impact of [admit no bed] and long boarding times in the emergency department on stroke outcome

To examine and test the possible association between boarding time and stroke patients' outcome. This study is a retrospective review of stroke patients presenting to the Emergency Department [ED] of King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia from 2007-2010. We excluded thrombolysis cases and those deemed critically ill. We collected time of stroke onset, ED arrival, decision to admit, and arrival to ward. Boarding time [BT] was defined as time of arrival to ward minus time of decision to admit. Primary outcome [PO] was defined as a composite of mortality, and/or any of post-stroke complications. We included 300 patients with a mean age +/- standard deviation of 69 +/- 12 years, and 66.3% were men. The PO occurred in 37.7%. There was no association between BT and PO [odds ratio [OR] =0.9, p=0.3[, or any of the secondary outcomes, such as, death [OR=0.97, p=0.5], severe disability [OR=0.97, p=0.3], pneumonia [OR=1, p=0.9], urinary tract infection [OR=1,p=0.9], or neurological deterioration [OR=0.8,p=0.1]. Multivariate analysis included gender, age, stroke severity, subtype, hypertension, diabetes, coronary disease, atrial fibrillation, heart failure [HF], onset to ED, BT and ED wait time; only moderate to severe stroke, HF, and previous stroke predicted poor outcome. Although [admit no bed] was not associated with adverse effects, the results should be interpreted with caution, and early admission to the stroke unit should be encouraged

Isolated lateral rectus myositis

Orbital myositis is a rare non-granulomatous inflammatory process within the orbit. Grave's disease and lymphoproliferative disorders are considered the most common cause of orbital myositis. The idiopathic form should be considered after exclusion of known causes or associations. Isolated orbital myositis is a very rare form of this disease. We report a case of an isolated lateral rectus myositis to draw the attention of physicians to this condition, as prompt treatment in our patient resulted in complete recovery

Guillain-Barre syndrome following cardiac surgery. Difficult diagnosis in the intensive care unit

Weakness of limb and respiratory muscles developing in the course of treatment in the intensive care unit [ICU] is commonly due to critical illness polyneuropahty, a complication of sepsis, or critical illness myopathy, a complication of the use of neuromuscular blocking agents and steroids. Guillain-Barre syndrome may rarely occur in this setting. WE report 2 patients identified in our ICU in the last 20 years. Surgery was an apparent precipitating event in both patients. The clinical, electrophysiological, and cerebrospinal fluid features were consistent with this diagnosis. Both patients responded to treatment; the first case was treated with plasmapheresis while the other with intravenous immune globulin. Thus, while rare, it is important to identify this disorder in the ICU because of its response of specific treatment