Torture Survivors and Asylum: Legal, Medical, and Psychological Perspectives.

Torture occurs worldwide. Survivors seeking asylum are detained and must complete a complicated legal process to prove a "well-founded fear of persecution" if returned to their home countries. Forensic evaluations guided by the United Nations Istanbul Protocol increase asylum grant rates.

Evolutionary Medicine Perspectives: Helicobacter pylori, Lactose Intolerance, and 3 Hypotheses for Functional and Inflammatory Gastrointestinal and Hepatobiliary Disorders.

Many clinicians have suboptimal knowledge of evolutionary medicine. This discipline integrates social and basic sciences, epidemiology, and clinical medicine, providing explanations, especially ultimate causes, for many conditions. Principles include genetic variation from population bottleneck and founder effects, evolutionary trade-offs, and coevolution.

An Evolutionary Medicine Perspective on Treatment of Pediatric Functional Abdominal Pain.

In a recent issue, Kovacic et al. analyze data from a randomized sham-controlled trial and show that pretreatment vagal efficiency, an index related to respiratory sinus arrhythmia, is a predictor of pain improvement in adolescents with functional abdominal pain when treated with auricular percutaneous electrical nerve field stimulation. The underlying premise is the polyvagal hypothesis, an explanatory framework for the evolution of the mammalian autonomic nervous system, which proposes that functional gastrointestinal disorders can result from a chronic maladaptive state of autonomic neural control mechanisms after traumatic stress.

Foot Torture (Falanga): Ten Victims with Chronic Plantar Hyperpigmentation.

Background: Falanga is a widespread form of torture, but details of the chronic skin sequelae on physical examination are unreported.

Methods: In an organization dedicated to the care of torture victims, we prospectively documented examination findings in 10 consecutive, black African falanga victims.

Results: Ten individuals (8 men) suffered 1 or more episodes of falanga, most recently 9 to 29 months (9 cases) or 10 years (1 case) earlier.

Misdiagnosis of Diverticulitis After a Prior Diagnosis of Irritable Bowel Syndrome (IBS).

Introduction: Irritable bowel syndrome (IBS) and diverticulitis share clinical features. Misdiagnosed diverticulitis can cause unnecessary antibiotic therapy. Among IBS and non-IBS patients, we compared outpatient, clinically diagnosed (no computed tomography) diverticulitis rates.

Internists' Misconceptions About PPIs: Increasing Knowledge and Implementing Guidelines.

Misconceptions about proton-pump inhibitor (PPI) adverse effects were common among internists, and many had changed prescribing. Among 4 scenarios representing a risk spectrum for upper gastrointestinal bleeding, 86% of physicians properly chose discontinuing PPI for a minimum-risk patient with previous gastroesophageal reflux disease, but 79% inappropriately chose discontinuing PPI for a high-risk patient with a peptic ulcer history taking low-dose aspirin. Physician self-assessment is often inaccurate.

Low Rate of Cancer Detection by Colonoscopy in Asymptomatic, Average-Risk Subjects with Negative Results From Fecal Immunochemical Tests.

Background & Aims: Screening colonoscopies are of uncertain benefit for persons with negative results from a fecal immunochemical test (FIT). We investigated detection of CRC by colonoscopy in asymptomatic, average-risk, FIT-negative subjects.

Methods: We conducted a retrospective, population-based cohort study of 96,804 subjects with an initial negative result from a FIT at ages 50-75 years, from 2008 through 2014, who then underwent colonoscopy, using the Kaiser Permanente California databases.

Clinically Diagnosed Acute Diverticulitis in Outpatients: Misdiagnosis in Patients with Irritable Bowel Syndrome.

Background: Physicians often diagnose diverticulitis and prescribe antibiotics in outpatients with abdominal pain and tenderness without other evidence.

Aim: We investigated the misattribution of irritable bowel syndrome (IBS) symptoms to diverticulitis in outpatients.

Methods: In patients diagnosed with diverticulitis and dispensed antibiotics in an integrated healthcare system, we retrospectively compared 15,846 outpatients managed without computed tomography (CT) versus 3750 emergency department/inpatients who had CT.

Right-Side Colon Ischemia: Clinical Features, Large Visceral Artery Occlusion, and Long-Term Follow-Up.

Context: Large visceral artery occlusion (LVAO) could underlie right-side colon ischemia (RSCI) but is little known.

Objective: To assess patients with RSCI through long-term follow-up, including features and management of LVAO.

Main Outcome Measures: Mesenteric ischemia and mortality.

Acute colonic diverticulitis: diagnostic evidence, demographic and clinical features in three practice settings.

Background And Aims: Diverticulitis is often diagnosed in outpatients, yet little evidence exists on diagnostic evidence and demographic/clinical features in various practice settings. We assessed variation in clinical characteristics and diagnostic evidence in inpatients, outpatients, and emergency department cases and effects of demographic and clinical variables on presentation features.

Methods: In a retrospective cohort study of 1749 patients in an integrated health care system, we compared presenting features and computed tomography findings by practice setting and assessed independent effects of demographic and clinical factors on presenting features.

Development and validation of algorithms to identify acute diverticulitis.

Purpose: The objectives of this study were to develop and validate algorithms to accurately identify patients with diverticulitis using electronic medical records (EMRs).

Methods: Using Kaiser Permanente Southern California's EMRs of adults (≥18 years) with International Classification of Diseases, Clinical Modifications, Ninth Revision diagnosis codes of diverticulitis (562.11, 562.