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Female gymnasts are the athletes that are most likely to experience Achilles tendon rupture, due to the high energy and eccentric load place on their Achilles tendon related to their sport. It is postulated that degenerative changes, watershed vascular supply, calcifications, and high amounts of inflammatory cells may play a role. This case report highlights an athlete with an asymptomatic Achilles tendon that was visualized to be normal utilizing ultrasound. She was found to have no evidence of underlying tendon pathology. The athlete then ruptured her Achilles tendon 8 months later during a gymnastic meet with no proceeding symptoms. This case report challenges the accepted theory that preexisting tendinosis or pathology proceeds Achilles tendon rupture. In this case, it is postulated that tendon rupture may be secondary to significant mechanical force even without underlying pathology.Level of evidence: Level 4.

Objective: Acute type A aortic dissection (ATAAD) is a surgical emergency with significant morbidity and mortality, as well as significant center-level variation in outcomes. Our study aims to leverage a nationally representative database to assess contemporary in-hospital outcomes in surgical repair of ATAAD, as well as the association of age and sex with outcomes. Methods: The National Inpatient Sample was queried to identify hospital discharge records of patients aged ≥18 years who underwent urgent surgical repair of ATAAD between 2017 and 2018. Patients with a diagnosis of thoracic aortic dissection, who underwent surgical intervention of the ascending aorta, were identified. Patient demographics were assessed, and predictors of in-hospital mortality were identified. Results: We identified 7805 weighted cases of surgically repaired ATAAD nationally, with an overall mortality of 15.3%. Mean age was 60.0 ± 13.6 years. There was a male predominance, although female subjects made up a larger proportion of older age groups—female subjects up 18.4% of patients younger than 40 years with ATAAD but 53.6% of patients older than 80 years. In multivariable analysis controlling for sex, race, comorbidities, and malperfusion, age was a significant predictor of mortality. Patients aged 71 to 80 years had a 5.3-fold increased risk of mortality compared with patients ≤40 years old (P 80 years had a 6.8-fold increased risk of mortality (P

Skenitis refers to the infection of the Skene's glands. Skene's glands are paraurethral glands localized on the upper wall of the vagina. The diagnosis of Skene's glands abscess or infection is usually made based on the history and physical examination, but half of women with para-urethral gland symptoms present with non-palpable lesions and necessitate further evaluation with imaging. Patients may present with chronic urethral pain, recurrent urinary tract infections, unexplained dyspareunia, and dysuria. At imaging Skene's glands are typically located on the anterior vaginal wall, at symphysis level and paramedian to urethra. Clinicians should consider Skenitis in the differential diagnosis of lower urinary tract symptoms. We report a case of a 48-year-old woman with acute lower urinary tract symptoms with a final diagnosis of Skene's glands abscess.

ABSTRACT: Iliopsoas bursitis is characterized by distension of the iliopsoas muscle bursa due to synovial fluid and/or hypertrophic synovium. Hip disease is usually associated with it, however, isolated bursitis is also present. Clinically Diagnosing iliopsoas bursitis can be difficult, and imaging is usually required to differentiate iliopsoas bursitis from other inguinal masses such as lymphadenopathy, hernias, and tumors. We present the case of a 45-year-old athletic patient who underwent diagnostic examination for recurrent right hip pain and a recent development (last 3 months) of a bulky right inguinal mass.

Background: Maternal gestational weight gain (GWG) influences not only on pregnancy outcome but also impacts on mothers’ and children's long-term health. However, there is no consensus on recommendations of optimal GWG in Asians or the Chinese population. Methods: We performed a secondary analysis of the birth outcome of Chinese women who had joined the “Hyperglycemia and Adverse Pregnancy Outcome” study in Hong Kong and their children's cardiometabolic risk at 7-year of age. Optimal ranges of GWG were derived from models based on the probabilities of small for gestational age and large for gestational age (model 1), lean and fat infants (model 2) and the integration of model 1 and 2 (model 3), and were compared with that recommended by the Institute of Medicine (IOM) on children's cardiometabolic risk. Findings: GWG range derived from model 2 is associated with 8 cardiometabolic risk factors, while that from models 1 and 3 are associated with 1 and 7 of them respectively. Mothers whose GWG lie within the recommended range increases from 40.8% according to the IOM recommendation to 50.2% according to that derived from model 2. Interpretation: Optimal GWG derived from model 2 (i.e. 14.0-18.5 kg, 9.0-16.5 kg and 5.0-11.0 kg for underweight, normal weight and overweight Chinese women, respectively) appeared to be associated with the lowest cardiometabolic risk in the offspring. Funding: General Research Fund of the Research Grants Council of the Hong Kong SAR, China (grants CUHK 473408 and, in part, CUHK 471713).

We report the case of a 67-year-old man admitted to our hospital in an obtunded state. We found that a severe hyponatremia (115 mEq/L) was the cause of patient's status. In turn, hyponatremia was due to hypopituitarism (nonfunctioning macroadenoma). Mild to moderate hyponatremia had been previously detected in this patient, but it was overlooked. Correction of hyponatremia and treatment replacement therapy for central hypothyroidism and hypocortisolism restored a satisfactory clinical condition before discharge. The clinical onset of hypopituitarism is often characterized by mild nonspecific symptoms especially in older people, and it is often overlooked. Hypoglycemia can be another clue to undiagnosed hypopituitarism, and in the reported case, suspicious episodes of hypoglycemia occurred in the months preceding admission. Furthermore, several physicians consider hyponatremia as a normal consequence of aging. Although hyponatremia is a common electrolyte disorder in the elderly, physicians should not forget that it could be the leading manifestation of hypopituitarism. Hypopituitarism may be easily diagnosed, but clinical suspicion is needed. Because of the excess mortality associated with hypopituitarism, hormone assays should be included in the initial diagnostic work-up of hyponatremia. Keywords: Electrolyte balance, Hyponatremia, Hypopituitarism, Adrenal insufficiency, Elderly

Objectives: This study examined the validity of hand therapists' self-report of cumulative trauma disorder (CTD) risk factors by comparing the self-report to observations performed by the raters. Inter-rater reliability was also analyzed between the raters who observed the hand therapists. Study Design: Two raters simultaneously observed each hand therapist during a splinting task at a therapy facility. Following this task, the raters and the hand therapist independently completed an identical assessment tool. Thirteen therapists were observed and a total of six raters observed the therapists. Responses from two categories of the self-assessment, 'posture' and 'mechanical stress', were compared. percentage of agreement was calculated by dividing the number of like responses by the total number of possible responses for each category. Results: Overall inter-rater reliability was 72%, significantly above the accepted minimum standard of 60-70%, and validity was 39%, significantly below the accepted minimum. Conclusion: The high percentage of inter-rater reliability established consistency and accuracy among the raters in their observations. However, the low percentage of validity should prompt hand therapists to investigate the accuracy of a patient's self-report before relying on it for treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study examined the validity of hand therapists' self-report of cumulative trauma disorder (CTD) risk factors by comparing the self-report to observations performed by the raters. Inter-rater reliability was also analyzed between the raters who observed the hand therapists. STUDY DESIGN: Two raters simultaneously observed each hand therapist during a splinting task at a therapy facility. Following this task, the raters and the hand therapist independently completed an identical assessment tool. Thirteen therapists were observed and a total of six raters observed the therapists. Responses from two categories of the self-assessment, "posture" and "mechanical stress", were compared. Percentage of agreement was calculated by dividing the number of like responses by the total number of possible responses for each category. RESULTS: Overall inter-rater reliability was 72%, significantly above the accepted minimum standard of 60-70%, and validity was 39%, significantly below the accepted minimum. CONCLUSION: The high percentage of inter-rater reliability established consistency and accuracy among the raters in their observations. However, the low percentage of validity should prompt hand therapists to investigate the accuracy of a patient's self-report before relying on it for treatment.