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Evangelista RR, Silva Lopes B, Coutinho D, Moreira E, Silva A, Almeida PL, Ermida V, Caldas J, Gomes A, Carmezim I, Barreira V, Pinheiro-Guedes L. Subacute stroke: new-onset poststroke bladder and bowel dysfunctions and possible associated factors. Disabil Rehabil 2024; 46:1073-1081. [PMID: 36960634 DOI: 10.1080/09638288.2023.2189317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/04/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE Bladder and bowel poststroke dysfunctions negatively impact patients' health. Stroke-related characteristics associated to these dysfunctions are poorly known. This study aims to estimate the prevalence of new-onset poststroke bladder and bowel dysfunctions, characterize their associated factors, and describe the dysfunctions' clinical approach. MATERIALS AND METHODS Cross-sectional study including 157 patients admitted to a single hospital's stroke unit with a first-ever stroke, during 3 months. An 18-item questionnaire was applied to assess dysfunctions pre and poststroke. The McNemar test was used to compare pre and poststroke prevalence. A logistic regression was used to estimate associations (OR, 95% CI) between individual characteristics and new-onset dysfunctions. RESULTS We had 113 (72%) respondents. There was a significant increase in the prevalence of bladder and bowel dysfunctions poststroke (p < 0.001). Higher stroke severity was significantly associated with both new-onset poststroke bladder and bowel dysfunctions (OR = 15.00, 95% CI [4.92,45.76] and OR = 5.87,95%CI [2.14,16.12], respectively). Total anterior circulation strokes, cardioembolic strokes, and lower functionality at discharge were also significantly associated with both dysfunctions. Thirteen patients (11.5%) reported that health professionals addressed these dysfunctions. CONCLUSIONS Poststroke bladder and bowel dysfunctions are highly prevalent. Being aware of their epidemiology helps draw attention to patients at higher risk of developing these dysfunctions, enhancing the rehabilitation process.IMPLICATIONS FOR REHABILITATIONPoststroke bladder and bowel dysfunctions are highly prevalent and under-recognised consequences of stroke.Being aware of their epidemiology and associated factors may help identify patients at higher risk of developing these dysfunctions.It is necessary to raise clinical awareness to ensure a more efficient diagnostic and therapeutic approach, enhancing patients' rehabilitation process, quality of life and lowering collateral societal burden.
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Affiliation(s)
| | - Bruno Silva Lopes
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - David Coutinho
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Elisa Moreira
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Andreia Silva
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Pedro Leonel Almeida
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Vera Ermida
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Jorge Caldas
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Ana Gomes
- Department of Internal Medicine, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Ilídia Carmezim
- Department of Internal Medicine, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Viviana Barreira
- General Practice and Family Medicine, USF Horizonte, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
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Zandalasini M, Pelizzari L, Ciardi G, Giraudo D, Guasconi M, Paravati S, Lamberti G, Frizziero A. Bowel dysfunctions after acquired brain injury: a scoping review. Front Hum Neurosci 2023; 17:1146054. [PMID: 37900728 PMCID: PMC10602674 DOI: 10.3389/fnhum.2023.1146054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Bowel dysfunction is a common consequence of neurological diseases and has a major impact on the dignity and quality of life of patients. Evidence on neurogenic bowel is focused on spinal cord injury and multiple sclerosis; few studies have focused on patients with acquired brain injury (ABI). Neurogenic bowel dysfunction is related to a lifelong condition derived from central neurological disease, which further increases disability and social deprivation. The manifestations of neurogenic bowel dysfunction include fecal incontinence and constipation. Almost two out of three patients with central nervous system disorder have bowel impairment. This scoping review aims to comprehend the extent and type of evidence on bowel dysfunction after ABI and present conservative treatment. For this scoping review, the PCC (population, concept, and context) framework was used: patients with ABI and bowel dysfunction; evaluation and treatment; and intensive/extensive rehabilitation path. Ten full-text articles were included in the review. Oral laxatives are the most common treatment. The Functional Independence Measure (FIM) subscale is the most common scale used to assess neurogenic bowel disease (60%), followed by the Rome II and III criteria, and the colon transit time is used to test for constipation; however, no instrumental methods have been used for incontinence. An overlapping between incontinence and constipation, SCI and ABI increase difficulties to manage NBD. The need for a consensus between the rehabilitative and gastroenterological societies on the diagnosis and medical care of NBD. Systematic review registration Open Science Framework on August 16, 2022 https://doi.org/10.17605/OSF.IO/NEQMA.
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Affiliation(s)
- Matteo Zandalasini
- Department of Rehabilitative Medicine, Azienda USL Piacenza, Piacenza, Italy
| | - Laura Pelizzari
- Department of Rehabilitative Medicine, Azienda USL Piacenza, Piacenza, Italy
| | - Gianluca Ciardi
- Department of Rehabilitative Medicine, Azienda USL Piacenza, Piacenza, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Donatella Giraudo
- Department of Urology, San Raffaele Hospital, Ville Turro, Milan, Italy
| | - Massimo Guasconi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Dipartimento della Direzione delle Professioni Sanitarie, Azienda USL Piacenza, Piacenza, Italy
| | - Stefano Paravati
- Department of Rehabilitative Medicine, Azienda USL Piacenza, Piacenza, Italy
| | - Gianfranco Lamberti
- Department of Rehabilitative Medicine, Azienda USL Piacenza, Piacenza, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Antonio Frizziero
- Department of Rehabilitative Medicine, Azienda USL Piacenza, Piacenza, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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Han IJ, Lee JE, Song HN, Baek IY, Choi J, Chung JW, Bang OY, Kim GM, Seo WK. Imaging and clinical predictors of acute constipation in patients with acute ischemic stroke. Front Neurosci 2023; 17:1263693. [PMID: 37781258 PMCID: PMC10534029 DOI: 10.3389/fnins.2023.1263693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/31/2023] [Indexed: 10/03/2023] Open
Abstract
Background Constipation symptoms are highly prevalent in acute ischemic stroke, but the clinical and neuroimaging predictors are unknown. This study aimed to identify lesions and clinical features associated with acute constipation. Methods Data from patients with acute ischemic stroke registered in a hospital-based stroke registry between January 2018 and December 2019 were analyzed. Clinical, laboratory, and imaging features were examined for associations with acute constipation. Using the topographic lesion on diffusion-weighted images, multivariate support vector regression-based lesion-symptom mapping (SVR-LSM) was conducted and compared between the non-constipation and acute constipation groups. Results A total of 256 patients (mean age 67 years, men: 64%) were included. Acute constipation was noted in 81 patients (32%). Initial stroke severity, represented by initial National Institutes of Health and Stroke Scale (NIHSS) scores, was associated with acute constipation. Laboratory parameters, including fibrin degradation products (FDP), fibrinogen, D-dimer, lipoprotein (a), and free fatty acid levels, also showed statistically significant differences between the non-constipation and constipation groups. FDP, D-dimer, and free fatty acid levels were independently associated with acute constipation in the logistic regression model after adjusting for initial NIHSS scores and potassium levels. SVR-LSM revealed that bilateral lesions in the precentral gyrus, insula, opercular part of the inferior frontal gyrus, the inferior parietal lobule, and lesions in the right middle frontal gyrus were significantly associated with acute constipation. The results were consistent after controlling for the initial NIHSS scores and poststroke potassium levels. When cardioembolic stroke subjects were excluded, the right insular and prefrontal cortex lesions lost their association with acute constipation. Conclusion Acute constipation symptoms after acute ischemic stroke are mainly related to bilateral lesions in the insula, precentral gyrus, postcentral gyrus, and inferior parietal lobule. Clinically important predictors of acute constipation include initial neurological severity and thromboembolic markers of stroke.
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Affiliation(s)
- I Joon Han
- Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Eun Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ha-Na Song
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - In-Young Baek
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jongun Choi
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
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Shang J, He Y, Wang R, Xu Y, Xu J. Comparison of therapeutic effects of different acupuncture and moxibustion therapies on constipation after stroke treatment: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2021; 100:e27397. [PMID: 34731111 PMCID: PMC8519190 DOI: 10.1097/md.0000000000027397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/15/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Constipation is a common complication after stroke, which seriously affects patients' quality of life and recovery. Many evidences show that acupuncture and moxibustion therapy has advantages in the treatment of constipation after stroke. But different types of acupuncture and moxibustion have different effects, and there is no research to prove which one is more effective. METHODS According to the search strategy, we will retrieve the randomized controlled studies of acupuncture and moxibustion in the treatment of constipation after stroke from China Knowledge Network, Wanfang, VIP, China Biomedical medicine, PubMed, Embase, Web of Science, and The Cochrane Library databases. The retrieval time was from the establishment of the database to July 2021. Studies will be screened according to inclusion and exclusion criteria, and the quality of the studies will be assessed using the Cochrane Risk Bias Assessment Tool. All data analyses will be performed using Revman 5.4, Gemtc 0.14.3, and Stata 14.0. Finally, we will evaluate the strength of evidence using the Grading of Recommendations Assessment, Development, and Evaluation method. RESULTS In this study, the efficacy of different acupuncture and moxibustion therapies in the treatment of constipation after stroke will be evaluated by evaluating defecation frequency, stool property score, constipation symptom score, quality of life score, adverse reactions, etc. CONCLUSIONS This study will provide reliable evidence-based evidence for selecting the best acupuncture and moxibustion therapy for constipation after stroke.
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Affiliation(s)
- Jingwen Shang
- Chengdu Eighth People's Hospital (Geriatric Hospital of Chengdu Medical College), Chengdu, Sichuan Province, China
| | - Yongyang He
- Chengdu Eighth People's Hospital (Geriatric Hospital of Chengdu Medical College), Chengdu, Sichuan Province, China
| | - Rui Wang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yifan Xu
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jia Xu
- Chengdu Eighth People's Hospital (Geriatric Hospital of Chengdu Medical College), Chengdu, Sichuan Province, China
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Chen W, Zhao J, Li X, Wang X, Chen J, Zhang T, Ma L, Li D. Using Electronic Medical Records of Nursing Care to Characterize Constipation in Patients with Intracerebral Hemorrhage. Cerebrovasc Dis 2021; 50:535-542. [PMID: 34148034 DOI: 10.1159/000515706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/25/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Constipation is one of the common poststroke complications that directly affect the patients' quality of life in patients with intracerebral hemorrhage (ICH), which has not been paid enough attention. OBJECTIVE This study investigates constipation's clinical characteristics and its risk factors in ICH patients driven by the electronic medical records of nursing care. METHODS This retrospective chart review investigated patients with acute spontaneous ICH admitted at a tertiary care center from October 2010 to December 2018. Poststroke constipation was defined as a first stool passage occurring after 3 days postadmission and the use of enemas or laxatives after ICH. The associations between constipation present and potential factors were evaluated. RESULTS Of 1,748 patients, 408 (70.3% men, mean age 58 ± 14 years) patients with poststroke constipation were identified. After adjusting for potential confounding variables, the risk factors independently associated with poststroke constipation are admission Glasgow Coma Scale score (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.44-0.88; p = 0.007), use of mechanical ventilation (OR 3.74, 95% CI 2.37-5.89, p < 0.001), enteral nutrition (OR 2.82, 95% CI 1.85-4.30, p < 0.001), hematoma evacuation (OR 2.10, 95% CI 1.40-3.16; p < 0.001), opioid analgesics (OR 1.86, 95% CI 1.32-2.62; p < 0.001), sedation (OR 1.83, 95% CI 1.20-2.77; p = 0.005), and vasopressors (OR 1.81, 95% CI 1.26-2.61; p = 0.001) in order. Similar associations were observed in the prespecified length of the stay subgroup. Patients with constipation were associated with a longer hospital stay length (2.24 days, 95% CI 1.43-3.05, p < 0.001) but not with in-hospital mortality (OR 1.05, 95% CI 0.58-1.90, p = 0.871). CONCLUSIONS Our findings suggested that risk factors influence the absence of constipation after ICH with the synergy of different weights. The occurrence of constipation likely affects a longer length of stay, but not in-hospital mortality. Future prospective investigations are warranted to validate our findings and identify the optimal management of constipation that may improve the quality of life in patients with ICH.
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Affiliation(s)
- Wei Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.,West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jieyi Zhao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangkui Li
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyu Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Dong Li
- Division of Hospital Medicine, Emory School of Medicine, Atlanta, Georgia, USA
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Wei M, Huang Q, Liu Z, Luo Y, Xia J. Intestinal Barrier Dysfunction Participates in the Pathophysiology of Ischemic Stroke. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 20:401-416. [PMID: 33749565 DOI: 10.2174/1871527320666210322115808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/12/2020] [Accepted: 11/30/2020] [Indexed: 11/22/2022]
Abstract
The gastrointestinal tract is a major organ for the body to absorb nutrients, water and electrolytes. At the same time, it is a tight barrier to resist the invasion of harmful substances and maintain the homeostasis of the internal environment. Destruction of the intestinal barrier is linked to the digestive system, cardiovascular system, endocrine system and other systemic diseases. Mounting evidence suggests that ischemic stroke not only changes the intestinal microbes, but also increases the permeability of the intestinal barrier, leading to bacterial translocation, infection, and even sepsis. The intestinal barrier, as part of the gut-brain axis, has also been proven to participate in the pathophysiological process of ischemic stroke. However, little attention has been paid to it. Since ischemic stroke is a major public health issue worldwide, there is an urgent need to know more about the disease for better prevention, treatment and prognosis. Therefore, understanding the pathophysiological relationship between ischemic stroke and the intestinal barrier will help researchers further uncover the pathophysiological mechanism of ischemic stroke and provide a novel therapeutic target for the treatment of ischemic stroke. Here, we review the physiology and pathology between ischemic stroke and intestinal barrier based on related articles published in the past ten years about the relationship between ischemic stroke, stroke risk factors and intestinal flora, intestinal barrier, and discuss the following parts: the intestinal barrier; possible mechanisms of intestinal barrier destruction in ischemic stroke; intestinal barrier destruction caused by stroke-related risk factors; intestinal barrier dysfunction in ischemic stroke; targeting the intestinal barrier to improve stroke; conclusions and perspectives.
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Affiliation(s)
- Minping Wei
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008. China
| | - Qin Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008. China
| | - Zeyu Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008. China
| | - Yunfang Luo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008. China
| | - Jian Xia
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008. China
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Abstract
OBJECTIVES Constipation is prevalent in individuals after stroke. However, the pathophysiological mechanisms of poststroke constipation remain unclear. This study was designed (i) to investigate the difference in anorectal motility and rectal sensation among stroke patients with constipation, stroke patients without constipation, and healthy controls (HC), (ii) to evaluate the impact of stroke sites on constipation and rectal sensation, (iii) to explore the role of autonomic functions, and (iv) to determine the independent risk factors for poststroke constipation. METHODS Seventy-one stroke patients and 24 HC were recruited. General information, clinical characteristics, and relevant questionnaires were collected. Meanwhile, an anorectal manometry test was performed to assess functions of anorectal motility and rectal sensation, and an electrocardiogram was recorded to evaluate autonomic functions. RESULTS (i) Constipation patients exhibited increased rectal sensation thresholds, compared with patients without constipation or HC (P < 0.001). Almost no difference was detected in anorectal motility parameters among 3 groups. Constipation-associated clinical characteristics, such as spontaneous bowel movements, were weakly or moderately correlated with rectal sensation thresholds (P < 0.05 to P < 0.001 for various parameters). (ii) Patients with brainstem lesions had increased prevalence of constipation and first sensation threshold, compared with patients without brainstem lesions (P = 0.045, P = 0.025, respectively). (iii) There was a weak positive correlation between sympathetic activity and stroke severity and a weak negative one between vagal activity and stroke severity. Rectal sensation thresholds were positively and weakly correlated with sympathetic activity but negatively with vagal activity. (iv) The desire of defecation threshold and the physical activity were independent risk factors for poststroke constipation (P = 0.043, P = 0.025, respectively). DISCUSSION Poststroke constipation is characterized by elevated thresholds for rectal sensation, rather than altered anorectal motility. Patients with brainstem lesions are predisposed to constipation possibly because of the disruption of afferent pathway from the rectum to the brain. Moreover, the desire of defecation threshold and the physical activity level are factors independently associated with poststroke constipation.
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Kohnen R, Lavrijsen J, Smals O, Gerritsen D, Koopmans R. Prevalence and characteristics of neuropsychiatric symptoms, quality of life and psychotropics in people with acquired brain injury in long-term care. J Adv Nurs 2019; 75:3715-3725. [PMID: 31318085 PMCID: PMC6900174 DOI: 10.1111/jan.14156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/28/2019] [Accepted: 07/08/2019] [Indexed: 12/19/2022]
Abstract
Aim Establishing the prevalence of neuropsychiatric symptoms (NPS), quality of life and psychotropic drug use in people aged ≤65 years with acquired brain injury in nursing homes. Design Cross‐sectional, observational study among patients aged 18–≤65 years with acquired brain injury admitted to special care units in Dutch nursing homes. Methods According to the Committee on Research Involving Human Subjects in January 2017 this study did not require ethics approval. Nursing homes will be recruited through the national acquired brain injury expertise network for patients with severe brain injury, the regional brain injury teams and by searching the internet. Patient characteristics will be collected through digital questionnaires. Neuropsychiatric symptoms will be assessed with the NeuroPsychiatric Inventory‐Nursing Home version, the Cohen–Mansfield Agitation Inventory and the St. Andrews Sexual Behaviour Assessment; cognition with the Mini‐Mental State Examination, quality of life with the Quality of Life after Brain Injury Overall Scale and activities of daily living with the Disability Rating Scale. Medication will be retrieved from the electronic prescription system. Data collection commenced in 2017 and will be followed by data analysis in 2019. Reporting will be completed in 2020. Discussion Little is known about NPS among patients with acquired brain injury in nursing homes. In patients up to the age of 65 years, only six studies were found on prevalence rates of NPS. Impact Patients with severe acquired brain injury experience lifelong consequences, that have a high impact on them and their environment. Although there is increasing attention for the survival of this vulnerable group of patients, it is also important to enlarge awareness on long‐term consequences, specifically the NPS, quality of life and psychotropic drug use in acquired brain injury. Insight into the magnitude of these issues is necessary to achieve appropriate care for these patients.
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Affiliation(s)
- Roy Kohnen
- Vivent, Rosmalen and Livio, Enschede, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Jan Lavrijsen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Odile Smals
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Vivent, Rosmalen, The Netherlands
| | - Debby Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Raymond Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, De Waalboog, "Joachim and Anna", Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
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Merino R, Pérez A, Fierro J, Terré R. Prevalence of medication and off-label medication use in acquired brain injury at a neurorehabilitation hospital. Eur J Clin Pharmacol 2019; 75:985-994. [PMID: 30834963 DOI: 10.1007/s00228-019-02651-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/15/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Patients who suffer acquired brain injury (ABI) require a great variety of drugs. Furthermore, the lack of evidence on the medication effects in this type of patient increases off-label prescription. The aim of this study was to describe the pattern of medication use and the practice of prescribing off-label drugs in these patients. METHODS A cross-sectional study was conducted in patients with ABI, of either traumatic or non-traumatic cause, admitted to a neurorehabilitation hospital for rehabilitation. Demographic and clinical data and prevalence of medication use and off-label prescription were collected. RESULTS The majority of the studied patients (85.2%) were considered polymedicated since they were prescribed ≥ 6 drugs concomitantly. In traumatic brain injury (TBI) patients, antidepressants (81.5%) were the Anatomical Therapeutic Chemical (ATC) group's most prescribed versus antithrombotic agents (80.5%) in non-traumatic brain injury (N-TBI) patients. Up to 37.3% of all active substances prescribed in TBI patients were off-label compared with 24.9% in N-TBI patients. The most prescribed off-label active substances in both groups were those related to the Nervous System (N) ATC group to treat neurobehavioural problems. CONCLUSION A multidisciplinary pharmacotherapeutic follow-up of these patients would be essential to address the high prescription rate of medications and the off-label prescription practice. In this way, medication problems related to polypharmacy could be minimised and the benefit-risk ratio of prescribed off-label drugs could be ensured according to the available medical evidence.
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Affiliation(s)
- Raquel Merino
- Pharmacy Service, Institut Guttmann, Neurorehabilitation Hospital, Camí de Can Ruti s/n, 08916, Badalona, Barcelona, Spain.
| | - Ana Pérez
- Pharmacy Service, Institut Guttmann, Neurorehabilitation Hospital, Camí de Can Ruti s/n, 08916, Badalona, Barcelona, Spain
| | - Josana Fierro
- Pharmacy Service, Institut Guttmann, Neurorehabilitation Hospital, Camí de Can Ruti s/n, 08916, Badalona, Barcelona, Spain
| | - Rosa Terré
- Neurorehabilitation Unit, Institut Guttmann, Neurorehabilitation Hospital, Camí de Can Ruti s/n, 08916, Badalona, Barcelona, Spain
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Zhang T, Wang G, Li B, Wang L, Guo J, Hu J, Du X, Hong Q, Sun J, Liu C. Effect of acupuncture for constipation after ischemic stroke: study protocol for a randomized controlled trial. Trials 2018; 19:454. [PMID: 30134942 PMCID: PMC6106942 DOI: 10.1186/s13063-018-2750-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 06/19/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Constipation is a common complication after stroke that can severely influence a patient's quality of life and rehabilitation. Treatments for constipation after stroke vary. Acupuncture may improve spontaneous bowel movements, quality of life, and clinical symptoms. The study seeks to assess the preliminary effects of acupuncture on constipation after an ischemic stroke. METHODS/DESIGN This is a prospective randomized controlled pilot trial design in which 120 eligible patients will be randomly allocated to one of three groups. The acupuncture group (n = 40) will receive acupuncture and routine care, the medication group (n = 40) will receive mosapride citrate and routine care, and the control group (n = 40) will receive only routine care for ischemic stroke. Patients will be recruited 2 weeks to 6 months after stroke onset and will receive the intervention continuously over 4 weeks, with a follow-up period of 4 additional weeks. Adverse events will be recorded to assess the safety and tolerability of acupuncture for constipation after an ischemic stroke. The primary outcome will be the change in the weekly mean number of complete spontaneous bowel movements. Secondary outcomes will include any change in the weekly mean number of spontaneous bowel movements, mean stool consistency scores, mean straining scores during defecation, and frequency of laxative use. All outcome measures will be assessed at inception, after the intervention (4 weeks), and at the follow-up (8 weeks). DISCUSSION This study will provide evidence of the preliminary effects and inform future sample size calculations for studies of acupuncture for constipation following an ischemic stroke. These findings will inform subsequent large-scale randomized controlled trials. TRIAL REGISTRATION ISRCTN, 22214747 . Registered on 17 August 2015.
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Affiliation(s)
- Tao Zhang
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Guiling Wang
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Bin Li
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Linpeng Wang
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Jing Guo
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Junxia Hu
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Xin Du
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Qiuyang Hong
- Department of Acupuncture and Moxibustion, Shunyi Hospital affiliated to Beijing Hospital of Traditional Chinese Medicine, Beijing, China
| | - Jingqing Sun
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China.
| | - Cunzhi Liu
- Dongfang Hospital affiliated to Beijing University of Traditional Chinese Medicine, Beijing, China.
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Enevoldsen J, Vistisen ST, Krogh K, Nielsen JF, Knudsen K, Borghammer P, Andersen H. Gastrointestinal transit time and heart rate variability in patients with mild acquired brain injury. PeerJ 2018; 6:e4912. [PMID: 29892504 PMCID: PMC5994161 DOI: 10.7717/peerj.4912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/16/2018] [Indexed: 11/20/2022] Open
Abstract
Background Constipation is suspected to occur frequently after acquired brain injury (ABI). In patients with ABI, heart rate variability (HRV) is reduced suggesting autonomic dysfunction. Autonomic dysfunction may be associated with prolonged gastrointestinal transit time (GITT). The primary aim of this study was to investigate if GITT is prolonged in patients with ABI. Secondarily, HRV and its correlation with GITT was investigated. Methods We included 25 patients with ABI (18 men, median age: 61.3 years, range [30.7-74.5]). GITT was assessed using radio-opaque markers and HRV was calculated from 24-hour electrocardiograms. Medical records were reviewed for important covariates, including primary diagnosis, time since injury, functional independence measure, and use of medication. The GITT assessed in patients was compared to a control group of 25 healthy subjects (18 men, median age: 61.5 years, range [34.0-70.9]). Results In ABI patients, the mean GITT was significantly longer than in healthy controls (2.68 days, 95% CI [2.16-3.19] versus (1.92 days, 95% CI [1.62-2.22], p = 0.011)). No correlation was found between HRV and GITT. Conclusion Patients with mild to moderate ABI have prolonged GITT unrelated to the HRV.
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Affiliation(s)
| | - Simon T Vistisen
- Research Centre for Emergency Medicine, Aarhus University, Aarhus, Denmark
| | - Klaus Krogh
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus Univeristy Hospital, Aarhus, Denmark
| | - Jørgen F Nielsen
- Hammel Neurocenter and University Clinic, Aarhus University, Aarhus, Denmark
| | - Karoline Knudsen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Per Borghammer
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Abstract
The aims of this study were to estimate the prevalence of constipation and identify associated factors among adults living in an urban area in Londrina, Brazil. This was a secondary analysis of an epidemiological, population-based study on bowel habit performed in 2008 with 2,162 individuals selected through cluster sampling. Interviews were administered using a sociodemographic questionnaire and the adapted and validated Brazilian version of the "Bowel Function in the Community" tool. Variables from the original database were used to determine the prevalence of constipation (according to the Rome Criteria III) and associated factors. The chi-square test and multivariate logistic regression were used for data analysis. The overall prevalence of constipation (14.6%; n = 315) was higher among women than among men (21.9% vs. 5.3%), increased with age among men, and was inversely related to family income. Overall, female gender, low socioeconomic status, history of anal fissure, anorectal surgery, stroke, nervous system disease, fistulae, and hemorrhoids were factors significantly associated with constipation. The variables low social economic status, stroke, anal fissure history, and anorectal surgery were statistically significant in all three tested statistical models.
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14
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Li J, Yuan M, Liu Y, Zhao Y, Wang J, Guo W. Incidence of constipation in stroke patients: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e7225. [PMID: 28640117 PMCID: PMC5484225 DOI: 10.1097/md.0000000000007225] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
There is growing awareness of a link between the gut and cardiovascular disease. Constipation is common among individuals who have had a stroke, and it negatively affects social functioning and quality of life. However, no systematic study on the incidence of constipation in stroke patients has been reported.We selected studies included in Medline, Embase, Cochrane database, and Web of Science. Studies were included if they reported the incidence in stroke patients. Two authors selected the studies, extracted the data independently, and assessed these. Subgroup analyses were conducted according to the stroke subtype and stage of stroke.After detailed evaluations, 8 studies (n = 1385 participants) were found that contained data that were suitable for meta-analytic synthesis. A forest plot showed that the incidence of constipation was 48% (95% confidence interval [CI] = 33%-63%). In the analysis of the type of stroke subgroup, the incidence of constipation in patients who had had a hemorrhagic stroke (66% [95% CI = 40-91%]) was higher than that in patients who had experienced an ischemic stroke (51% [95% CI = 27%-75%]). The incidence in the acute stage (45% [95% CI = 36%-54%]) was lower than that in the rehabilitation stage (48% [95% CI = 23%-73%]).Constipation after a stroke event occurs frequently. This finding may raise awareness about bowel complications to allow correct evaluation and proper management.
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Affiliation(s)
- Jianxiang Li
- Department of the First Clinical Medical College, School of Nanjing University of Chinese Medicine
- Third Affiliated Hospital, School of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Mengguo Yuan
- Department of the First Clinical Medical College, School of Nanjing University of Chinese Medicine
| | - Yunfang Liu
- Department of the First Clinical Medical College, School of Nanjing University of Chinese Medicine
| | - Yang Zhao
- Third Affiliated Hospital, School of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Jingqing Wang
- Third Affiliated Hospital, School of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Weifeng Guo
- Department of the First Clinical Medical College, School of Nanjing University of Chinese Medicine
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15
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Houlden A, Goldrick M, Brough D, Vizi E, Lénárt N, Martinecz B, Roberts I, Denes A. Brain injury induces specific changes in the caecal microbiota of mice via altered autonomic activity and mucoprotein production. Brain Behav Immun 2016; 57:10-20. [PMID: 27060191 PMCID: PMC5021180 DOI: 10.1016/j.bbi.2016.04.003] [Citation(s) in RCA: 237] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/09/2016] [Accepted: 04/05/2016] [Indexed: 12/28/2022] Open
Abstract
Intestinal microbiota are critical for health with changes associated with diverse human diseases. Research suggests that altered intestinal microbiota can profoundly affect brain function. However, whether altering brain function directly affects the microbiota is unknown. Since it is currently unclear how brain injury induces clinical complications such as infections or paralytic ileus, key contributors to prolonged hospitalization and death post-stroke, we tested in mice the hypothesis that brain damage induced changes in the intestinal microbiota. Experimental stroke altered the composition of caecal microbiota, with specific changes in Peptococcaceae and Prevotellaceae correlating with the extent of injury. These effects are mediated by noradrenaline release from the autonomic nervous system with altered caecal mucoprotein production and goblet cell numbers. Traumatic brain injury also caused changes in the gut microbiota, confirming brain injury effects gut microbiota. Changes in intestinal microbiota after brain injury may affect recovery and treatment of patients should appreciate such changes.
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Affiliation(s)
- A. Houlden
- Faculty of Life Sciences, University of Manchester, Manchester, UK
| | - M. Goldrick
- Faculty of Life Sciences, University of Manchester, Manchester, UK
| | - D. Brough
- Faculty of Life Sciences, University of Manchester, Manchester, UK
| | - E.S. Vizi
- Laboratory of Drug Research, Institute of Experimental Medicine, Hungarian Academy of Sciences, P.O.B. 67, H-1450 Budapest, Hungary,Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - N. Lénárt
- Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
| | - B. Martinecz
- Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
| | - I.S. Roberts
- Faculty of Life Sciences, University of Manchester, Manchester, UK,Corresponding authors at: Faculty of Life Sciences, University of Manchester, Manchester, UK (I.S. Roberts); Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary (A. Denes).Faculty of Life SciencesUniversity of ManchesterManchesterUK
| | - A. Denes
- Faculty of Life Sciences, University of Manchester, Manchester, UK,Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary,Corresponding authors at: Faculty of Life Sciences, University of Manchester, Manchester, UK (I.S. Roberts); Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary (A. Denes).Faculty of Life SciencesUniversity of ManchesterManchesterUK
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16
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Factors Associated With Intestinal Constipation in Chronic Patients With Stroke Sequelae Undergoing Rehabilitation. Gastroenterol Nurs 2016; 39:432-442. [DOI: 10.1097/sga.0000000000000163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Szigeti K, Horváth I, Veres DS, Martinecz B, Lénárt N, Kovács N, Bakcsa E, Márta A, Semjéni M, Máthé D, Dénes Á. A novel SPECT-based approach reveals early mechanisms of central and peripheral inflammation after cerebral ischemia. J Cereb Blood Flow Metab 2015; 35. [PMID: 26219594 PMCID: PMC4671129 DOI: 10.1038/jcbfm.2015.174] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Inflammation that develops in the brain and peripheral organs after stroke contributes profoundly to poor outcome of patients. However, mechanisms through which inflammation impacts on brain injury and overall outcome are improperly understood, in part because the earliest inflammatory events after brain injury are not revealed by current imaging tools. Here, we show that single-photon emission computed tomography (NanoSPECT/CT Plus) allows visualization of blood brain barrier (BBB) injury after experimental stroke well before changes can be detected with magnetic resonance imaging (MRI). Early 99mTc-DTPA (diethylene triamine pentaacetic acid) signal changes predict infarct development and systemic inflammation preceding experimental stroke leads to very early perfusion deficits and increased BBB injury within 2 hours after the onset of ischemia. Acute brain injury also leads to peripheral inflammation and immunosuppression, which contribute to poor outcome of stroke patients. The SPECT imaging revealed early (within 2 hours) changes in perfusion, barrier function and inflammation in the lungs and the gut after experimental stroke, with good predictive value for the development of histopathologic changes at later time points. Collectively, visualization of early inflammatory changes after stroke could open new translational research avenues to elucidate the interactions between central and peripheral inflammation and to evaluate in vivo 'multi-system' effects of putative anti-inflammatory treatments.
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Affiliation(s)
- Krisztián Szigeti
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Ildikó Horváth
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Dániel S Veres
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Bernadett Martinecz
- Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
| | - Nikolett Lénárt
- Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
| | - Noémi Kovács
- CROmed Translational Research Centers, Budapest, Hungary
| | - Erika Bakcsa
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Alexa Márta
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | | | - Domokos Máthé
- CROmed Translational Research Centers, Budapest, Hungary
| | - Ádám Dénes
- Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
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18
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Lim SF, Ong SY, Tan YL, Ng YS, Chan YH, Childs C. Incidence and predictors of new-onset constipation during acute hospitalisation after stroke. Int J Clin Pract 2015; 69:422-8. [PMID: 25656963 DOI: 10.1111/ijcp.12528] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 07/18/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES We investigated new-onset constipation in patients with stroke compared with orthopaedic conditions and explored the predictors associated with constipation during acute hospitalisation. METHODS This was a prospective matched cohort study of 110 patients comparing stroke patients (n = 55) with orthopaedic patients (n = 55) admitted to a large tertiary acute hospital. Both cohorts were matched by age and sex. The incidence of new-onset constipation which occurred during a patient's acute hospitalisation was determined. Demographics, comorbidity, clinical factors, laboratory parameters and medications were evaluated as possible predictors of constipation. RESULTS The incidence of new-onset constipation was high for both stroke (33%) and orthopaedic patients (27%; p = 0.66). Seven stroke patients (39%) and four orthopaedic patients (27%) developed their first onset of constipation on day 2 of admission. Mobility gains (RR 0.741, p < 0.001) and the use of prophylactic laxatives (RR 0.331, p < 0.01) had a protective effect against constipation. Bedpan use (RR 2.058, p < 0.05) and longer length of stay (RR 1.032, p < 0.05) increased the risk of developing new-onset constipation. CONCLUSIONS New-onset constipation is common among patients admitted for stroke and orthopaedic conditions during acute hospitalisation. The early occurrence, on day 2 of admission, calls for prompt preventive intervention for constipation.
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Affiliation(s)
- S-F Lim
- Specialist Nursing Services, Department of Rehabilitation Medicine, Singapore General Hospital, Singapore; Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Engler TMNDM, Dourado CC, Amâncio TG, Farage L, de Mello PA, Padula MPC. Stroke: bowel dysfunction in patients admitted for rehabilitation. Open Nurs J 2014; 8:43-7. [PMID: 25419252 PMCID: PMC4238029 DOI: 10.2174/1874434601408010043] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 06/15/2014] [Accepted: 06/20/2014] [Indexed: 11/29/2022] Open
Abstract
Aim : to assess the prevalence of diminished frequency of bowel movements, lumpy or hard stools, intestinal constipation, straining, incomplete evacuation, incontinence (bowel dysfunctions) in patients with brain injury resulting from cerebrovascular accident, either self-reported or reported by their caregivers; to describe the type and frequency of such dysfunctions; and the prevalence of laxative use both before and after stroke. Method : cross-sectional study with 98 hospitalized patients admitted for rehabilitation between December 2009 and May 2010. Results : the prevalence of bowel dysfunctions before stroke was 23.96% whereas after the lesion it was 55.21% (p<0.0001). As reported by patients/caregivers, the chances of developing bowel dysfunctions increase sevenfold after stroke, 95% CI (2.44-24.26). The most frequent dysfunctions before stroke were intestinal constipation (73.91%) and diminished frequency of bowel movements (17.39%). After stroke, constipation remains to be the most frequent dysfunction reported (50%), followed by diminished frequency of bowel movements (26.79%), incomplete evacuation (12.50%), and lack of privacy (5.36%). The use of laxatives was 19,15% after the lesion, but not statisticaly significant (p=0.0736). Conclusion : Bowel dysfunctions increases significantly after stroke. Therefore, further studies are needed to better understand and characterize such dysfunctions, which are scarcely described in the literature.
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Affiliation(s)
- Tânia M N de M Engler
- Graduate Program in Health Sciences, Universidade de Brasília (UnB), Brazil ; Neurological rehabilitation program in the SARAH Network of Rehabilitation Hospitals, Brasília (DF), Brazil
| | - Cinthia C Dourado
- Neurological rehabilitation program in the SARAH Network of Rehabilitation Hospitals, Brasília (DF), Brazil
| | - Thais G Amâncio
- Secretaria de Estado de Saúde do Distrito Federal, Brasília (DF), Brazil
| | - Luciano Farage
- Faculty of Medicine, Universidade de Brasília-UnB-Brasília (DF), Brazil
| | - Paulo A de Mello
- Faculty of Medicine, Universidade de Brasília-UnB-Brasília (DF), Brazil
| | - Marcele P C Padula
- Faculty of Medical Sciences of Santa Casa São Paulo-São Paulo (SP), Brazil
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20
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Camara-Lemarroy CR, Ibarra-Yruegas BE, Gongora-Rivera F. Gastrointestinal complications after ischemic stroke. J Neurol Sci 2014; 346:20-5. [PMID: 25214444 DOI: 10.1016/j.jns.2014.08.027] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 08/18/2014] [Accepted: 08/20/2014] [Indexed: 01/25/2023]
Abstract
Ischemic stroke is an important cause of morbidity and mortality, and currently the leading cause of adult disability in developed countries. Stroke is associated with various non-neurological medical complications, including infections and thrombosis. Gastrointestinal complications after stroke are also common, with over half of all stroke patients presenting with dysphagia, constipation, fecal incontinence or gastrointestinal bleeding. These complications are associated with increased hospital length of stay, the development of further complications and even increased mortality. In this article we review the epidemiology, pathophysiology, diagnosis, management and prevention of the most common gastrointestinal complications associated with ischemic stroke.
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Affiliation(s)
- Carlos R Camara-Lemarroy
- Departamento de Neurología, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey, NL 64460, Mexico.
| | - Beatriz E Ibarra-Yruegas
- Departamento de Psiquiatria, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey, NL 64460, Mexico
| | - Fernando Gongora-Rivera
- Departamento de Neurología, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey, NL 64460, Mexico
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Chen IC, Huang HJ, Yang SF, Chen CC, Chou YC, Kuo TM. Prevalence and Effectiveness of Laxative Use Among Elderly Residents in a Regional Hospital Affiliated Nursing Home in Hsinchu County. Nurs Midwifery Stud 2014; 3:e13962. [PMID: 25414891 PMCID: PMC4228520 DOI: 10.17795/nmsjournal13962] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 09/08/2013] [Accepted: 11/03/2013] [Indexed: 12/03/2022] Open
Abstract
Background: Long-term care residents are susceptible to constipation and one-half to three quarter of older nursing home residents receive laxatives regularly. Objectives: The purpose of this study was to evaluate the factors related to abnormal bowel function and explore the effectiveness of laxative treatment among the elderly residents of a nursing home. Patients and Methods: A total of 110 residents older than 65 years old was enrolled in this study. The following variables were gathered: age, gender, body mass index (BMI), length of stay, daily fluid intake, type of food, functional level, cognitive ability, physical therapy status, somatic and psychiatric diseases, number of medications, and medication use. The use and dosage of laxatives were recorded by means of Anatomical Therapeutic Chemical (ATC) classification system. Normal bowel function was defined as defecation frequency from three defecations per day to three defecations per week and stool consistency score of three to five on Bristol Stool Form Scale. A comparison between groups with normal and abnormal bowel function was drawn. Results: Low BMI, increased fluid intake, liquid food intake, poor functional level, poor cognition, and a history of stroke were significantly associated with altered bowel function (P < 0.05). The most frequently used laxatives were glycerol, senna glycoside, and magnesium oxide. There were significant differences in laxative regimens between residents with normal and altered bowel function; those with altered bowel function tended to take more laxatives than those with normal bowel function. Conclusions: This study suggested that treatment of constipation in the nursing home was unsatisfactory. To improve treatment outcomes in those susceptible to altered bowel function, a coordinated approach with involvement of physicians, nursing staff, and other professionals including dieticians and pharmacists seems necessary.
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23
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Vistisen ST, Hansen TK, Jensen J, Nielsen JF, Fleischer J. Heart rate variability in neurorehabilitation patients with severe acquired brain injury. Brain Inj 2013; 28:196-202. [PMID: 24295072 DOI: 10.3109/02699052.2013.860477] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Acquired brain injury (ABI) cause neural deficits. In addition to motor and cognitive deficits, the autonomic nervous system may be affected. This has been shown for neurorehabilitation patients with traumatic brain injury (TBI) by means of reduced heart rate variability (HRV). It was hypothesized that patient groups with other ABI aetiology (mainly stroke, subarachnoid haemorrhage and anoxia) would also present reduced HRV. METHODS Patients consecutively admitted and severely ABI injured were considered for HRV measurements. HRV was extracted as a mean of four 5-minute ECG recordings at 6 pm, 10 pm, 2 am and 6 am the following day (scheduled resting periods). One 5-minute HRV recording from a sex- and age-matched group of healthy volunteers constituted control data. Standard deviation of normal-to-normal intervals (SDNN) and low frequency (LF) were primary HRV variables. RESULTS Of 71 admitted patients, HRV was extracted from 49 patients. Patient SDNN and LF were reduced compared to controls (SDNN: 13 ms (CI = [10.8; 15.3]) vs 40.3 ms (CI = [36.6; 44.2]), p < 0.0001; LF: 29.4 ms² (CI = [19.8; 43.7]) vs 518 ms² (CI = [419; 639]), p < 0.0001). HRV appeared identical across ABI aetiology. CONCLUSION It was found that HRV was considerably reduced in an heterogenic ABI patient group admitted for neurorehabilitation.
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Affiliation(s)
- Simon Tilma Vistisen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University and
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24
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Lim SF, Childs C. A systematic review of the effectiveness of bowel management strategies for constipation in adults with stroke. Int J Nurs Stud 2012; 50:1004-10. [PMID: 23279967 DOI: 10.1016/j.ijnurstu.2012.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 12/03/2012] [Accepted: 12/03/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Constipation is one of the most common medical complications of acute stroke. Currently, management strategies to guide clinical practice are limited. This review aimed to examine the effectiveness of bowel management strategies for constipation in adults with stroke. DESIGN A systematic review of randomised controlled trials or other quantitative research designs in the absence of randomised controlled trials was undertaken. DATA SOURCES A comprehensive search of major electronic databases and all reference lists of relevant articles in the English language were performed from January 1990 up to March 2011. REVIEW METHODS Data were extracted and assessed by two independent reviewers. Due to differences in the study designs, the findings are presented in narrative form. RESULTS There were a total of three studies (two randomised controlled trials and one quasi-experimental study). One of the randomised controlled trials examined a single (once-only) structured nurse-led intervention and the other randomised controlled trial evaluated four bowel management programmes. Both studies yield improvements respectively in symptoms of bowel dysfunction and bowel training efficiency when the programme corresponded with the subjects' bowel patterns before the stroke onset. The quasi-experimental study compared the effectiveness of daily digital stimulation versus every other day and found higher bowel regularity with daily digital stimulation. CONCLUSION Constipation management strategies are limited. This review suggests that structured bowel programmes and nurse-led intervention in bowel care have a significant effect in improving bowel evacuations.
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Affiliation(s)
- Su Fee Lim
- Rehabilitation Medicine, Block 6, Level 9, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
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25
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Dourado CC, Engler TMNDM, Oliveira SBD. Disfunção intestinal em pacientes com lesão cerebral decorrente de acidente vascular cerebral e traumatismo craniencefálico: estudo retrospectivo de uma série de casos. TEXTO & CONTEXTO ENFERMAGEM 2012. [DOI: 10.1590/s0104-07072012000400022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A disfunção intestinal é uma queixa comum entre pacientes com lesão cerebral decorrente de Acidente Vascular Cerebral e Traumatismo Craniencefálico. Este estudo objetivou pesquisar a prevalência da disfunção intestinal (incontinência anal e constipação intestinal) em pacientes com lesão cerebral decorrente de Acidente Vascular Cerebral e Traumatismo Craniencefálico, admitidos para reabilitação. Trata-se de um estudo retrospectivo de uma série de casos, a partir da análise dos dados de 138 prontuários de pacientes internados no primeiro semestre de 2009. A prevalência de disfunção intestinal foi 41%, sendo 33 (24%) incontinência anal e 37 (27%) constipação intestinal. Comprometimento motor, auxílio locomoção, alterações de memória e comunicação estiveram associados à presença de incontinência anal. A prevalência de disfunção intestinal é alta nessa população, identificá-la precocemente, bem como os fatores relacionados, e promover a reeducação intestinal, poderá contribuir para melhora na qualidade de vida dessas pessoas.
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26
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Lim YH, Kim DH, Lee MY, Joo MC. Bowel dysfunction and colon transit time in brain-injured patients. Ann Rehabil Med 2012; 36:371-8. [PMID: 22837973 PMCID: PMC3400877 DOI: 10.5535/arm.2012.36.3.371] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 04/27/2012] [Indexed: 01/14/2023] Open
Abstract
Objective To report the defecation patterns of brain-injured patients and evaluate the relationship between functional ability and colon transit time (CTT) in stroke patients. Method A total of 55 brain-injured patients were recruited. Patient interviews and medical records review of pattern of brain injury, anatomical site of lesion, bowel habits, constipation score, and Bristol scale were conducted. We divided the patients into constipation (n=29) and non-constipation (n=26) groups according to Rome II criteria for constipation. The CTTs of total and segmental colon were assessed using radio-opaque markers Kolomark® and functional ability was evaluated using the functional independence measure (FIM). Results Constipation scores in constipation and non-constipation groups were 7.32±3.63 and 5.04±2.46, respectively, and the difference was statistically significant. The CTTs of the total colon in both groups were 46.6±18.7 and 32.3±23.5 h, respectively. The CTTs of total, right, and left colon were significantly delayed in the constipation group (p<0.05). No significant correlation was found between anatomical location of brain injury and constipation score or total CTT. Only the CTT of the left colon was delayed in the patient group with pontine lesions (p<0.05). Conclusion The constipation group had significantly elevated constipation scores and lower Bristol stool form scale, with prolonged CTTs of total, right, and left colon. In classification by site of brain injury, we did not find significantly different constipation scores, Bristol stool form scale, or CTTs between the groups with pontine and suprapontine injury.
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Affiliation(s)
- Yu Hyun Lim
- Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan 570-749, Korea
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Qu W, Li Y, Song W, Zhou X, Kang Y, Yan L, Sui H, Yuan H. Prevalence and risk factors for angle-closure disease in a rural Northeast China population: a population-based survey in Bin County, Harbin. Acta Ophthalmol 2011; 89:e515-20. [PMID: 21834920 DOI: 10.1111/j.1755-3768.2011.02146.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To estimate the prevalence of primary angle-closure glaucoma (PACG), primary angle closure (PAC) and primary angle-closure suspect (PACS) and associated risk factors for PACG in a rural population in Northeast China. METHODS A population-based survey was conducted in Bin County, Harbin, Northeast China. Glaucoma was diagnosed using the International Society of Geographical and Epidemiological Ophthalmology (ISGEO) criteria. All subjects underwent a complete ophthalmic examination. RESULTS A total of 4956 (86.01%) of 5762 subjects aged 40 years or older were examined. The mean intraocular pressure (IOP) of the right eyes was 14.0 mmHg. The mean vertical cup-to-disc ratio of the right and the left eyes was 0.31 and 0.31, respectively. The prevalence of PACG, PAC and PACS was 1.57% [95% confidence interval (CI), 1.469-1.671], 1.33% (95% CI, 1.236-1.424), and 4.68% (95% CI, 4.541-4.819), respectively. Among all PACG subjects, 42 (53.84%) had elevated IOP >21 mmHg in either eye and 37 (47.44%) had been treated by laser, surgical iridectomy or trabeculectomy. Sixty-four subjects (82.05%) had vision impairment of varying degrees. Multivariate analysis revealed that old age, family history of PACG, constipation and IOP were significant independent risk factors. CONCLUSIONS Primary angle-closure glaucoma was a disease of high prevalence in rural Northeast China. Old age, family history of PACG, constipation and IOP were significant independent risk factors for PACG.
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Affiliation(s)
- Wei Qu
- Department of Ophthalmology, The 2nd Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
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Yi JH, Chun MH, Kim BR, Han EY, Park JY. Bowel function in acute stroke patients. Ann Rehabil Med 2011; 35:337-43. [PMID: 22506142 PMCID: PMC3309224 DOI: 10.5535/arm.2011.35.3.337] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 01/15/2011] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate factors related to bowel function and colon motility in acute stroke patients. Method Fifty-one stroke patients (29 males, mean age 63.4±13.6 years, onset 13.4±4.8 days) were recruited and divided into two groups: constipation (n=25) and non-constipation (n=26) groups. We evaluated the amount of intake, voiding function, concomitant swallowing problem and colon transit time (CTT) using radio-opaque markers for ascending, descending and rectosigmoid colons. The Adapted Patient Evaluation Conference System (APEC), Korean version of Modified Bathel Index (K-MBI) and Motricity Index (MI) were evaluated. Results The constipation group showed significantly prolonged CTT of ascending, descending and entire colon (p<0.05) and more severe swallowing problems (p=0.048). The APEC scale (2.65±1.44 vs 1.52±0.92, p=0.001), K-MBI scores (59.4±14.4 vs 28.0±24.3, p<0.001) and MI scores (69.1±22.3 vs 46.8±25.9, p=0.001) of the constipation group were significantly lower compared to the non-constipation group. Conclusion Our study demonstrated that bowel function in acute stroke patients was associated with functional status and swallowing function, indicating the need for intensive functional training in post-stroke constipation patients.
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Affiliation(s)
- Jin Hwa Yi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
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Engler TMNDM, Farage L, Mello PAD. Constipação intestinal em pacientes admitidos em programa de reabilitação neurológica. ACTA PAUL ENFERM 2011. [DOI: 10.1590/s0103-21002011000600013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVOS: Conhecer a prevalência da constipação intestinal em pacientes admitidos para reabilitação e verificar os resultados de dois modelos de condutas instituídas para reeducação intestinal durante a internação. MÉTODOS: Estudo longitudinal, analítico, com 98 pacientes internados em enfermaria de reabilitação entre dezembro de 2009 e maio de 2010. RESULTADOS: A prevalência de constipação foi de 57,1%, não houve correlação entre as variáveis sexo, escolaridade, idade, auxílio locomoção, alteração de linguagem, atividade física, dieta e presença de constipação intestinal; a melhora na capacidade funcional foi um preditor de progresso na frequência intestinal; as condutas introduzidas apresentaram um importante papel na melhora do hábito intestinal. CONCLUSÕES: Estudos de condutas poderão fornecer subsídios no tratamento da constipação intestinal, aperfeiçoando a qualidade de vida dessas pessoas.
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Kim SJ, Kim SI, Ahn HS, Choi JB, Kim YS, Kim SJ. Risk factors for acute prostatitis after transrectal biopsy of the prostate. Korean J Urol 2010; 51:426-30. [PMID: 20577611 PMCID: PMC2890061 DOI: 10.4111/kju.2010.51.6.426] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 05/29/2010] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the incidence, clinical features, pathogenic bacteria, and risk factors associated with acute prostatitis after transrectal prostate biopsy. Materials and Methods We retrospectively reviewed the medical records of 923 transrectal ultrasound-guided needle biopsies of the prostate in 878 patients performed at our institution from June 2004 to May 2009. The indications for biopsy were generally serum prostate-specific antigen (PSA) elevation, abnormal findings on a digital rectal examination, or both. All biopsies were performed with the patient hospitalized except for 10 patients who refused to be hospitalized, and ciprofloxacin was administered as an antibiotic prophylaxis. The incidence, clinical features, pathogenic bacteria, and potential risk factors associated with acute prostatitis after prostate biopsy were evaluated. Results Acute prostatitis developed in 18 (2.0%) cases after prostate biopsy. Among them, 9 (1.0%) had bacteremia and 2 (0.2%) showed clinical features of sepsis. Of the total 50 urine or blood specimens sent for culture study, 27 (54.0%) specimens showed positive cultures, including E. coli in 25. Among the 27 culture-positive specimens, 26 (96.3%) were resistant to ciprofloxacin. Among the potential risk factors for acute prostatitis after prostate biopsy, biopsy performed as an outpatient procedure without a cleansing enema (p=0.001) and past history of cerebrovascular accident (p=0.048) were statistically significant. Conclusions Fluoroquinolone is effective as an antibiotic prophylaxis for transrectal prostate biopsy in most cases. The incidence of acute prostatitis after transrectal prostate biopsy was 2.0%, and almost all cases were caused by fluoroquinolone-resistant E. coli. A cleansing enema is recommended before transrectal prostate biopsy.
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Affiliation(s)
- Sang Jin Kim
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
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Ameer NH, Lee JH, Choi MA, Jin GS, Kim MS, Park BR. The Effects of Glutamate NMDA Receptor Antagonist MK-801 on Gastrointestinal Motility after Middle Cerebral Artery Occlusion in Rats. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2010; 14:151-156. [PMID: 20631887 PMCID: PMC2902806 DOI: 10.4196/kjpp.2010.14.3.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 05/20/2010] [Accepted: 05/26/2010] [Indexed: 05/29/2023]
Abstract
This study was performed to investigate the role of glutamate neurotransmitter system on gastrointestinal motility in a middle cerebral artery occlusion (MCAO) model of rats. The right middle cerebral artery was occluded by surgical operation, and intestinal transit and geometric center as a parameter of gastrointestinal motility and expression of c-Fos protein in the insular cortex and cingulate cortex were measured at 2 and 12 h after MCAO. Intestinal transit was 66.3+/-7.5% and 62.3+/-5.7% 2 and 12 h after sham operation, respectively, and MCAO significantly decreased intestinal transit to 39.0+/-3.5% and 47.0+/-5.1% at 2 and 12 h after the occlusion, respectively (p<0.01). The geometric center was 5.6+/-0.4 and 5.2+/-0.9 at 2 and 12 h after sham operation, respectively, and MCAO significantly decreased geometric center to 2.9+/-0.8 and 3.0+/-0.3 at 2 and 12 h after the occlusion, respectively (p<0.01). In control animals, injection of atropine decreased intestinal transit to 35.9+/-5.2%, and injection of glutamate NMDA receptor antagonist, MK-801, decreased intestinal transit to 28.8+/-9.5%. Pretreatment with MK-801, a glutamate NMDA receptor antagonist, in the MCAO group decreased intestinal transit to 11.8+/-3.2%, which was significantly decreased compared to MCAO group (p<0.01). MCAO markedly increased the expression of c-Fos protein in the insular cortex and cingulate cortex ipsilateral to the occlusion 2 h after MCAO, and pretreatment with MK-801 produced marked reduction of c-Fos protein expression compared to MCAO group (p<0.01). These results suggest that modulation of gastrointestinal motility after MCAO might be partially mediated through a glutamate NMDA receptor system.
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Affiliation(s)
- Nasir Hussin Ameer
- Department of Physiology, Wonkwang University School of Medicine, and Brain Research Institute at Wonkwang University, Iksan 570-749, Korea
| | - Jae Hee Lee
- Department of Physiology, Wonkwang University School of Medicine, and Brain Research Institute at Wonkwang University, Iksan 570-749, Korea
| | - Myoung Ae Choi
- Department of Physiology, Wonkwang University School of Medicine, and Brain Research Institute at Wonkwang University, Iksan 570-749, Korea
| | - Guang-Shi Jin
- Department of Neurosurgery, Affiliated Hospital of Yanbian University, Yanji 133000, Jilin, China
| | - Min Sun Kim
- Department of Physiology, Wonkwang University School of Medicine, and Brain Research Institute at Wonkwang University, Iksan 570-749, Korea
| | - Byung Rim Park
- Department of Physiology, Wonkwang University School of Medicine, and Brain Research Institute at Wonkwang University, Iksan 570-749, Korea
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Di Saverio S, Tugnoli G, Orlandi PE, Casali M, Catena F, Biscardi A, Pillay O, Baldoni F. A 73-year-old man with long-term immobility presenting with abdominal pain. PLoS Med 2009; 6:e1000092. [PMID: 19597540 PMCID: PMC2702819 DOI: 10.1371/journal.pmed.1000092] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Salomone Di Saverio and colleagues discuss the diagnosis and management of a man presenting with symptoms of partial intestinal obstruction.
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Affiliation(s)
- Salomone Di Saverio
- Department of Emergency, Emergency Surgery and Trauma Surgery Unit, Trauma Center, Maggiore Hospital-Bologna Local Health District, Bologna, Italy.
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Cardin F, Minicuci N, Droghi AT, Inelmen EM, Sergi G, Terranova O. Constipation in the acutely hospitalized older patients. Arch Gerontol Geriatr 2009; 50:277-81. [PMID: 19481272 DOI: 10.1016/j.archger.2009.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 04/07/2009] [Accepted: 04/08/2009] [Indexed: 12/18/2022]
Abstract
The aim of this work was to establish the factors that determine the onset of constipation in acutely hospitalized older patients with a view to contributing towards an evidence-based identification of which patients warrant early, specific preventive measures. To evade the problem posed by the definition of constipation, we have considered parameters that are part of the daily routine in the hospital ward, such as the prescription of laxatives, also paying attention to how the co-operative older person subjectively interpret this condition. One thirds of the 192 hospitalized older patients needed a laxative at least once every 3 days. Multivariate analysis identified the use of laxatives at home as the only risk factor for objective constipation while in hospital (odds ratio (OR)=3.0). A significant risk of being dissatisfied with their bowel emptying emerged among patients who were bedridden for more than 2 weeks (OR=6.0), and in those who experienced cerebrovascular events (OR=3.1). The use of laxatives at home and awareness that satisfaction with bowel movements drops in patients obliged to stay in bed for lengthy periods of time and in those who have suffered cerebrovascular damage, should provide the grounds for a screening program to establish rational guidelines on bowel movement therapy.
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Affiliation(s)
- Fabrizio Cardin
- Geriatrics Department, Surgery Geriatric Unit, Via Giustiniani 2, 35128 Padova, Italy.
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