RESUMO
Patients on anticoagulation are at increased risk for intracranial hemorrhage (ICH) after trauma. This is important for geriatric trauma patients, who are increasing in number, frequently fall, and often take anticoagulants. This study sought to evaluate whether prehospital use of dabigatran, a newer anticoagulant, is associated with outcome differences in geriatric trauma patients suffering falls when compared with warfarin. The registry of a Level II community trauma center was used to identify 247 patients aged 65 and older who sustained a fall while taking prehospital dabigatran or warfarin admitted between December 2010 and March 2014. Patients on warfarin were included if their International Normalized Ratio was therapeutic (2-3). About 176 of the 247 patients were then compared using coarsened exact matching. In the matched analysis, overall population means for age, Glasgow Coma Score, and Injury Severity Score were 83.5, 14.7, and 5.1, respectively. The overall rate of ICH was 12.5 per cent, with a mortality rate of 16.1 per cent for patients who sustained an ICH. There were no observed differences in ICH, hospital length of stay, intensive care unit length of stay, or mortality between patients taking prehospital warfarin or dabigatran.
Assuntos
Acidentes por Quedas , Dabigatrana/administração & dosagem , Hemorragias Intracranianas/epidemiologia , Sistema de Registros , Tromboembolia/prevenção & controle , Varfarina/administração & dosagem , Ferimentos e Lesões/complicações , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Antitrombinas/administração & dosagem , Antitrombinas/efeitos adversos , California/epidemiologia , Dabigatrana/efeitos adversos , Feminino , Seguimentos , Escala de Coma de Glasgow , Humanos , Incidência , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/etiologia , Masculino , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Varfarina/efeitos adversosRESUMO
Free, student-run health initiatives for refugees fill a gap in needed health services and prepare medical students for understanding cross-cultural and systems-based medical practice.
Assuntos
Centros Médicos Acadêmicos , Serviços de Saúde Comunitária/organização & administração , Relações Comunidade-Instituição , Refugiados , Promoção da Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Pennsylvania , Estudantes de MedicinaRESUMO
The highly pyramidalized alkene, pentacyclo[4.3.0.0(2,4).0(3,8).0(5,7)]non-4-ene (9), has been generated via treatment of 4,5-diiodopentacyclo[4.3.0.0(2,4).0(3,8).0(5,7)]nonane (12) with n-butyllithium and tert-butyllithium. The title alkene has also been trapped as its Diels-Alder adduct with 1,3-diphenylisobenzofuran, 2,5-dimethylfuran, and spiro[2.4]hepta-4,6-diene. Products resulting from alkyllithium addition to the pyramidalized double bond of 9 have been isolated and fully characterized spectroscopically. The geometry, olefin strain energy, heat of hydrogenation, and relative HOMO/LUMO energies of 9 have been obtained by ab initio calculations at the MP2 and B3LYP levels using the 6-31G* basis set.