[Coma: etiology, diagnosis, and treatment]. / Koma: priezastys, diagnostika, gydymas.

SUMMARY: Coma is the disorder of consciousness because of the damage to diffused bilateral cerebral hemisphere cortex or reticular activating system. Coma can be caused by neurogenic (head brain injury), metabolic (endogenic), and toxic (exogenic) factors. To determine the cause of metabolic and toxic coma, laboratory tests are performed; in case of neurogenic coma, the neurologic examination is essential, when five systems are evaluated: the level of consciousness (according to Glasgow Coma Scale or Full Outline of Unresponsiveness Scale), photoreaction of pupils and ophthalmoscopic examination, oculomotoric, motoric, and cardiopulmonary systems. For the treatment of coma, adequate oxygenation and correction of blood circulation disorders are important. The treatment of metabolic coma is guided by special schemes; antidotes often are needed in the treatment of toxic coma, and surgery helps if traumatic brain injury is present. The prognosis and outcomes of the comatose patient depend on the age and comorbid diseases of the patient, the underlying cause of coma, timely medical help and its quality, and intensive treatment and care of the patient in coma.

[Staphylococcus aureus prevalence among preschool- and school-aged pupils]. / Staphylococcus aureus paplitimas tarp ikimokyklinio ir mokyklinio amziaus vaiku.

OBJECT: To determine the prevalence and incidence of Staphylococcus aureus strains among preschool- and school-aged pupils and susceptibility of these strains to antimicrobial materials. MATERIAL AND METHODS: A study of 243 preschool- and 300 school-aged pupils was conducted during 2003-2004. Identification of Staphylococcus aureus was made with plasmacoagulase and DNase tests. The resistance of Staphylococcus aureus to antibiotics, beta-lactamase activity, phagotypes, and phage groups were determined. The isolated Staphylococcus aureus strains were tested for resistance to methicillin by performing disc diffusion method using commercial discs (Oxoid) (methicillin 5 microg per disk and oxacillin 1 microg per disk). RESULTS: A total of 292 (53.8%) Staphylococcus aureus strains were isolated and identified (113 (46.5%) from preschool- and 179 (59.7%) from school-aged pupils). The prevalence of Staphylococcus aureus strains among preschool-aged pupils varied from 46.5% to 47%. It increased to 59.0% (P>0.05) among schoolchildren aged from 11 to 15 years and to 73.0% (P<0.001) among schoolchildren aged from 16 to 19 years. Six methicillin-resistant Staphylococcus aureus strains were isolated: two (1.8%) of them were from preschool-aged and four (2.2%) from school-aged pupils. The prevalence of Staphylococcus aureus strains with beta-lactamase activity increased from 70.7 to 76.6% in preschool-aged pupils, and it varied from 72.0 to 79.0% in school-aged pupils (P>0.05). Staphylococcus aureus strains of phage group II (32.2-43.4%) were prevailing; nontypable Staphylococcus aureus strains made up 19.2-33.6%. CONCLUSIONS: The prevalence of Staphylococcus aureus among preschool-aged children is 41.7 to 48.8%, and it increases among 9th-12th-grade pupils (73.0%, P<0.001). Some Staphylococcus aureus strains (2.1%) were resistant to methicillin. Staphylococcus aureus strains of phage group II (39.0%, P<0.05) are most prevalent among preschool- and school-aged pupils. Pupils were colonized with methicillin-resistant Staphylococcus aureus strains belonging to phage group III phagotype 83A and 77.