Abstract WP226: Isolated Aphasia in the Emergency Department: Prevalence and Characteristics of Isolated Aphasia Due to Stroke Within a Population

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Elisheva R Coleman ◽  
Jane C Khoury ◽  
Charles J Moomaw ◽  
Kathleen Alwell ◽  
Brett M Kissela ◽  
...  
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Left Middle Cerebral Artery ◽  
Chi Square ◽  
Exact Test ◽  
The Public ◽  
Language Deficit ◽  
Wilcoxon Rank Sum Test ◽  
The Mean ◽  
Left Middle

Background: Aphasia is a disabling consequence of ischemic stroke (IS), usually caused by strokes in the territory of the left middle cerebral artery. It is often seen as part of a larger syndrome with right hemiparesis and other left hemisphere signs. Isolated aphasia may be difficult to recognize given the lack of motor symptoms, potentially delaying treatment. Our study seeks to determine the prevalence of isolated aphasia, the rate at which these patients call 911, and the rate and speed of treatment with rt-PA compared with the general IS population. Methods: Adult IS patients in 2005 and 2010 in the Greater Cincinnati/Northern KY region (pop. 1.3 million) were ascertained from all local hospitals via ICD-9 codes 430-436, using retrospective chart review. We limited analysis to acute IS cases that presented to an ED. Isolated aphasia was defined by a score >0 on item 9 of the initial rNIHSS (indicating language deficit) and scores of 0 on all other items except 1b and 1c. We compared rates of EMS use and rt-PA administration and median times to presentation and treatment for those with isolated aphasia versus not, using chi-square, Fisher’s exact test, t-test, or Wilcoxon rank-sum test. Results: In 2005 and 2010, 3814 IS cases presented to EDs in the region; 22% were black, 56% were female, and the mean (SD) age was 70 (15) years. Of these, 120 (3.2%) presented with isolated aphasia. Characteristics of the isolated aphasia group are compared with all other IS in Table 1. Isolated aphasia patients showed a trend toward later arrival and lower rate of treatment with rt-PA. Discussion: The trend toward later arrival in patients with isolated aphasia, though not statistically significant, suggests a need to better educate the public on recognizing this stroke syndrome. Isolated aphasia was significantly associated with atrial fibrillation and was associated with decreased small vessel and increased cardioembolic and undetermined stroke subtypes, a finding that merits further study.

scholarly journals Are the First and Second Hip in Staged Bilateral Total Hip Arthroplasty Equal? A Hospital Adverse Event and Perioperative Risk Comparison

2021 ◽  
Author(s):  
Jesus M. Villa ◽  
Tejbir S. Pannu ◽  
Carlos A. Higuera ◽  
Juan C. Suarez ◽  
Preetesh D. Patel ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Adverse Events ◽  
Hip Arthroplasty ◽  
Retrospective Chart Review ◽  
Consecutive Series ◽  
Level Of Evidence ◽  
Exact Test ◽  
Total Hip ◽  
Discharge Disposition ◽  
The Mean

AbstractHospital adverse events remain a significant issue; even “minor events” may lead to increased costs. However, to the best of our knowledge, no previous investigation has compared perioperative events between the first and second hip in staged bilateral total hip arthroplasty (THA). In the current study, we perform such a comparison. A retrospective chart review was performed on a consecutive series of 172 patients (344 hips) who underwent staged bilateral THAs performed by two surgeons at a single institution (2010–2016). Based on chronological order of the staged arthroplasties, two groups were set apart: first-staged THA and second-staged THA. Baseline-demographics, length of stay (LOS), discharge disposition, hospital adverse events, and hospital transfusions were compared between groups. Statistical analyses were performed using independent t-tests, Fisher's exact test, and/or Pearson's chi-squared test. The mean time between staged surgeries was 465 days. There were no significant differences in baseline demographics between first-staged THA and second-staged THA groups (patients were their own controls). The mean LOS was significantly longer in the first-staged THA group than in the second (2.2 vs. 1.8 days; p < 0.001). Discharge (proportion) to a facility other than home was noticeably higher in the first-staged THA group, although not statistically significant (11.0 vs. 7.6%; p = 0.354). The rate of hospital adverse events in the first-staged THA group was almost twice that of the second (37.2 vs. 20.3%; p = 0.001). There were no significant differences in transfusion rates. However, these were consistently better in the second-staged THA group. When compared with the first THA, our findings suggest overall shorter LOS and fewer hospital adverse events following the second. Level of Evidence Level III.

Late endoscopic evaluation of the ostium size after external dacryocystorhinostomy

2020 ◽  
pp. 112067212097604
Author(s):  
Reem R Al Huthail ◽  
Yasser H Al-Faky
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Nasal Endoscope ◽  
Long Term Follow Up ◽  
Mean Size ◽  
External Dacryocystorhinostomy ◽  
The Mean

Objective: To evaluate the effect of chronicity on the size of the ostium after external dacryocystorhinostomy (DCR) with intubation. Methods: Design: A retrospective chart review of patients who underwent external DCR with intubation over 10 years from January 2003 at a tertiary hospital. All patients were recruited and examined with rigid nasal endoscope. Results: A total number of 66 (85 eyes) patients were included. The mean age at the time of evaluation was 53.1 years with gender distribution of 54 females (81.8 %). The mean duration ±SD between the date of surgery and the date of evaluation was 33.2 ± 33.6 (6–118 months). Our study showed an overall anatomical and functional success of 98.8% and 95.3%, respectively. The mean size of the ostium (±SD) was 23.0 (±15.7) mm2 (ranging from 1 to 80.4 mm2). The size of the ostium was not a significant factor for failure ( p = 0.907). No statistically significant correlation was found between the long-term duration after surgery and the size of the ostium ( R: 0.025, p = 0.157). Conclusions: Nasal endoscopy after DCR is valuable in evaluating the ostium with no observed potential correlation between the long-term follow-up after surgery and the size of the ostium.

Pediatric Organ Donor Maintenance: Pathophysiologic Derangements and Nursing Requirements

PEDIATRICS ◽  
1989 ◽  
Vol 84 (4) ◽  
pp. 688-693
Author(s):  
N. Kissoon ◽  
T. C. Frewen ◽  
M. Bloch ◽  
M. Gayle ◽  
C. Stiller
Keyword(s):  
Chart Review ◽  
Premature Ventricular Contraction ◽  
Retrospective Chart Review ◽  
Stability Index ◽  
Organ Donor ◽  
Pulmonary Insufficiency ◽  
Organ Donors ◽  
Maintenance Time ◽  
Donor Support ◽  
The Mean

A retrospective chart review was conducted of 26 organ donors to determine hemodynamic and metabolic derangements encountered and nursing requirements for donor organ maintenance. There were 15 boys and 11 girls with a mean age 6.57 ± 5.46 years. Mean donor maintenance time was 10.5 ± 6.7 hours. Cardiorespiratory derangements included hypotension in 16, hypertension in 6, arrhythmias in 17 (premature ventricular contraction in 4, bradycardia in 8, paroxysmal atrial tachycardia in 3, and ventricular tachycardia in 2), asystolic events in 5, pulmonary insufficiency in 6, anemia in 8, and thrombocytopenia in 8. Metabolic and hormonal derangements included hyperglycemia in 18, hypokalemia in 20, hyperkalemia in 4, hyponatremia in 3, hypernatremia in 17, metabolic acidosis in 10, and diabetes insipidus in 15. Hypothermia (temperature 33.3°± 0.4°C, mean ± SD) occurred in 14 donors. The mean physiologic Stability Index score was 22.2 ± 4.7 and mean Therapeutic Intervention Score was 46.7 ± 5.8. Total number of nursing hours spent in donor maintenance was 424.5 hours. Therapies offered included diuretics in 10, sodium bicarbonate in 8, antibiotics in 6, insulin in 12, pitressin in 13, verapamil in 3, isoproterenol in 3, dopamine in 17, and intravenous potassium boluses in 14. Of the potential 26 donors, 46 kidneys, 8 hearts, 14 livers, 3 pancreas, and 9 corneas were retrieved in transplantable condition. With appropriate donor maintenance, organs suitable for transplantation can be retrieved despite significant pathophysiologic derangements. Physicians intending to provide donor support should be comfortable with invasive monitoring and cardiorespiratory support and be prepared to provide a nurse to patient ratio of 2:1 at the bedside.

scholarly journals Prevalence of amblyopia and patterns of refractive error in the amblyopic children of a tertiary eye care center of Nepal

2013 ◽  
Vol 5 (1) ◽  
pp. 38-44 ◽  
Author(s):  
K Sapkota ◽  
A Pirouzian ◽  
NS Matta
Keyword(s):  
Visual Acuity ◽  
Refractive Error ◽  
Chart Review ◽  
Care Center ◽  
Retrospective Chart Review ◽  
Ophthalmological Examination ◽  
Eye Care ◽  
Common Cause ◽  
Ocular Pathology ◽  
The Mean

Introduction: Refractive error is a common cause of amblyopia. Objective: To determine prevalence of amblyopia and the pattern and the types of refractive error in children with amblyopia in a tertiary eye hospital of Nepal. Materials and methods: A retrospective chart review of children diagnosed with amblyopia in the Nepal Eye Hospital (NEH) from July 2006 to June 2011 was conducted. Children of age 13+ or who had any ocular pathology were excluded. Cycloplegic refraction and an ophthalmological examination was performed for all children. The pattern of refractive error and the association between types of refractive error and types of amblyopia were determined. Results: Amblyopia was found in 0.7 % (440) of 62,633 children examined in NEH during this period. All the amblyopic eyes of the subjects had refractive error. Fifty-six percent (248) of the patients were male and the mean age was 7.74 ± 2.97 years. Anisometropia was the most common cause of amblyopia (p < 0.001). One third (29 %) of the subjects had bilateral amblyopia due to high ametropia. Forty percent of eyes had severe amblyopia with visual acuity of 20/120 or worse. About twothirds (59.2 %) of the eyes had astigmatism. Conclusion: The prevalence of amblyopia in the Nepal Eye Hospital is 0.7%. Anisometropia is the most common cause of amblyopia. Astigmatism is the most common types of refractive error in amblyopic eyes. Nepal J Ophthalmol 2013; 5(9):38-44 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7820

scholarly journals Seroprevalence of Brucellosis and Associated Risk Factors among Indigenous Breeds of Goats in Wukari, Taraba State, Nigeria

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Olaolu T. Olufemi ◽  
Danjuma B. Dantala ◽  
Paul A. Shinggu ◽  
Umesi A. Dike ◽  
Gbeminiyi R. Otolorin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cross Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Exact Test ◽  
The Public ◽  
Factors Associated ◽  
Males And Females ◽  
Associated Risk Factors ◽  
La Jolla

A cross-sectional study was conducted in Wukari, Taraba state, Nigeria, to determine the prevalence of Brucella antibodies and the risk factors associated with brucellosis in indigenous breeds of goats. A total of 386 goats were sampled from three political wards: Puje, Avyi, and Hospital: harvested sera samples were subjected to Rose Bengal Plate Test (RBPT). GraphPad Prism version 7.03 for Windows (GraphPad Software, La Jolla California, USA) was used to analyse the association between seroprevalence of brucellosis and age, sex, breed, location, and management system by using Chi square and Fisher’s exact test as appropriate. Brucellosis was detected in all three wards: Puje; 15%, Avyi; 6.6%, and Hospital; 7.6%. A prevalence rate of 2.8%, 8%, 18.7%, and 1% was recorded for <20-month, 22-35-month, 36-45-month, and ≥46-55-month age categories, respectively (P < 0.05). Only 9.5% was observed for male animals while 9.8% was observed for female animals with no statistical difference between the males and females. Breed-specific seroprevalence yielded 7.4%, 5.4% 12%, 12.8%, and 11.6%, for Cross, West Africa Dwarf, Red Sokoto, Kano Brown, and Sahel breeds of goat, respectively. There is an evidence of brucellosis (9.6%) in Wukari L.G.A, Taraba State, and age is a risk factor for the disease in the study area. There is a need to enlighten the public on the zoonotic potentials and economic impacts of brucellosis.

Comparing the Effect of Hand and Foot Reflexology Massages on the Severity of Nausea, Vomiting and Ileus in patients after Abdominal Surgery

2021 ◽  
Vol 15 (6) ◽  
pp. 1589-1593
Author(s):  
Elham Shahraki Moghadam ◽  
Zahrasadat Manzari ◽  
Hossein Rashki Ghalenow ◽  
Hajar Noori Sanchooli
Keyword(s):  
Abdominal Surgery ◽  
Repeated Measures ◽  
Abdominal Distension ◽  
Repeated Measure ◽  
Chi Square ◽  
Exact Test ◽  
Positive Effects ◽  
Significant Difference ◽  
The Mean ◽  
Hands And Feet

Background: Common clinical problems after surgery include nausea, vomiting and ileus that many patients complain of after their surgery. These complications can delay the patient's discharge from hospital. Nowadays, to reduce drug side effects, the use of complementary medicine, including reflexology, has received a great deal of attention. Aim: To compare the effect of hand and foot reflexology massages on the severity of nausea, vomiting and ileus in patients after abdominal surgery. Methods: This is a clinical trial study that was conducted between 2013 and 2015 in the emergency surgical departments of Imam Reza (AS) and Ghaem (AS) hospitals in Mashhad. The samples of this study included 90 women with cholecystitis and appendicitis who met the inclusion criteria. In this study, patients were randomly divided into 3 groups of hand reflexology massage, foot reflexology massage and control. To check the digestive status, gastrointestinal sounds were checked every hour using a clinical stethoscope. Also, information on gas and feces elimination was collected and recorded every hour. The intervention was performed 1 and 12 hours after the surgery. In both groups of hands and foot reflexology massages, after general massage of the hands and feet, the areas related to the abdominal distension and removal of the ileus were pressed. It should be noted that, the duration of massage for each person was 10 minutes (20 minutes in total). Data were analyzed by SPSS software version 16 using Chi-square, Fisher’s exact test, two-way ANOVA, Kruskal-Wallis test and repeated measures ANOVA. Results: There was no statistically significant difference in the mean score of severity of nausea before the intervention between the three groups (p = 0.90), but after the intervention a significant difference was observed in the mean score of severity of nausea between the three groups (p=0.002). Also, the result of ANOVA test with repeated measure showed a statistically significant difference in the mean score of nausea by group and stage (p<0.001). There was also no statistically significant difference in the frequency of vomiting severity between the three groups after the intervention. However, at 4 and 24 hours after the intervention, a statistically significant difference was observed between the three groups in that regard. Conclusion: The results showed that both types of hand and foot reflexology massage has positive effects on nausea and return of gastrointestinal movements, so nurses can use reflexology as a non-pharmacological and complementary method to reduce the severity of nausea and return gastrointestinal movements in postoperative patients. Since the reflexology had little or no effect on the severity of vomiting and the acceleration of gastrointestinal movements in patients, further studies in this area are recommended. Keywords: Reflexology, Pain, Nausea and vomiting, Ileus, Surgery

Abstract 3235: Low LDL is Associated with Hematoma Expansion in Chronic Daily Alcohol Users with Intracranial Hemorrhage

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Gayle R Pletsch ◽  
Christopher Burns ◽  
Karen C Albright ◽  
Amelia K Boehme ◽  
T. M Beasley ◽  
...  
Keyword(s):  
Chart Review ◽  
Ldl Cholesterol ◽  
Independent Predictor ◽  
Retrospective Chart Review ◽  
Platelet Inhibition ◽  
Demographic Variables ◽  
Hematoma Expansion ◽  
Chi Square ◽  
Alcohol Users

Background: Prior studies have reported elevated blood pressure, platelet inhibition, and low LDL cholesterol in chronic daily alcohol users (CDA). Each of these has been shown to be associated with intracerebral hemorrhage (ICH) growth. We hypothesized that CDA patients with ICH and low LDL were at higher risk for ICH growth than CDA users with high LDL. Methods: Retrospective chart review was performed on patients who presented to Tulane University from 7/1/08-12/31/10 with a spontaneous ICH. Patients who underwent hematoma evacuation were excluded. Clinical and demographic variables were abstracted. Hemorrhages volumes were calculated based on ABC/2 method. LDL was dichotomized into low (<100mg/dl) and high (≥100mg/dl) values. Comparisons were made using t-tests, Chi-square and non-parametric equivalents where appropriate. ICH growth in 24 hours and CDA use were evaluated using linear regression. Results: Of the 99 patients with spontaneous ICH, 25.3% were CDA users. No significant differences were observed when comparing baseline demographics of CDA users with LDL<100 and CDA users with LDL>=100 ( Table 1). Patients with low LDL had larger baseline ICH volumes (21.4 vs. 7.5, p=.03) and were more likely to experience ICH growth (87.5% vs. 57.1%, p=0.0002). Initial LDL was an independent predictor for 24 hour ICH growth. Every 10 points the initial LDL was below 100 predicted 1 cc of growth. LDL did not predict ICH growth in non-CDA users (p=0.9430). Discussion: Our data suggest that initial LDL level in chronic daily alcohol users can be used to predict ICH growth. The role of LDL in the importance of vessel fragility and clot stabilization needs to be further explored as this appears be important in patients who are chronic daily alcohol users.

scholarly journals P047: Emergency department practice patterns of UTI investigation among the delirious elderly: a retrospective chart review

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S81-S81
Author(s):  
R. Pinnell ◽  
P. Joo
Keyword(s):  
Emergency Department ◽  
Elderly Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Urinary Symptoms ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Indwelling Catheter ◽  
Exact Test

Introduction: Delirium is a common emergency department (ED) presentation in elderly patients. Urinary tract infection (UTI) investigation and treatment are often initiated in delirious patients in the absence of specific urinary symptoms, despite a paucity of evidence to support this practice. The purpose of this study is to describe the prevalence of UTI investigation, diagnosis and treatment in delirious elderly patients in the ED. Methods: We performed a retrospective chart review of elderly patients presenting to the ED at The Ottawa Hospital between January 15-July 30, 2018 with a chief complaint of confusion or similar. Exclusion criteria were pre-existing and current UTI diagnosis, Glasgow Coma Scale <13, current indwelling catheter or nephrostomy tube, transfers between hospitals, and leaving without being seen. The primary outcome was the proportion of patients for whom urine tests (urinalysis or culture) or antibiotic treatment were ordered. Secondary outcomes were associations between patient characteristics, rates of UTI investigation, and patient outcomes. Descriptive values were reported as proportions with exact binomial confidence intervals for categorical variables and means with standard deviations for continuous variables. Comparisons were conducted with Fischer's exact test for categorical variables and t-tests for continuous variables. Results: After analysis of 1039 encounters with 961 distinct patients, 499 encounters were included. Urine tests were conducted in 324 patients (64.9% [60.6-69.1]) and antibiotics were prescribed to 176 (35.2% [31.1-39.6]). Overall 57 patients (11.4% [8.8-14.5]) were diagnosed with UTI, of which only 12 (21.1% [11.4-33.9]) had any specific urinary symptom. For those patients who had no urinary symptoms or other obvious indication for antibiotics (n = 342), 199 (58.2% [52.8-63.5]) received urine tests and 62 (18.1% [14.2-22.6]) received antibiotics. Patients who received urine tests were older (82.4 ± 8.8 vs. 78.3 ± 8.4 years, p < 0.001) but did not differ in sex distribution from those than those who did not. Additionally, patients who received antibiotics were more likely to be admitted (OR = 2.6 [1.48-4.73]) and had higher mortality at 30 days (OR = 4.2 [1.35-12.91]) and 6 months (OR = 3.2 [1.33-7.84]) than those who did not. Conclusion: Delirious patient without urinary symptoms in the ED were frequently investigated and treated for UTI despite a lack of evidence regarding whether this practice is beneficial.

Age and Sex Differences in Overuse Injuries Presenting to Pediatric Sports Medicine Clinics

2019 ◽  
Vol 58 (7) ◽  
pp. 770-777 ◽  
Author(s):  
Amy Elizabeth Valasek ◽  
Julie A. Young ◽  
Lihong Huang ◽  
Bhavna Singichetti ◽  
Jingzhen Yang
Keyword(s):  
Sports Medicine ◽  
Chart Review ◽  
Sports Injuries ◽  
Retrospective Chart Review ◽  
Overuse Injuries ◽  
Cartilage Injuries ◽  
Red Flag ◽  
The Mean ◽  
Articular Cartilage Injuries ◽  
Age And Sex

Pediatric overuse injuries present with a gradual mechanism of onset and an underlying pathogenesis of microtrauma. We evaluated the clinical presentation of pediatric sports injuries to determine if differences exist between age and sex. A retrospective chart review was performed over a 6-year period; 6593 overuse injuries were included with the mean age of 13.4 years. Males presented with a greater proportion of apophysis, physis, and articular cartilage injuries ( P < .01). Females presented with greater bone, tendon, and “other” injuries ( P < .01). Children <9 years of age demonstrated apophysis and physis injuries. Conversely, children older than 15 years of age presented with tendon, bone, bursa, and other ( P < .01) overuse injuries. A significant number of pediatric athletes in this cohort reported playing through pain prior to clinical evaluation. Injury prevention programs need to educate children, and a red flag should be raised when pediatric athletes are participating with pain.

Safety and Efficacy of Brivaracetam in Pediatric Refractory Epilepsy: A Single-Center Clinical Experience

2019 ◽  
Vol 35 (2) ◽  
pp. 102-105 ◽  
Author(s):  
Sara McGuire ◽  
Gustavo Silva ◽  
Darshan Lal ◽  
Divya S. Khurana ◽  
Agustin Legido ◽  
...  
Keyword(s):  
Seizure Frequency ◽  
Chart Review ◽  
Refractory Epilepsy ◽  
Focal Epilepsy ◽  
Retrospective Chart Review ◽  
Average Dose ◽  
Limited Data ◽  
Duration Of Treatment ◽  
Seizure Reduction ◽  
The Mean

Brivaracetam is a new antiepileptic drug with limited data in children. The objective of this study was to assess the efficacy/tolerability of brivaracetam. This is a retrospective chart review of children/adolescents with refractory epilepsy treated with brivaracetam from 2016 to 2018. The primary outcome was seizure reduction (decrease in seizure frequency >50%). Twenty-three patients were identified. Mean age at initiation was 12.5 years. Fourteen were females. Epilepsy was focal in 11, generalized in 6, and mixed in 3. Average dose was 3.9 mg/kg/d. The mean duration of treatment was 8.2 months. Eight had greater than 50% decrease in seizure frequency, of which 7 had focal epilepsy, and 1 had Lennox-Gastaut/mixed epilepsy. Two had drowsiness and 3 behavioral complaints. One experienced tingling and dizziness. Our retrospective review suggests that brivaracetam is an effective therapy for refractory focal epilepsy in children older than 4 years of age.

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