• Journal of Neurogastroenterology and Motility
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• v.24 no.4
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• pp.536-543
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• 2018

Culture forms an integral aspect of environmental factors which influences disease presentation and clinical outcomes in functional gastrointestinal disorders (FGIDs). In this review, the role of culture in FGIDs in the East is briefly explored with regards to symptom presentation and diagnostic issues, lifestyle and cultural habits, epidemiology, and healthcare seeking behavior. In both functional dyspepsia and irritable bowel syndrome, symptom presentation and disease sub-typing in Asians are known to differ from their Western counterparts, possibly relating to cultural dietary practices and from cultural perception of symptoms. Dietary patterns, together with defecating practices are explored as factors contributing to a lower prevalence of constipation in the East. An urban-rural difference in the prevalence of FGIDs in Asia is attributed to a change in dietary patterns in rapidly developing urban communities, together with an increased level of psychological morbidity. Lastly, cultural attitudes towards traditional/local remedies, variation in healthcare systems, anxiety regarding organic disease, and religious practices have been shown to influence healthcare seeking behavior among FGID patients in the East.

• Clinical and Experimental Emergency Medicine
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• v.5 no.4
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• pp.282-285
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• 2018

The objective is to review a case of pneumoparotitis and to discuss how knowledge of this unique presentation is important when making differential diagnoses in emergency medicine. A patient with recurrent subcutaneous emphysema of the head and neck is reviewed. Stenson's duct demonstrated purulent discharge. Physical examination revealed palpable crepitance of the head and neck. Fiberoptic laryngoscopy and barium esophagram were normal. Computed tomography demonstrated left pneumoparotitis and subcutaneous emphysema from the scalp to the clavicles. This is an unusual presentation of pneumoparotitis and malingering. Emergency physicians should be aware of pneumoparotitis and its presentation when creating a differential diagnosis for pneumomediastinum, which includes more life-threatening diagnoses such as airway or esophageal injuries.

• Korean Journal of Audiology
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• v.25 no.4
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• pp.235-240
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• 2021

Sudden sensorineural hearing loss (SSNHL) is a common disorder; however, sequential, bilateral presentation of the disease is rarer than unilateral presentation. Clinical otologists usually focus on treating the side with impaired hearing when patients first present with unilateral SSNHL, and therefore, may not warn patients of the possibility of subsequent hearing impairment in the contralateral ear. Furthermore, it is professionally discouraging when a patient presents with profound, sequential SSNHL after initial treatment. This may adversely impact the doctor-patient relationship, even if the patient is offered the best possible care from their first visit. Herein, we report the case of a patient with profound, idiopathic, bilateral SSNHL with a time interval of 37 days between involvement of both ears. Even though high-dose steroids were administered intraorally and intratympanically, the patient's hearing was not restored, and the patient eventually required bilateral cochlear implant surgery. Our report demonstrates that sequential, profound, bilateral SSNHL may manifest without any specific signs.

• Journal of Audiology & Otology
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• v.25 no.4
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• pp.235-240
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• 2021

Sudden sensorineural hearing loss (SSNHL) is a common disorder; however, sequential, bilateral presentation of the disease is rarer than unilateral presentation. Clinical otologists usually focus on treating the side with impaired hearing when patients first present with unilateral SSNHL, and therefore, may not warn patients of the possibility of subsequent hearing impairment in the contralateral ear. Furthermore, it is professionally discouraging when a patient presents with profound, sequential SSNHL after initial treatment. This may adversely impact the doctor-patient relationship, even if the patient is offered the best possible care from their first visit. Herein, we report the case of a patient with profound, idiopathic, bilateral SSNHL with a time interval of 37 days between involvement of both ears. Even though high-dose steroids were administered intraorally and intratympanically, the patient's hearing was not restored, and the patient eventually required bilateral cochlear implant surgery. Our report demonstrates that sequential, profound, bilateral SSNHL may manifest without any specific signs.

• Korean Medical Education Review
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• v.18 no.3
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• pp.132-144
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• 2016

The aim of this study is to provide the background of developing guides to clinical performance and basic clinical skills and to introduce how to teach and learn using the guide. The students' performance problems presented in an objective clinical skills examination were disease-centered tertiary hospital clinical care, incomplete performance, doing by rote, and an exam-oriented learning attitude. The problems were caused by a tertiary hospital-based educational environment as well as schools and faculty who are unfamiliar with the concept of patient-centered care. The purpose of the guide to clinical performance and basic clinical skills is to overcome these problems and address the causes. The guides show a clinical presentation approach to primary care; clinical care integrated with knowledge, skills, and attitude; a schematic approach; and a patient-centered attitude. To achieve these goals, a strategy to change the educational culture is important. Curricular reform, faculty development, and improving educational facilities and environments are suggested.

• Parasites, Hosts and Diseases
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• v.48 no.2
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• pp.167-169
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• 2010

We report a case of Hymenolepis diminuta infection in a 2-year-old child living in a suburban area of Catania, Italy. This case was initially referred to us as Dipylidium caninum infection, which was not cured after being treated twice with mebendazole. However, by analyzing the clinical presentation and stool samples we arrived to the diagnosis of H. diminuta infection. The case presented with atypical allergic manifestations which had never been reported as clinical features of symptomatic H. diminuta infection; remittent fever with abdominal pain, diffuse cutaneous itching, transient thoracic rash, and arthromyalgias. The patient was treated with a 7-day cycle of oral niclosamide, which proved to be safe and effective. This case report emphasizes that a correct parasitological diagnosis requires adequate district laboratories and trained personnel. In addition, we recommend the importance of reporting all H. diminuta infection cases, in order to improve knowledge on epidemiology, clinical presentation, and treatment protocols.

• Journal of Chest Surgery
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• v.9 no.2
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• pp.169-174
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• 1976

Since. its first description by Albrecht in 1904 that hamartoma (Greek. meaning "error" and "tumor")is tumor-like malformation characterized by abnormal mixture of normal constituent in any organ it arises, hamartoma involving the lung has assumed the following clinical features.: 1) all the pulmonary lesions presenting as "coin lesions", it occupies about 8% according to various reports. It also constitutes the most prevalent lesion of all the benign lung tumors, appearing in 0.25% of the general population. 2) Peak incidence of the lesion occurs in the 5th and 6th decade as the carcinoma patient do, and the occasional growing tendency and periperal location as in this presentation renders the differential diagnosis from the malignant disease difficult and surgical intervention inevitable for definite histological diagnosis and treatment. 3) Nearly all the clinical investigations such as history, physical exam, bronchoscopy, culture, and cytological exam of sputum sre likely to futile:the only tool for detecting the presence of the lesion is X-ray, butthat's short of telling the true nature of it. 4) Because of its age of presentation and growing tendency in middle-aged adult, it still controversial whether it is developmental anomaly as Albrecht described, or true neoplasm denovo of fibrous connective tissue origin. This is a case report of surgical experience of pulmonary hamartoma which had nearly all the typical clinical features above mentioned and was reviewed with related literatures.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.17
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• pp.7467-7472
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• 2015

Background: Breast cancer is known to be one of the most prevalent cancers among women in both developing and developed countries. The incidence of breast cancer in Pakistan has increased dramatically within the last few years and is the second country after Israel in Asia to have highest proportional cases of breast cancer. However, there are limited data for breast cancer available in the literature from Pakistan. Objectives: The study was conducted to bring to light the common clinical presentation of breast cancer and to evaluate the frequency of established risk factors in breast carcinoma patients and furthermore to compare the findings between premenopausal and postmenopausal women in Pakistan. Materials and Methods: A 6 months (from July 2012 to Dec 2012) cross sectional survey was conducted in Surgical and Oncology Units of Civil Hospital, Karachi. Data were collected though a well developed questionnaire from 105 female patients diagnosed with carcinoma of breast and analyzed using SPSS version 17. Institutional ethical approval was obtained prior to data collection. Results: Out of 105 patients, 43 were premenopausal and 62 were postmenopausal, 99 being married. Mean age at diagnosis was $47.8{\pm}12.4years$. A painless lump was the most frequent symptom, notived by 77.1%(n=81). Some 55.2% (n=58) patients had a lump in the right breast and 44.8%(n=47) in the left breast. In the majority of cases, the lump was present in upper outer quadrant 41.9% (n=44). Mean period of delay from appearance of symptoms to consulting a doctor was $5.13{\pm}4.8months$, from the shortest 1 month to the longest 36 months. Long delay (> 3 months) was the most frequent figure 41.9%. Considering overall risk factors most frequent were first pregnancy after 20 years of age (41%), physical breast trauma (28.6%), lack of breast feeding(21.9%), and early menarche <11 years (19%), followed by null parity (16.2%), consumption of high fat diet (15.2%), family history of breast cancer or any other cancer in first degree relatives (9.5% and 13.3%, respectively). Some of the less common factors were late menopause >54 years (8.6%), use of oral contraceptive pills (10.5%), use of hormone replacement therapy (4.7%),smoking (4.7%) and radiation (0.96%). Significant differences (p<0.005) were observed between pre and post menopausal women regarding history of physical breast trauma, practice of breast feeding and parity. Conclusions: A painless lump was the most frequent clinical presentation noted. Overall age at first child > 20 years, physical breast trauma, lack of breast feeding, early menarche <11 were the most frequent risk factors. Physical breast trauma, lower parity, a trend for less breast feeding had more significant associations with pre-menopausal than post-menopausal onset. Increase opportunity of disease prevention can be obtained through better understanding of clinical presentation and risk factors important in the etiology of breast cancer.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.1
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• pp.221-227
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• 2014

Background: Aberrant phenotypes in acute leukemia have variable frequency and their prognostic and predictive relevance is controversial, despite several reports of clinical significance. Aims: To determine the prevalence of aberrant antigen expression in acute leukemia, assess clinical relevance and demonstrate immunophenotype-karyotype correlations. Materials and Methods: A total of 73 (40 AML and 33 ALL) newly diagnosed acute leukemia cases presenting to KAMC, Kingdom of Saudi Arabia, were included. Diagnosis was based on WHO criteria and FAB classification. Immunophenotyping by flow cytometry, conventional karyotyping and fluorescence in situ hybridization for gene rearrangements were performed. Results: Aberrant antigens were detected in 27/40 (67.5%) of AML and in 14/33 (42.4%) in ALL cases. There were statistically significant higher TLC in Ly+ AML than in Ly-AML (p=0.05) and significant higher blast count in ALL with aberrant antigens at presentation and day 14 (p=0.005, 0.046). There was no significant relation to clinical response, relapse free survival (RFS) or overall survival (p>0.05), but AML cases expressing ${\geq}2$ Ly antigens showed a lower median RFS than those expressing a single Ly antigen. In AML, CD 56 was expressed in 11/40. CD7 was expressed in 7/40, having a significant relation with an unfavorable cytogenetic pattern (p=0.046). CD4 was expressed in 5/40. CD19 was detected in 4/40 AML associated with M2 and t (8; 21). In ALL cases, CD33 was expressed in 7/33 and CD13 in 5/33. Regarding T Ag in B-ALL CD2 was expressed in 2 cases and CD56 in 3 cases. Conclusions: Aberrant antigen expression may be associated with adverse clinical data at presentation. AML cases expressing ${\geq}2$ Ly antigens may have shorter median RFS. No specific cytogenetic pattern is associated with aberrant antigen expression but individual antigens may be related to particular cytogenetic patterns. Immunophenotype-karyotype correlations need larger studies for confirmation.

• Journal of Preventive Medicine and Public Health
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• v.56 no.3
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• pp.212-220
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• 2023

Objectives: This study compared the epidemiological and clinical manifestations of patients hospitalized with respiratory syncytial virus (RSV) infection before and during the coronavirus disease 2019 (COVID-19) pandemic at a tertiary care hospital in Chiang Mai Province, Thailand. Methods: This retrospective observational study utilized data from all cases of laboratory-confirmed RSV infection at Maharaj Nakorn Chiang Mai Hospital from January 2016 to December 2021. Differences in the clinical presentation of RSV infection before (2016 to 2019) and during (2020 to 2021) the COVID-19 pandemic were analyzed and compared. Results: In total, 358 patients hospitalized with RSV infections were reported from January 2016 to December 2021. During the COVID-19 pandemic, only 74 cases of hospitalized RSV infection were reported. Compared to pre-pandemic levels, the clinical presentations of RSV infection showed statistically significant decreases in fever on admission (p=0.004), productive cough (p=0.004), sputum (p=0.003), nausea (p=0.03), cyanosis (p=0.004), pallor (p<0.001), diarrhea (p<0.001), and chest pain (p<0.001). Furthermore, vigilant measures to prevent the spread of COVID-19, including lockdowns, also interrupted the RSV season in Thailand from 2020 to 2021. Conclusions: The incidence of RSV infection was affected by the COVID-19 pandemic in Chiang Mai Province, Thailand, which also changed the clinical presentation and seasonal pattern of RSV infection in children.