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For smoothies and things of that nature order silagra master card, it is easier to keep frozen fruit in your freezer section discount silagra 100mg mastercard. Pumpkin seeds are a very nutritous food purchase silagra in india, but for some reason don’t resonate with me buy silagra line. Generally, I don’t eat a lot of cashews and pistachios because I tend to be sensitive to them as well. In my cupboards I always have cans of cooked beans (mostly organic) and also whole-food, organic types of soups such as min- estrone, lentils, split pea, Cuban black bean, and other vegetarian things like chili. I buy several quarts of an organic vegetarian broth to be used in soups, to stir fry, to “quick cook” my greens, or sometimes cook my pastas or grains in. Your cooking grains can be in the cup- board or freezer, and remember that the first ingredient for any - 153 - staying healthy in the fast lane grain or flour product ideally should be “whole grain” or “sprouted grain. I do use, sparingly, extra-virgin olive oil (monounsaturated fat) for cooking sometimes. I have been more oil-calorie conscious lately, since really becoming aware that added oils are one of the biggest reasons for excess calories in our diet. If you are lean having a small amount of cold-pressed oil or spread or extra-virgin olive oil is probably fine. If you feel you have to have some type of milky substance, there are soy, almond, and other different types of “milks,” including hemp, ha- zelnut, oat, multigrain, and rice milks. If you get fish, poultry, or beef, ideally it should be wild fish and/or poultry or red meat that is grass-fed, free-ranged, and without hormones and antibiotics, or hunted game. I realize some whole-food purists, whom I respect, might look down on eating canned goods or pre-packaged, pre-washed veg- etables. Ideally I’d grow my own vegetables, eat totally from my fruit trees, cook all my beans, and wash my own lettuce and greens every day, but it is not practical for me time-wise. One good thing about modern urbanization is that some businesses have done some smart things to make eating healthy in a busy world easier. By shopping and eating in this way, we can not only be healthy, but we can also help create a new, sustainable economy and jobs cen- - 154 - the triad diet program tered around producing whole, healthy foods that are convenient for people in the busy, modern world. Eating out in the Fast Lane Whether you eat at a fast-food restaurant or a high-end estab- lishment, these simple guidelines can help you reduce your calo- ries, increase your nutrient intake, and do more good than harm with meals eaten away from home. You have to ask to have dairy, es- pecially cheese and sour cream, removed from many dishes. Presently most restaurants just add cheese and sour cream as normal fare to many foods. The goal of eating out healthy, or doing the least amount of harm, is to keep excess calories to a minimum and eat as many unprocessed foods as possible. That is achieved by keeping creamy sauces and added oils off your basic foods; not eating lots of pre- main course snack foods; keeping high-calorie foods out of your main courses (cheeses, creamy sauces, and oils); avoiding deep fried food; avoiding alcohol; and eating as many vegetables in sal- ads, appetizers, or in your main course, as possible. Controlling Food Cravings The key to controlling food cravings is to eat lots of good, whole food that gives you an even blood sugar from time-released carbo- hydrates and adequate protein, and has lots of fiber or natural bulk from water content. In addition, these whole foods should be nu- trient dense, packed with lots of vitamins, minerals, antioxidants, and phytochemicals. Joel Fuhrman (Eat to Live, 2011) and col- leagues recently showed in a study in the Nutrition Journal that the higher the micronutrient density of the diet, the less hunger people had while consuming fewer calories. Conclusion When you can’t seem to digest another nutrition concept, read another label, or find the belief to trust a new fad diet, remember that a good diet is very simple. When my patients get confused, don’t want to hear another diet suggestion, and their eyes are get- ting a bit “glazed over,” I just pick out one of my favorite nutrition books of all time, Beating The Food Giants, and show them the front and back cover. With permission from Natural Press & Barbara Stitt, Beating the Food Giants by Paul Stitt (1982). Looking at any part of our human evolutionary history, there is no question that we were “born to move. If we look at the modern- day “Blue Zone” populations, those enclaves of modern-day aging wonders who live and are functional into their eighties, nineties, and one hundreds, we can see that they move daily—and they move a lot! Everyone Agrees on the Importance of Exercise Virtually no expert says that exercise isn’t important for opti- mal health. You give me a regular daily exerciser as a pa- tient, and he/she sees me less and gets well faster (usually; there are some exceptions), and generally all the therapies you try work - 159 - staying healthy in the fast lane better. So if you want to be well and stay well, stay away from doc- tors and hospitals, have lower medical insurance rates and bills, have more vitality, and function into your senior years then move every day! Do something daily that gets your heart rate up (aerobics), challenges your muscles (strength training), and causes you to extend and contract ligaments, muscles, and tendons (flexibility). Thinking about how we evolved and the amount of movement done by healthy aging cultures, we need to expect movement ev- ery day—not three days per week, but every day, for a minimum of a half-hour per day. If you shoot for one hour and fall short a day or two, two things usually happen: 1. Daily structured movement has to be as important and expected as brushing your teeth, taking a shower, combing your hair, and other normal and expected activities of daily living. When you get to the point where not exercising feels “not right,” the way you’d feel if you didn’t brush your teeth for the day, then you have built the exercise habit. When you don’t go home from work until you exercise, you have built the exercise habit. When you are looking for ways to exercise when you are away from home on business or vacation, you have built the exercise habit. When you don’t try to make an excuse for not exer- cising, you have built the exercise habit. If you say, “Some exercise is better than no exercise” when you can’t do your regular exercise routine, and you do something else involving movement, you have developed the exercise habit. It’s about Time and Consistency More than Intensity and Technique If you are new to the exercise game, it is going to take three to nine months before you build the exercise habit and it becomes “part of you. It doesn’t matter at first what type of exercise, as long as it is some type of aerobic, big muscle-moving exercise and is safe. Success with exercise is more about consistency and time than it is about technique and intensity. If you build in the time to exercise as part of your normal day and are consistent with your exercise program, you will see results and will naturally start to pick up the intensity and duration of the - 161 - staying healthy in the fast lane exercise after a few weeks. For the average person it is far more important to have lots of victories to keep your exer- cise program alive than to push through pain and injure yourself or be so sore you quit. Nagging injuries, persistent soreness, and pain are “killers” to building the exercise habit. Down the road, af- ter exercising three months to a year, if you really want to push yourself, give it a try. The most common excuse I get in the clinic is “I can’t exercise because I am too busy (and/ or too tired). I am very efficient with my exercise from strength training to aerobics and my flexibility work. You want to have a good cardiovascular system, be strong, and be flexible—and you want to do the exercises fast, efficiently, and safely. When you have that exerciser’s mentality—when that exercise habit is part of you—you will see the opportunities within your daily life to exercise efficiently and safely. How to Increase “Non-Exercise” Exercise More traditional cultures get their exercise from “non-exer- cise” exercise. Just the work they have to do to feed themselves, their daily jobs, and taking care of their dwellings provide some vigorous physical activity. If you are older and all you have is canned products around, use the cans as dumb bells. We are talking about a few extra minutes, not hours, be- cause you choose to walk. I have heard some very successful weight-loss specialists talk about how important it is to get obese people to add this “non- exercise” exercise to a structured exercise program. He committed himself to using the stairs during his hospital rounds versus the elevator and was amazed at how much exercise he got while seeing patients in his very busy medical practice. Just think: These basic examples only cover the simple things we can do as a part of our daily routines. They don’t even begin to account for all the exercise opportunities just waiting to be incor- porated into our “fun” time! Exercising when Traveling for Business or Pleasure When staying at a hotel, always ask if there is a fitness room. Trips can be stressful enough (whether for business or plea- sure), so it’s critical to have a space to exercise, take a little edge off, and do something good for your body.

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Professional drivers m ay be relicenced 3 m onths after m yocardial infarction provided that there is no angina cheap silagra 50 mg overnight delivery, peripheral vascular disease or heart failure buy silagra with visa. Arrhythm ia purchase discount silagra online, if present buy generic silagra online, m ust not have caused sym ptom s w ithin the last 2 years. Treatm ent is allow ed provided that it causes no sym ptom s likely to im pair perform ance. Private drivers need not inform the licencing authority after m yocardial infarction, but should not drive for one m onth. If arrhythm ia causes sym ptom s likely to affect perform ance, or if angina occurs w hilst driving, the licencing authority m ust be inform ed, and driving m ust cease until sym ptom s are adequately controlled. How should such patients be m anaged to im prove outcom e and what are the results? Prithwish Banerjee and Michael S Norrell The advent of the throm bolytic era has not altered the incidence or m ortality rate for cardiogenic shock com plicating m yocardial infarction (M I). It still represents alm ost 10% of patients w ith M I, w ith alm ost 90% dying w ithin 30 days. Recently, a few random ised trials have attem pted to com pare such early (w ithin 48 hours) revascularisation w ith a strategy of initial m edical stabilisation. Thirty day m ortality w as reduced in the early intervention group (46% vs 56% ) w ith this benefit extending out to 6 m onths and particularly apparent in the younger (<75 years) age group. The low m ortality in the control group is striking, and explains the lack of a large difference betw een the tw o groups. Nevertheless, it suggests benefit even w ith a relatively aggressive conservative policy in these patients. Because of trial recruitm ent difficulties it is unlikely that further random ised data w ill em erge in the foreseeable future. M ean tim e to revascularisation w as under 1 hour in the trial, and quite how m uch later such benefit m ight extend is unclear. Em ergency cardiac procedures in patients in cardiogenic shock due to com plications of coronary artery disease. Early revascularisation in acute m yocardial infarction com plicated by cardiogenic shock. The figures given should ideally be those currently being achieved by the team to w hom the patient is referred. In general term s, registry data are m ore representative than published series, w hich inevitably include bias tow ards m ore successful figures. The data should be adjusted up or dow n to m atch the circum stances of the individual patient, w ho is helped tow ards a rational decision based on the anticipated risks and benefits. It therefore applies to the typical patients – m ale, elective, aged 60–70, w ith an adequate left ventricle. Patients w ith one or m ore risk factors for perioperative death, w hich are older age, fem ale sex, obesity, w orse ventricular function, diabetes, very unstable or em ergency status, or significant co-m orbidity of any type, should have the stated risk appropriately increased. The United Kingdom Heart Valve Registry provides very reliable thirty day m ortality figures w hich for the three years 1994–1996 inclusive w ere 5% for aortic valve replacem ent and 6% for m itral valve replacem ent. Lethal brain damage and permanently disabling hemiplegia are rare w ith a com bined risk of about 0. If every focal deficit discovered on brain im aging, or every transient neurological 100 Questions in Cardiology 71 sign is included the incidence w ould probably be nearer 5%. Air, left atrial throm bus and calcific valve debris are additional risk in valve surgery. Som e difficulty w ith concentration and m em ory affects about a quarter of patients – but very few are troubled by it to any extent. In good hands it rarely com plicates valve operations w ithout coronary artery disease. In coronary surgery incidence depends on definition but m yocardial dysfunction, local or global, is the com m onest cause of death. The incidence of infarction is entirely dependant on definition and any figure from 2% to 10% could be given, depending on the criteria used. London and Philadelphia: Current Science, 1994: 161–9 72 100 Questions in Cardiology 34 W hich patients with post-infarct septal rupture should be treated surgically, and what are the success rates? Tom Treasure M yocardial rupture is a m ore com m on cause of death after infarction than is generally appreciated. The hospital m ortality for surgical repair is probably 40% (w ithout reporting bias – but there is surgical selection and natural selection – m ost have had to survive transfer to a surgical centre). Favourable features are younger age, anterior rather than inferior infarcts, m ore surviving left and right ventricular m yocardium , and functioning kidneys. There w as a vogue for holding these patients on a balloon pum p to operate on them w hen the infarcted tissue is better able to take stitches. It is a long w ait before there is any m aterial advantage, and any benefit in reported figures of percentage operative survival w as due to loss of patients along the w ay. If you are going to operate on these cases, it is probably a case of the sooner the better. Should coronary artery bypass grafting be perform ed at the sam e tim e as repair of a post-infarct ventricular septal defect? The Society of Thoracic Surgeons National Database m ortality figures1 for 80,881 patients under- going isolated bypass surgery betw een 1980 and 1990 w ere 4. Recognised factors affecting in-hospital m ortality include older age, fem ale sex, co-m orbid renal and cardiovascular disease, diabetes, cardiogenic shock, em ergency, salvage or redo operation, preoperative intra-aortic balloon pum p use and associated valve disease. Long term survival after surgery The late results of bypass surgery depend on the extent of cardiac disease, the effectiveness of the original operation, progression rate of atherosclerosis and the im pact of non-cardiac disease. Patient-related variables associated w ith poorer late survival include reduced ventricular function, congestive cardiac failure, triple vessel or left m ain stem disease, severity of sym ptom s, advanced age and diabetes. It is therefore difficult to extrapolate data from this trial to m odern patient populations. Com bining results from seven of these early random ised trials led to the publication of survival figures for 5, 7 and 10 years. Coronary artery bypass grafting: Society of Thoracic Surgeons National Database experience. Eighteen year follow up in the Veterans Affairs Cooperative study of coronary artery bypass surgery for unstable angina. Tw elve year follow up of survival in the Random ised European Coronary Surgery Study. This procedure provides excellent short and interm ediate term outcom e but is lim ited, in the long term , by vein graft failure. Furtherm ore, these benefits extended across all groups of patients w ith a five year life expectancy including “elderly” patients (up to m id-seventies), and those w ith diabetes and im paired ventricular function. The radial artery is a versatile conduit, w hich can be harvested easily and safely, has handling characteristics superior to those of other arterial grafts and com fortably reaches any coronary target. For the patient it offers the prospect of superior graft patency com pared to saphenous vein grafts4 as w ell as im proved w ound healing. The potential im pact of the radial artery on survival is not yet established as it has only been in w idespread use for five years. Finally, m any patients are interested to know “how long grafts are likely to last”. This m ay be view ed m ost helpfully in term s of event rates, rather than physical lack of occlusion of a graft: “ischaem ic event rate” (5% per year) and cardiac m ortality (2–2. A recurrent “event” (death, M I or recurrence of angina) occurs in 25% of surgically treated patients in <5 years, and 50% at 10 years. In sum m ary, the use of arterial grafts offers substantial short and long term clinical and prognostic benefits. Current evidence suggests that the superior patency of arterial grafts also reduces perioperative m ortality by reducing perioperative m yocardial infarction. This is particularly true in patients w ith sm aller or m ore severely diseased coronary arteries (fem ales, diabetics, Asian background) w here discrepancy betw een the size of vein grafts and coronary vessels leads to “run- off” problem s and a predisposition to graft throm bosis. Relative contraindications to arterial grafts are patients w ho are likely to require significant inotropic support in the postoperative period (because of the risk of graft vasoconstriction) or those w ith severely im paired ventricular function (ejection fraction less than 25% ) and lim ited life expectancy. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from random ised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. How ever, the reported frequency w ith w hich these problem s occur varies considerably.

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Which of the following is the term used to (A) Recruit intracellular kinases describe the elimination rate via metabolism (B) Undergo autophosphorylation catalyzed by alcohol dehydrogenase when the (C) Diffuse through lipid membranes enzyme is saturated? Which of the following parameters is used to (D) Biotransformation indicate the ability of a drug to produce the (E) Redistribution desired therapeutic effect relative to a toxic effect? A 69-year-old woman is being treated in (A) Potency the intensive care unit for presumed staphylo- (B) Intrinsic activity coccal sepsis purchase generic silagra on line. What specific disease presents to the emergency room with considerations will have to be made with obstipation and feculent emesis silagra 100mg. A diagnosis of regard to adjustments of the prescribed small bowel obstruction is made generic silagra 100mg amex, and she is medication? Postoperatively purchase genuine silagra line, the patient is noted to preparation have elevated blood pressure, and oral meto- (B) The patient will need to be water restricted prolol is administered; however, no improve- to decrease the volume of distribution ment of hypertension is observed. Glucuronidation reactions (D) It enhances drug metabolism (A) Are considered phase I reactions (E) It decreases untoward side effects (B) Require an active center as the site of conjugation 11. Erythromycin is prescribed ‘‘qid,’’ or four (C) Include the enzymatic activity of alcohol times daily, because of its short half-life. A 38-year-old woman presents to her psychi- drug atrist with a request to try a different antidepres- (E) To ensure that the drug concentration sant medication, since she doesn’t feel her remains constant over time current medication is helping. He is diagnosed with try imipramine; however, since this drug is epilepsy, and phenytoin therapy is started. To known to undergo an extensive first-pass effect, achieve proper drug concentrations in plasma, he orders a hepatic function panel before pre- the patient is first given a loading dose, followed scribing it, given the patient’s recent history of by maintenance doses. What is the rationale for the doc- nytoin is frequently monitored to adjust the tor’s decision? What is the ra- (A) In the presence of hepatic dysfunction, tionale behind such a regimen? A 43-year-old man who was recently fired from a well-paying job decides to commit sui- 13. The C0, obtained by extrap- at home sleeping, but notices that he has olation of the elimination phase, is determined diminished breathing, low body temperature, to be 0. A drug has a volume of distribution of 50 L (B) It decreases proximal tubular secretion and undergoes zero-order elimination at a rate (C) It decreases distal tubular reabsorption of 2 mg/hour at plasma concentrations greater Chapter 1 General Principles of Drug Action 21 than 2 mg/L. In most patients, an antibiotic is eliminated with a plasma concentration of 4 mg/L of the 25% by hepatic metabolism, 50% by renal filtra- drug, how long will it take (in hours) for the tion, and 25% by biliary excretion. If the oral dosing rate of a drug is held con- one 50 mg tablet every 12 hours, what will be stant, what willbethe effectof increasing thebio- the resulting average plasma concentration (in availability of the preparation? You administer to a patient an oral mainte- (A) Blood flow to the tissues nance dose of drug calculated to achieve a (B) Fat content of the tissues steady-state plasma concentration of 5 mcg/L. A decrease in which cell types of the following parameters explains this higher (E) Specific organ clearances than anticipated plasma drug concentration? A drug is administered in the form of an (B) Volume of distribution inactive pro-drug. The pro-drug increases the (C) Clearance expression of a cytochrome P-450 that converts (D) Half-life the pro-drug to its active form. The table below illus- (B) The potency will increase trates the plasma concentration of X as a (C) The efficacy will decrease function of time after the initial loading dose. Which subfamily of cytochrome P-450s is responsible for the highest fraction of clinically important drug interactions resulting from 9 12. Which of the following factors will deter- (D) Decreases the maximum response to an mine the number of drug–receptor complexes agonist formed? Which of the following is an action of a non- (A) Glomerular filtration competitive antagonist? Ligand-activated ion channel is an example of interaction of specific ligand with an ion channel, which permits passage of ions through the channel. Receptor-activated tyrosine kinase is exemplified by insulin, where binding of ligand acti- vates specific tyrosine kinase, leading to a cascade of reactions within the cell. The ability to target intracellular receptors depends on the ligand’s ability to cross lipid barriers, such as the nuclear envelope. Recruitment of intracellular kinases is charac- terized by some receptor-activated tyrosine kinases. Interaction with G-proteins and adenylyl cyclase are characteristics of mem- brane receptors. Lithium is an example of drug with a very low therapeutic index, which requires frequent monitoring of the plasma level to achieve the balance between the desired effect and untoward toxicity. Efficacy of the drug is the maximal drug effect that can be achieved in a patient under a given set of conditions. Bio- availability of the drug is the fraction of the drug that reaches the bloodstream unaltered. Adequate passage of drug through the small intestine is required to observe the effects of the drug, because most of the absorption takes place in the small intestine. After extensive abdominal surgery, especially that involving a resection of a portion of small bowel, the passage may be slowed, or even stopped, for a period of time. Abdominal surgery rarely results in reduced blood flow to the intestine, nor does such an operation influence protein binding, or the first-pass effect. Because of the patient’s edema and ascites, the apparent volume of distribu- tion will be increased, which may require small adjustments in his usual medication doses. In first-order elimination, the rate of elimination actually depends on the concentration of the drug, multiplied by proportionality constant. Biotransformation simply refers to the general mechanism of a partic- ular drug’s elimination. Redistribution is one of the possible fates of a drug, which usually termi- nates drug action. Since vancomycin is cleared by the kidneys, renal functional status needs to be considered when prescribing such a drug, because it may accumulate and produce undesirable toxic side effects. Switching from the vancomycin to an oral preparation will reduce its bioavaila- bility. There is no indication that the patient is in the state of increased volume of distribution (such as edema), and water restriction will not have a noticeable effect on apparent volume of 23 24 Pharmacology distribution. Changes to the current regimen are necessary because of the patient’s acute renal failure, and this has to be done regardless of the urgency of the situation. The fact that the patient is being ventilated may indicate that she needs extra hydration because of increased insensible losses, but this has nothing to do with her vancomycin dose directly. First-pass metabolism simply means passage through the portal circulation before reaching the systemic circulation. A hepatic function panel is generally not used to deduce a patient’s sus- ceptibility to the drug. Bioavailability of drugs is decreased, not increased by the fraction removed after the first pass through the liver. Drugs are usually less rapidly metabolized when hepatic enzymes are elevated (which indicates hepatic dysfunction). Alterations of urinary pH affect renal distal tubular reabsorption of drugs by changing the degree of ionization. Glomerular filtration depends mainly on the size of the drug as well as protein binding. Drug metabolism is not affected at the levels of the kidney, where most elimination takes place. Alkalinization of urine is unlikely to affect undesirable side effects of the drug. Dosing schedules of drugs are adjusted according to their half-lives to achieve steady-state plasma concentration. Attempting to avoid the toxicity of the drug because of its low therapeutic index represents an unlikely scenario, since to reduce toxicity of a drug with a low therapeutic index, one would reduce the dosing schedule, not increase it. Some fluctuation in plasma concentration occurs even at steady state; it is the aver- age concentration over time that is the goal of steady state. The rationale for the loading dose is to give a patient a sufficient dose of a med- ication to achieve the desired effect quickly, which is necessary in some situation (such as pre- vention of further seizures). When drug is administered at maintenance rate, steady state is achieved after about five half-lives. The loading dose depends on the volume of distribution, whereas the maintenance dose depends on the clearance of the drug. To calculate the volume of distribution, use the formula in which the dose of the drug is divided by the plasma concentration.

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Aydemir2 was to identify QoL of subjects presenting with residual neurologi- cal defcits from a spinal cord injury and living at home purchase 100 mg silagra with visa. After informed consent was obtained buy 50mg silagra amex, a clini- partment of Physical Therapy and Rehabilitation generic silagra 50mg with mastercard, Ankara discount silagra 50mg visa, Turkey cal examination was conducted and questionnaires were flled out by the subjects. Results: The mean age was to evaluate the effectiveness of this protocol in tetraplegic patients. The evaluation was performed after on average of ing respiratory assessment and management themes was developed 3 years. Conclusion: In recent years, the focus of rehabilitation patients successfully weaned from mechanical ventilator and 30 of outcomes has shifted from the illness itself to a broader picture of 35 patients were decannulated. Four patients referred for diaphragm well-being; QoL is an important measure of the success of reha- pace stimulation and tracheal stenosis surgery. The majority of the the pattern of change in severity of involuntary movements as the lesions were at the thoracic level (58. Surgical stabilization of the spine was performed in 50 disorders presenting with a change in the nature of chorea in patients patients (49%). Some purposeful movement was regained but there 513 was also increasingly forid chorea and dystonia in her face, neck and shoulders. The initial presentation is subtle as interpretation of neurology is diffcult and may only Introduction/Background: Delirium has been shown to be a com- manifest as a change in the severity of involuntary movements. He then developed hyperactive delirium secondary to a urinary 1Universiti Kebangsaan Malaysia, Rehabilitation Unit- Depart- tract infection further compounded by pain, constipation and no- ment of Orthopedics and Traumatology, Cheras, Malaysia, 2Uni- socomial pneumonia. Managing neurogenic bladder Lumpur, Malaysia, 3Universiti Kebangsaan Malaysia, Rehabilita- and bowel aggravates agitation due to the invasive nature of in- tion Unit- Department of Orthopedics and Traumatology, Kuala terventions. Resultant constipation and incontinence worsens de- Lumpur, Malaysia lirium creating a vicious cycle. Loss of sensation increases risk of self harm during periods of psychomotor agitation e. There is The study is approved by the ethic committee of Hospital Univer- muscle atrophy under bilateral deltoid muscle. Results: We targeted a sample size of tion around the anus but partial sensation of pressure in lower limbs 30. Data available from all subjects recruited by May 2016 pairment scale is B (complete motor C4 lesion). In addition, the results of this study will provide important cians supported the subject in balance and weight-bearing (Fig). Hospital Sultanah Nur Zahirah, Department of Rehabilitation Medicine, Kuala Terengganu, Malaysia 518 Introduction/Background: Spinal Cord Injury is a devastating event with lasting implications to one’s life. Hasnan 1University of Malaya, Department of Rehabilitation Medicine- Material and Methods: 22 year old man who had motor vehicle accident in Apr 2012 and sustained comminuted fracture T3 to T5 Faculty of Medicine, Kuala Lumpur, Malaysia and subluxation T3/T4. Material and Methods: We report a 64 years rehabilitation team at 3 years post injury and he remains as com- old gentleman who sustained hyperextension injury of neck. Prior to admission, prognosis cated with spinal cord edema at C3/C4 level resulted by spinal canal and expected functional outcome explained. Neurogenic shock on day one of injury was stabi- discussed and set before the admission. On third day post injury, he underwent was monitored using Spinal Cord Independence Measure. He choked on his Our patient showed marked improvement during his 3 weeks of meal after the surgery. Spinal Cord Independence Measure right palate elevation, tongue deviation to right on protrusion and scored 26/100 on admission and 65/100 upon discharge. Complication of aspiration sion: Rehabilitation is an essential treatment for any spinal cord pneumonia had hindered the rehabilitation progress for the follow- injured patient to achieve functional independence and improve ing week. Results: Recovery 517 of dysphagia was slow despite aggressive swallowing therapies, practicing of swallowing maneuvers and compensatory strategies. He gained some 1 2 3 4 3 motor recovery but still required maximal assistance in daily activi- A. The exact mechanism has 1University of Tsukuba, Department of Orthopedic Surgery- Faculty not been clearly defned. Researcher observed a trend toward re- of Medicine, Tsukuba City, Japan, 2University of Tsukuba, Division covery over 2 to 6 months after surgery. However, it takes longer in J Rehabil Med Suppl 55 Poster Abstracts 153 this case scenario. Bedside swallowing and neurological assessment 1Wakayama Medical University, Rehabilitation Medicine, Wakay- should be performed for all patients with acute cervical spinal cord ama, Japan injury and those who undergone anterior cervical spinal surgery. Moreover, we evaluated effects of even admitted because of osteoporotic fractures with spinal cord in- local heating and cooling in both sensory-intact and disturbance volvement. Results: In our studies, sympathetic speaking bone research societies should be used in this very special control of thermoregulatory responses were strikingly attenuated patient group. During mild cold stress, even a decrease in body core tempera- glucocorticoid-induced osteoporosis there are separate guidelines. Conclusion: In medication and if necessary further work up of secondary causes are summary, thermoregulatory responses via central nervous system initiated. Results: In terial and Methods: Twelve paraplegic persons were participated 1976 only 14% of the patients had nontraumatic spinal cord injury, in the study. The range in age, time after injury, neurologic level, in the frst six months of 2015 its part had been 58%. The protocol was approved by the ethics committees at the two participating institutions, and all 521 participants provided written informed consent. Pa- gor, Malaysia, 3University Malaya, Department of Rehabilitation tients may experience severe neuropathic pain, weakness, abnor- Medicine, Kuala Lumpur, Malaysia mal sensation, particularly in the hands. The maximum intensity for heat sensation was set up at eration, degenerative disc, muscle fatigue. There were 523 studies were in the 4, 2, and 1 stepping algorithm with null stimuli test. Thirty-three threshold was measured by averaging the results after giving 20 studies were screened on their abstracts, and 10 studies were eligible stimuli for 3 seconds, with 10-second intervals in between. Seven out of 10 studies showed a high prevalence ended when there was wrong response to 3 consecutive stimuli. Depression was found to be the Results: The thresholds for heat sensation in syringomyelia patient most common factor associated with fatigue as shown in 5 stud- are as described in the table below. Pain was found as the second most common factor associated myelopathy showed higher threshold for warm and cold sensation with fatigue, as shown in 3 studies. Fatigue may lead to depression in both upper extremities compared to the control subject. How- as shown in 2 studies, as well as a barrier to physical functioning ever, there is no difference of temperature sensation in traumatic as shown in 2 studies. Conclusion: There is a high prevalence of myelopathy patients between syringomyelia and non-syrinx. Depression and pain were the most clusion: The results showed that traumatic myelopathy results in common factors associated with fatigue. These may lead to depres- sensory defcit for temperature, but the syringomyelia itself does sion and limited physical function. Material and Methods: A retrospective descriptive study, Material and Methods: A population-based cohort study. Medical conducted at the physical medicine department of Sousse, including claim data analyzed in this study comprised 2152 incident cases of patient with spinal cord injury dating back at least 2 years. Incidence that half of the patients had depression score between 8 and 10 (doubt- rate of depression was estimated with Poisson assumption, and ful depression) and anxiety scores over 10 (some anxious state). Conclusion: The spinal cord may be from the rehabilitation group treated for depression, representing an accompanied by restrictions on body, social and also psychological. The corresponding So the management of spinal cord injured patients should be multi- J Rehabil Med Suppl 55 Poster Abstracts 155 disciplinary. Furthermore, the physical, the psychological condition more intermittent catheter, 1 less incontinent. Compare results 1University of Ibadan, Department of Physiotherapy, Ibadan, Ni- with National results.