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Younger Stroke Victims Benefit from Earlier MRIs

By MedImaging International staff writers
Posted on 28 Feb 2011

Performing magnetic resonance imaging (MRI) sooner on younger stroke patients entering emergency rooms (ERs) can lower the rate of misdiagnosis and lead to more timely appropriate treatment.

While the American Stroke Association reports that stroke is the third leading cause of death and one of the top causes of disability in the United States, young adults demonstrating signs of suffering a stroke are sometimes misdiagnosed in hospital ERs, preventing them from receiving early effective treatment that can avoid serious damage. Researchers from Wayne State University (WSU)-Detroit Medical Center Stroke Program (MI, USA) presented their findings during the American Heart Association/American Stroke Association's International Stroke Conference 2011 in Los Angeles (CA, USA), in February 2011. The investigators studied the cases of 77 patients with a mean age of 37.9 years who reported to an emergency room displaying stroke symptoms. Of those cases, 14.5% of the patients were at first misdiagnosed.

The risk of a misdiagnosis decreased if physicians performed an MRI scan of the patient within 48 hours. The probability of a misdiagnosis increased as the age of the patients decreased. The study concluded that early performance of an MRI leads to greater accuracy of a stroke diagnosis in young adults brought to emergency rooms, and patients younger than 35 years of age are at greater risk of being misdiagnosed when exhibiting stroke symptoms. However, if a patient showing stroke symptoms arrived via ambulance, there was a lower rate of misdiagnosis. The researchers theorized that arrival by ambulance might increase an emergency room staff's perception of the gravity of the patient's condition.

"Accurate diagnosis of stroke on initial presentation in young adults can reduce the number of patients who have continued paralysis and continued speech problems,” said Seemant Chaturvedi, MD, professor of neurology and director of the WSU-DMC Stroke Program. "We have seen several young patients who presented to emergency rooms with stroke-like symptoms within three to six hours of symptom onset, and these patients did not get proper treatment due to misdiagnosis. The first hours are really critical. Part of the problem is that the emergency room staff may not be thinking ‘stroke' when the patient is younger. Physicians must comprehend that a stroke is the sudden onset of these symptoms.” Patients arriving with "seemingly trivial symptoms like vertigo and nausea” should be carefully evaluated, he reported. Moreover, he noted that delay could be costly. After 48 to 72 hours, there are no major interventions available to improve stroke outcome.

Intravenous delivery of the clot-dissolving agent tissue plasminogen activator is the only US government-approved treatment for acute stroke. The drug must be given within three hours of symptom onset to reduce permanent disability.

The study's findings build on the team's 2009 study in which members reviewed seven years' worth of data covering 57 patients between the ages of 16 and 50. The patients were enrolled in the Young Stroke Registry at the Comprehensive Stroke Center at the WSU School of Medicine. Four males and three females (average age 34) in the study were misdiagnosed with migraine headaches, vertigo, alcohol intoxication, or other conditions. They were discharged from the ER, but later were found to have suffered a stroke.

Related Links:
Wayne State University-Detroit Medical Center Stroke Program

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61 (73.19450378418): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (541.92543029785): SELECT fid FROM jos_deeppockets WHERE id=294733641 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294733641 AND published='1' LIMIT 1

63 (279.18815612793): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

64 (41.961669921875): select jos_twitters.link from jos_twitters where cat=10

65 (28.133392333984): select jos_facebook.link from jos_facebook where cat=10

66 (30.040740966797): select jos_google_plus.link from jos_google_plus where cat=10

67 (28.133392333984): select jos_linkedin.link from jos_linkedin where cat=10

68 (64.13459777832): SELECT fid FROM jos_deeppockets WHERE id=294733641 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294733641 AND published='1' LIMIT 1

69 (33.140182495117): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

70 (237.94174194336): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733641 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (224.82872009277): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733641 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (42.915344238281): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (64.13459777832): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (60.081481933594): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733641 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (35.04753112793): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733641 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (52.213668823242): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (55.074691772461): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

105 (52.213668823242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

106 (56.028366088867): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294733641 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (46.014785766602): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294733641 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

109 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

110 (48.160552978516): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294733641 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (380.03921508789): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294733641 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 2308.8455200195): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (390.05279541016): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (!!!!! 1794.8150634766): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

115 (761.98577880859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

116 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

117 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

118 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

119 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

120 (63.180923461914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

121 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

122 (215.05355834961): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 53925.99105835): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (705.95741271973): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733641 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733641 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 31872.987747192): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (66.041946411133): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (298.02322387695): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (36.954879760742): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (!!!!! 6387.9489898682): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (123.02398681641): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (810.14633178711): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (46.968460083008): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (!!!!! 1008.9874267578): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (70.095062255859): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (439.88227844238): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (320.9114074707): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (211.95411682129): SELECT name FROM jos_deeppockets WHERE id=212

138 (33.140182495117): SELECT name FROM jos_deeppockets WHERE id=212

139 (574.11193847656): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (509.02366638184): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (!!!!! 4353.0464172363): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

142 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

143 (!!!!! 11857.986450195): TRUNCATE TABLE jos_trademed_module

144 (86.069107055664): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294733641 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (989.91394042969): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294733641 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (858.06846618652): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 1312.9711151123): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

149 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

150 (!!!!! 1152.9922485352): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

152 (54.836273193359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

153 (35.04753112793): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733641 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733641 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (!!!!! 1537.0845794678): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

155 (66.995620727539): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

156 (66.041946411133): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

158 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733641 AND published='1' LIMIT 1

159 (273.9429473877): select jos_twitters.link from jos_twitters where cat=10

160 (41.007995605469): select jos_facebook.link from jos_facebook where cat=10

161 (!!!!! 3959.1789245605): select jos_google_plus.link from jos_google_plus where cat=10

162 (77.009201049805): select jos_linkedin.link from jos_linkedin where cat=10

163 (328.06396484375): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1078.1288146973): insert into jos_banners_delta values (14615,'2025-06-27 17:09:14','216.73.216.249','view'),(14202,'2025-06-27 17:09:14','216.73.216.249','view'),(14203,'2025-06-27 17:09:14','216.73.216.249','view')

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