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Objectives: To successfully prescribe a homoeopathic remedy, it is important to have not only good knowledge of symptomatology but also an ability to closely differentiate a remedy from others indicated for similar conditions. Despite good knowledge of Materia Medica, its clinical application often fails. Therefore, the best way to understand Materia Medica is to study it in an actual clinical setting. Fright which is an extreme fear excited by sudden danger; something strange, ugly or shocking, is one such emotion that the homoeopathic physician encounters in his practice. Materials and Methods: Five successfully treated cases with prominent shades of fright from the author’s practice were studied to understand the causation, evolution and expressions of fright. The qualified expressions were studied through repertory and their finer shades were studied through Materia Medica to understand the key differential indications of the remedies prescribed. Results: The events or life situations that lead to fright and the patients’ response and its evolution lend a characteristic value to individualisation and prescribing based on differentiating from other remedies. Aconite, Opium, Stramonium and Gelsemium were drugs found in this study. Aconite has sudden and extreme effects of fright or repeated sudden effects leading to febrile expressions. Opium has prolonged effects of fright at the sensorium in the form of insomnia, but lacks the intensity or violence of Aconite. Stramonium has a fear of imminent danger or being attacked. The fears are intense, to the extent of terrors; the patient desires company and clings to persons OR hides and tries to escape from the situation. Gelsemium has fright leading to anticipation as well as fear of falling and/or receiving injury. Conclusion: In this study, plant remedies prescribed in higher potencies and infrequent repetition brought about effective resolution of fright in all five cases. The remedies also mitigated the consequences of fright on the mind and body and improved the overall susceptibility in all cases.

To offer some thoughts on the sensorial aspects of homelessness in North America, the author likes to draw upon ethnographic research that he conducted in a homeless shelter in downtown Boston, the main findings of which are noted in a book entitled Shelter Blues: Sanity and Selfhood among the Homeless. The point is not that psychiatric or political-economic approaches to the question of homelessness are necessarily misguided or incorrect. The shelter was set up by the Massachusetts Department of Mental Health, or DMH, in early 1981 to provide temporary housing for persons troubled by mental illness. Many shelter residents had spent a significant time on ‘the street,’ which most spoke of as if it was a single location with a singularly forced sensorium of fear, cold weather, isolation, and transience. Some of the otherness faced by residents involved commands and instructions asserted by staff.

How to cite this article: Singhal V. Clinical Approach to Acute Decline in Sensorium. Indian J Crit Care Med 2019;23(Suppl 2):S120–S123.

A 54-year-old man presented with a 1-month history of generalised weakness and a 2-day history of altered sensorium with poor response to verbal commands and repetitive speech, along with headache and vomiting. Neurological examination did not reveal any focal motor, sensory, or cerebellar

This chapter challenges approaches to reading that rely on “scopic dominance” (here referred to as Cyclopean) and suggests that Ulysses, in particular, rewards readers who feel with, through, and about bodies—human and textual. The chapter proposes an approach to reading that produces an affective: one that moves us and that we move, one that we encounter with our living bodies. The sense modalities of sight and touch are used to illustrate Joyce’s broader approach to senses, perception, and epistemological questions more broadly. To read Ulysses “feelingly” is to engage the senses together with the emotions in the act of reading. Such readings cultivate a multi-perspectival proximity to the content, context, and language of the work. Affect theory provides a useful way of reconceiving the reading self: as porous, responsive, and part of an ever-unfolding process of being in relation with the world. This essay stages an encounter between text and reader that is designed to show readers how to feel their way through the text in a way that allows reading to become more reciprocal or mutual. The value of such an approach is that it makes it easier for a reader to be touched, and perhaps altered, in return.

BACKGROUND: Dissociative Trance Disorder is uncommon, particularly in the eastern part of the world. Complexity and uniqueness of the symptoms, triggers, as well as the management strategy of this disease, make it an exceptional burden for the family. CASE REPORT: We reported a 17-year-old woman of a Karo descent who was admitted to Tiga Binanga Primary Health Center by her family due to frequent depressive mood, secluding herself, loss of interest, and frequent fatigue. The complaints persisted for about three weeks. The patient had a confirmed history of dissociative trance disorder known as trance or kesurupan in the local language. This condition is often linked to the local cultural tradition of Nini Pagar performed by the patient. There was neither a history of delusional thoughts, illusions, nor hallucinations. However, the eidetic image was evident. CONCLUSION: Nini Pagar, in this case, induces trans dissociative disorder and feature of this post dissociative trance disorder is moderate depression. We found that the eidetic image with sensorium is clear (compos mentis). Psychotherapy and pharmacotherapy were helping.

A 9-year-old girl from North India presented with poor intellect and behavioural abnormalities noticed since early childhood and two episodes of generalised seizures during the past 6 months. There was no history of alteration in sensorium, vision or hearing impairment, waxing and waning, or

Ancient Egyptian civilization is one of the oldest cultures in human history. Ancient Egyptians are well-known for pioneering the fields of art, medicine, and the documentation of discoveries as mythological tales. The Egyptians mastered the integration of anatomy and mythology into artistic symbols and figures. The mythology of Isis, Osiris, and Horus is arguably one of the most recognized mythologies in ancient Egypt. The Eye of Horus was used as a sign of prosperity and protection, derived from the myth of Isis and Osiris. This symbol has an astonishing connection between neuroanatomical structure and function. Artistically, the Eye is comprised of six different parts. From the mythological standpoint, each part of the Eye is considered to be an individual symbol. Additionally, parts of the Eye represent terms in the series 1/2, 1/4, 1/8, 1/16, and 1/32; when this image is superimposed upon a sagittal image of the human brain, it appears that each part corresponds to the anatomic location of a particular human sensorium. In this manuscript, we highlight the possible scientific speculation of the ingenuity of ancient Egyptians' remarkable insight into human anatomy and physiology.

Organisms are adapted to each other and the environment because there is an inbuilt striving toward security, stability, and equilibrium. A General Theory of Behavior connects imagery, affect, and action with the central executive system we call consciousness, a direct emergent property of cerebral activity. The General Theory is founded on the assumption that the primary motivation of all of consciousness and intentional behavior is psychological homeostasis. Psychological homeostasis is as important to the organization of mind and behavior as physiological homeostasis is to the organization of bodily systems. Consciousness processes quasi-perceptual images independently of the input to the retina and sensorium. Consciousness is the “I am„ control center for integration and regulation of (my) thoughts, (my) feelings, and (my) actions with (my) conscious mental imagery as foundation stones. The fundamental, universal conscious desire for psychological homeostasis benefits from the degree of vividness of inner imagery. Imagery vividness, a combination of clarity and liveliness, is beneficial to imagining, remembering, thinking, predicting, planning, and acting. Assessment of vividness using introspective report is validated by objective means such as functional magnetic resonance imaging (fMRI). A significant body of work shows that vividness of visual imagery is determined by the similarity of neural responses in imagery to those occurring in perception of actual objects and performance of activities. I am conscious; therefore, I am.

Any patient presenting in altered sensorium poses a diagnostic and therapeutic challenge for the treating physician. With the advent of increasing number of non-infectious causes, especially autoimmune encephalitis, the diagnostic work-up of patient with encephalopathy is ever growing and so are the management options. Recently many antibodies against intracellular antigens, synaptic receptors, ion channels and other cell surface proteins have been recognized in association with wide variety of autoimmune encephalitic syndromes, which has further complicated the work-up of patients of febrile encephalopathy. The timely recognition of these non-infectious syndromes is equally important as aggressive immunosuppression can prevent long-term sequelae [1–5].

The Sensorium is a multimodal neurofeedback environment that reflects a person's physiological state by presenting physiological signals via orchestral sounds from a speaker and multi-coloured lights projected onto a white surface. The software manages acquisition, real-time processing, storage, and sonification of various physiological signals such as the electroencephalogram (EEG) or electrocardiogram (ECG). Each of the 36 participants completed 6 interventional conditions consisting of three different Sensorium-phases with EEG and ECG feedback, a mindfulness meditation, a guided body scan exercise, and a Pseudo-Sensorium using pre-recorded data that did not reflect the subject's own physiology. During all phases EEG, ECG, skin conductance, and respiration were recorded. A feedback questionnaire assessed the participants' subjective reports of changes in well-being, perception, and life-spirit. The results indicate that the Sensorium sessions were not statistically inferior compared to their corresponding active control conditions with respect to improvements in subjective reports concerning well-being and perception. Additionally, the Sensorium was rated as being a more extraordinary experience, as compared to meditation. During the Sensorium conditions the EEG showed lower levels of theta2 (7-8.5 Hz), alpha (9-12 Hz) and beta (12.5-25 Hz) activity. Since participants reported benefit from the Sensorium experience regardless of any prior experience with meditation, we propose this novel method of meditative and extraordinary self-experience to be utilized as a modern alternative to more traditional forms of meditation.

Brain metastases are known to be present with a history of increased intra-cranial pressure headache, seizures or altered sensorium. Corresponding to the clinical brain metastases are the most feared complication of a systemic cancer. Classically, brain metastases are associated with significant morbidity and are known to present with a history of increased intracranial pressure headache, seizures or altered sensorium. Neuroimaging is usually suggestive of massive peri-lesional edema and mass effect surrounding the space occupying lesions. This, however it is not a universal rule. We report a 50-year-old gentleman who presented with rapidly progressive forgetfulness. Interestingly, the patient’s neuroimaging discretely showed disproportionate involvement with regards to the clinical picture. The lesions were finally recognized as metastases underscoring the importance of an avid search for a primary systemic malignancy if similar findings are noted on radiology.

Destructured sensory fields, involving homogenous stimulation with little or no time-varying structure, provide a fertile ground for testing hypotheses about predictive coding in the human brain. Extended exposure to sensory patterns that deviate substantially from the statistics of natural environments can elicit a bewildering range of perceptual phenomena, up to and including vivid oneiric imagery. We illustrate how this large variety of perceptual effects can be understood as the experiential counterpart of auto-generated neuronal dynamics, unconstrained by parameters that tune the waking sensorium. We synthesize the literature on autonomous neuronal activity across multiple spatiotemporal scales with generative models of brain function and evidence from artificial neural architectures. Perception, we argue, emerges from a process of non-random sampling from an intrinsic distribution of hypotheses rather than a direct transfer of information from the world. The imagery that occurs in altered sensory environments is explained as the outcome of an iterative search through internal world models in which the structural typology of percepts reflects the brain's intrinsic functional architectures.

This collaborative commentary brings together both clinical and sensory science perspectives in an effort to explain the mechanisms of cancer treatment and the ensuing implications for the sensorium. This paper makes the distinction between food hedonics and true chemosensory effects in the cancer context and describes the adverse effects cancer and its treatment have on the eating and drinking experience, including gastronomic, nutritional and emotional implications. Results from a prospective breast cancer cohort study, conducted by an interdisciplinary team of nurses, medical oncologists, dietitians and sensory science researchers shed new light on specific sensory symptomatology associated with chemotherapy treatment and the implications this has for informing reliable pre-treatment patient education. Two conceptual models are posed as frameworks for better understanding the determinants and consequences of altered eating and drinking experiences during chemotherapy, as well as the link between patient-reported symptoms and chemosensory or hedonic disturbances. Application of evidence of cancer treatment and its sensory effects in the patient treatment context continues to be a challenge for cancer clinicians, especially where standardised testing of taste and smell function are not able to be practically administered. Recommendations are made for further research and practice pursuits to underpin improved food enjoyment and dietary quality throughout the cancer trajectory. Clinician education of sensory science is also encouraged.

May Morris (1862–1938), renowned craftswoman and daughter of William Morris, had an unconventional Victorian childhood in a home where all the members of the family were engaged in various forms of aesthetic labor, either as amateurs or professionals, and shared an aesthetic philosophy that blended the artisanal and the experimental from which would develop the Arts and Crafts movement. This article will examine the fragmentary recollections of her childhood recorded by May Morris in the introductions she wrote for the twenty-four-volume edition of The Collected Works of William Morris as a rich resource for Victorian sensory history because of the emphasis she places on the development of the child's sensorium, especially in relation to touch as the vital sense that linked family intimacy with creative activity. Employing the term “tactile aesthetics,” I show how, in the Morris household, the pleasurable sensual apprehension of the objects or materials worked by the hands of the craftsperson was ...

Martha Knox was a 33-year-old woman of Anglo-Australian heritage. Her obstetrician referred Mrs Knox to the psychologist for "anxiety related issues". The referral letter stated that Mrs Knox had been undergoing In-Vitro Fertilisation (IVF) for the past two years and in this time she received five embryo transfers without success. Martha's sensorium was clear and her memory and cognition were in-tact. After hearing the benefits of psychotherapy she displayed good insight and judgement. Overall her mental state improved throughout the course of therapy. Given all of the information presented, it was likely that Martha presented with Generalised Anxiety Disorder (GAD) according to the fifth edition of the Diagnostic and statistical manual of mental disorders. Given the identified problems with anxiety, Martha will most likely benefit from continued therapy with a specific focus on Cognitive Behaviour Therapy (CBT).

Sleep paralysis (SP) is a benign, transient episode of immobility lasting a few seconds to a few minutes that can occur whilefalling asleep or on awakening. It is a condition of unknown etiology. During the episode, all the skeletal muscles are virtually‘paralyzed’, resulting in an inability to move or speak but individual remains conscious. Because it occurs in a clear sensorium,the individual is able to describe the experience vividly. It is associated with extreme anxiety, phobia, and nervousness, restlessand, sometime, hallucinations.We present a case of 35 year old male personal driver, who had recurrent episode of sleep paralysis, we must rule outphysical, psychological or social suffering and the subject must be examined by sleep clinicians or psychiatrist. “Supernatural”experiences associated to SP have been interpreted as pathological. We must enrich the knowledge about these experiencesof SP and their psychological and cultural aspects. SP may be misdiagnosed as being due to depression and psychosis (e.g.schizophrenia) and alternatively depending on how they construe these experiences.

International audience; This paper draws on Walter Benjamin and Marshall McLuhan’s conceptions of the technological sensorium to examine the relation between writing and technology in Will Self’s novel Umbrella. Inspired by historical cases of patients suffering from post-encephalitic syndrome, the novel follows the attempts of a psychiatrist to help a group of patients who caught encephalitis lethargica in the 1920s, and have remained prisoners of crippling paralysis and tics for fifty years. As a new drug begins to take effect on the patients, their movements acquire legibility for both doctor and reader, and their alienated bodies come to embody “the entire mechanical age”. Through this allegorical tale, Self explores humanity’s relation to technology as a pathology, in which a modified sensorium is a key symptom of technological existence. Yet the focalizers of Self’s narrative do not only incorporate technology into the fibres of their bodies; their vivid perceptions innervate the apparatus that surrounds them, drawing the reader into a living mechanical environment. I propose to examine this extension of the human sensorium in the light of Benjamin’s reflections on mimetic innervation, and to ask to what extent Self’s writing is in itself an attempt to create an innervated and innervating reader.

A 51-year-old man presented with persistent altered sensorium following a seizure. His magnetic resonance imaging (MRI) showed features of focal encephalitis involving the left temporal, parietal, and occipital regions. His electroencephalogram (EEG) showed ongoing epileptiform discharges over the left hemisphere. This article discusses dilemmas in the diagnosis of nonconvulsive status epilepticus in such a case scenario.

Background: The Pediatric Risk of Mortality (PRISM) Score has been devised to predict outcome and risk of mortality. The PRISM III score is one of the most recent scoring systems of pediatric mortality. This was developed involving 32 PICUs. Physiological data included the most abnormal values from the first 12 and second 12 hours of the PICU stay. To evaluate the mortality rate in children with altered sensorium by applying PRISM III (pediatric risk of mortality) score.Methods: This study was done in the paediatric intensive care unit of the Department of Paediatrics, Government Mohan Kumaramangalam Medical College Hospital, Salem, Tamil Nadu, India on 100 children of both sexes aged between 1 month and 13 years. The study was carried out for a period from December 2017 to July 2018. PRISM III scoring scale was applied for every child in his/her first 24 hours of PICU admission and their calculated score was recorded into the proforma. The clinical details at admission, laboratory data were recorded into the proforma.Results: Three major groups that contributed to the bulk of the admissions were acute CNS infection, seizure disorder and, bites and stings. They constituted to around 54% of our total admissions. As PRISM III Score increases there is a steady increase in the mortality rate. This table shows that the mortality rate is 0% for the 0-9 group and that it increases to 100% for 20-29 and 30 and above groups as the PRISM III score increase.Conclusions: PRISM III score provides an objective assessment of the severity of illness. PRISM III, when performed well, is good to predict mortality in an Indian PICU. Scoring systems with fewer laboratory parameters will be more useful in author’s context. Larger studies are needed to develop/validate a mortality prediction score for our country.

Background: Apart from head injury many patients present to the tertiary care hospital in unconscious state, the etiology of which is obscure in most of the cases. The present study was conducted with on objective to provide insight into the clinical features and diagnostic methods to know the aetiology of patients with non-traumatic cases of altered sensorium and to study the outcome of these patients.Methods: This is an observational study on 100 patients of altered sensorium of non-traumatic origin during the period from October 2012 to September 2014 conducted in the Department of General Medicine, MKCG Medical College Hospital, Berhampur, Odisha, India. All patients were selected for the study based on the inclusion exclusion criteria. Detailed history, clinical evaluation, laboratory investigations like neuroimaging studies etc. were carried out. Statistical data analysis was done using Graph pad Prism 6 and Microsoft Excel. P value

Exploring missionary study at an Assemblies of God Bible college through ethnography and training manuals demonstrates systematic pedagogies that cultivate sensory capabilities encouraging yielding, opening to rupture, and constraint. Ritual theory and the Anthropology of Christianity shift analytic scales to include “cultivation,” a “third term” enabling simultaneous apprehension and consolidating of the oppositions (experience–doctrine, revival–church, or spontaneous rupture–restrained continuity) internal and central to Pentecostalism. Further, cultivation complicates valorizations of the disjunctive “event” as militant radical icon.

Purpose To evaluate EEG predictors of outcome in patients with altered sensorium suspected to have seizure and to assess whether short term EEG is as effective as long term continuous EEG (cEEG) in predicting the outcome of patients with altered sensorium due to neurological causes. Methods We identified 99 consecutive critically ill patients with altered sensorium in whom nonconvulsive seizures were suspected. They underwent cEEG. Functional outcome was assessed with the modified Rankin Scale (mRS) at 4 weeks, discharge or death. We compared efficacy of short term EEG and long term continuous EEG in recording the abnormal patterns on EEG. Logistic regression analysis was performed to identify EEG findings associated with poor outcome, defined as mRS 4–6 (dead or moderately to severely disabled). Results Poor outcome was associated with nonconvulsive seizures (NCS), nonconvulsive status epilepticus (NCSE), periodic lateralized epileptiform discharges (PLEDS), PLEDS plus, generalized periodic epileptiform discharges (GPEDS) and abnormal EEG background. Short term EEG can detect seizure activity and other electrographic markers of poor outcome but the values are statistically insignificant. Conclusion cEEG monitoring provides independent prognostic information in patients with altered sensorium and suspected seizures. Unfavorable findings include nonconvulsive seizures, periodic epileptiform discharges and abnormal background. Short term EEG is ineffective in detecting seizures on EEG in patients with altered sensorium and should not be used as substitute for Long term EEG

This article examines the work of eighteenth-century Scottish physician Robert Whytt. With a philosophical sensibility, Whytt produced a theory of the nerves that viewed the nervous system as an organic unity, one that continuously integrated man’s vital motions and rational capacities. With Whytt, the human had become “nervous” through and through, that is, neurologically self-unified to the point that nervous illness itself became a contingency that folded back into the nervous norm. The article examines Whytt’s writings along with some of the conceptual challenges surrounding the nature of the brain and nerves that historically converged in his work.

It remains uncertain whether particular ictal manifestations of psychogenic nonepileptic events (PNEE) can reflect distinctive psychological processes or prognostic outcomes. We hypothesize that the integrity of ictal sensorium may affect the clinical outcome of PNEE following disclosure of diagnosis. We prospectively studied 47 veterans who were diagnosed with video–EEG-confirmed PNEE, presented with the diagnosis utilizing a standardized communication strategy, and followed for their clinical progress. When compared to patients with intact ictal sensorium, significantly smaller proportion of patients with impaired ictal sensorium endorsed improvement of either PNEE frequency or intensity across both the initial 1- to 3-month (p = 0.005) and ensuing 6- to 9-month (p = 0.01) follow-ups. However, improvement among patients with impaired ictal sensorium was more significantly associated with their level of understanding for the PNEE diagnosis across both the initial (rho = 0.41, p = 0.017) and ensuing (rho = 0.43, p = 0.015) follow-ups. Our study presents preliminary evidence underscoring the potential clinical significance of ictal sensorial integrity when evaluating patients with PNEE.

Introduction: The anatomic seat of the human soul has been a controversial matter of discussion in the philosophical, theological and scientific fields throughout history. One of the more known hypotheses on this subject was proposed by Descartes, for whom the soul would host in the pineal gland, a brain body with a special location that would adequately address the functionalism of the human body. Development: In this work, we discuss the historical influences which made possible the Cartesian model of the relationship between spirit (res cogitans) and body-machine (res extensa) and the technical bases of his dualism doctrine. In philosophical terms, Descartes supported Augustine approaches and in physiological and anatomical terms adopted some theories of the classical Antiquity, essentially the proposals of Alexandrian pneumatic school (Herophilos, Erasistratus) in relation to the animal spirits. Descartes might also have known the hypotheses of some contemporary anatomists (Diemerbroeck) which established the location of sensorium commune in the pineal gland. Conclusions: Although Cartesian theories had strong criticism even in his time, some aspects of these postulates remained up to mid 19th century. Resumen: Introducción: La ubicación anatómica del alma humana ha constituido un controvertido motivo de discusión en los ámbitos filosófico, teológico y científico a lo largo de la historia. Una de las hipótesis más conocidas sobre este tema fue propuesta por Descartes, para quien el alma se alojaría en la glándula pineal, órgano cerebral cuya especial localización le permitiría dirigir adecuadamente el funcionamiento del cuerpo humano. Desarrollo: En el presente trabajo, analizaremos las influencias históricas que posibilitaron el modelo cartesiano de relación entre el pensamiento (res cogitans) y la extensión (cuerpo-máquina) y las bases técnicas de su principio de dualismo espíritu-materia. En materia filosófica, Descartes se apoyó en los planteamientos de San Agustín y en materia fisiológica y anatómica adoptó gran parte de las teorías vigentes desde la Antigüedad clásica, fundamentalmente las propuestas de la escuela neumática alejandrina (Herófilo, Erasístrato) en relación con los espíritus animales. Asimismo, también podría conocer las hipótesis de algunos anatomistas coetáneos (Diemerbroeck), que establecían la localización del sensorium commune en la glándula pineal. Conclusiones: Aunque desde el primer momento las teorías de Descartes tuvieron serios detractores, algunos aspectos de éstas perduraron hasta mediados el siglo xix. Keywords: Pineal gland, Soul, Descartes, Dualism, Animal spirits, History of neuroscience, Palabras clave: Glándula pineal, Alma, Descartes, Dualismo, Espíritus animales, Historia de la neurociencia

Research teams from around the world reflect on their brain sensing setups.

The incidents in this short story are refracted through the shattered sensorium of a traumatized but ethically intact survivor of the Holocaust. His narrative kaleidoscopically reconfigures horror and everyday life, nightmare and history, the gates of a Jewish ghetto in Nazi-occupied Poland and a checkpoint at the border between Israel and Palestine during the First Intifada. His act of witness defends the specificity of the human being, the other, in the face of the reasons of state and the abstractions of ideology.

Isolated sleep paralysis (ISP) is a potentially terrifying sleep disorder that has received relatively little empirical and clinical attention. However, ISP is a fairly common condition that can cause a variety of negative affective states and even clinical impairment. Many different cultures have discussed ISP for at least the past 2000 years, and it possesses cultural importance. After first reviewing the history of ISP, this chapter systematically reviews the diagnosis of ISP, as well as some of its associated features and individual components (e.g., atonia, hallucinations, and a clear sensorium). All three of these components have the potential to create fear and other negative affective states, leading to clinically significant distress and/or impairment. Finally, this chapter considers the limited data on ISP’s associations with positive affect states.

The cause of altered sensorium in critical care settings includes metabolic derangements, drug and toxin overdose, central nervous system infections, neurodegenerative disorders, vascular events, hypo-perfusion states, and septic encephalopathy. Here, we present a case of an elderly woman who presented to us with altered sensorium with respiratory failure requiring mechanical ventilation. Her metabolic parameters, imaging, and cerebrospinal fluid study were all normal despite that she continued to remain in altered sensorium and had an unrecognized behavioral state that delayed her weaning.

To predict factors causing altered sensorium at admission in children with diabetic ketoacidosis (DKA).This retrospective study was done on 139 children with DKA who presented to Pediatric Emergency of a tertiary care hospital between January 2008 and November 2012. The case records were reviewed and information regarding personal details, clinical features, biochemical parameters and outcome was recorded. Statistical analyses were performed in small STATA version 12. Variables associated with altered sensorium in bivariate analysis (P 0.05) were selected for inclusion in the multivariable logistic regression model.Mean age was 8.04 ± 4.1 y; Male: Female ratio 0.75:1. The newly diagnosed diabetics were 54.6 % whereas rest were known diabetics. Eighty one percent children in severe DKA, 63 % moderate DKA and 18 % mild DKA had altered sensorium at admission. Univariate analysis revealed significant P values (P 0.05) for pH and degree of dehydration. Results of final multivariate logistic regression revealed significant P values for pH (for pH 7.1-7.2, AOR-5.47, 95 % CI-1.24-24.1, P = 0.025 and for pH7.1, AOR-14.19, 95 % CI - 4.13-48.7, P = 0.001) using pH7.2 as the reference category.Alteration in sensorium in children at initial admission with DKA is associated to low blood pH. ROC curve suggested good discrimination of pH for prediction of altered sensorium. The exact pathophysiologic mechanism of how low pH alters sensorium in DKA is still unknown and requires further studies.

Recent considerations of sound, music, voice and noise have opened up alternatives to what has been characterised as the ‘death circuit’ of modernity, polarised between ‘the disembodied voice of mass communications, and the non-vocal, non-sounding, anaerobic voice of the mind’.1 These approaches often depict western modernity as beset by a cultural desiccation of the moist and fecund sonic ecologies to be found in other cultures and historical epochs. Whilst a re-engagement with the thinking through vibration, as it were, that emerged in the nineteenth century has produced more complex and contradictory accounts of the emergence of the modern sensorium, it remains the case that bodies and expressive individualism have been, to a significant extent, displaced from their previous humanistic centrality. Instead, this revised history situates the human organism as a relay in the transmission of more or less impersonal energies, which are in turn harnessed to the prosthetic expansion of human communicative capacities through technologies such as the phonograph, telephone and their digital progeny.

Group therapy provides the ideal arena for helping individuals cultivate the observing ego--that part of the sensorium that has the power of witnessing oneself in the world. The essence of our method is to employ the group as a temporary observing ego, out of which members may develop their own observing egos. A five-step process is presented to (1) help the members see how they are affecting others when they do not see this themselves, (2) help the members see how they produce this effect, (3) help the members see the self-injurious nature of their behavior, (4) resolve resistance to seeing any of this, and (5) help the members arrive at new modes of behavior.

An approach to the pregnant patient with altered consciousness is presented. The unconscious pregnant patient often represents a straightforward simple problem if the event is a minor syncope secondary to physiologic changes of pregnancy. Most loss of consciousness is postictal in nature after either an epileptic or eclamptic seizure. If these are ruled out, other more serious causes must be considered, and the patient must be fully evaluated by appropriate neurologic consultants.

The Sensorium is a neurofeedback environment that allows people to experience signals from their nonperceptible body processes visually and auditorily. Various (neuro-)physiological rhythms and frequencies are projected simultaneously as soundscapes and “lightscapes” into the environment. A wireless physiological amplifier device sends signals such as EEG and ECG to a computer for real-time processing using the modified brain-computer interface software “Thought Translation Device” (TTD). The TTD performs signal filtering, parametric orchestral sonification, and light control. In a pilot study, 20 participants have been exposed to their ongoing brain and heart signals while sitting inside the Sensorium, a small room equipped with a speaker and lighting system. Almost all of them reported an increase in contentment, relaxation, happiness, and inner harmony. They also reported a widening in their body consciousness. In future, therapeutic paradigms will be developed and the treatment effects on people with psychosomatic diseases will be evaluated.