Effects of two alveolar recruitment manoeuvres (sustained inflation and stepwise) followed by positive end-expiratory pressure on cardiac output (measured with lithium dilution), invasive blood pressure and arterial oxygen tension in isoflurane-anaesthetised goats.

Alveolar recruitment manoeuvres (ARM) performed during general anaesthesia improve oxygenation; however cardiovascular depression may be observed. The aim of the study was to compare the effects of sustained inflation (SI) and stepwise ARMs on cardiac output (CO), mean arterial blood pressure and arterial oxygen tension (PaO2) in ten mechanically ventilated goats anaesthetised with isoflurane. In the SI ARM, peak inspiratory presure (PIP) was increased to 30 cmH2O and sustained for 20 s. In the stepwise ARM, the PIP was increased by 5 cmH2O each minute for three minutes from 10 to 25 cmH2O. Both ARMs were followed by positive end-expiratory pressure of 5 cmH2O. Paired lithium dilution CO measurements and arterial blood samples were obtained before and after each ARM. The order of the ARM was randomised and each goat was subjected to both techniques. Data was reported as median and interquartile range (IQR). Significance was set at 0.05. The median change in CO (measured by subtracting values after and before ARM) was -0.15 L min-1 (IQR -0.51; 0.03) and - 0.90 L min-1 (IQR -1.69; -0.58) for SI and stepwise ARM respectively (p = 0.04). The median change in PaO2 was 3 kPa (IQR -2.7; 7.6) and 0.4 kPa (IQR -3.4; 5.5) for SI and stepwise ARM respectively (p = 0.03). In conclusion, SI ARM causes less impact on CO and provides a better improvement in PaO2 compared to stepwise ARM in goats.

Teoría de los cuidados, aplicada en el cuidado de niños con enfermedades neuropsiquiátricas durante la estimulación cerebral no invasiva / Theory of care, applied in the care of children with neuropsychiatric diseases during non-invasive brain stimulation

Introducción: el cuidado es la razón de ser de la profesión de enfermería y constituye su objeto de estudio, convertirlo en el centro de interés de la investigación en enfermería, es una necesidad, pues permitirá robustecer su cuerpo de conocimientos, con fundamentos y principios científicos, humanistas sustentado en modelos teóricos que orientan la disciplina y práctica profesional. Objetivo: describir la vinculación de la teoría de los cuidados al cuidado de niños con enfermedades neuropsiquiátricas durante la estimulación cerebral no invasiva. Material y métodos: revisión no sistemática de la literatura para desarrollar un análisis crítico reflexivo de documentos como: libros, tesis y artículos científicos. Se utilizaron las bases de datos bibliográficas: PubMed, CUMED, CINAHL, CUIDEN, Lilacs y Google académico. Se siguieron los principios de análisis de contenido, integrando la identificación de significados que se señalaban de forma más repetitiva, la consistencia, explicaciones y relaciones de éstos, a través de todos los estudios incluidos en esta revisión. Conclusiones: se evidencia la importancia de realizar una gestión enfocada estratégicamente en los cuidados donde se consideren valores, actitudes y conocimientos de la disciplina que conlleven a realizar un liderazgo dirigido a la meja continua de los cuidados.

Introduction: care is the raison d'être of the nursing profession and constitutes its object of study, making it the center of interest for nursing research, it is a necessity, which will strengthen its body of knowledge, with foundations and scientific, humanistic principles based on theoretical models that guide discipline and professional practice. Objective: describe the link of theory of care to the care of children with neuropsychiatric diseases during non-invasive brain stimulation. Material and methods: a non-systematic review of the literature was carried out to develop a reflective critical analysis of different documents that included books, theses and scientific articles. Bibliographic databases: PubMed, CUMED, CINAHL, CUIDEN, Lilacs and Google Scholar were used. The principles of content analysis were followed, including the identification of meanings that were indicated more repetitively, their consistency, explanations and relationships, throughout all the studies included in this review. Conclusions: Swanson's theory of care describes the relationships between nursing professionals and clients; It contributes to the nursing professional assuming responsible decisions regarding care that ensure their quality.

[Functional connectivity derived from an electroencephalogram during non-REM sleep in autism spectrum disorders]. / Conectividad funcional derivada del electroencefalograma durante el sueño no REM en los trastornos del espectro autista.

AIM: To know the differences in the patterns of functional connectivity, the topological characteristics of the network and the relationship between these latter and the interictal epileptiform anomalies in children with primary and secondary autism spectrum disorder (ASD). PATIENTS AND METHODS: A retrospective study was conducted with 27 children aged between 3 and 13 years diagnosed with ASD. Subjects were submitted to an electroencephalogram in a functional state of spontaneous sleep. Functional connectivity and the properties of the network were analysed using data obtained from the electroencephalogram during the N2 stage of non-REM sleep. The frequency of discharge of the interictal epileptiform activity (FDIEA) was determined and was correlated with the topological properties of the network. RESULTS: Synchronisation was diminished in patients with secondary ASD for the alpha frequency and increased for the theta and delta frequency compared with patients with primary ASD. Local alpha efficiency was higher in patients who presented interictal epileptiform activity. Additionally, in patients with secondary ASD there was a statistically significant positive and negative correlation between FDIEA and the topological properties of the network. CONCLUSIONS: Patients with secondary ASD display patterns of functional connectivity that are weaker for the alpha frequency and stronger for theta and delta than patients with primary ASD. In patients with secondary ASD, the interictal epileptiform activity is related to local and global connectivity of the network for the alpha and beta bands during non-REM sleep.

TITLE: Conectividad funcional derivada del electroencefalograma durante el sueño no REM en los trastornos del espectro autista.Objetivo. Conocer las diferencias en los patrones de conectividad funcional, las caracteristicas topologicas de la red y la relacion de estas con las anomalias epileptiformes interictales en niños con trastorno del espectro autista (TEA) primario y secundario. Pacientes y metodos. Se realizo un estudio retrospectivo con 27 niños de 3-13 años diagnosticados con TEA, a los que se les realizo un electroencefalograma en estado funcional de sueño espontaneo. Se analizo la conectividad funcional y las propiedades de la red a partir de los datos obtenidos del electroencefalograma durante la etapa N2 del sueño no REM. Se determino la frecuencia de descarga de la actividad epileptiforme interictal (FDAEI) y se correlaciono con las propiedades topologicas de la red. Resultados. Los pacientes con TEA secundario tenian una disminucion de la sincronizacion para la frecuencia alfa y un incremento para la frecuencia theta y delta en comparacion con los pacientes con TEA primario. La eficiencia local alfa fue mayor en los pacientes que presentaban actividad epileptiforme interictal. Ademas, en los pacientes con TEA secundario, existia una correlacion positiva y negativa estadisticamente significativa entre la FDAEI y las propiedades topologicas de red. Conclusiones. Los pacientes con TEA secundario muestran patrones de conectividad funcional mas debiles para la frecuencia alfa y mas fuerte para la theta y delta que los pacientes con TEA primario. En pacientes con TEA secundario, la actividad epileptiforme interictal se relaciona con la conectividad local y global de la red para las bandas de frecuencia alfa y beta durante el sueño no REM.

[Corticospinal dysfunction in patients with primary and amyotrophic lateral sclerosis]. / Disfunción corticoespinal en pacientes con esclerosis lateral primaria y amiotrófica.

INTRODUCTION: Corticoespinal dysfunction is a common finding in primary and amyotrophic lateral sclerosis (PLS and ALS). AIM. To compare the behaviour of motor evoked potentials (MEP) with transcranial magnetic stimulation (TMS) in patients with ALS and PLS. PATIENTS AND METHODS: It was performed a retrospective analysis of MEP recordings of 11 patients with PLS and 10 patients with sporadic ALS. Central motor conduction time and amplitude ratio were the selected variables for the statistical analysis of MEP from abductor pollicis brevis and tibialis anterior muscle from the four limbs, using non-parametric methods. RESULTS: As a general observation there was a high incidence of abnormal recordings in both groups of patients; in 30% of recording from ALS patients response to TMS was absent, but only the 4.5% in the group of PLS had the same characteristic. In PLS patients abnormal central motor conduction time was the most frequent finding, as it was the low amplitude ratio in ALS patients; both variables showed statistically significant differences between groups (Kruskall-Wallis, H = 6.32, p = 0.011; and Kruskall-Wallis, H = 5.777, p = 0.0163, respectively). CONCLUSION: Corticoespinal dysfunction has different characteristics in ALS and PLS patients, and the analysis of MEP could add useful information for differential diagnosis of these diseases.

[Brainstem lesions: clinicoradiological electrophysiological correlation when chronic]. / Lesiones del tronco cerebral en estadio crónico: correlación clínica, radiológica y electrofisiológica.

INTRODUCTION: The brainstem is a vital structure. Imaging and electrophysiological studies are important aids to clinical diagnosis. OBJECTIVE: To define the clinical, imaging and electrophysiological correlation in 28 patients with chronic brainstem lesions. PATIENTS AND METHODS: We analyzed the results of physical examination, imaging studies (CAT and MR) and brainstem auditory evoked potentials (BEAP) in each patient. RESULTS: There was a predominance of males in the group studied. The commonest age groups were between 25 34 and 35 44 years old. Involvement of the cranial nerves was the commonest neurological finding, and the XII cranial nerve was the one most commonly involved. The condition had persisted for 1 to 4 years in 60.8% of the patients. There was a predominance of lesions of the pons in 28.6%. In five patients classical syndromes were seen. The commonest aetiology was ischaemic cerebrovascular disease in 53.6% of the patients. The lesions were detected on MR in 86.6% of the cases and on CAT scans in only 27.3%. The BEAP was abnormal in 75% of the patients. There was close correlation between the clinical topography and results of MR (p<0.05) but little correlation with the CAT scans or PEATC. CONCLUSION: We consider that MR is the investigation of choice in these patients.

[Intensive multifactorial rehabilitation in patients with multiple sclerosis]. / Rehabilitación multifactorial e intensiva en pacientes con esclerosis múltiple.

INTRODUCTION: Studies have been published recommending rehabilitation in multiple sclerosis (EM), but in practice this is often not indicated. PATIENTS AND METHODS: We made a retrospective analysis of 41 patients diagnosed as definitely having EM (clinical form of relapse remission, in phase of remission) according to the criteria of Poser et al. These patients carried out a programme of intensive multifactorial rehabilitation of 41 hours per week with a minimum duration of 10 days and a maximum of 178 days. There were classified on the EDSS scale of Kurztke and Hanser s ambulatory index on admission and when their treatment had finished. These results were compared using the Wilcoxon test for paired series and we analysed the relation between the time of treatment and final score on the scales applying the Spearman s multiple range correlation test. RESULTS: The differences were statistically significant between the scores for initial and final evaluations of the Kurztke and Hauser scales (Z: 3.17, p: 0.001475 and Z: 3.29, p: 0.000983 respectively). No correlation was shown between total duration of treatment or total duration of the disorder and the final score on the scale (p > 0.05). CONCLUSION: Intensive multifactorial rehabilitation treatment may have a positive effect in patients with Em with the clinical form of relapse remission, according to the scales applied. We therefore recommend their indication in patients during the remission phase.

[The importance of multifactorial rehabilitation treatment in amyotrophic lateral sclerosis]. / Importancia del tratamiento rehabilitador multifactorial en la esclerosis lateral amiotrófica.

INTRODUCTION: The treatment of amyotrophic lateral sclerosis (ALS) is still a major challenge. Rehabilitation treatment is scarcely considered and its usefulness in these patients continues to be controversial. PATIENTS AND METHODS: A multidisciplinary team made up of neurologists, physiotherapists, logopaedists, defectologists, psychologists and specialist physicians treated six patients with ALS in an intensive rehabilitation programme of 41 hours per week for four weeks. We follow certain basic principles in rehabilitation including: 1. Treatment by a multidisclipinary team; 2. Treatment tailored to the individual; 3. Avoidance of muscle fatigue and vigorous exercise, and 4. Intensive treatment with carefully measured amounts of different activities (logophoniatrics, occupational therapy, psychology, physical therapy, etc.) to avoid fatigue. The patients fulfilled the criteria of E1 Escorial for the diagnosis of definite ALS, and gave their informed consent to undergo the treatment. Forced Vital Capacity (FVC) and ALS Functional Rating Scale (ALSFRS) tests were done on all patients at the beginning and end of the treatment. The Wilcoxon test for paired series, comparing scores at the start and finish, were done in each case. RESULTS: In all patients the FVC and ALSFRS improved after the treatment. The results were statistically significant (Z: 2.2013; p= 0.027) on the Wilcoxon paired series test and no complications were seen. CONCLUSIONS: Intensive, multifactorial rehabilitation treatment for four weeks improved the FVC and ALSFRS in all patients with ALS and no complications were seen. Until there is a curative treatment for ALS, multifactorial rehabilitation remains the best hope for these patients.

[Giant evoked potentials]. / Potenciales evocados gigantes.

INTRODUCTION: There are many, diverse nosological entities with the common factor of the genesis of cortical evoked potentials of great amplitude, commonly known as giant evoked potentials. In most cases they are conditions with the common clinical condition of myoclonic of cortical origin, such as progressive myoclonic epilepsy, generalized idiopathic epilepsy, myoclonias of toxic, infectious or postanoxic origin. Giant potentials have been shown both in studies of focal hemisphere lesions and in some cases of patients with corticobasal degeneration. OBJECTIVE: The aim of this paper was to show, by presenting interesting cases, some of the conditions mentioned and to review some concepts concerning the mechanisms which may be involved in the production of these electrophysiological responses. PATIENTS AND METHODS: We studied 6 patients aged between 2 and 22 years, in whom multimodal evoked potentials, electroencephalograms and imaging studies had been done. RESULTS: Giant somatosensory potentials were shown in the patients with obvious myoclonia. Visual potentials of great amplitude were common to the other patients presented, with or without myoclonia. CONCLUSION: Giant evoked potentials respond to a state of cortical hyperexcitability which may have various causes.

[Cortical plasticity and restoration of neurologic functions: an update on this topic]. / Plasticidad cortical y restauración de funciones neurológicas: una actualización sobre el tema.

INTRODUCTION: Neuroplasticity is a natural property of the nervous system to change its function and to reorganize due to a lesion or environmental changes. We review some of the main experimental and clinical experiences on cortical sensorimotor plasticity related to central nervous system (CNS) lesions. DEVELOPMENT: In the last 10 years increasing interest in neuronal plasticity has been prompted by several important discoveries. Long term potentiation and depression have been described as basic synaptic mechanism mediating functional recovery after CNS lesions, modulated by the up-down regulation of inhibitory-excitatory activity related to GABA, acetylcholine and glutamate between other neurotransmitters. In humans there are evidences from functional reorganization in the affected hemisphere in patients with hemispheric lesions, and the activation of homologues areas in the contralateral healthy hemisphere. Significative changes in the topography of cortical somatosensory and motor maps have been demonstrated using non invasive mapping techniques as multichannel EEG, evoked potential, transcranial magnetic stimulation, functional magnetic resonance imaging and positron emission tomography. Axonal and dendritic sprouting take place in animal models of brain lesions; but effective neural regeneration in the CNS does not seem to be a plausible mechanism for functional restoring. CONCLUSIONS: Plastic changes after CNS lesions make it possible the restoration of neurological functions in a high number of patients. It is important now to understand which changes are related to the clinical improvement of patients, and what might be done to promote or facilitate this changes and to inhibit maladaptive phenomena, for the design of rationale therapeutics strategies with modulatory influence on this process.

[Single fiber electromyography in the diagnosis of myasthenia gravis]. / Electromiografía de fibra única en el diagnóstico de la miastenia gravis.

INTRODUCTION: The electrophysiological exam complements the clinical diagnosis in patients with suspected myasthenia gravis. The most common used electrophysiological test are the repetitive nerve stimulation test (RNST) and the single fiber electromyography (SFEMG); this last one is more sensitive than the first one. OBJECTIVE: To describe the usefulness of SFEMG in a group of myasthenic patients. PATIENTS AND METHODS: We studied 52 patients with a clinical diagnosis of myasthenia gravis (female: 35, male: 17; age range: 10-48 years). They were classified according to Osserman (type I, IIa, IIb, III and IV) and correlated to the electrophysiological findings. RNST was carried out in abductor digiti minimi, trapezius and orbicularis oculi; and SFEMG was carried out in the extensor digiturum communis and frontalis muscles. It was analyzed the sensitiveness of each technique detecting neuromuscular transmission abnormalities, and the correspondence between the results of both techniques. RESULTS: The most frequent clinical form observed was the type I (22 patients), followed by 18 as type IIa, 9 as type IIb, and 3 as type IV; no one as type III. RNST with positive decrement was observed in 48% of patients, but neuromuscular jitter calculated by means of SFEMG was abnormal in the 100% of them, being statistically significant the difference (chi 2 = 79.72; p = 0.000). The highest positivity index in the SFEMG was observed in the frontalis muscle. Patients from groups IV, IIb and I were the most electrophysiologically affected (t = 8.23211; p < 0.05). CONCLUSION: SFEMG is a very sensitive electrophysiological tool, detecting abnormalities in neuromuscular jitter in the 100% of myasthenic patients, with an excellent clinical correlation.

[Juvenile amyotrophic lateral sclerosis. Apropos of a case]. / Esclerosis lateral amiotrófica juvenil. A propósito de un caso.

INTRODUCTION: There are scanty reports on juvenile forms of amyotrophic lateral sclerosis, specially amyotrophic lateral sclerosis and deafness, and it is known as Madras pattern of motor neurone disease. CLINICAL CASE: We describe an sporadic case of juvenile amyotrophic lateral sclerosis with deafness in a young person who started with hearing loss at 21 years old, loss of strength in upper limbs and muscular atrophy. He was seen by a neurologist when he was 25 years old, there were evident generalized fasciculation activity in proximal and distal muscles in the four limbs and the tongue, with swallowing troubles, and increased tendon reflexes in lower limbs with abnormal plantar extensor responses. All the paraclinical test were normal, except the electromyogram, showing a classical pattern of lower motor neuron disease, and the auditory brain stem response with absence of the main components of this evoked response, as expression of VIII cranial nerve damage. DISCUSSION: Patients like this one were first described in Madras (India), and the evolution of this kind of juvenile form of amyotrophic lateral sclerosis is chronically progressive and relative benign, in relation to the classical form of amyotrophic lateral sclerosis and other forms of motor neurone disease which begin in childhood, adolescence or young adulthood. CONCLUSION: Its recognition is very important in order to diminish misleading therapies in these patients.