Brain Death in Children

Brain death (BD) is a distinct mode of death in pediatric intensive care units, accounting for 16–23% of deaths. Coma, absent brainstem reflexes, and apnea in a patient with acute irreversible neurological insult should alarm the attending physician to start the appropriate actions to establish or refute the diagnosis for BD. BD diagnosis is clinical, starting with the preconditions that should be met, and based on the examination of all brainstem reflexes, including the apnea test. Apnea testing should be conducted according to standard criteria to demonstrate the absence of spontaneous respirations, in the case of an intense ventilatory stimulus, setting at increased PaCO2 levels ≥60 and ≥20 mm Hg, compared to baseline. When elements of clinical examination and/or apnea test cannot be performed, ancillary studies to demonstrate the presence/absence of electrocerebral silence and/or cerebral blood flow are guaranteed. Two clinical examinations by qualified physicians at set intervals are required. Time of death is the time of second examination and ventilator support should stop at that time, except for organ donation. The use of check list in documentation of BD helps in the uniformity of diagnosis and fosters further trust from medical, family, and community personnel

A successfully thrombolysed acute inferior myocardial infarction due to type A aortic dissection with lethal consequences: the importance of early cardiac echocardiography

Thrombolysis, a standard therapy for ST elevation myocardial infarction (STEMI) in non-PCI-capable hospitals, may be catastrophic for patients with aortic dissection leading to further expansion, rupture and uncontrolled bleeding. Stanford type A aortic dissection, rarely may mimic myocardial infarction. We report a case of a patient with an inferior STEMI thrombolysed with tenecteplase and followed by clinical and electrocardiographic evidence of successful reperfusion, which was found later to be a lethal acute aortic dissection. Prognostic implications of early diagnosis applying transthoracic echocardiography (TTE) are described

NeuroSuitUp: System Architecture and Validation of a Motor Rehabilitation Wearable Robotics and Serious Game Platform

Background: This article presents the system architecture and validation of the NeuroSuitUp body–machine interface (BMI). The platform consists of wearable robotics jacket and gloves in combination with a serious game application for self-paced neurorehabilitation in spinal cord injury and chronic stroke. Methods: The wearable robotics implement a sensor layer, to approximate kinematic chain segment orientation, and an actuation layer. Sensors consist of commercial magnetic, angular rate and gravity (MARG), surface electromyography (sEMG), and flex sensors, while actuation is achieved through electrical muscle stimulation (EMS) and pneumatic actuators. On-board electronics connect to a Robot Operating System environment-based parser/controller and to a Unity-based live avatar representation game. BMI subsystems validation was performed using exercises through a Stereoscopic camera Computer Vision approach for the jacket and through multiple grip activities for the glove. Ten healthy subjects participated in system validation trials, performing three arm and three hand exercises (each 10 motor task trials) and completing user experience questionnaires. Results: Acceptable correlation was observed in 23/30 arm exercises performed with the jacket. No significant differences in glove sensor data during actuation state were observed. No difficulty to use, discomfort, or negative robotics perception were reported. Conclusions: Subsequent design improvements will implement additional absolute orientation sensors, MARG/EMG based biofeedback to the game, improved immersion through Augmented Reality and improvements towards system robustness