Intracranial subdural hematoma (ICSH) is a rare complication of spinal anesthesia (SA). Because of similar characteristics with postdural puncture headache (PDPH), the definitive diagnosis of ICSH is usually delayed or masked, which potentially results in morbidity or mortality. Herein, we report the case of a young male who developed ICSH following SA and emphasize the differences between ICSH and PDPH in terms of atypical presentations. Furthermore, this report aims to identify the criteria for performing an epidural blood patch in patients with ICSH after dural puncture.

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Background: Due to globalization, the frequency to stay in other countries has increased, resulting in more chances to nursing staff to communicate with foreign patients in English. However, English is not the native language in many countries, including Taiwan. Many nurses cannot communicate with foreign patients efficiently. Aim: This study aimed to identify the clinical English Communication Abilities of nurses and their willingness and requirements to improve, negative communication situations, and their influential factors. Methods: A questionnaire to conduct a descriptive, exploratory, cross-sectional survey was applied to 273 clinical nurses at a teaching hospital in Taiwan. Results: Most nurses stated that their English Communication Abilities was insufficient to cope with clinical requirements and were willing to improve this ability. In negative communication situations, the major problems included the nurses felt that they had to spend more time, were more stressed, and were not able to perform at a professional level when interacting with foreign patients, which would reduce interaction with patients. The factors that impact these problems include frequency of self-study and clinical English communicative abilities. English handout containing hygiene instructions was considered the most useful resource to facilitate clinical English conversation. Conclusions: Inadequate English Communication Abilities results in more time spent when communicating with foreign patients. Nurses who have better English Communication Abilities or have set hours for studying English may reduce the frequency of negative situations while communicating in English. Periodical advanced study of English might reduce the negative situation of nurse–patient communicated in English. To provide high-quality international medical service, the hospital managers have to offer appropriate assist strategies to improve nurses' clinical English communication abilities.

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Background: Better labial closure strength (LCS) may improve eating, swallowing, and quality of life. Patakara is an efficient device to enhance lip strength. In this study, we analyzed differences in LCS and quality of life between before and after training with Patakara in people with intellectual disabilities. Methods: We recruited twenty participants with intellectual disabilities who had poor eating status, lower LCS, or poor oral hygiene status. These participants performed training using Patakara three times a day (3 min each time for five times/week) for 3 months. Oral examination was performed twice, and structural questionnaires and lip force measurements were performed five times. Cheek temperature was also recorded. Results: The maximum value of lip force showed a significant increase during the 3-month training period. In addition, the proportion of participants who kept food in the mouth for a long time when eating significantly reduced. Moreover, the physical functioning and mental health scores of SF-36 showed a significant increase. Conclusions: Patakara training effectively increased lip muscle strength and improved dietary function. Nevertheless, further studies with a longer training duration to investigate the long-term effects of Patakara training are needed.

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The number of proximal femoral fractures is increasing due to traumatic injuries, falls, and heavy exercises. In femoral neck fractures, a number of screws or a device called dynamic hip screw (DHS) are commonly used to fix the fractured hip. In intertrochanteric fractures, DHS or intramedullary nailing (IMN) is usually used to fix the fracture. In subtrochanteric fractures, IMN is usually used to fix the fracture. An orthopedic physician may decide not to perform the surgery only in patients who do not tolerate surgery due to severe and advanced comorbidities or patients who could not walk even before fracture. Rarely, in some types of hip fractures that are completely stable and nondisplaced, the physician may decide to use nonsurgical treatments, mostly bed-rest at home. However, this type of treatment is associated with the risk of further fracture displacement, during the rest period. If a nonsurgical treatment is chosen, strict follow-ups and frequent radiographies should be performed for the patient's fractures so that the physician can be informed if fractures are dislocated and, if necessary, perform surgery on the patient.

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Giant adrenal myelolipoma is a rare entity. It becomes evident due to symptoms of dragging sensation and discomfort or pain. We report hereby a rare case report giant adrenal myelolipoma. A 51-year-old female presented with pain in the right upper abdomen, dull aching, non radiating, no aggravating, or relieving factor present. It was associated with a lump in the right upper abdomen. Computed tomography of the abdomen suggested a 20 cm × 18 cm well encapsulated, hypodense mass, arising from right suprarenal gland inferior to the right lobe of the liver, pushing right kidney inferiorly, and inferior vena cava medially. It showed predominantly fat component and a small area of soft-tissue attenuation with maintained adjacent fat planes, suggestive of right adrenal myelolipoma. After preoperative stabilization, excision of right adrenal myelolipoma was done under general anesthesia and epidural anesthesia.

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Acute fatty liver of pregnancy (AFLP) is a sudden and devastating illness which occurs mostly around the 36^th week of gestation in pregnant females. It is characterized by microvesicular fatty infiltration of the liver which eventually results in encephalopathy and hepatic failure. It carries significant perinatal and maternal mortality and requires early diagnosis and intervention to prevent maternal and fetal death. The foremost cause of AFLP is thought to be due to a mitochondrial dysfunction in the oxidation of fatty acids leading to their continuous accumulation in the hepatocytes. Early diagnosis is extremely important and the only definitive therapy is delivery. Here, we present the case of a 28-year-old pregnant female presenting with abdominal pain, vomiting, and jaundice who was diagnosed with AFLP and gradually worsened postpartum. Due to persistent hypoglycemia and rapidly developing fulminant hepatic failure, the patient expired 5 days after admission.

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Background: Diabetes is an important risk factor of cardiomyopathy which can eventually lead to acute or chronic heart failure. Many factors such as obesity, hyperglycemia, suboptimal glycemic control, and hyperlipidemia predispose as well as aggravate long-term complications in diabetes mellitus (DM). Aim: The present study was conducted to assess the relation of glycosylated hemoglobin (HbA1c) and obesity indices (body mass index [BMI], waist circumference [WC]) with diastolic dysfunction in participants with type 2 DM (T2DM). Methods: This was a cross-sectional study conducted at the teaching hospital during a 1-year period. All 100 consecutive T2DM participants were investigated for HbA1c, blood sugars and lipid profile parameters, and echocardiography. Standardized transthoracic echocardiographic examination was performed (American Society of Echocardiography) using Vivid S6 ultrasound machine with 4–5 MHz probe. Left ventricular diastolic dysfunction (LVDD) was labeled if 3 or more of these variables were abnormal: “Septal e <7 cm/s, lateral e <10 cm/s, E/e' >14, LA volume index >34 mL/m2, and Peak TR velocity >2.8 m/s.” Results: Out of the total 100 diabetics, 37% had diastolic dysfunction (Grade I: 30 [81.08%] and Grade II: 7 [18.91%]). The peak early transmitral filling wave velocity (E) in diabetics with obesity was low as compared to diabetics with normal weight (44 ± 11 cm/s vs. 52 ± 7.5 cm/s). Higher BMI was associated with higher peak late transmitral velocity (A) (61 ± 14 cm/s vs. 38 ± 6.24 cm/s). The mean of E/A ratio was significantly lower in diabetics with obesity. The E/e' ratio was higher in diabetics with obesity (14.8 ± 2.8 vs. 12.86 ± 2.14). The mean of WC was 90.18 ± 6.82 cm in participants of diastolic dysfunction, whereas it was 86.46 ± 6.42 cm in those without dysfunction. Diastolic dysfunction was present in participants with a suboptimal glycemic control, HbA1c ≥ 6.% (40%), with longer duration of diabetes (62.16%) (P = 0.003). Thus, a higher BMI was associated with higher diastolic dysfunction (P = 0.027). Conclusions: The present study reveals burden of LVDD in asymptomatic T2DM participants with its significant association with age, obesity indices (WC and BMI), HbA1c levels, and longer duration of diabetes. This highlights the magnitude of obesity and suboptimal glycemic control that should be considered in the management of cardiac complications in the form of development of diastolic dysfunction. It will benefit in triage for the optimal management of diabetes.

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Background: The number of recurrent tonsillitis and tonsillar hyperplasia requiring tonsillectomies annually is huge. Poor oral hygiene has been linked with the occurrence of these tonsillar diseases. The main objective of the present study is to determine the oral hygiene status of patients treated for tonsillitis and/or tonsillar hyperplasia at our hospital. Methods: This was a prospective case series of participants with tonsillitis or tonsillar hyperplasia at our hospital from 2018 to 2020. Results: A total of 80 participants with tonsillitis/or tonsillar hyperplasia were recruited into the study within August 2016 and March 2017 comprising 49 (61.3%) females and 31 (38.7%) males, with age ranging from 16 to 32 years (18.27 ± 4.21). Conclusions: The present study demonstrated a high proportion of less than optimal oral hygiene status in participants with tonsillitis/or tonsilar hyperplasia. This suggests that there might be an association between oral hygiene and tonsillitis/or tonsilar hyperplasia. Further research is, however, needed to prove this.

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