The importance of imaging for status epilepticus patients to rule out fractures – A case report

AbstractStatus epilepticus could be the first presentation of underlying epilepsy or may occur in patients with known epilepsy. The literature has reported many cases of seizures severe enough to cause dislocations or fracture-dislocations of the shoulder or hip joints and death from hemorrhaging. Although shoulder and hip injuries due to seizures are rare, such events are known to occur, especially in patients with a history of osteoporosis or other risk factors for fractures. We describe a case of a 35-year-old healthy male with no history of osteoporosis or reduced bone density. His first presentation of epilepsy manifested with status epilepticus. This prolonged seizure resulted in bilateral acetabular fracture with left proximal humerus fracture without any trauma or falls. Although fractures associated with seizures have been reported in the literature, dislocation and fractures from seizures involving both the hip and the shoulder joints have only been described in a few cases. Two of these cases involved patients with known epilepsy, osteoporosis and osteomalacia. To the best of our knowledge, this is the first described case of a patient with bilateral hip and one shoulder fracture that had no previous history of epilepsy or seizures, except for febrile seizure as a child, which did not requiring any treatment. He was also not taking any antiepileptic medications, which are known to reduce bone density. This case shows the severity of status epilepticus and the importance of screening for fractures in patients, especially in those with risk factors for reduced bone density

The Relationship Between Cardiac Scar and Electrical Markers of Sudden Cardiac Arrest Risk

The optimal approach to identifying patients at risk of serious arrhythmias after myocardial infarction (MI) is unclear. Electrocardiographic markers, including T-wave alternans (TWA) and Heart Rate Turbulence (HRT) and myocardial scar characteristics, assessed via cardiac magnetic resonance (CMR), appear to provide useful information in this regard. However, the relationship between electrical and structural markers is unclear. A meta-analysis was conducted and demonstrated the utility of HRT after MI. In addition, a cross-sectional study was performed to assess the relationships of HRT and TWA with CMR-assessed myocardial scar extent and pattern. A total of 99 patients were enrolled 3-15 months after MI. No linear relationship between TWA and scar was observed. Yet, maximal TWA values were higher in patients with transmural versus non-trans-mural scar; particularly those with anterior, trans-mural scar. HRT slope was not related to myocardial scar. Based on these data, additional research is recommended to better define these relationships.2 year

The Characteristics of Treated Pulmonary Arterial Hypertension Patients in Ontario

Background. There are no Canadian prevalence studies on pulmonary arterial hypertension (PAH) to date. We described the characteristics of treated PAH patients and the healthcare utilization and costs associated with PAH in a population of public drug plan beneficiaries in Ontario, Canada. Methods. A retrospective cross-sectional analysis was conducted between April 2010 and March 2011 to identify treated PAH patients using population-based health administrative databases. We investigated demographic and clinical characteristics of treated PAH patients and conducted a cohort study to determine treatment patterns, healthcare utilization, and associated costs, over a one-year follow-up period (March 2012). Results. We identified 326 treated PAH cases in Ontario’s publicly funded drug plan. Overall mean age was 59.4 years (±20.3 years) and over 77% of cases were women (). Combination therapy was used to treat 22.9% () of cases, costing an average of $4,569 (SD$1,544) per month. Median monthly healthcare costs were $264 (IQR$96–$747) for those who survived and$2,021 (IQR $993–$6,399) for those who died over a one-year period, respectively (). Conclusions. PAH care in Ontario is complex and has high healthcare costs. This data may help guide towards improved patient management.Peer Reviewe

Association of prior outpatient diabetes screening with cardiovascular events and mortality among people with incident diabetes: a population-based cohort study

Abstract Background Outcomes of diabetes screening in contemporary, multi-ethnic populations are unknown. We examined the association of prior outpatient diabetes screening with the risks of cardiovascular events and mortality in Ontario, Canada. Methods We conducted a population-based cohort study using administrative databases among adults aged ≥ 20 years with incident diabetes diagnosed during 2014–2016. The exposure was outpatient diabetes screening performed within 3 years prior to diabetes diagnosis. The co-primary outcomes were (1) a composite of all-cause mortality and hospitalization for myocardial infarction, stroke, coronary revascularization, and (2) all-cause mortality (followed up until 2018). We calculated standardized rates of each outcome and conducted cause-specific hazard modelling to determine the adjusted hazard ratio (HR) of the outcomes, adjusting for prespecified confounders and accounting for the competing risk of death. Results We included 178,753 Ontarians with incident diabetes (70.2% previously screened). Individuals receiving prior screening were older (58.3 versus 53.4 years) and more likely to be women (49.6% versus 40.0%) than previously unscreened individuals. Individuals receiving prior screening had relatively lower standardized event rates than those without prior screening across all outcomes (composite: 12.8 versus 18.1, mortality: 8.2 versus 11.1 per 1000 patient-years). After multivariable adjustment, prior screening was associated with 34% and 32% lower risks of the composite (HR 0.66, 0.63–0.69) and mortality (0.68, 0.64–0.72) outcomes. Among those receiving prior screening, a result in the prediabetes range was associated with lower risks of the composite (0.82, 0.77–0.88) and mortality (0.71, 0.66–0.78) outcomes than a result in the normoglycemic range. Conclusions Previously screened individuals with diabetes had lower risks of cardiovascular events and mortality versus previously unscreened individuals. Better risk assessment tools are needed to support wider and more appropriate uptake of diabetes screening, especially among young adults

Prevalence of nocturia in Parkinson's disease patients from various ethnicities

Objectives: One of the most common non-motor symptoms in Parkinson's disease (PD) is nocturia. This paper seeks to address the prevalence of nocturia in PD and correlate it to various factors such as gender, Hoehn and Yahr (H&Y) stage, age, and ethnicities.\ud \ud Methods: In particular, 332 PD patients were seen in a community movement disorders clinic and their charts were analyzed from 2005 to 2010. Within this population, more than one-third (34·9%) patients were diagnosed with nocturia.\ud \ud Results: Age, gender, and PD stage were significant predictors of nocturia in PD. With every one-year increase in age, the odds of developing nocturia in PD increases by 3·1% while an increase in H&Y stage increases the odds of nocturia in PD by 1·645 times. Also, males had greater odds of experiencing nocturia in PD. Ethnicities alone were of no significant importance. However, after performing interaction analyses, Asian and Indian males, especially, were at significantly greater risk than other ethnicities.\ud \ud Discussion: Future research is indeed required to understand why certain ethnicities are especially at risk. Clinicians must also be aware of the epidemiology of nocturia in PD to prevent and treat this debilitating symptom