Role of Ketamine as Part of the Anti-Hyperalgesic Approach in Opioid-Free Anesthesia (OFA) and Postoperative Analgesia (OFAA)

There is increasing evidence of the close relationship between persistent activation of the glutaminergic pathway, central sensitization, hyperalgesia and chronic pain. Opioids have long been the standard analgesics used in the perioperative. However, their side effects, namely opioid-induced hyperalgesia, opioid tolerance and post-operative dependence in patients with chronic pain that are to undergo aggressive surgeries have motivated anesthesiologists to develop alternative anesthetic techniques. They include analgesic and anti-inflammatory drugs that act by modulating the nociceptive pathways with an opioid-sparing effect and even opioid-free anesthesia (OFA). In OFA plus postoperative analgesia (OFAA) techniques, ketamine plays a fundamental role as an analgesic with its antagonist action on the N-Methyl-D-Aspartate-receptors (NMDAr). However, ketamine is limited to use at sub-anesthetic doses (“low-doses”) due to its dose-dependent side effects. Consequently, other analgesic drugs with anti-NMDAr effects like magnesium sulfate and other non-opioid analgesics such as lidocaine and alpha-2-adrenergic agonists are often used in OFAA techniques. The aim of this text is to present a summary of the importance of the use of ketamine in OFA based on nociceptive pathophysiology. Additionally, the perioperative protocol (OFAA) with the anti-hyperalgesic approach of ketamine, lidocaine and dexmedetomidine co-administration in our center will be described. Some of the main indications for the OFAA protocol will be mentioned

Spanish Norms for Mini-SEA (Mini Social Cognition and Emotional Assessment) in adults in Buenos Aires

Introducción y objetivos: El Mini-SEA es una evaluación cognitiva rápida para estudiar la cognición social. Consiste en una versión de la Prueba de faux pas y una prueba de reconocimiento emocional. El objetivo deltrabajo fue obtener los primeros valores normativos del Mini-SEA de habla hispana. Material y métodos: Sereclutaron 64 voluntarios sanos que fueron evaluados con el Mini-SEA por neuropsicólogos especializados dedos centros especializados en Buenos Aires. Resultados: La media (M) total fue de 25+/- 4. La M del Score delfaux pas fue de 12,5+/- 2,4 y del Score del Reconocimiento Emocional fue 12,8+/- 1,5. Se dividió la muestraen 4 grupos etarios: Grupo 1 (<50 años), Grupo 2 (50-59 años), Grupo 3 (60-69 años) y Grupo 4 (más de 70años). Se hallaron diferencias en el continuo de la edad en el puntaje del Reconocimiento Emocional entre elgrupo 1 y 4 (p<0,05) y entre el grupo 3 y el 4 (p<0,01), no así en la prueba modificada del faux pas. Conclusión:Este estudio presenta los primeros valores normativos del Mini-SEA para una población de habla hispana. Esuna prueba rápida y fácil y permite estudiar la cognición social de forma adecuada y precisa sobre todo enestadios prodrómicos de enfermedades neurodegenerativas.Introduction and objective: The Mini-SEA is a quick and brief cognitive assessment test developed to study social cognition. It consists of a modified version of the faux pas Test and an emotional recognition test based on Ekman’s faces. The objective of this work was to obtain the first Spanish Speaking norms for the Mini-SEA test. Material and methods: 64 healthy volunteers, between 35 and 80 years old, were recruited and evaluated with the Mini-SEA by specialized neuropsychologists from the Cities of Buenos Aires and La Plata, both in the Province of Buenos Aires, Argentina. Results: The total mean (M) of the Mini-SEA was 25 +/- 4. The M of the faux pas Score was 12.5 +/- 2.4 and the M of the Emotional Recognition Score was 12.8 +/- 1.5. The sample was divided into 4 age groups: Group 1 (<50 years), Group 2 (50-59 years), Group 3 (60-69 years) and Group 4 (more than 70 years). Differences were found in the age continuum in the Emotional Recognition score between group 1 and 4 (p <0.05) and between group 3 and 4 (p <0.01), but not in the Faux Pas Score. Conclusion:This study presents the first normative values of the Mini-SEA Social Cognition test for a Spanish-speaking population. The Mini-SEA, being a quick and easy to administer test, allows the study of social cognition in an adequate and precise way, especially in prodromal stages of neurodegenerative disease.Fil: Clarens, Maria Florencia. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Crivelli, Lucía. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Fisiología, Biología Molecular y Neurociencias. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Fisiología, Biología Molecular y Neurociencias; ArgentinaFil: Martin, Maria Eugenia. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Fisiología, Biología Molecular y Neurociencias. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Fisiología, Biología Molecular y Neurociencias; ArgentinaFil: Fernández, Rodrigo Sebastián. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Fisiología, Biología Molecular y Neurociencias. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Fisiología, Biología Molecular y Neurociencias; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Canyazo, Carlos. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Arruabarrena, Micaela. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Tabernero, Maria Eugenia. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Fisiología, Biología Molecular y Neurociencias. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Fisiología, Biología Molecular y Neurociencias; ArgentinaFil: Cervino, Cecilia. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Varela, Yanina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Prestupa, Romina Vanesa. Instituto de Neurociencias Alexander Luria; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Pereyra, Lucrecia. Instituto de Neurociencias Alexander Luria; ArgentinaFil: Rossi, Francina. Instituto de Neurociencias Alexander Luria; ArgentinaFil: Sarasola, Ruben. Instituto de Neurociencias Alexander Luria; ArgentinaFil: Allegri, Ricardo Francisco. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Fisiología, Biología Molecular y Neurociencias. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Fisiología, Biología Molecular y Neurociencias; Argentin

EuReCa ONE—27 Nations, ONE Europe, ONE Registry A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe

AbstractIntroductionThe aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.MethodsThis was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.ResultsData on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.ConclusionThe results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe.EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events

Short apraxia screening test

Background: Limb apraxia comprises many different and common disorders, which are largely unrecognized essentially because there is no easy-to-use screening test sensitive enough to identify all types of limb praxis deficits. Method: We evaluated 70 right-handed patients with limb apraxia due to a single focal lesion of the left hemisphere and 40 normal controls, using a new apraxia screening test. The test covered 12 items including: intransitive gestures, transitive gestures elicited under verbal, visual, and tactile modalities, imitation of meaningful and meaningless postures and movements, and a multiple object test. Results: Interrater reliability was maximum for a cutoff of >2 positive items identifying apraxia on the short battery (Cohen's kappa.918, p 3 items (Cohen's kappa.768, p 2 was higher, indicating greater apraxia diagnosis agreement between raters at this cutoff value. Conclusions: The screening test proved to have high specificity and sensitivity to diagnose every type of upper limb praxis deficit, thus showing advantages over previously published tests.Fil: Leiguarda, Ramón Carlos. Fundación para la Lucha Contra las Enfermedades Neurológicas de la Infancia. Instituto de Investigaciones Neurológicas "Raúl Carrea". Servicio de Neurología Cognitiva, Neuropsiquiatría y Neuropsicología; ArgentinaFil: Clarens, María Florencia. Fundación para la Lucha Contra las Enfermedades Neurológicas de la Infancia. Instituto de Investigaciones Neurológicas "Raúl Carrea". Servicio de Neurología Cognitiva, Neuropsiquiatría y Neuropsicología; ArgentinaFil: Amengual, Alejandra. Fundación para la Lucha Contra las Enfermedades Neurológicas de la Infancia. Instituto de Investigaciones Neurológicas "Raúl Carrea". Servicio de Neurología Cognitiva, Neuropsiquiatría y Neuropsicología; ArgentinaFil: Drucaroff, Lucas Javier. Fundación para la Lucha Contra las Enfermedades Neurológicas de la Infancia. Instituto de Investigaciones Neurológicas "Raúl Carrea". Servicio de Neurología Cognitiva, Neuropsiquiatría y Neuropsicología; ArgentinaFil: Hallett, Mark. National Institutes of Health; Estados Unido

Argentina-Alzheimer's disease neuroimaging initiative (Arg-ADNI): neuropsychological evolution profile after one-year follow up

ABSTRACT The Argentina-Alzheimer's disease neuroimaging initiative (Arg-ADNI) study is a longitudinal prospective cohort of 50 participants at a single institution in Buenos Aires, Argentina. Longitudinal assessments on a neuropsychological test battery were performed on 15 controls, 24 mild cognitive impairment (MCI) patients and 12 Alzheimer's disease (AD) dementia patients. In our study population, there was a high prevalence of positive AD biomarkers in the AD group, 92.3% (12/13); and a low prevalence in the normal controls, 20%; almost half (48%) of the patients diagnosed with MCI had positive amyloid detection. After a one year, the significant differences found at baseline on neuropsychological testing were similar at the follow-up assessment even though the AD group had significantly altered its functional performance (FAQ and CDR). The exception was semantic fluency, which showed greater impairment between the AD group and MCI and normal controls respectively. For these tests, the addition of AD biomarkers as a variable did not significantly alter the variations previously found for the established clinical group's model. Finally, the one-year conversion rate to dementia was 20% in the MCI cohort

Argentina-Alzheimer's disease neuroimaging initiative (Arg-ADNI): neuropsychological evolution profile after one-year follow up

<div><p>ABSTRACT The Argentina-Alzheimer's disease neuroimaging initiative (Arg-ADNI) study is a longitudinal prospective cohort of 50 participants at a single institution in Buenos Aires, Argentina. Longitudinal assessments on a neuropsychological test battery were performed on 15 controls, 24 mild cognitive impairment (MCI) patients and 12 Alzheimer's disease (AD) dementia patients. In our study population, there was a high prevalence of positive AD biomarkers in the AD group, 92.3% (12/13); and a low prevalence in the normal controls, 20%; almost half (48%) of the patients diagnosed with MCI had positive amyloid detection. After a one year, the significant differences found at baseline on neuropsychological testing were similar at the follow-up assessment even though the AD group had significantly altered its functional performance (FAQ and CDR). The exception was semantic fluency, which showed greater impairment between the AD group and MCI and normal controls respectively. For these tests, the addition of AD biomarkers as a variable did not significantly alter the variations previously found for the established clinical group's model. Finally, the one-year conversion rate to dementia was 20% in the MCI cohort.</p></div