Degree Of Incapacitation Research Articles

The remote results of treatment of ischemic stroke conditioned by atherosclerotic affection of carotid arteries

The ischemic stroke is a disease that leads to dysfunctions in life of any individual. The mortality rate of cerebral infarcts reaches up to 39%. Besides, the most acute period of an ischemic stroke, which lasts up to 5-7 days, is especially problematic and is characterized by the highest mortality. The first day of disease results in 21.74% of deaths (out of the total annual number of deaths). The article presents the results of the analysis of treatment of the patients with ischemic stroke caused by the atherosclerosis of brachiocephalic arteries. The role of endovascular technologies in the treatment of the acute cerebrovascular cases has not been fully revealed. The retrospective analysis of treatment of 171 patients with atherosclerotic subtype of ischemic stroke was carried out. The patients were distributed in two groups: in the first group (83 patients) the applied conservative therapy was supplemented by endovascular intervention during the acute period of ischemic insult; in the second group (88 patients) the conservative therapy alone was applied. Both groups were comparable in terms of gender, age and associated diseases. The risk factors of ischemic insult were analyzed such as IHD that requires surgery; hypertensive disease; hypercholesterolemia; ischemic insult in medical history; heart dysrhythmia; diabetes mellitus. All patients had more than one risk factor. There mortality, incapacitation, degree of neurological impairment, frequency of symptoms of hemorrhagic suffusion and of hemorrhagic transformation were analyzed. The remote results were analyzed in sampling of 54 patients: 32 patients from the first group, 22 patients from the second group. The quality of life was measured using technique of non-specific survey SF-36 when its 36 items were grouped into eight scales: physical functioning, role activity, body pain, general health, vitality, social functioning, emotional state, psychological health. The degree of incapacitation was measured with the modified Rankin scale, the quality of life was examined with the SF-36 survey, the survival rate was measured with the Kaplan-Meier estimator. The statistical analysis was carried out with the help of the Statistica 6.0 software.

The rules of engagement

The rules of engagement

Occurrence of ethanol and other drugs in blood and urine specimens from female victims of alleged sexual assault

Results of toxicological analysis of blood and urine specimens from 1806 female victims of alleged non-consensual sexual activity are reported. After making contact with the police authorities, the victims were examined by a physician for injuries and biological specimens were taken for forensic toxicology and other purposes (e.g. DNA). Urine if available or otherwise on an aliquot of blood after protein precipitation was screened for the presence of drugs by enzyme immunoassay methods (EMIT/CEDIA). All positive results from screening were verified by more specific methods, involving isotope dilution gas chromatography–mass spectrometry (GC–MS) for illicit drugs. A large number of prescription drugs were analyzed in blood by capillary column gas chromatography with a nitrogen–phosphorous (N–P) detector. Ethanol was determined in blood and urine by headspace gas chromatography and concentrations less than 0.1 g/L were reported as negative. The number of reported cases of alleged sexual assault was highest during the warmer summer months and the mean age of victims was 24 years (median 20 years), with ∼60% being between 15 and 25 years. In 559 cases (31%) ethanol and drugs were negative. In 772 cases (43% of total) ethanol was the only drug identified in blood or urine. In 215 cases (12%) ethanol occurred together with at least one other drug. The mean, median and highest concentrations of ethanol in blood ( N = 806) were 1.24 g/L, 1.19 g/L and 3.7 g/L, respectively. The age of victims and their blood-alcohol concentration (BAC) were positively correlated ( r = 0.365, p < 0.001). Because BAC decreases at a rate of 0.10–0.25 g/(L h), owing to metabolism the concentration in blood at time of sampling is often appreciably less than when the crime was committed several hours earlier. Licit or illicit drugs were identified in blood or urine in N = 262 cases (15%). Amphetamine and tetrahydrocannabinol were the most common illicit drugs at mean (median) concentrations in blood of 0.22 mg/L (0.1 mg/L) and 0.0012 mg/L (0.0006 mg/L), respectively. Among prescription drugs, sedative-hypnotics such as diazepam and zopiclone were common findings along with SSRI antidepressants and various opiate analgesics. Interpreting the analytical results in terms of voluntary vs. surreptitious administration of drugs and the degree of incapacitation in the victim as well as ability to give informed consent for sexual activity is fraught with difficulties.

Acute chest pain in African Americans: factors in the delay in seeking emergency care.

African Americans have been shown to have longer delay times than the majority population in seeking care for acute cardiac problems. The purpose of this study was to determine whether socioeconomic factors affect delay times. Structured interviews were administered to 254 African Americans admitted to a public hospital and 194 African Americans admitted to a private hospital for suspected acute myocardial infarction. Patient characteristics found by multiple regression analysis to affect decision-making and travel time for care-seeking were structural access to care, persistence of symptoms, degree of incapacitation, consultation with a layperson, consultation with medical professionals, and mode of transportation. Within-group differences were found to be related to socioeconomic status. Strategies to increase knowledge about heart attack symptoms, improve access to care, and improve the socioeconomic status of at-risk African Americans are indicated.

Factors Influencing Early and Late Survival in Patients with Combined Mitral Valve Replacement and Myocardial Revascularization and in Those with Isolated Replacement

During a 5 1/2-year period, 251 patients underwent mitral valve replacement (MVR) at our institution: 76 had combined MVR and coronary artery bypass grafting (CABG), and 175 without major coronary artery disease (CAD) had isolated MVR. In-hospital mortality for MVR + CABG was 13.2% (10/76); it was 8.6% (6/70) when patients with preoperative mechanical support were excluded, 7.9% (5/63) for elective operations, and 8.2% (5/61) for nonischemic mitral disease. Overall, in-hospital mortality for isolated MVR was 6.3% (11/175); it was 4.4% (7/161) excluding patients requiring mechanical support and 3.1% (5/157) for elective operations. Of a host of clinical characteristics in patients with MVR + CABG, few were found to influence in-hospital mortality: age greater than 60 years, degree of incapacitation (New York Heart Association Functional Class IV), previous history of myocardial infarction or congestive heart failure, cardiac enlargement (cardiothoracic index greater than 50%), and ischemic mitral disease (33.3% in-hospital mortality; p < 0.05). Of the invasive variables, only one influenced in-hospital mortality: wall motion score greater than 10 (31.6% in-hospital mortality; p < 0.01). Of the operative variables studied, the number of grafts (3 or more: 33.3% in-hospital mortality; p < 0.05), the need for mechanical support (47.4% in-hospital mortality; p < 0.0001), and emergency operation (38.5% in-hospital mortality; p < 0.005) had a significant effect on mortality. The type of mitral lesion, the type of prosthesis, the extent of CAD or the completeness of revascularization, the presence of pulmonary hypertension, and atrial fibrillation appeared to have no influence. Survival at 6 years was 83 ± 5% for patients having MVR + CABG and 89 ± 2% for those having isolated MVR ( p < 0.03). Of the following variables—ejection fraction, extent of CAD, completeness of revascularization, etiology of lesion, and wall motion score—only the last strongly influenced late survival in patients with MVR + CABG. In summary, in-hospital mortality is higher among patients having MVR + CABG, especially if urgent operation or mechanical support is needed and multiple bypass grafts are performed. Age and cardiac enlargement also play a role. Once CAD is corrected, that is, when most— but not necessarily all—diseased arteries are bypassed, overall survival does not differ from that of patients with isolated MVR and no major CAD. The single most important variable for early and late survival in MVR + CABG appears to be wall motion score at cineventriculography.

The hyperalgesic effects of prostacyclin and prostaglandin E 2

Hyperalgesia induced in rat paws or dog knee joints by prostacyclin (PGI 2) and prostaglandin E 2 was measured by a modification of the Randall-Selitto method (1) of by the degree of incapacitation (2). In both species PGI 2 induced an immediate hyperalgesic effect but the effect of PGE 2 had a longer latency. Low doses of PGI 2 caused a short lasting effect but PGE 2, large doses of PGI 2 or successive administration of small doses of PGI 2 caused a long lasting effect. It is suggested that prostacyclin mediates rat paw hyperalgesia induced by carrageenin. The long lasting hyperalgesic effect of PGE 2 and high doses of PGI 2 is possibly an indirect effect caused by stimulation of a sensory nerve sensitising mechanism.