An-Najah Staff

Objectives Pneumonia is one of the most frequent medical complications of acute ischemic stroke, often apparent early after stroke onset, and it is associated with increased risk of death after stroke attack. We aimed to identify clinically useful factors associated with pneumonia, and to examine the effect of pneumonia on patient's functional outcome at discharge and on in-hospital mortality after the attack.
Objectives Pneumonia is one of the most frequent medical complications of acute ischemic stroke, often apparent early after stroke onset, and it is associated with increased risk of death after stroke attack. We aimed to identify clinically useful factors associated with pneumonia, and to examine the effect of pneumonia on patient's functional outcome at discharge and on in-hospital mortality after the attack.It is an evaluation of post-stroke pneumonia complication among ischemic stroke patients attending a hospital in Malaysia from November 1, 2008 to April 30, 2009. Data included demographic information, risk factors and clinical characteristics. Functional outcome at discharge as measured by the Modified Barther Index (MBI) and in-hospital mortality were assessed. Poor outcome was defined as MBI < 75. SPSS version 15 was used for data analysis.
Results A total of 256 patients were studied, of which 33 (12.9%) experienced pneumonia complication during hospitalization. The key baseline factors associated with the occurrence of post-stroke pneumonia were total anterior circulation infarct (P < 0.001), moderate and severe Glasgow Coma Scale (P < 0.001), atrial fibrillation (P = 0.035) and renal impairment (P < 0.001). Moreover, 24 (60%) of dead cases were suffering from pneumonia during hospitalization (P < 0.001). Additionally, after excluding the dead cases, 8 (9.2%) of patients discharged with poor functional outcome were having pneumonia during their hospital stay (P = 0.002).
Conclusions Pneumonia is independently associated with ischemic stroke poor outcome. Identification of medical history and clinical characteristics on admission can assist clinicians to identify patients at higher risk of developing post-stroke pneumonia thus hastening the initiation of certain interventions to improve patient outcome. 

Intravenous N-acetylcysteine (IV-NAC) is usually regarded as a safe antidote to acetaminophen overdose. However, during infusion of the loading dose, adverse drug reactions such as a headache may occur. The objectives of this study were to investigate the prevalence of headache in patients presenting to hospital after acetaminophen overdose and to determine which clinical findings are most predictive of headache among these patients. This is a retrospective cohort study of hospital admissions for acute acetaminophen overdose that was conducted over a period of 4 years from January 1, 2005 to December 31, 2008. Demographic data, clinical characteristics, and predictors of headache were analyzed. spss 15 was used for data analysis. Two-hundred and fifty-five patients were studied; their mean age was 23.1 ± 1.6; 83.9% of them were women and 14.9% had a headache during hospitalization. Headache among patients was significantly associated with IV-NAC administration (P = 0.001), intentional ingestion of drug (P = 0.04), acetaminophen concentration above ‘possible toxicity’ treatment line (P = 0.04), a high acetaminophen concentration (P = 0.04), and a long hospital stay (P = 0.03). Multiple logistic regression showed a significant risk factor for headache in patients administered IV-NAC (P = 0.04). We recorded a high frequency of headache in patients with acute acetaminophen overdose in our geographical area. This study suggests that among those patients, the use of IV-NAC is associated with an increased risk of headache.

Background and objectives: Intravenous N-acetylcysteine (IV-NAC) is widely recognized as the antidote of choice for acetaminophen overdose [1]. However, its use is not without adverse drug reactions (ADR) which might affect therapeutic outcome or lead to treatment delay [2, 3]. The aims of this study were to investigate the type and incidence of ADR induced by IV-NAC in patients treated for acetaminophen overdose and to assess the causality of individual ADR to IV-NACusing Naranjo's algorithm [4].
Methods: This is a retrospective study of patients admitted to the hospital for acute acetaminophen overdose over a period of 5 years (January 1, 2004 to December 31, 2008). The primary outcome of interest in this study was the occurrence of ADR during NAC administration. The probability of an ADR was assessed using the Naranjo algorithm, which consists of 10 questions), and has been used to determine the likelihood that an ADR was related to a specific medication [4].
Results: During the study period, 305 patients with a diagnosis of overdose of paracetamol-containing compounds were admitted to the hospital for monitoring and treatment. Different types of ADR occurred in 137 patients (137/305; 44.9%). Of those patients who had an ADR, 98 (98/137; 71.5%) had been treated with IV-NAC and 39 (39/137; 28.5%) had not(p < 0.001). Comparison of different ADR in all patients showed that the following ADR were significantly associated with IV-NAC administration: nausea (p = 0.004), vomiting (p < 0.001), flushing (p < 0.001), rash (P < 0.001), pruritus (p < 0.001), chest pain (p = 0.001), bronchospasm (p = 0.015), coughing (p = 0.017), headache (p < 0.001), dizziness (p < 0.001), convulsion (p = 0.035) and hypotension (p = 0.001). Based on Naranjo’s algorithm, 226 events were judged to be NAC-related – 31.1% probably and 67.9% possibly drug-related. None of the events were definitely drug-related. Conclusion: Adverse drug reactions to IV-NAC were common among patients with acetaminophen overdose but mostly minor, and that all reported adverse reactions were easily managed.

Purpose: To compare the incidence of radiocontrast-induced nephropathy (RCIN) in patients undergoing coronary angiography pretreated with N-acetylcysteine NAC plus saline hydration or saline hydration alone and to determine the association between various risk factors and RCIN.
Methods: Patients were retrospectively evaluated over a one-year period. RCIN was defined as an acute rise in serum creatinine of at least 0.5 mg/dl or more than 25 % from baseline value. SPSS software, version 13 was used for data analysis.
Results: Overall, 299 patients were studied. Thirteen patients (4.3%) developed RCIN. RCIN was 3.3 % in patients treated with hydration, and 8.3 % in patients treated with NAC plus hydration (p = 0.09). In patients with RCIN, the changes in creatinine and % change in creatinine after 24 h were significantly lower in the NAC plus hydration group (p = 0.039 and p = 0.042, respectively). RCIN was significantly associated with male gender (p = 0.017), history of renal failure (p = 0.006), ischemic heart disease (p =0.003), and diuretic treatment (p = 0.013).
Conclusion: NAC plus saline hydration may not be more effective than saline hydration alone in decreasing RCIN after coronary angiography. Additional efforts to find an ideal preventive treatment are needed.

Purpose  To investigate the relationship between different types of adverse drug reaction (ADR) and late time to N-acetylcysteine (NAC) infusion in patients presenting to the hospital with acetaminophen overdose.
Methods  This is a retrospective study of patients admitted to the hospital for acute acetaminophen overdose over a period of 5 years (1 January 2004 to 31 December 2008). The primary outcome of interest was the relationship between ADR, if any, and late time to NAC infusion. Parametric and non-parametric tests were used to test differences between groups depending on the normality of the data. SPSS 15 was used for data analysis.
Results  Of 305 patients with acetaminophen overdose, 146 (47.9%) were treated with intravenous NAC and 139 (45.6%) were included in this study. Different types of ADR were observed in 94 (67.6%) patients. Late time to NAC infusion was significantly associated with cutaneous anaphylactoid reactions when compared to patients without this type of ADR (p < 0.001). However, there were no significant differences in time to NAC infusion between patients with and without the following ADR: gastrointestinal reactions (p = 0.11), respiratory reactions (p = 0.77), central nervous reactions (p = 0.64), and cardiovascular reactions (p = 0.63).
Conclusion  Late time to NAC infusion is a risk factor for developing cutaneous anaphylactoid reactions, suggesting, rather than proving, that early NAC infusion (≤8 hours) may be protective against this type of ADR.

Intravenous N-acetylcysteine (IV-NAC) is usually regarded as a safe antidote to acetaminophen overdose. However, during infusion of the loading dose, adverse drug reactions such as a headache may occur. The objectives of this study were to investigate the prevalence of headache in patients presenting to hospital after acetaminophen overdose and to determine which clinical findings are most predictive of headache among these patients. This is a retrospective cohort study of hospital admissions for acute acetaminophen overdose that was conducted over a period of 4 years from January 1, 2005 to December 31, 2008. Demographic data, clinical characteristics, and predictors of headache were analyzed. spss 15 was used for data analysis. Two-hundred and fifty-five patients were studied; their mean age was 23.1 ± 1.6; 83.9% of them were women and 14.9% had a headache during hospitalization. Headache among patients was significantly associated with IV-NAC administration (P = 0.001), intentional ingestion of drug (P = 0.04), acetaminophen concentration above 'possible toxicity' treatment line (P = 0.04), a high acetaminophen concentration (P = 0.04), and a long hospital stay (P = 0.03). Multiple logistic regression showed a significant risk factor for headache in patients administered IV-NAC (P = 0.04). We recorded a high frequency of headache in patients with acute acetaminophen overdose in our geographical area. This study suggests that among those patients, the use of IV-NAC is associated with an increased risk of headache.

Purpose:To investigate the relationship between different types of adverse drug reaction (ADR) and late time to N-acetylcysteine (NAC) infusion in patients presenting to the hospital with acetaminophen overdose.
Methods: This is a retrospective study of patients admitted to the hospital for acute acetaminophen overdose over a period of 5 years (1 January 2004 to 31 December 2008). The primary outcome of interest was the relationship between ADR, if any, and late time to NAC infusion. Parametric and non-parametric tests were used to test differences between groups depending on the normality of the data. SPSS 15 was used for data analysis.
Results: Of 305 patients with acetaminophen overdose, 146 (47.9%) were treated with intravenous NAC and 139 (45.6%) were included in this study. Different types of ADR were observed in 94 (67.6%) patients. Late time to NAC infusion was significantly associated with cutaneous anaphylactoid reactions when compared to patients without this type of ADR (p < 0.001). However, there were no significant differences in time to NAC infusion between patients with and without the following ADR: gastrointestinal reactions (p = 0.11), respiratory reactions (p = 0.77), central nervous reactions (p = 0.64), and cardiovascular reactions (p = 0.63(
Conclusion: Late time to NAC infusion is a risk factor for developing cutaneous anaphylactoid reactions, suggesting, rather than proving, that early NAC infusion (≤8 hours) may be protective against this type of ADR.