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Signa Vitae

Journal of Intensive Care and Emergency Medicine

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Risk factors for developing epilepsy after neonatal seizures


Neonatal seizures are the most frequent neurological disorder in the neonatal period. The incidence is reported to be higher than at any other period in life. Because of the unique nature of neonatal brain anatomy, connections and the paradoxical nature of neurotransmitters, seizures in this age group vary in semiology from those in older children. They may cause irreversible changes to the synapses in the immature brain and progress to epilepsy.

The aim of the study was to analyse laboratory, clinical, neurophysiological and neuroimaging risk factors for epilepsy in a group of children who experienced seizures in the neonatal period.

A retrospective study of 176 newborns admitted to the Department of Neonatology, University Children’s Hospital Ljubljana, due to seizures, was performed. Metabolic disorders and hypoxic-ischaemic encephalopathy were the most frequent aetiological factors associated with seizures. Epilepsy rate in the group was 18%. Pathological cardiotocography, reanimation after delivery, myoclonic type of seizures, more than one type of seizures, severely abnormal electroencephalography, abnormal neurological examination and neuroimaging, treatment with more than one antiepileptic drug and duration of treatment more than one month constituted statistically significant independent predictive factors for epilepsy (p< 0.05).

The results of our study further elucidate risk factors for epilepsy after neonatal seizures.

Key words: newborns, seizures, epilepsy, risk factors

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Impact of pre-hospital oxygenation and ventilation status on outcome in patients with isolated severe traumatic brain injury


Introduction. Hypoxia is one of the secondary insults and it worsens the outcome in patients with severe traumatic brain injury (TBI). On the other hand, there is some controversy about the impact of hyperoxia on the outcome in these patients. The aim of the study was to determine the impact of pre-hospital hypoxia, hyperoxia and pre-hospital ventilation status on outcome after isolated TBI.

Methods. We retrospectively reviewed charts from patients with isolated severe TBI who underwent pre-hospital endotracheal intubation. The population was sorted into groups based on PaO2 (hypoxic, PaO2 <100 mmHg; normoxic, PaO2 100-200 mmHg; hyperoxic, PaO2 > 200 mmHg) and initial Glasgow Coma Scale (GCS) level (3-5 and ≥ 6). Ventilation status was defined as: hypocarbic (PaCO2 < 35 mmHg), normocarbic (PaCO2 35-45 mmHg) and hypercarbic (PaCO2 > 45 mmHg).

Results. Oxygenation status had no significant impact on 24- and 48-hour survival, on the length of hospital stay or on neurological outcome (measured by the Glasgow Outcome Scale (GOS), Glasgow Pittsburgh Cerebral Performance Categories Scale (CPC), and GCS score at discharge) when all six groups were compared together. We were unable to prove a deleterious effect of hypoxia or hyperoxia compared to normoxia on rate of survival to hospital discharge (STHD) (0.38 (0.52) vs 0.50 (0.51) vs 0.65 (0.49), where 0 – no and 1 – yes; f = 1.246, p = 0.298). Ventilation status also failed to significantly affect survival and functional outcome in patients with isolated severe TBI.

Conclusion. Pre-hospital oxygenation and ventilation status have no significant impact on outcome in patients with isolated severe TBI.

Key words: hypoxia, pre-hospital, intubation, hyperventilation, traumatic brain injury

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Automated external defibrillator skills among lay people in the region of Koroska: a pilot study


Background. In the region of Koroška, there are more and more public spaces equipped with automated external defibrillators which can be used by a witnessed bystander. The aim of this study was to gain insight into the skills required for using automated external defibrillators.

Methods. This was a cross-sectional survey conducted in two family medicine practices. We included volunteers who visited their family doctor during a period of four days. Skills were assessed in a virtual setting using a plastic manikin.

Results. There were 107 participants in the sample, 60.0% were women. Average age of the sample was 47.6±16.8 years. In the practical part (skills testing), the participants earned 2.7 points from a total of 5 points. Younger participants and those who attended a course in basic life support, in the past 10 years, had a significantly higher score.

Conclusion. Lay people need more education regarding skills for using automated external defibrillators.

Key words: automated external defibrillator, basic life support, lay people, survival, cardiac arrest

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Rheumatic heart disease with triple valve involvement


Acute rheumatic fever (ARF) is a postinfectious, nonsuppurative sequela of pharyngeal infection caused by Streptococcus pyogenes, or Group A β hemolytic Streptococcus (GABHS). Of the associated symptoms, only damage to the heart’s valvular tissue, or rheumatic heart disease (RHD), can become a chronic condition leading to congestive heart failure, stroke, endocarditis, and death. ARF is the most common cause of cardiac disease in children in developing countries. A joint meeting of the World Health Organization and the International Society estimated that 12 million people in developing countries were affected by acute rheumatic fever and rheumatic heart disease, with the majority of these being children. This level of morbidity is comparable to developed countries’ in the last century, before an increase in the standard of living and the introduction of penicillin. Significant trivalvular disease, involving the mitral, aortic and tricuspid valves, is uncommon. Although rare, trivalvular disease has been described in the literature. Clinical and hemodynamic manifestations depend on the severity of each lesion. We reported this case because of the rare presentation of an uncommon disorder and to highlight the fact that the presence of trivalvular disease can be difficult to diagnose, even for a trained physician.

Key words: rheumatic heart disease, triple valve disease, rheumatic valve disease

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Sympathetic hyperactivity syndrome following cerebral fat embolization


To date, there have been no reports of paroxysmal sympathetic hyperactivity syndrome (PSHS) associated with cerebral fat embolization. We describe the case of a young male who developed acute brain injury and acute hypoxemic respiratory failure secondary to significant fat embolization following a traumatic femur injury. Our patient demonstrated episodes of significant hypertension, tachycardia, fever and extensor posturing. Extensive evaluation lead to the diagnosis and appropriate treatment for PSHS. Ultimately, the patient went on to have a good neurologic recovery after a prolonged hospitalization. We will discuss PSHS diagnostic criteria, pathophysiology and treatment options. This diagnosis should be considered in all brain-injured patients with paroxysms of autonomic instability and abnormal movements.

Key words: acute brain injury, myoclonic encephalopathy, fat embolism, autonomic nervous system diseases, adult respiratory distress syndrome,wound, injuries

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