scholarly journals QOL-38. USE OF COMPUTERIZED NEUROPSYCHOLOGICAL MEASURES TO ASSESS COGNITIVE MORBIDITY IN SURVIVORS OF CHILDHOOD BRAIN TUMORS

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii438-iii438
Author(s):  
Duncan Dickson ◽  
Jessica Channell ◽  
Ashley Mettetal ◽  
Elizabeth Chick ◽  
Greta Wilkening ◽  
...  
Keyword(s):  
Treatment Group ◽  
Tumor Treatment ◽  
Standard Score ◽  
Neuropsychological Measures ◽  
Computerized Measures ◽  
Healthy Sibling ◽  
Unit Increase ◽  
History Of ◽  
Pediatric Populations ◽  
Neuropsychological Evaluations

Abstract Treatment of central nervous system (CNS) tumors in pediatric populations is associated with significant cognitive morbidity. Documentation of neuropsychological deficits is vital to treatment and educational planning. We investigated the feasibility and utility of a computerized neuropsychological measure (NIH Toolbox Cognitive Battery) in differentiating individuals who received tumor treatment from healthy controls. Participants included pediatric CNS tumor survivors (N = 85; Mean Age = 13.47; SD = 4.76) at least 1-year post-completion of treatment and healthy sibling controls (N = 20; Mean Age = 10.2; SD = 3.21) who completed the NIH Toolbox. Ninety-eight percent of the participants enrolled completed the computerized tasks. The overall logistical regression model, with NIH Toolbox tests as predictors, was statistically significant [χ2 (7, N = 105) = 26.176; p < .001] and improved correct group classification from 81% to 82.9%. Picture Sequencing (β = -0.059; Wald = 6.942; p = .008) and Flanker (β = -0.083; Wald = 7.473; p = .006) were both statistically significant and negatively predictive of membership in the treatment group. For each 1 unit increase in standard score on measures of working memory and inhibition, odds of membership in the treatment group decreased by 6.2% and 8.7%, respectively. Consistent with the literature, worse performance on computerized measures of cognitive functioning mediated by executive functioning was correlated with a history of brain tumor treatment. Further investigation will focus on comparing computerized neuropsychological tools to traditional comprehensive neuropsychological evaluations and clarifying the trajectory of these deficits across recovery.

Abstract MP86: Effects of Immediate Blood Pressure Reduction on Death and Major Disability in Acute Ischemic Stroke Patients by History of Hypertension and Use of Antihypertensive Medications

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Tan Xu ◽  
Yonghong Zhang ◽  
Yingxian Sun ◽  
Chung-Shiuan Chen ◽  
Jing Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Treatment Group ◽  
Acute Ischemic Stroke ◽  
Hospital Discharge ◽  
Odds Ratio ◽  
Recurrent Stroke ◽  
Stroke Patients ◽  
Antihypertensive Medications ◽  
History Of

Introduction: The effects of blood pressure (BP) reduction on clinical outcomes among acute stroke patient remain uncertain. Hypothesis: We tested the effects of immediate BP reduction on death and major disability at 14 days or hospital discharge and 3-month follow-up in acute ischemic stroke patients with and without a previous history of hypertension or use of antihypertensive medications. Methods: The China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) randomly assigned patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP) to receive antihypertensive treatment (N=2,038) or to discontinue all antihypertensive medications (N=2,033) during hospitalization. Randomization was stratified by participating hospitals and use of antihypertensive medications. Study outcomes were assessed at 14 days or hospital discharge and 3-month post-treatment follow-up. The primary outcome was death and major disability (modified Rankin Scale score≥3), and secondary outcomes included recurrent stroke and vascular events. Results: Mean SBP was reduced 12.7% in the treatment group and 7.2% in the control group within 24 hours after randomization (P<0.001). Mean SBP was 137.3 mmHg in the treatment group and 146.5 in the control group at day 7 after randomization (P<0.001). At 14 days or hospital discharge, the primary and secondary outcomes were not significantly different between the treatment and control groups by subgroups. At the 3-month follow-up, recurrent stroke was significantly reduced in the antihypertensive treatment group among patients with a history of hypertension (odds ratio 0.43, 95% CI 0.24-0.75, P=0.003) and among patients with a history of use of antihypertensive medications (odds ratio 0.41, 95% CI 0.20-0.84, P=0.01). All-cause mortality (odds ratio 2.84, 95% CI 1.11-7.27, P=0.03) was increased among patients without a history of hypertension. Conclusion: Immediate BP reduction lowers recurrent stroke among acute ischemic stroke patients with a previous history of hypertension or use of antihypertensive medications at 3 months. On the other hand, BP reduction increases all-cause mortality among patients without a history of hypertension.

Abstract P83: Predictors of Length of Stay for HF Patients: Results from Get With the Guidelines

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
David J Whellan ◽  
Xin Zhao ◽  
Adrian F Hernandez ◽  
Eric D Peterson ◽  
Deepak L Bhatt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Length Of Stay ◽  
Vital Signs ◽  
P Value ◽  
Chi Square ◽  
Unit Increase ◽  
History Of ◽  
Multivariable Regression ◽  
Get With The Guidelines

Background: Heart failure (HF) admissions are frequent and result in significant expenditures. Identifying predictors of increased length of stay (LOS), particularly above the median LOS, may help providers set expectations for patients and target resources effectively. Methods: We analyzed HF admissions (n= 70,094) from January 2005 through April 2007 from 246 hospitals in the AHA's Get With The Guidelines-HF program. In a subset with BNP (n=44,535), baseline characteristics, admission vital signs and selected labs (BNP, creatinine, BUN, hemoglobin, and sodium) were included in a multivariable regression analysis to determine factors associated with LOS ≥4 days. Results: Patients were median age of 72, 45% female, 53% had ischemic etiology, and median LVEF was 35%. Median LOS was 4 days (25 th ,75 th 2,6). The most significant predictors of LOS ≥ 4 days were a higher admission BUN, higher heart rate, and lower SBP (Table 1). Age, insurance, race, creatinine, and LVEF were not. Conclusion: Upon admission for HF, certain vital signs, comorbidites, and laboratory values are associated with an increased likelihood of a LOS ≥ 4 days. These observations may be of value in the implementation of interventions aimed at reducing LOS and improving quality of care in HF. Variables Associated With Hospital LOS >/= 4 Days Variable Chi-Square OR Lower (95% CI) Upper (95% CI) P-value Admissioun BUN (/1 unit increase) 221.8 1.01 1.01 1.01 <.001 Admission SBP (/ 10-unit increase) 129.6 0.96 0.95 0.96 <.001 Heart Rate (/ 10-unit increase) 122.4 1.07 1.06 1.09 <.001 History of COPD/Asthma 45.8 1.19 1.13 1.25 <.001 Admission BNP (per 100-unit increase) 37.6 1.01 1.00 1.01 <.001 Female vs. Male 29.7 1.12 1.08 1.17 <.001 History of renal insufficiency 27.4 1.17 1.10 1.24 <.001 History of heart failure 18.0 0.89 0.85 0.94 <.001 Region: (MW vs. NE)
 (S vs NE)
 (W vs. NE) 17.3 0.71
 0.91
 0.71 0.60
 .077
 0.56 0.85
 1.08
 0.88 <.001

Brain Death

2017 ◽  
Author(s):  
Anupamaa Seshadri ◽  
Ali Salim
Keyword(s):  
Brain Death ◽  
Apnea Test ◽  
Brainstem Reflex ◽  
Practice Parameters ◽  
Confirmatory Tests ◽  
History Of ◽  
Pediatric Populations ◽  
Definition Of

The concept of “brain death” is one that has been controversial over time, requiring the development of clear guidelines to diagnose and give prognoses for patients after devastating neurologic injury. This review discusses the history of the definition of brain death, as well as the most recent guidelines and practice parameters on the determination of brain death in both the adult and pediatric populations. We provide specific and detailed instructions on the various clinical tests required, including the brain death neurologic examination and the apnea test, and discuss pitfalls in the diagnosis of brain death. This review also considers the most recent literature and guidelines as to the role of confirmatory tests making this diagnosis.  Key Words: apnea test, brain death, brainstem reflex, death examination

Abstract P014: Cardiovascular Risk Factors Associated with Low Dehydroepiandrosterone Sulfate

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Monik C Jimenez ◽  
JoAnn E Manson ◽  
Kathryn M Rexrode
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Heart Disease ◽  
Dehydroepiandrosterone Sulfate ◽  
Stepwise Logistic Regression ◽  
Postmenopausal Hormone ◽  
Reactive Protein ◽  
Unit Increase ◽  
History Of ◽  
Hormone Use

Introduction: Low dehydroepiandrosterone sulfate (DHEAS) levels recently have been related to elevated risk of ischemic stroke. However, the association between DHEAS and traditional cardiovascular risk factors remains unclear. Methods: Blood samples were collected in 1989-1990 among 32,826 participants of the Nurses’ Health Study. Samples were assayed for DHEAS, lipids, and other biomarkers as part of a nested case control study evaluating risk of ischemic stroke and 340 stroke-free controls with complete data were available. Lifestyle covariates were ascertained in 1988. Stepwise logistic regression models were used to evaluate the association of between CVD risk factors and low DHEAS (<42 μ g/dL), while stepwise linear regression was used to evaluate the association with continuous DHEAS. Stepwise models utilized an entry threshold of α=0.20 and exit criterion of α=0.10. Results: The mean level of DHEAS was 78.38 μ g/dL (s.d. 50.02; median=67.03) in this population of women aged 43-69 years (median=62). Age was strongly associated with lower DHEAS. Women with history of heart disease and higher total/HDL cholesterol were more likely to have low DHEAS. In stepwise logistic regression analyses, age (OR=2.94; 95%CI: 1.73-5.00 for 10 yrs) and history of heart disease (OR=1.84; 95% CI: 0.91-3.70) were identified as risk factors for low DHEAS. In stepwise linear regression modeling, age, postmenopausal hormone use, history of heart disease and C-reactive protein (CRP) were associated with lower DHEAS levels while alcohol use was associated with higher DHEAS levels (Table 1). Body mass index, smoking, diabetes, glycosylated hemoglobin and lipids were not associated with low DHEAS. Conclusions: In this population of healthy women, lower levels of DHEAS were associated with older age, history of heart disease, postmenopausal hormone use, higher CRP and lower levels of alcohol consumption. Further research is needed to explore these associations. Table 1 Multivariable * adjusted estimates for DHEAS by cardiovascular disease risk factors DHEAS (continuous μ g/dL) β † 95%CI Age ‡ −28.40 −36.75, -20.05 History of Heart disease −18.76 −39.23, 1.71 Postmenopausal Hormone Therapy Use & −12.01 −21.99, -2.04 CRP £ (mg/L) −0.66 −1.37, 0.04 Alcohol # (g/day) 2.95 0.46, 5.45 * All variables mutually adjusted for one another † Estimated from stepwise logistic regression model ‡ per 10 year increase in age & Ref = No use of postmenopausal hormone therapy £ per 1 unit increase in C-reactive protein (CRP- mg/L) # per 5 unit increase in alcohol consumption (g/day)

Puerperal Affective Psychosis: is There a Case for Lithium Prophylaxis?

1992 ◽  
Vol 161 (5) ◽  
pp. 692-694 ◽  
Author(s):  
M-P. V. Austin
Keyword(s):  
Treatment Group ◽  
High Risk ◽  
Controlled Trial ◽  
Similar Group ◽  
Affective Psychosis ◽  
Bipolar Illness ◽  
Manic Depressive ◽  
History Of ◽  
Risk Of Relapse

It is well known that women with a history of manic-depressive or puerperal affective psychosis are at particularly high risk of relapse in the puerperium. This paper describes the use of lithium given during or after pregnancy to women with a history of bipolar illness or puerperal affective psychosis. The rate of puerperal relapse in these subjects was compared with that in a similar group of women not on lithium. The significantly better outcome of the treatment group highlights the need for a prospective controlled trial looking at the effectiveness of lithium in minimising puerperal bipolar relapse.

Sire and growth path effects on sheep meat production. 1. Growth and carcass characteristics

2007 ◽  
Vol 47 (10) ◽  
pp. 1208 ◽  
Author(s):  
D. L. Hopkins ◽  
D. F. Stanley ◽  
L. C. Martin ◽  
E. N. Ponnampalam ◽  
R. van de Ven
Keyword(s):  
Growth Rate ◽  
Treatment Group ◽  
Subcutaneous Fat ◽  
Carcass Characteristics ◽  
Gluteus Medius ◽  
Feed Restriction ◽  
Meat Production ◽  
Fat Percentage ◽  
Cross Sectional ◽  
Unit Increase

The growth and carcass characteristics of 627 crossbred lamb progeny from 20 Poll Dorset sires was studied. The sires were selected on the basis of Australian sheep breeding values (ASBVs) for postweaning growth (PWWT), depth of loin muscle (PEMD) and depth of subcutaneous fat (PFAT). Lambs were weaned either at 20- or 30-kg liveweight and then within each of these groups were maintained at their weaning weight for 55 days or fully fed, giving four treatment groups. Restricted lambs were realimented subsequent to the period of feed restriction and all lambs within each treatment group were slaughtered when their mean liveweight reached 45 kg. After adjusting for the weaning group and weaning age, liveweight at weaning depended on birthweight, rearing type and sex. For the late-weaning group, it also depended on whether the lamb was born as a single or a multiple and on sire ASBVs for PWWT and PEMD. This was such that liveweight increased by 0.14 ± 0.05 kg for each unit increase in sire ASBV for PWWT and decreased by 0.55 ± 0.20 kg for a unit increase in sire ASBV for PEMD. During the period of feed restriction, sire ASBV for PWWT had an effect on the growth rate of lambs in all treatments with a coefficient of 1.67 ± 0.52. Lamb growth rate during the realimentation phase increased with increasing ASBVs for PWWT at a rate estimated as 2.21 ± 0.49 g/day for each unit increase in PWWT. Early-weaned (20 kg), restricted lambs grew on average 26.0 ± 3.4 g/day faster during the refeeding period than the early-weaned, fully fed lambs, and for late-weaned lambs (30 kg) the difference was 35.5 ± 5.4 g/day. Lambs subjected to a restricted intake of pasture produced carcasses 0.79 ± 0.32 mm fatter on average than those fully fed as measured at the GR site (110 mm from the midline over the 12th rib). As the sire PFAT ASBV increased, the carcasses of the progeny were fatter at the GR site, fat C site (over the longissimus muscle at the 12th rib), the rump site (30-mm distal to the lumbar–sacral junction over the gluteus medius muscle) and in terms of carcass fat percentage. As the sire PEMD ASBV increased, progeny carcasses had larger loin muscle cross sectional areas, and as the sire PFAT ASBV increased, there was a decrease in loin cross sectional area. There was no impact of treatment group on lean percentage. As the sire PFAT ASBV increased, the carcasses contained less lean and as PEMD ASBV increased, the carcasses contained more lean equating to a potential 2% increase given the range of ASBVs in the experiment, which represents ~0.4 kg lean on average.

scholarly journals PENAMBAHAN NEUROMUSCULAR TRAINING PROGRAM DALAM MENINGKATKAN PERFORMA FUNGSIONAL ANKLE ATLET SEPAK BOLA LAKI-LAKI DENGAN RIWAYAT ANKLE SPRAIN

2020 ◽  
Vol 8 (3) ◽  
pp. 435
Author(s):  
Dominggus Ruku Yudit Pramono ◽  
Damayanti Tinduh ◽  
Harlina Harlina
Keyword(s):  
Treatment Group ◽  
Training Program ◽  
Ankle Sprain ◽  
Functional Performance ◽  
Test Group ◽  
Neuromuscular Training ◽  
Performance Measurements ◽  
A Value ◽  
Post Test ◽  
History Of

When there is an ankle sprain injury the athlete has decreased functional ability and decreased instability of the ankle joint. One of the actions used to reduce the risk of injury and increase the performance of athletes is by providing a Neuromuscular Training Program (NMT). This study to prove the effect of the provision of the Neuromuscular Training Program on the functional performance. This study used a Randomized Pre Test and Post Test Group Design study design. Respondents of this study were male soccer athletes, amounting to 18 athletes who met the inclusion criteria, then divided into 2 groups randomly, each group consisted of 9 respondents. The study showed that there were differences in improvement in functional performance after the administration of the Neuromuscular Training Program in male soccer athletes with a history of ankle sprain. In the treatment group shows the results of functional performance (SLHT) with a value of p = 0,000 indicates a significant effect. Then the results of subjective functional performance measurements using Cumberland Ankle and Instability Tools (CAIT) in the treatment group showed the results of functional performance (CAIT) with a value of p = 0.005. From the results of the study that there were differences and improves in functional performance after the administration of the Neuromuscular Training Program in male soccer athletes with a history of ankle sprain.

scholarly journals Paraganglioma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A596-A597
Author(s):  
Oluwatomisin A Aluko ◽  
Edward Ruby
Keyword(s):  
Reference Range ◽  
Incidental Finding ◽  
Treatment Options ◽  
Adrenal Tumors ◽  
Tumor Treatment ◽  
Radiographic Testing ◽  
Chief Complaints ◽  
History Of ◽  
Biochemical Testing ◽  
Total Urine

Abstract Introduction: Paragangliomas are rare neuroendocrine tumors arising from extra-adrenal medullary neural crest derivatives. The terms pheochromocytoma and paraganglioma are often used interchangeably because morphologically and functionally these entities are almost the same. However, paragangliomas that arise in the adrenal medulla are called pheochromocytomas and those outside the adrenal gland are called paragangliomas. Paragangliomas are often discovered incidentally during imaging studies performed for other reasons. We report a case of a patient who had incidental finding of retroperitoneal paraganglioma on imaging done for evaluation of thigh and gluteal cellulitis. Clinical Case: A 24-year-old female presented with chief complaints of episodic headaches, multiple skin abscesses, fever and malaise. She has a history of Type 1DM and had been non-compliant on insulin. Vitals on presentation was significant for tachycardia with heart rate of 124, blood pressure of 119/81, respiratory rate of 16. Initial labs were consistent with DKA. CT abdomen and pelvis done for further evaluation of gluteal and thigh abscess showed incidental finding of a 3.4 cm retroperitoneal/para-aortic well-circumscribed rim-enhancing mass with central hypoenhancing component, suspicious for neoplasm such as paraganglioma. Biochemical testing was performed. 24-hour urine catecholamine levels obtained showed elevated urine norepinephrine level of 1008μg/day (reference range 15-100μg/day), urine dopamine 410μg/day (reference range 65- 400μg/day), urine epinephrine less than 2μg/day (reference range 0-20μg/day). Total urine catecholamines was elevated 1008μg/day (reference range 15-100μg/day). These results confirmed diagnosis of paraganglioma. Treatment options were discussed with the patient including surgery for removal of paraganglioma which she has currently declined. Conclusion: Diagnosis of a paraganglioma can usually be made using biochemical and radiographic testing. All patients with paraganglioma should be tested for hypersecretion of catecholamines in a 24-hour urine or serum collection, even if they do not present with a clinical picture of catecholamine hypersecretion. Importantly these extra-adrenal tumors do not have the enzymatic capacity to form epinephrine from norepinephrine as was exemplified by our case. For catecholamine-secreting tumors, biochemical diagnosis should be followed by radiological evaluation (typically either CT or MRI of the abdomen and pelvis) to locate the tumor. Treatment options are dependent on location of tumor, size, presence of symptoms and if there is metastatic disease present.

scholarly journals Public health burden of pre-diabetes and diabetes in Luxembourg: finding from the 2013–2015 European Health Examination Survey

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e022206 ◽  
Author(s):  
Valéry Bocquet ◽  
Maria Ruiz-Castell ◽  
Carine de Beaufort ◽  
Jessica Barré ◽  
Nathalie de Rekeneire ◽  
...  
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Medical Diagnosis ◽  
Undiagnosed Diabetes ◽  
Health Examination ◽  
Family History Of Diabetes ◽  
Unit Increase ◽  
History Of ◽  
European Health ◽  
Diagnosed Diabetes

ObjectiveThe aim of this study was to determine the burden and risk factors of prediabetes and diabetes in the general adult population of Luxembourg.DesignCross-sectional survey between 2013 and 2015.SettingData were collected as part of the European Health Examination Survey in Luxembourg (EHES-LUX).Participants1451 individuals were recruited in a random sample of the 25–64-year-old population of Luxembourg.OutcomesDiabetes was defined by a glycaemic biomarker (fasting plasma glucose (FPG) ≥7.0 mmol/L), self-reported medication and medical diagnosis; prediabetes by a glycaemic biomarker (FPG 5.6–6.9 mmol/L), no self-reported medication and no medical diagnosis. Undiagnosed diabetes was defined only from the glycaemic biomarker; the difference between total and undiagnosed diabetes was defined as diagnosed diabetes. Odds of diabetes and prediabetes as well as associated risk factors were estimated.ResultsThe weighted prevalence of prediabetes and diabetes was 25.6% and 6.5%, respectively. Nearly 4.8% (men: 5.8%; women: 3.8%) were diagnosed diabetes and 1.7% (men: 2.6%; women: 0.7%) were undiagnosed diabetes. The multivariable-adjusted OR (MVOR) for diabetes risk were: age 1.05 (95% CI 1.01 to 1.09), family history of diabetes 3.24 (1.95–5.38), abdominal obesity 2.63 (1.53–4.52), hypertension 3.18 (1.76–5.72), one-unit increase of triglycerides 1.16 (1.10–1.22) and total cholesterol 0.74 (0.64–0.86). The MVOR for prediabetes risk were: age 1.04 (95% CI 1.02 to 1.06), male sex 1.84 (1.30–2.60), moderate alcohol consumption 1.38 (1.01–1.89), family history of diabetes 1.52 (1.13–2.05), abdominal obesity 1.44 (1.06–1.97), second-generation immigrants 0.61 (0.39–0.95) and a one-unit increase of serum high-density lipoprotein cholesterol 0.70 (0.54–0.90).ConclusionsIn Luxembourg, an unexpectedly high number of adults may be affected by prediabetes and diabetes. Therefore, these conditions should be addressed as a public health priority for the country, requiring measures for enhanced detection and surveillance, which are currently lacking, especially in primary care settings.

The Bible of Child/Pediatric Clinical Neuropsychology Has Been Written

2004 ◽  
Vol 10 (6) ◽  
pp. 920-921
Author(s):  
R.W. Butler
Keyword(s):  
New York ◽  
Normative Data ◽  
Neuropsychological Evaluation ◽  
Pediatric Neuropsychology ◽  
Clinical Neuropsychology ◽  
Neuropsychological Measures ◽  
Cognitive Domains ◽  
Oxford University ◽  
The Bible ◽  
Neuropsychological Evaluations

The Neuropsychological Evaluation of the Child. Ida Sue Baron. 2004. New York: Oxford University Press. 454 pp., $79.95 (HB).It is with extreme pleasure that I write a review of this outstanding text, and also pride that I was selected to be the reviewer. When Dr. Lezak mailed me the book with a request to write a review for JINS, I literally called her and thanked her for this opportunity. I should note, this was not because I would receive a complimentary copy of The Neuropsychological Evaluation of the Child, as I had already purchased and read the text, and ordered an additional copy for my clinic and trainees' access. Dr. Baron has provided those of us in the field of child/pediatric neuropsychology with has long been needed: a general background on clinical issues in conducting neurocognitive assessments with children and adolescents, along with practical matters and concerns, such as how to cope with the varying needs of different referral sources, and providing feedback to parents. Moreover, and most essential, the text comprehensively reviews neuropsychological measures under all cognitive domains, and presents exhaustively researched historical and current normative data for the developmental population. This compilation is an excellently written book that is comprehensive, detailed, current, thoughtful, and an invaluable reference for every child and pediatric neuropsychologist. Indeed, our colleagues who specialize in adult neuropsychological evaluations would well benefit from reading the text because the clinical insights are germane to all ages, and the normative data will enrich their understanding of brain function and progression throughout the development years.

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