Intensive Unit Research Articles

Prevalence of medication-induced delirium in older people admitted to intensive critical unit: a systematic review

Objective: to estimate the prevalence of medication-induced delirium and drug-related problems (DRP) in older people hospitalized in intensive care unit (ICU). Methods: A systematic review were conducted in PubMed, EMBASE, LILACS, Ageline, Web of Science, and Cochrane databases (until March 2023). Clinical trials and observational studies that investigated the contribution of medication in the occurrence of delirium and compared with critically ill older patients (aged≥65 years old) without the syndrome were included. We excluded emergency departments, medical wards, primary and secondary healthcare levels, patients with delirium tremens; metabolic encephalopathy; dementia; palliative care; and brain metastasis. The references were entered into Rayyan QCRI. Two pairs of reviewers selected the articles, extracted data, and assessed the risk of bias (ROBINS-I). Results: Of 12,492 studies retrieved, after de-duplication exclusion (n=6,025), title/abstract (n=6,467) and full reading (n=286), two met the inclusion criteria. Both were observational (cohort), developed in high-income countries, with high level of risk of bias (overall). The frequency of delirium and subsyndromal delirium was 15.8% to 33.9%. Independent risk factors were the exposure of opioids and use of corticosteroids. Delirium increased the length of hospital stay in ICU, and the mechanical ventilation. Conclusion: Further studies are necessary to understand the DRP and characteristics of pharmacotherapy associated with delirium in critically ill older people. Adverse drug reactions and deliriogenic load seem to contribute to the occurrence of syndrome.

Major low-energy trauma results in non-specific immunoglobulin generation without evidence for specific autoantibody production: A prospective cohort study.

Cellular debris resulting from large trauma might overwhelm the scavenger mechanisms and lead to autoimmune reactions. We analysed whether a major well-defined trauma in humans induces laboratory signs of transient autoimmunity in the months after the insult. We included 50 patients with pertrochanteric femur fracture undergoing intramedullary nail osteosynthesis in a prospective cohort study and followed them at 3-4 days, 6 weeks, 12 weeks and 12 months postoperatively. By standard techniques, we assessed levels of total immunoglobulins, anti-nuclear antibodies (ANA), anti-cardiolipin antibodies, anti-dsDNA antibodies and anti-C1q antibodies, as well as antibodies against cytomegalovirus (CMV) as a control. Blood leukocyte differential and lymphocyte subpopulations were determined at baseline and in the first two postoperative samples. The mean age of the patients reached 80.1 years, and 23 (46%) completed all visits. Serum concentrations of total IgG, IgM and IgA increased at all follow-up time points. The ANA fluorescence light intensity units increased at 12 weeks and 12 months postoperatively (p < 0.0001), but the proportion of ANA-positive patients did not change (35%). The values of anti-C1q mildly increased at all follow-up visits, but not the ratio to total IgG. Anti-dsDNA remained negative in all patients, and anti-cardiolipin IgG/IgM antibodies did not change. Anti-CMV IgG antibodies increased significantly at all follow-up visits, without change in the ratio to total IgG. Flow cytometry showed an increased proportion of B-cells 3-4 days postoperatively. In conclusion, major musculoskeletal trauma in elderly patients induces a generalized non-specific increase in immunoglobulin production without laboratory signs for enhanced systemic autoimmunity.

Thai novice nurses’ lived experiences and perspectives of breastfeeding and human milk in the Neonatal Intensive Care Unit (NICU)

BackgroundBreastfeeding and human milk have well-documented health benefits for newborn infants, particularly those who are sick. However, breastfeeding rates and human milk feeding among infants in neonatal intensive units (NICU) in Thailand are still low; thus, breastfeeding promotion and support are required for Thai mothers of premature infants. Newly graduated nurses can play a critical role within the healthcare support system and can have a significant impact on improving breastfeeding practices in the NICU. The objective of this study was to investigate the lived experiences and perspectives of Thai novice nurses on supporting breastfeeding and human milk feeding in the NICU.MethodsThe study was conducted between March 2021 and May 2022 at three medical centers in the central region of Thailand. This study employed a descriptive phenomenological approach to explore Thai novice nurses’ experiences and perspectives on breastfeeding. Purposive sampling was used to invite Thai novice nurses who have work experience in providing breastfeeding support to NICU mothers and their infants to participate in online interviews using a video conference platform (Zoom). Semi-structured questions were used to interview study participants in their native language. Data were analyzed using Colaizzi’s method of data analysis to identify emergent themes. Member checks, peer debriefing, and self-reflection were applied to ensure the validity and trustworthiness of the study results. Back-translation was also used as a quality and accuracy assurance.ResultsA total of thirteen novice nurses agreed to participate in the study. All were female, and their ages ranged from 21 to 24 years old at the time of the interview. The researchers identified five major themes related to the overall study objectives and research questions. They are: positive attitude toward breastfeeding and human milk, facing breastfeeding challenges at work, self-confidence rooted in experience, professional skill needs, and requiring further support.ConclusionsOur results suggest that breastfeeding education plays a vital role in encouraging new nurses to provide breastfeeding support to mothers of preterm infants. Establishing breastfeeding support training and innovative learning strategies can be crucial in developing appropriate breastfeeding practice guidelines and policies to support Thai breastfeeding mothers in the NICU.

THE NEW APPROACHES TO IDENTIFICATION OF TINCTURES AND MEDICINAL PLANTS

Objective: The objective of this study is to develop methods for identifying herbal medicines and tinctures by processing spectral results across a wide range of wavelengths using principal component analysis (PCA). Methods: Medicinal plants and tinctures of valerian, motherwort, and hawthorn have been analyzed using UV spectrophotometry, spectrofluorimetry, ATR FTIR spectrometry, and X-ray fluorescence spectrometry. PCA was used to process the results of spectral analysis. Statistical processing of spectral results was carried out using the OriginPro program (OriginLab Corporation, USA, 2021). Results: For herbal medicines with sedative, hypotensive, and cardiotonic effects, spectral data libraries have been created in the following dimensions: UV spectrophotometry with 1800 absorption units (Ai), spectrofluorimetry with 4010 fluorescence intensity units (Ii), IR spectroscopy with a light transmittance of 50250 units (Ti), and X-ray fluorescence spectrometry with an intensity of 1568 (Ii). These libraries were used as the primary matrices for PCA. Visualization of the PCA results was done using a scores plot and a loadings plot, which illustrate the contribution of each principal component (PC) to the PCA model. After performing chemometric processing on the original spectral results, it was discovered that samples belonging to the same botanical genus occupy distinct and compact regions in two-dimensional or three-dimensional space. Unknown plant samples (blind samples) and samples of other botanical species were successfully tested using new method. Conclusion: For the first time, tinctures and medicinal plants were identified based on their botanical genus using spectral techniques coupled with principal component analysis, eliminating the need for a chemical reference substance.

Preterm prelabour rupture of membranes before 23 weeks’ gestation: prospective observational study

ObjectiveTo describe perinatal and maternal outcomes of preterm prelabour rupture of membranes (PPROM) before 23 weeks' gestation in a national cohort.DesignProspective observational study.SettingNational population based cohort study with the UK...

Heart Rate Variability as a Prognostic Tool for Gastroschisis Infants in the Neonatal Intensive Critical Unit.

Gastroschisis is the most common congenital abdominal wall defect, with an increasing incidence. It results in extrusion of abdominal contents with associated delayed intestinal motility. Abnormal heart rate characteristics (HRCs) such as decreased variability occur due to the inflammatory response to sepsis in preterm infants. This study aimed to test the hypothesis that infants with gastroschisis have decreased heart rate variability (HRV) after birth and that this physiomarker may predict outcomes. We analyzed heart rate data from and clinical variables for all infants admitted with gastroschisis from 2009 to 2020. Forty-seven infants were admitted during the study period and had available data. Complex gastroschisis infants had reduced HRV after birth. For those with sepsis and necrotizing enterocolitis, abnormal HRCs occurred early in the course of illness. Decreased HRV was associated with complex gastroschisis. Infants in this group experienced complications that prolonged time to full enteral feeding and time on total parenteral nutrition. · Infants with gastroschisis can be classified into two subcategories, simple and complex disease.. · Those with complex disease often require prolonged stays in the neonatal intensive care unit and costly hospitalizations. We hypothesized that infants with complex gastroschisis are more likely to have abnormal HRC due to intestinal inflammation.. · In this study, we identified associations between abnormal HRV, heart rate characteristicHRC, and the development of gastroschisis complications. Additionally, we described differences in clinical characteristics between infants with complex versus simple gastroschisis..

Association mining of coastline change and land use patterns to enhance conservation

Coastal zones, as interfaces between marine and terrestrial ecosystems, possess great ecological and economic value but are environmentally fragile. This research provides a new perspective for studying development and change patterns in coastal zones, offering insights for land planning and contributing to the ecological preservation and sustainable development of coastal areas. We utilized Landsat TM and OLI sensor imagery (from the years 1990, 2000, 2010, and 2020) to extract coastline and land use information from the coastal zone of Shandong Province. Through the establishment of association mining models between coastline changes and land use patterns, the relationships between spatial layout changes and development processes in different geographical locations are revealed. In the initial stage, weak expansion and moderate changes in the coastline corresponded to units with lower land development intensity sequences. In the intermediate stage, with increasing coastline expansion and intense changes, the sequence of land development intensity was extremely strong > strong > moderate > weak from the sea to the land. This type of association was mostly distributed in the Laizhou Bay salt field and coastal port areas and was mostly focused on aquaculture and port trade, causing “strong” and “extremely strong” units of regional land development intensity. In the later stage, as coastline expansion slowed, the use of ports and docks caused the development intensity of the surrounding land to fluctuate. Farming, fishing, salt field and port construction in the coastal zone of Shandong Province were the major forms of land expansion and change. The association rules between coastline expansion or erosion and coastal development intensity revealed the impact of coastline changes on the spatial pattern from sea to land, which is important for planning layouts, optimizing industrial structures, and maximizing socioeconomic and environmental benefits in coastal areas.

Ventilator-Associated Lower Respiratory Tract Infections and Their Association With COVID-19: A Retrospective Cohort Study in a Portuguese Intensive Treatment Unit.

Introduction Ventilator-associated pneumonia (VAP) is the most common infectious complication related to admission to an Intensive Treatment Unit (ITU). Ventilator-associated lower respiratory tract infection (VA-LRTI) is a broader diagnosis than VAP. By disregarding radiological criteria, it will include both VAP and ventilator-associated tracheobronchitis. This study,conducted in the setting of a Portuguese ITU, aims to study the incidence, microbiology and clinical outcome of VA-LRTI and its association with COVID-19. Methods A retrospective cohort study included patients admitted to a Portuguese ITU who underwent invasive mechanical ventilation (IMV) for over 48 hours between 01/01/2021 and 31/12/2021. The Hospitals in Europe Link for Infection Control through Surveillance (HELICS) criteria were applied, disregarding the radiological criteria, for the diagnosis of VA-LRTI. Results The group of patients with COVID-19 had 46.38 episodes of VA-LRTI/1000 days of ventilation, while patients without COVID-19 had 16.35 episodes/1000 days of ventilation (RR 2.78, p < 0.001). Of the 85 microorganisms isolated, 82% were gram-negative microorganisms, with species of the genus Klebsiella being the most prevalent (22.4%). There was a lower prevalence of beta-lactam-resistant organisms in patients with COVID-19 (RR 0.35, p = 0.031). The development of VA-LRTI is associated with longer times ofIMV (difference in medians 10 days, p < 0.001), but with no significant differences in mortality (RR 1.21, p = 0.14). Discussion Patients with COVID-19 seem more predisposed to developing VA-LRTI, possibly due to intrinsic characteristics of the disease. Although no increase in mortality has been demonstrated, VA-LRTI can entail important costs related to morbidity, antibiotic pressure and economic costs that must be considered.

Systematic Aetiological Assessment of Myocarditis: A Prospective Cohort Study.

Myocarditis is commonly diagnosed in the intensive care cardiology unit (ICCU). No current recommendation nor guideline aids exist for aetiological assessments. From September 2021 to October 2023, 84 patients with acute myocarditis underwent thorough and systematic serum and blood cell panel evaluations to determine the most common causes of myocarditis. Of the 84 patients (median age 34 years, range 22-41 years, 79% male), 16 presented with complicated myocarditis. The systematic aetiological assessment revealed that 36% of patients were positive for lupus anticoagulant, 12% for antinuclear antibodies, 8% for anti-heart antibodies, and 12% for anti-striated muscle antibodies. Viral serology did not yield any significant results. After the aetiological assessment, one patient was diagnosed with an autoimmune inflammatory disorder (Still's disease). T-cell subset analyses indicated that myocarditis severity tended to increase with the T-cell lymphopenia status. A comprehensive, systematic aetiological assessment was of limited value in terms of predicting the clinical or therapeutic outcomes in myocarditis patients presenting to the ICCU.

Home care models dedicated to COVID-19 patients: the experience of a Local Health District of Veneto Region (Italy).

During COVID-19 pandemic, health professionals have been working in an extreme uncertainty context. Affected patients needed to be cared at home as long as possible to avoid virus spreading and hospital resources saturation. The Veneto Regional Administration (North-east of Italy) released Regional guidelines about it. The Western Healthcare District of the Local Health Authority of the city of Vicenza (180,000 inhabitants) implemented a healthcare pathway following them. Aim of the study is to describe the results and outcomes of such implementation. In the implemented health care pathway, a new service called "Special Unit of continuity of care" (USCA) with physicians and nurses has been dedicated to the prise en charge at home of patients suffering from Sars-CoV-2. They were referred to the USCA by general practitioners or by hospital specialists, and managed through a daily clinical monitoring by regular home visits and phone calls, specialist consultations and therapy management. In order to prevent hospital admission, an oxygen concentrator when possible has been employed and managed at home by the members of the USCA when the oxygen saturation was below 93%. An observational retrospective study has been conducted using anonymized data from different databases: the USCA activity database (from 12/01/20 to 21/31/21), the hospital and Emergency Department discharge databases, and the "healthcare co-payments exemptions database". The latter database refers to the people excluded - because of their chronicity - from the co-payment of a list of medical exams and services. Descriptive and multivariate logistic regression analyses have been implemented. 1,419 patients suffering from Sars-CoV-2 have been cared and managed by the USCA in the considered period of time (mean 11.4 days), of whom 787 (55.5%) with at least one chronic condition (described in the above quoted "healthcare co-payments exemption database") and 261 provided with oxygen concentrator. 275 (19.4%) needed a hospital admission, 39 (2.8%) in intensive unit; 53 died during hospitalization (3.8%). Out of the 261 patients utilizing oxygen concentrator, 103 have been admitted to hospital (39.5%), 7.3% in intensive unit and 8.0% died. In implemented multivariate analyses, the use of oxygen concentrator, proxy measure of the severity of the condition, is the major determinant for the risk of hospital admission (adj OR: 3.2, CI 2.3-4.3) and of dying within 30 days (adj OR: 2.8 CI 1.5-5.1). Among the 261 patients provided with oxygen concentrator, 158 (60,5%) have been managed at home without any admission to emergency department and/or hospitalization. In an uncertain context such as COVID-19 pandemic, the already-implemented home care model has been modified by integrating the USCA physicians and nurses and specialist care networks to prevent hospitalization and the sense of isolation and abandonment of people as much as possible. Almost 1,500 patients suffering from COVID-19 have been cared for at home over 13 months by such new service with complex and multidisciplinary activities. The risk of hospitalization and death appears determined by the severity of the pathology with high and significant OR 60% of patients with oxygen concentrators who, despite an initial high hyposaturation were not hospitalized, represent, partly, the group of patients who would have been requiring hospital care in the absence of a home care pathway in a standard situation.

Abstract WP154: Factors Associated With Prolonged Length of Intensive Unit Stay Following Mechanical Thrombectomy for Acute Ischemic Stroke

Objective and Background: The objective of the study was to investigate factors affecting the length of stay (LOS) in the intensive care unit (ICU) following mechanical thrombectomy (MT) for acute ischemic stroke. Methods: We identified patients undergoing MT from a prospective registry at a comprehensive stroke center between January 2021 and June 2023. ICU stay for more than 48 hours was defined as prolonged ICU stay. Results: Out of 363 patients, 41.6% (n=151) required a prolonged ICU stay. Prolonged ICU stay were more likely to have higher baseline median NIHSS score (19 vs. 14%, p &lt; 0.0001), posterior circulation stroke (12.6% vs. 5.7%, p = 0.0200), intubation for the procedure (86.7% vs. 69.3%, p = 0.0001), complications including pneumonia (18.5% vs. 6.1%, p = 0.0002), deep vein thrombosis (7.3 vs. 2.3, p = 0.0242), urinary tract infection (12.6% vs. 6.1%, p = 0.0326), and symptomatic intracerebral hemorrhage (7.3% vs. 1.9%, p = 0.0109). Patients receiving thrombolysis prior to thrombectomy were less likely to have a prolonged LOS (27.8% vs. 41.7%, p = 0.0086). Independent predictors for prolonged ICU LOC included higher NIHSS (odds ratio [OR] 2.7, p = 0.0002), intubation prior to the procedure (OR 2.7, p = 0.0002), not receiving IV thrombolysis (OR 2.3, p = 0.0069), thrombolysis in cerebral infarction (TICI) score ≥ 2B (OR 0.458, p = 0.0754), composite ICU complications (OR 2.4, p = 0.0027), and symptomatic intracranial hemorrhage (OR 5.2, p = 0.0157). Conclusions: Almost one-third of the acute ischemic stroke patients required a prolonged ICU stay following MT. A better understanding of the factors associated with prolonged ICU stay may assist in appropriate allocation of resources.

Skin lesions associated with invasive devices in highly complex neonatal and pediatric patients

The skin is the largest organ of the human body. It has three layers: epidermis, dermis and hypodermis. The epidermis performs multiple functions in the body, standing out as a defensive barrier and internal integrity in addition to containing the evasion of moisture, and exogenous substances. Injury is by definition any interruption in the continuity of the skin regardless of its extent and may be chronic or acute. A newborn's skin is delicate and vulnerable, and the use of invasive devices in highly complex care can negatively affect its integrity. This review study addressed data from Brazilian research on newborn skin in intensive hospital treatment units. The studies evaluated were obtained from the SciELO, Medline and Lilacs, Google Scholar and Elsevier databases. The inclusion criteria were articles, monographs, dissertations and theses published in the period between 2018 and 2023, in Portuguese with a pre-established theme, and the exclusion criteria were articles, monographs, dissertations and repeated theses, incomplete manuscripts and with unauthorized access free of charge. As results, 3 categories were obtained: Category 1 – Main causes of skin lesions in newborns and highly complex children. Category 2- Prevention measures in newborns and highly complex children with skin lesions. Category 3- Highly complex skin care strategies for newborns and children. It is evident that due to the high susceptibility of newborns and children to develop highly complex skin lesions, it requires greater attention from the nursing team. Early detection of the risk of skin lesions and the use of prophylaxis enable a better quality of life for newborns hospitalized in high complexity, avoiding and minimizing skin lesions caused by the care provided.

Spiritual Well-Being of Acute Coronary Syndrome Patients in The Cardiac Intensive Care Unit

Patients with Acute Coronary Syndrome (ACS) are at risk of experiencing problems in various aspects of life. Changes in spiritual conditions are one of the problems that often occur, especially spiritual well-being. Existential well-being (EWB) and religious well-being (RWB) are specific parts of spiritual well-being that will be analyzed in this study. The research design used is descriptive with a cross-sectional approach. The study population was patients who experienced Acute Coronary Syndrome and were treated in the cardiac intensive unit with a total of 84 patients who were taken using a non-probability sampling technique with a purposive sampling method. The instrument used is the Indonesian version of the Spiritual Well-Being Scale (SWBS) questionnaire and has received permission from the original owners Ellison and Paloutzian by paying for the copyright. The results showed that the level of religious well-being (RWB) and existential (EWB) was in the high category with 86.9% and 71.4% respectively. There were no respondents who had a low level of religious or existential spiritual well-being. Health service providers are expected to be able to assess the spiritual well-being of ACS patients so that spiritual problems can be detected and efforts to treat them as early as possible.

Stroke-related epilepsy in the rehabilitation setting: Insights from the inpatient post-stroke rehabilitation study – RIPS

In stroke survivors, persistent seizure activity could be associated with poor functional outcomes. At the same time, antiepileptic over-treatment could hamper post-stroke recovery. We systematically investigated the occurrence of seizures, the prevalence of epileptic discharges, and delta slow waves on electroencephalogram (EEG) and anti-seizure medication (ASM) management in relation to clinical manifestations and EEG abnormalities. This was a multi-centre prospective study involving two intensive rehabilitation units (IRUs). Clinical and EEG data were acquired at admission to the IRU, discharge (T1), and six-month follow-up (T2). A total of 163 patients underwent EEG recording upon admission to the IRU, while 149 were available for analysis at discharge from the IRU. Eighteen patients were treated with ASMs upon IRU admission despite only five of these patients having early seizures. Among the 145 patients not treated upon admission to the IRU, eight had late seizures, of which six were during the IRU stay, while two were after discharge from the IRU. During IRU stay, ASMs were generally discontinued in patients with no early seizures reported and were started in patients with late seizures. Among the 18 patients treated with ASMs at admission to the IRU, only six maintained the therapy also at T2. Our results suggest that post-acute inpatient rehabilitation is a proper setting to observe patients treated with ASMs after stroke and provide personalized post-stroke epilepsy management.

Lung Parenchymal Damage Due to High Voltage Electric Shock

In electric shocks, lung tissue is a poor conductor and has low resistance. Therefore, they are not very sensitive to the development of tissue damage due to electric current. In this study, we wanted to present a rare case of lung parenchymal burn as a result of electric shock. A 21-year-old male patient was brought to the emergency department by ambulance after being electrocuted with a current of 15,000 volts after contact with a high voltage line while working with a construction machine. The general condition of the patient was good and vital signs were stable. However, his pulse oxygen value was 74 and his breathing was slightly tachypneic. There were no lesions in the chest and abdomen due to electrical burns. Radiologic imaging showed bilateral diffuse tissue damage in the lung tissue. The patient was referred to a tertiary care institution with an intensive care burn unit. In traumas caused by high-voltage electric shock, burns on the body surface may be insufficient to determine the severity of the trauma. A multidisciplinary approach must be provided to these patients.

Characterization and neuroprotective care for preterm newborns in an Intensive Care Unit

Objective: To characterize the clinical-epidemiological profile of premature infants admitted to the intensive unit of a public hospital in Paraná. Methods: This is a retrospective observational study based on 170 medical records of newborns &lt;32 weeks, born and staying at the study institution and without associated pathologies, hospitalized between 2017 and 2021. Data were collected between June and August 2022, after approval of the Ethics Committee, and, subsequently, a descriptive analysis was carried out, with simple and relative frequencies, mean, median, standard deviation and interquartile range, and inferential, using the chi-square test and the Mann-Whitney test. Results: The majority were male, delivered by cesarean section, very premature, with very low birth weight, Apgar ≥7 at the fifth minute, needing immediate assistance at birth. There were 31 (18.2%) deaths and there was a higher frequency of peri-intraventricular hemorrhage in males preterm newborns, with lower gestational ages, birth weight and Apgar. Minimum care measures were recorded in 43 (25.3%) medical records, which guided neuroprotective care and reduced the risk of brain injury and subsequent problems. Conclusion: Identifying the profile and factors that can be intervened can prevent premature dbirths and reduce the number of newborns affected by peri-intraventricular hemorrhage. The importance of developing public policies and effective programs aimed at maternal and child health is highlighted, in order to improve quality of care and reduce negative outcomes.

Decrease in the intensive care unit-acquired weakness with a multicomponent protocol implementation: A quasi-experimental clinical trial

Intensive care unit-acquired weakness is a frequent complication that affects the prognosis of critical illness during hospital stay and after hospital discharge. To determine if a multicomponent protocol of early active mobility involving adequate pain control, non-sedation, non-pharmacologic delirium prevention, cognitive stimulation, and family support, reduces intensive care unit-acquired weakness at the moment of discharge. We carried out a non-randomized clinical trial in two mixed intensive care units in a high-complexity hospital, including patients over 14 years old with invasive mechanical ventilation for more than 48 hours. We compared the intervention –the multicomponent protocol– during intensive care hospitalization versus the standard care. We analyzed 82 patients in the intervention group and 106 in the control group. Muscle weakness acquired in the intensive care unit at the moment of discharge was less frequent in the intervention group (41.3% versus 78.9%, p<0.00001). The mobility score at intensive unit care discharge was better in the intervention group (median = 3.5 versus 2, p < 0.0138). There were no statistically significant differences in the invasive mechanical ventilation-free days at day 28 (18 versus 15 days, p<0.49), and neither in the mortality (18.2 versus 27.3%, p<0.167). A multi-component protocol of early active mobility significantly reduces intensive care unit-acquired muscle weakness at the moment of discharge.

Changes in cognitive impairment after multidimentional rehabilitation in Neuro COVID severe respiratory failure patients

AbstractBackgroundA Post Intensive Care Syndrome Unit (PICSU) was developed during COVID 19 pandemic. The aim of this study was to evaluate Cognitive Impairment (CI) evolution after PICSU treatment in Neuro COVID patients.MethodsProspective observational study. Population: Neuro COVID patients treated in a PICSU. CI was achieved by means of the Spanish version of the MoCA at ICU discharge and one month after, muscle function was evaluated by means of Medical Research Council test for Intensive Care Acquired Weakness (ICUAW). Statistical analysis was performed by ANOVA and Chi squared test. Age, sex, comorbidities, mechanical ventilation days and length of stay at the PICSU wre also measured.Patients were submitted to an intensive rehabilitation program that included physical, swallowing, speech therapy, occupational therapy ones, as well as nutritional and psychological support.Results27 patients were admitted to PICSU, 5 were female, average age was 57 yo. 30% of them presented normal cognition. Regarding CI patients mean initial MoCA value was 18 and improved to 23 (p &lt; 0.05), MRC values were 42 y 52 respectively (p &lt; 0.05). According MoCA values using a cutoff point of 26 to determinate normal cognition, 16 to 25 for MCI and 15 for Mild Dementia, 26% had MCI and 74% at ICU discharge that evolved to normal (26%), MCI (58%) and MD (16%) (p &lt; 0.05). There was a close relationship between MoCA and MCR enhancement, CI and ICUAW improved simultaneously (p &lt; 0.05).ConclusionPICSU rehabilitation program was useful for cognition and motor function improvement. The close relationship between cognition and motor function could be explained by the myokines and neurotrophic factors release toward muscle activity. This could be an opportunity for future research.

A rare presentation of measles and post-measles complications in a neonate: case report

BackgroundMeasles is a common infection in children. Measles infection in children less than 6 months of age is very rare since maternal antibodies play a major role in the prevention of the disease.Case presentationHere we present a rare case of a 34-day-old infant, who had a history of fever with a rash on the 18th day of life and significant history of measles contact with mother and elder brother. The patient presented to us with septic shock and multiorgan involvement in the form of pneumonia, acute gastroenteritis with severe dehydration, mucopurulent conjunctivitis, and post-measles encephalitis. The patient had a strong measles contact and epidemiological linkage to the measles epicenter, Govandi (a locality in the Mumbai region of western India), so measles IgM antibody was obtained which were significantly raised.The patient was successfully revived from this critical presentation with early and appropriate resuscitation, timely ionotropic support, and the use of empirical broad-spectrum antibiotics. The patient required intensive unit care for four days and was started on feeds and discharged after 12 days of hospital stay. On follow-up, the patient is doing well and gaining weight.ConclusionUncommon presentation and the epidemiology of the disease should alert the clinician of having a high index of suspicion. Early intervention and prompt treatment can help reduce morbidity and mortality.

Optimizing the generation of mature bone marrow-derived dendritic cells in vitro: a factorial study design

BackgroundFactorial design is a simple, yet elegant method to investigate the effect of multiple factors and their interaction on a specific response simultaneously. Hence, this type of study design reaches the best optimization conditions of a process. Although the interaction between the variables is widely prevalent in cell culture procedures, factorial design per se is infrequently utilized in improving cell culture output. Therefore, we aim to optimize the experimental conditions for generating mature bone marrow-derived dendritic cells (BMDCs). Two different variables were investigated, including the concentrations of the inducing factors and the starting density of the bone marrow mononuclear cells. In the current study, we utilized the design of experiments (DoE), a statistical approach, to systematically assess the impact of factors with varying levels on cell culture outcomes. Herein, we apply a two-factor, two-level (22) factorial experiment resulting in four conditions that are run in triplicate. The two variables investigated here are cytokines combinations with two levels, granulocyte–macrophage colony-stimulating factor (GM-CSF) alone or with interleukin-4 (IL4). The other parameter is cell density with two different concentrations, 2 × 106 and 4 × 106 cells/mL. Then, we measured cell viability using the trypan blue exclusion method, and a flow cytometer was used to detect the BMDCs expressing the markers FITC-CD80, CD86, CD83, and CD14. BMDC marker expression levels were calculated using arbitrary units (AU) of the mean fluorescence intensity (MFI). ResultsThe current study showed that the highest total viable cells and cells yield obtained were in cell group seeded at 2 × 106 cells/mL and treated with GM-CSF and IL-4. Importantly, the expression of the co-stimulatory molecules CD83 and CD80/CD86 were statistically significant for cell density of 2 × 106 cells/mL (P < 0.01, two-way ANOVA). Bone marrow mononuclear cells seeded at 4 × 106 in the presence of the cytokine mix less efficiently differentiated and matured into BMDCs. Statistical analysis via two-way ANOVA revealed an interaction between cell density and cytokine combinations. ConclusionThe analysis of this study indicates a substantial interaction between cytokines combinations and cell densities on BMDC maturation. However, higher cell density is not associated with optimizing DC maturation. Notably, applying DoE in bioprocess designs increases experimental efficacy and reliability while minimizing experiments, time, and process costs.