ABSTRACT
BACKGROUND: Pulmonary embolism (PE) is a critical condition with various recognized risk factors. This study investigates these factors in a regional Australian population. AIMS: The primary aim is to examine the significance of traditional risk factors in the clinical decision to request a computed tomography pulmonary angiography (CTPA) scan for suspected PE within this population and assess the association between the timing of CTPA requests (office vs. after-hours) and PE occurrence. METHODS: In this single-center retrospective study, we analyzed data from 434 patients undergoing CTPA at Goulburn Valley Health's (GVH) emergency department (ED) between January and August 2022. Covariates included age, clinical indications, and medical background. Statistical tests were applied with a p-value <0.05 indicating significance. RESULTS: Pulmonary embolism was diagnosed in 39 (20.9%) males and 17 (6.9%) females, with a mean age of 65.04 years (SD: 16.11). Univariate regression indicated a positive association between age and PE. Multivariate analysis showed a significant positive association for unilateral lower limb (LL) swelling/deep vein thrombosis (DVT) (OR: 5.474, p=0.003) and a significant negative association for being female (OR: 0.308, p<0.001). Variables such as shortness of breath, tachycardia, syncope, and chest pain were not significantly associated with PE. No association was found between CTPA request time and PE (χ²=0.9535, df=1, p=0.3288). CONCLUSION: Increasing age and unilateral LL swelling/DVT are significantly associated with PE. Some signs and symptoms showed negative or positive odds but were not statistically significant. The timing of CTPA requests did not correlate with PE incidence.
ABSTRACT
BACKGROUND: Opsoclonus myoclonus syndrome is a rare neurological disorder that usually manifests as a paraneoplastic phenomenon. Although some viruses are reported to cause this condition, opsoclonus myoclonus syndrome by Japanese encephalitis has not been reported previously. CASE PRESENTATION: Here we present the case of a 31-year-old Sri Lankan woman who presented with fever, altered level of consciousness, opsoclonus, and facial myoclonus. She was diagnosed as having Japanese encephalitis based on cerebrospinal fluid and serum Japanese encephalitis-specific immunoglobulin M antibody and characteristic magnetic resonance imaging abnormalities. She was given intravenously administered methylprednisolone pulses (1000 mg per day) for 5 days. With this she improved gradually with reduction in opsoclonus and myoclonic movements. Her limb muscle power and speech also improved slowly. CONCLUSIONS: We intended to highlight the fact that opsoclonus myoclonus syndrome can be a feature of infection with Japanese encephalitis and that it can be added to the list of viruses which cause opsoclonus. Currently there is no well-accepted treatment for opsoclonus myoclonus syndrome and intravenously administered methylprednisolone pulses and immunosuppressants can be used successfully in these patients for early recovery.
