Medicine
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Review Case Reports
Primary gastric tuberculosis was misdiagnosed as submucosal mass: A rare case report and review of literature.
Tuberculosis of stomach is the rarest form of the tuberculosis family. It is not only lacks specificity in clinical symptoms, but also lacks specificity in auxiliary examination results such as upper gastrointestinal barium meal and gastroscopy. In addition, gastric tuberculosis can coexist with gastric ulcer or gastric cancer, which is difficult to confirm the diagnosis and easy to misdiagnose. ⋯ We performed endoscopic ultrasonography and histopathological biopsy for the patient, and found that the "submucosal mass" was actually a gastric tuberculosis lesion. After confirming the diagnosis of gastric tuberculosis, we transferred the patient to a tuberculosis specialist hospital for antituberculosis treatment.Through a series of literature review, we rediscuss the diagnosis and differential diagnosis of gastric tuberculosis, aiming at improving the understanding of gastroenterologists to this disease, so as to timely diagnose and treat patients with gastric tuberculosis.
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To understand and analyze the prevalence and treatment of hypertension among residents aged 45 years and older in northern and southern Anhui Province to provide an opportunity to improve awareness, taking into account and standardizing hypertension management. Using a stratified cluster random sampling method, Anhui Province was divided into northern and southern Anhui regions using the Yangtze River as the boundary. The prevalence rate, awareness rate, treatment rate, control rate, related risk factors and complications of hypertension in the community population aged ≥ 45 years in Anhui Province were investigated using a questionnaire survey and a physical examination. ⋯ The risk factors for hypertension were older age, rural residence, male, obesity, low education level, high salt diet, smoking, excessive drinking, poor sleep, insufficient exercise, a family history of hypertension, a history of diabetes, and a history of hyperlipidemia. The most common complication of hypertension in middle-aged and elderly people in Anhui Province was cerebrovascular disease, followed by cardiovascular disease. Calcium channel blockers were the most commonly used antihypertensive drugs in middle-aged and elderly people in Anhui Province, followed by angiotensin converting enzyme inhibitor or angiotensin receptor blocker receptor antagonists.
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Heterotopic gastric mucosa (HGM) can occur in all segments of the gastrointestinal tract, but rectal is very rare. In recent years, rectal HGM is more often treated by endoscopic resection (ER). ⋯ Rectal HGM has acid secretion function and HP can be colonized, causing a variety of symptoms such as abdominal pain, bloody stool, and anal pain and has the potential risk of malignant transformation; resection is the best treatment method, and ESD has its unique advantages and can be promoted in the clinic.
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Approved direct-acting antiviral (DAA) regimens against hepatitis C virus (HCV) can cure nearly all patients; however, socioeconomic disparities may impact access and outcome. This study assesses socioeconomic factors, differences in insurance coverage and the drug prior authorization process in HCV-infected patients managed in community practices partnered with a dedicated pharmacy team with expertise in liver disease. This Institutional Review Board-approved, ongoing study captures data on a cohort of 2480 patients from community practices. ⋯ DAA therapy resulted in cure in 95.3% of patients (sustained virologic response = 94.8% HW, 94.0% BAA, 96.5% NHW). Despite having more advanced diseases and more negative socioeconomic factors, >94% of HW and BAA patients were cured. Continued patient education and communication with the healthcare team can lead to high adherence and > 94% HCV cure rates regardless of race/ethnicity or underlying socioeconomic factors in the community setting.
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The COVID-19 pandemic has highlighted disparities in outcomes by social determinants to health. It is unclear how much end-of-life discussions and a patient's decision about code status ("do not resuscitate," do not resuscitate, or "comfort measures only," [CMO] orders) might contribute to in hospital disparities in care, especially given know racial inequities in end-of-life care. Here, we looked at factors associated with code status orders at the end of hospitalization for patients with COVID-19. ⋯ Additionally, we found that patients with white race (OR 2.9; P = .02) were more likely to carry a CMO order. Patient race and ADI were associated with different code status orders at the end of hospitalization. Differences in code status might have contributed to disparities in COVID-19 outcomes early in the pandemic, though further investigations are warranted.