scholarly journals Symptoms presented during emergency telephone calls for patients with spontaneous subarachnoid haemorrhage

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Asger Sonne ◽  
Sarita Egholm ◽  
Laurits Elgaard ◽  
Niklas Breindahl ◽  
Alice Herrlin Jensen ◽  
...  
Keyword(s):  
Neck Pain ◽  
Subarachnoid Haemorrhage ◽  
Telephone Call ◽  
Control Group ◽  
Time Period ◽  
National Patient ◽  
Telephone Calls ◽  
Audio Files ◽  
Record Review ◽  
Nested Case Control

Abstract Background A spontaneous subarachnoid haemorrhage (SAH) is one of the most critical neurological emergencies a dispatcher can face in an emergency telephone call. No study has yet investigated which symptoms are presented in emergency telephone calls for these patients. We aimed to identify symptoms indicative of SAH and to determine the sensitivity of these and their association (odds ratio, OR) with SAH. Methods This was a nested case–control study based on all telephone calls to the medical dispatch center of Copenhagen Emergency Medical Services in a 4-year time period. Patients with SAH were identified in the Danish National Patient Register; diagnoses were verified by medical record review and their emergency telephone call audio files were extracted. Audio files were replayed, and symptoms extracted in a standardized manner. Audio files of a control group were replayed and assessed as well. Results We included 224 SAH patients and 609 controls. Cardiac arrest and persisting unconsciousness were reported in 5.8% and 14.7% of SAH patients, respectively. The highest sensitivity was found for headache (58.9%), nausea/vomiting (46.9%) and neck pain (32.6%). Among conscious SAH patients these symptoms were found to have the strongest association with SAH (OR 27.0, 8.41 and 34.0, respectively). Inability to stand up, speech difficulty, or sweating were reported in 24.6%, 24.2%, and 22.8%. The most frequent combination of symptoms was headache and nausea/vomiting, which was reported in 41.6% of SAH patients. More than 90% of headaches were severe, but headache was not reported in 29.7% of conscious SAH patients. In these, syncope was described by 49.1% and nausea/vomiting by 37.7%. Conclusion Headache, nausea/vomiting, and neck pain had the highest sensitivity and strongest association with SAH in emergency telephone calls. Unspecific symptoms such as inability to stand up, speech difficulty or sweating were reported in 1 out of 5 calls. Interestingly, 1 in 3 conscious SAH patients did not report headache. Trial registration NCT03980613 (www.clinicaltrials.gov).

scholarly journals SAT0547 RADIOGRAPHIC IMAGING IN ASSESSMENT OF FLUOROSCOPIC GUIDED INJECTION OF RHEUMATOID ATLANTOAXIAL JOINT INFLAMMATION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1230.1-1231
Author(s):  
D. Fouad ◽  
S. Rashad ◽  
M. Ghaly ◽  
M. Hassanien
Keyword(s):  
Rheumatoid Arthritis ◽  
Neck Pain ◽  
Sleep Quality ◽  
Sleep Disturbance ◽  
Steroid Injection ◽  
Therapeutic Option ◽  
Control Group ◽  
Atlantoaxial Joint ◽  
Post Intervention

Background:Rheumatoid spondylitis is a feature of long-lasting Rheumatoid arthritis (RA) that is presented by neck pain, headache and sleep disturbance. Atlantoaxial joint (AAJ) is the commonest cervical spine joint that affected in patients with RA. When it is involved, it can be associated with dangerous complications. Magnetic Resonance Imaging (MRI) can be used for assessing the disease activity, the amount of cartilage destruction, associated cervical myelopathy and differentiating synovial fluid from inflammatory pannus (Taniguchi D, et al., 2008).Objectives:This study aimed to evaluate the efficacy of intra-articular steroid injection of inflamed AAJ in RA patients, regarding neck pain, headache and sleep quality using pre and post-interventions MRI.Methods:A prospective case control study. Patients with inflamed AAJ were recruited. Group 1 (AAJ group, n = 30), received intraarticular AAJ steroid injection, guided by fluoroscopy and Group 2 (control group, n = 30), received systemic steroids. Both groups were assessed with: Visual Analogue scale (VAS) for nocturnal neck pain and headache. Pittsburgh sleep quality index (PSQI) was used for sleep disturbance. Pre and post contrasts enhanced MRI interventions were done for both groups during the period of follow up (three months).Results:Nocturnal neck pain, headache and sleep disturbance have significantly decreased, during follow up visits (3 months), in AAJ group in comparison to the control group. The Pre-intervention nocturnal pain score was 60.3 ±17.1 in AAJ group & 58.5 ±17.9 in control group. Pain has significantly decreased after 2weeks in AAJ group with continuous improvement till 3 months’ post-intervention 6.9 ±4.65 & 51.26 ±10.54 respectively. The pre-intervention headache was 22.68 ±16.74 in AAJ group & 45.17 ±15.83 in control group decreased to 7.54 ±5.23 & 48.52 ±11.98 respectively post intervention. The percentage of patients who had sleep disturbance at baseline was 66.7% & 73.3% in AAJ and control groups respectively which has significantly decreased to 6.7% & 43.3% after 3 months. Regarding MRI, AAJ group hada statistical significant decreasein the percentage of patients with MRI synovial enhancement, inflammatorypannus,fibrosis and bone marrow edema in comparison to control group 3 months post intervention. All post-procedural side effects resolved within thmonth without further medical intervention, and no long-term sequelae were identifiedConclusion:Fluoroscopic guided intra-articular steroid injection of inflamed atlantoaxial joints is considered a beneficial therapeutic option in rheumatoid arthritis patients regarding clinical and radiological assessments.References:[1]Taniguchi D, Tokunaga D, Hase H, et al. Evaluation of lateral instability of AAJ in RA using dynamic open-mouth view radiographs. Clin Rheumatol.2008 Jul. 27(7):851-7.Disclosure of Interests:None declared

scholarly journals THU0453 THIRD OCCIPITAL NERVE RADIO-FREQUENCY UNDER FLUOROSCOPIC GUIDANCE IN MANAGEMENT OF CERVICOGENIC HEADACHE IN RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 463.2-464
Author(s):  
A. Alawamy ◽  
M. Hassanien ◽  
E. Talaat ◽  
E. Kamel
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Neck Pain ◽  
Neck Disability Index ◽  
Cervicogenic Headache ◽  
Control Group ◽  
Fluoroscopic Guidance ◽  
Occipital Nerve ◽  
Nocturnal Pain ◽  
Neck Disability

Background:Rheumatoid arthritis is a common type of autoimmune arthritis characterized by chronic inflammation. Cervical spine is often affected specially in long lasting diseaseObjectives:Evaluate efficacy of Third occipital nerve Radiofrequency under fluoroscopic guidance to treat refractory cervicogenic headache in RA patients.Methods:The current study was revised and approved from the local ethical committee of Faculty of Medicine; Assiut University, then registered in the clinical trials under the number ofNCT03852355. Inclusion criteria included, Patients who fulfilled the American College of Rheumatology (ACR) (2010) criteria for RA and suffering from upper neck pain and/or headache due to bilateral 3rd occipital nerve involvement, excluding other local cervical spine pathologies was confirmed by MRI and previously failed conservative treatment for at least three months prior to enrollment. Sixty adult patients were randomly assigned to one of the two studied groups Group 1 (RF, n = 30), received bilateral Third occipital nerve Radiofrequency under fluoroscopic guidance or Group 2 (control group, n = 30), received oral prednisolone 10 mg/day. The two groups were then followed-up with neck disability index (NDI), nocturnal neck pain VAS score and headache score every two weeks for three months. Sleep disturbance, sleep disability index were reassessed six months post intervention. Post interventional assessment was done by pain physician who were kept blind to the grouping process.Results:Neck disability index (1ry outcome), Nocturnal pain VAS, and severity of headache showed significant differences during the whole post-interventional study period. The patients in RF group demonstrated significant improvement of pain in comparison to baseline value over the whole six months with p-value < 0.001 as regard to the fore-mentioned three parameters. On the other aspect, the control group patients showed significant improvement in comparison to its baseline value after the 2nd, 12th and 24th weeks only as follows: (0.001,0.003, 0.003 for the NDI) (p values of 0.02,0.01, 0.01 for the nocturnal pain VAS), (0.001 0.009, 0.005 for the headache VAS severity.Conclusion:Radiofrequency of 3rd occipital nerve is effective in treatment of refractory cervicogenic headache in RA.Disclosure of Interests: :None declared

Hair Follicle Melanogenesis Reflected in Hair Pigmentation as a Developmental Factor in Alopecia Areata

2021 ◽  
pp. 1-3
Author(s):  
Margit Juhasz ◽  
Rosalynn R.Z. Conic ◽  
Natasha Atanaskova Mesinkovska
Keyword(s):  
Hair Follicle ◽  
Alopecia Areata ◽  
Large Scale ◽  
Medical Center ◽  
Control Group ◽  
Hair Color ◽  
Natural Hair ◽  
Hair Pigmentation ◽  
Developmental Factor ◽  
Record Review

The mechanism of alopecia areata (AA) is not well-elucidated, and hair follicle melanogenesis pathways are implicated as possible sources for autoantigens. After a retrospective medical record review at a single tertiary medical center, the hair color of 112 AA patients were identified and compared to a control group of 104 androgenetic alopecia patients. There were no statistically significant differences in the natural hair color prevalence between the 2 groups (<i>p</i> = 0.164), and hair color was not a predictor of the alopecia type. Our results suggest hair pigmentation, determined by the eumelanin-to-pheomelanin ratio, is not a positive risk factor for AA development. We hope that our study will encourage multiple large-scale, collaborative, retrospective medical reviews to determine if our results are reproducible in diverse patient populations.

Fascial treatment versus manual therapy (HVLA) in patients with chronic neck pain: A randomized controlled trial

2021 ◽  
pp. 1-10
Author(s):  
Katrin Brück ◽  
Kirsten Jacobi ◽  
Tobias Schmidt
Keyword(s):  
Neck Pain ◽  
Manual Therapy ◽  
Repeated Measures ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Severity Of Illness ◽  
Chronic Neck Pain ◽  
Secondary Outcome ◽  
Control Group ◽  
Industrialized Nations

BACKGROUND: Chronic neck pain (CNP) is a common health problem in western industrialized nations. In recent years, the fascial tissue has attracted the attention of therapists, and a treatment of the fasciae promises to be a meaningful approach in the therapy of patients with CNP. OBJECTIVE: The aim of this study was to investigate the effectiveness of a fascial treatment (FT) compared to manual therapy (MT) and to no intervention (control group, CG) in patients with CNP. METHODS: Sixty participants with CNP were randomized into three groups. Primary outcome parameters were pain intensity as measured by the visual analogue scale (VAS), and severity of illness as measured by the Neck Pain and Disability Scale (NPAD). Secondary outcome parameter was the range of motion (ROM) of the cervical spine. RESULTS: Repeated measures t-tests demonstrated significant decreases with medium to large effect sizes for the FT (VAS: dR⁢M= 1.14; NPAD: dR⁢M= 0.51) and for the MT (VAS: dR⁢M= 1.15; NPAD: dR⁢M= 0.72). CONCLUSION: Our results confirmed the effectiveness of MT on pain and severity of illness in the treatment of patients suffering from CNP. Furthermore, the results demonstrated the effectiveness and clinical relevance of FT for this population.

EFFICACY OF PRESSURE-BIOFEEDBACK GUIDED DEEP CERVICAL FLEXOR TRAINING ON NECK PAIN AND MUSCLE PERFORMANCE IN VISUAL DISPLAY TERMINAL OPERATORS

2013 ◽  
Vol 16 (03) ◽  
pp. 1350011 ◽  
Author(s):  
Md. Nezamuddin ◽  
Shahnawaz Anwer ◽  
Sohrab Ahmad Khan ◽  
Ameed Equebal
Keyword(s):  
Neck Pain ◽  
Pain Intensity ◽  
Exercise Program ◽  
Visual Display ◽  
Muscle Performance ◽  
Control Group ◽  
Women Patients ◽  
Flexor Muscle ◽  
Visual Display Terminal ◽  
Pressure Biofeedback

Purpose: This randomized trial study compared the efficacy of pressure-biofeedback guided deep cervical flexor training as an adjunct with conventional exercise on pain and muscle performance in visually displayed terminal operators. Methods: A total of 50 (22 men and 28 women) patients with neck pain participated in the study. Patients were randomly placed into two groups: a biofeedback group (n = 25) and a control group (n = 25). The biofeedback group received pressure-biofeedback guided deep cervical flexor training program for 5 days a week for 6 weeks, whereas the control group received an exercise program only. Results: On intergroup comparisons, the deep cervical flexor performance in biofeedback group, at the end of 6th week was significantly higher than those of control group (p < 0.01). Pain intensity was also significantly reduced in biofeedback group when compared to control group at the end of trial (p < 0.004). Conclusion: The addition of pressure-biofeedback to a 6-week conventional program appeared to increase deep cervical flexor muscle performance, compared to the exercise program alone for people with reduced muscle performance.

scholarly journals The role of leukotriene modifying agent treatment in neuropsychiatric events of elderly asthma patients: a nested case control study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Sang Oh Kang ◽  
Kyung Hyun Min ◽  
Hyun Jeong Kim ◽  
Tae Hyeok Kim ◽  
Woorim Kim ◽  
...  
Keyword(s):  
Case Control Study ◽  
Case Control ◽  
Boxed Warning ◽  
Control Group ◽  
Case Group ◽  
Newly Diagnosed ◽  
Crude Odds Ratio ◽  
Asthma Patients ◽  
Nested Case Control ◽  
Control Study

Abstract Background In March 2020, the US Food and Drug Administration decided that the dangers related to neuropsychiatric events (NPEs) of montelukast, one of the leukotriene modifying agents (LTMAs), should be communicated through ‘boxed warning’. In case of NPEs, the prevalence has been the highest in elderly people. Because the characteristics of the elderly such as old age itself can act as risk factors. Therefore, an investigation on safety of LTMAs related to NPEs in elderly using LTMAs is needed. Method A nested case-control study using an elderly sample cohort from the Korean National Health Insurance Service database was used. The asthma cohort included asthma patients newly diagnosed between 2003 and 2013. Within the asthma cohort, the case group was defined as patients who were diagnosed with NPEs. Among patients who had never been diagnosed with NPEs, the control group was selected by matching 1:1 by propensity score. Patients who were prescribed LTMAs for 1 year prior to index date were defined as the exposure group. The logistic regression model was used to measure the effect of LTMAs on NPEs. Results We identified 141,165 patients with newly diagnosed asthma, and selected 31,992 patients per each case and control group. Exposure to LTMAs significantly increased the risk of overall NPEs about in comparison with the absence of exposure (crude odds ratio [OR] 1.58, 95% CI 1.50–1.68). After adjusting for confounding factors, the overall NPEs risk increased (adjusted OR, 1.67, 95% CI 1.58–1.78). Conclusion This study suggests that elderly asthma patients prescribed LTMAs had a higher risk of NPEs than patients who were not treated with LTMAs. Therefore, clinicians should be aware of the potential risks of LTMAs.

Neurofibromatosis type 1 with subarachnoid haemorrhage from the left vertebral arteriovenous fistula: case presentation and literature review

2021 ◽  
Vol 14 (2) ◽  
pp. e239880
Author(s):  
Toshinori Nishizawa ◽  
Takahiro Tsuchiya ◽  
Yoshihiro Terasawa ◽  
Yasuhiro Osugi
Keyword(s):  
Neck Pain ◽  
Subarachnoid Haemorrhage ◽  
Arteriovenous Fistula ◽  
Neurofibromatosis Type 1 ◽  
Epidural Haematoma ◽  
Neurofibromatosis Type ◽  
Sudden Onset ◽  
Vertebral Arteriovenous Fistula ◽  
First Case

We present the case of a 47-year-old woman with neurofibromatosis type 1 (NF1) with subarachnoid haemorrhage (SAH) from the left vertebral arteriovenous fistula, along with a review of previous cases. Our patient had a family history of NF1 and presented to the emergency department with a sudden-onset severe headache and neck pain. CT scan showed SAH. CT angiography revealed a left vertebral arteriovenous fistula and an epidural haematoma. She underwent direct surgery and was discharged without neurologic deficits. To our knowledge, this is the first case of SAH caused by perimedullary drainage of a vertebral arteriovenous fistula associated with NF1. In a literature search, we identified 40 cases of vertebral arteriovenous fistula associated with NF1. The majority of vertebral arteriovenous fistulas occurred on the left side and in women. Patients with vertebral arteriovenous fistula typically experience neck pain, radiculopathy, radiculomyelopathy and bruits.

scholarly journals A Study of HLA-Linked Genes in a Monosymptomatic Psychotic Disorder in an Indian Bengali Population

2005 ◽  
Vol 50 (5) ◽  
pp. 269-274 ◽  
Author(s):  
Monojit Debnath ◽  
Sujit K Das ◽  
Nirmal K Bera ◽  
Chitta R Nayak ◽  
Tapas K Chaudhuri
Keyword(s):  
Human Leukocyte ◽  
Delusional Disorder ◽  
Control Group ◽  
Typing Method ◽  
Hla Genes ◽  
Healthy Donors ◽  
Serological Typing ◽  
Molecular Typing Method ◽  
Paranoid Symptoms ◽  
Nested Case Control

Objective: The etiology of delusional disorder is imperfectly understood. Involvement of biological factors has long been suspected. We examined the incidence of class I human leukocyte antigens (HLAs) in patients with delusional disorder to understand the role of HLA genes and explore a possible immunogenetic etiology for delusional disorder. Methods: We used a nested case–control study design. Psychiatric reference data were available for 27 500 patients registered between 1998 and 2003. Initially, we enrolled 150 patients with delusional disorder from the India-born Bengali population, using DSM-IV diagnostic criteria. After longitudinal follow-up, 80 patients were found to have only delusional disorder, while the remaining 70 patients represented different illnesses with paranoid symptoms and were excluded. We performed serological typing on all 150 patients and applied the polymerase chain reaction–based high-resolution molecular typing method to the 80 patients with delusional disorder. Eighty healthy donors of the same ethnic background, matched for age, sex, and other socioeconomic variables, formed the control group. Results: Some of the HLA alleles were associated with delusional disorder, and the gene HLA-A*03 was found to be significantly more frequent. This gene may influence patients' susceptibility to delusional disorder. Conclusion: The study reveals important associations between HLA genes and delusional disorder. This preliminary observation may help our understanding of this disorder's genetic basis.

scholarly journals TAP Block in Postoperative Analgesia, A First Time Clinical Trial In Bangladesh

2016 ◽  
Vol 27 (1) ◽  
pp. 3-11
Author(s):  
Bidhan Paul ◽  
Debashis Banik ◽  
AKM Shamsul Alam
Keyword(s):  
Postoperative Analgesia ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Transversus Abdominis ◽  
Control Group ◽  
Tap Block ◽  
Analgesic Regimen ◽  
Time Period ◽  
Group A ◽  
Group B

Background: In perioperative care, a reliable pain management is a vital appeal. Over recent years, Transversus Abdominis Plane (TAP) block is introduced as an important component of multimodal analgesia.Objective: To evaluate efficacy of TAP block in postoperative analgesia for Total Abdominal Hysterectomy (TAH) with subarachnoid block (SAB) in comparison of morphine consumption and VAS score.Methods: 60 patients were randomly allocated into 2 groups (TAP group-A & control group-B). Standard SAB was applied to all patients for elective TAH. Immediate after operation classical TAP block was performed through both Lumber Triangle Of Petit (LTOP) of group A patients. Both groups were placed in Post Anesthesia Care Unit (PACU), arranged a common standard postoperative analgesic regimen for all, observed periodically and documented it accordingly in pre-designed data sheet.Results: TAP block prolonged the mean time of 1st required I/V morphine (TAP vs control, mean±SD 271.23±40.34 vs 195.33±22.16 min., p=0.001HS). Morphine requirement was also reduced (17.4±5.4 vs 26.2±4.4 mg, p=0.001HS). Pain VAS scores at rest and movement were also reduced at all time period (p? 0.01 to 0.001). There was no complication attributed to the TAP block.Conclusion: TAP block provided considerably effective postoperative analgesia in first 24 hours after major abdominal surgery like TAH.Journal of Bangladesh Society of Anaesthesiologists 2014; 27(1): 3-11

Association Between Thyroid Diseases and Parkinson’s Disease: A Nested Case-Control Study Using a National Health Screening Cohort

2020 ◽  
pp. 1-10
Author(s):  
Ji Hee Kim ◽  
Heui Seung Lee ◽  
Jun Hyong Ahn ◽  
Jae Keun Oh ◽  
In Bok Chang ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
National Health ◽  
National Sample ◽  
Thyroid Diseases ◽  
Control Group ◽  
Region Of Residence ◽  
Pituitary Thyroid Axis ◽  
Nested Case Control ◽  
Levothyroxine Treatment

Background: Although the dopaminergic system is interconnected with the hypothalamic-pituitary-thyroid axis, few studies have explained the causal relationship between thyroid disease and Parkinson’s disease (PD). Objective: The goal of this study was to investigate the association between thyroid diseases and PD in Korean residents. Methods: The Korean National Health Insurance Service-National Sample Cohort, which includes individuals aged ≥40 years, was assessed from 2002 to 2015. A total of 5,586 PD patients were matched by age, sex, income, and the region of residence with 22,344 control participants at a ratio of 1:4. In the PD and control groups, previous histories of levothyroxine treatment, goiter, hypothyroidism, thyroiditis, and hyperthyroidism were investigated. Results: The rates of levothyroxine treatment for more than 3 months, hypothyroidism, and hyperthyroidism were higher in the PD group than the control group (3.2%, 3.8%, and 2.8% vs. 2.5%, 2.9%, and 1.9%, respectively, p <  0.05). The adjusted odds ratios (ORs) in model 2, which was adjusted for all potential confounders, for hypothyroidism and hyperthyroidism in the PD group were 1.25 (95% confidence interval (CI) 1.01–1.55, p = 0.044) and 1.37 (95% CI 1.13–1.67, p = 0.002), respectively. In subgroup analyses, the association between hypothyroidism and PD was maintained in men older than 70 years and the association between hyperthyroidism and PD was maintained in women younger than 70 years. Conclusion: Both hyperthyroidism and hypothyroidism were associated with higher risk of PD, particularly for women younger than 70 years and men older than 70 years, respectively.

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