BACKGROUND:Altered mental status(AMS) is a very common emergency case,but the exact etiology of many AMS patients is unknown.Patients often manifest vague symptoms,thus,AMS diagnosis and treatment are highly challengi...BACKGROUND:Altered mental status(AMS) is a very common emergency case,but the exact etiology of many AMS patients is unknown.Patients often manifest vague symptoms,thus,AMS diagnosis and treatment are highly challenging for emergency physicians.The aim of this study is to provide a framework for the assessment of AMS patients.This assessment should allow providers to better understand the etiology of mental status changes and therefore improve diagnostic skills and management.METHODS:This is a prospective cohort observational study.We recruited all adult patients with undifferentiated AMS at a single center tertiary care academic emergency department over 24months(June 2009 to June 2011).Demographic characteristics,clinical manifestations,assessment approaches,causative factors,emergency treatments and outcomes were collected prospectively.RESULTS:In 1934 patients with AMS recruited,accounting for 0.93%of all emergency department(ED) patients,1 026(53.1%) were male,and 908(46.9%) female.Their average age was 51.95±15.71 years.Etiologic factors were neurological(n=641;35.0%),pharmacological and toxicological(n=421;23.0%),systemic and organic(n=266;14.5%),infectious(n=167;9.1%),endocrine/metabolic(n=145;7.9%),psychiatric(n=71;3.9%),traumatic(n=38;2.1%),and gynecologic and obstetric(n=35;1.9%).Total mortality rate was 8.1%(n=156).The death rate was higher in elderly patients(≥60) than in younger patients(10.8%vs.6.9%,P=0.003).CONCLUSIONS:Patients with AMS pose a challenge for ED physicians.The most frequently encountered diagnostic categories causing AMS were primary CNS disorders,intoxication,organ system dysfunction,and endocrine/metabolic diseases.AMS has a high fatality rate in the ED.AMS is an important warning signal for ED patients because of its potentially fatal and reversible effects.Prompt evaluation and treatment are essential to decreasing morbidity and mortality associated with AMS.展开更多
BACKGROUND Intravascular large B-cell lymphoma(IVLBCL)is a rare and aggressive subtype of non-Hodgkin lymphoma with a varied presentation and no pathognomonic findings.Early diagnosis is critical to altering the disea...BACKGROUND Intravascular large B-cell lymphoma(IVLBCL)is a rare and aggressive subtype of non-Hodgkin lymphoma with a varied presentation and no pathognomonic findings.Early diagnosis is critical to altering the disease course as early treatment with chemoimmunotherapy is required to prevent a rapidly fatal outcome.Strategies including improved awareness of this clinical entity through publication of cases with unique presentations are essential to prompt consideration of IVLBCL early in the disease workup.Here,we present a case of IVLBCL presenting with altered mental status and systemic organ dysfunction.CASE SUMMARY A 61-year-old male patient presented with flu-like symptoms and a high fever.He experienced rapid clinical deterioration with liver,kidney failure,and shock despite rapid antibiotic administration and supportive care.A broad infectious workup was negative.Intracranial imaging revealed nonspecific changes to the corpus callosum suspicious for vasculitis.Renal biopsy was non-diagnostic.After further progression of his symptoms,the family elected to withdraw care and the patient died shortly thereafter.Post-mortem analysis revealed clear multi-organ involvement by IVLBCL,prompting re-examination of the ante-mortem renal biopsy that also identified IVLBCL involvement.CONCLUSION IVLBCL is a rare disease.Communication with specialties and early biopsy is critical to establishing the diagnosis and initiating therapy.展开更多
INTRODUCTION Increasing incidences of neurological complications are being encountered with the increase in the incidence of human immunodeficiency virus(HIV).[1]These can be due to the direct involvement of the centr...INTRODUCTION Increasing incidences of neurological complications are being encountered with the increase in the incidence of human immunodeficiency virus(HIV).[1]These can be due to the direct involvement of the central nervous system(CNS)by the virus or due to other opportunistic infections.Cerebral toxoplasmosis is a common opportunistic infection seen in HIV-infected patients。展开更多
BACKGROUND Hypertensive cerebral hemorrhage(HCH),the most common chronic diseases,has become a topic of global public health discussions.AIM To investigate the role of rehabilitative nursing interventions in optimizin...BACKGROUND Hypertensive cerebral hemorrhage(HCH),the most common chronic diseases,has become a topic of global public health discussions.AIM To investigate the role of rehabilitative nursing interventions in optimizing the postoperative mental status recovery phase and to provide clinical value for future rehabilitation of patients with HCH.METHODS This randomized controlled study included 120 patients with cerebral HCH who were contained to our neurosurgery department between May 2021–May 2023 as the participants.The participants have randomly sampled and grouped into the observation and control groups.The observation group received the rehabilitation nursing model,whereas the control group have given conventional nursing.The conscious state of the patients was assessed at 7,14,21,and 30 d postoperatively.After one month of care,sleep quality,anxiety,and depression were compared between the two groups.Patient and family satisfaction were assessed using a nursing care model.RESULTS The results showed that the state of consciousness scores of the patients in both groups significantly increased(P<0.05)after surgical treatment.From the 14th day onwards,differences in the state of consciousness scores between the two groups of patients began to appear(P<0.05).After one month of care,the sleep quality,anxiety state,and depression state of patients were significantly better in the observation group than in the control group(P<0.05).Satisfaction with nursing care was higher in the observation group than in the control group(P<0.05).CONCLUSION The rehabilitation nursing model has a more complete system compared to conventional nursing,which can effectively improve the postoperative quality of life of patients with cerebral hemorrhage and improve the efficiency of mental state recovery;however,further analysis and research are needed to provide more scientific evidence.展开更多
Irritable bowel syndrome(IBS)is a common chronic functional gastrointestinal disorder affecting 10%-22%of adults.Its development is closely related to the gut microbiota,and the inflammatory and immune responses trigg...Irritable bowel syndrome(IBS)is a common chronic functional gastrointestinal disorder affecting 10%-22%of adults.Its development is closely related to the gut microbiota,and the inflammatory and immune responses triggered by the gut microbiota can lead to IBS.Vitamin D(VD)effectively treats IBS with fewer side effects by improving gut microbiota,immune regulation,and anti-inflammatory effects.In the future,it is necessary to carry out epidemiological studies on the relationship between VD and IBS,clinical studies on the efficacy of supplementing VD to improve IBS,and animal studies on the mechanism of VD improving IBS.Therefore,this paper discussed the relationship between VD and IBS.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)epidemic disrupted education systems by forcing systems to shift to emergency online leaning.Online learning satisfaction affects academic achievement.Many factors affe...BACKGROUND The coronavirus disease 2019(COVID-19)epidemic disrupted education systems by forcing systems to shift to emergency online leaning.Online learning satisfaction affects academic achievement.Many factors affect online learning satisfaction.However there is little study focused on personal characteristics,mental status,and coping style when college students participated in emergency online courses.regression analyses were performed to identify factors that affected online learning satisfaction.RESULTS Descriptive findings indicated that 62.9%(994/1580)of students were satisfied with online learning.Factors that had significant positive effects on online learning satisfaction were online learning at scheduled times,strong exercise intensity,good health,regular schedule,focusing on the epidemic less than one hour a day,and maintaining emotional stability.Positive coping styles were protective factors of online learning satisfaction.Risk factors for poor satisfaction were depression,neurasthenia,and negative coping style.CONCLUSION College students with different personal characteristics,mental status,and coping style exhibited different degrees of online learning satisfaction.Our findings provide reference for educators,psychologists,and school adminis-trators to conduct health education intervention of college students during emergency online learning.展开更多
BACKGROUND Hepatic encephalopathy(HE)is a neurocognitive condition in cirrhosis leading to frequent hospitalizations.Nonselective beta-blockers(NSBBs)are the mainstay of pharmacologic treatment in cirrhotic patients.W...BACKGROUND Hepatic encephalopathy(HE)is a neurocognitive condition in cirrhosis leading to frequent hospitalizations.Nonselective beta-blockers(NSBBs)are the mainstay of pharmacologic treatment in cirrhotic patients.We hypothesized that since NSBBs decrease cardiac output and portal flow,the decreased metabolic filtering process of liver parenchyma may lead to increased HE-related hospitalizations.AIM To evaluate the impact of NSBB administration on HE-related readmissions in cirrhotic patients.METHODS In this retrospective cohort study,we included 393 patients admitted to Baylor University Medical Center for liver-related portal hypertension indications between January 2013 and July 2018.Independent predictors of the first HErelated readmissions were identified using Cox proportional hazards analysis.The cumulative incidence of the first HE-related readmissions between patients receiving NSBBs and not receiving NSBBs was examined using Fine-Gray modeling to account for the competing risk of death or liver transplantation.RESULTS The mean age was 58.1±10.2 years and most patients fell into Child class C(49.1%)or B(43.8%).The median Model for End-Stage Liver Disease-Sodium score was 22(IQR:11).The cumulative incidence of the first HE-related readmissions was significantly higher in patients taking NSBBs compared to patients not receiving NSBBs(71.8%vs 41.8%,P<0.0001).In multivariate analysis,after adjusting for demographics,markers of liver disease severity,selective beta-blocker,lactulose and rifaximin use,NSBB use[Hazard ratio:1.74(95%CI:1.29-2.34)]was independently associated with the first HE-related readmissions over a median follow-up of 3.8 years.CONCLUSION NSBB use is independently associated with increased HE-related readmissions in patients with cirrhosis,regardless of liver disease severity.展开更多
BACKGROUND: Non-convulsive seizure(NCS) is an underdiagnosed, potentially treatable emergency with significant mortality and morbidity. The objective of this study is to examine the characteristics of patients with NC...BACKGROUND: Non-convulsive seizure(NCS) is an underdiagnosed, potentially treatable emergency with significant mortality and morbidity. The objective of this study is to examine the characteristics of patients with NCS presenting with altered mental status(AMS) and diagnosed with electroencephalography(EEG), to identify the factors that could increase the pre-test probability of NCS.METHODS: Retrospective study using the data collected prospectively. Inclusion criteria: patients older than 13 years with AMS. Exclusion criteria:(1) immediately correctable AMS(e.g., hypoglycemia, opiod overdose);(2) inability to undergo EEG;(3) hemodynamic instability. Outcomes compared between NCS and non-NCS cases: vital signs, lactate level, gender, witnessed seizure, use of anticonvulsive in the field or in the ED, history of seizure or stroke, head injury, abnormal neurological finding and new abnormal findings on head CT. Data presented as medians and quartiles for categorical and percentages with 95%CI for continuous variables. Univariate analyses were performed with Man-Whitney U and Fisher's Exact tests. A multivariate analysis model was used to test the predictive value of clinical variables in identifying NCS.RESULTS: From 332 patients(median age 66 years, quartiles 50–78), 16 were diagnosed with NCS(5%, 95%CI 3%–8%). Only age was signifi cantly different between the NCS vs. non-NCS groups in both univariate(P=0.032) and multivariate analyses(P=0.016).CONCLUSION: Other than age, no other clinically useful variable could identify patients at high risk of NCS. ED physicians should have a high suspicion for NCS and should order EEG for these patients more liberally.展开更多
文摘BACKGROUND:Altered mental status(AMS) is a very common emergency case,but the exact etiology of many AMS patients is unknown.Patients often manifest vague symptoms,thus,AMS diagnosis and treatment are highly challenging for emergency physicians.The aim of this study is to provide a framework for the assessment of AMS patients.This assessment should allow providers to better understand the etiology of mental status changes and therefore improve diagnostic skills and management.METHODS:This is a prospective cohort observational study.We recruited all adult patients with undifferentiated AMS at a single center tertiary care academic emergency department over 24months(June 2009 to June 2011).Demographic characteristics,clinical manifestations,assessment approaches,causative factors,emergency treatments and outcomes were collected prospectively.RESULTS:In 1934 patients with AMS recruited,accounting for 0.93%of all emergency department(ED) patients,1 026(53.1%) were male,and 908(46.9%) female.Their average age was 51.95±15.71 years.Etiologic factors were neurological(n=641;35.0%),pharmacological and toxicological(n=421;23.0%),systemic and organic(n=266;14.5%),infectious(n=167;9.1%),endocrine/metabolic(n=145;7.9%),psychiatric(n=71;3.9%),traumatic(n=38;2.1%),and gynecologic and obstetric(n=35;1.9%).Total mortality rate was 8.1%(n=156).The death rate was higher in elderly patients(≥60) than in younger patients(10.8%vs.6.9%,P=0.003).CONCLUSIONS:Patients with AMS pose a challenge for ED physicians.The most frequently encountered diagnostic categories causing AMS were primary CNS disorders,intoxication,organ system dysfunction,and endocrine/metabolic diseases.AMS has a high fatality rate in the ED.AMS is an important warning signal for ED patients because of its potentially fatal and reversible effects.Prompt evaluation and treatment are essential to decreasing morbidity and mortality associated with AMS.
文摘BACKGROUND Intravascular large B-cell lymphoma(IVLBCL)is a rare and aggressive subtype of non-Hodgkin lymphoma with a varied presentation and no pathognomonic findings.Early diagnosis is critical to altering the disease course as early treatment with chemoimmunotherapy is required to prevent a rapidly fatal outcome.Strategies including improved awareness of this clinical entity through publication of cases with unique presentations are essential to prompt consideration of IVLBCL early in the disease workup.Here,we present a case of IVLBCL presenting with altered mental status and systemic organ dysfunction.CASE SUMMARY A 61-year-old male patient presented with flu-like symptoms and a high fever.He experienced rapid clinical deterioration with liver,kidney failure,and shock despite rapid antibiotic administration and supportive care.A broad infectious workup was negative.Intracranial imaging revealed nonspecific changes to the corpus callosum suspicious for vasculitis.Renal biopsy was non-diagnostic.After further progression of his symptoms,the family elected to withdraw care and the patient died shortly thereafter.Post-mortem analysis revealed clear multi-organ involvement by IVLBCL,prompting re-examination of the ante-mortem renal biopsy that also identified IVLBCL involvement.CONCLUSION IVLBCL is a rare disease.Communication with specialties and early biopsy is critical to establishing the diagnosis and initiating therapy.
文摘INTRODUCTION Increasing incidences of neurological complications are being encountered with the increase in the incidence of human immunodeficiency virus(HIV).[1]These can be due to the direct involvement of the central nervous system(CNS)by the virus or due to other opportunistic infections.Cerebral toxoplasmosis is a common opportunistic infection seen in HIV-infected patients。
文摘BACKGROUND Hypertensive cerebral hemorrhage(HCH),the most common chronic diseases,has become a topic of global public health discussions.AIM To investigate the role of rehabilitative nursing interventions in optimizing the postoperative mental status recovery phase and to provide clinical value for future rehabilitation of patients with HCH.METHODS This randomized controlled study included 120 patients with cerebral HCH who were contained to our neurosurgery department between May 2021–May 2023 as the participants.The participants have randomly sampled and grouped into the observation and control groups.The observation group received the rehabilitation nursing model,whereas the control group have given conventional nursing.The conscious state of the patients was assessed at 7,14,21,and 30 d postoperatively.After one month of care,sleep quality,anxiety,and depression were compared between the two groups.Patient and family satisfaction were assessed using a nursing care model.RESULTS The results showed that the state of consciousness scores of the patients in both groups significantly increased(P<0.05)after surgical treatment.From the 14th day onwards,differences in the state of consciousness scores between the two groups of patients began to appear(P<0.05).After one month of care,the sleep quality,anxiety state,and depression state of patients were significantly better in the observation group than in the control group(P<0.05).Satisfaction with nursing care was higher in the observation group than in the control group(P<0.05).CONCLUSION The rehabilitation nursing model has a more complete system compared to conventional nursing,which can effectively improve the postoperative quality of life of patients with cerebral hemorrhage and improve the efficiency of mental state recovery;however,further analysis and research are needed to provide more scientific evidence.
文摘Irritable bowel syndrome(IBS)is a common chronic functional gastrointestinal disorder affecting 10%-22%of adults.Its development is closely related to the gut microbiota,and the inflammatory and immune responses triggered by the gut microbiota can lead to IBS.Vitamin D(VD)effectively treats IBS with fewer side effects by improving gut microbiota,immune regulation,and anti-inflammatory effects.In the future,it is necessary to carry out epidemiological studies on the relationship between VD and IBS,clinical studies on the efficacy of supplementing VD to improve IBS,and animal studies on the mechanism of VD improving IBS.Therefore,this paper discussed the relationship between VD and IBS.
基金The study protocol was approved by the Ethics Committee of Hebei General University and complied strictly with ethical requirements.Ethics Review No.2020 scientific ethics No.30.
文摘BACKGROUND The coronavirus disease 2019(COVID-19)epidemic disrupted education systems by forcing systems to shift to emergency online leaning.Online learning satisfaction affects academic achievement.Many factors affect online learning satisfaction.However there is little study focused on personal characteristics,mental status,and coping style when college students participated in emergency online courses.regression analyses were performed to identify factors that affected online learning satisfaction.RESULTS Descriptive findings indicated that 62.9%(994/1580)of students were satisfied with online learning.Factors that had significant positive effects on online learning satisfaction were online learning at scheduled times,strong exercise intensity,good health,regular schedule,focusing on the epidemic less than one hour a day,and maintaining emotional stability.Positive coping styles were protective factors of online learning satisfaction.Risk factors for poor satisfaction were depression,neurasthenia,and negative coping style.CONCLUSION College students with different personal characteristics,mental status,and coping style exhibited different degrees of online learning satisfaction.Our findings provide reference for educators,psychologists,and school adminis-trators to conduct health education intervention of college students during emergency online learning.
文摘BACKGROUND Hepatic encephalopathy(HE)is a neurocognitive condition in cirrhosis leading to frequent hospitalizations.Nonselective beta-blockers(NSBBs)are the mainstay of pharmacologic treatment in cirrhotic patients.We hypothesized that since NSBBs decrease cardiac output and portal flow,the decreased metabolic filtering process of liver parenchyma may lead to increased HE-related hospitalizations.AIM To evaluate the impact of NSBB administration on HE-related readmissions in cirrhotic patients.METHODS In this retrospective cohort study,we included 393 patients admitted to Baylor University Medical Center for liver-related portal hypertension indications between January 2013 and July 2018.Independent predictors of the first HErelated readmissions were identified using Cox proportional hazards analysis.The cumulative incidence of the first HE-related readmissions between patients receiving NSBBs and not receiving NSBBs was examined using Fine-Gray modeling to account for the competing risk of death or liver transplantation.RESULTS The mean age was 58.1±10.2 years and most patients fell into Child class C(49.1%)or B(43.8%).The median Model for End-Stage Liver Disease-Sodium score was 22(IQR:11).The cumulative incidence of the first HE-related readmissions was significantly higher in patients taking NSBBs compared to patients not receiving NSBBs(71.8%vs 41.8%,P<0.0001).In multivariate analysis,after adjusting for demographics,markers of liver disease severity,selective beta-blocker,lactulose and rifaximin use,NSBB use[Hazard ratio:1.74(95%CI:1.29-2.34)]was independently associated with the first HE-related readmissions over a median follow-up of 3.8 years.CONCLUSION NSBB use is independently associated with increased HE-related readmissions in patients with cirrhosis,regardless of liver disease severity.
基金supported by NIH grant 1RC3NS070658 to Bio-Signal Group Inc
文摘BACKGROUND: Non-convulsive seizure(NCS) is an underdiagnosed, potentially treatable emergency with significant mortality and morbidity. The objective of this study is to examine the characteristics of patients with NCS presenting with altered mental status(AMS) and diagnosed with electroencephalography(EEG), to identify the factors that could increase the pre-test probability of NCS.METHODS: Retrospective study using the data collected prospectively. Inclusion criteria: patients older than 13 years with AMS. Exclusion criteria:(1) immediately correctable AMS(e.g., hypoglycemia, opiod overdose);(2) inability to undergo EEG;(3) hemodynamic instability. Outcomes compared between NCS and non-NCS cases: vital signs, lactate level, gender, witnessed seizure, use of anticonvulsive in the field or in the ED, history of seizure or stroke, head injury, abnormal neurological finding and new abnormal findings on head CT. Data presented as medians and quartiles for categorical and percentages with 95%CI for continuous variables. Univariate analyses were performed with Man-Whitney U and Fisher's Exact tests. A multivariate analysis model was used to test the predictive value of clinical variables in identifying NCS.RESULTS: From 332 patients(median age 66 years, quartiles 50–78), 16 were diagnosed with NCS(5%, 95%CI 3%–8%). Only age was signifi cantly different between the NCS vs. non-NCS groups in both univariate(P=0.032) and multivariate analyses(P=0.016).CONCLUSION: Other than age, no other clinically useful variable could identify patients at high risk of NCS. ED physicians should have a high suspicion for NCS and should order EEG for these patients more liberally.
