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
Rationale:Salmonella is a common etiological agent behind the tropical fever syndrome in the Indian subcontinent.Its prevalence in India remains high due to a lack of proper sanitation services in large parts of the c...Rationale:Salmonella is a common etiological agent behind the tropical fever syndrome in the Indian subcontinent.Its prevalence in India remains high due to a lack of proper sanitation services in large parts of the country.Its neuropsychiatric manifestations is rare and the understanding on their pathophysiology is still poor.Patient concerns:A 19-year-old male,presented with a 10-day history of altered mental status,high-grade fever and violent behaviour.2 Days prior to admission,he developed decreased responsiveness and a muttering delirium with self-talking.Diagnosis:Coma vigil secondary to salmonellosis.Interventions:Intravenous ceftriaxone and dexamethasone.Outcomes:The resolution of the coma vigil and the associated Salmonella infection were observed;however,the patient developed residual mutism.Lessons:The atypical presentation of a globally obtunded state followed by mutism in typhoid coma in this case should be brought to the attention of clinicians worldwide.Additionally,the enduring speech limitations and potential psychiatric consequences may be linked to the prolonged duration of the infection.展开更多
西方的科学研究成果大多来源于英语的语言文化环境,把西方的科学研究成果介绍到中国,必须重视英语的语言文化环境和汉语的语言文化环境的不同,这样才能使国人准确、方便地应用西方的科学研究成果,西学东渐。格拉斯哥昏迷评分(Glasgow co...西方的科学研究成果大多来源于英语的语言文化环境,把西方的科学研究成果介绍到中国,必须重视英语的语言文化环境和汉语的语言文化环境的不同,这样才能使国人准确、方便地应用西方的科学研究成果,西学东渐。格拉斯哥昏迷评分(Glasgow coma scale)被翻译、介绍到国内已有数十年,但汉语版的"Glasgow coma scale"多种多样,容易造成初学者和使用者的迷惑。本文复习有关"Glasgow coma scale"的原始英式英文文献、美式英语英文文献和以往的几个主要的汉语翻译版。结合英式英语、美式英语和汉语的语言文化特点,新译了"Glasgow coma scale",以方便医护人员使用。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Rationale:Salmonella is a common etiological agent behind the tropical fever syndrome in the Indian subcontinent.Its prevalence in India remains high due to a lack of proper sanitation services in large parts of the country.Its neuropsychiatric manifestations is rare and the understanding on their pathophysiology is still poor.Patient concerns:A 19-year-old male,presented with a 10-day history of altered mental status,high-grade fever and violent behaviour.2 Days prior to admission,he developed decreased responsiveness and a muttering delirium with self-talking.Diagnosis:Coma vigil secondary to salmonellosis.Interventions:Intravenous ceftriaxone and dexamethasone.Outcomes:The resolution of the coma vigil and the associated Salmonella infection were observed;however,the patient developed residual mutism.Lessons:The atypical presentation of a globally obtunded state followed by mutism in typhoid coma in this case should be brought to the attention of clinicians worldwide.Additionally,the enduring speech limitations and potential psychiatric consequences may be linked to the prolonged duration of the infection.
文摘西方的科学研究成果大多来源于英语的语言文化环境,把西方的科学研究成果介绍到中国,必须重视英语的语言文化环境和汉语的语言文化环境的不同,这样才能使国人准确、方便地应用西方的科学研究成果,西学东渐。格拉斯哥昏迷评分(Glasgow coma scale)被翻译、介绍到国内已有数十年,但汉语版的"Glasgow coma scale"多种多样,容易造成初学者和使用者的迷惑。本文复习有关"Glasgow coma scale"的原始英式英文文献、美式英语英文文献和以往的几个主要的汉语翻译版。结合英式英语、美式英语和汉语的语言文化特点,新译了"Glasgow coma scale",以方便医护人员使用。
