No abstract

Acute cholecystitis (AC) and acute appendicitis (AA), independently, are among the most commonly diagnosed conditions in the emergency department (ED). However, their synchronous presentation is very rare. Here, we present a 31-year-old man with worsening right flank abdominal pain, nausea, and vomiting. Physical examination results were significant for moderate to severe right upper abdominal quadrant pain with a positive Murphy's sign and right lower quadrant pain with rebound. Workup in the ED revealed leukocytosis with a left shift, and the abdominal ultrasound and computerized tomography scan showed AA and AC. A literature review revealed a paucity of publications on concomitant AA and AC. Reporting new cases will contribute to improving our understanding of the biology, natural history, and management of this rare pathological combination.

Heart rate variability (HRV) and the Short Recovery and Stress Scale (SRSS) are objective and subjective measures, respectively, that have been used to assess response to training in sport athletes. While a relationship between HRV and stress exists, the relationship between HRV and recovery is unclear. Further, these measures may provide valuable insight for a firefighter's (FF) readiness for duty, yet little research has been done in comparing these two metrics in the FF population. PURPOSE: To examine the relationship between objective and subjective measures of stress and recovery in FFs. METHODS: 16 (14 male, 2 female) active-duty FFs (38 + 10.4 yrs; 178.8 + 4.3 cm; 94.5 + 16.5 kg) volunteered to participate. Following completion of a shift, FFs were fitted with a heart rate monitor and sat in a chair for five minutes while also completing the 8-item SRSS. These procedures were repeated on a second day of testing, 48-72 hours after day one. HRV metrics of the log-transformed root mean square of successive R-R intervals (LnRMSSD) and the proportion of the number of times successive R-R intervals exceed 50ms (pNN50) were calculated posthoc. Dependent t-tests examined FF differences between days for each HRV metric and SRSS item. Spearman's rank correlations determined the relationship between the HRV metrics and the SRSS items for each day. An alpha of 0.05 determined statistical significance. RESULTS: There were no significant differences (p > 0.05) between days for LnRMSSD, pNN50, and each SRSS item. Significant correlations were identified on day one between LnRMSSD and physical stress (r = -0.639, p = 0.008), emotional stress (r = -0.633, p = 0.008), and overall stress (r = -0.504, p = 0.047) and between pNN50 and physical stress (r = -0.699, p = 0.003) and emotional stress (r = -0.659, p = 0.006). Significant correlations on day two were between LnRMSSD and emotional stress (r = -0.526, p = 0.036) and between pNN50 and emotional stress (r = -0.564, p = 0.023) and physical recovery (r = 0.511, p = 0.043). CONCLUSIONS: Subjective stress was more related to measures of parasympathetic activation (i.e., LnRMSSD, pNN50) than subjective recovery. Specifically, a FF's low LnRMSSD and pNN50 were related to perceptions of annoyance. The findings suggest that subjective measures of stress may add to the interpretation of HRV.