Infections in acute older stroke inpatients undergoing rehabilitation.

OBJECTIVE: The present study compares the incidence of various infections among patients in acute and rehabilitation wards and examines the risk factors and pathogens involved in rehabilitation ward infections. DESIGN: The study included 341 acute stroke patients (age, ≥65 yrs). The assessment of risk factors was done by comparison of patients with or without infection, urinary tract infection, and pneumonia. Possible precipitating factors in each comparison were included in the statistical analysis. RESULTS: Ninety-five (27.9%) patients experienced infections, and the most common type in the rehabilitation ward was urinary tract infection. The frequency of incidence of pneumonia in the rehabilitation ward (6.7%) was significantly lower than in the acute ward (23.8%) (P < 0.001). Patients with infection had a longer rehabilitation ward stay compared with those without infection (30.9 vs. 18.8 days, P = 0.002). A postvoid residual urine volume greater than 50 ml (odds ratio, 2.314; 95% CI, 1.204-4.448, P = 0.012) was found to be the most important risk factor for infection. CONCLUSIONS: Infection may prolong the length of stay in acute stroke patients in a rehabilitation ward. The present study provides important information for clinicians to help identify risk factors for infection.

Clinical use of high-resolution ultrasonography for the diagnosis of type II accessory navicular bone.

Medial foot pain is a common complaint in rehabilitation clinics. The differential diagnoses include many musculoskeletal disorders like tendonitis and inflammation of ossicles. Posterior tibialis tendonitis is a common cause of foot pain in adults. The accessory navicular (AN) bone is occasionally observed and considered as a secondary ossification center of the navicular bone. Occasionally, posterior tibialis tendonitis and AN bone may cause acute or chronic medial foot pain with varying degrees of dysfunction. Previously, the diagnosis of an AN bone in a painful medial foot was based on clinical presentation and radiographic examinations such as plain radiography, bone scintigraphy, and magnetic resonance imaging. However, the application of soft-tissue ultrasonography for the diagnosis of posterior tibialis tendonitis associated with an AN bone has not been documented. Here, we report the case of a 60-yr-old woman with painful medial foot which had a diagnosis of posterior tibialis tendonitis associated with an AN bone by high-resolution ultrasonography.