Prognostication of post-cardiac arrest coma: early clinical and electroencephalographic predictors of outcome

Purpose: To determine the temporal evolution, clinical correlates, and prognostic significance of electroencephalographic (EEG) patterns in post-cardiac arrest comatose patients treated with hypothermia. Methods: Prospective cohort study of consecutive post-anoxic patients receiving hypothermia and continuous EEG monitoring between May 2011 and June 2014 (n = 100). In addition to clinical variables, 5-min EEG clips at 6, 12, 24, 48, and 72 h after return of spontaneous circulation (ROSC) were reviewed. EEG background was classified according to the American Clinical Neurophysiological Society critical care EEG terminology. Clinical outcome at discharge was dichotomized as good [Glasgow outcome scale (GOS) 4–5, low to moderate disability] vs. poor (GOS 1–3, severe disability to death). Results: Non-ventricular fibrillation/tachycardia arrest, longer time to ROSC, absence of brainstem reflexes, extensor or no motor response, lower pH, higher lactate, hypotension requiring >2 vasopressors, and absence of reactivity on EEG were all associated with poor outcome (all p values ≤0.01). Suppression-burst at any time indicated a poor prognosis, with a 0 % false positive rate (FPR) [95 % confidence interval (CI) 0–10 %]. All patients (54/54) with suppression-burst or a low voltage (70 % for good outcome. Conclusions: Suppression-burst or a low voltage at 24 h after ROSC was not compatible with good outcome in this series. Normal background voltage without epileptiform discharges predicted a good outcome.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Experimentally induced intravaginal Tritrichomonas foetus infection in a mouse model Infecção experimental intravaginal com Tritricho-monas foetus em modelo camundongo

The interest to develop research on the host-parasite relationship in bovine tritrichomonosis has accomplished the use of experimental models alternative to cattle. The BALB/c mouse became the most appropriate species susceptible to vaginal Tritrichomonas foetus infection requiring previous estrogenization. For the need of an experimental model without persistent estrogenization and with normal estrous cycles, the establishment and persistence of vaginal infection on BALB/c mouse with different concentrations of T. foetus in two experimental groups was evaluated. Group A was treated with 5mg of b-estradiol 3-benzoate to synchronize the estrous, 48 hours before the T. foetus vaginal inoculation, and Group B was inoculated in natural estrus. At 5-7 days after treatment, estrogenic effect decreased allowing all animals to cycle regularly during the experiment. From the first week post-infection, samples of vaginal mucus were taken from all animals during 34 weeks, in order to evaluate the course of infection and the stage of the estrus cycle. Group A showed 93.6% of infected animals, and Group B showed 38%. Different doses of T. foetus were assayed to establish the vaginal infection, with a persistence of 34 weeks. Although different behavior was observed in each subgroup belonging to either Group A or Group B, there were no significant differences among the infecting doses used. The b-estradiol 3-benzoate treatment had a favorable effect on the establishment of the infection (P<0.0001), but it did not influence its persistence (P=0.1097). According to the results, an experimental mouse model is presented, appropriate for further studies on mechanisms of pathogenicity, immune response, protective evaluation of immunogen and therapeutic effect of drugs.<br>A necessidade de esclarecer a relação agente-hospedeiro na tricomoníase bovina deu motivo para o uso de modelos experimentais alternativos ao bovino. O camundongo BALB/c resultou como espécie mais adequada para a infeção vaginal com Tritrichomonas foetus, requerendo uma estrogenização prévia. Visando a necessidade de um modelo experimental sem estrogenização persistente e com ciclos estrais normais, foi avaliada a instalação e persistência da infeção vaginal no camundongo BALB/c com diferentes quantidades de T. foetus, em dois grupos experimentais. O Grupo A foi tratado com 5µg de 3-benzoato de beta estradiol, para sincronizar o estro, 48 h antes da inoculação vaginal com T. foetus, e o Grupo B foi inoculado durante o estro natural. O efeito do 3-benzoato de beta estradiol decresceu gradualmente. A totalidade dos animais ciclaram regularmente após 5-7 dias pós-tratamento. Após a primeira semana pós-infecção, todos os animais foram amostrados durante 34 semanas, para avaliar o andamento da infeção vaginal e o estádio de cío. O Grupo A apresentou 93,6% de animais infetados e o Grupo B 38%. Com diferentes dosagens de T. foetus se obteve a instalação e persistência da infecção vaginal durante 34 semanas. Embora tenham-se registrados diferentes comportamentos entre cada um dos lotes dos Grupos A e B, não houveram diferenças significativas entre as doses infectantes. O tratamento com 3-benzoato de beta estradiol teve efeito favorável na instalação da infecção (P<0,0001), porém não teve influência na persistência (P= 0,1097). Em função dos resultados obtidos, apresenta-se um modelo experimental em camundongo, adequado para aprofundar estudos sobre mecanismos de patogenicidade, resposta imune, avaliação protetora de imunógenos e o efeito terapêutico de fármacos