Symptomatic vaginal enterocele associated with malfunctioning ventriculoperitoneal shunt and cerebrospinal ascites.

Abdominal pseudocyst formation is a rare adult complication associated with ventriculoperitoneal (VP) shunts. Presenting symptoms are primarily abdominal and include distention, pain and anorexia, and secondarily neurological with signs and symptoms of shunt malfunction. We describe a case of VP shunt-related pseudocyst formation presenting as symptomatic pelvic organ prolapse with stage 4 enterocele 4 years after VP shunt placement. The patient's vaginal enterocele enlarged and became more symptomatic as intra-abdominal cyst formation expanded. Symptomatic relief of pelvic floor symptomatology including resolution of exteriorized prolapse was established by conservative measures and eventual VP shunt revision and removal. VP shunt malfunction may present as symptomatic pelvic organ prolapse and may require shunt removal or revision for resolution of symptoms.

The use of DIY (Do it yourself) sampling and telemonitoring model for COVID-19 qPCR testing scale up.

The first case of COVID-19 in Nigeria was recorded on February 27, 2020, being an imported case by an Italian expatriate, to the country. Since then, there has been steady increase in the number of cases. However, the number of cases in Nigeria is low in comparison to cases reported by other countries with similar large populations, despite the poor health system prevailing in the country. This has been mainly attributed to the low testing capacity in Nigeria among other factors. Therefore, there is a need for innovative ways to increase the number of persons testing for COVID-19. The aim of the study was to pilot a nasopharyngeal swab self-sample collection model that would help increase COVID-19 testing while ensuring minimal person-to-person contact being experienced at the testing center. 216 participants took part in this study which was carried out at the Nigerian Institute of Medical Research between June and July 2020. Amongst the 216 participants, 174 tested negatives for both self-collected samples and samples collected by Professionals, 30 tested positive for both arms, with discrepancies occurring in 6 samples where the self-collected samples were positive while the ones collected by the professionals were negative. The same occurred in another set of 6 samples with the self-collected samples being negative and the professional-collected sample coming out positive, with a sensitivity of 83.3% and a specificity of 96.7%. The results of the interrater analysis are Kappa = 0.800 (95% CI, 0.690 to 0.910) which implies an outstanding agreement between the two COVID-19 sampling methods. Furthermore, since p< 0.001 Kappa (k) coefficient is statistically different from zero, our findings have shown that self-collected samples can be reliable in the diagnosis of COVID-19.

Physical Abuse of Elderly Adults: Victim Characteristics and Determinants of Revictimization.

OBJECTIVES: To describe victim characteristics and determinants of recurrent physical abuse of elderly. DESIGN: Multicenter retrospective analysis of multiple data systems to study victims of elder mistreatment in the greater Chicago metropolitan area. SETTING: Five teaching hospitals with Level 1 trauma centers. PARTICIPANTS: Individuals aged 60 and older treated for physical and sexual abuse between 2000 and 2011. MEASUREMENTS: History of revictimization was based on hospital admission histories, Adult Protective Services records, and self-report. Death records were also linked to participant files. RESULTS: Fifty-eight individuals (52.3%) out of 111 cases suffering physical abuse had documented histories of revictimization. Based on multivariable models, individuals who were female, widowed, diagnosed with dementia, and returning to the home where the perpetrator lived or visited were substantially more likely to be revictimized. Revictimized individuals were more likely to be assaulted through unarmed force by a proximal relative, in particular a husband, boyfriend, child, or child-in-law. Based on hospital records, only 57% of community-dwelling cases had their abuse reported to Adult Protective Services or the police, and only 26.6% had Adult Protective Services investigations on record. CONCLUSION: Better screening that connects victims of abuse with community services, police action, and alternative residential options is important in reducing the risk of revictimization and connecting individuals with resources that can improve their safety at home, regardless of whether it is in the community or a residential facility.