The emerging role of tissue plasminogen activator in the management of severe frostbite.

This article presents a small case series demonstrating clinical success with thrombolytic agents for severe frostbite injury to the lower extremities. The authors report three patients with severe frostbite injuries to their distal lower extremities who were managed with urgent interventional radiology and intra-arterial tissue plasminogen activator infusion according to a prespecified protocol. Limbs and digits were successfully salvaged and patients returned to normal activity within 2 weeks. Although further studies are needed, results of this study support a new approach in the management of frostbite: from conservative management and observation to urgent interventional radiology and possible tissue plasminogen activator infusion. A protocol for the management of such injuries is presented.

Female patient self-diagnosis compared with emergency physician diagnosis of urinary tract infection.

BACKGROUND: Urinary tract infection (UTI) is a common emergency department (ED) complaint and self-diagnosis may be possible. OBJECTIVE: The objective was to compare female patient self-diagnosis compared with emergency physician (EP) diagnosis of UTI. METHODS: This was a prospective cohort study in a single urban ED. Women aged 18-64 years with a chief complaint of UTI, urinary frequency, or dysuria who presented to an urban academic ED were enrolled in a convenience sample fashion. Patients completed a written four-question survey by an ED greeter before triage. Charts of respondents were reviewed for demographic, laboratory, and EP diagnosis. RESULTS: Fifty women were enrolled; 100% of patients who were approached participated in the study. Mean age was 33.7 years (standard deviation 13.8). Forty-three patients (86%) had a history of UTI. Forty-one patients (82%) thought they had a UTI on the index visit. Thirty patients (60%) preferred to buy over-the-counter antibiotics for their symptoms instead of seeing a doctor. Fifteen patients (30%) identified a specific antibiotic they would take. Of the 41 patients who thought they had a UTI, 25 (61%) were given that diagnosis. Of the 30 patients who would have preferred over-the-counter antibiotics, 20 (67%) were actually prescribed them. Agreement between EP and women's final impressions was low (κ = 0.11). CONCLUSIONS: There was poor agreement between EP diagnosis and self-diagnosis of UTI. In our ED population, women should be encouraged to seek medical attention to confirm the diagnosis.

The prevalence and risk indicators of uncorrected refractive error and unmet refractive need in Latinos: the Los AngelesLatino Eye Study.

PURPOSE: To determine the age- and sex-specific prevalence and risk indicators of uncorrected refractive error and unmet refractive need among a population-based sample of Latino adults. METHODS: Self-identified Latinos 40 years of age and older (n = 6129) from six census tracts in La Puente, California, underwent a complete ophthalmic examination, and a home-administered questionnaire provided self-reported data on potential risk indicators. Uncorrected refractive error was defined as a >or=2-line improvement with refraction in the better seeing eye. Unmet refractive need was defined as having <20/40 visual acuity in the better seeing eye and achieving >or=20/40 after refraction (definition 1) or having <20/40 visual acuity in the better seeing eye and achieving a >or=2-line improvement with refraction (definition 2). Sex- and age-specific prevalence and significant risk indicators for uncorrected refractive error and unmet refractive need were calculated. RESULTS: The overall prevalence of uncorrected refractive error was 15.1% (n = 926). The overall prevalence of unmet refractive need was 8.9% (n = 213, definition 1) and 9.6% (n = 218, definition 2). The prevalence of uncorrected refractive error and either definition of unmet refractive need increased with age (P < 0.0001). No sex-related difference was present. Older age, <12 years of education, and lack of health insurance were significant independent risk indicators for uncorrected refractive error and unmet refractive need. CONCLUSIONS: The data suggest that the prevalence of uncorrected refractive error and unmet refractive need is high in Latinos of primarily Mexican ancestry. Better education and access to care in older Latinos are likely to decrease the burden of uncorrected refractive error in Latinos.

Sociodemographic factors and age-related macular degeneration in Latinos: the Los Angeles Latino Eye Study.

PURPOSE: To assess the association of various sociodemographic factors and early and advanced (geographic atrophy, exudative) age-related macular degeneration (AMD) in Latinos. DESIGN: Population-based, cross-sectional study METHODS: The study population included Latinos (primarily Mexican-American) aged 40 years and older living in La Puente, California. Sociodemographic factors, obtained from an interviewer-administered questionnaire, included age, sex, Native American ancestry, acculturation, country of birth, employment, income, marital status, health insurance, and education level. All participants underwent complete ophthalmic examination. AMD was diagnosed from stereoscopic macular photographs. Univariate and multivariable logistic regression was used to assess associations between sociodemographic factors and AMD. RESULTS: Gradable retinal photographs from 5875 participants were included. Mean participant age was 54.9 years, 42% were male, and 5% had Native American ancestry. Stepwise logistic regression analyses indicated that age, sex, and being born in the United States were associated with early AMD (odds ratio [OR] = 1.8, 1.8, and 0.80, respectively). Native American ancestry was the associated with any advanced AMD and geographic atrophy (OR = 3.8 and 16.4, respectively). Family history of AMD was also associated with geographic atrophy (OR = 28.1). Acculturation was not associated with AMD. CONCLUSION: Independent risk indicators for the various types of AMD include older age, male sex, being born outside of the United States, Native American ancestry, and a family history of AMD. These risk factors were independent of other possible behavioral factors such as smoking and alcohol consumption.