Heart rate on admission independently predicts in-hospital mortality in acute ischemic stroke patients

Hintergrund: Eine höhere Herzfrequenz ist bei Patienten mit vaskulären Erkrankungen im längerfristigen Verlauf ein prognostisch ungünstiger Faktor und insbesondere mit Mortalität assoziiert. Wir untersuchten, ob die Herzfrequenz bei Aufnahme bei Patienten mit akutem ischämischem Schlaganfall auch mit frühem Tod im Krankenhaus assoziiert ist. Methoden: Über einen Zeitraum von 30 Monaten wurden alle Patienten mit akutem ischämischem Schlaganfall, die auf unserer Stroke Unit behandelt wurden, prospektiv eingeschlossen. Patienten mit Vorhofflimmern bei Aufnahme wurden nicht in die Studie aufgenommen. Wir führten univariate und multiple logistische Regressionsanalysen durch, um einen möglichen Zusammenhang von Herzfrequenz bei Aufnahme mit Mortalität im Krankenhaus zu untersuchen. Die Herzfrequenz wurde dabei sowohl als kontinuierliche als auch als kategorielle Variable (Tertile) modelliert. Ergebnisse: Insgesamt wurden 1335 Patienten in die Studie eingeschlossen (medianes Alter 73 (Interquartilsbereich, IQB 65–81), medianer National Institutes of Health Stroke Scale Punktwert 4 (IQB 2–8), mediane Dauer des Krankenhausaufenthalts 5 Tage (IQB 4–7), weibliches Geschlecht 46%). Die Mortalität während des Krankenhausaufenthalts betrug 2,6%. Im Modell mit der Herzfrequenz als kategorieller Variable war eine Herzfrequenz ≥ 83/min im Vergleich zum Referenztertil (Herzfrequenz ≤ 69/min) unabhängig mit Mortalität im Krankenhaus assoziiert, wobei das Modell für prognostisch ungünstige Faktoren adjustiert war (adjustierte Odds Ratio 4,42, 95%-Konfidenzintervall 1,36–14,42, p=0,01). Im adjustierten Modell mit der Herzfrequenz als kontinuierlicher Variable war das relative Risiko, im Krankenhaus zu versterben, um 40% für jede Steigerung der Herzfrequenz um 10/min erhöht (p = 0,003). Dieser Zusammenhang blieb auch nach Berücksichtigung der Einnahme von Beta-Blockern im multiplen Modell unverändert bestehen. Schlussfolgerung: Bei Patienten mit akutem ischämischem Schlaganfall ist eine höhere Herzfrequenz bei Aufnahme auch nach Berücksichtigung anderer prognostisch ungünstiger Faktoren unabhängig mit einem höheren Risiko, im Krankenhaus zu versterben, assoziiert. Eine höhere Herzfrequenz könnte frühe ungünstige Folgen eines autonomen Ungleichgewichts anzeigen. Die Senkung einer höheren Herzfrequenz könnte ein therapeutisches Ziel bei akutem ischämischem Schlaganfall sein.Background: A higher heart rate is associated with worse outcomes – in particular death – in long term follow-up of patients with vascular diseases. We investigated whether heart rate measured on admission is associated with early in-hospital mortality in acute ischemic stroke patients. Methods: We prospectively enrolled all patients admitted to our hospital with acute ischemic stroke but without atrial fibrillation over a period of 30 months. We conducted univariate and multiple logistic regression analyses to estimate the impact of heart rate on in-hospital mortality. We analysed heart rate as continuous and categorical variable. Results: A total of 1335 patients (median age 73 (IQR 65–81), median National Institutes of Health Stroke Scale score 4 (IQR 2–8), median length of stay 5 days (IQR 4–7), female sex 46%) were studied. In-hospital mortality was 2.6%. When analyzed as categorical variable, heart rate ≥83 bpm was independently associated with in-hospital mortality after adjustment for predictors of poor outcome compared to the reference tertile (heart rate ≤69 bpm) (adjusted odds ratio 4.42, 95% CI 1.36–14.42, p= 0.01). When heart rate was modelled as continuous variable, relative risk for in-hospital death was elevated by 40% for every additional 10-bpm (p = 0.003). Including beta-blockers as covariate into the multiple regression model did not change the main results. Conclusions: Heart rate on admission is independently associated with in-hospital mortality in acute ischemic stroke patients suggesting early negative effects of autonomic imbalance. Heart rate may represent a therapeutic target to improve outcome after ischemic stroke

A rare cause of acute abdomen: radiotherapy-induced bladder rupture

Introduction: Spontaneous intraperitoneal rupture of the bladder, which is rare, is a life-threatening condition. In emergency services, when patients present with lower quadrant abdominal pain and acute renal failure in the patient's laboratory findings consistent with curriculum vitae should be suspected if there is a history of radiotherapy. A cystography is the most accurate and precise method to make a diagnosis. The definitive solution is surgery, which depends on the condition of the patient.Case Report: A 52-years-old female patient with diffuse abdominal pain applied to our emergency department with complaints of high fever and hematuria. The fact that operated from cervical cancer medical history and undergone radiotherapy was learned. A physical examination of the abdomen and midline defects detected a urine-like liquid coming from the defect. Cystography was also performed because of being macroscopic hematuria to patient, and bladder rupture was detected.Conclusion: The aim of this phenomenon in our presentation. If patients who present to the emergency department with acute renal failure and peritonitis with a medical history of radiotherapy have a history of pelvic radiotherapy in the curriculum vitae with acute renal failure and peritonitis emergency signs, spontaneous rupture of the bladder is to emphasize that occur years after radiation therapy should be considered

Reflective Documentation as a Movement Potential: Two Digital Platforms Building a Professional Learning Community

Creating dance and training dancers is a collaborative and co-creative process, and teaching has a central role in the co-creative artistic processes. Yet dance teachers, whether free-lance or working in an institution, often develop and maintain their physical teaching practice in isolation. Additionally, because of the ephemeral nature of dance and the relational nature of dance education, these practices usually do not end up being recorded or documented as a body of knowledge. In the face of such a reality the online database IDOCDE.net provides a platform for the development and maintenance of an inclusive professional learning community through a process of shared documentation. Its sister digital publication MINDTHEDANCE.com guides the reader towards development of a personal and sustainable documentation practice. IDOCDE.net seeks to establish a knowledge base, a living archive and encourages collaboration and dialogue for fostering of both individual practice and the work field. MIND THE DANCE inspires educators to develop their personal, creative and reflective documentation practice via a variety of examples from professionals from different backgrounds, covering a wide range of approaches from writing, drawing, notating, video art to creating scores and templates. This article examines these digital publications and how they influence a meaningful and creative approach to reflective documentation

Evaluation of stereopsis in children with corrected anisometropia according to type, severity, and presence of amblyopia

Objective: This study was designed to determine the level of stereopsis in anisometropic children with and without amblyopia who used corrective glasses and to investigate the effect of the type and magnitude of anisometropia on the level of stereopsis. Materials and Methods: The medical records of 256 children with a diagnosis of non-amblyopic anisometropia or anisometropic amblyopia, and healthy controls were retrospectively reviewed for this study. Anisometropia was categorized into 3 groups: spherical equivalent-only anisometropia, astigmatic-only anisometropia, or combined anisometropia. The level of stereopsis was measured using the Titmus stereo test, compared between groups, and the correlation of the stereopsis with the magnitude of anisometropia was analyzed. Results: Patients in the non-amblyopic anisometropia group had a similar stereopsis level when compared with the control group (55.2 +/- 41.03 and 47.2 +/- 19.8 seconds of arc, respectively; p=0.223). The level of stereopsis was significantly less in the anisometropic amblyopia group (279.4 +/- 120 seconds of arc) compared with the non-amblyopic anisometropia (55.2 +/- 41.03 seconds of arc) and control groups (47.2 +/- 19.8 seconds of arc) (p=0.008, p=0.006, respectively). A greater spherical equivalent difference between the eyes resulted in poorer stereopsis in the anisometropic amblyopia group, and combined anisometropia was found to be associated with poorer stereopsis levels in the nonamblyopic anisometropia (NA) group. Conclusion: The NA patients had a similar level of stereopsis compared with controls while wearing corrective glasses. This result suggests that as long as patients have good visual acuity, stereopsis is preserved, and that refractive correction with glasses does not interfere with stereopsis in childhood anisometropia

A comparison of dexmedetomidine, moxonidine and alpha-methyldopa effects on acute, lethal cocaine toxicity

Background: The treatment of cocaine toxicity is an important subject for emergency physicians. We investigated the effects of dexmedetomidine, moxonidine and alpha-methyldopa on acute cocaine toxicity in mice. Objectives: The aim of this study was to evaluate the effects of dexmedetomidine, moxonidine and alpha-methyldopa in a mouse model of acute cocaine toxicity. Materials and Methods: We performed an experiment consisting of four groups (n = 25 each). The first group received normal saline solution, the second group received 40 μg/kg of dexmedetomidine, the third group received 0.1 mg/kg of moxonidine and the fourth group received 200 mg/kg of alpha-methyldopa, all of which were intraperitoneally administered 10 minutes before cocaine hydrochloride (105 mg/kg). All animals were observed for seizures (popcorn jumping, tonic-clonic activity, or a loss of the righting reflex) and lethality over the 30 minutes following cocaine treatment. Results: The ratio of animals with convulsions was lower in all treated groups when compared to the control (P 0.05). In addition, the time to lethality was also longer in the same group (P < 0.001). Conclusions: The present study provides the first experimental evidence in support of dexmedetomidine treatment for cocaine-induced seizures. Premedication with dexmedetomidine reduces seizure activity in a mouse model of acute cocaine toxicity. In addition, while dexmedetomidine may be effective, moxonidine and alpha-methyldopa did not effectively prevent cocaine-induced lethality. © 2015, Iranian Red Crescent Medical Journal

Standardized classification of mechanical ocular injuries: Efficacy and shortfalls

Objectives: The aim of this study was to examine the efficacy and the shortfalls of the Birmingham Eye Trauma Terminology classification system for ocular trauma in predicting the visual outcome. Methods: The records of 256 eyes of 246 patients with a diagnosis of mechanical ocular trauma admitted to the Osman Gazi University Hospital ophthalmology department between 1995 and 2000 were retrospectively reviewed. The zone, type, grade, and pupil status of the injuries were determined according to the Birmingham classification system. Injuries with a good prognosis were defined as injuries that resulted in vision of equal to or better than counting fingers at 1 meter. Fischer’s exact test was used to determine the statistical significance of relationships between the final visual acuity and the initial clinical findings. Results: Open eye injuries restricted to zone I, those with no afferent pupillary defect, and those graded as 3 or better or classed as type B were significantly associated with a better visual outcome (p<0.05). Open eye injuries that extended to zone III, had an afferent pupillary defect, or were graded as 4 or worse were significantly associated with a poorer visual outcome (p<0.05). Closed eye injuries classified as type B or grade 4 were significantly associated with a poor visual outcome (p<0.05). Conclusion: The Birmingham classification system for mechanical ocular trauma offers a standardized method for both open and closed eye injuries, however, adding subclasses to type C (injuries with foreign body involvement) could enhance the classification method and help to understand the influence of foreign body properties and sizes on the outcome

The objectives of disaster education from teachers’ perspectives

This study aims to examine teachers’ judgments on the objectives of disaster education regarding basic three aspects; clarity, measurability and attainability. A 3-point Likert-type scale was developed, and completed by 142 teachers who participated in several in-service trainings about disaster education. Descriptive statistics were carried out to analyze the data. Results of this study revealed that there was no single objective that teachers perceived as clear, measurable and attainable at one hundred percent. So, there is an urgent need to do a comprehensive list of learning objectives in a way that they are perceived clearer, more measureable and attainable for the purpose of achieving a well-qualified disaster education including all domains of disaster education, namely cognitive, affective and psychomotor