Failure of Non-Invasive Respiratory Support in Patients with SARS-CoV-2.

INTRODUCTION: The objective of this study is to assess the failure of therapies with HFNO (high-flow nasal oxygen), CPAP, Bilevel, or combined therapy in patients with hypoxemic acute respiratory failure due to SARS-CoV-2 during their hospitalization. METHODS: This was a retrospective and observational study of SARS-CoV-2-positive patients who required non-invasive respiratory support (NIRS) at the Reina Sofía General University Hospital of Murcia between March 2020 and May 2021. RESULTS: Of 7355 patients, 197 (11.8%) were included; 95 of them failed this therapy (48.3%). We found that during hospitalization in the ward, the combined therapy of HFNO and CPAP had an overall lower failure rate and the highest treatment with Bilevel (p = 0.005). In the comparison of failure in therapy without two levels of airway pressure, HFNO, CPAP, and combined therapy of HFNO with CPAP, (35.6% of patients) presented with 24.2% failure, compared to those who had two levels of pressure with Bilevel and combined therapy of HFNO with Bilevel (64.4% of patients), with 75.8% associated failure (OR: 0, 374; CI 95%: 0.203-0.688. p = 0.001). CONCLUSIONS: The use of NIRS during conventional hospitalization is safe and effective in patients with respiratory failure secondary to SARS-CoV-2 infection. The therapeutic strategy of Bilevel increases the probability of failure, with the combined therapy strategy of CPAP and HFNO being the most promising option.

Luis II de Baviera, El Rey Loco (Ludwig, 1973). La peritación psiquiátrica para una incapacitación, un caso histórico / Ludwig (1973). A Psychiatric Expertise for Incapacitation, a Historic Case

En este trabajo, partiendo de un personaje histórico como fue Luis II de Baviera, se hace un estudio de las circunstancias y hechos que se aportaron durante la peritación que una comisión de psiquiatras llevó a cabo para incapacitar al rey y apartarlo de la jefatura del Estado de Baviera. Se repasa la historia clínica del rey, desde sus antecedentes familiares a los personales y enfermedad actual. Las sustancias de las que el rey era dependiente y los síntomas que presentaba cuando se procedió a incapacitarlo. Todo ello en un contexto que nos lleva a preguntarnos: ¿Lo que realmente ocurrió fue un golpe de Estado, amparándose en que el dictamen de los psiquiatras decía que el rey estaba incapacitado para gobernar? El autor cinematográfico Luchino Visconti, en una de sus películas de la trilogía alemana, Luis II de Baviera, el rey loco / Ludwig (1973) de Luchino Visconti, nos muestra de una manera ejemplar, como se produjo aquel proceso. (AU)

This work, based on a historical character like Luis II of Bavaria, is a study of the circumstances surrounding the appraisal made by a Commission of psychiatrists to incapacitate the King and remove him from the leadership of the State of Bavaria. It makes a review of the clinical history of the King, from their family history to the personal one, the substances of which the King was dependent: chloroform, laudanum, alcohol and the symptoms presented on him when he was disabled, and everything with the evidence that what really happened was a coup d'Etat relying on the fact the King was unable to govern. This paper discusses possible diagnoses like Paranoia (according to the Expert Commission) to a PGP (tertiary syphilis) or the recent diagnoses of Dr. Haffner that state that what the King suffered was a bausuchtig, as well as a social phobia as a reaction to his homosexuality. In the final discussion we analyze of all these diagnostic and historical possibilities and we expose our opinion. The cinematographic author Luchino Visconti, in one of his films of the German trilogy, Ludwig (1973), shows us in an exemplary way, how that process took place. (AU)

Visual search in unilateral spatial neglect: The effects of distractors on a dynamic visual search task.

The objective of this study was to examine visual scanning performance in patients with Unilateral Spatial Neglect (USN) in a visual search task. Thirty-one right hemisphere stroke patients with USN were recruited. They performed a dynamic visual search task with two conditions, with and without distractors, while eye movements were monitored with an eye-tracker. The main goal of the task was to select target stimuli that appeared from the top of the screen and moved vertically downward. Target detection and visual scanning percentage were assessed over two hemispaces (right, left) on two conditions (distractor, no distractor). Most Scanned Regions (MSR) were calculated to analyze the areas of the screen where most points of fixation were directed to. Higher target detection rate and visual scanning percentages were found on the right hemispace on both conditions. From the MSRs we found that participants with a center of attention further to the right of the screen also presented smaller overall MSRs. Right hemisphere stroke patients with USN presented not only a significant rightward bias but reduced overall search areas, implying hyperattention does not only restrict search on the horizontal (right-left) axis but the vertical axis (top-bottom) too.

Combination treatment in the rehabilitación of visuospatial neglect / Tratamiento combinado en la rehabilitación de la negligencia visuo-espacial

BACKGROUND: Visuo-spatial neglect predicts longer hospitalization, poorer recovery of motor skills and greater functional limitation. The aim of the present study was to analyze whether the combined administration of computerized cognitive rehabilitation with right hemifield eye-patching in patients with left spatial neglect following a right hemisphere stroke is more effective than computerized cognitive rehabilitation applied in isolation. METHOD: Randomized clinical trial conducted in 28 patients. These were grouped into two experimental groups: single treatment group (ST) (n= 15) and combined treatment group (CT) (n= 13). All received an average of 15 one-hour sessions of computerized cognitive rehabilitation using the Guttmann, NeuroPersonalTrainer® telerehabilitation platform. Those patients in the TC group performed the sessions wearing a visual device with which the right hemifield of each eye was occluded. RESULTS: Following treatment, both the ST and the TC group showed improvements in neuropsychological examination protocol although there were no differences pre- and post-treatment on the functional scale in either group. Likewise, no statistically significant differences were observed in intergroup comparison. CONCLUSIONS: The results from this study indicate that combination treatment is not more effective than rehabilitation applied in isolation

ANTECEDENTES: la negligencia visuo-espacial predice mayor tiempo de hospitalización, peor recuperación de las habilidades motoras y limitaciones funcionales. El objetivo fue analizar si la administración combinada de rehabilitación cognitiva informatizada junto con el right hemifield eye patching, en participantes que presentan negligencia espacial izquierda como consecuencia de un ictus hemisférico derecho, es más eficaz que la rehabilitación cognitiva informatizada aplicada de forma aislada. MÉTODO: ensayo clínico aleatorizado realizado con 28 participantes. Dos grupos experimentales: grupo tratamiento único (TU) (n= 15) y grupo tratamiento combinado (TC) (n= 13). Todos ellos recibieron una media de 15 sesiones de rehabilitación cognitiva informatizada de una hora de duración mediante la plataforma de telerehabilitación Guttmann, NeuroPersonalTrainer®. Los participantes del grupo TC las ejecutaron con un dispositivo visual que llevaba el hemicampo derecho de cada ojo ocluido. RESULTADOS: tras el tratamiento, tanto el grupo TU como el TC mostraron mejoras en el protocolo de exploración neuropsicológica aunque no hubo diferencias pre- y post-tratamiento en la escala funcional en ninguno de los dos grupos. Asimismo, no se observaron diferencias estadísticamente significativas en la comparación intergrupal. CONCLUSIONES: los resultados derivados de este estudio indican que el tratamiento combinado no es más eficaz que la rehabilitación aplicada de forma aislada

Combination treatment in the rehabilitation of visuo-spatial neglect.

BACKGROUND: Visuo-spatial neglect predicts longer hospitalization, poorer recovery of motor skills and greater functional limitation. The aim of the present study was to analyze whether the combined administration of computerized cognitive rehabilitation with right hemifield eye-patching in patients with left spatial neglect following a right hemisphere stroke is more effective than computerized cognitive rehabilitation applied in isolation. METHOD: Randomized clinical trial conducted in 28 patients. These were grouped into two experimental groups: single treatment group (ST) (n= 15) and combined treatment group (CT) (n= 13). All received an average of 15 one-hour sessions of computerized cognitive rehabilitation using the Guttmann, NeuroPersonalTrainer® telerehabilitation platform. Those patients in the TC group performed the sessions wearing a visual device with which the right hemifield of each eye was occluded. RESULTS: Following treatment, both the ST and the TC group showed improvements in neuropsychological examination protocol although there were no differences pre- and post-treatment on the functional scale in either group. Likewise, no statistically significant differences were observed in intergroup comparison. CONCLUSIONS: The results from this study indicate that combination treatment is not more effective than rehabilitation applied in isolation.

[What is hidden behind the Baking Tray Task? Study of sensibility and specificity in right-hemispheric stroke patients]. / Que se esconde tras el Baking Tray Task? Estudio de sensibilidad y especificidad en sujetos con ictus hemisferico derecho.

INTRODUCTION: Tham and Tegner proposed the Baking Tray Task (BTT) as a fast simple assessment test for detecting spatial negligence. However, very few studies have examined its validity as a diagnostic test. AIM: To analyse the diagnostic validity of the BTT by measuring its specificity and sensitivity in a sample of subjects with right hemisphere strokes. SUBJECTS AND METHODS: Forty-eight patients with right hemisphere vascular lesions were distributed in two groups (negligence group, n = 35; non-negligence group, n = 13) according to the scores obtained in a battery of visuospatial examination tests. The participants' performance on the BTT was compared with that of a healthy control group (n = 12). RESULTS: The results showed a high level of sensitivity of the BTT, but low specificity. The performance on the BTT of eight of the 13 members of the non-negligence group was suggestive of negligence. CONCLUSIONS: The BTT has proved to be a sensitive test for the detection of spatial negligence. Yet, based on its low specificity, its use alone as a single diagnostic test is not recommended.

TITLE: Que se esconde tras el Baking Tray Task? Estudio de sensibilidad y especificidad en sujetos con ictus hemisferico derecho.Introduccion. Tham y Tegner propusieron el Baking Tray Task (BTT) como una prueba de evaluacion rapida y simple para la deteccion de negligencia espacial. No obstante, apenas existen estudios que hayan examinado su validez como prueba diagnostica. Objetivo. Analizar la validez diagnostica del BTT, midiendo su especificidad y sensibilidad, en una muestra de sujetos con ictus hemisfericos derechos. Sujetos y metodos. Cuarenta y ocho pacientes con lesiones vasculares hemisfericas derechas distribuidos en dos grupos (grupo negligencia, n = 35; grupo no negligencia, n = 13) en funcion de las puntuaciones obtenidas en una bateria de exploracion visuoespacial. La ejecucion de los participantes en el BTT se comparo con un grupo control sano (n = 12). Resultados. Los resultados mostraron una alta sensibilidad del BTT, pero una baja especificidad. Ocho de los 13 integrantes del grupo no negligencia obtuvieron un rendimiento en el BTT sugestivo de negligencia. Conclusiones. El BTT se muestra como un test sensible para la deteccion de la negligencia espacial. Sin embargo, basandonos en su baja especificidad, no es recomendable su uso aislado como prueba unica de diagnostico.

¿Qué se esconde tras el Baking Tray Task? Estudio de sensibilidad y especificidad en sujetos con ictus hemisférico derecho / What is hidden behind the Baking Tray Task? Study of sensibility and specificity in right-hemispheric stroke patients

Introducción. Tham y Tegnér propusieron el Baking Tray Task (BTT) como una prueba de evaluación rápida y simple para la detección de negligencia espacial. No obstante, apenas existen estudios que hayan examinado su validez como prueba diagnóstica. Objetivo. Analizar la validez diagnóstica del BTT, midiendo su especificidad y sensibilidad, en una muestra de sujetos con ictus hemisféricos derechos. Sujetos y métodos. Cuarenta y ocho pacientes con lesiones vasculares hemisféricas derechas distribuidos en dos grupos (grupo negligencia, n = 35; grupo no negligencia, n = 13) en función de las puntuaciones obtenidas en una batería de exploración visuoespacial. La ejecución de los participantes en el BTT se comparó con un grupo control sano (n = 12). Resultados. Los resultados mostraron una alta sensibilidad del BTT, pero una baja especificidad. Ocho de los 13 integrantes del grupo no negligencia obtuvieron un rendimiento en el BTT sugestivo de negligencia. Conclusiones. El BTT se muestra como un test sensible para la detección de la negligencia espacial. Sin embargo, basándonos en su baja especificidad, no es recomendable su uso aislado como prueba única de diagnóstico (AU)

Introduction. Tham and Tegnér proposed the Baking Tray Task (BTT) as a fast simple assessment test for detecting spatial negligence. However, very few studies have examined its validity as a diagnostic test. Aim. To analyse the diagnostic validity of the BTT by measuring its specificity and sensitivity in a sample of subjects with right hemisphere strokes. Subjects and methods. Forty-eight patients with right hemisphere vascular lesions were distributed in two groups (negligence group, n = 35; non-negligence group, n = 13) according to the scores obtained in a battery of visuospatial examination tests. The participants’ performance on the BTT was compared with that of a healthy control group (n = 12). Results. The results showed a high level of sensitivity of the BTT, but low specificity. The performance on the BTT of eight of the 13 members of the non-negligence group was suggestive of negligence. Conclusions. The BTT has proved to be a sensitive test for the detection of spatial negligence. Yet, based on its low specificity, its use alone as a single diagnostic test is not recommended (AU)

Cognitive rehabilitation with right hemifield eye-patching for patients with sub-acute stroke and visuo-spatial neglect: a randomized controlled trial.

OBJECTIVE: To assess whether, following a right-hemisphere stroke, the combined administration of computer-based cognitive rehabilitation and right hemifield eye-patching in patients with visuo-spatial neglect is more effective than computer-based cognitive rehabilitation alone. METHODS: Twelve patients were randomized into two treatment groups: a single treatment group (n = 7) and a combination treatment group (n = 5). In both cases, the treatment consisted of a mean number of 15 sessions, each lasting 1 hour. Visuo-spatial neglect was assessed using a specific exploration protocol (Bell Cancellation Test, Figure Copying of Odgen, Line Bisection, Baking Tray Task and Reading Task). The functional effects of the treatment were assessed using the Catherine Bergego Scale. RESULTS: Significant between-group differences were observed when comparing the pre- and post-treatment scores for the Reading Task. No differences were observed in either group in the Catherine Bergego Scale administered at baseline and at the final intervention. CONCLUSION: The results obtained do not allow one to conclude that the combination treatment with cognitive rehabilitation and right hemifield eye-patching is more effective than cognitive rehabilitation alone. Although partial improvement in the performance of neuropsychological tests was observed, this improvement is not present at functional level.

La rotación rural: un reto y una oportunidad para mejorar / Rural rotation: a challenge and an opportunity for improvement

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