PGPR, PEMUPUKAN AN ORGANIK DAN VERMIKOMPOST TERHADAP PANJANG BATANG & DIAMETER TEBU (Saccharum officinarum L.) DI SCREENHOUSE

Combine between fertilizer vermicompos, inorganic fertilizer and PGPR is a breakthrough in the development of agricultural technology to increase the growth of persistent vegetative state and the results of production plant cane. This researsh aims to determine the effect of a combination of organic fertilizers (vermicompost), inorganic and PGPR on the growth of the length and diameter of plant cane. Vegetative growth studycondukted in screenhouse Brawijaya university poor starts in August 2019 until january 2020. Treatment such as 1). PGPR 5 ml per liter or 10 ml per liter combined with fertilizer inorganic 100% (7 kw ZA + 3 kw SP 36 + 3 kw kcl 2). PGPR 5ml per liter or 10 ml per liter combined with vermikompos 10 ton/ha mixed with 50% inorganic fertilizer the research was compiled using random design comlplete factorial. Repeated three times result showing that the PGPR 10 ml per liter proved to be able to increase long stalks of, the provision of a mixture of fertilizer and inorganic vermikompos 50% able to ancrease growth of plant in the trunk dameter, sugar cane, a combination pgpr and vermikompos mixed inorganic fertilizers able to enlarge the diameter of a plant stem sugar cane.

Analysis of prognostic factors and complications following decompressive craniectomy for traumatic brain injury

Background: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality. Decompressive craniectomy (DC) is a common surgery done for patients with TBI. An analysis of factors that determine the outcome and complications will go a long way in improving the prognosis of such patients.Methods: This is a single‑center, retrospective study of TBI patients who underwent DC from March 2016 to February 2020 at a tertiary care hospital in South India. Demographic profile, clinical data, radiological findings, intraoperative observations, postoperative complications, and Glasgow Outcome Score (GOS) at discharge were noted.Results: 164 patients underwent DC. Road Traffic Accident was the most common cause (116 patients) 71%. The mortality rate among patients with a motor score of M1 was 73.8%, 77.8% in the M2 group, 54.4%, 34.6%, and 10.6% in M3, M4, and M5 groups respectively. The survival rate among patients with bilaterally dilated pupils was 18.1%. 48.3% and 62.1% in those with unequal and equal reactive pupils respectively. The most common pathology was subdural hemorrhage in 108 (65.9%). External cerebral herniation was seen in 62 cases (37.8%). The mortality rate was 39% (64 patients). Persistent vegetative state was noted in 6.1% (10 patients) and severe disability in 24.4% (40 patients). Poor outcome was seen in 69.5% (114 patients). Primary DC was done in 113 patients (68.9%) with a mortality rate of 39.8% (45 patients) and secondary DC in 51 patients (31.1%) with a mortality rate of 37.2% (19 patients).Conclusions: Preoperative low motor score and dilated pupils were associated with higher mortality rate. The most common pathologies were subdural hemorrhage (SDH) and contusion and external cerebral herniation was the most common complication. Primary DC had a higher mortality rate than secondary DC.

MEDICAL ERROR, PERSISTENT VEGETATIVE STATE AND OVER NINETEEN LONG YEARS OF MEDICAL CARE

A medical error is a preventable adverse effect of medical care. Errors can happen in the hospital at the doctor’s office, at the pharmacy, laboratory and ward. These can also occur at home by the patient or the attendant. These errors may lead to death or major/minor injuries or can also be harmless. However these should be recorded, analysed and remedial measures implemented to reduce the risk of being committed in the future. We are reporting the medical care of our patient in persistent vegetative state over nineteen years due to medical error at our hospital resulting in brain anoxia. The key issues faced during the care were recurrent respiratory and urinary tract infections and in last one year kidney calculi leading to chronic kidney disease and its complications. There are no contractures or thrombo-embolic events and above all no bed sore over this period.

Patient Outcomes in Disorders of Consciousness Following Transcranial Magnetic Stimulation: A Systematic Review and Meta-Analysis of Individual Patient Data

Background: There are few treatments with limited efficacy for patients with disorders of consciousness (DoC), such as minimally conscious and persistent vegetative state (MCS and PVS).Objective: In this meta-analysis of individual patient data (IPD), we examine studies utilizing transcranial magnetic stimulation (TMS) as a treatment in DoC to determine patient and protocol-specific factors associated with improved outcomes.Methods: We conducted a systematic review of PubMed, Ovid Medline, and Clinicaltrials.gov through April 2020 using the following terms: “minimally conscious state,” or “persistent vegetative state,” or “unresponsive wakefulness syndrome,” or “disorders of consciousness” and “transcranial magnetic stimulation.” Studies utilizing TMS as an intervention and reporting individual pre- and post-TMS Coma Recovery Scale-Revised (CRS-R) scores and subscores were included. Studies utilizing diagnostic TMS were excluded. We performed a meta-analysis at two time points to generate a pooled estimate for absolute change in CRS-R Index, and performed a second meta-analysis to determine the treatment effect of TMS using data from sham-controlled crossover studies. A linear regression model was also created using significant predictors of absolute CRS-R index change.Results: The search yielded 118 papers, of which 10 papers with 90 patients were included. Patients demonstrated a mean pooled absolute change in CRS-R Index of 2.74 (95% CI, 0.62–4.85) after one session of TMS and 5.88 (95% CI, 3.68–8.07) at last post-TMS CRS-R assessment. The standardized mean difference between real rTMS and sham was 2.82 (95% CI, −1.50 to 7.14), favoring rTMS. The linear regression model showed that patients had significantly greater CRS-R index changes if they were in MCS, had an etiology of stroke or intracranial hemorrhage, received 10 or more sessions of TMS, or if TMS was initiated within 3 months from injury.Conclusions: TMS may improve outcomes in MCS and PVS. Further evaluation with randomized, clinical trials is necessary to determine its efficacy in this patient population.

Persistent vegetative state: an overview

Background Disorder of consciousness diagnosis, especially when is classified as persistent vegetative state (without misestimating the other diagnosis classifications), in the intensive care is an important diagnosis to evaluate and treat. Persistent vegetative state diagnosis is a challenge in the daily clinical practice because the diagnosis is made mainly based upon the clinical history and the patient behavior observation. There are some specific criteria for this diagnosis, and this could be very tricky when the physician is not well trained. Main body We made a literature review regarding the persistent vegetative state diagnosis, clinical features, management, prognosis, and daily medical practice challenges while considering the bioethical issues and the family perspective about the patient status. The objective of this overview is to provide updated information regarding this clinical state’s features while considering the current medical literature available. Conclusions Regardless of the currently available guidelines and literature, there is still a lot of what we do not know about the persistent vegetative state. There is a lack of evidence regarding the optimal diagnosis and even more, about how to expect a natural history of this disorder of consciousness. It is important to recall that the patients (despite of their altered mental state diagnosis) should always be treated to avoid some of the intensive care unit long-stance complications.

The Clinical Effect of Repetitive Transcranial Magnetic Stimulation on the Disturbance of Consciousness in Patients in a Vegetative State

ObjectiveTo explore the effect of combining repetitive transcranial magnetic stimulation (rTMS) and conventional rehabilitation on the recovery of consciousness in patients in a persistent vegetative state (PVS).MethodsA total of 48 patients in a PVS were randomly divided into a treatment and control group. Patients in the treatment group were treated with rTMS to stimulate the dorsolateral prefrontal cortex, and patients in the control group were treated with false stimulation. All patients were evaluated using scales and neuroelectrophysiological assessment before treatment, after 30 days of treatment, and following 60 days of treatment.ResultsBased on the Coma Recovery Scale-Revised (CRS-R) and electroencephalogram (EEG) grading indexes, the treatment group was significantly higher than those of the control group after 30 and 60 days of treatment. The average difference in the three measurements between the two groups before treatment, at 30 days, and 60 days was 0.04, 1.54, and 2.09 for CRS-R and 0.08, −0.83, and −0.62 for EEG indexes, respectively. The latency periods of each wave of the brainstem auditory evoked potentials (BAEPs) in the treatment group were shorter than those in the control group after 30 and 60 days of treatment. In both groups, the BAEP scores after 30 days of treatment were significantly higher than the scores before treatment, and the scores after 60 days of treatment were higher than the scores after 30 days.ConclusionIn patients in a PVS, rTMS assists in the recovery of consciousness function.

Hydrocephalus in Mexican children with Coccidioidal Meningitis: Clinical, serological, and neuroimaging findings

Background: Coccidioidal meningitis (CM) is a fungal infectious disease that rarely affects children. Even in endemic areas, coccidiomycosis rarely affects the pediatric population. However, 40% of affected children develop hydrocephalus. Here, we describe the clinical, serological, and neuroimaging findings in a series of Mexican children admitted to our neurosurgical service with hydrocephalus and subsequently diagnosed with CM. Methods: We report a prospective series of pediatric patients with hydrocephalus secondary to CM in an endemic area at the north of Mexico. Our report includes children with CM who were hospitalized from 2015 to 2019 in a regional hospital in Torreón, Coahuila. Clinical evolution was monitored for 1 year after hospital discharge. Results: Our series include five children with CM (2–17-years-old, three female), who were hospitalized for hydrocephalus and developed intracranial hypertension. The most frequent neuroimaging findings were leptomeningeal enhancement (5/5) and basal arachnoiditis (4/5), followed by asymmetric hydrocephalus (3/5), abnormalities in fourth ventricle morphology (3/5), and cerebral vasculitis (2/5). CM was diagnosed by positive serology or pathology studies. All children were initially managed with fluconazole and a shunt was placed for management of hydrocephalus. Four patients recovered without permanent neurological deficits and one subject developed persistent vegetative state. One year after hospital discharge, none of the subjects died. Conclusion: This series contributes to the limited number of pediatric CM cases reported in the literature, and describes neuroimaging findings in the pediatric population. The cases here presented show that the identification of Coccidioides as causal agent in pediatric meningitis is crucial for targeted treatment and can affect dramatically neurological prognosis. Furthermore, our report stresses that even in endemic areas pediatric coccidiomycosis represents a diagnostic challenge, which is further exacerbated by the limited availability of resources in these regions. Therefore, a positive immunoglobulin G by enzyme immunoassay is enough for diagnosis of CM in endemic areas without access to CF.