6 Drug treatment of older patients presenting to a tic disorder clinic, a descriptive study

2020 ◽  
Vol 91 (8) ◽  
pp. e10.2-e10
Author(s):  
Sophia G Raymond ◽  
Jeremy S Stern ◽  
Helen Simmons
Keyword(s):  
Drug Treatment ◽  
Older Patients ◽  
Age Of Onset ◽  
Late Onset ◽  
Clinical Information ◽  
Female Ratio ◽  
Tic Disorder ◽  
Male Female Ratio ◽  
Tic Severity

AimsDrugs such as neuroleptics are known to have varying efficacy in the management of Tourette’s syndrome, and there is a particular lack of research about their efficacy when used for older patients presenting for treatment for the first time. Therefore, in this study, we aim to describe the outcomes of drug treatment in patients aged 40 years and older who presented to a Tic Disorder clinic.MethodThe Tic Disorder clinic letter database was used to search for patients who presented to the clinic aged 40+. Clinical information gleaned from the letters including age of onset, severity of symptoms, comorbidities and treatments offered was recorded in an Excel spreadsheet. Those patients with incomplete data were removed from the sample. The spreadsheet data was then used to describe the severity of tics in this cohort and the effectiveness of drugs for all patients who used them.ResultsThere were a total of 33 patients aged 40+ who presented to the Tic Disorder Clinic, that we could find a set of clinical notes on. Male: female ratio = 26:7 Tic severity was calculated from either clinical comment, or in most cases, the Yale Global Tic Severity Score (YGTSS). YGTSS of 1–19 is mild, 20–39: moderate and 40–50: severe. Patients with tics since childhood: 75.8%, late onset tics >40 yrs: 15.2%, unknown: 9%. 63.6% have had obsessionality, a common comorbidity of GTS, and 42.4% suffer with two or more psychiatric comorbidities. 25/33 patients tried drugs for tics, whether before or at presentation to this clinic. 40% of them found drugs beneficial; 60% did not, or experienced adverse reactions or were lost to follow up (see bar chart).ConclusionsOverall, even though this study shows that medications for tics is more likely to be unsuccessful or cause adverse effects, it was still effective in a substantial proportion of patients and thus may be a good intervention for some. The study also suggests that this may be more difficult cohort to monitor due to the frequency of absences to follow up.

scholarly journals Management and Complications of Nasal Septal Collections

2021 ◽  
Vol 18 (2) ◽  
pp. 79-84
Author(s):  
Olusola Ayodele Sogebi ◽  
Emmanuel Abayomi Oyewole
Keyword(s):  
Clinical Information ◽  
Delayed Presentation ◽  
Adult Males ◽  
Female Ratio ◽  
Incision And Drainage ◽  
Factors Associated ◽  
Co Morbidity ◽  
Male Female Ratio ◽  
Nasal Trauma

Background: Nasal septum collections (hematoma and abscess) can lead to structural and functional abnormalities. Our objective was to assess the clinical characteristics, management and complications of nasal septal collections, and document factors associated withtheir complications. Methods: This was a retrospective study of patients managed for nasal septal collections. Socio-demographic and clinical information was recorded, and the main investigations and results noted. Follow-up and complications of septal collections were documented and the clinical factors associated with the complications explored. Results: Twenty-four patients records were studied: male: female ratio=2:1, mean age 40.1±13.1years,62.5% presented with complaints of nasal obstruction, 66.7% had antecedent nasal trauma, presentation was from 2 to 13 days,25%had co-morbid disease(s). All patients had incision and drainage of the septal collection within 1–7 h; 41.2% of the aspirated collections cultured microorganisms, 20.8% developed complications. Increased age above 45 years, co-morbidity, delayed presentation, culture-positive aspirate was all significantly associated with development of complications. Conclusion: Nasal septal collections were more common in adult males with antecedent nasal trauma; 20% developedcomplications associated with the presence of culturepositive abscesses, increased age, and duration of septal collection. Keywords: Nasal trauma, Septal hematoma, Septal abscess, Complications

scholarly journals Current Situation of Treatment and Follow-up Re-examination of Children with Epilepsy at Vietnam National Children’s Hospital

2020 ◽  
Vol 4 (5) ◽  
Author(s):  
Thi Huyen Tran ◽  
Vu Hung Cao ◽  
Van Hoc Tran ◽  
Danh Ngon Nguyen
Keyword(s):  
Treatment Time ◽  
Age Of Onset ◽  
Treatment Compliance ◽  
Duration Of Treatment ◽  
Cross Sectional ◽  
Female Ratio ◽  
Children's Hospital ◽  
Male Female Ratio ◽  
Children’S Hospital

Purpose: To assess treatment compliance and follow-up appointment of children with epilepsy at the Vietnam National Children’s Hospital in 2019. Method: A cross-sectional descriptive study was conducted on pediatric patients and primary caregivers came for examination and treatment at the Neurology Department, Vietnam National Children’s Hospital from January 2019 to December 2019. Results: Mean age was 74.3 ± 45.1 (month age). The most common age group was the 2-6 year old group (40.5%), the lower rate was the 6-12 year old group (30.0%), and rest groups was the low rate. The male: female ratio is 1.43:1. Most of the main caregivers are parents (92.5%). Average treatment time was 20.4 ± 15.7 months, the rate of good adherence to treatment 43.5%, 31.5% of children had  moderated adhering to treatment and 25.0% had poor adhering to treatment. Within 6 months, 40.5% of children re-examined on time. The reasons for not complying with on-time re-examination were mainly due to the caregiver's busy work or the child was busy at school (37.8%) and the distance from home to hospital (26.1%). Conclusions: The percentage of patients who complied with treatment and re-examination was not high. Factors that were statistically significant for children's non-compliance were: health insurance level, age of onset, duration of treatment, and frequency of attacks following treatment.

CLINICAL FEATURES, INDICATIONS AND RESULT OF TRACHEOTOMY

2017 ◽  
pp. 50-55
Author(s):  
Duc Luu Ngo ◽  
Tu The Nguyen ◽  
Manh Hung Ho ◽  
Thanh Thai Le
Keyword(s):  
Clinical Features ◽  
University Hospital ◽  
Female Ratio ◽  
Tube Obstruction ◽  
Level Ii ◽  
Study Results ◽  
Male Female Ratio ◽  
Hospital Patients ◽  
Level I

Background: This study aims to survey some clinical features, indications and results of tracheotomy at Hue Central Hospital and Hue University Hospital. Patients and method: Studying on 77 patients who underwent tracheotomy at all of departments and designed as an prospective, descriptive and interventional study. Results: Male-female ratio was 4/1. Mean age was 49 years. Career: farmer 44.2%, worker 27.2%, officials 14.3%, student 7.8%, other jobs 6.5%. Respiratory condition before tracheotomy: underwent intubation 62.3%, didn’t undergo intubation 37.7%. Period of stay of endotracheal tube: 1-5 days 29.2%, 6-14 days 52.1%, >14 days 18.7%. Levels of dyspnea before tracheotomy: level I 41.4%, level II 48.3%, level III 0%, 10.3% of cases didn’t have dyspnea. Twenty cases (26%) were performed as an emergency while fifty seven (74%) as elective produces. Classic indications (37.7%) and modern indications (62.3%). On the bases of the site, we divided tracheostomy into three groups: high (0%), mid (25.3%) and low (74.7%). During follow-up, 44 complications occurred in 29 patients (37.7%). Tracheobronchitis 14.3%, tube obstruction 13%, subcutaneous empysema 10.4%, hemorrhage 5%, diffcult decannulation 5.2%, tube displacement 3.9%, canule watery past 2.6%, wound infection 1.3%. The final result after tracheotomy 3 months: there are 33 patients (42.9%) were successfully decannulated. In the 33 patients who were successfully decannulated: the duration of tracheotomy ranged from 1 day to 90 days, beautiful scar (51.5%), medium scar (36.4%), bad scar (12.1%). Conclusions: In tracheotomy male were more than female, adult were more than children. The main indication was morden indication. Tracheobronchitis and tube obstruction were more common than other complications. Key words: Tracheotomy

Age, Age of Onset and Course of Primary Depressive Illness in the Elderly*

1983 ◽  
Vol 28 (2) ◽  
pp. 102-104 ◽  
Author(s):  
Martin G. Cole
Keyword(s):  
Elderly Patients ◽  
Depressive Episode ◽  
Early Onset ◽  
Age Of Onset ◽  
Late Onset ◽  
The Elderly ◽  
Depressive Illness ◽  
Physical Illness ◽  
Course Of Illness

Thirty-eight elderly patients with primary depressive illness (Feighner criteria) were followed up for 7–31 months. In the absence of persistent organic signs and severe physical illness, age of onset (first depressive episode after 60) but not age was significantly related to course of illness. Compared to early onset depressives, late onset depressives were more likely to remain completely well during the follow-up period and less likely to have frequent or disabling relapses.

scholarly journals Twist drill aspiration of chronic subdural hematoma at the Ignace Deen hospital of Conakry

2021 ◽  
Vol 9 (5) ◽  
Author(s):  
Alpha Boubacar Bah ◽  
Seylan Diawara ◽  
Ibrahima Sory Souare ◽  
Abdoulaye Barry ◽  
Ansoumane Donzo ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Outcome Data ◽  
Twist Drill ◽  
Suitable Alternative ◽  
Female Ratio ◽  
Tertiary Centre ◽  
Male Female Ratio ◽  
Reasonable Approach

Bedside percutaneous twist drill aspiration (TDA) is described as a surgical method of management of Chronic subdural hematoma (CSDH) and appear to be a reasonable approach in low medical resources environment. We report the results of TDA of CSDH in a single tertiary centre in Conakry Republic of Guinea in West Africa, for the period March 2015 to October 2017. The charts and medical record of 38 cases of CSDH treated with TDA were collected retrospectively, with a mean follow-up of 84.2 days. The outcome data assessed were neurologic status evaluated by the follow-up Markwalder grading scale (MGS: 0=normal to 4=coma), recurrence, infection and mortality. The Male-Female ratio was 1.3:1. Mean age at diagnosis was 78.2+/-12 years. Traumatic brain injury (TBI) was identified as causal in 28.2% of cases studied. All patients were operated on under local anesthesia and had a postoperative drain left in place for 3 days. The mean postoperative MGS was 1.06, up from a mean preoperative MGS of 3.7. Two cases of recurrence occurred subsequent to TDA causing death and three other patients died from unknown causes during the follow-up period. No cases of post-operative infection were diagnosed during the follow-up. Our study shows that Bedside TDA appears to be a suitable alternative to burr hole craniotomies in urgent cases of CSDH in the low socio-economic setting, where a surgical theatre is not always available.

scholarly journals Treatment of Chalazian: a Comparative Cross-sectional Study

2019 ◽  
Vol 1 (1) ◽  
pp. 5-9
Author(s):  
Binita Bhattarai ◽  
Koshal Shrestha ◽  
Sushila Patel ◽  
Laxmi Devi Manandhar ◽  
Rosy Karki ◽  
...  
Keyword(s):  
Triamcinolone Acetonide ◽  
Complete Resolution ◽  
Cross Sectional Study ◽  
Meibomian Gland ◽  
Intralesional Injection ◽  
Cross Sectional ◽  
Female Ratio ◽  
Male Female Ratio ◽  
Eye Symptoms

Background: Chalazion is a common eyelid disease caused by plugged meibomian glands and chronic lipogranulomatous inflammation. It can affect individuals of all ages and may cause local eye symptoms such as irritation and inflammation and cosmetic disfigurement. There are mainly three methods of treating chalazion: Intralesional Triamcinolone Acetonide (0.1-0.3 ml of 40mg/ml), Incision and Curettage and Conservative Treatment (hot compression +lid hygiene + antibiotic ointment) to the affected eyelid. To comparing which method is the best this study has been carried out Methodology: Patients with chalazion presenting to OPD from 15 March to 15 July 2017 were included in the study. They underwent any of the three procedures according to their choice. Follow up visit was done at two weeks to determine effectiveness in terms of reduction of size or complete resolution of the chalazion. Results: Out of 112 patients enrolled in study 65(58%) were females and 47(42%) were male with a male: female ratio of (0.7:1). The mean age of involvement was 25.7years (SD 10.3). At 2 weeks follow up there was complete resolution in incision and curettage (I and C) group 77 %( 41/53) and in Triamcinolone Acetonide (TA) injection group 63 %( 20/32). Pearsons correlations showed that I and C were superior to any other forms of intervention for any size of chalazion followed by intralesional injection of TA. Conclusion: Among the three methods, Incision and Curettage remained the best choice for treatment of chalazion followed by triamcinolone acetonide injection but may need multiple injections. Keywords: Chalazion, Intralesional Triamcinolone, Incision and Curettage, Meibomian Gland

scholarly journals Hippocampal Volume in Provisional Tic Disorder Predicts Tic Severity at 12-Month Follow-up

2020 ◽  
Vol 9 (6) ◽  
pp. 1715
Author(s):  
Soyoung Kim ◽  
Deanna J. Greene ◽  
Carolina Badke D’Andrea ◽  
Emily C. Bihun ◽  
Jonathan M. Koller ◽  
...  
Keyword(s):  
Symptom Severity ◽  
Structural Mri ◽  
Hippocampal Volume ◽  
Subcortical Structures ◽  
Tic Disorder ◽  
Tic Severity ◽  
Mri Scans ◽  
One Year ◽  
Important Marker

Previous studies have investigated differences in the volumes of subcortical structures (e.g., caudate nucleus, putamen, thalamus, amygdala, and hippocampus) between individuals with and without Tourette syndrome (TS), as well as the relationships between these volumes and tic symptom severity. These volumes may also predict clinical outcome in Provisional Tic Disorder (PTD), but that hypothesis has never been tested. This study aimed to examine whether the volumes of subcortical structures measured shortly after tic onset can predict tic symptom severity at one-year post-tic onset, when TS can first be diagnosed. We obtained T1-weighted structural MRI scans from 41 children with PTD (25 with prospective motion correction (vNavs)) whose tics had begun less than 9 months (mean 4.04 months) prior to the first study visit (baseline). We re-examined them at the 12-month anniversary of their first tic (follow-up), assessing tic severity using the Yale Global Tic Severity Scale. We quantified the volumes of subcortical structures using volBrain software. Baseline hippocampal volume was correlated with tic severity at the 12-month follow-up, with a larger hippocampus at baseline predicting worse tic severity at follow-up. The volumes of other subcortical structures did not significantly predict tic severity at follow-up. Hippocampal volume may be an important marker in predicting prognosis in Provisional Tic Disorder.

scholarly journals Outcome of Probing for Congenital Naso-Lacrimal Duct Obstruction

2015 ◽  
Vol 14 (1) ◽  
pp. 36-37
Author(s):  
Mozammel Hoq Sharife ◽  
M Jalal Uddin ◽  
Mostak Ahmed
Keyword(s):  
Nasolacrimal Duct ◽  
Age Group ◽  
Lacrimal Duct ◽  
Female Ratio ◽  
Congenital Nasolacrimal Duct Obstruction ◽  
Duct Obstruction ◽  
Male Female Ratio ◽  
Group A ◽  
Level Hospital

Objective: The study was conducted to evaluate outcome of probing for congenital nasolacrimal duct obstruction. It was an interventional study at a tertiary level hospital of Chittagong. Methods: The study was conducted during April 2009 to March 2013 (04 years). Total 120 eyes of 102 children of 1-3 years age group were probed. Minimum follow up time was 01 year. Results: 110 eyes fully cured, 05 eyes needed re-probing, 03 eyes needed Dacrocystorhinostomy operation (DCR) and 02 cases were dropped out. Male female ratio was 72 (60%) and 48 (40%). Conclusion: Outcome of probing is better among 1-2 years age group than that of 2- 3 years age group. A discussion is made with updated literature review. DOI: http://dx.doi.org/10.3329/cmoshmcj.v14i1.22879 Chatt Maa Shi Hosp Med Coll J; Vol.14 (1); Jan 2015; Page 36-37

scholarly journals Is Consultation-Liaison Psychiatry ‘Getting Old’? How Psychiatry Referrals in the General Hospital Have Changed over 20 Years

2020 ◽  
Vol 17 (20) ◽  
pp. 7389
Author(s):  
Silvia Ferrari ◽  
Giorgio Mattei ◽  
Mattia Marchi ◽  
Gian Maria Galeazzi ◽  
Luca Pingani
Keyword(s):  
Older Patients ◽  
Clinical Training ◽  
University Hospital ◽  
Liaison Psychiatry ◽  
Female Ratio ◽  
Research Activities ◽  
Male Female Ratio ◽  
Health Related ◽  
Consultation Liaison Psychiatry ◽  
Management Changes

There is an ever-growing awareness of the health-related special needs of older patients, and Consultation-Liaison Psychiatry Services (CLPS) are significantly involved in providing such age-friendly hospital care. CLPS perform psychiatric assessment for hospitalized patients with suspected medical-psychiatric comorbidity and support ward teams in a bio-psycho-social oriented care management. Changes in features of the population referred to a CLPS over a 20-year course were analysed and discussed, especially comparing older and younger referred subjects. Epidemiological and clinical data from all first psychiatric consultations carried out at the Modena (North of Italy) University Hospital CLPS in the period 2000–2019 (N = 19,278) were included; two groups of consultations were created according to the age of patients: OV65 (consultations for patients older than 64 years) and NONOV65 (all the rest of consultations). Consultations for OV65 were about 38.9% of the total assessments performed, with an average of approximately 375 per year, vs. the 589 performed for NOV65. The number of referrals for older patients significantly increased over the 20 years. The mean age and the male/female ratio of the sample changed significantly across the years in the whole sample as well as both among OV65 and NOV65. Urgent referrals were more frequent among NOV65 and the rate between urgent/non urgent referrals changed differently in the two subgroups. The analysis outlined recurring patterns that should guide future clinical, training and research activities.

scholarly journals Role of Multidetector Computerised Tomography in Evaluation of Proptosis

2019 ◽  
Vol 9 (2) ◽  
pp. 24-31
Author(s):  
Elina Shrestha ◽  
Narayan Bikram Thapa ◽  
Shankar Bahadur Singh Rajbhandari
Keyword(s):  
Predictive Value ◽  
Clinical Information ◽  
Cross Sectional Study ◽  
Computerised Tomography ◽  
Cross Sectional ◽  
Female Ratio ◽  
Male Female Ratio ◽  
One Year ◽  
Female Male Female

Introduction: Proptosis is defined as bulging of eye anteriorly out of the orbit. Our main objective was to analyze the pattern of computerised tomographic findings in evaluation of proptosis. Computerised tomography (CT) is noninvasive, easily accessible, affordable and reliable imaging which helps in early diagnosis and prompt treatment. Methods: A descriptive cross sectional study of total 58 patients presenting with proptosis referred to our department of radiology for computerised tomography evaluation during one year period were undertaken into study. The clinical information provided by ophthalmologist also helped our study to derive into conclusion. SPSS version 20 software was used for statistical data analysis. Results: Out of 58 patients, the most common cause of proptosis was neoplasm constituting of 25 cases (43.1%). Retinoblastoma was the commonest orbital tumor. Out of remaining cases, 15 (25.8%) were infective, 14 (24.1%) were inflammatory, two (3.44%) were traumatic and remaining two cases (3.44%) had no definitive cause for proptosis. Bilateral proptosis was commonly associated with thyroid ophthalmopathy. Among the subjects 32 were male, 26 were female. Male: Female ratio was 1:1.23. Age group was ranging from 1 month to 73 years.Mean age was 26.4 ± 22 years. Conclusions: Computerised tomography has an important role in distinguishing the different types of lesions based on their characteristics, location and extension prior to undertaking definitive surgical and medical treatment. Overall accuracy of CT in our study was 81%, sensitivity of 82.6%, specificity of 80.6%, positive predictive value of 76% and negative predictive value of 86.2%.

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