Malignant Psoas abscess or pseudomyxoma extraperitonei

Primary adenocarcinoma of appendix is an uncommon gastrointestinal malignancy. Similarly, Psoas abscess is an entity, which sometimes requires extensive work-up to reach a diagnosis. Combined presentation of these two rare conditions is not only exceptional, but also diagnostically challenging. We present a case of a lady who presented with recurrent UTI secondary to right sided ureteric obstruction, referred right hip joint pain resulting from a Psoas abscess, which eventually turned out to be a consequence of metastatic adenocarcinoma of appendix, causing pseudomyxoma extraperitonei, with simultaneous intraperitoneal deposits

Hydatidosis: experience with hepatic and pulmonary hydatid disease

From 1989-1992, 35 cases comprising of 20 hepatic and 15 pulmonary hydatid cysts were seen. Four patients with pulmonary hydatid disease had previous or concomitant hepatic hydatidosis compared to no concomitant pulmonary hydatid disease in the hepatic group. Hepatic hydatid disease had a greater tendency to be right sides, infected and calcified. Anaphylactic reactions occurred in 3 of 20 patients with hepatic hydatid disease against none in 15 patients with pulmonary disease. Management consisted of evacuation, drainage and obliteration of the residual cavity by capittonage in the lung and omentoplasty in the liver. Two patients, one hepatic and one with pulmonary hydatid disease developed infection of the residual cavity. Bronchocystic fistula occurred in 4 pulmonary and cystobiliary fistula in 2 hepatic hydatid disease patients. One patient with severe pleuropulmonary hydatidosis required a thoracoplasty. No recurrences have been noted in either group over a mean follow-up of 11 months (range 3 weeks- 3 years)

The Impact of Stigmatized Identities and Culture on the Mental Health of East and South Asian Americans

There is limited understanding of the factors impacting the mental and physical health of Asian Americans. Stigma has been identified as an important contributor to poor mental and physical health in the general population (DHHS, 1999) and as a barrier to seeking mental health services in the Asian American community (e.g., Ting & Hwang, 2009). The current study evaluated a model of the impact of stigma against concealable stigmatized identities (CSIs) on the mental and physical health outcomes of Asian Americans. The current sample consisted of 246 Asian Americans (168 East Asian and 78 South Asian Americans). Participants with a CSI reported the degree to which they believe others will stigmatize them because of their CSIs (anticipated stigma), how important their CSI is to them (stigma centrality), how frequently they think about their identity (stigma salience), their adherence to traditional Asian values, their anticipation of discrimination based on their ethnicity, and their symptoms of depression, anxiety, and physical well-being. Participants without a CSI rated the cultural stigma associated with specific CSIs. The results indicated that stigma salience was the only stigma construct to significantly predict depression and anxiety symptoms in a community sample of Asian Americans. Anticipated ethnic discrimination and Asian values significantly predicted depression and anxiety. The only significant unique predictor of physical health was Asian values. The salience of Asian Americans’ CSIs, their adherence to traditional Asian values, and their anticipation of ethnic discrimination are important areas for intervention to improve their mental and physical health

A Stochastic Simulation Model of Alarm Response Strategies on a Telemetry Floor

The large quantity of alarms characteristic of clinical settings have resulted in nursing staff suffering from a phenomenon termed ‘alarm fatigue’. Alarm fatigue is desensitization via habituation – as these commonly heard noises cause caregivers to have delayed or no response to alarms. Alarm management was ranked number one on the annual top ten list of technology hazards afflicting healthcare institutions published by the ECRI Institute for 2012. Several patient safety organizations have established alarm fatigue as a priority concern, and are working to eradicate the issue from the healthcare environment by 2017. To better understand the problem, a simplified simulation model was created using AutoMod® to investigate the routine processes involved in responding to cardiac arrhythmia alarms on a telemetry unit as well as the sources of noise attributing to alarm fatigue. By quantifying these workflows and response strategies, this model can be utilized to aid administrators and managers in selecting alarm escalation times as well as modifying hospital protocols to minimize alarm response time and enhance nursing efficacy. The results also support the identification of hospital policy elements where clinical workflow could be augmented based on the physical layout of the telemetry floor, use of distributed alarm notification systems and staff roles and responsibilities

Post-colectomy peristomal pyoderma gangrenosum

We report a patient with peristomal pyoderma gangrenosum which mimicked a necrotizing bacterial infection. It occurred as an extra-intestinal manifestation of chronic mucosal ulcerative colitis (MUC). Initially misdiagnosed as a cutaneous infection, it finally responded to intravenous high dose corticosteroid therapy