Video pulse rate variability analysis in stationary and motion conditions

Background: In the last few years, some studies have measured heart rate (HR) or heart rate variability (HRV) parameters using a video camera. This technique focuses on the measurement of the small changes in skin colour caused by blood perfusion. To date, most of these works have obtained HRV parameters in stationary conditions, and there are practically no studies that obtain these parameters in motion scenarios and by conducting an in-depth statistical analysis. Methods: In this study, a video pulse rate variability (PRV) analysis is conducted by measuring the pulse-to-pulse (PP) intervals in stationary and motion conditions. Firstly, given the importance of the sampling rate in a PRV analysis and the low frame rate of commercial cameras, we carried out an analysis of two models to evaluate their performance in the measurements. We propose a selective tracking method using the Viola–Jones and KLT algorithms, with the aim of carrying out a robust video PRV analysis in stationary and motion conditions. Data and results of the proposed method are contrasted with those reported in the state of the art. Results: The webcam achieved better results in the performance analysis of video cameras. In stationary conditions, high correlation values were obtained in PRV parameters with results above 0.9. The PP time series achieved an RMSE (mean ± standard deviation) of 19.45 ± 5.52 ms (1.70 ± 0.75 bpm). In the motion analysis, most of the PRV parameters also achieved good correlation results, but with lower values as regards stationary conditions. The PP time series presented an RMSE of 21.56 ± 6.41 ms (1.79 ± 0.63 bpm). Conclusions: The statistical analysis showed good agreement between the reference system and the proposed method. In stationary conditions, the results of PRV parameters were improved by our method in comparison with data reported in related works. An overall comparative analysis of PRV parameters in motion conditions was more limited due to the lack of studies or studies containing insufficient data analysis. Based on the results, the proposed method could provide a low-cost, contactless and reliable alternative for measuring HR or PRV parameters in non-clinical environments.Peer ReviewedPostprint (published version

Role of Innate and Adaptive Cytokines in the Survival of COVID-19 Patients

SARS-CoV-2 is a new coronavirus characterized by a high infection and transmission capacity. A significant number of patients develop inadequate immune responses that produce massive releases of cytokines that compromise their survival. Soluble factors are clinically and pathologically relevant in COVID-19 survival but remain only partially characterized. The objective of this work was to simultaneously study 62 circulating soluble factors, including innate and adaptive cytokines and their soluble receptors, chemokines and growth and wound-healing/repair factors, in severe COVID-19 patients who survived compared to those with fatal outcomes. Serum samples were obtained from 286 COVID-19 patients and 40 healthy controls. The 62 circulating soluble factors were quantified using a Luminex Milliplex assay. Results. The patients who survived had decreased levels of the following 30 soluble factors of the 62 studied compared to those with fatal outcomes, therefore, these decreases were observed for cytokines and receptors predominantly produced by the innate immune system-IL-1 alpha, IL-1 alpha, IL-18, IL-15, IL-12p40, IL-6, IL-27, IL-1Ra, IL-1RI, IL-1RII, TNF alpha, TGF alpha, IL-10, sRAGE, sTNF-RI and sTNF-RII-for the chemokines IL-8, IP-10, MCP-1, MCP-3, MIG and fractalkine; for the growth factors M-CSF and the soluble receptor sIL2Ra; for the cytokines involved in the adaptive immune system IFN gamma, IL-17 and sIL-4R; and for the wound-repair factor FGF2. On the other hand, the patients who survived had elevated levels of the soluble factors TNF beta, sCD40L, MDC, RANTES, G-CSF, GM-CSF, EGF, PDGFAA and PDGFABBB compared to those who died. Conclusions. Increases in the circulating levels of the sCD40L cytokine; MDC and RANTES chemokines; the G-CSF and GM-CSF growth factors, EGF, PDGFAA and PDGFABBB; and tissue-repair factors are strongly associated with survival. By contrast, large increases in IL-15, IL-6, IL-18, IL-27 and IL-10; the sIL-1RI, sIL1RII and sTNF-RII receptors; the MCP3, IL-8, MIG and IP-10 chemokines; the M-CSF and sIL-2Ra growth factors; and the wound-healing factor FGF2 favor fatal outcomes of the disease

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Análisis de la variabilidad de la frecuencia cardíaca mediante fotopletismografía por imagen

La Variabilidad de la Frecuencia Cardíaca (VFC) es un parámetro fisiológico que en las últimas décadas ha tomado mayor importancia por su implicación con el sistema nervioso autónomo y su relación con los trastornos cardiovasculares. En este trabajo es llevado a cabo la adquisición de la señal del ritmo cardíaco mediante la técnica de fotopletismografía por imagen haciendo uso de una cámara de video comercial para un posterior análisis de la VFC. Se comparan los resultados obtenidos por el método propuesto con la señal de ECG adquirida con un sistema de referencia. Los resultados del análisis estadístico de la VFC muestran una gran similitud entre ambos métodos

Video pulse rate variability analysis in stationary and motion conditions

Background: In the last few years, some studies have measured heart rate (HR) or heart rate variability (HRV) parameters using a video camera. This technique focuses on the measurement of the small changes in skin colour caused by blood perfusion. To date, most of these works have obtained HRV parameters in stationary conditions, and there are practically no studies that obtain these parameters in motion scenarios and by conducting an in-depth statistical analysis. Methods: In this study, a video pulse rate variability (PRV) analysis is conducted by measuring the pulse-to-pulse (PP) intervals in stationary and motion conditions. Firstly, given the importance of the sampling rate in a PRV analysis and the low frame rate of commercial cameras, we carried out an analysis of two models to evaluate their performance in the measurements. We propose a selective tracking method using the Viola–Jones and KLT algorithms, with the aim of carrying out a robust video PRV analysis in stationary and motion conditions. Data and results of the proposed method are contrasted with those reported in the state of the art. Results: The webcam achieved better results in the performance analysis of video cameras. In stationary conditions, high correlation values were obtained in PRV parameters with results above 0.9. The PP time series achieved an RMSE (mean ± standard deviation) of 19.45 ± 5.52 ms (1.70 ± 0.75 bpm). In the motion analysis, most of the PRV parameters also achieved good correlation results, but with lower values as regards stationary conditions. The PP time series presented an RMSE of 21.56 ± 6.41 ms (1.79 ± 0.63 bpm). Conclusions: The statistical analysis showed good agreement between the reference system and the proposed method. In stationary conditions, the results of PRV parameters were improved by our method in comparison with data reported in related works. An overall comparative analysis of PRV parameters in motion conditions was more limited due to the lack of studies or studies containing insufficient data analysis. Based on the results, the proposed method could provide a low-cost, contactless and reliable alternative for measuring HR or PRV parameters in non-clinical environments.Peer Reviewe

Análisis de la variabilidad de la frecuencia cardíaca mediante fotopletismografía por imagen

La Variabilidad de la Frecuencia Cardíaca (VFC) es un parámetro fisiológico que en las últimas décadas ha tomado mayor importancia por su implicación con el sistema nervioso autónomo y su relación con los trastornos cardiovasculares. En este trabajo es llevado a cabo la adquisición de la señal del ritmo cardíaco mediante la técnica de fotopletismografía por imagen haciendo uso de una cámara de video comercial para un posterior análisis de la VFC. Se comparan los resultados obtenidos por el método propuesto con la señal de ECG adquirida con un sistema de referencia. Los resultados del análisis estadístico de la VFC muestran una gran similitud entre ambos métodos

Neurorretinitis en enfermedad por arañazo de gato

Case report: We report the case of a 38-year-old woman, without remarkable medical history but whose brother is being screened for multiple sclerosis. She reports decreased visual acuity (AV) in her left eye. Funduscopy reveals papilledema with hard macular exudates in a star pattern. After being asked the patient says that she owns a cat. Possible CSD is suspected and antibiotherapy is prescribed. After 2 months of follow-up the patient shows recovery. Discussion: Neuroretinitis associated with CSD is uncommon. A good anamnesis and ophtalmological screening are crucial for correct diagnosis and treatment.Caso clínico: presentamos el caso clínico de una paciente de 38 años sin antecedentes personales de interés y que tiene como antecedentes familiares un hermano en estudio por esclerosis múltiple. Acude a nuestro servicio por disminución de agudeza visual (AV) por el ojo izquierdo (OS), En la funduscopia presenta papiledema con exudados duros maculares en forma de estrella. Al interrogar más exhaustivamente a la paciente refiere tener un gato en su entorno, tras haber descartado otras causas, se sospecha una posible enfermedad por arañazo de gato y se pauta antibioterapia, evolucionando durante 2 meses de seguimiento hacia la resolución. Discusión: la neurorretinitis por arañazo de gato es una patología poco frecuente. Es fundamental una correcta anamnesis y una exploración oftalmológica minuciosa para el correcto diagnóstico y posterior tratamiento de la enfermeda

Impact of the Innate Inflammatory Response on ICU Admission and Death in Hospitalized Patients with COVID-19

Objective: To describe the capacity of a broad spectrum of cytokines and growth factors to predict ICU admission and/or death in patients with severe COVID-19. Design: An observational, analytical, retrospective cohort study with longitudinal follow-up. Setting: Hospital Universitario Príncipe de Asturias (HUPA). Participants: 287 patients diagnosed with COVID-19 admitted to our hospital from 24 March to 8 May 2020, followed until 31 August 2020. Main outcome measures: Profiles of immune response (IR) mediators were determined using the Luminex Multiplex technique in hospitalized patients within six days of admission by examining serum levels of 62 soluble molecules classified into the three groups: adaptive IR-related cytokines (n = 19), innate inflammatory IR-related cytokines (n = 27), and growth factors (n = 16). Results: A statistically robust link with ICU admission and/or death was detected for increased serum levels of interleukin (IL)-6, IL-15, soluble (s) RAGE, IP10, MCP3, sIL1RII, IL-8, GCSF and MCSF and IL-10. The greatest prognostic value was observed for the marker combination IL-10, IL-6 and GCSF. Conclusions: When severe COVID-19 progresses to ICU admission and/or death there is a marked increase in serum levels of several cytokines and chemokines, mainly related to the patient's inflammatory IR. Serum levels of IL-10, IL-6 and GCSF were most prognostic of the outcome measure

Gut Microbiota Metabolites in Major Depressive Disorder—Deep Insights into Their Pathophysiological Role and Potential Translational Applications

The gut microbiota is a complex and dynamic ecosystem essential for the proper functioning of the organism, affecting the health and disease status of the individuals. There is continuous and bidirectional communication between gut microbiota and the host, conforming to a unique entity known as “holobiont”. Among these crosstalk mechanisms, the gut microbiota synthesizes a broad spectrum of bioactive compounds or metabolites which exert pleiotropic effects on the human organism. Many of these microbial metabolites can cross the blood–brain barrier (BBB) or have significant effects on the brain, playing a key role in the so-called microbiota-gut-brain axis. An altered microbiota-gut-brain (MGB) axis is a major characteristic of many neuropsychiatric disorders, including major depressive disorder (MDD). Significative differences between gut eubiosis and dysbiosis in mental disorders like MDD with their different metabolite composition and concentrations are being discussed. In the present review, the main microbial metabolites (short-chain fatty acids -SCFAs-, bile acids, amino acids, tryptophan -trp- derivatives, and more), their signaling pathways and functions will be summarized to explain part of MDD pathophysiology. Conclusions from promising translational approaches related to microbial metabolome will be addressed in more depth to discuss their possible clinical value in the management of MDD patients