Pediatric Early Warning Score (PEWS) in predicting prognosis of critical pediatric trauma patients: a retrospective study.

BACKGROUND: This study aimed to compare the predictive value of Pediatric Early Warning Score (PEWS) to Pediatric Risk of Mortality-3 (PRISM-3), Pediatric Trauma Score (PTS), and Pediatric Glasgow Coma Score (pGCS) in determining clinical severity and mortality among critical pediatric trauma patients. METHOD: A total of 122 patients monitored due to trauma in the pediatric intensive care unit between 2020 and 2023 were included in the study. Physical examination findings, vital parameters, laboratory values, and all scoring calculations for patients during emergency room admissions and on the first day of intensive care follow-up were recorded. Comparisons were made between two groups identified as survivors and non-survivors. RESULTS: The study included 85 (69.7%) male and 37 (30.3%) female patients, with an average age of 75 ± 59 months for all patients. Forty-one patients (33.6%) required Invasive Mechanical Ventilation (IMV) and 11 patients (9%) required inotropic therapy. Logistic regression analysis revealed a significant association between mortality and PEWS (p < 0.001), PRISM-3 (p < 0.001), PTS (p < 0.001), and pGCS (p < 0.001). Receiver operating characteristics curve analysis demonstrated that the PEWS score (cutoff > 6.5, AUC = 0.953, 95% CI 0.912-0.994) was highly predictive of mortality, showing similar performance to the PRISM-3 score (cutoff > 21, AUC = 0.999, 95% CI 0.995-1). Additionally, the PEWS score was found to be highly predictive in forecasting the need for IMV and inotropic therapy. CONCLUSION: The Pediatric Early Warning Score serves as a robust determinant of mortality in critical pediatric trauma patients. Simultaneously, it demonstrates strong predictability in anticipating the need for IMV and inotropic therapy.

Performance of the neutrophil-lymphocyte ratio as a predictor of severity and mortality in children and adolescents with traumatic brain injury.

PURPOSE: An inflammatory cascade associated with the systemic neutrophil response can be triggered after traumatic brain injury (TBI), causing neuronal dysfunction, which is considered to be related to the prognosis of the victims. The scope of this research is to identify the performance of the neutrophil-lymphocyte ratio (NLR) as a predictor of prognosis considering TBI severity and death as outcomes in a group of pediatric patients. METHODS: We retrospectively evaluated NLR through a consecutive review of the medical records (cross-sectional study) of children and adolescents aged < 17 years victims of TBI. To determine the highest NLR value identified as a predictor, different cutoff points were tested for each outcome. The cutoff points were defined based on the area under curve (AUC) of the receiver operating characteristic (ROC). RESULTS: Among the 82 children with TBI included in the sample, the performance of AUC-ROC was 0.72 when evaluating NLR as a predictor of TBI severity, with NLR cutoff point of 3, and 0.76 when considering mortality as the outcome, with an increase in the cutoff point to 11. CONCLUSION: NLR can be considered a biomarker of brain injury in children and adolescent victims of TBI. Patients with NLR ≥ 3 had a fivefold higher probability of severe TBI and patients with NLR ≥ 11 experienced a ninefold higher risk of death.

Platelet Bioenergetics and Associations With Delirium and Coma in Patients With Sepsis: A Prospective Cohort Study.

BACKGROUND: Acute brain dysfunction during sepsis, which manifests as delirium or coma, is common and is associated with multiple adverse outcomes, including longer periods of mechanical ventilation, prolonged hospital stays, and increased mortality. Delirium and coma during sepsis may be manifestations of alteration in systemic metabolism. Because access to brain mitochondria is a limiting factor, measurement of peripheral platelet bioenergetics offers a potential opportunity to understand metabolic changes associated with acute brain dysfunction during sepsis. RESEARCH QUESTION: Are altered platelet mitochondrial bioenergetics associated with acute brain dysfunction during sepsis? STUDY DESIGN AND METHODS: We assessed participants with critical illness in the ICU for the presence of delirium or coma via validated assessment measures. Blood samples were collected and processed to isolate and measure platelet mitochondrial oxygen consumption. We used Seahorse extracellular flux to measure directly baseline, proton leak, maximal oxygen consumption rate, and extracellular acidification rate. We calculated adenosine triphosphate-linked, spare respiratory capacity, and nonmitochondrial oxygen consumption rate from the measured values. RESULTS: Maximum oxygen consumption was highest in patients with coma, as was spare respiratory capacity and extracellular acidification rate in unadjusted analysis. After adjusting for age, sedation, modified Sequential Organ Failure Assessment score without the neurologic component, and preexisting cognitive function, increased spare respiratory capacity remained associated with coma. Delirium was not associated with any platelet mitochondrial bioenergetics. INTERPRETATION: In this single-center exploratory prospective cohort study, we found that increased platelet mitochondrial spare respiratory capacity was associated with coma in patients with sepsis. Future studies powered to determine any relationship between delirium and mitochondrial respiration bioenergetics are needed.

Coma Prevalence in Critical Care Units in Chile: Results of a Cross-Sectional Survey on World Coma Day.

BACKGROUND: The purpose of this study was to assess the prevalence of coma among patients in critical care units in Chile. We also aimed to provide insight into the demographic characteristics, etiologies, and complications associated with coma. METHODS: A single day cross-sectional study was conducted through a national survey of public and private hospitals with critical and intensive cardiac care units across Chile. Data were collected using an online questionnaire that contained questions regarding critically ill patients' information, demographic characteristics, etiology and duration of coma, medical complications, and support requirements. RESULTS: A total of 84% of all health facilities answered, accounting for a total of 2,708 patients. The overall coma prevalence was 2.9%. The median age of the comatose patients was 61 years (interquartile range 50-72) and 66.2% were male. The median coma duration was five days (interquartile range 2-9). Cerebral hemorrhage was the most common etiology, followed by severe hypoxic-ischemic encephalopathy, acute ischemic stroke, and traumatic brain injury. A total of 48.1% of coma patients experienced acute and ongoing treatment complications, with pneumonia being the most common complication, and 97.4% required support during comatose management. CONCLUSIONS: This study provides an overview of the prevalence of coma in Chilean critical and cardiac care units. Coma is a common condition. Comatose patients frequently experience medical complications during their hospitalization.

Long-term hospital care needs after Bothrops atrox envenomation with hemorrhagic stroke in the Brazilian Amazon: 'From social to physical death' - A case report.

Hemorrhagic stroke is a severe complication reported in cases of Bothrops atrox snakebite envenomation. We report an unusual case of a patient who evolved with an intracranial hemorrhagic stroke and was in a coma for more than five years in a tertiary hospital located in Manaus, Amazonas. 52-year-old man, carpenter, resident in the rural area of the municipality of Tabatinga, located 1106 km from Manaus, capital of Amazonas, Brazil, victim of an accident involving Bothrops atrox evolution with cardiorespiratory arrest, acute kidney injury and hemorrhagic stroke. After 43 days of hospitalization in the ICU, he was transferred to the ward, without contact with the environment and family, sent for home treatment, however, without acceptance by family members. During a long hospital stay for a period of 6 years, totally dependent on special care, in a flexed position, using a tracheostomy and mechanical ventilation, diagnosed and treated for hospital infections throughout his hospitalization, he died due to bacterial pneumonia. Losses of autonomy can result in an individual being completely disconnected from social life - a "social death before physical death".

Severe osmotic demyelination syndrome with cortical involvement in the context of severe hyponatremia and central diabetes insipidus: an uncommon presentation of an unusual combination.

BACKGROUND: Osmotic demyelination syndrome (ODS) with cerebral cortical involvement is a rare complication of severe hyponatremia correction. Careful management of hyponatremia is crucial, particularly in patients with risk factors, such as alcohol use disorder and diabetes insipidus. CASE: A patient in his 40s with a history of alcohol use disorder and central diabetes insipidus developed ODS after a 24 mEq/L osmolar increase during the treatment of hyponatremia. The patient's condition progressed into locked-in syndrome and then improved to spastic tetraparesis after cortical basal ganglia ODS improved. DISCUSSION: The differential diagnosis of cortical demyelination includes laminar cortical necrosis, being the interpretation of Apparent Diffusion Coefficient (ADC) MRI sequence is a useful tool.This case underscores the need to investigate and improve diagnosis and treatment strategies in patients with ODS. It also emphasises the significance of careful hyponatremia correction and frequent monitoring, particularly in patients with known risk factors for ODS.

Caracterización de las complicaciones intrahospitalarias de los estados hiperglucémicos en pacientes adultos internados en el Hospital Nacional de Itauguá, Paraguay, en 2015-2022

Introducción: las complicaciones más graves de la diabetes mellitus son la cetoacidosis diabética y el estado hiperglucémico hiperosmolar, muchas veces se observan alteraciones clínicas y laboratoriales que abarcan los dos espectros y que denominamos estado mixto, representan cerca del 50% de las hospitalizaciones en el servicio de urgencias en pacientes diabéticos. Objetivo: determinar las complicaciones intrahospitalarias y los desenlaces de los estados hiperglucémicos en pacientes adultos internados en el Hospital Nacional, Itauguá, Paraguay, en el periodo 2015-2022. Metodología: se aplicó un diseño de cohortes retrospectivas. Se seleccionaron pacientes con diagnósticos de diabetes mellitus tipo 1 y tipo 2, mayores de 18 años, de ambos sexos, agrupados en tres cohortes que corresponden a cada una de las descompensaciones agudas de la diabetes mellitus. La muestra estuvo conformada por 180 pacientes distribuidos en tres grupos de cohortes con 60 pacientes cada una. Resultados: 51% correspondió al sexo masculino. Se halló mayor desarrollo de eventos cardiovasculares, infecciones intrahospitalarias, requerimiento de cuidados intensivos y mortalidad en la cohorte con estado hiperosmolar. Conclusión: la cohorte con estado hiperosmolar hiperglucémico se caracterizó por la mayor cantidad de complicaciones.

Introduction: The most serious complications of diabetes mellitus are diabetic ketoacidosis and the hyperosmolar hyperglycemic state. Clinical and laboratory alterations are often observed that cover both spectrums and which we call a mixed state. They represent close to 50% of hospitalizations in the service. of emergencies in diabetic patients. Objective: To determine in-hospital complications and outcomes of hyperglycemic states in adult patients admitted to the Hospital Nacional, Itauguá, Paraguay, in the period 2015-2022. Methodology: A retrospective cohort design was applied. Male and female patients with diagnoses of type 1 and type 2 diabetes mellitus, who were over 18 years of age, were selected and grouped into three cohorts that corresponded to each of the acute decompensations of diabetes mellitus. The sample was made up of 180 patients distributed into three cohort groups with 60 patients each. Results: Fifty one percent were male. A greater development of cardiovascular events, hospital-acquired infections, intensive care requirements and mortality were found in the cohort with hyperosmolar state. Conclusion: the cohort with hyperglycemic hyperosmolar state was characterized by the highest number of complications.

A retrospective study of Cerebrolysin in patients with moderate to severe traumatic brain injury: Cognitive and functional outcomes.

In this retrospective study, we aimed to evaluate the effects of the neurotrophic compound Cerebrolysin on executive, cognitive, and functional performance in patients with traumatic brain injury (TBI) with a highly severe disability level. A total of 44 patients were included in the study, with 33 patients in the control group and 11 patients in the interventional group who received intravenous infusions of 30 mL Cerebrolysin. Both groups received standard rehabilitation therapy following the rehabilitation protocol for patients with TBI at Hospital Clínico Mutual de Seguridad. Functional and cognitive scales were evaluated at baseline, at four months, and at the endpoint of the intervention therapy at seven months (on average). The results revealed a significant improvement in the Cerebrolysin-treated group compared to the control group. Specifically, patients who received Cerebrolysin showed a moderate residual disability and a significant reduction in the need for care. Concerning the promising results and considering the limitations of the retrospective study design, we suggest that randomized controlled studies be initiated to corroborate the positive findings for Cerebrolysin in patients with moderate to severe brain trauma.

Effect of brief exposures of anesthesia on thermotolerance and metabolic rate of the spotted-wing fly, Drosophila suzukii: Differences between sexes?

The spotted-wing fly, Drosophila suzukii, is a world-wide pest insect for which there is increasing interest in its physiological traits including metabolism and thermotolerance. Most studies focus only on survival to different time exposures to extreme temperatures, mainly in female flies. In addition, it has not been tested yet how anesthesia affects these measurements. We analyzed the effects of anesthesia by brief exposures to cold, anoxia by CO2 or N2 on three standard thermotolerance assays, as well as the aerobic metabolic rate in both sexes. For heat tolerance we measured CTmax by thermolimit respirometry, and CTmin and chill-coma recovery time for cold tolerance. Aerobic metabolism was calculated by CO2 production of individual flies in real time by open flow respirometry. Results showed that females have a significantly higher V̇CO2 for inactive (at 25 °C) and maximum metabolic rate than males. This difference is mainly explained by body mass and disappears after mass correction. Males had a more sensitive MR to temperature than females showed by a significantly higher Q10 (2.19 vs. 1.98, for males and females, respectively). We observed a significantly lower CTmin (X2 = 4.27, P = 0.03) in females (3.68 ± 0.38 °C) than males (4.56 ± 0.39 °C), although we did not find significant effects of anesthesia. In contrast, anesthesia significantly modifies CTmax for both sexes (F3,62 = 7.86, P < 0.001) with a decrease of the CTmax in cold-anesthetized flies. Finally, we found a significantly higher CTmax in females (37.87 ± 0.07 °C) than males (37.36 ± 0.09 °C). We conclude that cold anesthesia seems to have detrimental effects on heat tolerance, and females have broader thermotolerance range than males, which could help them to establish in invaded temperate regions with more variable environmental temperatures.

Disfunción hipofisaria post traumatismo encefalocraneano / Pituitary Dysfunction after Brain Injury

Introducción. El hipopituitarismo debe detectarse precozmente en pacientes con traumatismo encéfalo craneano por la alta morbi-mortalidad asociada. Objetivo. Analizar la disfunción hormonal hipofisaria post traumatismo encéfalo craneano y la relación entre su gravedad y las alteraciones hormonales encontradas. Materiales y métodos. Estudio observacional prospectivo, 101 pacientes internados en los servicios de Neurocirugía y Terapia Intensiva del Hospital "Ángel C. Padilla" de San Miguel de Tucumán, Argentina, entre el 1 de mayo y el 30 de junio de 2021. Se registraron datos demográficos, escala de Glasgow, tipo de traumatismo encéfalo craneano, lesiones asociadas, dosajes de hormonas hipotálamo-hipofisarias y natremia en los primeros siete días post traumatismo encéfalo craneano. Resultados. Incluidos 83 hombres y 18 mujeres con predominante afectación entre los 20-29 años (36,6%). El traumatismo encéfalo craneano leve afectó a 7,9%, el traumatismo encéfalo craneano moderado a 59,4% y el traumatismo encéfalo craneano grave a 32,7%. La lesión estructural descripta con mayor frecuencia fue la contusión (43,6%). El 83,2% del total de los pacientes tenían un dosaje de corticotropina normal, mientras que en el 11,9% fue bajo; el 43,5% de los pacientes registraron cortisol alto y en el 10% de los casos fue bajo. La testosterona se vio disminuida en un 42,6% y el resto de las hormonas del eje no tuvieron cambios significativos. La ACTH fue baja en el 11,9% de los traumas graves con una hipernatremia del 22%. Conclusión. Existe relación entre la gravedad del TEC y la disfunción hipofisaria, estando el trauma grave asociado a déficit hormonal de ACTH e hipernatremia(AU)

Background. Hypopituitarism is an event that must be detected early in patients with head injuries, due to the high associated morbidity and mortality. Objectives. To analyze the pituitary dysfunction after a head injury and the correlation between the severity and the hormonal alterations found. Methods. Observational and prospective study. 101 patients hospitalized in the Neurosurgery and Intensive Care Unit of "Ángel C. Padilla" Hospital in San Miguel de Tucumán, Argentina, between May 1 and June 30, 2021. Demographic data, score of Glasgow coma, associated injuries, hypothalamic-pituitary hormone determination and blood sodium levels were recorded in the first 7 days after brain injury. Results. A total of 83 men and 18 women were affected with predominant involvement between 20-29 years (36.6%). Mild head trauma affected 7.9%, moderate 59.4%, and severe 32.7%. The most frequently described structural lesion was contusion (43.6%). 83.2% of all patients had a normal dose of corticotropin, while in 11.9% it was low; High cortisol was recorded in 43.5% of the patients and low in 10% of the cases. Testosterone was reduced by 42.6% and the rest of the pituitary hormones had no significant changes. ACTH was low in 11.9% of severe trauma with hypernatremia in 22%. Conclusion. There is a relationship between the severity of traumatic brain injury and pituitary dysfunction, with major severity of trauma associated to corticotropin deficiency and hypernatremia(AU)

Glasgow coma scale pupil score (GCS-P) and the hospital mortality in severe traumatic brain injury: analysis of 1,066 Brazilian patients / Escala de coma de Glasgow com resposta pupilar (ECC-P) e mortalidade hospitalar em traumatismo cranioencefálico grave: análise de 1.066 pacientes brasileiros

Abstract Background Pupil reactivity and the Glasgow Coma Scale (CCS) score are the most clinically relevant information to predict the survival of traumatic brain injury (TBI) patients. Objective We evaluated the accuracy of the CCS-Pupil score (CCS-P) as a prognostic index to predict hospital mortality in Brazilian patients with severe TBI and compare it with a model combining CCS and pupil response with additional clinical and radiological prognostic factors. Methods Data from 1,066 patients with severe TBI from 5 prospective studies were analyzed. We determined the association between hospital mortality and the combination of CCS, pupil reactivity, age, glucose levels, cranial computed tomography (CT), or the CCS-P score by multivariate binary logistic regression. Results Eighty-five percent (n = 908) of patients were men. The mean age was 35 years old, and the overall hospital mortality was 32.8%. The area under the receiver operating characteristic curve (AUROC) was 0.73 (0.70-0.77) for the model using the CCS-P score and 0.80 (0.77-0.83) for the model including clinical and radiological variables. The CCS-P score showed similar accuracy in predicting the mortality reported for the patients with severe TBI derived from the International Mission for Prognosis and Clinical Trials in TBI (IMPACT) and the Corticosteroid Randomization After Significant Head Injury (CRASH) studies. Conclusion Our results support the external validation of the CCS-P to predict hospital mortality following a severe TBI. The predictive value of the CCS-P for long-term mortality, functional, and neuropsychiatric outcomes in Brazilian patients with mild, moderate, and severe TBI deserves further investigation.

Resumo Antecedentes A reatividade pupilar e o escore da Escala de Coma de Glasgow (ECC) representam as informações clínicas mais relevantes para predizer a sobrevivência de pacientes com traumatismo cranioencefálico (TCE). Objetivo Avaliar a acurácia da ECC com resposta pupilar (ECC-P) como índice prognóstico para predizer mortalidade hospitalar em pacientes brasileiros acometidos por TCE grave e compará-lo com um modelo combinando ECC e resposta pupilar com fatores prognósticos radiológicos. Métodos Foram analisados dados de 1.066 pacientes com TCE grave de 5 estudos prospectivos. Foi determinada a associação entre mortalidade hospitalar e a combinação de ECC, reatividade pupilar, idade, níveis glicêmicos, tomografia computadorizada (TC) de crânio ou o escore ECC-P por regressão logística binária multivariada. Resultados Oitenta e cinco por cento (n = 908) dos pacientes eram homens. A média de idade foi de 35 anos e a mortalidade hospitalar geral foi de 32,8%. A AUROC (em português, Curva Característica de Operação do Receptor) foi de 0,73 (0,70-0,77) para o modelo utilizando o escore ECC-P e de 0,80 (0,77-0,83) para o modelo incluindo variáveis clínicas e radiológicas. O escore ECC-P mostrou acurácia semelhante na previsão da mortalidade relatada para pacientes com TCE grave derivados dos estudos International Mission for Prognosis and Clinical Trials in TBI (IMPACT, na sigla em inglês) e Corticosteroid Randomization After Significant Head Injury (CRASH, na sigla em inglês). Conclusão Nossos resultados apoiam a validação externa da ECC-P para prever a mortalidade hospitalar após um TCE grave. O valor preditivo da ECC-P para mortalidade a longo prazo, resultados funcionais e neuropsiquiátricos em pacientes brasileiros com TCE leve, moderado e grave precisam ser investigados.

Lesión cerebral post paro cardiaco: aspectos médicos, éticos y legales / Brain injury after cardiac arrest: Medical, ethical and legal issues disorder

RESUMEN Los sobrevivientes de la reanimación cardiopulmonar posterior a un paro cardiaco pueden tener un amplio rango de desenlaces y van desde recuperación neurológica completa, estado de vigilia sin respuesta, compromiso cognoscitivo diverso o la muerte. La lesión del tejido cerebral se presenta inmediatamente después del paro cardíaco, durante la reanimación y al retornar la circulación espontánea. La severidad y duración de la noxa isquémica determinarán el devenir neurológico. El examen clínico es el punto de partida en el abordaje multimodal del neuropronóstico. Se debe complementar con electroencefalograma, potenciales evocados somatosensoriales, neuroimágenes y biomar-cadores séricos. Entre un 10 a 15% de los pacientes con lesión cerebral posterior al paro cardiaco evolucionan hacia muerte por criterios neurológicos y son potenciales candidatos a la donación de órganos. Un retiro temprano de las terapias de sostenimiento de vida puede malograr la posibilidad de un potencial donante de órganos. Se puede estimar de manera temprana qué pacientes tienen mayor riesgo de evolucionar a muerte por criterios neurológicos. El neurólogo tiene un papel protagónico en el manejo de pacientes con lesión cerebral post paro cardiaco y sus decisiones tienen implicaciones éticas y legales.

ABSTRACT People who survive cardiopulmonary resuscitation (CPR) after cardiac arrest, have a wide range of outcomes including complete neurological recovery, coma, compromised cognitive function and death. Injury of the brain parenchyma starts immediately after a cardiac arrest, during CPR and return of spontaneous circulation. The severity of the ischemic injury will define the neurological outcome. The first step needed to determine a neurological prognosis is the clinical exam, with the help of electroencephalography, somatosensory evoked potentials, neuroimaging, and serum biomarkers. Between 10 and 15% of patients with brain injury after a cardiac arrest, develop brain death and become potential candidates for organ donation. A premature withdrawal of vital support can hamper the possibility of organ donation. The patients with higher risk of developing brain death can be identified early based on neurological criteria. The neurologist has a major role in the approach of patients with brain injury after cardiac arrest and the decision making with legal and ethical consequences.

Propofol versus sodium thiopentone for the treatment of status epilepticus and refractory status epilepticus in dogs.

AIMS: To compare the effect on mortality and length of hospital stay of propofol with that of sodium thiopentone for the management of dogs with status epilepticus (SE) and refractory status epilepticus (RSE). METHODS: In this cohort study, medical records of a veterinary referral clinic in Argentina were retrospectively searched for dogs that were hospitalised and required induction of therapeutic coma (TC) with either propofol or sodium thiopentone for the management of SE or RSE of any cause. A logistic regression model was performed to evaluate the association between the type of anaesthetic used and in-hospital mortality adjusting for the type of epilepsy (idiopathic, structural, or reactive). Kaplan-Meier estimated survival curves for the length of hospital stay by the type of anaesthetic drug were compared using the log-rank test (deaths were considered censored events). Cox proportional hazards regression was used to estimate hazard ratios for time to hospital discharge, unadjusted and adjusted for type of epilepsy. RESULTS: A total of 24 dogs with SE were included in the study: eight treated with propofol and 16 treated with sodium thiopentone. Four dogs treated with propofol (proportion = 0.50; 95% CI = 0.15-0.84), and eight treated with sodium thiopentone (proportion = 0.50; 95% CI = 0.50-0.74) died during hospitalisation. The median hospitalisation time was 43 (IQR 24-56) hours for dogs that were treated with propofol and 72 (IQR 64-96) hours for dogs that were treated with sodium thiopentone. There was no evidence of a difference in the median duration of TC in dogs treated with propofol (12 (IQR 8-24) hours) or with sodium thiopentone (12 (IQR 7.5-20) hours; p = 0.946). In the logistic regression model, no evidence of association between the anaesthetic protocol for the management of RSE and in-hospital mortality, adjusted for the type of epilepsy, was found (OR 1.09 (95% CI = 0.17-6.87); p = 0.925). Cox regression analysis revealed a difference in the time to hospital discharge, adjusted by the type of epilepsy, between treatment groups (HR = 0.05 (95% CI = 0.01-0.54); p = 0.013). CONCLUSIONS AND CLINICAL RELEVANCE: The time spent in hospital before discharge was longer in dogs with RSE treated with sodium thiopentone compared to those treated with propofol. However, as the sample size was very small, the results obtained in the present study should be analysed with caution. Further studies including a greater number of dogs are required.

Redo Total Aortic Arch Replacement in Patients with Aortic Dissection After Open-Heart Surgery and Long-Term Follow-Up Results.

INTRODUCTION: The objectives of this study were to investigate the main treatment strategies and long-term follow-up results of aortic dissection surgery after open-heart surgery (ADSOHS) and to analyze the risk factors that cause ADSOHS. METHODS: One hundred thirty-seven patients with ADSOHS hospitalized in our hospital from January 2009 to December 2018 were selected as the research object. Long-term follow-up results, complications, mortality, and changes of cardiac function before and after operation were used to explore the value of Sun's operation. RESULTS: The length of stay in intensive care unit of these 137 patients ranged from 9.5 to 623.75 hours (average of 76.41±97.29 hours), auxiliary ventilation time ranged from 6.0 to 259.83 hours (average of 46.16±55.59 hours), and hospital stay ranged from six to 85 days (average of 25.06±13.04 days). There were seven cases of postoperative low cardiac output, 18 cases of coma and stroke, and six cases of transient neurological dysfunction. A total of 33 patients died; 19 patients died during the perioperative period, 18 died during Sun's operation and one died during other operation; and 14 patients died during follow-up (January 2021), 12 cases of Sun's operation and two cases of other operations. CONCLUSION: ADSOHS treatment strategy is of high application value, and the risk of neurological complications and mortality is low. The main risk factors are postoperative low cardiac output, coma, stroke, and transient neurological dysfunction. The extracorporeal circulation time is relatively long. Short- and long-term follow-up effects are good, and it is worthy of clinical promotion.

Redo Total Aortic Arch Replacement in Patients with Aortic Dissection After Open-Heart Surgery and Long-Term Follow-Up Results

ABSTRACT Introduction: The objectives of this study were to investigate the main treatment strategies and long-term follow-up results of aortic dissection surgery after open-heart surgery (ADSOHS) and to analyze the risk factors that cause ADSOHS. Methods: One hundred thirty-seven patients with ADSOHS hospitalized in our hospital from January 2009 to December 2018 were selected as the research object. Long-term follow-up results, complications, mortality, and changes of cardiac function before and after operation were used to explore the value of Sun's operation. Results: The length of stay in intensive care unit of these 137 patients ranged from 9.5 to 623.75 hours (average of 76.41±97.29 hours), auxiliary ventilation time ranged from 6.0 to 259.83 hours (average of 46.16±55.59 hours), and hospital stay ranged from six to 85 days (average of 25.06±13.04 days). There were seven cases of postoperative low cardiac output, 18 cases of coma and stroke, and six cases of transient neurological dysfunction. A total of 33 patients died; 19 patients died during the perioperative period, 18 died during Sun's operation and one died during other operation; and 14 patients died during follow-up (January 2021), 12 cases of Sun's operation and two cases of other operations. Conclusion: ADSOHS treatment strategy is of high application value, and the risk of neurological complications and mortality is low. The main risk factors are postoperative low cardiac output, coma, stroke, and transient neurological dysfunction. The extracorporeal circulation time is relatively long. Short- and long-term follow-up effects are good, and it is worthy of clinical promotion.

The new prognostic factor in pre-intubation follow-up of critically ill patients: integrated pulmonary index monitoring

SUMMARY OBJECTIVE: The objective of this study was to identify the integrated pulmonary index in the follow-up of non-intubated critically ill patients in the emergency department and its efficacy in deciding on advanced airway application in comparison with the Glasgow Coma Scale. METHODS: This is a prospective, single-center, methodological study. In our study, we recorded the demographic characteristics, Glasgow Coma Scale, and the integrated pulmonary index of 90 patients with respiratory failure who were followed up in the emergency department between June 1, 2019 and September 1, 2019, and we compared the results of Glasgow Coma Scale and integrated pulmonary index in making the endotracheal intubation decision. RESULTS: Endotracheal intubation was applied to 30% of the 90 patients included in the study. The area under the curve was calculated as 0.906 for integrated pulmonary index and 0.860 for Glasgow Coma Scale in predicting endotracheal intubation. There was no significant difference between the area under the curves of integrated pulmonary index and Glasgow Coma Scale. According to the best cutoff values determined in the estimation of endotracheal intubation, sensitivity was 74.07% and specificity was 95.24% for integrated pulmonary index, and sensitivity was 74.07% and specificity was 85.71% for Glasgow Coma Scale. CONCLUSION: The integrated pulmonary index monitoring provides an objective evaluation in the follow-up of critically ill patients with spontaneous breathing in the emergency department and is predictive in deciding on timely endotracheal intubation.

Análise do conhecimento da escala de coma de glasgow em acadêmicos de enfermagem cursando o último e penúltimo semestres / Analysis of knowledge of the glasgowcoma scale in nursing students in their last and penultimate semesters / Análisis del conocimiento de la Escala de Coma de Glasgow en estudiantes de enfermería del último y penúltimo semestre

Objetivo: analisar o conhecimento da Escala de Coma de Glasgow em acadêmicos de enfermagem cursando o último e penúltimo semestres do Centro Universitário Planalto do Distrito Federal Campus Águas Claras.Método: Este estudo utilizou-se abordagem quantitativa com o método descritivo, utilizando para coleta de dados um questionário com seis questões objetivas.Resultado: A pesquisa realizada com uma amostra de 20 acadêmicos de enfermagem, evidenciou que 80% demonstraram saber o que é avaliado na escala, porém constatou-se que apenas 20% entendem como utilizar de forma correta a escala de coma de Glasgow.Conclusão: a maioria dos acadêmicospossui conhecimento teórico sobre a Escala de Coma de Glasgow, entretanto possuem déficit na aplicação da escala

Objective:to analyze the knowledge of the Glasgow Coma Scale in nursing students in the last and penultimate semesters of Centro Universitário Planalto do Distrito Federal Campus Águas Claras. Method:This study used a quantitative approach with the descriptive method, using a questionnaire with six objective questions for data collection. Results:The research carried out with a sample of 20 nursing students showed that 80% demonstrated that they know what is evaluated on the scale, but it was found that only 20% understand how to correctly use the Glasgow Coma Scale. Conclusion:most students have theoretical knowledge about the Glasgow Coma Scale, but they have deficits in the application of the scale.

Objetivo:Analizar el conocimiento de la Escala de Coma de Glasgow en estudiantes de enfermería que cursan el último y penúltimo semestre del Centro Universitario Planalto del Distrito Federal Campus Águas Claras. Método:Este estudio utilizó un enfoque cuantitativo con el método descriptivo, utilizando un cuestionario con seis preguntas objetivas para la recolección de datos. Resultados:La investigación realizada con una muestra de 20 estudiantes de enfermería mostró que el 80% demostró saber lo que se evalúa en la escala, pero se encontró que solo el 20% entiende cómo utilizar correctamente la Escala de Coma de Glasgow. Conclusión:la mayoría de los estudiantes tienen conocimientos teóricos sobre la Escala de Coma de Glasgow, pero tienen déficits en la aplicación de la escala.

Myxedema heart disease and non-comatose presentation of myxedema: A case report.

Myxedema coma is an emergency that develops from non-diagnosed or severe hypothyroidism and requires early recognition and management. Cardiac manifestations are uncommon and pose a challenge in the recognition of myxedema coma. We present the case of a 76-year-old male with a history of thyroidectomy secondary to a follicular carcinoma, who presented with dyspnea, generalized edema, drowsiness, disorientation, memory loss, and episodic generalized tonic-clonic seizures. Antiepileptic and diuretic treatment for seizures and heart failure exacerbation did not improve the symptoms. Further blood analysis revealed a thyroid-stimulating hormone and free thyroxine of 163 mUL/L and 0.64 ng/dL, respectively. Treatment with intravenous hydrocortisone and levothyroxine led to progressive clinical improvement. Uncommon clinical manifestations such as cardiac and non-specific neurologic symptoms should be considered as manifestations of myxedema coma. A comatose mental status is not a universal manifestation, and milder symptoms should be considered. An adequate assessment, including diagnostic scores and prompt hormonal supplementation prevents fatal consequences.

Suicide Attempts Assisted By Firefighters According to Traumatic Brain Injury.

Studies worldwide have reported increasing trends in suicides and attempts during the pandemic. The literature shows that improving surveillance and monitoring of suicide and attempts requires broad multisectoral prevention strategies. In Brazil, the São Paulo State Fire Department (CBPMESP) makes up the emergency response team for suicide and suicide attempted calls and public emergencies. Given this context, this paper sought to describe the characteristics of suicide attempts assisted by the CBPMESP according to traumatic brain injury (TBI), between 2018 and 2020, measured by the Glasgow Coma Scale (GCS). For this purpose, a descriptive study of 6,582 suicide attempts attended by CBPMESP was carried out. The factors associated with trauma brain injury according to the Glasgow Coma Scale (dependent variable) were analyzed by a multinomial regression model. Results show a significant increase of 8.0% (p = 0.039) in the number of calls responded by CBPMESP between 2018 and 2020. Men presented a higher prevalence of more violent methods for suicide attempts, namely firearms and hanging, followed by severe TBI; in women, severe TBI occurred mostly by hanging. Despite the increase in fatal suicide attempts during the pandemic, time to attend to victim acted as a protective factor for preventing severe TBI in men and women.

Coma mixedematoso asociado a infección por SARS-CoV-2 / Myxedema coma associated with SARS-CoV-2 infection / Coma mixedematoso associado à infecção por SARS-CoV-2

Resumen: Aunque se sabe que la infección por SARS-CoV-2 es una causa importante de enfermedad pulmonar, se han observado múltiples manifestaciones extrapulmonares asociadas a COVID-19. Existen en la literatura reportes de tirotoxicosis secundarios a COVID-19, pero los casos de hipotiroidismo descompensado por COVID-19 son escasos. Reportamos el caso de una paciente de 37 años con obesidad que presentó coma mixedematoso asociado a infección por SARS-CoV-2. El estado proinflamatorio secundario a obesidad, el daño directo a la glándula tiroidea por SARS-CoV-2 y la elevación de mediadores inflamatorios en sangre observados durante la infección viral podrían ser mecanismos que desencadenen el coma mixedematoso. En pacientes con COVID-19 severo es importante la búsqueda intencionada de signos de coma mixedematoso y su confirmación con un perfil tiroideo al ingreso hospitalario.

Abstract: Although SARS-CoV-2 infection is known to be an important cause of lung disease, multiple extrapulmonary manifestations associated with COVID-19 have been observed. There are reports of thyrotoxicosis secondary to COVID-19 in the literature, but cases of decompensated hypothyroidism due to COVID-19 are rare. We report the case of a 37-year-old female patient with obesity who presented myxedema coma associated with SARS-CoV-2 infection. The pro-inflammatory state secondary to obesity, direct damage to the thyroid gland by SARS-CoV-2, and the elevation of inflammatory mediators in the blood observed during viral infection could be mechanisms that trigger myxedema coma. In patients with severe COVID-19, the intentional search for signs of myxedema coma and its confirmation with a thyroid profile at hospital admission is important.

Resumo: Embora a infecção por SARS-CoV-2 seja conhecida por ser uma causa importante de doença pulmonar, foram observadas várias manifestações extrapulmonares associadas ao COVID-19. Há relatos na literatura de tireotoxicose secundária à COVID-19, mas os casos de hipotireoidismo descompensado por COVID-19 são raros. Relatamos o caso de um paciente de 37 anos com obesidade que apresentou coma mixedematoso associado à infecção por SARS-CoV-2. O estado pró-inflamatório secundário à obesidade, o dano direto à glândula tireoide pelo SARS-CoV-2 e a elevação de mediadores inflamatórios no sangue observados durante a infecção viral podem ser mecanismos que desencadeiam o coma mixedematoso. Em pacientes com COVID-19 grave, é importante a busca intencional de sinais de coma mixedematoso e sua confirmação com perfil tireoidiano na admissão hospitalar.