Objective: The consensus is that life expectancy for individuals with Parkinson’s disease (PD) is reduced, but estimations vary. We aimed to provide an overview of 20 years of mortality and risk factor data from the Queensland Parkinson’s Project. Methods: The analysis included 1,334 PD and 1,127 control participants. Preliminary analysis of baseline characteristics (sex, age at onset, family history, smoking status, pesticide exposure, depression and neurosurgery) was conducted, and Kaplan–Meier curves were generated for each potential risk factor. Standardized mortality ratios (SMRs) were calculated comparing this cohort to the general Australian population. Cox proportional hazards regression modeling was used to analyze potential predictors of mortality. Results: In total, 625 (46.8%) PD and 237 (21.0%) control participants were deceased. Mean disease duration until death was 15.3 ± 7.84 years. Average ages at death were 78.0 ± 7.4 years and 80.4 ± 8.4 years for the deceased PD and control participants, respectively. Mortality was significantly increased for PD in general {SMR = 2.75 [95% confidence interval (CI): 2.53–2.96]; p = 0.001}. SMRs were slightly higher for women and those with an age of onset before 60 years. Multivariate analysis showed that deep brain stimulation (DBS) treatment was associated with lower mortality [hazard ratio (HR) = 0.76; 95% CI: 0.59–0.98], while occasional pesticide exposure increased mortality risk (HR = 1.48; 95% CI: 1.17–1.88). Family history of PD, smoking and depression were not independent predictors of mortality. Conclusion Mortality in PD is increased. Sex, age at onset and occasional pesticide exposure were independent determinants of increased mortality, while DBS treatment was associated with reduced mortality.

Snake bites are one among the under reported clinical emergencies from tropical countries. There are variations in clinical presentation of snake bites and its toxic features differ with the species and type of bite. There are lots of controversies in the treatment guidelines which often makes it difficult to manage. We report the case of a severe hemotoxic snake bite who presented to the outpatient service of our hospital with a trivial foot injury. Even though snakebites are familiar clinical situations for an emergency physician from tropics, we report this case as most are under reported. We also intend to emphasize the excellent outcome of appropriately diagnosed and treated cases of snake bite.
Adult ; Animals ; Anticoagulants ; toxicity ; Antivenins ; therapeutic use ; Blood Coagulation ; Humans ; Male ; Snake Bites ; blood ; drug therapy ; pathology ; Snake Venoms ; toxicity ; Viperidae

Purpose: Low bone mineral density (BMD) is a complication in children with inflammatory bowel disease (IBD). There are limited data evaluating dual-energy x-ray absorptiometry (DXA) as a screening tool for low BMD in children with IBD. We performed a single site retrospective analysis of DXA use. Methods: Children aged 5–18 years with IBD diagnosed between 2013 to 2017 at the Royal Children’s Hospital, Australia, were included. Patient demographics, measures of disease activity, DXA scores, and factors related to BMD were collected. Results: Over a median follow up of 5.1 (4–6.4) years, 72/239 (30.1%) children underwent DXA, and 28/239 (11.7%) children had a second DXA. Our DXA practice differed to consensus guidelines regarding initial screening based on height and/or body mass index (BMI) z-score (8/17 [47.1%]), and repeat surveillance (13/42 [31.0%]). Children had a median lumbar spine (LS) z-score −0.80 (−1.65–0.075). Children with LS z-score≤−2.0 (n=14) had lower weight (6.57 [1.78–23.7] vs. 51.1 [26.5–68.7], p=0.0002) and height centiles (3.62 [1.17–17.1] vs.42 [16.9–67.1], p=0.0001), and higher faecal calprotectin (FCP) (3041 [1182–4192] vs. 585 [139–2419], p=0.009) compared to children with LS z-score>−2.0. No fractures were reported. Of 28 children who underwent a second DXA 1.6 (1.1–2.2) years following initial DXA, no significant change in z-scores occurred. Conclusion Children with IBD had low BMD. In addition to height centile and weight centile, FCP was associated with lower BMD, and should be considered in DXA screening guidelines. Greater clinician awareness of DXA consensus guidelines is required. Future prospective studies are required.

We tested 59 Greek patients with Behcet's Disease (BD) for serum anti-Saccharomyces cerevisiae antibodies. No increase of these antibodies was detected in the cases compared to 55 healthy unrelated blood donors from the same population. This finding is in contrast with the correlation between Saccharomyces cerevisiae antibodies and BD as reported in other populations. It seems that environmental factors may contribute to disease expression in different populations, producing different effects according to the individual's genetic predisposition. Saccharomyces cerevisiae antibodies do not seem to be of any significance in the Greek population.
Adolescent ; Adult ; Aged ; Antibodies, Fungal/*immunology ; Behcet Syndrome/*immunology/microbiology ; Case-Control Studies ; Female ; Greece ; Humans ; Immunoglobulin A/immunology ; Immunoglobulin G/immunology ; Male ; Middle Aged ; Saccharomyces cerevisiae/*immunology ; Young Adult

OBJECTIVE: Myelography has been shown to highlight foraminal and lateral recess stenosis more readily than computed tomography (CT) or magnetic resonance imaging (MRI). It also has the advantage of providing dynamic assessment of stenosis in the loaded spine. The advent of weight-bearing MRI may go some way towards improving assessment of the loaded spine and is less invasive, however availability remains limited. This study evaluates the potential role of myelography and its impact upon surgical decision making. METHODS: Of 270 patients undergoing myelography during 2006–2009, a period representing peak utilisation of this imaging modality in our unit, we identified 21 patients with degenerative scoliosis who fulfilled our inclusion criteria. An operative plan was formulated by our senior author based initially on interpretation of an MRI scan. Subsequent myelogram and CT myelogram investigations were scrutinised, with any additional abnormalities noted and whether these impacted upon the operative plan. RESULTS: From our 21 patients, 18 (85.7%) had myelographic findings not identified on MRI. Of note, in 4 patients, supine CT myelography yielded additional information when compared to supine MRI in the same patients. The management of 7 patients (33%) changed as a result of myelographic investigation. There were no complications of myelography of the total 270 analysed. CONCLUSION: MRI scan alone understates the degree of central and lateral recess stenosis. In addition to the additional stenosis displayed by dynamic myelography in the loaded spine, we have also shown that static myelography and CT myelography are also invaluable tools with regards to surgical planning in these patients.
Congenital Abnormalities ; Constriction, Pathologic ; Decision Making ; Humans ; Magnetic Resonance Imaging ; Myelography* ; Scoliosis* ; Spine ; Weight-Bearing

BACKGROUND:Atrial fibrillation (AF) is the most common arrhythmia treated in the emergency department (ED), with primary electrical cardioversion (PEC) the preferred method of rhythm control. Anecdotally, patients undergoing ED procedural sedation (EDPS) for PEC differ from those requiring EDPS for other procedures:they are at higher risk of adverse events, and require fewer drugs and lower doses. We attempt to verify this using an EDPS registry at a Canadian, tertiary care teaching hospital. METHODS:This is a retrospective review of patients that underwent EDPS for the period of June 2006 to September 2014. We compared demographics, medication use and intra-procedural adverse events between those receiving EDPS for PEC for AF compared to that for other indications. We report the asssociation between AEs and predictors using logistic regression. RESULTS:A total of 4867 patients were included, 714 for PEC for AF and 4153 for other indications. PEC patients were more likely male (58.5％vs. 47.1％), older (59.5 years vs. 48.1 years), and less likely to be ASA I (46.6％ vs. 69.0％). PEC patients received smaller doses of propofol and less likely to receive adjuvant analgesic therapy (11.5％ vs. 78.2％). PEC patients were more likely to experience hypotension (27.6％vs. 16.5％) but respiratory AEs (apnea, hypoxia and airway intervention) were not different. CONCLUSION:EDPS for PEC differs from that conducted for other purposes:patients tend to be less healthy, receive smaller doses of medication and more likely to suffer hypotension without an increase in respiratory AEs. These factors should be considered when performing EDPS.

Several anatomical variables critically influence therapeutic strategizing for anterior choroidal artery (AChA) aneurysms, and specifically, the safety of flow diversion for these lesions. We review the microsurgical anatomy of the AChA, discussing and detailing these considerations in the treatment of AChA aneurysms, theoretically and in the light of our recent findings.
Aneurysm* ; Arteries* ; Choroid*

BACKGROUND:This prospective, randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry (ETC) to pulse oximetry (PO) in patients undergoing procedural sedation and analgesia (PSA) in the emergency department (ED). METHODS:The patients were randomized to monitoring with or without ETC in addition to the current standard of care. Primary endpoints included respiratory adverse events, with secondary endpoints of level of sedation, hypotension, other PSA-related adverse events and patient satisfaction. RESULTS:Of 986 patients, 501 were randomized to usual care and 485 to additional ETC monitoring. In this series, 48％ of the patients were female, with a mean age of 46 years. Orthopedic manipulations (71％), cardioversion (12％) and abscess incision and drainage (12％) were the most common procedures, and propofol and fentanyl were the sedative/analgesic combination used for most patients. There was no difference in patients experiencing de-saturation (SaO2<90％) between the two groups; however, patients in the ETC group were more likely to require airway repositioning (12.9％ vs. 9.3％,P=0.003). Hypotension (SBP<100 mmHg or <85 mmHg if baseline <100 mmHg) was observed in 16 (3.3％) patients in the ETC group and 7 (1.4％) in the control group (P=0.048). CONCLUSIONS:The addition of ETC does not appear to change any clinically significant outcomes. We found an increased incidence of the use of airway repositioning maneuvers and hypotension in cases where ETC was used. We do not believe that ETC should be recommended as a standard of care for the monitoring of patients undergoing PSA.

Heat-cured PMMA is one of the most frequently used materials in the manufacture of removable dentures. Heat-cured material used to fabricate dentures contain soluble elements, allowing the material to absorb and release substances. These factors all directly affect the longevity and performance of protheses fabricated from polymethyl methacrylate denture base material. Various procedures associated with fabrication of removable dentures from heat-cure denture base material are reported to significantly influence the sorption and solubility experienced by the prosthesis. A comprehensive search of peer-reviewed journals located within academic databases was conducted to identify relevant literature pertaining to sorption and solubility of denture base materials. Key aspects of each paper were captured in Microsoft® Excel® to record author/s, location, study design, sample size, methodology, results and conclusions. Mixing ratios and polymerisation cycles have been identified as variables that can negatively influence the rate of sorption and solubility of denture base materials during the fabrication process. Certain surface treatment procedures, as well as storing the denture in artificial saliva solution may reduce the levels of sorption and solubility experienced and optimise its lifespan. In this review we identify these factors and consider the detrimental effects of sorption and solubility on denture base acrylic materials.