Remdesivir use in pregnant women with severe COVID-19

Numerous therapeutic strategies are proposed and tested for SARS CO-V2 infection. Remdesivir is researched and proposed by various societies. Studies about efficacy and safety in pregnancy are limited. A case series of 22 pregnant women effected with severe COVID disease and who received remdesivir, over a period of 1 year from May 2020 to May 2021 is presented. The 12 antenatal and 10 post-partum women were included. Demographic factors, baseline, day 3 and day 7 blood values of haemoglobin, total leukocyte count, platelets, liver enzymes, serum creatinine and D-dimers were collected. Adverse events were reported. Pregnancy complications and foetal and neonatal complications were studied. Pre-eclampsia was the most common comorbidity. The 99% of pregnant women and 100% of postpartum women recovered from COVID disease after remdesivir use. Lab investigations did not change considerably during the week of remdesivir use, suggesting its safety. Incidence of adverse events reported is 36.3%, of these 9% are serious adverse events. There are no antenatal or post-natal complications. No incidence of teratogenicity, foetal or neonatal complications. Incidence of feto-maternal transmission was 9%. Remdesivir is effective in treating severe SARS-CoV2 infection and has safety profile in pregnancy with regard to maternal and foetal effects

Analysis of patient safety event report categories at one large academic hospital

Given the persistent safety incidents in operating rooms (ORs) nationwide (approx. 4000 preventable harmful surgical errors per year), there is a need to better analyze and understand reported patient safety events. This study describes the results of applying the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) supported by the Teamwork Evaluation of Non-Technical Skills (TENTS) instrument to analyze patient safety event reports at one large academic medical center. Results suggest that suboptimal behaviors stemming from poor communication, lack of situation monitoring, and inappropriate task prioritization and execution were implicated in most reported events. Our proposed methodology offers an effective way of programmatically sorting and prioritizing patient safety improvement efforts

Analysis of patient safety event report categories at one large academic hospital

Given the persistent safety incidents in operating rooms (ORs) nationwide (approx. 4,000 preventable harmful surgical errors per year), there is a need to better analyze and understand reported patient safety events. This study describes the results of applying the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) supported by the Teamwork Evaluation of Non-Technical Skills (TENTS) instrument to analyze patient safety event reports at one large academic medical center. Results suggest that suboptimal behaviors stemming from poor communication, lack of situation monitoring, and inappropriate task prioritization and execution were implicated in most reported events. Our proposed methodology offers an effective way of programmatically sorting and prioritizing patient safety improvement efforts

Confidence and psychosis: a neuro-computational account of contingency learning disruption by NMDA blockade.

A state of pathological uncertainty about environmental regularities might represent a key step in the pathway to psychotic illness. Early psychosis can be investigated in healthy volunteers under ketamine, an NMDA receptor antagonist. Here, we explored the effects of ketamine on contingency learning using a placebo-controlled, double-blind, crossover design. During functional magnetic resonance imaging, participants performed an instrumental learning task, in which cue-outcome contingencies were probabilistic and reversed between blocks. Bayesian model comparison indicated that in such an unstable environment, reinforcement learning parameters are downregulated depending on confidence level, an adaptive mechanism that was specifically disrupted by ketamine administration. Drug effects were underpinned by altered neural activity in a fronto-parietal network, which reflected the confidence-based shift to exploitation of learned contingencies. Our findings suggest that an early characteristic of psychosis lies in a persistent doubt that undermines the stabilization of behavioral policy resulting in a failure to exploit regularities in the environment.FV was supported by the Groupe Pasteur Mutualité. RG was supported by the Fondation pour la Recherche Médicale and the Fondation Bettencourt Schueller. SP is supported by a Marie Curie Intra-European fellowship (FP7-PEOPLE-2012-IEF). AF was supported by National Health and Medical Research Council grants (IDs : 1050504 and 1066779) and an Australian Research Council Future Fellowship (ID: FT130100589). This work was supported by the Wellcome Trust and the Bernard Wolfe Health Neuroscience Fund.This is the final version of the article. It first appeared from the Nature Publishing Group via http://dx.doi.org/10.1038/mp.2015.7

Selective augmentation of striatal functional connectivity following NMDA receptor antagonism: implications for psychosis

The psychotomimetic effect of the N-methyl-D-aspartate receptor (NMDAR) antagonist ketamine is thought to arise from a functional modulation of the brain's fronto-striato-thalamic (FST) circuits. Animal models suggest a pronounced effect on ventral ‘limbic' FST systems, although recent work in patients with psychosis and high-risk individuals suggests specific alterations of dorsal ‘associative' FST circuits. Here, we used functional magnetic resonance imaging to investigate the effects of a subanesthetic dose of ketamine on measures of functional connectivity as indexed by the temporal coherence of spontaneous neural activity in both dorsal and ventral FST circuits, as well as their symptom correlates. We adopted a placebo-controlled, double-blind, randomized, repeated-measures design in which 19 healthy participants received either an intravenous saline infusion or a racemic mixture of ketamine (100 ng/ml) separated by at least 1 week. Compared with placebo, ketamine increased functional connectivity between the dorsal caudate and both the thalamus and midbrain bilaterally. Ketamine additionally increased functional connectivity of the ventral striatum/nucleus accumbens and ventromedial prefrontal cortex. Both connectivity increases significantly correlated with the psychosis-like and dissociative symptoms under ketamine. Importantly, dorsal caudate connectivity with the ventrolateral thalamus and subthalamic nucleus showed inverse correlation with ketamine-induced symptomatology, pointing to a possible resilience role to disturbances in FST circuits. Although consistent with the role of FST in mediating psychosis, these findings contrast with previous research in clinical samples by suggesting that acute NMDAR antagonism may lead to psychosis-like experiences via a mechanism that is distinct from that implicated in frank psychotic illness

Online and automated reliable system design to remove blink and muscle artefact in EEG

Electroencephalograms (EEGs) are progressively emerging as a significant measure of brain activity and are very effective tool for the diagnosis and treatment of mental and brain diseases and disorders including sleep apnea, Alzheimer's disease and Neurodevelopmental disorders. However, EEG signal is mixed with other biological signals including Ocular and Muscular artefacts making it difficult to extract the diagnostic features. Therefore, the contaminated EEG channels are often discarded by the medical practitioners resulting less accurate diagnosis. In this paper we propose a real-time low-complexity and reliable system design methodology to remove these artefacts and noise in an automated fashion to aid online diagnosis under the pervasive personalized healthcare set-up without the need of any reference electrode. The simulation and hardware performance of the proposed methodology are measured and compared in terms of correlation and regression statistics lying above 80% and 67% which are much improved over the state-of-the art methodologies