Abstract W P333: Seizure as the Presenting Symptom of ICH Patient Characteristics and EEG Utilization

Background and Purpose: Seizures are the presenting symptom in a significant number of patients with spontaneous ICH. The role of EEG in the routine evaluation patients, with or without clinical evidence of seizures, is unclear. This study was undertaken to better understand seizures and the use of EEG in patients with ICH. Methods: Retrospective review of consecutive spontaneous ICH patients at our institution from 2008-2013. Patients were considered to have a seizure on presentation if a clinical evidence of a seizure was documented in the medical record; EEG data was not required to confirm seizure on presentation. Demographics, vascular risk factors, ICH score, and EEG findings were assessed. Results: Of 402 spontaneous ICH patients (mean age 63, 42% black, 43% female), 10% presented with seizure. Patients presenting with seizure were younger (mean age 65 vs. 54, p<.001). Compared to patients with ICH presenting without a seizure, blacks presented more frequently with seizure (62% vs. 40%, p=.009). A higher proportion of patients who presented with seizure had a history of alcohol use (50% vs. 27%, p=.008) and substance abuse (23% vs. 10%, p=.025). Patients who presented with seizure more frequently had cortical ICH (54% vs. 32%, p=.007). EEGs were performed more frequently in ICH patients that presented with seizure (66% vs. 19%, p<.001). Among patients with an EEG, epileptiform discharges or rhythmic pattern was more common in patients who presented with seizure (30% vs. 10%, p=.040) and with a cortical ICH (29% vs. 9%, p=.036). There were no significant differences in the proportion of patients that received EEG based on race, history of alcohol abuse, or history of substance abuse. Conclusions: Patients who presented with seizure were younger, black, and a higher proportion had a history of alcohol and substance abuse compared to patients with ICH who did not present with a seizure. Only 66% of those presenting with clinical seizure underwent EEG. Despite the prevalence of subclinical seizures in ICH patients, only 19% of patients who did not present with a seizure underwent EEG. Our study suggests that there may be room for improvement on the part of stroke neurologists in the diagnosis and management seizure of ICH patients.

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A Case of Schizophrenia in a Young Male Adult with no History of Substance Abuse: Impact of Clinical Pharmacists’ Interventions on Patient Outcome

Case Reports in Psychiatry ◽

10.1155/2020/3419609 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Mercy N. A. Opare-Addo ◽

Josephine Mensah ◽

Grace Owusu Aboagye

Keyword(s):

Substance Abuse ◽

Sense Of Self ◽

Young Male ◽

Antipsychotic Therapy ◽

Male Adult ◽

Clinical Pharmacists ◽

History Of ◽

Young Male Adult ◽

Key Interventions

Schizophrenia is a chronic and severe mental disorder characterized by distortions in thinking, perception, emotions, language, sense of self, and behaviour. This report presents the role of clinical pharmacists in the management of a patient diagnosed with schizophrenia with symptoms of paranoia. A gainfully employed young African male adult reported to be roaming around town moving from one bank to another was arrested. The patient was referred to the psychiatric unit of a hospital and diagnosed with schizophrenia. Key interventions offered included rapid tranquilization, electroconvulsive therapy, and psychotherapy. Medications administered to the patient while on admission included IV diazepam, IM haloperidol, IV Ketamine, IM flupentixol, olanzapine tablets, and trihexyphenidyl tablets. Issues raised by clinical pharmacists during the patient’s admission included need for alternative medication for rapid tranquilization, need for initial investigations and documentation of the patient’s vitals, initiation of antipsychotic therapy without initial monitoring and screening for substance abuse, inappropriate dose at initiation of antipsychotic medications, untreated indication, and incidence of missed doses. Interventions by the clinical pharmacists contributed to improvement in the patient’s symptoms prior to hospital discharge. The case proves that it is critical for clinical pharmacists to be involved in the multidisciplinary team during management of patients with psychosis.

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Postoperative atrial fibrillation: Target for stroke prevention?

European Stroke Journal ◽

10.1177/2396987317719363 ◽

2017 ◽

Vol 2 (3) ◽

pp. 222-228 ◽

Cited By ~ 6

Author(s):

Vincent Thijs ◽

Robin Lemmens ◽

Omar Farouque ◽

Geoffrey Donnan ◽

Hein Heidbuchel

Keyword(s):

Atrial Fibrillation ◽

Lifestyle Changes ◽

Adverse Outcomes ◽

Postoperative Atrial Fibrillation ◽

Long Term Outcomes ◽

Number Of Patients ◽

History Of ◽

Long Term Mortality

Purpose A substantial number of patients without a history of atrial fibrillation who undergo surgery develop one or more episodes of atrial fibrillation in the first few days after the operation. We studied whether postoperative transient atrial fibrillation is a risk factor for future atrial fibrillation, stroke and death. Method We performed a narrative review of the literature on epidemiology, mechanisms, risk of atrial fibrillation, stroke and death after postoperative atrial fibrillation. We reviewed antithrombotic guidelines on this topic and identified gaps in current management. Findings Patients with postoperative atrial fibrillation are at high risk of developing atrial fibrillation in the long term. Mortality is also increased. Most, but not all observational studies report a higher risk of stroke. The optimal antithrombotic regimen for patients with postoperative atrial fibrillation has not been defined. The role of lifestyle changes and of surgical occlusion of the left atrial appendage in preventing adverse outcomes after postoperative atrial fibrillation is not established. Conclusion Further studies are warranted to establish the optimal strategy to prevent adverse long-term outcomes after transient, postoperative atrial fibrillation.

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Burden of comorbid conditions in children and young people with juvenile idiopathic arthritis: a collaborative analysis of 3 JIA registries

Rheumatology ◽

10.1093/rheumatology/keab641 ◽

2021 ◽

Author(s):

Lianne Kearsley-Fleet ◽

Jens Klotsche ◽

Joeri W van Straalen ◽

Wendy Costello ◽

Gianfranco D’Angelo ◽

...

Keyword(s):

Patient Characteristics ◽

Incidence Rates ◽

Varicella Vaccination ◽

Patient Registries ◽

Biologic Treatment ◽

Systemic Jia ◽

History Of ◽

First Time

Abstract Objectives Burden of comorbidities are largely unknown in JIA. From 2000, national and international patient registries were established to monitor biologic treatment, disease activity and adverse events in patients with JIA. The aim of this analysis was to investigate in parallel, for the first time, three of the largest JIA registries in Europe/internationally—UK JIA Biologic Registers (BCRD/BSPAR-ETN), German biologic registers (BiKeR/JuMBO), multinational Pharmachild—to quantify the occurrence of selected comorbidities in patients with JIA. Methods Information on which data the registers collect were compared. Patient characteristics and levels of comorbidity were presented, focussing on four key conditions: uveitis, MAS, varicella, and history of tuberculosis. Incidence rates of these on MTX/biologic therapy were determined. Results 8066 patients were registered into the three JIA registers with similar history of the four comorbidities across the studies; however, varicella vaccination coverage was higher in Germany (56%) vs UK/Pharmachild (16%/13%). At final follow-up, prevalence of varicella infection was lower in Germany (15%) vs UK/Pharmachild (37%/50%). Prevalence of TB (0.1–1.8%) and uveitis (15–19%) was similar across all registers. The proportion of systemic-JIA patients who ever had MAS was lower in Germany (6%) vs UK (15%) and Pharmachild (17%). Conclusion This analysis is the first and largest to investigate the occurrence of four important comorbidities in three JIA registries in Europe and the role of anti-rheumatic drugs. Combined, these three registries represent one of the biggest collection of cases of JIA worldwide and offer a unique setting for future JIA outcome studies.

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Haemophilic Arthropathy Is a Risk Factor for Reduced Bone Mineral Density and Vitamin D Deficiency

Blood ◽

10.1182/blood.v126.23.4685.4685 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4685-4685

Author(s):

M. Cem Ar ◽

Serdar Sahin ◽

Sevil Sadri ◽

Isil Erdogan ◽

Ayse Salihoglu ◽

...

Keyword(s):

Vitamin D ◽

Bone Health ◽

Patient Characteristics ◽

Haemophilia A ◽

Mineral Density ◽

On Demand ◽

Haemophilic Arthropathy ◽

Number Of Patients ◽

Increased Risk ◽

History Of

Abstract Introduction: Recent studies indicate an increased risk for developing low bone mineral density (BMD) in patients with haemophilia. This has been suggested to result from less physical activity, and impaired vitamin D metabolism due to viral liver disease. Here we present the preliminary results of an ongoing study aiming to identify the risk factors for impaired bone health in adult haemophilia patients. Material and Method: Twenty-nine severe and 7 moderate haemophilia A and B patients were included in the study. Patient characteristics were given in Table-1. All patients had haemophilic arthropathy in ≥1 joints and were on prophylactic factor replacement therapy except 2 on demand patients. None of the patients had decompensated chronic liver disease. Eleven patients had a history of joint intervention (RAS or joint replacement). None of the patients had received on vitamin D supplementation. DEXA scans to screen BMD, blood chemical analysis including liver and kidney function tests, vit. D (25 hydroxy vitamin D) calcium, parathormone, alkaline phosphatase were obtained from all patients at study entry. Results: Osteoporosis and/or osteopenia according to WHO criteria were detected by DEXA scans in 2/3 of the patients. Twenty-six patients (72%) had vit. D levels below 20ng/mL, with half of them having levels less than 10ng/mL. Median lumbar and femur T scores were in the osteopenia range, being -1.2 and -2.2, respectively. Osteoporosis/penia rates and vit. D levels did not significantly differ between patients with severe and moderate haemophilia. However, patients with severe haemophilia had lower lumbar T scores (p=0.048) and seemed to acquire low BMD 2 times more likely than moderate haemophiliacs. Patients with a history of joint intervention had significantly lower vit. D levels (p=0.005) and 1.4 times more risk for low BMD. Conclusion: Preliminary results of our study are in line with the recent literature indicating an increased frequency for osteopenia and osteoporosis in patients with haemophilia. Despite their young age our cohort of patients had lower BMD and vitamin D levels than the age-matched healthy population. This is an interesting finding in a country like Turkey where the average yearly total number of hours of bright sunshine is over 3000. Data at hand suggest increased risk for reduced BMD especially in severe haemophiliacs with impaired joint mobility. The most probable underlying cause for reduced BMD seems to be haemophilic arthropathy related inactivity. Furthermore, impaired bone health seems to be partially associated with less sunlight exposure, which is probably a result of increased home confinement of patients with haemophilia due to joint disease. The study is still recruiting. We hope to clarify other questions regarding factors influencing bone health in haemophiliacs when the study is completed and additional data on radiological and physical examination as well as on quality of life are obtained. Table. Patient Characteristics (n=36) Age, years (median [range]) 35 [20 - 55] Type of haemophilia ( A/B), n 32/4 Genotype (severe/moderate), n 29/7 Factor activity level, % (median [range]) 0.4 [0.1 - 4.2] Type of treatment (prophylaxis/on demand) 34/2 Annual bleeding rate (median [range]) 4 [1 - 12] Joint replacement, number of patients (%) 7 (19) Radioactive synoviectomy, number of patients (%) 7 (19) Any joint intervention, number of patients (%) 11 (30.5) Lumbar T scores (median [range]) -1.2 [-5.2 - 1] Femur T scores (median [range]) -2.2 [-3.9 - 0.6] Vit. D, ng/mL (median [range]) 10.5 [1.3 - 45] Calcium, mg/dL (median [range]) 9.6 [8.9 - 10.2] Alkaline phosphatase, U/L (median [range]) 91.5 [53 - 177] Parathormon, pg/mL (median [range]) 39 [20 - 179] Haemoglobin, g/dL (median [range]) 14.75 [8.9 - 16] Osteopenia, number of patients (%) 12 (33) Osteoporosis, number of patients (%) 12 (33) HBV/HCV/HIV, n 1/11/0 Disclosures No relevant conflicts of interest to declare.

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ROLE OF RIGID BRONCHOSCOPY IN MANAGEMENT OF TRACHEOBRONCHIAL FOREIGN BODY ASPIRATION

Journal of Medical Sciences ◽

10.52764/jms.20.28.4.8 ◽

2020 ◽

Vol 28 (4) ◽

pp. 345-347

Author(s):

Israr ud Din ◽

Muhammad Hafeez ◽

Muhammad Junaid ◽

Arif Raza Khan ◽

Imran Khan

Keyword(s):

Foreign Body ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Foreign Body Bronchus ◽

Number Of Patients ◽

Tracheobronchial Foreign Body ◽

History Of ◽

Male Patients ◽

One Year

Objective: To determine the role of Rigid Bronchoscopy in Management of Tracheobronchial Foreign Body Aspiration. Material and Methods: This study was conducted in otolaryngology department, Khyber teaching hospital, Peshawar of one year duration from January 2018 to December 2019. Total 90 Patients of age 4 months to 14 years on clinical suspicion of foreign body bronchus were included, while patients with history of bronchial asthma, pulmonary tuberculosis and radio opaque foreign body bronchus were excluded. Results: Total number of patients was 90 in which male patients were 60 (66.67 %) and female patients were 30 (33.33 %), patients with foreign body bronchus were 80 (88.89%). Male patients with foreign body bronchus was 53 (58.89%) and female 27 (30.00%). In age range from 4 months to 3 years, 35(39%) Patients underwent bronchoscopy in which foreign body bronchus retrieved in 30(37.5%) patients. Conclusion: Patients with history of repeated chest infection, relieved by medicines for some time should not be over look, as vegetative foreign body bronchus are radiolucent and patients usually present late in respiratory compromised state, the clinician must urge, for prompt treatment as rigid bronchoscopy.

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Laparoscopy in acute abdomen between encouragement and inhibition

International Surgery Journal ◽

10.18203/2349-2902.isj20194400 ◽

2019 ◽

Vol 6 (10) ◽

pp. 3507

Author(s):

Mena Zarif Helmy ◽

Ahmed Abdel Kahaar Aldardeer

Keyword(s):

Abdominal Pain ◽

Acute Abdomen ◽

Acute Abdominal Pain ◽

Past History ◽

Abdominal Distension ◽

X Ray ◽

Main Complaint ◽

Number Of Patients ◽

History Of

Background: Laparoscopy has been a valuable technique in the treatment of acute abdominal diseases and can be considered either to diagnose or to treat selected cases.Methods: Here, we randomly select patients with acute abdominal pain in whom the diagnosis was not clear after ultrasonography and plain X-ray, we did diagnostic laparoscopy and according to its findings, we proceeded to surgical intervention. 50 cases with acute abdomen were included in this study in order to clarify the role of laparoscopy in the diagnosis and treatment of acute abdomen.Results: From the 50 patients, the main complaint was abdominal pain and presented in (100%) of patients, 38 of patients had vomiting, fever in 29 patients and 14 patients had abdominal distension, 7 patients had alteration in bowel habits and burning micturition in 6 patients. In this study, 10 patients had past history of previous surgery. By laparoscopy we could see the pathology in 46 patients and complete the management in all of patients but failed to reach the diagnosis in 2 cases and conversion to laparotomy in other 2 cases. Laparoscopic surgery mean was 47.9±12.4 minutes. Hospital stay mean was (1.851) days. Morbidity was 10%. No mortality was found in our study.Conclusions: Laparoscopy can be considered safe for diagnosis and effective in the treatment of patients with acute abdomen. It may be useful to avoid the unnecessary laparotomies in a large number of patients presented with acute abdominal pain.

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The Role of Combination of 20% Azelaic Acid with 0.05% Tretinoin Cream in the Treatment of Melasma

Bangladesh Medical Journal ◽

10.3329/bmj.v40i2.18501 ◽

2014 ◽

Vol 40 (2) ◽

pp. 26-30

Author(s):

SC Hazra ◽

MR Siddique ◽

L Khondker ◽

MSI Khan ◽

MM Mahmud

Keyword(s):

Azelaic Acid ◽

Positive Family History ◽

Severity Index ◽

Number Of Patients ◽

Severity Index Score ◽

History Of ◽

Facial Area ◽

History Of Use ◽

Medical University

Melasma is characterized by brown patches, typically on malar prominences and forehead. The pigmented patches are usually affect darker complexioned individual especially Asian. So it is a great problem in our country. A clinical trial was conducted to find out the effect of the combination of 20% azelaic acid cream with 0.05% tretinoin cream in the treatment of melasma. Thirty clinically diagnosed cases of melasma attending the outpatient department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, were enrolled Majority of !he study subjects (43%) were between 26 to 30 years and most of them (73.3%) were female. Regarding occupation 56.7% were housewife. Out of the study subjects 70% were married and 86.7% were of middle class. Around 66.7% cases had positive family history of melasma and maximum 93.3% patient had no history of systemic drug and the maxim11m 73.3% patient had no history of use of cosmetics. It was observed that highest (93.3%) number of patients had malar area involvement and 6. 7% had centro-facial area involvement. The st11dy showed that after treatment, the average MASI (Melasma Area and Severity Index) score was decreased by 38 66% indicating moderate reduction of the severity of melasma Out of the study subjects, 50%, 30%, 16% developed burning sensation, itching and erythema respectively It could be concluded that combination of 20% azelaic acid and 0.05% tretinoin cream, has a moderate lightening effect in the treatment of melasma. DOI: http://dx.doi.org/10.3329/bmj.v40i2.18501 Bangladesh Medical Journal 2011 Vol.40(2): 26-30

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Parenting With a Substance Abuse History: The Moderating Role of Parenting Behaviors on Obesity and Internalizing Symptoms in Adolescence

Youth & Society ◽

10.1177/0044118x18815274 ◽

2018 ◽

Vol 52 (8) ◽

pp. 1436-1456

Author(s):

H. Isabella Lanza ◽

Patricia Pittman ◽

Yih-Ing Hser

Keyword(s):

Substance Abuse ◽

Internalizing Symptoms ◽

Emotional Health ◽

Parenting Behaviors ◽

Hierarchical Regression ◽

Physical Discipline ◽

Obesity Status ◽

History Of ◽

The Relationship

Although numerous studies have shown that child obesity is associated with internalizing symptoms, relatively few studies have examined the role of parenting behaviors on this relationship. Youth meeting obesity status may be at higher risk of psychosocial maladjustment when exposed to more vulnerable parenting contexts. The current study interviewed mothers with a history of substance abuse to assess whether parenting behaviors moderated the relationship between obesity and internalizing symptoms among adolescents ( N = 160; 51% girls; M = 12.76 years). Hierarchical regression analyses identified physical discipline as a moderator; girls meeting obesity status displayed higher levels of internalizing symptoms when exposed to higher versus lower levels of physical discipline. Prevention/intervention efforts targeting mothers with substance abuse histories should aim to not only improve physical and emotional health but also highlight the connections between physical and emotional health and the influence of parenting behaviors on associations.

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The Past Victim, the Future Abuser

Archives of Iranian Medicine ◽

10.34172/aim.2020.s2 ◽

2020 ◽

Vol 23 (4Suppl1) ◽

pp. S6-S8

Author(s):

Ali Firoozabadi

Keyword(s):

Substance Abuse ◽

Childhood Abuse ◽

Adult Life ◽

Early Years ◽

Policy Makers ◽

History Of Childhood ◽

Abusive Behavior ◽

Number Of Patients ◽

Health Practitioners ◽

History Of

Background: Childhood trauma exerts a significant effect on psychological life of people. It is a ubiquitous phenomenon. We face a social epidemic with serious consequences that shatter the life of survivors. Victimization in early years of life entraps the individuals in the victim-rescuer-abuser triangle. Many perpetrators and criminals have had history of childhood abuse. The main objective of this study was the assessment of patients with a history of child abuse who behaved in abusive manner in adulthood. Methods: By reviewing the files of 3694 patients referred to my outpatient private clinic, I tried to gather data to answer the questions related to this study including history of abuse, victimization, substance abuse, and the percent of patients who were involved in abusive behaviors in adulthood. Results: In total, 1075 patients reported a history of some abuse during childhood (29.10%). Of them, 19.44% (total = 209, 78 men and 131 women) behaved as an abuser for most of their life. The prevalence of substance abuse in people with history of abuse was 36.6% compared to 28.36% in those without. The prevalence of acting as an abuser and perpetrator in adult life was 27.5%, 19.5%, 18.4% and 11.11% among the divorced, married, single and widowed respectively. Conclusion: This preliminary study showed that a significant number of patients with history of childhood abuse involved in abusive behavior and victimization of others in adulthood. Paying attention to this issue by mental health practitioners and policy makers can prevent the intergenerational transmission of abuse and development of a more peaceful society.

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Profile of Patients with Gaster Perforation at Dr. Moewardi General Hospital Surakarta in The Period of January-December 2018

BioScientia Medicina ◽

10.32539/bsm.v5i6.325 ◽

2021 ◽

Vol 5 (6) ◽

pp. 596-598

Author(s):

Imam Hafidh Zaini ◽

Ida Bagus Budhi

Keyword(s):

Gastric Perforation ◽

Patient Characteristics ◽

Age Group ◽

Free Air ◽

Number Of Patients ◽

History Of ◽

Research Findings ◽

Continue Research ◽

Over 40 Years ◽

Analgesic Use

Introduction: A gastric perforation is a form of hollow digestive organ perforation in which the entire thickness of the stomach wall is injured. Perforation of hollow organs can be suspected based upon the clinical picture, and the diagnosis becomes obvious through an image of free air on imaging performed. Methods: Data of patient characteristics were observed retrospectively from medical records of patients diagnosed with gastric perforation between January and December 2018. Results: Between January and December 2018, 45 patients with gastric perforation were identified, with data distributed by gender. There were 36 women (80%) and 9 men (20%) in the group. Based on the age group, 32 patients (71%) were distinguished by the age group over 40 years and 13 patients (29 %) under 40 years of age. When viewed from the location of the gastric perforations, it was found that 4 patients (9%) had a perforation in the antrum, 36 patients (80%) in the Prepylorus, and 5 patients (11.2%) in the major curvature. Data on analgesic use revealed 32 patients (71%) had a history of taking analgesics and 13 patients (29%) without a history of taking analgesics. Conclusion: In 2018, the majority of gastric perforation patients at Dr. Moewardi Hospital were female (80%), with the highest age group being over 40 years (71%) and the most gastric perforations occurring in the pylori (80%). The number of patients with gastric perforation who had previously used herbs and analgesics was higher (70%) than those who had not. Thus, the results of this retrospective study are consistent with previous research findings and can be used to continue research into the relationships (correlations) between the aforementioned variables.

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