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Article
Stroke Related Pneumonia Incidence and Possible Risk Factors

Authors: Ahmad M. Jaffer --- Kassim M. Sultan --- Akram Al-Mahdawi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 3 Pages: 376-381
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:The stroke patient is at risk of developing hospital acquired infection, with the lungs being especially vulnerable. Stroke associated pneumonia (SAP) occurring after two days of admission and is the most nosocomial infection seen in the medical wards , pneumonia is the major cause of morbidity and mortality after stroke .The establishment of an accurate diagnosis of stroke associated pneumonia remains problematic and yet there is still no accepted "gold standard" for diagnosis.OBJECTIVE:To determine the incidence and risk factors of stroke associated pneumonia.METHODS:This is prospective cohort study for 82 stroke patients admitted to medical wards .The study conduct from the 1st July 2009 to the 10th January 2010. Initially stroke diagnosed clinically and by CT scan. Theses cases are assessed after 48 hours after admission, full history, physical examination and investigations were done using clinical criteria (body temperature, WBC count and chest radiography ) for diagnosis of pneumonia.RESULTS:11(13.4%) patients developed stroke associated pneumonia from 82 stroke patients admitted to medical wards. Most patients who were developed pneumonia were older than patients who did not developed pneumonia . The incidence is higher in patient with infarction and older age groups than patients with hemorrhagic stroke and younger age groups, and there is no association between the disease and gender .The incidence of late onset is more common than early onset pneumonia. Presence of dysphagia was present in (81.8%) nasogastric tube in (72.7% ),unconsciousness(54.5%),tobacco ,vomiting (36.6%) and fit (27.2%) were found as an important risk factors .The mortality more in hemorrhagic(75%) than thrombotic stroke (14.3%).CONCLUSION:stroke associated pneumonia is an important cause of mortality. It is associated with older age, dysphagia , NG intubation ,coma ,vomiting and fit .Simple assessment of these variables could be used to identify patients at high risk of developing pneumonia after stroke.

Keywords

Pneumonia --- stroke --- risk factors


Article
Causes of Acute Confusional State in Medical Consultations for Elderly Patients
أسباب تشوش الوعي خلال الاستشارات الطبية لدى كبار السن

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Abstract

Objective: Assessment of the causes of acute confusional state in elderly patients in medical consultation of physicians for neurologists in what is considered as obscure cases.Methods: This is an observational prospective study that enrolled 100 elderly patients with acute confessional state regarding medical consultations to the neurologist in obscure cases in Al-Yarmouk teaching hospital in Baghdad-Iraq during the period between the 1st of June,2004 to 31st of May ,2006. All of the patients have been subjected to thorough clinical assessment and laboratory investigations.Results: This study reveals slight female predominance that represent 56% of cases with acute confusional state. The mean age of patients was 70 years. The most common risk factors are dementia: 35%, pre existing brain disease: 40%, sensory deprivation: 55%.The mortality rate is 35%. Case distribution was as follow: community acquired acute confusional state represent 70% of cases while hospital acquired acute confusional state represented 30% of cases. The most common causes were: infection; 30%, metabolic; 25.7%& neurological; 25.7%. Conclusions: This study reveals that the causes of A.C.S. in old age patients are of huge number & the commonest are infection, metabolic, & central nervous system disorders. Keywords: Delirium, confusion, elderly, neurology, medical, consultation

تعريف : تشويش الوعي الحاد هو من الاعرض الشائعة المصاحبة لأنواع مختلفة من الإمراض لدى كبار السن وترتبط بعقابيل مهمة وبنسبة وفيات عالية .الهدف :تقييم أسباب تشويش الوعي الحاد لدى المرضى المسنين تبعا للاستشارات الطبية الباطنية إلى أطباء الجملة العصبية .الطرق :أخذت هذه الدراسة مئة مريض من المسنين المصابين بتشوش الوعي الحاد تبعا للاستشارات الطبية الباطنية إلى أطباء الجملة العصبية في مستشفى اليرموك التعليمية في بغداد العراق أثناء الفترة بين أول من حزيران لسنة إلفين وأربعة إلى الحادي والثلاثون من مايس لسنة إلفين وستة كل المرضى أخضعوا إلى التقيم السريري الشامل ، الفحوصات مختبريه والدراسات الإشعاعيةالنتائج :تكشف هذه الدراسة عن أغلبية طفيفة للإناث التي تمثل ستة وخمسين بالمائة من الحالاتالعمر المتوسط للمرضى كان سبعين سنة وان عوامل الخطر الأكثر شيوعا هي : الخرفويمثل خمس وثلاثين بالمائة ، أمراض الدماغ العضوية تمثل أربعون بالمائة ، ضعف حسي( بصري أو سمعي ): تمثل خمس وخمسون بالمائة ، وكان معدل الوفيات هو خمس وثلاثون بالمائةتم تقسيم الحالات كالتالي :الحالات التي أدخلت إلى المستشفى مع تشوش الوعي الحاد وتمثل سبعين بالمائةوالحالات التي ظهر فيها تشويش الوعي إثناء الرقود في المستشفى وتمثل ثلاثين بالمائةإن الأسباب الأكثر هي : العدوى أربع وثلاثون بالمائة ، الإمراض العصبية اثنان وعشرون بالمائة ، الإمراض ذات التغيرات الايضية ثمانية بالمائة ، والتأثيرات الدوائية أربعة عشر بالمائةالاستنتاجات :تكشف هذه الدراسة بأن تشويش الوعي الحاد لدى المسنين غالبا ما ينتج : الالتهابات المعديةَ ، أمراض الجهاز العصبي ، الإمراض ذات التغيرات الايضية والتأثيرات الدوائية

Keywords

Delirium --- confusion --- elderly --- neurology --- medical --- consultation

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