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Introduction: Sleep-deprivation is a state of combinedabsence of sleep and extended wakefulness. Notoriouslyknown to be associated with slowing of cognitive processeslike attention, working memory, and executive functions, it isalso a consequence of insomnia which in turn is an infamoussymptom of depression. Depression has adverse effects onsocial functioning, which further shape its course and outcome.Material and Methods: This systematic review is basedon a systematic search of electronic database PubMedand provides an overview of literature defining cognitiveimpairment and depression, followed by their associationswith sleep deprivation, entailing possible mechanisms ofthese inter-relationships along with the networks in the humanbrain which are susceptible or resilient towards the effectsof insufficient sleep. A total of 47 such articles and studiesconsidering all these aspects were reviewed.Results: Reductions in functional MRI signals in thedorsolateral prefrontal cortex in sleep deprivation are thoughtto account for attention deficits. Impaired working memoryseconded by an overall increase in reaction times wereobserved, while scanning efficiency was claimed to remainunaffected,by some authors. Long term potentiation wasseen to decrease due to sleep deprivation. Alterations in theHPA axis, stress and high cortisol levels, low brain-derivedneurotrophic factor levels were also interlinked with bothsleep deprivation and depression.Conclusion: Sleep deprivation interrupts physiologicalfunctions, neurocognitive processes, and worsens depression.Hence sleep for upto six to eight hours each night isrecommended on the lines of this review.
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Background: Venoarterial extracorporeal membrane oxygenation [ECMO] provides systemic arterial support without directly unloading the left heart, which causes an elevated left ventricular [LV] pressure. The aim of the present study was to investigate the adjunctive application of the Impella device for LV unloading in patients during ECMO
Methods: This retrospective cohort study included patients who received Impella support in addition to venoarterial ECMO between April 2012 and December 2015. ECMO cannulation was performed peripherally or centrally, while the Impella device was surgically inserted into the femoral artery or the right axillary artery
Results: Among 62 patients, 10 [16.1%] received an Impella device during ECMO support. Following Impella support, right atrial pressure improved from a median of 18 [IQR, 14-24] mmHg to 13 [IQR, 10-15] mmHg and pulmonary wedge pressure improved from 30 [IQR, 26-35] mmHg to 16 [IQR, 12-19] mmHg in all the patients [p value < 0.001]. Follow-up transthoracic echo car diagrams [n = 6] showed a median decrease of 0.8 cm in LV end-diastolic volume [p value = 0.021]. There were 5 [50%] in-hospital deaths due to sustained brain injury [n = 3] and refractory cardiogenic shock [n = 2]. The remaining 5 patients were discharged and successfully bridged to more permanent LV assist device [n = 2] or heart transplantation [n = 3]
Conclusion: The findings of the present study indicate that the application of the Impella device during ECMO support is effective in LV unloading and confers optimal hemodynamic support
RESUMEN
Neurofibroma is a rare tumor of the oral cavity. It is generally associated with a generalized syndrome of neurofibromatosis but a few cases of the solitary intraoral lesions have also been reported. A one such rare case of neurofibroma of the lip is being presented with a note on the importance of early diagnosis and adequate treatment of this lesion.