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481. Management of Multiple Sclerosis

Demyelinating Encephalomyelitis (ADEM) 47, level III; 63, level III • An acute autoimmune demyelinating disease of CNS • Triggered by viral infections and immunisations • Usually a monophasic course • Characterised by: ? subacute encephalopathy evolving over one week to three months, disturbance of consciousness and/or behavioural abnormality ? seizures or coma ? multifocal symptoms and signs: cerebellar or cerebral ? ON or TM ? MRI brain shows symmetrical multifocal or diffuse brain lesions - supra (...) -examined the MS disease phenotypes and revised its clinical descriptions of relapsing and progressive MS. While retaining core features above, it included assessment of disease activity based on clinical relapses, imaging findings and disease progression as the 2013 revisions.The progressive relapsing category was eliminated and it is now called primary progressive MS with disease activity. CIS is now included under the spectrum of MS. 67, level III Refer to Appendix 5.Management of Multiple Sclerosis

2015 Ministry of Health, Malaysia

482. Thyroid Dysfunction: Screening

Thyroid gland disorders are among the most common endocrine conditions evaluated and treated by clinicians. Thyroid dysfunction represents a continuum from asymptomatic biochemical changes to clinically symptomatic disease. In rare cases, it can produce life-threatening complications, such as myxedema coma or thyroid storm. , Subclinical hypothyroidism is defined as an asymptomatic condition in which a patient has a serum thyroid-stimulating hormone (TSH) level exceeding the upper threshold (...) that evaluated the benefits of treatment of subclinical hyperthyroidism on final health outcomes, such as fractures, cancer, or cardiovascular morbidity or mortality. Except for 1 small ( n = 67) nonrandomized study that examined bone mineral density, no evidence was found on the effects of treatment of “overt” hyperthyroidism (with or without symptoms). , Potential Harms The harms of treatment of thyroid dysfunction have not been well-studied. The most important potential harms are false-positive results

2015 U.S. Preventive Services Task Force

483. Management of Dengue Infection in Adults

(consider acute - HIV seroconversion illness) Co-morbidities (consider sepsis particularly in patients with diabetes - mellitus) 2. Physical examination i. Assess mental state and GCS score ii. Assess hydration status iii. Assess haemodynamic status Skin colour (C), capillary refill time (normal 3 times over 24 hours) Persistent diarrhoea ( • >3 times over 24 hours) Third space fluid accumulation (such as ascites, pleural and • pericardial effusion) Spontaneous bleeding tendency • Lethargy/restlessness (...) Absence of warning signs (refer to Table 3) 2. Physical examination: 3. Haemodynamically stable • No tachypnoea or acidotic breathing • No tender liver or abdominal tenderness • No bleeding manifestation • No sign of third space fluid accumulation • No alterations in mental state • Investigation: 4. Stable serial HCT • No other criteria for admission (i.e. co-morbidities, pregnancy, social 5. factors)16 CPG Management of Dengue Infection In Adults (Third Edition) 2015 17 7.2 P A TIENT TRIAGING A T

2015 Ministry of Health, Malaysia

484. The Neurology and Neuropsychiatry of COVID-19 Full Text available with Trip Pro

enhancement. LP demonstrated a lymphocytic pleocytosis and was positive for SARS-CoV-2 PCR. Publication date / reference: 30/05/20 Summary: 51-year-old female with SARS-CoV-2 (negative in CSF) developed coma, left hemiparesis and impaired unilateral oculocephalic response. She had multiple acute demyelinating lesions on MRI. Publication date / reference: 29/05/20 Summary: 35-year-old SARS-CoV-2 positive patient with intractable seizures from a presumed glial cell tumour. However, the resultant cause (...) in the brain (six ischaemic strokes and two TIAs). Publication date / reference: 08/06/20 Summary: retrospective case control study of stroke patients with (n=31) and without (n=99) SARS-CoV-2 infection. Patients with COVID-19 were older had more large vessel and more severe strokes on average. Publication date / reference: 05/06/20 Summary: Case report of an 81-year-old man receiving non-invasive respiratory support, who developed confusion progressing subacutely to coma. CT angiogram suggested partial

2020 JNNP blog

486. Brain injury rehabilitation in adults

prognosis in people with brain injuries correlates to different extents with various factors including levels of consciousness, duration of post-traumatic amnesia, age, gender and pre-injury education and employment. The most widely used index of injury severity is the Glasgow Coma Score (GCS) which classifies injuries into mild, moderate or severe categories based on level of consciousness post injury (see Table 1). It should be noted that severity of symptoms associated with an injury may (...) systematic evidence to support it in practice, denying services randomly in order to conduct an RCT could be considered unethical. 16 Few rehabilitation-focused, observational studies control for selection bias. A systematic review of multidisciplinary rehabilitation services in post-acute care across a range of populations concluded that adjusting for case mix when examining the influence of two or more interventions on an outcome does not necessarily sufficiently reduce the selection bias associated

2013 SIGN

487. Influence of alcohol on early glasgow coma scale in head-injured patients. Full Text available with Trip Pro

Influence of alcohol on early glasgow coma scale in head-injured patients. To assess the depressant effects of alcohol on the level of consciousness of patients admitted with head injuries, this study examined the changes that occur in the Glasgow Coma Scale (GCS) of traumatic brain injury patients over time.The records of 269 head trauma patients consecutively admitted to the neurosurgery intensive care unit were examined retrospectively. Eighty-one patients were excluded because of incomplete

2010 Journal of Trauma

488. Validation of the Full Outline of Unresponsiveness (FOUR) Scale for conscious state in the emergency department: comparison against the Glasgow Coma Scale. (Abstract)

Validation of the Full Outline of Unresponsiveness (FOUR) Scale for conscious state in the emergency department: comparison against the Glasgow Coma Scale. To determine (a) the inter-rater reliability of pairs of emergency doctors' and/or nurses' ratings of the Glasgow Coma Scale (GCS) and the Full Outline of Unresponsiveness (FOUR) Scale in emergency department (ED) patients, (b) the concurrent validity of the FOUR Scale using the GCS as the reference scale and (c) doctors' and nurses (...) to determine the predictive validity of the FOUR Scale and to further examine the reliability of the scale in various patient populations.

2010 Emergency Medicine Journal

489. Traumatic Retroclival Epidural Hematoma. (Abstract)

Traumatic Retroclival Epidural Hematoma. Retroclival epidural hematomas are particularly rare conditions that are frequently the result of high-energy, hyperflexion-hyperextension injuries in pediatric patients. We present the case of a 7-year-old previously healthy girl with traumatic retroclival epidural hematoma after a fall from a swing. She presented with a Glasgow Coma Scale score of 15 with severe neck pain and limitation of cervical movements in all directions. Radiological examination

2019 Pediatric Emergency Care

490. Woman with acute onset involuntary limb movements. (Abstract)

Woman with acute onset involuntary limb movements. An 88-year-old woman presented with acute onset of involuntary limb movements for one day. Two days prior she had fallen a suffered a left hip contusion but no head trauma. There was no fever or difficulty breathing. Her heart rate was 72 bpm with blood pressure of 109/68 mm Hg. Physical examination revealed restricted left hip motion due to pain and a sustained twisted posture of the upper extremity without paresis. Glasgow Coma Scale was 15

2019 Emergency Medicine Journal

491. The Nimodipine-Sparing Effect of Perioperative Dexmedetomidine Infusion During Aneurysmal Subarachnoid Hemorrhage: A Prospective, Randomized, Controlled Trial. Full Text available with Trip Pro

), postoperative pain intensity scores, dexmedetomidine and sufentanil consumption, hemodynamic, satisfaction of patients and neurosurgeon, neurologic examination (Glasgow Coma Scale, GCS), Bruggemann comfort scale, and adverse effects. Intraoperative hemodynamics were recorded at the following time-points: arrival at the operating room (T1); before intubation (T2); intubation (T3); 5 min (T4), 10 min (T5), and 15 min (T6) after intubation; suturing of femoral artery (T7); end of surgery (T8); extubation (T9

2019 Frontiers in pharmacology Controlled trial quality: predicted high

492. Role of automated pupillometry in critically ill patients. (Abstract)

Role of automated pupillometry in critically ill patients. Pupillary examination has fundamental diagnostic and prognostic values in clinical practice. However, pupillary assessment was relied until present on manual, qualitative, examination, using manual flash penlights or lamps. Quantitative examination with the use of automated infrared video-pupillometers allows an objective assessment of several pupillary parameters and may be superior to manual subjective examination. The potential (...) for quantitative pupillometry is multiple in the setting of critical care, for the monitoring and detection of secondary cerebral insults and to assess brainstem dysfunction and early coma outcome prognostication, and in the intra-operative anesthesiology setting, to assess analgesia and opioid requirement. Here, we describe the pupillometry technique and review recent critical care and anesthesiology studies that demonstrate the value and potential clinical utility of quantitative pupillometry

2019 Minerva anestesiologica

493. Zones matter: Hemodynamic effects of zone 1 vs zone 3 resuscitative endovascular balloon occlusion of the aorta placement in trauma patients. (Abstract)

Zones matter: Hemodynamic effects of zone 1 vs zone 3 resuscitative endovascular balloon occlusion of the aorta placement in trauma patients. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a therapy for hemorrhagic shock to limit ongoing bleeding and support proximal arterial pressures. Current REBOA algorithms recommend zone selection based on suspected anatomic location of injury rather than severity of shock. We examined the effects of Zone 1 versus Zone 3 (...) the study period. Of these, 245 underwent REBOA and 99 patients met inclusion criteria. The initial balloon position was Zone 1 in 55 patients, Zone 3 in 36 patients, and unknown or Zone 2 in 8 patients. The change in proximal SBP was greater after REBOA in the Zone 1 group compared to the Zone 3 group (58 ± 4 mmHg vs 41 ± 4 mmHg, P = 0.008). The zone of occlusion was significantly associated with the change in proximal SBP in a linear regression analysis which included initial SBP, Glasgow Coma Scale

2019 Injury

494. Missed foot fractures in multiple trauma patients. Full Text available with Trip Pro

Missed foot fractures in multiple trauma patients. Missed or underestimated injuries are one of the central problems in trauma care. Foot injuries can easily be missed because they lay beyond the regularly screened field of a trauma computer tomography scan (CT scan). During primary and secondary survey a careful examination of the extremities often becomes of secondary interest in the severely injured patient.Thirty-four thousand ninety-one multiple trauma patients of the TraumaRegister DGU® (...) diagnosed foot injuries and 144 patients had initially missed foot injuries. Missed foot injuries were especially found in patients with car accidents or fall from ≥3 m. Patients with higher Abbreviated Injury Scale (AIS) or lower Glasgow Coma Scale (GCS) were not significantly more affected by missed foot injuries. Missing foot injuries was also not caused by injury severity or higher age.Our data highlights the need of careful evaluation of the feet during primary and secondary survey particularly

2019 BMC Musculoskeletal Disorders

495. Cannabis-related emergencies in children and teens. (Abstract)

Cannabis-related emergencies in children and teens. To examine the spectrum of emergency department presentations associated with cannabis use or misuse that are currently seen in the pediatric population.There is a growing concern that pediatric emergency department visits related to cannabis are on the rise, especially given rapidly changing legislation on cannabis and its broad availability in certain areas. These concerns are substantiated in the current literature, as the evidence mounts (...) of cannabis-related symptoms is possible from acute use or exposure. Common presentations include acute intoxication, hyperemesis, depression and acute physical injuries from impaired psychomotor function. Uncommon presentations include cardiorespiratory effects, and a range of symptoms in young children that include hyperkinesis and coma. Clinical vigilance is needed to suspect and clinically diagnose cannabis exposure in the emergency department.

2019 Current Opinion in Pediatrics

496. Recovery After Mild Traumatic Brain Injury in Patients Presenting to US Level I Trauma Centers: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study. (Abstract)

Recovery After Mild Traumatic Brain Injury in Patients Presenting to US Level I Trauma Centers: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study. Most traumatic brain injuries (TBIs) are classified as mild (mTBI) based on admission Glasgow Coma Scale (GCS) scores of 13 to 15. The prevalence of persistent functional limitations for these patients is unclear.To characterize the natural history of recovery of daily function following mTBI vs peripheral (...) orthopedic traumatic injury in the first 12 months postinjury using data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, and, using clinical computed tomographic (CT) scans, examine whether the presence (CT+) or absence (CT-) of acute intracranial findings in the mTBI group was associated with outcomes.TRACK-TBI, a cohort study of patients with mTBI presenting to US level I trauma centers, enrolled patients from February 26, 2014, to August 8, 2018

2019 JAMA neurology

497. Kratom Use and Toxicities in the United States. (Abstract)

examiner's office in New York State to identify kratom-associated fatalities.A total of 2312 kratom exposures were reported, with 935 cases involving kratom as the only substance. Kratom most commonly caused agitation (18.6%), tachycardia (16.9%), drowsiness (13.6%), vomiting (11.2%), and confusion (8.1%). Serious effects of seizure (6.1%), withdrawal (6.1%), hallucinations (4.8%), respiratory depression (2.8%), coma (2.3%), and cardiac or respiratory arrest (0.6%) were also reported. Kratom was listed (...) as a cause or contributing factor in the death of four decedents identified by the county medical examiner's office.Kratom use is increasing and is associated with significant toxicities. Our findings suggest kratom is not reasonably expected to be safe and poses a public health threat due to its availability as an herbal supplement.© 2019 Pharmacotherapy Publications, Inc.

2019 Pharmacotherapy

498. Acute kidney injury and the risk of mortality in patients with methanol intoxication. Full Text available with Trip Pro

Acute kidney injury and the risk of mortality in patients with methanol intoxication. Methanol poisoning is a serious public health issue in developing countries, but few data are available in the literature on acute kidney injury (AKI) after methanol intoxication.This study examined the clinical features, spectrum and outcomes of AKI in patients with methanol intoxication and evaluated the predictors of mortality after methanol intoxication. A total of 50 patients with methanol intoxication (...) ) and Glasgow coma scale score (odds ratio 1.370, confidence interval 1.079-1.739, P = 0.010) were significant factors associated with mortality. The Kaplan-Meier analysis disclosed that AKI patients suffered lower cumulative survival than non-AKI patients (log-rank test, chi-square = 5.115, P = 0.024).AKI was common (66.0%) after methanol intoxication and was predictive of in-hospital hospital mortality. The development of AKI was associated with a 19.670-fold higher risk of in-hospital mortality.

2019 BMC Nephrology

499. Anti-N-methyl-D-aspartate receptor encephalitis associated with reactivated Epstein-Barr virus infection in pediatric patients: Three case reports. Full Text available with Trip Pro

; Case 2 was a 7-year-old male with the manifestation of repeated emesis, headache, involuntary movement, altered personality, seizures, and cognitive impairment; Case 3 was a 2-year-old female with repeated fever, emesis, seizures, coma, and decreased muscle strength of limbs. Anti-NMDAR antibody was identified in cerebrospinal fluid (CSF) in the 3 cases, confirming the diagnosis of anti-NMDAR encephalitis. Pathogenic examinations revealed positive serum Epstein-Barr virus (EBV)-nuclear antigen

2019 Medicine

500. Otitis Media-associated Bacterial Meningitis in Children in a Low-income Country. (Abstract)

Otitis Media-associated Bacterial Meningitis in Children in a Low-income Country. Otitis media (OM) is a common childhood infection that may result in bacterial meningitis (BM). However, OM-associated BM remains poorly characterized. We aimed to study the occurrence, clinical presentation and outcome of this type of childhood BM in Luanda, Angola.Five hundred twelve children from our previous clinical BM trial, with the ear meticulously examined, were analyzed whether they had or not OM (...) ), and showed higher odds of complicated clinical course or death (odds ratios 2.27, 95% CI: 1.004-5.15, P = 0.049) compared with children without OM. The >12-month-old children with OM often arrived in poor clinical condition with coma and/or ptosis. Otorrhea was associated with HIV positivity. Infants with otorrhea frequently lived under poor socioeconomic conditions.Children with OM-associated BM were prone to many problems, such as being especially ill at presentation, undergoing a difficult clinical

2019 Pediatric Infectious Dsease Journal

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