Virtual reality-based early neurocognitive stimulation in critically ill patients: A pilot randomized clinical trial

This study focuses on the application of a non-immersive virtual reality (VR)-based neurocognitive intervention in critically ill patients. Our aim was to assess the feasibility of direct outcome measures to detect the impact of this digital therapy on patients’ cognitive and emotional outcomes. Seventy-two mechanically ventilated adult patients were randomly assigned to the “treatment as usual” (TAU, n = 38) or the “early neurocognitive stimulation” (ENRIC, n = 34) groups. All patients received standard intensive care unit (ICU) care. Patients in the ENRIC group also received adjuvant neurocognitive stimulation during the ICU stay. Outcome measures were a full neuropsychological battery and two mental health questionnaires. A total of 42 patients (21 ENRIC) completed assessment one month after ICU discharge, and 24 (10 ENRIC) one year later. At onemonth follow-up, ENRIC patients had better working memory scores (p = 0.009, d = 0.363) and showed up to 50% less non-specific anxiety (11.8% vs. 21.1%) and depression (5.9% vs. 10.5%) than TAU patients. A general linear model of repeated measures reported a main effect of group, but not of time or group–time interaction, on working memory, with ENRIC patients outperforming TAU patients (p = 0.008, ¿p2 = 0.282). Our results suggest that non-immersive VR-based neurocognitive stimulation may help improve short-term working memory outcomes in survivors of critical illness. Moreover, this advantage could be maintained in the long term. An efficacy trial in a larger sample of participants is feasible and must be conducted. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Group and sex differences in social cognition in bipolar disorder, schizophrenia/schizoaffective disorder and healthy people

Background: Impairment of social cognition is documented in bipolar disorder (BD) and schizophrenia/schizoaffective disorder (SCH). In healthy individuals, women perform better than men in some of its sub-domains. However, in BD and SCH the results are mixed. Our aim was to compare emotion recognition, affective Theory of Mind (ToM) and first- and second-order cognitive ToM in BD, SCH and healthy subjects, and to investigate sex-related differences. Methods: 120 patients (BD = 60, SCH = 60) and 40 healthy subjects were recruited. Emotion recognition was assessed by the Pictures of Facial Affect (POFA) test, affective ToM by the Reading the Mind in the Eyes Test (RMET) and cognitive ToM by several false-belief stories. Group and sex differences were analyzed using parametric (POFA, RMET) and non-parametric (false-belief stories) tests. The impact of age, intelligence quotient (IQ) and clinical variables on patient performance was examined using a series of linear/logistic regressions. Results: Both groups of patients performed worse than healthy subjects on POFA, RMET and second-order false-belief (p < 0.001), but no differences were found between them. Instead, their deficits were related to older age and/or lower IQ (p < 0.01). Subthreshold depression was associated with a 6-fold increased risk of first-order false-belief failure (p < 0.001). Sex differences were only found in healthy subjects, with women outperforming men on POFA and RMET (p ≤ 0.012), but not on first/second-order false-belief. Limitations: The cross-sectional design does not allow for causal inferences. Conclusion: BD and SCH patients had deficits in emotion recognition, affective ToM, and second-order cognitive ToM, but their performance was comparable to each other, highlighting that the differences between them may be subtler than previously thought. First-order cognitive ToM remained intact, but subthreshold depression altered their normal functioning. Our results suggest that the advantage of healthy women in the emotional and affective aspects of social cognition would not be maintained in BD and SCH

Deformación de la presión de las vías respiratorias durante la ventilación mecánica invasiva detectada mediante técnicas de aprendizaje automático supervisado

Es esencial una interacción paciente-ventilador adecuada en aquellos pacientes que reciben Ventilación Mecánica Invasiva (VMI). Los clínicos suelen analizar las ondas generadas por el ventilador para detectar interacciones inadecuadas, pero a veces esto lleva a un diagnóstico insuficiente. La Inteligencia Artificial (IA) podría ser una herramienta poderosa en la detección de forma automática de episodios de mala interacción paciente- ventilador. El objetivo del trabajo fue desarrollar un algoritmo de IA supervisado para identificar la deformación de la presión en la vía aérea durante la VMI. Se realizó un estudio multicéntrico y retrospectivo en pacientes adultos ingresados en la Unidad de Cuidados Intensivos (UCI) sometidos a VMI. Expertos clasificaron la gravedad de la deformación de la onda de presión en vía aérea. Se entrenaron modelos de redes neuronales convolucionales y recurrentes, y se evaluaron mediante métricas de rendimiento. Se analizaron 6.428 respiraciones de 28 pacientes, y se encontró que el 42% se clasificaron como normales-leves, el 23% como moderadas y el 34% como graves en términos de deformación de la presión. Los modelos de IA mostraron una precisión del 87,7% en la red recurrente y 87% en la convolucional para la detección de la deformación de la presión. Nuestro estudio sugiere que la IA es una herramienta prometedora para identificar la deformación de la presión en vía aérea durante la VMI de forma continua y automática. Estos modelos podrían utilizarse en tiempo real para mejorar la monitorización y minimizar los periodos de interacción inadecuada entre el paciente y el ventilador.Este proyecto cuenta con el apoyo del programa Pla Estratègic de Recerca i Innovació en Salut (PERIS: SLT017/20/000153) del Departamento de Salud de la Generalitat de Catalunya, España. Y del proyecto 202118 (413/C/2021) Fundació La Marató de TV3, Programa CERCA/Generalitat de Catalunya y Fundació Institut d'Investigació i Innovació Parc Taulí-I3PT y CIBER -Consorcio Centro de Investigación Biomédica en Red- (CB06/06/1097), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación

FATAL ANAPHYLACTIC SHOCK CEFTRIAXONE-INDUCED IN A 4 YEAR-OLD CHILD

One of the most used cephalosporin in clinical practice is ceftriaxone. Anaphylaxis due to the administration of ceftriaxone is considered a rare event. Here, we report a case of fatal anaphylactic shock after the administration of ceftriaxone in a child who had tolerated the drug in past exposures. The allergic pathogenesis is sustained by the clinical data (short time between the inoculation of the drug and the onset of the symptoms; past exposure to the same molecule and probable sensitization) and the postmortem examination findings (polivisceral congestion and intense eosinophilia found in the histological examination)

Fatal multi-organ failure following anaphylactic shock induced by ceftriaxone

In the latest years, based on the wide use of cephalosporins for antibiotic therapy, a large interest focused on the identification of causal relationship of adverse reactions after their prescription. We report a case of fatal anaphylactic shock following the administration of ceftriaxone in a woman who had tolerated the previous exposure to the drug. This case adds a contribution to the few cases reported in literature to further suggest the possibility of severe anaphylaxis after the administration of ceftriaxone even in patients without any previous reaction to this drug

Single muon angular distributions observed in the LVD particle astrophysics experiment

The first angular distribution data from 5547 hours of operation of the LVD detector are presented. The technique of track reconstruction is described. A total of 452 657 single muons were reconstructed for this period. The data are acceptance corrected in our final plots. The total single muon flux (the total flux from above impinging on a sphere of unit cross sectional area) in the Gran Sasso Laboratory is 1.03 muons per hour per square meter. The total flux crossing a unit horizontal area from above is 0.79 muons per hour per square meter. The acceptance-corrected intensity at cos theta = 1 is 0.349 muons per hour per square meter per steradian (9.7 x 10(-9) muons per second per square centimeter per steradian). We present, for the first time from Gran Sasso Laboratory, data at near-horizontal zenith angles.22103116Italian Institute for Nuclear Physics (INFN)US Department of EnergyUS National Science FoundationState of Texas under its TATRP progra