scholarly journals LO010: Clinical assessment of transient ischemic attack patients for symptomatic carotid disease in the emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S33-S33
Author(s):  
N. Motamedi ◽  
K. Abdulaziz ◽  
M. Sharma ◽  
J.J. Perry
Keyword(s):  
Carotid Stenosis ◽  
Clinical Features ◽  
Univariate Analysis ◽  
Disease Diagnosis ◽  
Older Age ◽  
Carotid Disease ◽  
Multicenter Cohort Study ◽  
Symptomatic Carotid ◽  
History Of ◽  
Male Sex

Introduction: TIAs precede about 30% of strokes, with 4-10% having a stroke within 90 days of their TIA. In patients with a TIA due to symptomatic carotid disease, diagnosis and treatment within 2 weeks has been shown to have much better outcomes, while delay beyond 12 weeks no longer reduces subsequent stroke risk. The objective of this study was to determine the clinical findings associated with symptomatic critical disease following an ED visit for TIA to indicate patients requiring prompt carotid imaging. Methods: We performed a prospective Canadian multicenter cohort study, at 13 academic sites, of ED patients with TIA or non-disabling stroke from 2006-2014. Treating ED physicians indicate clinical features on standardized data collection forms. Symptomatic carotid disease was carotid stenosis 50-99%, or carotid dissection, adjudicated by stroke neurology to be the etiology of the index event. Patients were followed by medical review and telephone up to 90 days. Univariate analysis was conducted for clinical features associated with patients who were eventually found to have symptomatic carotid disease as a cause for their TIA. Results: The cohort included 305 patients with and 5,277 without symptomatic carotid disease. Positive predictors of symptomatic carotid disease included older age (74.0 yrs vs 68.0 yrs p<0.0001), male sex (62.9% vs 47.9%; p<0.0001), history of weakness (63.3% vs 41.4%; p<0.0001), language disturbance (52.1% vs 40.0%; p<0.0001), weakness on physical exam (25.5% vs 17.1%; p=0.0002), history of hypertension (74.8% vs 59.5%; p<0.0001), and known history of carotid stenosis (18.9% vs 3.1%; p<0.0001). Negative predictors of symptomatic carotid disease included first ever TIA (56.8% vs 68.8%; p<0.0001), history of altered sensation (39.4% vs 45.8%; p=0.0322), lightheadedness (13.0% vs 22.4%; p=0.0002), and vertigo (3.6% vs 12.7%; p<0.0001). Conclusion: TIA patients with older age, male sex, weakness, language disturbance or history of carotid stenosis need to be promptly imaged to assess for symptomatic carotid disease.

scholarly journals LO012: High-risk investigation findings for symptomatic carotid disease in ED TIA patients

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S34-S34
Author(s):  
N. Motamedi ◽  
K. Abdulaziz ◽  
M. Sharma ◽  
J.J. Perry
Keyword(s):  
Platelet Count ◽  
Blood Glucose ◽  
High Risk ◽  
Carotid Stenosis ◽  
Univariate Analysis ◽  
Carotid Disease ◽  
Multicenter Cohort Study ◽  
Symptomatic Carotid ◽  
Acute Infarction ◽  
Large Vessel Disease

Introduction: About 20% of TIAs are due to large vessel disease. Carotid stenosis >50% which is causing a TIA or stroke needs to be definitely managed quickly in order to benefit. Alternatively, dual antiplatelet therapy may be considered. The objective of this study was to determine high-risk diagnostic findings associated with symptomatic carotid disease in ED patients with TIA to indicate patients requiring urgent carotid imaging. Methods: We performed a prospective Canadian multicenter cohort study, at 13 academic sites, of ED patients with TIA or non-disabling stroke from 2006-2014. Study research nurses recorded imaging findings on standardized data collection forms from the final reports of all imaging tests ordered in the ED on prospectively enrolled patients by treating emergency physicians. Symptomatic carotid disease was defined as carotid stenosis 50-99% or carotid dissection and was adjudicated by stroke neurology to be the etiology of the index event. Patients were followed by medical review and telephone up to 90 days. Univariate analysis was conducted for investigation results with our primary outcome. Results: The cohort included 305 patients with and 5,277 without symptomatic carotid disease. Positive predictors of symptomatic carotid disease included platelet count over 400 x 109/L (15.3% vs 7.6%; p=0.0095), blood glucose >15 mmol/L (11.4% vs 4.4%; p<0.0001), CT evidence of acute infarction (9.8% vs 4.1%; p<0.0001), CT evidence of old infarction (35.7% vs 24.1%; p<0.0001), and CT evidence of any infarct (43.3% vs 26.7%; p<0.0001). There were no negative predictors of symptomatic carotid disease. Conclusion: High-risk investigation findings suggestive of symptomatic carotid disease in ED TIA patients include platelet count over 400 x 109/L, blood glucose >15 mmol/L, CT evidence of any infarction. Patients with any of these findings should be considered for rapid carotid imaging.

Abstract TP174: Identifying Predictors for Final Diagnosis of Ischemic Events in an Emergency Department Observation Unit

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Arooshi Kumar ◽  
Koto Ishida ◽  
Ava Liberman ◽  
Cen Zhang ◽  
Shadi Yaghi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Features ◽  
Univariate Analysis ◽  
Final Diagnosis ◽  
Minor Stroke ◽  
Symptom Duration ◽  
Facial Weakness ◽  
Presenting Symptoms ◽  
History Of ◽  
Ischemic Events

Introduction: Transient neurologic events have high rates of diagnostic uncertainty. Emergency department observation units (ED-OU) allow an accelerated diagnostic work up for suspected transient ischemic attacks (TIAs). However, clinical decision support regarding which patients to admit to these units is lacking. This study aimed to identify clinical features that differentiate true ischemic events from nonischemic transient neurological attacks (NI-TNA) among patients admitted to an ED-OU for suspected TIA. Methods: A retrospective analysis was performed on consecutive patients admitted to the ED-OU at a single academic center for suspected TIA. Demographics, vascular risk factors, presenting symptoms, and details of the clinical presentation were abstracted from chart review. Final discharge diagnosis was dichotomized to either ischemic event (TIA or minor stroke, TIAMS) or NI-TNA based on the treating vascular neurologist’s final diagnosis. Standard statistical tests were used for comparison testing between the two groups. Significantly different factors with p<0.2 on univariate analysis were carried forward in a multivariable logistic regression model. Results: Of 186 consecutive patients, 101 (54%) had a final diagnosis of NI-TNA and 85 (46%) of TIAMS. The median population ABCD2 score was 4 [IQR 3-4]. On univariate analysis, older age (63 vs. 70, p<0.01), history of atrial fibrillation (AF) (12% vs. 26%, p=0.01), and facial weakness (5% vs. 14% p=0.03) were associated with TIAMS. Headache (24% vs. 12%, p=0.04) and symptom duration>60min (57% vs. 40%, p=0.02) were associated with NI-TNA. On multivariable analysis, only symptom duration>60 minutes predicted NI-TNA (OR 0.39, p=0.04) and only history of AF (OR 2.53, p=0.03) predicted TIAMS. Facial weakness was strongly predictive of TIAMS (OR 3.22, p=0.05), but not significant. Conclusion: We identified two clinical features that distinguished TIAMS from NI-TNA among patients admitted to an ED-OU for suspected TIA.These may be helpful in emergency room triage of TIAMS. Data from ED-OU can be used to identify factors associated with cerebral ischemia and improve current care pathways for patients with suspected TIA, so diagnostic evaluation is received in the most appropriate setting.

Conjunctival melanoma: Risk factors for recurrent or new tumor in 540 patients at a single ocular oncology center

2020 ◽  
pp. 112067212097039
Author(s):  
Sarangdev Vaidya ◽  
Lauren A Dalvin ◽  
Antonio Yaghy ◽  
Richard Pacheco ◽  
Jerry A Shields ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Tumor Location ◽  
Tumor Formation ◽  
Older Age ◽  
Conjunctival Melanoma ◽  
Secondary Tumor ◽  
Unit Increase ◽  
History Of

Purpose: To investigate risk factors for recurrent or new tumor in patients with conjunctival melanoma. Methods: Retrospective review of patients with conjunctival melanoma managed on the Ocular Oncology Service, Wills Eye Hospital from 1974 to 2019. Results: There were 540 patients with mean follow-up of 57.6 months, of whom 176 (33%) had recurrent or new tumor formation. Risk factors for recurrent or new tumor on univariate analysis included presentation at older age (OR: 1.02 [1.01–1.03] per 1-year increase in age, p = 0.002), history of prior conjunctival surgery (OR: 1.62 [1.05–2.49], p = 0.03), worse visual acuity at presentation (OR: 1.76 [1.04–2.98] per 1 log-unit increase, p = 0.04), more advanced AJCC clinical T-subcategory (OR: 1.08 [1.02–1.14] per 1 subcategory increase, p = 0.01), tumor primary location in tarsal conjunctiva (OR: 1.80 [1.09–2.98], p = 0.02), and secondary tumor involvement of the fornix (OR: 1.68 [1.06–2.65], p = 0.03), and eyelid (OR: 1.92 [1.07–3.43], p = 0.03). Risk factors on multivariate analysis using all demographics, clinical features, and tumor location included presentation at older age (OR: 1.02 [1.00–1.03], p = 0.01), history of prior conjunctival surgery (OR: 1.84 [1.16–2.94], p = 0.01), and more advanced AJCC clinical T-subcategory (OR: 1.07 [1.01–1.13] per one subcategory increase, p = 0.03). Conclusion: On multivariate analysis, the strongest predictors of recurrent or new tumor formation following treatment of conjunctival melanoma included older age, history of prior conjunctival surgery, and advanced AJCC T-subcategory. These results suggest that earlier detection and the first surgery in conjunctival melanoma management are critical for prevention of recurrent or new tumor, and we recommend prompt referral to an experienced surgeon.

Current Status of Carotid Endarterectomy for Atheromatous Disease

Neurosurgery ◽  
1983 ◽  
Vol 13 (6) ◽  
pp. 718-723 ◽  
Author(s):  
Christopher M. Loftus ◽  
Donald O. Quest
Keyword(s):  
Surgical Treatment ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Neurological Deficit ◽  
Carotid Occlusion ◽  
Current Status ◽  
Carotid Surgery ◽  
Transient Ischemic Attacks ◽  
Carotid Disease ◽  
Symptomatic Carotid

Abstract The authors discuss the indications for both elective and emergency carotid endarterectomy. Reports on the surgical treatment of asymptomatic bruit and contralateral carotid stenosis are reviewed. The results of endarterectomy for symptomatic carotid disease, including transient ischemic attacks, acute neurological deficit, and complete carotid occlusion, are discussed. The complications and risks of carotid surgery are also presented.

scholarly journals Association between assisted reproductive technology and autism spectrum disorders in Iran: a case-control study

2020 ◽  
Vol 63 (9) ◽  
pp. 368-372
Author(s):  
Ensiyeh Jenabi ◽  
Mahdieh Seyedi ◽  
Ronak Hamzehei ◽  
Saeid Bashirian ◽  
Mohammad Rezaei ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Case Control Study ◽  
Univariate Analysis ◽  
Autism Spectrum ◽  
Case Control ◽  
Control Group ◽  
Delivery Mode ◽  
History Of ◽  
Male Sex ◽  
Control Study

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by impairments in social interaction and verbal and nonverbal communication.Purpose: Determine the association between use of assisted reproduction technology (ART) and the risk of ASD among children.Methods: This case-control study included 300 participants (100 cases, 200 controls). The control group included women with a child aged 2–10 years without ASD, while the cases were women with a child aged 2–10 years with ASD. We used a researcher-made questionnaire. Data were analyzed using Stata ver. 14 at the 0.05 significance level.Results: In the univariate analysis, there was significant association between child sex, delivery mode, history of preterm delivery, history of using ART, and maternal age at child’s birth and the risk of ASD. After the adjustment for other variables, this association was significant for male sex (2.66; 95% confidence interval [CI], 1.11–4.31; P=0.001) and history of using ART (4.03; 95% CI, 1.76–9.21; <i>P</i>=0.001). Therefore, after the adjustment for confounder variables, there was no significant association between ART and the risk of ASD among children (4.98; 95% CI, 0.91–27.30; <i>P</i>=0.065).Conclusion: After the adjustment for other variables, risk factors for ASD were male sex and history preterm delivery. Thus, there was no significant association between ART and the risk of ASD among children.

scholarly journals Hypertension and Its Associations with Dental Status: Data from the Dental, Oral, Medical Epidemiological (DOME) Nationwide Records-Based Study

2021 ◽  
Vol 10 (2) ◽  
pp. 176
Author(s):  
Galit Almoznino ◽  
Avraham Zini ◽  
Ron Kedem ◽  
Noam E. Protter ◽  
Dorit Zur ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Multivariate Analysis ◽  
Fatty Liver ◽  
Western Europe ◽  
Univariate Analysis ◽  
Positive Association ◽  
Dental Status ◽  
Older Age ◽  
Birth Country ◽  
Male Sex

Conflicting results have been published regarding the associations between dental status and hypertension. This study aims to explore whether or not hypertension is associated with dental status among young to middle-aged adults. To that end, data from the Dental, Oral, Medical Epidemiological (DOME) study were analyzed. The DOME is a cross-sectional records-based study that combines comprehensive socio-demographic, medical, and dental databases of a nationally representative sample of military personnel. Included were 132,529 subjects aged 18–50 years who attended the military dental clinics for one year. The prevalence of hypertension in the study population was 2.5% (3363/132,529). Following multivariate analysis, the associations between hypertension and dental parameters were lost and hypertension retained a positive association with obesity (Odds ratio (OR) = 4.2 (3.7–4.9)), diabetes mellitus (OR = 4.0 (2.9–5.7)), birth country of Western Europe vs. Israeli birth country (OR = 1.9 (1.6–2.2)), male sex (OR = 1.9 (1.6–2.2)), cardiovascular disease (OR = 1.9 (1.6–2.3)), presence of fatty liver (OR = 1.8 (1.5–2.3)), the birth country Asia vs. Israeli birth country (OR = 1.6 (1.1–2.3)), smoking (OR = 1.2 (1.05–1.4)), and older age (OR = 1.05 (1.04–1.06)). Further analysis among an age-, smoking- and sex matched sub-population (N = 13,452) also revealed that the dental parameters lost their statistically significant association with hypertension following multivariate analysis, and hypertension retained a positive association with diabetes (OR = 4.08 (2.6–6.1)), obesity (OR = 2.7 (2.4–3.2)), birth country of Western Europe vs. Israel (OR = 1.9 (1.6–2.3)), cardiovascular disease (OR = 1.8 (1.5–2.2)), fatty liver (OR = 1.7 (1.3–2.3)), high school education vs. academic (OR = 1.5 (1.3–1.8)), and low socio-economic status (SES) vs. high (OR = 1.4 (1.03–1.8)). We analyzed the associations between C-reactive protein (CRP) and dental parameters and combined the statistically significant variables to create a dental inflammation score (DIS). This crated a final model with the appropriate weights written as follows: DIS = (periodontal disease × 14) + (the number of teeth that required crowns × 11) + (missing teeth × 75). The mean DIS was 10.106 ± 25.184, and it exhibited a weak positive association with hypertension in the univariate analysis (OR = 1.011 (1.010–1.012)). Receiver operating characteristic (ROC) analysis of the DIS against hypertension produced a failed area under the curve (AUC) result (0.57 (0.56–0.58)). Moreover, the DIS also lost its statistical significance association with hypertension following multivariate analysis. We conclude that hypertension had no statistically significant nor clinically significant association with dental status. The study established a profile of the “patient vulnerable to hypertension”, which retained well-known risk factors for hypertension such as older age, male sex, smoking, diabetes, obesity, and fatty liver but not dental parameters.

scholarly journals Study of carotid disease in patients with peripheral artery disease

2014 ◽  
Vol 41 (5) ◽  
pp. 311-318 ◽  
Author(s):  
Leonardo Ghizoni Bez ◽  
Túlio Pinho Navarro
Keyword(s):  
Peripheral Arterial Disease ◽  
Carotid Stenosis ◽  
Carotid Arteries ◽  
Color Doppler ◽  
Univariate Analysis ◽  
Arterial Disease ◽  
History Of ◽  
Artery Disease ◽  
Peripheral Arterial ◽  
Cerebrovascular Symptoms

Objective: To study the stenosis of the carotid arteries in patients with symptomatic peripheral arterial disease.Methods: we assessed 100 consecutive patients with symptomatic peripheral arterial disease in stages of intermittent claudication, rest pain or ulceration. Carotid stenosis was studied by echo-color-doppler, and considered significant when greater than or equal to 50%. We used univariate analysis to select potential predictors of carotid stenosis, later taken to multivariate analysis.Results: The prevalence of carotid stenosis was 84%, being significant in 40% and severe in 17%. The age range was 43-89 years (mean 69.78). Regarding gender, 61% were male and 39% female. Half of the patients had claudication and half had critical ischemia. Regarding risk factors, 86% of patients had hypertension, 66% exposure to smoke, 47% diabetes, 65% dyslipidemia, 24% coronary artery disease, 16% renal failure and 60% had family history of cardiovascular disease. In seven patients, there was a history of ischemic cerebrovascular symptoms in the carotid territory. The presence of cerebrovascular symptoms was statistically significant in influencing the degree of stenosis in the carotid arteries (p = 0.02 at overall assessment and p = 0.05 in the subgroups of significant and non-significant stenoses).Conclusion: the study of the carotid arteries by duplex scan examination is of paramount importance in the evaluation of patients with symptomatic peripheral arterial disease, and should be systematically conducted in the study of such patients.

A retropective analysis of colorectal cancer in adolescents and young adults: A report from the Surgical Committee of the Children's Oncology Group

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9568-9568
Author(s):  
M. P. La Quaglia ◽  
M. Morris ◽  
J. Shia ◽  
K. Idrees ◽  
S. Rosenberg ◽  
...  
Keyword(s):  
Overall Survival ◽  
Family History ◽  
Clinical Features ◽  
Univariate Analysis ◽  
Signet Ring Cell ◽  
Cox Proportional Hazards ◽  
Rank Test ◽  
R0 Resection ◽  
Oncology Group ◽  
History Of

9568 Background: The genetic origin, clinical features, and prognosis of early onset colorectal carcinomas (CRC diagnosed ≤ 30 years of age) are poorly understood. To evaluate these parameters, we performed a multi-institutional review. Methods: This is a retrospective review accomplished through a survey of Children's Oncology Group Institutions. 167 patients (median age=21yrs., range 10–30 yrs.) with adequate material were reviewed. Immunostaining for mismatch repair (MMR) proteins (MSH2, MLH1, MSH6, PMS1) was performed for 119 cases with sufficient archival tumor. Survival estimates were computed using Kaplan Meier methodology and associations assessed using a log-rank test or Cox proportional hazards. Results: The overall stage of disease at presentation: 9% stage I, 16% stage II, 34% stage III, 38% stage IV, and 4% unknown. Site of origin in the colon included: 17% right, 8% transverse, 14% left, 15% sigmoid, 37% rectosigmoid or rectum, and 9% unknown. 37% of cancers were poorly differentiated and 23% had signet ring cell features. A family history of CRC was reported in 46 (40%) of 114 patients for whom data were available. HNPCC criteria (Amsterdam II) were met in only 10 of these cases. MMR protein expression was deficient in 20 of 119 evaluable cases (17%) and was correlated to HNPCC status (P<0.0001) but not to other clinical features. R0 resection was accomplished in 115 patients. Of 159 patients with follow-up data the median survival was 44 mos. (95% CI: 31–65mos.). The 1, 3, and 5-year overall survival were 81%, 54%, and 42% respectively. Variables associated with overall survival in univariate analysis included: age (p=0.02), family history of CRC (P=0.03), HNPCC status (P=0.03), stage (P<0.0001), grade (P=0.0003), and R0 status (P<0.0001). Conclusions: CRC in this age group is associated with clinical features distinct from adult CRC, including advanced stage, high grade pathology, and poor survival. The majority of cases occur sporadically, and less than 25% can be associated with HNPCC either by clinical criteria or by MMR immunostaining. Future studies should pursue more detailed molecular characterization, improved detection strategies, and better treatment to improve outcome for these aggressive cancers. No significant financial relationships to disclose.

The Importance of Two-Step Tuberculin Skin Testing for Newly Employed Healthcare Workers

2006 ◽  
Vol 27 (5) ◽  
pp. 512-514 ◽  
Author(s):  
Elizabeth C. Frenzel ◽  
Georgia A. Thomas ◽  
Hend A. Hanna
Keyword(s):  
Tuberculin Skin Test ◽  
Skin Test ◽  
Healthcare Workers ◽  
Skin Testing ◽  
Older Age ◽  
Second Step ◽  
Tuberculin Skin Testing ◽  
Test Results ◽  
History Of ◽  
Male Sex

At the time of hire, 4059 of 6522 healthcare workers required a 2-step tuberculin skin test; 114 workers (2.8%) demonstrated a boosted reaction after the second step. Boosted reactions were significantly associated with male sex and older age. A verbal history of previous tuberculin skin test results was not a reliable indicator of baseline tuberculin skin test status at the time of hire.

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