International Journal of Clinical Research

Unmasking Denial in Symptomatology: Delving into the Psychological, Sociocultural, and Contextual Factors of Denial of Patient Symptoms

Saksham Sharma Sharma — 2024-09-12

Background: Symptom denial is a multifaceted response, intricately woven with individual psychology, societal pressures, and environmental cues. This Narrative review delves into this complexity, spotlighting the critical role of a patient's mindset in determining their acceptance or denial of a disease.

Objectives: The literature aims to elucidate the denial of symptoms and its various underlying factors to make healthcare more inclusive of these variations in patient presentations.

Methods: A literature search was conducted across the PubMed database, and hand searches were done on Google Scholar to acquire literature based on SANRA guidelines with structured inclusion and exclusion criteria.

Results: The culmination of this exploration underscores the intricate nature of symptom denial, revealing its multifaceted origins within individual psychology, societal norms, and the broader environment. Denial emerges not as a monolithic reaction but as a nuanced interplay of coping mechanisms, cultural beliefs, socioeconomic factors, and health literacy.

Discussion: Acknowledging these complexities is vital for tailored healthcare approaches. By unraveling the layers of denial, we pave the way for informed interventions that respect diverse perspectives and foster improved symptom acknowledgment, ultimately enhancing overall well-being and patient outcomes.

Assessing the Effects of the 2023 Turkish Earthquakes on Mental Health in Lebanon: A Cross-sectional Study

Moussa Hojeij — 2024-06-15

Background: On the 6 of February 2023, an earthquake registering 7.8 on the Richter Scale hit the South and center of Turkey, as well as the North and West Syria. Subsequently, another seismic event with a magnitude of 7.5 ensued a few hours later. Two weeks later, a new earthquake of 6.4 magnitude shook both countries again. These two events left behind more than 50000 deaths and a lot of damage, both economically and psychologically, which affected the Lebanese population.

Aim: This study evaluates the adverse effects of these earthquakes on the mental health of people in Lebanon.

Methods: This is a cross-sectional study conducted between 6 March, and 23 March 2023, using an online survey. The questionnaire was divided into 4 sections: demographics, the mental health of participants, anxiety before the earthquakes, and anxiety after the earthquakes using the Lebanese Anxiety Scale- to differentiate between healthy and anxious participants.

Results: The study involves 670 Lebanese participants aged 18 or above. Anxiety proportion rose post-earthquakes. Pre-earthquakes, anxiety risk factors included female gender, younger age, Beirut residency, mental health issues, and medication use; these factors also significantly raised anxiety after earthquakes.

Conclusion: This study demonstrates a remarkable escalation in anxiety proportion following the earthquakes. Pre-existing risk factors such as female gender, younger age, Beirut residency, mental health issues, and medication use for symptom relief exhibited a heightened association with anxiety after the tectonic events. These findings deepen the importance of targeted interventions to address the psychological impact of earthquakes on vulnerable populations.

Endometrial Stromal Sarcoma in Term Pregnancy: A Unique Case Report and Review of the Literature

Eva Koulaymi — 2024-07-18

Background: Endometrial stromal sarcoma (ESS)is a rare malignancy described only in a limited number of case reports. It accounts for only 2% of all uterine tumors.

Case Report: We describe a case of a 29-year-old pregnant lady presenting at 37 weeks of gestation in labor. A huge intra-cavitary mass was seen on bedside ultrasound upon her presentation. The patient underwent an urgent repeat cesarean section where a twenty cm uterine mass was identified after delivering the baby and the placenta. The pathology exam of the group showed low-grade endometrial stromal sarcoma with anti-CD10 and anti-estrogen receptors. A radical hysterectomy with bilateral salpingo-oophorectomy was performed two days later as the ESS was staged 1B following the post-cesarean PET scan result.

Conclusion: ESS is infrequent in young women as well as pregnant patients. This is the first case of asymptomatic endometrial stromal sarcoma in pregnancy, giving birth to a full-term baby with successful treatment.

A Case of an Adult Complicated Left Diaphragmatic Hernia: Case Report and Literature Review

Souad Ghattas — 2024-06-12

Introduction: Diaphragmatic hernia by definition is the protrusion of abdominal structures into the thoracic cavity. Classified as either congenital or acquired, adult diaphragmatic hernia without a history of trauma is rare, and iatrogenic diaphragmatic hernia is rarer. The array of symptoms may be acute or latent and will depend on the herniated organ, which certainly makes this pathology a challenge at the level of diagnosis and subsequent management.

Case Report: Here we present the case of a 73-year-old male patient who presented one year post left nephrectomy complicated by splenectomy (post splenic injury), with two weeks history of diffuse abdominal pain, non-bilious vomiting, and shortness of breath. Workup done revealed a left diaphragmatic hernia containing necrotic-perforated small bowel loops. A laparotomy with intestinal resection, loop ileostomy along with a primary repair of the diaphragmatic defect were performed.

Conclusion: Although a great portion of acquired diaphragmatic hernias remain asymptomatic, they may be presenting with severe symptomatology and aggravating complications. At the level of clinical manifestation, suspicion of diaphragmatic hernia ascends the ladder of differential diagnosis in a patient with combined respiratory and gastrointestinal symptoms and hence is essential to avoid delayed treatment and superimposing lethal complications. Definitive treatment of diaphragmatic hernia is surgical repair given the high morbidity and mortality associated with such injury.

Unilateral Vocal Cord Paralysis Following COVID-19 Infection: A Case Report and Literature Review

Hadi Abou Zeid — 2024-05-31

Background: Throughout the COVID-19 pandemic, numerous symptoms and complications were encountered. These symptoms ranged from conjunctivitis, diarrhea, and anosmia to headache, confusion, lightheadedness, acute cerebrovascular disease, epilepsy, acute disseminated encephalomyelitis, encephalitis, loss of taste, pain in muscles, and Guillain-Barre Syndrome. Some carriers were asymptomatic and only had a diminished sense of smell. Besides, one of the rare manifestations that may be encountered post-COVID-19 infection is vocal fold paralysis, unilaterally or bilaterally.

Case report: This is the case of a 47-year-old female patient presenting with hoarseness of 10 weeks duration and 11 weeks post-COVID-19 infection. Using laryngoscopy, the patient was diagnosed with right vocal cord paresis with incomplete abduction. However, there were no abnormalities found in the brain, thorax, or upper mediastinum. After refusing to take corticosteroids, gradual improvement in hoarseness was observed 2 weeks after her first visit to the clinic, and the patient reached complete remission in 4 weeks.

Conclusion: This case represents a very rare complication following coronavirus infection. Considering the sparse reports of such cases, it is extremely important to shed light on the possibility of vocal fold paresis after infection with COVID-19 and how these cases are being managed.

Myocarditis Mimicking ST-Elevation Myocardial Infarction: A Case Report

Mohammed Dabbouss — 2024-05-28

Background: Myocarditis is the inflammation of the heart muscle, which affects mostly the young population. Patients may experience symptoms ranging from chest pain, fatigue, dyspnea, to more serious conditions such as heart failure and arrhythmias. Diagnosis of myocarditis may be quite confusing as it may mimic myocardial infarction, particularly when ST-elevation is present on electrocardiogram (ECG). Here, we present a challenging presentation of myocarditis mimicking ST-segment elevation myocardial infarction (STEMI).

Case Report: A 54-year-old man admitted to the emergency department due to severe chest pain of two hours duration. Lab tests revealed high levels of troponin and D-dimer. ECG revealed tachycardia and ST-elevation in the anterolateral leads, making the diagnosis towards STEMI very likely. However, coronary angiogram didn’t show any obstruction in the right or left coronary arteries. Cardiac magnetic resonance (CMR) imaging was then performed and showed evidence of myocarditis. The patient was treated with colchicine and beta-blocker in which he showed a gradual recovery.

Conclusion: Our case highlights the difficulties that a physician may encounter when it comes to diagnosing a case of myocarditis. It should always be kept in mind when dealing with patients presenting with chest pain and ST-elevation, as it may mimic a typical STEMI presentation. A thorough clinical evaluation and the choice of appropriate diagnostic tools are key to the diagnosis of such challenging cases.

Unraveiling the Mystery: Jejunal Stenosis Post-Stroke: A Case Report

Priyaben Bhakta — 2024-05-28

Background: Jejunal stenotic strictures are relatively rare but have significant clinical entities and various complex etiologies characterized by the narrowing or obstruction of the jejunum.

Case Report: The patient presented with a two-month history of abdominal pain, persistent nausea, bilious vomiting, and dizziness, following a left posterior cerebral artery (PCA) stroke. Workup and various imaging studies revealed stenosis of the 3rd and 4th portion of the proximal jejunum, leading to the decision to proceed with exploratory laparotomy with bowel resection and anastomosis. The histological examination of the 15cm jejunum resection revealed significant transmural inflammation, encompassing both acute and chronic components. The presence of ulcers and prominent lymphocyte infiltration was noted, along with granulation tissue and hypertrophic muscularis propria.

Conclusion: The absence of focal deficits and subsequent ischemic events, accompanied by a history of inflammatory bowel disease, suggested ischemic enteritis (IE) as the primary etiology. The patient exhibited a full recovery following the surgical intervention and reported normal gastrointestinal (GI) function. This case emphasizes the necessity for further research to gain a comprehensive understanding of the pathophysiology and optimal management approaches for jejunal stenosis. It further highlights the significance of considering IE in patients with persistent GI symptoms post-stroke.

3 mL Versus 5 mL of 0.75% Ropivacaine for Ultrasound-Guided Interscalene Block: A Randomized Clinical Trial

Mohammad Daher — 2024-05-19

Background: Ropivacaine is a local anesthetic used in nerve blocks for post-operative analgesia with dose-dependent side effects. Research indicated that ropivacaine may have better safety profiles than most local anesthetics, but toxicity and other dose-dependent side effects can still occur. Our aim is to show that a lower dose of ropivacaine is as effective when it comes to anesthesia and has a lower rate of complications.

Methods: This study aims to compare 3 mL and 5 mL of 0.75% ropivacaine used for ultrasound-guided interscalene nerve block in shoulder arthroscopy in terms of postoperative analgesia and complications. We compared two groups (group 3 and group 5). Each group consisted of 30 patients. One group received 3 mL of 0.75% ropivacaine while the other group received 5 mL of the same product. The pain scale was evaluated in the post-anesthesia care unit (PACU) every 30 minutes up to two hours, then via phone call questionnaire for patients discharged during the first 24 hours. The incidence of complications was also evaluated in both groups.

Results: Both groups had the same analgesic effect. No difference in the incidence of postoperative complications was noted however, more hemidiaphragmatic paralysis was observed in group 5 (p=0.023).

Conclusion: Both 3 mL and 5 mL of 0.75% ropivacaine had the same post-operative analgesic effect with a lower incidence of hemidiaphragmatic paralysis seen in group 3, Further investigation on respiratory function must be undertaken.