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  • UNDERSTANDING HOW TO REACH THE HARD TO REACH IN CANCER REHABILITATION

    Introduction: Regular exercise helps manage side effects of cancer treatment, however, less than 30% of survivors participate in regular exercise. Exercise-related barriers, facilitators, and needs of general populations of cancer survivors are described in the literature. No information exists describing this information for hard to reach populations. Purpose: To determine the barriers, facilitators, and exercise needs of hard to reach cancer survivors. Materials and Methods: Research design: Descriptive qualitative study. Population: Hard to reach cancer survivors, including young adults (18-39 years), those living in rural communities, and those living in areas of low socioeconomic status. Data collection: Semi-structured interviews were conducted with participants. Interviews were audio recorded and transcribed verbatim. Transcripts were coded independently by two researchers. Coded data was aggregated into nodes and grouped into themes. Results: Five themes were identified that influence exercise participation in hard to reach survivors: accessibility of exercise programs, appropriateness of exercise programs, social support, personal factors, and exercise information. Young adults described a lack of appropriate exercise programs for their age group, those in rural settings described availability issues, and those in areas of low SES described cost and social support as barriers to exercise. Conclusion: This project identified unique exercise-related barriers, facilitators, and needs of hard to reach cancer survivors. Results can be used by researchers and clinicians when creating exercise interventions for cancer survivors. Interventions must be tailored to the specific needs of each individual in order to facilitate accessible participation in regular exercise and facilitate sustained behaviour change.

  • Pseudo-endocarditis secondary to ruptured posteromedial papillary muscle with anatomical variation: A Case Report

    Myocardial infarction is the leading cause of papillary muscle rupture. This complication occurs in up to 5% of cases post MI and although rare, it constitutes a cardiac emergency if left untreated. On this basis, a 59-year-old male presented with low-grade fever and atypical chest pain with raised inflammatory markers and troponin levels. He was treated for infective endocarditis after echocardiography revealed a mass on the mitral valve, which was presumed to be a mitral valve vegetation and so he completed a 6-weeks course of antibiotics followed by elective mitral valve replacement surgery. During surgery, it was discovered that there was no endocarditis. Instead an unusually small muscle head of one of the posteromedial papillary muscle groups had ruptured secondary to an inferior myocardial infarction. This ruptured muscle head was highly mobile and mimicked a mitral valve vegetation. The mitral valve was successfully repaired, and the right coronary artery grafted. He made a full recovery but developed new-onset atrial fibrillation for which he is awaiting elective cardioversion. One should have a high index of suspicion for diagnosing papillary muscle rupture as it may mimic valvular vegetation on echocardiography, especially if the papillary muscle involved is an anatomical variant.

  • SEMI-RIGID LUMBAR SPINE FIXATION WITH PEEK RODS AS A TREATMENT OPTION FOR MONO-SEGMENTAL DEGENERATIVE DISK DISEASE

    Long lasting back pain due to degenerative disc disease is one of the major reasons for reduced quality of life and work incapacity. In some of these patients conservative treatment will not improve back pain significantly. Therefore fusion surgery as a surgical option is offered to these patients. The main aim of this kind of treatment is the reduction of segmental motion leading to an improvement in pain. Rigid fixation leads to high fusion rates but may also contribute to stress shielding and adjacent segment degeneration. Therefore a semi-rigid stabilization with PEEK rods may be an option because it is associated with less implant related rigidity and is a less invasive procedure. The aim of this retrospective study was to evaluate the improvement in back pain after minimally invasive semi-rigid lumbar stabilization with screws and PEEK rods in 45 patients and to identify potential implant failures during a follow up of two years. Six weeks after surgery the patients showed a significant improvement in their back pain, which persisted during the whole observation time of two years (p

  • OSTEOPOROSIS VERSUS TOOTH LOSS

    Osteoporosis is a common metabolic disease of the bones that increases bone fragility due to decreased bone mass and bad quality of bone, leading to an increased risk of bone fracture. This disease affects all the bones, including femurs/pelvis, spine, forearms, ribs, mandible, and maxillary bone. Periodontitis is an inflammation of the tissue around the teeth that results from infections and leads to tooth loss due to attachment loss and destruction of the alveolar bones around the teeth. Apart from Periodontitis, does Osteoporosis also lead to tooth loss? The purpose of this article is to answer this question. An electronic search of English language literature was conducted through PubMed, Medline, and Google scholar. The articles were selected through their topics and contents regarding osteoporosis, periodontitis, and tooth loss. The selected articles included cross-sectional, cohort, and review studies. Osteoporosis and periodontitis are multifactorial diseases and recent studies revealed a positive relation between periodontal disease and osteoporosis. In summary, as well as osteoporosis has an indirect correlation with tooth loss by periodontitis, it also has a direct relationship with tooth loss by decreasing mandibular and maxillary alveolar bone density. Not only Tooth loss could occur due to periodontitis, but also it has many other reasons, which with nowadays researches osteoporosis counts as one of them. Due to the effect of osteoporosis in the reduction of BMD and its relationship with periodontitis, it can both directly and indirectly result in tooth loss. Further well-controlled researches are required to clarify the inter-relationship between osteoporosis and tooth loss.

  • EFFECTS OF FACTORS OF INFORMAL CARE ON THE UTILIZATION OF SOCIAL CARE INSURANCE BENEFITS: A CROSS-SECTIONAL STUDY

    Background: Presently in Germany, as there is a shortage of nursing staff, informal caregivers have become highly relevant. Because they often deal with care related burden, legislation was passed to improve caregivers’ situations by offering more supports. Nonetheless, a considerable percentage of caregivers do not utilize it. Methods: Data was collected in Saxony (Germany) from November 2019 to December 2019 by using an online survey and a postal survey (cross-sectional study design; n= 1,716). For analysis bivariate logistic regression (forward method LR, α≤0.05) was performed. Results: The average age of the sample was 61.9 years, 52.9% were female and 45.7% male. Results indicate a medium utilization of care insurance services. Considerable associations were time spent on care and utilization of care allowance (OR: 1.77), such as duration of care degree and utilization of residential care services (OR: 1.88) and substitute care (OR: 1.81). Conclusions: Informal caregivers putting intensive effort into care do tend to utilize services. The resulting questions of why newer informal caregivers do not tend to utilize services and why there is a medium utilization among all caregivers implies that people need to gain better access to services independently of care factors.

  • Secondary hyperparathyroidism and symptomatic hypercalcemia: overlooked complications of chronic liver disease

    A 71-year-old female with biopsy-proven liver cirrhosis was brought to the ER due to confusion for 5 days. She was diagnosed with acute decompensated liver disease and hepatic encephalopathy. Investigations also revealed PTH-dependent hypercalcemia. Both of these entities could be causing her symptoms. Neck ultrasound did not reveal any parathyroid lesions. Alteration in mental status persisted even after the management and resolution of hepatic encephalopathy. Symptomatic resolution occurred after normalization of her calcium levels which required normal saline, cinacalcet as well as calcitonin over the course of 7 days. Hypercalcemia secondary to chronic liver disease should be considered in the differential diagnosis of patients with liver cirrhosis presenting with an altered mental status. Hypercalcemia of chronic liver disease is not always transient and managed with normal saline as previously reported; It could necessitate more aggressive therapy with calcitonin and cinacalcet as reported in this case.

  • Miller Fisher syndrome associated with respiratory failure

    Miller Fischer syndrome (MFS) is a rare clinical variant of Guillain-Barre syndrome. The diagnosis suspected primarily on clinical trial of areflexia, ophtalmoplegia and ataxia, is confirmed by the mandatory presence of antiganglioside antibodies (anti GQ1b). An acute onset is typical of MFS, beginning with neurological symptoms following a respiratory or digestive infectious illness. The therapeutic options are either the plasmapheresis or the administration of intravenous immunoglobulin (IVIG). Although rare, in certain cases the patients present with respiratory symptoms needing intensive care. We report the case report of a patient which presented with the classical triad of MFS but also with rapid progressive respiratory failure due to bilateral vocal cords palsy and general muscle weakness. He needed respiratory mechanical support. The patient received a treatment by IVIG without any improvement in symptomatology. Eventually he completely recovered and he was discharged from the hospital 3 month later.

  • Tuberculosis Mimicking a Testicular Tumor

    Genitourinary tuberculosis is a challenging clinical entity which can affect the entire male genital tract. Seventy-five- year old male presented with a testicular lump masquerading a testicular malignancy. Histological and microbiological examination of testicular biopsy specimens established the diagnosis of tuberculosis. Isolated testicular tuberculosis is rarely reported. High degree of clinical suspicion and histological sampling are paramount important in the process of diagnostic evaluation.

  • Conditional Dysosmia: a Very Unpleasant Symptom Causing Severe Anorexia and Breathing Problems in Covid-19: a Case Report

    The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new coronavirus that is highly contagious and responsible for the ongoing pandemic disease; coronavirus disease (COVID-19). The disease was first identified in December 2019, and the World Health Organization declared the pandemic on the 11th of March 2020. Although individuals infected with SARS-CoV-2 may be asymptomatic, the disease can present as an upper respiratory tract illness. In the majority of the cases, it is of a mild type, however, some patients experience severe viral pneumonia that leads to respiratory failure, and, in some cases to death. A COVID-19 diagnosis is confirmed by viral RNA detection in nasopharyngeal swab specimens; nonetheless, in some countries, COVID-19 tests are not available for screening and are only used to diagnose severe cases. Since 31 December 2019 and as of 17 October 2020 and in accordance with the applied case definitions and testing strategies in the affected countries 39 400 032 cases of COVID-19 have been reported, including 1 105 353 deaths [1]. The main way to control the spread of COVID-19 is to prevent human-to-human transmission, which can be achieved through a combination of public health measures, including the rapid identification and isolation of infected people [1]. Diagnostic suspicion is based on nonspecific symptoms, such as fever, odynophagia, head- ache, and dry cough which are present in almost all acute respiratory virus cases [2]. Anosmia, which may be associated with the loss of taste, has been initially observed in European cases and seems to be a more specific symptom of COVID-19. Thus, during the pandemic, individuals with these symptoms should be tested for COVID-19; when tests are not available, isolation of the patient is indicated [3]. It should also be noted that olfactory dysfunction significantly influences the physical well-being, quality of life, safety, and…

  • THE BICEPS BRACHII ROLE IN THE STABILIZATION OF THE CROSS PUNCH

    Purpose: starting from an injury background, we assumed that the biceps brachii’s activations could have an important role in upper limbs injury. In this work we analyzed whether different activations of the biceps brachii impact on the power transfer of the punch and how boxers of different skill levels activate the biceps brachii when deliver a punch according to their skill level and efficacy. Methods: we enrolled, basing on official rankings, 23 skilled (n=6) and unskilled boxers. Subjects were instructed to perform three cross punches directed to a fixed elastic target triggered by the coach whistling, and were monitored through a surface electromyography sensor (EMG) on the biceps brachii to estimate the muscular activation during the performance, and through an accelerometer placed inside the elastic impact target to estimate the impact energy. We analyzed the oscillatory content of the EMG signal in order to assess the muscular activation between skilled and unskilled boxers, and between weak and strong punches. Results: both skilled and unskilled boxers threw strong, medium and weak strikes. Skilled boxers performed better than unskilled boxers (47% vs 25% in the “strong punch” category).The EMG analysis revealed a significant increase of lower and higher frequencies (2-4 Hz and 15-17 Hz) and a decrease on the medium frequencies (7-9 Hz) in the skilled boxers compared to the unskilled boxers in strong punches. Weak punches had a similar activation patterns in the two groups. Conclusions: our results support the hypothesis that skilled boxers adapt their activation pattern of the biceps to better stabilize the punch delivery (and thus increasing the transfer of force).