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521. Effect of intraoperative infusion of dexmedetomidine on postoperative recovery in patients undergoing endovascular interventional therapies: A prospective, randomized, controlled trial. (Full text)

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 PubMed abstract

522. Evaluation of Nonfatal Strangulation in Alert Adults. (Abstract)

a retrospective analysis of alert strangled patients treated in the ED of an academic Level I trauma center. Exclusions were Glasgow Coma Scale (GCS) score less than 13, younger than 16 years, and interhospital transfers. Trained researchers used structured forms to abstract demographics, symptoms, examination findings, radiology and operative findings, and final diagnoses. Injuries requiring greater than 24 hours' observation or specific treatment (surgery, procedure, specific medication) were considered (...) Evaluation of Nonfatal Strangulation in Alert Adults. There is a paucity of evidence to guide the diagnostic evaluation of emergency department (ED) patients presenting after nonfatal strangulation (manual strangulation or near hanging). We seek to define the rate of serious injuries in alert strangled patients and determine which symptoms and examination findings, if any, predict such injuries.Using prospectively populated databases and electronic medical record review, we performed

2019 Annals of Emergency Medicine

523. Contribution of Malaria to Inhospital Mortality in Papua New Guinean Children from a Malaria-Endemic Area: A Prospective Observational Study. (Full text)

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 PubMed abstract

524. 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

525. Factors related to delayed intensive care unit admission from emergency department-A retrospective cohort study. (Abstract)

 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

526. Effect of Physician-Staffed Emergency Medical Services (P-EMS) on the Outcome of Patients with Severe Traumatic Brain Injury: A Review of the Literature. (Full text)

the neurological outcome were examined. Additionally, data concerning hypotension, hypoxia, length of stay (hospital and intensive care unit) and the number of required early neurosurgical interventions were taken into account.The overall mortality was decreased in three of the fourteen included studies after the implementation of a physician in the prehospital setting. One study found also a decrease in mortality only for patients with a Glasgow Coma Scale of 6-8. Strikingly, two other studies reported higher

2019 Prehospital emergency care PubMed abstract

527. Brain metastasis from ovarian clear cell carcinoma: A case report. (Full text)

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 PubMed abstract

528. Early Heart Rate Variability and Electroencephalographic Abnormalities in Acutely Brain-Injured Children Who Progress to Brain Death. (Full text)

is an early indicator of autonomic system failure, and it predicts progression to brain death. We additionally explored the association between heart rate variability and markers of brain dysfunction such as electroencephalogram and neurologic examination between brain-injured children who progressed to brain death and those who survived.Retrospective case-control study.PICU, single institution.Children up to 18 years with a Glasgow Coma Scale score of less than 8 admitted between August of 2016

2019 Pediatric Critical Care Medicine PubMed abstract

529. 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

530. Treating Disorders of Consciousness With Apomorphine: Protocol for a Double-Blind Randomized Controlled Trial Using Multimodal Assessments. (Full text)

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 PubMed abstract

531. International prospective observational study on intracranial pressure in intensive care (ICU): the SYNAPSE-ICU study protocol. (Full text)

) 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 PubMed abstract

532. Speckle Tracking Analysis of Left Ventricular Systolic Function Following Traumatic Brain Injury: A Pilot Prospective Observational Cohort Study. (Abstract)

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

533. Is there an association between female gender and outcome in severe trauma? A multi-center analysis in the Netherlands. (Full text)

(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 PubMed abstract

534. Effect of Dexmedetomidine on Mortality and Ventilator-Free Days in Patients Requiring Mechanical Ventilation With Sepsis: A Randomized Clinical Trial. (Full text)

Effect of Dexmedetomidine on Mortality and Ventilator-Free Days in Patients Requiring Mechanical Ventilation With Sepsis: A Randomized Clinical Trial. Dexmedetomidine provides sedation for patients undergoing ventilation; however, its effects on mortality and ventilator-free days have not been well studied among patients with sepsis.To examine whether a sedation strategy with dexmedetomidine can improve clinical outcomes in patients with sepsis undergoing ventilation.Open-label, multicenter (...) duration). Sequential Organ Failure Assessment score (days 1, 2, 4, 6, 8), sedation control, occurrence of delirium and coma, intensive care unit stay duration, renal function, inflammation, and nutrition state were assessed as secondary outcomes.Of the 203 screened patients, 201 were randomized. The mean age was 69 years (SD, 14 years); 63% were male. Mortality at 28 days was not significantly different in the dexmedetomidine group vs the control group (19 patients [22.8%] vs 28 patients [30.8

2017 JAMA Controlled trial quality: predicted high PubMed abstract

535. A nomogram to predict cognitive impairment after supratentorial spontaneous intracranial hematoma in adult patients: A retrospective cohort study. (Full text)

in this study. They were divided into development (n = 92) and validation (n = 35) dataset according to their admission time. Mini-mental State Examination (MMSE) was conducted between the third and the sixth month after the onset of stroke. MMSE ≤ 24 was considered as cognitive impairment. Univariate and multivariate logistic regression was used to screen for independent risk factors which correlate with cognitive impairment on the development dataset. A nomogram was built based on Akaike Information (...) Criterion (AIC). Receiver operating characteristic (ROC) curve and calibration curve on development and validation dataset was drawn with each area under the curves (AUC) calculated. The decision curve analysis was also conducted with the development dataset.The bleeding volume, Glasgow Coma Scale (GCS), and intraventricular hemorrhage (IVH) are the most significant risk factors which may cause cognitive impairment both in the univariate and multivariate analysis. The finial model performed good

2019 Medicine PubMed abstract

536. Acute diffuse edematous-hemorrhagic Epstein-Barr virus meningoencephalitis: A case report. (Full text)

Acute diffuse edematous-hemorrhagic Epstein-Barr virus meningoencephalitis: A case report. In this study, we presented a rare case of Epstein-Barr virus (EBV) meningoencephalitis presented with meningoencephalitis-like symptoms and diffuse edematous hemorrhage.A 77-year-old male patient was admitted to our hospital with fever, headache, confusion, and unconsciousness for 7 days. Physical examination revealed unconsciousness and stiffness of the neck.The final diagnosis was EBV (...) meningoencephalitis.Ganciclovir (two times 350 mg/day, 21 days), methylprednisolone sodium succinate (120 mg, 5 days), and IV immunoglobulins (IV Ig) (0.4 g/kg, 5 days) were given to this patient.But the patient's clinical symptoms did not improve, and he was still in a coma. His family refused to be further diagnosed and discharged. After discharge for 2 months, the patient was in a coma. Four months later, the patient died of complications of pulmonary infection.The patient is an adult, and imaging was dominated

2019 Medicine PubMed abstract

537. Cerebral autoregulation in hemorrhagic stroke: A systematic review and meta-analysis of transcranial Doppler ultrasonography studies. (Full text)

analysis phase and higher mean flow correlation values: these were associated with worsened clinical parameters including ICH-volume and Glasgow Coma Scale. Meta-analysis of CBV demonstrated that, compared to controls, mean CBV was significantly lower in the ipsilateral (49.7 vs 64.8 cm s-1 , Z = 4.26, P < .0001) and contralateral hemispheres following ICH (51.5 vs 64.8 cm s-1 , Z = 3.44, P = .0006).Lower mean CBV in combination with impaired CA may have implications for more intensive BP lowering (...) and warrants further studies examining such strategies on cerebral blood flow and its regulatory mechanisms.© 2018 Wiley Periodicals, Inc.

2019 Journal of clinical ultrasound : JCU PubMed abstract

538. Treatment of obesity in patients with type 2 diabetes mellitus - Guideline synopsis and supplementary search for and assessment of systematic reviews

and the Cochrane Database of Systematic Reviews (Cochrane Reviews), the Database of Abstracts of Reviews of Effects (Other Reviews) and the Health Technology Assessment Database (Technology Assessments). The literature search covered the period up to 28.09.2011. Systematic reviews published in German, English or French, based on randomized controlled trials (RCTs) with a minimum duration of 24 weeks in adult patients with type 2 diabetes and concurrent obesity, were included. The interventions to be examined (...) : all-cause mortality, cardiac morbidity and mortality, cerebral morbidity and mortality, vascular-related non-cardiac and non-cerebral morbidity and mortality, blindness or its precursor states, end-stage renal failure with the need for dialysis, amputation (major and minor), hyperosmolar or ketoacidotic coma, symptoms caused by chronic hyperglycaemia, hypoglycaemia, especially severe hypoglycaemia, adverse events of the interventions, health-related quality of life and diabetes remission

2012 Institute for Quality and Efficiency in Healthcare (IQWiG)

539. Ryzodeg (insulin degludec (genetical recombination) / insulin aspart (genetical recombination))

should be reported to the Pharmaceutical Affairs Department of the Pharmaceutical Affairs and Food Sanitation Council. The product is not classified as a biological product or a specified biological product and its re- examination period should be until September 27, 2020 so that it is in line with the re-examination period for an approved product containing Insulin Degludec (Genetical Recombination), one of the active ingredients of the product. The drug substance and the drug product are both (...) were mild in severity except for left thigh haematoma (moderate) and a causal relationship to trial product was denied for all events. No hypoglycaemic symptoms or injection site reactions were reported. No deaths, severe adverse events (SAEs), or adverse events (AEs) leading to withdrawal were reported. 22 No clinically significant changes in vital signs, ECG, laboratory parameters, or physical examination were observed. 4.(ii).A.(1).2) IDegAsp multiple-dose trial in Japanese healthy adult

2012 Pharmaceuticals and Medical Devices Agency, Japan

540. Management of perinatal mood disorders

The majority cluster around 10% to 15% with one meta-analysis giving a prevalence of 13%. 23 There is some evidence that, while the overall prevalence of postnatal depression is not significantly different from that of depression at other times, there is an increased risk of depression occurring in the early postnatal period (threefold in the first five postnatal weeks). 22,24 A smaller body of literature has examined the prevalence of antenatal depression, but the findings also suggest little difference (...) history In a UK study examining the influence of family history, women with bipolar disorder who had a family history of postpartum psychosis were at more than a sixfold greater risk of suffering an episode of postpartum psychosis (odds ratio (oR) 6.54, 95% CI 2.55 to 16.76) than parous women with bipolar disorder who had no such family history. 51 In a Danish cohort study of first time mothers with no previous history of mental disorders, family psychopathology was a risk factor for onset

2012 SIGN

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