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561. Contribution LUS in the Diagnosis of Acute Heart Failure (AHF) in Patients Admitted to the ED

for immediate diagnosis, which sometimes compromises outcome. Physical examination, laboratory findings and radiography are imperfect, resulting in a need for sophisticated test results that delay management. Lung ultrasonography is becoming a standard tool in critical cases in the ED. the investigators aim to perform ultrasonography on consecutive patients admitted to the ICU with dyspnea, comparing lung ultrasonography results on initial presentation with the final diagnosis by the ICU team. Three items (...) table for eligibility information Ages Eligible for Study: 18 Years to 90 Years (Adult, Older Adult) Sexes Eligible for Study: All Sampling Method: Non-Probability Sample Study Population all patients admitted to the ED with acute dyspnea, with the final diagnosis of heart failure by the ICU team Criteria Inclusion Criteria: non traumatic dyspnea with the final diagnosis of heart failure Exclusion Criteria: coma, shock,Mechanical Ventilation, vasopressor drugs arrhythmia serious and sustained, non

2018 Clinical Trials

562. Plasma Ropivacaine Concentrations After Sciatic Nerve Block in Patients With Chronic Kidney Disease

: Not yet recruiting First Posted : September 12, 2018 Last Update Posted : February 21, 2019 See Sponsor: Seoul National University Hospital Information provided by (Responsible Party): Jin-Tae Kim, Seoul National University Hospital Study Details Study Description Go to Brief Summary: This prospective observational study aimed to examine the pharmacokinetics of ropivacaine in patients with chronic kidney disease after sciatic nerve block. Sciatic nerve block for foot and ankle surgery (...) numeric rating scale ranging from '0' representing one extreme (e.g. "extremely dissatisfied") to '10' representing the other extreme (e.g. "extremely satisfied") Local anesthetic systemic toxicity [ Time Frame: 2, 6, 24 hours after sciatic nerve block ] numbness of the tongue, twitching, convulsion, dysarrhythmia, coma Biospecimen Retention: Samples Without DNA Arterial blood sampling will be taken at 2.5, 5, 15, 30, 60 minutes and 2, 6, 24 hours after sciatic nerve block. Eligibility Criteria Go

2018 Clinical Trials

563. Clinical and Neurobiological Profile Predictive of Pejorative Outcome of Depression

in the same order (for the verbal span location) or in reverse order (for the verbal span) reverse). The examiner notes the maximum size of the correctly recalled series of digits for both types of empan; Mattis Scale [ Time Frame: at 6, 12, 24, 36 months ] Mattis scale: evaluation of cognitive functions. This scale evaluates, from several simple neuropsychological tests, the attention, the initiation, the visuo-constructive capacities, the conceptualization, the temporo-spatial orientation, the mnemic (...) of executive functions. This test assesses mental flexibility and visual exploration capabilities. It is divided into two parts. In Part A, the patient must link the figures in ascending order as quickly as possible. In Part B, the patient must link the numbers and letters in ascending order by following an alternating rule. The time (in seconds) put by the participant to take part A and B and the number of errors will be recorded. For Part B, the examiner also records the number of perseveration errors

2018 Clinical Trials

564. Two Bag System for Diabetic Ketoacidosis

Frame: During hospitalization ] Desaturations less than 89% requiring supplemental oxygen Pulmonary edema [ Time Frame: During hospitalization ] Pulmonary edema seen on either chest X-ray or with the change in the lung exam Chest pain with EKG changes [ Time Frame: During hospitalization ] Onset of new chest pain with new EKG changes concerning for ischemia Hyponatremia events [ Time Frame: During hospitalization ] Sodium values less than 135 mmol/L (corrected for glucose) Hypokalemia events [ Time (...) Frame: During hospitalization ] Potassium values less than 3.3 mmol/L ICU length of stay [ Time Frame: During hospitalization ] Total time the patient was admitted in the stepdown unit and/or medical ICU Changes in mental status [ Time Frame: During hospitalization ] Worsening in either CAM-ICU score or Glasgow Coma Scale Total volume of intravenous fluids administered [ Time Frame: During hospitalization ] Total volume of intravenous fluids administered Eligibility Criteria Go to Information from

2018 Clinical Trials

565. Treatment of Insomnia for Adolescents With Mild Traumatic Brain Injury

of this study is to examine the treatment of sleep disturbance using cognitive-behavioural therapy for insomnia (CBT-I) in those adolescents who have a protracted recovery from their mTBI. This represents a novel treatment option for this patient population and is anticipated to improve outcomes and quality of life. Condition or disease Intervention/treatment Phase Mild Traumatic Brain Injury Post-Concussion Syndrome Insomnia Behavioral: Cognitive Behavioural Therapy for Insomnia Not Applicable Study Design (...) -weeks later) ] The PSQI is a widely used brief self-report measure of sleep quality aimed at examining the facets of sleep disturbance. It is composed of 19 items that measure sleep disruptions in the month prior to questionnaire completion. The PSQI contains seven subscales: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medications, and daytime dysfunction, which are combined into a total sleep quality score. The total PSQI raw

2018 Clinical Trials

566. Safety and Effectiveness Evaluation of the ISS System in Treatment of Acute Ischemic Stroke

: BrainsGate Information provided by (Responsible Party): BrainsGate Study Details Study Description Go to Brief Summary: The primary objective of this pilot study is the assessment of the safety of the ISS500 System in patients who have experienced an acute ischemic stroke within the anterior circulation. The secondary objectives of this study are to examine the effectiveness of the ISS500 System implantation in the treatment of acute ischemic stroke. Condition or disease Intervention/treatment Phase (...) infarct (pure motor hemiparesis, ataxic hemiparesis, sensorimotor stroke), unless brain imaging demonstrates a relevant lesion > 1.5 cm in size Not a stroke in the anterior circulation Minor stroke with non-disabling deficit or rapidly improving neurological symptoms with a high probably to Transient Ischemic Attack (TIA) Eligible to or treated with IV or IA t-PA or mechanical thrombolysis Baseline NIHSS >20 or < 7 Neurological deficit that has led to stupor or coma (NIHSS level of consciousness score

2018 Clinical Trials

567. Acute spontaneous intracerebral hemorrhage and traumatic brain injury are the most common causes of critical illness in the ICU and have high early mortality. Full Text available with Trip Pro

to examine critically ill patients (aged over 15 years) in the general ICU in Shuyang County in northern China (1/2014-12/2015). The incidences and causes of critical illnesses and their corresponding early mortality rates in the ICU were determined by an expert panel.During the 2-year study period, 1,211,138 person-years (PY) and 1645 critically ill patients (mean age, 61.8 years) were documented. The median Glasgow Coma Scale (GCS) score was 6 (range, 3-15). The mean acute physiology and chronic health

2018 BMC Neurology

568. Effects of salvianolic acid on cerebral perfusion in patients after acute stroke: A single-center randomized controlled trial Full Text available with Trip Pro

Effects of salvianolic acid on cerebral perfusion in patients after acute stroke: A single-center randomized controlled trial Hypoperfusion following acute stroke is common in the infarct core and periphery tissues. The present study evaluated the efficacy of salvianolic acid (SA) on the cerebral perfusion of patients who had suffered from acute stroke using perfusion-weighted magnetic resonance imaging (PWI) to examine the blood perfusion of the affected brain tissue prior to and following (...) treatment. Patients who were admitted to PLA 153 Central Hospital within 72 h of acute stroke symptom onset and had a Glasgow coma scale ≥5 were randomized into two groups: SA and control groups. Patients in the SA group were administered SA 0.13 g/day for 14 days. PWI was performed for all patients at admission and post-treatment. The National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were applied to assess neurological function at admission and 3 months post treatment

2018 Experimental and therapeutic medicine Controlled trial quality: uncertain

569. Neuregulin-1 attenuates experimental cerebral malaria (ECM) pathogenesis by regulating ErbB4/AKT/STAT3 signaling Full Text available with Trip Pro

Neuregulin-1 attenuates experimental cerebral malaria (ECM) pathogenesis by regulating ErbB4/AKT/STAT3 signaling Human cerebral malaria (HCM) is a severe form of malaria characterized by sequestration of infected erythrocytes (IRBCs) in brain microvessels, increased levels of circulating free heme and pro-inflammatory cytokines and chemokines, brain swelling, vascular dysfunction, coma, and increased mortality. Neuregulin-1β (NRG-1) encoded by the gene NRG1, is a member of a family (...) tissue damage.In the current study, we examined how NRG-1 treatment attenuates pathogenesis and mortality associated with ECM. We examined whether NRG-1 protects against CXCL10- and heme-induced apoptosis using human brain microvascular endothelial (hCMEC/D3) cells and M059K neuroglial cells. hCMEC/D3 cells grown in a monolayer and a co-culture system with 30 μM heme and NRG-1 (100 ng/ml) were used to examine the role of NRG-1 on blood brain barrier (BBB) integrity. Using the in vivo ECM model, we

2018 Journal of neuroinflammation

570. Cerebral Aneurysms in Judicial Precedents Full Text available with Trip Pro

Cerebral Aneurysms in Judicial Precedents From November 30, 2016, the Korean Government carried the revised Medical Dispute Mediation and Arbitration Act into effect. Mediation will start automatically without agreements of the defendant, when the outcome of the patient was death, coma more than a month or severe disability. Cerebral aneurysm has a definite risk of bad outcome, especially in the worst condition. Any surgical intervention to this lesion has its own high risk of complications (...) of the independent medical examination. To avoid medical disputes, shared decision making seems to be useful, especially in cases of high risk condition or procedures.

2018 Journal of Korean Neurosurgical Society

571. Delayed Post-hypoxic Leukoencephalopathy: A Case Series and Review of the Literature Full Text available with Trip Pro

by a recovery phase with subsequent delayed clinical decline. Patient 1 suffered hypoxia from drug-induced respiratory depression and lack of post-operative positive airway pressure (PAP) support. Her neurological exam on follow-up revealed progressive cognitive decline. Magnetic resonance imaging (MRI) brain showed bilateral white matter changes involving the centrum semiovale. Patient 2 developed a generalized tonic-clonic seizure during an endobronchial biopsy procedure and was found to have multiple air (...) emboli on computed tomography (CT) head scan. She was initially in a drug-induced coma for her seizures. Electroencephalography (EEG) on day 14 of admission showed changes consistent with diffuse encephalopathy. MRI brain showed bilateral white matter changes particularly at the watershed zones and in the centrum semiovale. DPHL is a rare and under-recognized clinical entity that requires clinical suspicion and detailed evaluation for diagnosis. Neuroimaging studies can provide prognostic information

2018 Cureus

572. Absence of cognitive symptoms in a 6-year-old male with post-traumatic increased intracranial pressure - A case report Full Text available with Trip Pro

Absence of cognitive symptoms in a 6-year-old male with post-traumatic increased intracranial pressure - A case report Traumatic Brain Injuries (TBIs) can range from mild to severe, and may result in increased intracranial pressure (ICP). Increased ICP causes hallmark physical signs, such as diaphoresis, emesis, fixed pupils, and altered mental status. Monitoring the patient's score on the Glasgow Coma Scale (GCS) and cranial CT scans are routine measures used in clinical practice to monitor (...) the development of a TBI.A 6-year-old male fell off his father's shoulders and subsequently presented to ED for suspected head trauma. He was transferred to our Level 1 Trauma Center after a head CT scan demonstrated a subdural hematoma. His GCS score remained 15. The next day he began to have episodes of apnea and desaturation. Further imaging indicated expansion of the hematoma with a 5mm midline shift. He remained consistently alert and a neurological exam revealed cranial nerves to be grossly intact

2018 Annals of Medicine and Surgery

573. Natural History of Isolated Skull Fractures in Children Full Text available with Trip Pro

for the elevation of the depressed skull fracture. Analyzing the NTDB yielded similar results. In 5,194 children with isolated SFs and a normal neurological examination on presentation, there were no fatalities and 249 (4.8%) required neurosurgical intervention, almost all involving craniotomy/craniectomy and/or elevation of the SF segments. In conclusion, children with non-depressed isolated skull fractures and a normal Glasgow coma scale (GCS) at the time of initial presentation are at extremely low risk (...) Natural History of Isolated Skull Fractures in Children Head injury is the most common cause of neurologic disability and mortality in children. We had hypothesized that in children with isolated skull fractures (SFs) and a normal neurological examination on presentation, the risk of neurosurgical intervention is very low. We retrospectively reviewed the medical records of all children aged six to sixteen years presenting to our Level 1 trauma center with traumatic brain injuries between

2018 Cureus

574. Comatose patient with hypothermia, dyspnea, and general edema in the emergency department: a case report Full Text available with Trip Pro

or examinations. She presented to the emergency department with a 1-month history of progressive dyspnea associated with general weakness. She also showed hypothermia, decreased mental status, and general edema. Echocardiography revealed increased pericardial effusion without tamponade. Laboratory examination suggested myxedema coma and hypothyroidism. She received thyroxine, glucocorticoid supplement, and intensive supportive care, after which she gradually improved and was discharged. This case suggests (...) Comatose patient with hypothermia, dyspnea, and general edema in the emergency department: a case report Patients presenting to the emergency department with hypothermia are rare and often require prompt diagnosis and management. Myxedema coma, which may cause severe hypothermia, is a true endocrine emergency requiring early and appropriate treatment. We report on a 47-year-old woman with a history of hyperthyroidism who underwent thyroidectomy 5 years previously, with no regular medication

2018 The Journal of international medical research

575. A Case of Delayed-Onset Posthypoxic Leukoencephalopathy in a Pediatric Patient Full Text available with Trip Pro

A Case of Delayed-Onset Posthypoxic Leukoencephalopathy in a Pediatric Patient We present a 16-year-old female status post traumatic brain injury from severe motor vehicle crash with prolonged extrication. Initially with a Glasgow Coma Scale of 4 and blood pressure of 80/40, she required emergent intubation. Head computed tomography was notable for skull fracture with hematoma, diffuse axonal injury, and 6-mm midline shift with right uncal herniation. On hospital day 1, she underwent (...) follow commands. Magnetic resonance imaging now demonstrated confluent restricted diffusion consistent with acute changes. Imaging and examination findings were consistent with delayed-onset posthypoxic leukoencephalopathy.

2018 Child Neurology Open

576. Late Recovery from Severe Streptococcus pneumoniae Comatose Meningitis with Concomitant Diffuse Subcortical Cytotoxic Edema and Cortical Hypometabolism Full Text available with Trip Pro

Late Recovery from Severe Streptococcus pneumoniae Comatose Meningitis with Concomitant Diffuse Subcortical Cytotoxic Edema and Cortical Hypometabolism A 75-year-old woman was admitted to ICU with coma following Streptococcus pneumoniae meningitis with bacteremia. Her Glasgow Coma Scale (GCS) score fluctuated around 4 to 6 over the next four weeks. There was no evidence of increased intracranial pressure (ICP). Electroencephalogram (EEG) showed only diffuse aspecific slowing. Impaired cerebral (...) blood flow (CBF) autoregulation was suggested at transcranial Doppler (TCD). Repeated brain magnetic resonance imaging (MRI) examination failed to demonstrate venous thrombosis, arterial ischemic stroke, or brain abscesses but revealed diffuse but reversible cortical cytotoxic edema at diffusion-weighted (DW) sequences. The brain FDG-positron emission tomography (FDG-PET) showed diffuse cortical hypometabolism. The patient unexpectedly experienced a complete neuropsychological recovery the next few

2018 Case reports in neurological medicine

577. Therapeutic hypothermia to reduce intracranial pressure after traumatic brain injury: the Eurotherm3235 RCT. Full Text available with Trip Pro

Therapeutic hypothermia to reduce intracranial pressure after traumatic brain injury: the Eurotherm3235 RCT. Traumatic brain injury (TBI) is a major cause of disability and death in young adults worldwide. It results in around 1 million hospital admissions annually in the European Union (EU), causes a majority of the 50,000 deaths from road traffic accidents and leaves a further ≈10,000 people severely disabled.The Eurotherm3235 Trial was a pragmatic trial examining the effectiveness (...) hypothermia.The primary outcome measure was the GOSE [range 1 (dead) to 8 (upper good recovery)] at 6 months after the injury as assessed by an independent collaborator, blind to the intervention. A priori subgroup analysis tested the relationship between minimisation factors including being aged < 45 years, having a post-resuscitation Glasgow Coma Scale (GCS) motor score of < 2 on admission, having a time from injury of < 12 hours and patient outcome.We enrolled 387 patients from 47 centres in 18 countries

2018 Health technology assessment (Winchester, England) Controlled trial quality: predicted high

578. Association Of Seizure Occurrence With Aneurysm Treatment Modality In Aneurysmal Subarachnoid Hemorrhage Patients Full Text available with Trip Pro

Association Of Seizure Occurrence With Aneurysm Treatment Modality In Aneurysmal Subarachnoid Hemorrhage Patients Data on new-onset seizures after treatment of aneurysmal subarachnoid hemorrhage (aSAH) patients are limited and variable. We examined the association between new-onset seizures after aSAH and aneurysm treatment modality, as well their relationship with initial clinical severity of aSAH and outcomes.This is a retrospective cohort study of all aSAH patients admitted to our (...) institution over a 6-year period. 'Seizures' were defined as any observed clinical seizure or electrographic seizure on continuous electroencephalogram (cEEG) recordings, as determined by the reviewing neurophysiologist. Subgroup analyses were performed in low-grade (Hunt-Hess 1-3) and high-grade (Hunt-Hess 4-5) patients. Outcomes measures were Glasgow Coma Score (GCS) at intensive care unit (ICU) discharge and modified Rankin Scale (mRS) at outpatient follow-up.There were 282 patients with aSAH; 203

2018 Neurocritical care

579. Stroke in-hospital survival and its predictors: the first results from Tabriz Stroke Registry of Iran Full Text available with Trip Pro

and hemorrhagic subtypes were selected based on the registry data and International Classification of Diseases, 10th edition. At admission, details of examination including vital signs, neurologic and systemic examination, Modified Rankin Scale, and Glasgow Coma Scale were recorded. Baseline hematological and biochemical parameter assessments as well as computerized tomographic scanning were conducted. Cox regression was used to investigate and detect potential predictors of in-hospital survival.A total (...) that at least 7 variables could independently predict hospital survival of patients with stroke including age ≥65 years, higher admission modified Rankin Scale score, lower admission Glasgow Coma Scale score, hemorrhagic stroke nature, diabetes, having valvular heart disease, and having aspiration pneumonia.The case-fatality of stroke in the present study setting is high and needs to be appropriately addressed through prevention or management of some of these factors such as diabetes, pneumonia

2018 International journal of general medicine

580. Emergency Department Time Course for Mild Traumatic Brain Injury Workup Full Text available with Trip Pro

Emergency Department Time Course for Mild Traumatic Brain Injury Workup Mild traumatic brain injury (mTBI) is a common cause for visits to the emergency department (ED). The actual time required for an ED workup of a patient with mTBI in the United States is not well known. National emergency medicine organizations have recommended reducing unnecessary testing, including head computed tomography (CT) for these patients.10.To examine this issue, we developed a care map that included each step (...) of evaluation of mTBI (Glasgow Coma Scale Score 13-15) - from initial presentation to the ED to discharge. Time spent at each step was estimated by a panel of United States emergency physicians and nurses. We subsequently validated time estimates using retrospectively collected, real-time data at two EDs. Length of stay (LOS) time differences between admission and discharged patients were calculated for patients being evaluated for mTBI.Evaluation for mTBI was estimated at 401 minutes (6.6 hours) in EDs

2018 Western Journal of Emergency Medicine

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