it differently.Ruifang Yang (1), Leila Khalili (1), Zhi Cheng (1), Ana Markic (2), Napatkamon Ayutanont (3), Hossein Akhondi (1) ; 1. Department of Internal Medicine, MountainView Hospital, University of Nevada. 2 Department of Endocrinology, University of Arizona. 3. MountainView HospitalIncludes bibliographical reference

Haemophilus aphrophilus Endocarditis after Tongue Piercing

Piercing invades subcutaneous areas and has a high potential for infectious complications. The number of case reports of endocarditis associated with piercing is increasing. We studied a 25-year-old man with a pierced tongue, who arrived at Memorial Health University Medical Center with fever, chills, rigors, and shortness of breath of 6 days duration and had an aortic valvuloplasty for correction of congenital aortic stenosis

Choledochoduodenal fistula presenting with pneumobilia in a patient with gallbladder cancer: a case report

<p>Abstract</p> <p>Introduction</p> <p>Spontaneous biliary tract fistulas are rare entities. Most of them are associated with long-standing gallstones (especially common bile duct stones, or recurrent biliary tract infections), some with more uncommon diseases such as gallbladder cancer. Some authors believe that back flow from fistulas predisposes patients to gallbladder cancer and some believe that cancer causes necrosis and fistula formation. Gallbladder cancer has a dismal prognosis and 85% of patients are dead within a year of diagnosis. A common complication of gallbladder cancer is obstruction of the common bile duct, which may produce multiple intra-hepatic abscesses in or near the tumor-laden gallbladder. Fistula formation may further complicate the clinical picture.</p> <p>Case presentation</p> <p>We present a case of choledochoduodenal fistula in a 60-year-old diabetic African-American woman with gallbladder cancer. The initial clinical presentation was confusing and complex. Our patient was also found to have a gallbladder fossa abscess that was drained percutaneously as another complicating factor relating to her cancer. She developed myocardial infarction, massive upper gastrointestinal bleeding and respiratory arrest during her stay in hospital. Computed tomography was very helpful in assessing our patient and we discuss how, in a patient with pneumobilia, it can be helpful for detecting fistula, air in bile ducts or to show contractions of the gallbladder.</p> <p>Conclusions</p> <p>We believe this case merits reporting as it shows an entity that is not frequently thought of, is hard to diagnose and can be fatal, as in our patient. Careful evaluation, and computed tomography studies and endoscopic retrograde cholangio-pancreatography are helpful in early diagnosis and finding better management options for these patients.</p

Diagnostic approaches and treatment of eosinophilic esophagitis. A review article

Eosinophilic Esophagitis (EoE) is a condition that involves eosinophilic influx into the esophageal epithelium. It affects both children and adultsAdults present with dysphagia whereas children with vague abdominal complaints. The clinical symptoms as well as pathologic features of EoE and gastro esophageal reflux disease (GERD) are similar. Since eosinophilia in the esophagus is a non-specific finding, the clinical presentation in conjunction with endoscopic findings and pathology, is crucial in determining a differential diagnosis. Infections such as parasites, allergic phenomenon, Crohn's disease, malignancies, medication, and chemotherapy are all associated with eosinophilia. A primary endoscopic difference to note between EoE and GERD is that EoE often involves long segments of the esophagus, could be patchy or focal and frequently involves the proximal esophagus. GERD, however, typically involves the distal much more frequently than the proximal esophagus. Because of the similarity between them, GERD should be excluded by using high dose proton pump inhibitor (PPI) treatment or through evidence of a normal pH by esophageal testing, prior to treatment with an elimination diet or steroids. Until further research establishes different diagnostic tests and criteria, clinical and pathological response to therapy is considered to be the absolute confirmation of this diagnosis. The following is a more detailed discussion of this entity. (C) 2017 The Author. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY-NC-ND licens

Epiphrenic Diverticula

Epiphrenic diverticulum, also known as a pulsion diverticulum, is a rare type of esophageal diverticulum occurring in the distal 10 centimeters of the esophagus, most commonly 4 to 8 centimeters above the gastric cardia. These rare diverticula are diagnosed with a barium esophagram and can be managed both non-operatively and operatively, depending on the patient\u27s symptoms and underlying disorders. This activity reviews the evaluation and management of epiphrenic diverticula and explains the role of the interprofessional team in evaluating and treating patients with this condition

Epiphrenic Diverticula

Epiphrenic diverticulum, also known as a pulsion diverticulum, is a rare type of esophageal diverticulum occurring in the distal 10 centimeters (CM) of the esophagus, most commonly 4cm to 8 cm above the gastric cardia. These diverticula are made up of the mucosal and submucosal lining, herniating through a weakness in the muscularis layer of the esophagus, classifying them as false or pseudodiverticula. This anatomical weakness in the muscularis layer is where nerves and blood vessels enter to supply the distal esophagus

Nutritional Factors Related to Colorectal Cancer in the Residents of Yazd City, Iran

Background: Colorectal cancer is one of the most common gastrointestinal cancers accounting for about 10 percent of cancer-related mortalities. The present study was performed in order to investigate the relationship between nutritional factors and colorectal cancer risk in the population of Yazd, Iran. Methods: This case-control study was conducted on 60 patients with colorectal cancer and 120 healthy individuals in Yazd city. Data were collected by using a researcher-made questionnaire and based on interviews with patients and controls. Data analysis was done through SPSS16 and using Chi-square test and Logistic regression. Results: The mean age of subjects in case and control groups was respectively 58.4 ± 16.4 and 58.3 ± 16.4 years. According to the results of logistic regression, high consumption of red meat, fried foods and low consumption of fruits were the significant predictors of colorectal cancer; so that consumption of red meat or fried food 4 times or more per week and consumption of 1 unit or less fruit per day increased the risk of colorectal cancer by 7.4, 17.8 and 8.3 times, respectively. Conclusion: Results showed that dietary factors such as consumption of fried foods and red meat and also inadequate consumption of fruit can act as risk factors for colorectal cancer. Therefore, adequate dietary planning should be considered for the prevention of colorectal cancer. Keywords: Colorectal cancer, nutrition, Yazd