A nine-year-old male neutered Labrador retriever presented with a history of chronic urinary tract infections and occasional dribbling of urine. Abdominal ultrasound showed changes suggestive of a left ectopic ureter. A pneumocystogram revealed an air-filled distended tubular and tortuous structure extending from the region of the prostatic urethra to the left kidney, consistent with an ectopic ureter. Intravenous urography depicted the presence of an additional left ureter with only slightly larger diameter than the right and with normal insertion in the bladder neck. A duplicated ectopic left ureter was suspected and confirmed during surgery. To the authors' knowledge, this is the first description of a duplicated ectopic ureter in the canine species. The combination of ultrasound and contrast radiography was important to reach the diagnosis.
Introduction We aimed to validate the Medication Adherence Report Scale-5 (MARS-5) as a tool for assessing medication adherence in inflammatory bowel disease (IBD) and to determine predictors of medication adherence. Methods One hundred twelve (N = 112) adults with confirmed IBD participating in the longitudinal Manitoba Living With IBD Study were eligible. Demographics, IBD type, surgeries, disease activity (using the Inflammatory Bowel Disease Symptom Inventory and fecal calprotectin levels), perceived stress, and medication use were collected biweekly through online surveys. The MARS-5 scores were obtained at baseline and at 1 year. Correlation between medication monitoring data and MARS-5 scores was performed and the optimal MARS-5 cutoff point for adherence assessment determined. Predictors of medication adherence were assessed at both ≥90% and ≥80%. Results Participants were predominantly female (71.4%), mean age was 42.9 (SD = 12.8), and the majority (67.9%) had Crohn disease (CD). Almost half (46.4%) were taking more than 1 IBD medication, with thiopurines (41.9%) and biologics (36.6%) the most common. Only 17.9% (n = 20) were nonadherent at a <90% level; of those, 90% (n = 18) were using oral medications. The MARS-5 was significantly associated with adherence based on medication monitoring data at baseline (r = 0.48) and week 52 (r = 0.57). Sensitivity and specificity for adherence ≥80% and ≥90% were maximized at MARS-5 scores of >22 and >23, respectively. Having CD (OR = 4.62; 95% confidence interval, 1.36-15.7) was the only significant predictor of adherence. Conclusion MARS-5 is a useful measure to evaluate adherence in an IBD population. In this highly adherent sample, disease type (CD) was the only predictor of medication adherence.
Limited research exists examining long-term mental and physical health outcomes in adult survivors of pediatric burns. The authors examine the postinjury lifetime prevalence of common mental and physical disorders in a large pediatric burn cohort and compare the results with matched controls. Seven hundred and forty five survivors of childhood burns identified in the Burn Registry (<18 years old and total BSA >1% between April 1, 1988 and March 31, 2010) were matched 1:5 to the general population based on age at time of injury (index date), sex, and geographic residence. Postinjury rate ratio (RR) was used to compare burn cases and control cohorts for common mental and physical illnesses through physician billings, and hospital claims. RR was adjusted for sex, rural residence, and income. Compared with matched controls, postburn cases had significantly higher RR of all mental disorders, which remained significant (P < .05) after adjustment (major depression RR = 1.5 [confidence limit {CL}: 1.2-1.8], anxiety disorder RR = 1.5 [CL: 1.3-1.8), substance abuse RR = 2.3 [CL: 1.7-3.2], suicide attempt RR = 4.3 [CL: 1.6-12.1], or any mental disorder RR = 1.5 [CL: 1.3-1.8]). The relative rate of some physical illnesses was also significantly increased in burn survivors: arthritis RR = 1.2 (CL: 1.1-1.4), fractures RR = 1.4 (CL: 1.2-1.6), total respiratory morbidity RR = 1.1 (CL: 1.02-1.3), and any physical illness RR = 1.2 (CL: 1.1-1.3). Adult survivors of childhood burn injury have significantly increased rates of postburn mental and physical illnesses. Screening and appropriate management of these illnesses is essential when caring for this population.
Tetanus is a life-threatening clinical syndrome that commonly presents with muscular spasms, rigidity, and autonomic instability. It is considered rare in industrialized countries, and tetanus occurring secondary to dental abscesses, procedures, or infections has been infrequently reported. We describe the case of a patient inadequately immunized for tetanus, who presented to the emergency department with muscular spasms, rigidity, and autonomic instability in the setting of an odontogenic infection. A clinical diagnosis of tetanus was made and subsequently managed successfully. RÉSUMÉLe tétanos est une maladie clinique, potentiellement mortelle, qui s'accompagne souvent de spasmes musculaires, de rigidité et d'une instabilité du système nerveux autonome. Il s'agit d'une maladie rare dans les pays industrialisés, et les cas de tétanos consécutifs à des abcès dentaires, à une intervention ou à des infections ne font pas souvent l'objet de description dans la documentation médicale. Sera exposé ici un cas de tétanos chez un malade non suffisamment immunisé contre la maladie, qui a consulté un médecin au service des urgences pour des spasmes musculaires, de la rigidité et une instabilité du système nerveux autonome, dans le contexte d'une infection odontogène. Un diagnostic clinique de tétanos a été posé et la maladie a été traitée adéquatement.Keywords: tetanus, dental, immunization CASE REPORTA healthy 32-year-old male presented to the emergency department with generalized body muscular spasms and a 2-week history of right upper-third molar tooth pain due to a recent tooth fracture in the setting of multiple dental caries and baseline poor dentition.He reported 48 hours of intermittent episodes of jaw twitching lasting for approximately 10 minutes, re-occurring every 15 minutes. Thereafter, the spasms spread to involve the neck, shoulder, arms, back, and legs with increasing intensity and duration. He described the spasms as extremely painful.The patient had no other significant past medical history and denied illicit drug use. The patient was a roof mechanic. He denied any recent lacerations. The immunization records revealed that he was inadequately immunized and was last vaccinated against tetanus 12 years previous.Examination revealed moderate swelling and erythema surrounding the right upper-third molar site that was fractured. The spasms involved the majority of facial muscles causing trismus (lockjaw due to spasm of the muscles of mastication), dysphagia, and eyelid closure. Spasms of the neck and back resulted in stiffness, involuntary extension, and arching; and of the upper and lower limbs causing various extension and flexion movements. There was no impairment of consciousness during the patient's entire presentation, and in between episodes he had normal power and sensation throughout; however, he had increased muscular tone and widespread exaggerated reflexes with elicited Babinski reflexes bilaterally. Despite the patient's increased nuchal muscle tone, he did not exhibit other signs of meni...
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