Current Issue : January - March Volume : 2013 Issue Number : 1 Articles : 6 Articles
Introduction: Trauma patients with a positive blood alcohol concentration (BAC) are often believed to be at\r\nhigh risk for the alcohol withdrawal syndrome (AWS). Therefore some centers prophylaxis all BAC positive patients.\r\nThis study prospectively measures the incidence of AWS among trauma patients admitted to the hospital who have\r\nconsumed alcohol and determines their risk factors for AWS.\r\nMethods: A cohort of trauma patients admitted to a non-ICU hospital setting was prospectively monitored for\r\nthe development of AWS during the first 10 days of hospitalization. The 10-item Alcohol Use Disorders Identification\r\nTest (AUDIT) and questions about alcohol withdrawal history were administered on the first day and the revised\r\nClinical Institute for Withdrawal of Alcohol Scale (CIWA-Ar) was administered daily.\r\nResults: 113 patients were followed through discharge or for the first 10 days of hospitalization. 74.3% (n = 84)\r\nreported drinking alcohol. Of the 89 patients with a measured BAC, 25 (28%) were positive. Mean BAC for positive\r\npatients was 187.7 mg/dl. No person who denied drinking had a measurable BAC or developed AWS. Among the\r\n84 drinkers, 3 were diagnosed with AWS by CIWA-Ar (3.6% risk), giving an incidence rate of 1.4 episodes per 100\r\npatient days. All patients developing AWS admitted to a previous history of AWS symptoms upon stopping drinking.\r\nAll AWS patients drank at least 2-3 times per week compared to only 37% of drinkers who did not develop AWS (p\r\n= .05). Positive response to dependence items from the AUDIT were highly associated with AWS risk (67% AWS vs\r\n16% non-AWS, p = .005). Implementation of a prophylaxis protocol for all positive BAC would have resulted in 88%\r\n(22/25) of BAC positive patients receiving unwarranted medication.\r\nConclusion: AWS has a low incidence rate among intoxicated trauma patients admitted to a non-ICU setting. It\r\nis associated with frequent drinking and is found in patients who report dependence symptoms. Patients can reliably\r\ntell physicians whether they are at risk for AWS. Routine prophylaxis for positive BAC patients will likely result in\r\nsubstantial excess medication use....
Background: Data on clinical characteristics and outcomes in regard to hip fracture (HF) type are controversial.\r\nThis study aimed to evaluate whether clinical and laboratory predictors of poorer outcomes differ by HF type.\r\nMethods: Prospective evaluation of 761 consecutively admitted patients (mean age 82.3 �± 8.8 years; 74.9%\r\nwomen) with low-trauma non-pathological HF. Clinical characteristics and short-term outcomes were recorded.\r\nHaematological, renal, liver and thyroid status, C-reactive protein, cardiac troponin I, serum 25(OH) vitamin D, PTH,\r\nleptin, adiponectin and resistin were determined.\r\nResults: The cervical compared to the tronchanteric HF group was younger, have higher mean haemoglobin,\r\nalbumin, adiponectin and resistin and lower PTH levels (all P < 0.05). In-hospital mortality, length of hospital stay\r\n(LOS), incidence of post-operative myocardial injury and need of institutionalisation were similar in both groups.\r\nMultivariate analysis revealed as independent predictors for in-hospital death in patient with cervical HF male sex,\r\nhyperparathyroidism and lower leptin levels, while in patients with trochanteric HF only hyperparathyroidism; for\r\npost-operative myocardial injury dementia, smoking and renal impairment in the former group and coronary artery\r\ndisease (CAD), hyperparathyroidism and hypoleptinaemia in the latter; for LOS > 20 days CAD, and age > 75 years\r\nand hyperparathyroidism, respectively. Need of institutionalisation was predicted by age > 75 years and dementia\r\nin both groups and also by hypovitaminosis D in the cervical and by hyperparathyroidism in the trochanteric HF.\r\nConclusions: Clinical characteristics and incidence of poorer short-term outcomes in the two main HF types are\r\nrather similar but risk factors for certain outcomes are site-specific reflecting differences in underlying mechanisms....
Over the past half century there have been few therapeutic breakthroughs for the treatment of spinal cord\r\ninjuries. It has been previously shown that following a Spinal Cord Injury (SCI), scar tissue develops at the site of\r\ninjury through which axons are unable to penetrate to make appropriate neurological connections into the distal\r\nspinal cord. Over the past few years it has been reported that placing the omentum directly on a traumatized spinal\r\ncord can result in a favorable clinical result. The omentum has been shown to limit the development of scar tissue\r\nfollowing SCI, which strongly suggests that omental transposition to an SCI now appears warranted to justify a\r\ncarefully controlled evaluation of the benefits of omental application to an SCI.\r\n\r\nSpinal cord injuries are devastating events. Unfortunately, in spite of improved medical and surgical treatment\r\nof the condition, there has not been a significant improvement in the neurological results of these injuries during\r\nthe past half century. The purpose of this paper is to suggest a surgical technique that might increase functional\r\nimprovement in the future treatment of spinal cord injuries (SCI). A new approach to the problem seems warranted.\r\n\r\nOver a hundred years ago, Ramon y Cajal, the famous neuro-histologist, stated that axons are unable to\r\nconnect to neural structures distal to an SCI based on his observations that axons cannot penetrate through scar\r\ntissue which routinely develops at the site of an SCI [1]. A half century later, Dr. L.H. Freeman, confirmed Cajalââ?¬â?¢s\r\nobservations by showing that axons had the inherent capacity to grow distally within an injured spinal cord (SC),\r\nbut their progress routinely encountered a scar barrier in which axons ââ?¬Å?simply form neuromata at the injury siteââ?¬Â [2].\r\nBased on these observations, if neuro-protection within an SCI is to be addressed, laboratory and clinical efforts\r\nshould be increasingly aimed at preventing the development of scar tissue in an acute SCI and decreasing the scar\r\nbarrier present in a chronic SCI....
Introduction: Protocols for caring for elderly hip fracture patients vary among hospitals. The purpose of this\r\nstudy was to examine two different approaches of care for this patient population at our institution.\r\nMethods: Retrospective review of 389 consecutive patients 65 years and older with the diagnosis of a lowenergy,\r\nhip fracture between January 2006 and May 2010. 227 consecutive patients for which a nonstandard method\r\nof admission (OP) to either medicine (133 patients) or orthopedic service (94 patients) were compared to a new plan\r\nof care (NP) that included 162 consecutive patients in which all patients were admitted to medicine. We evaluated\r\nperioperative complications rates, time to surgery (TTS), and length of hospital stay (LOS).\r\nResults: There were no significant differences in LOS, TTS, 30 day re-admission, rapid response codes,\r\nperioperative complications or death between either model of care. The NP did demonstrate a significant increase in\r\npatients being transfused (51.85% vs. 36.56%) and number of patients being diagnosed with Vitamin D deficiency\r\n(42.12% vs. 20.70%).\r\nConclusion: While our change in protocol did not alter the rate of perioperative complications, nor did it provide\r\nquicker care or shorter hospital stays, it did provide more comprehensive osteoporosis care to our patients....
Objective: To investigate the injury pattern, management and outcome of road traffic injuries in the elderly\r\npatients (60 years and above) involved in motor vehicle accidents and to compare factors associated with trauma\r\nand differences in trauma mortality between elderly and younger adult patients.\r\nMethods: This is a retrospective descriptive study conducted at a teaching hospital during Jun 2002 to Jan\r\n2010, studying the differing pattern, and management of road traffic injuries in patients aged 60 years and above,\r\ndesignated as Group-A, and those below 60 years of age, designated as Group ââ?¬â??B, regardless of gender of the\r\npatients.\r\nAll the patients were referred through casualty and were assessed clinically followed by relevant investigations.\r\nPatients who sustained minor injuries were discharged after necessary treatment while those with serious injuries\r\nrequiring intervention were admitted and managed accordingly. Patients having purely orthopaedic problems like\r\nisolated fractures or spine injuries were also excluded from the study. Treatment was instituted according to the\r\nseverity of the trauma ranging from conservative treatment to laparotomy and chest intubation. The variables studied\r\nincluded demographics of both groups of patients, pattern of injuries sustained in both groups, trauma indices ISS\r\nand GCS, mechanism of injury, major injuries sustained, treatment instituted, mean number of hospital days, and\r\nmorbidity and mortality.\r\nDetails of individual patients were recorded on a proforma and data analyzed statistically on SPSS version 17.\r\nResults: A total 300 patients (Group-A n=149[49.66%] versus Group-B n=151[50.33%]) admitted and\r\nintervened were included in the study. Male patients predominated both the groups (Group-A. [Mean age 66.91, Std\r\n6.859, Males n=115, Females n= 34] vs Group-B [Mean age 35.52, Std 13.814, Males n= 140, Females n= 11]).\r\nThe group-A patients had significantly higher proportion of co-morbidities (p<0.001) compared to group-B patients\r\n(64.42% versus 18.66%). The mortality rises progressively with age and is almost twice as high as in younger\r\npopulation at all levels of severity of trauma. Incidence of chest injuries with rib fractures was more common in elderly\r\nvictims (P<0.001) compared to the younger patients (40.26%) versus (12.58%). The overall in hospital mortality in\r\nGroup-A patients was 14.76% compared to (4.63) in group-B for an almost comparable severity of injuries sustained.\r\nConclusion: The incidence of road traffic accidents is on the rise in the elderly. The elderly patients have a\r\ndifferent pattern of road traffic injuries and they respond poorly to the sustained injuries despite low ISS compared\r\nto the younger patients...
Background: Rapid economic growth in Vietnam over the last decade has led to an increased frequency of road\r\ntraffic injury (RTI), which now represents one of the leading causes of death in the nation. Various efforts toward\r\ninjury prevention have not produced a significant decline in the incidence of RTIs. Our study sought to describe\r\nthe geographic distribution of RTIs in Hanoi, Vietnam and to evaluate the accessibility of trauma centers to those\r\ninjured in the city.\r\nMethods: We performed a cross-sectional study using Hanoi city police reports from 2006 to describe the\r\nepidemiology of RTIs occurring in Hanoi city. Additionally, we identified geographic patterns and determined the\r\ndirect distance from injury sites to trauma centers by applying geographical information system (GIS) software.\r\nFactors associated with the accessibility of trauma centers were evaluated by multivariate regression analysis.\r\nResults: We mapped 1,271 RTIs in Hanoi city. About 40% of RTIs occurred among people 20-29 years of age.\r\nAdditionally, 63% of RTIs were motorcycle-associated incidents. Two peak times of injury occurrence were\r\nobserved: 12 am-4 pm and 8 pm-0 am. ââ?¬Å?Hot spotsââ?¬Â of road traffic injuries/fatalities were identified in the city area\r\nand on main highways using Kernel density estimation. Interestingly, RTIs occurring along the two north-south\r\nmain roads were not within easy access of trauma centers. Further, fatal cases, gender and injury mechanism were\r\nsignificantly associated with the distance between injury location and trauma centers.\r\nConclusions: Geographical patterns of RTIs in Hanoi city differed by gender, time, and injury mechanism; such\r\ninformation may be useful for injury prevention. Specifically, RTIs occurring along the two north-south main roads\r\nhave lower accessibility to trauma centers, thus an emergency medical service system should be established....
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