Correlation of Platelet Indices with Severity of Acute Ischemic Stroke in Non-Diabetic and NonHypertensive Patients in Hubli, Karnataka

BACKGROUND Platelet size, measured as mean platelet volume (MPV), is a marker of platelet function and is positively associated with indicators of platelet activity, including aggregation and release of thromboxane A2, platelet factor 4, and thromboglobulin.1 Larger platelets are metabolically more active, produce more prothrombotic factors, aggregate more easily & act as index of homeostasis and its dysfunction thrombosis.2 The purpose of this study was to examine the relationship between platelet indices and stroke, as well as its severity and outcome. METHODS This was a prospective observational case control study. This study was conducted with 105 non-diabetic, non-hypertensive ischemic stroke patients who had no history of previous thrombotic events and who had not previously taken any antiplatelet medications. These patients were examined within 24 hours of onset of symptoms and severity of stroke was calculated by Canadian neurological scale (CNS). The results were compared with 105 age and sex match controls. RESULTS Mean age of patients was 61.72 ± 12 and of controls was 62.85 ± 10.68. Based on the CNS score, participants were allocated into two groups; the first group were those who had a comprehension deficit (1st group, 43 patients) and the second group were those without a comprehension deficit (2nd group, 62 patients). Mean values for platelet distribution width (PDW) & MPV in 1st group was 18.329 and 12.55 respectively and in 2nd group was 16.98 and 11.48 respectively. The mean value of PDW and MPV for stroke patients was 17.53 ± 0.76 and 11.92 ± 0.58 and was significantly higher than mean value of PDW & MPV respectively in controls, which were 15.47 ± 0.26 and 10.43 ± 0.23. PDW & MPV was found to be significantly associated with severity of motor deficit. CONCLUSIONS Larger studies may be required to determine its utility in day-to-day clinical practice. However, platelet indices can be used for predicting the severity of deficit in patients of acute ischemic stroke. KEYWORDS Platelet Indices, Stroke

The impact of teach-back on patient recall and understanding of discharge information in the emergency department: the Emergency Teach-Back (EM-TeBa) study

Background Previous research has demonstrated that patients leaving the emergency department (ED) have poor recall and understanding of their discharge information. The teach-back method is an easy technique that can be used to check, and if necessary correct, inaccurate recall. In our study, we aimed to determine the direct and short-term impact of teach-back as well as feasibility for routine use in the ED. Methods A prospective cohort study in an urban, non-academic ED was performed which included adult patients who were discharged from the ED with a new medical problem. The control group with the standard discharge was compared to the intervention group using the teach-back method. Recall and comprehension scores were assessed immediately after discharge and 2–4 days afterward by phone, using four standardized questions concerning their diagnosis, treatment, follow-up care, and return precautions. Results Four hundred eighty-three patients were included in the study, 239 in the control group, and 244 in the intervention group. Patients receiving teach-back had higher scores on all domains immediately after discharge and on three domains after 2–4 days (6.3% versus 4.5%). After teach-back, the proportion of patients that left the ED with a comprehension deficit declined from 49 to 11.9%. Deficits were most common for return precautions in both groups (41.3% versus 8.1%). Teach-back conversation took 1:39 min, versus an average of 3:11 min for a regular discharge interview. Conclusion Teach-back is an efficient and non-time-consuming method to improve patients’ immediate and short-term recall and comprehension of discharge information in the ED.

Neurobehavioral sequelae of moderate traumatic brain injury

Background: The goal of providing neurobehavioural rehabilitation of traumatic brain injury (TBI) survivors still remains largely unachieved, as the problem is still neglected. This study analysed the change in behavioural sequelae in TBI patients over a period of twelve months, so that appropriate measures may be taken for their adequate rehabilitation.Methods: All patients admitted with moderate TBI, aged between 15 and 60 years, during the study period of one year, or until the sample size (n=118) was reached, were included in the study. The initial details regarding the mechanism of injury and the initial Glasgow coma scale (GCS), number of days in intensive care unit (ICU), and so on were recorded. At follow up periods of six months and one year, the neuro behavioral rating scale was used in the review clinic to assess the change in neuro behavioral status. Data was analyzed using SPSS.Results: Out of the 118 subjects included in the study, there was statistically significant improvement in inattention, disorientation, expressive deficit, memory deficit, inaccurate insight, depressive mood, hallucinatory behaviour, unusual thought content, comprehension deficit, speech articulation defect, and so on. There was worsening of anxiety, guilt, tension, etc. There was no much change in somatic concern, hostility and so on.Conclusions: In view of significant worsening of behavioural components, this study has highlighted the need for individualized regimens for overall rehabilitation of the victims, thereby lessening burden on the patient, family and society.

Hiding in Plain Sight: Text Comprehension, Hyperlexia, and Adolescents With Autism Spectrum Disorder

Purpose Reading comprehension is a critical skill for success in academic, social, and vocational settings. However, comprehension problems for readers with autism spectrum disorder (ASD) are often overlooked during the period when most children are learning to read, masked by strong early decoding skills, a good memory for specific facts, and an understanding of concrete content. As students progress through the grades, the content of what they must read to be successful becomes increasingly complex and the comprehension deficit, present but unrecognized from the earliest interactions with text, is revealed. This article provides an overview of how the core deficits of individuals with ASD impact on the reading comprehension and academic success of older students. Conclusion Identification and intervention to address the underlying comprehension deficit has the potential to provide benefit in academic and personal pursuits of adolescent readers with ASD.

The Comprehension Problems of Children With Poor Reading Comprehension Despite Adequate Decoding: A Meta-Analysis

The purpose of this meta-analysis was to examine the comprehension problems of children who have a specific reading comprehension deficit (SCD), which is characterized by poor reading comprehension despite adequate decoding. The meta-analysis included 86 studies of children with SCD who were assessed in reading comprehension and oral language (vocabulary, listening comprehension, storytelling ability, and semantic and syntactic knowledge). Results indicated that children with SCD had deficits in oral language (d = −0.78, 95% confidence interval, CI [−0.89, −0.68], but these deficits were not as severe as their deficit in reading comprehension (d = −2.78, 95% CI [−3.01, −2.54]). When compared with reading comprehension age–matched normal readers, the oral language skills of the two groups were comparable (d = 0.32, 95% CI [−0.49, 1.14]), which suggests that the oral language weaknesses of children with SCD represent a developmental delay rather than developmental deviance. Theoretical and practical implications of these findings are discussed.

Der Simultandolmetscher als Textproduzent

The simultaneous interpreter is a secondary text producer in the sense that s/he is not responsible for the contents of the text to be transferred to the target language. In this paper it is assumed 1) that this lack of autonomy results in the construction of a discourse model which differs from the speaker’s discourse model and 2) that this difference is reflected in different referential expressions used by the speaker and the interpreter respectively. Based on Mira Ariel’s Accessibility Theory, referential expressions are regarded as accessibility markers, by means of which the text producer signals to the hearer whether the mental representation of the referent in question has a high or low degree of accessibility in his/her memory. It is claimed that, whenever text production is difficult due to special conditions of the simultaneous mode, the interpreter tends to choose referential expressions which indicate that a particular referent has a lower state of activation in his/her discourse model as compared with the speaker’s. If a higher accessibility marker is used in such a case this can be explained as a misunderstanding, comprehension deficit or loss of information.