Early Management of Cervical Impairments and the Incidence of Delayed Recovery in Adolescents With Acute Concussion

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S12.1-S12
Author(s):  
Jacob I. McPherson ◽  
Patrick Sparks ◽  
Mohammad Nadir Haider ◽  
Barry Stewart Willer ◽  
John J. Leddy
Keyword(s):  
Recovery Time ◽  
Sleep Disturbances ◽  
Neck Disability Index ◽  
Controlled Study ◽  
Symptom Scale ◽  
Retrospective Case ◽  
Blurred Vision ◽  
Early Management ◽  
Persistent Symptoms ◽  
Significant Difference

ObjectiveTo determine if concussed adolescents with positive cervical findings on examination provided with early cervical treatment demonstrate recovery time and incidence of persistent post-concussive symptoms (PPCS, recovery = 30 days) comparable to those without cervical findings.BackgroundCervical impairments resulting from concussive injury are historically associated with longer recovery times. Concomitant cervical injuries may result in symptoms that overlap with concussion, including headache, dizziness, tinnitus, sleep disturbances, and blurred vision. Current recommendations include assessment of the cervical spine; however, there is limited evidence for the effect of immediate cervical intervention on recovery.Design/MethodsRetrospective case-controlled study. Patients included adolescents with acute concussion presenting with (n = 132, 14.99 ± 1.9 years, 58% male, 5.70 ± 3.3 days since injury) and without (n = 138, 14.85 ± 1.8 years, 65% male, 6.13 ± 3.4 days since injury) cervical findings on physical exam. Patients were assessed with the Buffalo Concussion Physical Examination (BCPE), Neck Disability Index (NDI) and Post-Concussion Symptom Scale (PCSS) instruments. Groups were separated based on positive or negative cervical findings on the BCPE. Cervical impairments were addressed by physicians specializing in concussion management using a clinical algorithm. Mild impairments were managed conservatively (over-the-counter analgesics, warm/cold compresses, and/or neck stretching exercises). Patients with moderate or greater impairments were assessed by a physical therapist at the initial clinic encounter and given specific cervical interventions.ResultsPhysician-observed cervical findings had moderate agreement with self-reported function on the NDI (? = 0.414, p < 0.001). Patients with cervical findings reported greater symptom severity on the PCSS (37.9 ± 22.1 vs 30.8 ± 20.2, p = 0.011); however, there was no significant difference in recovery time (34.44 ± 33.2 vs 34.81 ± 39.0 days, p = 0.933) or incidence of persistent symptoms (39% vs 35%, p = 0.511).ConclusionsIn this group of adolescents, cervical impairment managed early after concussion was not associated with prolonged recovery. Early management of cervical impairments may reduce the development of PPCS. Prospective evaluation is warranted.

Before School Exercise Effects on Fitness and Academic Performance in Schoolchildren: A Retrospective Case-Controlled Study

2021 ◽  
pp. 1-6
Author(s):  
Austin J. Kulp ◽  
Xihe Zhu
Keyword(s):  
Academic Performance ◽  
Cardiorespiratory Fitness ◽  
Comparison Group ◽  
Fifth Graders ◽  
Reading Test ◽  
Analysis Of Covariance ◽  
Controlled Study ◽  
Retrospective Case ◽  
Significant Difference ◽  
Before School

Background/Purpose: Before school exercise programs (BSEPs) give students time for breakfast and add time to their daily physical activity. However, the effects of BSEP on physical fitness and academic achievement in the classroom remain unclear. The purpose of this study is to examine the effects of BSEP on cardiorespiratory fitness and academic performance among fourth- and fifth-grade students. Method: A retrospective case-controlled design was used in this study. Fourth and fifth graders (N = 84) were participants, half signed up for BSEP that met once a week for 10 weeks. A retrospectively case-controlled comparison group was generated from the classmates of those in BSEP in the same school. All students took PACER and statewide academic performance assessments. Multivariate analysis of covariance for student cardiorespiratory fitness, and mathematics and reading, were conducted, adjusting for pretest performances. Analysis/Results: There were improvements for both groups in academic performances and cardiorespiratory fitness. The cardiorespiratory fitness and reading test improvements were greater in the BSEP group than those in the comparison group, controlling for their pretests. However, there was no significant difference in student mathematics test performances. Conclusion: Students in BSEP group benefited from participating in the program with greater improvement in cardiorespiratory and reading test performances than the comparison group. These findings suggested that providing a BSEP once a week for 45 min may be beneficial to fourth and fifth graders.

scholarly journals Correlation between Rotator Cuff Tears and Repeated Subacromial Steroid Injections: A Case-Controlled Study

2009 ◽  
Vol 91 (5) ◽  
pp. 414-416 ◽  
Author(s):  
M Bhatia ◽  
B Singh ◽  
N Nicolaou ◽  
KJ Ravikumar
Keyword(s):  
Rotator Cuff ◽  
Causative Factor ◽  
Rotator Cuff Tears ◽  
Controlled Study ◽  
Distribution Analysis ◽  
Subacromial Impingement ◽  
Subacromial Space ◽  
Retrospective Case ◽  
Significant Difference ◽  
Magnetic Resonance Imaging Mri

INTRODUCTION Concern exists regarding potential damage to the rotator cuff from repeated corticosteroid injections into the subacromial space. PATIENTS AND METHODS In this retrospective, case-controlled study, 230 consecutive patients presenting to three orthopaedic units with subacromial impingement and investigated as an end-point with magnetic resonance imaging (MRI) of the shoulder were divided into groups having received less than three or three or more subacromial injections of corticosteroids. RESULTS With no significant difference in age and sex distribution, analysis by MRI showed no significant difference between the two groups in the incidence of rotator cuff tear (P < 1.0). CONCLUSIONS This suggests that corticosteroid use in patients with subacromial impingement should not be considered a causative factor in rotator cuff tears.

scholarly journals Patterns of alcohol consumption after liver transplantation

Gut ◽  
1998 ◽  
Vol 43 (1) ◽  
pp. 140-145 ◽  
Author(s):  
H Tang ◽  
R Boulton ◽  
B Gunson ◽  
S Hubscher ◽  
J Neuberger
Keyword(s):  
Liver Transplantation ◽  
Alcohol Consumption ◽  
Liver Injury ◽  
Rapid Development ◽  
Controlled Study ◽  
Queen Elizabeth Hospital ◽  
Fatty Change ◽  
Retrospective Case ◽  
Significant Difference ◽  
Heavy Alcohol Consumption

Background—Uncertainty exists about the extent and consequences of a return to alcohol consumption after liver transplantation for alcoholic liver disease (ALD).Aims—To determine the prevalence and consequences of alcohol consumption in patients transplanted for ALD.Methods—A retrospective case controlled study of all patients transplanted for ALD at the Queen Elizabeth Hospital, Birmingham, between 1987 and 1996.Results—Seventy patients with ALD were transplanted, of which 59 survived more than three months; 56 were interviewed. Twenty eight had consumed some alcohol after transplantation; for the nine “heavy drinkers” (HD), the median time to resumption of alcohol intake was six months and for the 19 “moderate drinkers” (MD) it was eight months. There was no significant difference in episodes of acute rejection or compliance with medication between those who were abstinent, MD, or HD. Histological evidence of liver injury was common in ALD patients who had returned to drink. Mild fatty change was found in 1/11 biopsy specimens from abstinent patients but moderate to severe fatty change and ballooned hepatocytes were seen in 3/5 MD and 2/5 HD specimens. Two HD patients had early fibrosis. One HD patient has died of alcohol related complications.Conclusions—Moderate to heavy alcohol consumption occurs in patients transplanted for ALD. Patient recall of abstinence advice is unreliable, and patients return to alcohol mainly within the first year after liver transplantation. Return to alcohol consumption after liver transplantation is associated with rapid development of histological liver injury including fibrosis.

scholarly journals Effect of dexmedetomidine on prevention of postoperative nausea and vomiting in pediatric strabismus surgery: A randomized controlled study

2020 ◽  
Author(s):  
shuangshuang li ◽  
Tingjie Liu ◽  
Junming Xia ◽  
Jie Jia ◽  
Wenxian Li
Keyword(s):  
Placebo Group ◽  
Postoperative Nausea ◽  
Recovery Time ◽  
Pediatric Patients ◽  
Postoperative Nausea And Vomiting ◽  
Strabismus Surgery ◽  
Nausea And Vomiting ◽  
Controlled Study ◽  
Extubation Time ◽  
Significant Difference

Abstract Background : Postoperative nausea and vomiting (PONV) are common side-effects following strabismus surgery. The present study aimed to compare the effects of different doses of dexmedetomidine (DEX) on PONV incidence in pediatric patients undergoing strabismus surgery. Methods : In this prospective randomized double-blinded study, 126 pediatric patients undergoing strabismus surgery were randomized into one of three groups: Placebo group, normal saline; DEX1 group, 0.3 ug/kg dexmedetomidine, and DEX2 group, 0.5 ug/kg dexmedetomidine. Oculocardiac reflex (OCR) events were recorded during surgery. PONV or postoperative vomiting (POV) was recorded for 24 hours in the ward. Pediatric anesthesia emergence delirium (PAED) scale and emergence agitation (EA) scale were recorded in the recovery room. Results : Intraoperative OCR was significantly reduced in DEX2 group (42%) as compared to that of Placebo group (68%) (p=0.0146). During the first 24 hours post-op, the overall incidence of PONV was significantly lower in DEX2 group (10%) than that of Placebo group (32%) (p=0.0142). There was no significant difference in POV among the three groups. PAED or EA scores among the three groups were similar during recovery time. Conclusion : Dexmedetomidine (0.5 ug/kg) reduced OCR and PONV without lengthening extubation time or recovery time in pediatric patients undergoing strabismus surgery.

scholarly journals Effect of dexmedetomidine on prevention of postoperative nausea and vomiting in pediatric strabismus surgery: A randomized controlled study

2019 ◽  
Author(s):  
shuangshuang li ◽  
Tingjie Liu ◽  
Junming Xia ◽  
Jie Jia ◽  
Wenxian Li
Keyword(s):  
Placebo Group ◽  
Postoperative Nausea ◽  
Recovery Time ◽  
Pediatric Patients ◽  
Postoperative Nausea And Vomiting ◽  
Strabismus Surgery ◽  
Nausea And Vomiting ◽  
Controlled Study ◽  
Extubation Time ◽  
Significant Difference

Abstract Background Postoperative nausea and vomiting (PONV) are common side-effects following strabismus surgery. The present study aimed to compare the effects of different doses of dexmedetomidine (DEX) on PONV incidence in pediatric patients undergoing strabismus surgery. Methods In this prospective randomized double-blinded study, 126 pediatric patients undergoing strabismus surgery were randomized into one of three groups: Placebo group, normal saline; DEX1 group, 0.3 ug/kg dexmedetomidine, and DEX2 group, 0.5 ug/kg dexmedetomidine. Oculocardiac reflex (OCR) events were recorded during surgery. PONV or postoperative vomiting (POV) was recorded for 24 hours in the ward. Pediatric anesthesia emergence delirium (PAED) scale and emergence agitation (EA) scale were recorded in the recovery room. Results Intraoperative OCR was significantly reduced in DEX2 group (41.5%) as compared to that of Placebo group (68.3%) (p=0.026). During the first 24 hours post-op, the overall incidence of PONV was significantly lower in DEX2 group (9.8%) than that of Placebo group (31.7%) (p=0.029). There was no significant difference in POV among the three groups. PAED or EA scores among the three groups were similar during recovery time. Conclusion Dexmedetomidine (0.5 ug/kg) reduced OCX and PONV without lengthening extubation time or recovery time in pediatric patients undergoing strabismus surgery.

scholarly journals NT-pro BNP in AECOPD-PH: Old Biomarker, New Insights-Based on a Large Retrospective Case-Controlled Study

2021 ◽  
Author(s):  
Fengming Tian ◽  
Wen Song ◽  
Liang Wang ◽  
Qiang Zeng ◽  
Zhenyu Zhao ◽  
...  
Keyword(s):  
Rank Correlation ◽  
Roc Curves ◽  
Controlled Study ◽  
Chronic Obstructive ◽  
Weak Correlation ◽  
Retrospective Case ◽  
Diagnostic Efficacy ◽  
Obstructive Pulmonary Disease ◽  
Distribution Width ◽  
Significant Difference

Abstract Pulmonary hypertension (PH) is one of the common complications in chronic obstructive pulmonary disease (COPD). The study aimed to evaluate the predicting ability of N-terminal pro brain natriuretic peptide (NT-pro BNP) in patients with AECOPD-PH and its relationship with the severity of PH. A large retrospective case-controlled study (n=1072) was performed in the First Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2020, and patients were divided into stable COPD (n=178), AECOPD (n=688) and AECOPD-PH group (n=206). In unadjusted analysis and PSM (model 1, 2, 3), red cell distribution width (RDW), total bilirubin (TBIL), and NT-pro BNP were higher in patients with AECOPD-PH than those in AECOPD group. Logistic regression analysis showed that RDW had no statistic difference. When the range of NT-proBNP was 271-1165 pg/mL (OR: 0.293; 95%CI: 0.184-0.467; P<0.001) and NT-proBNP > 1165pg/mL (OR: 0.559; 95%CI: 0.338-0.926; P=0.024), the morbidity risk of PH in AECOPD patients was increased, so did TBIL. In receiver operating characteristic (ROC) curves, at the cut-off value of NT-proBNP was 175.14 pg/mL, AUC was 0.651 (P<0.001), which was better than TBIL (AUC: 0.590, P<0.001). As for the results of rank correlation analysis, TBIL had no significant difference, and NT-proBNP had a weak correlation with severity of PH with AECOPD (r=0.299, P=0.001).Our findings suggest that NT-proBNP has a diagnostic efficacy in AECOPD-PH and NT-proBNP has a weak correlation with severity of PH with AECOPD.

scholarly journals Continuous Infusion of Lidocaine in Pediatric Colonoscopy: A Randomized Double-Blind Placebo-Controlled Study

2021 ◽  
Author(s):  
Chao Yuan ◽  
Chengli Wang ◽  
Jiayao Wu ◽  
Ningyang Gao ◽  
Kuiwei Li ◽  
...  
Keyword(s):  
Continuous Infusion ◽  
Recovery Time ◽  
Oxygen Desaturation ◽  
Secondary Outcome ◽  
Controlled Study ◽  
Double Blind ◽  
Lidocaine Group ◽  
Double Blind Placebo ◽  
Significant Difference ◽  
Pediatric Colonoscopy

Abstract Background: Propofol is commonly used for providing procedural sedation during pediatric colonoscopy. Intravenous (i.v.) lidocaine can mitigate visceral pain and reduce propofol requirements during surgery. The aim of this study is to investigate the effect of intravenous lidocaine on perioperative propofol and sufentanil dose, pulse oxygen saturation, postoperative pain score, and recovery time during pediatric colonoscopy.Methods: We designed a randomized double-blind placebo-controlled study and enrolled 80 children aged from 3 to 10 years old who underwent colonoscopy. After titration of propofol to achieve unconsciousness, the patients were given i.v. lidocaine (1.5 mg/kg then 2 mg/kg/h) or the same volume of saline. Sedation was standardized and combined propofol with sufentanil. The primary outcome variables were intraoperative propofol and sufentanil requirements, and the number of oxygen desaturation episodes. Secondary outcome variables were recovery time after colonoscopy and post-colonoscopy pain.Results: Lidocaine infusion resulted in a significant reduction in propofol requirements: (median (quartile) 1.8 (1.5-2.0) vs. 3.0 (2.8-3.3) mg/kg respectively; P<0.001) and sufentanil requirements: (median (quartile) 0.06 (0.05-0.08) vs. 0.1 (0.1-0.1) μg/kg respectively; P<0.001). The number of subjects who experienced oxygen desaturation below 95% in the lidocaine group was also significantly less than that in the control group: 2 vs. 8 (P=0.04). The mean (SD) recovery time was significantly shorter in the lidocaine group: (19.2 (2.6) vs. 13.3 (2.6) min respectively; P<0.001). There was no significant difference regarding post-colonoscopy pain.Conclusion: Continuous infusion of lidocaine resulted in reduction in propofol and sufentanil dose requirements, recovery time, and risk of hypoxemia during pediatric colonoscopy.Trial Registration: Chinese Clinical Trials Registry, ChiCTR2000028927, January 8, 2020, prospectively registered.

scholarly journals Effect of dexmedetomidine on prevention of postoperative nausea and vomiting in pediatric strabismus surgery: A randomized controlled study

2020 ◽  
Author(s):  
shuangshuang li ◽  
Tingjie Liu ◽  
Junming Xia ◽  
Jie Jia ◽  
Wenxian Li
Keyword(s):  
Placebo Group ◽  
Postoperative Nausea ◽  
Recovery Time ◽  
Pediatric Patients ◽  
Postoperative Nausea And Vomiting ◽  
Strabismus Surgery ◽  
Nausea And Vomiting ◽  
Controlled Study ◽  
Extubation Time ◽  
Significant Difference

Abstract Background : Postoperative nausea and vomiting (PONV) are common side-effects following strabismus surgery. The present study aimed to compare the effects of different doses of dexmedetomidine (DEX) on PONV incidence in pediatric patients undergoing strabismus surgery. Methods : In this prospective randomized double-blinded study, 126 pediatric patients undergoing strabismus surgery were randomized into one of three groups: Placebo group, normal saline; DEX1 group, 0.3 ug/kg dexmedetomidine, and DEX2 group, 0.5 ug/kg dexmedetomidine. Oculocardiac reflex (OCR) events were recorded during surgery. PONV or postoperative vomiting (POV) was recorded for 24 hours in the ward. Pediatric anesthesia emergence delirium (PAED) scale and emergence agitation (EA) scale were recorded in the recovery room. Results : Intraoperative OCR was significantly reduced in DEX2 group (42%) as compared to that of Placebo group (68%) (p=0.0146). During the first 24 hours post-op, the overall incidence of PONV was significantly lower in DEX2 group (10%) than that of Placebo group (32%) (p=0.0142). There was no significant difference in POV among the three groups. PAED or EA scores among the three groups were similar during recovery time. Conclusion : Dexmedetomidine (0.5 ug/kg) reduced OCR and PONV without lengthening extubation time or recovery time in pediatric patients undergoing strabismus surgery.

scholarly journals Effect of dexmedetomidine on prevention of postoperative nausea and vomiting in pediatric strabismus surgery: A randomized controlled study

2019 ◽  
Author(s):  
shuangshuang li ◽  
Tingjie Liu ◽  
Junming Xia ◽  
Jie Jia ◽  
Wenxian Li
Keyword(s):  
Placebo Group ◽  
Postoperative Nausea ◽  
Recovery Time ◽  
Pediatric Patients ◽  
Postoperative Nausea And Vomiting ◽  
Strabismus Surgery ◽  
Nausea And Vomiting ◽  
Controlled Study ◽  
Extubation Time ◽  
Significant Difference

Abstract Background : Postoperative nausea and vomiting (PONV) are common side-effects following strabismus surgery. The present study aimed to compare the effects of different doses of dexmedetomidine (DEX) on PONV incidence in pediatric patients undergoing strabismus surgery. Methods : In this prospective randomized double-blinded study, 126 pediatric patients undergoing strabismus surgery were randomized into one of three groups: Placebo group, normal saline; DEX1 group, 0.3 ug/kg dexmedetomidine, and DEX2 group, 0.5 ug/kg dexmedetomidine. Oculocardiac reflex (OCR) events were recorded during surgery. PONV or postoperative vomiting (POV) was recorded for 24 hours in the ward. Pediatric anesthesia emergence delirium (PAED) scale and emergence agitation (EA) scale were recorded in the recovery room. Results : Intraoperative OCR was significantly reduced in DEX2 group (42%) as compared to that of Placebo group (68%) (p=0.0146). During the first 24 hours post-op, the overall incidence of PONV was significantly lower in DEX2 group (10%) than that of Placebo group (32%) (p=0.0142). There was no significant difference in POV among the three groups. PAED or EA scores among the three groups were similar during recovery time. Conclusion : Dexmedetomidine (0.5 ug/kg) reduced OCR and PONV without lengthening extubation time or recovery time in pediatric patients undergoing strabismus surgery.

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