Characteristics of Patient with Status Epilepticus at the Emergency Department of Sanglah General Hospital

Introduction: Status epilepticus is a neurological condition caused by a failure of body mechanism to terminate the seizures or the onset of abnormal seizure activity resulting in prolonged seizure’s duration for more than five minutes. The available research data on status epilepticus in Indonesia is still limited. The purpose of this study was to determine the profile of patients with status epilepticus at Sanglah General Hospital from 2020 to 2021. Methods: This was a descriptive study with a retrospective approach. The study populations were patients with status epilepticus who were treated at Sanglah General Hospital in 2019-2020 who had no missing data in the medical records. Results: There were 117 patients with status epilepticus, 63 males (53.8%) and 54 females (46.2%). There are 41 patients>60 years (35%), general onset in 63 patients (53.8%), and focal onset in 54 patients (46.2%). Etiology from cerebral was 68 patients (58.1%), followed by metabolic in 28 patients (23.9%). The most common OAE therapy was phenytoin (86.3%) and the longest length of stay status epilepticus patients was 8 days (55.6%). Patients with status epilepticus had leukocytosis (73.5%), increased NLR (66.7%), and decreased mean platelet volume (53.8%). Conclusion: The highest incidence of status epilepticus is in women, above 60 years, general onset type of seizure, and etiology from cerebral. Initial therapy in 117 patients was intravenous diazepam followed by phenytoin for maintenance. NLR increased in most of the patients showing signs of inflammation which further worsened the patient's outcome with a mortality rate of 47%. Keywords: Status epilepticus, seizure duration, anticonvulsant, neutrophil-lymphocyte ratio.

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Noncompliance Contributing to Apparent Drug Failure in Status Epilepticus

PEDIATRICS ◽

10.1542/peds.53.6.938 ◽

1974 ◽

Vol 53 (6) ◽

pp. 938-940

Author(s):

John T. Wilson

Keyword(s):

Status Epilepticus ◽

Plasma Levels ◽

Seizure Activity ◽

Drug Level ◽

Continuous Control ◽

Drug Plasma ◽

Intravenous Diazepam ◽

Grand Mal ◽

History Of ◽

Drug Plasma Levels

The case to be described illustrates apparent drug failure because of noncompliance in the drug delivery system, and the sequelae of this mishap. In connection with investigation of this case further occurrences of noncompliance were found. This incident also brings into focus the importance of plasma drug level determinations for effective application of therapy. CASE REPORT A 7-year-old, 26-kg, black girl was admitted with a 16-month history of nonprogressive neurologic disease accompanied by clinical and EEG evidence of petit mal and grand mal epilepsy which responded to diphenylhydantoin (DPH), phenobarbital or ethosuximide (Zarontin) treatment. Generalized convulsions had been infrequent for four months, but, before the present admission, a marked increase in grand mal seizures was noted. On the day of admission (day 1), recurrent generalized seizure activity progressed to status epilepticus within six hours. Intravenous diazepam (Valium [0.18/mg/kg]) controlled the seizures. Primidone (Mysoline), 250 mg tid, and ethosuximide, 500 mg tid were prescribed as maintenance anticonvulsants in an attempt to allay further progression to status epilepticus. For the next several days her seizures could be controlled only with paraldehyde (0.36 mg/kg intravenously), although administration of other drugs was continued. Assays of drug plasma levels did not become available until day 6. They disclosed that plasma levels of diazepam and demethyldiazepam were high (289 and 50 ng/ml, respectively) one hour after dosing with 0.18 mg/kg. This indicated that diazepam was not effective for continuous control of seizures, but this information was not acted upon immediately. The most striking finding was that primidone was not detected in plasma, although the prescibed dosage was 250 mg tid.

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Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio in Missed Abortion

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0040-1709693 ◽

2020 ◽

Vol 42 (05) ◽

pp. 235-239

Author(s):

Ismail Biyik ◽

Mustafa Albayrak ◽

Fatih Keskin

Keyword(s):

Pregnant Women ◽

Medical Records ◽

Complete Blood Count ◽

Platelet Distribution Width ◽

Platelet Volume ◽

Missed Abortion ◽

Distribution Width ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Inflammatory Parameters

Abstract Objective Missed abortion occurs in ∼ 15% of all clinical pregnancies. The pathogenesis is not clearly known. However, defective placentation resulting in maternal systemic inflammatory response is considered responsible for missed abortion. Platelet lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) are increasingly cited parameters of inflammation in the literature. However, no study evaluated the PLR and NLR rates in missed abortions so far. The aim of the present study is to investigate whether complete blood count (CBC) inflammatory parameters such as NLR and PLR are increased in patients with missed abortion. Methods Medical records of 40 pregnant women whose gestation ended in missed abortion at between 6 and14 weeks of gestation and of 40 healthy pregnant women were collected and compared retrospectively. The groups were compared regarding hemoglobin, hematocrit, platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), PLR and NLR. Results Platelet distribution width, NLR and PLR values were higher in the missed abortion group compared with the healthy pregnant women group (rates are p = 0.043; p = 0.038; and p = 0.010, respectively). Hematocrit, MPV, and lymphocyte values were found to be lower in the missed abortion group compared with the healthy pregnant women group (p = 0.027, p = 0.044 and p = 0.025, respectively). Conclusion The PDW, NLR and PLR values of the missed abortion group were reported high; and MPV values were reported low in the present study. These findings may help to speculate a defective placentation in the pathogenesis of missed abortion.

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Prehospital Administration of Rectal Diazepam in Pediatric Status Epilepticus

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00026741 ◽

1990 ◽

Vol 5 (2) ◽

pp. 155-158

Author(s):

Rodney E. Drawbaugh ◽

Christopher G. Deibler ◽

David R. Eitel

Keyword(s):

Status Epilepticus ◽

Seizure Activity ◽

Neuronal Damage ◽

Rectal Administration ◽

The United States ◽

Morbidity Rate ◽

Drug Of Choice ◽

Rectal Diazepam ◽

Intravenous Diazepam ◽

Alternate Routes

Seizures are a common pediatric problem encountered by prehospital personnel. Status epilepticus is defined as seizure activity lasting longer than 15 minutes, or recurrent seizures that occur close together without a period of consciousness between ictal periods. It is estimated that 60,000 to 160,000 cases of status epilepticus occur each year within the United States. Prior to 1960, status epilepticus carried a 50% morbidity rate. However, improved anticonvulsive medications, aggressive airway management, and the spread of EMS Systems throughout the nation have reduced the morbidity rate to a range of 8% to 12%.Prompt and vigorous treatment is paramount in the successful management of status epilepticus because delays can result in neuronal damage and death. Although intravenous diazepam currently is the drug of choice to terminate seizure activity, it may be difficult to rapidly establish a patent intravenous (IV) line during status epilepticus in young children with vigorous motor activity. Alternate routes, such as intramuscular injections, are unreliable due to unpredictable absorption. Rectal administration of diazepam may provide an useful alternate route for delivery of the drug during status epilepticus when IV attempts fail.In this review, the authors discuss a case of status epilepticus wherein intravenous access could not be established rapidly and the patient was given diazepam rectally with favorable results.

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Loss of Limb Following Intravenous Diazepam

PEDIATRICS ◽

10.1542/peds.53.1.112 ◽

1974 ◽

Vol 53 (1) ◽

pp. 112-114

Author(s):

Sanford Schneider ◽

John W. Mace

Keyword(s):

Cardiac Arrest ◽

Status Epilepticus ◽

Side Effects ◽

Venous Thrombosis ◽

Intravenous Administration ◽

Seizure Activity ◽

Significant Morbidity ◽

Prolonged Seizure ◽

Intravenous Diazepam

Since its introduction for the control of status epilepticus in 1965, parenterally administered diazepam has proven to be extremely effective in halting prolonged seizure activity. Reported side effects have been minimal and usually not associated with significant morbidity. However, apnea, bradycardia, hypotension, cardiac arrest, and conversion of atypical spike and wave status epilepticus to graudmal status have been reported. Additionally, thrombophlebitis following intravenous administration has been associated with diazepam. Langdon et al. recently stated that 3.5% of patients receiving diazepam intravenously Prior to esophagogastroscopy developed thrombophlebitis. In several patients venous thrombosis was marked and tender cords were palpable many months after injection.

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Risk Factor Of Substitution ARV First Line People Living With HIV/AIDS In General Hospital Buleleng Bali

STRADA JURNAL ILMIAH KESEHATAN ◽

10.30994/sjik.v9i1.240 ◽

2020 ◽

Vol 9 (1) ◽

pp. 190-197

Author(s):

Luh Putu Desy Puspaningrat ◽

Gusti Putu Candra ◽

Putu Dian Prima Kusuma Dewi ◽

I Made Sundayana ◽

Indrie Lutfiana

Keyword(s):

Risk Factor ◽

General Hospital ◽

Medical Records ◽

Secondary Data ◽

District General Hospital ◽

People Living With Hiv ◽

First Line ◽

The Past ◽

Factor Substitution ◽

Living With Hiv

Substitution is still a threat to the failure of ARV therapy so that no matter how small it must be noted and monitored in ARV therapy. The aims was analysis risk factor substitution ARV first line in therapy ARV. This study was an analytic longitudinal study with retrospective secondary data analysis in a cohort of patients receiving ARV therapy at the District General Hospital of Buleleng District for the period of 2006-2015 and secondary data from medical records of PLHA patients receiving ART. Result in this study that the percentage of first-line ARV substitution events is 9.88% (119/1204) who received ARV therapy for the past 11 years. Risk factors that increase the risk of substitution in ARV therapy patients are zidovudine (aOR 4.29 CI 1.31 -2.65 p 0.01), nevirapine (aOR1.86 CI 2.15 - 8.59 p 0.01) and functional working status (aOR 1.46 CI 1.13 - 1.98 p 0.01).

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CDDO-Me Distinctly Regulates Regional Specific Astroglial Responses to Status Epilepticus via ERK1/2-Nrf2, PTEN-PI3K-AKT and NFκB Signaling Pathways

Antioxidants ◽

10.3390/antiox9101026 ◽

2020 ◽

Vol 9 (10) ◽

pp. 1026

Author(s):

Ji-Eun Kim ◽

Hana Park ◽

Tae-Cheon Kang

Keyword(s):

Status Epilepticus ◽

Signaling Pathways ◽

Seizure Activity ◽

Molecular Layer ◽

Antioxidant Properties ◽

Acid Methyl Ester ◽

Related Factor ◽

Nuclear Factor ◽

Reactive Astrogliosis ◽

Nrf2 Expression

2-Cyano-3,12-dioxo-oleana-1,9(11)-dien-28-oic acid methyl ester (CDDO-Me) is a triterpenoid analogue of oleanolic acid. CDDO-Me shows anti-inflammatory and neuroprotective effects. Furthermore, CDDO-Me has antioxidant properties, since it activates nuclear factor-erythroid 2-related factor 2 (Nrf2), which is a key player of redox homeostasis. In the present study, we evaluated whether CDDO-Me affects astroglial responses to status epilepticus (SE, a prolonged seizure activity) in the rat hippocampus in order to understand the underlying mechanisms of reactive astrogliosis and astroglial apoptosis. Under physiological conditions, CDDO-Me increased Nrf2 expression in the hippocampus without altering activities (phosphorylations) of phosphatase and tensin homolog deleted on chromosome 10 (PTEN), phosphatidylinositol-3-kinase (PI3K), and AKT. CDDO-Me did not affect seizure activity in response to pilocarpine. However, CDDO-Me ameliorated reduced astroglial Nrf2 expression in the CA1 region and the molecular layer of the dentate gyrus (ML), and attenuated reactive astrogliosis and ML astroglial apoptosis following SE. In CA1 astrocytes, CDDO-Me inhibited the PI3K/AKT pathway by activating PTEN. In contrast, CDDO-ME resulted in extracellular signal-related kinases 1/2 (ERK1/2)-mediated Nrf2 upregulation in ML astrocytes. Furthermore, CDDO-Me decreased nuclear factor-κB (NFκB) phosphorylation in both CA1 and ML astrocytes. Therefore, our findings suggest that CDDO-Me may attenuate SE-induced reactive astrogliosis and astroglial apoptosis via regulation of ERK1/2-Nrf2, PTEN-PI3K-AKT, and NFκB signaling pathways.

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References to Alcohol Consumption and Alcoholism in Medical Records of a General Hospital of Porto Alegre, Brazil—

Substance Abuse ◽

10.1300/j465v25n02_05 ◽

2005 ◽

Vol 25 (2) ◽

pp. 29-34 ◽

Cited By ~ 1

Author(s):

Flávio Pechansky ◽

Vanessa Krebs Genro ◽

Lísia von Diemen ◽

Félix Henrique Paim Kessler ◽

Rafael Alberto Pacheco da Silveira-Santos

Keyword(s):

Alcohol Consumption ◽

General Hospital ◽

Medical Records ◽

Porto Alegre

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Status Epilepticus in Children With Epilepsy: The Role of Antiepileptic Drug Levels in Prevention

PEDIATRICS ◽

10.1542/peds.98.6.1119 ◽

1996 ◽

Vol 98 (6) ◽

pp. 1119-1121

Author(s):

Joseph Maytal ◽

Gerald Novak ◽

Catherine Ascher ◽

Robert Bienkowski

Keyword(s):

Status Epilepticus ◽

Antiepileptic Drug ◽

Medical Records ◽

Clinic Visit ◽

Drug Levels ◽

Progressive Encephalopathy ◽

History Of ◽

The Mean ◽

Subtherapeutic Level

Objectives. To determine the association between subtherapeutic antiepileptic drug (AED) levels or AED withdrawal and status epilepticus (SE) in children with epilepsy. Methods. We studied the AED levels at the time of SE in 51 consecutive children with epilepsy. Information about prior AED levels, possible etiology of seizures, and acute precipitants was extracted from medical records. Results. The mean age at the time of SE was 5.7 years (range, 3 months through 18 years). Forty-three patients had history of remote insult, five had history of progressive encephalopathy, and three patients were classified as idiopathic. At the time of SE all AED levels were therapeutic in 34 (66%) patients and at least one level was therapeutic in 42 (82%) patients. All levels were subtherapeutic in 9 (18%) patients. Four patients had their AED reduced or discontinued less than 1 week before SE. Twelve patients with therapeutic AED levels on their most recent clinic visit had at least one subtherapeutic level at the time of SE. Eight (16%) patients were febrile and one was hyponatremic. Of the 51 patients, 31 (61%) had no obvious explanation for the development of SE, as all known AEDs were therapeutic and there were no known acute insults. Conclusions. Neurologically abnormal children with preexisting epilepsy are at high risk for development of SE despite having therapeutic AED levels at that time. Acute precipitants of SE, such as fever or AED withdrawal, may play a role in inducing SE only in a minority of patients.

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CHARACTERISTICS OF PATIENTS WITH BRAIN INJURY DUE TO LAND TRAFFIC ACCIDENTS TREATED AT NINH BINH PROVINCIAL GENERAL HOSPITAL IN 2018

Tạp chí Y học Cộng đồng ◽

10.52163/jcm.v62i5.149 ◽

2021 ◽

Vol 62 (5) ◽

Author(s):

Luong Xuan Hien ◽

Nguyen Quoc Tien ◽

Tran Thi Phuong

Keyword(s):

Brain Injury ◽

General Hospital ◽

Medical Records ◽

Traffic Accidents ◽

Brain Injuries ◽

First Aid ◽

Temporal Region ◽

Age Group ◽

Research Subjects ◽

Broken Bones

This was an epidemiological study through a retrospective review of 215 medical records of patients with brain injury due to land traffic accidents treated at Ninh Binh Provincial General Hospital. Theresults showed that the majority of research subjects were male, accounting for 80.5%; The age group with higher prevalence of accidents was under 30 years old, accounting for 31.2%; The agegroup of 50-59 years old was at lower prevalence of accidents accounting for 15.8%. The time of the higher chance of occurring accident was between 4p.m and 11p.m daily. The majorityof traffic accidents occurred when riding motorbikes and electric bicycles (82.3%). About 75.0% of the victims received first aid with a gauze bandage; 5.4% of them had broken bones fixed. Amongthe brain injuries, 34.4% of the victims suffered from frontal trauma; 29.3% had unilateral cerebral hemisphere injury, 24.2% had temporal region injury, 15.8% had occipital region injury, and 8.4% ofvictims had parietal injury. More than half of the study subjects (53.5%) were hospitalized for 7-10 days. The rate of patients who have been discharged from the hospital with improved symptoms was81.4%; and 14.9% of patients were transferred to higher level hospitals.

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