Tetanus: a retrospective study of clinical presentations and outcomes in a medical teaching hospital.

BACKGROUND: Tetanus has been a serious infectious disease with high mortality and morbidity. Some clinical factors can predict its severity. OBJECTIVE: Survey the clinical profiles, their correlation with the severity of tetanus and the final outcomes after treatment. MATERIAL AND METHOD: A retrospective study of the medical records of patients with tetanus who attended Songklanagarind hospital between January 1982 and June 2008 was done. The correlation between clinical profiles and severity was analyzed by Fisher exact test to detect the significant correlation (p < 0.05). RESULTS: Forty-seven cases of tetanus, composed of 36 male and 11 female patients, were reviewed. The mean age of onset was 45.5 years (SD = 19.6 years). Generalized tetanus was the most common form found (91.4%). History of injury or wound was reported in 80.8%. Age over sixty, puncture wound, onset time of less than seven days, and generalized tetanus, significantly correlated with clinical severity. Only two cases died, but the rest of the cases had residual muscle rigidity after treatment. CONCLUSION: The overall clinical features of tetanus and their correlation with the disease severity were presented. Unlike in the past, patients with tetanus can now be reversible under appropriate intensive critical care.

Comparing the effects of rehabilitation swallowing therapy vs. neuromuscular electrical stimulation therapy among stroke patients with persistent pharyngeal dysphagia: a randomized controlled study.

BACKGROUND: Dysphagia after stroke is associated with increased mortality, higher dependence, and longer hospitalization. Different therapeutic strategies have been introduced to improve swallowing impairment. There are no current studies that compare rehabilitation swallowing therapy (RST) and neuromuscular electrical stimulation therapy (NMES). OBJECTIVE: To compare treatment outcomes between RST and NMES intervention in stroke patients with pharyngeal dysphagia. STUDY DESIGN: A randomized controlled study. MATERIAL AND METHOD: Twenty-three stroke patients with persistent pharyngeal dysphagia (RST 11, NMES 12) were enrolled in the present study. The subjects received 60 minutes of either RST or NMES treatment for five consecutive days, had two days off and then five more consecutive days of treatment for a four-week period or until they reached functional oral intake scale (FOIS) level 7. The outcome measures assessed were change in FOIS, complications related to the treatment and number of therapy sessions. RESULTS: There were no significant differences in the stroke characteristics and the VFSS results between the two groups. At the end of treatment, the average numbers of therapy sessions per subject in the RST and NMES groups were 18.36 +/- 3.23 and 17.25 +/- 5.64, respectively, a non-significant difference. Average changes in FOIS scores were 2.46 +/- 1.04 for the RST group and 3.17 +/- 1.27 for the NMES group, statistically significant at p < 0.001. No complications were observed in either group. CONCLUSION: While both RST and NMES therapy showed a positive effect in the treatment of persistent dysphagia in stroke patients, NMES was significantly superior.

Clinical prognostic factors for treatment outcome in Bell's palsy: a prospective study.

OBJECTIVE: To evaluate the clinical factors for predicting the outcome in Bell's palsy patients treated by oral prednisolone. DESIGN: Prospective study in a tertiary-care neurological hospital. MATERIAL AND METHOD: Three hundred and eighty cases of acute unilateral lower motor neuron type of facial palsy were enrolled initially from a neurological clinic. After exclusion of the unfulfilled criteria cases, 201 cases of Bell's palsy completed the study protocol and were followed for six months after a seven-day course of 60 mg/day followed by a five-day taper-off dosage of oral prednisolone. A modified House-Brackman facial paralysis grading system was used to evaluate the recovery of facial weakness in the serial follow-up examination. Correlation between demographic data, clinical presenting symptoms and signs, and the final outcome were analyzed by multiple logistic regressions to determine the significant clinical prognostic factors. RESULTS: There was a significant overall recovery of the facial weakness in succession throughout the 12 weeks of the follow-up period. The mean facial muscle scores approached the level of favorable outcome at the twelfth week after treatment. Duration between onset and treatment longer than seven days (RR = 18.87, 95% CI = 4.97-71.53), severe facial paralysis (RR = 5.01, 95% CI = 2.52-9.95), hearing defect (RR = 3.01, 95% CI = 1.16-7.84), and history of recurrence (RR = 3.75, 95% CI=1.21-11.59) were the significant prognostic factors for unfavorable outcome of treatment (p < 0. 05). CONCLUSION: Delayed in initiation of oral prednisolone, severe facial weakness, hearing defect, and history of recurrence were significant prognostic factors determining the poor outcome. To yield a satisfactory therapeutic result, early treatment of Bell's palsy with oral prednisolone should be recommended in cases of severe facial paralysis.

Type A aortic dissection presenting as acute ischemic stroke caution for thrombolytic therapy: a case report and literatures review.

The authors reported a patient who had type A aortic dissection presenting with sudden onset of right hemiplegia and depressed consciousness. CT scan of brain showed acute cerebral infarction of left corona radiata, posterior limb of left internal capsule combined with left hemispheric brain swelling. An old cerebral infarction at the posterior limb of right internal capsule was also noted Clinical signs of aortic regurgitation and difference in blood pressures and amplitude of pulses on both arms were associated. Initial chest x-ray revealed widening of the mediastinum. CT scan of chest revealed dissecting aorta extending from the ascending aorta to the mid of the descending aorta. Surgical correction of the aorta was refused and the patient was treated medically with partial neurological deficit. No additional cardiovascular events occurred.