Impact of Subsyndromal Delirium Occurrence and Its Trajectory during ICU Stay

Funding Information: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Publisher Copyright: © 2022 by the authors.Despite recent advances in the field, the association between subsyndromal delirium (SSD) in the ICU and poor outcomes is not entirely clear. We performed a retrospective multicentric observational study analyzing mental status during the first 72 h of ICU stay. Of the 681 patients included, SSD occurred in 22.7%. Considering the worst cognitive assessment during the first 72 h, 233 (34%) patients had normal mental status, 124 (18%) patients had SSD and 324 (48%) patients had delirium or coma. SSD was not independently associated with an increased risk of death when compared with normal mental status (OR 95%IC 1.0 vs. 1.35 [0.73–1.49], p = 0.340), but was associated with a longer ICU LOS (7.0 (4–12) vs. 4 (3–8) days, p 23 points. Our findings support the association of SSD with increased ICU LOS, but not with ICU mortality. Monitoring the trajectory of SSD early at ICU admission can help to identify patients with increased risk of conversion from SSD to delirium or coma.publishersversionpublishe

The impact of SARS-CoV-2 in dementia across Latin America : A call for an urgent regional plan and coordinated response

The SARS-CoV-2 global pandemic will disproportionately impact countries with weak economies and vulnerable populations including people with dementia. Latin American and Caribbean countries (LACs) are burdened with unstable economic development, fragile health systems, massive economic disparities, and a high prevalence of dementia. Here, we underscore the selective impact of SARS-CoV-2 on dementia among LACs, the specific strain on health systems devoted to dementia, and the subsequent effect of increasing inequalities among those with dementia in the region. Implementation of best practices for mitigation and containment faces particularly steep challenges in LACs. Based upon our consideration of these issues, we urgently call for a coordinated action plan, including the development of inexpensive mass testing and multilevel regional coordination for dementia care and related actions. Brain health diplomacy should lead to a shared and escalated response across the region, coordinating leadership, and triangulation between governments and international multilateral networks

Outcomes of subsyndromal delirium in ICU: a systematic review and meta-analysis

Submitted by Janaína Nascimento ([email protected]) on 2019-02-21T13:01:17Z No. of bitstreams: 1 ve_Serafim_Rodrigo_etal_INI_2017.pdf: 832231 bytes, checksum: 11384e55f62a47e051f4b7ebf8512328 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-02-21T14:59:38Z (GMT) No. of bitstreams: 1 ve_Serafim_Rodrigo_etal_INI_2017.pdf: 832231 bytes, checksum: 11384e55f62a47e051f4b7ebf8512328 (MD5)Made available in DSpace on 2019-02-21T14:59:39Z (GMT). No. of bitstreams: 1 ve_Serafim_Rodrigo_etal_INI_2017.pdf: 832231 bytes, checksum: 11384e55f62a47e051f4b7ebf8512328 (MD5) Previous issue date: 2017Instituto D’Or de Pesquisa e Ensino. Rio de Janeiro, RJ, Brasil / Hospital Copa D’Or. Rio de Janeiro, RJ, Brasil / Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Hospital Universitário Clementino Fraga Filho. Instituto de Doenças do Tórax. Rio de Janeiro, RJ, Brasil.Instituto D’Or de Pesquisa e Ensino. Rio de Janeiro, RJ, Brasil / Universidade Federal do Rio de Janeiro. Programa de Pós-Graduação em Clinica Médica. Rio de Janeiro, RJ, Brasil.Instituto D’Or de Pesquisa e Ensino. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Hospital Universitário Clementino Fraga Filho. Instituto de Doenças do Tórax. Rio de Janeiro, RJ, Brasil.Universidade do Extremo Sul Catarinense. Laboratório de Patofisiologia Experimental. Programa de Graduação em Ciências Médicas. Criciúma, SC, Brasil.Centro Hospitalar de Lisboa Ocidental. Hospital de São Francisco Xavier. Unidade de Cuidados Intensivos Polivalente. Lisboa, Portugal.Centro Hospitalar de Lisboa Ocidental. Hospital de São Francisco Xavier. Unidade de Cuidados Intensivos Polivalente. Lisboa, Portugal / Universidade Nova de Lisboa. NOVA Medical School. Centro de Estudos de Doenças Crónicas. Lisboa, Portugal.Instituto D’Or de Pesquisa e Ensino. Rio de Janeiro, RJ, Brasil / Universidade Federal do Rio de Janeiro. Programa de Pós-Graduação em Clinica Médica. Rio de Janeiro, RJ, Brasil.Background: Subsyndromal delirium (SSD) is a frequent condition and has been commonly described as an intermediate stage between delirium and normal cognition. However, the true frequency of SSD and its impact on clinically relevant outcomes in the intensive care unit (ICU) remains unclear. Methods: We performed a systematic search in PubMed, Embase, CINAHL, Cochrane Library, and PsychINFO, with no language restrictions, up to 1 October 2016 to identify publications that evaluated SSD in ICU patients. Results: The six eligible studies were evaluated. SSD was present in 950 (36%) patients. Four studies evaluated only surgical patients. Four studies used the Intensive Care Delirium Screening Checklist (ICDSC) and two used the Confusion Assessment Method (CAM) score to diagnose SSD. The meta-analysis showed an increased hospital length of stay (LOS) in SSD patients (0.31, 0.12–0.51, p = 0.002; I2 = 34%). Hospital mortality was described in two studies but it was not significant (hazard ratio 0.97, 0.61–1.55, p = 0.90 and 5% vs 9%, p = 0.05). The use of antipsychotics in SSD patients to prevent delirium was evaluated in two studies but it did not modify ICU LOS (6.5 (4–8) vs 7 (4–9) days, p = 0.66 and 2 (2–3) vs 3 (2–3) days, p = 0.517) or mortality (9 (26.5%) vs 7 (20.6%), p = 0.55). Conclusions: SSD occurs in one-third of the ICU patients and has limited impact on the outcomes. The current literature concerning SSD is composed of small-sample studies with methodological differences, impairing a clear conclusion about the association between SSD and progression to delirium or worse ICU clinical outcomes

Fatal Human Case of Zika and Chikungunya Virus Co-Infection with Prolonged Viremia and Viruria

Zika virus (ZIKV) infection usually presents as a mild and self-limited illness, but it may be associated with severe outcomes. We describe a case of a 30-year-old man with systemic erythematous lupus and common variable immunodeficiency who became infected with both Zika (ZIKV) and Chikungunya (CHIKV) virus during the 2016 outbreak in Rio de Janeiro, Brazil. The patient presented with intense wrist and right ankle arthritis, and ZIKV RNA and virus particles were detected in synovial tissue, blood and urine, and CHIKV RNA in serum sample, at the time of the diagnosis. During the follow up, ZIKV RNA persisted for 275 days post symptoms onset. The patient evolved with severe arthralgia/arthritis and progressive deterioration of renal function. Fatal outcome occurred after 310 days post ZIKV and CHIKV co-infection onset. The results show the development of severe disease and fatal outcome of ZIKV infection in an immunosuppressed adult. The data suggests a correlation between immunodeficiency and prolonged ZIKV RNA shedding in both blood and urine with progressive disease. The results also indicate a possible role for arbovirus co-infections as risk factors for severe and fatal outcomes from ZIKV infection

A Brief History of Giant Viruses’ Studies in Brazilian Biomes

Almost two decades after the isolation of the first amoebal giant viruses, indubitably the discovery of these entities has deeply affected the current scientific knowledge on the virosphere. Much has been uncovered since then: viruses can now acknowledge complex genomes and huge particle sizes, integrating remarkable evolutionary relationships that date as early as the emergence of life on the planet. This year, a decade has passed since the first studies on giant viruses in the Brazilian territory, and since then biomes of rare beauty and biodiversity (Amazon, Atlantic forest, Pantanal wetlands, Cerrado savannas) have been explored in the search for giant viruses. From those unique biomes, novel viral entities were found, revealing never before seen genomes and virion structures. To celebrate this, here we bring together the context, inspirations, and the major contributions of independent Brazilian research groups to summarize the accumulated knowledge about the diversity and the exceptionality of some of the giant viruses found in Brazil

<i>L. (V.) braziliensis</i> isolates differ in their ability to hydrolyze adenine nucleotides.

<p>Promastigotes were isolated on the 5th day of culture and incubated with ATP (A), ADP (B) and AMP (C) for 1 hr at 30°C. Enzymatic activity was evaluated by the measurement of inorganic phosphate released. Bars represent the mean+standard deviation (SD) of three or more independent experiments performed in triplicates. Significant differences are shown below each graph. Statistical analysis was performed by one-way ANOVA followed by Bonferroni post-test.</p

Promastigotes with high ecto-nucleotidase activity inhibit NO production by activated macrophages.

<p>J774-macrophages were infected with promastigotes of <i>L. (V.) braziliensis</i> isolates (5 parasites/cell) for 3 and 72 hr, in presence or not of IFN-γ/LPS. (A) Percentage of infected cells and ATPase activity of promastigotes (nmolPi/10⁸ parasites/hr). (B) Number of parasites per infected macrophage. (C) NO production in 72 hr supernatants. Bars represent the mean+SD of two independent experiments performed in duplicates. (*) indicates statistical difference (p<0.05). Statistical analysis was performed by Students's <i>t</i>-test.</p

Course of infection of <i>Leishmania (V.) braziliensis</i> isolates in C57BL/6J mice.

<p>C57BL/6J mice were inoculated in the footpad of the left hind leg with 10⁷ promastigotes obtained from mucosal (ML)/mucocutaneous (MCL) lesions (A) or cutaneous lesions (CL) (B). Lesion sizes were measured weekly. The lesion size was defined as the difference between the infected and uninfected contralateral footpad from two independent experiments with four mice per group with the exception of isolates RS, SAP, IMG3 and RPL5 (one experiment each). Each line represents a distinct isolate and was drawn based on the mean lesion size for each time point. Error bars were not included to facilitate visualization. Eleven weeks after infection, animals were sacrificed and the relationship between lesion size and clinical form (C) as well the parasite load by limiting dilution technique was determined (D). Each point represents a different isolate. The line represents the mean of the group. Statistical analysis was performed by Students's <i>t</i>-test.</p