Effect of an early neurocognitive rehabilitation on autonomic nervous system in critically ill patients

Introduction Recent clinical and electrophysiological studies reveal a high incidence of autonomic nervous system (ANS) dys- function in patients treated in ICU [1]. ANS disturbances may produce diverse and unexpected consequences. For instance, critically ill patients are at risk of neurocognitive impairments that may persist after hospital discharge. Among various pathophysiological mechanisms proposed, ANS dysfunction leading cholinergic deficiency seems one of the most viable to explain the development of long-term sequelae. Heart rate variability (HRV) has been related to the activity of the prefrontal cortex [2] hence, prefrontal activation could help to strengthen the auto- nomic nervous system integrity. We are interested in assessing the improvement of the ANS dysfunction through neural circuits’ activation. Thus, we propose a novel therapy that could allow the reinforcing of ANS through an early neurocognitive intervention targeted to improve prefrontal activation. Objectives The aim of this study was to explore if the integrity of the ANS, via cardiac vagal tone, measured by the HRV can be modified after early neurocognitive rehabilitation in ICU patients. Methods A total of 17 critically ill patients received a 20-minute Early Neurocognitive Rehabilitation (ENR) session in their own bed in the ICU. HRV was derived from the recorded ECG signal during pre-session, session and post-session. Power in the specific frequency bands related to sympathetic and parasympathetic systems was computed (PLF and PHF for low and high frequency bands, respectively). PLF was computed within the clas- sic band, while PHF was computed within a band cen- tered at respiratory rate. Changes in the HRV parameters from pre-session to session, and from pre- session to post-session were studied using Wilcoxon signed-rank test. Results Clinical data of the sample are summarized in table 1. Comparing with baseline values, 9 patients (53%) showed a decreased PLF in post-session, while 8 patients (47%) presented a higher PLF (p = .759). In 12 patients (71%), PHF increased after the ENR session, suggesting an increase of parasympathetic activity (p = .836). Conclusions Diagnosis, severity of illness or medication could explain the differential effect in the evolution of the HRV para- meters among different patients. Despite differences, an early neurocognitive rehabilitation seems to increase parasympathetic activity after the session in the majority of the patients. Clinical characteristics of the critical ill patients should be further studied to determinate which patients could be the best candidates for early neurocog- nitive intervention

Leishmania (L.) mexicana infected bats in Mexico: novel potential reservoirs

Leishmania (Leishmania) mexicana causes cutaneous leishmaniasis, an endemic zoonosis affecting a growing number of patients in the southeastern states of Mexico. Some foci are found in shade-grown cocoa and coffee plantations, or near perennial forests that provide rich breeding grounds for the sand fly vectors, but also harbor a variety of bat species that live off the abundant fruits provided by these shade-giving trees. The close proximity between sand flies and bats makes their interaction feasible, yet bats infected with Leishmania (L.) mexicana have not been reported. Here we analyzed 420 bats from six states of Mexico that had reported patients with leishmaniasis. Tissues of bats, including skin, heart, liver and/or spleen were screened by PCR for Leishmania (L.) mexicana DNA. We found that 41 bats (9.77%), belonging to 13 species, showed positive PCR results in various tissues. The infected tissues showed no evidence of macroscopic lesions. Of the infected bats, 12 species were frugivorous, insectivorous or nectarivorous, and only one species was sanguivorous (Desmodus rotundus), and most of them belonged to the family Phyllostomidae. The eco-region where most of the infected bats were caught is the Gulf Coastal Plain of Chiapas and Tabasco. Through experimental infections of two Tadarida brasiliensis bats in captivity, we show that this species can harbor viable, infective Leishmania (L.) mexicana parasites that are capable of infecting BALB/c mice. We conclude that various species of bats belonging to the family Phyllostomidae are possible reservoir hosts for Leishmania (L.) mexicana, if it can be shown that such bats are infective for the sand fly vector. Further studies are needed to determine how these bats become infected, how long the parasite remains viable inside these potential hosts and whether they are infective to sand flies to fully evaluate their impact on disease epidemiology

Polarimetric calibration of a spectropolarimeter instrument with high precision: Sunrise chromospheric infrared spectropolarimeter (SCIP) for the sunrise iii balloon telescope

The Sunrise chromospheric infrared spectropolarimeter (SCIP) installed in the international balloon experiment sunrise iii will perform spectropolarimetric observations in the near-infrared band to measure solar photospheric and chromospheric magnetic fields simultaneously. The main components of SCIP for polarization measurements are a rotating wave plate, polarization beam splitters, and CMOS imaging sensors. In each of the sensors, SCIP records the orthogonal linearly polarized components of light. The polarization is later demodulated on-board. Each sensor covers one of the two distinct wavelength regions centered at 770 and 850 nm. To retrieve the proper circular polarization, the new parameter , defined as the 45° phase shifted component of Stokes in the modulation curve, is introduced. SCIP is aimed at achieving high polarization precision (1<3×10−4 of continuum intensity) to capture weak polarization signals in the chromosphere. The objectives of the polarization calibration test presented in this paper are to determine a response matrix of SCIP and to measure its repeatability and temperature dependence to achieve the required polarization precision. Tolerances of the response matrix elements were set after considering typical photospheric and chromospheric polarization signal levels. We constructed a feed optical system such that a telecentric beam can enter SCIP with the same -number as the light distribution instrument of the sunrise iii telescope. A wire-grid linear polarizer and achromatic wave plate were placed before SCIP to produce the known polarization. The obtained response matrix was close to the values expected from the design. The wavelength and spatial variations, repeatability, and temperature dependence of the response matrix were confirmed to be smaller than tolerances. © 2022 Optica Publishing Group.Japan Society for the Promotion of Science KAKENHI (JP18H05234); Max Planck Foundation; National Aeronautics and Space Administration (#80NSSC18K0934); ISAS/JAXA Small Mission-of Opportunity Program; Spanish Research Agency (RTI2018-096886-B-C5); Centro de Excelencia Severo Ochoa Program (SEV-2017-0709).Peer reviewe

SPGCam: A specifically tailored camera for solar observations

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Designing a new astronomical instrument typically challenges the available cameras on the market. In many cases, no camera can fulfill the requirements of the instrument in terms of photon budget, speed, and even interfaces with the rest of the instrument. In this situation, the only options are to either downgrade the performance of the instrument or design new cameras from scratch, provided it is possible to identify a compliant detector. The latter is the case of the SPGCams, the cameras developed to be used with the Tunable Magnetograph (TuMag) and the Sunrise Chromospheric Infrared spectroPolarimeter (SCIP) for the Sunrise iii mission. SPGCams have been designed, developed, and built entirely in-house by the Solar Physics Group (SPG) at the Instituto de Astrofísica de Andalucía (IAA-CSIC). We report here on the scientific rationale and system engineering requirements set by the two instruments that drove the development, as well as on the technical details and trade-offs used to fulfill the specifications. The cameras were fully verified before the flight, and results from the assembly and verification campaign are presented as well. SPGCams share the design, although some parametric features differentiate the visible cameras (for TuMag) and the IR ones (for SCIP). Even though they were specifically developed for the Sunrise iii mission, the robust and careful design makes them suitable for different applications in other astronomical instruments. © 2023 Orozco Suárez, Álvarez García, López Jiménez, Balaguer Jiménez, Hernández Expósito, Labrousse, Bailén, Bustamante Díaz, Bailón Martínez, Aparicio del Moral, Morales Fernández, Sánchez Gómez, Tobaruela Abarca, Moreno Mantas, Ramos Más, Pérez Grande, Piqueras Carreño, Katsukawa, Kubo, Kawabata, Oba, Rodríguez Valido, Magdaleno Castelló and Del Toro Iniesta.This work was funded by the Spanish MCIN/AEI, under projects RTI 2018-096886-B-C5, PID 2021-125325OB-C5, and PCI 2022-135009-2, and co-funded by European FEDER funds, “A way of making Europe,” under grants CEX 2021-001131-S and 10.13039/501100011033.Peer reviewe

The SADDEN DEATH Study: Results from a Pilot Study in Non-ICU COVID-19 Spanish Patients

Introduction: The worldwide pandemic, coronavirus disease 2019 (COVID-19) is a novel infection with serious clinical manifestations, including death. Our aim is to describe the first non-ICU Spanish deceased series with COVID-19, comparing specifically between unexpected and expected deaths. Methods: In this single-centre study, all deceased inpatients with laboratory-confirmed COVID-19 who had died from March 4 to April 16, 2020 were consecutively included. Demographic, clinical, treatment, and laboratory data, were analyzed and compared between groups. Factors associated with unexpected death were identified by multivariable logistic regression methods. Results: In total, 324 deceased patients were included. Median age was 82 years (IQR 76–87); 55.9% males. The most common cardiovascular risk factors were hypertension (78.4%), hyperlipidemia (57.7%), and diabetes (34.3%). Other common comorbidities were chronic kidney disease (40.1%), chronic pulmonary disease (30.3%), active cancer (13%), and immunosuppression (13%). The Confusion, BUN, Respiratory Rate, Systolic BP and age ≥65 (CURB-65) score at admission was >2 in 40.7% of patients. During hospitalization, 77.8% of patients received antivirals, 43.3% systemic corticosteroids, and 22.2% full anticoagulation. The rate of bacterial co-infection was 5.5%, and 105 (32.4%) patients had an increased level of troponin I. The median time from initiation of therapy to death was 5 days (IQR 3.0–8.0). In 45 patients (13.9%), the death was exclusively attributed to COVID-19, and in 254 patients (78.4%), both COVID-19 and the clinical status before admission contributed to death. Progressive respiratory failure was the most frequent cause of death (92.0%). Twenty-five patients (7.7%) had an unexpected death. Factors independently associated with unexpected death were male sex, chronic kidney disease, insulin-treated diabetes, and functional independence. Conclusions: This case series provides in-depth characterization of hospitalized non-ICU COVID-19 patients who died in Madrid. Male sex, insulin-treated diabetes, chronic kidney disease, and independency for activities of daily living are predictors of unexpected death

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality