Role of spherical aberration and coma in orthokeratology for myopia control / 国际眼科杂志(Guoji Yanke Zazhi)

As a highly prevalent global condition, myopia significantly impacts the ocular health of young individuals in China. Orthokeratology lens, as a rigid corneal contact lens, has demonstrated effective control over the progression of myopia; however, its mechanism of action remains incompletely elucidated. As one of the factors influencing visual acuity, higher-order aberrations will undergo marked changes after orthokeratology, with particular emphasis on the alterations in spherical aberrations and coma. The changes in corneal morphology induced by orthokeratology lead to significant positive increase in both spherical aberration and coma. Furthermore, the elevation of spherical aberration and coma demonstrates a negative correlation with the rate of axial length growth following orthokeratology. The interplay among spherical aberration, coma, defocus, accommodation, astigmatism, and pseudo-accommodation may constitute the underlying mechanism governing the control of myopia through orthokeratology.

Glasgow coma scale pupil score (GCS-P) and the hospital mortality in severe traumatic brain injury: analysis of 1,066 Brazilian patients / Escala de coma de Glasgow com resposta pupilar (ECC-P) e mortalidade hospitalar em traumatismo cranioencefálico grave: análise de 1.066 pacientes brasileiros

Abstract Background Pupil reactivity and the Glasgow Coma Scale (CCS) score are the most clinically relevant information to predict the survival of traumatic brain injury (TBI) patients. Objective We evaluated the accuracy of the CCS-Pupil score (CCS-P) as a prognostic index to predict hospital mortality in Brazilian patients with severe TBI and compare it with a model combining CCS and pupil response with additional clinical and radiological prognostic factors. Methods Data from 1,066 patients with severe TBI from 5 prospective studies were analyzed. We determined the association between hospital mortality and the combination of CCS, pupil reactivity, age, glucose levels, cranial computed tomography (CT), or the CCS-P score by multivariate binary logistic regression. Results Eighty-five percent (n = 908) of patients were men. The mean age was 35 years old, and the overall hospital mortality was 32.8%. The area under the receiver operating characteristic curve (AUROC) was 0.73 (0.70-0.77) for the model using the CCS-P score and 0.80 (0.77-0.83) for the model including clinical and radiological variables. The CCS-P score showed similar accuracy in predicting the mortality reported for the patients with severe TBI derived from the International Mission for Prognosis and Clinical Trials in TBI (IMPACT) and the Corticosteroid Randomization After Significant Head Injury (CRASH) studies. Conclusion Our results support the external validation of the CCS-P to predict hospital mortality following a severe TBI. The predictive value of the CCS-P for long-term mortality, functional, and neuropsychiatric outcomes in Brazilian patients with mild, moderate, and severe TBI deserves further investigation.

Resumo Antecedentes A reatividade pupilar e o escore da Escala de Coma de Glasgow (ECC) representam as informações clínicas mais relevantes para predizer a sobrevivência de pacientes com traumatismo cranioencefálico (TCE). Objetivo Avaliar a acurácia da ECC com resposta pupilar (ECC-P) como índice prognóstico para predizer mortalidade hospitalar em pacientes brasileiros acometidos por TCE grave e compará-lo com um modelo combinando ECC e resposta pupilar com fatores prognósticos radiológicos. Métodos Foram analisados dados de 1.066 pacientes com TCE grave de 5 estudos prospectivos. Foi determinada a associação entre mortalidade hospitalar e a combinação de ECC, reatividade pupilar, idade, níveis glicêmicos, tomografia computadorizada (TC) de crânio ou o escore ECC-P por regressão logística binária multivariada. Resultados Oitenta e cinco por cento (n = 908) dos pacientes eram homens. A média de idade foi de 35 anos e a mortalidade hospitalar geral foi de 32,8%. A AUROC (em português, Curva Característica de Operação do Receptor) foi de 0,73 (0,70-0,77) para o modelo utilizando o escore ECC-P e de 0,80 (0,77-0,83) para o modelo incluindo variáveis clínicas e radiológicas. O escore ECC-P mostrou acurácia semelhante na previsão da mortalidade relatada para pacientes com TCE grave derivados dos estudos International Mission for Prognosis and Clinical Trials in TBI (IMPACT, na sigla em inglês) e Corticosteroid Randomization After Significant Head Injury (CRASH, na sigla em inglês). Conclusão Nossos resultados apoiam a validação externa da ECC-P para prever a mortalidade hospitalar após um TCE grave. O valor preditivo da ECC-P para mortalidade a longo prazo, resultados funcionais e neuropsiquiátricos em pacientes brasileiros com TCE leve, moderado e grave precisam ser investigados.

Lesión cerebral post paro cardiaco: aspectos médicos, éticos y legales / Brain injury after cardiac arrest: Medical, ethical and legal issues disorder

RESUMEN Los sobrevivientes de la reanimación cardiopulmonar posterior a un paro cardiaco pueden tener un amplio rango de desenlaces y van desde recuperación neurológica completa, estado de vigilia sin respuesta, compromiso cognoscitivo diverso o la muerte. La lesión del tejido cerebral se presenta inmediatamente después del paro cardíaco, durante la reanimación y al retornar la circulación espontánea. La severidad y duración de la noxa isquémica determinarán el devenir neurológico. El examen clínico es el punto de partida en el abordaje multimodal del neuropronóstico. Se debe complementar con electroencefalograma, potenciales evocados somatosensoriales, neuroimágenes y biomar-cadores séricos. Entre un 10 a 15% de los pacientes con lesión cerebral posterior al paro cardiaco evolucionan hacia muerte por criterios neurológicos y son potenciales candidatos a la donación de órganos. Un retiro temprano de las terapias de sostenimiento de vida puede malograr la posibilidad de un potencial donante de órganos. Se puede estimar de manera temprana qué pacientes tienen mayor riesgo de evolucionar a muerte por criterios neurológicos. El neurólogo tiene un papel protagónico en el manejo de pacientes con lesión cerebral post paro cardiaco y sus decisiones tienen implicaciones éticas y legales.

ABSTRACT People who survive cardiopulmonary resuscitation (CPR) after cardiac arrest, have a wide range of outcomes including complete neurological recovery, coma, compromised cognitive function and death. Injury of the brain parenchyma starts immediately after a cardiac arrest, during CPR and return of spontaneous circulation. The severity of the ischemic injury will define the neurological outcome. The first step needed to determine a neurological prognosis is the clinical exam, with the help of electroencephalography, somatosensory evoked potentials, neuroimaging, and serum biomarkers. Between 10 and 15% of patients with brain injury after a cardiac arrest, develop brain death and become potential candidates for organ donation. A premature withdrawal of vital support can hamper the possibility of organ donation. The patients with higher risk of developing brain death can be identified early based on neurological criteria. The neurologist has a major role in the approach of patients with brain injury after cardiac arrest and the decision making with legal and ethical consequences.

Redo Total Aortic Arch Replacement in Patients with Aortic Dissection After Open-Heart Surgery and Long-Term Follow-Up Results

ABSTRACT Introduction: The objectives of this study were to investigate the main treatment strategies and long-term follow-up results of aortic dissection surgery after open-heart surgery (ADSOHS) and to analyze the risk factors that cause ADSOHS. Methods: One hundred thirty-seven patients with ADSOHS hospitalized in our hospital from January 2009 to December 2018 were selected as the research object. Long-term follow-up results, complications, mortality, and changes of cardiac function before and after operation were used to explore the value of Sun's operation. Results: The length of stay in intensive care unit of these 137 patients ranged from 9.5 to 623.75 hours (average of 76.41±97.29 hours), auxiliary ventilation time ranged from 6.0 to 259.83 hours (average of 46.16±55.59 hours), and hospital stay ranged from six to 85 days (average of 25.06±13.04 days). There were seven cases of postoperative low cardiac output, 18 cases of coma and stroke, and six cases of transient neurological dysfunction. A total of 33 patients died; 19 patients died during the perioperative period, 18 died during Sun's operation and one died during other operation; and 14 patients died during follow-up (January 2021), 12 cases of Sun's operation and two cases of other operations. Conclusion: ADSOHS treatment strategy is of high application value, and the risk of neurological complications and mortality is low. The main risk factors are postoperative low cardiac output, coma, stroke, and transient neurological dysfunction. The extracorporeal circulation time is relatively long. Short- and long-term follow-up effects are good, and it is worthy of clinical promotion.

The new prognostic factor in pre-intubation follow-up of critically ill patients: integrated pulmonary index monitoring

SUMMARY OBJECTIVE: The objective of this study was to identify the integrated pulmonary index in the follow-up of non-intubated critically ill patients in the emergency department and its efficacy in deciding on advanced airway application in comparison with the Glasgow Coma Scale. METHODS: This is a prospective, single-center, methodological study. In our study, we recorded the demographic characteristics, Glasgow Coma Scale, and the integrated pulmonary index of 90 patients with respiratory failure who were followed up in the emergency department between June 1, 2019 and September 1, 2019, and we compared the results of Glasgow Coma Scale and integrated pulmonary index in making the endotracheal intubation decision. RESULTS: Endotracheal intubation was applied to 30% of the 90 patients included in the study. The area under the curve was calculated as 0.906 for integrated pulmonary index and 0.860 for Glasgow Coma Scale in predicting endotracheal intubation. There was no significant difference between the area under the curves of integrated pulmonary index and Glasgow Coma Scale. According to the best cutoff values determined in the estimation of endotracheal intubation, sensitivity was 74.07% and specificity was 95.24% for integrated pulmonary index, and sensitivity was 74.07% and specificity was 85.71% for Glasgow Coma Scale. CONCLUSION: The integrated pulmonary index monitoring provides an objective evaluation in the follow-up of critically ill patients with spontaneous breathing in the emergency department and is predictive in deciding on timely endotracheal intubation.

Análise do conhecimento da escala de coma de glasgow em acadêmicos de enfermagem cursando o último e penúltimo semestres / Analysis of knowledge of the glasgowcoma scale in nursing students in their last and penultimate semesters / Análisis del conocimiento de la Escala de Coma de Glasgow en estudiantes de enfermería del último y penúltimo semestre

Objetivo: analisar o conhecimento da Escala de Coma de Glasgow em acadêmicos de enfermagem cursando o último e penúltimo semestres do Centro Universitário Planalto do Distrito Federal Campus Águas Claras.Método: Este estudo utilizou-se abordagem quantitativa com o método descritivo, utilizando para coleta de dados um questionário com seis questões objetivas.Resultado: A pesquisa realizada com uma amostra de 20 acadêmicos de enfermagem, evidenciou que 80% demonstraram saber o que é avaliado na escala, porém constatou-se que apenas 20% entendem como utilizar de forma correta a escala de coma de Glasgow.Conclusão: a maioria dos acadêmicospossui conhecimento teórico sobre a Escala de Coma de Glasgow, entretanto possuem déficit na aplicação da escala

Objective:to analyze the knowledge of the Glasgow Coma Scale in nursing students in the last and penultimate semesters of Centro Universitário Planalto do Distrito Federal Campus Águas Claras. Method:This study used a quantitative approach with the descriptive method, using a questionnaire with six objective questions for data collection. Results:The research carried out with a sample of 20 nursing students showed that 80% demonstrated that they know what is evaluated on the scale, but it was found that only 20% understand how to correctly use the Glasgow Coma Scale. Conclusion:most students have theoretical knowledge about the Glasgow Coma Scale, but they have deficits in the application of the scale.

Objetivo:Analizar el conocimiento de la Escala de Coma de Glasgow en estudiantes de enfermería que cursan el último y penúltimo semestre del Centro Universitario Planalto del Distrito Federal Campus Águas Claras. Método:Este estudio utilizó un enfoque cuantitativo con el método descriptivo, utilizando un cuestionario con seis preguntas objetivas para la recolección de datos. Resultados:La investigación realizada con una muestra de 20 estudiantes de enfermería mostró que el 80% demostró saber lo que se evalúa en la escala, pero se encontró que solo el 20% entiende cómo utilizar correctamente la Escala de Coma de Glasgow. Conclusión:la mayoría de los estudiantes tienen conocimientos teóricos sobre la Escala de Coma de Glasgow, pero tienen déficits en la aplicación de la escala.

Comas non traumatiques chez l'adulte à l'Unité de soins intensifs du Centre Hospitalier Universitaire Sylvanus Olympio: à propos de 484 cas / Non-traumatic comas with the adult in the intensise care unit of the Sylvanus Olympio Teaching Hospital: concerning 484 cases

Introduction : Le coma non traumatique est une urgence médicale, relativement fréquente dont les différents aspects restent encore obscurs dans les services de réanimation en Afrique. Objectif : Cette étude avait pour but de décrire les aspects épidémiologiques, étiologiques et pronostiques des comas non traumatiques (CNT). Méthodes : Il s'était agi d'une étude rétrospective descriptive menée au Centre Hospitalier Universitaire Sylvanus Olympio à l'Unité des Soins Intensifs (USI) de janvier 2018 à décembre 2019. Résultats : L'étude avait concerné 484 patients hospitalisés pour comas non traumatiques sur un total de 1835 patients. Les comas non traumatiques de l'adulte représentaient 26,4% des admissions à l'USI. L'âge moyen des patients était de 52,8 ans (extrêmes de 18 et 92 ans) avec une sex-ratio (H/F) de 0,94. Plus de la moitié des patients avait été référée de structures sanitaires périphériques (55,4%). L'hypertension artérielle (HTA) était l'antécédent le plus retrouvé dans 36,4% ; suivi du diabète et de l'infection au virus de l'immunodéficience acquise (VIH) dans 14,9% chacun. Le coma était de survenue brutale dans 77,7% des cas. Les étiologies des comas étaient dominées par les causes vasculaires dans 32,2% des cas, puis les causes infectieuses dans 27,3% des cas et les comas urémiques dans 14,1% des cas. Le pronostic était défavorable avec une mortalité de 68,6%. La première étiologie de décès concernait les causes vasculaires. Conclusion : L'amélioration du pronostic des comas non traumatiques passe nécessairement par une amélioration du plateau technique pour une meilleure prise en charge des patients

Introduction: The non-traumatic coma is a medical emergency relatively frequent which different aspects remain obscure in intensive care units in Africa. Goals: The aim of this study was therefore to describe the epidemiological, etiological and prognostic aspects of non-traumatic comas. Methodology: This was a retrospective descriptive study carried out at the Sylvanus Olympio Teaching Hospital in the Intensive Care Unit (USI) from January 2018 to December 2019. Results: The study involved 484 patients hospitalized for non-traumatic comas out of 1835 patients. Non-traumatic comas in adults were 26.4% of admissions in the Intensive Care Unit. The mean age of patients was 52.8 years of a sex ratio (M / F) of 0.94. More than half of patients (55.4%) were referred from peripheral care centers. Arterial hypertension was the most common antecedent found in 36.4%, followed by diabetes and the infection of human immunodeficiency virus (HIV) at 14.9% each. The coma was sudden aspect in 77.7% of the cases. Aetiologies of the comas were dominated by vascular causes in 32.2% of causes, then infectious in 27.3% of cases and uremic comas in 14.1% of cases. The prognosis was unfavorable with 68.6% mortality. The first etiology of death was related to vascular cases. Conclusion: The Improving of the prognosis of non-traumatic comas needs an improvement of modern medical technology for a better patient care.

Troubles de la conscience au service de réanimation polyvalente du Centre Hospitalier Universitaire Analakininina, Toamasina, Madagascar / Impaired consciousness in the intensive care unit at Analankininina Teaching Hospital of Toamasina, Madagascar

La survenue d'un coma ou de troubles de la conscience en réanimation est très fréquemment observée et leur présence est associée à un pronostic sévère. Nos objectifs étaient de décrire le profil épidémio-clinique des patients admis pour coma et trouble de la conscience ainsi que les principales étiologies de ces manifestations cliniques. Méthodes : Il s'agissait d'une étude prospective, descriptive, longitudinale de Juin à Novembre 2019. Le cadre de notre étude était le service de réanimation polyvalente du centre hospitalier universitaire (CHU) Analakininina Toamasina. Résultats : Nous avions recensé 77 patients dont 37 femmes et 40 hommes (sex ratio de 1,081). La moyenne d'âge était de 39 +/-17 ans. La majorité des patients soit 67% présentait un trouble de la conscience, le reste (31%) était comateux. La principale étiologie des troubles rencontrés était l'AVC (53%) dont 61% était hémorragiques, 17% ischémiques, et 22% non étiquetés. Plus de la moitié des patients avaient évolué vers le décès (61%). Conclusion : Pour l'amélioration du pronostic des patients, il serait nécessaire de connaitre les étiologies fréquentes afin d'adapter la prise en charge

Les facteurs associés aux morbi-mortalités maternelles de l'éclampsie à la maternité de Befelatanana / Factors associated with maternal eclampsia morbidity and mortality at the maternity hospital of Befelatanana

L'éclampsie est une complication neurologique majeure de la pré-éclampsie sévère, responsable d'une lourde morbidité et mortalité maternelle. L'objectif de cette étude était de déterminer les facteurs associés aux morbimortalités maternelles de l'éclampsie. Patients et Méthodes : Il s'agissait d'une étude rétrospective, transversale, descriptive et analytique ; sur une période de 36 mois, allant de Janvier 2019 à Décembre 2021, réalisée à la maternité de Befelatanana. Les paramètres cliniques et obstétricales, la prise en charge, les complications et l'évolution maternelle ont été les paramètres étudiés. Résultats : Sur 21 514 accouchements, 461 cas (2,14%) d'éclampsie ont été recensé dont 288 cas inclus dans l'étude. L'âge moyen était de 23,29±6 ans ; l'âge gestationnel était > 37 semaine d'aménorrhée dans 60,10% (n= 173) des cas et la grossesse étaient mal suivies dans 49,70% (n=143) des cas. Les complications maternelles dominées par : la détresse respiratoire aigüe sur pneumopathie d'inhalation; le coma prolongé ; une hémorragie intracérébrale et l'association à d'autres complications tel que : un HELLP syndrome, un hématome rétroplacentaire et une insuffisance rénale oligo-anurique aigue. Les facteurs associés aux décès étaient : l'existence de trouble de la conscience postcritique (p=0,026 ; OR=3,2 [1,09-9,37]), l'existence de coma prolongé ≥24h (p=10-8 ; OR=34 [11,47-100,71]), l'existence d'une insuffisance rénale aigue (p=10-4 ; OR=4,42 [2,08-9,4]) et l'association à un HELLP syndrome (p=10-8 ; OR=29,16 [12,08-70,41]). Conclusion : La morbi-mortalité de l'éclampsie reste encore très élevé à Madagascar ; une éducation de la population Malagasy doit être renforcer sur le suivi médical rapproché de la grossesse

Effects of Sevoflurane and Propofol on Neurological Recovery of Traumatic Brain Injury Patients in the Early Postoperative Stage: A Retrospective Cohort Study / 中国医学科学杂志(英文版)

Objective To investigate the effects of propofol and sevoflurane on neurological recovery of traumatic brain injury (TBI) patients in the early postoperative stage.Methods We retrospectively analyzed the clinical data of TBI patients who underwent craniotomy or decompressive craniectomy. Generalized additive mixed model (GAMM) was used to analyze effects of propofol and sevoflurane on Glasgow Coma Scale (GCS) on postoperative days 1, 3, and 7. Multivariate regression analysis was used to analyze effects of the two anesthetics on Glasgow Outcome Scale (GOS) at discharge.Results A total of 340 TBI patients were enrolled in this study. There were 110 TBI patients who underwent craniotomy including 75 in the propofol group and 35 in the sevoflurane group, and 134 patients who underwent decompressive craniectomy including 63 in the propofol group and 71 in the sevoflurane group. It showed no significant difference in GCS at admission between the propofol and the sevoflurane groups among craniotomy patients (β = 0.75, 95%CI: -0.55 to 2.05, P = 0.260). However, elevation in GCS from baseline was 1.73 points (95%CI: -2.81 to -0.66, P = 0.002) less in the sevoflurane group than that in the propofol group on postoperative day 1, 2.03 points (95%CI: -3.14 to -0.91, P < 0.001) less on day 3, and 1.31 points (95%CI: -2.43 to -0.19, P = 0.022) less on day 7. The risk of unfavorable GOS (GOS 1, 2, and 3) at discharge was higher in the sevoflurane group (OR = 4.93, 95%CI: 1.05 to 23.03, P = 0.043). No significant difference was observed among two-group decompressive craniectomy patients in GCS and GOS.Conclusions Compared to propofol, sevoflurane was associated with worse neurological recovery during the hospital stay in TBI patients undergoing craniotomy. This difference was not detected in TBI patients undergoing decompressive craniectomy.

CT features of inflammatory pseudotumor like follicular dendritic cell sarcoma of the spleen / 中华肝胆外科杂志

Objective:To explore the CT features of inflammatory pseudotumor like follicular dendritic cell sarcoma (FDCS) of the spleen.Methods:The clinical data of 12 patients with splenic inflammatory pseudotumor like FDCS admitted to 3 central hospitals including Yongjia People's Hospital in Zhejiang Province from January 2015 to December 2022 were retrospectively analyzed, including 4 males and 8 females, with a median age of 60 years old. The number, shape, size and CT features of the lesions were analyzed based on patient's CT image data.Results:CT scans of 12 patients showed 15 lesions, including 10 single lesions and 2 multiple lesions. The lesions were circular in 5 cases, elliptical in 4 cases, and irregular in 3 cases. The median maximum diameter of the mass is 6.5 cm. On plain scan, all 12 tumors showed low density or slightly low density. The CT value is (41.3±7.2) HU; 8 cases had uneven density and 4 cases had uniform density. There were 8 cases with clear tumor boundaries and 4 cases with unclear boundaries. There were 8 cases with tumor necrosis and cystic transformation, and 5 cases showed patchy bleeding lesions in the center of the tumor. Enhancement: the arterial phase shows small patches or flocculent enhancement at the edges or parenchymal parts of the tumor, with CT value of (56.0±3.8) HU. Among them, there were 7 cases of mild enhancement, 4 cases of moderate enhancement, and 1 case of significant enhancement. During the portal phase, there was mild to moderate persistent small patchy uneven enhancement, with CT value of (62.0±4.3) HU. Among them, there were 8 cases of mild enhancement and 4 cases of moderate enhancement. The delayed phase showed a slow withdrawal of enhancement, with CT value of (45.0±8.2) HU. All 12 cases underwent complete resection and were diagnosed with FDCS through pathological examination.Conclusion:FDCS plain scan shows circular or elliptical uneven low-density masses, with small patches or flocculent light to moderate uneven enhancement in the arterial phase, continuous enhancement in the portal phase, and slow withdrawal in the delayed phase as the main characteristics.

Clinical diagnosis and prognosis analysis in patients with emergency septic encephalopathy / 中国医师杂志

Objective:To investigate the clinical diagnosis and prognosis in patients with emergency septic encephalopathy.Methods:Case data of 131 patients with septic encephalopathy admitted to the emergency department of Chuiyangliu Hospital Affiliated to Tsinghua University from January 2020 to December 2021 were selected and divided into survival group and death group. Logistic regression was used to analyze the risk factors affecting diagnosis, treatment and prognosis in patients with septic encephalopathy. Receiver operating characteristic (ROC) curve was used to evaluate the prognostic value of each indicator in patients with septic encephalopathy.Results:The mean arterial pressure (MAP) and pH level in the death group were lower than those in the survival group, while the C reactive protein (CRP), troponin T (TNI), D-dimer, lactic acid, creatinine, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, Sequential Organ Failure Assessment (SOFA), proportion of ventilator support, proportion of vasoactive drug use in the death group were higher than those in the survival group, with statistically significant difference (all P<0.05). Multivariate logistic regression analysis showed that APACHEⅡ score ( OR=1.290, 95% CI: 1.121-1.485, P<0.001), SOFA score ( OR=1.447, 95% CI: 1.183-1.796, P<0.001), the proportion of vasoactive drug use ( OR=18.720, 95% CI: 4.486-78.108, P<0.001) could predict the prognosis of patients with septic encephalopathy, and the area under the curve (AUC) was 0.823, 0886, 0.787. Conclusions:Elderly age and underlying brain diseases are important factors in the occurrence of septic encephalopathy. APACHE Ⅱ score, SOFA score, and the proportion of vasoactive drug use can predict the prognosis of patients with septic encephalopathy.

The value of monitoring regional cerebral oxygen saturation in the prognosis assessment of comatose children in PICU / 中国小儿急救医学

Objective:To evaluate the value of monitoring regional cerebral oxygen saturation (rSO 2) in the prognosis of comatose children in pediatric intensive care unit (PICU). Methods:A total of 127 coma children who admitted to PICU at Henan Children′s Hospital from January 2019 to September 2021 were collected and divided into mild[Glasgow coma score(GCS): 13-15], moderate(GCS: 9-12) and severe coma(GCS: 3-8) groups according to GCS.A cerebral oxygen monitor was used to monitor the rSO 2 of all children before treatment, and on the 3rd, 7th and 14th day after treatment.The outcomes were assessed according to the pediatric cerebral performance category (PCPC), and the children were divided into recovery group(PCPC score: 1), disability group(PCPC score: 2-4) and poor prognosis group(PCPC score: 5-6). Multiple linear regression and receiver operating characteristic(ROC) curve were used to analyze the correlation between rSO 2 and PCPC score. Results:rSO 2 in mild, moderate and severe coma groups before treatment were (78.06±3.21)%, (66.07±6.05)%, and (52.87±6.49)%, respectively ( F=209.263, P<0.05). rSO 2 before treatment was positively correlated with GCS( r=0.806, P<0.05). There were significant differences in rSO 2 among recovery group, disability group and poor prognosis group before treatment and that on the 3rd, 7th and 14th day after treatment ( P<0.05). Notably, rSO 2 in recovery group was higher than that in disability group, and rSO 2 in disability group was higher than that in poor prognosis group.The rSO 2 of three groups showed an increasing trend over time ( P<0.05). Multiple linear regression analysis showed that rSO 2 on the 7th and 14th day of treatment were independent prognostic factors ( OR -0.042, 95% CI -0.082~0.003, P<0.05; OR -0.047, 95% CI -0.094~0.000, P<0.05). ROC analysis showed that rSO 2 on the 7th day of treatment had a relatively higher prognostic value for children in coma, and the area under the ROC curve for predicting the prognosis of abnormal brain function and no wakefulness were 0.741 and 0.746, respectively. Conclusion:Monitoring rSO 2 has predictive value for the prognosis of brain function of coma children in PICU, in which the prognostic value of rSO 2 on the 7th day after treatment is relatively higher and can be used as a reference index for prognosis assessment of coma children in PICU.

The Effect of Monochromatic Aberrations of the Cornea on Contrast Sensitivity under Photopic and Mesopic Conditions

Purpose: Vision is one of the most important senses. The first stage of vision is the creation of the observed object抯 image on the retina. The quality of the retinal image is affected by several factors, such as diffraction, sampling on the retina, chromatic aberration, scattering and higher order aberrations. The measurement of the quality is achieved both with subjective (visual acuity, contrast sensitivity) and objective methods (PSF, MTF, Strehl ratio, RMS). The purpose of this project is the measurement of higher order aberrations of the anterior corneal surface (with a Placido corneal topographer) and of the contrast sensitivity (with a Pelli Robson optotype). Then, we will try to find if there is a correlation between them.Methods and Materials: 20 persons participated in this survey, divided in two groups of 10 persons each. The first group (group 1) included subjects up to 39 years old and the second group (group 2) from 40 years and up. The participants didn抰 have any pathological problems, except lower order refractive errors. Both eyes of each individual were included in the procedure. First, the higher order aberrations of the anterior corneal surface were measured, with the implementation of a Placido corneal topographer. This was followed by a measurement of the contrast sensitivity. The whole procedure took place under two lighting conditions, both photopic and mesopic. The examination presentation of the higher order aberrations is performed with the use of Zernike polynomials.Results: The results of the measuring procedure showed that for the first group, under photopic conditions (luminance 32.70 cd/m2) the mean value (� standard deviation) for the higher order aberrations RMS and decimal logarithm contrast sensitivity was 0.073 � 0.018?m and 1.54 � 0,16 (contrast 2.88 � 1.24%) respectively. For the second group the corresponding values were 0.080 � 0.036?m and 1.59 � 0.16 (contrast 2.57 � 1.24%). Accordingly, under mesopic conditions (luminance 1.14 cd/m2) the values for the first group were 0.252 � 0.064 ?m and 1.27 � 0.15 (contrast 5.37 � 2.06%), while for the second were 0.253 � 0.069?m and 1.32 � 0.12 (contrast 4.79 � 1.35%). Spherical aberration and coma (horizontal and vertical) were also measured for both groups under photopic and mesopic conditions. The results showed that for the first group, under photopic conditions, RMS for coma and spherical aberration is 0.033 � 0.014 ?m and 0.022 � 0.011 ?m respectively, while for the second group 0.041 � 0.027 ?m and 0.024 � 0.008 ?m. Under mesopic conditions, the relevant results are 0.139 � 0.065 ?m and 0.124 � 0.035?m for the first group and 0.149 � 0.066 ?m and 0.107 � 0.038 ?m for the second group.Finally, we should mention here that the equivalent defocus error corresponding to the higher order aberration RMS was estimated. The results for all the participants (without age separation), are 0.23 � 0.09D (photopic conditions) and 0.28 � 0.07D (mesopic conditions).Conclusions: From the statistical analysis of the results we conclude that there exists a symmetry between left and right eyes regarding higher order aberrations. Furthermore, it seems that age is not a significant factor for differences on the magnitude of higher order aberrations both under photopic and mesopic conditions as well. Similar conclusions are also reached for the contrast sensitivity measurements. In addition, we have observed that a correlation exists between the higher order aberrations of the anterior corneal surface and the contrast sensitivity, for both photopic and mesopic conditions. Correlation also exists between coma and contrast only under photopic conditions. But there is no significant correlation between spherical aberration and contrast. The age difference of these two groups has not an effect on the results. Finally, the equivalent defocus is too small, both for photopic and mesopic conditions and between each other, in order to be clinically significant.

Coma mixedematoso asociado a infección por SARS-CoV-2 / Myxedema coma associated with SARS-CoV-2 infection / Coma mixedematoso associado à infecção por SARS-CoV-2

Resumen: Aunque se sabe que la infección por SARS-CoV-2 es una causa importante de enfermedad pulmonar, se han observado múltiples manifestaciones extrapulmonares asociadas a COVID-19. Existen en la literatura reportes de tirotoxicosis secundarios a COVID-19, pero los casos de hipotiroidismo descompensado por COVID-19 son escasos. Reportamos el caso de una paciente de 37 años con obesidad que presentó coma mixedematoso asociado a infección por SARS-CoV-2. El estado proinflamatorio secundario a obesidad, el daño directo a la glándula tiroidea por SARS-CoV-2 y la elevación de mediadores inflamatorios en sangre observados durante la infección viral podrían ser mecanismos que desencadenen el coma mixedematoso. En pacientes con COVID-19 severo es importante la búsqueda intencionada de signos de coma mixedematoso y su confirmación con un perfil tiroideo al ingreso hospitalario.

Abstract: Although SARS-CoV-2 infection is known to be an important cause of lung disease, multiple extrapulmonary manifestations associated with COVID-19 have been observed. There are reports of thyrotoxicosis secondary to COVID-19 in the literature, but cases of decompensated hypothyroidism due to COVID-19 are rare. We report the case of a 37-year-old female patient with obesity who presented myxedema coma associated with SARS-CoV-2 infection. The pro-inflammatory state secondary to obesity, direct damage to the thyroid gland by SARS-CoV-2, and the elevation of inflammatory mediators in the blood observed during viral infection could be mechanisms that trigger myxedema coma. In patients with severe COVID-19, the intentional search for signs of myxedema coma and its confirmation with a thyroid profile at hospital admission is important.

Resumo: Embora a infecção por SARS-CoV-2 seja conhecida por ser uma causa importante de doença pulmonar, foram observadas várias manifestações extrapulmonares associadas ao COVID-19. Há relatos na literatura de tireotoxicose secundária à COVID-19, mas os casos de hipotireoidismo descompensado por COVID-19 são raros. Relatamos o caso de um paciente de 37 anos com obesidade que apresentou coma mixedematoso associado à infecção por SARS-CoV-2. O estado pró-inflamatório secundário à obesidade, o dano direto à glândula tireoide pelo SARS-CoV-2 e a elevação de mediadores inflamatórios no sangue observados durante a infecção viral podem ser mecanismos que desencadeiam o coma mixedematoso. Em pacientes com COVID-19 grave, é importante a busca intencional de sinais de coma mixedematoso e sua confirmação com perfil tireoidiano na admissão hospitalar.

Elementos básicos para el diagnóstico y manejo terapéutico del coma mixedematoso en el paciente adulto / Basic elements for the diagnosis and therapeutic management of myxedematous coma in adult patients

Introducción: A pesar de su baja incidencia, la gravedad del cuadro clínico y la alta mortalidad hacen del coma mixedematoso una complicación a tener en cuenta. Objetivo: Describir los elementos básicos para el diagnóstico y manejo terapéutico del coma mixedematoso en el paciente adulto. Métodos: Se realizó una búsqueda de literatura relevante sobre el tema. Se utilizaron buscadores de información científica como Pubmed y Google Académico. La estrategia de búsqueda incluyó los siguientes términos como palabras clave: hipotiroidismo primario, hipotiroidismo subclínico, diagnóstico y tratamiento. Fueron evaluados artículos de revisión, de investigación y páginas web que tuvieran menos de 10 años de publicados. Se consideraron los textos en idioma español e inglés y que hicieran referencia específicamente al tema de estudio a través del título. Fueron excluidos los artículos que no cumplieron con estas condiciones. Esto permitió el estudio de 64 artículos, de los cuales 40 fueron referenciados. Conclusiones: Para el diagnóstico del coma mixedematoso en el paciente adulto lo más importante es sospecharlo en aquellas personas que presenten factores precipitantes, acompañados de síntomas y signos de hipotiroidismo severo con diferentes grados de insuficiencia del sistema nervioso central, hipotermia, hipoventilación, insuficiencia circulatoria e hiponatremia. A esto se sumaría el escenario humoral característico y los posibles hallazgos dependientes de la enfermedad causante del hipotiroidismo. Se debe tratar con un reemplazo agresivo de levotiroxina sódica (vía endovenosa u oral, según posibilidades), unido a otras medidas de apoyo en el entorno hospitalario(AU)

Introduction: Despite its low incidence, the severity of the clinical picture and the high mortality make myxedematous coma a complication to be taken into account. Objective: Describe the basic elements for the diagnosis and therapeutic management of myxedematous coma in adult patients. Methods: A search of relevant literature on the subject was carried out. Pubmed and Google Scholar were used as search engines for scientific information. The search strategy included the following keyword terms: primary hypothyroidism, subclinical hypothyroidism, diagnosis and treatment. Review articles, research articles and Web pages that, in general, had less than 10 years of publication, in Spanish and English that specifically referred to the subject of study through the title were evaluated. Articles that did not meet these conditions were excluded. This allowed the study of 64 articles, of which 40 were referenced. Conclusions: For the diagnosis of myxedematous coma in the adult patient, the most important thing is to suspect it in those people who present precipitating factors, accompanied by symptoms and signs of severe hypothyroidism with different degrees of central nervous system insufficiency, hypothermia, hypoventilation, circulatory insufficiency and hyponatremia. To this would be added the characteristic humoral scenario and the possible findings dependent on the disease causing hypothyroidism. It should be treated with an aggressive replacement of levothyroxine sodium (intravenous or oral way, accodring to the possibilities), together with other supportive measures in the hospital setting(AU)

Correlation between neutrophil lymphocyte count ratio and outcomes of severe traumatic head injury

Background: Raised peripheral neutrophil lymphocyte ratio is associated with poorer outcomes in conditions such as severe brain injury, ICH, cardiovascular conditions, cancer.Methods:Retrospective analysis of 96 severe Traumatic Brain injury data treated at our institute over a period of 1 year. The patients were followed up for a period of at least 1 month. The primary outcome of the study was 1 month GOS and the various variables which may be associated with the poor GOS at 1 month follow up. Model based analysis was done for NLCR <24 hrs at 48 hrs and GCS at the time of presentation and discriminative ability of the models were studied by the Area under the curve.Results:Univariate analysis were done of 96 patients of severe traumatic brain injury for various variables such as age, sex, mode of head injury, type of head injury, presenting GCS and NLCR at 24 hrs and 48 hrs to that of GOS at 1 month follow up. Initial GCS <7(p=0.0138) with AUC=0.6689 and peak NLCR (<24 hr) of > 9.6 (AUC=0.931) with a p value of <0.001 with sensitivity of 100% and specificity of 79.27% and peak NLCR (48 hrs) of >12.4 (AUC= 0.973) with a p value of <0.001 with sensitivity of 100% and specificity of 89.02% were associated with unfavourable outcome.Conclusions:High NLCR and initial poor GCS are independent unfavourable prognostic factors in 1 month GOS following severe traumatic head injury.

Presentación mixta de cetoacidosis diabética y estado hiperosmolar hiperglucémico en el embarazo: reporte de caso / Mixed presentation of diabetic ketoacidosis and hyperglycemic hyperosmolar state in pregnant woman: Case report

Resumen ANTECEDENTES: La cetoacidosis diabética y el estado hiperosmolar hiperglucémico son complicaciones agudas de la diabetes que se superponen en uno de cada cuatro casos, y cada una pone en peligro la vida de la madre y del feto. Existe poca información acerca del diagnóstico y tratamiento de las complicaciones agudas de la diabetes en el embarazo. OBJETIVO: Reportar el caso de una embarazada sin controles prenatales y sin antecedentes personales ni familiares de importancia que tuvo una crisis hiperglucémica mixta asociada con eclampsia y óbito. CASO CLÍNICO: Paciente primigesta, de 21 años, con 33 semanas de embarazo que ingresó al hospital debido a: náuseas, disnea y ausencia de movimientos fetales. Al ingreso se encontró somnolienta y con presión arterial elevada. Los exámenes de laboratorio se reportaron compatibles con cetoacidosis diabética y estado hiperosmolar hiperglucémico. A pesar del tratamiento, sobrevino la eclampsia. El embarazo finalizó mediante cesárea, con un recién nacido sin latidos cardiacos. La paciente evolucionó favorablemente con la atención multidisciplinaria. Fue dada de alta con valores de glucosa y presión arterial en límites normales. CONCLUSIÓN: Las crisis hiperglucémicas durante el embarazo se asocian con morbilidad y mortalidad materna y fetal, además de trastornos hipertensivos. El diagnóstico temprano de diabetes en los controles prenatales es fundamental para evitar este cuadro.

Abstract BACKGROUND: Diabetic ketoacidosis and hyperglycemic hyperosmolar state are acute complications of diabetes. These two overlap in one in four cases, and each endangers the life of the mother and the fetus. There is little information about the diagnosis and management of acute complications of diabetes in pregnancy. OBJECTIVE: To report the case of a pregnant woman without prenatal controls and without significant personal or family history who developed a mixed hyperglycemic crisis associated with eclampsia and death. CLINICAL CASE: 21-year-old primigravida admitted at 33 weeks' gestation due to nausea, dyspnea and absence of fetal movements. She was drowsy and had high blood pressure values. Laboratory tests were consistent with a mixed presentation of diabetic ketoacidosis and hyperosmolar hyperglycemic state. Despite treatment, the patient developed eclampsia. Cesarean delivery was performed, extracting a newborn without fetal heartbeat. The patient evolved favorably with multidisciplinary management. She was discharged with glucose and blood pressure values within normal limits. CONCLUSION: Hyperglycemic crises in pregnancy are associated with maternal-fetal morbidity and mortality and hypertensive disorders of pregnancy. Early diagnosis of diabetes in prenatal checkups is essential to avoid this condition.

Brain death communication with parents of children and adolescents: care strategies / Comunicación de la muerte cerebral a los padres de niños y adolescentes: estrategias de atención / Comunicação da morte encefálica junto aos pais de crianças e adolescentes: estratégias de cuidados

ABSTRACT Objectives: to identify care strategies developed by professionals from critically ill patients' units in communicating BD with parents of children and adolescents. Methods: an exploratory and descriptive research with a qualitative approach, carried out in two health institutions between October and December 2019, through semi-structured interviews. Data analysis took place through content analysis. Results: twenty-one professionals participated. Three care strategies were identified: actual clinical situation in suspected brain death; sensitizing families to the real clinical situation after brain death diagnosis; and time to assimilate the death information. Final Considerations: the care strategies for communicating brain death to families identified in this study present the possibility of subsidizing health managers in training and support promotion for professionals in care practice. Moreover, they can be incorporated and validated in the care practice of the studied context.

RESUMEN Objetivos: identificar las estrategias de atención desarrolladas por profesionales de pacientes críticos en la comunicación de la muerte encefálica con los padres de niños y adolescentes. Métodos: investigación exploratoria y descriptiva con enfoque cualitativo, realizada en dos instituciones de salud entre octubre y diciembre de 2019, a través de entrevistas semiestructuradas. El análisis de los datos se llevó a cabo a través del análisis de contenido. Resultados: participaron 21 profesionales. Se identificaron tres estrategias de atención: situación clínica real ante la sospecha de muerte encefálica; sensibilizar a la familia sobre la situación clínica real tras el diagnóstico de muerte encefálica; y tiempo para asimilar la información de la muerte. Consideraciones Finales: las estrategias de cuidado para comunicar la muerte encefálica a las familias identificadas en este estudio presentan la posibilidad de subsidiar a los gestores de salud en la promoción de la formación y apoyo a los profesionales en la práctica del cuidado. Además, pueden ser incorporados y validados en la práctica asistencial del contexto estudiado.

RESUMO Objetivos: identificar estratégias de cuidados desenvolvidas pelos profissionais das unidades de pacientes críticos na comunicação da morte encefálica junto aos pais de crianças e adolescentes. Métodos: pesquisa exploratória e descritiva com abordagem qualitativa, realizada em duas instituições de saúde entre outubro e dezembro de 2019, por meio de entrevistas semiestruturadas. A análise dos dados ocorreu através da análise de conteúdo. Resultados: participaram 21 profissionais. Foram três estratégias de cuidados identificadas: real situação clínica na suspeita de morte encefálica; sensibilizando a família da real situação clínica após o diagnóstico de morte encefálica; e tempo para assimilar a informação da morte. Considerações Finais: as estratégias de cuidados para comunicação de morte encefálica às famílias identificadas neste estudo apresentam a possibilidade de subsidiar gestores de saúde na promoção de capacitações e apoio aos profissionais na prática assistencial. Além disso, podem ser incorporadas e validadas na prática assistencial do contexto estudado.

Knowledge and Practice about Glasgow Coma Scale Assessment among Nurses Working in Adult Intensive Care Units of Federal Public Hospitals in Addis Ababa, Ethiopia: A Cross-Sectional Study

The Glasgow Coma Scale is a dependable and objective neurological assessment instrument used for determining and recording a patient's level of consciousness. Therefore, the knowledge, practice, and factors affecting Glasgow coma scale evaluation among nurses working in adult intensive care units of federally administered hospitals in Addis Ababa, Ethiopia, were investigated. METHODS: From April 4 to 24, 2020, 121 Adult Intensive Care Unit nurses at Ethiopian federal hospitals participated in an institutional-based cross-sectional survey with a standardized selfadministered questionnaire. The information was entered into Epidata version 3.1 and then exported to SPSS version 25.0 for analysis. Bivariable and multivariable logistic regressions were used to examine the relationships between independent and dependent variables. RESULT: According to this study, nurses working in the Adult Intensive Care Unit of federal hospitals in Addis Ababa, Ethiopia, had poor knowledge (51.2%) and poor practice (62%) of the Glasgow Coma Scale's basic theoretical notions and competencies. Furthermore, the education and gender of nurses were linked to their level of knowledge and clinical practice. Being a male and having a master's degree were both significantly linked with knowledge (AOR = 4.13, 95% CI: (1.87­9.1)), (AOR=7.4, 95% CI: (1.4-38)) and practice (AOR = 2.7, 95% CI: (1.2­6)), (AOR = 10.4, 95% CI: (2.0­53)) respectively. CONCLUSION: The findings from this study showed that nurses had poor knowledge and application of practice-related clinical scenarios on the Glasgow Coma Scale