ABSTRACT
Turner syndrome (TS) complicated with Madelung deformity and complex brachydactyly are rare clinically, and it is even rarer to combine with ankylosing spondylitis (AS). This article reports a case of a 36 year-old female patient who was admitted to the hospital with "ankylosing spondylitis" due to repeated back, hip and knee pain for 11 years and aggravated for 1 month. After admission, the karyotype showed "46, X, i (Xq)" due to short stature, dysplasia of secondary sexual characteristics, limb deformity etc, thus confirming TS. Further examination revealed bilateral Madelung deformity and complex brachydactyly characterized by shortening of the fourth metacarpal, multiple missing and shortened middle phalanxes. By reviewing the relevant literature, we believe that autoimmune diseases such as AS should be excluded in TS patients. TS aggravates the inflammatory response of AS, but the combination of TS and AS is more likely to be an accidental event. Patients with Madelung deformity should be careful to exclude TS. Madelung deformity and shortening of the fourth metacarpal are mainly associated with haploinsufficiency of SHOX gene. Brachydactyly characterized by multiple loss and shortening of the middle phalanx may be a new clinical manifestation of TS, especially the karyotype of 46, X, i (Xq). It is possible that there are some genes on the short arm of X chromosome, which regulate the number, growth and development of fingers. Early estrogen replacement therapy can greatly benefit patients.
ABSTRACT
Objective@#To understand knowledge, attitude and behavior toward Coronavirus disease 2019 (COVID 19) among middle school students in Wuhan, in the phase of normalized control and prevention of COVID 19, so as to provide evidence for further health education.@*Methods@#In January 2021, cluster random sampling method was used to select one middle school from Hongshan and Dongxihu District, as well as Donghu high tech zone, respectively. By using the "questionnaire star" platform, questionnaire QR code were sent to students through QQ or wechat by schools. A total of 4 531 middle school students were investigated.@*Results@#Preventive knowledge and behavior rate was 71.5% (3 238) and 56.0% (2 537), respectively. Preventive behaviors towards COVD 19 was reported in 56.0% (2 537) of participants. Students with parents as health care workers reported higher preventive behaviors(P<0.05).Girls had a higher rate of possession of health knowledge for prevention and control than boys. Compared with "essentially no concern about the epidemic","students with less concern about the epidemic" and "those with similar concern as 2020" were more likely to have higher awareness of health knowledge for prevention and control. Compared with the first-year junior middle school students, high school students were less likely to have the rates of knowledge for prevention and control health [OR(95%CI）=1.24（1.09-1.43）,2.56(1.54-4.25),3.30(1.99-5.48),0.49(0.39-0.62),0.45(0.36-0.57),0.63(0.46-0.88)].In terms of health behavior rate, middle school students whose mothers are undergraduates, whose incomes were more than 8 001-15 000 and 15 000 yuan, "whose attention to epidemic situation has declined" , "whose attention is the same as that in 2020" , "who did not plan to study medicine before" , "who are determined to study medicine, and who plan to study medicine more firmly after epidemic situation " were more likely to have health behavior,[OR(95%CI)=1.29(1.04-1.60),1.39（1.07-1.82）,1.74(1.32-2.29),1.77(1.06-2.96),3.47(2.08-5.81)] ,The grade-2 high middle school students had lower probability of preventing and controlling health behaviors [OR(95%CI)=0.74(0.60-0.90)](P<0.05). Preventive knowledge and behaviors towards COVID 19 are mainly from school education, communication with parents and mobile learning.@*Conclusion@#Preventive knowledge and behaviors towards COVID 19 among Wuhan middle school students are needed to be improved and targeted health education should be implemented accordingly.