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Sample records for drowsiness

  1. Drowsiness detection using heart rate variability.

    Science.gov (United States)

    Vicente, José; Laguna, Pablo; Bartra, Ariadna; Bailón, Raquel

    2016-06-01

    It is estimated that 10-30 % of road fatalities are related to drowsy driving. Driver's drowsiness detection based on biological and vehicle signals is being studied in preventive car safety. Autonomous nervous system activity, which can be measured noninvasively from the heart rate variability (HRV) signal obtained from surface electrocardiogram, presents alterations during stress, extreme fatigue and drowsiness episodes. We hypothesized that these alterations manifest on HRV and thus could be used to detect driver's drowsiness. We analyzed three driving databases in which drivers presented different sleep-deprivation levels, and in which each driving minute was annotated as drowsy or awake. We developed two different drowsiness detectors based on HRV. While the drowsiness episodes detector assessed each minute of driving as "awake" or "drowsy" with seven HRV derived features (positive predictive value 0.96, sensitivity 0.59, specificity 0.98 on 3475 min of driving), the sleep-deprivation detector discerned if a driver was suitable for driving or not, at driving onset, as function of his sleep-deprivation state. Sleep-deprivation state was estimated from the first three minutes of driving using only one HRV feature (positive predictive value 0.80, sensitivity 0.62, specificity 0.88 on 30 drivers). Incorporating drowsiness assessment based on HRV signal may add significant improvements to existing car safety systems.

  2. Drowsiness

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    ... Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also ... urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows ...

  3. Drowsiness in conditional automation : Proneness, diagnosis and driving performance effects

    NARCIS (Netherlands)

    Goncalves, J.; Happee, R.; Bengler, KJ; Rosetti, R.; Wolf, D.

    2016-01-01

    Fatigue and drowsiness can play an important role in Conditional Automation (CA), as drowsy drivers may fail to properly recover control. In order to provide better insight in the effects of drowsy driving in Take Over Request (TOR), we designed a driving experiment that extends related

  4. Detecting Driver Drowsiness Based on Sensors: A Review

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    Kenneth Sundaraj

    2012-12-01

    Full Text Available In recent years, driver drowsiness has been one of the major causes of road accidents and can lead to severe physical injuries, deaths and significant economic losses. Statistics indicate the need of a reliable driver drowsiness detection system which could alert the driver before a mishap happens. Researchers have attempted to determine driver drowsiness using the following measures: (1 vehicle-based measures; (2 behavioral measures and (3 physiological measures. A detailed review on these measures will provide insight on the present systems, issues associated with them and the enhancements that need to be done to make a robust system. In this paper, we review these three measures as to the sensors used and discuss the advantages and limitations of each. The various ways through which drowsiness has been experimentally manipulated is also discussed. We conclude that by designing a hybrid drowsiness detection system that combines non-intusive physiological measures with other measures one would accurately determine the drowsiness level of a driver. A number of road accidents might then be avoided if an alert is sent to a driver that is deemed drowsy.

  5. Microcontroller based driver alertness detection systems to detect drowsiness

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    Adenin, Hasibah; Zahari, Rahimi; Lim, Tiong Hoo

    2018-04-01

    The advancement of embedded system for detecting and preventing drowsiness in a vehicle is a major challenge for road traffic accident systems. To prevent drowsiness while driving, it is necessary to have an alert system that can detect a decline in driver concentration and send a signal to the driver. Studies have shown that traffc accidents usually occur when the driver is distracted while driving. In this paper, we have reviewed a number of detection systems to monitor the concentration of a car driver and propose a portable Driver Alertness Detection System (DADS) to determine the level of concentration of the driver based on pixelated coloration detection technique using facial recognition. A portable camera will be placed at the front visor to capture facial expression and the eye activities. We evaluate DADS using 26 participants and have achieved 100% detection rate with good lighting condition and a low detection rate at night.

  6. Monitoring alert and drowsy states by modeling EEG source nonstationarity

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    Hsu, Sheng-Hsiou; Jung, Tzyy-Ping

    2017-10-01

    Objective. As a human brain performs various cognitive functions within ever-changing environments, states of the brain characterized by recorded brain activities such as electroencephalogram (EEG) are inevitably nonstationary. The challenges of analyzing the nonstationary EEG signals include finding neurocognitive sources that underlie different brain states and using EEG data to quantitatively assess the state changes. Approach. This study hypothesizes that brain activities under different states, e.g. levels of alertness, can be modeled as distinct compositions of statistically independent sources using independent component analysis (ICA). This study presents a framework to quantitatively assess the EEG source nonstationarity and estimate levels of alertness. The framework was tested against EEG data collected from 10 subjects performing a sustained-attention task in a driving simulator. Main results. Empirical results illustrate that EEG signals under alert versus drowsy states, indexed by reaction speeds to driving challenges, can be characterized by distinct ICA models. By quantifying the goodness-of-fit of each ICA model to the EEG data using the model deviation index (MDI), we found that MDIs were significantly correlated with the reaction speeds (r  =  -0.390 with alertness models and r  =  0.449 with drowsiness models) and the opposite correlations indicated that the two models accounted for sources in the alert and drowsy states, respectively. Based on the observed source nonstationarity, this study also proposes an online framework using a subject-specific ICA model trained with an initial (alert) state to track the level of alertness. For classification of alert against drowsy states, the proposed online framework achieved an averaged area-under-curve of 0.745 and compared favorably with a classic power-based approach. Significance. This ICA-based framework provides a new way to study changes of brain states and can be applied to

  7. Intrusions of a drowsy mind: neural markers of phenomenological unpredictability.

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    Noreika, Valdas; Canales-Johnson, Andrés; Koh, Justin; Taylor, Mae; Massey, Irving; Bekinschtein, Tristan A

    2015-01-01

    The transition from a relaxed to a drowsy state of mind is often accompanied by hypnagogic experiences: most commonly, perceptual imagery, but also linguistic intrusions, i.e., the sudden emergence of unpredictable anomalies in the stream of inner speech. This study has sought to describe the contents of such intrusions, to verify their association with the progression of sleep onset, and to investigate the electroencephalographic processes associated with linguistic intrusions as opposed to more common hypnagogic perceptual imagery. A single participant attended 10 experimental sessions in the EEG laboratory, where he was allowed to drift into a drowsy state of mind, while maintaining metacognition of his own experiences. Once a linguistic intrusion or a noticeable perceptual image occurred, the participant pressed a button and reported it verbally. An increase in the EEG-defined depth of drowsiness as assessed by the Hori system of sleep onset was observed in the last 20 s before a button press. Likewise, EEG Dimension of Activation values decreased before the button press, indicating that the occurrence of cognitively incongruous experiences coincides with the rapid change of EEG predictability patterns. EEG hemispheric asymmetry analysis showed that linguistic intrusions had a higher alpha and gamma power in the left hemisphere electrodes, whereas perceptual imagery reports were associated with a higher beta power over the right hemisphere. These findings indicate that the modality as well as the incongruence of drowsiness-related hypnagogic experiences is strongly associated with distinct EEG signatures in this participant. Sleep onset may provide a unique possibility to study the neural mechanisms accompanying the fragmentation of the stream of consciousness in healthy individuals.

  8. Intrusions of a drowsy mind: Neural markers of phenomenological unpredictability

    Directory of Open Access Journals (Sweden)

    Valdas eNoreika

    2015-03-01

    Full Text Available The transition from a relaxed to a drowsy state of mind is often accompanied by hypnagogic experiences: most commonly, perceptual imagery, but also linguistic intrusions, i.e. the sudden emergence of unpredictable anomalies in the stream of inner speech. This study has sought to describe the contents of such intrusions, to verify their association with the progression of sleep onset, and to investigate the electroencephalographic processes associated with linguistic intrusions as opposed to more common hypnagogic perceptual imagery. A single participant attended 10 experimental sessions in the EEG laboratory, where he was allowed to drift into a drowsy state of mind, while maintaining metacognition of his own experiences. Once a linguistic intrusion or a noticeable perceptual image occurred, the participant pressed a button and reported it verbally. An increase in the EEG-defined depth of drowsiness as assessed by the Hori system of sleep onset was observed in the last 20 sec before a button press. Likewise, EEG Dimension of Activation values decreased before the button press, indicating that the occurrence of cognitively incongruous experiences coincides with the rapid change of EEG predictability patterns. EEG hemispheric asymmetry analysis showed that linguistic intrusions had a higher alpha and gamma power in the left hemisphere electrodes, whereas perceptual imagery reports were associated with a higher beta power over the right hemisphere. These findings indicate that the modality as well as the incongruence of drowsiness-related hypnagogic experiences is strongly associated with distinct EEG signatures in this participant. Sleep onset may provide a unique possibility to study the neural mechanisms accompanying the fragmentation of the stream of consciousness in healthy individuals.

  9. Electrodermal Activity Based Wearable Device for Drowsy Drivers

    Science.gov (United States)

    Malathi, D.; Dorathi Jayaseeli, JD; Madhuri, S.; Senthilkumar, K.

    2018-04-01

    Road safety and road accident mortality rate are a serious concern for the government. With rise in fatal road accidents, who’s leading cause is the driver being drowsy behind the wheel, measures to alleviate this problem becomes the prime task. To meet the purpose, methods adopted must be of minimum discomfort for the driver, easy to install, provide good detection accuracy and timely alert to circumvent a probable accident. A good candidate to meet these specifications is EDA. As it detects the level of sweat which directly corresponds to the mental state of the person, using EDA for the purposes of driver safety forms a good option. The novelty of this project lies in making use of EDA as a measure to detect if a person is drowsy or not. Much of the challenge lies in building a device equipped with the necessary sensors and processing the data on real-time. The novelty of this work lies in development of an embedded device interfaced with sensors and actuators to detect and alert a driver when found drowsy using sweat as a parameter.

  10. Study on Awakening Effect by Fragrance Presentation Against Drowsy Driving and Construction of Fragrance Presentation System

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    Kakamu, Yuki; Yoshikawa, Masahito; Shimizu, Takayuki; Yanagida, Yasuyuki; Nakano, Tomoaki; Yamamoto, Shin; Yamada, Muneo

    Traffic accidents caused by drowsy driving never disappear and easily result in fatal crash when heavy vehicle is involved. General methods to prevent drowsy driving are caution-advisory indicators and alarm sounds. However visual and auditory information are excessive enough to alert drivers. This study aims to focus on olfactory stimuli, which do not provoke interference with driving actions, and examine the effectiveness in combating drowsiness. Changing type of scent, we performed investigations on the effectiveness of each countermeasure to remain alert against drowsy driving.

  11. Driver drowsiness detection using behavioral measures and machine learning techniques: A review of state-of-art techniques

    CSIR Research Space (South Africa)

    Ngxande, Mkhuseli

    2017-11-01

    Full Text Available This paper presents a literature review of driver drowsiness detection based on behavioral measures using machine learning techniques. Faces contain information that can be used to interpret levels of drowsiness. There are many facial features...

  12. Drowsiness and uncommon fever in a child after cannabis ingestion.

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    Feliu, Catherine; Cazaubon, Yoann; Fouley, Aurélie; Guillemin, Hélène; Millart, Hervé; Gozalo, Claire; Djerada, Zoubir

    2017-08-01

    Trivialization of cannabis consumption goes hand in hand with a growing exposure of children and the number of cannabis poisoning cases is steadily increasing. As clinical presentation can be different from what is currently seen in adults, added to the fact that it is not always suspected, diagnosis of cannabis intoxication in children is often delayed or missed. A 16-month-old girl was admitted to the pediatric emergency unit for an important drowsiness combined to moderate fever. After elimination of infectious causes, a toxic origin was considered and biological analyses led to the diagnosis of involuntary acute cannabis intoxication. In conclusion, cannabis intoxication in child has uncommon presentations compared to that seen in adults. In this context, biological analyses have a great importance for a rapid diagnosis and also for the understanding intoxication circumstance. This is of paramount importance because it may lead to consider child protection measures.

  13. Ventilation is unstable during drowsiness before sleep onset.

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    Thomson, Stuart; Morrell, Mary J; Cordingley, Jeremy J; Semple, Stephen J

    2005-11-01

    Ventilation is unstable during drowsiness before sleep onset. We have studied the effects of transitory changes in cerebral state during drowsiness on breath duration and lung volume in eight healthy subjects in the absence of changes in airway resistance and fluctuations of ventilation and CO2 tension, characteristic of the onset of non-rapid eye movement sleep. A volume-cycled ventilator in the assist control mode was used to maintain CO2 tension close to that when awake. Changes in cerebral state were determined by the EEG on a breath-by-breath basis and classified as alpha or theta breaths. Breath duration and the pause in gas flow between the end of expiratory airflow and the next breath were computed for two alpha breaths which preceded a theta breath and for the theta breath itself. The group mean (SD) results for this alpha-to-theta transition was associated with a prolongation in breath duration from 5.2 (SD 1.3) to 13.0 s (SD 2.1) and expiratory pause from 0.7 (SD 0.4) to 7.5 s (SD 2.2). Because the changes in arterial CO2 tension (PaCO2) are unknown during the theta breaths, we made in two subjects a continuous record of PaCO2 in the radial artery. PaCO2 remained constant from the alpha breaths through to the expiratory period of the theta breath by which time the duration of breath was already prolonged, representing an immediate and altered ventilatory response to the prevailing PaCO2. In the eight subjects, the CO2 tension awake was 39.6 Torr (SD 2.3) and on assisted ventilation 38.0 Torr (1.4). We conclude that the ventilatory instability recorded in the present experiments is due to the apneic threshold for CO2 being at or just below that when awake.

  14. Real-time monitoring of drowsiness through wireless nanosensor systems

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    Ramasamy, Mouli; Varadan, Vijay K.

    2016-04-01

    Detection of sleepiness and drowsiness in human beings has been a daunting task for both engineering and medical technologies. Accuracy, precision and promptness of detection have always been an issue that has to be dealt by technologists. Generally, the bio potential signals - ECG, EOG, EEG and EMG are used to classify and discriminate sleep from being awake. However, the potential drawbacks may be high false detections, low precision, obtrusiveness, aftermath analysis, etc. To overcome the disadvantages, this paper reviews the design aspects of a wireless and a real time monitoring system to track sleep and detect fatigue. This concept involves the use of EOG and EEG to measure the blink rate and asses the person's condition. In this user friendly and intuitive approach, EOG and EEG signals are obtained by the textile based nanosensors mounted on the inner side of a flexible headband. The acquired signals are then electrically transmitted to the data processing and transmission unit, which transmits the processed data to the receiver/monitoring module through ZigBee communication. This system is equipped with a software program to process, feature extract, analyze, display and store the information. Thereby, immediate detection of a person falling asleep is made feasible and, tracking the sleep cycle continuously provides an insight about the fatigue level. This approach of using a wireless, real time, dry sensor on a flexible substrate mitigates obtrusiveness that is expected from a wearable system. We have previously presented the results of the aforementioned wearable systems. This paper aims to extend our work conceptually through a review of engineering and medical techniques involved in wearable systems to detect drowsiness.

  15. Motivational factors associated with drowsy driving behavior: a qualitative investigation of college students.

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    Beck, Kenneth H; Lee, Clark J; Weiner, Talia

    2018-02-01

    This qualitative investigation sought to identify the motivational factors that contribute to drowsy driving in college students and to discover important messaging strategies that may help prevent or reduce this behavior in this population. Four focus groups of college students. A large university in the Washington, DC, metropolitan area during the Fall 2016 term. Twenty-six undergraduate students between the ages of 18 and 25 years. Notes and transcripts from the focus group sessions were analyzed to identify recurring themes regarding attitudes, motivations, experiences, influences, and potential preventive messaging strategies related to drowsy driving. Although most participants had heard of drowsy driving and were concerned about it, they did not associate it with legal risks and were more concerned about alcohol-impaired and distracted driving as crash risks. Participants viewed drowsy driving as a normal and unavoidable part of their lives over which they had little control. For potential anti-drowsy driving messaging strategies, participants preferred messages delivered via audiovisual or social media that featured graphic and emotional portrayals of crashes and their consequences. Participants also voiced strong support for preventive messaging strategies equating various degrees of sleep deprivation to known impairing levels of alcohol, as well as messages providing cues to action to actual drowsy drivers on roadways. Increased enforcement, education, and public messaging campaigns are needed to increase knowledge and influence attitudes and opinions among young drivers about the dangers and social unacceptability of drowsy driving. Copyright © 2018 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

  16. A Context-Aware EEG Headset System for Early Detection of Driver Drowsiness

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    Gang Li

    2015-08-01

    Full Text Available Driver drowsiness is a major cause of mortality in traffic accidents worldwide. Electroencephalographic (EEG signal, which reflects the brain activities, is more directly related to drowsiness. Thus, many Brain-Machine-Interface (BMI systems have been proposed to detect driver drowsiness. However, detecting driver drowsiness at its early stage poses a major practical hurdle when using existing BMI systems. This study proposes a context-aware BMI system aimed to detect driver drowsiness at its early stage by enriching the EEG data with the intensity of head-movements. The proposed system is carefully designed for low-power consumption with on-chip feature extraction and low energy Bluetooth connection. Also, the proposed system is implemented using JAVA programming language as a mobile application for on-line analysis. In total, 266 datasets obtained from six subjects who participated in a one-hour monotonous driving simulation experiment were used to evaluate this system. According to a video-based reference, the proposed system obtained an overall detection accuracy of 82.71% for classifying alert and slightly drowsy events by using EEG data alone and 96.24% by using the hybrid data of head-movement and EEG. These results indicate that the combination of EEG data and head-movement contextual information constitutes a robust solution for the early detection of driver drowsiness.

  17. Driver drowsiness classification using fuzzy wavelet-packet-based feature-extraction algorithm.

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    Khushaba, Rami N; Kodagoda, Sarath; Lal, Sara; Dissanayake, Gamini

    2011-01-01

    Driver drowsiness and loss of vigilance are a major cause of road accidents. Monitoring physiological signals while driving provides the possibility of detecting and warning of drowsiness and fatigue. The aim of this paper is to maximize the amount of drowsiness-related information extracted from a set of electroencephalogram (EEG), electrooculogram (EOG), and electrocardiogram (ECG) signals during a simulation driving test. Specifically, we develop an efficient fuzzy mutual-information (MI)- based wavelet packet transform (FMIWPT) feature-extraction method for classifying the driver drowsiness state into one of predefined drowsiness levels. The proposed method estimates the required MI using a novel approach based on fuzzy memberships providing an accurate-information content-estimation measure. The quality of the extracted features was assessed on datasets collected from 31 drivers on a simulation test. The experimental results proved the significance of FMIWPT in extracting features that highly correlate with the different drowsiness levels achieving a classification accuracy of 95%-- 97% on an average across all subjects.

  18. Fatigued and drowsy driving: a survey of attitudes, opinions and behaviors.

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    Vanlaar, Ward; Simpson, Herb; Mayhew, Dan; Robertson, Robyn

    2008-01-01

    There is evidence suggesting that the problem of fatigued or drowsy driving is an important contributor to road crashes. However, not much is known about public perceptions of the issue. The purpose of this study was to obtain information on attitudes, opinions, and professed practices related to fatigued or drowsy driving. The data were gathered by means of a public opinion poll among a representative sample of 750 Ontario drivers. A majority of drivers (58.6%) admitted that they occasionally drive while fatigued or drowsy. Of greater importance, 14.5% of respondents admitted that they had fallen asleep or "nodded off" while driving during the past year. Nearly 2% were involved in a fatigue or drowsy driving related crash in the past year. Respondents were also asked about measures they take to overcome fatigue or drowsiness. Results indicate that relatively ineffective measures such as opening the window or playing music are the most popular; the most effective preventive measure--taking a rest--is the least popular. The prevalence of the behavior, coupled with the ineffective prevention measures favored by the public suggest there is a need for increasing their level of awareness and knowledge about the problem. Results from this study further emphasize the importance of increasing the fatigued and drowsy driving knowledge base and the need to educate the public about it.

  19. Gaze position modulates the effectiveness of forward collision warnings for drowsy drivers.

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    Gaspar, John G; Schwarz, John-Chris W; Brown, Timothy L; Kang, Julie

    2017-12-22

    Advanced driver assistance systems (ADAS) have the potential to prevent crashes and reduce their severity. Forward collision warnings (FCW) are quickly becoming standard across vehicle lineups and may prevent frontal crashes by alerting drivers. Previous research has demonstrated the effectiveness of FCW for distracted drivers, but their effectiveness for other types of impairment remains unknown. Like distraction, drowsiness can impair driver response time and lead to crashes. The goal of the present study was to evaluate the effectiveness of FCW for moderately and severely drowsy drivers using a high-fidelity driving simulator. Drowsy drivers were divided into three warning conditions during a revealed stop vehicle forward collision event: An auditory alert, a haptic seat vibration, and a no warning baseline. Results indicate that FCW were effective at speeding drowsy driver response, but only when the drowsy drivers were looking away from the forward roadway at the onset of the event. These results have important implications for ADAS technology and driver state monitoring systems. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Drowsiness detection for single channel EEG by DWT best m-term approximation

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    Tiago da Silveira

    Full Text Available Introduction In this paper we propose a promising new technique for drowsiness detection. It consists of applying the best m-term approximation on a single-channel electroencephalography (EEG signal preprocessed through a discrete wavelet transform. Methods In order to classify EEG epochs as awake or drowsy states, the most significant m terms from the wavelet expansion of an EEG signal are selected according to the magnitude of their coefficients related to the alpha and beta rhythms. Results By using a simple thresholding strategy it provides hit rates comparable to those using more complex techniques. It was tested on a set of 6 hours and 50 minutes EEG drowsiness signals from PhysioNet Sleep Database yielding an overall sensitivity (TPR of 84.98% and 98.65% of precision (PPV. Conclusion The method has proved itself efficient at separating data from different brain rhythms, thus alleviating the requirement for complex post-processing classification algorithms.

  1. Driver Drowsiness Warning System Using Visual Information for Both Diurnal and Nocturnal Illumination Conditions

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    Flores MarcoJavier

    2010-01-01

    Full Text Available Every year, traffic accidents due to human errors cause increasing amounts of deaths and injuries globally. To help reduce the amount of fatalities, in the paper presented here, a new module for Advanced Driver Assistance System (ADAS which deals with automatic driver drowsiness detection based on visual information and Artificial Intelligence is presented. The aim of this system is to locate, track, and analyze both the drivers face and eyes to compute a drowsiness index, where this real-time system works under varying light conditions (diurnal and nocturnal driving. Examples of different images of drivers taken in a real vehicle are shown to validate the algorithms used.

  2. Drowsiness detection by thoracic effort signal analysis in real driving environments.

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    Rodrígue-Ibáñez, N; García-González, M A; Fernández-Chimeno, M; Ramos-Castro, J

    2011-01-01

    Detection of drowsiness while driving is a leading objective in advanced driver assistance systems. This work presents a new index to assess the alertness state of drivers based on the respiratory dynamics derived from an inductive band. More than 100 hours of driving in real environments from 13 healthy subjects were analyzed. The proposed method has a sensitivity of 93.7% and specificity of 86.3% in detecting full awake drivers while it has a sensitivity of 83.1% and specificity of 95.3% in detecting drowsy drivers. The results show that the proposed index may be promising to assess the alertness state of real drivers.

  3. Intentions and willingness to drive while drowsy among university students: An application of an extended theory of planned behavior model.

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    Lee, Clark J; Geiger-Brown, Jeanne; Beck, Kenneth H

    2016-08-01

    A web-based questionnaire was used to assess the utility of constructs from the Theory of Planned Behavior (TPB) and the Prototype Willingness Model (PWM) to predict intentions and willingness to engage in drowsy driving in a sample of 450 university students. Those students who reported more favorable attitudes and subjective norm and greater perceived control and willingness in relation to drowsy driving behavior were more likely to report stronger intentions to engage in drowsy driving behavior. Augmenting the TPB constructs with the PWM construct of willingness significantly explained up to an additional 8 percent of the variance in drowsy driving intention. Perceived behavioral control and willingness were consistently the strongest predictors of drowsy driving intention in the augmented model, which together with the control (personal) variables explained up to 70 percent of the variance in intention. Thus, the Theory of Planned Behavior and the Prototype Willingness Model may be useful for understanding motivational influences on drowsy driving behavior in young people and present promising theoretical frameworks for designing more effective interventions against drowsy driving in this population. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Drowsy driver mobile application: Development of a novel scleral-area detection method.

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    Mohammad, Faisal; Mahadas, Kausalendra; Hung, George K

    2017-10-01

    A reliable and practical app for mobile devices was developed to detect driver drowsiness. It consisted of two main components: a Haar cascade classifier, provided by a computer vision framework called OpenCV, for face/eye detection; and a dedicated JAVA software code for image processing that was applied over a masked region circumscribing the eye. A binary threshold was performed over the masked region to provide a quantitative measure of the number of white pixels in the sclera, which represented the state of eye opening. A continuously low white-pixel count would indicate drowsiness, thereby triggering an alarm to alert the driver. This system was successfully implemented on: (1) a static face image, (2) two subjects under laboratory conditions, and (3) a subject in a vehicle environment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Asleep at the Wheel-The Road to Addressing Drowsy Driving.

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    Higgins, J Stephen; Michael, Jeff; Austin, Rory; Åkerstedt, Torbjörn; Van Dongen, Hans P A; Watson, Nathaniel; Czeisler, Charles; Pack, Allan I; Rosekind, Mark R

    2017-02-01

    Drowsy driving is a dangerous behavior that leads to thousands of deaths and injuries each year. It is also a controllable factor for drivers. Drivers are capable of modifying this behavior if given sufficient information and motivation. Our goal is to establish a comprehensive and strategic effort to end drowsy driving crashes and deaths. This article highlights some of the conclusions of a unique recent meeting of sleep experts and highway safety professionals and describes the first steps the community has taken and plans to take in the future to address this issue. Published by Oxford University Press on behalf of Sleep Research Society (SRS) 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  6. Data Fusion to Develop a Driver Drowsiness Detection System with Robustness to Signal Loss

    Directory of Open Access Journals (Sweden)

    Sajjad Samiee

    2014-09-01

    Full Text Available This study proposes a drowsiness detection approach based on the combination of several different detection methods, with robustness to the input signal loss. Hence, if one of the methods fails for any reason, the whole system continues to work properly. To choose correct combination of the available methods and to utilize the benefits of methods of different categories, an image processing-based technique as well as a method based on driver-vehicle interaction is used. In order to avoid driving distraction, any use of an intrusive method is prevented. A driving simulator is used to gather real data and then artificial neural networks are used in the structure of the designed system. Several tests were conducted on twelve volunteers while their sleeping situations during one day prior to the tests, were fully under control. Although the impact of the proposed system on the improvement of the detection accuracy is not remarkable, the results indicate the main advantages of the system are the reliability of the detections and robustness to the loss of the input signals. The high reliability of the drowsiness detection systems plays an important role to reduce drowsiness related road accidents and their associated costs.

  7. Automatic recognition of alertness and drowsiness from EEG by an artificial neural network.

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    Vuckovic, Aleksandra; Radivojevic, Vlada; Chen, Andrew C N; Popovic, Dejan

    2002-06-01

    We present a novel method for classifying alert vs drowsy states from 1 s long sequences of full spectrum EEG recordings in an arbitrary subject. This novel method uses time series of interhemispheric and intrahemispheric cross spectral densities of full spectrum EEG as the input to an artificial neural network (ANN) with two discrete outputs: drowsy and alert. The experimental data were collected from 17 subjects. Two experts in EEG interpretation visually inspected the data and provided the necessary expertise for the training of an ANN. We selected the following three ANNs as potential candidates: (1) the linear network with Widrow-Hoff (WH) algorithm; (2) the non-linear ANN with the Levenberg-Marquardt (LM) rule; and (3) the Learning Vector Quantization (LVQ) neural network. We showed that the LVQ neural network gives the best classification compared with the linear network that uses WH algorithm (the worst), and the non-linear network trained with the LM rule. Classification properties of LVQ were validated using the data recorded in 12 healthy volunteer subjects, yet whose EEG recordings have not been used for the training of the ANN. The statistics were used as a measure of potential applicability of the LVQ: the t-distribution showed that matching between the human assessment and the network output was 94.37+/-1.95%. This result suggests that the automatic recognition algorithm is applicable for distinguishing between alert and drowsy state in recordings that have not been used for the training.

  8. Identification of common features of vehicle motion under drowsy/distracted driving: A case study in Wuhan, China.

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    Chen, Zhijun; Wu, Chaozhong; Zhong, Ming; Lyu, Nengchao; Huang, Zhen

    2015-08-01

    Drowsy/distracted driving has become one of the leading causes of traffic crash. Only certain particular drowsy/distracted driving behaviors have been studied by previous studies, which are mainly based on dedicated sensor devices such as bio and visual sensors. The objective of this study is to extract the common features for identifying drowsy/distracted driving through a set of common vehicle motion parameters. An intelligent vehicle was used to collect vehicle motion parameters. Fifty licensed drivers (37 males and 13 females, M=32.5 years, SD=6.2) were recruited to carry out road experiments in Wuhan, China and collecting vehicle motion data under four driving scenarios including talking, watching roadside, drinking and under the influence of drowsiness. For the first scenario, the drivers were exposed to a set of questions and asked to repeat a few sentences that had been proved valid in inducing driving distraction. Watching roadside, drinking and driving under drowsiness were assessed by an observer and self-reporting from the drivers. The common features of vehicle motions under four types of drowsy/distracted driving were analyzed using descriptive statistics and then Wilcoxon rank sum test. The results indicated that there was a significant difference of lateral acceleration rates and yaw rate acceleration between "normal driving" and drowsy/distracted driving. Study results also shown that, under drowsy/distracted driving, the lateral acceleration rates and yaw rate acceleration were significantly larger from the normal driving. The lateral acceleration rates were shown to suddenly increase or decrease by more than 2.0m/s(3) and the yaw rate acceleration by more than 2.5°/s(2). The standard deviation of acceleration rate (SDA) and standard deviation of yaw rate acceleration (SDY) were identified to as the common features of vehicle motion for distinguishing the drowsy/distracted driving from the normal driving. In order to identify a time window for

  9. Topographic distribution of EEG alpha attractor correlation dimension values in wake and drowsy states in humans.

    Science.gov (United States)

    Kalauzi, Aleksandar; Vuckovic, Aleksandra; Bojić, Tijana

    2015-03-01

    Organization of resting state cortical networks is of fundamental importance for the phenomenon of awareness, which is altered in the first part of hypnagogic period (Hori stages 1-4). Our aim was to investigate the change in brain topography pattern of EEG alpha attractor correlation dimension (CD) in the period of transition from Hori stage 1 to 4. EEG of ten healthy adult individuals was recorded in the wake and drowsy states, using a 14 channel average reference montage, from which 91 bipolar channels were derived and filtered in the wider alpha (6-14 Hz) range. Sixty 1s long epochs of each state and individual were subjected to CD calculation according to the Grassberger-Procaccia method. For such a collection of signals, two embedding dimensions, d={5, 10}, and 22 time delays τ=2-23 samples were explored. Optimal values were d=10 and τ=18, where both saturation and second zero crossing of the autocorrelation function occurred. Bipolar channel CD underwent a significant decrease during the transition and showed a positive linear correlation with electrode distance, stronger in the wake individuals. Topographic distribution of bipolar channels with above median CD changed from longitudinal anterior-posterior pattern (awake) to a more diagonal pattern, with localization in posterior regions (drowsiness). Our data are in line with the literature reporting functional segregation of neuronal assemblies in anterior and posterior regions during this transition. Our results should contribute to understanding of complex reorganization of the cortical part of alpha generators during the wake/drowsy transition. Copyright © 2014 Elsevier B.V. All rights reserved.

  10. Drowsy Driving

    Science.gov (United States)

    ... Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep. 2015;38(6):843–844. Hirshkowitz M, ...

  11. Objective assessment of drowsiness and reaction time during intermittent Ramadan fasting in young men: a case-crossover study.

    Science.gov (United States)

    Bahammam, Ahmed S; Nashwan, Samar; Hammad, Omeima; Sharif, Munir M; Pandi-Perumal, Seithikurippu R

    2013-08-12

    Ramadan fasting and its attendant lifestyle changes induce changes in the circadian rhythm and in associated physiological and metabolic functions. Previous studies that have assessed psychomotor performance during Ramadan fasting have reported conflicting results. Therefore, we designed this study to objectively assess the effects of intermittent fasting during and outside Ramadan (to control for lifestyle changes) on drowsiness, blink total duration and mean reaction time (MRT) test while controlling for potential confounders. Eight healthy volunteers with a mean age of 25.3 ± 2.9 years and a mean body mass index (BMI) of 23.4 ± 3.2 kg/m2 reported to the sleep laboratory on four occasions for polysomnography (PSG) and drowsiness and psychomotor assessments as follows: 1) adaptation; 2) 4 weeks before Ramadan while performing the Islamic fasting for 1 week (baseline fasting) (BLF); 3) 1 week before Ramadan (non-fasting baseline) (BL); and 4) during the second week of Ramadan while fasting (Ramadan). OPTALERT™ was used to objectively assess daytime drowsiness using the Johns Drowsiness Scale (JDS), and blink total duration and a visual reaction time test were used to assess MRT. Rapid eye movement (REM) sleep percentage was significantly lower at BLF (17.7 ± 8.1%) and at Ramadan (18.6 ± 10.7%) compared with BL (25.6 ± 4.8%) (p intermittent fasting has no impact on drowsiness and vigilance as measured by the JDS, total blink duration and MRT.

  12. Fusion of optimized indicators from Advanced Driver Assistance Systems (ADAS) for driver drowsiness detection.

    Science.gov (United States)

    Daza, Iván García; Bergasa, Luis Miguel; Bronte, Sebastián; Yebes, Jose Javier; Almazán, Javier; Arroyo, Roberto

    2014-01-09

    This paper presents a non-intrusive approach for monitoring driver drowsiness using the fusion of several optimized indicators based on driver physical and driving performance measures, obtained from ADAS (Advanced Driver Assistant Systems) in simulated conditions. The paper is focused on real-time drowsiness detection technology rather than on long-term sleep/awake regulation prediction technology. We have developed our own vision system in order to obtain robust and optimized driver indicators able to be used in simulators and future real environments. These indicators are principally based on driver physical and driving performance skills. The fusion of several indicators, proposed in the literature, is evaluated using a neural network and a stochastic optimization method to obtain the best combination. We propose a new method for ground-truth generation based on a supervised Karolinska Sleepiness Scale (KSS). An extensive evaluation of indicators, derived from trials over a third generation simulator with several test subjects during different driving sessions, was performed. The main conclusions about the performance of single indicators and the best combinations of them are included, as well as the future works derived from this study.

  13. Fusion of Optimized Indicators from Advanced Driver Assistance Systems (ADAS for Driver Drowsiness Detection

    Directory of Open Access Journals (Sweden)

    Iván G. Daza

    2014-01-01

    Full Text Available This paper presents a non-intrusive approach for monitoring driver drowsiness using the fusion of several optimized indicators based on driver physical and driving performance measures, obtained from ADAS (Advanced Driver Assistant Systems in simulated conditions. The paper is focused on real-time drowsiness detection technology rather than on long-term sleep/awake regulation prediction technology. We have developed our own vision system in order to obtain robust and optimized driver indicators able to be used in simulators and future real environments. These indicators are principally based on driver physical and driving performance skills. The fusion of several indicators, proposed in the literature, is evaluated using a neural network and a stochastic optimization method to obtain the best combination. We propose a new method for ground-truth generation based on a supervised Karolinska Sleepiness Scale (KSS. An extensive evaluation of indicators, derived from trials over a third generation simulator with several test subjects during different driving sessions, was performed. The main conclusions about the performance of single indicators and the best combinations of them are included, as well as the future works derived from this study.

  14. Delirium in the intensive care setting and the Richmond Agitation and Sedation Scale (RASS): Drowsiness increases the risk and is subthreshold for delirium.

    Science.gov (United States)

    Boettger, Soenke; Nuñez, David Garcia; Meyer, Rafael; Richter, André; Fernandez, Susana Franco; Rudiger, Alain; Schubert, Maria; Jenewein, Josef

    2017-12-01

    Sedation is a core concept in the intensive care setting, however, the impact of sedation on delirium has not yet been studied to date. In this prospective cohort study, 225 patients with Richmond Agitation and Sedation (RASS) scores of -1 - drowsiness and 0 - alert- and calmness were assessed with the Delirium Rating Scale-Revised 1998 (DRS-R-98) and DSM-IV-TR-determined diagnosis of delirium assessing drowsiness versus alertness. By itself, drowsiness increased the odds for developing delirium eightfold (OR 7.88 pmemory representing the core domains of delirium, or the temporal onset were very sensitive towards delirium, however lacked specificity. Conversely, delusions, perceptual abnormalities and lability of affect representing the non-core domain were very specific for delirium in the drowsy, however, not very sensitive. In the absence of delirium, drowsiness caused attentional impairment and language abnormalities. Drowsiness increased the odds for developing delirium eightfold and caused more severe delirium, which was characterized by sleep-wake cycle and language abnormalities. Further, drowsiness by itself caused attentional impairment and language abnormalities, thus, with its disturbance in consciousness was subthreshold for delirium. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. SUBJECTIVE AND INDIRECT METHODS TO OBSERVE DRIVER’S DROWSINESS AND ALERTNESS: AN OVERVIEW

    Directory of Open Access Journals (Sweden)

    NOR KAMALIANA K.

    2016-04-01

    Full Text Available The measurement of drivers' workload has great interest these days due to the following reasons: high numbers of accidents seemingly ineradicable, very costly, and largely attributable to the human factor. The objective of this review is to assess the current status of fatigue performance and detection technology research and to identify any pertinent issues. Twenty-six relevant studies were identified and chosen from electronic databases, dating as far back as 1997. Fatigue, drowsiness, alertness, sleepiness, subjective, direct method and driver were the keyword search terms for this paper. Past studies demonstrated various purposes and implementation of subjective and indirect assessment among the driver for evaluating fatigue. It provides a better understanding for future researchers and industry to deal with fatigue issues among drivers. This review will provide a critical discussion on the designs used, discuss the findings in the search of directions for future studies, as well as provide insights into the use of counter measures for preventing fatigue-related accidents.

  16. Variation of the Heartbeat and Activity as an Indicator of Drowsiness at the Wheel Using a Smartwatch

    Directory of Open Access Journals (Sweden)

    Sergio Ríos Aguilar

    2015-06-01

    Full Text Available Sleepiness is one of the first causal factors of accidents. An estimated 10-30% of road deaths are related to fatigue driving. A large number of research studies have been conducted to reduce the risk of accidents while driving. Many of these studies are based on the detection of biological signals by drowsiness/sleepiness. The activity of the autonomic nervous system (ANS presented alterations during different physical states such as stress or sleepiness. This activity is measured by ECG (electroencephalogram and, in different studies, it can be measured with the variation of the heart beat (HRV-Heart Rate Variability in order to analyze it and then detect drowsiness/sleepiness in drivers. The main advantage is that HRV can be performed using non invasive and uncomfortable means compared to EEG sensors. New Wearables technologies are capable of measuring the heart beat and, further, using other sensors like Accelerometer and Gyroscope, embedded on a simple clock allow us to monitor the physical activity of the user. Our main goal is to use the pulsations measurements in conjunction with the physical activity for the detection of driver drowsiness/sleepiness in advance in order to prevent accidents derived from fatigue.

  17. Detection of Driver Drowsiness Using Wavelet Analysis of Heart Rate Variability and a Support Vector Machine Classifier

    Directory of Open Access Journals (Sweden)

    Gang Li

    2013-12-01

    Full Text Available Driving while fatigued is just as dangerous as drunk driving and may result in car accidents. Heart rate variability (HRV analysis has been studied recently for the detection of driver drowsiness. However, the detection reliability has been lower than anticipated, because the HRV signals of drivers were always regarded as stationary signals. The wavelet transform method is a method for analyzing non-stationary signals. The aim of this study is to classify alert and drowsy driving events using the wavelet transform of HRV signals over short time periods and to compare the classification performance of this method with the conventional method that uses fast Fourier transform (FFT-based features. Based on the standard shortest duration for FFT-based short-term HRV evaluation, the wavelet decomposition is performed on 2-min HRV samples, as well as 1-min and 3-min samples for reference purposes. A receiver operation curve (ROC analysis and a support vector machine (SVM classifier are used for feature selection and classification, respectively. The ROC analysis results show that the wavelet-based method performs better than the FFT-based method regardless of the duration of the HRV sample that is used. Finally, based on the real-time requirements for driver drowsiness detection, the SVM classifier is trained using eighty FFT and wavelet-based features that are extracted from 1-min HRV signals from four subjects. The averaged leave-one-out (LOO classification performance using wavelet-based feature is 95% accuracy, 95% sensitivity, and 95% specificity. This is better than the FFT-based results that have 68.8% accuracy, 62.5% sensitivity, and 75% specificity. In addition, the proposed hardware platform is inexpensive and easy-to-use.

  18. Construction and validation of the EEG analogues of the Karolinska sleepiness scale based on the Karolinska drowsiness test.

    Science.gov (United States)

    Putilov, Arcady A; Donskaya, Olga G

    2013-07-01

    Simple methods of sleepiness assessment are greatly needed for both fundamental research and practical applications. The Karolinska drowsiness test (KDT) was applied to construct physiological alertness scales and to validate them against such well-known instrument of subjective sleepiness assessment as the Karolinska sleepiness scale (KSS). Seven-min EEG recordings were obtained with 2-h interval from frontal and occipital derivations during the last 32-50 h of 44-61-h wakefulness of 15 healthy study participants. Occipital alpha-theta power difference and frontal and occipital scores on the 2nd principal component of the EEG spectrum were calculated for each one-min interval of 5-min eyes closed section of the record. To obtain scores (from 0 to 5) on alertness scales for each of these EEG indexes, all positive one-min values of the index were assigned to 1, and all remaining (negative) values were assigned to 0. Scores on any of the physiological alertness scales were found to be strongly associated with KSS scores. Physiological analogues of KSS were offered by utilising the EEG recordings on eyes closed interval of KDT. The constructed physiological scales can help in improving validity and user-friendliness of the field and laboratory methods of quantification of drowsy state. Copyright © 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  19. A Microcontroller Based Car-Safety System Implementing Drowsiness Detection And Vehicle-Vehicle Distance Detection In Parallel.

    Directory of Open Access Journals (Sweden)

    Pragyaditya Das.

    2015-08-01

    Full Text Available Abstract Accidents due to drowsiness can be controlled and prevented with the help of eye blink sensor using IR rays. It consists of IR transmitter and an IR receiver. The transmitter transmits IR rays into the eye. If the eye is shut then the output is high. If the eye is open then the output is low. This output is interfaced with an alarm inside and outside the vehicle. This module can be connected to the braking system of the vehicle and can be used to reduce the speed of the vehicle. The alarm inside the vehicle will go on for a period of time until the driver is back to his senses. If the driver is unable to take control of the vehicle after that stipulated amount of time then the alarm outside the vehicle will go on to warn and tell others to help the driver.

  20. Adaptability of drowsiness level detection that measures blinks utilizing image processing to changes in the ambient light; Hikari kankyo no henka ni tekiosuru kao gazo shori ni yoru inemuri unten kenchi

    Energy Technology Data Exchange (ETDEWEB)

    Kaneda, M; Obara, H; Nasu, T [Nissan Motor Co. Ltd, Tokyo (Japan)

    1997-10-01

    A drowsiness warning system that measures blinks utilizing image processing technology has a number of issues that need to be resolved. One issue is the adaptability of the system to changes in the ambient light environment in the actual vehicle interior. We have devised image processing software which is robust to changes in the ambient light. The drowsiness detection performance of the system was evaluated in laboratory tests and actual driving tests. It was found that the system can has a positive effect on detecting drowsiness level. 3 refs., 10 figs.

  1. Study into the use of continuous positive airway pressure in obstructive sleep apnoea-hypopnoea syndrome patients with daytime drowsiness

    Directory of Open Access Journals (Sweden)

    Clélia Maria Ribeiro Franco

    2009-03-01

    Full Text Available Background: Obstructive sleep apnoea-hypopnoea syndrome (OSAHS is a respiratory disorder with high morbidity and mortality. Continuous positive airway pressure (CPAP is the most commonly prescribed conservative treatment for adults with OSAHS. CPAP therapy normalises or decreases OSAHS symptoms and can reduce and prevent OSAHS complications. Aims: To evaluate adherence to nasal CPAP treatment and CPAP impact on daytime drowsiness. Method: A sample of 20 patients evaluated for daytime drowsiness using the Epworth sleepiness scale and interviewed for adherence to nasal CPAP use. Results: There was a significant decrease in the level of daytime sleepiness of the patients users of nasal CPAP (p=0.017; patients not using nasal CPAP experienced a decrease without statistical significance (p=0.162. 100% of CPAP users reported benefits and 50% of these reported related discomforts. Conclusions: Patients with OSAHS that use CPAP have a greater reduced level of sleepiness than those who do not use it. Resumo: Introdução: A síndroma da apneia-hipopneia obstrutiva do sono (SAHOS é um distúrbio respiratório de elevada morbimortalidade. A terapia com pressão positiva contínua das vias aéreas (CPAP representa o tratamento conservador mais prescrito para a SAHOS e tem o intuito de restabelecer a patência das vias aéreas, normalizando o índice de eventos respiratórios obstrutivos, corrigindo os sintomas. Objectivo: Avaliar o impacto do uso do CPAP nasal sobre a hipersonia diurna em portadores de SAHOS. Método: Amostra de vinte doentes portadores de SAHOS diagnosticados por estudo de polissonografia de noite inteira, usuários ou não de CPAP nasal, todos avaliados quanto à hipersonia diurna através da escala de sonolência de Epworth. Resultados: O decréscimo do nível de sonolência diurna dos usuários de CPAP nasal foi significante (p=0,017, enquanto para não usuários de CPAP nasal a m

  2. Development of wireless brain computer interface with embedded multitask scheduling and its application on real-time driver's drowsiness detection and warning.

    Science.gov (United States)

    Lin, Chin-Teng; Chen, Yu-Chieh; Huang, Teng-Yi; Chiu, Tien-Ting; Ko, Li-Wei; Liang, Sheng-Fu; Hsieh, Hung-Yi; Hsu, Shang-Hwa; Duann, Jeng-Ren

    2008-05-01

    Biomedical signal monitoring systems have been rapidly advanced with electronic and information technologies in recent years. However, most of the existing physiological signal monitoring systems can only record the signals without the capability of automatic analysis. In this paper, we proposed a novel brain-computer interface (BCI) system that can acquire and analyze electroencephalogram (EEG) signals in real-time to monitor human physiological as well as cognitive states, and, in turn, provide warning signals to the users when needed. The BCI system consists of a four-channel biosignal acquisition/amplification module, a wireless transmission module, a dual-core signal processing unit, and a host system for display and storage. The embedded dual-core processing system with multitask scheduling capability was proposed to acquire and process the input EEG signals in real time. In addition, the wireless transmission module, which eliminates the inconvenience of wiring, can be switched between radio frequency (RF) and Bluetooth according to the transmission distance. Finally, the real-time EEG-based drowsiness monitoring and warning algorithms were implemented and integrated into the system to close the loop of the BCI system. The practical online testing demonstrates the feasibility of using the proposed system with the ability of real-time processing, automatic analysis, and online warning feedback in real-world operation and living environments.

  3. Severe metabolic alkalosis, hypokalemia, and respiratory acidosis induced by the Chinese herbal medicine yokukansan in an elderly patient with muscle weakness and drowsiness.

    Science.gov (United States)

    Yamada, Shunsuke; Tokumoto, Masanori; Kansui, Yasuo; Wakisaka, Yoshinobu; Uchizono, Yuji; Tsuruya, Kazuhiko; Ooboshi, Hiroaki

    2013-05-01

    Yokukansan is a Chinese herbal medicine containing licorice that has been shown to alleviate the behavioral and psychological symptoms of Alzheimer's disease, with few adverse effects. Increasing numbers of patients with Alzheimer's disease in Japan are now being treated with this drug. However, yokukansan should be used with caution because of its potential to induce pseudoaldosteronism through the inhibition of 11-beta-hydroxysteroid dehydrogenase type 2, which metabolizes cortisol into cortisone. We present the case of an 88-year-old woman with a history of Alzheimer's disease who was transferred to our emergency department because of drowsiness, anorexia, and muscle weakness. Her blood pressure was 168/90 mmHg. Laboratory data showed serum potassium of 1.9 mmol/l, metabolic alkalosis (pH 7.54; HCO 3 - , 50.5 mmol/l; chloride, 81 mmol/l; sodium, 140 mmol/l), and respiratory disorders (pCO 2 , 60.5 mmHg; pO 2 , 63.8 mmHg). Plasma renin activity and aldosterone concentration were suppressed, and urinary potassium excretion was 22 mmol/l (calculated transtubular potassium gradient 12.9). An electrocardiogram showed flat T-waves and U-waves with ventricular premature contractions. Echocardiography denied volume depletion. Medical interview disclosed that she had been treated with a Chinese herbal medicine (yokukansan) containing licorice. The final diagnosis was pseudoaldosteronism and respiratory acidosis induced by licorice. Hypokalemia, metabolic alkalosis, and respiratory acidosis all subsided shortly after the discontinuation of yokukansan and initiation of intravenous potassium replacement. This case highlights the need for nephrologists to consider the possible involvement of Chinese herbal medicines, including yokukansan, when they encounter hypokalemia in elderly patients.

  4. Drowsy Driver Detection via Steering Wheel

    Directory of Open Access Journals (Sweden)

    Herlina ABDUL RAHIM

    2010-09-01

    Full Text Available The main purpose of this project is to produce a safety system especially for fatigue car driver so as to prevent from accidents. The statistic on road fatality shows that human error constitute of 64.84 % road accidents fatality and 17.4 % due to technical factors. These systems encompassed the approach of hand pressure applied on the steering wheel. The steering will be installed with pressure sensors. At the same time these sensors can be used to measure gripping force while driving.

  5. SUBJECTIVE METHODS FOR ASSESSMENT OF DRIVER DROWSINESS

    Directory of Open Access Journals (Sweden)

    Alina Mashko

    2017-12-01

    Full Text Available The paper deals with the issue of fatigue and sleepiness behind the wheel, which for a long time has been of vital importance for the research in the area of driver-car interaction safety. Numerous experiments on car simulators with diverse measurements to observe human behavior have been performed at the laboratories of the faculty of the authors. The paper provides analysis and an overview and assessment of the subjective (self-rating and observer rating methods for observation of driver behavior and the detection of critical behavior in sleep deprived drivers using the developed subjective rating scales.

  6. Drowsy Driving: Asleep at the Wheel

    Science.gov (United States)

    ... For more warning signs visit American Academy of Sleep Medicine. How often do Americans fall asleep while driving? ... is Enough? Accessed October 19, 2015. Institute of Medicine. Sleep Disorders and Sleep Deprivation: An Unmet Public Health ...

  7. Drowsy Cheetah Hunting Antelopes: A Diffusing Predator Seeking Fleeing Prey

    OpenAIRE

    Winkler, Karen; Bray, Alan J.

    2004-01-01

    We consider a system of three random walkers (a `cheetah' surrounded by two `antelopes') diffusing in one dimension. The cheetah and the antelopes diffuse, but the antelopes experience in addition a deterministic relative drift velocity, away from the cheetah, proportional to their distance from the cheetah, such that they tend to move away from the cheetah with increasing time. Using the backward Fokker-Planck equation we calculate, as a function of their initial separations, the probability...

  8. Drowsy cheetah hunting antelopes: a diffusing predator seeking fleeing prey

    Science.gov (United States)

    Winkler, Karen; Bray, Alan J.

    2005-02-01

    We consider a system of three random walkers (a 'cheetah' surrounded by two 'antelopes') diffusing in one dimension. The cheetah and the antelopes diffuse, but the antelopes experience in addition a deterministic relative drift velocity, away from the cheetah, proportional to their distance from the cheetah, such that they tend to move away from the cheetah with increasing time. Using the backward Fokker-Planck equation we calculate, as a function of their initial separations, the probability that the cheetah has caught neither antelope after infinite time.

  9. Non drowsy obstructive sleep apnea as a potential cause of resistant hypertension: a case report

    Directory of Open Access Journals (Sweden)

    Mirrakhimov Aibek E

    2012-05-01

    Full Text Available Abstract Background Obstructive sleep apnea (OSA and arterial hypertension (AH are common and underrecognized medical disorders. OSA is a potential risk factor for the development of AH and/or may act as a factor complicating AH management. The symptoms of excessive daytime sleepiness (EDS are considered essential for the initiation of continuous positive airway pressure (CPAP therapy, which is a first line treatment of OSA. The medical literature and practice is controversial about the treatment of people with asymptomatic OSA. Thus, OSA patients without EDS may be left at increased cardiovascular risk. Case presentation The report presents a case of 42year old Asian woman with symptoms of heart failure and angina like chest pain upon admission. She didnt experience symptoms of EDS, and the Epworth Sleepiness Scale was seven points. Snoring was reported on direct questioning. The patient had prior medical history of three unsuccessful pregnancies complicated by gestational AH and preeclampsia with C-section during the last pregnancy. The admission blood pressure (BP was 200/120mm Hg. The patients treatment regimen consisted of five hypotensive medications including diuretic. However, a target BP wasnt achieved in about one and half month. The patient was offered to undergo a polysomnography (PSG study, which she rejected. One month after discharge the PSG study was done, and this showed an apnea-hypopnea index (AHI of 46 events per hour. CPAP therapy was initiated with a pressure of 11H20cm. After 2months of compliant CPAP use, adherence to pharmacologic regimen and lifestyle modifications the patients BP decreased to 134/82mm Hg. Conclusions OSA and AH are common and often underdiagnosed medical disorders independently imposing excessive cardiovascular risk on a diseased subject. When two conditions coexist the cardiovascular risk is likely much greater. This case highlights a possible clinical phenotype of OSA without EDS and its association with resistant AH. Most importantly a good hypotensive response to medical treatment in tandem with CPAP therapy was achieved in this patient. Thus, it is reasonable to include OSA in the differential list of resistant AH, even if EDS is not clinically obvious.

  10. Fluctuating drowsiness following cardiac catheterisation: artery of Percheron ischaemic stroke causing bilateral thalamic infarcts.

    Science.gov (United States)

    Hammersley, Daniel; Arora, Ankur; Dissanayake, Madhava; Sengupta, Nabarun

    2017-01-02

    An 81-year-old man underwent cardiac catheterisation to investigate breathlessness and left ventricular impairment of unknown cause. He had unobstructed coronary arteries. Immediately following the procedure, he became suddenly unresponsive with vertical gaze palsy, anisocoria and bilateral upgoing plantar responses. He made a rapid recovery to his premorbid state 25 min later with no residual focal neurological signs. He then had multiple unresponsive episodes, interspaced with complete resolution of symptoms and neurological signs. MRI of the brain identified bilateral medial thalamic infarcts and midbrain infarcts, consistent with an artery of Percheron territory infarction. By the time the diagnosis was reached, the thrombolysis window had elapsed. The unresponsive episodes diminished with time and the patient was discharged to inpatient rehabilitation. At 6-month review after the episode, the patient has a degree of progressive cognitive impairment. 2017 BMJ Publishing Group Ltd.

  11. Highway driving safety the day after using sleep medication: the direction of lapses and excursions out-of-lane in drowsy drivers.

    Science.gov (United States)

    Verster, Joris C; Mooren, Loes; Bervoets, Adriana C; Roth, Thomas

    2017-10-24

    The primary outcome measure of the on-road driving test is the Standard Deviation of Lateral Position. However, other outcome measures, such as lapses and excursions out-of-lane, also need to be considered as they may be related to crash risk. The aim of this study was to determine the direction of lapses and excursions out-of-lane (i.e. towards/into the adjacent traffic lane or towards/into the road shoulder). In total, data from 240 driving tests were re-analysed, and 628 lapses and 401 excursions out-of-lane were identified. The analyses revealed that lapses were made equally frequently over left (49.4%) and over right (43.3%). In contrast, excursions out-of-lane were almost exclusively directed over right into the (safer) road shoulder (97.3%). These findings suggest that drivers are unaware of having lapses, whereas excursions out-of-lane are events where the driver is aware of loss of vehicle control. © 2017 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.

  12. “Clozapine makes me quite drowsy, so when I wake up in the morning those first cups of coffee are really handy”: an exploratory qualitative study of excessive caffeine consumption among individuals with schizophrenia

    Science.gov (United States)

    2014-01-01

    Background Research has shown that individuals with schizophrenia use caffeine at higher rates than the general population; however, no qualitative research has been undertaken investigating problematic caffeine use and its effects on this population. This article explores the role of caffeine consumption in the lives of people with schizophrenia through a narrative analysis of the attitudes and beliefs associated with this practice, and how these, in turn, influence caffeine consumption. Methods A qualitative study was undertaken with individuals who had previously scored in either a ‘moderate’ or ‘high’ risk category for caffeine use on the Alcohol, Smoking and Substance Involvement Screening Tool (ASSIST). In-depth interviews were undertaken with 20 individuals, and transcripts were analysed thematically to identify prominent perspectives. Results Consistent with previous literature, participants’ caffeine consumption was driven largely by its stimulating properties; however, participants also identified ‘cravings’ as an important motivating factor. Participants’ behaviours related to caffeine consumption seemed to be tempered by their previous experiences of consumption; if participants had experienced positive effects such as alertness or relaxation in the past, their use was maintained at a similar level or increased. Conversely, participants who anticipated negative consequences often altered their patterns of caffeine consumption; for example, by substituting caffeinated drinks that minimised or ceased their experience of negative side effects for those that directly caused such impacts. Overall, participants largely identified caffeine consumption as a highly meaningful activity, which provided structure to their day and facilitated opportunities for social interaction. Conclusions The inconsistencies between individuals’ beliefs about their health and the actual risk of harm associated with health-related behaviours present significant and ongoing challenges for the implementation of relevant and effective strategies for health promotion among individuals diagnosed with mental illness. As a starting point, it would be worthwhile for services engaging with people diagnosed with mental illness, and in particular schizophrenia, to consider implementing caffeine-related health literacy strategies to educate consumers about the risk of excessive caffeine consumption and the interactions between caffeine and antipsychotic medications. PMID:24735451

  13. "Clozapine makes me quite drowsy, so when I wake up in the morning those first cups of coffee are really handy": an exploratory qualitative study of excessive caffeine consumption among individuals with schizophrenia.

    Science.gov (United States)

    Thompson, Lisa; Pennay, Amy; Zimmermann, Adam; Cox, Merrilee; Lubman, Dan I

    2014-04-16

    Research has shown that individuals with schizophrenia use caffeine at higher rates than the general population; however, no qualitative research has been undertaken investigating problematic caffeine use and its effects on this population. This article explores the role of caffeine consumption in the lives of people with schizophrenia through a narrative analysis of the attitudes and beliefs associated with this practice, and how these, in turn, influence caffeine consumption. A qualitative study was undertaken with individuals who had previously scored in either a 'moderate' or 'high' risk category for caffeine use on the Alcohol, Smoking and Substance Involvement Screening Tool (ASSIST). In-depth interviews were undertaken with 20 individuals, and transcripts were analysed thematically to identify prominent perspectives. Consistent with previous literature, participants' caffeine consumption was driven largely by its stimulating properties; however, participants also identified 'cravings' as an important motivating factor. Participants' behaviours related to caffeine consumption seemed to be tempered by their previous experiences of consumption; if participants had experienced positive effects such as alertness or relaxation in the past, their use was maintained at a similar level or increased. Conversely, participants who anticipated negative consequences often altered their patterns of caffeine consumption; for example, by substituting caffeinated drinks that minimised or ceased their experience of negative side effects for those that directly caused such impacts. Overall, participants largely identified caffeine consumption as a highly meaningful activity, which provided structure to their day and facilitated opportunities for social interaction. The inconsistencies between individuals' beliefs about their health and the actual risk of harm associated with health-related behaviours present significant and ongoing challenges for the implementation of relevant and effective strategies for health promotion among individuals diagnosed with mental illness. As a starting point, it would be worthwhile for services engaging with people diagnosed with mental illness, and in particular schizophrenia, to consider implementing caffeine-related health literacy strategies to educate consumers about the risk of excessive caffeine consumption and the interactions between caffeine and antipsychotic medications.

  14. Antidepressants: Another Weapon Against Chronic Pain

    Science.gov (United States)

    ... same dosages useful for treating pain. Venlafaxine can cause drowsiness, insomnia or elevated blood pressure, and may worsen heart problems. Duloxetine can cause side effects, such as drowsiness, insomnia, nausea, dry ...

  15. Spearmint

    Science.gov (United States)

    ... Some chemicals might also harm cancer cells and kill bacteria. ... Herbs and supplements that cause sleepiness and drowsinessSpearmint contains a chemical that might cause sleepiness and drowsiness. ...

  16. Citalopram

    Science.gov (United States)

    ... the body drowsiness fast, irregular, or pounding heartbeat memory loss confusion seizures coma (loss of consciousness) fast breathing bluish color around mouth, fingers, or fingernails muscle pain dark- ...

  17. Acute tubular necrosis

    Science.gov (United States)

    Symptoms may include any of the following: Decreased consciousness , coma, delirium or confusion , drowsiness, and lethargy Decreased urine output or no urine output General swelling, fluid retention ...

  18. Contac overdose

    Science.gov (United States)

    Symptoms of a Contac overdose include: Blurred vision Depression Delirium Disorientation, nervousness, hallucinations Drowsiness Enlarged pupils Fever Inability to urinate or completely empty the bladder Increased ...

  19. Central pontine myelinolysis

    Science.gov (United States)

    Symptoms may include any of the following: Confusion , delirium , hallucinations Balance problems, tremor Problem swallowing Reduced alertness , drowsiness or sleepiness , lethargy , poor responses Slurred speech ...

  20. Sadhana | Indian Academy of Sciences

    Indian Academy of Sciences (India)

    This paper proposes a novel approach for open-eye detection that can be used in driver drowsiness analysis based on computer vision techniques. The proposed method captures the driver video using a low resolution camera. The proposed drowsiness detection system has three main stages. The first stage is ...

  1. Vital Sign Monitoring and Mobile Phone Usage Detection Using IR-UWB Radar for Intended Use in Car Crash Prevention

    OpenAIRE

    Seong Kyu Leem; Faheem Khan; Sung Ho Cho

    2017-01-01

    In order to avoid car crashes, active safety systems are becoming more and more important. Many crashes are caused due to driver drowsiness or mobile phone usage. Detecting the drowsiness of the driver is very important for the safety of a car. Monitoring of vital signs such as respiration rate and heart rate is important to determine the occurrence of driver drowsiness. In this paper, robust vital signs monitoring through impulse radio ultra-wideband (IR-UWB) radar is discussed. We propose a...

  2. Obstructive Sleep Apnea

    Medline Plus

    Full Text Available ... OSA causes daytime drowsiness that can result in accidents, lost productivity and relationship problems. The National Sleep ... 30 apneas during a seven-hour sleep. In severe cases, periods of not breathing may last for ...

  3. Estimating Driving Performance Based on EEG Spectrum Analysis

    Directory of Open Access Journals (Sweden)

    Jung Tzyy-Ping

    2005-01-01

    Full Text Available The growing number of traffic accidents in recent years has become a serious concern to society. Accidents caused by driver's drowsiness behind the steering wheel have a high fatality rate because of the marked decline in the driver's abilities of perception, recognition, and vehicle control abilities while sleepy. Preventing such accidents caused by drowsiness is highly desirable but requires techniques for continuously detecting, estimating, and predicting the level of alertness of drivers and delivering effective feedbacks to maintain their maximum performance. This paper proposes an EEG-based drowsiness estimation system that combines electroencephalogram (EEG log subband power spectrum, correlation analysis, principal component analysis, and linear regression models to indirectly estimate driver's drowsiness level in a virtual-reality-based driving simulator. Our results demonstrated that it is feasible to accurately estimate quantitatively driving performance, expressed as deviation between the center of the vehicle and the center of the cruising lane, in a realistic driving simulator.

  4. Traumatic Brain Injury: Hope Through Research

    Science.gov (United States)

    ... fatigue or drowsiness; a lack of energy or motivation changes in sleep patterns (e.g., sleeping a ... nerve cells in the brain causing strange sensations, emotions, and behavior, or sometimes convulsions, muscle spasms, and ...

  5. CDC Vital Signs: Trucker Safety

    Science.gov (United States)

    ... from text messaging or using a handheld cell phone while driving a truck. Working to improve trucking safety through ... from text messaging or using a handheld cell phone while driving a truck. Learn how to avoid drowsy and ...

  6. Hydrocodone/oxycodone overdose

    Science.gov (United States)

    ... belong to a class of narcotic medicines called opiates. These medicines are man-made versions of the ... Weak pulse Nervous system: Coma (unresponsiveness) Drowsiness Possible seizures Respiratory system: Difficulty breathing Slow breathing that requires ...

  7. Fentanyl

    Science.gov (United States)

    ... low blood pressure; mental problems such as depression, schizophrenia (a mental illness that causes disturbed or unusual ... not go away: drowsiness stomach pain gas heartburn weight loss difficulty urinating changes in vision anxiety depression unusual ...

  8. Medical students' use of caffeine for 'academic purposes' and their ...

    African Journals Online (AJOL)

    Third-year students were the heaviest consumers of coffee for academic purposes. .... Caffeine can, however, only reliably affect cognitive performance and mood if the ... decreased alertness, drowsiness, decreased contentedness, depressed.

  9. Hydrocephalus

    Science.gov (United States)

    ... drowsiness, irritability, or other changes in personality or cognition including memory loss. Symptoms of normal pressure hydrocephalus ... example, if the symptoms of hydrocephalus return), medical attention should be sought immediately. top What is the ...

  10. Your Baby's First Vaccines: What You Need to Know

    Science.gov (United States)

    ... term seizures, coma, lowered consciousness, and permanent brain damage have been reported following DTaP vaccination. These reports are extremely rare. Pneumococcal Vaccine • Mild Problems: Drowsiness or temporary loss of appetite ( ...

  11. Your child's first vaccines

    Science.gov (United States)

    ... term seizures, coma, lowered consciousness, and permanent brain damage have been reported following DTaP vaccination. These reports are extremely rare. Pneumococcal Vaccine Mild Problems: drowsiness or temporary loss of appetite ( ...

  12. Your Baby's First Vaccines

    Science.gov (United States)

    ... term seizures, coma, lowered consciousness, and permanent brain damage have been reported following DTaP vaccination. These reports are extremely rare. Pneumococcal Vaccine Mild Problems: Drowsiness or temporary loss of appetite ( ...

  13. Fatigue

    Science.gov (United States)

    ... sleep. Fatigue is a lack of energy and motivation. Drowsiness and apathy (a feeling of not caring ... Call your provider right away if you have any of the following: Confusion or dizziness Blurred vision Little or no urine, or recent ...

  14. Selegiline Transdermal Patch

    Science.gov (United States)

    ... patch from direct heat such as heating pads, electric blankets, heat lamps, saunas, hot tubs, and heated ... may make you drowsy. Do not drive a car or operate machinery until you know how this ...

  15. Imipramine

    Science.gov (United States)

    ... treated with electroshock therapy (procedure in which small electric shocks are administered to the brain to treat ... may make you drowsy. Do not drive a car or operate machinery until you know how this ...

  16. Fluoxetine

    Science.gov (United States)

    ... treated with electroshock therapy (procedure in which small electric shocks are administered to the brain to treat ... may make you drowsy. Do not drive a car or operate machinery until you know how this ...

  17. Harmful Interactions: Mixing Alcohol with Medicines

    Science.gov (United States)

    ... Depakene®, Depakote® Valproic acid Drowsiness, dizziness; tremors; increased risk for side effects, such as restlessness, impaired motor control; loss of appetite; stomach upset; irregular bowel movement; joint or muscle ...

  18. Pentazocine

    Science.gov (United States)

    ... who inject dissolved tablets will not experience the desired effects of pentazocine. ... symptoms are severe or do not go away: feeling very tired lightheadedness drowsiness mood changes headache upset ...

  19. Bernoulli Runs Using 'Book Cricket' to Evaluate Cricketers

    Indian Academy of Sciences (India)

    both the game as well as statistical ... drowsiness in school we resorted to playing 'book cricket'. The book .... die probabilistic model to take advantage of the easy availability of the ..... enclopedia, Online; accessed 31-Dec-2010/. URL http://.

  20. Schinzel–Giedion Syndrome: A Novel Case, Review and Revised ...

    Indian Academy of Sciences (India)

    Administrator

    She had psychomotor delay with sitting at 1 ... She presented drowsiness, poor sense of pain, and less crying before the age of 5. .... developed complications of severe condition, remarkable scoliosis, luxation of hip, articular retractions and ...

  1. IC Treatment: Antihistamines

    Science.gov (United States)

    ... drowsiness period is shorter and not as intense. Pregnancy & Warnings Animal studies have found that fetal abnormalities ... Self Management Physical Therapy Antidepressants Antihistamines Pentosan Polysulfate Sodium Bladder Instillations Immunosuppresants Surgical Procedures Neuromodulation Botox Other ...

  2. Adverse reactions to antidepressants

    DEFF Research Database (Denmark)

    Uher, Rudolf; Farmer, Anne; Henigsberg, Neven

    2009-01-01

    (74%), constipation (33%) and weight gain (15%) were associated with nortriptyline treatment. Diarrhoea (9%), insomnia (36%) and yawning (16%) were more common during treatment with escitalopram. Problems with urination and drowsiness predicted discontinuation of nortriptyline. Diarrhoea and decreased...

  3. Obstructive Sleep Apnea

    Medline Plus

    Full Text Available ... include heart attack, stroke, irregular heartbeat, high blood pressure, heart disease and decreased libido. In addition, OSA causes daytime drowsiness that can result in accidents, lost productivity and relationship problems. The National Sleep Foundation ...

  4. Rohypnol

    Science.gov (United States)

    ... Jobs Sports Expert Answers (Q&A) Staying Safe Videos for ... Because it can cause extreme drowsiness (or "blackouts"), it is often used in date rapes. Sometimes Called: roofies, roach, forget-me pill, date ...

  5. Trazodone hydrochloride overdose

    Science.gov (United States)

    ... SYSTEM Coma (lack of responsiveness) Dizziness Drowsiness Headache Insomnia Seizures Lack of coordination Tremor OTHER Abnormal erection that lasts for more than 4 hours and can cause permanent damage to the penis.

  6. Cerebral amyloid angiopathy

    Science.gov (United States)

    ... immediate symptoms occur and resemble a stroke. These symptoms include: Drowsiness Headache (usually in a certain part of the head) Nervous system changes that may start suddenly, including confusion , delirium , double vision , decreased vision , sensation changes, speech problems, ...

  7. PATTERNS OF SEVEN AND COMPLICATED MALARIA IN CHILDREN

    African Journals Online (AJOL)

    GB

    10.0% experienced daytime fatigue, and 8.0% experienced drowsy driving. ... high prevalence of obstructive sleep apnoea symptoms from this study should form the basis for ... 5Department of Medicine, Federal Medical Centre, Yola, Nigeria.

  8. Drugs with anticholinergic side‑effects in primary care

    African Journals Online (AJOL)

    2014-05-31

    May 31, 2014 ... retention or hesitancy, visual impairment, falls, confusion, drowsiness ... updated in 2012; as drugs, which may cause dementia and cognitive ... Two questions were asked to determine physicians' attention ... Even if selective.

  9. Frostbite

    Science.gov (United States)

    ... Intense shivering Slurred speech Drowsiness and loss of coordination Causes Frostbite occurs when skin and underlying tissues ... windproof materials make the best headwear for cold protection. Wear mittens rather than gloves. Mittens provide better ...

  10. Hypoglycemia

    Science.gov (United States)

    ... fall too low, the body releases the hormone adrenaline, which helps get stored glucose into the bloodstream ... heart rate are early warning signs of this adrenaline release. More severe symptoms — such as confusion, drowsiness, ...

  11. Human Activity Recognition in a Car with Embedded Devices

    Directory of Open Access Journals (Sweden)

    Danilo Burbano

    2015-11-01

    Full Text Available Detection and prediction of drowsiness is key for the implementation of intelligent vehicles aimed to prevent highway crashes. There are several approaches for such solution. In thispaper the computer vision approach will be analysed, where embedded devices (e.g.videocameras are used along with machine learning and pattern recognition techniques for implementing suitable solutions for detecting driver fatigue. Most of the research in computer vision systems focused on the analysis of blinks, this is a notable solution when it is combined with additional patterns like yawing or head motion for the recognition of drowsiness. The first step in this approach is the face recognition, where AdaBoost algorithm shows accurate results for the feature extraction, whereas regarding the detection of drowsiness the data-driven classifiers such as Support Vector Machine (SVM yields remarkable results. One underlying component for implementing a computer vision technology for detection of drowsiness is a database of spontaneous images from the Facial Action Coding System (FACS, where the classifier can be trained accordingly. This paper introduces a straightforward prototype for detection of drowsiness, where the Viola-Jones method is used for face recognition and cascade classifier is used for the detection of a contiguous sequence of eyes closed, which a reconsidered as drowsiness.

  12. Fatigue Countermeasures in Aviation

    Science.gov (United States)

    2009-01-01

    rbucks® Short 1 Starbucks ® Tall 1 Sta rbucks® Grande 1 Coke® 1 Mountain Dew® 1 cup tea 2 Anacin® 2 Excedrin Xtra. Strength 1 Max. Strength NoDoz® 46...72. Dinges OF, Price N],Maislin G, Powell JW, Ecker AJ, Malli.s MM. Szuba, et a1. Prospective laboratory re-validation of ocular-based drowsiness...detection technologies and countermeasures. In: Wierwille WW, Hanowski RJ, Olson RL, Dinges OF, Price NJ, Maislin G, et a1. NHTSA Drowsy Driver ·Detection

  13. Workplace stress in South African mineworkers

    CSIR Research Space (South Africa)

    Edwards, A

    2012-04-01

    Full Text Available Questionnaire - psychological demand and decision latitude in the workplace ? General Health Questionnaire - health and mental wellbeing ? Subjective Fatigue Checklist - drowsiness, loss of concentration and physical fatigue Data Analysis ? comparing male... 16 17 18 19 20 21 General Health Questionnaire Males Females Slide 20 Males vs Females Drowsiness Concentration Physical impairment Males 21.10 15.96 24.04 Females 33.70 18.15 46.30 0 10 20 30 40 50 60 70 80 90 100 Pe rce...

  14. Case report

    African Journals Online (AJOL)

    abp

    2012-11-19

    Nov 19, 2012 ... Examination showed a right VI nerve palsy, diplopia, and tinnitus in the right ear, with some hearing loss (Figure 1). He later became drowsy and had a generalised seizure. Diagnosis and commencement of treatment was delayed due to the absence of CT/MRI brain imaging facilities in the local district.

  15. 78 FR 17749 - Parts and Accessories Necessary for Safe Operation; Exemption Renewal for Greyhound Lines, Inc.

    Science.gov (United States)

    2013-03-22

    ... placement of video event recorders at the top of the windshields on its buses. Greyhound may continue to use... driving behaviors such as distracted driving and drowsiness; (2) enhanced monitoring of passenger behavior..., Office of Bus and Truck Standards and Operations, MC-PSV, (202) 366-1225, Federal Motor Carrier Safety...

  16. Intentional intravenous mercury injection

    African Journals Online (AJOL)

    In this case report, intravenous complications, treatment strategies and possible ... Mercury toxicity is commonly associated with vapour inhalation or oral ingestion, for which there exist definite treatment options. Intravenous mercury ... personality, anxiousness, irritability, insomnia, depression and drowsi- ness.[1] However ...

  17. Fatal Fat Embolism In Traumatized Patients: An Experience From ...

    African Journals Online (AJOL)

    One patient developed drowsiness, respiratory distress and lapsed into coma 12 hours after injury. He died 24 hours later despite prompt treatment with anticoagulants and assisted respiration with a ventilator. Another patient with crush injury of the thigh developed similar symptoms and died within 12 hours of sustaining ...

  18. Investigation of metabolic encephalopathy

    African Journals Online (AJOL)

    cycle defects is the X-linked recessive disorder, ornithine ... life, or if the child is fed the compounds that they are unable .... as learning difficulties, drowsiness and avoidance of ... Table 2. Laboratory investigation of suspected metabolic encephalopathy. Laboratory .... Clinical approach to treatable inborn metabolic diseases:.

  19. 46 CFR Appendix C to Subpart C to... - Medical Surveillance Guidelines for Benzene

    Science.gov (United States)

    2010-10-01

    ... depression of the hematopoietic system, pancytopenia, aplastic anemia, and leukemia. Inhalation of high... excitation, or giddiness, followed by a period of depression, drowsiness, or fatigue. A sensation of... indices may be a normal statistical variation. Whereas, if the low white count is accompanied by decreases...

  20. 21 CFR 310.201 - Exemption for certain drugs limited by new-drug applications to prescription sale.

    Science.gov (United States)

    2010-04-01

    ... children under 6 years of age, except as directed by a physician, and against driving a car or operating... other drugs, in an aqueous vehicle suitable for administration in self-medication as nose drops, and..., and against driving a car or operating machinery while using the drug, since it may cause drowsiness...

  1. Flutamide

    Science.gov (United States)

    ... in sexual ability or desire breast enlargement in men drowsiness confusion depression anxiety swelling of the hands, feet, ankles, or lower legs blue-green or orange-colored urine Some side effects can be ... is rare, some men taking flutamide have developed breast cancer. Talk to ...

  2. Stay Awake Behind the Wheel (A Cup of Health with CDC)

    Centers for Disease Control (CDC) Podcasts

    Being a safe driver requires complete focus on the road and the cars around you. Unfortunately, many people get behind the wheel when they’ve had a long day at work or haven’t gotten enough sleep. In this podcast, Dr. Anne Wheaton discusses the dangers of drowsy driving.

  3. A randomized, open, parallel group, multicenter trial to investigate analgesic efficacy and safety of a new transdermal fentanyl patch compared to standard opioid treatment in cancer pain

    DEFF Research Database (Denmark)

    Kress, H.G.; Laage, D. Von der; Hoerauf, K.H.

    2008-01-01

    as a percentage of the maximum possible PI area under the curve. Any adverse events were recorded; four tolerability endpoints, constipation, nausea, daytime drowsiness, and sleeping disturbances, were assessed daily. Noninferiority was shown; the upper 95% confidence interval limits os the mean difference...

  4. Homeostasis in primates in hyperacceleration fields

    Science.gov (United States)

    Fuller, C. A.

    1984-01-01

    Various homeostatic responses of a nonhuman primate, the squirrel monkey (Saimiri sciureus) to acute changes in the acceleration environment were examined. When these animals were exposed to a hyperdynamic field the body temperature was consistently depressed and the animals showed behavioral indications of increased drowsiness. Further, time of day played a significant role in influencing these responses.

  5. Alcoholic Hepatitis

    Science.gov (United States)

    ... yellow color. Confusion, drowsiness and slurred speech (hepatic encephalopathy). A damaged liver has trouble removing toxins from your body. The ... of toxins can damage your brain. Severe hepatic encephalopathy can result in ... of the liver frequently leads to liver failure. Kidney failure. A ...

  6. Comparative Resuscitation Measures for Drug Toxicities Utilizing Lipid Emulsions

    Science.gov (United States)

    2015-01-13

    CARPA like reactions (major cardiovascular depression) after lipid infusions. Other studies have shown a transient increase in pulmonary hypertension ...reuptake inhibitor. The most common symptoms from overdose include sinus tachycardia, hypertension , drowsiness, lethargy, agitation, nausea and vomiting...Walker R (2007) Pain and combat injuries in soldiers returning from Operations Enduring Freedom and Iraqi Freedom: Implications for research and

  7. Effect of clebopride on lower esophageal sphincter pressure.

    Science.gov (United States)

    Ribeiro, V; da Silva, A L; Castro, L de P

    1981-01-01

    In 12 individuals without gastrointestinal symptoms, the IV administration of metoclopramide and of clebopride produced both a significant increase on the lower esophageal sphincter pressure. The increase induced by clebopride was significantly higher than that induced by metoclopramide. The tolerability of clebopride was satisfactory with just mild drowsiness being noted in most cases.

  8. Genetics Home Reference: familial hemiplegic migraine

    Science.gov (United States)

    ... features of an aura can include difficulty with speech, confusion, and drowsiness. An aura typically develops gradually over a few minutes and lasts about an hour. Unusually severe migraine episodes have been reported in some people with familial hemiplegic migraine . These ...

  9. Sports-related concussion relevant to the South African football ...

    African Journals Online (AJOL)

    with any combination of physical, cognitive, emotional and sleep- related symptom ... depressed affect, fatigue and drowsiness. The last 8 years ... vulnerability, making the brain less able to respond adequately to a second injury .... Decisions regarding returning to sport will be made taking into consideration your individual ...

  10. Apomorphine

    Science.gov (United States)

    ... nervous system that causes difficulties with movement, muscle control, and balance) who are taking other medications for their disorder. ... when taken along with apomorphine may increase your risk of drowsiness, dizziness, and falls. However, do not stop taking trimethobenzamide without first ...

  11. Improving Driver Alertness through Music Selection Using a Mobile EEG to Detect Brainwaves

    Directory of Open Access Journals (Sweden)

    Hsiang-Ming Hsu

    2013-06-01

    Full Text Available Driving safety has become a global topic of discussion with the recent development of the Smart Car concept. Many of the current car safety monitoring systems are based on image discrimination techniques, such as sensing the vehicle drifting from the main road, or changes in the driver’s facial expressions. However, these techniques are either too simplistic or have a low success rate as image processing is easily affected by external factors, such as weather and illumination. We developed a drowsiness detection mechanism based on an electroencephalogram (EEG reading collected from the driver with an off-the-shelf mobile sensor. This sensor employs wireless transmission technology and is suitable for wear by the driver of a vehicle. The following classification techniques were incorporated: Artificial Neural Networks, Support Vector Machine, and k Nearest Neighbor. These classifiers were integrated with integration functions after a genetic algorithm was first used to adjust the weighting for each classifier in the integration function. In addition, since past studies have shown effects of music on a person’s state-of-mind, we propose a personalized music recommendation mechanism as a part of our system. Through the in-car stereo system, this music recommendation mechanism can help prevent a driver from becoming drowsy due to monotonous road conditions. Experimental results demonstrate the effectiveness of our proposed drowsiness detection method to determine a driver’s state of mind, and the music recommendation system is therefore able to reduce drowsiness.

  12. Improving driver alertness through music selection using a mobile EEG to detect brainwaves.

    Science.gov (United States)

    Liu, Ning-Han; Chiang, Cheng-Yu; Hsu, Hsiang-Ming

    2013-06-26

    Driving safety has become a global topic of discussion with the recent development of the Smart Car concept. Many of the current car safety monitoring systems are based on image discrimination techniques, such as sensing the vehicle drifting from the main road, or changes in the driver's facial expressions. However, these techniques are either too simplistic or have a low success rate as image processing is easily affected by external factors, such as weather and illumination. We developed a drowsiness detection mechanism based on an electroencephalogram (EEG) reading collected from the driver with an off-the-shelf mobile sensor. This sensor employs wireless transmission technology and is suitable for wear by the driver of a vehicle. The following classification techniques were incorporated: Artificial Neural Networks, Support Vector Machine, and k Nearest Neighbor. These classifiers were integrated with integration functions after a genetic algorithm was first used to adjust the weighting for each classifier in the integration function. In addition, since past studies have shown effects of music on a person's state-of-mind, we propose a personalized music recommendation mechanism as a part of our system. Through the in-car stereo system, this music recommendation mechanism can help prevent a driver from becoming drowsy due to monotonous road conditions. Experimental results demonstrate the effectiveness of our proposed drowsiness detection method to determine a driver's state of mind, and the music recommendation system is therefore able to reduce drowsiness.

  13. Antiemetic prophylaxis with promethazine or ondansetron in major ...

    African Journals Online (AJOL)

    Southern African Journal of Anaesthesia and Analgesia ... Abstract. Background: Postoperative nausea and vomiting remain a significant cause of morbidity among patients undergoing general anaesthesia. ... Drowsiness was a significant side-effect with promethazine, and this will be a disadvantage in ambulatory surgery.

  14. A study on the effects of fatigue driving and drunk driving on drivers' physical characteristics.

    Science.gov (United States)

    Zhang, Xingjian; Zhao, Xiaohua; Du, Hongji; Rong, Jian

    2014-01-01

    The purpose of this study was to analyze the effects of fatigue driving and drunk driving on drivers' physical characteristics; to analyze the differences in drivers' physical characteristics affected by different kinds of fatigue; and to compare the differences in the effects of the 2 driving states, fatigue driving and drunk driving. Twenty-five participants' physical characteristics were collected under 5 controlled situations: normal, tired driving, drowsy driving, drowsiness + tired driving, and drunk driving. In this article, fatigue driving refers to tiredness and drowsiness and includes 3 situations: tired driving, drowsy driving, and drowsiness + tired driving. The drivers' physical characteristics were measured in terms of 9 parameters: systolic blood pressure (SBP), heart rate (HR), eyesight, dynamic visual acuity (DVA), time for dark adaption (TDA), reaction time to sound (RTS), reaction time to light (RTL), deviation of depth perception (DDP), and time deviation of speed anticipation (TDSA). They were analyzed using analysis of variance (ANOVA) with repeated measures. Binary logistical regression analysis was used to explain the relationship between drivers' physical characteristics and the two driving states. Most of the drivers' physical characteristic parameters were found to be significantly different under the influence of different situations. Four indicators are significantly affected by fatigue driving during deep fatigue (in decreasing order of influence): HR, RTL, SBP and RTS. HR and RTL are significant in the logistical regression model of the drowsiness + tired driving situation and normal situations. Six indicators of the drivers' physical characteristics are significantly affected by drunk driving (in decreasing order of influence): SBP, RTL, DDP, eyesight, RTS, and TDSA. SBP and DDP have a significant effect in the logistical regression model of the drunk driving situation and the normal situation. Both fatigue driving and drunk driving

  15. High risk of near-crash driving events following night-shift work.

    Science.gov (United States)

    Lee, Michael L; Howard, Mark E; Horrey, William J; Liang, Yulan; Anderson, Clare; Shreeve, Michael S; O'Brien, Conor S; Czeisler, Charles A

    2016-01-05

    Night-shift workers are at high risk of drowsiness-related motor vehicle crashes as a result of circadian disruption and sleep restriction. However, the impact of actual night-shift work on measures of drowsiness and driving performance while operating a real motor vehicle remains unknown. Sixteen night-shift workers completed two 2-h daytime driving sessions on a closed driving track at the Liberty Mutual Research Institute for Safety: (i) a postsleep baseline driving session after an average of 7.6 ± 2.4 h sleep the previous night with no night-shift work, and (ii) a postnight-shift driving session following night-shift work. Physiological measures of drowsiness were collected, including infrared reflectance oculography, electroencephalography, and electrooculography. Driving performance measures included lane excursions, near-crash events, and drives terminated because of failure to maintain control of the vehicle. Eleven near-crashes occurred in 6 of 16 postnight-shift drives (37.5%), and 7 of 16 postnight-shift drives (43.8%) were terminated early for safety reasons, compared with zero near-crashes or early drive terminations during 16 postsleep drives (Fishers exact: P = 0.0088 and P = 0.0034, respectively). Participants had a significantly higher rate of lane excursions, average Johns Drowsiness Scale, blink duration, and number of slow eye movements during postnight-shift drives compared with postsleep drives (3.09/min vs. 1.49/min; 1.71 vs. 0.97; 125 ms vs. 100 ms; 35.8 vs. 19.1; respectively, P Night-shift work increases driver drowsiness, degrading driving performance and increasing the risk of near-crash drive events. With more than 9.5 million Americans working overnight or rotating shifts and one-third of United States commutes exceeding 30 min, these results have implications for traffic and occupational safety.

  16. Vital Sign Monitoring and Mobile Phone Usage Detection Using IR-UWB Radar for Intended Use in Car Crash Prevention.

    Science.gov (United States)

    Leem, Seong Kyu; Khan, Faheem; Cho, Sung Ho

    2017-05-30

    In order to avoid car crashes, active safety systems are becoming more and more important. Many crashes are caused due to driver drowsiness or mobile phone usage. Detecting the drowsiness of the driver is very important for the safety of a car. Monitoring of vital signs such as respiration rate and heart rate is important to determine the occurrence of driver drowsiness. In this paper, robust vital signs monitoring through impulse radio ultra-wideband (IR-UWB) radar is discussed. We propose a new algorithm that can estimate the vital signs even if there is motion caused by the driving activities. We analyzed the whole fast time vital detection region and found the signals at those fast time locations that have useful information related to the vital signals. We segmented those signals into sub-signals and then constructed the desired vital signal using the correlation method. In this way, the vital signs of the driver can be monitored noninvasively, which can be used by researchers to detect the drowsiness of the driver which is related to the vital signs i.e., respiration and heart rate. In addition, texting on a mobile phone during driving may cause visual, manual or cognitive distraction of the driver. In order to reduce accidents caused by a distracted driver, we proposed an algorithm that can detect perfectly a driver's mobile phone usage even if there are various motions of the driver in the car or changes in background objects. These novel techniques, which monitor vital signs associated with drowsiness and detect phone usage before a driver makes a mistake, may be very helpful in developing techniques for preventing a car crash.

  17. Vital Sign Monitoring and Mobile Phone Usage Detection Using IR-UWB Radar for Intended Use in Car Crash Prevention

    Directory of Open Access Journals (Sweden)

    Seong Kyu Leem

    2017-05-01

    Full Text Available In order to avoid car crashes, active safety systems are becoming more and more important. Many crashes are caused due to driver drowsiness or mobile phone usage. Detecting the drowsiness of the driver is very important for the safety of a car. Monitoring of vital signs such as respiration rate and heart rate is important to determine the occurrence of driver drowsiness. In this paper, robust vital signs monitoring through impulse radio ultra-wideband (IR-UWB radar is discussed. We propose a new algorithm that can estimate the vital signs even if there is motion caused by the driving activities. We analyzed the whole fast time vital detection region and found the signals at those fast time locations that have useful information related to the vital signals. We segmented those signals into sub-signals and then constructed the desired vital signal using the correlation method. In this way, the vital signs of the driver can be monitored noninvasively, which can be used by researchers to detect the drowsiness of the driver which is related to the vital signs i.e., respiration and heart rate. In addition, texting on a mobile phone during driving may cause visual, manual or cognitive distraction of the driver. In order to reduce accidents caused by a distracted driver, we proposed an algorithm that can detect perfectly a driver's mobile phone usage even if there are various motions of the driver in the car or changes in background objects. These novel techniques, which monitor vital signs associated with drowsiness and detect phone usage before a driver makes a mistake, may be very helpful in developing techniques for preventing a car crash.

  18. Modafinil for attentional and psychomotor dysfunction in advanced cancer: a double-blind, randomised, cross-over trial

    DEFF Research Database (Denmark)

    Lundorff, L E; Jønsson, B H; Sjøgren, P

    2009-01-01

    Cognitive impairment seems to be highly prevalent in patients with advanced cancer. Modafinil, a novel vigilance and wake-promoting agent, may be an alternative treatment. We wanted to investigate this treatment on attentional and psychomotor dysfunction in cancer patients. 28 cancer patients wit...... cognitive tests of psychomotor speed and attention. Furthermore subjective scores of depression and drowsiness were significantly improved by modafinil.......Cognitive impairment seems to be highly prevalent in patients with advanced cancer. Modafinil, a novel vigilance and wake-promoting agent, may be an alternative treatment. We wanted to investigate this treatment on attentional and psychomotor dysfunction in cancer patients. 28 cancer patients...... were statistically significantly improved on modafinil (p-values=0.006 and 0.042, respectively). On ESAS, depression and drowsiness also improved statistically significantly (p-values=

  19. Evaluation of flurazepam and placebo on sleep disorders in childhood

    Directory of Open Access Journals (Sweden)

    Rubens Reimão

    1982-03-01

    Full Text Available The clinically observed results in 40 patients, from 1 to 15 years old, presenting sleep disturbances, in a comparative and statistically approached study of flurazepam 15mg daily against placebo, are reported. Placebo was administered, followed by the drug, during 14 days each. The chief complaints were sleepwalking, sleep-talking, sleep terror, sleep-related bruxism, sleep-related headbanging, insomnia and excessive movements during sleep. A significant effect of flurazepam on sleepwalking, sleep-talking, bruxism, sleep terror and excessive movement during sleep, was observed. The insomniac and headbanging patients were not enough for statistical analysis. Flurazepam side effects were excessive drowsiness during daytime in 3 cases; irritability, 3 cases; nausea and vomiting, 2 cases, and were not correlated with age. Placebo side effects were similar, except for nausea and vomiting which were not observed. It was necessary to discontinue flurazepam in 2 cases, because of excessive drowsiness during daytime, which did not improve when reducing the dose.

  20. SAFETY AND PREVENTION OF FEBRILE SEIZURES IN PEDIATRICS, IDENITIFY NEW SYMPTOMS, ADVERSE EFFECTS, SIDE EFFECTS, LIFE STYLE MODIFICATIONS, PATIENT COUNCELLING , OBSERVING, MONITORING BY INVOLVING DOCTOR OF PHARMACY

    OpenAIRE

    Dr. Gangadhar Rao Gundapu; M. Bhavani; Myle Akshay Kiran; Naveen Kumar Bathula; Dr. Ashok kumar

    2017-01-01

    To observe the management and treatment of febrile seizures in children that is to prevent the condition from becoming worse and to prevent it from causing other complications. A Perform was designed to collect data related to the patient’s treatment . when patients are administration of drugs then we(Doctor of pharmacy) identified new adverse drug reactions like drowsiness, vomiting etc. and also identified new side effects due to antiepiliptic drugs in piadiatric patients with seizures li...

  1. Commercial Motor Vehicle Driving Safety Website

    OpenAIRE

    Tidwell, Scott; Trimble, Tammy; Blanco, Myra

    2016-01-01

    This report documents the CMV Driving Safety website (http://cmvdrivingsafety.org/), which was created by the National Surface Transportation Safety Center for Excellence (NSTSCE) as an outreach effort to assist commercial motor vehicle (CMV) fleets and drivers, driver trainers, CMV training schools, and insurance companies. The website contains 15 unique pages and provides six downloadable training modules on driver distraction, driver health, hours of service, driver drowsiness and fatigue,...

  2. Stay Awake Behind the Wheel (A Cup of Health with CDC)

    Centers for Disease Control (CDC) Podcasts

    2016-11-10

    Being a safe driver requires complete focus on the road and the cars around you. Unfortunately, many people get behind the wheel when they’ve had a long day at work or haven’t gotten enough sleep. In this podcast, Dr. Anne Wheaton discusses the dangers of drowsy driving.  Created: 11/10/2016 by MMWR.   Date Released: 11/10/2016.

  3. A comparative study of various therapeutic regimens in urticaria

    Directory of Open Access Journals (Sweden)

    Mukhopadhyay Amiyakumar

    1995-01-01

    Full Text Available 127 patients of urticaria were treated with chlorpheniramine maleate alone and in combination with cyproheptadine hydrochloride, ranitidine and doxepin and levamisole. Chlorpheniramine and doxepin combination showed a satisfactory result in 88.46% of patients. Overall study showed that a combination regimen is better than the antihistaminics alone. Drowsiness was the commonest side effect. Levamisole and chlorpheniramine maleate combination was found to be more effective than the antihimstamine alone.

  4. Changes in the Occurrence, Severity, and Distress of Symptoms in Patients With Gastrointestinal Cancers Receiving Chemotherapy

    OpenAIRE

    Tantoy, IY; Cooper, BA; Dhruva, A; Cataldo, J; Paul, SM; Conley, YP; Hammer, M; Wright, F; Dunn, LB; Levine, JD; Miaskowski, C

    2018-01-01

    Studies on multiple dimensions of the symptom experience of patients with gastrointestinal cancers are extremely limited.Purpose was to evaluate for changes over time in the occurrence, severity, and distress of seven common symptoms in these patients.Patients completed Memorial Symptom Assessment Scale, six times over two cycles of chemotherapy (CTX). Changes over time in occurrence, severity, and distress of pain, lack of energy, nausea, feeling drowsy, difficulty sleeping, and change in th...

  5. OLED Display For Real Time Vision System

    OpenAIRE

    Sandhyalakshmi Narayanan; Sanjana Sridhar; Neha Deshpande; Ashwini Gaikwad

    2015-01-01

    This innovative glass design will carry an OLED based display controlled via nano Ardiuno board having Bluetooth connectivity with a Smartphone to exchange information along with onboard accelerometer. We are using a tilt angle sensor for detecting if the driver is feeling drowsy. An alcohol sensor has been used to promote the safe driving habit. The glasses will be getting latest updates about the current speed of the vehicle navigation directions nearby or approaching sign broads or service...

  6. Characterization and pathogenesis of aerosolized eastern equine encephalitis in the common marmoset (Callithrix jacchus)

    OpenAIRE

    Porter, Aimee I.; Erwin-Cohen, Rebecca A.; Twenhafel, Nancy; Chance, Taylor; Yee, Steven B.; Kern, Steven J.; Norwood, David; Hartman, Laurie J.; Parker, Michael D.; Glass, Pamela J.; DaSilva, Luis

    2017-01-01

    Background Licensed antiviral therapeutics and vaccines to protect against eastern equine encephalitis virus (EEEV) in humans currently do not exist. Animal models that faithfully recapitulate the clinical characteristics of human EEEV encephalitic disease, including fever, drowsiness, anorexia, and neurological signs such as seizures, are needed to satisfy requirements of the Food and Drug Administration (FDA) for clinical product licensing under the Animal Rule. Methods In an effort to meet...

  7. Driver assistance system for lane departure avoidance by steering and differential braking

    OpenAIRE

    MINOIU-ENACHE, N; MAMMAR, S; GLASER, S; LUSETTI, B

    2010-01-01

    Lane departure avoidance systems assist actively the driver during inattention or drowsiness and increase driving safety. Most of the lane departure avoidance systems use for the lateral control of the vehicle in closed loop a DC motor similar to the electrical powered steering (EPS) assistance. Important difficulties and limits of this approach are the shared control with the driver on the steering wheel and the vehicle handling at limits. In this paper a combined lateral control using a DC ...

  8. [The newest epidemiology trend of insomnia].

    Science.gov (United States)

    Ikeda, Maki; Kaneita, Yoshitaka

    2014-03-01

    Sleep disturbance such as insomnia is one of common complaint among adults in developed countries. Insomnia induces sleepiness and drowsiness, resulting in a reduction of working efficiency in the daytime. Drivers in the transportation system and machine operators could cause serious industrial accidents if they have sleep disturbances. Recent studies reported that approximately 20% of Japanese population had sleep disturbances. Here we provide a general account of sleep disturbance about Japanese population.

  9. EEG quantification of alertness: methods for early identification of individuals most susceptible to sleep deprivation

    Science.gov (United States)

    Berka, Chris; Levendowski, Daniel J.; Westbrook, Philip; Davis, Gene; Lumicao, Michelle N.; Olmstead, Richard E.; Popovic, Miodrag; Zivkovic, Vladimir T.; Ramsey, Caitlin K.

    2005-05-01

    Electroencephalographic (EEG) and neurocognitive measures were simultaneously acquired to quantify alertness from 24 participants during 44-hours of sleep deprivation. Performance on a three-choice vigilance task (3C-VT), paired-associate learning/memory task (PAL) and modified Maintenance of Wakefulness Test (MWT), and sleep technician-observed drowsiness (eye-closures, head-nods, EEG slowing) were quantified. The B-Alert system automatically classifies each second of EEG on an alertness/drowsiness continuum. B-Alert classifications were significantly correlated with technician-observations, visually scored EEG and performance measures. B-Alert classifications during 3C-VT, and technician observations and performance during the 3C-VT and PAL evidenced progressively increasing drowsiness as a result of sleep deprivation with a stabilizing effect observed at the batteries occurring between 0600 and 1100 suggesting a possible circadian effect similar to those reported in previous sleep deprivation studies. Participants were given an opportunity to take a 40-minute nap approximately 24-hours into the sleep deprivation portion of the study (i.e., 7 PM on Saturday). The nap was followed by a transient period of increased alertness. Approximately 8 hours after the nap, behavioral and physiological measures of drowsiness returned to levels prior to the nap. Cluster analysis was used to stratify individuals into three groups based on their level of impairment as a result of sleep deprivation. The combination of B-Alert and neuro-behavioral measures may identify individuals whose performance is most susceptible to sleep deprivation. These objective measures could be applied in an operational setting to provide a "biobehavioral assay" to determine vulnerability to sleep deprivation.

  10. Survey and comparison of sleep quality among fixed and changing shift staff in a steel factory in Tehran, Iran.

    Science.gov (United States)

    Mohammadian, Farugh; Abbasinia, Marzieh; Rahmani, Abdolrasoul; Monazzam, Mohammad Reza; Asghari, Mehdi; Ahmadnezhad, Iman; Asadi, Ali

    2013-01-01

    Given the hazardous nature of the work in steel factories and that the staff has to deal with hazardous equipment and machines, improper sleep quality and drowsiness among the works tackles performance and boosts rate of job accidents. This study is aimed to survey the quality of sleep and sleepiness status and the pertinent factors among the workers in a rolling mill and a steel production company in Tehran, Iran. In a Cross-Sectional study 2011, 180 workers were selected randomly from a rolling mill and a steel production company in Tehran. A questionnaire was designed to collect demographic data and variables of work condition. Pitersborg's sleep quality questionnaire was used to survey quality and problems of Participants' sleep. Epworth Sleepiness questionnaire was used to deals with sleepiness during work, studying, watching TV, or during time spent in public. Average score of sleep quality for the fixed shift staff and changing shift staff were 7.5±2.82 and 8.49±2.95 respectively. Surveys of sleep quality for the two groups of the participants based on T-test showed a significant difference between the two groups so that the changing shift staff group suffered poorer sleep quality (p=0.03). Comparison of average drowsiness scores between the two groups of participants based on Mann-Whitney test showed no significant difference (p>0.005). Chi square test showed a significant difference between severity of drowsiness and type of working shift (p =0.028 and 0.009). Staff in revolving shifts suffers poor sleep quality comparing with staff with fixed working shift. Moreover, type of working shift greatly affects severity of drowsiness as staff at different work shift experienced different level of sleepiness. It is essential to survey sleep disorder of the staff in the industry and pay more emphasis on sleep disorder epidemic in other fields of industry.

  11. Helmet-based physiological signal monitoring system.

    Science.gov (United States)

    Kim, Youn Sung; Baek, Hyun Jae; Kim, Jung Soo; Lee, Haet Bit; Choi, Jong Min; Park, Kwang Suk

    2009-02-01

    A helmet-based system that was able to monitor the drowsiness of a soldier was developed. The helmet system monitored the electrocardiogram, electrooculogram and electroencephalogram (alpha waves) without constraints. Six dry electrodes were mounted at five locations on the helmet: both temporal sides, forehead region and upper and lower jaw strips. The electrodes were connected to an amplifier that transferred signals to a laptop computer via Bluetooth wireless communication. The system was validated by comparing the signal quality with conventional recording methods. Data were acquired from three healthy male volunteers for 12 min twice a day whilst they were sitting in a chair wearing the sensor-installed helmet. Experimental results showed that physiological signals for the helmet user were measured with acceptable quality without any intrusions on physical activities. The helmet system discriminated between the alert and drowsiness states by detecting blinking and heart rate variability (HRV) parameters extracted from ECG. Blinking duration and eye reopening time were increased during the sleepiness state compared to the alert state. Also, positive peak values of the sleepiness state were much higher, and the negative peaks were much lower than that of the alert state. The LF/HF ratio also decreased during drowsiness. This study shows the feasibility for using this helmet system: the subjects' health status and mental states could be monitored without constraints whilst they were working.

  12. Characteristics of social drinkers with and without a hangover after heavy alcohol consumption

    Directory of Open Access Journals (Sweden)

    Hogewoning A

    2016-11-01

    Full Text Available A Hogewoning,1,* AJAE Van de Loo,1,* M Mackus,1 SJ Raasveld,1 R De Zeeuw,1 ER Bosma,1 NH Bouwmeester,1 KA Brookhuis,2 J Garssen,1,3 JC Verster1,4 1Division of Pharmacology, Utrecht University, Utrecht, 2Faculty of Behavioral and Social Sciences, Groningen University, Groningen, 3Nutricia Research, Utrecht, the Netherlands; 4Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC, Australia *These authors contributed equally to this work Background: A number of social drinkers claim that they do not experience next-day hangovers despite consuming large quantities of alcohol. The aim of this study was to investigate the characteristics of drinkers who claim to be hangover immune and compare them with drinkers who do report having hangovers. Methods: A total of 36 social drinkers participated in a naturalistic study consisting of a hangover day (alcohol consumed and a control day (no alcohol consumed. Data were collected on alcohol consumption, demographics, sleep, next-day adverse effects, and mood. Data from drinkers with a hangover (N=18 were compared with data from drinkers who claim to be hangover immune (N=18. Results: Drinkers with a hangover reported drowsiness-related symptoms, symptoms related to reduced cognitive functioning, and classic hangover symptoms such as headache, nausea, dizziness, weakness, and stomach pain. Corresponding mood changes comprised increased feelings of depression, anger–hostility, fatigue, and reduced vigor–activity. In contrast, hangover-immune drinkers reported relatively few hangover symptoms, with only mild corresponding severity scores. The reported symptoms were limited to drowsiness-related symptoms such as sleepiness and being tired. The classic hangover symptoms were usually not reported by these drinkers. Conclusion: In contrast to drinkers with a hangover, for those who claim to be hangover immune, next-day adverse effects of alcohol consumption are limited to a mild increase in

  13. A systematic review of the effect of various interventions on reducing fatigue and sleepiness while driving

    Directory of Open Access Journals (Sweden)

    Seyed Saeed Hashemi Nazari

    2017-10-01

    Full Text Available Purpose: To identify and appraise the published studies assessing interventions accounting for reducing fatigue and sleepiness while driving. Methods: This systematic review searched the following electronic databases: Medline, Science direct, Scopus, EMBASE, PsycINFO, Transport Database, Cochrane, BIOSIS, ISI Web of Knowledge, specialist road injuries journals and the Australian Transport and Road Index database. Additional searches included websites of relevant organizations, reference lists of included studies, and issues of major injury journals published within the past 15 years. Studies were included if they investigated interventions/exposures accounting for reducing fatigue and sleepiness as the outcome, measured any potential interventions for mitigation of sleepiness and were written in English. Meta-analysis was not attempted because of the heterogeneity of the included studies. Results: Of 63 studies identified, 18 met the inclusion criteria. Based on results of our review, many interventions in the world have been used to reduce drowsiness while driving such as behavioral (talking to passengers, face washing, listening to the radio, no alcohol use, limiting the driving behavior at the time of 12 p.m. – 6 a.m. etc, educational interventions and also changes in the environment (such as rumble strips, chevrons, variable message signs, etc. Meta-analysis on the effect of all these interventions was impossible due to the high heterogeneity in methodology, effect size and interventions reported in the assessed studies. Conclusion: Results of present review showed various interventions in different parts of the world have been used to decrease drowsy driving. Although these interventions can be used in countries with high incidence of road traffic accidents, precise effect of each intervention is still unknown. Further studies are required for comparison of the efficiency of each intervention and localization of each intervention

  14. Improving Night Time Driving Safety Using Vision-Based Classification Techniques.

    Science.gov (United States)

    Chien, Jong-Chih; Chen, Yong-Sheng; Lee, Jiann-Der

    2017-09-24

    The risks involved in nighttime driving include drowsy drivers and dangerous vehicles. Prominent among the more dangerous vehicles around at night are the larger vehicles which are usually moving faster at night on a highway. In addition, the risk level of driving around larger vehicles rises significantly when the driver's attention becomes distracted, even for a short period of time. For the purpose of alerting the driver and elevating his or her safety, in this paper we propose two components for any modern vision-based Advanced Drivers Assistance System (ADAS). These two components work separately for the single purpose of alerting the driver in dangerous situations. The purpose of the first component is to ascertain that the driver would be in a sufficiently wakeful state to receive and process warnings; this is the driver drowsiness detection component. The driver drowsiness detection component uses infrared images of the driver to analyze his eyes' movements using a MSR plus a simple heuristic. This component issues alerts to the driver when the driver's eyes show distraction and are closed for a longer than usual duration. Experimental results show that this component can detect closed eyes with an accuracy of 94.26% on average, which is comparable to previous results using more sophisticated methods. The purpose of the second component is to alert the driver when the driver's vehicle is moving around larger vehicles at dusk or night time. The large vehicle detection component accepts images from a regular video driving recorder as input. A bi-level system of classifiers, which included a novel MSR-enhanced KAZE-base Bag-of-Features classifier, is proposed to avoid false negatives. In both components, we propose an improved version of the Multi-Scale Retinex (MSR) algorithm to augment the contrast of the input. Several experiments were performed to test the effects of the MSR and each classifier, and the results are presented in experimental results section

  15. Evaluation of sleep profile in schizophrenia patients treated with extended-release paliperidone: an open-label prospective study in Southeast Asia

    Directory of Open Access Journals (Sweden)

    Kongsakon R

    2017-10-01

    Full Text Available Ronnachai Kongsakon,1 Nuntika Thavichachart,2 Ka Fai Chung,3 Leslie Lim,4 Beverly Azucena,5 Elizabeth Rondain,6 Benson Go,7 Fe Costales,8 Osot Nerapusee9 1Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Medicine, Division of Psychiatry, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand; 3Department of Psychiatry, University of Hong Kong, Hong Kong, People’s Republic of China; 4Department of Psychiatry, Singapore General Hospital, Singapore; 5National Center for Mental Health, Mandaluyong, Philippines; 6Makati Medical Center, Makati, Philippines; 7Northern Mindanao Medical Center, Cagayan De Oro, Misamis Oriental, Philippines; 8Perpetual Succour Hospital, Cebu, Philippines; 9Medical Affairs, Janssen‑Cilag, Bangkok, Thailand Objective: To evaluate the effect of 6 months of treatment with paliperidone extended-release (ER tablets on the sleep profile of patients with schizophrenia.Methods: A total of 984 patients meeting the The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV criteria for schizophrenia who switched their antipsychotic to paliperidone ER were recruited from 61 sites in five countries in Southeast Asia. We recorded patient demographics and assessed sleep quality and daytime drowsiness using visual analog scales.Results: Approximately 70% of patients completed the 6-month study. After the use of paliperidone ER, patients reported significantly better sleep quality (76.44 vs 65.48; p<0.001 and less daytime drowsiness compared with their baseline value (23.18 vs 34.22; p<0.001. Factors predicting sleep profile improvement were completion of the study and higher baseline Positive and Negative Syndrome Scale scores.Conclusion: Paliperidone ER can help schizophrenia patients to improve sleep quality and reduce daytime drowsiness; this was seen especially in the patients who completed the 6-month

  16. [Sleep deprivation and its effect on the ability to maintain wakefulness: implications on functioning and driving].

    Science.gov (United States)

    Furman, Gabriela Dorfman; Cahan, Clement; Baharav, Armada

    2009-05-01

    During the last century, western society suffers from an increasing steep debt. A large number of accidents occur due to drowsy drivers. People are not aware of the influence of fatigue/drowsiness on their functioning and driving capacity. Our goal is to identify and characterize measurable physioLogicaL information capable of monitoring simple and reliable performance of driver vigilance. Eight healthy volunteers without sleep disorders were included in the study. They participated in two missions, on and off every two hours during 34-36 hours, in order to create an accumulative sleep debt. The tasks included the Maintenance of wakefulness test (MWT) and the driving simulator test. White tested, they remained connected to EEG, EMG, EOG, ECG and audio-video registration. These first results are related to 60 MWT tests. The first falling asleep events (FA) appeared around the early afternoon hours, in agreement to the physiological tendency to fall asleep, according to the biological clock. The night was characterized by FAs with a very short sleep Latency time at around 4 AM. On the second day of the experiment, the averaged sleep latency was larger than in the night before, despite the accumulation of sleep debt. The fluctuations of RRI increased after the first micro sleep. The autonomic nervous regulation displays an increase in the overall sympathetic activity as an indicator of increased stress. There is a correlation between parameters associated with instantaneous autonomic changes of heart rhythm (RRI) and the FA/almost-FA events observed on EEG. These attributes may provide a useful tool for monitoring drowsy drivers and preventing accidents.

  17. An unusual effect of interferential therapy.

    LENUS (Irish Health Repository)

    Keramat, Keramat Ullah

    2012-11-01

    In this report, a patient with severe shoulder pain was treated with interferential currents, a commonly used modality in physiotherapy for the management of pain. He reported loss of concentration, drowsiness, decreased alertness and gait disturbance, along with analgaesia, for 4-5 h after each treatment. He was regularly taking tramadol HCl for pain relief. Endogenous opioids produced in response to interferential therapy may be excessive or may interact with the tramadol HCl and potentiate its effect. There is no published report of interferential-induced symptoms, as described above, in the authors\\' knowledge. The clinician using interferential currents should be aware of this possible effect.

  18. Subacute epidural hematoma

    International Nuclear Information System (INIS)

    Gonzalez Orlandi, Ivey; Elizondo Barrier, Luis; Junco Martin, Reinel

    2011-01-01

    This is the case of a patient presenting with right temporoparietal subacute hematoma secondary to a physical act of aggression. In clinical picture at 24 hours there was predominance of headache of moderate intensity with drowsiness and slight psychomotor restlessness. The skull single radiographies didn't show alterations. Symptoms remained despite the medical treatment, thus a single skull axial tomography was carried out showing the presence of a right temporoparietal subacute epidural hematoma with displacement from the middle line structures. A right temporoparietal craniotomy was carried out to evacuation of the posterior hematoma. Patient evolved satisfactorily with a total recovery as much clinical as imaging. (author)

  19. RAF 7014: Applying Nuclear Analytical Techniques to Support Harmful Algal Bloom Management in the Context of Climate and Environmental Change, Phase II

    International Nuclear Information System (INIS)

    Okuku, E.; Mwangi, S.

    2017-01-01

    Saxitoxins tend to inhibit/block voltage-gated sodium channels thus cause numbness of lips and fingertips, loss of coordination, drowsiness, incoherence, paralysis and death of shellfish and pufferfish. The Domoic acid: stimulates glutamate receptors causes nausea, vomiting, loss of coordination, short-term memory loss, seizure and finally death of shellfish. The proposed projects of RAF 7014 aims to increased socio-economic benefits and revenue generation from coastal zones that Safe seafood for local and international markets,Safe recreational and drinking water. For Sustainability, the project activities has been mainstreamed into KMFRI activities, Reaching out to the industry for collaboration, and having Training and mentorship programs

  20. Sleep, immunity and shift workers: A review

    Directory of Open Access Journals (Sweden)

    Carlos Mauricio Oliveira de Almeida

    2016-07-01

    Full Text Available To date, shift workers represent between 15% and 25% of the modern day workforce. Work time poses a great challenge to workers as it requires that they balance productivity and sleep time between shifts. As a result, these workers experience chronic sleep deprivation with increased fatigue and drowsiness due to this sleep deprivation. The impact of this kind of work on the immune system is not yet known. We conducted a literature review with the aim of evaluating articles on this specific type of work's effects on sleep and immunity.

  1. Profound bradycardia associated with NIV removal.

    Science.gov (United States)

    Echevarria, C; Bourke, S C; Gibson, G J

    2012-01-01

    A patient with lower-limb onset ALS presented with a one-month history of vasovagal episodes and a one-week history of cough productive of green sputum and lethargy. She was drowsy and in acute on chronic type-two respiratory failure. She responded to non-invasive ventilation, however she suffered recurrent episodes of profound bradycardia on removal of the mask, which gradually resolved over ten days. We have reviewed the literature and offer a potential explanation for these events.

  2. Orthorexia nervosa with hyponatremia, subcutaneous emphysema, pneumomediastimum, pneumothorax, and pancytopenia.

    Science.gov (United States)

    Park, Sang Won; Kim, Jeong Yup; Go, Gang Ji; Jeon, Eun Sil; Pyo, Heui Jung; Kwon, Young Joo

    2011-06-01

    30-year-old male was admitted with general weakness and drowsy mental status. He had eaten only 3-4 spoons of brown rice and fresh vegetable without salt for 3 months to treat his tic disorder, and he had been in bed-ridden state. He has had weight loss of 14 kg in the last 3 months. We report a patient with orthorexia nervosa who developed hyponatremia, metabolic acidosis, subcutaneous emphysema, mediastinal emphysema, pneumothorax, and pancytopenia and we will review the literature. Also, we mention to prevent refeeding syndrome, and to start and maintain feeding in malnourished patients.

  3. Beta-hemolytic streptococcus group a endocarditis: a rare clinical presentation

    International Nuclear Information System (INIS)

    Alam, A.; Tariq, M.

    2008-01-01

    A case report of an elderly gentleman is reported herein, who presented with one week history of fever, drowsiness and left lower limb weakness. Examination revealed left lower limb weakness with power of grade 3/5. His workup showed evidence of infection and multiple cerebral infarcts on the right side. Blood culture grew Streptococcus pyogens. Echocardiogram showed two vegetations on the aortic valve. Fever was the main presenting feature in this case but it was the presentation of patient with multiple cerebral infarcts that lead to the diagnosis of infective endocarditis. The organism causing Infective Endocarditis (IE) in this patient was a rare one. (author)

  4. Noninvasive biological sensor system for detection of drunk driving.

    Science.gov (United States)

    Murata, Kohji; Fujita, Etsunori; Kojima, Shigeyuki; Maeda, Shinitirou; Ogura, Yumi; Kamei, Tsutomu; Tsuji, Toshio; Kaneko, Shigehiko; Yoshizumi, Masao; Suzuki, Nobutaka

    2011-01-01

    Systems capable of monitoring the biological condition of a driver and issuing warnings during instances of drowsiness have recently been studied. Moreover, many researchers have reported that biological signals, such as brain waves, pulsation waves, and heart rate, are different between people who have and have not consumed alcohol. Currently, we are developing a noninvasive system to detect individuals driving under the influence of alcohol by measuring biological signals. We used the frequency time series analysis to attempt to distinguish between normal and intoxicated states of a person as the basis of the sensing system.

  5. Motion Sickness: Significance in Aerospace Operations and Prophylaxis (Le Mal des Transports: Son Importance pour les Operations Aerospatiales et Prophylaxies)

    Science.gov (United States)

    1991-09-01

    a range of complex mental reactions including fatigue, drowsiness, poor motivation for work, and depression. 2-20 AUTONOMIC-STRESS REACTIONS It is... rmotions at. 12 ]I;?, z., - 0.19 aInds. 1 J’( tnlro i’, "- 0.5’t, arid P:. -- 0.81 Yiv irq i (It ’’ti tied IttI’ Intill ltk e’r- I rtr’dc’nc" cit 46...cindtoses modifior son comporteomnt at sm motivation par rapport it lora do IPanirsinamant on Icola do pilotage cat I. taux do tnae situation

  6. Prophylactic antiemetic effects of midazolam, dexamethasone, and its combination after middle ear surgery

    International Nuclear Information System (INIS)

    Makhdoom, Naeem K; Farid, Magdy F

    2009-01-01

    To evaluate and compare the efficacy of the combination of midazolam and dexamethasone, with midazolam and dexamethasone alone, for the prevention of postoperative nausea and vomiting (PONV) in female patients undergoing middle ear surgery. A prospective, randomized, double-blind, placebo-controlled study in 80 female patients (mean age 32.6 years), undergoing middle ear surgery with general anesthesia at Ohud Hospital, Madina, Kingdom of Saudi Arabia from May 2007 to May 2008. Patients were classified into 4 groups. They received intravenous normal saline (S group), midazolam 0.075 mg/kg (M group), or dexamethasone 10 mg (D group), or a combination of midazolam and dexamethasone (MD group), before the induction of anesthesia. Postoperatively for 24 hours observation and assessment of nausea, vomiting, rescue anti-emetics, and side effects of the study drugs such as headache and drowsiness were carried out. There was a significant difference between the 4 groups. The MD group was the least to develop PONV compared to other groups (p<0.01). Regarding nausea, there was a non-significant difference between the 4 groups, although the MD group developed the least symptoms among the 4 groups, there were no significant differences in pain intensity and side effects such as, headache, dizziness, and drowsiness between the 4 groups. The combination of midazolam 0.075 mg/kg and dexamethasone 10 mg intravenously is better than either drug alone in reducing the incidence of PONV in female patients after middle ear surgery. (author)

  7. Brain Dynamics in Predicting Driving Fatigue Using a Recurrent Self-Evolving Fuzzy Neural Network.

    Science.gov (United States)

    Liu, Yu-Ting; Lin, Yang-Yin; Wu, Shang-Lin; Chuang, Chun-Hsiang; Lin, Chin-Teng

    2016-02-01

    This paper proposes a generalized prediction system called a recurrent self-evolving fuzzy neural network (RSEFNN) that employs an on-line gradient descent learning rule to address the electroencephalography (EEG) regression problem in brain dynamics for driving fatigue. The cognitive states of drivers significantly affect driving safety; in particular, fatigue driving, or drowsy driving, endangers both the individual and the public. For this reason, the development of brain-computer interfaces (BCIs) that can identify drowsy driving states is a crucial and urgent topic of study. Many EEG-based BCIs have been developed as artificial auxiliary systems for use in various practical applications because of the benefits of measuring EEG signals. In the literature, the efficacy of EEG-based BCIs in recognition tasks has been limited by low resolutions. The system proposed in this paper represents the first attempt to use the recurrent fuzzy neural network (RFNN) architecture to increase adaptability in realistic EEG applications to overcome this bottleneck. This paper further analyzes brain dynamics in a simulated car driving task in a virtual-reality environment. The proposed RSEFNN model is evaluated using the generalized cross-subject approach, and the results indicate that the RSEFNN is superior to competing models regardless of the use of recurrent or nonrecurrent structures.

  8. Sleep Disorders Associated With Mild Traumatic Brain Injury Using Sport Concussion Assessment Tool 3.

    Science.gov (United States)

    Tkachenko, Nataliya; Singh, Kanwaljit; Hasanaj, Lisena; Serrano, Liliana; Kothare, Sanjeev V

    2016-04-01

    Sleep problems affect 30% to 80% of patients with mild traumatic brain injury. We assessed the prevalence of sleep disorders after mild traumatic brain injury and its correlation with other symptoms. Individuals with mild traumatic brain injury were assessed at the New York University Concussion Center during 2013-2014 with the Sports Concussion Assessment Tool, third edition, data following mild traumatic brain injury. The relationship between sleep problems (drowsiness, difficulty falling asleep, fatigue or low energy), psychiatric symptoms (sadness, nervousness or anxiousness), headache, and dizziness were analyzed by Spearman correlation and logistic regression using moderate to severe versus none to mild categorization. Ninety-three patients were retrospectively considered. The most common injury causes were falls (34.4%) and motor vehicle accidents (21.5%). There was a positive correlation between dizziness, headache, psychiatric problems (sadness, anxiety, irritability), and sleep problems (fatigue, drowsiness, and difficulty falling asleep) (P sleep symptoms (P Sleep symptoms became more severe with increased time interval from mild traumatic brain injury to Sport Concussion Assessment Tool 3 administration (odds ratio = 1.005, 1.006, and 1.008, P sleep disorders following mild traumatic brain injury and should be counseled and initiated with early interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Wearable sensor glove based on conducting fabric using electrodermal activity and pulse-wave sensors for e-health application.

    Science.gov (United States)

    Lee, Youngbum; Lee, Byungwoo; Lee, Myoungho

    2010-03-01

    Improvement of the quality and efficiency of health in medicine, both at home and the hospital, calls for improved sensors that might be included in a common carrier such as a wearable sensor device to measure various biosignals and provide healthcare services that use e-health technology. Designed to be user-friendly, smart clothes and gloves respond well to the end users for health monitoring. This study describes a wearable sensor glove that is equipped with an electrodermal activity (EDA) sensor, pulse-wave sensor, conducting fabric, and an embedded system. The EDA sensor utilizes the relationship between drowsiness and the EDA signal. The EDA sensors were made using a conducting fabric instead of silver chloride electrodes, as a more practical and practically wearable device. The pulse-wave sensor measurement system, which is widely applied in oriental medicinal practices, is also a strong element in e-health monitoring systems. The EDA and pulse-wave signal acquisition module was constructed by connecting the sensor to the glove via a conductive fabric. The signal acquisition module is then connected to a personal computer that displays the results of the EDA and pulse-wave signal processing analysis and gives accurate feedback to the user. This system is designed for a number of applications for the e-health services, including drowsiness detection and oriental medicine.

  10. A Fuzzy Model to Interpret Data of Drive Performances from Patients with Sleep Deprivation

    Directory of Open Access Journals (Sweden)

    Pasquale Sena

    2012-01-01

    Full Text Available The search for safe vehicles is increasing with both diffusion of high traffic density over the world and availability of new technologies providing sophisticated tools previously impossible to realize. Design and development of the necessary devices may be based on simulation tests that reduce cost allowing trials in many directions. A proper choice of the arrangement of the drive simulators, as much as of the parameters to be monitored, is of basic importance as they can address the design of devices somehow responsible for the drivers safety or, even their lives. This system setup, consisting of a free car simulator equipped with a monitoring system, collects in a nonintrusive way data of the car lateral position within the road lane and of its first derivative. Based on these measured parameters, the system is able to detect symptoms of drowsiness and sleepiness. The analysis is realized by a fuzzy inferential process that provides an immediate warning signal as soon as drowsiness is detected with a high level of certainty. Enhancement of reliability and minimisation of the false alarm rate are obtained by operating continuous comparison between learned driver typical modalities of operation on the control command of the vehicle the pattern recorded.

  11. A fuzzy model to interpret data of drive performances from patients with sleep deprivation.

    Science.gov (United States)

    Sena, Pasquale; Attianese, Paolo; Carbone, Francesca; Pellegrino, Arcangelo; Pinto, Aldo; Villecco, Francesco

    2012-01-01

    The search for safe vehicles is increasing with both diffusion of high traffic density over the world and availability of new technologies providing sophisticated tools previously impossible to realize. Design and development of the necessary devices may be based on simulation tests that reduce cost allowing trials in many directions. A proper choice of the arrangement of the drive simulators, as much as of the parameters to be monitored, is of basic importance as they can address the design of devices somehow responsible for the drivers safety or, even their lives. This system setup, consisting of a free car simulator equipped with a monitoring system, collects in a nonintrusive way data of the car lateral position within the road lane and of its first derivative. Based on these measured parameters, the system is able to detect symptoms of drowsiness and sleepiness. The analysis is realized by a fuzzy inferential process that provides an immediate warning signal as soon as drowsiness is detected with a high level of certainty. Enhancement of reliability and minimisation of the false alarm rate are obtained by operating continuous comparison between learned driver typical modalities of operation on the control command of the vehicle the pattern recorded.

  12. Investigating Driver Fatigue versus Alertness Using the Granger Causality Network

    Directory of Open Access Journals (Sweden)

    Wanzeng Kong

    2015-08-01

    Full Text Available Driving fatigue has been identified as one of the main factors affecting drivers’ safety. The aim of this study was to analyze drivers’ different mental states, such as alertness and drowsiness, and find out a neurometric indicator able to detect drivers’ fatigue level in terms of brain networks. Twelve young, healthy subjects were recruited to take part in a driver fatigue experiment under different simulated driving conditions. The Electroencephalogram (EEG signals of the subjects were recorded during the whole experiment and analyzed by using Granger-Causality-based brain effective networks. It was that the topology of the brain networks and the brain’s ability to integrate information changed when subjects shifted from the alert to the drowsy stage. In particular, there was a significant difference in terms of strength of Granger causality (GC in the frequency domain and the properties of the brain effective network i.e., causal flow, global efficiency and characteristic path length between such conditions. Also, some changes were more significant over the frontal brain lobes for the alpha frequency band. These findings might be used to detect drivers’ fatigue levels, and as reference work for future studies.

  13. Clinical and financial implications of emergency department visits for synthetic marijuana.

    Science.gov (United States)

    Rowley, Eric; Benson, David; Tiffee, Aaron; Hockensmith, Adam; Zeng, Henry; Jones, Glenn N; Musso, Mandi W

    2017-10-01

    Many users believe that synthetic cannabinoids offer a safe and legal means of getting high. However, spikes in emergency department visits have been associated with use of synthetic cannabinoids. The purpose of the current study was to document emergency department visits from three large hospitals in one metropolitan area over a two month period. This was a retrospective chart review examining 218 patients presenting to three inner city emergency departments between March and April 2014. Data collected included demographic information, information regarding ED diagnosis and treatment, signs and symptoms, ancillary testing, ED disposition, and cost of the medical treatment. The majority of patients (75.7%) were discharged after ED workup, but 12.4% were admitted for medical treatment and 11.5% were admitted for psychiatric treatment. Ten patients (4.6%) were admitted to the ICU. Symptoms experienced most frequently include: hypertension, tachycardia, agitation, drowsiness, nausea, and confusion. Cluster analysis revealed four symptom clusters of individuals presenting after using synthetic cannabinoids: 1) confusion, hostility, agitation, 2) nausea, vomiting, abdominal pain, 3) drowsiness, and 4) the absence of these symptoms. This study has three important findings. First, significant ED resources are being used to treat individuals presenting due to effects of synthetic cannabis. Second, synthetic cannabis is not a benign substance. Third, while the hostile and agitated user is generally presented in the media, this study finds significant heterogeneity in presentation. Further research is needed to fully understand the implications of synthetic cannabinoid use. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Comparison of toxicity of acute overdoses with citalopram and escitalopram.

    Science.gov (United States)

    Hayes, Bryan D; Klein-Schwartz, Wendy; Clark, Richard F; Muller, Allison A; Miloradovich, Jane E

    2010-07-01

    Seizures and QTc prolongation are associated with citalopram poisoning; however, overdose experience with escitalopram is more limited. The goals of this study were to compare citalopram's vs. escitalopram's clinical effects in overdose, including the incidence of seizures. A retrospective review was conducted for single-substance acute overdoses with citalopram and escitalopram, managed in hospitals, that were reported to six U.S. poison centers from 2002-2005. There were 374 citalopram and 421 escitalopram overdose cases. Gender and ages were similar between the two, with 68-70% females and a median age of 20 years for citalopram and 18 years for escitalopram. Median dose by history was 310 mg for citalopram and 130 mg for escitalopram. More serious outcomes were associated with citalopram overdoses (p escitalopram were tachycardia, drowsiness, hypertension, and vomiting. Seizures (30 vs. 1, respectively, p escitalopram cases (p = 0.109). There was an association between increasing dose and severity of outcome for citalopram (p escitalopram (p = 0.011). In children escitalopram cases experienced toxicity, such as drowsiness, nausea/vomiting, and tachycardia. There were no seizures in this age group. Escitalopram seems to be less toxic than citalopram after an acute overdose; seizures and tremors were more common with citalopram. Initial management of overdoses should include seizure precautions for citalopram and cardiac monitoring for both drugs. Copyright 2010 Elsevier Inc. All rights reserved.

  15. The Effect of Aromatherapy on Insomnia and Other Common Symptoms Among Patients With Acute Leukemia

    Science.gov (United States)

    Blackburn, Lisa; Achor, Sara; Allen, Betty; Bauchmire, Nicole; Dunnington, Danielle; Klisovic, Rebecca; Naber, Steven; Roblee, Kirsten; Samczak, Angela; Tomlinson-Pinkham, Kelly; Chipps, Esther

    2017-07-01

    To determine if the use of aromatherapy improves insomnia and other common symptoms in hospitalized patients with newly diagnosed acute leukemia. A randomized, crossover, washout trial. An inpatient acute leukemia unit at the Arthur G. James Cancer Hospital and Richard L. Solove Research Institute of the Wexner Medical Center at Ohio State University in Columbus. 50 patients who were newly diagnosed with acute leukemia and hospitalized to receive their initial four weeks of intensive induction chemotherapy. Patients were offered a choice of three scents to be used during the trial: lavender, peppermint, or chamomile. Each patient was randomized to receive either the chosen aromatherapy intervention or a placebo intervention during alternate weeks, with a washout period in between. Sleep quality and other common symptoms were measured. Aromatherapy, sleep, insomnia, pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, and well-being. Most patients reported poor quality sleep at baseline, but aromatherapy had a statistically significant positive impact. Improvements were noted in tiredness, drowsiness, lack of appetite, depression, anxiety, and well-being because of aromatherapy. Aromatherapy is a viable intervention for improving insomnia and other symptoms commonly experienced by patients with acute leukemia. Oncology nurses can employ aromatherapy safely and inexpensively, and with minimal training, as an effective tool in decreasing many symptoms that plague patients with leukemia. Patients can exercise a greater sense of control over their treatment environments through the use of aromatherapy.

  16. Napping on the Night Shift: A Two-Hospital Implementation Project

    Science.gov (United States)

    Brown, Jeanne Geiger; Sagherian, Knar; Zhu, Shijun; Wieroniey, Margaret; Blair, Lori; Warren, Joan; Hinds, Pamela; Szeles, Rose

    2015-01-01

    Some nurses who work the night shift experience high levels of sleepiness. Napping has been adopted as an effective countermeasure to sleepiness and fatigue in other safety-sensitive industries but has not had widespread acceptance in nursing. In this two-hospital implementation project, napping was offered to six nursing units where nurse executives had previously approved nap implementation for the night shift as a pilot project. Successful implementation occurred in only one of the six units with partial success in a second unit. Barriers primarily occurred at the point of seeking unit-based nursing leadership approval. On the successful unit, one hundred fifty three 30-minutes naps were taken during the 3-month pilot period. A Nap Experience Survey measured sleepiness prior to the nap, the nap duration and perceived sleep, sleep inertia after the nap, and the perceived helpfulness of the nap. A high level of sleepiness was present at the beginning of 44% of naps. For over half of naps, nurses reported sleeping slightly (43%) or deeply (14%). Sleep inertia was rare (very groggy or sluggish on arising, 1.3%). The average score of helpfulness of napping was high (7.3 on a 1–10 scale). Nurses who napped reported being less drowsy while driving home after their shift. These data suggest that when barriers to napping are overcome, napping on the nightshift is feasible and can reduce sleepiness and drowsy driving in nurses. PMID:27082421

  17. Optical flow and driver's kinematics analysis for state of alert sensing.

    Science.gov (United States)

    Jiménez-Pinto, Javier; Torres-Torriti, Miguel

    2013-03-28

    Road accident statistics from different countries show that a significant number of accidents occur due to driver's fatigue and lack of awareness to traffic conditions. In particular, about 60% of the accidents in which long haul truck and bus drivers are involved are attributed to drowsiness and fatigue. It is thus fundamental to improve non-invasive systems for sensing a driver's state of alert. One of the main challenges to correctly resolve the state of alert is measuring the percentage of eyelid closure over time (PERCLOS), despite the driver's head and body movements. In this paper, we propose a technique that involves optical flow and driver's kinematics analysis to improve the robustness of the driver's alert state measurement under pose changes using a single camera with near-infrared illumination. The proposed approach infers and keeps track of the driver's pose in 3D space in order to ensure that eyes can be located correctly, even after periods of partial occlusion, for example, when the driver stares away from the camera. Our experiments show the effectiveness of the approach with a correct eyes detection rate of 99.41%, on average. The results obtained with the proposed approach in an experiment involving fifteen persons under different levels of sleep deprivation also confirm the discriminability of the fatigue levels. In addition to the measurement of fatigue and drowsiness, the pose tracking capability of the proposed approach has potential applications in distraction assessment and alerting of machine operators.

  18. Online Detection of Driver Fatigue Using Steering Wheel Angles for Real Driving Conditions

    Directory of Open Access Journals (Sweden)

    Zuojin Li

    2017-03-01

    Full Text Available This paper presents a drowsiness on-line detection system for monitoring driver fatigue level under real driving conditions, based on the data of steering wheel angles (SWA collected from sensors mounted on the steering lever. The proposed system firstly extracts approximate entropy (ApEnfeaturesfromfixedslidingwindowsonreal-timesteeringwheelanglestimeseries. Afterthat, this system linearizes the ApEn features series through an adaptive piecewise linear fitting using a given deviation. Then, the detection system calculates the warping distance between the linear features series of the sample data. Finally, this system uses the warping distance to determine the drowsiness state of the driver according to a designed binary decision classifier. The experimental data were collected from 14.68 h driving under real road conditions, including two fatigue levels: “wake” and “drowsy”. The results show that the proposed system is capable of working online with an average 78.01% accuracy, 29.35% false detections of the “awake” state, and 15.15% false detections of the “drowsy” state. The results also confirm that the proposed method based on SWA signal is valuable for applications in preventing traffic accidents caused by driver fatigue.

  19. Positive emotion word use and longevity in famous deceased psychologists.

    Science.gov (United States)

    Pressman, Sarah D; Cohen, Sheldon

    2012-05-01

    This study examined whether specific types of positive and negative emotional words used in the autobiographies of well-known deceased psychologists were associated with longevity. For each of the 88 psychologists, the percent of emotional words used in writing was calculated and categorized by valence (positive or negative) and arousal (activated [e.g., lively, anxious] or not activated [e.g., calm, drowsy]) based on existing emotion scales and models of emotion categorization. After controlling for sex, year of publication, health (based on disclosed illness in autobiography), native language, and year of birth, the use of more activated positive emotional words (e.g., lively, vigorous, attentive, humorous) was associated with increased longevity. Negative terms (e.g., angry, afraid, drowsy, sluggish) and unactivated positive terms (e.g., peaceful, calm) were not related to longevity. The association of activated positive emotions with longevity was also independent of words indicative of social integration, optimism, and the other affect/activation categories. Results indicate that in writing, not every type of emotion correlates with longevity and that there may be value to considering different categories beyond emotional valence in health relevant outcomes.

  20. Comparison of the Effects of Attachment Training for Mothers on the Behavioral Responses of Premature Infants: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Mitra Edraki

    2015-06-01

    Full Text Available Background: Premature infants are among high-risk groups in community who need to be hospitalized at intensive care units for survival and receiving basic or special care. Hospitalization at neonatal intensive care units (NICUs unsettles the family and leads to the separation of parents from their infants. This study aimed to determine the effects of maternal attachment behaviors on the behavioral responses of premature infants, hospitalized at NICUs. Methods: In this randomized clinical trial, 64 premature infants, who were hospitalized at NICUs and were eligible for the study, were randomly allocated to study and control groups. Attachment behaviors including touching, massage and kangaroo care were applied for the study group, while the conventional attachment method was adopted for the control group. Behavioral responses were evaluated two hours before and two hours after training attachment behaviors. Data were analyzed, using Chi-square and student’s t-test. Results: The mean difference in the duration of deep sleep and consciousness was more significant in the study group, compared to the control group. Furthermore, the duration of drowsiness was significantly less in the study group, compared to the control group. Conclusion: The implementation of attachment training at NICUs decreased the time of drowsiness and improved behavioral responses, deep sleep time and consciousness.

  1. Anesthesia Practice and Clinical Trends in Interventional Radiology: A European Survey

    International Nuclear Information System (INIS)

    Haslam, Philip J.; Yap, Bernard; Mueller, Peter R.; Lee, Michael J.

    2000-01-01

    Purpose: To determine current European practice in interventional radiology regarding nursing care, anesthesia, and clinical care trends.Methods: A survey was sent to 977 European interventional radiologists to assess the use of sedoanalgesia, nursing care, monitoring equipment, pre- and postprocedural care, and clinical trends in interventional radiology. Patterns of sedoanalgesia were recorded for both vascular and visceral interventional procedures. Responders rated their preferred level of sedoanalgesia for each procedure as follows: (a) awake/alert, (b) drowsy/arousable, (c) asleep/arousable, (d) deep sedation, and (e) general anesthesia. Sedoanalgesic drugs and patient care trends were also recorded. A comparison was performed with data derived from a similar survey of interventional practice in the United States.Results: Two hundred and forty-three of 977 radiologists responded (25%). The total number of procedures analyzed was 210,194. The majority (56%) of diagnostic and therapeutic vascular procedures were performed at the awake/alert level of sedation, 32% were performed at the drowsy/arousable level, and 12% at deeper levels of sedation. The majority of visceral interventional procedures were performed at the drowsy/arousable level of sedation (41%), 29% were performed at deeper levels of sedation, and 30% at the awake/alert level. In general, more sedoanalgesia is used in the United States. Eighty-three percent of respondents reported the use of a full-time radiology nurse, 67% used routine blood pressure/pulse oximetry monitoring, and 46% reported the presence of a dedicated recovery area. Forty-nine percent reported daily patient rounds, 30% had inpatient hospital beds, and 51% had day case beds.Conclusion: This survey shows clear differences in the use of sedation for vascular and visceral interventional procedures. Many, often complex, procedures are performed at the awake/alert level of sedation in Europe, whereas deeper levels of sedation are

  2. Evaluation of blue light exposure to beta brainwaves on simulated night driving

    Science.gov (United States)

    Purawijaya, Dandri Aly; Fitri, Lulu Lusianti; Suprijanto

    2015-09-01

    Numbers of night driving accident in Indonesia since 2010 are exponentially rising each year with total of loss more than 50 billion rupiah. One of the causes that contribute to night driving accident is drowsiness. Drowsiness is affected by circadian rhythm resulted from the difference of blue light quality and quantity between night and day. Blue light may effect on human physiology through non-visual pathway by suppressing melatonin hormone suppression that influence drowsiness. Meanwhile, the production of hormones and other activities in brain generate bioelectrical activity such as brainwaves and can be recorded using Electroencephalograph (EEG). Therefore, this research objective is to evaluate the effect of blue light exposure to beta brainwave emergence during night driving simulation to a driver. This research was conducted to 4 male subjects who are able to drive and have a legitimate car driving license. The driving simulator was done using SCANIA Truck Driving Simulator on freeform driving mode in dark environment. Subjects drove for total 32 minutes. The data collections were taken in 2 days with 16 minutes for each day. The 16 minutes were divided again into 8 minutes adaptation in dark and 8 minutes for driving either in blue light exposure or in total darkness. While driving the simulation, subjects' brainwaves were recorded using EEG EMOTIV 14 Channels, exposed by LED monochromatic blue light with 160 Lux from source and angle 45o and sat 1 m in front of the screen. Channels used on this research were for visual (O1; O2), cognition (F3; F4; P7; P8), and motor (FC5; FC6). EEG brainwave result was filtered with EEGLab to obtain beta waves at 13 - 30 Hz frequencies. Results showed that beta waves response to blue light varied for each subject. Blue light exposure either increased or decreased beta waves in 2 minutes pattern and maintaining beta waves on cognition and motor area in 3 out of 4 subjects. Meanwhile, blue light exposure did not maintain

  3. Patient-reported symptoms during radiotherapy : Clinically relevant symptom burden in patients treated with palliative and curative intent.

    Science.gov (United States)

    Körner, Philipp; Ehrmann, Katja; Hartmannsgruber, Johann; Metz, Michaela; Steigerwald, Sabrina; Flentje, Michael; van Oorschot, Birgitt

    2017-07-01

    The benefits of patient-reported symptom assessment combined with integrated palliative care are well documented. This study assessed the symptom burden of palliative and curative-intent radiation oncology patients. Prior to first consultation and at the end of RT, all adult cancer patients planned to receive fractionated percutaneous radiotherapy (RT) were asked to answer the Edmonton Symptom Assessment Scale (ESAS; nine symptoms from 0 = no symptoms to 10 = worst possible symptoms). Mean values were used for curative vs. palliative and pre-post comparisons, and the clinical relevance was evaluated (symptom values ≥ 4). Of 163 participating patients, 151 patients (90.9%) completed both surveys (116 curative and 35 palliative patients). Before beginning RT, 88.6% of palliative and 72.3% of curative patients showed at least one clinically relevant symptom. Curative patients most frequently named decreased general wellbeing (38.6%), followed by tiredness (35.0%), anxiety (32.4%), depression (30.0%), pain (26.3%), lack of appetite (23.5%), dyspnea (17.8%), drowsiness (8.0%) and nausea (6.1%). Palliative patients most frequently named decreased general wellbeing (62.8%), followed by pain (62.8%), tiredness (60.0%), lack of appetite (40.0%), anxiety (38.0%), depression (33.3%), dyspnea (28.5%), drowsiness (25.7%) and nausea (14.2%). At the end of RT, the proportion of curative and palliative patients with a clinically relevant symptom had increased significantly to 79.8 and 91.4%, respectively; whereas the proportion of patients reporting clinically relevant pain had decreased significantly (42.8 vs. 62.8%, respectively). Palliative patients had significantly increased tiredness. Curative patients reported significant increases in pain, tiredness, nausea, drowsiness, lack of appetite and restrictions in general wellbeing. Assessment of patient-reported symptoms was successfully realized in radiation oncology routine. Overall, both groups showed a high symptom

  4. Patient-reported symptoms during radiotherapy. Clinically relevant symptom burden in patients treated with palliative and curative intent

    International Nuclear Information System (INIS)

    Koerner, Philipp; Ehrmann, Katja; Hartmannsgruber, Johann; Metz, Michaela; Steigerwald, Sabrina; Flentje, Michael; Oorschot, Birgitt van

    2017-01-01

    The benefits of patient-reported symptom assessment combined with integrated palliative care are well documented. This study assessed the symptom burden of palliative and curative-intent radiation oncology patients. Prior to first consultation and at the end of RT, all adult cancer patients planned to receive fractionated percutaneous radiotherapy (RT) were asked to answer the Edmonton Symptom Assessment Scale (ESAS; nine symptoms from 0 = no symptoms to 10 = worst possible symptoms). Mean values were used for curative vs. palliative and pre-post comparisons, and the clinical relevance was evaluated (symptom values ≥ 4). Of 163 participating patients, 151 patients (90.9%) completed both surveys (116 curative and 35 palliative patients). Before beginning RT, 88.6% of palliative and 72.3% of curative patients showed at least one clinically relevant symptom. Curative patients most frequently named decreased general wellbeing (38.6%), followed by tiredness (35.0%), anxiety (32.4%), depression (30.0%), pain (26.3%), lack of appetite (23.5%), dyspnea (17.8%), drowsiness (8.0%) and nausea (6.1%). Palliative patients most frequently named decreased general wellbeing (62.8%), followed by pain (62.8%), tiredness (60.0%), lack of appetite (40.0%), anxiety (38.0%), depression (33.3%), dyspnea (28.5%), drowsiness (25.7%) and nausea (14.2%). At the end of RT, the proportion of curative and palliative patients with a clinically relevant symptom had increased significantly to 79.8 and 91.4%, respectively; whereas the proportion of patients reporting clinically relevant pain had decreased significantly (42.8 vs. 62.8%, respectively). Palliative patients had significantly increased tiredness. Curative patients reported significant increases in pain, tiredness, nausea, drowsiness, lack of appetite and restrictions in general wellbeing. Assessment of patient-reported symptoms was successfully realized in radiation oncology routine. Overall, both groups showed a high symptom burden

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

    Directory of Open Access Journals (Sweden)

    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.

  6. A case of multiple intracranial tuberculomas accompanied by tuberculous meningitis

    International Nuclear Information System (INIS)

    Fukabori, Takashi; Takamatsu, Hajime; Nakanishi, Yasuhiro

    1986-01-01

    A 63-year-old man was admitted for headache and progressive drowsiness. In spite of negative results from cerebrospinal fluid (CSF) stains and cultures of tuberculosis and other bacteria, CSF findings and tuberculosis-positive sputum culture led to a tentative diagnosis of tuberculous meningitis. Symptoms and neurological test results both improved remarkably during antituberculous chemotherapy. Although the brain CT scan taken on admission showed no abnormal findings, one taken two months later revealed multiple high-density areas after enhancement with a contrast medium, suggesting multiple intracranial tuberculomas accompanied by tuberculous meningitis. The size of the multiple high-density areas gradually decreased during antituberculous chemotherapy. The CT scan can clearly locate lesions, detect complications, and evaluate the effects of treatment in patients with intracranial tuberculosis. (author)

  7. A Case of Nongerminomatous Germ Cell Tumor of the Pineal Region: Risks and Advantages of Biopsy by Endoscopic Approach.

    Science.gov (United States)

    Dobran, Mauro; Nasi, Davide; Mancini, Fabrizio; Gladi, Maurizio; Scerrati, Massimo

    2018-01-01

    A 21-year-old male was admitted to our department with headache and drowsiness. CT scan and MRI revealed acute obstructive hydrocephalus caused by a pineal region mass. The serum and CSF levels of beta-human chorionic gonadotropin (beta-hCG) were 215 IU/L and 447 IU/L, respectively, while levels of alpha-fetoprotein (AFP) were normal. A germ cell tumor (GCT) was suspected, and the patient underwent endoscopic third ventriculostomy (ETV) with biopsy. After four days from surgery, the tumor bled with mass expansion and ETV stoma occlusion; thus, a ventriculoperitoneal shunt was positioned. After ten months, the tumor metastasized to the thorax and abdomen with progression of intracerebral tumor mass. Despite the aggressive nature of this tumor, ETV remains a valid approach for a pineal region mass, but in case of GCT, the risk of bleeding should be taken into account, during and after the surgical procedure.

  8. A Case of Nongerminomatous Germ Cell Tumor of the Pineal Region: Risks and Advantages of Biopsy by Endoscopic Approach

    Directory of Open Access Journals (Sweden)

    Mauro Dobran

    2018-01-01

    Full Text Available A 21-year-old male was admitted to our department with headache and drowsiness. CT scan and MRI revealed acute obstructive hydrocephalus caused by a pineal region mass. The serum and CSF levels of beta-human chorionic gonadotropin (beta-hCG were 215 IU/L and 447 IU/L, respectively, while levels of alpha-fetoprotein (AFP were normal. A germ cell tumor (GCT was suspected, and the patient underwent endoscopic third ventriculostomy (ETV with biopsy. After four days from surgery, the tumor bled with mass expansion and ETV stoma occlusion; thus, a ventriculoperitoneal shunt was positioned. After ten months, the tumor metastasized to the thorax and abdomen with progression of intracerebral tumor mass. Despite the aggressive nature of this tumor, ETV remains a valid approach for a pineal region mass, but in case of GCT, the risk of bleeding should be taken into account, during and after the surgical procedure.

  9. Superior orbital fissure syndrome in herpes zoster ophthalmicus.

    LENUS (Irish Health Repository)

    Kirwan, R P

    2012-02-01

    AIM: To report a case of superior orbital fissure syndrome (SOFS) in a patient with herpes zoster ophthalmicus (HZO). MATERIALS AND METHODS: A case report. RESULTS: A 71-year-old male with HZO presented acutely to accident and emergency complaining of right vision loss, double vision and drowsiness. The right visual acuity was counting fingers. There was no relative afferent pupillary defect. He had interstitial keratitis, ptosis, proptosis and total ophthalmoplaegia. The signs indicated HZO complicated by SOFS. Brain imaging and lumbar puncture confirmed the diagnosis of varicella zoster encephalitis. Systemic acyclovir and prednisolone led to recovery of visual acuity and ocular motility in addition to resolution of his proptosis and ptosis. CONCLUSION: SOFS is a rare complication of herpes zoster infection. With the appropriate treatment and follow-up, patients may be reassured that recovery of their visual acuity and ocular motility will occur.

  10. Herpetic brainstem encephalitis: report of a post-mortem case studied electron microscopically and immunohisiochemically

    Directory of Open Access Journals (Sweden)

    José Eymard Homem Pitella

    1987-03-01

    Full Text Available A post-mortem examined case of herpetic brainstem encephalitis is presented. Clinically, the patient had cephalea followed by ataxia, drowsiness and multiple palsies of some cranial nerves, developing into death in eight days. The pathologic examination of the brain showed necrotizing encephalitis in multiple foci limited to the brainstem, more distinctly in the pons and medula oblongata. The technique of immunoperoxidase revealed rare glial cells with intranuclear immunoreactivity for herpes antigen. Rare viral particles with the morphological characteristics of the herpesvirus were identified in the nuclei of neurons in 10% formol fixed material. This is the second reported case of herpetic brainstem encephalitis confirmed by post-mortem examination. The pathway used by the virus to reach the central nervous system and its posterior dissemination to the oral cavity, the orbitofrontal region and the temporal lobes as well as to the brainstem, after a period of latency and reactivation, are discussed.

  11. Myocardial infarction after near drowning.

    Science.gov (United States)

    Chen, Li-Bang; Lai, Yen-Chun; Chen, Chang-Chih; Chang, Wen-Han; Su, Yu-Jang

    2008-06-01

    During summer, near drowning is a common accident in Taiwan. It may lead to multiple organ damages in cases where severe hypothermia and hypoxemia occur. We present a case of myocardial infarction after near drowning. The patient was sent to our ED by the emergency medical services called by the witness. On arrival to our ED, hypothermia and hypoxemia overcame him. Endotracheal intubation and warm intravenous fluid were applied at once owing to drowsy consciousness, respiratory distress, and hypothermia. Electrocardiogram showed diffuse ST-segment elevation over the precordial leads V2-V6. The initial level of cardiac enzymes was within normal limit but elevated in troponin I on the second day after hospitalization. We presumed that the possibility of myocardial infarction resulted from near drowning-related hypoxemia. To our knowledge, this is the first case describing myocardial injury with electrocardiogram changes after near drowning.

  12. Hypoglycaemic haemiparesis

    Science.gov (United States)

    Kirresh, Othman; Kamara, Achmed; Samadian, Samad

    2013-01-01

    Hypoglycaemic haemiparesis (HH) is an uncommon but important presentation to the emergency department, and it often mimics stroke and is therefore frequently misdiagnosed by clinicians. The mechanism of haemiparesis is not fully understood. This case outlines a diabetic elderly woman, who had been having frequent hypoglycaemic episodes and presented to paramedics with hypoglycaemia associated with a right-sided haemiparesis. She was immediately transferred to the local stroke centre after presenting to the emergency department. CT and MRI did not fit in with her presenting neurology. Her weakness resolved, after normoglycaemia was achieved with dextrose infusion; however, she was reported to be more sleepy and drowsy than usual. After extensive and costly investigations during her prolonged inpatient stay, her unifying diagnosis was an HH which triggered of a hypoactive delirium. PMID:24130203

  13. Psychophysiological Manifestations Associated With Stress in Students of a Public University in Mexico.

    Science.gov (United States)

    Pozos-Radillo, Elizabeth; Preciado-Serrano, Lourdes; Plascencia-Campos, Ana; Valdez-López, Rosa; Morales-Fernández, Armando

    2016-05-01

    Academic stress is defined as a physiological, emotional, cognitive, and behavioral activation reaction to stimuli. This stress can impact students' ability to cope with the school environment. To identify the psychophysiological manifestations associated with high-level academic stress in public university students in Mexico. A representative random sampling of 527 students was evaluated during 2012. The Academic Stress Symptom Inventory and the Rossi classification were used; data were analyzed with a binary logistic regression analysis to estimate association between psychophysiological manifestations and the high level of academic stress in public university students. Results indicated a meaningful association between high levels of academic stress situations and psychophysiological manifestations such as concentration and memory problems, mental blocks and chronic fatigue, drowsiness, and despair. Identifying academic stress situations and students' maladaptive responses may help promote timely attention to psychophysiological manifestations before they exacerbate and become harmful to college students' health. © 2016 Wiley Periodicals, Inc.

  14. Losing the left side of the world: rightward shift in human spatial attention with sleep onset.

    Science.gov (United States)

    Bareham, Corinne A; Manly, Tom; Pustovaya, Olga V; Scott, Sophie K; Bekinschtein, Tristan A

    2014-05-28

    Unilateral brain damage can lead to a striking deficit in awareness of stimuli on one side of space called Spatial Neglect. Patient studies show that neglect of the left is markedly more persistent than of the right and that its severity increases under states of low alertness. There have been suggestions that this alertness-spatial awareness link may be detectable in the general population. Here, healthy human volunteers performed an auditory spatial localisation task whilst transitioning in and out of sleep. We show, using independent electroencephalographic measures, that normal drowsiness is linked with a remarkable unidirectional tendency to mislocate left-sided stimuli to the right. The effect may form a useful healthy model of neglect and help in understanding why leftward inattention is disproportionately persistent after brain injury. The results also cast light on marked changes in conscious experience before full sleep onset.

  15. Antipsychotic-induced somnolence in mothers with schizophrenia.

    Science.gov (United States)

    Seeman, Mary V

    2012-03-01

    Although it is known that many antipsychotic drugs, at the doses prescribed for schizophrenia, are sedative and cause daytime drowsiness, the effect of potentially diminished vigilance on parenting parameters has not been studied. The aim of this paper is to advise clinicians about sedative load in mothers who are prescribed antipsychotic medication. A Medline search was conducted into the sedative effects of antipsychotics, with the following search terms: sleep; sedation; somnolence; wakefulness; antipsychotics; schizophrenia, parenting, maternal behavior, and custody. The results showed that antipsychotic drugs differ in their propensity to induce sedation and do so via their effects on a variety of neurotransmitter systems. It is important to note that mothers with schizophrenia risk losing custody of their infants if they are perceived as potentially neglectful because of excessive daytime sleepiness. Clinicians must choose antipsychotic medications carefully and monitor for sedative effects whenever the patient has important responsibilities that require the maintenance of vigilance.

  16. Quadratus lumborum block for post-operative pain relief in patient with Prune belly syndrome.

    Science.gov (United States)

    Garg, Chitra; Khanna, Sangeeta; Mehta, Yatin

    2017-10-01

    Abdominal field blocks are commonly used as part of multimodal analgesia for post-operative pain relief in patients undergoing abdominal surgery. Conventionally, transversus abdominis plane block is used, but has the disadvantage of limited spread only to T10-T12 segments, providing only partial pain relief. The new quadratus lumborum (QL) block has the advantage of providing wider sensory block from T6 to L1 and thus has an evolving role in opioid-free anaesthesia. Opioid-induced cough depression, urinary retention, and drowsiness can be problematic in patients with Prune belly syndrome, who have deficient abdominal muscles and myriad of genitourinary problems. We report a case of a young male with Prune belly syndrome, who had a pain-free post-operative period after high inguinal orchidectomy with unilateral QL block.

  17. Quadratus lumborum block for post-operative pain relief in patient with Prune belly syndrome

    Directory of Open Access Journals (Sweden)

    Chitra Garg

    2017-01-01

    Full Text Available Abdominal field blocks are commonly used as part of multimodal analgesia for post-operative pain relief in patients undergoing abdominal surgery. Conventionally, transversus abdominis plane block is used, but has the disadvantage of limited spread only to T10–T12 segments, providing only partial pain relief. The new quadratus lumborum (QL block has the advantage of providing wider sensory block from T6 to L1 and thus has an evolving role in opioid-free anaesthesia. Opioid-induced cough depression, urinary retention, and drowsiness can be problematic in patients with Prune belly syndrome, who have deficient abdominal muscles and myriad of genitourinary problems. We report a case of a young male with Prune belly syndrome, who had a pain-free post-operative period after high inguinal orchidectomy with unilateral QL block.

  18. Noninvasive Ventilatory Correction as an Adjunct to an Experimental Systemic Reperfusion Therapy in Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Kristian Barlinn

    2010-01-01

    Full Text Available Background. Obstructive sleep apnea (OSA is a common condition in patients with acute ischemic stroke and associated with early clinical deterioration and poor functional outcome. However, noninvasive ventilatory correction is hardly considered as a complementary treatment option during the treatment phase of acute ischemic stroke. Summary of Case. A 55-year-old woman with an acute middle cerebral artery (MCA occlusion received intravenous tissue plasminogen activator (tPA and enrolled into a thrombolytic research study. During tPA infusion, she became drowsy, developed apnea episodes, desaturated and neurologically deteriorated without recanalization, re-occlusion or intracerebral hemorrhage. Urgent noninvasive ventilatory correction with biphasic positive airway pressure (BiPAP reversed neurological fluctuation. Her MCA completely recanalized 24 hours later. Conclusions. Noninvasive ventilatory correction should be considered more aggressively as a complementary treatment option in selected acute stroke patients. Early initiation of BiPAP can stabilize cerebral hemodynamics and may unmask the true potential of other therapies.

  19. Caffeine and exercise.

    Science.gov (United States)

    Paluska, Scott A

    2003-08-01

    Caffeine is the most commonly consumed drug in the world, and athletes frequently use it as an ergogenic aid. It improves performance and endurance during prolonged, exhaustive exercise. To a lesser degree it also enhances short-term, high-intensity athletic performance. Caffeine improves concentration, reduces fatigue, and enhances alertness. Habitual intake does not diminish caffeine's ergogenic properties. Several mechanisms have been proposed to explain the physiologic effects of caffeine, but adenosine receptor antagonism most likely accounts for the primary mode of action. It is relatively safe and has no known negative performance effects, nor does it cause significant dehydration or electrolyte imbalance during exercise. Routine caffeine consumption may cause tolerance or dependence, and abrupt discontinuation produces irritability, mood shifts, headache, drowsiness, or fatigue. Major sport governing bodies ban excessive use of caffeine, but current monitoring techniques are inadequate, and ethical dilemmas persist regarding caffeine intake by athletes.

  20. Adolescent Sleepiness: Causes and Consequences.

    Science.gov (United States)

    Hansen, Shana L; Capener, Dale; Daly, Christopher

    2017-09-01

    Insufficient sleep duration and poor sleep quality are common among adolescents. The multidimensional causes of insufficient sleep duration and poor sleep quality include biological, health-related, environmental, and lifestyle factors. The most common direct consequence of insufficient and/or poor sleep quality is excessive daytime sleepiness, which may contribute to poor academic performance, behavioral health problems, substance use, and drowsy driving. Evaluation of sleepiness includes a detailed sleep history and sleep diary, with polysomnography only required for the assessment of specific sleep disorders. Management involves encouraging healthy sleep practices such as having consistent bed and wake times, limiting caffeine and electronics at night before bed, and eliminating napping, in addition to treating any existing sleep or medical disorders. [Pediatr Ann. 2017;46(9):e340-e344.]. Copyright 2017, SLACK Incorporated.

  1. Endogenous endophthalmitis and Horner’s syndrome secondary to brain abscess in HIV patient

    Directory of Open Access Journals (Sweden)

    Ali Raghibi

    2011-09-01

    Full Text Available A 39-year-old Malay gentleman was presented with sudden onset of blurring of vision, associated with pain, redness and partial ptosis in the left eye (LE for 2 weeks. It was also associated with headache and drowsiness that were progressively worsened. On examination, the vision was hand movement LE. There was partial upper lid ptosis with injected conjunctiva and mild anterior chamber reaction. The view of the posterior segment was hazy on LE. The right eye was essentially normal. On investigation, B-scan ultrasound was suggestive of LE vitreous opacity. CT scan and MRI of the orbit and brain showed multiple enhancing brain lesions. Toxoplasma IgG, anti-HCV and anti-HIV were reactive and the patient was treated with toxoplasma infection.

  2. Rifampicin-induced adrenal crisis in a patient with tuberculosis: a therapeutic challenge.

    Science.gov (United States)

    Denny, Nicholas; Raghunath, Sarika; Bhatia, Praveen; Abdelaziz, Muntasir

    2016-11-29

    A 55-year-old Indian man presented with productive cough and a large left pleural effusion. Pleural fluid culture grew Mycobacterium tuberculosis, and he was started on antituberculosis therapy. One week later, the patient presented to hospital with drowsiness, dehydration and hypotension. He was transferred to critical care and only improved after starting hydrocortisone and stopping rifampicin. His short synACTHen test subsequently confirmed primary adrenal insufficiency, and a CT of the abdomen showed bilateral adrenal enlargement. Rifampicin is known to accelerate cortisol metabolism. We report the rare case of a rifampicin-induced adrenal crisis as a first presentation of Addison's disease in a patient with tuberculous infiltration of the adrenal glands. 2016 BMJ Publishing Group Ltd.

  3. [Adverse effects of oxcarbazepine].

    Science.gov (United States)

    Fang, Shu; Gong, Zhi-Cheng

    2015-04-01

    Oxcarbazepine is a new antiepileptic drug. The results of clinical trials suggest that oxcarbazepine is well tolerated and has less drug interactions. It is being used more and more widely in clinical practice, but its adverse effects should not be ignored. The most common adverse effects of oxcarbazepine are usually related to the central nervous system and digestive system, including fatigue, drowsiness, diplopia, dizziness, nausea and vomit. The common skin adverse reaction is rash. Long-term use of oxcarbazepine may also cause hyponatremia. This article reviews the literature from China and overseas about the adverse effets of oxcarbazepine over the last 10 years in order to find information about rational clinical use of oxcarbazepine.

  4. Sleep Management Strategy and Performance in an Extreme Mountain Ultra-marathon.

    Science.gov (United States)

    Poussel, Mathias; Laroppe, Julien; Hurdiel, Rémy; Girard, Julien; Poletti, Laurence; Thil, Catherine; Didelot, Antoine; Chenuel, Bruno

    2015-01-01

    We intended to assess the relationship between sleep strategies and performance during the North-Face Ultra-Trail du Mont-Blanc 2013, to test the hypothesis that sleep management can influence athletic performance. Almost all runners specifically adopted sleep management strategies before the race. Among the finishers 72% didn't sleep at all during the race and 28% took a least one break for sleep. Non-sleepers completed the race faster than the sleepers (P = 0.0008). Race time was positively correlated with drowsiness (P sleep management strategy based on increased sleep time before the race completed the race faster (P = 0.0258). Most finishers seemed to be aware of the importance of developing sleep management strategies and increasing sleep time some nights before the race appeared to be the most relevant strategy to improve performance.

  5. A risk scoring model based on vital signs and laboratory data predicting transfer to the intensive care unit of patients admitted to gastroenterology wards.

    Science.gov (United States)

    Kim, Won-Young; Lee, Jinmi; Lee, Ju-Ry; Jung, Youn Kyung; Kim, Hwa Jung; Huh, Jin Won; Lim, Chae-Man; Koh, Younsuck; Hong, Sang-Bum

    2017-08-01

    To compare the ability of a score based on vital signs and laboratory data with that of the modified early warning score (MEWS) to predict ICU transfer of patients with gastrointestinal disorders. Consecutive events triggering medical emergency team activation in adult patients admitted to the gastroenterology wards of the Asan Medical Center were reviewed. Binary logistic regression was used to identify factors predicting transfer to the ICU. Gastrointestinal early warning score (EWS-GI) was calculated as the sum of simplified regression weights (SRW). Of the 1219 included patients, 468 (38%) were transferred to the ICU. Multivariate analysis identified heart rate≥105bpm (SRW 1), respiratory rate≥26bpm (SRW 2), ACDU (Alert, Confused, Drowsy, Unresponsive) score≥1 (SRW 2), SpO 2 /FiO 2 ratiogastroenterology wards. The EWS-GI should be prospectively validated. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Olfactory neuroblastoma complicated by postirradiation pneumocephalus

    Energy Technology Data Exchange (ETDEWEB)

    Fusejima, Toru; Matsumura, Kenichirou; Hayano, Makoto [Mito Saiseikai Hospital (Japan)

    1990-11-01

    A 56-year-old male was admitted with the complaints of nasal bleeding, gait disturbance, and disturbance of consciousness. Neurological examination revealed drowsiness, right hemiparesis, and choked discs. Computed tomography scan showed an enhanced mass at the frontal base, which extended to the left nasal and paranasal cavities. Angiography showed a tumor stain with a mass sign. The intracranial part of the tumor was removed completely and he was discharged ambulatorily. Two months after surgery, however, he was admitted again for the regrowth of the tumor. Ventriculoperitoneal shunting was emplaced and radiation therapy was given to the brain and nasal cavity. After 3000 rad irradiation the clinical condition suddenly became worse because of pneumocephalus. The cranial tumor disappeared after irradiation but he died of metastases and general prostration. Clinically this case was diagnosed as an olfactory groove meningioma at first, but immunohistochemical diagnosis was olfactory neuroblastoma. (author).

  7. Sleep dysfunctions influence decision making in undemented Parkinson's disease patients: a study in a virtual supermarket.

    Science.gov (United States)

    Albani, Giovanni; Raspelli, Simona; Carelli, Laura; Priano, Lorenzo; Pignatti, Riccardo; Morganti, Francesca; Gaggioli, Andrea; Weiss, Patrice L; Kizony, Rachel; Katz, Noomi; Mauro, Alessandro; Riva, Giuseppe

    2011-01-01

    In the early-middle stages of Parkinson's disease (PD), polysomnographic studies show early alterations of the structure of the sleep, which may explain frequent symptoms reported by patients, such as daytime drowsiness, loss of attention and concentration, feeling of tiredness. The aim of this study was to verify if there is a correlation between the sleep dysfunction and decision making ability. We used a Virtual Reality version of the Multiple Errand Test (VMET), developed using the NeuroVR free software (http://www.neurovr2.org), to evaluate decision-making ability in 12 PD not-demented patients and 14 controls. Five of our not-demented 12 PD patients showed abnormalities in the polysomnographic recordings associated to significant differences in the VMET performance.

  8. Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: a randomized, double-blind study

    DEFF Research Database (Denmark)

    Holte, Kathrine; Klarskov, Birthe; Christensen, Dorte Stig

    2004-01-01

    ). All other aspects of perioperative management as well as preoperative fluid status were standardized. Primary outcome parameters were assessed repeatedly for the first 24 postoperative hours and included pulmonary function (spirometry), exercise capacity (submaximal treadmill test), cardiovascular...... hormonal responses, balance function, pain, nausea and vomiting, recovery, and hospital stay. RESULTS: Intraoperative administration of 40 mL/kg compared with 15 mL/kg LR led to significant improvements in postoperative pulmonary function and exercise capacity and a reduced stress response (aldosterone......, antidiuretic hormone, and angiotensin II). Nausea, general well-being, thirst, dizziness, drowsiness, fatigue, and balance function were also significantly improved, as well as significantly more patients fulfilled discharge criteria and were discharged on the day of surgery with the high-volume fluid...

  9. Real-time driver fatigue detection based on face alignment

    Science.gov (United States)

    Tao, Huanhuan; Zhang, Guiying; Zhao, Yong; Zhou, Yi

    2017-07-01

    The performance and robustness of fatigue detection largely decrease if the driver with glasses. To address this issue, this paper proposes a practical driver fatigue detection method based on face alignment at 3000 FPS algorithm. Firstly, the eye regions of the driver are localized by exploiting 6 landmarks surrounding each eye. Secondly, the HOG features of the extracted eye regions are calculated and put into SVM classifier to recognize the eye state. Finally, the value of PERCLOS is calculated to determine whether the driver is drowsy or not. An alarm will be generated if the eye is closed for a specified period of time. The accuracy and real-time on testing videos with different drivers demonstrate that the proposed algorithm is robust and obtain better accuracy for driver fatigue detection compared with some previous method.

  10. Sleepiness and health in midlife women: results of the National Sleep Foundation's 2007 Sleep in America poll.

    Science.gov (United States)

    Chasens, Eileen R; Twerski, Sarah R; Yang, Kyeongra; Umlauf, Mary Grace

    2010-01-01

    The 2007 Sleep in America poll, a random-sample telephone survey, provided data for this study of sleep in community-dwelling women aged 40 to 60 years. The majority of the respondents were post- or perimenopausal, overweight, married or living with someone, and reported good health. A subsample (20%) reported sleepiness that consistently interfered with daily life; the sleepy subsample reported more symptoms of insomnia, restless legs syndrome, obstructive sleep apnea, depression and anxiety, as well as more problems with health-promoting behaviors, drowsy driving, job performance, household duties, and personal relationships. Hierarchical regression showed that sleepiness along with depressive symptoms, medical comorbidities, obesity, and lower education were associated with poor self-rated health, whereas menopause status (pre-, peri- or post-) was not. These results suggest that sleep disruptions and daytime sleepiness negatively affect the daily life of midlife women.

  11. [Child poisoning after ingestion of a wild apiaceae: a case report].

    Science.gov (United States)

    Durand, M-F; Pommier, P; Chazalette, A; de Haro, L

    2008-02-01

    Apiaceae family (formerly Umbelliferae) contains several highly toxic species, including Poison Hemlock (Conium maculatum), Water Hemlock (Cicuta virosa) and Hemlock Water Dropwort (Oenanthe crocata) which are the three main poisonous Apiaceae species growing in France. Thinking he was identifying wild carrots, an 11-year-old boy without previous history ingested the root from a wild Apiaceae. One hour later, he was confused, had drowsiness, headache as well as abdominal pain, vomiting and diarrhoea. Upon hospital admission, myosis, ophtalmoplegia and a moderate rhabdomyolysis were noted. The patient recovered after 24 h of symptomatic treatments. In this case, the description of the ingested plant allowed to identify the Apiaceae family but not the species involved. The geographical location (Southern France in a humid area), the clinical features and the aspect of the ingested root, with an orange secretion led to implicate Oenanthe crocata as the origin of this unusual poisoning.

  12. [Guillain-Barré syndrome and pregnancy].

    Science.gov (United States)

    Panduro Baron, J G; Gamboa, R; Gaxiola Castro, R; Zamora Gallegos, G Y; Arellano Loera, D

    1993-07-01

    Guillain-Barré syndrome is a rare occurrence in pregnant women. We describe the case of a 21-year old woman, seen at "Nuevo Hospital Civil de Guadalajara" with a term pregnancy, who presented with limbs weakness and paresthesias, drowsiness and malaise. Her vital signs were normal but she was quadriparetic, there was muscular atrophy in the extremities and deep tendon reflexes were decreased. Spinal fluid analysis revealed a protein of 71.2 mg/dl, glucosa 48 mg/dl and no white cells and both Gram stain and routine cultures were negative. EMG studies reported poliradiculoneuritis; a C-section was done, and both the mother and a newborn girl did very well. Guillain-Barré syndrome should be suspected in similar cases in order to offer prompt intervention.

  13. Percutaneous transfermoral embolization of intracerebral arteriovenous malformation by using conventional catheter

    International Nuclear Information System (INIS)

    Choo, In Wook; Park, Soo Sung; Yoon, Jung Sup; Lim, Hyo Keun; Lee, Kyu Ho; Eoh, Whan

    1988-01-01

    Non-surgical transfermoral embolization of centrally located huge intracerebral arteriovenous malformation (AVM) was successfully performed by using conventional 6.5F DAVIS II Catheter in the department of Radiology, Kangdong Sacred Heart Hospital, May 17, 1988. The large A.V.M. was located in left basal ganglia and thalamus on brain C.T. and was supplied by multiple dilated lateral lenticulostriate arteries from left middle cerebral artery and posterior thalamoperforating artery, posterior choroidal artery from left posterior cerebral artery angiographically. The AVM was partially obliterated after embolization of lateral lenticulostriate arteries and thalamoperforating artery with P.V.A. (Polyvinyl Alcohol, ivalon) using conventional 6.5F DAVIS II angiographic catheter. There was no complication which was related to those embolization procedures except transient drowsy consciousness after embolization but it is completely recovered to the level of preembolization state after 10 hours.

  14. Should a reliable information processor be chaotic (brain models)

    Energy Technology Data Exchange (ETDEWEB)

    Nicolis, J S

    1982-01-01

    Brain-like structures have evolved by performing signal processing initially by minimizing tracking errors on a competitive basis. Such systems are highly complex and at the same time notoriously disordered. The functional trace of the cerebral cortex of the human brain is a good example. The electroencephalogram (EEG) appears particularly fragmented during the execution of mental tasks, as well as during the recurrent episodes of rem sleep. A stochastically regular or a highly synchronized EEG on the other hand, characterises a drowsy (relaxing) or epileptic subject respectively and indicates-in both cases-a very incompetent information processor. The author suggests that such behavioral changeovers are produced via bifurcations which trigger the thalamocortical nonlinear pacemaking oscillator to switch from an unstable limit cycle to a strange attractor regime (i.e. to chaos), or vice versa. This analysis aims to show that the EEGs characteristics are not accidental but inevitable and even necessary and, therefore, functionally significant. 25 references.

  15. Acute organophosphorus poisoning complicated by acute coronary syndrome.

    Science.gov (United States)

    Pankaj, Madhu; Krishna, Kavita

    2014-07-01

    We report a case of 30 year old alcoholic male admitted with vomiting, drowsiness, limb weakness and fasciculations after alleged history of consumption of 30 ml of chlorpyriphos insecticide. He had low serum cholinesterase levels. With standard treatment for organophosphorus poisoning (OPP), he improved gradually until day 5, when he developed neck and limb weakness and respiratory distress. This intermediate syndrome was treated with oximes, atropine and artificial ventilation. During treatment, his ECG showed fresh changes of ST elevation. High CPK & CPK-MB levels, septal hypokinesia on 2D echo suggested acute coronary syndrome. Coronary angiography was postponed due to his bedridden and obtunded status. The patient finally recovered fully by day 15 and was discharged. Acute coronary syndrome is a rare occurrence in OP poisoning. The present case thus emphasises the need for careful electrocardiographic and enzymatic monitoring of all patients of organophosphorus poisoning to prevent potential cardiac complication which can prove fatal.

  16. Homeostasis in Primates in the Hyperdynamic Environment. [circadian timekeeping and effects of lower body positive pressure on sleep

    Science.gov (United States)

    Fuller, C. A.

    1985-01-01

    The influence of chronic centrifugation upon the homestatic regulation of the circadian timekeeping system was examined. The interactions of body temperature regulation and the behavioral state of arousal were studied by evaluating the influence of cephalic fluid shifts induced by lower body positive air pressure (LBPP), upon these systems. The small diurnal squirrel monkey (Saimiri sciureus) was used as the non-human primate model. Results show that the circadian timekeeping system of these primates is functional in the hyperdynamic environment, however, some of its components appear to be regulated at different homeostatic levels. The LBPP resulted in an approximate 0.7 C decrease in DBT (p 0.01). However, although on video some animals appeared drowsy during LBPP, sleep recording revealed no significant changes in state of arousal. Thus, the physiological mechanisms underlying this lowering of body temperature can be independent of the arousal state.

  17. Risk factors for automobile accidents caused by falling asleep while driving in obstructive sleep apnea syndrome.

    Science.gov (United States)

    Arita, Aki; Sasanabe, Ryujiro; Hasegawa, Rika; Nomura, Atsuhiko; Hori, Reiko; Mano, Mamiko; Konishi, Noriyuki; Shiomi, Toshiaki

    2015-12-01

    We examined the risk factors for automobile accidents caused by falling asleep while driving in subjects with obstructive sleep apnea syndrome (OSAS). We asked licensed drivers with history of snoring and excessive daytime sleepiness who had undergone polysomnography (PSG) at the Department of Sleep Medicine/Sleep Disorders Center at Aichi Medical University Hospital to complete the questionnaires on accidents caused by falling asleep while driving. As a subjective measure of sleepiness, we used the Epworth sleepiness scale (ESS). Based on PSG results, 2387 subjects diagnosed with OSAS were divided into three groups according to apnea-hypopnea index (AHI): mild-to-moderate (5 ≤ AHI accidents in the past 5 years due to falling asleep. Our multivariate analysis suggests that scores on the ESS and patient-reported frequency of feeling drowsy while regular driving and working are related to automobile accidents caused by falling asleep while driving.

  18. Clinical efficacy and safety of cisapride and clebopride in the management of chronic functional dyspepsia: a double-blind, randomized study.

    Science.gov (United States)

    Sabbatini, F; Minieri, M; Manzi, G; Piai, G; D'Angelo, V; Mazzacca, G

    1991-01-01

    The clinical efficacy and the safety of chronic oral administration of cisapride, a new gastrointestinal prokinetic agent, (10 mg tid) and clebopride (0.5 mg tid) was assayed in 48 outpatients affected with functional dyspepsia, in a randomized double-blind study. Each of the drugs induced a significant reduction in dyspeptic symptoms after 2 and 4 weeks (p less than 0.001). Two patients, given clebopride, dropped out of the study because of severe side effects during the first week of treatment. Mild adverse reactions were reported in 6 out of 23 cisapride-treated patients and in 10 out of 20 clebopride-treated patients who completed the study. The most common side effect of cisapride was diarrhoea and that of clebopride was drowsiness. Cisapride appears to be as effective as clebopride in reducing dyspeptic symptoms and seems to induce less severe side effects.

  19. ACUTE INTESTINAL INFECTIONS: THERAPEUTICAL TACTICS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    A.N. Surkov

    2011-01-01

    Full Text Available Acute intestinal infections are quite common among children. Their clinical presentations include intoxication syndrome (drowsiness, low appetite, fever etc, infectious toxic syndrome (toxicosis with exicosis, neurotoxicosi, hypovolemic or infectious-toxic shockand diarrhea syndrome. Sometimes intestinal infections can be quite severe and even lethal. However disease duration and outcome depend on timelines and adequacy of prescribed treatment. Main guidelines of intestinal infections treatment include probiotics. That is why the right choice of probiotics is important for a pediatrician. The article contains basic information upon etiopathogenesis, classification, diagnostic criteria and acute pediatric intestinal infections treatment guidelines.Key words: acute intestinal infections, etiopathogenesis, diagnostic criteria, treatment, probiotics, children. (Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6: 141–147

  20. Psychophysiological monitoring of operator's emotional stress in aviation and astronautics.

    Science.gov (United States)

    Simonov, P V; Frolov, M V; Ivanov, E A

    1980-01-01

    The level of emotional stress depending on the power of motivation and the estimation by the subject of the probability (possibility) of goal achievement, largely influences the operator's skill performance (that of a pilot, controller, astronaut). A decrease in the emotional tonus leads to drowsiness, lack of vigilance, missing of significant signals, and to slower reactions. The extremely high stress level disorganizes the activity, complicates it with a trend toward untimely acts and reactions to the insignificant signals (false alarms). The best methods to monitor the degree of the operator's emotional state during his skill performance are the integral estimation of the changes in heart-rate and T-peak amplitude, as well as the analysis of spectral and intonational characteristics of the human voice during radio conversation. These methods were tested on paratroopers, pilots in civil aviation, and airport controllers.

  1. Effects of Listening to Music on the Comfort of Chemotherapy Patients.

    Science.gov (United States)

    Bilgiç, Şebnem; Acaroğlu, Rengin

    2017-06-01

    The symptoms of an illness that requires chemotherapy and the corresponding effects of such treatment exacerbate the pain and discomfort that patients typically experience. Listening to music may help patients cope with chemotherapy symptoms, thereby contributing to their physical ease and well-being. Seventy patients who were receiving treatment at the outpatient chemotherapy unit were invited to participate in this work. During chemotherapy sessions and the week after the sessions, the patients listened to music with headphones. The occurrence of chemotherapy symptoms such as pain, tiredness, nausea, depression, anxiety, drowsiness, lack of appetite, not feeling well, and shortness of breath in the intervention group was statistically significant after listening to music ( p listening to music effectively reduces the severity of chemotherapy symptoms and enhances the comfort of patients receiving the treatment.

  2. Variable-Width Datapath for On-Chip Network Static Power Reduction

    Energy Technology Data Exchange (ETDEWEB)

    Michelogiannakis, George; Shalf, John

    2013-11-13

    With the tight power budgets in modern large-scale chips and the unpredictability of application traffic, on-chip network designers are faced with the dilemma of designing for worst- case bandwidth demands and incurring high static power overheads, or designing for an average traffic pattern and risk degrading performance. This paper proposes adaptive bandwidth networks (ABNs) which divide channels and switches into lanes such that the network provides just the bandwidth necessary in each hop. ABNs also activate input virtual channels (VCs) individually and take advantage of drowsy SRAM cells to eliminate false VC activations. In addition, ABNs readily apply to silicon defect tolerance with just the extra cost for detecting faults. For application traffic, ABNs reduce total power consumption by an average of 45percent with comparable performance compared to single-lane power-gated networks, and 33percent compared to multi-network designs.

  3. Herpes Simplex Encephalitis Presenting with Normal CSF Analysis

    International Nuclear Information System (INIS)

    Ahmed, R.; Kiani, I. G.; Shah, F.; Rehman, R. N.; Haq, M. E.

    2013-01-01

    A 28 years old female presented with headache, fever, altered sensorium and right side weakness for one week. She was febrile and drowsy with right sided hemiplegia and papilledema. Tuberculous or bacterial meningitis, tuberculoma and abscess were at the top of the diagnosis list followed by Herpes simplex meningo-encephalitis (HSE). MRI showed abnormal signal intensity of left temporal lobe without significant post-contrast enhancement and midline shift. CSF examination was normal, gram stain and Ziehl-Neelsen stain showed no micro-organism, or acid fast bacilli. CSF for MTB PCR was negative. PCR DNA for Herpes simplex 1 on CSF was detected. Acyclovir was started and the patient was discharged after full recovery. A high index of suspicion is required for HSE diagnosis in Pakistan where other infections predominantly affect the brain and HSE may be overlooked as a potential diagnosis. (author)

  4. Psychogenic Polydipsia: The Result, or Cause of, Deteriorating Psychotic Symptoms? A Case Report of the Consequences of Water Intoxication

    Directory of Open Access Journals (Sweden)

    Melissa Gill

    2015-01-01

    Full Text Available Water intoxication is a rare condition characterised by overconsumption of water. It can occur in athletes engaging in endurance sports, users of MDMA (ecstasy, and patients receiving total parenteral nutrition. This case outlines water intoxication in a patient with psychogenic polydipsia. When the kidney’s capacity to compensate for exaggerated water intake is exceeded, hypotonic hyperhydration results. Consequences can involve headaches, behavioural changes, muscular weakness, twitching, vomiting, confusion, irritability, drowsiness, and seizures. Cerebral oedema can lead to brain damage and eventual death. In this case, psychogenic polydipsia led to significant hyponatraemia, cerebral oedema, and tonic-clonic seizures. Differential diagnoses for hyponatraemia are outlined. The aetiology of psychogenic polydipsia is uncertain, but postulated hypotheses are explored. Psychogenic polydipsia occurs in up 20% of psychiatric patients and this case serves to remind us to be cognizant of water overconsumption.

  5. Cortical venous thrombosis following exogenous androgen use for bodybuilding.

    Science.gov (United States)

    Sveinsson, Olafur; Herrman, Lars

    2013-02-05

    There are only a few reports of patients developing cerebral venous sinus thrombosis (CVST) after androgen therapy. We present a young man who developed cortical venous thrombosis after using androgens to increase muscle mass. He was hospitalised for parasthesia and dyspraxia in the left hand followed by a generalised tonic-clonic seizure. At admission, he was drowsy, not fully orientated, had sensory inattention, pronation drift and a positive extensor response, all on the left side. The patient had been using anabolic steroids (dainabol 20 mg/day) for the last month for bodybuilding. CT angiography showed a right cortical venous thrombosis. Anticoagulation therapy was started with intravenous heparin for 11 days and oral anticoagulation (warfarin) thereafter. A control CT angiography 4 months later showed resolution of the thrombosis. He recovered fully.

  6. A case of traumatic intraventricular hemorrhage

    International Nuclear Information System (INIS)

    Ikeda, Yukio; Yamakawa, Kazuomi; Nakazawa, Shozo.

    1980-01-01

    CT scan is recognized to be a rapid, noninvasive and informative examination in evaluation of the head injured patient. It is also possible to evaluate the presence of the intracerebral hematoma without remarkable mass effect, cerebral contusion, associated cerebral edema and ventricular hemorrhage. We present a case of traumatic intraventricular hemorrhage. The patient was a 40-year-old male admitted to our hospital in a drowsy state following a fall from about one meter high. Craniogram showed a linear fracture in the left parietotemporal regions. In the CT scan, intraventricular hemorrhage associated with subarachnoid hemorrhage without intracerebral hematoma was shown. A symmetrical moderate dilatation of both lateral ventricles was also shown. Cerebral angiography revealed no abnormality. His condition deteriorated progressively, so ventricular drainage was performed, but he expired 5 days later. Considering this case, the mechanisms of pure intraventricular hemorrhage following head injury were discussed. (author)

  7. A comparative study of loratadine versus pheniramine maleate in chronic idiopathic urticaria

    Directory of Open Access Journals (Sweden)

    Raval Ranjan

    1995-01-01

    Full Text Available Fifty cases with chronic idiopathic urticaria of more than 3 months duration were selected and divided into two groups. Group ′A′ was given 10 mg loratadine once daily, while group ′B′ was given pheniramine maleate 25 mg, twice daily for one month. All patients were followed for one month more. 48% excellent response was observed in group ′A′ while 16% excellent response was observed in group ′B′. Good response was observed in 24% of patients in group ′A′, while in group ′B′ 16% of patients had good response. No side effects were observed in loratadine group, while drowsiness was observed in pheniramine group

  8. Grave's disease with transverse and sigmoid sinus thrombosis needing surgical intervention.

    Science.gov (United States)

    Srikant, Banumathy; Balasubramaniam, Srikant

    2013-07-01

    Thrombosis of venous sinuses associated with thyrotoxicosis is rare, and isolated transverse and sigmoid sinus thrombosis is rarer and reported only once previously. We present a case of Graves disease, who suffered unilateral sigmoid and transverse sinus thrombosis with intracranial hemorrhage. A 42-year-old female, a diagnosed case of Graves disease, presented to us with headache, drowsiness, and hemiparesis. Computed Tomography revealed a large right temporo-parieto-occipital venous infarct. The patient needed surgical intervention in the form of decompressive craniotomy following which she improved, and on follow-up is having no deficits. Thrombophilia profile showed a low Protein S and Anti thrombin III (AT III) levels. Deranged thrombophilia profile in combination with the hypercoagulable state in thyrotoxicosis, most likely precipitated the thrombotic event. Timely surgical intervention can be offered in selective cases with a good clinical outcome.

  9. Chronic pretrigeminal and cerveau isolé cats.

    Science.gov (United States)

    Slósarska, M; Zernicki, B

    1973-01-01

    Ten pretrigeminal and ten cerveau isole cats were observed chronically. During 24-36 h sessions EEG activity was continuously recorded and the EEG and ocular responses to visual and olfactory stimuli were studied. In the pretrigeminal cat acute and chronic stages were distinguished, and in the cerveau isole, acute, "early chronic" and "late chronic" stages. During the acute stage, the pretrigeminal cat is continuously awake, whereas the cerveau isole is comatose. During the "early chronic stage", which lasted at least about 3 weeks, the cerveau isole is semicomatose. During the chronic stage in the pretrigeminal cat and the "late chronic stage" in the cerveau isole, the sleep-waking cycle is present. In both preparations alert wakefulness, drowsiness, light .synchronized sleep and deep synchronized sleep occupy, respectively, about 30 percent, 45 percent, 15 percent and 10 percent of the time. Thus, synchronized sleep is strikingly reduced in comparison with an intact cat, while desynchronized sleep is absent.

  10. Co-Morbidity, Mortality, Quality of Life and the Healthcare/Welfare/Social Costs of Disordered Sleep: A Rapid Review.

    Science.gov (United States)

    Garbarino, Sergio; Lanteri, Paola; Durando, Paolo; Magnavita, Nicola; Sannita, Walter G

    2016-08-18

    Sleep disorders are frequent (18%-23%) and constitute a major risk factor for psychiatric, cardiovascular, metabolic or hormonal co-morbidity and mortality. Low social status or income, unemployment, life events such as divorce, negative lifestyle habits, and professional requirements (e.g., shift work) are often associated with sleep problems. Sleep disorders affect the quality of life and impair both professional and non-professional activities. Excessive daytime drowsiness resulting from sleep disorders impairs efficiency and safety at work or on the road, and increases the risk of accidents. Poor sleep (either professional or voluntary) has detrimental effects comparable to those of major sleep disorders, but is often neglected. The high incidence and direct/indirect healthcare and welfare costs of sleep disorders and poor sleep currently constitute a major medical problem. Investigation, monitoring and strategies are needed in order to prevent/reduce the effects of these disorders.

  11. Co-Morbidity, Mortality, Quality of Life and the Healthcare/Welfare/Social Costs of Disordered Sleep: A Rapid Review

    Directory of Open Access Journals (Sweden)

    Sergio Garbarino

    2016-08-01

    Full Text Available Sleep disorders are frequent (18%–23% and constitute a major risk factor for psychiatric, cardiovascular, metabolic or hormonal co-morbidity and mortality. Low social status or income, unemployment, life events such as divorce, negative lifestyle habits, and professional requirements (e.g., shift work are often associated with sleep problems. Sleep disorders affect the quality of life and impair both professional and non-professional activities. Excessive daytime drowsiness resulting from sleep disorders impairs efficiency and safety at work or on the road, and increases the risk of accidents. Poor sleep (either professional or voluntary has detrimental effects comparable to those of major sleep disorders, but is often neglected. The high incidence and direct/indirect healthcare and welfare costs of sleep disorders and poor sleep currently constitute a major medical problem. Investigation, monitoring and strategies are needed in order to prevent/reduce the effects of these disorders.

  12. Morphine as first medication for treatment of cancer pain

    Directory of Open Access Journals (Sweden)

    Beatriz C. Nunes

    2014-07-01

    Full Text Available BACKGROUND AND OBJECTIVES: the medications used according to the recommendation of the World Health Organization do not promote pain relief in a number of patients with cancer pain. The aim of this study was to evaluate the use of morphine as first medication for the treatment of moderate cancer pain in patients with advanced and/or metastatic disease, as an option to the recommendations of the World Health Organization analgesic ladder. METHOD: sixty patients without opioid therapy, with >18 years of age, were randomized into two groups. G1 patients received medication according to the analgesic ladder and started treatment with non-opioids in the first, weak opioids in the second, and strong opioids in the third step; G2 patients received morphine as first analgesic medication. The efficacy and tolerability of initial use of morphine were evaluated every two weeks for three months. RESULTS: the groups were similar with respect to demographic data. There was no significant difference between the groups regarding pain intensity, quality of life, physical capacity, satisfaction with treatment, need for complementation and dose of morphine. In G1 there was a higher incidence of nausea (p = 0.0088, drowsiness (p = 0.0005, constipation (p = 0.0071 and dizziness (p = 0.0376 in the second visit and drowsiness (p = 0.05 in the third. CONCLUSIONS: the use of morphine as first medication for pain treatment did not promote better analgesic effect than the ladder recommended by World Health Organization, with higher incidence of adverse effects.

  13. In Search of a Safe Natural Sleep Aid.

    Science.gov (United States)

    Rao, Theertham P; Ozeki, Motoko; Juneja, Lekh R

    2015-01-01

    Sleep deprivation is associated with an elevated risk of various diseases and leads to a poor quality of life and negative socioeconomic consequences. Sleep inducers such as drugs and herbal medicines may often lead to dependence and other side effects. L-Theanine (γ-glutamylethylamide), an amino acid naturally found abundant in tea leaves, has anxiolytic effects via the induction of α brain waves without additive and other side effects associated with conventional sleep inducers. Anxiolysis is required for the initiation of high-quality sleep. In this study, we review the mechanism(s), safety, and efficacy of L-theanine. Collectively, sleep studies based on an actigraph, the obstructive sleep apnea (OSA) sleep inventory questionnaire, wakeup after sleep onset (WASO) and automatic nervous system (ANS) assessment, sympathetic and parasympathetic nerve activities, and a pediatric sleep questionnaire (PSQ) suggest that the administration of 200 mg of L-theanine before bed may support improved sleep quality not by sedation but through anxiolysis. Because L-theanine does not induce daytime drowsiness, it may be useful at any time of the day. The no observable adverse effect level (NOAEL) for the oral administration of L-theanine was determined to be above 2000 mg/kg bw/day. KEY TEACHING POINTS: Sleep deprivation-associated morbidity is an increasing public health concern posing a substantial socioeconomic burden. Chronic sleep disorders may seriously affect quality of life and may be etiological factors in a number of chronic diseases such as depression, obesity, diabetes, and cardiovascular diseases. Most sleep inducers are sedatives and are often associated with addiction and other side effects. L-Theanine promotes relaxation without drowsiness. Unlike conventional sleep inducers, L-theanine is not a sedative but promotes good quality of sleep through anxiolysis. This review suggests that L-theanine is a safe natural sleep aid.

  14. Critical appraisal of bilastine for the treatment of allergic rhinoconjunctivitis and urticaria

    Directory of Open Access Journals (Sweden)

    Sadaba B

    2013-05-01

    Full Text Available Belen Sadaba, Jose Ramon Azanza, Almundena Gomez-Guiu, Raquel RodilClinical Pharmacology Service, Clinica Universidad de Navarra, Navarra, SpainAbstract: Bilastine is a second generation antihistamine indicated for the treatment of seasonal or perennial allergic rhinoconjunctivitis and chronic urticaria with a daily dose of 20 mg, in adults and children over 12 years of age. The efficacy of bilastine has been shown to be similar to that of the comparator drugs for the control of the nasal and nonnasal symptoms of allergic rhinoconjunctivitis, while also showing a subjective improvement in the quality of life and in overall clinical impression. For chronic urticaria the symptoms (itching and the development of papules lessens from the second day of treatment onwards, in a similar way to other antihistamines used as comparators. Bilastine should not be administered at meal times to avoid interference with the absorption process. It is not distributed to the central nervous system, is scarcely metabolized, and elimination is through the kidneys and feces, with a 14-hour elimination half-life. It has no effect on cytochrome P450. During clinical development, bilastine was shown to be a drug that is adequately tolerated, with a similar effect to placebo with regard to drowsiness and changes in heart rate. In relation to its use, headaches were the most frequent adverse effect to be reported. No cardiotoxic effects have been observed, and the therapeutic dose does not alter the state of alertness.Keywords: bilastine, allergic rhinoconjunctivitis, chronic urticaria, second generation antihistamine, drowsiness, CYP450

  15. Symptom burden among young adults with breast or colorectal cancer.

    Science.gov (United States)

    Sanford, Stacy D; Zhao, Fengmin; Salsman, John M; Chang, Victor T; Wagner, Lynne I; Fisch, Michael J

    2014-08-01

    Cancer incidence has increased among young adults (YAs) and survival rates have not improved compared with other age groups. Patient-reported outcomes may enhance our understanding of this vulnerable population. In a multisite prospective study, patients completed a cancer symptom inventory at the time of enrollment (T1) and 4 weeks to 5 weeks later (T2). YAs (those aged ≤ 39 years) with breast or colorectal cancer were compared with older adults (those aged ≥ 40 years) with breast or colorectal cancer with regard to symptom severity, symptom interference, changes over time, and medical care. Participants included 1544 patients with breast cancer (96 of whom were YAs) and 718 patients with colorectal cancer (37 of whom were YAs). Compared with older adults, YAs with breast cancer were more likely to report moderate/severe drowsiness, hair loss, and symptom interference with relationships at T1. YAs with colorectal cancer were more likely to report moderate/severe pain, fatigue, nausea, distress, drowsiness, shortness of breath, and rash plus interference in general activity, mood, work, relationships, and life enjoyment compared with older adults. Compared with older adults, shortness of breath, appetite, and sore mouth were more likely to improve in YAs with breast cancer; vomiting was less likely to improve in YAs with colorectal cancer. Referrals for supportive care were few, especially among patients with colorectal cancer. YAs with breast cancer were somewhat more likely to be referred to nutrition and psychiatry services than older patients. YAs reported symptom severity, symptom interference, and variations over time that were distinct from older patients. Distinctions were found to differ by diagnostic group. These findings enhance the understanding of symptom burden in YAs and inform the development of targeted interventions and future research. © 2014 American Cancer Society.

  16. Topical treatments of skin pain: a general review with a focus on hidradenitis suppurativa with topical agents.

    Science.gov (United States)

    Scheinfeld, Noah

    2014-07-15

    Hidradenitis Supprurativa (HS) is a painful chronic follicular disease. Few papers have addressed pain control for this debilitating condition. Possible topical agents include tricyclic antidepressants, opioids, anticonvulsants, NSAIDs, NMDA receptor antagonists, local anesthetics and other agents. The first line agents for the topical treatment of the cutaneous pain of HS are diclonefac gel 1% and liposomal xylocaine 4% and 5% cream or 5% ointment. The chief advantage of topical xylocaine is that is quick acting i.e. immediate however with a limited duration of effect 1-2 hours. The use of topical ketamine, which blocks n-methyl-D-aspartate receptors in a non-competitive fashion, might be a useful tool for the treatment of HS pain. Topical doxepin, which available in a 5% commercially preparation (Zonalon®) , makes patients drowsy and is not useful for controlling the pain of HS . Doxepin is available in a 3% or 3.3% concentration (which causes less drowsiness) from compounding pharmacies and can be used in compounded analgesic preparations with positive effect. Topical doxepin is preferred over use of topical amitriptyline because topical doxepin is more effective. Nevertheless, topical amitriptyline increase of the tactile and mechanical nociceptive thresholds and can be used for topical pain control in compound mixture of analgesics . Gabapentin and pregablin can also be used compounded with other agents in topical analgesic preparations with positive topical anesthetic effect. Capsaicin is not useful for topical treatment of the pain of HS. Sometimes compounded of anesthetics medications such as ketamine 10%, bupivacaine 1%, diclofenac 3%, doxepin 3% or 3.3%, and gabapentin 6% can extend the duration of effect so that medication only needs to be used 2 or 3 times a day. Still in my experience the easiest to get and most patient requested agent is topical diclonefac 1% gel.

  17. Emotional well-being in children and adolescents treated with atomoxetine for attention-deficit/hyperactivity disorder: Findings from a patient, parent and physician perspective using items from the pediatric adverse event rating scale (PAERS

    Directory of Open Access Journals (Sweden)

    Dittmann Ralf W

    2008-05-01

    Full Text Available Abstract Background The objective of this analysis was to measure changes in items on the Pediatric Adverse Event Rating Scale (PAERS that relate to emotional well-being of children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD during treatment with atomoxetine for up to 24 weeks from the perspective of the patient, the parent, and the physician. Methods Patients aged 6–17 years with ADHD were treated with atomoxetine (target dose 1.2 mg/kg/day. In the two studies on which this secondary analysis is based the PAERS was used to assess the tolerability of atomoxetine in children and adolescents. This scale has a total of 48 items. The ten items that reflect emotional well-being were selected to measure changes over time from a patient, parent, and physician perspective. Results 421 patients were treated with atomoxetine. 355 patients completed the 8-week treatment period, and 260 patients completed the 24-week treatment period. The ten items that reflect emotional well-being were grouped in five dimensions: depressed mood, self-harm, irritability/agitation, drowsiness, and euphoria. The scores of these dimensions decreased over time, both from a patient as well as from a parent and physician perspective. Only the dimension self-harm was extremely low at baseline and stayed low over time. The mean scores for the ten items depended on the rater perspective. Conclusion The emotional well-being of children and adolescents with ADHD improved in terms of depressed mood, irritability/agitation, drowsiness, and euphoria during treatment with atomoxetine for up to 24 weeks.

  18. Severe hyponatremia as the initial sign preceding Guillain-Barré syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Abhishek Wankar

    2014-01-01

    Full Text Available Diagnosis of Guillain-Barrι syndrome (GBS is established clinically and is supported by nerve conduction studies and cerebrospinal fluid examination. Renal function is usually not affected, but recent case reports have established a link between GBS and hyponatremia. A 60-year-old woman presenting with lower back ache since 3 days, became drowsy the next day and developed paraparesis and bulbar symptoms. Her sensorium and power deteriorated progressively over the next 2 days and she was brought to hospital in a drowsy state. She was found to have severe hyponatremia (Na + at 113 and nerve conduction study (NCS was son of AMAN. The patient was started on intravenous immunoglobulin and her sodium levels were corrected, and the patient recovered completely. The occurrence of hyponatremia in patients diagnosed with GBS is well described. However, there have been only two prior case reports in which hyponatremia had been observed before the manifestation of neuromuscular deficits. Our patient case is unique in that severe hyponatremia occurred simultaneously with neurologic symptoms and the diagnosis of GBS. In most cases reported in the literature, hyponatremia was noted after a diagnosis of GBS was established. The mean period of onset of syndrome of inappropriate antidiuretic hormone (SIADH was 8.8 days after the onset of symptoms of GBS. In Conclusion , this presentation raises the possibility that early changes in the autonomic nervous system triggered by GBS might lead to alterations in water and sodium balance that can precede symptomatic changes in the peripheral nervous system. Although rarely, but both GBS and its treatment, intravenous immunoglobulin, should be considered in the differential diagnosis of hyponatremia.

  19. The association between benzodiazepine use and sleep quality in residential aged care facilities: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Lynna Chen

    2016-11-01

    Full Text Available Abstract Background Benzodiazepines are commonly prescribed in residential aged care facilities (RACFs for their sedative and anxiolytic effects. The objective of this study was to investigate the association between benzodiazepine use and sleep quality in residents of RACFs. Methods A cross-sectional study involving 383 participants was conducted in six Australian RACFs. Night-time sleep quality, day-time drowsiness and day-time napping behavior were assessed using a validated questionnaire. Logistic regression was used to compute adjusted odds ratios (AORs and 95% confidence intervals (CIs for the association between benzodiazepine use and sleep quality. Covariates included pain, dementia severity, depression, insomnia and other sedative use. Results Of the 383 residents (mean age 87.5 years, 77.5% female, 96(25.1% used a benzodiazepine on a regular basis. Residents who used long-acting benzodiazepines on a regular basis had higher night-time sleep quality than non-users (AOR = 4.00, 95%CI 1.06 – 15.15. Residents who used short-acting benzodiazepines on a PRN only basis had longer daytime napping times than non-users (AOR = 1.77, 95%CI 1.01 – 3.08. No benzodiazepine category was associated with day-time drowsiness. Conclusions The association between benzodiazepine use and sleep quality is dependent on the half-life and prescribing pattern of the benzodiazepine. Short-acting PRN benzodiazepines were associated with lower night time sleep quality and longer day-time napping compared to long-acting regular benzodiazepines. Longitudinal studies are needed to determine whether these findings reflect channeling of short-acting agents to residents at higher risk of sleep disorders.

  20. CE: Original Research: Napping on the Night Shift: A Two-Hospital Implementation Project.

    Science.gov (United States)

    Geiger-Brown, Jeanne; Sagherian, Knar; Zhu, Shijun; Wieroniey, Margaret Ann; Blair, Lori; Warren, Joan; Hinds, Pamela S; Szeles, Rose

    2016-05-01

    : Nurses who work the night shift often experience high levels of sleepiness. Napping has been adopted as an effective countermeasure to sleepiness and fatigue in other safety-sensitive industries, but has not had widespread acceptance in nursing. To assess the barriers to successful implementation of night-shift naps and to describe the nap experiences of night-shift nurses who took naps. In this two-hospital pilot implementation project, napping on the night shift was offered to six nursing units for which the executive nursing leadership had given approval. Unit nurse managers' approval was sought, and where granted, further explanation was given to the unit's staff nurses. A nap experience form, which included the Karolinska Sleepiness Scale, was used to assess pre-nap sleepiness level, nap duration and perceived sleep experience, post-nap sleep inertia, and the perceived helpfulness of the nap. Nurse managers and staff nurses were also interviewed at the end of the three-month study period. Successful implementation occurred on only one of the six units, with partial success seen on a second unit. Barriers primarily occurred at the point of seeking the unit nurse managers' approval. On the successful unit, 153 30-minutes naps were taken during the study period. A high level of sleepiness was present at the beginning of 44% of the naps. For more than half the naps, nurses reported achieving either light (43%) or deep (14%) sleep. Sleep inertia was rare. The average score of helpfulness of napping was high (7.3 on a 1-to-10 scale). Nurses who napped reported being less drowsy while driving home after their shift. These data suggest that when barriers to napping are overcome, napping on the night shift is feasible and can reduce nurses' workplace sleepiness and drowsy driving on the way home. Addressing nurse managers' perceptions of and concerns about napping may be essential to successful implementation.

  1. Bioavailability and Pharmacodynamics of Promethazine in Human Subjects

    Science.gov (United States)

    Putcha, Lakshmi; Flynn, Chris; Paloski, W. H. (Technical Monitor)

    2000-01-01

    Space Motion Sickness (SMS) is often treated in space with promethazine (PMZ). Anecdotal reports indicate that the common side effects of drowsiness and decrements in cognitive performance that are associated with PMZ administration (50 mg IM on the ground, are absent or less pronounced in space suggesting I that-the bioavailability and/or pharmacodynamic behavior of PMZ may be altered during space flight. There are limited flight opportunities available for clinical research in space, the NRA-99, therefore, solicits research required to improve, or answer specific questions about in-flight diagnosis, therapy, and post-flight rehabilitation. We propose here, to establish a noninvasive method for pharmacodynamic and therapeutic assessment of PMZ. The specific objectives of the proposed research are to, 1. Establish a saliva to plasma ratio of PMZ after administration, 2. Estimate the relative bioavailability of the three flight-specific dosage forms of PMZ, and 3. Establish the dose-response relationship of PMZ. We will estimate the bioavailability of intramuscular injection (IM), oral tablets and rectal suppositories in normal subjects during ambulatory and antiorthostatic; bed rest (ABR) conditions using novel stable isotope techniques. Drowsiness, cognitive performance and salivary flow rate will be measured as a function of circulating drug concentrations after administration of three IM doses of PMZ. We will compare and contrast the bioavailability of PMZ during normal and ABR conditions to examine whether or not ABR can simulate changes in drug, absorption and availability similar to those anticipated in a microgravity environment. Results of this study will validate methods for an approved study with this medication awaiting a flight opportunity for manifestation. These data will also provide the much needed information on the dynamics and therapeutic index. of this medication and their implications on crew fatigue and performance in space. Key words

  2. [Dietary factors associated with daytime somnolence in healthy elderly of Chile].

    Science.gov (United States)

    Durán Agüero, Samuel; Sánchez Reyes, Hugo; Díaz Narváez, Víctor; Araya Pérez, Mónica

    2015-01-01

    To determine the prevalence of mild and excessive somnolence and the associated factors with the presence of daytime sleepiness in the elderly. A total of 1780 independent individuals 60 years and older of both sexes (70.9±7.9 years old; females 62%), were included, of which 1704 of them completed all the information. All of them were assessed using an Epworth sleepiness scale (ESE), an Pittsburgh sleep quality index, plus information of cigarettes smoking, dinner time, and an anthropometric evaluation. An ESE score>10 was considered drowsiness and scores>15 excessive or severe drowsiness. Among the population under 80 years, 5.3% showed ESE score>15 and 26.2% an ESE score>10. For over 80 years, the prevalence of sleepiness was 6.3% for an ESE score>15 and 32.5% for an ESE score>10. In the adjusted model, the factors associated with increased risk of sleepiness (ESE>10) were age older than 80 years (OR=1.58; 95% CI=1.14 to 2.19) and dinner after 21 hours (OR=1.3; 95% CI=1.01 to 1.68). By contrast, only age older than 80 years was independently associated with severe sleepiness (OR=1.81; 95% CI=1.01 to 3.29). Meals after 21 hours and age above 80 years are associated with increased likelihood of daytime sleepiness. Instead, only older than 80 years is associated with severe daytime sleepiness. Copyright © 2015 SEGG. Published by Elsevier Espana. All rights reserved.

  3. Analiza obrazu klinicznego niedoczynności tarczycy u kobiet w okresie menopauzy

    Directory of Open Access Journals (Sweden)

    Beata Matuszek

    2010-12-01

    Full Text Available The objective of this retrospective study was to analyze the clinical picture of hypothyroidism in women, inrelation to their menopausal status. Materials and methods: A total of 694 female ambulatory patients were divided into 3 groups: group I – 258menstruating patients aged up to 45, group II – 124 perimenopausal patients aged between 46 and 52, group III– 312 postmenopausal patients aged over 52. Medical documentation of the patients with hypothyroidism wasevaluated in terms of the selected features of their medical history and clinical picture of the disease. Results: The main cause of hypothyroidism was the chronic autoimmune thyroid gland inflammation; ingroup I it concerned 62.8% of patients, in the remaining two groups it was 50.0% and 51.6%, respectively. Analysing the prevalence of clinical symptoms it was found that the most frequent ones were: weight gain (18.6%,weakness (16.3% and drowsiness (14.7%. In group II the prevailing symptoms were: hypertension (37.1%,weight gain (21.8%, drowsiness and weakness (12.1% whereas in group III hypertension (60.3%, symptoms ofischemic heart disease (24.4% and weight gain (14.4% were dominant. Mean daily doses of levothyroxine usedin the 3 groups of patients were 90 μg, 81 μg ,74 μg, respectively. In women from groups II and III, a lipid balancedisorder (hypercholesterolemia was observed significantly more often than in younger patients. Conclusions: Hyperthyroidism was diagnosed most frequently in postmenopausal women. The main causeof hypothyroidism was the chronic autoimmune thyroid gland inflammation. In postmenopausal women unusualclinical symptoms of hyperthyroidism dominated, which resulted from the coexistence of other diseases,mainly cardiovascular disorders. A 24-hour long-dose of levothyroxine in postmenopausal women was lower ascompared to menstruating women. Hypercholesterolemia was a considerably frequent element of the clinicalpicture of hypothyroidism in postmenopausal

  4. Optical Flow and Driver’s Kinematics Analysis for State of Alert Sensing

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    Miguel Torres-Torriti

    2013-03-01

    Full Text Available Road accident statistics from different countries show that a significant number of accidents occur due to driver’s fatigue and lack of awareness to traffic conditions. In particular, about 60% of the accidents in which long haul truck and bus drivers are involved are attributed to drowsiness and fatigue. It is thus fundamental to improve non-invasive systems for sensing a driver’s state of alert. One of the main challenges to correctly resolve the state of alert is measuring the percentage of eyelid closure over time (PERCLOS, despite the driver’s head and body movements. In this paper, we propose a technique that involves optical flow and driver’s kinematics analysis to improve the robustness of the driver’s alert state measurement under pose changes using a single camera with near-infrared illumination. The proposed approach infers and keeps track of the driver’s pose in 3D space in order to ensure that eyes can be located correctly, even after periods of partial occlusion, for example, when the driver stares away from the camera. Our experiments show the effectiveness of the approach with a correct eyes detection rate of 99.41%, on average. The results obtained with the proposed approach in an experiment involving fifteen persons under different levels of sleep deprivation also confirm the discriminability of the fatigue levels. In addition to the measurement of fatigue and drowsiness, the pose tracking capability of the proposed approach has potential applications in distraction assessment and alerting of machine operators.

  5. Safety of veralipride for the treatment of vasomotor symptoms of menopause.

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    Valencia, Marcelino Hernández; Arias, María de Jesús Vega; González, Cuauhtémoc Celis; Marín, Imelda Hernández; González, Juan Humberto Martín; Campos, Enrique Rafael Morcate; Rodríguez, María Antonia Basavilvazo; Álvarez, Ignacio Morales; Vargas, María Antonia Valdés; Flores, José Braulio Everardo Otero; Haro, Samuel Santoyo; Bonilla, Manuel Cortes; Escudero, Roberto Bernardo; Campero, Rosalba Alonso

    2014-05-01

    Veralipride is a nonhormonal option for the treatment of vasomotor symptoms of menopause. Incidence of adverse events in a Mexican population and drug compliance according to correct use were evaluated. We carried out a longitudinal, prospective, and analytical study in Mexican women who received veralipride to treat symptoms of menopause from 2011 to 2012. There were 386 treatment cycles; 272 were assigned to dosing schedule 1, which included 20 days of treatment with 10 days of suspension, and 114 were assigned to dosing schedule 2, which included 5 days of treatment and 2 days of suspension. A total of 57 adverse events were registered during the 386-month treatment. For the 20 × 10 dosing schedule, the highest incidence was observed for anxiety (2.2%), drowsiness, and weakness (1.5%); for the 5 × 2 dosing schedule, the highest incidence was observed for drowsiness (5.3%) and headache (2.6%). The Hamilton Depression Rating Scale was used to assess the presence and severity of depression; improvement was noted. The Unified Parkinson's Disease Rating Scale was used to assess neurological movement disorders; no adverse neurological events were detected. Based on the assessments of both women and physicians, the highest frequency was observed for "very satisfied" (45.5% and 52.3%, respectively), followed by "satisfied" (23.9% and 27.3%, respectively). Both dosing schedules show acceptable safety profiles for up to 6 months of use when used according to the contraindications in the current prescribing information for standard use (2012) and recent medical literature.

  6. An Evaluation of the Frequency and Severity of Motion Sickness Incidences in Personnel Within the Command and Control Vehicle (C2V)

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    Cowings, Patricia S.; Toscano, William B.; DeRoshia, Charles

    1998-01-01

    The purpose of this study was to assess the frequency and severity of motion sickness in personnel during a field exercise in the Command and Control Vehicle (C2V). This vehicle contains four workstations where military personnel are expected to perform command decisions in the field during combat conditions. Eight active duty military men (U.S. Army) at the Yuma Proving Grounds in Arizona participated in this study. All subjects were given baseline performance tests while their physiological responses were monitored on the first day. On the second day of their participation, subjects rode in the C2V while their physiological responses and performance measures were recorded. Self-reports of motion sickness were also recorded. Results showed that only one subject experienced two incidences of emesis. However, seven out of the eight subjects reported other motion sickness symptoms; most predominant was the report of drowsiness, which occurred a total of 19 times. Changes in physiological responses were observed relative to motion sickness symptoms reported and the different environmental conditions (i.e., level, hills, gravel) during the field exercise. Performance data showed an overall decrement during the C2V exercise. These findings suggest that malaise and severe drowsiness can potentially impact the operational efficiency of the C2V crew. It was concluded that conflicting sensory information from the subject's visual displays and movements of the vehicle during the field exercise significantly contributed to motion sickness symptoms. It was recommended that a second study be conducted to further evaluate the impact of seat position or orientation and C2V experience on motion sickness susceptibility. Further, it was recommended that an investigation be performed on behavioral methods for improving crew alertness, motivation, and performance and for reducing malaise.

  7. Psychopharmacotherapy of panic disorder: 8-week randomized trial with clonazepam and paroxetine

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    A.E. Nardi

    2011-04-01

    Full Text Available The objective of the present randomized, open-label, naturalistic 8-week study was to compare the efficacy and safety of treatment with clonazepam (N = 63 and paroxetine (N = 57 in patients with panic disorder with or without agoraphobia. Efficacy assessment included number of panic attacks and clinician ratings of the global severity of panic disorders with the clinical global impression (CGI improvement (CGI-I and CGI severity (CGI-S scales. Most patients were females (69.8 and 68.4% in the clonazepam and paroxetine groups, respectively and age (mean ± SD was 35.9 ± 9.6 years for the clonazepam group and 33.7 ± 8.8 years for the paroxetine group. Treatment with clonazepam versus paroxetine resulted in fewer weekly panic attacks at week 4 (0.1 vs 0.5, respectively; P < 0.01, and greater clinical improvements at week 8 (CGI-I: 1.6 vs 2.9; P = 0.04. Anxiety severity was significantly reduced with clonazepam versus paroxetine at weeks 1 and 2, with no difference in panic disorder severity. Patients treated with clonazepam had fewer adverse events than patients treated with paroxetine (73 vs 95%; P = 0.001. The most common adverse events were drowsiness/fatigue (57%, memory/concentration difficulties (24%, and sexual dysfunction (11% in the clonazepam group and drowsiness/fatigue (81%, sexual dysfunction (70%, and nausea/vomiting (61% in the paroxetine group. This naturalistic study confirms the efficacy and tolerability of clonazepam and paroxetine in the acute treatment of patients with panic disorder.

  8. Overdose of drugs for attention-deficit hyperactivity disorder: clinical presentation, mechanisms of toxicity, and management.

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    Spiller, Henry A; Hays, Hannah L; Aleguas, Alfred

    2013-07-01

    The prevalence of attention-deficit hyperactivity disorder (ADHD) in the USA is estimated at approximately 4-9% in children and 4% in adults. It is estimated that prescriptions for ADHD medications are written for more than 2.7 million children per year. In 2010, US poison centers reported 17,000 human exposures to ADHD medications, with 80% occurring in children cause an increase in extracellular concentrations of dopamine, norepinephrine, and serotonin in the neocortex. Overdose with modafinil is generally of moderate severity, with reported ingestions of doses up to 8 g. The most common neurological effects include increased anxiety, agitation, headache, dizziness, insomnia, tremors, and dystonia. The management of modafinil overdose is largely supportive, with a focus on sedation, and control of dyskinesias and blood pressure. Atomoxetine is a selective presynaptic norepinephrine transporter inhibitor. The clinical presentation after overdose with atomoxetine has generally been mild. The primary effects have been drowsiness, agitation, hyperactivity, GI upset, tremor, hyperreflexia, tachycardia hypertension, and seizure. The management of atomoxetine overdose is largely supportive, with a focus on sedation, and control of dyskinesias and seizures. Clonidine is a synthetic imidazole derivative with both central and peripheral alpha-adrenergic agonist actions. The primary clinical syndrome involves prominent neurological and cardiovascular effects, with the most commonly reported features of depressed sensorium, bradycardia, and hypotension. While clonidine is an anti-hypertensive medication, a paradoxical hypertension may occur early with overdose. The clinical syndrome after overdose of guanfacine may be mixed depending on central or peripheral alpha-adrenoreceptor effects. Initial clinical effects may be drowsiness, lethargy, dry mouth, and diaphoresis. Cardiovascular effects may depend on time post-ingestion and may present as hypotension or hypertension. The

  9. Sistema Automático Para la Detección de Distracción y Somnolencia en Conductores por Medio de Características Visuales Robustas

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    Alberto Fernández Villán

    2017-07-01

    , pudiendo aumentar la precisión en la detección de la región facial de un 86.88% a un 96.46%. Las pruebas en entornos reales se realizaron durante varios días recogiendo condiciones lumínicas muy diferentes durante las horas diurnas involucrando a 16 conductores, los cuales realizaron diversas actividades para reproducir síntomas de distracción y somnolencia. Dependiendo del tipo de actividad y su duración, se obtuvieron diferentes resultados. De manera general y considerando de forma conjunta todas las actividades se obtiene una tasa media de detección del 93.11%. Abstract: According to the most recent studies published by the World Health Organization (WHO in 2013, it is estimated that 1.25 million people die as a result of traffic crashes. Many of them are caused by what it is known as inattention, whose main contributing factors are both distraction and drowsiness. Overall, it is estimated that inattention causes between 25% and 75% of the crashes and near-crashes. That is why this is a thoroughly studied field by the research community, where solutions to combat distraction and drowsiness, in particular, and inattention, in general, can be classified into three main categories, and, where computer vision has clearly become a non-obtrusive effective tool for the detection of both distraction and drowsiness. The aim of this paper is to propose, build and validate an architecture based on the analysis of visual characteristics by using computer vision techniques and machine learning to detect both distraction and drowsiness in drivers. Firstly, the modules have been tested with all its components independently using several datasets. More specifically, the presence/absence of the driver is detected with an accuracy of 100%, 90.56%, 88.96% by using a marker positioned onto the headrest, the LBP operator and the CS-LBP operator, respectively. Regarding the eye closeness validation with CEW dataset, an accuracy of 93.39% and 91.84% is obtained using a new method

  10. Mood and sleep problems in adolescents and young adults: an econometric analysis.

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    Settineri, Salvatore; Gitto, Lara; Conte, Fabio; Fanara, Giusy; Mallamace, Domenico; Mento, Carmela; Silvestri, Rosalia; Tati, Filippo; Zoccali, Rocco; Cordici, Francesco; Grugno, Rosario; Polimeni, Giovanni; Vitetta, Antongiulio; Bramanti, Placido

    2012-03-01

    Sleep related problems affect approximately 25-40% of children and adolescents. The acquisition of sleep patterns characterised by later bedtimes, insomnia and excessive daytime sleepiness is related to poorer school performance, daytime drowsiness, physical tiredness and a higher rate of psychiatric illnesses. Many studies have investigated the correlation between sleep and mood in children and adolescents and overall, show a positive association between sleep problems and psychiatric disorders. However, little is known about adolescents' personal perception of their psychological status as it is linked with the occurrence of mood changes and sleep-related problems. The aim of the study is to explore the impact of variables such as age, gender, education and the perception of their own psychological status (evaluated through suitable questionnaires) on the simultaneous presence of sleep disturbances and affective symptoms in a sample of adolescents. A positive correlation between these two dependent variables signals the need to intervene with proper support programs. A recursive bivariate probit model has been employed. This method allows us to take into account two dependent dummy variables and to consider the relationship between the two, presuming that one may also influence the other. The analysis has been carried out on a sample of 2,005 adolescents out of a total of 4,000 who declared their willingness to be telephonically interviewed using a questionnaire in two parts designed to obtain information about the participants sleep habits and affective symptoms. There is a positive correlation between sadness and daytime drowsiness. The estimated joint probability ranging from 5.5% to 9% in girls demonstrates a greater tendency for girls to experience both depression and altered sleep patterns. DISCUSSION AND LIMITATIONS OF THE STUDY: Just as sadness is a key symptom of affective disorders, daytime drowsiness indicates the presence of sleep disorders caused by

  11. Obstructive Sleep Syndrom in Patient with Plonjon Guatr: Case Report

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    Haldun sevketbeyoglu

    2014-08-01

    Full Text Available A large number of predisposing factors (obesity, nasal obstruction, adenoid hypertrophy, macroglossia, etc. are reported to be associated with obstructive sleep apnea syndrome (OUAS. In addition to these factors, the large goiter and hypothyroidism were reported to be associated with OSAS as well. However, this relationship could not yet be fully demonstrated. In our case related to plonjon goiter, we wanted to show the effect of hyroidectomy to OSAS and #8211;if there is- and the relationship between pressure and OSAS. Two years ago, a 72-year-old female with BMI: 26.8 kg/m2 patient was admitted to our clinic with complaints of respiratory standstill during sleep, snoring, morning headaches and drowsiness during daylight. In the chest X-ray, chest computed tomography and ultrasonography applied to the patient, it was detected that the trachea was deviated to the left due to euthyroid plonjon goiter and severe OSAS and polisomnografisi (PSG was diagnosed for the patient. The patients apnea-hypopnea index (AHI was measured 63.1/h. With the aim of treatment, in 7cm H2O pressure, nasal continuous positive airway pressure (nCPAP was applied to the patient and AHI decreased to the level of 11.4/h. Thyroidectomy was performed one month after the diagnosis. AHI was found 34.8 /h on the PSG applied for the purpose of 8 week-postoperative control. There were recovery on the levels of total sleep time, AHI, obstructive apnea index, hypopnea index, average desaturation index, stage 3 and REM as 16%, 44.8%, 84.7%, 19%, 38.3%, 52.4% and 28% respectively when compared the preoperative term with and postoperative term. It was demonstrated that there was no change of the in the degree of OSAS after thyroidectomy but only some partial improvement in the OSAS. The conclusion that there may be some improvements in nCPAP pressures after thyroidectomy and nCPAP treatment should not be stopped was reached. Also, it should be kept in mind that patients who apply to

  12. Frequency of reporting and predictive factors for anxiety and depression in patients with advanced cancer.

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    Salvo, N; Zeng, L; Zhang, L; Leung, M; Khan, L; Presutti, R; Nguyen, J; Holden, L; Culleton, S; Chow, E

    2012-03-01

    The prevalence of anxiety and depression in patients with advanced cancer has been reported to be on average 25% and to significantly affect patients' quality of life. Despite high prevalence rates, these disorders remain underdiagnosed and undertreated. The purpose of our study was to examine the self-report rates of anxiety and depression with the Edmonton Symptom Assessment System (ESAS) and to assess the predictive factors for these reports in cancer patients with metastatic disease. Consecutive patients who attended the Rapid Response Radiotherapy Program (RRRP) completed the ESAS as well as baseline demographic information. Ordinal logistic regression analysis was used to determine factors that significantly predicted anxiety and/or depression. Pearson χ(2) was used to test goodness-of-fit for categorical variables and established whether or not an observed frequency distribution differed from a predicted frequency distribution. A univariate analysis was conducted first and those variables with a P valueanalysis. A score test was used to test the proportional odds assumption. In total, 1439 patients seen in the RRRP between January 1999 and October 2009 completed ESAS questionnaires. Fifty-five per cent of patients reported at least mild symptoms of depression and 65% reported at least mild anxiety. In the univariate analysis, patients who were female, who had a lower performance status score, or primary lung cancer were more likely to report depressed and anxious feelings. Primary prostate cancer patients were significantly less likely to report depression and anxiety. Patients referred for spinal cord compression were significantly less depressed. The multivariate models showed that younger patients were significantly more anxious than older patients and females reported more anxiety than males. Patients who reported higher feelings of nausea, tiredness, drowsiness, dyspnoea, and worse appetite and overall well-being on the ESAS tool were more likely to

  13. School start times and teenage driver motor vehicle crashes.

    Science.gov (United States)

    Foss, Robert D; Smith, Richard L; O'Brien, Natalie P

    2018-04-26

    Shifting school start times to 8:30 am or later has been found to improve academic performance and reduce behavior problems. Limited research suggests this may also reduce adolescent driver motor vehicle crashes. A change in the school start time from 7:30 am to 8:45 am for all public high schools in one North Carolina county presented the opportunity to address this question with greater methodologic rigor. We conducted ARIMA interrupted time-series analyses to examine motor vehicle crash rates of high school age drivers in the intervention county and 3 similar comparison counties with comparable urban-rural population distribution. To focus on crashes most likely to be affected, we limited analysis to crashes involving 16- & 17-year-old drivers occurring on days when school was in session. In the intervention county, there was a 14% downward shift in the time-series following the 75 min delay in school start times (p = .076). There was no change approaching statistical significance in any of the other three counties. Further analysis indicated marked, statistically significant shifts in hourly crash rates in the intervention county, reflecting effects of the change in school start time on young driver exposure. Crashes from 7 to 7:59 am decreased sharply (-25%, p = .008), but increased similarly from 8 to 8:59 am (21%, p = .004). Crashes from 2 to 2:59 pm declined dramatically (-48%, p = .000), then increased to a lesser degree from 3 to 3:59 pm (32%, p = .024) and non-significantly from 4 to 4:59 (19%, p = .102). There was no meaningful change in early morning or nighttime crashes, when drowsiness-induced crashes might have been expected to be most common. The small decrease in crashes among high school age drivers following the shift in school start time is consistent with the findings of other studies of teen driver crashes and school start times. All these studies, including the present one, have limitations, but the similar

  14. Driver education: Enhancing knowledge of sleep, fatigue and risky behaviour to improve decision making in young drivers.

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    Alvaro, Pasquale K; Burnett, Nicole M; Kennedy, Gerard A; Min, William Yu Xun; McMahon, Marcus; Barnes, Maree; Jackson, Melinda; Howard, Mark E

    2018-03-01

    This study assessed the impact of an education program on knowledge of sleepiness and driving behaviour in young adult drivers and their performance and behaviour during simulated night driving. Thirty-four participants (18-26 years old) were randomized to receive either a four-week education program about sleep and driving or a control condition. A series of questionnaires were administered to assess knowledge of factors affecting sleep and driving before and after the four-week education program. Participants also completed a two hour driving simulator task at 1am after 17 h of extended wakefulness to assess the impact on driving behaviour. There was an increase in circadian rhythm knowledge in the intervention group following the education program. Self-reported risky behaviour increased in the control group with no changes in other aspects of sleep knowledge. There were no significant differences in proportion of intervention and control participants who had microsleeps (p ≤ .096), stopped driving due to sleepiness (p = .107), recorded objective episodes of drowsiness (p = .455), and crashed (p = .761), although there was a trend towards more control participants having microsleeps and stopping driving. Those in the intervention group reported higher subjective sleepiness at the end of the drive [M = 6.25, SD = 3.83, t(31) = 2.15, p = .05] and were more likely to indicate that they would stop driving [M = 3.08, SD = 1.16, t(31) = 2.24, p = .04]. The education program improved some aspects of driver knowledge about sleep and safety. The results also suggested that the education program lead to an increased awareness of sleepiness. Education about sleep and driving could reduce the risk of drowsy driving and associated road trauma in young drivers, but requires evaluation in a broader sample with assessment of real world driving outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Prevalence of delirium in advanced cancer patients in home care and hospice and outcomes after 1 week of palliative care.

    Science.gov (United States)

    Mercadante, Sebastiano; Masedu, Francesco; Balzani, Isabella; De Giovanni, Daniela; Montanari, Luigi; Pittureri, Cristina; Bertè, Raffaella; Russo, Domenico; Ursini, Laura; Marinangeli, Franco; Aielli, Federica

    2018-03-01

    The aim of this study was to assess the prevalence of delirium in advanced cancer patients admitted to different palliative care services in Italy and possible related factors. The secondary outcome was to assess the changes of delirium after 1 week of palliative care. A consecutive sample of patients was screened for delirium in period of 1 year in seven palliative care services. General data, including primary tumor, age, gender, concomitant disease, palliative prognostic score (PaP), and Karnofsky status, were collected. Possible causes or factors associated with delirium were looked for. The Edmonton Symptom Assessment Scale was used to assess physical and psychological symptoms and the Memorial Delirium Assessment Scale (MDAS) to assess the cognitive status of patients, at admission (T0) and 1 week after palliative care (T7). Of 848 patients screened, 263 patients were evaluated. Sixty-six patients had only the initial evaluation. The mean Karnofsky status was 34.1 (SD = 6.69); the mean PaP score at admission was 6.9 (SD = 3.97). The mean duration of palliative care assistance, equivalent to survival, was 38.4 days (SD = 48, range 2-220). The mean MDAS values at admission and after 1 week of palliative care were 6.9 (SD = 6.71) and 8.8 (SD = 8.26), respectively. One hundred ten patients (41.8%) and 167 patients (67.3%) had MDAS values ≥ 7 at admission and after 1 week of palliative care, respectively. Age, dehydration, cachexia, chemotherapy in the last three months, and intensity of drowsiness and dyspnea were independently associated with a MDAS > 7. A worsening of drowsiness, the use of opioids, and the use of corticosteroids were independently associated with changes of MDAS from T0 to T7. Although the prevalence of delirium seems to be similar to that reported in other acute settings, delirium tended to worsen or poorly responded to a palliative care treatment. Some clinical factors were independently associated with delirium. This

  16. Sleepiness at the wheel across Europe: a survey of 19 countries.

    Science.gov (United States)

    Gonçalves, Marta; Amici, Roberto; Lucas, Raquel; Åkerstedt, Torbjörn; Cirignotta, Fabio; Horne, Jim; Léger, Damien; McNicholas, Walter T; Partinen, Markku; Téran-Santos, Joaquín; Peigneux, Philippe; Grote, Ludger

    2015-06-01

    The European Sleep Research Society aimed to estimate the prevalence, determinants and consequences of falling asleep at the wheel. In total, 12 434 questionnaires were obtained from 19 countries using an anonymous online questionnaire that collected demographic and sleep-related data, driving behaviour, history of drowsy driving and accidents. Associations were quantified using multivariate logistic regression. The average prevalence of falling asleep at the wheel in the previous 2 years was 17%. Among respondents who fell asleep, the median prevalence of sleep-related accidents was 7.0% (13.2% involved hospital care and 3.6% caused fatalities). The most frequently perceived reasons for falling asleep at the wheel were poor sleep in the previous night (42.5%) and poor sleeping habits in general (34.1%). Falling asleep was more frequent in the Netherlands [odds ratio = 3.55 (95% confidence interval: 1.97; 6.39)] and Austria [2.34 (1.75; 3.13)], followed by Belgium [1.52 (1.28; 1.81)], Portugal [1.34 (1.13, 1.58)], Poland [1.22 (1.06; 1.40)] and France [1.20 (1.05; 1.38)]. Lower odds were found in Croatia [0.36 (0.21; 0.61)], Slovenia [0.62 (0.43; 0.89)] and Italy [0.65 (0.53; 0.79)]. Individual determinants of falling asleep were younger age; male gender [1.79 (1.61; 2.00)]; driving ≥20 000 km year [2.02 (1.74; 2.35)]; higher daytime sleepiness [7.49 (6.26; 8.95)] and high risk of obstructive sleep apnea syndrome [3.48 (2.78; 4.36) in men]. This Pan European survey demonstrates that drowsy driving is a major safety hazard throughout Europe. It emphasizes the importance of joint research and policy efforts to reduce the burden of sleepiness at the wheel for European drivers.

  17. Prevalence and correlates of dizziness in community-dwelling older people: a cross sectional population based study

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    de Moraes Suzana Albuquerque

    2013-01-01

    Full Text Available Abstract Background Dizziness is a common complaint among older adults and has been linked to a wide range of health conditions, psychological and social characteristics in this population. However a profile of dizziness is still uncertain which hampers clinical decision-making. We therefore sought to explore the relationship between dizziness and a comprehensive range of demographic data, diseases, health and geriatric conditions, and geriatric syndromes in a representative sample of community-dwelling older people. Methods This is a cross-sectional, population-based study derived from FIBRA (Network for the Study of Frailty in Brazilian Elderly Adults, with 391 elderly adults, both men and women, aged 65 years and older. Elderly participants living at home in an urban area were enrolled through a process of random cluster sampling of census regions. The outcome variable was the self-report of dizziness in the last year. Several feelings of dizziness were investigated including vertigo, spinning, light or heavy headedness, floating, fuzziness, giddiness and instability. A multivariate logistic regression analysis was conducted to estimate the adjusted odds ratios and build the probability model for dizziness. Results The complaint of dizziness was reported by 45% of elderly adults, from which 71.6% were women (p=0.004. The multivariate regression analysis revealed that dizziness is associated with depressive symptoms (OR = 2.08; 95% CI 1.29–3.35, perceived fatigue (OR = 1.93; 95% CI 1.21-3.10, recurring falls (OR = 2.01; 95% CI 1.11-3.62 and excessive drowsiness (OR = 1.91; 95% CI 1.11–3.29. The discrimination of the final model was AUC = 0.673 (95% CI 0.619-0.727 (p Conclusions The prevalence of dizziness in community-dwelling elderly adults is substantial. It is associated with other common geriatric conditions usually neglected in elderly adults, such as fatigue and drowsiness, supporting its possible multifactorial manifestation. Our

  18. Characterization of edible marijuana product exposures reported to United States poison centers.

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    Cao, Dazhe; Srisuma, Sahaphume; Bronstein, Alvin C; Hoyte, Christopher O

    2016-11-01

    Edible marijuana products are sold as brownies, cookies, and candies, which may be indistinguishable from counterparts without marijuana and are palatable to children and adults. The consumption of an entire product containing multiple dose-units may result in overdose. To characterize edible marijuana exposures reported to US poison centers with subgroup analysis by age. We analyzed single substance, human exposure calls coded to marijuana brownies, candies, cookies, beverages, or other foods reported to the National Poison Data System from January 2013 to December 2015. Calls were analyzed by state, age, gender, exposure route, clinical effect, therapies, and level of healthcare facility utilization. Four-hundred and thirty calls were reported: Colorado (N = 166, 1.05/100,000 population/year) and Washington (96, 0.46) yielded the highest number of exposures. Three hundred and eighty-one (91%) calls occurred in states with decriminalized medical/recreational marijuana. The number of calls increased every year of the study. The most common age groups were: ≤5 years (N = 109, 0.15/100,000 population/year) and 13-19 (78, 0.09). The most frequent clinical effects were drowsiness/lethargy (N = 118, percentage = 43%), tachycardia (84, 31%), agitated/irritable (37, 14%), and confusion (37, 14%). Children ≤5 years have more drowsiness/lethargy, ataxia, and red eye/conjunctivitis. No deaths were reported. The most common therapies administered were intravenous fluids (85, 20%), dilute/irrigate/wash (48, 11 %), and benzodiazepines (47, 11%). Three patients (ages 4, 10, and 57 years) received intubation. 97 (23%), 217 (50%), and 12 (3%) calls were managed at home, treated/released, admitted to a critical care unit, respectively. Although most clinical effects are minor, ventilatory support may be necessary for children and adults. We speculate the increasing exposures may be related to a combination of delayed absorption kinetics of Δ9

  19. Ketamine for pain in adults and children with cancer: a systematic review and synthesis of the literature.

    Science.gov (United States)

    Bredlau, Amy Lee; Thakur, Rajbala; Korones, David Nathan; Dworkin, Robert H

    2013-10-01

    Chronic cancer pain is often refractory and difficult to treat. Ketamine is a medication with evidence of efficacy in the treatment of chronic pain. This article presents a synthesis of the data on ketamine for refractory cancer pain in adults and children. There are five randomized, double-blind, controlled trials of ketamine use in cancer pain that demonstrate improvement in pain for some patients. There are six prospective, uncontrolled trials in cancer pain that also demonstrate improvement in pain scores for some patients. There are no randomized, controlled trials in children with cancer pain, although there are a few studies reflecting improved pain control with ketamine for children with cancer pain. Adverse events for adults on ketamine are most commonly somnolence, feelings of insobriety, nausea/vomiting, hallucinations, depersonalization/derealization, and drowsiness. However, when ketamine is combined with benzodiazepines, feelings of insobriety, hallucinations, and depersonalization/derealization are not reported. Children on ketamine have had few reported adverse effects, which include sedation, anorexia, urinary retention, and myoclonic movements. Recommended ketamine infusion dosages are from 0.05 to 0.5 mg/kg/h (intravenous or subcutaneous). Recommended oral dosages of ketamine are 0.2-0.5 mg/kg/dose two to three times daily with a maximum of 50 mg/dose three times daily. Despite limitations in the breadth and depth of data available, there is evidence that ketamine may be a viable option for treatment-refractory cancer pain. Wiley Periodicals, Inc.

  20. A Review of Prognostic Models on Diagnosis and Therapeutic Strategies of Typhoid Fever

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    Aslam Babar

    2018-05-01

    Full Text Available Background:      Typhoid infection is an insidious onset type of fever and some other gastrointestinal disorders which may have a fatal outcome. The causative agents are Salmonella typhi, Salmonella paratyphi A, and Salmonella paratyphi B.  Clinical features include, gradual rising fever, white coated tongue, and severe degree of malaise, drowsiness and pain in abdomen, perforation with bleeding in the intestines, shock and death. It involves mostly male victims of school going age. It is water born disease which spreads due to poor sanitation mostly in congested populated areas. According to World Health Organization sixteen to seventeen million typhoid fever cases were reported annually, out of which 600,000 died. Typhoid fever is 10 to 29 times more in subcontinent than China. Infection only occurs when food is handled by infected person. Isolated strains of Salmonella spp from suspected cases show resistance against routine antibiotics and the modern antibiotics are much more expensive and un affordable.Conclusion:    Need of this review is especially for Silver Nanoparticles (AgNPs manufactured by some types of fungi introduced by recent researchers have an edge to control or treat some sort of infections due to their antibacterial properties. In this study these (AgNPs in the form of suspension, give positive results against the Salmonella species. It enables us to treat the typhoid infection in a less expensive way.

  1. Sluggish cognitive tempo in abnormal child psychology: an historical overview and introduction to the special section.

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    Becker, Stephen P; Marshall, Stephen A; McBurnett, Keith

    2014-01-01

    There has recently been a resurgence of interest in Sluggish Cognitive Tempo (SCT) as an important construct in the field of abnormal child psychology. Characterized by drowsiness, daydreaming, lethargy, mental confusion, and slowed thinking/behavior, SCT has primarily been studied as a feature of Attention-Deficit/Hyperactivity Disorder (ADHD), and namely the predominately inattentive subtype/presentation. Although SCT is strongly associated with ADHD inattention, research increasingly supports the possibility that SCT is distinct from ADHD or perhaps a different mental health condition altogether, with unique relations to child and adolescent psychosocial adjustment. This introductory article to the Special Section on SCT provides an historical overview of the SCT construct and briefly describes the contributions of the eight empirical papers included in the Special Section. Given the emerging importance of SCT for abnormal psychology and clinical science, there is a clear need for additional studies that examine (1) the measurement, structure, and multidimensional nature of SCT, (2) SCT as statistically distinct from not only ADHD-inattention but also other psychopathologies (particularly depression and anxiety), (3) genetic and environmental contributions to the development of SCT symptoms, and (4) functional impairments associated with SCT. This Special Section brings together papers to advance the current knowledge related to these issues as well as to spur research in this exciting and expanding area of abnormal psychology.

  2. A case of peripheral gangrene and osteomyelitis secondary to terlipressin therapy in advanced liver disease

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    Heon Ju Lee

    2013-06-01

    Full Text Available Variceal bleeding and hepatorenal syndrome (HRS are serious and life-threatening complications of advanced liver disease. Terlipressin is widely used to manage both acute variceal bleeding and HRS due to its potency and long duration of action. The most severe (though rare adverse event is ischemia. The present report describes the case of a patient with gangrene and osteomyelitis secondary to terlipressin therapy. A 71-year-old male with alcoholic liver cirrhosis (Child-Pugh B and chronic hepatitis C was admitted due to a drowsy mental status. The patient had several experiences of orthopedic surgery. His creatinine level had gradually elevated to 4.02 mg/dL, and his urine output decreased to 500 mL/24 hr. The patient was diagnosed as having grade III hepatic encephalopathy (HE and type II HRS. Terlipressin and albumin were administered intravenously to treat the HRS over 11 days. Although he recovered from the HE and HRS, the patient developed peripheral gangrene and osteomyelitis in both feet. His right toes were cured with the aid of rescue therapy, but his left three toes had to be amputated. Peripheral gangrene and osteomyelitis secondary to terlipressin therapy occur only rarely, and there is no specific rescue therapy for these conditions. Thus, attention should be paid to the possibility of ischemia of the skin and bone during or after terlipressin therapy.

  3. Activating Student to Learn Chemistry using Chemmy Card 6-1 Game as an Instructional Medium in IUPAC Nomenclature of Inorganic Compounds

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    Lutfi, A.; Hidayah, R.

    2018-01-01

    The aim of this study is to know the effect of Internet-assisted Chemmy Card 6-1 game as an instructional medium in IUPAC Nomenclature of Inorganic Compounds material for X grade of senior high school on students’ activity, learning motivation, and learning outcome. The study was conducted at SMA Negeri Sidoarjo, Indonesia, in two different classes. The instruction was done based on the lesson plan made. The observation on students’ activity was conducted during the instruction with the game while test and questionnaire were given after the instruction. The result showed positive activities, which students listened to the teacher’s explanation, actively delivered questions, and enabled to solve problems in naming compounds. It was also effective to avoid the drowsiness. The result of students’ motivation of X MIPA 6 was 74.78% (good) while X MIPA 7 was 83.80% (very good). The pretest results of two classes showed that no students mastered but 100% students mastered and the increase of N-gain scores in two classes was categorized as high, ≥0,7, after the instruction. The result of this study showed that the use of Internet-assisted Chemmy Card 6-1 game in IUPAC nomenclature of inorganic compounds for X grade of senior high school could be pleasant for students to learn and effective in achieving the learning objective.

  4. PCA-induced respiratory depression simulating stroke following endoluminal repair of abdominal aortic aneurysm: a case report

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    Ahmad Javed

    2007-07-01

    Full Text Available Abstract Aim To report a case of severe respiratory depression with PCA fentanyl use simulating stroke in a patient who underwent routine elective endoluminal graft repair for abdominal aortic aneurysm (AAA Case presentation A 78-year-old obese lady underwent routine endoluminal graft repair for AAA that was progressively increasing in size. Following an uneventful operation postoperative analgesia was managed with a patient-controlled analgesia (PCA device with fentanyl. On the morning following operation the patient was found to be unusually drowsy and unresponsive to stimuli. Her GCS level was 11 with plantars upgoing bilaterally. A provisional diagnosis of stroke was made. Urgent transfer to a high-dependency unit (HDU was arranged and she was given ventilatory support with a BiPap device. CT was performed and found to be normal. Arterial blood gas (ABG analysis showed respiratory acidosis with PaCO2 81 mmHg, PaO2 140 mmHg, pH 7.17 and base excess -2 mmol/l. A total dose of 600 mcg of fentanyl was self-administered in the 16 hours following emergence from general anaesthesia. Naloxone was given with good effect. There was an increase in the creatinine level from 90 μmol/L preoperatively to 167 μmol/L on the first postoperative day. The patient remained on BiPap for two days that resulted in marked improvement in gas exchange. Recovery was complete.

  5. Efficacy of zolpidem for dystonia: a study among different subtypes

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    Yoshimichi eMiyazaki

    2012-04-01

    Full Text Available Although there are some newly-developed options to treat dystonia, its medical treatment is not always satisfactory. Zolpidem, an imidazopyridine agonist with a high affinity on benzodiazepine subtype receptor BZ1(ω1 , was found to improve clinical symptoms of dystonia in a limited number of case reports. To investigate what subtype of dystonia is responsive to the therapy, we conducted an open label study to assess the efficacy of zolpidem (5-20mg in 34 patients suffering from miscellaneous types of dystonia using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS. Patients were entered into the study if they had been refractory to other medications as evaluated by BFMDRS (no change in the previous 2 successive visits. After zolpidem therapy, the scores in the patients as a whole were decreased from 7.2±7.9 to 5.5±5.0 (P=0.042. Patients with generalized dystonia, Meige syndrome/blepharospasm, and hand dystonia improved in the scale by 27.8%, 17.8% and 31.0%, respectively, whereas no improvement was found in cervical dystonia patients. Overall response rate among patients were comparable to that of trihexyphenidyl. Zolpidem may be a therapeutic option for generalized dystonia, Meige syndrome and hand dystonia including musician’s. Drowsiness was the dose-limiting factor.

  6. Validation of the Karolinska sleepiness scale against performance and EEG variables.

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    Kaida, Kosuke; Takahashi, Masaya; Akerstedt, Torbjörn; Nakata, Akinori; Otsuka, Yasumasa; Haratani, Takashi; Fukasawa, Kenji

    2006-07-01

    The Karolinska sleepiness scale (KSS) is frequently used for evaluating subjective sleepiness. The main aim of the present study was to investigate the validity and reliability of the KSS with electroencephalographic, behavioral and other subjective indicators of sleepiness. Participants were 16 healthy females aged 33-43 (38.1+/-2.68) years. The experiment involved 8 measurement sessions per day for 3 consecutive days. Each session contained the psychomotor vigilance task (PVT), the Karolinska drowsiness test (KDT-EEG alpha & theta power), the alpha attenuation test (AAT-alpha power ratio open/closed eyes) and the KSS. Median reaction time, number of lapses, alpha and theta power density and the alpha attenuation coefficients (AAC) showed highly significant increase with increasing KSS. The same variables were also significantly correlated with KSS, with a mean value for lapses (r=0.56). The KSS was closely related to EEG and behavioral variables, indicating a high validity in measuring sleepiness. KSS ratings may be a useful proxy for EEG or behavioral indicators of sleepiness.

  7. [Association between homozygous c.318A>GT mutation in exon 2 of the EIF2B5 gene and the infantile form of vanishing white matter leukoencephalopathy].

    Science.gov (United States)

    Esmer, Carmen; Blanco Hernández, Gabriela; Saavedra Alanís, Víctor; Reyes Vaca, Jorge Guillermo; Bravo Oro, Antonio

    Vanishing white matter disease is one of the most frequent leukodystrophies in childhood with an autosomal recessive inheritance. A mutation in one of the genes encoding the five subunits of the eukaryotic initiation factor 2 (EIF2B5) is present in 90% of the cases. The diagnosis can be accomplished by the clinical and neuroradiological findings and molecular tests. We describe a thirteen-month-old male with previous normal neurodevelopment, who was hospitalized for vomiting, hyperthermia and irritability. On examination, cephalic perimeter and cranial pairs were normal. Hypotonia, increased muscle stretching reflexes, generalized white matter hypodensity on cranial tomography were found. Fifteen days after discharge, he suffered minor head trauma presenting drowsiness and focal seizures. Magnetic resonance showed generalized hypointensity of white matter. Vanishing white matter disease was suspected, and confirmed by sequencing of the EIF2B5 gene, revealing a homozygous c.318A> T mutation in exon 2. Subsequently, visual acuity was lost and cognitive and motor deterioration was evident. The patient died at six years of age due to severe pneumonia. This case contributes to the knowledge of the mutational spectrum present in Mexican patients and allows to extend the phenotype associated to this mutation. Copyright © 2017. Publicado por Masson Doyma México S.A.

  8. Association between an aplastic basilar artery, unaccompanied by a primitive carotid-vertebrobasilar anastomosis, and multiple aneurysms on the dominant posterior communicating artery.

    Science.gov (United States)

    Behari, Sanjay; Krishna, Himanshu; Kumar, Marakani V Kiran; Sawlani, Vijay; Phadke, Rajendra V; Jain, Vijendra K

    2004-05-01

    Basilar artery (BA) aplasia when unaccompanied by a primitive carotid-vertebrobasilar anastomosis is exceedingly rare. The association of BA aplasia with two aneurysms on the dominant posterior communicating artery (PCoA) has not been previously reported. This 40-year-old man presented in a state of drowsiness and responded to simple commands only after being coaxed. He had complete left cranial third nerve palsy, right hemiparesis, and persisting signs of meningeal irritation. A computerized tomography (CT) scan revealed subarachnoid and intraventricular hemorrhage. An angiogram revealed BA aplasia. The right PCoA followed a sinuous course with multiple loops and provided the dominant supply to the posterior circulation. This vessel harbored two aneurysms, one at the origin of the PCoA from the internal carotid artery and the other at the looping segment just proximal to the brainstem. The left PCoA was extremely thin. The pterional transsylvian approach was used to clip the two aneurysms on the PCoA. The hemodynamic changes produced by the BA aplasia may have produced alterations in the cerebral vasculature leading to aneurysm formation and consequent subarachnoid hemorrhage.

  9. Bioavailability of Promethazine during Spaceflight

    Science.gov (United States)

    Boyd, Jason L.; Wang, Zuwei; Putcha, Lakshmi

    2009-01-01

    Promethazine (PMZ) is the choice anti-motion sickness medication for treating space motion sickness (SMS) during flight. The side effects associated with PMZ include dizziness, drowsiness, sedation, and impaired psychomotor performance which could impact crew performance and mission operations. Early anecdotal reports from crewmembers indicate that these central nervous system side effects of PMZ are absent or greatly attenuated in microgravity, potentially due to changes in pharmacokinetics (PK) and pharmacodynamics in microgravity. These changes could also affect the therapeutic effectiveness of drugs in general and PMZ, in particular. In this investigation, we examined bioavailability and associated pharmacokinetics of PMZ in astronauts during and after space flight. Methods. Nine astronauts received, per their preference, PMZ (25 or 50 mg as intramuscular injection, oral tablet, or rectal suppository) on flight day one for the treatment of SMS and subsequently collected saliva samples and completed sleepiness scores for 72 h post dose. Thirty days after the astronauts returned to Earth, they repeated the protocol. Bioavailability and PK parameters were calculated and compared between flight and ground. Results. Maximum concentration (Cmax) was lower and time to reach Cmax (tmax) was longer in flight than on the ground. Area under the curve (AUC), a measure of bioavailability, was lower and biological half-life (t1/2) was longer in flight than on the ground. Conclusion. Results indicate that bioavailability of PMZ is reduced during spaceflight. Number of samples, sampling method, and sampling schedule significantly affected PK parameter estimates.

  10. Symptomatic Cerebral Vasospasm and Delayed Cerebral Ischemia Following Transsphenoidal Resection of a Craniopharyngioma.

    Science.gov (United States)

    Ricarte, Irapuá Ferreira; Funchal, Bruno F; Miranda Alves, Maramélia A; Gomes, Daniela L; Valiente, Raul A; Carvalho, Flávio A; Silva, Gisele S

    2015-09-01

    Vasospasm has been rarely described as a complication associated with craniopharyngioma surgery. Herein we describe a patient who developed symptomatic vasospasm and delayed cerebral ischemia after transsphenoidal surgery for a craniopharyngioma. A 67-year-old woman became drowsy 2 weeks after a transsphenoidal resection of a craniopharyngioma. A head computed tomography (CT) was unremarkable except for postoperative findings. Electroencephalogram and laboratory studies were within the normal limits. A repeated CT scan 48 hours after the initial symptoms showed bilateral infarcts in the territory of the anterior cerebral arteries (ACA). Transcranial Doppler (TCD) showed increased blood flow velocities in both anterior cerebral arteries (169 cm/second in the left ACA and 145 cm/second in the right ACA) and right middle cerebral artery (164 cm/second) compatible with vasospasm. A CT angiography confirmed the findings. She was treated with induced hypertension and her level of consciousness improved. TCD velocities normalized after 2 weeks. Cerebral vasospasm should be considered in the differential diagnosis of patients with altered neurologic status in the postoperative period following a craniopharyngioma resection. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  11. an Adhesive Patch

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    S. Mojtaba Taghizadeh

    2013-01-01

    Full Text Available Drug-in-adhesive transdermal drug delivery systems  TDDSs containing stimulants, termed as energetic substances, such as caffeine and pantothenic acid, were studied. Caffeine is a white crystalline substance and a stimulant to central nervous system. In humans, caffeine acts as a central nervous system stimulant, temporarily warding off drowsiness and restoring alertness. Pantothenic acid, also recognized as vitamin B5, is a water-soluble vitamin. For many animals, pantothenic acid is an essential nutrient. Animals require pantothenic acid to synthesize and metabolize proteins, carbohydrates and fats. For this purpose caffeine and pantothenic acid were  used  as  drug  components with  6.32%  and  1.12%  loadings,  in  different functional and non-functional acrylic pressure sensitive adhesives (PSAs of 52.89%, respectively. Ethylene glycol as a chemical enhancer was used in all TDDSs with 39.67%. The effect of PSAs  type on  in vitro  release and adhesion properties  (peel strength and tack values from drug delivery devices were evaluated. It was found that TDDS containing -COOH functional PSA showed  the  lowest steady state fux. The adhesion properties of the samples were improved by addition of functional acrylic PSA in formulations.

  12. The relationship between physical and psychological symptoms and health care utilization in hospitalized patients with advanced cancer.

    Science.gov (United States)

    Nipp, Ryan D; El-Jawahri, Areej; Moran, Samantha M; D'Arpino, Sara M; Johnson, P Connor; Lage, Daniel E; Wong, Risa L; Pirl, William F; Traeger, Lara; Lennes, Inga T; Cashavelly, Barbara J; Jackson, Vicki A; Greer, Joseph A; Ryan, David P; Hochberg, Ephraim P; Temel, Jennifer S

    2017-12-01

    Patients with advanced cancer often experience frequent and prolonged hospitalizations; however, the factors associated with greater health care utilization have not been described. We sought to investigate the relation between patients' physical and psychological symptom burden and health care utilization. We enrolled patients with advanced cancer and unplanned hospitalizations from September 2014-May 2016. Upon admission, we assessed physical (Edmonton Symptom Assessment System [ESAS]) and psychological symptoms (Patient Health Questionnaire 4 [PHQ-4]). We examined the relationship between symptom burden and healthcare utilization using linear regression for hospital length of stay (LOS) and Cox regression for time to first unplanned readmission within 90 days. We adjusted all models for age, sex, marital status, comorbidity, education, time since advanced cancer diagnosis, and cancer type. We enrolled 1,036 of 1,152 (89.9%) consecutive patients approached. Over one-half reported moderate/severe fatigue, poor well being, drowsiness, pain, and lack of appetite. PHQ-4 scores indicated that 28.8% and 28.0% of patients had depression and anxiety symptoms, respectively. The mean hospital LOS was 6.3 days, and the 90-day readmission rate was 43.1%. Physical symptoms (ESAS: unstandardized coefficient [B], 0.06; P cancer experience a high symptom burden, which is significantly associated with prolonged hospitalizations and readmissions. Interventions are needed to address the symptom burden of this population to improve health care delivery and utilization. Cancer 2017;123:4720-4727. © 2017 American Cancer Society. © 2017 American Cancer Society.

  13. Identification of symptom clusters in cancer patients at palliative care clinic

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    Gülçin Senel Özalp

    2017-01-01

    Full Text Available Objective: Cancer patients often experience a large number of symptoms together. The aim of this study is to determine the symptom clusters in cancer patients at palliative care clinic. Methods: Hundred and seventy consecutive patients were enrolled in the study. Memorial Symptom Assessment Scale was used for symptom assessment of the patients. Results: The most experienced symptoms by the patients during the past week before hospitalization in palliative care clinic were lack of energy (95.4%, weight loss (91.2%, lack of appetite (89.4%, pain (88.2%, dry mouth (87.6%, feeling sad (87.6%, feeling nervous (82.9%, worrying (81.2%, and feeling irritable (80.6%. Five symptom clusters were defined. First cluster: pain, feeling nervous, dry mouth, worrying, feeling irritable, weight loss; second cluster: feeling drowsy, numbness/tingling in hands/feet, difficulty in sleeping, dizziness, constipation, I do not look like myself; third cluster: nausea, vomiting; fourth cluster: shortness of breath, difficulty in swallowing, cough, change in the way food tastes; and fifth cluster: feeling bloated, problems with urination, diarrhea, itching, mouth sores, hair loss, swelling of arm or legs, change in the skin. Conclusions: We encountered various symptom clusters in advanced cancer patients. Identification of symptom clusters and knowledge of cluster composition in oncological population may particularly contribute individualization of the treatment.

  14. Ventilation and Heart Rate Monitoring in Drivers using a Contactless Electrical Bioimpedance System

    Science.gov (United States)

    Macías, R.; García, M. A.; Ramos, J.; Bragós, R.; Fernández, M.

    2013-04-01

    Nowadays, the road safety is one of the most important priorities in the automotive industry. Many times, this safety is jeopardized because of driving under inappropriate states, e.g. drowsiness, drugs and/or alcohol. Therefore several systems for monitoring the behavior of subjects during driving are researched. In this paper, a device based on a contactless electrical bioimpedance system is shown. Using the four-wire technique, this system is capable of obtaining the heart rate and the ventilation of the driver through multiple textile electrodes. These textile electrodes are placed on the car seat and the steering wheel. Moreover, it is also reported several measurements done in a controlled environment, i.e. a test room where there are no artifacts due to the car vibrations or the road state. In the mentioned measurements, the system response can be observed depending on several parameters such as the placement of the electrodes or the number of clothing layers worn by the driver.

  15. Relationship between the severity of obstructive sleep apnea syndrome and asymptomatic cerebrovascular disease

    International Nuclear Information System (INIS)

    Nishibayashi, Momoka

    2008-01-01

    In this study, examined were prevalence of asymptomatic cerebrovascular disease (ACD) in patients with obstructive sleep apnea syndrome (OSAS) and relationship between its severity and ACD prevalence. Subjects were 192 cases (M 170/F 20, av. age 50.6 y) with chief complaint of snore, sleep apnea (apnea-hypopnea index/AHI 0-118.4/h), midday drowsiness and so on without CD history, who underwent the overnight polysomnographic recording, vascular risk assessment like life habits, blood pressure and impaired GT, and brain MRI. The last item was conducted with Siemence 1.5T machine to get T1-, T2-weighted and FLAIR images to evaluate asymptomatic lacunar infarction (ALI) and periventricular hyperintensity (PVH). Light (AHI<15/h), moderate (15≤AHI<30) and severe (AHI≥30) OSASs were found in 44, 35 and 61 cases, respectively. ALIs were found in 7 light, 17 moderate and 61 severe cases and PVH, in 9, 19 and 61 cases, respectively. Thus it was revealed that patients with moderate to severe OSAS had complication of ACD in a higher rate than those with light OSAS and that prevalence of ACD was higher in OSAS patients with AHI 15/h or more. (R.T.)

  16. A Family Clustered Nitrite Intoxication Investigation in Gaoxin District, Suzhou, China, 2013.

    Science.gov (United States)

    Wang, Ruiping; Teng, Chengang; Zhang, Ning; Zhang, Jun; Conway, George

    2013-12-01

    In April, 2013, a Suzhou Hospital reported a nitrite intoxication patient in coma as well as 2 family members with the similar symptom 5 days ahead. We investigated the event to identify the cause, source and possible pollution ways of the contamination. We defined case as any person living in YSHY community who has cyanosis and with at least one of the following symptoms: dizziness, headache, fatigue, tachycardia, drowsiness, nausea, vomiting, abdominal pain or diar-rhea during April 15 to April 25, 2013. We searched for case by interviewing community residents and reviewing clinics' medical records; information was then retrospectively collected on the patient's food history, cooking procedures and food sources. We identified 3 nitrite intoxication cases, 1 male and 2 female from a family. The interval time between dinner and onset was mix asparagus' on April 17 and 'scrambled asparagus' on April 21 were suspected foods. Both suspected dishes had 'sugar' added, sourced from a clean-up of a neighboring rental house. Nitrite was detected in a vomitus sample, the 'sugar' and two leftover food samples. This family clustered nitrite intoxication was induced by using unidentified nitrite as sugar to cook dishes. We recommend sodium nitrite should be dyed with bright colors to avoid mistaking it for plain salt or sugar, health departments strengthen food hygiene propaganda to improve people's recognition of food safety, and to alert them the dangerous of eating unidentified or unknown source food.

  17. Transient widespread cortical and splenial lesions in acute encephalitis/encephalopathy associated with primary Epstein–Barr virus infection

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    Shuo Zhang

    2016-01-01

    Full Text Available Infection with Epstein–Barr virus (EBV is very common and usually occurs in childhood or early adulthood. Encephalitis/encephalopathy is an uncommon but serious neurological complication of EBV. A case of EBV-associated encephalitis/encephalopathy with involvement of reversible widespread cortical and splenial lesions is presented herein. An 8-year-old Chinese girl who presented with fever and headache, followed by seizures and drowsiness, was admitted to the hospital. Magnetic resonance imaging revealed high signal intensities on diffusion-weighted imaging in widespread cortical and splenial lesions. The clinical and laboratory examination results together with the unusual radiology findings suggested acute encephalitis/encephalopathy due to primary EBV infection. After methylprednisolone pulse therapy together with ganciclovir, the patient made a full recovery without any brain lesions. The hallmark clinical–radiological features of this patient included severe encephalitis/encephalopathy at onset, the prompt and complete recovery, and rapidly reversible widespread involvement of the cortex and splenium. Patients with EBV encephalitis/encephalopathy who have multiple lesions, even with the widespread involvement of cortex and splenium of the corpus callosum, may have a favorable outcome with complete disappearance of all brain lesions.

  18. Hypothyroidism causing paralytic ileus and acute kidney injury - case report

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    Rodrigo Chaturaka

    2011-02-01

    Full Text Available Abstract We present a patient with severe hypothyroidism complicated by paralytic ileus and acute kidney injury. A 65 year old male patient, diagnosed with hypothyroidism one year ago was transferred to our unit in a state of drowsiness and confusion. He was severely hypothyroid and had paralytic ileus and impaired renal function at the time of transfer. Hypokalaemia was present, and was likely to have contributed to the paralytic ileus and this together with dehydration was likely to have contributed to renal injury. Nonetheless, hypothyroidism is very likely to have been the principal precipitant of both these complications, and both paralytic ileus and acute kidney injury improved with thyroxine replacement. Unfortunately, the patient died unexpectedly eight days after admission to the unit. Hypothyroidism may induce de novo acute kidney injury or it may exacerbate ongoing chronic kidney disease. This rare complication is assumed to be due to the hypodynamic circulatory state created by thyroid hormone deficiency. Paralytic ileus is an even rarer fatal manifestation of hypothyroidism and is thought to be due to an autonomic neuropathy affecting the intestines that is reversible with thyroxine replacement. To our knowledge, both these complications have not been observed in a single patient so far. It is important that clinicians are aware of these rare manifestations of hypothyroidism as in most occasions, thyroxine deficiency may be missed, and treatment can reverse the complications.

  19. Acute effect of glucose on cerebral blood flow, blood oxygenation, and oxidative metabolism.

    Science.gov (United States)

    Xu, Feng; Liu, Peiying; Pascual, Juan M; Xiao, Guanghua; Huang, Hao; Lu, Hanzhang

    2015-02-01

    While it is known that specific nuclei of the brain, for example hypothalamus, contain glucose-sensing neurons thus their activity is affected by blood glucose level, the effect of glucose modulation on whole-brain metabolism is not completely understood. Several recent reports have elucidated the long-term impact of caloric restriction on the brain, showing that animals under caloric restriction had enhanced rate of tricarboxylic acid cycle (TCA) cycle flux accompanied by extended life span. However, acute effect of postprandial blood glucose increase has not been addressed in detail, partly due to a scarcity and complexity of measurement techniques. In this study, using a recently developed noninvasive MR technique, we measured dynamic changes in global cerebral metabolic rate of O2 (CMRO2 ) following a 50 g glucose ingestion (N = 10). A time dependent decrease in CMRO2 was observed, which was accompanied by a reduction in oxygen extraction fraction (OEF) with unaltered cerebral blood flow (CBF). At 40 min post-ingestion, the amount of CMRO2 reduction was 7.8 ± 1.6%. A control study without glucose ingestion was performed (N = 10), which revealed no changes in CMRO2 , CBF, or OEF, suggesting that the observations in the glucose study was not due to subject drowsiness or fatigue after staying inside the scanner. These findings suggest that ingestion of glucose may alter the rate of cerebral metabolism of oxygen in an acute setting. © 2014 Wiley Periodicals, Inc.

  20. Temporal Patterns of Fatigue Predict Pathologic Response in Patients Treated With Preoperative Chemoradiation Therapy for Rectal Cancer

    International Nuclear Information System (INIS)

    Park, Hee Chul; Janjan, Nora A.; Mendoza, Tito R.; Lin, Edward H.; Vadhan-Raj, Saroj; Hundal, Mandeep; Zhang Yiqun; Delclos, Marc E.; Crane, Christopher H.; Das, Prajnan; Wang, Xin Shelley; Cleeland, Charles S.; Krishnan, Sunil

    2009-01-01

    Purpose: To investigate whether symptom burden before and during preoperative chemoradiation therapy (CRT) for rectal cancer predicts for pathologic tumor response. Methods and Materials: Fifty-four patients with T3/T4/N+ rectal cancers were treated on a Phase II trial using preoperative capecitabine and concomitant boost radiotherapy. Symptom burden was prospectively assessed before (baseline) and weekly during CRT by patient self-reported questionnaires, the MD Anderson Symptom Inventory (MDASI), and Brief Fatigue Inventory (BFI). Survival probabilities were estimated using the Kaplan-Meier method. Symptom scores according to tumor downstaging (TDS) were compared using Student's t tests. Logistic regression was used to determine whether symptom burden levels predicted for TDS. Lowess curves were plotted for symptom burden across time. Results: Among 51 patients evaluated for pathologic response, 26 patients (51%) had TDS. Fatigue, pain, and drowsiness were the most common symptoms. All symptoms increased progressively during treatment. Patients with TDS had lower MDASI fatigue scores at baseline and at completion (Week 5) of CRT (p = 0.03 for both) and lower levels of BFI 'usual fatigue' at baseline. Conclusion: Lower levels of fatigue at baseline and completion of CRT were significant predictors of pathologic tumor response gauged by TDS, suggesting that symptom burden may be a surrogate for tumor burden. The relationship between symptom burden and circulating cytokines merits evaluation to characterize the molecular basis of this phenomenon.

  1. Acute Spontaneous Posterior Fossa Subdural Hematoma

    Directory of Open Access Journals (Sweden)

    Osama Shukir Muhammed Amin

    2014-02-01

    Full Text Available Acute posterior fossa subdural hematomas are rare and most of them are trauma-related. Non-traumatic ones have been reported in patients who had idiopathic thrombocytopenic purpura or those who had been receiving anticoagulant therapy. We report on the case of 57-year-old Iranian man who developed sudden severe occipital headache, drowsiness, repeated vomiting, and instability of stance and gait. He was neither hypertensive nor diabetic. No history of head trauma was obtained and he denied illicit drug or alcohol ingestion. A preliminary diagnosis of acute intra-cerebellar hemorrhage was made. His CT brain scan revealed an acute right-sided, extra-axial, crescent-shaped hyperdense area at the posterior fossa. His routine blood tests, platelets count, bleeding time, and coagulation profile were unremarkable. The patient had spontaneous acute infratentorial subdural hematoma. He was treated conservatively and discharged home well after 5 days. Since then, we could not follow-up him, clinically and radiologically because he went back to Iran. Our patient’s presentation, clinical course, and imaging study have called for conservative management, as the overall presentation was relatively benign. Unless the diagnosis is entertained and the CT brain scan is well-interpreted, the diagnosis may easily escape detection.

  2. Disulfiram for binge eating disorder: an open trail.

    Science.gov (United States)

    Farci, Anna Maria Giulia; Piras, Simona; Murgia, Magnolia; Chessa, Alessandra; Restivo, Angelo; Gessa, Gian Luigi; Agabio, Roberta

    2015-01-01

    To evaluate the efficacy and safety of disulfiram for treatment of binge eating disorder. Two hundred and fifty milligrams per day of disulfiram was administered to 12 patients affected by binge eating disorder for 16 weeks; the number of binge eating episodes per week and the number of participants who reported side effects were evaluated. Nine participants (75.0%) completed the trial, while the other 3 (25.0%) discontinued prematurely. Disulfiram significantly decreased the mean frequency of binge eating episodes per week from 7.9±1.2 to 0.9±0.6 (pbinge eating episodes, and 7 participants (58.3%) achieved remission of binge eating. Eleven participants (91.7%) reported side effects [drowsiness (N=9), headache (N=7), dysgeusia (N=3), tachycardia (N=3), dizziness (N=2), and nausea (N=2)]. While disulfiram reduced the frequency of binge eating episodes, side effects were observed in the majority of participants. Longer-term placebo-controlled studies are warranted to exclude the contribution of a placebo response from these results and to evaluate drugs with similar pharmacological activity but improved tolerability. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Design of a Fatigue Detection System for High-Speed Trains Based on Driver Vigilance Using a Wireless Wearable EEG

    Directory of Open Access Journals (Sweden)

    Xiaoliang Zhang

    2017-03-01

    Full Text Available The vigilance of the driver is important for railway safety, despite not being included in the safety management system (SMS for high-speed train safety. In this paper, a novel fatigue detection system for high-speed train safety based on monitoring train driver vigilance using a wireless wearable electroencephalograph (EEG is presented. This system is designed to detect whether the driver is drowsiness. The proposed system consists of three main parts: (1 a wireless wearable EEG collection; (2 train driver vigilance detection; and (3 early warning device for train driver. In the first part, an 8-channel wireless wearable brain-computer interface (BCI device acquires the locomotive driver’s brain EEG signal comfortably under high-speed train-driving conditions. The recorded data are transmitted to a personal computer (PC via Bluetooth. In the second step, a support vector machine (SVM classification algorithm is implemented to determine the vigilance level using the Fast Fourier transform (FFT to extract the EEG power spectrum density (PSD. In addition, an early warning device begins to work if fatigue is detected. The simulation and test results demonstrate the feasibility of the proposed fatigue detection system for high-speed train safety.

  4. Cognitive and personality peculiarities in children sluggish cognitive tempo and ADHD

    Directory of Open Access Journals (Sweden)

    Agris A.R.

    2013-03-01

    Full Text Available The article presents the review of data obtained by foreign investigators and concerning a set of symptoms united by the umbrella term “sluggish cognitive tempo” (SCT. At present this complex of symptoms is regarded as typical for children with either attention deficit without hyperactivity or as a subtype of attention deficit syndrome. ChildrenwithSCT often look inhibited, they tend to plunge into their own flow of thoughts and imaginations during the work, feel drowsiness in day time.Accordingtotheempiricaldata the decrease in information processing speed, sustained attention and selective attention are typical for this category of children. A number of studies also indicatein them the deficit of visual information processing and a lack of some components regulating the executive function. A number of studies disclose the expressed inclination of children with SCT to anxiety and depressive disorders as well as to poor social contacts and maladaptation. There exists a hypothesisthat a significant deficit of motivation is typical for children with this kind of impairment. Yet, the diagnostic status of this symptom group as well as itsneuro-cognitive and emotion-personality peculiarities haven’t been found so far and need further investigating.

  5. Cell phone users, reported crash risk, unsafe driving behaviors and dispositions: a survey of motorists in Maryland.

    Science.gov (United States)

    Beck, Kenneth H; Yan, Fang; Wang, Min Qi

    2007-01-01

    The purpose of this investigation was to identify risky driving behaviors and dispositions that distinguish drivers who use a cell phone while operating a motor vehicle from non-cell phone using drivers. Annual telephone surveys were used to identify drivers who reported using a cell phone while driving in the last month (n=1803) and were compared to those who said they did not use cell phones while driving (n=1578). Cell phone using drivers were more likely to report driving while drowsy, going 20 mph over the speed limit, driving aggressively, running a stop sign or red light, and driving after having had several drinks. They were also more likely to have had a prior history of citation and crash involvement than non-cell phone using drivers. Cell phone using drivers also reported they were less careful and more in a hurry when they drive than non-cell phone using drivers. Cell phone using drivers report engaging in many behaviors that place them at risk for a traffic crash, independent of the specific driving impairments that cell phone usage may produce. Strategies that combine coordinated and sustained enforcement activities along with widespread public awareness campaigns hold promise as effective countermeasures for these drivers, who resemble aggressive drivers in many respects.

  6. An exploratory study of long-haul truck drivers' secondary tasks and reasons for performing them.

    Science.gov (United States)

    Iseland, Tobias; Johansson, Emma; Skoog, Siri; Dåderman, Anna M

    2018-08-01

    Research on drivers has shown how certain visual-manual secondary tasks, unrelated to driving, increase the risk of being involved in crashes. The purpose of the study was to investigate (1) if long-haul truck drivers in Sweden engage in secondary tasks while driving, what tasks are performed and how frequently, (2) the drivers' self-perceived reason/s for performing them, and (3) if psychological factors might reveal reasons for their engaging in secondary tasks. The study comprised 13 long-haul truck drivers and was conducted through observations, interviews, and questionnaires. The drivers performed secondary tasks, such as work environment related "necessities" (e.g., getting food and/or beverages from the refrigerator/bag, eating, drinking, removing a jacket, face rubbing, and adjusting the seat), interacting with a mobile phone/in-truck technology, and doing administrative tasks. The long-haul truck drivers feel bored and use secondary tasks as a coping strategy to alleviate boredom/drowsiness, and for social interaction. The higher number of performed secondary tasks could be explained by lower age, shorter driver experience, less openness to experience, lower honesty-humility, lower perceived stress, lower workload, and by higher health-related quality of life. These explanatory results may serve as a starting point for further studies on large samples to develop a safer and healthier environment for long-haul truck drivers. Copyright © 2018. Published by Elsevier Ltd.

  7. Nitrous oxide for the management of labor pain: a systematic review.

    Science.gov (United States)

    Likis, Frances E; Andrews, Jeffrey C; Collins, Michelle R; Lewis, Rashonda M; Seroogy, Jeffrey J; Starr, Sarah A; Walden, Rachel R; McPheeters, Melissa L

    2014-01-01

    We systematically reviewed evidence addressing the effectiveness of nitrous oxide for the management of labor pain, the influence of nitrous oxide on women's satisfaction with their birth experience and labor pain management, and adverse effects associated with nitrous oxide for labor pain management. We searched the MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for articles published in English. The study population included pregnant women in labor intending a vaginal birth, birth attendees or health care providers who may be exposed to nitrous oxide during labor, and the fetus/neonate. We identified a total of 58 publications, representing 59 distinct study populations: 2 studies were of good quality, 11 fair, and 46 poor. Inhalation of nitrous oxide provided less effective pain relief than epidural analgesia, but the quality of studies was predominately poor. The heterogeneous outcomes used to assess women's satisfaction with their birth experience and labor pain management made synthesis of studies difficult. Most maternal adverse effects reported in the literature were unpleasant side effects that affect tolerability, such as nausea, vomiting, dizziness, and drowsiness. Apgar scores in newborns whose mothers used nitrous oxide were not significantly different from those of newborns whose mothers used other labor pain management methods or no analgesia. Evidence about occupational harms and exposure was limited. The literature addressing nitrous oxide for the management of labor pain includes few studies of good or fair quality. Further research is needed across all of the areas examined: effectiveness, satisfaction, and adverse effects.

  8. Caffeine use and dependence in adolescents: one-year follow-up.

    Science.gov (United States)

    Oberstar, Joel V; Bernstein, Gail A; Thuras, Paul D

    2002-01-01

    The objectives were to conduct a 1-year follow-up of daily caffeine-using adolescents to further describe caffeine dependence symptoms and to determine whether caffeine dependence is associated with other substance dependence disorders. Twenty-one of 36 (58.3%) adolescents who participated in a study of caffeine dependence returned for follow-up. The previous study was a case series of adolescents who consumed caffeine daily and met some Diagnostic and Statistical Manual of Mental Disorders (fourth edition) substance dependence criteria as applied to caffeine. At follow-up, caffeine consumption from beverages was 179.9 +/- 151.8 mg/day. Of the 21 teenagers, 23.8% (n = 5) met criteria for caffeine dependence. Four of these participants developed caffeine dependence during the follow-up period. Other substance dependence disorders were not overrepresented in the caffeine dependent group compared to the caffeine nondependent group. The most commonly reported withdrawal symptoms in dependent teenagers (at baseline and follow-up combined) were feeling drowsy/tired, fatigued, or sluggish/slowed down (83.3% each) and headache (75.0%). Caffeine dependence occurs in some adolescents who drink caffeine daily and is marked by symptoms similar to those found in adults.

  9. MRI findings of acute disseminated encephalomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Sei Jung; Suh, Jung Ho; Kim, Dong Ik; Chung, Tae Sub; Lee, So Jin [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1993-07-15

    Acute disseminate encephalomyelitis (ADEM) is a demyelinating disease of probable autoimmune etiology. The MR images of patients with clinically suspected ADEM were retrospectively reviewed. The clinical symptoms occurred 5 days to 1 month after viral upper respiratory infection (4) and Coxsakie viral infection (1). The symptoms had begun with fever (3), headache (3), sore throat (1), and drowsy mental state (1), which progressed with monophasic course to altered mental change (2), extremity weakness (2), seizure (1) and/or cerebellar symptom (1). MRI findings of ADEM showed patchy (4), non hemorrhagic (5), asymmetric (5) high signal intensity lesions on T2-weighted images. The number of the lesions was mostly multiple (4). The lesions mainly involved the brain stem (3) and subcortical while matter (3). Follow-up MR images of 13 days to 20 days after high dose steroid therapy showed marked improvement in two of three, which well corrected with clinical manifestations. MR finding of multiple, patchy, nonhemorrhagic and asymmetric lesions in subcortical white matter and brain stem on T2-weighted images seem to be characteristic features of ADEM, but nonspecific. Therefore, clinical correlation is required in evaluating ADEM.

  10. Informational need of emotional stress

    Science.gov (United States)

    Simonov, P. V.; Frolov, M. V.

    According to the informational theory of emotions[1], emotions in humans depend on the power of some need (motivation) and the estimation by the subject of the probability (possibility) of the need staisfaction (the goal achievement). Low probability of need satisfaction leads to negative emotions, actively minimized by the subject. Increased probability of satisfaction, as compared to earlier forecast, generates positive emotions, which the subject tries to maximize, i.e. to enhance, to prolong, to repeat. The informational theory of emotions encompasses their reflective function, the laws of their appearance, the regulatory significance of emotions, and their role in organization of behavior. The level of emotional stress influences the operator's performance. A decrease in the emotional tonus leads to drowsiness, lack of vigilance, missing of significant signals and to slower reactions. An extremely high stress level disorganizes the activity, complicates it with a trend toward incorrect actions and reactions to insignificant signals (false alarms). The neurophysiological mechanisms of the influence of emotions on perceptual activity and operator performance as well as the significance of individuality are discussed.

  11. Sauropus androgynus (L. Merr. Induced Bronchiolitis Obliterans: From Botanical Studies to Toxicology

    Directory of Open Access Journals (Sweden)

    Hamidun Bunawan

    2015-01-01

    Full Text Available Sauropus androgynus L. Merr. is one of the most popular herbs in South Asia, Southeast Asia, and China where it was known as a slimming agent until two outbreaks of pulmonary dysfunction were reported in Taiwan and Japan in 1995 and 2005, respectively. Several studies described that the excessive consumption of Sauropus androgynus could cause drowsiness, constipation, and bronchiolitis obliterans and may lead to respiratory failure. Interestingly, this herb has been used in Malaysia and Indonesia in cooking and is commonly called the “multigreen” or “multivitamin” plant due to its high nutritive value and inexpensive source of dietary protein. The plant is widely used in traditional medicine for wound healing, inducing lactation, relief of urinary disorders, as an antidiabetic cure and also fever reduction. Besides these medicinal uses, the plant can also be used as colouring agent in food. This review will explore and compile the fragmented knowledge available on the botany, ethnobotany, chemical constitutes, pharmacological properties, and toxicological aspects of this plant. This comprehensive review will give readers the fundamental, comprehensive, and current knowledge regarding Sauropus androgynus L. Merr.

  12. Safety of subcutaneous microinjections (mesotherapy) in musicians.

    Science.gov (United States)

    Navarte, Danik Arana; Rosset-Llobet, Jaume

    2011-06-01

    Determine the safety and tolerance of mesotherapy as a technique for the treatment of musculoskeletal complaints in musicians. 67 patients (55.2% women) were subjected to a total of 267 mesotherapy sessions. A mesotherapy needle or normal needle was used randomly. The drugs employed were thiocolchicoside and diazepam as muscular relaxants, pentoxifylline or buflomedil as vasodilators, and piroxicam as an anti-inflammatory, as directed. A visual analogue scale was used to quantify the pain produced by the microinjections as well as the degree of immediate and midterm side effects as reported on a standard questionnaire. A mean of 155.5 microinjections were performed per session, of which 45.6% were perceived as painful by the patient with a mean severity of 4.3 out of 10. The pain reduced to 0.5 out of 10 after 24 hours. The most sensitive areas were the levator scapulae and splenius muscles. Systemic symptoms were reported by 5.99% of the musicians after the mesotherapy sessions (muscular weakness 1.5%, rash 1.5%, drowsiness 1.1% and itching 1.1%, being the most frequent). The mean severity of these symptoms was 2.77 out of 10. In all cases the symptoms had completely disappeared after 24 hours. No patient referred to signs of local or systemic infection. The application of drugs by means of subcutaneous injections (mesotherapy) in musicians is a technique that is safe, well tolerated, and without any severe complications.

  13. Intravenous regional block is similar to sympathetic ganglion block for pain management in patients with complex regional pain syndrome type I

    Directory of Open Access Journals (Sweden)

    M.S.A. Nascimento

    2010-12-01

    Full Text Available Sympathetic ganglion block (SGB or intravenous regional block (IVRB has been recommended for pain management in patients with complex regional pain syndrome type I (CRPS-I. Forty-five patients were initially selected but only 43 were accepted for the study. The present study evaluated the efficacy of IVRB produced by combining 70 mg lidocaine with 30 µg clonidine (14 patients, 1 male/13 females, age range: 27-50 years versus SGB produced by the injection of 70 mg lidocaine alone (14 patients, 1 male/13 females, age range: 27-54 years or combined with 30 µg clonidine (15 patients, 1 male/14 females, age range: 25-50 years into the stellate ganglion for pain management in patients with upper extremity CRPS-I. Each procedure was repeated five times at 7-day intervals, and pain intensity and duration were measured using a visual analog scale immediately before each procedure. A progressive and significant reduction in pain scores and a significant increase in the duration of analgesia were observed in all groups following the first three blocks, but no further improvement was obtained following the last two blocks. Drowsiness, the most frequent side effect, and dry mouth occurred only in patients submitted to SGB with lidocaine combined with clonidine. The three methods were similar regarding changes in pain intensity and duration of analgesia. However, IVRB seems to be preferable to SGB due to its easier execution and lower risk of undesirable effects.

  14. E. coli Meningitis Presenting in a Patient with Disseminated Strongyloides stercoralis.

    Science.gov (United States)

    Gomez, Juliana B; Maque, Yvan; Moquillaza, Manuel A; Anicama, William E

    2013-01-01

    Introduction. Spontaneous Escherichia coli meningitis is an infrequent condition in adults and is associated with some predisposing factors, including severe Strongyloides stercoralis (SS) infections. Case Presentation. A 43-year-old Hispanic man, with history of travelling to the jungle regions of Peru and Brazil two decades ago, and who received prednisone due to Bell's palsy for three weeks before admission, presented to the Emergency Department with diarrhea, fever, and hematochezia. A week after admission he developed drowsiness, meningeal signs, abdominal distension, and constipation. A cerebrospinal fluid culture showed extended spectrum β -lactamase producing E. coli. A colonoscopy was performed and showed pancolitis. Three days after the procedure the patient became unstable and developed peritoneal signs. He underwent a laparotomy, which ended up in a total colectomy and partial proctectomy due to toxic megacolon. Three days later the patient died in the intensive care unit due to septic shock. Autopsy was performed and microscopic examination revealed the presence of multiple Strongyloides larvae throughout the body. Conclusion. Strongyloides stercoralis infection should be excluded in adults with spontaneous E. coli meningitis, especially, if gastrointestinal symptoms and history of travelling to an endemic area are present. Even with a proper diagnosis and management, disseminated strongyloidiasis has a poor prognosis.

  15. E-learning in Type 1 Medical Universities of Iran

    Directory of Open Access Journals (Sweden)

    Mohammad Bagher ROKNI

    2005-07-01

    Full Text Available ABSTRACT Nowadays the Internet is the technological pedestal of organization in the information society and one of the main applications that the Internet offers is the Digital Library (DL. Each society, especially those that claim training of the public, predictably need implementation and endorsement these systems. The time of chalk and board is passed and the globalization and universal village demands a movement targeting to establish an information society. The university is said to be responsible for making "Human". In the era of information explosion, how can a university rely on a physical classroom, a tired teacher and some drowsy students listening to him? Internet "the sweet invention of man" is a bridge, between "slump" and "spurt". It is up to each authority in a university to design, employ, develop and evaluate a system embracing Internet, Multimedia, Network and so on to go parallel in modern era and to introduce the supreme system of E-learning in its program. Of different aspects of E-learning including computer networks, multimedia, search engines, electronic libraries, distance learning, and all that (Piskurich, 2003, most of the type 1 medical universities of Iran exploit, some how or another, all or some of them. These universities including Tehran, Iran, Shahid Beheshti, Mashhad, Isfahan, Tabriz, Shiraz, Ahwaz, and Kerman, at present encompass a powerful link with their audiences regarding digital libraries, search engine and authentic data bases. The present article is going to have a bird's eye view at various capacities of these universities in this regard.

  16. E. coli Meningitis Presenting in a Patient with Disseminated Strongyloides stercoralis

    Directory of Open Access Journals (Sweden)

    Juliana B. Gomez

    2013-01-01

    Full Text Available Introduction. Spontaneous Escherichia coli meningitis is an infrequent condition in adults and is associated with some predisposing factors, including severe Strongyloides stercoralis (SS infections. Case Presentation. A 43-year-old Hispanic man, with history of travelling to the jungle regions of Peru and Brazil two decades ago, and who received prednisone due to Bell’s palsy for three weeks before admission, presented to the Emergency Department with diarrhea, fever, and hematochezia. A week after admission he developed drowsiness, meningeal signs, abdominal distension, and constipation. A cerebrospinal fluid culture showed extended spectrum β-lactamase producing E. coli. A colonoscopy was performed and showed pancolitis. Three days after the procedure the patient became unstable and developed peritoneal signs. He underwent a laparotomy, which ended up in a total colectomy and partial proctectomy due to toxic megacolon. Three days later the patient died in the intensive care unit due to septic shock. Autopsy was performed and microscopic examination revealed the presence of multiple Strongyloides larvae throughout the body. Conclusion. Strongyloides stercoralis infection should be excluded in adults with spontaneous E. coli meningitis, especially, if gastrointestinal symptoms and history of travelling to an endemic area are present. Even with a proper diagnosis and management, disseminated strongyloidiasis has a poor prognosis.

  17. The exploding head syndrome: polysomnographic recordings and therapeutic suggestions.

    Science.gov (United States)

    Sachs, C; Svanborg, E

    1991-06-01

    Attention has recently been drawn to a condition termed the exploding head syndrome, which is characterized by unpleasant, even terrifying sensations of flashing lights and/or sounds during reported sleep. Nine patients complaining of sensations of explosions in the head during sleep or drowsiness were investigated with polysomnographic recordings. None of them had any neurological disorder. Five patients reported explosions during the recording sessions. According to the recordings, the attacks always took place when the patients were awake and relaxed. In two cases abrupt electroencephalographic (EEG) and electromyographic changes indicating increasing alertness were recorded at the time of the reported attacks. In the remaining three cases no EEG changes were seen. Thus, there were no indications of an epileptic etiology to the condition. In all patients the symptoms ameliorated spontaneously with time. The severity of the symptoms was reduced by reassurance of the harmlessness of the condition. Clomipramine was prescribed to three patients who all reported immediate relief of symptoms. It is concluded that symptoms of this type are probably not true hypnagogic phenomena but may be an expression of emotional stress in the awake state.

  18. A prospective study of the early clinical symptoms following a 2 Gy therapeutic whole-body irradiation

    International Nuclear Information System (INIS)

    Fizazi, K.; Chaillet, M.P.; Fourquet, A.; Jammet, P.; Cosset, J.M.

    1995-01-01

    Early human tolerance following total body irradiation (TBI) according to the dose received is still poorly known. Thirteen selected patients were prospectively evaluated for clinical side effects during the first 10 hours following a 2 Gy TBI prior to bone marrow transplantation. All of them but one were treated for haematological malignancies and were in clinical remission at the date of TBI. There were 10 males and 3 females, with a median age of 43 y (range 16*61) and a good performance status (WHO 0-1). They received granisetron (3 mg) injected intravenously 1 h before the time of TBI in order to prevent nausea and vomiting. The main symptoms consisted in drowsiness (69%), headache (62%), xerostomia (62%), nausea and vomiting (46%), anorexia (38%), parotid gland pain (23%) and abdominal pain (8%). Their intensity was always moderate, except for 2 patients who experimented severe vomiting. The incidence rate and the time-course of the symptoms of the prodromal phase may proved to be helpful for early clinical evaluation and triage of victims of an accidental irradiation. In particular, absence of fever at the 6 th h after TBI supports the assumption of an estimated exposure dose below 2 Gy. (authors). 23 refs., 2 tabs

  19. Geranisetron versus gabapentin in preventing postoperative nausea and vomiting after middle ear surgery in adults: A double-blinded randomized clinical trial study

    Directory of Open Access Journals (Sweden)

    Morteza Heidari

    2015-01-01

    Full Text Available Background: The incidence of postoperative nausea and vomiting (PONV after middle ear surgery is high. In this study we want to compare the effects of intravenous granisetron and oral gabapentin as a premedication before surgery on the incidence and severity of PONV after middle ear surgery in adult patents. Materials and Methods: We enrolled 90 patients that were randomly divided into the three groups of 30 in each. Group I received granisetron 3 mg iv 2 minutes before induction of anesthesia; Group II received oral gabapentin 300 mg 1 hour before anesthesia and Group III received placebo. The incidence and severity of PONV were recorded each 15 minutes in the post-anesthesia care unit (PACU and each 8 hours until 24 hours after discharge from the PACU. Result: The incidence and severity of nausea and vomiting at different time intervals in Groups I and Group II was significantly lower compared with Group III (P < 0.05. There was no significant difference in the incidence of side effects of study drug administration including respiratory depression, apnea, extra pyramidal disorders, drowsiness, dizziness, vertigo and headache in three groups. Conclusion: The study was shown that using gabapentin and granisetron have equal anti-emetic effects, but significant differences were seen between these two groups compared to the control group. These submit the efficiency of these drugs in preventing PONV.

  20. A prospective study of the early clinical symptoms following a 2 Gy therapeutic whole-body irradiation; Etude prospective de la symptomatologie clinique precoce apres irradiation corporelle totale therapeutique de 2 Gy

    Energy Technology Data Exchange (ETDEWEB)

    Fizazi, K.; Chaillet, M.P.; Fourquet, A.; Jammet, P.; Cosset, J.M. [Institut Curie, 75 - Paris (France)

    1995-10-01

    Early human tolerance following total body irradiation (TBI) according to the dose received is still poorly known. Thirteen selected patients were prospectively evaluated for clinical side effects during the first 10 hours following a 2 Gy TBI prior to bone marrow transplantation. All of them but one were treated for haematological malignancies and were in clinical remission at the date of TBI. There were 10 males and 3 females, with a median age of 43 y (range 16*61) and a good performance status (WHO 0-1). They received granisetron (3 mg) injected intravenously 1 h before the time of TBI in order to prevent nausea and vomiting. The main symptoms consisted in drowsiness (69%), headache (62%), xerostomia (62%), nausea and vomiting (46%), anorexia (38%), parotid gland pain (23%) and abdominal pain (8%). Their intensity was always moderate, except for 2 patients who experimented severe vomiting. The incidence rate and the time-course of the symptoms of the prodromal phase may proved to be helpful for early clinical evaluation and triage of victims of an accidental irradiation. In particular, absence of fever at the 6{sup th} h after TBI supports the assumption of an estimated exposure dose below 2 Gy. (authors). 23 refs., 2 tabs.

  1. [Drug use and involvement in risky driving styles in a sample of university students. The uniHcos project].

    Science.gov (United States)

    Jiménez-Mejías, Eladio; Medina-García, Miguel Ángel; Martínez-Ruiz, Virginia; Pulido-Manzanero, José; Fernández-Villa, Tania

    2015-09-01

    Drug and alcohol use are known to increase the risk of traffic accidents, especially among youth. However, the association between habitual drug use and the adoption of risky driving behavior is not well known. The aim of this study was to identify and quantify the association between habitual drug use and involvement in risky driving practices overall and by gender among university students. A cross sectional study was conducted. The study population was composed of 559 car drivers younger than 31 years who completed an online questionnaire during the 2011-2012 academic year. Among other factors, the questionnaire assessed the following items: habitual drug consumption (20 or more days) during the last year and involvement in other risky driving practices during the last month. A total of 27.7% of students reported they had used drugs regularly during the last year. Drug use was associated with a higher frequency of involvement in risky driving practices. In men, the factors most strongly associated with drug consumption were speeding, driving under influence of alcohol, and feeling drowsy while driving. In women, drug consumption was mainly associated with smoking while driving, drunk driving, and driving without rest. The results of our study support the hypothesis that habitual drug use is associated with an increased frequency of risky driving behavior. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

  2. Integration of Body Sensor Networks and Vehicular Ad-hoc Networks for Traffic Safety

    Directory of Open Access Journals (Sweden)

    Angelica Reyes-Muñoz

    2016-01-01

    Full Text Available The emergence of Body Sensor Networks (BSNs constitutes a new and fast growing trend for the development of daily routine applications. However, in the case of heterogeneous BSNs integration with Vehicular ad hoc Networks (VANETs a large number of difficulties remain, that must be solved, especially when talking about the detection of human state factors that impair the driving of motor vehicles. The main contributions of this investigation are principally three: (1 an exhaustive review of the current mechanisms to detect four basic physiological behavior states (drowsy, drunk, driving under emotional state disorders and distracted driving that may cause traffic accidents is presented; (2 A middleware architecture is proposed. This architecture can communicate with the car dashboard, emergency services, vehicles belonging to the VANET and road or street facilities. This architecture seeks on the one hand to improve the car driving experience of the driver and on the other hand to extend security mechanisms for the surrounding individuals; and (3 as a proof of concept, an Android real-time attention low level detection application that runs in a next-generation smartphone is developed. The application features mechanisms that allow one to measure the degree of attention of a driver on the base of her/his EEG signals, establish wireless communication links via various standard wireless means, GPRS, Bluetooth and WiFi and issue alarms of critical low driver attention levels.

  3. The reproducibility of binocular pattern reversal visual evoked potentials: a single subject design.

    Science.gov (United States)

    Mellow, Tessa B; Liasis, Alki; Lyons, Ruth; Thompson, Dorothy A

    2011-06-01

    This study aimed to investigate the within-participant variability over time of both amplitude and peak latency measures of pattern reversal visual evoked potentials (pVEPs). As a large number of factors are known to contribute to the variability of the pVEPs (such as fixation instability and drowsiness), testing was conducted in controlled conditions with two co-operative participants. PVEPs were recorded during 24 sessions, over an eight-week period using the same equipment and recording settings. The participants viewed a plasma monitor binocularly from a distance of 1 meter. High contrast (97%), black and white checks of side subtense 50', 25', and 12.5' pattern reversed 3/s in a 28 degree test field. The different sized checks were presented in a pseudo-random order. Three runs, each of 100 trials, were acquired to each stimulus from an active electrode placed at Oz referred to aFz. The amplitude of N80-P100 and the latency of P100 were measured. P100 amplitude and latency were stable across sessions and did not depend upon the order of check size presentation. As expected, variation in amplitude was greater than peak latency. The coefficients of variation for different check sizes and participants were 9-14% for pVEP amplitude, but only 1-2% for P100 latency.

  4. Development of a method to maintain vigilance level; Kakusei teika keigen shuho no kaihatsu

    Energy Technology Data Exchange (ETDEWEB)

    Okamoto, Y.; Horiguchi, A.; Ishida, K.; Hata, S. [Mazda Motor Corp., Hiroshima (Japan)

    1995-04-20

    As a part of measures to prevent accidents caused by reduced vigilance and drowsiness of drivers, this paper reports the result of experiments that presents effectiveness of a method to give drivers intermittent auditory stimuli as environmental stimulation. It was found that vigilance decline can be reduced by intermittent auditory stimuli under a laboratory condition using a selective reaction time in monotonous selective reaction works as a parameter; and the effective interval in the intermittence is 30 seconds. A driving simulator was used to prove that the vigilance decline reducing effect by the intermittent auditory stimuli has the same level of effect as chewing gums even under the environment composed of driving operation, vehicle motions, and background noise. However, a number of questions remain yet to be discussed, such as the effect when the ratio of sound presentation time and no presentation time was varied. Furthermore, a number of other physical stimuli in addition to auditory stimulation may be assumed that has effective possibility as vigilance decline reducing stimuli, including hot heat and vibration. It was verified, however, that vigilance decline can be reduced by properly varying the environmental stimulation. 6 refs., 15 figs., 1 tab.

  5. Influence of tiamulin therapy on weight gain in Brachyspira dysentery in piglets

    Directory of Open Access Journals (Sweden)

    Alexandru Octavian Doma

    2014-05-01

    Full Text Available The aim of research was to evaluate the therapeutic and economic efficiency (daily individual weight gain / observation period of two available tiamulin fumarate antibiotic conditionings (one oral and one injectable in a farm environment, were Brachyspira evolution was suspicioned and confirmed. The experiment was conducted in a pig growing and fattening unit from Timis County, constituted as an intensive system. The sick piglets manifested acute clinical signs, mainly: drowsiness, enophtalmia, kyphosis and the sanguinolent diarrhoea in all cases. Clinical and morphopathologic suspicion was confirmed by the laboratory and bacterioscopic examination, which ascertained the presence of Brachyspira hyodysenteriae. Consequently, were chosen 48 ill piglets from the age group of 35 to 45 days and three experimental therapeutic (T and one Control (C groups were constituted as follows: group T1 - oral way treatment for five consecutive days with Tiamutin 45% soluble granules (Ceva, at doses of 6 and 8 mg.kg.bw., (for group T2 and respectively Tiamutin 10% injectable (Dopharma (T3, 8mg.kg.bw-1 I.M., four consecutive days. Study duration was 21 days, revealing the economic superiority of the oral conditionings vs. injectable of tiamulin fumarate and also the therapeutic efficiency of this form as primal choice in the enteric disease outbreaks.

  6. Multiple brain abscesses due to Enterobacter cloacae in an immune-competent child

    Directory of Open Access Journals (Sweden)

    Arushi G. Saini

    2017-09-01

    Full Text Available Brain abscesses due to Enterobacteriaceae in immune-competent children are rare, and those due to Enterobacter cloacae are even rarer. We report an interesting case of community-acquired E. cloacae neuroinfection resulting in multiple brain abscesses in a young child with no underlying risk-factors. A 10 year-old-boy presented with low-grade fever, headache, neck pain and progressive deterioration of sensorium. On examination, he was conscious but drowsy with photophobia, normal fundii, meningeal signs, mild hypertonia, brisk muscle stretch reflexes and extensor plantar responses. Magnetic resonance imaging of brain showed bilateral, multiple pyogenic abscesses. Culture of the abscess material aspirated at the time of surgical drainage showed growth of E. cloacae. He received intravenous imipenem for 18 weeks guided by clinical and radiological response. A pragmatic approach combining early surgical drainage, targeted antimicrobial therapy and patient-tailored duration based on the clinico-radiological response is needed in such difficult cases. Keywords: Neuroinfection, Enterobacter, Brain abscess, Pyogenic, Carbapenems

  7. A double-blind, placebo-controlled, multicenter study with alprazolam and extended-release alprazolam in the treatment of panic disorder.

    Science.gov (United States)

    Pecknold, J; Luthe, L; Munjack, D; Alexander, P

    1994-10-01

    This is a double-blind, placebo-controlled, flexible-dose, multicenter, 6-week study comparing regular alprazolam (compressed tablet, CT), given four times per day, and extended release alprazolam (XR), given once in the morning. The aim of the XR preparation is to offer less frequent dosing and to reduce interdose anxiety. Of the intent-to-treat group of 209 patients, 184 completed 3 weeks of medication and were evaluated according to protocol. There was a completer rate for the 6 weeks of 94% (CT), 97% (XR), and 87% (placebo). On global measures, Hamilton Rating Scale for Anxiety, phobia rating, and work disability measures, both active treatment groups were equally effective and significantly more efficacious than the placebo cell on endpoint MANOVA analysis. On analysis of the panic factor with endpoint data, both active treatment groups were equally effective throughout the 6-week trial and significantly more efficacious than the placebo group. Drowsiness occurred more frequently with CT alprazolam (86% of patients) than with the XR preparation (79%) or placebo (49%).

  8. Characterization of "Yaa Chud" Medicine on the Thailand-Myanmar border: selecting for drug-resistant malaria and threatening public health.

    Science.gov (United States)

    Newton, Paul N; Hampton, Christina Y; Alter-Hall, Krystyn; Teerwarakulpana, Thanongsak; Prakongpan, Sompol; Ruangveerayuth, Ronnatrai; White, Nicholas J; Day, Nicholas P J; Tudino, Mabel B; Mancuso, Natalia; Fernández, Facundo M

    2008-11-01

    Multidrug-resistant Plasmodium falciparum malaria is a severe public health problem on the Thailand-Myanmar border. Many villagers buy packets of 4-5 mixed medicines ("yaa chud") from shops without medical assessment as their first-line malaria treatment. In 2000-2001 a local researcher purchased 50 yaa chud from 44 shops around Mae Sot, Thailand and Myawaddy, Myanmar (Burma), for his wife who was said to be pregnant with fever and drowsiness. The tablets/capsules were provisionally identified by appearance and active ingredients determined in a subset by using mass and atomic spectrometry. The most frequently detected active ingredients were acetaminophen (22%), chlorpheniramine (13.4%), chloroquine (12.6%), tetracycline/doxycycline (11.4%), and quinine (5.1%). Only seven bags contained potentially curative medicine for malaria. A total of 82% of the bags contained medicines contraindicated in pregnancy. Inappropriate, ineffective antimalarial drugs on the Thailand-Myanmar border are likely to increase malaria morbidity, mortality and health costs and engender the emergence and spread of antimalarial drug resistance.

  9. Inadequate Helmet Fit Increases Concussion Severity in American High School Football Players.

    Science.gov (United States)

    Greenhill, Dustin A; Navo, Paul; Zhao, Huaqing; Torg, Joseph; Comstock, R Dawn; Boden, Barry P

    2016-05-01

    There is limited information on the relationship between football helmet fit and concussion severity. Poor helmet fit may predispose football players to a more severe concussion. Descriptive epidemiology study. Level 3. Data from concussion injury reports were obtained from the National High School Sports-Related Injury Surveillance System over a 9-year period. Symptoms, duration, and helmet parameters (fit, interior padding) were analyzed for all first-time concussions. Data from 4580 concussions were analyzed. Patients who suffered concussions with a helmet that did not fit properly (3.22%), as determined by an athletic trainer, had higher rates of drowsiness (RR, 1.46; P = 0.005), hyperexcitability (RR, 2.38; P = 0.047), and sensitivity to noise (RR, 1.88; P football helmet is a risk factor for a concussion with more symptoms and of longer duration. Concussions of longer duration are also more common in players with an air bladder-lined helmet. Current high school football rules should mandate supervision and maintenance of helmet fit throughout the season, prior to impact. Team physicians, athletic trainers, coaches, and high school officials should ensure proper oversight of helmet fit in high school athletes to decrease concussion severity and duration. © 2016 The Author(s).

  10. Anticholinergic syndrome following an unintentional overdose of scopolamine

    Directory of Open Access Journals (Sweden)

    Carmela E Corallo

    2009-09-01

    Full Text Available Carmela E Corallo1, Ann Whitfield2, Adeline Wu21Department of Pharmacy, The Alfred, Melbourne, Victoria, Australia; 2Intensive Care Unit, Box Hill Hospital, Melbourne, Victoria, AustraliaAbstract: Scopolamine hydrobromide (hyoscine is an antimuscarinic drug which is primarily used in the prophylaxis and treatment of motion sickness and as a premedication to dry bronchial and salivary secretions. In acute overdosage, the main clinical problem is central nervous system (CNS depression. In Australia, tablets containing scopolamine hydrobromide 0.3 mg are available over the counter in packs of ten. The recommended dose for adults is one to two tablets as a single dose, repeated four to six hours later, if required. The maximum dose stated on the pack is four tablets over a 24-hour period with a caution regarding drowsiness and blurred vision. We describe a patient who presented with symptoms of anticholinergic syndrome secondary to an unintentional overdose of scopolamine. Whilst at work, the patient noticed that he had forgotten his prescribed medication, domperidone, at home; a friend gave him some travel sickness medication which contained scopolamine for relief of nausea. On a previous occasion, he had experienced a similar, less severe reaction with another anticholinergic agent, loperamide. This report highlights the need to consider nonprescription products, ie, over the counter medications, herbal/nutritional supplements as causes of anticholinergic syndrome when a patient presents with symptoms suggestive of this diagnosis.Keywords: domperidone, scopolamine, nonprescription drugs, toxicity, anticholinergic syndrome

  11. The impact of Australian legislative changes on synthetic cannabinoid exposures reported to the New South Wales Poisons Information Centre.

    Science.gov (United States)

    Cairns, Rose; Brown, Jared A; Gunja, Naren; Buckley, Nicholas A

    2017-05-01

    The emergence of new psychoactive substances (NPS), including synthetic cannabinoid receptor agonists (SCRAs) poses novel challenges for drug regulation and public health. Misconceptions of safety and legality, coupled with the fact that NPS are undetectable on routine drugs screens contributes to their popularity. Concerns over the unpredictable toxicity and abuse potential of NPS has led to a variety of legislative responses worldwide. We wish to describe Australian trends in SCRA use, examining the effects of legislative changes on calls to Australia's largest poisons centre. A retrospective review of calls to the New South Wales Poisons Information Centre (NSWPIC). Cases occurring between 1 January 2010 and 30 June 2015 with documented use of SCRAs were included. There were 146 exposures to SCRAs recorded in the NSWPIC database. Federal bans of specific SCRA compounds in 2011/2012 had little impact on call volumes. State-based legislation introduced in 2013 banning specific brand names of SCRA products was followed by a dramatic, sustained decrease in exposures. The most common symptoms reported with SCRA use were tachycardia, vomiting, drowsiness, anxiety/panic, decreased level of consciousness, chest pain, agitation, hallucinations, confusion, seizures and hypertension. Banning of specific brand names of SCRA (timed with raids and social media campaigns) appears effective at reducing SCRA exposures. We postulate that this raised awareness within the community of the illegality of these substances while also reducing supply through bricks-and-mortar shops. These results could help inform future legislative responses. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Ventriculo-pleural shunt patency study

    International Nuclear Information System (INIS)

    Yeates, K.

    2000-01-01

    Full text: A twenty-four year old male was admitted to hospital complaining of headaches, drowsiness and blurred vision. He suffered from congenital hydrocephalus and had had a ventriculo-peritoneal shunt inserted in infancy. This had undergone many revisions due to persistent peritoneal infections and had recently been replaced with a ventriculo-pleural shunt. The symptoms described suggested shunt blockage and he was referred for a Shunt Patency Study. The current shunt is a HAKIM Programmable Valve Shunt System and the opening pressure was 12cm of CSF (within the normal range). Forty megabecquerels of filtered 99 Tc m O 4 was injected into the pre-chamber of the shunt. Serial images and counts were obtained for twenty-five minutes after the injection. The images showed the tracer flowing from the shunt within the first ten minutes. At twenty minutes almost all of the tracer had drained from the shunt and was present in the right pleural cavity, indicating shunt patency. This study is presented to demonstrate the appearances of a normally functioning, but rarely seen Ventriculo-Pleural CSF Shunt. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

  13. Synthetic Cannabinoids.

    Science.gov (United States)

    Mills, Brooke; Yepes, Andres; Nugent, Kenneth

    2015-07-01

    Synthetic cannabinoids (SCBs), also known under the brand names of "Spice," "K2," "herbal incense," "Cloud 9," "Mojo" and many others, are becoming a large public health concern due not only to their increasing use but also to their unpredictable toxicity and abuse potential. There are many types of SCBs, each having a unique binding affinity for cannabinoid receptors. Although both Δ-tetrahydrocannabinol (THC) and SCBs stimulate the same receptors, cannabinoid receptor 1 (CB1) and cannabinoid receptor 2 (CB2), studies have shown that SCBs are associated with higher rates of toxicity and hospital admissions than is natural cannabis. This is likely due to SCBs being direct agonists of the cannabinoid receptors, whereas THC is a partial agonist. Furthermore, the different chemical structures of SCBs found in Spice or K2 may interact in unpredictable ways to elicit previously unknown, and the commercial products may have unknown contaminants. The largest group of users is men in their 20s who participate in polydrug use. The most common reported toxicities with SCB use based on studies using Texas Poison Control records are tachycardia, agitation and irritability, drowsiness, hallucinations, delusions, hypertension, nausea, confusion, dizziness, vertigo and chest pain. Acute kidney injury has also been strongly associated with SCB use. Treatment mostly involves symptom management and supportive care. More research is needed to identify which contaminants are typically found in synthetic marijuana and to understand the interactions between different SBCs to better predict adverse health outcomes.

  14. Regulating danger on the highways: hours of service regulations.

    Science.gov (United States)

    Mansfield, Daniel; Kryger, Meir

    2015-12-01

    Current hours of service regulations governing commercial truck drivers in place in the United States, Canada, Australia, and the European Union are summarized and compared to facilitate the assessment of the effectiveness of such provisions in preventing fatigue and drowsiness among truck drivers. Current hours of service provisions governing commercial truck drivers were derived from governmental sources. The commercial truck driver hours of service provisions in the United States, Canada, and the European Union permit drivers to work 14 hours and those of Australia permit drivers to work 12 hours a day on a regular basis. The regulations do not state what a driver may do with time off. They are consistent with a driver being able to drive after 24 hours without sleep. They do not take into account circadian rhythm by linking driving or rest to time of day. Current hours of service regulations governing commercial truck drivers leave gaps--permitting drivers to work long hours on a regular basis, permitting driving after no sleep for 24 hours, and failing to take into account the importance of circadian rhythm, endangering the public safety and the truck drivers themselves. Copyright © 2015 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

  15. Quantitative analysis on electrooculography (EOG) for neurodegenerative disease

    Science.gov (United States)

    Liu, Chang-Chia; Chaovalitwongse, W. Art; Pardalos, Panos M.; Seref, Onur; Xanthopoulos, Petros; Sackellares, J. C.; Skidmore, Frank M.

    2007-11-01

    Many studies have documented abnormal horizontal and vertical eye movements in human neurodegenerative disease as well as during altered states of consciousness (including drowsiness and intoxication) in healthy adults. Eye movement measurement may play an important role measuring the progress of neurodegenerative diseases and state of alertness in healthy individuals. There are several techniques for measuring eye movement, Infrared detection technique (IR). Video-oculography (VOG), Scleral eye coil and EOG. Among those available recording techniques, EOG is a major source for monitoring the abnormal eye movement. In this real-time quantitative analysis study, the methods which can capture the characteristic of the eye movement were proposed to accurately categorize the state of neurodegenerative subjects. The EOG recordings were taken while 5 tested subjects were watching a short (>120 s) animation clip. In response to the animated clip the participants executed a number of eye movements, including vertical smooth pursued (SVP), horizontal smooth pursued (HVP) and random saccades (RS). Detection of abnormalities in ocular movement may improve our diagnosis and understanding a neurodegenerative disease and altered states of consciousness. A standard real-time quantitative analysis will improve detection and provide a better understanding of pathology in these disorders.

  16. Amitriptyline adverse reactions reported by outpatients / Reacciones adversas a amitriptilina relatadas por pacientes ambulatoriales / Reações adversas a amitriptilina relatadas por pacientes ambulatoriais

    Directory of Open Access Journals (Sweden)

    Sebastião ECO

    2005-04-01

    Full Text Available Aim: The aim of the present study was to know the profile of adverse drug reactions (ADR, at ambulatory level, suffered by patients using amitrityline. Method: After an informed consent, 130 randomly chosen patients using pharmacy services from eight different health units in Riberão Preto - São Paulo (Brazil were interviewed. To gather socioeconomic, clinical data and ADR, an structured questionnaire was used. The latter were analyzed regarding their seriousness, frequency, causality and preventability. Results: All surveyed patients reported at least one ADR to amitriptyline, being doubtful (4%, possible (44% and probable (52%. From probable/possible, 29% were reported as moderate/serious, and among them, 67% were frequent. 79% of total ADR were considered as preventable. 5 more cited symptoms (29.5% were: dry mouth or taste disturbances, drowsiness, orthostatic hypotension and weakness. Conclusions: Reported amitriptylin ADRs could have been prevented or reduced their seriousness, or, at least, advised when occurring, because they may produce other drug-related problems, non-compliance or discomfort. Patients should be taken into account as ADR information sources, improving physician-patient relationship and their quality of life by improving medical care.

  17. Black henbane and its toxicity – a descriptive review

    Directory of Open Access Journals (Sweden)

    Anahita Alizadeh

    2014-09-01

    Full Text Available Black henbane (BH or Hyoscyamus niger, has been used as a medicine since last centuries and has been described in all traditional medicines. It applies as a herbal medicine, but may induce intoxication accidentally or intentionally. All part of BH including leaves, seeds and roots contain some alkaloids such as Hyoscyamine, Atropine, Tropane and Scopolamine. BH has pharmacological effects like bronchodilating, antisecretory, urinary bladder relaxant, spasmolytic, hypnotic, hallucinogenic, pupil dilating, sedative and anti-diarrheal properties. Clinical manifestations of acute BH poisoning are very wide which include mydriasis, tachycardia, arrhythmia, agitation, convulsion and coma, dry mouth, thirst, slurred speech, difficulty speaking, dysphagia, warm flushed skin, pyrexia, nausea, vomiting, headache, blurred vision and photophobia, urinary retention, distension of the bladder, drowsiness, hyper reflexia, auditory, visual or tactile hallucinations, confusion, disorientation, delirium, aggressiveness, and combative behavior. The main treatment of BH intoxicated patients is supportive therapies including gastric emptying (not by Ipecac, administration of activated charcoal and benzodiazepines. Health care providers and physicians particularly emergency physicians and clinical toxicologists should know the nature, medical uses, clinical features, diagnosis and management of BH poisoning.

  18. The efficacy and safety of aripiprazole for tic disorders in children and adolescents: A systematic review and meta-analysis.

    Science.gov (United States)

    Wang, Shuai; Wei, Yan-Zhao; Yang, Jian-Hong; Zhou, Yu-Ming; Cheng, Yu-Hang; Yang, Chao; Zheng, Yi

    2017-08-01

    The aims are to evaluate the efficacy and safety of aripiprazole for tic disorders (TDs) in children and adolescents. We searched PubMed, Embase, PsychINFO, Cochrane database as well as Chinese databases of CNKI, VIP, CBM and Wanfang from the database inception to October 2016, and 17 full-text studies (N=1305) were included in our article. The meta-analysis of 10 studies (N=817) showed that there was no significant difference in the reduction of total YGTSS score between aripiprazole and other drugs, and meta-analysis of 7 studies (n=324) which used tic symptom control ≧30% as outcome measure showed that there was no significant difference between aripiprazole and other treatments. The most common AEs of aripiprazole were the drowsiness, nausea/vomiting and increased appetite, and meta analysis which used the TESS scale as the outcome measurement showed that there was a significant difference between aripiprazole and haloperidol. In conclusion, these data provide moderate quality evidence that aripiprazole could be an effective and safe treatment option for TDs, and results from further trials are urgently needed to extend this evidence base. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  19. Twice-weekly aripiprazole for treating children and adolescents with tic disorder, a randomized controlled clinical trial.

    Science.gov (United States)

    Ghanizadeh, Ahmad

    2016-01-01

    Treating tic disorder is challenging. No trial has ever examined whether twice weekly aripiprazole is effective for treating tic disorders. Participants of this 8-week randomized controlled parallel-group clinical trial were a clinical sample of 36 children and adolescents with tic disorder. Yale global tic severity scale was used to assess the outcome. Both groups received daily dosage of aripiprazole for the first 14 days. Then, one group received daily dose of aripiprazole while the other group received twice weekly dosage of aripiprazole for the next 46 days. The patients were assessed at baseline, week 2, 4, and 8. Tic scores decreased in both group significantly 22.8 (18.5) versus 22.0 (11.6). Moreover, there was no between group difference. The final mean (SD) score of motor and vocal tics in the group treated with daily treatment was not significantly different from the twice weekly group (Cohen's d = 0.36). The odds ratios for sedation and increased appetite were 3.05 and 3, respectively. For the first time, current findings support that twice weekly aripiprazole efficacy was not different from that of daily treatment. The rate of drowsiness in the twice weekly treatment group was less than that of the daily treatment group. This trial was registered at http://www.irct.ir. The registration number of this trial was: IRCT201312263930N32. http://www.irct.ir/searchresult.php?id=3930&number=32.

  20. Ammonia encephalopathy and awake craniotomy for brain language mapping: cause of failed awake craniotomy.

    Science.gov (United States)

    Villalba Martínez, G; Fernández-Candil, J L; Vivanco-Hidalgo, R M; Pacreu Terradas, S; León Jorba, A; Arroyo Pérez, R

    2015-05-01

    We report the case of an aborted awake craniotomy for a left frontotemporoinsular glioma due to ammonia encephalopathy on a patient taking Levetiracetam, valproic acid and clobazam. This awake mapping surgery was scheduled as a second-stage procedure following partial resection eight days earlier under general anesthesia. We planned to perform the surgery with local anesthesia and sedation with remifentanil and propofol. After removal of the bone flap all sedation was stopped and we noticed slow mentation and excessive drowsiness prompting us to stop and control the airway and proceed with general anesthesia. There were no post-operative complications but the patient continued to exhibit bradypsychia and hand tremor. His ammonia level was found to be elevated and was treated with an infusion of l-carnitine after discontinuation of the valproic acid with vast improvement. Ammonia encephalopathy should be considered in patients treated with valproic acid and mental status changes who require an awake craniotomy with patient collaboration. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. A randomised trial of the effect of the glycine reuptake inhibitor Org 25935 on cognitive performance in healthy male volunteers.

    Science.gov (United States)

    Christmas, David; Diaper, Alison; Wilson, Sue; Rich, Ann; Phillips, Suzanne; Udo de Haes, Joanna; Sjogren, Magnus; Nutt, David

    2014-03-01

    Cognitive impairment is integral to many neurological illnesses. Specific enhancement of glutamatergic transmission may improve memory and learning. Org 25935 increases the synaptic availability of glycine, an obligate co-agonist with glutamate at N-methyl-D-aspartate receptors. We hypothesised that Org 25935 would acutely improve the learning and memory of healthy volunteers. A randomised, double-blind, parallel-group, single-dose study of Org 25935 and placebo was carried out. Thirty-two healthy male volunteers took either 12-mg Org 25935 or matching placebo and were later assessed with the manikin task, digit span and verbal memory tests. Systematic assessments of cardiovascular and adverse events were also taken. There was no effect of Org 25935 on reaction time, number of correct responses or learning (greater or slower improvement over successive tasks) compared with placebo. Org 25935 caused significantly more dizziness and drowsiness compared with placebo; these side effects were mainly mild. A single dose of Org 25935 does not improve learning or memory in healthy male individuals. However, the drug was well tolerated, and it remains to be seen whether it would have a positive effect on cognition in patient groups with pre-existing cognitive deficits.

  2. Four Intoxication Cases Related to the Misuse of Sage Oil

    Directory of Open Access Journals (Sweden)

    Suzan Gündüz

    2016-06-01

    Full Text Available Infantile colic is excessive crying of infants younger than 4 months. Families of children suffering from infantile colic attend to the emergency department frequently and the etiology is not well-known. However many families of chil­dren suffering from infantile colic try pharmacologic and non-pharmacologic treatment, they are sleepless and ex­hausted and are affected negatively. Sage oil is in volatile form and it is recommended to apply 1-2 drops on plantar and tummy region of the body by massage for the treat­ment of infantile colic. Most of drugs used for infantile colic are drops and used orally. Families who do not learn detailed usage information may use it orally or may pre­sumed another drug while suffering from sleepless and drowsiness. Herein we reported 4 cases of sage oil intoxi­cation because of wrong information of wrong application of sage oil. We aimed to reduce the prescribing of sage oil in the treatment of infantile colic and emphasize to give more information about proper use of sage oil.

  3. Age-related changes in sleep-wake rhythm in dog.

    Science.gov (United States)

    Takeuchi, Takashi; Harada, Etsumori

    2002-10-17

    To investigate a sleep-wake rhythm in aged dogs, a radio-telemetry monitoring was carried out for 24 h. Electrodes and telemetry device were surgically implanted in four aged dogs (16-18 years old) and four young dogs (3-4 years old). Electroencephalogram (EEG), electromyogram (EMG) and electrocardiogram (ECG) were recorded simultaneously as parameters to determine vigilance states and an autonomic nervous function. Wakefulness, slow wave sleep (SWS) and paradoxical sleep (PS) were identified according to the EEG and EMG pattern. We also examined whether absolute powers and the low frequency-to-high frequency ratio (LF/HF) derived from the heart rate variability power spectrum could detect shifts in autonomic balance correlated with aging. The aged dogs showed a marked reduction of PS and a fragmentation of wakefulness in the daytime and a sleep disruption in the night. The pattern of 24 h sleep and waking was dramatically altered in the aged dog. It was characterized by an increase in the total amount of time spent in SWS during the daytime followed by an increasing of time spent in wakefulness during the night. Furthermore, LF/HF ratio showed a very low amplitude of variance throughout the day in the aged dog. These results suggest that the aged dog is a useful model to investigate sleep disorders in human such as daytime drowsiness, difficulties in sleep maintenance. The abnormality in sleep-wake cycle might be reflected by the altered autonomic balance in the aged dogs.

  4. Wireless sleep monitoring headband to identify sleep and track fatigue

    Science.gov (United States)

    Ramasamy, Mouli; Oh, Sechang; Varadan, Vijay K.

    2014-04-01

    Detection of sleepiness and drowsiness in human beings has been a daunting task for both engineering and medical technologies. Accuracy, precision and promptness of detection have always been an issue that has to be dealt by technologists. Commonly, the rudimentary bio potential signals - ECG, EOG, EEG and EMG are used to classify and discriminate sleep from being awake. However, the potential drawbacks may be high false detections, low precision, obtrusiveness, aftermath analysis, etc. To overcome the disadvantages, this paper proposes the design of a wireless and a real time monitoring system to track sleep and detect fatigue. This concept involves the use of EOG and EEG to measure the blink rate and asses the person's condition. In this user friendly and intuitive approach, EOG and EEG signals are obtained by the dry gold wire nano-sensors fabricated on the inner side of a flexible headband. The acquired signals are then electrically transmitted to the data processing and transmission unit, which transmits the processed data to the receiver/monitoring module through WCDMA/GSM communication. This module is equipped with a software program to process, feature extract, analyze, display and store the information. Thereby, immediate detection of a person falling asleep is made feasible and, tracking the sleep cycle continuously provides an insight about the experienced fatigue level. The novel approach of using a wireless, real time, dry sensor on a flexible substrate reduces the obtrusiveness, and techniques adopted in the electronics and software facilitates and substantial increase in efficiency, accuracy and precision.

  5. Decreased electrophysiological activity represents the conscious state of emptiness in meditation

    Science.gov (United States)

    Hinterberger, Thilo; Schmidt, Stephanie; Kamei, Tsutomu; Walach, Harald

    2014-01-01

    Many neuroscientific theories explain consciousness with higher order information processing corresponding to an activation of specific brain areas and processes. In contrast, most forms of meditation ask for a down-regulation of certain mental processing activities while remaining fully conscious. To identify the physiological properties of conscious states with decreased mental and cognitive processing, the electrical brain activity (64 channels of EEG) of 50 participants of various meditation proficiencies was measured during distinct and idiosyncratic meditative tasks. The tasks comprised a wakeful “thoughtless emptiness (TE),” a “focused attention,” and an “open monitoring” task asking for mindful presence in the moment and in the environment without attachment to distracting thoughts. Our analysis mainly focused on 30 highly experienced meditators with at least 5 years and 1000 h of meditation experience. Spectral EEG power comparisons of the TE state with the resting state or other forms of meditation showed decreased activities in specific frequency bands. In contrast to a focused attention task the TE task showed significant central and parietal gamma decreases (p meditation practice did not present those differences significantly. Our findings indicate that a conscious state of TE reached by experienced meditators is characterized by reduced high-frequency brain processing with simultaneous reduction of the low frequencies. This suggests that such a state of meditative conscious awareness might be different from higher cognitive and mentally focused states but also from states of sleep and drowsiness. PMID:24596562

  6. On Suggestibility and Placebo: A Follow-Up Study.

    Science.gov (United States)

    Lifshitz, Michael; Sheiner, Eli O; Olson, Jay A; Thériault, Rémi; Raz, Amir

    2017-04-01

    Identifying what makes some people respond well to placebos remains a major challenge. Here, we attempt to replicate an earlier study in which we found a relationship between hypnotic suggestibility and subjective ratings of relaxation following the ingestion of a placebo sedative (Sheiner, Lifshitz, & Raz, 2016). To assess the reliability of this effect, we tested 34 participants using a similar design. Participants ingested a placebo capsule in one of two conditions: (1) relaxation, wherein we described the capsule as a herbal sedative, or (2) control, wherein we described the capsule as inert. To index placebo response, we collected measures of blood pressure and heart rate, as well as self-report ratings of relaxation and drowsiness. Despite using a similar experimental design as in our earlier study, we were unable to replicate the correlation between hypnotic suggestibility and placebo response. Furthermore, whereas in our former experiment we observed a change in subjective ratings of relaxation but no change in physiological measures, here we found that heart rate dropped in the relaxation condition while subjective ratings remained unchanged. Even within a consistent context of relaxation, therefore, our present results indicate that placebos may induce effects that are fickle, tenuous, and unreliable. Although we had low statistical power, our findings tentatively accord with the notion that placebo response likely involves a complex, multifaceted interaction between traits, expectancies, and contexts.

  7. Efficacy of Zolpidem for Dystonia: A Study Among Different Subtypes

    Science.gov (United States)

    Miyazaki, Yoshimichi; Sako, Wataru; Asanuma, Kotaro; Izumi, Yuishin; Miki, Tetsuro; Kaji, Ryuji

    2012-01-01

    Although there are some newly developed options to treat dystonia, its medical treatment is not always satisfactory. Zolpidem, an imidazopyridine agonist with a high affinity on benzodiazepine subtype receptor BZ1 (ω1), was found to improve clinical symptoms of dystonia in a limited number of case reports. To investigate what subtype of dystonia is responsive to the therapy, we conducted an open label study to assess the efficacy of zolpidem (5–20 mg) in 34 patients suffering from miscellaneous types of dystonia using the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS). Patients were entered into the study if they had been refractory to other medications as evaluated by BFMDRS (no change in the previous two successive visits). After zolpidem therapy, the scores in the patients as a whole were decreased from 7.2 ± 7.9 to 5.5 ± 5.0 (P = 0.042). Patients with generalized dystonia, Meige syndrome/blepharospasm, and hand dystonia improved in the scale by 27.8, 17.8, and 31.0%, respectively, whereas no improvement was found in cervical dystonia patients. Overall response rate among patients were comparable to that of trihexyphenidyl. Zolpidem may be a therapeutic option for generalized dystonia, Meige syndrome, and hand dystonia including musician’s. Drowsiness was the dose-limiting factor. PMID:22529836

  8. Alcohol and the young child.

    Science.gov (United States)

    Bradford, D E

    1984-01-01

    With the increasing availability of alcohol in modern times, the child neglect and abuse portrayed in Hogarth's engraving Gin Lane may once again be witnessed. Reports occur occasionally of alcohol being given deliberately to infants to quieten them, but alcohol poisoning in the slightly older child is not uncommon. The introduction of child-proof containers has altered poisoning figures recently. However, alcohol poisoning tends to occur at ages 3 and 4, that is, about 2 years after the peak of all poisonings in children. This difference may be an indication that alcohol is taken in imitation of parents' drinking, a suggestion which has some support from reported cases of mouthwash poisoning. Holidays and high days where children and alcohol mix, are potentially dangerous periods. Since alcohol poisoning can be fatal, yet if recognised is relatively easily managed, every child with the slightest degree of drowsiness should be suspect until proven or not by blood alcohol. The prevention of alcohol poisoning in the young child consists in protecting the alcohol by lock and key, not setting an example by drinking or gargling in front of children. Many substances such as mouthwash and perfume should also be under supervision. Once actual poisoning has occurred blood sugar is probably more important than the level of blood ethanol and blood sugar levels should be monitored frequently and the child treated with glucose, preferably intravenously.

  9. Risperidone-induced type 2 diabetes presenting with diabetic ketoacidosis

    Directory of Open Access Journals (Sweden)

    Clarissa Ern Hui Fang

    2018-05-01

    Full Text Available A 28-year-old male presented with 2 days of vomiting and abdominal pain, preceded by 2 weeks of thirst, polyuria and polydipsia. He had recently started risperidone for obsessive-compulsive disorder. He reported a high dietary sugar intake and had a strong family history of type 2 diabetes mellitus (T2DM. On admission, he was tachycardic, tachypnoeic and drowsy with a Glasgow Coma Scale (GCS of 10/15. We noted axillary acanthosis nigricans and obesity (BMI 33.2 kg/m2. Dipstick urinalysis showed ketonuria and glycosuria. Blood results were consistent with diabetic ketoacidosis (DKA, with hyperosmolar state. We initiated our DKA protocol, with intravenous insulin, fluids and potassium, and we discontinued risperidone. His obesity, family history of T2DM, acanthosis nigricans and hyperosmolar state prompted consideration of T2DM presenting with ‘ketosis-prone diabetes’ (KPD rather than T1DM. Antibody markers of beta-cell autoimmunity were subsequently negative. Four weeks later, he had modified his diet and lost weight, and his metabolic parameters had normalised. We reduced his total daily insulin dose from 35 to 18 units and introduced metformin. We stopped insulin completely by week 7. At 6 months, his glucometer readings and glycated haemoglobin (HbA1c level had normalised.

  10. Symptom communication during critical illness: the impact of age, delirium, and delirium presentation.

    Science.gov (United States)

    Tate, Judith A; Sereika, Susan; Divirgilio, Dana; Nilsen, Marci; Demerci, Jill; Campbell, Grace; Happ, Mary Beth

    2013-08-01

    Symptom communication is integral to quality patient care. Communication between patients and nurses in the intensive care unit (ICU) is complicated by oral or endotracheal intubation and fluctuating neurocognitive status or delirium. We report the (a) prevalence of delirium and its subtypes in non-vocal, mechanically ventilated, critically ill patients; (b) impact of age on delirium; and (c) influence of delirium and age on symptom communication. Videorecorded interactions between patients (N = 89) and nurses (N = 30) were analyzed for evidence of patient symptom communication at four time points across 2 consecutive days. Delirium was measured at enrollment and following sessions. Delirium prevalence was 23.6% at enrollment and 28.7% across sessions. Participants age >60 were more likely to be delirious on enrollment and during observational sessions. Delirium was associated with self-report of pain, drowsiness, and feeling cold. Patients were significantly less likely to initiate symptom communication when delirious. Symptom identification should be carefully undertaken in older adults with or without delirium. Copyright 2013, SLACK Incorporated.

  11. Sleep quality and functional gastrointestinal disorders. A psychological issue.

    Science.gov (United States)

    Bouchoucha, Michel; Mary, Florence; Bon, Cyriaque; Bejou, Bakhtiar; Airinei, Gheorghe; Benamouzig, Robert

    2018-02-01

    Sleep disorders are often associated with functional gastrointestinal disorders (FGIDs). This study aims to evaluate the association of sleep disorders with specific FGIDs and to assess the related importance of psychological disorders. We included 1009 consecutive patients with FGIDs (70.9% females). The patients completed a Rome III questionnaire and after a psychological evaluation on anxiety and depression they were classified according to their sleep disorders using a 7-point grading scale: Groups 1-3, drowsiness (severe, moderate, mild); Group 4, no change; Groups 5-7, insomnia (mild, moderate, severe). Multinomial logistic regression using sleep group as a dependent variable with no sleep change as reference and body mass index, FGIDs, anxiety and depression as independent variables were used for statistical analysis. Altogether 667 (66.1%) patients reported changes in sleep disorders, of whom 487 (48.3%) had decreased sleep and 180 (17.8%) had increased sleep while 342 (33.9%) reported no change. Depression was lower in patients with no change in sleep pattern and increased with the severity of their sleep disorder (P proctalgia fugax. Sleep disorders are associated with FGIDs, especially in the presence of depressive symptoms. © 2018 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

  12. Hyperamonemia in children. Study of 72 cases

    Directory of Open Access Journals (Sweden)

    Jiménez Pérez Mario

    2014-07-01

    Full Text Available Hyperammonemia (HA is a metabolic emergency, and when not diagnosed and treated in a timely manner leads to severe neuro- logical damage and/ or death. HA may have multiple origins, but the EIM are one of the causes that should always be suspected. The objective of this work is to make a clinical description of the causes of HA in a sample of patients from the National Institute of Pediatrics (INP, to know the proportion of patients with HA in which could confirm the presence of an inborn error of metabolism (IEM. We found 72 patients with HA in the past 10 years, of whom 11 were patients already known to have an IEM and 61 with unknown cause; Of the latter, 46% of patients underwent metabolic studies (amino acids quantification, organic acids analysis and orotic acid quantification and in 14 cases (30% an IEM was diagnosed. The clinical symptoms most frequently observed were neurological (seizures, drowsiness, lethargy, irritability, developmental delay, and hypotonia stupor, etc., followed by digestive disturbances such as vomiting and refusal to eat. Urea cycle disorders, aminoacidopathies and organic acidemias were diagnosed, so the management and treatment of these should be known by the pediatricians, especially those dedicated to emergencies.

  13. A Case of a Contraband Body Packer Requiring High-Dose Naloxone

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    Khusro Shamim

    2017-09-01

    Full Text Available Background:Body packers occasionally refer to the Emergency Department (ED, after leakage of package contents within intestinal lumen, resulting in life-threatening toxicities, depending upon the nature of the chemical product. Case Presentation: We present a case report of a patient presented with sudden onset of drowsiness while he was on board a flight. He was brought in by the airport security staff. On arrival to the ED, his Glasgow Coma Scale (GCS was 3/15 and pupils were pinpoint bilaterally. He was empirically treated with Naloxone on clinical suspicion of narcotic overdose. He required a cumulative dose of 12 mg of Naloxone for reversal of respiratory depression and coma. On subsequent investigation in the ED, he was identified to be a body packer. Discussion: This case represents a rare clinical example of narcotic overdose which resulted in a life-threatening opioid toxicity due to leakage of the package contents into his bowels. In this case, a dosage greater than 10 mg of the maximum recommended dose of Naloxone is required for reversal of toxicity. Conclusion:It is imperative to have a high level of suspicion for managing possible opioid intoxication as immediate treatment can be diagnostic and lifesaving. Our case required more than the recommended dosage of Naloxone, highlighting the possible suggestion of further studies to look into the maximum threshold of this reversal agent.

  14. Excessive Video Game Use, Sleep Deprivation, and Poor Work Performance Among U.S. Marines Treated in a Military Mental Health Clinic: A Case Series.

    Science.gov (United States)

    Eickhoff, Erin; Yung, Kathryn; Davis, Diane L; Bishop, Frank; Klam, Warren P; Doan, Andrew P

    2015-07-01

    Excessive use of video games may be associated with sleep deprivation, resulting in poor job performance and atypical mood disorders. Three active duty service members in the U.S. Marine Corps were offered mental health evaluation for sleep disturbance and symptoms of blunted affect, low mood, poor concentration, inability to focus, irritability, and drowsiness. All three patients reported insomnia as their primary complaint. When asked about online video games and sleep hygiene practices, all three patients reported playing video games from 30 hours to more than 60 hours per week in addition to maintaining a 40-hour or more workweek. Our patients endorsed sacrificing sleep to maintain their video gaming schedules without insight into the subsequent sleep deprivation. During the initial interviews, they exhibited blunted affects and depressed moods, but appeared to be activated with enthusiasm and joy when discussing their video gaming with the clinical provider. Our article illustrates the importance of asking about online video gaming in patients presenting with sleep disturbances, poor work performance, and depressive symptoms. Because excessive video gaming is becoming more prevalent worldwide, military mental health providers should ask about video gaming when patients report problems with sleep. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  15. Fatal Nonhepatic Hyperammonemia in ICU Setting: A Rare but Serious Complication following Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Gyanendra Acharya

    2016-01-01

    Full Text Available Bariatric surgery is well established in reducing weight and improving the obesity-associated morbidity and mortality. Hyperammonemic encephalopathy following bariatric surgery is rare but highly fatal if not diagnosed in time and managed aggressively. Both macro- and micronutrients deficiencies play a role. A 42-year-old Hispanic female with a history of Roux-en-Y Gastric Bypass Procedure was brought to ED for progressive altered mental status. Physical exam was remarkable for drowsiness with Glasgow Coma Scale 11, ascites, and bilateral pedal edema. Labs showed elevated ammonia, low hemoglobin, low serum prealbumin, albumin, HDL, and positive toxicology. She remained obtunded despite the treatment with Narcan and flumazenil and the serum ammonia level fluctuated despite standard treatment with lactulose and rifaximin. Laboratory investigations helped to elucidate the etiology of the hyperammonemia most likely secondary to unmasking the functional deficiency of the urea cycle enzymes. Hyperammonemia in the context of normal liver function tests becomes diagnostically challenging for physicians. Severe hyperammonemia is highly fatal. Early diagnosis and aggressive treatment can alter the prognosis favorably.

  16. Cardiac Glycoside Plants Self-Poisoning

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    Radenkova-Saeva J.

    2014-06-01

    Full Text Available Cardiac glycosides are found in a diverse group of plants including Digitalis purpurea and Digitalis lanata (foxgloves, Nerium oleander, Convallaria majalis (lily of the valley, Strophanthus gratus, etc. Nerium Oleander is an indoor and ornamental plant of an evergreen shrub. It’s widespread in countries with a Mediterranean climate. Oleander is one of the most poisonous plants known to humans. All parts of the nerium oleander are poisonous, primarily due to the contained cardiac glycosides - oleandrin, nerin, digitoxigenin, and olinerin of which oleandrin is the principal toxin. The bark contains the toxic substances of rosagenin which causes strychnine-like effects. Signs of poisoning appear a few hours after the adoption of the parts of the plant. Two cases of Nerium Oleander poisoning were presented. Clinical picture included gastrointestinal, cardiovascular and central nervous system effects. The clinical symptoms were characterized by nausea, vomiting, salivation, colic, diarrhoea, ventricular tachycardia, dysrhythmia, heart block, ataxia, drowsiness, muscular tremor. Treatment included administration of activated charcoal, symptomatic and supportive care.

  17. Rectal methadone in cancer patients with pain. A preliminary clinical and pharmacokinetic study.

    Science.gov (United States)

    Ripamonti, C; Zecca, E; Brunelli, C; Rizzio, E; Saita, L; Lodi, F; De Conno, F

    1995-10-01

    Cancer pain can be treated in most cases with oral analgesics. However, during their clinical history, 53% to 70% of patients will need alternative routes of opioid administration. The rectal administration of opioids is a simple alternative route for many patients. There are no data in the literature regarding the pharmacodynamics and pharmacokinetics of rectal methadone. We evaluated the analgesia, tolerability and absorption profile of methadone hydrochloride in six opioid-naive cancer patients with pain. A blood sample was collected before administration of a single dose of drug (10 mg) and then again after fixed times. At these fixed times the patients were asked about pain, nausea and drowsiness by means of a visual analogue scale of 0-100 mm (VAS). Pain relief was statistically significant as early as 30 minutes and up to eight hours after methadone administration. None of the patients reported significant side effects. The pharmacokinetics of rectal methadone showed rapid and extensive distribution phases followed by a slow elimination phase. Rectal methadone can be considered an effective analgesic therapy for patients with cancer pain for whom oral and/or parenteral opioids are not indicated or available.

  18. School start times for adolescents.

    Science.gov (United States)

    2014-09-01

    The American Academy of Pediatrics recognizes insufficient sleep in adolescents as an important public health issue that significantly affects the health and safety, as well as the academic success, of our nation's middle and high school students. Although a number of factors, including biological changes in sleep associated with puberty, lifestyle choices, and academic demands, negatively affect middle and high school students' ability to obtain sufficient sleep, the evidence strongly implicates earlier school start times (ie, before 8:30 am) as a key modifiable contributor to insufficient sleep, as well as circadian rhythm disruption, in this population. Furthermore, a substantial body of research has now demonstrated that delaying school start times is an effective countermeasure to chronic sleep loss and has a wide range of potential benefits to students with regard to physical and mental health, safety, and academic achievement. The American Academy of Pediatrics strongly supports the efforts of school districts to optimize sleep in students and urges high schools and middle schools to aim for start times that allow students the opportunity to achieve optimal levels of sleep (8.5-9.5 hours) and to improve physical (eg, reduced obesity risk) and mental (eg, lower rates of depression) health, safety (eg, drowsy driving crashes), academic performance, and quality of life. Copyright © 2014 by the American Academy of Pediatrics.

  19. The impact of an online prematriculation sleep course (sleep 101 on sleep knowledge and behaviors in college freshmen: a pilot study

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    Quan SF

    2017-04-01

    Full Text Available College students have a high prevalence of poor sleep quality and sleep deficiency which negatively impacts their academic, mental and physical performance. A prematriculation course focused on improving sleep knowledge and behaviors may reduce sleep problems. “Sleep 101” is an online prematriculation course developed to educate incoming college freshmen about the importance of sleep in their lives and to recommend behaviors that will improve their sleep health. In a pilot program, “Sleep 101” was administered to freshman at four universities. The results of a voluntary survey after completion of the course indicated that there was an improvement in knowledge about sleep and the effects of caffeine use, and that students were less likely to drive drowsy and pull “all-nighters,” These pilot data suggest that an internet administered prematriculation course on the importance of sleep and the adoption of healthy sleep behaviors will be effective in reducing sleep problems among college students.

  20. Efficacy and safety of tramadol/acetaminophen in the treatment of breakthrough pain in cancer patients.

    Science.gov (United States)

    Ho, Ming-Lin; Chung, Chih-Yuan; Wang, Chuan-Cheng; Lin, Hsuan-Yu; Hsu, Nicholas C; Chang, Cheng-Shyong

    2010-12-01

    We evaluated the analgesic efficacy and safety of tramadol 37.5 mg/acetaminophen 325 mg combination tablet, for the treatment of breakthrough pain in cancer patients. This study was conducted at Changhua Christian Hospital, Changhua, Taiwan from January 2006 to February 2007. The single-center and open-label study enrolled 59 opioid-treated cancer patients with at least moderate breakthrough pain (visual analog scale [VAS] score ≥40mm on a 100-mm scale). The efficacy measures included VAS scores and adverse effect assessment 10, 30, and 60 minutes after the administration of tramadol/acetaminophen. Visual analog scale score at time of pain relief was reported. The mean VAS score when the breakthrough pain episode began (0 minute) was 77.8. Analysis showed significant better mean pain VAS scores at 10, 30, and 60 minutes after the administration of tramadol/acetaminophen (p≤0.001 versus 0 min for all 3 time points). The mean time to pain relief was 597.2 seconds and the mean VAS score at time of relief was 43.4. The effective rates, defined by more than 30% reduction of the VAS score, after 10 minutes of administration was 74.6%, 30 minutes 86.4%, and one hour 94.9% (p≤0.001 versus 0 minute for all 3 time points). Two cases of drowsiness were reported. Tramadol/acetaminophen might be efficacious and safe in the treatment of breakthrough pain in cancer.

  1. Ventilation and Heart Rate Monitoring in Drivers using a Contactless Electrical Bioimpedance System

    International Nuclear Information System (INIS)

    Macías, R; García, M A; Ramos, J; Bragós, R; Fernández, M

    2013-01-01

    Nowadays, the road safety is one of the most important priorities in the automotive industry. Many times, this safety is jeopardized because of driving under inappropriate states, e.g. drowsiness, drugs and/or alcohol. Therefore several systems for monitoring the behavior of subjects during driving are researched. In this paper, a device based on a contactless electrical bioimpedance system is shown. Using the four-wire technique, this system is capable of obtaining the heart rate and the ventilation of the driver through multiple textile electrodes. These textile electrodes are placed on the car seat and the steering wheel. Moreover, it is also reported several measurements done in a controlled environment, i.e. a test room where there are no artifacts due to the car vibrations or the road state. In the mentioned measurements, the system response can be observed depending on several parameters such as the placement of the electrodes or the number of clothing layers worn by the driver.

  2. Adrenal Insufficiency as a Cause of Acute Liver Failure: A Case Report

    Directory of Open Access Journals (Sweden)

    Jamshid Vafaeimanesh

    2013-01-01

    Full Text Available Introduction. Many diseases and conditions can contribute to elevated liver enzymes. Common causes include viral and autoimmune hepatitis, fatty liver, and bile duct diseases, but, in uncommon cases like liver involvement in endocrine disorders, liver failure is also seen. Adrenal insufficiency is the rarest endocrine disorder complicating the liver. In the previously reported cases of adrenal insufficiency, mild liver enzymes elevation was seen but we report a case with severe elevated liver enzymes and liver failure due to adrenal insufficiency. Based on our knowledge, this is the first report in this field. Case Report. A 39-year-old woman was referred to emergency ward due to drowsiness and severe fatigue. Her laboratory tests revealed prothrombin time: 21 sec, alanine aminotransferase (ALT: 2339 IU/L, aspartate aminotransferase (AST: 2002 IU/L, and ALP: 90 IU/L. No common cause of liver involvement was discovered, and eventually, with diagnosis of adrenal insufficiency and corticosteroid therapy, liver enzymes and function became normal. Finally, the patient was discharged with good general condition. Conclusion. With this report, we emphasize adrenal insufficiency (primary or secondary as a reason of liver involvement in unexplainable cases and recommend that any increase in the liver enzymes, even liver failure, in these patients should be observed.

  3. A Study of Deep CNN-Based Classification of Open and Closed Eyes Using a Visible Light Camera Sensor

    Directory of Open Access Journals (Sweden)

    Ki Wan Kim

    2017-06-01

    Full Text Available The necessity for the classification of open and closed eyes is increasing in various fields, including analysis of eye fatigue in 3D TVs, analysis of the psychological states of test subjects, and eye status tracking-based driver drowsiness detection. Previous studies have used various methods to distinguish between open and closed eyes, such as classifiers based on the features obtained from image binarization, edge operators, or texture analysis. However, when it comes to eye images with different lighting conditions and resolutions, it can be difficult to find an optimal threshold for image binarization or optimal filters for edge and texture extraction. In order to address this issue, we propose a method to classify open and closed eye images with different conditions, acquired by a visible light camera, using a deep residual convolutional neural network. After conducting performance analysis on both self-collected and open databases, we have determined that the classification accuracy of the proposed method is superior to that of existing methods.

  4. Avaliação da sonolência diurna e qualidade do sono em idosos e sua relação com a qualidade de vida

    Directory of Open Access Journals (Sweden)

    Anna Carolina Rocha Magalhães

    2018-02-01

    Full Text Available Objective: To evaluate daytime sleepiness and sleep quality in the elderly and their influence on quality of life. Methods: Quantitative, cross-sectional and descriptive research. For the evaluation of daytime sleepiness was used the Epworth Sleepiness Scale (ESS, to evaluate sleep quality, the Pittsburgh Sleep Quality Index (PSQI, and to assess the quality of life of the WHOQOL-BREF. For analysis and interpretation of the results, the elderly was divided into groups according to the classification of ESS and PSQI. Results: A total of 128 elderly patients were evaluated. When analyzing ESS, 24.2% of the elderly had a score equal to or greater than 11 points, which indicates Excessive Day Drowsiness (EDD. When the quality of sleep was evaluated, 69.6% of the elderly had a score higher than 5 in the PSQI, which indicates poor quality sleep. When comparing from the ESS, the group of elderly people who did not present EDD with the elderly classified with EDD, a significant difference was observed in the psychological domain of the WHOQOL-BREF, when comparing the elderly with PSQI, there was a significant difference for the physical and environmental domains. Conclusion: The occurrence of excessive daytime sleepiness and poor sleep quality can have an impact on quality of life.

  5. Subdural Hemorrhage after Scoliosis and Detethering of Cord Surgery

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    Rohan Bhimani

    2018-01-01

    Full Text Available Introduction. Intracranial hypotension may occur when CSF leaks from the subarachnoid space. Formation of intracranial, subdural, and subarachnoid hemorrhage has been observed after significant CSF leak as seen in lumbar puncture or ventricular shunt placement. However, very few cases, referring to these remote complications following spine surgery, have been described in literature. We present a case of a 10-year-old male child operated for idiopathic scoliosis with low-lying conus medullaris who postoperatively developed subdural hemorrhage. Case Report. A case of a 10-year-old male operated for idiopathic scoliosis with low-lying conus medullaris is presented. To correct this, detethering was done at the L3 level, laminectomy was done from L2 to L3 with pedicular screw fixation from T3 to L2, and bone grafting with right costoplasty was done from the 3rd to the 6th ribs. On the 5th day postoperatively, the patient developed convulsions and drowsiness and recovered subsequently by postoperative day 7. Conclusion. We report a rare case of an acute intracranial subdural hemorrhage caused by intracranial hypotension following scoliosis and detethering of cord surgery. This report highlights the potential morbidity associated with CSF leak occurring after this surgery.

  6. González de la Vega, René. (2017. Tolerance and Modern Liberalism. From Paradox to Aretaic Moral Ideal. Maryland, United States of America: Lexington. 231 pp.

    Directory of Open Access Journals (Sweden)

    Guillermo Lariguet

    2017-06-01

    Full Text Available In political and moral philosophy we are used to an uninterrupted succession of texts, heirs of the liberal traditions (headed by John Rawls, communitarians (led by the likes of Michael Sandel, Charles Taylor, etc., analytical Marxists (authors like Gerald Cohen, Jon Elster, etc..Besides the names mentioned above, there is a succession of texts that tend to give rise to a sense of routine and, as a result, of lethargy. It is the feeling that political and moral philosophy has reached a plateau within a set of accepted doctrines. Doctrines which, to paraphrase Thomas Kuhn, make up a kind of “normal science” of philosophical theory.But from time to time, the routine drowsiness is sharply interrupted. This happens when works of philosophy show up to question prevailing theories in political philosophy. Such is the case of the work I propose to review herein. It is the work of Mexican philosopher René González de la Vega, whose text on political philosophy features philosophical rigour, originality and depth...

  7. Integration of Body Sensor Networks and Vehicular Ad-hoc Networks for Traffic Safety.

    Science.gov (United States)

    Reyes-Muñoz, Angelica; Domingo, Mari Carmen; López-Trinidad, Marco Antonio; Delgado, José Luis

    2016-01-15

    The emergence of Body Sensor Networks (BSNs) constitutes a new and fast growing trend for the development of daily routine applications. However, in the case of heterogeneous BSNs integration with Vehicular ad hoc Networks (VANETs) a large number of difficulties remain, that must be solved, especially when talking about the detection of human state factors that impair the driving of motor vehicles. The main contributions of this investigation are principally three: (1) an exhaustive review of the current mechanisms to detect four basic physiological behavior states (drowsy, drunk, driving under emotional state disorders and distracted driving) that may cause traffic accidents is presented; (2) A middleware architecture is proposed. This architecture can communicate with the car dashboard, emergency services, vehicles belonging to the VANET and road or street facilities. This architecture seeks on the one hand to improve the car driving experience of the driver and on the other hand to extend security mechanisms for the surrounding individuals; and (3) as a proof of concept, an Android real-time attention low level detection application that runs in a next-generation smartphone is developed. The application features mechanisms that allow one to measure the degree of attention of a driver on the base of her/his EEG signals, establish wireless communication links via various standard wireless means, GPRS, Bluetooth and WiFi and issue alarms of critical low driver attention levels.

  8. The impact of multiple care giving roles on fatigue, stress, and work performance among hospital staff nurses.

    Science.gov (United States)

    Scott, Linda D; Hwang, Wei-Ting; Rogers, Ann E

    2006-02-01

    This study describes fatigue and stress among a random sample of full-time hospital staff nurses (n=393) who provide care for aging family members, compares the results to nurses with and without children younger than 18 years living at home, examines differences in sleep duration, and explores the effects on work performance by care giving status during a 4-week period. Little attention has been given to the effects of care giver well-being when individuals assume dual roles as family and professional care givers. Hospital staff nurses recorded daily information concerning their work hours, errors, sleep/wake patterns, perceptions of fatigue, alertness, and stress and periods of drowsiness and sleep episodes while on duty for 28 days. Fatigue and stress levels were significantly higher among nurses caring for both children and elders. However, nurses providing elder care at home were more fatigued, sleep-deprived, and likely to make errors at work. These findings underscore the importance of restorative sleep interventions and fatigue countermeasures for hospital staff nurses involved in dual care giving roles. Limiting overtime and applying circadian principles to hospital scheduling processes would ensure a more alert workforce, minimize health risks for nurses, and maximize the safety of those in their care.

  9. Irritable bowel syndrome and symptom severity: evidence of negative attention bias, diminished vigour, and autonomic dysregulation.

    Science.gov (United States)

    Phillips, Kristy; Wright, Bradley J; Kent, Stephen

    2014-07-01

    To determine if cognitive processing, and subjective and physiological responses to stress and relaxation differed between an irritable bowel syndrome (IBS) group and control group. How these variables relate to the severity of IBS symptoms was also determined. Twenty-one IBS participants and 20 controls provided cognitive (attention and processing), subjective (perceived stress and vigour), and physiological (heart rate, blood pressure, and skin conductance) data during a relaxation and stress phase. Logistic regression analyses determined which variables are related to the IBS group and hierarchical linear regression assessed how the variables are related to the severity of IBS symptoms. Subjective and cognitive factors (drowsiness at baseline, total vigour, and reduced Stroop colour-naming accuracy for negative words) are significantly related to IBS, χ2 (3, N=41)=23.67, pself-schema, as well as perceived low vigour were important in categorising IBS. Low subjective vigour and reduced physiological reactivity to both relaxation and stress conditions were associated with IBS severity, suggestive of illness-related allostatic load. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Advance Care Planning in Glioblastoma Patients

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    Lara Fritz

    2016-11-01

    Full Text Available Despite multimodal treatment with surgery, radiotherapy and chemotherapy, glioblastoma is an incurable disease with a poor prognosis. During the disease course, glioblastoma patients may experience progressive neurological deficits, symptoms of increased intracranial pressure such as drowsiness and headache, incontinence, seizures and progressive cognitive dysfunction. These patients not only have cancer, but also a progressive brain disease. This may seriously interfere with their ability to make their own decisions regarding treatment. It is therefore warranted to involve glioblastoma patients early in the disease trajectory in treatment decision-making on their future care, including the end of life (EOL care, which can be achieved with Advance Care Planning (ACP. Although ACP, by definition, aims at timely involvement of patients and proxies in decision-making on future care, the optimal moment to initiate ACP discussions in the disease trajectory of glioblastoma patients remains controversial. Moreover, the disease-specific content of these ACP discussions needs to be established. In this article, we will first describe the history of patient participation in treatment decision-making, including the shift towards ACP. Secondly, we will describe the possible role of ACP for glioblastoma patients, with the specific aim of treatment of disease-specific symptoms such as somnolence and dysphagia, epileptic seizures, headache, and personality changes, agitation and delirium in the EOL phase, and the importance of timing of ACP discussions in this patient population.

  11. An unusual case of central diabetes insipidus & hyperglycemic hyperosmolar state following cardiorespiratory arrest

    Science.gov (United States)

    2013-01-01

    Background We are describing an unusual case of severe hyperglycemia and hypernatremia, resistant to treatment. Case presentation A thirty year old female with adenocarcinoma of rectum was admitted with increasing lethargy, headache and drowsiness. She deteriorated rapidly and had cardiac arrest, following which she remained comatose. Her initial serum glucose and sodium were normal, but after receiving dexamethasone and mannitol, the serum glucose progressively increased to 54.7 mmol/L and sodium to 175 mmol/L, despite receiving very high dose of intravenous (IV) insulin infusion. She was evaluated for diabetes insipidus because of continued polyuria even after correction of hyperglycemia. Her serum osmolality was 337 mmol/kg, and urine osmolality was 141 mmol/kg which rose to 382 mmol/kg, after receiving 4 mcg of IV Desmopressin. Conclusion Our patient developed central diabetes insipidus post cardiac arrest and severe dehydration because of diabetes insipidus. Stress of critical illness, dehydration, dexamethasone and IV dextrose infusion were likely responsible for this degree of severe and resistant to treatment hyperglycemia. PMID:23947429

  12. Characteristics of hand sanitizer ingestions by adolescents reported to poison centers.

    Science.gov (United States)

    Forrester, Mathias B

    2015-02-01

    There had been reports of adolescents using hand sanitizers to obtain alcohol and ending up in emergency departments with alcohol poisoning. This study aimed to describe the pattern of adolescent ingestions of hand sanitizers reported to a statewide poison center system. Our study subjects included patients aged 13-19 years who reported hand sanitizer ingestions as reported to Texas poison centers during 2000-2013. The distribution of the ingestions was determined for various demographic and clinical factors. Of 385 total cases, 61% of the patients were male, and the mean age was 15.3 years. The ingestion reason was unintentional (61%), intentional abuse/misuse (18%), and malicious (10%). Ingestion site was most frequently reported to be the patient's own residence (53%), followed by school (35%). About 77% of the patients were managed on site. The medical outcome was serious (moderate effect or unable to follow-potentially toxic) in 5% of the cases. The most frequently reported adverse clinical effects were vomiting (5%), abdominal pain (4%), nausea (4%), throat irritation (4%), and drowsiness (2%). Adolescents who ingested hand sanitizers were more likely to be male and younger. One-third of the ingestions occurred at school, suggesting that school personnel might be made aware of the potential problem of hand sanitizer ingestions by adolescents. Nevertheless, despite the potential for serious outcomes from adolescent hand sanitizer ingestion, most of the ingestions reported to poison centers are not likely to be serious and can be successfully managed outside of a healthcare facility.

  13. OLED Display For Real Time Vision System

    Directory of Open Access Journals (Sweden)

    Sandhyalakshmi Narayanan

    2015-08-01

    Full Text Available This innovative glass design will carry an OLED based display controlled via nano Ardiuno board having Bluetooth connectivity with a Smartphone to exchange information along with onboard accelerometer. We are using a tilt angle sensor for detecting if the driver is feeling drowsy. An alcohol sensor has been used to promote the safe driving habit. The glasses will be getting latest updates about the current speed of the vehicle navigation directions nearby or approaching sign broads or services like petrol pumps. Itll also display information like incoming calls or received messages. All this information will be obtained through a Smartphone connected via Bluetooth. Also the car mileage can be monitored with help of fuel sensor as the consumption of fuel is directly related to it. Abnormalities if detected will be immediately notified in the glasses. Also the angle of the tilt angle sensor can be defined and set by the user according to his needs. Also the main idea of using OLED glasses is that it is organic thereby helps in reducing the carbon footprint and is quite slim. Therefore it can be easily mounted on the specs without making it heavy. Also they higher level of flexibility and have low power drain and energy consumption

  14. Upper Limb Muscle and Brain Activity in Light Assembly Task on Different Load Levels

    Science.gov (United States)

    Zadry, Hilma Raimona; Dawal, Siti Zawiah Md.; Taha, Zahari

    2010-10-01

    A study was conducted to investigate the effect of load on upper limb muscles and brain activities in light assembly task. The task was conducted at two levels of load (Low and high). Surface electromyography (EMG) was used to measure upper limb muscle activities of twenty subjects. Electroencephalography (EEG) was simultaneously recorded with EMG to record brain activities from Fz, Pz, O1 and O2 channels. The EMG Mean Power Frequency (MPF) of the right brachioradialis and the left upper trapezius activities were higher on the high-load task compared to low-load task. The EMG MPF values also decrease as time increases, that reflects muscle fatigue. Mean power of the EEG alpha bands for the Fz-Pz channels were found to be higher on the high-load task compared to low-load task, while for the O1-O2 channels, they were higher on the low-load task than on the high-load task. These results indicated that the load levels effect the upper limb muscle and brain activities. The high-load task will increase muscle activities on the right brachioradialis and the left upper tapezius muscles, and will increase the awareness and motivation of the subjects. Whilst the low-load task can generate drowsiness earlier. It signified that the longer the time and the more heavy of the task, the subjects will be more fatigue physically and mentally.

  15. Bilastine and the central nervous system.

    Science.gov (United States)

    Montoro, J; Mullol, J; Dávila, I; Ferrer, M; Sastre, J; Bartra, J; Jáuregui, I; del Cuvillo, A; Valero, A

    2011-01-01

    Antihistamines have been classifed as first or second generation drugs, according to their pharmacokinetic properties, chemical structure and adverse effects. The adverse effects of antihistamines upon the central nervous system (CNS) depend upon their capacity to cross the blood-brain barrier (BBB) and bind to the central H1 receptors (RH1). This in turn depends on the lipophilicity of the drug molecule, its molecular weight (MW), and affinity for P-glycoprotein (P-gp) (CNS xenobiotic substances extractor protein). First generation antihistamines show scant affinity for P-gp, unlike the second generation molecules which are regarded as P-gp substrates. Histamine in the brain is implicated in many functions (waking-sleep cycle, attention, memory and learning, and the regulation of appetite), with numerous and complex interactions with different types of receptors in different brain areas. Bilastine is a new H1 antihistamine that proves to be effective in treating allergic rhinoconjunctivitis (seasonal and perennial) and urticaria. The imaging studies made, as well as the objective psychomotor tests and subjective assessment of drowsiness, indicate the absence of bilastine action upon the CNS. This fact, and the lack of interaction with benzodiazepines and alcohol, define bilastine as a clinically promising drug with a good safety profile as regards adverse effects upon the CNS.

  16. The Analgesic Efficacy of Nonsteroidal Anti-inflammatory Agents (NSAIDs) in Patients Undergoing Cesarean Deliveries: A Meta-Analysis.

    Science.gov (United States)

    Zeng, Angela M; Nami, Nina F; Wu, Christopher L; Murphy, Jamie D

    Postoperative pain after cesarean delivery, which accounts for approximately 1 in 3 live births in the United States, can be severe in many patients. Nonsteroidal anti-inflammatory agents (NSAIDs) are potent analgesics that are effective in the treatment of postoperative pain. In this meta-analysis, we assessed the analgesic efficacy of NSAIDs in postoperative cesarean delivery patients. An electronic literature search of the Library of Medicine's PubMed, Cochrane CENTRAL, Scopus, and EMBASE databases was conducted in May 2013 and updated in January 2015 (Appendix, Supplemental Digital Content 1, http://links.lww.com/AAP/A174). Searches were limited to randomized controlled trials. The primary outcome variable was visual analog scale or numerical rating scale pain scores. Secondary outcomes included cumulative postoperative opioid consumption and opioid-related adverse effects (drowsiness/sedation, nausea, and vomiting). Data extraction was performed independently by 2 reviewers. Extracted data were input into Review Manager. Twenty-two randomized controlled trials compared a NSAID (n = 639) to a control (n = 674). Patients in the NSAID group versus control reported lower pain scores at 12 hours (P = 0.003) and at 24 hours (P breastfeeding.

  17. Evaluation of the efficacy and safety of fexofenadine in the management of chronic idiopathic urticaria: A prospective study with 512 patients

    Directory of Open Access Journals (Sweden)

    Dhar Sandipan

    2002-01-01

    Full Text Available Five hundred and twelve patients with chronic idiopathic urticaria (CIU were treated with fexofenadine at a dose on 180mg/day. Maximum number of patients were between 20 to 40 years of age and female to male ratio was 1.45:1. The severity of itching was calculated on a scale of 0 to 4 and was recorded by the patients. The mean daily total symptom score (TSS was measured as sum of the patients′ pruritus and number of wheal scores (0 to 7. A mean TSS was determined for each week. Baseline TSS came down to ′0′ by 4 weeks in all groups except those with TSS 4. There was no correlation between the baseline TSS and degree of improvement. Of 512, 14 (2.73% patients did not complete the study. The commonest adverse effect was headache (9.04%. There was no report of drowsiness or cardiac arrythmia. In no patient fexofenadine had to be withdrawn because of its adverse effects.

  18. [A 53-year-old man with herpes encephalitis showing acceleration of improvement in higher brain function after general anesthesia with sevoflurane: a case report].

    Science.gov (United States)

    Togashi, Naohiko; Kaida, Kenichi; Hongo, Yu; Ogawa, Go; Ishikawa, Yukinobu; Takeda, Katsuhiko; Kamakura, Keiko

    2014-01-01

    We experienced a right-handed 53-year-old man who presented with disturbance of consciousness and fever. Herpes simplex encephalitis (HSE) was diagnosed based on the detection of herpes simplex virus DNA in the cerebrospinal fluid. The administration of acyclovir for 42 days improved his consciousness level. Drowsiness, fever and seizures reappeared 20 days after stopping acyclovir treatment (day 67) and he responded well to vidarabine and methylprednisolone pulse therapy. An assessment of aphasia on day 98 revealed transcortical sensory aphasia. Brain MRI showed lesion in the left temporal lobe, bilateral insular cortexes and bilateral frontal lobe. His higher brain dysfunction continued. On day 156, he underwent hip replacement arthroplasty under general anesthesia sevoflurane. His higher brain dysfunction rapidly improved thereafter. We concluded that the accelerated improvement in our patient's higher brain function was related to the protective effect of sevoflurane. Some reports also show the protective effects of sevoflurane in experimental allergic encephalomyelitis by inhibition of T cell activation. These protective and anti-inflammatory effects may explain the accelerated improvement in higher brain function after general anesthesia.

  19. Tramadol versus methadone for the management of acute opioid withdrawal: an add-on study

    Directory of Open Access Journals (Sweden)

    M Salehi

    2006-07-01

    Full Text Available BACKGROUND: Opioid agonists such as methadone have been used widely in controlling opioid withdrawal symptoms. Tramadol, a partial opioid agonist, also has been prescribed to manage acute and chronic pain. We sought to compare the efficacy of tramadol and methadone in reducing the severity of opioid withdrawal symptoms. METHODS: In a double blind clinical trial 70 opioid dependent patients who used daily opium equal to 15 mg methadone randomly were assigned in two groups. In one group, methadone was started at 15 mg/day while in the other group 450 mg/day tramadol was prescribed. Both drugs were tapered in a week and placebo was prescribed in the 2nd week. The severity of withdrawal symptoms were assessed five times by short opioid withdrawal scale (SOWS. Data were analyzed by Repeated Measures Analysis of Variance, Mann-Whitney U, and Wilcoxon tests. RESULTS: There were statistically significant differences between two groups in the severity of anxiety (P = 0.015, irritability (P = 0.044, palpitation (P = 0.018, agitation (P = 0.037, and dysphoria (P = 0.044 that all were more common in methadone group. Comparison of side effects revealed statistically significant differences in sweating (P = 0.003 and drowsiness (P = 0.019 between two groups that were more frequent in methadone group. DISCUSSION: Tramadol was more efficacious in controlling opioid withdrawal symptoms with lower side effects. KEYWORDS: Methadone, tramadol, opioid withdrawal.

  20. Four faces of baroreflex failure: hypertensive crisis, volatile hypertension, orthostatic tachycardia, and malignant vagotonia

    Science.gov (United States)

    Ketch, Terry; Biaggioni, Italo; Robertson, RoseMarie; Robertson, David

    2002-01-01

    BACKGROUND: The baroreflex normally serves to buffer blood pressure against excessive rise or fall. Baroreflex failure occurs when afferent baroreceptive nerves or their central connections become impaired. In baroreflex failure, there is loss of buffering ability, and wide excursions of pressure and heart rate occur. Such excursions may derive from endogenous factors such as stress or drowsiness, which result in quite high and quite low pressures, respectively. They may also derive from exogenous factors such as drugs or environmental influences. METHODS AND RESULTS: Impairment of the baroreflex may produce an unusually broad spectrum of clinical presentations; with acute baroreflex failure, a hypertensive crisis is the most common presentation. Over succeeding days to weeks, or in the absence of an acute event, volatile hypertension with periods of hypotension occurs and may continue for many years, usually with some attenuation of pressor surges and greater prominence of depressor valleys during long-term follow-up. With incomplete loss of baroreflex afferents, a mild syndrome of orthostatic tachycardia or orthostatic intolerance may appear. Finally, if the baroreflex failure occurs without concomitant destruction of the parasympathetic efferent vagal fibers, a resting state may lead to malignant vagotonia with severe bradycardia and hypotension and episodes of sinus arrest. CONCLUSIONS: Although baroreflex failure is not the most common cause of the above conditions, correct differentiation from other cardiovascular disorders is important, because therapy of baroreflex failure requires specific strategies, which may lead to successful control.

  1. Knowledge of hypoglycemia and its associated factors among type 2 diabetes mellitus patients in a Tertiary Care Hospital in South India.

    Science.gov (United States)

    Shriraam, Vanishree; Mahadevan, Shriraam; Anitharani, M; Jagadeesh, Nalini Sirala; Kurup, Sreelekha Bhaskara; Vidya, T A; Seshadri, Krishna G

    2015-01-01

    Hypoglycemia being the rate limiting complication in the attainment of strict glycemic control in diabetes management, in this study, we intended to study the knowledge of its symptoms, target blood levels during treatment and ways of prevention among type 2 diabetes patients attending Outpatient Department (OPD) of a medical college hospital. Every fifth patient attending the OPD during the 4 months between March and June 2013 was interviewed using a questionnaire. The study included 366 type 2 diabetic patients, of which 76.5% were females. The target fasting and postprandial blood glucose levels while on treatment was known to 135 (36.9%) and 126 (34.4%) patients, respectively. The common symptoms of hypoglycemia known to the study subjects were dizziness (81.4%), weakness (73.8%), and drowsiness (72.1%). Overall, 242 (66.1%) diabetic patients had good knowledge on hypoglycemia (knowledge of at least three symptoms of hypoglycemia together with at least one precipitating factor and at least one remedial measure). Higher age, illiteracy, low socioeconomic status were associated with poor knowledge whereas treatment with insulin along with oral hypoglycemic agents was associated with good knowledge on hypoglycemia. Sex and duration of disease were not associated with knowledge on hypoglycemia. Although the knowledge on symptoms of hypoglycemia, precipitating factors, remedial measures are high in this study, the target blood levels, complications were known to just a third of them. There is a knowledge gap on important aspects of hypoglycemia among type 2 diabetic patients.

  2. [Electroencephalographic effects of chlorphenesin carbamate, a new central muscle relaxant, in rabbits (author's transl)].

    Science.gov (United States)

    Watanabe, S; Araki, H; Kawasaki, H; Ueki, S

    1977-05-01

    Electroencephalographic (EEG) effects of chlorphenesin carbamate were investigated in rabbits with chronic electrode implants, and compared with those of chlormezanone and methocarbamol. Chlorphenesin carbamate (50 mg/kg i.v., 100 mg/kg i.d.) induced a drowsy pattern of spontaneous EEG consisting of high voltage slow waves in the cortex and amygdala, and desynchronization of hippocampal theta waves. Chlormezanone also elicited similar EEG changes but such were much more potent than chlorphenesin carbamate. Methocarbamol showed no effect on spontaneous EEG. Chlorphenesin carbamate caused sedation in this period and muscle relaxation was more potent than that of chlormezanone. The EEG arousal response to auditory stimulation and to electric stimulation of the posterior hypothalamus, centromedian thalamus and mesencephalic reticular formation was slightly depressed by chlorphenesin carbamate. Chlorphenesin carbamate, as with chlormezanone, markedly depressed the limbic afterdischarges elicited by hippocampal stimulation. These EEG effects of chlorphenesin carbamate were qualitatively similar to but much weaker than those of chlormezanone, whereas the muscle relaxant effect of chlorphenesin carbamate was more potent than that of chlormezanone.

  3. Postnatal development of EEG patterns, catecholamine contents and myelination, and effect of hyperthyroidism in Suncus brain.

    Science.gov (United States)

    Takeuchi, T; Sitizyo, K; Harada, E

    1998-03-01

    The postnatal development of the central nervous system (CNS) in house musk shrew in the early stage of maturation was studied. The electroencephalogram (EEG) and visual evoked potential (VEP) in association with catecholamine contents and myelin basic protein (MBP) immunoreactivity were carried out from the 1st to the 20th day of postnatal age. Different EEG patterns which were specific to behavioral states (awake and drowsy) were first recorded on the 5th day, and the total power which was obtained by power spectrum analysis increased after this stage. The latencies of all peaks in VEP markedly shortened between the 5th and the 7th day. Noradrenalin (NA) content of the brain showed a slight increase after the 3rd day, and reached maximum levels on the 7th day, which was delayed a few days compared to dopamine (DA). In hyperthyroidism, the peak latency of VEP was shortened and biosynthesis of NA in cerebral cortex and DA in hippocampus was accelerated. The most obvious change in MBP-immunoreactivity of the telencephalon occurred from the 7th to the 10th day. These morphological changes in the brain advanced at the identical time-course to those in the electrophysiological development and increment of DA and NA contents.

  4. Nabilone for the Management of Pain.

    Science.gov (United States)

    Tsang, Corey C; Giudice, Mirella G

    2016-03-01

    Nabilone, a synthetic cannabinoid, is approved in many countries including, but not limited to, Canada, the United States, Mexico, and the United Kingdom for the treatment of severe nausea and vomiting associated with chemotherapy. Clinical evidence is emerging for its use in managing pain conditions with different etiologies. We review the efficacy and safety of nabilone for various types of pain as well as its abuse potential, precautions and contraindications, and drug interactions; summarize pertinent clinical practice guidelines; and provide recommendations for dosing, monitoring, and patient education. Citations involving nabilone were identified through systematic reviews evaluating cannabinoids for pain. A systematic search (updated July 23, 2015) of the Ovid MEDLINE, EMBASE, PubMed, and Cochrane Library databases was performed. Eight randomized controlled trials, two prospective cohort trials, and one retrospective chart review were retrieved. Cancer pain, chronic noncancer pain, neuropathic pain, fibromyalgia, and pain associated with spasticity were the pain conditions evaluated. Nabilone was most commonly used as adjunctive therapy and led to small but significant reductions in pain. The most common adverse drug reactions included euphoria, drowsiness, and dizziness. Nabilone was rarely associated with severe adverse drug reactions requiring drug discontinuation, and the likelihood of abuse was thought to be low. Although the optimal role of nabilone in the management of pain is yet to be determined, certain clinical practice guidelines consider nabilone as a third-line agent. © 2016 Pharmacotherapy Publications, Inc.

  5. Clinical pharmacology of sibutramine hydrochloride (BTS 54524), a new antidepressant, in healthy volunteers.

    Science.gov (United States)

    King, D J; Devaney, N

    1988-01-01

    The cardiovascular, anticholinergic and central effects of single doses of 30, 45 and 60 mg of sibutramine hydrochloride (BTS 54524), a new potential antidepressant, were compared with amitriptyline (50 mg) and placebo given at weekly intervals in a randomised design to six healthy male volunteers. Sibutramine was associated with increases in both supine heart rate and systolic blood pressure at 1, 2 and 6 h after 60 mg (P less than 0.05). Amitriptyline caused a significant 50-60% decrease in salivation compared with placebo at 2 and 6 h but there were no changes with sibutramine. No significant changes in pupil size were detected with either drug. Visual analogue rating scales (VARS) revealed significant drowsiness with amitriptyline but neither sedative nor stimulant effects with sibutramine. Impairments of simple auditory and visual reaction times, visual two-choice reaction time, finger tapping and trail making, measured using an automated test battery, occurred with amitriptyline compared with sibutramine. If sibutramine proves to be an effective antidepressant it should be devoid of anticholinergic or central depressant effects. Chronic dosage studies are indicated to evaluate the clinical significance of its cardiovascular effects. PMID:3207566

  6. The role of midazolam-induced sedation in bone marrow aspiration/trephine biopsies.

    Science.gov (United States)

    Mainwaring, C J; Wong, C; Lush, R J; Smith, J G; Singer, C R

    1996-12-01

    This study was undertaken in 102 adult patients to evaluate the safety and efficacy of intravenous (i.v.) midazolam in the setting of bone marrow aspiration and trephine biopsy (BMAT). Combined local anaesthetic (LA) and sedation was used in 87% of patients and 13% received LA alone. Amnesia occurred in all sedated patients with only 9% experiencing a mild degree of post-procedure pain. This contrasted sharply with the non-sedated group, in whom 85% had intense pain during the biopsy followed by protracted local discomfort in approximately 54%. Drowsiness and some psychomotor impairment were the only notable sedation-related side-effects in approximately 20%. None required assisted ventilation. There was a resounding patient preference for BMAT with sedation. Considering the ease of use, safety and efficacy of i.v. midazolam, the availability of flumazenil as a reversal agent and the undoubted positive effects on quality of life, we would advocate using it in BMAT provided that there were no contraindications.

  7. Quadriplegia caused by an epidural abscess occurring at the same level of cervical destructive spondyloarthropathy: a case report.

    Science.gov (United States)

    Lee, Jun-Seok; Ryu, Ji-Hyun; Park, Jong-Tae; Kim, Ki-Won

    2017-01-10

    Destructive spondyloarthropathy (DSA) is one of the major complications in patients undergoing long-term hemodialysis. To the best of our knowledge, an epidural abscess occurring at the level of preexisting cervical DSA has not been well described in the literature. We report a unique case of quadriplegia caused by an epidural abscess occurring at the same level of preexisting cervical DSA. A 49-year-old woman was transferred to our emergency department with 5 days of sepsis, drowsy mental status, and quadriplegia below the C5 level. The patient had a medical history of hemodialysis for 10 years. Magnetic resonance imaging showed spinal cord compression by an epidural abscess at the level of preexisting cervical DSA. Blood culture revealed methicillin-sensitive Staphylococcus aureus. Infection of the arteriovenous (AV) shunt was considered as the primary focus of sepsis and pyogenic spondylitis. We performed an emergent open door laminoplasty and the vascular team debrided the infected AV shunt site. Approximately 8 months after surgery, the patient was able to perform activities of daily living somewhat independently. Emergent surgical decompression and intensive medical care led to successful recovery from a septic and quadriplegic state in this patient. When diagnosing a patient who has undergone long-term hemodialysis presenting with neurologic deficits, the possibility of infectious spondylitis at the same level as DSA should be considered.

  8. Principle for the Validation of a Driving Support using a Computer Vision-Based Driver Modelization on a Simulator

    Directory of Open Access Journals (Sweden)

    Baptiste Rouzier

    2015-07-01

    Full Text Available This paper presents a new structure for a driving support designed to compensate for the problems caused by the behaviour of the driver without causing a feeling of unease. This assistance is based on a shared control between the human and an automatic support that computes and applies an assisting torque on the steering wheel. This torque is computed from a representation of the hazards encountered on the road by virtual potentials. However, the equilibrium between the relative influences of the human and the support on the steering wheel are difficult to find and depend upon the situation. This is why this driving support includes a modelization of the driver based on an analysis of several face features using a computer vision algorithm. The goal is to determine whether the driver is drowsy or whether he is paying attention to some specific points in order to adapt the strength of the support. The accuracy of the measurements made on the face features is estimated, and the interest of the proposal as well as the concepts raised by such assistance are studied through simulations.

  9. Efficacy and tolerability of high-dose phenobarbital in children with focal seizures.

    Science.gov (United States)

    Okumura, Akihisa; Nakahara, Eri; Ikeno, Mitsuru; Abe, Shinpei; Igarashi, Ayuko; Nakazawa, Mika; Takasu, Michihiko; Shimizu, Toshiaki

    2016-04-01

    We retrospectively reviewed the outcomes of children with focal epilepsy treated with oral high-dose phenobarbital. We reviewed data on children (agedphenobarbital (>5 mg/kg/day to maintain a target serum level >40 μg/mL) for at least 6 months. Seizure frequency was evaluated after phenobarbital titration, and 1 and 2 years after high-dose phenobarbital treatment commenced. Treatment was judged effective when seizure frequencies fell by ⩾75%. Seven boys and eight girls were treated. The median age at commencement of high-dose phenobarbital therapy was 30 months. The maximal serum phenobarbital level ranged from 36.5 to 62.9 μg/mL. High-dose PB was effective in seven. In two patients, treatment was transiently effective, but seizure frequency later returned to the baseline. High-dose PB was ineffective in six. No significant association between effectiveness and any clinical variable was evident. Drowsiness was recorded in nine patients, but no patient developed a behavioral problem or hypersensitivity. Oral high-dose phenobarbital was effective in 7 of 15 patients with focal epilepsy and well tolerated. High-dose PB may be useful when surgical treatment is difficult. Copyright © 2015 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  10. Current status of epilepsy treatment and efficacy of standard phenobarbital therapy in rural areas of Northern China.

    Science.gov (United States)

    Yu, Jinbei; Luo, Nan; Wang, Zan; Lin, Weihong

    2017-08-01

    To investigate the current status of epilepsy treatment and the efficacy and adverse effects of phenobarbital therapy in rural areas of Northern China. A total of 2192 patients diagnosed with convulsive epilepsy were recruited from seven different rural regions in Jilin Province, China to investigate the current status of epilepsy treatment, and 1379 of them were enrolled in a standard phenobarbital therapy trial. Patients were selected according to strict inclusion and exclusion criteria, and medical records for all patients were collected and analyzed before the standard treatment was started. Patients were followed up monthly, and efficacy in 1218 patients was analyzed at 1, 3, 6 and 12 months of treatment. More patients had the initial seizure in juveniles than in adults, and 40.72% of the 2192 patients were not receiving any treatment before the treatment trial. The efficacy of phenobarbital increased and adverse effects decreased within the treatment period. Among the 349 patients who were followed up for 12 months from the beginning of the phenobarbital treatment, seizures were decreased by more than 75% in 71.3% of patients using a low-to-medium dose of phenobarbital. Major adverse effects of phenobarbital included mild exhaustion, drowsiness, dizziness and headache. Standardized long-term and regular administration of phenobarbital at a low-to-medium dose can be used as an effective, economic and safe treatment against epilepsy in rural areas.

  11. [Clinical correlation of hypnagogic hypersynchrony during sleep in normal children and those with learning disability].

    Science.gov (United States)

    Olmos G de Alba, G; Fraire-Martínez, M I; Valenzuela-Romero, R

    One of the electroencephalographic (EEG) patterns that can be mistaken for paroxysmal clinical activity, when not taken into account and especially in children, is hypnagogic hypersynchrony (HH). This consists in generalised, paroxysmal, synchronic, symmetrical, slow, high voltage waves lasting 2 8 seconds, which appear in drowsiness and in stage I. It was observed that this pattern often appeared in children with learning disability (LD). AIMS. To correlate clinical data with the presence of HH during sleep in normal children and those with LD. We assessed 180 children between the ages of 6 12 years with normal neurological development, 130 of which suffered LD and 50 who did not have LD. EEG was performed with sleep deprivation, following the International Federation of Clinical Neurophysiology guidelines. The presence or absence of HH, together with its characteristics, was assessed. Of the children with LD, 35.38% displayed HH and of the children without LD, only 4% displayed HH. Since the characteristics of HH in the children with LD were different to previous descriptions, we put forward criteria with which to evaluate those differences. HH appeared more often in children with LD than in normal children. Qualitative, quantitative (p< 0.05) and morphological changes were found in the paroxysmal activity of HH during the stages of sleep in children with LD.

  12. Functional imaging of sleep vertex sharp transients.

    Science.gov (United States)

    Stern, John M; Caporro, Matteo; Haneef, Zulfi; Yeh, Hsiang J; Buttinelli, Carla; Lenartowicz, Agatha; Mumford, Jeanette A; Parvizi, Josef; Poldrack, Russell A

    2011-07-01

    The vertex sharp transient (VST) is an electroencephalographic (EEG) discharge that is an early marker of non-REM sleep. It has been recognized since the beginning of sleep physiology research, but its source and function remain mostly unexplained. We investigated VST generation using functional MRI (fMRI). Simultaneous EEG and fMRI were recorded from seven individuals in drowsiness and light sleep. VST occurrences on EEG were modeled with fMRI using an impulse function convolved with a hemodynamic response function to identify cerebral regions correlating to the VSTs. A resulting statistical image was thresholded at Z>2.3. Two hundred VSTs were identified. Significantly increased signal was present bilaterally in medial central, lateral precentral, posterior superior temporal, and medial occipital cortex. No regions of decreased signal were present. The regions are consistent with electrophysiologic evidence from animal models and functional imaging of human sleep, but the results are specific to VSTs. The regions principally encompass the primary sensorimotor cortical regions for vision, hearing, and touch. The results depict a network comprising the presumed VST generator and its associated regions. The associated regions functional similarity for primary sensation suggests a role for VSTs in sensory experience during sleep. Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  13. 1996 Fall Meeting of JSAE (Japan Society of Automotive Engineers). Preprint of the academic lecture (No. 966); JSAE 1996 nendo shuki taikai. Gakujutsu koenkai maezurishu (No.966)

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-10-01

    The JSAE 1996 Fall Meeting was held in Sapporo during October 22-24, and 232 papers were reported. As for the lubricating oil, the papers with the following titles were made public: Influence of engine oil viscosity and friction modifiers on coefficients of friction; Study on diesel fuel lubricity; Effect of diesel fuel components on lubricity; etc. As to the driving sensation, reported were: Study of incidence factor of car sickness and the evaluation of a passenger`s feeling and his physiological responses; A study on evaluation of drowsiness; Experimental study on vigilance decline during a monotonous-driving simulation task; etc. In the computer soft relation, Development of ECU data acquisition and analysis support system; Development of software engineering system for automotive control system; etc. In addition, a lot of papers were read including the following: A study on the heat transfer performance improvement of condenser for automotive air conditioning system; A study for preventing corrosion for tube of aluminum oil coolers; A study of engine cooling fan.

  14. Perception of the quality of care, work environment and sleep characteristics of nurses working in the National Health System.

    Science.gov (United States)

    Moreno-Casbas, María Teresa; Alonso-Poncelas, Emma; Gómez-García, Teresa; Martínez-Madrid, María José; Escobar-Aguilar, Gema

    2018-03-19

    To describe nurses' perception in relation to the quality of care and their work environment, as well as to describe their quality of sleep. To analyze the relationship between ward and work shift with nurses' perception of their work environment, sleep quality and day time drowsiness. A multicentre, observational and descriptive study carried out between 2012-2014 in seven hospitals of the Spanish National Health System. Work environment, work satisfaction, sleep quality and quality of patient care were evaluated through validated tools. 635 registered nurses participated in the study. Eighty-three point seven percent perceived the quality of cares as good/excellent, and 55.1% rated the work environment of their hospital as good/excellent. PES-NWI classified 39% of hospitals as unfavourable and 20% as favourable. Fifteen point four percent of the nurses had a high level of burnout and 58.3% had low burnout. Sleep quality was 6.38 for nurses working on day shifts, 6.78 for the rotational shifts and 7.93 for night shifts. Significant differences were found between subjective sleep quality score, sleep duration, sleep disturbances and daytime dysfunction. In the provision of quality care services, there is a multitude of related factors such as shift, ward, satisfaction, and nurses' perceptions of patient safety and sleep quality. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

  15. Thalidomide for Epistaxis in Patients with Hereditary Hemorrhagic Telangiectasia: A Preliminary Study.

    Science.gov (United States)

    Fang, Jia; Chen, Xiaomeng; Zhu, Bijun; Ye, Haibo; Zhang, Weitian; Guan, Jian; Su, Kaiming

    2017-08-01

    To evaluate the effectiveness of thalidomide for epistaxis in hereditary hemorrhagic telangiectasia (HHT), 7 HHT patients with recurrent epistaxis were treated with thalidomide at an initial dose of 50 mg/d, gradually increasing to 100 mg/d if needed. The Epistaxis Severity Score (ESS) was used to evaluate the treatment effects. Patients reported that epistaxis improved 1 to 3 weeks after starting thalidomide. The mean ESS before treatment, at the end of treatment, and 3 months after stopping treatment was 5.03 ± 2.05, 0.90 ± 0.84 ( P = .003), and 1.98 ± 1.33 ( P = .006), respectively. Four patients reported mild to moderate side effects, including drowsiness, dizziness, constipation, nausea, and peripheral neuropathy. Two patients stopped the treatment because of adverse effects. Those results showed that thalidomide may be a treatment choice for recurrent epistaxis in HHT patients, although the side effects should be considered. Further study should focus on guidelines for dosing and course and investigate how to reduce the adverse effects.

  16. Pharmacology of antihistamines

    Directory of Open Access Journals (Sweden)

    Martin K Church

    2013-01-01

    Full Text Available H 1- antihistamines, the mainstay of treatment for urticaria, were developed from anticholinergic drugs more than 70 years ago. They act as inverse agonists rather than antagonists of histamine H 1 -receptors which are members of the G-protein family. The older first generation H 1- antihistamines penetrate readily into the brain to cause sedation, drowsiness, fatigue and impaired concentration and memory causing detrimental effects on learning and examination performance in children and on impairment of the ability of adults to work and drive. Their use should be discouraged. The newer second-generation H 1 -antihistamines are safer, cause less sedation and are more efficacious. Three drugs widely used for symptomatic relief in urticaria, desloratadine, levocetirizine and fexofenadine are highlighted in this review. Of these levocetirizine and fexofenadine are the most potent in humans in vivo. However, levocetirizine may cause somnolence in susceptible individuals, whereas fexofenadine has a relatively short duration of action and may be required to be given twice daily for all round daily protection. Although desloratadine is less potent, it has the advantages of rarely causing somnolence and having a long duration of action.

  17. Fatigue and symptoms of eating disorders in professional dancers

    Directory of Open Access Journals (Sweden)

    Yasmin Cristina Feitosa Rodrigues

    2017-05-01

    Full Text Available DOI: http://dx.doi.org/10.5007/1980-0037.2017v19n1p96   The aim of this study was to make a comparison between fatigue and eating disorders in professional dancers in Brazil. Overall, 108 Classical Ballet or Contemporary Dance dancers (28.6 ± 7.7 years (49 women and 59 men of companies from São Paulo, Rio de Janeiro, Minas Gerais and Rio Grande do Sul participated in this study. The following validated instruments were used (Eating Attitudes Test; Bulimic Inventory Test Edinburgh; Yoshitake Fatigue Questionnaire, general Information. Results: 16% of dancers have symptoms of anorexia; 25% in the symptomatic bulimia scale and 30% in the bulimia scale. Significant data were identified in the comparison of bulimia nervosa scales with fatigue domains; on the symptomatic scale with drowsiness and lack of attention at work domain (p = 0.015, on the severity scale with fatigue projections to the body domain (p = 0.014, and in both scales in the impaired concentration and attention domain (p = 0.003 and p = 0.047 and in the general fatigue score (p = 0.016. Dancers with higher scores for difficulty in concentration and attention are 1.558 (95% CI 1.113 to 2.179 times more likely to have symptoms of bulimia. This study showed that there is a relationship between fatigue and symptoms of bulimia.

  18. Symptoms Experienced and Information Needs of Women Receiving Chemotherapy.

    Science.gov (United States)

    Uysal, Neşe; Toprak, Filiz Ünal; Kutlutsürkan, Sevinç; Erenel, Ayten Şentürk

    2018-01-01

    This study is carried out to determine the symptoms and information necessity on chemotherapy (CT) treatment of the women with breast cancer. A total of 170 women older than 18 years old, who receive CT with breast cancer diagnosis, are volunteered to participate in the study. Mixed method was used in the study. Data are collected using Descriptive Data Form, Interview Form and Memorial Symptom Assessment Scale. As a result of the cluster analysis, four clusters and the symptoms within have been obtained. These are: pain, lack of energy, feeling drowsy, sweat, swelling of hands, and feet in the first cluster; feeling nervous, difficulty sleeping, feeling sad, worrying in the second cluster; nausea, feeling bloating, change in the way food tastes, hair loss, constipation in the third cluster; vomiting, diarrhea, problems with sexual interest, lack of appetite, dizziness, and weight loss in the forth cluster. Women's information necessity related to the CT are follows: the effects of CT, other treatment options beyond CT, complementary methods, the effect of the CT treatment on reproductive health and sexuality, nutrition, and symptom control. The results of this study will enable determination of symptom clusters, which health professionals are easier to focus on these symptoms. An understanding information need of patients can help to ensure that individual's coping strategies and self-management.

  19. Meningoencefalitis amebiana primaria: comunicacion de dos nuevos casos Venezolanos Primary amebic meningoencephalitis: two new cases report from Venezuela

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    Fátima Petit

    2006-12-01

    Full Text Available La meningoencefalitis amebiana primaria (MAP es infrecuente. Describimos dos nuevos casos de MAP en pacientes Venezolanos. Caso 1, Varón de 10 años, con fiebre, cefalea, vómitos y debilidad generalizada, y antecedente de inmersión en un estanque de agua días antes del inicio de sus síntomas, falleciendo 72 horas después del ingreso. Caso 2, Varón de 23 años con historia de cefalea, fiebre, vómitos, somnolencia y cambios de conducta. El paciente falleció 40 horas después. El estudio neuropatológico en ambos casos reveló MAP por Naegleria fowleri. La encefalitis por amebas anfizoicas debe sospecharse en casos de meningoencefalitis asépticas.Primary amebic menigoencephalitis (PAM is rare. Two cases of PAM in Venezuelan patients are described. Case 1, a 10 year-old male with headache, fever, vomiting. The patient swam in a water reservoir before the onset of his disease. He died during his third hospital day. Case 2, a 23 year-old male with a history of headache, fever, vomiting, drowsiness, and behavioral disturbances. The patient died on his second hospital day. The diagnosis in both cases was PAM due to Naegleria fowleri. Central nervous system infection by free-living amebas should be considered in meningoencephalitides with bacterial-free cerebro-spinal fluid.

  20. TRENDS AND ISSUES IN SAFE DRIVER ASSISTANCE SYSTEMS

    Directory of Open Access Journals (Sweden)

    Sadayuki TSUGAWA

    2006-01-01

    Full Text Available In recent years, ITS projects in Japan, Europe and the US have been characterized by a strong emphasis on safe driver assistance systems designed to prevent traffic accidents. As it has become clear that eradicating accidents will be impossible by means of vehicle passive safety and single-vehicle active safety efforts alone, research and development of systems for preventing accidents through road-vehicle cooperation and vehicle-vehicle cooperation have been promoted in Japan (ASV, AHS, Europe (PReVENT, SAFESPOT and the US (VII. The key to such technology is road-to-vehicle communications and inter-vehicle communications. On the other hand, a number of driver assistance systems have been brought to market, including lidar-based forward collision warnings, ACC, lane keeping support and drowsiness warnings, but their penetration rates in Japan are extremely low. Furthermore, one major challenge is that safe driver assistance systems based on road-vehicle and vehicle-vehicle cooperation are premised upon a high penetration rate. Finally, we introduce a system for improving driver acceptance of safe driver assistance systems based on driver monitoring and forward monitoring as well as cooperative driver assistance systems for elderly drivers, an issue now receiving attention in Japan.

  1. Integration of Body Sensor Networks and Vehicular Ad-hoc Networks for Traffic Safety

    Science.gov (United States)

    Reyes-Muñoz, Angelica; Domingo, Mari Carmen; López-Trinidad, Marco Antonio; Delgado, José Luis

    2016-01-01

    The emergence of Body Sensor Networks (BSNs) constitutes a new and fast growing trend for the development of daily routine applications. However, in the case of heterogeneous BSNs integration with Vehicular ad hoc Networks (VANETs) a large number of difficulties remain, that must be solved, especially when talking about the detection of human state factors that impair the driving of motor vehicles. The main contributions of this investigation are principally three: (1) an exhaustive review of the current mechanisms to detect four basic physiological behavior states (drowsy, drunk, driving under emotional state disorders and distracted driving) that may cause traffic accidents is presented; (2) A middleware architecture is proposed. This architecture can communicate with the car dashboard, emergency services, vehicles belonging to the VANET and road or street facilities. This architecture seeks on the one hand to improve the car driving experience of the driver and on the other hand to extend security mechanisms for the surrounding individuals; and (3) as a proof of concept, an Android real-time attention low level detection application that runs in a next-generation smartphone is developed. The application features mechanisms that allow one to measure the degree of attention of a driver on the base of her/his EEG signals, establish wireless communication links via various standard wireless means, GPRS, Bluetooth and WiFi and issue alarms of critical low driver attention levels. PMID:26784204

  2. Parental cannabis abuse and accidental intoxications in children: prevention by detecting neglectful situations and at-risk families.

    Science.gov (United States)

    Pélissier, Fanny; Claudet, Isabelle; Pélissier-Alicot, Anne-Laure; Franchitto, Nicolas

    2014-12-01

    Cannabis intoxication in toddlers is rare and mostly accidental. Our objectives were to focus on the characteristics and management of children under the age of 6 years who were admitted to our emergency department with cannabis poisoning reported as accidental by parents, and to point out the need to consider accidental cannabis ingestions as an indicator of neglect. The medical records of children hospitalized for cannabis poisoning in a pediatric emergency department from January 2007 to November 2012 were retrospectively evaluated. Data collected included age, sex, drug ingested, source of drug, intentional versus accidental ingestion, pediatric intensive care unit or hospital admission, treatment and length of hospital stay, toxicology results, and rate of child protectives services referral. Twelve toddlers (4 boys and 8 girls; mean age, 16.6 months) were included. All had ingested cannabis. Their parents reported the ingestion. Seven children experienced drowsiness or hypotonia. Three children were given activated charcoal. Blood screening for cannabinoids, performed in 2 cases, was negative in both, and urine samples were positive in 7 children (70%). All children had favorable outcomes after being hospitalized from 2 to 48 hours. Nine children were referred to social services for further assessment before discharge. Cannabis intoxication in children should be reported to child protection services with the aim of prevention, to detect situations of neglect and at-risk families. Legal action against the parents may be considered. Accidental intoxication and caring parents should be no exception to this rule.

  3. A comparison of the effects of transcranial direct current stimulation and caffeine on vigilance and cognitive performance during extended wakefulness.

    Science.gov (United States)

    McIntire, Lindsey K; McKinley, R Andy; Goodyear, Chuck; Nelson, Justin

    2014-01-01

    Sleep deprivation from extended duty hours is a common complaint for many occupations. Caffeine is one of the most common countermeasures used to combat fatigue. However, the benefits of caffeine decline over time and with chronic use. Our objective was to evaluate the efficacy of anodal transcranial direct current stimulation (tDCS) applied to the pre-frontal cortex at 2 mA for 30 min to remediate the effects of sleep deprivation and to compare the behavioral effects of tDCS with those of caffeine. Three groups of 10 participants each received either active tDCS with placebo gum, caffeine gum with sham tDCS, or sham tDCS with placebo gum during 30 h of extended wakefulness. Our results show that tDCS prevented a decrement in vigilance and led to better subjective ratings for fatigue, drowsiness, energy, and composite mood compared to caffeine and control in sleep-deprived individuals. Both the tDCS and caffeine produced similar improvements in latencies on a short-term memory task and faster reaction times in a psychomotor task when compared to the placebo group. Interestingly, changes in accuracy for the tDCS group were not correlated to changes in mood; whereas, there was a relationship for the caffeine and sham groups. Our data suggest that tDCS could be a useful fatigue countermeasure and may be more beneficial than caffeine since boosts in performance and mood last several hours. Published by Elsevier Inc.

  4. Common late-onset subcortical cerebral hemorrhage following excessive alcohol consumption: a case report

    International Nuclear Information System (INIS)

    Incedayi, M.; Sivrioglu, A.; Velioglu, M.; Aribal, S.; Sonmez, G.; Basekim, C.

    2012-01-01

    Full text: 50 year old male patient who was suffering from cooperation disorder and bilaterally blindness was admitted to our emergency service. He was addicted to alcohol and had excessive alcohol consumption the day before. Cranial nonenhanced CT was normal. T2 weighed MR imaging performed at 1,5 T unit showed high signal intensity in bilateral putaminal foci. In this localization diffusion-weighed images (DWI) were hyperintense due to restricted diffusion and low ADC values. After two weeks, drowsiness and confusion were appeared suddenly. Cranial nonenhanced CT was showed extensive subcortical white matter and basal ganglia abnormalities consistent with edema and hemorrhagic changes. The patient was transferred to intensive care unit and died after one day. In methanol intoxication, cerebral and intraventricular hemorrhage, cerebellar necrosis, diffuse cerebral edema, bilateral subcortical white matter necrosis and edema were defined It should also be known that 2 or 3 weeks after ingestion of methyl alcohol, the deterioration of the patient's general situation is responsible for cerebral subcortical hemorrhage. We have also thought that patients' mortality and morbidity can be reduced with radiological imaging due to early diagnosis

  5. Sleep-wake patterns and their influence on school performance in Portuguese adolescents.

    Science.gov (United States)

    Duarte, João; Nelas, Paula; Chaves, Cláudia; Ferreira, Manuela; Coutinho, Emília; Cunha, Madalena

    2014-11-01

    To characterise sleep-wake patterns and their influence on academic performance for a sample of Portuguese adolescents. Cross-sectional, analytical-explanatory, correlational epidemiological research. The protocol includes the composite morningness questionnaire (Barton et al, 1985 adapted by Silva et al, 1985), the Epworth Sleepiness Scale (Murray, 1991), chronic fatigue scale (Smith et al, 1995), the Pittsburgh Sleep Quality Index (Buysse, 1988), Educational Achievement (Fermin, 2005), personal and academic data. 2094 students (55.3% girls; 16-23 years old; M=16.82±1.25) attending secondary school in central Portugal. Living in urban areas, living with their parents and about 57.1% are in a family with reasonable economic resources. Adolescents' sleep patterns reveal that they sleep on average between 8-9 hours a night, do not use medication to sleep, with sleep latency within the normal range, with good sleep efficiency, without daytime dysfunction and with undisturbed sleep, predominantly intermediate chronotype. Minor drowsiness, increased sleep efficiency, improved subjective sleep satisfaction, less sleep disturbance, less daytime dysfunction, not consuming hypnotic medications, associated with better academic performance. Morningness/eveningness, sleep efficiency, daytime dysfunction and sleep latency emerge as predictors of academic performance. The chronotype interacts to predict the quality of sleep enhancing it as a mediator of school performance. Sleep and associated individual characteristics should be considered in the diagnosis and intervention process in secondary education. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  6. Acute fish liver intoxication induced blisters formation and generalized skin peeling.

    Science.gov (United States)

    Chang, Chih-Hao; Lu, Chun-Wei; Chung, Wen-Hung; Ho, Hsin-Chun

    2018-02-01

    Acute fish liver intoxication, including hypervitaminosis A and hypervitaminosis D, may result from the ingestion of certain fish livers. The typical symptoms of hypervitaminosis A include nausea, headache, blurred vision, and cutaneous manifestations, such as flushing, vesicles formation, and desquamation. Hypervitaminosis D may result in hypercalcemia. We report a case of acute fish liver intoxication with systemic and cutaneous manifestations. A 63-year-old male presented to the clinic with generalized desquamation and multiple clear-fluid filled flaccid vesicles after eating approximately two fist-sized portions (about 300-400 g) of cooked seerfish (Scomberomorus spp.) liver. Laboratory examination showed a high serum level of vitamin A and D, and hypercalcemia. Fish liver consumption from particular fish may result in acute hypervitaminosis A and D. In patients with skin detachment or blister formation, headache, drowsiness, and other symptoms and signs consistent with hypervitaminosis A and/or hypercalcemia, a history of fish intake should be sought, and a serum level of vitamin A and D should be measured.

  7. Mobile Healthcare for Automatic Driving Sleep-Onset Detection Using Wavelet-Based EEG and Respiration Signals

    Directory of Open Access Journals (Sweden)

    Boon-Giin Lee

    2014-09-01

    Full Text Available Driving drowsiness is a major cause of traffic accidents worldwide and has drawn the attention of researchers in recent decades. This paper presents an application for in-vehicle non-intrusive mobile-device-based automatic detection of driver sleep-onset in real time. The proposed application classifies the driving mental fatigue condition by analyzing the electroencephalogram (EEG and respiration signals of a driver in the time and frequency domains. Our concept is heavily reliant on mobile technology, particularly remote physiological monitoring using Bluetooth. Respiratory events are gathered, and eight-channel EEG readings are captured from the frontal, central, and parietal (Fpz-Cz, Pz-Oz regions. EEGs are preprocessed with a Butterworth bandpass filter, and features are subsequently extracted from the filtered EEG signals by employing the wavelet-packet-transform (WPT method to categorize the signals into four frequency bands: α, β, θ, and δ. A mutual information (MI technique selects the most descriptive features for further classification. The reduction in the number of prominent features improves the sleep-onset classification speed in the support vector machine (SVM and results in a high sleep-onset recognition rate. Test results reveal that the combined use of the EEG and respiration signals results in 98.6% recognition accuracy. Our proposed application explores the possibility of processing long-term multi-channel signals.

  8. Therapeutic efifect of doxepin in chronic idiopathic urticaria

    Directory of Open Access Journals (Sweden)

    S Ghose

    1990-01-01

    Full Text Available Among 56 recalcitrant cases of chronic idiopathic urticaria 28 subjects (Group A selected at random, were, treated with doxepin 10 mg thrice daily and the rest ( Group B with pheniramine maleate 22.5mgthrice daily.B 3 weeks of therapy group.A and group B respectively showed complete remission in 28.6% and 10.7% cases, partial remission in 64.3% and 39.3% cases and no improvement in 7.1% and 50% cases. The difference in clinical improvement between the two groups was statistii significant (p0.001. One week after stopping the treatment among totally syrnptom - free patients, 37.5% in group A and 100% in-group B developed recurrence. Drowsiness was more common in-group B (60.7% than in group A (35.7% whereas dryness of the mouth was more frequent in group A (64.3% than in group B (46.4%.

  9. Effects of oral cetirizine, a selective H1 antagonist, on allergen- and exercise-induced bronchoconstriction in subjects with asthma.

    LENUS (Irish Health Repository)

    Gong, H

    1990-03-01

    The protective efficacy of oral cetirizine, a selective and potent H1-receptor antagonist, against the immediate bronchoconstrictive response to allergen inhalation and exercise challenge was evaluated in 16 subjects with stable, predominantly mild asthma. The subjects underwent double-blind, crossover pretreatments in randomized order in two separate protocols with (1) three daily oral doses of 20 mg of cetirizine and placebo, followed by allergen inhalation, and (2) single oral doses of cetirizine (5, 10, and 20 mg), albuterol (4 mg), and placebo, followed by exercise with cold-air inhalation. Cetirizine failed to decrease bronchial sensitivity to inhaled allergen in eight of 10 subjects. Neither cetirizine nor albuterol uniformly inhibited exercise-induced bronchoconstriction. Serum concentrations of cetirizine were consistent with systemic H1-blocking activity. Modest bronchodilation occurred after administration of cetirizine and albuterol before exercise but not after the third dose of cetirizine in the allergen protocol. One subject developed moderate drowsiness during multiple dosing with cetirizine. Thus, cetirizine, in the doses studied, is not uniformly effective in preventing allergen- or exercise-induced bronchoconstriction. Histamine is one of many mediators participating in immediate asthmatic responses, and selective H1 antagonists do not completely block these airway events. However, cetirizine may still clinically benefit some patients with asthma, such as patients with allergic rhinitis or urticaria.

  10. Robust driver heartbeat estimation: A q-Hurst exponent based automatic sensor change with interactive multi-model EKF.

    Science.gov (United States)

    Vrazic, Sacha

    2015-08-01

    Preventing car accidents by monitoring the driver's physiological parameters is of high importance. However, existing measurement methods are not robust to driver's body movements. In this paper, a system that estimates the heartbeat from the seat embedded piezoelectric sensors, and that is robust to strong body movements is presented. Multifractal q-Hurst exponents are used within a classifier to predict the most probable best sensor signal to be used in an Interactive Multi-Model Extended Kalman Filter pulsation estimation procedure. The car vibration noise is reduced using an autoregressive exogenous model to predict the noise on sensors. The performance of the proposed system was evaluated on real driving data up to 100 km/h and with slaloms at high speed. It is shown that this method improves by 36.7% the pulsation estimation under strong body movement compared to static sensor pulsation estimation and appears to provide reliable pulsation variability information for top-level analysis of drowsiness or other conditions.

  11. Primate body temperature and sleep responses to lower body positive pressure

    Science.gov (United States)

    Edgar, D. M.; Fuller, C. A.

    1984-01-01

    Cephalic fluid shifts, induced by lower body positive pressure (LBPP) are known to influence various physiological systems (i.e., cardiovascular and renal). In earlier experiments, an apparent change in the arousal state of primates in such LBPP conditions was observed. This study was designed to examine the effects of LBPP on arousal state and body temperature level which is normally correlated with sleep. Chair-restrained male squirrel monkeys were exposed to 40 mmHg LBPP for 90-100 minutes between the daytime hours of 13:00-15:00. Each monkey was placed in a specially modified restraint chair to which they were highly trained. Deep body temperature (DBT) was collected from 10 animals. Sleep parameters were obtained from six animals chronically implanted for sleep recording. A video camera was used to observe each animal's apparent state of arousal. LBPP resulted in an approximate 0.9 C decrease in DBT. During video observation, some animals appeared drowsy during LBPP; however, sleep recording revealed no significant changes in the state of arousal. Thus, LBPP is capable of inducing a mild hyperthermia. Further, the mechanisms underlying the observed lowering of body temperature appear to be independent of arousal state.

  12. Strain-dependent profile of misfolded prion protein aggregates.

    Science.gov (United States)

    Morales, Rodrigo; Hu, Ping Ping; Duran-Aniotz, Claudia; Moda, Fabio; Diaz-Espinoza, Rodrigo; Chen, Baian; Bravo-Alegria, Javiera; Makarava, Natallia; Baskakov, Ilia V; Soto, Claudio

    2016-02-15

    Prions are composed of the misfolded prion protein (PrP(Sc)) organized in a variety of aggregates. An important question in the prion field has been to determine the identity of functional PrP(Sc) aggregates. In this study, we used equilibrium sedimentation in sucrose density gradients to separate PrP(Sc) aggregates from three hamster prion strains (Hyper, Drowsy, SSLOW) subjected to minimal manipulations. We show that PrP(Sc) aggregates distribute in a wide range of arrangements and the relative proportion of each species depends on the prion strain. We observed a direct correlation between the density of the predominant PrP(Sc) aggregates and the incubation periods for the strains studied. The relative presence of PrP(Sc) in fractions of different sucrose densities was indicative of the protein deposits present in the brain as analyzed by histology. Interestingly, no association was found between sensitivity to proteolytic degradation and aggregation profiles. Therefore, the organization of PrP molecules in terms of the density of aggregates generated may determine some of the particular strain properties, whereas others are independent from it. Our findings may contribute to understand the mechanisms of strain variation and the role of PrP(Sc) aggregates in prion-induced neurodegeneration.

  13. Are there any benefits from minimizing fasting and optimization of nutrition and fluid management for patients undergoing day surgery?

    Science.gov (United States)

    Nygren, Jonas; Thorell, Anders; Ljungqvist, Olle

    2007-12-01

    As a result of advances in anaesthesia and surgery, an increasing number of surgical procedures are currently possible in the ambulatory setting. Nausea/vomiting and sedation/drowsiness are often associated with delayed discharge and readmission. These symptoms are also related to pharmacological treatment as well as dehydration and fasting. The evidence that preoperative fasting and dehydration not only reduces preoperative well being, but may also affect postoperative recovery is currently being reviewed. In association with minor surgical procedures, rehydration with approximately 1 l fluid, and in cases with a moderate degree of surgery, such as laparoscopic surgery, 1-3 l fluid, given perioperatively will improve postoperative well being and recovery. Administration of a carbohydrate-rich beverage not only provides fluid but also counteracts the negative effects of preoperative fasting, which in turn reduces preoperative hunger and improves well being. Postoperatively, this treatment reduces insulin resistance, which may be relevant in surgery with significant postoperative stress response. Two studies on laparoscopic cholecystectomy demonstrate different results regarding effects on postoperative outcome and nausea/vomiting and further evaluation is required. When preoperative dehydration is corrected, postoperative well being and clinical outcome improves. Avoiding preoperative fasting by administration of carbohydrate-rich beverages improves preoperative well being while effects on postoperative recovery in patients undergoing ambulatory surgery need to be further evaluated.

  14. New Onset Refractory Status Epilepticus as an Unusual Presentation of a Suspected Organophosphate Poisoning

    Directory of Open Access Journals (Sweden)

    Shahan Waheed

    2014-01-01

    Full Text Available New onset refractory status epilepticus (NORSE is a new entity in medical literature. It has different infectious and noninfectious etiologies showing a devastating impact onto the clinical outcome of patients. Therapy with anaesthetic and antiepileptic agents often fails to improve the condition, unless the primary cause is rectified. Here is presented the case of a young female with a history of depression who after a recent bereavement came to the Emergency Department of Aga Khan University Hospital with complaints of drowsiness that lasted for few hours. Though she had no history of organophosphate poisoning, her physical examination and further investigations were suggestive of the diagnosis. During her hospital stay, she developed refractory status epilepticus. Her seizures did not respond to standard antiepileptic and intravenous anesthetic agents and subsided only after intravenous infusion of atropine for a few days. Organophosphate poisoning is a very common presentation in the developing world and the associated status epilepticus poses a devastating problem for emergency physicians. In patients with suspected organophosphate poisoning with favoring clinical exam findings, the continuation of atropine intravenous infusion can be a safe option to abate seizures.

  15. MODERN POSSIBILITIES OF IMPORT SUBSTITUTION IN THE TREATMENT OF PAIN SYNDROME IN CANCER P ATIENTS

    Directory of Open Access Journals (Sweden)

    G. R. Abuzarova

    2014-01-01

    Full Text Available Objective. To evaluate the efficacy and safety of prosidol in cheek tablets in the treatment of chronic pain syndrome in cancer patients.Material and methods. The study was conducted at 152 cancer patients with chronic pain syndrome caused by  malignant neoplasms. The objectification of pain intensity was conducted on a 5 — point verbal scale assessments (SVA, assessed the state of physical activity of patients on a 5‑point scale ECOG, objectified the mental status and a night’s sleep: 0‑no pain; 1 — slight pain; 2 — moderate pain; 3 — severe pain; 4 points unbearable pain. We registered the duration of analgesic effect of prosidol, calculated single and daily doses of analgesic in the dynamics on the stages of therapy and its side effects. The results of the study were assessed on stages: 1 — initial, before treatment, 2 — first day of therapy, 3 — completion of the selection of doses of analgesic (3–4 days, 4 — a week after the start of treatment, 5–2 weeks after the start of treatment, 6 — at the end of the 3rd week of treatment.Results. Initial single dose of buccal prosidol (20 mg caused effective analgesia after 10 to 45 (21,3+8,9 minutes after the first dose and lasted from 1 to 8 (6,0+1,8 hours: 21.8% of patients complete elimination of pain (more than 50% from baseline; in 63.6% of the pain was reduced by 30–50%; reduction of pain less than 30% — in 14.6% of patients. In General, a significant decrease in the intensity of pain with 2,47+0.37 to 0.5 to+0.30 VAS score (p<0.05. The failures of the drug were observed. All patients continued prosidol therapy after a 3‑week study period. The initial average daily dose of prosidol was 82.2 + 9,7 mg; 1 week of therapy — 112,3+16 mg, by the end of the 3rd week increased to 148,2+57 mg/day mg Tolerability was judged as good. Side effects: drowsiness and nausea most noted for 1–3 days of therapy was expressed moderately or

  16. Estudo sobre o impacto do uso de aparelho de emissão de pressão positiva contínua nas vias aéreas superiores na hipersonia diurna em portadores da síndroma de apneia do sono

    Directory of Open Access Journals (Sweden)

    Clélia Maria Ribeiro Franco

    2009-03-01

    Full Text Available Resumo: Introdução: A síndroma da apneia-hipopneia obstrutiva do sono (SAHOS é um distúrbio respiratório de elevada morbimortalidade. A terapia com pressão positiva contínua das vias aéreas (CPAP representa o tratamento conservador mais prescrito para a SAHOS e tem o intuito de restabelecer a patência das vias aéreas, normalizando o índice de eventos respiratórios obstrutivos, corrigindo os sintomas.Objectivo: Avaliar o impacto do uso do CPAP nasal sobre a hipersonia diurna em portadores de SAHOS.Método: Amostra de vinte doentes portadores de SAHOS diagnosticados por estudo de polissonografia de noite inteira, usuários ou não de CPAP nasal, todos avaliados quanto à hipersonia diurna através da escala de sonolência de Epworth.Resultados: O decréscimo do nível de sonolência diurna dos usuários de CPAP nasal foi significante (p=0,017, enquanto para não usuários de CPAP nasal a média do mesmo diminuiu sem significância estatística (p=0,162. Quanto à adesão à terapia com CPAP, 100% dos usuários relataram benefícios e, destes, 50% referiram desconfortos durante o uso.Conclusões: Portadores de SAHOS usuários do CPAP nasal têm o seu nível de hipersonia diurna diminuído em relação àqueles que não o utilizam.Rev Port Pneumol 2009; XV (2: 215-226 Abstract: Background: Obstructive sleep apnoea-hypopnoea syndrome (OSAHS is a respiratory disorder with high morbidity and mortality. Continuous positive airway pressure (CPAP is the most commonly prescribed conservative treatment for adults with OSAHS. CPAP therapy normalises or decreases OSAHS symptoms and can reduce and prevent OSAHS complications.Aims: To evaluate adherence to nasal CPAP treatment and CPAP impact on daytime drowsiness.Method: A sample of 20 patients evaluated for daytime drowsiness using the Epworth sleepiness scale and interviewed for adherence to nasal CPAP use

  17. Tolerability and efficacy of paliperidone ER compared to olanzapine in the treatment of schizophrenia: A randomized, double-blind, multicentric trial

    Directory of Open Access Journals (Sweden)

    Sandip Shah

    2011-01-01

    Full Text Available Background: Paliperidone is an active metabolite of risperidone and actss through a combination of central dopamine Type 2 (D2 and serotonin Type 2 (5HT2A receptor antagonism. Aim: The present randomized, double-blind, multicentric trial was designed to determine the safety and efficacy of paliperidone extended release (ER compared to olanzapine in the treatment of acute schizophrenia. Materials and Methods: A total of 214 patients with diagnosis of schizophrenia were randomized to paliperidone ER (n=109 and olanzapine (n=106 treatment groups. Totally 206 patients were evaluated for efficacy parameters using Positive and negative syndrome scale (PANSS score and Clinical Global Impression-severity of illness (CGI-S and Clinical Global Impression-improvement of illness (CGI-I scales. Safety was assessed by treatment-emergent adverse events and movement disorders. Results: All patients showed significant reduction in PANSS scores at the end of treatment. However, the results were comparable and there was no significant difference at the end of the trial between paliperidone ER group and olanzapine group. Both the treatment groups showed decrease in the severity of illness and improvement in symptomatology. The most common adverse events reported in paliperidone ER versus olanzapine group were Extra Pyramidal Syndrome (EPS (13.7% vs. 15.6%, headache (12.7% vs. 8.9%, increased appetite (8.8% vs. 10.0% and drowsiness (4.9% vs. 303%. There was no clinically relevant difference in change from baseline to the end of the trial in abnormal involuntary movement scale (AIMS and barnes akathisia rating scale (BARS total scores between both the groups. Conclusion: Paliperidone ER is effective in controlling schizophrenic symptoms as well as exhibits comparable tolerability profile. Thus, paliperidone ER has the potential to be a useful new treatment option for patients with schizophrenia.

  18. Nutrition Influences Caffeine-Mediated Sleep Loss in Drosophila.

    Science.gov (United States)

    Keebaugh, Erin S; Park, Jin Hong; Su, Chenchen; Yamada, Ryuichi; Ja, William W

    2017-11-01

    Plant-derived caffeine is regarded as a defensive compound produced to prevent herbivory. Caffeine is generally repellent to insects and often used to study the neurological basis for aversive responses in the model insect, Drosophila melanogaster. Caffeine is also studied for its stimulatory properties where sleep or drowsiness is suppressed across a range of species. Since limiting access to food also inhibits fly sleep-an effect known as starvation-induced sleep suppression-we tested whether aversion to caffeinated food results in reduced nutrient intake and assessed how this might influence fly studies on the stimulatory effects of caffeine. We measured sleep and total consumption during the first 24 hours of exposure to caffeinated diets containing a range of sucrose concentrations to determine the relative influence of caffeine and nutrient ingestion on sleep. Experiments were replicated using three fly strains. Caffeine reduced total consumption and nighttime sleep, but only at intermediate sucrose concentrations. Although sleep can be modeled by an exponential dose response to nutrient intake, caffeine-mediated sleep loss cannot be explained by absolute caffeine or sucrose ingestion alone. Instead, reduced sleep strongly correlates with changes in total consumption due to caffeine. Other bitter compounds phenocopy the effect of caffeine on sleep and food intake. Our results suggest that a major effect of dietary caffeine is on fly feeding behavior. Changes in feeding behavior may drive caffeine-mediated sleep loss. Future studies using psychoactive compounds should consider the potential impact of nutrition when investigating effects on sleep. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

  19. Symptom recovery after thoracic surgery: Measuring patient-reported outcomes with the MD Anderson Symptom Inventory.

    Science.gov (United States)

    Fagundes, Christopher P; Shi, Qiuling; Vaporciyan, Ara A; Rice, David C; Popat, Keyuri U; Cleeland, Charles S; Wang, Xin Shelley

    2015-09-01

    Measuring patient-reported outcomes (PROs) has become increasingly important for assessing quality of care and guiding patient management. However, PROs have yet to be integrated with traditional clinical outcomes (such as length of hospital stay), to evaluate perioperative care. This study aimed to use longitudinal PRO assessments to define the postoperative symptom recovery trajectory in patients undergoing thoracic surgery for lung cancer. Newly diagnosed patients (N = 60) with stage I or II non-small cell lung cancer who underwent either standard open thoracotomy or video-assisted thoracoscopic surgery lobectomy reported multiple symptoms from before surgery to 3 months after surgery, using the MD Anderson Symptom Inventory. We conducted Kaplan-Meier analyses to determine when symptoms returned to presurgical levels and to mild-severity levels during recovery. The most-severe postoperative symptoms were fatigue, pain, shortness of breath, disturbed sleep, and drowsiness. The median time to return to mild symptom severity for these 5 symptoms was shorter than the time to return to baseline severity, with fatigue taking longer. Recovery from pain occurred more quickly for patients who underwent lobectomy versus thoracotomy (8 vs 18 days, respectively; P = .022). Patients who had poor preoperative performance status or comorbidities reported higher postoperative pain (all P < .05). Assessing symptoms from the patient's perspective throughout the postoperative recovery period is an effective strategy for evaluating perioperative care. This study demonstrates that the MD Anderson Symptom Inventory is a sensitive tool for detecting symptomatic recovery, with an expected relationship among surgery type, preoperative performance status, and comorbid conditions. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  20. Remifentanil versus placebo for analgesia during external cephalic version: a randomised clinical trial.

    Science.gov (United States)

    Muñoz, H; Guerra, S; Perez-Vaquero, P; Valero Martinez, C; Aizpuru, F; Lopez-Picado, A

    2014-02-01

    Breech presentation occurs in up to 3% of pregnancies at term and may be an indication for caesarean delivery. External cephalic version can be effective in repositioning the fetus in a cephalic presentation, but may be painful for the mother. Our aim was to assess the efficacy of remifentanil versus placebo for pain relief during external cephalic version. A randomized, double-blind, controlled trial that included women at 36-41 weeks of gestation with non-cephalic presentations was performed. Women were randomized to receive either a remifentanil infusion at 0.1 μg/kg/min and demand boluses of 0.1 μg/kg, or saline placebo. The primary outcome was the numerical rating pain score (0-10) after external cephalic version. Sixty women were recruited, 29 in the control group and 31 in the remifentanil group. There were significant differences in pain scores at the end of the procedure (control 6.5 ± 2.4 vs. remifentanil 4.7 ± 2.5, P = 0.005) but not 10 min later (P = 0.054). The overall success rate for external cephalic version was 49% with no significant differences between groups (remifentanil group 54.8% vs. control group 41.3%, P = 0.358). In the remifentanil group, there was one case of nausea and vomiting, one of drowsiness and three cases of fetal bradycardia. In the control group, there were three cases of nausea and vomiting, one of dizziness and nine cases of fetal bradycardia. Intravenous remifentanil with bolus doses on demand during external cephalic version achieved a reduction in pain and increased maternal satisfaction. There were no additional adverse effects, and no difference in the success rate of external cephalic version or the incidence of fetal bradycardia. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. Report of a parent survey of cannabidiol-enriched cannabis use in pediatric treatment-resistant epilepsy.

    Science.gov (United States)

    Porter, Brenda E; Jacobson, Catherine

    2013-12-01

    Severe childhood epilepsies are characterized by frequent seizures, neurodevelopmental delays, and impaired quality of life. In these treatment-resistant epilepsies, families often seek alternative treatments. This survey explored the use of cannabidiol-enriched cannabis in children with treatment-resistant epilepsy. The survey was presented to parents belonging to a Facebook group dedicated to sharing information about the use of cannabidiol-enriched cannabis to treat their child's seizures. Nineteen responses met the following inclusion criteria for the study: a diagnosis of epilepsy and current use of cannabidiol-enriched cannabis. Thirteen children had Dravet syndrome, four had Doose syndrome, and one each had Lennox-Gastaut syndrome and idiopathic epilepsy. The average number of antiepileptic drugs (AEDs) tried before using cannabidiol-enriched cannabis was 12. Sixteen (84%) of the 19 parents reported a reduction in their child's seizure frequency while taking cannabidiol-enriched cannabis. Of these, two (11%) reported complete seizure freedom, eight (42%) reported a greater than 80% reduction in seizure frequency, and six (32%) reported a 25-60% seizure reduction. Other beneficial effects included increased alertness, better mood, and improved sleep. Side effects included drowsiness and fatigue. Our survey shows that parents are using cannabidiol-enriched cannabis as a treatment for their children with treatment-resistant epilepsy. Because of the increasing number of states that allow access to medical cannabis, its use will likely be a growing concern for the epilepsy community. Safety and tolerability data for cannabidiol-enriched cannabis use among children are not available. Objective measurements of a standardized preparation of pure cannabidiol are needed to determine whether it is safe, well tolerated, and efficacious at controlling seizures in this pediatric population with difficult-to-treat seizures. © 2013.

  2. Chronic subdural hematoma associated with moyamoya phenomenon after radiotherapy for medulloblastoma; A case report

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    Fuse, Takahisa; Takagi, Takuji; Fukushima, Tsuneyuki; Mizuno, Shiroh; Hashimoto, Nobukazu; Suzuki, Osamu (Nagoya City Higashi General Hospital (Japan))

    1994-04-01

    A 9-year-old boy had been diagnosed at the age of 9 months as having a cerebellar medulloblastoma and had received 40 Gy of radiation therapy to the brain after removal of the tumor. Cerebral angiography at the time of initial diagnosis did not show any evidence of occlusive disease involving the internal carotid circulation. At the age of 6 years, the patient developed generalized seizures. On examination, he was drowsy and had right hemiparesis. CT scan demonstrated a low-density area in the left frontal lobe. Cerebral angiography showed a marked narrowing of the bilateral internal carotid arteries with moyamoya vessels. The patient was treated medically with aspirin (100 mg/day) and anticonvulsants. His neurological deficits improved gradually. At the age of 8 years, there was no recurrence of the tumor although a slight left subdural hematoma was seen on CT scan. On August 10, 1993, at the age of 9 years, he was admitted for treatment of a developing subdural hematoma. MRI showed a chronic subdural hematoma with thick outer and inner membranes. Cerebral angiography showed occlusion of the left internal carotid artery which fed the right frontal lobe through moyamoya vessels, marked narrowing of the right internal carotid artery distal to the ophthalmic artery, moyamoya vessels at the base, and cortical revascularization througth the ophthalmic, posterior cerebral and middle meningeal arteries. Trepanation and aspiration of the hematoma were performed. The outer membrane of the hematoma was about 2 mm thick and the hematoma cavity was filled with a partially organized hematoma. In this case, we speculate that development of the chronic subdural hematoma involved the following factors: (1) transdural external-internal carotid anastomosis after radiation-induced cerebrovasculopathy; (2) repeated mild head trauma due to gait disturbance after removal of the cerebellar tumor; and (3) administration of acetylsalicylic acid. (author).

  3. Delirium diagnosis methodology used in research: a survey-based study.

    Science.gov (United States)

    Neufeld, Karin J; Nelliot, Archana; Inouye, Sharon K; Ely, E Wesley; Bienvenu, O Joseph; Lee, Hochang Benjamin; Needham, Dale M

    2014-12-01

    To describe methodology used to diagnose delirium in research studies evaluating delirium detection tools. The authors used a survey to address reference rater methodology for delirium diagnosis, including rater characteristics, sources of patient information, and diagnostic process, completed via web or telephone interview according to respondent preference. Participants were authors of 39 studies included in three recent systematic reviews of delirium detection instruments in hospitalized patients. Authors from 85% (N = 33) of the 39 eligible studies responded to the survey. The median number of raters per study was 2.5 (interquartile range: 2-3); 79% were physicians. The raters' median duration of clinical experience with delirium diagnosis was 7 years (interquartile range: 4-10), with 5% having no prior clinical experience. Inter-rater reliability was evaluated in 70% of studies. Cognitive tests and delirium detection tools were used in the delirium reference rating process in 61% (N = 21) and 45% (N = 15) of studies, respectively, with 33% (N = 11) using both and 27% (N = 9) using neither. When patients were too drowsy or declined to participate in delirium evaluation, 70% of studies (N = 23) used all available information for delirium diagnosis, whereas 15% excluded such patients. Significant variability exists in reference standard methods for delirium diagnosis in published research. Increasing standardization by documenting inter-rater reliability, using standardized cognitive and delirium detection tools, incorporating diagnostic expert consensus panels, and using all available information in patients declining or unable to participate with formal testing may help advance delirium research by increasing consistency of case detection and improving generalizability of research results. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  4. Predictors of neonatal sepsis in developing countries.

    Science.gov (United States)

    Weber, Martin W; Carlin, John B; Gatchalian, Salvacion; Lehmann, Deborah; Muhe, Lulu; Mulholland, E Kim

    2003-08-01

    Neonatal infections are a major cause of death worldwide. Simple procedures for identifying infants with infection that need referral for treatment are therefore of major public health importance. We investigated 3303 infants Ethiopia, The Gambia, Papua New Guinea and The Philippines, using a standardized approach. Historical factors and clinical signs predicting sepsis, meningitis, hypoxemia, deaths and an ordinal scale indicating severe disease were investigated by logistic regression, and the performance of simple combination rules was explored. In multivariable analysis, reduced feeding ability, no spontaneous movement, temperature >38 degrees C, being drowsy/unconscious, a history of a feeding problem, history of change in activity, being agitated, the presence of lower chest wall indrawing, respiratory rate >60 breaths/min, grunting, cyanosis, a history of convulsions, a bulging fontanel and slow digital capillary refill were independent predictors of severe disease. The presence of any 1 of these 14 signs had a sensitivity for severe disease (defined as sepsis, meningitis, hypoxemia, or radiologically proven pneumonia) of 87% and a specificity of 54%. More stringent combinations, such as demanding 2 signs from the list, resulted in a considerable loss of sensitivity. By contrast only slight loss of sensitivity and considerable gain of specificity resulted from reducing the list to 9 signs. Requiring the presence of fever and any other sign produced a diagnostic rule with extremely low sensitivity (25%). Physical signs can be used to identify young infants at risk of severe disease, however with limited specificity, resulting in large numbers of unnecessary referrals. Further studies are required to validate and refine the prediction of severe disease, especially in the first week of life, but there appear to be limits on the accuracy of prediction that is achievable.

  5. A novel and cost-effective way to follow-up adequacy of pain relief, adverse effects, and compliance with analgesics in a palliative care clinic

    Directory of Open Access Journals (Sweden)

    Radhika Kannan

    2013-01-01

    Full Text Available Introduction: A way to assess compliance with analgesics in an outpatient palliative care clinic is essential since often the patient is too ill or weak to come to hospital for weekly follow-ups. A pilot study was conducted using Short Messaging Service via mobile phone as a follow-up tool. Context: A predominantly outpatient palliative care clinic of a 300 bedded multidisciplinary hospital. Materials and Methods: Sixty patients attending the palliative care clinic were enrolled in the study. Analgesic drugs, co-analgesics, and adjuvants were prescribed on an outpatient basis. If possible, patients were admitted for 1 or 2 days. A simple scoring system was devised and taught to the patients and their attenders. A short message service had to be sent to the author′s mobile number. The period was fixed at 2 weeks by which the patients and attenders were familiar with the drugs and pain relief as well. Drowsiness was a worrisome complaint. The mobile number of the patient was called and attender instructed to skip one or two doses of morphine and reassurance given. If required, attender was asked to bring patient to the hospital or come to the hospital for a different prescription as the situation warranted. Results: Out of 60 patients, 22 were admitted initially for dose titration and all others were outpatients. Three patients were lost to follow-up and one patient died after 7 days. 93% of patients responded promptly. Random survey was done in 10 patients to confirm their SMS response and the results were analyzed. Conclusion: Mobile phones are available with all strata of people. It is easy to train patients to send an SMS.This technology can be used to follow- up palliative care patients and help them comply with their treatment regimen.

  6. Oxaliplatin-Induced Hyperammonemic Encephalopathy in a Patient with Metastatic Pancreatic Cancer: A Case Report

    Directory of Open Access Journals (Sweden)

    Takatsugu Ogata

    2017-10-01

    Full Text Available Oxaliplatin-based chemotherapy is widely used to treat advanced cancer. Oxaliplatin-induced hyperammonemic encephalopathy is rarely reported. Here, we report a case of oxaliplatin-induced hyperammonemic encephalopathy occurring after gemcitabine plus oxaliplatin (GEMOX chemotherapy in a patient with pancreatic cancer. A 76-year-old man received GEMOX regimen as first-line treatment for pancreatic adenocarcinoma with peritoneal dissemination. GEMOX consists of gemcitabine (1,000 mg/m2 and oxaliplatin (100 mg/m2 on day 1, repeated every 2 weeks. The second cycle of GEMOX was administered as planned. However, he appeared to have difficulties with daily activities. Two days later, he visited the emergency room complaining of drowsiness. On examination, the patient had a Glasgow Coma Scale (GCS score of 14 (E4V4M6, and asterixis was not present. Blood examination revealed a serum ammonia level of 202 µg/dL. The levels of serum hepatic enzymes were only mildly elevated, and the hemoglobin level was typical for this patient. Computed tomography, magnetic resonance imaging, lumbar puncture test, and blood culture showed no abnormality. Based on these results, he was diagnosed with oxaliplatin-induced hyperammonemia. One day after hospitalization, GCS score had significantly decreased to 6 (E1V1M4. His consciousness disorder improved after administration of a nutritional supplement containing a high concentration of branched-chain amino acids for 5 days, and the level of serum ammonia improved to 79 µg/dL. He stated that he could not remember the episode. The findings of this case suggest the importance of examining serum ammonia levels in patients receiving an oxaliplatin-containing regimen who develop disordered consciousness.

  7. Car Crashes and Central Disorders of Hypersomnolence: A French Study.

    Directory of Open Access Journals (Sweden)

    Fabio Pizza

    Full Text Available Drowsiness compromises driving ability by reducing alertness and attentiveness, and delayed reaction times. Sleep-related car crashes account for a considerable proportion of accident at the wheel. Narcolepsy type 1 (NT1, narcolepsy type 2 (NT2 and idiopathic hypersomnia (IH are rare central disorders of hypersomnolence, the most severe causes of sleepiness thus being potential dangerous conditions for both personal and public safety with increasing scientific, social, and political attention. Our main objective was to assess the frequency of recent car crashes in a large cohort of patients affected with well-defined central disorders of hypersomnolence versus subjects from the general population.We performed a cross-sectional study in French reference centres for rare hypersomnia diseases and included 527 patients and 781 healthy subjects. All participants included needed to have a driving license, information available on potential accident events during the last 5 years, and on potential confounders; thus analyses were performed on 282 cases (71 IH, 82 NT2, 129 NT1 and 470 healthy subjects.Patients reported more frequently than healthy subjects the occurrence of recent car crashes (in the previous five years, a risk that was confirmed in both treated and untreated subjects at study inclusion (Untreated, OR = 2.21 95%CI = [1.30-3.76], Treated OR = 2.04 95%CI = [1.26-3.30], as well as in all disease categories, and was modulated by subjective sleepiness level (Epworth scale and naps. Conversely, the risk of car accidents of patients treated for at least 5 years was not different to healthy subjects (OR = 1.23 95%CI = [0.56-2.69]. Main risk factors were analogous in patients and healthy subjects.Patients affected with central disorders of hypersomnolence had increased risk of recent car crashes compared to subjects from the general population, a finding potentially reversed by long-term treatment.

  8. A RARE CASE OF SPONTANEOUS PNEUMOCEPHALUS AS A COMPLICATION OF NONTRAUMATIC CEREBROSPINAL FLUID RHINORRHEA. AN EVIDENCEBASED REVIEW

    Directory of Open Access Journals (Sweden)

    E. V. Shelesko

    2017-01-01

    Full Text Available Pneumocephalus is defined as intracranial air. Pneumaticcephaly is associated with several etiological factors, such as head injuries, surgical interventions, infections and neoplasms. On average, the incidence of posttraumatic pneumocephaly fluctuates between 0.5-1% of all skull injuries. Spontaneous pneumocephalus without cerebrospinal fluid leak is very rare. Clinical manifestations of pneumocephaly depend on the location and volume of air in the cranial cavity. The most common and described symptoms are headache, “splashing sound”, rhinorrhea and otorrhea, meningism, dysfunction of cerebrospinal nerves, epileptic seizures, collaptoid states, psychiatric symptoms. In this article we report an effective treatment of spontaneous cerebrospinal fluid leak, complicated by pneumocephaly and meningitis. A 57-year-old patient was admitted to National Scientific and Practical Center of Neurosurgery named after academician N.N. Burdenko in the department of neurotrauma in a serious condition. Medical history: One year ago the patient began to notice the flow of clear fluid from the left nasal passage, which periodically spontaneously ceased, then again recurred. Two months before admission she noticed headaches, fever, nausea, vomiting. Objective data on admission: serious condition, level of consciousness: stunning, drowsiness, lethargy. There is stiff neck. The SCT of the brain shows destructive changes in the posterior wall of the main sinus, with the presence of the exudative component in the left parts of the main sinus, the latticed labyrinth, the posterior parts of the left maxillary sinus. In the ventricular system, basal cisterns, anterior sections of the frontal lobes, the accumulation of air is determined. Under general anesthesia, the operation “Endoscopic endonasal plastic of a complex skull base defect in the region of the sphenoid sinus on the left under the control of the navigation system” was performed. There was subdural

  9. Hematoma epidural subagudo Subacute epidural hematoma

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    Yvei González Orlandi

    2011-03-01

    Full Text Available Se presenta el caso de un paciente con hematoma epidural subagudo, temporoparietal derecho, secundario a una agresión física. En el cuadro clínico, a las 24 h, predominó la cefalea de intensidad moderada, con somnolencia y agitación psicomotora ligera. Las radiografías simples de cráneo no mostraron alteraciones. Los síntomas se mantuvieron a pesar del tratamiento médico, por lo que se realizó una tomografía axial simple de cráneo que mostró la presencia de un hematoma epidural subagudo temporoparietal derecho, con desplazamiento de estructuras de la línea media. Se realizó una craneotomía temporoparietal derecha para la evacuación del hematoma posterior. El paciente evolucionó satisfactoriamente y se recuperó por completo, tanto clínica como imaginológicamente.This is the case of a patient presenting with right temporoparietal subacute hematoma secondary to a physical act of aggression. In clinical picture at 24 hours there was predominance of headache of moderate intensity with drowsiness and slight psychomotor restlessness. The skull single radiographies didn't show alterations. Symptoms remained despite the medical treatment, thus a single skull axial tomography was carried out showing the presence of a right temporoparietal subacute epidural hematoma with displacement from the middle line structures. A right temporoparietal craniotomy was carried out to evacuation of the posterior hematoma. Patient evolved satisfactorily with a total recovery as much clinical as imaging.

  10. Snakebites in Turkey: epidemiological and clinical aspects between the years 1995 and 2004

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    Y Cesaretli

    2010-01-01

    Full Text Available The venom of poisonous snakes comprises a complex mixture of several proteins with other less significant constituents, resulting in principles capable of changing viable tissues. The hemotoxic factor is the main responsible for necrosis and tissue sloughing. Envenomations are common in rural areas of Turkey caused by snake species that present hepatotoxic venom, which causes local swelling, ecchymosis and alterations in blood profile. The epidemiological and clinical findings of snake envenomations in Turkey were evaluated based on data recorded by the National Poison Information Center (NPIC between 1995 and 2004, in a total of 550 snakebite cases. The month of peak incidence was June (24.3% while most incidents occurred in Marmara, Central Anatolia and Black Sea regions of Turkey. The victims were mainly adults (54.1%. Hospitalized patients displayed clinical signs of local (75.2% and systemic effects (24.7%. Local clinical symptoms comprised edema, pain, hyperemia, numbness and ecchymosis, while systemic clinical symptoms included nausea, vomiting, hypotension, tachycardia, dyspnea, dry mouth, paresthesia, generalized edema, cyanosis and compartment syndrome. Occasionally, convulsions, confusion, loss of consciousness, hyperthermia, hepatic and circulation failure, hematoma, drowsiness, epistaxis, chest and abdominal pain, venous spasm, thrombocytopenia and bradycardia were recorded. Approximately one third (34.2% of the patients were treated symptomatically, while 10.5% required antivenom therapy along with symptomatic treatments and 26.3% of all patients were exclusively treated with antivenom. Although a significant number of incidents were reported, no deaths occurred. These findings emphasize the presence of multiple medically important snake species in Turkey and that public awareness and therapeutic approaches appear sufficient to manage snakebite incidents.

  11. Effect of trazodone on sleep bruxism in children and adolescents 6-18 years of age, a pilot study

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    Fereshteh Shakibaei

    2008-02-01

    Full Text Available

    • BACKGROUND: Sleep bruxism is a common sleep disorder with unclear etiology and no definitive treatment. Recent
    • suggested medications are not often practically used due to their numerous limitations. Based on the fact that sleep bruxism occurs most often in the second stage of non-REM sleep, this study aimed to assess the effect of trazodone on sleep bruxism.
    • METHODS: This pilot study was conducted as a before-after design on 28 children and adolescents with 6-18 years of age suffering from sleep bruxism referring by children and adolescents mental health clinic, children dental specialists and pediatricians. The treatment started with 0.5mg/kg/day. In non-responders, it was weekly added by 0.5 mg/kg/day (with optimum of 2 mg/kg/day. Frequency of bruxism and related morning face/jaw pain were assessed daily from two weeks before (baseline to four weeks after starting the intervention by the parents/roommate.
    • RESULTS: Findings showed a significant reduction in the frequency of both bruxism and related morning pain from baseline to the 2nd and the 4th weeks of the intervention (P<0.001. Minor side effects such as drowsiness, nausea and dry mouth were seen among approximately one-third of the patients. These side effects were self-limited and tolerable.
    • CONCLUSIONS: Trazodone could be effective in reducing the frequency of sleep bruxism and its related morning face/jaw pain. Well-designed placebo-controlled trials are needed to confirm the results.
    • KEY WORDS: Sleep bruxism, trazodone, teeth clenching, teeth grinding.

  12. Low-Dose Ketamine Infusion for Adjunct Management during Vaso-occlusive Episodes in Adults with Sickle Cell Disease: A Case Series.

    Science.gov (United States)

    Palm, Nicole; Floroff, Catherine; Hassig, Tanna B; Boylan, Alice; Kanter, Julie

    2018-05-23

    The optimal management of recurrent painful episodes in individuals living with sickle cell disease (SCD) remains unclear. Currently, the primary treatment for these episodes remains supportive, using fluids and intravenous opioid and anti-inflammatory medications. Few reports have described the use of adjunct subanesthetic doses of ketamine to opioids for treatment of refractory pain in SCD. This article reports a retrospective case series of five patients admitted to the intensive care unit (ICU) with prolonged vaso-occlusive episodes (VOEs). Patients were treated with a continuous-infusion of low-dose ketamine (up to 5 µg/kg/min) after insufficient pain control with opioid analgesic therapy. Outcomes studied included impact on opioid analgesic use, a description of ketamine dosing strategy, and an analysis of adverse events due to opioid or ketamine analgesia. Descriptive statistics are provided. During ketamine infusion, patients experienced a lower reported pain score (mean numeric rating scale [NRS] score 7.2 vs. 6.4), reduced opioid-induced adverse effects, and decreased opioid dosing requirements (median reduction of 90 mg morphine equivalents per patient). The average duration of severe pain during admission prior to ketamine therapy was 8 days. Only one of five patients reported an adverse effect (vivid dreams) secondary to ketamine infusion. The Richmond Agitation Sedation Scale (RASS) was assessed throughout therapy, with only one patient experiencing light drowsiness. Low-dose ketamine infusion may be considered as an adjunct analgesic agent in patients with vaso-occlusive episodes who report continued severe pain despite high-dose opioid therapy, particularly those experiencing opioid-induced adverse effects.

  13. Safety and effectiveness of moderate sedation for radiologic non-vascular intervention

    International Nuclear Information System (INIS)

    Kim, Tae-Hoon

    2006-01-01

    The purpose of this study was to prospectively characterize the safety and effectiveness of moderate sedation/analgesia for performing radiologic non-vascular abdominal intervention. During a 3-month period, a total of 63 adult patients with a mean age of 64 years (range:27-82) underwent moderate sedation for 72 radiologic non-vascular interventional procedures. A combination of fentanyl citrate and midazolam hydrochloride, based on the patient's body weight, was intravenously administered until the patient was drowsy and tranquil. The adverse events associated with this moderate sedation were assessed. The visual analog scale format was used to measure the subjective feelings of the patient's pre-pro- cedural anxiety and intraprocedural pain. The mean total dose per kilogram of body weight of fentanyl used in PTBD was 1.148 μg. The mean total dose per kilogram of body weight of midazolam was 0.035 mg in PTBD, PTGBD, AD, PCN, DJS, GS and FRA, 0.039 mg in TDC, and 0.043 mg in BS. A temporary reduction of systolic blood pressure to less than 80 mmHg was observed during 5 procedures (6.9%), whereas a temporary elevation of systolic blood pressure above 150 mmHg was observed during 10 procedures (13.8%). A reduction of arterial oxygen saturation to less than 90% was observed during 14 procedures (19.4%). None of the patients required pharmacologic reversal agents or cardiopulmonary resuscitation. The mean anxiety score recorded before all procedures was 5.2 (distressing). The mean pain score during the procedure, which was recorded after all procedures, was 2.9 (mild). Moderate sedation allows performance of safe and effective radiologic non-vascular intervention, and it is also easy for an interventional radiologist to use. The patients should be continuously monitored to check their vital signs and arterial oxygen saturation during the procedures

  14. Safety and effectiveness of moderate sedation for radiologic non-vascular intervention

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae-Hoon [Dankook University Hospital, Chungju (Korea, Republic of)

    2006-06-15

    The purpose of this study was to prospectively characterize the safety and effectiveness of moderate sedation/analgesia for performing radiologic non-vascular abdominal intervention. During a 3-month period, a total of 63 adult patients with a mean age of 64 years (range:27-82) underwent moderate sedation for 72 radiologic non-vascular interventional procedures. A combination of fentanyl citrate and midazolam hydrochloride, based on the patient's body weight, was intravenously administered until the patient was drowsy and tranquil. The adverse events associated with this moderate sedation were assessed. The visual analog scale format was used to measure the subjective feelings of the patient's pre-pro- cedural anxiety and intraprocedural pain. The mean total dose per kilogram of body weight of fentanyl used in PTBD was 1.148 {mu}g. The mean total dose per kilogram of body weight of midazolam was 0.035 mg in PTBD, PTGBD, AD, PCN, DJS, GS and FRA, 0.039 mg in TDC, and 0.043 mg in BS. A temporary reduction of systolic blood pressure to less than 80 mmHg was observed during 5 procedures (6.9%), whereas a temporary elevation of systolic blood pressure above 150 mmHg was observed during 10 procedures (13.8%). A reduction of arterial oxygen saturation to less than 90% was observed during 14 procedures (19.4%). None of the patients required pharmacologic reversal agents or cardiopulmonary resuscitation. The mean anxiety score recorded before all procedures was 5.2 (distressing). The mean pain score during the procedure, which was recorded after all procedures, was 2.9 (mild). Moderate sedation allows performance of safe and effective radiologic non-vascular intervention, and it is also easy for an interventional radiologist to use. The patients should be continuously monitored to check their vital signs and arterial oxygen saturation during the procedures.

  15. Palliative sedation, not slow euthanasia: a prospective, longitudinal study of sedation in Flemish palliative care units.

    Science.gov (United States)

    Claessens, Patricia; Menten, Johan; Schotsmans, Paul; Broeckaert, Bert

    2011-01-01

    Palliative sedation remains a much debated and controversial issue. The limited literature on the topic often fails to answer ethical questions concerning this practice. The aim of this study was to describe the characteristics of patients who are being sedated for refractory symptoms in palliative care units (PCUs) from the time of admission until the day of death. A prospective, longitudinal, descriptive design was used to assess data in eight PCUs. The total sample consisted of 266 patients. Information on demographics, medication, food and fluid intake, decision making, level of consciousness, and symptom experience were gathered by nurses and researchers three times a week. If patients received palliative sedation, extra information was gathered. Of all included patients (n=266), 7.5% received palliative sedation. Sedation started, on average, 2.5 days before death and for half of these patients, the form of sedation changed over time. At the start of sedation, patients were in the end stage of their illness and needed total care. Patients were fully conscious and had very limited oral food or fluid intake. Only three patients received artificial fluids at the start of sedation. Patients reported, on average, two refractory symptoms, the most important ones being pain, fatigue, depression, drowsiness, and loss of feeling of well-being. In all cases, the patient gave consent to start palliative sedation because of increased suffering. This study revealed that palliative sedation is only administered in exceptional cases where refractory suffering is evident and for those patients who are close to the ends of their lives. Moreover, this study supports the argument that palliative sedation has no life-shortening effect. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  16. EVALUATION OF PRIMARY PROPHYLAXIS WITH PROPRANOLOL AND ELASTIC BAND LIGATION IN VARICEAL BLEEDING IN CIRRHOTIC CHILDREN AND ADOLESCENTS

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    Júlio Rocha PIMENTA

    Full Text Available ABSTRACT Background The efficacy of nonselective β-blocker and endoscopic procedures, such as endoscopic variceal ligation, as primary prophylaxis of variceal hemorrhage in cirrhotic adults was demonstrated by numerous controlled trials, but in pediatric population, few are the number of studies. Objective The objective of this study is to evaluate the primary prophylaxis with β-blocker in cirrhotic children and adolescents with portal hypertension. Methods This is a cohort study encompassing 26 cirrhotic patients. β-blocker prophylaxis was performed with propranolol. When contraindicated the use of β-blocker, or if side effects presents, the patients were referred to endoscopic therapy with band ligation. Patients were evaluated by endoscopy, and those who had varicose veins of medium and large caliber or reddish spots, regardless of the caliber of varices, received primary prophylaxis. Results Of the 26 patients evaluated, 9 (34.6% had contraindications to the use of propranolol and were referred for endoscopic prophylaxis. Six (35.3% of the 17 patients who received β-blocker (propranolol, had bled after a median follow-up time of 1.9 years. β-blockage dosage varied from 1 mg/kg/day to 3.1 mg/kg/day and seven (41.2% patients had the propranolol suspended due to fail of the β-blockage or adverse effects, such as drowsiness, bronchospasm and hypotension. Patients who received endoscopic prophylaxis (elastic bandage had no bleeding during the follow-up period. Conclusion All of the patients that had upper gastroinstestinal bleeding in this study were under propranolol prophylaxis. The use of propranolol showed a high number of contraindications and side effects, requiring referral to endoscopic prophylaxis. The endoscopic prophylaxis was effective in reducing episodes of bleeding.

  17. Obstructive sleep apnoea syndrome in a patient with retrosternal goiter: a case report

    International Nuclear Information System (INIS)

    Sevketbeyoglu, H.; Kara, K.; Ince, M.; Karaagac, H.

    2012-01-01

    Full text: Introduction: Obstructive sleep apnoea syndrome (OSAS) is associated with a large number of predisposing factors (obesity, nasal obstruction, adenoid hypertrophy, macroglossia etc.). In addition to these factors goiter and hypothyroidism have been reported to be associated with OSAS. Objectives and tasks: In our case with retrosternal goiter, values of OSAS before and after thyroidectomy were shown. Materials and methods: Seventy-two years old, BMI: 26,8 kg/m 2 , female patient was admitted our hospital because of complaints to stop breathing during sleep, snoring, morning headache and daytime drowsiness. Results: Thorax CT and ultrasonography of thyroid shown retrosternal goiter and left tracheal deviation. Severe OSAS was diagnosed by polysomnography (PSG). Thyroid function tests were normal. Apneahypopnea index (AHI) was 63,1/h. Patients was performed 7 cm H 2 O nasal continuous positive airway pressure (gvrnCPAP). AHI was 11,4/h under nCPAP. One month after OSAS diagnosis the patient underwent thyroidectomy operation. Pathological examination was reported as multinodular GOITER. In postoperative period CPAP treatment couldn't continue, because patient was not compliant. In postoperative 8-th weeks, PSG was performed; AHI was 34,8/h. The patient's weight and BMI didn't change. Conclusion: In our case, despite absence of continued CPAP treatment after thyroidectomy, symptoms and PSG values improved partially. As a result of these findings, especially, compression of upper airway and deterioration of venous circulation of patients with large goiter may lead to an increase in OSAS symptoms. During patients with OSAS are treated with CPAP, goiter needs to be investigated

  18. The clinical and virological features of the first imported case causing MERS-CoV outbreak in South Korea, 2015.

    Science.gov (United States)

    Lee, Ji Yeon; Kim, You-Jin; Chung, Eun Hee; Kim, Dae-Won; Jeong, Ina; Kim, Yeonjae; Yun, Mi-Ran; Kim, Sung Soon; Kim, Gayeon; Joh, Joon-Sung

    2017-07-14

    In 2015, the largest outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection outside the Middle East occurred in South Korea. We summarized the epidemiological, clinical, and laboratory findings of the first Korean case of MERS-CoV and analyzed whole-genome sequences of MERS-CoV derived from the patient. A 68-year-old man developed fever and myalgia 7 days after returning to Korea, following a 10-day trip to the Middle East. Before diagnosis, he visited 4 hospitals, potentially resulting in secondary transmission to 28 patients. On admission to the National Medical Center (day 9, post-onset of clinical illness), he presented with drowsiness, hypoxia, and multiple patchy infiltrations on the chest radiograph. He was intubated (day 12) because of progressive acute respiratory distress syndrome (ARDS) and INF-α2a and ribavirin treatment was commenced. The treatment course was prolonged by superimposed ventilator associated pneumonia. MERS-CoV PCR results converted to negative from day 47 and the patient was discharged (day 137), following rehabilitation therapy. The complete genome sequence obtained from a sputum sample (taken on day 11) showed the highest sequence similarity (99.59%) with the virus from an outbreak in Riyadh, Saudi Arabia, in February 2015. The first case of MERS-CoV infection had high transmissibility and was associated with a severe clinical course. The patient made a successful recovery after early treatment with antiviral agents and adequate supportive care. This first case in South Korea became a super-spreader because of improper infection control measures, rather than variations of the virus.

  19. Symptoms and Symptom Clusters Identified by Adolescents and Young Adults With Cancer Using a Symptom Heuristics App.

    Science.gov (United States)

    Ameringer, Suzanne; Erickson, Jeanne M; Macpherson, Catherine Fiona; Stegenga, Kristin; Linder, Lauri A

    2015-12-01

    Adolescents and young adults (AYAs) with cancer experience multiple distressing symptoms during treatment. Because the typical approach to symptom assessment does not easily reflect the symptom experience of individuals, alternative approaches to enhancing communication between the patient and provider are needed. We developed an iPad-based application that uses a heuristic approach to explore AYAs' cancer symptom experiences. In this mixed-methods descriptive study, 72 AYAs (13-29 years old) with cancer receiving myelosuppressive chemotherapy used the Computerized Symptom Capture Tool (C-SCAT) to create images of the symptoms and symptom clusters they experienced from a list of 30 symptoms. They answered open-ended questions within the C-SCAT about the causes of their symptoms and symptom clusters. The images generated through the C-SCAT and accompanying free-text data were analyzed using descriptive, content, and visual analyses. Most participants (n = 70) reported multiple symptoms (M = 8.14). The most frequently reported symptoms were nausea (65.3%), feeling drowsy (55.6%), lack of appetite (55.6%), and lack of energy (55.6%). Forty-six grouped their symptoms into one or more clusters. The most common symptom cluster was nausea/eating problems/appetite problems. Nausea was most frequently named as the priority symptom in a cluster and as a cause of other symptoms. Although common threads were present in the symptoms experienced by AYAs, the graphic images revealed unique perspectives and a range of complexity of symptom relationships, clusters, and causes. Results highlight the need for a tailored approach to symptom management based on how the AYA with cancer perceives his or her symptom experience. © 2015 Wiley Periodicals, Inc.

  20. Standardized Computer-based Organized Reporting of EEG: SCORE

    Science.gov (United States)

    Beniczky, Sándor; Aurlien, Harald; Brøgger, Jan C; Fuglsang-Frederiksen, Anders; Martins-da-Silva, António; Trinka, Eugen; Visser, Gerhard; Rubboli, Guido; Hjalgrim, Helle; Stefan, Hermann; Rosén, Ingmar; Zarubova, Jana; Dobesberger, Judith; Alving, Jørgen; Andersen, Kjeld V; Fabricius, Martin; Atkins, Mary D; Neufeld, Miri; Plouin, Perrine; Marusic, Petr; Pressler, Ronit; Mameniskiene, Ruta; Hopfengärtner, Rüdiger; Emde Boas, Walter; Wolf, Peter

    2013-01-01

    The electroencephalography (EEG) signal has a high complexity, and the process of extracting clinically relevant features is achieved by visual analysis of the recordings. The interobserver agreement in EEG interpretation is only moderate. This is partly due to the method of reporting the findings in free-text format. The purpose of our endeavor was to create a computer-based system for EEG assessment and reporting, where the physicians would construct the reports by choosing from predefined elements for each relevant EEG feature, as well as the clinical phenomena (for video-EEG recordings). A working group of EEG experts took part in consensus workshops in Dianalund, Denmark, in 2010 and 2011. The faculty was approved by the Commission on European Affairs of the International League Against Epilepsy (ILAE). The working group produced a consensus proposal that went through a pan-European review process, organized by the European Chapter of the International Federation of Clinical Neurophysiology. The Standardised Computer-based Organised Reporting of EEG (SCORE) software was constructed based on the terms and features of the consensus statement and it was tested in the clinical practice. The main elements of SCORE are the following: personal data of the patient, referral data, recording conditions, modulators, background activity, drowsiness and sleep, interictal findings, “episodes” (clinical or subclinical events), physiologic patterns, patterns of uncertain significance, artifacts, polygraphic channels, and diagnostic significance. The following specific aspects of the neonatal EEGs are scored: alertness, temporal organization, and spatial organization. For each EEG finding, relevant features are scored using predefined terms. Definitions are provided for all EEG terms and features. SCORE can potentially improve the quality of EEG assessment and reporting; it will help incorporate the results of computer-assisted analysis into the report, it will make

  1. Topiramate sprinkle is effective in the treatment of childhood epilepsy

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    Prastiya Indra Gunawan

    2012-04-01

    Full Text Available Background Epilepsy remains one of the most frequently occurring pediatric problems. Approximately 10-15% patients do not respond to conventional therapy. Topiramate as a novel antiepileptic drug has a broad spectrum activity, presumably indicative of multiple anti-seizure mechanisms. Previous studies of topiramate as adjunctive and monotherapy in adults have shown beneficial effects. The objective of this research was to evaluate the efficacy and tolerability of topiramate sprinkle monotherapy in pediatric epilepsy. Methods This experimental research was conducted in the Pediatric Neurology outpatient clinic department, Soetomo hospital, Surabaya, involving 18 consecutive subjects. Subjects meeting the inclusion criteria were treated with topiramate sprinkle adjusted dose. Seizure frequency and side effects were observed in weeks 1, 4, 8, 12, 16, 20 and 24, respectively. Electro encephalogram (EEG and laboratory examinations were performed prior to and after 6 months of treatment. The t-test for related samples and McNemar test were utilized for statistical analysis. Results A total of 15 subjects completed the study. Topiramate-treated patients showed a statistically significant difference of seizure frequency reduction from 2.7 ± 1.16 to 0.13 ± 0.51 (p=0.000 with 93.7% patients being seizure free in 20 weeks. EEG recordings did not differ statistically in decrement of epileptiform activity in 20% subjects. About 7% subjects developed drowsiness and 33.3% subjects suffered from appetite suppression in the initial treatment. Laboratory results showed no abnormalities. Conclusions There was reduction of seizure frequency and no EEG recording alterations after topiramate sprinkle monotherapy. Topiramate as a monotherapy is highly effcicacious in childhood epilepsy.

  2. Developing an EEG based On-line Closed-loop Lapse Detection and Mitigation System

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    Yu-Te eWang

    2014-10-01

    Full Text Available In America, sixty percent of adults reported that they have driven a motor vehicle while feeling drowsy, and at least 15-20% of fatal car accidents are fatigue-related. This study translates previous laboratory-oriented neurophysiological research to design, develop, and test an On-line Closed-loop Lapse Detection and Mitigation (OCLDM System featuring a mobile wireless dry-sensor EEG headgear and a cell-phone based real-time EEG processing platform. Eleven subjects participated in an event-related lane-keeping task, in which they were instructed to manipulate a randomly deviated, fixed-speed cruising car on a 4-lane highway. This was simulated in a 1st person view with an 8-screen and 8-projector immersive virtual-realty environment. When the subjects experienced lapses or failed to respond to events during the experiment, auditory feedback was delivered to rectify the performance decrements. However, the arousing auditory signals were not always effective. The EEG spectra exhibited statistically significant differences between effective and ineffective arousing signals, suggesting that EEG spectra could be used as a countermeasure of the efficacy of arousing signals. In this on-line pilot study, the proposed OCLDM System was able to continuously detect EEG signatures of fatigue, deliver arousing feedback to subjects suffering momentary cognitive lapses, and assess the efficacy of the feedback in near real-time to rectify cognitive lapses. The on-line testing results of the OCLDM System validated the efficacy of the arousing signals in improving subjects' response times to the subsequent lane-departure events. This study may lead to a practical on-line lapse detection and mitigation system in real-world environments.

  3. Scale-free music of the brain.

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    Dan Wu

    Full Text Available BACKGROUND: There is growing interest in the relation between the brain and music. The appealing similarity between brainwaves and the rhythms of music has motivated many scientists to seek a connection between them. A variety of transferring rules has been utilized to convert the brainwaves into music; and most of them are mainly based on spectra feature of EEG. METHODOLOGY/PRINCIPAL FINDINGS: In this study, audibly recognizable scale-free music was deduced from individual Electroencephalogram (EEG waveforms. The translation rules include the direct mapping from the period of an EEG waveform to the duration of a note, the logarithmic mapping of the change of average power of EEG to music intensity according to the Fechner's law, and a scale-free based mapping from the amplitude of EEG to music pitch according to the power law. To show the actual effect, we applied the deduced sonification rules to EEG segments recorded during rapid-eye movement sleep (REM and slow-wave sleep (SWS. The resulting music is vivid and different between the two mental states; the melody during REM sleep sounds fast and lively, whereas that in SWS sleep is slow and tranquil. 60 volunteers evaluated 25 music pieces, 10 from REM, 10 from SWS and 5 from white noise (WN, 74.3% experienced a happy emotion from REM and felt boring and drowsy when listening to SWS, and the average accuracy for all the music pieces identification is 86.8%(kappa = 0.800, P<0.001. We also applied the method to the EEG data from eyes closed, eyes open and epileptic EEG, and the results showed these mental states can be identified by listeners. CONCLUSIONS/SIGNIFICANCE: The sonification rules may identify the mental states of the brain, which provide a real-time strategy for monitoring brain activities and are potentially useful to neurofeedback therapy.

  4. Substance abuse and the risk of readmission of people with schizophrenia at Amanuel Psychiatric Hospital, Ethiopia

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    M.S. Bimerew

    2007-09-01

    Full Text Available Frequent readmissions of people with schizophrenia pose considerable pressure on the psychiatric service provision of Amanuel Psychiatric Hospital. The purpose of the study was to ascertain factors mainly contributing to the rate of readmissions of people with schizophrenia. Descriptive survey methods and qualitative focus group interviews were employed to conduct the study. Random sampling techniques were used to select 43 respondents of people with schizophrenia from 231 people with schizophrenia who were readmitted for two or more times in the last two years and who gained access during the time of the study. Structured interviews were used for respondents of people with schizophrenia. Fourteen (N = 14 family members/caregivers were selected using purposive sampling methods for focus group discussions. Quantitative data was analyzed using the SPSS Version 11.00 program and the qualitative data was analyzed by generating themes and categories. The results suggest that alcohol and that abuse were contributing factors for the rate of readmissions of people with schizophrenia into the Amanuel Psychiatric Hospital. It was found that communities contribute to the problems of substance abuse by providing and/or selling it to those mentally ill people. The study also revealed that patients use alcohol and that in order to tolerate the severe side effects of the anti-psychotic drugs, to suppress hunger due to shortage of food and to avoid drowsiness. Raising community awareness, psycho-education, strengthening the capacities of caretakers and laws to prevent substance abuse, as well as campaigning to prevent people from abusing mentally ill sufferers, should be established.

  5. [Analgesic effect and clinical tolerability of the combination of paracetamol 500 mg and caffeine 50 mg versus paracetamol 400 mg and dextropropoxyphene 30 mg in back pain].

    Science.gov (United States)

    Kuntz, D; Brossel, R

    1996-09-07

    A double-blind randomized multicentric study was performed to test the hypothesis that the analgesic effect of paracetamol-cafeine is equivalent to that of paracetamol-dextropropoxyphen in patients suffering from pain due to osteoarthritis of the spine. Rhumatologists included 124 patients who were randomized into two groups of 62 each. Pain was measured daily during the seven-day treatment Huskisson's Analog Visual Scales; 112 were per protocol and evaluable. The two treatment groups were statistically similar for demographics, vital signs, medical and treatment history. A majority of them had pain located at the lumbar spine only; the other patients had either pain at the cervical or dorsal spine or at several sites. At the end of the week there was a major reduction in pain level: 51.2% in patients given paracetamol-cafeine and 47.0% in those given paracetamol-dextropropoxyphen. The main criteria of efficacy--the percentage of success (decrease of pain > 50%)--was similar in the two groups as well in the intention-to-treat population (p = 0.01) as the per protocol population (p = 0.028). Kinetics of pain decrease during the first day of treatment were assessed with an hourly evaluation during the six first hours and at the 12th hour. There was no difference between the two groups. There was no serious adverse event and the frequency and intensity of the adverse events were similar in the two groups. The potentializing action of cafeine on paracetamol-induced pain relief enables a degree of pain relief equivalent to that of a combination using an analgesic with a peripheral action, paracetamol, and another with a central action, dextropoxyphen. The fact that the paracetamol-cafeine combination does not have a central action avoids secondary effects induced by central analgesics (drowsiness, constipation) in patients with osteoarthritis back pain.

  6. Howling at the moon? The effect of lunar phases on post-surgical pain outcome.

    Science.gov (United States)

    Komann, Marcus; Weinmann, Claudia; Meissner, Winfried

    2014-05-01

    Many people are convinced that lunar phases influence their lives - despite the fact that a lot of studies have shown that this belief is wrong. In this article, we investigate the effect of lunar phases on acute post-surgical pain and on treatment-related side effects. We hypothesize that there is no influence. The data for the study were collected in 2010 and 2011 in 10 international hospitals participating in the research project PAIN OUT. Hospitalized patients were asked for their pain after surgery and pain treatment side effects using numerical ratings scales from 0 to 10. We applied Kurskal-Wallis H-tests to find out if the four moon phases show significant differences in 14 outcome variables. Afterwards, we adjusted for age, gender and three tracer surgeries. A total of 12,224 patient data sets were assessed. For most variables and sub-groups, there is no lunar effect on the observed outcome variables. The only items that show statistically significant differences are pain interference with sleep (p = 0.01) and drowsiness (p = 0.01). The only sub-groups that show statistically significant connections to lunar phases in some variables are men (7 out of 14 variables significant) and elderly people (4 out of 14 variables significant). Even in the statistically significant sub-groups, the differences are small and only show up in some variables. We conclude that lunar phases have no effect on post-surgical pain or its side effects. The hypothesis holds. Thus, there is no reason for patients to postpone surgeries or to fear surgeries on any given date.

  7. [Encephalitis due to the Epstein-Barr virus: a description of a clinical case and review of the literature].

    Science.gov (United States)

    Barón, Johanna; Herrero-Velázquez, Sonia; Ruiz-Piñero, Marina; Pedraza, M Isabel; Rojo-Rello, Silvia; Guerrero-Peral, Ángel Luis

    2013-11-16

    INTRODUCTION. Infection by the Epstein-Barr virus (EBV) -either as a primary infection, a reactivation or an active chronic infection- can give rise to several clinical forms of involvement of the central nervous system. We report a case of encephalitis due to EBV produced by viral reactivation in an immunocompetent patient which initially mimicked, from the clinical and electroencephalographic point of view, encephalitis due to type 1 herpes simplex virus (HSV-1). CASE REPORT. A 51-year-old male who had reported the presence of dorsal herpes zoster some days earlier. The patient visited the emergency department after suffering a holocranial oppressive headache and febricula for seven days; 24 hours before admission to hospital, he was suffering from drowsiness and language disorder. The neurological examination revealed stiffness in the back of the neck and dysphasia. An analysis of the cerebrospinal fluid revealed pleocytosis (422 cells/mm(3)) with 98% of mononuclear cells and normal protein and glucose concentration levels in cerebrospinal fluid. Magnetic resonance imaging of the brain and electroencephalogram readings were normal with periodic lateralised epileptiform discharges in the left temporal region. Intravenous acyclovir treatment was initiated, but renal failure meant it had to be changed to oral valaciclovir with clinical resolution and improvement of the liquoral parameters. Polymerase chain reaction in the cerebrospinal fluid was positive for EBV and negative for the other neurotropic viruses. In blood, the serology test for EBV with IgG was positive, while IgM and heterophile antibody tests were negative. CONCLUSIONS. EBV infection can give rise to acute disseminated encephalomyelitis or affect several locations in the central nervous system, especially the cerebellum. Clinical pictures mimicking HSV-1 are less frequent. When encephalitis is related to viral reactivation, precipitating factors can be detected, as in our case.

  8. Infarction of the entire corpus callosum as a complication in subarachnoid hemorrhage: A case report

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    Satoru Takahashi, M.D.

    2017-03-01

    Full Text Available The corpus callosum is the major commissural pathway connecting the cerebral hemispheres. This pathway receives its blood supply from anterior communicating artery, pericallosal artery, and posterior pericallosal artery. However, in some cases, the entire corpus callosum is supplied by median callosal artery; thus, occlusion of this artery can lead to infarction of the entire corpus callosum. Few reports have described this type of infarction, and no reports after subarachnoid hemorrhage (SAH exist. Here, we report on a 42-year-old female who was diagnosed with SAH after two aneurysms were discovered in bifurcation of left anterior cerebral artery (A1-A2. After successful clipping was performed, the patient was alert and had no neurological deficits; moreover, the computed tomography images that were acquired after the operation showed no evidence of infarction. Nine days after admittance to the hospital, drowsiness and weakness of the left limbs with brain swelling appeared and decompressive hemi-craniectomy was performed. Diagnostic cerebral angiography revealed vasospasms in both anterior and middle cerebral arteries, thus fasudil hydrochloride was administered intra-arterially. While blood flow in all arteries improved, diffusion-weighted magnetic resonance imaging detected infarction along the entire length of the corpus callosum and in the medial region of the right frontal lobe. We believe this infarction was due to secondary ischemia of median callosal artery. This case reminded us of the anatomical variation wherein median callosal artery is the sole blood supply line for the corpus callosum and demonstrated that infarction of the entire corpus callosum is possible.

  9. Single-dose pharmacokinetics and tolerability of oral delta-9- tetrahydrocannabinol in patients with amyotrophic lateral sclerosis.

    Science.gov (United States)

    Joerger, Markus; Wilkins, Justin; Fagagnini, Stefania; Baldinger, Reto; Brenneisen, Rudolf; Schneider, Ursula; Goldman, Bea; Weber, Markus

    2012-06-01

    Cannabinoids exert neuroprotective and symptomatic effects in amyotrophic lateral sclerosis (ALS). We assessed the pharmacokinetics (PK) and tolerability of delta-9-tetrahydrocannabinol (THC) in ALS patients. Nine patients received THC single oral doses of 5mg and 10mg, separated by a wash-out period of two weeks. Blood samples for the determination of THC, 11-nor-9-carboxy-THC (THC-COOH) and hydroxy-THC (THC-OH) were taken up to 8 hours after intake. Adverse events were assessed by visual analogue scales (VAS). Plasma concentrations of the active metabolite THC-OH were submitted to sequential pharmacokinetic-pharmacodynamic population modeling on individual heart rate as a proxy for THC's cardiovasculatory effects. Drowsiness, euphoria, orthostasis, sleepiness, vertigo and weakness were significantly more frequent in patients receiving 10mg compared to 5 mg THC. A marked interindividual variability was found for the absorption of oral THC (84%) and elimination of THC-COOH (45%). PK data did not support any clinically relevant deviation from linear PK in the investigated range of concentrations. Plasma concentrations of THC-OH were positively correlated with the individual heart rate. An E(max-model) was successfully fitted to individual heart rate, with a THC-OH plasma concentration of 3.2 x 10(-4) μmol/L for EC(50) and an E(max) of 93 bpm for heart rate. The higher 10mg dose of THC was dose-limiting in patients with ALS. High interindividual PK variability requires individuell titration of THC for potential therapeutic use in patients with ALS.

  10. Associating crash avoidance maneuvers with driver attributes and accident characteristics: a mixed logit model approach.

    Science.gov (United States)

    Kaplan, Sigal; Prato, Carlo Giacomo

    2012-01-01

    The current study focuses on the propensity of drivers to engage in crash avoidance maneuvers in relation to driver attributes, critical events, crash characteristics, vehicles involved, road characteristics, and environmental conditions. The importance of avoidance maneuvers derives from the key role of proactive and state-aware road users within the concept of sustainable safety systems, as well as from the key role of effective corrective maneuvers in the success of automated in-vehicle warning and driver assistance systems. The analysis is conducted by means of a mixed logit model that represents the selection among 5 emergency lateral and speed control maneuvers (i.e., "no avoidance maneuvers," "braking," "steering," "braking and steering," and "other maneuvers) while accommodating correlations across maneuvers and heteroscedasticity. Data for the analysis were retrieved from the General Estimates System (GES) crash database for the year 2009 by considering drivers for which crash avoidance maneuvers are known. The results show that (1) the nature of the critical event that made the crash imminent greatly influences the choice of crash avoidance maneuvers, (2) women and elderly have a relatively lower propensity to conduct crash avoidance maneuvers, (3) drowsiness and fatigue have a greater negative marginal effect on the tendency to engage in crash avoidance maneuvers than alcohol and drug consumption, (4) difficult road conditions increase the propensity to perform crash avoidance maneuvers, and (5) visual obstruction and artificial illumination decrease the probability to carry out crash avoidance maneuvers. The results emphasize the need for public awareness campaigns to promote safe driving style for senior drivers and warning about the risks of driving under fatigue and distraction being comparable to the risks of driving under the influence of alcohol and drugs. Moreover, the results suggest the need to educate drivers about hazard perception, designing

  11. Thirteen years of oxcarbazepine exposures reported to US poison centers: 2000 to 2012.

    Science.gov (United States)

    Spiller, H A; Strauch, J; Essing-Spiller, S J; Burns, G

    2016-10-01

    Oxcarbazepine (OXC) is a 10-keto analogue of carbamazepine used in patients with partial and secondary generalized seizures. We evaluated ingestions of OXC reported to US poison centers for adverse effects from supratherapeutic doses and/or overdose. Retrospective analysis of data reported to National Poison Data System from single-substance OXC ingestions between January 2000 and December 2012. There were 18,867cases with a mean of 1451 exposures/year. The patients were predominantly adults with 5464 exposures in children effects were drowsiness (n = 4703, 25%), vomiting (n = 1559, 8%), tachycardia (n = 590, 3%), agitated (n = 342, 1.8%), hypotension (n = 178, 0.9%), electrolyte disturbance (n = 153, 0.8%), coma (n = 156, 0.8%), and seizures (n = 121, 0.6%). There were 176 patients with a major effect of which 31 involved were children and 1728 (9%) patients with moderate effects of which 300 involved were children. Five deaths were reported in adults. Intentional exposure (e.g. suicide) was the reason for exposure in 68% of patients with major effects and in all fatalities. Fifty-three percent of adults and 38% of children were managed in a health-care facility (HCF). HCF utilization levels remained consistent. Severe outcomes appear to be infrequent (<1%). Unlike other anticonvulsants OXC does not appear to be proconvulsant in overdose. Serious outcomes for OXC overdoses are unlikely in the pediatric patient. With only mild symptoms likely, observation at home may be appropriate for the majority of cases. In the adult population there appears to be few neurologic and cardiovascular complications even in the intentional exposure. © The Author(s) 2015.

  12. Inadequate Helmet Fit Increases Concussion Severity in American High School Football Players

    Science.gov (United States)

    Greenhill, Dustin A.; Navo, Paul; Zhao, Huaqing; Torg, Joseph; Comstock, R. Dawn; Boden, Barry P.

    2016-01-01

    Background: There is limited information on the relationship between football helmet fit and concussion severity. Hypothesis: Poor helmet fit may predispose football players to a more severe concussion. Study Design: Descriptive epidemiology study. Level of Evidence: Level 3. Methods: Data from concussion injury reports were obtained from the National High School Sports-Related Injury Surveillance System over a 9-year period. Symptoms, duration, and helmet parameters (fit, interior padding) were analyzed for all first-time concussions. Results: Data from 4580 concussions were analyzed. Patients who suffered concussions with a helmet that did not fit properly (3.22%), as determined by an athletic trainer, had higher rates of drowsiness (RR, 1.46; P = 0.005), hyperexcitability (RR, 2.38; P = 0.047), and sensitivity to noise (RR, 1.88; P < 0.001); had more symptoms (5.34 vs 4.54, P = 0.004); and had longer symptom duration (P = 0.04). Athletes with helmets lined with an air bladder had greater rates of sensitivity to light (RR, 1.13; P = 0.02), sensitivity to noise (RR, 1.25; P = 0.009), and longer symptom duration (P = 0.004) compared with foam or gel liners. Conclusion: An improperly fitted football helmet is a risk factor for a concussion with more symptoms and of longer duration. Concussions of longer duration are also more common in players with an air bladder–lined helmet. Current high school football rules should mandate supervision and maintenance of helmet fit throughout the season, prior to impact. Clinical Relevance: Team physicians, athletic trainers, coaches, and high school officials should ensure proper oversight of helmet fit in high school athletes to decrease concussion severity and duration. PMID:27005467

  13. Coronal MRI in the diagnosis of corona radiata infarcts adjacent to the lateral ventricles

    Energy Technology Data Exchange (ETDEWEB)

    Iwamoto, Toshihiko; Abe, Shin-e; Kanaya, Kiyoshi; Kubo, Hideki; Takasaki, Masaru (Tokyo Medical Coll. (Japan))

    1992-04-01

    To clarify pathophysiology of vascular lesions in corona radiata infarcts adjacent to the body of the lateral ventricle (CRILV), 17 patients with CRILV were studied by using magnetic resonance (MR) imaging. Based on the coronal MR images obtained between the anterior and posterior commissures, the patients were divided into two groups: (I) the group having infarcts below a line extending from the upper edge of the insular cistern to the external angle of the lateral ventricle adjacent to the corpus callosum (n=11); and (II) the group having lesions above the line towards the centrum semiovale (n=6). Most of the patients in both groups were male and had hypertension. Symptoms were gradually deteriorated and stroke in the morning was frequent in both groups, althrough the time from onset to completion was longer in Group II than Group I. In comparing clinical manifestations in Groups I and II, pure motor hemiparesis was found in 5 and 3 patients, and sensorimotor stroke in 2 and one patients, respectively. Drowsiness was found in 2 for Group I, while aphasia occurred in 2 for Group II. In addition, pseudobular and asymptomatic palsy occurred in each one patient for Group I. Prognosis was favorable in both groups, except for 2 who died of aspiration pneumonia. In Group I, 11 infarcts were well-defined, less than 15 mm in diameter on CT scans and were sclerotic in the main arteries without obstruction on angiograms. In contrast, Group II had ill-defined, larger low-density areas on CT scans and trunk obstruction of the internal carotid or middle cerebral arteries on angiograms. SPECT scans showed diffuse defect in Group II, in contrast to normal to diffuse or multiple defects in Group I. In Group I, lacunar lesions seemed to be caused by ischemia of the perforators, and in Group II, terminal zone infarcts in the territory of the cortical branches or watershed infarcts seemd to be caused by main trunk obstruction. (N.K.).

  14. Obstructive sleep apnoea syndrome as a cause of road traffic accidents.

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    Aguiar, M; Valença, J; Felizardo, M; Caeiro, F; Moreira, S; Staats, R; Bugalho de Almeida, A A

    2009-01-01

    Several studies have demonstrated that obstructive sleep apnoea syndrome (OSAS) patients have a higher rate of road traffic accidents. Our study aimed to analyse any differences in OSAS patients between those who reported having had road traffic accidents and/or near misses and those who did not. We studied 163 patients with OSAS (apnoea- hypopnoea index (AHI)>10/h) diagnosed using nocturnal polysomnography (NPSG), all drivers, 18.4% of whom drove for a living. Patients were asked at their first clinical interview to self-report road traffic accidents and/or near misses over the past 3 years which had been caused by abnormal daytime drowsiness. This allowed patients to be divided into two groups, those who had had road traffic accidents and/or near misses and those who had not. Both were compared as to age, body mass index (BMI), Epworth Sleepiness Scale (ESS), daytime PaO2 and PaCO2, Functional Outcomes of Sleep Questionnaire (FOSQ) test and NPSG data. This latter was total sleep time (TTS), sleep efficiency, sleep stages, arousal index (ARI), AHI, minimal and average SaO2, % of time with SaO2 TDAH) (T test). Group I (no road traffic accidents) No=89 patients; group II (road traffic accidents) No=74 patients. Age (years) was 57.6+/-11.8 vs. 54.7+/-10.9 (ns); male gender, 75% vs. 78.4%; ESS, 12.3+/-5.4 vs. 17.6+/-4.3 (pTDAH (minutes), 98.5+/-63.7 vs. 133.3+/-83.2 (p=0,005). In our experience patients who had road traffic accidents and/or near misses had a more severe OSAS, with higher AHI, excessive daytime sleepiness and lower quality of life.

  15. Predicting morphine related side effects in the ED: An international cohort study.

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    Bounes, Vincent; Charriton-Dadone, Béatrice; Levraut, Jacques; Delangue, Cyril; Carpentier, Françoise; Mary-Chalon, Stéphanie; Houze-Cerfon, Vanessa; Sommet, Agnès; Houze-Cerfon, Charles-Henri; Ganetsky, Michael

    2017-04-01

    Morphine is the reference treatment for severe acute pain in an emergency department. The purpose of this study was to describe and analyse opioid-related ADRs (adverse drug reactions) in a large cohort of emergency department patients, and to identify predictive factors for those ADRs. In this prospective, observational, pharmaco-epidemiological international cohort study, all patients aged 18years or older who were treated with morphine were enrolled. The study was done in 23 emergency departments in the US and France. Baseline numerical rating scale score and initial and total doses of morphine titration were recorded. Logistic regression analysis was used to study the effects of demographic, clinical and medical history covariates on the occurrence of opioid-induced ADRs within 6h after treatment. A total of 1128 patients were included over 10months. Median baseline initial pain scores were 8/10 (7-10) versus 3/10 (1-4) after morphine administration. Median titration duration was 10min (IQR, 1-30). The occurrence of opioid-induced ADRs was 25% and 2% were serious. Patients experienced mainly nausea and drowsiness. Medical history of travel sickness (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.01-2.86) and history of nausea or vomiting post morphine (OR, 3.86; 95% CI, 2.29-6.51) were independent predictors of morphine related ADRs. Serious morphine related ADRs are rare and unpredictable. Prophylactic antiemetic therapy could be proposed to patients with history of travel sickness and history of nausea or vomiting in a postoperative setting or after morphine administration. Copyright © 2016. Published by Elsevier Inc.

  16. “ICE” – A rare cause for coagulopathy in a case of massive post-partum hemorrhage

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    Navkiran Singh Gill

    2017-05-01

    Full Text Available A case of massive post-partum hemorrhage in East-Malaysia, associated with 3-4 methylene-dioxy-methamphetamine (MDMA abuse otherwise known as Ecstasy or locally as “ICE”, injected by the patient as a means to suppress labor pains prior to hospital presentation. We report a rare case of substance abuse that lead to life threatening hemorrhage in a maternal patient of productive age group. Presenting to the labor suite in second stage of labor in breech presentation, exhibiting active neuropsychiatric symptoms of intoxication like euphoria, drowsiness, mydriasis but able to obey commands. A rapid response by the Obstetric on-call team proceeded with an assisted-breech delivery. Post-delivery, a baby girl with poor Apgar score was born and intubated. The mother was then posted for an Examination Under Anesthesia as she was noted to have slow blood oozing per-vaginally using a single shot spinal as she exhibited features of difficult intubation and high risk of aspiration. During the procedure, she tipped into massive PPH complicated with DIVC, and was rushed into the intensive care unit for stabilization and back into the operation theatre, needing a total abdominal hysterectomy (TAH as definitive bleeding control. She required large scale resuscitative efforts peri-operatively including continuous veno-venous hemofiltration (CVVH as well as regional intensive care consultation. We describe, chronologically the anesthetic challenges faced in managing a patient in acute substance intoxication at presentation to our district hospital during twilight hours. We then explain the pharmacodynamics of MDMA in provoking coagulopathy. No reports of similar cases in the South-East Asia region.

  17. Physiotherapy programme reduces fatigue in patients with advanced cancer receiving palliative care: randomized controlled trial.

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    Pyszora, Anna; Budzyński, Jacek; Wójcik, Agnieszka; Prokop, Anna; Krajnik, Małgorzata

    2017-09-01

    Cancer-related fatigue (CRF) is a common and relevant symptom in patients with advanced cancer that significantly decreases their quality of life. The aim of this study was to evaluate the effect of a physiotherapy programme on CRF and other symptoms in patients diagnosed with advanced cancer. The study was designed as a randomized controlled trial. Sixty patients diagnosed with advanced cancer receiving palliative care were randomized into two groups: the treatment group (n = 30) and the control group (n = 30). The therapy took place three times a week for 2 weeks. The 30-min physiotherapy session included active exercises, myofascial release and proprioceptive neuromuscular facilitation (PNF) techniques. The control group did not exercise. The outcomes included Brief Fatigue Inventory (BFI), Edmonton Symptom Assessment Scale (ESAS) and satisfaction scores. The exercise programme caused a significant reduction in fatigue scores (BFI) in terms of severity of fatigue and its impact on daily functioning. In the control group, no significant changes in the BFI were observed. Moreover, the physiotherapy programme improved patients' general well-being and reduced the intensity of coexisting symptoms such as pain, drowsiness, lack of appetite and depression. The analysis of satisfaction scores showed that it was also positively evaluated by patients. The physiotherapy programme, which included active exercises, myofascial release and PNF techniques, had beneficial effects on CRF and other symptoms in patients with advanced cancer who received palliative care. The results of the study suggest that physiotherapy is a safe and effective method of CRF management.

  18. Severe Sepsis in Severely Malnourished Young Bangladeshi Children with Pneumonia: A Retrospective Case Control Study.

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    Mohammod Jobayer Chisti

    Full Text Available In developing countries, there is no published report on predicting factors of severe sepsis in severely acute malnourished (SAM children having pneumonia and impact of fluid resuscitation in such children. Thus, we aimed to identify predicting factors for severe sepsis and assess the outcome of fluid resuscitation of such children.In this retrospective case-control study SAM children aged 0-59 months, admitted to the Intensive Care Unit (ICU of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh from April 2011 through July 2012 with history of cough or difficult breathing and radiologic pneumonia, who were assessed for severe sepsis at admission constituted the study population. We compared the pneumonic SAM children with severe sepsis (cases = 50 with those without severe sepsis (controls = 354. Severe sepsis was defined with objective clinical criteria and managed with fluid resuscitation, in addition to antibiotic and other supportive therapy, following the standard hospital guideline, which is very similar to the WHO guideline.The case-fatality-rate was significantly higher among the cases than the controls (40% vs. 4%; p<0.001. In logistic regression analysis after adjusting for potential confounders, lack of BCG vaccination, drowsiness, abdominal distension, acute kidney injury, and metabolic acidosis at admission remained as independent predicting factors for severe sepsis in pneumonic SAM children (p<0.05 for all comparisons.We noted a much higher case fatality among under-five SAM children with pneumonia and severe sepsis who required fluid resuscitation in addition to standard antibiotic and other supportive therapy compared to those without severe sepsis. Independent risk factors and outcome of the management of severe sepsis in our study children highlight the importance for defining optimal fluid resuscitation therapy aiming at reducing the case fatality in such children.

  19. Accelerated neuroregulation for therapy of opiate dependency

    Directory of Open Access Journals (Sweden)

    S. Sunatrio

    2004-03-01

    Full Text Available Acute weaning from chronic opioid abuse during general anesthesia is usually followed by adrenergic outflow effects. This article is to report our experience with accelerated neuroregulation that reverses the physical and psychological dependency. After a comprehensive psychological and medical examination, 361 heroin dependent patients were admitted to ICU to be hospitalized for a full 24 or 36 hours, including a 6 hour pre-procedure medication process (solbutamol, clonidine, diazepam, ranitidine, omeprazole, vitamin C, octreotide, and ondansetron. Anesthesia was induced with midazolam and propofol iv and maintained with propofol infusion. Naltrexon, clonidine, octreotide, and diazepam were then administered. Anesthesia was maintained for 3 ½ - 5 hours depending on severity of withdrawal symptoms precipitated by naltrexone. Analgetics and sedatives were given as needed afterwards. Upon discharge on the following day, patient was prescribed a regimen of oral naltrexone for 10-12 months. All 361 patients were successfully detoxified without any adverse anesthetic events. The side effects encountered were fatigue, insomnia, drowsy, shivering, abdominal pain, nausea, diarrhoea, myalgia, goose bumps and uncomfortable feeling. In most of the patients these symptoms disappeared without any treatment. Symptomatic treatments were needed in 32.7% of patients. In all 166 patients who completed their naltrexone maintenance treatment, craving disappeared in the 10th month. The main problem was the low patient compliance to oral naltrexone, so that only 45.9% of the patients completed their therapy. Conclusion: Accelerated neuroregulation which includes naltrexone maintenance treatment (10-12 months was highly effective to detoxify and to abolish craving in the heroin dependent patients. (Med J Indones 2004; 13: 53-8Keywords: detoxification, craving management

  20. A comparison of blue light and caffeine effects on cognitive function and alertness in humans.

    Science.gov (United States)

    Beaven, C Martyn; Ekström, Johan

    2013-01-01

    The alerting effects of both caffeine and short wavelength (blue) light have been consistently reported. The ability of blue light to enhance alertness and cognitive function via non-image forming neuropathways have been suggested as a non-pharmacological countermeasure for drowsiness across a range of occupational settings. Here we compare and contrast the alerting and psychomotor effects of 240 mg of caffeine and a 1-h dose of ~40 lx blue light in a non-athletic population. Twenty-one healthy subjects performed a computer-based psychomotor vigilance test before and after each of four randomly assigned trial conditions performed on different days: white light/placebo; white light/240 mg caffeine; blue light/placebo; blue light/240 mg caffeine. The Karolinska Sleepiness Scale was used to assess subjective measures of alertness. Both the caffeine only and blue light only conditions enhanced accuracy in a visual reaction test requiring a decision and an additive effect was observed with respect to the fastest reaction times. However, in a test of executive function, where a distraction was included, caffeine exerted a negative effect on accuracy. Furthermore, the blue light only condition consistently outperformed caffeine when both congruent and incongruent distractions were presented. The visual reactions in the absence of a decision or distraction were also enhanced in the blue light only condition and this effect was most prominent in the blue-eyed participants. Overall, blue light and caffeine demonstrated distinct effects on aspects of psychomotor function and have the potential to positively influence a range of settings where cognitive function and alertness are important. Specifically, despite the widespread use of caffeine in competitive sporting environments, the possible impact of blue light has received no research attention.

  1. A comparison of blue light and caffeine effects on cognitive function and alertness in humans.

    Directory of Open Access Journals (Sweden)

    C Martyn Beaven

    Full Text Available The alerting effects of both caffeine and short wavelength (blue light have been consistently reported. The ability of blue light to enhance alertness and cognitive function via non-image forming neuropathways have been suggested as a non-pharmacological countermeasure for drowsiness across a range of occupational settings. Here we compare and contrast the alerting and psychomotor effects of 240 mg of caffeine and a 1-h dose of ~40 lx blue light in a non-athletic population. Twenty-one healthy subjects performed a computer-based psychomotor vigilance test before and after each of four randomly assigned trial conditions performed on different days: white light/placebo; white light/240 mg caffeine; blue light/placebo; blue light/240 mg caffeine. The Karolinska Sleepiness Scale was used to assess subjective measures of alertness. Both the caffeine only and blue light only conditions enhanced accuracy in a visual reaction test requiring a decision and an additive effect was observed with respect to the fastest reaction times. However, in a test of executive function, where a distraction was included, caffeine exerted a negative effect on accuracy. Furthermore, the blue light only condition consistently outperformed caffeine when both congruent and incongruent distractions were presented. The visual reactions in the absence of a decision or distraction were also enhanced in the blue light only condition and this effect was most prominent in the blue-eyed participants. Overall, blue light and caffeine demonstrated distinct effects on aspects of psychomotor function and have the potential to positively influence a range of settings where cognitive function and alertness are important. Specifically, despite the widespread use of caffeine in competitive sporting environments, the possible impact of blue light has received no research attention.

  2. [Psychomotor reaction in primates placed in ballistic flight in rockets].

    Science.gov (United States)

    Grandpierre, R; Chatelier, G

    1968-01-01

    Psychomotor reactions have been studied in Nemestrina Macaques during flights in rockets in which there were periods of weightlessness lasting about 10 minutes. The animals had undergone motor conditioning and responded to a light signal by pressing on a button placed on a panel where there were four other undifferentiated buttons. The lighting of the panel and pressing on the different buttons in reply was recorded with respect to time. Movement was observed by film recording, and electrical activity of the brain was kept under observation by six different recordings of the cortex. Activity of stretching and bending muscles of the legs was recorded, as well as breathing, and heart activity was recorded on an electrocardiogram. These psychological parameters were transmitted to the earth by long-distance measurement during the entire flight. The recordings made it possible to confirm that the absence of the sensation of weight seems to reduce the alertness of the animals. This fact had already been observed in Wistar's rat and cat. The sensor-psychomotor responses undergo important individual variations and depend on the motivation of the subjects. A very well motivated one reacted after a short period of adaption, as it did in the laboratory: one that was much less motivated would not work until after weightlessness has ended, and showed signs of drowsiness. These observations made during the flights in rockets confirm those of Chambers et al., Harris et al., Lilly et al. made in immersion studies; they show the important role of weight in maintaining alertness, but that changes of psychomotor activity are particularly related to motivation.

  3. A profile of concurrent alcohol and alcohol-interactive prescription drug use in the US population.

    Science.gov (United States)

    Jalbert, Jessica J; Quilliam, Brian J; Lapane, Kate L

    2008-09-01

    The risk of adverse events among alcohol-interactive medication users can occur with one standard alcoholic drink. Research on the extent to which this occurs is scant. To examine the prevalence and correlates of concurrent alcohol and alcohol-interactive (AI) medication use across different levels of risk for an alcohol-related adverse event in a nationally representative sample of American adults. Cross-sectional analysis of past year, self-reported drinking history as well as past month, self-reported and visually inspected prescription drug use data from the 1999-2000 and 2001-2002 NHANES questionnaire section (n = 8,246). Medications were considered AI if concurrent use of alcohol and the prescription drug could intensify the effects of alcohol, resulting in increased sedation, drowsiness, or dizziness. Weighted prevalence estimates and polytomous logistic regression accounted for the complex survey design. Overall, 13.5% took prescription AI medications, of which 5.6% reported alcohol consumption of three or more drinks on each drinking occasion. Correlates of such use were being a man [adjusted odds ratio (AOR): 4.37; 95% confidence interval (CI): 1.84-10.35], between the ages of 20 and 54 (AOR=12.28; 95% CI: 3.12-48.25), and currently smoking (AOR: 2.61; 95% CI: 1.28-5.29), with alcohol-abstaining AI users as the referent group. Combining alcohol and AI medications is a common phenomenon, and the risk of alcohol-related adverse drug events may be nontrivial. Screening for alcohol use before prescribing AI medications would be prudent. Better communication regarding the dangers of mixing alcohol with AI medications is warranted.

  4. Comparative efficacy and safety of methylphenidate and atomoxetine for attention-deficit hyperactivity disorder in children and adolescents: Meta-analysis based on head-to-head trials.

    Science.gov (United States)

    Liu, Qiang; Zhang, Hong; Fang, Qingqing; Qin, Lili

    2017-11-01

    Comparative efficacy and safety are important issues for appropriate drug selection for attention-deficit hyperactivity disorder (ADHD) treatment. Therefore we conducted a meta-analysis, where we compared atomoxetine (ATX) and methylphenidate (MPH) for ADHD treatment in children and adolescents. Literature retrieval was conducted in relevant databases from their inception to April 2016 to select head-to-head trials that compared ATX and MPH in children and adolescents. Outcomes like response rate, ADHD Rating Scale (ADHD-RS) score, and adverse events were compared between ATX and MPH treatments. The standardized mean difference (SMD) and risk ratio (RR) with their corresponding 95% confidence intervals (CIs) were used as the effect size for continuous data or dichotomous data, respectively. Eleven eligible randomized-controlled trials were included, and two of them were double-blind, while the remaining were open-label. Compared to ATX, MPH showed a higher response rate (RR = 1.14, 95% CI [1. 09, 1.20]), decreased inattention (SMD = -0.13, 95% CI [-0.25, -0.01]) and lower risk of adverse events (drowsiness: RR = 0.17, 95% CI [0.11, 0.26; nausea: RR = 0.49; 95% CI [0.29, 0.85; vomiting: RR = 0.41, 95% CI [0.27, 0.63]). However, MPH presented a higher risk of insomnia than ATX (RR = 2.27, 95% CI [1.63, 3.15], p < .01). Results of the meta-analysis add additional evidence of the effectiveness of both ATX and MPH and suggest that MPH should be a first treatment option in most patients with ADHD.

  5. Retrospective study of mistletoe ingestion.

    Science.gov (United States)

    Spiller, H A; Willias, D B; Gorman, S E; Sanftleban, J

    1996-01-01

    There are limited data concerning accidental exposure to Phoradendron flavescens (Phoradendron serotinum, American Mistletoe). The only published reports include a review of 14 cases which revealed no symptoms and a single fatality from an intentional ingestion of an unknown amount of an elixir brewed from the berries. The risk of serious toxicity from accidental exposure to this plant appears to be minimal, yet it continues to be regarded as a dangerous plant. We reviewed charts for four years (1990-1993) from three poison centers where Phoradendron flavescens is indigenous. Ninety-two human cases were located. Age ranged from four months to 42 years, with a mean of six years (SD 8.8) and median of two years. There were 14 symptomatic cases of which 11 were determined to be related to mistletoe exposure. There were six gastrointestinal upset, two mild drowsiness, one eye irritation, one ataxia (21 months), one seizure (13 months). Treatments included gastrointestinal decontamination in 54 patients (59%), ocular irrigation in one and IV benzodiazepine in one. Decontamination did not appear to affect outcome. Amount ingested ranged from one berry or leaf to more than 20 berries or five leaves. In cases with a known amount ingested, eight of ten cases with > or = 5 berries remained symptom free. In the 11 cases with leaf-only ingestion (range 1-5 leaves), three patients had gastrointestinal upset. The one case with five leaves ingested remained asymptomatic. The infant with seizures was an unwitnessed exposure, found with both berries and leaves in the crib. No arrhythmias or cardiovascular changes were reported in any case. All symptomatic cases had onset of symptoms in Cardiovascular effects were not seen.

  6. Reversal of Progressive Conscious Disturbance with Epidural Blood Patch for Cerebrospinal Fluid Leakage at C2 Level.

    Science.gov (United States)

    Lai, Yi-Chen; Chia, Yuan-Yi; Lien, Wei-Hung

    2017-03-01

    Intracranial hypotension syndrome (IHS) is generally caused by cerebrospinal fluid (CSF) leakage. Complications include bilateral subdural hygroma or haematoma and herniation of the cerebellar tonsils. Epidural blood patch (EBP) therapy is indicated if conservative treatment is ineffective. We reported the case of a 46-year-old man with a history of postural headache and dizziness. The patient was treated with bed rest and daily hydration with 2000 mL of fluid for 2 weeks. However, dizziness and headache did not resolve, and he became drowsy and disoriented with incomprehensible speech. Magnetic resonance imaging demonstrated diffuse dural enhancement on the postcontrast study, sagging of the midbrain, and CSF leakage over right lateral posterior thecal sac at C2 level. We performed EBP at the level of T10-T11. We injected 14 mL of autologous blood slowly in the Trendelenburg position. Within 30 minutes, he became alert and oriented to people, place, and time. We chose thoracic EBP as first line treatment in consideration of the risk of cervical EBP such as spinal cord and nerve root compression or puncture, chemical meningitis. Also we put our patient in Trendelenburg position to make blood travel towards the site of the leak. Untreated IHS may delay the course of resolution and affect the patient's consciousness. Delivery of EBP via an epidural catheter inserted from the thoracic spine is familiar with most of anesthesiologists. It can be a safe and effective treatment for patients with IHS caused by CSF leak even at C2.Key words: Anaesthetic techniques, regional, thoracic; cerebrospinal fluid leakage; epidural blood patch; heavily T2-weighted magnetic resonance myelography; intracranial hypotension syndrome; Trendelenburg position.

  7. HEALTH EFFECTS OF SLEEP DEPRIVATION ON NURSES WORKING SHIFTS.

    Science.gov (United States)

    Stanojevic, Cedomirka; Simic, Svetlana; Milutinovic, Dragana

    2016-10-01

    Atypical work schedules cause reduced sleep, leading to drowsiness, fatigue, decline of cognitive performance and health problems among the members of the nursing staff. The study was aimed at reviewing current knowledge and attitudes concerning the impact of sleep disorders on health and cognitive functions among the members of the nursing staff. Sleep and Interpersonal Relations in Modern Society. The modern 24-hour society involves more and more employees (health services, police departments, public transport) in non-standard forms of work. In European Union countries, over 50% of the nursing staff work night shifts, while in the United States of America 55% of nursing staff work more than 40 hours a week, and 30-70% of nurses sleep less than six hours before their shift. Cognitive Effects of Sleep Deprivation. Sleep deprivation impairs the performance of tasks that require intensive and prolonged attention which increases the number of errors in patients care, and nurses are subject to incre- ased risk of traffic accidents. Sleep Deprivation and Health Disorders. Sleep deprived members of the nursing staff are at risk of obesity, diabetes, gastrointestinal disorders and cardiovascular disease. The risk factors for breast cancer are increased by 1.79 times. and there is a significantly higher risk for colorectal carcinoma. Too long or repeated shifts reduce the opportunity for sleep, shorten recovery time in nurses, thus endangering their safety and health as well as the quality of care and patients' safety. Bearing in mind the significance of the problerm it is necessary to conduct the surveys of sleep quality and health of nurses in the Republic of Serbia as well in order to tackle this issue which is insufficiently recognized.

  8. When elephants fall asleep: A literature review on elephant rest with case studies on elephant falling bouts, and practical solutions for zoo elephants.

    Science.gov (United States)

    Schiffmann, Christian; Hoby, Stefan; Wenker, Christian; Hård, Therese; Scholz, Robert; Clauss, Marcus; Hatt, Jean-Michel

    2018-05-01

    Little attention has been paid to the resting and sleeping behavior of zoo elephants so far. An important concern is when elephants avoid lying down, due to degenerative joint and foot disease, social structure, or stressful environmental changes. Inability or unwillingness to lie down for resting is an important welfare issue, as it may impair sleep. We emphasize the importance of satisfying rest in elephants by reviewing the literature on resting behavior in elephants (Loxodonta africana and Elephas maximus) as well as the documentation of four cases from European zoos and our own direct observations in a zoo group of four female African elephants during 12 entire days. The common denominator in the case reports is the occurrence of a falling bout out of a standing position subsequently to a cessation of lying rest for different periods of time. Although well-known in horses as "episodic collapse" or "excessive drowsiness," this syndrome has not been described in elephants before. To enable its detection, we recommend nocturnal video monitoring for elephant-keeping institutions. The literature evaluation as well as own observational data suggest an inverse relationship between lying rest and standing rest. Preventative measures consist of enclosure modifications that facilitate lying rest (e.g., sand hills) or standing rest in a leaning position as a substitute. Anecdotal observations suggest that the provision of appropriate horizontal environmental structures may encourage safe, sleep-conducive standing rest. We provide drawings on how to install such structures. Effects of providing such structures should be evaluated in the future. © 2018 Wiley Periodicals, Inc.

  9. Symptom Cluster Trajectories During Chemotherapy in Breast Cancer Outpatients.

    Science.gov (United States)

    Hsu, Hsin-Tien; Lin, Kuan-Chia; Wu, Li-Min; Juan, Chiung-Hui; Hou, Ming-Feng; Hwang, Shiow-Li; Liu, Yi; Dodd, Marylin J

    2017-06-01

    Breast cancer patients often experience multiple symptoms and substantial discomfort. Some symptoms may occur simultaneously and throughout the duration of chemotherapy treatment. The aim of this study was to investigate symptom severity and symptom cluster trajectories during chemotherapy in outpatients with breast cancer in Taiwan. This prospective, longitudinal, repeated measures study administered a standardized questionnaire (M. D. Anderson Symptom Inventory Taiwan version) to 103 breast cancer patients during each day of the third 21-day cycle of chemotherapy. Latent class growth analysis was performed to examine symptom cluster trajectories. Three symptom clusters were identified within the first 14 days of the 21-day chemotherapy cycle: the neurocognition cluster (pain, shortness of breath, vomiting, memory problems, and numbness/tingling) with a trajectory of Y = 2.09 - 0.11 (days), the emotion-nausea cluster (nausea, disturbed sleep, distress/upset, drowsiness, and sadness) with a trajectory ofY = 3.57 - 0.20 (days), and the fatigue-anorexia cluster (fatigue, lack of appetite, and dry mouth) with a trajectory of Y = 4.22 - 0.21 (days). The "fatigue-anorexia cluster" and "emotion-nausea cluster" peaked at moderate levels on chemotherapy days 3-5, and then gradually decreased to mild levels within the first 14 days of the 21-day chemotherapy cycle. Distinct symptom clusters were observed during the third cycle of chemotherapy. Systematic and ongoing evaluation of symptom cluster trajectories during cancer treatment is essential. Healthcare providers can use these findings to enhance communication with their breast cancer patients and to prioritize symptoms that require attention and intervention. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  10. Efficacy and safety of Vitex agnus-castus extract for treatment of premenstrual syndrome in Japanese patients: a prospective, open-label study.

    Science.gov (United States)

    Momoeda, Mikio; Sasaki, Hidetaka; Tagashira, Eiko; Ogishima, Masayuki; Takano, Yuichi; Ochiai, Kazunori

    2014-03-01

    Herbal medicine containing Vitex agnus-castus (VAC) extract is widely used by women with premenstrual syndrome (PMS) in Europe, however, in Japan, clinical evidence remains to be determined. This study attempted to investigate the efficacy and safety profiles of VAC extract in Japanese patients with PMS. A multi-center, prospective, open-label, single-arm, phase 3 study was performed in Japanese women with PMS and aged 18-44 years. The patients received Prefemin® (Max Zeller Söhne AG, Romanshorn, Switzerland), containing 20 mg of VAC extract, once daily for three menstrual cycles. The efficacy profile was examined based on the intensity of ten PMS symptoms-irritability, depressed mood, anger, headache, bloating, breast fullness, skin disorder, fatigue, drowsiness, and sleeplessness-recorded by patients via a visual analog scale (VAS). In addition, the responder rate was calculated based on the total VAS score defined by the sum of the VAS scores of the first six symptoms mentioned above. Furthermore, physician's global assessment (PGA) scores were recorded. Adverse events including vital signs and laboratory test values were monitored as safety evaluation. Sixty-nine patients received Prefemin®. After the first menstrual cycle, a statistically significant decrease in total VAS score was observed (P<0.001), and the score continued to diminish for the following two cycles. Each of the ten symptom scores decreased significantly in this manner. In addition, the responder rate increased in a time-dependent manner; the rate at the third menstrual cycle was 91.0%, and almost all of the patients were without symptoms or exhibited only mild symptoms based on PGA. Eight patients exhibited non-serious adverse events, one of which was allergic dermatitis whose causal relationship with VAC was not ruled out. VAC extract improved PMS symptoms in Japanese patients, with no substantial adverse events. This is the first study to report the effect of VAC extract in Japanese

  11. Kangaroo supported diagonal flexion positioning: New insights into skin-to-skin contact for communication between mothers and very preterm infants.

    Science.gov (United States)

    Buil, A; Carchon, I; Apter, G; Laborne, F X; Granier, M; Devouche, E

    2016-09-01

    Skin-to-skin contact shows benefits in the relationship developed between a mother and her premature infant. In the skin-to-skin session, face-to-face exchanges are impossible in vertical infant positioning. We therefore undertook an observational, prospective, single-center study using kangaroo "supported diagonal flexion" (SDF) positioning. The first aim was to evaluate the safety of kangaroo SDF positioning compared to the usual vertical positioning. The second aim was to evaluate SDF positioning on early communication between the mother and her infant and to improve their well-being. Fifteen mothers and their very premature infants (birth 26communication with their infant were assessed through questionnaires. In terms of the infant's physiology, no negative effects were associated with SDF positioning in comparison with the usual vertical positioning. SDF positioning led to fewer disorganized gestures, negative vocalizations, and drowsiness, in favor of more deep sleep. SDF led to more mother-infant eye-to-eye contact as well as maternal vocalizations, smiles, and caressing, although these differences did not reach significance. The score for the risk of postnatal depression decreased significantly between the first and the last session in the SDF group, whereas it did not change in the vertical positioning group. These results support the idea that the kangaroo SDF positioning technique is physiologically safe, has obvious immediate benefits on mothers' infant-directed communicative behaviors, and respects the baby's naturally flexed and asymmetrical tonic neck posture. It is an innovative, inexpensive, easy-to-use technique in daily practice, by all healthcare professionals working in a neonatal intensive care unit. These data suggest that the current kangaroo positioning technique could be improved. More studies are needed to confirm the benefits and safety of the kangaroo SDF positioning in larger groups of preterm infants. Copyright © 2016 Elsevier Masson

  12. Signs and symptoms in children with a serious infection: a qualitative study

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    Aerssens Peter

    2005-08-01

    Full Text Available Abstract Background Early diagnosis of serious infections in children is difficult in general practice, as incidence is low, patients present themselves at an early stage of the disease and diagnostic tools are limited to signs and symptoms from observation, clinical history and physical examination. Little is known which signs and symptoms are important in general practice. With this qualitative study, we aimed to identify possible new important diagnostic variables. Methods Semi-structured interviews with parents and physicians of children with a serious infection. We investigated all signs and symptoms that were related to or preceded the diagnosis. The analysis was done according to the grounded theory approach. Participants were recruited in general practice and at the hospital. Results 18 children who were hospitalised because of a serious infection were included. On average, parents and paediatricians were interviewed 3 days after admittance of the child to hospital, general practitioners between 5 and 8 days after the initial contact. The most prominent diagnostic signs in seriously ill children were changed behaviour, crying characteristics and the parents' opinion. Children either behaved drowsy or irritable and cried differently, either moaning or an inconsolable, loud crying. The parents found this illness different from previous illnesses, because of the seriousness or duration of the symptoms, or the occurrence of a critical incident. Classical signs, like high fever, petechiae or abnormalities at auscultation were helpful for the diagnosis when they were present, but not helpful when they were absent. Conclusion behavioural signs and symptoms were very prominent in children with a serious infection. They will be further assessed for diagnostic accuracy in a subsequent, quantitative diagnostic study.

  13. Efficacy and Tolerability of High-Dose Escitalopram in Posttraumatic Stress Disorder.

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    Qi, Wei; Gevonden, Martin; Shalev, Arieh

    2017-02-01

    Open-label trials suggest that escitalopram (up to 20 mg/d) is an effective treatment for some, but not all posttraumatic stress disorder (PTSD) patients. Higher doses of escitalopram effectively reduced major depression symptoms in patients who had not responded to regular doses. The current study examines the efficacy, tolerability, and adherence to high-dose escitalopram in PTSD. Forty-five PTSD patients received 12 weeks of gradually increasing doses of escitalopram reaching 40 mg daily at 4 weeks. Among those, 12 participants received regular doses of antidepressants at study onset including escitalopram (n = 7). The Clinician-Administered PTSD Scale (CAPS) evaluated PTSD symptoms severity before treatment, at 3 months (upon treatment termination), and at 6 months (maintenance effect). A 20% reduction in CAPS scores was deemed clinically significant. Adverse events and medication adherence were monitored at each clinical session. Linear mixed-models analysis showed a significant reduction of mean CAPS scores (11.5 ± 18.1 points) at 3 months and maintenance of gains by 6 months (F2,34.56 = 8.15, P = 0.001). Eleven participants (34.3%) showed clinically significant improvement at 3 months. Only 9 participants (20%) left the study. There were no serious adverse events and few mild ones with only 2 adverse events (diarrhea, 11.1%; drowsiness, 11.1%) reported by more than 10% of participants. High doses of escitalopram are tolerable and well adhered to in PTSD. Their beneficial effect at a group level is due to a particularly good response in a subset of patients.Variability in prior pharmacological treatment precludes a definite attribution of the results to high doses of escitalopram.

  14. Ocular Measures of Sleepiness Are Increased in Night Shift Workers Undergoing a Simulated Night Shift Near the Peak Time of the 6-Sulfatoxymelatonin Rhythm

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    Ftouni, Suzanne; Sletten, Tracey L.; Nicholas, Christian L.; Kennaway, David J.; Lockley, Steven W.; Rajaratnam, Shantha M.W.

    2015-01-01

    Study Objectives: The study examined the relationship between the circadian rhythm of 6-sulphatoxymelatonin (aMT6s) and ocular measures of sleepiness and neurobehavioral performance in shift workers undergoing a simulated night shift. Methods: Twenty-two shift workers (mean age 33.4, SD 11.8 years) were tested at approximately the beginning (20:00) and the end (05:55) of a simulated night shift in the laboratory. At the time point corresponding to the end of the simulated shift, 14 participants were classified as being within range of 6-sulphatoxymelatonin (aMT6s) acrophase— defined as 3 hours before or after aMT6s peak—and 8 were classified as outside aMT6s acrophase range. Participants completed the Karolinska Sleepiness Scale (KSS) and the auditory psychomotor vigilance task (aPVT). Waking electroencephalography (EEG) was recorded and infrared reflectance oculography was used to collect ocular measures of sleepiness: positive and negative amplitude/velocity ratio (PosAVR, NegAVR), mean blink total duration (BTD), the percentage of eye closure (%TEC), and a composite score of sleepiness levels (Johns Drowsiness Scale; JDS). Results: Participants who were tested within aMT6s acrophase range displayed higher levels of sleepiness on ocular measures (%TEC, BTD, PosAVR, JDS), objective sleepiness (EEG delta power frequency band), subjective ratings of sleepiness, and neurobehavioral performance, compared to those who were outside aMT6s acrophase range. Conclusions: The study demonstrated that objective ocular measures of sleepiness are sensitive to circadian rhythm misalignment in shift workers. Citation: Ftouni S, Sletten TL, Nicholas CL, Kennaway DJ, Lockley SW, Rajaratnam SM. Ocular measures of sleepiness are increased in night shift workers undergoing a simulated night shift near the peak time of the 6-sulfatoxymelatonin rhythm. J Clin Sleep Med 2015;11(10):1131–1141. PMID:26094925

  15. A Review on Clinical Pharmacokinetics of Tamsulosin in Patients with Benign Prostatic Hyperplasia

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    Tolou Ghamari

    2016-08-01

    Full Text Available Context Benign prostatic hyperplasia (BPH that disturbs aged males is described as the abundant, chronic progressive disorder usually associated with lower urinary tract symptoms. The alpha 1A-adrenergic receptor antagonist, tamsulosin (Flomax®/Omnic®, seems to be an appropriate management from the view point of urological surgeons. The current review aimed to evaluate the clinical pharmacological properties of tamsulosin in prostate disorders. Evidence Acquisition United States national library of medicine (PubMed, NLM were searched from April 1991 to March 2016. The Mesh terms were: tamsulosin, tamsulosin pharmacokinetics in urology, tamsulosin in BPH and clinical pharmacokinetics of tamsulosin in BPH. Published clinical trials and review articles applicable to pharmacotherapy of tamsulosin in BPH were reviewed. Results In patients with mild international prostate symptom score (< 8 to moderate symptoms of BPH, initial treatment with an alpha 1-adrenergic antagonist monotherapy were useful. With a half-life of 9 - 13 hours, the oral bioavailability of drug was reported 100%. The drug is metabolized by liver. Excretion through renal was reported 76%. Initial dose of drug was 0.4 mg/day and the maximum dose was reported 0.8 mg/day. The drug could cause dizziness, sever drowsiness and problems in thinking, driving and many other complications. Other serious adverse reactions could be mentioned as hives, rash, itching, and difficulty in breathing, swelling of face, lips, tongue and throat. Tamsulosin therapy should be stopped in patients who experience hypotension. Conclusions To treat BPH therapeutically, it is necessary to stabilize severities of the patient’s symptoms with potential side effects of the treatment. Tamsulosin blocks alpha 1-receptors in smooth muscles both in the bladder neck and prostate, which leads to relaxation and subsequently less resistance to urinary flow. By advancement of tamsulosin, pharmacotherapy strategies could

  16. Zolpidem as a Sleep Aid for Military Aviators.

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    Sen Kew, Guan; See, Brian

    2018-04-01

    Zolpidem is a short-acting nonbenzodiazepine hypnotic that has been approved by the Republic of Singapore Air Force (RSAF) for aircrew sleep management since 2005. Prior to consuming zolpidem for operational reasons, each RSAF aircrew member is required to undergo a ground test to exclude operationally relevant adverse drug effects. This study describes the RSAF's zolpidem ground testing outcomes over a 12.5-yr period. This is a retrospective case series of 578 RSAF aircrew members who underwent zolpidem test dosing from 1 January 2005 to 30 June 2017. The median age was 29 yr (range, 19-54 yr) and the mean age was 30.1 yr ± 6.3 yr. Of the aircrew members, 568 (98.3%) were men and all were of Asian origin; 558 (96.5%) were medically cleared for the operational use of zolpidem. Among the 20 (3.5%) who failed zolpidem ground testing, next-day drowsiness (cumulative incidence, 1.04%), headache (cumulative incidence, 0.87%), and dizziness (cumulative incidence, 0.35%) were the most common causes of failure. None of the aircrew members reported abnormal sleep behaviors or major adverse drug events from zolpidem ingestion. Our results suggest a low occurrence of adverse effects among military aircrew members who undergo zolpidem test dosing prior to using the drug operationally. To our knowledge, this is the single largest published case series of zolpidem ground testing outcomes among Asian military aviators.Kew GS, See B. Zolpidem as a sleep aid for military aviators. Aerosp Med Hum Perform. 2018; 89(4):406-408.

  17. Detection of microsleep events in a car driving simulation study using electrocardiographic features

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    Lenis Gustavo

    2016-09-01

    Full Text Available Microsleep events (MSE are short intrusions of sleep under the demand of sustained attention. They can impose a major threat to safety while driving a car and are considered one of the most significant causes of traffic accidents. Driver’s fatigue and MSE account for up to 20% of all car crashes in Europe and at least 100,000 accidents in the US every year. Unfortunately, there is not a standardized test developed to quantify the degree of vigilance of a driver. To account for this problem, different approaches based on biosignal analysis have been studied in the past. In this paper, we investigate an electrocardiographic-based detection of MSE using morphological and rhythmical features. 14 records from a car driving simulation study with a high incidence of MSE were analyzed and the behavior of the ECG features before and after an MSE in relation to reference baseline values (without drowsiness were investigated. The results show that MSE cannot be detected (or predicted using only the ECG. However, in the presence of MSE, the rhythmical and morphological features were observed to be significantly different than the ones calculated for the reference signal without sleepiness. In particular, when MSE were present, the heart rate diminished while the heart rate variability increased. Time distances between P wave and R peak, and R peak and T wave and their dispersion increased also. This demonstrates a noticeable change of the autonomous regulation of the heart. In future, the ECG parameter could be used as a surrogate measure of fatigue.

  18. Validation of the FOUR Score (Spanish Version) in acute stroke: an interobserver variability study.

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    Idrovo, Luis; Fuentes, Blanca; Medina, Josmarlin; Gabaldón, Laura; Ruiz-Ares, Gerardo; Abenza, María José; Aguilar-Amat, María José; Martínez-Sánchez, Patricia; Rodríguez, Luis; Cazorla, Rubén; Martínez, Marta; Tafur, Alfonso; Wijdicks, Eelco F M; Diez-Tejedor, Exuperio

    2010-01-01

    Methods to assess impaired consciousness in acute stroke typically include the Glasgow Coma Scale (GCS), but the verbal component has limitations in aphasic or intubated patients. The FOUR (Full Outline of UnResponsiveness) score, a new coma scale, evaluates 4 components: eye and motor responses, brainstem reflexes and respiration. We aimed to study the interobserver variability of the FOUR score in acute stroke patients. We prospectively enrolled consecutive patients with acute stroke admitted from February to July 2008 to the stroke unit of our Neurology Department. Patients were evaluated by neurology residents and nurses using the FOUR score and the GCS. For both scales, we obtained paired and total weighted kappa values (Kw) and intraclass correlation coefficients (ICC). NIH stroke scale was also recorded on admission. We obtained a total of 75 paired evaluations in 60 patients (41 cerebral infarctions, 15 cerebral hemorrhages and 4 transient ischemic attacks). Thirty-three (55%) patients were alert, 17 (28.3%) drowsy and 10 (16.7%) stuporous or comatose. The overall rater agreement was excellent in the FOUR score (Kw 0.93; 95% CI 0.89-0.97) with an ICC of 0.94 (95% CI 0.91-0.96) and in the GCS (Kw 0.96; 95% CI 0.94-0.98) with an ICC of 0.96 (95% CI 0.93-0.97). A good correlation was found between the FOUR score and the GCS (rho 0.83; p FOUR score and the NIH stroke scale (rho -0.78; p FOUR score is a reliable scale for evaluating the level of consciousness in acute stroke patients, showing a good correlation with the GCS and the NIH stroke scale. Copyright 2010 S. Karger AG, Basel.

  19. Gabapentin for overactive bladder and nocturia after anticholinergic failure

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    Yong T. Kim

    2004-08-01

    Full Text Available INTRODUCTION: We reviewed our experience with the use of gabapentin to treat symptoms of overactive bladder (OAB and nocturia in patients who have failed conventional anticholinergic therapy. METHODS: Thirty-one patients referred to us with refractory (OAB and/or nocturia were treated with oral gabapentin. All the patients had tried or remained on antimuscarinic drugs during treatment. Twenty-four of 31 complained of bothersome symptoms during day and night and the other seven had primary complaints of nocturia. Initial gabapentin doses ranged from 100-300 mg at bedtime. Dose was slowly titrated up to 3,000 mg based on patients' symptomatology and tolerability. RESULTS:The mean age was 51 years old (range 27-78. There were 13 men and 18 women. The median steady state dose chosen by the patient after initial titration was 600 mg/day. Fourteen of 31 patients reported subjective improvement of their frequency and 8 have been on the medication for over 12 months with persistent efficacy. For the 14 improved patients, mean frequency/24 hours decreased from 14.1 ± 2.2 to10.0 + 2.1. Three patients with primary nocturia reported improvement from a mean of 4.0 ± 1.3 to 1.0 ± 0.3 episodes/night. Six patients stopped taking the drug within one month due to side effects mostly described as drowsiness or lethargy. CONCLUSION: Fourteen of 31 patients with refractory (OAB and nocturia improved with oral gabapentin. Gabapentin was generally well tolerated and can be considered in selective patients when conventional modalities have failed.

  20. Exercise and sleep in aging: emphasis on serotonin.

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    Melancon, M O; Lorrain, D; Dionne, I J

    2014-10-01

    Reductions in central serotonin activity with aging might be involved in sleep-related disorders in later life. Although the beneficial effects of aerobic exercise on sleep are not new, sleep represents a complex recurring state of unconsciousness involving many lines of transmitters which remains only partly clear despite intense ongoing research. It is known that serotonin released into diencephalon and cerebrum might play a key inhibitory role to help promote sleep, likely through an active inhibition of supraspinal neural networks. Several lines of evidence support the stimulatory effects of exercise on higher serotonergic pathways. Hence, exercise has proved to elicit acute elevations in forebrain serotonin concentrations, an effect that waned upon cessation of exercise. While adequate exercise training might lead to adaptations in higher serotonergic networks (desensitization of forebrain receptors), excessive training has been linked to serious brain serotonergic maladaptations accompanied by insomnia. Dietary supplementation of tryptophan (the only serotonin precursor) is known to stimulate serotonergic activity and promote sleep, whereas acute tryptophan depletion causes deleterious effects on sleep. Regarding sleep-wake regulation, exercise has proved to accelerate resynchronization of the biological clock to new light-dark cycles following imposition of phase shifts in laboratory animals. Noteworthy, the effect of increased serotonergic transmission on wake state appears to be biphasic, i.e. promote wake and thereafter drowsiness. Therefore, it might be possible that acute aerobic exercise would act on sleep by increasing activity of ascending brain serotonergic projections, though additional work is warranted to better understand the implication of serotonin in the exercise-sleep axis. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  1. Acute effect of carbamazepine on corticothalamic 5-9-Hz and thalamocortical spindle (10-16-Hz) oscillations in the rat.

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    Zheng, Thomas W; O'Brien, Terence J; Kulikova, Sofya P; Reid, Christopher A; Morris, Margaret J; Pinault, Didier

    2014-03-01

    A major side effect of carbamazepine (CBZ), a drug used to treat neurological and neuropsychiatric disorders, is drowsiness, a state characterized by increased slow-wave oscillations with the emergence of sleep spindles in the electroencephalogram (EEG). We conducted cortical EEG and thalamic cellular recordings in freely moving or lightly anesthetized rats to explore the impact of CBZ within the intact corticothalamic (CT)-thalamocortical (TC) network, more specifically on CT 5-9-Hz and TC spindle (10-16-Hz) oscillations. Two to three successive 5-9-Hz waves were followed by a spindle in the cortical EEG. A single systemic injection of CBZ (20 mg/kg) induced a significant increase in the power of EEG 5-9-Hz oscillations and spindles. Intracellular recordings of glutamatergic TC neurons revealed 5-9-Hz depolarizing wave-hyperpolarizing wave sequences prolonged by robust, rhythmic spindle-frequency hyperpolarizing waves. This hybrid sequence occurred during a slow hyperpolarizing trough, and was at least 10 times more frequent under the CBZ condition than under the control condition. The hyperpolarizing waves reversed at approximately -70 mV, and became depolarizing when recorded with KCl-filled intracellular micropipettes, indicating that they were GABAA receptor-mediated potentials. In neurons of the GABAergic thalamic reticular nucleus, the principal source of TC GABAergic inputs, CBZ augmented both the number and the duration of sequences of rhythmic spindle-frequency bursts of action potentials. This indicates that these GABAergic neurons are responsible for the generation of at least the spindle-frequency hyperpolarizing waves in TC neurons. In conclusion, CBZ potentiates GABAA receptor-mediated TC spindle oscillations. Furthermore, we propose that CT 5-9-Hz waves can trigger TC spindles. © 2013 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

  2. Evaluation of nitrous oxide-oxygen and triclofos sodium as conscious sedative agents

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    Priya Subramaniam

    2017-01-01

    Full Text Available Background: Conscious sedation is used in the pediatric dentistry to reduce fear and anxiety in children and promote favorable treatment outcomes. To achieve them, the primary clinical need is for a well-tolerated, effective, and expedient analgesic and sedative agent that is safe to use. Aim: The aim of the present study was to evaluate the efficacy of nitrous oxide-oxygen and triclofos sodium as conscious sedative agents in 5–10-year-old children. Methodology: Sixty children aged 5–10 years showing anxious, uncooperative, and apprehensive behavior were randomly divided and assigned into two groups (Groups A and B such that Group A received 40% nitrous oxide-60% oxygen and Group B received triclofos sodium in the dose of 70 mg/kg body weight, given 30 min before the treatment procedure. During the whole course of sedation procedure, the response of the child was assessed using Houpt's behavior rating scale. The acceptance of route of drug administration by the patient and parent was also assessed. Data obtained were statistically evaluated using the Mann–Whitney U-test and Chi-square test. Results: Children sedated with triclofos sodium were significantly more drowsy and disoriented compared to those sedated with nitrous oxide. The overall behavior of children in both the groups was similar. Good parental acceptance was observed for both the routes of administration. Patients accepted the oral route significantly better than inhalation route. Conclusion: Both nitrous oxide-oxygen and triclofos sodium were observed to be effective sedative agents, for successful and safe use in 5–10-year-old dental patients. Patients showed a good acceptance of the oral route compared to the inhalation route for sedation.

  3. Increased neuronal firing in resting and sleep in areas of the macaque medial prefrontal cortex.

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    Gabbott, Paul L; Rolls, Edmund T

    2013-06-01

    The medial prefrontal cortex (mPFC) of humans and macaques is an integral part of the default mode network and is a brain region that shows increased activation in the resting state. A previous paper from our laboratory reported significantly increased firing rates of neurons in the macaque subgenual cingulate cortex, Brodmann area (BA) 25, during disengagement from a task and also during slow wave sleep [E.T. Rolls et al. (2003) J. Neurophysiology, 90, 134-142]. Here we report the finding that there are neurons in other areas of mPFC that also increase their firing rates during disengagement from a task, drowsiness and eye-closure. During the neurophysiological recording of single mPFC cells (n = 249) in BAs 9, 10, 13 m, 14c, 24b and especially pregenual area 32, populations of neurons were identified whose firing rates altered significantly with eye-closure compared with eye-opening. Three types of neuron were identified: Type 1 cells (28.1% of the total population) significantly increased (mean + 329%; P ≪ 0.01) their average firing rate with eye-closure, from 3.1 spikes/s when awake to 10.2 spikes/s when asleep; Type 2 cells (6.0%) significantly decreased (mean -68%; P areas of mPFC, implicated in the anterior default mode network, there is a substantial population of neurons that significantly increase their firing rates during periods of eye-closure. Such neurons may be part of an interconnected network of distributed brain regions that are more active during periods of relaxed wakefulness than during attention-demanding tasks. © 2013 Federation of European Neuroscience Societies and Blackwell Publishing Ltd.

  4. Derrame pericárdico grave en un paciente con hipotiroidismo Severe pericardial effusion in a patient with hypothyroidism

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    María Norbelis Viamonte Tapia

    2012-12-01

    Full Text Available Se expone el caso clínico de un paciente de 40 años de edad, con aparente buena salud, atendido en el Hospital Clinicoquirúrgico Docente "Dr. Joaquín Castillo Duany" de Santiago de Cuba por presentar, desde hacía varios meses, dolor abdominal en epigastrio, no irradiado, asociado a molestia en la región anterior del tórax, dificultad para respirar, hinchazón en las piernas, decaimiento, somnolencia y dolores articulares, así como andar lento y disminución de la memoria, entre otros síntomas. Los resultados de los exámenes complementarios confirmaron que se trataba de un derrame pericárdico de causa hipotiroidea. Se indicó tratamiento sustitutivo con hormonas tiroideas (levotiroxina sódica. Evolucionó favorablemente y egresó de la institución hospitalaria, pero fue reevaluado a los 3 meses, observándose una mejoría significativa.The case of an apparently healthy 40 year-old patient is reported, who was attended in "Dr. Joaquín Castillo Duany" Clinical Surgical Hospital of Santiago de Cuba to present with epigastric abdominal pain for several months, no irradiated and associated with discomfort in anterior chest, breathing difficulty, swelling of the legs, weakness, drowsiness and joint pains, as well as slow gait, impaired memory, and other symptoms. The results of additional tests confirmed a pericardial effusion of hypothyroid cause. A replacement therapy was administered with thyroid hormones (sodium levothyroxine. He made good progress and was discharged from the hospital, but he was reevaluated at 3 months and a significant improvement was observed.

  5. Effects of radiotherapy for brain metastases on quality of life (QoL). Prospective pilot study of the DEGRO QoL working party

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    Steinmann, Diana; Bruns, Frank [Medical School, Hannover (Germany). Radiation Oncology; Schaefer, Christof; Hipp, Matthias [Regensburg Univ. (Germany). Radiation Oncology; Oorschot, Birgitt van [Wuerzburg Univ. (Germany). Radiation Oncology; Wypior, Hans-Joachim [Hospital Landshut (Germany). Radiation Oncology; Boelling, Tobias [Muenster Univ. (Germany). Radiation Oncology; Sehlen, Susanne [Ludwig Maximilians Univ., Muenchen (Germany). Radiation Oncology; Hagg, Juliane [Ulm Univ. (Germany). Radiation Oncology; Bayerl, Anja [Hospital Krems (Austria). Radiation Oncology; Geinitz, Hans [Technical Univ. Muenchen (Germany). Radiation Oncology; Vordermark, Dirk [Halle-Wittenberg Univ., Halle (Germany). Radiation Oncology

    2009-03-15

    Background: Prospective data on quality-of-life (QoL) effects of radiotherapy for brain metastases are currently lacking, but would be of great interest to guide therapeutic decisions. Patients and Methods: From 01/2007 to 08/2007, 46 patients with previously untreated brain metastases were recruited at eight centers. QoL was measured at start of treatment (T{sub 0}) and at 3 months ({sub T3mo}). In the pilot study, two combinations of QoL instruments could be used at the discretion of the centers (A: EORTC QLQ-C30 and B: EORTC QLQ-C15-PAL both with brain module BN20, assessment by proxies with A: Palliative Care Outcome Scale, B: self-constructed brain-specific instrument). Results: All patients received whole-brain radiotherapy, four with an additional boost irradiation. At T{sub 3mo}, 26/46 patients (56.5%) had died. 17/20 survivors (85%) completed the questionnaires. In 3-month survivors, QoL deteriorated in most domains, significant in drowsiness, hair loss and weakness of legs. The scores for headaches and seizures were slightly better after 3 months. Assessment by proxies also suggested worsening of QoL. Initial QoL at T{sub 0} was better in those alive than in those deceased at T{sub 3mo}, significant for physical function and for the symptom scales of fatigue and pain, motor dysfunction, communication deficit and weakness of legs. Conclusion: Practicability and compliance appeared better with the (shorter) version B. This version is now used in the ongoing main phase of the study with additional centers. First results indicate a moderate worsening of QoL during the first 3 months after start of palliative radiotherapy for brain metastases. QoL at initiation of radiotherapy may be prognostic for survival. (orig.)

  6. A randomized double-blind crossover comparison of continuous and intermittent subcutaneous administration of opioid for cancer pain.

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    Watanabe, Sharon; Pereira, Jose; Tarumi, Yoko; Hanson, John; Bruera, Eduardo

    2008-05-01

    ABSTRACT Although the preferred route of opioid administration is oral, patients with cancer often require an alternative route. Options include continuous subcutaneous infusion (CSCI) or regularly scheduled intermittent subcutaneous injections (ISCI). CSCI maintains steady drug levels, theoretically avoiding the "bolus effect" of nausea and sedation immediately post-dose, and breakthrough pain prior to the next dose. However, portable infusion pumps can be costly to use. The Edmonton Injector is an inexpensive portable device for ISCI. CSCI and ISCI have not been directly compared. The objective of this trial was to compare CSCI and ISCI of opioid for treatment of cancer pain. Patients were recruited from two tertiary palliative care units. Eligibility criteria included stable cancer pain requiring opioid therapy, need for parenteral route, and normal cognition. Patients were randomly assigned to receive opioid by CSCI by portable pump or ISCI by Edmonton Injector for 48 hours, followed by crossover to the alternative modality for 48 hours. During each phase, placebo was administered by the alternative modality. The study was closed after 12 patients were entered, due to slow accrual. Eleven patients completed the study. There were no differences between CSCI and ISCI in mean visual analogue score (VAS) for pain, nausea or drowsiness; categorical rating score of pain; number of breakthrough opioid doses per day; global rating of treatment effectiveness; or adverse effects. In all cases, patients and investigators expressed no preference for one modality over another. Further research is required to confirm that opioid administration by CSCI and ISCI provide similar analgesic and adverse effects.

  7. Association between desloratadine and prednisolone in the treatment of children with acute symptoms of allergic rhinitis: a double-blind, randomized and controlled clinical trial

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    Gustavo F. Wandalsen

    Full Text Available Abstract Introduction: A combination of antihistamines and oral corticosteroids is often used to treat acute symptoms of allergic rhinitis. Objective: To evaluate safety and efficacy of desloratadine plus prednisolone in the treatment of acute symptoms of children (2-12 years with allergic rhinitis, and to compare it to dexchlorpheniramine plus betamethasone. Methods: Children with moderate/severe persistent allergic rhinitis and symptomatic (nasal symptoms score [0-12] ≥ 6 were allocated in a double-blind, randomized fashion to receive dexchlorpheniramine plus betamethasone (n = 105; three daily doses or desloratadine plus prednisolone (n = 105; single dose followed by two of placebo for 7 days. At the beginning and end of the evaluation, the following were obtained: nasal symptoms score, extra nasal symptoms score, peak nasal inspiratory flow, blood biochemistry, and electrocardiogram. Ninety-six children of the dexchlorpheniramine plus betamethasone group and 98 of the desloratadine plus prednisolone group completed the protocol. Results: The two groups were similar regarding initial and final nasal symptoms scores, extra nasal symptoms scores and peak nasal inspiratory flow. A drop of 76.4% and 79.1% for nasal symptoms score, 86.0% and 79.2% for extra nasal symptoms score, as well as an increase of 25.2% and 24.3% for peak nasal inspiratory flow occurred for those treated with desloratadine plus prednisolone and dexchlorpheniramine plus betamethasone, respectively. There were no significant changes in blood chemistry. Sinus tachycardia was the most frequent electrocardiogram change, but with no clinical significance. Drowsiness was reported significantly more often among those of dexchlorpheniramine plus betamethasone group (17.14% × 8.57%, respectively. Conclusion: The desloratadine plus prednisolone combination was able to effectively control acute symptoms of rhinitis in children, improving symptoms and nasal function. Compared to the

  8. Multidisciplinary Team Contributions Within a Dedicated Outpatient Palliative Radiotherapy Clinic: A Prospective Descriptive Study

    International Nuclear Information System (INIS)

    Pituskin, Edith; Fairchild, Alysa; Dutka, Jennifer; Gagnon, Lori; Driga, Amy; Tachynski, Patty; Borschneck, Jo-Ann; Ghosh, Sunita

    2010-01-01

    Purpose: Patients with bone metastases may experience pain, fatigue, and decreased mobility. Multiple medications for analgesia are often required, each with attendant side effects. Although palliative-intent radiotherapy (RT) is effective in decreasing pain, additional supportive care interventions may be overlooked. Our objective was to describe the feasibility of multidisciplinary assessment of patients with symptomatic bone metastases attending a dedicated outpatient palliative RT clinic. Methods and Materials: Consecutive patients referred for RT for painful bone metastases were screened for symptoms and needs relevant to their medications, nutritional intake, activities of daily living, and psychosocial and spiritual concerns from January 1 to December 31, 2007. Consultations by appropriate team members and resulting recommendations were collected prospectively. Patients who received RT were contacted by telephone 4 weeks later to assess symptom outcomes. Results: A total of 106 clinic visits by 82 individual patients occurred. As determined by screening form responses, the clinical Pharmacist, Occupational Therapist, Registered Dietician and Social Worker were consulted to provide assessments and recommendations within the time constraints presented by 1-day palliative RT delivery. In addition to pain relief, significant improvements in tiredness, depression, anxiety, drowsiness and overall well-being were reported at 4 weeks. Conclusions: Systematic screening of this population revealed previously unmet needs, addressed in the form of custom verbal and written recommendations. Multidisciplinary assessment is associated with a high number of recommendations and decreased symptom distress. Our findings lend strong support to the routine assessment by multiple supportive care professionals for patients with advanced cancer being considered for palliative RT.

  9. Laxative-induced rhabdomyolysis

    Directory of Open Access Journals (Sweden)

    Alfonso Merante

    2010-03-01

    Full Text Available Alfonso Merante1, Pietro Gareri2,3, Norma Maria Marigliano2, Salvatore De Fazio2, Elvira Bonacci1, Carlo Torchia1, Gaetano Russo1, Pasquale Lacroce1, Roberto Lacava3, Alberto Castagna3, Giovambattista De Sarro2, Giovanni Ruotolo11Geriatrist, Geriatric Unit “Pugliese-Ciaccio” Hospital, Catanzaro, Italy; 2Department of Experimental and Clinical Medicine, Faculty of Medicine and Surgery, University Magna Graecia of Catanzaro, Clinical Pharmacology and Pharmacovigilance Unit, Mater Domini University Hospital, Catanzaro, Italy; 3Geriatrist, Operative Unit Elderly Health Care, Catanzaro, ItalyAbstract: The present study describes a case of laxative-induced rhabdomyolysis in an elderly patient. An 87-year-old woman was hospitalized for the onset of confusion, tremors, an inability to walk, and a fever that she had been experiencing for 36 hours. She often took high dosages of lactulose and sorbitol syrup as a laxative (about 70 g/day. During her physical examination, the patient was confused, drowsy, and she presented hyposthenia in her upper and lower limbs, symmetric and diffuse moderate hyporeflexia, and her temperature was 37.8°C. Laboratory tests revealed severe hyponatremia with hypokalemia, hypocalcemia, hypochloremia, and metabolic alkalosis. Moreover, rhabdomyolysis markers were found. The correction of hydroelectrolytic imbalances with saline, potassium and sodium chlorure, calcium gluconate was the first treatment. During her hospitalization the patient presented acute delirium, treated with haloperidol and prometazine chloridrate intramuscularly. She was discharged 12 days later, after resolution of symptoms, and normalized laboratory tests. Over-the-counter drugs such as laxatives are usually not considered dangerous; on the other hand, they may cause serum electrolytic imbalance and rhabdomyolysis. A careful monitoring of all the drugs taken by the elderly is one of the most important duties of a physician since drug interactions and

  10. Two cases of subdural hematoma with niveau formation on CT

    International Nuclear Information System (INIS)

    Shimizu, Satoshi; Fukuda, Atsuhiro; Sato, Masaharu; Kohama, Akitsugu

    1984-01-01

    The authors report a case of a bilateral chronic subdural hematoma with niveau formation and another rare case of an acute subdural hematoma with niveau formation on plain CT. The different mechanisms of the niveau formation in these cases are speculated about. The first case was a 75-year-old male who showed a drowsy state, urinary incontinence, and muscle weakness of the bilateral lower limbs. No definite history of head trauma could be found. A plain CT scan showed a bilateral-crescent type fluid collection with niveau formation, consisting of a low-density area in the upper part and a high-density area in the lower part. An operation showed bilateral, moderately encapsulated subdural hematomas; they were evacuated. The second case was a 61-year-old male with head trauma due to a fall from a ladder. On admission, neurological examination revealed a decerebrate posture, a deep coma, and anisocoria. A plain CT scan twenty hours after the onset showed a crescent-type fluid collection with niveau formation in the left fronto-parietal region. The operation showed an acute subdural hematoma containing xanthochromic fluid and coagulated blood. No capsule of hematoma could be seen. The incidence of niveau formation in chronic subdural hematomas is not low (5 - 20%); such niveau formation is thought to be caused by rebleeding into the hematoma and the spending of considerable time in the supine position. On the other hand, no case of an acute subdural hematoma with niveau formation has previously been reported. With regard to this mechanism of niveau formation, we speculate that the hematoma is mixed with cerebrospinal fluid from the arachnoidal tear caused by the head trauma; also, a considerable time in the supine position is necessary. (author)

  11. Was Ugo Foscolo (1778-1827) affected by alpha-1 antitrypsin deficiency?

    Science.gov (United States)

    Perciaccante, A; Negri, C; Coralli, A; Charlier, P; Appenzeller, O; Bianucci, R

    2018-02-01

    Niccolò Ugo Foscolo (1778-1827), known as Ugo, is one of the masters of the Italian poetry. A writer and a revolutionary, he embraced the ideals of the French Revolution and took part in the stormy political discussions, which the fall of the Republic of Venice had provoked. Despite his poor health, Foscolo lived an adventurous life serving as a volunteer in the Guardia Nazionale and in the Napoleonic army. Following Napoleon's fall (1814), he went into voluntary exile in early 1815. He reached London in Sept. 1816 and lived in poverty at Turnham Green (Chiswick) until his premature death. Foscolo's medical history has been poorly investigated and the cause of his death remains unclear. In an attempt to shed light on his clinical history, we analyzed his Correspondence (Epistolario), a series of more than 3000 letters written between 1794 and 1827. From the age of 26 (1808), Foscolo had frequent episodes of cough and dyspnea that progressively worsened. Four acute respiratory exacerbations occurred in 1812. Between September 1812 and April 1813, he had breathlessness as that of asthma. Frail and ailing, he developed a chronic liver disease in 1826. In August 1827, weakness, dyspepsia and drowsiness further increased and dropsy became manifest. He went into coma on September 7, 1827 and died aged 49 three days later. Based on a brief history of urethritis and urinary obstructions (1811-1812), previous scholars have suggested that Foscolo had urethral stenosis that caused a chronic bladder outlet obstruction and led to consequent renal failure. This hypothesis, however, does not mention the respiratory symptomatology present since 1804, which is a pivotal feature of Foscolo's illness. We surmise that Foscolo suffered from alpha-1 anti trypsin (AAT) deficiency, a rare genetic disease, which caused his premature death and support our interpretation with documental evidence. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Bilateral cerebellar and brain stem infarction resulting from vertebral artery injury following cervical trauma without radiographic damage of the spinal column: A case report

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    Mimata, Yoshikuni; Sato, Kotaro; Suzuki, Yoshiaki [Iwate Prefectural Chubu Hospital, Department of Orthopaedic Surgery, Kitakami (Japan); Murakami, Hideki [Iwate Medical University, Department of Orthopaedic Surgery, School of Medicine, Morioka (Japan)

    2014-01-15

    Vertebral artery injury can be a complication of cervical spine injury. Although most cases are asymptomatic, the rare case progresses to severe neurological impairment and fatal outcomes. We experienced a case of bilateral cerebellar and brain stem infarction with fatal outcome resulting from vertebral artery injury associated with cervical spine trauma. A 69-year-old male was admitted to our hospital because of tetraplegia after falling down the stairs and hitting his head on the floor. Marked bony damage of the cervical spine was not apparent on radiographs and CT scans, so the injury was initially considered to be a cervical cord injury without bony damage. However, an intensity change in the intervertebral disc at C5/C6, and a ventral epidural hematoma were observed on MRI. A CT angiogram of the neck showed the right vertebral artery was completely occluded at the C4 level of the spine. Forty-eight hours after injury, the patient lapsed into drowsy consciousness. The cranial CT scan showed a massive low-density area in the bilateral cerebellar hemispheres and brain stem. Anticoagulation was initiated after a diagnosis of the right vertebral artery injury, but the patient developed bilateral cerebellar and brain stem infarction. The patient's brain herniation progressed and the patient died 52 h after injury. We considered that not only anticoagulation but also treatment for thrombosis would have been needed to prevent cranial embolism. We fully realize that early and appropriate treatment are essential to improve the treatment results, and constructing a medical system with a team of orthopedists, radiologists, and neurosurgeons is also very important. (orig.)

  13. Mercury toxicity following unauthorized siddha medicine intake – A mimicker of acquired neuromyotonia - Report of 32 cases

    Directory of Open Access Journals (Sweden)

    G Gnanashanmugam

    2018-01-01

    Full Text Available Context: Mercury is used extensively in the preparation of Siddha medicines, after purification. In this study, we present 32 patients of mercury toxicity following unauthorized Siddha medicine intake who mimicked neuromyotonia clinically. We analyzed the clinical features of these patients, the role of autoimmunity in etiopathology, and compared it with acquired neuromyotonia. Subjects and Methods: This is a retrospective study to analyze inpatients in a tertiary care center, admitted with mercury toxicity following Siddha medicine intake from August 2012 to October 2016. We analyzed the clinical features, laboratory data including mercury, arsenic and lead levels in blood, and serum voltage-gated potassium channels (VGKC-CASPR2 Ab in selected patients. Results: Thirty-two patients who had high blood mercury levels following Siddha medicine intake were included in the study. All patients (100% had severe intractable neuropathic pain predominantly involving lower limbs. Twenty-six (81.25% patients had fasciculations and myokymia. Fifteen patients (46.86% had autonomic dysfunction (postural hypotension and resting tachycardia. Nine (28.12% patients had encephalopathic features such as dullness, apathy, drowsiness, or delirium. Anti-VGKC Ab was positive in 12 patients with myokymia. All the patients in the study consumed Siddha medicines obtained from unauthorized dealers. Conclusions: Mercury toxicity following Siddha medicine intake closely mimics acquired neuromyotonia; severe intolerable neuropathic pain is the hallmark feature; Positive VGKC-CASPR2 antibody in some patients must be due to triggered autoimmunity secondary to mercury toxicity due to Siddha medicine intake. The government should establish licensing system to prevent distribution of unauthorized Siddha medicines.

  14. Mercury Toxicity Following Unauthorized Siddha Medicine Intake – A Mimicker of Acquired Neuromyotonia - Report of 32 Cases

    Science.gov (United States)

    Gnanashanmugam, G.; Balakrishnan, R.; Somasundaram, S. P.; Parimalam, N.; Rajmohan, P.; Pranesh, M. B.

    2018-01-01

    Context: Mercury is used extensively in the preparation of Siddha medicines, after purification. In this study, we present 32 patients of mercury toxicity following unauthorized Siddha medicine intake who mimicked neuromyotonia clinically. We analyzed the clinical features of these patients, the role of autoimmunity in etiopathology, and compared it with acquired neuromyotonia. Subjects and Methods: This is a retrospective study to analyze inpatients in a tertiary care center, admitted with mercury toxicity following Siddha medicine intake from August 2012 to October 2016. We analyzed the clinical features, laboratory data including mercury, arsenic and lead levels in blood, and serum voltage-gated potassium channels (VGKC)-CASPR2 Ab in selected patients. Results: Thirty-two patients who had high blood mercury levels following Siddha medicine intake were included in the study. All patients (100%) had severe intractable neuropathic pain predominantly involving lower limbs. Twenty-six (81.25%) patients had fasciculations and myokymia. Fifteen patients (46.86%) had autonomic dysfunction (postural hypotension and resting tachycardia). Nine (28.12%) patients had encephalopathic features such as dullness, apathy, drowsiness, or delirium. Anti-VGKC Ab was positive in 12 patients with myokymia. All the patients in the study consumed Siddha medicines obtained from unauthorized dealers. Conclusions: Mercury toxicity following Siddha medicine intake closely mimics acquired neuromyotonia; severe intolerable neuropathic pain is the hallmark feature; Positive VGKC-CASPR2 antibody in some patients must be due to triggered autoimmunity secondary to mercury toxicity due to Siddha medicine intake. The government should establish licensing system to prevent distribution of unauthorized Siddha medicines. PMID:29720798

  15. Mercury Toxicity Following Unauthorized Siddha Medicine Intake - A Mimicker of Acquired Neuromyotonia - Report of 32 Cases.

    Science.gov (United States)

    Gnanashanmugam, G; Balakrishnan, R; Somasundaram, S P; Parimalam, N; Rajmohan, P; Pranesh, M B

    2018-01-01

    Mercury is used extensively in the preparation of Siddha medicines, after purification. In this study, we present 32 patients of mercury toxicity following unauthorized Siddha medicine intake who mimicked neuromyotonia clinically. We analyzed the clinical features of these patients, the role of autoimmunity in etiopathology, and compared it with acquired neuromyotonia. This is a retrospective study to analyze inpatients in a tertiary care center, admitted with mercury toxicity following Siddha medicine intake from August 2012 to October 2016. We analyzed the clinical features, laboratory data including mercury, arsenic and lead levels in blood, and serum voltage-gated potassium channels (VGKC)-CASPR2 Ab in selected patients. Thirty-two patients who had high blood mercury levels following Siddha medicine intake were included in the study. All patients (100%) had severe intractable neuropathic pain predominantly involving lower limbs. Twenty-six (81.25%) patients had fasciculations and myokymia. Fifteen patients (46.86%) had autonomic dysfunction (postural hypotension and resting tachycardia). Nine (28.12%) patients had encephalopathic features such as dullness, apathy, drowsiness, or delirium. Anti-VGKC Ab was positive in 12 patients with myokymia. All the patients in the study consumed Siddha medicines obtained from unauthorized dealers. Mercury toxicity following Siddha medicine intake closely mimics acquired neuromyotonia; severe intolerable neuropathic pain is the hallmark feature; Positive VGKC-CASPR2 antibody in some patients must be due to triggered autoimmunity secondary to mercury toxicity due to Siddha medicine intake. The government should establish licensing system to prevent distribution of unauthorized Siddha medicines.

  16. The effect of autogenic training and biofeedback on motion sickness tolerance.

    Science.gov (United States)

    Jozsvai, E E; Pigeau, R A

    1996-10-01

    Motion sickness is characterized by symptoms of vomiting, drowsiness, fatigue and idiosyncratic changes in autonomic nervous system (ANS) responses such as heart rate (HR) and skin temperature (ST). Previous studies found that symptoms of motion sickness are controllable through self-regulation of ANS responses and the best method to teach such control is autogenic-feedback (biofeedback) training. Recent experiments indicated that biofeedback training is ineffective in reducing symptoms of motion sickness or in increasing tolerance to motion. If biofeedback facilitates learning of ANS self-regulation then autogenic training with true feedback (TFB) should lead to better control over ANS responses and better motion tolerance than autogenic training with false feedback (FFB). If there is a relationship between ANS self-regulation and coping with motion stress, a significant correlation should be found between amounts of control over ANS responses and measures of motion tolerance and/or symptoms of motion sickness. There were 3 groups of 6 subjects exposed for 6 weeks to weekly sessions of Coriolis stimulation to induce motion sickness. Between the first and second Coriolis sessions, subjects in the experimental groups received five episodes of autogenic training with either true (group TFB) or false (group FFB) feedback on their HR and ST. The control group (CTL) received no treatment. Subjects learned to control their HR and ST independent of whether they received true or false feedback. Learned control of ST and HR was not related to severity of motion sickness or subject's ability to withstand Coriolis stimulation following treatment. A lack of significant correlation between these variables suggested that subjects were not able to apply their skills of ANS self-regulation in the motion environment, and/ or such skills had little value in reducing symptoms of motion sickness or enhancing their ability to withstand rotations.

  17. A COMPARATIVE STUDY OF EFFICACY AND TOLERABILITY OF TRAMADOL AND ACECLOFENAC IN TREATMENT OF OSTEOARTHRITIS

    Directory of Open Access Journals (Sweden)

    Ganga

    2016-02-01

    nausea, dyspepsia, epigastric distress, drowsiness. CONCLUSION Aceclofenac is efficacious and safer drug than Tramadol in treatment of osteoarthritis of knee.

  18. Benign focal epilepsy of childhood with centrotemporal spikes (BECTS: clinical characteristics of seizures according to age at first seizure

    Directory of Open Access Journals (Sweden)

    Miziara Carmen Silvia M.G.

    2002-01-01

    Full Text Available BECTS is characterized by the presence of simple partial motor seizures in the face and/or oropharynx, with or without sensory symptoms and often with secondary generalization. These seizures tend to occur more often during sleep or drowsiness. According to some authors, generalized seizures prevail over other types particularly among children aged five or less. The purpose of this study is to determine the characteristics of the first epileptic episode among children with BECTS, grouped by age as of their first epileptic seizure, as well as to analyze how such seizures change over the course of clinical evolution. A total of 61 children were examined, 16 of whom below the age of 5 and 45 above. With regard to the first and recurrent epileptic episodes, our final assessment showed that partial seizures occurred more frequently than generalized tonic-clonic seizures in both groups. Although no conclusive relation could be established between the type of partial seizure (i.e. simple versus complex and the children's age as of their first epileptic episode, it was possible to correlate the type of epileptic seizure with their clinical evolution, in which case simple partial seizures proved to be more frequent than complex partial seizures. It should be noted that the number of children under the age of five was relatively small, which evinces the need for further studies. It should also be borne in mind that the reported frequency of generalized seizures in these children's first epileptic episode may be due to their parents' lack of attention and familiarity with this pathology and their attendant difficulty in characterizing its clinical symptoms.

  19. Symptom Clusters and Quality of Life in Hospice Patients with Cancer

    Science.gov (United States)

    Omran, Suha; Khader, Yousef; McMillan, Susan

    2017-09-27

    Background: Symptom control is an important part of palliative care and important to achieve optimal quality of life (QOL). Studies have shown that patients with advanced cancer suffer from diverse and often severe physical and psychological symptoms. The aim is to explore the influence of symptom clusters on QOL among patients with advanced cancer. Materials and Methods: 709 patients with advanced cancer were recruited to participate in a clinical trial focusing on symptom management and QOL. Patients were adults newly admitted to hospice home care in one of two hospices in southwest Florida, who could pass mental status screening. The instruments used for data collection were the Demographic Data Form, Memorial Symptom Assessment Scale (MSAS), and the Hospice Quality of Life Index-14. Results: Exploratory factor analysis and multiple regression were used to identify symptom clusters and their influence on QOL. The results revealed that the participants experienced multiple concurrent symptoms. There were four symptom clusters found among these cancer patients. Individual symptom distress scores that were the strongest predictors of QOL were: feeling pain; dry mouth; feeling drowsy; nausea; difficulty swallowing; worrying and feeling nervous. Conclusions: Patients with advanced cancer reported various concurrent symptoms, and these form symptom clusters of four main categories. The four symptoms clusters have a negative influence on patients’ QOL and required specific care from different members of the hospice healthcare team. The results of this study should be used to guide health care providers’ symptom management. Proper attention to symptom clusters should be the basis for accurate planning of effective interventions to manage the symptom clusters experienced by advanced cancer patients. The health care provider needs to plan ahead for these symptoms and manage any concurrent symptoms for successful promotion of their patient’s QOL. Creative Commons

  20. Burden of allergic rhinitis: allergies in America, Latin America, and Asia-Pacific adult surveys.

    Science.gov (United States)

    Meltzer, Eli O; Blaiss, Michael S; Naclerio, Robert M; Stoloff, Stuart W; Derebery, M Jennifer; Nelson, Harold S; Boyle, John M; Wingertzahn, Mark A

    2012-01-01

    Allergic rhinitis (AR; also nasal allergies or "hay fever") is a chronic upper airway inflammatory disease that affects ∼60 million adults and children in the United States. The duration and severity of AR symptoms contribute to a substantial burden on patients' quality of life (QoL), sleep, work productivity, and activity. This study was designed to examine symptoms, QoL, productivity, comorbidities, disease management, and pharmacologic treatment of AR in United States and ex-U.S. sufferers. Allergies in America was a comprehensive telephone-based survey of 2500 adults with AR. These data are compared and contrasted with findings from the Pediatric Allergies in America, Allergies in Latin America, and Allergies in Asia-Pacific telephone surveys. The prevalence of physician-diagnosed AR was 14% in U.S. adults, 7% in Latin America adults, and 9% in Asia-Pacific adults. Nasal congestion is the most common and bothersome symptom for adults. Approximately two-thirds of adults rely on medication to relieve intolerable AR symptoms. Incomplete relief, slow onset, <24-hour relief, and reduced efficacy with sustained use were commonly reported with AR medications, including intranasal corticosteroids. One in seven U.S. adults reported achieving little to no relief with AR medications. Bothersome adverse effects of AR medications included drowsiness, a drying feeling, medication dripping down the throat, and bad taste. Perception of inadequate efficacy was the leading cause of medication discontinuation or change and contributed to treatment dissatisfaction. These findings support the assertion that AR burden has been substantially underestimated and identify several important challenges to successful management of AR.

  1. Comprehensibility of selected USP pictograms by illiterate and literate Farsi speakers: The first experience in Iran - Part I.

    Science.gov (United States)

    Zargarzadeh, Amir H; Ahamdi, Sahar

    2017-01-01

    Good understanding of medication instructions is paramount to a good pharmaceutical care. The aim of our study was to examine the understandability of the selected three most applicable pictograms by participants and their recall after educational mini sessions. First, nine experienced pharmacists selected the three most potentially applicable pictograms. Pictograms A to C were determined, respectively, "A-take medication with food," "B-medication may cause drowsiness," and "C-take medication before sleep." In the second phase, we measured the comprehensibility of pictograms by three groups of participants (sample of 358): highly educated participants of two major universities of Isfahan (Groups 1 and 2), low-literate and illiterate individuals (Groups 3 and 4), and the rest were participants interviewed in three teaching pharmacies affiliated to the Isfahan School of Pharmacy (Group 5). The American National Standards Institute (ANSI) and International Organization for Standardization (ISO) were used to compare the comprehensibility of pictograms. Furthermore, five qualitative questions were asked about the impact of pictograms on several parameters. In the pre-follow-up period, only Group 1 (75%) understood pictogram A while pictogram B did not pass the ANSI and ISO thresholds for acceptability in none of the groups. In the pre-follow-up period, Groups 1 and 2 surpassed the ANSI threshold and Group 5 passed the ISO limit for C. In the post-follow-up period, C passed the ISO limit in Group 3. Regarding the qualitative questions, 84.1% believed that pictograms had positive impact on the correct use of medications and timing of administration. The groups with high level of literacy interpreted the pictograms better than those with lower levels of literacy.

  2. Long-term retention of a divided attention psycho-motor test combining choice reaction test and postural balance test: A preliminary study.

    Science.gov (United States)

    Rossi, R; Pascolo, P B

    2015-09-01

    Driving in degraded psychophysical conditions, such as under the influence of alcohol or drugs but also in a state of fatigue or drowsiness, is a growing problem. The current roadside tests used for detecting drugs from drivers suffer various limitations, while impairment is subjective and does not necessarily correlate with drug metabolite concentration found in body fluids. This work is a validation step towards the study of feasibility of a novel test conceived to assess psychophysical conditions of individuals performing at-risk activities. Motor gestures, long-term retention and learning phase related to the protocol are analysed in unimpaired subjects. The protocol is a divided attention test, which combines a critical tracking test achieved with postural movements and a visual choice reaction test. Ten healthy subjects participated in a first set of trials and in a second set after about six months. Each session required the carrying out of the test for ten times in order to investigate learning effect and performance over repetitions. In the first set the subjects showed a learning trend up to the third trial, whilst in the second set of trials they showed motor retention. Nevertheless, the overall performance did not significantly improve. Gestures are probably retained due to the type of tasks and the way in which the instructions are conveyed to the subjects. Moreover, motor retention after a short training suggests that the protocol is easy to learn and understand. Implications for roadside test usage and comparison with current tests are also discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Sensitivity and validity of psychometric tests for assessing driving impairment: effects of sleep deprivation.

    Science.gov (United States)

    Jongen, Stefan; Perrier, Joy; Vuurman, Eric F; Ramaekers, Johannes G; Vermeeren, Annemiek

    2015-01-01

    To assess drug induced driving impairment, initial screening is needed. However, no consensus has been reached about which initial screening tools have to be used. The present study aims to determine the ability of a battery of psychometric tests to detect performance impairing effects of clinically relevant levels of drowsiness as induced by one night of sleep deprivation. Twenty four healthy volunteers participated in a 2-period crossover study in which the highway driving test was conducted twice: once after normal sleep and once after one night of sleep deprivation. The psychometric tests were conducted on 4 occasions: once after normal sleep (at 11 am) and three times during a single night of sleep deprivation (at 1 am, 5 am, and 11 am). On-the-road driving performance was significantly impaired after sleep deprivation, as measured by an increase in Standard Deviation of Lateral Position (SDLP) of 3.1 cm compared to performance after a normal night of sleep. At 5 am, performance in most psychometric tests showed significant impairment. As expected, largest effect sizes were found on performance in the Psychomotor Vigilance Test (PVT). Large effects sizes were also found in the Divided Attention Test (DAT), the Attention Network Test (ANT), and the test for Useful Field of View (UFOV) at 5 and 11 am during sleep deprivation. Effects of sleep deprivation on SDLP correlated significantly with performance changes in the PVT and the DAT, but not with performance changes in the UFOV. From the psychometric tests used in this study, the PVT and DAT seem most promising for initial evaluation of drug impairment based on sensitivity and correlations with driving impairment. Further studies are needed to assess the sensitivity and validity of these psychometric tests after benchmark sedative drug use.

  4. Sensitivity and validity of psychometric tests for assessing driving impairment: effects of sleep deprivation.

    Directory of Open Access Journals (Sweden)

    Stefan Jongen

    Full Text Available To assess drug induced driving impairment, initial screening is needed. However, no consensus has been reached about which initial screening tools have to be used. The present study aims to determine the ability of a battery of psychometric tests to detect performance impairing effects of clinically relevant levels of drowsiness as induced by one night of sleep deprivation.Twenty four healthy volunteers participated in a 2-period crossover study in which the highway driving test was conducted twice: once after normal sleep and once after one night of sleep deprivation. The psychometric tests were conducted on 4 occasions: once after normal sleep (at 11 am and three times during a single night of sleep deprivation (at 1 am, 5 am, and 11 am.On-the-road driving performance was significantly impaired after sleep deprivation, as measured by an increase in Standard Deviation of Lateral Position (SDLP of 3.1 cm compared to performance after a normal night of sleep. At 5 am, performance in most psychometric tests showed significant impairment. As expected, largest effect sizes were found on performance in the Psychomotor Vigilance Test (PVT. Large effects sizes were also found in the Divided Attention Test (DAT, the Attention Network Test (ANT, and the test for Useful Field of View (UFOV at 5 and 11 am during sleep deprivation. Effects of sleep deprivation on SDLP correlated significantly with performance changes in the PVT and the DAT, but not with performance changes in the UFOV.From the psychometric tests used in this study, the PVT and DAT seem most promising for initial evaluation of drug impairment based on sensitivity and correlations with driving impairment. Further studies are needed to assess the sensitivity and validity of these psychometric tests after benchmark sedative drug use.

  5. Adverse Effects of Antidepressants Reported by 1,431 people from 38 Countries: Emotional Blunting, Suicidality, and Withdrawal Effects.

    Science.gov (United States)

    Read, John; Williams, James

    2018-06-04

    Studies of the adverse effects of antidepressants tend to focus on biological symptoms. The prevalence of suicidality and withdrawal effects are currently a source of controversy. To directly ascertain the experiences of an international sample of antidepressant users. An online survey asked adult antidepressant users whether they had experienced 20 adverse effects 'as a result of taking the antidepressant', and if so, to what degree of severity. 1,431 people from 38 countries responded. 61% of the respondents reported at least ten of the 20 effects, most commonly: 'Feeling emotionally numb' (reported by 71%), 'Feeling foggy or detached' (70%); 'Feeling not like myself' (66%), 'Sexual difficulties' (66%), 'Drowsiness' (63%), and 'Reduction in positive feelings' (60%). 'Suicidality' as a result of the drugs was reported by 50%. Withdrawal effects were reported by 59%, and 'Addiction' by 40%. Rates of adverse effects were higher for those prescribed multiple antidepressants and those who also took antipsychotics. Younger age and longer use of ADs were positively related to total adverse effects. One third did not recall being told about any side effects by the prescriber. Less than 5% were told about suicidality, emotional numbing, withdrawal effects or addiction. Asking people directly reveals far higher rates of adverse responses to antidepressants than previously understood, especially in the emotional, psychological and interpersonal domains. Given recent findings that antidepressants are only marginally more effective than placebo, the findings of the current study imply a cost-benefit analysis that cannot justify the extremely high prescription rates for these drugs. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  6. The Glasgow antipsychotic side-effects scale for clozapine in inpatients and outpatients with schizophrenia or schizoaffective disorder.

    Science.gov (United States)

    Ignjatović Ristić, Dragana; Cohen, Dan; Obradović, Andrea; Nikić-Đuričić, Katarina; Drašković, Marija; Hinić, Darko

    2018-02-01

    The inconsistency in clinician and patient ratings of clozapine-induced side effects underscore the need to supplement clinician-based estimates of side effects with patient-reported ones. The main aims of the study are validation of the Glasgow antipsychotic side-effects scale for clozapine (GASS-C) in Serbian inpatients/outpatients with schizophrenia or schizo-affective disorder and recommendations for its future use, based on common and rare clozapine-associated side-effects. The GASS-C was administered to 95 outpatients/inpatients diagnosed with schizophrenia, schizoaffective, or chronic psychotic disorder. The scale showed good overall reliability, with an internal consistency coefficient of α = 0.84, an average retest coefficient of rho = 0.76, and a Spearman-Brown coefficient of validity of 0.81. Side effects were absent or mild in 64.2% of the patients, moderate in 31.6%, severe in 4.2%; 14% of the subjects considered their symptoms distressing. The most commonly reported side-effects were drowsiness, thirst, frequent urination, and dry mouth. Women reported more side effects than men, and patients not in a relationship reported significantly fewer side effects than patients in a relationship. Results indicate a weak positive correlation (rho = 0.231; p = .025) between severity of side effects and clozapine dose. The GASS-C showed good psychometric characteristics in clinical population of patients on clozapine. In future studies, clozapine serum concentrations should be measured when using the GASS-C to monitor side effects.

  7. Truckers drive their own assessment for obstructive sleep apnea: a collaborative approach to online self-assessment for obstructive sleep apnea.

    Science.gov (United States)

    Smith, Ben; Phillips, Barbara A

    2011-06-15

    Commercial motor vehicle drivers are at an increased risk for obstructive sleep apnea (OSA). The Federal Motor Carrier Safety Administration (FMCSA) Medical Review Board has recommended that commercial motor vehicle drivers undergo testing for OSA if they have a positive Berlin Questionnaire or a BMI ≥ 30 kg/m(2). We developed an online screening tool based on the Berlin Questionnaire for anonymous use by commercial drivers to assess their risk of OSA prior to their required FMCSA physicals. We based the survey on the Berlin Sleep Questionnaire. The survey was hosted on the Truckers for a Cause Chapter of Alert Well and Keeping Energetic of the American Sleep Apnea Association (TFAC-AWAKE) organization website, and was promoted through the TFAC's XM radio, word of mouth, and trucking industry press contacts. A total of 595 individuals completed the survey. Of these, 55.9% were positive on the Berlin, 78.3% had either hypertension or obesity, 69.6% were obese, 47.6% had a BMI > 33 kg/m(2), and 20.5% reported falling asleep at stoplights. Some commercial drivers willingly assess their OSA risk anonymously online, and a majority of those who do so are obese, have positive Berlin screening questionnaires, and would be required to undergo polysomnography if recommendations made to the FMCSA became regulation. In contrast to reported behavior during actual Commercial Driver Medical Examinations physicals, some commercial drivers will report OSA symptoms if it is "safe" to do so. Sleep health professionals need expedient, non-punitive methods to keep commercial motor vehicle drivers healthy and driving and to raise drivers' awareness of the dangers of drowsy driving and unhealthy lifestyles.

  8. Alcohol dependence induced in rats by semivoluntary intermittent intake

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    M.S. Macieira

    1997-09-01

    Full Text Available The objective of the present experiment was to assess ethyl alcohol (ETOH dependence brought about by a semivoluntary intermittent intake regimen in rats. Male Wistar rats weighing 150-250 g at the onset of the experiment were assigned to the following groups: 0% ETOH (N = 11, 5% ETOH (N = 20, 20% ETOH (N = 20 and 40% ETOH (N = 18. ETOH solutions were offered at the end of the day and overnight from Monday to Friday, and throughout weekends, for 90 days. The concentration of the ETOH solutions was increased in a stepwise fashion allowing the rats to get used to the taste of alcohol. Reposition of pure water was permitted during 1-h water drinking periods in the morning. Daily volume intake (± SEM averaged 25.4 ± 0.4 ml (0% ETOH, 23.8 ± 0.6 ml (5% ETOH, 17.6 ± 0.7 ml (20% ETOH and 17.5 ± 0.6 ml (40% ETOH. ETOH consumption differed significantly (P<0.05 among groups, averaging 4.4 ± 0.2 g kg-1 day-1 (5% ETOH, 10.3 ± 0.3 g kg-1 day-1 (20% ETOH and 26 ± 1.2 g kg-1 day-1 (40% ETOH. Furthermore, ETOH detection in plasma 10-12 h after offering the solution indicated that its consumption in the 40% ETOH group was sufficient to override its metabolism. Overt signs of ETOH dependence, such as increased thirst, hyperactivity, puffing, hair ruffling and startle responsiveness as well as reduced drowsiness, were significantly increased in the 20% and 40% ETOH groups compared to the 0% and 5% groups. Accordingly, the model described here proved to be a useful tool for the evaluation of subtle or moderate behavioral and physical consequences of long-term ETOH intake

  9. A preliminary observation of the adverse effects of phenobarbital among patients with convulsive epilepsy in rural West China.

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    Si, Yang; Liu, Ling; Tian, Linyu; Mu, Jie; Chen, Deng; Chen, Tao; Deng, Ying; He, Jun; Li, You; He, Li; Zhou, Dong

    2016-01-01

    This study explored the adverse effect (AE) profile of phenobarbital (PB) among patients with active convulsive epilepsy (ACE) from resource-poor areas. Patients with ACE were enrolled into an epilepsy management project in rural West China. Information was obtained from monthly follow-up questionnaires. The demographic and clinical features of the patients with AE were firstly described. After that, the occurrence rate was estimated for each subtype of AE at three different severity levels (mild, moderate, and serious). Survival analysis was used to determine the potential risk factors of AEs. A total of 7231 patients (3780 men) were included in the present cohort. During the follow-up time period (average 33.4months), the most common AEs were drowsiness (moderate: 4.4%, serious: 0.68%), dizziness (moderate: 3.7%, serious: 0.5%), and headache (moderate: 2.9%, serious: 0.41%). In the confirmed AE groups (moderate and serious severity levels), the symptoms tended to be transient, with durations of less than 3months. Polytherapy was an independent risk factor for AEs and had an increasing risk when the severity of the AE increased (Hazard Ratio 1.12, 1.55, and 2.52 for mild AE, moderate AE, and serious AE, respectively). Receiving a high dosage of PB (>180mg/day) indicated a slightly elevated risk (Hazard Ratio 1.22 and 1.27 for mild AE and moderate AE, respectively). Phenobarbital demonstrates overall tolerability, and serious AEs were not common. Patients receiving a high dose of PB or polytherapy are at increased risk of developing AEs. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Comparative effectiveness of antiepileptic drugs in patients with mesial temporal lobe epilepsy with hippocampal sclerosis.

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    Androsova, Ganna; Krause, Roland; Borghei, Mojgansadat; Wassenaar, Merel; Auce, Pauls; Avbersek, Andreja; Becker, Felicitas; Berghuis, Bianca; Campbell, Ellen; Coppola, Antonietta; Francis, Ben; Wolking, Stefan; Cavalleri, Gianpiero L; Craig, John; Delanty, Norman; Koeleman, Bobby P C; Kunz, Wolfram S; Lerche, Holger; Marson, Anthony G; Sander, Josemir W; Sills, Graeme J; Striano, Pasquale; Zara, Federico; Sisodiya, Sanjay M; Depondt, Chantal

    2017-10-01

    Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is a common epilepsy syndrome that is often poorly controlled by antiepileptic drug (AED) treatment. Comparative AED effectiveness studies in this condition are lacking. We report retention, efficacy, and tolerability in a cohort of patients with MTLE-HS. Clinical data were collected from a European database of patients with epilepsy. We estimated retention, 12-month seizure freedom, and adverse drug reaction (ADR) rates for the 10 most commonly used AEDs in patients with MTLE-HS. Seven hundred sixty-seven patients with a total of 3,249 AED trials were included. The highest 12-month retention rates were observed with carbamazepine (85.9%), valproate (85%), and clobazam (79%). Twelve-month seizure freedom rates varied from 1.2% for gabapentin and vigabatrin to 11% for carbamazepine. Response rates were highest for AEDs that were prescribed as initial treatment and lowest for AEDs that were used in a third or higher instance. ADRs were reported in 47.6% of patients, with the highest rates observed with oxcarbazepine (35.7%), topiramate (30.9%), and pregabalin (27.4%), and the lowest rates with clobazam (6.5%), gabapentin (8.9%), and lamotrigine (16.6%). The most commonly reported ADRs were lethargy and drowsiness, dizziness, vertigo and ataxia, and blurred vision and diplopia. Our results did not demonstrate any clear advantage of newer versus older AEDs. Our results provide useful insights into AED retention, efficacy, and ADR rates in patients with MTLE-HS. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

  11. Co-activated yet disconnected-Neural correlates of eye closures when trying to stay awake.

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    Ong, Ju Lynn; Kong, Danyang; Chia, Tiffany T Y; Tandi, Jesisca; Thomas Yeo, B T; Chee, Michael W L

    2015-09-01

    Spontaneous eye-closures that herald sleep onset become more frequent when we are sleep deprived. Although these are typically associated with decreased responsiveness to external stimuli, it is less clear what occurs in the brain at these transitions to drowsiness and light sleep. To investigate this, task-free fMRI of sleep-deprived participants was acquired. BOLD activity associated with periods of spontaneously occurring eye closures were marked and analyzed. We observed concurrent and extensive hypnagogic co-activation of the extrastriate visual, auditory, and somatosensory cortices as well as the default mode network, consistent with internal sensory activity without external stimulation. Co-activation of fronto-parietal areas known to mediate attentional control could correspond with participants resisting sleep or additional engagement of mental imagery. This constellation of signal changes differed from those elicited by cued eye closures of similar duration and distribution in the same, rested participants. They also differ from signal changes associated with mind-wandering and consolidated light sleep. Concurrent with the observed event-related changes, eye closures elicited additional reduction in functional connectivity within nodes of the DMN and DAN, superposed on already reduced connectivity associated with sleep deprivation. There was concurrent deactivation of the thalamus during eye-closure during the sleep-deprived state but almost similar changes occurred in the well-rested state that may also be relevant. These findings highlight the dynamic shifts in brain activity and connectivity at border between wakefulness and sleep. Copyright © 2015. Published by Elsevier Inc.

  12. Poor Sleep Quality is Associated with Insulin Resistance in Postmenopausal Women With and Without Metabolic Syndrome.

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    Kline, Christopher E; Hall, Martica H; Buysse, Daniel J; Earnest, Conrad P; Church, Timothy S

    2018-05-01

    Poor sleep quality has previously been shown to be related to insulin resistance in apparently healthy adults. However, it is unclear whether an association between sleep quality and insulin resistance exists among adults with metabolic syndrome (MetS). Participants included 347 overweight/obese postmenopausal women without type 2 diabetes (age: 57.5 ± 6.5 years; body mass index [BMI]: 31.7 ± 3.7 kg/m 2 ; 54% with MetS). Sleep quality was assessed with the six-item Medical Outcomes Study Sleep Scale; values were categorized into quartiles. Insulin resistance was calculated from fasting glucose and insulin with the homeostasis model assessment of insulin resistance (HOMA2-IR) method. Analysis of covariance models were used to examine the association between sleep quality and HOMA2-IR after accounting for MetS and covariates (e.g., BMI, cardiorespiratory fitness, and energy intake). Women with the worst sleep quality had significantly higher HOMA2-IR values than women in all other quartiles (P ≤ 0.05 for each), and women with MetS had significantly higher HOMA2-IR values than women without MetS (P quality and HOMA2-IR did not differ between those with or without MetS (P = 0.26). Women with MetS in the worst quartile of sleep quality had higher HOMA2-IR values than all other women (P 30 min to fall asleep, frequent restless sleep, and frequent daytime drowsiness were each related to higher HOMA2-IR values (each P quality is an important correlate of insulin resistance in postmenopausal women with and without MetS. Intervention studies are needed to determine whether improving sleep improves insulin resistance in populations at elevated cardiometabolic risk.

  13. Methadone Poisoning in Children: A Systematic Review and Meta-Analysis in Iran

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    Yasaman Allameh

    2017-05-01

    Full Text Available Context Symptoms of methadone poisoning, as one of the most dangerous types of poisoning, are very serious in children. Objectives The aim of this study was to describe causes and clinical symptoms of methadone poisoning in children admitted to hospitals in Iran. Data Sources Relevant studies published in national and international journals before January 29, 2016 were identified by studying the available databases, including PubMed, Web of Sciences, Google Scholar, Scopus, SID, Iranmedex, MagIran, and Irandoc. Study Selection After excluding duplicate, irrelevant, and low-quality articles, relevant papers were entered into the meta-analysis. The prevalence, mean, and standard deviation of methadone poisoning symptoms in children were statistically analyzed, using Stata version 11, and causes of methadone poisoning were presented in tables. Data Extraction Studies with unknown sample sizes, abstracts without access to full text, articles with quality assessment scores below 15.5, and studies carried out on non-Iranian populations were excluded from the meta-analysis. Results During the initial advanced search, 1594 articles were identified. After quality assessment, 12 papers were found eligible for the final systematic review and meta-analysis, based on the inclusion and exclusion criteria. The reported symptoms included drowsiness, vomiting, apnea, cyanosis, seizure, ataxia, and delirium. In the meta-analysis, prevalence of symptoms in referred patients was estimated at 44% (0.95% confidence interval, 0.288 to 0.609. The causes of poisoning in children included accidental feeding by parents, storage of drugs in inappropriate containers, parental addiction, and low educational level of parents. Conclusions It is important to keep methadone in a suitable container away from children. Also, it is essential to focus on educating parents on health issues of their children.

  14. Postoperative complications of pediatric dental general anesthesia procedure provided in Jeddah hospitals, Saudi Arabia

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    Almushayt Abdullah

    2009-02-01

    Full Text Available Abstract Background Review of post-operative morbidity reports for pediatric dental care under general anesthesia (GA show great variations. Until now, no morbidity data has been available to estimate the safety of pediatric patients under GA for dental rehabilitation in Saudi Arabia. The purposes of this study were to (1 investigate post-operative complications associated with dental care under GA and (2 correlate morbidity reports with patient's characteristics, dental procedures, and hospital protocol. Methods Study sample included 90 children attending GA for dental treatment at major governmental hospitals in Jeddah. Data were collected from every patient on three occasions, intra-operatively at the operating room, and post-operatively via phone calls in the first and third days after operation. Results Results showed that 99% of the children had one or more complaints in the first day in contrast to only 33% in the third day. Inability to eat (86%, sleepiness (71%, and pain (48% were the most common complaints in the first day, followed by bleeding (40%, drowsiness (39%, sore throat (34%, vomiting (26%, psychological changes (24%, fever (21%, cough (12%, and nausea (8%. A great significant complaints reduction was reported by the third post-operative day. Age, gender, admission type of the patients and GA duration were the factors that showed a significant relationship with post-operative complaints. Conclusion Post-operative morbidity was common, but mostly of mild severity and limited to the first day. Hospital staff efforts should be directed to control commonly reported postoperative complaints.

  15. Knowledge of hypoglycemia and its associated factors among type 2 diabetes mellitus patients in a Tertiary Care Hospital in South India

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    Vanishree Shriraam

    2015-01-01

    Full Text Available Introduction: Hypoglycemia being the rate limiting complication in the attainment of strict glycemic control in diabetes management, in this study, we intended to study the knowledge of its symptoms, target blood levels during treatment and ways of prevention among type 2 diabetes patients attending Outpatient Department (OPD of a medical college hospital. Materials and Methods: Every fifth patient attending the OPD during the 4 months between March and June 2013 was interviewed using a questionnaire. Results: The study included 366 type 2 diabetic patients, of which 76.5% were females. The target fasting and postprandial blood glucose levels while on treatment was known to 135 (36.9% and 126 (34.4% patients, respectively. The common symptoms of hypoglycemia known to the study subjects were dizziness (81.4%, weakness (73.8%, and drowsiness (72.1%. Overall, 242 (66.1% diabetic patients had good knowledge on hypoglycemia (knowledge of at least three symptoms of hypoglycemia together with at least one precipitating factor and at least one remedial measure. Higher age, illiteracy, low socioeconomic status were associated with poor knowledge whereas treatment with insulin along with oral hypoglycemic agents was associated with good knowledge on hypoglycemia. Sex and duration of disease were not associated with knowledge on hypoglycemia. Conclusion: Although the knowledge on symptoms of hypoglycemia, precipitating factors, remedial measures are high in this study, the target blood levels, complications were known to just a third of them. There is a knowledge gap on important aspects of hypoglycemia among type 2 diabetic patients.

  16. Prospective evaluation of quality of life effects in patients undergoing palliative radiotherapy for brain metastases

    International Nuclear Information System (INIS)

    Steinmann, Diana; Gerstein, Johanna; Gharbi, Nadine; Hagg, Juliane; Hipp, Matthias; Kleff, Irmgard; Müller, Axel; Schäfer, Christof; Schleicher, Ursula; Sehlen, Susanne; Theodorou, Marilena; Paelecke-Habermann, Yvonne; Wypior, Hans-Joachim; Zehentmayr, Franz; Oorschot, Birgitt van; Vordermark, Dirk; Geinitz, Hans; Aschoff, Raimund; Bayerl, Anja; Bölling, Tobias; Bosch, Elisabeth; Bruns, Frank; Eichenseder-Seiss, Ute

    2012-01-01

    Recently published results of quality of life (QoL) studies indicated different outcomes of palliative radiotherapy for brain metastases. This prospective multi-center QoL study of patients with brain metastases was designed to investigate which QoL domains improve or worsen after palliative radiotherapy and which might provide prognostic information. From 01/2007-01/2009, n=151 patients with previously untreated brain metastases were recruited at 14 centers in Germany and Austria. Most patients (82 %) received whole-brain radiotherapy. QoL was measured with the EORTC-QLQ-C15-PAL and brain module BN20 before the start of radiotherapy and after 3 months. At 3 months, 88/142 (62 %) survived. Nine patients were not able to be followed up. 62 patients (70.5 % of 3-month survivors) completed the second set of questionnaires. Three months after the start of radiotherapy QoL deteriorated significantly in the areas of global QoL, physical function, fatigue, nausea, pain, appetite loss, hair loss, drowsiness, motor dysfunction, communication deficit and weakness of legs. Although the use of corticosteroid at 3 months could be reduced compared to pre-treatment (63 % vs. 37 %), the score for headaches remained stable. Initial QoL at the start of treatment was better in those alive than in those deceased at 3 months, significantly for physical function, motor dysfunction and the symptom scales fatigue, pain, appetite loss and weakness of legs. In a multivariate model, lower Karnofsky performance score, higher age and higher pain ratings before radiotherapy were prognostic of 3-month survival. Moderate deterioration in several QoL domains was predominantly observed three months after start of palliative radiotherapy for brain metastases. Future studies will need to address the individual subjective benefit or burden from such treatment. Baseline QoL scores before palliative radiotherapy for brain metastases may contain prognostic information

  17. Symptom burden in long-term germ cell tumor survivors.

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    Oechsle, Karin; Hartmann, Michael; Mehnert, Anja; Oing, Christoph; Bokemeyer, Carsten; Vehling, Sigrun

    2016-05-01

    Testicular germ cell tumor (GCT) and its treatment may cause distressing long-term symptoms. We aimed to examine self-reported symptom frequency and distress as well as the impact of demographic and medical characteristics in GCT survivors. A total of 164 GCT survivors receiving follow-up care at the University Cancer Center Hamburg and a specialized private practice facility were interviewed at a median time of 11.6 years after first diagnosis. Metastatic disease was present in 48 % of the patients and relapse had occurred in 17 %. The patients completed the short form of the Memorial Symptom Assessment Scale (MSAS-SF) assessing 28 physical and 4 psychological symptoms. The mean number of physical symptoms was 4.5 (SD = 4.3) (psychological symptoms M = 1.4, SD = 1.4; total M = 5.9, SD = 5.2). The most frequent physical symptoms were lack of energy (49 %), feeling drowsy (42 %), sleeping problems (36 %), and difficulty in concentration (32 %). Lack of energy was experienced as highly distressing by 21 % of the patients. The most frequent psychological symptoms were irritability (47 %) and being worried (42 %). The number of physical symptoms was associated with higher age, lower socioeconomic status, and shorter time since diagnosis in multivariate regression analyses controlling for metastatic vs. localized disease, relapse, extent of surgery, number of chemotherapy cycles, and radiotherapy. GCT survivors suffered from a significant number of long-term symptoms. Fatigue-related symptoms were most frequent and perceived as highly distressing. Continuous attention toward fatigue is necessary throughout follow-up care to offer support in time, particularly in more vulnerable patients of higher age and lower socioeconomic status.

  18. Safety and efficacy of intrathecal ziconotide in the management of severe chronic pain

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    Howard S Smith

    2009-07-01

    Full Text Available Howard S Smith,1 Timothy R Deer21Albany Medical College, Department of Anesthesiology, Albany, New York, USA; 2The Center for Pain Relief, Clinical Professor, West Virginia, University, Charleston, West Virginia, USAAbstract: Ziconotide is a conopeptide intrathecal (IT analgesic which is approved by the US Food and Drug Administration (FDA for the management of severe chronic pain. It is a synthetic equivalent of a naturally occurring conopeptide found in the venom of the fish-eating marine cone snail and provides analgesia via binding to N-type voltage-sensitive calcium channels in the spinal cord. As ziconotide is a peptide, it is expected to be completely degraded by endopeptidases and exopeptidases (Phase I hydrolytic enzymes widely located throughout the body, and not by other Phase I biotransformation processes (including the cytochrome P450 system or by Phase II conjugation reactions. Thus, IT administration, low plasma ziconotide concentrations, and metabolism by ubiquitous peptidases make metabolic interactions of other drugs with ziconotide unlikely. Side effects of ziconotide which tend to occur more commonly at higher doses may include: nausea, vomiting, confusion, postural hypotension, abnormal gait, urinary retention, nystagmus/amblyopia, drowsiness/somnolence (reduced level of consciousness, dizziness or lightheadedness, weakness, visual problems (eg, double vision, elevation of serum creatine kinase, or vestibular side effects. Initially, when ziconotide was first administered to human subjects, titration schedules were overly aggressive and led to an abundance of adverse effects. Subsequently, clinicians have gained appreciation for ziconotide’s relatively narrow therapeutic window. With appropriate usage multiple studies have shown ziconotide to be a safe and effective intrathecal analgesic alone or in combination with other intrathecal analgesics.Keywords: pain, ziconotide, intrathecal analgesics, safety, patient

  19. Sleep and alertness during alternating monophasic and polyphasic rest-activity cycles.

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    Porcú, S; Casagrande, M; Ferrara, M; Bellatreccia, A

    1998-07-01

    People involved in shift work often have to face altered patterns of sleep and wakefulness. This is particularly true for schedules involving night shifts and/or fragmentation of duty periods throughout the 24-hr day. In such conditions, it can be difficult to obtain satisfactory periods of sleep, and sleepiness on duty is a frequent and dangerous occurrence. The aim of this study was to evaluate sleep and wakefulness periods of subjects whose work schedule was characterized by an alternation of 2 hours of activity and 4 hours of rest (sleep allowed), repeated 4 times throughout the 24-hr day. This schedule was alternated with 24 hours off duty. Nine healthy male volunteers were monitored by means of ambulatory polysomnography while attending their 24-hr rest-activity schedule. Sleep periods were visually scored according to standard criteria. Wake periods were visually scored using both 30 s and 5 s epochs in order to reveal episodes of drowsiness and/or microsleep. Results showed that total sleep time was substantially reduced as compared to the usual 7-8 hour monophasic nocturnal sleep. Subjects did not sleep during the first rest period (11.00-15.00). Time in sleep linearly increased in the course of the 3 remaining rest periods. Normal sleep stage distribution was substantially spared only in the last rest period (3.00-7.00 a.m.). With regard to duty periods, only a few microsleeps were detected and their number did not significantly vary across the four 2-hr activity periods. In conclusion, this rest-activity schedule, despite the considerable sleep reduction, allowed maintaining good levels of vigilance as shown by the virtual absence of EEG microsleeps. Whether future research will prove that this regimen does not cause an impairment of performance, it should be a suitable strategy for the management of continuous operations.

  20. The Neurological Manifestations of H1N1 Influenza Infection; Diagnostic Challenges and Recommendations

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    Ali Akbar Asadi-Pooya

    2011-03-01

    Full Text Available Background: World Health Organization declared pandemic phase of human infection with novel influenza A (H1N1 in April 2009. There are very few reports about the neurological complications of H1N1 virus infection in the literature. Occasionally, these complications are severe and even fatal in some individuals. The aims of this study were to report neurological complaints and/or complications associated with H1N1 virus infection. Methods: The medical files of all patients with H1N1 influenza infection admitted to a specified hospital in the city of Shiraz, Iran from October through November 2009 were reviewed. More information about the patients were obtained by phone calls to the patients or their care givers. All patients had confirmed H1N1 virus infection with real-time PCR assay. Results: Fifty-five patients with H1N1 infection were studied. Twenty-three patients had neurological signs and/or symptoms. Mild neurological complaints may be reported in up to 42% of patients infected by H1N1 virus. Severe neurological complications occurred in 9% of the patients. The most common neurological manifestations were headache, numbness and paresthesia, drowsiness and coma. One patient had a Guillain-Barre syndrome-like illness, and died in a few days. Another patient had focal status epilepticus and encephalopathy. Conclusions: The H1N1 infection seems to have been quite mild with a self-limited course in much of the world, yet there appears to be a subset, which is severely affected. We recommend performing diagnostic tests for H1N1influenza virus in all patients with respiratory illness and neurological signs/symptoms. We also recommend initiating treatment with appropriate antiviral drugs as soon as possible in those with any significant neurological presentation accompanied with respiratory illness and flu-like symptoms

  1. Sleep, stress and compensatory behaviors in Australian nurses and midwives

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    Jillian Dorrian

    2011-10-01

    Full Text Available OBJECTIVE: To describe sleep, stress and compensatory behaviors in nurses and midwives. METHODS: The study included 41 midwives and 21 nurses working in Australian hospitals between 2005 and 2009. Participation was voluntary. All participants recorded on a daily basis their work and sleep hours, levels of stress and exhaustion, caffeine intake and use of sleep aids for a month (1,736 days, 1,002 work shifts. RESULTS: Participants reported moderate to high levels of stress and exhaustion on 20-40% of work days; experienced sleep disruption on more than 50% of work days; struggled to remain awake on 27% of work days; and suffered extreme drowsiness or experienced a near accident while travelling home on 9% of workdays. Age, perceived sleep duration and work hours were significant predictors of caffeine intake. About 60% of participants reported using sleep aids (about 20% reported taking prescription medications and 44% of nurses and 9% of midwives reported alcohol use as a sleep aid at least once during the study. Stress and workdays were significant predictors of sedative use. Overall, 22% reported being indifferent or mildly dissatisfied with their job. CONCLUSIONS: Sleep problems, high levels of stress and exhaustion and low job satisfaction are prevalent among nurses and midwives. The use of alcohol and sleeping pills as sleep aids, and the use of caffeine to help maintain alertness is also common. Nurses and midwives may use caffeine to compensate for reduced sleep, especially on workdays, and sleeping pills to cope with their daily work-related stress.

  2. [Effectiveness and safety of oxcarbazepine in chronic neuropathic pain: a study of 40 cases].

    Science.gov (United States)

    Fenollosa-Vázquez, P; Canós-Verdecho, M A; Núñez-Cornejo, C; Pallarés-Delgado, J

    Neuropathic pain (NP) often fails to respond to the commonly established analgesic treatment. This fact, together with the existence of side effects, has led to the need to evaluate the analgesic effectiveness of antiepileptic drugs, which, as in the case of oxcarbazepine (OXC), are a valid alternative. The aim of this study was to evaluate the effectiveness and safety of OXC in patients suffering from chronic NP. We conducted a prospective, open study involving a series of 40 patients diagnosed with a long history of NP, which was previously resistant to different kinds of treatment with anticonvulsants, non-steroidal anti-inflammatory (NSAI) drugs, opiates and adjuncts. Patients were treated with OXC and they were evaluated in both the basal (prior to treatment) and final visits (after treatment) by means of the visual analogue scale (VAS), SF-McGill questionnaire and the Lattinen test. The patient's general impression of the result was also obtained. The statistical analysis was performed by calculating the "effect size", by computing Cohen's d. Treatment with OXC diminishes different symptomatic variations of this pain, but especially so in the case of lancinating discharges (d = 0.87, important effect) and burning pain (d = 0.60, moderate-important effect), although the allodynia (d = 0.48, moderate effect) also improved with treatment. In the opinion of the patients themselves, response to treatment was good or very good in 50% of cases. The chief side effects observed were dizziness, drowsiness and abdominal upsets. OXC can be seen as a therapeutic alternative to be taken very much into account in patients with NP having different aetiologies; it has a good benefit-risk ratio and is a form of treatment that is well accepted by patients.

  3. Targeting the neurokinin receptor 1 with aprepitant: a novel antipruritic strategy.

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    Ständer, Sonja; Siepmann, Dorothee; Herrgott, Ilka; Sunderkötter, Cord; Luger, Thomas A

    2010-06-04

    Chronic pruritus is a global clinical problem with a high impact on the quality of life and lack of specific therapies. It is an excruciating and frequent symptom of e.g. uncurable renal, liver and skin diseases which often does not respond to conventional treatment with e.g. antihistamines. Therefore antipruritic therapies which target physiological mechanisms of pruritus need to be developed. Substance P (SP) is a major mediator of pruritus. As it binds to the neurokinin receptor 1 (NKR1), we evaluated if the application of a NKR1 antagonist would significantly decrease chronic pruritus. Twenty hitherto untreatable patients with chronic pruritus (12 female, 8 male; mean age, 66.7 years) were treated with the NKR1 antagonist aprepitant 80 mg for one week. 16 of 20 patients (80%) experienced a considerable reduction of itch intensity, as assessed by the visual analog scale (VAS, range 0 to 10). Considering all patients, the mean value of pruritus intensity was significantly reduced from 8.4 VAS points (SD +/-1.7) before treatment to 4.9 VAS points (SD +/-3.2) (pprofit from the treatment. Side-effects were mild (nausea, vertigo, and drowsiness) and only occurred in three patients. The high response rate in patients with therapy refractory pruritus suggests that the NKR1 antagonist aprepitant may indeed exhibit antipruritic effects and may present a novel, effective treatment strategy based on pathophysiology of chronic pruritus. The results are promising enough to warrant confirming the efficacy of NKR1 antagonists in a randomized, controlled clinical trial.

  4. Targeting the neurokinin receptor 1 with aprepitant: a novel antipruritic strategy.

    Directory of Open Access Journals (Sweden)

    Sonja Ständer

    2010-06-01

    Full Text Available Chronic pruritus is a global clinical problem with a high impact on the quality of life and lack of specific therapies. It is an excruciating and frequent symptom of e.g. uncurable renal, liver and skin diseases which often does not respond to conventional treatment with e.g. antihistamines. Therefore antipruritic therapies which target physiological mechanisms of pruritus need to be developed. Substance P (SP is a major mediator of pruritus. As it binds to the neurokinin receptor 1 (NKR1, we evaluated if the application of a NKR1 antagonist would significantly decrease chronic pruritus.Twenty hitherto untreatable patients with chronic pruritus (12 female, 8 male; mean age, 66.7 years were treated with the NKR1 antagonist aprepitant 80 mg for one week. 16 of 20 patients (80% experienced a considerable reduction of itch intensity, as assessed by the visual analog scale (VAS, range 0 to 10. Considering all patients, the mean value of pruritus intensity was significantly reduced from 8.4 VAS points (SD +/-1.7 before treatment to 4.9 VAS points (SD +/-3.2 (p<0.001, CI 1.913-5.187. Patients with dermatological diseases (e.g. atopic diathesis, prurigo nodularis had the best profit from the treatment. Side-effects were mild (nausea, vertigo, and drowsiness and only occurred in three patients.The high response rate in patients with therapy refractory pruritus suggests that the NKR1 antagonist aprepitant may indeed exhibit antipruritic effects and may present a novel, effective treatment strategy based on pathophysiology of chronic pruritus. The results are promising enough to warrant confirming the efficacy of NKR1 antagonists in a randomized, controlled clinical trial.

  5. Glucose Induces Slow-Wave Sleep by Exciting the Sleep-Promoting Neurons in the Ventrolateral Preoptic Nucleus: A New Link between Sleep and Metabolism.

    Science.gov (United States)

    Varin, Christophe; Rancillac, Armelle; Geoffroy, Hélène; Arthaud, Sébastien; Fort, Patrice; Gallopin, Thierry

    2015-07-08

    Sleep-active neurons located in the ventrolateral preoptic nucleus (VLPO) play a crucial role in the induction and maintenance of slow-wave sleep (SWS). However, the cellular and molecular mechanisms responsible for their activation at sleep onset remain poorly understood. Here, we test the hypothesis that a rise in extracellular glucose concentration in the VLPO can promote sleep by increasing the activity of sleep-promoting VLPO neurons. We find that infusion of a glucose concentration into the VLPO of mice promotes SWS and increases the density of c-Fos-labeled neurons selectively in the VLPO. Moreover, we show in patch-clamp recordings from brain slices that VLPO neurons exhibiting properties of sleep-promoting neurons are selectively excited by glucose within physiological range. This glucose-induced excitation implies the catabolism of glucose, leading to a closure of ATP-sensitive potassium (KATP) channels. The extracellular glucose concentration monitors the gating of KATP channels of sleep-promoting neurons, highlighting that these neurons can adapt their excitability according to the extracellular energy status. Together, these results provide evidence that glucose may participate in the mechanisms of SWS promotion and/or consolidation. Although the brain circuitry underlying vigilance states is well described, the molecular mechanisms responsible for sleep onset remain largely unknown. Combining in vitro and in vivo experiments, we demonstrate that glucose likely contributes to sleep onset facilitation by increasing the excitability of sleep-promoting neurons in the ventrolateral preoptic nucleus (VLPO). We find here that these neurons integrate energetic signals such as ambient glucose directly to regulate vigilance states accordingly. Glucose-induced excitation of sleep-promoting VLPO neurons should therefore be involved in the drowsiness that one feels after a high-sugar meal. This novel mechanism regulating the activity of VLPO neurons reinforces the

  6. Developing an EEG-based on-line closed-loop lapse detection and mitigation system.

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    Wang, Yu-Te; Huang, Kuan-Chih; Wei, Chun-Shu; Huang, Teng-Yi; Ko, Li-Wei; Lin, Chin-Teng; Cheng, Chung-Kuan; Jung, Tzyy-Ping

    2014-01-01

    In America, 60% of adults reported that they have driven a motor vehicle while feeling drowsy, and at least 15-20% of fatal car accidents are fatigue-related. This study translates previous laboratory-oriented neurophysiological research to design, develop, and test an On-line Closed-loop Lapse Detection and Mitigation (OCLDM) System featuring a mobile wireless dry-sensor EEG headgear and a cell-phone based real-time EEG processing platform. Eleven subjects participated in an event-related lane-keeping task, in which they were instructed to manipulate a randomly deviated, fixed-speed cruising car on a 4-lane highway. This was simulated in a 1st person view with an 8-screen and 8-projector immersive virtual-reality environment. When the subjects experienced lapses or failed to respond to events during the experiment, auditory warning was delivered to rectify the performance decrements. However, the arousing auditory signals were not always effective. The EEG spectra exhibited statistically significant differences between effective and ineffective arousing signals, suggesting that EEG spectra could be used as a countermeasure of the efficacy of arousing signals. In this on-line pilot study, the proposed OCLDM System was able to continuously detect EEG signatures of fatigue, deliver arousing warning to subjects suffering momentary cognitive lapses, and assess the efficacy of the warning in near real-time to rectify cognitive lapses. The on-line testing results of the OCLDM System validated the efficacy of the arousing signals in improving subjects' response times to the subsequent lane-departure events. This study may lead to a practical on-line lapse detection and mitigation system in real-world environments.

  7. Oculometric variations during mind wandering

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    Romain eGrandchamp

    2014-02-01

    Full Text Available A significant body of literature supports the contention that pupil size varies depending on cognitive load, affective state, and level of drowsiness. Here we assessed whether oculometric measures such as gaze position, blink frequency and pupil size were correlated with the occurrence and time course of self-reported mind-wandering episodes. We recorded the pupil size of two subjects engaged in a monotonous breath counting task while keeping their eyes on a fixation cross. Each subject performed ten 20-minute sessions, for total duration of about 4 hours. This task is conducive to producing mind-wandering episodes. Subjects were instructed to report spontaneous mind-wandering episodes by pressing a button when they lost count of their breath. After each button press, subjects filled in a short questionnaire describing the characteristics of their mind-wandering episode. We observed larger pupil size during the breath-focusing period compared to the mind-wandering period (p< 0.01 for both subjects. Our findings contradict previous research showing a higher baseline pupil size during mind wandering episodes in visual tasks. We discuss possible explanations for this discrepancy. We also analyzed nine other oculometric measures including blink rate, blink duration and gaze position. We built a support vector machine classifier and showed that mean pupil size was the most reliable predictors of mind wandering in both subjects. The classification accuracy of mind wandering data segments versus breath-focusing data segments was 81% for the first subject and 77% for the second subject. Additionally, we analyzed oculometric measures in light of the phenomenological data collected in the questionnaires. We showed that how well subjects remembered their thoughts while mind wandering was positively correlated with pupil size (subject 1, p< 0.001; subject 2, p< 0.05. Feelings of well being were also positively correlated with pupil size (subject 1, p< 0

  8. Sleep-waking cycle in the cerveau isolé cat.

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    Slósarska, M; Zernicki, B

    1973-06-01

    The experiments were performed on ten chronic low cerveau isolé cats: in eight cats the brain stem transection was prepontine and in two cats, intercollicular. The preparations survived from 24 to 3 days. During 24-36 hr sessions the ECoG activity was continuously recorded, and the ocular and ECoG components of the orienting reflexes to visual and olfactory stimuli were studied. 2. Three periods can be recognized in the recovery process of the low cerveau isolé cat. They are called acute, early chronic and late chronic stages. The acute stage lasts 1 day and the early chronic stage seems to last 3 weeks at least. During the acute stage the ability to desynchronize the EEG, either spontaneously or in response to sensory stimulations, is dramatically impaired and the pupils are fissurated. Thus the cat is comatous. 4. During the early chronic stage, although the ECoG synchronization-desynchronization cycle and the associated fissurated myosis-myosis cycle already exist, the episodes of ECoG desynchronization occupy only a small percentage of time and usually develop slowly. Visual and olfactory stimuli are often ineffective. Thus the cat is semicomatous. In the late chronic stage the sleep-waking cycle is present. The animal can be easily awakened by visual and olfactory stimuli. The intensity of the ECoG arousal to visual stimuli and the distribution of time between alert wakefulness, drowsiness, light synchronized sleep and deep synchronized sleep are similar to those in the chronic pretrigeminal cat. The recovery of the cerveau isolé seems to reach a steady level when the sleep-waking cycle becomes similar to that present in the chronic pretrigeminal cat. During the whole survival period the vertical following reflex is abortive.

  9. Xylazine Exposures Reported to Texas Poison Centers.

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    Forrester, Mathias B

    2016-10-01

    Xylazine is a sedative, analgesic, anesthetic, and central muscle relaxant approved for animals but not humans. Although xylazine is an emerging drug of abuse, there are limited data on potentially adverse exposures to the drug. The intent of this study was to describe potentially adverse xylazine exposures reported to a large poison center system. All xylazine exposures reported to Texas poison centers between 2000 and 2014 were included. The distribution of cases by select variables was determined. Of 76 total cases, 93% of the patients were ≥20 years of age, and 54% were male. Fifty-one percent of the exposures occurred by injection, 28% by ingestion, 16% were dermal, 14% were ocular, and 3% by inhalation. Sixty-four percent of the exposures were unintentional, 32% were intentional, and 1% each was related to malicious use and adverse reaction. Sixty-seven percent of the patients were already at or en route to a health care facility when the poison center was contacted, 21% were managed on-site, and 9% were referred to a health care facility. The most common clinical effects were drowsiness or lethargy (47%), bradycardia (20%), hypotension (11%), hypertension (9%), puncture or wound (8%), and slurred speech (8%). Xylazine exposures tended to involve patients who were adult males, exposures were typically unintentional; and most often occurred by injection. Most of the patients were already at or en route to a health care facility when a poison center was contacted. The most frequently reported adverse effects were cardiovascular or neurologic in nature. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Sleep Quality and Academic Progression among Students of Tabriz University of Medical Sciences, Northwest of Iran

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    Horyeh Sarbazvatan

    2017-06-01

    Full Text Available Background: Sleep deprivation and drowsiness are very common among university students. The aim of this study was to examine the sleep quality and academic achievement among university students across all medical disciplines in Northwest of Iran. Methods: This study was based on data from a longitudinal study, the "Health and Lifestyle of University Students" (HeLiS. The Pittsburgh Sleep Quality Index (PSQI, a self-administered questionnaire consisting of general information about sleep quality, was completed by students during the first eight weeks of the first semester and academic achievement was assessed via Grade Point Average (GPA in the two semesters following the administration of the PSQI. Results: The mean age of students was 19.16±1.04 and the majority were female (64%. The mean overall score on the PSQI was 6.87±2.25; the majority of students (70% had a global PSQI score greater than 5, indicating they were poor sleepers. Only 28% reported getting over 7 hours of sleep. Female students had higher scores than male students in subjective sleep quality, which was statistically significant (2.15 vs. 1.95 respectively, P = 0.01; however, there was no difference between males and females on other component scores or on the global score. Results of a multiple regression model showed that PSQI score was a predictor of academic achievement (β=-.07, P=0.035, which implies that GPA will be lower among students whose quality of sleep is lower. Conclusion: Based on our sleep quality should be considered and assessed, and sleep hygiene should be promoted among medical university students in order to improve academic achievement.

  11. Mycoplasma pneumoniae-associated mild encephalitis/encephalopathy with a reversible splenial lesion: report of two pediatric cases and a comprehensive literature review

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    Norishi Ueda

    2016-11-01

    Full Text Available Abstract Background No literature review exists on Mycoplasma pneumoniae-associated mild encephalitis/encepharopathy with a reversible splenial lesion (MERS. Methods M.pneumoniae-associated MERS cases were searched till August 2016 using PubMed/Google for English/other-language publications and Ichushi ( http://www.jamas.or.jp/ for Japanese-language publications. Inclusion criteria were children fulfilling definition for encephalitis, M.pneumoniae infection, and neuroimaging showing hyperintensity in the splenium of the corpus callosum (SCC alone (type I or SCC/other brain areas (type II. Results We described two children with type I and II M.pneumoniae-associated MERS. Thirteen cases found by the search and our 2 cases were reviewed. Mean age, male/female ratio, duration of prodromal illness was 8.3 years, 1.5 and 3.5 days. The most common neurological symptom was drowsiness, followed by abnormal speech/behavior, ataxia, seizure, delirium, confusion, tremor, hallucination, irritability, muscle weakness, and facial nerve paralysis. Fever was the most common non-neurological symptom, followed by cough, headache, gastrointestinal symptoms, headache, lethargy and dizziness. Seizure and respiratory symptoms were less common. All were diagnosed for M.pneumoniae by serology. Cerebrospinal fluid (CSF M.pneumoniae was undetectable by PCR in the 3 patients. Three patients were clarithromycin-resistant. Leukocytosis, positive C-reactive protein, hyponatremia, CSF pleocytosis and slow wave on electroencephalography frequently occurred. All except 2 were type I MERS. Neuroimaging abnormalities disappeared within 18 days in the majority of patients. All type I patients completely recovered within 19 days. Two type II patients developed neurological sequelae, which recovered 2 and 6 months after onset. Conclusions Prognosis of M.pneumoniae-associated MERS is excellent. Type II MERS may increase a risk of neurological sequelae.

  12. WHO Multidrug Therapy for Leprosy: Epidemiology of Default in Treatment in Agra District, Uttar Pradesh, India

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    Kumar, Anil; Girdhar, Anita; Chakma, Joy Kumar; Girdhar, Bhuwneswar Kumar

    2015-01-01

    Aim. To study the magnitude of default, time of default, its causes, and final clinical outcome. Methods. Data collected in active surveys in Agra is analyzed. Patients were given treatment after medical confirmation and were followed up. The treatment default and other clinical outcomes were recorded. Results. Patients who defaulted have comparable demographic characteristics. However, among defaulters more women (62.7% in PB, 42.6% in MB) were seen than those in treatment completers (PB 52.7% and MB 35.9%). Nerve involvement was high in treatment completers: 45.7% in PB and 91.3% in MB leprosy. Overall default rate was lower (14.8%) in ROM than (28.8%) in standard MDT for PB leprosy (χ 1 2 = 11.6, P = 0.001) and also for MB leprosy: 9.1% in ROM compared to 34.5% in MDT (χ 1 2 = 6.0, P = 0.015). Default rate was not different (28.8% versus 34.5%, P > 0.05) in both types of leprosy given MDT. Most patients defaulted at early stage of treatment and mainly due to manageable side effects. Conclusion. The default in standard MDT both for PB and MB leprosy was observed to be significantly higher than in ROM treatment. Most defaults occurred at early stage of treatment and major contribution of default is due to side effects like drowsiness, weakness, vomiting, diarrhea, and so forth, related to poor general health. Although about half of the defaulters were observed to be cured 2.2% in PB-MDT and 10.9% of MB-MDT developed disability. This is an issue due to default. Attempts are needed to increase treatment compliance. The use of specially designed disease related health education along with easily administered drug regimens may help to reduce default. PMID:25705679

  13. Patient-reported symptoms during radiotherapy. Clinically relevant symptom burden in patients treated with palliative and curative intent

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    Koerner, Philipp [Universitaetsklinikum Wuerzburg, Interdisziplinaeres Zentrum Palliativmedizin, Wuerzburg (Germany); Universitaetsklinikum Wuerzburg, Klinik und Poliklinik fuer Strahlentherapie, Wuerzburg (Germany); Ehrmann, Katja [Universitaetsklinikum Wuerzburg, Medizinische Psychologie und Psychotherapie, Medizinische Soziologie und Rehabilitationswissenschaften, Wuerzburg (Germany); Hartmannsgruber, Johann [Praxis Landshut, Kinderzahnheilkunde, Landshut (Germany); Metz, Michaela; Steigerwald, Sabrina; Flentje, Michael [Universitaetsklinikum Wuerzburg, Klinik und Poliklinik fuer Strahlentherapie, Wuerzburg (Germany); Oorschot, Birgitt van [Universitaetsklinikum Wuerzburg, Interdisziplinaeres Zentrum Palliativmedizin, Wuerzburg (Germany)

    2017-07-15

    The benefits of patient-reported symptom assessment combined with integrated palliative care are well documented. This study assessed the symptom burden of palliative and curative-intent radiation oncology patients. Prior to first consultation and at the end of RT, all adult cancer patients planned to receive fractionated percutaneous radiotherapy (RT) were asked to answer the Edmonton Symptom Assessment Scale (ESAS; nine symptoms from 0 = no symptoms to 10 = worst possible symptoms). Mean values were used for curative vs. palliative and pre-post comparisons, and the clinical relevance was evaluated (symptom values ≥ 4). Of 163 participating patients, 151 patients (90.9%) completed both surveys (116 curative and 35 palliative patients). Before beginning RT, 88.6% of palliative and 72.3% of curative patients showed at least one clinically relevant symptom. Curative patients most frequently named decreased general wellbeing (38.6%), followed by tiredness (35.0%), anxiety (32.4%), depression (30.0%), pain (26.3%), lack of appetite (23.5%), dyspnea (17.8%), drowsiness (8.0%) and nausea (6.1%). Palliative patients most frequently named decreased general wellbeing (62.8%), followed by pain (62.8%), tiredness (60.0%), lack of appetite (40.0%), anxiety (38.0%), depression (33.3%), dyspnea (28.5%), drowsiness (25.7%) and nausea (14.2%). At the end of RT, the proportion of curative and palliative patients with a clinically relevant symptom had increased significantly to 79.8 and 91.4%, respectively; whereas the proportion of patients reporting clinically relevant pain had decreased significantly (42.8 vs. 62.8%, respectively). Palliative patients had significantly increased tiredness. Curative patients reported significant increases in pain, tiredness, nausea, drowsiness, lack of appetite and restrictions in general wellbeing. Assessment of patient-reported symptoms was successfully realized in radiation oncology routine. Overall, both groups showed a high symptom burden

  14. The analysis of factors responsible for sleep quality

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    Piotr Kozłowski

    2017-08-01

    Full Text Available The aim of the study was to evaluate the behavior and habits of sleep. The cause of sleep disorders can be financial problems, depression and anxiety, cigarettes, coffee, alcohol or chronic diseases. The study found the most common mistakes in sleep hygiene. The study included 122 participants. In the study group, 60,7% of respondents were females whereas 39,3% were males. The age of participants ranged from 17 to 53 years. The study conducted in the period from November 2016 to January 2017 and it employed standardized interview research method. Research tool, which was used for data collection was a questionnaire consisted of 18 questions single-choice questions and 4 open questions. Statistical analysis was performed using the chi-square test. All values for which p <0.05 (probability of error were considered statistically significant. Respondents were asked about education, hygiene knowledge, hygiene practice, family sleep disorders. Respondents answered for questions about the quality of sleep. There were 71.3% of respondents have variable and irregular duration of fall asleep, 68.9% of them were female (p <0.05. On the other hand, variable and irregular duration of fsleep affects 52.5% of respondents, 37.5% of them have shift work. The most commonly reported sleep problem was fatigue after waking up (64.8% of respondents. Not much less because 57.4% of respondents feel drowsy during the day, more often respondents who did not consume coffee. 23.8% of respondents reported nighttime waking and falling asleep. Morning sickness is reported by 42.6% of respondents in the early morning, the problem was more common among women. Among the causes of sleep disorders were: stress, daytime abuse of coffee, personal problems, work or school problems, high levels of noise, smoking, watching TV late at night, using the Internet, increased physical activity in the evening, frequent night science, the presence of chronic illness. As many as 43.4% of

  15. Mitigating vestibular disturbances during space flight using virtual reality training and reentry vehicle design guidelines

    Science.gov (United States)

    Stroud, Kenneth Joshua

    Seventy to eighty percent of astronauts reportedly exhibit undesirable vestibular disturbances during the first few days of weightlessness, including space motion sickness (SMS) and spatial disorientation (SD). SMS presents a potentially dangerous situation, both because critical piloted tasks such as docking maneuvers and emergency reentry may be compromised, and because of the potential for asphyxiation should an astronaut vomit while wearing a space suit. SD can be provocative for SMS as well as become dangerous during an emergency in which it is critical for an astronaut to move quickly through the vehicle. In the U.S. space program, medication is currently used both for prevention and treatment of SMS. However, this approach has had only moderate success, and the side effects of drowsiness and lack of concentration are undesirable. Research suggests that preflight training in virtual reality devices can simulate certain aspects of microgravity and may prove to be an effective countermeasure for SMS and SD. It was hypothesized that exposing subjects preflight to variable virtual orientations, similar to those encountered during space flight, will reduce the incidence and/or severity of SMS and SD. Results from a study conducted at the NASA Johnson Space Center as part of this research demonstrated that this type of training is effective for reducing motion sickness and improving task performance in potentially disorienting visual surroundings, thus suggesting the possibility that such training may prove an effective countermeasure for SMS, SD and related performance decrements that occur in space flight. In addition to the effects associated with weightlessness, almost all astronauts experience vestibular disturbances associated with gravity-transitions incurred during the return to Earth, which could be exacerbated if traveling in a spacecraft that is designed differently than a conventional aircraft. Therefore, for piloted descent and landing operations

  16. PENGARUH AROMA TERAPI LAVENDER TERHADAP KUALITAS TIDUR LANSIA DI WISMA CINTA KASIH

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    Dian Sari

    2018-03-01

    Full Text Available Bad sleep quality causes fatigue, difficulty concentrating, and often drowsiness in the elderly. The purpose of this study was to determine the effect of aroma of lavender therapy on the quality of elderly sleep at Wisma Cinta Kasih Padang. This type of research is quantitative with pre-experimental design using One Group Pretest-Posttest Design design using T-test dependent test. Sampling technique in this research use purposive sampling 30 responden as intervention group. The research to do in Wisma Cinta Kasih Padang. The results of the study found that all elderly (100% had poor sleep quality before lavender aromatherapy and only 40% experienced poor sleep quality after lavender therapy. The statistical test obtained p value = 0.000, where there is influence of lavender therapy to sleep quality of elderly in Wisma Cinta Kasih Padang. The smell of lavender therapy can improve the quality of elderly sleep. Officer Wisma Cinta Kasih Padang in order to provide lavender therapy every 2 times / week at bedtime so as to improve the quality of elderly sleep. Kualitas tidur buruk menyebabkan kelelahan, sulit berkonsentrasi, dan sering mengantuk pada lansia. Tujuan penelitian ini adalah untuk mengetahui pengaruh aroma terapi lavender terhadap kualitas tidur lansia di Wisma Cinta Kasih Padang. Jenis penelitian ini adalah kuantitatif dengan desain preekperimental menggunakan rancangan One Group Pretest-Posttest Design menggunakan uji T-test dependent. Teknik pengambilan sampel dalam penelitian ini menggunakan purposive sampling 30 responden sebagai kelompok intervensi. Penelitian dilakukan di Wisma Cinta Kasih Padang. Hasil penelitian didapatkan seluruh lansia (100% mengalami kualitas tidur yang buruk sebelum diberikan aromaterapi lavender dan hanya 40% yang mengalami kualitas tidur buruk sesudah diberikan aroma terapi lavender. Uji statistik didapatkan nilai p= 0,000, dimana terdapat pengaruh terapi lavender terhadap kualitas tidur lansia di Wisma

  17. Treatment of a case of emphysematous pyelonephritis that presented with acute abdomen and pneumoperitoneum: a case report.

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    Park, Sang Hyun; Kim, Ki Hoon

    2015-08-01

    Emphysematous pyelonephritis is a severe, life-threatening infection of the renal parenchyma and perinephric tissues. This condition is primarily encountered in patients with diabetes mellitus or ureteral obstruction, and is characterized by the production of intrarenal and perinephric gas. Emphysematous pyelonephritis is associated with a high degree of morbidity and a high mortality rate. A 72-year-old woman with a history of diabetes mellitus, hypertension, and renal calculi was referred to our emergency department following 6 days of abdominal pain. She suddenly developed pain in the entire abdomen, and was transferred. Physical examination was a distended abdomen with hypoactive bowel sounds. The tenderness was diffuse, but was most prominent in the right upper abdominal quadrant; moreover, rebound tenderness was noted. Laboratory tests revealed a white blood cell count of 4,480/mm(3), platelet count of 17,000/mm(3), creatinine level of 1.64 mg/dl, and serum glucose level of 603 mg/dl. Abdominal computed tomography indicated the presence of free air in the intraperitoneal cavity and right perirenal space, hydronephrosis of the right kidney, and stones in the right distal ureter. After 1 hour, the vital signs changed and she appeared to become drowsy. Therefore, the patient was transferred to the operation room for laparotomy. On exploration of the abdomen, 1.5 L of pus-colored fluid was removed. Although the abdominal viscera and pelvic organs were examined, hollow viscus perforation site could not be observed. Moreover, tissue necrosis and a perforation site were identified at the superior border of the right kidney. Thus, emphysematous pyelonephritis was diagnosed and she underwent right radical nephrectomy. After the surgery, the patient was admitted to the intensive care unit for postoperative management. Follow-up CT performed after 10 days showed fluid collection and hematoma at the nephrectomy site. Hence, percutaneous drainage was performed. Another

  18. A 41-Year-Old Woman with Seizure

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    Fatemeh Mohammadi

    2017-01-01

    Full Text Available The patient was a 41 year old woman that was brought to the emergency department (ED by her husband following seizure. According to the relatives accompanying her, the seizure was of tonic-clonic type, had occurred one hour before presentation to ED, and had lasted 3 minutes. The patient had been drowsy for about 15 minutes after the end of the seizure. She had no history of head trauma and did not mention headache, nausea and vomiting, fever, vision problems or others. On presentation, amnesia regarding the things that happened was evident. In her history, she had a generalized tonic-clonic seizure 4 years back, regarding which she had not done proper follow up for taking necessary diagnostic measures and had not been treated with anti-epileptic medication. She had a history of surgery for removing cold thyroid nodule 20 years ago and was under calcium treatment for 15 years but she had decided to stop taking her medications since 5 year ago. She did not have a history of alcohol or drug abuse. The patient was conscious and awake on presentation and did not have any specific clinical complaints. Her vital signs on presentation were as follows:Blood Pressure = 120/70mmHg, Pulse Rate = 68/minute, Respiratory Rate = 16/minute, O2saturation= 98% at air room, Oral Temperature= 37°C, and bedside blood sugar in the normal range.In head and neck examination, the surgery scar was seen in the thyroid region. Examination of the thyroid also showed a nodular surface in palpation. Examination of the heart, lungs, abdomen and extremities did not have pathologic findings. Neurologic examinations including evaluation of cranial nerves, sense and power of the muscles, cerebellar examination and deep tendon reflexes were normal. Based on the opinion of the in-charge physician, anti-epileptic drugs were not prescribed at this stage. Laboratory tests including complete blood cell count, liver function tests (LFT, and level of blood sugar (BS, sodium, potassium

  19. Adverse Effects of Antidepressants for Chronic Pain: A Systematic Review and Meta-analysis

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    Carina Riediger

    2017-07-01

    Full Text Available BackgroundAntidepressants are widely used in the treatment of chronic pain. Applied doses are lower than those needed to unfold an antidepressive effect. While efficacy of antidepressants for chronic pain has been reported in large randomized-controlled trials (RCT, there is inconsistent data on adverse effects and tolerability. We aimed at synthesizing data from RCT to explore adverse effect profiles and tolerability of antidepressants for treatment of chronic pain.MethodsSystematic literature research and meta-analyses were performed regarding side effects and safety of different antidepressants in the treatment of chronic pain according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The National Center for Biotechnology Information library and MEDLINE were searched. Randomized placebo-controlled trials were included in quantitative data synthesis.ResultsOut of 1,975 screened articles, 33 papers published between 1995 and 2015 were included in our review and 23 studies were included in the meta-analyses. A higher risk for adverse effects compared to placebo was observed in all antidepressants included in our analyses, except nortriptyline. The most prevalent adverse effects were dry mouth, dizziness, nausea, headache, and constipation. Amitriptyline, mirtazapine, desipramine, venlafaxine, fluoxetine, and nortriptyline showed the highest placebo effect-adjusted risk of adverse effects. Risk for withdrawal due to adverse effects was highest in desipramine (risk ratio: 4.09, 95%-confidence interval [1.31; 12.82] followed by milnacipran, venlafaxine, and duloxetine. The most common adverse effects under treatment with antidepressants were dry mouth, dizziness, nausea, headache, and constipation followed by palpitations, sweating, and drowsiness. However, overall tolerability was high. Each antidepressant showed distinct risk profiles of adverse effects.ConclusionOur synthesized data analysis confirmed overall

  20. Analgesic efficacy, adverse effects, and safety of oxycodone administered as continuous intravenous infusion in patients after total hip arthroplasty

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    Olczak B

    2017-05-01

    Full Text Available Bogumił Olczak,1 Grzegorz Kowalski,1,2 Wojciech Leppert,2 Iwona Zaporowska-Stachowiak,3 Katarzyna Wieczorowska-Tobis2 1Department of Anesthesiology, Józef Struś Multiprofile Municipal Hospital, 2Department of Palliative Medicine, Poznan University of Medical Sciences, 3Department of Pharmacology, Poznan University of Medical Sciences, Poland Background: Total hip arthroplasty (THA causes extensive tissue damage and severe pain. This study aimed to assess the analgesic efficacy, adverse effects (AEs, and safety of continuous intravenous (iv oxycodone infusion with ketoprofen (injected into the iv line in patients after THA, and to assay serum oxycodone levels.Patients and methods: Fourteen patients, aged 59‒82 years with American Society of Anesthesiologists (ASA classification I or III, underwent THA with intrathecal analgesia and sedation induced by iv propofol. After the surgery, oxycodone (continuous iv infusion at a dose of 1 mg/h (five patients or 2 mg/h (nine patients with 100 mg ketoprofen (injected into the iv line was administered to each patient every 12 h. Pain was assessed using a numerical rating scale (NRS: 0 – no pain, 10 – the most severe pain at rest and during movement. AEs, including hemodynamic unsteadiness, nausea, vomiting, pruritus, cognitive impairment, and respiratory depression, were registered during the first 24 h after surgery.Results: Oxycodone (continuous iv infusion at a dose of 2 mg/h with ketoprofen (100 mg administered every 12 h provided satisfactory analgesia in all nine patients without the need of rescue analgesics within the first 24 h after THA. In three out of five patients, oxycodone at 1 mg/h was effective. Oxycodone did not induce drowsiness, vomiting, pruritus, respiratory depression, or changes in blood pressure. Bradycardia appeared in two patients, and nausea was observed in one patient.Conclusion: Oxycodone infusion with ketoprofen administered by iv is effective in patients after THA