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At least 577 records · Page 32Linked to original sources
PubMed1988

Lactulose detoxifies in vitro short-chain fatty acid production in colonic contents induced by blood: implications for hepatic coma.

Short-chain (C2-C6) fatty acids constitute the major anions of colonic contents. Acetate is nontoxic in contrast to C(3)4-C6 fatty acids, which induce coma in animals and have been reported to be of importance in the development of hepatic coma in humans. An in vitro fecal incubation system was used to demonstrate how blood, hemoglobin, albumin, lactulose, galactose, fructose, and glucose influence short-chain fatty acid production in the colon. Blood, hemoglobin, and albumin caused increased production of all C2-C6 fatty acids, with the most pronounced increase (fourfold) in C4-C6 fatty acids. Lactulose was converted to acetate only, as were its monosaccharide components, D-galactose and D-fructose. In assays incubated with blood, the production of C4-C6 fatty acids was completely inhibited by lactulose, D-galactose, D-fructose, and D-glucose, respectively, whereas the production of acetate was increased. Lactulose thus "detoxified" the profile of short-chain fatty acids produced in the presence of blood and proteins, indicating that colonic fermentative bacteria prefer lactulose to blood when both substrates are available. The effect of lactulose in the treatment of hepatic coma caused by episodes of gastrointestinal bleeding may therefore be due to a shift in bacterial metabolism from blood or proteins, or both, to lactulose in the colon, resulting in a simultaneous reduction in toxic nitrogenous and organic acid products.

Bacteria↗
PubMed1988

Serum apoproteins A and B and the lecithin: cholesterol acyl transferase activities in liver cirrhosis and hepatic coma patients.

Serum apoproteins A and B and LCAT activities were estimated in 80 patients, 46 with posthepatic cirrhosis and 34 with alcoholic cirrhosis. The cirrhosis patients were also divided into compensated, decompensated, and hepatic coma subgroups. Apo-A and LCAT activities were significantly decreased in both cirrhotic groups without any significant difference between posthepatitic and alcoholic cirrhotic groups, while Apo-B was decreased in hepatic coma patients only. The decompensated cirrhosis patients showed lower Apo-A levels than the compensated cirrhosis patients and hepatic coma patients showed still lower levels compared to decompensated subgroup, while no significant decrease was observed in LCAT activities between compensated and decompensated cirrhosis patients. Apo-A level was correlated more significantly with serum albumin level than the LCAT activity. The study confirms that Apo-A level is highly related to the degree of liver injury and also suggests that this decrease may be mainly due to impaired liver synthesis and that the serum levels of Apo-A and Apo-B can be utilized in the differential diagnosis of chronic liver diseases.

Adult↗
PubMed2004

The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility.

OBJECTIVE: To determine the measurement properties and diagnostic utility of the JFK Coma Recovery Scale-Revised (CRS-R). DESIGN: Analysis of interrater and test-retest reliability, internal consistency, concurrent validity, and diagnostic accuracy. SETTING: Acute inpatient brain injury rehabilitation hospital. PARTICIPANTS: Convenience sample of 80 patients with severe acquired brain injury admitted to an inpatient Coma Intervention Program with a diagnosis of either vegetative state (VS) or minimally conscious state (MCS). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The CRS-R, the JFK Coma Recovery Scale (CRS), and the Disability Rating Scale (DRS). RESULTS: Interrater and test-retest reliability were high for CRS-R total scores. Subscale analysis showed moderate to high interrater and test-retest agreement although systematic differences in scoring were noted on the visual and oromotor/verbal subscales. CRS-R total scores correlated significantly with total scores on the CRS and DRS indicating acceptable concurrent validity. The CRS-R was able to distinguish 10 patients in an MCS who were otherwise misclassified as in a VS by the DRS. CONCLUSIONS: The CRS-R can be administered reliably by trained examiners and repeated measurements yield stable estimates of patient status. CRS-R subscale scores demonstrated good agreement across raters and ratings but should be used cautiously because some scores were underrepresented in the current study. The CRS-R appears capable of differentiating patients in an MCS from those in a VS.

Adolescent↗
PubMed2000

Flight muscle resting potential and species-specific differences in chill-coma.

Resting potentials in Apis mellifera and Drosophila melanogaster flight muscles decrease with falling temperatures. When resting potentials fall to between -37 and -45 mV they activate a final burst of spontaneous muscle action potentials (MAPs). This final burst of MAPs marks the beginning of chill-coma for each species. The temperature at which the final burst occurs for D. melanogaster (7.0+/-0.9 degrees C) is significantly lower than that of A. mellifera workers (10.6+/-1.2 degrees C), queens (10.2+/-0.8 degrees C), and drones (12.8+/-0.8 degrees C). Prior to chill-coma, MAP amplitudes decrease and durations increase with falling temperatures in both A. mellifera and D. melanogaster. The rate of these changes and the temperatures at which they occur appear to be related to the rate of decline in each species' resting potential. These results suggest that insect chill-coma varies with a species' ability to maintain its resting potential at low temperatures.

Journal Article↗
PubMed2005

Expression and characterization of the peptidase domain of Streptococcus pneumoniae ComA, a bifunctional ATP-binding cassette transporter involved in quorum sensing pathway.

ComA, a member of the bacteriocin ATP-binding cassette transporters, is postulated to be responsible for both the processing of the propeptide ComC and secretion of the mature competence-stimulating peptide, which regulates the competence and subsequent genetic transformation in Streptococcus pneumoniae. A recombinant N-terminal peptidase domain of ComA, designated PEP, was expressed as a soluble protein in Escherichia coli, purified to homogeneity, and characterized. Gel-filtration analysis revealed that PEP functions as a monomer. The purified PEP exhibited an efficient proteolytic activity for the substrate ComC, which was cleaved after the double glycine site. The stability of PEP was examined by circular dichroism analyses. A convenient method for analyzing the proteolytic activity of PEP was developed, and the kinetic parameters for ComC were determined (k(cat) = 1.5 +/- 0.083 min(-1) and Km = 62 +/- 9.0 microM). Replacements of Cys17 of PEP with Ser or Ala and His96 with Ala resulted in complete loss of activity, indicating that both Cys17 and His96 are essential for the catalysis. Together with information from a protease data base, the N-terminal domain of ComA was concluded to belong to the same clan as the papain-like cysteine proteases. Mutant substrates, in which each of the double glycines was replaced with Ala, were cleaved very poorly by PEP. The mechanism of this strict substrate specificity is discussed on the basis of the sequence alignment with other cysteine proteases.

Adenosine Triphosphate↗
PubMed1997

Ubiquitous distribution of the competence related genes comA and comC among isolates of Streptococcus pneumoniae.

DNA probes specific for the pneumococcal competence regulatory genes comA and comC were used to test the presence of these genes in 214 pneumococcal isolates selected to represent a wide variety of clonal types and genetic backgrounds (as defined by chromosomal macrorestriction patterns and multilocus enzyme analysis), a variety of serotypes, isolation dates (between 1916 and 1996), geographic origins (on four continents), as well as different clinical origins (including both infection sites and colonization sites). Each isolate gave positive signal with both DNA probes. The comA and comC genes were never on the same SmaI restriction fragment and the comA gene showed a considerable degree of polymorphism from one strain to another. While DNA sequencing of 50 of the isolates have identified three distinct alleles of the comC gene, the number of mutations within the leader peptide were minimal. The results suggest that the mechanism to undergo genetic transformation is widespread within the species of Streptococcus pneumoniae.

Alleles↗
PubMedDate not supplied

Refractory increased intracranial pressure in severe traumatic brain injury: barbiturate coma and bispectral index monitoring.

Patients with severe traumatic brain injury resulting in increased intracranial pressure refractory to first-tier interventions challenge the critical care team. After exhausting these initial interventions, critical care practitioners may utilize barbiturate-induced coma in an attempt to reduce the intracranial pressure. Titrating appropriate levels of barbiturate is imperative. Underdosing the drug may fail to control the intracranial pressure, whereas overdosing may lead to untoward effects such as hypotension and cardiac compromise. Monitoring for a therapeutic level of barbiturate coma includes targeting drug levels and using continuous electroencephalogram monitoring, considered the gold standard. New technology, the Bispectral Index monitor, utilizes electroencephalogram principles to monitor the level of sedation and hypnosis in the critical care environment. This technology is now being considered for targeting appropriate levels of barbiturate coma.

Adult↗
PubMed1997

Coma stimulation.

Coma stimulation is a treatment in which a health care professional or a patient's family member systematically applies stimulation to one or more of the patient's five senses, for the purpose of increasing patient responsiveness. The rationale is that exposure to frequent and various sensory stimulation will facilitate both dendritic growth and improve synaptic connectivity in those with damaged nervous systems (Ansell, 1991; Kater, 1989). This review was conducted to determine whether research supports the incorporation of a coma stimulation program into routine nursing care. Included studies were of stimulation programs in inpatient settings, analyzing both multimodal and unimodal sensory stimulation. Implications for nursing practice are given, including specific prescriptives for implementing a coma stimulation program and areas for further research.

Journal Article↗
PubMed1996

Diffuse Extreme-Ultraviolet Emission from the Coma Cluster: Evidence for Rapidly Cooling Gases at Submegakelvin Temperatures

The central region of the Coma cluster of galaxies was observed in the energy band from 0.065 to 0.245 kiloelectron volts by the Deep Survey telescope aboard the Extreme Ultraviolet Explorer. A diffuse emission halo of angular diameter approximately 30 arc minutes was detected. The extreme-ultraviolet (EUV) emission level exceeds that expected from the x-ray temperature gas in Coma. This halo suggests the presence of two more phases in the emitting gas, one at a temperature of approximately 2 x 10(6) kelvin and the other at approximately 8 x 10(5) kelvin. The latter phase cools rapidly and, in steady state, would have produced cold matter with a mass of approximately 10(14) solar masses within the EUV halo. Although a similar EUV enhancement was discovered in the Virgo cluster, this detection in Coma applies to a noncooling flow system.

Journal Article↗
PubMed1991

Transcription initiation region of the srfA operon, which is controlled by the comP-comA signal transduction system in Bacillus subtilis.

srfA is an operon required for the production of the lipopeptide antibiotic surfactin, competence development, and efficient sporulation in Bacillus subtilis. The expression of srfA is induced after the end of exponential growth and is dependent on the products of late-growth regulatory genes comP, comA, and spo0K. To begin to understand the mechanism of srfA regulation, the srfA promoter region was identified and characterized. To examine srfA promoter activity, the srfA promoter was fused to lacZ and inserted into the B. subtilis chromosome as a single copy at the SP beta prophage. The location of the transcription start site of srfA was determined by primer extension analysis and shown to be preceded by a sequence that resembles the consensus promoter recognized by the sigma A form of RNA polymerase. The srfA operon was found to have a sequence corresponding to a long, untranslated leader region of the srfA mRNA (300 bp). A nucleotide sequence and mutational analysis of the promoter identified a region of dyad symmetry required for srfA-lacZ expression. A similar sequence is found in the region upstream of the degQ promoter, transcription from which is also regulated by ComA. This region of dyad symmetry found upstream of these promoters may be the target for ComA-dependent transcriptional activation.

Bacillus subtilis↗
PubMed1987

Effect of barbiturate coma on glucose utilization in normal brain versus gliomas. Positron emission tomography studies.

Glucose utilization by normal and neoplastic cerebral tissue can be measured in humans using positron emission tomography (PET) with fluorine-18-labeled 2-deoxy-D-glucose (FDG). Malignant gliomas are known to exhibit hypermetabolic glucose consumption compared to normal brain. Barbiturate-sensitive cerebral glucose utilization is coupled to neuronal activity, and lesions lacking neuronal activity should be relatively insensitive to barbiturate suppression of glucose utilization. In a study to examine this phenomenon, three patients with cerebral gliomas underwent FDG-PET while awake and during deep barbiturate coma. Cerebral glucose utilization was measured in normal brain, tumor, and a homologous, non-neoplastic control site in the contralateral hemisphere. A glucose utilization ratio for tumor/control tissue was calculated. The mean reduction of glucose utilization during barbiturate coma was: gray matter 67%, white matter 47%, basal ganglia 66%, thalamus 57%, cerebellar cortex 55%, tumor 32%, and the contralateral control site 64%. The mean tumor glucose utilization ratio was 1.48:1 in the awake state and 2.69:1 during barbiturate coma. The changes in gray matter, basal ganglia, thalamus, cerebellar cortex, and tumor/control tissue ratio were significant (p less than 0.05). In one patient, deep tumor invasion not evident on computerized tomography, magnetic resonance imaging, or baseline FDG-PET was apparent during barbiturate-enhanced FDG-PET scanning. The study findings suggest that gliomas resist suppression of glucose utilization by barbiturates; this supports the hypothesis that barbiturates reduce neuronal metabolism by blocking synaptic activity. This differential effect on normal brain and gliomas enhances the capability to assess the extent of neoplastic tissue in brain and may represent the basis for novel therapeutic strategies.

Adult↗
PubMed1975

Silent acute pancreatitis with encephalomalacia mimicking hepatic coma.

A very rare case of acute pancreatitis with concurrent encephalomalacia and ascites mimicking hepatic coma is described. The possibliity that the pancreatitis was caused by the administration of chlorothiazide in a diabetic patient is suggested as possible etiology. It is emphasized that when a cirrhotic patient develops coma, the possibility of painless,silent pancreatitis with encephalomalacia as well as hepatic coma should be considered in the differential diagnosis.

Acute Disease↗
PubMed1979

[Electroencephalographic changes in coma due to hepatic insufficiency with porto-caval shunt (author's transl)].

EEG studies were done in 19 patients comatose due to severe hepatic insufficiency associated with porto-caval shunting. The neurological deficits were graded in 5 stages and related to the abnormal EEG-pattern observed in 38 records. With deepening of coma, alpha-frequencies were gradually replaced by theta- and delta-activities. The frequency of theta- and delta-runs decreased with neurological deterioration. Triphasic waves (typical and/or atypical) were seen in 26% of the records. Typical triphasic waves were found to be limited to stage 3 of coma, whereas atypical forms appeared in earlier and later stages. After infusions of L-Valin, a transient improvement and disappearance of triphasic waves was observed, but no significant effect could be established on the final course of the disease. Sleep-like potentials and the reactivity to external stimuli decreased in deep stages of coma. Severe EEG abnormalities were correlated to low cholinesterase and high lactid acid blood level, but no correlation was found to the level of ammonia.

Alpha Rhythm↗
PubMedDate not supplied

[Hepatic coma. The nursing care].

The hepatic coma is an entity tending to occur as a complication of severe hepatic diseases and in which the recognition of symptoms and signs by the personnel caring for those patients is essential for the early detection of this condition. A review of the literature is made making emphasis on the pathogenesis, clinical picture and the trigger factors of the hepatic coma. The nursing care for patients with hepatic coma are described; stressing that the nursing diagnosis of the first signs Ia essential for the prognosis and the clinical course of these patients. It is pointed out how health education in these patients is oriented to maintain and improve their health condition, to have a better response to the treatment and to avoid a relapse in prone patients.

Combined Modality Therapy↗
PubMed1993

Alternatives to the Glasgow Coma Scale as a quality of life predictor following traumatic brain injury.

Conventional "staging " of traumatic brain injury (TBI) typically uses depth of coma assessed by the Glasgow Coma Scale (GCS) score near admission as a severity marker. Frequently, early GCS scores are contaminated by alcohol or drug ingestion and other, nonneurological organ system trauma. As well, this measure's usefulness is limited due to its restricted range in survivors. Here we explore the utility of using length of posttraumatic amnesia, coma duration, and age as indirect markers of severity. Cluster analytic techniques were used to examine the relationship of severity so defined to long-term outcome in 106 mild, moderate, and severe TBI patients. Results indicate complex relationships between cluster groups with the influence of age of patient being highlighted as an important moderator in determining severity of injury and later psychosocial outcome.

Journal Article↗
PubMed2000

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

BACKGROUND: Evaluation of the role of euthyroid sick syndrome and pituitary gland hormonal changes and the prognosis of patient mortality after severe brain injury. METHODS: The research was conducted on 65 patients with isolated severe brain injury. Blood samples were obtained as soon as possible after the injury and on the 1st, 2nd, 3rd, 5th and 7th day after the injury. Blood concentrations of T(3), rT(3), T(4), FT(4), TSH, and PRL were estimated. The patients' state of health was evaluated in the sixth hour after the injury, using Glasgow Coma Scale, and after 180 days, using the Glasgow Outcome Scale. Multidirectional correlation was sought between the concentrations of the estimated hormones and the score obtained in the Glasgow Coma Scale and Glasgow Outcome Scale. RESULTS: Cluster analysis showed that concentrations of the hormones in the patients who died are grouped in different clusters from those in the patients who survived. This proves that hormonal patterns are different in these groups. Statistically significant lower T(3) concentrations were observed on the 3rd day in comparison with the 0 day. Cumulative proportion surviving was lower for the OP group in comparison with the NOP group and amounted to 0.57. CONCLUSIONS: In all patients covered by the research euthyroid sick syndrome was diagnosed. T(3) concentration on the 3rd day after the injury together with the evaluation in Glasgow Coma Scale allows for more precise prognosis.

Journal Article↗
PubMed1991

[Forced insulin coma therapy and its efficacy].

The title method was applied to the treatment of schizophrenic patients suffering from schizoaffective, paranoid and hallucinatory paranoid attacks. Definite correlations were established between the development of insulin coma and the type of the reverse development of psychosis. Five variants of schizophrenia reduction due to the treatment method under consideration were distinguished and described: variant 1--harmonic critical, variant 2--harmonic lytic, variant 3--disharmonious deliric, variant 4--disharmonious affective, and variant 5--incomplete reduction. The established correlations between variants of the development of insulin coma and the type of psychosis reduction enable one to predict whether the use of forced insulin coma therapy will be desirable and effective.

Chronic Disease↗
PubMedDate not supplied

[Questionnaire studies of the effectiveness of atropine coma in patients treated at the I Clinic for Mental Diseases, Medical Academy, in Gdańsk 1979-1987].

The questionnaire follow-up study of 86 patients treated with atropine comas in the Ist Clinic of Psychiatry, Medical Academy in Gdańsk was carried out. 47 patients (62%) responded to the questionnaire. The atropine coma was estimated as the best tolerated method of treatment by 33 responders. The study confirm therapeutic efficiency of atropine coma in obsessive-compulsive neurosis and anancastic syndrome.

Adolescent↗