074 First seizures in emergency department vs ward: study in an elderly population

2018 ◽  
Vol 89 (6) ◽  
pp. A30.2-A30
Author(s):  
Emma Foster ◽  
Sarah Holper ◽  
Patrick Kwan
Keyword(s):  
Risk Factors ◽  
Older Patients ◽  
Management Strategies ◽  
Individual Risk ◽  
Not Otherwise Specified ◽  
Therapeutic Decisions ◽  
Icd 10 ◽  
Symptomatic Seizures ◽  
Acute Disturbance

IntroductionSeizures are common in hospitals, both as presentations to Emergency Departments (ED) and as hospital onset seizures (HOS), occurring in ward patients hospitalised for non-seizure reasons. Prompt identification of seizure aetiology is important, as it affects prognosis and management choices. Acute symptomatic seizures due to acute disturbance of brain function have a far lower risk of recurrence compared to unprovoked seizures. Timely investigations and specialist review assesses individual risk for seizure recurrence, which then guides therapeutic decisions including antiepileptic drug (AED) use. This study includes a larger proportion of older patients than usually reported, and as such, provides important insights into seizure aetiology and management strategies in this demographic.MethodsThis retrospective survey of medical charts reviewed patients aged 18 or over with a hospital separation coded as ICD-10 G40 (Epilepsy), G41 (Status epilepticus), or R56.9 (convulsions not otherwise specified), presenting between 1 January 2008 through 30 November 2016, to a large metropolitan private hospital. 97 episodes of ED attendance for first seizure and 54 episodes of HOS were identified.ResultsMedian age was 70 years in ED-cohort and 80.5 years in HOS-cohort. Symptomatic seizure risk factors were identified in 62.89% of ED-cohort and 83.33% of HOS-cohort, including exposure to known epileptogenic drugs in 38.89% of HOS-cohort. Antiepileptic drugs (AEDs) were prescribed on discharge to 74.23% of ED-cohort and 81.48% of HOS-cohort, but far fewer had scheduled Neurologist review (58.76% of ED- and 35.19% of HOS-cohorts).ConclusionThis study includes a larger proportion of older patients than usually reported, and as such, provides important insights into seizure aetiology and management strategies in this demographic. This includes caution when prescribing known epileptogenic drugs; mindful prescription of AED on discharge; and ensuring adequate Neurologist follow-up to monitor further seizure activity, addressing seizure risk factors, and ongoing need for AED.

scholarly journals Cardiovascular risk factors during cancer treatment: prevalence, incidence and prognostic relevance

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Caro Codon ◽  
T Lopez-Fernandez ◽  
C Alvarez-Ortega ◽  
P Zamora Aunon ◽  
I Rodriguez Rodriguez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Cancer Therapy ◽  
Cancer Patients ◽  
Individual Risk ◽  
Funding Source ◽  
Number Of Patients ◽  
All Cause Mortality

Abstract Background The actual usefulness of CV risk factor assessment in the prognostic evaluation of cancer patients treated with cardiotoxic treatment remains largely unknown. Design Prospective multicenter study in patients scheduled to receive anticancer therapy related with moderate/high cardiotoxic risk. Methods A total of 1324 patients underwent follow-up in a dedicated cardio-oncology clinic from April 2012 to October 2017. Special care was given to the identification and control of CV risk factors. Clinical data, blood samples and echocardiographic parameters were prospectively collected according to protocol, at baseline before cancer therapy and then at 3 weeks, 3 months, 6 months, 1 year, 1.5 years and 2 years after initiation of cancer therapy. Results At baseline, 893 patients (67.4%) presented at least 1 risk factor, with a significant number of patients newly diagnosed during follow-up. Individual risk factors were not related with worse prognosis during a 2-year follow-up. However, a higher Systemic Coronary Risk Estimation (SCORE) was significantly associated with higher rates of severe cardiotoxicity and all-cause mortality [HR 1.79 (95% CI 1.16–2.76) for SCORE 5–9 and HR 4.90 (95% CI 2.44–9.82) for SCORE ≥10 when compared with patients with lower SCORE (0–4)]. Conclusions This large cohort of patients treated with a potentially cardiotoxic regimen showed a significant prevalence of CV risk factors at baseline and significant incidence during follow-up. Baseline cardiovascular risk assessment using SCORE predicted severe cardiotoxicity and all-cause mortality. Therefore, its use should be recommended in the evaluation of cancer patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was partially funded by the Fondo Investigaciones Sanitarias (Spain), Centro de Investigaciόn Biomédica en Red Cardiovascular CIBER-CV (Spain)

scholarly journals Discriminating uninfected surgical bed cysts from bacterial brain abscesses after Carmustine wafer implantation in newly diagnosed IDH-wildtype glioblastomas

2021 ◽  
Author(s):  
Alexandre Roux ◽  
Hichem Ammar ◽  
Alessandro Moiraghi ◽  
Sophie Peeters ◽  
Marwan Baroud ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mass Effect ◽  
Cyst Formation ◽  
Individual Risk ◽  
Newly Diagnosed ◽  
Postoperative Mri ◽  
Carmustine Wafer ◽  
Brain Abscesses ◽  
Individual Risk Factors

Abstract PurposeCarmustine wafers can be implanted in the surgical bed of high-grade gliomas, which can induce surgical bed cyst formation, leading to clinically relevant mass effect.MethodsAn observational retrospective monocentric study was conducted including 122 consecutive adult patients with a newly diagnosed supratentorial glioblastoma who underwent a surgical resection with Carmustine wafer implantation as first line treatment (2005–2018).FindingsTwenty-two patients (18.0%) developed a postoperative contrast-enhancing cyst within the surgical bed: 16 uninfected cysts and six bacterial abscesses. All patients with an uninfected surgical bed cyst were managed conservatively, all resolved on imaging follow-up, and no patient stopped the radiochemotherapy. Independent risk factors of formation of a postoperative uninfected surgical bed cyst were age ≥ 60 years (p = 0.019), number of Carmustine wafers implanted ≥ 8 (p = 0.040), and partial resection (p = 0.025). Compared to uninfected surgical bed cysts, the occurrence of a postoperative bacterial abscess requiring surgical management was associated more frequently with a shorter time to diagnosis from surgery (p = 0.009), new neurological deficit (p < 0.001), fever (p < 0.001), residual air in the cyst (p = 0.018), a cyst diameter greater than that of the initial tumor (p = 0.027), and increased mass effect and brain edema compared to early postoperative MRI (p = 0.024). Contrast enhancement (p = 0.473) and diffusion signal abnormalities (p = 0.471) did not differ between postoperative bacterial abscesses and uninfected surgical bed cysts.ConclusionsClinical and imaging findings help discriminate between uninfected surgical bed cysts and bacterial abscesses following Carmustine wafer implantation. Surgical bed cysts can be managed conservatively. Individual risk factors will help tailor their steroid therapy and imaging follow-up.

scholarly journals Metabolic risk factors in first-episode schizophrenia: baseline prevalence and course analysed from the European First-Episode Schizophrenia Trial

2013 ◽  
Vol 16 (5) ◽  
pp. 987-995 ◽  
Author(s):  
W. Wolfgang Fleischhacker ◽  
Cynthia O. Siu ◽  
Robert Bodén ◽  
Elizabeth Pappadopulos ◽  
Onur N. Karayal ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Prevalence Rate ◽  
Individual Risk ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Treatment Groups ◽  
Individual Risk Factors ◽  
First Episode Schizophrenia

Abstract Available data on antipsychotic-induced metabolic risks are often constrained by potential confounding effects due to prior antipsychotic treatment. In this study, we assessed the baseline prevalence of metabolic abnormalities and changes following treatment with five commonly-used antipsychotic drugs (haloperidol, amisulpride, olanzapine, quetiapine or ziprasidone) in first-episode, partially antipsychotic-naive patients with schizophrenia in the European first-episode schizophrenia trial (EUFEST). Overall baseline prevalence of metabolic syndrome (MetS) was 6.0%, with similar rates observed in the antipsychotic-naive patients (5.7%, 9/157) and in the other patients with only a brief prior exposure to antipsychotics (6.1%, 20/326). These results are consistent with the MetS prevalence rate estimated in a general population of similar age. Examination of individual risk factors showed 58.5% of subjects had one or more elevated metabolic risks at baseline: 28.5% demonstrated suboptimal HDL; 24.2% hypertension; 17.7% hypertriglyceridemia; 8.2% abdominal obesity; 7.3% hyperglycaemia. Increase in body weight (kg/month) occurred in patients treated with haloperidol (0.62 s.e. 0.11), amisulpride (0.76 s.e. 0.08), olanzapine (0.98 s.e. 0.07) and quetiapine (0.58 s.e. 0.09), which was significantly greater than that in the ziprasidone group (0.18 s.e. 0.10). The incidence rate of new diabetes cases over a 52-wk follow-up period was 0.82% (4/488). More patients experienced worsening rather than improvement of hypertriglyceridemia or hyperglycaemia in all treatment groups. Our findings suggest that in first-episode, partially antipsychotic-naive patients, the baseline prevalence rate of MetS appears to be no higher than that in the general population, but serious underlying individual risk factors nevertheless existed.

Non-Myeloablative Hematopoietic Stem Cell Transplantation in Older Patients with AML and MDS: Results from the Center for International Blood and Marrow Transplant Research (CIBMTR)

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 346-346 ◽  
Author(s):  
Brian McClune ◽  
Daniel J. Weisdorf ◽  
John F. DiPersio ◽  
Armand Keating ◽  
Tanya L. Pedersen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Complete Remission ◽  
Cell Transplantation ◽  
Older Patients ◽  
Univariate Analysis ◽  
Hematopoietic Stem ◽  
Age Cohorts ◽  
Allogeneic Hct ◽  
First Complete Remission

Abstract Background: AML and MDS disproportionately affect older-aged individuals. Hematopoietic cell transplantation (HCT) is the best established curative therapy but is generally not offered due to concerns about toxicity and poor outcome. Reduced-intensity conditioning (RIC) regimens have been developed to allow allografting in older patients; however, there is a paucity of data to support transplantation in patients over 65 years of age. Purpose: To better study age as a predictor of outcome, we retrospectively analyzed data reported to the CIBMTR from 1995–2005 among patients receiving RIC HCT for MDS (551 patients) and AML (565 patients) in first complete remission (CR). Patient and Methods: Outcomes analyzed for both disease groups included transplant-related mortality (TRM), engraftment, incidence of acute and chronic graft-versus-host disease (GVHD), leukemia-free (LFS) and overall survival (OS). Patients were stratified according to age cohorts for comparison: 40–54, 54–59, 60–64 and ≥65 years. Results: Clinical characteristics were well matched across age cohorts but notably, most AML patients presented with de novo disease (P=0.001) and received their allograft from a matched related donor (MRD) (P=0.001) with 51% of patients ≥65 years having a MRD. MDS patients more often had unrelated donors (URD), especially in the older cohorts (73% for ≥ 65 years); but donor type was not significantly different between groups. Most patients received peripheral blood (PB) allografts (76–97%), fludarabine-containing regimens for conditioning and cyclosporine-containing regimens for GVHD prophylaxis. Univariate analysis demonstrated no statistically significant differences in TRM across age cohorts and no overall difference in occurrence of acute (31–35% at 100 days) or chronic GVHD (36–53% at 2 years). Relapse rates were similar across all age groups (29–39% at 3 years) (Table). Multivariate analysis revealed no statistically significant impact of age on TRM, relapse, LFS, or OS (all p &gt; 0.4). Disease and status at transplant were significant risk factors for OS/LFS at 1 year while affecting TRM/relapse at 2 years. Performance status and HLA disparity were also significant at 2 years for nearly all outcomes. Conclusion: 1. The outcomes for older adults undergoing allogeneic HCT are not significantly different than for younger adults, even after adjusting for multiple risk factors; 2. Age by itself should not be the limiting factor for proceeding to allogeneic HCT in older patients with AML or MDS; 3. Continued participation in clinical trials should be encouraged to explore strategies that could improve treatment outcome. Univariate probabilities of patients age ≥40 years receiving allogeneic HCT for AML/MDS in first complete remission reported to the CIBMTR, 1995–2005. N 40–54 N 55–60 N 60–64 N &gt;65 AML TRM 220 150 132 63 100 days 11 (7–16)% 6 (3–10)% 13 (8–20)% 10 (4–18)% 1 year 20 (15–26)% 18 (12–24)% 24 (17–33)% 30 (19–42)% Relapse 1 year 27 (21–33)% 34 (26–42)% 31 (23–40)% 22 (12–33)% 3 years 32 (26–39)% 35 (27–43)% 39 (30–49)% 33 (21–46)% LFS 1 year 53 (46–60)% 49 (41–58)% 44 (35–53)% 48 (36–61)% 3 years 43 (36–51)% 41 (32–50)% 27 (19–37)% 34 (22–47)% OS 100 days 84 (78–88)% 92 (87–96)% 83 (76–89)% 89 (80–95)% 1 year 59 (52–65)% 60 (52–68)% 51 (42–60)% 51 (39–64)% 3 years 45 (40–54)% 47 (42–59)% 30 (25–43)% 36(24–49)% Follow-up (months) 37 (2–110) 25 (1–87) 36 (3–96) 29 (3–59) MDS TRM 219 150 127 55 100 days 17 (13–23)% 17 (11–23)% 14 (9–21)% 19 (9–30)% 1 year 31 (24–37)% 33 (25–41)% 32 (24–41)% 34 (22–47)% Relapse 1 year 26 (20–32)% 27 (20–35)% 26 (18–34)% 25 (14–37)% 3 years 29 (23–35)% 29 (22–37)% 31 (23–40)% higher 33 (20–47)% LFS 1 year 43 (36–50)% 40 (32–49)% 43 (34–51)% 42 (29–56)% 3 years 36 (29–43)% 27 (–2035)% 29 (21–39)% 23 (12–38)% OS 100 days 77 (71–82)% 77 (70–83)% 81 (74–87)% 76 (64–87)% 1 year 50 (43–56)% 46 (38–54)% 53 (44–62)% 48 (35–61)% 3 years 39 (32–46)% 29 (22–37)% 30 (21–40)% 29 (17–43)% Follow-up (months) 36 (2–86) 40 (3–86) 35 (3–68) 36 (3–85)

Second Malignant Neoplasms Following Multiple Myeloma: A Cohort Study On 744 Patients Treated 1997-2011

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3100-3100 ◽  
Author(s):  
Martina Kleber ◽  
Kerstin Höck ◽  
Gabriele Ihorst ◽  
Bernd Koch ◽  
Ralph Waesch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Alkylating Agents ◽  
Malignant Neoplasm ◽  
Individual Risk ◽  
Malignant Neoplasms ◽  
Seer Database ◽  
Educational Grant ◽  
Second Malignant Neoplasms

Abstract Introduction Second malignant neoplasms after first-line therapy and maintenance-therapy have been reported in clinical studies; however, no risk factors have been established. Moreover, second malignant neoplasms is gaining increasingly more attention as multiple myeloma patients live longer and data from randomized studies suggest there are associations between certain newer drugs and the risk of developing second malignant neoplasms. Clinical trials are not statically powered to define risk factors for second malignant neoplasms. Methods We have conducted a large study designed to define the rate of second malignant neoplasms in a well-characterized clinical multiple myeloma cohort. We identified 744 consecutive patients treated at our institution between 1997-2011 and analyzed 1. onset of second malignant neoplasms, 2. patient characteristics (age, gender, familiar risks, smoking status, immune status), 3. frequency of different neoplasms, 4. potential multiple myeloma specific risk factors and 5. possible treatment-related risk factors (novel agents, autologous stem cell transplantation [single vs. tandem (t)-ASCT], allogeneic (allo-) SCT, frequency of alkylating agents, cycles/lines of therapy and ionizing radiation). Results 118 (16%) multiple myeloma patients developed second malignant neoplasms. Prior or synchronous malignant neoplasms were observed in 83 patients (63%) and second malignant neoplasms developed subsequent to multiple myeloma in 49 (37%) patients. Overall, most (77%) of these neoplasms were solid tumors; whereas hematological neoplasms with 23% were prominently observed subsequent to multiple myeloma. Furthermore, multiple myeloma who developed second malignant neoplasms (versus those who did not) were older, predominantly male, had IgG-MM and more CTx-cycles, use of steroids, alkylators, lenalidomide/thalidomide and radiotherapy, but lacked laboratory abnormalities nor did they have more ASCTs or bortezomib therapy. The risk of dying of multiple myeloma due to disease progression remained substantially higher than that of developing a second malignant neoplasm (cumulative incidence at 20 years: 78% vs. 11%, respectively). However, since multiple myeloma prognosis increases and death at 20 years of follow-up decreases, the development of second malignant neoplasms remains highly relevant (Figure 1; comparison of the SEER database with our UKF data). Conclusions Matching the SEER database with our data (Figure 1) confirms the rate of second malignant neoplasms at 20 years of follow-up at around 10%, whereas death from other causes (multiple myeloma) seems to substantially decrease. Further comparison is currently under way and will expand our knowledge on the development of second malignant neoplasms. Our prior (Hasskarl J.,..Engelhardt M. 2011) and previous analyses suggest that physicians need to discuss individual risk-benefit ratios with patients and stay updated as more knowledge becomes available on this topic. It is likely that second malignant neoplasms in multiple myeloma patients remain important given that the prognosis in multiple myeloma has substantially increased and patients live significantly longer. Disclosures: Kleber: Celgene: Educational grant Other. Engelhardt:Celgene: Educational grant Other.

scholarly journals Risk factors for new depressive episodes in primary health care: an international prospective 12-month follow-up study

2002 ◽  
Vol 32 (4) ◽  
pp. 595-607 ◽  
Author(s):  
K. BARKOW ◽  
W. MAIER ◽  
T. B. ÜSTÜN ◽  
M. GÄNSICKE ◽  
H.-U. WITTCHEN ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Depressive Episode ◽  
Icd 10 ◽  
Depressive Episodes ◽  
Psychiatric Problems

Background. Studies that examined community samples have reported several risk factors for the development of depressive episodes. The few studies that have been performed on primary care samples were mostly cross-sectional. Most samples had originated from highly developed industrial countries. This is the first study that prospectively investigates the risk factors of depressive episodes in an international primary care sample.Methods. A stratified primary care sample of initially non-depressed subjects (N = 2445) from 15 centres from all over the world was examined for the presence or absence of a depressive episode (ICD-10) at the 12 month follow-up assessment. The initial measures addressed sociodemographic variables, psychological/psychiatric problems and social disability. Logistic regression analysis was carried out to determine their relationship with the development of new depressive episodes.Results. At the 12-month follow-up, 4·4% of primary care patients met ICD-10 criteria for a depressive episode. Logistic regression analysis revealed that the recognition by the general practitioner as a psychiatric case, repeated suicidal thoughts, previous depressive episodes, the number of chronic organic diseases, poor general health, and a full or subthreshold ICD-10 disorder were related to the development of new depressive episodes.Conclusions. Psychological/psychiatric problems were found to play the most important role in the prediction of depressive episodes while sociodemographic variables were of lower importance. Differences compared with other studies might be due to our prospective design and possibly also to our culturally different sample. Applied stratification procedures, which resulted in a sample at high risk of developing depression, might be a limitation of our study.

Abstract P251: The Impact of Clinical Risk Factors on Risk of Peripheral Arterial Disease in Men

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Michel M Joosten ◽  
Jennifer K Pai ◽  
Eric B Rimm ◽  
Donna Spiegelman ◽  
Murray A Mittleman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Clinical Risk Factors ◽  
Individual Risk ◽  
Clinical Risk ◽  
Hazard Ratios ◽  
History Of ◽  
Peripheral Arterial

Background: Previous studies have examined individual risk factors in relation to peripheral arterial disease (PAD) but the combined effects of these factors are largely unknown. We investigated the degree to which clinical risk factors may explain the risk of PAD among men. Methods: We prospectively followed 45,596 men from the Health Professional Follow-up Study without a history of cardiovascular disease at baseline during a 22-year period (1986–2008). We defined four clinical risk factors - smoking, history of type 2 diabetes, hypertension, and hypercholesterolemia - that were updated biennially during follow-up. Cox proportional hazard models were used to compare PAD risk across individual and joint risk factors. Results: During 874,769 person-years of follow-up, 497 confirmed PAD cases occurred. All four clinical risk factors were significantly and independently associated with a higher risk of PAD after multivariate adjustment (Figure). Risk of PAD more than doubled (hazard ratio: 2.14; 95% confidence interval [95% CI]: 1.95–2.35) for each additional risk factor compared with the group free of risk factors. Men without any of the four risk factors had a relative risk of PAD of 0.19 compared with all other men (95% CI: 0.11–0.31). In 96.8% (95% CI: 95.2–98.3%) of the PAD cases, at least one of the four risk factors was present. Overall, 8 out of 10 cases of PAD appeared to be attributable to these four conventional risk factors. Conclusion: The great majority of PAD can be explained by four conventional risk factors. Figure legend: Hazard ratios for incident peripheral arterial disease (PAD) according to individual and joint risk factors. Hazard ratios are adjusted for age, height, aspirin use, family history of myocardial infarction before age 60 y, geographical region, body mass index, physical activity, alcohol consumption (and each of the other three binary clinical risk factors in the individual risk factor analyses).

The concordance of ICD-10 acute and transient psychosis and DSM-IV brief psychotic disorder

2002 ◽  
Vol 32 (3) ◽  
pp. 525-533 ◽  
Author(s):  
F. PILLMANN ◽  
A. HARING ◽  
S. BALZUWEIT ◽  
R. BLÖINK ◽  
A. MARNEROS
Keyword(s):  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Good Prognosis ◽  
Acute Onset ◽  
Schizophreniform Disorder ◽  
Not Otherwise Specified ◽  
Brief Psychotic Disorder ◽  
Icd 10 ◽  
Dsm Iv

Background. ICD-10 acute and transient psychotic disorder (ATPD; F23) and DSM-IV brief psychotic disorder (BPD; 298.8) are related diagnostic concepts, but little is known regarding the concordance of the two definitions.Method. During a 5-year period all in-patients with ATPD were identified; DSM-IV diagnoses were also determined. We systematically evaluated demographic and clinical features and carried out follow-up investigations at an average of 2·2 years after the index episode using standardized instruments.Results. Forty-two (4·1%) of 1036 patients treated for psychotic disorders or major affective episode fulfilled the ICD-10 criteria of ATPD. Of these, 61·9% also fulfilled the DSM-IV criteria of brief psychotic disorder; 31·0%, of schizophreniform disorder; 2·4%, of delusional disorder; and 4·8%, of psychotic disorder not otherwise specified. BPD showed significant concordance with the polymorphic subtype of ATPD, and DSM-IV schizophreniform disorder showed significant concordance with the schizophreniform subtype of ATPD. BPD patients had a significantly shorter duration of episode and more acute onset compared with those ATPD patients who did not meet the criteria of BPD (non-BPD). However, the BPD group and the non-BPD group of ATPD were remarkably similar in terms of sociodemography (especially female preponderance), course and outcome, which was rather favourable for both groups.Conclusions. DSM-IV BPD is a psychotic disorder with broad concordance with ATPD as defined by ICD-10. However, the DSM-IV time criteria for BPD may be too narrow. The group of acute psychotic disorders with good prognosis extends beyond the borders of BPD and includes a subgroup of DSM-IV schizophreniform disorder.

scholarly journals Prevalence, Risk Factors, and Complications of Oropharyngeal Dysphagia in Older Patients with Dementia

Nutrients ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 863 ◽  
Author(s):  
Mᵃ Carmen Espinosa-Val ◽  
Alberto Martín-Martínez ◽  
Mercè Graupera ◽  
Olivia Arias ◽  
Amparo Elvira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Patients ◽  
Respiratory Infections ◽  
Oropharyngeal Dysphagia ◽  
Therapeutic Effects ◽  
Fluid Viscosity ◽  
Volume Viscosity ◽  
Texture Modification ◽  
Prospective Longitudinal

The prevalence of older patients with dementia and oropharyngeal dysphagia (OD) is rising and management is poor. Our aim was to assess the prevalence, risk factors, and long-term nutritional and respiratory complications during follow-up of OD in older demented patients. We designed a prospective longitudinal quasi-experimental study with 255 patients with dementia. OD was assessed with the Volume-Viscosity Swallowing Test and a geriatric evaluation was performed. OD patients received compensatory treatments based on fluid viscosity and texture modified foods and oral hygiene, and were followed up for 18 months after discharge. Mean age was 83.5 ± 8.0 years and Alzheimer’s disease was the main cause of dementia (52.9%). The prevalence of OD was 85.9%. Up to 82.7% patients with OD required fluid thickening and 93.6% texture modification, with poor compliance. OD patients were older (p < 0.007), had worse functionality (p < 0.0001), poorer nutritional status (p = 0.014), and higher severity of dementia (p < 0.001) than those without OD and showed higher rates of respiratory infections (p = 0.011) and mortality (p = 0.0002) after 18 months follow-up. These results show that OD is very prevalent among patients with dementia and is associated with impaired functionality, malnutrition, respiratory infections, and increased mortality. New nutritional strategies should be developed to increase the compliance and therapeutic effects for this growing population of dysphagic patients.

scholarly journals Predictors of Seizure Recurrence after Acute Symptomatic Seizures in Ischemic Stroke Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Pravin George ◽  
Vineet Punia ◽  
Prashant A. Natteru ◽  
Stephen Hantus ◽  
Christopher Newey
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Seizure Recurrence ◽  
Stroke Patients ◽  
Clinical Recurrence ◽  
Sharp Waves ◽  
Nonconvulsive Seizures ◽  
Symptomatic Seizures ◽  
Acute Symptomatic Seizures

Purpose. Seizure is a well-recognized complication of both remote and acute ischemic strokes. Predictors of seizure recurrence and epilepsy in patients with ischemic stroke who develop acute symptomatic seizures (ASyS) on continuous electroencephalography (cEEG) have not been well studied. Methods. We present a five-year retrospective study of acute and remote ischemic stroke patients who developed ASyS on cEEG. We then identified risk factors for the development of seizure recurrence. Results. Sixty-five patients with ischemic stroke and ASyS were identified and reviewed. All ASyS were noted to be nonconvulsive seizures. Clinical recurrence of seizures was identified in 19 of these patients (29.2%) at follow-up. Rate of seizure recurrence was higher in remote ischemic stroke patients (84.2%), compared to acute ischemic stroke patients (15.8%, p=0.0116, OR 0.17, 95% CI 0.049–0.65). Sharp waves/spikes on follow-up EEG significantly correlated with seizure recurrence (p=0.006, OR 0, 95% CI 0–0.3926). Patients discharged on ≥3 antiepileptic drugs (AEDs) were at a higher risk of having seizure recurrence (p=0.0015, OR 0.05, 95% CI 0.0089–0.37). Conclusion. We identified risk factors of seizure recurrence in patients with ASyS as remote ischemic stroke, requiring multiple AEDs, and the presence of sharp waves on follow-up EEG. This study highlights the usefulness of cEEG in evaluating patients with acute or remote strokes.

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