scholarly journals LO006: Interarm blood pressure differential as a clinical marker for acute aortic dissection in the emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S32-S32
Author(s):  
S.W. Um ◽  
R. Ohle ◽  
J.J. Perry

Introduction: Acute Aortic Dissection (AAD) is life threatening, requiring early diagnosis. Although previous literature suggest interarm BP differential is an independent predictor of AAD, up to 20% of a healthy population can have a significant differential. Our objectives were to assess the rate of bilateral BP measurement in acute non-traumatic truncal pain patients, and the association of BP differential with non-traumatic AAD. Methods: This is a historical matched case control study: participants were adults >18 years old presenting to two tertiary care EDs with a triage diagnosis of truncal (i.e. chest, abdominal, flank, back) pain. Cases were selected based on an ED or in-hospital diagnosis of non-traumatic AAD confirmed by CT or Echo. Controls were from a single calendar year matched in a 1:1.5 ratio by sex and age within 5 years. ED and referral consult BP measurements were used. Exclusion criteria: clear diagnosis on basic investigation (i.e. UTI, pneumonia, pneumothorax, acute fracture) or pain >14 days/no pain. Sample size of 126 cases and 183 controls was calculated based on 20% exposure in controls (80% power and alpha of 5%), to detect an OR >2. P-values were calculated using chi square analysis. Results: A total of 294 (119 cases, 175 controls) patients were included (mean 66+/-14.5yrs, 59.5% male). Cases (199 potential: 119 included; 80 excluded). Controls (8239 potential: 305 reviewed; 175 included; 130 excluded). Bilateral BP was measured in 70.6% of cases (n=84, mean difference=15.5mmHg) versus 31.3% of controls (n=55, mean difference=10.9mmHg). Among included controls, most common diagnoses were: Unspecified Chest (36.0%) or Abdominal (9.7%) Pain, ACS (12.6%), Muscular Back Pain (5.1%), and Renal Colic (4.0%). BP differential >10mmHg was found in 58.8% of cases and 40.7% of controls (P=0.10). A BP differential >20mmHg was found in 31.3% of cases and 22.2% of controls (P=0.37). BP differential >20mmHg did not significantly increase the odds of AAD (OR 2.0 (95%CI 0.82-4.90), p<0.129). Conclusion: Interarm BP differential is not routinely measured in ED patients with acute non-traumatic truncal pain, and there is no significant difference in the presence or magnitude of differentials in patients with or without AAD. Therefore, physicians should not rely on BP differentials to aid in their diagnosis or exclusion of AAD.

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sean Cavanaugh ◽  
Jennifer Williams ◽  
Andria Ford ◽  
Peter Panagos ◽  
Laura Heitsch

Background: Target Stroke establishes the goal to administer IV Alteplase within 60 minutes of ED arrival. High-performing centers frequently treat within 45 minutes. Median door-to-needle (DTN) times at our tertiary care academic hospital are consistently < 30 minutes. Monthly case reviews investigate factors associated with DTN times greater than 45 minutes. Methods: Utilizing our stroke registry, patients treated with Alteplase from 2013-2015 were identified. Baseline demographics, medical comorbidities, weekend or after hours (7PM-7AM) presentation, initial NIHSS, initial BP greater than 185/110 and management, posterior circulation symptoms and ED crowding using the National Emergency Department Overcrowding Scale (NEDOCS) were extracted. Arrival date and time of arrival were cross-referenced with NEDOCS. Patients were divided into cohorts of treatment less than 45 minutes vs. greater than 45 minutes. Continuous variables were tested for normal distribution using Shapiro-Wilk, then either an unpaired t test or Wilcoxon’s test was applied to test for significance. Dichotomous variables were tested for significance with Chi-square analysis. Results: A total of 239 patients were included in the analysis. Data is presented in Table 1. After adjusting for multiple comparisons, there was a statistically significant difference in the distribution of baseline NIHSS scores (p=0.0006), diabetes (p=0.0023), and minor strokes (NIHSS less than 3, p=0.0003). Conclusion: Diabetics and patients with minor symptoms are more likely to have longer DTN times. Elevated BP, ED crowding, weekend and after hour arrivals do not significantly delay evaluation and treatment. While not significant after adjusting for multiple tests, both posterior stoke recognition and method of treating BP should be scrutinized as they are modifiable risk factors. Future awareness of discrete patient characteristics may help identify patients at risk for prolonged DTN.DTN.


Author(s):  
Sarwat Memon

Background: The palatal rugae are special constructions that are inalterable in their position and pattern during the lifestyles of an individual. This imparts them an exceptional role in the forensic dentistry and may play potential role in malocclusion identification. This study was aimed to see association of rugae pattern with sagittal skeletal malocclusion in orthodontic patients visiting tertiary care hospital. Methods: This cross-sectional examination was completed on pretreatment records (lateral Cephalometric radiographs and maxillary dental casts) of 384 subjects at the orthodontic department of Ziauddin Dental Hospital, Karachi. The study duration was from January to July 2019. The samples were sub-divided into three sagittal skeletal groups based on ANB angle proposed by Steiner’s on lateral Cephalometric radiographs (Class I with ANB angle between 0° to 4°; Class II: ANB angle greater than 5°; Class III: ANB angle less than 0°). The shapes of three most-anterior primary rugae were then evaluated bilaterally using Kapali et al., Classification. Chi Square test was applied to find association of rugae pattern among sagittal skeletal malocclusions groups. Results: Circular and curved rugae shapes were the most prevalent in all skeletal malocclusions. The primary palatal rugae pattern was seen to be significantly different among three skeletal malocclusion groups (p<0.05). The right and left sided palatal rugae pattern showed significant difference in all three skeletal malocclusion groups (p<0.05). Conclusion: The present study showed no specific palatal rugae pattern associated with sagittal skeletal malocclusion. Further studies on larger sample and use of modern 3D technologies to scan the maxillary casts are required for results that are more precise.


2021 ◽  
Vol 11 (8) ◽  
pp. 3469
Author(s):  
Khalid H. Almadi ◽  
Muhammad Adeel Ahmed ◽  
Tuba Ghazal ◽  
Rizwan Jouhar ◽  
Mazen F. Alkahtany ◽  
...  

Propolis is proposed to possess antibacterial and anti-inflammatory properties, which can be used in endodontic applications. However, evidence on its efficacy in comparison to chlorhexidine against Enterococcus faecalis (E. faecalis) is controversial. The aim of the current study was to compare the antibacterial efficacy of Propolis and chlorhexidine as an intracanal medicament against E. faecalis in extracted human permanent teeth. The focused question was, “Does Propolis show better antibacterial efficacy than Chlorhexidine (CHX) as an intracanal medicament against E. faecalis in extracted human permanent teeth?”. Databases including PubMed/Medline, Scopus, EMBASE, ISI-Web of Science were searched from 1990 to August 2020 using different combinations of the following keywords: “Propolis”, “Intracanal medicament”, “E. faecalis”, “Antibacterial activity” and “Chlorhexidine”. Ten studies fulfilling inclusion criteria were considered for qualitative analysis, followed by quantitative analysis of eight studies. Heterogeneity was calculated for colony forming units (CFU) of E. Faecalis using the Chi-square test and I2 statistics. Forest plots were computed reporting standard mean difference (SMD) of outcomes and 95% confidence intervals. The overall mean difference for CFU of E. faecalis showed a statistically significant difference between the antibacterial efficacy of Propolis and CHX (SMD = 3.20 [1.70, 4.69] Z = 4.20; p < 0.001). CHX showed superior antibacterial efficacy against E. faecalis compared to Propolis.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Watanabe ◽  
H Yoshino ◽  
T Takahashi ◽  
M Usui ◽  
K Akutsu ◽  
...  

Abstract   Both acute aortic dissection (AAD) and acute myocardial infarction (AMI) present with chest pain and are life-threatening diseases that require early diagnosis and treatment for better clinical outcome. However, two critical diseases in the very acute phase are sometimes difficult to differentiate, especially prior to arrival at the hospital for urgent diagnosis and selection of specific treatment. The aim of our study was to clarify the diagnostic markers acquired from the information gathered from medical history taking and physical examination for discriminating AAD from AMI by using data from the Tokyo Cardiovascular Care Unit (CCU) Network database. We examined the clinical features and laboratory data of patients with AAD and AMI who were admitted to the hospital in Tokyo between January 2013 and December 2015 by using the Tokyo CCU Network database. The Tokyo CCU Network consists of &gt;60 hospitals that fulfil certain clinical criteria and receive patients from ambulance units coordinated by the Tokyo Fire Department. Of 15,061 patients diagnosed as having AAD and AMI, 3,195 with chest pain within 2 hours after symptom onset (537 AAD and 2,658 AMI) were examined. The patients with out-of-hospital cardiac arrest were excluded. We compared the clinical data of the patients with chest pain who were diagnosed as having AAD and AMI. The following indicators were more frequent or had higher values among those with AAD: female sex (38% vs. 20%, P&lt;0.001), systolic blood pressures (SBPs) at the time of first contact by the emergency crew (142 mmHg vs. 127 mmHg), back pain in addition to chest pain (54% vs. 5%, P&lt;0.001), history of hypertension (73% vs. 58%, P&lt;0.001), SBP ≥150 mmHg (39% vs. 22%, P&lt;0.001), back pain combined with SBP ≥150 mmHg (23% vs. 0.8%, P&lt;0.001), and back pain with SBP &lt;90 mmHg (4.5% vs. 0.1%, P&lt;0.001). The following data were less frequently observed among those with AAD: diabetes mellitus (7% vs. 28%, P&lt;0.001), dyslipidaemia (17% vs. 42%, P&lt;0.001), and history of smoking (48% vs. 61%, P&lt;0.001). The multivariate regression analysis suggested that back pain with SBP ≥150 mmHg (odds ratio [OR] 47; 95% confidence interval [CI] 28–77; P&lt;0.001), back pain with SBP &lt;90 mmHg (OR 68, 95% CI 16–297, P&lt;0.001), and history of smoking (OR 0.49, 95% CI 0.38–0.63, P&lt;0.001) were the independent markers of AAD. The sensitivity and specificity of back pain with SBPs of ≥150 mmHg and back pain with SBPs &lt;90 mmHg for detecting AAD were 23% and 99%, and 4% and 99%, respectively. In patients with chest pain suspicious of AAD and AMI, “back pain accompanied by chest pain with SBP ≥150 mmHg” or “back pain accompanied by chest pain with SBP &lt;90 mmH” is a reliable diagnostic marker of AAD with high specificity, although the sensitivity was low. The two SBP values with back pain are markers that may be useful for the ambulance crew at their first contact with patients with chest pain. Funding Acknowledgement Type of funding source: None


2021 ◽  
Vol 10 (12) ◽  
pp. 2637
Author(s):  
Mª. Ángeles del Buey-Sayas ◽  
Elena Lanchares-Sancho ◽  
Pilar Campins-Falcó ◽  
María Dolores Pinazo-Durán ◽  
Cristina Peris-Martínez

Purpose: To evaluate and compare corneal hysteresis (CH), corneal resistance factor (CRF), and central corneal thickness (CCT), measurements were taken between a healthy population (controls), patients diagnosed with glaucoma (DG), and glaucoma suspect patients due to ocular hypertension (OHT), family history of glaucoma (FHG), or glaucoma-like optic discs (GLD). Additionally, Goldmann-correlated intraocular pressure (IOPg) and corneal-compensated IOP (IOPcc) were compared between the different groups of patients. Methods: In this prospective analytical-observational study, a total of 1065 patients (one eye of each) were recruited to undergo Ocular Response Analyzer (ORA) testing, ultrasound pachymetry, and clinical examination. Corneal biomechanical parameters (CH, CRF), CCT, IOPg, and IOPcc were measured in the control group (n = 574) and the other groups: DG (n = 147), FHG (n = 78), GLD (n = 90), and OHT (n = 176). We performed a variance analysis (ANOVA) for all the dependent variables according to the different diagnostic categories with multiple comparisons to identify the differences between the diagnostic categories, deeming p < 0.05 as statistically significant. Results: The mean CH in the DG group (9.69 mmHg) was significantly lower compared to controls (10.75 mmHg; mean difference 1.05, p < 0.001), FHG (10.70 mmHg; mean difference 1.00, p < 0.05), GLD (10.63 mmHg; mean difference 0.93, p < 0.05) and OHT (10.54 mmHg; mean difference 0.84, p < 0.05). No glaucoma suspects (FHG, GLD, OHT groups) presented significant differences between themselves and the control group (p = 1.00). No statistically significant differences were found in the mean CRF between DG (11.18 mmHg) and the control group (10.75 mmHg; mean difference 0.42, p = 0.40). The FHG and OHT groups showed significantly higher mean CRF values (12.32 and 12.41 mmHg, respectively) than the DG group (11.18 mmHg), with mean differences of 1.13 (p < 0.05) and 1.22 (p < 0.001), respectively. No statistically significant differences were found in CCT in the analysis between DG (562 μ) and the other groups (control = 556 μ, FHG = 576 μ, GLD = 569 μ, OHT = 570 μ). The means of IOPg and IOPcc values were higher in the DG patient and suspect groups than in the control group, with statistically significant differences in all groups (p < 0.001). Conclusion: This study presents corneal biomechanical values (CH, CRF), CCT, IOPg, and IOPcc for diagnosed glaucoma patients, three suspected glaucoma groups, and a healthy population, using the ORA. Mean CH values were markedly lower in the DG group (diagnosed with glaucoma damage) compared to the other groups. No significant difference was found in CCT between the DG and control groups. Unexpectedly, CRF showed higher values in all groups than in the control group, but the difference was only statistically significant in the suspect groups (FHG, GLD, and OHT), not in the DG group.


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ghufran adnan ◽  
Osman Faheem ◽  
Maria Khan ◽  
Pirbhat Shams ◽  
Jamshed Ali

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.


2006 ◽  
Vol 62 (4) ◽  
Author(s):  
D. O. Odebiyi ◽  
A. O. Akinpelu ◽  
M. O. B. Olaogun

Back schools are educational programmes originally developed in a work place (Volvo factory in Sweden) for patients with back pain, to enable them to manage their own back problems better. ‘Back school’ was originally aimed at modifying the behaviours of patients with low back pain (LBP), with the view to prevent relapses. In an effort to encourage and stimulate the use of ‘back school’ among health workers in Nigeria, this study was designed to evaluate the efficacy of a back school protocol in a Soap Making Industry in Lagos, Nigeria. One hundred and ten (110) workers of a Soap Making Industry in Lagos, Nigeria,  participated in this study. A pre-test, post-test experimental design was employed. The participants were divided into two groups - office workers and factory workers for the purpose of the training in the content of the back school protocol. The ‘back school’ consisted of classroom teaching and the use of two videotapes titled “lifting technique” and “back pain”. Data on demographic information, knowledge of back structures and back care were collected using a questionnaire with closed ended questions, which was completed before, immediately after and 8 weeks after the administrations of the contents of the back school protocol (Akinpelu and Odebiyi, 2004). The records of the factory’s clinic were also reviewed for the 12-months before and 12 months after the study. The mean values of the participants’ age, height, weight and body mass index (BMI) were 36.60 ± 9.10 years, 1.65 ± 0.10 m,69.13 ± 7.70 kg and 25.40 ± 3.30 kg/m2 respectively. The results showed that the 12-months prevalence of low back pain (LBP) among the workers was 71%. The result also showed that over 50% of the participants never had any  information or lesson on back care, and those that had some form of information obtained it by chance. There was 23% reduction in referral for care of back pain 12 months after the administration of the back school protocol. However, Chi square analysis showed that there was no significant difference (p = 0.23) between the number of  physiotherapy referrals to the factory’s clinic 12-months before the study and 12-months after the studyThe findings of this study suggest that the back school protocol was able to impart some knowledge (of back pain and back care) in the industrial workers. This knowledge seems to have assisted this group of individuals to cultivate good postural habits, particularly at work. This might have led to the 23% reduction in the reported cases of patients with LBP to the factory’s Physiotherapy Clinic.


2009 ◽  
Vol 36 (2) ◽  
pp. 133-137 ◽  
Author(s):  
P. M. Dang ◽  
D. L. Rowland ◽  
W. H. Faircloth

Abstract Diagnosis of Tomato spotted wilt virus (TSWV) in peanut can be accomplished by enzyme-linked immunosorbent assay (ELISA) or reverse transcription polymerase chain reaction (RT-PCR) but there has been no report of a direct comparison of the success of the two assays in evaluating infection rates of field-grown peanut. We collected peanut root samples from field-grown plants, 76 in 2006 and 48 in 2007, and tested these samples by both ELISA and RT-PCR assays for the presence of TSWV. Out of 124 samples, 50 (40.3%) and 57 (46.0%) were positive for TSWV by ELISA and RT-PCR respectively. In 13.7% of these samples, ELISA and RT-PCR differed in their results. However, Chi square analysis showed no significant difference between the results for these two assays. This result supports the conclusion that ELISA and RT-PCR are comparable for detecting TSWV infection rates in field-grown peanuts.


Author(s):  
E.A. Omudu ◽  
E.U. Amuta

Domestic environmental pollution resulting from urban livestock farming was investigated in Makurdi using parasitological techniques. The test tube flotation technique was used for the parasitological analysis of animal faecal matter and soil samples collected from residential premises. Ectoparasitic fauna of dogs, goats, sheep and cattle cohabiting with humans within the same residential compound were also collected and identified. The hand-picking and body brushing methods were employed to search for ticks, fleas, lice and mites. Of the 150 soil samples examined, 55 (36.7 %) were positive for 1 or more eggs of helminth parasites. There was no significant difference in the distribution of eggs in the soil samples from the 3 areas sampled (c2=0.046, df=2, P>0.05). Ascaris species were the dominant parasite eggs found. Of the 180 faecal samples examined, 107 (59.4 %) were positive for 1 or more eggs of helminth parasites. Chi-square analysis showed no significant difference in the level of infection of different animal faeces sampled (c2=5.74, df=4, P>0.05). Ascaris species were again the dominating helminth parasite eggs found. There was also no significant difference in the prevalence of helminth eggs in the animal faecal samples from the 3 areas sampled (c2=5.99, df=4, P>0.05). A total of 1908 ectoparasites was recovered (ticks: 32.80 %; lice: 22.43 %; fleas: 22.06% and mite: 22.69 %). There was no significant difference in infestation animals between sexes (c2=0.10, df=4, P>0.05). The predominant genus encountered for ticks were Amblyomma, while Linognathus (43.90%), Ctenocephalides (97.38%) and Sarcoptes (58.89 %) were most predominant for lice, fleas and mites respectively. The public health implications of the findings, especially as these relate to the increasing incidence and prevalence of zoonotic infections, are discussed.


2021 ◽  
pp. 56-62
Author(s):  
Theophilus Apenuvor ◽  
John Blay ◽  
Joseph Aggreyfynn ◽  
Simon Drafor

Over-population and stunted growth had been major challenges in the culture of tilapia. The use of synthetic androgen 17- α Methyl Testosterone (MT) was a breakthrough. However, its optimum level towards effective masculinization and growth is a concern. The aim of this research was to ascertain the optimum level of MT towards effective all-male population production and growth of Black-Chinned tilapia. In the present study, the effect of different dose rates of synthetic androgen 17-α Methyl Testosterone (MT) i.e., 0, 30, 60, and 120 mg of the hormone per kg of feed on sex, growth, and condition of Black-Chinned tilapia was evaluated. MT was administered orally by using powdered dry starter feed (Crude Protein 40 %) and Ethanol. The fry was fed for 30 days in the experimental tanks. At the end of the experiment, the sex ratios were determined by examining the operculum coloration as a means of sex identification. Growth performance was monitored by measuring and recording the morphometric characteristics. Bodyweight and total length of the fish on the start of feeding, end of feeding (one month sex reversal period), and two months after feeding were measured. The results of the present study showed that all MT receiving treatment showed a significantly higher male proportion than the control (0 mg MT/kg feed individuals). In all MT treatments groups, the control expects the 30 mg MT/kg in feed individuals’ deviate significantly from the normal 1:1 sex ratio (Chi-square analysis). The dose rate of 120 mg MT /kg feed resulted in the maximum male population (92.7%). Hence, for an effective high percentage of all-male population production in Black-Chinned tilapia, 120 mg MT /kg in feed is recommended. In terms of growth and condition factor, all the individual treatments, as well as the control, showed no significant difference. All the treated individuals showed similar condition factors during the pre and post-treatment, however, the individuals treated with 30 mg MT /kg feed exhibited better condition during the pre-treatment than the post-treatment period. Temperature, pH and dissolved oxygen recorded in this study were within the desirable limit for tilapia.


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