A comparison of functional outcomes in hypoxia and traumatic brain injury: a pilot study.

We present our experience with 30 patients on functional outcomes of patients with anoxic brain injury (ABI, n=15) due to cardiac etiologies from freestanding inpatient rehabilitation hospital. A convenience sample of patient with traumatic brain injury (TBI, n=15) with similar demographic characteristic to ABI was used for comparison on indices of activity of daily living, cognition, mobility as well as other indices of functional prognosis such as hospital length of stay, cost and discharge predisposition. No statistical significant differences were found between the two groups on the presently employed outcome measures. This investigation supports the positive impact of inpatient rehabilitation for individuals with hypoxia of cardiac etiology. Future research comparing outcomes of ABI to TBI with larger, controlled trials is warranted.

Apathy and depression in cross-cultural survivors of traumatic brain injury.

The disturbance of motivation and its relationship to depression continues to spark contradictory findings among European and North American populations. Could a cross-cultural study shed some light on the situation? This study aims to detect the prevalence of apathy and to test whether the Apathy Evaluation Scale (AES) can spot the presence or absence of depression in survivors of traumatic brain injury (TBI) in Oman. Eighty subjects who sustained a TBI were given an Arabic version of the AES and were also interviewed with the semistructured Composite International Diagnostic Interview (CIDI). The authors found that the incidence of apathy and depression among Omani people who sustained TBI is similar to that reported elsewhere. The AES has poor discriminatory power in identifying cases of depression. These findings emphasize the importance of developing assessment tools that are culturally sensitive in light of the rising incidence of TBI in developing countries such as Oman.

Acquired brain injury, visual attention, and the useful field of view test: A pilot study.

OBJECTIVE: To compare the findings of the Useful Field of View (UFOV) test with those of conventional neuropsychologic tests to determine the utility of the UFOV test as a measure of attention in a population with brain injury. DESIGN: Cohort study. SETTING: Freestanding rehabilitation hospital. PARTICIPANTS: Fifteen inpatients with severe brain injury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: UFOV test, FIM\T instrument, length of stay (LOS), and standard neuropsychologic testing. RESULTS: The UFOV subtest UF2 correlated strongly with the other 2 subtests, UF1 and UF3. The UF2 subtest correlated most strongly with paper and pencil tests of visual attention. The UF2 predicted 52% of the FIM change and 60% of the LOS variance, second only to admission FIM score, which predicted 75% and 80% of FIM change and LOS variance, respectively. CONCLUSIONS: Among the patients in our study, the UFOV test can be used to determine the visual divided attention of patients with acquired brain injury. The results also showed that the UFOV test correlated with LOS and FIM change in patients with acquired brain injury recovering in a rehabilitation facility. Because the UFOV test is much more quickly administered and scored than other measures of attention and divided attention, these results suggest that the UFOV test may provide an easy means to measure a critical variable in the population with head injury.

Functional outcomes following anoxic brain injury: a comparison with traumatic brain injury.

PRIMARY OBJECTIVE: To compare the functional outcomes of patients with anoxic brain injury (ABI) and patients with traumatic brain injury (TBI) following inpatient rehabilitation. RESEARCH DESIGN: Retrospective chart review. METHODS AND PROCEDURES: Data on 68 patients with brain injury (34 with ABI and 34 with TBI) were collected. MAIN OUTCOMES AND RESULTS: The ABI and TBI groups were demographically similar, except that patients with ABI were more likely to be married. Both groups significantly improved their function and were similar upon discharge. For the ABI group, there were trends toward a shorter length of stay, increased total FIM efficiency and decreased cost of stay when compared with the TBI group. The patients with ABI tended to be discharged to a sub-acute rehabilitation facility more than those in the TBI group. CONCLUSIONS: This study is important because it shows that patients with ABI benefit from inpatient rehabilitation and made significant functional gains comparable to the gains of patients with TBI.

Upper-extremity deep vein thrombosis.

Upper-extremity deep vein thrombosis (UEDVT) was an understudied disease until recently. Previously thought of as benign, UEDVT has been shown in recent studies to pose a significant risk for pulmonary embolus and death. This article reviews the epidemiology, risk factors, clinical features, diagnostic tests, treatment options, complications, and prevention strategies for patients with UEDVT.

Outcomes in bilateral and simultaneous quadriceps tendon rupture.

This study reviewed 55 case reports of simultaneous and bilateral quadriceps tendon rupture and analyzed factors related to outcomes. Mean patient age was 52 years and 82% of patients were male. Most patients (76%) had underlying medical conditions predisposing them to rupture and 16 (32%) patients had multiple risk factors. Falls accounted for a majority of injuries (72%) and the osseotendinous junction was frequently the location of the tear (60%). Patients were almost always treated surgically (96%). Gender, mechanism of injury, tear location, and time to diagnosis and repair were not related to outcomes, whereas age, multiple risk factors, and renal or endocrine disease or diabetes were related to outcomes.

Treatment of upper limb deep vein thrombosis with low molecular weight heparin.

Upper limb deep vein thrombosis has been an under-recognized disease; however, physicians' awareness of it as a cause of arm pain and edema is increasing. Previously thought of as benign, upper limb deep vein thrombosis has been shown in recent studies to pose a significant risk for pulmonary embolus and death. The need for treatment is now recognized; however, effective treatments for upper limb deep vein thrombosis have not been fully defined. Anticoagulation with oral agents is known to be successful in preventing complications and recurrence. This report presents the first case of upper limb deep vein thrombosis successfully treated with only low molecular weight heparin.

Upper-extremity deep vein thrombosis and paralysis: a case report.

Upper-extremity deep venous thrombosis (DVT) has been understudied in the rehabilitation population. Patients undergoing rehabilitation often have many risk factors that predispose them to DVT. It is important to recognize upper-extremity DVT, because recent studies have shown it to pose a significant risk for pulmonary embolus and death. This is the first reported association of an upper-extremity DVT with paralysis.

Charcot's joint: an overlooked diagnosis.

Charcot's joint, also known as neuropathic osteoarthropathy, is a common complication of diabetes that often is unrecognized and misdiagnosed. It may be present in up to 35% of patients with diabetic neuropathy. This disorder causes progressive destruction of weight bearing joints leading to dislocations, fractures, and deformities. We report a case of Charcot's joint in a 55-year-old man with type two diabetes. He presented with unilateral foot and ankle swelling, foot pain, warmth, and erythema. A magnetic resonance image of his foot revealed changes consistent with a Charcot's joint. Treatment consisted of joint immobilization in a total contact cast and then an ankle foot orthosis with custom footware. Charcot's joint should be considered in patients with a unilateral, warm, erythematous, swollen foot without other systemic symptoms. Early recognition of a Charcot's joint is important in ultimate outcome. Immobilization of the joint, patient education, and proper footcare and footware are essential in preventing further complications including ulceration and amputation.

Outcomes in patients with Goodpasture's syndrome and hydrocarbon exposure.

Goodpasture's Syndrome has been associated with hydrocarbon exposure. No study has examined outcomes in these patients. All reported cases of Goodpasture's Syndrome and hydrocarbon exposure were identified using MEDLINE and was analyzed for factors related to outcomes. A total of 43 cases were identified since 1969. The mean age of patients was 28 years old. There was a slight predilection for males (60%) when analyzing gender. Various types of hydrocarbons were identified and the duration of exposure varied from minutes to years. A majority of patients (86%) had pulmonary hemorrhage and antiglomerular basement membrane antibodies (AGBM) (92%). Patients were treated with immunosuppressive agents. The only significant statistical correlation was female patients with hydrocarbon exposure were younger. There was no correlation between age, gender, duration of exposure, presence of pulmonary hemorrhage or AGBM, or other risk factors and outcome. The relationship between hydrocarbon exposure and Goodpasture's Syndrome remains unclear since only 6% of cases in the literature had exposure. Even though most patients survived, no factor studied affected outcome making it difficult to predict prognosis in these patients.

Comparative responses to alpha,beta-methylene-ATP in cat pulmonary, mesenteric, and hindquarter vascular beds.

Responses to the P2X-purinoceptor agonist alpha,beta-methylene-ATP (alpha,beta-MeATP) were investigated in the pulmonary, hindquarter, and mesenteric vascular beds in the cat. Under constant-flow conditions, injections of alpha,beta-MeATP caused dose-related increases in perfusion pressure in the pulmonary and hindquarter beds and a biphasic response in the mesenteric circulation. In the pulmonary vascular bed, the order of potency was alpha,beta-MeATP > U-46619 > angiotensin II, whereas, in the hindquarters, the order of potency was angiotensin II > U-46619 > alpha,beta-MeATP. The order of potency was similar in the hindquarter and mesenteric beds when the pressor component of the response to alpha,beta-MeATP was compared with responses to angiotensin II and U-46619. The P2X-receptor antagonist pyridoxal-phosphate-6-azophenyl-2',4'-disulfonic acid attenuated the pressor response to alpha,beta-MeATP in the hindquarter circulation and the pressor component in the mesenteric vascular bed. Pressor responses to alpha,beta-MeATP were not altered by cyclooxygenase, alpha-adrenergic, or angiotensin AT(1) antagonists. These data show that alpha,beta-MeATP has potent pressor activity in the pulmonary circulation, where it was 100-fold more potent than angiotensin II. In contrast, alpha,beta-MeATP had modest pressor activity in the systemic bed, where it was 1,000-fold less potent than angiotensin II. These data suggest that responses to alpha,beta-MeATP are dependent on the vascular bed studied and may be dependent on the density of P2X receptors in the vascular bed.

Simultaneous bilateral rupture of quadriceps tendons: analysis of risk factors and associations.

BACKGROUND: Simultaneous bilateral quadriceps tendon rupture is an uncommon injury that is frequently misdiagnosed. It has been associated with multiple medical conditions including renal disease, rheumatologic disorders, and endocrine disorders. METHODS: All reported cases of simultaneous bilateral quadriceps tendon rupture were identified using MEDLINE. Each case was reviewed for information regarding the injury, and this information was analyzed. RESULTS: There were 66 cases of simultaneous bilateral quadriceps tendon rupture reported in the English-language literature. This review presents descriptive data on all the cases and analyzes the following factors surrounding rupture: age, sex, time before diagnosis, mechanism of injury, location of rupture, and associated chronic diseases. Most patients were treated surgically, followed by 4 to 6 weeks of immobilization, which resulted in a good outcome. CONCLUSION: Numerous associations were found and are discussed in this review. Patients with quadriceps tendon rupture should be evaluated for an underlying chronic disease.

Sacral stress fractures: an unusual cause of low back pain in an athlete.

STUDY DESIGN: A case report of a sacral stress fracture causing low back pain in an athlete. OBJECTIVE: To document the occurrence of sacral stress fractures in athletes and to recommend it in the differential diagnosis of low back pain, especially in runners and volleyball players. SUMMARY OF BACKGROUND DATA: Low back pain is common both in the general population and in athletes. Athletes place high physical demands on their bodies, which often lead to stress fractures. Sacral stress fractures can cause back pain and are often not included in the differential diagnosis of back pain. METHODS: The authors were involved in the care and treatment of this patient and reviewed all medical records, radiologic tests, and related literature. RESULTS: In a 16-year-old volleyball player with a 4-week history of low back pain, magnetic resonance imaging of her pelvis revealed a stress fracture of the left sacral ala. She was treated with nonsteroidal anti-inflammatory agents, rest, and conditioning exercises and had a good functional outcome. CONCLUSION: Sacral stress fractures should be included in the differential diagnosis of athletes with low back pain, particularly runners and volleyball players. To the authors' best knowledge, this is the first report of a volleyball player with a sacral stress fracture. A review of the literature yielded 29 cases of sacral stress fractures in athletes, mainly runners.

Transposition of the great arteries and hypocalcemia in a patient with fetal hydantoin syndrome.

We report a patient with fetal hydantoin syndrome (FHS) with associated d-transposition of the great arteries (d-TGA) and persistent hypocalcemia. d-TGA and hypocalcemia have each been individually reported once in association with FHS, but these patients were also prenatally exposed to phenobarbital. To our knowledge, this is the first report of these problems occurring after prenatal exposure to hydantoin alone. The combination of congenital heart disease and hypocalcemia in our patient raises the possibility of a hydantoin effect on neural crest migration.

Characteristics and outcomes of patients with Goodpasture's syndrome.

BACKGROUND: Goodpasture's syndrome is a rare disorder characterized by pulmonary hemorrhage, glomerulonephritis, and antiglomerular basement membrane antibodies. METHODS: Case reports of Goodpasture's syndrome between 1993 and 2000 were identified using MEDLINE. Each case was reviewed for clinical manifestations, laboratory features, pathophysiology, treatment options, and outcomes. RESULTS: Eighty-five cases of Goodpasture's syndrome were reported in the English language literature. The mean age of patients in this review was 44 years. Most patients had multiple risk factors. Smoking was strongly associated with pulmonary hemorrhage. Most patients presented with hemoptysis and crackles. More than 90% had antiglomerular basement membrane antibodies, and 80% had crescenteric glomerulonephritis on renal biopsy. CONCLUSION: Most patients were treated with immunosuppression and plasma exchange and were alive at follow-up. Patients with either pulmonary or renal signs and symptoms should be evaluated for Goodpasture's syndrome, since early diagnosis allows prompt treatment and improved outcome.

Cyclic adenosine monophosphate-dependent vascular responses to purinergic agonists adenosine triphosphate and uridine triphosphate in the anesthetized mouse.

The mechanism by which purinergic agonist adenosine triphosphate (ATP) and uridine triphosphate (UTP) decrease systemic arterial pressure in the anesthetized mouse was investigated. Intravenous injections of adenosine triphosphate (ATP) and uridine triphosphate (UTP) produced dose-dependent decreases in systemic blood pressure in the mouse. The order of potency was ATP > UTP. Vasodilator responses to ATP and UTP were altered by the cyclic adenosine monophosphate (cAMP) phosphodiesterase inhibitor rolipram. The vascular responses to ATP and UTP were not altered by a nitric oxide synthase inhibitor, a cyclooxygenase inhibitor, a cGMP phosphodiesterase inhibitor, or a particular P2 receptor antagonist. These data suggest that ATP and UTP cause a decrease in systemic arterial pressure in the mouse via a cAMP-dependent pathway via a novel P2 receptor linked to adenylate cyclase and that nitric oxide release, prostaglandin synthesis, cGMP, and P2X1, P2Y1, and P2Y4 receptors play little or no role in the vascular effects of these purinergic agonists in the mouse.

Perception of and attitude towards mental illness in Oman.

BACKGROUND: As conceptions of mental illness are often dictated by prevailing socio-cultural factors and the philosophy of the time, there is little research to substantiate how mental illness is perceived in the Arab world in the light of both traditional and more recent modernization and acculturation processes. AIMS: To examine whether social factors exert an influence on a person's attitude towards people with mental illness (PWMI) in the rapidly changing country of Oman. METHODS: This study compares the response elicited from medical students, relatives of psychiatric patients and the general Omani public on the causes of mental illness, attitudes toward PWMI and the care and management of people with mental illness. RESULTS: This study found no relationship between attitudes towards PWMI, and demographic variables such as age, educational level, marital status, sex and personal exposure to people with mental illness. Both medical students and the public rejected a genetic factor as the cause of mental illness; instead they favoured the role of spirits as the aetiological factor for mental illness. There were favourable responses on statements regarding value of life, family life, decision-making ability, and the management and care of mental illness. However, both medical students and the public thought that PWMI tend to have peculiar and stereotypical appearances and the majority preferred that facilities for psychiatric care should be located away from the community. Although the relatives of psychiatric patients were concerned about the welfare of mental patients, their responses varied and were often contingent upon their expectations. CONCLUSIONS: The data suggest that neither socio-demographic factors nor previous exposure to PWMI was related to attitudes towards PWMI. Although the attitudes of Omanis toward PWMI appear to fluctuate in complex ways, traditional beliefs on mental illness have yet to be eroded by exposure to a biomedical model of mental illness. This study largely supports the view that the extent of stigma varies according to the cultural and sociological backgrounds of each society.