A Comparison of Falls and Dizziness Handicap by Vestibular Diagnosis

Purpose There is a paucity of data that directly compares the falls rate and dizziness handicap of different vestibular diagnoses. The purpose of this study is to compare the falls rate and dizziness handicap of common vestibular diagnoses encountered among a cohort of vestibular patients at a single institution. Method We conducted a retrospective cross-sectional study of patients evaluated for dizziness at a tertiary care center vestibular clinic between August 1, 2017, and March 19, 2019. Vestibular diagnosis, demographic variables, comorbidities, falls status, and Dizziness Handicap Inventory (DHI) were extracted from the medical record for analysis. Associations between vestibular diagnosis and falls history or DHI were evaluated using multivariate logistic and linear regression, respectively. Results A total of 283 patients met our inclusion criteria with the following diagnoses: benign paroxysmal positional vertigo (BPPV; n = 55), acoustic neuroma ( n = 30), Ménière's disease ( n = 28), multiple vestibular diagnoses ( n = 15), vestibular migraine ( n = 135), or vestibular neuritis ( n = 20). After adjusting for age, sex, race, medications, and comorbidities, the odds of falling was 2.47 times greater (95% CI [1.08, 6.06], p = .039) and the DHI score was 11.66 points higher (95% CI [4.99, 18.33], p < .001) in those with vestibular migraine compared to those with BPPV. Other diagnoses were comparable to BPPV with respect to odds of falling and dizziness handicap. Conclusions Patients with vestibular migraine may suffer an increased risk of falls and dizziness handicap compared to patients with BPPV. Our findings highlight the need for timely evaluation and treatment of all patients with vestibular disease.

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Unrecognized benign paroxysmal positional vertigo in elderly patients

Otolaryngology ◽

10.1067/mhn.2000.105415 ◽

2000 ◽

Vol 122 (5) ◽

pp. 630-634 ◽

Cited By ~ 8

Author(s):

John S. Oghalai ◽

Spiros Manolidis ◽

Justine L. Barth ◽

Michael G. Stewart ◽

Herman A. Jenkins

Keyword(s):

Elderly Patients ◽

Benign Paroxysmal Positional Vertigo ◽

The Elderly ◽

Cross Sectional Study ◽

Geriatric Population ◽

Cross Sectional ◽

Balance Disorders ◽

Positional Vertigo ◽

Increased Risk ◽

Paroxysmal Positional Vertigo

Balance disorders in elderly patients are associated with an increased risk of falls but are often difficult to diagnose because of comorbid chronic medical problems. We performed a cross-sectional study to determine the prevalence of unrecognized benign paroxysmal positional vertigo (BPPV) and associated lifestyle sequelae in a public, inner-city geriatric population. Dizziness was found in 61% of patients, whereas balance disorders were found in 77% of patients. Nine percent were found to have unrecognized BPPV. Multivariate analysis demonstrated that the presence of a spinning sensation and the absence of a lightheadedness sensation predicted the presence of unrecognized BPPV. Patients with unrecognized BPPV were more likely to have reduced activities of daily living scores, to have sustained a fall in the previous 3 months, and to have depression. These data indicate that unrecognized BPPV is common within the elderly population and has associated morbidity. Further prospective studies are warranted.

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Co-occurrence of apathy and impulse control disorders in Parkinson disease

Neurology ◽

10.1212/wnl.0000000000010965 ◽

2020 ◽

Vol 95 (20) ◽

pp. e2769-e2780 ◽

Cited By ~ 1

Author(s):

Bonnie M. Scott ◽

Robert S. Eisinger ◽

Matthew R. Burns ◽

Janine Lopes ◽

Michael S. Okun ◽

...

Keyword(s):

Parkinson Disease ◽

Impulse Control ◽

Care Center ◽

Tertiary Care ◽

Cross Sectional Study ◽

Demographic Variables ◽

Impulse Control Disorders ◽

Anxiety And Depression ◽

Cross Sectional ◽

Clinically Significant

ObjectiveTo empirically test whether apathy and impulse control disorders (ICDs) represent independent, opposite ends of a motivational spectrum.MethodsIn this single-center, cross-sectional study, we obtained retrospective demographics and clinical data for 887 patients with idiopathic Parkinson disease (PD) seen at a tertiary care center. Mood and motivation disturbances were classified using recommended cutoff scores from self-reported measures of apathy, ICD, anxiety, and depression.ResultsPrevalence rates included 29.0% of patients with PD with depression, 40.7% with anxiety, 41.3% with apathy, 27.6% with ICDs, and 17.0% with both apathy and ICD. The majority (61.6%) of people reporting clinically significant ICDs also reported clinically significant apathy, and more than a third of patients with apathy (41.3%) also reported elevated ICD. Anxiety and depression were highest in patients with both apathy and ≥1 ICDs. Dopamine agonist use was higher in people with only ICD compared to people with only apathy. Mood significantly interacted with demographic variables to predict motivational disturbances.ConclusionsMotivational disturbances are common comorbid conditions in patients with PD. In addition, these complex behavioral syndromes interact with mood in clinically important ways that may influence the design of future clinical trials and the development of novel therapies. This study challenges the concept of apathy and ICD in PD as opposite ends of a spectrum.

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Unrecognized Benign Paroxysmal Positional Vertigo in Elderly Patients

Otolaryngology ◽

10.1016/s0194-5998(00)70187-2 ◽

2000 ◽

Vol 122 (5) ◽

pp. 630-634 ◽

Cited By ~ 164

Author(s):

John S. Oghalai ◽

Spiros Manolidis ◽

Justine L. Barth ◽

Michael G. Stewart ◽

Herman A. Jenkins

Keyword(s):

Elderly Patients ◽

Benign Paroxysmal Positional Vertigo ◽

The Elderly ◽

Cross Sectional Study ◽

Geriatric Population ◽

Cross Sectional ◽

Balance Disorders ◽

Positional Vertigo ◽

Increased Risk ◽

Paroxysmal Positional Vertigo

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Prehospital Intubations Are Associated with Elevated Endotracheal Tube Cuff Pressures: A Cross-Sectional Study Characterizing ETT Cuff Pressures at a Tertiary Care Emergency Department

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21000297 ◽

2021 ◽

pp. 1-4

Author(s):

Ruo S. Chen ◽

Laurel O’Connor ◽

Matthew R. Rebesco ◽

Kara L. LaBarge ◽

Edgar J. Remotti ◽

...

Keyword(s):

Endotracheal Tube ◽

Cuff Pressure ◽

Care Center ◽

Tertiary Care ◽

Cross Sectional Study ◽

Endotracheal Tube Cuff ◽

Cross Sectional ◽

Tube Cuff ◽

Respiratory Therapists ◽

Significant Difference

Abstract Introduction: Emergency Medical Services (EMS) providers are trained to place endotracheal tubes (ETTs) in the prehospital setting when indicated. Endotracheal tube cuffs are traditionally inflated with 10cc of air to provide adequate seal against the tracheal lumen. There is literature suggesting that many ETTs are inflated well beyond the accepted safe pressures of 20-30cmH2O, leading to potential complications including ischemia, necrosis, scarring, and stenosis of the tracheal wall. Currently, EMS providers do not routinely check ETT cuff pressures. It was hypothesized that the average ETT cuff pressure of patients arriving at the study site who were intubated by EMS exceeds the safe pressure range of 20-30cmH2O. Objectives: While ETT cuff inflation is necessary to close the respiratory system, thus preventing air leaks and aspiration, there is evidence to suggest that over-inflated ETT cuffs can cause long-term complications. The purpose of this study is to characterize the cuff pressures of ETTs placed by EMS providers. Methods: This project was a single center, prospective observational study. Endotracheal tube cuff pressures were measured and recorded for adult patients intubated by EMS providers prior to arrival at a large, urban, tertiary care center over a nine-month period. All data were collected by respiratory therapists utilizing a cuff pressure measurement device which had a detectable range of 0-100cmH2O and was designed as a syringe. Results including basic patient demographics, cuff pressure, tube size, and EMS service were recorded. Results: In total, 45 measurements from six EMS services were included with ETT sizes ranging from 6.5-8.0mm. Mean patient age was 52.2 years (67.7% male). Mean cuff pressure was 81.8cmH2O with a range of 15 to 100 and a median of 100. The mode was 100cmH2O; 40 out of 45 (88.9%) cuff pressures were above 30cmH2O. Linear regression showed no correlation between age and ETT cuff pressure or between ETT size and cuff pressure. Two-tailed T tests did not show a significant difference in the mean cuff pressure between female versus male patients. Conclusion: An overwhelming majority of prehospital intubations are associated with elevated cuff pressures, and cuff pressure monitoring education is indicated to address this phenomenon.

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Prevalence and risk factors of low back pain among operation room staff at a Tertiary Care Center, Makkah, Saudi Arabia: a cross-sectional study

Annals of Occupational and Environmental Medicine ◽

10.1186/s40557-016-0089-0 ◽

2016 ◽

Vol 28 (1) ◽

Cited By ~ 18

Author(s):

Moath Bin Homaid ◽

Doaa Abdelmoety ◽

Waleed Alshareef ◽

Amer Alghamdi ◽

Fareed Alhozali ◽

...

Keyword(s):

Risk Factors ◽

Low Back Pain ◽

Back Pain ◽

Care Center ◽

Tertiary Care ◽

Cross Sectional Study ◽

Low Back ◽

Tertiary Care Center ◽

Sectional Study ◽

Cross Sectional

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Usefulness of the Non-Contact Tonometry in Out-Patient Screening

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v15i2.232 ◽

2016 ◽

Vol 15 (2) ◽

Author(s):

Satheesh Solomon T Selvin ◽

Chris Elsa Samson Jacob ◽

Thomas Kuriakose

Keyword(s):

Central Corneal Thickness ◽

Care Center ◽

Corneal Thickness ◽

Tertiary Care ◽

Cross Sectional Study ◽

Applanation Tonometry ◽

Cross Sectional ◽

Significant Difference ◽

Iop Measurement ◽

The Mean

Purpose: Goldmann applanation tonometry (GAT) is considered the gold standard for Intraocular Pressure (IOP) measurement. It has the disadvantages of being a contact device, need for a slit-lamp, non-portability and need of a skilled examiner. Many hospitals are using a Non Contact Tonometry (NCT) as a screening device to save clinician time, however the usefulness is not proved in terms of reliability. This study was aimed to determine the usefulness of the Air-puff tonometer (TONOREF NIDEK II, NIDEK CO., LTD., JAPAN) over a GAT in a tertiary care center. Design: Cross-sectional Study Methods: This was a cross-sectional, non interventional observational study conducted on 224 eyes (right eye) from 224 patients. All patients underwent the IOP measurement with both methods and a central corneal thickness (CCT) measured. The data was analyzed using SPSS 20.0 software. Results: The mean age of the patients was 40.3±11.29 years. There was a statistically significant difference (p<0.001) between the mean NCT and GAT readings which persisted even after correction for central corneal thickness. The correlation between NCT and GAT using Pearson’s correlation coefficient was strong irrespective of the corrections for their corneal thickness (r = 0.751 and 0.718 for uncorrected and corrected values respectively). The correlation of the individual clinicians for the readings varied from moderate to strong. The ROC curve showed the best sensitivity and specificity to occur at around 13 to 14 mmHg. Conclusion: NCT seems to overestimate the IOP at low ranges as compared to the GAT and underestimate at higher ranges. The crossover of the values is seen between 12 to 13 mmHg. The clinician should do an individualized analysis of his/her GAT measurements to the readings of the NCT machine at the clinic to obtain clinician specific nomogram.

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An observational study on patient compliance and adverse drug reactions of antihypertensives drugs in a tertiary care center of Bihar

IP International Journal of Comprehensive and Advanced Pharmacology ◽

10.18231/j.ijcaap.2021.033 ◽

2021 ◽

Vol 6 (4) ◽

pp. 190-193

Author(s):

Mrityunjay Kumar Pandit ◽

Kumar Gaurav ◽

Jeetendra Kumar

Keyword(s):

Blood Pressure ◽

Combination Therapy ◽

Antihypertensive Drugs ◽

Care Center ◽

Adult Population ◽

Tertiary Care ◽

Cross Sectional Study ◽

High Dose ◽

Cross Sectional ◽

Institutional Ethics

Hypertension is among the most common non-communicable and lifestyle disease in our country that affects adult population of both the genders from all socio-economic backgrounds and urban and rural population. In-spite of this, early diagnosis and appropriate treatment are suboptimal. Adherence of prescribed treatment has been studied in patients of hypertension in this study. : An observational and cross-sectional study was conducted in the Department of Pharmacology, Jawahar Lal Nehru Medical College and Hospital, Bhagalpur, Bihar. Prior to the initiation of the study, clearance was obtained from the Institutional Ethics Committee. Study period was between January 2021 and June 2021.A predesigned pretested interview schedule was used to collect the data from the 247 study participants. This schedule contained information related to socio-demographic variables, comorbidity, a format to assess the compliance to antihypertensive drugs prescribed and any adverse event. : A significant improvement in maintain optimal in blood pressure was observed in patients treated with one pill per day as compared to patients prescribed with two and three pills per day. Compliance was significantly better in patients in combination therapy as compared to monotherapy. : Low dose combination therapy has been stated to be more effective than high dose monotherapy in controlling blood pressure. It shows better compliance and lesser incidence of side-effects.

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The Effect of the Covid-19 Pandemic on Traumatic and Non-traumatic Orthopedic Practice in a Tertiary Care Center: A Descriptive Cross-Sectional Study

Kafkas Journal of Medical Sciences ◽

10.5505/kjms.2021.88557 ◽

2021 ◽

Vol 11 (3) ◽

pp. 369-375

Author(s):

Serdar Toy ◽

Oktay Polat ◽

Hakan Ozbay

Keyword(s):

Care Center ◽

Tertiary Care ◽

Cross Sectional Study ◽

Tertiary Care Center ◽

Sectional Study ◽

Cross Sectional

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Thyroid dysfunction in patients of metabolic syndrome: A study from a tertiary care center in India

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i10.38313 ◽

2021 ◽

Vol 12 (10) ◽

pp. 47-50

Author(s):

Ritu Gupta ◽

Akhil K Vijayan ◽

Sushma Choudhary

Keyword(s):

Metabolic Syndrome ◽

Thyroid Dysfunction ◽

Care Center ◽

Tertiary Care ◽

Cross Sectional Study ◽

Thyroid Stimulating Hormone ◽

P Value ◽

Overt Hypothyroidism ◽

Free T4 ◽

Cross Sectional

Background: Metabolic syndrome is characterized by hypertension, dyslipidemia, central obesity, glucose intolerance, insulin resistance. Thyroid hormone acts as general pacemaker, accelerating metabolic process and may be associated with metabolic syndrome. There is no information available in literature regarding the prevalence and association of thyroid dysfunction in metabolic syndrome in this central region of the country. Aims and Objective: To estimate the prevalence of thyroid dysfunction in patients of metabolic syndrome. Materials and Methods: It is a duration based prospective cross sectional study including 200 patients of metabolic syndrome. A detailed history, clinical examination and relevant investigations including serum Free T4 (FT4), Free T3 (FT3), Thyroid Stimulating Hormone (TSH) were done. Range, frequencies, percentage, mean, standard deviation and P value were calculated. P value of < 0.05 was taken as significant. Results: Prevalence of thyroid dysfunction in metabolic syndrome patients was 28.5%. Prevalence of subclinical and overt hypothyroidism was 18.5% and 8.5% respectively. In patients with both metabolic syndrome and thyroid dysfunction, most common components associated are diabetes mellitus and hypertriglyceridemia. Conclusion: Thyroid dysfunction is significantly common in metabolic syndrome patients. It should be aggressively detected and treated in these patients for better outcome.

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