Background: Coma is a highly frequent situation associated with several diseases. Objective: That is to assess the prognostic factors of comas at the intensive care unit of the university teaching hospital of Parakou....Background: Coma is a highly frequent situation associated with several diseases. Objective: That is to assess the prognostic factors of comas at the intensive care unit of the university teaching hospital of Parakou. Patients and Methods: It is a cross-sectional study with descriptive and analytical purpose based on prospective gathering of data. It has been performed from March 1 to July 31, 2014. The population study consists of 100 adult patients admitted to the intensive care unit for coma. The vital and functional prognosis data are studied. Results: The admission frequency of comatose patients to the intensive care unit is 44.4%. Patients’ mean age is 27 ± 13.9 years with extremes of 16 and 88 years. The average length of stay in the intensive care unit is 5.2 ± 5.6 days with extremes of 2 hours 30 minutes and 30 days. Mortality rate is 30%. Poor prognostic factors are: average Glasgow score of 6.8 ± 2.9 (p = 0.01), average outpatient simplified severity index (OSSI) of 9.1 ± 3.5 (p = 0.02), pupillary abnormality (p = 0.00), motor weakness (p = 0.00), average glycemia of 1.5 ± 0.82 g/L (p = 0.02), average systolic blood pressure of 130.9 ± 44.5 mm Hg (p = 0.03), average diastolic blood pressure of 80.8 ± 22.3 mm Hg (p = 0.03), average respiratory rate of 30.9 ± 10.6 cycles/min (p = 0.03) and average temperature of 37.8°C ± 1.2°C (p = 0.03). Conclusion: Coma is a pathological entity with high frequency in clinical medicine. Its positive diagnosis is easy, but etiological research is hard. Hospital mortality is high and influenced by several factors. Taking into account, those factors in care strategies can improve their prognosis.展开更多
Background: Non-traumatic coma is the most common pediatric medical emergency. Its clinical diagnosis is easy. The difficulty lies in finding the etiology. Objective: To determine the prevalence and clinical profiles ...Background: Non-traumatic coma is the most common pediatric medical emergency. Its clinical diagnosis is easy. The difficulty lies in finding the etiology. Objective: To determine the prevalence and clinical profiles of non-traumatic Coma at the Centre Hospitalier Universitaire Pédiatrique de Bangui (CHUPB). Methodology: This was a descriptive and analytical cross-sectional study conducted between January 1 and June 31, 2021, at CHUPB. Children aged 1 month to 15 years, admitted to the emergency room with a Glasgow score less than or equal to 8 without any traumatism were included. The variables studied were sociodemographic, clinical and paraclinical. Data were entered and analyzed using SPSS 20.0 statistical software. The statistical test used was Pearson’s chi<sup>2</sup>, any p-value Results: Of 8551 children hospitalized during the study period, 370 were hospitalized for non-traumatic coma: 4.32%. They were divided into 57.5% (n = 213) boys and 42.44% (n = 157) girls, giving a sex ratio of 1.35. Their mean age was 35.95 ± 27.21 months. Children aged 1 to 24 months represented 54.59% (n = 202) of cases. The mean time to the consultation was 2.91 days ± 1.8. Fever 86.48% (n = 320) and convulsions 80% (n = 296) were the main reasons for consultation. Coma stages II - III and IV represented 52.44% (n = 194), 42.97% (n = 159) and 4.59% (n = 17) respectively. Neuromalaria (29.72%;n = 110), meningitis-meningoencephalitis-encephalitis (30%;n = 111), sepsis (19.72%;n = 73) and acidosis Coma (5.40%;n = 20) were the main etiologies. Conclusion: Non-traumatic coma is common at CHUPB. Infections were the main etiology, particularly cerebral malaria. The reduction of its frequency requires, among others, the strengthening of the national monitoring malaria program. The strengthening of the technical platform for a good etiological diagnosis constitutes the other axis of prevention.展开更多
Objective To explore the relationship between serum chloride levels and prognosis in patients with hepatic coma in the intensive care unit(ICU).Methods We analyzed 545 patients with hepatic coma in the ICU from the Me...Objective To explore the relationship between serum chloride levels and prognosis in patients with hepatic coma in the intensive care unit(ICU).Methods We analyzed 545 patients with hepatic coma in the ICU from the Medical Information Mart for Intensive Care IV(MIMIC-IV)database.Associations between serum chloride levels and 28-day and 1-year mortality rates were assessed using restricted cubic splines(RCSs),Kaplan-Meier(KM)curves,and Cox regression.Subgroup analyses,external validation,and mechanistic studies were also performed.Results A total of 545 patients were included in the study.RCS analysis revealed a U-shaped association between serum chloride levels and mortality in patients with hepatic coma.The KM curves indicated lower survival rates among patients with low chloride levels(<103 mmol/L).Low chloride levels were independently linked to increased 28-day and 1-year all-cause mortality rates.In the multivariate models,the hazard ratio(HR)for 28-day mortality in the low-chloride group was 1.424(95%confidence interval[CI]:1.041–1.949),while the adjusted hazard ratio for 1-year mortality was 1.313(95%CI:1.026–1.679).Subgroup analyses and external validation supported these findings.Cytological experiments suggested that low chloride levels may activate the phosphorylation of the NF-κB signaling pathway,promote the expression of pro-inflammatory cytokines,and reduce neuronal cell viability.Conclusion Low serum chloride levels are independently associated with increased mortality in patients with hepatic coma.展开更多
BACKGROUND The optic nerve sheath diameter(ONSD)measured by ultrasound has emerged as a significant noninvasive method for detecting elevated intracranial pressure(ICP),guiding timely interventions,and monitoring trea...BACKGROUND The optic nerve sheath diameter(ONSD)measured by ultrasound has emerged as a significant noninvasive method for detecting elevated intracranial pressure(ICP),guiding timely interventions,and monitoring treatment response.Previous studies have shown that the baseline ONSD at admission is a prognostic indicator of mortality in adult patients with cerebrovascular events,traumatic brain injury,hepatic encephalopathy,and acute stroke.However,pediatric data on the dynamic changes in ONSD remain limited.AIM To study the association between within-48 hours admission dynamic ONSD changes and mortality in children with clinically relevant elevated ICP.METHODS This single-institution prospective study was performed at a tertiary Children’s Hospital in Vietnam,between November 2023 and August 2024.The primary outcome was in-hospital mortality rate.ONSD data were measured at admission,24 hours,and 48 hours post-admission to pediatric intensive care unit(PICU).Linear mixed-effects models accounting for repeated measures within individuals were used to analyze the association between ONSD changes and in-hospital mortality.RESULTS A total of 69 PICU-admitted children with clinically relevant raised ICP were enrolled and included in the analysis.The median patient age was 6 years(interquartile range:1-12),and males accounted for 54%of all patients.The inhospital mortality rate in children with clinically relevant raised ICP was 23.2%.Traumatic brain injury,sepsisassociated encephalopathy,and septic shock were the main causes of death in this cohort.Linear mixed-effects analysis showed that dynamic variability in ONSD values upon PICU admission and during the first 48 hours later correlated significantly with increased mortality.Nonsurvivors had a 5.3%increase in the mean ONSD at 48 hours compared to baseline levels,while the survivors showed a 5.6%reduction in ONSD.CONCLUSION Serial ultrasound-based ONSD measurements within 48 hours of admission better predicted mortality than baseline data in critically ill children,offering a practical,noninvasive tool for early prognosis in elevated ICP.展开更多
BACKGROUND Traumatic brain injury(TBI)is the second most common presentation of trauma victims.Among the various non-neurological complications after TBI,acute kidney injury(AKI)is not uncommon.AIM To establish the in...BACKGROUND Traumatic brain injury(TBI)is the second most common presentation of trauma victims.Among the various non-neurological complications after TBI,acute kidney injury(AKI)is not uncommon.AIM To establish the incidence,risk factors,and predictors of AKI in TBI victims.The secondary aim was to study the impact of AKI development on the outcomes of patients with TBI.METHODS This was a single-center retrospective cohort study of TBI victims with a Glasgow coma scale(GCS)≤11 in an apex trauma center in a metropolitan city.RESULTS The incidence of AKI after TBI was 11%.The risk factors for AKI after TBI were old age(P<0.001),comorbidities(P=0.023),shock(P<0.001),blood transfusion(P=0.016),consecutive neurosurgical intervention(P=0.029),high intracranial pressure(ICP)(P<0.001),rhabdomyolysis(P<0.001),and diabetes insipidus(P<0.001).The predictors of AKI after TBI were,on point-biserial correlation:Lower GCS(rpb=-0.27,n=331,P<0.001);and on multivariate logistic regression:(1)Shock(odds ratio[OR]:-11.94,P<0.001);(2)Rhabdomyolysis(OR:-7.33,P=0.001);(3)High ICP(OR:-4.39,P=0.018);(4)High Carlson comorbidity index(OR:-1.97,P=0.001);and(5)High acute physiology and chronic health evaluation-2(APACHE-2)score(OR:-1.13,P<0.001).The phenomenon of post-TBI AKI increased the extent of stay in intensive care unit(P=0.008),demand for ventilators(P=0.0170),ventilator days(P<0.001),incidence of brain death(P<0.001),and mortality(P<0.001).CONCLUSION Every tenth TBI victim suffers from AKI.AKI after TBI can be predicted by the patient's underlying comorbidities,on arrival low GCS,high APACHE-2 score,shock,rhabdomyolysis,and high ICP.The occurrence of AKI in TBI victims adversely affects outcome variables;however,this may be a reflection of the severe nature of TBI in the AKI group.New research is needed to understand the effects of AKI on outcome variables.展开更多
Objective:This study aimed to evaluate the prognostic impact of citicoline sodium capsules on patients with traumatic brain injury(TBI)and its safety.Methods:This study is a multicenter,single-arm,prospective,observat...Objective:This study aimed to evaluate the prognostic impact of citicoline sodium capsules on patients with traumatic brain injury(TBI)and its safety.Methods:This study is a multicenter,single-arm,prospective,observational study of brain trauma patients who met the inclusion criteria between March 2023 and June 2024 and who could be treated with citicoline sodium capsules after being evaluated by the investigator.The Glasgow Coma Scale(GCS)and Mini-Mental State Examination(MMSE),the incidence of adverse drug reactions/adverse events during treatment,and the abnormalities of safety tests with clinical evaluation significance were observed at 1 month and 2 months after treatment.Results:A total of 2806 patients,63.1%of whom were male,with an average age of 58.85 years old.The GCS and MMSE scores of the patients at 1 month and 2 months after treatment were significantly improved and were statistically significant,indicating that citicoline sodium had a significant effect on improving the state of consciousness and cognitive function of patients with TBI.Only 8 adverse reactions were reported in the study,all of which were mild gastrointestinal reactions and anaphylaxis,and did not lead to treatment interruption or serious consequences.Conclusion:Citicoline sodium has a significant therapeutic effect on patients with TBI and has good safety.展开更多
文摘Background: Coma is a highly frequent situation associated with several diseases. Objective: That is to assess the prognostic factors of comas at the intensive care unit of the university teaching hospital of Parakou. Patients and Methods: It is a cross-sectional study with descriptive and analytical purpose based on prospective gathering of data. It has been performed from March 1 to July 31, 2014. The population study consists of 100 adult patients admitted to the intensive care unit for coma. The vital and functional prognosis data are studied. Results: The admission frequency of comatose patients to the intensive care unit is 44.4%. Patients’ mean age is 27 ± 13.9 years with extremes of 16 and 88 years. The average length of stay in the intensive care unit is 5.2 ± 5.6 days with extremes of 2 hours 30 minutes and 30 days. Mortality rate is 30%. Poor prognostic factors are: average Glasgow score of 6.8 ± 2.9 (p = 0.01), average outpatient simplified severity index (OSSI) of 9.1 ± 3.5 (p = 0.02), pupillary abnormality (p = 0.00), motor weakness (p = 0.00), average glycemia of 1.5 ± 0.82 g/L (p = 0.02), average systolic blood pressure of 130.9 ± 44.5 mm Hg (p = 0.03), average diastolic blood pressure of 80.8 ± 22.3 mm Hg (p = 0.03), average respiratory rate of 30.9 ± 10.6 cycles/min (p = 0.03) and average temperature of 37.8°C ± 1.2°C (p = 0.03). Conclusion: Coma is a pathological entity with high frequency in clinical medicine. Its positive diagnosis is easy, but etiological research is hard. Hospital mortality is high and influenced by several factors. Taking into account, those factors in care strategies can improve their prognosis.
文摘Background: Non-traumatic coma is the most common pediatric medical emergency. Its clinical diagnosis is easy. The difficulty lies in finding the etiology. Objective: To determine the prevalence and clinical profiles of non-traumatic Coma at the Centre Hospitalier Universitaire Pédiatrique de Bangui (CHUPB). Methodology: This was a descriptive and analytical cross-sectional study conducted between January 1 and June 31, 2021, at CHUPB. Children aged 1 month to 15 years, admitted to the emergency room with a Glasgow score less than or equal to 8 without any traumatism were included. The variables studied were sociodemographic, clinical and paraclinical. Data were entered and analyzed using SPSS 20.0 statistical software. The statistical test used was Pearson’s chi<sup>2</sup>, any p-value Results: Of 8551 children hospitalized during the study period, 370 were hospitalized for non-traumatic coma: 4.32%. They were divided into 57.5% (n = 213) boys and 42.44% (n = 157) girls, giving a sex ratio of 1.35. Their mean age was 35.95 ± 27.21 months. Children aged 1 to 24 months represented 54.59% (n = 202) of cases. The mean time to the consultation was 2.91 days ± 1.8. Fever 86.48% (n = 320) and convulsions 80% (n = 296) were the main reasons for consultation. Coma stages II - III and IV represented 52.44% (n = 194), 42.97% (n = 159) and 4.59% (n = 17) respectively. Neuromalaria (29.72%;n = 110), meningitis-meningoencephalitis-encephalitis (30%;n = 111), sepsis (19.72%;n = 73) and acidosis Coma (5.40%;n = 20) were the main etiologies. Conclusion: Non-traumatic coma is common at CHUPB. Infections were the main etiology, particularly cerebral malaria. The reduction of its frequency requires, among others, the strengthening of the national monitoring malaria program. The strengthening of the technical platform for a good etiological diagnosis constitutes the other axis of prevention.
文摘Objective To explore the relationship between serum chloride levels and prognosis in patients with hepatic coma in the intensive care unit(ICU).Methods We analyzed 545 patients with hepatic coma in the ICU from the Medical Information Mart for Intensive Care IV(MIMIC-IV)database.Associations between serum chloride levels and 28-day and 1-year mortality rates were assessed using restricted cubic splines(RCSs),Kaplan-Meier(KM)curves,and Cox regression.Subgroup analyses,external validation,and mechanistic studies were also performed.Results A total of 545 patients were included in the study.RCS analysis revealed a U-shaped association between serum chloride levels and mortality in patients with hepatic coma.The KM curves indicated lower survival rates among patients with low chloride levels(<103 mmol/L).Low chloride levels were independently linked to increased 28-day and 1-year all-cause mortality rates.In the multivariate models,the hazard ratio(HR)for 28-day mortality in the low-chloride group was 1.424(95%confidence interval[CI]:1.041–1.949),while the adjusted hazard ratio for 1-year mortality was 1.313(95%CI:1.026–1.679).Subgroup analyses and external validation supported these findings.Cytological experiments suggested that low chloride levels may activate the phosphorylation of the NF-κB signaling pathway,promote the expression of pro-inflammatory cytokines,and reduce neuronal cell viability.Conclusion Low serum chloride levels are independently associated with increased mortality in patients with hepatic coma.
文摘BACKGROUND The optic nerve sheath diameter(ONSD)measured by ultrasound has emerged as a significant noninvasive method for detecting elevated intracranial pressure(ICP),guiding timely interventions,and monitoring treatment response.Previous studies have shown that the baseline ONSD at admission is a prognostic indicator of mortality in adult patients with cerebrovascular events,traumatic brain injury,hepatic encephalopathy,and acute stroke.However,pediatric data on the dynamic changes in ONSD remain limited.AIM To study the association between within-48 hours admission dynamic ONSD changes and mortality in children with clinically relevant elevated ICP.METHODS This single-institution prospective study was performed at a tertiary Children’s Hospital in Vietnam,between November 2023 and August 2024.The primary outcome was in-hospital mortality rate.ONSD data were measured at admission,24 hours,and 48 hours post-admission to pediatric intensive care unit(PICU).Linear mixed-effects models accounting for repeated measures within individuals were used to analyze the association between ONSD changes and in-hospital mortality.RESULTS A total of 69 PICU-admitted children with clinically relevant raised ICP were enrolled and included in the analysis.The median patient age was 6 years(interquartile range:1-12),and males accounted for 54%of all patients.The inhospital mortality rate in children with clinically relevant raised ICP was 23.2%.Traumatic brain injury,sepsisassociated encephalopathy,and septic shock were the main causes of death in this cohort.Linear mixed-effects analysis showed that dynamic variability in ONSD values upon PICU admission and during the first 48 hours later correlated significantly with increased mortality.Nonsurvivors had a 5.3%increase in the mean ONSD at 48 hours compared to baseline levels,while the survivors showed a 5.6%reduction in ONSD.CONCLUSION Serial ultrasound-based ONSD measurements within 48 hours of admission better predicted mortality than baseline data in critically ill children,offering a practical,noninvasive tool for early prognosis in elevated ICP.
文摘BACKGROUND Traumatic brain injury(TBI)is the second most common presentation of trauma victims.Among the various non-neurological complications after TBI,acute kidney injury(AKI)is not uncommon.AIM To establish the incidence,risk factors,and predictors of AKI in TBI victims.The secondary aim was to study the impact of AKI development on the outcomes of patients with TBI.METHODS This was a single-center retrospective cohort study of TBI victims with a Glasgow coma scale(GCS)≤11 in an apex trauma center in a metropolitan city.RESULTS The incidence of AKI after TBI was 11%.The risk factors for AKI after TBI were old age(P<0.001),comorbidities(P=0.023),shock(P<0.001),blood transfusion(P=0.016),consecutive neurosurgical intervention(P=0.029),high intracranial pressure(ICP)(P<0.001),rhabdomyolysis(P<0.001),and diabetes insipidus(P<0.001).The predictors of AKI after TBI were,on point-biserial correlation:Lower GCS(rpb=-0.27,n=331,P<0.001);and on multivariate logistic regression:(1)Shock(odds ratio[OR]:-11.94,P<0.001);(2)Rhabdomyolysis(OR:-7.33,P=0.001);(3)High ICP(OR:-4.39,P=0.018);(4)High Carlson comorbidity index(OR:-1.97,P=0.001);and(5)High acute physiology and chronic health evaluation-2(APACHE-2)score(OR:-1.13,P<0.001).The phenomenon of post-TBI AKI increased the extent of stay in intensive care unit(P=0.008),demand for ventilators(P=0.0170),ventilator days(P<0.001),incidence of brain death(P<0.001),and mortality(P<0.001).CONCLUSION Every tenth TBI victim suffers from AKI.AKI after TBI can be predicted by the patient's underlying comorbidities,on arrival low GCS,high APACHE-2 score,shock,rhabdomyolysis,and high ICP.The occurrence of AKI in TBI victims adversely affects outcome variables;however,this may be a reflection of the severe nature of TBI in the AKI group.New research is needed to understand the effects of AKI on outcome variables.
文摘Objective:This study aimed to evaluate the prognostic impact of citicoline sodium capsules on patients with traumatic brain injury(TBI)and its safety.Methods:This study is a multicenter,single-arm,prospective,observational study of brain trauma patients who met the inclusion criteria between March 2023 and June 2024 and who could be treated with citicoline sodium capsules after being evaluated by the investigator.The Glasgow Coma Scale(GCS)and Mini-Mental State Examination(MMSE),the incidence of adverse drug reactions/adverse events during treatment,and the abnormalities of safety tests with clinical evaluation significance were observed at 1 month and 2 months after treatment.Results:A total of 2806 patients,63.1%of whom were male,with an average age of 58.85 years old.The GCS and MMSE scores of the patients at 1 month and 2 months after treatment were significantly improved and were statistically significant,indicating that citicoline sodium had a significant effect on improving the state of consciousness and cognitive function of patients with TBI.Only 8 adverse reactions were reported in the study,all of which were mild gastrointestinal reactions and anaphylaxis,and did not lead to treatment interruption or serious consequences.Conclusion:Citicoline sodium has a significant therapeutic effect on patients with TBI and has good safety.
