The Relationship of Modified Rankin Score and Risk Factors with Stroke Mortality in the South Dakota Native American Population: A Descriptive Study.

OBJECTIVE: To describe the impact of multiple risk factors on stroke outcomes among Native Americans in South Dakota. METHODS: This is a retrospective chart review of 189 Native American patients treated for stroke in South Dakota between Jan. 1, 2016, to May 1, 2021 at a single hospital system. RESULTS: Risk factor prevalence in the population: hypertension (76.1%), smoking (74.2%), diabetes mellitus (56.8%), dyslipidemia (55.4%), alcohol use (43.7%), cardiac or vascular disease (39.7%), stroke history (26.4%), and atrial fibrillation (13.3%). There was no significant difference between admission and 90-day post-discharge modified Rankin scale scores in all patients. Five risk factors were significantly associated with death: older age, hemorrhagic stroke, female sex, atrial fibrillation, and cardiac/vascular disease. CONCLUSION: These results align with previous studies that concluded many stroke risk factors are more prevalent among Native Americans in comparison to other racial/ethnic groups. Therefore, it remains an imperative public health initiative that efforts be made to improve preventative measures which address comorbid conditions and behaviors in Native American populations to reduce risk for stroke with subsequent related disability or death.

The Relationship of Modified Rankin Score and Risk Factors with Stroke Mortality in the South Dakota American Indian Population: A Descriptive Study.

INTRODUCTION: To describe the impact of multiple risk factors on stroke outcomes among American Indians in South Dakota. METHODS: This is a retrospective chart review of 189 American Indian patients treated for stroke in South Dakota between Jan 1, 2016, to May 1, 2021, at a single hospital system. RESULTS: Risk factor prevalence in the population: hypertension (76.1%), smoking (74.2%), diabetes mellitus (56.8%), dyslipidemia (55.4%), alcohol use (43.7%), cardiac or vascular disease (39.7%), stroke history (26.4%), and atrial fibrillation (13.3%). There was no significant difference between admission and 90-day post-discharge modified Rankin scale scores in all patients. Five risk factors were significantly associated with death: older age, hemorrhagic stroke, female sex, atrial fibrillation, and cardiac/vascular disease. CONCLUSIONS: These results align with previous studies that concluded many stroke risk factors are more prevalent among American Indians in comparison to other racial/ethnic groups. Therefore, it remains an imperative public health initiative that efforts be made to improve preventative measures which address comorbid conditions and behaviors in American Indian populations to reduce risk for stroke with subsequent related disability or death.

Unusual Hand Deformity in Parkinson's Disease.

We describe two patients with prominent hand deformities attributable to Parkinson's disease. This uncommon condition, which mimics inflammatory arthritis, can be hard to diagnose and is disabling. As these two cases illustrate, hand deformities attributable to Parkinson's can be a late complication of the disease or present in the early stage as initial symptomatology.

Antibiotic Prescribing Practices in Group B Streptococcus Positive Obstetric Patients with Penicillin Allergy.

INTRODUCTION: Group B Streptococcus (GBS) positive patients with penicillin allergies receive intrapartum antibiotics for neonatal sepsis prophylaxis based on recommendations from the American College of Obstetricians and Gynecologists (ACOG). The objective of this study was to determine which antibiotics are used in GBS positive patients with documented penicillin allergies and evaluate for antibiotic stewardship improvements at a tertiary hospital in the Midwestern U.S. METHODS: Retrospective chart review identified GBS positive patients with and without penicillin allergies admitted to the labor and delivery floor. EMR-documented penicillin allergy severity, results of antibiotic susceptibility testing, and all antibiotics administered from admission to delivery were recorded. The study population was divided based on penicillin allergy status with antibiotic choice analyzed using Fisher's exact test. RESULTS: 406 GBS positive patients underwent labor between May 1, 2019, and April 30, 2020. Penicillin allergy was documented in 62 (15.3 percent) patients. Of these patients, cefazolin and vancomycin were prescribed most frequently for intrapartum neonatal sepsis prophylaxis. Antibiotic susceptibility testing was performed on the GBS isolate in 74.2 percent of the penicillin allergic patients. Between penicillin allergy and no penicillin allergy groups, the frequency of ampicillin, cefazolin, clindamycin, gentamicin, and vancomycin use showed statistical differences. CONCLUSION: The study results suggest that antibiotic choice for neonatal sepsis prophylaxis in GBS positive patients with penicillin allergy at a tertiary Midwestern hospital follows current ACOG guidelines. Cefazolin was used most frequently in this population followed by vancomycin and clindamycin. Our results identify room for improvement regarding regular antibiotic susceptibility testing in GBS positive patients with penicillin allergy.