- Corneal crosslinking without epithelial removal. [Journal Article]
- JCJ Cataract Refract Surg 2018 Sep 15
- CONCLUSIONS: Epithelium-on CXL using this new protocol halted the progression of keratoconus and ectasia after LASIK. It was safer and provided more rapid visual recovery than CXL with epithelial removal, allowing routine bilateral, simultaneous treatment.
- Disorders of Consciousness due to Traumatic Brain Injury: Functional Status Ten Years Post-Injury. [Journal Article]
- JNJ Neurotrauma 2018 Sep 18
- Few studies have assessed the long-term functional outcomes of patients with a disorder of consciousness due to traumatic brain injury (TBI). This study examined functional status during the first te...
Few studies have assessed the long-term functional outcomes of patients with a disorder of consciousness due to traumatic brain injury (TBI). This study examined functional status during the first ten years after TBI among a cohort with disorders of consciousness (i.e., coma, vegetative state, minimally conscious state). The study sample included 110 individuals with TBI who were unable to follow commands prior to inpatient rehabilitation and for whom follow-up data were available at 1, 2, 5, and 10 years post-injury. The sample was subdivided into those who demonstrated command-following early (before 28 days post-injury) versus late (>28 days post-injury or never). Functional Independence Measure (FIM) at 1, 2, 5, and 10 years following TBI was used to measure functional outcomes. Measureable functional recovery occurred throughout the 10-year period, with more than 2/3 of the sample achieving independence in mobility and self-care, and about 1/4 achieving independent cognitive function by 10 years. Following commands prior to 28 days was associated with greater functional independence at all outcome time points. Multi-trajectory modeling of recovery of 3 FIM subscales (self-care, mobility, cognition) revealed 4 distinct prognostic groups with different temporal patterns of change on these subscales. More than half the sample achieved near-maximal recovery by 1-year post-injury, while the later command-following subgroups recovered over longer periods of time. Significant late functional decline was not observed in this cohort. Among a cohort of patients unable to follow commands at the time of inpatient rehabilitation, a substantial proportion achieved functional independence in self-care, mobility, and cognition. The proportion of participants achieving functional independence increased between 5 and 10 years post-injury. These findings suggest that individuals with disorders of consciousness may benefit from ongoing functional monitoring and updated care plans for at least the first decade after TBI.
- Predicting Mortality for Adolescent and Adult Patients with Fever in Resource-Limited Settings. [Journal Article]
- AJAm J Trop Med Hyg 2018 Sep 17
- Febrile illnesses are a major cause of mortality in sub-Saharan Africa. Early identification of patients at increased risk of death may avert adverse outcomes. We aimed to independently evaluate the ...
Febrile illnesses are a major cause of mortality in sub-Saharan Africa. Early identification of patients at increased risk of death may avert adverse outcomes. We aimed to independently evaluate the performance of the Modified Early Warning Score, quick Sequential Organ Failure Assessment (qSOFA) score, and Integrated Management of Adolescent and Adult Illness (IMAI) emergency signs and severity criteria to predict in-hospital mortality among a prospective cohort of febrile patients in Tanzania. We evaluated 419 patients aged ≥ 10 years in the period 2007-2008. Of the 44 patients who died, 31 (70.5%) were human immunodeficiency virus (HIV) infected. On univariate analysis, in-hospital mortality was associated with HIV infection, oxygen saturation < 90%, respiratory distress, Glasgow Coma Scale < 15, neck stiffness, unconsciousness, convulsions, hemoglobin < 9 g/dL, absence of a systemic syndrome, and neurologic syndrome. A qSOFA score ≥ 2, the presence of at least one, two, or three IMAI emergency signs, and IMAI severe respiratory distress syndrome without shock were significantly associated with in-hospital mortality. The criterion "presence of at least one IMAI emergency sign" showed a good diagnostic accuracy, as highlighted by the high sensitivity, low negative likelihood ratio, and wide area under the receiver operating characteristics curve. The remaining scores showed a poor performance in predicting fatal outcomes in our study population. Further studies are needed to validate our findings and to derive early warning scores that have good clinical performance in settings throughout sub-Saharan Africa.
- A proposal for prospective evaluation of elderly subjects with low Glasgow Coma Scale. [Letter]
- AJAm J Emerg Med 2018 Sep 14
- Development and pharmacist-mediated use of tools for monitoring atypical antipsychotic-induced side effects related to blood glucose levels. [Journal Article]
- PDPharmacoepidemiol Drug Saf 2018 Sep 17
- CONCLUSIONS: The results suggested that regardless of pharmacists' experience or skill, the introduction of this tool enables centralization of side effect monitoring and can contribute to proper drug use.
- Polymorphonuclear (PMN) elastase in patients after severe traumatic brain injury. [Journal Article]
- EJEur J Med Res 2018 Sep 15; 23(1):44
- CONCLUSIONS: This is the first study to demonstrate that the PMN elastase levels in CSF significantly increased in the early posttraumatic phase (48 h and 72 h after TBI) in patients. The function of the BCSFB showed no significant influence on the PMN levels.
- Clinical Signs of Basilar Skull Fracture and Their Predictive Value in Diagnosis of This Injury. [Journal Article]
- JTJ Trauma Nurs 2018 Sep/Oct; 25(5):301-306
- Although clinical signs for the diagnosis of basilar skull fracture (BSF) are ambiguous, they are widely used to make decisions on initial interventions involving trauma patients. We aimed to assess ...
Although clinical signs for the diagnosis of basilar skull fracture (BSF) are ambiguous, they are widely used to make decisions on initial interventions involving trauma patients. We aimed to assess the performance of early and late (within 48 hr posttrauma) signs for BSF diagnosis and to verify the correlation between the presence of these signs and head injury severity. We conducted a prospectively designed follow-up study at a referral hospital for trauma care in Sao Paulo, Brazil, and performed structured observations for 48 hr post-blunt head injury in patients aged 12 years or older. The following signs of BSF were considered: raccoon eyes, Battle's sign, otorrhea, and rhinorrhea. Among the 136 enrolled patients (85.3% male; mean age 40 ± 21.4 years), 28 patients (20.6%) had BSF. The clinical signs for the early or late detection of BSF had low accuracy (55.9% vs. 43.4%), specificity (52.8% vs. 30.5%), and positive predictive value (25.7% vs. 27.1%). However, the presence of these signs was correlated to head injury severity, indicated by the Glasgow Coma Scale (p = .041) and Maximum Abbreviated Injury Scale-Head region (p = .002). In view of the low accuracy of these signs, resulting low clinical value of their presence, and their high sensitivity in the late stage, the study results contraindicate the value of BSF signs for making decisions about using the nasal route for the introduction of catheters and tubes in initial trauma care.
- EEG Reactivity Evaluation Practices for Adult and Pediatric Hypoxic-Ischemic Coma Prognostication in North America. [Journal Article]
- JCJ Clin Neurophysiol 2018 Sep 13
- CONCLUSIONS: There is substantial variability in EEG reactivity evaluation practices during cardiac arrest prognostication among North American academic hospitals. Efforts are needed to standardize protocols and nomenclature according with national guidelines and promote best practices in EEG reactivity evaluation.
- Intracranial pressure elevations in diffuse axonal injury: association with nonhemorrhagic MR lesions in central mesencephalic structures. [Journal Article]
- JNJ Neurosurg 2018 Sep 14; :1-8
- CONCLUSIONS: Increased ICP occurs in approximately one-third of patients with severe TBI who have DAI. Age and lesions on DWI sequences in the central mesencephalon (i.e., SN-T) are associated with elevated ICP. These findings suggest that MR lesion localization may aid prediction of increased ICP in patients with DAI.
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- Effects of Brain Temperature on the Outcome of Patients with Traumatic Brain Injury: A Prospective Observational Study. [Journal Article]
- JNJ Neurotrauma 2018 Sep 14
- A prospective observational study collected temperature data from 51 patients in 11 neurosurgical centers and follow-up outcome information at 6-months in 49 patients. Brain temperature (T<sub>br</su...
A prospective observational study collected temperature data from 51 patients in 11 neurosurgical centers and follow-up outcome information at 6-months in 49 patients. Brain temperature (T<sub>br</sub>) was measured directly by an intraventricular temperature sensor. Axillary temperature (T<sub>ax</sub>) and rectal temperature (T<sub>re</sub>) were measured by electric thermometers. T<sub>br</sub> was 0.4 ~ 1.5℃ higher than body temperature. T<sub>re</sub> correlated well with the T<sub>br</sub> (coefficient: 0.7378, P<0.05). Among all patients, Glasgow Coma Scale (GCS) scores on admission were significantly lower in the patients with postoperatively extreme peak temperature (T<sub>peak</sub>, <37℃ or >39℃ in first 24 hours) and major temperature variation (T<sub>vari</sub> >1℃ in first 12 hours) (P<0.05, P<0.01, respectively). Among the patients with no temperature intervention, extreme T<sub>peak</sub> group showed a lower Glasgow Outcome Scale-Extended (GOS-E) scores at 6-months (P<0.05) with lower GCS scores on admission (P<0.01), compared to the moderate T<sub>peak</sub> group. Remarkably, the major T<sub>vari</sub> group showed significantly lower GOS-E scores (P<0.05) with the same GCS scores as the minor T<sub>vari</sub> group. Thus, T<sub>re</sub> is the better candidate to estimate T<sub>br</sub>. Spontaneously extreme T<sub>peak</sub> in TBI represents both more serious injury on admission and worse prognosis, and T<sub>vari</sub> might be used as a novel prognostic parameter in TBI. Brain temperature is therefore one of the critical indicators evaluating injury severity, prognostication, and monitoring in the management of TBI. This prospective observational study has been registered in ClinicalTrials.gov (https://clinicaltrials.gov/), and the registration number is NCT03068143.