Reversible Cerebral Vasoconstriction Syndrome Following Exposure to Oleoresin Capsicum "Pepper Spray".

OBJECTIVES: To report a case associating the use of Oleoresin Capsicum Pepper Spray (OCPS) during law enforcement training with development of Reversible Cerebral Vasoconstriction Syndrome (RCVS). MATERIALS AND METHODS: RCVS is radiographically characterized by multifocal smooth narrowing of cerebral arteries heralded by clinical manifestations of recurrent thunderclap headaches. 70% of cases with RCVS have a clear precipitating factor and agents commonly implicated were cannabis, selective serotonin reuptake inhibitors, nasal decongestants, cocaine, postpartum state, eclampsia and strenuous physical/sexual activity.1 RESULTS: 24-year-old female police officer with no past medical history who presented with thunderclap headaches after exposure to pepper spray to her face during work training. Neurological examination was unremarkable. CT angiogram (CTA) of the head and neck and subsequent conventional angiogram revealed multifocal mild arterial narrowing of bilateral middle cerebral arteries (MCA), bilateral posterior cerebral arteries (PCA) and left anterior cerebral artery (ACA) concerning for RCVS. Eight weeks later, she had a repeat MRA head and neck demonstrating complete resolution of the previously noted narrowing of her cerebral arteries. CONCLUSIONS: OCPS is widely used in law enforcement training as well as by general population as a self- defense tool. It is generally assumed to be safe, although the consequences of its use can never be predicted with certainty.2 As our case highlights, use of OCPS may be associated with development of RCVS and awareness needs to be raised regarding this rare but serious complication.

A community-based cross-sectional study to assess the prevalence of post-partum depression: Why are the mothers depressed?

Introduction: Post-partum depression can have adverse long term effects. For the mother, the episode can be the precursor of chronic recurrent depression. For her children her on going depression can contribute to emotional, cognitive and interpersonal problems in their later life. In the present study, we aimed to identify the incidence of depression in post-partum period and explore the underlying etiological factors responsible for the same. Materials and Methods: A cross sectional study was conducted on 250 post- natal mothers covered under UHTC, Tripuri, Patiala. The data collection was done through one to one interview technique with mental evaluation done by Edinburgh Postnatal Depression Scale instrument. Based upon the results, the cases were classified either as normal or presence of psychiatric morbidity. Psychiatry referral was provided to those requiring it. Association of post-partum depression with various socio-demographic and medical correlates was then sought through statistical analysis. Results: Post-partum depression was observed in 82 out of 250 females (32.8%). On univariable analysis family income, illiteracy, history of depression, caesarean section, death in family, were significantly associated with post-partum depression. On multi-variable analysis, poverty, female gender of baby, domestic violence and were observed as true predictors of depression in post-partum period (p<0.05). Conclusion: Depression was prevalent among almost one-third of postnatal females. Poverty, Cesarean section, domestic violence and poor spousal support have been identified as major contributors towards psychiatric morbidities. Taking care of these largely modifiable risk factors can prevent development of postpartum depression.

Emergency Medical Services Providers' Knowledge, Practices, And Barriers To Stroke Management.

PURPOSE: Many strokes are not recognized by emergency medical services (EMS) providers and many providers do not prenotify emergency departments (EDs) of incoming stroke patients. The objectives of this project were to survey EMS providers to (1) assess knowledge of prehospital care related to stroke identification, time window for intravenous tissue plasminogen activator (IV tPA) administration, and comprehensive stroke centers in our health system, (2) gain insight from EMS providers regarding barriers to providing prenotification, information they provide for a prenotification, and optimal methods of providing feedback, and (3) provide EMS providers with stroke care and management information. METHODS: A survey was administered to EMS providers at four hospital EDs. The survey included questions related to knowledge of prehospital stroke care and barriers to providing prenotification. EMS providers were also provided a one-page flyer with information related to prehospital stroke care. Descriptive statistics were used to describe results. RESULTS: Of 301 EMS providers surveyed, 96.0% report that they use the Cincinnati Prehospital Stroke Scale to identify stroke, and 11.0% correctly identified the time window for IV tPA administration for acute ischemic stroke as within 4.5 hrs from the last known well time. The majority (82.7%) correctly identified the comprehensive stroke center in our health system. Barriers to providing prenotification included short transport time (40.5%), information being lost in dispatch (39.5%), and not having direct communication with ED staff (30.2%). Most reported wanting to receive feedback on the stroke patients they transported (93.7%), and 49.5% reported that the optimal method of providing feedback is via a mobile application. CONCLUSION: Deficits in stroke care knowledge among EMS providers were identified. Short transport time, inability to communicate with ED staff, and information lost in dispatch were cited as barriers to providing prenotification. Most EMS providers desire real-time feedback regarding patients via a mobile application.