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Biomedical subjects

Latha G Stead

Publications and source records attributed to Latha G Stead.

At least 19 recordsLinked to original sources
PubMed2006

A sinister cause of nausea and vomiting.

A 30-year-old intellectually challenged woman with recent travel history to Texas presented with intractable nausea and nonprojectile vomiting for 3 weeks. She had diffuse abdominal pain with no change in her bowel movements. Her family noted that she had recently become more withdrawn. On presentation, she was afebrile with a normal abdominal exam. Physical examination was remarkable for subtle bilateral end-gaze nystagmus. An extensive workup at an outside hospital over 2 weeks included upper endoscopy with small bowel follow-through, pelvic sonogram, and a head computed tomography (CT), all of which were reportedly unremarkable. No outside films were accessible at the time. At our facility, laboratory examination was obtained that ruled out an infectious etiology. Abdominal CT showed no gastrointestinal or hepatobiliary abnormalities. Because of reported personality changes and nystagmus on physical exam, magnetic resonance imaging (MRI) of the head was obtained to rule out cerebellar or vestibular pathology.

Adult↗
PubMed2006

Pneumocephalus secondary to lumbar catheterization.

A 60-year-old woman with a history of chronic back pain presented to the emergency department with headache, slurred speech, and altered sensorium reported by her family. The previous day, she had a lumbar catheter placed for symptomatic relief of her chronic back pain. The patient complained only of headache, but otherwise thought she was unaffected. The patient's past medi- cal history was remarkable for diabetes, hypertension, peripheral neuropathy, gastritis, supraventricular tachycardia, and chronic back pain. On physical examination she was alert, fully orientated, and in no acute distress. Her vital signs were normal. Neurological examination revealed subtle word-finding difficulties and dysarthria. There were no physical signs of raised intracranial pressure (ICP). The remainder of her examination was entirely normal.

Catheters, Indwelling↗
PubMed2006

The role of hyperglycemia in acute ischemic stroke.

Stroke remains a leading cause of death and long-term disability in the developed world. Reperfusion and anti-thrombotic therapies are of limited benefit for the majority of patients following acute ischemic stroke, and increasing interest has focused on therapeutic approaches that seek to modulate infarct evolution. Animal and human studies have linked hyperglycemia in the acute phase of ischemic stroke to worse clinical outcomes regardless of the presence of pre-existing diabetes mellitus. Experimental data suggest that elevated blood glucose may directly contribute to infarct expansion through a number of maladaptive metabolic pathways, and that treatment with insulin may attenuate these adverse effects. In this review, we analyze the relationship between elevated serum glucose and acute cerebrovascular ischemia, and critically appraise the potential of a clinical strategy that targets euglycemia in all acute stroke patients.

Animals↗
PubMed2005

Initial emergency department blood pressure as predictor of survival after acute ischemic stroke.

OBJECTIVE: To evaluate the association of diastolic blood pressure (dBP), systolic blood pressure (sBP), and mean arterial pressure (MAP) in the emergency department (ED) with mortality within 90 days in patients with acute ischemic stroke (AIS). METHODS: This observational study was conducted at an ED with an annual census of 70,000 visits, with approximately 500 for AIS. The cohort consisted of 357 patients who presented to the ED within 24 hours of stroke symptom onset. sBP and dBP were measured at triage by a nurse blinded to the study. The duration of follow-up was limited to the first 90 days following ED presentation. BP levels were categorized as low, normotensive, and high after examining scatter plots of a patient's risk of death adjusted for duration of follow-up vs dBP, sBP, and MAP. These BP categories were evaluated using indicator variables in Cox proportional hazards models, after adjusting for age, sex, and the National Institute of Health Stroke Scale (NIHSS) score. RESULTS: Patients with low BP (dBP <70, sBP <155, or MAP <100 mm Hg) were significantly more likely to die within 90 days than those with BP in the normotensive range (dBP 70 to 105, sBP 155 to 220, MAP 100 to 140 mm Hg). These associations were significant even after adjusting for age, gender, and NIHSS score. CONCLUSIONS: There appears to be an optimal acute BP range below which early mortality is greater following AIS, suggesting avoidance of hypotension in the first 24 hours.

Acute Disease↗
PubMed2005

Neuron-specific enolase as a marker for acute ischemic stroke: a systematic review.

BACKGROUND: To date, most work delineating the usefulness of neuron-specific enolase (NSE) as a marker for acute ischemic stroke has been inconclusive. This study had the following objectives: (1) to determine whether serum concentrations of NSE correlate with time of onset of stroke symptoms, volume of infarcted tissue, stroke severity, functional outcome, or length of hospital stay; (2) to determine whether serial measurements of NSE levels are useful markers for ongoing brain ischemia, and (3) to determine whether NSE levels at various time intervals are significantly higher in patients with stroke than in controls. METHODS: All abstracts and published full reports identified as potentially relevant by the literature search were independently assessed for inclusion in the review by each reviewer. Twelve studies (including 597 patients) satisfied the entry criteria for this qualitative analysis. RESULTS: In 4 studies, time of onset of stroke symptoms was compared with time of first detectable NSE levels, which ranged from 4 to 8 h after stroke onset. In 7 studies, NSE levels increased with increased size of stroke, but in 2 studies there was no correlation. In the 2 studies that compared stroke severity with NSE levels, high NSE levels generally indicated worse outcome, but at low NSE levels the results were equivocal. In 7 studies, functional outcome at hospital dismissal and follow-up was compared with NSE levels; in 4, there was no correlation. CONCLUSIONS: The serum level of NSE does seem to be higher in stroke patients than in controls, and it does appear to correlate with volume of infarcted tissue. However, it does not appear to correlate with functional outcome, and its relationship to stroke severity is unclear. This may be explained at least in part by the disparity in sampling times because the NSE level has been shown to peak after 24 h in most studies. Hence, the more delayed the sampling, the greater the correlation with stroke severity.

Acute Disease↗
PubMed2005

Severe hypertension in the emergency department patient.

Severely elevated blood pressure is a common clinical problem en-countered in the Emergency Department. It is often difficult for physicians to differentiate between patients who need emergent blood pressure reduction, requiring the use of intravenous agents and in-tensive monitoring, and those for whom careful, slow reduction in BP is more appropriate. The optimal assessment and management of these patients is reviewed here, with an emphasis on clinical strategies that will most efficiently identify those at greatest risk.

Blood Pressure↗
PubMed2005

Academic career development for emergency medicine residents: a road map.

As the marketplace for academic positions in emergency medicine grows more competitive, it becomes increasingly important for residents who desire academic careers to distinguish themselves during their residency. This report attempts to outline a road map for department and residency program leaders to help their houseofficers become successful candidates for an academic emergency medicine position. Specific ways a resident can enhance his or her "academic marketability" include 1) involvement in research, 2) establishment of a track record of productivity via scholarly writing, 3) awareness of the literature in the specialty, 4) involvement in specialty organizations and hospital committees, 5) competition for national awards, 6) gaining education skills, 7) developing an academic niche, and 8) fellowship training.

Awards and Prizes↗
PubMed2004

Management of acute ischemic stroke.

The treatment of acute ischemic stroke has evolved from observation and the passage of time dictating outcome to an approach that emphasizes time from ictus, rapid response, and a dedicated treatment team. We review the treatment of acute ischemic stroke from the prehospital setting, to the emergency department, to the inpatient hospital setting. We discuss the importance of prehospital assessment and treatment, including the use of elements of the neurologic examination, recognition of symptoms that can mimic those of acute ischemic stroke, and rapid transport of patients who are potential candidates for thrombolytic therapy to hospitals with that capability. Coordinated management of acute ischemic stroke in the emergency department is critical as well, beginning with non-contrast-enhanced computed tomography of the brain. The advantages of a multidisciplinary dedicated stroke team are discussed, as are thrombolytic therapy and other inpatient treatment options. Finally, we cover evolving management strategies, treatments, and tools that could improve patient outcomes.

Acute Disease↗
PubMed2004

Evaluation of the educational utility of patient follow-up.

OBJECTIVES: To date, no studies in emergency medicine (EM) have addressed the educational value of the Residency Review Committee for Emergency Medicine's (RRC-EM) requirement for patient follow-up (FU). The authors examined whether performance of patient FU improved EM resident education. METHODS: All EM resident FU encounters from September 25, 2001, through September 24, 2002, were documented and analyzed. All EM residents at a regional tertiary referral emergency department (ED) initiated patient FU encounters by entering information regarding patients' initial ED presentations into a Web-based follow-up system (WBFUS), subsequently entered FU information, and indicated whether they thought that the specific FU encounters improved their education (yes/no). Supervising faculty members then reviewed the residents' completed FU entries. Blinded to residents' responses regarding educational utility, faculty members evaluated whether they thought the specific FU encounters were educational for the residents (yes/no). Data entered into the WBFUS were then summarized as percentages. RESULTS: Eight hundred forty-seven FU encounters were completed by 18 EM residents and 29 EM faculty. Ninety-three percent of the FU entries were deemed by at least one evaluator (resident or faculty) to have educational value. Residents found the act of performing FU educational in 81.3% of cases, whereas faculty thought 80.4% were educational for the resident. Although the residents and faculty agreed on the educational value in 75.4% of cases, the overall strength of the agreement was slight to fair (kappa statistic = 0.21). CONCLUSIONS: This study indicates that EM residents and faculty believe that the act of performing patient FU has educational value for EM residents; however, the interobserver agreement between residents and faculty was low.

Adolescent↗
PubMed2003

Pulmonary embolism.

PE is one of the great challenges in medicine. It is a disease that carries with it a high mortality rate, yet no historical piece of information, physical examination finding, or diagnostic modality is perfect at excluding its possibility. Emergency physicians must be vigilant about considering PE in the differential diagnosis of a variety of presenting complaints and must use a variety of diagnostic and therapeutic options as they manage patients with suspected or confirmed PE. The diagnostic options range from bedside diagnostic tests to highly specialized imaging available at only specialized institutions. Knowing the advantages and disadvantages of each of the diagnostic modalities assists the physician in employing the best test. Therapeutic options also vary widely and include anticoagulation, vena caval interruption, systemic thrombolysis, embolectomy, and other therapeutic adjuncts, such as ECMO and inhaled nitric oxide. Similarly, awareness of the indications and contraindications to the varied therapeutic agents ensures appropriate therapy when the diagnosis is made.

Anticoagulants↗