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Sample records for barbiturate coma therapy

  1. Energy expenditure during barbiturate coma.

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    Ashcraft, Christine M; Frankenfield, David C

    2013-10-01

    Barbiturate coma may have a significant effect on metabolic rate, but the phenomenon is not extensively studied. The primary purpose of the current study was to compare the metabolic rate of general critical care patients with those requiring barbiturate coma. A secondary purpose was to evaluate the accuracy of the Penn State prediction equation between these 2 groups of patients. Indirect calorimetry was used to measure the resting metabolic rate of mechanically ventilated, critically ill patients in a barbiturate coma and those of similar height, weight, and age but not in a barbiturate coma. Measurements of resting metabolic rate were compared with predictions using the Penn State equation accounting for body size, body temperature, and minute ventilation. The barbiturate coma group had a lower resting metabolic rate than the control group that remained lower even after adjustment for predicted healthy metabolic rate and maximum body temperature (1859 ± 290 vs 2037 ± 289 kcal/d, P = .020). When minute ventilation was also included in the analysis, the resting metabolic rate between the groups became statistically insignificant (1929 ± 229 vs 2023 ± 226 kcal/d, P = .142). The Penn State equation, which uses these variables, was accurate in 73% of the control patients and also the barbiturate coma patients. Resting metabolic rate is moderately reduced in barbiturate coma, but the decrease is out of proportion with changes in body temperature. However, if both body temperature and minute ventilation are considered, then the change is predictable.

  2. Economic evaluation of decompressive craniectomy versus barbiturate coma for refractory intracranial hypertension following traumatic brain injury.

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    Alali, Aziz S; Naimark, David M J; Wilson, Jefferson R; Fowler, Robert A; Scales, Damon C; Golan, Eyal; Mainprize, Todd G; Ray, Joel G; Nathens, Avery B

    2014-10-01

    Decompressive craniectomy and barbiturate coma are often used as second-tier strategies when intracranial hypertension following severe traumatic brain injury is refractory to first-line treatments. Uncertainty surrounds the decision to choose either treatment option. We investigated which strategy is more economically attractive in this context. We performed a cost-utility analysis. A Markov Monte Carlo microsimulation model with a life-long time horizon was created to compare quality-adjusted survival and cost of the two treatment strategies, from the perspective of healthcare payer. Model parameters were estimated from the literature. Two-dimensional simulation was used to incorporate parameter uncertainty into the model. Value of information analysis was conducted to identify major drivers of decision uncertainty and focus future research. Trauma centers in the United States. Base case was a population of patients (mean age = 25 yr) who developed refractory intracranial hypertension following traumatic brain injury. We compared two treatment strategies: decompressive craniectomy and barbiturate coma. Decompressive craniectomy was associated with an average gain of 1.5 quality-adjusted life years relative to barbiturate coma, with an incremental cost-effectiveness ratio of $9,565/quality-adjusted life year gained. Decompressive craniectomy resulted in a greater quality-adjusted life expectancy 86% of the time and was more cost-effective than barbiturate coma in 78% of cases if our willingness-to-pay threshold is $50,000/quality-adjusted life year and 82% of cases at a threshold of $100,000/quality-adjusted life year. At older age, decompressive craniectomy continued to increase survival but at higher cost (incremental cost-effectiveness ratio = $197,906/quality-adjusted life year at mean age = 85 yr). Based on available evidence, decompressive craniectomy for the treatment of refractory intracranial hypertension following traumatic brain injury provides better

  3. Evolution of Cerebral Atrophy in a Patient with Super Refractory Status Epilepticus Treated with Barbiturate Coma

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    Christopher R. Newey

    2017-01-01

    Full Text Available Introduction. Status epilepticus is associated with neuronal breakdown. Radiological sequelae of status epilepticus include diffusion weighted abnormalities and T2/FLAIR cortical hyperintensities corresponding to the epileptogenic cortex. However, progressive generalized cerebral atrophy from status epilepticus is underrecognized and may be related to neuronal death. We present here a case of diffuse cerebral atrophy that developed during the course of super refractory status epilepticus management despite prolonged barbiturate coma. Methods. Case report and review of the literature. Case. A 19-year-old male with a prior history of epilepsy presented with focal clonic seizures. His seizures were refractory to multiple anticonvulsants and eventually required pentobarbital coma for 62 days and midazolam coma for 33 days. Serial brain magnetic resonance imaging (MRI showed development of cerebral atrophy at 31 days after admission to our facility and progression of the atrophy at 136 days after admission. Conclusion. This case highlights the development and progression of generalized cerebral atrophy in super refractory status epilepticus. The cerebral atrophy was noticeable at 31 days after admission at our facility which emphasizes the urgency of definitive treatment in patients who present with super refractory status epilepticus. Further research into direct effects of therapeutic coma is warranted.

  4. Barbiturate intoxication and overdose

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    ... users who do not know these combinations can lead to coma or death Experienced users who use them on purpose to alter their consciousness Symptoms Symptoms of barbiturate intoxication and overdose include: Altered level of consciousness Difficulty ...

  5. Music therapy for coma patients: preliminary results.

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    Sun, J; Chen, W

    2015-04-01

    The application of quantitative EEG (δ+θ/α+β value) and GCS value to evaluate the role of music therapy for traumatic brain injury coma patients. Forty patients of traumatic brain injury coma were selected to meet the inclusion criteria. Twenty cases were selected for the rehabilitation, neurology and neurosurgery ward, whose families could actively cooperate with, and the patients could receive a long-term fixed nursing staff with formal music therapy (music group). Twenty cases were in the intensive care unit of the rehabilitation, neurology and neurosurgery ward. Their families members cooperated poorly, had often changing nursing staff, and without a formal music therapy (control group). After a one monthe follow up, the GCS value and quantitative EEG (δ+θ/α+β value) were compared between the two groups. Between the two groups, except for the presence or absence of formal music therapy, the rest of treatment had no significant difference and was matched by age, gender, and injury types. In 40 cases of traumatic brain injury patients, the GCS value increased in the music group after treatment when compared to the control group. The difference between the two groups was significant (p coma has obviously an effect on promoting to regain consciousness. The quantitative EEG (δ+θ/α+β value) can be used as an objective index to evaluate the state of brain function.

  6. Extracorporeal treatment for barbiturate poisoning

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    Mactier, Robert; Laliberté, Martin; Mardini, Joelle

    2014-01-01

    The EXTRIP (Extracorporeal Treatments in Poisoning) Workgroup conducted a systematic review of barbiturate poisoning using a standardized evidence-based process to provide recommendations on the use of extracorporeal treatment (ECTR) in patients with barbiturate poisoning. The authors reviewed all...... treatment should be continued during ECTR. (4) Cessation of ECTR is indicated when clinical improvement is apparent. This report provides detailed descriptions of the rationale for all recommendations. In summary, patients with long-acting barbiturate poisoning should be treated with ECTR provided at least......-acting barbiturates are dialyzable and short-acting barbiturates are moderately dialyzable. Four key recommendations were made. (1) The use of ECTR should be restricted to cases of severe long-acting barbiturate poisoning. (2) The indications for ECTR in this setting are the presence of prolonged coma, respiratory...

  7. COMA

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    P.F. Litvitsky

    2010-01-01

    Full Text Available The lecture reviews modern ideas of comatose conditions: their types, etiology, common key pathogenesis elements, stages, key manifestations, treatment principles; it characterizes the specifics of certain coma varieties and key impairments of consciousness. Key words: coma, stupor, sopor, hypoxia, impairments of energy supply for neurons.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2010;9(5:48-54

  8. Split high-dose oral levothyroxine treatment as a successful therapy option in myxedema coma.

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    Charoensri, Suranut; Sriphrapradang, Chutintorn; Nimitphong, Hataikarn

    2017-10-01

    High-dose intravenous thyroxine (T4) is the preferable treatment for myxedema coma. We describe the clinical course of a 69-year-old man who presented with myxedema coma and received oral levothyroxine (LT4) therapy (1 mg) in a split dose. This suggests split high-dose oral LT4 as a therapeutic option in myxedema coma.

  9. Myxedema coma associated with combination aripiprazole and sertraline therapy.

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    Church, Chelsea O; Callen, Erin C

    2009-12-01

    To describe a case of myxedema coma (MC) associated with combination aripiprazole and sertraline therapy. A 41-year-old male presented to the emergency department with confusion, right-sided numbness and tingling, slurred speech, dizziness, and facial edema. His blood pressure was 160/113 mm Hg, with a pulse of 56 beats/min and temperature of 35.4 degrees C. Initial abnormal laboratory values included creatine kinase (CK) 439 U/L; serum creatinine 1.6 mg/dL; aspartate aminotransferase 85 U/L; and alanine aminotransferase 35 U/L. Repeat cardiac markers revealed an elevated CK level of 3573 U/L with a CK-MB of 24 ng/mL. Thyroid function tests showed thyroid-stimulating hormone 126.4 microIU/mL and free thyroxine 0.29 ng/dL. Home medications of unknown duration were sertraline 200 mg and aripiprazole 20 mg daily. He was admitted to the intensive care unit and initially treated with intravenous levothyroxine and dexamethasone. By hospital day 4, the patient was clinically stable and discharged to home. Myxedema coma, the most significant form of hypothyroidism (HT), is a rare but potentially fatal condition. The known precipitating causes of MC were ruled out in this patient, which left his home medications as the likely cause. Cases of HT caused by certain atypical antipsychotics and antidepressants are found in the literature, but none was reported with aripiprazole therapy. There are also no reported cases of sertraline or aripiprazole inducing MC. Use of the Naranjo probability scale indicates that the combination of aripiprazole and sertraline was a probable inducer of MC in this patient. Due to the widespread use of psychotropic medications, clinicians should be reminded of the rare, yet life-threatening, occurrence of MC when treating patients, especially with combination therapies such as sertraline and aripiprazole.

  10. Split high‐dose oral levothyroxine treatment as a successful therapy option in myxedema coma

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    Charoensri, Suranut; Sriphrapradang, Chutintorn; Nimitphong, Hataikarn

    2017-01-01

    Key Clinical Message High‐dose intravenous thyroxine (T4) is the preferable treatment for myxedema coma. We describe the clinical course of a 69‐year‐old man who presented with myxedema coma and received oral levothyroxine (LT4) therapy (1 mg) in a split dose. This suggests split high‐dose oral LT4 as a therapeutic option in myxedema coma.

  11. Extracorporeal treatment for barbiturate poisoning: recommendations from the EXTRIP Workgroup.

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    Mactier, Robert; Laliberté, Martin; Mardini, Joelle; Ghannoum, Marc; Lavergne, Valery; Gosselin, Sophie; Hoffman, Robert S; Nolin, Thomas D

    2014-09-01

    The EXTRIP (Extracorporeal Treatments in Poisoning) Workgroup conducted a systematic review of barbiturate poisoning using a standardized evidence-based process to provide recommendations on the use of extracorporeal treatment (ECTR) in patients with barbiturate poisoning. The authors reviewed all articles, extracted data, summarized key findings, and proposed structured voting statements following a predetermined format. A 2-round modified Delphi method was used to reach a consensus on voting statements, and the RAND/UCLA Appropriateness Method was used to quantify disagreement. 617 articles met the search inclusion criteria. Data for 538 patients were abstracted and evaluated. Only case reports, case series, and nonrandomized observational studies were identified, yielding a low quality of evidence for all recommendations. Using established criteria, the workgroup deemed that long-acting barbiturates are dialyzable and short-acting barbiturates are moderately dialyzable. Four key recommendations were made. (1) The use of ECTR should be restricted to cases of severe long-acting barbiturate poisoning. (2) The indications for ECTR in this setting are the presence of prolonged coma, respiratory depression necessitating mechanical ventilation, shock, persistent toxicity, or increasing or persistently elevated serum barbiturate concentrations despite treatment with multiple-dose activated charcoal. (3) Intermittent hemodialysis is the preferred mode of ECTR, and multiple-dose activated charcoal treatment should be continued during ECTR. (4) Cessation of ECTR is indicated when clinical improvement is apparent. This report provides detailed descriptions of the rationale for all recommendations. In summary, patients with long-acting barbiturate poisoning should be treated with ECTR provided at least one of the specific criteria in the first recommendation is present. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  12. Brain MRS glutamine as a biomarker to guide therapy of hyperammonemic coma.

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    O'Donnell-Luria, Anne H; Lin, Alexander P; Merugumala, Sai K; Rohr, Frances; Waisbren, Susan E; Lynch, Rebecca; Tchekmedyian, Vatche; Goldberg, Aaron D; Bellinger, Andrew; McFaline-Figueroa, J Ricardo; Simon, Tracey; Gershanik, Esteban F; Levy, Bruce D; Cohen, David E; Samuels, Martin A; Berry, Gerard T; Frank, Natasha Y

    2017-05-01

    Acute idiopathic hyperammonemia in an adult patient is a life-threatening condition often resulting in a rapid progression to irreversible cerebral edema and death. While ammonia-scavenging therapies lower blood ammonia levels, in comparison, clearance of waste nitrogen from the brain may be delayed. Therefore, we used magnetic resonance spectroscopy (MRS) to monitor cerebral glutamine levels, the major reservoir of ammonia, in a gastric bypass patient with hyperammonemic coma undergoing therapy with N-carbamoyl glutamate and the ammonia-scavenging agents, sodium phenylacetate and sodium benzoate. Improvement in mental status mirrored brain glutamine levels, as coma persisted for 48h after plasma ammonia normalized. We hypothesize that the slower clearance for brain glutamine levels accounts for the delay in improvement following initiation of treatment in cases of chronic hyperammonemia. We propose MRS to monitor brain glutamine as a noninvasive approach to be utilized for diagnostic and therapeutic monitoring purposes in adult patients presenting with idiopathic hyperammonemia. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. [On the history of barbiturates].

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    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

  14. Myxedema coma.

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    Kwaku, Maxwell P; Burman, Kenneth D

    2007-01-01

    Untreated or unrecognized hypothyroidism may progress to severe decompensated hypothyroidism or myxedema coma. Relatively few cases are reported in the literature since the first case was apparently reported from the St. Thomas Hospital in London in 1879. The paucity of cases may be due to either underreporting or improvement in the diagnosis and treatment of uncomplicated hypothyroidism. However, despite the ready availability of sensitive thyrotropin assays, the recognition and treatment of myxedema coma remains a challenge. Although thyroid hormone treatment is highly effective when combined with ventilatory and hemodynamic support in the intensive care unit setting, controversies abound on the optimal and most effective choice of thyroid hormone preparation: thyroxine and triiodothyronine and in what amount. Accumulated evidence now shows that proper use of either thyroxine alone or in combination with triiodothyronine may be effective therapy.

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

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    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.

  16. An Interesting Case of Barbiturate Automatism and Review of Literature

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    Sankalp Gokhale

    2013-01-01

    Full Text Available A 48 year old man with a diagnosis of HIV infection since 1993, on highly active anti-retro viral therapy (HAART with stable CD4 count and undetectable viral load for years and seizure disorder presented with recurrent drowsiness. His seizures were well controlled on phenobarbitone for years. Repeated laboratory evaluation demonstrated toxic levels of phenobarbitone in his blood. A thorough clinical, psychiatric, laboratory and imaging evaluation did not reveal any obvious etiology for the recurrent barbiturate intoxication in this man. Our findings suggest the possible diagnosis of barbiturate drug automatism in this patient. Though drug automatism is a controversial entity, it merits continued attention. There are recent reports of similar phenomenon with newer sedative agents such as Zolpidem. It is important to be aware of this phenomenon as a possible explanation for recurrent intoxication with barbiturates without a clear etiology for drug overdose.

  17. Performing a cure for schizophrenia: insulin coma therapy on the wards.

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    Doroshow, Deborah Blythe

    2007-04-01

    Most historians of psychiatry regard insulin coma therapy (ICT) either as an embarrassing stumble on the path to modern biological psychiatry or as one member of a long line of somatic therapies used to treat mental illness in the mid-twentieth century. This article explores the ICT era, roughly 1933-60, as a key moment in the development of American psychiatry. Developed only ten years after insulin had been embraced as a "miracle drug" for the treatment of diabetes, ICT was perceived by psychiatrists as a means of bringing their field closer to mainstream medicine, particularly to neurology. In addition, the story of ICT reveals how a treatment never quite proven on paper was unquestionably efficacious in the local world in which it was performed. An institutionally-based treatment, ICT was administered in a specific area of the mental hospital deemed the insulin unit, a room with its own staff, practices, and attitudes toward mental illness. There, psychiatrists often experienced wondrous recoveries of individual, formerly intractable patients. These intense personal experiences allowed psychiatrists to feel truly efficacious, enabling them to reinvent themselves as medical doctors rather than behavioral and disciplinary supervisors. The confidence they derived from this capacity, along with the operating room-like setting of the insulin unit, the unit's specialized staffing and group bond, and the availability of both risk-assessment tests and a medley of treatments that countered side effects and complications, allowed ICT to be understood as an efficacious treatment for schizophrenia within the local world in which it was administered.

  18. A BARBITURATE ANTIDOTE—Use of Methylethylglutarimide in Barbiturate Intoxication and in Terminating Barbiturate Anesthesia

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    Marmer, Milton J.

    1959-01-01

    Methylethylglutarimide was administered to 488 patients ranging in age from 7 to 89 years, in a study on sleep-reversal after harbiturate anesthesia. Sodium surital or sodium pentothal were the barbiturates used. The drug was administered intravenously in doses varying from 25 to 200 mg. Dosage below 25 mg. was found to be ineffective. Almost all patients showed signs of awakening as evidenced by the return of corneal and conjunctival reflexes, the opening of the eyes, and stirring or moving about. Many responded to questioning. Almost all showed evidence of greater responsiveness within five minutes. No untoward reactions were noted. No convulsions were produced. Five patients ranging in age from 24 to 70 years were treated for barbiturate poisoning with Mikedimide® given intravenously in doses varying from 550 mg. to 1950 mg. All recovered consciousness within 30 minutes to an hour. No convulsions were produced. While it is not known whether Mikedimide is a direct barbiturate antagonist, or whether it is an analeptic, it appears to be a useful drug in reversing the respiratory depression and the cerebral depression produced by harbiturate intoxication and barbiturate anesthesia. PMID:14421358

  19. Coma mixedematoso Myxedema coma

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    Lisette Leal Curí

    2012-12-01

    Full Text Available El coma mixedematoso es la forma más severa y profunda del hipotiroidismo. Se presenta con mayor frecuencia en mujeres y ancianos. Entre los factores precipitantes se encuentran: la sepsis, la exposición al frío, los eventos agudos graves, el uso de anestésicos, sedantes o narcóticos, así como la descontinuación del tratamiento sustitutivo con hormonas tiroideas, entre otros. El diagnóstico clínico se realiza por la presencia de síntomas y signos característicos de un hipotiroidismo severo, con hipotermia y alteraciones de la conciencia. Apoyan este diagnóstico los hallazgos de laboratorio: hiponatremia, hipoxemia, hipercapnia, alteraciones hemoquímicas y el aumento de la tirotropina por la disminución de las hormonas tiroideas en el caso de la enfermedad primaria. El tratamiento se debe realizar en una unidad de cuidados intensivos, con monitorización, medidas de soporte respiratorio y cardiovascular, calentamiento corporal interno, hidratación, corrección de la hipotensión y de los trastornos electrolíticos. Se administrarán, además, glucocorticoides, antibióticos de amplio espectro y hormonas tiroideas. La evolución depende de la demora en el inicio del tratamiento, la edad, las comorbilidades, la hipotermia persistente y las complicaciones asociadas.Myxedema coma is the most severe and deepest form of hypothyroidism. It occurs more often in the women and the elderly. Among the unleashing factors found are sepsis, exposure to cold, acute severe events, use of anesthetic drugs, sedatives or narcotics as well as the interruption of the replacement treatment with thyroid hormones, among others. The clinical diagnosis is based on the presence of symptoms and signs that are characteristic of severe hypothyroidism, with hypothermia and altered consciousness. This diagnosis is also supported by the lab findings: hyponatremia, hypoxemia, hypercapnia, hemochemical alterations and the rise of thyrotropin due to the decrease of

  20. High-dose phenobarbital with intermittent short-acting barbiturates for acute encephalitis with refractory, repetitive partial seizures.

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    Uchida, Takashi; Takayanagi, Masaru; Kitamura, Taro; Nishio, Toshiyuki; Numata, Yurika; Endo, Wakaba; Haginoya, Kazuhiro; Ohura, Toshihiro

    2016-08-01

    Acute encephalitis with refractory, repetitive partial seizures (AERRPS) is characterized by repetitive seizures during the acute and chronic phases and has a poor neurological outcome. Burst-suppression coma via continuous i.v. infusion of a short-acting barbiturate is used to terminate refractory seizures, but the severe side-effects of short-acting barbiturates are problematic. We report on a 9-year-old boy with AERRPS who was effectively treated with very-high-dose phenobarbital (VHDPB) combined with intermittent short-acting barbiturates. VHDPB side-effects were mild, especially compared with those associated with continuous i.v. infusion of short-acting barbiturates (dosage, 40-75 mg/kg/day; maximum blood level, 290 μg/mL). Using VHDPB as the main treatment, short-acting barbiturates were used intermittently and in small amounts. This is the first report to show that VHDPB, combined with intermittent short-acting barbiturates, can effectively treat AERRPS. After treatment, convulsions were suppressed and daily life continued, but intellectual impairment and high-level dysfunction remained. © 2016 Japan Pediatric Society.

  1. Myxedema coma

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    Leonardo F. L. Rizzo

    2017-08-01

    Full Text Available 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

  2. [Myxedema coma].

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    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.

  3. Myxedema coma after esophagectomy.

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    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.

  4. Functional coma.

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    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.

  5. Hyperosmolar nonketotic hyperglycemic coma induced by methylprednisolone pulse therapy for acute rejection after liver transplantation: a case report and review of the literature

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    Zhou J

    2014-12-01

    Full Text Available Jian Zhou,* Weiqiang Ju,* Xiaopeng Yuan, Xiaofeng Zhu, Dongping Wang, Xiaoshun HeOrgan Transplant Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China *These authors contributed equally to this work Abstract: Hyperosmolar nonketotic hyperglycemic coma (HNKHC is a serious, rare complication induced by methylprednisolone (MP pulse therapy for acute rejection after orthotopic liver transplantation (OLT. Herein, we report an unusual case of a 58-year-old woman who experienced acute rejection at 30 months after OLT, only one case in which HNKHC resulted in MP pulse therapy for acute rejection in all 913 recipients in our center. The general morbidity of HNKHC was 1.09‰ in this study. HNKHC is characterized by rapid onset, rapid progression, and a lack of specific clinical manifestations. High-dose MP management was a clear risk factor. The principle of treatment included rapid rehydration, low-dose insulin infusion, and correcting disorders of electrolytes and acidosis. In conclusion, clinicians considering MP pulse therapy after OLT should be alert to the occurrence of HNKHC. Keywords: liver transplantation, complications, hyperosmolar nonketotic hyperglycemic coma, methylprednisolone pulse therapy, principle of treatment

  6. [The diagnosis and treatment of myxedema coma].

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    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.

  7. Myxedema coma leading to respiratory depression in a dog

    OpenAIRE

    Atkinson, Kathryn; Aubert, Isabelle

    2004-01-01

    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.

  8. Myxedema coma leading to respiratory depression in a dog.

    Science.gov (United States)

    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.

  9. Coma blisters in children: case report and review of the literature.

    Science.gov (United States)

    Bosco, Laura; Schena, Donatella; Colato, Chiara; Biban, Paolo; Girolomoni, Giampiero

    2013-12-01

    Coma-induced blisters is a rare condition associated with prolonged impairment of conscious level, which is relatively well-known in adults following overdose with barbiturates. However, it has been very rarely described in children. A case of coma-bullae occurring in an 11-year-old child with meningoencephalitis is herein reported. The bullous lesions occurred on the limbs and trunks, and evolved into necrotic ulcers in a few days. No correlation with any drug overdosage was found. A skin biopsy revealed epidermal and eccrine sweat gland necrosis with abundant neutrophils, and thrombosis of the vessels in the lower dermis. A comprehensive review of the literature showed that only 5 cases of coma-bullae in children have been published so far. Coma blistering resolves spontaneously within days or weeks. Diagnosis of coma-bullae may require careful clinical-pathologic correlation to exclude other blistering diseases in children.

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

    Science.gov (United States)

    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.

  11. new spiro (thio) barbiturates based on cyclohexanone and bicyclo

    African Journals Online (AJOL)

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    condensation can be operated with the aid of strong acids or bases [2, 13]. Several catalytic methods have been achieved for crossed-aldol condensation [4, 14-31]. Several spiro-(thio)barbituric acid derivatives in which the active methylene carbon of. (thio)barbituric acid is substituted by an unsubstituted cyclobutane or ...

  12. Resuscitation therapy for traumatic brain injury-induced coma in rats: mechanisms of median nerve electrical stimulation

    Directory of Open Access Journals (Sweden)

    Zhen Feng

    2015-01-01

    Full Text Available In this study, rats were put into traumatic brain injury-induced coma and treated with median nerve electrical stimulation. We explored the wake-promoting effect, and possible mechanisms, of median nerve electrical stimulation. Electrical stimulation upregulated the expression levels of orexin-A and its receptor OX1R in the rat prefrontal cortex. Orexin-A expression gradually increased with increasing stimulation, while OX1R expression reached a peak at 12 hours and then decreased. In addition, after the OX1R antagonist, SB334867, was injected into the brain of rats after traumatic brain injury, fewer rats were restored to consciousness, and orexin-A and OXIR expression in the prefrontal cortex was downregulated. Our findings indicate that median nerve electrical stimulation induced an up-regulation of orexin-A and OX1R expression in the prefrontal cortex of traumatic brain injury-induced coma rats, which may be a potential mechanism involved in the wake-promoting effects of median nerve electrical stimulation.

  13. EEG and Coma.

    Science.gov (United States)

    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.

  14. 3d-METAL COMPLEXES WITH BARBITURIC ACID DERIVATIVES

    Directory of Open Access Journals (Sweden)

    T. V. Koksharova

    2015-04-01

    Full Text Available The various aspects of the 3d-metal complexes with barbiturates and uric acid chemistry such as composition, structure, physicochemical properties, possible fields of application – have been illustrated in this review

  15. Synthesis of carboranyl amino acids, hydantoins, and barbiturates

    International Nuclear Information System (INIS)

    Wyzlic, I.M.; Tjarks, W.; Soloway, A.H.

    1996-01-01

    The syntheses of three novel boronated hydantoins, 5-(o-carboran-1-ylmethyl)hydantoin, 14, the tetraphenylphosphonium salt of 7-(hydantoin-5-ylmethyl)dodecahydro-7,8-dicarba-nido-undecaborate, 15, 5-(o-carboran-1-ylmethyl)-2-thiohydantoin, 16, and two new barbiturates, 5,5-bis(but-2-ynyl)barbiturate, 18, and 5,5-bis[(2-methyl-0-carboran-1-yl)methyl]barbiturate, 20, are described. Hydantoins 14-16 were synthesized from o-carboranylalanine (Car, 13). The detailed synthesis of Car and two other carborane-containing amino acids, O-(o-carboran-1-ylmethyl)tyrosine (CBT, 5a) and p-(o-carboran-1-yl)phenylalanine (CBPA, 5b), presented earlier as a communication, 16 are also described. Hydantoin 14 and barbiturates 18 and 20 were tested for their potential anticonvulsant activity. Initial qualitative screening showed moderate activities for hydantoin 14 and barbiturate 18. Barbiturate 20 had no activity. Compound 14 appeared to be nontoxic at doses of 300 mg/kg (mice, ip) and 50 mg/kg (rats, oral). However, 18 was very toxic under similar conditions

  16. [Coma in France today].

    Science.gov (United States)

    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.

  17. Anions in Cometary Comae

    Science.gov (United States)

    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.

  18. Myxedema coma and cardiac ischemia in relation to thyroid hormone replacement therapy in a 38-year-old Japanese woman.

    Science.gov (United States)

    Taguchi, Takafumi; Iwasaki, Yasumasa; Asaba, Koichi; Takao, Toshihiro; Hashimoto, Kozo

    2007-12-01

    Although thyroid hormone deficiency, either clinical or subclinical, is an established risk factor for cardiovascular disease, coronary ischemia in a premenopausal woman in her 30s is relatively rare. A 38-year-old woman was referred to our hospital with severe breathlessness and depressed consciousness. Physical examination found facial, abdominal, and pretibial edema; coarse hair, hoarse voice, and dry skin; engorged jugular veins; a distant heart sound; and reduced bilateral entry of air into the chest. Laboratory examinations revealed severe hypothyroidism, hyperlipidemia, and elevated serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 125 (CA125). A computed tomography scan showed massive pleural and pericardial effusions. After 3 months of levothyroxine replacement therapy (initial dose: 12.5 microg/d; maintenance dose: 125 microg/d), all abnormal laboratory values associated with hypothyroidism returned to within normal ranges, with the exception of a transient and paradoxical rise in serum thyroid-stimulating hormone levels. However, 3 weeks after the initiation of therapy, the patient reported intermittent chest pains during the course of therapy, and a coronary artery angiogram revealed diffuse stenosis of all 3 branches. The patient underwent coronary artery bypass grafting, with subsequent improvement in coronary perfusion. Careful cardiovascular evaluation is recommended before the start of thyroid hormone replacement therapy. In addition, care should be taken in the interpretation of serum biomarkers of malignancy (eg, CEA, CA125) in patients with myxedema, as values may be elevated in a hypothyroid state. Long-standing hypothyroidism may be associated with severe coronary atherosclerosis, even in a relatively young, premenopausal woman. The potential adverse cardiovascular effects of thyroid hormone must be considered during replacement therapy, even in relatively young patients.

  19. Intensive Care for Eclampic Coma

    Directory of Open Access Journals (Sweden)

    V. V. Moroz

    2010-01-01

    Full Text Available Objective: to enhance the efficiency of treatment of puerperas with eclampic coma, by substantiating, developing, and introducing new algorithms for correction of systemic hemodynamic, metabolic disturbances, and perfusion-metabolic changes in brain tissues. Subjects and methods. Studies were conducted in 18 puerperas with eclampic coma (Group 2 in whom the authors used a new treatment algorithm aimed at maintaining baseline cerebral perfusion pressure (CPP, restoring volemic levels at the expense of interstitial fluid. A control group (Group 1 included 30 patients who received conventional standard therapy. Regional cerebral circulation was measured by a non-invasive (inhalation radioisotopic method, by applying the tracer 131Xe, as described by V. D. Obrist et al., on a modified КПРДИ-1 apparatus (USSR. The rate of brain oxygen uptake was determined from the oxygen content between the artery and the internal jugular vein. Central hemodynamic parameters were studied by the direct method of right heart catheterization using a flow-directed Swan-Ganz catheter. The volumes of total and extracellular fluids were estimated using 20% urea and mannitol solutions, respectively, at 0.2 g/kg weight by the procedure of V. M. Mogen. Circulating blood volume (CBV was determined by a radioisotopic method using 131iodine albumin on an УPI-7 apparatus (USSR. Cerebral spinal fluid pressure was measured by an ИиНД apparatus. Studies were made in four steps: 1 on admission; 2 on days 2—3; 3 during emergence from coma; 4 before transition. Results. The use of the new algorithm for intensive care for eclampic coma, which is aimed at improving the perfusion metabolic provision of brain structures, with a reduction in mean blood pressure by 10—15% of the baseline level, by administering magnesium sulfate and nimodipine, and at compensating for CBV by high-molecular-weight hydroxyethylated starch (stabizol, ensured early emergence from a comatose state

  20. Homeopathic treatment for prolonged postoperative coma: a case report.

    Science.gov (United States)

    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.

  1. Chemical kinetics in the coma

    International Nuclear Information System (INIS)

    Huebner, W.F.

    1980-01-01

    Physical and chemical conditions in the coma of a bright new comet are related to the composition of the nucleus. Chemical and photolytic processes are described and related to distance in the coma above the nucleus and to heliocentric distance of the comet. Comparison of the model with coma observations leads to some restrictions about the nucleus composition. It is expected that these restrictions become more stringent as coma models are developed further and as observations become more detailed

  2. Abnormal temperature control after intoxication with short-acting barbiturates.

    Science.gov (United States)

    de Villota, E D; Mosquera, J M; Shubin, H; Weil, M H

    1981-09-01

    Changes in rectal and toe temperatures were measured in 16 patients who had been intoxicated with short-acting barbiturates. The lowest temperatures observed in the group of 16 patients averaged 35.5 +/- 2.0 degrees C. In 11 patients, the interval between intoxication and admission was documented. There was a significant correlation (r = 0.83) between the time of estimated intoxication and hypothermia. Patients who were admitted soon after the ingestion of the barbiturates had the lowest rectal temperatures. These observations indicate that hypothermia is a usual clinical sign in the initial period after intoxication with a short-acting barbiturate. Except for 2 patients, rectal temperature exceeded 38 degrees C during the interval of recovery with the maximum rectal temperature averaging 39.0 +/- 0.8 degrees C. Hyperthermia was not related to infection of the airways, lungs, urinary tract, or bloodstream. In 11 patients, pathogenic organisms were recovered from the airway and/or urine, but there was no difference in the highest rectal temperature in these patients (39.0 +/- 0.9 degrees C) when compared with 5 patients from whom no pathogenic organisms were recovered (39.2 +/- 0.7 degrees C). Accordingly, there was no evidence that hyperthermia was due to infection. The skin temperatures of the ventrum of the first toe were not typically decreased during hypothermia. To the contrary, increases in skin temperatures were often observed during hypothermia. These observations provide evidence of altered thermoregulation with increased surface heat loss accounting for the hypothermia in the early course and heat conservation with hyperthermia during the later course of intoxication by short-acting barbiturates.

  3. Capturing the Coma

    Science.gov (United States)

    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.

  4. Hypothyroidism and myxedema coma.

    Science.gov (United States)

    Finora, Kevin; Greco, Deborah

    2007-01-01

    Hypothyroidism is a common endocrinopathy in dogs but is rare in cats. Lymphocytic thyroiditis and idiopathic thyroid atrophy are common causes of this condition. Specific thyroid function tests, in conjunction with clinical signs and physical examination findings, are used to help confirm a diagnosis of hypothyroidism. This disease can be managed with synthetic hormone supplementation and has an excellent prognosis. Myxedema coma is a rare and potentially fatal manifestation of severe hypothyroidism that can be successfully treated using intravenous levothyroxine.

  5. Coma cluster of galaxies

    Science.gov (United States)

    1999-01-01

    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). The remaining members are mostly smaller ellipticals, but spiral galaxies are also evident in the 2MASS image. The cluster is seen toward the constellation Coma Berenices, but is actually at a distance of about 100 Mpc (330 million light years, or a redshift of 0.023) from us. At this distance, the cluster is in what is known as the 'Hubble flow,' or the overall expansion of the Universe. As such, astronomers can measure the Hubble Constant, or the universal expansion rate, based on the distance to this cluster. Large, rich clusters, such as Coma, allow astronomers to measure the 'missing mass,' i.e., the matter in the cluster that we cannot see, since it gravitationally influences the motions of the member galaxies within the cluster. The near-infrared maps the overall luminous mass content of the member galaxies, since the light at these wavelengths is dominated by the more numerous older stellar populations. Galaxies, as seen by 2MASS, look fairly smooth and homogeneous, as can be seen from the Hubble 'tuning fork' diagram of near-infrared galaxy morphology. Image mosaic by S. Van Dyk (IPAC).

  6. Application of thermoresponsive HPLC to forensic toxicology: determination of barbiturates in human urine

    OpenAIRE

    Kanno, Sanae; Watanabe, Kanako; Hirano, Seishiro; Yamagishi, Itaru; Gonmori, Kunio; Minakata, Kayoko; Suzuki, Osamu

    2009-01-01

    A high-performance liquid chromatography (HPLC) method has been developed for the assays of five barbiturates in human urine using a new thermoresponsive polymer separation column, which is composed of N-isopropylacrylamide polymer. According to elevating the column temperature from 10 ℃ to 50 ℃, five barbiturates, such as metharbital, primidone, phenobarbital, mephobarbital and pentobarbital, became well separated by this method. Five barbiturates showed good linearity in the range of 0.2-10...

  7. Direct radioimmunoassay for the detection of barbiturates in blood and urine

    International Nuclear Information System (INIS)

    Mason, P.A.; Law, B.; Pocock, K.; Moffat, A.C.

    1982-01-01

    A radioimmunoassay has been developed for the detection of barbiturates in blood and urine without any pre-treatment of the sample. It is based on a radioiodinated derivative of 4-hydroxyphenobarbitone which allows use of relatively simple gamma-counting procedures. The assay can detect therapeutic levels of barbiturates in very small amounts (50 μl) of blood and urine samples. It is cheap, rapid, simple to perform and is broadly specific for the barbiturate class of drugs to the exclusion of related drugs. The assay is, therefore, very well suited to the task of screening large numbers of samples for the presence of barbiturates. (author)

  8. [Thyroid emergencies : Thyroid storm and myxedema coma].

    Science.gov (United States)

    Spitzweg, C; Reincke, M; Gärtner, R

    2017-10-01

    Thyroid emergencies are rare life-threatening endocrine conditions resulting from either decompensated thyrotoxicosis (thyroid storm) or severe thyroid hormone deficiency (myxedema coma). Both conditions develop out of a long-standing undiagnosed or untreated hyper- or hypothyroidism, respectively, precipitated by an acute stress-associated event, such as infection, trauma, or surgery. Cardinal features of thyroid storm are myasthenia, cardiovascular symptoms, in particular tachycardia, as well as hyperthermia and central nervous system dysfunction. The diagnosis is made based on clinical criteria only as thyroid hormone measurements do not differentiate between thyroid storm and uncomplicated hyperthyroidism. In addition to critical care measures therapy focusses on inhibition of thyroid hormone synthesis and secretion (antithyroid drugs, perchlorate, Lugol's solution, cholestyramine, thyroidectomy) as well as inhibition of thyroid hormone effects in the periphery (β-blocker, glucocorticoids).Cardinal symptoms of myxedema coma are hypothermia, decreased mental status, and hypoventilation with risk of pneumonia and hyponatremia. The diagnosis is also purely based on clinical criteria as measurements of thyroid hormone levels do not differ between uncomplicated severe hypothyroidism and myxedema coma. In addition to substitution of thyroid hormones and glucocorticoids, therapy focusses on critical care measures to treat hypoventilation and hypercapnia, correction of hyponatremia and hypothermia.Survival of both thyroid emergencies can only be optimized by early diagnosis based on clinical criteria and prompt initiation of multimodal therapy including supportive measures and treatment of the precipitating event.

  9. Neuroimaging after coma

    International Nuclear Information System (INIS)

    Tshibanda, Luaba; Vanhaudenhuyse, Audrey; Soddu, Andrea; Bruno, Marie-Aurelie; Noirhomme, Quentin; Boly, Melanie; Laureys, Steven; Moonen, Gustave

    2010-01-01

    Following coma, some patients will recover wakefulness without signs of consciousness (only showing reflex movements, i.e., the vegetative state) or may show non-reflex movements but remain without functional communication (i.e., the minimally conscious state). Currently, there remains a high rate of misdiagnosis of the vegetative state (Schnakers et. al. BMC Neurol, 9:35, 8) and the clinical and electrophysiological markers of outcome from the vegetative and minimally conscious states remain unsatisfactory. This should incite clinicians to use multimodal assessment to detect objective signs of consciousness and validate para-clinical prognostic markers in these challenging patients. This review will focus on advanced magnetic resonance imaging (MRI) techniques such as magnetic resonance spectroscopy, diffusion tensor imaging, and functional MRI (fMRI studies in both ''activation'' and ''resting state'' conditions) that were recently introduced in the assessment of patients with chronic disorders of consciousness. (orig.)

  10. EEG in connection with coma.

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  12. Myxedema coma: diagnosis and treatment.

    Science.gov (United States)

    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.

  13. [Thyroid Storm and Myxedema Coma].

    Science.gov (United States)

    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.

  14. Survey of Opioid and Barbiturate Prescriptions in Patients Attending a Tertiary Care Headache Center.

    Science.gov (United States)

    Minen, Mia T; Lindberg, Kate; Wells, Rebecca E; Suzuki, Joji; Grudzen, Corita; Balcer, Laura; Loder, Elizabeth

    2015-10-01

    To educate physicians about appropriate acute migraine treatment guidelines by determining (1) where headache patients were first prescribed opioids and barbiturates, and (2) the characteristics of the patient population who had been prescribed opioids and barbiturates. Several specialty societies issued recommendations that caution against the indiscriminate use of opioids or barbiturate containing medications for the treatment of migraine. These medications are still being prescribed in various medical settings and could put headache specialists in a difficult position when patients request these agents. Patients presenting to a headache center comprised of eight physicians were asked to complete a survey that assessed headache types, comorbid conditions, and whether they had ever been prescribed opioids or barbiturates. If they responded affirmatively to the latter question, they were asked about the prescribing doctor, medication effectiveness, and whether they were currently on the medication. Data collection took place over a one month period. Two hundred forty-four patients were given the survey and 218 of these patients completed it. The predominant diagnosis was migraine (83.9%). More than half of the patients reported having been prescribed an opioid (54.8%) or a barbiturate (56.7%). About one fifth were on opioids (19.4%) or barbiturates (20.7%) at the time of completing the survey. Most patients reported being on opioids for more than 2 years (24.6%) or less than one week (32.1%). The reasons most frequently cited for stopping opioids were that the medications did not help (30.9%) or that they saw a new doctor who would not prescribe them (29.4%). Among patients who had previously been on barbiturates, 32.2% had been on these for over 2 years. Most patients (61.8%) stopped barbiturates because they did not find the medication helpful, while 17.6% said they saw a new doctor who would not prescribe them. The physician specialty most frequently cited as

  15. [Myxedema coma. A case reported].

    Science.gov (United States)

    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.

  16. [Thyrotoxic storm and myxedema coma].

    Science.gov (United States)

    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.

  17. Reversible photocapture of a [2]rotaxane harnessing a barbiturate template.

    Science.gov (United States)

    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.

  18. Synthesis and Antiangiogenic Properties of Tetrafluorophthalimido and Tetrafluorobenzamido Barbituric Acids.

    Science.gov (United States)

    Ambrożak, Agnieszka; Steinebach, Christian; Gardner, Erin R; Beedie, Shaunna L; Schnakenburg, Gregor; Figg, William D; Gütschow, Michael

    2016-12-06

    The development of novel thalidomide derivatives as immunomodulatory and anti-angiogenic agents has revived over the last two decades. Herein we report the design and synthesis of three chemotypes of barbituric acids derived from the thalidomide structure: phthalimido-, tetrafluorophthalimido-, and tetrafluorobenzamidobarbituric acids. The latter were obtained by a new tandem reaction, including a ring opening and a decarboxylation of the fluorine-activated phthalamic acid intermediates. Thirty compounds of the three chemotypes were evaluated for their anti-angiogenic properties in an ex vivo assay by measuring the decrease in microvessel outgrowth in rat aortic ring explants. Tetrafluorination of the phthalimide moiety in tetrafluorophthalimidobarbituric acids was essential, as all of the nonfluorinated counterparts lost anti-angiogenic activity. An opening of the five-membered ring and the accompanying increased conformational freedom, in case of the corresponding tetrafluorobenzamidobarbituric acids, was well tolerated. Their activity was retained, although their molecular structures differ in torsional flexibility and possible hydrogen-bond networking, as revealed by comparative X-ray crystallographic analyses. © 2016 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  19. Imaging in the diagnosis of coma

    International Nuclear Information System (INIS)

    Aubin, M.L.; Molho, M.

    1989-01-01

    Imaging has become one of the main methods to diagnose and monitor coma. CT is the technique of choice in the exploration of traumatic coma or spontaneous intracerebral haemorrhage, but MRI is better than CT to explore comas of ischaemic, infective, tumoral or toxic origin, as it provides earlier and more precise images [fr

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

    Science.gov (United States)

    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.

  1. Comet coma sample return instrument

    Science.gov (United States)

    Albee, A. L.; Brownlee, Don E.; Burnett, Donald S.; Tsou, Peter; Uesugi, K. T.

    1994-01-01

    The sample collection technology and instrument concept for the Sample of Comet Coma Earth Return Mission (SOCCER) are described. The scientific goals of this Flyby Sample Return are to return to coma dust and volatile samples from a known comet source, which will permit accurate elemental and isotopic measurements for thousands of individual solid particles and volatiles, detailed analysis of the dust structure, morphology, and mineralogy of the intact samples, and identification of the biogenic elements or compounds in the solid and volatile samples. Having these intact samples, morphologic, petrographic, and phase structural features can be determined. Information on dust particle size, shape, and density can be ascertained by analyzing penetration holes and tracks in the capture medium. Time and spatial data of dust capture will provide understanding of the flux dynamics of the coma and the jets. Additional information will include the identification of cosmic ray tracks in the cometary grains, which can provide a particle's process history and perhaps even the age of the comet. The measurements will be made with the same equipment used for studying micrometeorites for decades past; hence, the results can be directly compared without extrapolation or modification. The data will provide a powerful and direct technique for comparing the cometary samples with all known types of meteorites and interplanetary dust. This sample collection system will provide the first sample return from a specifically identified primitive body and will allow, for the first time, a direct method of matching meteoritic materials captured on Earth with known parent bodies.

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

    Science.gov (United States)

    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

  3. Synthesis and steriostructure of 5-(5-R-2- furfur lidene)- barbituric acid

    International Nuclear Information System (INIS)

    Abdel-Wahab, A.

    2012-01-01

    Heterocyclic compounds 5-(5-R-2-furfur lidene)- barbituric acid were obtained and their physical and chemical properties were studied. Their structures were identified by spectroscopic methods. This study proved by 1 H-NMR Spectroscopy data that these compounds exist in S-cis form. (author)

  4. Recognition of anesthetic barbiturates by a protein binding site: a high resolution structural analysis.

    Directory of Open Access Journals (Sweden)

    Simon Oakley

    Full Text Available Barbiturates potentiate GABA actions at the GABA(A receptor and act as central nervous system depressants that can induce effects ranging from sedation to general anesthesia. No structural information has been available about how barbiturates are recognized by their protein targets. For this reason, we tested whether these drugs were able to bind specifically to horse spleen apoferritin, a model protein that has previously been shown to bind many anesthetic agents with affinities that are closely correlated with anesthetic potency. Thiopental, pentobarbital, and phenobarbital were all found to bind to apoferritin with affinities ranging from 10-500 µM, approximately matching the concentrations required to produce anesthetic and GABAergic responses. X-ray crystal structures were determined for the complexes of apoferritin with thiopental and pentobarbital at resolutions of 1.9 and 2.0 Å, respectively. These structures reveal that the barbiturates bind to a cavity in the apoferritin shell that also binds haloalkanes, halogenated ethers, and propofol. Unlike these other general anesthetics, however, which rely entirely upon van der Waals interactions and the hydrophobic effect for recognition, the barbiturates are recognized in the apoferritin site using a mixture of both polar and nonpolar interactions. These results suggest that any protein binding site that is able to recognize and respond to the chemically and structurally diverse set of compounds used as general anesthetics is likely to include a versatile mixture of both polar and hydrophobic elements.

  5. Complementary hydrogen bonding of a carboxylato-barbiturate with urea and acetamide: Experimental and theoretical approach

    Czech Academy of Sciences Publication Activity Database

    Hasan, Md. A.; Seshaditya, A.; Záliš, Stanislav; Mishra, L.

    2011-01-01

    Roč. 83, č. 1 (2011), s. 532-539 ISSN 1386-1425 Institutional research plan: CEZ:AV0Z40400503 Keywords : barbiturate derivative * binding study * 1H-NMR titration Subject RIV: CG - Electrochemistry Impact factor: 2.098, year: 2011

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

    Science.gov (United States)

    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.

  7. Coma

    Science.gov (United States)

    ... Stroke Association 9707 East Easter Lane Suite B Centennial CO Centennial, CO 80112-3747 info@stroke.org http://www. ... Stroke Association 9707 East Easter Lane Suite B Centennial CO Centennial, CO 80112-3747 info@stroke.org ...

  8. Amiodarone induced myxedema coma: Two case reports and literature review.

    Science.gov (United States)

    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.

  9. Elliptical shape of the coma cluster

    International Nuclear Information System (INIS)

    Schipper, L.; King, I.R.

    1978-01-01

    The elliptical shape of the Coma cluster is examined quantitatively. The degree of ellipticity is high and depends to some extent on the radial distance of the sample from the Coma center as well as on the brightness of the sample. The elliptical shape does not appear to be caused by rotation; other possible causes are briefly discussed

  10. Postanoxic coma: prognosis after therapeutic hypothermia

    NARCIS (Netherlands)

    Bouwes, A.

    2012-01-01

    Postanoxic coma, also known as anoxic-ischemic coma, is a state of unconsciousness caused by global anoxia of the brain. The most common cause is primary cardiac arrest followed by successful cardiopulmonary resuscitation (CPR). Other causes include primary respiratory arrest, near-drowning,

  11. [Brain function recovery after prolonged posttraumatic coma].

    Science.gov (United States)

    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.

  12. [Arreflexic coma and MELAS syndrome].

    Science.gov (United States)

    Muñoz-Guillén, N; León-López, R; Ferrer-Higueras, M J; Vargas-Vaserot, F J; Dueñas-Jurado, J M

    2009-01-01

    MELAS is a progressive neurodegenerative and fatal disease characterized by mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes. It is the result of a mitochondrial DNA mutation. Although the incidence of MELAS is currently unknown, it is suspected that approximately 1 out of every 5,000 persons world-wide have some type of defect in mitochondrial DNA. Cardinal clinical features observed in more than 90% of the patients include severe headache that may be associated with stroke-like episodes, seizures and the onset of symptoms before the age of 40 years. Diagnosis is established through genetic test or by with muscle biopsies that reveal the presence of ragged-red fibers. Prognosis is poor, with death at an early age. In this article, we present the clinical case of a 31-year old women diagnosed of MELAS syndrome who was admitted to the Intensive Care Unit of our hospital with arreflexic coma.

  13. Severe oligozoospermia in a patient with myxedema coma.

    Science.gov (United States)

    Komiya, Akira; Watanabe, Akihiko; Kawauchi, Yoko; Takano, Atsuko; Fuse, Hideki

    2012-10-01

    A case of severe oligozoospermia with myxedema coma is herein presented. The patient was referred to a male infertility clinic with a 5-year history of primary infertility. Decreased serum testosterone and elevated serum prolactin without abnormal MRI findings in the hypothalamus, and decreased semen volume and sperm motility were noted. A GnRH test revealed a decreased luteinizing hormone response, whereas the HCG test showed a normal testosterone increase. Because a urinalysis after ejaculation indicated retrograde ejaculation, imipramine administration was started. However, the semen quality deteriorated, so the patient was referred to an ART clinic. Twenty-one months from the initial visit, the patient developed a loss of consciousness and edema due to myxedema coma, a life-threatening state of hypothyroidism. The patient recovered after 1 month of thyroid hormone replacement therapy (HRT) with corticosteroids. Three months after the myxedema coma, a semen analysis showed a decreased semen volume (0.2 mL) and severe oligozoospermia (two spermatozoa/ejaculate). Elevated prolactin and decreased testosterone levels were still present. These parameters gradually improved after restoration of euthyroidism by HRT. In conclusion, physicians should confirm the thyroid function in the management of male infertility, especially in patients with elevated prolactin levels.

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

    Science.gov (United States)

    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.

  15. Initial Diagnosis and Management of Coma.

    Science.gov (United States)

    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.

  16. Is the Coma cluster binary dominated?

    International Nuclear Information System (INIS)

    The, L.S.; White, S.D.M.

    1990-01-01

    It is investigated whether the model of an expanding cluster dominated by a massive binary galaxy, first suggested by Valtonen and Byrd (1979), is consistent with optical data on the surface density and velocity dispersion of the Coma cluster. The evolution of this model is simulated for a wide variety of initial conditions. It is found that galaxy counts in the model can be made to agree with observation, but that the observed velocity dispersion profile cannot be reproduced. A number of other arguments suggest that the central galaxies in Coma cannot be as massive as required by the model. This model is not a viable representation of the Coma cluster. 25 refs

  17. Synthesis and mechanism of formation of oxadeazaflavines by microwave thermal cyclization of ortho-halobenzylidene barbiturates

    Energy Technology Data Exchange (ETDEWEB)

    Figueroa-Villar, J. Daniel; Oliveira, Sandra C.G. de, E-mail: figueroa@ime.eb.br [Grupo de Quimica Medicinal, Departamento de Quimica, Instituto Militar de Engenharia, Rio de Janeiro, RJ (Brazil)

    2011-09-15

    The thermal cyclization reaction of o-halobenzylidene barbiturates was developed as an efficient and simple method for the preparation of oxadeazaflavines. The use of solid state reaction conditions with microwave irradiation afforded the products in 5 min with 47 to 98% yield. Experimental synthetic results and thermogravimetric reaction analyses agree with the molecular modeling mechanism simulation, indicating that this reaction occurs through an intramolecular hetero-Diels-Alder cyclization followed by fast re-aromatization. (author)

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

    Energy Technology Data Exchange (ETDEWEB)

    Savechenkov, Pavel Y.; Zhang, Xi; Chiara, David C.; Stewart, Deirdre S.; Ge, Rile; Zhou, Xiaojuan; Raines, Douglas E.; Cohen, Jonathan B.; Forman, Stuart A.; Miller, Keith W.; Bruzik, Karol S. (Harvard-Med); (Mass. Gen. Hosp.); (UIC)

    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 in 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.

  19. Prediction of Recovery from Coma After CPR

    Science.gov (United States)

    ... 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 ...

  20. Myxedema Coma with Reversible Cardiopulmonary Failure: a Rare Entity in 21St Century.

    Science.gov (United States)

    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.

  1. [Coma in the emergency room].

    Science.gov (United States)

    Braun, M; Ploner, C J; Lindner, T; Möckel, M; Schmidt, W U

    2017-06-01

    Coma of unknown origin (CUO) is a frequent unspecific emergency symptom associated with a high mortality. A fast diagnostic work-up is essential given the wide spectrum of underlying diagnoses that are made up of approximately 50% primary central nervous system (CNS) pathologies and approximately 50% extracerebral, almost exclusively internal medical causes. Despite the high mortality associated with this symptom, there are currently no generally accepted management guidelines for adult patients presenting with CUO. We propose an interdisciplinary standard operating procedure (SOP) for patients with acute CUO as has been established in our maximum care hospital. The SOP is triggered by simple triage criteria that are sufficient to identify CUO patients before arrival in hospital. The in-hospital response team is led by a neurologist. Collaboration with nursing staff, internal medicine, anesthesiology, neurosurgery and trauma surgery is organized along structured pathways that include standardized laboratory tests, including cerebrospinal fluid (CSF), toxicology, computed tomography (CT) and CT angiography imaging (CTA). Our data suggest that neurologists and internists need to be placed at the beginning of the diagnostic work-up. Imaging should not just be carried out depending on the clinical syndrome because sensitivity, specificity and inter-rater reliability of the latter are not sufficient and because in many cases, multiple pathologies can be detected that could each explain CUO alone. Clinical examination, imaging and laboratory testing should be regarded as components of an integrative diagnostic approach and the final aetiological classification should only be made after the diagnostic work-up is complete.

  2. Acupuncture Treatment for 15 Cases of Post-traumatic Coma

    Institute of Scientific and Technical Information of China (English)

    He Jing; Wu Bin; Zhang Yongling; Wang Xinzhong

    2005-01-01

    In order to observe the effects of acupuncture combined with point-injection therapy on post-traumatic coma, 30 such cases were randomly divided into the following two groups. The patients in the control group were simply treated with the basic neural medical treatment; while patients in the treatment group were treated by acupuncture and point-injection therapy in addition to the above treatment. Comparisons were made between the two groups in the therapeutic effects by GCS evaluations as well as in the changes of main symptoms. The results showed that the GCS value in the treatment group was higher than that of the control group, but with no statistical significance (P>0.05). However, the main symptoms of the patients in treatment group, such as aphasia, hemiplegia, and injuries of cranial nerves (including injuries of the facial, oculomotor and abducent nerves) were obviously improved, showing significant differences as compared with the control group (P<0.05). Conclusion can be made that acupuncture combined with point-injection has the consciousness-inducing effect for post-traumatic coma, and shows good effects for the cranial nerve injuries and aphasia.

  3. Myxedema coma in a 74 year old man: case report and narrative review

    Directory of Open Access Journals (Sweden)

    Idania Teresa Mora López

    2013-05-01

    Full Text Available The follicular cells of the thyroid gland produce thyroxine and triiodothyronine hormones, as regulated by the thyrotropic hormone of the anterior pituitary, also called thyroid stimulating hormone. Myxedema coma is defined as profound hypothyroidism characterized by impairment of consciousness ranging from lethargy to stupor and coma, associated with hypothermia, hypoglycemia, seizures, hypotension, and manifestations of uncompensated hypothyroidism. The condition can be prevented if diagnosis of primary hypothyroidism is established and thyroid hormone replacement therapy is instituted. It is considered a medical emergency with high mortality rates, where environmental factors such as cold, severe infections and drug poisoning are important triggering factors. We report the case of a 74 year old male adult with no history of thyroid disease who was admitted to the Internal Medicine Ward of the “Enrique Cabrera” Hospital, Havana, Cuba, in December 2011, with clinical and laboratory signs of thyroid hypofunction. Myxedema coma was confirmed and patient course was untoward.

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

    Science.gov (United States)

    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.

  5. Pyrole-substituted barbituric derivatives as pharmaceutically significant compounds and intermediates

    International Nuclear Information System (INIS)

    Bijev, A.; Prodanova, P.

    2004-01-01

    Pyrrole- and indolecarbaldehydes are condensed with 5-unsubstituted barbituric acids targeting 16 new heterocyclic structures with a prospective pharmacological profile. So 1H-2-pyrrolecarbaldehyde, diethyl 5-formyl-3-methyl-1H-2,4-pyrroledicarboxylate, ethyl 5-formy 1-2,4-dimethyl-l.fl'-3-pyrrolecarboxylate, ethyl 4-formyl-3,5-dimethyl-1H-2-pyrrolecarboxylate, ethyl 4-formyl-2,5-dimethyl-1H-3-pyrrolecarboxylate and l-acetyl-1H-3-indolecarbaldehyde have been condensed in a molar ratio with hexahydro-2,4,6-pyrimidinetrione (barbituric acid) and its 1,3-dimethyl-, 1,3-diphenyl- and 1,3-dicyclohexyl- derivatives. The synthesis takes place in ethanol (or in ethanol/water in the cases of unsubstituted barbituric acid) within several hours at 20 0 - 60 0 C in the absence of any catalyst with yields in the range of 70-95%. An insufficient carbonyl activity of N-unsubstituted indole-3-carbaldehyde has been observed and overcome by a preliminary N-acethylation avoiding the inactive vinylene-carboxamide form. In addition to their pharmaceutical significance based on the interaction of two heterocyclic pharmacophores, the condensation products could also be useful as versatile intermediates for further synthesis of new heterocyclic systems. The synthesis of 5-[(4-acetyl-3,5-dimethyl-1H-2-pyrrolyl)(l-acetyl-1H-3-indolyl)methyl] hexahydr= o-2,4,6-pyrimidinetrione (60% in enol-form according to 1 H-NMR) by refluxing of [(1-acetyl-1H-3-indolyl) methylene]hexahydro-2,4,6-pyrimidinetrione] and 3-acethyl-2,4-dimethylpyrrole for 6 h in CH 3 CN illustrates their capability to add C-nucleophiles to the double bound bridging 3 heterocyclic units together. The new 17 products are TLC pure and their structures are proved by 1 H-NMR/IR-spectra which interpretation is displayed. (authors)

  6. A Greener, Efficient Approach to Michael Addition of Barbituric Acid to Nitroalkene in Aqueous Diethylamine Medium

    Directory of Open Access Journals (Sweden)

    Hany J. Al-Najjar

    2014-01-01

    Full Text Available An efficient method for the synthesis of a variety of pyrimidine derivatives 3a–t by reaction of barbituric acids 1a,b as Michael donor with nitroalkenes 2a–k as Michael acceptor using an aqueous medium and diethylamine is described. This 1,4-addition strategy offers several advantages, such as using an economic and environmentally benign reaction media, high yields, versatility, and shorter reaction times. The synthesized compounds were identified by 1H-NMR, 13C-NMR, CHN, IR, and MS. The structure of compound 3a was further confirmed by single crystal X-ray structure determination.

  7. Determination of the rate constants of the reactions CO/sub 2/+OH/sup -/ -> HCO/sub 3//sup -/ and barbituric acid -> barbiturate anion -> H/sup -/ using the pulse radiolyse technique

    Energy Technology Data Exchange (ETDEWEB)

    Schuchmann, M.N.; von Sonntag, C.

    1982-09-01

    The kinetics of the reactions of CO/sub 2/ + OH /sup -/-> HCO/sub 3//sup -/ (i) and barbituric acid -> barbiturate anion + H/sup +/ (ii) have been remeasured using as a new approach the pulse radiolysis technique with optical and conductivity detection. The rate constants obtained in the present study, ksub(j) (21/sup 0/C) = 6900 +- 700 M/sup -1/ s/sup -1/ and ksub(II) (19/sup 0/C) = 22 +- 2 s/sup -1/ agree within experimental errors with values obtained earlier by other methods.

  8. NAGD regimen for the coma of drug-related overdose.

    Science.gov (United States)

    Rappolt, R T; Gay, G R; Decker, W J; Inaba, D S

    1980-07-01

    A specific arousal therapy with NAGD (Naloxone, Activated Charcoal, Glucagon, Doxapram) is outlined for victims of drug overdose in comatose and semi-comatose states. Several direct benefits accrue if early awakening or lightening of such patients is safely accomplished. There are: 1) elimination of need for prolonged intubation or tracheostomy; 2) patient's ability to tell which drug(s) were taken; 3) excessively frantic and vigorous supportive treatment is obviated; and 4) the overall hospital stay is shortened. The NAGD regimen has been found to effectively, safely, and predictably reverse coma. Therapy consists of: naloxone 0.8 mg to 1.6 mg intravenously; large-bore orogastric tube instillation of 100 gm to 120 gm activated charcoal slurry; glucagon 1 mg to 2 mg intravenously; and, in selected cases, doxapram 1 mg/kg to 2 mg/kg intravenously.

  9. A forgotten life-threatening medical emergency: myxedema coma

    Directory of Open Access Journals (Sweden)

    Elisa Pizzolato

    2016-08-01

    Full Text Available Nowadays myxedema coma is a rare medical emergency but, sometimes, it still remains a fatal condition even if appropriate therapy is soon administered. Although physical presentation is very non-specific and diversified, physicians should pay attention when patients present with low body temperature and alteration of neurological status; the presence of precipitating events in past medical history can help in making a diagnosis. Here we discuss one such case: an 83-year-old female presented with abdominal pain since few days. Laboratory tests and abdomen computed tomography scan demonstrated alithiasic cholecystitis; she was properly treated but, during the Emergency Department stay she experienced a cardiac arrest. Physicians immediately started advance cardiovascular life support algorithm and she survived. Later on, she was admitted to the Intensive Care Unit where doctors discovered she was affected by severe hypothyroidism. Straightway they started the right therapy but, unfortunately, the patient died in a few hours.

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

    Science.gov (United States)

    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.

  11. Temperature- and moisture-dependent phase changes in crystal forms of barbituric acid

    International Nuclear Information System (INIS)

    Zencirci, Neslihan; Gstrein, Elisabeth; Langes, Christoph; Griesser, Ulrich J.

    2009-01-01

    The dihydrate of barbituric acid (BAc) and its dehydration product, form II were investigated by means of moisture sorption analysis, hot-stage microscopy, differential scanning calorimetry, thermogravimetry, solution calorimetry, IR- and Raman-spectroscopy as well as powder X-ray diffraction. The dihydrate desolvates already at and below 50% relative humidity (RH) at 25 deg. C whereas form II is stable up to 80% RH, where it transforms back to the dihydrate. The thermal dehydration of barbituric acid dihydrate (BAc-H2) is a single step, nucleation controlled process. The peritectic reaction of the hydrate was measured at 77 deg. C and a transformation enthalpy of Δ trs H H2-II = 17.3 kJ mol -1 was calculated for the interconversion between the hydrate and form II. An almost identical value of 17.0 kJ mol -1 was obtained from solution calorimetry in water as solvent (Δ sol H H2 = 41.5, Δ sol H II = 24.5 kJ mol -1 ). Additionally a high-temperature form (HT-form) of BAc, which is enantiotropically related to form II and unstable at ambient conditions has been characterized. Furthermore, we observed that grinding of BAc with potassium bromide (KBr) induces a tautomeric change. Therefore, IR-spectra recorded with KBr-discs usually display a mixture of tautomers, whereas the IR-spectra of the pure trioxo-form of BAc are obtained if alternative preparation techniques are used

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

    Science.gov (United States)

    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).

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

    Science.gov (United States)

    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.

  14. Hyperalgesic effect induced by barbiturates, midazolam and ethanol: pharmacological evidence for GABA-A receptor involvement

    Directory of Open Access Journals (Sweden)

    M.A.K.F. Tatsuo

    1997-02-01

    Full Text Available The involvement of GABA-A receptors in the control of nociception was studied using the tail-flick test in rats. Non-hypnotic doses of the barbiturates phenobarbital (5-50 mg/kg, pentobarbital (17-33 mg/kg, and thiopental (7.5-30 mg/kg, of the benzodiazepine midazolam (10 mg/kg or of ethanol (0.4-1.6 g/kg administered by the systemic route reduced the latency for the tail-flick response, thus inducing a 'hyperalgesic' state in the animals. In contrast, non-convulsant doses of the GABA-A antagonist picrotoxin (0.12-1.0 mg/kg administered systemically induced an increase in the latency for the tail-flick response, therefore characterizing an 'antinociceptive' state. Previous picrotoxin (0.12 mg/kg treatment abolished the hyperalgesic state induced by effective doses of the barbiturates, midazolam or ethanol. Since phenobarbital, midazolam and ethanol reproduced the described hyperalgesic effect of GABA-A-specific agonists (muscimol, THIP, which is specifically antagonized by the GABA-A antagonist picrotoxin, our results suggest that GABA-A receptors are tonically involved in the modulation of nociception in the rat central nervous system

  15. Hyperosmolar Hyperglycemic Non Ketotic Coma and ...

    African Journals Online (AJOL)

    Recognition of this association will enable better management of the patient and reduce the burden on the care taker by preventing the onset of complications that can prove fatal. It is also important to realise that hyperosmolar coma can be the presenting complaint of a diabetic seeking medical attention for the first time.

  16. New red jewels in Coma Berenices

    International Nuclear Information System (INIS)

    Terrien, Ryan C.; Mahadevan, Suvrath; Deshpande, Rohit; Bender, Chad F.; Hearty, Frederick R.; Schneider, Donald P.; Cargile, Phillip A.; Pepper, Joshua; Rodriguez, Joseph E.; Siverd, Robert J.; Stassun, Keivan G.; Cottaar, Michiel; Allende Prieto, Carlos; Fleming, Scott W.; Frinchaboy, Peter M.; Jackson, Kelly M.; Johnson, Jennifer A.; Majewski, Steven R.; Nidever, David L.; Weaver, Benjamin A.

    2014-01-01

    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 with 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.

  17. New red jewels in Coma Berenices

    Energy Technology Data Exchange (ETDEWEB)

    Terrien, Ryan C.; Mahadevan, Suvrath; Deshpande, Rohit; Bender, Chad F.; Hearty, Frederick R.; Schneider, Donald P. [Department of Astronomy and Astrophysics, The Pennsylvania State University, 525 Davey Laboratory, University Park, PA 16802 (United States); Cargile, Phillip A.; Pepper, Joshua; Rodriguez, Joseph E.; Siverd, Robert J.; Stassun, Keivan G. [Department of Physics and Astronomy, Vanderbilt University, VU Station 1807, Nashville, TN 37235 (United States); Cottaar, Michiel [Institute for Astronomy, ETH Zürich, Wolfgang-Pauli-Strasse 27, CH-8093 Zurich (Switzerland); Allende Prieto, Carlos [Instituto de Astrofísica de Canarias (IAC), C/Vía Láctea, s/n, E-38200 La Laguna, Tenerife (Spain); Fleming, Scott W. [Space Telescope Science Institute, 3700 San Martin Drive, Baltimore, MD 21211 (United States); Frinchaboy, Peter M.; Jackson, Kelly M. [Department of Physics and Astronomy, Texas Christian University, TCU Box 298840, Fort Worth, TX 76129 (United States); Johnson, Jennifer A. [Department of Astronomy, Ohio State University, 140 West 18th Avenue, Columbus, OH 43210 (United States); Majewski, Steven R.; Nidever, David L. [Department of Astronomy, University of Virginia, P.O. Box 400325, Charlottesville, VA 22904-4325 (United States); Weaver, Benjamin A., E-mail: rct151@psu.edu [Center for Cosmology and Particle Physics, New York University, New York, NY 10003 (United States); and others

    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 with 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.

  18. Prognostic value of EEG in different etiological types of coma.

    Science.gov (United States)

    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; pEEG patterns' association with coma outcome only in hemorrhagic and traumatic coma (chi-sqr.=12.95; pEEG patterns and coma outcome. Low amplitude decreased power delta and theta frequencies correlated with SND in survived coma patients (r=+0.21; pEEG 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

  19. Simultaneous effect of organic modifier and physicochemical parameters of barbiturates on their retention on a narrow-bore PGC column

    Czech Academy of Sciences Publication Activity Database

    Forgács, E.; Cserháti, T.; Mikšík, Ivan; Eckhardt, Adam; Deyl, Zdeněk

    2004-01-01

    Roč. 800, č. 1-2 (2004), s. 259-262 ISSN 1570-0232 Grant - others:CZ - HU(CZ) Cooperation programme Institutional research plan: CEZ:AV0Z5011922 Keywords : barbiturates * porous graphitized carbon Subject RIV: CB - Analytical Chemistry, Separation Impact factor: 2.176, year: 2004

  20. Hydrogen bond donor–acceptor–donor organocatalysis for conjugate addition of benzylidene barbiturates via complementary DAD– ADA hydrogen bonding

    NARCIS (Netherlands)

    Leung, King-Chi; Cui, Jian-Fang; Hui, Tsz-Wai; Zhou, Zhong-Yuan; Wong, Man-Kin

    2014-01-01

    A new class of hydrogen bond donor-acceptor-donor (HB-DAD) organocatalysts has been developed for conjugate addition of benzylidene barbiturates. HB-DAD organocatalyst 1a (featuring para-chloro-pyrimidine as the hydrogen bond acceptor (HBA), N-H as the hydrogen bond donor (HBD) and a trifluoroacetyl

  1. Barbiturate End-Capped Non-Fullerene Acceptors for Organic Solar Cells: Tuning Acceptor Energetics to Suppress Geminate Recombination Losses

    KAUST Repository

    Tan, Ching-Hong

    2018-01-10

    We report the synthesis of two barbiturate end-capped non-fullerene acceptors and demonstrate their efficient function in high voltage output organic solar cells. The acceptor with the lower LUMO level is shown to exhibit suppressed geminate recombination losses, resulting in enhanced photocurrent generation and higher overall device efficiency.

  2. Improved detectability of barbiturates in high-performance liquid chromatography by pre-column labelling and ultraviolet detection

    NARCIS (Netherlands)

    Hulshoff, A.; Roseboom, H.; Renema, J.

    1979-01-01

    2-Naphthacyl derivatives of barbiturates are formed in acetone at 30° within 30 min, in an essentially quantitative manner, using caesium carbonate as a catalyst. These derivatives absorb UV radiation strongly at 254 nm. Using a variable-wavelength detector set at 249 nm, 1 ng of

  3. Barbiturate End-Capped Non-Fullerene Acceptors for Organic Solar Cells: Tuning Acceptor Energetics to Suppress Geminate Recombination Losses

    KAUST Repository

    Tan, Ching-Hong; Gorman, Jeffrey; Wadsworth, Andrew; Holliday, Sarah; Subramaniyan, Selvam; Jenekhe, Samson A.; Baran, Derya; McCulloch, Iain; Durrant, James

    2018-01-01

    We report the synthesis of two barbiturate end-capped non-fullerene acceptors and demonstrate their efficient function in high voltage output organic solar cells. The acceptor with the lower LUMO level is shown to exhibit suppressed geminate recombination losses, resulting in enhanced photocurrent generation and higher overall device efficiency.

  4. Barbiturate ingestion in three adult captive tigers (Panthera tigris and concomitant fatal botulism of one : clinical communication

    Directory of Open Access Journals (Sweden)

    J. H. Williams

    2011-05-01

    Full Text Available 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

  5. Estimation of very low concentrations of Ruthenium by spectrophotometric method using barbituric acid as complexing agent

    International Nuclear Information System (INIS)

    Ramakrishna Reddy, S.; Srinivasan, R.; Mallika, C.; Kamachi Mudali, U.; Natarajan, R.

    2012-01-01

    Spectrophotometric method employing numerous chromogenic reagents like thiourea, 1,10-phenanthroline, thiocyanate and tropolone is reported in the literature for the estimation of very low concentrations of Ru. A sensitive spectrophotometric method has been developed for the determination of ruthenium in the concentration range 1.5 to 6.5 ppm in the present work. This method is based on the reaction of ruthenium with barbituric acid to produce ruthenium(ll)tris-violurate, (Ru(H 2 Va) 3 ) -1 complex which gives a stable deep-red coloured solution. The maximum absorption of the complex is at 491 nm due to the inverted t 2g → Π(L-L ligand) electron - transfer transition. The molar absorptivity of the coloured species is 9,851 dm 3 mol -1 cm -1

  6. Analysis of 'Coma strip' galaxy redshift catalog

    International Nuclear Information System (INIS)

    Klypin, A.A.; Karachentsev, I.D.; Lebedev, V.S.

    1990-01-01

    We present results of the analysis of a galaxy redshift catalog made at the 6-m telescope by Karachentsev and Kopylov (1990. Mon. Not. R. astr. Soc., 243, 390). The catalog covers a long narrow strip on the sky (10 arcmin by 63 0 ) and lists 283 galaxies up to limiting blue magnitude m B = 17.6. The strip goes through the core of Coma cluster and this is called the 'Coma strip' catalog. The catalog is almost two times deeper than the CfA redshift survey and creates the possibility of studying the galaxy distribution on scales of 100-250 Mpc. Due to the small number of galaxies in the catalog, we were able to estimate only very general and stable parameters of the distribution. (author)

  7. [Hysterical pseudo-coma: A case report].

    Science.gov (United States)

    Chouaib, N; Chouaib, H; Belyamani, L; Otheman, Y; Bichra, M Z

    2015-09-01

    Hysterical pseudo-coma corresponds to a state of clinical sleep with contrasting waking electroencephalogram. It can last several hours or even several days in the absence of an underlying organic disease. In psychiatry, this disorder is currently part of the "dissociative disorder not otherwise specified". Through this case report, we describe the evolution of a hysterical pseudo-coma that lasted four days in a 28-year-old man. The normality of biological, radiological and electroencephalographic assessments, and responsiveness of the patient during the implementation of a nasogastric tube, led us to suspect a mental origin. An adapted psychiatric care allowed the patient to recover his autonomy after three days of hospitalization. This had prevented the escalation of explorations and invasive treatments. However, the search for organic comorbidity and its management remains a priority. Copyright © 2014 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  8. Temperature- and moisture-dependent phase changes in crystal forms of barbituric acid

    Energy Technology Data Exchange (ETDEWEB)

    Zencirci, Neslihan; Gstrein, Elisabeth; Langes, Christoph [Institute of Pharmacy, Faculty of Chemistry and Pharmacy, University of Innsbruck, Innrain 52, 6020 Innsbruck (Austria); Griesser, Ulrich J. [Institute of Pharmacy, Faculty of Chemistry and Pharmacy, University of Innsbruck, Innrain 52, 6020 Innsbruck (Austria)], E-mail: ulrich.griesser@uibk.ac.at

    2009-03-10

    The dihydrate of barbituric acid (BAc) and its dehydration product, form II were investigated by means of moisture sorption analysis, hot-stage microscopy, differential scanning calorimetry, thermogravimetry, solution calorimetry, IR- and Raman-spectroscopy as well as powder X-ray diffraction. The dihydrate desolvates already at and below 50% relative humidity (RH) at 25 deg. C whereas form II is stable up to 80% RH, where it transforms back to the dihydrate. The thermal dehydration of barbituric acid dihydrate (BAc-H2) is a single step, nucleation controlled process. The peritectic reaction of the hydrate was measured at 77 deg. C and a transformation enthalpy of {delta}{sub trs}H{sub H2-II} = 17.3 kJ mol{sup -1} was calculated for the interconversion between the hydrate and form II. An almost identical value of 17.0 kJ mol{sup -1} was obtained from solution calorimetry in water as solvent ({delta}{sub sol}H{sub H2} = 41.5, {delta}{sub sol}H{sub II} = 24.5 kJ mol{sup -1}). Additionally a high-temperature form (HT-form) of BAc, which is enantiotropically related to form II and unstable at ambient conditions has been characterized. Furthermore, we observed that grinding of BAc with potassium bromide (KBr) induces a tautomeric change. Therefore, IR-spectra recorded with KBr-discs usually display a mixture of tautomers, whereas the IR-spectra of the pure trioxo-form of BAc are obtained if alternative preparation techniques are used.

  9. Irreversible Coma clinicopathologic correlations in 79 observations

    OpenAIRE

    Jerí, F. Raúl

    2014-01-01

    Clinical and developmental data of 79 patients suffering from deep coma associated with isoelectric electroencephalogram for at least 24 consecutive hours are presented. The neuropathological study showed that the vast majority had ischemic lesions in the cerebral cortex hiccups field , cerebellum , striatum , thalamus and to a lesser extent , in the brain - stem . Failed to check precise relationship between the clinical manifestations of the specific nerve dysfunction and destruction of neu...

  10. Carotid artery aneurysm resulting in myxedema coma

    Directory of Open Access Journals (Sweden)

    Elizabeth M. Lamos

    2015-06-01

    Full Text Available Intra-sellar aneurysms are a rare, but important consideration when evaluating pituitary masses. Identification of aneurysms is critical to appropriate treatment and avoiding perilous consequences. These vascular aneurysms can result in severe endocrine dysfunction due to mass effect, stripping of the vascular supply to the pituitary, or hemorrhage. Here we describe a novel case of spontaneous myxedema coma and pituitary apoplexy secondary to a large internal carotid artery aneurysm.

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

    Science.gov (United States)

    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.

  12. Diagnosis of reversible causes of coma.

    Science.gov (United States)

    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.

  13. Dynamic molecular oxygen production in cometary comae

    Science.gov (United States)

    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.

  14. The outskirts of the Coma cluster

    Science.gov (United States)

    Gavazzi, Giuseppe

    Evolved Coma-like clusters of galaxies are constituted of relaxed cores composed of ''old'' early-type galaxies, embedded in large-scale structures, mostly constituted of unevolved (late-type) systems. According to the hierarchical theory of cluster formation the central regions are being fed with unevolved, low-mass systems infalling from the surroundings that are gradually transformed into elliptical/S0 galaxies by tidal galaxy-galaxy and galaxy-cluster interactions, taking place at some boundary distance. The Coma cluster, the most studied of all local clusters, provides us with the ideal test-bed for such an evolutionary study because of the completeness of the photometric and kinematic information already at hands. The field of view of the planned GALEX observations is not big enough to include the boundary interface where most transformations processes are expected to take place, including the truncation of the current star formation. We propose to complete the outskirt of Coma with an additional corona of 11 GALEX imaging fields of 1500 sec exposure each, matching the deepness (UV_{AB}=23.5 mag) of the fields observed in guarantee time. Given the priority of the target, we also propose one optional Central pointing that includes one bright star marginally exceeding the detector brightness limit.

  15. Extragalactic Gamma Ray Excess from Coma Supercluster Direction

    Indian Academy of Sciences (India)

    More precise analysis of EGRET data however, makes it possible to estimate the diffuse gamma ray in Coma supercluster (i.e., Coma\\A1367 supercluster) direction with a value of ( > 30MeV) ≃ 1.9 × 10-6 cm-2 s-1, which is considered to be an upper limit for the diffuse gamma ray due to Coma supercluster. The related ...

  16. Myxedema coma: a new look into an old crisis.

    Science.gov (United States)

    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.

  17. Myxedema Coma: A New Look into an Old Crisis

    Directory of Open Access Journals (Sweden)

    Vivek Mathew

    2011-01-01

    Full Text Available 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.

  18. ULTRA-COMPACT DWARFS IN THE COMA CLUSTER

    International Nuclear Information System (INIS)

    Chiboucas, Kristin; Tully, R. Brent; Marzke, R. O.; Phillipps, S.; Price, J.; Peng, Eric W.; Trentham, Neil; Carter, David; Hammer, Derek

    2011-01-01

    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 R = -12. Another 14 candidates may also prove to be Coma members, 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.

  19. Nucleobase-Based Barbiturates: Their Protective Effect against DNA Damage Induced by Bleomycin-Iron, Antioxidant, and Lymphocyte Transformation Assay

    Directory of Open Access Journals (Sweden)

    Bhaveshkumar D. Dhorajiya

    2014-01-01

    Full Text Available A number of nucleobase-based barbiturates have been synthesized by combination of nucleic acid bases and heterocyclic amines and barbituric acid derivatives through green and efficient multicomponent route and one pot reaction. This approach was accomplished efficiently using aqueous medium to give the corresponding products in high yield. The newly synthesized compounds were characterized by spectral analysis (FT-IR, 1H NMR, 13C NMR, HMBC, and UV spectroscopy and elemental analysis. Representative of all synthesized compounds was tested and evaluated for antioxidant, bleomycin-dependent DNA damage, and Lymphocyte Transformation studies. Compounds TBC > TBA > TBG showed highest lymphocyte transformation assay, TBC > TBA > BG showed inhibitory antioxidant activity using ABTS methods, and TBC > BPA > BAMT > TBA > 1, 3-TBA manifested the best protective effect against DNA damage induced by bleomycin.

  20. THERMODYNAMICS OF THE COMA CLUSTER OUTSKIRTS

    International Nuclear Information System (INIS)

    Simionescu, A.; Werner, N.; Urban, O.; Allen, S. W.; Fabian, A. C.; Sanders, J. S.; Walker, S. A.; Mantz, A.; Matsushita, K.; Sasaki, T.; Sato, T.; Nulsen, P. E. J.; Takei, Y.

    2013-01-01

    We present results from a large mosaic of Suzaku observations of the Coma Cluster, the nearest and X-ray brightest hot (∼8 keV), dynamically active, non-cool core system, focusing on the thermodynamic properties of the intracluster medium on large scales. For azimuths not aligned with an infalling subcluster toward the southwest, our measured temperature and X-ray brightness profiles exhibit broadly consistent radial trends, with the temperature decreasing from about 8.5 keV at the cluster center to about 2 keV at a radius of 2 Mpc, which is the edge of our detection limit. The southwest merger significantly boosts the surface brightness, allowing us to detect X-ray emission out to ∼2.2 Mpc along this direction. Apart from the southwestern infalling subcluster, the surface brightness profiles show multiple edges around radii of 30-40 arcmin. The azimuthally averaged temperature profile, as well as the deprojected density and pressure profiles, all show a sharp drop consistent with an outwardly-propagating shock front located at 40 arcmin, corresponding to the outermost edge of the giant radio halo observed at 352 MHz with the Westerbork Synthesis Radio Telescope. The shock front may be powering this radio emission. A clear entropy excess inside of r 500 reflects the violent merging events linked with these morphological features. Beyond r 500 , the entropy profiles of the Coma Cluster along the relatively relaxed directions are consistent with the power-law behavior expected from simple models of gravitational large-scale structure formation. The pressure is also in agreement at these radii with the expected values measured from Sunyaev-Zel'dovich data from the Planck satellite. However, due to the large uncertainties associated with the Coma Cluster measurements, we cannot yet exclude an entropy flattening in this system consistent with that seen in more relaxed cool core clusters

  1. Modified Newtonian dynamics and the Coma cluster

    International Nuclear Information System (INIS)

    The, L.S.; White, S.D.M.

    1988-01-01

    The consistency of Milgrom's theory of modified Newtonian dynamics is checked against optical and X-ray data for the Coma cluster of galaxies. It is found that viable models for the cluster containing no dark matter can be constructed. They require an extensive gaseous atmosphere through which galaxies move on near-radial orbits. The gas temperature is predicted to have a shallow minimum near the cluster center; this structure may conflict with the best X-ray spectra of the cluster. 18 references

  2. Piracetam and TRH analogues antagonise inhibition by barbiturates, diazepam, melatonin and galanin of human erythrocyte D-glucose transport

    OpenAIRE

    Naftalin, Richard J; Cunningham, Philip; Afzal-Ahmed, Iram

    2004-01-01

    Nootropic drugs increase glucose uptake into anaesthetised brain and into Alzheimer's diseased brain. Thyrotropin-releasing hormone, TRH, which has a chemical structure similar to nootropics increases cerebellar uptake of glucose in murine rolling ataxia. This paper shows that nootropic drugs like piracetam (2-oxo 1 pyrrolidine acetamide) and levetiracetam and neuropeptides like TRH antagonise the inhibition of glucose transport by barbiturates, diazepam, melatonin and endogenous neuropeptide...

  3. Behaviour of Some Activated Nitriles Toward Barbituric Acid, Thiobarbituric Acid and 3-Methyl-1-Phenylpyrazol-5-one

    Directory of Open Access Journals (Sweden)

    M. M. Habashy

    2000-05-01

    Full Text Available The effect of some active methylene containing heterocyclic compounds, namely barbituric acid, thiobarbituric acid and 3-methyl-1-phenylpyrazol-5-one on a-cyano-3,4,5-trimethoxycinnamonitrile and ethyl a-cyano-3,4,5-trimethoxycinnamate (1a,b was investigated. The structure of the new products was substantiated by their IR,1H-NMR and mass spectra.

  4. On the Action of General Anesthetics on Cellular Function: Barbiturate Alters the Exocytosis of Catecholamines in a Model Cell System.

    Science.gov (United States)

    Ye, Daixin; Ewing, Andrew

    2018-01-22

    General anesthetics are essential in many areas, however, the cellular mechanisms of anesthetic-induced amnesia and unconsciousness are incompletely understood. Exocytosis is the main mechanism of signal transduction and neuronal communication through the release of chemical transmitters from vesicles to the extracellular environment. Here, we use disk electrodes placed on top of PC12 cells to show that treatment with barbiturate induces fewer molecules released during exocytosis and changes the event dynamics perhaps by inducing a less stable fusion pore that is prone to close faster during partial exocytosis. Larger events are essentially abolished. However, use of intracellular vesicle impact electrochemical cytometry using a nano-tip electrode inserted into a cell shows that the distribution of vesicle transmitter content does not change after barbiturate treatment. This indicates that barbiturate selectively alters the pore size of larger events or perhaps differentially between types of vesicles. Alteration of exocytosis in this manner could be linked to the effects of general anesthetics on memory loss. © 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  5. Myxedema coma with cardiac tamponade and severe cardiomyopathy

    OpenAIRE

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

    2015-01-01

    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.

  6. Myxedema coma with cardiac tamponade and severe cardiomyopathy.

    Science.gov (United States)

    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.

  7. The Spinning Corona of FK Comae

    Science.gov (United States)

    Kashyap, Vinay

    2010-09-01

    FK Comae is an ultra-fast rotating, single yellow giant, product of a recent W UMa merger. Extraordinary levels of FUV and X-ray emission rate FK Comae a coronal powerhouse on par with the most extreme of the better known activity heavyweights: short-period RS CVn binaries. As a single star, FK Comae has clear advantages as a laboratory for exploring the outer limits of magnetospheric activity among the coronal cool stars. FK Comae has a long history of attention at optical and X-ray wavelengths, thanks to its generously spotted surface, and proclivity to flare regularly at high energies. FUSE discovered ultra-broad, redshifted profiles of OVI and CIII, but unfortunately the singular observation could not be repeated, thanks to the satellite's flaky attitude system. The remarkable FUV spectrum was taken just a few months before STIS failed in 2004, so there was no opportunity to turn the more powerful gaze of Hubble to the task. Now, finally, the amazing sensitivity of Cosmic Origins Spectrograph can be brought to bear: a single orbit can capture an FUV spectrum of FK Comae with S/N at instrumental limits for bright lines, and digging down to faint FeXXI 1354 {bridge to the coordinated Chandra HETGS pointing we are carrying out}.We will trace how the bright FUV regions relate spatially to the photospheric dark spots, to inform ideas of coronal structure and heating in these advanced objects. We will probe whether a global magnetosphere exists, and whether the field lines are loaded with hot coronal gas {>10 MK}, as well as the cooler 0.3 MK material already suggested by highly broadened FUSE OVI. Further, we will test whether the striking 100 km/s redshifts of the FUV lines, and similar shifts seen in NeX by Chandra HETGS, are caused by persistent coronal flows {outflows, perhaps implicated in magnetic braking; or inflows, like "coronal rain" on the Sun}. Our method is to exploit, on the one hand, emission-line "Doppler imaging," whereby bright surface regions are

  8. Radio observations of the peripheral region of the Coma cluster near Coma A

    International Nuclear Information System (INIS)

    Giovannini, G.

    1986-01-01

    VLA and WSRT observations are reported for the extended radio source 1253+275 on the periphery of the Coma cluster and for two active Coma radio galaxies within 20 arcmin of 1253+275. The data are presented in contour maps and characterized in detail. Source 1253+275 is shown to be a relic radio galaxy with physical conditions similar to those seen in the external regions (30-50 kpc from the cores) of the two active sources (NGC 4789 and NGC 4827). It is suggested that these regions survived for long periods (400 Myr) after the last acceleration of the radiating electrons because transverse expansion was inhibited by the local intergalactic medium, which has a density comparable to that in other rich clusters of galaxies. 7 references

  9. Flip-flops of FK Comae Berenices

    DEFF Research Database (Denmark)

    Hackman, T.; Pelt, J.; Mantere, M. J.

    2013-01-01

    Context.FK Comae Berenices is a rapidly rotating magnetically active star, the light curve of which is modulated by cool spots on its surface. It was the first star where the "flip-flop" phenomenon was discovered. Since then, flip-flops in the spot activity have been reported in many other stars....... Follow-up studies with increasing length have shown, however, that the phenomenon is more complex than was thought right after its discovery. Aims. Therefore, it is of interest to perform a more thorough study of the evolution of the spot activity in FK Com. In this study, we analyse 15 years......-flop cannot be interpreted as a single phenomenon, where the main activity jumps from one active longitude to another. In some of our cases the phase shifts can be explained by differential rotation: two spot regions move with different angular velocity and even pass each other. Comparison between the methods...

  10. FK Comae Berenices, King of Spin

    DEFF Research Database (Denmark)

    Ayres, Thomas R.; Kashyap, V.; Saar, S.

    2016-01-01

    COCOA-PUFS is an energy-diverse, time-domain study of the ultra-fast spinning, heavily spotted, yellow giant FK Comae Berenices (FK Com: HD117555; G4 III). This single star is thought to be a recent binary merger, and is exceptionally active by measure of its intense ultraviolet (UV) and X......-ray emissions, and proclivity to flare. COCOA-PUFS was carried out with the Hubble Space Telescope in the UV (1200-3000 Å), using mainly its high-performance Cosmic Origins Spectrograph, but also high precision Space Telescope Imaging Spectrograph; Chandra X-ray Observatory in the soft X-rays (0.5-10 ke......V), utilizing its High-Energy Transmission Grating Spectrometer; together with supporting photometry and spectropolarimetry in the visible from the ground. This is an introductory report on the project. FK Com displayed variability on a wide range of timescales over all wavelengths during the week-long main...

  11. Brain connectivity in pathological and pharmacological coma

    Directory of Open Access Journals (Sweden)

    Quentin Noirhomme

    2010-12-01

    Full Text Available Recent studies in patients with disorders of consciousness (DOC tend to support the view that awareness is not related to activity in a single brain region but to thalamo-cortical connectivity in the frontoparietal network. Functional neuroimaging studies have shown preserved albeit disconnected low level cortical activation in response to external stimulation in patients in a vegetative state or unresponsive wakefulness syndrome. While activation of these primary sensory cortices does not necessarily reflect conscious awareness, activation in higher order associative cortices in minimally conscious state patients seems to herald some residual perceptual awareness. PET studies have identified a metabolic dysfunction in a widespread fronto-parietal global neuronal workspace in DOC patients including the midline default mode network, ‘intrinsic’ system, and the lateral frontoparietal cortices or ‘extrinsic system’. Recent studies have investigated the relation of awareness to the functional connectivity within intrinsic and extrinsic networks, and with the thalami in both pathological and pharmacological coma. In brain damaged patients, connectivity in all default network areas was found to be non-linearly correlated with the degree of clinical consciousness impairment, ranging from healthy controls and locked-in syndrome to minimally conscious, vegetative, coma and brain dead patients. Anesthesia-induced loss of consciousness was also shown to correlate with a global decrease in cortico-cortical and thalamo-cortical connectivity in both intrinsic and extrinsic networks, but not in auditory or visual networks. In anesthesia, unconsciousness was also associated with a loss of cross-modal interactions between networks. These results suggest that conscious awareness critically depends on the functional integrity of thalamo-cortical and cortico-cortical frontoparietal connectivity within and between intrinsic and extrinsic brain networks.

  12. A diagnostic scoring system for myxedema coma.

    Science.gov (United States)

    Popoveniuc, Geanina; Chandra, Tanu; Sud, Anchal; Sharma, Meeta; Blackman, Marc R; Burman, Kenneth D; Mete, Mihriye; Desale, Sameer; Wartofsky, Leonard

    2014-08-01

    To develop diagnostic criteria for myxedema coma (MC), a decompensated state of extreme hypothyroidism with a high mortality rate if untreated, in order to facilitate its early recognition and treatment. The frequencies of characteristics associated with MC were assessed retrospectively in patients from our institutions in order to derive a semiquantitative diagnostic point scale that was further applied on selected patients whose data were retrieved from the literature. Logistic regression analysis was used to test the predictive power of the score. Receiver operating characteristic (ROC) curve analysis was performed to test the discriminative power of the score. Of the 21 patients examined, 7 were reclassified as not having MC (non-MC), and they were used as controls. The scoring system included a composite of alterations of thermoregulatory, central nervous, cardiovascular, gastrointestinal, and metabolic systems, and presence or absence of a precipitating event. All 14 of our MC patients had a score of ≥60, whereas 6 of 7 non-MC patients had scores of 25 to 50. A total of 16 of 22 MC patients whose data were retrieved from the literature had a score ≥60, and 6 of 22 of these patients scored between 45 and 55. The odds ratio per each score unit increase as a continuum was 1.09 (95% confidence interval [CI], 1.01 to 1.16; P = .019); a score of 60 identified coma, with an odds ratio of 1.22. The area under the ROC curve was 0.88 (95% CI, 0.65 to 1.00), and the score of 60 had 100% sensitivity and 85.71% specificity. A score ≥60 in the proposed scoring system is potentially diagnostic for MC, whereas scores between 45 and 59 could classify patients at risk for MC.

  13. Endozepine-4 levels are increased in hepatic coma.

    Science.gov (United States)

    Malaguarnera, Giulia; Vacante, Marco; Drago, Filippo; Bertino, Gaetano; Motta, Massimo; Giordano, Maria; Malaguarnera, Michele

    2015-08-14

    To evaluate the serum levels of endozepine-4, their relation with ammonia serum levels, the grading of coma and the severity of cirrhosis, in patients with hepatic coma. In this study we included 20 subjects with Hepatic coma, 20 subjects with minimal hepatic encephalopathy (MHE) and 20 subjects control. All subjects underwent blood analysis, Child Pugh and Model for End - stage liver disease (MELD) assessment, endozepine-4 analysis. Subjects with hepatic coma showed significant difference in endozepine-4 (P blood ammonia concentration was noted to be raised in patients with hepatic coma, with the highest ammonia levels being found in those who were comatose. We also found a high correlation between endozepine-4 and ammonia (P < 0.001). In patients with grade IV hepatic coma, endozepine levels were significantly higher compared to other groups. This study suggests that an increased level of endozepine in subjects with higher levels of MELD was observed. In conclusion, data concerning involvement of the GABA-ergic system in HE coma could be explained by stage-specific alterations.

  14. Which EEG patterns in coma are nonconvulsive status epilepticus?

    Science.gov (United States)

    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.

  15. An Atypical Case of Myxedema Coma with Concomitant Nonconvulsive Seizure

    Directory of Open Access Journals (Sweden)

    Pratik Patel

    2016-01-01

    Full Text Available 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.

  16. Myxedema coma in a patient with Down's syndrome.

    Science.gov (United States)

    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.

  17. Thyroid gland disorder emergencies: thyroid storm and myxedema coma.

    Science.gov (United States)

    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.

  18. An Atypical Case of Myxedema Coma with Concomitant Nonconvulsive Seizure.

    Science.gov (United States)

    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.

  19. Chinese calligraphy handwriting (CCH: a case of rehabilitative awakening of a coma patient after stroke

    Directory of Open Access Journals (Sweden)

    Kao HSR

    2018-01-01

    Full Text Available Henry SR Kao,1 Stewart PW Lam,2 Tin Tin Kao3,4 1Calligraphy Therapy Laboratory, Shenzhen Institute of Neuroscience, Shenzhen, China; 2Research and Development Division, Calli-Health Society, 3Department of Geography, 4Department of Psychology, University of Hong Kong, Hong Kong Introduction: This study investigated the efficacy of Chinese calligraphy handwriting (CCH for the awakening of patients under a vegetative state after stroke. The theories, the instrument, and the treatment protocols were reported. A single case of a severe stroke patient who was in a coma state for 2 years is presented in this study. The objectives were to apply finger writing as a new method to awaken a stroke patient in a coma state and to test the effect of this method in improving the patient’s vegetative states over time. Case presentation: A 55-year-old man suffered a severe stroke in 2004 which left him in a coma for 2 years without any systematic rehabilitation. A culture-based finger-writing method of visual-spatial intervention was then applied to improve his condition. The writing tasks involved aided viewing and finger tracing of sets of innovative characters with enriched visual-spatial and movement characteristics. Following regular treatment protocols involving diverse movement and sensory feedback, the patient was awakened after 12 months. As a consequence, the patient showed significant behavioral changes favoring enhanced focusing, alertness, visual scan, visual span, and quickened visual and motor responses. The treatment continued for another 12 months. As the treatment progressed, we gradually observed improvements in his attention span and mental concentration. His eye ball movements – the left eye in particular – were quickened and showed wider visual angularity in his focal vision. Currently, the patient can now watch television, engage in improved visual sighting, and focus on visual-spatial and cognitive-linguistic materials. Conclusion

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

    Science.gov (United States)

    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.

  1. Cometary Coma Chemical Composition (C4) Mission

    Science.gov (United States)

    Carle, Glenn C.; Clark, Benton C.; Knocke, Philip C.; OHara, Bonnie J.; Adams, Larry; Niemann, Hasso B.; Alexander, Merle; Veverka, Joseph; Goldstein, Raymond; Huebner, Walter; hide

    1994-01-01

    Cometary exploration remains of great importance to virtually all of space science. Because comets are presumed to be remnants of the early solar nebula, they are expected to provide fundamental knowledge as to the origin and development of the solar system as well as to be key to understanding of the source of volatiles and even life itself in the inner solar system. Clearly the time for a detailed study of the composition of these apparent messages from the past has come. A comet rendezvous mission, the Cometary Coma Chemical Composition (C4) Mission, is now being studied as a candidate for the new Discovery program. This mission is a highly-focussed and usefully-limited subset of the Cometary Rendezvous Asteroid Flyby (CRAF) Mission. The C4 mission will concentrate on measurements that will produce an understanding of the composition and physical makeup of a cometary nucleus. The core science goals of the C4 mission are 1) to determine the chemical, elemental, and isotopic composition of a cometary nucleus and 2) to characterize the chemical and isotopic nature of its atmosphere. A related goal is to obtain temporal information about the development of the cometary coma as a function of time and orbital position. The four short-period comets -- Tempel 1, Tempel 2, Churyumov-Gerasimenko, and Wirtanen -which all appear to have acceptable dust production rates, were identified as candidate targets. Mission opportunities have been identified beginning as early as 1998. Tempel I with a launch in 1999, however, remains the baseline comet for studies of and planning the C4 mission. The C4 mission incorporates two science instruments and two engineering instruments in the payload to obtain the desired measurements. The science instruments include an advanced version of the Cometary Ice and Dust Experiment (CIDEX), a mini-CIDEX with a sample collection system, an X-ray Fluorescence Spectrometer and a Pyrolysis-Gas Chromatograph, and a simplified version of the Neutral

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

    Science.gov (United States)

    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.

  3. An Atypical Case of Myxedema Coma with Concomitant Nonconvulsive Seizure

    OpenAIRE

    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 expr...

  4. Development and Preliminary Validation of the Coma Arousal Communication Scale.

    Science.gov (United States)

    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.

  5. 21 centimeter study of spiral galaxies in the Coma supercluster

    International Nuclear Information System (INIS)

    Gavazzi, G.

    1987-01-01

    High-sensitivity, 21 cm line observations of 130 galaxies in the Coma/A1367 Supercluster region are presented and used to study the large-scale distribution of galaxies in the direction of the Coma Supercluster and the H I content in spiral galaxies as a function of the local galaxy density. Groups of galaxies are found to form a quasi-continuous structure that connects the Local Supercluster to the Coma Supercluster. This structure is composed of real filaments only in the vicinity of the Coma Cluster. Spiral galaxies in the surveyed groups and multiple systems have H I content not dissimilar from that of isolated galaxies. Galaxies within about 1 Abell radius from the Coma Cluster contain about three times less hydrogen on average than isolated galaxies. There is a strong tendency for galaxies that are more severely H I-depleted to be redder and of earlier Hubble type. In the Coma Cluster a considerable fraction of late-type, blue galaxies have large deficiency parameters. 51 references

  6. Synthesis and Evaluation of Changes Induced by Solvent and Substituent in Electronic Absorption Spectra of New Azo Disperse Dyes Containig Barbiturate Ring

    Directory of Open Access Journals (Sweden)

    Hooshang Hamidian

    2013-01-01

    Full Text Available Six azo disperse dyes were prepared by diazotizing 4-amino hippuric acid and coupled with barbituric acid and 2-thiobarbituric acid. Then, the products were reacted with aromatic aldehyde, sodium acetate, and acetic anhydride, and oxazolone derivatives were formed. Characterization of the dyes was carried out by using UV-Vis, FT-IR, 1H NMR and 13C NMR, and mass spectroscopic techniques. The solvatochromic behavior of azo disperse dyes was evaluated in various solvents. The effects of substituents of aromatic aldehyde, barbiturate, and thiobarbiturate ring on the color of dyes were investigated.

  7. Hyperammoniemic coma in a patient with ureterosigmoidostomy and normal liver function.

    Science.gov (United States)

    Van Laethem, J L; Gay, F; Franck, N; Van Gossum, A

    1992-11-01

    Hyperammoniemic encephalopathy has been reported after ureterosigmoidostomy. Its development is related to a problem of bacterial overgrowth and, most often, is favored by the presence of an underlying liver dysfunction. We report the case of a 43-year-old woman with a ureterosigmoidostomy done 28 years earlier who developed hyperammoniemic coma induced by an acute rectocolitis and in the absence of any detectable liver dysfunction. Neither administration of Lactilol and neomycin nor rectal tube drainage were effective; systemic antimicrobial therapy effective against the urease-producing gram-negative bacilli was required and led to a decrease in serum ammonia levels and a dramatic clinical improvement.

  8. Myxedema coma of both primary and secondary origin, with non-classic presentation and extremely elevated creatine kinase.

    Science.gov (United States)

    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.

  9. Routine intracranial pressure monitoring in acute coma.

    Science.gov (United States)

    Forsyth, Rob J; Raper, Joseph; Todhunter, Emma

    2015-11-02

    We know that the brain damage resulting from traumatic and other insults is not due solely to the direct consequences of the primary injury. A significant and potentially preventable contribution to the overall morbidity arises from secondary hypoxic-ischaemic damage. Brain swelling accompanied by raised intracranial pressure (ICP) prevents adequate cerebral perfusion with well-oxygenated blood.Detection of raised ICP could be useful in alerting clinicians to the need to improve cerebral perfusion, with consequent reductions in brain injury. To determine whether routine ICP monitoring in severe coma of any cause reduces the risk of all-cause mortality or severe disability at final follow-up. We searched the Cochrane Injuries Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL Plus, ISI Web of Science (SCI-EXPANDED & CPCI-S), clinical trials registries and reference lists. We ran the most recent search on 22 May 2015. All randomised controlled studies of real-time ICP monitoring by invasive or semi-invasive means in acute coma (traumatic or non-traumatic aetiology) versus clinical care without ICP monitoring (that is, guided only by clinical or radiological inference of the presence of raised ICP). Two authors (ET and RF) worked independently to identify the one study that met inclusion criteria. JR and RF independently extracted data and assessed risk of bias. We contacted study authors for additional information, including details of methods and outcome data. One randomized controlled trial (RCT) meeting the selection criteria has been identified to date.The included study had 324 participants. We judged risk of bias to be low for all categories except blinding of participants and personnel, which is not feasible for this intervention. There were few missing data, and we analysed all on an intention-to-treat basis.Participants could be 13 years of age or older (mean age of sample 29

  10. Testing chameleon gravity with the Coma cluster

    International Nuclear Information System (INIS)

    Terukina, Ayumu; Yamamoto, Kazuhiro; Lombriser, Lucas; Bacon, David; Koyama, Kazuya; Nichol, Robert C.

    2014-01-01

    We propose a novel method to test the gravitational interactions in the outskirts of galaxy clusters. When gravity is modified, this is typically accompanied by the introduction of an additional scalar degree of freedom, which mediates an attractive fifth force. The presence of an extra gravitational coupling, however, is tightly constrained by local measurements. In chameleon modifications of gravity, local tests can be evaded by employing a screening mechanism that suppresses the fifth force in dense environments. While the chameleon field may be screened in the interior of the cluster, its outer region can still be affected by the extra force, introducing a deviation between the hydrostatic and lensing mass of the cluster. Thus, the chameleon modification can be tested by combining the gas and lensing measurements of the cluster. We demonstrate the operability of our method with the Coma cluster, for which both a lensing measurement and gas observations from the X-ray surface brightness, the X-ray temperature, and the Sunyaev-Zel'dovich effect are available. Using the joint observational data set, we perform a Markov chain Monte Carlo analysis of the parameter space describing the different profiles in both the Newtonian and chameleon scenarios. We report competitive constraints on the chameleon field amplitude and its coupling strength to matter. In the case of f(R) gravity, corresponding to a specific choice of the coupling, we find an upper bound on the background field amplitude of |f R0 | < 6 × 10 −5 , which is currently the tightest constraint on cosmological scales

  11. Testing chameleon gravity with the Coma cluster

    Energy Technology Data Exchange (ETDEWEB)

    Terukina, Ayumu; Yamamoto, Kazuhiro [Department of Physical Science, Hiroshima University, Higashi-Hiroshima, Kagamiyama 1-3-1, 739-8526 (Japan); Lombriser, Lucas; Bacon, David; Koyama, Kazuya; Nichol, Robert C., E-mail: telkina@theo.phys.sci.hiroshima-u.ac.jp, E-mail: lucas.lombriser@port.ac.uk, E-mail: kazuhiro@hiroshima-u.ac.jp, E-mail: david.bacon@port.ac.uk, E-mail: kazuya.koyama@port.ac.uk, E-mail: bob.nichol@port.ac.uk [Institute of Cosmology and Gravitation, University of Portsmouth, Dennis Sciama Building, Portsmouth, PO1 3FX (United Kingdom)

    2014-04-01

    We propose a novel method to test the gravitational interactions in the outskirts of galaxy clusters. When gravity is modified, this is typically accompanied by the introduction of an additional scalar degree of freedom, which mediates an attractive fifth force. The presence of an extra gravitational coupling, however, is tightly constrained by local measurements. In chameleon modifications of gravity, local tests can be evaded by employing a screening mechanism that suppresses the fifth force in dense environments. While the chameleon field may be screened in the interior of the cluster, its outer region can still be affected by the extra force, introducing a deviation between the hydrostatic and lensing mass of the cluster. Thus, the chameleon modification can be tested by combining the gas and lensing measurements of the cluster. We demonstrate the operability of our method with the Coma cluster, for which both a lensing measurement and gas observations from the X-ray surface brightness, the X-ray temperature, and the Sunyaev-Zel'dovich effect are available. Using the joint observational data set, we perform a Markov chain Monte Carlo analysis of the parameter space describing the different profiles in both the Newtonian and chameleon scenarios. We report competitive constraints on the chameleon field amplitude and its coupling strength to matter. In the case of f(R) gravity, corresponding to a specific choice of the coupling, we find an upper bound on the background field amplitude of |f{sub R0}| < 6 × 10{sup −5}, which is currently the tightest constraint on cosmological scales.

  12. Reliability of self-reported use of amphetamine, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, and opiates among acutely hospitalized elderly medical patients

    DEFF Research Database (Denmark)

    Glintborg, B.; Olsen, L.; Poulsen, H.

    2008-01-01

    Undisclosed use of illicit drugs and prescription controlled substances is frequent in some settings. The aim of the present study was to estimate the reliability of self-reported use of amphetamine, barbiturates, benzodiazepines, cannabinoids, cocaine, methadone, and opiates among acutely...

  13. The determination of pentobarbital and other barbiturates in blood plasma by gas—liquid chromatography with on-column and pre-column butylation

    NARCIS (Netherlands)

    Hulshoff, A.; Houwen, O.A.G.J. van der; Barends, D.M.; Kostenbauder, H.B.

    1979-01-01

    Two g.l.c. methods for the determination of pentobarbital and other barbiturates are reported. In the first method the plasma samples are extracted with toluene; the toluene layer is back-extracted with a small volume of a tetrabutylammonium hydroxide solution of which an aliquot is injected into

  14. Bacteriology of aspiration pneumonia in patients with acute coma.

    Science.gov (United States)

    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.

  15. The outflow speed of the coma of Halley's comet

    International Nuclear Information System (INIS)

    Combi, M.R.

    1989-01-01

    Data concerning the outflow speed of the coma of Comet Halley are studied in relation to a generalization of the coupled pure-gas-dynamic/Monte Carlo model of Combi and Smyth (1988) to include the dusty-gas dynamics of the inner coma. Measurements made by the Giotto neutral-gas spectrometer, IR water observations from the Kuiper Airborne Observatory, and Doppler radio line profiles of HCN and OH are used to examine the radial dependence of the outflow speed, the asymmetry in the outflow speed, and the overall heliocentric distance dependence of the Doppler profiles, respectively. The results suggest that the model makes it possible to understand the gross long-term behavior and radial structure of the dynamics of the cometary coma. 23 refs

  16. Dynamic analysis of constellation of Coma Berenices galaxies

    International Nuclear Information System (INIS)

    Des Forets, Guillaume; Dominguez-Tenreiro, Rosa; Gerbal, Daniel; Mathez, Guy; Mazure, Alain; Salvador-Sole, Eduardo

    1981-01-01

    In a preceding note, the equations of the simplest dynamical model accounting for most of available data on Coma Cluster have been established. One finds typically: the optical core radius 30', the X-ray core radius 18'; the total radius of Coma is found to be approximately 3 deg, while the X-ray emission is restricted to within a radius 75'. The galaxy central mass density ranges around: 10 -27 g/cm -3 and the central electron density is 2x10 -3 cm -3 . The mean dynamical mass of Coma is 8x10 14 M of the sun (H 0 =50km/s/Mpc). 2/3 of the total mass is due to galaxies up to msub(ν)=19.4 and the remaining 1/3 is due to the X-ray emitting plasma. This total mass depends on the temperature gradient, which can be more or less steep [fr

  17. EEG as an Indicator of Cerebral Functioning in Postanoxic Coma.

    Science.gov (United States)

    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.

  18. Contemporary approach to neurologic prognostication of coma after cardiac arrest.

    Science.gov (United States)

    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.

  19. Bullous lesions, sweat gland necrosis and rhabdomyolysis in alcoholic coma

    Directory of Open Access Journals (Sweden)

    Neelakandhan Asokan

    2014-01-01

    Full Text Available A 42-year-old male developed hemorrhagic bullae and erosions while in alcohol induced coma. The lesions were limited to areas of the body in prolonged contact with the ground in the comatose state. He developed rhabdomyolysis, progressing to acute renal failure (ARF. Histopathological examination of the skin showed spongiosis, intraepidermal vesicles, and necrosis of eccrine sweat glands with denudation of secretory epithelial lining cells. With supportive treatment and hemodialysis, the patient recovered in 3 weeks time. This is the first reported case of bullous lesions and sweat gland necrosis occurring in alcohol-induced coma complicated by rhabdomyolysis and ARF.

  20. On the production of positive molecular ions in cometary comas

    International Nuclear Information System (INIS)

    Tarafdar, S.P.; Wickramasinghe, N.C.

    1977-01-01

    Positively charged molecular ions, such as H 2 O + , which have been observed in cometary comas, may be efficiently produced by the evaporation of positively charged clathrate grains of radii in the range approximately 10 -6 -10 -3 cm. Such grains may be expelled from nuclei of comets, along with gaseous molecules. Grain charging occurs via interaction with solar ultraviolet photons and/or solar wind protons. Observational data on the total quantities as well as the distributions of H 2 O and H 2 O + in cometary comas are shown to be in accord with detailed model calculations. (Auth.)

  1. NON-TRAUMATIC COMA- INCIDENCE, AETIOLOGY AND OUTCOME

    Directory of Open Access Journals (Sweden)

    Mallikarjun R. Patil

    2017-10-01

    Full Text Available BACKGROUND Acute non-traumatic coma is one of the most common paediatric emergencies, which arouses much anxiety and apprehension in both parents and physicians. Due to heterogeneity of causes in these patients, prediction of outcome is difficult and unfortunately no single clinical, laboratory or electrophysiological parameters singly predict their outcome. Aetiology of nontraumatic coma varies depending on different geographical area. We have attempted to find the incidence, aetiology and outcome and delineate neurological signs to predict the prognosis in this study. The aim of this study is to study the incidence, aetiology and outcome of non-traumatic coma in children. MATERIALS AND METHODS 100 consecutive cases of non-traumatic coma between 5months and 15 years of age were selected for the study. Clinical signs and findings were recorded at admission (‘0’ Hr and after ‘48’ Hrs. of hospital stay. Aetiology of coma is determined on the basis of clinical history, examination and relevant laboratory investigations by the treating physician. These children were followed up till the death in the hospital or discharged from the hospital. Discharged patients were asked for followup after 4 weeks. During this period, all of them were evaluated by formal neurological examination and for special sensory involvement. The neurological outcomes were categorised into 6 groups (I-VI based on the severity of neurological involvement. Chisquare test was applied to determine the predictors of outcome. RESULTS 1. The incidence of non-traumatic coma in our hospital based study was 8.02% of all paediatric admissions and 21.64% of all PICU admissions. 2. CNS infections contributed the majority (58% of cases. (Dengue encephalitis-28%, viral encephalitis-12%, TB meningitis-8%, pyogenic meningitis- 6%, Shigella encephalopathy-3% and cerebral malaria-1%. 3. Other non-infectious aetiologies were toxic and metabolic group- 21%, post status epilepticus- 9

  2. Chorea--an unusual manifestation in a woman recovering from myxedema coma.

    Science.gov (United States)

    Yu, Catherine H Y; Stovel, Rebecca; Fox, Susan

    2012-01-01

    To report a case of reversible chorea in a woman with myxedema coma. We describe the clinical course, imaging findings, and laboratory test results of a patient who initially presented with myxedema coma and then developed reversible chorea upon treatment. A 33-year-old woman with a known history of primary hypothyroidism presented with a 3-week history of lethargy, progressing to a precipitous decline in consciousness that required intubation. Physical examination revealed concurrent hypothermia and bradycardia. Laboratory investigations demonstrated a thyrotropin concentration greater than 100 mIU/L, a free triiodothyronine concentration of 1.9 pg/mL, and a free thyroxine concentration of 0.24 ng/dL, but no other metabolic abnormalities. She was treated with intravenous levothyroxine therapy on the first 2 days of hospital admission (200 mcg and 250 mcg, respectively). On day 2, she was obeying commands and she was extubated. She began exhibiting choreiform movements. Thyroid function test results revealed a normal free thyroxine concentration (1.10 ng/dL), but an elevated thyrotropin concentration (40.98 mIU/L) and a low free triiodothyronine concentration (1.9 pg/mL). Findings from computed tomography and magnetic resonance imaging of her brain and analysis of cerebrospinal fluid were normal. Her regimen was transitioned to oral levothyroxine, 88 mcg daily, and by day 4, her choreiform movements ceased. Neurologic manifestations of hypothyroidism include psychomotor slowing, memory deficits, and dementia, with myxedema coma at the extreme of this spectrum. Although chorea is a rare manifestation of hyperthyroidism, this is the first report of a patient with acquired, reversible choreiform movement disorder while still being severely hypothyroid and treated with levothyroxine.

  3. Evaluation of the protein metabolism during hepatic coma evidenced by 15N tracer data

    International Nuclear Information System (INIS)

    Matkowitz, R.; Hartig, W.; Junghans, P.; Jung, K.; Hirschberg, K.; Bornhak, H.

    1983-01-01

    In patients in coma hepaticum as well as in pigs with experimental hepatic coma the protein metabolism was studied under conditions of parenteral application of an amino acid diet using 15 N-glycine as tracer

  4. Predicting outcome from coma : man-in-the-barrel syndrome as potential pitfall

    NARCIS (Netherlands)

    Elting, JW; Haaxma, R; De Keyser, J; Sulter, G.

    The Glasgow coma scale motor score is often used in predicting outcome after hypoxic ischemic coma. Judicious care should be exerted when using this variable in predicting outcome in patients with coma following hypotension since borderzone infarction can obscure the clinical picture. We describe a

  5. Unusual cause of coma | Jaggi | Malawi Medical Journal

    African Journals Online (AJOL)

    Journal Home > Vol 8, No 2 (1992) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Unusual cause of coma. P Jaggi, AD Harries. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL ...

  6. The comparison of modified early warning score and Glasgow coma ...

    African Journals Online (AJOL)

    Introduction: The purpose of this study is to assess and compare the discriminatory ability of the Glasgow coma scale (GCS)‑age‑systolic blood pressure (GAP) score and modified early warning scoring system (mEWS) score for 4‑week mortality, for the patients being in the triage category 1 and 2 who refer to Emergency ...

  7. Challenges in the Management of a Patient with Myxoedema Coma ...

    African Journals Online (AJOL)

    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 ...

  8. Assessment of physicians' knowledge of Glasgow Coma Score ...

    African Journals Online (AJOL)

    Background: Glasgow Coma Scale (GCS) is the most commonly used tool in assessing comatose patients. It is simple, easily communicable, and useful in prognostication and determination of the treatment modality in head injury. Unfortunately, a high percentage of clinicians who are not in the emergency or neurological ...

  9. Two-dimensional molecular line transfer for a cometary coma

    Science.gov (United States)

    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).

  10. Color gradients in the coma of P/Halley

    International Nuclear Information System (INIS)

    Meech, K.

    1988-01-01

    Some important information relevant to the understanding of the gas/dust dynamics near the surface of a comet nucleus concerns knowledge of the grain composition and scattering properties as well as the particle size distribution of dust in the coma. Ground based measurements of light scattered from the dust comae can provide some information about the physical grain properties, in particular about the mean optically dominant grain size. Optical spectra of continua of nine comets presented by Jewitt and Meech, 1986, show that all of the scattered light is reddened with respect to the Sun. There is significant scatter in the amount of reddening seen for different comets. In the near IF regions, the reddening decreases until near 2 to 3 micrometers where the reflectivity is nearly neutral. It is of particular interest to see if there are any observable changes in the grain size distribution during outburst. Although no coma colar changes were observed during the Nov. 1985 outbursts, a color gradient within the coma has been observed in Halley. Radial color gradients in J, H, and K images of Halley as reported by Campins have not been observed by the author

  11. Challenges in the Management of a Patient with Myxoedema Coma ...

    African Journals Online (AJOL)

    ism.1 The incidence in western countries is reported to be 0.22 million per year, however, there is a paucity of data from countries adjacent to the equator.2 Myxoede- ma coma is a medical emergency associated with high mortality rates ranging from 25–60% even with the best possible treatment and settings.1,3 Patients ...

  12. PCA/HEXTE Observations of Coma and A2319

    Science.gov (United States)

    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.

  13. Modeling Coma Gas Jets in Comet Hale-Bopp

    Science.gov (United States)

    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.

  14. Ultraviolet and optical view of galaxies in the Coma Supercluster

    Science.gov (United States)

    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.

  15. Gait and Glasgow Coma Scale scores can predict functional recovery in patients with traumatic brain injury☆

    Science.gov (United States)

    Bilgin, Sevil; Guclu-Gunduz, Arzu; Oruckaptan, Hakan; Kose, Nezire; Celik, Bülent

    2012-01-01

    Fifty-one patients with mild (n = 14), moderate (n = 10) and severe traumatic brain injury (n = 27) received early rehabilitation. Level of consciousness was evaluated using the Glasgow Coma Score. Functional level was determined using the Glasgow Outcome Score, whilst mobility was evaluated using the Mobility Scale for Acute Stroke. Activities of daily living were assessed using the Barthel Index. Following Bobath neurodevelopmental therapy, the level of consciousness was significantly improved in patients with moderate and severe traumatic brain injury, but was not greatly influenced in patients with mild traumatic brain injury. Mobility and functional level were significantly improved in patients with mild, moderate and severe traumatic brain injury. Gait recovery was more obvious in patients with mild traumatic brain injury than in patients with moderate and severe traumatic brain injury. Activities of daily living showed an improvement but this was insignificant except for patients with severe traumatic brain injury. Nevertheless, complete recovery was not acquired at discharge. Multiple regression analysis showed that gait and Glasgow Coma Scale scores can be considered predictors of functional outcomes following traumatic brain injury. PMID:25624828

  16. Myxedema coma in a patient with subclinical hypothyroidism.

    Science.gov (United States)

    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

  17. A rapid murine coma and behavior scale for quantitative assessment of murine cerebral malaria.

    Directory of Open Access Journals (Sweden)

    Ryan W Carroll

    Full Text Available BACKGROUND: Cerebral malaria (CM is a neurological syndrome that includes coma and seizures following malaria parasite infection. The pathophysiology is not fully understood and cannot be accounted for by infection alone: patients still succumb to CM, even if the underlying parasite infection has resolved. To that effect, there is no known adjuvant therapy for CM. Current murine CM (MCM models do not allow for rapid clinical identification of affected animals following infection. An animal model that more closely mimics the clinical features of human CM would be helpful in elucidating potential mechanisms of disease pathogenesis and evaluating new adjuvant therapies. METHODOLOGY/PRINCIPAL FINDINGS: A quantitative, rapid murine coma and behavior scale (RMCBS comprised of 10 parameters was developed to assess MCM manifested in C57BL/6 mice infected with Plasmodium berghei ANKA (PbA. Using this method a single mouse can be completely assessed within 3 minutes. The RMCBS enables the operator to follow the evolution of the clinical syndrome, validated here by correlations with intracerebral hemorrhages. It provides a tool by which subjects can be identified as symptomatic prior to the initiation of trial treatment. CONCLUSIONS/SIGNIFICANCE: Since the RMCBS enables an operator to rapidly follow the course of disease, label a subject as affected or not, and correlate the level of illness with neuropathologic injury, it can ultimately be used to guide the initiation of treatment after the onset of cerebral disease (thus emulating the situation in the field. The RMCBS is a tool by which an adjuvant therapy can be objectively assessed.

  18. Antibacterial Barbituric Acid Analogues Inspired from Natural 3-Acyltetramic Acids; Synthesis, Tautomerism and Structure and Physicochemical Property-Antibacterial Activity Relationships

    Directory of Open Access Journals (Sweden)

    Yong-Chul Jeong

    2015-02-01

    Full Text Available The synthesis, tautomerism and antibacterial activity of novel barbiturates is reported. In particular, 3-acyl and 3-carboxamidobarbiturates exhibited antibacterial activity, against susceptible and some resistant Gram-positive strains of particular interest is that these systems possess amenable molecular weight, rotatable bonds and number of proton-donors/acceptors for drug design as well as less lipophilic character, with physicochemical properties and ionic states that are similar to current antibiotic agents for oral and injectable use. Unfortunately, the reduction of plasma protein affinity by the barbituric core is not sufficient to achieve activity in vivo. Further optimization to reduce plasma protein affinity and/or elevate antibiotic potency is therefore required, but we believe that these systems offer unusual opportunities for antibiotic drug discovery.

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

    Science.gov (United States)

    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 (pcoma have different effects on the BBB permeability depending on the energy metabolism. PMID:21619558

  20. Absorption of folic acid and its rate of disappearance from the blood of patients receiving barbiturates in excess in combination with alcohol

    International Nuclear Information System (INIS)

    Gyftaki, H.; Kesse-Elias, M.; Alevizou-Terzaki, V.; Rapidis, P.; Sdougou-Christakopoulou, J.

    1975-01-01

    It is known that megaloblastic anaemia may occur from the intake of phenobarbital, which apparently responds to folic acid and vitamin B 12 . Its site of action is not known but there is evidence that it may act as a pyrimidine antagonist. It is also known that alcoholics with or without cirrhosis have folate deficiency. Furthermore, although potentiating effects of alcohol and barbiturates exist it is not known how the combination of barbiturates and alcohol acts on folic acid metabolism. In thirty patients receiving barbiturates in excess in combination with alcohol, absorption of folic acid and its rate of disappearance were studied in the blood. Two series of studies were performed. In the first, folic acid (15μg/kg of body weight) was administered orally and the maximum concentration in the blood as well as its disappearance rate were determined. In the second, folinic acid (15 μg/kg of body weight) was administered intramuscularly and the disappearance rate of folic acid was again determined. Blood samples were taken at certain intervals after administration of folic or folinic acid. Estimation of serum folic acid level was obtained by a competitive protein-binding technique developed in our laboratory. The results are discussed and compared with those in normal subjects. (author)

  1. Modeling the Thermodynamic Properties of the Inner Comae of Comets

    Science.gov (United States)

    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

  2. Optical characterization and blu-ray recording properties of metal(II) azo barbituric acid complex films

    Energy Technology Data Exchange (ETDEWEB)

    Li, X.Y. [Shanghai Institute of Optics and Fine Mechanics, Chinese Academy of Sciences, Shanghai 201800 (China)], E-mail: xyli@siom.ac.cn; Wu, Y.Q. [Shanghai Institute of Optics and Fine Mechanics, Chinese Academy of Sciences, Shanghai 201800 (China); Key Lab of Functional Inorganic Material Chemistry (Heilongjiang University), Ministry of Education, Haerbin 150080 (China)], E-mail: yqwu@siom.ac.cn; Gu, D.D.; Gan, F.X. [Shanghai Institute of Optics and Fine Mechanics, Chinese Academy of Sciences, Shanghai 201800 (China)

    2009-02-25

    Smooth thin films of nickel(II), cobalt(II) and zinc(II) complexes with azo barbituric acid were prepared by the spin-coating method. Absorption spectra of the thin films on K9 glass substrates in 300-700 nm wavelength region were measured. Optical constants (complex refractive index N = n + ik) of the thin films prepared on single-crystal silicon substrates in 275-695 nm wavelength region were investigated on rotating analyzer-polarizer type of scanning ellipsometer, and dielectric constant {epsilon} ({epsilon} = {epsilon}{sub 1} + i{epsilon}{sub 2}) as well as absorption coefficient {alpha} of thin films were calculated at 405 nm. In addition, static optical recording properties of the cobalt(II) complex thin film with an Ag reflective layer was carried out using a 406.7 nm blue-violet laser and a high numerical aperture (NA) of 0.90. Clear recording marks with high reflectivity contrast (>60%) at proper laser power and pulse width were obtained, and the size of recording mark was as small as 250 nm. The results indicate that these metal(II) complexes are promising organic recording medium for the blu-ray optical storage system.

  3. Piracetam and TRH analogues antagonise inhibition by barbiturates, diazepam, melatonin and galanin of human erythrocyte D-glucose transport

    Science.gov (United States)

    Naftalin, Richard J; Cunningham, Philip; Afzal-Ahmed, Iram

    2004-01-01

    Nootropic drugs increase glucose uptake into anaesthetised brain and into Alzheimer's diseased brain. Thyrotropin-releasing hormone, TRH, which has a chemical structure similar to nootropics increases cerebellar uptake of glucose in murine rolling ataxia. This paper shows that nootropic drugs like piracetam (2-oxo 1 pyrrolidine acetamide) and levetiracetam and neuropeptides like TRH antagonise the inhibition of glucose transport by barbiturates, diazepam, melatonin and endogenous neuropeptide galanin in human erythrocytes in vitro. The potencies of nootropic drugs in opposing scopolamine-induced memory loss correlate with their potencies in antagonising pentobarbital inhibition of erythrocyte glucose transport in vitro (Pnootropics, D-levetiracetam and D-pyroglutamate, have higher antagonist Ki's against pentobarbital inhibition of glucose transport than more potent L-stereoisomers (Pnootropics, like aniracetam and levetiracetam, while antagonising pentobarbital action, also inhibit glucose transport. Analeptics like bemigride and methamphetamine are more potent inhibitors of glucose transport than antagonists of hypnotic action on glucose transport. There are similarities between amino-acid sequences in human glucose transport protein isoform 1 (GLUT1) and the benzodiazepine-binding domains of GABAA (gamma amino butyric acid) receptor subunits. Mapped on a 3D template of GLUT1, these homologies suggest that the site of diazepam and piracetam interaction is a pocket outside the central hydrophilic pore region. Nootropic pyrrolidone antagonism of hypnotic drug inhibition of glucose transport in vitro may be an analogue of TRH antagonism of galanin-induced narcosis. PMID:15148255

  4. Extreme hyperphosphatemia and hypocalcemic coma associated with phosphate enema.

    Science.gov (United States)

    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.

  5. An ultrasoft X-ray source in Coma Berenices

    International Nuclear Information System (INIS)

    Margon, B.; Malina, R.; Bowyer, S.; Cruddace, R.; Lampton, M.

    1976-01-01

    We have observed an intense soft X-ray source with an extraordinary spectrum in Coma Berenices, 4 0 northeast of and unassociated with the Coma cluster of galaxies. Two spectra, obtained at different times in a sounding rocket flight, indicate that the source temperature in thermal models is less than 10 6 K; a power-law model requires photon power-law indices steeper than n=-3. The intensity in the 44--165 A band is of the order of 5x10 -10 ergs cm -2 s -1 , but no flux is present at energies 0.3--2.1 keV to a limit of 1x10 -10 ergs cm -2 s -1 . The lack of bright stars or a supernova remnant in the error box implies that this may be a new class of soft X-ray sources

  6. The radio halo and active galaxies in the Coma cluster

    International Nuclear Information System (INIS)

    Cordey, R.A.

    1985-01-01

    The Cambridge Low-Frequency Synthesis Telescope has been used to map the Coma cluster at 151 MHz. Two new extended sources are found, associated with the cluster galaxies NGC4839 and NGC4849. The central halo radio source is shown not to have a simple symmetrical structure but to be distorted, with separate centres of brightening near the radio galaxies NGC4874 and IC4040. The structure cannot be accounted for by cluster-wide acceleration processes but implies a close connection with current radio galaxies and, in particular, models requiring diffusion of electrons out of radio sources seem to be favoured. The other large source, near Coma A, is detected and higher resolution data at 1407 MHz are used to clarify its structure. (author)

  7. Energy balance and photochemical processes in the inner coma

    International Nuclear Information System (INIS)

    Huebner, W.F.; Keady, J.J.

    1982-01-01

    Energy balance and multifluid flow in the coma are described. Expansion cooling, radiative cooling, photodissociative heating, chemical heating, and relative multifluid flow are the processes determining the energy budget. In the fluid dynamics, fast atomic and molecular hydrogen are considered as separate fluids with larger collision mean free paths than the cold bulk fluid that has a larger mean molecular weight. The transition from fluid flow to free molecular flow is approximated. The model predicts hydrogen and bulk fluid flow velocities in general agreement with observations. The effects of the temperature profile and the fast hydrogen flow on the chemistry in the inner coma are investigated. Results from a model approximating conditions in Halley's comet are presented

  8. Spontaneous intraparenchymal otogenic pneumocephalus presenting with abrupt onset of coma

    International Nuclear Information System (INIS)

    Scuotto, A.; Cappabianca, S.; Capasso, R.; Natale, M.; D'Oria, S.; Rotondo, M.

    2016-01-01

    We report a case of spontaneous otogenic pneumocephalus, manifesting with a rapid deterioration of consciousness level. A 37-year-old man presented a 3-days history of headache and fluctuant confusion. On admission the patient was neurologically intact except for temporo-spatial disorientation. Brain Computed Tomography (CT) scan showed a large air collection in the left temporal lobe, causing mass effect. Hyperpneumatisation of mastoid air cells was also noticed. Because of the abrupt onset of coma (Glasgow Coma Scale = 10), emergency surgical evacuation of tensive pneumocephalus was carried out. Postoperatively, the patient quickly regained a good level of consciousness and was headache-free. - Highlights: • Spontaneous otogenic pneumocephalus generally presents with subtle symptoms. • Sudden consciousness involvement is a rare onset condition. • Hyperpneumatisation of the petrous bone is a predisposing factor.

  9. The Nature and Origin of UCDs in the Coma Cluster

    Science.gov (United States)

    Chiboucas, Kristin; Tully, R. Brent; Madrid, Juan; Phillipps, Steven; Carter, David; Peng, Eric

    2018-01-01

    UCDs are super massive star clusters found largely in dense regions but have also been found around individual galaxies and in smaller groups. Their origin is still under debate but currently favored scenarios include formation as giant star clusters, either as the brightest globular clusters or through mergers of super star clusters, themselves formed during major galaxy mergers, or as remnant nuclei from tidal stripping of nucleated dwarf ellipticals. Establishing the nature of these enigmatic objects has important implications for our understanding of star formation, star cluster formation, the missing satellite problem, and galaxy evolution. We are attempting to disentangle these competing formation scenarios with a large survey of UCDs in the Coma cluster. Using ACS two-passband imaging from the HST/ACS Coma Cluster Treasury Survey, we are using colors and sizes to identify the UCD cluster members. With a large size limited sample of the UCD population within the core region of the Coma cluster, we are investigating the population size, properties, and spatial distribution, and comparing that with the Coma globular cluster and nuclear star cluster populations to discriminate between the threshing and globular cluster scenarios. In previous work, we had found a possible correlation of UCD colors with host galaxy and a possible excess of UCDs around a non-central giant galaxy with an unusually large globular cluster population, both suggestive of a globular cluster origin. With a larger sample size and additional imaging fields that encompass the regions around these giant galaxies, we have found that the color correlation with host persists and the giant galaxy with unusually large globular cluster population does appear to host a large UCD population as well. We present the current status of the survey.

  10. Dynamics of rich clusters of galaxies. I. The Coma cluster

    International Nuclear Information System (INIS)

    Kent, S.M.; Gunn, J.E.

    1982-01-01

    The structure and dynamics of the Coma cluster are analyzed using self-consistent equilibrium dynamical models. Observational material for Coma is culled from a variety of sources. Projected surface, density, and velocity-dispersion profiles are derived extending out to a radius of 3 0 from the cluster center, which are essentially free from field contamination. Segregation of galaxies by luminosity and morphology are discussed and a quantitative estimate of the latter is made. The method of constructing self-consistent dynamical models is discussed. Four different forms of the distribution function are analyzed allowing for different possible dependences of f on energy and angular momentum. Properties of typical models that might resemble actual clusters are presented, and the importance of having velocity-dispersion information is empha sized. The effect of a central massive object such as a cD galaxy on the core structure is illustrated. A comparison of these models with Coma reveals that only models with a distribution function in which the ratio of tangential to radial velocity dispersions is everywhere constant give acceptable fits. In particular, it is possible to rule out models that have isotropic motions in the core and predominantly radial motions in the halo. For H 0 = 50, the best-fitting models give a total projected mass inside 3 0 of 2.9 x 10 15 M/sub sun/ , a core radius of 340--400 kpc (8.5'--10'), an upper limit to any central massive object of approx.10 13 M/sub sun/ , and a mass-to-blue-light ratio of M/L = 181. From cosmological considerations the cluster ''edge'' is determined to lie at rapprox.5 0 --6 0 . The possible distribution of ''dark matter'' in Coma is discussed and it is argued that this distribution cannot be significantly different from that of the galaxies. The dynamics of morphological segregation are examined quantitatively, and are explained at least qualitatively

  11. The HST/ACS Coma Cluster Survey - VII. Structure and assembly of massive galaxies in the centre of the Coma cluster

    NARCIS (Netherlands)

    Weinzirl, Tim; Jogee, Shardha; Neistein, Eyal; Khochfar, Sadegh; Kormendy, John; Marinova, Irina; Hoyos, Carlos; Balcells, Marc; den Brok, Mark; Hammer, Derek; Peletier, Reynier F.; Kleijn, Gijs Verdoes; Carter, David; Goudfrooij, Paul; Lucey, John R.; Mobasher, Bahram; Trentham, Neil; Erwin, Peter; Puzia, Thomas

    2014-01-01

    We constrain the assembly history of galaxies in the projected central 0.5 Mpc of the Coma cluster by performing structural decomposition on 69 massive (M⋆ ≥ 109 M⊙) galaxies using high-resolution F814W images from the Hubble Space Telescope (HST) Treasury Survey of Coma. Each galaxy is modelled

  12. EXTINCTION IN THE COMA OF COMET 17P/HOLMES

    Energy Technology Data Exchange (ETDEWEB)

    Lacerda, Pedro [Astrophysics Research Centre, Queen' s University Belfast, Belfast BT7 1NN (United Kingdom); Jewitt, David, E-mail: lacerda.pedro@gmail.com [Department of Earth and Space Sciences, University of California Los Angeles (UCLA), 595 Charles Young Drive, Los Angeles, CA 90095-1567 (United States)

    2012-11-20

    On 2007 October 29, the outbursting comet 17P/Holmes passed within 0.''79 of a background star. We recorded the event using optical, narrowband photometry and detect a 3%-4% dip in stellar brightness bracketing the time of closest approach to the comet nucleus. The detected dimming implies an optical depth {tau} Almost-Equal-To 0.04 at 1.''5 from the nucleus and an optical depth toward the nucleus center {tau}{sub n} < 13.3. At the time of our observations, the coma was optically thick only within {rho} {approx}< 0.''01 from the nucleus. By combining the measured extinction and the scattered light from the coma, we estimate a dust red albedo p{sub d} = 0.006 {+-} 0.002 at {alpha} = 16 Degree-Sign phase angle. Our measurements place the most stringent constraints on the extinction optical depth of any cometary coma.

  13. Investigation of previously derived Hyades, Coma, and M67 reddenings

    International Nuclear Information System (INIS)

    Taylor, B.J.

    1980-01-01

    New Hyades polarimetry and field star photometry have been obtained to check the Hyades reddening, which was found to be nonzero in a previous paper. The new Hyades polarimetry implies essentially zero reddening; this is also true of polarimetry published by Behr (which was incorrectly interpreted in the previous paper). Four photometric techniques which are presumed to be insensitive to blanketing are used to compare the Hyades to nearby field stars; these four techniques also yield essentially zero reddening. When all of these results are combined with others which the author has previously published and a simultaneous solution for the Hyades, Coma, and M67 reddenings is made, the results are E (B-V) =3 +- 2 (sigma) mmag, -1 +- 3 (sigma) mmag, and 46 +- 6 (sigma) mmag, respectively. No support for a nonzero Hyades reddening is offered by the new results. When the newly obtained reddenings for the Hyades, Coma, and M67 are compared with results from techniques given by Crawford and by users of the David Dunlap Observatory photometric system, no differences between the new and other reddenings are found which are larger than about 2 sigma. The author had previously found that the M67 main-sequence stars have about the same blanketing as that of Coma and less blanketing than the Hyades; this conclusion is essentially unchanged by the revised reddenings

  14. Disconnection of the Ascending Arousal System in Traumatic Coma

    Science.gov (United States)

    Edlow, Brian L.; Haynes, Robin L.; Takahashi, Emi; Klein, Joshua P.; Cummings, Peter; Benner, Thomas; Greer, David M.; Greenberg, Steven M.; Wu, Ona; Kinney, Hannah C.; Folkerth, Rebecca D.

    2013-01-01

    Traumatic coma is associated with disruption of axonal pathways throughout the brain but the specific pathways involved in humans are incompletely understood. In this study, we used high angular resolution diffusion imaging (HARDI) to map the connectivity of axonal pathways that mediate the 2 critical components of consciousness – arousal and awareness – in the postmortem brain of a 62-year-old woman with acute traumatic coma and in 2 control brains. HARDI tractography guided tissue sampling in the neuropathological analysis. HARDI tractography demonstrated complete disruption of white matter pathways connecting brainstem arousal nuclei to the basal forebrain and thalamic intralaminar and reticular nuclei. In contrast, hemispheric arousal pathways connecting the thalamus and basal forebrain to the cerebral cortex were only partially disrupted, as were the cortical “awareness pathways.” Neuropathologic examination, which utilized β-amyloid precursor protein and fractin immunomarkers, revealed axonal injury in the white matter of the brainstem and cerebral hemispheres that corresponded to sites of HARDI tract disruption. Axonal injury was also present within the grey matter of the hypothalamus, thalamus, basal forebrain, and cerebral cortex. We propose that traumatic coma may be a subcortical disconnection syndrome related to the disconnection of specific brainstem arousal nuclei from the thalamus and basal forebrain. PMID:23656993

  15. A study of the reliability of the Nociception Coma Scale.

    Science.gov (United States)

    Riganello, F; Cortese, M D; Arcuri, F; Candelieri, A; Guglielmino, F; Dolce, G; Sannita, W G; Schnakers, C

    2015-04-01

    In this study, we investigated the reliability of the Nociception Coma Scale which has recently been developed to assess nociception in non-communicative, severely brain-injured patients. Prospective cross-sequential study. Semi-intensive care unit and long-term brain injury care. Forty-four patients diagnosed as being in a vegetative state (n=26) or in a minimally conscious state (n=18). Patients were assessed by two experts (rater A and rater B) on two consecutive weeks to measure inter-rater agreement and test-retest reliability. Total scores and subscores of the Nociception Coma Scale. We performed a total of 176 assessments. The inter-rater agreement was moderate for the total scores (k = 0.57) and fair to substantial for the subscores (0.33 ≤ k ≤ 0.62) on week 2. The test-retest reliability was substantial for the total scores (k = 0.66) and moderate to almost perfect for the subscores (0.53 ≤ k ≤ 0.96) for rater A. The inter-rater agreement was weaker on week 1, whereas the test-retest reliability was lower for the least experienced rater (rater B). This study provides further evidence of the psychometric qualities of the Nociception Coma Scale. Future studies should assess the impact of practical experience and background on administration and scoring of the scale. © The Author(s) 2014.

  16. Model of comet comae. II. Effects of solar photodissociative ionization

    International Nuclear Information System (INIS)

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

    1980-01-01

    Improvements to our computer model of coma plotochemistry are described. These include an expansion of the chemical reactions network and new rate constants that have been measured only recently. Photolytic reactions of additional molecules are incorporated, and photolytic branching ratios are treated in far greater detail than in our previous work. A total of 25 photodissociative ionization (PDI) reactions are now considered (as compared to only 3 PDI reactions previously). Solar PDI of the mother molecule CO 2 is shown to compete effectively with photoionization of CO in the production of observed CO + . The CO + density peak predicted by our improved model, for COP 2 or CO mother molecules, is deep in the inner coma, in better agreement with observation than our old CO 2 model. However, neither CO 2 nor CO mother molecule calculations reproduce the CO + /H 2 O + ratio observed in comet Kohoutek. PDI products of CO 2 , CO, CH 4 , and NH 3 mother molecules fuel a complex chemistry scheme, producing inner coma abundances of CN, C 2 , and C 3 much greater than previously calculated

  17. Alpha coma in an adolescent with diabetic ketoacidosis.

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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).

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

    OpenAIRE

    Dixit, Siddharth; 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 o...

  2. Infrared color gradient in the inner coma of Comet Halley

    International Nuclear Information System (INIS)

    Campins, H.; Rieke, M.J.; Rieke, G.H.

    1989-01-01

    A well-defined gradient is noted in the J-H and H-K colors of near-IR images obtained for Comet Halley in November, 1985, within about 8000 km of the nucleus; the bluest colors are at the photocenter, in conjunction with surface brightness profiles that are steeper than those expected. The color gradient and the brightness profiles are both explainable by the present analysis in terms of the presence of volatile, dirty-ice grains in the inner coma. An outburst of Rayleigh-scattering dust particles (unsupported by spacecraft measurements obtained to date) may also account for the observational data. 27 references

  3. Isothermality of the gas in the Coma cluster

    International Nuclear Information System (INIS)

    Hughes, J.P.; Yamashita, K.; Okumura, Y.; Tsunemi, H.; Matsuoka, M.

    1988-01-01

    The high-quality X-ray spectrum of the Coma cluster observed by the Japanese satelite Tenma in conjunction with imaging data from the Einstein Observatory was used to explore the temperature distribution of the cluster gas. It is found that pure polytropic models are inadequate to describe this temperature distribution. Instead, a hybrid model is proposed consisting of a central isothermal region surrounded by a polytropic distribution. It is shown that as much as 75 percent of the global emission may come from the isothermal component. 30 references

  4. EXTINCTION IN THE COMA OF COMET 17P/HOLMES

    International Nuclear Information System (INIS)

    Lacerda, Pedro; Jewitt, David

    2012-01-01

    On 2007 October 29, the outbursting comet 17P/Holmes passed within 0.''79 of a background star. We recorded the event using optical, narrowband photometry and detect a 3%-4% dip in stellar brightness bracketing the time of closest approach to the comet nucleus. The detected dimming implies an optical depth τ ≈ 0.04 at 1.''5 from the nucleus and an optical depth toward the nucleus center τ n d = 0.006 ± 0.002 at α = 16° phase angle. Our measurements place the most stringent constraints on the extinction optical depth of any cometary coma.

  5. Interaction between metals and nucleic acids. Part 3. Synthesis and structural studies of copper(II) complexes with Schiff base ligands derived from barbituric acid

    Energy Technology Data Exchange (ETDEWEB)

    Sasaki, I.; Gaudemer, A.; Chiaroni, A.; Riche, C.

    1986-02-17

    Schiff bases have been prepared from 5-formylbarbituric acid and 5-formyl-1,3-dimethyl-barbituric acid and various di- or tri-amines. The structure of the corresponding copper(II) complexes have been established by elemental analysis and spectroscopic methods. The molecular structure of one of the complexes, Cu(DiMeBardpt), was determined by X-ray diffraction. Electrochemical study shows that these complexes are reduced at slightly more negative potentials than the corresponding complexes obtained from uracil, which suggests that these new ligands are better electron-donors.

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

    Science.gov (United States)

    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.

  7. EEG dynamical correlates of focal and diffuse causes of coma.

    Science.gov (United States)

    Kafashan, MohammadMehdi; Ryu, Shoko; Hargis, Mitchell J; Laurido-Soto, Osvaldo; Roberts, Debra E; Thontakudi, Akshay; Eisenman, Lawrence; Kummer, Terrance T; Ching, ShiNung

    2017-11-15

    Rapidly determining the causes of a depressed level of consciousness (DLOC) including coma is a common clinical challenge. Quantitative analysis of the electroencephalogram (EEG) has the potential to improve DLOC assessment by providing readily deployable, temporally detailed characterization of brain activity in such patients. While used commonly for seizure detection, EEG-based assessment of DLOC etiology is less well-established. As a first step towards etiological diagnosis, we sought to distinguish focal and diffuse causes of DLOC through assessment of temporal dynamics within EEG signals. We retrospectively analyzed EEG recordings from 40 patients with DLOC with consensus focal or diffuse culprit pathology. For each recording, we performed a suite of time-series analyses, then used a statistical framework to identify which analyses (features) could be used to distinguish between focal and diffuse cases. Using cross-validation approaches, we identified several spectral and non-spectral EEG features that were significantly different between DLOC patients with focal vs. diffuse etiologies, enabling EEG-based classification with an accuracy of 76%. Our findings suggest that DLOC due to focal vs. diffuse injuries differ along several electrophysiological parameters. These results may form the basis of future classification strategies for DLOC and coma that are more etiologically-specific and therefore therapeutically-relevant.

  8. Polyuria, acidosis, and coma following massive ibuprofen ingestion.

    Science.gov (United States)

    Levine, Michael; Khurana, Amandeep; Ruha, Anne-Michelle

    2010-09-01

    Ibuprofen was the first over-the-counter nonsteroidal anti-inflammatory drug available in the United States. Despite being a common agent of ingestion, significant toxicity in overdose is rare. We report a case of a massive ibuprofen ingestion who developed polyuria, acidosis, and coma but survived, despite having a serum ibuprofen concentration greater than previous fatal cases. A 19-year-old man ingested 90 g (1,200 mg/kg) ibuprofen. He was initially awake and alert, but his level of consciousness deteriorated over several hours. Seven hours following the ingestion, he was intubated and mechanically ventilated secondary to loss of airway reflexes. He developed a lactic acidosis and polyuria, which lasted for nearly 24 h. His serum creatinine peaked at 1.12 mg/dL. An ibuprofen level drawn 7 h postingestion was 739.2 mg/L (therapeutic 5-49 mg/L). We describe a case of a massive ibuprofen overdose characterized by metabolic acidosis, coma, and a state of high urine output who survived with aggressive supportive care. This case is unique in several ways. First, ibuprofen levels this high have only rarely been described. Second, polyuria is very poorly described following ibuprofen ingestions.

  9. Myxedema coma: A case report of pediatric emergency care.

    Science.gov (United States)

    Zhu, Yueniu; Qiu, Wenjuan; Deng, Mengyan; Zhu, Xiaodong

    2017-05-01

    Myxedema coma (MC) is extremely rare but lethal in pediatric patients with hypothyroidism leading to altered mental status and hypothermia. But there is no clinical guideline for such cases. A 6-year-old Chinese girl presented with coma and hypothermia preceded by pneumonia. Her lab results were: free thyroxin (T4) 4.18 pmol/L and thyroid-stimulating hormone (TSH) > 150 μIU/mL with extremely elevated anti-thyroid peroxidase (TPO-Ab) and anti-thyroglobulin. Pneumonia, mild pleural, and pericardial effusion were seen on computed tomographic (CT) scan. MC, autoimmune hypothyroidism, pneumonia and sepsis were diagnosed. Gastric levothyroxine, intravenous dexamethasone and antibiotics were administered. Her consciousness was restored and temperature returned to normal 2 days after starting levothyroxine. She was discharged two weeks later. MC is rare but may be the initial presentation in pediatric patients with prolonged untreated hypothyroidism. Autoimmune thyroiditis could cause hypothyroidism in children. MC should be suspected in pediatric patients with altered mental status, hypothermia and cardiovascular instability. Treatment with 100 mg/m of gastric levothyroxine is an option for pediatric patients with MC.

  10. Effectiveness of Sensory Stimulation to Improve Arousal and Alertness of People in a Coma or Persistent Vegetative State After Traumatic Brain Injury: A Systematic Review.

    Science.gov (United States)

    Padilla, René; Domina, Anna

    2016-01-01

    This systematic review evaluates the effectiveness of sensory stimulation to improve arousal and alertness of people in a coma or persistent vegetative state after traumatic brain injury (TBI). Databases searched included Medline, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews. The search was limited to outcomes studies published in English in peer-reviewed journals between 2008 and 2013. Included studies provide strong evidence that multimodal sensory stimulation improves arousal and enhances clinical outcomes for people in a coma or persistent vegetative state after TBI. Moderate evidence was also provided for auditory stimulation, limited evidence was provided for complex stimuli, and insufficient evidence was provided for median nerve stimulation. Interventions should be tailored to client tolerance and premorbid preferences. Bimodal or multimodal stimulation should begin early, be frequent, and be sustained until more complex activity is possible. Copyright © 2016 by the American Occupational Therapy Association, Inc.

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

    Science.gov (United States)

    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 coma longer than 24 hours (P 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.

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

    OpenAIRE

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

    2017-01-01

    Key Clinical Message 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.

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

    Science.gov (United States)

    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.

  14. Influence of coma aberration on aperture averaged scintillations in oceanic turbulence

    Science.gov (United States)

    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.

  15. 3D-QSAR Studies on Barbituric Acid Derivatives as Urease Inhibitors and the Effect of Charges on the Quality of a Model

    Directory of Open Access Journals (Sweden)

    Zaheer Ul-Haq

    2016-04-01

    Full Text Available 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.

  16. 3D-QSAR Studies on Barbituric Acid Derivatives as Urease Inhibitors and the Effect of Charges on the Quality of a Model.

    Science.gov (United States)

    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.

  17. SUZAKU OBSERVATIONS OF SUBHALOS IN THE COMA CLUSTER

    Energy Technology Data Exchange (ETDEWEB)

    Sasaki, Toru; Matsushita, Kyoko; Sato, Kosuke [Department of Physics, Tokyo University of Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601 (Japan); Okabe, Nobuhiro, E-mail: j1213703@ed.tus.ac.jp, E-mail: matusita@rs.kagu.tus.ac.jp [Department of Physical Science, Hiroshima University, 1-3-1 Kagamiyama, Higashi-Hiroshima, Hiroshima 739-8526 (Japan)

    2015-06-10

    We observed three massive subhalos in the Coma cluster with Suzaku. These subhalos, labeled “ID 1,” “ID 2,” and “ID 32,” were detected with a weak-lensing survey using Subaru/Suprime-Cam, and are located at the projected distances of 1.4 r{sub 500}, 1.2 r{sub 500}, and 1.6 r{sub 500} from the center of the Coma cluster, respectively. The subhalo “ID 1” has a compact X-ray excess emission close to the center of the weak-lensing mass contour, and the gas mass to weak-lensing mass ratio is about 0.001. The temperature of the emission is about 3 keV, which is slightly lower than that of the surrounding intracluster medium (ICM) and that expected for the temperature versus mass relation of clusters of galaxies. The subhalo “ID 32” shows an excess emission whose peak is shifted toward the opposite direction from the center of the Coma cluster. The gas mass to weak-lensing mass ratio is also about 0.001, which is significantly smaller than regular galaxy groups. The temperature of the excess is about 0.5 keV and significantly lower than that of the surrounding ICM and far from the temperature versus mass relation of clusters. However, there is no significant excess X-ray emission in the “ID 2” subhalo. Assuming an infall velocity of about 2000 km s{sup −1}, at the border of the excess X-ray emission, the ram pressures for “ID 1” and “ID 32” are comparable to the gravitational restoring force per area. We also studied the effect of the Kelvin–Helmholtz instability to strip the gas. Although we found X-ray clumps associated with the weak-lensing subhalos, their X-ray luminosities are much lower than the total ICM luminosity in the cluster outskirts.

  18. Infrared emission from dust in the Coma cluster of galaxies

    International Nuclear Information System (INIS)

    Dwek, E.; Rephaeli, Y.; Mather, J.C.

    1990-01-01

    Detailed calculations of the infrared emission from collisionally heated dust in the Coma cluster are presented. The proposed model includes continuous dust injection from galaxies, grain destruction by sputtering, and transient grain heating by the hot plasma. The computed infrared fluxes are in agreement with the upper limits obtained from the IRAS. The calculations, and constraints implied by the IRAS observations, suggest that the intracluster dust in the central region of the cluster must be significantly depleted compared to interstellar abundances. The observed visual extinction can therefore not be attributed to the presence of dust in that region. Extinction due to cluster galaxies or their haloes is ruled out as well. The only alternative explanation is that the extinction is caused by dust at great distances from the cluster center. 30 refs

  19. Phase Synchronization in Electroencephalographic Recordings Prognosticates Outcome in Paediatric Coma

    Science.gov (United States)

    Nenadovic, Vera; Perez Velazquez, Jose Luis; Hutchison, James Saunders

    2014-01-01

    Brain injury from trauma, cardiac arrest or stroke is the most important cause of death and acquired disability in the paediatric population. Due to the lifetime impact of brain injury, there is a need for methods to stratify patient risk and ultimately predict outcome. Early prognosis is fundamental to the implementation of interventions to improve recovery, but no clinical model as yet exists. Healthy physiology is associated with a relative high variability of physiologic signals in organ systems. This was first evaluated in heart rate variability research. Brain variability can be quantified through electroencephalographic (EEG) phase synchrony. We hypothesised that variability in brain signals from EEG recordings would correlate with patient outcome after brain injury. Lower variability in EEG phase synchronization, would be associated with poor patient prognosis. A retrospective study, spanning 10 years (2000–2010) analysed the scalp EEGs of children aged 1 month to 17 years in coma (Glasgow Coma Scale, GCS, <8) admitted to the paediatric critical care unit (PCCU) following brain injury from TBI, cardiac arrest or stroke. Phase synchrony of the EEGs was evaluated using the Hilbert transform and the variability of the phase synchrony calculated. Outcome was evaluated using the 6 point Paediatric Performance Category Score (PCPC) based on chart review at the time of hospital discharge. Outcome was dichotomized to good outcome (PCPC score 1 to 3) and poor outcome (PCPC score 4 to 6). Children who had a poor outcome following brain injury secondary to cardiac arrest, TBI or stroke, had a higher magnitude of synchrony (R index), a lower spatial complexity of the synchrony patterns and a lower temporal variability of the synchrony index values at 15 Hz when compared to those patients with a good outcome. PMID:24752289

  20. Binary model for the coma cluster of galaxies

    International Nuclear Information System (INIS)

    Valtonen, M.J.; Byrd, G.G.

    1979-01-01

    We study the dynamics of galaxies in the Coma cluster and find that the cluster is probably dominated by a central binary of galaxies NGC 4874--NGC4889. We estimate their total mass to be about 3 x 10 14 M/sub sun/ by two independent methods (assuming in Hubble constant of 100 km s -1 Mpc -1 ). This binary is efficient in dynamically ejecting smaller galaxies, some of of which are seen in projection against the inner 3 0 radius of the cluster and which, if erroneously considered as bound members, cause a serious overestimate of the mass of the entire cluster. Taking account of the ejected galaxies, we estimate the total cluster mass to be 4--9 x 10 14 M/sub sun/, with a corresponding mass-to-light ratio for a typical galaxy in the range of 20--120 solar units. The origin of the secondary maximum observed in the radial surface density profile is studied. We consider it to be a remnant of a shell of galaxies which formed around the central binary. This shell expanded, then collapsed into the binary, and is now reexpanding. This is supported by the coincidence of the minimum in the cluster eccentricity and radical velocity dispersion at the same radial distance as the secondary maximum. Numerical simulations of a cluster model with a massive central binary and a spherical shell of test particles are performed, and they reproduce the observed shape, galaxy density, and radial velocity distributions in the Coma cluster fairly well. Consequences of extending the model to other clusters are discussed

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

    Directory of Open Access Journals (Sweden)

    Yosuke Ono

    2017-04-01

    Full Text Available Background: 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. Methods: 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. Results: 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. Conclusions: 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.

  2. {sup 1} H and {sup 13} C NMR studies on the enoling of 5-benzyl barbituric acids; Estudos por H-1 e C-13 RMN da enolizacao de acidos 5-benzil barbituricos

    Energy Technology Data Exchange (ETDEWEB)

    Villar, Jose Daniel Figueroa; Santos, Nedina Lucia dos; Cruz, Elizabete Rangel [Instituto Militar de Engenharia (IME), Rio de Janeiro, RJ (Brazil). Secao de Quimica

    1992-12-31

    This work shows that the derivatives of the 5-benzyl barbituric acids hydroxylated at the ortho position of the aromatic ring only exist in the enol form. and that the alkylation of this hydroxyl gives products which exist mainly in the ketone form of the DMSO 5 refs., 2 figs., 2 tabs.

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

    Science.gov (United States)

    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 (pcoma and poor outcome in SAH are associated with an aneurysmal origin and do not characterize naSAH. Copyright © 2013 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

    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 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

  5. Molecular distribution in the comae of H2O-comets: an analytic model

    International Nuclear Information System (INIS)

    Yamamoto, T.

    1981-01-01

    Density distribution in cometary comae resulting from photodissociation, ionization and ion-molecule reaction of H 2 O is investigated in an analytic manner. It is assumed that particles expand isotropically around the nucleus, and that each species has its own constant radial velocity. Formulae for the density distribution of photochemical products are presented throughout the coma, and approximate formulae are given for the distribution of ion-molecule reaction products in the inner coma. Characteristics of the density profile are discussed on the basis of these analytic formulae. (Auth.)

  6. 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.

    Science.gov (United States)

    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.

  7. Effect of barbiturates on radiosensitivity of cells: a comparative study of electrophoretic mobility, colony forming ability and thymidine uptake on human amnion cells

    International Nuclear Information System (INIS)

    Lalwani, N.D.; Chaubal, K.A.

    1980-01-01

    Suspensions of human amnion cells were 60 Co γ-irradiated in the presence of phenobarbital or thiobarbital (50 μg/ml). The barbiturates protected the cells against the dose-dependent reduction in electrophoretic mobility (EPM) observed 4 hours after irradiation of untreated cells, although there was an initial decrease in the EPM of treated cells followed by recovery. Treated irradiated cells exhibited greater colony-forming ability than the untreated cells. Pentobarbital and phenobarbital had similar effects, but thiobarbital was not so effective. 3 H-TdR uptake increased within 4 hours of irradiation for the treated cells. The reproductive capacity of the cells was retained at doses as high as 500 rad. The results are discussed with reference to the effects of anaesthetics on cell membranes. (U.K.)

  8. 5-(2-Cyclohexylideneethyl)-5-ethyl barbituric acid (CHEB): correlation of hypnotic and convulsant properties with alterations of synaptosomal 45Ca2+ influx

    International Nuclear Information System (INIS)

    Chandler, L.J.; Leslie, S.W.; Gonzales, R.

    1986-01-01

    Male ICR mice were given either 5-(2-cyclohexylideneethyl)-5-ethyl barbituric acid (CHEB) alone or CHEB after a 1 h pretreatment with phenobarbital CHEB alone produced excitatory behavior but not convulsive seizures. Higher doses produced convulsive seizures resulting in death. Pretreatment with phenobarbital prevented seizure activity. In vitro, CHEB significantly inhibited 'fast-phase' K + -stimulated 45 Ca 2+ uptake into cerebrocortical synaptosomes. CHEB also significantly increased basal 45 Ca 2+ uptake. The addition of CHEB or pentobarbital to striatal synaptosomes inhibited 'fast-phase' K + -stimulated 45 Ca 2+ uptake and endogenous dopamine release. CHEB, but not pentobarbital, produced a time- and dose-dependent increase in the resulting release of endogenous dopamine from striatal synaptosomes. The results of this study show that CHEB possesses hypnotic activity if its lethal convulsant actions are blocked. The hypnotic actions of CHEB appear to correlate with inhibition of voltage-dependent calcium channels in brain synaptosomes. (Auth.)

  9. Hyperosmolar non-ketotic diabetic coma as a cause of emergency ...

    African Journals Online (AJOL)

    Five of the known diabetic patients had defaulted from treatment (2 deaths). .... volume and type of fluid used in the treatment of HNKC and the final outcome; it ... Krentz AJ, Nattrass M. Diabetic ketoacidosis, non-ketotic hyperosmolar coma and.

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

    Science.gov (United States)

    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.

  11. Disruption of posteromedial large-scale neural communication predicts recovery from coma.

    Science.gov (United States)

    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 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 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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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).

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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

  17. CoMA, an instrument for the detailed in-situ analysis of collected cometary particulates

    International Nuclear Information System (INIS)

    Kissel, J.; Fechtig, H.; Jessberger, E.K.; Krueger, F.R.; Niemczyk, N.; Schaefer, G.; Zscheeg, H.

    1988-01-01

    The proposal for CoMA, a pulsed time-of-flight SIMS instrument to be flown onboard CRAF to rendezvous with a comet, had been accepted by NASA in October 1986. After several attempts it seems that funding by BMFT for the instrument pre-development phase can be obtained. Apart from that we made first essential progress in producing the primary ion pulses from an indium liquid metal ion source. Those pulses are needed to operate CoMA. (orig.)

  18. Solar wind effects on the outer ion coma of Comet Halley

    International Nuclear Information System (INIS)

    Flammer, K.R.

    1987-01-01

    A simple two-dimensional model is developed to examine the composition of the cometary ion coma in the region outside the ionopause which is strongly affected by the solar wind. Two-dimensional ion distributions are obtained assuming a cylindrically symmetric ion coma which accounts for the dynamic effects of the mass-loaded solar wind flow around the cometary ionosphere. The results of this model are discussed in the context of analyzing the GIOTTO ion data

  19. Soft x-ray emission from the direction of the Coma cluster

    International Nuclear Information System (INIS)

    Hayakawa, Satio; Tanaka, Yasuo; Yamashita, Koujun; Bleeker, J.A.M.; Deerenberg, A.J.M.

    1975-01-01

    A soft X-ray source was observed in the direction of the Coma cluster. The flux in the energy range 0.2--0.4 keV was found to change within a time scale shorter than 80 s. The fast transient and the energy spectrum prohibit identification of this source with the Coma cluster. It is suggested that this source belongs to a class of nearby transient soft X-ray sources. (auth.)

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

    OpenAIRE

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

    2017-01-01

    Background: 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. Methods: 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 myxedem...

  1. Lithium toxicity precipitated by thyrotoxicosis due to silent thyroiditis: cardiac arrest, quadriplegia, and coma.

    Science.gov (United States)

    Sato, Yoshinori; Taki, Katsumi; Honda, Yuki; Takahashi, Shoichiro; Yoshimura, Ashio

    2013-06-01

    Lithium is widely used to treat bipolar disorders. Lithium toxicity is generally caused by inappropriately high doses of lithium or impaired lithium excretion. Most lithium is eliminated via the kidneys and, since thyroid hormone increases tubular reabsorption of lithium, thyrotoxicosis could contribute to the development of lithium toxicity. We report a case of severe lithium toxicity that was apparently precipitated by the onset of thyrotoxicosis resulting from silent thyroiditis and dehydration. The patient was a 64-year-old woman who was admitted for muscle weakness in the lower extremities, diarrhea, and palpitations. She had bipolar disorder and was being treated with lithium carbonate, which she discontinued one week before admission. Her circulating lithium levels had been monitored yearly. Early in her admission she was dehydrated and had febrile episodes, paroxysmal atrial fibrillation, and muscle weakness. Initially, fluid therapy was started, but she lost consciousness and had a cardiac arrest for 2 minutes due to prolonged sinus arrest. Chest compression and manual artificial ventilation were performed, and body surface pacing was started. Serum lithium was markedly elevated to 3.81 mEq/L (therapeutic range, 0.4-1.0 mEq/L), and thyroid hormone levels were increased (free triiodothyronine, 8.12 pg/mL; free thyroxine, 4.45 ng/dL), while thyrotropin (TSH) was suppressed (quadriplegia and deep coma. She gradually recovered. On day 36, she was discharged without any neurological symptoms or thyrotoxicosis. A 64-year-old woman taking lithium for bipolar disorder developed lithium toxicity in the setting of what seemed likely to be a recent onset of thyrotoxicosis due to silent thyroiditis. Thyrotoxicosis may be a contributing cause of lithium toxicity, particularly if it is abrupt in onset and even with cessation of lithium therapy if renal function is compromised. Thyroid function should be assessed immediately in patients with suspected lithium

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  7. Photographic measurements of the diffuse light in the coma cluster

    International Nuclear Information System (INIS)

    Thuan, T.X.; Kormendy, J.

    1977-01-01

    The diffuse background light in the Coma cluster is measured using isodensity tracings of B, G, V, and R photographic plates taken with the Palomar 1.2-m Schmidt telescope. The isodensity contours are calibrated using the star profile derived by Kormendy (1973). Between 4 and 14 arc min from the center, the surface brightness of the diffuse light decreases from approximately 26 to approximately 28 G magnitudes arc sec -2 . The total magnitude in this annulus is G = 11.22, which is approximately 45 percent of the light in galaxies alone, or approximately 30 percent of the total. This does little to alleviate the ''missing mass'' problem. The isodensity contours and the equivalent profile of the diffuse light closely parallel the distribution of light in galaxies, implying no strong mass segregation. However, the background light appears to be bluer than the galaxies. This is consistent with the hypothesis that the background consists of stars tidally stripped from galaxies, which generally become bluer at larger radii. The present technique is very different from methods used in the past. Comparison of a variety of measurements shows that a reasonably consistent body of data on the background light now exists

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  10. Coma cluster ultradiffuse galaxies are not standard radio galaxies

    Science.gov (United States)

    Struble, Mitchell F.

    2018-02-01

    Matching members in the Coma cluster catalogue of ultradiffuse galaxies (UDGs) from SUBARU imaging with a very deep radio continuum survey source catalogue of the cluster using the Karl G. Jansky Very Large Array (VLA) within a rectangular region of ∼1.19 deg2 centred on the cluster core reveals matches consistent with random. An overlapping set of 470 UDGs and 696 VLA radio sources in this rectangular area finds 33 matches within a separation of 25 arcsec; dividing the sample into bins with separations bounded by 5, 10, 20 and 25 arcsec finds 1, 4, 17 and 11 matches. An analytical model estimate, based on the Poisson probability distribution, of the number of randomly expected matches within these same separation bounds is 1.7, 4.9, 19.4 and 14.2, each, respectively, consistent with the 95 per cent Poisson confidence intervals of the observed values. Dividing the data into five clustercentric annuli of 0.1° and into the four separation bins, finds the same result. This random match of UDGs with VLA sources implies that UDGs are not radio galaxies by the standard definition. Those VLA sources having integrated flux >1 mJy at 1.4 GHz in Miller, Hornschemeier and Mobasher without SDSS galaxy matches are consistent with the known surface density of background radio sources. We briefly explore the possibility that some unresolved VLA sources near UDGs could be young, compact, bright, supernova remnants of Type Ia events, possibly in the intracluster volume.

  11. Assessment of physicians' knowledge of Glasgow coma score.

    Science.gov (United States)

    Emejulu, Jkc; Nkwerem, Spu; Ekweogwu, O C

    2014-01-01

    Glasgow Coma Scale (GCS) is the most commonly used tool in assessing comatose patients. It is simple, easily communicable, and useful in prognostication and determination of the treatment modality in head injury. Unfortunately, a high percentage of clinicians who are not in the emergency or neurological services are not conversant with this life-saving tool. The objective of this study was to assess the level of knowledge of GCS among physicians practicing in a tertiary institution in South-East Nigeria, and to evaluate the call for a new and simpler scoring system. This study was carried out using the instrument of a structured-questionnaire in Nnamdi Azikiwe University Teaching Hospital Nnewi, a federal government tertiary health institution in South-East Zone of Nigeria, which is a 350-bed facility employing about 550 medical doctors of different cadres. A total of 139 questionnaires were distributed to the doctors practicing in the institution who consented to participating in the study. The questionnaires were completed at the point of their administration and completed questionnaires were retrieved on the spot, and data were collated, and analyzed with the Statistical Package for Social Sciences, SPSS version 17.0. Statistical significance was calculated with the chi square, P ≤ 0.5. The modal age group was 20-30 years 66 (48%), and most were resident doctors 99 (66.2%). One week prior to the questionnaire distribution, 56 (42.1%) had been actively involved in emergency care of patients, and 41 (30%) could not recall what GCS stood for. Medical and house officers showed a better knowledge of GCS. There was a poor knowledge of GCS among a good number of physicians practicing in our setting and hence, continuing medical education on GCS is strongly advocated.

  12. The reliability of the Glasgow Coma Scale: a systematic review.

    Science.gov (United States)

    Reith, Florence C M; Van den Brande, Ruben; Synnot, Anneliese; Gruen, Russell; Maas, Andrew I R

    2016-01-01

    The Glasgow Coma Scale (GCS) provides a structured method for assessment of the level of consciousness. Its derived sum score is applied in research and adopted in intensive care unit scoring systems. Controversy exists on the reliability of the GCS. The aim of this systematic review was to summarize evidence on the reliability of the GCS. A literature search was undertaken in MEDLINE, EMBASE and CINAHL. Observational studies that assessed the reliability of the GCS, expressed by a statistical measure, were included. Methodological quality was evaluated with the consensus-based standards for the selection of health measurement instruments checklist and its influence on results considered. Reliability estimates were synthesized narratively. We identified 52 relevant studies that showed significant heterogeneity in the type of reliability estimates used, patients studied, setting and characteristics of observers. Methodological quality was good (n = 7), fair (n = 18) or poor (n = 27). In good quality studies, kappa values were ≥0.6 in 85%, and all intraclass correlation coefficients indicated excellent reliability. Poor quality studies showed lower reliability estimates. Reliability for the GCS components was higher than for the sum score. Factors that may influence reliability include education and training, the level of consciousness and type of stimuli used. Only 13% of studies were of good quality and inconsistency in reported reliability estimates was found. Although the reliability was adequate in good quality studies, further improvement is desirable. From a methodological perspective, the quality of reliability studies needs to be improved. From a clinical perspective, a renewed focus on training/education and standardization of assessment is required.

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

    Science.gov (United States)

    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.

  14. Induction of burst suppression or coma using intravenous anesthetics in refractory status epilepticus.

    Science.gov (United States)

    Kang, Bong Su; Jung, Keun-Hwa; Shin, Jeong-Won; Moon, Jang Sup; Byun, Jung-Ick; Lim, Jung-Ah; Moon, Hye Jin; Kim, Young-Soo; Lee, Soon-Tae; Chu, Kon; Lee, Sang Kun

    2015-05-01

    General anesthetic-induced coma therapy has been recommended for the treatment of refractory status epilepticus (RSE). However, the influence of electroencephalographic (EEG) burst suppression (BS) on outcomes still remains unclear. This study investigated the impact of intravenous anesthetic-induced BS on the prognosis of RSE using a retrospective analysis of all consecutive adult patients who received intravenous anesthetic treatment for RSE at the Seoul National University Hospital between January 2006 and June 2011. Twenty-two of the 111 episodes of RSE were enrolled in this study. Of the 22 RSE patients, 12 (54.5%) were women and 18 (81.4%) exhibited generalized convulsive status epilepticus. Sixteen patients (72.7%) were classified as having acute symptomatic etiology, including three patients with anoxic encephalopathy, and others with remote symptomatic etiology. Only two patients (9.1%) had a favorable Status Epilepticus Severity Score (0-2) at admission. All patients received midazolam (MDZ) as a primary intravenous anesthetic drug for RSE treatment; three (13.6%) received MDZ and propofol, and one (4.5%) received MDZ and pentobarbital. The rates of mortality and poor outcome at discharge were 13.6% (n=3) and 54.5% (n=12), respectively. While BS was achieved in six (27.5%) patients, it was not associated with mortality or poor outcome. Induced BS was associated with prolonged hospital stay in subgroup analysis when excluding anoxic encephalopathy. Our results suggest that induction of BS for treating RSE did not affect mortality or outcome at discharge and may lead to an increased length of hospital stay. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Multiwalled carbon nanotubes as a solid-phase extraction adsorbent for the determination of three barbiturates in pork by ion trap gas chromatography-tandem mass spectrometry (GC/MS/MS) following microwave assisted derivatization

    Energy Technology Data Exchange (ETDEWEB)

    Zhao Haixiang [College of Science, China Agricultural University, Beijing 100094 (China); Inspection Technology and Equipment Institute, Chinese Academy of Inspection and Quarantine, Beijing 100025 (China); Department of Basic Agricultural Science, Hebei North College, Zhangjiakou Hebei 075131 (China); Wang Liping [College of Science, China Agricultural University, Beijing 100094 (China); Qiu Yueming [Inspection Technology and Equipment Institute, Chinese Academy of Inspection and Quarantine, Beijing 100025 (China); Zhou Zhiqiang [College of Science, China Agricultural University, Beijing 100094 (China)]. E-mail: zqzhou@cau.edu.cn; Zhong Weike [Inspection Technology and Equipment Institute, Chinese Academy of Inspection and Quarantine, Beijing 100025 (China); Li Xiang [Inspection Technology and Equipment Institute, Chinese Academy of Inspection and Quarantine, Beijing 100025 (China)

    2007-03-14

    A new method was developed for the rapid screening and confirmation analysis of barbital, amobarbital and phenobarbital residues in pork by gas chromatography-tandem mass spectrometry (GC/MS/MS) with ion trap MSD. The residual barbiturates in pork were extracted by ultrasonic extraction, cleaned up on a multiwalled carbon nanotubes (MWCNTs) packed solid phase extraction (SPE) cartridge and applied acetone-ethyl acetate (3:7, v/v) mixture as eluting solvent and derivatized with CH{sub 3}I under microwave irradiation. The methylated barbiturates were separated on a TR-5MS capillary column and detected with an ion trap mass detector. Electron impact ion source (EI) operating MS/MS mode was adopted for identification and external standard method was employed for quantification. One precursor ion m/z 169 was selected for analysis of barbital and amobarbital and m/z 232 was selected for phenobarbital. The product ions were obtained under 1.0 V excitation voltage. Good linearities (linear coefficient R > 0.99) were obtained at the range of 0.5-50 {mu}g kg{sup -1}. Limit of detection (LOD) of barbital was 0.2 {mu}g kg{sup -1} and that of amobarbital and phenobarbital were both 0.1 {mu}g kg{sup -1} (S/N {>=} 3). Limit of quatification (LOQ) was 0.5 {mu}g kg{sup -1} for three barbiturates (S/N {>=} 10). Satisfying recoveries ranging from 75% to 96% of the three barbiturates spiked in pork were obtained, with relative standard deviations (R.S.D.) in the range of 2.1-7.8%.

  16. Multiwalled carbon nanotubes as a solid-phase extraction adsorbent for the determination of three barbiturates in pork by ion trap gas chromatography-tandem mass spectrometry (GC/MS/MS) following microwave assisted derivatization

    International Nuclear Information System (INIS)

    Zhao Haixiang; Wang Liping; Qiu Yueming; Zhou Zhiqiang; Zhong Weike; Li Xiang

    2007-01-01

    A new method was developed for the rapid screening and confirmation analysis of barbital, amobarbital and phenobarbital residues in pork by gas chromatography-tandem mass spectrometry (GC/MS/MS) with ion trap MSD. The residual barbiturates in pork were extracted by ultrasonic extraction, cleaned up on a multiwalled carbon nanotubes (MWCNTs) packed solid phase extraction (SPE) cartridge and applied acetone-ethyl acetate (3:7, v/v) mixture as eluting solvent and derivatized with CH 3 I under microwave irradiation. The methylated barbiturates were separated on a TR-5MS capillary column and detected with an ion trap mass detector. Electron impact ion source (EI) operating MS/MS mode was adopted for identification and external standard method was employed for quantification. One precursor ion m/z 169 was selected for analysis of barbital and amobarbital and m/z 232 was selected for phenobarbital. The product ions were obtained under 1.0 V excitation voltage. Good linearities (linear coefficient R > 0.99) were obtained at the range of 0.5-50 μg kg -1 . Limit of detection (LOD) of barbital was 0.2 μg kg -1 and that of amobarbital and phenobarbital were both 0.1 μg kg -1 (S/N ≥ 3). Limit of quatification (LOQ) was 0.5 μg kg -1 for three barbiturates (S/N ≥ 10). Satisfying recoveries ranging from 75% to 96% of the three barbiturates spiked in pork were obtained, with relative standard deviations (R.S.D.) in the range of 2.1-7.8%

  17. THE SPATIAL DISTRIBUTION OF OH AND CN RADICALS IN THE COMA OF COMET ENCKE

    International Nuclear Information System (INIS)

    Ihalawela, Chandrasiri A.; Pierce, Donna M.; Dorman, Garrett R.; Cochran, Anita L.

    2011-01-01

    Multiple potential parent species have been proposed to explain CN abundances in comet comae, but the parent has not been definitively identified for all comets. This study examines the spatial distribution of CN radicals in the coma of comet Encke and determines the likelihood that CN is a photodissociative daughter of HCN in the coma. Comet Encke is the shortest orbital period (3.3 years) comet known and also has a low dust-to-gas ratio based on optical observations. Observations of CN were obtained from 2003 October 22 to 24, using the 2.7 m telescope at McDonald Observatory. To determine the parent of CN, the classical vectorial model was modified by using a cone shape in order to reproduce Encke's highly aspherical and asymmetric coma. To test the robustness of the modified model, the spatial distribution of OH was also modeled. This also allowed us to obtain CN/OH ratios in the coma. Overall, we find the CN/OH ratio to be 0.009 ± 0.004. The results are consistent with HCN being the photodissociative parent of CN, but we cannot completely rule out other possible parents such as CH 3 CN and HC 3 N. We also found that the fan-like feature spans ∼90°, consistent with the results of Woodney et al..

  18. HI-deficient spiral galaxies in the Coma cluster and Abell 1367

    International Nuclear Information System (INIS)

    Sullivan, W.T. III; Johnson, P.E.

    1978-01-01

    A sample of 11 spiral galaxies in each of the clusters Abell 1367 and Coma (Abell 1656) was observed in the 21-cm H I line with the Arecibo 305-m radio telescope. Nine galaxies are detected in Al367 and three in Coma. Comparison of the quantity log M/sub H/L/sub pg/ for each galaxy with the mean value for its Hubble type from the standard samples of nearby spirals compiled by Balkowski and by Roberts indicates that the A1367 and Coma spirals have lower values of log M/sub H/L/sub pg/ than field spirals by a factor of at least 4, with the Coma values probably more extreme. It is argued that little of this effect (perhaps a factor approx. 1.5) can be attributed to the bias toward high luminosities in the sample, and thus that these spirals are deficient in H I by factors of at least 3 to 5 in comparison with the standard samples. For the present limited sample, several mechanisms seem adequate to account qualitatively for stripping of H I from the Coma cluster spirals, but the case of the A1367 spirals is puzzling. 2 figures

  19. A computational and observational study of peculiar galaxies in the Coma cluster

    International Nuclear Information System (INIS)

    Fujimoto, Mitsuaki; Sofue, Yoshiaki; Jugaku, Jun.

    1977-01-01

    Expected numbers of elliptical galaxies distorted tidally in the Coma cluster are formulated in terms of the various parameters of the cluster, and of cross section of galaxy-galaxy encounters and duration of associated tidal distributions. For the latter two quantities, numerical computations are carried out by simulating elliptical galaxies with hundreds of test particles. Comparisons are made with the number of peculiar galaxies observed in the Coma cluster. The hypothesis that the ''missing mass'' of the Coma cluster is hidden in the form of invisible galaxies or huge black holes of ordinary galaxy masses is also tested. It is concluded that tidal interaction between the visible galaxies plays only a minor role in the origin of the peculiar galaxies in the Coma cluster. Most of them would be due to their individual non-tidal mechanisms. If invisible galaxies or massive black holes are assumed as cluster members, their encounters with the luminous members increase the frequency of observable tidal distortion, and approximately half of the number of the peculiar galaxies could be explained in terms of tidal interaction. This result is discussed in relation to some special types of the peculiar galaxies in the Coma cluster. (auth.)

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

    Science.gov (United States)

    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).

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

    Science.gov (United States)

    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.

  2. An analysis of CCD images of the coma of Comet Halley. Final report, October 1989-September 1990

    International Nuclear Information System (INIS)

    Combi, M.

    1990-12-01

    The analysis of selected CCD images of the coma of comet P/Halley is presented. The images were taken using specially designed filters that isolate regions of a comet's spectrum such that only sunlight which has been scattered by the dust in the coma is recorded. The modeling analysis objective is to make use of the skills developed in the development of Monte Carlo particle trajectory models for the distributions of gas species in cometary comae and to use those models as a basis for a new dust coma model. This model will include a self-consistant picture of the time-dependent dusty-gas dynamics of the inner coma and the three-dimensional time-dependent trajectories of the dust particles under the influence of solar gravity and solar radiation pressure in the outer coma. The model is intended to be used as a tool to analyze selected images from the two sets of CCD images with the hope that it will help the understanding of the effects of a number of important processes on the spatial morphology of the observed dust coma. The processes of importance to the observed dust coma include: (1) the dust particle size distribution function; (2) the terminal velocities of various sized dust particles in the inner coma; (3) the radiation scattering properties of dust particles, which are important both in terms of the observe scattered radiation and the radiation pressure acceleration on dust particles; (4) the fragmentation and/or vaporization of dust particles; and (5) the relative importance of CHON and silicate dust particles as they contribute both to the dusty-gasdynamics in the inner coma (that produce the dust particle terminal velocities) and to the observed spatial morphology on the outer dust coma

  3. Chameleonic contribution to the Sunyaev-Zel'dovich radial profile of the Coma cluster

    International Nuclear Information System (INIS)

    Davis, Anne-Christine; Schelpe, Camilla A. O.; Shaw, Douglas J.

    2011-01-01

    We constrain the chameleonic Sunyaev-Zel'dovich (CSZ) effect in the Coma cluster from measurements of the Coma radial profile presented in the WMAP 7-year results. The CSZ effect arises from the interaction of a scalar (or pseudoscalar) particle with the cosmic microwave background in the magnetic field of galaxy clusters. We combine this radial profile data with SZ measurements towards the center of the Coma cluster in different frequency bands, to find ΔT SZ,RJ (0)=-410±50 μK and ΔT CSZ 204 GHz (0) > or approx. -50 μK (at 95% confidence) for the thermal SZ and CSZ effects in the cluster, respectively. This leads to an estimated bound on the photon to scalar (or pseudoscalar) coupling strength of g eff -10 GeV -1 .

  4. Cometary models - excitation of molecules at radio wavelengths and thermodynamics of the coma

    International Nuclear Information System (INIS)

    Crovisier, J.

    1987-01-01

    Models for molecular excitation under physical conditions of cometary atmospheres are obviously a requisite for interpreting radio spectroscopic observations of comets. A review of such models is presented. The prevailing excitation mechanism for the rotational lines of parent molecules is pumping of the fundamental vibrational bands by the solar infrared radiation field, followed by spontaneous decay; the molecular rotational population is then at fluorescence equilibrium. Another competing mechanism in the inner coma is thermal excitation by collisions. Its evaluation needs the knowledge of the coma kinetic temperature law, which up to now can only be achieved by modeling the coma thermodynamics. A review of cometary thermodynamical models is also given here, and the relations between such models and cometary molecular observations are discussed. 50 references

  5. ALP conversion and the soft X-ray excess in the outskirts of the Coma cluster

    International Nuclear Information System (INIS)

    Kraljic, David; Rummel, Markus; Conlon, Joseph P.

    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 to 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

  6. H-alpha observations of spiral galaxies in Cancer, A1367, and Coma

    International Nuclear Information System (INIS)

    Kennicutt, R.C.; Bothun, G.D.; Schommer, R.A.

    1984-01-01

    We have used large aperture Hα photometry of 65 spiral galaxies in the Cancer, Coma, and Abell 1367 clusters to compare the ionized-gas contents and star-formation rates in cluster and field spirals. Overall, we do not observe any significant deficiency of Hα emission in the cluster members. Emission strength correlates strongly with integrated galaxy colors, but only weakly with H I content. All three clusters contain several galaxies with unusually strong Hα emission, including several H I-poor objects in Coma and A1367. Thus, spirals which appear ''anemic'' in their morphology or exhibit weak Hα emission are not necessarily H I poor; conversely, H I poor spirals can show strong Hα emission, indicating relatively high current star-formation rates. Gas depletion time scales for some objects in the core of Coma are significantly shorter than the field, indicating rapid stellar and gaseous evolution

  7. Dark energy and the structure of the Coma cluster of galaxies

    Science.gov (United States)

    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 (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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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

  10. New spiro (thio barbiturates based on cyclohexanone and bicyclo [3.1.1]heptan-6-one by nonconcerted [1+5] cycloaddition reaction and their conformational structures

    Directory of Open Access Journals (Sweden)

    N. N. Pesyan

    2014-09-01

    Full Text Available Crossed-aldol condensation reaction of aromatic aldehydes with ketones such as; acetone and cyclohexanone leads to the efficient formation of cross conjugated α,β-unsaturated ketones in excellent yield. The intermolecular and then intramolecular Michael addition reaction of α,β-unsaturated ketones derived from acetone and cyclohexanone with (thiobarbituric acids lead to synthesis new type of 7,11-diaryl-2,4-diazaspiro[5.5]undecane-1,3,5,9-tetraone and 2,4-diaryl-1'H-spiro[bicyclo[3.3.1]nonane-3,5'-pyrimidine]-2',4',6',9(3'H-tetraone, respectively in good yield. Structure elucidation is carried out by 1H NMR, 13C NMR, FT-IR, UV-Visible, mass spectroscopy and X-ray crystallography techniques. A possible mechanism of the formation is discussed. The structural conformation also demonstrated by coupling constants derived from dihedral angles between vicinal and geminal protons. The 1H NMR spectra of NH protons of spiro compounds derived from barbituric acid show a broad singlet peak instead, these protons in the spiro compounds derived from thiobarbituric acid show two distinct peaks. DOI: http://dx.doi.org/10.4314/bcse.v28i3.12

  11. A new synthetic methodology for the preparation of biocompatible and organo-soluble barbituric- and thiobarbituric acid based chitosan derivatives for biomedical applications

    Energy Technology Data Exchange (ETDEWEB)

    Shahzad, Sohail [Interdisciplinary Research Center in Biomedical Materials, COMSATS Institute of Information Technology, Lahore 54000 (Pakistan); Department of Chemistry, The Islamia University of Bahawalpur, Bahawalpur 63100 (Pakistan); Shahzadi, Lubna [Interdisciplinary Research Center in Biomedical Materials, COMSATS Institute of Information Technology, Lahore 54000 (Pakistan); Mahmood, Nasir [Department of Allied Health Sciences and Chemical Pathology, Department of Human Genetics and Molecular Biology, University of Health Sciences, Lahore (Pakistan); Siddiqi, Saadat Anwar [Interdisciplinary Research Center in Biomedical Materials, COMSATS Institute of Information Technology, Lahore 54000 (Pakistan); Rauf, Abdul [Department of Chemistry, The Islamia University of Bahawalpur, Bahawalpur 63100 (Pakistan); Manzoor, Faisal; Chaudhry, Aqif Anwar [Interdisciplinary Research Center in Biomedical Materials, COMSATS Institute of Information Technology, Lahore 54000 (Pakistan); Rehman, Ihtesham ur [Interdisciplinary Research Center in Biomedical Materials, COMSATS Institute of Information Technology, Lahore 54000 (Pakistan); Department of Materials Science and Engineering, The Kroto Research Institute, The University of Sheffield, North Campus, Broad Lane, Sheffield, S3 7HQ (United Kingdom); Yar, Muhammad, E-mail: drmyar@ciitlahore.edu.pk [Interdisciplinary Research Center in Biomedical Materials, COMSATS Institute of Information Technology, Lahore 54000 (Pakistan)

    2016-09-01

    Chitosan's poor solubility especially in organic solvents limits its use with other organo-soluble polymers; however such combinations are highly required to tailor their properties for specific biomedical applications. This paper describes the development of a new synthetic methodology for the synthesis of organo-soluble chitosan derivatives. These derivatives were synthesized from chitosan (CS), triethyl orthoformate and barbituric or thiobarbituric acid in the presence of 2-butannol. The chemical interactions and new functional motifs in the synthesized CS derivatives were evaluated by FTIR, DSC/TGA, UV/VIS, XRD and {sup 1}H NMR spectroscopy. A cytotoxicity investigation for these materials was performed by cell culture method using VERO cell line and all the synthesized derivatives were found to be non-toxic. The solubility analysis showed that these derivatives were readily soluble in organic solvents including DMSO and DMF. Their potential to use with organo-soluble commercially available polymers was exploited by electrospinning; the synthesized derivatives in combination with polycaprolactone delivered nanofibrous membranes. - Highlights: • Development of a new synthetic methodology • Synthesis of organo-soluble chitosan (CS) derivatives • VERO cells proliferation • Nanofibrous membranes from the synthesized chitosan derivatives and polycaprolactone.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

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

    International Nuclear Information System (INIS)

    Wik, Daniel R.; Sarazin, Craig L.; Finoguenov, Alexis; Matsushita, Kyoko; Nakazawa, Kazuhiro; Clarke, Tracy E.

    2009-01-01

    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 from 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 -12 erg s -1 cm -2 (20-80 keV, for Γ = 2.0), which implies a lower limit on the cluster-averaged magnetic field of B>0.15 μG. 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 ∼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.

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

    Science.gov (United States)

    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.

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

    International Nuclear Information System (INIS)

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

    2012-01-01

    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 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 (α ≈ –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 parameterization of the UV LFs resulting in a faint-end slope of α ≈ –1.15 in both GALEX bands. The two-component model gives faint-end slopes shallower than α = –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 UV ≈ –14 owing to a deficit of dwarf star-forming galaxies in Coma with stellar masses below M * = 10 8 M ☉ . 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.

  17. Etiologies et pronostic des comas non-traumatiques de l'enfant a l ...

    African Journals Online (AJOL)

    Objectif. Déterminer la fréquence, le profil clinique, l'étiologie et l'évolution du coma non traumatique de l'enfant de un mois à 16 ans. Méthode. Tous les cas consécutifs de coma identifiés dans les services de pédiatrie du CHU de Lomé ont fait l'objet d'une étude prospective à partir d'une fiche d'enquête préétablie.

  18. Planck intermediate results. X. Physics of the hot gas in the Coma cluster

    DEFF Research Database (Denmark)

    Planck Collaboration,; Ade, P. A. R.; Aghanim, N.

    2013-01-01

    We present an analysis of Planck satellite data on the Coma Cluster observed via the Sunyaev-Zeldovich effect. Planck is able, for the first time, to detect SZ emission up to r ~ 3 X R_500. We test previously proposed models for the pressure distribution in clusters against the azimuthally averaged...... data. We find that the Arnaud et al. universal pressure profile does not fit Coma, and that their pressure profile for merging systems provides a good fit of the data only at rR_500 than the mean pressure profile predicted by the simulations. The Planck image shows significant local steepening of the y...

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

    Science.gov (United States)

    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.

  20. Sudden cardiac arrest as a rare presentation of myxedema coma: case report.

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  2. The HST/ACS Coma Cluster Survey : VI. Colour gradients in giant and dwarf early-type galaxies

    NARCIS (Netherlands)

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

    Using deep, high-spatial-resolution imaging from the Hubble Space Telescope/Advanced Camera for Surveys (HST/ACS) Coma Cluster Treasury Survey, we determine colour profiles of early-type galaxies in the Coma cluster. From 176 galaxies brighter than M-F814W(AB) = -15 mag that are either

  3. Glasgow Coma Scale in acute poisonings before and after use of antidote in patients with history of use of psychotropic agents.

    Science.gov (United States)

    Poplas-Susić, Tonka; Klemenc-Ketis, Zalika; Komericki-Grzinić, Marija; Kersnik, Janko

    2010-01-01

    Data on emergency interventions in poisonings are scarce. Objective To determine the effectiveness of antidote therapy in acute poisoning-related emergency medical services (EMS) interventions. A prospective observational study included all poisoning-related intervention cases over 3 years (1999-2001) in the Celje region, Slovenia, covering 125,000 inhabitants. Data were recorded on an EMS form. Psychoactive agents were present in 56.5% out of 244 poisoning-related EMS interventions. Prescription drugs were a cause of intoxication in 93 (39.2%) cases alone or in combination with alcohol or illegal drugs. More than one fifth of poisonings were due to the use of illegal drugs in 52 (21.9%) cases, 43 (18.1%) out of them heroin related. At the time of EMS arrival, more patients who ingested illegal drugs were in coma or comatose than the rest. 24 (45.3%) vs. 32 (17.3%) of poisoned patients were in coma (p < 0.001). Glasgow Coma Scale (GCS) at the first contact was lower in patients who ingested illegal drugs than in the remaining patients (9.0 vs. 11.6, p = 0.001). In 23.2% of the cases, an antidote was administered. In 29 (12.2%) naloxone and in 16 (6.7%) flumazenil was administered. Mean GCS after intervention was higher in all cases but significantly higher in illegal drug cases, 13.4 vs. 12.2 (p = 0.001), with a mean positive change in GCS of 4.5 vs. 0.6 (p < 0.001). In illegal drug users, mean change after antidote administration was 8.2 vs. 0.5 without antidote administration (p < 0.001). High rate of successful antidote use during the intervention indicated the importance of good EMS protocols and the presence of a skilled doctor in the EMS team.

  4. Glasgow coma scale in acute poisonings before and after use of antidote in patients with history of use of psychotropic agents

    Directory of Open Access Journals (Sweden)

    Poplas-Sušić Tonka

    2010-01-01

    Full Text Available Introduction. Data on emergency interventions in poisonings are scarce. Objective. To determine the effectiveness of antidote therapy in acute poisoning-related emergency medical services (EMS interventions. Methods. A prospective observational study included all poisoning-related intervention cases over 3 years (1999-2001 in the Celje region, Slovenia, covering 125,000 inhabitants. Data were recorded on an EMS form. Results. Psychoactive agents were present in 56.5% out of 244 poisoning-related EMS interventions. Prescription drugs were a cause of intoxication in 93 (39.2% cases alone or in combination with alcohol or illegal drugs. More than one fifth of poisonings were due to the use of illegal drugs in 52 (21.9% cases, 43 (18.1% out of them heroin related. At the time of EMS arrival, more patients who ingested illegal drugs were in coma or comatose than the rest. 24 (45.3% vs. 32 (17.3% of poisoned patients were in coma (p<0.001. Glasgow Coma Scale (GCS at the first contact was lower in patients who ingested illegal drugs than in the remaining patients (9.0 vs. 11.6, p=0.001. In 23.2% of the cases, an antidote was administered. In 29 (12.2% naloxone and in 16 (6.7% flumazenil was administered. Mean GCS after intervention was higher in all cases but significantly higher in illegal drug cases, 13.4 vs. 12.2 (p=0.001, with a mean positive change in GCS of 4.5 vs. 0.6 (p<0.001. In illegal drug users, mean change after antidote administration was 8.2 vs. 0.5 without antidote administration (p<0.001. Conclusion. High rate of successful antidote use during the intervention indicated the importance of good EMS protocols and the presence of a skilled doctor in the EMS team.

  5. 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.

    Science.gov (United States)

    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

  6. Acidosis y coma en el Diabético

    Directory of Open Access Journals (Sweden)

    Alfredo Jácome Roca

    1992-12-01

    Full Text Available

    Definición. La cetoacidosis diabética (CADy la alcohólica, la acidosis láctica y el síndrome hiperosmolar hiperglucémico (SHH a menudo se sobreponen en grado considerable, por lo que los revisaremos en conjunto. Definiremos la cetoacidosLs diabética como la descompensación grave de la diabetes, la emergencia endocrina más común caracterizada por un desequilibrio ácido-básico, de líquidos y electrolitos, asociado a una diuresis osmótica y catabolismo de las grasas por hiperglucemia insulino- deficiente.

    El síndrome hiperosmolar hiperglucémico es de comienzo lento y se caracteriza por trastorno del estado de conciencia, deshidratación profunda e hiperglucemia sin cetoacidosis. La cetoacidosLs alcohólica es un desequilibrio ácido-básico con deshidratación en alcohólicos, mujeres por lo común, no necesariamente diabéticas, aunque puede haber moderada hiperglucemia. La acidos Ls láctica puede ser complicación de un estado de shock y/o deshidratación severa, o de ingesta abundante de alcohol, lo que también puede llevar a hiperuricemia y gota.

    Signos y síntomas. Malestar general, astenia, anorexia, náusea, vómito, dolor abdominal con somnolencia, estupor y/o coma, pueden ser manifestaciones de cualquiera de las entidades arriba mencionadas.

    Sin embargo, aunque tanto en CADcomo en SHH hay signos de deshidratación (sequedad de mucosa con piel seca sin turgencia, ojos hundidos, en el primero hay náusea, vómito y respiración acidótica (rápida y profunda, lo que generalmente falta en el segundo. ElCADes de niños y adultos jóvenes o maduros, con función cardio-renal aceptable mientras que el SHHes más de ancianos, a menudo hipertensos con fallas renal o cardíaca, hemiparéticos, que pueden consultar por convulsiones focales. No siempre el paciente es reconocido como diabético, sobre todo en SHH.

    Lapoliuria y la polidipsia caracterizan a la acidosis diabética y al s

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

    Science.gov (United States)

    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/

  8. Accessibility assessment of MOOC platforms in Spanish: UNED COMA, COLMENIA and Miriada X

    OpenAIRE

    Iniesto, Francisco; Rodrigo, Covadonga

    2014-01-01

    This article develops a methodology for the assessment of MOOC courses, focusing on the degree of accessibility of three Spanish MOOC platforms: UNED COMA, COLMENIA and Miriada X. Four different criteria have been\\ud used in this context: automatic tools, disability simulators, testing tools and educational content

  9. A case report on near manual strangulation and glasgow coma scale.

    African Journals Online (AJOL)

    Abstract. Background: 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 scor- ing of the GCS. Survival from strangulation is uncommon, and if it ...

  10. Hyperosmolar non-ketotic diabetic coma as a cause of emergency ...

    African Journals Online (AJOL)

    %) while 16 admissions (12%) were as a result of hyperosmolar non-ketotic coma (HNKC), defined as hyperglycaemia, dehydration and an altered level of consciousness with a plasma osmolality ≥ 330 and an arterial pH ≥ 7,30, with absent ...

  11. Prognosis of non traumatic coma: The role of some socio-economic ...

    African Journals Online (AJOL)

    Background : Coma occurring in the course of an illness, irrespective of cause, traditionally implies a poor prognosis and many factors may determine its outcome. These factors must be identified and possibly stratified in their order of importance. This research seeks to identify these factors and how they influenced the ...

  12. Nurses assessing pain with the Nociception Coma Scale: interrater reliability and validity

    NARCIS (Netherlands)

    Vink, Peter; Eskes, Anne Maria; Lindeboom, Robert; van den Munckhof, Pepijn; Vermeulen, Hester

    2014-01-01

    The Nociception Coma Scale (NCS) is a pain observation tool, developed for patients with disorders of consciousness (DOC) due to acquired brain injury (ABI). The aim of this study was to assess the interrater reliability of the NCS and NCS-R among nurses for the assessment of pain in ABI patients

  13. VizieR Online Data Catalog: HST/ACS Coma cluster survey. II. (Hammer+, 2010)

    NARCIS (Netherlands)

    Hammer, D.; Verdoes Kleijn, G.; Hoyos, C.; den Brok, M.; Balcells, M.; Ferguson, H. C.; Goudfrooij, P.; Carter, D.; Guzman, R.; Peletier, R. F.; Smith, R. J.; Graham, A. W.; Trentham, N.; Peng, E.; Puzia, T. H.; Lucey, J. R.; Jogee, S.; Aguerri, A. L.; Batcheldor, D.; Bridges, T. J.; Chiboucas, K.; Davies, J. I.; Del Burgo, C.; Erwin, P.; Hornschemeier, A.; Hudson, M. J.; Huxor, A.; Jenkins, L.; Karick, A.; Khosroshahi, H.; Kourkchi, E.; Komiyama, Y.; Lotz, J.; Marzke, R. O.; Marinova, I.; Matkovic, A.; Merritt, D.; Miller, B. W.; Miller, N. A.; Mobasher, B.; Mouhcine, M.; Okamura, S.; Percival, S.; Phillipps, S.; Poggianti, B. M.; Price, J.; Sharples, R. M.; Tully, R. B.; Valentijn, E.

    2010-01-01

    This data release contains catalogs for the ACS Images in F475W and F814W bands of 25 fields in the Coma cluster of galaxies. Each field is about 202x202arcsec. Please see the release notes for further details. (25 data files).

  14. On-chip COMA cache-coherence protocol for microgrids of microthreaded cores

    NARCIS (Netherlands)

    Zhang, L.; Jesshope, C.

    2008-01-01

    This paper describes an on-chip COMA cache coherency protocol to support the microthread model of concurrent program composition. The model gives a sound basis for building multi-core computers as it captures concurrency, abstracts communication and identifies resources, such as processor groups

  15. Morfología de la Coma del Cometa Hale - Bopp

    Science.gov (United States)

    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.

  16. A NuSTAR observation of the center of the coma cluster

    DEFF Research Database (Denmark)

    Gastaldello, Fabio; Wik, Daniel R.; Molendi, S.

    2015-01-01

    . The brightness of the thermal component in this central region does not allow more stringent upper limits on the IC component when compared with non-imaging instruments with much larger fields of view where claims of detections have been made. Future mosaic NuSTAR observations of Coma will further address...

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

    Science.gov (United States)

    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.

  18. Communication Opportunities via Special Messaging Technology for Two Post-Coma Persons with Multiple Disabilities

    Science.gov (United States)

    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…

  19. Discovery of intergalactic radio emission in the Coma-A1367 supercluster

    International Nuclear Information System (INIS)

    Kim, K.T.; Kronberg, P.P.; Venturi, T.

    1989-01-01

    The Coma cluster is a rich cluster of galaxies nested in an even larger super cluster of galaxies. The plane of the supercluster seems to be defined by the Coma cluster itself and another galaxy cluster, Abell 1367, which lies ∼ 40 Mpc farther west. The largest structures known are the giant voids and superclusters which are as large as 70h 75 -1 Mpc (refs 3-5). The Coma cluster of galaxies seems to be located on the rim of a giant void in the three-dimensional distribution of galaxies. Here we describe the detection of faint, supercluster-scale radio emission at 326 MHz that extends between the Coma cluster of galaxies and the Abell 1367 cluster and which is apparently not associated with any individual galaxy system in the complex. The radiation's synchrotron origin implies the existence of a large-scale intercluster magnetic field with an estimated strength of 0.3-0.6 μG, which is remarkably strong. The synchrotron-emitting relativistic electrons cannot be older than a few times 10 8 yr, but we speculate that the magnetic field is the fossil of a pre-galactic primaeval field, which was amplified in the course of the formation of intergalactic voids and superclusters. (author)

  20. FAST MOTIONS OF GALAXIES IN THE COMA I CLOUD: A CASE OF DARK ATTRACTOR?

    International Nuclear Information System (INIS)

    Karachentsev, Igor D.; Nasonova, Olga G.; Courtois, Helene M.

    2011-01-01

    We note that nearby galaxies having high negative peculiar velocities are distributed over the sky very inhomogeneously. A part of this anisotropy is caused by the 'Local Velocity Anomaly', i.e., by the bulk motion of nearby galaxies away from the Local Void. However, half of the fast-flying objects reside within a small region known as the Coma I cloud. According to Makarov and Karachentsev, this complex contains 8 groups, 5 triplets, 10 pairs, and 83 single galaxies with a total mass of 4.7 × 10 13 M ☉ . We use 122 galaxies in the Coma I region with known distances and radial velocities V LG –1 to draw the Hubble relation for them. The Hubble diagram shows a Z-shaped effect of infall with an amplitude of +200 km s –1 on the nearby side and –700 km s –1 on the back side. This phenomenon can be understood as the galaxy infall toward a dark attractor with a mass of ∼2 × 10 14 M ☉ situated at a distance of 15 Mpc from us. The existence of a large void between the Coma and Virgo clusters also probably affects the Hubble flow around the Coma I.

  1. Poor outcome prediction by burst suppression ratio in adults with post-anoxic coma without hypothermia.

    Science.gov (United States)

    Yang, Qinglin; Su, Yingying; Hussain, Mohammed; Chen, Weibi; Ye, Hong; Gao, Daiquan; Tian, Fei

    2014-05-01

    Burst suppression ratio (BSR) is a quantitative electroencephalography (qEEG) parameter. The purpose of our study was to compare the accuracy of BSR when compared to other EEG parameters in predicting poor outcomes in adults who sustained post-anoxic coma while not being subjected to therapeutic hypothermia. EEG was registered and recorded at least once within 7 days of post-anoxic coma onset. Electrodes were placed according to the international 10-20 system, using a 16-channel layout. Each EEG expert scored raw EEG using a grading scale adapted from Young and scored amplitude-integrated electroencephalography tracings, in addition to obtaining qEEG parameters defined as BSR with a defined threshold. Glasgow outcome scales of 1 and 2 at 3 months, determined by two blinded neurologists, were defined as poor outcome. Sixty patients with Glasgow coma scale score of 8 or less after anoxic accident were included. The sensitivity (97.1%), specificity (73.3%), positive predictive value (82.5%), and negative prediction value (95.0%) of BSR in predicting poor outcome were higher than other EEG variables. BSR1 and BSR2 were reliable in predicting death (area under the curve > 0.8, P coma who do not undergo therapeutic hypothermia when compared to other qEEG parameters.

  2. Abnormal intra-aural pressure waves associated with death in African children with acute nontraumatic coma.

    Science.gov (United States)

    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.

  3. New research initiatives program. Project W-219: chemistry in comet comae. Final report

    International Nuclear Information System (INIS)

    Huebner, W.F.

    1978-02-01

    The scientific objective to investigate theoretically chemical reactions in the comae of comets was accomplished using a one-dimensional model. Ninety-eight species, which involved 441 reactions in the presence of wavelength-dependent solar radiation, were considered in a time-dependent calculation, which includes effects resulting from ultraviolet opacity

  4. How does information influence hope in family members of traumatic coma patients in intensive care unit?

    NARCIS (Netherlands)

    F.J. van Zuuren; Prof. Dr. M.S.H. Duijnstee; T. Defloor; M.H.F. Grypdonck; S.T.L. Verhaeghe

    2007-01-01

    AIMS: To assess the interplay between hope and the information provided by health care professionals. BACKGROUND: 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

  5. The HST/ACS Coma Cluster Survey : II. Data Description and Source Catalogs

    NARCIS (Netherlands)

    Hammer, Derek; Kleijn, Gijs Verdoes; Hoyos, Carlos; den Brok, Mark; Balcells, Marc; Ferguson, Henry C.; Goudfrooij, Paul; Carter, David; Guzman, Rafael; Peletier, Reynier F.; Smith, Russell J.; Graham, Alister W.; Trentham, Neil; Peng, Eric; Puzia, Thomas H.; Lucey, John R.; Jogee, Shardha; Aguerri, Alfonso L.; Batcheldor, Dan; Bridges, Terry J.; Chiboucas, Kristin; Davies, Jonathan I.; del Burgo, Carlos; Erwin, Peter; Hornschemeier, Ann; Hudson, Michael J.; Huxor, Avon; Jenkins, Leigh; Karick, Arna; Khosroshahi, Habib; Kourkchi, Ehsan; Komiyama, Yutaka; Lotz, Jennifer; Marzke, Ronald O.; Marinova, Irina; Matkovic, Ana; Merritt, David; Miller, Bryan W.; Miller, Neal A.; Mobasher, Bahram; Mouhcine, Mustapha; Okamura, Sadanori; Percival, Sue; Phillipps, Steven; Poggianti, Bianca M.; Price, James; Sharples, Ray M.; Tully, R. Brent; Valentijn, Edwin

    The Coma cluster, Abell 1656, was the target of an HST-ACS Treasury program designed for deep imaging in the F475W and F814W passbands. Although our survey was interrupted by the ACS instrument failure in early 2007, the partially completed survey still covers ~50% of the core high-density region in

  6. Transient Coma Due To Epidural Anesthesia: The Role of Loss of Sensory Input.

    LENUS (Irish Health Repository)

    Dardis, Christopher

    2015-12-21

    Epidural anesthesia is the most commonly used method of pain relief during labor in the USA. It is not classically associated with alterations in level of alertness. Coma during the procedure is rare, with a reported incidence of 0.1-0.3%.

  7. Heart failure presenting as myxedema coma: case report and review article.

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    La Forgia, Fiorangela [Department of Physics and Astronomy, University of Padova, Vicolo dellOsservatorio 3, I-35122 Padova (Italy); Bodewits, Dennis; A’Hearn, Michael F.; Protopapa, Silvia; Kelley, Michael S. P.; Sunshine, Jessica; Feaga, Lori; Farnham, Tony, E-mail: fiorangela.laforgia@unipd.it [Department of Astronomy, University of Maryland, College Park, MD 20742-2421 (United States)

    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 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.

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

    Science.gov (United States)

    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.

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

    International Nuclear Information System (INIS)

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

    2017-01-01

    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 H 2 O directly produces excited OH*( A 2 Σ + ) 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.

  12. NUMERICAL SIMULATION OF DUST IN A COMETARY COMA: APPLICATION TO COMET 67P/CHURYUMOV-GERASIMENKO

    International Nuclear Information System (INIS)

    Tenishev, Valeriy; Combi, Michael R.; Rubin, Martin

    2011-01-01

    The Rosetta spacecraft is en route to comet 67P/Churyumov-Gerasimenko for a rendezvous, landing, and extensive orbital phase beginning in 2014. With a limited amount of available observational data, planning of the mission as well as the interpretation of measurements obtained by instruments on board the spacecraft requires modeling of the dusty/gas environment of the comet. During the mission, the collision regime in the inner coma will change starting from transitional to fully collisionless. As a result, a physically correct model has to be valid at conditions that are far from equilibrium and account for the kinetic nature of the processes occurring in the coma. A study of the multi-species coma of comet 67P/Churyumov-Gerasimenko is presented in our previous paper, where we describe our kinetic model and discuss the results of its application to cases that correspond to the different stages during the mission. In this work, we focus on numerical modeling of the dust phase in the coma of comet 67P/Churyumov-Gerasimenko and its interaction with the surrounding gas. The basic phenomena that govern the dynamics and energy balance of the dust grains are outlined. The effect of solar radiation pressure and the nucleus gravity in limiting the maximum liftable mass of the grains is discussed. The distribution of the terminal velocity of the dust grains as a function of subsolar angle is derived in the paper. We have found that in the regions with high gradients of the gas density, spike-like features can form in the dust flow. The obtained results represent the state of the coma in the vicinity of the nucleus for a series of stages throughout the Rosetta mission. The implications of the model results for future measurements by the GIADA instrument are discussed.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  16. 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.

    Science.gov (United States)

    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.

  17. Why do insects enter and recover from chill coma? Low temperature and high extracellular potassium compromises muscle function in Locusta migratoria

    DEFF Research Database (Denmark)

    Findsen, Anders; Pedersen, Thomas Holm; Petersen, Asbjørn G

    2014-01-01

    When exposed to low temperatures, many insect species enter a reversible comatose state (chill coma), which is driven by a failure of neuromuscular function. Chill coma and chill coma recovery have been associated with a loss and recovery of ion-homeostasis (particularly extracellular [K......+]) and accordingly onset of chill coma has been hypothesised to result from depolarization of membrane potential caused by loss of ion-homeostasis. Here we examined whether onset of chill coma is associated with a disturbance in ion balance by examining the correlation between disruption of ion homeostasis and onset...... of chill coma in locusts exposed to cold at varying rates of cooling. Chill coma onset temperature changed maximally 1°C under different cooling rates and marked disturbances of ion homeostasis were not observed at any of the cooling rates. In a second set of experiments we used isolated tibial muscle...

  18. Properties of the Nucleus, Dust Coma, and Gas Coma of Comet 29P/Schwassmann-Wachmann 1 As Observed By WISE/NEOWISE

    Science.gov (United States)

    Fernandez, Yanga R.; Bauer, J. M.; Lisse, C. M.; Grav, T.; Mainzer, A. K.; Masiero, J. R.; Walker, R. G.; Meech, K. J.

    2012-10-01

    We present our analysis of mid-infrared imaging of comet 29P/Schwassmann-Wachmann 1 by the Wide-field Infrared Survey Explorer (WISE) [1,2]. The comet was observed on May 3-4, 2010 - not in strong outburst - with imaging at 3.4, 4.6, 12, and 22 microns (a.k.a. bands W1, W2, W3, and W4). W1 and W2 were sensitive to the reflected-sunlight continuum and W3 and W4 to thermal emission. The comet's coma was seen in all bands, with a point-source clearly embedded in W1, W3, and W4 imaging. A coma-fitting technique [3,4] let us photometrically extract this point-source from the images, thereby letting us measure the nucleus's size, W1-band geometric albedo, and infrared beaming. The dust coma was most clearly seen at bands W1, W3, and W4, letting us estimate the dust production rate, extract spatially-resolved information about the dust albedo and color temperature, and constrain the grain composition and size distribution. W2 imaging shows a coma whose radial surface-brightness profile and photometry suggest we are seeing a gas component, specifically emission from CO and/or CO2, i.e. high-abundance species with emission lines within the bandpass. This lets us estimate 29P’s gas production rate and dust-to-gas ratio independently from earlier methods. We present a comparison of our dust, gas, and nucleus results to those from earlier studies of this comet. References: [1] E. L. Wright et al. 2010, AJ, 140, 1868. [2] A. K. Mainzer et al. 2011, ApJ, 731, 53. [3] C. M. Lisse et al. 1999, Icarus, 140, 189. [4] P. L. Lamy et al. 2004, in Comets II, pp. 223-264. Acknowledgements: This publication makes use of data products from (1) WISE, which is a joint project of UCLA and JPL/Caltech, funded by NASA; and (2) NEOWISE, which is a project of JPL/Caltech, funded by the Planetary Science Division of NASA.

  19. The Enigmatic (Almost) Dark Galaxy Coma P: The Atomic Interstellar Medium

    Science.gov (United States)

    Ball, Catherine; Cannon, John M.; Leisman, Lukas; Adams, Elizabeth A. K.; Haynes, Martha P.; Józsa, Gyula I. G.; McQuinn, Kristen B. W.; Salzer, John J.; Brunker, Samantha; Giovanelli, Riccardo; Hallenbeck, Gregory; Janesh, William; Janowiecki, Steven; Jones, Michael G.; Rhode, Katherine L.

    2018-02-01

    We present new high-resolution H I spectral line imaging of Coma P, the brightest H I source in the system HI 1232+20. This galaxy with extremely low surface brightness was first identified in the ALFALFA survey as an “(Almost) Dark” object: a clearly extragalactic H I source with no obvious optical counterpart in existing optical survey data (although faint ultraviolet emission was detected in archival GALEX imaging). Using a combination of data from the Westerbork Synthesis Radio Telescope and the Karl G. Jansky Very Large Array, we investigate the H I morphology and kinematics at a variety of physical scales. The H I morphology is irregular, reaching only moderate maxima in mass surface density (peak {σ }{{H}{{I}}}∼ 10 {M}ȯ pc‑2). Gas of lower surface brightness extends to large radial distances, with the H I diameter measured at 4.0 ± 0.2 kpc inside the 1 {M}ȯ pc‑2 level. We quantify the relationships between mass surface density of H I gas and star formation on timescales of ∼100–200 Myr as traced by GALEX far-ultraviolet emission. While Coma P has regions of dense H I gas reaching the {N}{{H}{{I}}}={10}21 cm‑2 level typically associated with ongoing star formation, it lacks massive star formation as traced by Hα emission. The H I kinematics are extremely complex: a simple model of a rotating disk cannot describe the H I gas in Coma P. Using spatially resolved position–velocity analysis we identify two nearly perpendicular axes of projected rotation that we interpret as either the collision of two H I disks or a significant infall event. Similarly, three-dimensional modeling of the H I dynamics provides a best fit with two H I components. Coma P is just consistent (within 3σ) with the known {M}{{H}{{I}}}{--}{D}{{H}{{I}}} scaling relation. It is either too large for its H I mass, has too low an H I mass for its H I size, or the two H I components artificially extend its H I size. Coma P lies within the empirical scatter at the faint end

  20. Jet morphology and coma analysis of comet 103P/Hartley 2

    Science.gov (United States)

    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

  1. THE HST/ACS COMA CLUSTER SURVEY. II. DATA DESCRIPTION AND SOURCE CATALOGS

    International Nuclear Information System (INIS)

    Hammer, Derek; Verdoes Kleijn, Gijs; Den Brok, Mark; Peletier, Reynier F.; Hoyos, Carlos; Balcells, Marc; Aguerri, Alfonso L.; Ferguson, Henry C.; Goudfrooij, Paul; Carter, David; Guzman, Rafael; Smith, Russell J.; Lucey, John R.; Graham, Alister W.; Trentham, Neil; Peng, Eric; Puzia, Thomas H.; Jogee, Shardha; Batcheldor, Dan; Bridges, Terry J.

    2010-01-01

    The Coma cluster, Abell 1656, was the target of an HST-ACS Treasury program designed for deep imaging in the F475W and F814W passbands. Although our survey was interrupted by the ACS instrument failure in early 2007, the partially completed survey still covers ∼50% of the core high-density region in Coma. Observations were performed for 25 fields that extend over a wide range of cluster-centric radii (∼1.75 Mpc or 1 0 ) with a total coverage area of 274 arcmin 2 . The majority of the fields are located near the core region of Coma (19/25 pointings) with six additional fields in the southwest region of the cluster. In this paper, we present reprocessed images and SEXTRACTOR source catalogs for our survey fields, including a detailed description of the methodology used for object detection and photometry, the subtraction of bright galaxies to measure faint underlying objects, and the use of simulations to assess the photometric accuracy and completeness of our catalogs. We also use simulations to perform aperture corrections for the SEXTRACTOR Kron magnitudes based only on the measured source flux and its half-light radius. We have performed photometry for ∼73,000 unique objects; approximately one-half of our detections are brighter than the 10σ point-source detection limit at F814W = 25.8 mag (AB). The slight majority of objects (60%) are unresolved or only marginally resolved by ACS. We estimate that Coma members are 5%-10% of all source detections, which consist of a large population of unresolved compact sources (primarily globular clusters but also ultra-compact dwarf galaxies) and a wide variety of extended galaxies from a cD galaxy to dwarf low surface brightness galaxies. The red sequence of Coma member galaxies has a color-magnitude relation with a constant slope and dispersion over 9 mag (-21 F814W < -13). The initial data release for the HST-ACS Coma Treasury program was made available to the public in 2008 August. The images and catalogs described

  2. DEEP GALEX OBSERVATIONS OF THE COMA CLUSTER: SOURCE CATALOG AND GALAXY COUNTS

    International Nuclear Information System (INIS)

    Hammer, D.; Hornschemeier, A. E.; Miller, N.; Jenkins, L.; Mobasher, B.; Smith, R.; Arnouts, S.; Milliard, B.

    2010-01-01

    We present a source catalog from a deep 26 ks Galaxy Evolution Explorer (GALEX) observation of the Coma cluster in the far-UV (FUV; 1530 A) and near-UV (NUV; 2310 A) wavebands. The observed field is centered ∼0. 0 9 (1.6 Mpc) southwest of the Coma core in a well-studied region of the cluster known as 'Coma-3'. The entire field is located within the apparent virial radius of the Coma cluster, and has optical photometric coverage with Sloan Digital Sky Survey (SDSS) and deep spectroscopic coverage to r ∼ 21. We detect GALEX sources to NUV = 24.5 and FUV = 25.0, which corresponds to a star formation rate of ∼10 -3 M sun yr -1 for galaxies at the distance of Coma. We have assembled a catalog of 9700 galaxies with GALEX and SDSS photometry, including 242 spectroscopically confirmed Coma member galaxies that span a large range of galaxy types from giant spirals and elliptical galaxies to dwarf irregular and early-type galaxies. The full multi-wavelength catalog (cluster plus background galaxies) is ∼80% complete to NUV = 23 and FUV = 23.5. The GALEX images presented here are very deep and include detections of many resolved cluster members superposed on a dense field of unresolved background galaxies. This required a two-fold approach to generating a source catalog: we used a Bayesian deblending algorithm to measure faint and compact sources (using SDSS coordinates as position prior), and used the GALEX pipeline catalog for bright and/or extended objects. We performed simulations to assess the importance of systematic effects (e.g., object blends, source confusion, Eddington Bias) that influence the source detection and photometry when using both methods. The Bayesian deblending method roughly doubles the number of source detections and provides reliable photometry to a few magnitudes deeper than the GALEX pipeline catalog. This method is free from source confusion over the UV magnitude range studied here; we estimate that the GALEX pipeline catalogs are

  3. Early blindness and coma during intrathecal chemotherapy for meningeal carcinomatosis.

    Science.gov (United States)

    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.

  4. Ogilvie's syndrome in a case of myxedema coma.

    Science.gov (United States)

    Yanamandra, Uday; Kotwal, Narendra; Menon, Anil; Nair, Velu

    2012-05-01

    Ogilvie's syndrome [acute colonic pseudo-obstruction (ACPO)] presents as massive colonic dilatation without a mechanical cause, usually in critically ill patients due to imbalanced sympathetic and parasympathetic activity. The initial therapy remains conservative with supportive measures (correction of metabolic, infectious or pharmacologic factors) followed by neostigmine and decompressive colonoscopy. Surgery is reserved for patients with clinical deterioration or with evidence of colonic ischemia or perforation. A 60-year-old lady presented with fever, altered sensorium, obstipation, bradycardia and abdominal distension. Investigation revealed hyponatremia and acute colonic pseudo-obstruction. Supportive measures and decompressive colonoscopy were not of great benefit. Thyroid profile was suggestive of primary hypothyroidism. Colonic motility was restored only on starting thyroxin. The case is illustrative of the need to consider hypothyroidism, a common endocrine disorder, in the differential diagnosis of Ogilvie's.

  5. Ogilvie′s syndrome in a case of myxedema coma

    Directory of Open Access Journals (Sweden)

    Uday Yanamandra

    2012-01-01

    Full Text Available Ogilvie′s syndrome [acute colonic pseudo-obstruction (ACPO] presents as massive colonic dilatation without a mechanical cause, usually in critically ill patients due to imbalanced sympathetic and parasympathetic activity. The initial therapy remains conservative with supportive measures (correction of metabolic, infectious or pharmacologic factors followed by neostigmine and decompressive colonoscopy. Surgery is reserved for patients with clinical deterioration or with evidence of colonic ischemia or perforation. A 60-year-old lady presented with fever, altered sensorium, obstipation, bradycardia and abdominal distension. Investigation revealed hyponatremia and acute colonic pseudo-obstruction. Supportive measures and decompressive colonoscopy were not of great benefit. Thyroid profile was suggestive of primary hypothyroidism. Colonic motility was restored only on starting thyroxin. The case is illustrative of the need to consider hypothyroidism, a common endocrine disorder, in the differential diagnosis of Ogilvie′s.

  6. A DOZEN NEW GALAXIES CAUGHT IN THE ACT: GAS STRIPPING AND EXTENDED EMISSION LINE REGIONS IN THE COMA CLUSTER

    International Nuclear Information System (INIS)

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

    2010-01-01

    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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  9. Physical process in the coma of comet 67P derived from narrowband imaging of fragment species

    Science.gov (United States)

    Perez Lopez, F.; Küppers, M.; Marín-Yaseli de la Parra, J.; Besse, S.; Moissl, R.

    2017-09-01

    During the rendezvous of the Rosetta spacecraft with comet 67P/Churyumov-Gerasimenko, the OSIRIS scientific cameras monitored the near-nucleus gas environment in various narrow-band filters, observing various fragment species. It turned out that the excitation processes in the innermost coma are significantly different from the overall coma, as observed from the ground [1]. In particular, some of the observed emissions of fragments (daughter molecules) are created by direct dissociation of parent molecules, and in those cases the spatial distribution of the emission directly maps the distribution of parent molecules. We investigate the evolution of the brightness and distribution of the emissions over time to improve our understanding of the underlying emission mechanisms and to derive the spatial distribution of H2O and CO2. The outcome will provide constraints on the homogeneity of the cometary nucleus.

  10. Model for the coma of Comet Halley, based on the Astron ultraviolet spectrophotometry

    International Nuclear Information System (INIS)

    Boiarchuk, A.A.; Grinin, V.P.; Petrov, P.P.; Sheikhet, A.I.; Zvereva, A.M.

    1986-01-01

    The development of a model of the Comet Halley coma from spectral and photometric data is described. Spectra in the 1500-3500 A range and photometric scans at the 3085 A and 2190 A in the (0-0) band of the OH and CO(+) molecules were obtained by the UV telescope of the satellite Astron on December 3, 13, and 23, 1985. Surface-brightness profiles of the coma in the (0-0) band of OH, NH, and CS molecules are derived. The source and formation of these molecules, the lifetime of their radicals, the radial velocity of their parent molecules, and the water-molecule sublimation rate are computed and examined. The basic characteristics of the comet observed from the UV data are compared to the properties of other comets. It is observed that Comet Halley is similar to other large short-period comets. 29 references

  11. Coma-free alignment of high resolution electron microscopes with the aid of optical diffractograms

    International Nuclear Information System (INIS)

    Zemlin, F.; Weiss, K.; Schiske, P.; Kunath, W.; Herrmann, K.-H.

    1978-01-01

    Alignment by means of current commutating and defocusing of the objective does not yield the desired rotational symmetry of the imaging pencils. This was found while aligning a transmission electron microscope with a single field condenser objective. A series of optical diffractograms of micrographs taken under the same tilted illumination yet under various azimuths have been arranged in a tableau, wherein strong asymmetry is exhibited. Quantitative evaluation yields the most important asymmetric aberration to be the axial coma, which becomes critical when a resolution better than 5 A 0 is obtained. The tableau also allows an assessment of the three-fold astigmatism. A procedure has been developed which aligns the microscope onto the coma-free and dispersion-free pencil axis and does not rely on current communication. The procedure demands equal appearance of astigmatic carbon film images produced under the same tilt yet diametrical azimuth. (Auth.)

  12. Studies of cluster X-ray sources. Energy spectra for the Perseus, Virgo, and Coma clusters

    International Nuclear Information System (INIS)

    Kellogg, E.; Baldwin, J.R.; Koch, D.

    1975-01-01

    We present the final Uhuru X-ray differential-energy spectra for the Perseus, Virgo, and Coma clusters of galaxies. The power-law and isothermal bremsstrahlung model forms, both with a low-energy cutoff, are given. For bremsstrahlung, the energy-dependent Gaunt factor is calculated by an improved method. The spectra, best fits to the Uhuru 2-10 keV data, are also compared with other observations of these sources in the energy range 0.1-100 keV. For Perseus, the data above 20 keV favor the bremsstrahlung fit marginally. For Virgo, the data of Catura et al. between 0.25 and 1.0 keV clearly favor the bremsstrahlung curve. For Coma, the weakest of the three sources, the data are less precise, but there is some evidence for a low-energy turnover or cutoff. The implications of such a cutoff are discussed briefly

  13. Optical identifications of IRAS point sources: the Fornax, Hydra I and Coma clusters

    International Nuclear Information System (INIS)

    Wang, G.; Leggett, S.K.; Savage, A.

    1991-01-01

    We present optical identifications for 66 IRAS point sources in the region of the Fornax cluster of galaxies, 106 IRAS point sources in the region of the Hydra I cluster of galaxies (Abell 1060) and 59 IRAS point sources in the region of the Coma cluster of galaxies (Abell 1656). Eight other sources in Hydra I do not have optical counterparts and are very probably due to infrared cirrus. Twenty-three (35 per cent) of the Fornax sources are associated with stars and 43 (65 per cent) with galaxies; 48 (42 per cent) of the Hydra I sources are associated with stars and 58 (51 per cent) with galaxies; 18 (31 per cent) of the Coma sources are associated with stars and 41 (69 per cent) with galaxies. The stellar and infrared cirrus surface density is consistent with the galactic latitude of each field. (author)

  14. Dust coma of Halley comet: measurements with the dust counter and mass analyzer (DUSMA)

    International Nuclear Information System (INIS)

    Simpson, J.A.; Sagdeev, R.Z.; Tuzzolino, A.J.; AN SSSR, Moscow. Inst. Kosmicheskikh Issledovanij)

    1986-01-01

    The paper represents a preliminary report on measurements of spatial and temporal distribution of mass and flows of dust particles coming from comet nucleus performed by means of devices constructed on the new principle of detecting comet dust specks. The device has a high time resolution (∼ 4 μs) in the wide range of mass and dust flows. On the base of a preliminary analysis the following conclusions are drawn: dust coma in quiet state (''Vega-2'') as well as at the presence of considerable emissions (''Vega-1'') manifests the presence of important short-term out-bursts having by time a quasi-periodic structure. Integral mass spectra show flows intensity growth with the decrease of measured mass (which contradicts some theoretical models). Flow levels lie approximately in the region previously determined by ground observations. The coma is extremely dynamic both in space and in time which proves the complex structure of regions of dust emission from the nucleus

  15. Non-thermal Hard X-Ray Emission from Coma and Several Abell Clusters

    International Nuclear Information System (INIS)

    Correa, C

    2004-01-01

    We report results of hard X-Ray observations of the clusters Coma, Abell 496, Abell754, Abell 1060, Abell 1367, Abell2256 and Abell3558 using RXTE data from the NASA HEASARC public archive. Specifically we searched for clusters with hard x-ray emission that can be fitted by a power law because this would indicate that the cluster is a source of non-thermal emission. We are assuming the emission mechanism proposed by Vahk Petrosian where the inter cluster space contains clouds of relativistic electrons that by themselves create a magnetic field and emit radio synchrotron radiation. These relativistic electrons Inverse-Compton scatter Microwave Background photons up to hard x-ray energies. The clusters that were found to be sources of non-thermal hard x-rays are Coma, Abell496, Abell754 and Abell 1060

  16. Spectroscopic studies of the molecular parentage of radical species in cometary comae

    Science.gov (United States)

    Lewis, Benjamin; Pierce, Donna; Cochran, Anita

    2015-11-01

    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, CH, CN, NH2). By constructing azimuthal average profiles from the full-coma spectroscopic images we can test Haser model parameters with our observations. The Haser model was used to determine production rates and possible parent lifetimes that would be consistent with the model. By iterating through a large range of possible parents lifetimes, we can see what range of values in which the Haser model is consistent with observations. Also, this type of analysis gives us perspective on how sensitive the model's fit quality is to changes in parent lifetimes. Here, we present the work completed to date, and we compare our results to other comet taxonomic surveys.

  17. Jet Morphology and Coma Analysis of 103P/Hartley 2

    Science.gov (United States)

    Vaughan, Charles; Pierce, D.; Dorman, G.; Cochran, A.

    2012-10-01

    We have observed comet 103P/Hartley 2 using the George and Cynthia Mitchell Spectrograph (formerly VIRUS-P) on the 2.7 m telescope at McDonald Observatory (Hill et al. 2008). Data for CN, C2, C3, and NH2 were collected over six nights from 2010 July 15 to November 10. The data were processed to form images of the coma for each of the observed species. We have performed azimuthal average division on each of the coma images to examine jet morphology and have investigated the nature of the production of the radical species using our modified vectorial model (Ihalawela et al. 2011). This work enhances the ongoing investigation of the chemistry and outgassing behavior of Hartley 2 as studied by the EPOXI flyby mission.

  18. Structural and electronic properties of barbituric acid and melamine-containing ribonucleosides as plausible components of prebiotic RNA: implications for prebiotic self-assembly.

    Science.gov (United States)

    Kaur, Sarabjeet; Sharma, Purshotam; Wetmore, Stacey D

    2017-11-22

    The RNA world hypothesis assumes that RNA was the first informational polymer that originated from prebiotic chemical soup. However, since the reaction of d-ribose with canonical nucleobases (A, C, G and U) fails to yield ribonucleosides (rNs) in substantial amounts, the spontaneous origin of rNs and the subsequent synthesis of RNA remains an unsolved mystery. To this end, it has been suggested that RNA may have evolved from primitive genetic material (preRNA) composed of simpler prebiotic heterocycles that spontaneously form glycosidic bonds with ribose. As an effort toward evaluating this hypothesis, the present study uses density functional theory (DFT) to assess the suitability of barbituric acid (BA) and melamine (MM) to act as prebiotic nucleobases, both of which have recently been shown to spontaneously form a glycosidic bond with ribose and organize into supramolecular assemblies in solution. The significant strength of hydrogen bonds involving BA and MM indicates that such interactions may have played a crucial role in their preferential selection over competing heterocycles that interact solely through stacking interactions from the primordial soup during the early phase of evolution. However, the greater stability of stacked dimers involving BA or MM and the canonical nucleobases compared to those consisting solely of BA and/or MM points towards the possible evolution of intermediate informational polymers consisting of prebiotic and canonical nucleobases, which could have eventually evolved into RNA. Analysis of the associated rNs reveals an anti conformational preference for the biologically-relevant β-anomer of both BA and MM rNs, which will allow complementary WC-like hydrogen bonding that can stabilize preRNA polymers. Large calculated deglycosylation barriers suggest BA rNs containing C-C glycosidic bonds are relevant in challenging prebiotic environments such as volcanic geotherms, while lower barriers indicate the MM rNs containing C

  19. GLOBULAR CLUSTERS AND SPUR CLUSTERS IN NGC 4921, THE BRIGHTEST SPIRAL GALAXY IN THE COMA CLUSTER

    International Nuclear Information System (INIS)

    Lee, Myung Gyoon; Jang, In Sung

    2016-01-01

    We resolve a significant fraction of globular clusters (GCs) in NGC 4921, the brightest spiral galaxy in the Coma cluster. We also find a number of extended bright star clusters (star complexes) in the spur region of the arms. The latter are much brighter and bluer than those in the normal star-forming region, being as massive as 3 × 10 5 M ⊙ . The color distribution of the GCs in this galaxy is found to be bimodal. The turnover magnitudes of the luminosity functions of the blue (metal-poor) GCs (0.70 < (V − I) ≤ 1.05) in the halo are estimated V(max) = 27.11 ± 0.09 mag and I(max) = 26.21 ± 0.11 mag. We obtain similar values for NGC 4923, a companion S0 galaxy, and two Coma cD galaxies (NGC 4874 and NGC 4889). The mean value for the turnover magnitudes of these four galaxies is I(max) = 26.25 ± 0.03 mag. Adopting M I (max) = −8.56 ± 0.09 mag for the metal-poor GCs, we determine the mean distance to the four Coma galaxies to be 91 ± 4 Mpc. Combining this with the Coma radial velocity, we derive a value of the Hubble constant, H 0  = 77.9 ± 3.6 km s −1 Mpc −1 . We estimate the GC specific frequency of NGC 4921 to be S N  = 1.29 ± 0.25, close to the values for early-type galaxies. This indicates that NGC 4921 is in the transition phase to S0s

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

    Science.gov (United States)

    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

  1. The etiology and outcome of non-traumatic coma in critical care: a systematic review.

    Science.gov (United States)

    Horsting, Marlene Wb B; Franken, Mira D; Meulenbelt, Jan; van Klei, Wilton A; de Lange, Dylan W

    2015-04-29

    Non-traumatic coma (NTC) is a serious condition requiring swift medical or surgical decision making upon arrival at the emergency department. Knowledge of the most frequent etiologies of NTC and associated mortality might improve the management of these patients. Here, we present the results of a systematic literature search on the etiologies and prognosis of NTC. Two reviewers independently performed a systematic literature search in the Pubmed, Embase and Cochrane databases with subsequent reference and citation checking. Inclusion criteria were retrospective or prospective observational studies on NTC, which reported on etiologies and prognostic information of patients admitted to the emergency department or intensive care unit. Eventually, 14 studies with enough data on NTC, were selected for this systematic literature review. The most common causes of NTC were stroke (6-54%), post-anoxic coma (3-42%), poisoning (coma (54-89%) and lowest for poisoning (0-39%) and epilepsy (0-10%). NTC represents a challenge to the emergency and the critical care physicians with an important mortality and moderate-severe disability rate. Even though, included studies were very heterogeneous, the most common causes of NTC are stroke, post anoxic, poisoning and various metabolic etiologies. The best outcome is achieved for patients with poisoning and epilepsy, while the worst outcome was seen in patients with stroke and post-anoxic coma. Adequate knowledge of the most common causes of NTC and prioritizing the causes by mortality ensures a swift and adequate work-up in diagnosis of NTC and may improve outcome.

  2. Post-anoxic quantitative MRI changes may predict emergence from coma and functional outcomes at discharge.

    Science.gov (United States)

    Reynolds, Alexandra S; Guo, Xiaotao; Matthews, Elizabeth; Brodie, Daniel; Rabbani, Leroy E; Roh, David J; Park, Soojin; Claassen, Jan; Elkind, Mitchell S V; Zhao, Binsheng; Agarwal, Sachin

    2017-08-01

    Traditional predictors of neurological prognosis after cardiac arrest are unreliable after targeted temperature management. Absence of pupillary reflexes remains a reliable predictor of poor outcome. Diffusion-weighted imaging has emerged as a potential predictor of recovery, and here we compare imaging characteristics to pupillary exam. We identified 69 patients who had MRIs within seven days of arrest and used a semi-automated algorithm to perform quantitative volumetric analysis of apparent diffusion coefficient (ADC) sequences at various thresholds. Area under receiver operating characteristic curves (ROC-AUC) were estimated to compare predictive values of quantitative MRI with pupillary exam at days 3, 5 and 7 post-arrest, for persistence of coma and functional outcomes at discharge. Cerebral Performance Category scores of 3-4 were considered poor outcome. Excluding patients where life support was withdrawn, ≥2.8% diffusion restriction of the entire brain at an ADC of ≤650×10 -6 m 2 /s was 100% specific and 68% sensitive for failure to wake up from coma before discharge. The ROC-AUC of ADC changes at ≤450×10 -6 mm 2 /s and ≤650×10 -6 mm 2 /s were significantly superior in predicting failure to wake up from coma compared to bilateral absence of pupillary reflexes. Among survivors, >0.01% of diffusion restriction of the entire brain at an ADC ≤450×10 -6 m 2 /s was 100% specific and 46% sensitive for poor functional outcome at discharge. The ROC curve predicting poor functional outcome at ADC ≤450×10 -6 mm 2 /s had an AUC of 0.737 (0.574-0.899, p=0.04). Post-anoxic diffusion changes using quantitative brain MRI may aid in predicting persistent coma and poor functional outcomes at hospital discharge. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Prospective Cohort Study Evaluating the Prognostic Value of Simple EEG Parameters in Postanoxic Coma.

    Science.gov (United States)

    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.

  4. Early Prediction and Outcome of Septic Encephalopathy in Acute Stroke Patients With Nosocomial Coma

    OpenAIRE

    Tong, Dao-Ming; Zhou, Ye-Ting; Wang, Guang-Sheng; Chen, Xiao-Dong; Yang, Tong-Hui

    2015-01-01

    Background Septic encephalopathy (SE) is the most common acute encephalopathy in ICU; however, little attention has been focused on risk of SE in the course of acute stroke. Our aim is to investigate the early prediction and outcome of SE in stroke patients with nosocomial coma (NC). Methods A retrospective cohort study was conducted in an ICU of the tertiary teaching hospital in China from January 2006 to December 2009. Ninety-four acute stroke patients with NC were grouped according to with...

  5. Intubation is not a marker for coma after in-hospital cardiac arrest: A retrospective study.

    Science.gov (United States)

    Berg, Katherine M; Grossestreuer, Anne V; Uber, Amy; Patel, Parth V; Donnino, Michael W

    2017-10-01

    In-hospital cardiac arrest (IHCA) strikes over 200,000 people in the United States annually. Targeted temperature management (TTM) is considered beneficial in other settings, but there is no prospective data for IHCA. Recent work on TTM and IHCA found an association between TTM and worse outcome. However, the authors used intubation as a marker for coma to determine eligibility for TTM. The validity of this approach is unexplored. Retrospective, single center study of adult patients with IHCA occurring in an intensive care unit, intubated prior to or during the event, or immediately after ROSC. We evaluated the percentage of patients documented as comatose after arrest, defined as Glasgow Comas Score (GCS) <8 for the primary analysis. We also evaluated the difference in hospital survival in patients with GCS <8 versus ≥8. Two sensitivity analyses using different methods for defining coma using post-ROSC GCS were conducted. 29/102 (28%) intubated patients had a post-ROSC GCS≥8, and 22 (22%) were documented as following commands. Survival in patients with GCS≥8 vs.<8 was 62% (18/29) vs. 37% (27/73) in unadjusted analysis (p=0.02). The adjusted odds ratio for survival to hospital discharge was 3.81 (95%CI: 1.37-10.61, p=0.01). Results were similar in both sensitivity analyses. Intubation prior to or during IHCA was not a valid marker of coma after ROSC. Post-ROSC mental status was associated with hospital survival, and thus could be an important confounder when conducting observational studies on the association of TTM with outcomes in this patient population. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. A DEEP VERY LARGE ARRAY RADIO CONTINUUM SURVEY OF THE CORE AND OUTSKIRTS OF THE COMA CLUSTER

    International Nuclear Information System (INIS)

    Miller, Neal A.; Hornschemeier, Ann E.; Mobasher, Bahram

    2009-01-01

    We present deep 1.4 GHz Very Large Array radio continuum observations of two ∼0.5 deg 2 fields in the Coma cluster of galaxies. The two fields, 'Coma 1' and 'Coma 3', correspond to the cluster core and southwest infall region and were selected on account of abundant preexisting multiwavelength data. In their most sensitive regions the radio data reach 22 μJy rms per 4.''4 beam, sufficient to detect (at 5σ) Coma member galaxies with L 1.4 G Hz = 1.3 x 10 20 W Hz -1 . The full catalog of radio detections is presented herein and consists of 1030 sources detected at ≥5σ, 628 of which are within the combined Coma 1 and Coma 3 area. We also provide optical identifications of the radio sources using data from the Sloan Digital Sky Survey. The depth of the radio observations allows us to detect active galactic nucleus in cluster elliptical galaxies with M r r r ∼ sun yr -1 .

  7. Origins of ultra-diffuse galaxies in the Coma cluster - II. Constraints from their stellar populations

    Science.gov (United States)

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

    2018-06-01

    In this second paper of the series we study, with new Keck/DEIMOS spectra, the stellar populations of seven spectroscopically confirmed ultra-diffuse galaxies (UDGs) in the Coma cluster. We find intermediate to old ages (˜ 7 Gyr), low metallicities ([Z/H]˜ - 0.7 dex) and mostly super-solar abundance patterns ([Mg/Fe] ˜ 0.13 dex). These properties are similar to those of low-luminosity (dwarf) galaxies inhabiting the same area in the cluster and are mostly consistent with being the continuity of the stellar mass scaling relations of more massive galaxies. These UDGs' star formation histories imply a relatively recent infall into the Coma cluster, consistent with the theoretical predictions for a dwarf-like origin. However, considering the scatter in the resulting properties and including other UDGs in Coma, together with the results from the velocity phase-space study of the Paper I in this series, a mixed-bag of origins is needed to explain the nature of all UDGs. Our results thus reinforce a scenario in which many UDGs are field dwarfs that become quenched through their later infall onto cluster environments, whereas some UDGs could be be genuine primordial galaxies that failed to develop due to an early quenching phase. The unknown proportion of dwarf-like to primordial-like UDGs leaves the enigma of the nature of UDGs still open.

  8. Hyperammonemic coma in a patient with late-onset OTC deficiency

    Directory of Open Access Journals (Sweden)

    V. D’Onofrio

    2014-06-01

    Full Text Available Urea Cycle Disorders ( UCD are among the most common genetic diseases of the metabolism and ornithine transcarbamylase deficiency (OTC, an X-linked defect is the most frequent among them. It is responsible for hyperammonemia that can lead to chronic neurological illness and potentially to death in case of delayed diagnosis and treatment. With regards to the OTC deficiency there is great clinical heterogeneity with early-onset phenotypes with mostly poor prognosis and late-onset phenotypes with a better one. In the article it is reported the case of a 8 years old patient with diagnosis of OTC deficit with late-onset phenotype. The kid was brought to our hospital because of continuous vomiting and gastro- intestinal disorders, associated with irritability and lethargy later resulted into coma. Measurement of plasma ammonia concentration, followed by measurement of plasma amino acid and urine orotic acid levels allowed to diagnose the OTC deficit, lately confirmed by molecular genetic studies. The patient has been promptly treated with Sodium Phenylbutyrate, Arginine and discontinuing the protein intake. Gradually the ammonemia value decreased, and general and neurological conditions improved with resolution of the coma. To conclude, for patients presenting unexplained neurological symptoms, confusion and decreased level of consciousness, up to coma, urea cycle disorders and in particularly OTC deficiency should be considered in the differential diagnosis and an urgent ammonia level determined. In case of hyperammonemia, the treatment should be started immediately , even without a precise ethiologic diagnosis.

  9. ULTRA-COMPACT DWARFS IN THE CORE OF THE COMA CLUSTER

    International Nuclear Information System (INIS)

    Madrid, Juan P.; Graham, Alister W.; Forbes, Duncan A.; Spitler, Lee R.; Harris, William E.; Goudfrooij, Paul; Ferguson, Henry C.; Carter, David; Blakeslee, John P.

    2010-01-01

    We have discovered both a red and a blue subpopulation of ultra-compact dwarf (UCD) galaxy candidates in the Coma galaxy cluster. We analyzed deep F475W (Sloan g) and F814W (I) Hubble Space Telescope images obtained with the Advanced Camera for Surveys Wide Field Channel as part of the Coma Cluster Treasury Survey and have fitted the light profiles of ∼5000 point-like sources in the vicinity of NGC 4874, one of the two central dominant galaxies of the Coma Cluster. Although almost all of these sources are globular clusters that remain unresolved, we found that 52 objects have effective radii between ∼10 and 66 pc, in the range spanned by dwarf globular transition objects (DGTOs) and UCDs. Of these 52 compact objects, 25 are brighter than M V ∼ -11 mag, a magnitude conventionally thought to separate UCDs and globular clusters. The UCD/DGTO candidates have the same color and luminosity distribution as the most luminous globular clusters within the red and blue subpopulations of the immensely rich NGC 4874 globular cluster system. Unlike standard globular clusters, blue and red UCD/DGTO subpopulations have the same median effective radius. The spatial distribution of UCD/DGTO candidates reveals that they congregate toward NGC 4874 and are not uniformly distributed. We find a relative deficit of UCD/DGTOs compared with globular clusters in the inner 15 kpc around NGC 4874; however, at larger radii UCD/DGTO and globular clusters follow the same spatial distribution.

  10. Observation of the Coma cluster of galaxies with ROSAT during the all-sky survey

    Science.gov (United States)

    Briel, U. G.; Henry, J. P.; Boehringer, H.

    1992-01-01

    The Coma cluster of galaxies was observed with the position sensitive proportional counter (PSPC) during the ROSAT all sky survey. We find evidence for substructure in this cluster. Diffuse X-ray emission is detected from the regions of the NGC 4839 and 4911 subgroups at 6 percent and 1 percent of the total cluster emission respectively. There may be emission associated with the NGC 4874 and 4889 subgroups as well. The NGC 4839 group appears to be in the process of merging with the cluster. These X-ray data show that at least some of the groups previously found in projection are in fact physical objects possessing potential wells deep enough to trap their own X-ray gas. Because of the unlimited field of view of the all sky survey and the low background of the PSPC, we were able to measure the azimuthally averaged surface brightness of Coma out to approximately 100 arcmin, twice as far as was previously possible. Given the validity of our mass models, these new X-ray data imply that within 5/h(50) Mpc the binding mass of the Coma cluster is 1.8 +/- 0.6 x 10 exp 15/h(50) solar mass, and the fraction of cluster mass contained in hot gas is 0.30 +/- 0.14h(50) exp -3/2. Furthermore, the binding mass is more centrally concentrated than is the X-ray gas.

  11. Near-death experiences in non-life-threatening events and coma of different etiologies

    Directory of Open Access Journals (Sweden)

    Vanessa eCharland-Verville

    2014-05-01

    Full Text Available Background: Near death experiences (NDEs are increasingly being reported as a clearly identifiable physiological and psychological reality of clinical significance. However, the definition and causes of the phenomenon as well as the identification of NDE experiencers is still a matter of debate. To date, the most widely used standardized tool to identify and characterize NDEs in research is the Greyson NDE Scale. Using this scale, retrospective and prospective studies have been trying to estimate their incidence in various populations but few studies have tackled to associate the experiences’ intensity and content related to etiology. Methods: This retrospective investigation assessed the most frequently recounted features of self-reported NDEs after a non-life-threatening event (i.e., NDE-like experience or after a pathological coma (i.e., classical NDEs and according to the etiology of the acute brain insult. We also compared our retrospectively acquired data in anoxic coma with historical data from the published literature on prospective post-anoxic studies using the Greyson NDE Scale. Results: From our 190 reports who met the criteria for NDE (i.e., NDE scale total score Conclusions: It appears that real NDEs after coma of different etiologies are similar to NDE-like experiences occurring after non-life threatening events. Subjects reporting NDEs retrospectively tend to have experienced a different content compared to the prospective experiencers

  12. THE PLANCK SUNYAEV-ZEL'DOVICH VERSUS THE X-RAY VIEW OF THE COMA CLUSTER

    International Nuclear Information System (INIS)

    Fusco-Femiano, R.; Lapi, A.; Cavaliere, A.

    2013-01-01

    The Planck collaboration has recently published precise and resolved measurements of the Sunyaev-Zel'dovich (SZ) effect in Abell 1656 (the Coma cluster of galaxies), thus directly gauging the electron pressure profile in the intracluster plasma. On the other hand, such a quantity may be also derived from combining the density and temperature provided by X-ray observations of the thermal bremsstrahlung radiation emitted by the plasma. We find a model-independent tension between the SZ and the X-ray pressure, with the SZ one being definitely lower by 15%-20%. We propose that such a challenging tension can be resolved in terms of an additional, non-thermal support to the gravitational equilibrium of the intracluster plasma. This can be straightforwardly included in our Supermodel, so as to fit in detail the Planck SZ profile while being consistent with the X-ray observables. Possible origins of the non-thermal component include cosmic-ray protons, ongoing turbulence, and relativistic electrons; given the existing observational constraints on the first two options, here we focus on the third. For this to be effective, we find that the electron population must include not only an energetic tail accelerated to γ ∼> 10 3 responsible for the Coma radiohalo, but also many more, lower energy electrons. The electron acceleration is to be started by merging events similar to those that provided the very high central entropy of the thermal intracluster plasma in Coma.

  13. Prognostic and diagnostic value of EEG signal coupling measures in coma.

    Science.gov (United States)

    Zubler, Frederic; Koenig, Christa; Steimer, Andreas; Jakob, Stephan M; Schindler, Kaspar A; Gast, Heidemarie

    2016-08-01

    Our aim was to assess the diagnostic and predictive value of several quantitative EEG (qEEG) analysis methods in comatose patients. In 79 patients, coupling between EEG signals on the left-right (inter-hemispheric) axis and on the anterior-posterior (intra-hemispheric) axis was measured with four synchronization measures: relative delta power asymmetry, cross-correlation, symbolic mutual information and transfer entropy directionality. Results were compared with etiology of coma and clinical outcome. Using cross-validation, the predictive value of measure combinations was assessed with a Bayes classifier with mixture of Gaussians. Five of eight measures showed a statistically significant difference between patients grouped according to outcome; one measure revealed differences in patients grouped according to the etiology. Interestingly, a high level of synchrony between the left and right hemisphere was associated with mortality on intensive care unit, whereas higher synchrony between anterior and posterior brain regions was associated with survival. The combination with the best predictive value reached an area-under the curve of 0.875 (for patients with post anoxic encephalopathy: 0.946). EEG synchronization measures can contribute to clinical assessment, and provide new approaches for understanding the pathophysiology of coma. Prognostication in coma remains a challenging task. qEEG could improve current multi-modal approaches. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  14. Measurements of the gas temperature and iron abundance distribution in the Coma Cluster

    International Nuclear Information System (INIS)

    Hughes, J.P.; Gorenstein, P.; Fabricant, D.

    1988-01-01

    The medium energy X-ray detectors onboard the EXOSAT Observatory have been used to determine the gas temperature at several positions in the Coma Cluster of galaxies. Evidence is found at greater than 95 percent confidence for a higher temperature in the center of the cluster than in a position approximately 45 arcmin off-center. No difference in iron abundance is observed between the center and off-center regions and the equilibrium model for the distribution of elements in the Coma Cluster of Abramopoulos, Chanan, and Ku can be rejected with greater than 99.5 percent confidence, in favor of a model with more uniform composition. A phenomenological model is presented of the Coma Cluster, which is consistent with the data presented here, as well as the imaging data from the Einstein Observatory and the Tenma X-ray spectrum. The model has a central isothermal region of temperature about 9 keV extending to about 25 arcmin (about 1 Mpc). Beyond this radius the temperature falls as a polytrope with index about 1.6. 36 references

  15. A case report on near manual strangulation and glasgow coma scale.

    Science.gov (United States)

    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.

  16. Negative Ion Chemistry in the Coma of Comet 1P/Halley

    Science.gov (United States)

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

    2012-01-01

    Negative ions (anions) were identified in the coma of comet 1P/Halley from in-situ measurements performed by the Giotto spacecraft in 1986. These anions were detected with masses in the range 7-110 amu, but with insufficient mass resolution to permit unambiguous identification. We present details of a new chemical-hydrodynamic model for the coma of comet Halley that includes - for the first time - atomic and molecular anions, in addition to a comprehensive hydrocarbon chemistry. Anion number densities arc calculated as a function of radius in the coma, and compared with the Giotto results. Important anion production mechanisms arc found to include radiative electron attachment, polar photodissociation, dissociative electron attachment, and proton transfer. The polyyne anions C4H(-) and C6H(-) arc found to be likely candidates to explain the Giotto anion mass spectrum in the range 49-73 amu. Thc CN(-) anion probably makes a significant contribution to the mass spectrum at 26 amu. Larger carbon-chain anions such as C8H(1) can explain the peak near 100 amu provided there is a source of large carbon-chain-bearing molecules from the cometary nucleus.

  17. Hall effect in the coma of 67P/Churyumov-Gerasimenko

    Science.gov (United States)

    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.

  18. Euthyroid sick syndrome in head injury patients compared with Glasgow Coma and Outcome Scales

    International Nuclear Information System (INIS)

    Palugniok, R.; Kochanska-Dziurowicz, A.A.

    2000-01-01

    Background: Evaluation of the role of euthyroid sick syndrome and pituitary gland hormonal changes and the prognosis of patient mortality after severe brain injury. METHODS: The research was conducted on 65 patients with isolated severe brain injury. Blood samples were obtained as soon as possible after the injury and on the 1st, 2nd, 3rd, 5th and 7th day after the injury. Blood concentrations of T3, rT3, T4, FT4, TSH, and PRL were estimated. The patients' state of health was evaluated in the sixth hour after the injury, using Glasgow Coma Scale, and after 180 days, using the Glasgow Outcome Scale. Multidirectional correlation was sought between the concentrations of the estimated hormones and the score obtained in the Glasgow Coma Scale and Glasgow Outcome Scale. RESULTS: Cluster analysis showed that concentrations of the hormones in the patients who died are grouped in different clusters from those in the patients who survived. This proves that hormonal patterns are different in these groups. Statistically significant lower T3 concentrations were observed on the 3rd day in comparison with the 0 day. Cumulative proportion surviving was lower for the OP group in comparison with the NOP group and amounted to 0.57. CONCLUSIONS: In all patients covered by the research euthyroid sick syndrome was diagnosed. T3 concentration on the 3rd day after the injury together with the evaluation in Glasgow Coma Scale allows for more precise prognosis. (author)

  19. AN ANALYSIS OF CO PRODUCTION IN COMETARY COMAE: CONTRIBUTIONS FROM GAS-PHASE PHENOMENA

    International Nuclear Information System (INIS)

    Pierce, Donna M.; A'Hearn, Michael F.

    2010-01-01

    Understanding the sources of CO in cometary comae is important for understanding comet chemistry and the roles comets have played in the development of the solar system. Among comets sampled to date, the CO abundances vary widely and no direct correlation of CO abundance with other known comet properties has been identified. The picture is complicated further by the discovery of CO production in the comae of some comets, most notably comets Halley and Hale-Bopp. In this study, we investigate the conditions under which CO can be produced in the coma via gas-phase phenomena. We include photochemistry of several parent molecules, as well as two-body chemical reactions that involve the parents and their photodissociative daughter and granddaughter products. We also consider the level of excitation of 'hot' hydrogen (H*) and O( 1 D) in the network, because the level of excitation of these reactants strongly influences reaction rates. Our results suggest that the dominant gas-phase contributor to CO formation is the photodissociation of H 2 CO. Even though typical abundances of H 2 CO are at ∼1% relative to water in the coma, it produces more CO than other processes due to its relatively short photodissociation lifetime. Because other studies have shown H 2 CO to have a distributed source as well, it suggests that at least some CO formation in the coma is connected to the H 2 CO distributed source. We take the time to examine the CO 2 /CO ratio and note that while the CO 2 /CO ratio in comets Halley, Hale-Bopp, and Hyakutake are noticeably different when only native CO is considered, the CO 2 /CO ratios show greater similarity when total CO is considered. Although this sample is relatively small, should the relatively similar CO 2 /CO Total ratio of ∼0.25 indeed be constant for comets with distributed CO sources, it suggests that the extended CO source of these comets is tied directly to the overall C, H, O chemistry of comets, as is likely to happen if hydrogenation

  20. The HST/ACS Coma Cluster Survey. II. Data Description and Source Catalogs

    Science.gov (United States)

    Hammer, Derek; Kleijn, Gijs Verdoes; Hoyos, Carlos; Den Brok, Mark; Balcells, Marc; Ferguson, Henry C.; Goudfrooij, Paul; Carter, David; Guzman, Rafael; Peletier, Reynier F.; hide

    2010-01-01

    The Coma cluster, Abell 1656, was the target of a HST-ACS Treasury program designed for deep imaging in the F475W and F814W passbands. Although our survey was interrupted by the ACS instrument failure in early 2007, the partially-completed survey still covers approximately 50% of the core high density region in Coma. Observations were performed for twenty-five fields with a total coverage area of 274 aremin(sup 2), and extend over a wide range of cluster-centric radii (approximately 1.75 Mpe or 1 deg). The majority of the fields are located near the core region of Coma (19/25 pointings) with six additional fields in the south-west region of the cluster. In this paper we present SEXTRACTOR source catalogs generated from the processed images, including a detailed description of the methodology used for object detection and photometry, the subtraction of bright galaxies to measure faint underlying objects, and the use of simulations to assess the photometric accuracy and completeness of our catalogs. We also use simulations to perform aperture corrections for the SEXTRACTOR Kron magnitudes based only on the measured source flux and its half-light radius. We have performed photometry for 76,000 objects that consist of roughly equal numbers of extended galaxies and unresolved objects. Approximately two-thirds of all detections are brighter than F814W=26.5 mag (AB), which corresponds to the 10sigma, point-source detection limit. We estimate that Coma members are 5-10% of the source detections, including a large population of compact objects (primarily GCs, but also cEs and UCDs), and a wide variety of extended galaxies from cD galaxies to dwarf low surface brightness galaxies. The initial data release for the HST-ACS Coma Treasury program was made available to the public in August 2008. The images and catalogs described in this study relate to our second data release.

  1. Clinical, Radiologic, and Legal Significance of "Extensor Response" in Posttraumatic Coma.

    Science.gov (United States)

    Firsching, Raimund; Woischneck, Dieter; Langejürgen, Alexander; Parreidt, Andreas; Bondar, Imre; Skalej, Martin; Röhl, Friedrich; Voellger, Benjamin

    2015-11-01

    The timely detection of neurologic deterioration can be critical for the survival of a neurosurgical patient following head injury. Because little reliable evidence is available on the prognostic value of the clinical sign "extensor response" in comatose posttraumatic patients, we investigated the correlation of this clinical sign with outcome and with early radiologic findings from magnetic resonance imaging (MRI). This retrospective analysis of prospectively obtained data included 157 patients who had remained in a coma for a minimum of 24 hours after traumatic brain injury. All patients received a 1.5-T MRI within 10 days (median: 2 days) of the injury. The correlations between clinical findings 12 and 24 hours after the injury-in particular, extensor response and pupillary function, MRI findings, and outcome after 1 year-were investigated. Statistical analysis included contingency tables, Fisher exact test, odds ratios (ORs) with confidence intervals (CIs), and weighted κ values. There were 48 patients with extensor response within the first 24 hours after the injury. Patients with extensor response (World Federation of Neurosurgical Societies coma grade III) statistically were significantly more likely to harbor MRI lesions in the brainstem when compared with patients in a coma who had no further deficiencies (coma grade I; p = 0.0004 by Fisher exact test, OR 10.8 with 95% CI, 2.7-42.5) and patients with unilateral loss of pupil function (coma grade II; p = 0.0187, OR 2.8 with 95% CI, 1.2-6.5). The correlation of brainstem lesions as found by MRI and outcome according to the Glasgow Outcome Scale after 1 year was also highly significant (p ≤ 0.016). The correlation of extensor response and loss of pupil function with an unfavorable outcome and with brainstem lesions revealed by MRI is highly significant. Their sudden onset may be associated with the sudden onset of brainstem dysfunction and should therefore be regarded as one of the most

  2. THE HST/ACS COMA CLUSTER SURVEY. IV. INTERGALACTIC GLOBULAR CLUSTERS AND THE MASSIVE GLOBULAR CLUSTER SYSTEM AT THE CORE OF THE COMA GALAXY CLUSTER

    International Nuclear Information System (INIS)

    Peng, Eric W.; Ferguson, Henry C.; Goudfrooij, Paul; Hammer, Derek; Lucey, John R.; Marzke, Ronald O.; Puzia, Thomas H.; Carter, David; Balcells, Marc; Bridges, Terry; Chiboucas, Kristin; Del Burgo, Carlos; Graham, Alister W.; Guzman, Rafael; Hudson, Michael J.; Matkovic, Ana

    2011-01-01

    Intracluster stellar populations are a natural result of tidal interactions in galaxy clusters. Measuring these populations is difficult, but important for understanding the assembly of the most massive galaxies. The Coma cluster of galaxies is one of the nearest truly massive galaxy clusters and is host to a correspondingly large system of globular clusters (GCs). We use imaging from the HST/ACS Coma Cluster Survey to present the first definitive detection of a large population of intracluster GCs (IGCs) that fills the Coma cluster core and is not associated with individual galaxies. The GC surface density profile around the central massive elliptical galaxy, NGC 4874, is dominated at large radii by a population of IGCs that extend to the limit of our data (R +4000 -5000 (systematic) IGCs out to this radius, and that they make up ∼70% of the central GC system, making this the largest GC system in the nearby universe. Even including the GC systems of other cluster galaxies, the IGCs still make up ∼30%-45% of the GCs in the cluster core. Observational limits from previous studies of the intracluster light (ICL) suggest that the IGC population has a high specific frequency. If the IGC population has a specific frequency similar to high-S N dwarf galaxies, then the ICL has a mean surface brightness of μ V ∼ 27 mag arcsec -2 and a total stellar mass of roughly 10 12 M sun within the cluster core. The ICL makes up approximately half of the stellar luminosity and one-third of the stellar mass of the central (NGC 4874+ICL) system. The color distribution of the IGC population is bimodal, with blue, metal-poor GCs outnumbering red, metal-rich GCs by a ratio of 4:1. The inner GCs associated with NGC 4874 also have a bimodal distribution in color, but with a redder metal-poor population. The fraction of red IGCs (20%), and the red color of those GCs, implies that IGCs can originate from the halos of relatively massive, L* galaxies, and not solely from the disruption of

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

    Science.gov (United States)

    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 coma were satisfactory. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  4. Hemometabolismo cerebral: variações na fase aguda do coma traumático Cerebral hemometabolism: variability in the acute phase of traumatic coma

    Directory of Open Access Journals (Sweden)

    ANTONIO L. E. FALCÃO

    2000-09-01

    Full Text Available OBJETIVO: avaliar as interrelações entre as alterações hemometabólicas cerebrais e sistêmicas em pacientes com traumatismo craniencefálico (TCE grave submetidos a um protocolo terapêutico padronizado. DESENHO: estudo prospectivo, intervencionista em pacientes com coma traumático. LOCAL: uma UTI geral em hospital universitário. PACIENTES E MÉTODOS: vinte e sete pacientes (21M e 6F, idade 14-58 anos, com TCE grave, com três a oito pontos na escala de coma de Glasgow, foram avaliados prospectivamente segundo um protocolo cumulativo padronizado para tratamento da hipertensão intracraniana aguda, o qual incluía medidas rotineiras da pressão intracraniana (PIC e da extração cerebral de oxigênio (ECO2. Foram analisadas as interrelações hemometabólicas envolvendo: pressão arterial média (PAM, PIC, pressão parcial de gás carbônico arterial (PaCO2, ECO2, pressão de perfusão cerebral (PPC e extração sistêmica de oxigênio (ESO2. INTERVENÇÕES: apenas as padronizadas no protocolo terapêutico. RESULTADOS: não houve correlação entre a ECO2 e a PPC (r = -0,07; p = 0,41. Houve correlação inversa entre a PaCO2 e a ECO2 (r = -0,24; p = 0,005 e direta entre a ESO2 e a ECO2 (r = 0,24; p = 0,01. A mortalidade geral dos pacientes foi de 25,9% (7/27. CONCLUSÃO: 1 a PPC não se correlaciona com a ECO2 em quaisquer níveis de PIC; 2 a ECO2 está estreitamente relacionada aos diferentes níveis de PaCO2 ; e 3 durante a hiperventilação otimizada existe um acoplamento entre a ECO2 e a ESO2.OBJECTIVE: to evaluate the interrelationships between cerebral and systemic hemometabolic alterations in patients with severe traumatic brain injury managed according to a standardized therapeutic protocol. DESIGN: prospective, interventional study in patients with traumatic coma. SETTING: a general Intensive Care Unit in a teaching hospital. PATIENTS AND METHODS: twenty-seven patients (21M e 6F, aging 14--58 years, with severe acute brain trauma

  5. Anesthesia for pediatric external beam radiation therapy

    International Nuclear Information System (INIS)

    Fortney, Jennifer T.; Halperin, Edward C.; Hertz, Caryn M.; Schulman, Scott R.

    1999-01-01

    Background: For very young patients, anesthesia is often required for radiotherapy. This results in multiple exposures to anesthetic agents over a short period of time. We report a consecutive series of children anesthetized for external beam radiation therapy (EBRT). Methods: Five hundred twelve children ≤ 16 years old received EBRT from January 1983 to February 1996. Patient demographics, diagnosis, anesthesia techniques, monitoring, airway management, complications, and outcome were recorded for the patients requiring anesthesia. Results: One hundred twenty-three of the 512 children (24%) required 141 courses of EBRT with anesthesia. Anesthetized patients ranged in age from 20 days to 11 years (mean 2.6 ± 1.8 ). The frequency of a child receiving EBRT and requiring anesthesia by age cohort was: ≤ 1 year (96%), 1-2 years (93%), 2-3 years (80%), 3-4 years (51%), 4-5 years (36%), 5-6 years (13%), 6-7 years (11%), and 7-16 years (0.7%). Diagnoses included: primary CNS tumor (28%), retinoblastoma (27%), neuroblastoma (20%), acute leukemia (9%), rhabdomyosarcoma (6%), and Wilms' tumor (4%). Sixty-three percent of the patients had been exposed to chemotherapy prior to EBRT. The mean number of anesthesia sessions per patient was 22 ± 16. Seventy-eight percent of the treatment courses were once daily and 22% were twice daily. Anesthesia techniques included: short-acting barbiturate induction + inhalation maintenance (21%), inhalation only (20%), ketamine (19%), propofol only (12%), propofol induction + inhalation maintenance (7%), ketamine induction + inhalation maintenance (6%), ketamine or short-acting barbiturate induction + inhalation maintenance (6%). Monitoring techniques included: EKG (95%), O 2 saturation (93%), fraction of inspired O 2 (57%), and end-tidal CO 2 (55%). Sixty-four percent of patients had central venous access. Eleven of the 74 children with a central line developed sepsis (15%): 6 of the 11 were anesthetized with propofol (55%), 4 with a

  6. Sinais vitais e expressão facial de pacientes em estado de coma Signos vitales y expresión facial de pacientes en estado de coma Vital signs and facial expression of patients in coma

    Directory of Open Access Journals (Sweden)

    Ana Cláudia Giesbrecht Puggina

    2009-06-01

    Full Text Available O objetivo foi verificar a influência da música e mensagem oral sobre os Sinais Vitais e Expressão Facial dos pacientes em coma fisiológico ou induzido. Realizou-se um Ensaio Clínico Controlado e Randomizado. A amostra consistiu-se de 30 pacientes de Unidade de Terapia Intensiva, que foram divididos em 2 grupos: Grupo Controle (sem estímulos auditivos e Grupo Experimental (com estímulos auditivos. Os pacientes foram submetidos a 3 sessões, em dias consecutivos. Encontraram-se alterações estatisticamente significativas nos sinais vitais (saturação de O2 - sessão 1; saturação de O2 - sessão 3; freqüência respiratória - sessão 3 durante a mensagem e na expressão facial, sessão 1, durante a música e a mensagem. Aparentemente a mensagem foi um estímulo mais forte do que a música em relação à capacidade de produzir respostas fisiológicas sugestivas de audição.El objetivo era verificar la influencia de la música y del mensaje verbal en los Señales Vitales y la Expresión Facial de los pacientes en coma fisiológico o inducido. Un Ensayo Clínico Controlado y Randomizado fue echo. La muestra fue consistida en 30 pacientes de Unidad de terapia Intensiva, que fueran divididos en 2 grupos: Grupo Control (sin estímulos auditivos y Grupo Experimental (con los estímulos auditivos. Los pacientes fueran sometidos a las 3 sesiones, en días consecutivos. Los cambios estadísticamente significativos en las Señales Vitales fueran encuentrados (saturación del oxigeno - sesión 1; saturación del oxigeno - sesión 3; frecuencia respiratoria - sesión 3 durante el mensaje y en la Expresión Facial, sesión 1, durante música y el mensaje. Aparentemente el mensaje era uno estimulo más fuerte de qué la música en lo que refiere a la capacidad de producir respuestas fisiológicas de audición.The objective was to check music and voice message influence on the Vital Signals and Facial Expressions of patients in physiological or

  7. Recorrência da Crise Convulsiva após Terapia Anticonvulsivante com Sulfato de Magnésio em Pacientes com Eclâmpsia Recurrence of Seizures after Anticonvulsant Therapy with Magnesium Sulfate in Patients with Eclampsia

    Directory of Open Access Journals (Sweden)

    Melania Maria Ramos de Amorim

    2000-04-01

    . Patients and Methods: a prospective cohort study was conducted, enrolling all cases of eclampsia managed at IMIP between January/1995 and June/1998. Magnesium sulfate and oxygen therapy were administered routinely and interruption of pregnancy was performed after maternal stabilization. The frequency of recurrence of seizures and its association with maternal complications were determined. chi² test for association was used at a 5% level of significance. Results: twelve cases presented recurrence of convulsions after magnesium sulfate (10% and all received a repeated dose. In four of them convulsions persisted and they received intravenous diazepam. After diazepam, one patient still had seizures, with unsuccessful administration of phenytoin and therefore barbituric coma was induced (thionembutal. This patient had a CT-scan with evidence of intracerebral hemorrhage. Maternal complications were significantly more frequent in the group with recurrence: coma (16.7% versus 0.95, acidosis (50% versus 2.9%, pulmonary edema (16.7% versus 2.9%, cerebral hemorrhage (16.7% versus 0% and acute renal failure (16.7% versus 1.9%. Three cases of maternal death occurred in patients with recurrence (25% versus 2 cases in patients without recurrence (1.9%. Conclusions: rate of recurrence after anticonvulsant therapy with magnesium sulfate is low (10% but it is associated with increased maternal morbidity and mortality. These cases must be managed in an intensive care unit and submitted to routine CT-scan because cerebral hemorrhage can be the cause of recurrence.

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

    Science.gov (United States)

    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

  9. The globular cluster systems of 54 Coma ultra-diffuse galaxies: statistical constraints from HST data

    Science.gov (United States)

    Amorisco, N. C.; Monachesi, A.; Agnello, A.; White, S. D. M.

    2018-04-01

    We use data from the HST Coma Cluster Treasury program to assess the richness of the globular cluster systems (GCSs) of 54 Coma ultra-diffuse galaxies (UDGs), 18 of which have a half-light radius exceeding 1.5 kpc. We use a hierarchical Bayesian method tested on a large number of mock data sets to account consistently for the high and spatially varying background counts in Coma. These include both background galaxies and intra-cluster globular clusters (ICGCs), which are disentangled from the population of member globular clusters (GCs) in a probabilistic fashion. We find no candidate for a GCS as rich as that of the Milky Way, our sample has GCSs typical of dwarf galaxies. For the standard relation between GCS richness and halo mass, 33 galaxies have a virial mass Mvir ≤ 1011 M⊙ at 90 per cent probability. Only three have Mvir > 1011 M⊙ with the same confidence. The mean colour and spread in colour of the UDG GCs are indistinguishable from those of the abundant population of ICGCs. The majority of UDGs in our sample are consistent with the relation between stellar mass and GC richness of `normal' dwarf galaxies. Nine systems, however, display GCSs that are richer by a factor of 3 or more (at 90 per cent probability). Six of these have sizes ≲1.4 kpc. Our results imply that the physical mechanisms responsible for the extended size of the UDGs and for the enhanced GC richness of some cluster dwarfs are at most weakly correlated.

  10. Masses and K-line absolute magnitudes of γ Leonis and 35 Comae

    International Nuclear Information System (INIS)

    Deming, D.; Dykton, M.

    1979-01-01

    The visual binary system γ Leonis consists of two K giants whose total mass was found by Wilson to be less than 0.6M/sub sun/ when a distance was obtained from K-line absolute magnitudes of both components. Since the orbital period of the system is of order 600 years, the orbital solution has usually been regarded as the most likely explanation of the anomalous mass. We have investigated the uniqueness of the orbital solution. We find that the individual orbital elements are only poorly determined, but that a 3 /P 2 is known to within +- 10%. The anomalous mass of this binary system implies either extensive mass-loss or the need for revisions in the K-line absolute magnitudes. We also investigate the binary system 35 Comae. Wilson has noted that in this system the K-line absolute magnitude of the G8 III primary component implies a total mass of 8 M/sub sun/. However the A component of 35 Comae is not sufficiently luminous to justify such a large total mass. The system has a period of order 700 years, and the uniqueness of the orbital solution is therefore suspect. However, in this case also we have investigated the uniqueness of the orbital solution and find that individual orbital elements are poorly determined, but that a 3 /P 2 is known to within +- 17%. We point out that 35 Comae is known to be very metal rich, in contrast to γ Leonis which is metal poor. We conclude that a composition-dependent correction to the K-line absolute magnitudes provides the simplest explanation of these mass anomalies. Such a correction would also give better agreement with the trigonometric parallaxes of these binary systems

  11. Prediction of cognitive outcome based on the progression of auditory discrimination during coma.

    Science.gov (United States)

    Juan, Elsa; De Lucia, Marzia; Tzovara, Athina; Beaud, Valérie; Oddo, Mauro; Clarke, Stephanie; Rossetti, Andrea O

    2016-09-01

    To date, no clinical test is able to predict cognitive and functional outcome of cardiac arrest survivors. Improvement of auditory discrimination in acute coma indicates survival with high specificity. Whether the degree of this improvement is indicative of recovery remains unknown. Here we investigated if progression of auditory discrimination can predict cognitive and functional outcome. We prospectively recorded electroencephalography responses to auditory stimuli of post-anoxic comatose patients on the first and second day after admission. For each recording, auditory discrimination was quantified and its evolution over the two recordings was used to classify survivors as "predicted" when it increased vs. "other" if not. Cognitive functions were tested on awakening and functional outcome was assessed at 3 months using the Cerebral Performance Categories (CPC) scale. Thirty-two patients were included, 14 "predicted survivors" and 18 "other survivors". "Predicted survivors" were more likely to recover basic cognitive functions shortly after awakening (ability to follow a standardized neuropsychological battery: 86% vs. 44%; p=0.03 (Fisher)) and to show a very good functional outcome at 3 months (CPC 1: 86% vs. 33%; p=0.004 (Fisher)). Moreover, progression of auditory discrimination during coma was strongly correlated with cognitive performance on awakening (phonemic verbal fluency: rs=0.48; p=0.009 (Spearman)). Progression of auditory discrimination during coma provides early indication of future recovery of cognitive functions. The degree of improvement is informative of the degree of functional impairment. If confirmed in a larger cohort, this test would be the first to predict detailed outcome at the single-patient level. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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

    Science.gov (United States)

    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.

  13. Automated EEG entropy measurements in coma, vegetative state/unresponsive wakefulness syndrome and minimally conscious state

    Science.gov (United States)

    Gosseries, Olivia; Schnakers, Caroline; Ledoux, Didier; Vanhaudenhuyse, Audrey; Bruno, Marie-Aurélie; Demertzi, Athéna; Noirhomme, Quentin; Lehembre, Rémy; Damas, Pierre; Goldman, Serge; Peeters, Erika; Moonen, Gustave; Laureys, Steven

    Summary Monitoring the level of consciousness in brain-injured patients with disorders of consciousness is crucial as it provides diagnostic and prognostic information. Behavioral assessment remains the gold standard for assessing consciousness but previous studies have shown a high rate of misdiagnosis. This study aimed to investigate the usefulness of electroencephalography (EEG) entropy measurements in differentiating unconscious (coma or vegetative) from minimally conscious patients. Left fronto-temporal EEG recordings (10-minute resting state epochs) were prospectively obtained in 56 patients and 16 age-matched healthy volunteers. Patients were assessed in the acute (≤1 month post-injury; n=29) or chronic (>1 month post-injury; n=27) stage. The etiology was traumatic in 23 patients. Automated online EEG entropy calculations (providing an arbitrary value ranging from 0 to 91) were compared with behavioral assessments (Coma Recovery Scale-Revised) and outcome. EEG entropy correlated with Coma Recovery Scale total scores (r=0.49). Mean EEG entropy values were higher in minimally conscious (73±19; mean and standard deviation) than in vegetative/unresponsive wakefulness syndrome patients (45±28). Receiver operating characteristic analysis revealed an entropy cut-off value of 52 differentiating acute unconscious from minimally conscious patients (sensitivity 89% and specificity 90%). In chronic patients, entropy measurements offered no reliable diagnostic information. EEG entropy measurements did not allow prediction of outcome. User-independent time-frequency balanced spectral EEG entropy measurements seem to constitute an interesting diagnostic – albeit not prognostic – tool for assessing neural network complexity in disorders of consciousness in the acute setting. Future studies are needed before using this tool in routine clinical practice, and these should seek to improve automated EEG quantification paradigms in order to reduce the remaining false

  14. Neural signature of coma revealed by posteromedial cortex connection density analysis.

    Science.gov (United States)

    Malagurski, Briguita; Péran, Patrice; Sarton, Benjamine; Riu, Beatrice; Gonzalez, Leslie; Vardon-Bounes, Fanny; Seguin, Thierry; Geeraerts, Thomas; Fourcade, Olivier; de Pasquale, Francesco; Silva, Stein

    2017-01-01

    Posteromedial cortex (PMC) is a highly segregated and dynamic core, which appears to play a critical role in internally/externally directed cognitive processes, including conscious awareness. Nevertheless, neuroimaging studies on acquired disorders of consciousness, have traditionally explored PMC as a homogenous and indivisible structure. We suggest that a fine-grained description of intrinsic PMC topology during coma, could expand our understanding about how this cortical hub contributes to consciousness generation and maintain, and could permit the identification of specific markers related to brain injury mechanism and useful for neurological prognostication. To explore this, we used a recently developed voxel-based unbiased approach, named functional connectivity density (CD). We compared 27 comatose patients (15 traumatic and 12 anoxic), to 14 age-matched healthy controls. The patients' outcome was assessed 3 months later using Coma Recovery Scale-Revised (CRS-R). A complex pattern of decreased and increased connections was observed, suggesting a network imbalance between internal/external processing systems, within PMC during coma. The number of PMC voxels with hypo-CD positive correlation showed a significant negative association with the CRS-R score, notwithstanding aetiology. Traumatic injury specifically appeared to be associated with a greater prevalence of hyper-connected (negative correlation) voxels, which was inversely associated with patient neurological outcome. A logistic regression model using the number of hypo-CD positive and hyper-CD negative correlations, accurately permitted patient's outcome prediction (AUC = 0.906, 95%IC = 0.795-1). These points might reflect adaptive plasticity mechanism and pave the way for innovative prognosis and therapeutics methods.

  15. Mapping of coma anisotropies to plasma structures of weak comets: a 3-D hybrid simulation study

    Directory of Open Access Journals (Sweden)

    N. Gortsas

    2009-04-01

    Full Text Available The effects of coma anisotropies on the plasma environment of comets have been studied by means of a 3-D hybrid model which treats electrons as a massless, charge-neutralizing fluid, whereas ion dynamics are covered by a kinetic approach. From Earth-based observations as well as from in-situ spacecraft measurements the shape of the coma of many comets is ascertained to be anisotropic. However, most plasma simulation studies deploy a spherically symmetric activity pattern. In this paper anisotropy is studied by considering three different coma shape models. The first model is derived from the Haser model and is characterised by spherically symmetry. This reference model is then compared with two different neutral gas shape models: the dayside restricted model with no nightside activity and a cone shaped model with opening angle of π/2. In all models the integrated surface activity is kept constant. The simulations have been done for the Rosetta target comet 67P/Churyumov-Gerasimenko for two heliocentric distances, 1.30 AU and 3.25 AU. It is found that shock formation processes are modified as a result of increasing spatial confinement. Characteristic plasma structures of comets such as the bow shock, magnetic barrier region and the ion composition boundary exhibit a shift towards the sun. In addition, the cone shaped model leads to a strong increase of the mass-loaded region which in turn leads to a smooth deceleration of the solar wind flow and an increasing degree of mixture between the solar wind and cometary ion species. This creates an additional transport channel of the magnetic field from the magnetic barrier region away which in turn leads to a broadening of this region. In addition, it leads to an ion composition boundary which is only gradually developed.

  16. KECK/LRIS SPECTROSCOPIC CONFIRMATION OF COMA CLUSTER DWARF GALAXY MEMBERSHIP ASSIGNMENTS

    International Nuclear Information System (INIS)

    Chiboucas, Kristin; Tully, R. Brent; Marzke, Ronald O.; Trentham, Neil; Ferguson, Henry C.; Hammer, Derek; Carter, David; Khosroshahi, Habib

    2010-01-01

    Keck/LRIS multi-object spectroscopy has been carried out on 140 of some of the lowest and highest surface brightness faint (19 < R < 22) dwarf galaxy candidates in the core region of the Coma Cluster. These spectra are used to measure redshifts and establish membership for these faint dwarf populations. The primary goal of the low surface brightness sample is to test our ability to use morphological and surface brightness criteria to distinguish between Coma Cluster members and background galaxies using high resolution Hubble Space Telescope/Advanced Camera for Surveys images. Candidates were rated as expected members, uncertain, or expected background. From 93 spectra, 51 dwarf galaxy members and 20 background galaxies are identified. Our morphological membership estimation success rate is ∼100% for objects expected to be members and better than ∼90% for galaxies expected to be in the background. We confirm that low surface brightness is a very good indicator of cluster membership. High surface brightness galaxies are almost always background with confusion arising only from the cases of the rare compact elliptical (cE) galaxies. The more problematic cases occur at intermediate surface brightness. Many of these galaxies are given uncertain membership ratings, and these were found to be members about half of the time. Including color information will improve membership determination but will fail for some of the same objects that are already misidentified when using only surface brightness and morphology criteria. cE galaxies with B-V colors ∼0.2 mag redward of the red sequence in particular require spectroscopic follow up. In a sample of 47 high surface brightness, ultracompact dwarf candidates, 19 objects have redshifts which place them in the Coma Cluster, while another 6 have questionable redshift measurements but may also prove to be members. Redshift measurements are presented and the use of indirect means for establishing cluster membership is

  17. Modelo Vectorial para la Inferencia del Estado Cognitivo de Pacientes en Estados Derivados del Coma

    Directory of Open Access Journals (Sweden)

    Esteban Velásquez R.

    2014-06-01

    Full Text Available La forma tradicional de evaluar el estado de conciencia de un individuo, ha sido mediante la aplicación de estímulos y el análisis de sus respuestas, sin embargo, esta técnica se ve limitada cuando el individuo es incapaz de responder evidentemente ante un estímulo, como es el caso de los pacientes en estados derivados del coma. En estos casos, se requiere de una conexión directa con el cerebro del paciente para detectar una respuesta. Por consiguiente, en este artículo se desarrolla y analiza un modelo computacional basado en los principios de las máquinas de soporte vectorial (MSV, para inferir el estado cognitivo de pacientes en estados derivados del coma, mediante la utilización de un equipo de electroencefalografía comercial. Los resultados obtenidos, mostraron que el modelo logró clasificar correctamente una tarea cognitiva en al menos cuatro de cada cinco pruebas en pacientes de control, lo que se traduce en la obtención de un sistema de bajo costo para el análisis del estado de conciencia y para la posible comunicación con algunos pacientes en estados derivados del coma mediante protocolos médicos definidos. De esta manera, este sistema se presenta como un gran aporte para las clínicas y centros hospitalarios, como herramienta potencial de diagnóstico para este tipo de pacientes.

  18. Radio-Observaciones del OH EN la Coma del Cometa Halley Desde EL Hemisferio Sur

    Science.gov (United States)

    Silva, A. M.; Bajaja, E.; Morras, R.; Cersosimo, J. C.; Martin, M. C.; Arnal, E. M.; Poppel, W. G. L.; Colomb, F. R.; Mazzaro, J.; Olalde, J. C.; Boriakoff, V.; Mirabel, I. F.

    1987-05-01

    Se utilizó una antena de 30 metros del Instituto Argentino de Radioastronomía para observaciones diarias Cf ebrero a abril de 1986) de la transición en 1667 MHz ( λ = 18 cm) del OH en la coma del cometa Halley. De las observaciones realizadas se concluye: 1) El número promedio de moléculas de OH en la coma durante 37 días de observación fue de (8.9±3.5)x1034 moléculas, lo que implica una tasa de producción promedio de OH de 1.8x1029 moléculas seg-1 y consecuentemente una pérdida de masa promedio de 17±6 toneladas seg-1 . Este valor está de acuerdo con las mediciones realizadas por las sondas Vega y Giotto. 2) El monitoreo desde el lAR revela la existencia de variaciones bruscas en los flujos de absorción del OH. Estas variaciones son consistentes con los modelos que representan la producción gaseosa a partir de ejecciones y/o desprendimientos discretos de materia congelada del núcleo. 3) Las variaciones en la densidad de flujo son consistentes con las estimaciones de los tiem- pos de vida medios del H2O y del OH en presencia del campo de radiación solar. 4) Se encuentra una correlación entre la intensidad del flujo absorbido y anisotropías en Ia dinamica de la coma.

  19. Theoretical description of spectral line profiles of parent molecules in cometary comae

    International Nuclear Information System (INIS)

    Hu, Hong-Yao; Larson, H.P.; Hsieh, K.C.

    1991-01-01

    The present overview of cometary spectral-line profiles obtainable through advancements in high-resolution spectroscopic studies, which allow the retrieval of coma kinematic properties from velocity-resolved spectral-line profiles, incorporates the most important gas dynamic processes into an outflow model which is tailored to the interpretation of spectroscopic observations of parent molecules. The model is then used to study the influence on parent-molecule spectral line profile formation of the field-of-view, the expansion velocity, the kinetic temperature, and the anisotropic outflow distributions. 31 refs

  20. GLOBULAR CLUSTERS AND SPUR CLUSTERS IN NGC 4921, THE BRIGHTEST SPIRAL GALAXY IN THE COMA CLUSTER

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Myung Gyoon; Jang, In Sung, E-mail: mglee@astro.snu.ac.kr, E-mail: isjang@astro.snu.ac.kr [Astronomy Program, Department of Physics and Astronomy, Seoul National University, Gwanak-gu, Seoul 151-742 (Korea, Republic of)

    2016-03-01

    We resolve a significant fraction of globular clusters (GCs) in NGC 4921, the brightest spiral galaxy in the Coma cluster. We also find a number of extended bright star clusters (star complexes) in the spur region of the arms. The latter are much brighter and bluer than those in the normal star-forming region, being as massive as 3 × 10{sup 5} M{sub ⊙}. The color distribution of the GCs in this galaxy is found to be bimodal. The turnover magnitudes of the luminosity functions of the blue (metal-poor) GCs (0.70 < (V − I) ≤ 1.05) in the halo are estimated V(max) = 27.11 ± 0.09 mag and I(max) = 26.21 ± 0.11 mag. We obtain similar values for NGC 4923, a companion S0 galaxy, and two Coma cD galaxies (NGC 4874 and NGC 4889). The mean value for the turnover magnitudes of these four galaxies is I(max) = 26.25 ± 0.03 mag. Adopting M{sub I} (max) = −8.56 ± 0.09 mag for the metal-poor GCs, we determine the mean distance to the four Coma galaxies to be 91 ± 4 Mpc. Combining this with the Coma radial velocity, we derive a value of the Hubble constant, H{sub 0} = 77.9 ± 3.6 km s{sup −1} Mpc{sup −1}. We estimate the GC specific frequency of NGC 4921 to be S{sub N} = 1.29 ± 0.25, close to the values for early-type galaxies. This indicates that NGC 4921 is in the transition phase to S0s.

  1. Coma of unknown origin in the emergency department: implementation of an in-house management routine.

    Science.gov (United States)

    Braun, Mischa; Schmidt, Wolf Ulrich; Möckel, Martin; Römer, Michael; Ploner, Christoph J; Lindner, Tobias

    2016-04-27

    Coma of unknown origin is an emergency caused by a variety of possibly life-threatening pathologies. Although lethality is high, there are currently no generally accepted management guidelines. We implemented a new interdisciplinary standard operating procedure (SOP) for patients presenting with non-traumatic coma of unknown origin. It includes a new in-house triage process, a new alert call, a new composition of the clinical response team and a new management algorithm (altogether termed "coma alarm"). It is triggered by two simple criteria to be checked with out-of-hospital emergency response teams before the patient arrives. A neurologist in collaboration with an internal specialist leads the in-hospital team. Collaboration with anaesthesiology, trauma surgery and neurosurgery is organised along structured pathways that include standardised laboratory tests and imaging. Patients were prospectively enrolled. We calculated response times as well as sensitivity and false positive rates, thus proportions of over- and undertriaged patients, as quality measures for the implementation in the SOP. During 24 months after implementation, we identified 325 eligible patients. Sensitivity was 60 % initially (months 1-4), then fluctuated between 84 and 94 % (months 5-24). Overtriage never exceeded 15 % and undertriage could be kept low at a maximum of 11 % after a learning period. We achieved a median door-to-CT time of 20 minutes. 85 % of patients needed subsequent ICU treatment, 40 % of which required specialised neuro-ICUs. Our results indicate that our new simple in-house triage criteria may be sufficient to identify eligible patients before arrival. We aimed at ensuring the fastest possible proceedings given high portions of underlying time-sensitive neurological and medical pathologies while using all available resources as purposefully as possible. Our SOP may provide an appropriate tool for efficient management of patients with non-traumatic coma. Our results

  2. Deep Galex Observations of the Coma Cluster: Source Catalog and Galaxy Counts

    Science.gov (United States)

    Hammer, D.; Hornschemeier, A. E.; Mobasher, B.; Miller, N.; Smith, R.; Arnouts, S.; Milliard, B.; Jenkins, L.

    2010-01-01

    We present a source catalog from deep 26 ks GALEX observations of the Coma cluster in the far-UV (FUV; 1530 Angstroms) and near-UV (NUV; 2310 Angstroms) wavebands. The observed field is centered 0.9 deg. (1.6 Mpc) south-west of the Coma core, and has full optical photometric coverage by SDSS and spectroscopic coverage to r-21. The catalog consists of 9700 galaxies with GALEX and SDSS photometry, including 242 spectroscopically-confirmed Coma member galaxies that range from giant spirals and elliptical galaxies to dwarf irregular and early-type galaxies. The full multi-wavelength catalog (cluster plus background galaxies) is 80% complete to NUV=23 and FUV=23.5, and has a limiting depth at NUV=24.5 and FUV=25.0 which corresponds to a star formation rate of 10(exp -3) solar mass yr(sup -1) at the distance of Coma. The GALEX images presented here are very deep and include detections of many resolved cluster members superposed on a dense field of unresolved background galaxies. This required a two-fold approach to generating a source catalog: we used a Bayesian deblending algorithm to measure faint and compact sources (using SDSS coordinates as a position prior), and used the GALEX pipeline catalog for bright and/or extended objects. We performed simulations to assess the importance of systematic effects (e.g. object blends, source confusion, Eddington Bias) that influence source detection and photometry when using both methods. The Bayesian deblending method roughly doubles the number of source detections and provides reliable photometry to a few magnitudes deeper than the GALEX pipeline catalog. This method is also free from source confusion over the UV magnitude range studied here: conversely, we estimate that the GALEX pipeline catalogs are confusion limited at NUV approximately 23 and FUV approximately 24. We have measured the total UV galaxy counts using our catalog and report a 50% excess of counts across FUV=22-23.5 and NUV=21.5-23 relative to previous GALEX

  3. Rabdomiolisis y ampollas del coma debido a una poliintoxicación aguda.

    Directory of Open Access Journals (Sweden)

    Margarita Carnero Fernández

    2012-12-01

    Full Text Available Mujer de 35 años, consumidora de alcohol, cocaína y neurolépticos. Ingresa en el hospital en situación de coma, con respuesta a estímulos dolorosos, tras intento de autolisis (ingesta de 12 comprimidos de amoxicilina, 60 de quetiapina, 500 cc de aguardiente, 2 cervezas y cocaína no cuantificada en las horas previas. En la piel se apreciaban placas eritematosas, edematosas, bien delimitadas en cadera, dorso de articulaciones interfalángicas y pies, que en pocas horas evolucionaron formando ampollas tensas de contenido claro.

  4. Hyperosmolar nonketotic coma precipitated by lithium-induced nephrogenic diabetes insipidus.

    Science.gov (United States)

    Azam, H.; Newton, R. W.; Morris, A. D.; Thompson, C. J.

    1998-01-01

    A 45-year-old man, with a 10-year history of manic depression treated with lithium, was admitted with hyperosmolar, nonketotic coma. He gave a five-year history of polyuria and polydipsia, during which time urinalysis had been negative for glucose. After recovery from hyperglycaemia, he remained polyuric despite normal blood glucose concentrations; water deprivation testing indicated nephrogenic diabetes insipidus, likely to be lithium-induced. We hypothesize that when this man developed type 2 diabetes, chronic polyuria due to nephrogenic diabetes insipidus was sufficient to precipitate hyperosmolar dehydration. PMID:9538487

  5. Thoracentesis-reverting cardiac tamponade physiology in a patient with myxedema coma and large pleural effusion.

    Science.gov (United States)

    Werlang, Monia E; Pimentel, Mario R; Diaz-Gomez, Jose L

    2017-07-01

    A large pleural effusion causing cardiac tamponade physiology and severe hemodynamic compromise is an uncommon event. We report a case of a 53-year-old woman with severe hypothyroidism presenting with myxedema coma and refractory shock. Her hemodynamic status failed to respond to fluid resuscitation and vasopressors. A transthoracic echocardiogram and chest radiograph demonstrated a pericardial fluid accumulation associated with a large left-sided pleural effusion. Thoracostomy tube insertion resulted in prompt improvement of the patient's hemodynamic status. Our finding demonstrates that a large pleural effusion may play an important role in cardiac tamponade physiology.

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

    Science.gov (United States)

    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.

  7. Myxoedema coma

    DEFF Research Database (Denmark)

    Salomo, Louise Havkrog; Laursen, Adam Hoegsbro; Reiter, Nanna

    2014-01-01

    A 48-year-old man was admitted to department of emergency medicine at a tertiary referral hospital due to dizziness and fatigue. Clinical features on admission were non-pitting oedema, dry skin, very sparse hair, a hoarse voice, hypothermia (rectal temperature 28.7°C), macroglossia, sinus...

  8. Diabetic Coma

    Science.gov (United States)

    ... unawareness). CGMs are devices that use a small sensor inserted underneath the skin to track trends in ... may help you control your glucose better. Drink alcohol with caution. Because alcohol can have an unpredictable ...

  9. Diffuse radio emission in the Coma cluster and Abell 1367: observations at 430 and 1400 MHz

    International Nuclear Information System (INIS)

    Hanisch, R.J.

    1980-01-01

    Two rich clusters of galaxies, Abell 1656 (the Coma cluster) and Abell 1367, have been mapped at both 430 and 1400 MHz with the 305-m telescope at Arecibo. The contribution to the observed radio emission due to known discrete sources has been calculated by convolving interferometrically determined source lists with observed Arecibo beam patterns, and maps of the diffuse radio emission alone have been constructed. Both clusters contain regions of diffuse radio emission, although the source in Coma is larger and much more luminous than the source in Abell 1367. The linear extent of the diffuse emission and its dependence on frequency have been used to study particle propagation rates and modes of diffusion in the intracluster medium. The possible correlations between the diffuse radio emission and x-ray emission in these clusters have been investigated, and it has been found that the observed x-ray luminosities can be accounted for if the intracluster gas is heated through Coulomb interactions with the relativistic electrons responsible for the diffuse radio emission

  10. DRY MERGER RATE AND POST-MERGER FRACTION IN THE COMA CLUSTER CORE

    Energy Technology Data Exchange (ETDEWEB)

    Cordero, Juan P.; Campusano, Luis E.; Haines, Christopher P. [Departamento de Astronomía, Universidad de Chile, Casilla 36-D, Santiago (Chile); De Propris, Roberto [Finnish Centre for Astronomy with ESO, University of Turku, Vaisalantie 20, Piikkio, FI-21500 (Finland); Weinzirl, Tim [School of Physics and Astronomy, The University of Nottingham, University Park, Nottingham NG7 2RD (United Kingdom); Jogee, Shardha, E-mail: jcordero@das.uchile.cl [Department of Astronomy, The University of Texas at Austin, Austin, TX 78712-1205 (United States)

    2016-01-20

    We evaluate the dry merger activity in the Coma cluster, using a spectroscopically complete sample of 70 red-sequence (RS) galaxies, most of which (∼75%) are located within 0.2R{sub 200} (∼0.5 Mpc) from the cluster center, with data from the Coma Treasury Survey obtained with the Hubble Space Telescope. The fraction of close galaxy pairs in the sample is the proxy employed for the estimation of the merger activity. We identify 5 pairs and 1 triplet, enclosing a total of 13 galaxies, based on limits on projected separation and line-of-sight velocity difference. Of these systems, none show signs of ongoing interaction, and therefore we do not find any true mergers in our sample. This negative result sets a 1σ upper limit of 1.5% per Gyr for the major dry merger rate, consistent with the low rates expected in present-day clusters. Detailed examination of the images of all the RS galaxies in the sample reveals only one with low surface brightness features identifiable as the remnant of a past merger or interaction, implying a post-merger fraction below 2%.

  11. Reversible coma and Duret hemorrhage after intracranial hypotension from remote lumbar spine surgery: case report.

    Science.gov (United States)

    Bonow, Robert H; Bales, James W; Morton, Ryan P; Levitt, Michael R; Zhang, Fangyi

    2016-03-01

    Intracranial hypotension is a rare condition caused by spontaneous or iatrogenic CSF leaks that alter normal CSF dynamics. Symptoms range from mild headaches to transtentorial herniation, coma, and death. Duret hemorrhages have been reported to occur in some patients with this condition and are traditionally believed to be associated with a poor neurological outcome. A 73-year-old man with a remote history of spinal fusion presented with syncope and was found to have small subdural hematomas on head CT studies. He was managed nonoperatively and discharged with a Glasgow Coma Scale score of 15, only to return 3 days later with obtundation, fixed downward gaze, anisocoria, and absent cranial nerve reflexes. A CT scan showed Duret hemorrhages and subtle enlargement of the subdural hematomas, though the hematomas remained too small to account for his poor clinical condition. Magnetic resonance imaging of the spine revealed a large lumbar pseudomeningocele in the area of prior fusion. His condition dramatically improved when he was placed in the Trendelenburg position and underwent repair of the pseudomeningocele. He was kept flat for 7 days and was ultimately discharged in good condition. On long-term follow-up, his only identifiable deficit was diplopia due to an internuclear ophthalmoplegia. Intracranial hypotension is a rare condition that can cause profound morbidity, including tonsillar herniation and brainstem hemorrhage. With proper identification and treatment of the CSF leak, patients can make functional recoveries.

  12. DRY MERGER RATE AND POST-MERGER FRACTION IN THE COMA CLUSTER CORE

    International Nuclear Information System (INIS)

    Cordero, Juan P.; Campusano, Luis E.; Haines, Christopher P.; De Propris, Roberto; Weinzirl, Tim; Jogee, Shardha

    2016-01-01

    We evaluate the dry merger activity in the Coma cluster, using a spectroscopically complete sample of 70 red-sequence (RS) galaxies, most of which (∼75%) are located within 0.2R 200 (∼0.5 Mpc) from the cluster center, with data from the Coma Treasury Survey obtained with the Hubble Space Telescope. The fraction of close galaxy pairs in the sample is the proxy employed for the estimation of the merger activity. We identify 5 pairs and 1 triplet, enclosing a total of 13 galaxies, based on limits on projected separation and line-of-sight velocity difference. Of these systems, none show signs of ongoing interaction, and therefore we do not find any true mergers in our sample. This negative result sets a 1σ upper limit of 1.5% per Gyr for the major dry merger rate, consistent with the low rates expected in present-day clusters. Detailed examination of the images of all the RS galaxies in the sample reveals only one with low surface brightness features identifiable as the remnant of a past merger or interaction, implying a post-merger fraction below 2%

  13. The relationship between pneumonia and Glasgow coma scale assessment on acute stroke patients

    Science.gov (United States)

    Ritarwan, K.; Batubara, C. A.; Dhanu, R.

    2018-03-01

    Pneumonia is one of the most frequent medical complications of a stroke. Despite the well-documented association of a stroke associated infections with increased mortality and worse long-term outcome, on the other hand, the limited data available on independent predictors of pneumonia in acute stroke patients in an emergency unit. To determine the independentrelationship between pneumonia and Glasgow Coma Scale assessment on acute stroke patients. The cohort retrospective study observed 55 acute stroke patients who stayed in intensive care unit Adam Malik General Hospital from January until August 2017. Pneumonia was more frequent in patients with Ischemic stroke (OR 5.40; 95% CI: 1.28 – 6.40, p=0.003), higher National Institute of Health Stroke Scale (NIHSS) (p=0.014) and lower Glasgow Coma Scale (p=0.0001). Analysis multivariate logistic regression identified NIHSS as an independent of predictors of pneumonia (95% CI : 1.047 – 1.326, p=0.001). Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deficits evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients.

  14. A Spanish validation of the Coma Recovery Scale-Revised (CRS-R).

    Science.gov (United States)

    Tamashiro, Mercedes; Rivas, Maria Elisa; Ron, Melania; Salierno, Fernando; Dalera, Marisol; Olmos, Lisandro

    2014-01-01

    Analysis of inter-rater reliability and concurrent validity. To determine measurement properties of a Spanish version of The Coma Recovery Scale-Revised (CRS-R). A sample of 35 in-patients with severe acquired brain injury. To test concurrent validity of the translated scale, the Glasgow Coma Scale (GSC) and Disability Rating Scale (DRS) were also administered. Two experts in the field were recruited to assess inter-rater agreement. Inter-rater reliability was good for total CRS-R scores (Cronbach α = 0.973, p = 0.001). Sub-scale analysis showed moderate-to-high inter-rater agreement. Total CRS-R scores correlated significantly (p < 0.05) with total GCS (r = 0.74) and DRS (r = 0.54) scores, indicating acceptable concurrent validity. The Spanish version of CRS-R can be administered reliably by trained and experienced examiners. CRS-R appears capable of differentiating patients in Emergence from Minimally Conscious State (EMCS) or in Minimally Conscious State (MCS) from those in a Vegetative State (VS).

  15. A NuSTAR OBSERVATION OF THE CENTER OF THE COMA CLUSTER

    Energy Technology Data Exchange (ETDEWEB)

    Gastaldello, Fabio; Molendi, S. [IASF-Milano, INAF, Via Bassini 15, I-20133 Milan (Italy); Wik, Daniel R.; Zhang, W. W. [Astrophysics Science Division, NASA/Goddard Space Flight Center, Greenbelt, MD 20771 (United States); Westergaard, N. J.; Hornstrup, A.; Ferreira, D. D. M.; Christensen, F. E. [DTU Space, National Space Institute, Technical University of Denmark, Elektrovej 327, DK-2800 Lyngby (Denmark); Madejski, G. [Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, Menlo Park, CA 94025 (United States); Boggs, S. E.; Craig, W. W. [Space Sciences Laboratory, University of California, Berkeley, CA 94720 (United States); Grefenstette, B. W.; Harrison, F. A.; Madsen, K. K. [Cahill Center for Astronomy and Astrophysics, California Institute of Technology, Pasadena, CA 91125 (United States); Hailey, C. J. [Columbia Astrophysics Laboratory, Columbia University, New York, NY 10027 (United States); Stern, D., E-mail: gasta@lambrate.inaf.it [Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 (United States)

    2015-02-20

    We present the results of a 55 ks NuSTAR observation of the core of the Coma Cluster. The global spectrum can be explained by thermal gas emission, with a conservative 90% upper limit to non-thermal inverse Compton (IC) emission of 5.1 × 10{sup –12} erg cm{sup –2} s{sup –1} in a 12' × 12' field of view. The brightness of the thermal component in this central region does not allow more stringent upper limits on the IC component when compared with non-imaging instruments with much larger fields of view where claims of detections have been made. Future mosaic NuSTAR observations of Coma will further address this issue. The temperature map shows a relatively uniform temperature distribution with a gradient from the hot northwest side to the cooler southeast, in agreement with previous measurements. The temperature determination is robust given the flat effective area and low background in the 3-20 keV band, making NuSTAR an ideal instrument to measure high temperatures in the intracluster medium.

  16. Observing RAM Pressure Stripping and Morphological Transformation in the Coma Cluster

    Science.gov (United States)

    Gregg, Michael; West, Michael

    2017-07-01

    The two largest spirals in the Coma cluster, NGC4911 and NGC4921, are being vigorously ram-pressure stripped by the hot intracluster medium. Our HST ACS and WFC3 images have revealed galactic scale shock fronts, giant "Pillars of Creation", rivulets of dust, and spatially coherent star formation in these grand design spirals. We have now obtained HST WFC3 imaging of five additional large Coma spirals to search for and investigate the effects of ram pressure stripping across the wider cluster environment. The results are equally spectacular as the first two examples. The geometry of the interactions in some cases allows an estimation of the various time scales involved, including gas flows out of the disk leading to creation of the ICM, and the attendant triggered star formation in the galaxy disks. The global star formation patterns yield insights into the spatial and temporal ISM-ICM interactions driving cluster galaxy evolution and ultimately transforming morphologies from spiral to S0. These processes were much more common in the early Universe when the intergalactic and intracluster components were initially created from stripping and destruction of member galaxies.

  17. Coma hiponatrêmico como manifestação de doença de Addison Hyponatremic coma as a manifestation of Addison's disease

    Directory of Open Access Journals (Sweden)

    Paulo S.M. Esperon

    2001-08-01

    Full Text Available OBJETIVO: alertar sobre a importância de distúrbio hidroeletrolítico grave devido a doença crônica não previamente diagnosticada. MÉTODO: relato de um caso de coma hiponatrêmico devido a crise adrenal em criança portadora de doença de Addison não diagnosticada previamente, apesar de história clínica sugestiva desta doença há cerca de quatro anos. RESULTADO: Após atendimento inicial à emergência, com correção da hiponatremia grave com hipovolemia discreta, hipernatriúria e hiperpotassemia, o diagnóstico diferencial deste distúrbio hidroeletrolítico revelou tratar-se de uma crise adrenal secundária a uma insuficiência adrenal primária crônica. O tratamento com hidrocortisona oral possibilitou alta hospitalar com correção total dos distúrbios metabólicos. CONCLUSÃO: é importante manter um alto grau de suspeita de doença de Addison para evitar as graves conseqüências de seu diagnóstico tardio, como distúrbios hidroeletrolíticos graves, além de atraso de crescimento e desenvolvimento.OBJECTIVE: To show the importance of severe hydroelectrolytic disorder as a consequence of previously undiagnosed chronic disease. DESCRIPTION: Case report of hyponatremic coma caused by adrenal crisis in a child with previously undiagnosed Addison's disease despite suggestive clinical findings of this disease in the last four years. After correction of severe hyponatremia, mild hypovolemia, hypernatriuria and hyperkalemia, the differential diagnosis of this hydroelectrolytic disorder revealed an adrenal crisis resulting from a primary chronic adrenal insufficiency. Oral treatment with hydrocortisone was efficient in correcting the metabolic disorder and the patient was then discharged. COMMENTS: It is very important to highly suspect of Addison's disease in order to avoid the dangerous consequences of late diagnosis such as severe hydroelectrolytic disorders and retarded growth and development.

  18. Acompañamiento pedagógico en la práctica docente en nivel primaria, Comas, 2015

    OpenAIRE

    Sulca Alarcón, Silvia Marina

    2015-01-01

    La investigación titulada Acompañamiento pedagógico en la práctica docente en el nivel primaria Comas, 2015 se desarrolló con el objetivo de demostrar que, el acompañamiento pedagógico influye en la práctica docente de las instituciones Educativas correspondientes a la UGEL 04 Comas 2015. El estudio realizado en el contexto en contribuir esfuerzos para la mejora del servicio educativo. La investigación se sustenta en la teoría que sostiene que elacompañamiento pedsgógico es una...

  19. Monte Carlo modeling of the net effects of coma scattering and thermal reradiation on the energy input to cometary nucleus

    International Nuclear Information System (INIS)

    Salo, H.

    1988-01-01

    A Monte Carlo simulation method is presented that can, to an accuracy of a few percent, calculate the effects of a dusty coma on the total energy input to the cometary nucleus. This method treats nonconservative nonisotropic scattering, as well as the reflection from the nucleus surface. Results are presented as a function of the optical thickness of the dust column in the sun-comet axis. The total energy input to the nucleus appears to be only weakly dependent on the opacity of the coma, the radial distribution of the dust, or the details of the extinction processes. 18 references

  20. THE REINCARNATION OF INTERSTELLAR DUST: THE IMPORTANCE OF ORGANIC REFRACTORY MATERIAL IN INFRARED SPECTRA OF COMETARY COMAE AND CIRCUMSTELLAR DISKS

    Energy Technology Data Exchange (ETDEWEB)

    Kimura, Hiroshi, E-mail: hiroshi_kimura@cps-jp.org [Graduate School of Science, Kobe University, c/o CPS (Center for Planetary Science), Chuo-ku Minatojima Minamimachi 7-1-48, Kobe 650-0047 (Japan)

    2013-09-20

    We consider the reincarnation of interstellar dust to be reborn in protoplanetary disks as aggregates consisting of submicron-sized grains with a crystalline or amorphous silicate core and an organic-rich carbonaceous mantle. We find that infrared spectra of reincarnated interstellar dust reproduce emission peaks at correct wavelengths where the peaks were observed in cometary comae, debris disks, and protoplanetary disks if the volume fraction of organic refractory meets the constraints on elemental abundances. We discuss what we can learn from the infrared spectra of reincarnated interstellar dust in cometary comae and circumstellar disks.

  1. The Reincarnation of Interstellar Dust: The Importance of Organic Refractory Material in Infrared Spectra of Cometary Comae and Circumstellar Disks

    Science.gov (United States)

    Kimura, Hiroshi

    2013-09-01

    We consider the reincarnation of interstellar dust to be reborn in protoplanetary disks as aggregates consisting of submicron-sized grains with a crystalline or amorphous silicate core and an organic-rich carbonaceous mantle. We find that infrared spectra of reincarnated interstellar dust reproduce emission peaks at correct wavelengths where the peaks were observed in cometary comae, debris disks, and protoplanetary disks if the volume fraction of organic refractory meets the constraints on elemental abundances. We discuss what we can learn from the infrared spectra of reincarnated interstellar dust in cometary comae and circumstellar disks.

  2. THE REINCARNATION OF INTERSTELLAR DUST: THE IMPORTANCE OF ORGANIC REFRACTORY MATERIAL IN INFRARED SPECTRA OF COMETARY COMAE AND CIRCUMSTELLAR DISKS

    International Nuclear Information System (INIS)

    Kimura, Hiroshi

    2013-01-01

    We consider the reincarnation of interstellar dust to be reborn in protoplanetary disks as aggregates consisting of submicron-sized grains with a crystalline or amorphous silicate core and an organic-rich carbonaceous mantle. We find that infrared spectra of reincarnated interstellar dust reproduce emission peaks at correct wavelengths where the peaks were observed in cometary comae, debris disks, and protoplanetary disks if the volume fraction of organic refractory meets the constraints on elemental abundances. We discuss what we can learn from the infrared spectra of reincarnated interstellar dust in cometary comae and circumstellar disks

  3. Effect of vitamin A adjunct therapy for cerebral malaria in children ...

    African Journals Online (AJOL)

    Objective: To determine the effect of vitamin A supplementation on treatment outcome of cerebral malaria Methods: In this randomised double-blind placebo controlled clinical trial we ... Conclusions: Vitamin A as adjunct therapy did not significantly reduce coma duration but there were fewer deaths in the vitamin A arm.

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

    Science.gov (United States)

    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.

  5. Evolution of H2O related species in the neutral coma of 67P

    Science.gov (United States)

    Bieler, A. M.; Altwegg, K.; Balsiger, H. R.; Bar-Nun, A.; Berthelier, J. J.; Bochsler, P. A.; Briois, C.; Calmonte, U.; Combi, M. R.; De Keyser, J.; van Dishoeck, E.; 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. C.; Reme, H.; Rubin, M.; Sémon, T.; Tzou, C. Y.; Waite, J. H., Jr.; Walsh, C.; Wurz, P.

    2015-12-01

    The ROSINA-DFMS mass spectrometer has been probing the coma of 67Psince the spacecraft arrived at the comet in August 2014.The acquired data set covers a large range of viewing geometries forthe ever changing conditions of 67P along its journey to pericenter. With the high temporal resolutionof ROSINA-DFMS we are able to examine diurnal and seasonal changesof different species in the gaseous coma.Large scale heterogeneities in the coma have been reported since the very first measurements of the neutral inventory at 67P.Many of the minor species are seen to follow one of the major compounds,H2O, CO or CO2.In this paper we will present the latest results on H2O related species.We will discuss the possible trapping/building mechanisms responsible for these species and why it is different from other species such asCO, N2 or CO2. Acknowledgements:Work at the University of Michigan was funded by NASA contract JPL-1266313.Work at UoB was funded by the State of Bern, the Swiss National Science Foundationand the European Space Agency PRODEX Program. Work at MPS was funded by the Max-Planck Society and BMWI contract 50QP1302. Work at Southwest Research institute was supported by subcontract #1496541 from the Jet Propulsion Laboratory. Work at BIRA-IASB was supported by the Belgian Science Policy Office via PRODEX/ROSINA PEA 90020. This work has been carried out thanks to the support of the A*MIDEX project (n° ANR-11-IDEX-0001-02) funded by the « Investissements d'Avenir » French Government program, managed by the French National Research Agency (ANR). This work was supported by CNES grants at IRAP, LATMOS, LPC2E, UTINAM, CRPG, and by the European Research Council (grant no. 267255 to B. Marty). A. Bar-Nun thanks the Ministry of Science and the Israel Space agency. Work by JHW at Southwest Research Institute was funded by the NASA JPL subcontract NAS703001TONMO710889. EvD and CW are supported by A-ERC grant 291141 CHEMPLAN and an NWO Veni award. We acknowledge herewith the

  6. 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.

    Science.gov (United States)

    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.

  7. Predictive value of neurological examination for early cortical responses to somatosensory evoked potentials in patients with postanoxic coma

    NARCIS (Netherlands)

    Bouwes, Aline; Binnekade, Jan M.; Verbaan, Bart W.; Zandbergen, Eveline G. J.; Koelman, Johannes H. T. M.; Weinstein, Henry C.; Hijdra, Albert; Horn, Janneke

    2012-01-01

    Bilateral absence of cortical N20 responses of median nerve somatosensory evoked potentials (SEP) predicts poor neurological outcome in postanoxic coma after cardiopulmonary resuscitation (CPR). Although SEP is easy to perform and available in most hospitals, it is worthwhile to know how

  8. Accuracy of clinical signs, SEP, and EEG in predicting outcome of hypoxic coma: a meta-analysis.

    Science.gov (United States)

    Lee, Y C; Phan, T G; Jolley, D J; Castley, H C; Ingram, D A; Reutens, D C

    2010-02-16

    Accurate prediction of neurologic outcome after hypoxic coma is important. Previous systematic reviews have not used summary statistics to summarize and formally compare the accuracy of different prognostic tests. We therefore used summary receiver operating characteristic curve (SROC) and cluster regression methods to compare motor and pupillary responses with sensory evoked potential (SEP) and EEG in predicting outcome after hypoxic coma. We searched PubMed, MEDLINE, and Embase (1966-2007) for reports in English, German, and French and identified 25 suitable studies. An SROC was constructed for each marker (SEP, EEG, M1 and M SEP was larger than those for M1, M SEP (AUC 0.891) and that for M1 (AUC 0.786) was small (0.105, 95% confidence interval 0.023-0.187), only reaching significance on day 1 after coma onset. The use of M SEP) is marginally better than M1 at predicting outcome after hypoxic coma. However, the superiority of SEP diminishes after day 1 and when M SEP is a better marker than clinical signs.

  9. Microswitch- and VOCA-Assisted Programs for Two Post-Coma Persons with Minimally Conscious State and Pervasive Motor Disabilities

    Science.gov (United States)

    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…

  10. Rosetta/Alice Measurements of Atomic and Molecular Abundances in the Coma of 67P/Churyumov-Gerasimenko

    Science.gov (United States)

    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.

  11. Fractional excretion of beta-2-microglobulin in the urine of patients with normal or reduced renal function and hepatic coma

    DEFF Research Database (Denmark)

    Hansen, P B; Dalhoff, K; Joffe, P

    1991-01-01

    The purpose of this prospective study was to evaluate beta-2-microglobulin (beta 2m) as a differential diagnostic indicator between hepatic nephropathy (HN) and acute tubulointerstitial nephropathy (ATIN) in patients with reduced renal function and hepatic coma, and to determine whether beta 2m e...

  12. Combination of Glasgow Coma Scale, Age, and Systolic Blood Pressure in Assessing Patients’ Outcomes with Decreased Consciousness

    Directory of Open Access Journals (Sweden)

    Amir S Madjid

    2017-04-01

    Full Text Available Glasgow Coma Scale (GCS is commonly used to assess outcomes of patients with loss of consciousness, but it is insufficient in predicting the outcome of some cases. This study aimed to assess the combination of GCS, systolic blood pressure and age to predict the outcome of patients with decreased consciousness. This was a retrospective cohort observational study of 76 loss of consciousness patients that comes into the Emergency Department of Dr. Cipto Mangunkusumo General Hospital in June-August 2014. Data was obtained from the medical records . GCS, systolic blood pressure and age were recorded when patients were admitted to the triage. Outcome was assessed two weeks after admission in the emergency department. Bivariate analysis on the GCS and age showed significant different between patients with poor outcome group with good outcome group (p<0.05 and no significant different of the systolic blood pressure between both groups (p>0.05. Multivariate analysis on the GCS and age showed good probability equation based on the calibration test and discrimination. The combination of Glasgow Coma Scale and age was accurate in assessing the outcomes of patients with loss of consciousness. Keywords. Glasgow Coma Scale, systolic, age, outcomes     Gabungan Glasgow Coma Scale, Umur, dan Tekanan Darah Sistolik Sebagai Penilai Luaran Pasien Penurunan Kesadaran   Abstrak Glasgow Coma Scale (GCS telah menjadi salah satu penilaian yang digunakan untuk menilai luaran pasien penurunan kesadaran, tetapi dinilai masih belum mampu memprediksi luaran yang terjadi. Penelitian ini bertujuan untuk menilai gabungan GCS, tekanan darah sistolik dan umur untuk memprediksi luaran pasien dengan penurunan kesadaran. Penelitian ini merupakan studi observasional kohort retrospektif yang melibatkan 76 pasien dengan penurunan kesadaran yang datang ke IGD RSUPN Dr. Cipto Mangunkusumo selama bulan Juni-Agustus 2014. Data diambil dari rekam medik. GCS, tekanan darah sistolik dan

  13. CoMA, an experiment for the detailed in-situ analysis of collected cometary particulates

    International Nuclear Information System (INIS)

    Kissel, J.; Fechtig, H.; Jessberger, E.K.; Krueger, F.R.; Niemczyk, N.; Schaefer, G.; Zscheeg, H.

    1989-01-01

    After NASA accepted for the implementation phase (up to October 1990) our proposal for the CoMA investigation to be flown onboard CRAF to rendezvous with a comet, funding by the BMFT for instrument pre-development has been obtained. Most contracts could be let, some, however, with substantial delay due to administrative problems. Progress can be reported as the group in Bremen could demonstrate a mass resolution of 60 000 for a low magnetic field ICR-experiment, resolving 12 CH + and 13 C + ions. Also a first successful attempt was made to theoretically describe the dust collection efficiencies of different materials. As yet such a model did not exist - a fact that made the interpretation and extrapolation of laboratory data obsolete. The experimental setup in which the Indium liquid ion source is tested could be completed by the successful addition of a bunching structure. In future it will serve those partners that develop in detail the primary beam system. (orig.)

  14. Neural signature of coma revealed by posteromedial cortex connection density analysis

    Directory of Open Access Journals (Sweden)

    Briguita Malagurski

    2017-01-01

    A complex pattern of decreased and increased connections was observed, suggesting a network imbalance between internal/external processing systems, within PMC during coma. The number of PMC voxels with hypo-CD positive correlation showed a significant negative association with the CRS-R score, notwithstanding aetiology. Traumatic injury specifically appeared to be associated with a greater prevalence of hyper-connected (negative correlation voxels, which was inversely associated with patient neurological outcome. A logistic regression model using the number of hypo-CD positive and hyper-CD negative correlations, accurately permitted patient's outcome prediction (AUC = 0.906, 95%IC = 0.795–1. These points might reflect adaptive plasticity mechanism and pave the way for innovative prognosis and therapeutics methods.

  15. Neurological prognostication of outcome in patients in coma after cardiac arrest.

    Science.gov (United States)

    Rossetti, Andrea O; Rabinstein, Alejandro A; Oddo, Mauro

    2016-05-01

    Management of coma after cardiac arrest has improved during the past decade, allowing an increasing proportion of patients to survive, thus prognostication has become an integral part of post-resuscitation care. Neurologists are increasingly confronted with raised expectations of next of kin and the necessity to provide early predictions of long-term prognosis. During the past decade, as technology and clinical evidence have evolved, post-cardiac arrest prognostication has moved towards a multimodal paradigm combining clinical examination with additional methods, consisting of electrophysiology, blood biomarkers, and brain imaging, to optimise prognostic accuracy. Prognostication should never be based on a single indicator; although some variables have very low false positive rates for poor outcome, multimodal assessment provides resassurance about the reliability of a prognostic estimate by offering concordant evidence. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Testing a generalized cubic Galileon gravity model with the Coma Cluster

    Energy Technology Data Exchange (ETDEWEB)

    Terukina, Ayumu; Yamamoto, Kazuhiro; Okabe, Nobuhiro [Department of Physical Sciences, Hiroshima University, 1-3-1 Kagamiyama, Higashi-Hiroshima, Hiroshima 739-8526 (Japan); Matsushita, Kyoko; Sasaki, Toru, E-mail: telkina@theo.phys.sci.hiroshima-u.ac.jp, E-mail: kazuhiro@hiroshima-u.ac.jp, E-mail: okabe@hiroshima-u.ac.jp, E-mail: matusita@rs.kagu.tus.ac.jp, E-mail: j1213703@ed.tus.ac.jp [Department of Physics, Tokyo University of Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo 162-8601 (Japan)

    2015-10-01

    We obtain a constraint on the parameters of a generalized cubic Galileon gravity model exhibiting the Vainshtein mechanism by using multi-wavelength observations of the Coma Cluster. The generalized cubic Galileon model is characterized by three parameters of the turning scale associated with the Vainshtein mechanism, and the amplitude of modifying a gravitational potential and a lensing potential. X-ray and Sunyaev-Zel'dovich (SZ) observations of the intra-cluster medium are sensitive to the gravitational potential, while the weak-lensing (WL) measurement is specified by the lensing potential. A joint fit of a complementary multi-wavelength dataset of X-ray, SZ and WL measurements enables us to simultaneously constrain these three parameters of the generalized cubic Galileon model for the first time. We also find a degeneracy between the cluster mass parameters and the gravitational modification parameters, which is influential in the limit of the weak screening of the fifth force.

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

    Science.gov (United States)

    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.

  18. MERIDIONAL COMA OF NEGATIVE ANASTIGMATIC LENSES AT THE FINAL POSITION OF AN OBJECT

    Directory of Open Access Journals (Sweden)

    V. A. Bezrukov

    2015-03-01

    Full Text Available The paper deals with the findings of negative anastigmatic lenses at the final position of an object. The negative lenses are considered with refraction index n=1.7849 (type of glass is TF12 and thickness d=5 mm, working with paraxial magnifications β=1,1x;1,3x;1,5x with account of the distances from the first lens surface to the object S1=9; 25 mm and the size of the object y=15 mm. Dependences of negative lens forms from the position of anastigmatic pupils and from radii of meridional caustics which are convenient for understanding aberrational properties of anastigmatic lenses. The findings give the possibility to synthesize wide-angle lenses with the corrected aberrations of image curvature and meridional coma without geometrical vignetting of wide sloping bunches.

  19. New conception of the spatial structure of the galactic clusters: Pleiades, Praesepe and Coma Berenices

    International Nuclear Information System (INIS)

    Pejkov, Z.I.

    1990-01-01

    The spatial structure of the galactic cluster Pleiads, Praesepe and Coma Berenices in the dependence on different star magnitude intervals and on different limiting star magnitudes is investigated on the basis of the star density distribution functions which were published by Kholopov and Artyukhina. It is shown that the spatial structure of these clusters, similarly to the globular ones, systematically changes with the star magnitude of the included stars, starting from the brightest stars of the upper part of the main sequance and descending along the 'V, B-V' diagram for the clusters. This change consists in an increase of the spatial zones radii, following the same law, whith the transition to the fainter stars

  20. Food deprivation and prior anoxic coma have opposite effects on the activity of a visual interneuron in the locust.

    Science.gov (United States)

    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.

  1. Extending technology-aided leisure and communication programs to persons with spinal cord injury and post-coma multiple disabilities.

    Science.gov (United States)

    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.

  2. Hyperammonemic coma after craniotomy: Hepatic encephalopathy from upper gastrointestinal hemorrhage or valproate side effect?: Case report and literature review.

    Science.gov (United States)

    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.

  3. Soft X-ray excess in the Coma cluster from a Cosmic Axion Background

    Energy Technology Data Exchange (ETDEWEB)

    Angus, Stephen; Conlon, Joseph P.; Marsh, M.C. David; Powell, Andrew J.; Witkowski, Lukas T., E-mail: stephen.angus@physics.ox.ac.uk, E-mail: j.conlon1@physics.ox.ac.uk, E-mail: david.marsh1@physics.ox.ac.uk, E-mail: andrew.powell2@physics.ox.ac.uk, E-mail: l.witkowski@thphys.uni-heidelberg.de [Rudolf Peierls Centre for Theoretical Physics, University of Oxford, 1 Keble Road, Oxford OX1 3NP (United Kingdom)

    2014-09-01

    We show that the soft X-ray excess in the Coma cluster can be explained by a cosmic background of relativistic axion-like particles (ALPs) converting into photons in the cluster magnetic field. We provide a detailed self-contained review of the cluster soft X-ray excess, the proposed astrophysical explanations and the problems they face, and explain how a 0.1- 1 keV axion background naturally arises at reheating in many string theory models of the early universe. We study the morphology of the soft excess by numerically propagating axions through stochastic, multi-scale magnetic field models that are consistent with observations of Faraday rotation measures from Coma. By comparing to ROSAT observations of the 0.2- 0.4 keV soft excess, we find that the overall excess luminosity is easily reproduced for g{sub aγγ} ∼ 2 × 10{sup -13} Ge {sup -1}. The resulting morphology is highly sensitive to the magnetic field power spectrum. For Gaussian magnetic field models, the observed soft excess morphology prefers magnetic field spectra with most power in coherence lengths on O(3 kpc) scales over those with most power on O(12 kpc) scales. Within this scenario, we bound the mean energy of the axion background to 50 eV∼< ( E{sub a} ) ∼< 250 eV, the axion mass to m{sub a} ∼< 10{sup -12} eV, and derive a lower bound on the axion-photon coupling g{sub aγγ} ∼> √(0.5/Δ N{sub eff}) 1.4 × 10{sup -13} Ge {sup -1}.

  4. Soft X-ray excess in the Coma cluster from a Cosmic Axion Background

    International Nuclear Information System (INIS)

    Angus, Stephen; Conlon, Joseph P.; Marsh, M.C. David; Powell, Andrew J.; Witkowski, Lukas T.

    2014-01-01

    We show that the soft X-ray excess in the Coma cluster can be explained by a cosmic background of relativistic axion-like particles (ALPs) converting into photons in the cluster magnetic field. We provide a detailed self-contained review of the cluster soft X-ray excess, the proposed astrophysical explanations and the problems they face, and explain how a 0.1- 1 keV axion background naturally arises at reheating in many string theory models of the early universe. We study the morphology of the soft excess by numerically propagating axions through stochastic, multi-scale magnetic field models that are consistent with observations of Faraday rotation measures from Coma. By comparing to ROSAT observations of the 0.2- 0.4 keV soft excess, we find that the overall excess luminosity is easily reproduced for g aγγ  ∼ 2 × 10 -13  Ge -1 . The resulting morphology is highly sensitive to the magnetic field power spectrum. For Gaussian magnetic field models, the observed soft excess morphology prefers magnetic field spectra with most power in coherence lengths on O(3 kpc) scales over those with most power on O(12 kpc) scales. Within this scenario, we bound the mean energy of the axion background to 50 eV∼< ( E a  ) ∼< 250 eV, the axion mass to m a  ∼< 10 -12  eV, and derive a lower bound on the axion-photon coupling g aγγ  ∼> √(0.5/Δ N eff ) 1.4 × 10 -13  Ge -1

  5. Chemical evolution of the coma of comet P/Stephan-Oterma

    International Nuclear Information System (INIS)

    Cochran, A.L.

    1982-01-01

    Observations of comet P/Stephan-Oterma were made with an Intensified Dissector Scanner spectrograph on the McDonald Observatory 2.7m telescope during the period from July, 1980 to February, 1981. These spectra covered a range of heliocentric distances from 2.3 au pre-perihelion to 1.8 au post-perihelion. A study of the spatial distribution of the gasses in the coma was conducted. Column densities of the observed cometary emissions (CN, C 3 , CH, and C 2 ) were calculated. It was shown that Stephan-Oterma was very nearly sperically symmetric. A computer code to calculate the time dependent non-equilibrium chemistry taking place within the coma was developed. This code incorporates over 1200 chemical reactions involving 125 species. Models were calculated for pure gas-phase chemistry and for gas-phase chemistry plus grain photolysis. It was shown that: (1) HCN is the parent for CN; (2) C 2 H 2 is a parent for C 2 ; (3) pure gas-phase chemistry cannot adequately reproduce the observed C 3 but a single-step process such as grain photolysis can; (4) there must be much more CH 4 in this comet than had previously been envisioned for any comet; and (5) at least prior to perihelion, the vaporization rate seems to have been controlled by water vaporization. The model of Haser (1957) is discussed and it is shown that a family of solutions for this model exist which can reproduce the observed CN gas distribution. The implications for solar system formation of the large CH 4 abundance are discussed. Present data taking methods are reviewed. Future work is suggested

  6. An Italian multicentre validation study of the coma recovery scale-revised.

    Science.gov (United States)

    Estraneo, A; Moretta, P; De Tanti, A; Gatta, G; Giacino, J T; Trojano, L

    2015-10-01

    Rate of misdiagnosis of disorders of consciousness (DoC) can be reduced by employing validated clinical diagnostic tools, such as the Coma Recovery Scale-Revised (CRS-R). An Italian version of the CRS-R has been recently developed, but its applicability across different clinical settings, and its concurrent validity and diagnostic sensitivity have not been estimated yet. To perform a multicentre validation study of the Italian version of the Coma Recovery Scale-Revised (CRS-R). Analysis of inter-rater reliability, concurrent validity and diagnostic sensitivity of the scale. One Intensive Care Unit, 8 Post-acute rehabilitation centres and 2 Long-term facilities Twenty-seven professionals (physicians, N.=11; psychologists, N.=5; physiotherapists, N.=3; speech therapists, N.=6; nurses, N.=2) from 11 Italian Centres. CRS-R and Disability Rating Scale (DRS) applied to 122 patients with clinical diagnosis of Vegetative State (VS) or Minimally Conscious State (MCS). CRS-R has good-to-excellent inter-rater reliability for all subscales, particularly for the communication subscale. The Italian version of the CRS-R showed a high sensitivity and specificity in detecting MCS with reference to clinical consensus diagnosis. The CRS-R showed good concurrent validity with the Disability Rating Scale, which had very low specificity with reference to clinical consensus diagnosis. The Italian version of the CRS-R is a valid scale for use from the sub-acute to chronic stages of DoC. It can be administered reliably by all members of the rehabilitation team with different specialties, levels of experience and settings. The present study promote use of the Italian version of the CRS-R to improve diagnosis of DoC patients, and plan tailored rehabilitation treatment.

  7. A pediatric FOUR score coma scale: interrater reliability and predictive validity.

    Science.gov (United States)

    Czaikowski, Brianna L; Liang, Hong; Stewart, C Todd

    2014-04-01

    The Full Outline of UnResponsiveness (FOUR) Score is a coma scale that consists of four components (eye and motor response, brainstem reflexes, and respiration). It was originally validated among the adult population and recently in a pediatric population. To enhance clinical assessment of pediatric intensive care unit patients, including those intubated and/or sedated, at our children's hospital, we modified the FOUR Score Scale for this population. This modified scale would provide many of the same advantages as the original, such as interrater reliability, simplicity, and elimination of the verbal component that is not compatible with the Glasgow Coma Scale (GCS), creating a more valuable neurological assessment tool for the nursing community. Our goal was to potentially provide greater information than the formally used GCS when assessing critically ill, neurologically impaired patients, including those sedated and/or intubated. Experienced pediatric intensive care unit nurses were trained as "expert raters." Two different nurses assessed each subject using the Pediatric FOUR Score Scale (PFSS), GCS, and Richmond Agitation Sedation Scale at three different time points. Data were compared with the Pediatric Cerebral Performance Category (PCPC) assessed by another nurse. Our hypothesis was that the PFSS and PCPC should highly correlate and the GCS and PCPC should correlate lower. Study results show that the PFSS is excellent for interrater reliability for trained nurse-rater pairs and prediction of poor outcome and in-hospital mortality, under various situations, but there were no statistically significant differences between the PFSS and the GCS. However, the PFSS does have the potential to provide greater neurological assessment in the intubated and/or sedated patient based on the outcomes of our study.

  8. MAPPING THE GAS TURBULENCE IN THE COMA CLUSTER: PREDICTIONS FOR ASTRO-H

    Energy Technology Data Exchange (ETDEWEB)

    ZuHone, J. A. [Kavli Institute for Astrophysics and Space Research, Massachusetts Institute of Technology, Cambridge, MA 02139 (United States); Markevitch, M. [Astrophysics Science Division, X-ray Astrophysics Laboratory, Code 662, NASA/Goddard Space Flight Center, Greenbelt, MD 20771 (United States); Zhuravleva, I. [Kavli Institute for Particle Astrophysics and Cosmology, Stanford University, 452 Lomita Mall, Stanford, California 94305-4085 (United States)

    2016-02-01

    Astro-H will be able for the first time to map gas velocities and detect turbulence in galaxy clusters. One of the best targets for turbulence studies is the Coma cluster, due to its proximity, absence of a cool core, and lack of a central active galactic nucleus. To determine what constraints Astro-H will be able to place on the Coma velocity field, we construct simulated maps of the projected gas velocity and compute the second-order structure function, an analog of the velocity power spectrum. We vary the injection scale, dissipation scale, slope, and normalization of the turbulent power spectrum, and apply measurement errors and finite sampling to the velocity field. We find that even with sparse coverage of the cluster, Astro-H will be able to measure the Mach number and the injection scale of the turbulent power spectrum—the quantities determining the energy flux down the turbulent cascade and the diffusion rate for everything that is advected by the gas (metals, cosmic rays, etc.). Astro-H will not be sensitive to the dissipation scale or the slope of the power spectrum in its inertial range, unless they are outside physically motivated intervals. We give the expected confidence intervals for the injection scale and the normalization of the power spectrum for a number of possible pointing configurations, combining the structure function and velocity dispersion data. Importantly, we also determine that measurement errors on the line shift will bias the velocity structure function upward, and show how to correct this bias.

  9. Mapping the Gas Turbulence in the Coma Cluster: Predictions for Astro-H

    Science.gov (United States)

    ZuHone, J. A.; Markevitch, M.; Zhuravleva, I.

    2016-01-01

    Astro-H will be able for the first time to map gas velocities and detect turbulence in galaxy clusters. One of the best targets for turbulence studies is the Coma cluster, due to its proximity, absence of a cool core, and lack of a central active galactic nucleus. To determine what constraints Astro-H will be able to place on the Coma velocity field, we construct simulated maps of the projected gas velocity and compute the second-order structure function, an analog of the velocity power spectrum. We vary the injection scale, dissipation scale, slope, and normalization of the turbulent power spectrum, and apply measurement errors and finite sampling to the velocity field. We find that even with sparse coverage of the cluster, Astro-H will be able to measure the Mach number and the injection scale of the turbulent power spectrum-the quantities determining the energy flux down the turbulent cascade and the diffusion rate for everything that is advected by the gas (metals, cosmic rays, etc.). Astro-H will not be sensitive to the dissipation scale or the slope of the power spectrum in its inertial range, unless they are outside physically motivated intervals. We give the expected confidence intervals for the injection scale and the normalization of the power spectrum for a number of possible pointing configurations, combining the structure function and velocity dispersion data. Importantly, we also determine that measurement errors on the line shift will bias the velocity structure function upward, and show how to correct this bias.

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

    Science.gov (United States)

    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.

  11. Monte Carlo particle-trajectory models for neutral cometary gases. I. Models and equations. II. The spatial morphology of the Lyman-alpha coma

    International Nuclear Information System (INIS)

    Combi, M.R.; Smyth, W.H.

    1988-01-01

    The mathematical derivations of various methods employed in the Monte Carlo particle-trajectory model (MCPTM) are presented, and the application of the MCPTM to the calculation of the photochemical heating of the inner coma through the partial thermalization of cometary hydrogen atoms produced by the photodissociation of water is discussed. This model is then used to explain the observed morphology of the spatially extended Ly-alpha comas of comets. The rocket and Skylab images of the Ly-alpha coma of Comet Kohoutek are examined. 90 references

  12. Synthesis and spectral properties of diethyl organylchalcogenoalkyl(alkyl)malonates, RX(CH/sub 2/)/sub n/CR'(COOC/sub 2/H/sub 5/)/sub 2/, and 5-alkyl-5-(organylchalcogenoalkyl)barbiturates, RX(CH/sub 2/)/sub n/C(R')CONHC(Y)NHCO (X = Se, Te)

    Energy Technology Data Exchange (ETDEWEB)

    Grigsby, Jr, R A; Irgolic, K J; Knapp, Jr, F F

    1983-01-01

    Barbiturates substituted at the 5-position with organyltelluroalkyl or organylselenoalkyl groups were prepared by ring annulation of appropriately substituted diethyl malonates with urea or thiourea. The substituted diethyl malonates (phenyltellurobutyl(ethyl), i-propyltelluropropyl(ethyl), i-propyltelluropropyl(allyl), i-propyselenopropyl(ethyl), and phenylselenohexyl(methyl)) were prepared in 55-91% yield by reaction of diethyl omega-bromoalkyl(alkyl)malonates with organyltellurolates or selenolates (RXNa; X = Se, Te) in ethanol/benzene. The following barbiturates were obtained in 28-84% yield: phenyltellurobutyl(ethyl), m.p. 100/sup 0/C; i-propyltelluropropyl(ethyl), m.p. 119/sup 0/C; i-propylselenopropyl(ethyl), m.p. 137/sup 0/C; phenyl-selenohexyl(methyl), m.p. 124/sup 0/C. The 5-substituted thiobarbiturates i-propyltelluropropyl(ethyl)-(m.p. 75/sup 0/C) and i-propylselenopropyl(ethyl)thiobarbiturate (m.p. 83/sup 0/C) were isolated in 32 and 20% yield, respectively. The barbiturates and thiobarbiturates were purified by chromatography and recrystallization and characterized by elemental analyses, mass spectrometry, /sup 1/H, /sup 125/Te and /sup 77/Se NMR spectroscopy and UV-VIS spectrometry. The chalcogenobarbiturates radiolabeled with /sup 123m/Te or /sup 77/Se may be useful as brain imaging agents. 31 references, 4 tables.

  13. Predictive Utility of the Total Glasgow Coma Scale Versus the Motor Component of the Glasgow Coma Scale for Identification of Patients With Serious Traumatic Injuries.

    Science.gov (United States)

    Chou, Roger; Totten, Annette M; Carney, Nancy; Dandy, Spencer; Fu, Rongwei; Grusing, Sara; Pappas, Miranda; Wasson, Ngoc; Newgard, Craig D

    2017-08-01

    The motor component of the Glasgow Coma Scale (mGCS) has been proposed as an easier-to-use alternative to the total GCS (tGCS) for field assessment of trauma patients by emergency medical services. We perform a systematic review and meta-analysis to compare the predictive utility of the tGCS versus the mGCS or Simplified Motor Scale in field triage of trauma for identifying patients with adverse outcomes (inhospital mortality or severe brain injury) or who underwent procedures (neurosurgical intervention or emergency intubation) indicating need for high-level trauma care. Ovid MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Health and Psychosocial Instruments, and the Cochrane databases were searched through June 2016 for English-language cohort studies. We included studies that compared the area under the receiver operating characteristic curve (AUROC) of the tGCS versus the mGCS or Simplified Motor Scale assessed in the field or shortly after arrival in the emergency department for predicting the outcomes described above. Meta-analyses were performed with a random-effects model, and subgroup and sensitivity analyses were conducted. We included 18 head-to-head studies of predictive utility (n=1,703,388). For inhospital mortality, the tGCS was associated with slightly greater discrimination than the mGCS (pooled mean difference in [AUROC] 0.015; 95% confidence interval [CI] 0.009 to 0.022; I 2 =85%; 12 studies) or the Simplified Motor Scale (pooled mean difference in AUROC 0.030; 95% CI 0.024 to 0.036; I 2 =0%; 5 studies). The tGCS was also associated with greater discrimination than the mGCS or Simplified Motor Scale for nonmortality outcomes (differences in AUROC from 0.03 to 0.05). Findings were robust in subgroup and sensitivity analyses. The tGCS is associated with slightly greater discrimination than the mGCS or Simplified Motor Scale for identifying severe trauma. The small differences in discrimination are likely to be

  14. The Hydrogen Bonded Structures of Two 5-Bromobarbituric Acids and Analysis of Unequal C5–X and C5–X′ Bond Lengths (X = X′ = F, Cl, Br or Me in 5,5-Disubstituted Barbituric Acids

    Directory of Open Access Journals (Sweden)

    Thomas Gelbrich

    2016-04-01

    Full Text Available The crystal structure of the methanol hemisolvate of 5,5-dibromobarbituric acid (1MH displays an H-bonded layer structure which is based on N–H∙∙∙O=C, N–H∙∙∙O(MeOH and (MeOHO–H∙∙∙O interactions. The barbiturate molecules form an H-bonded substructure which has the fes topology. 5,5′-Methanediylbis(5-bromobarbituric acid 2, obtained from a solution of 5,5-dibromobarbituric acid in nitromethane, displays a N–H···O=C bonded framework of the sxd type. The conformation of the pyridmidine ring and the lengths of the ring substituent bonds C5–X and C5–X′ in crystal forms of 5,5-dibromobarbituric acid and three closely related analogues (X = X′ = Br, Cl, F, Me have been investigated. In each case, a conformation close to a C5-endo envelope is correlated with a significant lengthening of the axial C5–X′ in comparison to the equatorial C5–X bond. Isolated molecule geometry optimizations at different levels of theory confirm that the C5-endo envelope is the global conformational energy minimum of 5,5-dihalogenbarbituric acids. The relative lengthening of the axial bond is therefore interpreted as an inherent feature of the preferred envelope conformation of the pyrimidine ring, which minimizes repulsive interactions between the axial substituent and pyrimidine ring atoms.

  15. H2S induced coma and cardiogenic shock in the rat: Effects of phenothiazinium chromophores

    Science.gov (United States)

    SONOBE, TAKASHI; HAOUZI, PHILIPPE

    2015-01-01

    Context Hydrogen sulfide (H2S) intoxication produces an acute depression in cardiac contractility-induced circulatory failure, which has been shown to be one of the major contributors to the lethality of H2S intoxication or to the neurological sequelae in surviving animals. Methylene blue (MB), a phenothiazinium dye, can antagonize the effects of the inhibition of mitochondrial electron transport chain, a major effect of H2S toxicity. Objectives We investigated whether MB could affect the immediate outcome of H2S-induced coma in unanesthetized animals. Second, we sought to characterize the acute cardiovascular effects of MB and two of its demethylated metabolites—azure B and thionine—in anesthetized rats during lethal infusion of H2S. Materials and methods First, MB (4 mg/kg, intravenous [IV]) was administered in non-sedated rats during the phase of agonal breathing, following NaHS (20 mg/kg, IP)-induced coma. Second, in 4 groups of urethane-anesthetized rats, NaHS was infused at a rate lethal within 10 min (0.8 mg/min, IV). Whenever cardiac output (CO) reached 40% of its baseline volume, MB, azure B, thionine, or saline were injected, while sulfide infusion was maintained until cardiac arrest occurred. Results Seventy-five percent of the comatose rats that received saline (n = 8) died within 7 min, while all the 7 rats that were given MB survived (p = 0.007). In the anesthetized rats, arterial, left ventricular pressures and CO decreased during NaHS infusion, leading to a pulseless electrical activity within 530 s. MB produced a significant increase in CO and dP/dtmax for about 2 min. A similar effect was produced when MB was also injected in the pre-mortem phase of sulfide exposure, significantly increasing survival time. Azure B produced an even larger increase in blood pressure than MB, while thionine had no effect. Conclusion MB can counteract NaHS-induced acute cardiogenic shock; this effect is also produced by azure B, but not by thionine, suggesting

  16. Low Metallicities and Old Ages for Three Ultra-diffuse Galaxies in the Coma Cluster

    Science.gov (United States)

    Gu, Meng; Conroy, Charlie; Law, David; van Dokkum, Pieter; Yan, Renbin; Wake, David; Bundy, Kevin; Merritt, Allison; Abraham, Roberto; Zhang, Jielai; Bershady, Matthew; Bizyaev, Dmitry; Brinkmann, Jonathan; Drory, Niv; Grabowski, Kathleen; Masters, Karen; Pan, Kaike; Parejko, John; Weijmans, Anne-Marie; Zhang, Kai

    2018-05-01

    A large population of ultra-diffuse galaxies (UDGs) was recently discovered in the Coma cluster. Here we present optical spectra of three such UDGs, DF 7, DF 44, and DF 17, which have central surface brightnesses of μ g ≈ 24.4–25.1 mag arcsec‑2. The spectra were acquired as part of an ancillary program within the SDSS-IV MaNGA Survey. We stacked 19 fibers in the central regions from larger integral field units (IFUs) per source. With over 13.5 hr of on-source integration, we achieved a mean signal-to-noise ratio in the optical of 9.5 Å‑1, 7.9 Å‑1, and 5.0 Å‑1, respectively, for DF 7, DF 44, and DF 17. Stellar population models applied to these spectra enable measurements of recession velocities, ages, and metallicities. The recession velocities of DF 7, DF 44, and DF 17 are {6599}-25+40 km s‑1, {6402}-39+41 km s‑1, and {8315}-43+43 km s‑1, spectroscopically confirming that all of them reside in the Coma cluster. The stellar populations of these three galaxies are old and metal-poor, with ages of {7.9}-2.5+3.6 Gyr, {8.9}-3.3+4.3 Gyr, and {9.1}-5.5+3.9 Gyr, and iron abundances of [Fe/H] -{1.0}-0.4+0.3, -{1.3}-0.4+0.4, and -{0.8}-0.5+0.5, respectively. Their stellar masses are (3–6) × 108 M ⊙. The UDGs in our sample are as old or older than galaxies at similar stellar mass or velocity dispersion (only DF 44 has an independently measured dispersion). They all follow the well-established stellar mass–stellar metallicity relation, while DF 44 lies below the velocity dispersion-metallicity relation. These results, combined with the fact that UDGs are unusually large for their stellar masses, suggest that stellar mass plays a more important role in setting stellar population properties for these galaxies than either size or surface brightness.

  17. Enorme kyste hydatique cérébral révélé par un coma | Khattala ...

    African Journals Online (AJOL)

    La localisation cérébrale du kyste hydatique est rare (2%), nous rapportons le cas d'une fille de 6 ans, admise aux urgences pour un coma d'installation progressive et dont le bilan radiologique a montré un énorme kyste cérébral fronto-pariétal, le diagnostic de kyste hydatique a été retenu après traitement chirurgical.

  18. An adaptive and generalizable closed-loop system for control of medically induced coma and other states of anesthesia

    Science.gov (United States)

    Yang, Yuxiao; Shanechi, Maryam M.

    2016-12-01

    Objective. Design of closed-loop anesthetic delivery (CLAD) systems is an important topic, particularly for medically induced coma, which needs to be maintained for long periods. Current CLADs for medically induced coma require a separate offline experiment for model parameter estimation, which causes interruption in treatment and is difficult to perform. Also, CLADs may exhibit bias due to inherent time-variation and non-stationarity, and may have large infusion rate variations at steady state. Finally, current CLADs lack theoretical performance guarantees. We develop the first adaptive CLAD for medically induced coma, which addresses these limitations. Further, we extend our adaptive system to be generalizable to other states of anesthesia. Approach. We designed general parametric pharmacodynamic, pharmacokinetic and neural observation models with associated guidelines, and derived a novel adaptive controller. We further penalized large steady-state drug infusion rate variations in the controller. We derived theoretical guarantees that the adaptive system has zero steady-state bias. Using simulations that resembled real time-varying and noisy environments, we tested the closed-loop system for control of two different anesthetic states, burst suppression in medically induced coma and unconsciousness in general anesthesia. Main results. In 1200 simulations, the adaptive system achieved precise control of both anesthetic states despite non-stationarity, time-variation, noise, and no initial parameter knowledge. In both cases, the adaptive system performed close to a baseline system that knew the parameters exactly. In contrast, a non-adaptive system resulted in large steady-state bias and error. The adaptive system also resulted in significantly smaller steady-state infusion rate variations compared to prior systems. Significance. These results have significant implications for clinically viable CLAD design for a wide range of anesthetic states, with potential cost

  19. The near-infrared Tully-Fisher relation - A preliminary study of the Coma and Abell 400 clusters

    Science.gov (United States)

    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.

  20. Study of the coma of comet 67P/Churyumov-Gerasimenko based on the ROSINA/RTOF instrument onboard Rosetta

    Science.gov (United States)

    Hoang, M.; Garnier, P.; Lasue, J.; Reme, H.; Altwegg, K.; Balsiger, H. R.; Bieler, A. M.; Calmonte, U.; Fiethe, B.; Galli, A.; Gasc, S.; Gombosi, T. I.; Jäckel, A.; Mall, U.; Le Roy, L.; Rubin, M.; Tzou, C. Y.; Waite, J. H., Jr.; Wurz, P.

    2015-12-01

    The ROSETTA spacecraft of ESA is in the environment of comet 67P/Churyumov-Gerasimenko since August 2014. Among the experiments onboard the spacecraft, 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 a pressure sensor (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. The Reflectron-type Time-Of-Flight (RTOF) mass spectrometer possesses a wide mass range and a high temporal resolution [1,2]. It was designed to measure cometary neutral gas as well as cometary ions. A detailed description of the main volatiles (H2O, CO2, CO) dynamics and of the heterogeneities of the coma will then be provided. The influence of various parameters on the coma measurements is investigated on a statistical basis, with the parameters being distance to the comet, heliocentric distance, longitude and latitude of nadir point. Our analysis of the northern hemisphere summer season shows the presence of water vapor mostly in the illuminated northern hemisphere near the neck region with cyclic diurnal variations whereas CO2 was confined to the cold southern hemisphere with a more spatially homogeneous composition, in agreement with previous observations of 67P [2] or Hartley 2 [3]. A comparison will also be provided with the COPS total density and DFMS abundance measurements. [1] Balsiger et al., "ROSINA - Rosetta Orbiter Spectrometer for Ion and Neutral Analysis", Space Sci. Rev., 2007. [2] Scherer et al., "A novel principle for an ion mirror design in time-of-flight mass spectrometry," Int. Jou. Mass Spectr., 2006. [3] Hässig et al., "Time variability and heterogeneity in the coma of 67P/Churyumov-Gerasimenko", Science, 2015. [4] A'Hearn et al., "EPOXI at comet Hartley 2", Science, 2011.

  1. Evidence of Absence of Tidal Features in the Outskirts of Ultra Diffuse Galaxies in the Coma Cluster

    Science.gov (United States)

    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 =0.8 and median axis ratio =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%.

  2. A Cluster Of Activities On Coma From The Hubble Space Telescope, StarDate, And McDonald Observatory

    Science.gov (United States)

    Hemenway, Mary Kay; Jogee, S.; Fricke, K.; Preston, S.

    2011-01-01

    With a goal of providing a vast audience of students, teachers, the general public, and Spanish-speakers with activities to learn about research on the Coma cluster of galaxies based on the HST ACS Treasury survey of Coma, McDonald Observatory used a many-faceted approach. Since this research offered an unprecedented legacy dataset, part of the challenge was to convey the importance of this project to a diverse audience. The methodology was to create different products for different (overlapping) audiences. Five radio programs were produced in English and Spanish for distribution on over 500 radio stations in the US and Mexico with a listening audience of over 2 million; in addition to the radio listeners, there were over 13,000 downloads of the English scripts and almost 6000 of the Spanish. Images were prepared for use in the StarDate Online Astronomy Picture of the Week, for ViewSpace (used in museums), and for the StarDate/Universo Teacher Guide. A high-school level activity on the Coma Cluster was prepared and distributed both on-line and in an upgraded printed version of the StarDate/Universo Teacher Guide. This guide has been distributed to over 1700 teachers nationally. A YouTube video about careers and research in astronomy using the Coma cluster as an example was produced. Just as the activities were varied, so were the evaluation methods. This material is based upon work supported by the National Aeronautics and Space Administration under Grant/Contract/Agreement No. HST-EO-10861.35-A issued through the Space Telescope Science Institute, which is operated by the Association of Universities for Research in Astronomy, Inc., under NASA contract NAS5-26555.

  3. Prediction of recovery from a post-traumatic coma state by diffusion-weighted imaging (DWI) in patients with diffuse axonal injury

    International Nuclear Information System (INIS)

    Zheng, W.B.; Liu, G.R.; Wu, R.H.; Li, L.P.

    2007-01-01

    To determine whether diffusion-weighted magnetic resonance (MR) imaging findings combined with initial clinical factors indicate the depth of shearing lesions in the brain structure and therefore relate to coma duration in diffuse axonal injury (DAI). A total of 74 adult patients (48 male and 26 female) with DAI were examined with conventional MR imaging and diffusion-weighted MR imaging between 2 hours and 20 days after injury. Apparent diffusion coefficient (ADC) maps were obtained and the mean ADC values of each region of interest (ROI) were measured using MRI console software. The involvement of the brainstem, deep gray matter, and corpus callosum was determined for each sequence separately as well as for the combination of all sequences. The correlations between MR imaging findings indicating the presence of apparent brain injury combined with initial clinical factors were determined. Clinical characteristics, such as initial score on the Glasgow coma scale (GCS), age and number of all lesions, and ADC scores were predictive of the duration of coma. It was possible to predict post-traumatic coma duration in DAI from cerebral MR imaging findings combined with clinical prognostic factors in the acute to subacute stage after head injury. Age, ADC scores, GCS score and number of lesions were highly significant in predicting coma duration. The technique presented here might provide a tool for in vivo detection of DAI to allow the prediction of the coma duration during the early stages in patients with traumatic brain injury. (orig.)

  4. Predictive Value of Glasgow Coma Score and Full Outline of Unresponsiveness Score on the Outcome of Multiple Trauma Patients.

    Science.gov (United States)

    Baratloo, Alireza; Shokravi, Masumeh; Safari, Saeed; Aziz, Awat Kamal

    2016-03-01

    The Full Outline of Unresponsiveness (FOUR) score was developed to compensate for the limitations of Glasgow coma score (GCS) in recent years. This study aimed to assess the predictive value of GCS and FOUR score on the outcome of multiple trauma patients admitted to the emergency department. The present prospective cross-sectional study was conducted on multiple trauma patients admitted to the emergency department. GCS and FOUR scores were evaluated at the time of admission and at the sixth and twelfth hours after admission. Then the receiver operating characteristic (ROC) curve, sensitivity, specificity, as well as positive and negative predictive value of GCS and FOUR score were evaluated to predict patients' outcome. Patients' outcome was divided into discharge with and without a medical injury (motor deficit, coma or death). Finally, 89 patients were studied. Sensitivity and specificity of GCS in predicting adverse outcome (motor deficit, coma or death) were 84.2% and 88.6% at the time of admission, 89.5% and 95.4% at the sixth hour and 89.5% and 91.5% at the twelfth hour, respectively. These values for the FOUR score were 86.9% and 88.4% at the time of admission, 89.5% and 100% at the sixth hour and 89.5% and 94.4% at the twelfth hour, respectively. Findings of this study indicate that the predictive value of FOUR score and GCS on the outcome of multiple trauma patients admitted to the emergency department is similar.

  5. Fractional excretion of beta-2-microglobulin in the urine of patients with normal or reduced renal function and hepatic coma

    DEFF Research Database (Denmark)

    Hansen, P B; Dalhoff, K; Joffe, P

    1991-01-01

    The purpose of this prospective study was to evaluate beta-2-microglobulin (beta 2m) as a differential diagnostic indicator between hepatic nephropathy (HN) and acute tubulointerstitial nephropathy (ATIN) in patients with reduced renal function and hepatic coma, and to determine whether beta 2m...... excretion could be used as a marker of renal impairment before increased serum creatinine (S-Cr) concentration or decreased creatinine clearance (Cr-Cl). Finally, the use of beta 2m as a prognostic indicator was investigated. Eighteen patients in hepatic coma grade III-IV were entered in the study and were...... to the small number of patients. FE-beta 2m could not predict the development of renal failure earlier than the increase in S-Cr or decrease in Cr-Cl. However, a few patients who survived paracetamol intoxication had increased FE-beta 2M in the beginning of the coma and normal S-Cr and Cr-Cl. Patients who died...

  6. Gas Distributions in Comet ISON’s Coma: Concurrent Integral-Field Spectroscopy and Narrow-band Imaging.

    Science.gov (United States)

    Schmidt, Carl; Johnson, Robert E.; Baumgardner, Jeffrey; Mendillo, Michael

    2014-11-01

    At a solar distance of 0.44 AU, Oort cloud comet C/2012 S1 (ISON) exhibited an outburst phase that was observed by small telescopes at the McDonald Observatory. In conjunction with narrow-band (14Å) imaging over a wide-field, an image-slicer spectrograph ( 20,000) simultaneously measured the spatial distribution of ISON’s coma over a 1.6 x 2.7 arcminute field made up of 246 individual spectra. More than fifty emission lines from C2, NH2, CO, H2O+ and Na were observed within a single Echelle order spanning 5868Å to 5930Å. Spatial reconstructions of these species reveal that ISON’s coma was quite elongated several thousand km along the axis perpendicular to its motion. The ion tail appeared distinctly broader than the neutral Na tail, providing strong evidence that Na in the coma did not originate by dissociative recombination of a sodium bearing molecular ion. Production rates increased from 1.6 ± 0.3 x 1023 to 5.8 ± 1 x 1023 Na atoms/s within 24 hours, outgassing much less than comparable comets relative to ISON’s water production. The anti-sunward Na tail was imaged >106 km from the nucleus. Its distribution indicates origins both near the nucleus and in the dust tail, with the ratio of these Na sources varying on hourly timescales due to outburst activity.

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

    Science.gov (United States)

    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.

  8. Early prediction and outcome of septic encephalopathy in acute stroke patients with nosocomial coma.

    Science.gov (United States)

    Tong, Dao-Ming; Zhou, Ye-Ting; Wang, Guang-Sheng; Chen, Xiao-Dong; Yang, Tong-Hui

    2015-07-01

    Septic encephalopathy (SE) is the most common acute encephalopathy in ICU; however, little attention has been focused on risk of SE in the course of acute stroke. Our aim is to investigate the early prediction and outcome of SE in stroke patients with nosocomial coma (NC). A retrospective cohort study was conducted in an ICU of the tertiary teaching hospital in China from January 2006 to December 2009. Ninety-four acute stroke patients with NC were grouped according to with or without SE. Risk factors for patients with SE were compared with those without SE by univariate and multivariate analysis. Of 94 stroke patients with NC, 46 (49%) had NC with SE and 48 (51%) had NC without SE. The onset-to-NC time was significant later in stroke patients with SE than those without SE (P stroke patients with SE was higher than those without SE (76.1% vs. 45.8%, P = 0.003). High fever and severe SIRS are two early predictors of stroke patients with SE, and survival rates were worse in stroke patients with SE than those without SE.

  9. A rabbit model of fatal hypothyroidism mimicking "myxedema coma" established by microscopic total thyroidectomy.

    Science.gov (United States)

    Ono, Yosuke; Fujita, Masanori; Ono, Sachiko; Ogata, Sho; Tachibana, Shoichi; Tanaka, Yuji

    2016-06-30

    Myxedema coma (MC) is a life-threatening endocrine crisis caused by severe hypothyroidism. However, validated diagnostic criteria and treatment guidelines for MC have not been established owing to its rarity. Therefore, a valid animal model is required to investigate the pathologic and therapeutic aspects of MC. The aim of the present study was to establish an animal model of MC induced by total thyroidectomy. We utilized 14 male New Zealand White rabbits anesthetized via intramuscular ketamine and xylazine administration. A total of 7 rabbits were completely thyroidectomized under a surgical microscope (thyroidectomized group) and the remainder underwent sham operations (control group). The animals in both groups were monitored without thyroid hormone replacement for 15 weeks. Pulse rate, blood pressure, body temperature, and electrocardiograms (ECG) were recorded and blood samples were taken from the jugular vein immediately prior to the thyroidectomy and 2 and 4 weeks after surgery. The thyroidectomized rabbits showed a marked reduction of serum thyroxine levels at 4 weeks after the surgical procedure vs. controls (0.50±0.10 vs. 3.32±0.68 μg/dL, pmyxedema heart. In summary, we have established a rabbit model of fatal hypothyroidism mimicking MC, which may facilitate pathophysiological and molecular investigations of MC and evaluations of new therapeutic interventions.

  10. A case of myxedema coma caused by isolated thyrotropin stimulating hormone deficiency and Hashimoto's thyroiditis.

    Science.gov (United States)

    Iida, Keiji; Hino, Yasuhisa; Ohara, Takeshi; Chihara, Kazuo

    2011-01-01

    Myxedema coma (MC) is a rare, but often fatal endocrine emergency. The majority of cases that occur in elderly women with long-standing primary hypothyroidism are caused by particular triggers. Conversely, MC of central origin is extremely rare. Here, we report a case of MC with both central and primary origins. A 56-year-old woman was transferred to our hospital due to loss of consciousness; a chest x-ray demonstrated severe cardiomegaly. Low body temperature, bradycardia, and pericardial effusion suggested the presence of hypothyroidism. Endocrinological examination revealed undetectable levels of serum free thyroxine (T(4)) and free triiodothyronine (T(3)), whereas serum thyroid-stimulating hormone (TSH) levels were not elevated. The woman's serum anti-thyroid peroxidase antibody and anti-thyroglobulin antibody tests were positive, indicating that she had Hashimoto's thyroiditis. Provocative tests to the anterior pituitary revealed that she had TSH and growth hormone (GH) deficiency; however, GH levels were restored after supplementation with levothyroxine for 5 months. This was not only a rare case of MC with TSH deficiency and Hashimoto's thyroiditis; the patient also developed severe osteoporosis and possessed transient elevated levels of serum carcinoembryonic antigen (CEA). This atypical case may suggest the role of anterior pituitary hormone deficiencies, as well as hypothyroidism, in the regulation of bone metabolism.

  11. Modeling of the VIRTIS-M Observations of the Coma of Comet 67P/Churyumov-Gerasimenko

    Science.gov (United States)

    Fougere, Nicolas; Combi, Michael R.; Tenishev, Valeriy; Bieler, Andre; Migliorini, Alessandra; Piccioni, Giuseppe; Capaccioni, Fabrizio; Filacchione, Gianrico; Toth, Gabor; Huang, Zhenguang; Gombosi, Tamas; Hansen, Kenneth; Bockelee-Morvan, Dominique; Debout, Vincent; Erard, Stephane; Leyrat, Cedric; Fink, Uwe; Rubin, Martin; Altwegg, Kathrin; Tzou, Chia-Yu; Le Roy, Lena; Calmonte, Ursina; Berthelier, Jean-Jacques; Reme, Henri; Hassig, Myrtha; Fuselier, Stephen; Fiethe, Bjorn; De Keyser, Johan

    2015-11-01

    The recent images of the inner coma of 67P/Churyumov-Gerasimenko (CG) made by the infrared channel of the VIRTIS-M instrument on board the Rosetta spacecraft show the gas distribution as it expands in the coma (Migliorini et al. 2015, DPS abstract).Since VIRTIS is a remote sensing instrument, a proper modeling of these observations requires the computation of the full coma of comet CG, which necessitates the use of a kinetic approach due to the rather low gas densities. Hence, we apply a Direct Simulation Monde Carlo (DSMC) method to solve the Boltzmann equation and describe CG’s coma from the nucleus surface up to a few hundreds of kilometers. The model uses the SHAP5 nucleus shape model from the OSIRIS team. The gas flux distribution takes into account solar illumination, including self-shadowing. The local activity at the surface of the nucleus is given by spherical harmonics expansion reproducing best the ROSINA-DFMS data. The densities from the DSMC model outputs are then integrated along the line-of-sight to create synthetic images that are directly comparable with the VIRTIS-M column density measurements.The good agreement between the observations and the model illustrates our continuously improving understanding of the physics of the coma of comet CG.AcknowledgementsWork at UofM was supported by contracts JPL#1266313, JPL#1266314 and NASA grant NNX09AB59G. Work at UoB was funded by the State of Bern, the Swiss National Science Foundation and by the European Space Agency PRODEX Program. Work at Southwest Research institute was supported by subcontract #1496541 from the JPL. Work at BIRA-IASB was supported by the Belgian Science Policy Office via PRODEX/ROSINA PEA 90020. The authors would like to thank ASI, CNES, DLR, NASA for supporting this research. VIRTIS was built by a consortium formed by Italy, France and Germany, under the scientific responsibility of the IAPS of INAF, which guides also the scientific operations. The consortium includes also the

  12. Modeling of the Inner Coma of Comet 67P/Churyumov-Gerasimenko Constrained by VIRTIS and ROSINA Observations

    Science.gov (United States)

    Fougere, N.; Combi, M. R.; Tenishev, V.; Bieler, A. M.; Migliorini, A.; Bockelée-Morvan, D.; Toth, G.; Huang, Z.; Gombosi, T. I.; Hansen, K. C.; Capaccioni, F.; Filacchione, G.; Piccioni, G.; Debout, V.; Erard, S.; Leyrat, C.; Fink, U.; Rubin, M.; Altwegg, K.; Tzou, C. Y.; Le Roy, L.; Calmonte, U.; Berthelier, J. J.; Rème, H.; Hässig, M.; Fuselier, S. A.; Fiethe, B.; De Keyser, J.

    2015-12-01

    As it orbits around comet 67P/Churyumov-Gerasimenko (CG), the Rosetta spacecraft acquires more information about its main target. The numerous observations made at various geometries and at different times enable a good spatial and temporal coverage of the evolution of CG's cometary coma. However, the question regarding the link between the coma measurements and the nucleus activity remains relatively open notably due to gas expansion and strong kinetic effects in the comet's rarefied atmosphere. In this work, we use coma observations made by the ROSINA-DFMS instrument to constrain the activity at the surface of the nucleus. The distribution of the H2O and CO2 outgassing is described with the use of spherical harmonics. The coordinates in the orthogonal system represented by the spherical harmonics are computed using a least squared method, minimizing the sum of the square residuals between an analytical coma model and the DFMS data. Then, the previously deduced activity distributions are used in a Direct Simulation Monte Carlo (DSMC) model to compute a full description of the H2O and CO2 coma of comet CG from the nucleus' surface up to several hundreds of kilometers. The DSMC outputs are used to create synthetic images, which can be directly compared with VIRTIS measurements. The good agreement between the VIRTIS observations and the DSMC model, itself constrained with ROSINA data, provides a compelling juxtaposition of the measurements from these two instruments. Acknowledgements Work at UofM was supported by contracts JPL#1266313, JPL#1266314 and NASA grant NNX09AB59G. Work at UoB was funded by the State of Bern, the Swiss National Science Foundation and by the ESA PRODEX Program. Work at Southwest Research institute was supported by subcontract #1496541 from the JPL. Work at BIRA-IASB was supported by the Belgian Science Policy Office via PRODEX/ROSINA PEA 90020. The authors would like to thank ASI, CNES, DLR, NASA for supporting this research. VIRTIS was built

  13. Potencial evocado auditivo de tronco encefálico no prognóstico do coma superficial

    Directory of Open Access Journals (Sweden)

    Libia Camargo Ribeiro Leite

    2013-08-01

    Full Text Available O coma é a redução persistente do nível de consciência, arresponsivo a estímulos, devido à baixa atividade cerebral. Para verificar o nível de consciência, um recurso frequentemente utilizado é a Escala de Coma de Glasgow. Outro método que se destaca é o Potencial Evocado Auditivo de Tronco Encefálico, o qual avalia a atividade elétrica das vias auditivas ascendentes, desde o trajeto periférico até o mesencéfalo. O exame é simples, imune a medicamentos depressores e ambientes eletricamente carregados, sendo o mais adequado dos potenciais para a monitoração dos estados de coma. O presente estudo teve por objetivo verificar as características do Potencial Evocado Auditivo de Tronco Encefálico no estado de coma leve (Glasgow 7 - 8 e suas respectivas contribuições. Foi realizado um estudo prospectivo transversal em dois pacientes em coma (Glasgow 7, estado secundário a traumatismo cranioencefálico. Os resultados do exame evidenciaram presença de atividade elétrica em toda extensão da via estudada, em ambos os casos, com indicações de diferentes alterações, quanto à redução na latência entre os intervalos, morfologia e replicação das ondas. Tais diferenças foram contempladas com a evolução de cada caso: caso 1 evoluiu a alta hospitalar e caso 2 evoluiu a óbito. Os resultados confirmaram os achados da literatura, que descreve que a presença do Potencial Evocado Auditivo de Tronco Encefálico normal está associada à boa evolução do caso clínico, enquanto alterações no exame podem sinalizar para um mau prognóstico.

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

    Science.gov (United States)

    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.

  15. Assessment of nurse's knowledge about Glasgow coma scale at a university hospital.

    Science.gov (United States)

    Santos, Wesley Cajaíba; Vancini-Campanharo, Cássia Regina; Lopes, Maria Carolina Barbosa Teixeira; Okuno, Meiry Fernanda Pinto; Batista, Ruth Ester Assayag

    2016-01-01

    To assess knowledge of nurses of emergency services and intensive care units about Glasgow Coma Scale. This cross-sectional analytical study included 127 nurses of critical units of an university hospital. We used structured interview with 12 questions to evaluate their knowledge about the scale. Association of Knowledge with professionals' sociodemographic variables were verified by the Fisher-test, χ2 and likelihood ratio. Most of participants were women mean aged 31.1 years, they had graduated more than 5 years previously, and had 1 to 3 years of work experience. In the assessment of best score possible for Glasgow scale (question 3) nurses who had graduate more than 5 years ago presented a lower percentage success rate (p=0.0476). However, in the question 7, which evaluated what interval of the scale indicated moderate severity of brain trauma injury, those with more years of experience had higher percentage of correct answers (p=0.0251). In addition, nurses from emergency service had more correct answers than nurses from intensive care unit (p=0.0143) in the same question. Nurses graduated for more than 5 years ago had a lower percentage of correct answers in question 7 (p=0.0161). Nurses with more work experience had a better score (p=0.0119) to identify how assessment of motor response should be started. Number of year since graduation, experience, and work at critical care units interfered in nurses' knowledge about the scale, which indicates the need of training. Avaliar o conhecimento de enfermeiros de unidades críticas, serviços de emergência e unidades de terapia intensiva em relação à escala de coma de Glasgow. Estudo transversal e analítico com 127 enfermeiros de unidades críticas de um hospital universitário. Utilizou-se entrevista estruturada com 12 questões que avaliaram conhecimento sobre a escala. Associação do conhecimento com variáveis sociodemográficas dos profissionais foi verificada pelo teste de Fisher, teste χ2 e razão de

  16. Early EEG for outcome prediction of postanoxic coma: prospective cohort study with cost-minimization analysis.

    Science.gov (United States)

    Sondag, Lotte; Ruijter, Barry J; Tjepkema-Cloostermans, Marleen C; Beishuizen, Albertus; Bosch, Frank H; van Til, Janine A; van Putten, Michel J A M; Hofmeijer, Jeannette

    2017-05-15

    We recently showed that electroencephalography (EEG) patterns within the first 24 hours robustly contribute to multimodal prediction of poor or good neurological outcome of comatose patients after cardiac arrest. Here, we confirm these results and present a cost-minimization analysis. Early prognosis contributes to communication between doctors and family, and may prevent inappropriate treatment. A prospective cohort study including 430 subsequent comatose patients after cardiac arrest was conducted at intensive care units of two teaching hospitals. Continuous EEG was started within 12 hours after cardiac arrest and continued up to 3 days. EEG patterns were visually classified as unfavorable (isoelectric, low-voltage, or burst suppression with identical bursts) or favorable (continuous patterns) at 12 and 24 hours after cardiac arrest. Outcome at 6 months was classified as good (cerebral performance category (CPC) 1 or 2) or poor (CPC 3, 4, or 5). Predictive values of EEG measures and cost-consequences from a hospital perspective were investigated, assuming EEG-based decision- making about withdrawal of life-sustaining treatment in the case of a poor predicted outcome. Poor outcome occurred in 197 patients (51% of those included in the analyses). Unfavorable EEG patterns at 24 hours predicted a poor outcome with specificity of 100% (95% CI 98-100%) and sensitivity of 29% (95% CI 22-36%). Favorable patterns at 12 hours predicted good outcome with specificity of 88% (95% CI 81-93%) and sensitivity of 51% (95% CI 42-60%). Treatment withdrawal based on an unfavorable EEG pattern at 24 hours resulted in a reduced mean ICU length of stay without increased mortality in the long term. This gave small cost reductions, depending on the timing of withdrawal. Early EEG contributes to reliable prediction of good or poor outcome of postanoxic coma and may lead to reduced length of ICU stay. In turn, this may bring small cost reductions.

  17. Neurophysiological prediction of neurological good and poor outcome in post-anoxic coma.

    Science.gov (United States)

    Grippo, A; Carrai, R; Scarpino, M; Spalletti, M; Lanzo, G; Cossu, C; Peris, A; Valente, S; Amantini, A

    2017-06-01

    Investigation of the utility of association between electroencephalogram (EEG) and somatosensory-evoked potentials (SEPs) for the prediction of neurological outcome in comatose patients resuscitated after cardiac arrest (CA) treated with therapeutic hypothermia, according to different recording times after CA. Glasgow Coma Scale, EEG and SEPs performed at 12, 24 and 48-72 h after CA were assessed in 200 patients. Outcome was evaluated by Cerebral Performance Category 6 months after CA. Within 12 h after CA, grade 1 EEG predicted good outcome and bilaterally absent (BA) SEPs predicted poor outcome. Because grade 1 EEG and BA-SEPs were never found in the same patient, the recording of both EEG and SEPs allows us to correctly prognosticate a greater number of patients with respect to the use of a single test within 12 h after CA. At 48-72 h after CA, both grade 2 EEG and BA-SEPs predicted poor outcome with FPR=0.0%. When these neurophysiological patterns are both present in the same patient, they confirm and strengthen their prognostic value, but because they also occurred independently in eight patients, poor outcome is predictable in a greater number of patients. The combination of EEG/SEP findings allows prediction of good and poor outcome (within 12 h after CA) and of poor outcome (after 48-72 h). Recording of EEG and SEPs in the same patients allows always an increase in the number of cases correctly classified, and an increase of the reliability of prognostication in a single patient due to concordance of patterns. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Relativistic protons in the Coma galaxy cluster: first gamma-ray constraints ever on turbulent reacceleration

    Science.gov (United States)

    Brunetti, G.; Zimmer, S.; Zandanel, F.

    2017-12-01

    The Fermi-LAT (Large Area Telescope) collaboration recently published deep upper limits to the gamma-ray emission of the Coma cluster, a cluster hosting the prototype of giant radio haloes. In this paper, we extend previous studies and use a formalism that combines particle reacceleration by turbulence and the generation of secondary particles in the intracluster medium to constrain relativistic protons and their role for the origin of the radio halo. We conclude that a pure hadronic origin of the halo is clearly disfavoured as it would require excessively large magnetic fields. However, secondary particles can still generate the observed radio emission if they are reaccelerated. For the first time the deep gamma-ray limits allow us to derive meaningful constraints if the halo is generated during phases of reacceleration of relativistic protons and their secondaries by cluster-scale turbulence. In this paper, we explore a relevant range of parameter space of reacceleration models of secondaries. Within this parameter space, a fraction of model configurations is already ruled out by current gamma-ray limits, including the cases that assume weak magnetic fields in the cluster core, B ≤ 2-3 μG. Interestingly, we also find that the flux predicted by a large fraction of model configurations assuming magnetic fields consistent with Faraday rotation measures (RMs) is not far from the limits. This suggests that a detection of gamma-rays from the cluster might be possible in the near future, provided that the electrons generating the radio halo are secondaries reaccelerated and the magnetic field in the cluster is consistent with that inferred from RM.

  19. Soft X-ray structure of the Coma cluster of galaxies

    International Nuclear Information System (INIS)

    Gorenstein, P.; Fabricant, D.; Topka, K.; Harnden, F.R. Jr.

    1979-01-01

    An X-ray image of the Coma cluster of galaxies was obtained in the 0.15--2.0 keV band with an imaging telescope. In contrast to the Virgo and Perseus clusters, which were observed previously with the same instrument, there is no indication of a strong contribution from an individual galaxy. However, there is granularity within the central region of the X-ray source that is suggestive of the galaxy distribution. For the 0.15--0.28 keV band only, the flux is much larger in the region north of the cluster center as compared to the south. We interpret this as a Galactic feature accidentally superposed upon the cluster.There is a marginal indication of ellipticity in the region between 10' and 25' from the center. The major axis is approximately along the E-W direction and is 1.2 +- 0.1 times larger than the minor axis. This is consistent with the distribution of galaxies.Assuming radial symmetry, three models containing a free parameter were fitted to the radial distribution of surface brightness: isothermal hydrostatic, adiabatic hydrostatic, and the isothermal sphere. All three fit the data with an acceptable value for the chi 2 . Of the three, the isothermal hydrostatic model is unique in its prediction of an extended halo beyond the range of measurements. For this model β=0.49, meaning that gas density falls off with radius approximately as the square root of the galaxy density. This value of of β is in agreement with the number computed from optical data and the X-ray temperature. Comparison of our 0.5--2.0 keV intensity with an extrapolation of a higher energy measurement obtained with a broader field of view detector aboard OSO 8 provides tentative evidence that the isothermal hydrostatic model is the most appropriate of the three models considered

  20. FK Comae Berenices, King of Spin: The COCOA-PUFS Project

    Science.gov (United States)

    Ayres, Thomas R.; Kashyap, V.; Saar, S.; Huenemoerder, D.; Korhonen, H.; Drake, J. J.; Testa, P.; Cohen, O.; Garraffo, C.; Granzer, T.; Strassmeier, K.

    2016-03-01

    COCOA-PUFS is an energy-diverse, time-domain study of the ultra-fast spinning, heavily spotted, yellow giant FK Comae Berenices (FK Com: HD117555; G4 III). This single star is thought to be a recent binary merger, and is exceptionally active by measure of its intense ultraviolet (UV) and X-ray emissions, and proclivity to flare. COCOA-PUFS was carried out with the Hubble Space Telescope in the UV (1200-3000 Å), using mainly its high-performance Cosmic Origins Spectrograph, but also high precision Space Telescope Imaging Spectrograph; Chandra X-ray Observatory in the soft X-rays (0.5-10 keV), utilizing its High-Energy Transmission Grating Spectrometer; together with supporting photometry and spectropolarimetry in the visible from the ground. This is an introductory report on the project. FK Com displayed variability on a wide range of timescales over all wavelengths during the week-long main campaign, including a large X-ray flare; “super-rotational broadening” of the far-ultraviolet “hot lines” (e.g., Si IV 1393 Å 8 × 104 K) together with chromospheric Mg II 2800 Å and C II 1335 Å (1-3 × 104 K); large Doppler swings suggestive of bright regions alternately on advancing and retreating limbs of the star; and substantial redshifts of the epoch-average emission profiles. These behaviors paint a picture of a highly extended, dynamic, hot (˜10 MK) coronal magnetosphere around the star, threaded by cooler structures perhaps analogous to solar prominences and replenished continually by surface activity and flares. Suppression of angular momentum loss by the confining magnetosphere could temporarily postpone the inevitable stellar spindown, thereby lengthening this highly volatile stage of coronal evolution. COordinated Campaign of Observations and Analysis, Photosphere to Upper Atmosphere, of a Fast-rotating Star.

  1. FK COMAE BERENICES, KING OF SPIN: THE COCOA-PUFS PROJECT

    Energy Technology Data Exchange (ETDEWEB)

    Ayres, Thomas R. [Center for Astrophysics and Space Astronomy, 389 UCB, University of Colorado, Boulder, CO 80309 (United States); Kashyap, V.; Saar, S.; Drake, J. J.; Testa, P.; Cohen, O.; Garraffo, C. [Harvard-Smithsonian Center for Astrophysics, Cambridge, MA (United States); Huenemoerder, D. [Massachusetts Institute of Technology, Cambridge, MA (United States); Korhonen, H. [Finnish Centre for Astronomy with ESO (FINCA), University of Turku, Väisäläntie 20, FI-21500 Piikkiö (Finland); Granzer, T.; Strassmeier, K., E-mail: Thomas.Ayres@Colorado.edu [Leibniz-Institut für Astrophysik Potsdam (AIP), An der Sternwarte 16, D-14482 Potsdam (Germany)

    2016-03-15

    COCOA-PUFS is an energy-diverse, time-domain study of the ultra-fast spinning, heavily spotted, yellow giant FK Comae Berenices (FK Com: HD117555; G4 III). This single star is thought to be a recent binary merger, and is exceptionally active by measure of its intense ultraviolet (UV) and X-ray emissions, and proclivity to flare. COCOA-PUFS was carried out with the Hubble Space Telescope in the UV (1200–3000 Å), using mainly its high-performance Cosmic Origins Spectrograph, but also high precision Space Telescope Imaging Spectrograph; Chandra X-ray Observatory in the soft X-rays (0.5–10 keV), utilizing its High-Energy Transmission Grating Spectrometer; together with supporting photometry and spectropolarimetry in the visible from the ground. This is an introductory report on the project. FK Com displayed variability on a wide range of timescales over all wavelengths during the week-long main campaign, including a large X-ray flare; “super-rotational broadening” of the far-ultraviolet “hot lines” (e.g., Si iv 1393 Å; 8 × 10{sup 4} K) together with chromospheric Mg ii 2800 Å and C ii 1335 Å (1–3 × 10{sup 4} K); large Doppler swings suggestive of bright regions alternately on advancing and retreating limbs of the star; and substantial redshifts of the epoch-average emission profiles. These behaviors paint a picture of a highly extended, dynamic, hot (∼10 MK) coronal magnetosphere around the star, threaded by cooler structures perhaps analogous to solar prominences and replenished continually by surface activity and flares. Suppression of angular momentum loss by the confining magnetosphere could temporarily postpone the inevitable stellar spindown, thereby lengthening this highly volatile stage of coronal evolution.

  2. FK COMAE BERENICES, KING OF SPIN: THE COCOA-PUFS PROJECT

    International Nuclear Information System (INIS)

    Ayres, Thomas R.; Kashyap, V.; Saar, S.; Drake, J. J.; Testa, P.; Cohen, O.; Garraffo, C.; Huenemoerder, D.; Korhonen, H.; Granzer, T.; Strassmeier, K.

    2016-01-01

    COCOA-PUFS is an energy-diverse, time-domain study of the ultra-fast spinning, heavily spotted, yellow giant FK Comae Berenices (FK Com: HD117555; G4 III). This single star is thought to be a recent binary merger, and is exceptionally active by measure of its intense ultraviolet (UV) and X-ray emissions, and proclivity to flare. COCOA-PUFS was carried out with the Hubble Space Telescope in the UV (1200–3000 Å), using mainly its high-performance Cosmic Origins Spectrograph, but also high precision Space Telescope Imaging Spectrograph; Chandra X-ray Observatory in the soft X-rays (0.5–10 keV), utilizing its High-Energy Transmission Grating Spectrometer; together with supporting photometry and spectropolarimetry in the visible from the ground. This is an introductory report on the project. FK Com displayed variability on a wide range of timescales over all wavelengths during the week-long main campaign, including a large X-ray flare; “super-rotational broadening” of the far-ultraviolet “hot lines” (e.g., Si iv 1393 Å; 8 × 10 4 K) together with chromospheric Mg ii 2800 Å and C ii 1335 Å (1–3 × 10 4 K); large Doppler swings suggestive of bright regions alternately on advancing and retreating limbs of the star; and substantial redshifts of the epoch-average emission profiles. These behaviors paint a picture of a highly extended, dynamic, hot (∼10 MK) coronal magnetosphere around the star, threaded by cooler structures perhaps analogous to solar prominences and replenished continually by surface activity and flares. Suppression of angular momentum loss by the confining magnetosphere could temporarily postpone the inevitable stellar spindown, thereby lengthening this highly volatile stage of coronal evolution

  3. Factors Influencing the Reliability of the Glasgow Coma Scale: A Systematic Review.

    Science.gov (United States)

    Reith, Florence Cm; Synnot, Anneliese; van den Brande, Ruben; Gruen, Russell L; Maas, Andrew Ir

    2017-06-01

    The Glasgow Coma Scale (GCS) characterizes patients with diminished consciousness. In a recent systematic review, we found overall adequate reliability across different clinical settings, but reliability estimates varied considerably between studies, and methodological quality of studies was overall poor. Identifying and understanding factors that can affect its reliability is important, in order to promote high standards for clinical use of the GCS. The aim of this systematic review was to identify factors that influence reliability and to provide an evidence base for promoting consistent and reliable application of the GCS. A comprehensive literature search was undertaken in MEDLINE, EMBASE, and CINAHL from 1974 to July 2016. Studies assessing the reliability of the GCS in adults or describing any factor that influences reliability were included. Two reviewers independently screened citations, selected full texts, and undertook data extraction and critical appraisal. Methodological quality of studies was evaluated with the consensus-based standards for the selection of health measurement instruments checklist. Data were synthesized narratively and presented in tables. Forty-one studies were included for analysis. Factors identified that may influence reliability are education and training, the level of consciousness, and type of stimuli used. Conflicting results were found for experience of the observer, the pathology causing the reduced consciousness, and intubation/sedation. No clear influence was found for the professional background of observers. Reliability of the GCS is influenced by multiple factors and as such is context dependent. This review points to the potential for improvement from training and education and standardization of assessment methods, for which recommendations are presented. Copyright © 2017 by the Congress of Neurological Surgeons.

  4. 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.

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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

  6. CONSTRAINING THE DUST COMA PROPERTIES OF COMET C/SIDING SPRING (2013 A1) AT LARGE HELIOCENTRIC DISTANCES

    International Nuclear Information System (INIS)

    Li, Jian-Yang; Samarasinha, Nalin H.; Kelley, Michael S. P.; Farnham, Tony L.; A'Hearn, Michael F.; Mutchler, Max J.; Lisse, Carey M.; Delamere, W. Alan

    2014-01-01

    The close encounter of comet C/2013 A1 (Siding Spring) with Mars on 2014 October 19 presented an extremely rare opportunity to obtain the first flyby quality data of the nucleus and inner coma of a dynamically new comet. However, the comet's dust tail potentially posed an impact hazard to those spacecraft orbiting Mars. To characterize the comet at large heliocentric distances, study its long-term evolution, and provide critical inputs to hazard modeling, we imaged C/Siding Spring with the Hubble Space Telescope when the comet was at 4.58, 3.77, and 3.28 AU from the Sun. The dust production rate, parameterized by the quantity Afρ, was 2500, 2100, and 1700 cm (5000 km radius aperture) for the three epochs, respectively. The color of the dust coma is (5.0 ± 0.3)%/100 nm for the first two epochs, and (9.0 ± 0.3)%/100 nm for the last epoch, and reddens with increasing cometocentric distance out to ∼3000 km from the nucleus. The spatial distribution and the temporal evolution of the dust color are most consistent with the existence of icy grains in the coma. Two jet-like dust features appear in the northwest and south-southeast directions projected in the sky plane. Within each epoch of 1-2 hr, no temporal variations were observed for either feature, but the position angle of the south-southeastern feature varied between the three epochs by ∼30°. The dust feature morphology suggests two possible orientations for the rotational pole of the nucleus, (R.A., decl.) = (295° ± 5°, +43° ± 2°) and (190° ± 10°, +50° ± 5°), or their diametrically opposite orientations

  7. CONSTRAINING THE DUST COMA PROPERTIES OF COMET C/SIDING SPRING (2013 A1) AT LARGE HELIOCENTRIC DISTANCES

    Energy Technology Data Exchange (ETDEWEB)

    Li, Jian-Yang; Samarasinha, Nalin H. [Planetary Science Institute, 1700 East Fort Lowell Road, Suite 106, Tucson, AZ 85719 (United States); Kelley, Michael S. P.; Farnham, Tony L.; A' Hearn, Michael F. [Department of Astronomy, University of Maryland, College Park, MD 20742 (United States); Mutchler, Max J. [Space Telescope Science Institute, 3700 San Martin Drive, Baltimore, MD 21218-2463 (United States); Lisse, Carey M. [Johns Hopkins University Applied Physics Laboratory, Space Department, 11100 Johns Hopkins Road, Laurel, MD 20723 (United States); Delamere, W. Alan, E-mail: jyli@psi.edu, E-mail: nalin@psi.edu, E-mail: msk@astro.umd.edu, E-mail: farnham@astro.umd.edu, E-mail: ma@astro.umd.edu, E-mail: mutchler@stsci.edu, E-mail: carey.lisse@jpuapl.edu, E-mail: alan@delamere.biz [Delamere Support Service, Boulder, CO 80304 (United States)

    2014-12-10

    The close encounter of comet C/2013 A1 (Siding Spring) with Mars on 2014 October 19 presented an extremely rare opportunity to obtain the first flyby quality data of the nucleus and inner coma of a dynamically new comet. However, the comet's dust tail potentially posed an impact hazard to those spacecraft orbiting Mars. To characterize the comet at large heliocentric distances, study its long-term evolution, and provide critical inputs to hazard modeling, we imaged C/Siding Spring with the Hubble Space Telescope when the comet was at 4.58, 3.77, and 3.28 AU from the Sun. The dust production rate, parameterized by the quantity Afρ, was 2500, 2100, and 1700 cm (5000 km radius aperture) for the three epochs, respectively. The color of the dust coma is (5.0 ± 0.3)%/100 nm for the first two epochs, and (9.0 ± 0.3)%/100 nm for the last epoch, and reddens with increasing cometocentric distance out to ∼3000 km from the nucleus. The spatial distribution and the temporal evolution of the dust color are most consistent with the existence of icy grains in the coma. Two jet-like dust features appear in the northwest and south-southeast directions projected in the sky plane. Within each epoch of 1-2 hr, no temporal variations were observed for either feature, but the position angle of the south-southeastern feature varied between the three epochs by ∼30°. The dust feature morphology suggests two possible orientations for the rotational pole of the nucleus, (R.A., decl.) = (295° ± 5°, +43° ± 2°) and (190° ± 10°, +50° ± 5°), or their diametrically opposite orientations.

  8. Sensitivity and Specificity of the Coma Recovery Scale--Revised Total Score in Detection of Conscious Awareness.

    Science.gov (United States)

    Bodien, Yelena G; Carlowicz, Cecilia A; Chatelle, Camille; Giacino, Joseph T

    2016-03-01

    To describe the sensitivity and specificity of Coma Recovery Scale-Revised (CRS-R) total scores in detecting conscious awareness. Data were retrospectively extracted from the medical records of patients enrolled in a specialized disorders of consciousness (DOC) program. Sensitivity and specificity analyses were completed using CRS-R-derived diagnoses of minimally conscious state (MCS) or emerged from minimally conscious state (EMCS) as the reference standard for conscious awareness and the total CRS-R score as the test criterion. A receiver operating characteristic curve was constructed to demonstrate the optimal CRS-R total cutoff score for maximizing sensitivity and specificity. Specialized DOC program. Patients enrolled in the DOC program (N=252, 157 men; mean age, 49y; mean time from injury, 48d; traumatic etiology, n=127; nontraumatic etiology, n=125; diagnosis of coma or vegetative state, n=70; diagnosis of MCS or EMCS, n=182). Not applicable. Sensitivity and specificity of CRS-R total scores in detecting conscious awareness. A CRS-R total score of 10 or higher yielded a sensitivity of .78 for correct identification of patients in MCS or EMCS, and a specificity of 1.00 for correct identification of patients who did not meet criteria for either of these diagnoses (ie, were diagnosed with vegetative state or coma). The area under the curve in the receiver operating characteristic curve analysis is .98. A total CRS-R score of 10 or higher provides strong evidence of conscious awareness but resulted in a false-negative diagnostic error in 22% of patients who demonstrated conscious awareness based on CRS-R diagnostic criteria. A cutoff score of 8 provides the best balance between sensitivity and specificity, accurately classifying 93% of cases. The optimal total score cutoff will vary depending on the user's objective. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  9. Recovery of Patients with Pure Diffuse Axonal Injury Who Remained in a Coma for 6 Hours or More.

    Science.gov (United States)

    Almeida Vieira, Rita de Cássia; Paiva, Wellingson Silva; de Oliveira, Daniel Vieira; de Paula Guirado, Vinícius Monteiro; Caetano Lança, Ellen de Fátima; de Sousa, Regina Márcia Cardoso

    2018-01-01

    Diffuse axonal injury (DAI) is a traumatic brain injury and one of the most common causes of unfavorable outcome and death. The aim of this study was to investigate the recovery of patients with pure DAI who remained in a coma for 6 hours or longer after brain injury. This was a follow-up study of 75 patients diagnosed with pure DAI, aged 18-60 years, with a Glasgow Coma Scale score ≤8 at hospital admission. Patient data were collected at hospital admission, hospital discharge, and 3 and 6 months after DAI. Recovery was assessed by score changes in the Katz Index of Independence in Activities of Daily Living and Extended Glasgow Outcome Scale. The percentage of patients in a coma for 6-24 hours, >24 hours without brainstem signs, and >24 hours with brainstem signs was 42.7%, 20%, and 37.3%, respectively. The 6-month mortality rate was 32.0%, and the mean Extended Glasgow Outcome Scale score among survivors decreased from 3.8 at discharge (SD = 1.2) to 2.1 at 3 months (SD = 1.6) and 1.2 at 6 months (SD = 1.6). The mean Katz Index of Independence in Activities of Daily Living scores were 8.5 (SD = 5.5), 3.5 (SD = 5.8), and 1.8 (SD = 4.5) at discharge and 3 and 6 months after trauma, respectively. Statistically significant differences were observed among the 3 evaluation periods. Mortality was high among patients with DAI, but almost all survivors had favorable outcomes at 6 months. Functional improvement was more pronounced in the first 3 months. Copyright © 2017. Published by Elsevier Inc.

  10. [Clinical efficacy observation of acupuncture at suliao (GV 25) on improving regain of consciousness from coma in severe craniocerebral injury].

    Science.gov (United States)

    Xu, Kai-Sheng; Song, Jian-Hua; Huang, Tiao-Hua; Huang, Zhi-Hua; Yu, Lu-Chang; Zheng, Wei-Ping; Chen, Xiao-Shan; Liu, Chuan

    2014-06-01

    To compare the clinical therapeutic effects differences between acupuncture at Suliao (GV 25) and Shuigou (GV 26) on promoting regain of consciousness from coma in severe craniocerebral injury. Based on regular emergency treatments of neurosurgery, eighty-two cases of craniocerebral injury who were under stable condition were randomly divided into an observation group (42 cases) and a control group (40 cases). Suliao (GV 25) was selected as main aupoint, while Laogong (PC 8) and Yongquan (KI 1), etc. were selected as adjuvant acupoints and Neiguan (PC 6), Sanyinjiao (SP 6), Yifeng (TE 17) and Wangu (GB 12), etc. were selected as matching acupoints in the observation group where a strong needle manipulation was applied to improve the regain of consciousness. The main acupoint of Shuigou (GV 26) along with identical adjuvant acupoints and matching acupoints in the observation group were selected in the control group with identical strong needle manipulation. The treatment was given once a day in both groups, five times per week and ten times were considered as one session. The immediate clinical symptoms after acupuncture at Suliao (GV 25) and Shuigou (GV 26) were observed as well as Glasgow coma scale (GCS) before the treatment, after 45 days and 90 days of treatment to assess the resuscitation time and rate. Also the clinical efficacy was compared between both groups. The occurrence rate of sneezing reflex was 85.7% (36/42) in the observation group, which was higher than 25.0% (10/40) in the control group (P 0.05). Compared before the treatment, GCS were both improved after the treatment in two groups (both P coma in severe craniocerebral injury is positive. It could specifically improve sneezing reflex and stimulate respiratory center, which has more obvious effect than acupuncture at Shuigou (GV 26).

  11. CT-angiography source images indicate less fatal outcome despite coma of patients in the Basilar Artery International Cooperation Study.

    Science.gov (United States)

    Pallesen, Lars P; Khomenko, Andrei; Dzialowski, Imanuel; Barlinn, Jessica; Barlinn, Kristian; Zerna, Charlotte; van der Hoeven, Erik Jrj; Algra, Ale; Kapelle, L Jaap; Michel, Patrik; Bodechtel, Ulf; Demchuk, Andrew M; Schonewille, Wouter; Puetz, Volker

    2017-02-01

    Background Coma is associated with poor outcome in patients with basilar artery occlusion. Aims We sought to assess whether the posterior circulation Acute Stroke Prognosis Early CT Score and the Pons-Midbrain Index applied to CT angiography source images predict the outcome of comatose patients in the Basilar Artery International Cooperation Study. Methods Basilar Artery International Cooperation Study was a prospective, observational registry of patients with acute basilar artery occlusion with 48 recruiting centers worldwide. We applied posterior circulation Acute Stroke Prognosis Early CT Score and Pons-Midbrain Index to CT angiography source images of Basilar Artery International Cooperation Study patients who presented with coma. We calculated adjusted risk ratios to assess the association of dichotomized posterior circulation Acute Stroke Prognosis Early CT Score (≥8 vs. International Cooperation Study registry, CT angiography source images were available for review in 158 patients. Among these, 78 patients (49%) presented with coma. Compared to non-comatose patients, comatose patients were more likely to die (risk ratios 2.34; CI 95% 1.56-3.52) and less likely to have a favourable outcome (risk ratios 0.44; CI 95% 0.24-0.80). Among comatose patients, a Pons-Midbrain Index < 3 was related to reduced mortality (adjusted RR 0.66; 95% CI 0.46-0.96), but not to favourable outcome (adjusted RR 1.19; 95% CI 0.39-3.62). Posterior circulation Acute Stroke Prognosis Early CT Score dichotomized at ≥ 8 vs. <8 was not significantly associated with death (adjusted RR 0.70; 95% CI 0.46-1.05). Conclusion In comatose patients with basilar artery occlusion, the extent of brainstem ischemia appears to be related to mortality but not to favourable outcome.

  12. Primate study suggests pentobarbital may help protect the brain during radiation therapy

    International Nuclear Information System (INIS)

    Skolnick, A.

    1990-01-01

    Radiation therapy, an often indispensable treatment for a wide range of brain tumors, is a double-edged sword, especially when used to treat children. Research reported at the 72nd Annual Meeting of the Endocrine Society, in Atlanta, Ga., now suggests that pentobarbital and perhaps other barbiturates may help protect the brain from radiation-induced damage, especially to the pituitary and hypothalmus, where such damage can lead to serious, life-long problems for children. Jeffrey J. Olson, MD, now assistant professor of neurosurgery at Emory University School of Medicine, Atlanta, reported the results of a study of the radioprotective effects of pentobarbital on the brain of a primate, which he and colleagues at the National Institute of Neurological Disorders and Stroke recently completed

  13. Comparison of the Mineralogy of Comet Wild 2 Coma Grains to Other Astromaterials

    Science.gov (United States)

    Frank, David; Zolensky, Michael

    2010-01-01

    We propose that Kuiper Belt samples (in this case comet coma grains from the Jupiter family comet Wild 2) are recognizably different from the bulk of materials in outer belt asteroids, because of their different formation positions and times in the early solar system. We believe this despite similarities found between some Wild 2 grains and components of carbonaceous chondrites (i.e. some CAI and chondrules). Kuiper Belt samples must preserve measurable mineralogical and compositional evidence of formation at unique positions and times in the early solar nebula, and these formational differences must have imparted recognizable special characteristics. We hypothesize that these characteristics include: (1) Unique major element compositional ranges of common astromaterial minerals, especially olivine and pyroxene; (2) Unique minor element compositions of major silicate phases, especially olivine and low-Ca pyroxene; (3) Degree and effects of radiation processing -- including amorphous rims, metal coatings, and Glass with Embedded Metal and Sulfides (GEMS); (4) Presence of abundant presolar silicate grains as recognized by anomalous oxygen in silicates; (5) Oxidation state of the mineral assemblage. We are working our way through all available Wild 2 samples, selecting 1-2 non-consecutive viable TEM grids from each possible extracted Wild 2 grain. We especially prefer TEM grids from grains for which complete mineralogical details have not been published (which is to say the majority of the extracted grains). We are performing a basic mineralogic survey by E-beam techniques, to establish the essential features of the extracted Wild 2 grains. We are making a particular effort to carefully and accurately measure minor elements of olivine and pyroxene, as these minerals are widespread in astromaterials, and comparisons of their compositions will serve to place the Wild 2 silicates in contact with asteroids, meteorites and chondritic interplanetary dust particles

  14. Photometric redshifts as a tool for studying the Coma cluster galaxy populations

    Science.gov (United States)

    Adami, C.; Ilbert, O.; Pelló, R.; Cuillandre, J. C.; Durret, F.; Mazure, A.; Picat, J. P.; Ulmer, M. P.

    2008-12-01

    Aims: We apply photometric redshift techniques to an investigation of the Coma cluster galaxy luminosity function (GLF) at faint magnitudes, in particular in the u* band where basically no studies are presently available at these magnitudes. Methods: Cluster members were selected based on probability distribution function from photometric redshift calculations applied to deep u^*, B, V, R, I images covering a region of almost 1 deg2 (completeness limit R ~ 24). In the area covered only by the u* image, the GLF was also derived after a statistical background subtraction. Results: Global and local GLFs in the B, V, R, and I bands obtained with photometric redshift selection are consistent with our previous results based on a statistical background subtraction. The GLF in the u* band shows an increase in the faint end slope towards the outer regions of the cluster. The analysis of the multicolor type spatial distribution reveals that late type galaxies are distributed in clumps in the cluster outskirts, where X-ray substructures are also detected and where the GLF in the u* band is steeper. Conclusions: We can reproduce the GLFs computed with classical statistical subtraction methods by applying a photometric redshift technique. The u* GLF slope is steeper in the cluster outskirts, varying from α ~ -1 in the cluster center to α ~ -2 in the cluster periphery. The concentrations of faint late type galaxies in the cluster outskirts could explain these very steep slopes, assuming a short burst of star formation in these galaxies when entering the cluster. Based on observations obtained with MegaPrime/MegaCam, a joint project of CFHT and CEA/DAPNIA, at the Canada-France-Hawaii Telescope (CFHT) which is operated by the National Research Council (NRC) of Canada, the Institut National des Sciences de l'Univers of the Centre National de la Recherche Scientifique (CNRS) of France, and the University of Hawaii. This work is also partly based on data products produced at

  15. A percepção auditiva nos pacientes em estado de coma: uma revisão bibliográfica La percepción auditiva en los pacientes en estado de coma: una revisión bibliográfica The auditory perception in the patients in state of coma: a bibliographical revision

    Directory of Open Access Journals (Sweden)

    Ana Cláudia Giesbrecht Puggina

    2005-09-01

    Full Text Available Muito ainda precisa ser estudado pela neurociência, tanto em relação aos estados de consciência quanto aos processos cognitivos e a percepção auditiva nos estados de coma. Assim, esse estudo de revisão bibliográfica sobre a percepção auditiva dos pacientes em estado de coma parece ser relevante no sentido de trazer maiores esclarecimentos e identificação de evidências. Identificar, nas publicações, as lacunas, consistências e inconsistências desse tema. O estudo consiste em levantamento bibliográfico nas bases de dados LILACS e PUBMED. Os artigos foram analisados quanto ao método e os principais resultados do estudo. Foram selecionados 10 artigos sobre o tema, sendo nenhum deles nacional. A maior parte dos estudos selecionados foi publicada no período de 1971-1995 (80%, pelos Estados Unidos (70%, como pesquisa longitudinal (50% ou relato de caso (30%; a amostra variou entre 1 e 5 (70%, a maioria usou a música (80%; o EEG (60% e a observação comportamental (50% foram as medidas de resposta ao estímulo mais utilizadas. Os procedimentos foram variados, porém a maioria dos estudos, apontam para a existência de uma percepção auditiva nos pacientes em estado de coma.Mucho aún se hace necesario a ser estudiado por la neurociencia, tanto en relación a los estados de conciencia cuanto a los procesos cognitivos y la percepción auditiva en lo estado de coma. Así, este estudio de revisión bibliográfica sobre la percepción auditiva de los pacientes en estado de coma parece ser relevante para traer mayores esclarecimientos e identificar las evidencias. Identificar, en las publicaciones encuentradas, las lacunas, las consistencias y las inconsistencias de este tema. Este estudo consistió en un levantamiento bibliográfico en las bases de datos LILACS y PUBMED. Para esto, los artículos fueron analizados de acuerdo con el método y los resultados principales del estudo. Fueron seleccionados 10 artículos sobre el tema

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

    Science.gov (United States)

    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; Pcoma, 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.

  17. Comet 81p/Wild 2: The Updated Stardust Coma Dust Fluence Measurement for Smaller (Sub 10-Micrometre) Particles

    Science.gov (United States)

    Price, M. C.; Kearsley, A. T.; Burchell, M. J.; Horz, Friedrich; Cole, M. J.

    2009-01-01

    Micrometre and smaller scale dust within cometary comae can be observed by telescopic remote sensing spectroscopy [1] and the particle size and abundance can be measured by in situ spacecraft impact detectors [2]. Initial interpretation of the samples returned from comet 81P/Wild 2 by the Stardust spacecraft [3] appears to show that very fine dust contributes not only a small fraction of the solid mass, but is also relatively sparse [4], with a low negative power function describing grain size distribution, contrasting with an apparent abundance indicated by the on-board Dust Flux Monitor Instrument (DFMI) [5] operational during the encounter. For particles above 10 m diameter there is good correspondence between results from the DFMI and the particle size inferred from experimental calibration [6] of measured aerogel track and aluminium foil crater dimensions (as seen in Figure 4 of [4]). However, divergence between data-sets becomes apparent at smaller sizes, especially submicrometre, where the returned sample data are based upon location and measurement of tiny craters found by electron microscopy of Al foils. Here effects of detection efficiency tail-off at each search magnification can be seen in the down-scale flattening of each scale component, but are reliably compensated by sensible extrapolation between segments. There is also no evidence of malfunction in the operation of DFMI during passage through the coma (S. Green, personal comm.), so can the two data sets be reconciled?

  18. Electroretinogram (ERG) to photic stimuli should be carefully distinct from photic brainstem reflex in patients with deep coma.

    Science.gov (United States)

    Mitsuhashi, Masahiro; Hitomi, Takefumi; Aoyama, Akihiro; Kaido, Toshimi; Ikeda, Akio; Takahashi, Ryosuke

    2017-08-31

    Patient 1: A 35-year-old woman became deep coma because of intracranial hemorrhage after pulmonary surgery. Patient 2: A 39-year-old woman became deep coma because of cerebellar hemorrhage after hepatic surgery. Scalp-recorded digital electroencephalography (EEG) showed electrocerebral inactivity in both cases. In addition, both EEG showed repetitive discharges at bilateral frontopolar electrodes in response to photic stimuli. The amplitude and latency of the discharges was 17 μV and 24 msec in case 1, and 9 μV and 27 msec in case 2 respectively. The activity at left frontopolar electrode disappeared after coverage of the ipsilateral eye. Based on these findings, we could exclude the possibility of brainstem response and judged it as electroretinogram (ERG). Photic stimulation is a useful activation method in EEG recording, and we can also evaluate brainstem function by checking photic blink reflex if it is evoked. However, we should be cautious about the distinction of ERG from photic blink reflex when brain death is clinically suspected.

  19. FUV Spectral Signatures of Molecules and the Evolution of the Gaseous Coma of Comet 67P/Churyumov–Gerasimenko

    Science.gov (United States)

    Feldman, Paul D.; A’Hearn, Michael F.; Bertaux, Jean-Loup; Feaga, Lori M.; Keeney, Brian A.; Knight, Matthew M.; Noonan, John; Parker, Joel Wm.; Schindhelm, Eric; Steffl, Andrew J.; Stern, S. Alan; Vervack, Ronald J.; Weaver, Harold A.

    2018-01-01

    The Alice far-ultraviolet imaging spectrograph onboard Rosetta observed emissions from atomic and molecular species from within the coma of comet 67P/Churyumov–Gerasimenko during the entire escort phase of the mission from 2014 August to 2016 September. The initial observations showed that emissions of atomic hydrogen and oxygen close to the surface were produced by energetic electron impact dissociation of H2O. Following delivery of the lander, Philae, on 2014 November 12, the trajectory of Rosetta shifted to near-terminator orbits that allowed for these emissions to be observed against the shadowed nucleus that, together with the compositional heterogeneity, enabled us to identify unique spectral signatures of dissociative electron impact excitation of H2O, CO2, and O2. CO emissions were found to be due to both electron and photoexcitation processes. Thus, we are able, from far-ultraviolet spectroscopy, to qualitatively study the evolution of the primary molecular constituents of the gaseous coma from start to finish of the escort phase. Our results show asymmetric outgassing of H2O and CO2 about perihelion, H2O dominant before and CO2 dominant after, consistent with the results from both the in situ and other remote sensing instruments on Rosetta.

  20. Involuntary movements and coma as the prognostic marker for acute encephalopathy with biphasic seizures and late reduced diffusion.

    Science.gov (United States)

    Lee, Sooyoung; Sanefuji, Masafumi; Torio, Michiko; Kaku, Noriyuki; Ichimiya, Yuko; Mizuguchi, Soichi; Baba, Haruhisa; Sakai, Yasunari; Ishizaki, Yoshito; Torisu, Hiroyuki; Kira, Ryutaro; Hara, Toshiro; Ohga, Shouichi

    2016-11-15

    Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) occurs in children associated with infection. It is characterized by a prolonged febrile seizure in the first phase, and a cluster of seizures, deterioration of consciousness and the white matter lesions with reduced diffusion in the second phase. The patients often have severe neurological sequelae, but the prognostic indicators remain unknown. The present study aimed to clarify the characteristics of AESD patients who subsequently exhibited severe neurological sequelae. We retrospectively analyzed the clinical and laboratory findings along with the brain imaging in patients who had severe (n=8) and non-severe neurodevelopmental outcomes (n=12). Severe group more frequently showed coma (p=0.014) or involuntary movements including dystonia and oral dyskinesia (p=0.018) before the second phase than non-severe group. Severe group exhibited higher levels of serum alanine aminotransferase than non-severe group (p=0.001). Quantitatively assessed MRI in the second phase revealed that severe group had more extensive lesions than non-severe group, in the anterior (p=0.015) and posterior parts (p=0.011) of the cerebrum and basal ganglia (p=0.020). Early appearing involuntary movements or coma might account for the extension of acute brain lesions and the poor neurological outcomes in AESD patients. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. Successful use of haemodialysis to treat phenobarbital overdose.

    Science.gov (United States)

    Hoyland, Kimberley; Hoy, Michael; Austin, Richard; Wildman, Martyn

    2013-11-21

    A 50-year-old woman presented with coma caused by a phenobarbital overdose, requiring intubation and admission to critical care. She was an international visitor and had been prescribed the drug for night-sedation. Phenobarbital is a long-acting barbiturate, which in an overdose can cause central nervous system depression, respiratory failure and haemodynamic instability; these patients can remain obtunded for many days. After initial supportive therapy, she was dialysed to help in the elimination of the drug. Haemodialysis resulted in a markedly reduced plasma level of phenobarbital, which decreased the length of intubation and stay in the critical care unit and aided full recovery.

  2. Rotation and magnetic activity of the Hertzsprung-gap giant 31 Comae

    Science.gov (United States)

    Strassmeier, K. G.; Granzer, T.; Kopf, M.; Weber, M.; Küker, M.; Reegen, P.; Rice, J. B.; Matthews, J. M.; Kuschnig, R.; Rowe, J. F.; Guenther, D. B.; Moffat, A. F. J.; Rucinski, S. M.; Sasselov, D.; Weiss, W. W.

    2010-09-01

    Context. The single rapidly-rotating G0 giant 31 Comae has been a puzzle because of the absence of photometric variability despite its strong chromospheric and coronal emissions. As a Hertzsprung-gap giant, it is expected to be at the stage of rearranging its moment of inertia, hence likely also its dynamo action, which could possibly be linked with its missing photospheric activity. Aims: Our aim is to detect photospheric activity, obtain the rotation period, and use it for a first Doppler image of the star's surface. Its morphology could be related to the evolutionary status. Methods: We carried out high-precision, white-light photometry with the MOST satellite, ground-based Strömgren photometry with automated telescopes, and high-resolution optical echelle spectroscopy with the new STELLA robotic facility. Results: The MOST data reveal, for the first time, light variations with a full amplitude of 5 mmag and an average photometric period of 6.80 ± 0.06 days. Radial-velocity variations with a full amplitude of 270 m s-1 and a period of 6.76 ± 0.02 days were detected from our STELLA spectra, which we also interpret as due to stellar rotation. The two-year constancy of the average radial velocity of +0.10 ± 0.33 km s-1 confirms the star's single status, as well as the membership in the cluster Melotte 111. A spectrum synthesis gives Teff = 5660 ± 42 K, log g = 3.51 ± 0.09, and [Fe/H] = -0.15 ± 0.03, which together with the revised Hipparcos distance, suggests a mass of 2.6 ± 0.1 M_⊙ and an age of ≈540 Myr. The surface lithium abundance is measured to be nearly primordial. A detection of a strong He i absorption line indicates nonradiative heating processes in the atmosphere. Our Doppler images show a large, asymmetric polar spot, cooler than Teff by ≈1600 K, and several small low-to-mid latitude features that are warmer by ≈300-400 K and are possibly of chromospheric origin. We computed the convective turnover time for 31 Com as a function of depth

  3. The Noble Gas Abundances in the Coma of Comet 67P/Churyumov-Gerasimenko from Rosetta/ROSINA

    Science.gov (United States)

    Rubin, M.; Altwegg, K.; Balsiger, H. R.; Berthelier, J. J.; Briois, C.; Combi, M. R.; De Keyser, J.; Fiethe, B.; Fuselier, S. A.; Gasc, S.; Gombosi, T. I.; Hansen, K. C.; Jäckel, A.; Kopp, E.; Korth, A.; Mall, U.; Marty, B.; Mousis, O.; Owen, T.; Reme, H.; Schuhmann, M.; Schroeder, I. R. H. G.; Semon, T.; Tzou, C. Y.; Waite, J. H., Jr.; Wurz, P.

    2017-12-01

    The Rosetta Orbiter Spectrometer for Ion and Neutral Analysis (ROSINA), the mass spectrometer suite on board the European Space Agency's Rosetta mission, was dedicated to the measurement of the volatiles in the coma of comet 67P/Churyumov-Gerasimenko (67P) [1]. Among many other species, ROSINA DFMS, the Double Focusing Mass Spectrometer, detected and quantified the three noble gases argon, krypton, and xenon including their major isotopes [2,3]. Noble gases provide important clues to the physical and chemical conditions during and possibly even before and after the comet's formation in the early solar system. Furthermore, measurements of the isotope ratios provide constraints on the amount of cometary material brought to Earth and its early atmosphere. In this presentation, we will report on the measured coma densities and derived nucleus bulk abundances of these three noble gases and investigate correlations with other volatiles. Furthermore, we will discuss the measured isotope ratios and the implications of these results. AcknowledgementsUoB was funded by the State of Bern, the Swiss National Science Foundation and by the European Space Agency PRODEX Programme. Work at MPS was funded by the Max-Planck Gesellschaft and BMWI (contract 50QP1302), at Southwest Research institute by Jet Propulsion Laboratory (subcontract #1496541 and JPL subcontract to JWH NAS703001TONMO710889), at the University of Michigan by NASA (contract JPL-1266313). This work has been supported through the A*MIDEX project from the French National Research Agency (ANR) (n° ANR-11-IDEX- 0001-02) and by CNES grants at IRAP, LATMOS, LPC2E, LAM, CRPG, by the European Research Council (grant no. 267255 to B. Marty) and at BIRA-IASB by the Belgian Science Policy Office via PRODEX/ROSINA PEA C4000107705. References[1] Balsiger, H., et al., Rosina - Rosetta orbiter spectrometer for ion and neutral analysis. Space Science Reviews. 128, 745-801, 2007. [2] Balsiger, H., et al., Detection of argon in the

  4. Structure And Chemistry Of Ion Masses ≤ 40 Amu In The Inner Coma Of Comet HalleyStructure And Chemistry Of Ion Masses ≤ 40 Amu In The Inner Coma Of Comet Halley

    Science.gov (United States)

    Haider, S. A.; Bhardwaj, A.

    In this paper, we have developed a chemical model to study the chemistry of 46 ions (CH5+, SH+, S+, H2S+, NH3OH+, CH3+, HCO+, H2CO+, C2H3+, C3H3+, H3CO+, H2CN+, H3S+, NH3+, CH3OH2+, CH3OH+, NH4+, H3O+, N+, NH+, NH2+, N2+, C2H+, C+, CH2+, CH+, C2N+, C3H+, C2H4+, C2H5+, CO+, O+, H+, C2+, HCN+, OH+, O2+, CHOH2+, HNO+, N2H+, H2O+, CH4+, C2H2+, (H2O)2+, H5O2+ and C3H+) corresponding to masses ≤ 40 amu in the inner coma of comet Halley. The ionization sources included in the model are solar EUV photon, photoelectron and auroral electron of solar wind origin. The production rates, loss rates and mass densities of these ions are calculated using Analytical Yield Spectrum approach and coupled continuity equation controlled by steady state photochemical model, which involves over 600 chemical reactions between ions, neutrals, photons and electrons in the coma. The calculated mass densities are compared with Giotto Ion Mass Spectrometer (IMS) and Neutral Mass Spectrometer (NMS) data at radial distances 1500 km, 3500 km and 6000 km. The nine major peaks at 12, 15, 19, 26, 28, 31, 33, 35, and 39 amu observed in IMS/NMS spectra are reproduced well by model calculation. ^

  5. Elevated transaminases as a predictor of coma in a patient with anorexia nervosa: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Yoshida Shuhei

    2010-09-01

    Full Text Available Abstract Introduction Liver injury is a frequent complication associated with anorexia nervosa, and steatosis of the liver is thought to be the major underlying pathology. However, acute hepatic failure with transaminase levels over 1000 IU/mL and deep coma are very rare complications and the mechanism of pathogenesis is largely unknown. Case presentation A 37-year-old Japanese woman showed features of acute liver failure and hepatic coma which were not associated with hypoglycemia or hyper-ammonemia. Our patient's consciousness was significantly improved with the recovery of liver function and normalization of transaminase levels after administration of nutritional support. Conclusions Our case report demonstrates that transaminase levels had an inverse relationship with the consciousness of our patient, although the pathogenesis of coma remains largely unknown. This indicates that transaminase levels can be one of the key predictors of impending coma in patients with anorexia nervosa. Therefore, frequent monitoring of transaminase levels combined with rigorous treatment of the underlying nutritional deficiency and psychiatric disorder are necessary to prevent this severe complication.

  6. Kinetic simulation of neutral/ionized gas and electrically charged dust in the coma of comet 67P/Churyumov-Gerasimenko

    International Nuclear Information System (INIS)

    Tenishev, Valeriy; Rubin, Martin; Combi, Michael R.

    2011-01-01

    The cometary coma is a unique phenomenon in the solar system being a planetary atmosphere influenced by little or no gravity. As a comet approaches the sun, the water vapor with some fraction of other gases sublimate, generating a cloud of gas, ice and other refractory materials (rocky and organic dust) ejected from the surface of the nucleus. Sublimating gas molecules undergo frequent collisions and photochemical processes in the near-nucleus region. Owing to its negligible gravity, comets produce a large and highly variable extensive dusty coma with a size much larger than the characteristic size of the cometary nucleus.The Rosetta spacecraft is en route to comet 67P/Churyumov-Gerasimenko for a rendezvous, landing, and extensive orbital phase beginning in 2014. Both, interpretation of measurements and safety consideration of the spacecraft require modeling of the comet's dusty gas environment.In this work we present results of a numerical study of multispecies gaseous and electrically charged dust environment of comet Chyuryumov-Gerasimenko. Both, gas and dust phases 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 of the coma connected to the solar wind. Trajectories of ions and electrically charged dust grains are simulated by accounting for the Lorentz force and the nucleus gravity.

  7. Post-Coma Persons with Motor and Communication/Consciousness Impairments Choose among Environmental Stimuli and Request Stimulus Repetitions via Assistive Technology

    Science.gov (United States)

    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)…

  8. Post-Coma Persons Emerged from a Minimally Conscious State and Showing Multiple Disabilities Learn to Manage a Radio-Listening Activity

    Science.gov (United States)

    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…

  9. Fatal coma in a young adult due to late-onset urea cycle deficiency presenting with a prolonged seizure: a case report.

    Science.gov (United States)

    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.

  10. A Comparative Study of Glasgow Coma Scale and Full Outline of Unresponsiveness Scores for Predicting Long-Term Outcome After Brain Injury.

    Science.gov (United States)

    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 coma scores performed best for both tools, with GCS discharge scores predictive in multivariate models.

  11. Technology-Aided Leisure and Communication Opportunities for Two Post-Coma Persons Emerged from a Minimally Conscious State and Affected by Multiple Disabilities

    Science.gov (United States)

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

    2013-01-01

    This study assessed technology-aided programs for helping two post-coma persons, who had emerged from a minimally conscious state and were affected by multiple disabilities, to (a) engage with leisure stimuli and request caregiver's procedures, (b) send out and listen to text messages for communication with distant partners, and (c) combine…

  12. QTL for the thermotolerance effect of heat hardening, knowckdown resistance to heat and chill-coma recovery in an intercontinental set of recombinant inbred lines of Drosophila melanogaster

    DEFF Research Database (Denmark)

    Norry, Fabian M.; Scannapieco, Alejandra C.; Sambucetti, Pablo

    2008-01-01

    The thermotolerance effect of heat hardening (also called short-term acclimation), knockdown resistance to high temperature (KRHT) with and without heat hardening and chill-coma recovery (CCR) are important phenotypes of thermal adaptation in insects and other organisms. Drosophila melanogaster...

  13. Post-Coma Persons with Extensive Multiple Disabilities Use Microswitch Technology to Access Selected Stimulus Events or Operate a Radio Device

    Science.gov (United States)

    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…

  14. A Technology-Assisted Learning Setup as Assessment Supplement for Three Persons with a Diagnosis of Post-Coma Vegetative State and Pervasive Motor Impairment

    Science.gov (United States)

    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…

  15. Post-coma persons emerging from a minimally conscious state with multiple disabilities make technology-aided phone contacts with relevant partners

    NARCIS (Netherlands)

    Lancioni, G.E.; Singh, N.N.; O'Reilly, M.F.; Sigafoos, J.; Oliva, D.; Campodonico, F.; D'Amico, F.; Buonocunto, F.; Sacco, V.; Didden, H.C.M.

    2013-01-01

    Post-coma individuals emerging from a minimally conscious state with multiple disabilities may enjoy contact with relevant partners (e.g., family members and friends), but may not have easy access to them. These two single-case studies assessed whether those individuals could make contact with

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

    Science.gov (United States)

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

    2012-01-01

    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 greater than100 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 the order of (2-5) x 10(sup -8) photons m(sup -2) s(sup -1) (VERITAS,greater than 220 GeV) and approximately 2 x 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 less than 16% from VERITAS data and less than 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 approximately (2-5.5)microG, 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

  17. Efficacy of Intravenous Haloperidol on the duration of Delirium and Coma in Critically Ill Patients (Hope-ICU): a Randomised, Placebo-Controlled Trial

    Science.gov (United States)

    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

  18. Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (Hope-ICU): a randomised, double-blind, placebo-controlled trial.

    Science.gov (United States)

    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

  19. Solar-insolation-induced changes in the coma morphology of comet 67P/Churyumov-Gerasimenko. Optical monitoring with the Nordic Optical Telescope

    Science.gov (United States)

    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

  20. How phenobarbital revolutionized epilepsy therapy: the story of phenobarbital therapy in epilepsy in the last 100 years.

    Science.gov (United States)

    Yasiry, Zeid; Shorvon, Simon D

    2012-12-01

    Phenobarbital (phenobarbitone) was first used as an antiepileptic drug 100 years ago, in 1912. This article tells the story of the discovery of its antiepileptic action, its early development, and the subsequent course of its clinical use over the 100-year period. The side effects, pharmacokinetics, and misuse of barbiturates are considered, along with the more recent clinical trials and the drug's current clinical utilization. The introduction of controlled drug regulations, the comparative cost of phenobarbital, and its inclusion on the World Health Organization (WHO) essential drug list are discussed. It is one of the few drugs on the formulary in 1912 that is still listed today, and remarkably its efficacy in epilepsy has not been significantly bettered. The current recommendation by the WHO is that phenobarbital should be offered as the first option for therapy for convulsive epilepsy in adults and children if availability can be ensured. This is rated as a strong recommendation because of the proven efficacy and low cost of phenobarbital, and despite its perceived side-effect profile and the practical problems of access. Whether this recommendation puts "a hierarchy on the brain," as has been suggested, is arguable. Much still needs to be learned about the drug's effects, and the issues raised by phenobarbital have lessons for all antiepileptic drug therapy. Wiley Periodicals, Inc. © 2012 International League Against Epilepsy.