How theories evolved concerning the mechanism of action of barbiturates.

PubMed

Löscher, Wolfgang; Rogawski, Michael A

2012-12-01

The barbiturate phenobarbital has been in use in the treatment of epilepsy for 100 years. It has long been recognized that barbiturates act by prolonging and potentiating the action of γ-aminobutyric acid (GABA) on GABA(A) receptors and at higher concentrations directly activating the receptors. A large body of data supports the concept that GABA(A) receptors are the primary central nervous system target for barbiturates, including the finding that transgenic mice with a point mutation in the β3 GABA(A) -receptor subunit exhibit diminished sensitivity to the sedative and immobilizing actions of the anesthetic barbiturate pentobarbital. Although phenobarbital is only modestly less potent as a GABA(A) -receptor modulator than pentobarbital, phenobarbital is minimally sedating at effective anticonvulsant doses. Possible explanations for the reduced sedative effect of phenobarbital include more regionally restricted action; partial agonist activity; reduced propensity to directly activate GABA(A) receptors (possibly including extrasynaptic receptors containing δ subunits); and reduced activity at other ion channel targets, including voltage-gated calcium channels. In recent years, substantial progress has been made in defining the structural features of GABA(A) receptors responsible for gating and allosteric modulation by drugs. Although the precise sites of action of barbiturates have not yet been defined, the second and third transmembrane domains of the β subunit appear to be critical; binding may involve a pocket formed by β-subunit methionine 286 as well as α-subunit methionine 236. In addition to effects on GABA(A) receptors, barbiturates block AMPA/kainate receptors, and they inhibit glutamate release through an effect on P/Q-type high-voltage activated calcium channels. The combination of these various actions likely accounts for their diverse clinical activities. Despite the remarkable progress of the last century, there is still much to learn about the actions of barbiturates that can be applied to the discovery of new, more therapeutically useful agents. Wiley Periodicals, Inc. © 2012 International League Against Epilepsy.

Neurotoxic effects of carambola in rats: the role of oxalate.

PubMed

Chen, Chien-Liang; Chou, Kang-Ju; Wang, Jyh-Seng; Yeh, Jeng-Hsien; Fang, Hua-Chang; Chung, Hsiao-Min

2002-05-01

Carambola (star fruit) has been reported to contain neurotoxins that cause convulsions, hiccups, or death in uremic patients, and prolong barbiturate-induced sleeping time in rats. The constituent responsible for these effects remains uncertain. Carambola contains a large quantity of oxalate, which can induce depression of cerebral function and seizures. This study was conducted to investigate the role of oxalate in carambola toxicity in rats. The effects on barbiturate-induced sleeping time and death caused by intraperitoneal administration of carambola juice were observed in Sprague-Dawley rats. To obtain a dose-dependent response curve and evaluate the lethal dose, rats were treated with serial amounts of pure carambola juice diluted with normal saline in a volume of 1:1. To test the role of oxalate in the neurotoxic effect of carambola, either 5.33 g/kg carambola after oxalate removal or 5.33 g/kg of pure carambola juice diluted with normal saline were administered intraperitoneally, while the control group was given normal saline before pentobarbital injection. The effects of carambola and oxalate-removed carambola on barbiturate-induced sleeping time were compared with those of saline. To assess the lethal effect of oxalate in carambola, we gave rats chemical oxalate at comparable concentrations to the oxalate content of carambola. Carambola juice administration prolonged barbiturate-induced sleeping time in a dose-dependent manner. The sleeping time of rats that received normal saline and 1.33 g/kg, 2.67 g/kg, 5.33 g/kg, and 10.67 g/kg of carambola juice were 66 +/- 16.6, 93.7 +/- 13.4, 113.3 +/- 11.4, 117.5 +/- 29.0, and 172.5 +/- 38.8 minutes, respectively. The three higher-dose groups had longer sleeping times than controls (p < 0.05 or 0.005). This effect was eliminated after the removal of oxalate from carambola juice. Four of eight rats in the 10.67-g/kg group and all rats in the 21.33 g/kg and chemical oxalate groups died after seizure. Lethal doses of carambola juice were rendered harmless by the oxalate removal procedure. Oxalate is a main constituent of carambola neurotoxicity. This finding suggests that patients with carambola intoxication should be treated for oxalate toxicosis.

Can anesthetic treatment worsen outcome in status epilepticus?

PubMed

Sutter, Raoul; Kaplan, Peter W

2015-08-01

Status epilepticus refractory to first-line and second-line antiepileptic treatments challenges neurologists and intensivists as mortality increases with treatment refractoriness and seizure duration. International guidelines advocate anesthetic drugs, such as continuously administered high-dose midazolam, propofol, and barbiturates, for the induction of therapeutic coma in patients with treatment-refractory status epilepticus. The seizure-suppressing effect of anesthetic drugs is believed to be so strong that some experts recommend using them after benzodiazepines have failed. Although the rationale for the use of anesthetic drugs in patients with treatment-refractory status epilepticus seems clear, the recommendation of their use in treating status epilepticus is based on expert opinions rather than on strong evidence. Randomized trials in this context are lacking, and recent studies provide disturbing results, as the administration of anesthetics was associated with poor outcome independent of possible confounders. This calls for caution in the straightforward use of anesthetics in treating status epilepticus. However, there are still more questions than answers, and current evidence for the adverse effects of anesthetic drugs in patients with status epilepticus remains too limited to advocate a change of treatment algorithms. In this overview, the rationale and the conflicting clinical implications of anesthetic drugs in patients with treatment-refractory status epilepticus are discussed, and remaining questions are elaborated. This article is part of a Special Issue entitled "Status Epilepticus". Copyright © 2015 Elsevier Inc. All rights reserved.

Factors predisposing to coma and delirium: fentanyl and midazolam exposure; CYP3A5, ABCB1, and ABCG2 genetic polymorphisms; and inflammatory factors.

PubMed

Skrobik, Yoanna; Leger, Caroline; Cossette, Mariève; Michaud, Veronique; Turgeon, Jacques

2013-04-01

Delirium and sedative-induced coma are described as incremental manifestations of cerebral dysfunction. Both may be associated with sedative or opiate doses and pharmacokinetic or pharmacogenetic variables, such as drug plasma levels (exposure), drug metabolism, and/or their transport across the blood-brain barrier. To compare biological and drug treatment characteristics in patients with coma and/or delirium while in the ICU. In 99 patients receiving IV fentanyl, midazolam, or both, we evaluated drug doses, covariates likely to influence drug effects (age, body mass index, and renal and hepatic dysfunction); delirium risk factors; concomitant administration of CYP3A and P-glycoprotein substrates/inhibitors; ABCB1, ABCG2, and CYP3A5 genetic polymorphisms; and fentanyl and midazolam plasma levels. Delirium and coma were evaluated daily. In patients with only coma (n=15), only delirium (n=7), and neither ever (n=14), we measured plasma levels of tumor necrosis factor-α, interleukin (IL)-1β, IL-1RA, IL-6, IL-8, IL-10, IL-17,macrophage inflammatory protein-1β, and monocyte chemotactic protein-1. Time to first coma was associated with fentanyl and midazolam doses (p=0.03 and p=0.01, respectively). The number of days in coma was associated with the number of days of coadministration of CYP3A inhibitors (r=0.30; p=0.006). Plasma levels of fentanyl were higher in patients with clinical coma (3.7±4.7 vs. 2.0±1.8 ng/mL, p=0.0001) as were midazolam plasma levels (1050±2232 vs. 168±249 ng/mL, p=0.0001). Delirium occurrence was unrelated to midazolam administration, cumulative doses, or serum levels. Days with delirium were associated with days of coadministration of P-glycoprotein inhibitor (r=0.35; p=0.0004). Delirious patients had higher levels of the inflammatory mediator IL-6 than comatose patients (129.3 vs. 35.0 pg/mL, p=0.05). Coma is associated with fentanyl and midazolam exposure; delirium is unrelated to midazolam and may be linked to inflammatory status. These data suggest that iatrogenic coma and delirium are not mechanistically linked.

[Cerebral protection].

PubMed

Cattaneo, A D

1993-09-01

Cerebral protection means prevention of cerebral neuronal damage. Severe brain damage extinguishes the very "human" functions such as speech, consciousness, intellectual capacity, and emotional integrity. Many pathologic conditions may inflict injuries to the brain, therefore the protection and salvage of cerebral neuronal function must be the top priorities in the care of critically ill patients. Brain tissue has unusually high energy requirements, its stores of energy metabolites are small and, as a result, the brain is totally dependent on a continuous supply of substrates and oxygen, via the circulation. In complete global ischemia (cardiac arrest) reperfusion is characterized by an immediate reactive hyperemia followed within 20-30 min by a delayed hypoperfusion state. It has been postulated that the latter contributes to the ultimate neurologic outcome. In focal ischemia (stroke) the primary focus of necrosis is encircled by an area (ischemic penumbra) that is underperfused and contains neurotoxic substances such as free radicals, prostaglandins, calcium, and excitatory neurotransmitters. The variety of therapeutic effort that have addressed the question of protecting the brain reflects their limited success. 1) Barbiturates. After an initial enthusiastic endorsement by many clinicians and years of vigorous controversy, it can now be unequivocally stated that there is no place for barbiturate therapy following resuscitation from cardiac arrest. One presumed explanation for this negative statement is that cerebral metabolic suppression by barbiturates (and other anesthetics) is impossible in the absence of an active EEG. Conversely, in the event of incomplete ischemia EEG activity in usually present (albeit altered) and metabolic suppression and hence possibly protection can be induced with barbiturates. Indeed, most of the animal studies led to a number of recommendations for barbiturate therapy in man for incomplete ischemia. 2) Isoflurane. From a cerebral metabolic standpoint, exposure to isoflurane at concentration of 2 MAC is credited with providing the same potential for protection as high dose barbiturate (isoelectric EEG). A possible major difference between barbiturates and isoflurane is the modest cerebral vasodilation induced by the latter while barbiturates are associated with decreased CBF. This suggests that in focal ischemia isoflurane may elicit an intracerebral steal. 3) Calcium entry blockers. Some calcium entry blockers with the distinctive feature of acting preferably on cerebral as opposed to systemic vascular smooth muscles may exert beneficial effects during or after brain ischemia. Two such drugs which have shown promise are nimodipine and lidoflazine. In animal and human studies nimodipine has been reported to improve the neurologic outcome of both the cerebral vasospasm and the postischemic hypoperfusion state.(ABSTRACT TRUNCATED AT 400 WORDS)

A Method of Managing Severe Traumatic Brain Injury in the Absence of Intracranial Pressure Monitoring: The Imaging and Clinical Examination Protocol.

PubMed

Chesnut, Randall M; Temkin, Nancy; Dikmen, Sureyya; Rondina, Carlos; Videtta, Walter; Petroni, Gustavo; Lujan, Silvia; Alanis, Victor; Falcao, Antonio; de la Fuenta, Gustavo; Gonzalez, Luis; Jibaja, Manuel; Lavarden, Arturo; Sandi, Freddy; Mérida, Roberto; Romero, Ricardo; Pridgeon, Jim; Barber, Jason; Machamer, Joan; Chaddock, Kelley

2018-01-01

The imaging and clinical examination (ICE) algorithm used in the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure (BEST TRIP) randomized controlled trial is the only prospectively investigated clinical protocol for traumatic brain injury management without intracranial pressure (ICP) monitoring. As the default literature standard, it warrants careful evaluation. We present the ICE protocol in detail and analyze the demographics, outcome, treatment intensity, frequency of intervention usage, and related adverse events in the ICE-protocol cohort. The 167 ICE protocol patients were young (median 29 years) with a median Glasgow Coma Scale motor score of 4 but with anisocoria or abnormal pupillary reactivity in 40%. This protocol produced outcomes not significantly different from those randomized to the monitor-based protocol (favorable 6-month extended Glasgow Outcome Score in 39%; 41% mortality rate). Agents commonly employed to treat suspected intracranial hypertension included low-/moderate-dose hypertonic saline (72%) and mannitol (57%), mild hyperventilation (adjusted partial pressure of carbon dioxide 30-35 mm Hg in 73%), and pressors to maintain cerebral perfusion (62%). High-dose hyperosmotics or barbiturates were uncommonly used. Adverse event incidence was low and comparable to the BEST TRIP monitored group. Although this protocol should produce similar/acceptable results under circumstances comparable to those in the trial, influences such as longer pre-hospital times and non-specialist transport personnel, plus an intensive care unit model of aggressive physician-intensive care by small groups of neurotrauma-focused intensivists, which differs from most high-resource models, support caution in expecting the same results in dissimilar settings. Finally, this protocol's ICP-titration approach to suspected intracranial hypertension (vs. crisis management for monitored ICP) warrants further study.

An Atypical Case of Myxedema Coma with Concomitant Nonconvulsive Seizure.

PubMed

Patel, Pratik; Bekkerman, Mikhael; Varallo-Rodriguez, Cristina; Rampersaud, Rajendra

2016-01-01

Hypothyroidism is a prevalent condition in the general population that is treatable with appropriately dosed thyroid hormone replacement medication. Infrequently, patients will present with myxedema coma, characterized by hypothermia, hypotension, bradycardia, and altered mental status in the setting of severe hypothyroidism. Myxedema coma has also been known to manifest in a number of unusual and dangerous forms. Here, we present the case of a woman we diagnosed with an uncharacteristic expression of myxedema coma and nonconvulsive seizure complicated by a right middle cerebral artery infarct.

An Atypical Case of Myxedema Coma with Concomitant Nonconvulsive Seizure

PubMed Central

Patel, Pratik; Varallo-Rodriguez, Cristina

2016-01-01

Hypothyroidism is a prevalent condition in the general population that is treatable with appropriately dosed thyroid hormone replacement medication. Infrequently, patients will present with myxedema coma, characterized by hypothermia, hypotension, bradycardia, and altered mental status in the setting of severe hypothyroidism. Myxedema coma has also been known to manifest in a number of unusual and dangerous forms. Here, we present the case of a woman we diagnosed with an uncharacteristic expression of myxedema coma and nonconvulsive seizure complicated by a right middle cerebral artery infarct. PMID:27872766

Fulminant hyperammonaemia induced by thiopental coma in rats.

PubMed

Ivnitsky, Jury Ju; Rejniuk, Vladimir L; Schäfer, Timur V; Malakhovsky, Vladimir N

2006-07-25

Fulminant hyperammonaemia as a threshold effect of coma-inducing dose of sodium thiopental has been revealed in rats. Blood ammonia content increased progressively after the introduction of 1.0 LD(50) (but not 0.8 LD(50)) of sodium thiopental three times in 3h and five times in 18h. The urinary ammonia excretion was not impaired while the volatilization of ammoniac from the body of ST-treated rats was higher, giving evidence of the augmentation of ammonia production. Blood urea increased by one third despite of insignificant alterations of haematocrit and blood creatinine. Ammonia hyperproduction in the digestive tract could result from gastrointestinal stasis, which has been verified by roentgenography and confirmed by correlation of hyperammonaemia with the stool retardation. In thiopental coma rats the slope of a dose-dependent increase of the blood ammonia and the blood urea after the intraperitoneal injection of ammonium acetate did not exceed that in intact animals. So the ammonia hyperproduction in the digestive tract could be the main contributing cause of fulminant hyperammonaemia in rats with thiopental coma and thus be involved into pathogenesis of the coma.

Barbiturates Bind in the GLIC Ion Channel Pore and Cause Inhibition by Stabilizing a Closed State*♦

PubMed Central

Fourati, Zaineb; Ruza, Reinis Reinholds; Laverty, Duncan; Drège, Emmanuelle; Delarue-Cochin, Sandrine; Joseph, Delphine; Koehl, Patrice; Smart, Trevor; Delarue, Marc

2017-01-01

Barbiturates induce anesthesia by modulating the activity of anionic and cationic pentameric ligand-gated ion channels (pLGICs). Despite more than a century of use in clinical practice, the prototypic binding site for this class of drugs within pLGICs is yet to be described. In this study, we present the first X-ray structures of barbiturates bound to GLIC, a cationic prokaryotic pLGIC with excellent structural homology to other relevant channels sensitive to general anesthetics and, as shown here, to barbiturates, at clinically relevant concentrations. Several derivatives of barbiturates containing anomalous scatterers were synthesized, and these derivatives helped us unambiguously identify a unique barbiturate binding site within the central ion channel pore in a closed conformation. In addition, docking calculations around the observed binding site for all three states of the receptor, including a model of the desensitized state, showed that barbiturates preferentially stabilize the closed state. The identification of this pore binding site sheds light on the mechanism of barbiturate inhibition of cationic pLGICs and allows the rationalization of several structural and functional features previously observed for barbiturates. PMID:27986812

Acute migraine medication adherence, migraine disability and patient satisfaction: A naturalistic daily diary study.

PubMed

Seng, Elizabeth K; Robbins, Matthew S; Nicholson, Robert A

2017-09-01

Objective To examine the influence of acute migraine medication adherence on migraine disability and acute medication satisfaction. Methods Adults with migraine completed three months of daily electronic diaries assessing headache symptoms, acute medication taken, acute medication satisfaction, and daily migraine disability. Repeated measures mixed-effects models examined the effect of initial medication type [migraine-specific medication (MSM) vs. over-the-counter analgesic (OTC) vs. an opiate/barbiturate], the severity of pain at dosing, and their interaction with daily migraine disability and satisfaction with acute medication. Results Participants (N = 337; 92.5% female; 91.1% Caucasian, non-Hispanic; 84.0% with episodic migraine) recorded 29,722 diary days. Participants took acute medication on 96.5% of 8090 migraine days. MSM was most frequently taken first (58%), followed by OTC (29.9%) and an opiate/barbiturate (12.1%). Acute medication was most frequently taken when pain was mild (41.2%), followed by moderate (37.7%) and severe pain (11.4%). Initially dosing with MSM while pain was mild was associated with the lowest daily disability [medication × pain at dosing F (4, 6336.12) = 58.73, p < .001] and highest acute medication satisfaction [medication × pain at dosing F (4, 3867.36) = 24.00, p < .001]. Conclusion Using an MSM (triptan or ergot) first was associated with the lowest migraine disability and highest acute medication satisfaction.

21 CFR 522.775 - Doxapram.

Code of Federal Regulations, 2013 CFR

2013-04-01

... No. 000010 in § 510.600(c) of this chapter. (c) Conditions of use—(1) Amount. For intravenous use in dogs and cats at a dose of 21/2 to 5 mg per pound (/lb) body weight in barbiturate anesthesia, 0.5 mg... repeated in 15 to 20 minutes if necessary. (2) Indications for use. Administer to dogs, cats, and horses to...

21 CFR 522.775 - Doxapram.

Code of Federal Regulations, 2014 CFR

2014-04-01

... No. 000010 in § 510.600(c) of this chapter. (c) Conditions of use—(1) Amount. For intravenous use in dogs and cats at a dose of 21/2 to 5 mg per pound (/lb) body weight in barbiturate anesthesia, 0.5 mg... repeated in 15 to 20 minutes if necessary. (2) Indications for use. Administer to dogs, cats, and horses to...

21 CFR 522.775 - Doxapram.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Nos. 000010 and 015914 in § 510.600(c) of this chapter. (c) Conditions of use—(1) Amount. For intravenous use in dogs and cats at a dose of 21/2 to 5 mg per pound (/lb) body weight in barbiturate... be repeated in 15 to 20 minutes if necessary. (2) Indications for use. Administer to dogs, cats, and...

Targeted deletion of the GABRA2 gene encoding alpha2-subunits of GABA(A) receptors facilitates performance of a conditioned emotional response, and abolishes anxiolytic effects of benzodiazepines and barbiturates.

PubMed

Dixon, C I; Rosahl, T W; Stephens, D N

2008-07-01

Mice with point-mutated alpha2 GABA(A) receptor subunits (rendering them diazepam insensitive) are resistant to the anxiolytic-like effects of benzodiazepines (BZs) in the conditioned emotional response (CER) test, but show normal anxiolytic effects of a barbiturate. We investigated the consequence of deleting the alpha2-subunit on acquisition of the CER with increasing intensity of footshock, and on the anxiolytic efficacy of a benzodiazepine, diazepam, and a barbiturate, pentobarbital. alpha2 knockout (KO) and wildtype (WT) mice were trained in a conditioned emotional response (CER) task, in which lever pressing for food on a variable interval (VI) schedule was suppressed during the presentation of a compound light/tone conditioned stimulus (CS+) that predicted footshock. The ability of diazepam and of pentobarbital to reduce suppression during the CS+ was interpreted as an anxiolytic response. There were no differences between the genotypes in shock sensitivity, as assessed by their flinch responses to increasing levels of shock. However, alpha2 KO mice showed a greater suppression of lever pressing than WT littermates in the presence of a compound cue signalling footshock. Diazepam (0, 0.5, 1 and 2 mg/kg) induced a dose-dependent anxiolytic-like effect in WT mice but no such effect was seen in KO mice. Similarly, although pentobarbital (20 mg/kg) reduced the ability of the CS+ to reduce lever pressing rates in WT mice, this effect was not seen in the KO. These findings suggest that alpha2-containing GABA(A) receptors mediate the anxiolytic effects of barbiturates, as well as benzodiazepines, and that they may be involved in neuronal circuits underlying conditioned anxiety.

[Drugs for intravenous induction of anesthesia: barbiturates].

PubMed

Dumps, C; Halbeck, E; Bolkenius, D

2018-05-09

The discovery of barbituric acid and research on its derivatives have long been of importance in advancements in modern anesthesia. Decades of clinical use of barbiturates worldwide and their abuse has led to an enormous amount of knowledge. Thiopental and methohexital are ultra-short acting derivatives of barbiturates. Their clinical application has been accompanied by an enormous increase in the knowledge of the pharmacology of cerebrally active drugs, in particular gamma-aminobutyric acid (GABA A ) receptor and GABA-induced effects on nerve cell membranes. Despite the development of newer substances, thiopental still has a firm place in clinical applications. Currently it is mainly used in obstetrics for induction of cesarean sections under general anesthesia. A disadvantage, when properly used to induce anesthesia, is usually only the prolonged elimination kinetics of barbiturates. It is beneficial that barbiturates do not require side effect provoking solubilizers.

The Effect of Methysergide and X-irradiation on the Barbiturate Sleeping-time in Rats

DOE Office of Scientific and Technical Information (OSTI.GOV)

Varagić, V.; Stepanović, S.; Hajduković, S.

1962-10-01

Methysergide (1-methyl-D-lysergic acid butanolamide bimaleate), a highly potent and specific 5-hydroxytryptamine antagonist, if injected after irradiation, significantly depresses the proionging effect of x irradiation on the barbiturate sleeping-time in rats. Lysergic acid diethylamide did not show tius type of activity. 5-Hydroxytryptamine, when injected before irradiation, did not depress the typical response of the irradiated animals to barbiturates. When used after irradiation, 5-hydroxytryptamine caused a further prolongation of the barbiturate sleeping-time. Cysteamine, when injected before irradiation, depressed or blocked the prolonging effect of x irradiation on the barbiturate sleeping-time. When injected after irradiation, cysteamine was found to cause a further prolongationmore » of the barbiturate sleeping-time. The mechanisms of action of methysergide, 5-hydroxytryptamine, and cysteamine are briefly discussed. (auth)« less

Anxiolytic-like effect of Carvacrol (5-isopropyl-2-methylphenol) in mice: involvement with GABAergic transmission.

PubMed

Melo, Francisca Helvira Cavalcante; Venâncio, Edith Teles; de Sousa, Damião Pergentino; de França Fonteles, Marta Maria; de Vasconcelos, Silvânia Maria Mendes; Viana, Glauce Socorro Barros; de Sousa, Francisca Cléa Florenço

2010-08-01

Carvacrol (5-isopropyl-2-methylphenol) is a monoterpenic phenol present in the essencial oil of many plants. It is the major component of the essential oil fraction of oregano and thyme. This work presents the behavioral effects of carvacrol in animal models of elevated plus maze (EPM), open field, Rotarod and barbiturate-induced sleeping time tests in mice. Carvacrol (CVC) was administered orally, in male mice, at single doses of 12.5; 25 and 50 mg/kg while diazepam 1 or 2 mg/kg was used as standard drug and flumazenil (2.5 mg/kg) was used to elucidate the possible anxiolytic mechanism of CVC on the plus maze test. The results showed that CVC, at three doses, had no effect on the spontaneous motor activity in the Rotarod test nor in the number of squares crossed in the open-field test. However, CVC decreased the number of groomings in the open-field test. In the plus maze test, CVC, at three doses significantly increased all the observed parameters in the EPM test and flumazenil was able to reverse the effects of diazepam and CVC. Therefore, CVC did not alter the sleep latency and sleeping time in the barbiturate-induced sleeping time test. These results show that CVC presents anxiolytic effects in the plus maze test which are not influenced by the locomotor activity in the open-field test.

[On the history of barbiturates].

PubMed

Norn, Svend; Permin, Henrik; Kruse, Edith; Kruse, Poul R

2015-01-01

Throughout the history of humanity, numerous therapeutic agents have been employed for their sedative and hypnotic properties such as opium, henbane (Hyoscyamus niger) and deadly nightshade (Atropa belladonna), but also alcohol and wine. In the 19th century potassium bromide was introduced as a sedative - and antiepileptic drug and chloral hydrate as sedative-hypnotics. A new era was reached by the introduction of barbiturates. The story started with the chemist Adolf von Baeyer. His breakthrough in the synthesis of new agents as barbituric acid and indigo and his education of young chemists was of great importance for the science of organic chemistry and the development of the dye and medicine industry in the late 19th century. The next important step was the development of barbiturates. The pioneers were Josef von Mering and Emil Fischer. Using the Grimaux-method they synthesized various barbiturates. It was von Mering who got the idea of introducing ethyl groups in the inactive barbituric acid to obtain sedatives, but the synthesis was succeeded by the chemist Emil Fischer. Experiments with dogs clearly showed sedative and hypnotic effect of the barbiturates and the oral administration of barbital (Veronal) confirmed the effect in humans. Barbital was commercialized in 1903 and in 1911 phenobarbital (Luminal) was introduced in the clinic, and this drug showed hypnotic and antiepileptic effects. Thereafter a lot of new barbiturates appeared. Dangerous properties of the drugs were recognized as abuse, addiction, and poisoning. An optimum treatment of acute barbiturate intoxication was obtained by the "Scandinavian method", which was developed in the Poison Centre of the Bispebjerg Hospital in Copenhagen. The centre was established by Carl Clemmesen in 1949 and the intensive care treatment reduced the mortality of the admitted persons from 20% to less than 2%. To-day only a few barbiturates are used in connection with anaesthesia and for the treatment of epilepsy, and chemists are focusing on drugs with more selective effects.

High dose phenobarbitone coma in pediatric refractory status epilepticus; a retrospective case record analysis, a proposed protocol and review of literature.

PubMed

Gulati, Sheffali; Sondhi, Vishal; Chakrabarty, Biswaroop; Jauhari, Prashant; Lodha, Rakesh; Sankar, Jhuma

2018-04-01

Ongoing refractory status epilepticus is associated with significant morbidity and mortality. Therapeutic coma induction with midazolam, thiopentone, phenobarbitone or propofol is indicated when conventional antiepileptics fail to abort seizure. Of these, the most extensively studied is midazolam. Amongst the remaining three, phenobarbitone has the most favourable pharmacological profile, but has not been studied adequately, more so in the pediatric age group. The current retrospective case records analysis is an attempt to describe use of phenobarbitone coma in pediatric refractory status epilepticus. Case records of patients, admitted with status epilepticus to the pediatric inpatient services of a tertiary care teaching hospital of North India between January 2014 and December 2016 were reviewed. Those with refractory status epilepticus who failed to respond to midaolam infusion and phenobarbitone coma was used were included for analysis. Overall, 108 children presented in status, of which 34 developed refractory status epilepticus. Of these 34, 21 responded to midazolam infusion and in 13 high dose phenobarbitone coma following a standardised protocol was used. Amongst these 13 (8 males and 5 females, median age 6 years, IQR: 2.5-9.5), 12 responded and 1 succumbed. The median time to clinical seizure resolution and desired electroencephalographic changes post phenobarbitone initiation were 16 (IQR: 12-25) and 72 h (IQR: 48-120) respectively. High dose phenobarbitone appears to be an effective therapeutic modality in pediatric refractory status epilepticus. The current study provides a protocol for its use which can be validated in future studies with larger sample size. Copyright © 2018 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Complete recovery after severe myxoedema coma complicated by status epilepticus

PubMed Central

Fjølner, Jesper; Søndergaard, Esben; Kampmann, Ulla; Nielsen, Søren

2015-01-01

We report a case of life-threatening myxoedema presenting with hypothermia, hypotension, bradycardia, pericardial effusion and deep coma. The condition was complicated by prolonged status epilepticus. The optimal treatment strategy has been debated over the years and the literature is briefly reviewed. Treatment with l-thyroxine (LT4) monotherapy without initial loading dose and with no l-triiodothyronine (LT3) treatment was successful with full recovery after hospitalisation for more than a month. Myxoedema coma is a rare, reversible condition with a high mortality and should be considered as a differential diagnosis in medical emergencies. PMID:25809434

Complete recovery after severe myxoedema coma complicated by status epilepticus.

PubMed

Fjølner, Jesper; Søndergaard, Esben; Kampmann, Ulla; Nielsen, Søren

2015-03-25

We report a case of life-threatening myxoedema presenting with hypothermia, hypotension, bradycardia, pericardial effusion and deep coma. The condition was complicated by prolonged status epilepticus. The optimal treatment strategy has been debated over the years and the literature is briefly reviewed. Treatment with l-thyroxine (LT4) monotherapy without initial loading dose and with no l-triiodothyronine (LT3) treatment was successful with full recovery after hospitalisation for more than a month. Myxoedema coma is a rare, reversible condition with a high mortality and should be considered as a differential diagnosis in medical emergencies. 2015 BMJ Publishing Group Ltd.

Pharmacologic Treatment Reduces Pressure Times Time Dose and Relative Duration of Intracranial Hypertension.

PubMed

Colton, Katharine; Yang, S; Hu, P F; Chen, H H; Bonds, B; Stansbury, L G; Scalea, T M; Stein, D M

2016-05-01

Past work has shown the importance of the "pressure times time dose" (PTD) of intracranial hypertension (intracranial pressure [ICP] > 19 mm Hg) in predicting outcome after severe traumatic brain injury. We used automated data collection to measure the effect of common medications on the duration and dose of intracranial hypertension. Patients >17 years old, admitted and requiring ICP monitoring between 2008 and 2010 at a single, large urban tertiary care facility, were retrospectively enrolled. Timing and dose of ICP-directed therapy were recorded from paper and electronic medical records. The ICP data were collected automatically at 6-second intervals and averaged over 5 minutes. The percentage of time of intracranial hypertension (PTI) and PTD (mm Hg h) were calculated. A total of 98 patients with 664 treatment instances were identified. Baseline PTD ranged from 27 (before administration of propofol and fentanyl) to 150 mm Hg h (before mannitol). A "small" dose of hypertonic saline (HTS; ≤250 mL 3%) reduced PTD by 38% in the first hour and 37% in the second hour and reduced the time with ICP >19 by 38% and 39% after 1 and 2 hours, respectively. A "large" dose of HTS reduced PTD by 40% in the first hour and 63% in the second (PTI reduction of 36% and 50%, respectively). An increased dose of propofol or fentanyl infusion failed to decrease PTD but reduced PTI between 14% (propofol alone) and 30% (combined increase in propofol and fentanyl, after 2 hours). Barbiturates failed to decrease PTD but decreased PTI by 30% up to 2 hours after administration. All reductions reported are significantly changed from baseline, P < .05. Baseline PTD values before drug administration reflects varied patient criticality, with much higher values seen before the use of mannitol or barbiturates. Treatment with HTS reduced PTD and PTI burden significantly more than escalation of sedation or pain management, and this effect remained significant at 2 hours after administration. © The Author(s) 2014.

Demographic profile and extent of healthcare resource utilisation of patients with severe traumatic brain injury: still a major public health problem.

PubMed

Wee, Jing Zhong; Yang, Yun Rui Jasmine; Lee, Qian Yi Ruth; Cao, Kelly; Chong, Chin Ted

2016-09-01

Trauma is the fifth principal cause of death in Singapore, with traumatic brain injury (TBI) being the leading specific subordinate cause. This study was an eight-year retrospective review of the demographic profiles of patients with severe TBI who were admitted to the neurointensive care unit (NICU) of the National Neuroscience Institute at Tan Tock Seng Hospital, Singapore, between 2004 and 2011. A total of 780 TBI patients were admitted during the study period; 365 (46.8%) patients sustained severe TBI (i.e. Glasgow Coma Scale score ≤ 8), with the majority (75.3%) being male. The ages of patients with severe TBI ranged from 14-93 years, with a bimodal preponderance in young adults (i.e. 21-40 years) and elderly persons (i.e. > 60 years). Motor vehicle accidents (48.8%) and falls (42.5%) were the main mechanisms of injury. Invasive line monitoring was frequently employed; invasive arterial blood pressure monitoring and central venous pressure monitoring were used in 81.6% and 60.0% of the patients, respectively, while intracranial pressure (ICP) measurement was required in 47.4% of the patients. The use of tiered therapy to control ICP (e.g. sedation, osmotherapy, cerebrospinal fluid drainage, moderate hyperventilation and barbiturate-induced coma) converged with international practices. The high-risk groups for severe TBI were young adults and elderly persons involved in motor vehicle accidents and falls, respectively. In the NICU, the care of patients with severe TBI requires heavy utilisation of resources. The healthcare burden of these patients extends beyond the acute critical care phase.

Formation of a hydrogen-bonded barbiturate [2]-rotaxane.

PubMed

Tron, Arnaud; Thornton, Peter J; Rocher, Mathias; Jacquot de Rouville, Henri-Pierre; Desvergne, Jean-Pierre; Kauffmann, Brice; Buffeteau, Thierry; Cavagnat, Dominique; Tucker, James H R; McClenaghan, Nathan D

2014-03-07

Interlocked structures containing the classic Hamilton barbiturate binding motif comprising two 2,6-diamidopyridine units are reported for the first time. Stable [2]-rotaxanes can be accessed either through hydrogen-bonded preorganization by a barbiturate thread followed by a Cu(+)-catalyzed "click" stoppering reaction or by a Cu(2+)-mediated Glaser homocoupling reaction.

Interactions of Enolizable Barbiturate Dyes.

PubMed

Schade, Alexander; Schreiter, Katja; Rüffer, Tobias; Lang, Heinrich; Spange, Stefan

2016-04-11

The specific barbituric acid dyes 1-n-butyl-5-(2,4-dinitro-phenyl) barbituric acid and 1-n-butyl-5-{4-[(1,3-dioxo-1H-inden-(3 H)-ylidene)methyl]phenyl}barbituric acid were used to study complex formation with nucleobase derivatives and related model compounds. The enol form of both compounds shows a strong bathochromic shift of the UV/Vis absorption band compared to the rarely coloured keto form. The keto-enol equilibria of the five studied dyes are strongly dependent on the properties of the environment as shown by solvatochromic studies in ionic liquids and a set of organic solvents. Enol form development of the barbituric acid dyes is also associated with alteration of the hydrogen bonding pattern from the ADA to the DDA type (A=hydrogen bond acceptor site, D=donor site). Receptor-induced altering of ADA towards DDA hydrogen bonding patterns of the chromophores are utilised to study supramolecular complex formation. As complementary receptors 9-ethyladenine, 1-n-butylcytosine, 1-n-butylthymine, 9-ethylguanidine and 2,6-diacetamidopiridine were used. The UV/Vis spectroscopic response of acid-base reaction compared to supramolecular complex formation is evaluated by (1)H NMR titration experiments and X-ray crystal structure analyses. An increased acidity of the barbituric acid derivative promotes genuine salt formation. In contrast, supramolecular complex formation is preferred for the weaker acidic barbituric acid. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

[Could it be a little less? Let the dose of thiopental in euthanasia depend on the body weight].

PubMed

Sprij, Bram

2010-01-01

The Dutch 'euthanasia and assisted suicide' practice guideline advises using 2000 mg thiopental to induce coma, followed by a muscle relaxant to cause death by respiratory paralysis. However, when a doctor administers such a high dose of thiopental as a bolus injection to a cachectic patient, there is a high likelihood of immediate death and other side effects, which can be distressing for the family. Doctors who administered less than 2000 mg have been reprimanded for not working according to current standards. Arguments are given concerning in which circumstances it is reasonable to use the advised dose of 2000 mg of thiopental and when to use less thiopental to induce coma by direct intravenous injection. The author suggests that it may be better to adjust the dose of thiopental according to the body weight of the patient. The current practice guideline needs revision.

Management of refractory status epilepticus in adults

PubMed Central

Rossetti, Andrea O.; Lowenstein, Daniel H.

2011-01-01

Summary Refractory status epilepticus (RSE) can be defined as status epilepticus that continues despite treatment with benzodiazepines and one antiepileptic drug. RSE should be treated promptly to prevent morbidity and mortality; however, scarce evidence is available to support the choice of specific treatments. Major independent outcome predictors are age (not modifiable) and etiology (that should be actively targeted). Recent recommendations for adults, relying upon limited evidence, suggest that RSE treatment aggressiveness should be tailored to the clinical situation: to minimize ICU-related complications, focal RSE without major consciousness impairment might initially be approached more conservatively; conversely, early induction of pharmacological coma is advisable in generalized-convulsive forms. At this stage, midazolam, propofol or barbiturates represent the most used alternatives. Several other treatments, such as additional anesthetics, other antiepileptic or immunomodulatory compounds, or non-pharmacological approaches (electroconvulsive treatment, hypothermia), have been used in protracted RSE. Treatment lasting weeks or months may sometimes result in a good outcome, as in selected cases after cerebral anoxia and encephalitis. Well-designed prospective studies of this condition are urgently needed. PMID:21939901

Pentobarbital quantitation using EMIT serum barbiturate assay reagents: application to monitoring of high-dose pentobarbital therapy.

PubMed

Pape, B E; Cary, P L; Clay, L C; Godolphin, W

1983-01-01

Pentobarbital serum concentrations associated with a high-dose therapeutic regimen were determined using EMIT immunoassay reagents. Replicate analyses of serum controls resulted in a within-assay coefficient of variation of 5.0% and a between-assay coefficient of variation of 10%. Regression analysis of 44 serum samples analyzed by this technique (y) and a reference procedure (x) were y = 0.98x + 3.6 (r = 0.98; x = ultraviolet spectroscopy) and y = 1.04x + 2.4 (r = 0.96; x = high-performance liquid chromatography). Clinical evaluation of the results indicates the immunoassay is sufficiently sensitive and selective for pentobarbital to allow accurate quantitation within the therapeutic range associated with high-dose therapy.

Central effects of citral, myrcene and limonene, constituents of essential oil chemotypes from Lippia alba (Mill.) n.e. Brown.

PubMed

do Vale, T Gurgel; Furtado, E Couto; Santos, J G; Viana, G S B

2002-12-01

Citral, myrcene and limonene (100 and 200 mg/kg body wt., i.p.), constituents of essential oils from Lippia alba chemotypes, decreased not only the number of crossings but also numbers for rearing and grooming, as measured by the open-field test in mice. Although muscle relaxation detected by the rota rod test was seen only at the highest doses of citral (200 mg/kg body wt.) and myrcene (100 and 200 mg/kg body wt.), this effect was observed even at the lowest dose of limonene (50 mg/kg body wt.). Also, citral and myrcene (100 and 200 mg/kg body wt.) increased barbiturate sleeping time as compared to control. Limonene was also effective at the highest dose, and although citral did not increase the onset of sleep, it increased the duration of sleep, which is indicative of a potentiation of sleeping time. Citral (100 and 200 mg/kg body wt.) increased 2.3 and 3.5 times, respectively, the barbiturate sleeping time in mice. Similar effects were observed for myrcene and limonene at the highest dose (200 mg/kg body wt.) which increased the sleeping time around 2.6 times. In the elevated-plus maze, no effect was detected with citral up to 25 mg/kg body wt., while at a high dose it decreased by 46% the number of entries in the open arms. A smaller but significant effect was detected with limonene (5 mg/kg body wt.). While myrcene (10 mg/kg body wt.) decreased only by 22% the number of entries in the open arms, this parameter was decreased by 48% at the highest dose. Our study showed that citral, limonene and myrcene presented sedative as well as motor relaxant effects. Although only at the highest dose, they also produced a potentiation of the pentobarbital-induced sleeping time in mice, which was more intense in the presence of citral. In addition, neither of them showed an anxiolytic effect, but rather a slight anxiogenic type of effect at the higher doses.

[Myxedema coma as a rare differential diagnosis of severe consciousness disturbance].

PubMed

Kollmar, R; Schellinger, P D; Bardutzky, J; Meisel, F; Schwaninger, M

2002-12-01

Myxedema coma is a rare and life-threatening complication of untreated hypothyroidism. Therefore, it must be part of the differential diagnosis in comatose patients. We report one patient who presented with CO(2) narcosis,hypothermia, bradycardia,hyporeflexia, tetraparesis, ascitis, pleural effusions, and heart insufficiency. Examination of the CSF, cranial CT, MRI, and MR angiography were normal. In suspicion of myxedema coma,the patient was treated with high dose L-thyroxine and hydrocortisone for preventing secondary adrenal insufficiency. A fast clinical recovery, decreased T4 (7.2 ng/l) and T3 (0.93 ng/l), and increased TSH (20.19 mU/l) together with the following anamnesis of radio iodine therapy and insufficient thyroxine intake confirmed the diagnosis. In conclusion, treatment of the myxedema coma must be started as soon as the laboratory results are confirmatory, since its course depends on the time of initiation of treatment.

Occurrence and fate of barbiturates in the aquatic environment.

PubMed

Peschka, Manuela; Eubeler, Jan P; Knepper, Thomas P

2006-12-01

Barbiturates have been widely used as sedative hypnotics in the mid-1960s and since then mainly as veterinary drugs. To monitor their presence and fate in the aquatic environment, a method based on gas chromatography-mass spectrometry (GC-MS) has been developed to quantify butalbital, secobarbital, hexobarbital, aprobarbital, phenobarbital, and pentobarbital, all with a limit of detection (LOD) down to 1 ng/L. From the various investigated waste and surface water samples, barbiturates were only, but regularly detected in the Mulde, a tributary of the river Elbe in Germany at relevant concentrations up to several microg/L. Investigations of groundwater being affected with wastewater infiltration several decades ago also revealed a barbiturate pattern, indicating a strong recalcitrance of these drugs. To confirm this hypothesis, studies were carried out on biotic and abiotic degradation. Both, the biodegradability under aerobic conditions and hydrolysis did not show any degradation, implementing, that the investigated barbiturates, once released into the aquatic environment, show high stability over a long period of time.

Direct Synthesis of 5-Aryl Barbituric Acids by Rhodium(II)-Catalyzed Reactions of Arenes with Diazo Compounds**

PubMed Central

Best, Daniel; Burns, David J; Lam, Hon Wai

2015-01-01

A commercially available rhodium(II) complex catalyzes the direct arylation of 5-diazobarbituric acids with arenes, allowing straightforward access to 5-aryl barbituric acids. Free N—H groups are tolerated on the barbituric acid, with no complications arising from N—H insertion processes. This method was applied to the concise synthesis of a potent matrix metalloproteinase (MMP) inhibitor. PMID:25959544

The history of barbiturates a century after their clinical introduction

PubMed Central

López-Muñoz, Francisco; Ucha-Udabe, Ronaldo; Alamo, Cecilio

2005-01-01

The present work offers an analysis of the historical development of the discovery and use of barbiturates in the field of psychiatry and neurology, a century after their clinical introduction. Beginning with the synthesis of malonylurea by von Baeyer in 1864, and up to the decline of barbiturate therapy in the 1960s, it describes the discovery of the sedative properties of barbital, by von Mering and Fischer (1903), the subsequent synthesis of phenobarbital by this same group (1911), and the gradual clinical incorporation of different barbiturates (butobarbital, amobarbital, secobarbital, pentobarbital, thiopental, etc). We describe the role played in therapy by barbiturates throughout their history: their traditional use as sedative and hypnotic agents, their use with schizophrenic patients in so-called “sleep cures” (Klaesi, Cloetta), the discovery of the antiepileptic properties of phenobarbital (Hauptmann) and their use in the treatment of epilepsy, and the introduction of thiobarbiturates in intravenous anesthesia (Lundy, Waters). We also analyze, from the historical perspective, the problems of safety (phenomena of dependence and death by overdose) which, accompanied by the introduction of a range of psychoactive drugs in the 1950s, brought an end to barbiturate use, except in specific applications, such as the induction of anesthesia and the treatment of certain types of epileptic crisis. PMID:18568113

Spatial variation in automated burst suppression detection in pharmacologically induced coma.

PubMed

An, Jingzhi; Jonnalagadda, Durga; Moura, Valdery; Purdon, Patrick L; Brown, Emery N; Westover, M Brandon

2015-01-01

Burst suppression is actively studied as a control signal to guide anesthetic dosing in patients undergoing medically induced coma. The ability to automatically identify periods of EEG suppression and compactly summarize the depth of coma using the burst suppression probability (BSP) is crucial to effective and safe monitoring and control of medical coma. Current literature however does not explicitly account for the potential variation in burst suppression parameters across different scalp locations. In this study we analyzed standard 19-channel EEG recordings from 8 patients with refractory status epilepticus who underwent pharmacologically induced burst suppression as medical treatment for refractory seizures. We found that although burst suppression is generally considered a global phenomenon, BSP obtained using a previously validated algorithm varies systematically across different channels. A global representation of information from individual channels is proposed that takes into account the burst suppression characteristics recorded at multiple electrodes. BSP computed from this representative burst suppression pattern may be more resilient to noise and a better representation of the brain state of patients. Multichannel data integration may enhance the reliability of estimates of the depth of medical coma.

[Etiology of initially unexplained confusion of excitability in deadly nightshade poisoning with suicidal intent. Symptoms, differential diagnosis, toxicology and physostigmine therapy of anticholinergic syndrome].

PubMed

Heindl, S; Binder, C; Desel, H; Matthies, U; Lojewski, I; Bandelow, B; Kahl, G F; Chemnitius, J M

2000-11-10

After a walk in a wood a 55-year-old teacher was admitted to the emergency unit of a university hospital because of somnolence and excitability. Her rectal temperature was 37.8 degrees C, she had sinus tachycardia (rate of 130/min) but no other significant findings. With the exception of C-reactive protein (10 mg/dl), MCV (101 fl), MCH (34 pg) and arterial blood gases (pH 7.483, pCO2 35.5 mmHg, base excess 5.1 mmp/l) laboratory tests were within normal limits. Qualitative screening of serum for benzodiazepines, barbiturates and antidepressives was negative. Neurological examination, including lumbar puncture and cranial computed tomography were noncontributory. 10 hours after admission the patient developed signs of an anticholinergic syndrome with mydriasis, dry mouth, tachycardia, hot skin and an atonic bladder. Physostigmine 2 mg completely reversed the neurological and mental symptoms. After gas chromatography, mass-spectrometry of a urine sample showed an atropine molecular fragment with a molecular weight of 271. At intervals of 3 to 5 hours the recurrence of confusion and excitability required 4 further i.v. injection of physostigmine. The patient subsequently became accessible to psychiatric examination and reported that during the walk she had swallowed 8-10 berries of deadly nightshade with suicidal intent. In case of excitability and confusion as well as somnolence or coma of uncertain aetiology an anticholinergic syndrome caused by ingestion of atropine-containing plants or psychoactive drugs (phenothiazines, butyrophenones, tri- or tetracyclic antidepressants) should be included in the differential diagnosis. If there are suggestive clinical findings (tachycardia, somnolence, coma or threatened respiratory arrest, physostigmine should be given if there are no contraindications.

Role of Intracranial Pressure Monitoring in Management of Patients with Severe Traumatic Brain Injury: Results of a Large Level I Trauma Center in Southern Iran.

PubMed

Khalili, Hosseinali; Sadraei, Nazanin; Niakan, Amin; Ghaffarpasand, Fariborz; Sadraei, Amin

2016-10-01

To determine the role of intracranial pressure (ICP) monitoring in management of patients with severe traumatic brain injury (TBI) admitted to a large level I trauma center in Southern Iran. This was a cohort study performed during a 2-year period in a level I trauma center in Southern Iran including all adult patients (>16 years) with severe TBI (Glasgow Coma Scale [GCS] score, 3-8) who underwent ICP monitoring through ventriculostomy. The management was based on the recorded ICP values with threshold of 20 mm Hg. Decompressive craniectomy was performed in patients with intractable intracranial hypertension (persistent ICP ≥25 mm Hg). In unresponsive patients, barbiturate coma was induced. Patients were followed for 6 months and Glasgow Outcome Scale Extended was recorded. The determinants of favorable and unfavorable outcome were also determined. Overall, we included 248 patients with mean age of 34.6 ± 16.6 years, among whom there were 216 men (87.1%) and 32 women (12.9%). Eighty-five patients (34.2%) had favorable and 163 (65.8%) unfavorable outcomes. Those with favorable outcome had significantly lower age (P = 0.004), higher GCS score on admission (P < 0.001), lower Rotterdam score (P = 0.035), fewer episodes of intracranial hypertension (P < 0.001), and lower maximum recorded ICP (P = 0.041). These factors remained statistically significant after elimination of confounders by multivariate logistic regression model. Age, GCS score on admission, Rotterdam score, intracranial hypertension, and maximum recorded ICP are important determinants of outcome in patients with severe TBI. ICP monitoring assisted us in targeted therapy and management of patients with severe TBI. Copyright © 2016 Elsevier Inc. All rights reserved.

A Comparison of Pharmacologic Therapeutic Agents Used for the Reduction of Intracranial Pressure After Traumatic Brain Injury.

PubMed

Alnemari, Ahmed M; Krafcik, Brianna M; Mansour, Tarek R; Gaudin, Daniel

2017-10-01

In neurotrauma care, a better understanding of treatments after traumatic brain injury (TBI) has led to a significant decrease in morbidity and mortality in this population. TBI represents a significant medical problem, and complications after TBI are associated with the initial injury and postevent intracranial processes such as increased intracranial pressure and brain edema. Consequently, appropriate therapeutic interventions are required to reduce brain tissue damage and improve cerebral perfusion. We present a contemporary review of literature on the use of pharmacologic therapies to reduce intracranial pressure after TBI and a comparison of their efficacy. This review was conducted by PubMed query. Only studies discussing pharmacologic management of patients after TBI were included. This review includes prospective and retrospective studies and includes randomized controlled trials as well as cohort, case-control, observational, and database studies. Systematic literature reviews, meta-analyses, and studies that considered conditions other than TBI or pediatric populations were not included. Review of the literature describing the current pharmacologic treatment for intracranial hypertension after TBI most often discussed the use of hyperosmolar agents such as hypertonic saline and mannitol, sedatives such as fentanyl and propofol, benzodiazepines, and barbiturates. Hypertonic saline is associated with faster resolution of intracranial hypertension and restoration of optimal cerebral hemodynamics, although these advantages did not translate into long-term benefits in morbidity or mortality. In patients refractory to treatment with hyperosmolar therapy, induction of a barbiturate coma can reduce intracranial pressure, although requires close monitoring to prevent adverse events. Current research suggests that the use of hypertonic saline after TBI is the best option for immediate decrease in intracranial pressure. A better understanding of the efficacy of each treatment option can help to direct treatment algorithms during the critical early hours of trauma care and continue to improve morbidity and mortality after TBI. Copyright © 2017 Elsevier Inc. All rights reserved.

Barbiturate intoxication and overdose

MedlinePlus

... breathing Slow, slurred speech Sluggishness Staggering Excessive and long-term use of barbiturates, such as phenobarbital, may produce the following chronic symptoms: Changes in alertness Decreased functioning Irritability Memory loss

21 CFR 862.3150 - Barbiturate test system.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Toxicology Test Systems § 862... in monitoring levels of barbiturate to ensure appropriate therapy. (b) Classification. Class II. ...

4 CFR 25.8 - Alcoholic beverages and narcotics.

Code of Federal Regulations, 2014 CFR

2014-01-01

... alcoholic beverages, narcotic drugs, hallucinogens, marijuana, barbiturates, or amphetamines is prohibited..., marijuana, barbiturate, or amphetamine. This prohibition shall not apply in cases where the drug is being...

4 CFR 25.8 - Alcoholic beverages and narcotics.

Code of Federal Regulations, 2011 CFR

2011-01-01

... alcoholic beverages, narcotic drugs, hallucinogens, marijuana, barbiturates, or amphetamines is prohibited..., marijuana, barbiturate, or amphetamine. This prohibition shall not apply in cases where the drug is being...

4 CFR 25.8 - Alcoholic beverages and narcotics.

Code of Federal Regulations, 2012 CFR

2012-01-01

... alcoholic beverages, narcotic drugs, hallucinogens, marijuana, barbiturates, or amphetamines is prohibited..., marijuana, barbiturate, or amphetamine. This prohibition shall not apply in cases where the drug is being...

4 CFR 25.8 - Alcoholic beverages and narcotics.

Code of Federal Regulations, 2010 CFR

2010-01-01

... alcoholic beverages, narcotic drugs, hallucinogens, marijuana, barbiturates, or amphetamines is prohibited..., marijuana, barbiturate, or amphetamine. This prohibition shall not apply in cases where the drug is being...

4 CFR 25.8 - Alcoholic beverages and narcotics.

Code of Federal Regulations, 2013 CFR

2013-01-01

... alcoholic beverages, narcotic drugs, hallucinogens, marijuana, barbiturates, or amphetamines is prohibited..., marijuana, barbiturate, or amphetamine. This prohibition shall not apply in cases where the drug is being...

Hematin and propranolol in acute intermittent porphyria. Full recovery from quadriplegic coma and respiratory failure.

PubMed

Brezis, M; Ghanem, J; Weiler-Ravell, D; Epstein, O; Morris, D

1979-01-01

The authors present a case of acute intermittent porphyria (AIP) in an almost fatal relapse with quadriplegia, bulbar paralysis and coma. Intravenous hematin produced an immediate arousal from coma and allowed a gradual resumption of bulbar and autonomic functions. Persistent tachycardia and hypertension necessitated huge doses of intravenous propranolol. Both hematin and propranolol administrations were followed by a remarkable decrease in urinary amino-levulinic acid and porphobilinogen excretion. Nevertheless, after the acute stage, the patient was left with a severe generalized muscle wasting. After 7 months of intensive physical therapy, complete recovery of all neuromuscular functions was achieved. The modern aspects of the management of AIP are presented; the efficacy and the limits of hematin and propranolol therapy are discussed.

Virtual Reality Pain Control During Burn Wound Debridement of Combat-Related Burn Injuries Using Robot-Like Arm Mounted VR Goggles

DTIC Science & Technology

2011-07-01

naturally contracts as it heals. Physical therapy stretches help to counteract contraction, increasing skin elasticity, and en- hancing range of motion.3...excru- ciating pain during medical procedures such as wound clean- ing and physical therapy .4 Although opioids are the cornerstone analgesic for patients...Used at low doses, ketamine is a non-barbiturate intravenous anesthetic that is used as part of a multi-modal therapy . Ketamine does not cause

32 CFR 228.9 - Prohibition on narcotics and illegal substances.

Code of Federal Regulations, 2014 CFR

2014-07-01

... narcotic drug, hallucinogen, marijuana, barbiturate or amphetamine is prohibited. Operation of a motor..., hallucinogens, marijuana, barbiturates or amphetamines is also prohibited. These prohibitions shall not apply in...

32 CFR 228.9 - Prohibition on narcotics and illegal substances.

Code of Federal Regulations, 2011 CFR

2011-07-01

... narcotic drug, hallucinogen, marijuana, barbiturate or amphetamine is prohibited. Operation of a motor..., hallucinogens, marijuana, barbiturates or amphetamines is also prohibited. These prohibitions shall not apply in...

32 CFR 228.9 - Prohibition on narcotics and illegal substances.

Code of Federal Regulations, 2013 CFR

2013-07-01

... narcotic drug, hallucinogen, marijuana, barbiturate or amphetamine is prohibited. Operation of a motor..., hallucinogens, marijuana, barbiturates or amphetamines is also prohibited. These prohibitions shall not apply in...

32 CFR 228.9 - Prohibition on narcotics and illegal substances.

Code of Federal Regulations, 2012 CFR

2012-07-01

... narcotic drug, hallucinogen, marijuana, barbiturate or amphetamine is prohibited. Operation of a motor..., hallucinogens, marijuana, barbiturates or amphetamines is also prohibited. These prohibitions shall not apply in...

32 CFR 228.9 - Prohibition on narcotics and illegal substances.

Code of Federal Regulations, 2010 CFR

2010-07-01

... narcotic drug, hallucinogen, marijuana, barbiturate or amphetamine is prohibited. Operation of a motor..., hallucinogens, marijuana, barbiturates or amphetamines is also prohibited. These prohibitions shall not apply in...

Exacerbation of benign familial neonatal epilepsy induced by massive doses of phenobarbital and midazolam.

PubMed

Maeda, Tomoki; Shimizu, Miki; Sekiguchi, Kazuhito; Ishii, Atsushi; Ihara, Yukiko; Hirose, Shinichi; Izumi, Tatsuro

2014-08-01

Barbiturates and benzodiazepines are the first-line anticonvulsants for neonatal seizures. However, in immature brains, those drugs may lead to paradoxical neuronal excitation. A patient with benign familial neonatal epilepsy developed epileptic encephalopathy after massive doses of phenobarbital that were followed by a continuous infusion of midazolam on postnatal day 3. Electroencephalography revealed rhythmic delta activity in clusters with migrating epileptic foci. After discontinuation of both drugs, the patient's consciousness promptly improved and her electroencephalography normalized on postnatal day 5. This baby developed persistent electroencephalographic seizures due to massive doses of phenobarbital and midazolam. Clinicians should be aware of this anticonvulsant-induced paradoxical neuronal excitation and the uncoupling phenomenon, especially in individuals with benign familial neonatal epilepsy, who have low seizure thresholds. Copyright © 2014 Elsevier Inc. All rights reserved.

Burst Suppression on Processed Electroencephalography as a Predictor of Post-Coma Delirium in Mechanically Ventilated ICU Patients

PubMed Central

Andresen, Jennifer M.; Girard, Timothy D.; Pandharipande, Pratik P.; Davidson, Mario A.; Ely, E. Wesley; Watson, Paula L.

2015-01-01

Objectives Many patients, due to a combination of illness and sedatives, spend a considerable amount of time in a comatose state that can include time in burst suppression. We sought to determine if burst suppression measured by processed electroencephalography (pEEG) during coma in sedative-exposed patients is a predictor of post-coma delirium during critical illness. Design Observational convenience sample cohort Setting Medical and surgical ICUs in a tertiary care medical center Patients Cohort of 124 mechanically ventilated ICU patients Measurements and Main Results Depth of sedation was monitored twice daily using the Richmond Agitation-Sedation Scale and continuously monitored by pEEG. When non-comatose, patients were assessed for delirium twice daily using Confusion Assessment Method for the ICU (CAM-ICU). Multiple logistic regression and Cox proportional hazards regression were used to assess associations between time in burst suppression and both incidence and time to resolution of delirium, respectively, adjusting for time in deep sedation and a principal component score consisting of APACHE II score and cumulative doses of sedatives while comatose. Of the 124 patients enrolled and monitored, 55 patients either never had coma or never emerged from coma yielding 69 patients for whom we performed these analyses; 42 of these 69 (61%) had post-coma delirium. Most patients had burst-suppression during coma, though often short-lived [ median (intraquartile range) time in burst suppression, 6.4 (1-58) minutes]. After adjusting for covariates, even this short time in burst suppression independently predicted a higher incidence of post-coma delirium [odds ratio 4.16; 95% confidence interval (CI) 1.27-13.62; p=0.02] and a lower likelihood (delayed) resolution of delirium (hazard ratio 0.78; 95% CI 0.53-0.98; p=0.04). Conclusions Time in burst suppression during coma, as measured by processed EEG, was an independent predictor of incidence and time to resolution of post-coma/post-deep sedation delirium. These findings of this single center investigation support lighter sedation strategies. PMID:25072756

Pediatric intensive care treatment of uncontrolled status epilepticus.

PubMed

Wilkes, Ryan; Tasker, Robert C

2013-04-01

The critically ill mechanically ventilated child with ongoing seizures that are refractory to any treatment presents a distinct challenge in pediatric neurocritical care. The evidence base from randomized controlled trials on which anti-epileptic drug (AED) strategy should be used is inadequate. This review of refractory and super-refractory status epilepticus summarizes recent pediatric case series regarding definitions, the second-tier AED therapies once initial anticonvulsants have failed, and the experience of high-dose midazolam, barbiturate anesthesia, and volatile anesthetics for uncontrolled status epilepticus. Copyright © 2013 Elsevier Inc. All rights reserved.

Synthesis of Barbiturate-Based Methionine Aminopeptidase-1 Inhibitors

PubMed Central

Haldar, Manas K.; Scott, Michael D.; Sule, Nitesh; Srivastava, D. K.; Mallik, Sanku

2008-01-01

The syntheses of a new class of barbiturate-based inhibitors for human and E. Coli Methionine Aminopeptidase -1 (MetAP-1) are described. Some of the synthesized inhibitors show selective inhibition of the human enzyme with high potency. PMID:18343108

Comparative Actions of Barbiturates Studied by Pollen Grain Germination.

ERIC Educational Resources Information Center

Kordan, Herbert A.; Mumford, Pauline M.

1979-01-01

Describes a simple experimental system whereby the comparative actions of long, medium, and short-acting barbiturates can be demonstrated in a relatively short period of time under optical microscopy using pollen grains as the biological test or assay system. (Author/HM)

38 CFR 1.218 - Security and law enforcement at VA facilities.

Code of Federal Regulations, 2012 CFR

2012-07-01

... the influence of alcoholic beverages, narcotic drugs, hallucinogens, marijuana, barbiturates, or amphetamines is prohibited. Entering property under the influence of any narcotic drug, hallucinogen, marijuana... property of any narcotic drug, hallucinogen, marijuana, barbiturate, or amphetamine (unless prescribed by a...

38 CFR 1.218 - Security and law enforcement at VA facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... the influence of alcoholic beverages, narcotic drugs, hallucinogens, marijuana, barbiturates, or amphetamines is prohibited. Entering property under the influence of any narcotic drug, hallucinogen, marijuana... property of any narcotic drug, hallucinogen, marijuana, barbiturate, or amphetamine (unless prescribed by a...

38 CFR 1.218 - Security and law enforcement at VA facilities.

Code of Federal Regulations, 2013 CFR

2013-07-01

... the influence of alcoholic beverages, narcotic drugs, hallucinogens, marijuana, barbiturates, or amphetamines is prohibited. Entering property under the influence of any narcotic drug, hallucinogen, marijuana... property of any narcotic drug, hallucinogen, marijuana, barbiturate, or amphetamine (unless prescribed by a...

38 CFR 1.218 - Security and law enforcement at VA facilities.

Code of Federal Regulations, 2014 CFR

2014-07-01

... the influence of alcoholic beverages, narcotic drugs, hallucinogens, marijuana, barbiturates, or amphetamines is prohibited. Entering property under the influence of any narcotic drug, hallucinogen, marijuana... property of any narcotic drug, hallucinogen, marijuana, barbiturate, or amphetamine (unless prescribed by a...

38 CFR 1.218 - Security and law enforcement at VA facilities.

Code of Federal Regulations, 2011 CFR

2011-07-01

... the influence of alcoholic beverages, narcotic drugs, hallucinogens, marijuana, barbiturates, or amphetamines is prohibited. Entering property under the influence of any narcotic drug, hallucinogen, marijuana... property of any narcotic drug, hallucinogen, marijuana, barbiturate, or amphetamine (unless prescribed by a...

KETAMINE ABREACTION : A NEW APPROACH TO NARCOANALYSIS

PubMed Central

Golechha, G.R.; Sethi, I.C.; Misra, S.L.; Jayaprakash, N.P.

1986-01-01

SUMMARY Ketamine is a parenterally administered non barbiturate anaesthetic agent, in use for more than a decade. It is a safer than Na Pentothal. Administered intramuscularly, in dose of 6 to 15 mgm/Kg body wt. it produces dissociative anaesthesia. But, in smaller sub anaesthetic doses it may act as an abreactant. We report in this study the abreaction effect of Ketamine in dose of .5 to 1.5 mgm/kg body wt. given intramuscularly in 30 selected psychiatric cases requiring narcoanalysis for diagnostic or therapeutic purpose. The results are compared with another ten cases subjected to pentothal interview and five cases subjected to narcoanalysis with intravenous Na Amytal and methidrine. Our findings suggest that Ketamine has property of an efficacious abreactant in doses of 1 to 1.5 mgm/kg body wt. administered intramuscularly and can successfully be used for narcoanalysis in properly selected cases as a good substitute for intravenous pentothal or sodium amytal with methidrine. The relative cardio respiratory safety and ease of administration are its two added advantages. PMID:21927193

21 CFR 862.3150 - Barbiturate test system.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Barbiturate test system. 862.3150 Section 862.3150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Toxicology Test Systems § 862...

21 CFR 862.3150 - Barbiturate test system.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Barbiturate test system. 862.3150 Section 862.3150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Toxicology Test Systems § 862...

21 CFR 862.3150 - Barbiturate test system.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Barbiturate test system. 862.3150 Section 862.3150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Toxicology Test Systems § 862...

21 CFR 862.3150 - Barbiturate test system.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Barbiturate test system. 862.3150 Section 862.3150 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES Clinical Toxicology Test Systems § 862...

Decompressive craniectomy or medical management for refractory intracranial hypertension: an AAST-MIT propensity score analysis.

PubMed

Nirula, Ram; Millar, D; Greene, Tom; McFadden, Molly; Shah, Lubdha; Scalea, Thomas M; Stein, Deborah M; Magnotti, Louis J; Jurkovich, Gregory J; Vercruysse, Gary; Demetriades, Demetrios; Scherer, Lynette A; Peitzman, Andrew; Sperry, Jason; Beauchamp, Kathryn; Bell, Scott; Feiz-Erfan, Iman; O'Neill, Patrick; Coimbra, Raul

2014-04-01

Moderate/severe traumatic brain injury (TBI) management involves minimizing cerebral edema to maintain brain oxygen delivery. While medical therapy (MT) consisting of diuresis, hyperosmolar therapy, ventriculostomy, and barbiturate coma is the standard of care, decompressive craniectomy (DC) for refractory intracranial hypertension (ICH) has gained renewed interest. Since TBI treatment guidelines consider DC a second-tier intervention after MT failure, we sought to determine if early DC (<48 hours) was associated with improved survival in patients with refractory ICH. Eleven Level 1 trauma centers provided clinical data and head computed tomographic scans for patients with a Glasgow Coma Scale (GCS) score of 13 or less and radiographic evidence of TBI excluding deaths within 48 hours. Computed tomographic scans were graded according to the Marshall classification. A propensity score to receive DC (regardless of whether DC was performed) was calculated for each patient based on patient characteristics, physiology, injury severity, GCS, severity of intracranial injury, and treatment center. Patients who actually received a DC were matched to patients with similar propensity scores who received MT for analysis. Outcomes were compared between early (<48 hours of injury) primary or secondary DC and matched controls and then between early primary DC only and matched controls. There were 2,602 patients who met the inclusion criteria ,of whom 264 (10.1%) received DC (either primary or secondary to another cranial procedure) and 109 (5%) had a DC that was primary. Variables associated with performing a DC included sex, race, intracranial pressure monitor placement, in-house trauma attending, traumatic subarachnoid hemorrhage, midline shift, and basal cistern compression. There was no survival benefit with early primary DC compared with the controls (relative risk, 1.07; 95% confidence interval, 0.67-1.73; p = 0.77), and resource use was higher. Early DC does not seem to significantly improve mortality in patients with refractory ICH compared with MT. Neurosurgeons should pause before entertaining this resource-demanding form of therapy. Therapeutic care/management, level III.

Direct Synthesis of 5-Aryl Barbituric Acids by Rhodium(II)-Catalyzed Reactions of Arenes with Diazo Compounds.

PubMed

Best, Daniel; Burns, David J; Lam, Hon Wai

2015-06-15

A commercially available rhodium(II) complex catalyzes the direct arylation of 5-diazobarbituric acids with arenes, allowing straightforward access to 5-aryl barbituric acids. Free N-H groups are tolerated on the barbituric acid, with no complications arising from N-H insertion processes. This method was applied to the concise synthesis of a potent matrix metalloproteinase (MMP) inhibitor. © 2015 The Authors. Published by Wiley-VCH Verlag GmbH & Co. KGaA. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Effectiveness of lorazepam-assisted interviews in an adolescent with dissociative amnesia: A case report★

PubMed Central

Seo, Yuna; Shin, Mi-Hee; Kim, Sung-Gon; Kim, Ji-Hoon

2013-01-01

To facilitate gathering information during a psychiatric interview, some psychiatrists advocate augmenting the interview using drugs. Rather than barbiturates, benzodiazepines have been used for drug-assisted interviews. Dissociative amnesia is one of the indications for these interviews. Herein, we present the case of a 15-year-old female who was diagnosed as having dissociative amnesia because of conflicts with her friends. She was administered a lorazepam-assisted interview to aid recovery of her memories. In this case, a small dose of lorazepam was sufficient to recover her memories without any adverse effects. PMID:25206490

Effectiveness of lorazepam-assisted interviews in an adolescent with dissociative amnesia: A case report.

PubMed

Seo, Yuna; Shin, Mi-Hee; Kim, Sung-Gon; Kim, Ji-Hoon

2013-01-15

To facilitate gathering information during a psychiatric interview, some psychiatrists advocate augmenting the interview using drugs. Rather than barbiturates, benzodiazepines have been used for drug-assisted interviews. Dissociative amnesia is one of the indications for these interviews. Herein, we present the case of a 15-year-old female who was diagnosed as having dissociative amnesia because of conflicts with her friends. She was administered a lorazepam-assisted interview to aid recovery of her memories. In this case, a small dose of lorazepam was sufficient to recover her memories without any adverse effects.

Barbiturates Block Sodium and Potassium Conductance Increases in Voltage-Clamped Lobster Axons

PubMed Central

Blaustein, M. P.

1968-01-01

Sodium pentobarbital and sodium thiopental decrease both the peak initial (Na) and late steady-state (K) currents and reduce the maximum sodium and potassium conductance increases in voltage-clamped lobster giant axons. These barbiturates also slow the rate at which the sodium conductance turns on, and shift the normalized sodium conductance vs. voltage curves in the direction of depolarization along the voltage axis. Since pentobarbital (pKa = 8.0) blocks the action potential more effectively at pH 8.5 than at pH 6.7, the anionic form of the drug appears to be active. The data suggest that these drugs affect the axon membrane directly, rather than secondarily through effects on intermediary metabolism. It is suggested that penetration of the lipid layer of the membrane by the nonpolar portion of the barbiturate molecules may cause the decrease in membrane conductances, while electrostatic interactions involving the anionic group on the barbiturate, divalent cations, and "fixed charges" in the membrane could account for the slowing of the rate of sodium conductance turn-on and the shift of the normalized conductance curves along the voltage axis. PMID:5648829

Barbiturate ingestion in three adult captive tigers (Panthera tigris) and concomitant fatal botulism of one.

PubMed

Williams, J H; Bester, L; Venter, L; Pretorius, D; Greyling, F

2011-12-01

Zoo animals, including tigers, have been reported to suffer from barbiturate intoxication, with pentabarbitone being most commonly recorded. Clinical signs range from mild ataxia to general anaesthesia with recovery over hours to days with several factors affecting hepatic barbiturate metabolism and tissue partitioning. Botulism is an often fatal intoxication in man, animals, birds and certain fish. The occurrence in carnivores is uncommon to rare, with only 2 reports found of botulism in felids. This report relates to 3 adult captive cohabiting tigers that simultaneously developed signs of abdominal discomfort, progressive ataxia, recumbency and comatose sleep resembling stage 2 anaesthesia, alternating with periods of distracted wakefulness and ataxic movements. These signs occurred 4 days after being fed the carcass of a horse that had ostensibly died of colic and not been euthanased. The male tiger that was the dominant animal in the feeding hierarchy was worst affected and had to be given intravenous fluids. The female that was lowest in hierarchy was unaffected. After 48-72 hours of treatment at the Onderstepoort Veterinary Academic Hospital the females could eat and made an uneventful recovery. The male tiger showed partial recovery but died during the night a few hours after drinking water on his return to the owner. Necropsy revealed severe oesophageal dilation and impaction with decaying grass; some of this material and water were present in the pharynx and trachea, and had been aspirated causing acute widespread bronchopneumonia. Colon content tested negative for common pesticides but, together with liver, tested positive for barbiturate. Serum taken on the day of admission had tested negative for barbiturate and the residual serum from the 3 animals later tested negative for botulinum toxin. Colon and oesophageal content from the male at necropsy were positive for Clostridium botulinum toxin type C by the mouse bioassay neutralisation test, confirming that this male had had concomitant barbiturate toxicity and botulism, and had succumbed to aspiration bronchopneumonia secondary to pharyngeal, laryngeal and oesophageal paralysis and oesophageal

High-Resolution X-Ray Structures of Two Functionally Distinct Members of the Cyclic Amide Hydrolase Family of Toblerone Fold Enzymes

PubMed Central

Peat, Thomas S.; Balotra, Sahil; Wilding, Matthew; Hartley, Carol J.; Newman, Janet

2017-01-01

ABSTRACT The Toblerone fold was discovered recently when the first structure of the cyclic amide hydrolase, AtzD (a cyanuric acid hydrolase), was elucidated. We surveyed the cyclic amide hydrolase family, finding a strong correlation between phylogenetic distribution and specificity for either cyanuric acid or barbituric acid. One of six classes (IV) could not be tested due to a lack of expression of the proteins from it, and another class (V) had neither cyanuric acid nor barbituric acid hydrolase activity. High-resolution X-ray structures were obtained for a class VI barbituric acid hydrolase (1.7 Å) from a Rhodococcus species and a class V cyclic amide hydrolase (2.4 Å) from a Frankia species for which we were unable to identify a substrate. Both structures were homologous with the tetrameric Toblerone fold enzyme AtzD, demonstrating a high degree of structural conservation within the cyclic amide hydrolase family. The barbituric acid hydrolase structure did not contain zinc, in contrast with early reports of zinc-dependent activity for this enzyme. Instead, each barbituric acid hydrolase monomer contained either Na+ or Mg2+, analogous to the structural metal found in cyanuric acid hydrolase. The Frankia cyclic amide hydrolase contained no metal but instead formed unusual, reversible, intermolecular vicinal disulfide bonds that contributed to the thermal stability of the protein. The active sites were largely conserved between the three enzymes, differing at six positions, which likely determine substrate specificity. IMPORTANCE The Toblerone fold enzymes catalyze an unusual ring-opening hydrolysis with cyclic amide substrates. A survey of these enzymes shows that there is a good correlation between physiological function and phylogenetic distribution within this family of enzymes and provide insights into the evolutionary relationships between the cyanuric acid and barbituric acid hydrolases. This family of enzymes is structurally and mechanistically distinct from other enzyme families; however, to date the structure of just two, physiologically identical, enzymes from this family has been described. We present two new structures: a barbituric acid hydrolase and an enzyme of unknown function. These structures confirm that members of the CyAH family have the unusual Toblerone fold, albeit with some significant differences. PMID:28235873

One barbiturate and two solvated thiobarbiturates containing the triply hydrogen-bonded ADA/DAD synthon, plus one ansolvate and three solvates of their coformer 2,4-diaminopyrimidine.

PubMed

Hützler, Wilhelm Maximilian; Egert, Ernst; Bolte, Michael

2016-09-01

A path to new synthons for application in crystal engineering is the replacement of a strong hydrogen-bond acceptor, like a C=O group, with a weaker acceptor, like a C=S group, in doubly or triply hydrogen-bonded synthons. For instance, if the C=O group at the 2-position of barbituric acid is changed into a C=S group, 2-thiobarbituric acid is obtained. Each of the compounds comprises two ADA hydrogen-bonding sites (D = donor and A = acceptor). We report the results of cocrystallization experiments of barbituric acid and 2-thiobarbituric acid, respectively, with 2,4-diaminopyrimidine, which contains a complementary DAD hydrogen-bonding site and is therefore capable of forming an ADA/DAD synthon with barbituric acid and 2-thiobarbituric acid. In addition, pure 2,4-diaminopyrimidine was crystallized in order to study its preferred hydrogen-bonding motifs. The experiments yielded one ansolvate of 2,4-diaminopyrimidine (pyrimidine-2,4-diamine, DAPY), C4H6N4, (I), three solvates of DAPY, namely 2,4-diaminopyrimidine-1,4-dioxane (2/1), 2C4H6N4·C4H8O2, (II), 2,4-diaminopyrimidine-N,N-dimethylacetamide (1/1), C4H6N4·C4H9NO, (III), and 2,4-diaminopyrimidine-1-methylpyrrolidin-2-one (1/1), C4H6N4·C5H9NO, (IV), one salt of barbituric acid, viz. 2,4-diaminopyrimidinium barbiturate (barbiturate is 2,4,6-trioxopyrimidin-5-ide), C4H7N4(+)·C4H3N2O3(-), (V), and two solvated salts of 2-thiobarbituric acid, viz. 2,4-diaminopyrimidinium 2-thiobarbiturate-N,N-dimethylformamide (1/2) (2-thiobarbiturate is 4,6-dioxo-2-sulfanylidenepyrimidin-5-ide), C4H7N4(+)·C4H3N2O2S(-)·2C3H7NO, (VI), and 2,4-diaminopyrimidinium 2-thiobarbiturate-N,N-dimethylacetamide (1/2), C4H7N4(+)·C4H3N2O2S(-)·2C4H9NO, (VII). The ADA/DAD synthon was succesfully formed in the salt of barbituric acid, i.e. (V), as well as in the salts of 2-thiobarbituric acid, i.e. (VI) and (VII). In the crystal structures of 2,4-diaminopyrimidine, i.e. (I)-(IV), R2(2)(8) N-H...N hydrogen-bond motifs are preferred and, in two structures, additional R3(2)(8) patterns were observed.

New one-pot synthesis of spiro[furo[2,3-d]pyrimidine-6,5'-pyrimidine]pentaones and their sulfur analogues.

PubMed

Jalilzadeh, Mohammad; Noroozi Pesyan, Nader; Rezaee, Fereshteh; Rastgar, Saeed; Hosseini, Yaser; Sahin, Ertan

2011-08-01

Reaction of barbituric acid (BA), 1,3-dimethyl barbituric acid (DMBA) and 2-thiobarbituric acid (TBA) with cyanogen bromide and various aldehydes in presence of triethylamine afforded a new class of heterocyclic stable 5-alkyl and/or 5-aryl-1H, 1'H-spiro[furo[2,3-d]pyrimidine-6,5'-pyrimidine]2,2',4,4',6'(3H,3'H,5H)-pentaones which are dimeric forms of barbiturate (uracil and thiouracil derivatives) at 0 °C to ambient temperatures. Structure elucidation is proved by X-ray crystallography, (1)H NMR, (13)C NMR, FT-IR, CHN and mass analyses techniques. Mechanisms of the formations are discussed.

The Role of Ammonia in the Metabolic Effects of Hydrazine.

DTIC Science & Technology

various experiments, various doses of hydrazine were given. The dogs given high doses developed hyperammonemia, respiratory alkalosis , coma and...The acute effects of administration of hydrazine on plasma ammonia, blood urea nitrogen, pH, pCO2, and respiratory rate were studied in dogs. In...convulsions. Relatively little change in blood urea nitrogen was found. Since brain function is adversely affected by hyperammonemia and alkalosis , it is

Phenytoin: 80 years young, from epilepsy to breast cancer, a remarkable molecule with multiple modes of action.

PubMed

Keppel Hesselink, Jan M; Kopsky, David J

2017-08-01

In 1908 phenytoin (5,5-diphenylhydantoin) was first synthesized as a barbiturate derivative in Germany by professor Heinrich Biltz (1865-1943) and subsequently resynthesized by an American chemist of the pharmaceutical company Parke-Davis in 1923 in Detroit. Screening phenytoin did not reveal comparable sedative side effects as barbiturates and, thus, Parke-Davis discarded this compound as a useful drug. In 1936, phenytoin's anticonvulsive properties were identified via a new animal model for convulsive disorders, developed by Putnam and Merritt, who also evaluated its clinical value in a number of patients in the period 1937-1940. For many diseases, mechanism of action of phenytoin remains obscure. The voltage-gated sodium channel was and is generally regarded as the main target to explain phenytoin's activity as an anticonvulsant and an anti-arrhythmic drug. This target, however, does not explain many of the other clinical properties of phenytoin. We will explore a number of original articles on phenytoin published in its 80 years history and give extra attention to the various hypothesis and experiments done to elucidate its mechanisms of action. Phenytoin has been explored in over 100 different disorders; the last two promising indications tested in the clinic are breast cancer and optic neuritis. Most probably, there are multiple targets active for these various disorders, and the insight into which targets are relevant is still very incomplete. It is remarkable that many pharmacological studies tested one dose only, mostly 50 or 100 μM, doses which most probably are higher than the non-plasma bound phenytoin plasma levels obtained during treatment.

Status epilepticus severity score (STESS): A useful tool to predict outcome of status epilepticus.

PubMed

Goyal, Manoj Kumar; Chakravarthi, Sudheer; Modi, Manish; Bhalla, Ashish; Lal, Vivek

2015-12-01

The treatment protocols for status epilepticus (SE) range from small doses of intravenous benzodiazepines to induction of coma. The pros and cons of more aggressive treatment regimen remain debatable. The importance of an index need not be overemphasized which can predict outcome of SE and guide the intensity of treatment. We tried to evaluate utility of one such index Status epilepticus severity score (STESS). 44 consecutive patients of SE were enrolled in the study. STESS results were compared with various outcome measures: (a) mortality, (b) final neurological outcome at discharge as defined by functional independence measure (FIM) (good outcome: FIM score 5-7; bad outcome: FIM score 1-4), (c) control of SE within 1h of start of treatment and (d) need for coma induction. A higher STESS score correlated significantly with poor neurological outcome at discharge (p=0.0001), need for coma induction (p=0.0001) and lack of response to treatment within 1h (p=0.001). A STESS of <3 was found to have a negative predictive value of 96.9% for mortality, 96.7% for poor neurological outcome at discharge and 96.7% for need of coma induction, while a STESS of <2 had negative predictive value of 100% for mortality, coma induction and poor neurological outcome at discharge. STESS can reliably predict the outcome of status epilepticus. Further studies on STESS based treatment approach may help in designing better therapeutic regimens for SE. Copyright © 2015 Elsevier B.V. All rights reserved.

Thiopental Anesthesia and Tannic Acid Diagnostic Enemas

PubMed Central

Singh, Jasbir; Boyd, Eldon M.

1966-01-01

The administration to albino rats of tannic acid as a retention enema (in doses of 0.2 g./kg. body weight and over) prolonged the duration of anesthesia induced by thiopental given immediately before, or 72 hours after, the tannic acid. This dose of tannic acid corresponds, on the basis of body weight, to a radiodiagnostic enema of 2 1. of 0.25% tannic acid in barium sulfate suspension given to a child weighing 25 kg. By excluding certain hypothermic effects of tannic acid, it was concluded that thiopental potentiation was probably due to impairment by the tannic acid of the liver's ability to detoxify the barbiturate. The results suggest that a drug which is detoxified in the liver should be administered three to five days after a tannic acid-barium sulfate radiodiagnostic enema only with considerable caution. PMID:5947612

Effects of anticonvulsants in vivo on high affinity choline uptake in vitro in mouse hippocampal synaptosomes.

PubMed Central

Miller, J. A.; Richter, J. A.

1985-01-01

The effects of several anticonvulsant drugs on sodium-dependent high affinity choline uptake (HACU) in mouse hippocampal synaptosomes was investigated. HACU was measured in vitro after in vivo administration of the drug to mice. HACU was inhibited by drugs which have in common the ability to facilitate gamma-aminobutyric acid (GABA) transmission, pentobarbitone, phenobarbitone, barbitone, diazepam, chloridiazepoxide, and valproic acid. Dose-response relationships were determined for these drugs and the drugs' potencies at inhibiting HACU correlated well with their anticonvulsant potencies. Clonazepam, ethosuximide, carbamazepine, and barbituric acid had no effect on HACU in the doses used while phenytoin and trimethadione stimulated HACU. These results suggest that certain anticonvulsants may elicit a part of their anticonvulsant activity by modulating cholinergic neurones. This effect may be mediated through a GABA mechanism. PMID:3978310

Discriminative-stimulus effects of zolpidem, triazolam, pentobarbital, and caffeine in zolpidem-trained humans.

PubMed

Rush, C R; Baker, R W; Rowlett, J K

2000-02-01

Six non-drug-abusing humans were trained to discriminate 15 mg zolpidem in the present experiment. After participants acquired discrimination, a range of doses of zolpidem (2.5-15.0 mg), triazolam (0.0625-0.3750 mg), pentobarbital (25-150 mg), caffeine (100-600 mg), and placebo were tested to determine whether they shared discriminative-stimulus effects with 15 mg zolpidem. The participant-rated and performance-impairing effects of zolpidem, triazolam, pentobarbital, and caffeine were assessed concurrently. Triazolam and pentobarbital dose dependently increased zolpidem-appropriate responding. Caffeine occasioned low levels of zolpidem-appropriate responding. Zolpidem, triazolam, and pentobarbital, but not caffeine, generally produced a similar constellation of participant-rated drug effects (e.g., increased scores for the Pentobarbital, Chlorpromazine, and Alcohol Group subscale on the Addiction Research Center Inventory) and dose dependently impaired performance. These results suggest that humans can reliably discriminate zolpidem. Despite its unique benzodiazepine-receptor binding profile, the discriminative-stimulus, participant-rated, and performance-impairing effects of zolpidem are similar to those of the barbiturates and benzodiazepines.

Allyl m-Trifluoromethyldiazirine Mephobarbital: An Unusually Potent Enantioselective and Photoreactive Barbiturate General Anesthetic

DOE Office of Scientific and Technical Information (OSTI.GOV)

Savechenkov, Pavel Y.; Zhang, Xi; Chiara, David C.

2012-12-10

We synthesized 5-allyl-1-methyl-5-(m-trifluoromethyl-diazirynylphenyl)barbituric acid (14), a trifluoromethyldiazirine-containing derivative of general anesthetic mephobarbital, separated the racemic mixture into enantiomers by chiral chromatography, and determined the configuration of the (+)-enantiomer as S by X-ray crystallography. Additionally, we obtained the {sup 3}H-labeled ligand with high specific radioactivity. R-(-)-14 is an order of magnitude more potent than the most potent clinically used barbiturate, thiopental, and its general anesthetic EC{sub 50} approaches those for propofol and etomidate, whereas S-(+)-14 is 10-fold less potent. Furthermore, at concentrations close to its anesthetic potency, R-(-)-14 both potentiated GABA-induced currents and increased the affinity for the agonist muscimol inmore » human {alpha}1{beta}2/3{gamma}2L GABA{sub A} receptors. Finally, R-(-)-14 was found to be an exceptionally efficient photolabeling reagent, incorporating into both {alpha}1 and {beta}3 subunits of human {alpha}1{beta}3 GABAA receptors. These results indicate R-(-)-14 is a functional general anesthetic that is well-suited for identifying barbiturate binding sites on Cys-loop receptors.« less

Human Brain Activity Patterns beyond the Isoelectric Line of Extreme Deep Coma

PubMed Central

Kroeger, Daniel; Florea, Bogdan; Amzica, Florin

2013-01-01

The electroencephalogram (EEG) reflects brain electrical activity. A flat (isoelectric) EEG, which is usually recorded during very deep coma, is considered to be a turning point between a living brain and a deceased brain. Therefore the isoelectric EEG constitutes, together with evidence of irreversible structural brain damage, one of the criteria for the assessment of brain death. In this study we use EEG recordings for humans on the one hand, and on the other hand double simultaneous intracellular recordings in the cortex and hippocampus, combined with EEG, in cats. They serve to demonstrate that a novel brain phenomenon is observable in both humans and animals during coma that is deeper than the one reflected by the isoelectric EEG, and that this state is characterized by brain activity generated within the hippocampal formation. This new state was induced either by medication applied to postanoxic coma (in human) or by application of high doses of anesthesia (isoflurane in animals) leading to an EEG activity of quasi-rhythmic sharp waves which henceforth we propose to call ν-complexes (Nu-complexes). Using simultaneous intracellular recordings in vivo in the cortex and hippocampus (especially in the CA3 region) we demonstrate that ν-complexes arise in the hippocampus and are subsequently transmitted to the cortex. The genesis of a hippocampal ν-complex depends upon another hippocampal activity, known as ripple activity, which is not overtly detectable at the cortical level. Based on our observations, we propose a scenario of how self-oscillations in hippocampal neurons can lead to a whole brain phenomenon during coma. PMID:24058669

Factors associated with mortality of myxedema coma: report of eight cases and literature survey.

PubMed

Yamamoto, T; Fukuyama, J; Fujiyoshi, A

1999-12-01

High-dose thyroid hormone replacement has been recommended for treatment of myxedema coma (MC) while questions of safety of the therapy and of efficacy of low-dose thyroid hormone replacement have not been systematically addressed. We treated 8 patients with MC in a period of 18 years, the first 3 with high-dose intravenous injections of levotriiodothyronine (LT3) and the other 5 patients with a smaller amount of either LT3 or levothyroxine (LT4). Two of the first 3 patients died of pneumonia and the other 5 recovered despite pulmonary abnormalities at the outset. To find factors associated with fatal outcome after treatment, the MEDLINE database was searched for MC cases with data of thyroid hormone replacement and outcome within 1 month of therapy. Clinical data for our 5 patients and 82 cases from the MEDLINE search were pooled and factors associated with mortality were sought among age, gender, presence of cardiac or pulmonary complications, and doses of thyroid hormone by multiple logistic regression analysis. It revealed that greater age, cardiac complications, and high-dose thyroid hormone replacement (LT4 > or = 500 microg/d or LT3 > or = 75 microg/d) were significantly associated with a fatal outcome within 1 month of treatment. Elderly MC patients can be treated with low-dose hormone replacement. A bolus of 500 microg LT4, especially by mouth or via nasogastric tube, appears to be tolerated by younger patients (< 55 years) without cardiac complication. The conclusion remains to be confirmed in more patients.

Psychiatry in the U.S. Army: Lessons for Community Psychiatry

DTIC Science & Technology

2005-01-01

narcosynthesis and hypnosis may still be useful techniques in treating acute reactions in which amnesia is present and in treating some refractory PTSD...residency under Army auspices) also required instruction in combat psychiatry and was introduced to the techniques of hypnosis and barbiturate interviews. As...manifestations and prevalence of gain in illness, brief directive methods of psychotherapy, and the use of hypnosis and barbiturate interviews as

Epidemiology of acute drug poisoning in a tertiary center from Iasi County, Romania.

PubMed

Sorodoc, Victorita; Jaba, Irina M; Lionte, Catalina; Mungiu, Ostin C; Sorodoc, Laurentiu

2011-12-01

The aim of this retrospective epidemiological study was to investigate the demographical, etiological and clinical characteristics of acute drug poisonings in Iasi County, Romania. All patients were referred and admitted in the Toxicology Clinic of "Sf. Ioan" Emergency Clinic Hospital Iasi, Romania. Between 2003 and 2009, 811 cases of acute drug poisonings were recorded, counting for 28.43% from the total number of poisonings. The majority of these poisonings resulted in mild (51.94%) and medium (28.35%) clinical forms, while 19.71% were coma situations. In all, 63.51% of patients originated from urban areas, 39.94% were unemployed and the patients were predominantly women (66.46%). A high percentage (97.27%) were suicide attempts, using only one type of drug (65.88%) and the 21-30 years group (29.8%) records the highest incidence, for both women and men. The most frequently involved drugs were benzodiazepines 13.69%, anticonvulsive drugs 8.63%, barbiturates 8.51% and cardiovascular drugs 5.92%. Drugs combinations were recorded in 32.92% of cases and 1.2% were combinations between drugs and other substances. Mortality was the outcome in 0.3% of the total registered number of acute drug poisonings. This study underlines that in order to provide a proper management of these situations, a Regional Poison Information Center is absolutely necessary.

The Blue Coma: The Role of Methylene Blue in Unexplained Coma After Cardiac Surgery.

PubMed

Martino, Enrico Antonio; Winterton, Dario; Nardelli, Pasquale; Pasin, Laura; Calabrò, Maria Grazia; Bove, Tiziana; Fanelli, Giovanna; Zangrillo, Alberto; Landoni, Giovanni

2016-04-01

Methylene blue commonly is used as a dye or an antidote, but also can be used off label as a vasopressor. Serotonin toxicity is a potentially lethal and often misdiagnosed condition that can result from drug interaction. Mild serotonin toxicity previously was reported in settings in which methylene blue was used as a dye. The authors report 3 cases of life-threatening serotonin toxicity in patients undergoing chronic selective serotonin reuptake inhibitor (SSRI) therapy who also underwent cardiac surgery and received methylene blue to treat vasoplegic syndrome. An observational study. A cardiothoracic intensive care unit (ICU) in a teaching hospital. Three patients who received methylene blue after cardiac surgery, later discovered to be undergoing chronic SSRI therapy. None. All 3 patients received high doses of fentanyl during general anesthesia. They all developed vasoplegic syndrome and consequently were given methylene blue in the ICU. All 3 patients developed serotonin toxicity, including coma, after this administration and diagnostic tests were negative for acute intracranial pathology. Coma lasted between 1 and 5 days. Two patients were discharged from the ICU shortly after awakening, whereas the third patient experienced a complicated postoperative course for concomitant refractory low-cardiac-output syndrome. Patients undergoing chronic SSRI therapy should not be administered methylene blue to treat vasoplegic syndrome. Copyright © 2016 Elsevier Inc. All rights reserved.

Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury: a randomized controlled trial

PubMed Central

Pérez-Bárcena, Jon; Llompart-Pou, Juan A; Homar, Javier; Abadal, Josep M; Raurich, Joan M; Frontera, Guillem; Brell, Marta; Ibáñez, Javier; Ibáñez, Jordi

2008-01-01

Introduction Experimental research has demonstrated that the level of neuroprotection conferred by the various barbiturates is not equal. Until now no controlled studies have been conducted to compare their effectiveness, even though the Brain Trauma Foundation Guidelines recommend that such studies be undertaken. The objectives of the present study were to assess the effectiveness of pentobarbital and thiopental in terms of controlling refractory intracranial hypertension in patients with severe traumatic brain injury, and to evaluate the adverse effects of treatment. Methods This was a prospective, randomized, cohort study comparing two treatments: pentobarbital and thiopental. Patients who had suffered a severe traumatic brain injury (Glasgow Coma Scale score after resuscitation ≤ 8 points or neurological deterioration during the first week after trauma) and with refractory intracranial hypertension (intracranial pressure > 20 mmHg) first-tier measures, in accordance with the Brain Trauma Foundation Guidelines. Results A total of 44 patients (22 in each group) were included over a 5-year period. There were no statistically significant differences in ' baseline characteristics, except for admission computed cranial tomography characteristics, using the Traumatic Coma Data Bank classification. Uncontrollable intracranial pressure occurred in 11 patients (50%) in the thiopental treatment group and in 18 patients (82%) in the pentobarbital group (P = 0.03). Under logistic regression analysis – undertaken in an effort to adjust for the cranial tomography characteristics, which were unfavourable for pentobarbital – thiopental was more effective than pentobarbital in terms of controlling intracranial pressure (odds ratio = 5.1, 95% confidence interval 1.2 to 21.9; P = 0.027). There were no significant differences between the two groups with respect to the incidence of arterial hypotension or infection. Conclusions Thiopental appeared to be more effective than pentobarbital in controlling intracranial hypertension refractory to first-tier measures. These findings should be interpreted with caution because of the imbalance in cranial tomography characteristics and the different dosages employed in the two arms of the study. The incidence of adverse effects was similar in both groups. Trial Registration (Trial registration: US Clinical Trials registry NCT00622570.) PMID:18759980

Reduction in radiation-induced brain injury by use of pentobarbital or lidocaine protection

DOE Office of Scientific and Technical Information (OSTI.GOV)

Oldfield, E.H.; Friedman, R.; Kinsella, T.

1990-05-01

To determine if barbiturates would protect brain at high doses of radiation, survival rates in rats that received whole-brain x-irradiation during pentobarbital- or lidocaine-induced anesthesia were compared with those of control animals that received no medication and of animals anesthetized with ketamine. The animals were shielded so that respiratory and digestive tissues would not be damaged by the radiation. Survival rates in rats that received whole-brain irradiation as a single 7500-rad dose under pentobarbital- or lidocaine-induced anesthesia was increased from between from 0% and 20% to between 45% and 69% over the 40 days of observation compared with the othermore » two groups (p less than 0.007). Ketamine anesthesia provided no protection. There were no notable differential effects upon non-neural tissues, suggesting that pentobarbital afforded protection through modulation of ambient neural activity during radiation exposure. Neural suppression during high-dose cranial irradiation protects brain from acute and early delayed radiation injury. Further development and application of this knowledge may reduce the incidence of radiation toxicity of the central nervous system (CNS) and may permit the safe use of otherwise unsafe doses of radiation in patients with CNS neoplasms.« less

Mannitol dosing error during interfacility transfer for intracranial emergencies.

PubMed

Elliott, Cameron A; MacKenzie, Mark; O'Kelly, Cian J

2015-11-01

Mannitol is commonly used to treat elevated intracranial pressure (ICP). The authors analyzed mannitol dosing errors at peripheral hospitals prior to or during transport to tertiary care facilities for intracranial emergencies. They also investigated the appropriateness of mannitol use based on the 2007 Brain Trauma Foundation guidelines for severe traumatic brain injury. The authors conducted a retrospective review of the Shock Trauma Air Rescue Society (STARS) electronic patient database of helicopter medical evacuations in Alberta, Canada, between 2004 and 2012, limited to patients receiving mannitol before transfer. They extracted data on mannitol administration and patient characteristics, including diagnosis, mechanism, Glasgow Coma Scale score, weight, age, and pupil status. A total of 120 patients with an intracranial emergency received a mannitol infusion initiated at a peripheral hospital (median Glasgow Coma Scale score 6; range 3-13). Overall, there was a 22% dosing error rate, which comprised an underdosing rate (<0.25 g/kg) of 8.3% (10 of 120 patients), an overdosing rate (>1.5 g/kg) of 7.5% (9 of 120), and a nonbolus administration rate (>1 hour) of 6.7% (8 of 120). Overall, 72% of patients had a clear indication to receive mannitol as defined by meeting at least one of the following criteria based on Brain Trauma Foundation guidelines: neurological deterioration (11%), severe traumatic brain injury (69%), or pupillary abnormality (25%). Mannitol administration at peripheral hospitals is prone to dosing error. Strategies such as a pretransport checklist may mitigate this risk.

Trisubstituted barbiturates and thiobarbiturates: Synthesis and biological evaluation as xanthine oxidase inhibitors, antioxidants, antibacterial and anti-proliferative agents.

PubMed

Figueiredo, Joana; Serrano, João L; Cavalheiro, Eunice; Keurulainen, Leena; Yli-Kauhaluoma, Jari; Moreira, Vânia M; Ferreira, Susana; Domingues, Fernanda C; Silvestre, Samuel; Almeida, Paulo

2018-01-01

Barbituric and thiobarbituric acid derivatives have become progressively attractive to medicinal chemists due to their wide range of biological activities. Herein, different series of 1,3,5-trisubstituted barbiturates and thiobarbiturates were prepared in moderate to excellent yields and their activity as xanthine oxidase inhibitors, antioxidants, antibacterial agents and as anti-proliferative compounds was evaluated in vitro. Interesting bioactive barbiturates were found namely, 1,3-dimethyl-5-[1-(2-phenylhydrazinyl)ethylidene]pyrimidine-2,4,6(1H,3H,5H)-trione (6c) and 1,3-dimethyl-5-[1-[2-(4-nitrophenyl)hydrazinyl]ethylidene]pyrimidine-2,4,6(1H,3H,5H)-trione (6e), which showed concomitant xanthine oxidase inhibitory effect (IC 50 values of 24.3 and 27.9 μM, respectively), and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity (IC 50 values of 18.8 and 23.8 μM, respectively). In addition, 5-[1-(2-phenylhydrazinyl)ethylidene]pyrimidine-2,4,6(1H,3H,5H)-trione (6d) also revealed DPPH radical scavenger effect, with an IC 50 value of 20.4 μM. Moreover, relevant cytotoxicity against MCF-7 cells (IC 50  = 13.3 μM) was observed with 5-[[(2-chloro-4-nitrophenyl)amino]methylene]-2-thioxodihydropyrimidine-4,6(1H,5H)-dione (7d). Finally, different 5-hydrazinylethylidenepyrimidines revealed antibacterial activity against Acinetobacter baumannii (MIC values between 12.5 and 25.0 μM) which paves the way for developing new treatments for infections caused by this Gram-negative coccobacillus bacterium, known to be an opportunistic pathogen in humans with high relevance in multidrug-resistant nosocomial infections. The most promising bioactive barbiturates were studied in silico with emphasis on compliance with the Lipinski's rule of five as well as several pharmacokinetics and toxicity parameters. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Self-induced drug intoxication in baclofen: of the calm hypotonic coma in the status epilepticus.

PubMed

Thill, Chloé; Di Constanzo, Laurence; Pessey, François; Aries, Philippe; Montelescaut, Étienne; Sapin, Jeanne; Vaillant, Catherine; Drouillard, Isabelle

2016-06-01

Baclofen is an agonist of peripheral and central B gamma-aminobutyric acid receptors, whose activation causes a myorelaxation and a powerfull depression of the central nervous system. Moreover, it has an action against addiction, in reducing craving. Commercialized since 1975 in France, to control muscle spasticity due to medullar affection or multiple sclerosis, it receives a temporary recommendation of use in march 2014, as a last-line adjuvant treatment in alcohol withdrawal. Beyond its therapeutic use, baclofen is involved in many self-induced intoxications. We report the case of a patient who develops, after a massive ingestion of baclofen (supposed dose ingested: 1 200 mg), a hypotonic and calm coma, requiring her admission in our intensive care unit, and then a status epilepticus.

Pharmacological Protection of the Retina against Damaging Laser Exposures: A Feasibility Study

DTIC Science & Technology

1988-09-01

subsequently administered through this route. Because rabbits can easily be lethally overdosed with barbiturates, surgical plane anesthesia was achieved by...adequately anesthetized. After removal of the second eye, the rabbit was euthanatized by barbiturate overdose . The eye was excised from the rabbit as quickly...Component mq/L uM L-glutamine 73 500 taurine 0.75 6 choline Cl 0.6 4.3 myo-inositol 27 150 Na pyruvate 22 200 ascorbate 18 100 glucose 1800 10,000

The role of training dose in drug discrimination: a review

PubMed Central

Stolerman, Ian P; Childs, Emma; Ford, Matthew M; Grant, Kathleen A

2011-01-01

Drug discrimination has been an important technique in behavioural pharmacology for at least 40 years. The characteristics of drug-produced discriminative stimuli are influenced by behavioural and pharmacological variables, including the doses used to establish discriminations. This review covers studies on the effects of varying the training dose of a drug in a search for general principles that are applicable across different drug classes and methodological approaches. With respect to quantitative changes, relationships between training dose and rate of acquisition or magnitude of stimulus control were found for most drug classes. Acquisition accelerated with dose up to a point beyond which drug-induced impairments of performance had a deleterious impact. Sensitivity to the training drug as measured by ED50 values typically increased when the training dose was reduced. Qualitative changes were more complex and appeared to fall into three categories: (i) changes in profiles of generalisation between partial and full agonists; (ii) reduced specificity of some discriminations at small training doses and (iii) changes in the relative salience of actions mediated through different neurotransmitter systems or from central and peripheral sites. Three-lever discrimination procedures incorporating ‘drug versus drug’ or “dose versus dose” contingencies enabled detection of more subtle differences than the simple ‘drug versus no drug’ approach when applied to the opioid, hallucinogen and barbiturate classes of drugs. These conclusions have implications for the interpretation of data from studies that utilise either within- or between-subject designs for studying the discriminative stimulus effects of drugs. PMID:21808191

Barbiturates

USGS Publications Warehouse

Thomas, N.J.

1999-01-01

Barbiturate products are commonly used to euthanize domestic animals. The primary active component in euthanasia solutions is sodium pentobarbital, but some products also contain other minor ingredients (Fig. 48.1).Euthanasia solutions are generally injected intravenously in domestic animals; therefore, after death, the solutions will be most concentrated in the blood and the highly vascularized organs, such as the liver or spleen, of the euthanized animal.Euthanized carcasses that are available as carrion pose a hazard to scavenging birds and mammals. Large domestic animal carcasses, such as horses, that are not used for food or rendering but that are sufficiently valuable (monetarily or psychologically) to warrant veterinary services and euthanasia drugs are the most common sources of barbiturate poisoning in scavengers. In one instance in British Columbia, a single cow carcass was responsible for poisoning 29 bald eagles.Circumstances that interfere with burial, such as frozen winter soil or bulky carcasses, result in euthanized carcasses being available for scavenger species. This problem could increase in the future if more stringent air-quality standards restrict carcass incineration.

Amiodarone-induced myxoedema coma.

PubMed

Hassan, Syed; Ayoub, Walaa; Hassan, Mona; Wisgerhof, Max

2014-04-12

A 62-year-old man was found to have bradycardia, hypothermia and respiratory failure 3 weeks after initiation of amiodarone therapy for atrial fibrillation. Thyroid-stimulating hormone was found to be 168 μIU/mL (nl. 0.3-5 μIU/mL) and free thyroxine (FT4) was <0.2 ng/dL (nl. 0.8-1.8 ng/dL). He received intravenous fluids, vasopressor therapy and stress dose steroids; he was intubated and admitted to the intensive care unit. He received 500 μg of intravenous levothyroxine in the first 18 h of therapy, and 150 µg intravenous daily thereafter. Haemodynamic improvement, along with complete recovery of mental status, occurred after 48 h. Twelve hours after the initiation of therapy, FT4 was 0.96 ng/dL. The patient was maintained on levothyroxine 175 (g POorally daily. A thyroid ultrasound showed diffuse heterogeneity. The 24 hour excretion of iodine was 3657 (mcg (25-756 ( mcg). The only two cases of amiodarone-induced myxoedema coma in the literature report patient death despite supportive therapy and thyroid hormone replacement. This case represents the most thoroughly investigated case of amiodarone-induced myxoedema coma with a history significant for subclinical thyroid disease.

Toxic nephropathy after low-dose methoxyflurane anesthesia: drug interaction with secobarbital?

PubMed

Churchill, D; Yacoub, J M; Siu, K P; Symes, A; Gault, M H

1976-02-21

Vasopressin-resistant nonoliguric renal insufficiency developed in a 57-year-old man after 2 1/2 hours of low-dose methoxyflurane anesthesia. Secobarbital, 100 mg daily, had been taken for 1 month before. Of 13 patients in whom the influence of methoxyflurane on renal function was being studied, he was the only one to have taken a drug that induces microsomal enzymes. Blood values of methoxyflurane in this patient were lower than group means on all five occasions during anesthesia. Postoperatively his serum inorganic fluoride value reached 114 mumol/l -- more than two standard deviations greater than the group mean. Peak values for serum urea nitrogen, creatinine and uric acid and postvasopressin urine osmolality, and the lowest creatinine clearance in this patient also differed by more than 2 SD from the group mean, and the peak amount of oxalate excreted in his urine was double the group mean. Pretreatment with the barbiturate appears to have altered methoxyflurane metabolism and led to toxic concentrations of metabolites in the blood.

Toxic nephropathy after low-dose methoxyflurane anesthesia: drug interaction with secobarbital?

PubMed Central

Churchill, D.; Yacoub, J. M.; Siu, K. P.; Symes, A.; Gault, M. H.

1976-01-01

Vasopressin-resistant nonoliguric renal insufficiency developed in a 57-year-old man after 2 1/2 hours of low-dose methoxyflurane anesthesia. Secobarbital, 100 mg daily, had been taken for 1 month before. Of 13 patients in whom the influence of methoxyflurane on renal function was being studied, he was the only one to have taken a drug that induces microsomal enzymes. Blood values of methoxyflurane in this patient were lower than group means on all five occasions during anesthesia. Postoperatively his serum inorganic fluoride value reached 114 mumol/l -- more than two standard deviations greater than the group mean. Peak values for serum urea nitrogen, creatinine and uric acid and postvasopressin urine osmolality, and the lowest creatinine clearance in this patient also differed by more than 2 SD from the group mean, and the peak amount of oxalate excreted in his urine was double the group mean. Pretreatment with the barbiturate appears to have altered methoxyflurane metabolism and led to toxic concentrations of metabolites in the blood. PMID:1253070

Marked EEG worsening following Levetiracetam overdose: How a pharmacological issue can confound coma prognosis.

PubMed

Bouchier, Baptiste; Demarquay, Geneviève; Guérin, Claude; André-Obadia, Nathalie; Gobert, Florent

2017-01-01

Levetiracetam is an anti-epileptic drug commonly used in intensive care when seizure is suspected as a possible cause of coma. We propose to question the cofounding effect of Levetiracetam during the prognostication process in a case of anoxic coma. We report the story of a young woman presenting a comatose state following a hypoxic cardiac arrest. After a first EEG presenting an intermediate EEG pattern, a seizure suspicion led to prescribe Levetiracetam. The EEG showed then the appearance of burst suppression, which was compatible with a very severe pattern of post-anoxic coma. This aggravation was in fact related to an overdose of Levetiracetam (the only medication introduced recently) and was reversible after Levetiracetam cessation. The increased plasmatic dosages of Levetiracetam confirming this overdose could have been favoured by a moderate reduction of renal clearance, previously underestimated because of a low body-weight. This EEG dynamic was unexpected under Levetiracetam and could sign a functional instability after anoxia. Burst suppression is classically observed with high doses of anaesthetics, but is not expected after a minor anti-epileptic drug. This report proposes that Levetiracetam tolerance might not be straightforward after brain lesions and engages us to avoid confounding factors during the awakening prognostication, which is mainly based on the severity of the EEG. Hence, prognosis should not be decided on an isolated parameter, especially if the dynamic is atypical after a new prescription, even for well-known drugs. For any suspicion, the drug's dosage and replacement should be managed before any premature care's withdrawal. Copyright © 2016 Elsevier B.V. All rights reserved.

Myxedema Coma Secondary to Central Hypothyroidism: A Rare but Real Cause of Altered Mental Status in Pediatrics.

PubMed

Thompson, Michael D; Henry, Rohan K

2017-01-01

Myxedema coma (MC), a medical emergency defined as severe hypothyroidism leading to altered mental status, is more common in older women with hypothyroidism. A 7-year-old Caucasian male with chromosome 1q deletion presented with altered mental status preceded by milestone regression. His presenting labs results were: thyroid-stimulating hormone (TSH) 0.501 μIU/ml and free thyroxine (T4) <0.5 ng/dl. His morning cortisol level was 8.1 μg/dl with repeat testing, while TSH was 1.119 μIU/ml and free T4 was 0.5 ng/dl. Low-dose cosyntropin test showed baseline and peak cortisol levels of 1.9 and 16 μg/dl, respectively. Aside from altered mental status, heart block was present in addition to hypothermia and hypercarbia. Diffuse cerebral cortical and corpus callosum atrophy were seen on MRI. An intravenous (i.v.) stress dose of hydrocortisone was administered for 24 h prior to an i.v. loading dose of levothyroxine. His activity level subsequently returned to baseline within 48 h after treatment had been initiated. Though MC is rare, occurring mainly with noncompliance in primary hypothyroidism, it may occur at the diagnosis of secondary hypothyroidism. Based on features like hypothermia, hypoventilation, and cardiovascular instability occurring in the setting of central hypothyroidism, it should be suspected and managed urgently in order to avert the associated high mortality resulting from treatment delays. © 2016 S. Karger AG, Basel.

Amiodarone-induced myxoedema coma

PubMed Central

Hassan, Syed; Ayoub, Walaa; Hassan, Mona; Wisgerhof, Max

2014-01-01

A 62-year-old man was found to have bradycardia, hypothermia and respiratory failure 3 weeks after initiation of amiodarone therapy for atrial fibrillation. Thyroid-stimulating hormone was found to be 168 μIU/mL (nl. 0.3–5 μIU/mL) and free thyroxine (FT4) was <0.2 ng/dL (nl. 0.8–1.8 ng/dL). He received intravenous fluids, vasopressor therapy and stress dose steroids; he was intubated and admitted to the intensive care unit. He received 500 μg of intravenous levothyroxine in the first 18 h of therapy, and 150 µg intravenous daily thereafter. Haemodynamic improvement, along with complete recovery of mental status, occurred after 48 h. Twelve hours after the initiation of therapy, FT4 was 0.96 ng/dL. The patient was maintained on levothyroxine 175 (g POorally daily. A thyroid ultrasound showed diffuse heterogeneity. The 24 hour excretion of iodine was 3657 (mcg (25–756 ( mcg). The only two cases of amiodarone-induced myxoedema coma in the literature report patient death despite supportive therapy and thyroid hormone replacement. This case represents the most thoroughly investigated case of amiodarone-induced myxoedema coma with a history significant for subclinical thyroid disease. PMID:24729111

The Three Sources of Gas in the Comae of Comets

NASA Technical Reports Server (NTRS)

Huebner, W. F.

1995-01-01

Surface water ice on a comet nucleus is the major source of coma gas. Dust, entrained by coma gas, fragments and vaporizes, forming a second, distributed source of coma gas constituents. Ice species more volatile than water ice below the surface of the nucleus are a third source of coma gas. Vapors from these ices, produced by heat penetrating into the nucleus, diffuse through pores outward into the coma. The second and third sources provide minor, but sometimes easily detectible, gaseous species in the coma. We present mixing ratios of observed minor coma constituents relative to water vapor as a function of heliocentric and cometocentric distances and compare these ratios with model predictions, assuming the sources of the minor species are either coma dust or volatile ices in the nucleus.

Associations of Adverse Clinical Course and Ingested Substances among Patients with Deliberate Drug Poisoning: A Cohort Study from an Intensive Care Unit in Japan.

PubMed

Ichikura, Kanako; Okumura, Yasuyuki; Takeuchi, Takashi

2016-01-01

Some patients with deliberate drug poisoning subsequently have an adverse clinical course. The present study aimed to examine whether the type of drugs ingested and psychiatric diagnoses were related to an adverse clinical course. We conducted a cohort study of patients with deliberate drug poisoning admitted to the intensive care unit of a university hospital located in Tokyo, Japan, between September 2006 and June 2013. Intensive care unit (ICU) stay of ≥4 days was used as a primary outcome measure, while the incidence of aspiration pneumonitis was used as a secondary outcome measure. Ingested substances and psychiatric diagnoses were used as explanatory variables. Of the 676 patients with deliberate drug poisoning, 88% had a history of psychiatric treatment and 82% had ingested psychotropic drugs. Chlorpromazine-promethazine-phenobarbital combination drug (Vegetamin®) ranked fifth among the most frequently ingested substances in cases of deliberate drug poisoning and had the highest incidence of prolonged ICU stay (20%) and aspiration pneumonitis (29%). The top three major classes consisted of benzodiazepines (79%), new-generation antidepressants (25%), and barbiturates/non-barbiturates (23%). Barbiturate overdose was independently associated with increased odds of both prolonged ICU stay (8% vs. 17%; odds ratio [OR], 2.97; 95% confidence interval [CI], 1.60-5.55) and aspiration pneumonitis (8% vs. 24%; OR, 3.83; 95% CI, 2.18-6.79) relative to those associated with overdose of only other sedative-hypnotics (i.e., benzodiazepines). These results suggest that judicious prescribing of barbiturates by psychiatrists could reduce the risk of an adverse clinical course when a patient attempts an overdose.

Multi-Component synthesis and computational studies of three novel thio-barbituric acid carbohydrate derivatives

NASA Astrophysics Data System (ADS)

Gupta, Stuti; Khare, Naveen K.

2017-01-01

The thio-barbituric acid is convenient starting compound for the preparation of fused heterocycles and its 5-substituted derivatives which are pharmacologically one of the most important classes of compounds. The fused compounds of thio-barbituric acid, 4-(1R,2S,3S,4S)-1,2,3,4,5-tetrahydroxy pentyl-10-phenyl-1,3,6,8,9,10 hexahydro-2,7-dithiooxopyrido [2,3-d; 6,5'] dipyrimidine-4,5 diones (1), 4-(1S,2S,3S,4S)-1,2,3,4,5-tetrahydroxy pentyl-10-phenyl-1,3,6,8,9,10 hexahydro-2,7-dithiooxopyrido [2,3-d; 6,5'] dipyrimidine-4,5 diones (2), 3-(1R,2S,3S)-1,2,3,4-tetrahydroxy butyl-10-phenyl-1,3,6,8,9,10 hexahydro-2,7-dithiooxopyrido [2,3-d; 6,5'] dipyrimidine-4,5 diones (3) have been synthesized in single step by the condensation of thio-barbituric acid with sugars (L-rhamnose, L-fucose and L-arabinose) & aniline using para-toluene sulfonic acid (p-TSA) as an effective acid catalyst under refluxing conditions. The molecular structure and detailed spectroscopic analysis of all three novel synthesized thiones derivatives have been performed using experimental techniques like 1H, 13C NMR, 2D (COSY, HSQC, DEPT-135 and DEPT-90) as well as theoretical calculations by density functional theory (DFT) using B3LYP and 6-311G + (d, p) basis set. The strength and nature of weak intramolecular interactions have been studied by atom in molecule (AIM) approach. Global reactivity descriptors have been computed to predict reactivity and reactive sites in the molecule.

The effects of hypoglycemic and alcoholic coma on the blood-brain barrier permeability

PubMed Central

Yorulmaz, Hatice; Seker, Fatma Burcu; Oztas, Baria

2011-01-01

In this investigation, the effects of hypoglycemic coma and alcoholic coma on the blood-brain barrier (BBB) permeability have been compared. Female adult Wistar albino rats weighing 180-230 g were divided into three groups: Control group (n=8), Alcoholic Coma Group (n=18), and Hypoglycemic Coma group (n=12). The animals went into coma approximately 3-4 hours after insulin administration and 3-5 minutes after alcohol administration. Evans blue (4mL/kg) was injected intravenously as BBB tracer. It was observed that the alcoholic coma did not significantly increase the BBB permeability in any of the brain regions when compared to control group. Changes in BBB permeability were significantly increased by the hypoglycemic coma in comparison to the control group values (p<0.01). Our findings suggest that hypoglycemic and alcoholic coma have different effects on the BBB permeability depending on the energy metabolism. PMID:21619558

Binding of urea and thiourea with a barbiturate derivative: experimental and theoretical approach.

PubMed

Dixit, Namrata; Shukla, P K; Mishra, P C; Mishra, Lallan; Roesky, Herbert W

2010-01-14

A barbiturate derivative [1,5-dihydro-5-[5-pyrimidine-2,4(1H,3H)-dionyl]-2H-chromeno[2,3-d] pyrimidine-2,4(3H)-dione)] (L1) possesses functionalities complementary to amide and thioamide. Hence its binding with urea and thiourea, is monitored using UV-vis and fluorescence titrations as well as isothermal titration calorimetry (ITC) study. Theoretical studies on hydrogen-bonded complexes of L1-urea and L1-thiourea in the gas phase, aqueous, and DMSO medium are carried out using density functional theory (DFT) at the B3LYP/6-31G** level. The theoretical calculations support the experimental results.

Structure-energy relationship in barbituric acid: a calorimetric, computational, and crystallographic study.

PubMed

Roux, María Victoria; Temprado, Manuel; Notario, Rafael; Foces-Foces, Concepción; Emel'yanenko, Vladimir N; Verevkin, Sergey P

2008-08-14

This paper reports the value of the standard (p(o) = 0.1 MPa) molar enthalpy of formation in the gas phase at T = 298.15 K for barbituric acid. The enthalpies of combustion and sublimation were measured by static bomb combustion calorimetry and transference (transpiration) method in a saturated N2 stream and a gas-phase enthalpy of formation value of -(534.3 +/- 1.7) kJ x mol(-1) was determined at T = 298.15 K. G3-calculated enthalpies of formation are in very good agreement with the experimental value. The behavior of the sample as a function of the temperature was studied by differential scanning calorimetry, and a new polymorph of barbituric acid at high temperature was found. In the solid state, two anhydrous forms are known displaying two out of the six hydrogen-bonding patterns observed in the alkyl/alkenyl derivatives retrieved from the Cambridge Crystallographic Database. The stability of these motifs has been analyzed by theoretical calculations. X-ray powder diffraction technique was used to establish to which polymorphic form corresponds to the commercial sample used in this study and to characterize the new form at high temperature.

Monoalkylated barbiturate derivatives: X-ray crystal structure, theoretical studies, and biological activities

NASA Astrophysics Data System (ADS)

Barakat, Assem; Al-Majid, Abdullah Mohammed; Soliman, Saied M.; Islam, Mohammad Shahidul; Ghawas, Hussain Mansur; Yousuf, Sammer; Choudhary, M. Iqbal; Wadood, Abdul

2017-08-01

Barbiturate derivatives are privileged structures with a broad range of pharmaceutical applications. We prepared a series of 5-monoalkylated barbiturate derivatives (3a-l) and evaluated, in vitro, their antioxidant (DPPH assay), and α-glucosidase inhibitory activities. Compounds 3a-l were synthesized via Michael addition. The structure of compound 3k was determined using X-ray single-crystal diffraction, and geometric parameters were calculated using density functional theory at the B3LYP/6-311G(d,p) level of theory. Further, the structural analysis of 3k were also investigated. Biological studies revealed that compounds 3b (IC50 = 133.1 ± 3.2 μM), 3d (IC50 = 305 ± 7.7 μM), and 3e (IC50 = 184 ± 2.3 μM) have potent α-glucosidase enzyme inhibitors and showed greater activity than the standard drug acarbose (IC50 = 841 ± 1.73 μM). Compounds 3a-3i were found to show weak antioxidant activity against 1,1-diphenyl-2-picryl-hydrazyl (DPPH) radicals (IC50 = 91 ± 0.75 to 122 ± 1.0 μM) when tested against a standard antioxidant, gallic acid (IC50 = 23 ± 0.43 μM).

Positive and Negative Allosteric Modulation of an α1β3γ2 γ-Aminobutyric Acid Type A (GABAA) Receptor by Binding to a Site in the Transmembrane Domain at the γ+-β− Interface*

PubMed Central

Jayakar, Selwyn S.; Zhou, Xiaojuan; Savechenkov, Pavel Y.; Chiara, David C.; Desai, Rooma; Bruzik, Karol S.; Miller, Keith W.; Cohen, Jonathan B.

2015-01-01

In the process of developing safer general anesthetics, isomers of anesthetic ethers and barbiturates have been discovered that act as convulsants and inhibitors of γ-aminobutyric acid type A receptors (GABAARs) rather than potentiators. It is unknown whether these convulsants act as negative allosteric modulators by binding to the intersubunit anesthetic-binding sites in the GABAAR transmembrane domain (Chiara, D. C., Jayakar, S. S., Zhou, X., Zhang, X., Savechenkov, P. Y., Bruzik, K. S., Miller, K. W., and Cohen, J. B. (2013) J. Biol. Chem. 288, 19343–19357) or to known convulsant sites in the ion channel or extracellular domains. Here, we show that S-1-methyl-5-propyl-5-(m-trifluoromethyl-diazirynylphenyl) barbituric acid (S-mTFD-MPPB), a photoreactive analog of the convulsant barbiturate S-MPPB, inhibits α1β3γ2 but potentiates α1β3 GABAAR responses. In the α1β3γ2 GABAAR, S-mTFD-MPPB binds in the transmembrane domain with high affinity to the γ+-β− subunit interface site with negative energetic coupling to GABA binding in the extracellular domain at the β+-α− subunit interfaces. GABA inhibits S-[3H]mTFD-MPPB photolabeling of γ2Ser-280 (γM2–15′) in this site. In contrast, within the same site GABA enhances photolabeling of β3Met-227 in βM1 by an anesthetic barbiturate, R-[3H]methyl-5-allyl-5-(m-trifluoromethyl-diazirynylphenyl)barbituric acid (mTFD-MPAB), which differs from S-mTFD-MPPB in structure only by chirality and two hydrogens (propyl versus allyl). S-mTFD-MPPB and R-mTFD-MPAB are predicted to bind in different orientations at the γ+-β− site, based upon the distance in GABAAR homology models between γ2Ser-280 and β3Met-227. These results provide an explanation for S-mTFD-MPPB inhibition of α1β3γ2 GABAAR function and provide a first demonstration that an intersubunit-binding site in the GABAAR transmembrane domain binds negative and positive allosteric modulators. PMID:26229099

Homeopathic treatment for prolonged postoperative coma: a case report.

PubMed

Vithoulkas, G; Văcăraș, V; Kavouras, J; Buzoianu, A D; Mărginean, M; Văcăraș, D; Cozma, S

2017-01-01

Coma is the state of unrousable unconsciousness. There are variations in the degree of coma and the findings and signs found on the patient's clinical examination depend on the underlying cause of the disorder. The Glasgow Coma scale evaluates the best motor, verbal and eye answers of the patient. A patient is considered to be in a coma if his Glasgow Coma Scale is below 8 points. The progress that we have made throughout the years has also led to complications that can culminate in a major catastrophe like death, permanent brain damage, coma. A study performed reached the conclusion that prior comorbidity, older age, intraoperative hypotension, and cardiovascular surgery may predispose patients to postoperative coma. The article presents a case of postoperative coma treated successfully with homeopathy. Although a rare complication, postoperative coma is a severe, death-leading condition, causing immense suffering on both the patient and the patient's family. A multidisciplinary and thorough approach is necessary for these patients, but even after a well-conducted therapy, this condition leads to the death of the patient.

Homeopathic treatment for prolonged postoperative coma: a case report

PubMed Central

Vithoulkas, G; Văcăraș, V; Kavouras, J; Buzoianu, AD; Mărginean, M; Văcăraș, D; Cozma, S

2017-01-01

Coma is the state of unrousable unconsciousness. There are variations in the degree of coma and the findings and signs found on the patient’s clinical examination depend on the underlying cause of the disorder. The Glasgow Coma scale evaluates the best motor, verbal and eye answers of the patient. A patient is considered to be in a coma if his Glasgow Coma Scale is below 8 points. The progress that we have made throughout the years has also led to complications that can culminate in a major catastrophe like death, permanent brain damage, coma. A study performed reached the conclusion that prior comorbidity, older age, intraoperative hypotension, and cardiovascular surgery may predispose patients to postoperative coma. The article presents a case of postoperative coma treated successfully with homeopathy. Although a rare complication, postoperative coma is a severe, death-leading condition, causing immense suffering on both the patient and the patient’s family. A multidisciplinary and thorough approach is necessary for these patients, but even after a well-conducted therapy, this condition leads to the death of the patient. PMID:28616086

Prognostic value of EEG in different etiological types of coma.

PubMed

Khaburzania, M; Beridze, M

2013-06-01

Study aimed at evaluation of prognostic value of standard EEG in different etiology of coma and the influence of etiological factor on the EEG patterns and coma outcome. Totally 175 coma patients were investigated. Patients were evaluated by Glasgow Coma Scale (GCS), clinically and by 16 channel electroencephalography. Auditory evoked potentials studied by EEG -regime for evoked potentials in patients with vegetative state (VS). Patients divided in 8 groups according to coma etiology. All patients were studied for photoreaction, brainstem reflexes, localization of sound and pain, length of coma state and outcome. Brain injury visualized by conventional CT. Outcome defined as death, VS, recovery with disability and without disability. Disability was rated by Disability Rating Scale (DRS). Recovered patients assessed by Mini Mental State Examination (MMSE) scale. Statistics performed by SPSS-11.0. From 175 coma patients 55 patients died, 23 patients found in VS, 97 patients recovered with and without disability. In all etiological groups of coma the background EEG patterns were established. Correspondence analysis of all investigated factors revealed that sound localization had the significant association with EEG delta and theta rhythms and with recovery from coma state (Chi-sqr. =31.10493; p= 0.000001). Among 23 VS patients 9 patients had the signs of MCS and showed the long latency waves (p300) after binaural stimulation. The high amplitude theta frequencies in frontal and temporal lobes significantly correlated with prolongation of latency of cognitive evoked potentials (r=+0.47; p<0.01). Etiological factor had the significant effect on EEG patterns' association with coma outcome only in hemorrhagic and traumatic coma (chi-sqr.=12.95; p<0.005; chi-sqr.=7.92; p<0.03 respectively). Significant correlations established between the delta and theta EEG patterns and coma outcome. Low amplitude decreased power delta and theta frequencies correlated with SND in survived coma patients (r=+0.21; p<0.001; r=+0.27; p<0.001 respectively). Standard EEG is the useful tool for elucidation of coma patients with a high probability to recover as well as those patients, who are at high risk of SND in case of recovery from coma state.

The effect of oral castor oil on the disposition of methyprylon in intoxicated dogs.

PubMed

Gwilt, P R; Pankaskie, M C; Mitala, J J

1982-07-01

Clinical observations indicate that large oral doses of castor oil are effective in reducing the time of coma resulting from acute intoxication with lipophilic drugs. It has been further suggested that the rate of removal of these drugs from the body is increased by castor oil. In order to investigate the effect of castor oil on the disposition of lipophilic drugs, five dogs were given toxic doses of methyprylon by intravenous infusion. Each dog was treated with a large oral dose of castor oil in a cross-over fashion. No significant difference was observed in the sleep times of the dogs treated with castor oil, or in the methyprylon pharmacokinetics compared to controls. It was concluded that castor oil does not affect the disposition of methyprylon.

Cerebellar pressor response in the dog

NASA Technical Reports Server (NTRS)

Dormer, K. J.; Stone, H. L.

1976-01-01

A fastigial pressor response has been elicited in the anesthetized mongrel dog. Stimulation within the rostral portions of this nucleus results in mean arterial pressure rises up to 150 mmHg above control. A proportional tachycardia is simultaneously evoked which may rapidly attain heart rates of 190 beats/min above control levels. Peak tachycardias immediately subside and often the heart rate declines below control values during stimulation while arterial pressure remains elevated. When either the carotid sinuses were isolated by ligation or a bilateral vagotomy was performed, the fastigial tachycardia was sustained. The response could still be attained when submaximal doses of alpha-chloralose anesthesia or high levels of barbiturates (30-40 mg/kg) were given. Both portions of the response result from widespread sympathetic activation; however, buffering of the response through the baroreceptor reflexes is only demonstrated in the cardiac segment of the response.

A review of the evidence of zolpidem efficacy in neurological disability after brain damage due to stroke, trauma and hypoxia: A justification of further clinical trials.

PubMed

Sutton, J A; Clauss, R P

2017-01-01

During 15 years, 23 clinical reports and 6 studies have demonstrated associations between sub-sedative doses of zolpidem and recoveries from brain damage due to strokes, trauma and hypoxia. Clinical findings include unexpected awakenings from vegetative states and regressions of stroke symptoms after dosing that disappear during elimination and reappear on repeat dosing. Initially single-photon emission computed tomography scans showed improved perfusion within, around and distant from infarctions. Then positron emission tomography scans and electroencephalography detected renewed metabolic and neuronal activity. Placebo or a similar, gamma-aminobutyric acid (GABA)-ergic, sedative zopiclone has no such effect. The effect appears only several months after the injury, reflecting recent evidence in mice of substantial differences between the states of GABA receptors in acute and chronic repair phases of recovery. Zolpidem's good safety record and rapid absorption further indicate a need for more clinical trials. List of acronyms: BOLD, Blood-Oxygen-Level Dependent contrast imaging in MRI; CRS, Coma Recovery Scale; CRS-R, Coma Recovery Scale Revised; CSI, Cerebral State Index; CSM, Cerebral State Monitor; DOC, Disorder of Consciousness; EEG, Electro Encephalography; FDG-PET, FluoroDeoxyGlucose-Positron Emission Tomography; FTD, Frontotemporal dementia; GABA, Gamma-Aminobutyric Acid; MCS, Minimally Conscious State; M-EEG, Magneto-Encephalography; MRI, Magnetic Resonance Image; MSN, Median Spiny Neurones; PET, Positron Emission Tomography; PVS, Persistent Vegetative Sate; RLAC, Rancho Los Amigos Cognitive scores; SPECT, Single-photon emission computed tomography; TFES, Tinetti Falls Efficacy Scale; 99mTc HMPAO, Technetium hexamethylpropyleneamine oxime.

The role of liquid chromatography-tandem mass spectrometry (LC-MS/MS) to test blood and urine samples for the toxicological investigation of drug-facilitated crimes.

PubMed

Deveaux, Marc; Chèze, Marjorie; Pépin, Gilbert

2008-04-01

The authors present an overview of the drug-facilitated crime (DFC) phenomenon, especially in France. Recently, there has been an increase in reports of incidents (mainly sexual assaults and robbery) as well as in scientific publications and congress presentations on the topic. From enquiries conducted nationally, a list of drugs reportedly associated with DFC was established and includes benzodiazepines and benzodiazepine-like drugs (zolpidem, zopiclone), minor tranquilizers and neuroleptics, barbiturates, narcotics, hallucinogens, and anaesthetics. Some of these molecules are specific to France in DFC cases. A study using healthy volunteers who had taken benzodiazepines (lorazepam, bromazepam, flunitrazepam, clonazepam), zolpidem and zopiclone, showed that the only way to increase the duration of detection of these drugs is to use liquid chromatography-tandem mass spectrometry (LC-MS/MS) to test blood and urine samples. The very high sensitivity of this method appears to be an essential condition to document the cases, because the drugs tested were still detectable in urine at least 6 days after the ingestion of one therapeutic dose. Limits of detection were always lower than 0.5 ng/mL in urine. The actual list of molecules and metabolites the authors screened for in urine and blood by LC-MS/MS, in every DFC, is given in detail: 25 benzodiazepines and benzodiazepine-like drugs, 11 minor tranquilizers and neuroleptics, 2 barbiturates, 12 narcotics, 4 hallucinogens, and 1 anaesthetic. However, the distinction between continual therapeutic use of a psychotropic drug or illegal narcotic and a single ingestion has to be documented by sequential analysis of hair, again with LC-MS/MS.

EEG in connection with coma.

PubMed

Wilson, John A; Nordal, Helge J

2013-01-08

Coma is a dynamic condition that may have various causes. Important changes may take place rapidly, often with consequences for treatment. The purpose of this article is to provide a brief overview of EEG patterns in comas with various causes, and indicate how EEG contributes in an assessment of the prognosis for coma patients. The article is based on many years of clinical and research-based experience of EEG used for patients in coma. A self-built reference database was supplemented by searches for relevant articles in PubMed. EEG reveals immediate changes in coma, and can provide early information on cause and prognosis. It is the only diagnostic tool for detecting a non-convulsive epileptic status. Locked-in- syndrome may be overseen without EEG. Repeated EEG scans increase diagnostic certainty and make it possible to monitor the development of coma. EEG reflects brain function continuously and therefore holds a key place in the assessment and treatment of coma.

Incidence, predictors and outcomes of postoperative coma: an observational study of 858,606 patients.

PubMed

Newman, Jessica; Blake, Kathryn; Fennema, Jordan; Harris, David; Shanks, Amy; Avidan, Michael S; Kelz, Max B; Mashour, George A

2013-08-01

Coma is a state of profound unresponsiveness that can occur as a serious perioperative complication. The study of risk factors for, and sequelae of, postoperative coma has been limited due to the rarity of the event. To determine the incidence, risk factors and impact of postoperative coma in a large patient population. Observational study using a prospectively gathered national dataset. Data from 858 606 patients were analysed. The incidence of postoperative coma of more than 24-h duration was identified. Logistic regression was used to identify independent predictors and develop a risk model of postoperative coma in derivation and validation cohorts; 30-day mortality was also analysed. The incidence of postoperative coma was 0.06%. Multivariate analysis revealed the following independent predictors: liver disease, systemic sepsis, age at least 63 years, renal disease, emergency operation, cardiac disease, hypertension, prior neurological disease, diabetes mellitus and BMI 25 to 29.99 kg m (protective). These predictors were incorporated into a risk index classification; odds ratios for postoperative coma increased from 2.5 with one risk factor to 18.4 with three. Coma was associated with 74.2% all-cause mortality; coma associated with cardiac arrest had a 1.9-fold higher mortality. This is the largest study of postoperative coma ever reported and will be useful for determining risk of coma of more than 24 h duration when evaluating an unresponsive patient following surgery. Data on prognosis will aid medical and ethical decision-making for the comatose surgical patient.

The coma cluster after lunch: Has a galaxcy group passed through the cluster core?

NASA Technical Reports Server (NTRS)

Burns, Jack O.; Roettiger, Kurt; Ledlow, Michael; Klypin, Anatoly

1994-01-01

We propose that the Coma cluster has recently undergone a collision with the NGC 4839 galaxy group. The ROSAT X-ray morphology, the Coma radio halo, the presence of poststarburst galaxies in the bridge between Coma and NGC 4839, the usually high velocity dispersion for the NGC 4839 group, and the position of a large-scale galaxy filament to the NE of Coma are all used to argue that the NGC 4839 group passed through the core of Coma approximately 2 Gyr ago. We present a new Hydro/N-body simulation of the merger between a galaxy group and a rich cluster that reproduces many of the observed X-ray and optical properties of Coma/NGC 4839.

Phenytoin intoxication with no symptoms correlated with serum drug level: a case study.

PubMed

Avcil, Mucahit; Duman, Ali; Turkdogan, Kenan Ahmet; Kapci, Mucahit; Akoz, Ayhan; Canakci, Selcuk Eren; Ozluer, Yunus Emre

2015-01-01

In high-dose intake of phenytoin, which is used frequently to treat epilepsy, nystagmus, diplopia, nausea-vomiting, lethargy, confusion, seizure, and coma can be observed. In recent studies on phenytoin intoxication, in which seizure and coma were observed in drug levels greater than 50 ug/mL. The serum phenytoin level of a patient, who consumed approximately 100 pcs of 100 mg phenytoin tablets in an effort to commit suicide, and who had no pathological finding in her neurologic examination, was 124 ug/mL. High drug level and the absence of toxic effect (or the absence of toxic effect correlated with the drug level) indicates that cytochrome P450 is functioning, but there can be a mutation in the MDR1 gene. In our case study, we report on phenytoin intoxication in a patient having a high level of phenytoin but no symptoms correlated with serum drug level, as supported by the findings in the literature.

Epileptic seizures, coma and EEG burst-suppression from suicidal bupropion intoxication.

PubMed

Noda, Anna Hiro; Schu, Ulrich; Maier, Tanja; Knake, Susanne; Rosenow, Felix

2017-03-01

Bupropion, an amphetamine-like dual mechanism drug, is approved and increasingly used for the treatment of major depression, and its use is associated with a dose-dependent risk of epileptic seizures. Suicide attempts are frequent in major depression and often an overdose of the drugs available is ingested. Therefore, it is important to be aware of the clinical course, including EEG and neurological symptoms, as well as treatment and prognosis of bupropion intoxication. We report on the clinical and EEG course of a women who ingested 27 g of bupropion in a suicide attempt. Myoclonic seizures were followed by generalized tonic-clonic seizures and coma associated with EEG burst-suppression and brief tonic seizures. Active carbon and neuro-intensive care treatment, including respiratory support, were given. Within three days, the patient returned to a stable clinical condition with a mildly encephalopathic EEG. In conclusion, bupropion intoxication requires acute intensive care treatment and usually has a good prognosis, however, misinterpretation of the clinical and EEG presentation may lead to errors in management.

Withdrawal strategies for outpatients

PubMed Central

Mezciems, Edgar

1996-01-01

This article discusses outpatient withdrawal strategies for patients addicted to alcohol, benzodiazepines, barbiturates, and opiates and describes some practical ways to support recovery. PMID:8828877

The portrayal of coma in contemporary motion pictures.

PubMed

Wijdicks, Eelco F M; Wijdicks, Coen A

2006-05-09

Coma has been a theme of screenplays in motion pictures, but there is no information about its accuracy. The authors reviewed 30 movies from 1970 to 2004 with actors depicting prolonged coma. Accurate depiction of comatose patients was defined by appearance, the complexity of care, accurate cause of coma and probability of awakening, and appropriate compassionate discussion between the physician and family members. Twenty-two key scenes from 17 movies were rated for accuracy by a panel of neurointensivists and neuroscience nurses and then were shown to 72 nonmedical viewers. Accuracy of the scenes was assessed using a Likert Scale. Coma was most often caused by motor vehicle accidents or violence (63%). The time in a comatose state varied from days to 10 years. Awakening occurred in 18 of 30 motion pictures (60%). Awakening was sudden with cognition intact, even after prolonged time in a coma. Actors personified "Sleeping Beauty" (eyes closed, beautifully groomed). Physicians appeared as caricatures. Only two movies had a reasonable accurate representation (Dream Life of Angels and Reversal of Fortune). The majority of the surveyed viewers identified inaccuracy of representation of coma, awakenings, and conversations on the experience of being in a coma, except in 8 of the 22 scenes (36%). Twenty-eight of the 72 viewers (39%) could potentially allow these scenes to influence decisions in real life. Misrepresentation of coma and awakening was common in motion pictures and impacted on the public perception of coma. Neurologic advice regarding prolonged coma is needed.

Daily isoflurane exposure increases barbiturate insensitivity in medullary respiratory and cortical neurons via expression of ε-subunit containing GABA ARs.

PubMed

Hengen, Keith B; Nelson, Nathan R; Stang, Kyle M; Johnson, Stephen M; Smith, Stephanie M; Watters, Jyoti J; Mitchell, Gordon S; Behan, Mary

2015-01-01

The parameters governing GABAA receptor subtype expression patterns are not well understood, although significant shifts in subunit expression may support key physiological events. For example, the respiratory control network in pregnant rats becomes relatively insensitive to barbiturates due to increased expression of ε-subunit-containing GABAARs in the ventral respiratory column. We hypothesized that this plasticity may be a compensatory response to a chronic increase in inhibitory tone caused by increased central neurosteroid levels. Thus, we tested whether increased inhibitory tone was sufficient to induce ε-subunit upregulation on respiratory and cortical neurons in adult rats. Chronic intermittent increases in inhibitory tone in male and female rats was induced via daily 5-min exposures to 3% isoflurane. After 7d of treatment, phrenic burst frequency was less sensitive to barbiturate in isoflurane-treated male and female rats in vivo. Neurons in the ventral respiratory group and cortex were less sensitive to pentobarbital in vitro following 7d and 30d of intermittent isoflurane-exposure in both male and female rats. The pentobarbital insensitivity in 7d isoflurane-treated rats was reversible after another 7d. We hypothesize that increased inhibitory tone in the respiratory control network and cortex causes a compensatory increase in ε-subunit-containing GABAARs.

Thiobarbiturate and barbiturate salts of pefloxacin drug: Growth, structure, thermal stability and IR-spectra

NASA Astrophysics Data System (ADS)

Golovnev, Nicolay N.; Molokeev, Maxim S.; Lesnikov, Maxim K.; Sterkhova, Irina V.; Atuchin, Victor V.

2017-12-01

Three new salts of pefloxacin (PefH) with thiobarbituric (H2tba) and barbituric (H2ba) acids, pefloxacinium 2-thiobarbiturate trihydrate, PefH2(Htba)·3H2O (1), pefloxacinium 2-thiobarbiturate, PefH2(Htba) (2) and bis(pefloxacinium barbiturate) hydrate, (PefH2)2(Hba)2·2.56H2O (3) are synthesized and structurally characterized by the X-ray single-crystal diffraction. The structures of 1-3 contain intramolecular hydrogen bonds Csbnd H⋯F, Osbnd H⋯O. Intermolecular hydrogen bonds Nsbnd H⋯O and Osbnd H⋯O form a 2D plane network in 1. In 2 and 3, intermolecular hydrogen bonds Nsbnd H⋯O form the infinite chains. In 1-3, the Htba- and Hba- ions are connected with PefH2+ only by one intermolecular hydrogen bond Nsbnd H⋯O. In 2 and 3, two Htba- and Hba- ions are connected by two hydrogen bonds Nsbnd H⋯O. These pairs form infinite chains. All three structures are stabilized by the π-π interactions of the head-to-tail type between PefH2+ ions. Compounds 2 and 3 are characterized by powder XRD, TG-DSC and FT-IR.

The inter-rater reliability and prognostic value of coma scales in Nepali children with acute encephalitis syndrome.

PubMed

Ray, Stephen; Rayamajhi, Ajit; Bonnett, Laura J; Solomon, Tom; Kneen, Rachel; Griffiths, Michael J

2018-02-01

Background Acute encephalitis syndrome (AES) is a common cause of coma in Nepali children. The Glasgow coma scale (GCS) is used to assess the level of coma in these patients and predict outcome. Alternative coma scales may have better inter-rater reliability and prognostic value in encephalitis in Nepali children, but this has not been studied. The Adelaide coma scale (ACS), Blantyre coma scale (BCS) and the Alert, Verbal, Pain, Unresponsive scale (AVPU) are alternatives to the GCS which can be used. Methods Children aged 1-14 years who presented to Kanti Children's Hospital, Kathmandu with AES between September 2010 and November 2011 were recruited. All four coma scales (GCS, ACS, BCS and AVPU) were applied on admission, 48 h later and on discharge. Inter-rater reliability (unweighted kappa) was measured for each. Correlation and agreement between total coma score and outcome (Liverpool outcome score) was measured by Spearman's rank and Bland-Altman plot. The prognostic value of coma scales alone and in combination with physiological variables was investigated in a subgroup (n = 22). A multivariable logistic regression model was fitted by backward stepwise. Results Fifty children were recruited. Inter-rater reliability using the variables scales was fair to moderate. However, the scales poorly predicted clinical outcome. Combining the scales with physiological parameters such as systolic blood pressure improved outcome prediction. Conclusion This is the first study to compare four coma scales in Nepali children with AES. The scales exhibited fair to moderate inter-rater reliability. However, the study is inadequately powered to answer the question on the relationship between coma scales and outcome. Further larger studies are required.

Flubromazolam--A new life-threatening designer benzodiazepine.

PubMed

Łukasik-Głębocka, Magdalena; Sommerfeld, Karina; Teżyk, Artur; Zielińska-Psuja, Barbara; Panieński, Paweł; Żaba, Czesław

2016-01-01

In addition to designer benzodiazepines such as etizolam, deschloroetizolam, pyrazolam, diclazepam, nifoxipam, or clonazolam, a new psychoactive substance like flubromazolam, triazole of flubromazepam has become available. Flubromazolam is currently not marketed as a medication but rather as a research chemical and recreational drug. It mostly causes sedative effects but also has moderate anti-anxiety and muscle relaxant effects. A case of a severe intoxication of flubromazolam has been reported. A 27-year-old man, presented with deep coma, bilateral pinpoint unreactive pupils, acute respiratory failure and hypotension, complicated by hypoxic ischemic changes in the central nervous system. A positive result of a urine screening test confirmed the presence of benzodiazepines, which resulted in administration of flumazenil and improved patient consciousness. Quantitative method of liquid chromatography indicated flubromazolam in the patient's serum at 59 ng/mL and urine at 105 ng/mL about 19 h after ingestion of 3 mg dose. On admission, serum creatine kinase was 15,960 U/L. The patient was treated with mechanical ventilation, intravenous fluids, flumazenil and continuous infusion of norepinephrine at a dose of 0.12 µg/kg/min. The patient survived and on the ninth day of hospitalization he was transferred to the Department of Neurology. Flubromazolam is a new designer drug. Recreational use may be a cause of prolonged, severe intoxication associated with coma, hypotension, and rhabdomyolysis.

[Witches' ointments and love-potions: a contribution to the cultural history of nightshades].

PubMed

Muller, J

1998-01-01

The nightshades (solanaceae) were used as intoxicants since the ancient civilizations and are still in use today. Their alkaloids, atropine and scopolamine, were the major active substances of the ointments of witches, of medieval "anaesthetics", and of modern poisons for murder. In a medium dose-range the predominant symptoms are hallucinations and illusions. This explains the use of nightshades in fortune-telling and religious rituals. In higher doses the alkaloids produce coma and apnea. Scopolamine enjoyed a particular popularity as a poison for murder. In the 19th century the nightshade alkaloids were also in clinical use. This article focusses on the medical history of the psychosis due to intoxication with solanaceae.

ULTRA-COMPACT DWARFS IN THE COMA CLUSTER

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chiboucas, Kristin; Tully, R. Brent; Marzke, R. O.

2011-08-20

We have undertaken a spectroscopic search for ultra-compact dwarf galaxies (UCDs) in the dense core of the dynamically evolved, massive Coma cluster as part of the Hubble Space Telescope/Advanced Camera for Surveys (HST/ACS) Coma Cluster Treasury Survey. UCD candidates were initially chosen based on color, magnitude, degree of resolution within the ACS images, and the known properties of Fornax and Virgo UCDs. Follow-up spectroscopy with Keck/Low-Resolution Imaging Spectrometer confirmed 27 candidates as members of the Coma cluster, a success rate >60% for targeted objects brighter than M{sub R} = -12. Another 14 candidates may also prove to be Coma members,more » but low signal-to-noise spectra prevent definitive conclusions. An investigation of the properties and distribution of the Coma UCDs finds these objects to be very similar to UCDs discovered in other environments. The Coma UCDs tend to be clustered around giant galaxies in the cluster core and have colors/metallicity that correlate with the host galaxy. With properties and a distribution similar to that of the Coma cluster globular cluster population, we find strong support for a star cluster origin for the majority of the Coma UCDs. However, a few UCDs appear to have stellar population or structural properties which differentiate them from the old star cluster populations found in the Coma cluster, perhaps indicating that UCDs may form through multiple formation channels.« less

Immediate coma and poor outcome in subarachnoid haemorrhage are independently associated with an aneurysmal origin.

PubMed

Tsermoulas, Georgios; Flett, Lisa; Gregson, Barbara; Mitchell, Patrick

2013-08-01

Subarachnoid haemorrhage (SAH) may present with coma and this is known to be associated with aneurysmal origin and blood load. Aneurysmal origin is associated with increased blood load and existing data do not allow us to determine if the association between coma and aneurysmal SAH is wholly due to blood load or if aneurysmal origin has an additional independent effect. The objective of our study is to find if an aneurysmal origin is a predictor of acute onset of coma independent of blood load. A series of consecutive patients with spontaneous SAH were divided into two groups: aneurysmal (aSAH) and non-aneurysmal--angiographically negative SAH (naSAH). Blood load was quantified so that the effect of aneurysmal origin could be resolved from the effect of the amount of blood spilled. Non-parametric regression was used to relate blood load to coma and poor outcome rates for aneurysmal bleeds. We analysed a total of 421 patients presenting during the period 2009-2011. Ninety aneurysmal cases presented with coma, seventy immediately in the early phase and seven shortly after rebleeding. None of the naSAH cases presented with immediate coma and 1 developed delayed coma. Delayed coma was associated with acute hydrocephalus in both groups. Aneurysmal origin was found to be an independent determinant of immediate coma (p=0.02) and poor outcome (p<0.001). Immediate coma and poor outcome in SAH are associated with an aneurysmal origin and do not characterize naSAH. Copyright © 2013 Elsevier B.V. All rights reserved.

EEG and Coma.

PubMed

Ardeshna, Nikesh I

2016-03-01

Coma is defined as a state of extreme unresponsiveness, in which a person exhibits no voluntary movement or behavior even to painful stimuli. The utilization of EEG for patients in coma has increased dramatically over the last few years. In fact, many institutions have set protocols for continuous EEG (cEEG) monitoring for patients in coma due to potential causes such as subarachnoid hemorrhage or cardiac arrest. Consequently, EEG plays an important role in diagnosis, managenent, and in some cases even prognosis of coma patients.

Part-body and multibody effects on absorption of radio-frequency electromagnetic energy by animals and by models of man

NASA Technical Reports Server (NTRS)

Gandhi, O. P.; Hagmann, M. J.; Dandrea, J. A.

1979-01-01

Fine structure in the whole-body resonant curve for radio-frequency energy deposition in man can be attributed to part-body resonances. As for head resonance, which occurs near 350 MHz in man, the absorptive cross section is nearly three times the physical cross section of the head. The arm has a prominent resonance at 150 MHz. Numerical solutions, antenna theory, and experimental results on animals have shown that whole-body energy deposition may be increased by 50 percent or more because of multiple bodies that are strategically located in the field. Empirical equations for SARs are also presented along with test data for several species of laboratory animals. Barbiturate anesthesia is sufficiently disruptive of thermoregulation that delta Ts of colonic temperature yield energy dose values in several mammals that compare quite favorably with those based on whole-body calorimetry.

Anaesthesia for Barotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cass, N. M.

An evaluation was made of various anesthetic techniques and agents employed in the newly developed high-pressure oxygen radiotherapeutic method. Results are reported for 334 courses of anesthesia given to patients prior to treatment with megavoltage x rays under high oxygen pressure. Reasons for anesthesia during barotherapy are discussed. The optimal anesthetic technique combines heavy premedication with pentobarbitone. Promethazine (25 mg) is given orally 4 hr before treatment. Two hours before treatment papaveretum and scopolamine are given hypodermically. On arrival in the treatment suite, patients are given pentobarbitone (Nembutal) intravenously. Since light hypnosis with barbiturates increases reflex response to pain, pethidinemore » was given intravenously in doses of 50 to 150 mg. Four % cocaine in adrenaline (1: 100,000 solution) is then applied to the nostrils, and the trachea and larynx sprayed with 4% lignocaine. In 334 anesthetic courses there were no deaths and minimal complications. Epileptiform convulsions occurred during three compressions. (BRB)« less

IDENTIFICATION AND MANAGEMENT OF ALCOHOL WITHDRAWAL SYNDROME

PubMed Central

Mirijello, Antonio; D’Angelo, Cristina; Ferrulli, Anna; Vassallo, Gabriele; Antonelli, Mariangela; Caputo, Fabio; Leggio, Lorenzo; Gasbarrini, Antonio; Addolorato, Giovanni

2016-01-01

Symptoms of alcohol withdrawal syndrome may develop within 6–24 hours after the abrupt discontinuation or decrease of alcohol consumption. Symptoms can vary from autonomic hyperactivity and agitation to delirium tremens. The gold-standard treatment for alcohol withdrawal syndrome is represented by benzodiazepines. Among them, different agents (i.e., long-acting or short-acting) and different regimens (front-loading, fixed dose or symptom-triggered) may be chosen on the basis of patient characteristics. Severe withdrawal could require ICU admission and the use of barbiturates or propofol. Other drugs, such as alpha2-agonists (clonidine and dexmetedomidine) and beta-blockers can be used as adjunctive treatments to control neuroautonomic hyperactivity. Furthermore, neuroleptics can help control hallucinations. Finally, other medications for the treatment for alcohol withdrawal syndrome have been investigated with promising results. These include carbamazepine, valproate, sodium oxybate, baclofen, gabapentin, and topiramate. The usefulness of these agents will be discussed in the text. PMID:25666543

Myxedema coma leading to respiratory depression in a dog.

PubMed

Atkinson, Kathryn; Aubert, Isabelle

2004-04-01

A 10-year-old, intact male, cocker spaniel was presented with hypothermia, without shivering, and progressive stupor leading to coma. Myxedema coma, potentially precipitated by diuretic therapy, was tentatively diagnosed and treatment initiated, but progressive respiratory depression led to the decision to euthanize. Postmortem findings supported the diagnosis of myxedema coma.

Myxedema coma leading to respiratory depression in a dog

PubMed Central

2004-01-01

Abstract A 10-year-old, intact male, cocker spaniel was presented with hypothermia, without shivering, and progressive stupor leading to coma. Myxedema coma, potentially precipitated by diuretic therapy, was tentatively diagnosed and treatment initiated, but progressive respiratory depression led to the decision to euthanize. Postmortem findings supported the diagnosis of myxedema coma. PMID:15144105

Severe angioedema in myxedema coma: a difficult airway in a rare endocrine emergency.

PubMed

Lee, Christopher H; Wira, Charles R

2009-10-01

Myxedema coma is the most lethal manifestation of hypothyroidism. It is a true medical emergency and can result in profound hemodynamic instability and airway compromise. Myxedema coma currently remains a diagnostic challenge due to the rarity of cases seen today, and failure to promptly initiate therapy with replacement thyroid hormone can be fatal. As thyroid hormone therapy can take days or weeks to reverse the manifestations of myxedema coma, interim supportive therapy is critical while awaiting clinical improvement. Some patients will require endotracheal intubation in the emergency department (ED), and physicians should be aware that unanticipated posterior pharyngeal edema in myxedema coma could severely complicate airway management. Although mechanical ventilation is a well-described adjunctive therapy for myxedema coma, reports of the potential difficulty in securing a definitive airway in these patients are rare. We describe a case of an unidentified woman who presented to the ED with myxedema coma requiring urgent endotracheal intubation and was found to have extensive posterior pharyngeal angioedema inconsistent with her relatively benign external examination. This case highlights the typical features of myxedema coma and discusses our necessity for a rescue device in definitive endotracheal tube placement. Emergency physicians should anticipate a potentially difficult airway in all myxedema coma patients regardless of the degree of external facial edema present.

Characterization of the warm-hot intergalactic medium near the Coma cluster through high-resolution spectroscopy of X Comae

NASA Astrophysics Data System (ADS)

Bonamente, M.; Ahoranta, J.; Tilton, E.; Tempel, E.; Morandi, A.

2017-08-01

We have analysed all available archival XMM-Newton observations of X Comae, a bright X-ray quasar behind the Coma cluster, to study the properties of the warm-hot intergalactic medium (WHIM) in the vicinity of the nearest massive galaxy cluster. The reflection grating spectrometer observations confirm the possible presence of a Ne ix K α absorption line at the redshift of Coma, although with a limited statistical significance. This analysis is therefore in line with the earlier analysis by Takei et al. based on a sub-set of these data. Its large column density and optical depth, however, point to implausible conditions for the absorbing medium, thereby casting serious doubts to its reality. Chandra has never observed X Comae and therefore cannot provide additional information on this source. We combine upper limits to the presence of other X-ray absorption lines (notably from O vii and O viii) at the redshift of Coma with positive measurements of the soft excess emission from Coma measured by ROSAT (Bonamente et al.). The combination of emission from warm-hot gas at kT ˜ 1/4 keV and upper limits from absorption lines provide useful constraints on the density and the sightline length of the putative WHIM towards Coma. We conclude that the putative warm-hot medium towards Coma is consistent with expected properties, with a baryon overdensity δb ≥ 10 and a sightline extent of order of tens of Mpc.

Survival rate and expression of Heat-shock protein 70 and Frost genes after temperature stress in Drosophila melanogaster lines that are selected for recovery time from temperature coma.

PubMed

Udaka, Hiroko; Ueda, Chiaki; Goto, Shin G

2010-12-01

In this study, we investigated the physiological mechanisms underlying temperature tolerance using Drosophila melanogaster lines with rapid, intermediate, or slow recovery from heat or chill coma that were established by artificial selection or by free recombination without selection. Specifically, we focused on the relationships among their recovery from heat or chill coma, survival after severe heat or cold, and survival enhanced by rapid cold hardening (RCH) or heat hardening. The recovery time from heat coma was not related to the survival rate after severe heat. The line with rapid recovery from chill coma showed a higher survival rate after severe cold exposure, and therefore the same mechanisms are likely to underlie these phenotypes. The recovery time from chill coma and survival rate after severe cold were unrelated to RCH-enhanced survival. We also examined the expression of two genes, Heat-shock protein 70 (Hsp70) and Frost, in these lines to understand the contribution of these stress-inducible genes to intraspecific variation in recovery from temperature coma. The line showing rapid recovery from heat coma did not exhibit higher expression of Hsp70 and Frost. In addition, Hsp70 and Frost transcription levels were not correlated with the recovery time from chill coma. Thus, Hsp70 and Frost transcriptional regulation was not involved in the intraspecific variation in recovery from temperature coma. Copyright © 2010 Elsevier Ltd. All rights reserved.

Childhood acute non-traumatic coma: aetiology and challenges in management in resource-poor countries of Africa and Asia.

PubMed

Gwer, Samson; Chacha, Clifford; Newton, Charles R; Idro, Richard

2013-08-01

This review examines the best available evidence on the aetiology of childhood acute non-traumatic coma in resource-poor countries (RPCs), discusses the challenges associated with management, and explores strategies to address them. Publications in English and French which reported on studies on the aetiology of childhood non-traumatic coma in RPCs are reviewed. Primarily, the MEDLINE database was searched using the keywords coma, unconsciousness, causality, aetiology, child, malaria cerebral, meningitis, encephalitis, Africa, Asia, and developing countries. 14 records were identified for inclusion in the review. Cerebral malaria (CM) was the commonest cause of childhood coma in most of the studies conducted in Africa. Acute bacterial meningitis (ABM) was the second most common known cause of coma in seven of the African studies. Of the studies in Asia, encephalitides were the commonest cause of coma in two studies in India, and ABM was the commonest cause of coma in Pakistan. Streptococcus pneumoniae was the most commonly isolated organism in ABM. Japanese encephalitis, dengue fever and enteroviruses were the viral agents most commonly isolated. Accurate diagnosis of the aetiology of childhood coma in RPCs is complicated by overlap in clinical presentation, limited diagnostic resources, disease endemicity and co-morbidity. For improved outcomes, studies are needed to further elucidate the aetiology of childhood coma in RPCs, explore simple and practical diagnostic tools, and investigate the most appropriate specific and supportive interventions to manage and prevent infectious encephalopathies.

'Is she alive? Is she dead?' Representations of chronic disorders of consciousness in Douglas Coupland's Girlfriend in a Coma.

PubMed

Colbeck, Matthew

2016-09-01

Depictions of coma have come to dominate literary and filmic texts over the last half century, a phenomenon coinciding with advancements in medical technology that have led to remarkable increases in the survival rates of patients with chronic disorders of consciousness. Authors of coma fiction are preoccupied with the imagined subjective experience of coma, often creating complex, dream-like worlds from which the protagonist must escape if survival is to be achieved. However, such representations appear to conflict with medical case studies and patient narratives that reveal that most often survivors of coma have no recollection of the coma itself. Providing a close reading of Douglas Coupland's Girlfriend in a Coma (1998) against the context of medical literature and diagnoses, this article examines how the coma patient is represented, often depicting the realities of a prolonged vegetative state, in contrast with other popular representations of coma. It explores how the author develops a work of 'fantastic' fiction (a genre defined by the structuralist critic Tzvetan Todorov), using the condition of coma as a metaphor for a postmodern existential crisis, while simultaneously employing mimetic techniques that raise important medical, ethical and philosophical questions surrounding the ontological status of the comatose patient. It is argued that coma fiction, even in its misrepresentation of the condition, can help us to engage with and interrogate how we think about chronic disorders of consciousness, thereby providing a valuable insight into our attitudes towards illness and mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

[Brain function recovery after prolonged posttraumatic coma].

PubMed

Klimash, A V; Zhanaidarov, Z S

2016-01-01

To explore the characteristics of brain function recovery in patients after prolonged posttraumatic coma and with long-unconscious states. Eighty-seven patients after prolonged posttraumatic coma were followed-up for two years. An analysis of a clinical/neurological picture after a prolonged episode of coma was based on the dynamics of vital functions, neurological status and patient's reactions to external stimuli. Based on the dynamics of the clinical/neurological picture that shows the recovery of functions of the certain brain areas, three stages of brain function recovery after a prolonged episode of coma were singled out: brain stem areas, diencephalic areas and telencephalic areas. These functional/anatomic areas of brain function recovery after prolonged coma were compared to the present classifications.

Intracranial pressure monitoring after primary decompressive craniectomy in traumatic brain injury: a clinical study.

PubMed

Picetti, Edoardo; Caspani, Maria Luisa; Iaccarino, Corrado; Pastorello, Giulia; Salsi, Pierpaolo; Viaroli, Edoardo; Servadei, Franco

2017-04-01

Intracranial pressure (ICP) monitoring represents an important tool in the management of traumatic brain injury (TBI). Although current information exists regarding ICP monitoring in secondary decompressive craniectomy (DC), little is known after primary DC following emergency hematoma evacuation. Retrospective analysis of prospectively collected data. Inclusion criteria were age ≥18 years and admission to the intensive care unit (ICU) for TBI and ICP monitoring after primary DC. Exclusion criteria were ICU length of stay (LOS) <1 day and pregnancy. Major objectives were: (1) to analyze changes in ICP/cerebral perfusion pressure (CPP) after primary DC, (2) to evaluate the relationship between ICP/CPP and neurological outcome and (3) to characterize and evaluate ICP-driven therapies after DC. A total of 34 patients were enrolled. Over 308 days of ICP/CPP monitoring, 130 days with at least one episode of intracranial hypertension (26 patients, 76.5%) and 57 days with at least one episode of CPP <60 mmHg (22 patients, 64.7%) were recorded. A statistically significant relationship was discovered between the Glasgow Outcome Scale (GOS) scores and mean post-decompression ICP (p < 0.04) and between GOS and CPP minimum (CPPmin) (p < 0.04). After DC, persisting intracranial hypertension was treated with: barbiturate coma (n = 7, 20.6%), external ventricular drain (EVD) (n = 4, 11.8%), DC diameter widening (n = 1, 2.9%) and removal of newly formed hematomas (n = 3, 8.8%). Intracranial hypertension and/or low CPP occurs frequently after primary DC; their occurence is associated with an unfavorable neurological outcome. ICP monitoring appears useful in guiding therapy after primary DC.

Accuracy of self-reported length of coma and posttraumatic amnesia in persons with medically verified traumatic brain injury.

PubMed

Sherer, Mark; Sander, Angelle M; Maestas, Kacey Little; Pastorek, Nicholas J; Nick, Todd G; Li, Jingyun

2015-04-01

To determine the accuracy of self-reported length of coma and posttraumatic amnesia (PTA) in persons with medically verified traumatic brain injury (TBI) and to investigate factors that affect self-report of length of coma and PTA duration. Prospective cohort study. Specialized rehabilitation center with inpatient and outpatient programs. Persons (N=242) with medically verified TBI who were identified from a registry of persons who had previously participated in TBI-related research. Not applicable. Self-reported length of coma and self-reported PTA duration. Review of medical records revealed that the mean medically documented length of coma and PTA duration was 6.9±12 and 19.2±22 days, respectively, and the mean self-reported length of coma and PTA duration was 16.7±22 and 106±194 days, respectively. The average discrepancy between self-report and medical record for length of coma and PTA duration was 8.2±21 and 64±176 days, respectively. Multivariable regression models revealed that time since injury, performance on cognitive tests, and medical record values were associated with self-reported values for both length of coma and PTA duration. In this investigation, persons with medically verified TBI showed poor accuracy in their self-report of length of coma and PTA duration. Discrepancies were large enough to affect injury severity classification. Caution should be exercised when considering self-report of length of coma and PTA duration. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

An unusual case of relay pentobarbital toxicosis in a dog.

PubMed

Bischoff, Karyn; Jaeger, Robin; Ebel, Joseph G

2011-09-01

Sodium pentobarbital and phenytoin are common constituents of veterinary euthanasia solutions in the United States. Relay, or secondary, barbiturate toxicosis has been reported in carnivorous animals that have fed from the carcasses of euthanized livestock. This case report presents barbiturate toxicosis in a dog. A 2-year-old female spayed Australian shepherd presented comatose 2 h after ingesting an unknown substance on the beach. The material was retrieved from the stomach by gastric lavage and visually identified as fish or other animal tissue. The dog recovered with symptomatic and supportive therapy and was released on the third day of hospitalization. Tissue found on the beach near where the dog walked and a urine sample from the dog were analyzed by gas chromatography/mass spectrometry. Both samples were positive for pentobarbital and phenytoin. The tissue was consistent with mammalian blubber based on gross and histological examination. Three weeks previously, a juvenile humpback whale had stranded on the beach where the dog had ingested the unknown substance. The whale had been euthanized with a barbiturate solution, necropsied, and removed from the beach. It was not definitively determined that the pentobarbital-containing blubber ingested by the dog was from the euthanized whale, but that was the most likely source. Although attempts were made to remove the whale's remains from the beach, practical considerations made complete removal challenging, if not impossible.

3D-QSAR Studies on Barbituric Acid Derivatives as Urease Inhibitors and the Effect of Charges on the Quality of a Model.

PubMed

Ul-Haq, Zaheer; Ashraf, Sajda; Al-Majid, Abdullah Mohammed; Barakat, Assem

2016-04-30

Urease enzyme (EC 3.5.1.5) has been determined as a virulence factor in pathogenic microorganisms that are accountable for the development of different diseases in humans and animals. In continuance of our earlier study on the helicobacter pylori urease inhibition by barbituric acid derivatives, 3D-QSAR (three dimensional quantitative structural activity relationship) advance studies were performed by Comparative Molecular Field Analysis (CoMFA) and Comparative Molecular Similarity Indices Analysis (CoMSIA) methods. Different partial charges were calculated to examine their consequences on the predictive ability of the developed models. The finest developed model for CoMFA and CoMSIA were achieved by using MMFF94 charges. The developed CoMFA model gives significant results with cross-validation (q²) value of 0.597 and correlation coefficients (r²) of 0.897. Moreover, five different fields i.e., steric, electrostatic, and hydrophobic, H-bond acceptor and H-bond donors were used to produce a CoMSIA model, with q² and r² of 0.602 and 0.98, respectively. The generated models were further validated by using an external test set. Both models display good predictive power with r²pred ≥ 0.8. The analysis of obtained CoMFA and CoMSIA contour maps provided detailed insight for the promising modification of the barbituric acid derivatives with an enhanced biological activity.

Actions of general anaesthetics on 5-HT3 receptors in N1E-115 neuroblastoma cells.

PubMed Central

Jenkins, A.; Franks, N. P.; Lieb, W. R.

1996-01-01

1. NIE-115 mouse neuroblastoma cells were studied under voltage clamp in the whole-cell patch-clamp configuration. Peak currents induced by bath application of 5-hydroxytryptamine (5-HT) were inwardly rectifying, reversed at 0.4 +/- 0.2 mV (mean +/- s.e.mean), and were approximately half-inhibited (at 1 microM 5-HT) by 2 nM of the 5-HT3 selective antagonist MDL-72222 (3-tropanyl-3,5-dichlorobenzoate). 2. Peak inward currents activated by a low concentration of 5-HT at a holding potential of -50 mV were potentiated by volatile general anaesthetics. At their human minimum alveolar concentrations (MACs), the degree of potentiation increased in the order isoflurane < halothane < enflurane < methoxyflurane. Potentiation by methoxyflurane was independent of membrane potential in the range -70 mV to +40 mV. The reversal potential was the same in the presence and absence of methoxyflurane. 3. Methoxyflurane shifted the 5-HT dose-response curve to lower 5-HT concentrations, without significantly changing the Hill coefficient or maximum response. The EC50 concentration for 5-HT decreased from 1.86 +/- 0.02 microM to 1.07 +/- 0.11 microM (means +/- s.e.mean) due to the presence of 1 MAC (270 microM) methoxyflurane. 4. In contrast to the volatile anaesthetics, the barbiturate anaesthetic, thiopentone, inhibited the 5-HT3 receptor. Hill analysis of thiopentone dose-response data gave an average IC50 = 117 +/- 8 microM thiopentone and Hill coefficient = 1.6 +/- 0.2 (means +/- s.e.mean). These parameters were not significantly different for data obtained at 5-HT concentrations above and below the control EC50 concentration for 5-HT, consistent with non-competitive inhibition. 5. The n-alcohols occupied an intermediate position between the volatile and barbiturate anaesthetics. The lower alcohols (butanol and hexanol) potentiated 5-HT responses at low alcohol concentrations but inhibited them at high concentrations. In contrast, the higher alcohols (octanol, decanol, dodecanol, tridecanol, tetradecanol and pentadecanol) produced no potentiation, but only inhibition, at all alcohol concentrations. 6. Inhibition of the 5-HT3 receptor by the n-alcohols exhibited a cutoff in potency similar to those previously found for tadpoles, luciferase enzymes and a neuronal nicotinic acetylcholine receptor channel. PMID:8730747

A Rare Case of Myxedema Coma with Neuroleptic Malignant Syndrome (NMS).

PubMed

Dixit, Siddharth; Dutta, Manoj Kumar; Namdeo, Mayank

2015-05-01

Myxedema coma or hypothyroid crisis is an endocrine emergency and needs ICU management. Neuroleptic malignant syndrome (NMS) is another medical emergency which needs high degree of clinical suspicion else mortality can be high. There is a paradox in co existence of myxedema coma and NMS. While one is hypometabolic state another is hypermetabolic state and both can be precipitated by antipsychotics use. Hypothermia and flaccidity commonly expected in myxedema coma may mask fever and rigidity of classical NMS contributing to diagnostic problem and treatment delay. Scientific literature on coexistance of myxedema coma and NMS is sparse. We hereby report first case with coexisting myxedema coma and NMS in a patient of schizophrenia treated with antipsychotic, where classical symptoms of NMS were masked by myxedema coma. Prompt diagnosis and effective management by a team resulted in favourable outcome in our patient. This case is reported to alert intensive care physicians to atypical manifestations of NMS in presence of hypothyroidism.

A Rare Case of Myxedema Coma with Neuroleptic Malignant Syndrome (NMS)

PubMed Central

Dutta, Manoj Kumar; Namdeo, Mayank

2015-01-01

Myxedema coma or hypothyroid crisis is an endocrine emergency and needs ICU management. Neuroleptic malignant syndrome (NMS) is another medical emergency which needs high degree of clinical suspicion else mortality can be high. There is a paradox in co existence of myxedema coma and NMS. While one is hypometabolic state another is hypermetabolic state and both can be precipitated by antipsychotics use. Hypothermia and flaccidity commonly expected in myxedema coma may mask fever and rigidity of classical NMS contributing to diagnostic problem and treatment delay. Scientific literature on coexistance of myxedema coma and NMS is sparse. We hereby report first case with coexisting myxedema coma and NMS in a patient of schizophrenia treated with antipsychotic, where classical symptoms of NMS were masked by myxedema coma. Prompt diagnosis and effective management by a team resulted in favourable outcome in our patient. This case is reported to alert intensive care physicians to atypical manifestations of NMS in presence of hypothyroidism. PMID:26155541

Monte Carlo Particle Trajectory Models for Neutral Cometary Gases. II. The Spatial Morphology of the Lyman-Alpha Coma

NASA Astrophysics Data System (ADS)

Combi, Michael R.; Smyth, William H.

1988-04-01

The Monte Carlo particle-trajectory model (MCPTM) developed in Paper 1 is applied to explain the observed morphology of the spatially extended Lyα comae of comets. The physical processes and assumptions used in the model as they relate to the photodissociation of H2O and OH and the solar radiation pressure acceleration are presented herein. For this first application, the rocket and Skylab images of the Lyα coma of comet Kohoutek were chosen for study. The self-consistent modeling analysis of these data consisted of two parts. The first part entailed using a steady state spherically symmetric inner coma MCPTM coupled with a simple gas-dynamic model to calculate the physical development of the coma, i.e., the dependence of coma temperature and outflow speed on radial distance to the center of the nucleus, as a function of the (time) heliocentric distance of the comet. The inner coma MCPTM was used to calculate correctly the photo-chemical heating of the coma due to the partial collisional thermalization of the hot hydrogen atoms produced in the photodissociation of water molecules. In the second part of the analysis the results from the first part were used in a fully time-dependent and three-dimensional extended coma MCPTM which includes the explicit calculation of partial thermalization of the H atoms by multiple collisions with coma molecules. The same physical model yielded very good matches between the modeled Lycα isophotes and those observed in both of the two very different images of comet Kohoutek. The production rate was varied in time as implied by the shape of the visual light curve. All other physical parameters were varied only according to their naturally expected heliocentric distance and velocity dependencies. The complete physical description of the inner coma provided by the coupled gas-dynamic/MCPTM calculation was needed to obtain a good fit to the data. The correct inner coma description is important since it provides not only the initial conditions for the photodissociated H atoms but also (and most importantly) the collisional targets for the H atoms produced in the innermost regions of the coma. Simplistic descriptions for the coma (single speed and perfectly radial molecular motion) do not yield realistic isophote contours. The implications of the model results as they apply to other comets, species, and a variety of conditions are also discussed.

The role of regional nerve block anesthesia for carotid endarterectomy: an experimental comparison with previous series with the use of general anesthesia and barbiturates for cerebral protection.

PubMed

Agrifoglio, G; Agus, G B; Bonalumi, F; Costantini, A; Carlesi, R

1987-01-01

A retrospective analysis was performed on a consecutive series of 60 cases divided into two groups given carotid endarterectomy (C.E.) for atherosclerotic disease. In the first group general anesthesia and barbiturate cerebral protection were employed; in group two, loco-regional anesthesia. Indications and risk factors were similar in the two groups; the surgical procedure was identical. The differences in the results are reported and factors contributing to cerebral protection or reduction in the risk of stroke are analyzed. The analysis indicates that loco-regional anesthesia for C.E. is a reliable method for detecting cerebral ischemia and guaranteeing cerebral protection by means of a temporary shunt when strictly necessary.

Robust control of burst suppression for medical coma

NASA Astrophysics Data System (ADS)

Westover, M. Brandon; Kim, Seong-Eun; Ching, ShiNung; Purdon, Patrick L.; Brown, Emery N.

2015-08-01

Objective. Medical coma is an anesthetic-induced state of brain inactivation, manifest in the electroencephalogram by burst suppression. Feedback control can be used to regulate burst suppression, however, previous designs have not been robust. Robust control design is critical under real-world operating conditions, subject to substantial pharmacokinetic and pharmacodynamic parameter uncertainty and unpredictable external disturbances. We sought to develop a robust closed-loop anesthesia delivery (CLAD) system to control medical coma. Approach. We developed a robust CLAD system to control the burst suppression probability (BSP). We developed a novel BSP tracking algorithm based on realistic models of propofol pharmacokinetics and pharmacodynamics. We also developed a practical method for estimating patient-specific pharmacodynamics parameters. Finally, we synthesized a robust proportional integral controller. Using a factorial design spanning patient age, mass, height, and gender, we tested whether the system performed within clinically acceptable limits. Throughout all experiments we subjected the system to disturbances, simulating treatment of refractory status epilepticus in a real-world intensive care unit environment. Main results. In 5400 simulations, CLAD behavior remained within specifications. Transient behavior after a step in target BSP from 0.2 to 0.8 exhibited a rise time (the median (min, max)) of 1.4 [1.1, 1.9] min; settling time, 7.8 [4.2, 9.0] min; and percent overshoot of 9.6 [2.3, 10.8]%. Under steady state conditions the CLAD system exhibited a median error of 0.1 [-0.5, 0.9]%; inaccuracy of 1.8 [0.9, 3.4]%; oscillation index of 1.8 [0.9, 3.4]%; and maximum instantaneous propofol dose of 4.3 [2.1, 10.5] mg kg-1. The maximum hourly propofol dose was 4.3 [2.1, 10.3] mg kg-1 h-1. Performance fell within clinically acceptable limits for all measures. Significance. A CLAD system designed using robust control theory achieves clinically acceptable performance in the presence of realistic unmodeled disturbances and in spite of realistic model uncertainty, while maintaining infusion rates within acceptable safety limits.

Robust control of burst suppression for medical coma

PubMed Central

Westover, M Brandon; Kim, Seong-Eun; Ching, ShiNung; Purdon, Patrick L; Brown, Emery N

2015-01-01

Objective Medical coma is an anesthetic-induced state of brain inactivation, manifest in the electroencephalogram by burst suppression. Feedback control can be used to regulate burst suppression, however, previous designs have not been robust. Robust control design is critical under real-world operating conditions, subject to substantial pharmacokinetic and pharmacodynamic parameter uncertainty and unpredictable external disturbances. We sought to develop a robust closed-loop anesthesia delivery (CLAD) system to control medical coma. Approach We developed a robust CLAD system to control the burst suppression probability (BSP). We developed a novel BSP tracking algorithm based on realistic models of propofol pharmacokinetics and pharmacodynamics. We also developed a practical method for estimating patient-specific pharmacodynamics parameters. Finally, we synthesized a robust proportional integral controller. Using a factorial design spanning patient age, mass, height, and gender, we tested whether the system performed within clinically acceptable limits. Throughout all experiments we subjected the system to disturbances, simulating treatment of refractory status epilepticus in a real-world intensive care unit environment. Main results In 5400 simulations, CLAD behavior remained within specifications. Transient behavior after a step in target BSP from 0.2 to 0.8 exhibited a rise time (the median (min, max)) of 1.4 [1.1, 1.9] min; settling time, 7.8 [4.2, 9.0] min; and percent overshoot of 9.6 [2.3, 10.8]%. Under steady state conditions the CLAD system exhibited a median error of 0.1 [−0.5, 0.9]%; inaccuracy of 1.8 [0.9, 3.4]%; oscillation index of 1.8 [0.9, 3.4]%; and maximum instantaneous propofol dose of 4.3 [2.1, 10.5] mg kg−1. The maximum hourly propofol dose was 4.3 [2.1, 10.3] mg kg−1 h−1. Performance fell within clinically acceptable limits for all measures. Significance A CLAD system designed using robust control theory achieves clinically acceptable performance in the presence of realistic unmodeled disturbances and in spite of realistic model uncertainty, while maintaining infusion rates within acceptable safety limits. PMID:26020243

Particle Sizes in the Coma of Comet 45P/Honda-Mrkos-Pajdušáková from Arecibo Radar Observations

NASA Astrophysics Data System (ADS)

Springmann, Alessondra; Howell, Ellen S.; Harmon, John K.; Lejoly, Cassandra; Rivera-Valentin, Edgard G.; Virkki, Anne; Zambrano-Marin, Luisa F.; Taylor, Patrick A.; Harris, Walter M.; Mueller, Beatrice E. A.; Samarasinha, Nalin H.; Rodriguez Sanchez-Vahamonde, Carolina

2017-10-01

Radar observations of cometary comae can provide information about not only the cross-section of the coma, but also constraints on the particle sizes comprising the coma. Harmon et al. (2011) described analysis of radar observations of comet 103P/Hartley 2 to constrain the sizes of its coma particles, as well as modeling to analyze the particle velocity distribution in the coma and orientation with respect to the sun. Arecibo Observatory planetary radar system observations of comet 45P/Honda-Mrkos-Pajdušáková were obtained 9-16 February 2017 by transmitting a continuous wave of polarized radio waves at the comet. By examining the polarization ratios of the returned signal (whether it has the same sense or opposite sense of the transmitted signal), we can look for non-zero same sense polarization signal. Detectable same sense signal indicates the presence of particles with sizes larger than the Rayleigh transition size criteria, a = λ/2π ≈ 2 cm (for the Arecibo wavelength of 12.6 cm).The observations show strong opposite sense signal return from the comet nucleus, as well as a larger ‘skirt’ of surrounding grains in the coma. Preliminary analysis of this data indicates at least a weak same sense polarized signal, implying a population of grains larger than 2 cm in the coma. The sizes of particles in the coma, compared with the area of the coma, can help us constrain the minimum mass for particles at the Rayleigh size limit in the 45P coma. Further, a detectable grain halo of large particles around 45P would imply significant lofting of grains from the comet nucleus.ReferencesHarmon, John K., et al. "Radar observations of comet 103P/Hartley 2." The Astrophysical Journal Letters 734.1 (2011): L2.

Assessment of refractive astigmatism and simulated therapeutic refractive surgery strategies in coma-like-aberrations-dominant corneal optics.

PubMed

Zhou, Wen; Stojanovic, Aleksandar; Utheim, Tor Paaske

2016-01-01

The aim of the study is to raise the awareness of the influence of coma-like higher-order aberrations (HOAs) on power and orientation of refractive astigmatism (RA) and to explore how to account for that influence in the planning of topography-guided refractive surgery in eyes with coma-like-aberrations-dominant corneal optics. Eleven eyes with coma-like-aberrations-dominant corneal optics and with low lenticular astigmatism (LA) were selected for astigmatism analysis and for treatment simulations with topography-guided custom ablation. Vector analysis was used to evaluate the contribution of coma-like corneal HOAs to RA. Two different strategies were used for simulated treatments aiming to regularize irregular corneal optics: With both strategies correction of anterior corneal surface irregularities (corneal HOAs) were intended. Correction of total corneal astigmatism (TCA) and RA was intended as well with strategies 1 and 2, respectively. Axis of discrepant astigmatism (RA minus TCA minus LA) correlated strongly with axis of coma. Vertical coma influenced RA by canceling the effect of the with-the-rule astigmatism and increasing the effect of the against-the-rule astigmatism. After simulated correction of anterior corneal HOAs along with TCA and RA (strategies 1 and 2), only a small amount of anterior corneal astigmatism (ACA) and no TCA remained after strategy 1, while considerable amount of ACA and TCA remained after strategy 2. Coma-like corneal aberrations seem to contribute a considerable astigmatic component to RA in eyes with coma-like-aberrations dominant corneal optics. If topography-guided ablation is programmed to correct the corneal HOAs and RA, the astigmatic component caused by the coma-like corneal HOAs will be treated twice and will result in induced astigmatism. Disregarding RA and treating TCA along with the corneal HOAs is recommended instead.

Observational data needs useful for modeling the coma

NASA Technical Reports Server (NTRS)

Huebner, W. F.; Giguere, P. T.

1981-01-01

A computer model of comet comae is described; results from assumed composition of frozen gases are summarized and compared to coma observations. Restrictions on relative abundance of some frozen constituents are illustrated. Modeling, when tightly coupled to observational data, can be important for comprehensive analysis of observations, for predicting undetected molecular species and for improved understanding of coma and nucleus. To accomplish this, total gas production rates and relative elemental abundances of H:C:N:O:S are needed as a function of heliocentric distance of the comet. Also needed are relative column densitites and column density profiles with well defined diaphragm range and pointing position on the coma. Production rates are less desirable since they are model dependent. Total number (or upper limits) of molecules in the coma and analysis of unidentified spectral lines are needed also.

Influence of coma aberration on aperture averaged scintillations in oceanic turbulence

NASA Astrophysics Data System (ADS)

Luo, Yujuan; Ji, Xiaoling; Yu, Hong

2018-01-01

The influence of coma aberration on aperture averaged scintillations in oceanic turbulence is studied in detail by using the numerical simulation method. In general, in weak oceanic turbulence, the aperture averaged scintillation can be effectively suppressed by means of the coma aberration, and the aperture averaged scintillation decreases as the coma aberration coefficient increases. However, in moderate and strong oceanic turbulence the influence of coma aberration on aperture averaged scintillations can be ignored. In addition, the aperture averaged scintillation dominated by salinity-induced turbulence is larger than that dominated by temperature-induced turbulence. In particular, it is shown that for coma-aberrated Gaussian beams, the behavior of aperture averaged scintillation index is quite different from the behavior of point scintillation index, and the aperture averaged scintillation index is more suitable for characterizing scintillations in practice.

Successful management of drug-induced hypercapnic acidosis with naloxone and noninvasive positive pressure ventilation.

PubMed

Agrafiotis, Michalis; Tryfon, Stavros; Siopi, Demetra; Chassapidou, Georgia; Galanou, Artemis; Tsara, Venetia

2015-02-01

A 74-year-old man was referred to our hospital due to deteriorating level of consciousness and desaturation. His Glasgow Coma Scale was 6, and his pupils were constricted but responded to light. Chest radiograph was negative for significant findings. Arterial blood gas evaluation on supplemental oxygen revealed severe acute on chronic respiratory acidosis: pH 7.15; PCO2, 133 mm Hg; PO2,64 mm Hg; and HCO3, 31 mmol/L. He regained full consciousness (Glasgow Coma Scale, 15) after receiving a 0.4 mg dose of naloxone, but because of persistent severe respiratory acidosis (pH 7.21; PCO2, 105 mm Hg), he was immediately commenced on noninvasive positive pressure ventilation (NIV) displaying a remarkable improvement in arterial blood gas values within the next few hours. However, in the days that followed, he remained dependent on NIV, and he was finally discharged on a home mechanical ventilation prescription. In cases of drug-induced respiratory depression, NIV should be regarded as an acceptable treatment, as it can provide ventilatory support without the increased risks associated with invasive mechanical ventilation.

VizieR Online Data Catalog: HST/ACS Coma Cluster Survey. VI. (den Brok+, 2011)

NASA Astrophysics Data System (ADS)

den Brok, M.; Peletier, R. F.; Valentijn, E. A.; Balcells, M.; Carter, D.; Erwin, P.; Ferguson, H. C.; Goudfrooij, P.; Graham, A. W.; Hammer, D.; Lucey, J. R.; Trentham, N.; Guzman, R.; Hoyos, C.; Verdoes Kleijn, G.; Jogee, S.; Karick, A. M.; Marinova, I.; Mouhcine, M.; Weinzirl, T.

2018-01-01

We have used the data from the HST/ACS Coma Cluster Survey, a deep two-passband imaging survey of the Coma cluster. A full description of the observations and data reduction can be found in Paper I (Carter et al., 2008ApJS..176..424C). We have derived colour gradients for a sample of confirmed or very likely Coma cluster members. (2 data files).

[The diagnosis and treatment of myxedema coma].

PubMed

Aoki, Chie; Kasai, Kikuo

2012-11-01

Myxedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to dysfunction in multiple organs. It is very rare disease with high mortality rate. Early recognition and therapy of myxedema coma are essential, and treatment should be begun on the basis of clinical suspection. However, regimen of myxedema is not well established even now, especially about thyroid hormone supplementation. Japan Thyroid Association is drawing up "The diagnostic criteria of myxedema coma (3rd draft) and preliminary guide to treatment of it". According to this criteria and preliminary guide, the clinical presentation, diagnosis, and treatment of myxedema coma will be reviewed here.

Identifying Drugs

MedlinePlus

... Phencyclidine) Peyote and Mescaline Psilocybin Rohypnol Salvia Divinorum Spice/ K2, Synthetic Marijuana Steroids U-47700 Amphetamines Barbiturates ... Phencyclidine) Peyote and Mescaline Psilocybin Rohypnol Salvia Divinorum Spice/ K2, Synthetic Marijuana Steroids U-47700 Aerosol cans ...

Development and Preliminary Validation of the Coma Arousal Communication Scale.

PubMed

Garin, Julie; Reina, Margot; DeiCas, Paula; Rousseaux, Marc

To develop a Coma Arousal Communication Scale and perform preliminary validation. A group of experts developed a questionnaire to assess communication between patients emerging from coma and caregiver (participation, communication modes, and themes) and the strategies used to facilitate communication. To assess the scale's psychometric characteristics, it was presented to the caregivers of 40 inpatients admitted to 5 coma units and (to obtain reference data) to 29 control participants. The Coma Arousal Communication Scale displayed good intra- and interrater reliability as judged by intraclass correlation coefficients (between 0.76 and 0.98) and Bland and Altman plots. Cohen κ coefficient revealed moderate to almost perfect levels of agreement for most individual items and slight levels for a few items dealing with compensatory strategies. We observed good internal consistency, relations with the Wessex Head Injury Matrix, and sensitivity to change for patients who had sustained brain injury in the previous 6 months. The Coma Arousal Communication Scale provides accurate information about communication skills of individuals emerging from coma. However, some compensatory strategies adopted by caregivers are difficult to characterize.

The relation between persistent coma and brain ischemia after severe brain injury.

PubMed

Cheng, Quan; Jiang, Bing; Xi, Jian; Li, Zhen Yan; Liu, Jin Fang; Wang, Jun Yu

2013-12-01

To investigate the relation between brain ischemia and persistent vegetative state after severe traumatic brain injury. The 66 patients with severe brain injury were divided into two groups: The persistent coma group (coma duration ≥10 d) included 51 patients who had an admission Glasgow Coma Scale (GCS) of 5-8 and were unconscious for more than 10 d. There were 15 patients in the control group, their admission GCS was 5-8, and were unconscious for less than 10 d. The brain areas, including frontal, parietal, temporal, occipital lobes and thalamus, were measured by Single Photon Emission Computed Tomography (SPECT). In the first SPECT scan, multiple areas of cerebral ischemia were documented in all patients in both groups, whereas bilateral thalamic ischemia were presented in all patients in the persistent coma group and were absented in the control group. In the second SPECT scan taken during the period of analepsia, with an indication that unilateral thalamic ischemia were persisted in 28 of 41 patients in persistent coma group(28/41,68.29%). Persistent coma after severe brain injury is associated with bilateral thalamic ischemia.

Coma measurement by transmission image sensor with a PSM

NASA Astrophysics Data System (ADS)

Wang, Fan; Wang, Xiangzhao; Ma, Mingying; Zhang, Dongqing; Shi, Weijie; Hu, Jianming

2005-01-01

As feature size decreases, especially with the use of resolution enhancement technique such as off axis illumination and phase shifting mask, fast and accurate in-situ measurement of coma has become very important in improving the performance of modern lithographic tools. The measurement of coma can be achieved by the transmission image sensor, which is an aerial image measurement device. The coma can be determined by measuring the positions of the aerial image at multiple illumination settings. In the present paper, we improve the measurement accuracy of the above technique with an alternating phase shifting mask. Using the scalar diffraction theory, we analyze the effect of coma on the aerial image. To analyze the effect of the alternating phase shifting mask, we compare the pupil filling of the mark used in the above technique with that of the phase-shifted mark used in the new technique. We calculate the coma-induced image displacements of the marks at multiple partial coherence and NA settings, using the PROLITH simulation program. The simulation results show that the accuracy of coma measurement can increase approximately 20 percent using the alternating phase shifting mask.

Myxoedema coma presenting in status epilepticus.

PubMed Central

Woods, K. L.; Holmes, G. K.

1977-01-01

A 71-year-old woman with myxoedema coma presenting in status epilepticus is reported. Although this complication of myxoedema coma is considered to be fatal the patient described responded dramatically to treatment and remains in good health. PMID:876913

Anions in Cometary Comae

NASA Technical Reports Server (NTRS)

Charnley, Steven B.

2011-01-01

The presence of negative ions (anions) in cometary comae is known from Giotto mass spectrometry of IP/Halley. The anions 0-, OH-, C-, CH- and CN- have been detected, as well as unidentified anions with masses 22-65 and 85-110 amu (Chaizy et al. 1991). Organic molecular anions are known to have a significant impact on the charge balance of interstellar clouds and circumstellar envelopes and have been shown to act as catalysts for the gas-phase synthesis of larger hydrocarbon molecules in the ISM, but their importance in cometary comae has not yet been explored. We present details of the first attempt to model the chemistry of anions in cometary comae. Based on the combined chemical and hydro dynamical model of Rodgers & Charnley (2002), we investigate the role of large carbon-chain anions in cometary coma chemistry. We calculate the effects of these anions on coma thermodynamics, charge balance and examine their impact on molecule formation.

Gas Dynamics and Kinetics in the Cometary Coma: Theory and Observations

NASA Technical Reports Server (NTRS)

Combi, Michael R.; Harris, Walter M.; Smyth, William H.

2005-01-01

Our ability to describe the physical state of the expanding coma affects fundamental areas of cometary study both directly and indirectly. In order to convert measured abundances of gas species in the coma to gas production rates, models for the distribution and kinematics of gas species in the coma are required. Conversely, many different types of observations, together with laboratory data and theory, are still required to determine coma model attributes and parameters. Accurate relative and absolute gas production rates and their variations with time and from comet to comet are crucial to our basic understanding of the composition and structure of cometary nuclei and their place in the solar system. We review the gas dynamics and kinetics of cometary comae from both theoretical and observational perspectives, which are important for understanding the wide variety of physical conditions that are encountered.

Bibliography [On Drugs].

ERIC Educational Resources Information Center

National Association of Student Personnel Administrators, Detroit, MI.

A bibliography of materials on drugs is presented. The book and paper back entries are annotated. Selected technical references are listed under these major findings: (1) dependency, (2) barbiturates, (3) amphetamines, and (4) general pharmacology. (PS)

41 CFR Appendix to Part 102 - 74-Rules and Regulations Governing Conduct on Federal Property

Code of Federal Regulations, 2012 CFR

2012-01-01

... from— (a) Being under the influence, using or possessing any narcotic drugs, hallucinogens, marijuana... alcoholic beverages, narcotic drugs, hallucinogens, marijuana, barbiturates, or amphetamines. Alcoholic...

41 CFR Appendix to Part 102 - 74-Rules and Regulations Governing Conduct on Federal Property

Code of Federal Regulations, 2010 CFR

2010-07-01

... from— (a) Being under the influence, using or possessing any narcotic drugs, hallucinogens, marijuana... alcoholic beverages, narcotic drugs, hallucinogens, marijuana, barbiturates, or amphetamines. Alcoholic...

41 CFR Appendix to Part 102 - 74-Rules and Regulations Governing Conduct on Federal Property

Code of Federal Regulations, 2014 CFR

2014-01-01

... from— (a) Being under the influence, using or possessing any narcotic drugs, hallucinogens, marijuana... alcoholic beverages, narcotic drugs, hallucinogens, marijuana, barbiturates, or amphetamines. Alcoholic...

41 CFR Appendix to Part 102 - 74-Rules and Regulations Governing Conduct on Federal Property

Code of Federal Regulations, 2013 CFR

2013-07-01

... from— (a) Being under the influence, using or possessing any narcotic drugs, hallucinogens, marijuana... alcoholic beverages, narcotic drugs, hallucinogens, marijuana, barbiturates, or amphetamines. Alcoholic...

41 CFR Appendix to Part 102 - 74-Rules and Regulations Governing Conduct on Federal Property

Code of Federal Regulations, 2011 CFR

2011-01-01

... from— (a) Being under the influence, using or possessing any narcotic drugs, hallucinogens, marijuana... alcoholic beverages, narcotic drugs, hallucinogens, marijuana, barbiturates, or amphetamines. Alcoholic...

Analysis of Risk Factors for Hypoglycemic Coma in 194 Patients with Type 2 Diabetes

PubMed Central

Lu, Zefen; Liu, Jianfeng; He, Qing; Chakraborty, Anindita; Zhu, Tiehong

2017-01-01

Background The present study was conducted to analyze possible risk factors in patients with type 2 diabetes who are in hypoglycemic coma. Material/Methods A total of 194 patients with type 2 diabetic hypoglycemic coma who were admitted to our hospital between January 2010 and January 2016 were included. The patients were all in coma on admission, and their blood glucose levels were lower than 2.8 mmol/L. None of the patients had type I diabetes, specific types of diabetes, or gestational diabetes. Multiple linear regression analysis was used to determine possible factors associated with hypoglycemic coma. Results Among the patients, 82 were male and 112 were female (mean age, 66.88±10.62 years). In addition, 72 patients lived in urban areas and 122 lived in rural areas. Occurrence of hypoglycemic coma was correlated with difference between urban and rural residence, glycosylated hemoglobin (HbA1c) level, combined hypertension, and combined neural complications. Self-purchased drugs resulted in significantly lower blood glucose level at the onset of hypoglycemic coma than insulin, secretagogue, or non-secretagogue drugs. Blood glucose level at onset was correlated with season. Patients living in rural areas or with combined macrovascular or microvascular complications had prolonged hospital stay and poor prognosis. Conclusions Our results demonstrate that rural residence, higher HbA1c level, combined hypertension, and combined neural complications increase the incidence of hypoglycemic coma. Use of self-purchased drugs and colder seasons may result in lower blood glucose levels in patients with hypoglycemic coma. PMID:29180613

The Complex Outgassing of Comets and the Resulting Coma, a Direct Simulation Monte-Carlo Approach

NASA Astrophysics Data System (ADS)

Fougere, Nicolas

During its journey, when a comet gets within a few astronomical units of the Sun, solar heating liberates gases and dust from its icy nucleus forming a rarefied cometary atmosphere, the so-called coma. This tenuous atmosphere can expand to distances up to millions of kilometers representing orders of magnitude larger than the nucleus size. Most of the practical cases of coma studies involve the consideration of rarefied gas flows under non-LTE conditions where the hydrodynamics approach is not valid. Then, the use of kinetic methods is required to properly study the physics of the cometary coma. The Direct Simulation Monte-Carlo (DSMC) method is the method of choice to solve the Boltzmann equation, giving the opportunity to study the cometary atmosphere from the inner coma where collisions dominate and is in thermodynamic equilibrium to the outer coma where densities are lower and free flow conditions are verified. While previous studies of the coma used direct sublimation from the nucleus for spherically symmetric 1D models, or 2D models with a day/night asymmetry, recent observations of comets showed the existence of local small source areas such as jets, and extended sources via sublimating icy grains, that must be included into cometary models for a realistic representation of the physics of the coma. In this work, we present, for the first time, 1D, 2D, and 3D models that can take into account the full effects of conditions with more complex sources of gas with jets and/or icy grains. Moreover, an innovative work in a full 3D description of the cometary coma using a kinetic method with a realistic nucleus and outgassing is demonstrated. While most of the physical models used in this study had already been developed, they are included in one self-consistent coma model for the first time. The inclusion of complex cometary outgassing processes represents the state-of-the-art of cometary coma modeling. This provides invaluable information about the coma by refining the understanding of the material that constitutes comets. This helps us to comprehend the process of the Solar System formation, one of the top priority questions in the 2013-2022 Planetary Science Decadal survey.

[Myxedema coma].

PubMed

Rizzo, Leonardo F L; Mana, Daniela L; Bruno, Oscar D; Wartofsky, Leonard

2017-01-01

Hypothyroidism is a frequently diagnosed and simply treated disease. If not recognised, however, in time it may develop into the most severe manifestation of hypothyroidism known as myxedema coma. The term "myxedema coma" is generally seen as misleading since most patients do not initially present in a coma. The typical progression is lethargy evolving into stupor and, eventually, into coma with respiratory failure and hypothermia. It mainly affects elderly women, often occurring in winter and is relatively rare. It can be considered a form of decompensated hypothyroidism often triggered by a variety of non-thyroid conditions or diseases provoking an extremely severe condition of multiple system failure with lethal consequences unless an early diagnosis is made and an aggressive treatment is administered.

Influence of chronic barbiturate administration on sleep apnea after hypersomnia presentation: case study.

PubMed Central

Takhar, J; Bishop, J

2000-01-01

When sleepiness is excessive, undesirable, inappropriate or unexplained, it often indicates a clinical disorder that is generically termed hypersomnia. One of the leading causes of hypersomnia is sleep apnea. We present the case of a 44-year-old woman with a history of bipolar spectrum disorder and epilepsy who initially showed evidence of hypersomnia. The hypersomnia settled with changes to her medication, but the patient was subsequently found to have severe obstructive sleep apnea. The relation between the patient's medication and sleep apnea is discussed, and the possible respiratory-suppressant effects of chronic barbiturate treatment are considered. The role of other evoking factors within the context of this case and the mechanisms by which drug interactions and psychotropic treatment may worsen, obscure or perpetuate sleep apnea are also examined. PMID:11022396

Nuclear medicine technology progress report for quarter ending September 30, 1980

DOE Office of Scientific and Technical Information (OSTI.GOV)

Knapp, F.F. Jr.

1981-03-01

Brain uptake of several /sup 75/Se- and /sup 123m/Te-labelled barbiturates is being studied. These new agents, substituted at the C-5 position, freely pass through the intact blood-brain barrier. Barbiturates labelled with gamma-emitting radionuclides may be an attractive new class of agents for measurement of regional cerebral blood flow. The diffusion chamber assay system has been used to assess the chronic effects of As/sub 2/O/sub 3/ toxicity. A small osmotically actuated minipump was used to deliver aqueous As/sub 2/O/sub 3/ at a continuous delivery rate to animals having intraperitoneally implanted diffusion chambers containing human lung cells (Flow 200). In these preliminarymore » studies, a 49 to 53% inhibition of cell growth was observed over a five-day period when animals received As/sub 2/O/sub 3/ at a dose of 1.7 to 2 mg (kg-d). These initial studies suggest that the minipump may be a useful means of studying the chronic effects of substances on cell proliferation in conjunction with the diffusion chamber assay system. A microscale synthesis of gold antirheumatoid agents was developed. This method involves reaction of thiohexose derivatives such as thioglucosetetraacetate (..beta..-D-TGTA) with trialkylphosphinegold halide intermediates (R/sub 3/PAu-Cl) in the presence of pyridine to give the coupling products R/sub 3/PAu(..beta..-D-TGTA) in good yield (>75%). Using this method, the triethyl analog Et/sub 3/PAu(..beta..-D-TGTA) and triphenyl analog (phi/sub 3/PAu(..beta..-D-TGTA)) have been prepared and characterized.This method will be used to prepare the /sup 195/Au-labeled agents. The platinum antitumor agent cis-dichloro-trans-dihydroxy-bis-(isopropylamine)-platinum (IV) (CHIP) has been purified. This system is efficient for separation of CHIP from impurities produced during the synthetic sequence and will be used to prepare /sup 195m/Pt-CHIP for biological evaluation. (ERB)« less

Coma Associated with Microscopy-Diagnosed Plasmodium vivax: A Prospective Study in Papua, Indonesia

PubMed Central

Hardianto, Setiawan O.; Tjitra, Emiliana; Kenangalem, Enny; Sugiarto, Paulus; Price, Ric N.; Anstey, Nicholas M.

2011-01-01

Background Coma complicates Plasmodium falciparum infection but is uncommonly associated with P. vivax. Most series of vivax coma have been retrospective and have not utilized molecular methods to exclude mixed infections with P. falciparum. Methods We prospectively enrolled patients hospitalized in Timika, Indonesia, with a Glasgow Coma Score (GCS) ≤10 and P. vivax monoinfection on initial microscopy over a four year period. Hematological, biochemical, serological, radiological and cerebrospinal fluid (CSF) examinations were performed to identify other causes of coma. Repeat microscopy, antigen detection and polymerase chain reaction (PCR) were performed to exclude infections with other Plasmodium species. Results Of 24 patients fulfilling enrolment criteria, 5 had clear evidence for other non-malarial etiologies. PCR demonstrated 10 mixed infections and 3 P. falciparum monoinfections. 6 (25%) patients had vivax monoinfection and no apparent alternative cause, with a median GCS of 9 (range 8–10) and a median coma duration of 42 (range 36–48) hours. CSF leukocyte counts were <10/ul (n = 3); 2 of the 3 patients without CSF examination recovered with antimalarial therapy alone. One patient had a tremor on discharge consistent with a post-malarial neurological syndrome. No patient had other organ dysfunction. The only death was associated with pure P. falciparum infection by PCR. Vivax monoinfection-associated risk of coma was estimated at 1 in 29,486 clinical vivax infections with no deaths. In comparison, the risk of falciparum-associated coma was estimated at 1 in 1,276 clinical infections with an 18.5% mortality rate. Conclusions P. vivax-associated coma is rare, occurring 23 times less frequently than that seen with falciparum malaria, and is associated with a high proportion of non-malarial causes and mixed infections using PCR. The pathogenesis of coma associated with vivax malaria, particularly the role of comorbidities, is uncertain and requires further investigation. PMID:21666785

Which EEG patterns in coma are nonconvulsive status epilepticus?

PubMed

Trinka, Eugen; Leitinger, Markus

2015-08-01

Nonconvulsive status epilepticus (NCSE) is common in patients with coma with a prevalence between 5% and 48%. Patients in deep coma may exhibit epileptiform EEG patterns, such as generalized periodic spikes, and there is an ongoing debate about the relationship of these patterns and NCSE. The purposes of this review are (i) to discuss the various EEG patterns found in coma, its fluctuations, and transitions and (ii) to propose modified criteria for NCSE in coma. Classical coma patterns such as diffuse polymorphic delta activity, spindle coma, alpha/theta coma, low output voltage, or burst suppression do not reflect NCSE. Any ictal patterns with a typical spatiotemporal evolution or epileptiform discharges faster than 2.5 Hz in a comatose patient reflect nonconvulsive seizures or NCSE and should be treated. Generalized periodic diacharges or lateralized periodic discharges (GPDs/LPDs) with a frequency of less than 2.5 Hz or rhythmic discharges (RDs) faster than 0.5 Hz are the borderland of NCSE in coma. In these cases, at least one of the additional criteria is needed to diagnose NCSE (a) subtle clinical ictal phenomena, (b) typical spatiotemporal evolution, or (c) response to antiepileptic drug treatment. There is currently no consensus about how long these patterns must be present to qualify for NCSE, and the distinction from nonconvulsive seizures in patients with critical illness or in comatose patients seems arbitrary. The Salzburg Consensus Criteria for NCSE [1] have been modified according to the Standardized Terminology of the American Clinical Neurophysiology Society [2] and validated in three different cohorts, with a sensitivity of 97.2%, a specificity of 95.9%, and a diagnostic accuracy of 96.3% in patients with clinical signs of NCSE. Their diagnostic utility in different cohorts with patients in deep coma has to be studied in the future. This article is part of a Special Issue entitled "Status Epilepticus". Copyright © 2015. Published by Elsevier Inc.

The child in coma

NASA Technical Reports Server (NTRS)

Lewinn, E. B.

1978-01-01

Children in coma continue to pose medical, social, economic, ethical, moral, and legal problems. Modern life-support technology has aggravated these problems. Coma is viewed as a pathological state of unconsciousness from which the patient has not achieved arousal, and which calls for vigorous action to help him regain consciousness. There are two variables that have an especially important bearing on the ability to achieve arousal. These are: the character of the brain injury that caused the coma, and environmental factors that affect the patient after the injury.

[Evaluation of prognosis in purulent meningitis-myelitis based on the Glasgow Coma Scale].

PubMed

Garlicki, A; Caban, J; Bociaga, M; Krukowiecki, J; Warunek, W; Skwara, P

1996-01-01

We presented data from the investigation of the usefulness of the Glasgow Coma Scale in predicting the outcome of bacterial meningitis. Patients who aggregated high Glasgow Coma Scale scores had a good prognosis, whereas those patients with low scores had a very poor prognosis, inspite of this limitation the Glasgow Coma Scale seems to be a valuable supplement to the physical examination of patients with bacterial meningitis and may help in predicting the outcome of the disease.

Initial Diagnosis and Management of Coma.

PubMed

Traub, Stephen J; Wijdicks, Eelco F

2016-11-01

Coma represents a true medical emergency. Drug intoxications are a leading cause of coma; however, other metabolic disturbances and traumatic brain injury are also common causes. The general emergency department approach begins with stabilization of airway, breathing, and circulation, followed by a thorough physical examination to generate a limited differential diagnosis that is then refined by focused testing. Definitive treatment is ultimately disease-specific. This article presents an overview of the pathophysiology, causes, examination, and treatment of coma. Copyright © 2016 Elsevier Inc. All rights reserved.

Neuroanatomical Predictors of Awakening in Acutely Comatose Patients

PubMed Central

Kowalski, Robert G.; Buitrago, Manuel M.; Duckworth, Josh; Chonka, Zachary D.; Puttgen, H. Adrian; Stevens, Robert D.; Geocadin, Romergryko G.

2016-01-01

Objective Lateral brain displacement has been associated with loss of consciousness and poor outcome in a range of acute neurologic disorders. We studied the association between lateral brain displacement and awakening from acute coma. Methods This prospective observational study included all new onset coma patients admitted to the Neurosciences Critical Care Unit (NCCU) over 12 consecutive months. Head computed tomography (CT) scans were analyzed independently at coma onset, after awakening, and at follow-up. Primary outcome measure was awakening, defined as the ability to follow commands before hospital discharge. Secondary outcome measures were discharge Glasgow Coma Scale (GCS), modified Rankin Scale, Glasgow Outcome Scale, and hospital and NCCU lengths of stay. Results Of the 85 patients studied, the mean age was 58 ± 16 years, 51% were female, and 78% had cerebrovascular etiology of coma. Fifty-one percent of patients had midline shift on head CT at coma onset and 43 (51%) patients awakened. In a multivariate analysis, independent predictors of awakening were younger age (odds ratio [OR] = 1.039, 95% confidence interval [CI] = 1.002–1.079, p = 0.040), higher GCS score at coma onset (OR = 1.455, 95% CI = 1.157–1.831, p = 0.001), nontraumatic coma etiology (OR = 4.464, 95% CI = 1.011–19.608, p = 0.048), lesser pineal shift on follow-up CT (OR = 1.316, 95% CI = 1.073–1.615, p = 0.009), and reduction or no increase in pineal shift on follow-up CT (OR = 11.628, 95% CI = 2.207–62.500, p = 0.004). Interpretation Reversal and/or limitation of lateral brain displacement are associated with acute awakening in comatose patients. These findings suggest objective parameters to guide prognosis and treatment in patients with acute onset of coma. PMID:25628166

Acute Kidney Injury as a Risk Factor for Delirium and Coma during Critical Illness.

PubMed

Siew, Edward D; Fissell, William H; Tripp, Christina M; Blume, Jeffrey D; Wilson, Matthew D; Clark, Amanda J; Vincz, Andrew J; Ely, E Wesley; Pandharipande, Pratik P; Girard, Timothy D

2017-06-15

Acute kidney injury may contribute to distant organ dysfunction. Few studies have examined kidney injury as a risk factor for delirium and coma. To examine whether acute kidney injury is associated with delirium and coma in critically ill adults. In a prospective cohort study of intensive care unit patients with respiratory failure and/or shock, we examined the association between acute kidney injury and daily mental status using multinomial transition models adjusting for demographics, nonrenal organ failure, sepsis, prior mental status, and sedative exposure. Acute kidney injury was characterized daily using the difference between baseline and peak serum creatinine and staged according to Kidney Disease Improving Global Outcomes criteria. Mental status (normal vs. delirium vs. coma) was assessed daily with the Confusion Assessment Method for the ICU and Richmond Agitation-Sedation Scale. Among 466 patients, stage 2 acute kidney injury was a risk factor for delirium (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.07-2.26) and coma (OR, 2.04; 95% CI, 1.25-3.34) as was stage 3 injury (OR for delirium, 2.56; 95% CI, 1.57-4.16) (OR for coma, 3.34; 95% CI, 1.85-6.03). Daily peak serum creatinine (adjusted for baseline) values were also associated with delirium (OR, 1.35; 95% CI, 1.18-1.55) and coma (OR, 1.44; 95% CI, 1.20-1.74). Renal replacement therapy modified the association between stage 3 acute kidney injury and daily peak serum creatinine and both delirium and coma. Acute kidney injury is a risk factor for delirium and coma during critical illness.

VizieR Online Data Catalog: ETGs sample for the Coma cluster (Riguccini+, 2015)

NASA Astrophysics Data System (ADS)

Riguccini, L.; Temi, P.; Amblard, A.; Fanelli, M.; Brighenti, F.

2017-10-01

For the Coma Cluster, we utilize the work of Mahajan et al. (2010, J/MNRAS/404/1745) to build our ETG sample. Mahajan et al. (2010, J/MNRAS/404/1745) used a combination of MIPS 24 μm observations and SDSS photometry and spectra to investigate the star formation history of galaxies in the Coma supercluster. All of their galaxies from the SDSS data in the Coma supercluster region are brighter than r~17.77, the completeness limit of the SDSS spectroscopic galaxy catalog. Their 24 μm fluxes are obtained from archival data covering 2x2 deg2 for Coma Cluster. Our final sample of 124 sources is composed of 49 ellipticals and 75 lenticulars. (1 data file).

EFFECTS OF X-IRRADIATION ON THE HEXOBARBITAL METABOLIZING ENZYME SYSTEM OF RAT LIVER MICROSOMES.

DTIC Science & Technology

RADIATION EFFECTS , *ENZYME INHIBITORS, *HYPNOTICS AND SEDATIVES, ENZYMES, BIOSYNTHESIS, METABOLISM, DETOXIFICATION, BARBITURATES, OXIDATION...MICROSOMES, LIVER, REGENERATION(ENGINEERING), EXCISION, SUBLETHAL DOSAGE, TOXICITY , HYPNOSIS, SLEEP, HEAD(ANATOMY), MALES, FEMALES, RATS.

Myxedema coma with cardiac tamponade and severe cardiomyopathy.

PubMed

Majid-Moosa, Abdulla; Schussler, Jeffrey M; Mora, Adan

2015-10-01

Myxedema coma is an infrequent but potentially fatal complication of hypothyroidism. We present a rare case of previously undiagnosed hypothyroidism presenting in cardiogenic shock from pericardial tamponade and depressed myocardial contractility in myxedema coma. Here, we focus on cardiovascular complications associated with the condition.

Modeling the coma of 2060 Chiron

NASA Technical Reports Server (NTRS)

Boice, D. C.; Konno, I.; Stern, S. Alan; Huebner, W. F.

1991-01-01

Observations of comet-like activity and a resolved coma have established that 2060 Chiron is a comet. Determinations of its radius range from 65 to 200 km. This unusually large size for a comet suggests that the atmosphere of Chiron is intermediate to the tightly bound, thin atmospheres typical of planets and satellite and the greatly extended atmospheres in free expansion typical of cometary comae. Under certain conditions it may gravitationally bind an atmosphere that is thick compared to its size, while a significant amount of gas escapes to an extensive exosphere. These attributes coupled with reports of sporadic outbursts at large heliocentric distances and the identification of CN in the coma make Chiron a challenging object to model. Simple models of gas production and the dusty coma were recently presented but a general concensus on many basic features has not emerged. Development was begun on a more complete coma model of Chiron. The objectives are to report progress on this model and give the preliminary results for understanding Chiron.

The ketogenic diet as broad-spectrum treatment for super-refractory pediatric status epilepticus: challenges in implementation in the pediatric and neonatal intensive care units.

PubMed

Cobo, Nicole H; Sankar, Raman; Murata, Kristina K; Sewak, Sarika L; Kezele, Michele A; Matsumoto, Joyce H

2015-02-01

Refractory status epilepticus carries significant morbidity and mortality. Recent reports have promoted the use of the ketogenic diet as an effective treatment for refractory status epilepticus. We describe our recent experience with instituting the ketogenic diet for 4 critically ill children in refractory status epilepticus, ranging in age from 9 weeks to 13.5 years after failure of traditional treatment. The ketogenic diet allowed these patients to be weaned off continuous infusions of anesthetics without recurrence of status epilepticus, though delayed ketosis and persistently elevated glucose measurements posed special challenges to effective initiation, and none experienced complete seizure cessation. The ease of sustaining myocardial function with fatty acid energy substrates compares favorably over the myocardial toxicity posed by anesthetic doses of barbiturates and contributes to the safety profile of the ketogenic diet. The ketogenic diet can be implemented successfully and safely for the treatment of refractory status epilepticus in pediatric patients. © The Author(s) 2014.

Diagnosis of myxedema coma complicated by renal failure: a case report.

PubMed

Takamura, Akiteru; Sangen, Ryusho; Furumura, Yoshiki; Usuda, Daisuke; Kasamaki, Yuji; Kanda, Tsugiyasu

2017-04-01

Myxedema coma, caused by severe lack of thyroid hormone, is characterized by deterioration of mental status, hypothermia, hypotension, hyponatremia, and hypoventilation. We describe an 84-year-old woman who presented with renal failure and new onset severe hypothyroidism leading to challenges in the recognition of myxedema coma.

Myxedema coma in a patient with Down's syndrome.

PubMed

Bansal, Darpan; Nanda, Ashish; Gupta, Ekta; Croker, Mary; Williams, Misty L; Bacchus, Amy; Simmons, Debra; Erbland, Marcia

2006-11-01

hyroid dysfunction is common in Down's syndrome, most common being hypothyroidism. Longstanding, untreated hypothyroidism can lead to myxedema coma. Here we report a patient with Down's syndrome who presented with myxedema coma. The three essential elements for the diagnosis of myxedema coma include altered mental status, defective thermoregulation and a precipitating event or illness; all of these were present in our patient. Also, very high TSH, low T3 and T4, and the rapid response to the treatment with levothyroxine confirmed the diagnosis. Patients with Down's syndrome should have regular screening for thyroid dysfunction.

Thyroid gland disorder emergencies: thyroid storm and myxedema coma.

PubMed

Hampton, Jessica

2013-01-01

Although thyroid dysfunction will develop in more than 12% of the US population during their lifetimes, true thyroid emergencies are rare. Thyroid storm and myxedema coma are endocrine emergencies resulting from thyroid hormone dysregulation, usually coupled with an acute illness as a precipitant. Careful assessment of risk and rapid action, once danger is identified, are essential for limiting morbidity and mortality related to thyroid storm and myxedema coma. This article reviews which patients are at risk, explains thyroid storm and myxedema coma, and describes pharmacological treatment and supportive cares.

Time variability and heterogeneity in the coma of 67P/Churyumov-Gerasimenko

NASA Astrophysics Data System (ADS)

Hässig, M.; Altwegg, K.; Balsiger, H.; Bar-Nun, A.; Berthelier, J. J.; Bieler, A.; Bochsler, P.; Briois, C.; Calmonte, U.; Combi, M.; De Keyser, J.; Eberhardt, P.; Fiethe, B.; Fuselier, S. A.; Galand, M.; Gasc, S.; Gombosi, T. I.; Hansen, K. C.; Jäckel, A.; Keller, H. U.; Kopp, E.; Korth, A.; Kührt, E.; Le Roy, L.; Mall, U.; Marty, B.; Mousis, O.; Neefs, E.; Owen, T.; Rème, H.; Rubin, M.; Sémon, T.; Tornow, C.; Tzou, C.-Y.; Waite, J. H.; Wurz, P.

2015-01-01

Comets contain the best-preserved material from the beginning of our planetary system. Their nuclei and comae composition reveal clues about physical and chemical conditions during the early solar system when comets formed. ROSINA (Rosetta Orbiter Spectrometer for Ion and Neutral Analysis) onboard the Rosetta spacecraft has measured the coma composition of comet 67P/Churyumov-Gerasimenko with well-sampled time resolution per rotation. Measurements were made over many comet rotation periods and a wide range of latitudes. These measurements show large fluctuations in composition in a heterogeneous coma that has diurnal and possibly seasonal variations in the major outgassing species: water, carbon monoxide, and carbon dioxide. These results indicate a complex coma-nucleus relationship where seasonal variations may be driven by temperature differences just below the comet surface.

Reestablishment of ion homeostasis during chill-coma recovery in the cricket Gryllus pennsylvanicus

PubMed Central

MacMillan, Heath A.; Williams, Caroline M.; Staples, James F.; Sinclair, Brent J.

2012-01-01

The time required to recover from cold-induced paralysis (chill-coma) is a common measure of insect cold tolerance used to test central questions in thermal biology and predict the effects of climate change on insect populations. The onset of chill-coma in the fall field cricket (Gryllus pennsylvanicus, Orthoptera: Gryllidae) is accompanied by a progressive drift of Na+ and water from the hemolymph to the gut, but the physiological mechanisms underlying recovery from chill-coma are not understood for any insect. Using a combination of gravimetric methods and atomic absorption spectroscopy, we demonstrate that recovery from chill-coma involves a reestablishment of hemolymph ion content and volume driven by removal of Na+ and water from the gut. Recovery is associated with a transient elevation of metabolic rate, the time span of which increases with increasing cold exposure duration and closely matches the duration of complete osmotic recovery. Thus, complete recovery from chill-coma is metabolically costly and encompasses a longer period than is required for the recovery of muscle potentials and movement. These findings provide evidence that physiological mechanisms of hemolymph ion content and volume regulation, such as ion-motive ATPase activity, are instrumental in chill-coma recovery and may underlie natural variation in insect cold tolerance. PMID:23184963

METHOD OF SUPPRESSING GASTROINTESTINAL UREASE ACTIVITY

DOEpatents

Visek, W.J.

1963-04-23

This patent shows a method of increasing the growth rate of chicks. Certain diacyl substituted ureas such as alloxan, murexide, and barbituric acid are added to their feed, thereby suppressing gastrointestinal urease activity and thus promoting growth. (AEC)

Clinical characteristics and outcomes of myxedema coma: Analysis of a national inpatient database in Japan.

PubMed

Ono, Yosuke; Ono, Sachiko; Yasunaga, Hideo; Matsui, Hiroki; Fushimi, Kiyohide; Tanaka, Yuji

2017-03-01

Myxedema coma is a life-threatening and emergency presentation of hypothyroidism. However, the clinical features and outcomes of this condition have been poorly defined because of its rarity. We conducted a retrospective observational study of patients diagnosed with myxedema coma from July 2010 through March 2013 using a national inpatient database in Japan. We investigated characteristics, comorbidities, treatments, and in-hospital mortality of patients with myxedema coma. We identified 149 patients diagnosed with myxedema coma out of approximately 19 million inpatients in the database. The mean (standard deviation) age was 77 (12) years, and two-thirds of the patients were female. The overall proportion of in-hospital mortality among cases was 29.5%. The number of patients was highest in the winter season. Patients treated with steroids, catecholamines, or mechanical ventilation showed higher in-hospital mortality than those without. Variations in type and dosage of thyroid hormone replacement were not associated with in-hospital mortality. The most common comorbidity was cardiovascular diseases (40.3%). The estimated incidence of myxedema coma was 1.08 per million people per year in Japan. Multivariable logistic regression analysis revealed that higher age and use of catecholamines (with or without steroids) were significantly associated with higher in-hospital mortality. The present study identified the clinical characteristics and outcomes of patients with myxedema coma using a large-scale database. Myxedema coma mortality was independently associated with age and severe conditions requiring treatment with catecholamines. Copyright © 2016 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

Development of an objective tool for the diagnosis of myxedema coma.

PubMed

Chiong, Yien V; Bammerlin, Elaine; Mariash, Cary N

2015-09-01

Myxedema coma, a rare entity, with a reported 25%-65% mortality had no objective criteria for making the diagnosis when we began our study. We developed an objective screening tool for myxedema coma to more easily identify patients and examine the best treatment method in future prospective studies to reduce the mortality of this entity. We conducted a retrospective chart review to find all patients aged ≥18 years admitted with myxedema coma from January 1, 2005 through June 13, 2010 at Indiana University Health Methodist Hospital. On the basis of both our retrospective chart review and on literature accounts, we identified 6 criteria to diagnose myxedema coma. We identified 10 patients initially diagnosed with myxedema coma and established a control group consisting of 13 patients identified with altered mental status and increased thyroid-stimulating hormone (TSH) levels. The 6 variables we created for the screening tool were heart rate, temperature, Glasgow coma scale, TSH, free thyroxine, and precipitating factors. The screening tool has a sensitivity and specificity of about 80%. We ran a logistic regression model using the 10 study patients and 13 controls with the 6 variables. No variables alone significantly contributed to the model. However, the overall model was highly significant (P = 0.012), providing strong support for a scoring system that uses these variables simultaneously. This screening tool enables physicians to rapidly diagnose myxedema coma to expedite treatment. A more refined diagnostic tool may be used in future clinical studies designed to determine the optimal treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

A comparative study on assessment procedures and metric properties of two scoring systems of the Coma Recovery Scale-Revised items: standard and modified scores.

PubMed

Sattin, Davide; Lovaglio, Piergiorgio; Brenna, Greta; Covelli, Venusia; Rossi Sebastiano, Davide; Duran, Dunja; Minati, Ludovico; Giovannetti, Ambra Mara; Rosazza, Cristina; Bersano, Anna; Nigri, Anna; Ferraro, Stefania; Leonardi, Matilde

2017-09-01

The study compared the metric characteristics (discriminant capacity and factorial structure) of two different methods for scoring the items of the Coma Recovery Scale-Revised and it analysed scale scores collected using the standard assessment procedure and a new proposed method. Cross sectional design/methodological study. Inpatient, neurological unit. A total of 153 patients with disorders of consciousness were consecutively enrolled between 2011 and 2013. All patients were assessed with the Coma Recovery Scale-Revised using standard (rater 1) and inverted (rater 2) procedures. Coma Recovery Scale-Revised score, number of cognitive and reflex behaviours and diagnosis. Regarding patient assessment, rater 1 using standard and rater 2 using inverted procedures obtained the same best scores for each subscale of the Coma Recovery Scale-Revised for all patients, so no clinical (and statistical) difference was found between the two procedures. In 11 patients (7.7%), rater 2 noted that some Coma Recovery Scale-Revised codified behavioural responses were not found during assessment, although higher response categories were present. A total of 51 (36%) patients presented the same Coma Recovery Scale-Revised scores of 7 or 8 using a standard score, whereas no overlap was found using the modified score. Unidimensionality was confirmed for both score systems. The Coma Recovery Scale Modified Score showed a higher discriminant capacity than the standard score and a monofactorial structure was also supported. The inverted assessment procedure could be a useful evaluation method for the assessment of patients with disorder of consciousness diagnosis.

Memory disorder related to coma duration after head injury.

PubMed Central

Vilkki, J; Poropudas, K; Servo, A

1988-01-01

The relationship of memory and intelligence test performances to coma duration was studied in 51 head injured patients who had not been operated on for intracranial haematoma. Memory defect was related to coma duration, and was not secondary to impaired perceptual or conceptual analysis of the material to be remembered. PMID:3236022

[Coma in France today].

PubMed

Do, Chung Hi

2015-01-01

Comas result from acute life-threatening neurological failure. To understand coma, it is firstly necessary to define it, to cite the aetiologies and their epidemiology and to describe the chronic disorders of consciousness. It is also important to address the challenges and principles of treatment during the acute phase. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Early blindness and coma during intrathecal chemotherapy for meningeal carcinomatosis.

PubMed

Boogerd, W; Moffie, D; Smets, L A

1990-02-01

A 35-year-old woman was treated with intraventricular methotrexate (MTX) with a total dose of 70 mg followed by cytosine arabinoside (Ara-C) with a total dose of 80 mg for meningeal metastasis of breast carcinoma. Radiation therapy was not given. Despite a response of the meningeal tumor the patient developed in the third week of MTX treatment a progressive visual loss and loss of consciousness which worsened during subsequent Ara-C treatment and led to death within 3 weeks. Postmortem examination revealed only minimal neoplastic infiltration of the meninges. Multiple foci of axonal degeneration and demyelination were found in the optic nerves and chiasm, the superficial layers of the brainstem, and spinal cord and to some extent in other cranial nerves and spinal nerve roots. The possible causes of this previously unreported early complication are discussed.

Between My Body and My "Dead Body": Narratives of Coma.

PubMed

Meoded Danon, Limor

2016-01-01

This article is based on narrative research that focuses on corporeal experience during coma and during the rehabilitation process. Seventeen participants from different areas of Israel who had been in various kinds of coma states reveal what the corporeal experience of coma is. The participants are divided into three types of narrative protagonists--"dead-alive," "rational," and "emissaries." Each of the participants redefined the boundaries of the body, especially in cases when they spoke of experiences they did not understand as corporeal, for example, out-of-body experiences, near-death experiences, or experiences of being between the earthly and unearthly. Their struggle to find suitable words to tell their coma stories emphasizes these boundaries between experiencing and telling, which crossed the normative discursive border of the medical establishment and illustrates the ambiguous nature of human existence. © The Author(s) 2015.

Myxedema coma: diagnosis and treatment.

PubMed

Wall, C R

2000-12-01

Myxedema coma, the extreme manifestation of hypothyroidism, is an uncommon but potentially lethal condition. Patients with hypothyroidism may exhibit a number of physiologic alterations to compensate for the lack of thyroid hormone. If these homeostatic mechanisms are overwhelmed by factors such as infection, the patient may decompensate into myxedema coma. Patients with hypothyroidism typically have a history of fatigue, weight gain, constipation and cold intolerance. Physicians should include hypothyroidism in the differential diagnosis of every patient with hyponatremia. Patients with suspected myxedema coma should be admitted to an intensive care unit for vigorous pulmonary and cardiovascular support. Most authorities recommend treatment with intravenous levothyroxine (T4) as opposed to intravenous liothyronine (T3). Hydrocortisone should be administered until coexisting adrenal insufficiency is ruled out. Family physicians are in an important position to prevent myxedema coma by maintaining a high level of suspicion for hypothyroidism.

Models for Cometary Comae Containing Negative Ions

NASA Technical Reports Server (NTRS)

Cordiner, M. A.; Charnley, S. B.

2012-01-01

The presence of negative ions (anions) in cometary comae is known from Giotto mass spectrometry of IP/Halley. The anions O(-), OH(-), C(-), CH(-) and CN(-) have been detected, as well as unidentified anions with masses 22-65 and 85-110 amu [I]. Organic molecular anions such as C4H(-) and C6H(-) are known to have a significant impact on the charge balance of interstellar clouds and circumstellar envelopes and have been shown to act as catalysts for the gas phase synthesis of larger hydrocarbon molecules in the ISM, but their importance in cometary comae has not yet been fully explored. We present details of our new models for the chemistry of cometary comae that include atomic and molecular anions. We calculate the impact of these anions on the charge balance and examine their importance for cometary coma chemistry.

PERTURBATION OF VOLTAGE-SENSITIVE CALCIUM FUNCTION IN PHEOCHROMOCYTOMA CELLS BY VOLATILE ORGANIC SOLVENTS.

EPA Science Inventory

Volatile organic solvents such as toluene (TOL) and trichloroethylene perturb nervous system function and share characteristic effects with other central nervous system depressants such as anesthetic gasses, ethanol, benzodiazepines and barbiturates. Recently, mechanistic studies...

Effect of GABA agonists and GABA-A receptor modulators on cocaine- and food-maintained responding and cocaine discrimination in rats.

PubMed

Barrett, Andrew C; Negus, S Stevens; Mello, Nancy K; Caine, S Barak

2005-11-01

Recent studies indicate that GABAergic ligands modulate abuse-related effects of cocaine. The goal of this study was to evaluate the effects of a mechanistically diverse group of GABAergic ligands on the discriminative stimulus and reinforcing effects of cocaine in rats. One group of rats was trained to discriminate 5.6 mg/kg cocaine from saline in a two-lever, food-reinforced, drug discrimination procedure. In two other groups, responding was maintained by cocaine (0-3.2 mg/kg/injection) or liquid food (0-100%) under a fixed ratio 5 schedule. Six GABA agonists were tested: the GABA-A receptor agonist muscimol, the GABA-B receptor agonist baclofen, the GABA transaminase inhibitor gamma-vinyl-GABA (GVG), and three GABA-A receptor modulators (the barbiturate pentobarbital, the high-efficacy benzodiazepine midazolam, and the low-efficacy benzodiazepine enazenil). When tested alone, none of the compounds substituted fully for the discriminative stimulus effects of cocaine. As acute pretreatments, select doses of midazolam and pentobarbital produced 2.2- to 3.6-fold rightward shifts in the cocaine dose-effect function. In contrast, muscimol, baclofen, GVG, and enazenil failed to alter the discriminative stimulus effects of cocaine. In assays of cocaine- and food-maintained responding, midazolam and pentobarbital decreased cocaine self-administration at doses 9.6- and 3.3-fold lower, respectively, than those that decreased food-maintained responding. In contrast, muscimol, baclofen, and GVG decreased cocaine self-administration at doses that also decreased food-maintained responding. Enazenil failed to alter cocaine self-administration. Together with previous studies, these data suggest that among mechanistically diverse GABA agonists, high-efficacy GABA-A modulators may be the most effective for modifying the abuse-related effects of cocaine.

A Study of the Effects of Faint Dust Comae on the Spectra of Asteroids

NASA Astrophysics Data System (ADS)

Rondón, E.; Carvano, J.; Lorenz-Martins, S.

2017-09-01

The presence of dust comae on asteroids and centaurs is a phenomenon that became accepted in the last decades and which challenges the traditional definitions of asteroids and comets. A possible way of improving the chances of discovery of Active Asteroids is to use large multi-colour surveys or catalogs, like SDSS Moving Object Catalog. In this work we analyze the effects of faint dust comae on asteroid spectra and then use it to investigate the effects that a faint dust comae would have over the spectrum, magnitude, and radial profile of asteroids.

Balance of corneal horizontal coma by internal optics in eyes with intraocular artificial lenses: evidence of a passive mechanism.

PubMed

Marcos, Susana; Rosales, Patricia; Llorente, Lourdes; Barbero, Sergio; Jiménez-Alfaro, I

2008-01-01

It is well known that the aberrations of the cornea are partially compensated by the aberrations of the internal optics of the eye (primarily the crystalline lens) in young subjects. This effect has been found not only for the spherical aberration, but also for horizontal coma. It has been debated whether the compensation of horizontal coma is the result of passive mechanism [Artal, P., Benito, A., & Tabernero, J. (2006). The human eye is an example of robust optical design. Journal of Vision, 6 (1), 1-7] or through an active developmental feedback process [Kelly, J. E., Mihashi, T., & Howland, H. C. (2004). Compensation of corneal horizontal/vertical astigmatism, lateral coma, and spherical aberration by internal optics of the eye. Journal of Vision, 4 (4), 262-271]. In this study we investigate the active or passive nature of the horizontal coma compensation using eyes with artificial lenses, where no active developmental process can be present. We measured total and corneal aberrations, and lens tilt and decentration in a group of 38 eyes implanted with two types of intraocular lenses designed to compensate the corneal spherical aberration of the average population. We found that spherical aberration was compensated by 66%, and horizontal coma by 87% on average. The spherical aberration is not compensated at an individual level, but horizontal coma is compensated individually (coefficients of correlation corneal/internal aberration: -0.946, p<0.0001). The fact that corneal (but not total) horizontal coma is highly correlated with angle lamda (computed from the shift of the 1st Purkinje image from the pupil center, for foveal fixation) indicates that the compensation arises primarily from the geometrical configuration of the eye (which generates horizontal coma of opposite signs in the cornea and internal optics). The amount and direction of tilts and misalignments of the lens are comparable to those found in young eyes, and on average tend to compensate (rather than increase) horizontal coma. Computer simulations using customized model eyes and different designs of intraocular lenses show that, while not all designs produce a compensation of horizontal coma, a wide range of aspheric biconvex designs may produce comparable compensation to that found in young eyes with crystalline lenses, over a relatively large field of view. These findings suggest that the lens shape, gradient index or foveal location do not need to be fine-tuned to achieve a compensation of horizontal coma. Our results cannot exclude a fine-tuning for the orientation of the crystalline lens, since cataract surgery seems to preserve the position of the capsule.

Effects of a screening and treatment protocol with haloperidol on post-cardiotomy delirium: a prospective cohort study†

PubMed Central

Schrøder Pedersen, Sofie; Kirkegaard, Thomas; Balslev Jørgensen, Martin; Lind Jørgensen, Vibeke

2014-01-01

OBJECTIVES Post-cardiotomy delirium is common and associated with increased morbidity and mortality. No gold standard exists for detecting delirium, and evidence to support the choice of treatment is needed. Haloperidol is widely used for treating delirium, but indication, doses and therapeutic targets vary. Moreover, doubt has been raised regarding overall efficacy. The purpose of this study was to assess the effect of a combination of early detection and standardized treatment with haloperidol on post-cardiotomy delirium, with the hypothesis that the proportion of delirium- and coma-free days could be increased. Length of stay (LOS), complications and 180-day mortality are reported. METHODS Prospective interventional cohort study. One hundred and seventeen adult patients undergoing cardiac surgery were included before introduction of a screening and treatment protocol with haloperidol for delirium, and 123 patients were included after. Nurses screened patients using validated tools (the Delirium Observation Screening (DOS) scale and confusion assessment method for the intensive care unit (CAM-ICU)). In case of delirium, a checklist to eliminate precipitating/ inducing factors and a protocol for standardized dosing with haloperidol was applied. Group comparison was done using non-parametric tests and analysis of fractions, and associations between delirium and predefined covariates were analysed with logistic regression. RESULTS Incidence of delirium after cardiac surgery was 21 (14–29) and 22 (15–30) %, onset was on postoperative day 1 (1–4) and 1 (1–3), duration was 1 (1–4) day and 3 (1–5) days, respectively, with no significant difference (Period 1 vs 2, all values are given as the median and 95% confidence interval). The proportion of delirium- and coma-free days was 67 (61–73) and 65 (60–70) %, respectively (ns). There was no difference in LOS or complication rate. Delirium was associated to increasing age, increased length of stay and complications. CONCLUSIONS We observed no increase in the proportion of delirium- and coma-free days after introduction of a combination of early detection and standardized treatment with haloperidol on post-cardiotomy delirium. Most patients were not severely affected, and the few who were, proved difficult to treat, indicating that a simple treatment protocol with haloperidol was ineffective. PMID:24357472

Chemical and Hydrodynamical Models of Cometary Comae

NASA Technical Reports Server (NTRS)

Charnley, Steven

2012-01-01

Multi-fluid modelling of the outflowing gases which sublimate from cometary nuclei as they approach the Sun is necessary for understanding the important physical and chemical processes occurring in this complex plasma. Coma chemistry models can be employed to interpret observational data and to ultimately determine chemical composition and structure of the nuclear ices and dust. We describe a combined chemical and hydrodynamical model [1] in which differential equations for the chemical abundances and the energy balance are solved as a function of distance from the cometary nucleus. The presence of negative ions (anions) in cometary comae is known from Giotto mass spectrometry of 1P/Halley. The anions O(-), OH(-), C(-), CH(-) and CN(-) have been detected, as well as unidentified anions with masses 22-65 and 85-110 amu [2]. Organic molecular anions such as C4H(-) and C6H(-) are known to have a significant impact on the charge balance of interstellar clouds and circumstellar envelopes and have been shown to act as catalysts for the gas-phase synthesis of larger hydrocarbon molecules in the ISM, but their importance in cometary comae has not yet been fully explored. We present details of new models for the chemistry of cometary comae that include atomic and molecular anions and calculate the impact of these anions on the coma physics and chemistry af the coma.

Jet Morphology and Coma Analysis of Comet 103P/Hartley 2

NASA Astrophysics Data System (ADS)

Vaughan, Charles M.; Pierce, Donna M.; Cochran, Anita L.

2017-12-01

Spectral data for the coma of Hartley 2 were acquired across four nights in late 2010 using an integral field spectrometer at McDonald Observatory. For the 30 observations during these four nights, we detected five radical species in the coma: C2, C3, CH, CN, and NH2. Using division by azimuthal mean and division by radial profile, we enhanced 150 images of the coma to reveal subtle coma structure. These images revealed noticeable temporal evolution and spatial variations between species. To quantify the observed variation between species, we partitioned the coma and used analysis of variance (ANOVA) techniques to provide a statistical basis for heterogeneity. Nearly every ANOVA test indicated a spatially diverse distribution in the coma when considering all species collectively. To examine the temporal behavior, we used the works by Belton et al., Thomas et al., and Bruck Syal et al. to predict nucleus orientation and active jet directions at our observation times. Several of these reported jet sites correlated to high radical concentrations, and the sites on the smaller lobe are more closely associated with high radical concentrations. Lastly, we provide constraints for the suspect parent molecules of the detected radicals, and we propose that photolysis reactions occurring at or near extended icy grains are a source for the more enigmatic radicals, such as C3.

Asymmetric Spherical Coupled Escape Probability: Model and Results for Optically Thick Cometary Comae

NASA Astrophysics Data System (ADS)

Gersch, Alan; A'Hearn, M. F.

2012-05-01

We have adapted the Coupled Escape Probability method of radiative transfer calculations for use in asymmetrical spherical situations and applied it to modeling molecular emission spectra of potentially optically thick cometary comae. Recent space missions (e.g. Deep Impact & EPOXI) have provided spectra from comets of unprecedented spatial resolution of the regions of the coma near the nucleus, where the coma may be optically thick. Currently active missions (e.g. Rosetta) and hopefully more in the future will continue the trend and demonstrate the need for better modeling of comae with optical depth effects included. Here we present a brief description of our model and results of interest for cometary studies, especially for space based observations. Although primarily motivated by the need for comet modeling, our (asymmetric spherical) radiative transfer model could be used for studying other astrophysical phenomena as well.

Cometary science. Time variability and heterogeneity in the coma of 67P/Churyumov-Gerasimenko.

PubMed

Hässig, M; Altwegg, K; Balsiger, H; Bar-Nun, A; Berthelier, J J; Bieler, A; Bochsler, P; Briois, C; Calmonte, U; Combi, M; De Keyser, J; Eberhardt, P; Fiethe, B; Fuselier, S A; Galand, M; Gasc, S; Gombosi, T I; Hansen, K C; Jäckel, A; Keller, H U; Kopp, E; Korth, A; Kührt, E; Le Roy, L; Mall, U; Marty, B; Mousis, O; Neefs, E; Owen, T; Rème, H; Rubin, M; Sémon, T; Tornow, C; Tzou, C-Y; Waite, J H; Wurz, P

2015-01-23

Comets contain the best-preserved material from the beginning of our planetary system. Their nuclei and comae composition reveal clues about physical and chemical conditions during the early solar system when comets formed. ROSINA (Rosetta Orbiter Spectrometer for Ion and Neutral Analysis) onboard the Rosetta spacecraft has measured the coma composition of comet 67P/Churyumov-Gerasimenko with well-sampled time resolution per rotation. Measurements were made over many comet rotation periods and a wide range of latitudes. These measurements show large fluctuations in composition in a heterogeneous coma that has diurnal and possibly seasonal variations in the major outgassing species: water, carbon monoxide, and carbon dioxide. These results indicate a complex coma-nucleus relationship where seasonal variations may be driven by temperature differences just below the comet surface. Copyright © 2015, American Association for the Advancement of Science.

A Case of Myxedema Coma Presenting as a Brain Stem Infarct in a 74-Year-Old Korean Woman

PubMed Central

Ahn, Ji Yun; Kwon, Hyuk-Sool; Ahn, Hee Chol

2010-01-01

Myxedema coma is the extreme form of untreated hypothyroidism. In reality, few patients present comatose with severe myxedema. We describe a patient with myxedema coma which was initially misdiagnosed as a brain stem infarct. She presented to the hospital with alteration of the mental status, generalized edema, hypothermia, hypoventilation, and hypotension. Initially her brain stem reflexes were absent. After respiratory and circulatory support, her neurologic status was not improved soon. The diagnosis of myxedema coma was often missed or delayed due to various clinical findings and concomitant medical condition and precipitating factors. It is more difficult to diagnose when a patient has no medical history of hypothyroidism. A high index of clinical suspicion can make a timely diagnosis and initiate appropriate treatment. We report this case to alert clinicians considering diagnosis of myxedema coma in patients with severe decompensated metabolic state including mental change. PMID:20808690

Severe congestive heart failure patient on amiodarone presenting with myxedemic coma: a case report.

PubMed

Shaheen, Mazen

2009-01-01

This is a case report of myxedema coma secondary to amiodarone-induced hypothyroidism in a patient with severe congestive heart failure (CHF). To our knowledge and after reviewing the literature there is one case report of myxedema coma during long term amiodarone therapy. Myxedema coma is a life threatening condition that carries a mortality reaching as high as 20% with treatment. The condition is treated with intravenous thyroxine (T4) or intravenous tri-iodo-thyronine (T3). Patients with CHF on amiodarone may suffer serious morbidity and mortality from hypothyroidism, and thus may deserve closer follow up for thyroid stimulating hormone (TSH) levels. This case report carries an important clinical application given the frequent usage of amiodarone among CHF patients. The myriad clinical presentation of myxedema coma and its serious morbidity and mortality stresses the need to suspect this clinical syndrome among CHF patients presenting with hypotension, weakness or other unexplained symptoms.

A case of myxedema coma presenting as a brain stem infarct in a 74-year-old Korean woman.

PubMed

Ahn, Ji Yun; Kwon, Hyuk-Sool; Ahn, Hee Chol; Sohn, You Dong

2010-09-01

Myxedema coma is the extreme form of untreated hypothyroidism. In reality, few patients present comatose with severe myxedema. We describe a patient with myxedema coma which was initially misdiagnosed as a brain stem infarct. She presented to the hospital with alteration of the mental status, generalized edema, hypothermia, hypoventilation, and hypotension. Initially her brain stem reflexes were absent. After respiratory and circulatory support, her neurologic status was not improved soon. The diagnosis of myxedema coma was often missed or delayed due to various clinical findings and concomitant medical condition and precipitating factors. It is more difficult to diagnose when a patient has no medical history of hypothyroidism. A high index of clinical suspicion can make a timely diagnosis and initiate appropriate treatment. We report this case to alert clinicians considering diagnosis of myxedema coma in patients with severe decompensated metabolic state including mental change.

The origin of low mass particles within and beyond the dust coma envelopes of Comet Halley

NASA Technical Reports Server (NTRS)

Simpson, J. A.; Rabinowitz, D.; Tuzzolino, A. J.; Ksanfomality, L. V.; Sagdeev, R. Z.

1987-01-01

Measurements from the Dust Counter and Mass Analyzer (DUCMA) instruments on VEGA-1 and -2 revealed unexpected fluxes of low mass (up to 10 to the minus 13th power g) dust particles at very great distances from the nucleus (300,000 to 600,000 km). These particles are detected in clusters (10 sec duration), preceded and followed by relatively long time intervals during which no dust is detected. This cluster phenomenon also occurs inside the envelope boundaries. Clusters of low mass particles are intermixed with the overall dust distribution throughout the coma. The clusters account for many of the short-term small-scale intensity enhancements previously ascribed to microjets in the coma. The origin of these clusters appears to be emission from the nucleus of large conglomerates which disintegrate in the coma to yield clusters of discrete, small particles continuing outward to the distant coma.

[Prognostic value of EEG in acute posttraumatic coma (author's transl)].

PubMed

Walser, H; Friedli, W; Glinz, W

1981-12-01

To evaluate the prognostic power of a single EEG-record, the recordings of 50 patients with posttraumatic coma performed within 48 hours after the injury were compared with the outcome after 6 months. A 5-point scale comprising 2 EEG-patterns being notorious for their dismal prognostic significance (suppression bursts, alpha-coma) and changes of vigilance were used as a mean of visual assessment of the recordings. In 24 out of the 28 patients with a bad outcome, the EEG had shown the patterns of category I, II and III (suppression bursts, alpha coma, no changes of vigilance). Of the 22 patients with a good outcome, the EEG had been classified as IV or V (clearly discernible changes of vigilance, sleep patterns). Further findings of particular dismal prognostic significance were focal epileptic discharges, as 9 out of the 11 patients with this EEG pattern had not survived the posttraumatic coma for more than 6 months.

Streaming Clumps Ejection Model and the Heterogeneous Inner Coma of Comet Wild 2

NASA Technical Reports Server (NTRS)

Clark, B. C.; Economou, T. E.; Green, S. F.; Sandford, S. A.; Zolensky, M. E.

2004-01-01

The conventional concept of cometary comae is that they are dominated by fine particulates released individually by sublimation of surface volatiles and subsequent entrainment in the near-surface gas. It has long been recognized that such particulates could be relatively large, with early estimates that objects perhaps up to one meter in size may be levitated from the surface of the typical cometary nucleus. However, the general uniformity and small average particulate size of observed comae and the relatively smooth, monotonic increases and decreases in particle density during the Giotto flythrough of comet Halley s coma in 1986 reinforced the view that the bulk of the particles are released at the surface, are fine-sized and inert. Jets have been interpreted as geometrically constrained release of these particulates. With major heterogeneities observed during the recent flythrough of the inner coma of comet Wild 2, these views deserve reconsideration.

Medical Readings on Drug Abuse.

ERIC Educational Resources Information Center

Byrd, Oliver E.

Summaries are presented of over 150 articles in the recent medical and psychiatric literature. Topics covered are: effects of drugs, tobacco, alcohol, drugs used in medicine, vapor sniffing, marijuana, barbiturates, tranquilizers, amphetamines, methamphetamine, lysergic acid diethylamide, other hallucinogens, heroin and the opiates, psychiatric…

44 CFR 15.9 - Alcoholic beverages and narcotics.

Code of Federal Regulations, 2012 CFR

2012-10-01

... beverages, narcotic drugs, hallucinogens, marijuana, barbiturates or amphetamines as defined in Title 21 of... property being under the influence of or using or possessing any narcotic drug, marijuana, hallucinogen... influence of alcoholic beverages; (d) Bringing alcoholic beverages, narcotic drugs, hallucinogens, marijuana...

44 CFR 15.9 - Alcoholic beverages and narcotics.

Code of Federal Regulations, 2014 CFR

2014-10-01

... beverages, narcotic drugs, hallucinogens, marijuana, barbiturates or amphetamines as defined in Title 21 of... property being under the influence of or using or possessing any narcotic drug, marijuana, hallucinogen... influence of alcoholic beverages; (d) Bringing alcoholic beverages, narcotic drugs, hallucinogens, marijuana...

44 CFR 15.9 - Alcoholic beverages and narcotics.

Code of Federal Regulations, 2013 CFR

2013-10-01

... beverages, narcotic drugs, hallucinogens, marijuana, barbiturates or amphetamines as defined in Title 21 of... property being under the influence of or using or possessing any narcotic drug, marijuana, hallucinogen... influence of alcoholic beverages; (d) Bringing alcoholic beverages, narcotic drugs, hallucinogens, marijuana...

44 CFR 15.9 - Alcoholic beverages and narcotics.

Code of Federal Regulations, 2011 CFR

2011-10-01

... beverages, narcotic drugs, hallucinogens, marijuana, barbiturates or amphetamines as defined in Title 21 of... property being under the influence of or using or possessing any narcotic drug, marijuana, hallucinogen... influence of alcoholic beverages; (d) Bringing alcoholic beverages, narcotic drugs, hallucinogens, marijuana...

44 CFR 15.9 - Alcoholic beverages and narcotics.

Code of Federal Regulations, 2010 CFR

2010-10-01

... beverages, narcotic drugs, hallucinogens, marijuana, barbiturates or amphetamines as defined in Title 21 of... property being under the influence of or using or possessing any narcotic drug, marijuana, hallucinogen... influence of alcoholic beverages; (d) Bringing alcoholic beverages, narcotic drugs, hallucinogens, marijuana...

The distribution of early- and late-type galaxies in the Coma cluster

NASA Technical Reports Server (NTRS)

Doi, M.; Fukugita, M.; Okamura, S.; Turner, E. L.

1995-01-01

The spatial distribution and the morohology-density relation of Coma cluster galaxies are studied using a new homogeneous photmetric sample of 450 galaxies down to B = 16.0 mag with quantitative morphology classification. The sample covers a wide area (10 deg X 10 deg), extending well beyond the Coma cluster. Morphological classifications into early- (E+SO) and late-(S) type galaxies are made by an automated algorithm using simple photometric parameters, with which the misclassification rate is expected to be approximately 10% with respect to early and late types given in the Third Reference Catalogue of Bright Galaxies. The flattened distribution of Coma cluster galaxies, as noted in previous studies, is most conspicuously seen if the early-type galaxies are selected. Early-type galaxies are distributed in a thick filament extended from the NE to the WSW direction that delineates a part of large-scale structure. Spiral galaxies show a distribution with a modest density gradient toward the cluster center; at least bright spiral galaxies are present close to the center of the Coma cluster. We also examine the morphology-density relation for the Coma cluster including its surrounding regions.

Origins of ultra-diffuse galaxies in the Coma cluster - I. Constraints from velocity phase-space

NASA Astrophysics Data System (ADS)

Alabi, Adebusola; Ferré-Mateu, Anna; Romanowsky, Aaron J.; Brodie, Jean; Forbes, Duncan A.; Wasserman, Asher; Bellstedt, Sabine; Martín-Navarro, Ignacio; Pandya, Viraj; Stone, Maria B.; Okabe, Nobuhiro

2018-06-01

We use Keck/DEIMOS spectroscopy to confirm the cluster membership of 16 ultra-diffuse galaxies (UDGs) in the Coma cluster, bringing the total number of spectroscopically confirmed UDGs from the Yagi et al. (Y16) catalog to 25. We also identify a new cluster background UDG, confirming that most (˜95 per cent) of the UDGs in the Y16 catalog belong to the Coma cluster. In this pilot study of Coma UDGs in velocity phase-space, we find evidence of a diverse origin for Coma cluster UDGs, similar to normal dwarf galaxies. Some UDGs in our sample are consistent with being late infalls into the cluster environment while some may have been in the cluster for ≥8 Gyr. The late infallen UDGs have higher absolute relative line-of-sight velocities, bluer optical colors, and within the projected cluster core, are smaller in size, compared to the early infalls. The early infall UDGs, which may also have formed in-situ, have been in the cluster environment for as long as the most luminous galaxies in the Coma cluster and they may be failed galaxies which experienced star formation quenching at earlier epochs.

Abundant molecular oxygen in the coma of comet 67P/Churyumov-Gerasimenko.

PubMed

Bieler, A; Altwegg, K; Balsiger, H; Bar-Nun, A; Berthelier, J-J; Bochsler, P; Briois, C; Calmonte, U; Combi, M; De Keyser, J; van Dishoeck, E F; Fiethe, B; Fuselier, S A; Gasc, S; Gombosi, T I; Hansen, K C; Hässig, M; Jäckel, A; Kopp, E; Korth, A; Le Roy, L; Mall, U; Maggiolo, R; Marty, B; Mousis, O; Owen, T; Rème, H; Rubin, M; Sémon, T; Tzou, C-Y; Waite, J H; Walsh, C; Wurz, P

2015-10-29

The composition of the neutral gas comas of most comets is dominated by H2O, CO and CO2, typically comprising as much as 95 per cent of the total gas density. In addition, cometary comas have been found to contain a rich array of other molecules, including sulfuric compounds and complex hydrocarbons. Molecular oxygen (O2), however, despite its detection on other icy bodies such as the moons of Jupiter and Saturn, has remained undetected in cometary comas. Here we report in situ measurement of O2 in the coma of comet 67P/Churyumov-Gerasimenko, with local abundances ranging from one per cent to ten per cent relative to H2O and with a mean value of 3.80 ± 0.85 per cent. Our observations indicate that the O2/H2O ratio is isotropic in the coma and does not change systematically with heliocentric distance. This suggests that primordial O2 was incorporated into the nucleus during the comet's formation, which is unexpected given the low upper limits from remote sensing observations. Current Solar System formation models do not predict conditions that would allow this to occur.

Coma morphology of comet 67P controlled by insolation over irregular nucleus

NASA Astrophysics Data System (ADS)

Shi, X.; Hu, X.; Mottola, S.; Sierks, H.; Keller, H. U.; Rose, M.; Güttler, C.; Fulle, M.; Fornasier, S.; Agarwal, J.; Pajola, M.; Tubiana, C.; Bodewits, D.; Barbieri, C.; Lamy, P. L.; Rodrigo, R.; Koschny, D.; Barucci, M. A.; Bertaux, J.-L.; Bertini, I.; Boudreault, S.; Cremonese, G.; Da Deppo, V.; Davidsson, B.; Debei, S.; De Cecco, M.; Deller, J.; Groussin, O.; Gutiérrez, P. J.; Hviid, S. F.; Ip, W.-H.; Jorda, L.; Knollenberg, J.; Kovacs, G.; Kramm, J.-R.; Kührt, E.; Küppers, M.; Lara, L. M.; Lazzarin, M.; Lopez-Moreno, J. J.; Marzari, F.; Naletto, G.; Oklay, N.; Toth, I.; Vincent, J.-B.

2018-05-01

While the structural complexity of cometary comae is already recognizable from telescopic observations1, the innermost region, within a few radii of the nucleus, was not resolved until spacecraft exploration became a reality2,3. The dust coma displays jet-like features of enhanced brightness superposed on a diffuse background1,4,5. Some features can be traced to specific areas on the nucleus, and result conceivably from locally enhanced outgassing and/or dust emission6-8. However, diffuse or even uniform activity over topographic concavity can converge to produce jet-like features9,10. Therefore, linking observed coma morphology to the distribution of activity on the nucleus is difficult11,12. Here, we study the emergence of dust activity at sunrise on comet 67P/Churyumov-Gerasimenko using high-resolution, stereo images from the OSIRIS camera onboard the Rosetta spacecraft, where the sources and formation of the jet-like features are resolved. We perform numerical simulations to show that the ambient dust coma is driven by pervasive but non-uniform water outgassing from the homogeneous surface layer. Physical collimations of gas and dust flows occur at local maxima of insolation and also via topographic focusing. Coma structures are projected to exhibit jet-like features that vary with the perspective of the observer. For an irregular comet such as 67P/Churyumov-Gerasimenko, near-nucleus coma structures can be concealed in the shadow of the nucleus, which further complicates the picture.

MMN and novelty P3 in coma and other altered states of consciousness: a review.

PubMed

Morlet, Dominique; Fischer, Catherine

2014-07-01

In recent decades, there has been a growing interest in the assessment of patients in altered states of consciousness. There is a need for accurate and early prediction of awakening and recovery from coma. Neurophysiological assessment of coma was once restricted to brainstem auditory and primary cortex somatosensory evoked potentials elicited in the 30 ms range, which have both shown good predictive value for poor coma outcome only. In this paper, we review how passive auditory oddball paradigms including deviant and novel sounds have proved their efficiency in assessing brain function at a higher level, without requiring the patient's active involvement, thus providing an enhanced tool for the prediction of coma outcome. The presence of an MMN in response to deviant stimuli highlights preserved automatic sensory memory processes. Recorded during coma, MMN has shown high specificity as a predictor of recovery of consciousness. The presence of a novelty P3 in response to the subject's own first name presented as a novel (rare) stimulus has shown a good correlation with coma awakening. There is now a growing interest in the search for markers of consciousness, if there are any, in unresponsive patients (chronic vegetative or minimally conscious states). We discuss the different ERP patterns observed in these patients. The presence of novelty P3, including parietal components and possibly followed by a late parietal positivity, raises the possibility that some awareness processes are at work in these unresponsive patients.

MMN and Novelty P3 in Coma and Other Altered States of Consciousness: A Review

PubMed Central

Morlet, Dominique; Fischer, Catherine

2014-01-01

In recent decades, there has been a growing interest in the assessment of patients in altered states of consciousness. There is a need for accurate and early prediction of awakening and recovery from coma. Neurophysiological assessment of coma was once restricted to brainstem auditory and primary cortex somatosensory evoked potentials elicited in the thirty millisecond range, which have both shown good predictive value for poor coma outcome only. In this paper, we review how passive auditory oddball paradigms including deviant and novel sounds have proved their efficiency in assessing brain function at a higher level, without requiring the patient’s active involvement, thus providing an enhanced tool for the prediction of coma outcome. The presence of an MMN in response to deviant stimuli highlights preserved automatic sensory memory processes. Recorded during coma, MMN has shown high specificity as a predictor of recovery of consciousness. The presence of a novelty P3 in response to the subject’s own first name presented as a novel (rare) stimulus has shown a good correlation with coma awakening. There is now a growing interest in the search for markers of consciousness, if there are any, in unresponsive patients (chronic vegetative or minimally conscious states). We discuss the different ERP patterns observed in these patients. The presence of novelty P3, including parietal components and possibly followed by a late parietal positivity, raises the possibility that some awareness processes are at work in these unresponsive patients. PMID:24281786

Studies of Circulatory and Metabolic Changes during Ketamine Narcosis,

DTIC Science & Technology

1985-03-13

Braun, U., Hensel, I., Kettler, D., Lohr, B.: The effects of methoxyflurane , halothane, dipiritramide, barbiturate and ketamine on the total oxygen...narcosis caus- ed by ether, halothane, methoxyflurane , ketamine and piritranide, as well as neuroleptanalgesia. Lecture at the XIIth. General Con

Clinical Concepts on Thyroid Emergencies

PubMed Central

Papi, Giampaolo; Corsello, Salvatore Maria; Pontecorvi, Alfredo

2014-01-01

Objective: Thyroid-related emergencies are caused by overt dysfunction of the gland which are so severe that require admission to intensive care units (ICU) frequently. Nonetheless, in the ICU setting, it is crucial to differentiate patients with non-thyroidal illness and alterations in thyroid function tests from those with intrinsic thyroid disease. This review presents and discusses the main etiopathogenetical and clinical aspects of hypothyroid coma (HC) and thyrotoxic storm (TS), including therapeutic strategy flow-charts. Furthermore, a special chapter is dedicated to the approach to massive goiter, which represents a surgical thyroid emergency. Data Source: We searched the electronic MEDLINE database on September 2013. Data Selection and Data Extraction: Reviews, original articles, and case reports on “myxedematous coma,” “HC,” “thyroid storm,” “TS,” “massive goiter,” “huge goiter,” “prevalence,” “etiology,” “diagnosis,” “therapy,” and “prognosis” were selected. Data Synthesis and Conclusion: Severe excess or defect of thyroid hormone is rare conditions, which jeopardize the life of patients in most cases. Both HC and TS are triggered by precipitating factors, which occur in patients with severe hypothyroidism or thyrotoxicosis, respectively. The pillars of HC therapy are high-dose l-thyroxine and/or tri-iodothyroinine; i.v. glucocorticoids; treatment of hydro-electrolyte imbalance (mainly, hyponatraemia); treatment of hypothermia; often, endotracheal intubation and assisted mechanic ventilation are needed. Therapy of TS is based on beta-blockers, thyrostatics, and i.v. glucocorticoids; eventually, high-dose of iodide compounds or lithium carbonate may be of benefit. Surgery represents the gold standard treatment in patients with euthyroid massive nodular goiter, although new techniques – e.g., percutaneous laser ablation – are helpful in subjects at high surgical risk or refusing operation. PMID:25071718

Oral drug self-administration: an overview of laboratory animal studies.

PubMed

Meisch, R A

2001-06-01

Many abused drugs can be established as orally delivered reinforcers for rhesus monkeys and other animals. Benzodiazepines, barbiturates, opioids, psychomotor stimulants, dissociative anesthetics, and ethanol can come to serve as reinforcers when taken by mouth. The principal problems in establishing drugs as reinforcers by the oral route of administration are (1) aversive taste, (2) delay in onset of central nervous system effects, and (3) consumption of low volumes of drug solution. Strategies have been devised to successfully overcome these problems, and orally delivered drugs can be established as effective reinforcers. Reinforcing actions are demonstrated by consumption of greater volumes of drug solution than volumes of the water vehicle, and supporting evidence for reinforcing effects consists of the maintenance of behavior under intermittent schedules of reinforcement and the generation of orderly dose-response functions. This article presents an overview of studies of behavior reinforced by oral drug reinforcement. Factors that control oral drug intake include dose, schedule of reinforcement, food restriction, and alternative reinforcers. Many drugs, administered by the experimenter, can alter oral drug reinforcement. Relative reinforcing effects can be assessed by choice procedures and by persistence of behavior across increases in schedule size. In general, reinforcing effects increase directly with dose. Rhesus monkeys prefer combinations of reinforcing drugs to the component drugs. The taste of drug solutions may act as a conditioned reinforcer and a discriminative stimulus. Consequences of drug intake include tolerance and physiological dependence. Findings with orally self-administered drugs are similar to many findings with other positive reinforcers, including intravenously self-administered drugs.

A controlled investigation of propofol, thiopentone and methohexitone.

PubMed

Gold, M I; Abraham, E C; Herrington, C

1987-09-01

This was a randomized study of 180 ASA physical status I and II patients, 60 in each group who received propofol (PROP), 2.5 mg . kg-1, thiopentone (THIO), 4 mg . kg-1, or methohexitone (METH), 1.5 mg . kg-1. Control values, followed by changes after induction and during a 3-min delay before intubation were recorded for the following parameters: heart rate (HR), systolic and diastolic blood pressures (SBP, DBP), respiratory rate (RR), end-tidal CO2 (PETCO2), and induction time (IT). In addition, the incidence of adverse reactions and time for recovery from anaesthesia were noted. The IT (mean +/- SE) was 35 +/- 1 sec for propofol, 35 +/- 1.2 sec for thiopentone and 34 +/- 1.4 sec for methohexitone. Ninety-three per cent of the PROP group fell asleep with one dose and required no additional doses. Fifty per cent of each of the THIO and METH groups required additional agents (p less than 0.05). METH was associated with the highest elevation in HR, PROP the least (p less than 0.05). PROP was associated with the most decrease in SBP and DBP and in addition respiratory depression (p less than 0.05). The incidence of injection pain or excitatory activity was equal in the three groups with the exception that 14 patients who received METH developed hiccoughs while none did in the other groups. PROP was associated with the most rapid recovery, particularly with respect to the orientation time. We conclude that PROP is an effective alternative to barbiturate induction and that the published recommended doses of THIO and METH are often ineffective.

[Ketamine as anesthetic agent in electroconvulsion therapy].

PubMed

Janke, C; Bumb, J M; Aksay, S S; Thiel, M; Kranaster, L; Sartorius, A

2015-05-01

Electroconvulsive therapy (ECT) is a well-established, safe and effective treatment for severe psychiatric disorders. Ketamine is known as a core medication in anesthesiology and has recently gained interest in ECT practice as there are three potential advantages: (1) ketamine has no anticonvulsive actions, (2) according to recent studies ketamine could possess a unique intrinsic antidepressive potential and (3) ketamine may exhibit neuroprotective properties, which again might reduce the risk of cognitive side effects associated with ECT. The use of ketamine in psychiatric patients has been controversially discussed due to its dose-dependent psychotropic and psychotomimetic effects. This study was carried out to test if the occurrence of side effects is comparable and if seizure quality is better with ketamine when compared to thiopental. This retrospective study analyzed a total of 199 patients who received ketamine anesthesia for a total of 2178 ECT sessions. This cohort was compared to patients who were treated with thiopental for 1004 ECT sessions. A repeated measurement multiple logistic regression analysis revealed significant advantages in the ketamine group for seizure concordance and postictal suppression (both are surrogates for central inhibition). S-ketamin also necessitated the use of a higher dose of urapidil and a higher maximum postictal heart frequency. Clinically relevant psychiatric side effects were rare in both groups. No psychiatric side effects occurred in the subgroup of patients with schizophrenia (ketamine: n = 30). The mean dose of S-ketamine used increased in the first years but stabilized at 63 mg per patient in 2014. From these experiences it can be concluded that S-ketamine can be recommended at least as a safe alternative to barbiturates.

Predictors of Stroke and Coma After Neurosurgery: An ACS-NSQIP Analysis.

PubMed

Larsen, Alexandra M G; Cote, David J; Karhade, Aditya V; Smith, Timothy R

2016-09-01

The American College of Surgeons National Surgical Quality Improvement Program database aims to reduce 30-day postoperative complications. Reduction of postoperative stroke and coma can decrease length and cost of hospitalization, improve patient functional status, and decrease morbidity and mortality. We performed a search of the American College of Surgeons National Surgical Quality Improvement Program database for all patients from 2006 to 2013 undergoing an operation with a surgeon whose primary specialty was neurologic surgery. Of 94,546 neurosurgical patients reported, there were 687 (0.73%) cases of postoperative stroke and coma. The annual rate of coma longer than 24 hours decreased from 0.90% in 2006 to 0.002% in 2013 (P < 0.001), and the annual rate of stroke decreased from 1.2% in 2006 to 0.5% in 2013 (P = 0.013). Multivariate analysis showed that inpatient status (P = 0.001; odds ratio [OR], 30.3), age (P = 0.005; OR, 1.012), history of diabetes (P = 0.017; OR, 1.515), ventilator dependence (P < 0.001; OR, 4.379), impaired sensorium (P < 0.001; OR, 2.314), history of coma longer than 24 hours (P < 0.001; OR, 2.655), hemiparesis (P = 0.022; OR, 1.492), cerebrovascular accident/stroke with neurologic deficit (P < 0.001; OR, 2.091), cerebrovascular accident/stroke without neurologic deficit (P = 0.001; OR, 2.44), and tumor involving central nervous system (P < 0.001; OR, 2.928) are significant risk factors for developing postneurosurgical stroke and coma. The rate of postneurosurgical stroke decreased from 1.2% in 2006 to 0.5% in 2013 and the rate of postneurosurgical coma greater than 24 hours decreased from 0.9% in 2006 to 0.002% in 2013. Ten risk factors for developing postneurosurgical stroke and coma were identified using multivariable analysis. These risk factors should be assessed preoperatively and incorporated into clinical decision making so that individuals who are at higher risk for the development of stroke and coma can be appropriately monitored during the postoperative period. Copyright © 2016 Elsevier Inc. All rights reserved.

Yellow fever

MedlinePlus

... the heart, liver, and kidney. Bleeding disorders, seizures, coma, and delirium may also occur. Symptoms may include: ... heartbeats (arrhythmias) Bleeding (may progress to hemorrhage) Seizures Coma

[Myxedema coma. A case reported].

PubMed

Rebollo-Gómez, Héctor

2010-01-01

Myxedema coma is a life-threatening condition; it is a complication of untreated hypothyroidism and an endocrine emergency. Most patients are elderly women with a previous history of long-standing hypothyroidism which presents during the winter. The myxedema coma has an insidious onset and it is very rare; its recognition can be quite difficult. Once suspected, treatment can be lifesaving and should be start promptly in anticipation of confirmation of the diagnosis by laboratory test. The mortality rate is high. I presented a case of an old woman with myxedema coma with an undiagnosed hypothyroidism, with altered mental status, normal temperature, pneumonia, hyponatremia and high level of creatine phosphokinase, who presented in the emergency room.

A CO2-rich coma model applied to the neutral coma of Comet West

NASA Technical Reports Server (NTRS)

Mitchell, G. F.; Swift, M. B.; Huntress, W. T.

1982-01-01

Models of the cometary coma in which the dominant volatile is CO2 have been constructed for a range of heliocentric distances. Model coma abundances of C2, C3, and CN are compared with the abundances observed in Comet West and are found to be in good agreement. Furthermore, the variation with heliocentric distance of C2, C3, and CN model abundances agree well with the observed variation in Comet West. The present work lends detailed support to a previous suggestion that a substance more volatile than water, such as CO2, controls the evaporation of the nucleus of Comet West. The implications for cometary formation are briefly discussed.

The dust distribution within the inner coma of comet P/Halley 1982i - Encounter by Giotto's impact detectors

NASA Technical Reports Server (NTRS)

Mcdonnell, J. A. M.; Evans, G. C.; Evans, S. T.; Alexander, W. M.; Burton, W. M.; Firth, J. G.; Bussoletti, E.; Grard, R. J. L.; Hanner, M. S.; Sekanina, Z.

1987-01-01

Analyses are presented of Giotto's Dust Impact Detection System experiment measurements of dust grains incident on the Giotto dust shield along its trajectory through the coma of comet P/Halley on March 13 and 14, 1986. Ground-based CCD imagery of the inner coma dust continuum at the time of the encounter are used to derive the area of grains intercepted by Giotto. Data obtained at large masses show clear evidence of a decrease in the mass distribution index at these masses within the coma; it is shown that such a value of the mass index can furnish sufficient mass for consistency with an observed deceleration.

Thermal modeling of cometary nuclei

NASA Astrophysics Data System (ADS)

Weissman, P. R.; Kieffer, H. H.

1981-09-01

A model of the sublimation of volatile ices from a cometary nucleus is presented which includes the effects of (1) diurnal heating and cooling, (2) rotation period and pole orientation, (3) the thermal properties of the ice and subsurface layers, and (4) the contributions from coma opacity, scattering and thermal emission where the properties of the coma are derived from the integrated rate of volatile production by the nucleus. In applying the model to the case of the 1986 apparition of Halley's comet, it is found that the generation of a cometary dust coma increases the total energy reaching the Halley nucleus due to the greater geometrical cross-section of the coma as compared with the bare nucleus. The calculated coma opacity of Halley is about 0.2 at 1 AU from the sun and 1.2 at perihelion. Possible consequences of the results obtained for the generation of nongravitational forces, volatile production rates for comets and cometary lifetimes against sublimation are discussed.

Coma Morphology Due to an Extended Active Region and Implications for the Spin State of Comet Hale-Bopp

NASA Technical Reports Server (NTRS)

Samarasinha, Nalin H.

2000-01-01

We show that the circular character of continuum structures observed in the coma of comet Hale-Bopp around the perihelion passage is most likely due to a dust jet from a large extended active region on the surface. Coma morphology due to a wide jet is different from that due to a narrow jet. The latter shows foreshortening effects due to observing geometry, wider jet produces more circular features. This circularization effect provides a self-consistent explanation for the evolution of near-perihelion coma morphology. No changes in the direction of the rotational angular momentum vector are required during this period in contrast to the models of Schleicher et al. This circularization effect also enables us to produce near-circular coma features in the S-E quadrant during 1997 late February and therefore questions the basic premise on which Sekanina bases his morphological arguments for a gravitationally bound satellite nucleus.

Chemical Aspects of General Anesthesia: Part II. Current Practices

ERIC Educational Resources Information Center

Brunsvold, Robert; Ostercamp, Daryl L.

2006-01-01

The basics of balanced general anesthesia developed since 1956 and the update on existing practices of intravenous induction anesthetics and inhalational anesthetics are discussed. Some of the progressive anesthetics discussed are propofol instead of barbiturate such as thiopental or methohexital, inhalational anesthetic halothane,…

Synthesis of pyrimidine-2,4,6-trione derivatives: Anti-oxidant, anti-cancer, α-glucosidase, β-glucuronidase inhibition and their molecular docking studies.

PubMed

Barakat, Assem; Islam, Mohammad Shahidul; Al-Majid, Abdullah Mohammed; Ghabbour, Hazem A; Yousuf, Sammer; Ashraf, Mahwish; Shaikh, Nimra Naveed; Iqbal Choudhary, M; Khalil, Ruqaiya; Ul-Haq, Zaheer

2016-10-01

This paper describes a facile protocol, efficient, and environmentally benign for the synthesis a series of barbiturate acid substituted at C5 position 3a-o. The desired compounds subjected in vitro for different set of bioassays including against anti-oxidant (DPPH and super oxide scavenger assays), anti-cancer, α-glucosidase and β-glucuronidase inhibitions. Compound 3m (IC50=22.9±0.5μM) found to be potent α-glucosidase enzyme inhibitors and showed more activity than standard acarbose (IC50=841±1.73μM). Compound 3f (IC50=86.9±4.33μM) found to be moderate β-Glucuronidase enzyme inhibitors and showed activity comparatively less than the standard d-saccharic acid 1,4-lactone (IC50=45.75±2.16μM). Furthermore, in sillico investigation was carried out to investigate bonding mode of barbiturate acid derivatives. Copyright © 2016 Elsevier Inc. All rights reserved.

Knoevenagel Reaction of Unprotected Sugars

NASA Astrophysics Data System (ADS)

Scherrmann, Marie-Christine

The Knoevenagel reaction of unprotected sugars was investigated in the 1950s using zinc chloride as promoter. The so-called Garcia Gonzalez reaction had been almost forgotten for 50 years, until the emergence of new water tolerant catalysts having Lewis acid behavior. The reaction was thus reinvestigated and optimal conditions have been found to prepare trihydroxylated furan derivatives from pentose or β-tetrahydrofuranylfuran from hexoses with non-cyclic β-keto ester or β-diketones. Other valuable compounds such as β-linked tetrahydrobenzofuranyl glycosides or hydroxyalkyl-3,3,6,6,-tetramethyl-3,4,5,6,7,9-hexahydro-1H-xanthene-1,8(2H)-dione can be obtained using cyclic β-dicarbonylic derivatives. Apart from one report in the 1950s, the Knoevenagel reaction of unprotected carbohydrate in basic condition has been studied only in the mid-1980s to prepare C-glycosyl barbiturates from barbituric acids and, later on, from non-cyclic β-diketones, β-C-glycosidic ketones. The efficient method exploited to prepare such compounds has found an industrial development in cosmetics.

[Biperiden abuse as a partial factor in polytoxicomania].

PubMed

Schulte, R M

1988-03-01

We found 16 patients (15%) taking the anticholinergic biperiden because of its psychotropic action, occasionally, rather frequently or regularly, among a subgroup of 120 drug-dependent patients (drugs of the barbiturate and amphetamin types) out of a studied total of 194 imprisoned male addicts. These biperiden abusers suffered without exception from polytoxicomania associated with drug dependence and alcoholism. Most prominent was drug dependence on drugs of the morphine type. We could not prove a case of an isolated "primary" abuse of biperiden. Direct medical prescription was a rather secondary factor in procuring this preparation, in contrast to analgesics, tranquilisers, barbiturates and clomethiazol. Increase of biperiden abuse is due, on the one hand, to a generally noticeable tendency to polytoxicomania, and on the other hand to a change in Federal German drug prescription rules effective 1 August 1986 according to which fenetylline hydrochloride, a sympathomimetic, is now subject to medical prescription. Other centrally acting anticholinergics were unknown among this group of patients and were not abused. The results are discussed on the basis of available literature.

[The coma awakening unit, between intensive care and rehabilitation].

PubMed

Mimouni, Arnaud

2015-01-01

After intensive care and before classic neurological rehabilitation is possible, patients in an altered state of consciousness are cared for at early stages in so-called coma awakening units. The care involves, on the one hand, the complex support of the patient's awakening from coma as a neurological and existential process, and on the other, support for their families. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Evaluating early administration of the hydroxymethylglutaryl-CoA reductase inhibitor simvastatin in the prevention and treatment of delirium in critically ill ventilated patients (MoDUS trial): study protocol for a randomized controlled trial.

PubMed

Casarin, Annalisa; McAuley, Daniel F; Alce, Timothy M; Zhao, Xiaobei; Ely, E Wesley; Jackson, Jim C; McDowell, Cliona; Agus, Ashley; Murphy, Lynn; Page, Valerie J

2015-05-16

The incidence of delirium in ventilated patients is estimated at up to 82%, and it is associated with longer intensive care and hospital stays, and long-term cognitive impairment and mortality. The pathophysiology of delirium has been linked with inflammation and neuronal apoptosis. Simvastatin has pleiotropic properties; it penetrates the brain and, as well as reducing cholesterol, reduces inflammation when used at clinically relevant doses over the short term. This is a single centre randomised, controlled trial which aims to test the hypothesis that treatment with simvastatin will modify delirium incidence and outcomes. The ongoing study will include 142 adults admitted to the Watford General Hospital Intensive Care Unit who require mechanical ventilation in the first 72 hours of admission. The primary outcome is the number of delirium- and coma-free days in the first 14 days. Secondary outcomes include incidence of delirium, delirium- and coma-free days in the first 28 days, days in delirium and in coma at 14 and 28 days, number of ventilator-free days at 28 days, length of critical care and hospital stay, mortality, cognitive decline and healthcare resource use. Informed consent will be taken from patient's consultee before randomisation to receive either simvastatin (80 mg) or placebo once daily. Daily data will be recorded until day 28 after randomisation or until discharge from the ICU if sooner. Surviving patients will be followed up on at six months from discharge. Plasma and urine samples will be taken to investigate the biological effect of simvastatin on systemic markers of inflammation, as related to the number of delirium- and coma-free days, and the potential of cholinesterase activity and beta-amyloid as predictors of the risk of delirium and long-term cognitive impairment. This trial will test the efficacy of simvastatin on reducing delirium in the critically ill. If patients receiving the statin show a reduced number of days in delirium compared with the placebo group, the inflammatory theory implicated in the pathogenesis of delirium will be strengthened. The trial was registered with the International Standard Randomised Controlled Trial Registry ( ISRCTN89079989 ) on 26 March 2013.

Contemporary approach to neurologic prognostication of coma after cardiac arrest.

PubMed

Ben-Hamouda, Nawfel; Taccone, Fabio S; Rossetti, Andrea O; Oddo, Mauro

2014-11-01

Coma after cardiac arrest (CA) is an important cause of admission to the ICU. Prognosis of post-CA coma has significantly improved over the past decade, particularly because of aggressive postresuscitation care and the use of therapeutic targeted temperature management (TTM). TTM and sedatives used to maintain controlled cooling might delay neurologic reflexes and reduce the accuracy of clinical examination. In the early ICU phase, patients' good recovery may often be indistinguishable (based on neurologic examination alone) from patients who eventually will have a poor prognosis. Prognostication of post-CA coma, therefore, has evolved toward a multimodal approach that combines neurologic examination with EEG and evoked potentials. Blood biomarkers (eg, neuron-specific enolase [NSE] and soluble 100-β protein) are useful complements for coma prognostication; however, results vary among commercial laboratory assays, and applying one single cutoff level (eg, > 33 μg/L for NSE) for poor prognostication is not recommended. Neuroimaging, mainly diffusion MRI, is emerging as a promising tool for prognostication, but its precise role needs further study before it can be widely used. This multimodal approach might reduce false-positive rates of poor prognosis, thereby providing optimal prognostication of comatose CA survivors. The aim of this review is to summarize studies and the principal tools presently available for outcome prediction and to describe a practical approach to the multimodal prognostication of coma after CA, with a particular focus on neuromonitoring tools. We also propose an algorithm for the optimal use of such multimodal tools during the early ICU phase of post-CA coma.

Outcome in patients with bacterial meningitis presenting with a minimal Glasgow Coma Scale score

PubMed Central

Lucas, Marjolein J.; Brouwer, Matthijs C.; van der Ende, Arie

2014-01-01

Objective: In bacterial meningitis, a decreased level of consciousness is predictive for unfavorable outcome, but the clinical features and outcome in patients presenting with a minimal score on the Glasgow Coma Scale are unknown. Methods: We assessed the incidence, clinical characteristics, and outcome of patients with bacterial meningitis presenting with a minimal score on the Glasgow Coma Scale from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands from 2006 to 2012. Results: Thirty of 1,083 patients (3%) presented with a score of 3 on the Glasgow Coma Scale. In 22 of 30 patients (73%), the minimal Glasgow Coma Scale score could be explained by use of sedative medication or complications resulting from meningitis such as seizures, cerebral edema, and hydrocephalus. Systemic (86%) and neurologic (47%) complications occurred frequently, leading to a high proportion of patients with unfavorable outcome (77%). However, 12 of 30 patients (40%) survived and 7 patients (23%) had a good functional outcome, defined as a score of 5 on the Glasgow Outcome Scale. Patients presenting with a minimal Glasgow Coma Scale score on admission and bilaterally absent pupillary light responses, bilaterally absent corneal reflexes, or signs of septic shock on admission all died. Conclusions: Patients with community-acquired bacterial meningitis rarely present with a minimal score on the Glasgow Coma Scale, but this condition is associated with high rates of morbidity and mortality. However, 1 out of 5 of these severely ill patients will make a full recovery, stressing the continued need for aggressive supportive care in these patients. PMID:25340065

Pre- and Post-equinox ROSINA production rates calculated using a realistic empirical coma model derived from AMPS-DSMC simulations of comet 67P/Churyumov-Gerasimenko

NASA Astrophysics Data System (ADS)

Hansen, Kenneth; Altwegg, Kathrin; Berthelier, Jean-Jacques; Bieler, Andre; Calmonte, Ursina; Combi, Michael; De Keyser, Johan; Fiethe, Björn; Fougere, Nicolas; Fuselier, Stephen; Gombosi, Tamas; Hässig, Myrtha; Huang, Zhenguang; Le Roy, Lena; Rubin, Martin; Tenishev, Valeriy; Toth, Gabor; Tzou, Chia-Yu

2016-04-01

We have previously used results from the AMPS DSMC (Adaptive Mesh Particle Simulator Direct Simulation Monte Carlo) model to create an empirical model of the near comet coma (<400 km) of comet 67P for the pre-equinox orbit of comet 67P/Churyumov-Gerasimenko. In this work we extend the empirical model to the post-equinox, post-perihelion time period. In addition, we extend the coma model to significantly further from the comet (~100,000-1,000,000 km). The empirical model characterizes the neutral coma in a comet centered, sun fixed reference frame as a function of heliocentric distance, radial distance from the comet, local time and declination. Furthermore, we have generalized the model beyond application to 67P by replacing the heliocentric distance parameterizations and mapping them to production rates. Using this method, the model become significantly more general and can be applied to any comet. The model is a significant improvement over simpler empirical models, such as the Haser model. For 67P, the DSMC results are, of course, a more accurate representation of the coma at any given time, but the advantage of a mean state, empirical model is the ease and speed of use. One application of the empirical model is to de-trend the spacecraft motion from the ROSINA COPS and DFMS data (Rosetta Orbiter Spectrometer for Ion and Neutral Analysis, Comet Pressure Sensor, Double Focusing Mass Spectrometer). The ROSINA instrument measures the neutral coma density at a single point and the measured value is influenced by the location of the spacecraft relative to the comet and the comet-sun line. Using the empirical coma model we can correct for the position of the spacecraft and compute a total production rate based on the single point measurement. In this presentation we will present the coma production rate as a function of heliocentric distance both pre- and post-equinox and perihelion.

Compressed spectral arrays of patients with fulminant hepatic failure in hepatic coma undergoing liver transplantation.

PubMed

Takeichi, Takayuki; Asonuma, Katsuhiro; Kim, Ildeok; Inomata, Yukihiro; Kasahara, Mureo; Ohwada, Susumu; Morishita, Yasuo; Tanaka, Koichi

2002-08-01

Assessing the coma status of patients with fulminant hepatic failure (FHF) is important for determining the reversibility of brain damage and for properly timing liver transplantation. The compressed spectral array (CSA) method is a frequency analysis technique that processes electroencephalogram signals by computer to facilitate on-line interpretation. This method has been used to monitor the consciousness levels of neurointensive care unit patients. In this study, we determined whether CSA could be used to assess the coma status of patients with FHF, and whether CSA provided information that was useful in deciding when to proceed with liver transplantation. CSA recording was carried out in 17 FHF patients with encephalopathy (coma grade III-IV) who underwent living-related liver transplantation between August 1997 and May 1999. Recording was performed with a Neuromonitor OEE-72044 (NIHON KOHDEN, Osaka, Japan) every 24 h before and after transplantation, until the patients regained consciousness. The CSAs of healthy controls were distributed almost equally between 0 and 16 Hz. The CSAs of FHF patients in hepatic coma were classified into three patterns. Eight of the 17 patients showed very prominent slow waves of about 2 Hz (group A), and seven patients showed strongly suppressed rapid waves between 8 and 16 Hz (group B). The remaining two patients showed CSA patterns that were similar to those of healthy controls, even though these patients were comatose (group C). Abnormal CSA patterns were observed in 15 of the 17 patients (88%). Group B patients seemed to have higher coma grades than did group A patients. Sixteen patients underwent liver transplantation, completely recovered from hepatic encephalopathy, and subsequently showed CSA patterns similar to those of healthy controls. One patient died without regaining consciousness. These results suggest that CSA is useful in assessing the coma status of FHF patients and in evaluating electrophysiological recovery from hepatic coma after liver transplantation.

Analysis of IUE Observations of Hydrogen in Comets

NASA Technical Reports Server (NTRS)

Combi, Michael R.; Feldman, Paul D.

1998-01-01

The 15-years worth of hydrogen Lyman-alpha observations of cometary comae obtained with the International Ultraviolet Explorer (IUE) satellite had gone generally unanalyzed because of two main modeling complications. First, the inner comae of many bright (gas productive) comets are often optically thick to solar Lyman-alpha radiation. Second, even in the case of a small comet (low gas production) the large IUE aperture is quite small as compared with the immense size of the hydrogen coma, so an accurate model which properly accounts for the spatial distribution of the coma is required to invert the infrared brightnesses to column densities and finally to H atom production rates. Our Monte Carlo particle trajectory model (MCPTM), which for the first time provides the realistic full phase space distribution of H atoms throughout the coma has been used as the basis for the analysis of IUE observations of the inner coma. The MCPTM includes the effects of the vectorial ejection of the H atoms upon dissociation of their parent species (H2O and OH) and of their partial collisional thermalization. Both of these effects are crucial to characterize the velocity distribution of the H atoms. This combination of the MCPTM and spherical radiative transfer code had already been shown to be successful in understanding the moderately optically thick coma of comet P/Giacobini-Zinner and the coma of comet Halley that varied from being slightly to very optically thick. Both of these comets were observed during solar minimum conditions. Solar activity affects both the photochemistry of water and the solar Lyman-alpha radiation flux. The overall plan of this program here was to concentrate on comets observed by IUE at other time during the solar cycle, most importantly during the two solar maxima of 1980 and 1990. Described herein are the work performed and the results obtained.

Delirium and coma evaluated in mechanically ventilated patients in the intensive care unit in Japan: a multi-institutional prospective observational study.

PubMed

Tsuruta, Ryosuke; Oda, Yasutaka; Shintani, Ayumi; Nunomiya, Shin; Hashimoto, Satoru; Nakagawa, Takashi; Oida, Yasuhisa; Miyazaki, Dai; Yabe, Shigemi

2014-06-01

The object of this study is to evaluate the prevalence and effects of delirium on 28-day mortality in critically ill patients on mechanical ventilation in Japan. Prospective cohort study was conducted in medical and surgical intensive care units (ICUs) of 24 medical centers. Patients were followed up daily for delirium during ICU stay after enrollment. Coma was defined with the Richmond Agitation Sedation Scale score of -4 or -5. Delirium was diagnosed using the Confusion Assessment Method for the ICU. The Cox proportional hazards regression model was used to assess the effects of delirium and coma on 28-day mortality, time to extubation, and time to ICU discharge; delirium and coma were included as time-varying covariates after controlling for age, Acute Physiology and Chronic Health Evaluation II score, ventilator-associated pneumonia, and the reason for intubation with infection. Of 180 patients, 115 patients (64%) developed delirium. Moreover, 15 patients (8%) died within 28 days after ICU admission, including 7 patients who experienced coma and 8 patients who experienced both coma and delirium. There were no deaths among patients who did not experience coma. Delirium was associated with a shorter time to extubation (hazard ratio [HR], 2.52; 95% confidence interval [CI], 1.65-3.85; P<.001) and a shorter ICU length of stay in comatose patients (HR, 1.59; 95% CI, 1.04-2.44; P=.034), whereas delirium appeared with prolonged time to ICU discharge among patients without coma, although statistical significance was not detected due to limited analytical power (HR, 0.62; 95% CI, 0.34-1.12; P=.114). Delirium during ICU stay was not associated with higher mortality. Further study is needed to investigate the discrepancy between these and previous data. Copyright © 2014 Elsevier Inc. All rights reserved.

Comparison of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in predicting mortality in critically ill patients*.

PubMed

Wijdicks, Eelco F M; Kramer, Andrew A; Rohs, Thomas; Hanna, Susan; Sadaka, Farid; O'Brien, Jacklyn; Bible, Shonna; Dickess, Stacy M; Foss, Michelle

2015-02-01

Impaired consciousness has been incorporated in prediction models that are used in the ICU. The Glasgow Coma Scale has value but is incomplete and cannot be assessed in intubated patients accurately. The Full Outline of UnResponsiveness score may be a better predictor of mortality in critically ill patients. Thirteen ICUs at five U.S. hospitals. One thousand six hundred ninety-five consecutive unselected ICU admissions during a six-month period in 2012. Glasgow Coma Scale and Full Outline of UnResponsiveness score were recorded within 1 hour of admission. Baseline characteristics and physiologic components of the Acute Physiology and Chronic Health Evaluation system, as well as mortality were linked to Glasgow Coma Scale/Full Outline of UnResponsiveness score information. None. We recruited 1,695 critically ill patients, of which 1,645 with complete data could be linked to data in the Acute Physiology and Chronic Health Evaluation system. The area under the receiver operating characteristic curve of predicting ICU mortality using the Glasgow Coma Scale was 0.715 (95% CI, 0.663-0.768) and using the Full Outline of UnResponsiveness score was 0.742 (95% CI, 0.694-0.790), statistically different (p = 0.001). A similar but nonsignificant difference was found for predicting hospital mortality (p = 0.078). The respiratory and brainstem reflex components of the Full Outline of UnResponsiveness score showed a much wider range of mortality than the verbal component of Glasgow Coma Scale. In multivariable models, the Full Outline of UnResponsiveness score was more useful than the Glasgow Coma Scale for predicting mortality. The Full Outline of UnResponsiveness score might be a better prognostic tool of ICU mortality than the Glasgow Coma Scale in critically ill patients, most likely a result of incorporating brainstem reflexes and respiration into the Full Outline of UnResponsiveness score.

Right median nerve electrical stimulation for acute traumatic coma (the Asia Coma Electrical Stimulation trial): study protocol for a randomised controlled trial.

PubMed

Wu, Xiang; Zhang, Chao; Feng, Junfeng; Mao, Qing; Gao, Guoyi; Jiang, Jiyao

2017-07-10

Traumatic brain injury (TBI) has become the most common cause of death and disability in persons between 15 and 30 years of age, and about 10-15% of patients affected by TBI will end up in a coma. Coma caused by TBI presents a significant challenge to neuroscientists. Right median nerve electrical stimulation has been reported as a simple, inexpensive, non-invasive technique to speed recovery and improve outcomes for traumatic comatose patients. This multicentre, prospective, randomised (1:1) controlled trial aims to demonstrate the efficacy and safety of electrical right median nerve stimulation (RMNS) in both accelerating emergence from coma and promoting long-term outcomes. This trial aims to enrol 380 TBI comatose patients to partake in either an electrical stimulation group or a non-stimulation group. Patients assigned to the stimulation group will receive RMNS in addition to standard treatment at an amplitude of 15-20 mA with a pulse width of 300 μs at 40 Hz ON for 20 s and OFF for 40 s. The electrical treatment will last for 8 h per day for 2 weeks. The primary endpoint will be the percentage of patients regaining consciousness 6 months after injury. The secondary endpoints will be Extended Glasgow Outcome Scale, Coma Recovery Scale-Revised and Disability Rating Scale scores at 28 days, 3 months and 6 months after injury; Glasgow Coma Scale, Glasgow Coma Scale Motor Part and Full Outline of Unresponsiveness scale scores on day 1 and day 7 after enrolment and 28 days, 3 months and 6 months after injury; duration of unconsciousness and mechanical ventilation; length of intensive care unit and hospital stays; and incidence of adverse events. Right median nerve electrical stimulation has been used as a safe, inexpensive, non-invasive therapy for neuroresuscitation of coma patients for more than two decades, yet no trial has robustly proven the efficacy and safety of this treatment. The Asia Coma Electrical Stimulation (ACES) trial has the following novel features compared with other major RMNS trials: (1) the ACES trial is an Asian multicentre randomised controlled trial; (2) RMNS therapy starts at an early stage 7-14 days after the injury; and (3) various assessment scales are used to evaluate the condition of patients. We hope the ACES trial will lead to optimal use of right median nerve electrical treatment. ClinicalTrials.gov, NCT02645578 . Registered on 23 December 2015.

The Coma Cluster Luminosity Function from Ultraviolet to Near-Infrared

NASA Astrophysics Data System (ADS)

Andreon, S.; Cuillandre, J.-C.; Pello, R.

The Coma cluster luminosity function (LF) from ultraviolet (2000 AA ) to the near-infrared (H band) is summarized. In the UV the LF is very steep, much steeper than in the optical. The steep Coma UV LF implies that faint and bright galaxies give similar contributions to the total UV flux and to the total metal production rate. The ComaUV LF is dominated in number and luminosity by blue galaxies, which are often faint in the optical. Therefore the Coma UV LF is dominated by star forming galaxies, not by massive and large galaxies. The optical Coma LF is relatively steep (alpha=-1.4) over the 11 magnitudes sampled, but its slope and shape depend on considered filter and magnitude. We found a clear steeping of the FL going from B to R bands, indicative of the presence of a large number of red dwarfs, as faint as three bright globular clusters. Furthermore, using Hubble Space Telescope images, we discover that blends of globular clusters, not resolved in individual components due to seeing, look like dwarf galaxies when observed from the ground and are numerous and bright. The existence of these fake extended sources increases the steepness of the LF at faint magnitudes, if not deal on. This concern affects previous deep probing of the luminosity function, but not the present work. The near-infrared LF wa s computed on a near-infrared selected sample of galaxies which photometry is complete down to the typical dwarf (M* +5) luminosity. The Coma LF can be described by a Schechter function with intermediate slope (alpha sim-1.3), plus a dip at MH~-22 mag. The shape of the Coma LF in H band is quite similar to th e one found in the B band. The similarity of the LF in the optical and H bands implies that in the central region of Coma there is no new population of galaxies which is too faint to be observed in the optical band (because dust enshrouded, for instance), down to the magnitudes of dwarfs. The exponential cut of the LF at the bright end is in good agreement with the one derived from shallower near-infrared samples o f galaxies, both in clusters and in the field. The faint end of the LF, reaching MH~-19 mag (roughly MB~ -15), is steep, but less than previously suggested from shallower near-infrared observations of an adjacent region in the Coma cluster.

[Thyroid Storm and Myxedema Coma].

PubMed

Milkau, Malte; Sayk, Friedhelm

2018-03-01

Thyroid storm and myxedema coma are the most severe clinical forms of thyroid dysfunction. While both hyper- and hypothyroidsm are common diseases, thyroid storm and myxedema coma are rare. Due to their unspecific signs and symptoms they are often difficult to diagnose. Both disorders are medical emergencies, which still show a significant mortality. The following article summarizes diagnostic tools and treatment options for these disorders. © Georg Thieme Verlag KG Stuttgart · New York.

Intravenous administration of levothyroxine for treatment of suspected myxedema coma complicated by severe hypothermia in a dog.

PubMed

Henik, R A; Dixon, R M

2000-03-01

A 7-year-old male English Coonhound with suspected myxedema coma complicated by severe hypothermia and metabolic abnormalities was treated with a combination of active external and core rewarming techniques, i.v. and oral administration of levothyroxine, supplemental oxygen, and administration of fluids (0.9% NaCl solution). Myxedema coma develops as a consequence of severe hypothyroidism and is characterized by a hypometabolic, stuporous state. Myxedema coma is associated with a high mortality rate, and most reported cases have involved Doberman Pinschers. Intravenous administration of levothyroxine can be used successfully in combination with oral administration to restore normal metabolic function and assist in warming and thermoregulation, although dosages should be conservative to avoid adverse cardiovascular effects.

[Selected Readings for the Professional Working with Drug Related Problems.

ERIC Educational Resources Information Center

Wisconsin Univ., Madison.

A bibliography of selected readings compiled at the University of Wisconsin for the National Drug Education Training Program. These selected readings include information on narcotics, amphetamines, mescaline, psilogybin, hallucinogens, LSD, barbiturates, alcohol, and other stimulants. The intended user of this bibliography is the professional…

The Effectiveness of the Human Patient Simulator in Teaching Anesthesia Pharmacology to First Year Nurse Anesthesia Students

DTIC Science & Technology

2002-12-01

month period. Simulator scenarios included overdose of inhalation anesthetic, oxygen source failure, cardiac arrest, malignant hypothermia, tension...may most effectively attenuate emergence delirium? a. Propofol b. Versed*** c. Fentanyl d. Droperidol 6. Barbituric acid is formed by the

Comet 67P/Churyumov-Gerasimenko during the Rosetta mission: numerical simulation of dusty gas coma

NASA Astrophysics Data System (ADS)

Tenishev, Valeriy; Combi, Michael; Rubin, Martin; Hansen, Kenneth; Gombosi, Tamas

The Rosetta spacecraft is en route to comet 67P/Churyumov-Gerasimenko for a rendezvous, landing, and extensive orbital phase beginning in 2014. Having a limited amount of information regarding its coma, interpretation of measurements and safety consideration of the spacecraft will require modeling of the comet's environment. Such models should be able to simulate both the gas and dust phases of the coma as well as the interaction between them in a self-consistent manner. The relevant physical processes in the coma include photolytic reactions and interaction with the nucleus for the gas phase and drag by the gas, gravity of the nucleus, solar gravity and radiation pressure, and charging by the ambient plasma for the dust phase. Developing of such modeling capabilities will be able to link measurements obtained by different instruments onboard of spacecraft. Some examples of cometary comae simulations can be found in [1-3]. In this work we present our kinetic model of a dusty gas coma [4] with results of its application to the case of comet Churyumov-Gerasimenko at conditions corresponding to some stages the during the Rosetta mission. Based on the surface properties and local production rates obtained by MIRO, RSI and VIRTIS the model will be able to propagate the injected gas and dust into the coma linking the measurements to those obtained by ALICE, MIDAS and ROSINA for the gas phase and COSIMA and GIADA for the dust phase of the coma. A simultaneous simulation of the major components of the multi-phase coma will allow us to link observations of the gas and dust phases. In this work we present results of a numerical study of neutral/ionized multispecies gaseous and electrically charged dust environment of the comet Churyumov-Gerasimenko at a helio-centric distance of 1.3 AU. The simulation is performed in fully 3D geometry with a realistic nucleus model that describes its topological features and source distribution. Both, neutral and ionized components of the gas phase of the coma are simulated kinetically. Photolytic reactions are taken into account. Parameters of the ambient plasma as well as the distribution of electric/magnetic fields are obtained from an MHD simulation [5] of the coma connected to the solar wind. Those parameters are used for calculation of the electric charge of dust grains. Trajectories of ions and electrically charged dust grains are simulated by accounting for the gas drag, Lorentz force, nucleus gravity and radiation pressure. REFFERENCES [1] M.R. Combi, Icarus, 123, 207-226 (1996) [2] Y. Skorov, G.N. Markelov, H.U. Keller, Solar Sys. Res. 38, 455-475 (2004) [3] V.V. Zakharov, A.V. Rodionov, G. A. Lukianov, J.F. Crifo, Icarus 201, 358-380 (2009) [4] V. Tenishev, M. R. Combi, B. Davidsson, Astrophysical Journal, 685, 659-677 (2008) [5] M. Rubin, K. C. Hansen, T. Gombosi, M. R. Combi, K. Altwegg, H. Balsiger, Icarus, 199, 505-519 (2009)

Drug-induced apnea.

PubMed

Boutroy, M J

1994-01-01

Drugs have been in the past and will in the future still be liable to induce apnea in neonates, infants and older children. At these different stages of development, the child may be abnormally vulnerable to respiratory disorders and apnea, and doses of drugs, without any abnormal side effects in adult patients, can be harmful in younger subjects. Drugs responsible for apnea during development are numerous, but more than half of the problems are induced by sedatives and hypnotics, among which phenothiazines, barbiturates, benzodiazepines (included transplacentally acquired) and general anesthetics are a few. Other pharmacological families are apnea inducers in the neonatal period and childhood: analgesics and opioid narcotics, agents acting at the levels of neuromuscular function and autonomic ganglia, and cardiovascular agents. The pathogenesis of these apneas depends on the disturbance of any mechanism responsible for the respiratory activity: medullary centers and brain stem structures, afferent influx to CNS, sleep stages, upper airways, lungs and respiratory muscles. At key stages such as birth and infancy, drugs may emphasize the particular sensitivity of the mechanisms responsible for inducing apnea. This might explain unexpected respiratory disorders during development.

Clinically favourable effects of ketamine as an anaesthetic for electroconvulsive therapy: a retrospective study.

PubMed

Kranaster, Laura; Kammerer-Ciernioch, Jutta; Hoyer, Carolin; Sartorius, Alexander

2011-12-01

In a retrospective chart review, we examined the effects of ketamine, an N-methyl-d-aspartate (NMDA) receptor antagonist, as electroconvulsive therapy (ECT) anaesthetic in patients suffering from therapy-resistant depression. We included 42 patients who received ECT treatment with either ketamine (n = 16) or the barbiturate thiopental (n = 26). We analysed the number of sessions until completion of ECT treatment (used as a surrogate parameter for outcome), psychopathology as assessed by pre- and post-ECT Mini-Mental State Examination (MMSE) and Hamilton Rating Scale for Depression (HAM-D) scores as well as ECT and seizure parameters (stimulation dose, seizure duration and concordance, urapidil dosage for post-seizure blood pressure management). The ketamine group needed significantly fewer ECT sessions and had significantly lower HAM-D and higher MMSE scores afterwards. As expected, the ketamine group needed more urapidil for blood pressure control. Taking into account the limits inherent in a retrospective study design and the rather small sample size, our results nonetheless point towards synergistic effects of ECT and ketamine anaesthesia, less cognitive side effects and good tolerability of ketamine.

Repeatability of the Dust and Gas Morphological Structures in the Coma of Comet

NASA Astrophysics Data System (ADS)

Lejoly, Cassandra; Samarasinha, N. H.; Ojha, L.; Schleicher, D. G.

2013-10-01

Comet 1P/Halley is the most famous comet in history and has been observed for over two millennia, making it one of the most extensively studied comets. The morphology in the coma of comet 1P/Halley originates due to the activity at the nucleus and could be used as a probe of the nuclear rotation and the activity. We will present the results from a study summarizing the evolution of coma morphology of comet 1P/Halley observed from ground between October 1985 and June 1986. The results to be presented include analysis of dust features as well as gas (CN) features in the coma and comparisons will be made between their spatial and temporal evolution. About 80 CN images and 300 continuum images from the Small Bodies Node of the NASA Planetary Data System were analyzed using image enhancement techniques that were not available n the 1980s. This enables us to see coma structure never observed before in comet 1P/Halley. Because of the comet's proximity to Earth, most of our best signal-to-noise images were taken in the March-April interval of 1986. Despite the limited coverage of preceding and following months, there is a sufficient number of images to monitor morphological evolution over many months. The initial synodic periods as a function of time used to phase the images together were extrapolated from the lightcurves of the active coma (Schleicher et al. 1990, AJ, 100, 896-912). We will present the periods of repeatability of individual coma features measured using the position angle at different spatial distances from the nucleus in adjacent cycles. Separate features appear to have slightly different periods of repeatability, perhaps depending on the corresponding source regions on the nucleus and/or projection effects. The periods of repeatability of coma morphologies will be presented as a function of time from the perihelion. These results will ultimately be used in detailed modeling of the coma morphologies of comet 1P/Halley over the 1985-1986 apparition in order to characterize the activity of the comet. This work is supported by NASA Planetary Atmospheres grant NNX11AD85G and C.L.'s participation at the meeting is supported by a gift to the Lunar and Planetary Laboratory at the University of Arizona.

Combining DSMC Simulations and ROSINA/COPS Data of Comet 67P/Churyumov-Gerasimenko to Develop a Realistic Empirical Coma Model and to Determine Accurate Production Rates

NASA Astrophysics Data System (ADS)

Hansen, K. C.; Fougere, N.; Bieler, A. M.; Altwegg, K.; Combi, M. R.; Gombosi, T. I.; Huang, Z.; Rubin, M.; Tenishev, V.; Toth, G.; Tzou, C. Y.

2015-12-01

We have previously published results from the AMPS DSMC (Adaptive Mesh Particle Simulator Direct Simulation Monte Carlo) model and its characterization of the neutral coma of comet 67P/Churyumov-Gerasimenko through detailed comparison with data collected by the ROSINA/COPS (Rosetta Orbiter Spectrometer for Ion and Neutral Analysis/COmet Pressure Sensor) instrument aboard the Rosetta spacecraft [Bieler, 2015]. Results from these DSMC models have been used to create an empirical model of the near comet coma (<200 km) of comet 67P. The empirical model characterizes the neutral coma in a comet centered, sun fixed reference frame as a function of heliocentric distance, radial distance from the comet, local time and declination. The model is a significant improvement over more simple empirical models, such as the Haser model. While the DSMC results are a more accurate representation of the coma at any given time, the advantage of a mean state, empirical model is the ease and speed of use. One use of such an empirical model is in the calculation of a total cometary coma production rate from the ROSINA/COPS data. The COPS data are in situ measurements of gas density and velocity along the ROSETTA spacecraft track. Converting the measured neutral density into a production rate requires knowledge of the neutral gas distribution in the coma. Our empirical model provides this information and therefore allows us to correct for the spacecraft location to calculate a production rate as a function of heliocentric distance. We will present the full empirical model as well as the calculated neutral production rate for the period of August 2014 - August 2015 (perihelion).

Characteristics of Near-Death Experiences Memories as Compared to Real and Imagined Events Memories

PubMed Central

Brédart, Serge; Dehon, Hedwige; Ledoux, Didier; Laureys, Steven; Vanhaudenhuyse, Audrey

2013-01-01

Since the dawn of time, Near-Death Experiences (NDEs) have intrigued and, nowadays, are still not fully explained. Since reports of NDEs are proposed to be imagined events, and since memories of imagined events have, on average, fewer phenomenological characteristics than real events memories, we here compared phenomenological characteristics of NDEs reports with memories of imagined and real events. We included three groups of coma survivors (8 patients with NDE as defined by the Greyson NDE scale, 6 patients without NDE but with memories of their coma, 7 patients without memories of their coma) and a group of 18 age-matched healthy volunteers. Five types of memories were assessed using Memory Characteristics Questionnaire (MCQ – Johnson et al., 1988): target memories (NDE for NDE memory group, coma memory for coma memory group, and first childhood memory for no memory and control groups), old and recent real event memories and old and recent imagined event memories. Since NDEs are known to have high emotional content, participants were requested to choose the most emotionally salient memories for both real and imagined recent and old event memories. Results showed that, in NDE memories group, NDE memories have more characteristics than memories of imagined and real events (p<0.02). NDE memories contain more self-referential and emotional information and have better clarity than memories of coma (all ps<0.02). The present study showed that NDE memories contained more characteristics than real event memories and coma memories. Thus, this suggests that they cannot be considered as imagined event memories. On the contrary, their physiological origins could lead them to be really perceived although not lived in the reality. Further work is needed to better understand this phenomenon. PMID:23544039

A SUZAKU SEARCH FOR NONTHERMAL EMISSION AT HARD X-RAY ENERGIES IN THE COMA CLUSTER

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wik, Daniel R.; Sarazin, Craig L.; Finoguenov, Alexis

2009-05-10

The brightest cluster radio halo known resides in the Coma cluster of galaxies. The relativistic electrons producing this diffuse synchrotron emission should also produce inverse Compton emission that becomes competitive with thermal emission from the intracluster medium (ICM) at hard X-ray energies. Thus far, claimed detections of this emission in Coma are controversial. We present a Suzaku HXD-PIN observation of the Coma cluster in order to nail down its nonthermal hard X-ray content. The contribution of thermal emission to the HXD-PIN spectrum is constrained by simultaneously fitting thermal and nonthermal models to it and a spatially equivalent spectrum derived frommore » an XMM-Newton mosaic of the Coma field. We fail to find statistically significant evidence for nonthermal emission in the spectra which are better described by only a single- or multitemperature model for the ICM. Including systematic uncertainties, we derive a 90% upper limit on the flux of nonthermal emission of 6.0 x 10{sup -12} erg s{sup -1} cm{sup -2} (20-80 keV, for {gamma} = 2.0), which implies a lower limit on the cluster-averaged magnetic field of B>0.15 {mu}G. Our flux upper limit is 2.5 times lower than the detected nonthermal flux from RXTE and BeppoSAX. However, if the nonthermal hard X-ray emission in Coma is more spatially extended than the observed radio halo, the Suzaku HXD-PIN may miss some fraction of the emission. A detailed investigation indicates that {approx}50%-67% of the emission might go undetected, which could make our limit consistent with that of Rephaeli and Gruber and Fusco-Femiano et al. The thermal interpretation of the hard Coma spectrum is consistent with recent analyses of INTEGRAL and Swift data.« less

Which clinical variable influences health-related quality of life the most after spontaneous subarachnoid hemorrhage? Hunt and Hess scale, Fisher score, World Federation of Neurosurgeons score, Brussels coma score, and Glasgow coma score compared.

PubMed

Kapapa, Thomas; Tjahjadi, Martin; König, Ralph; Wirtz, Christian Rainer; Woischneck, Dieter

2013-12-01

To determine the strength of the correlation between the Hunt and Hess scale, Fisher score, Brussels coma score, World Federation of Neurosurgeons score, and Glasgow coma score and health-related quality of life. Evaluable questionnaires from 236 patients (5.6 years [± standard deviation, 2.854 years] on average after hemorrhage) were included in the analysis. Quality of life was documented using the MOS-36 item short form health survey. Because of the ordinal nature of the variables, Kendall tau was used for calculation. Significance was established as P ≤ 0.05. Weak and very weak correlations were found in general (r ≤ 0.28). The strongest correlations were found between the Glasgow coma score and quality of life (r = 0.236, P = 0.0001). In particular, the "best verbal response" achieved the strongest correlations in the comparison, at r = 0.28/P = 0.0001. The Fisher score showed very weak correlations (r = -0.148/P = 0.012). The Brussels coma score (r = -0.216/P = 0.0001), Hunt and Hess scale (r = -0.197/P = 0.0001), and the World Federation of Neurosurgeons score (r = -0.185/P = 0.0001) revealed stronger correlations, especially in terms of the physical aspects of quality of life. The Glasgow coma scale revealed the strongest, and the Fisher score showed the weakest correlations. Thus the Fisher score, as an indicator of the severity of a hemorrhage, has little significance in terms of health-related quality of life. Copyright © 2013 Elsevier Inc. All rights reserved.

Prognosis of patients in coma after acute subdural hematoma due to ruptured intracranial aneurysm.

PubMed

Torné, Ramon; Rodríguez-Hernández, Ana; Romero-Chala, Fabián; Arikan, Fuat; Vilalta, Jordi; Sahuquillo, Juan

2016-04-01

Acute subdural hematomas (aSDH) secondary to intracranial aneurysm rupture are rare. Most patients present with coma and their functional prognosis has been classically considered to be very poor. Previous studies mixed good-grade and poor-grade patients and reported variable outcomes. We reviewed our experience by focusing on patients in coma only and hypothesized that aSDH might worsen initial mortality but not long-term functional outcome. Between 2005 and 2013, 440 subarachnoid hemorrhage (SAH) patients were admitted to our center. Nineteen (4.3%) were found to have an associated aSDH and 13 (2.9%) of these presented with coma. Their prospectively collected clinical and outcome data were reviewed and compared with that of 104 SAH patients without aSDH who presented with coma during the same period. Median aSDH thickness was 10mm. Four patients presented with an associated aneurysmal cortical laceration and only one had good recovery. Overall, we observed good long-term outcomes in both SAH patients in coma with aSDH and those without aSDH (38.5% versus 26.4%). Associated aSDH does not appear to indicate a poorer long-term functional prognosis in SAH patients presenting with coma. Anisocoria and brain herniation are observed in patients with aSDH thicknesses that are smaller than those observed in trauma patients. Despite a high initial mortality, early surgery to remove the aSDH results in a good outcome in over 60% of survivors. Aneurysmal cortical laceration appears to be an independent entity which shows a poorer prognosis than other types of aneurysmal aSDH. Copyright © 2015 Elsevier Ltd. All rights reserved.

Dark energy and the structure of the Coma cluster of galaxies

NASA Astrophysics Data System (ADS)

Chernin, A. D.; Bisnovatyi-Kogan, G. S.; Teerikorpi, P.; Valtonen, M. J.; Byrd, G. G.; Merafina, M.

2013-05-01

Context. We consider the Coma cluster of galaxies as a gravitationally bound physical system embedded in the perfectly uniform static dark energy background as implied by ΛCDM cosmology. Aims: We ask if the density of dark energy is high enough to affect the structure of a large and rich cluster of galaxies. Methods: We base our work on recent observational data on the Coma cluster, and apply our theory of local dynamical effects of dark energy, including the zero-gravity radius RZG of the local force field as the key parameter. Results: 1) Three masses are defined that characterize the structure of a regular cluster: the matter mass MM, the dark-energy effective mass MDE (<0), and the gravitating mass MG (=MM + MDE). 2) A new matter-density profile is suggested that reproduces the observational data well for the Coma cluster in the radius range from 1.4 Mpc to 14 Mpc and takes the dark energy background into account. 3) Using this profile, we calculate upper limits for the total size of the Coma cluster, R ≤ RZG ≈ 20 Mpc, and its total matter mass, MM ≲ MM(RZG) = 6.2 × 1015 M⊙. Conclusions: The dark energy antigravity affects the structure of the Coma cluster strongly at large radii R ≳ 14 Mpc and should be considered when its total mass is derived.

Jet Morphology and Coma Analysis of 103P/Hartley 2: Temporal Evolution and Interspecies Comparisons

NASA Astrophysics Data System (ADS)

Vaughan, Charles M.; Pierce, Donna M.; Cochran, Anita L.

2014-11-01

We present our results on an expanded study of the jet and coma behavior of comet 103P/Hartley 2 (a continuation of original results presented in Vaughan et al. 2012). We observed Hartley 2 pre- and post-perihelion in 2010 using the George and Cynthia Mitchell Spectrograph on the 2.7 m telescope at McDonald Observatory. Data for CN, C2, C3, CH, and NH2 were collected over six nights from 15 July to 10 November. The spectral data were used to create coma maps for each of the observed species, and the maps were processed using radial and azimuthal division techniques to create enhanced images of the coma to examine coma morphological features. To compliment the ongoing investigation of Hartley 2 as studied by the EPOXI flyby mission, we use findings from other researchers (Belton et al. 2012; Syal et al. 2012; Thomas et al. 2012) to identify dust jet locations on the nucleus and compare the computed jet directions to the radical densities in the coma at our observation times. We also calculate production rates and mixing ratios with water for suspected parent species. This work was funded by the National Science Foundation Graduate K-12 (GK-12) STEM Fellows program (Award No. DGE-0947419) and NASA’s Planetary Atmospheres program (Award No. NNX14AH18G).

Chemistry in the Dusty Coma of Comet Hale-Bopp

NASA Astrophysics Data System (ADS)

Boice, D. C.; Cochran, A. L.; Disanti, M. A.; Huebner, W. F.

1998-09-01

Recent progress on a multifluid, hydrodynamic model is presented for the dusty gas flow in the inner coma of comet Hale-Bopp at several heliocentric distances. The simulations are based on a 1-D neutral coma model with detailed photo and gas-phase chemistry and dust entrainment by the gas, a separate energy balance for the electrons, separate flow of the neutral gas, fast neutral atomic and molecular hydrogen, and dust entrainment with fragmentation. The model accounts for three sources of gas release: sublimation from surface ices, transport of gas from subsurface regions through the surface, and release of gas from dust in the coma. This permits a consistent study of the importance and strength of each possible source for a variety of gas-phase species. The simulations allow a study of the changes with heliocentric distance of features within a cometary coma, e.g., spatial distributions of gas-phase species and dust of various sizes and the velocity and temperature profiles. In particular, the model is used to probe spatial distributions of gas-phase species (e.g., CN, CH, C_3, C_2, HCN, HNC, CO) and dust, and the velocity and temperature structure to understand the complex gas-phase chemistry that occurs in the inner coma. Comparisons with observations are made where available to characterize the environment surrounding comet Hale-Bopp and to aid in assimilating a variety of diverse observations of this unique comet.

Bacteriology of aspiration pneumonia in patients with acute coma.

PubMed

Lauterbach, Enise; Voss, Frederik; Gerigk, Roland; Lauterbach, Michael

2014-12-01

Loss of protective airway reflexes in patients with acute coma puts these patients at risk of aspiration pneumonia complicating the course of the primary disease. Available data vary considerably with regard to bacteriology, role of anaerobic bacteria, and antibiotic treatment. Our objective was to research the bacteriology of aspiration pneumonia in acute coma patients who were not pre-treated with antibiotics or hospitalized within 30 days prior to the event. We prospectively analyzed 127 patient records from adult patients admitted, intubated and ventilated to a tertiary medical intensive care unit with acute coma. Bacteriology and antibiotic resistance testing from tracheal aspirate sampled within 24 h after admission, blood cultures, ICU scores (APACHE II, SOFA), hematology, and clinical chemistry were assessed. Patients were followed up until death or hospital discharge. The majority of patients with acute coma suffered from acute cardiovascular disorders, predominantly myocardial infarction, followed by poisonings, and coma of unknown cause. In a majority of our patients, microaspiration resulted in overt infection. Most frequently S. aureus, H. influenzae, and S. pneumoniae were isolated. Anaerobic bacteria (Bacteroides spec., Fusobacteria, Prevotella spec.) were isolated from tracheal aspirate in a minority of patients, and predominantly as part of a mixed infection. Antibiotic monotherapy with a 2nd generation cephalosporin, or a 3rd generation gyrase inhibitor, was most effective in our patients regardless of the presence of anaerobic bacteria.

29 CFR Appendix A to Subpart T to... - Examples of Conditions Which May Restrict or Limit Exposure to Hyperbaric Conditions

Code of Federal Regulations, 2012 CFR

2012-07-01

... duration of isolation. History of seizure disorder other than early febrile convulsions. Malignancies... or drug use. Conditions requiring continuous medication for control (e.g., antihistamines, steroids, barbiturates, moodaltering drugs, or insulin). Meniere's disease. Hemoglobinopathies. Obstructive or...

29 CFR Appendix A to Subpart T of... - Examples of Conditions Which May Restrict or Limit Exposure to Hyperbaric Conditions

Code of Federal Regulations, 2013 CFR

2013-07-01

... duration of isolation. History of seizure disorder other than early febrile convulsions. Malignancies... or drug use. Conditions requiring continuous medication for control (e.g., antihistamines, steroids, barbiturates, moodaltering drugs, or insulin). Meniere's disease. Hemoglobinopathies. Obstructive or...

29 CFR Appendix A to Subpart T to... - Examples of Conditions Which May Restrict or Limit Exposure to Hyperbaric Conditions

Code of Federal Regulations, 2011 CFR

2011-07-01

... duration of isolation. History of seizure disorder other than early febrile convulsions. Malignancies... or drug use. Conditions requiring continuous medication for control (e.g., antihistamines, steroids, barbiturates, moodaltering drugs, or insulin). Meniere's disease. Hemoglobinopathies. Obstructive or...

29 CFR Appendix A to Subpart T of... - Examples of Conditions Which May Restrict or Limit Exposure to Hyperbaric Conditions

Code of Federal Regulations, 2014 CFR

2014-07-01

... duration of isolation. History of seizure disorder other than early febrile convulsions. Malignancies... or drug use. Conditions requiring continuous medication for control (e.g., antihistamines, steroids, barbiturates, moodaltering drugs, or insulin). Meniere's disease. Hemoglobinopathies. Obstructive or...

Utah Drop-Out Drug Use Questionnaire.

ERIC Educational Resources Information Center

Governor's Citizen Advisory Committee on Drugs, Salt Lake City, UT.

This questionnaire assesses drug use practices in high school drop-outs. The 79 items (multiple choice or apply/not apply) are concerned with demographic data and use, use history, reasons for use/nonuse, attitudes toward drugs, availability of drugs, and drug information with respect to narcotics, amphetamines, LSD, Marijuana, and barbiturates.…

21 CFR 1301.90 - Employee screening procedures.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., assumed that the following questions will become a part of an employer's comprehensive employee screening program: Question. Within the past five years, have you been convicted of a felony, or within the past two.... Question. In the past three years, have you ever knowingly used any narcotics, amphetamines or barbiturates...

29 CFR Appendix A to Subpart T to... - Examples of Conditions Which May Restrict or Limit Exposure to Hyperbaric Conditions

Code of Federal Regulations, 2010 CFR

2010-07-01

... duration of isolation. History of seizure disorder other than early febrile convulsions. Malignancies... or drug use. Conditions requiring continuous medication for control (e.g., antihistamines, steroids, barbiturates, moodaltering drugs, or insulin). Meniere's disease. Hemoglobinopathies. Obstructive or...

Corrigendum to ;Monoalkylated barbiturate derivatives: X-ray crystal structure, theoretical studies, and biological activities; [J. Mol. Struct. 1141 (2017) 624-633

NASA Astrophysics Data System (ADS)

Barakat, Assem; Al-Majid, Abdullah Mohammed; Soliman, Saied M.; Islam, Mohammad Shahidul; Ghawas, Hussain Mansur; Yousuf, Sammer; Choudhary, M. Iqbal; Wadood, Abdul

2017-09-01

;The correct CCDC reference for the compound 3k is 1546475 instead of 1024287 as mentioned in the text on page 625. The authors regret this error and would like to apologize for any inconvenience caused to anyone.;

A Dozen New Galaxies Caught in the Act: Gas Stripping and Extended Emission Line Regions in the Coma Cluster

NASA Astrophysics Data System (ADS)

Yagi, Masafumi; Yoshida, Michitoshi; Komiyama, Yutaka; Kashikawa, Nobunari; Furusawa, Hisanori; Okamura, Sadanori; Graham, Alister W.; Miller, Neal A.; Carter, David; Mobasher, Bahram; Jogee, Shardha

2010-12-01

We present images of extended Hα clouds associated with 14 member galaxies in the Coma cluster obtained from deep narrowband imaging observations with the Suprime-Cam at the Subaru Telescope. The parent galaxies of the extended Hα clouds are distributed farther than 0.2 Mpc from the peak of the X-ray emission of the cluster. Most of the galaxies are bluer than g - r ≈ 0.5 and they account for 57% of the blue (g - r < 0.5) bright (r < 17.8 mag) galaxies in the central region of the Coma cluster. They reside near the red- and blueshifted edges of the radial velocity distribution of Coma cluster member galaxies. Our findings suggest that most of the parent galaxies were recently captured by the Coma cluster potential and are now infalling toward the cluster center with their disk gas being stripped off and producing the observed Hα clouds. Based on data collected at the Subaru Telescope, which is operated by the National Astronomical Observatory of Japan.

The Spatial Distribution of C2, C3, and NH in Comet 2P/Encke

NASA Astrophysics Data System (ADS)

Dorman, Garrett; Pierce, Donna M.; Cochran, Anita L.

2013-12-01

We examine the spatial distribution of C2, C3, and NH radicals in the coma of comet Encke in order to understand their abundances and distributions in the coma. The observations were obtained from 2003 October 22-24, using the 2.7 m telescope at McDonald Observatory. Building on our original study of CN and OH, we have used our modified version of the vectorial model, which treats the coma as one large cone, in order to reproduce Encke's highly aspherical and asymmetric coma. Our results suggest that NH can be explained by the photodissociation of NH2, assuming that NH2 is produced rapidly from NH3 in the innermost coma. Our modeling of C2 and C3 suggests a multi-generational photodissociation process may be required for their production. Using the results of our previous study, we also obtain abundance ratios with respect to OH and CN. Overall, we find that Encke exhibits typical carbon-chain abundances, and the results are consistent with other studies of comet Encke.

Dust in Cometary Comae: Present Understanding of the Structure and Composition of Dust Particles

NASA Technical Reports Server (NTRS)

Levasseur-Regourd, A. C.; Zolensky, M.; Lasue, J.

2007-01-01

In situ probing of a very few cometary comae has shown that dust particles present a low albedo and a low density, and that they consist of both rocky material and refractory organics. Remote observations of solar light scattered by cometary dust provide information on the properties of dust particles in the coma of a larger set of comets. The observations of the linear polarization in the coma indicate that the dust particles are irregular, with a size greater (on the average) than about one micron. Besides, they suggest, through numerical and experimental simulations, that both compact grains and fluffy aggregates (with a power law of the size distribution in the -2.6 to -3 range), and both rather transparent silicates and absorbing organics are present in the coma. Recent analysis of the cometary dust samples collected by the Stardust mission provide a unique ground truth and confirm, for comet 81P/Wild 2, the results from remote sensing observations. Future space missions to comets should, in the next decade, lead to a more precise characterization of the structure and composition of cometary dust particles.

Hyperosmolar diabetic non-ketotic coma, hyperkalaemia and an unusual near death experience.

PubMed

Ting, J Y

2001-03-01

Generally, cardiac arrest due to pulseless electrical activity has a poor outcome, except when reversible factors such as acute hyperkalaemia are identified and managed early. Hyperosmolar diabetic non-ketotic coma may lead to acute hyperkalaemia. Hyperosmolar diabetic non-ketotic coma is a metabolic emergency usually seen in elderly non-insulin dependent diabetics, characterized by severe hyperglycaemia, volume depletion, altered consciousness, confusion and less frequently neurological deficit. Cerebrovascular accident or transient ischaemic attack may be mistakenly diagnosed, particularly if the patient has no history of diabetes mellitus. Delays in diagnosis and management of glycaemic emergencies presenting as a constellation of neurological abnormalities can be avoided by routine early measurement of blood glucose. Hyperosmolar diabetic non-ketotic coma should be considered in any patient with altered consciousness or neurologic deficit in conjunction with hyperglycaemia. As hyperosmolar diabetic non-ketotic coma results in severe fluid depletion, electrolyte disturbance, profound hyperglycaemia and an altered mental state, the guiding principles of therapy include aggressive rehydration, insulin therapy, correction of electrolyte abnormalities and treatment of any underlying illnesses. Treatment of acute hyperkalaemia includes calcium ions, insulin with dextrose, salbutamol and haemodialysis.

A Dusty Coma Model of Comet Hyakutake

NASA Astrophysics Data System (ADS)

Boice, D. C.; Benkhoff, J.

1996-09-01

We present a multifluid, hydrodynamic model for the gas, dust, and plasma flow in a cometary coma appropriate for Comet Hyakutake. The model accounts for three sources of gas release: sublimation from surface ices, transport of gas from subsurface regions through the surface, and release of gas from dust in the coma. The simulations are based on a spherically symmetric neutral coma model with detailed photo and gas-phase chemistry and dust entrainment by the gas. The model includes a separate energy balance for the electrons, separate flow of the neutral gas, fast neutral atomic and molecular hydrogen, and dust entrainment with fragmentation. The simulations allow a study of how certain features of a cometary coma, e.g., spatial distributions of gas-phase species and dust of various sizes, change with heliocentric distance. Special attention is given to observations of hydrocarbon and sulphur species. In comparison with observations, the model can be used to characterize the environment surrounding Hyakutake and aid in assimilating a variety of diverse observations of this bright comet. A complete description of the model and more extensive results with comparisons to observations where possible will be presented.

Challenges in the Management of a Patient with Myxoedema Coma in Ghana: A Case Report.

PubMed

Akpalu, Josephine; Atiase, Yacoba; Yorke, Ernest; Fiscian, Henrietta; Kootin-Sanwu, Cecilia; Akpalu, Albert

2017-03-01

Myxoedema coma is a rare life-threatening disease, and it is essential that it is managed appropriately to reduce the associated high mortality. However, in the setting where efficient healthcare delivery is hampered by inadequacies, the management of such cases may pose a significant challenge. We present the case of a middle-aged woman diagnosed with myxoedema coma and severe hyponatremia. The case report highlights some of the challenges that may be encountered during the management of myxoedema coma in similar settings and outlines the management strategies undertaken to overcome them in the absence of national guidelines. It also brings to the fore the need for clinicians to look out for clinical features suggestive of hypothyroidism particularly among high risk individuals for early diagnosis and treatment. None declared.

Spectroscopic Profiles of Comets Garradd and McNaught

NASA Astrophysics Data System (ADS)

Harris, Ien; Pierce, Donna M.; Cochran, Anita L.

2017-10-01

We have used the integral-field unit spectrograph (the George and Cynthia Mitchell Spectrograph) on the 2.7m Harlan J. Smith telescope at McDonald Observatory to obtain spectroscopic images of the comae of several comets. The images were obtained for various radical species (C2, C3, CN, NH2). Radial and azimuthal average profiles of the radical species were created to enhance any observed cometary coma morphological features. We compare the observed coma features across the observed species and over the different observation periods in order to constrain possible rotational states of the observed comets, as well as determine possible source differences in the coma between the observed radical species. We will present results for several comets, including C/2009 P1 (Garradd) and 260P (McNaught).

[Thyrotoxic storm and myxedema coma].

PubMed

Takasu, N

1999-08-01

Thyrotoxic or hyperthyroid storm is a grave, life-threatening, but relatively infrequent medical emergency. Immediate causes of death in this emergency are severe hyperpyrexia and pulmonary edema associated with arrhythmias, shock, and coma. This emergency is found in Graves' patients most frequently. Myxedema coma is an emergency clinical state caused by severe deficiency of thyroid hormones. This crisis represents the extreme expression of hypothyroidism. While it is quite useful to elicit a history of previous hypothyroidism, thyroid surgery, or radioactive iodine treatment, it is not obtainable.

Perioperative management of a patient with myxedema coma and septicemic shock.

PubMed

Baduni, Neha; Sinha, Sunil Kumar; Sanwal, Manoj K

2012-10-01

Myxedema coma is a life-threatening but uncommon complication of long-standing, neglected hypothyroidism. It was first reported by Ord in 1879. Till date only around 200 cases have been reported in literature. The incidence in European countries is 0.22 per million per year. No epidemiological data is available from the Indian subcontinent. We are reporting the case of an elderly lady who went into life-threatening myxedema coma along with septicemic shock, and was successfully treated with oral thyroxine.

[Hyperammonemia type II as an example of urea cycle disorder].

PubMed

Hawrot-Kawecka, Anna M; Kawecki, Grzegorz P; Duława, Jan

2006-01-01

Ornithine transcarbamylase deficiency is the most common inherited urea cycle disorder. Its clinical manifestations as lethargy, vomites, coma and cerebral edema are the effect of the higher concentration of the ammonia in plasma. Hyperammonemia, caused by mutation in ornithine transcarbamylase gene, is often considered as a reason of coma by pediatricians but skipped by internist, although it is the third reason of hepatic coma in adults. This article is the recapitulation of published studies and their implication on everyday clinical practice.

End-of-mission ROSINA/COPS measurements as a probe of the innermost coma of comet 67P/Churyumov-Gerasimenko

NASA Astrophysics Data System (ADS)

Tenishev, V.; Fougere, N.; Rubin, M.; Tzou, C. Y.; Combi, M. R.; Altwegg, K.; Gombosi, T. I.; Shou, Y.; Huang, Z.; Hansen, K. C.; Toth, G.

2017-12-01

A cometary coma is a unique phenomenon in the Solar system that represents an example of a planetary atmosphere influenced by little or no gravity. Due to the negligible gravity of a comet's nucleus, a coma has a characteristic size that exceeds that of the nucleus itself by many orders of magnitude. An extended dusty gas cloud that forms a coma is affected mainly by molecular collisions, radiative cooling, and photolytic, charge-exchange, and impact-ionization reactions. Such an environment has been extensively observed during the recent Rosetta mission, which was the first mission that escorts a comet along its way through the Solar system for an extended amount of time with the main scientific objectives of characterizing comet's nucleus, determining the surface composition, and studying the comet's activity development. The ROSINA (Rosetta Orbiter Spectrometer for Ion and Neutral Analysis) Comet Pressure Sensor (COPS) onboard the Rosetta spacecraft has performed one of the most exciting observations of the innermost coma during the spacecraft descend maneuver during the last ten hours of the mission when the random and outflow directed pressures in the coma have been measured all the way down to the comet's surface. Performed at such close proximity to the nucleus, these observations can help to characterize effects due to topological features and/or the gas local conditions at the surface of the nucleus. The major focus of the presented study is analyzing of the end-of-mission pressure measurements by the ROSINA/COPS instrument. Because the coma at a heliocentric distance of 3.8 AU was in a collisionless regime, it can be described by solving the Liouville equation, as we have done in our analysis. We have used the SHAP5 nucleus model to account for the topology of the volatile source. Spacecraft trajectory and the instrument pointing with respect to the comet's nucleus have been obtained with the SPICE library. Here, we present results of our analysis and discuss the effects of the surface topology and that of the local surface volatile injection on the distribution of gas in the innermost coma of comet 67P/Churyumov-Gerasimenko.

Analysis of the ROSINA/COPS end-of-mission measurements of the coma of comet 67P/Churyumov-Gerasimenko

NASA Astrophysics Data System (ADS)

Tenishev, Valeriy; Combi, Michael R.; Fougere, Nicolas; Rubin, Martin; Tzou, Chia-Yu; Shou, Yinsi; Gombosi, T. I.; Altwegg, Kathrin; Huang, Zhenguang; Toth, Gabor; Hansen, Kenneth C.

2017-10-01

A cometary coma is a unique phenomenon in the Solar system that represents an example of a planetary atmosphere influenced by little or no gravity. Due to the negligible gravity of a comet’s nucleus, a coma has a characteristic size that exceeds that of the nucleus itself by many orders of magnitude. An extended dusty gas cloud that forms a coma is affected mainly by molecular collisions, radiative cooling, and photolytic, charge-exchange, and impact-ionization reactions.Such an environment has been extensively observed during the recent Rosetta mission, which was the first mission that escorts a comet along its way through the Solar system for an extended amount of time with the main scientific objectives of characterizing comet’s nucleus, determining the surface composition, and studying the comet’s activity development.The ROSINA (Rosetta Orbiter Spectrometer for Ion and Neutral Analysis) Comet Pressure Sensor (COPS) onboard the Rosetta spacecraft has performed one of the most exciting observations of the innermost coma during the spacecraft descend maneuver during the last ten hours of the mission when the random and outflow directed pressures in the coma have been measured all the way down to the comet’s surface. Performed at such close proximity to the nucleus, these observations can help to characterize effects due to topological features and/or the gas local conditions at the surface of the nucleus.The major focus of the presented study is analyzing of the end-of-mission pressure measurements by the ROSINA/COPS instrument. Because the coma at a heliocentric distance of 3.8 AU was in a collisionless regime, it can be described by solving the Liouville equation, as we have done in our analysis. We have used the SHAP5 nucleus model to account for the topology of the volatile source. Spacecraft trajectory and the instrument pointing with respect to the comet’s nucleus have been obtained with the SPICE library. Here, we present results of our analysis and discuss the effects of the surface topology and that of the local surface volatile injection on the distribution of gas in the innermost coma of comet 67P/Churyumov-Gerasimenko.

Chemical Recycling of HCN in Cometary Comae

NASA Astrophysics Data System (ADS)

Boice, Daniel C.; Kawakita, Hideyo; Shinnaka, Yoshiharu; Mumma, Michael J.; Kobayashi, Hitomi; Ogawa, Sayuri

2014-11-01

Modeling is essential to understand the important physical and chemical processes that occur in cometary comae, especially the relationship between putative parent and daughter molecules, such as, HCN and CN. Photochemistry is a major source of ions and electrons that further initiate key gas-phase reactions, contributing to the plethora of molecules and atoms observed in comets. The effects of photoelectrons that interact via impacts are important to the overall excitation and dissociation processes in the inner coma. We consider the relevant processes in the collision-dominated, inner coma of a comet within a global modeling framework to understand observations of HCN and CN. The CN source(s) must be able to produce highly collimated jets, be consistent with the observed CN parent scale length, and have a production rate consistent with the observed CN production. HCN fulfills these conditions in some comets (e.g., 1P/Halley, Hale-Bopp) while it does not in others (e.g., 8P/Tuttle, 6P/d’Arrest, 73P/S-W3, 2P/Encke, 9P/Temple 1 and C/2007 W1).We investigate the chemistry of HCN with our chemical kinetics coma model including a network with other possible CN parents, as well as a dust component that may be a potential source of CN. It is seen that the major destruction pathways of HCN are via photo dissociation (into H and CN) and protonation with water group ions - primarily H3O+. We point out the intriguing “recycling” of HCN via protonation reactions with H3O+, H2O+, OH+, and subsequent dissociative recombination. It seems that HCN molecules observed in the coma can consist of those initially released from the nucleus and those that are freshly formed at different locations in the coma via these protonation/dissociation reactions. We will investigate implications for reconciling discrepancies between observations of HCN and CN in cometary comae.Acknowledgements: We appreciate support from the NSF Planetary Astronomy Program. This program is partially supported by the MEXT Supported Program for the Strategic Research Foundation at Private Universities, 2014-2018.

Long-term outcomes after immediate aortic repair for acute type A aortic dissection complicated by coma.

PubMed

Tsukube, Takuro; Haraguchi, Tomonori; Okada, Yasushi; Matsukawa, Ritsu; Kozawa, Shuichi; Ogawa, Kyoichi; Okita, Yutaka

2014-09-01

The management of acute type A aortic dissection complicated by coma remains controversial. We previously reported an excellent rate of recovery of consciousness provided aortic repair was performed within 5 hours of the onset of symptoms. This study evaluates the early and long-term outcomes using this approach. Between August 2003 and July 2013, of the 241 patients with acute type A aortic dissection brought to the Japanese Red Cross Kobe Hospital and Hyogo Emergency Medical Center, 30 (12.4%) presented with coma; Glasgow Coma Scale was less than 11 on arrival. Surgery was performed in 186 patients, including 27 (14.5%) who were comatose. Twenty-four comatose patients underwent successful aortic repair immediately (immediate group). Their mean age was 71.0 ± 11.1 years, Glasgow Coma Scale was 6.5 ± 2.4, and prevalence of carotid dissection was 79%. For brain protection, deep hypothermia with antegrade cerebral perfusion was used, and postoperative induced hypothermia was performed. Neurologic evaluations were performed using the Glasgow Coma Scale, National Institutes of Health Stroke Scale, and modified Rankin Scale. In the immediate group, the time from the onset of symptoms to arrival in the operating theater was 222 ± 86 minutes. Hospital mortality was 12.5%. Full recovery of consciousness was achieved in 79% of patients in up to 30 days. Postoperative Glasgow Coma Scale and National Institutes of Health Stroke Scale improved significantly when compared with the preoperative score (P < .05), and postoperative activities of daily living independence (modified Rankin Scale <3) was achieved in 50% of patients. The mean follow-up period was 56.5 months, and the cumulative survival was 48.2% after 10 years. Cox proportional hazards regression analysis indicated that immediate repair (hazard ratio, 4.3; P = .007) was the only significant predictor of postoperative survival over a 5-year period. The early and long-term outcomes as a result of immediate aortic repair for acute type A aortic dissection complicated by coma were satisfactory. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

The Meteoroid Fluence at Mars Due to Comet C/2013 A1 (Siding Spring)

NASA Technical Reports Server (NTRS)

Moorhead, A.; Wiegert, P.; Blaauw, R.; McCarty, C.; Kingery, A.; Cooke, W.

2014-01-01

Long-period comet C/2013 A1 (Siding Spring) will experience a close encounter with Mars on 2014 Oct 19. A collision between the comet and the planet has been ruled out, but the comet's coma may envelop Mars and its man-made satellites. By the time of the close encounter, five operational spacecraft will be present near Mars. Characterizing the coma is crucial for assessing the risk posed to these satellites by meteoroid impacts. We present an analytic model of cometary comae that describes the spatial and size distributions of cometary dust and meteoroids. This model correctly reproduces, to within an order of magnitude, the number of impacts recorded by Giotto near 1P/Halley [1] and by Stardust near comet 81P/Wild 2 [2]. Applied to Siding Spring, our model predicts a total particle fluence near Mars of 0.02 particles per square meter. In order to determine the degree to which Siding Spring's coma deviates from a sphere, we perform numerical simulations which take into account both gravitational effects and radiative forces. We take the entire dust component of the coma and tail continuum into account by simulating the ejection and evolution of dust particles from comet Siding Spring. The total number of particles simulated is essentially a free parameter and does not provide a check on the total fluence. Instead, these simulations illustrate the degree to which the coma of Siding Spring deviates from the perfect sphere described by our analytic model (see Figure). We conclude that our analytic model sacrifices less than an order of magnitude in accuracy by neglecting particle dynamics and radiation pressure and is thus adequate for order-of-magnitude fluence estimates. Comet properties may change unpredictably and therefore an analytic coma model that enables quick recalculation of the meteoroid fluence is highly desirable. NASA's Meteoroid Environment Office is monitoring comet Siding Spring and taking measurements of cometary brightness and dust production. We will discuss our coma model and nominal fluence taking the latest observations into account.

Dwarf galaxies in the coma cluster: Star formation properties and evolution

NASA Astrophysics Data System (ADS)

Hammer, Derek M.

The infall regions of galaxy clusters are unique laboratories for studying the impact of environment on galaxy evolution. This intermediate region links the low-density field environment and the dense core of the cluster, and is thought to host recently accreted galaxies whose star formation is being quenched by external processes associated with the cluster. In this dissertation, we measure the star formation properties of galaxies at the infall region of the nearby rich cluster of galaxies, Coma. We rely primarily on Ultraviolet (UV) data owing to its sensitivity to recent star formation and we place more emphasis on the properties of dwarf galaxies. Dwarf galaxies are good tracers of external processes in clusters but their evolution is poorly constrained as they are intrinsically faint and hence more challenging to detect. We make use of deep GALEX far-UV and near-UV observations at the infall region of the Coma cluster. This area of the cluster has supporting photometric coverage at optical and IR wavelengths in addition to optical spectroscopic data that includes deep redshift coverage of dwarf galaxies in Coma. Our GALEX observations were the deepest exposures taken for a local galaxy cluster. The depth of these images required alternative data analysis techniques to overcome systematic effects that limit the default GALEX pipeline analysis. Specifically, we used a deblending method that improved detection efficiency by a factor of ˜2 and allowed reliable photometry a few magnitudes deeper than the pipeline catalog. We performed deep measurements of the total UV galaxy counts in our field that were used to measure the source confusion limit for crowded GALEX fields. The star formation properties of Coma members were studied for galaxies that span from starbursts to passive galaxies. Star-forming galaxies in Coma tend to have lower specific star formation rates, on average, as compared to field galaxies. We show that the majority of these galaxies are likely in the process of being quenched or were only recently quenched. We modeled the quenching timescales for transition galaxies, or “green valley” objects, and found that the majority are quenched in less than 1 Gyr. This timescale is consistent with rapid dynamical processes that are active in the cluster environment as opposed to the more gradual quenching mechanisms that exist in the group environment. For the passive galaxy population, we have measured an average stellar age of 6-8 Gyr for the red sequence which is consistent with previous studies based on spectroscopic observations. We note that the star formation properties of Coma member galaxies were established from photometry alone, as opposed to using spectroscopic data which are more challenging to obtain for dwarf galaxies. We have measured the faintest UV luminosity functions (LFs) presented for a rich galaxy cluster thus far. The Coma UV LFs are 3.5 mag fainter than previous studies in Coma, and are sufficiently deep that we reach the dwarf passive galaxy population for the first time. We have introduced a new technique for measuring the LF which avoids color selection effects associated with previous methods. The UV LFs constructed separately for star-forming and passive galaxies follow a similar distribution at faint magnitudes, which suggests that the recent quenching of infalling dwarf star-forming galaxies is sufficient to build the dwarf passive population in Coma. The Coma UV LFs show a turnover at faint magnitudes as compared to the field, owing to a deficit of dwarf galaxies with stellar masses below M∗ = 108 M⊙ . We show that the UV LFs for the field behind the Coma cluster are nearly identical to the average field environment, and do not show evidence for a turnover at faint magnitudes. We suspect that the missing dwarf galaxies in Coma are severely disrupted by tidal processes as they are accreted onto the cluster, just prior to reaching the infall region studied here.

Prediction of Recovery from Coma After CPR

MedlinePlus

... to pain. There is good evidence* that myoclonus status epilepticus within the first day after CPR accurately predicts poor recovery from coma. Myoclonus status epilepticus is a constant twitching of muscles, including the ...

Using an integral-field unit spectrograph to study radical species in cometary coma

NASA Astrophysics Data System (ADS)

Lewis, Benjamin; Pierce, Donna M.; Vaughan, Charles M.; Cochran, Anita

2015-01-01

We have observed several comets using an integral-field unit spectrograph (the George and Cynthia Mitchell Spectrograph) on the 2.7m Harlan J. Smith telescope at McDonald Observatory. Full-coma spectroscopic images were obtained for various radical species (C2, C3, CN, NH2). Various coma enhancements were used to identify and characterize coma morphological features. The azimuthal average profiles and the Haser model were used to determine production rates and possible parent molecules. Here, we present the work completed to date, and we compare our results to other comet taxonomic surveys. This work was funded by the National Science Foundation Graduate K-12 (GK-12) STEM Fellows program (Award No. DGE-0947419), NASA's Planetary Atmospheres program (Award No. NNX14AH18G), and the Fund for Astrophysical Research, Inc.

Using an integral-field unit spectrograph to study radical species in cometary coma

NASA Astrophysics Data System (ADS)

Lewis, Benjamin; Pierce, Donna; Cochran, Anita; Vaughan, Charles

2014-11-01

We have observed several comets using an integral-field unit spectrograph (the George and Cynthia Mitchell Spectrograph) on the 2.7m Harlan J. Smith telescope at McDonald Observatory. Full-coma spectroscopic images were obtained for various radical species (C2, C3, CN, NH2). Various coma enhancements were used to identify and characterize coma morphological features. The azimuthal average profiles and the Haser model were used to determine production rates and possible parent molecules. Here, we present the work completed to date, and we compare our results to other comet taxonomic surveys. This work was funded by the National Science Foundation Graduate K-12 (GK-12) STEM Fellows program (Award No. DGE-0947419), NASA’s Planetary Atmospheres program (Award No. NNX14AH18G), and the Fund for Astrophysical Research, Inc.

Postoperative myxoedema coma.

PubMed

James, Robert; James, Jessie; Vij, Amarjit Singh; Vij, Kamaljeet Kaur

2014-02-13

Hypothyroidism is a commonly diagnosed endocrine disorder in medicine. Hyponatraemia is reported in up to 10% of hypothyroid patients, although it is usually mild and rarely causes symptoms. Myxoedema coma is a rare manifestation of hypothyroidism and it can be lethal if it goes undiagnosed and untreated. Our patient presented with an acute manifestation of probable long-standing, but undiagnosed, hypothyroidism. She was asymptomatic but when subjected to surgery (identifiable stress factor) it precipitated as myxoedema coma. Stressful situations such as surgery or infection are the usual precipitating factors for myxoedema coma. The patient responded well to treatment with levothyroxin, 0.9% saline infusion and other general supportive measures. Judicious use of intravenous saline to correct hyponatraemia is important. Correction with 3% normal saline should be carried out with great caution, as rapid correction with 3% normal saline can lead to central pontine demyelination.

Postoperative myxoedema coma

PubMed Central

James, Robert; James, Jessie; Vij, Amarjit Singh; Vij, Kamaljeet Kaur

2014-01-01

Hypothyroidism is a commonly diagnosed endocrine disorder in medicine. Hyponatraemia is reported in up to 10% of hypothyroid patients, although it is usually mild and rarely causes symptoms. Myxoedema coma is a rare manifestation of hypothyroidism and it can be lethal if it goes undiagnosed and untreated. Our patient presented with an acute manifestation of probable long-standing, but undiagnosed, hypothyroidism. She was asymptomatic but when subjected to surgery (identifiable stress factor) it precipitated as myxoedema coma. Stressful situations such as surgery or infection are the usual precipitating factors for myxoedema coma. The patient responded well to treatment with levothyroxin, 0.9% saline infusion and other general supportive measures. Judicious use of intravenous saline to correct hyponatraemia is important. Correction with 3% normal saline should be carried out with great caution, as rapid correction with 3% normal saline can lead to central pontine demyelination. PMID:24526192

A human brain network derived from coma-causing brainstem lesions.

PubMed

Fischer, David B; Boes, Aaron D; Demertzi, Athena; Evrard, Henry C; Laureys, Steven; Edlow, Brian L; Liu, Hesheng; Saper, Clifford B; Pascual-Leone, Alvaro; Fox, Michael D; Geerling, Joel C

2016-12-06

To characterize a brainstem location specific to coma-causing lesions, and its functional connectivity network. We compared 12 coma-causing brainstem lesions to 24 control brainstem lesions using voxel-based lesion-symptom mapping in a case-control design to identify a site significantly associated with coma. We next used resting-state functional connectivity from a healthy cohort to identify a network of regions functionally connected to this brainstem site. We further investigated the cortical regions of this network by comparing their spatial topography to that of known networks and by evaluating their functional connectivity in patients with disorders of consciousness. A small region in the rostral dorsolateral pontine tegmentum was significantly associated with coma-causing lesions. In healthy adults, this brainstem site was functionally connected to the ventral anterior insula (AI) and pregenual anterior cingulate cortex (pACC). These cortical areas aligned poorly with previously defined resting-state networks, better matching the distribution of von Economo neurons. Finally, connectivity between the AI and pACC was disrupted in patients with disorders of consciousness, and to a greater degree than other brain networks. Injury to a small region in the pontine tegmentum is significantly associated with coma. This brainstem site is functionally connected to 2 cortical regions, the AI and pACC, which become disconnected in disorders of consciousness. This network of brain regions may have a role in the maintenance of human consciousness. © 2016 American Academy of Neurology.

The Dependence of the Circumnuclear Coma Structure on the Properties of the Nucleus. IV. Structure of the Night-Side Gas Coma of a Strongly Sublimating Nucleus

NASA Astrophysics Data System (ADS)

Crifo, J. F.; Rodionov, A. V.

2000-12-01

The structure of the nightside coma in the vicinity of a strongly active comet nucleus of pure ice is investigated by solving gasdynamic equations for the flow of water vapour sublimated from—or condensed onto—the nucleus surface. To guarantee the physical validity of the solution, both Euler and Navier-Stokes Equations are solved, and the solutions are compared. A spherical nucleus is considered first and then a triaxial ellipsoidal nucleus. The results show that (1) a fluid coma of significant extent and very complicated physical structure is formed; (2) for low heat conduction transfer across the nucleus from the dayside to the nightside surface, a narrow conical weak shock appears near to the antisolar axis; the whole nightside surface acts as a cold trap for the vapor, part of which recondenses onto it; (3) for intermediate heat conduction, part of the nightside surface becomes weakly sublimating, and a different weak shock pattern is formed; and (4) at high heat conduction, the whole nightside surface is weakly sublimating, and the resulting flow pattern becomes similar to that existing in a coma formed by diffusion from the nucleus interior (see Crifo, Rodionov and Bockelée-Morvan, 1999, Icarus138, 83-106). The results are compared to related model results by other authors, and a discussion is made of their relevance to the 1996 observation of the near-nucleus nightside coma of Comet C/1996 B2 Hyakutake.

Functional coma.

PubMed

Ludwig, L; McWhirter, L; Williams, S; Derry, C; Stone, J

2016-01-01

Functional coma - here defined as a prolonged motionless dissociative attack with absent or reduced response to external stimuli - is a relatively rare presentation. In this chapter we examine a wide range of terms used to describe states of unresponsiveness in which psychologic factors are relevant to etiology, such as depressive stupor, catatonia, nonepileptic "pseudostatus," and factitious disorders, and discuss the place of functional or psychogenic coma among these. Historically, diagnosis of functional coma has sometimes been reached after prolonged investigation and exclusion of other diagnoses. However, as is the case with other functional disorders, diagnosis should preferably be made on the basis of positive findings that provide evidence of inconsistency between an apparent comatose state and normal waking nervous system functioning. In our review of physical signs, we find some evidence for the presence of firm resistance to eye opening as reasonably sensitive and specific for functional coma, as well as the eye gaze sign, in which patients tend to look to the ground when turned on to one side. Noxious stimuli such as Harvey's sign (application of high-frequency vibrating tuning fork to the nasal mucosa) can also be helpful, although patients with this disorder are often remarkably unresponsive to usually painful stimuli, particularly as more commonly applied using sternal or nail bed pressure. The use of repeated painful stimuli is therefore not recommended. We also discuss the role of general anesthesia and other physiologic triggers to functional coma. © 2016 Elsevier B.V. All rights reserved.

The effect of brain death and coma on gastric myoelectrical activity.

PubMed

Bor, Canan; Bordin, Dmitry; Demirag, Kubilay; Uyar, Mehmet

2016-05-01

Gastrointestinal motility problems and delayed gastric emptying in patients admitted to intensive care units are important because they can contribute to different problems. Herein we aimed to measure the changes in gastric myoelectrical activity with electrogastrography (EGG) following brain death (BD) and compare the results to those from patients in a deep coma without BD. Fifteen patients with BD and nine in a deep coma with a Glasgow Coma Score from 3 to 8 were included. An enteral nutrition solution was given via a nasogastric tube between 45 min of fasting and the postprandial periods. The mean dominant frequency (MnDF), normal gastric slow wave ratio (%), tachygastria and bradygastria (%), power ratio (PR: dominant power after test meal/fasting), and dominant frequency instability coefficient were evaluated. The median of MnDF was determined 3.20±0.6 (BD) vs 3.05±0.5 (control), p>0.05. Patients with BD displayed tachygastria, particularly during the fasting state, with this disturbance decreasing during the postprandial period (from 41% to 15%). However, none of the differences between the groups were statistically significant. PR was pathologic in 4/15 (26.7%) patients in the BD group and 4/9 (44.4%) patients in the control group (p=0.288). Patients with coma or BD bouth might have gastric myoelectrical activity disturbances. BD does not show more severe disturbance than coma wihouth BD. EGG might be useful as a non-invasive and easy-to-use technology; however, it needs further improvement.

A human brain network derived from coma-causing brainstem lesions

PubMed Central

Boes, Aaron D.; Demertzi, Athena; Evrard, Henry C.; Laureys, Steven; Edlow, Brian L.; Liu, Hesheng; Saper, Clifford B.; Pascual-Leone, Alvaro; Geerling, Joel C.

2016-01-01

Objective: To characterize a brainstem location specific to coma-causing lesions, and its functional connectivity network. Methods: We compared 12 coma-causing brainstem lesions to 24 control brainstem lesions using voxel-based lesion-symptom mapping in a case-control design to identify a site significantly associated with coma. We next used resting-state functional connectivity from a healthy cohort to identify a network of regions functionally connected to this brainstem site. We further investigated the cortical regions of this network by comparing their spatial topography to that of known networks and by evaluating their functional connectivity in patients with disorders of consciousness. Results: A small region in the rostral dorsolateral pontine tegmentum was significantly associated with coma-causing lesions. In healthy adults, this brainstem site was functionally connected to the ventral anterior insula (AI) and pregenual anterior cingulate cortex (pACC). These cortical areas aligned poorly with previously defined resting-state networks, better matching the distribution of von Economo neurons. Finally, connectivity between the AI and pACC was disrupted in patients with disorders of consciousness, and to a greater degree than other brain networks. Conclusions: Injury to a small region in the pontine tegmentum is significantly associated with coma. This brainstem site is functionally connected to 2 cortical regions, the AI and pACC, which become disconnected in disorders of consciousness. This network of brain regions may have a role in the maintenance of human consciousness. PMID:27815400

Radiation exposure in the young level 1 trauma patient: a retrospective review.

PubMed

Gottschalk, Michael B; Bellaire, Laura L; Moore, Thomas

2015-01-01

Computed tomography (CT) has become an increasingly popular and powerful tool for clinicians managing trauma patients with life-threatening injuries, but the ramifications of increasing radiation burden on individual patients are not insignificant. This study examines a continuous series of 337 patients less than 40 years old admitted to a level 1 trauma center during a 4-month period. Primary outcome measures included number of scans; effective dose of radiation from radiographs and CT scans, respectively; and total effective dose from both sources over patients' hospital stays. Several variables, including hospital length of stay, initial Glasgow Coma Scale score, and Injury Severity Score, correlated with greater radiation exposure. Blunt trauma victims were more prone to higher doses than those with penetrating or combined penetrating and blunt trauma. Location and mechanism of injury were also found to correlate with radiation exposure. Trauma patients as a group are exposed to high levels of radiation from X-rays and CT scans, and CT scans contribute a very high proportion (91.3% ± 11.7%) of that radiation. Certain subgroups of patients are at a particularly high risk of exposure, and greater attention to cumulative radiation dose should be paid to patients with the above mentioned risk factors.

Production, Outflow Velocity, and Radial Distribution of H2O and OH in the Coma of Comet C/1995 O1 [Hale-Bopp] from Wide Field Imaging of OH

NASA Technical Reports Server (NTRS)

Harris, Walter M.; Scherb, Frank; Mierkiewicz, Edwin; Oliverson, Ronald; Morgenthaler, Jeffrey

2003-01-01

Observations of OH are a useful proxy of the water production rate (Q(sub H2O)) and outflow velocity (V(sub out)) in comets. From wide field images taken on 03/28/1997 and 04/08/1997 that capture the entire scale length of the OH coma of comet C/1995 O1 (Hale-Bopp), we obtain Q(sub H2O) from the model-independent method of aperture summation. With an adaptive ring summation algorithm, we extract the radial brightness distribution of OH 0-0 band emission out to cometocentric distances of up to 10(exp 6) km, both as azimuthal averages and in quadrants covering different position angles relative to the comet-Sun line. These profiles are fit using both fixed and variable velocity 2-component spherical expansion models to estimate V(sub OH) with increasing distance from the nucleus. The OH coma of Hale-Bopp was more spatially extended than previous comets, and this extension is best matched by a variable acceleration of H2O and OH that acted across the entire coma, but was strongest within 1-2 x 10(exp 4) km from the nucleus. Our models indicate that V(sub OH) at the edge of our detectable field of view (10(exp 6) km) was approx. 2-3 times greater in Hale-Bopp than for a 1P/Halley-class comet at 1 AU, which is consistent with the results of more sophisticated gas-kinetic models, extrapolation from previous observations of OH in comets with Q(sub H2O) greater than 10(exp 29)/s , and direct radio measurements of the outer coma Hale-Bopp OH velocity. The most probable source of this acceleration is thermalization of the excess energy of dissociation of H2O and OH over an extended collisional coma. When the coma is broken down by quadrants in position angle, we find an azimuthal asymmetry in the radial distribution that is characterized by an increase in the spatial extent of OH in the region between the orbit-trailing and anti-sunward directions. Model fits specific to this area and comparison with radio OH measurements suggest greater acceleration here, with V(sub OH) approx. 1.5 times greater at a 10(exp 6) km cometocentric distance than elsewhere in the coma. We discuss several mechanisms that may have acted within the coma to produce the observed effect.

21 CFR 522.775 - Doxapram.

Code of Federal Regulations, 2011 CFR

2011-04-01

... anesthesia, 0.5 mg/lb in inhalation anesthesia; for intravenous use in horses at 0.25 mg/lb body weight in barbiturate anesthesia, 0.2 mg/lb in inhalation anesthesia, 0.25 mg/lb with chloral hydrate with or without... horses to stimulate respiration during and after general anesthesia; or to speed awakening and return of...

Restrictions in Means for Suicide: An Effective Tool in Preventing Suicide: The Danish Experience

ERIC Educational Resources Information Center

Nordentoft, Merete; Qin, Ping; Helweg-Larsen, Karin

2007-01-01

Restriction of means for suicide is an important part of suicide preventive strategies in different countries. The effect on method-specific suicide rate and overall suicide rate of restrictions on availability of carbon monoxide, barbiturates, and dextropropoxyphene was examined. From 1970 to 2000, overall suicide mortality and method-specific…

Patterns of Psychiatric Need and Intervention among U. S. Army Troops of the Vietnam Conflict

DTIC Science & Technology

1982-10-01

symptomatic, command referred and forensic cases, plus attendant work) _______ ________ __________ b. Direct treatment of patients...barbiturate to facilitate recall, abreaction, and reintegration) C 1 2 3 4 5 U C 1 2 3 4 5 U C 1 2 3 4 5 U Hypnosis : (similar but without

Desorption electrospray ionization (DESI) with atmospheric pressure ion mobility spectrometry for drug detection.

PubMed

Roscioli, Kristyn M; Tufariello, Jessica A; Zhang, Xing; Li, Shelly X; Goetz, Gilles H; Cheng, Guilong; Siems, William F; Hill, Herbert H

2014-04-07

Desorption electrospray ionization (DESI) was coupled to an ambient pressure drift tube ion mobility time-of-flight mass spectrometer (IM-TOFMS) for the direct analysis of active ingredients in pharmaceutical samples. The DESI source was also coupled with a standalone IMS demonstrating potential of portable and inexpensive drug-quality testing platforms. The DESI-IMS required no sample pretreatment as ions were generated directly from tablets and cream formulations. The analysis of a range of over-the-counter and prescription tablet formations was demonstrated for amphetamine (methylphenidate), antidepressant (venlafaxine), barbiturate (Barbituric acid), depressant (alprazolam), narcotic (3-methylmorphine) and sympatholytic (propranolol) drugs. Active ingredients from soft and liquid formulations, such as Icy Hot cream (methyl salicylate) and Nyquil cold medicine (acetaminophen, dextromethorphan, doxylamine) were also detected. Increased sensitivity for selective drug responses was demonstrated through the formation of sodiated adduct ions by introducing small quantities of NaCl into the DESI solvent. Of the drugs and pharmaceuticals tested in this study, 68% (22 total samples) provided a clear ion mobility response at characteristic mobilities either as (M + H)(+), (M - H)(-), or (M + Na)(+) ions.

Determination of sedative hypnotics in sewage sludge by pressurized liquid extraction with high-performance liquid chromatography and tandem mass spectrometry.

PubMed

Arbeláez, Paula; Granados, Judith; Borrull, Francesc; Marcé, Rosa Maria; Pocurull, Eva

2014-12-01

This paper describes a method for the determination of eight sedative hypnotics (benzodiazepines and barbiturates) in sewage sludge using pressurized liquid extraction and liquid chromatography with tandem mass spectrometry. Pressurized liquid extraction operating conditions were optimized and maximum recoveries were reached using methanol under the following operational conditions: 100ºC, 1500 psi, extraction time of 5 min, one extraction cycle, flush volume of 60% and purge time of 120 s. Pressurized liquid extraction recoveries were higher than 88% for all the compounds except for carbamazepine (55%). The repeatability and reproducibility between days, expressed as relative standard deviation (n = 5), were lower than 6 and 10%, respectively. The detection limits for all compounds were lower than 12.5 μg/kg of dry weight. The method was applied to determine benzodiazepines and barbiturates in sewage sludge from urban sewage treatment plants, and carbamazepine showed the highest concentration (7.9-18.9 μg/kg dry weight). © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Impact of helical organization on the photovoltaic properties of oligothiophene supramolecular polymers† †Electronic supplementary information (ESI) available: Synthesis and characterization of 3 and 4, UV-vis spectra, solar cell device properties and AFM images. See DOI: 10.1039/c7sc05093c

PubMed Central

Ouchi, Hayato; Kizaki, Takahiro; Yamato, Masaki; Lin, Xu; Hoshi, Nagahiro; Silly, Fabien; Kajitani, Takashi; Fukushima, Takanori

2018-01-01

Helical self-assembly of functional π-conjugated molecules offers unique photochemical and electronic properties in the spectroscopic level, but there are only a few examples that demonstrate their positive impact on the optoelectronic device level. Here, we demonstrate that hydrogen-bonded tapelike supramolecular polymers of a barbiturated oligo(alkylthiophene) show notable improvement in their photovoltaic properties upon organizing into helical nanofibers. A tapelike hydrogen-bonded supramolecular array of barbiturated oligo(butylthiophene) molecules was directly visualized by STM at a liquid–solid interface. TEM, AFM and XRD revealed that the tapelike supramolecular polymers further organize into helical nanofibers in solution and bulk states. Bulk heterojunction solar cells of the helical nanofibers and soluble fullerene showed a power conversion efficiency of 4.5%, which is markedly high compared to that of the regioisomer of butyl chains organizing into 3D lamellar agglomerates. PMID:29780493

New red jewels in Coma Berenices

DOE Office of Scientific and Technical Information (OSTI.GOV)

Terrien, Ryan C.; Mahadevan, Suvrath; Deshpande, Rohit

2014-02-20

We have used Sloan Digital Sky Survey-III (SDSS-III) Apache Point Observatory Galactic Evolution Experiment (APOGEE) radial velocity observations in the near-infrared H-band to explore the membership of the nearby (86.7 ± 0.9 pc) open cluster Coma Berenices (Melotte 111), concentrating on the poorly populated low-mass end of the main sequence. Using SDSS-III APOGEE radial velocity measurements, we confirm the membership of eight K/M dwarf members, providing the first confirmed low-mass members of the Coma Berenices cluster. Using R ∼ 2000 spectra from IRTF-SpeX, we confirm the independently luminosity classes of these targets, and find their metallicities to be consistent withmore » the known solar mean metallicity of Coma Berenices and of M dwarfs in the solar neighborhood. In addition, the APOGEE spectra have enabled measurement of vsin i for each target and detection for the first time of the low-mass secondary components of the known binary systems Melotte 111 102 and Melotte 111 120, as well as identification of the previously unknown binary system 2MASS J12214070+2707510. Finally, we use Kilodegree Extremely Little Telescope photometry to measure photometric variability and rotation periods for a subset of the Coma Berenices members.« less

Post-coma persons with multiple disabilities use assistive technology for their leisure engagement and communication.

PubMed

Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Oliva, Doretta; Buonocunto, Francesca; Sacco, Valentina; D'Amico, Fiora; Navarro, Jorge; Lanzilotti, Crocifissa; De Tommaso, Marina; Megna, Marisa

2014-01-01

Interventions for post-coma persons, who have emerged from a minimally conscious state but present with extensive neuro-motor impairment and lack of or minimal verbal skills, need to promote occupation and communication through the use of assistive technology. These two studies were aimed at assessing two technology-aided programs to promote leisure engagement and communication for three post-coma participants with multiple disabilities. Study I assessed a program to allow a woman and a man with extensive neuro-motor impairment and lack of speech to switch on music and videos, make requests to caregivers, and send messages to (communicate with) relevant partners and receive messages from those partners. Study II assessed a program to allow a post-coma woman with extensive motor impairment and reduced verbal behavior to activate music, videos and requests, send and receive messages, and make telephone calls. Data showed that both programs were successful. The participants of Study I managed leisure engagement, requests, as well as text messaging. The participant of Study II showed consistent leisure engagement, text messaging, and telephone calls. Assistive technology can be profitably used to provide post-coma persons with multiple disabilities relevant leisure and communication opportunities.

[Myxedema coma in a patient with type 1 neurofibromatosis: rare association].

PubMed

Sasazawa, Denise Tieko; Tsukumo, Daniela Miti; Lalli, Cristina Alba

2013-12-01

Myxedema coma, a rare but fatal emergency, is an extreme expression of hypothyroidism. We describe a 51-year-old male patient who has discontinued hypothyroidism treatment 10 months earlier and developed lethargy, edema, and cold intolerance symptoms. He also had a previous diagnosis of neurofibromatosis. After admission, he progressed to respiratory insufficiency and coma. The prompt recognition of the condition, thyroid hormone replacement, and management of the complications (hypoventilation, cardiogenic shock associated with swinging heart, adrenal and renal insufficiency and sepsis), resulted in a favorable evolution.

Analysis of hydrogen H-alpha observations of the coma of Comet P/Halley

NASA Technical Reports Server (NTRS)

Smyth, William H.; Marconi, M. L.; Scherb, Frank; Roesler, Fred L.

1993-01-01

The Monte Carlo Particle Trajectory Model of Combi and Smyth (1988) is used here to analyze observations of the H-alpha coma of Comet Halley. The solar excitation mechanism for the H-alpha emissions line is described. The H2O production rates derived for the H-alpha brightness measurements are shown to be very consistent with the H2O production rates determined from other Comet Halley observations of the H, O, and OH comae. Revised H2O production rates determined from 6300 A brightness measurements are presented.

Period change of a contact binary system RW Comae Berenices

NASA Astrophysics Data System (ADS)

Maithong, Wiraporn; Phao-ai, Parinda

2017-08-01

In this work, we studied about the period change of a contact binary system RW Comae Berenices. The binary system was observed on March 9th, 2016 by the 105 mm diameter of a refraction telescope with the DSLR digital camera at the Regional Observatory for the Public Nakhon Ratchasima, Thailand. The photometry used the IRIS program. The period change was analyzed by used the O-C diagram. The result shows that the period of the RW Comae Berenices is increasing with 1.89×10-3 seconds/year.

VizieR Online Data Catalog: Coma clusters and filaments galaxies FIR survey (Fuller+, 2016)

NASA Astrophysics Data System (ADS)

Fuller, C.; Davies, J. I.; Smith, M. W. L.; Valiante, E.; Eales, S.; Bourne, N.; Dunne, L.; Dye, S.; Furlanetto, C.; Ibar, E.; Ivison, R.; Maddox, S.; Sansom, A.; Michalowski, M. J.; Davis, T.

2017-05-01

We have undertaken a Herschel FIR survey of the Coma cluster and the galaxy filament it resides within. Our survey covers an area of ~150 deg2 observed in five bands at 100, 160, 250, 350 and 500um. We have used the SDSS spectroscopic survey to define an area and redshift selected sample of 744 Coma cluster galaxies - the CCC. For comparison, we also define in a similar way a sample of 951 galaxies in the connecting filament - the CFC. (2 data files).

DEEP ULTRAVIOLET LUMINOSITY FUNCTIONS AT THE INFALL REGION OF THE COMA CLUSTER

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hammer, D. M.; Hornschemeier, A. E.; Jenkins, L.

2012-02-01

We have used deep GALEX observations at the infall region of the Coma cluster to measure the faintest ultraviolet (UV) luminosity functions (LFs) presented for a rich galaxy cluster thus far. The Coma UV LFs are measured to M{sub UV} = -10.5 in the GALEX FUV and NUV bands, or 3.5 mag fainter than previous studies, and reach the dwarf early-type galaxy population in Coma for the first time. The Schechter faint-end slopes ({alpha} Almost-Equal-To -1.39 in both GALEX bands) are shallower than reported in previous Coma UV LF studies owing to a flatter LF at faint magnitudes. A Gaussian-plus-Schechtermore » model provides a slightly better parameterization of the UV LFs resulting in a faint-end slope of {alpha} Almost-Equal-To -1.15 in both GALEX bands. The two-component model gives faint-end slopes shallower than {alpha} = -1 (a turnover) for the LFs constructed separately for passive and star-forming galaxies. The UV LFs for star-forming galaxies show a turnover at M{sub UV} Almost-Equal-To -14 owing to a deficit of dwarf star-forming galaxies in Coma with stellar masses below M{sub *} = 10{sup 8} M{sub Sun }. A similar turnover is identified in recent UV LFs measured for the Virgo cluster suggesting this may be a common feature of local galaxy clusters, whereas the field UV LFs continue to rise at faint magnitudes. We did not identify an excess of passive galaxies as would be expected if the missing dwarf star-forming galaxies were quenched inside the cluster. In fact, the LFs for both dwarf passive and star-forming galaxies show the same turnover at faint magnitudes. We discuss the possible origin of the missing dwarf star-forming galaxies in Coma and their expected properties based on comparisons to local field galaxies.« less

The Inner Coma Physical Environments of Ecliptic Comets 45P/Honda-Mrkos-Pajdusakova, 2P/Encke, and 41P/Tuttle-Giacobini-Kresak Revealed Through Long-Slit Spectroscopy at NASA IRTF

NASA Astrophysics Data System (ADS)

Bonev, Boncho P.; DiSanti, Michael A.; Roth, Nathan; Dello Russo, Neil; Vervack, Ronald J.; Gibb, Erika L.; Villanueva, Geronimo Luis; Combi, Michael R.; Fougere, Nicolas; Kawakita, Hideyo; McKay, Adam J.; Saki, Mohammad; Cordiner, Martin; Protopapa, Silvia; de Val-Borro, Miguel

2017-10-01

Understanding the physical processes in the inner regions of cometary atmospheres is vital for interpretation of molecular cometary emission at all wavelengths. Furthermore, because ecliptic comets are continuously evaluated as space mission targets, understanding their coma environments is a central theme in both enhancing the science return of past missions (EPOXI, Rosetta) and in selecting future mission targets. With this motivation, we report long-slit high-resolution observations of H2O emission in the comae of three ecliptic comets observed in early 2017: 45P/Honda-Mrkos-Pajdusakova, 2P/Encke, and 41P/Tuttle-Giacobini-Kresak. Using the new crossed-dispersed spectrograph iSHELL at NASA IRTF, we detected a suite of water rovibrational emission lines from these comets and measured the spatial distributions of H2O rotational temperatures and molecular column densities. Both parameters are highly diagnostic of the physical environment in cometary comae, the competition between cooling and heating processes in these environments, and the presence (or lack thereof) of extended coma sources of gas-phase H2O. Comets 2P and 45P allowed a rare glimpse into coma physics at small (< 0.6 AU) heliocentric distances, where photochemical heating is particularly important, but direct H2O observations have been sparse. Our results add to the small sample of spatial-spectral measurements of this type. They will be discussed in the context of coma physics models along with prospects for investigations during the upcoming favorable apparitions of ecliptic comets 21P/Giacobini-Zinner and 46P/Wirtanen. We gratefully acknowledge support from the NASA Solar System Workings, Planetary Atmospheres, Earth and Space Science Fellowship, Solar System Observations, Emerging Worlds, and Astrobiology Programs, and NSF Solar and Planetary Research Grants. We are grateful to the entire IRTF staff for their help with these challenging observations, most of which were done during daytime.

Deep UV Luminosity Functions at the Infall Region of the Coma Cluster

NASA Technical Reports Server (NTRS)

Hammer, D. M.; Hornschemeier, A. E.; Salim, S.; Smith, R.; Jenkins, L.; Mobasher, B.; Miller, N.; Ferguson, H.

2011-01-01

We have used deep GALEX observations at the infall region of the Coma cluster to measure the faintest UV luminosity functions (LFs) presented for a rich galaxy cluster thus far. The Coma UV LFs are measured to M(sub uv) = -10.5 in the GALEX FUV and NUV bands, or 3.5 mag fainter than previous studies, and reach the dwarf early-type galaxy population in Coma for the first time. The Schechter faint-end slopes (alpha approximately equal to -1.39 in both GALEX bands) are shallower than reported in previous Coma UV LF studies owing to a flatter LF at faint magnitudes. A Gaussian-plus-Schechter model provides a slightly better parametrization of the UV LFs resulting in a faint-end slope of alpha approximately equal to -1.15 in both GALEX bands. The two-component model gives faint-end slopes shallower than alpha = -1 (a turnover) for the LFs constructed separately for passive and star forming galaxies. The UV LFs for star forming galaxies show a turnover at M(sub UV) approximately equal to -14 owing to a deficit of dwarf star forming galaxies in Coma with stellar masses below M(sub *) = 10(sup 8) solar mass. A similar turnover is identified in recent UV LFs measured for the Virgo cluster suggesting this may be a common feature of local galaxy clusters, whereas the field UV LFs continue to rise at faint magnitudes. We did not identify an excess of passive galaxies as would be expected if the missing dwarf star forming galaxies were quenched inside the cluster. In fact, the LFs for both dwarf passive and star forming galaxies show the same turnover at faint magnitudes. We discuss the possible origin of the missing dwarf star forming galaxies in Coma and their expected properties based on comparisons to local field galaxies.

Observation of CO2 in Comet C/2012 K5 LINEAR

NASA Astrophysics Data System (ADS)

McKay, Adam; Kelley, Michael; DiSanti, Michael; Chanover, Nancy

2012-12-01

The study of cometary composition is important to understanding the formation and evolution of our solar system. Comets have undergone very little thermal evolution in their lifetimes, which results in their near pristine composition. The nucleus of a comet is very rarely detected directly. Instead, we observe the coma that surrounds the nucleus. Physical and chemical processes in the coma affect its composition, and therefore coma composition is not a direct representation of nuclear composition. An important trend is the observed variation of coma composition with heliocentric distance, most likely influenced by the volatility of the main surface ices, H2O, CO2, and CO. Infrared studies of these molecules are complicated by telluric features, so often daughter molecules of these species such as OH are observed instead. A potentially effective tracer for these primary ices is atomic oxygen in the coma. However, the relationship between these ices and atomic oxygen is only understood at a qualitative level. We propose to use Spitzer observations in IRAC's 4.5 micron band pass to observe the CO2 v3 band at 4.26 microns in comet C/2012 K5 LINEAR. These observations will be coordinated with observations of atomic oxygen obtained at Apache Point Observatory and observations of H2O at Keck. These near simultaneous observations of H2O, CO2, and atomic oxygen in a cometary coma will increase our understanding of the link between these primary ices and atomic oxygen. With a complete understanding of the relationship between atomic oxygen and the primary ices on the nucleus, observations of atomic oxygen can serve as a powerful proxy for the production of these primary volatiles and aid our understanding of the variation in coma composition as a function of heliocentric distance, and therefore the composition of the nucleus and how our solar system was formed.

Long-lasting functional disabilities in patients who recover from coma after cardiac operations.

PubMed

Rodriguez, Rosendo A; Nair, Shona; Bussière, Miguel; Nathan, Howard J

2013-03-01

Uncertainty regarding the long-term functional outcome of patients who awaken from coma after cardiac operations is difficult for families and physicians and may delay rehabilitation. We studied the long-term functional status of these patients to determine if duration of coma predicted outcome. We followed 71 patients who underwent cardiac operations; recovered their ability to respond to verbal commands after coma associated with postoperative stroke, encephalopathy, and/or seizures; and were discharged from the hospital. The Glasgow Outcome Scale Extended (GOSE) was used to assess functional disability 2 to 4 years after discharge. Outcomes were classified as favorable (GOSE scores 7 and 8) and unfavorable (GOSE scores 1-6). Of 71 patients identified, 39 were interviewed, 15 died, 1 refused to be interviewed, and 16 were lost to follow-up. Of the 54 patients with completed GOSE evaluations, only 15 (28%) had favorable outcomes. Among patients with unfavorable outcomes, 15 (28%) died, 14 (26%) survived with moderate disabilities, and 10 (18%) had severe disabilities. Factors associated with unfavorable outcomes were increases in duration of coma (p = 0.007), time in intensive care (p = 0.006), length of hospitalization (p = 0.004), and postoperative serum creatine kinase levels (p = 0.006). Only duration of coma was an independent predictor of unfavorable outcome (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.008-1.537; p = 0.042). Patients with durations of coma greater than 4 days were more likely to have unfavorable outcomes (OR, 5.1; 95% CI, 1.3-21.3; p = 0.02). Two thirds of comatose patients who survived to discharge after cardiac operations had unfavorable long-term functional outcomes. A longer duration of unconsciousness is a predictor of unfavorable outcome. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Dust emission from comets at large heliocentric distances. I - The case of comet Bowell /1980b/

NASA Technical Reports Server (NTRS)

Houpis, H. L. F.; Mendis, D. A.

1981-01-01

Alternative processes of dust emission from comets at large heliocentric distances are considered, in order to explain the dust coma observed in comet Bowell (1980b) at a heliocentric distance as large as 7.17 AU. It is shown that the electrostatic blow-off of dust from a charged, H2O-dominated nucleus having a layer of loose, fine dust may be the formation process of the dust coma, with the coma size expected from the process being comparable to the observed value and the dust grain size being equal to or less than 0.4 microns in size. The upper limit for the total mass in the coma is 3.9 x 10 to the 8th g, and the spatial extension less than 10,000 km. The observed activity may alternatively be due to dust entrainment by the sublimating gas from a CO2-dominated nucleus.

Diagnostic Simulations of the Lunar Exosphere using Coma and Tail

NASA Astrophysics Data System (ADS)

Lee, Dong Wook; Kim, Sang J.

2017-10-01

The characteristics of the lunar exosphere can be constrained by comparing simulated models with observational data of the coma and tail (Lee et al., JGR, 2011); and thus far a few independent approaches on this issue have been performed and presented in the literature. Since there are two-different observational constraints for the lunar exosphere, it is interesting to find the best exospheric model that can account for the observed characteristics of the coma and tail. Considering various initial conditions of different sources and space weather, we present preliminary time-dependent simulations between the initial and final stages of the development of the lunar tail. Based on an updated 3-D model, we are planning to conduct numerous simulations to constrain the best model parameters from the coma images obtained from coronagraph observations supported by a NASA monitoring program (Morgan, Killen, and Potter, AGU, 2015) and future tail data.

Numerical simulations of particle orbits around 2060 Chiron

NASA Technical Reports Server (NTRS)

Stern, S. A.; Jackson, A. A.; Boice, D. C.

1994-01-01

Scattered light from orbiting or coorbiting dust is a primary signature by which Earth-based observers study the activity and atmosphere of the unusual outer solar system object 2060 Chiron. Therefore, it is important to understand the lifetime, dynamics, and loss rates of dust in its coma. We report here dynamical simulations of particles in Chiron's collisionless coma. The orbits of 17,920 dust particles were numerically integrated under the gravitational influence of Chiron, the Sun, and solar radiation pressure. These simulations show that particles ejected from Chiron are more likely to follow suborbital trajectories, or to escape altogether, than to enter quasistable orbits. Significant orbital lifetimes can only be achieved for very specific launch conditions. These results call into question models of a long-term, bound coma generated by discrete outbursts, and instead suggest that Chiron's coma state is closely coupled to the nearly instantaneous level of Chiron's surface activity.

Postoperative Conversion Disorder in Elderly Oral Cancer Patient.

PubMed

Yakushiji, Takashi; Hayashi, Kamichika; Morikawa, Takamichi; Migita, Masashi; Ogane, Satoru; Muramatsu, Kyotaro; Kamio, Takashi; Shibahara, Takahiko; Takano, Nobuo

2016-01-01

Conversion disorder is a condition in which psychological stress in response to difficult situations manifests as physical symptoms. Here, we report a case of postoperative coma due to conversion disorder in an elderly oral cancer patient. An 82-year-old woman was referred to Tokyo Dental College Chiba Hospital with a mass lesion on the tongue. A biopsy revealed a well-differentiated squamous cell carcinoma. Surgical treatment was performed for the tongue carcinoma and tracheotomy for management of the airway. On postoperative day 5, the patient exhibited loss of consciousness (Glasgow Coma Scale: E1, VT, M1; Japan Coma Scale: III-300). The patient's vital signs were all normal, as were the results of a full blood count, brain-CT, MRI, and MRA. Only the arm dropping test was positive. Therefore, the cause of the coma was diagnosed as conversion disorder. Seven hours later, the patient showed a complete recovery.

Therapeutic options to enhance coma arousal after traumatic brain injury: state of the art of current treatments to improve coma recovery.

PubMed

Cossu, Giulia

2014-04-01

Traumatic brain injury is a leading cause of death and disability. Optimizing the recovery from coma is a priority in seeking to improve patients' functional outcomes. Standards of care have not been established: pharmacological interventions, right median nerve and sensory stimulation, dorsal column stimulation (DCS), deep brain stimulation, transcranial magnetic stimulation, hyperbaric oxygen therapy and cell transplantation have all been utilized with contrasting results. The aim of this review is to clarify the indications for the various techniques and to guide the clinical practice towards an earlier coma arousal. A systematic bibliographic search was undertaken using the principal search engines (Pubmed, Embase, Ovid and Cochrane databases) to locate the most pertinent studies. Traumatic injury is a highly individualized process, and subsequent impairments are dependent on multiple factors: this heterogeneity influences and determines therapeutic responses to the various interventions.

EEG as an Indicator of Cerebral Functioning in Postanoxic Coma.

PubMed

Juan, Elsa; Kaplan, Peter W; Oddo, Mauro; Rossetti, Andrea O

2015-12-01

Postanoxic coma after cardiac arrest is one of the most serious acute cerebral conditions and a frequent cause of admission to critical care units. Given substantial improvement of outcome over the recent years, a reliable and timely assessment of clinical evolution and prognosis is essential in this context, but may be challenging. In addition to the classic neurologic examination, EEG is increasingly emerging as an important tool to assess cerebral functions noninvasively. Although targeted temperature management and related sedation may delay clinical assessment, EEG provides accurate prognostic information in the early phase of coma. Here, the most frequently encountered EEG patterns in postanoxic coma are summarized and their relations with outcome prediction are discussed. This article also addresses the influence of targeted temperature management on brain signals and the implication of the evolution of EEG patterns over time. Finally, the article ends with a view of the future prospects for EEG in postanoxic management and prognostication.

Local cortical dynamics of burst suppression in the anaesthetized brain.

PubMed

Lewis, Laura D; Ching, Shinung; Weiner, Veronica S; Peterfreund, Robert A; Eskandar, Emad N; Cash, Sydney S; Brown, Emery N; Purdon, Patrick L

2013-09-01

Burst suppression is an electroencephalogram pattern that consists of a quasi-periodic alternation between isoelectric 'suppressions' lasting seconds or minutes, and high-voltage 'bursts'. It is characteristic of a profoundly inactivated brain, occurring in conditions including hypothermia, deep general anaesthesia, infant encephalopathy and coma. It is also used in neurology as an electrophysiological endpoint in pharmacologically induced coma for brain protection after traumatic injury and during status epilepticus. Classically, burst suppression has been regarded as a 'global' state with synchronous activity throughout cortex. This assumption has influenced the clinical use of burst suppression as a way to broadly reduce neural activity. However, the extent of spatial homogeneity has not been fully explored due to the challenges in recording from multiple cortical sites simultaneously. The neurophysiological dynamics of large-scale cortical circuits during burst suppression are therefore not well understood. To address this question, we recorded intracranial electrocorticograms from patients who entered burst suppression while receiving propofol general anaesthesia. The electrodes were broadly distributed across cortex, enabling us to examine both the dynamics of burst suppression within local cortical regions and larger-scale network interactions. We found that in contrast to previous characterizations, bursts could be substantially asynchronous across the cortex. Furthermore, the state of burst suppression itself could occur in a limited cortical region while other areas exhibited ongoing continuous activity. In addition, we found a complex temporal structure within bursts, which recapitulated the spectral dynamics of the state preceding burst suppression, and evolved throughout the course of a single burst. Our observations imply that local cortical dynamics are not homogeneous, even during significant brain inactivation. Instead, cortical and, implicitly, subcortical circuits express seemingly different sensitivities to high doses of anaesthetics that suggest a hierarchy governing how the brain enters burst suppression, and emphasize the role of local dynamics in what has previously been regarded as a global state. These findings suggest a conceptual shift in how neurologists could assess the brain function of patients undergoing burst suppression. First, analysing spatial variation in burst suppression could provide insight into the circuit dysfunction underlying a given pathology, and could improve monitoring of medically-induced coma. Second, analysing the temporal dynamics within a burst could help assess the underlying brain state. This approach could be explored as a prognostic tool for recovery from coma, and for guiding treatment of status epilepticus. Overall, these results suggest new research directions and methods that could improve patient monitoring in clinical practice.

Myxedema coma: a new look into an old crisis.

PubMed

Mathew, Vivek; Misgar, Raiz Ahmad; Ghosh, Sujoy; Mukhopadhyay, Pradip; Roychowdhury, Pradip; Pandit, Kaushik; Mukhopadhyay, Satinath; Chowdhury, Subhankar

2011-01-01

Myxedema crisis is a severe life threatening form of decompensated hypothyroidism which is associated with a high mortality rate. Infections and discontinuation of thyroid supplements are the major precipitating factors while hypothermia may not play a major role in tropical countries. Low intracellular T3 leads to cardiogenic shock, respiratory depression, hypothermia and coma. Patients are identified on the basis of a low index of suspicion with a careful history and examination focused on features of hypothyroidism and precipitating factors. Arrythmias and coagulation disorders are increasingly being identified in myxedema crisis. Thyroid replacement should be initiated as early as possible with careful attention to hypotension, fluid replacement and steroid replacement in an intensive care facility. Studies have shown that replacement of thyroid hormone through ryles tube with a loading dose and maintenance therapy is as efficacious as intravenous therapy. In many countries T3 is not available and oral therapy with T4 can be used effectively without major significant difference in outcomes. Hypotension, bradycardia at presentation, need for mechanical ventilation, hypothermia unresponsive to treatment, sepsis, intake of sedative drugs, lower GCS and high APACHE II scores and Sequential Organ Failure Assessment (SOFA) scores more than 6 are significant predictors of mortality in myxedema crisis. Early intervention in hypothyroid patients developing sepsis and other precipitating factors and ensuring continued intake of thyroid supplements may prevent mortality and morbidity associated with myxedema crisis.

Myxedema Coma: A New Look into an Old Crisis

PubMed Central

Mathew, Vivek; Misgar, Raiz Ahmad; Ghosh, Sujoy; Mukhopadhyay, Pradip; Roychowdhury, Pradip; Pandit, Kaushik; Mukhopadhyay, Satinath; Chowdhury, Subhankar

2011-01-01

Myxedema crisis is a severe life threatening form of decompensated hypothyroidism which is associated with a high mortality rate. Infections and discontinuation of thyroid supplements are the major precipitating factors while hypothermia may not play a major role in tropical countries. Low intracellular T3 leads to cardiogenic shock, respiratory depression, hypothermia and coma. Patients are identified on the basis of a low index of suspicion with a careful history and examination focused on features of hypothyroidism and precipitating factors. Arrythmias and coagulation disorders are increasingly being identified in myxedema crisis. Thyroid replacement should be initiated as early as possible with careful attention to hypotension, fluid replacement and steroid replacement in an intensive care facility. Studies have shown that replacement of thyroid hormone through ryles tube with a loading dose and maintenance therapy is as efficacious as intravenous therapy. In many countries T3 is not available and oral therapy with T4 can be used effectively without major significant difference in outcomes. Hypotension, bradycardia at presentation, need for mechanical ventilation, hypothermia unresponsive to treatment, sepsis, intake of sedative drugs, lower GCS and high APACHE II scores and Sequential Organ Failure Assessment (SOFA) scores more than 6 are significant predictors of mortality in myxedema crisis. Early intervention in hypothyroid patients developing sepsis and other precipitating factors and ensuring continued intake of thyroid supplements may prevent mortality and morbidity associated with myxedema crisis. PMID:21941682

Predicting crystalline lens fall caused by accommodation from changes in wavefront error

PubMed Central

He, Lin; Applegate, Raymond A.

2011-01-01

PURPOSE To illustrate and develop a method for estimating crystalline lens decentration as a function of accommodative response using changes in wavefront error and show the method and limitations using previously published data (2004) from 2 iridectomized monkey eyes so that clinicians understand how spherical aberration can induce coma, in particular in intraocular lens surgery. SETTINGS College of Optometry, University of Houston, Houston, USA. DESIGN Evaluation of diagnostic test or technology. METHODS Lens decentration was estimated by displacing downward the wavefront error of the lens with respect to the limiting aperture (7.0 mm) and ocular first surface wavefront error for each accommodative response (0.00 to 11.00 diopters) until measured values of vertical coma matched previously published experimental data (2007). Lens decentration was also calculated using an approximation formula that only included spherical aberration and vertical coma. RESULTS The change in calculated vertical coma was consistent with downward lens decentration. Calculated downward lens decentration peaked at approximately 0.48 mm of vertical decentration in the right eye and approximately 0.31 mm of decentration in the left eye using all Zernike modes through the 7th radial order. Calculated lens decentration using only coma and spherical aberration formulas was peaked at approximately 0.45 mm in the right eye and approximately 0.23 mm in the left eye. CONCLUSIONS Lens fall as a function of accommodation was quantified noninvasively using changes in vertical coma driven principally by the accommodation-induced changes in spherical aberration. The newly developed method was valid for a large pupil only. PMID:21700108

Therapeutic burst-suppression coma in pediatric febrile refractory status epilepticus.

PubMed

Lin, Jainn-Jim; Chou, Cheng-Che; Lan, Shih-Yun; Hsiao, Hsiang-Ju; Wang, Yu; Chan, Oi-Wa; Hsia, Shao-Hsuan; Wang, Huei-Shyong; Lin, Kuang-Lin

2017-09-01

Evidence for the beneficial effect of therapeutic burst-suppression coma in pediatric patients with febrile refractory status epilepticus is limited, and the clinical outcomes of this treatment strategy are largely unknown. Therefore, the aim of this study was to explore the outcomes of therapeutic burst-suppression coma in a series of children with febrile refractory status epilepticus. We retrospectively reviewed consecutive pediatric patients with febrile refractory status epilepticus admitted to our pediatric intensive care unit between January 2000 and December 2013. The clinical characteristics were analyzed. Thirty-five patients (23 boys; age range: 1-18years) were enrolled, of whom 28 (80%) developed super-refractory status epilepticus. All of the patients received the continuous administration of intravenous antiepileptic drugs for febrile refractory status epilepticus, and 26 (74.3%) achieved therapeutic burst-suppression coma. All of the patients received mechanical ventilatory support, and 26 (74.3%) received inotropic agents. Eight (22.9%) patients died within 1month. The neurologically functional outcomes at 6months were good in six (27.3%) of the 22 survivors, of whom two returned to clinical baseline. The patients with therapeutic burst-suppression coma were significantly associated with hemodynamic support than the patients with electrographic seizures control (p=0.03), and had a trend of higher 1-month mortality rate, worse 6months outcomes, and a longer duration of hospitalization. Our results suggest that therapeutic burst-suppression coma to treat febrile refractory status epilepticus may lead to an increased risk of hemodynamic instability and a trend of worse outcomes. Copyright © 2017 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Near-UV OH Prompt Emission in the Innermost Coma of 103P/Hartley 2

NASA Astrophysics Data System (ADS)

La Forgia, Fiorangela; Bodewits, Dennis; A'Hearn, Michael F.; Protopapa, Silvia; Kelley, Michael S. P.; Sunshine, Jessica; Feaga, Lori; Farnham, Tony

2017-11-01

The Deep Impact spacecraft flyby of comet 103P/Hartley 2 occurred on 2010 November 4, 1 week after perihelion with a closest approach (CA) distance of about 700 km. We used narrowband images obtained by the Medium Resolution Imager on board the spacecraft to study the gas and dust in the innermost coma. We derived an overall dust reddening of 15%/100 nm between 345 and 749 nm and identified a blue enhancement in the dust coma in the sunward direction within 5 km from the nucleus, which we interpret as a localized enrichment in water ice. OH column density maps show an anti-sunward enhancement throughout the encounter, except for the highest-resolution images, acquired at CA, where a radial jet becomes visible in the innermost coma, extending up to 12 km from the nucleus. The OH distribution in the inner coma is very different from that expected for a fragment species. Instead, it correlates well with the water vapor map derived by the HRI-IR instrument on board Deep Impact. Radial profiles of the OH column density and derived water production rates show an excess of OH emission during CA that cannot be explained with pure fluorescence. We attribute this excess to a prompt emission process where photodissociation of H2O directly produces excited OH*(A 2Σ+) radicals. Our observations provide the first direct imaging of near-UV prompt emission of OH. We therefore suggest the use of a dedicated filter centered at 318.8 nm to directly trace the water in the coma of comets.

Thermal modeling of cometary nuclei

USGS Publications Warehouse

Weissman, P.R.; Kieffer, H.H.

1981-01-01

A new model of the sublimation of volatile ices from a cometary nucleus has been developed which includes the effects of diurnal heating and cooling, rotation period and pole orientation, and thermal properties of the ice and subsurface layers. The model also includes the contribution from coma opacity, scattering, and thermal emission, where the properties of the coma are derived from the integrated rate of volatile production by the nucleus. The model is applied to the specific case of the 1986 apparition of Halley's comet. It is found that the generation of a cometary dust coma actually increases the total energy reaching the Halley nucleus. This results because of the significantly greater geometrical cross section of the coma as compared with the bare nucleus, and because the coma provides an essentially isotropic source of multiply scattered sunlight and thermal emission over the entire nucleus surface. For Halley, the calculated coma opacity is approximately 0.2 at 1 AU from the Sun, and 1.2 at perihelion (0.587 AU). At 1 AU this has little effect on dayside temperatures (maximum ???200??K) but raises nightside temperatures (minimum ???150??K) by about 40??K. At perihelion the higher opacity results in a nearly isothermal nucleus with only small diurnal and latitudinal temperature variations. The general surface temperature is 205??K with a maximum of 209??K at local noon on the equator. Some possible consequences of the results with respect to the generation of nongravitational forces, observed volatile production rates for comets, and cometary lifetimes against sublimation are discussed. ?? 1981.

Prolonged dystonic reaction to chlorpromazine in myxoedema coma.

PubMed Central

Wood, G. M.; Waters, A. K.

1980-01-01

A case of myxoedema coma is reported where the administration of chlorpromazine resulted in a prolonged dystonic reaction. A similar challenge with a butyrophenone when the patient was on thyroxine caused a similar but much abbreviated response. PMID:7393810

Coma cluster of galaxies

NASA Image and Video Library

1999-12-02

Atlas Image mosaic, covering 34 x 34 on the sky, of the Coma cluster, aka Abell 1656. This is a particularly rich cluster of individual galaxies over 1000 members, most prominently the two giant ellipticals, NGC 4874 right and NGC 4889 left.

Water ice grains in comet C/2013 US10 (Catalina)

NASA Astrophysics Data System (ADS)

Protopapa, Silvia; Kelley, Michael S. P.; Yang, Bin; Woodward, Charles E.; Sunshine, Jessica M.

2017-10-01

Knowledge of the the physical properties of water ice in cometary nuclei is critical in determining how the Solar System was formed. While it is difficult to directly study the properties of water ice in comet nuclei, we can study comet interiors through their comae. Cometary activity makes the interiors of these objects available for characterization. However, the properties (grain size, abundance, purity, chemical state) of water-ice grains detected in the coma do not necessarily represent the characteristics of the water ice on the surface and/or in the interior of the nucleus. This is due to the potential physical and chemical evolution of the emitted material. Once in the coma, water-ice grains are heated by sunlight, and if temperatures are warm enough, they sublime. In this case, their sizes and potentially their ice-to-dust fractions are reduced.We present IRTF/SpeX measurements of the Oort cloud comet C/2013 US10 (Catalina), which reached perihelion in Nov 2015 at a heliocentric distance Rh=0.822 AU. Observations of US10 were acquired on UT 2014-08-13, 2016-01-12, and 2016-08-13 (Rh=5.9, 1.3, and 3.9 AU). This set of measurements, spanning a broad range in Rh, are rare and fundamental for estimating how ice grains evolve in the coma. The spectrum obtained close to perihelion is featureless and red sloped, which is consistent with a dust-dominated coma. Conversely, the spectra acquired on August 2014 and 2016 display neutral slopes and absorption bands at 1.5 and 2.0 μm, consistent with the presence of water-ice grains. These variations in water ice with heliocentric distance are correlated with sublimation rates. Additionally, the measurements obtained at 5.8 AU and 3.9 AU are nearly identical, suggesting that water-ice grains, once in the coma, do not sublime significantly. Therefore, the properties of these long-lived water-ice grains may represent their state in the nucleus or immediately after insertion into the coma. We will present radiative transfer models of the data and interpret the results in the context of spacecraft data of cometary nuclei, and of our on-going compositional survey of water-ice grain halos in cometary comae.This work was funded by NASA SSO, NASA PAST and NASA SOFIA grants.

CONSTRAINTS ON COSMIC RAYS, MAGNETIC FIELDS, AND DARK MATTER FROM GAMMA-RAY OBSERVATIONS OF THE COMA CLUSTER OF GALAXIES WITH VERITAS AND FERMI

DOE Office of Scientific and Technical Information (OSTI.GOV)

Arlen, T.; Aune, T.; Bouvier, A.

2012-10-01

Observations of radio halos and relics in galaxy clusters indicate efficient electron acceleration. Protons should likewise be accelerated and, on account of weak energy losses, can accumulate, suggesting that clusters may also be sources of very high energy (VHE; E > 100 GeV) gamma-ray emission. We report here on VHE gamma-ray observations of the Coma galaxy cluster with the VERITAS array of imaging Cerenkov telescopes, with complementing Fermi Large Area Telescope observations at GeV energies. No significant gamma-ray emission from the Coma Cluster was detected. Integral flux upper limits at the 99% confidence level were measured to be on themore » order of (2-5) Multiplication-Sign 10{sup -8} photons m {sup -2} s {sup -1} (VERITAS, >220 GeV) and {approx}2 Multiplication-Sign 10{sup -6} photons m {sup -2} s {sup -1} (Fermi, 1-3 GeV), respectively. We use the gamma-ray upper limits to constrain cosmic rays (CRs) and magnetic fields in Coma. Using an analytical approach, the CR-to-thermal pressure ratio is constrained to be <16% from VERITAS data and <1.7% from Fermi data (averaged within the virial radius). These upper limits are starting to constrain the CR physics in self-consistent cosmological cluster simulations and cap the maximum CR acceleration efficiency at structure formation shocks to be <50%. Alternatively, this may argue for non-negligible CR transport processes such as CR streaming and diffusion into the outer cluster regions. Assuming that the radio-emitting electrons of the Coma halo result from hadronic CR interactions, the observations imply a lower limit on the central magnetic field in Coma of {approx}(2-5.5) {mu}G, depending on the radial magnetic field profile and on the gamma-ray spectral index. Since these values are below those inferred by Faraday rotation measurements in Coma (for most of the parameter space), this renders the hadronic model a very plausible explanation of the Coma radio halo. Finally, since galaxy clusters are dark matter (DM) dominated, the VERITAS upper limits have been used to place constraints on the thermally averaged product of the total self-annihilation cross section and the relative velocity of the DM particles, ({sigma}v).« less

Constraints on Cosmic Rays, Magnetic Fields, and Dark Matter from Gamma-ray Observations of the Coma Cluster of Galaxies with VERITAS and FERMI

NASA Technical Reports Server (NTRS)

Arlen, T.; Aune, T.; Beilicke, M.; Benbow, W.; Bouvier, A.; Buckley, J. H.; Bugaev, V.; Byrum, K.; Cannon, A.; Cesarini, A.;

[Biochemical measurements of glucose metabolism in relation to cause of death and postmortem effects].

PubMed

Kernbach, G; Püschel, K; Brinkmann, B

1986-01-01

This study was performed to examine the relationship between postmortem biochemical values and cause of death. The follow samples were taken from 399 corpses: cerebrospinal fluid (CSF; n = 376, suboccipital), blood (n = 158, femoral vein), and urine (n = 101, at autopsy). (See Table 1 for causes of death) All samples were stored at -80 degrees C. A further 100 samples of blood were later taken and stored at +4 degrees C before testing. Biochemical determinations made were: glucose in CSF, blood, and urine (hexokinase method); lactate (LDH/GPT) and free acetone (HS-gas chromatography) in CSF; hemoglobin A1 in blood (microcolumn technique). In 34 cases fatal diabetic coma was considered verified by morphological and chemical findings. One hundred cases of sudden cardiac death were chosen as the main control group. In 32 of the 34 cases defined above, the value of the formula of Traub (glucose + lactate in CSF) exceeded 415 mg/dl. It is not influenced significantly by hyperglycemia or hyperlactatemia due to factors other than diabetes (i.e., carbon monoxide, asphyxia). After death the value rose till the 30th hpm, then remained stable for at least 1 week. Fatal coma was defined as the ketoacidotic form if free acetone in CSF ranged above 21 mg/l. In these cases, CSF glucose and free acetone correlated positively. Hemoglobin A1 remained stable after death. Its amount was independent from postmortem blood glucose, postmortem interval and total hemoglobin. Furthermore, the manner of storage (-80 degrees or +4 degrees C) had no significant influence on its values. In 29 of 34 cases of fatal coma, Hb A1 exceeded 12.1%. Analysis of urine glucose showed elevated levels (over 500 mg/dl) in diabetic comas. On conclusion, fatal diabetic coma seems indicated as the cause of death if measured values of postmortem biochemistry exceed the following limits: CSF-Traub 415 mg/dl, free acetone (CSF) 21 mg/l; Hb A1 12.1%; urine glucose 500 mg/dl. Most important are the Traub formula and hemoglobin A1. Usually, in fatal coma both values are elevated. If both of them are normal, diabetic coma can nearly be excluded. Combined evaluation of all values is absolutely necessary. Morphology must also always be taken into account. Consequently, a diagnosis of fatal coma can be obtained by a process of elimination.

Remote Photoregulated Ring Gliding in a [2]Rotaxane via a Molecular Effector.

PubMed

Tron, Arnaud; Pianet, Isabelle; Martinez-Cuezva, Alberto; Tucker, James H R; Pisciottani, Luca; Alajarin, Mateo; Berna, Jose; McClenaghan, Nathan D

2017-01-06

A molecular barbiturate messenger, which is reversibly released/captured by a photoswitchable artificial molecular receptor, is shown to act as an effector to control ring gliding on a distant hydrogen-bonding [2]rotaxane. Thus, light-driven chemical communication governing the operation of a remote molecular machine is demonstrated using an information-rich neutral molecule.

21 CFR 522.1642 - Oxymorphone hydrochloride injection.

Code of Federal Regulations, 2012 CFR

2012-04-01

... chloride. (b) Sponsor. See No. 060951 in § 510.600(c) of this chapter. (c) Conditions of use. (1) The drug... intramuscular, subcutaneous or intravenous administration to cats and dogs as follows: Animal Body weight....0 Cats Small 0.4-0.75 Large 0.75-1.5 (2) Do not mix with a barbiturate in the same syringe to...

Amphetamines, Barbiturates and Hallucinogens; An Analysis of Use, Distribution, and Control. Final Report.

ERIC Educational Resources Information Center

McGlothlin, William H.

This report is the third of three monographs to provide perspectives on the use, distribution, and control of illicit drugs. The first, conducted in 1971, described the prevalence, use patterns, sources, distribution, and economics of the marihuana market. The second (1972) estimated the cost, benefits, and potential of approaches to narcotic…

Substance Use by Fourth-Year Students at 13 U.S. Medical Schools.

ERIC Educational Resources Information Center

Conard, Scott; And Others

1988-01-01

A study investigated drug use by fourth-year medical students in 13 schools and compared drug use patterns with those of an age- and sex-matched cohort. Medical students reported less use of marijuana, cocaine, cigarettes, LSD, barbiturates, and amphetamines, similar use of opiates, and slightly more use of tranquilizers and alcohol. (MSE)

Antiemetics With Concomitant Sedative Use in Civil Aviation Pilot Fatalities: From 2000 to 2006

DTIC Science & Technology

2007-10-01

Unclassified Unclassified 13 Form DOT F 1700.7 (8-72) Reproduction of completed page authorized iii CONTENTS INTRODUCTION...sedative hypnotics , and ethanol. Antiemetics and drugs with antiemetic properties such as metoclopramide, diphenhydramine (a sedating...antihistamines, ethanol, barbiturates, serotonin modulators, and/or sedative- hypnotics . Antihistamines such as diphenhydramine are commonly used. The

Introduccion al estudio de la coma (Final) [Introduction to the Study of the Coma (Final Part)].

ERIC Educational Resources Information Center

Amilcar Cipriano, Nestor

1979-01-01

This concluding article in a series concerning the use of the comma in Spanish gives specific examples of its use from Spanish literature. Concluding remarks outline the major purposes of the comma. (NCR)

Transport and Distribution of Hydroxyl Radicals and Oxygen Atoms from H2O Photodissociation in the Inner Coma of Comet 67P/Churyumov-Gerasimenko

NASA Astrophysics Data System (ADS)

Lai, Ian-Lin; Su, Cheng-Chin; Ip, Wing-Huen; Wei, Chen-En; Wu, Jong-Shinn; Lo, Ming-Chung; Liao, Ying; Thomas, Nicolas

2016-03-01

With a combination of the Direct Simulation Monte Carlo (DSMC) calculation and test particle computation, the ballistic transport process of the hydroxyl radicals and oxygen atoms produced by photodissociation of water molecules in the coma of comet 67P/Churyumov-Gerasimenko is modelled. We discuss the key elements and essential features of such simulations which results can be compared with the remote-sensing and in situ measurements of cometary gas coma from the Rosetta mission at different orbital phases of this comet.

Sudden cardiac arrest as a rare presentation of myxedema coma: case report.

PubMed

Salhan, Divya; Sapkota, Deepak; Verma, Prakash; Kandel, Saroj; Abdulfattah, Omar; Lixon, Antony; Zwenge, Deribe; Schmidt, Frances

2017-01-01

Myxedema coma is a decompensated hypothyroidism which occurs due to long-standing, undiagnosed, or untreated hypothyroidism. Untreated hypothyroidism is known to affect almost all organs including the heart. It is associated with a decrease in cardiac output, stroke volume due to decreased myocardial contractility, and an increase in systemic vascular resistance. It can cause cardiac arrhythmias and the most commonly seen conduction abnormalities are sinus bradycardia, heart block, ventricular tachycardia, and torsade de pointes. The authors report a case of an elderly man who presented with sudden cardiac arrest and myxedema coma and who was successfully revived.

Myxedema coma after esophagectomy.

PubMed

Yuan, Yong; Hu, Yang; Xie, Tianpeng; Zhao, Yongfan

2010-07-01

For most patients with esophageal cancer, esophagectomy is an effective therapy. Perioperative management is critical for clinical outcomes after the operation. Great efforts should be made to avoid postoperative complications. We report myxedema coma, an emergency condition caused by severe hypothyroidism, after a patient underwent esophagectomy for esophageal cancer. The patient was successfully treated with intravenous levothyroxine. We strongly recommend that physicians test the thyroid hormone levels in patients with risk factors. If myxedema coma occurs, immediate use of intravenous levothyroxine is effective for this lethal complication. Copyright 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Spectroscopic Investigations of Fragment Species in the Coma

NASA Technical Reports Server (NTRS)

Feldman, Paul D.; Cochran, Anita L.; Combi, Michael R.

2004-01-01

The content of the gaseous coma of a comet is dominated by fragment species produced by photolysis of the parent molecules issuing directly from the icy nucleus of the comet. Spectroscopy of these species provides complementary information on the physical state of the coma to that obtained from observations of the parent species. Extraction of physical parameters requires detailed molecular and atomic data together with reliable high-resolution spectra and absolute fluxes of the primary source of excitation, the Sun. The large database of observations, dating back more than a century, provides a means to assess the chemical and evolutionary diversity of comets.

Morfología de la Coma del Cometa Hale - Bopp

NASA Astrophysics Data System (ADS)

Gil-Hutton, R.; Caballero, M.; Coldwell, G.; Cañada, M.; Godoy, G.; Trozzo, C.; Gómez, G.

Para lograr comprender plenamente los procesos físicos que se desarrollan en los núcleos cometarios y obtener un modelo que explique, no sólo su actividad, sino también sus efectos sobre la coma, es necesario obtener información detallada para el mayor número de cometas posible, siendo las características más interesantes para estudiar la ubicación de las regiones activas, la presencia de jets, las tasas de producción de gas y polvo y la interacción de la coma con el viento solar. En la actualidad, con técnicas de procesamiento de imágenes y tecnología CCD se pueden obtener este tipo de datos para cometas que ingresan al sistema solar interior y estudiar, de esta manera, la morfología de sus comas, tratando de correlacionar la actividad detectada con algún modelo teórico. En este trabajo se presenta un estudio parcial de la actividad desarrollada por el cometa Hale-Bopp, y sus efectos sobre la morfología de su coma, desde agosto de 1995 hasta la fecha en base a imágenes adquiridas con el telescopio de 0.76 m. de la Estación Astronómica Dr. Carlos Ulrrico Cesco.

Map-based trigonometric parallaxes of open clusters: Coma

NASA Technical Reports Server (NTRS)

Gatewood, George

1995-01-01

This is the fourth study in a series to determine the direct trigonometric parallaxes of four of the nearest open star clusters, the Hyades, the Pleiades, the Praesepe, and the nearby cluster in Coma (Gatewood et al. 1990; Gatewood et al. 1992); Gatewood & Kiewiet de Jonge 1994). The results for the open star cluster in Coma are compared with those of the other three clusters, and the members are found to be significantly subluminous. The trigonometric parallax of the cluster is estimated from that of three members studied with the Multichannel Astrometric Photometer (MAP) at the Thaw Refractor of the University of Pittsburgh's Allegheny Observatory. The weighted mean parallax of the cluster is +13.53 +/- 0.54 mass (0.00054 min), corresponding to a distance modulus of 4.34 +/- 0.09 mag. The U-B excess of the Coma cluster members may be used to adjust the observed absolute magnitudes and the B-V measurements as suggested by Sandage & Eggen (1959). The agreement obtained in this manner suggests that, like subdwarf stars, the stars of the Coma cluster appear subluminous because of line blanketing. One of the three members observed in this study was recognized as a member by its parallax and is the faintest known member of the cluster.

Coma Patient Monitoring System Using Image Processing

NASA Astrophysics Data System (ADS)

Sankalp, Meenu

2011-12-01

COMA PATIENT MONITORING SYSTEM provides high quality healthcare services in the near future. To provide more convenient and comprehensive medical monitoring in big hospitals since it is tough job for medical personnel to monitor each patient for 24 hours.. The latest development in patient monitoring system can be used in Intensive Care Unit (ICU), Critical Care Unit (CCU), and Emergency Rooms of hospital. During treatment, the patient monitor is continuously monitoring the coma patient to transmit the important information. Also in the emergency cases, doctor are able to monitor patient condition efficiently to reduce time consumption, thus it provides more effective healthcare system. So due to importance of patient monitoring system, the continuous monitoring of the coma patient can be simplified. This paper investigates about the effects seen in the patient using "Coma Patient Monitoring System" which is a very advanced product related to physical changes in body movement of the patient and gives Warning in form of alarm and display on the LCD in less than one second time. It also passes a sms to a person sitting at the distant place if there exists any movement in any body part of the patient. The model for the system uses Keil software for the software implementation of the developed system.

Map-based trigonometric parallaxes of open clusters: Coma

NASA Astrophysics Data System (ADS)

Gatewood, George

1995-06-01

This is the fourth study in a series to determine the direct trigonometric parallaxes of four of the nearest open star clusters, the Hyades, the Pleiades, the Praesepe, and the nearby cluster in Coma (Gatewood et al. 1990; Gatewood et al. 1992); Gatewood & Kiewiet de Jonge 1994). The results for the open star cluster in Coma are compared with those of the other three clusters, and the members are found to be significantly subluminous. The trigonometric parallax of the cluster is estimated from that of three members studied with the Multichannel Astrometric Photometer (MAP) at the Thaw Refractor of the University of Pittsburgh's Allegheny Observatory. The weighted mean parallax of the cluster is +13.53 +/- 0.54 mass (0.00054 min), corresponding to a distance modulus of 4.34 +/- 0.09 mag. The U-B excess of the Coma cluster members may be used to adjust the observed absolute magnitudes and the B-V measurements as suggested by Sandage & Eggen (1959). The agreement obtained in this manner suggests that, like subdwarf stars, the stars of the Coma cluster appear subluminous because of line blanketing. One of the three members observed in this study was recognized as a member by its parallax and is the faintest known member of the cluster.

The distribution of gas and ions in the inner coma of 67P/Churyumov-Gerasimenko between 3 AU before and after its perihelion

NASA Astrophysics Data System (ADS)

Bodewits, Dennis; Lara, Luisa; La Forgia, Fiorangela; A'Hearn, Michael F.; Knollenberg, Jörg; Lazzarin, Monica; Li, Zhong-Yi; Osiris Team

2016-10-01

Rosetta explored a regime not accessible before: the inner coma of a low-activity comet at a large range of heliocentric distances. The Wide Angle Camera (WAC) of the OSIRIS instrument on board the Rosetta spacecraft is equipped with several narrowband filters that are centered on the emission lines and bands of various molecules and ions. These filters center on fragment species that are relatively bright and that have been used for numerous comet studies from the ground (e.g. A'Hearn et al. 1995). Surprisingly, we found that outside 2 AU pre-perihelion, the emission in the filters was dominated by emission from dissociative electron impact excitation (Bodewits et al. 2016). Closer to perihelion, higher gas densities reduced electron temperatures in the inner coma and photo-processes drove much if not most of the emission from the comet. Our observations allowed us to study changes in the physical environment of the inner coma, and Rosetta's excursions as far as 1000 km from the surface allowed us to study different regions of the coma.In this contribution, we will summarize the results of our OSIRIS observations from approximately 3 AU before to 3 AU after perihelion.

Abnormal intra-aural pressure waves associated with death in African children with acute nontraumatic coma.

PubMed

Gwer, Samson; Kazungu, Michael; Chengo, Eddie; Ohuma, Eric O; Idro, Richard; Birch, Tony; Marchbanks, Robert; Kirkham, Fenella J; Newton, Charles R

2015-07-01

We explored the relationship between tympanic membrane displacement (TMD) measurements, a tool to monitor intracranial pressure noninvasively, and clinical features and death in children with acute coma in Kilifi, Kenya. Between November 2007 and September 2009, we made serial TMD measurements and clinical observations on children with acute coma (Blantyre coma score (BCS) ≤ 2) on the pediatric high dependency unit of Kilifi District Hospital, and on well children presenting to the hospital's outpatient department for routine follow-up. We examined middle ear function using tympanometry and measured cardiac pulse (CPA) and respiratory pulse pressure amplitudes (RPA) using the TMD analyzer. We recruited 75 children (32 (43%) females; median age 3.3 (IQR: 2.0, 4.3) years). Twenty-one (28%) children died. Higher TMD measurements predicted death. Adjusting for diagnosis, every 50 nl rise in both semirecumbent and recumbent CPA was associated with increased odds of death associated with intracranial herniation (OR: 1.61, 95% confidence interval (CI): 1.07, 2.41; P = 0.02 and OR: 1.35, 95% CI: 1.10, 1.66; P ≤ 0.01 respectively). Raised TMD pulse pressure measurements are associated with death and may be useful in detecting and monitoring risk of intracranial herniation and intracranial pressure in childhood coma.

High-dose benzodiazepine dependence: a qualitative study of patients' perception on cessation and withdrawal.

PubMed

Liebrenz, Michael; Gehring, Marie-Therese; Buadze, Anna; Caflisch, Carlo

2015-05-13

Benzodiazepine withdrawal syndrome has been reported following attempts to withdraw even from low or therapeutic doses and has been compared to barbiturate and alcohol withdrawal. This experience is known to deter patients from future cessation attempts. Research on other psychotropic substances shows that the reasons and motivations for withdrawal attempts - as well as the experiences surrounding those attempts - at least partially predict future efforts at discontinuation as well as relapse. We therefore aimed to qualitatively explore what motivates patients to discontinue this medication as well as to examine their experiences surrounding previous and current withdrawal attempts and treatment interventions in order to positively influence future help-seeking behavior and compliance. To understand these patients better, we conducted a series of 41 unstructured, narrative, in-depth interviews among adult Swiss patients with a long-term dependent use of benzodiazepines in doses equivalent to more than 40 mg diazepam per day and/or otherwise problematic use (mixing benzodiazepines, escalating dosage, recreational use or illegal purchase). Mayring's qualitative content analysis was used to evaluate findings. These high-dose benzodiazepine-dependent patients decision to change consumption patterns were affected by health concerns, the feeling of being addicted and social factors. Discontinuation attempts were frequent and not very successful with fast relapse. Withdrawal was perceived to be a difficult, complicated, and highly unpredictable process. The first attempt at withdrawal occurred at home and typically felt better than at the clinic. Inpatient treatment was believed to be more effective with long term treatment (approaches) than short term. Patients preferred gradual reduction of usage to abrupt cessation (and had experienced both). While no clear preferences for withdrawal were found for benzodiazepines with specific pharmacokinetic properties, participants frequently based their decision to participate in treatment on the availability of their preferred brand name and furthermore discarding equivalent dosage rationales. Our findings provide greater understanding of the factors that motivate high-dose benzodiazepine-dependent individuals to stop taking these medications, and how they experience withdrawal and treatment strategies. They underscore how patients' perceptions of treatment approaches contribute to compliant or non-compliant behavior.

Numerical simulations of the radiance from the limb measurements of dusty coma of the Comet 67P/Churyumov Gerasimenko

NASA Astrophysics Data System (ADS)

Błęcka, M. I.; Rinaldi, G.; Fink, U.; Capacioni, F.; Tozzi, G. P.

2013-09-01

The work we present deals with the spectrometric measurements of the VIRTIS instrument part of the payload of the Rosetta mission to the Comet 67P/Churyumov-Gerasimenko. This spectrometer will monitor (VIRTIS M channel: 0.25μm - 0.98μm; Δκ=20cm-1 ; 0.980 - 5.0 μm; Δκ=5cm-1; VIRTIS H channel: 2.0 μm- 5.0 μm ; Δκ=5cm-1) the nucleus and the coma in order to provide a picture of coma's composition, the production of gas and dust, and the structure and variation of mineralogy of the nucleus surface. The dust is an important constituent of cometary environment and is always present on the surface of the nucleus and in the coma. The cometary spectra are strongly affected by the processes taking place in the coma and by the structure, composition and the spatial distribution of cometary solid particles. The particles of the dust, illuminated by solar light, scatter, absorb and emit radiation. The reflected and emitted radiation are transmitted through the coma region before being collected by instruments such as VIRTIS. The reflection, absorption, scattering, and emission processes in the coma depend on the Comet-Sun geometry. In the VIRTIS team we have initiated and effort to simulate the dust radiance using several radiative transfer models (see Rinaldi et al, this issue). In the present paper, which is the continuation of our previous works (e.g. AGU fall meeting 2011, EGU 2012, EPSC2012 -abstracts), we are mainly concentrated on the influence of optical parameters of dust on spectra we expect from the VIRTIS/Rosetta measurements. To this purposes the equation of radiative transfer in limb geometry through the assembly of various dust grains and gases is solved. The number density distribution of the dust grains around the coma and their size distribution are drawn from recent theoretical models (e.g.Tenishev et.al.2011). A few phenomenological scattering phase functions are taken into account. We have assumed in the simulation the presence on the surface of H2O ice, in which are embedded dust grains of various mineralogies. These grains, when freed by the gas sublimation, were considered as the main constituent of the dusty coma. At the beginning the particles are spherical. Such an assumption would be reasonable in many cases. We have confined ourselves to the compact dust particles only. But it should be noted here that fluffy grains would have different optical properties and their presence would lead to different conclusions. The main purposes of the paper are: 1) discussion of the influence of the mineralogical composition of cometary dust including mixtures with ices, the size distributions and optical parameters - using the various possible phase functions, extinction and symmetry factors 2) influence of cometary activity on parameters of the coma and then the signal to be measured by the VIRTIS spectrometer at various distances from the Sun (3.7AU; 3.5AU; 3.0AU; 1.24AU).

THE HST/ACS COMA CLUSTER SURVEY. VIII. BARRED DISK GALAXIES IN THE CORE OF THE COMA CLUSTER

DOE Office of Scientific and Technical Information (OSTI.GOV)

Marinova, Irina; Jogee, Shardha; Weinzirl, Tim

2012-02-20

We use high-resolution ({approx}0.''1) F814W Advanced Camera for Surveys (ACS) images from the Hubble Space Telescope ACS Treasury survey of the Coma cluster at z {approx} 0.02 to study bars in massive disk galaxies (S0s), as well as low-mass dwarf galaxies in the core of the Coma cluster, the densest environment in the nearby universe. Our study helps to constrain the evolution of bars and disks in dense environments and provides a comparison point for studies in lower density environments and at higher redshifts. Our results are: (1) we characterize the fraction and properties of bars in a sample ofmore » 32 bright (M{sub V} {approx}< -18, M{sub *} > 10{sup 9.5} M{sub Sun }) S0 galaxies, which dominate the population of massive disk galaxies in the Coma core. We find that the measurement of a bar fraction among S0 galaxies must be handled with special care due to the difficulty in separating unbarred S0s from ellipticals, and the potential dilution of the bar signature by light from a relatively large, bright bulge. The results depend sensitively on the method used: the bar fraction for bright S0s in the Coma core is 50% {+-} 11%, 65% {+-} 11%, and 60% {+-} 11% based on three methods of bar detection, namely, strict ellipse fit criteria, relaxed ellipse fit criteria, and visual classification. (2) We compare the S0 bar fraction across different environments (the Coma core, A901/902, and Virgo) adopting the critical step of using matched samples and matched methods in order to ensure robust comparisons. We find that the bar fraction among bright S0 galaxies does not show a statistically significant variation (within the error bars of {+-}11%) across environments which span two orders of magnitude in galaxy number density (n {approx} 300-10,000 galaxies Mpc{sup -3}) and include rich and poor clusters, such as the core of Coma, the A901/902 cluster, and Virgo. We speculate that the bar fraction among S0s is not significantly enhanced in rich clusters compared to low-density environments for two reasons. First, S0s in rich clusters are less prone to bar instabilities as they are dynamically heated by harassment and are gas poor as a result of ram pressure stripping and accelerated star formation. Second, high-speed encounters in rich clusters may be less effective than slow, strong encounters in inducing bars. (3) We also take advantage of the high resolution of the ACS ({approx}50 pc) to analyze a sample of 333 faint (M{sub V} > -18) dwarf galaxies in the Coma core. Using visual inspection of unsharp-masked images, we find only 13 galaxies with bar and/or spiral structure. An additional eight galaxies show evidence for an inclined disk. The paucity of disk structures in Coma dwarfs suggests that either disks are not common in these galaxies or that any disks present are too hot to develop instabilities.« less

Extending technology-aided leisure and communication programs to persons with spinal cord injury and post-coma multiple disabilities.

PubMed

Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Ricciuti, Riccardo A; Trignani, Roberto; Oliva, Doretta; Signorino, Mario; D'Amico, Fiora; Sasanelli, Giovanni

2015-01-01

These two studies extended technology-aided programs to promote leisure and communication opportunities to a man with cervical spinal cord injury and a post-coma man with multiple disabilities. The studies involved the use of ABAB designs, in which A and B represented baseline and intervention phases, respectively. The programs focused on enabling the participants to activate songs, videos, requests, text messages, and telephone calls. These options were presented on a computer screen and activated through a small pressure microswitch by the man with spinal cord injury and a special touch screen by the post-coma man. To help the latter participant, who had no verbal skills, with requests and telephone calls, series of words and phrases were made available that he could activate in those situations. Data showed that both participants were successful in managing the programs arranged for them. The man with spinal cord injury activated mean frequencies of above five options per 10-min session. The post-coma man activated mean frequencies of about 12 options per 20-min session. Technology-aided programs for promoting leisure and communication opportunities might be successfully tailored to persons with spinal cord injury and persons with post-coma multiple disabilities. Implications for Rehabilitation Technology-aided programs may be critical to enable persons with pervasive motor impairment to engage in leisure activities and communication events independently. Persons with spinal cord injury, post-coma extended brain damage, and forms of neurodegenerative disease, such as amyotrophic lateral sclerosis, may benefit from those programs. The programs could be adapted to the participants' characteristics, both in terms of technology and contents, so as to improve their overall impact on the participants' functioning and general mood.

Near-UV OH Prompt Emission in the Innermost Coma of 103P/Hartley 2

DOE Office of Scientific and Technical Information (OSTI.GOV)

La Forgia, Fiorangela; Bodewits, Dennis; A’Hearn, Michael F.

The Deep Impact spacecraft flyby of comet 103P/Hartley 2 occurred on 2010 November 4, 1 week after perihelion with a closest approach (CA) distance of about 700 km. We used narrowband images obtained by the Medium Resolution Imager on board the spacecraft to study the gas and dust in the innermost coma. We derived an overall dust reddening of 15%/100 nm between 345 and 749 nm and identified a blue enhancement in the dust coma in the sunward direction within 5 km from the nucleus, which we interpret as a localized enrichment in water ice. OH column density maps show an anti-sunwardmore » enhancement throughout the encounter, except for the highest-resolution images, acquired at CA, where a radial jet becomes visible in the innermost coma, extending up to 12 km from the nucleus. The OH distribution in the inner coma is very different from that expected for a fragment species. Instead, it correlates well with the water vapor map derived by the HRI-IR instrument on board Deep Impact . Radial profiles of the OH column density and derived water production rates show an excess of OH emission during CA that cannot be explained with pure fluorescence. We attribute this excess to a prompt emission process where photodissociation of H{sub 2}O directly produces excited OH*( A {sup 2}Σ{sup +}) radicals. Our observations provide the first direct imaging of near-UV prompt emission of OH. We therefore suggest the use of a dedicated filter centered at 318.8 nm to directly trace the water in the coma of comets.« less

Food deprivation and prior anoxic coma have opposite effects on the activity of a visual interneuron in the locust.

PubMed

Cross, Kevin P; Britton, Samantha; Mangulins, Rebecca; Money, Tomas G A; Robertson, R Meldrum

2017-04-01

We compared how different metabolic stressors, anoxic coma and food deprivation, affected signaling in neural tissue. We used the locust's Descending Contralateral Movement Detector (DCMD) interneuron because its large axon, high firing frequencies, and rapid conduction velocity make it energetically expensive. We exposed locusts to a 30min anoxic coma or 1day of food deprivation and found contrasting effects on signaling within the axon. After a prior anoxic coma, the DCMD fired fewer high-frequency (>200Hz) action potentials (APs) (Control: 12.4±1.6; Coma: 6.3±0.9) with a reduction in axonal conduction velocity (CV) at all frequencies (∼4-8%) when presented with a standard looming visual stimulus. Prior anoxic coma was also associated with a loss of supernormal conduction by reducing both the number of supernormal APs and the firing frequency with the highest CV. Initially, food deprivation caused a significant increase in the number of low- and high-frequency APs with no differences observed in CV. After controlling for isolation, food deprivation resulted in an increase in high-frequency APs (>200Hz: Control: 17.1±1.7; Food-deprived: 19.9±1.3) and an increase in relative conduction velocity for frequencies >150Hz (∼2%). Action potentials of food-deprived animals had a smaller half-width (Control: 0.45±0.02ms; Food-deprived: 0.40±0.01ms) and decay time (Control: 0.62±0.03ms; Food-deprived: 0.54±0.02ms). Our data indicate that the effects of metabolic stress on neural signaling can be stressor-dependent. Copyright © 2017 Elsevier Ltd. All rights reserved.

DARK MATTER SUBHALOS AND THE X-RAY MORPHOLOGY OF THE COMA CLUSTER

DOE Office of Scientific and Technical Information (OSTI.GOV)

Andrade-Santos, Felipe; Nulsen, Paul E. J.; Kraft, Ralph P.

2013-04-01

Structure formation models predict that clusters of galaxies contain numerous massive subhalos. The gravity of a subhalo in a cluster compresses the surrounding intracluster gas and enhances its X-ray emission. We present a simple model, which treats subhalos as slow moving and gasless, for computing this effect. Recent weak lensing measurements by Okabe et al. have determined masses of {approx}10{sup 13} M{sub Sun} for three mass concentrations projected within 300 kpc of the center of the Coma Cluster, two of which are centered on the giant elliptical galaxies NGC 4889 and NGC 4874. Adopting a smooth spheroidal {beta}-model for themore » gas distribution in the unperturbed cluster, we model the effect of these subhalos on the X-ray morphology of the Coma Cluster, comparing our results to Chandra and XMM-Newton X-ray data. The agreement between the models and the X-ray morphology of the central Coma Cluster is striking. With subhalo parameters from the lensing measurements, the distances of the three subhalos from the Coma Cluster midplane along our line of sight are all tightly constrained. Using the model to fit the subhalo masses for NGC 4889 and NGC 4874 gives 9.1 Multiplication-Sign 10{sup 12} M{sub Sun} and 7.6 Multiplication-Sign 10{sup 12} M{sub Sun }, respectively, in good agreement with the lensing masses. These results lend strong support to the argument that NGC 4889 and NGC 4874 are each associated with a subhalo that resides near the center of the Coma Cluster. In addition to constraining the masses and 3-d location of subhalos, the X-ray data show promise as a means of probing the structure of central subhalos.« less

A New 3D Multi-fluid Model: A Study of Kinetic Effects and Variations of Physical Conditions in the Cometary Coma

NASA Astrophysics Data System (ADS)

Shou, Y.; Combi, M.; Toth, G.; Tenishev, V.; Fougere, N.; Jia, X.; Rubin, M.; Huang, Z.; Hansen, K.; Gombosi, T.; Bieler, A.

2016-12-01

Physics-based numerical coma models are desirable whether to interpret the spacecraft observations of the inner coma or to compare with the ground-based observations of the outer coma. In this work, we develop a multi-neutral-fluid model based on the BATS-R-US code of the University of Michigan, which is capable of computing both the inner and outer coma and simulating time-variable phenomena. It treats H2O, OH, H2, O, and H as separate fluids and each fluid has its own velocity and temperature, with collisions coupling all fluids together. The self-consistent collisional interactions decrease the velocity differences, re-distribute the excess energy deposited by chemical reactions among all species, and account for the varying heating efficiency under various physical conditions. Recognizing that the fluid approach has limitations in capturing all of the correct physics for certain applications, especially for very low density environment, we applied our multi-fluid coma model to comet 67P/Churyumov-Gerasimenko at various heliocentric distances and demonstrated that it yields comparable results to the Direct Simulation Monte Carlo (DSMC) model, which is based on a kinetic approach that is valid under these conditions. Therefore, our model may be a powerful alternative to the particle-based model, especially for some computationally intensive simulations. In addition, by running the model with several combinations of production rates and heliocentric distances, we characterize the cometary H2O expansion speeds and demonstrate the nonlinear dependencies of production rate and heliocentric distance. Our results are also compared to previous modeling work and remote observations, which serve as further validation of our model.

SMILE and Wavefront-Guided LASIK Out-Compete Other Refractive Surgeries in Ameliorating the Induction of High-Order Aberrations in Anterior Corneal Surface

PubMed Central

2016-01-01

Purpose. To compare the change of anterior corneal higher-order aberrations (HOAs) after laser in situ keratomileusis (LASIK), wavefront-guided LASIK with iris registration (WF-LASIK), femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK), and small incision lenticule extraction (SMILE). Methods. In a prospective study, 82 eyes underwent LASIK, 119 eyes underwent WF-LASIK, 88 eyes underwent FS-LASIK, and 170 eyes underwent SMILE surgery. HOAs were measured with Pentacam device preoperatively and 6 months after surgery. The aberrations were described as Zernike polynomials, and analysis focused on total HOAs, spherical aberration (SA), horizontal coma, and vertical coma over 6 mm diameter central corneal zone. Results. Six months postoperatively, all procedures result in increase of anterior corneal total HOAs and SA. There were no significant differences in the induced HOAs between LASIK and FS-LASIK, while SMILE induced fewer total HOAs and SA compared with LASIK and FS-LASIK. Similarly, WF-LASIK also induced less total HOAs than LASIK and FS-LASIK, but only fewer SA than FS-LASIK (P < 0.05). No significant difference could be detected in the induced total HOAs and SA between SMILE and WF-LASIK, whereas SMILE induced more horizontal coma and vertical coma compared with WF-LASIK (P < 0.05). Conclusion. FS-LASIK and LASIK induced comparable anterior corneal HOAs. Compared to LASIK and FS-LASIK, both SMILE and WF-LASIK showed advantages in inducing less total HOAs. In addition, SMILE also possesses better ability to reduce the induction of SA in comparison with LASIK and FS-LASIK. However, SMILE induced more horizontal coma and vertical coma compared with WF-LASIK, indicating that the centration of SMILE procedure is probably less precise than WF-LASIK. PMID:27818792

Hyperammonemic coma after craniotomy: Hepatic encephalopathy from upper gastrointestinal hemorrhage or valproate side effect?: Case report and literature review.

PubMed

Guo, Xiaopeng; Wei, Junji; Gao, Lu; Xing, Bing; Xu, Zhiqin

2017-04-01

Postoperative coma is not uncommon in patients after craniotomy. It generally presents as mental state changes and is usually caused by intracranial hematoma, brain edema, or swelling. Hyperammonemia can also result in postoperative coma; however, it is rarely recognized as a potential cause in coma patients. Hyperammonemic coma is determined through a complicated differential diagnosis, and although it can also be induced as a side effect of valproate (VPA), this cause is frequently unrecognized or confused with upper gastrointestinal hemorrhage (UGH)-induced hepatic encephalopathy. We herein present a case of valproate-induced hyperammonemic encephalopathy (VHE) to illustrate the rarity of such cases and emphasize the importance of correct diagnosis and proper treatment. A 61-year-old woman with meningioma was admitted into our hospital. Radical resection of the tumor was performed, and the patient recovered well as expected. After administration of valproate for 7 days, the patient was suddenly found in a deep coma, and her mental state deteriorated rapidly. The diagnoses of hepatic encephalopathy was confirmed. However, whether it origins from upper gastrointestinal hemorrhage or valproate side effect is uncertain. The patient's condition fluctuated without improvement during the subsequent 3 days under the treatment of reducing ammonia. With the discontinuation of valproate treatment, the patient regained complete consciousness within 48 hours, and her blood ammonia decreased to the normal range within 4 days. VHE is a rare but serious complication in patients after craniotomy and is diagnosed by mental state changes and elevated blood ammonia. Thus, the regular perioperative administration of VPA, which is frequently neglected as a cause of VHE, should be emphasized. In addition, excluding UGH prior to providing a diagnosis and immediately discontinuing VPA administration are recommended.

Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond

PubMed Central

Sachdeva, Ankur; Chandra, Mina

2015-01-01

Alcohol dependence is an increasing and pervasive problem. Alcohol withdrawal symptoms are a part of alcohol dependence syndrome and are commonly encountered in general hospital settings, in most of the departments. Alcohol withdrawal syndrome ranges from mild to severe. The severe complicated alcohol withdrawal may present with hallucinations, seizures or delirium tremens. Benzodiazepines have the largest and the best evidence base in the treatment of alcohol withdrawal, and are considered the gold standard. Others, such as anticonvulsants, barbiturates, adrenergic drugs, and GABA agonists have been tried and have evidence. Supportive care and use of vitamins is essential in the management. Symptom triggered regime is favoured over fixed tapering dose regime, although monitoring through scales is cumbersome. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome. We searched Pubmed for articles published in English on ‘Alcohol withdrawal syndrome’ in humans during the last 10 years. A total of 1182 articles came up. Articles not relevant to clinical utility and management were excluded based on the titles and abstract available. Full text articles, meta-analyses, systematic reviews and randomized controlled trials were obtained from this list and were considered for review. PMID:26500991

A preliminary model of the coma of 2060 Chiron

NASA Technical Reports Server (NTRS)

Boice, Daniel C.; Konno, I.; Stern, S. Alan; Huebner, Walter F.

1992-01-01

We have included gravity in our fluid dynamic model with chemical kinetics of dusty comet comae and applied it with two dust sizes to 2060 Chiron. A progress report on the model and preliminary results concerning gas/dust dynamics and chemistry is given.

Dynamic molecular oxygen production in cometary comae.

PubMed

Yao, Yunxi; Giapis, Konstantinos P

2017-05-08

Abundant molecular oxygen was discovered in the coma of comet 67P/Churyumov-Gerasimenko. Its origin was ascribed to primordial gaseous O 2 incorporated into the nucleus during the comet's formation. This thesis was put forward after discounting several O 2 production mechanisms in comets, including photolysis and radiolysis of water, solar wind-surface interactions and gas-phase collisions. Here we report an original Eley-Rideal reaction mechanism, which permits direct O 2 formation in single collisions of energetic water ions with oxidized cometary surface analogues. The reaction proceeds by H 2 O + abstracting a surface O-atom, then forming an excited precursor state, which dissociates to produce O 2 - . Subsequent photo-detachment leads to molecular O 2 , whose presence in the coma may thus be linked directly to water molecules and their interaction with the solar wind. This abiotic O 2 production mechanism is consistent with reported trends in the 67P coma and raises awareness of the role of energetic negative ions in comets.

Modeling of the illumination driven coma of 67P/Churyumov-Gerasimenko

NASA Astrophysics Data System (ADS)

Bieler, André

2015-04-01

In this paper we present results modeling 67P/Churyumov-Gerasimenko's (C-G) neutral coma properties observed by the Rosetta ROSINA experiment with 3 different model approaches. The basic assumption for all models is the idea that the out-gassing properties of C-G are mainly illumination driven. With this assumption all models are capable of reproducing most features in the neutral coma signature as detected by the ROSINA-COPS instrument over several months. The models include the realistic shape model of the nucleus to calculate the illumination conditions over time which are used to define the boundary conditions for the hydrodynamic (BATS-R-US code) and the Direct Simulation Monte Carlo (AMPS code) simulations. The third model finally computes the projection of the total illumination on the comet surface towards the spacecraft. Our results indicate that at large heliocentric distances (3.5 to 2.8 AU) most gas coma structures observed by the in-situ instruments can be explained by uniformly distributed activity regions spread over the whole nucleus surface.

Radical formation in the coma from photodissociation of ice grains

NASA Technical Reports Server (NTRS)

Jackson, William M.; Gerth, Christopher

1990-01-01

Long ago visual observations of comets suggested that there are jets in comets but it has only been recently that A'Hearn et al. have proven that some of these jets are due to emission from the CN radical. Recent studies in the lab have shown that CN radicals can be ejected directly into the gas phase from the photolysis of frozen vapors if the parent molecular has been excited to repulsive excited state. This later observation suggests that the jets that have been observed may be due to photodissociation of icy grains in the coma. A theory of radical formation from icy grains is presented. It is shown that direct formation of free radicals in the coma is an effective way to produce radicals from icy grains in the coma. The model predicts that icy grains could produce from 6 to 800,000 OH radicals/s per grain depending upon whether the radius of the grain is 0.3 to 100 micron.

ALP conversion and the soft X-ray excess in the outskirts of the Coma cluster

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kraljic, David; Rummel, Markus; Conlon, Joseph P., E-mail: David.Kraljic@physics.ox.ac.uk, E-mail: Markus.Rummel@physics.ox.ac.uk, E-mail: j.conlon1@physics.ox.ac.uk

2015-01-01

It was recently found that the soft X-ray excess in the center of the Coma cluster can be fitted by conversion of axion-like-particles (ALPs) of a cosmic axion background (CAB) to photons. We extend this analysis to the outskirts of Coma, including regions up to 5 Mpc from the center of the cluster. We extract the excess soft X-ray flux from ROSAT All-Sky Survey data and compare it to the expected flux from ALP to photon conversion of a CAB. The soft X-ray excess both in the center and the outskirts of Coma can be simultaneously fitted by ALP tomore » photon conversion of a CAB. Given the uncertainties of the cluster magnetic field in the outskirts we constrain the parameter space of the CAB. In particular, an upper limit on the CAB mean energy and a range of allowed ALP-photon couplings are derived.« less

Coma measurement by use of an alternating phase-shifting mask mark with a specific phase width

DOE Office of Scientific and Technical Information (OSTI.GOV)

Qiu Zicheng; Wang Xiangzhao; Yuan Qiongyan

2009-01-10

The correlation between the coma sensitivity of the alternating phase-shifting mask (Alt-PSM) mark and the mark's structure is studied based on the Hopkins theory of partially coherent imaging and positive resist optical lithography (PROLITH) simulation. It is found that an optimized Alt-PSM mark with its phase width being two-thirds its pitch has a higher sensitivity to coma than Alt-PSM marks with the same pitch and the different phase widths. The pitch of the Alt-PSM mark is also optimized by PROLITH simulation, and the structure of p=1.92{lambda}/NA and pw=2p/3 proves to be with the highest sensitivity. The optimized Alt-PSM mark ismore » used as a measurement mark to retrieve coma aberration from the projection optics in lithographic tools. In comparison with an ordinary Alt-PSM mark with its phase width being a half its pitch, the measurement accuracies of Z7 and Z14 apparently increase.« less

Myxedema Coma with Reversible Cardiopulmonary Failure: a Rare Entity in 21St Century.

PubMed

Dhakal, Prajwal; Pant, Manisha; Acharya, Pranab Sharma; Dahal, Sumit; Bhatt, Vijaya Raj

2015-09-01

Myxedema coma, a rare entity in 21st century in developed nations, is a decompensated phase of hypothyroidism with high mortality rates. We describe a young woman with myxedema, who developed respiratory failure, congestive heart failure and significant pericardial effusion, some of the uncommon manifestations. Decreased cardiac contractility can result in cardiomyopathy and heart failure. As illustrated by this case, myxedema can also result in significant pericardial effusion due to increased vascular permeability. Myxedema can further be complicated by alveolar hypoventilation and respiratory failure secondary to the lack of central drive as well as respiratory muscle weakness. Prompt therapy with thyroid hormone replacement, glucocorticoid therapy, aggressive supportive care and management of the precipitating event can save lives and reverse the cardiopulmonary symptoms, as in our patient. Hence, physicians should have a high index of suspicion for myxedema coma in patients with unexplained cardiopulmonary failure. Our report is, therefore, aimed at bringing awareness about the rare but fatal manifestations of myxedema coma.

Rapid reduction of acute subdural hematoma and redistribution of hematoma: case report.

PubMed

Watanabe, Arata; Omata, Tomohiro; Kinouchi, Hiroyuki

2010-01-01

An 88-year-old woman presented with acute subdural hematoma (ASDH) which showed rapid resolution on computed tomography (CT) and magnetic resonance (MR) imaging. She was transferred to our hospital after falling out of bed. On admission, she was comatose with Japan Coma Scale score of 200 and Glasgow Coma Scale score of E1V1M2. Brain CT showed a thick left frontotemporal ASDH. Conservative treatment consisted of 200 ml of glycerol administered intravenously twice a day, and maintenance in the approximately 20 degree head-up position to reduce intracranial pressure. Three days later, her consciousness recovered to Japan Coma Scale score of 30 and Glasgow Coma Scale score of E2V4M5. CT showed obvious reduction of the hematoma without brain or scalp swelling. Spinal MR imaging detected no redistribution of hematoma to the spine. The present case illustrates that rapid spontaneous reduction of ASDH may occur by redistribution of hematoma, mainly to the supratentorial subdural space because of brain atrophy.

Coma and vegetative states: state of the art and proposal of a novel approach combining existing coma scales.

PubMed

Bonsignore, Luca Tommaso; Macrì, Simone; Orsi, Paolo; Chiarotti, Flavia; Alleva, Enrico

2014-01-01

Brain damage of various aetiologies can lead to different disorders of consciousness (DOC), varying from coma to vegetative, to minimally conscious states. Each state is characterised by a different degree of wakefulness, awareness, pain sensitivity and is differentially handled with respect to treatment, ethical considerations and end-oflife decisions. Thus, its correct identification is crucial while devising or modulating appropriate treatment strategies. Actually, the main coma scales cannot always accurately determine the state of consciousness of an individual, while other tools (e.g. imaging techniques) present a certain degree of uncertainty. A complementary approach may be constituted by a 24-hour observation of patients, for a sufficient period of days, using an ad hoc behavioural scale, further correlated with physiological and pharmacological parameters measured on patients. The method herein described might help recognising the presence of consciousness of the different DOC patients, and thus discerning a vegetative from a minimally conscious state.

Cometary MHD and chemistry

NASA Technical Reports Server (NTRS)

Wegmann, R.; Schmidt, H. U.; Huebner, W. F.; Boice, D. C.

1987-01-01

An MHD and chemical comet-coma model was developed, applying the computer program of Huebner (1985) for the detailed chemical evolution of a spherically expanding coma and the program of Schmidt and Wegman (1982) and Wegman (1987) for the MHD flow of plasma and magnetic field in a comet to the Giotto-mission data on the ion abundances measured by the HIS ion mass spectrometer. The physics and chemistry of the coma are modeled in great detail, including photoprocesses, gas-phase chemical kinetics, energy balance with a separate electron temperature, multifluid hydrodynamics with a transition to free molecular flow, fast-streaming atomic and molecular hydrogen, counter and cross streaming of the ionized species relative to the neutral species in the coma-solar wind interaction region with momentum exchange by elastic collisions, mass-loading through ion pick-up, and Lorentz forces of the advected magnetic field. The results, both inside and outside of the contact surface, are discussed and compared with the relevant HIS ion mass spectra.

Composition/Structure/Dynamics of comet and planetary satellite atmospheres

NASA Technical Reports Server (NTRS)

Combi, Michael R. (Principal Investigator)

1995-01-01

This research program addresses two cases of tenuous planetary atmospheres: comets and Io. The comet atmospheric research seeks to analyze a set of spatial profiles of CN in comet Halley taken in a 7.4-day period in April 1986; to apply a new dust coma model to various observations; and to analyze observations of the inner hydrogen coma, which can be optically thick to the resonance scattering of Lyman-alpha radiation, with the newly developed approach that combines a spherical radiative transfer model with our Monte Carlo H coma model. The Io research seeks to understand the atmospheric escape from Io with a hybrid-kinetic model for neutral gases and plasma given methods and algorithms developed for the study of neutral gas cometary atmospheres and the earth's polar wind and plasmasphere. Progress is reported on cometary Hydrogen Lyman-alpha studies; time-series analysis of cometary spatial profiles; model analysis of the dust comae of comets; and a global kinetic atmospheric model of Io.

Dynamic molecular oxygen production in cometary comae

NASA Astrophysics Data System (ADS)

Yao, Yunxi; Giapis, Konstantinos P.

2017-05-01

Abundant molecular oxygen was discovered in the coma of comet 67P/Churyumov-Gerasimenko. Its origin was ascribed to primordial gaseous O2 incorporated into the nucleus during the comet's formation. This thesis was put forward after discounting several O2 production mechanisms in comets, including photolysis and radiolysis of water, solar wind-surface interactions and gas-phase collisions. Here we report an original Eley-Rideal reaction mechanism, which permits direct O2 formation in single collisions of energetic water ions with oxidized cometary surface analogues. The reaction proceeds by H2O+ abstracting a surface O-atom, then forming an excited precursor state, which dissociates to produce O2-. Subsequent photo-detachment leads to molecular O2, whose presence in the coma may thus be linked directly to water molecules and their interaction with the solar wind. This abiotic O2 production mechanism is consistent with reported trends in the 67P coma and raises awareness of the role of energetic negative ions in comets.

Diagnosis of reversible causes of coma.

PubMed

Edlow, Jonathan A; Rabinstein, Alejandro; Traub, Stephen J; Wijdicks, Eelco F M

2014-12-06

Because coma has many causes, physicians must develop a structured, algorithmic approach to diagnose and treat reversible causes rapidly. The three main mechanisms of coma are structural brain lesions, diffuse neuronal dysfunction, and, rarely, psychiatric causes. The first priority is to stabilise the patient by treatment of life-threatening conditions, then to use the history, physical examination, and laboratory findings to identify structural causes and diagnose treatable disorders. Some patients have a clear diagnosis. In those who do not, the first decision is whether brain imaging is needed. Imaging should be done in post-traumatic coma or when structural brain lesions are probable or possible causes. Patients who do not undergo imaging should be reassessed regularly. If CT is non-diagnostic, a checklist should be used use to indicate whether advanced imaging is needed or evidence is present of a treatable poisoning or infection, seizures including non-convulsive status epilepticus, endocrinopathy, or thiamine deficiency. Copyright © 2014 Elsevier Ltd. All rights reserved.

A case report on near manual strangulation and glasgow coma scale.

PubMed

Meel Banwari, L

2015-09-01

Glasgow Coma Scale (GCS) is considered as a gold standard in estimating the prognosis of the comatose patient. The management of the patient relies heavily on this scale. The mechanism of injury must also be included in scoring of the GCS. Survival from strangulation is uncommon, and if it occurs, it is often associated with various complications such as neurological consequences. To highlight a poor correlation with low GCS and ultimate outcome in cases of manual strangulation. This is a case report of young female adult who was raped and manually strangulated by a colleague during a training course for traditional healers. She was admitted with very low (3/15) Glasgow Coma Scale (GCS) and presumed to have a poor prognosis. She was rigorously ventilated in Intensive Care Unit (ICU), and was discharged from hospital after a week without any complications. The neck and genital injuries are described. This report discusses. A low Glasgow Coma Scale is not a predictive of poor prognosis in cases of manual strangulation.

Modeling the Thermodynamic Properties of the Inner Comae of Comets

NASA Astrophysics Data System (ADS)

Boice, Daniel C.

2017-10-01

Introduction: Modeling is central to understand the important properties of the cometary environment. We have developed a comet model, SUISEI, that self-consistently includes the relevant physicochemical processes within a global modeling framework, from the porous subsurface layers of the nucleus to the interaction with the solar wind. Our goal is to gain valuable insights into the intrinsic properties of cometary nuclei so we can better understand observations and in situ measurements. SUISEI includes a multifluid, reactive gas dynamics simulation of the dusty coma (ComChem) and a suite of other coupled numerical simulations. This model has been successfully applied to a variety of comets in previous studies over the past three decades. We present results from a quantitative study of the thermodynamic properties and chemistry of cometary comae as a function of cometocentric and heliocentric distance to aid in interpretation of observations and in situ measurements of comets.Results and Discussion: ComChem solves the fluid dynamic equations for the mass, momentum, and energy of three neutral fluids (H, H2, and the heavier bulk fluid), ions, and electrons. In the inner coma, the gas expands, cools, accelerates, and undergoes many photolytic and gas-phase chemical reactions tracking hundreds of sibling species. The code handles the transition to free molecular flow and describes the spatial distribution of species in the coma of a comet. Variations of neutral gas temperature and velocity with cometocentric distance and heliocentric distance for a comet approaching the Sun from 2.5 to 0.3 AU are presented. Large increases in the gas temperatures (>400 K) due to photolytic heating in the coma within ~0.5 AU are noted, with dramatic effects on the chemistry, optical depth, and other coma properties. Results are compared to observations when available.Conclusions: SUISEI has proven to be a unique and valuable model to understand the relevant physical processes and properties of small Solar System bodies, including near-Sun comets and asteroids.Acknowledgments: This work was supported by FAPESP under Grant No. 2015/03176-8 and the National Science Foundation Planetary Astronomy Program Grant No. 0908529.

An empirical model of H2O, CO2 and CO coma distributions and production rates for comet 67P/Churyumov-Gerasimenko based on ROSINA/DFMS measurements and AMPS-DSMC simulations

NASA Astrophysics Data System (ADS)

Hansen, Kenneth C.; Altwegg, Kathrin; Bieler, Andre; Berthelier, Jean-Jacques; Calmonte, Ursina; Combi, Michael R.; De Keyser, Johan; Fiethe, Björn; Fougere, Nicolas; Fuselier, Stephen; Gombosi, T. I.; Hässig, Myrtha; Huang, Zhenguang; Le Roy, Léna; Rubin, Martin; Tenishev, Valeriy; Toth, Gabor; Tzou, Chia-Yu; ROSINA Team

2016-10-01

We have previously used results from the AMPS DSMC (Adaptive Mesh Particle Simulator Direct Simulation Monte Carlo) model to create an empirical model of the near comet water (H2O) coma of comet 67P/Churyumov-Gerasimenko. In this work we create additional empirical models for the coma distributions of CO2 and CO. The AMPS simulations are based on ROSINA DFMS (Rosetta Orbiter Spectrometer for Ion and Neutral Analysis, Double Focusing Mass Spectrometer) data taken over the entire timespan of the Rosetta mission. The empirical model is created using AMPS DSMC results which are extracted from simulations at a range of radial distances, rotation phases and heliocentric distances. The simulation results are then averaged over a comet rotation and fitted to an empirical model distribution. Model coefficients are then fitted to piecewise-linear functions of heliocentric distance. The final product is an empirical model of the coma distribution which is a function of heliocentric distance, radial distance, and sun-fixed longitude and latitude angles. The model clearly mimics the behavior of water shifting production from North to South across the inbound equinox while the CO2 production is always in the South.The empirical model can be used to de-trend the spacecraft motion from the ROSINA COPS and DFMS data. The ROSINA instrument measures the neutral coma density at a single point and the measured value is influenced by the location of the spacecraft relative to the comet and the comet-sun line. Using the empirical coma model we can correct for the position of the spacecraft and compute a total production rate based on single point measurements. In this presentation we will present the coma production rates as a function of heliocentric distance for the entire Rosetta mission.This work was supported by contracts JPL#1266313 and JPL#1266314 from the US Rosetta Project and NASA grant NNX14AG84G from the Planetary Atmospheres Program.

Production, Outflow Velocity, and Radial Distribution of H2O and OH in the Coma of Comet C/1995 O1 [Hale-Bopp] from Wide Field Imaging of OH

NASA Technical Reports Server (NTRS)

Harris, Walter M.; Scherb, Frank; Mierkiewicz, Edwin; Oliversen, Ronald; Morgenthaler, Jeffrey

2001-01-01

Observations of OH are a useful proxy of the water production rate (Q(sub H2O)) and outflow velocity (V(sub out)) in comets. We use wide field images taken on 03/28/1997 and 04/08/1997 that capture the entire scale length of the OH coma of comet C/1995O1 (Hale-Bopp) to obtain Q(sub H2O) from the model-independent method of aperture summation. We also extract the radial brightness profile of OH 3080 angstroms out to cometocentric distances of up to 10(exp 6) km using an adaptive ring summation algorithm. Radial profiles are obtained as azimuthal averages and in quadrants covering different position angles relative to the comet-Sun line. These profiles are fit using both fixed and variable velocity two-component spherical expansion models to determine VOH with increasing distance from the nucleus. The OH coma of Hale-Bopp was more spatially extended than in previous comets, and this extension is best matched by a variable acceleration of H2O and OH that acted across the entire coma, but was strongest within 1-2 x 10(exp 4) km from the nucleus. This acceleration led to VOH at 10(exp 6) km that was 2-3 times greater than that obtained from a 1P/Halleytype comet at 1 AU, a result that is consistent with gas-kinetic models, extrapolation from previous observations of OH in comets with Q(sub H2O) > 10(exp 29)/s, and radio measurements of the outer coma Hale-Bopp OH velocity profile. When the coma is broken down by quadrant, we find an azimuthal asymmetry in the radial distribution that is characterized by an increase in the spatial extent of OH in the region between the orbit-trailing and anti-sunward directions. Model fits to this area and comparison with radio OH measurements suggest greater acceleration in this region, with VOH UP to 1.5 times greater at 10(exp 6) km radial distance than elsewhere in the coma.

Hco+ in the Coma of Comet Hale-Bopp

NASA Astrophysics Data System (ADS)

Lovell, A. J.; Schloerb, F. P.; Bergin, E. A.; Dickens, J. E.; De Vries, C. H.; Senay, M. C.; Irvine, W. M.

1997-05-01

Maps of comet C/1995 O1 (Hale-Bopp) in the millimeter-wave emission of the ion HCO^+ revealed a local minimum near the nucleus position, with a maximum about 100,000 km in the antisolar direction. These observed features of the HCO^+ emission require a low abundance of HCO^+ due to enhanced destruction in the inner coma of the comet, within a region of low electron temperature (T_e). To set constraints on the formation of HCO^+ in the coma, as well as the location and magnitude of the transition to higher T_e, the data are compared with the results of ion-molecule chemistry models.

Status epilepticus caused by a myxoedema coma.

PubMed

Jansen, H J; Doebé, S R Oedit; Louwerse, E S; van der Linden, J C; Netten, P M

2006-06-01

The case of a 63-year-old woman who presented with status epilepticus, coma and hypoventilation is reported. A primary neurological cause was considered. Hypothermia led to further investigations and a diagnosis of severe hypothyroidism. The neurological complications of hyperthyriodism include alteration in mental status with slowness, decreased concentration and lethargy, headache, cranial nerve palsies, dysarthria, hoarseness, myopathy, neuropathy, reflex changes, ataxia, and psychotic episodes. Our patient suffered from a rare consequence of severe hypothyroidism presenting with status epilepticus and she died despite treatment. To our knowledge this is the second patient to be reported with myxoedema coma with this kind of presentation. Despite therapeutic options, there is a high mortality rate.

Myxedema coma.

PubMed

Wartofsky, Leonard

2006-12-01

Myxedema coma is the term given to the most severe presentation of profound hypothyroidism and is often fatal in spite of therapy. Decompensation of the hypothyroid patient into a coma may be precipitated by a number of drugs, systemic illnesses (eg, pneumonia), and other causes. It typically presents in older women in the winter months and is associated with signs of hypothyroidism, hypothermia, hyponatremia, hypercarbia, and hypoxemia. Treatment must be initiated promptly in an intensive care unit setting. Although thyroid hormone therapy is critical to survival, it remains uncertain whether it should be administered as thyroxine, triiodothyronine, or both. Adjunctive measures, such as ventilation, warming, fluids, antibiotics, pressors, and corticosteroids, may be essential for survival.

HCO+ in the coma of comet Hale-Bopp

NASA Technical Reports Server (NTRS)

Lovell, A. J.; Schloerb, F. P.; Bergin, E. A.; Dickens, J. E.; Devries, C. H.; Senay, M. C.; Irvine, W. M.; Ferris, J. P. (Principal Investigator)

1997-01-01

Maps of comet C/1995 O1 (Hale-Bopp) in the millimeter-wave emission of the ion HCO+ revealed a local minimum near the nucleus position, with a maximum about 100,000 km in the antisolar direction. These observed features of the HCO+ emission require a low abundance of HCO+ due to enhanced destruction in the inner coma of the comet, within a region of low electron temperature (Te). To set constraints on the formation of HCO+ in the coma, as well as the location and magnitude of the transition to higher Te, the data are compared with the results of ion-molecule chemistry models.

Another collision for the Coma cluster

NASA Technical Reports Server (NTRS)

Vikhlinin, A.; Forman, W.; Jones, C.

1996-01-01

The wavelet transform analysis of the Rosat position sensitive proportional counter (PSPC) images of the Coma cluster are presented. The analysis shows, on small scales, a substructure dominated by two extended sources surrounding the two bright clusters NGC 4874 and NGC 4889. On scales of about 2 arcmin to 3 arcmin, the analysis reveals a tail of X-ray emission originating near the cluster center, curving to the south and east for approximately 25 arcmin and ending near the galaxy NGC 4911. The results are interpreted in terms of a merger of a group, having a core mass of approximately 10(exp 13) solar mass, with the main body of the Coma cluster.

Adult clonidine overdose: prolonged bradycardia and central nervous system depression, but not severe toxicity.

PubMed

Isbister, Geoffrey K; Heppell, Simon P; Page, Colin B; Ryan, Nicole M

2017-03-01

There are limited reports of adult clonidine overdose. We aimed to describe the clinical effects and treatment of clonidine overdose in adults. This was a retrospective review of a prospective cohort of poisoned patients who took clonidine overdoses (>200 μg). Demographic information, clinical effects, treatment, complications (central nervous system and cardiovascular effects) and length of stay (LOS) were extracted from a clinical database or medical records. From 133 admissions for clonidine poisoning (1988-2015), no medical record was available in 14 and 11 took staggered ingestions. Of 108 acute clonidine overdoses (median age 27 years; 14-65 years; 68 females), 40 were clonidine alone ingestions and 68 were clonidine with co-ingestants. Median dose taken was 2100 μg (interquartile range [IQR]: 400-15,000 μg). Median LOS was 21h (IQR: 14-35 h) and there were no deaths. Glasgow coma score [GCS] <15 occurred in 73/108 (68%), and more patients taking co-ingestants (8/68; 12%) had coma (GCS <9) compared to clonidine alone (2/40; 5%). Miosis occurred in 31/108 (29%) cases. Median minimum HR was 48 bpm (IQR: 40-57 bpm), similar between clonidine alone and co-ingestant overdoses. There was a significant association between dose and minimum HR for clonidine alone overdoses (p = 0.02). 82/108 (76%) had bradycardia, median onset 2.5 h post-ingestion (IQR: 1.7-5.5 h) and median duration 20 h (2.5-83 h), similar for clonidine alone and co-ingestant overdoses. There were no arrhythmias. Three patients ingesting 8000-12,000 μg developed early hypertension. Median minimum systolic BP was 96 mmHg (IQR: 90-105 mmHg) and hypotension occurred in 26/108 (24%). 12/108 patients were intubated, but only 2 were clonidine alone cases. Treatments included activated charcoal (24), atropine (8) and naloxone (23). The median total naloxone dose was 2 mg (IQR: 1.2-2.4 mg), but only one patient given naloxone was documented to respond with partial improvement in GCS. Clonidine causes persistent but not life-threatening clinical effects. Most patients develop mild central nervous system depression and bradycardia. Naloxone was not associated with improved outcomes.

Solar-insolation-induced changes in the coma morphology of comet 67P/Churyumov-Gerasimenko. Optical monitoring with the Nordic Optical Telescope

NASA Astrophysics Data System (ADS)

Zaprudin, B.; Lehto, H. J.; Nilsson, K.; Somero, A.; Pursimo, T.; Snodgrass, C.; Schulz, R.

2017-07-01

Context. 67P/Churyumov-Gerasimenko (67P/C-G) is a short-period Jupiter family comet with an orbital period of 6.55 yr. Being the target comet of ESA's Rosetta mission, 67P/C-G has become one of the most intensively studied minor bodies of the solar system. The Rosetta Orbiter and the Philae Lander have brought us unique information about the structure and activity of the comet nucleus, as well as its activity along the orbit, composition of gas, and dust particles emitted into the coma. However, as Rosetta stayed in very close proximity to the cometary nucleus (less than 500 km with a few short excursions reaching up to 1500 km), it could not see the global picture of a coma at the scales reachable by telescopic observations (103 - 105 km). Aims: In this work we aim to connect in-situ observations made by Rosetta with the morphological evolution of the coma structures monitored by the ground-based observations. In particular, we concentrate on causal relationships between the coma morphology and evolution observed with the Nordic Optical Telescope (NOT) in the Canary Islands, and the seasonal changes of the insolation and the activity of the comet observed by the Rosetta instruments. Methods: Comet 67P/C-G was monitored with the NOT in imaging mode in two colors. Imaging optical observations were performed roughly on a weekly basis, which provides good coverage of short- and long-term variability. With the three dimensional modeling of the coma produced by active regions on the southern hemisphere, we aim to qualify the observed morphology by connecting it to the activity observed by Rosetta. Results: During our monitoring program, we detected major changes in the coma morphology of comet 67P/C-G. These were long-term and long-lasting changes. They do not represent any sudden outburst or short transient event, but are connected to seasonal changes of the surface insolation and the emergence of new active regions on the irregular shaped comet nucleus. We have also found significant deviations in morphological changes from the prediction models based on previous apparitions of 67P/C-G, like the time delay of the morphology changes and the reduced activity in the northern hemisphere. According to our modeling of coma structures and geometry of observations, the changes are clearly connected with the activity in the southern hemisphere observed by the Rosetta spacecraft.

Journal of Special Operations Medicine, Volume 2, Edition 3

DTIC Science & Technology

2002-01-01

propranolol, methyldopa, guanethidine Thyroid hormones--thyroxine Hallucinogens--LSD Salicylates, barbiturates General anesthetics --halothane...Alcohol LSD, lysergic acid diethylamide. Volume 2, Edition 3 / Summer 02 21 must be available and palatable , and water intake must be monitored. Water... palatability are controversial. High sugar solutions may impede water absorption. Salt losses should be made up (during the first 2 weeks in a hot

DIETARY EXPOSURE OF PHENOBARBITAL TO MALE AND FEMALE CD1 MICE FOR 2 OR 7 DAYS: EXAMINATION OF IN-LIFE, HEPATOCELLULAR ENZYME, PROLIFERATION, AND GENE EXPRESSION RESPONSES.

EPA Science Inventory

Phenobarbital (PB) is a barbiturate used to relieve anxiety and control epilepsy. PB is also an archetypical inducer of the constitutive androstane receptor (CAR), resulting in liver hypertrophy in humans and both liver hypertrophy and hyperplasia in rodents. In this study, male ...

A Review of Palliative Sedation.

PubMed

Bobb, Barton

2016-09-01

Palliative sedation has become a standard practice to treat refractory symptoms at end-of-life. Dyspnea and delirium are the two most commonly treated symptoms. The medications used in palliative sedation are usually benzodiazepines, barbiturates, antipsychotics, and/or anesthetics. Some ethical considerations remain, especially surrounding the use of palliative sedation in psychological distress and existential suffering. Copyright © 2016 Elsevier Inc. All rights reserved.

Reversible photocapture of a [2]rotaxane harnessing a barbiturate template.

PubMed

Tron, Arnaud; Thornton, Peter J; Lincheneau, Christophe; Desvergne, Jean-Pierre; Spencer, Neil; Tucker, James H R; McClenaghan, Nathan D

2015-01-16

Photoirradiation of a hydrogen-bonded molecular complex comprising acyclic components, namely, a stoppered thread (1) with a central barbiturate motif and an optimized doubly anthracene-terminated acyclic Hamilton-like receptor (2b), leads to an interlocked architecture, which was isolated and fully characterized. The sole isolated interlocked photoproduct (Φ = 0.06) is a [2]rotaxane, with the dimerized anthracenes assuming a head-to-tail geometry, as evidenced by NMR spectroscopy and consistent with molecular modeling (PM6). A different behavior was observed on irradiating homologous molecular complexes 1⊂2a, 1⊂2b, and 1⊂2c, where the spacers of 2a, 2b, and 2c incorporated 3, 6, and 9 methylene units, respectively. While no evidence of interlocked structure formation was observed following irradiation of 1⊂2a, a kinetically labile rotaxane was obtained on irradiating the complex 1⊂2c, and ring slippage was revealed. A more stable [2]rotaxane was formed on irradiating 1⊂2b, whose capture is found to be fully reversible upon heating, thereby resetting the system, with some fatigue (38%) after four irradiation–thermal reversion cycles.

Causes of reduced survival of neonatal pigs by medium-chain triglycerides: blood metabolite and behavioral activity approaches.

PubMed

Lin, C L; Chiang, S H; Lee, H F

1995-07-01

Two experiments were conducted to investigate the causes of the failure of orally dosed medium-chain triglycerides (MCT) in improving the survival of neonatal pigs. In Exp. 1, four litters consisting of 24 unsuckled neonatal pigs were either dosed with 6 mL/kg BW.75 of MCT or the dosing process was mimicked by inserting and withdrawing the feeding tube at 10 and 18 h after birth. Blood beta-hydroxybutyrate concentration was increased (P < .06) and the depletion of liver glycogen was reduced (P < .05) by MCT. Plasma octanoate (C8) concentration peaked at 1 h and was minimized at 4 to 8 h after each MCT dosage; decanoate (C10) concentration increased (P < .001) gradually after each dosage. Activity of pigs was decreased (P < .01) by MCT. In Exp. 2, 94 litters consisting of 887 neonatal pigs were dosed with either 6 mL/kg BW.75 of MCT, coconut oil (CO), or saline at 10 to 14 and 20 to 28 h after birth. Milk intake (P < .05) and weight gain were reduced (P < .01) in 1- to 2-d-old pigs dosed with MCT compared with intake and gain of pigs dosed with saline. Mortality of large pigs (> 1 kg) was increased (P < .05) but mortality of small pigs (< 1 kg) was not affected by MCT. Mortality of small pigs was reduced (P < .05) but mortality of large pigs (> 1 kg) was not affected by CO. Standing, walking, and suckling behaviors of pigs were not affected by MCT or CO. Coma was evident in 9.7% of pigs dosed with MCT.(ABSTRACT TRUNCATED AT 250 WORDS)

Rosetta/Alice Measurements of Atomic and Molecular Abundances in the Coma of 67P/Churyumov-Gerasimenko

NASA Astrophysics Data System (ADS)

Vervack, R. J., Jr.; Weaver, H. A., Jr.; Knight, M. M.; Feldman, P.; Stern, A.; Parker, J. W.; Feaga, L. M.; Steffl, A.; Bertaux, J. L.; A'Hearn, M. F.; Keeney, B. A.

2017-12-01

During the Rosetta orbital phase from August 2014 through September 2016, the Alice far-ultraviolet (FUV) imaging spectrograph routinely monitored the FUV emission from the coma of 67P/Churyumov-Gerasimenko (67P). These data, spanning 700-2050 Å, provide both spatial and temporal information on the evolution of the coma composition throughout the encounter. Emissions from hydrogen (Lyman beta at 1025 Å), oxygen (1304 Å triplet, 1356 Å), sulfur (1429 Å and 1479 Å multiplets, 1814 Å triplet), and carbon (1561 Å, 1657 Å) were regularly observed, as well as emission from the CO Fourth Positive and Cameron bands. We present a preliminary analysis of these emissions with a focus on the abundances in the coma and a mapping of the temporal and spatial variations. Both short-term (days) and long-term (months) variations will be discussed in the context of rotational and seasonal timeframes. We also present ratios among various species with the goal of identifying the dominant processes at work in the coma as a function of time. Rosetta is an ESA mission with contributions from its member states and NASA. The Alice team acknowledges continuing support from NASA's Jet Propulsion Laboratory through contract 1336850 to the Southwest Research Institute. RJV's work was supported by a subcontract from Southwest Research Institute to the Johns Hopkins University Applied Physics Laboratory.

Myxedema coma of both primary and secondary origin, with non-classic presentation and extremely elevated creatine kinase.

PubMed

Benvenga, S; Squadrito, S; Saporito, F; Cimino, A; Arrigo, F; Trimarchi, F

2000-09-01

Myxedema coma is a rare, often fatal endocrine emergency that concerns elderly patients with long-standing primary hypothyroidism; myxedema coma of central origin is exceedingly rare. Here, we report a 37-year-old woman in whom classical symptoms of hypothyroidism had been absent. Six years earlier, she had severe obstetric hemorrhage and, shortly after, two subsequent episodes of pericardial effusion. On the day of admission, pericardiocentesis was performed for the third episode of pericardial effusion. Because of the subsequent grave arrhythmias and unconsciousness, she was transferred to our ICU. Prior to the endocrine consultation, a silent myocardial infarction had been suspected, based on the extremely high serum levels of creatine kinase (CK) and isoenzyme CK-MB. However, based on thyroid sonography, pituitary computed tomography, elevated titers of antithyroid antibodies and pituitary stimulation tests, the final diagnosis was myxedema coma of dual origin: an atrophic variant of Hashimoto's thyroiditis and post-necrotic pituitary atrophy (Sheehan syndrome). Substitutive therapy caused a prompt clinical amelioration and normalization of CK levels. Our patient is the first case of myxedema coma of double etiology, and illustrates how its presentation deviates markedly from the one endocrinologists and physicians at ICU are prepared to encounter. In addition, cardiac problems as those of our patient should not discourage from substitutive treatment (using L-thyroxine and the gastrointestinal route of absorption), if the age is relatively low.

Ultraviolet and optical view of galaxies in the Coma Supercluster

NASA Astrophysics Data System (ADS)

Mahajan, Smriti; Singh, Ankit; Shobhana, Devika

2018-05-01

The Coma supercluster (100h-1Mpc) offers an unprecedented contiguous range of environments in the nearby Universe. In this paper we present a catalogue of spectroscopically confirmed galaxies in the Coma supercluster detected in the ultraviolet (UV) wavebands. We use the arsenal of UV and optical data for galaxies in the Coma supercluster covering ˜500 square degrees on the sky to study their photometric and spectroscopic properties as a function of environment at various scales. We identify the different components of the cosmic-web: large-scale filaments and voids using Discrete Persistent Structures Extractor, and groups and clusters using Hierarchical Density-based spatial clustering of applications with noise, respectively. We find that in the Coma supercluster the median emission in Hα inclines, while the g - r and FUV - NUV colours of galaxies become bluer moving further away from the spine of the filaments out to a radius of ˜1 Mpc. On the other hand, an opposite trend is observed as the distance between the galaxy and centre of the nearest cluster or group decreases. Our analysis supports the hypothesis that properties of galaxies are not just defined by its stellar mass and large-scale density, but also by the environmental processes resulting due to the intrafilament medium whose role in accelerating galaxy transformations needs to be investigated thoroughly using multi-wavelength data.

Epidemiology and prognosis of coma in daytime television dramas

PubMed Central

Casarett, David; Fishman, Jessica M; MacMoran, Holly Jo; Pickard, Amy; Asch, David A

2005-01-01

Objective To determine how soap operas portray, and possibly misrepresent, the likelihood of recovery for patients in coma. Design Retrospective cohort study. Setting Nine soap operas in the United States reviewed between 1 January 1995 and 15 May 2005. Subjects 64 characters who experienced a period of unconsciousness lasting at least 24 hours. Their final status at the end of the follow-up period was compared with pooled data from a meta-analysis. Results Comas lasted a median of 13 days (interquartile range 7-25 days). Fifty seven (89%) patients recovered fully, five (8%) died, and two (3%) remained in a vegetative state. Mortality for non-traumatic and traumatic coma was significantly lower than would be predicted from the meta-analysis data (non-traumatic 4% v 53%; traumatic 6% v 67%; Fisher's exact test both P < 0.001). On the day that patients regained consciousness, most (49/57; 86%) had no evidence of limited function, cognitive deficit, or residual disability needing rehabilitation. Compared with meta-analysis data, patients in this sample had a much better than expected chance of returning to normal function (non-traumatic 91% v 1%; traumatic 89% v 7%; both P < 0.001). Conclusions The portrayal of coma in soap operas is overly optimistic. Although these programmes are presented as fiction, they may contribute to unrealistic expectations of recovery. PMID:16373744

PCA/HEXTE Observations of Coma and A2319

NASA Technical Reports Server (NTRS)

Rephaeli, Yoel

1998-01-01

The Coma cluster was observed in 1996 for 90 ks by the PCA and HEXTE instruments aboard the RXTE satellite, the first simultaneous, pointing measurement of Coma in the broad, 2-250 keV, energy band. The high sensitivity achieved during this long observation allows precise determination of the spectrum. Our analysis of the measurements clearly indicates that in addition to the main thermal emission from hot intracluster gas at kT=7.5 keV, a second spectral component is required to best-fit the data. If thermal, it can be described with a temperature of 4.7 keV contributing about 20% of the total flux. The additional spectral component can also be described by a power-law, possibly due to Compton scattering of relativistic electrons by the CMB. This interpretation is based on the diffuse radio synchrotron emission, which has a spectral index of 2.34, within the range allowed by fits to the RXTE spectral data. A Compton origin of the measured nonthermal component would imply that the volume-averaged magnetic field in the central region of Coma is B =0.2 micro-Gauss, a value deduced directly from the radio and X-ray measurements (and thus free of the usual assumption of energy equipartition). Barring the presence of unknown systematic errors in the RXTE source or background measurements, our spectral analysis yields considerable evidence for Compton X-ray emission in the Coma cluster.

An Integrated Modeling Study for Coordinated Observations of H, O, OH, and H2O(+) Emissions in the Coma and Ion Tail of the Comet Hale-Bopp

NASA Technical Reports Server (NTRS)

Smyth, William H.

2001-01-01

This project has two overall objectives. One objective is to advance our general understanding of both the comet neutral atmosphere and the cometary plasma in the atmosphere and ion tall. The other objective is to obtain specific key information about comet Hale-Bopp that is generally important for Hale-Bopp studies. The primary emphasis in this project is to analyze, in a self-consistent manner, excellent quality high resolution image and line profile observations obtained by the University of Wisconsin for H, O, OH, and H2O+ emissions from the inner coma, outer coma, and ion tail of Hale-Bopp. The information on the spatial and velocity distributions of H2O neutral and ionized photo-products in the inner coma, outer coma, and in the H2O+ ion tail is of substantial and direct importance in the development of an integrated understanding of the complex structure and dynamics of the neutral and plasma species in the atmosphere of Hale-Bopp in particular and comets in general. The H2O production rate of Hale-Bopp is determined and, together with the other information related to the structure and dynamics of the neutral and plasma atmospheres obtained in this study, provide critical information important for a wide variety of research conducted by other groups.

Two-dimensional molecular line transfer for a cometary coma

NASA Astrophysics Data System (ADS)

Szutowicz, S.

2017-09-01

In the proposed axisymmetric model of the cometary coma the gas density profile is described by an angular density function. Three methods for treating two-dimensional radiative transfer are compared: the Large Velocity Gradient (LVG) (the Sobolev method), Accelerated Lambda Iteration (ALI) and accelerated Monte Carlo (MC).

Modeling Coma Gas Jets in Comet Hale-Bopp

NASA Technical Reports Server (NTRS)

Lederer, S. M.; Campins, H.

2001-01-01

We present an analysis of OH, CN, and C2 jets observed in Comet Hale-Bopp. The relative contributions from and composition of the coma gas sources, and the parameters describing the active areas responsible for the gas jets will be discussed. Additional information is contained in the original extended abstract.

Modeling Cometary Coma with a Three Dimensional, Anisotropic Multiple Scattering Distributed Processing Code

NASA Technical Reports Server (NTRS)

Luchini, Chris B.

1997-01-01

Development of camera and instrument simulations for space exploration requires the development of scientifically accurate models of the objects to be studied. Several planned cometary missions have prompted the development of a three dimensional, multi-spectral, anisotropic multiple scattering model of cometary coma.

VizieR Online Data Catalog: Subaru-UDGs in the Coma cluster (Yagi+, 2016)

NASA Astrophysics Data System (ADS)

Yagi, M.; Koda, J.; Komiyama, Y.; Yamanoi, H.

2016-10-01

We retrieved a wide W-C-RC band (R-band) survey of the Coma cluster of Suprime-Cam from the Subaru public archive (SMOKA; Baba et al. 2002ASPC..281..298B) between 2011 Mar 02 and 2011 Apr 01. (1 data file).

These are two images of the inner coma of Comet Hyakutake

NASA Technical Reports Server (NTRS)

2002-01-01

These are two images of the inner coma of Comet Hyakutake made on April 3 and 4, 1996, using the NASA Hubble Space Telescope Wide Field Planetary Camera 2 (WFPC2). The first one, shown in red, was taken through a narrow-band red filter that shows only sunlight scattered by dust particles in the inner coma of the comet. The second one, shown in blue was taken with an ultraviolet 'Woods' filter image that shows the distribution of scattered ultraviolet radiation from hydrogen atoms in the inner coma. The coma is the head or dusty-gas atmosphere of a comet. The square field of view is 14,000 km on a side and the sun is toward the upper right corner of the image. Hydrogen atoms represent the most abundant gas in the whole coma of the comet. They are produced when solar ultraviolet light breaks up molecules of water, the major constitutent of the nucleus of the comet. These images were taken as part of an observing program to study water photochemistry in comets. Measurements of hydrogen (H) and hydroxyl (OH) in the coma (or atmosphere) of Comet Hyakutake were also made using the Goddard High Resolution Spectrograph (GHRS) and the Faint Object Spectrograph (FOS). A self-consistent analysis of all the data shows that the water production rate of the comet was between 7 and 8 tons per second on the April 3 and 4. A theoretical model was used in the analysis which accounts for the detailed physics and chemistry of the photochemical destruction of the water, the production of the H and OH, and their expansion in the coma (or atmosphere) of the comet. The model matched the velocity measurements of hydrogen atoms made using the high spectral resolution capabilities of the GHRS instrument. The importance of such a detailed model is that is permits the accurate calculation of the production rate of water from observations of H and OH. The inner yellow region near the center of the red dust image is dominated by the contribution from the dust which shows sunward directed spiral jets toward the upper right, and the thin straight particle trail pointing toward the lower left. The trail was a permanent feature of the comet around the time of its close approach to the earth in late March and early April. Also barely visible just beyond the lower left end of the trail are two of the many condensations which were seen to travel slowly down the tail are are believed to be clumps of material released from the nucleus. The inner white region of the blue image appears to show that the hydrogen atoms like the dust might be preferentially ejected toward the sunward or day side of the nucleus. However, this is not true. The asymmetric ultraviolet radiation pattern is produced by a roughly spherical distribution of hydrogen atoms because they are so efficient at scattering the incoming solar ultraviolet light. The atoms on the sunward side actually shadow the atoms on the tailward or night side of the coma. The same detailed model analysis of the coma which explains the expansion of the hydrogen atoms in the coma also explains the appearance of the image. The team was lead by Michael Combi, The University of Michigan, and included Michael Brown, California Institute of Technology, Paul Feldman, Johns Hopkins University, H. Uwe Keller of the Max Planck Institute, Lindau, Robert Meier of the Naval Research Laboratory, and William Smyth of Atmospheric and Environmental Research, Inc. Credit: M.R. Combi (The University of Michigan)

[Effects of acupuncture stimulation of different acupoint groups on sleeping latency, serum and hippocampal TNF-α and IL-25 contents in rats with gastric mucosal injury].

PubMed

Huang, Ying-Hua; Li, Qian; Yang, Ping; Yan, Ya-Nan; Ma, Hui-Fang

2015-04-01

To observe the effect of acupuncture intervention on gastric ulcer (GU) and sleeping quality from the viewpoint of brain-gut axis which plays an important role in the regulation of many vital functions in the body. Forty male Wistar rats were randomized into normal control, GU model, acupuncture of "Zhongwan"(CV 12)-"Zusanli"(ST 36, gastric function regulating acupoints), acupuncture of "Shenmai" (BL 62)-"Zhaohai" (KI 6, sleep-promotion acupoints), and acupuncture of CV 12-ST 36+ BL 62-KI 6 (combined treatment) groups, with 8 rats in each group. GU model was established by intragastric perfusion of dehydrated alcohol (1 mL/rat), and sleep model established by intraperitoneal injection of pentobarbital sodium (40 mg/kg) after the last treatment. The abovementioned acupoints were punctured with filiform needles and stimulated by manipulating the needle for about 30 s, once every 5 min during 20 min of needle retention. The treatment was conducted once daily for five days. The contents of tumor necrosis factor-alpha (TNF-α) and interleukin-25(IL-25) in the serum and hippocampal tissues were detected by ELISA. Compared with the normal control group, the gastric ulcer index score, barbiturate-induced sleeping time, and TNF-α and IL-25 contents in both serum and hippocampus were significantly increased in the model group (P < 0.01). Following acupuncture treatment, in comparison with the model group, the gastric ulcer index score, barbiturate-induced sleeping time, and TNF-α and IL-25 contents in both serum and hippocampus were significantly down-regulated in the CV 12-ST 36, BL 62-KI 6 and combined treatment groups (P < 0.01, P < 0.05). The effects of the CV 12-ST 36 and combined treatment groups were remarkably superior to those of the BL 62-KI 6 group in down-regulating ulcer index score, serum IL-25, and hippocampal TNF-α and IL-25 contents (P < 0.01, P < 0.05). In addition, the effects of the BL 62-KI 6 and combined treatment groups was considerably better than that of the CV 12-ST 36 group in shortening barbiturate-induced sleeping time (P < 0.01, P < 0.05). The effect of the combined treatment group was markedly better than that of the CV 12-ST 36 and BL 62-KI 6 groups in lowering serum TNF-α content (P < 0.05). Acupuncture stimulation of CV 12, ST 36, KI 6 and BL 62 can relieve the gastric mucosal lesion, and shorten barbiturate-induced sleeping time in gastric ulcer rats, which may be related to its effects in reducing TNF-α and IL-25 contents in the serum and hippocampus tissues, suggesting a correlation between the gastrointestinal disorder and sleeping.

Severe Carisoprodol Withdrawal After a 14-Year Addiction and Acute Overdose.

PubMed

Vo, Kathy T; Horng, Howard; Smollin, Craig G; Benowitz, Neal L

2017-05-01

Carisoprodol, a centrally acting muscle relaxant with a high abuse potential, has barbiturate-like properties at the GABA-A receptor, leading to central nervous system depression and desired effects. Its tolerance and dependence has been previously demonstrated in an animal model, and withdrawal has been described in several recent case reports. Many cases can be effectively managed with a short course of benzodiazepines or antipsychotic agents. However, abrupt cessation in a patient with a history of long-term and high-dose carisoprodol abuse may result in symptoms that are more difficult for providers to treat. We present a case of a 34-year-old man with a long history of carisoprodol abuse who was found unresponsive after having ingested 7.5 grams of carisoprodol. He was intubated and admitted to the intensive care unit. He was given propofol, dexmedetomidine, fentanyl, ketamine, lorazepam, midazolam, quetiapine, and haloperidol, some at high-dose infusions, before his agitation and ventilator asynchrony could be controlled. His improvement coincided with the addition of carisoprodol and phenobarbital to his treatment regimen. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Trends show increasing emergency department presentations for drug-related disorders and treatment. This case highlights an uncommon case of carisoprodol withdrawal that may be encountered by emergency physicians, and demonstrates that benzodiazepines may not be sufficient to suppress severe withdrawal symptoms. Treatment with carisoprodol and phenobarbital provided additional benefit and can be considered in cases of severe carisoprodol withdrawal. Copyright © 2016 Elsevier Inc. All rights reserved.

Extreme hyperphosphatemia and hypocalcemic coma associated with phosphate enema.

PubMed

Hsu, Heng Jung; Wu, Mai-Szu

2008-01-01

Fleet enema (sodium phosphate, C.B. Fleet Co., Inc., Lynchburg, Virginia) is widely used for bowel preparation or constipation relief in the hospital and over the counter. The potential risks, including hyperphosphatemia and hypocalcemic coma should be kept in mind of primary care physician. The patients with older age, bowel obstruction, small intestinal disorders, poor gut motility, and renal disease are contraindicated or should be administered with caution. We present a patient with old age and chronic renal failure who developed severe hyperphosphatemia and hypocalcemic tetany with coma after sodium phosphate enema. We recommend the use of alternative enema preparations, such as simple tap water or saline solution enemas, which can prevent fatal complications in high risk patients.

Study of the coma of comet 67P/Churyumov-Gerasimenko based on the ROSINA/RTOF instrument onboard Rosetta

NASA Astrophysics Data System (ADS)

Hoang, M.; Garnier, P.; Rème, H.; Altwegg, K.; Balsiger, H.; Calmonte, U.; Fiethe, B.; Galli, A.; Gasc, S.; Jäckel, A.; Mall, U.; Le Roy, L.; Rubin, M.; Tzou, C.-Y.; Waite, J. H.; Wurz, P.

2015-10-01

The Rosetta ESA mission investigates the environment of the comet 67P / Churyumov- Gerasimenko since August 2014. Among the experiments onboard the satellite, the ROSINA experiment (Rosetta Orbiter Spectrometer for Ion and Neutral Analysis) includes two mass spectrometers (DFMS and RTOF) to analyze the composition of neutrals and ions, and an instrument (COPS) to monitor the density and velocity of neutrals in the coma [1]. We will here analyze and discuss the data of the ROSINA/RTOF instrument during the comet escort phase. A detailed description of the main volatiles (H2O, CO2, CO) dynamics and of the heterogeneities of the coma will be provided.

The Meteoroid Fluence at Mars Due to Comet Siding Spring

NASA Technical Reports Server (NTRS)

Moorhead, Althea V.

2014-01-01

Long-period comet C/2013 A1 (Siding Spring) is headed for a close encounter with Mars on 2014 Oct 19. A collision between the comet and the planet has been ruled out, but the comets coma may envelop Mars and its man-made satellites. We present an analytic model of the dust component of cometary comae that describes the spatial distribution of cometary dust and meteoroids and their size distribution. If the coma reaches Mars, we estimate a total incident particle fluence on the planet and its satellites of 0.01 particles per square meter. We compare our model with numerical simulations, data from past comet missions, and recent Siding Spring observations.

[The myxoedema coma exists, we met it].

PubMed

Fritsch, N; Tran-Van, D; Dardare, E; Gentile, A; Deroudilhe, G; Fontaine, B

2007-09-01

The myxoedema coma corresponds to the ultimate evolution of a hypothyroidism and is characterized by a major deficit in thyroid hormones responsible for a collapse of the metabolism. The preventive and curative treatment is based on the administration of thyroid hormones, whose benefits are opposed to the cardiovascular risks related to an iatrogenic hyperthyroidism for patients often old with cardiopathy. We report the case of a 92-year-old patient with unbalanced hypothyroidism and chronic cardiac deficiency, who presented a myxoedema coma in the postoperative period of an urgent digestive surgery. This observation illustrates the difficulties in treating patients with unbalanced hypothyroidism following emergency surgery, in the absence of consensus on the type and the amounts of thyroid hormones substitution.

Coma of modified Gregorian and Cassegrainian mirror systems

NASA Technical Reports Server (NTRS)

Jones, R. T.

1976-01-01

The equivalence of the classical Newtonian, Cassegrainian, and Gregorian mirror systems with respect to the first two Seidel aberrations is rederived by means of a simple congruence. The effects of arbitrary small modifications of the two mirror systems are then studied and general formulas are derived for the effects of such modifications on the spherical aberration and coma. Spherical aberration is corrected to the third order if the amount of glass removed from one surface is replaced at the corresponding zone of the other surface. Modifications in which one surface is made spherical while the other is adjusted to eliminate spherical aberration result in large increases of coma for systems having the usual amplifying ratios.

Benign course after acute high dose levothyroxine intoxication in a 3-year-old boy.

PubMed

Hartman, Stan; Noordam, Kees; Maseland, Machiel; van Setten, Petra

2017-01-01

Acute ingestion of thyroid hormone preparations is a common intoxication, with 181 cases in children <12 yr in 2009 in the Netherlands, but generally has a mild course. However, some reports show that even low dosages may cause serious events such as seizures, thyroid storm and coma. We report a 3 yr old boy case with an acute intoxication with high dose levothyroxine (0.5 mg/kg). We describe the proper management of levothyroxine intoxication in children. A 3-year-old boy with no notable medical history ingested sixty tablets of levothyroxine 150 µg. His vital-signs were normal and the only symptom during admission was a tachycardia the following day. Laboratory data showed elevated T3, fT3 and fT4 levels; and decrease TSH levels. He was treated prophylactically and therapeutically with activated charcoal and propranolol. Despite very high levels, his clinical symptoms were relatively mild. After clinical follow-up for 3 d he was discharged. We propose that children with thyroid hormone intoxication with either a levothyroxine dose >0.1 g/kg, a short interval since ingestion, symptomatic presentation, and/or a fT4 >100 pmol/l should be monitored in the hospital during at least 48-72 h post-ingestion and on an outpatient basis for 14 d.

Effectiveness of hemodialysis in a case of severe valproate overdose.

PubMed

Nasa, Prashant; Sehrawat, Deepak; Kansal, Sudha; Chawla, Rajesh

2011-04-01

A case of severe sodium valproate overdose is presented in which medicinal management failed to reverse coma of the patient. High-flux hemodialysis was then used to eliminate sodium valproate. This case demonstrated the effectiveness of hemodialysis in not only decreasing valproate levels very rapidly but also as an effective anti-coma management.

Repetitive transcranial magnetic stimulation improves consciousness disturbance in stroke patients: A quantitative electroencephalography spectral power analysis.

PubMed

Xie, Ying; Zhang, Tong

2012-11-05

Repetitive transcranial magnetic stimulation is a noninvasive treatment technique that can directly alter cortical excitability and improve cerebral functional activity in unconscious patients. To investigate the effects and the electrophysiological changes of repetitive transcranial magnetic stimulation cortical treatment, 10 stroke patients with non-severe brainstem lesions and with disturbance of consciousness were treated with repetitive transcranial magnetic stimulation. A quantitative electroencephalography spectral power analysis was also performed. The absolute power in the alpha band was increased immediately after the first repetitive transcranial magnetic stimulation treatment, and the energy was reduced in the delta band. The alpha band relative power values slightly decreased at 1 day post-treatment, then increased and reached a stable level at 2 weeks post-treatment. Glasgow Coma Score and JFK Coma Recovery Scale-Revised score were improved. Relative power value in the alpha band was positively related to Glasgow Coma Score and JFK Coma Recovery Scale-Revised score. These data suggest that repetitive transcranial magnetic stimulation is a noninvasive, safe, and effective treatment technology for improving brain functional activity and promoting awakening in unconscious stroke patients.

Alpha coma in an adolescent with diabetic ketoacidosis.

PubMed

Ostojic, Slavica; Vukovic, Rade; Milenkovic, Tatjana; Mitrovic, Katarina; Djuric, Milena; Nikolic, Ljubica

2017-01-01

Ostojic S, Vukovic R, Milenkovic T, Mitrovic K, Djuric M, Nikolic L. Alpha coma in an adolescent with diabetic ketoacidosis. Turk J Pediatr 2017; 59: 318-321. This is the first report of alpha coma (AC) caused by brain edema in a patient with diabetic ketoacidosis (DKA). A previously healthy 15-year-old girl was admitted to the intensive care unit due to altered state of consciousness during the course of treatment for DKA. Patient was in a coma, intubated and had tachycardia with poor peripheral perfusion. Results of laboratory analyses indicated severe DKA and computed tomography scan indicated diffuse brain edema. The EEG pattern showed uniform alpha activity. Treatment with intravenous fluids, insulin and mannitol was started. Patient`s state of consciousness gradually improved and on the third day she was extubated. On the fifth day, her neurologic status and EEG findings were completely normal with no residual neurological deficits. In conclusion, although AC is associated with a high fatality rate, favorable outcome can be achieved with prompt recognition and treatment of cerebral edema in pediatric patients with DKA.

Hall effect in the coma of 67P/Churyumov-Gerasimenko

NASA Astrophysics Data System (ADS)

Huang, Z.; Tóth, G.; Gombosi, T. I.; Jia, X.; Combi, M. R.; Hansen, K. C.; Fougere, N.; Shou, Y.; Tenishev, V.; Altwegg, K.; Rubin, M.

2018-04-01

Magnetohydrodynamics simulations have been carried out in studying the solar wind and cometary plasma interactions for decades. Various plasma boundaries have been simulated and compared well with observations for comet 1P/Halley. The Rosetta mission, which studies comet 67P/Churyumov-Gerasimenko, challenges our understanding of the solar wind and comet interactions. The Rosetta Plasma Consortium observed regions of very weak magnetic field outside the predicted diamagnetic cavity. In this paper, we simulate the inner coma with the Hall magnetohydrodynamics equations and show that the Hall effect is important in the inner coma environment. The magnetic field topology becomes complex and magnetic reconnection occurs on the dayside when the Hall effect is taken into account. The magnetic reconnection on the dayside can generate weak magnetic field regions outside the global diamagnetic cavity, which may explain the Rosetta Plasma Consortium observations. We conclude that the substantial change in the inner coma environment is due to the fact that the ion inertial length (or gyro radius) is not much smaller than the size of the diamagnetic cavity.

Effect of third-order aberrations on dynamic accommodation.

PubMed

López-Gil, Norberto; Rucker, Frances J; Stark, Lawrence R; Badar, Mustanser; Borgovan, Theodore; Burke, Sean; Kruger, Philip B

2007-03-01

We investigate the potential for the third-order aberrations coma and trefoil to provide a signed cue to accommodation. It is first demonstrated theoretically (with some assumptions) that the point spread function is insensitive to the sign of spherical defocus in the presence of odd-order aberrations. In an experimental investigation, the accommodation response to a sinusoidal change in vergence (1-3D, 0.2Hz) of a monochromatic stimulus was obtained with a dynamic infrared optometer. Measurements were obtained in 10 young visually normal individuals with and without custom contact lenses that induced low and high values of r.m.s. trefoil (0.25, 1.03 microm) and coma (0.34, 0.94 microm). Despite variation between subjects, we did not find any statistically significant increase or decrease in the accommodative gain for low levels of trefoil and coma, although effects approached or reached significance for the high levels of trefoil and coma. Theoretical and experimental results indicate that the presence of Zernike third-order aberrations on the eye does not seem to play a crucial role in the dynamics of the accommodation response.

Evaluation of the effect of intensity of care on mortality after traumatic brain injury

PubMed Central

Thompson, Hilaire J.; Rivara, Frederick P.; Jurkovich, Gregory J.; Wang, Jin; Nathens, Avery B.; MacKenzie, Ellen J.

2008-01-01

Objectives To evaluate the effect of age on intensity of care provided to traumatically brain-injured adults and to determine the influence of intensity of care on mortality at discharge and 12 months postinjury, controlling for injury severity. Design Cohort study using the National Study on the Costs and Outcomes of Trauma (NSCOT) database. Risk ratio and Poisson regression analyses were performed using data weighted according to the population of eligible patients. Setting and Patients A total of 18 level 1 and 51 level 2 non-trauma centers located in 14 states in the United States and 1,776 adults aged 25−84 yrs with a diagnosis of traumatic brain injury. Measurements Injury severity was determined by the motor component of the Glasgow Coma Scale score, the Injury Severity Score, pupillary reactivity, and presence of midline shift. Factors evaluated as contributing to intensity of care included: admission to the intensive care unit, mechanical ventilation, placement of an intracranial pressure monitor, placement of a jugular bulb catheter, placement of a pulmonary artery catheter, critical care consultation, the number of specialty care consultations, mannitol use, treatment with barbiturate coma, decompressive craniectomy, number of nonneurosurgical procedures performed, the presence of a do-not-resuscitate order, and withdrawal of therapy. Main Results Controlling for injury-related factors, sex, and comorbidity, as age increased, the overall likelihood of receiving various interventions decreased. After controlling for injury severity, sex, and comorbidity, factors associated with higher risk of in-hospital death were: being aged 75−84 yrs (relative risk [RR] 1.32, 95% confidence interval [CI] 1.13, 1.55), pulmonary artery catheter use (RR 1.56, 95% CI 1.30, 1.86), intubation (RR 4.17, 95% CI 2.28, 7.61), the presence of a do-not-resuscitate order (RR 3.21, 95% CI 2.21, 4.65), and withdrawal of therapy (RR 2.33, 95% CI 1.69, 3.23). In contrast, a higher number of specialty care consultations (surgical consults: RR 0.63, 95% CI 0.54, 0.74; medical consults: RR 0.87, 95% CI 0.79, 0.95; and other consults: RR 0.43, 95% CI 0.26, 0.69) were associated with decreased risk of death. The results were similar for factors associated with death at 12 months, with the exception that the number of medical consultations was not significant, whereas the number of nonneurosurgical procedures performed was associated with lower risk of death (RR 0.96, 95% CI 0.92, 0.99), as was obtaining critical care consultation services (RR 0.84, 95% CI 0.71, 1.0). Conclusions There is a lower intensity of care provided to older adults with traumatic brain injury. Although the specific contributions of specialists to patient management are unknown, their consultation was associated with decreased risk of in-hospital death and death within 12 months. It is important that careproviders have an increased awareness of the potential contribution of multidisciplinary clinical decision making to patient outcomes in older traumatically brain-injured patients. PMID:18007264

Synthesis of novel heterocycles through reaction of indolin-2-one derivatives with active methylene and amino reagents.

PubMed

Abdel-Latif, F F; Ahmed, E K; Mekheimer, R; Mashaly, M M

1997-10-01

Several new spiro compounds were synthesized via one-pot ternary condensation of isatin, malononitrile and each of thiobarbituric acid, barbituric acid, 3-methyl-pyrazolin-5-one, 1-phenyl-3-methyl-pyrazolin-5-one, acetylacetone, benzoylacetone, ethyl acetoacetate, phenacyl cyanide or ethyl-cyanoacetate dimer. Structures and reaction mechanism were reported and supported via a second synthetic route.

Taming the ketamine tiger. 1965.

PubMed

Domino, Edward F

2010-09-01

Pharmacologic actions of CI-581, a chemical derivative of phencyclidine, were determined in 20 volunteers from a prison population. The results indicate that this drug is an effective analgesic and anesthetic agent in doses of 1.0 to 2.0 mg per kilogram. With intravenous administration the onset of action is within 1 min and the effects last for about 5 to 10 min, depending on dosage level and individual variation. No tachyphylaxis was evident on repeat doses. Respiratory depression was slight and transient. Hypertension, tachycardia, and psychic changes are undesirable characteristics of the drug. Whether these can be modified by preanesthetic medication was not determined in this study. Recovery from analgesia and coma usually took place within 10 min, although from electroencephalographic evidence it may be assumed that subjects were not completely normal until after 1 to 2 h. No evidence of liver or kidney toxicity was obtained. CI-581 produces pharmacologic effects similar to those reported for phencyclidine, but of shorter duration. The drug deserves further pharmacologic and clinical trials. It is proposed that the words "dissociative anesthetic" be used to describe the mental state produced by this drug.

A comparison of the near-infrared spectral features of early-type galaxies in the Coma Cluster, the Virgo cluster and the field

NASA Technical Reports Server (NTRS)

Houdashelt, Mark L.; Frogel, Jay A.

1993-01-01

Earlier researchers derived the relative distance between the Coma and Virgo clusters from color-magnitude relations of the early-type galaxies in each cluster. They found that the derived distance was color-dependent and concluded that the galaxies of similar luminosity in the two clusters differ in their red stellar populations. More recently, the color-dependence of the Coma-Virgo distance modulus has been called into question. However, because these two clusters differ so dramatically in their morphologies and kinematics, it is plausible that the star formation histories of the member galaxies also differed. If the conclusions of earlier researchers are indeed correct, then some signature of the resulting stellar population differences should appear in the near-infrared and/or infrared light of the respective galaxies. We have collected near-infrared spectra of 17 Virgo and 10 Coma early-type galaxies; this sample spans about four magnitudes in luminosity in each cluster. Seven field E/S0 galaxies have been observed for comparison. Pseudo-equivalent widths have been measured for all of the field galaxies, all but one of the Virgo members, and five of the Coma galaxies. The features examined are sensitive to the temperature, metallicity, and surface gravity of the reddest stars. A preliminary analysis of these spectral features has been performed, and, with a few notable exceptions, the measured pseudo-equivalent widths agree well with previously published values.

Fatal coma in a young adult due to late-onset urea cycle deficiency presenting with a prolonged seizure: a case report.

PubMed

Alameri, Majid; Shakra, Mustafa; Alsaadi, Taoufik

2015-11-23

Unexplained hyperammonemic coma in adults can be a medical dilemma in the absence of triggering factors and known comorbidities. Ornithine transcarbamylase deficiency presents most commonly with hyperammonemic coma. Although a rare disorder, ornithine transcarbamylase deficiency is the most common of the urea cycle disorders, which can occur both in children, and less commonly, in adults. The urea cycle disorder is usually acquired as an X-linked trait, and very rarely, similar to our reported case, may be acquired as a "new" mutation. Mutations that lead to later-onset presentations may lead to life-threatening disease and may be unrecognized, particularly when the first clinical symptoms occur in adulthood. We report the case of a previously healthy 17-year-old white man who developed a prolonged seizure and a rapid decline in mental status leading to coma over a 3-day period. Analysis of the OTC gene showed a 119G variant, which was identified in exon 2 of the OTC gene by sequencing. A diagnosis of ornithine transcarbamylase deficiency should be considered in adult patients who present with unexplained hyperammonemic coma and for all adult patients presenting with cryptogenic new-onset seizure and laboratory finding of elevated blood ammonia levels. This reported case highlights the importance of early recognition of this potentially reversible cause of life-threatening encephalopathy, as timely recognition and appropriate treatment can be lifesaving.

A Comparative Study of Glasgow Coma Scale and Full Outline of Unresponsiveness Scores for Predicting Long-Term Outcome After Brain Injury.

PubMed

McNett, Molly M; Amato, Shelly; Philippbar, Sue Ann

2016-01-01

The aim of this study was to compare predictive ability of hospital Glasgow Coma Scale (GCS) scores and scores obtained using a novel coma scoring tool (the Full Outline of Unresponsiveness [FOUR] scale) on long-term outcomes among patients with traumatic brain injury. Preliminary research of the FOUR scale suggests that it is comparable with GCS for predicting mortality and functional outcome at hospital discharge. No research has investigated relationships between coma scores and outcome 12 months postinjury. This is a prospective cohort study. Data were gathered on adult patients with traumatic brain injury admitted to urban level I trauma center. GCS and FOUR scores were assigned at 24 and 72 hours and at hospital discharge. Glasgow Outcome Scale scores were assigned at 6 and 12 months. The sample size was n = 107. Mean age was 53.5 (SD = ±21, range = 18-91) years. Spearman correlations were comparable and strongest among discharge GCS and FOUR scores and 12-month outcome (r = .73, p < .000; r = .72, p < .000). Multivariate regression models indicate that age and discharge GCS were the strongest predictors of outcome. Areas under the curve were similar for GCS and FOUR scores, with discharge scores occupying the largest areas. GCS and FOUR scores were comparable in bivariate associations with long-term outcome. Discharge coma scores performed best for both tools, with GCS discharge scores predictive in multivariate models.

The near-infrared Tully-Fisher relation - A preliminary study of the Coma and Abell 400 clusters

NASA Technical Reports Server (NTRS)

Guhathakurta, Puragra; Bernstein, Gary; Raychaudhury, Somak; Haynes, Martha; Giovanelli, Riccardo; Herter, Terry; Vogt, Nicole

1993-01-01

We have started a large project to study the NIR Tully-Fisher (TF) relation using H- and I-band surface photometry of spiral galaxies. A preliminary study of 20 spirals in the Coma and Abell 400 clusters is presented. The NIR images have been used to derive accurate inclinations and total magnitudes, and rotational linewidths are measured from high-quality 21-cm Arecibo data. The scatter in the Coma TF plot is found to be 0.19 mag in the H band and 0.20 mag in the I band for a set of 13 galaxies, if we assume that they are all at the same distance. The deviation of the Coma galaxies from the best-fit Tully-Fisher relation is correlated with their redshift, indicating that some of the galaxies are not bound to the cluster. Indeed, if we treat all the galaxies in the Coma sample as undergoing free Hubble expansion, the TF scatter drops to 0.12 and 0.13 mag for the H- and I-band datasets, respectively. The Abell 400 sample is best fit by a common distance model, yielding a scatter of 0.12 mag for seven galaxies in H using a fixed TF slope. We are in the process of studying cluster and field spirals out to about 10,000 km/s in order to calibrate the NIR TF relation and will apply it to more nearby galaxies to measure the peculiar velocity field in the local universe.

Intracranial Pressure Monitoring in Infants and Young Children With Traumatic Brain Injury.

PubMed

Dixon, Rebecca R; Nocera, Maryalice; Zolotor, Adam J; Keenan, Heather T

2016-11-01

To examine the use of intracranial pressure monitors and treatment for elevated intracranial pressure in children 24 months old or younger with traumatic brain injury in North Carolina between April 2009 and March 2012 and compare this with a similar cohort recruited 2000-2001. Prospective, observational cohort study. Twelve PICUs in North Carolina. All children 24 months old or younger with traumatic brain injury, admitted to an included PICU. None. The use of intracranial pressure monitors and treatments for elevated intracranial pressure were evaluated in 238 children with traumatic brain injury. Intracranial pressure monitoring (risk ratio, 3.7; 95% CI, 1.5-9.3) and intracranial pressure therapies were more common in children with Glasgow Coma Scale less than or equal to 8 compared with Glasgow Coma Scale greater than 8. However, only 17% of children with Glasgow Coma Scale less than or equal to 8 received a monitoring device. Treatments for elevated intracranial pressure were more common in children with monitors; yet, some children without monitors received therapies traditionally used to lower intracranial pressure. Unadjusted predictors of monitoring were Glasgow Coma Scale less than or equal to 8, receipt of cardiopulmonary resuscitation, nonwhite race. Logistic regression showed no strong predictors of intracranial pressure monitor use. Compared with the 2000 cohort, children in the 2010 cohort with Glasgow Coma Scale less than or equal to 8 were less likely to receive monitoring (risk ratio, 0.5; 95% CI, 0.3-1.0), although the estimate was not precise, or intracranial pressure management therapies. Children in the 2010 cohort with a Glasgow Coma Scale less than or equal to 8 were less likely to receive an intracranial pressure monitor or hyperosmolar therapy than children in the 2000 cohort; however, about 10% of children without monitors received therapies to decrease intracranial pressure. This suggests treatment heterogeneity in children 24 months old or younger with traumatic brain injury and a need for better evidence to support treatment recommendations for this group of children.

Immediate and Long-Term Outcome of Acute H2S Intoxication Induced Coma in Unanesthetized Rats: Effects of Methylene Blue

PubMed Central

Sonobe, Takashi; Chenuel, Bruno; Cooper, Timothy K.; Haouzi, Philippe

2015-01-01

Background Acute hydrogen sulfide (H2S) poisoning produces a coma, the outcome of which ranges from full recovery to severe neurological deficits. The aim of our study was to 1- describe the immediate and long-term neurological effects following H2S-induced coma in un-anesthetized rats, and 2- determine the potential benefit of methylene blue (MB), a compound we previously found to counteract acute sulfide cardiac toxicity. Methods NaHS was administered IP in un-sedated rats to produce a coma (n = 34). One minute into coma, the rats received MB (4 mg/kg IV) or saline. The surviving rats were followed clinically and assigned to Morris water maze (MWM) and open field testing then sacrificed at day 7. Results Sixty percent of the non-treated comatose rats died by pulseless electrical activity. Nine percent recovered with neurological deficits requiring euthanasia, their brain examination revealed major neuronal necrosis of the superficial and middle layers of the cerebral cortex and the posterior thalamus, with variable necrosis of the caudate putamen, but no lesions of the hippocampus or the cerebellum, in contrast to the typical distribution of post-ischemic lesions. The remaining animals displayed, on average, a significantly less effective search strategy than the control rats (n = 21) during MWM testing. Meanwhile, 75% of rats that received MB survived and could perform the MWM test (P<0.05 vs non-treated animals). The treated animals displayed a significantly higher occurrence of spatial search than the non-treated animals. However, a similar proportion of cortical necrosis was observed in both groups, with a milder clinical presentation following MB. Conclusion In conclusion, in rats surviving H2S induced coma, spatial search patterns were used less frequently than in control animals. A small percentage of rats presented necrotic neuronal lesions, which distribution differed from post-ischemic lesions. MB dramatically improved the immediate survival and spatial search strategy in the surviving rats. PMID:26115032

Myxedema coma in a patient with subclinical hypothyroidism.

PubMed

Mallipedhi, Akhila; Vali, Hamza; Okosieme, Onyebuchi

2011-01-01

Myxedema coma is the extreme manifestation of hypothyroidism, typically seen in patients with severe biochemical hypothyroidism. Its occurrence in association with subclinical hypothyroidism is extremely unusual. We describe a patient with subclinical hypothyroidism who developed clinical manifestations of myxedema coma. A 47-year-old woman presented to our endocrine clinic with complaints of fatigue and biochemical findings of subclinical hypothyroidism. She was started on treatment with thyroxine (T4) but remained unwell and was later admitted to hospital with hormone profile showing persisting subclinical hypothyroidism (elevated thyrotropin and normal free T4 [FT4] and free triiodothyronine [FT3]): FT4 10.7 pmol/L (reference range 10.3-24.5), FT3 2.7 pmol/L (reference range 2.67-7.03), and thyrotropin 6.09 mU/L (reference range 0.4-4.0). She subsequently developed hypothermia (temperature 33.2°C), circulatory collapse, and coma. Biochemical profile showed hyponatremia, elevated creatinine phosphokinase, metabolic acidosis, and renal failure. An echocardiogram revealed a moderate-sized pericardial effusion. We diagnosed myxedema coma and started treatment with intravenous T3. She responded dramatically with improvement in level of consciousness and normalization of metabolic parameters. We found no explanation other than hypothyroidism to account for the presentation. Adrenocorticotrophic hormone (ACTH) stimulation tests excluded adrenal insufficiency, and serum gonadotrophins were within the normal reference range. FT4 estimation by equilibrium dialysis excluded analytical interference, and molecular analysis for the thyroid hormone receptor β gene associated with thyroid hormone resistance was negative. To the best of our knowledge this is the first report of myxedema coma in a patient with subclinical hypothyroidism. The reason for normal thyroid hormone levels is unclear but may reflect deviation from a higher pre-morbid set-point. The case highlights the importance of careful clinical evaluation in patients with disparate clinical and laboratory findings.

A new 3D multi-fluid model: a study of kinetic effects and variations of physical conditions in the cometary coma

NASA Astrophysics Data System (ADS)

Shou, Yinsi; Combi, Michael R.; Toth, Gabor; Huang, Zhenguang; Jia, Xianzhe; Fougere, Nicolas; Tenishev, Valeriy; Gombosi, T. I.; Hansen, Kenneth C.; Bieler, Andre

2016-10-01

Physics-based numerical coma models are desirable whether to interpret the spacecraft observations of the inner coma or to compare with the ground-based observations of the outer coma. In this work, we develop a multi-neutral-fluid model based on BATS-R-US in the University of Michigan's SWMF (Space Weather Modeling Framework), which is capable of computing both the inner and the outer coma and simulating time-variable phenomena. It treats H2O, OH, H2, O, and H as separate fluids and each fluid has its own velocity and temperature, with collisions coupling all fluids together. The self-consistent collisional interactions decrease the velocity differences, re-distribute the excess energy deposited by chemical reactions among all species, and account for the varying heating efficiency under various physical conditions. Recognizing that the fluid approach has limitations in capturing all of the correct physics for certain applications, especially for very low density environment, we applied our multi-fluid coma model to comet 67P/Churyumov-Gerasimenko (CG) at various heliocentric distances and demonstrated that it is able to yield comparable results as the Direct Simulation Monte Carlo (DSMC) model, which is based on a kinetic approach that is valid under these conditions. Therefore, our model may be a powerful alternative to the particle-based model, especially for some computationally intensive simulations. In addition, by running the model with several combinations of production rates and heliocentric distances, we can characterize the cometary H2O expansion speeds and demonstrate the nonlinear effect of production rates or photochemical heating. Our results are also compared to previous modeling work (e.g., Bockelee-Morvan & Crovisier 1987) and remote observations (e.g., Tseng et al. 2007), which serve as further validation of our model. This work has been partially supported by grant NNX14AG84G from the NASA Planetary Atmospheres Program, and US Rosetta contracts JPL #1266313, JPL #1266314 and JPL #1286489.

Is the tail of 73P-B/Schwassman-Wachman 1 chasing its Remnant Nucleus?

NASA Technical Reports Server (NTRS)

Wooden, D. H.; Harker, D. E.; Woodward, C. E.; Ehrenfreund, P.; Geers, V. C.; Waters, L. B. F. M.; Cox, N.

2006-01-01

We report on imaging observations of comets 73P-B/Schwassmann-Wachmann 1 and 73P-C/Schwassmann-Wachmann 1 at the IRTF with SpeX (J, K) and MRSI (10 micron narrow band filter set) on 2006 Apr 17-19 UT and 2006 Jun 18-19, and at the VLT with VISIR (1 0 micron narrow band filters, 20 micron) on 2006 Apr 17 UT. Compared to when the comet was in the midst of breaking up in mid-April, in June the tail of 73P-B is much fainter and there is a compact coma detected well separated and ahead of its tail, and fainter than the tail. The width of the tail in J, K, and 10 micron images indicates that the pieces that were shed in April must still be outgassing and releasing small particles into the tail-shaped coma; small grains have relatively short lifetimes in the coma due to radiation pressure. The trailing tail is now well separated from the faint "leader of the pack" compact coma that we suppose is a remaining piece of the nucleus. It will be interesting to see post-perihelion if this "leading compact coma" object continues to gain distance on the debris and continues to weakly outgas and shed small grains. One wonders if it expended its volatiles (available to the surface) in breaking up; a short-lived release of volatiles occurred in the Deep Impact event with comet 9P/Tempel 1. 73P-C is extended with a more elongated coma structure closer to perihelion compared to 2006 Apr 18- 19 UT. The SEDs from 2006 Apr and Jun from SpeX-MIRSI (IRTF) are compared with VISIR (VLT) SEDs from 2006 Apr. Information on the heliocentric dependence of the activity and dust release yields insights into the origin of activity and the relationship between activity and grain size distribution/mineralogy.

Immediate and Long-Term Outcome of Acute H2S Intoxication Induced Coma in Unanesthetized Rats: Effects of Methylene Blue.

PubMed

Sonobe, Takashi; Chenuel, Bruno; Cooper, Timothy K; Haouzi, Philippe

2015-01-01

Acute hydrogen sulfide (H2S) poisoning produces a coma, the outcome of which ranges from full recovery to severe neurological deficits. The aim of our study was to 1--describe the immediate and long-term neurological effects following H2S-induced coma in un-anesthetized rats, and 2--determine the potential benefit of methylene blue (MB), a compound we previously found to counteract acute sulfide cardiac toxicity. NaHS was administered IP in un-sedated rats to produce a coma (n = 34). One minute into coma, the rats received MB (4 mg/kg i.v.) or saline. The surviving rats were followed clinically and assigned to Morris water maze (MWM) and open field testing then sacrificed at day 7. Sixty percent of the non-treated comatose rats died by pulseless electrical activity. Nine percent recovered with neurological deficits requiring euthanasia, their brain examination revealed major neuronal necrosis of the superficial and middle layers of the cerebral cortex and the posterior thalamus, with variable necrosis of the caudate putamen, but no lesions of the hippocampus or the cerebellum, in contrast to the typical distribution of post-ischemic lesions. The remaining animals displayed, on average, a significantly less effective search strategy than the control rats (n = 21) during MWM testing. Meanwhile, 75% of rats that received MB survived and could perform the MWM test (P<0.05 vs non-treated animals). The treated animals displayed a significantly higher occurrence of spatial search than the non-treated animals. However, a similar proportion of cortical necrosis was observed in both groups, with a milder clinical presentation following MB. In conclusion, in rats surviving H2S induced coma, spatial search patterns were used less frequently than in control animals. A small percentage of rats presented necrotic neuronal lesions, which distribution differed from post-ischemic lesions. MB dramatically improved the immediate survival and spatial search strategy in the surviving rats.

Wake-promoting actions of median nerve stimulation in TBI-induced coma: An investigation of orexin-A and orexin receptor 1 in the hypothalamic region.

PubMed

Zhong, Ying-Jun; Feng, Zhen; Wang, Liang; Wei, Tian-Qi

2015-09-01

A coma is a serious complication, which can occur following traumatic brain injury (TBI), for which no effective treatment has been established. Previous studies have suggested that neural electrical stimulation, including median nerve stimulation (MNS), may be an effective method for treating patients in a coma, and orexin‑A, an excitatory hypothalamic neuropeptide, may be involved in wakefulness. However, the exact mechanisms underlying this involvement remain to be elucidated. The present study aimed to examine the arousal‑promoting role of MNS in rats in a TBI‑induced coma and to investigate the potential mechanisms involved. A total of 90 rats were divided into three groups, comprising a control group, sham‑stimulated (TBI) group and a stimulated (TBI + MNS) group. MNS was performed on the animals, which were in a TBI‑induced comatose state. Changes in the behavior of the rats were observed following MNS. Subsequently, hypothalamic tissues were extracted from the rats 6, 12 and 24 h following TBI or MNS, respectively. The expression levels of orexin‑A and orexin receptor‑1 (OX1R) in the hypothalamus were examined using immunohistochemistry, western blotting and an enzyme‑linked immunosorbent assay. The results demonstrated that 21 rats subjected to TBI‑induced coma exhibited a restored righting reflex and response to pain stimuli following MNS. In addition, ignificant differences in the expression levels of orexin‑A and OXIR were observed among the three groups and among the time‑points. Orexin‑A and OX1R were upregulated following MNS. The rats in the stimulated group reacted to the MNS and exhibited a re‑awakening response. The results of the present study indicated that MNS may be a therapeutic option for TBI‑induced coma. The mechanism may be associated with increasing expression levels of the excitatory hypothalamic neuropeptide, orexin-A, and its receptor, OX1R, in the hypothalamic region.

The HST/ACS Coma Cluster Survey. II. Data Description and Source Catalogs

NASA Technical Reports Server (NTRS)

Hammer, Derek; Kleijn, Gijs Verdoes; Hoyos, Carlos; Den Brok, Mark; Balcells, Marc; Ferguson, Henry C.; Goudfrooij, Paul; Carter, David; Guzman, Rafael; Peletier, Reynier F.;

Polarization imaging of comets at geocentric distances smaller than 0.5 au: Comet 73P/Schwassmann-Wachmann 3

NASA Astrophysics Data System (ADS)

Hadamcik, E.; Levasseur-Regourd, A.-C.

2014-07-01

Remote observations of sunlight scattered by solid particles provide information on the particle properties for a large variety of comets. When comets approach the Sun, solid particles and gases are released from the surface or from the inner layers [1,2]. If the comet is close enough to the Earth, the inner coma may be studied. Different coma regions are observed corresponding to different dust properties, e.g., in jets or fresh ejected dust around the coma. Narrow-band continuum filters or broader-band filters in less contaminated spectral domains (red or near infrared) are currently used to avoid or reduce the contributions from gaseous emission. Comet 73P/Schwassmann-Wachmann 3 is a fascinating fragmenting comet. Different observations in 1995 revealed an increase of activity and at least four fragments of the nucleus. In its 2011 apparition, the fragments were well separated and appeared like small individual comets. In 2006, its apparition was very favorable and allowed high- spatial resolution imaging by different complementary techniques. We observed three fragments of comet 73P/Schwassmann-Wachmann 3 from April 27 to May 3, 2006, by imaging polarimetry with the 80-cm telescope at Observatoire de Haute-Provence. The distance to the Earth was smaller than 0.2 au. Fragment C resembles a classical active comet. Regions of high and lower polarization were observed in the inner coma, appearing to change almost periodically. The variation of polarization in the inner coma was important from one night to the next one, the whole coma polarization being about constant for nucleus distances greater than 2000 km and increasing with the phase angle. Fragment B continued its (sequential) fragmentation, with a region of secondary fragments progressively moving away from the main nucleus in the antisolar direction. The chemical composition has been reported as being similar in all the fragments [3], but differences were observed between them in polarization underlining differences in, e.g., structure or size distribution of the particles during their ejection and fragmentation. The variation of polarization in the coma and around the fragments will be presented. Finally, a comparison to other comets, including split comets observed at small geocentric distances, will be provided.

Jet morphology and coma analysis of comet 103P/Hartley 2

NASA Astrophysics Data System (ADS)

Vaughan, Charles M.

In 2010, comet 103P/Hartley 2 was observed pre- and post-perihelion using the George and Cynthia Mitchell Integral Field Spectrometer on the 2.7-m telescope at McDonald Observatory in Texas. Data for gaseous radicals C2, C3, CH, CN, and NH2 were collected over six nights from 15 July to 10 November. The spectral data were used to create coma maps for each of the observed species, and the maps were processed using radial and azimuthal mean division techniques to create enhanced images of the coma, revealing subtle morphological features. 340 enhanced coma images were created for each observation and species. Visual inspection reveals that the coma is heterogeneous between the five detected radicals, and statistical analyses verify this result. To compliment the ongoing investigation of Hartley 2 as studied by the EPOXI flyby mission, findings from other researchers (Belton et al., 2012; Syal et al., 2012; and Thomas et al., 2012) are used to characterize the nucleus spin state and identify dust jet locations on the nucleus. With rotational period measurements from EPOXI, dust jet vectors on the nucleus surface are rotated to relevant observation times in November to compare the computed jet directions with the radical densities in the coma. Dust jet sites on the smaller nucleus lobe show a stronger correlation with high radical concentrations than the dust sites on the larger nucleus lobe. Production rates for potential parentage of radical species are calculated using the radial outflow Haser model (Haser, 1957), which are compared to mixing ratios relative to water from separate campaigns to constrain parentage. NH3 is likely the sole producer of NH2, whereas CN may be produced from a combination of HCN, C2N2, and CH3CN. Traditional parentage of C2, C3, and CH do not yield acceptable fits or suitable mixing ratios with the Haser model, and it is possible that extended coma ices having relatively short scale lengths greatly contribute to production of these radicals. These results provide further evidence that the Hartley 2 nucleus is heterogeneous in composition, and the rotational analysis indicates that specific jet sites are correlated with certain radical species.

Efficacy of Intravenous Haloperidol on the duration of Delirium and Coma in Critically Ill Patients (Hope-ICU): a Randomised, Placebo-Controlled Trial

PubMed Central

Page, Valerie J; Ely, E Wesley; Gates, Simon; Zhao, Xiao Bei; Alce, Timothy; Shintani, Ayumi; Jackson, Jim; Perkins, Gavin D; McAuley, Daniel F

2016-01-01

Background Delirium is frequently diagnosed in critically ill patients and is associated with poor clinical outcomes. Haloperidol is the most commonly used drug for delirium despite little evidence of its effectiveness. The aim of this study was to establish whether early treatment with haloperidol would decrease the time that survivors of critical illness spent in delirium or in coma. Methods We did this double-blind, placebo-controlled randomised trial in a general adult intensive care unit (ICU). Critically ill patients (≥18 years) needing mechanical ventilation within 72 of admission were enrolled. Patients were randomised (by an independent nurse, in 1:1 ratio, with permuted block size of four and six, using a centralised, secure web-based randomisation service) to receive haloperidol 2·5mgs or 0·9% saline placebo intravenously every 8 h irrespective of coma or delirium status. Study drug was discontinued on ICU discharge, once delirium-free and coma-free for 2 consecutive days, or after a maximum of 14 days treatment, which ever came first. Delirium was assessed using the confusion assessment method - for the ICU (CAM-ICU). The primary outcome was delirium-free and coma-free days, defined as the number of days in the first 14 days after randomisation during which the patient was alive without delirium and not in coma from any cause. Patients who died within the 14-day study period were recorded as having 0 days free of delirium and coma. ICU clinical and research staff and patients were masked to treatment throughout the study. Analyses were by intention to treat. This trial is registered with the International Standard Randomised Controlled Trial Registry, number ISRCTN83567338. Findings 142 patients were randomised, 141 were included in the final analysis (71 haloperidol, 70 placebo). Patients in the haloperidol group spent about the same number of days alive, without delirium, and without coma as did patients in the placebo group (median 5 days [IQR 0-10] vs 6 days [0-11] days; p= 0·53). The most common adverse events were oversedation (11 patients in the haloperidol group vs. six in the placebo) and QTc prolongation (seven in haloperidol group and six in the placebo group). No patient had a serious adverse event related to study drug. Interpretation These results do not support the hypothesis that haloperidol modifies duration of delirium in critically ill patients. Although haloperidol can be used safely in this population of patients, pending the results of trials in progress, the use of intravenous haloperidol should be reserved for the short-term management of acute agitation. Funding National Institute for Health Research PMID:24461612

Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (Hope-ICU): a randomised, double-blind, placebo-controlled trial.

PubMed

Page, Valerie J; Ely, E Wesley; Gates, Simon; Zhao, Xiao Bei; Alce, Timothy; Shintani, Ayumi; Jackson, Jim; Perkins, Gavin D; McAuley, Daniel F

2013-09-01

Delirium is frequently diagnosed in critically ill patients and is associated with poor clinical outcomes. Haloperidol is the most commonly used drug for delirium despite little evidence of its effectiveness. The aim of this study was to establish whether early treatment with haloperidol would decrease the time that survivors of critical illness spent in delirium or coma. We did this double-blind, placebo-controlled randomised trial in a general adult intensive care unit (ICU). Critically ill patients (≥18 years) needing mechanical ventilation within 72 h of admission were enrolled. Patients were randomised (by an independent nurse, in 1:1 ratio, with permuted block size of four and six, using a centralised, secure web-based randomisation service) to receive haloperidol 2.5 mg or 0.9% saline placebo intravenously every 8 h, irrespective of coma or delirium status. Study drug was discontinued on ICU discharge, once delirium-free and coma-free for 2 consecutive days, or after a maximum of 14 days of treatment, whichever came first. Delirium was assessed using the confusion assessment method for the ICU (CAM-ICU). The primary outcome was delirium-free and coma-free days, defined as the number of days in the first 14 days after randomisation during which the patient was alive without delirium and not in coma from any cause. Patients who died within the 14 day study period were recorded as having 0 days free of delirium and coma. ICU clinical and research staff and patients were masked to treatment throughout the study. Analyses were by intention to treat. This trial is registered with the International Standard Randomised Controlled Trial Registry, number ISRCTN83567338. 142 patients were randomised, 141 were included in the final analysis (71 haloperidol, 70 placebo). Patients in the haloperidol group spent about the same number of days alive, without delirium, and without coma as did patients in the placebo group (median 5 days [IQR 0-10] vs 6 days [0-11] days; p=0.53). The most common adverse events were oversedation (11 patients in the haloperidol group vs six in the placebo group) and QTc prolongation (seven patients in the haloperidol group vs six in the placebo group). No patient had a serious adverse event related to the study drug. These results do not support the hypothesis that haloperidol modifies duration of delirium in critically ill patients. Although haloperidol can be used safely in this population of patients, pending the results of trials in progress, the use of intravenous haloperidol should be reserved for short-term management of acute agitation. National Institute for Health Research. Copyright © 2013 Elsevier Ltd. All rights reserved.

Hyponatraemic convulsion secondary to desmopressin treatment for primary enuresis.

PubMed

Apakama, D C; Bleetman, A

1999-05-01

The case of a 6 year old child who presented with convulsions and coma after unsupervised self administration of intranasal desmopressin (DDAVP) for nocturnal enuresis is presented. Children with enuresis can be embarassed by their condition and may believe that multiple doses of their nasal spray may bring about a rapid resolution. Water intoxication is an uncommon but serious adverse effect of treatment with intranasal DDAVP. These patients may present with seizure, mental state changes, or both. Basic management consists of stopping the drug, fluid restriction, and suppressive treatment for seizures. Recovery is usually rapid and complete. Administration of the nasal spray in children should be supervised by parents to prevent highly motivated children from accidental overdose. The risks of high fluid intake need to be carefully explained to both parents and children.

Thyroid Emergencies

PubMed Central

Leung, Angela M

2017-01-01

Myxedema coma and thyroid storm are thyroid emergencies associated with increased mortality. Prompt recognition of these states—which represent the severe, life-threatening conditions of extremely reduced or elevated circulating thyroid hormone concentrations, respectively—is necessary to initiate treatment. Management of myxedema coma and thyroid storm requires both medical and supportive therapies and should be treated in an intensive care unit setting. PMID:27598067

Heart failure presenting as myxedema coma: case report and review article.

PubMed

Chaudhari, Dhara; Gangadharan, Venkat; Forrest, Terry

2013-05-01

Hypothyroidism is a common medical problem easily treated when diagnosed but requiring regular follow-up and patient medication compliance. At times, this diagnosis can go untreated resulting in the development of severe consequences such as Myxedema Coma. Of all the clinical symptoms, cardiovascular manifestations tend to be especially severe and often life threatening.

Heart failure presenting as myxedema coma: case report and review article.

PubMed

Chaudhari, Dhara; Gangadharan, Venkat; Forrest, Terry

2014-02-01

Hypothyroidism is a common medical problem easily treated when diagnosed but requiring regular follow-up and patient medication compliance. At times, this diagnosis can go untreated resulting in the development of severe consequences such as Myxedema Coma. Of all the clinical symptoms, cardiovascular manifestations tend to be especially severe and often life threatening.

H2O(+) structures in the inner plasma tail of comet Austin

NASA Technical Reports Server (NTRS)

Jockers, Klaus; Bonev, T.; Geyer, E. H.

1992-01-01

We present images of comet Austin 1989c1 in the light of H2O(+) from which the contribution of the dust continuum and the gas coma was completely removed. We describe the behavior of the H2O(+) plasma in the inner coma where it is reliably observed for the first time.

Communication Opportunities via Special Messaging Technology for Two Post-Coma Persons with Multiple Disabilities

ERIC Educational Resources Information Center

Lancioni, Giulio E.; O'Reilly, Mark F.; Singh, Nirbhay N.; Sigafoos, Jeff; Buonocunto, Francesca; Sacco, Valentina; Colonna, Fabio; Navarro, Jorge; Lanzilotti, Crocifissa; de Pace, Claudia; Megna, Marisa; Oliva, Doretta

2011-01-01

This study extended the assessment of a special messaging technology with two additional post-coma adults who had emerged from a minimally conscious state, but showed multiple disabilities including profound motor and communication impairments. For each participant, the study involved an ABAB design, in which the A represented baseline phases and…

Effectiveness of hemodialysis in a case of severe valproate overdose

PubMed Central

Nasa, Prashant; Sehrawat, Deepak; Kansal, Sudha; Chawla, Rajesh

2011-01-01

A case of severe sodium valproate overdose is presented in which medicinal management failed to reverse coma of the patient. High-flux hemodialysis was then used to eliminate sodium valproate. This case demonstrated the effectiveness of hemodialysis in not only decreasing valproate levels very rapidly but also as an effective anti-coma management. PMID:21814378

Active music therapy in the rehabilitation of severe brain injured patients during coma recovery.

PubMed

Formisano, R; Vinicola, V; Penta, F; Matteis, M; Brunelli, S; Weckel, J W

2001-01-01

Active improvised music therapy may offer an adjuvant from of treatment in the early rehabilitation of severe brain-injured patients. Active music therapy consists of musical improvisation between patient and therapist by singing or by playing different musical instruments, according to the vital functions, the neurological conditions and the motor abilities of the patients. We studied 34 severe brain-injured patients with a mean coma duration of 52 days +/- 37.21 and a mean interval from coma onset to the beginning of rehabilitation of 154 days on average. Our preliminary results show a significant improvement of the collaboration of the severe brain-injured patients and a reduction of undesired behaviours such as inertia (reduced psychomotor initiative) or psychomotor agitation.

Spectral constraints on models of gas in clusters of galaxies

NASA Technical Reports Server (NTRS)

Henriksen, M. J.; Mushotzky, R.

1985-01-01

The HEAO 1A2 spectra of clusters of galaxies are used to determine the temperature profile which characterizes the X-ray emitting gas. Strong evidence of nonisothermality is found for the Coma, A85, and A1795 clusters. Properties of the cluster potential which binds the gas are calculated for a range of model parameters. The typical binding mass, if the gas is adiabatic, is 2-4E14 solar masses and is quite centrally concentrated. In addition, the Fe abundance in Coma is .26 + or - .06 solar, less than the typical value (.5) found for rich clusters. The results for the gas in Coma may imply a physical description of the cluster which is quite different from what was previously believed.

Using Spectroscopic Profiles to Study the Morphology of Comets

NASA Astrophysics Data System (ADS)

Harris, Ien; Pierce, Donna M.; Cochran, Anita L.

2016-10-01

We have used the integral-field unit spectrograph (the George and Cynthia Mitchell Spectrograph) on the 2.7m Harlan J. Smith telescope at McDonald Observatory to obtain spectroscopic images of the comae of several comets. The images were obtained for various radical species (C2, C3. CH, CN, NH2). Radial and azimuthal average profiles of the radical species were created to enhance any observed cometary coma morphological features. We compare the observed coma features across the observed species and over the different observation periods in order to constrain possible rotational states of the observed comets. We will present results for several comets, including 2009P1 (Garradd). This work was funded by NASA's Planetary Atmospheres program (Award No. NNX14AH186).

Amiodarone induced myxedema coma: Two case reports and literature review.

PubMed

Hawatmeh, Amer; Thawabi, Mohammad; Abuarqoub, Ahmad; Shamoon, Fayez

2018-05-21

Amiodarone is a benzofuran derivative that contains 37% iodine by weight and is structurally similar to the thyroid hormones. Amiodarone has a complex effect on the thyroid gland, ranging from abnormalities of thyroid function tests to overt thyroid dysfunction, with either thyrotoxicosis or hypothyroidism. Myxedema coma secondary to amiodarone use has been rarely reported in the literature. Our two case reports are an add on to the literature, and illustrate that amiodarone is an important cause of thyroid dysfunction including hypothyroidism and myxedema coma. Hence, healthcare providers should have a high index of suspicion for these conditions while treating patients who are taking amiodarone therapy as early recognition and management are essential to optimize outcomes. Copyright © 2018 Elsevier Inc. All rights reserved.

Thiopental inhibits nitric oxide production in rat aorta.

PubMed

Castillo, C; Asbun, J; Escalante, B; Villalón, C M; López, P; Castillo, E F

1999-12-01

We studied whether thiopental affects endothelial nitric oxide dependent vasodilator responses and nitrite production (an indicator of nitric oxide production) elicited by acetylcholine, histamine, and A23187 in rat aorta (artery in which nitric oxide is the main endothelial relaxant factor). In addition, we evaluated the barbiturate effect on nitric oxide synthase (NOS) activity in both rat aorta and kidney homogenates. Thiopental (10-100 microg/mL) reversibly inhibited the endothelium-dependent relaxation elicited by acetylcholine, histamine, and A23187. On the contrary, this anesthetic did not modify the endothelium-independent but cGMP-dependent relaxation elicited by sodium nitroprusside (1 nM - 1 microM) and nitroglycerin (1 nM - 1 microM), thus excluding an effect of thiopental on guanylate cyclase of vascular smooth muscle. Thiopental (100 microg/mL) inhibited both basal (87.8+/-14.3%) and acetylcholine- or A23187-stimulated (78.6+/-3.9 and 39.7+/-5.6%, respectively) production of nitrites in aortic rings. In addition the barbiturate inhibited (100 microg/mL) the NOS (45+/-4 and 42.8+/-9%) in aortic and kidney homogenates, respectively (measured as 14C-labeled citrulline production). In conclusion, thiopental inhibition of endothelium-dependent relaxation and nitrite production in aortic rings strongly suggests an inhibitory effect on NOS. Thiopental inhibition of the NOS provides further support to this contention.

Acid-base equilibrium in aqueous solutions of 1,3-dimethylbarbituric acid as studied by 13C NMR spectroscopy

NASA Astrophysics Data System (ADS)

Gryff-Keller, A.; Kraska-Dziadecka, A.

2011-12-01

13C NMR spectra of 1,3-dimethylbarbituric acid in aqueous solutions of various acidities and for various solute concentrations have been recorded and interpreted. The spectra recorded at pH = 2 and below contain the signals of the neutral solute molecule exclusively, while the ones recorded at pH = 7 and above only the signals of the appropriate anion, which has been confirmed by theoretical GIAO-DFT calculations. The signals in the spectra recorded for solutions of pH < 7 show dynamic broadenings. The lineshape analysis of these signals has provided information on the kinetics of the processes running in the dynamic acid-base equilibrium. The kinetic data determined this way have been used to clarify the mechanisms of these processes. The numerical analysis has shown that under the investigated conditions deprotonation of the neutral solute molecules undergoes not only via a simple transfer of the C-H proton to water molecules but also through a process with participation of the barbiturate anions. Moreover, the importance of tautomerism, or association, or both these phenomena for the kinetics of the acid-base transformations in the investigated system has been shown. Qualitatively similar changes of 13C NMR spectra with the solution pH variation have been observed for the parent barbituric acid.

What predicts the change from episodic to chronic migraine?

PubMed

Bigal, Marcelo E; Lipton, Richard B

2009-06-01

Because migraine worsens in a sizeable subgroup of sufferers, but not in most, identifying factors that predict the change from episodic into chronic migraine is of extreme interest and should be seen as a priority in headache research. Potentially remediable risk factors include frequency of migraine attacks, obesity, excessive use of medications containing opioids and barbiturates, caffeine overuse, stressful life events, depression, sleep disorders and cutaneous allodynia. While we wait for evidence regarding the benefits of risk factor modifications in the prevention of chronic migraine, several interventions are justifiable based on their other established benefits. For example, decreasing headache frequency with behavioral and pharmacological interventions will decrease current disability even if it does not modify clinical course. Monitoring the body mass index and encouraging maintenance of normal body weight is good practice in patients with and without migraine. Avoiding overuse of caffeine is desirable apart from its potential benefit in preventing progression. Sleep problems should be investigated and treated. Psychiatric comorbidities should be identified and addressed. Medications containing opioids and barbiturates should be reserved for a few selected cases of migraine, and their use should be monitored. For these interventions, the possibility of preventing progression may motivate clinicians to offer good care and patients to engage in the treatment plan.

2 years with comet 67P/Churyumov-Gerasimenko: H2O, CO2, CO as seen by ROSINA RTOF

NASA Astrophysics Data System (ADS)

Hoang, M.; Garnier, P.; Lasue, J.; Reme, H.; Altwegg, K.; Balsiger, H. R.; Bieler, A. M.; Calmonte, U.; Capria, M. T.; Combi, M. R.; De Keyser, J. M.; Fiethe, B.; Fougere, N.; Fuselier, S. A.; Galli, A.; Gasc, S.; Gombosi, T. I.; Hansen, K. C.; Jäckel, A.; Korth, A.; Mall, U.; Migliorini, A.; Rubin, M.; Sémon, T.; Tzou, C. Y.; Waite, J. H., Jr.; Wurz, P.

2017-12-01

The Rosetta space mission investigated comet 67P/Churyumov-Gerasimenko (67P) over two years from August 2014 to September 2016. Onboard the spacecraft, the ROSINA experiment included two mass spectrometers to derive the composition of neutrals and ions, and a COmet Pressure Sensor (COPS) to monitor the density and velocity of the neutrals in the coma. We will here analyse and discuss data from the Reflectron-type Time-Of-Flight instrument during the comet escort phase. The RTOF mass spectrometer possessed a wide mass range and a high temporal resolution (Balsiger et al., 2007). The analysis of 67P/C-G's coma major molecules over the mission showed strong variability of the comet coma's main volatiles concentrations (H2O, CO2, CO) and their relative abundances. The 2 years long Rosetta mission allowed us to observe the seasonal evolution in the atmosphere of 67P, in particular the change occurring during the equinoxes and at perihelion. In this work, we analyze the asymmetry in the outgassing rate before and after the perihelion (13/08/2015), the evolution of abundance ratios through the whole mission, and in particular the behavior of the very volatile CO molecules. Density maps projected on the surface of 67P demonstrate the evolution of the three main coma species after the outbound equinox. We will present first results of our comet nucleus thermal modelling used to simulate the internal structure and temperature evolution of 67P at characteristic surface areas. These results will be compared with the coma composition measurements obtained by ROSINA.

Adaptation to Low Temperature Exposure Increases Metabolic Rates Independently of Growth Rates

PubMed Central

Williams, Caroline M.; Szejner-Sigal, Andre; Morgan, Theodore J.; Edison, Arthur S.; Allison, David B.; Hahn, Daniel A.

2016-01-01

Metabolic cold adaptation is a pattern where ectotherms from cold, high-latitude, or -altitude habitats have higher metabolic rates than ectotherms from warmer habitats. When found, metabolic cold adaptation is often attributed to countergradient selection, wherein short, cool growing seasons select for a compensatory increase in growth rates and development times of ectotherms. Yet, ectotherms in high-latitude and -altitude environments face many challenges in addition to thermal and time constraints on lifecycles. In addition to short, cool growing seasons, high-latitude and - altitude environments are characterized by regular exposure to extreme low temperatures, which cause ectotherms to enter a transient state of immobility termed chill coma. The ability to resume activity quickly after chill coma increases with latitude and altitude in patterns consistent with local adaptation to cold conditions. We show that artificial selection for fast and slow chill coma recovery among lines of the fly Drosophila melanogaster also affects rates of respiratory metabolism. Cold-hardy fly lines, with fast recovery from chill coma, had higher respiratory metabolic rates than control lines, with cold-susceptible slow-recovering lines having the lowest metabolic rates. Fast chill coma recovery was also associated with higher respiratory metabolism in a set of lines derived from a natural population. Although their metabolic rates were higher than control lines, fast-recovering cold-hardy lines did not have faster growth rates or development times than control lines. This suggests that raised metabolic rates in high-latitude and -altitude species may be driven by adaptation to extreme low temperatures, illustrating the importance of moving “Beyond the Mean”. PMID:27103615

FORTY-SEVEN MILKY WAY-SIZED, EXTREMELY DIFFUSE GALAXIES IN THE COMA CLUSTER

DOE Office of Scientific and Technical Information (OSTI.GOV)

Van Dokkum, Pieter G.; Merritt, Allison; Geha, Marla

2015-01-10

We report the discovery of 47 low surface brightness objects in deep images of a 3° × 3° field centered on the Coma cluster, obtained with the Dragonfly Telephoto Array. The objects have central surface brightness μ(g, 0) ranging from 24-26 mag arcsec{sup –2} and effective radii r {sub eff} = 3''-10'', as measured from archival Canada-France-Hawaii Telescope images. From their spatial distribution we infer that most or all of the objects are galaxies in the Coma cluster. This relatively large distance is surprising as it implies that the galaxies are very large: with r {sub eff} = 1.5-4.6 kpcmore » their sizes are similar to those of L {sub *} galaxies even though their median stellar mass is only ∼6 × 10{sup 7} M {sub ☉}. The galaxies are relatively red and round, with (g – i) = 0.8 and (b/a) = 0.74. One of the 47 galaxies is fortuitously covered by a deep Hubble Space Telescope Advanced Camera for Surveys (ACS) observation. The ACS imaging shows a large spheroidal object with a central surface brightness μ{sub 475} = 25.8 mag arcsec{sup –2}, a Sérsic index n = 0.6, and an effective radius of 7'', corresponding to 3.4 kpc at the distance of Coma. The galaxy is not resolved into stars, consistent with expectations for a Coma cluster object. We speculate that these ''ultra-diffuse galaxies'' may have lost their gas supply at early times, possibly resulting in very high dark matter fractions.« less

The Large-Grained Dust Coma of 174P/Echeclus

NASA Technical Reports Server (NTRS)

Bauer, James M.; Choi, Young-Jun; Weissman, Paul R.; Stansberry, John A.; Fernandez, Yanga R.; Roe, Henry G.; Buratti, Bonnie J.; Sung, Hyun-Il

2008-01-01

On 2005 December 30, Y.-J. Choi and P. R. Weissman discovered that the formerly dormant Centaur 2000 EC98 was in strong outburst. Previous observations by P. Rousselot et al. spanning a 3-year period indicated a lack of coma down to the 27 mag arcsec 2 level.We present Spitzer Space Telescope MIPS observations of this newly active Centaur--now known as 174P/Echeclus (2000 EC98)--or 60558 Echeclus--taken in 2006 late February. The images show strong signal at both the 24 and 70 micron bands and reveal an extended coma about 2' in diameter. Analyses yield estimates of the coma signal contribution that are in excess of 90% of the total signal in the 24 micron band. Dust production estimates ranging from 1.7-4 x 10(exp 2) kg/s are on the order of 30 times that seen in other Centaurs. Simultaneous visible-wavelength observations were also obtained with Palomar Observatory's 200-inch telescope, the 1.8-m Vatican Advanced Technology Telescope, the Bohyunsan Optical Astronomy Observatory (BOAO) 1.8-m telescope, and Table Mountain Observatory's 0.6-m telescope, revealing a coma morphology nearly identical to the mid-IR observations. The grain size distribution derived from the data yields a log particle mass power-law with slope parameter (alpha) = -0.87 +/- 0.07, and is consistent with steady cometary-activity, such as that observed during the Stardust spacecraft's encounter at 81P/Wild 2, and not with an impact driven event, such as that caused by the Deep Impact experiment.

Prospective Cohort Study Evaluating the Prognostic Value of Simple EEG Parameters in Postanoxic Coma.

PubMed

Azabou, Eric; Fischer, Catherine; Mauguiere, François; Vaugier, Isabelle; Annane, Djillali; Sharshar, Tarek; Lofaso, Fréderic

2016-01-01

We prospectively studied early bedside standard EEG characteristics in 61 acute postanoxic coma patients. Five simple EEG features, namely, isoelectric, discontinuous, nonreactive to intense auditory and nociceptive stimuli, dominant delta frequency, and occurrence of paroxysms were classified yes or no. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC) of each of these variables for predicting an unfavorable outcome, defined as death, persistent vegetative state, minimally conscious state, or severe neurological disability, as assessed 1 year after coma onset were computed as well as Synek's score. The outcome was unfavorable in 56 (91.8%) patients. Sensitivity, specificity, PPV, NPV, and AUC of nonreactive EEG for predicting an unfavorable outcome were 84%, 80%, 98%, 31%, and 0.82, respectively; and were all very close to the ones of Synek score>3, which were 82%, 80%, 98%, 29%, and 0.81, respectively. Specificities for predicting an unfavorable outcome were 100% for isoelectric, discontinuous, or dominant delta activity EEG. These 3 last features were constantly associated to unfavorable outcome. Absent EEG reactivity strongly predicted an unfavorable outcome in postanoxic coma, and performed as accurate as a Synek score>3. Analyzing characteristics of some simple EEG features may easily help nonneurophysiologist physicians to investigate prognostic issue of postanoxic coma patient. In this study (a) discontinuous, isoelectric, or delta-dominant EEG were constantly associated with unfavorable outcome and (b) nonreactive EEG performed prognostic as accurate as a Synek score>3. © EEG and Clinical Neuroscience Society (ECNS) 2015.

Evidence of Absence of Tidal Features in the Outskirts of Ultra Diffuse Galaxies in the Coma Cluster

NASA Astrophysics Data System (ADS)

Mowla, Lamiya; van Dokkum, Pieter; Merritt, Allison; Abraham, Roberto; Yagi, Masafumi; Koda, Jin

2017-12-01

We study the presence of tidal features associated with ultra diffuse galaxies (UDGs) in galaxy clusters. Specifically, we stack deep Subaru images of UDGs in the Coma cluster to determine whether they show position angle twists at large radii. Selecting galaxies with central surface brightness μ (g,0)> 24 magarcsec-2 and projected half-light radius {r}e> 1.5 {kpc}, we identify 287 UDGs in the Yagi et al. catalog of low surface brightness Coma objects. The UDGs have apparent spheroidal shapes with median Sérsic index < n> =0.8 and median axis ratio < b/a> =0.7. The images are processed by masking all background objects and rotating to align the major axis before stacking them in bins of properties such as axis ratio, angle of major axis with respect to the cluster center, and separation from cluster center. Our image stacks reach further than 7 kpc (≳4r e). Analysis of the isophotes of the stacks reveals that the ellipticity remains constant up to the last measured point, which means that the individual galaxies have a non-varying position angle and axis ratio and show no evidence for tidal disruption out to ˜ 4{r}e. We demonstrate this explicitly by comparing our stacks with stacks of model UDGs with and without tidal features in their outskirts. We infer that the average tidal radius of the Coma UDGs is >7 kpc and estimate that the average dark matter fraction within the tidal radius of the UDGs inhabiting the innermost 0.5 Mpc of Coma is >99%.

Disruption of posteromedial large-scale neural communication predicts recovery from coma

PubMed Central

de Pasquale, Francesco; Vuillaume, Corine; Riu, Beatrice; Loubinoux, Isabelle; Geeraerts, Thomas; Seguin, Thierry; Bounes, Vincent; Fourcade, Olivier; Demonet, Jean-Francois; Péran, Patrice

2015-01-01

Objective: We hypothesize that the major consciousness deficit observed in coma is due to the breakdown of long-range neuronal communication supported by precuneus and posterior cingulate cortex (PCC), and that prognosis depends on a specific connectivity pattern in these networks. Methods: We compared 27 prospectively recruited comatose patients who had severe brain injury (Glasgow Coma Scale score <8; 14 traumatic and 13 anoxic cases) with 14 age-matched healthy participants. Standardized clinical assessment and fMRI were performed on average 4 ± 2 days after withdrawal of sedation. Analysis of resting-state fMRI connectivity involved a hypothesis-driven, region of interest–based strategy. We assessed patient outcome after 3 months using the Coma Recovery Scale–Revised (CRS-R). Results: Patients who were comatose showed a significant disruption of functional connectivity of brain areas spontaneously synchronized with PCC, globally notwithstanding etiology. The functional connectivity strength between PCC and medial prefrontal cortex (mPFC) was significantly different between comatose patients who went on to recover and those who eventually scored an unfavorable outcome 3 months after brain injury (Kruskal-Wallis test, p < 0.001; linear regression between CRS-R and PCC-mPFC activity coupling at rest, Spearman ρ = 0.93, p < 0.003). Conclusion: In both etiology groups (traumatic and anoxic), changes in the connectivity of PCC-centered, spontaneously synchronized, large-scale networks account for the loss of external and internal self-centered awareness observed during coma. Sparing of functional connectivity between PCC and mPFC may predict patient outcome, and further studies are needed to substantiate this potential prognosis biomarker. PMID:26561296

Disruption of posteromedial large-scale neural communication predicts recovery from coma.

PubMed

Silva, Stein; de Pasquale, Francesco; Vuillaume, Corine; Riu, Beatrice; Loubinoux, Isabelle; Geeraerts, Thomas; Seguin, Thierry; Bounes, Vincent; Fourcade, Olivier; Demonet, Jean-Francois; Péran, Patrice

2015-12-08

We hypothesize that the major consciousness deficit observed in coma is due to the breakdown of long-range neuronal communication supported by precuneus and posterior cingulate cortex (PCC), and that prognosis depends on a specific connectivity pattern in these networks. We compared 27 prospectively recruited comatose patients who had severe brain injury (Glasgow Coma Scale score <8; 14 traumatic and 13 anoxic cases) with 14 age-matched healthy participants. Standardized clinical assessment and fMRI were performed on average 4 ± 2 days after withdrawal of sedation. Analysis of resting-state fMRI connectivity involved a hypothesis-driven, region of interest-based strategy. We assessed patient outcome after 3 months using the Coma Recovery Scale-Revised (CRS-R). Patients who were comatose showed a significant disruption of functional connectivity of brain areas spontaneously synchronized with PCC, globally notwithstanding etiology. The functional connectivity strength between PCC and medial prefrontal cortex (mPFC) was significantly different between comatose patients who went on to recover and those who eventually scored an unfavorable outcome 3 months after brain injury (Kruskal-Wallis test, p < 0.001; linear regression between CRS-R and PCC-mPFC activity coupling at rest, Spearman ρ = 0.93, p < 0.003). In both etiology groups (traumatic and anoxic), changes in the connectivity of PCC-centered, spontaneously synchronized, large-scale networks account for the loss of external and internal self-centered awareness observed during coma. Sparing of functional connectivity between PCC and mPFC may predict patient outcome, and further studies are needed to substantiate this potential prognosis biomarker. © 2015 American Academy of Neurology.

How does information influence hope in family members of traumatic coma patients in intensive care unit?

PubMed

Verhaeghe, Sofie T L; van Zuuren, Florence J; Defloor, Tom; Duijnstee, Mia S H; Grypdonck, Mieke H F

2007-08-01

To assess the interplay between hope and the information provided by health care professionals. Earlier research learned that hope is crucial for relatives of traumatic coma patients. Also it has been reported that the need for information is extremely important for relatives of critically ill patients. A qualitative approach according to the 'grounded theory' method with constant comparison was used. We held 24 in-depth interviews with 22 family members of 16 patients with traumatic coma. Data processing and data analysis took place in a cyclic process wherein the induction of themes was alternated by confrontation with new material. Family members of traumatic coma patients want information that is as accurate as possible, provided by doctors and nurses in an understandable manner and leaving room for hope. At first, family members can do no more than passively absorb the information they receive. After some time, they actively start working with information and learn what to build their hope on. In this way, concrete hope evolves and seems to be strongly determined by information. Information that is more positive than warranted is not appreciated at all. It leads to false hope and once its real nature becomes apparent, to increased distress and loss of trust in the professionals. The process of hope is crucial in coping with traumatic coma and information can facilitate this process. If professionals, especially nurses, keep the process in mind that family members go through in handling information, they can not only facilitate this process but also help them to establish realistic hope.

Post-Coma Persons with Extensive Multiple Disabilities Use Microswitch Technology to Access Selected Stimulus Events or Operate a Radio Device

ERIC Educational Resources Information Center

Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Alberti, Gloria; Oliva, Doretta; Megna, Gianfranco; Iliceto, Carla; Damiani, Sabino; Ricci, Irene; Spica, Antonella

2011-01-01

The present two studies extended research evidence on the use of microswitch technology by post-coma persons with multiple disabilities. Specifically, Study I examined whether three adults with a diagnosis of minimally conscious state and multiple disabilities could use microswitches as tools to access brief, selected stimulus events. Study II…

Myxedema Coma.

PubMed

Munir, Atif

2018-01-01

Myxedema may be the first presentation of patients with undiagnosed hypothyroidism. Definitive management is with thyroid hormone but supportive measures, identification and treatment of precipitating factors in an appropriately safe environment are vital. There is no consensus about preferred thyroid hormone regimen. Corticosteroid therapy is given until adrenal insufficiency has been excluded. We present here a case of seventy-four years old woman of myxodema coma.

A Technology-Assisted Learning Setup as Assessment Supplement for Three Persons with a Diagnosis of Post-Coma Vegetative State and Pervasive Motor Impairment

ERIC Educational Resources Information Center

Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Buonocunto, Francesca; Sacco, Valentina; Colonna, Fabio; Navarro, Jorge; Lanzilotti, Crocifissa; Bosco, Andrea; Megna, Gianfranco; De Tommaso, Marina

2009-01-01

Post-coma persons in an apparent condition of vegetative state and pervasive motor impairment pose serious problems in terms of assessment and intervention options. A technology-based learning assessment procedure might serve for them as a diagnostic supplement with possible implications for rehabilitation intervention. The learning assessment…

Protocol for Management of Penetrating Carotid Artery Injury.

DTIC Science & Technology

1977-02-08

after hypotension had been corrected. The deficits consisted of monoplegia, hemiplegia or quadriplegia , with or without an associated comatose state. All... quadriplegia , aphasia, or coma. The comatose state was often found in conjunction with lateralizing signs. Forty-nine patients had restoration of...athero- sclerotic disease. II. All patients who have a significant neurological deficit (monoplegia, hemiplegia, quadriplegia , or aphasia) short of coma

Post-Coma Persons Emerged from a Minimally Conscious State and Showing Multiple Disabilities Learn to Manage a Radio-Listening Activity

ERIC Educational Resources Information Center

Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Colonna, Fabio; Buonocunto, Francesca; Sacco, Valentina; Megna, Marisa; Oliva, Doretta

2012-01-01

This study assessed microswitch-based technology to enable three post-coma adults, who had emerged from a minimally conscious state but presented motor and communication disabilities, to operate a radio device. The material involved a modified radio device, a microprocessor-based electronic control unit, a personal microswitch, and an amplified…

Microswitch- and VOCA-Assisted Programs for Two Post-Coma Persons with Minimally Conscious State and Pervasive Motor Disabilities

ERIC Educational Resources Information Center

Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Buonocunto, Francesca; Sacco, Valentina; Colonna, Fabio; Navarro, Jorge; Oliva, Doretta; Signorino, Mario; Megna, Gianfranco

2009-01-01

Intervention programs, based on learning principles and assistive technology, were assessed in two studies with two post-coma men with minimally conscious state and pervasive motor disabilities. Study I assessed a program that included (a) an optic microswitch, activated via double blinking, which allowed a man direct access to brief music…

Post-Coma Persons with Motor and Communication/Consciousness Impairments Choose among Environmental Stimuli and Request Stimulus Repetitions via Assistive Technology

ERIC Educational Resources Information Center

Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Buonocunto, Francesca; Sacco, Valentina; Colonna, Fabio; Navarro, Jorge; Lanzilotti, Crocifissa; Oliva, Doretta; Megna, Gianfranco

2010-01-01

This study assessed whether a program based on microswitch and computer technology would enable three post-coma participants (adults) with motor and communication/consciousness impairments to choose among environmental stimuli and request their repetition whenever they so desired. Within each session, 16 stimuli (12 preferred and 4 non-preferred)…

Capturing the Coma

NASA Technical Reports Server (NTRS)

2005-01-01

This image shows comet Tempel 1, as seen by the Deep Impact spacecraft on June 21, 2005. It was taken using the clear filter of the spacecraft's medium resolution imager camera. The spacecraft was 11,564,081.7 kilometers (7,185,920 miles) away from the comet. Twelve images were combined together, and a logarithmic stretch was applied to enhance the coma of the comet.

Evidence for methane and ammonia in the coma of comet P/Halley

NASA Technical Reports Server (NTRS)

Allen, M.; Delitsky, M.; Huntress, W.; Yung, Y.; Ip, W.-H.

1987-01-01

Methane and ammonia abundances in the coma of Halley are derived from Giotto ion mass spectrometer data using an Eulerian model of chemical and physical processes inside the contact surface to simulate Giotto high-intensity spectrometer ion mass spectral data for mass-to-charge ratios (m/q) from 15 to 19. The ratio m/q = 19/18 as a function of distance from the nucleus is not reproduced by a model for a pure water coma. It is necessary to include the presence of NH3, and uniquely NH3, in coma gases in order to explain the data. A ratio of production rates Q(NH3)/Q(H2O) = 0.01 = 0.02 results in model values approximating the Giotto data. Methane is identified as the most probable source of the distinct peak at m/q = 15. The observations are fit best with Q(CH4)/Q(Q2O) = 0.02. The chemical composition of the comet nucleus implied by these production rate ratios is unlike that of the outer planets. On the other hand, there are also significant differences from observations of gas phase interstellar material.