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521. Effects of Cerebrolysin® in Patients With Minimally Conscious State After Stroke: An Observational Retrospective Clinical Study. Full Text available with Trip Pro

patients have not yet been studied extensively. Therefore, we aimed to examine the effectiveness of Cerebrolysin on improving the consciousness level of stroke patients with minimally conscious state (MCS). Materials and Methods: In this retrospective study we included ischemic and/or hemorrhagic stroke patients with MCS according to the Coma Recovery Scale-Revised (CRS-R), who were admitted to our hospital between 2014 and 2017. All patients received comprehensive rehabilitation therapy including

2019 Frontiers in neurology Controlled trial quality: predicted high

522. Time to and Possible Risk Factors for Recurrence after Burr-hole Drainage of Chronic Subdural Hematoma: A Subanalysis of the cSDH-Drain Randomized Controlled Trial. Full Text available with Trip Pro

Time to and Possible Risk Factors for Recurrence after Burr-hole Drainage of Chronic Subdural Hematoma: A Subanalysis of the cSDH-Drain Randomized Controlled Trial. The randomized controlled Chronic Subdural Hematoma (cSDH)-Drain-Trial showed comparable recurrence rates after placing a subperiosteal drain (SPD) or a subdural drain (SDD) for surgically drained cSDH, although SDD was associated with higher rates of infection and iatrogenic brain injury. This subanalysis examines the time (...) assessed through univariate and multivariate analysis.Median time to recurrence was 22.5 days (interquartile range: 9.25-52 days, range: 0-81) showing no difference between the 2 groups. Less iBE (P = 0.019), lower Glasgow Outcome Scale score at discharge (P = 0.007), and lower Glasgow Coma Scale score at 24 hours (P = 0.037) were strongly associated with recurrence on univariate analysis. After multivariate logistic analysis, less iBE (odds ratio: 1.10, 95% CI: 1.01; 1.21; P = 0.03) remained the only

2019 World neurosurgery Controlled trial quality: uncertain

523. Effect of intraoperative infusion of dexmedetomidine on postoperative recovery in patients undergoing endovascular interventional therapies: A prospective, randomized, controlled trial. Full Text available with Trip Pro

to 0.6 μg kg-1  hr-1 throughout EIT). An analgesia system delivered sufentanil only. The primary outcome measure was the total consumption of nimodipine during the first 48 hr after surgery. The secondary outcome measures were sufentanil consumption, pain intensity, hemodynamics, functional activity score (FAS), neurologic examination, level of sedation (LOS), and Bruggrmann comfort scale (BCS). We also recorded the intraoperative hemodynamic data, requirement of narcotic and vasoactive drugs (...) surgery, and increased both BCS during the first 4 hr after surgery and hemodynamic stability. However, the LOS was increased at the 0.5 hr after surgery and surgeon satisfaction score was lower. There were no significant differences among the groups for consumption of vasoactive drugs except urapidil, Glasgow coma scale (GCS) and FAS during the first 48 hr after surgery, GOS at 3 months, and cerebral infarction after 30 days.Dexmedetomidine (an initial dose of 0.5 μg/kg for 10 min adjusted to 0.6 μg

2019 Brain and behavior Controlled trial quality: predicted high

524. 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

525. 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

526. 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

527. 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

528. 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

529. 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. Full Text available with Trip Pro

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

530. Prognostic accuracy of sTREM-1-based algorithms in febrile adults presenting to Tanzanian outpatient clinics. Full Text available with Trip Pro

identify febrile adults at risk of death.Plasma concentrations of markers of endothelial (Angpt-2, sFlt-1, sVCAM-1, sICAM-1) and immune (sTREM-1, IL-6, IL-8, CHI3L1, sTNFR1, PCT, CRP) activation pathways were determined in consecutive adults with acute fever (>38°C) at presentation to outpatient clinics in Dar es Salaam, Tanzania. We evaluated the accuracy of these mediators in predicting all-cause mortality, and examined whether markers could improve the prognostic accuracy of clinical scoring systems (...) , including the quick Sequential Organ Failure Assessment (qSOFA) and Glasgow Coma Scale (GCS).Of 507 febrile adults, 32 died (6.3%) within 28 days of presentation. sTREM-1 was the best prognostic marker for 28-day mortality (area under the receiver operating characteristic [AUROC] 0.87, 95% CI 0.81-0.92) and was significantly better than CRP (P <0.0001) and PCT (P = 0.0001). Prognostic accuracy of qSOFA and the GCS were significantly enhanced when sTREM-1 was added (0.80 [0.76-0.83] to 0.91 [0.88-0.94

2019 Clinical Infectious Diseases

531. International prospective observational study on intracranial pressure in intensive care (ICU): the SYNAPSE-ICU study protocol. Full Text available with Trip Pro

) or traumatic brain injury; Glasgow Coma Score (GCS) with no eye opening (Eyes response=1) and Motor score ≤5 (not following commands) at ICU admission, or neuro-worsening within the first 48 hours with no eye opening and a Motor score decreased to ≤5. Data related to clinical examination (GCS, pupil size and reactivity, Richmond Agitation-Sedation Scale score, neuroimaging) and to ICP interventions (Therapy Intensity Levels) will be recorded on admission, and at day 1, 3 and 7. The Glasgow Outcome Scale

2019 BMJ open

532. 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

533. Contribution of Malaria to Inhospital Mortality in Papua New Guinean Children from a Malaria-Endemic Area: A Prospective Observational Study. Full Text available with Trip Pro

Contribution of Malaria to Inhospital Mortality in Papua New Guinean Children from a Malaria-Endemic Area: A Prospective Observational Study. We aimed to identify clinical and laboratory predictors of mortality in children from a malaria-endemic area of Papua New Guinea hospitalized for severe illness. Children aged 0.5-10 years presenting with any WHO-defined feature of severe malarial illness were eligible for recruitment. Each child was assessed with a detailed clinical examination, blood (...) film microscopy, malaria rapid diagnostic testing (RDT), a full blood examination, and blood glucose and lactate concentrations. Clinical care was coordinated by local medical staff in accordance with national guidelines. Daily study assessments were conducted until death or discharge. Other biochemical tests and malaria PCR tests were performed subsequently. Logistic regression identified independent predictors of death. Of 787 evaluable children with severe illness, 336 had confirmed severe

2019 American Journal of Tropical Medicine & Hygiene

534. Factors related to delayed intensive care unit admission from emergency department-A retrospective cohort study. Full Text available with Trip Pro

 minutes were as follows: for Glasgow Coma Scale score > 9, 2.73 (1.39-5.32); for thrombocytes < 100 × 109 /mmol, 6.69 (2.32-19.26); for absence of pre-arrival notification, 5.27 (3.04-9.14); and for radiological examination, 3.95 (1.72-9.10). Trauma and intoxicated patients had shorter ED LOS while patients with medical conditions had more often prolonged admissions.The delays in ICU admissions were linked to therapeutic and diagnostic procedures and absence of pre-arrival notification. Patients were (...) as admission diagnosis. The aim of this study was to examine ED-related factors associated with prolonged ED stay.The study population consisted of adult patients admitted (n = 479) from ED to ICU between 31 May 2016 and 19 March 2017 in Oulu University Hospital. A patient's ED length of stay (LOS) exceeding 180 minutes was considered delayed.Most of the patients (380, 79.3%) were admitted to the ICU within 3 hours of hospital admission. In a logistic regression analysis, odds ratios (ORs) for ED LOS > 180

2019 Acta Anaesthesiologica Scandinavica

535. Is there an association between female gender and outcome in severe trauma? A multi-center analysis in the Netherlands. Full Text available with Trip Pro

(mortality and Intensive Care Unit (ICU) admission) among severely injured patients in the Netherlands.A retrospective multicentre study was performed including all polytrauma patients (Injury Severity Score (ISS) ≥16) admitted to the ED of three level 1 trauma centres, between January 1st, 2006 and December 31st, 2014. Data on age, gender, mechanism of injury, ISS, Abbreviated Injury Scale (AIS), prehospital intubation, Revised Trauma Score (RTS), systolic blood pressure (SBP) and Glasgow Coma Scale (...) 1.046-1.388), P = 0.010).The current study shows that in this population of severely injured patients, female sex is associated with a lower in-hospital mortality rate among those aged 16- to 44-years. Furthermore, female sex is independently associated with an overall decreased likelihood for ICU admission. More research is needed to examine the physiologic background of this protective effect of female sex in severe trauma.

2019 Scandinavian journal of trauma, resuscitation and emergency medicine

536. Effect of Auditory Stimulation on the Level of Consciousness in Comatose Patients Admitted to the Intensive Care Unit: A Randomized Controlled Trial. (Abstract)

Effect of Auditory Stimulation on the Level of Consciousness in Comatose Patients Admitted to the Intensive Care Unit: A Randomized Controlled Trial. Comatose patients are exposed to sensory deprivation in the intensive care units. Auditory stimulation of patients who are unconscious is a nonmedical procedure. This study examines the effect of organized voice, performed by a nurse, on the state of consciousness of comatose patients in intensive care units.This randomized controlled trial study (...) of 60 patients was conducted fitting between August 2017 and February 2018. For 10 days, patients received the voice of a male nurse twice a day in the morning and night shifts, recorded on MP3 and repeated at least 3 to 4 times. Glasgow Coma Scale (GCS) scores were recorded by the researcher before and after auditory stimulation.Patient mean age was 69.2 years; 56.7% of the experimental group and 53.3% of the control group were male. On the first day in the morning and evening after auditory

2019 The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses Controlled trial quality: uncertain

537. Speckle Tracking Analysis of Left Ventricular Systolic Function Following Traumatic Brain Injury: A Pilot Prospective Observational Cohort Study. Full Text available with Trip Pro

examined myocardial strain and regional strain patterns following moderate-severe TBI.We conducted a prospective cohort study of moderate-severe TBI patients (Glasgow Coma Scale≤12) and age/sex-matched controls. Transthoracic echocardiography was performed within the first day and 1 week following TBI. Myocardial function was assessed using both GLS and LVEF, and impaired systolic function was defined as GLS >-16% or LVEF ≤50%. Regional strain patterns and individual strain trajectories were (...) examined.Thirty subjects were included, 15 patients with TBI and 15 age/sex-matched controls. Among patients with adequate echocardiographic windows, systolic dysfunction was observed in 2 (17%) patients using LVEF and 5 (38%) patients using GLS within the first day after TBI. Mean GLS was impaired in patients with TBI compared with controls (-16.4±3.8% vs. -20.7±1.8%, P=0.001). Regional myocardial examination revealed impaired strain primarily in the basal and mid-ventricular segments

2019 Journal of neurosurgical anesthesiology

538. Treating Disorders of Consciousness With Apomorphine: Protocol for a Double-Blind Randomized Controlled Trial Using Multimodal Assessments. Full Text available with Trip Pro

are still unclear. Apomorphine may act through a modulation of the anterior forebrain mesocircuit, but neuroimaging and neurophysiological investigations to test this hypothesis are scarce. This clinical trial aims to (1) assess the treatment effect of subcutaneous apomorphine infusions in patients with DOC, (2) better identify the phenotype of responders to treatment, (3) evaluate tolerance and side effects in this population, and (4) examine the neural networks underlying its modulating action (...) on consciousness. Methods/Design: This study is a prospective double-blind randomized parallel placebo-controlled trial. Forty-eight patients diagnosed with DOC will be randomized to receive a 30-day regimen of either apomorphine hydrochloride or placebo subcutaneous infusions. Patients will be monitored at baseline 30 days before initiation of therapy, during treatment and for 30 days after treatment washout, using standardized behavioral scales (Coma Recovery Scale-Revised, Nociception Coma Scale-Revised

2019 Frontiers in neurology Controlled trial quality: predicted high

539. Effectiveness of Melatonin for the Prevention of Intensive Care Unit Delirium. (Abstract)

surgery, Acute Physiology and Chronic Health Evaluation II score, mechanical ventilation, ICU length of stay, dexmedetomidine use, and benzodiazepine use. For those patients who developed delirium, patients in the control group had, on average, 20.9 delirium-free days without coma in 28 days compared with 19.9 days in the melatonin group (p=0.72). In the melatonin group, melatonin was used for a mean ± SD of 6.3 ± 7.9 days, with a median dose of 3.5 mg/night (range 1-10 mg).The development of ICU (...) delirium was significantly lower in the melatonin group compared with that in the control group. To our knowledge, this is one of the only studies that has examined the use of melatonin for the prevention of ICU delirium. Melatonin may be a promising agent for the prevention of ICU delirium; however, a randomized study is needed to further validate its efficacy. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.

2019 Pharmacotherapy

540. Brain metastasis from ovarian clear cell carcinoma: A case report. Full Text available with Trip Pro

with the results of radiological and pathological examinations, the findings were consistent with a diagnosis of BM from OCCC.She received more than 20 courses of chemotherapy since July 2012. The BM was detected in 2016, and she underwent an intracranial lesion resection.Unfortunately, the patient went into a coma after the surgery, and passed away 1 month later.For early detection of BM in long-term ovarian cancer, emphasis should be placed on the patient's neurological symptoms and signs as well as serum

2019 Medicine

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