Delineation of intracavitary electrograms for the automatic quantification of decrement-evoked potentials in the coronary sinus with deep-learning techniques.

Cardiac arrhythmias cause depolarization waves to conduct unevenly on the myocardial surface, potentially delaying local components with respect to a previous beat when stimulated at faster frequencies. Despite the diagnostic value of localizing the distinct local electrocardiogram (EGM) components for identifying regions with decrement-evoked potentials (DEEPs), current software solutions do not perform automatic signal quantification. Electrophysiologists must manually measure distances on the EGM signals to assess the existence of DEEPs during pacing or extra-stimuli protocols. In this work, we present a deep learning (DL)-based algorithm to identify decrement in atrial components (measured in the coronary sinus) with respect to their ventricular counterparts from EGM signals, for disambiguating between accessory pathways (APs) and atrioventricular re-entrant tachycardias (AVRTs). Several U-Net and W-Net neural networks with different configurations were trained on a private dataset of signals from the coronary sinus (312 EGM recordings from 77 patients who underwent AP or AVRT ablation). A second, separate dataset was annotated for clinical validation, with clinical labels associated to EGM fragments in which decremental conduction was elucidated. To alleviate data scarcity, a synthetic data augmentation method was developed for generating EGM recordings. Moreover, two novel loss functions were developed to minimize false negatives and delineation errors. Finally, the addition of self-attention mechanisms and their effect on model performance was explored. The best performing model was a W-Net model with 6 levels, optimized solely with the Dice loss. The model obtained precisions of 91.28%, 77.78% and of 100.0%, and recalls of 94.86%, 95.25% and 100.0% for localizing local field, far field activations, and extra-stimuli, respectively. The clinical validation model demonstrated good overall agreement with respect to the evaluation of decremental properties. When compared to the criteria of electrophysiologists, the automatic exclusion step reached a sensitivity of 87.06% and a specificity of 97.03%. Out of the non-excluded signals, a sensitivity of 96.77% and a specificity of 95.24% was obtained for classifying them into decremental and non-decremental potentials. Current results show great promise while being, to the best of our knowledge, the first tool in the literature allowing the delineation of all local components present in an EGM recording. This is of capital importance at advancing processing for cardiac electrophysiological procedures and reducing intervention times, as many diagnosis procedures are performed by comparing segments or late potentials in subsequent cardiac cycles.

The healthy moms and babies app to prevent postpartum depression: analysis of user-profiles and dropout cases.

Introduction: Perinatal depression affects mothers, babies and society. Preventive interventions are needed, but face barriers to access. E-health interventions could be an effective and accessible option. To date, few studies have attempted to understand the use of mobile health (m-health) applications and why they are not more widely used. This study aims to understand the demographic characteristics of enrolled participants and examine dropout patterns through the Healthy Moms and Babies app. Methods: A longitudinal study was conducted with a sample of 511 women recruited between 2020 and 2022. Data were collected from the app, including sociodemographic information, the participant's progress through the modules of the app, and the permissions granted to use the app. Results: Out of the 511 women who completed the initial form to initiate participation, 279 downloaded the app and completed the evaluation. Results indicated that granting permission to be notified about the module's availability is related to an increase in the use of the first modules. Conclusion: This study shows the importance of establishing follow-ups in the use of mobile apps during the perinatal period.

Testing the performance, adequacy, and applicability of an artificial intelligence model for pediatric pneumonia diagnosis.

BACKGROUND: Community-acquired Pneumonia (CAP) is a common childhood infectious disease. Deep learning models show promise in X-ray interpretation and diagnosis, but their validation should be extended due to limitations in the current validation workflow. To extend the standard validation workflow we propose doing a pilot test with the next characteristics. First, the assumption of perfect ground truth (100% sensitive and specific) is unrealistic, as high intra and inter-observer variability have been reported. To address this, we propose using Bayesian latent class models (BLCA) to estimate accuracy during the pilot. Additionally, assessing only the performance of a model without considering its applicability and acceptance by physicians is insufficient if we hope to integrate AI systems into day-to-day clinical practice. Therefore, we propose employing explainable artificial intelligence (XAI) methods during the pilot test to involve physicians and evaluate how well a Deep Learning model is accepted and how helpful it is for routine decisions as well as analyze its limitations by assessing the etiology. This study aims to apply the proposed pilot to test a deep Convolutional Neural Network (CNN)-based model for identifying consolidation in pediatric chest-X-ray (CXR) images already validated using the standard workflow. METHODS: For the standard validation workflow, a total of 5856 public CXRs and 950 private CXRs were used to train and validate the performance of the CNN model. The performance of the model was estimated assuming a perfect ground truth. For the pilot test proposed in this article, a total of 190 pediatric chest-X-ray (CXRs) images were used to test the CNN model support decision tool (SDT). The performance of the model on the pilot test was estimated using extensions of the two-test Bayesian Latent-Class model (BLCA). The sensitivity, specificity, and accuracy of the model were also assessed. The clinical characteristics of the patients were compared according to the model performance. The adequacy and applicability of the SDT was tested using XAI techniques. The adequacy of the SDT was assessed by asking two senior physicians the agreement rate with the SDT. The applicability was tested by asking three medical residents before and after using the SDT and the agreement between experts was calculated using the kappa index. RESULTS: The CRXs of the pilot test were labeled by the panel of experts into consolidation (124/176, 70.4%) and no-consolidation/other infiltrates (52/176, 29.5%). A total of 31/176 (17.6%) discrepancies were found between the model and the panel of experts with a kappa index of 0.6. The sensitivity and specificity reached a median of 90.9 (95% Credible Interval (CrI), 81.2-99.9) and 77.7 (95% CrI, 63.3-98.1), respectively. The senior physicians reported a high agreement rate (70%) with the system in identifying logical consolidation patterns. The three medical residents reached a higher agreement using SDT than alone with experts (0.66±0.1 vs. 0.75±0.2). CONCLUSIONS: Through the pilot test, we have successfully verified that the deep learning model was underestimated when a perfect ground truth was considered. Furthermore, by conducting adequacy and applicability tests, we can ensure that the model is able to identify logical patterns within the CXRs and that augmenting clinicians with automated preliminary read assistants could accelerate their workflows and enhance accuracy in identifying consolidation in pediatric CXR images.

The impact of the war in Ukraine on the perinatal period: Perinatal mental health for refugee women (pmh-rw) protocol.

Background: The aim of the Perinatal Mental Health for Refugee Women (PMH-RW) Project is to investigate the impact of the war on perinatal mental health: anxiety, post-traumatic stress, depression, and birth trauma symptoms. It will also evaluate the factors that serve as protective elements for the development of these potential diagnoses (such as personality traits, social support, sociodemographic characteristics, and access to medical/mental health services). Method: An international observational cohort study with baseline data is being assessed in Ukraine (for internal refugees) and several European Countries (for external refugees). The study includes as participants both pregnant women and those who have recently given birth (with babies up to 1 year old). The assessment includes measures on depression (EPDS), anxiety (GAD-7), experiences during birth (City Birth Questionnaire), post-traumatic stress symptoms [Impact of events scale-revised (PTSD-R)], Personality (10-Item Personality Inventory-TIPI), and a questionnaire for socio-demographic data which also such social support. Conclusion: This study will provide needed information for determining the impact of the Ukrainian Crisis on perinatal mental health by studying potential risk and protective factors. The data collected will be used to inform policymakers with useful information that can be used in the development of plans to protect and promote the mental health of the perinatal refugees impacted by this event. Also, it is our hope that data collected from this study will serve to plant the seeds for further research regarding the impact of the crisis in Ukraine on the offspring and to analyze how these events are affecting further generations. Clinical Trial Registration: ClinicalTrials.gov, Identifier: NCT05654987.

Good Practices in Perinatal Mental Health for Women during Wars and Migrations: A Narrative Synthesis from the COST Action Riseup-PPD in the Context of the War in Ukraine / Las buenas prácticas en salud mental perinatal para mujeres en periodo de guerra y migraciones: una revisión narrativa de la Acción COST Riseup-PPD en el contexto de la guerra en Ucrania

Background: Since February 24th, 2022, the beginning of Russia’s aggression against Ukraine, more than 80,000 women were expected to give birth. Therefore, understanding the impact of war on the perinatal health of women is an important requisite to improve perinatal care. This narrative synthesis has two main purposes: on one hand, it aims to summarize the current evidence available based on perinatal health outcomes and care among perinatal women; on the other, it attempts to identify the gaps still present in research in relation to perinatal care. Method: A literature search was completed in diverse databases (e.g., Medline, PsychInfo). Results: Emergent matters related to practice and research in perinatal refugee women have been discussed. Conclusions: In the face of the war in Ukraine, we need to build up further research to provide an evidence-based foundation for preventing and treating the psychological consequences of pregnant women exposed directly to war and those who have been forced into a refugee status during this vulnerable period. Also, it is essential to support not only women transitioning to motherhood, but also supporting midwives and nurses in their work. (AU)

Antecedentes: Desde el 24 de febrero de 2022, el comienzo de la agresión de Rusia contra Ucrania, se esperaba que más de 80,000 mujeres dieran a luz. Por lo tanto, comprender el impacto de la guerra en la salud perinatal de las mujeres es un requisito importante para mejorar la atención perinatal. Esta revisión narrativa tiene dos propósitos principales: por un lado, tiene como objetivo resumir la evidencia actual disponible basada en los resultados de salud perinatal y la atención a las mujeres perinatales y, por otro lado, intenta identificar las brechas aún presentes en la investigación en relación con la atención perinatal. Método: Se completó una búsqueda bibliográfica en diversas bases de datos (p. ej., Medline, PsychInfo). Resultados: Se han discutido temas emergentes relacionados con la práctica y la investigación en mujeres refugiadas perinatales. Conclusiones: Frente a la guerra en Ucrania necesitamos más investigación para construir una base partiendo de la evidencia con el fin de prevenir y tratar las consecuencias psicológicas de las mujeres embarazadas expuestas directamente a la guerra y de aquellas que se han visto obligadas al estatus de refugiadas durante este período vulnerable. Además, es esencial apoyar no solo a las mujeres en transición a la maternidad, sino también a las matronas y enfermeras en su trabajo. (AU)

New-onset persistent left bundle branch block following sutureless aortic valve replacement.

OBJECTIVE: To evaluate the incidence, predictive factors and prognostic value of new-onset persistent left bundle branch block (NOP-LBBB) in patients undergoing sutureless surgical aortic valve replacement (SU-SAVR). METHODS: A total of 329 consecutive patients without baseline conduction disturbances or previous permanent pacemaker implantation (PPI) who underwent SU-SAVR with the Perceval valve (LivaNova Group, Saluggia, Italy) in two centres from 2013 to 2019 were included. Patients were on continuous ECG monitoring during hospitalisation and 12-lead ECG was performed after the procedure and at hospital discharge. NOP-LBBB was defined as a new postprocedural LBBB that persisted at hospital discharge. Baseline, procedural and follow-up clinical and echocardiography data were collected in a dedicated database. RESULTS: New-onset LBBB was observed in 115 (34.9%) patients, and in 76 (23.1%) persisted at hospital discharge. There were no differences in baseline and procedural characteristics between patients with (n=76) and without (n=253) NOP-LBBB. After a median follow-up of 3.3 years (2.3-4.4 years), patients with NOP-LBBB had a higher incidence of PPI (14.5% vs 6.3%, p=0.016), but exhibited similar rates of all-cause mortality (19.4% vs 19.2%, p=0.428), cardiac mortality (8.1% vs 9.4%, p=0.805) and heart failure readmission (21.0% vs 23.2%, p=0.648), compared with the no/transient LBBB group. NOP-LBBB was associated with a decrease in left ventricular ejection fraction (LVEF) at 1-year follow-up (delta: -5.7 vs +0.2, p<0.001). CONCLUSIONS: NOP-LBBB occurred in approximately a quarter of patients without prior conduction disturbances who underwent SU-SAVR and was associated with a threefold increased risk of PPI along with a negative impact on LVEF at follow-up.

Incidence, predictors and prognostic value of permanent pacemaker implantation following sutureless valve implantation in low-risk aortic stenosis patients.

OBJECTIVES: Sutureless aortic valve replacement (SU-SAVR) has been associated with higher rates of permanent pacemaker (PPM) compared with conventionally implanted aortic bioprostheses. The purpose of this study was to determine the incidence, predictors and mid-term prognostic impact of PPM after Perceval (Livanova, London, UK) SU-SAVR in low-risk patients. METHODS: A total of 400 consecutive low-risk (EuroSCORE II < 4%) patients without prior pacemaker who underwent surgical aortic valve replacement with the Perceval prosthesis from 2013 to 2019 in 2 centres were included. Baseline, clinical and electrocardiographic parameters, procedural characteristics and follow-up data were collected. RESULTS: PPM was required in 36 (9%) patients after SU-SAVR, with a median time between the procedure and PPM implantation of 7.5 (4.5-10.5) days. Older age and prior right bundle branch block (RBBB) were associated with an increased risk of PPM (P < 0.05 for all), but only baseline RBBB was found to be an independent predictor of new PPM requirement (odds ratio: 2.60, 95% confidence interval: 1.15-5.81; P = 0.022). At a median follow-up of 3.4 (2.3-4.5) years, there were no differences between groups in mortality (PPM: 36%, no PPM: 22%, P = 0.105) or heart failure rehospitalization (PPM: 25%, no PPM: 21%, P = 0.839). CONCLUSIONS: About 1 out of 10 low-risk patients with aortic stenosis undergoing SU-SAVR with the Perceval prosthesis required PPM implantation. Prior RBBB determined an increased risk (close to 3-fold) of PPM following the procedure. PPM was not associated with a higher risk of clinical events at 3-year follow-up.

International registry of dermatological manifestations secondary to COVID-19 infection in 347 Hispanic patients from 25 countries.

BACKGROUND: The infection by coronavirus disease 2019 (COVID-19) has been associated with multiple cutaneous manifestations, although characterization of them in Hispanic patients with darker skin phototypes is lacking. The objective of this study is to characterize the clinical dermatological manifestations associated with COVID-19 infection in cases with few or without general symptoms in patients from Latin America. METHODS: Cross-sectional study using a questionnaire that was made for health professionals (physicians with a specialty in dermatology) to investigate dermatological lesions associated with COVID-19 infection in patients from 25 countries of Latin America. The survey was active from June 9 to July 30, 2020. RESULTS: In this study, information was collected from a total of 347 patients. We found a female gender predominance: 179/347 (51.6%). The mean age at presentation was 40.87 years. The most frequent dermatological manifestations were maculopapular rash and urticarial lesions, followed by papulovesicular lesions, vesicular lesions, chilblain-like lesions, papular lesions, ecchymosis, petechial purpura, pityriasis rosea-like lesions, pruritus, palmoplantar dysesthesias, transient livedo, acral necrosis, palpable purpura, livedo racemosa, and retiform purpura. As far as we know, there are no previous reports of pruritus and palmoplantar dysesthesias. CONCLUSIONS: This registry emphasizes skin manifestations as an important criterion for establishing the diagnosis of COVID-19 infection in Latin American countries. This information will be useful for the early identification of suspected cases by health professionals (dermatologists and nondermatologists) and will allow contact tracing to mitigate the impact on health systems at different levels.

Neural Mechanisms in Eating Behaviors: A Pilot fMRI Study of Emotional Processing.

OBJECTIVE: Emotional processing dysfunction evident in eating disorders (ED) such as anorexia nervosa (AN) and bulimia nervosa (BN), is considered relevant to the development and maintenance of these disorders. The purpose of the current functional magnetic resonance imaging (fMRI) study was to pilot a comparison of the activity of the fronto-limbic and fronto-striatal brain areas during an emotion processing task in persons with ED. METHODS: 24 women patients with ED were scanned, while showing emotionally stimulating (pleasant, unpleasant) and neutral images from the International Affective Picture System (IAPS). RESULTS: During the pleasant condition, significant differences in Dorsolateral Prefrontal Cortex (DLPFC) activations were found with AN participants presenting greater activation compared to BN and ED comorbid groups (EDc) and healthy controls also showing greater activation of this brain area compared to BN and EDc. Left putamen was less activated in EDc compared to both controls (C) and AN. During the unpleasant condition, AN participants showed hyperactivation of the Orbito-frontal Cortex (OFC) when compared to EDc. CONCLUSION: This study highlights the potential functional relevance of brain areas that have been associated with self-control. These findings should help advance understanding the neural substrate of ED, though they should be considered as preliminary and be cautiously interpreted.

Sexting en universitarios: relación con edad, sexo y autoestima

El sexting es un fenómeno social globalizado que aumenta con la edad en adolescen tes, aunque hay pocas investigaciones centradas en conocer su práctica en universitarios, mo tivo del presente estudio, en el que participaron 899 jóvenes estudiantes de la Universidad de Granada (España) con edades entre 18 y 24 años. Los objetivos eran conocer (mediante análisis de frecuencias y correlaciones) la prevalencia del sexting entre hombres y mujeres, analizar su relación con la edad, el sexo y la autoestima; y determinar la prevalencia de la práctica del sex-ting por edad. Se utilizaron dos instrumentos, la Escala de Conductas sobre Sexting y la Escala de Autoestima de Rosenberg. La relevancia del estudio radica en que constata que tanto chicos como chicas realizan sexting, más los chicos, y que la práctica se incrementa hasta los 21 años, descendiendo ligeramente a los 24. No se encontró relación con autoestima. Como conclusión se recomienda prudencia (puesto que la mayoría ha realizado sexting alguna vez) al ser una práctica no exenta de riesgo de la que pueden derivarse consecuencias personales y profesio nales negativas, por la amplia difusión y permanencia que puede tener este material en la red.

Sexting is a globalized social phenomenon that increases with age in adolescents, although there are few researches focused in its practice in university students, goal of the present study, which involved 899 students of the University of Granada (Spain) with ages between 18 and 24 years. The objectives were to know (through analysis of frequencies and correlations) the prevalence of sexting between men and women, to analyze the re lation with age, sex and self-esteem; and to determine the prevalence of the practice of sexting by age. Two instruments were used, the Sexting Behaviors Scale and the Rosen berg Self-Esteem Scale. The relevance of the study lies in the fact that confirm that both men and women practice sexting, more men, and that the practice increases until the 21 years, falling slightly at 24. No relation was found with self-esteem. The study concludes that since most of the students have done sexting, precaution is recommended, because of the risk of the negative personal and professional consequences that may result, for the wide dissemination and permanence that can have this information in the network.

Relación entre autoconcepto y nivel de depresión en personas con retinosis pigmentaria / Relationship between self-concept and depression level in people with retinitis pigmentosa

Investigaciones previas han resaltado dificultades en autoconcepto y presencia de depresión en personas con una patología degenerativa visual (retinosis pigmentaria), pero no se conoce si existe relación entre estas variables, la estimación del número de personas de apoyo en caso de necesidad y la edad; siendo éste el primer objetivo del estudio, realizado con 51 personas (36.5% hombres y 63.5% mujeres) (M edad = 41.85) que padecen esta problemática; y determinar, en segundo lugar, si el nivel de depresión influye en el autoconcepto. Se utilizó la Escala de Autoconcepto Tennesse (Fitts, 1965), el Inventario de Depresión de Beck (Beck, Rush, Shaw, y Emery, 1979) y un documento sociodemográfico. La correlación de Pearson revela que el número de personas de apoyo correlaciona con los factores de autoconcepto físico y personal, la edad con puntuaciones más altas en depresión, asociándose ésta a menores puntuaciones justo en los dos factores mencionados. El MANCOVA efectuado confirma que las personas con depresión se percibían más negativamente en todos los factores de autoconcepto. Se concluye recomendando prevenir la depresión y favorecer la mejora del autoconcepto con el fin de potenciar la competencia personal, calidad de vida y funcionamiento visual de esta población

Previous studies have highlighted difficulties in self-concept and the presence of depression in people with a degenerative visual pathology visual (Retinitis Pigmentosa), but it is not known if there is a relationship between these variables, the estimate of the number of support people in case of need and age; this being the first objective of the study, carried out with 51 people affected (36.5% men and 63.5% women) (M age = 41.85); and secondly, to analyze if depression level could influence some selfconcept factors. Instruments such as the Tennessee Self-Concept Scale (Fitts, 1965), the Beck Depression Inventory (Beck, Rush, Shaw, & Emery, 1979) and a sociodemographic questionnaire were used. A Pearson's correlation analysis revealed that the number of support people correlates with the factors of physical and personal self-concept, age is associated with higher scores on depression, associating this to lower scores in the two factors above-mentioned. The MANCOVA made confirms that people with higher level of depression were perceived more negatively in all selfconcept factors. It concludes recommending to prevent depression and to promote the improvement of the self-concept, in order to enhance the personal competence, the quality of life and visual functioning of this people

Remote patient monitoring based on ZigBee: lessons from a real-world deployment.

AIM: This work presents detailed experimental performance results from tests executed in the hospital environment for Health Monitoring for All (HM4All), a remote vital signs monitoring system based on a ZigBee® (ZigBee Alliance, San Ramon, CA) body sensor network (BSN). MATERIALS AND METHODS: Tests involved the use of six electrocardiogram (ECG) sensors operating in two different modes: the ECG mode involved the transmission of ECG waveform data and heart rate (HR) values to the ZigBee coordinator, whereas the HR mode included only the transmission of HR values. In the absence of hidden nodes, a non-beacon-enabled star network composed of sensing devices working on ECG mode kept the delivery ratio (DR) at 100%. RESULTS: When the network topology was changed to a 2-hop tree, the performance degraded slightly, resulting in an average DR of 98.56%. Although these performance outcomes may seem satisfactory, further investigation demonstrated that individual sensing devices went through transitory periods with low DR. Other tests have shown that ZigBee BSNs are highly susceptible to collisions owing to hidden nodes. Nevertheless, these tests have also shown that these networks can achieve high reliability if the amount of traffic is kept low. Contrary to what is typically shown in scientific articles and in manufacturers' documentation, the test outcomes presented in this article include temporal graphs of the DR achieved by each wireless sensor device. CONCLUSIONS: The test procedure and the approach used to represent its outcomes, which allow the identification of undesirable transitory periods of low reliability due to contention between devices, constitute the main contribution of this work.

Emotional state of family members of adults with retinal degeneration / Estado emocional de familiares de adultos con degeneración retiniana

Various studies have documented the emotional changes that accompany the loss of vision in people with retinal degeneration (such as Retinitis Pigmentosa), but the emotional state of family members who live with them has not been extensively studied. However it is known that chronic diseases have repercussions not only on the well-being and quality of life of those affected, but also on their families, possibly making them more susceptible to depression and/or anxiety. Results from 37 family members tested against a control group (38 people) partially supported our hypothesis and revealed that the family members showed higher levels of anxiety, especially the women, whereas partners showed higher scores in depression. The findings indicated that the family members should be receiving some kind of support to help them to resolve problems associated with the progression of the visual pathology (AU)

Distintos estudios han documentado los cambios emocionales que acompañan a la pérdida de visión en personas con degeneración retiniana (como la retinosis pigmentaria), pero el estado emocional de miembros de la familia que conviven con ellas, no ha sido muy estudiado. Sin embargo, es conocido que la presencia de enfermedades crónicas no sólo repercute en el bienestar y calidad de vida de los afectados, sino también en el de sus familiares, haciéndoles posiblemente más vulnerables a la depresión y o la ansiedad. Los resultados obtenidos de 37 miembros de familias de personas afectadas, frente a un grupo control (38 personas), apoya parcialmente nuestra hipótesis y revela que los primeros mostraban niveles más altos de ansiedad, principalmente las mujeres; mientras las parejas de afectados presentaban puntuaciones más altas en depresión. Los hallazgos indicaban que los miembros de familias de personas afectadas deberían recibir algún tipo de apoyo para ayudarles a resolver problemas asociados al avance de la patología visual (AU)

Visual training and emotional state of people with retinitis pigmentosa.

The purpose of the study was to improve the visual functioning of people with restriction in contrast sensitivity (CS), such as retinitis pigmentosa (RP), by means of a visual training program. Twenty-six volunteers with RP participated, distributed in two groups: 15 who made up the experimental group (who received the training program) and 11 who participated as a control group (without training). Participants were evaluated before beginning training, on completion, and 3 mo following completion for CS with the Pelli-Robson Contrast Sensitivity (P&R) test, visual functioning with the Visual Function Questionnaire (VFQ), and in emotional state with the Beck Depression Inventory (BDI). The training program is based on software that generates luminous stimuli of varying duration and intensity and registers the stimuli perceived by the subject. The outcomes showed significant differences posttraining in the experimental group in depression (F1,14 = 5.42; p < 0.04), VFQ (Z = -2.27; p < 0.02), and P&R in the right eye (Z = -1.99; p < 0.046) and left eye (Z = -2.30; p < 0.02) but not in binocular (Z = -0.96; p < 0.34). The outcomes showed that the experimental group made significant progress in all variables and these effects remained after 3 mo, which suggests that the program could be a helpful addition to RP rehabilitation and help mitigate the damage.

ZigBee-based remote patient monitoring.

This paper describes a developed continuous patient monitoring system based on the ZigBee protocol. The system was tested in the hospital environment using six sensor devices in two different modes. For electrocardiogram transmission and in the absence of hidden-nodes, the system achieved a mean delivery ratio of 100% and 98.56%, respectively for star and 2-hop tree network topologies. When sensor devices were arranged in a way that three of them were unable to hear the transmissions made by the other three, the mean delivery ratio dropped to 83.96%. However, when sensor devices were reprogrammed to transmit only heart rate values, the mean delivery ratio increased to 99.90%, despite the presence of hidden-nodes.

Epileptic status as a complication of electroconvulsive therapy: a case report.

INTRODUCTION: Electroconvulsive therapy (ECT) is a safe and effective treatment for multiple indications in psychiatric disorders. However, rare complications, such as cardiovascular compromise, post-stroke agitation and epileptic status, can occur. CASE REPORT: The case of an 83-year old female who had clinical symptoms consistent with psychotic depression, intense anguish, pronounced psychomotor retardation and who refused intake with secondary dehydration is presented. Treatment was started with ECT with great improvement of the symptoms, but in the third session of ECT, with the same intensity as the previous ones, electrical epileptic status with no clinical manifestations appeared. It lasted approximately 700 seconds. ECT was suspended and the patient was monitored electroencephalographically. Recovery since then has been progressive but much slower. CONCLUSION: It is essential to recognize and treat prolonged seizures during ECT to prevent progression to epileptic status. We recommend conducting a retrospective study aimed at identifying risk factors for the occurrence of nonconvulsive status epilepticus in potential patients and to protocolize preventive measures in order to avoid this complication.

Status epiléptico como complicación de la terapia electroconvulsiva: a propósito de un caso / Epileptic status as a complication of electroconvulsive therapy: a case report

Introducción. La Terapia Electroconvulsiva (TEC) es un tratamiento seguro y eficaz en las indicaciones observadas en múltiples trastornos psiquiátricos. No obstante, pueden aparecer raras complicaciones como compromiso cardiovascular, agitación psicomotriz post-ictal y status epiléptico. Caso clínico. Mujer de 83 años que presenta un cuadro compatible con una depresión psicótica, con intensa angustia, marcada inhibición psicomotriz y negativa a la ingesta global que le conduce a un cuadro de deshidratación Se inicia tratamiento con TEC que resulta extraordinariamente eficaz, pero en la tercera sesión, utilizando la misma intensidad y tratamiento que en las previas, aparece un estatus epiléptico eléctrico no correspondiente con clínica de 700segundos de duración. Se suspende TEC y se realiza seguimiento electroencefalográfico. La recuperación desde entonces es progresiva aunque mucho más lenta. Conclusión. Es fundamental el reconocimiento y tratamiento de convulsiones prolongadas durante la TEC para prevenir la progresión a status epiléptico. Recomendamos la realización de un estudio retrospectivo con el objetivo de identificar factores de riesgo para la aparición de status epiléptico no convulsivo y protocolizar medidas preventivas para evitar dicha complicación (AU)

Introduction. Electroconvulsive therapy (ECT) is a safe and effective treatment for multiple indications in psychiatric disorders. However, rare complications, such as cardiovascular compromise, post-stroke agitation and epileptic status, can occur. Case report. The case of an 83-year old female who had clinical symptoms consistent with psychotic depression, intense anguish, pronounced psychomotor retardation and who refused intake with secondary dehydration is presented. Treatment was started with ECT with great improvement of the symptoms, but in the third session of ECT, with the same intensity as the previous ones, electrical epileptic status with no clinical manifestations appeared. It lasted approximately700 seconds. ECT was suspended and the patient was monitored electroencephalographically. Recovery since then has been progressive but much slower. Conclusion. It is essential to recognize and treat prolonged seizures during ECT to prevent progression to epileptic status. We recommend conducting a retrospective study aimed at identifying risk factors for the occurrence of non convulsive status epilepticus in potential patients and to protocolize preventive measures in order to avoid this complication (AU)