Respiración de Biot. Fracaso de la extubación / Breathing Biot. Extubation failure / Respiração de Biot. Falha na extubação

Resumen: La ventilación mecánica (VM) prolongada incrementa el riesgo de complicaciones. Por otra parte, el retiro precoz de la misma expone al paciente a los riesgos que presentaba antes de iniciarla. El evento vascular cerebral (EVC)puede complicarse, requerir intubación y ventilación mecánica para soporte respiratorio. Presentamos el caso de un hombre de 76 años de edad con isquemia aguda a nivel de cerebelo que fracasó en la extubación a pesar de presentar parámetros objetivos correctos y adecuada tolerancia a la prueba de «pieza en T¼. Los parámetros que evalúan el éxito o fracaso de la extubación en el paciente neurológico son un problema no resuelto, hasta el día de hoy la escala de coma de Glasgow (ECG) es la variable asociada a buenos o malos resultados.

Abstract: Mechanical ventilation (MV) long increases the risk of complications, moreover early retirement of it exposes the patient to the risks presented before starting. Cerebral vascular event (CVE) can be complicated, requiring intubation and mechanical ventilation for respiratory support. We report the case of a male 76 years of age with acute ischemia cerebellar that failed extubation despite having objective parameters correct and proper tolerance test «T-piece¼. The parameters that evaluate the success or failure of extubation in neurological patient is an unresolved problem until today the Glasgow coma scale (GCS) is the variable associated with good or bad results.

Resumo: A ventilação mecânica (VM) prolongada incrementa o risco de complicações, por outra parte, o retiro precoce da mesma, expõe o paciente aos riscos apresentados antes de começar. O acidente vascular cerebral (AVC) pode complicarse, necessitando de intubação e ventilação mecânica para suporte respiratório. Relatamos o caso de um paciente masculino de 76 anos de idade, com isquemia aguda a nível cerebelar que falharam na extubação apesar de ter parâmetros objetivos corretos e adecuada tolerância ao teste de tolerância correto do tubo «T¼. Os parâmetros que avaliam o sucesso ou fracasso de extubação em paciente neurológico é um problema não resolvido, até hoje a Escala de Coma de Glasgow (ECG) é a variável associada a resultados positivos ou negativos.

Nonlinear differential equations for the wavefront surface at arbitrary Hartmann-plane distances.

In the Hartmann test, a wave aberration function W is estimated from the information of the spot diagram drawn in an observation plane. The distance from a reference plane to the observation plane, the Hartmann-plane distance, is typically chosen as z=f, where f is the radius of a reference sphere. The function W and the transversal aberrations {X,Y} calculated at the plane z=f are related by two well-known linear differential equations. Here, we propose two nonlinear differential equations to denote a more general relation between W and the transversal aberrations {U,V} calculated at any arbitrary Hartmann-plane distance z=r. We also show how to directly estimate the wavefront surface w from the information of {U,V}. The use of arbitrary r values could improve the reliability of the measurements of W, or w, when finding difficulties in adequate ray identification at z=f.

Cerebrospinal fluid homovanillic acid is correlated to psychotic features in neurological patients with delirium.

OBJECTIVE: The aim of this study was to determine if cerebrospinal fluid (CSF) levels of homovanillic acid (HVA) are related to the clinical features of delirium in a group of patients with acute onset neurological illness. METHODS: Fifty-one patients with probable acute brain infection were classified as delirious and nondelirious according to Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) and Delirium Rating Scale (DRS). CSF HVA concentration was analyzed by high-performance liquid chromatography. RESULTS: Delirium was present in 60.8% of the total sample. HVA levels were not significantly different between delirious and nondelirious patients. Remarkably, patients with psychotic symptoms shown higher levels of CSF HVA as compared to nonpsychotic patient values. In addition, HVA levels were positively correlated to specific items of DRS such as delusions (r=0.463, P=.001), hallucinations (r=0.438, P=.001), cognitive dysfunction (r=0.286, P=.042) and fluctuation of symptoms (r=0.280, P=.046) in the total sample. Subanalyses excluding patients taking antipsychotic drugs revealed that HVA CSF levels were higher in those patients with delusions, and furthermore, the dopamine metabolite remained positively correlated to delusion subscale of DRS. CONCLUSIONS: Our results suggest that psychotic symptoms in delirious patients may be related to increased dopamine neurotransmission, as reflected by increased CSF HVA concentration, providing direct evidence to support the dopaminergic theory of psychosis.

Detection of bacterial infection of agave plants by laser-induced fluorescence.

Greenhouse-grown plants of Agave tequilana Weber var. azul were inoculated with Erwinia carotovora, the causal agent of stem soft rot. We investigated the laser-induced fluorescence (LIF) of agave plants to determine whether LIF can be used as a noninvasive sensing tool for pathological studies. The LIF technique was also investigated as a means of detecting the effect of the polyamine biosynthesis inhibitor beta-hydroxyethylhydrazine as a bactericide against the pathogenic bacterium Erwinia carotovora. A He-Ne laser at 632.8 nm was used as the excitation source, and in vivo fluorescence emission spectra were recorded in the 660-790-range. Fluorescence maxima were at 690 and 740 nm. The infected plants that were untreated with the bactericide showed a definite increase in fluorescence intensity at both maxima within the first three days after infection. Beginning on the fifth day, a steady decrease in fluorescence intensity was observed, with a greater effect at 740 than at 690 nm. After 30 days there was no fluorescence. The infected plants that had been treated with the bactericide showed no significant change in fluorescence compared with that of the uninfected plants. The ratio of fluorescence intensities was determined to be F 690 nm/F 740 nm for all treatments. These studies indicate that LIF measurements of agave plants may be used for the early detection of certain types of disease and for determining the effect of a bactericide on bacteria. The results also showed that fluorescence intensity ratios can be used as a reliable indicator of the progress of disease.