Is near-infrared spectroscopy a promising predictor for early intracranial hemorrhage diagnosis in the Emergency Department?

Intracranial hemorrhage (ICH) is a serious medical condition that can lead to significant morbidity and mortality if not diagnosed and treated promptly. Early detection and treatment are essential for improving the outcome in patients with ICH. Near-infrared spectroscopy (NIRS) is a non-invasive imaging technique that has been used to detect changes in brain tissue oxygenation and blood flow in various conditions. The aim of this study was to investigate the predictive potential of NIRS for early diagnosis of ICH in patients presenting to the Emergency Department (ED) triage with headache. A total of 378 patients were included in the study. According to the final diagnosis of the patients, 4 groups were formed: migraine, tension-cluster headache, intracranial hemorrhage and intracranial mass, and control group. Cerebral NIRS values "rSO2" were measured at the first professional medical contact with the patient. The right and left rSO2 (RrSO2, LrSO2) were significantly lower and the rSO2 difference was significantly higher in the intracranial hemorrhage group compared to all other patient groups (P<0.001). The cut-off values determined in the receiver operating characteristics (ROC) analysis were RrSO2 ≤67, LrSO2 ≤67, and ΔrSO2 ≥9. This study found that a difference of more than 9 in cerebral right-left NIRS values can be a non-invasive, easy-to-administer, rapid, and reliable diagnostic test for early detection of intracranial bleeding. NIRS holds promise as an objective method in ED triage for patients with intracranial hemorrhage. However, further research is needed to fully understand the potential benefits and limitations of this method.

Risk factors of mortality among COVID-19 patients receiving non-invasive ventilation at Addis Ababa governmental COVID-19 treatment centers

Introduction: during the global COVID-19 pandemic, non-invasive ventilation has become a widely utilized method for treating patients experiencing acute respiratory failure. Noninvasive pressure ventilation is frequently employed as a standard approach for managing acute respiratory failure resulting from COVID-19 pneumonia, as opposed to invasive ventilation methods. However, there is a lack of research on its effectiveness. Therefore, this study aimed to determine the risk of mortality among COVID-19 patients receiving non-invasive ventilation. Methods: a multi-centric retrospective cross sectional study was conducted on the records of 402 patients at the Eka Kotebe COVID-19 Center, St. Peter COVID-19 Care Center, and Millennium COVID-19 Treatment Center. The systematic random selection technique was employed in order to select the study unit, and data was extracted from patient charts using a pretested method and validated before being entered into Epi-data Manager 4.6 versions. Descriptive, bivariate, and multivariable analyses were performed using binary logistic regression in SPSS 25. In the multivariate logistic regression, a predictor variable was considered to have a significant connection if its p-value was less than 0.05 at a 95% confidence level. Results: four hundred and two patient records were reviewed during the study period and showed the mean patient´s age was 62.6 years, with male predominance. It revealed that 11.7% [CI: 8.7-15.2] of COVID-19 patients who received non-invasive positive pressure ventilation died, as being critical for COVID-19 patients was a main cause of noninvasive initiation. Patients over the age of 60 were more likely to die among those who received noninvasive ventilation for COVID-19 [AOR = 5.4 95% CI 1.32, 23.1]. Conversely, patients without diabetes were less likely to die [AOR = 0.23 95% CI 0.11, 0.48]. Moreover, patients with a tidal volume greater than 500 ml were more likely to pass away [AOR =2.2 95% CI 1.11,4.43], as were those who were on non-invasive ventilation (NIV) for more than 8 days [AOR = 0.24 95% CI.08, 0.81]. Conclusion: the significance of patients who were given non-invasive ventilators ended up dying. Age, diabetes, and high tidal volumes are linked to a higher risk of death. Non-invasive ventilation for over eight days showed a protective effect. Removing factors that caused NIV and ventilated COVID-19 patients' deaths may reduce mortality.

Innovative insights into extrachromosomal circular DNAs in gynecologic tumors and reproduction

Originating but free from chromosomal DNA, extrachromosomal circular DNAs (eccDNAs) are organized in circular form and have long been found in unicellular and multicellular eukaryotes. Their biogenesis and function are poorly understood as they are characterized by sequence homology with linear DNA, for which few detection methods are available. Recent advances in high-throughput sequencing technologies have revealed that eccDNAs play crucial roles in tumor formation, evolution, and drug resistance as well as aging, genomic diversity, and other biological processes, bringing it back to the research hotspot. Several mechanisms of eccDNA formation have been proposed, including the breakage-fusion-bridge (BFB) and translocation-deletion-amplification models. Gynecologic tumors and disorders of embryonic and fetal development are major threats to human reproductive health. The roles of eccDNAs in these pathological processes have been partially elucidated since the first discovery of eccDNA in pig sperm and the double minutes in ovarian cancer ascites. The present review summarized the research history, biogenesis, and currently available detection and analytical methods for eccDNAs and clarified their functions in gynecologic tumors and reproduction. We also proposed the application of eccDNAs as drug targets and liquid biopsy markers for prenatal diagnosis and the early detection, prognosis, and treatment of gynecologic tumors. This review lays theoretical foundations for future investigations into the complex regulatory networks of eccDNAs in vital physiological and pathological processes.

High-flow nasal cannula and non-invasive mechanical ventilation in pediatric asthma exacerbation: two-year prospective observational study in intensive care / Cánula nasal de alto flujo y ventilación no invasiva en asma pediátrico grave: estudio observacional prospectivo de dos años de duración en cuidados intensivos

Abstract Background: Asthma is a common cause of admission to the pediatric intensive care unit (PICU). We described and analyzed the therapies applied to children admitted to a tertiary PICU because of asthma. Later, we evaluated high-flow nasal cannula (HFNC) use in these patients and compared their evolution and complications with those who received non-invasive ventilation. Methods: We conducted a prospective observational study (October 2017-October 2019). Collected data: epidemiological, clinical, respiratory support therapy needed, complementary tests, and PICU and hospital stay. Patients were divided into three groups: (1) only HFNC; (2) HFNC and non-invasive mechanical ventilation (NIMV); and (3) only NIMV. Results: Seventy-six patients were included (39 female). The median age was 2 years and 1 month. The median pulmonary score was 5. The median PICU stay was 3 days, and the hospital stay was 6 days. Children with HNFC only (56/76) had fewer PICU days (p = 0.025) and did not require NIMV (6/76). Children with HFNC had a higher oxygen saturation/fraction of inspired oxygen ratio ratio (p = 0.025) and lower PCO2 (p = 0.032). In the group receiving both therapies (14/76), NIMV was used first in all cases. No epidemiologic or clinical differences were found among groups. Conclusion: HFNC was a safe approach that did not increase the number of PICU or hospital days. On admission, normal initial blood gases and the absence of high oxygen requirements were useful in selecting responders to HFNC. Further randomized and multicenter clinical trials are needed to verify these data.

Resumen Introducción: El asma es una causa frecuente de ingreso en la unidad de cuidados intensivos pediátricos (UCIP). En este, cuadro el uso de cánula nasal de alto flujo (CNAF) se ha visto extendido. En este trabajo se describe el tratamiento global en la UCIP ante el ingreso por asma en un hospital monográfico pediátrico y se evalúa la respuesta al uso de la CNAF, comparando la evolución de los pacientes con aquellos que recibieron ventilación no invasiva (VNI). Métodos: Se llevó a cabo un estudio observacional prospectivo (de octubre del 2017 a octubre del 2019). Se describieron epidemiología, clínica, tratamiento y soporte respiratorio. Para la comparación se crearon tres grupos de pacientes: 1) solo CNAF; 2) CNAF y VNI; y 3) solo VNI. Resultados: Se incluyeron 76 pacientes. La mediana de edad fue de dos años y un mes; la mediana de índice pulmonar fue 5. La mediana de ingreso en UCIP fue de tres días y de ingreso hospitalario, seis días. Los niños con solo CNAF (56/76) mostraron menos días de UCIP (p = 0.025) y no requirieron VNI (6/76). También mostraron mayor SatO2/FiO2 (saturación de oxígeno/fracción de oxígeno inspirado) (p = 0.025) y menor nivel de PCO2 (presión parcial de CO2) (p = 0.032). La VNI se utilizó primero siempre en el grupo que recibió ambas modalidades (14/76). No se encontraron diferencias epidemiológicas o clínicas entre grupos. Conclusiones: En nuestra serie, el uso de CNAF no aumentó los días de ingreso en la UCIP ni de hospital. Tampoco requirió cambio a VNI. Al ingreso, una gasometría normal y bajo requerimiento de oxígeno permitieron seleccionar a los pacientes respondedores. Se necesitan más ensayos multicéntricos clínicos aleatorizados para verificar estos datos.

Desarrollo de un modelo por inteligencia artificial con hemodinamia no invasiva para predecir preeclampsia en embarazos de alto riesgo / Artificial Intelligence Modeling with Non-Invasive Hemodynamics to Predict Preeclampsia in High-Risk Pregnancy

RESUMEN Introducción: la preeclampsia (PE) es la principal causa de morbimortalidad materno-fetal en nuestro país. Alteraciones hemodinámicas precoces durante el embarazo podrían predecir la evolución a PE. El machine learning (ML) permite el hallazgo de patrones ocultos que podrían detectar precozmente el desarrollo de PE. Objetivos: desarrollar un árbol de clasificación con variables de hemodinamia no invasiva para predecir precozmente desarrollo de PE. Material y métodos: estudio observacional prospectivo con embarazadas de alto riesgo (n=1155) derivadas del servicio de Obstetricia desde enero 2016 a octubre 2022 para el muestreo de entrenamiento por ML con árbol de clasificación j48. Se seleccionaron 112 embarazadas entre semanas 10 a 16, sin tratamiento farmacológico y que completaron el seguimiento con el término de su embarazo con evento final combinado (PE): preeclampsia, eclampsia y síndrome HELLP. Se evaluaron simultáneamente con cardiografía de impedancia y velocidad de onda del pulso y con monitoreo ambulatorio de presión arterial de 24 hs (MAPA). Resultados: presentaron PE 17 pacientes (15,18%). Se generó un árbol de clasificación predictivo con las siguientes variables: índice de complacencia arterial (ICA), índice cardíaco (IC), índice de trabajo sistólico (ITS), cociente de tiempos eyectivos (CTE), índice de Heather (IH). Se clasificaron correctamente el 93,75%; coeficiente Kappa 0,70, valor predictivo positivo (VPP) 0,94 y negativo (VPN) 0,35. Precisión 0,94, área bajo la curva ROC 0,93. Conclusión: las variables ICA, IC, ITS, CTE e IH predijeron en nuestra muestra el desarrollo de PE con excelente discriminación y precisión, de forma precoz, no invasiva, segura y con bajo costo.

ABSTRACT Background: Preeclampsia (PE) is the main cause of maternal-fetal morbidity and mortality in our country. Early hemodynamic changes during pregnancy could predict progression to PE. Machine learning (ML) enables the discovery of hidden patterns that could early detect PE development. Objectives: The aim of this study was to build a classification tree with non-invasive hemodynamic variables for the early prediction of PE occurrence. Results: Seventeen patients (15.18%) presented PE. A predictive classification tree was generated with arterial compliance index (ACI), cardiac index (CI), cardiac work index (CWI), ejective time ratio (ETR), and Heather index (HI). A total of 93.75% patients were correctly classified (Kappa 0.70, positive predictive value 0.94 and negative predictive value 0.35; accuracy 0.94, and area under the ROC curve 0.93). Conclusion: ACI, CI, CWI, ETR and HI variables predicted the early development of PE in our sample with excellent discrimination and accuracy, non-invasively, safely and at low cost.

Métodos no invasivos de oxigenación en pacientes con COVID-19 / Non-invasive oxygenation methods in patients with COVID-19

Resumen: Desde el inicio de la pandemia por COVID-19, dentro de las complicaciones más frecuentes de esta infección se encuentran la neumonía y el síndrome de dificultad respiratoria aguda. La hipoxemia y el aumento del trabajo respiratorio son determinantes para adoptar diversas estrategias terapéuticas de oxigenación no invasiva en pacientes con COVID-19. Es importante conocer y describir las diferentes modalidades de oxigenoterapia no invasiva, con la finalidad de preservar la oxigenación y un adecuado trabajo respiratorio, las estrategias descritas en la literatura abarcan: cánulas nasales convencionales, cánulas nasales de alto flujo y ventilación mecánica no invasiva, aunado a otras medidas de soporte como posición prono, administración de esquemas con esteroide, inmunomoduladores y óxido nítrico inhalado. Las estrategias no invasivas de oxigenación por diferentes métodos son herramientas indispensables para el tratamiento de pacientes con neumonía por COVID-19 moderada-grave. Es necesario evaluar el dispositivo a emplear, ya que esta enfermedad tiene características heterogéneas de acuerdo con gravedad y el tiempo de evolución.

Abstract: Since the start of the COVID-19 pandemic, the most frequent complications of this infection include pneumonia and Acute Respiratory Distress Syndrome. Hypoxemia and increased work of breathing are determining factors in adopting various non-invasive oxygenation therapeutic strategies in patients with COVID-19. It is important to know and describe the different modalities of non-invasive oxygen therapy, in order to preserve oxygenation and adequate respiratory work, the strategies described in the literature include: conventional nasal cannulas, high-flow nasal cannulas and non-invasive mechanical ventilation coupled with other support measures such as prone position, administration of schemes with steroids, immunomodulators and inhaled nitric oxide. Non-invasive oxygenation strategies by different methods are essential tools for the treatment of patients with moderate-severe COVID-19 pneumonia. It is necessary to evaluate the device to be used, since this disease has heterogeneous characteristics according to severity and time of evolution.

Conocimiento y manejo de cuidados respiratorios especializados en pacientes con enfermedades neuromusculares en unidades de cuidado intensivo: aproximación por encuesta a profesionales de la salud

Introducción: En las enfermedades neuromusculares la disminución de la capacidad vital se relaciona con dismunición de la capacidad tusígena y luego ventilatoria, la combinación de ambas genera complicaciones graves por falla ventilatoria. En los pacientes que son intubados, limita la extubación, sino se realizan cuidados respiratorios especializados. El conocimiento y aplicación de los profesionales que atienden a estos pacientes en cuidados intensivos resulta esencial. Objetivos: Reportar el conocimiento y aplicación especializada de cuidados respiratorios en enfermedades neuromusculares en las Unidades de Cuidados Intensivos. Materiales y métodos: Estudio cualitativo, descriptivo de corte transversal, no probabilístico, a criterio. La población accesible fueron profesionales de la Salud de las Unidades de Cuidados Intensivos, y el análisis de las respuestas de una encuesta estructurada, enviada a distintos profesionales a nivel mundial. Resultados: Se incluyeron los cuestionarios de 41 profesionales, el 34% de los profesionales reportaron la utilización regular de Asistente Mecánico de la Tos; 22% refirieron la utilización regular de apilamiento de aire; 31% reportaron la utilización regular de Asistencia Ventilatoria No Invasiva, 56.1% de los profesionales afirmaron conocer la diferencia entre Ventilación No Invasiva y Soporte Ventilatorio No Invasivo, 34% de los profesionales refirieron tener formación especializada en el área. Conclusión: Pese a existir una alta proporción de profesionales con conocimiento especializado, un grupo importante no los aplica rutinariamente. La justificación es principalmente por la dificultad de adquisición y financiación de los equipos necesarios.

Introduction: In neuromuscular diseases, the decrease in vital capacity relates to decreased coughing and then ventilatory capacity, the combination of both generating serious complications due to ventilatory failure. In intubated patients, the extubation process is difficult unless specialized respiratory care is provided. The knowledge and treatment application of the professionals who care for these patients in intensive care is of outmost importance. Objectives: Report the knowledge and specialized application of respiratory care in neuromuscular diseases in Intensive Care Units. Materials and methods: Qualitative, descriptive, cross-sectional, non-probabilistic study, at criteria. The accessible population were Health professionals from the Intensive Care Units, and the analysis of the responses of a structured survey, sent to different professionals worldwide. Results: The questionnaires of 41 professionals were included, 34% of the professionals reported the regular use of the Mechanical Cough Assistant; 22% reported the regular use of air stacking; 31% reported the regular use of Non-Invasive Ventilatory Assistance. 56.1% of the professionals stated that they knew the difference between Non-Invasive Ventilation and Non-Invasive Ventilatory Support, 34% of the professionals reported having specialized training in the area. Conclusion: Despite the existence of a high proportion of professionals with specialized knowledge, an important group does not routinely apply them. The justification is mainly due to the difficulty of acquiring and financing the necessary equipment.

Conocimiento y manejo de cuidados respiratorios especializados en pacientes con enfermedades neuromusculares en unidades de cuidado intensivo: aproximación por encuesta a profesionales de la salud / Knowledge and management in specialized respiratory care of patients with neuromuscular diseases in intensive care units: survey to health professionals

Introducción: En las enfermedades neuromusculares la disminución de la capacidad vital se relaciona con disminución de la capacidad tusígena y luego ventilatoria, la combinación de ambas genera complicaciones graves por falla ventilatoria. En los pacientes que son intubados, limita la extubación, sino se realizan cuidados respiratorios especializados. El conocimiento y aplicación de los profesionales que atienden a estos pacientes en cuidados intensivos resulta esencial. Objetivos: Reportar el conocimiento y aplicación especializada de cuidados respiratorios en enfermedades neuromusculares en las Unidades de Cuidados Intensivos. Materiales y métodos: Estudio cualitativo, descriptivo de corte transversal, no probabilístico, a criterio. La población accesible fueron profesionales de la Salud de las Unidades de Cuidados Intensivos, y el análisis de las respuestas de una encuesta estructurada, enviada a distintos profesionales a nivel mundial. Resultados: Se incluyeron los cuestionarios de 41 profesionales, el 34% de los profesionales reportaron la utilización regular de Asistente Mecánico de la Tos; 22% refirieron la utilización regular de apilamiento de aire; 31% reportaron la utilización regular de Asistencia Ventilatoria No Invasiva, 56.1% de los profesionales afirmaron conocer la diferencia entre Ventilación No Invasiva y Soporte Ventilatorio No Invasivo, 34% de los profesionales refirieron tener formación especializada en el área. Conclusión: Pese a existir una alta proporción de profesionales con conocimiento especializado, un grupo importante no los aplica rutinariamente. La justificación es principalmente por la dificultad de adquisición y financiación de los equipos necesarios.

Introduction: In neuromuscular diseases, the decrease in vital capacity relates to decreased coughing and then ventilatory capacity, the combination of both generating serious complications due to ventilatory failure. In intubated patients, the extubation process is difficult unless specialized respiratory care is provided. The knowledge and treatment application of the professionals who care for these patients in intensive care is of outmost importance. Objectives: Report the knowledge and specialized application of respiratory care in neuromuscular diseases in Intensive Care Units. Materials and methods: Qualitative, descriptive, cross-sectional, non-probabilistic study, at criteria. The accessible population were Health professionals from the Intensive Care Units, and the analysis of the responses of a structured survey, sent to different professionals worldwide. Results: The questionnaires of 41 professionals were included, 34% of the professionals reported the regular use of the Mechanical Cough Assistant; 22% reported the regular use of air stacking; 31% reported the regular use of Non-Invasive Ventilatory Assistance. 56.1% of the professionals stated that they knew the difference between Non-Invasive Ventilation and Non-Invasive Ventilatory Support, 34% of the professionals reported having specialized training in the area. Conclusion: Despite the existence of a high proportion of professionals with specialized knowledge, an important group does not routinely apply them. The justification is mainly due to the difficulty of acquiring and financing the necessary equipment.

¿Cómo Intervenir el Proceso de Caries en Personas Mayores? Adaptación del Consenso de ORCA/EFCD/DGZ

Los cambios demográficos y epidemiológicos actuales determinarán un aumento en la prevalencia e incidencia de caries, específicamente lesiones de caries radicular (RCLs, por sus siglas en inglés) en personas mayores, por lo que la necesidad de tratamiento de mayor cobertura y efectividad será también cada vez mayor. Este artículo resume en español la evidencia actual disponible acerca de las recomendaciones clínicas para las intervenciones preventivas, no invasivas, micro o mínimamente invasivas e invasivas para el manejo de la caries dental en personas mayores, con especial énfasis en RCLs. La presente publicación se basa en un taller de consenso, seguido de un proceso de consenso e-Delphi, realizado por un panel de expertos nominados por la Organización Europea para la Investigación en Caries (ORCA), la Federación Europea de Odontología Conservadora (EFCD) y la Federación Alemana de Odontología Conservadora (DGZ). El propósito de este artículo es presentar las principales conclusiones alcanzadas en el consenso de ORCA/EFCD/DGZ para permitir una mejor difusión del conocimiento y la aplicación de estos conceptos en la práctica clínica, orientando la correcta toma de decisiones en el manejo de la enfermedad y RCLs en las personas mayores.

Current demographic and epidemiological changes will condition increased caries prevalence and incidence, specifically root caries lesions (RCLs) in the elderly. There will be a need, therefore, for therapeutic approaches with greater coverage and effectiveness. This article summarizes, in Spanish, the current available evidence leading to clinical recommendations for preventive, non-invasive, micro or minimally invasive and invasive interventions for the management of dental caries in older people, with special emphasis on RCLs. This publication is based on a consensus workshop, followed by an e-Delphi consensus process, conducted by a panel of experts nominated by the European Organization for Caries Research (ORCA), the European Federation of Conservative Dentistry (EFCD) and the German Federation of Conservative Dentistry (DGZ). The purpose of this article is to present the main conclusions reached in the ORCA/EFCD/DGZ consensus to allow a better dissemination of knowledge and the application of these concepts in clinical practice, guiding the correct decision-making for the disease management and the RCLs in the elderly.

Parameters and results of non-invasive neuromodulation in the management of chronic pelvic pain: integrative literature review / Parâmetros e resultados da neuromodulação não invasiva no manejo da dor pélvica crônica: revisão integrativa da literatura

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic Pelvic Pain (CPP) is characterized by persistent pain in the pelvic region for more than six months, affecting both men and women and causing significant impairment in quality of life (QoL). Two of the main non-invasive approaches are Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS). These techniques aim to modulate neural activity and promote pain relief. In this context, this research conducted an integrative literature review to summarize the results of relevant studies, aiming to identify the key parameters used in TMS and tDCS for CPP treatment. The objective was to assess the effect and efficacy of non-invasive neuromodulation as a therapeutic intervention for CPP. CONTENTS: For this integrative review, electronic searches were conducted in Pubmed, Scielo, PEDro, Medline, Cochrane, and Scopus databases, examining studies in Portuguese, English, or Spanish. The keywords "pelvic pain," "transcranial direct current stimulation," and "transcranial magnetic stimulation" and their derivatives were searched in the three languages in studies from 2013 to 2023. Seven studies were included for analysis. Both techniques showed positive effects in managing CPP, improving pain levels and quality of life to a relevant extent. However, there is still no consensus on the parameters applied in TMS and tDCS techniques for CPP. CONCLUSION: Non-invasive neuromodulation improves pain levels and quality of life in patients with CPP. Further studies are needed to establish more reliable parameter relationships, and the limited number of studies restricts definitive conclusions on the subject.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor pélvica crônica (DPC) é caracterizada pela persistência da dor na região pélvica por mais de seis meses, afetando tanto homens quanto mulheres e causando prejuízos significativos na qualidade de vida (QV). Duas das principais abordagens não invasivas são Estimulação Magnética Transcraniana (EMT) e a Estimulação Transcraniana por Corrente Contínua (ETCC). Nesse contexto, esta pesquisa realizou uma revisão integrativa da literatura com o intuito de resumir os resultados de estudos relevantes, buscando identificar os principais parâmetros utilizados no tratamento da DPC. O objetivo foi fornecer uma visão abrangente sobre essas técnicas de neuromodulação e suas aplicações específicas no controle da dor pélvica crônica. CONTEÚDO: Para esta revisão integrativa, as buscas eletrônicas ocorreram nas bases de dados Pubmed, Scielo, PEDro, Medline, Cochrane e Scopus, verificando estudos em português, inglês ou espanhol. "Dor pélvica", "estimulação transcraniana por corrente contínua" e "estimulação magnética transcraniana" e suas derivações foram pesquisadas nos três idiomas em estudos entre 2013 e 2023. Sete estudos foram incluídos para análise. Ambas as técnicas apresentaram efeitos positivos no manejo da DPC, melhorando os níveis de dor e a QV em proporções relevantes. Entretanto, ainda não há um consenso sobre os parâmetros aplicados nas técnicas de EMT e ETCC para DPC. CONCLUSÃO: A neuromodulação não invasiva melhora os níveis de dor e a QV em pacientes com DPC. São necessários mais estudos para que relações mais confiáveis de parâmetros possam ser preestabelecidas e a ausência de um maior número de estudos limita conclusões acerca do assunto.

Uso de cánula nasal de alto flujo artesanal como oxigenoterapia en insuficiencia respiratoria por COVID-19 / Use of artisanal high flow nasal cannula as oxygen therapy in respiratory failure due to COVID-19

Los riesgos asociados a la neumonía por (SARS-CoV-2) es la generación de insuficiencia respiratoria secundaria que en algunos casos desencadenara al tan temido síndrome de distres respiratorio (SDRA); Informes sobre atención clínica, indican que tiene una incidencia (SDRA) de 3-10 % con necesidad de Asistencia Respiratoria Mecánica (ARM) en pacientes hospitalizados; por lo que dispositivos de oxigenación no invasivos siguen siendo una opción atractiva, de forma inicial. Caso clínico: mujer de 47 años con insuficiencia respiratoria secundario a neumonía por COVID-19, por la gravedad se indica su ingreso a terapia intensiva, pero por razones de falta de unidad es manejada en unidad respiratoria, con el uso de dispositivos de oxigenación de armado ARTESAL, de manera exitosa, con la utilización de CNAF-artesanal, se pretende mejorar el trabajo respiratorio, índices de oxigenación, mientras se da tratamiento a la infección por el COVID-19; el objetivo del presente caso es reportar el presente caso con evolución favorable a la literatura disponible. Discusión: El uso de terapia de oxigenación con dispositivo de Cánula Nasal de Alto Flujo, aún no ha sido normatizado en pacientes con COVID-19, pero existe evidencia clínica sobre los efectos beneficiosos en la insuficiencia respiratoria en neonatos mas no en adultos. Conclusión: El uso temprano de la CNAF-artesanal en la insuficiencia respiratoria resulta muy atractivo, más aún con dispositivo de confección artesanal, da una opción más al paciente fuera de UTI, pudiendo apoyar en evitar la intubación y su ingreso a ventilación mecánica.

The risks associated with pneumonia (SARS-CoV-2) is the generation of secondary respiratory failure that in some cases will trigger the much feared respiratory distress syndrome (ARDS); Reports on clinical care indicate that it has an incidence (ARDS) of 3-10% with the need for Mechanical Respiratory Assistance (ARM) in hospitalized patients; so non-invasive oxygenation devices remain an attractive option, initially. Clinical case: a 47-year-old woman with respiratory failure secondary to covid-19 pneumonia. Due to the severity, her admission to intensive care is indicated, but for reasons of lack of unity, she is managed in a common room, with the use of high-pressure oxygenation devices. ARTISAL assembly, successfully, with the use of CNAF-artisanal, is intended to improve the work of breathing, and oxygenation indices, while treating the infection by COVID-19; The objective of this case is to report the present case with a favorable evolution based on the available literature. Discussion: The use of oxygenation therapy with a High Flow Nasal Cannula device has not yet been standardized in patients with COVID-19, but there is clinical evidence on the beneficial effects in respiratory failure in neonates but not in adults. Conclusion: The early use of the artisan HFNC in respiratory failure is very attractive, even more so with an artisanal device, it gives the patient another option outside the ICU, being able to help avoid intubation and admission to mechanical ventilation.

Non-invasive prenatal screening & diagnosis of ?-thalassaemia in an affected foetus

Background & objectives: Non-invasive prenatal testing (NIPT) of maternally inherited alleles of ?-thalassaemia (MIB) remains to be a challenge. Furthermore, current techniques are not available for use as routine tests. NIPT for ?-thalassaemia disease was developed by using a specific droplet digital polymerase chain reaction (ddPCR) assay to analyze the cell-free foetal DNA (cffDNA) derived from maternal plasma. Methods: Pregnant women and their spouses who are at risk of bearing an offspring with ?-thalassaemia disease from common MIB mutations (CD 41/42-TCTT, CD17A>T, IVS1-1G>T and CD26G>A) were enrolled. The ddPCR assay sets were constructed for each of the four mutations. All cell-free DNA samples were first screened for the paternally inherited ?-thalassaemia (PIB) mutation. The PIB-negative samples were considered as non-disease and were not further analyzed. For PIB-positive samples, DNA fragments of 50-300 base pairs in size were isolated and purified, and further analyzed for MIB mutation. The allelic ratio between the mutant and the wild-type was used to determine the presence of MIB in cffDNA. All cases underwent a prenatal diagnosis by amniocentesis for a definite diagnosis. Results: Forty two couples at risk were enrolled. Twenty two samples were positive for PIBs. Among these 22 samples, there were 10 cases with allelic ratio >1.0 (MIB positive). All foetuses with over-represented mutant alleles were further diagnosed with ?-thalassaemia disease; eight with compound heterozygous and two with homozygous mutations. The 20 PIB-negative and 12 MIB-negative foetuses were non-affected. Interpretation & conclusions: The results of this study suggest that NIPT utilizing the ddPCR assay can be effectively used for the screening and diagnosis of foetal ?-thalassaemia in at risk pregnancies.

Multifaceted role of cardiovascular biomarkers

Cardiovascular diseases, a global health issue, claim the lives of many every year. Lifestyle changes and genetic predisposition are the key drivers for the development of CVDs. In many of the patients, the disease is detected at the end stage making heart transplantation the only treatment option. Hence every attempt should be made to identify the risk at an early stage and initiate preventive measures to improve the quality of their life. Biomarkers are one of the critical factors that aid in the early diagnosis of CVDs. More specific and highly sensitive biomarkers have been discovered lately and have been employed for prognosis and diagnosis of CVDs. The present review briefs about the various categories of cardiovascular biomarkers with emphasis on novel biomarkers and discusses the biomarkers employed for different purposes in CVDs. The biomarkers have also helped in identifying COVID-19 patients with increased risk for developing cardiovascular complications. Being non-invasive makes biomarkers advantageous over other methods for evaluating the pathophysiological status of CVDs.

Mapping the modulating effect of transcutaneous auricular vagus nerve stimulation on voxel-based analyses in patients with first-episode major depressive disorder: a resting-state functional magnetic resonance imaging study

Introduction: Seed-based analysis has shown that transcutaneous auricular vagus nerve stimulation (taVNS) can modulate the dysfunctional brain network in patients with major depressive disorder (MDD). However, the voxel-based neuropsychological mechanism of taVNS on patients with first-episode MDD is poorly understood. The objective of this study was to assess the effects of an 8-week course of taVNS on patients with first-episode MDD. Methods: Twenty-two patients with first-episode MDD accepted an 8-week course of taVNS treatment. Resting-state functional magnetic resonance imaging (rs-fMRI) scans were performed before and after treatment. Voxel-based analyses were performed to characterize spontaneous brain activity. Healthy controls (n=23) were recruited to minimize test-retest effects. Analysis of covariance (ANCOVA) was performed to ascertain treatment-related changes. Then, correlations between changes in brain activity and the Hamilton Depression Rating Scale (HAM-D)/Hamilton Anxiety Scale (HAM-A) remission rate were estimated. Results: Significant group-by-time interactions on voxel-based analyses were observed in the inferior ventral striatum (VSi) and precuneus. Post-hoc analyses showed that taVNS inhibited higher brain activity in the VSi, while upregulating it in the precuneus. Functional connectivity (FC) between the VSi and precuneus decreased. Positive correlations were found between the HAM-D remission rate and changes in brain activity in the VSi. Conclusion: taVNS reduced the FC between VSi and precuneus by normalizing the abnormal spontaneous brain activity of VSi in first-episode MDD patients.

Fatty Liver (part 2): Clinical Approach and Treatment

Patients with fatty liver are almost always asymptomatic; aminotransferases are usually elevated two to five times the expected value and are an important cause of initial consultation. All images can show fatty liver, and liver biopsy remains the gold standard for diagnosis. In any patient, non-invasive tests are an excellent alternative to biopsy to determine the degree of liver fibrosis and establish the stage of fibrogenesis. Weight loss and exercise are the fundamental pillars of the indicated treatment for all patients with overweight or obesity; a weight loss between 5% and 10% and a diet with caloric restriction of 500-1000 kcal/day, low in saturated fat and rich in Mediterranean diet products such as fruit, fish, vegetables, nuts, olive oil, among others, are recommended. There are other treatments, such as pharmacological measures and endoscopic and surgical procedures.

Los pacientes con hígado graso son casi siempre asintomáticos, las aminotransferasas usualmente están elevadas dos a cinco veces el valor normal y son una causa importante de consulta inicial. Todas las imágenes pueden evidenciar el hígado graso y la biopsia hepática sigue siendo la prueba de oro para su diagnóstico. En cualquier paciente las pruebas no invasivas son una excelente alternativa a la biopsia para determinar el grado de fibrosis hepática y establecer en qué etapa de la fibrogénesis se encuentra. La pérdida de peso y el ejercicio son los pilares fundamentales del tratamiento indicado para todos los pacientes con sobrepeso u obesidad; se recomienda una pérdida de peso entre 5% y 10% del peso corporal y una dieta con restricción calórica de 500-1000 kcal/día, baja en grasas saturadas y rica en productos de la dieta mediterránea como fruta, pescado, verduras, frutos secos, aceite de oliva, entre otros. Hay otros tratamientos como las medidas farmacológicas y los procedimientos endoscópicos y quirúrgicos.

Ventilación mecánica no invasiva en pacientes con enfermedad pulmonar obstructiva crónica agudizada en cuidados intensivos: diez años de experiencia / Non invasive mechanic ventilation in patients with acute chronic obstructive lung disease in intensive cares: ten years of experience:en

Introducción: La ventilación no invasiva es un tratamiento efectivo en pacientes con enfermedad pulmonar agudizada. Objetivo: Describir las características demográficas, clínicas, ventilatorias y hemogasométricas en pacientes tratados con ventilación no invasiva. Métodos: Se realizó un estudio observacional, descriptivo, longitudinal y prospectivo de 234 pacientes con enfermedad pulmonar obstructiva crónica agudizada, ventilados de forma no invasiva en la Unidad de Cuidados Intensivos del Hospital Provincial Clínico-Quirúrgico Docente Saturnino Lora de Santiago de Cuba de enero de 2011 a septiembre de 2021. Resultados: En la serie predominaron el sexo masculino, la neumonía extrahospitalaria y la insuficiencia cardíaca crónica; mientras que la edad media fue de 71 años y la ventilación no invasiva fracasó en 53,8 % de los afectados. Asimismo, la frecuencia respiratoria disminuyó de 34,3 a 23,5 respiraciones por minuto en la segunda hora y se observó, además, un incremento del pH, así como de la relación presión arterial de O2/fracción inspirada de O2 y saturación de oxígeno a la pulsioximetría/fracción inspiratoria de O2. La presión arterial de CO2 tuvo valores promedio de 61,8 mmHg al inicio y de 60,7 mmHg en la segunda hora. Conclusiones: Los valores basales de las variables clínicas, hemogasométricas y ventilatorias mejoraron luego del tratamiento con ventilación no invasiva. Entre los parámetros asociados al fracaso del tratamiento figuraron: frecuencia cardiaca, frecuencia respiratoria, presión arterial de CO2, escala de coma de Glasgow, pH y presencia de fugas; igualmente, la estadía prolongada, la ventilación por más de 48 horas y la mortalidad estuvieron relacionadas con dicho fracaso.

Introduction: The non invasive ventilation is an effective treatment in patients with acute lung disease. Objective: To describe the demographic, clinical, ventilatory and hemogasometric characteristics in patients treated with non invasive ventilation. Methods: An observational, descriptive, longitudinal and prospective study of 234 patients with chronic obstructive lung disease, non-invasive ventilated in the Intensive Cares Unit of Saturnino Lora Teaching Clinical-Surgical Provincial Hospital in Santiago de Cuba, was carried out, from January, 2011 to September, 2021. Results: In the series there was a prevalence of male sex, non hospital acquired pneumonia and chronic heart failure; while the mean age was 71 years and non invasive ventilation failed in 53.8 % of those affected. Also, the respiratory rate decreased from 34.3 to 23.5 breaths per minute in the second hour and an increase in pH was also observed, as well as in the relationship arterial pressure of O2/inspired fraction of O2 and oxygen saturation to the pulsioximetry/inspiratory fraction of O2. The arterial pressure of CO2 had average values of 61.8 mmHg to the beginning and of 60.7 mmHg in the second hour. Conclusions: The basal values of clinical, hemogasometric and ventilatory variables improved after treatment with non invasive ventilation. Among the parameters associated with the treatment failure there were heart frequency, respiratory frequency, arterial pressure of CO2, coma Glasgow scale, pH and leaks; equally, the long stay, the ventilation for more than 48 hours and mortality were related to this failure.

Impacto de la cánula nasal de alto flujo y la ventilación no invasiva en la fisiología deglutoria: revisión de la literatura / Impact of high-flow nasal cannula and non-invasive ventilation on swallowing physiology: a literature review

El proceso deglutorio requiere de una adecuada coordinación entre respiración y deglución. En el contexto clínico, el uso de dispositivos ventilatorios no invasivos, como la cánula nasal de alto flujo (CNAF) o la ventilación no invasiva (VNI), ha cobrado gran relevancia durante los últimos años. Sin embargo, existe escasa información respecto a la interferencia que estos dispositivos podrían ocasionar en la fisiología deglutoria. En este contexto, y con el objetivo de describir el impacto de la CNAF y la VNI en la fisiología deglutoria, se realizó una revisión de la literatura en PubMed, Medline, Embase, Web of Science, Lilacs y Scielo. Se incorporaron estudios que incluyeran población ≥18 años, con uso de CNAF o VNI. Se excluyeron estudios en población con antecedentes de disfagia, necesidad de intubación, presencia de enfermedad neurológica, neuromuscular o respiratoria, entre otros. Los resultados de los estudios muestran que la CNAF podría disminuir el número de degluciones (en flujos ≥ 20 L/min; p<0,05),disminuir el tiempo medio de activación de la respuesta deglutoria proporcional al flujo empleado (p<0,05), incrementar el riesgo aspirativo en flujos altos (>40 L/min, p<0,05) e incrementar en promedio la duración del cierre del vestíbulo laríngeo (p<0,001). La VNI modo BiPAP, por su parte, podría aumentar el riesgo aspirativo debido al incremento en la tasa de inspiración post deglución (SW-I, p<0,01). Si bien la evidencia disponible es limitada, los resultados aportan información relevante a considerar en el abordaje de usuarios que utilicen estos dispositivos ventilatorios. Futuras investigaciones deberían ser desarrolladas para fortalecer la evidencia presentada.

Deglutition requires adequatecoordination between breathing and swallowing. In the clinical context, the use of non-invasive ventilatory devices such as high-flow nasal cannulas(HFNC) or non-invasive ventilation (NIV) has become highlyrelevantin recent years. However, there is little information regarding howthese devices could interferewith the physiologyof deglutition. This study aimedto describe the impact of HFNC and NIV on swallowing physiology. To this end, aliterature review was carried out usingPubMed, Medline, Embase, Web of Science, Lilacs,and Scielo. Studies performed onpopulations≥18 years old where HFNC or NIV were used were included. Studies where thepopulation hada history of dysphagia, need for intubation, and presentedneurological, neuromuscular,or respiratory diseases, among others, were excluded. The results show that HFNC could decrease the swallowing rate(with flows≥ 20 L/min; p<.05), decrease the mean activation time of the swallowing reflex in proportion to the flow (p<.05), increase the risk of aspiration when usinghigherflows (>40 L/min, p<0.05),and increase the average duration of the laryngeal vestibuleclosure(p<.001).NIV, particularly BiPAP, could increase the risk of aspiration due to the higherrate of post-swallowing inspiration (SW-I, p<.01). Although the evidence available on this matter is limited, theseresults offerrelevant information that should beconsideredwhen working with patients who use these ventilatory devices. Furtherresearch should be carriedoutto strengthen the evidence that is provided in this study.

Terapia con cánula nasal de alto flujo en pacientes pediátricos en domicilio / High flow nasal cannula therapy in pediatric patients at home

Se realiza comentario de estudio de Israel en el cual analizan 75 pacientes pediátricos que utilizaron cánula nasal de alto flujo (CNAF) en domicilio, evaluando la seguridad, las indicaciones, los parámetros de utilización, la duración del tratamiento, los resultados clínicos y la satisfacción de los padres. Se acompaña de una revisión de la literatura del tema.

A comment is made on a study conducted in Israel analyzing 75 pediatric patients who used high-flow nasal cannula at home, evaluating safety, indications, utilization parameters, treatment duration, clinical outcomes, and parental satisfaction. It is accompanied by a literature review on the topic.

Comparative study between suprasternal and apical windows: a user-friendly cardiac output measurement for the anesthesiologist

Abstract Introduction Transthoracic echocardiography is a safe and readily available tool for noninvasive monitoring of Cardiac Output (CO). The use of the suprasternal window situated at the sternal notch can be an alternative approach for estimating blood flow. The present study aimed to compare two methods of CO calculation. We compared the descending aorta Velocity-Time Integral (VTI) measurement from the suprasternal window view with the standard technique to determine CO that uses VTI measurements from the LVOT (Left Ventricular Outflow Tract) view. We also aimed to find out whether after basic training a non-echocardiographer operator can obtain reproducible measurements of VTI using this approach. Methods In the first part of the study, 26 patients without known cardiovascular diseases were evaluated and VTI data were acquired from the suprasternal window by a non-echocardiographer and an echocardiographer. Next, 17 patients were evaluated by an echocardiographer only and VTI and CO measurements were obtained from suprasternal and apical windows. Data were analyzed using the Bland and Altman method (BA), correlation and regression. Results We found a strong correlation between measurements obtained by a non-expert and an expert echocardiographer and detected that an inexperienced trainee can acquire VTI measurements from the suprasternal window view. Regarding agreement between CO measurements, data obtained showed a positive correlation and the Bland and Altman analysis presented a total variation of 38.9%. Conclusion Regarding accuracy, it is likely that TTE (Transthoracic Echocardiogram) measurements of CO from the suprasternal window view are comparable to other minimally invasive techniques currently available. Due to its user-friendliness and low cost, it can be a convenient technique for obtaining perioperative hemodynamic measurements, even by inexperienced operators.

Cortical thickness is related to working memory performance after non-invasive brain stimulation

Non-invasive brain stimulation (NIBS) probing the dorsolateral prefrontal cortex (DLPFC) has been shown to have little effect on working memory. The variability of NIBS responses might be explained by inter-subject brain anatomical variability. We investigated whether baseline cortical brain thickness of regions of interest was associated with working memory performance after NIBS by performing a secondary analysis of previously published research. Structural magnetic resonance imaging data were analyzed from healthy subjects who received transcranial direct current stimulation (tDCS), intermittent theta-burst stimulation (iTBS), and placebo. Twenty-two participants were randomly assigned to receive all the interventions in a random order. The working memory task was conducted after the end of each NIBS session. Regions of interest were the bilateral DLPFC, medial prefrontal cortex, and posterior cingulate cortex. Overall, 66 NIBS sessions were performed. Findings revealed a negative significant association between cortical thickness of the bilateral dorsolateral prefrontal cortex and reaction time for both tDCS (left: P=0.045, right: P=0.037) and iTBS (left: P=0.007, right: P=0.007) compared to placebo. A significant positive association was found for iTBS and posterior cingulate cortex (P=0.03). No association was found for accuracy. Our findings provide the first evidence that individual cortical thickness of healthy subjects might be associated with working memory performance following different NIBS interventions. Therefore, cortical thickness could explain - to some extent - the heterogeneous effects of NIBS probing the DLPFC.