Characteristics and Outcomes of Younger Adults with Embolic Stroke of Undetermined Source (ESUS): A Retrospective Study

Introduction. Embolic stroke of undetermined source (ESUS) in younger adults may have different risk factors compared with ESUS in elderly, and the approach to ESUS in young adults may require new therapies. We aimed to investigate the characteristics and outcomes in younger adults with ESUS at a single centre in Saudi Arabia. Patients and Methods. A retrospective study was conducted using the medical records of younger adults with ESUS according to the criteria of the Cryptogenic Stroke/ESUS International Working Group. Younger adults (aged ≤50 years) with ESUS were compared with older patients, on admission and discharge from hospital, using the modified Rankin scale (mRS) and the National Institute of Health Stroke Scale (NIHSS). Results. Among 147 patients with ESUS, 39 (26.5%) were younger adults. Younger adults compared with older adults with ESUS had fewer vascular risk factors, including lower rates of hypertension (43.6% vs. 70.3%; P=0.004), diabetes (35.9% vs. 57.4%; P=0.03), and dyslipidaemia (12.8% vs. 28.7%; P=0.05). There was no significant difference in poor outcome at discharge (defined as mRS > 2), which was observed in 17.9% of younger adults and 28.7% of older adults. Further, there were no significant differences in stroke severity at discharge (NIHSS score ≤5) or median length of stay. Discussion. Although the outcomes of ESUS do not differ between younger and older patients, younger patients have fewer identified risk factors. Conclusion. This study showed that 26.5% of patients with ESUS were aged ≤50 years. Although younger adults with ESUS had fewer risk factors, there were no significant differences in neurologic disability or mortality at discharge, stroke severity, or median length of stay.

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Frequency and features of embolic stroke of undetermined source in young adults

European Stroke Journal ◽

10.1177/2396987318755585 ◽

2018 ◽

Vol 3 (2) ◽

pp. 110-116 ◽

Cited By ~ 10

Author(s):

Kanjana S Perera ◽

Balakumar Swaminathan ◽

Roland Veltkamp ◽

Antonio Arauz ◽

Sebastian Ameriso ◽

...

Keyword(s):

Risk Factors ◽

Young Adults ◽

Ischaemic Stroke ◽

Older Patients ◽

Vascular Risk Factor ◽

Cross Sectional Study ◽

Embolic Stroke ◽

Stroke Severity ◽

Vascular Risk ◽

Cross Sectional

Introduction The sources of emboli in those with embolic stroke of undetermined source may differ in old and young. We assessed the frequency, features and potential embolic sources of younger vs. older embolic stroke of undetermined source patients in the embolic stroke of undetermined source Global Registry. Patients and methods Cross-sectional study of consecutive patients over age 18 years, with recent ischaemic strokes at 19 centres conducted in 2013–2014. Characteristics of embolic stroke of undetermined source patients who aged ≤50 years were analysed and compared with embolic stroke of undetermined source patients who aged >50 years. Results Among 2144 patients with ischaemic stroke, 323 (15.1%, 95% confidence interval: 13.6–16.7%) were ≤50 years old and, 1821 >50 years. 24% ( n = 78) of young vs. 15% ( n = 273) of older patients met embolic stroke of undetermined source criteria. The mean age of young embolic stroke of undetermined source patients was 40 years (standard deviation +/−9), 33% were women and the most prevalent vascular risk factor was hypertension (38%). Conventional vascular risk factors were less frequent in younger embolic stroke of undetermined source patients. Fewer young embolic stroke of undetermined source patients (63%) had potential minor risk embolic sources identified vs. older embolic stroke of undetermined source patients (77%) ( p = 0.02). Stroke severity on admission was similar in younger vs. older patients (National Institute of Health Stroke Scale (NIHSS) 3 vs. 4, p = 0.06). Discussion Young embolic stroke of undetermined source patients comprise an important subset of ischaemic stroke patients around the world. Severity of stroke on admission and 30-day mortality rates are similar among young and older patients. However, there are important differences between younger vs. older embolic stroke of undetermined source patients with respect to risk factors, and potential embolic sources that could affect response to anticoagulants vs. antiplatelet therapies. Conclusion This study provides a benchmark for the global frequency and characteristics of young embolic stroke of undetermined source patients and shows consistent high frequency of embolic stroke of undetermined source in young adults.

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Incidence and Risk Factors for Neurological Deterioration in Posterior Corrective Surgeries for Severe Angular Kyphotic Deformities: A 10-Year Institutional Retrospective Study

Global Spine Journal ◽

10.1177/2192568220979122 ◽

2020 ◽

pp. 219256822097912

Author(s):

Kalyan Kumar Varma Kalidindi ◽

Sulaiman Sath ◽

Jeevan Kumar Sharma ◽

Gayatri Vishwakarma ◽

Harvinder Singh Chhabra

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Neurological Deficit ◽

Operative Time ◽

Deformity Correction ◽

Neurological Deterioration ◽

Kyphotic Deformity ◽

Neurological Deficits ◽

Retrospective Case ◽

Significant Difference

Study Design: Retrospective case-control study. Objective: Neurological deficit is one of the dreaded complications of kyphotic deformity correction procedures. There is inconsistency in the reports of neurological outcomes following such procedures and only a few studies have analyzed the risk factors for neurological deficits. We aimed to analyze the factors associated with neurological deterioration in severe kyphotic deformity correction surgeries. Methods: We performed a retrospective study of 121 consecutive surgically treated severe kyphotic deformity cases (49 males, 56 females) at a single institute (May 1st 2008 to May 31st 2018) and analyzed the risk factors for neurological deterioration. The demographic, surgical and clinical details of the patients were obtained by reviewing the medical records. Results: 105 included patients were divided into 2 groups: Group A (without neurological deficit) with 92 patients (42 males, 50 females) and Group B (with neurological deficit) with 13 patients (7 males, 6 females) (12.4%). Statistically significant difference between the 2 groups was observed in the preoperative sagittal Cobbs angle (p < 0.0001), operative time (p = 0.003) and the presence of myelopathic signs on neurological examination (p = 0.048) and location of the apex of deformity (p = 0.010) but not in other factors. Conclusions: Preoperative Sagittal Cobbs angle, presence of signs of myelopathy, operative time and location of apex in the distal thoracic region were significantly higher in patients with neurological deterioration as compared to those without neurological deterioration during kyphotic deformity correction surgery. Distal thoracic curve was found to have 4 times more risk of neurological deterioration compared to others.

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Abstract WP182: Trends in Acute Ischemic Stroke Hospitalizations and Risk Factors Among Young Adults: 12 Years of Nationally Representative Data

Stroke ◽

10.1161/str.48.suppl_1.wp182 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Urvish K Patel ◽

Priti Poojary ◽

Vishal Jani ◽

Mandip S Dhamoon

Keyword(s):

Risk Factors ◽

Older Adults ◽

Young Adults ◽

Ischemic Stroke ◽

Length Of Stay ◽

Acute Ischemic Stroke ◽

Stroke Risk ◽

Behavioral Risk Factors ◽

Behavioral Risk ◽

Stroke Risk Factors

Background: There is limited recent population-based data of trends in acute ischemic stroke (AIS) hospitalization rates among young adults (YA). Rising prevalence of stroke risk factors may increase stroke rates in YA. We hypothesized that 1) stroke hospitalizations and mortality among YA are increasing over time (2000-2011), 2) besides traditional stroke risk factors, non-traditional factors are associated with stroke in YA, 3) stroke hospitalization among YA is associated with higher mortality, length of stay (LOS), and cost. Methods: In the Nationwide Inpatient Sample database (years 2000-2011), adult hospitalizations for AIS and concurrent diagnoses were identified by ICD-9-CM codes; the analytic cohort constituted all AIS hospitalizations. We performed weighted analysis using chi-square, t-test, and Jonckheere trend test. Multivariable survey regression models evaluated interactions between age group (18-45 vs. >45 years) and traditional and non-traditional risk factors, with outcomes including mortality, LOS, and cost. Models were adjusted for race, sex, Charlson’s Comorbidity Index, primary payer, location and teaching status of hospital, and admission day. Results: Among 5220960 AIS hospitalizations, 231858 (4.4%) were YA. On trend analysis, proportion of YA amongst AIS increased from 3.6% in 2000 to 4.7% in 2011 (p<0.0001) but mortality in YA decreased from 3.7% in 2000 to 2.6% in 2011, compared to 7.1% in 2000 to 4.6% in 2011 (p<0.0001) among older adults. Non-traditional, especially behavioral, risk factors were more common among YA, and LOS and cost were higher (Table). Conclusion: There was a trend for higher proportion of YA among AIS hospitalizations, though there was a decreasing mortality trend over 10 years. Behavioral risk factors were more common among YA, and there was an increased length of stay and cost. AIS in YA may require different preventive approaches compared to AIS among older adults.

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Retrospective Study on Hospital Admissions due to Pyelonephritis in Type II Diabetic Patients

Journal of Medical - Clinical Research & Reviews ◽

10.33425/2639-944x.1220 ◽

2021 ◽

Vol 5 (6) ◽

Author(s):

Dilraj Dhillon ◽

Thomas Randall ◽

David Zezoff ◽

Mouchumi Bhattacharyya

Keyword(s):

Retrospective Study ◽

Length Of Stay ◽

Hospital Admissions ◽

Type Ii Diabetes Mellitus ◽

Hospitalized Patients ◽

Diabetic Patients ◽

Clean Intermittent Catheterization ◽

Type Ii ◽

Indwelling Catheters ◽

Significant Difference

Background: Pyelonephritis is a urinary tract infection that ascends to involve the kidneys. It can also occur as an infection secondary to bacteremia. Some pathogens that commonly cause pyelonephritis are E. coli, enterobacteriaceae, staphylococci, and pseudomonas. The initial patient presentation usually involves fever, chills, nausea, vomiting, costovertebral angle tenderness, and flank pain. Other cystitis symptoms such as dysuria, increased urinary frequency, malodorous urine, and hematuria may or may not be present. Symptoms of pyelonephritis with bacteriuria are sufficient for the diagnosis of pyelonephritis. Aim: The aim of this study was to investigate a potential link between Type II Diabetes Mellitus and pyelonephritis. Methods: In this retrospective study, hospitalized patients during the study period were reviewed. Variables examined were sex, age, and length of stay. Patients were excluded if they had known urogenital abnormalities, indwelling catheters (Foley, nephrostomy, suprapubic, or who regularly perform clean intermittent catheterization), were pregnant, or were on dialysis. Results: Of 333 patients analyzed, diabetics had a longer length of stay then non-diabetics (4.49 vs 3.67 days respectively; p=0.0041) and females were significantly younger than men in hospitalized patients for pyelonephritis were (50.0 vs 63.5 years; p=<0.0001). Further, it was found that diabetics were significantly older than nondiabetics were (60.4 vs 47.3; p=<0.0001) and more diabetics getting admitted with pyelonephritis were men vs women (59.32% vs 35.27%; p=0.0007). Conclusion: Results of the study were significant in showing that of all pyelonephritis-hospitalized patients on average the length of stay was longer for diabetics and it demonstrated that female patients with pyelonephritis are significantly younger than male patients hospitalized with pyelonephritis. Of note, there was no significant difference in the length of stay for diabetic patients based on their treatment modality (diet controlled vs. oral medications vs. insulin dependent vs. combined). The study also showed that diabetics getting admitted for pyelonephritis are more men and older in age compared to the nondiabetics.

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Effects of statins on clinical outcomes in hospitalized patients with community-acquired pneumonia

Journal of International Medical Research ◽

10.1177/0300060520938586 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052093858

Author(s):

Rony M. Zeenny ◽

Hanine Mansour ◽

Wissam K Kabbara ◽

Nibal Chamoun ◽

Myriam Audi ◽

...

Keyword(s):

Retrospective Study ◽

Length Of Stay ◽

Hospital Length ◽

Community Acquired Pneumonia ◽

Hospital Length Of Stay ◽

Comorbid Conditions ◽

C Reactive Protein ◽

Reactive Protein ◽

Significant Difference ◽

Chronic Use

Objective We evaluated the effect of chronic use of statins based on C-reactive protein (CRP) levels and hospital length of stay (LOS) in patients admitted with community-acquired pneumonia (CAP). Methods We conducted a retrospective study over 12 months at a teaching hospital in Lebanon comparing patients with CAP taking chronic statins with patients not taking statins. Included patients with CAP were older than age 18 years and had two CRP level measures during hospitalization. CURB-65 criteria were used to assess the severity of pneumonia. A decrease in CRP levels on days 1 and 3, LOS, and normalization of fever were used to assess the response to antibiotics. Results Sixty-one patients were taking statins and 90 patients were not taking statins. Patients on statins had significantly more comorbid conditions; both groups had comparable CURB-65 scores. In both groups, no statistically significant difference was seen for the decrease in CRP level on days 1 and 3 and LOS. No difference in days to normalization of fever was detected in either group. Conclusion No association was found between the chronic use of statins and CRP levels, LOS, or days to fever normalization in patients with CAP.

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Reliability and validity of a quick test of cognitive speed (AQT) in screening for mild cognitive impairment and dementia

BMC Geriatrics ◽

10.1186/s12877-021-02621-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Pouya Farokhnezhad Afshar ◽

Elisabeth H. Wiig ◽

Seyed Kazem Malakouti ◽

Behnam Shariati ◽

Sara Nejati

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Sensitivity And Specificity ◽

Older Patients ◽

Reliability And Validity ◽

Quick Test ◽

Significant Difference ◽

Cognitive Speed ◽

Color Form

Abstract Background Cognitive disorders are one of the important issues in old age. There are many cognitive tests, but some variables affect their results (e.g., age and education). This study aimed to evaluate the reliability and validity of A Quick Test of Cognitive Speed (AQT) in screening for mild cognitive impairment (MCI) and dementia. Methods This is a psychometric properties study. 115 older adults participated in the study and were divided into three groups (46 with MCI, 24 with dementia, and 45 control) based on the diagnosis of two geriatric psychiatrists. Participants were assessed by AQT and Mini-Mental State Examination (MMSE). Data were analyzed using Pearson correlation, independent t-test, and ROC curve by SPSS v.23. Results There was no significant correlation between AQT subscales and age and no significant difference between the AQT subscales in sex, educational levels. The test-retest correlations ranges were 0.84 from 097. Concurrent validity was significant between MMSE and AQT. Its correlation was with Color − 0.78, Form − 0.71, and Color-Form − 0.72. The cut-off point for Color was 43.50 s, Form 52 s, and Color-Form 89 s were based on sensitivity and specificity for differentiating older patients with MCI with controls. The cut-off point for Color was 62.50 s, for Form 111 s, and Color-Form 197.50 s based on sensitivity and specificity measures for differentiating older patients with dementia and MCI. Conclusion The findings showed that AQT is a suitable tool for screening cognitive function in older adults.

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Visitation and quality of life among older adults in jail

International Journal of Prisoner Health ◽

10.1108/ijph-06-2021-0058 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Stephanie Grace Prost ◽

Meghan A. Novisky

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Social Relationships ◽

Developmental Theory ◽

Cross Sectional ◽

Younger Adults ◽

Content Type ◽

Significant Difference ◽

The Relationship

Purpose The purpose of this paper aims to examine differences in measures of and relationships between visitation and quality of life (QOL) among older and younger jailed adults. The authors also explored the contribution of visitation to QOL among adults in this setting. The authors anticipated fewer visits and lower QOL among older adults. Framed by psychosocial developmental theory, the authors also anticipated a larger effect in the relationship between visitation and QOL among older rather than younger adults and that visitation would contribute most readily to psychological QOL. Design/methodology/approach Cross-sectional data from a large US jail were used (n = 264). The authors described the sample regarding visitation and QOL measures among older (≥45) and younger adults (≤44) and examined differences in measures of and relationships between visitation and QOL using independent sample t-tests and bivariate analyses. The authors explored the contribution of visitation to psychological, social relationships, physical and environmental QOL among jailed adults using hierarchical multiple linear regression. Findings Older adults had fewer family visits and lower physical QOL than younger adults, disparities were moderate in effect (d range = 0.33–0.35). A significant difference also emerged between groups regarding the visitation and environmental QOL relationship (z = 1.66, p <0.05). Visitation contributed to variation in physical and social relationships QOL among jailed adults (Beta range = 0.19–0.24). Originality/value Limited research exists among jailed older adults and scholars have yet to examine the relationship between visitation and QOL among persons in these settings.

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Reliability and validity of A Quick Test of Cognitive Speed (AQT) in Iranian older adults

10.21203/rs.3.rs-80986/v1 ◽

2020 ◽

Author(s):

Pouya Farokhnezhad Afshar ◽

Elisabeth H. Wiig ◽

Seyed Kazem Malakouti ◽

Behnam Shariati

Keyword(s):

Older Adults ◽

Sensitivity And Specificity ◽

Older Patients ◽

Convergent Validity ◽

Pearson Correlation ◽

Reliability And Validity ◽

Quick Test ◽

Significant Difference ◽

Cognitive Speed ◽

Color Form

Abstract Background: Cognitive disorders are one of the most important issues in old age. They may remain hidden in the early stages. There are many cognitive tests, but some variables affect their results (e.g., age and education.) This study aimed to evaluate the reliability and validity of A Quick Test of Cognitive Speed (AQT) in Iranian older adults.Methods: This study aimed to test the psychometric properties of AQT. 114 older adults participated in the study and were divided into three groups (46 with mild cognitive impairments (MCI), 24 with dementia, and 45 without MCI and dementia) based on the diagnosis of two geriatric psychiatrists. Participants were assessed by AQT and Mini-Mental State Examination (MMSE). Data were analyzed using Pearson correlation, independent t-test, and ROC curve by SPSS v.23.Results: There was no significant correlation between AQT subscales and age and no significant difference between the AQT subscales in male and female, educational levels, and marital status. The test-retest correlations (r) were significant for Color (C) 0.84, Form (F) 0.91 and Color-Form (CF) 0.94. Convergent validity was significant between MMSE and AQT. Its correlation was with Color -0.78, Form -0.71, and Color-Form -0.72. The cut-off point for Color was 43.50 s, Form 52 s, and Color-Form 89 s were based on sensitivity and specificity for differentiating older patients with MCI with controls. The cut-off point for Color was 62.50 s, for Form 111 s, and Color-Form 197.50 s based on sensitivity and specificity measures for differentiating older patients with dementia and MCI.Conclusion: The findings of this study showed that A Quick Test of Cognitive Speed (AQT) is a suitable tool for assessing cognitive function in older adults.

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664 Risk Factors for the Development of Transaminitis in Pediatric Burn Patients Treated with Oxandrolone

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.280 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S177-S177

Author(s):

Kate Pape ◽

Sarah Zavala ◽

Rita Gayed ◽

Melissa Reger ◽

Kendrea Jones ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Pediatric Patients ◽

Burn Injury ◽

Total Body Surface Area ◽

Future Research ◽

Burn Patients ◽

Thermal Burn ◽

Increased Risk ◽

Significant Difference

Abstract Introduction Oxandrolone is an anabolic steroid that is the standard of care for burn patients experiencing hypermetabolism. Previous studies have demonstrated the benefits of oxandrolone, including increased body mass and improved wound healing. One of the common side effects of oxandrolone is transaminitis, occurring in 5–15% of patients, but little is known about associated risk factors with the development of transaminitis. A recent multicenter study in adults found that younger age and those receiving concurrent intravenous vasopressors or amiodarone were more likely to develop transaminitis while on oxandrolone. The purpose of this study was to determine the incidence and identify risk factors for the development of transaminitis in pediatric burn patients receiving oxandrolone therapy. Methods This was a multicenter, retrospective risk factor analysis that included pediatric patients with thermal burn injury (total body surface area [TBSA] > 10%) who received oxandrolone over a 5-year time period. The primary outcome of the study was the development of transaminitis while on oxandrolone therapy, which was defined as aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >100 mg/dL. Secondary outcomes included mortality, length of stay, and change from baseline ALT/AST. Results A total of 55 pediatric patients from 5 burn centers met inclusion criteria. Of those, 13 (23.6%) developed transaminitis, and the mean time to development of transaminitis was 17 days. Patients who developed transaminitis were older (12 vs 6.4 years, p = 0.01) and had a larger mean %TBSA (45.9 vs 34.1, p = 0.03). The odds of developing transaminitis increased by 23% for each 1 year increase in age (OR 1.23, CI 1.06–1.44). The use of other concurrent medications was not associated with an increased risk of developing transaminitis. Renal function and hepatic function was not associated with the development of transaminitis. There was no significant difference in length of stay and mortality. Conclusions Transaminitis occurred in 23.6% of our study population and was associated with patients who were older and had a larger mean %TBSA burn. Older pediatric patients with larger burns who are receiving oxandrolone should be closely monitored for the development of transaminitis. Applicability of Research to Practice Future research is needed to identify appropriate monitoring and management of transaminitis in oxandrolone-treated pediatric burn patients.

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Age Is Not a Barrier: Older Adults With Cancer Derive Similar Benefit in a Randomized Controlled Trial of a Remote Symptom Monitoring Intervention Compared With Younger Adults

Cancer Control ◽

10.1177/1073274820968878 ◽

2020 ◽

Vol 27 (1) ◽

pp. 107327482096887

Author(s):

Lorinda A. Coombs ◽

Lee Ellington ◽

Angela Fagerlin ◽

Kathi Mooney

Keyword(s):

Older Adults ◽

Interactive Voice Response ◽

Controlled Trial ◽

Ease Of Use ◽

Younger Adults ◽

Symptom Monitoring ◽

Adult Participants ◽

Perceived Benefit ◽

Significant Difference ◽

Technological Tool

This study investigated a remote symptom monitoring intervention to examine if older participants with cancer received a similar magnitude of benefit compared with younger adults with cancer. We analyzed a longitudinal symptom monitoring intervention for 358 participants beginning a new course of chemotherapy treatment in community and academic oncology practices. The study design was a randomized control trial; participants were randomized to the intervention or usual care, the intervention was delivered during daily automated coaching. Older adults with moderate and severe symptoms derived similar benefit as those adults younger than 60 years of age, adherence to the study protocol which involved daily calls was high. There was no significant difference between the 2 age categories; on average, older adult participants made 88% of expected daily calls and younger adult participants made 90% of expected daily calls. Our results challenge the perception that older adults are unwilling or unable to use a technological tool such as interactive voice response and suggest that patient utilization may be guided by other factors, such as ease of use and perceived benefit from the intervention.

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