Displaying publications 1 - 20 of 90 in total

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  1. Nadarajah A
    Family Practitioner, 1978;3:8-12.
    Matched MeSH terms: Coma; Diabetic Coma
  2. Lee DA, Park KM, Kim HC, Khoo CS, Lee BI, Kim SE
    J Clin Neurophysiol, 2023 May 01;40(4):364-370.
    PMID: 34510091 DOI: 10.1097/WNP.0000000000000894
    PURPOSE: The aims of this study were to identify (1) the spectrum of ictal-interictal continuum (IIC) using the two dimensions of 2HELPS2B score and background suppression and (2) the response to subsequent anti-seizure drugs depends on the spectrum of IIC.

    METHODS: The study prospectively enrolled 62 patients with IIC on EEG. The diagnosis of nonconvulsive status epilepticus was attempted with Salzburg criteria as well as clinical and neuroimaging data. IICs were dichotomized into patients with nonconvulsive status epilepticus and coma-IIC. The 2HELPS2B score was evaluated as the original proposal. The suppression ratio was analyzed with Persyst software.

    RESULTS: Forty-seven cases (75.8%) were nonconvulsive status epilepticus-IIC and 15 cases (24.2%) were coma-IIC. Multivariate analysis revealed that the 2HELPS2B score was the only significant variable dichotomizing the spectrum of IIC (odds ratio, 3.0; 95% confidence interval, 1.06-8.6; P = 0.03 for nonconvulsive status epilepticus-IIC). In addition, the suppression ratio was significantly negatively correlated with 2HELPS2B scores (Spearman coefficient = -0.37, P = 0.004 for left hemisphere and Spearman coefficient = -0.3, P = 0.02 for right hemisphere). Furthermore, patients with higher 2HELPS2B score (74% [14/19] in ≥2 points vs. 44% [14/32] in <2 points, P = 0.03 by χ 2 test) and lower suppression ratio (62% [23/37] in ≤2.18 vs. 35% [6/17] in >2.18, P = 0.06 by χ 2 test) seemed to be more responsive to subsequent anti-seizure drug.

    CONCLUSIONS: The 2HELPS2B score and background suppression can be used to distinguish the spectrum of IIC and thereby predict the response to subsequent anti-seizure drug.

    Matched MeSH terms: Coma
  3. Tan BY, Cheah JS, Tan SK, Chew BK
    Med J Malaya, 1970 Jun;24(4):308-10.
    PMID: 4248355
    Matched MeSH terms: Diabetic Coma*
  4. Kan CH, Saffari M, Khoo TH
    Malays J Med Sci, 2009 Oct;16(4):25-33.
    PMID: 22135509 MyJurnal
    Traumatic Brain Injury (TBI) in children has been poorly studied, and the literature is limited. We evaluated 146 children with severe TBI (coma score less than 8) in an attempt to establish the prognostic factors of severe TBI in children.
    Matched MeSH terms: Coma; Glasgow Coma Scale
  5. von Tunzelmann EW
    Matched MeSH terms: Coma
  6. BROWNE J
    Med J Malaya, 1954 Dec;9(2):99-114.
    PMID: 14355274
    Matched MeSH terms: Insulin Coma*
  7. Chong SL, Ong GY, Zheng CQ, Dang H, Ming M, Mahmood M, et al.
    Neurosurgery, 2021 07 15;89(2):283-290.
    PMID: 33913493 DOI: 10.1093/neuros/nyab157
    BACKGROUND: Although early coagulopathy increases mortality in adults with traumatic brain injury (TBI), less is known about pediatric TBI.

    OBJECTIVE: To describe the prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet levels of children with moderate to severe TBI to identify predictors of early coagulopathy and study the association with clinical outcomes.

    METHODS: Using the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) TBI retrospective cohort, we identified patients <16 yr old with a Glasgow Coma Scale (GCS) ≤13. We compared PT, APTT, platelets, and outcomes between children with isolated TBI and multiple trauma with TBI. We performed logistic regressions to identify predictors of early coagulopathy and study the association with mortality and poor functional outcomes.

    RESULTS: Among 370 children analyzed, 53/370 (14.3%) died and 127/370 (34.3%) had poor functional outcomes. PT was commonly deranged in both isolated TBI (53/173, 30.6%) and multiple trauma (101/197, 51.3%). Predictors for early coagulopathy were young age (adjusted odds ratio [aOR] 0.94, 95% CI 0.88-0.99, P = .023), GCS

    Matched MeSH terms: Glasgow Coma Scale
  8. Seed, H.F., Thong, K.S., Siti-Nor Aizah, A.
    MyJurnal
    Although disturbance of consciousness in delirium patients have been well
    established, but sudden drop of Glasgow Coma Scale (GCS) level to three is
    frightening and mysterious. We are reporting a case of a delirious elderly
    man with multiple medical illnesses presented with acute precipitous
    decrement of GCS with pin point pupils bilaterally after given a course of
    benzodiazepines and regained full consciousness spontaneously 32 hours
    later. We discussed the use of deliriogenic medications in the context of
    delirious elderly gentleman with multiple medical illnesses. We also looked
    into the possible differentials of sudden drop of conscious level with bilateral
    pin point pupils.
    Matched MeSH terms: Glasgow Coma Scale
  9. Liong CC, Rahmat K, Mah JS, Lim SY, Tan AH
    Can J Neurol Sci, 2016 Sep;43(5):719-20.
    PMID: 27670213 DOI: 10.1017/cjn.2016.269
    Matched MeSH terms: Glasgow Coma Scale
  10. Alcamo AM, Weiss SL, Fitzgerald JC, Kirschen MP, Loftis LL, Tang SF, et al.
    Pediatr Crit Care Med, 2022 Aug 01;23(8):593-605.
    PMID: 36165937 DOI: 10.1097/PCC.0000000000002979
    OBJECTIVES: To compare outcomes associated with timing-early versus late-of any neurologic dysfunction during pediatric sepsis.

    DESIGN: Secondary analysis of a cross-sectional point prevalence study.

    SETTING: A total of 128 PICUs in 26 countries.

    PATIENTS: Less than 18 years with severe sepsis on 5 separate days (2013-2014).

    INTERVENTIONS: None.

    MEASUREMENTS AND MAIN RESULTS: Patients were categorized as having either no neurologic dysfunction or neurologic dysfunction (i.e., present at or after sepsis recognition), which was defined as Glasgow Coma Scale score less than 5 and/or fixed dilated pupils. Our primary outcome was death or new moderate disability (i.e., Pediatric Overall [or Cerebral] Performance Category score ≥3 and change ≥1 from baseline) at hospital discharge, and 87 of 567 severe sepsis patients (15%) had neurologic dysfunction within 7 days of sepsis recognition (61 at sepsis recognition and 26 after sepsis recognition). Primary site of infection varied based on presence of neurologic dysfunction. Death or new moderate disability occurred in 161 of 480 (34%) without neurologic dysfunction, 45 of 61 (74%) with neurologic dysfunction at sepsis recognition, and 21 of 26 (81%) with neurologic dysfunction after sepsis recognition (p < 0.001 across all groups). On multivariable analysis, in comparison with those without neurologic dysfunction, neurologic dysfunction whether at sepsis recognition or after was associated with increased odds of death or new moderate disability (adjusted odds ratio, 4.9 [95% CI, 2.3-10.1] and 10.7 [95% CI, 3.8-30.5], respectively). We failed to identify a difference between these adjusted odds ratios of death or new moderate disability that would indicate a differential risk of outcome based on timing of neurologic dysfunction (p = 0.20).

    CONCLUSIONS: In this severe sepsis international cohort, the presence of neurologic dysfunction during sepsis is associated with worse outcomes at hospital discharge. The impact of early versus late onset of neurologic dysfunction in sepsis on outcome remains unknown, and further work is needed to better understand timing of neurologic dysfunction onset in pediatric sepsis.

    Matched MeSH terms: Glasgow Coma Scale
  11. Yeoh CW, Law WC
    Medicine (Baltimore), 2023 Dec 22;102(51):e36676.
    PMID: 38134114 DOI: 10.1097/MD.0000000000036676
    RATIONALE: Heat-related illnesses have protean manifestations that can mimic other life-threatening conditions. The diagnosis of heat stroke requires a high index of suspicion if the patient has been exposed to a high-temperature environment. Central nervous system dysfunction is a cardinal feature. Strict adherence to temperature criteria can potentially lead to misdiagnosis.

    PATIENT CONCERNS: A 37-year-old construction worker was brought in by his wife and coworker due to a sudden loss of consciousness while resting after completing his work.

    DIAGNOSES: Due to challenges faced during the coronavirus disease 2019 pandemic, as well as language barriers, a detailed history from the coworker who witnessed the patient's altered sensorium was not available. He was initially suspected of having encephalitis and brainstem stroke. However, subsequent investigations revealed multiorgan dysfunction with a normal brain computed tomography and cerebral computed tomography angiogram. In view of the multiple risk factors for heat stroke, pupillary constriction, and urine color suggestive of rhabdomyolysis, a diagnosis of heat stroke was made.

    INTERVENTIONS: Despite delayed diagnosis, the patient's multiorgan dysfunction recovered within days with basic supportive care.

    OUTCOMES: There were no noticeable complications on follow-up 14 months later.

    LESSONS: Heat stroke can be easily confused with other neurological pathologies, particularly if no history can be obtained from the patient or informant. When approaching a comatose patient, we propose that serum creatinine kinase should be considered as an initial biochemical screening test.

    Matched MeSH terms: Coma
  12. Sofiah A, Hussain IH
    Ann Trop Paediatr, 1997 Dec;17(4):327-31.
    PMID: 9578792
    All post-neonatal children with acute non-traumatic coma admitted over an 8-month period were analysed and followed up for 18-24 months to determine the aetiology and outcome of their coma. One hundred and sixteen children, 72 boys and 44 girls, were recruited. Half the children were under 1 year of age and only 16 (14%) were more than 6 years of age. Eighty cases (69%) were due to infection, 15 (13%) to toxic metabolic causes, six (5%) to hypoxic ischaemic insults, four (3.5%) had intracranial haemorrhage, nine (7.8%) were due to miscellaneous causes and in two (1.7%) the cause was unknown. Seven cases were lost to follow-up. Of the remainder, 39 (35.7%) died, 32 (29.3%) developed permanent neurological deficit, and 38 (35%) were discharged well. The outcome was worst in the infectious group. Age of onset and sex did not significantly affect outcome. Our findings are similar to experience in Japan, where infection accounts for 74% of non-traumatic coma, but differ considerably from Western data on childhood coma where only a third of cases are due to infection.
    Matched MeSH terms: Coma/etiology*; Coma/microbiology
  13. Lim TO, Ngah BC
    Med J Malaysia, 1990 Sep;45(3):260-2.
    PMID: 2152091
    We report a patient with hyperosmolar non-ketotic hyperglycaemia who presented with chorea and septic arthritis on his knee. The chorea resolved completely and quickly with correction of the metabolic disturbance, only to return just as quickly when his metabolic disturbance subsequently deteriorated as a result of overwhelming septicaemia, suggesting coexisting cerebral ischaemia, although the basis of focal neurological sign in non-ketotic hyperglycaemia remains controversial.
    Matched MeSH terms: Hyperglycemic Hyperosmolar Nonketotic Coma/complications; Hyperglycemic Hyperosmolar Nonketotic Coma/diagnosis*
  14. Chan YF
    Med J Malaya, 1972 Mar;26(3):211-4.
    PMID: 5031019
    Matched MeSH terms: Diabetic Coma/drug therapy; Diabetic Coma/etiology*
  15. Arumugasamy N, Siqueira EB
    Med J Malaya, 1970 Dec;25(2):155-60.
    PMID: 4251137
    Matched MeSH terms: Diabetic Coma/complications; Diabetic Coma/etiology*
  16. Visvanathan R
    Aust N Z J Surg, 1994 Aug;64(8):527-9.
    PMID: 8048888
    Sixty-nine severely head-injured patients treated by general surgeons over a 28 month period with admission Glasgow Coma Scale motor scores of 3 to 8 were reviewed retrospectively. Fifty-one patients were comatose on admission with periods from injury to admission exceeding 4 h in 34 patients who were referred from peripheral hospitals. Forty patients with acute intracranial bleeding underwent emergency decompressive surgery with 13 good recoveries and 18 deaths; good recoveries were observed in 11 of 20 patients with extradural haemorrhages, one out of eight patients with subdural haemorrhages, and one of 12 patients with intracerebral and/or combined haemorrhages. Twenty-nine patients with no evidence of acute mass lesions were treated medically with sedation, mechanical ventilation and mannitol infusion for cerebral decompression with seven good recoveries and 16 deaths. There were 15 good outcomes in 40 patients with admission motor scores of 6, 7 or 8 and five good outcomes in 29 patients with scores of 3, 4 or 5. A good outcome of 29% in the study may be improved by (i) better neurosurgical training of surgical and nursing staff; (ii) provision of technologically advanced diagnostic and treatment modalities; (iii) an efficient referral system; and (iv) provision of effective long-term rehabilitation.
    Matched MeSH terms: Coma/surgery; Glasgow Coma Scale
  17. Law ZK, Meretoja A, Engelter ST, Christensen H, Muresan EM, Glad SB, et al.
    Eur Stroke J, 2017 Mar;2(1):13-22.
    PMID: 31008298 DOI: 10.1177/2396987316676610
    Purpose: Haematoma expansion is a devastating complication of intracerebral haemorrhage (ICH) with no established treatment. Tranexamic acid had been an effective haemostatic agent in reducing post-operative and traumatic bleeding. We review current evidence examining the efficacy of tranexamic acid in improving clinical outcome after ICH.

    Method: We searched MEDLINE, EMBASE, CENTRAL and clinical trial registers for studies using search strategies incorporating the terms 'intracerebral haemorrhage', 'tranexamic acid' and 'antifibrinolytic'. Authors of ongoing clinical trials were contacted for further details.

    Findings: We screened 268 publications and retrieved 17 articles after screening. Unpublished information from three ongoing clinical trials was obtained. We found five completed studies. Of these, two randomised controlled trials (RCTs) comparing intravenous tranexamic acid to placebo (n = 54) reported no significant difference in death or dependency. Three observational studies (n = 281) suggested less haematoma growth with rapid tranexamic acid infusion. There are six ongoing RCTs (n = 3089) with different clinical exclusions, imaging selection criteria (spot sign and haematoma volume), time window for recruitment and dosing of tranexamic acid.

    Discussion: Despite their heterogeneity, the ongoing trials will provide key evidence on the effects of tranexamic acid on ICH. There are uncertainties of whether patients with negative spot sign, large haematoma, intraventricular haemorrhage, or poor Glasgow Coma Scale should be recruited. The time window for optimal effect of haemostatic therapy in ICH is yet to be established.

    Conclusion: Tranexamic acid is a promising haemostatic agent for ICH. We await the results of the trials before definite conclusions can be drawn.

    Matched MeSH terms: Glasgow Coma Scale
  18. Mohamed Ludin S, Abdul Rashid N
    Clin Nurs Res, 2020 09;29(7):433-439.
    PMID: 30079766 DOI: 10.1177/1054773818792459
    Throughout recovery, patients with severe traumatic brain injury (TBI) show physical and functional improvement, but continue to have cognitive and psychosocial problems. The aim of this article was to review the literature regarding the functional and health-related quality of life (HRQOL) outcomes in severe TBI. There were 15 articles reviewed, 13 of them were quantitative studies and two were narrative review. Most of the articles showed an improvement occurs rapidly at 6 months post-injury. There were several factors that influence the outcome after TBI, most of it was the Glasgow Coma Scale (GCS) on admission, age, educational level, duration of posttraumatic amnesia (PTA), and length of stay (LOS) in the Intensive Care Unit (ICU). Thus, health care workers should help the survivors of severe TBI in the recovery process to ensure the latter can attain maximum function and quality of life.
    Matched MeSH terms: Glasgow Coma Scale
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