A Comparison of Glasgow Coma Scale Score with “Full Outline of Unresponsiveness Scale” to Predict Outcome of the Patients with Traumatic Brain Injury Presenting to Emergency Medicine Department

Introduction: In patients presenting to Emergency Department(ED) with traumatic brain injury, it is important to evaluate the neurological status to determine the present clinical status and to predict outcome of the patient. GCS is the most widely used score,but it has some drawbacks which led to the development of other scores such as the Full Outline of Unresponsiveness (FOUR) score. In our study, we compared the GCS and the FOUR scores in patients presenting with traumatic brain injury. Aims: 1) To compare the FOUR score with the GCS score in traumatic brain injury (TBI) patients. 2) To understand the effectiveness of FOUR score as an assessment tool. 3) To assess whether FOUR score is an alternative tool in TBI patients or could be complimentary. Methods: We conducted a prospective observational study at a trauma centre of a tertiary care hospital during January 2019 to March 2019 after taking institutional ethical committee approval. All patients presenting with clinical diagnosis of TBI were evaluated and given a GCS and FOUR score by the emergency physician. Relevant investigations were done and findings were noted. We tabulated all information in Microsoft Excel 2019 and statistical analysis was done with SPSS software. Results: The mean age of study population was 38.295+/- 15.33 years. Male patients were 79% and 21% were female patients. Road traffic accidents contributed highest percentages of causes of TBI (60%). By comparing the median value of FOUR score with mortality and the median value of GCS score with the mortality by using the Mann-Whitney test showed a p-value of ?1, which is statistically non-significant. Conclusions: FOUR score is equally reliable with GCS score. Both have their own significance

Comparison of full outline of unresponsiveness score and Glasgow Coma Scale in Medical Intensive Care Unit

Context: The Glasgow Coma Scale (GCS) is the most commonly used scale, and Full Outline of Unresponsiveness (FOUR) score is new validated coma scale as an alternative to GCS in the evaluation of the level of consciousness. Aim: The aim of the current study was to evaluate FOUR score and GCS ability in predicting the outcomes (Survivors, nonsurvivors) in Medical Intensive Care Unit (MICU). Setting and Design: This was an observational and prospective study of 300 consecutive patients admitted to the MICU during a 14 months' period. Materials and Methods: FOUR score, GCS score, and demographic characteristics of all patients were recorded in the first admission 24 h. Statistical Analysis Used: A receiver operator characteristic (ROC) curve, Hosmer–Lemeshow test, and Logistic regression were used in the statistical analysis (95% confidence interval). Results: Data analysis showed a significant statistical difference in FOUR score and GCS score between survivors and nonsurvivors (P < 0.0001, P < 0.0001; respectively). The discrimination power was good for both FOUR score and GCS (area under ROC curve: 87.3% (standard error [SE]: 2.1%), 82.6% [SE: 2.3%]; respectively). The acceptable calibration was seen just for FOUR score (χ2 = 8.059, P = 0.428). Conclusions: Both FOUR score and GCS are valuable scales for predicting outcomes in patients are admitted to the MICU; however, the FOUR score showed better discrimination and calibration than GCS, so it is superior to GCS in predicting outcomes in this patients population.

Grey areas in tuberculosis research: need to pay more attention

Tuberculosis research spanning over a century period, has led to several important breakthroughs. These discoveries have helped in developing microbiological and molecular methods for diagnosis. Efforts on drug discovery have provided several effective anti-TB drugs that have made the treatment highly effective. However, adaptation of Mycobacterium tuberculosis and resultant drug resistance/unresponsiveness has created a challenging situation. Further, capacity of this pathogen to lie dormant in the body for years together results in a big pool of hidden disease and potential reservoir of infection. While, there is gradually improving understanding of mechanisms of dormancy, it is still patchy and not enough. Focusing on these areas will prepare us better to tackle the disease in the long run. It will be highly desirable to concentrate the scientific efforts on these grey areas of tuberculosis research.

Research on relevant factors affecting results of extubation of trachea cannula in neurocritical care patients / 中华急诊医学杂志

Objective To Explored the relative factors which caused the extubation failure in neurological intensive care unit (NICU).Methods It was a retrospective study.40 cases of patients who met the criteria,were brought into statistical analysis.They were admitted in NICU in Nan Fang Hospital from December 2008 to February 2011.The name,sex,age,diagnosis,respiratory parameters,24 hours discrepancy quantity,sputum,and Glasgow Coma Scale,Full Outline of UnResponsiveness Scale were recorded.SPSS 13.0 was used as statistic software.P ＜ 0.05 was considered statistically significant.Results Both in extubation successful and failure groups,GCS and Four were significantly different (all P ＜ 0.05).Howerer,there were no statistically significant in the other factors.There were significantly differences between GCS and Four in predicting extubation results (P =0.012).Logistic multiple regression showed that Four and GCS grade were predictive factor of extubation failure (P =0.041).Conclusions The result suggests that it is statistically significant to use GCS and Four as factors to predict extubation results.It can be widely used to help medical personnels monitoring the changes of patients'clinical conditions,judging prognosis,and making treatment plan in NICU.Wether other factors would effect the extubation results,more prospective,randomized controlled studies were needed.

Predictive Factors of Neurologic Outcome in Patients With Hypoxic-Ischemic Encephalopathy After Cardiopulmonary Resuscitation

BACKGROUND: Cardiopulmonary resuscitation (CPR) can lead to various neurologic outcomes in patients with hypoxicischemic encephalopathy (HIE). This study investigated the usefulness of clinical markers and electroencephalography (EEG) in predicting the neurologic prognosis of HIE after CPR. METHODS: We reviewed the clinical findings of 51 patients with HIE, including the medical history, the duration from the onset of symptoms to the recovery of spontaneous circulation, Glasgow Coma Scale (GCS) and Full Outline of Unresponsiveness (FOUR) scores, and presence of seizure or status epilepticus. Patients were divided into three outcomes groups: death, persistent vegetative state, and recovering alertness and awareness. Digital EEG and visual and quantitative analyses were performed in each patient. For quantitative EEG (qEEG) analysis, we defined and compared the distance in the spatial band-power patterns and phase coherence patterns between healthy normal subjects and each patient. RESULTS: Patients with HIE showed a high mortality rate (54.9%, 28/51), and their neurologic prognosis was significantly related to the initial GCS and FOUR scores. In the qEEG analysis, patients' groups showed a prominent delta frequency band, and the healthy normal group presented a marked alpha predominance. As the severity decreased, the similarity in the spatial band-power pattern and functional connectivity pattern between normal subjects and patients increased. CONCLUSIONS: Low initial GCS and FOUR scores could be predictive of a poor neurologic prognosis in patients with HIE, and qEEG analysis might be a useful predictor of their neurologic outcomes.

A case of pseudohypoaldosteronism

No abstract available.

Interleukin-1 beta production by monocytes from leprosy patients

The cause responsible for the lack of an efficient cell-mediated immunity or a delayed type hypersensitivity to M. leprae in lepromatous patients is poorly understood. But the resistance to M. leprae infection in humans is likely mediated by the activated macrophages to present M. leprae antigen to T cells for cell-mediated immunity. Phenolic glycolipid-I (PGL-I) is a M. leprae-specific antigen and is supposed to play a significant role in the long lasting unresponsiveness in lepromatous leprosy. In this study, IL-1 activities were tested among leprosy patients to evaluate monocyte function and the role of IL-1 in the immunosuppression in leprosy. We found that peripheral blood mononuclear cells (PBMCs) from tuberculoid patients were strongly reactive to M. leprae (mean cpm; 28,853 +/- 28,916), but the proliferative responses of PBMCs from lepromatous patients (mean cpm; 6,051 +/- 803) were significantly lower. IL-1 concentration in culture supernatant of monocytes from lepromatous patients was similar to that from tuberculoid patients with stimulation of M. leprae (lepromatous: 1,014 +/- 637 pg/ml, tuberculoid: 1,012 +/- 167 pg/ml) or lipopolysaccharides (IPS) (lepromatous: 3,479 +/- 2,188 pg/ml, tuberculoid: 4,246 +/- 2,432 pg/ml). The IL-1 concentration is sera from lepromatous patients (42 +/- 30 pg/ml) tended to be higher than those from tuberculoid patients (28 +/- 69 pg/ml). And there was no significant difference in IL-1 production between peritoneal macrophages from mice sensitized with PGL-1 and those from nonsensitized mice. In conclusion, this study suggests that the immunosuppression in lepromatous patients may not be due to the decreased production of IL-1. And the increased IL-1 activity in sera may affect the inflammatory response of lepromatous patients.

Immunological unresponsiveness in leprosy and its relevance to immunoregulation in man.

The varied forms of leprosy form a clinical and immunological spectrum which offers extraordinary possibilities for insight into immunoregulatory mechanisms in man. At one pole, tuberculoid leprosy, patients develop high levels of cell-mediated immunity which ultimately results in killing of bacilli in the tissues, albeit often with damage to nerves. At the lepromatous pole, patients exhibit selective immunological unresponsiveness to antigens of Mycobacterium leprae. Even though all currently known protein species of Mycobacterium leprae and BCG are cross-reactive, lepromatous patients unreactive to Mycobacterium leprae antigens frequently respond strongly to tuberculin. In vitro experiments suggest the existence of lepromin-induced suppressor activity, mediated by both monocytes and Τ cells. The Τ suppressor cells have the T8 phenotype of which 50% express the activation markers, Ia and FcR. The one unique species of antigen of the leprosy bacillus is a phenolic glycolipid, and it appears that the Ts cells largely recognize the terminal trisaccharide of this unique antigen. Depletion of Ts cells restores in vitro reactivity of lymphocytes to lepromin in a portion of lepromatous patients, and addition of IL-2 containing supernatants partially restores responsiveness to Mycobacterium leprae antigens. Vaccination of lepromatous patients with a mixture of Mycobacterium leprae and live BCG restores cell-mediated immunity in the majority of lepromatous patients, and concomitantly reduces the in vitro suppressor activity and number of activated T8 cells. These experiments suggest the existence of stage-of-disease related suppressor cells in leprosy which appear to block the responsiveness of TH capable of responding to either specific or cross-reactive mycobacterial antigens. The mode of action of these Ts appears to be the inhibition of production of IL-2 and other lymphokines. Successful immunotherapeutic vaccination appears to overcome this block in the majority of patients.