Weeks Of Attack Research Articles

Sensitivity, Specificity, Predictive Values and Accuracy of clinical diagnosis of Acute Stroke

Background: Stroke is a leading cause of death and disability globally and particularly in low and middle-income countries, and the burden is increasing. To prevent complications and permanent defects in stroke, early diagnosis is the key that can easily obtained by a CT scan of brain. However, quick access to CT scanning is not available in every country and hospital specially in Bangladesh, various clinical findings especially neurological signs and symptoms and risk factors differentiation are helpful in differentiating the types of stroke. Objective: This study aimed to see the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical diagnosis in the detection of stroke subtype. Methods: This hospital based cross-sectional comparative study was conducted in Department of Medicine, Rangpur medical college hospital, Rangpur, Bangladesh from January 2010 to December 2011 on three hundred (300) suspected acute stroke patients selected by purposive sampling technique. The clinical diagnosis of type of stroke was made on the basis of mode of presentation, risk factors and signs and confirmed by CT scan of brain within 1 week of attack. Then the clinical diagnosis was compared with the results of CT scan. Statistical analyses related with this study were performed by using of SPSS-19 package program. Results: Among the 300 patients, 73(24.3%) patients were clinically diagnosed as hemorrhagic stroke and 227(75.6%) patients were as infarctive stroke. Out of 73 clinically diagnosed haemorrhagic stroke patients, CT scan revealed that 61 (83.6%) patients had intracerebral hemorrhage, 5 (6.8%) had infarct. And out of 133 diagnosed ischemic stroke patients, CT scan revealed that 203 (89.4%) patients had infarction, 6 (2.6%) had intracerebral hemorrhage. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical diagnosis of hemorrhagic stroke were 91.0%, 94.8%, 83.6%, 97.4% and 94.0% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of clinical diagnosis of infarctive stroke were 97.6%, 73.9%, 89.4%, 92.2% and 90.3% respectively. Conclusion: CT scan of brain remains the gold standard for differential diagnosis, but the availability of CT scan is not always feasible, and it is virtually impossible to submit all stroke patients to CT scan. Adequate knowledge on risk factors, clinical features and initial investigations may contribute to such a differentiation of cerebral infarction from intracerebral hemorrhage with high accuracy where rapid access to Computed Tomography (CT) is lacking. J Rang Med Col. March 2023; Vol. 8, No. 2:33-39

Prevalence of Psychiatric Morbidity Among Victims of Terrorist Attacks: Comparative Study

To evaluate the occurrence of psychiatric morbidity Posttraumatic Stress Disorder (PTSD); mood state; (state of depression, anxiety, stress) and its effect on general health among victims of terrorist attacks (mild injuries, severe injuries & amputation) in Peshawar, Khyber Pakhtunkhwa. Current study was a cross-sectional correlational research applied on three groups of admitted patients; who were injured during attacks (with mild injuries, severe injuries & severe injuries along with amputation), the data were collected after one week of attack during from the patients who had direct exposure to terrorist attacks and sought treatment from Combined Military Hospital, Peshawar, Pakistan, during the period of November 2021 to September 2022. Sample included all the survivors who sought medical assistance from the hospital. The instruments comprised upon Impact of Event Scale Revised (IES-R 22), General Health Questionnaire (GHQ-12), and Depression, Anxiety and Stress Scale (DASS-21). PTSD has positive association with Depression, Anxiety and Stress but negative association with General Health Questionnaire among terrorists’ attack victims. The terrorist attack victims had significantly higher psychiatric morbidity than non-exposed participants. Psychiatric morbidity was found highest in the victims of survivors of bomb blasts.

WE2.3 Comparative study of early versus delayed laparoscopic cholecystectomy following endoscopic sphincterotomy for mild to moderate acute biliary pancreatitis

Abstract Background Acute pancreatitis is an inflammatory disease of the pancreas with acute biliary pancreatitis (ABP) accounting for 75% of cases. Current recommendations favour early laparoscopic cholecystectomy (LC) for mild acute gall stone pancreatitis during the same index admission to prevent recurrent attacks reported to be as high as 18–61% in various studies. Endoscopic sphincterotomy in cases who are unfit for cholecystectomy during the index admission or there is delay in cholecystectomy due to logistics may benefit from ES while waiting for elective cholecystectomy, in terms of reducing the number of recurrent attacks and decreasing morbidity. Methods A total of fifty-seven (57) patients of mild to moderate ABP were included in this study and were divided into three groups undergoing LC within 5 days of admission, ES within 7 days of onset of pain abdomen and LC within 4 weeks of initial illness and LC after 8 weeks of attack in the three respective groups and evaluated for level of difficulty of cholecystectomy, recurrent attacks and associated morbidity. Results Difficult LC in terms of adhesions, calots anatomy was seen in 17(n=57) patients. 13(n=38) patients had recurrent attack of pancreatitis during the waiting period for cholecystectomy, 2(n=19) in the ER group and 11(n=19) in the conservative management group, with all patients in the conservative group having more than 2 recurrent attacks. Conclusion LC in early period is a safe, effective, in patients of gallstone induced pancreatitis. ES is well tolerated and viable alternative to cholecystectomy to prevent recurrent pancreatitis until definitive treatment.

AB0846 Audit on Gout Management, Adhering to the BSR and Eular Guidelines

BackgroundGout is one of the few curable conditions in Rheumatology, affecting 1.4% of the adult population in the UK. It is also one of the most frequently presenting conditions, both...

Training for information assurance

In 2001, cadets from three military institutions built networks and defended them against a week of attacks led by the National Security Agency. The trial-by-fire exercise; which repeats in 2002, is a step toward preparing future network designers and administrators to think more strategically.

Volatiles released from individual spruce bark beetle entrance holes Quantitative variations during the first week of attack

Volatiles released from individual entrance holes of eight spruce bark beetles (Ips typographus) were collected during the first week of attack on a resistant host tree. In order to quantify the release of the highly volatile 2-methyl-3-buten-2-ol (MB) from attacking males, a new method was developed with deuterated quantification standard released at the time of collection. The amounts of collected volatiles, as analyzed by GC and GC-MS, showed a large variation between individual holes and also between subsequent entrainments from the same hole. Most of the quantified compounds on the average have two maxima, with a pronounced intervening depression. The amounts of releasedcis-verbenol (cV) increased five times during the first two days, while the amounts of MB were consistently high. The attacked spruce tree was not taken by the beetles, and the average amounts of the two aggregation pheromone components, MB and cV, increased again after the first maxima. The first peak of oxygenated monoterpene, released in the beginning of the attack containing α-terpineol, terpinen-4-ol, bornyl acetate,trans-pinocarveol, and verbenone, was possibly due to spontaneous oxidation of monoterpene hydrocarbons from the tree. Microorganisms established in the gallery wall phloem probably participated in the production of oxygenated monoterpenes during the second increase.

Dyslipidaemia in Cortical Versus Subcortical Infarction

Objectives: The aim of the study was to predict risk of cerebral infarction either cortical or lacunar in population having dyslipidaemia and to create awareness regarding it as a risk factor for ischaemic stroke and to take preventive measures for the prevention of a first or recurrent ischaemic stroke. Method: This study was conducted in the Department of Nurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from March to October, 2006. This study included 30 acute ischaemic stroke patients diagnosed by history, clinical findings and confirmed by CT/MRI scan of head within 2 weeks of attack. Both man and woman age ranging from 40-90 years were eligible to enter into the study. The same number of age and sex matched nonstroke patients who gave blood for analysis were included as control. Result: In this study among other risk factors total serum cholesterol was raised in both cortical and lacunar infarct in 50% of cases in comparison to 33.3% controls (P<0.05). LDL-cholesterol levels were raised in both cortical and lacunar infarct in 50% of cases compared to 30% controls (P<0.05). HDL-cholesterol levels were significantly low in cases (70%) compared to control subjects (26.7%). It was significantly low in cases of cortical infarct (77.3%) compared to 50% cases of lacunar infarct (P<0.01). Serum triglyceride levels were raised in 60% of case group and 26.7% of control subjects (P<0.01). Serum triglyceride levels were raised in 54.5% cases of cortical infarcts compared to 75% cases of lacunar infarcts. Conclusion: The results indicate an association between dyslipidaemia and the risk of ischaemic stroke, specially cortical type. Dyslipidaemia more related to cortical infarct than subcortical infarct. Low level of HDL-cholesterol was related to cortical infarct but not with subcortical infarct. DOI: http://dx.doi.org/10.3329/bjn.v24i1.3037 Bangladesh Journal of Neuroscience 2008; Vol. 24 (1) : 24-33

The Coronary Care Unit

In the past two decades there have been momentous advances in the care of patients with cardiovascular ailments. Yet, mortality from coronary-artery disease has remained unaffected. Year after year myocardial infarction and its complications exact the highest toll of any single disease.¹In large metropolitan hospitals, the death rate from this condition 30 years ago ranged from 30% to 40% and remains unaltered today. Certain facts are forcing reevaluation of the problem. Peak mortality occurs at the very onset of myocardial infarction and then recedes almost exponentially, with 65% of deaths occurring in the initial three days and 85% during the first week of attack. Arrhythmias probably account for 40% of deaths. Of these about two thirds are due to ventricular fibrillation and one third to bradycardia, heart block, and asystole.²It is well established that these electrical catastrophes are usually not due to irreversible cardiac damage. On

HEMIPLEGIA OCCURRING DURING THE THTRD WEEK OF TYPHOID FEVER.

In the Medical Record , Dec. 19, 1903, I reported a case of sudden hemiplegia with aphasia occurring during the fourth week of an attack of typhoid fever in a boy aged five years, and I also referred to several other reported cases. Inasmuch as this complication of typhoid fever seems to be a rare one. I have though it worth while to briefly record the clinical notes of a second case which has since come under my observation. Patient. —A married man, aged 38, a bricklayer, habits good, previous history not significant. History. —The patient was in the fourth week of a simple uncomplicated attack of typhoid fever, when on Aug. 9, 1904, he developed the hemiplegia to be described. His physician saw him at 5 p. m. on the date mentioned, and noted nothing unusual. He saw the patient again at 9 p. m.