Falls in individuals with stroke during inpatient rehabilitation at a tertiary care hospital in Saudi Arabia.

OBJECTIVE: To determine the incidence and risk factors of falls in individuals with stroke undergoing inpatient rehabilitation. METHODS: Retrospective analysis of all patients with stroke admitted to from January 2011 to June 2013 was carried out in Inpatient rehabilitation Unit at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. Data collected included demographic variables, types of stroke, comorbidities, characteristics of falls, factors affecting falls and length of hospital stay. Data was descriptively analyzed. The Pearson Chi-square test was used to determine any significant relationship between the categorical variables. Binary logistic regression was used to evaluate predictors of falls during rehabilitation. RESULTS: Out of 146 stroke survivors, 36 patients had a fall during inpatient rehabilitation. Majority did not sustain any injury. Fall status was significantly associated with age group (p=0.048), type of stroke (p=0.005) and previous history of stroke (p=0.020). The side of stroke (p=0.011) and fall risk were statistically significantly related to fall outcomes (p=0.005). Length of hospital stay (LOS) was also associated with fall outcome (p=0.044). CONCLUSION: Age, hemorrhagic stroke, laterality of stroke and previous history of stroke were identified as risk factors associated with falls. Injured patients tend to stay longer for inpatient rehabilitation. Due to different culturual, environmental and health system variations, development of regional guidelines for fall prevention in stroke survivors can help to reduce the risk of falls.

The role of pediatric Physical Medicine and Rehabilitation in the national Leadership Education in Neurodevelopmental Disabilities (LEND) program: The Virginia experience.

This article describes the role of pediatric Physical Medicine and Rehabilitation (pediatric PM&R) in the Leadership Education in Neurodevelopmental Disabilities (LEND) program. It provides an overview of the LEND program and the field of pediatric rehabilitation, details the scope and resources of the national LEND network, and describes the role of pediatric PM&R within the Virginia LEND (Va-LEND) program. Emphasis is placed on the natural fit of pediatric rehabilitation within the LEND program in order to encourage others in the field to become involved in their own state or regional LEND program.

The impact of traumatic brain injuries: a global perspective.

Traumatic brain injury (TBI), according to the World Health Organization, will surpass many diseases as the major cause of death and disability by the year 2020. With an estimated 10 million people affected annually by TBI, the burden of mortality and morbidity that this condition imposes on society, makes TBI a pressing public health and medical problem. The burden of TBI is manifest throughout the world, and is especially prominent in Low and Middle Income Countries which face a higher preponderance of risk factors for causes of TBI and have inadequately prepared health systems to address the associated health outcomes. Latin America and Sub Saharan Africa demonstrate a higher TBI-related incidence rate varying from 150-170 per 100,000 respectively due to RTIs compared to a global rate of 106 per 100,000. As highlighted in this global review of TBI, there is a large gap in data on incidence, risk factors, sequelae, financial costs, and social impact of TBI. This should be addressed through planning of comprehensive TBI prevention programs in LMICs through well-established surveillance systems. Greater resources for research and prioritized interventions are critical to promote evidence-based policy for TBI.

Gram-negative meningitis and infections in individuals treated with intrathecal baclofen for spasticity: a retrospective study.

The aim of this retrospective study was to describe signs, symptoms, and clinical outcomes of individuals undergoing intrathecal baclofen (ITB) therapy who experienced pump-related Gram-negative infections including meningitis. Participants included 12 individuals (nine males, three females) aged 10 to 32 years (mean 17y 9mo), nine of whom had quadriplegic CP. A total of 571 baclofen pump surgeries were performed with 45 total infections. Of the 45 infections, 12 were by Gram-negative organisms, two resulting in meningitis. Ten of 12 Gram-negative infections (21 site encounters) occurred within 60 days of surgery. Eleven of 12 pumps were explanted. By site encounters, Pseudomonas aeruginosa accounted for eight Gram-negative infections, Escherichia coli for five, Proteus for three, Enterobacter cloacae for two, and Klebsiella, Enterobacter aerogenes, and Enterobacter vulnaris for one each. Two individuals with Gram-negative meningitis were admitted 72 to 96 hours after hospital discharge following pump replacement. Both patients had rapid deterioration requiring transfer to the pediatric intensive care unit, and developed coagulopathy and decrease in responsiveness. Both have improved and have elected not to replace the ITB pump. In Gram-negative infections in ITB therapy, the progression of signs and symptoms can be swift and devastating. Identification of the infectious agent in such cases is imperative; these infections can quickly become life threatening.

A site receptivity study to determine the threat of the re-introduction and re-establishment of malaria in Grenada

Malaria was eradicated from Grenada in 1962 and the island has since remained free of the disease. The resurgence of malaria in endemic areas, as well as in countries where it had been previously eradicated, provided the impetus for a study to assess the risk of the re-introduction and re-establishment of malaria in Grenada. This study surveyed the recorded historical breeding sites of Anopheles spp in Grenada between April 1996 and April 1997, thereby encompassing two dry seasons and one wet season. Although the threat of imported cases of malaria into Grenada has never been greater since the eradication of the disease, the results of this study indicate that the re-establishment of malaria as a serious public health problem is less likely. The unfamiliarity of diagnosis of malaria in this malaria free country, coupled with the presence of the vectors, however, mandates that malaria surveillance must be maintained, particularly since the government's spending on vector control activities has been reduced over the years

A site receptivity study to determine the threat of the re-introduction and re-establishment of malaria in Grenada

Malaria was eradicated from Grenada in 1962 and the island has since remained free of the disease. The resurgence of malaria in endemic areas, as well as in countries where it had been previously eradicated, provided the impetus for a study to assess the risk of the re-introduction and re-establishment of malaria in Grenada. This study surveyed the recorded historical breeding sites of Anopheles spp in Grenada between April 1996 and April 1997, thereby encompassing two dry seasons and one wet season. Although the threat of imported cases of malaria into Grenada has never been greater since the eradication of the disease, the results of this study indicate that the re-establishment of malaria as a serious public health problem is less likely. The unfamiliarity of diagnosis of malaria in this malaria free country, coupled with the presence of the vectors, however, mandates that malaria surveillance must be maintained, particularly since the government's spending on vector control activities has been reduced over the years