Usage of immersive virtual reality as a relaxation method in an intensive care unit.

INTRODUCTION: The usage of immersive virtual reality (iVR) in the context of an intensive care unit (ICU) is scarce. Our objective was to assess the feasibility of the usage of iVR in critical patients with or without mechanical ventilation (MV) and to determine the anxiety degree before and after each session. METHODS: Analytical, descriptive, prospective, and cross-sectional research. Pilot test with 20 patients from a polyvalent ICU of a tertiary hospital. Adult patients were included, either connected or not to MV, watchful and calmed (RASS -1/+1) and without delirium (negative CAM-ICU). Oculus Go (Facebook Technologies, LLC) iVR glasses were the model used. The relaxation strategy consisted in the visualization of an experience of 15 min with scenes related to nature and fantasy, relaxing music with a plot. The sessions were individual, with the patient monitored in a fowler position or seated. The anxiety degree before and after each session was evaluated following a reduced version of the Spanish "Cuestionario de Ansiedad Estado-Rasgo (STAI-e)" and they were analysed using T samples coupled (statistical significance when p-value was <0.05). RESULTS: Incorporation of 20 patients with an average age of 63.9 years old (60% men). A total of 34 sessions of iVR were conducted. 32% patients mechanically ventilated, 32% high-flow oxygen therapy, 36% other breathing supports. 80% of the sessions were completed without serious side effects. A significant decrease in the anxiety degree was observed after each iVR session: first session mean change -2.68 (SD = 2.75), p = 0.000; second session mean change -1.86 (SD = 1.57), p = 0.021; third session mean change -1.67 (SD = 1.63), p = 0.054. CONCLUSION: The usage of iVR in the context of an ICU is feasible, even with patients mechanically ventilated. iVR reduces the anxiety degree in the critic patient, which suggests that "digital therapies" can be effective to improve the emotional state during their stay in the ICU.

Manejo actual de las terapias continuas de reemplazo renal: Estudio epidemiológico multicéntrico / Current practice in continuous renal replacement therapy: An epidemiological multicenter study

OBJETIVO: Determinar las características más relevantes del manejo actual de las terapias continuas de reemplazo renal (TRRC), así como analizar la evolución de la función renal y la mortalidad de los pacientes tratados con estas terapias. MÉTODOS: Estudio observacional sin intervención de 3meses de duración en 2012 con un periodo de seguimiento de 90 días, realizado en 21 hospitales de Cataluña, en que se registraron escalas de gravedad, datos demográficos, clínicos y de las TRRC. CRITERIOS DE INCLUSIÓN: pacientes de ≥16 años ingresados en cuidados intensivos (UCI) tratados con TRRC. RESULTADOS: Se seleccionó a 261 pacientes. Un 35% tenía disfunción renal previa al ingreso. El principal motivo para iniciar las TRRC fue la oliguria, la modalidad más empleada fue la hemodiafiltración y la mediana de dosis prescrita al inicio fue de 35mL/kg/h. La mediana de tiempo de inicio de la TRRC desde el ingreso en UCI fue de un día. La mortalidad a los 30 y 90 días fue de 46 y 54%, respectivamente, y se relacionó con peores valores en las escalas de gravedad y con un inicio más tardío de la TRRC. Al alta hospitalaria, un 85% de los supervivientes había recuperado la función renal. CONCLUSIONES: El manejo de las TRRC en Cataluña se adecua a los estándares recomendados por las guías actuales. La mortalidad asociada a las TRRC se relaciona con un inicio más tardío. Un 85% de los pacientes tratados con TRRC recuperan la función renal al alta hospitalaria

OBJECTIVE: The aim of the study is to ascertain the most relevant aspects of the current management of renal replacement therapy (RRT) in critically ill patients, and to analyze renal function recovery and mortality in patients undergoing RRT. METHODS: A non-interventional three-month observational study was made in 2012, with a follow-up period of 90 days, in 21 centers in Catalonia (Spain). Demographic information, severity scores and clinical data were obtained, as well as RRT parameters. Inclusion criteria: patients aged ≥ 16 years admitted to Intensive Care Units (ICUs) and subjected to RRT. Results A total of 261 critically ill patients were recruited, of which 35% had renal dysfunction prior to admission. The main reason for starting RRT was oliguria; the most widely used RRT modality was hemodiafiltration; and the median prescribed dose at baseline was 35mL/kg/h. The median time of RRT onset from ICU admission was one day. The mortality rate at 30 and 90 days was 46% and 54%, respectively, and was associated to greater severity scores and a later onset of RRT. At discharge, 85% of the survivors had recovered renal function. CONCLUSIONS: Current practice in RRT in Catalonia abides with the current clinical practice guidelines. Mortality related to RRT is associated to later onset of such therapy. The renal function recovery rate at hospital discharge was 85% among the patients subjected to RRT

Plasmapheresis and other extracorporeal filtration techniques in critical patients / Plasmaféresis y otras técnicas de depuración extracorpórea en pacientes críticos

Plasmapheresis is an extracorporeal technique that eliminates macromolecules involved in pathological processes from plasma. A review is made of the technical aspects, main indications in critical care and potential complications of plasmapheresis, as well as of other extracorporeal filtration techniques such as endotoxin-removal columns and other devices designed to eliminate cytokines or modulate the inflammatory immune response in critical patients

La plasmaféresis es una técnica extracorpórea mediante la cual se procede a la eliminación de macromoléculas del plasma que se consideran mediadores de procesos patológicos. En este artículo se revisan los aspectos técnicos, las principales indicaciones en las patologías que suelen motivar ingreso en la Unidad de Cuidados Intensivos y las potenciales complicaciones de la plasmaféresis. Así mismo, se incluye una revisión de otras técnicas de depuración extracorpórea, tales como las columnas de fijación de endotoxinas y otros procedimientos que persiguen la eliminación de citoquinas o la inmunomodulación del proceso inflamatorio en el paciente crítico

Plasmapheresis and other extracorporeal filtration techniques in critical patients.

Plasmapheresis is an extracorporeal technique that eliminates macromolecules involved in pathological processes from plasma. A review is made of the technical aspects, main indications in critical care and potential complications of plasmapheresis, as well as of other extracorporeal filtration techniques such as endotoxin-removal columns and other devices designed to eliminate cytokines or modulate the inflammatory immune response in critical patients.

Current practice in continuous renal replacement therapy: An epidemiological multicenter study. / Manejo actual de las terapias continuas de reemplazo renal: Estudio epidemiológico multicéntrico.

OBJECTIVE: The aim of the study is to ascertain the most relevant aspects of the current management of renal replacement therapy (RRT) in critically ill patients, and to analyze renal function recovery and mortality in patients undergoing RRT. METHODS: A non-interventional three-month observational study was made in 2012, with a follow-up period of 90 days, in 21 centers in Catalonia (Spain). Demographic information, severity scores and clinical data were obtained, as well as RRT parameters. INCLUSION CRITERIA: patients aged ≥ 16 years admitted to Intensive Care Units (ICUs) and subjected to RRT. RESULTS: A total of 261 critically ill patients were recruited, of which 35% had renal dysfunction prior to admission. The main reason for starting RRT was oliguria; the most widely used RRT modality was hemodiafiltration; and the median prescribed dose at baseline was 35mL/kg/h. The median time of RRT onset from ICU admission was one day. The mortality rate at 30 and 90 days was 46% and 54%, respectively, and was associated to greater severity scores and a later onset of RRT. At discharge, 85% of the survivors had recovered renal function. CONCLUSIONS: Current practice in RRT in Catalonia abides with the current clinical practice guidelines. Mortality related to RRT is associated to later onset of such therapy. The renal function recovery rate at hospital discharge was 85% among the patients subjected to RRT.

[PCR-based detection of heteroplasmic deleted mitochondrial DNA in Kearns-Sayre syndrome]. / Detección de deleciones en DNA mitocondrial heteroplásmico por medio de PCR EN el síndrome de Kearns-Sayre.

OBJECTIVE: To describe the clinical data and the results of molecular analyses of the mitochondrial DNA in a patient with Kearns-Sayre Syndrome. METHODS: Molecular analyses of mitochondrial DNA from the patient included PCR amplification of a region where the common Kearns- Sayre deletion is located and Genotype-Phenotype correlations are discussed. RESULTS: The affected patient showed ptosis, progressive external ophthalmoplegia, pigmentary changes in the peripheral retina and right bundle block. Molecular analysis disclosed a approximately 5 kb deletion in the mitochondrial DNA and some wild type mtDNA indicating heteroplasmy. CONCLUSIONS: Molecular analysis of mitochondrial DNA confirmed the clinical diagnosis of Kearns-Sayre syndrome. PCR provides a rapid method to identify the common 4997 bp deletion in Kearns-Sayre syndrome. In such cases, PCR diagnosis could avoid invasive methods such as muscle biopsy or spinal tap.

Detección de deleciones en DNA mitocondrial heteroplásmico por medio de PCR en el síndrome de Kearns-Sayre / PCR-based detection of heteroplasmic deleted mitochondrial DNA in Kearns-Sayre syndrome

Objetivo: El síndrome de Kearns-Sayre (SKS) esun trastorno neuromuscular causado por defectosgenéticos en el DNA mitocondrial siendo delecionesde tamaño variable la alteración mas común. Sedescriben las características clínicas y los resultadosdel análisis molecular del DNA mitocondrial enuna paciente Mexicana con Síndrome de Kearns-Sayre.Métodos: Examen oftalmológico completo, caracterizaciónfenotípica del Síndrome de Kearns-Sayrey análisis del DNA mitocondrial mediante reacciónen cadena de la polimerasa (PCR). Se discutencorrelaciones genotipo-fenotipo.Resultados: La paciente afectada mostró ptosis,oftalmoplejia progresiva externa cambios pigmentariosen retina periférica y bloqueo de rama derechadel haz de His. Los análisis moleculares revelaronuna deleción de ~5 kb en el DNA mitocondrial además de trazas de DNA sin alteraciones indicandoheteroplasmia.Conclusiones: El análisis molecular del DNAmitocondrial confirmó el diagnostico clínico de síndromede Kearns-Sayre. La utilización de PCR,como se describe en este trabajo, es un método rápidoy económico para el diagnóstico de la delecióncomún de 4977 pb en el síndrome de Kearns-Sayre.En estos casos, el diagnóstico por PCR evitaría procedimientosdiagnósticos invasivos y traumáticoscomo biopsia muscular o punción lumbar

Objective: To describe the clinical data and theresults of molecular analyses of the mitochondrialDNA in a patient with Kearns-Sayre Syndrome.Methods: Molecular analyses of mitochondrialDNA from the patient included PCR amplificationof a region where the common Kearns- Sayre deletionis located and Genotype-Phenotype correlationsare discussed.Results: The affected patient showed ptosis, progressiveexternal ophthalmoplegia, pigmentarychanges in the peripheral retina and right bundleblock. Molecular analysis disclosed a ~5kb deletionin the mitochondrial DNA and some wild type mtDNAindicating heteroplasmy.Conclusions: Molecular analysis of mitochondrialDNA confirmed the clinical diagnosis of Kearns-Sayre syndrome. PCR provides a rapid method toidentify the common 4997 bp deletion in Kearns Sayre syndrome. In such cases, PCR diagnosiscould avoid invasive methods such as musclebiopsy or spinal tap

A/G Gln20Arg (exon 1) and G/A Val156Met (exon 5) polymorphisms of the human orosomucoid 1 gene in Mexico.

The human orosomucoid 1 gene (ORM1) codes an alpha-1-acid glycoprotein that has been classified as an acute-phase reactive protein, and a major drug-binding serum component, as well as an immunomodulatory protein with genetic polymorphisms. Evaluation of ORM variation through isoelectric focusing and immunobloting has revealed a world-wide distribution of the ORM1 F and ORM1 S alleles. We evaluated and examined the genetic characteristics of two Mexican populations that have different anthropological and cultural antecedents, examining two ORM1 genotypes (exon 1 - A/G (Gln20Arg) and exon 5 G/A (Val156Met)) in 145 individuals, using nested polymerase chain reaction, sequencing, and restricted fragment length polymorphism. Mexican Mestizos had higher frequencies of the exon 1 A allele (P = 0.020) and AA genotype (P = 0.018) and lower frequency of the G allele (P = 0.020) when compared to Teenek Amerindians. When we examined exon 5 G/A (Val156Met) polymorphisms, we found significantly higher frequencies of the G allele (P = 0.0007) and the GG genotype (P = 0.0003) in the Mexican Mestizo population. The Teenek population had a significantly higher frequency of the A allele than has been reported for Chinese and African (P < 0.05) populations, and the G/A genotype was more frequently found in this Mexican population than in Chinese, African and European populations (P < 0.05).

A/G Gln20Arg (exon 1) and G/A Val156Met (exon 5) polymorphisms of the human orosomucoid 1 gene in Mexico

The human orosomucoid 1 gene (ORM1) codes an alpha-1-acid glycoprotein that has been classified as an acute-phase reactive protein, and a major drug-binding serum component, as well as an immunomodulatory protein with genetic polymorphisms. Evaluation of ORM variation through isoelectric focusing and immunobloting has revealed a world-wide distribution of the ORM1 F and ORM1 S alleles. We evaluated and examined the genetic characteristicsof two Mexican populations that have different anthropological and cultural antecedents, examining two ORM1 genotypes (exon 1 - A/G (Gln20Arg) and exon 5 G/A (Val156Met)) in 145 individuals, using nested polymerase chain reaction, sequencing, and restrited fragment length polymorphism. Mexican Mestizos had higher frequencies of the exon 1 A allele (P = 0.020) and AA genotype(P = 0.018) and lower frequency of the G allele (P = 0.020) when compared to Teenek Amerindians. When we examined exon 5 G/A (Val156Met) polymorphisms, we found significantly higher frequencies of the G allele (P = 0.0007) and the GG genotype (P = 0.0003) in the Mexican Mestizo population. The Teenek population had a significantly higher frequency of the A allele than has been reported for Chinese and African (P < 0.05) populations, and the G/A genotype was more frequently found in this Mexican population than in Chinese, African and European populations (P < 0.05).