Abstract WP375: Gender Differences in Etiologies of Stroke-Related Deaths in an Era of Availability for Stroke Intervention

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Alyssa Bautista ◽  
Sai P Polineni ◽  
Seemant Chaturvedi
Keyword(s):  
Medical History ◽  
Social History ◽  
Causes Of Death ◽  
Statistical Significance ◽  
Post Treatment ◽  
Hospital Data ◽  
Systemic Complications ◽  
Treatment Complications ◽  
Index Stroke ◽  
Iv Tpa

Background: Stroke is a disease that affects women unequally more than men. With the aging of the US population, stroke prevalence is projected to increase, especially among elderly females. In an era of stroke where the availability of treatment for acute stroke and its early complications continues to rise, we sought to determine if there are identifiable differences for causes of stroke-related death among women and men. Methods: We used a registry of stroke deaths following acute ischemic stroke at a single academic center from 2009 to 2017. Past medical history, in-hospital data, and cause of death was retrospectively collected from chart review. Female baseline characteristics were compared to male. Causes of deaths among females >/=65 versus <65 were compared using student’s t- and x 2 tests. Results: Among all stroke deaths (n=162), there were 72 (44.%) females, 90 (55.6%) males, with a mean age of 73 and 69, respectively. The proportion of smokers was higher among men (60.2% v 28.6%, p<0.001). Other medical history and social history did not have baseline differences. Among causes of death, there was no difference seen between female and male groups for malignant edema (43.1 v 33.3%,p=0.20), index stroke (2.8 v 3.3%,p=1.00), systemic complication (27.8 v 35.6%, p=0.29), withdrawal of care (12.5 v 22.2%,p=0.11); however among post-treatment hemorrhage/complications, a trend was seen towards females that did not reach statistical significance (13.9 v 5.6%,p=0.07). Of these female deaths from post-treatment complications, 6 or 60% received both IV thrombolysis (IV-tPA) and endovascular treatment (EVT), while the minority received either (30% IV-tPA, 10% EVT). Comparing causes of death among elderly females >/=65 versus <65, there were no differences as well (malignant edema 43.1 v 42.9%, p=0.98; index stroke 3.9 v 0%, p=1.00; systemic complications 27.5 v 28.6%, p=0.92; post-treatment complications 17.7 v 4.8%, p=0.26; withdrawal of care 7.8 v 23.8%, p=0.11). Conclusion: The trend for higher rate of post-treatment complications in women deserves further study in larger datasets. Women could be at higher risk for hemorrhage following IV-tPA and EVT due to older age.

Cocaine-induced mesenteric ischaemia requiring small bowel resection

2021 ◽  
Vol 14 (1) ◽  
pp. e238593
Author(s):  
Asya Veloso Costa ◽  
Asiya Zhunus ◽  
Rehana Hafeez ◽  
Arsh Gupta
Keyword(s):  
Small Bowel ◽  
Social History ◽  
Bowel Resection ◽  
Early Recognition ◽  
Small Bowel Resection ◽  
Emergency Laparotomy ◽  
Mesenteric Ischaemia ◽  
Bowel Ischaemia ◽  
Systemic Complications ◽  
Gastrointestinal Complications

Cocaine use causes profound vasoconstriction leading to various systemic complications. Gastrointestinal complications such as mesenteric ischaemia are difficult to recognise and may result in serious consequences if not treated promptly. We report on the case of a 47-year-old man presenting with mesenteric ischaemia on a background of acute on chronic cocaine consumption, where diagnosis was not evident until second presentation. He underwent an emergency laparotomy with small bowel resection and jejunostomy formation and made a good recovery with eventual reversal surgery. The literature on cocaine-induced bowel ischaemia shows significant variability in presentation and outcome. Laboratory investigations are non-specific, and early recognition is vital. Given the increasing recreational use of cocaine in the UK, it is imperative to have a high clinical index of suspicion for mesenteric ischaemia in patients presenting with non-specific abdominal pain, and to ensure a detailed social history covering recreational drug use is not forgotten.

433 Insomnia and Restless Legs Syndrome in Patients with Upper Airway Stimulation Therapy

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A171-A172
Author(s):  
Mohammed Jomha ◽  
Shalini Manchanda ◽  
Stephanie Stahl ◽  
Noah Parker
Keyword(s):  
Restless Legs Syndrome ◽  
Statistical Significance ◽  
Upper Airway ◽  
Post Treatment ◽  
Apnea Hypopnea Index ◽  
Upper Airway Stimulation ◽  
Therapy Adherence ◽  
Restless Legs ◽  
Obstructive Sleep ◽  
Pre Treatment

Abstract Introduction Insomnia and restless legs syndrome (RLS) are common sleep disorders that may impact obstructive sleep apnea (OSA) treatment. To our knowledge, no studies have investigated whether these comorbidities affect upper airway stimulation (UAS) therapy adherence and outcomes. This study aims to explore possible effects of insomnia and RLS in patients using UAS therapy. Methods All patients who underwent UAS system implantation for treatment of OSA at our facility were retrospectively studied. Pre- and post-implant histories and data, including diagnostic sleep testing, otolaryngology evaluation, activation results, and treatment evaluation, were analyzed. Patients with no insomnia or RLS were compared to patients with insomnia, RLS, or both. Apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and adherence were compared pre- and post-treatment for each group. Results Sixty-four patients who have undergone UAS implantation at our center have completed post-treatment in-lab titration and evaluation of their UAS system. Insomnia was present in 47%, RLS in 28%, and both insomnia and RLS in 14%. In all groups, the overall AHI during in-lab titration was &gt;50% lower than the pre-treatment AHI (16.1+/-14.3/h vs 32.5+/-13.1/h, p&lt;0.001). While the trend in AHI reductions suggested a lower AHI in those without insomnia or RLS, the reduction did not reach statistical significance (no insomnia or RLS 15.7+/-12.9/h, insomnia 16.9+/-16.7/h, RLS 19.0+/-15.5/h, both insomnia and RLS 23.4+/-18.4/h). UAS therapy usage was reduced in patients with RLS (3.9+/-2.6 h/night, p=0.029) and in patients with both insomnia and RLS (3.9+/-1.3 h/night, p=0.046) compared to patients with neither comorbidity (5.9+/-1.9 h/night). Mean reduction in ESS was similar across groups, averaging from 11+/-5 pre-treatment to 7+/-5 post-treatment (p&lt;0.001). Conclusion Insomnia and RLS are common in patients using UAS therapy for OSA. Pre- and post-treatment residual AHI and ESS significantly improved in all patient groups assessed. A decrease in UAS usage was present in patients with RLS and both RLS and insomnia. Our study suggests that identification and treatment of RLS and insomnia may play an important role for UAS therapy adherence and efficacy, thus, optimizing care. Support (if any):

Abstract TP227: Outcomes of a Regionalized Stroke Care System

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Denisse Sequeira ◽  
Christian Martin-Gill ◽  
Gregory Lowry ◽  
Marcus Robinson ◽  
Hinnah Siddiqui ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Stroke Care ◽  
Discharge Diagnosis ◽  
Hospital Data ◽  
Exact Test ◽  
Endovascular Interventions ◽  
Good Functional Outcome ◽  
Suspected Stroke ◽  
Iv Tpa

Introduction: Strokes are one of the leading causes of death and disability. Time-sensitive therapies are available including IV-TPA and endovascular therapies which require rapid and effective triage. Endovascular therapies are available at comprehensive stroke centers (CSC). We evaluated if there was any improvement in outcomes for patients who are transported directly to a CSC. Hypothesis: Patients that receive acute interventions for stroke have improved outcomes when transferred directly to CSC as compared to transport to a PSC and then transferred to a interventional facility. Methods: A retrospective cohort study of 5,188 patients transported from January 2012 to December 2013 with an EMS provider impression of suspected stroke via both air and ground transport. Of these, data was complete for 1,196 patients with a confirmed discharge diagnosis of ischemic stroke. Pre-hospital data was abstracted from EMS charts. Ischemic strokes were identified by final hospital discharge diagnosis and good functional status was defined as a modified Rankin scale <3 at discharge. Categorical outcomes were tested using Fishers Exact Test and Ordinal outcomes using the Mann Whitney Test. Results: For those with complete data mortality was 10% (CI 8.3-11.7) in this cohort with good functional outcomes in 37% (CI 34.3-39.7) of patients. IV- TPA was administered to 293 (24%) and endovascular interventions were performed in 167 (14%). There were 739 (63%) inter-facility transfers and 442 (37%) received directly from the scene. Transport to the CSC occurred by air in 798 (67%) cases as compared to 398 (33%) by ground. Mortality and good functional outcome did not differ between patients transferred and those taken directly to the CSC. Among patients receiving either TPA or endovascular therapy, direct transport to the CSC is associated with good functional outcome (Fisher’s exact= 0.041) but not with mortality. Conclusions: Among patients with a diagnosis of ischemic stroke presenting to a CSC, there is no difference in mortality and good functional outcome as a function of transfer from the scene or transfer from another facility. However, among those who received tPA or endovascular intervention good functional outcome was associated with direct presentation to the CSC.

Abstract 202: The NIH Stroke Scale Can Miss Improvement After IV tPA For Acute Ischemic Stroke

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Elisabeth B Marsh ◽  
Erin Lawrence ◽  
Rafael H Llinas
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Post Treatment ◽  
Functional Improvement ◽  
Stroke Severity ◽  
Post Discharge ◽  
Significant Difference ◽  
The Mean ◽  
Iv Tpa

Background and Objective: The National Institute of Health Stroke Scale (NIHSS) is the most commonly used metric to evaluate stroke severity and improvement following intervention. Despite its advantages as a rapid, reproducible screening tool, it may be too insensitive to adequately capture functional improvement following treatment. We evaluated the difference in rate of improvement by previously accepted criteria (change of ≥4 NIHSS points) versus physician documentation in patients receiving IV tissue plasminogen activator (tPA) for acute ischemic stroke. Methods: Prospectively collected data on all patients receiving IV tPA over a 15 month period were retrospectively reviewed. NIHSS 24 hours post-treatment and on discharge were extrapolated based on examination and compared to NIHSS on presentation. NIHSS scores at post-discharge follow-up were also recorded. Two reviewers evaluated the medical record and determined improvement based on physician documentation. Using tests of proportion, ‘significant improvement’ by NIHSS was compared to physician documentation at each time point. Results: Forty-one patients were treated with IV tPA. The mean admission NIHSS was 8.6 and improved to 6.4 24 hours post-tPA. Twenty-nine of 41 patients (79%) were “better” by documentation; however only 11/41 (27%) met NIHSS criteria for improvement (p compared to documentation <0.001). On discharge, 20/41 patients (49%) met NIHSS criteria for improvement; however a significant difference between physician documentation remained (p=0.04). The mean post-discharge follow-up NIHSS score was 2.0. 20/21 patients (95%) were “better” compared to 16/21 (76%) meeting NIHSS criteria (p=0.08). Conclusion: The NIHSS may inadequately capture functional improvement post-treatment, especially in the days immediately following intervention.

INADVERTANT PENETRATION OF BLOOD VESSELS DURING INFERIOR ALVEOLAR NERVE BLOCK TECHNIQUES

2013 ◽  
Vol 5 (2) ◽  
pp. 21-25
Author(s):  
Manjunath. Shankariah ◽  
Malapati Sudhakar Rao ◽  
Kalappa T Muthanna
Keyword(s):  
Nerve Block ◽  
Statistical Significance ◽  
Inferior Alveolar Nerve ◽  
The Other ◽  
Fisher Exact Test ◽  
Inferior Alveolar Nerve Block ◽  
Systemic Complications ◽  
Exact Test ◽  
Group I ◽  
Significant Difference

ABSTRACT Background The blood aspiration technique before the injection of local anesthetic solution is an essential procedure, because it prevents possible systemic’ complications. The purpose of this study is to evaluate the incidence of intravascular injection in different techniques of inferior alveolar nerve block and to know the technique which has very low incidence of vascular penetration. Methods Fifty patients in the ages of 17-70 years irrespective of sex, who were indicated for bilateral extractions of mandibular teeth were selected for this study. Patients were randomly divided into two divisions consisting of 25 patients requiring bilateral extraction procedures. In first division classical technique of inferior alveolar nerve block was administered on one side and on 2nd appointment Angelo Sargenti technique was administered on the other side. In the second division of 25 patients, indirect technique was administered on one side in 1st appointment and Clark and Holmes technique was administered on the other side in next appointment. Incidence of positive aspiration due to inadvertent penetration of inferior alveolar vessels was recorded. Results In group I positive aspiration rate was 8%, group II it was 4%, group III it was 4% and group IV it was 8%. Chi-square and fisher exact test was used and statistically there was no significant difference in the incidence of positive aspiration in all four groups. We found an overall aspiration rate of 6% in all four groups. Conclusion The incidence of positive aspiration was evaluated in all the 4 groups. There was no statistical significance in the rate of positive aspiration in all the groups included in our study.

scholarly journals E-Mail Is an Effective Tool for Rapid Feedback in Acute Stroke

2017 ◽  
Vol 7 (4) ◽  
pp. 159-163 ◽  
Author(s):  
Sara K. Rostanski ◽  
Joshua I. Stillman ◽  
Lauren R. Schaff ◽  
Crismely A. Perdomo ◽  
Ava L. Liberman ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Medical Center ◽  
Statistical Significance ◽  
Treatment Team ◽  
Acute Stroke Care ◽  
Improvement Project ◽  
Intravenous Tissue Plasminogen Activator ◽  
Data Feedback ◽  
E Mail ◽  
Iv Tpa

Objective: To determine whether e-mail is a useful mechanism to provide prompt, case-specific data feedback and improve door-to-needle (DTN) time for acute ischemic stroke treated with intravenous tissue plasminogen activator (IV-tPA) in the emergency department (ED) at a high-volume academic stroke center. Methods: We instituted a quality improvement project at Columbia University Medical Center where clinical details are shared via e-mail with the entire treatment team after every case of IV-tPA administration in the ED. Door-to-needle and component times were compared between the prefeedback (January 2013 to March 2015) and postfeedback intervention (April 2015 to June 2016) periods. Results: A total of 273 cases were included in this analysis, 102 (37%) in the postintervention period. Median door-to-stroke code activation (2 vs 0 minutes, P < .01), door-to-CT Scan (21 vs 18 minutes, P < .01), and DTN (54 vs 49 minutes, P = .17) times were shorter in the postintervention period, although the latter did not reach statistical significance. The proportion of cases with the fastest DTN (≤45 minutes) was higher in the postintervention period (29.2% vs 42.2%, P = .03). Conclusion: E-mail is a simple and effective tool to provide rapid feedback and promote interdisciplinary communication to improve acute stroke care in the ED.

Targeted anthelminthic treatment of school children: effect of frequency of application on the intensity of Ascaris lumbricoides infection in children from rural Nigerian villages

Parasitology ◽  
1996 ◽  
Vol 113 (1) ◽  
pp. 87-95 ◽  
Author(s):  
C. V. Holland ◽  
S. O. Asaolu ◽  
D. W. T. Crompton ◽  
R. R. Whitehead ◽  
I. Coombs
Keyword(s):  
Ascaris Lumbricoides ◽  
Total Population ◽  
Statistical Significance ◽  
Post Treatment ◽  
Targeted Treatment ◽  
Treatment Intensity ◽  
Targeted Chemotherapy ◽  
School Teachers ◽  
Before And After ◽  
The Village

SUMMARYA study to compare the effects of different frequencies of targeted chemotherapy with levamisole (Ketrax: JAGAL Pharma, Lagos, Zeneca Pharmaceuticals UK) as an action for the control of Ascaris lumbricoides was carried out in 3 communities in rural Oyo State, Nigeria. The targeted group comprised children, aged 5 to 15 years, attending primary school within their village. Treatment was provided within the school with the assistance of the school teachers. Three frequencies of targeted treatment were offered. In one village targeted treatment was provided on 1 occasion in 1 year, in another village at two 6-monthly intervals and in the third village every 4 months. Prevalence and intensity (e.p.g.) of A. lumbricoides infection were determined immediately before and after the period of intervention using a modified Kato–Katz technique. In the villages which received treatment once and at 6-monthly intervals, a reduction in post-treatment intensity of A. lumbricoides was observed in the total population but this failed to attain statistical significance. In contrast, within the village which received 4-monthly targeted chemotherapy, a significant reduction in post-treatment intensity of A. lumbricoides was observed in the total population and in the targeted children. In general, reductions in the intensity of A. lumbricoides after intervention were not particularly pronounced in untreated children (aged 0–4 years) even in the 4-monthly targeted village, whereas in untreated adults, reductions approached statistical significance in villages which received targeted treatment once and at 4-monthly intervals.

scholarly journals Management Outcome and Associated Factors among Intestinal Obstruction Patients Treated Surgically, Eastern Ethiopia

2019 ◽  
Author(s):  
Tesfaye Derseh ◽  
Biniam Minuye ◽  
Mohammed Yusouf ◽  
Tariku Dingeta
Keyword(s):  
Logistic Regression ◽  
Intestinal Obstruction ◽  
General Hospital ◽  
Associated Factors ◽  
Statistical Significance ◽  
Unfavorable Outcome ◽  
High Rate ◽  
P Value ◽  
Hospital Data ◽  
Eastern Ethiopia

Abstract Background Intestinal obstruction is a global problem consuming much in terms of surgical services. It is a common surgical emergency and a significant health problem in Ethiopia. Several factors contribute to poor management outcomes in the case of intestinal obstruction. Post-operative mortality rate ranges from 3% to 30%. Despite this high rate of mortality, there is no recently published literature that has explored Intestinal Obstruction and its associated factors at Chiro General Hospital. Methods Institution based cross-sectional study was conducted among 254 of patients admitted with Intestinal obstruction who treated surgically at Chiro General Hospital. Data were collected using checklists from individual patient cards by trained three BSc nurses from 13 to 18 July 2018 and completeness of data collection was checked every day by the principal Investigator. Data were entered to Epi-Data version 3.1 computer software and exported to SPSS statistical software version 22 for analysis. Bivariable binary logistic regression was used to saw the association between each independent variable and dependent variable. All variables with P-value < 0.2 during bi-variable analyses were considered for multivariable logistic regression analyses. Odds ratio along with 95%CI were estimated to measure the strength of the association. Level of statistical significance was declared at p value less or equal to 0.05. Results In this study the magnitude of unfavorable outcome of Intestinal Obstruction was 21.3% (95% CI: (16.5, 26.4). Age group of 55 years or above [AOR=2.9, 95%CI: (1.03, 8.4)], duration of illness of 24hrs or above [AOR=3.1, 95%CI: (1.03, 9.4)], pre-operative diagnosis of gangrenous SBO & gangrenous LBO [(AOR=3.6, 95%CI: (1.3, 9.8)), (AOR=4.2, 95%CI: (1.3, 13.7))], respectively were significantly associated with unfavorable outcome. Conclusions The magnitude of unfavourable management outcome of patients with Intestinal obstruction who treated surgically in this study was high. Old age, late presentation of illness and gangrenous bowel obstruction were significantly associated with unfavourable management outcome. So that early detection prompt management of patients with Intestinal obstruction reduce the occurrence of unfavourable outcome of patients.

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