关键词： Traumatic brain injury   Polytrauma   Hypothermia   Multiply injuries   Neurological outcome  

摘要： PurposePatients with multiple injuries are particularly susceptible to accidental hypothermia which is correlated with an increased risk of post-traumatic complications and mortality;however, its impact on neurological outcome in cases where there is concomitant traumatic brain injury is *** analyzed severely injured patients (ISS16) including a moderate-to-severe traumatic brain injury (AIS(Head)3). The primary endpoint was objective neurological recovery, expressed as Glasgow Outcome Scale (GOS) score at time of discharge. Secondary endpoints were mortality, systemic inflammatory response syndrome (SIRS), sepsis, acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS). Statistical analysis included logistic regression (odds ratio). The significance level in all analyses was p=*** analyzed 278 patients (M age=43years, SD 19;M ISS=32.8, SD 10.7). Mortality was 17% (n=14). 102 patients (37%) were hypothermic on admission. Hypothermic patients were more severely injured (ISS 35.611.1 vs. 31.2 +/- 10.1, p=0.001;APACHE II 18.1 +/- 7.4 vs. 16.2 +/- 7.3, p=0.045) and had a higher transfusion requirement. Mortality rate in hypothermic patients was increased (23.5 vs. 13.1%, p=0.03);however, hypothermia was not an independent predictor of mortality. Median GOS at discharge was 3 (IQR 3);in 47% of patients the outcome was favorable (GOS 4 or 5) and 36% it was poor (GOS 2 or 3). There were no differences in post-traumatic complications. Analysis of 73 matched pairs of hypothermic and normothermic patients could not prove hypothermia as an independent predictor of poor neurological outcome (OR 1.7, 95% CI 0.8-3.6, p=0.1) in the total population. However, older patients (>41years) had a 4.2-times higher risk (95% CI 1.4-12.7;p=0.01) of poor neurological outcome, if they were hypothermic on *** hypothermia seems to have a negative impact on neurological recovery in older patients with mu

关键词： Cardiac arrest   Hypoxic liver injury   Hypoxic hepatitis   Ischemic hepatitis   Shock liver   Acute liver failure   Multiple organ failure   Intensive care unit  

摘要： Background: Hypoxic liver injury (HLI) is a frequent and life-threatening complication in critically ill patients that occurs in up to ten percent of critically ill patients. However, there is a lack of data on HLI following cardiac arrest and its clinical implications on outcome. Aim of this study was to investigate incidence, outcome and functional outcome of patients with HLI after in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). Methods: We conducted an analysis of a cardiac arrest registry data over a 7-year period. All patients with non-traumatic OHCA and IHCA with return of spontaneous circulation (ROSC) treated at the emergency department of a tertiary care hospital were included in the study. HLI was defined according to established criteria. Predictors of HLI, occurrence, clinical and neurological outcome were assessed using multivariable regression. Results: Out of 1068 patients after IHCA and OHCA with ROSC, 219 (21%) patients developed HLI. Rate of HLI did not differ significantly in IHCA and OHCA patients. Multivariate regression analysis identified time-to-ROSC [OR 1.18, 95% CI (1.01-1.38);p < 0.05], presence of cardiac failure [OR 2.57, 95% CI (1.65-4.01);p < 0.001] and Charlson comorbidity index [OR 0.83, 95% CI (0.72-0.95);p < 0.01] as independent predictors for occurrence of HLI. Good functional outcome was significantly lower in patients suffering from HLI after 28-days (35% vs. 48% p < 0.001) and 1-year (34% vs. 44%, p < 0.001). Occurrence of HLI was associated with unfavourable neurological outcome [OR 1.74, 95% CI (1.16-2.61);p < 0.01] in multivariate regression analysis. Conclusion: New onset of HLI is a frequent finding after IHCA and OHCA. HLI is associated with increased mortality, unfavourable neurological and overall outcome.

摘要： Despite the importance of incorporating sex as a variable in experimental and clinical studies being recognised by the US National Institute of Mental Health already in 2011, and subsequently by other funding agencies in the USA and Europe, substantial evidence gaps exist for sex differences in the epidemiology, clinical features, and pathophysiology of many neurological *** 2001, The Institute of Medicine, a branch of the National Academy of Sciences in the USA, formed a committee to explore current understanding of sex differences and the biological underpinnings of these differences in human *** a Review of sex differences in migraine, while the safety of drugs in women with the disorder, in relation to contraception, pregnancy, and hormone replacement therapy, was identified as a priority to be addressed, the authors further underscored the potential for underdiagnosis of migraine in men because of a presumption that migraine is a female disorder.

关键词： Burden   neurological disorders   northwestern Nigeria   relative frequency   retrospective study  

摘要： Background: Early diagnosis and management of diseases takes a center stage in the control and prevention of chronic debilitating disorders. It also plays a prominent role in ensuring that patients are better equipped on how to deal with the disease burden. One reliable means of achieving this objective is to retrospectively study the frequency of common diseases. Materials and Methods: This was a retrospective study conducted between January 2010 and December 2014. Relevant data were extracted from patients' case folders. Adjustment to correct for potential biases such as multiple admissions and secondary diagnosis using a covariate on admission data was made to correct for systematic error. Information obtained was analyzed for frequency and ***: The mean age of the patients was 44.9 years (standard deviation 16.7), with an age range of 15-99 years. The most common neurological disorder was stroke which accounted for 21.3%, followed by spinal cord compression syndromes (20.8%), epilepsy (17.3%), parkinsonian syndromes (8.9%), headaches (7.1%), and bacterial meningitis (5.2%). The highest number of cases of neurological disorder occurred within the age group of 45-54 years. Conclusion: The outcome of this study revealed that stroke and spinal cord compression syndromes were the most common neurological disorders in our center. It also showed that individuals within their productive age (50-54 years) were more affected. Given the present state of constrained resources, coordinated efforts at the institutional, state, and federal government levels are essential to encourage prioritization, funding, and implementation of effective health-care delivery system.

关键词： behaviorally passive and active rats   hemorrhagic stroke   neurological deficit   tracheal lymphoid tissue  

摘要： Specific features of neurological deficit and changes in the cellular composition of tracheal lymphoid structures during the immediate stage (day 1) of hemorrhagic stroke were studied in rats with various behavioral parameters. Modeling of hemorrhage in the left caudate nucleus of the brain was followed by the development of motor disturbances in the forelimb use asymmetry test and corner rotation paradigm. These animals preferred to use the left forelimb (ipsilateral to the side of hemorrhage) to lean on the cylinder wall. The frequency of using the right forelimb or both forelimbs was reduced under these conditions. The number of left-sided rotations increased, while the percentage of right-sided rotations decreased. The observed changes were accompanied by immune dysfunction. It was manifested in the depletion of lymphoid aggregates of the tracheal wall in lymphocytes and plasma cells. The severity of abnormal neurological symptoms and disturbances in immune homeostasis during the immediate stage of hemorrhagic stroke was greater in behaviorally passive rats than in active specimens.

关键词： Follow-up   Hypothyroidism   Long term   Neurological disease   Pediatric hospitalization   Pregnancy  

摘要： BackgroundMaternal hypothyroidism in pregnancy has been associated with neurocognitive impairment in exposed children, ranging from psychomotor-developmental delay to lower IQ *** investigate the long-term neurological morbidity of children to hypothyroid mothers during *** designA population-based cohort study was performed including all deliveries occurring in a period of 20years at a tertiary medical center. We excluded multiple pregnancies, fetuses with congenital malformations, perinatal mortality cases and women lacking prenatal care from the study. Neurological-related hospitalizations of children (up to 18years) were evaluated using neurological morbidities that were predefined by ICD-9 codes. Kaplan-Meier survival curve was used to compare cumulative hospitalization rate in exposed and unexposed children. A Cox regression model was used to control for *** the study period, 217,910 deliveries met the inclusion criteria. Of them, 1.1% (n=2403) were in mothers with known hypothyroidism during pregnancy. The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of neurological-related hospitalizations in the hypothyroidism group (log rank p=0.007). Total hospitalization rate per person years was significantly higher in the maternal hypothyroidism group (5.5 vs. 3.1, HR=1.37, 95% CI 1.10-1.73, p=0.007). The Cox regression model controlled for various possible confounders including maternal age, maternal obesity, birth weight, preterm birth, maternal diabetes, hypertensive disorders, induction of labor and mode of delivery, found maternal hypothyroidism to be independently associated with pediatric neurological morbidity in these children (adjusted HR=1.33, 95% CI 1.05-1.68, p=0.01).ConclusionMaternal hypothyroidism in pregnancy is independently associated with long-term pediatric neurological morbidity of the offspring.

关键词： Chikungunya   neurological complications   encephalitis  

摘要： Chikungunya (CHIK) has re-emerged as a potential neurotropic virus, with outbreaks recently being reported from many parts of India. The present study was conducted to study the spectrum and outcome of neurological complications in patients of CHIK during the 2016 outbreak in Delhi. A total of 42 cases seropositive for IgM CHIK antibodies by MAC-ELISA and developing neurological complications were enrolled. The male:female ratio was 1:2 (age range = 18-90 years). The neurological manifestations observed were encephalitis (n = 12), bulbar palsy (n = 3), acute disseminated encephalomyelitis (n = 1), cerebellitis (n = 1), myelopathy (n = 1), radiculoneuropathy (n = 3), carpal tunnel syndrome (n = 9) and tremors (n = 1). Ten patients reported worsening of pre-existing neuropathic symptoms of diabetic peripheral neuropathy (n = 4) and carpal tunnel syndrome (n = 6). One patient had aggravation of myasthenia gravis leading to respiratory failure. The majority of patients (n = 32) showed a good outcome;ten had a poor prognosis, out of which four died, all from the encephalitis group, particularly the elderly with co-morbidities.

关键词： Agmatine   Ion channels   Receptors   Neurodegenerative disease   Receptor blockade  

摘要： The central nervous system (CNS) is the most injury-prone part of the mammalian body. Any acute or chronic, central or peripheral neurological disorder is related to abnormal biochemical and electrical signals in the brain cells. As a result, ion channels and receptors that are abundant in the nervous system and control the electrical and biochemical environment of the CNS play a vital role in neurological disease. The N-methyl-d-aspartate receptor, 2-amino-3-(5-methyl-3-oxo-1,2-oxazol-4-yl) propanoic acid receptor, kainate receptor, acetylcholine receptor, serotonin receptor, 2-adrenoreceptor, and acid-sensing ion channels are among the major channels and receptors known to be key components of pathophysiological events in the CNS. The primary amine agmatine, a neuromodulator synthesized in the brain by decarboxylation of l-arginine, can regulate ion channel cascades and receptors that are related to the major CNS disorders. In our previous studies, we established that agmatine was related to the regulation of cell differentiation, nitric oxide synthesis, and murine brain endothelial cell migration, relief of chronic pain, cerebral edema, and apoptotic cell death in experimental CNS disorders. In this review, we will focus on the pathophysiological aspects of the neurological disorders regulated by these ion channels and receptors, and their interaction with agmatine in CNS injury.

关键词： climate change   environmental health   neurology  

摘要： Global temperatures are rising;extreme environmental heat can result in adverse health effects including heatstroke. Acute effects of heat are well recognised, but there is less understanding of potential long-term adverse outcomes. Our aim was to review recent medical literature for clinical cases of environmental heatstroke with a focus on neurological outcome. Structured search strategies were designed to retrieve publications of heatstroke case reports using Ovid Medline and Embase (2000-2016). One thousand and forty-nine abstracts were identified, and after application of exclusion criteria 71 articles deemed relevant. Ninety cases were identified from 71 articles. 100% presented with acute neurological symptoms;87.8% presented with non-neurological symptoms. 44.4% patients recovered fully, 23.3% died, 23.3% suffered convalescent or long-term neurological sequelae, and in 8.9% no long-term follow up was available. 57.1% of the patients who died or had a neurological deficit had no documented co-morbidity. Patterns of neurological deficits included 66.7% patients with motor dysfunction, 9.5% cognitive impairment, 19% both motor and cognitive impairment and 4.7% other. In total 71.4% of the impaired patients had long-term cerebellar dysfunction. Adverse long-term neurological outcomes were common in surviving patients presenting with environmental heatstroke. Permanent neurological deficits were present in 34.4% of survivors where outcome was known;many were young, healthy individuals. Cerebellar injury was common suggesting cerebellar structures are vulnerable to heat. These findings highlight that people of all ages and pre-morbid states are at risk of severe heat-related illness. In the face of climate change, effective interventions for heat-related illness, including both treatment and prevention are necessary.