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

Early recurrent ischemic lesions in patients with cryptogenic stroke and patent foramen ovale: an observational study

Background: Randomized controlled trials indicate that patent foramen ovate (PFO) closure reduces risk of stroke recurrence in patients with cryptogenic stroke and PFO. However, the optimal time point for PFO closure is unknown and depends on the risk of stroke recurrence. Objective: We aimed to investigate risk of early new ischemic lesions on cerebral magnetic resonance imaging (MRI) in cryptogenic stroke patients with and without PFO. Methods: Cryptogenic stroke patients underwent serial MRI examinations within 1 week after symptom onset to detect early new ischemic lesions. Diffusion-weighted imaging (DWI) lesions were delineated, co-registered, and analyzed visually for new hyperintensities by raters blinded to clinical details. A PFO was classified as stroke-related in patients with PFO and a Risk of Paradoxical Embolism (RoPE) score >5 points. Results: Out of 80 cryptogenic stroke patients, risk of early recurrent DWI lesions was not significantly different in cryptogenic stroke patients with and without PFO. Similar results were observed in patients <= 60 years of age. Patients with a stroke-related PFO even had a significantly lower risk of early recurrent ischemic lesions compared to all other patients with cryptogenic stroke (unadjusted odds ratio 0.23 [95% confidence interval 0.06-0.87], P = 0.030). Conclusion: Our data argue against a high risk of early stroke recurrence in patients with cryptogenic stroke and PFO

A Score for Risk of Thrombolysis-Associated Hemorrhage Including Pretreatment with Statins

Background: Symptomatic intracranial hemorrhage (sICH) after intravenous thrombolysis with recombinant tissue-plasminogen activator (rt-PA) for acute ischemic stroke is associated with a poor functional outcome. We aimed to develop a score assessing risk of sICH including novel putative predictors—namely, pretreatment with statins and severe renal impairment. Methods: We analyzed our local cohort (Berlin) of patients receiving rt-PA for acute ischemic stroke between 2006 and 2016. Outcome was sICH according to ECASS-III criteria. A multiple regression model identified variables associated with sICH and receiver operating characteristics were calculated for the best discriminatory model for sICH. The model was validated in an independent thrombolysis cohort (Basel). Results: sICH occurred in 53 (4.0%) of 1,336 patients in the derivation cohort. Age, baseline National Institutes of Health Stroke Scale, systolic blood pressure on admission, blood glucose on admission, and prior medication with medium- or high-dose statins were associated with sICH and included into the risk of intracranial hemorrhage score. The validation cohort included 983 patients of whom 33 (3.4%) had a sICH. c-Statistics for sICH was 0.72 (95% CI 0.66–0.79) in the derivation cohort and 0.69 (95% CI 0.60–0.77) in the independent validation cohort. Inclusion of severe renal impairment did not improve the score. Conclusion: We developed a simple score with fair discriminating capability to predict rt-PA- related sICH by adding prior statin use to known prognostic factors of sICH. This score may help clinicians to identify patients with higher risk of sICH requiring intensive monitoring

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

Bullying Among Special Education Students

The purpose of the study is to examine traditional and cyberbullying among the students with special education needs attending special education schools. Additionally, traditional and cyber victimization among special education students have been examined in terms of gender and grade levels. A sample of the present study consists of 295 students with special education needs (177 gifted, 118 deaf) attending segregated special education schools. The Revised Olweus Bully/Victim Questionnaire, the Revised Cyber Bullying Inventory-II, the Strengths and Difficulties Questionnaire, and a demographic data sheet were employed to collect data. Results of the study indicated that of the total 295 students with special education needs, 28.1% of the students with special education needs were bullies and 39.3% were victims of traditional bullying. Furthermore, 13.5% of the students with special education needs were identified as cyberbullies, and 23.3% of them were found as cybervictims. When gender and grade level were examined in regard to traditional and cyber victimization, significant gender differences were found in 9 and 10 grade levels. Male students with special education needs obtained higher scores for victimization than female students with special education needs. The results of the study were discussed in the light of literature

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

TV news induced fears of Turkish children: Reports from mothers and children

This study examined children’s fear responses to everyday TV news with regards to the following: a) the consistency between mothers’ observations and children’s reports on TV induced fears, b) the relationships between TV news contents that frighten children with regards to their age and gender, and c) the most common fearful coverage of TV news for children. In the study a quantitative research design was adopted. Television News Induced Fright Scale (TNIFS) and a demographic information form were administered to 186 mothers and their 186 children (ages from 8 to 13). Findings revealed inconsistency between responses of mothers and their children about children’s TV news induced fears. Mothers overestimate their children’s TV news induced fears regarding in terms of news coverage of interpersonal violence, war and suffering, fires and accidents and fantasy characters. Gender but not age differences were found. “Children and animals who get hurt”, “kidnapped children”, and “starving children in poor countries” were reported by children as some of the most fearful news coverages