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Coma Exam

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581. Correlates of patterns of health values of African Americans living with HIV/AIDS: Implications for advance care planning and HIV palliative care. Full Text available with Trip Pro

Americans living with HIV/AIDS and to examine correlates of these values.Data were from the first 325 participants in the AFFIRM Care study, which enrolled adults living with HIV/AIDS in Baltimore, Maryland, who had histories of illicit drug use. Respondents were asked whether (yes/no) they thought any of six health states would be worse than death: severe unremitting pain, total dependency on others, irreversible coma, being on mechanical ventilation, nursing home residence, and severe dementia. Latent (...) class analysis was used to group individuals by their pattern of responses, interpretable as preference for aggressive (life-sustaining) or nonaggressive (palliative) end-of-life care. Latent class regression analysis was used to examine associations between class membership and background, health status, and social variables.We found statistical support for a three-class latent class analysis model: 1) the nonaggressive treatment class, comprising 43% of cases, in which members perceived that every

2018 Journal of pain and symptom management

582. Association of Early Myocardial Workload and Mortality Following Severe Traumatic Brain Injury. Full Text available with Trip Pro

Association of Early Myocardial Workload and Mortality Following Severe Traumatic Brain Injury. To examine the impact of early myocardial workload on in-hospital mortality following isolated severe traumatic brain injury.Retrospective cohort study.Data from the National Trauma Databank, a multicenter trauma registry operated by the American College of Surgeons, from 2007 to 2014.Adult patients with isolated severe traumatic brain injury (defined as admission Glasgow Coma Scale < 8 and head

2018 Critical Care Medicine

583. Clinical Outcomes of SMILE With a Triple Centration Technique and Corneal Wavefront-Guided Transepithelial PRK in High Astigmatism. Full Text available with Trip Pro

patients) that received treatment for myopia with high astigmatism (≥ 2.50 diopters) using SMILE with a triple centration technique (SMILE group; 45 eyes) and corneal wavefront-guided transepithelial PRK (transepithelial PRK group; 44 eyes). Visual acuity measurement, manifest refraction, slit-lamp examination, autokeratometry, corneal topography, and evaluation of corneal wavefront aberration were performed preoperatively and at 1, 3, and 6 months after surgery. The safety, efficacy, vector parameters (...) , respectively). Whereas the transepithelial PRK group exhibited increased corneal spherical aberration and significantly reduced corneal coma and trefoil, no changes in aberrometric values were noted in the SMILE group.Both SMILE with a triple centration technique and corneal wavefront-guided transepithelial PRK are effective and provide predictable outcomes for the correction of high myopic astigmatism, although slight undercorrection was observed in the SMILE group. The triple centration technique

2018 Journal of Refractive Surgery

584. Characterization of EEG signals revealing covert cognition in the injured brain. Full Text available with Trip Pro

suppression of either 8-12 Hz 'alpha' or 13-40 Hz 'beta' power during task performance, or both. Nine of the 21 patients with EEG evidence of command-following also demonstrated functional MRI evidence of command-following. Nine of the patients with command-following capacity demonstrated by EEG showed no behavioural evidence of a communication channel as detected by a standardized behavioural assessment, the Coma Recovery Scale - Revised. We further examined the potential contributions of fluctuations (...) motor dissociation after severe brain injury is prominently marked by concomitant injuries across the cerebrum in addition to limited or no motoric function. In the present study, we sought to characterize the EEG signals used as indicators of cognition in patients with disorders of consciousness and examine their reliability for potential future use to re-establish communication. We compared EEG-based assessments to the results of using similar methods with functional MRI. Using power spectral

2018 Brain

585. Alpha lipoic acid intoxicatıon: An adult case report and lıterature revıew. (Abstract)

of 18g of ALA with a suicidal intention. The patient was found in an altered mental state and confused. During the physical examination, the patient's Glasgow Coma Scale was 13 (E4M6V3); however, she was neither alert nor oriented. Vital signs revealed a mildly decreased blood pressure, tachycardia, and an increased respiratory rate. Cranial nerve examination was normal except a horizontal gaze nystagmus. Laboratory testing showed a decompensated metabolic acidosis. T wave inversions were seen

2018 American Journal of Emergency Medicine

586. Sciatic neuropathy caused by a pressure ulcer: A case report. Full Text available with Trip Pro

Sciatic neuropathy caused by a pressure ulcer: A case report. Sciatic neuropathy has various causes; however, cases in which a pressure ulcer led to sciatic neuropathy have not been reported to date.A 33-year-old woman with no pre-existing mobility problems visited our department with the chief complaint of an extensive pressure ulcer and necrosis in her right buttock. She had a medical history of being bedridden for 2 days while in a coma due to a drug overdose 2 months previously. Physical (...) examination revealed loss of sensation and foot drop in the right foot.Physical examination, magnetic resonance imaging, and nerve conduction studies were conducted; the patient was diagnosed with a common peroneal branch injury of the right sciatic nerve.The necrotic tissue was debrided and sciatic nerve decompression was performed, followed by frequent dressing changes. In addition, psychiatric treatment and physical therapy were performed simultaneously.The pressure ulcer decreased in size and healed

2018 Medicine

587. 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

588. The role of core and accessory type IV pilus genes in natural transformation and twitching motility in the bacterium Acinetobacter baylyi. Full Text available with Trip Pro

The role of core and accessory type IV pilus genes in natural transformation and twitching motility in the bacterium Acinetobacter baylyi. Here we present an examination of type IV pilus genes associated with competence and twitching in the bacterium Acinetobacter baylyi (strain ADP1, BD413). We used bioinformatics to identify potential competence and twitching genes and their operons. We measured the competence and twitching phenotypes of the bioinformatically-identified genes. These results (...) and twitching are instead found to specialize in either of the two traits. The pilins are varied in their specialization with some required for either competence (FimT) and others for twitching (ComE). The protein that transports DNA across the inner membrane (ComA) specializes in competence, while signal transduction proteins (PilG, PilS, and PilR) specialize in twitching. Taken together our results suggest that the function of accessory proteins should not be based on homology alone. In addition

2017 PLoS ONE

589. Clinical Value of Dorsal Medulla Oblongata Involvement Detected with Conventional MRI for Prediction of Outcome in Children with Enterovirus 71-related Brainstem Encephalitis. (Abstract)

in children with enterovirus 71-related brainstem encephalitis (EBE) by using conventional magnetic resonance imaging (MRI) and to evaluate the value of dorsal medulla oblongata involvement in outcome prediction.Forty-six children with EBE were enrolled in the study. All subjects underwent a 1.5 Tesla MRI examination of the brain. The disease distribution and clinical data were collected. Dichotomized outcomes (good vs. poor) at longer than 6 months were available for 28 patients. Logistic regression (...) outcome group. Logistic regression analysis showed that dorsal medulla oblongata involvement was the most significant single variable in outcome prediction (predictive accuracy, 90.5%), followed by multiple area involvement, age and initial Glasgow Coma Scale score.Dorsal medulla oblongata involvement on conventional MRI correlated significantly with poor outcomes in EBE children, improved outcome prediction when compared with other clinical and disease location variables, and was most predictive when

2018 Pediatric Infectious Dsease Journal

590. Costal Margin Tenderness and the Risk for Intra-abdominal Injuries in Children with Blunt Abdominal Trauma. Full Text available with Trip Pro

Costal Margin Tenderness and the Risk for Intra-abdominal Injuries in Children with Blunt Abdominal Trauma. The risk of radiation exposure from computed tomography (CT) imaging in children is well recognized. Patient history and physical examination findings, including costal margin tenderness (CMT), influence a physician's decision to image a child with blunt torso trauma. The objective of this study was to determine the importance of CMT for identifying children with intraabdominal injuries (...) adjusted odds of IAI in children presenting with isolated and nonisolated CMT. Risk differences were calculated to estimate the risk of IAI independently attributable to CMT in the setting of isolated PECARN risk factors. Finally, CT use among exposure groups was estimated to quantify potentially avoidable imaging.Among 9,174 children with Glasgow Coma Scale scores of 14 or 15 who sustained blunt torso trauma, 1,267 (13.8%) had CMT. Among those with CMT, 177 (14.0%) had isolated CMT and 1,090 (86.0

2018 Academic Emergency Medicine

591. Diabetes Care and Dementia Among Older Adults: A Nationwide 3-Year Longitudinal Study. (Abstract)

, hospitalization for dementia, or antidementia drug delivery. They were matched (1:1) to a pair free of ADRS on age, sex, residence area, and insurance scheme. This study included France-Démence population with known diabetes for at least 2 years.Data related to diabetes control and complications: biological monitoring such as glycated hemoglobin A1c (HbA1c, ≥1/y, ≥2/y), lipid profile, microalbuminuria; eye examination; hospitalization for diabetes-related complications such as coma with ketoacidosis (...)  = 0.94, 95% confidence interval (CI) 0.93-0.95], 73.4% and 89.0% during Y0 (SIR = 0.83, 95% CI 0.82-0.84), and 75.4% and 89.3% during Y1 (SIR = 0.85, 95% CI 0.83‒0.86). Subjects with ADRS were also consistently more hospitalized than non-ADRS peers. The gap was maximal in the year following the diagnosis, as observed for hospitalizations for any cause related to diabetes (SIR Y-1: 2.04, Y0: 3.14, Y1: 1.67), diabetes mellitus with coma (SIR Y-1: 3.84, Y0: 9.30, Y1: 3.06), and hypoglycemia (SIR Y-1

2018 Journal of the American Medical Directors Association

592. Investigation of Public Perception of Brain Death Using the Internet. Full Text available with Trip Pro

information available to the public about brain death. The top 10 Google websites were analyzed for language complexity and accuracy in describing brain death. The top 10 YouTube videos were examined for content and the comments qualitatively analyzed for themes.Inaccuracies describing brain death inconsistent with national guidelines were prevalent amongst 4 of 10 Google websites, 6 of 10 YouTube videos, and 80% of YouTube comments. On average, Google websites were written at a 12th grade level and 90 (...) % mentioned organ donation. Videos were frequently emotional (78%); 33% included negative comments toward physicians, of which 50% mentioned organ donation. All videos included clarification comments questioning the differences between brain death, death, coma, and persistent vegetative states.The study revealed a significant amount of inaccurate information about brain death, affecting the public's understanding of the concept of brain death and resulting in negative emotions specifically toward

2018 Chest

593. Clinical Epidemiology of Adults With Moderate Traumatic Brain Injury. Full Text available with Trip Pro

, hospital course, and facility characteristics were examined. Admission characteristics associated with discharge outcomes were analyzed using multivariable Poisson regression models. Of 114,066 patients, most were white (62%), male (69%), and had median admission Glasgow Coma Scale score of 12 (interquartile range, 10-13). Seventy-seven percent had isolated traumatic brain injury. Concussion, which accounted for 25% of moderate traumatic brain injury, was the most frequent traumatic brain injury (...) Clinical Epidemiology of Adults With Moderate Traumatic Brain Injury. To characterize admission patterns, treatments, and outcomes among patients with moderate traumatic brain injury.Retrospective cohort study.National Trauma Data Bank.Adults (age > 18 yr) with moderate traumatic brain injury (International Classification of Diseases, Ninth revision codes and admission Glasgow Coma Scale score of 9-13) in the National Trauma Data Bank between 2007 and 2014.None.Demographics, mechanism of injury

2018 Critical Care Medicine

594. Case 252: Acute Hyperammonemic Encephalopathy Resulting from Late-Onset Ornithine Transcarbamylase Deficiency. Full Text available with Trip Pro

mother and described increasing confusion. Glasgow coma scale score on arrival in the emergency department was 4. Intravenous naloxone was administered, without immediate response. Initial blood glucose level was 232 mg/dL (12.8 mmol/L) (normal range, 79-140 mg/dL [4.4- 7.7 mmol/L]), and other routine laboratory test results were normal. Urine toxicology results were negative. Cerebrospinal fluid evaluation revealed levels were within normal limits. Neurologic examination revealed dilated pupils

2018 Radiology

595. Pathologic and molecular studies of enterovirus 71 infection in a fatal case from a recent epidemic in China: A case report. Full Text available with Trip Pro

for 3 days and intermittent seizures for 2 hours associated with rash on 4 limbs was brought to a hospital.The autopsy was performed to identify the cause of death for a medical dispute. The results of histologic examination, immunohistochemistry (IHC), nested reverse transcription polymerase chain reaction (RT-PCR), and viral isolation confirmed that this patient died of EV71 infection.The patient was transferred to neonatal intensive care unit and was intubated and mechanically ventilated (...) . The other treatment included cardiopulmonary resuscitation and intravenous injection of adrenaline.The patient presented persistent coma and intermittent seizures and suddenly developed respiratory arrest and died 16 hours after admission.Our results suggest that EV71 might invade into the central nervous system (CNS) through peripheral nerves which control the digestive tract in the early stage of infection. In addition, we successfully isolated one EV71 strain. Phylogenetic analysis showed

2018 Medicine

596. Traumatismo craneoencefálico leve Full Text available with Trip Pro

correlated well with final outcomes. We investigated indications for skull radiography and computed tomography (CT), as well as for hospital admission for clinical observation.In this study, the presence of a neurological focus on clinical examination, the existence of a fracture on plain radiographs, advanced age and the presence of a coagulation disorder were associated with the increased likelihood of intracranial complications and a poor prognosis. The Glasgow Coma Scale was deficient predicting (...) Traumatismo craneoencefálico leve Mild traumatic brain injury (TBI) represents a major health concern, because a sizeable number of patients with mild TBI will develop potentially life-threatening complications. The target of this study was to describe a large series of adult patients suffering from mild TBI, treated at University Hospital of Getafe, between 2010 and 2015 (n = 2480). We examined the patients' epidemiological and baseline clinical profile, diagnosis, treatment and ultimate

2018 Surgical neurology international

597. The Anticipated Organ Donation Approach

or Female over 18 years-old patients with serious brain damages medical decision of withdrawing life sustaining treatment Signed and dated informed consent by trusted person, or family Patient covered by social security regimen Glasgow Coma Scale (GCS) : Patient with serious brain-injured without confounding factors, without head trauma or brain anoxia : GCS<5 and loss of the corneal reflex or GCS<5 and loss of the brainstem reflex Patient with serious brain-injured with confounding factors, without (...) head trauma and brain anoxia : GCS<7 with a least one scanographic sign of gravity Deletion of the subarachnoid cisterns Deviation of the median line of more than 15 mm Hematoma volume < 65 cm3 Secondary hydrocephalus to an intra-ventricular bleeding with V3 or V4 flood. o Patient with head trauma or brain anoxia (no confounding factor) with reliable clinical examination required : GCS<5 and loss of the corneal reflex or GCS<5 and loss of the brainstem reflex Exclusion Criteria: No trusted person

2018 Clinical Trials

598. Study of Probable Benefit of the Neuro-Spinal Scaffoldâ„¢ in Subjects With Complete Thoracic AIS A Spinal Cord Injury as Compared to Standard of Care

arm.The ISNCSCI exam performed within 8 hours prior to surgery (pre-surgery ISNCSCI) will be used as the baseline. Change in sensory scores [ Time Frame: 3-months, 6-months, 12-months, 24-months post-open spine surgery ] A numerical summary score of sensory function in each determined by the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination. This score can reflect the degree of neurological impairment associated with the SCI, with lower score (...) that these preexisting morbidities will increase risk, affect safety monitoring, or confound study results Spinal cord injury associated with significant traumatic brain injury or coma that, in the opinion of the Investigator, would preclude adequate assessment of spinal cord function, brain injury that could be associated on its own with sensory or motor deficits, or subjects with any other reason that results in an unreliable ISNCSCI exam Subjects with clinically significant pre-existing respiratory disease

2018 Clinical Trials

599. Behaviors indicative of pain in brain-injured adult patients with different levels of consciousness in the intensive care unit. Full Text available with Trip Pro

procedures in the ICU and to examine interrater agreement of individual behaviors as well as discriminative and criterion validation of putative pain behaviors.Brain-injured ICU patients were observed using a 40-item behavioral checklist before and during soft touch (i.e., nonnociceptive procedure), turning, and other care procedures (nociceptive) by pairs of trained raters. When possible, patients self-reported their pain on a 0-10 visual thermometer. Patients were classified into unconscious (Glasgow (...) Coma Scale, 3

2018 Journal of pain and symptom management

600. Prevalence, Evolution, and Extent of Impaired Cerebral Autoregulation in Children Hospitalized With Complex Mild Traumatic Brain Injury. (Abstract)

Prevalence, Evolution, and Extent of Impaired Cerebral Autoregulation in Children Hospitalized With Complex Mild Traumatic Brain Injury. To examine cerebral autoregulation in children with complex mild traumatic brain injury.Prospective observational convenience sample.PICU at a level I trauma center.Children with complex mild traumatic brain injury (trauma, admission Glasgow Coma Scale score 13-15 with either abnormal head CT, or history of loss of consciousness).Cerebral autoregulation (...) was tested using transcranial Doppler ultrasound between admission day 1 and 8.The primary outcome was prevalence of impaired cerebral autoregulation (autoregulation index < 0.4),determined using transcranial Doppler ultrasonography and tilt testing. Secondary outcomes examined factors associated with and evolution and extent of impairment. Cerebral autoregulation testing occurred in 31 children 10 years (SD, 5.2 yr), mostly male (59%) with isolated traumatic brain injury (91%), median admission Glasgow

2018 Pediatric Critical Care Medicine

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