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2.
Gan To Kagaku Ryoho ; 46(10): 1632-1634, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31631158

RESUMO

We report a case of altered consciousness related to hyperammonemia due to FOLFIRI plus bevacizumab therapy in a patient with recurrent colorectal cancer and renal dysfunction.A 76-year-old man received third-line chemotherapy for left mediastinal lymph node metastasis.He complained of diarrhea on the evening of the same day, and mental confusion on day 3 of the first FOLFIRI therapy.He had a JCS of Ⅲ(200).The laboratory results revealed a marked hyperammonemia.5 - fluorouracil(5-FU)-induced hyperammonemia was diagnosed and the patient was ventilated and managed with branchedchain amino acid solutions, lactulose, and hemodialysis in the ICU.After hemodialysis, the blood ammonia level reduced to the normal limits, and the symptoms of encephalopathy resolved on the following day.He was discharged home on the 19th day of hospitalization.5 -FU-containing therapy should be carefully administered in patients with renal dysfunction.Herein, we report a case of 5-FU-induced hyperammonemia with literature considerations.


Assuntos
Neoplasias Colorretais , Fluoruracila/efeitos adversos , Hiperamonemia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Camptotecina , Estado de Consciência , Humanos , Hiperamonemia/induzido quimicamente , Leucovorina , Masculino , Recidiva Local de Neoplasia
3.
Hinyokika Kiyo ; 65(7): 287-289, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31501393

RESUMO

An 83-year-old man with an indwelling lumbar-peritoneal (L-P) shunt (for idiopathic normal-pressure hydrocephalus) underwent retroperitoneal laparoscopic radical right nephrectomy for renal cell carcinoma (pT1aN0M0). Peritoneal perforation occurred intraoperatively, and he developed postoperative disturbance of consciousness. Computed tomography showed mild ventricular enlargement, which was attributed to L-P shunt failure secondary to increased pneumoperitoneum pressure. His level of consciousness was improved when we raised his head. Few reports have discussed complications observed during retroperitoneal laparoscopic surgery in patients with an indwelling L-P shunt. This case report discusses this topic along with a discussion of previously reported findings.


Assuntos
Estado de Consciência , Neoplasias Renais , Laparoscopia , Nefrectomia , Idoso de 80 Anos ou mais , Humanos , Neoplasias Renais/cirurgia , Masculino , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias , Espaço Retroperitoneal
5.
Artigo em Japonês | MEDLINE | ID: mdl-31341118

RESUMO

OBJECTIVES: In our previous study in which we aimed to clarify the factors related to salt intake in women aged 40-59 years, salt intake was found to be not related to salt-reduction cognizance. The aim of this research was to clarify factors related to salt intake in those who were cognizant of the importance of reducing their salt intake. METHODS: Two hundred and forty-seven female guardians (effective rate, 32.2%) in a medical university, aged 40-59 years old, participated in this study. The participants were divided into three groups according to their salt-reduction cognizance. RESULTS: There was no significant difference in salt intake between the three groups who were salt-reduction cognizant. Intakes of potassium (mg/1,000 kcal), vegetables, and fruits were higher in those who were cognizant of the importance of reducing their salt intake. The frequencies of consuming stewed foods, miso soup, and vinegared and marinated dishes were also higher. Those who were salt-reduction cognizant were knowledgeable about salt consumption, had experienced making low-salt dishes, used low-sodium seasoning, and made light-tasting dishes by regulating ingredients when cooking. However, when it came to eating, there was no difference in the percentage of those who left most of the broth when eating noodle soups and the frequency with which they added seasoning in terms of salt-reduction cognizance. CONCLUSION: Salt-reduction cognizant women aged 40-59 years made conscious efforts to use less salt at the time of cooking, but made no efforts when eating, even though they were cognizant of the importance of reducing their salt intake.


Assuntos
Estado de Consciência , Dieta Hipossódica/psicologia , Dieta Hipossódica/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Tutores Legais/psicologia , Cloreto de Sódio na Dieta/administração & dosagem , Estudantes de Medicina , Adulto , Feminino , Frutas , Humanos , Tutores Legais/estatística & dados numéricos , Modelos Logísticos , Pessoa de Meia-Idade , Potássio na Dieta/administração & dosagem , Verduras
7.
Br J Anaesth ; 123(3): 298-308, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31277837

RESUMO

BACKGROUND: Emergence from sedation entails rapid increase in the levels of both awareness and wakefulness, the two axes of consciousness. Functional MRI (fMRI) studies of emergence from sedation often focus on the recovery period, with no description of the moment of emergence. We hypothesised that by focusing on the moment of emergence, novel insights, primarily about subcortical activity and increased wakefulness, will be gained. METHODS: We conducted a resting state fMRI analysis of 17 male subjects (20-40 yr old) gradually entering into and emerging from deep sedation (average computed propofol concentrations of 2.41 and 1.11 µg ml-1, respectively), using target-controlled infusion of propofol. RESULTS: Functional connectivity analysis revealed a robust spatiotemporal signature of return of consciousness, in which subcortical seeds showed transient positive correlations that rapidly turned negative shortly after emergence. Elements of this signature included four components of the ascending reticular activating system: the ventral tegmentum area, the locus coeruleus, median raphe, and the mammillary body. The involvement of the rostral dorsolateral pontine tegmentum, which is specifically impaired in comatose patients with pontine lesions, in emergence was previously unknown. CONCLUSIONS: Emergence from propofol sedation is characterised, and possibly driven, by a transient activation of brainstem loci. Some of these loci are known components of the ascending reticular activating system, whereas an additional locus was found that is also impaired in comatose patients.


Assuntos
Córtex Cerebral/efeitos dos fármacos , Sedação Profunda/métodos , Hipnóticos e Sedativos/farmacologia , Propofol/farmacologia , Adulto , Período de Recuperação da Anestesia , Mapeamento Encefálico/métodos , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/efeitos dos fármacos , Tronco Encefálico/fisiologia , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/fisiologia , Estado de Consciência/efeitos dos fármacos , Esquema de Medicação , Humanos , Hipnóticos e Sedativos/administração & dosagem , Imagem por Ressonância Magnética , Masculino , Rede Nervosa/efeitos dos fármacos , Propofol/administração & dosagem , Adulto Jovem
8.
Acta Psychol (Amst) ; 198: 102836, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31279183

RESUMO

An altered sense of the experience of time represents one of the nine dimensions that is conceived as characterizing a state of flow. While a number of other factors necessarily contribute to this overall experience of flow, subjective time perception is of particular quantitative interest and thus serves as the focus of the present meta-analysis. The extant body of relevant quantitative research was evaluated to identify data relating to both flow and change in the sense of time. Sixty-three (n = 63) articles were determined to qualify under the current specified inclusion criteria. These sixty-three studies yielded one thousand and ninety-four (n = 1094) effect sizes. All studies included in the meta-analysis were also coded for relevant moderator variables. Results indicated moderately positive correlations between affective, consciousness, and performance based aspects of flow (r = 0.4, 0.21, 0.17 respectively), thus reinforcing the original conceptualization of their relationship for the generation and maintenance of the flow state. Additionally, variations in environmental conditions (both physical and social) were found to have differential effects on the overall level of experienced flow. The results of this meta-analysis also serve to inform the process of further model development that can more accurately quantify and predict temporal perception as one metric of flow.


Assuntos
Percepção do Tempo , Afeto , Estado de Consciência , Humanos , Pensamento
9.
J Clin Neurosci ; 67: 167-171, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31262452

RESUMO

Alongside an increase in life expectancy, median age of patients presenting with traumatic acute subdural hematomas (ASDH) has increased as well. Treatment guidelines are based on studies performed on relatively young patients. The optimal management of elderly (>70 years old) patients with ASDH, specifically those with relatively preserved level of consciousness, was not thoroughly investigated so far. We retrospectively examined elderly patients presented to our medical center between the years 2006-2016 with traumatic convexity ASDH and GCS of 13-15. 773 patients were included in the initial cohort and 54 patients were included in the final analysis. The mean age at presentation was 81.5 years and the means of hematoma thickness and midline shift were 15.5 mm and 6.6 mm, respectively. Patients in our cohort had an overall unfavorable outcome (mRS 5-6) of 28% and 56% at discharge and at 1 year following injury, respectively. The results were not significantly different for the subgroups of patients older than 80 years and patients with high ASA-PS. Surgical evacuation of the ASDH was undertaken in 28 patients with focal neurologic deficit and/or worsening on subsequent brain scans. At 1 year, 64% (18 patients) in the surgery group had unfavorable outcome compared to 48% (12 patients) in the conservative group. We believe that these numbers should be taken under consideration when assessing elderly patients with convexity ASDH and relatively preserved level of consciousness.


Assuntos
Hematoma Subdural Agudo/complicações , Hematoma Subdural Agudo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estado de Consciência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Retrospectivos , Resultado do Tratamento
10.
High Blood Press Cardiovasc Prev ; 26(4): 273-281, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31297720

RESUMO

Syncope is a temporary loss of consciousness due to transient global cerebral hypoperfusion. Reflex syncope is the most frequent, representing 21% of all types of syncopal events, and includes: (a) the vasovagal syncope (classical type); (b) the situational syncope; (c) the carotid sinus syncope and (d) non-classical forms. An accurate anamnesis and physical examination are fundamental for the diagnosis. Although limited evidence is available regarding the efficacy of some treatments, a number of these can be successfully used in the clinical practice. It is, however, important to personalize the therapeutic approach in order to achieve an efficient reduction or suppression of syncopal episodes. Patients should be reassured about the benignity of these events and the possibility of reducing their frequency over time. They should be also educated on how to recognize and abort incoming syncopal episodes. Patients may be advised to increase their introit in water and salt, as well as to reduce vasoactive medications, if no contraindications exist. Orthostatic training may be beneficial but only in very motivated young patients capable of strictly adhering to the exercise plan. So far, any proposed pharmacological treatment has demonstrated very limited efficacy and, therefore, it should be tried in case of failure of non-pharmacological approaches. Pacemaker implantation is clearly indicated in patients with documented cardioinhibitory syncope in the absence of a vasodepressor component, which can compromise their quality of life. Despite the American and European guidelines for the treatment of syncope are similar, still some differences can be denoted. Aim of this study is to evaluate the management of patients with recurrent syncopal episodes focusing on pharmacological and non-pharmacological approaches.


Assuntos
Circulação Cerebrovascular , Estado de Consciência , Síncope Vasovagal/terapia , Pressão Sanguínea , Tomada de Decisão Clínica , Humanos , Guias de Prática Clínica como Assunto , Recidiva , Fatores de Risco , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/etiologia , Síncope Vasovagal/fisiopatologia , Resultado do Tratamento
11.
Toxicol Lett ; 314: 37-42, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31301370

RESUMO

OBJECTIVE: Ethanol intake can increase the sedative effects of gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL), although the real clinical impact is unknown. We studied the clinical impact of the co-ingestion of ethanol in patients presenting to the Emergency Department (ED) with acute toxicity related to GHB/GBL use. METHOD: We performed a secondary analysis of the Euro-DEN Plus Registry (14 countries, 22 EDs) which includes 17,371 consecutive patients presenting to the ED with acute recreational drug toxicity over 39 consecutive months (October 2013 - December 2016). We compared the epidemiological and clinical characteristics and ED management of patients identified as presenting with acute toxicity related to lone GHB/GBL (Group A) or GHB/GBL combined with ethanol (Group B) without other concomitant drugs. RESULTS: A total of 609 patients were included (age 32 (8) years; 116 women (19%); Group A: 183 patients and Group B: 426). The most common features were reduction in consciousness (defined as Glasgow Coma Score <13 points: 56.1%) and agitation/aggressiveness (33.6%). Those with ethanol co-ingestion were younger patients (Group A/B: 31.5/33.1 years, p = 0.029) and ethanol co-ingestion was associated with a lower frequency of bradycardia (23.5%/15.7%, p = 0.027) and more frequent arrival at the ED by ambulance (68.3/86.6%; p < 0.001), reduction in consciousness (58.9%/49.1%; p = 0.031), need for treatment in the ED (49.2%/60.4%; p = 0.011), use of sedatives (20.1%/12.8%; p = 0.034), admission to critical care units (22.4%/55.3%; p < 0.001), and longer hospital stay (stay longer than 6 h: 16.9%/28.4%; p = 0.003). CONCLUSIONS: Co-ingestion of ethanol increases the adverse effects of patients intoxicated by GHB/GBL, leading to greater depression of consciousness, need for treatment, admission to the ICU and longer hospital stay.


Assuntos
4-Butirolactona/efeitos adversos , Consumo de Bebidas Alcoólicas/efeitos adversos , Transtornos da Consciência/etiologia , Etanol/efeitos adversos , Oxibato de Sódio/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Agressão/efeitos dos fármacos , Consumo de Bebidas Alcoólicas/psicologia , Estado de Consciência/efeitos dos fármacos , Transtornos da Consciência/diagnóstico , Transtornos da Consciência/psicologia , Transtornos da Consciência/terapia , Serviço Hospitalar de Emergência , Europa (Continente) , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Admissão do Paciente , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Adulto Jovem
12.
NeuroRehabilitation ; 44(4): 545-554, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282434

RESUMO

BACKGROUND: Neurosensory stimulation is effective in enhancing the recovery process of severely brain-injured patients with disorders of consciousness. Multisensory environments are found in nature, recognized as beneficial to many medical conditions. Recent advances detected covert cognition in patients behaviorally categorized as un- or minimally responsive; a state described as cognitive motor dissociation (CMD). OBJECTIVE: To determine effectiveness of a neurosensory stimulation approach enhanced by outdoor therapy, in the early phases of recovery in patients presenting with CMD. METHODS: A prospective non-randomized crossover study was performed. A two-phase neurosensory procedure combined identical individually goal assessed indoor and outdoor protocols. All sessions were video-recorded and observations rated offline. The frequency of volitional behavior was measured using a behavioral grid. RESULTS: Fifteen patients participated in this study. The outdoor group patients had statistically significant higher number of intentional behaviors than the indoor group on seven features of the grid. Additionally, for all items assessed, total amount of behaviors in the outdoor condition where higher than those in the indoor condition. CONCLUSIONS: Although preliminary, this study provides robust evidence supporting the effectiveness and appropriateness of an outdoor neurosensory intervention in patients with covert cognition, to improve adaptive goal-oriented behavior. This may be a step towards helping to restore functional interactive communication.


Assuntos
Lesões Encefálicas/terapia , Transtornos Cognitivos/terapia , Cognição/fisiologia , Recuperação de Função Fisiológica/fisiologia , Terapia Recreacional/métodos , Sensação/fisiologia , Adulto , Idoso , Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/psicologia , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Estado de Consciência/fisiologia , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Ocupacional/métodos , Terapia Ocupacional/psicologia , Modalidades de Fisioterapia/psicologia , Estudos Prospectivos , Terapia Recreacional/psicologia , Adulto Jovem
13.
Rev. bioét. derecho ; (46): 133-147, jul. 2019.
Artigo em Espanhol | IBECS | ID: ibc-184856

RESUMO

Este trabajo comienza con una reflexión sobre la conciencia de mortalidad y la forma en que el ser humano puede situarse en la antesala de su propia muerte, refiriéndose algunas de las circunstancias y motivaciones en el suicidio. Por otra parte, se hace referencia a la formulación y postura filosófica de Cioran sobre el suicidio como recurso existencial para poder afrontar la vida en mejores condiciones. De manera semejante puede considerarse la eutanasia, observándose en su relación con el suicidio que la opción legal de acogerse a ella puede suponer para ciertas personas un alejamiento del suicidio mientras que su prohibición las puede precipitar a la autodestrucción definitiva para poder escapar así del sufrimiento insufrible


This paper begins by reflecting on people´s awareness of mortality and how they lie in the antechamber of their own death. It refers to several specific circumstances and motivations which lead to suicide. On the other hand, reference is made to Cioran´s ideas and philosophical stance on suicide as an existential resource which enables people to face life in better conditions. Similarly, euthanasia is considered, especially bearing in mind its close relationship to suicide, and it is observed as being the legal option of achieving that aim. This, however, can imply a flight from suicide for some sufferers while its prohibition can precipitate others towards definite self-destruction so as to escape from unbearable suffering. It is contrasted by using two illustrative cases


Aquest treball comença amb una reflexió sobre la consciència de mortalitat i la forma en què l'ésser humà pot situar-se en l'avantsala de la seva pròpia mort, referint-se algunes de les circumstàncies i motivacions en el suïcidi. D'altra banda, es fa referència a la formulació i postura filosòfica de Cioran sobre el suïcidi com a recurs existencial per a poder afrontar la vida en millors condicions. De manera semblant pot considerar-se l'eutanàsia, observant-se en la seva relació amb el suïcidi que l'opció legal d'acollir-se a ella pot suposar per a certes persones un allunyament del suïcidi mentre que la seva prohibició les pot precipitar a l'autodestrucció definitiva per a poder escapar així del sofriment insofrible, tal com apareix contrastat a través de dos casos il•lustratius


Assuntos
Humanos , Eutanásia/legislação & jurisprudência , Suicídio/legislação & jurisprudência , Direito a Morrer/ética , Estado de Consciência/ética , Estresse Psicológico , Autonomia Pessoal
14.
Med. intensiva (Madr., Ed. impr.) ; 43(5): 270-280, jun.-jul. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183239

RESUMO

Objetivo: Describir las variables relacionadas con la capacidad tusígena efectiva y el estado de la conciencia medidas previo a la decanulación y comparar sus valores medidos entre los diferentes ámbitos de atención como la Unidad de Cuidados Intensivos (UCI), sala general y centros de desvinculación de la ventilación mecánica y rehabilitación (CDVMR). Secundariamente analizar la evolución de los pacientes una vez decanulados. Diseño: Serie de casos, longitudinal y prospectiva. Ámbito: Multicéntrico 31 UCI (polivalentes) y en 5 CDVMR. Pacientes: Adultos traqueostomizados previos a la decanulación. Mediciones: Presión espiratoria máxima, pico flujo espiratorio tosido (PFET), Glasgow Coma Scale (GCS). Resultados: Doscientos siete pacientes decanulados, 124 (60%) en UCI, 59 (28%) en sala general y 24 (12%) en CDVMR. El PFET presentó diferencias entre los pacientes (UCI 110 - 190 l/min versus CDVMR 167,5 - 232,5 l/min; p<0,01). El GCS fue diferente entre la sala general (9 -15) versus UCI (10- 15) y CDVMR (12 - 15); p<0,01 y p<0,01, respectivamente. Hubo diferencias en los días de internación (p<0,01), los días con traqueostomía (<0,01) y la cantidad de pacientes derivados a domicilio (p=0,02) entre los distintos escenarios. Conclusión: Existen diferencias en los valores medidos de PFET y GCS entre los diferentes ámbitos. Una considerable cantidad de pacientes son decanulados con valores de PFET y presión espiratoria máxima por debajo de los puntos de corte sugeridos como predictores de falla en la literatura. Ningún paciente de nuestra serie fue decanulado con un SCG <8 puntos, esto refleja la importancia que le otorga el equipo tratante al estado de conciencia al momento de la decanulación


Objective: To describe the variables related to effective cough capacity and the state of consciousness measured prior to decannulation and compare their measured values between the different areas of care such as the Intensive Care Unit (ICU), General ward and Mechanical Ventilation Weaning and Rehabilitation Centers (MVWRC). Secondarily analyze the evolution of patients once decannulated. Design: Case series, longitudinal and prospective. Scope: Multicentric 31 ICUs (polyvalent) and 5 MVWRC. Patients: Tracheostomized adults prior to decannulation. Measurements: Maximum expiratory pressure, peak expiratory flow coughed (PEFC), Glasgow Coma Scale (GCS). Results: Two hundred and seven decannulated patients, 124 (60%) in ICU, 59 (28%) General ward and 24 (12%) in MVWRC. The PEFC presented differences between the patients (ICU 110 - 190 l/min versus MVWRC 167.5 - 232.5 l/min, p <.01). The GCS was different between General ward (9 -15) versus ICU (10-15) and MVWRC (12-15); p <.01 and p <.01, respectively. There were differences in the days of hospitalization (p <.01), days with tracheostomy (<0.01) and the number of patients referred at home (p =.02) between the different scenarios. Conclusion: There are differences in the values of PEFC and GCS observed when decannulating between different areas. A considerable number of patients are decannulated with values of PEFC and maximum expiratory pressure below the suggested cut-off points as predictors of failure in the literature. No patient in our series was decanulated with an GCS <8, this reflects the importance that the treating team gives to the state of consciousness prior to decannulation


Assuntos
Humanos , Adulto , Força Muscular , Estado de Consciência , Estudos Longitudinais , Unidades de Terapia Intensiva , Pressões Respiratórias Máximas/métodos , Pico do Fluxo Expiratório , Estudos Prospectivos , Cateterismo/instrumentação , Coma/diagnóstico
15.
Niger J Clin Pract ; 22(6): 801-805, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31187765

RESUMO

Background: Patients with cerebral palsy (CP) are at significant risk by means of periodontal disease and tooth decay. Pharmacological techniques that require intensive care such as sedation and general anesthesia are generally used for dental treatment of this patient group. Aim: The purpose of this retrospective study was to compare bispectral index (BIS) values and depth of sedation recorded during deep sedation protocols performed for healthy children and children with CP in the Department of Pediatric Dentistry, Faculty of Dentistry, Gazi University. Materials and Methods: The measurements of BIS and hemodynamic variables recorded during treatment of 26 healthy children and 26 children with CP between 3 and 10 years of age who were treated under sevoflurane and 50% N2O-50% O2 mixture deep sedation method were investigated retrospectively. Results: The mean BIS values in the CP group was statistically lower at all the time points when compared with the control group (P < 0.001). While there was no statistically significant difference between groups in terms of duration of treatment (P = 0.657), the median recovery time in the CP group was significantly longer than that recorded in the control group (P < 0.001). Significant correlation was found between modified Ramsay Sedation Scale (mRSS) scores and BIS levels at 5th, 10th, and 20th min in the control group (P < 0.001). Similar correlation was found in the CP group at 15th and 20th min. Conclusion: We concluded that it is necessary to consider the dosage and effect mechanisms of drugs used in children with CP to prevent overuse of anesthetics and emergence of anesthesia-related complications.


Assuntos
Anestésicos Inalatórios , Paralisia Cerebral/fisiopatologia , Estado de Consciência , Sedação Profunda , Sevoflurano , Anestesia Dentária , Criança , Pré-Escolar , Monitores de Consciência , Feminino , Humanos , Masculino , Estudos Retrospectivos
16.
Acta Psychol (Amst) ; 198: 102866, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31234035

RESUMO

Causal relations can be presented as subjective, involving someone's reasoning, or objective, depicting a real-world cause-consequence relation. Subjective relations require longer processing times than objective relations. We hypothesize that the extra time is due to the involvement of a Subject of Consciousness (SoC) in the mental representation of subjective information. To test this hypothesis, we conducted a Visual World Paradigm eye-tracking experiment on Dutch and Chinese connectives that differ in the degree of subjectivity they encode. In both languages, subjective connectives triggered an immediate increased attention to the SoC, compared to objective connectives. Only when the subjectivity information was not expressed by the connective, modal verbs presented later in the sentence induced an increase in looks at the SoC. This focus on the SoC due to the linguistic cues can be explained as the tracking of the information source in the situation models, which continues throughout the sentence.


Assuntos
Atenção , Linguagem , Percepção Visual/fisiologia , Estado de Consciência , Sinais (Psicologia) , Movimentos Oculares , Humanos , Linguística
17.
Hinyokika Kiyo ; 65(5): 163-166, 2019 May.
Artigo em Japonês | MEDLINE | ID: mdl-31247694

RESUMO

We describe the case of a patient with hyperammonemia owing to urinary tract infections. The patient, a 66-year-old-woman, was previously diagnosed with bilateral hydronephrosis. She was admitted to the emergency room with macrohematuria and bilateral lumbar pain, which persisted for 2 days. She was hospitalized with the diagnosis of pyelonephritis. Despite antibiotic treatment, she developed sudden disturbance in consciousness on the 2nd day of illness. To improve the hyperammonemia and metabolic acidosis, we initiated continuous hemodiafiltration (CHDF) and urinary drainage by bilateral nephrostomy, after which her consciousness improved, and she was discharged on day 19. For patients with urinary tract infections and who are unaware of disturbance in consciousness, it is important to consider that obstructive urinary tract infections can cause hyperammonemia.


Assuntos
Transtornos da Consciência , Hiperamonemia , Pielonefrite , Infecções Urinárias , Idoso , Estado de Consciência , Transtornos da Consciência/etiologia , Feminino , Humanos , Hiperamonemia/complicações , Hiperamonemia/etiologia , Diálise Renal
19.
Ann Agric Environ Med ; 26(2): 304-308, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31232063

RESUMO

INTRODUCTION: In spite of the rapid development in various communication-support technologies for those waking up from a coma, studies describing the sole process of reconstructing communication in this group of patients are scarce. OBJECTIVE: The aim of this study was to analyze communication reactions in a minimal state of consciousness and describe the nonverbal behaviours characteristic for each stages significant for the therapy of communication. MATERIAL AND METHODS: 18 severely brain-injured patients in a minimal state of consciousness participated in the half-year observation study, which included people experiencing at least 4 weeks of consciousness disorder/coma. Age of patients 25±5 years. Psychological assessment included: observation of various attempts of communications undertaken by patients, caregivers and family interview, the Glasgow Coma Scale (GCS) and Individual Communication Sheet. RESULTS: Data analysis showed a significant increase in preverbal communication, both in primal and sensory areas when compared between Stage II (GCS=6-8 points) and Stage III (GCS=9-12 points). After a time, primary communication reached a high level. Patients produced communication attempts from the behaviour organization level, and an increase in the nonverbal communication level was noted. Based on observations, nonverbal communication profiles for each stage of waking up from a coma were introduced. CONCLUSIONS: It was found that in the process of waking up from a coma the patients communicate with the use of the preverbal level of primal communication, the sensory and behaviour organization activities. The characteristics of the communication reactions show that in Stage III there is a significant increase in two preverbal communication areas: primal and sensory acts, when compared with Stage II.


Assuntos
Lesões Encefálicas Traumáticas/psicologia , Coma/psicologia , Comunicação não Verbal , Adulto , Lesões Encefálicas Traumáticas/reabilitação , Coma/reabilitação , Estado de Consciência , Família/psicologia , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Adulto Jovem
20.
Wiad Lek ; 72(3): 336-342, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31050977

RESUMO

OBJECTIVE: Introduction: Scientific information sources point to the significant effectiveness of curettage of uterine cavity (CUC) as a diagnostic and treatment mode of gynecologic oncology. Today the anesthesia service is able to satisfy virtually all the requirements of a surgeon and a female patient, however, some institutional factors, as for example postoperative recovery of consciousness, and factors influencing it, remain unaddressed. The aim: to explore the possibilities of influence of different combinations and dosages of medical preparations used to provide monitored anesthesia care of CUC, to change the time of postoperative recovery of patient's consciousness. PATIENTS AND METHODS: Materials and methods: an interview of 96 patients by VAS, studies of cortisol, insulin and glucose levels in blood serum, measurements of time from the end of surgery to the awakening and complete recovery of consciousness and statistical processing of the results have been conducted. RESULTS: Results: A combination of 50 mg of dexketoprofen and half-dose drugs for narcosis can hasten the postoperative wake-up time by 38%, while maintaining dosages can prolong by 37% on the contrary. There is a dose-dependent effect of drugs for narcosis on the time of full post-operative recovery of consciousness. The reduction of their dosages by half can reduce this time by almost 40%. CONCLUSION: Conclusions: the dosage modification of anesthetic drugs and their combinations may have a significant effect on the time of postoperative awaking and complete recovery of consciousness in female patients after CUC. As a result, it has a positive physiological, psychological and social effect.


Assuntos
Anestesia , Curetagem/métodos , Estado de Consciência/efeitos dos fármacos , Feminino , Humanos , Período Pós-Operatório
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