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P OSTER
A BSTRACTS
While we were not able to find another reported case of SOVT associated
with the presence of a lupus anticoagulant, evaluation for hypercoagulation
syndromes is probably warranted.
A92
Spontaneous Retroperitoneal Bleed Presenting as Right leg pain:
Psoas sign.
T. Hashim, A. H. Chaudhry. Hospitalist, Highline Medical Center,
Burien, WA.
We report case of 88year old man with past medical history of
atrial fibrillation on anti- coagulation with Coumadin for chronic
atrial fibrillation. Patient presented to our emergency room with 1
day history of right leg pain and inability to walk secondary to severe
pain and leg weakness. Patient denied any trauma. The pain was in
right groin which was made worse with extension of the hip and was
relieved with hip flexion. All other review of systems were negative.
His medical problems included diabetes, hypertension and history of
CHF.His home medications included Coumadin, Lisinopril, simvastatin
and Carvidelol.
On physical examination, his blood pressure was 122/65 heart
rate 110/min irregular, respiratory rate 22 /min and temperature of
98.7F. His cardio-pulmonary exam was unremarkable. Abdominal
exam was benign. Patient however was constantly keeping his right
thigh flexed. When patient was turned on his left side and an attempt
was made to extend his right leg at the thigh; it resulted in severe pain
(positive psoas sign). He also had sensory loss on the anterior upper
thigh and also has significant weakness of the right Quadriceps
Femoris Muscle.
Laboratory data showed hematocrit of 28 which was a drop
from his baseline hematocrit of 35. The INR was 4.6 and rest of the
chemistry panel was with in normal limits.
A CT scan of the abdomen and pelvis without contrast showed
huge 13cmx5cmx6.5cm complex fluid collection close to the right iliacus
muscle consistent with retroperitoneal bleed. Patient was admitted
to ICU for close monitoring. He was transfused 4 units of Fresh
frozen plasma along with 2 units of PRBCS and 10mg of IV vitamin
K. Surgery recommended conservative management and complete
reversal of anticoagulation and frequent hemoglobin checks.
Over the next couple of days the patient’s condition improved
and his hematocrit stabilized.
On the 5th day of hospitalization, patient was discharged home
with home health for physical therapy.
Conclusion:
Retroperitoneal bleed is a Known complication of anticoagulation
which usually presents with abdominal pain and back pain. However,
sometimes it presents as isolated Psoas sign. Clinicians taking
care of patients on anti- coagulation should have low threshold for
imaging the abdomen (CT or MRI) for patient who present with
groin pain or leg pain.
A93
The Functional Performance Predictors of Adverse Health Outcomes
in Community-Dwelling Older Adults: A preliminary study.
T. J. Tseng, 1 P. S. Lin, 1 H. S. Cheng, 2 B. H. Gi. 1 1. Department of
Physical Therapy, Graduate Institute of Rehabilitation Science, Chang
Gung University, Taoyuan, Taiwan; 2. Internal Medicine, Chang Gung
Memorial Hospital, LinKou Branch, Taoyuan, Taiwan.
Background and Purpose: The number of older adults keeps increasing
in Taiwan. “Frailty” is a newly defined syndrome, the declined
physiologic reserve capacities will make older people highly
vulnerable to adverse health outcomes, such as hospitalization and
mortality. Finding predictors is one of the solutions to prevent or
defer those adverse health outcomes. There are two purposes of this
study: (1) To examine the differences of the occurrence of the adverse
health outcomes in different levels of frailty for 2-year period. (2) To
examine the functional performance predictors of older adults’ adverse
health outcomes after 2-year period. Method: A convenient
sample of 337 older adults, aged 65 years and older, living in the community
participated in this study. The baseline evaluation included
demographic and health status, functional tests, mental and depressive
status. The subjects will be followed up annually and finally, medical
record confirms of the occurrence of adverse health outcomes, including
hospitalization, emergency visit, and fall. Results: Among the
337 enrolled, 96 of whom were “non-frail”, 191 were “pre-frail”, and
50 were “frail”. Results of preliminary analyses showed, at baseline,
the three groups were significantly different in height, weight, comorbidity,
GDS, MMSE and all functional tests. The frail older adults
have significantly higher percentage of falls (X2= 13.305, p=0.01). The
5-meter gait speed test, functional reach (FR) and 6-min walking test
(6 MWT) were the tests that could significantly predict older adults’
hospitalization, emergency visit and falls 2 years later, respectively.
Conclusion: The 5-meter gait speed test, FR and 6 MWT were recommended
for use to identify community-dwelling older adults who are
at risk of future adverse health outcomes.
A94
Older Minority Persons Living with HIV/AIDS (PLWHA) The
Influence of Social Support on Willingness to Participate in HIV
Clinical Trials.
R. Arakawa, 1,2 G. Corbie-Smith. 2,3 1. University of Hawaii John A
Burns School of Medicine, Honolulu, HI; 2. The Program on Health
Disparities Cecil G. Sheps Center for Health Services Research, The
University of North Carolina Chapel Hill, Chapel Hill, NC; 3. School
of Medicine, The University of North Carolina Chapel Hill, Chapel
Hill, NC.
Background: Racial and ethnic minorities are disproportionately
affected by the AIDS epidemic, yet have been underrepresented
in HIV research, including clinical trials. Older adults are increasingly
infected, and the population over 50 years old living with
AIDS is expected to grow. The unique experience of being an older
minority person living with HIV/AIDS (PLWHA), in the context of
clinical trial participation, is poorly understood. This study looked for
age-related differences in willingness to participate in a clinical trial
and specific facilitators of participation.
Methods: A cross-sectional, stratified analysis of baseline survey
data was conducted as an aspect of Project EAST (Education and
Access to Services and Testing), a community-based research project
devoted to increasing rural minority participation in research in
North Carolina. Textual data from interviews with PLWHA was
queried for qualitative support of the findings.
Results: Age was not associated with willingness to participate
(WTP), and study participants demonstrated a high level of baseline
willingness. Older age was associated with high levels of perceived social
support from church & religious faith, but lower levels of perceived
support from friends. Older participants had lower perceived
pressure from their doctors to participate, but most believed their
doctor would support their decision to enroll. Both age groups received
a higher frequency of support from other resources, including
their spouse/partner and other family.
Discussion: This study provides no empiric basis for excluding
older minority PLWHA from clinical trials research. The high baseline
willingness demonstrated by the survey participants is encouraging,
but social desirability should be examined as a possible con-
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