effect of organized auditory stimulations on the consciousness level of comatose patients

High frequency of traumatic and non-traumatic brain injuries in one hand and improvement of the health care condition to restore patient's life in the other hand has increased the frequency of comatose patients in ICU. These patients often experience physical, cognitive, behavior or sensory defects, and the sensory input reduction in intensive care units expose them to cognition disorders. It seems that using sensory stimulation programs may be effective in preventing from sensory deprivation and facilitating recovery process. In this quasi-experimental study, 30 comatose patients who were hospitalized in ICU in Shariati and Sina hospitals were sought to be studied. The subjects were selected randomly using matching that was placed in case and control group. In the intervention group, patients received an auditory stimulation for 2 weeks, 6 days of a week, 2 times a day. The auditory stimulator was a recorded tape [5-10 minutes] of a familiar voice for 30 minutes. The Glasgow Coma Scale [GCS] was used for measuring the level of consciousness [LOC]. LOC was measured before and after each intervention 4 times a day. The control group LOC was measured in a similar manner to the case group. At the same time, homodynamic symptoms [blood pressure, pulse rate, and mean arterial pressure] were measured. Non-parametric test was used for analyzing data. The data was analyzed through SPSS V.11.5 computer software. The findings indicated that there was a significant difference in LOC of the intervention group at the first day and after fourteen days of the intervention [P<0.001], but not in the control group [P=0.769]. Although 2 groups were similar in LOC of the first day [P=0.605] but there were a significant difference between their LOC at the fourteenth day [P=0.001]. The results showed that the auditory stimulations with familiar voice were effective in increasing LOC in the comatose patients. It is suggested that nurses expose comatose patients with auditory stimulations using a recorded tape of familiar voice in ICU

Efecto del número de lotes de aves sobre la composición química de la cama de pollos / Effect of lot of chicken number on poultry litter chemical composition

El presente trabajo tuvo como objetivo evaluar la influencia del número de lotes de pollos que han utilizado una misma cama sobre su composición química. Se utilizó un diseño completamente aleatorizado para comparar y evaluar seis tratamientos, establecidos según el número de lotes de pollos empleados. Siendo T0 la cama sin uso (solo cascarilla de arroz); T1, la cama utilizada por un lote de pollos y así sucesivamente hasta T5, que fue la cama sobre la cual pasaron cinco lotes de pollos. El estudio se realizó en una granja comercial de pollos de engorde que emplea un sistema intensivo de producción con galpones tradicionales de 1200 m² (10m de ancho x 120m de largo) que poseían las mismas características físicas y utilizando un densidad de 10 aves/m². Durante tres ciclos productivos consecutivos se tomaron 10 muestras de cama a lo largo de 10 galpones previamente enumerados. Las muestras fueron identificadas con el número del galpón donde eran tomadas y el número de lotes de pollos correspondiente a cada galpón. Las muestras por galpón fueron procesadas para ser analizados los contenidos de materia seca, cenizas, proteína cruda, calcio, fósforo y fibra detergente neutro. Los resultados indican que al aumentar el número de lotes que utiliza la misma cama incrementan significativamente los contenidos de proteína cruda (P<0,001), calcio (P<0,05) y fósforo (P<0,001) y disminuyen de la misma forma los de fibra (P<0,001), sin embargo, estas diferencias solo son cuantitativamente importantes hasta el segundo lote, a partir del cual las variaciones observadas no mostraron diferencias estadísticas.

Factors Affecting Malnutrition in Continuous Ambulatory Peritoneal Dialysis Patients: A Cross-sectional Study / 대한신장학회잡지

PURPOSE: Protein-calorie malnutrition is common in continuous ambulatory peritoneal dialysis (CAPD) patients and is associated with an increase in morbidity and mortality. This cross-sectional study was carried out to investigate prevalence of protein-calorie malnutrition in Korean CAPD patients. Other purposes were to ascertain relationship between various nutritional parameters and to evaluate factors independently associated with malnutrition in CAPD patients. METHODS: Subjects were clinically stable 127 patients who have been on CAPD for more than 3 months. Nutritional status was assessed by subjective global assessment (SGA), biochemical, anthropometric, and urea kinetic parameters. RESULTS: The mean age of the patients was 50.7+/-11.4 years with sex ratio (M : F) 1 : 1, and mean duration of dialysis was 67.3+/-39.7 months. Patients were divided into 3 groups according to SGA : group I (normal nutrition, n=75, 59.0%), group II (mild malnutrition, n=30, 23.6%) and group III (moderate to severe malnutrition, n=22, 17.4%). There were significant differences in age, CAPD duration, peritonitis rate and hospital-days per year between group I and group III. Among biochemical variables, serum creatinine, triglyceride, protein, albumin, prealbumin, IGF- 1, transferrin and leptin were significantly lower in group III compared to group I (p<0.05), and CRP, ferritin, and IL-6 were significantly higher in group III than group I. There were significant differences in serum albumin among all three groups. There were no differences in Kt/Vurea, nPNA and SCCr among three groups. However, there were significant differences in residual renal function (p<0.05) and PNA (p<0.05) between group I and group III. Among anthropometric variables, body weight, %IBW, BMI, %body fat mass, MAC, TSF, BSF, CAMA, and TBM were significantly lower in group III than the other two groups (p<0.05). But, there was no differences in exercise capacity and food intake among the three groups. To evaluate relationship between various parameters used for assessing malnutrition, we conducted Pearson's rank correlation test. Serum albumin (gamma=0.45), age (gamma=-0.29), %IBW (gamma=0.52), leptin (gamma=0.32), CRP (gamma=-0.24), TSF (gamma=0.45) and CAMA (gamma=0.41) significantly correlated with SGA. As a result of multiple regression analysis, albumin, leptin, and CRP were independent predictors of malnutrition (p<0.05). CONCLUSION: About 40% of CAPD patients were malnourished according to SGA, and multiple regression analysis revealed that serum albumin, leptin and CRP were independent predictors of malnutrition. These results suggest that acute and chronic inflammatory response plays an important role in the development of protein-calorie malnutrition in CAPD patients with comparable food intake and dialysis dose.

Auditory Stimulation Effect to Comatous Patients

As a result of significantly improved medical and surgical cares, traumatic brain injury has been significantly increasing. This calls for an imperative study of the perception ability and recovery in physiological and mental functions. With the assumption that comatous patients may respond to various auditory stimulations, authors studied somatic physiological responses searching for significant basic character of auditory stimulation using three different kinds of sound. Thirteen patients were stimulated with voices, classic musics and bird songs through the earphones. Pulse rates and respiration rates were checked simultaneously. The changes of pulse and respiration rates were not statistically significant. A trial to help recovery from a coma state, with Glasgow coma scale below 8, was not so significant clinically wiith these simple auditory stimulation. A further study of somatic physiological response to more complicated auditory stimulations or patients with clasgow coma scale above 8 would be necessary. In conclusion, for the comatous patients Glasgow coma scale below 8, family voices, classic musics and bird sounds did not change pulse rates and respiratory rates of statistical significance. In the comatous patients with Glasgow cama scale below 8, the trial to promote recovery by simple auditory stimulation seems to be unsuccessful clinically. More extensive study would be required.