Nasal Carriage of 200 Patients with Nasal Bone Fracture in Korea

BACKGROUND: Pathogens in the nasal cavity during nasal surgery could lead to a systemic infectious condition, such as bacteremia, nosocomial infection, or toxic shock syndrome. However, there is no research about the prevalence of nasal carriage in patients with nasal bone fracture. METHODS: This was a prospective, double-blind, randomized study about the rate of nasal carriage in 200 patients with nasal bone fracture in Korea. Nasal secretions were taken from both the middle nasal meatus and colonized. All analyses were carried out using SPSS software. RESULTS: Pathogens were identified in 178 of the 200 cases. Coagulase-negative staphylococci (CNS) were the most cultured bacteria in 127 (66.84%) of the 190 total patients after excluding 10 cases of contaminated samples, and methicillin-resistant coagulase-negative staphylococci (MRCNS) were found in 48 (25.26%). Staphylococcus aureus was the second most identified pathogen, found in 36 (18.95%), followed by 7 cases (3.68%) of methicillin-resistant Staphylococcus aureus (MRSA). The prevalence rate of MRSA in the females was higher than that in the males (RR=4.70; 95% CI, 1.09-20.18), but other demographic factors had no effect on the prevalence rate of MRSA and MRCNS. CONCLUSIONS: The prevalence rate of these pathogens in patients with nasal bone fracture in Korea was similar to other reports. However, few studies have addressed the prevalence rate of CNS and MRCNS in accordance with risk factors or the change in prevalence according to specific prophylaxis against infectious complications. Additional research is needed on the potential connections between clinical factors and microbiological data.

Cognitive Perceptual Assessment Tool for Evaluation of Driving Ability of Persons with Brain Injury

OBJECTIVE: To develop an evaluation tool of cognitive perceptual function for safe driving of the brain injured patients and to check the suitability of the tool. METHOD: Cognitive Perceptual Assessment for Driving (CPAD) was constructed with 8 tasks of depth perception, sustained attention, divided attention, Stroop test, digit span test, field dependence, trail making test A, and trail making test B. The predriving assessment with CPAD and road test were applied to 101 brain injured patients. The reliability and the validity of CPAD, and the cut-off score to resume driving were determined. RESULTS: The CPAD scores of pass group (n=46) and fail group (n=55) for on-road test were 51.67+/-5.53 and 44.30+/-8.44 respectively (p=0.0001). The internal consistency of the CPAD measured by Cronbach's alpha was 0.85. The cut-off score based on 95% confidence interval was 53 or above for pass group, 42 or below for fail group, 43~52 for borderline group. The positive and negative predictive value was 90.7% and 50.3%, respectively. CONCLUSION: The CPAD could be useful for the evaluation of driving ability of persons with brain injury.

Development and Application of Cognitive Perceptual Assessment for Driving of People with Brain Injury - Comparison with Cognitive Behavioral Driver's Inventory

OBJECTIVE: We developed the Cognitive Perceptual Assessment for Driving (CPAD) to assess the driving ability of people with acquired brain injury. To find out the usefulness of this tool as a screening test for safe driving, we compared it with the Cognitive Behavioral Driver's Inventory (CBDI). METHOD: Subjects were 101 people with acquired brain injury who had driven a car before the injury. Each subject was evaluated with CPAD and CBDI. CPAD consisted of 8 tasks and 10 variables. We calculated CPAD score using 10 variables and compared CPAD with CBDI result and score. RESULTS: The average CPAD score was 49.65 7.97. According to CBDI test, the number of CBDI passing group was 36, borderline group was 27, and failing group was 38. CPAD variables and score showed significant correlation with CBDI score (p<0.05). There was significant difference in CPAD variables and score among the 3 groups (p<0.05). CONCLUSION: CPAD can be a useful tool for assessing the driving ability of the people with acquired brain injury.

Driving State of the Brain Injured after Driver Training Program at the National Rehabilitation Center

OBJECTIVE: To investigate the actual driving state of the brain injured who had received driver training program. METHOD: We conducted a follow up survey with 64 brain injured who had received driver training program at the National Rehabilitation Center. 29 subjects were first attempting to obtain a license (First obtaining group) while 35 subjects were trying to re-obtain a license after being handicapped (Re-obtaining group). The contents of the survey were compared between first obtaining group and re-obtaining group, and between hemiplegic side. RESULTS: 41 subjects obtained license in regard to the total 64 subjects in which 39% of theses were actually driving. Licensed rate was 55% for first obtaining group and 71% for re-obtaining group. Driving rate was 56% for first obtaining group and 28% for re-obtaining group. Comparing to hemiplegic side, left hemiplegics (54%) showed a tendency to have higher rate of accident than right hemiplegics (0%) without statistical significance. CONCLUSION: Licensed rate of the brain injured was 64%, and driving rate and accident rate were 39% and 38%, respectively. Left hemiplegics, especially, had a higher rate of accident than right hemiplegics.

Effects of Gabapentin (Neurontin(R)) in the Post-Stroke Reflex Sympathetic Dystrophy

OBJECTIVE: To evaluate effects of gabapentin in post-stroke reflex sympathetic dystrophy (RSD). METHOD: To 20 RSD patients after stroke, gabapentin was administrated. We started medication with 300 mg per day and increased dosage by 300 mg per two days up to maximum 900~1,200 mg. We evaluated RSD symptom severities with hand pain, hand swelling and shoulder pain before gabapentin administration. Severity of each symptoms was graded and scored (0: no pain/swelling, 1: mild, 2: moderate, 3: severe). Severities of RSD symptoms were reevaluated on every dose increasing and on 1 week, 2 weeks and 4 weeks later after administrating maximum dosage. We defined as no effect group didn't have any improvement in symptom severity score in comparison with baseline score. Medications other than gabapentin were administrated in no effect group. RESULTS: Among 19 subjects whom we could follow-up, 4 subjects were defined as no effect group. 15 (78.9%) subjects showed improvement in symptom severity score. Statistically significant symptom improvements were observed after 4 weeks in comparison with baseline in hand pain and shoulder pain (p=0.000). From gabapentin 300~600 mg dosage, hand and shoulder pain showed significant pain decrease. Improvement of hand edema was observed after 4 weeks, but it was statistically insignificant. CONCLUSION: We conclude the gabapentin is effective for RSD pain, however further control study is required.