- Email: [email protected]
Poster 349 Vitamin B12 Deficiency a Potentially Hypercoagulable State: A Case Report
PM&R
disease course can be highly fluctuant despite availability of several pharmacological regimens. Poster 347 Hand Hygiene in the Rehabilitation Inpatient: Our Staff’s Role. Sathish Rajasekaran, MD (University of Saskatchewan, Saskatoon). Disclosures: S. Rajasekaran, No Disclosures. Objective: To assess what interventions would improve hand hygiene in rehabilitation inpatients. Design: Prospective, unblinded, controlled study. Setting: Inpatient rehabilitation unit lunchroom. Participants: Inpatients on a Rehabilitation Ward (stroke, spunal cord injury and brain injury). Interventions: Patients were observed during lunchtime. In week 1, no inteventions were used (preexisting gel dispenser at both entrances). In week 2, gel dispensers were placed on lunch tables. In week 3, sign posts were also placed on lunch tables. In week 4, staff also cued the patients prior to handing them lunch trays. Main Outcome Measures: Frequency of gel dispenser use prior to meals. Results: In week 1, 0% (0/18) patients cleansed their hands. In the ensuing weeks, the rates were as follows: week 2, 5% (1/22); week 3, 0% (0/22); week 4, 94% (17/18). We assumed hand-cleansing observations were independent after each intervention and used the Fisher’s exact test to show a significant difference (P⬍.001) in the proportion of patients who washed their hands in week 4. Conclusions: Accessibility and visual cuing were not effective on their own or in combination, but when staff cuing was also added patient compliance with hand hygiene significantly improved. All patients on our rehabilitation ward are now cued to wash their hands prior to receiving their lunch trays (gel dispensers on all tables). Poster 348 Biomechanical Study of Acetabular Anteversion and Acetabular Retroversion. Shihuan Cheng, MD (1st hospital of Jilin University, Changchun, China); He Li, MD; Zhenlan Li, MD. Disclosures: S. Cheng, No Disclosures. Objective: This research is to discuss the biomechanical characteristics of the acetabulum edge among patients suffering from developmental dysplasia of the hip. There were typically acetabular deformities such as acetabular anteversion and acetabular retroversion, which can result in a decrease of the joint contact area.The results would provide the biomechanical basis for clinical treatment. Design: 4 acetabular anteversion and retroversion models of the human pelvis. Conventional AP pelvic radiographs were obtained to determine whether there was acetabular anteversion and retroversion. Weight was placed on the models to determine the stress of the acetabulum edge by some rectangular rosettes. Setting: Paired T-test designed trial at the Anatomy School of Basic Medical Teaching and Research of Jilin University. Participants: 4 specimens of the adult pelvis, taken at the L3 level and the 1 / 3 at the junction of legs. Interventions: After 4 pelvic specimens were obtained, the muscles and periosteum which were attached to the pelvis were stripped, and the round ligament removed, leaving 8 normal acetabular specimens.
Vol. 4, Iss. 10S, 2012
S309
Main Outcome Measures: Bone mineral density of these specimens was measured by a Siemens X - ray machine. Biomechanical determination of acetabular rim was measured by strain gauge. Results: Biomechanics: there was a significant statistical difference of the strain in terms of the points of the acetabulum and retroversion group compared with the normal condition group. The data show that there was a significant change in force at the acetabulum rim when anteversion or retroversion occurred. Conclusions: Acetabular anteversion and retroversion occur commonly in association with a variety of hip diseases. In order to improve motor function and relieve pain, earlier discovery and treatment should be necessary. The decision to proceed with surgical treatment and rehabilitation for hip diseases can be designed according to these biomechanical characteristics. There should be emphasis on rehabilitation effect of biomechanical characteristics during treatment of hip diseases. Poster 349 Vitamin B12 Deficiency a Potentially Hypercoagulable State: A Case Report. Simer Preet Singh, MBBS, MPH (University of Rochester, Rochester, NY, United States); Andrew Rudmann, MD. Disclosures: S. Singh, No Disclosures. Case Description: A 41-year-old man with history of right kidney infarct 2 years ago presented to the hospital with dull constant left flank pain with radiation to back. Not associated with any GI symptoms, initial work up was unrevealing and pain was concerning enough to warrant a CT of abdomen pelvis that revealed acute kidney infarct on left side. He was on aspirin 325 mg for prevention given his history, after being on Coumadin for 6 months. He did report missing a few days of aspirin when he was travelling. He had no other significant risk factors other than smoking 2-7 cig/day. He had history of PFO. Setting: Inpatient. Results or Clinical Course: He was started on Coumadin with initially heparin bridge and then fragmin. A hypercoagulability work up was done and was negative except for hyperhomocysteinemia with levels up to 18; interestingly his homocysteine levels were 18 with first infarct a few years ago. A work up was done to evaluate etiology; adding to the interest his vitamin B12 levels were low to 151 and had normal folate. He was started on IM supplementation with cyanocobalamine. Discussion: Vitamin B12 supplementation has been shown to lower homocysteine levels by 30%; there has been some reports of hyperhomocysteinemia caused by vitamin B12 deficiency. In our patient hyperhomocysteinemia was likely caused by vitamin B12 deficiency resulting in a hypercoagulable state resulting in a possible thrombus in arterial or venous system resulting in renal infarct due to PFO. Conclusions: Homocysteine levels should be checked in all patients diagnosed with clots in venous or arterial system as a part of hypercoagulable work up and folate and vitamin B12 levels should also be included as it is an easily treatable and potentially hypercoagulable state. As physiatrists we deal with high-risk populations for thrombi; checking and making sure vitamin B12 and folate levels are adequate is a very simple way of preventing thrombi and thereby reducing morbidity and the cost of care in these tough times. More studies are needed to establish relation between vitamin B12 and homocysteine levels.
disease course can be highly fluctuant despite availability of several pharmacological regimens. Poster 347 Hand Hygiene in the Rehabilitation Inpatient: Our Staff’s Role. Sathish Rajasekaran, MD (University of Saskatchewan, Saskatoon). Disclosures: S. Rajasekaran, No Disclosures. Objective: To assess what interventions would improve hand hygiene in rehabilitation inpatients. Design: Prospective, unblinded, controlled study. Setting: Inpatient rehabilitation unit lunchroom. Participants: Inpatients on a Rehabilitation Ward (stroke, spunal cord injury and brain injury). Interventions: Patients were observed during lunchtime. In week 1, no inteventions were used (preexisting gel dispenser at both entrances). In week 2, gel dispensers were placed on lunch tables. In week 3, sign posts were also placed on lunch tables. In week 4, staff also cued the patients prior to handing them lunch trays. Main Outcome Measures: Frequency of gel dispenser use prior to meals. Results: In week 1, 0% (0/18) patients cleansed their hands. In the ensuing weeks, the rates were as follows: week 2, 5% (1/22); week 3, 0% (0/22); week 4, 94% (17/18). We assumed hand-cleansing observations were independent after each intervention and used the Fisher’s exact test to show a significant difference (P⬍.001) in the proportion of patients who washed their hands in week 4. Conclusions: Accessibility and visual cuing were not effective on their own or in combination, but when staff cuing was also added patient compliance with hand hygiene significantly improved. All patients on our rehabilitation ward are now cued to wash their hands prior to receiving their lunch trays (gel dispensers on all tables). Poster 348 Biomechanical Study of Acetabular Anteversion and Acetabular Retroversion. Shihuan Cheng, MD (1st hospital of Jilin University, Changchun, China); He Li, MD; Zhenlan Li, MD. Disclosures: S. Cheng, No Disclosures. Objective: This research is to discuss the biomechanical characteristics of the acetabulum edge among patients suffering from developmental dysplasia of the hip. There were typically acetabular deformities such as acetabular anteversion and acetabular retroversion, which can result in a decrease of the joint contact area.The results would provide the biomechanical basis for clinical treatment. Design: 4 acetabular anteversion and retroversion models of the human pelvis. Conventional AP pelvic radiographs were obtained to determine whether there was acetabular anteversion and retroversion. Weight was placed on the models to determine the stress of the acetabulum edge by some rectangular rosettes. Setting: Paired T-test designed trial at the Anatomy School of Basic Medical Teaching and Research of Jilin University. Participants: 4 specimens of the adult pelvis, taken at the L3 level and the 1 / 3 at the junction of legs. Interventions: After 4 pelvic specimens were obtained, the muscles and periosteum which were attached to the pelvis were stripped, and the round ligament removed, leaving 8 normal acetabular specimens.
Vol. 4, Iss. 10S, 2012
S309
Main Outcome Measures: Bone mineral density of these specimens was measured by a Siemens X - ray machine. Biomechanical determination of acetabular rim was measured by strain gauge. Results: Biomechanics: there was a significant statistical difference of the strain in terms of the points of the acetabulum and retroversion group compared with the normal condition group. The data show that there was a significant change in force at the acetabulum rim when anteversion or retroversion occurred. Conclusions: Acetabular anteversion and retroversion occur commonly in association with a variety of hip diseases. In order to improve motor function and relieve pain, earlier discovery and treatment should be necessary. The decision to proceed with surgical treatment and rehabilitation for hip diseases can be designed according to these biomechanical characteristics. There should be emphasis on rehabilitation effect of biomechanical characteristics during treatment of hip diseases. Poster 349 Vitamin B12 Deficiency a Potentially Hypercoagulable State: A Case Report. Simer Preet Singh, MBBS, MPH (University of Rochester, Rochester, NY, United States); Andrew Rudmann, MD. Disclosures: S. Singh, No Disclosures. Case Description: A 41-year-old man with history of right kidney infarct 2 years ago presented to the hospital with dull constant left flank pain with radiation to back. Not associated with any GI symptoms, initial work up was unrevealing and pain was concerning enough to warrant a CT of abdomen pelvis that revealed acute kidney infarct on left side. He was on aspirin 325 mg for prevention given his history, after being on Coumadin for 6 months. He did report missing a few days of aspirin when he was travelling. He had no other significant risk factors other than smoking 2-7 cig/day. He had history of PFO. Setting: Inpatient. Results or Clinical Course: He was started on Coumadin with initially heparin bridge and then fragmin. A hypercoagulability work up was done and was negative except for hyperhomocysteinemia with levels up to 18; interestingly his homocysteine levels were 18 with first infarct a few years ago. A work up was done to evaluate etiology; adding to the interest his vitamin B12 levels were low to 151 and had normal folate. He was started on IM supplementation with cyanocobalamine. Discussion: Vitamin B12 supplementation has been shown to lower homocysteine levels by 30%; there has been some reports of hyperhomocysteinemia caused by vitamin B12 deficiency. In our patient hyperhomocysteinemia was likely caused by vitamin B12 deficiency resulting in a hypercoagulable state resulting in a possible thrombus in arterial or venous system resulting in renal infarct due to PFO. Conclusions: Homocysteine levels should be checked in all patients diagnosed with clots in venous or arterial system as a part of hypercoagulable work up and folate and vitamin B12 levels should also be included as it is an easily treatable and potentially hypercoagulable state. As physiatrists we deal with high-risk populations for thrombi; checking and making sure vitamin B12 and folate levels are adequate is a very simple way of preventing thrombi and thereby reducing morbidity and the cost of care in these tough times. More studies are needed to establish relation between vitamin B12 and homocysteine levels.