Acute quetiapine overdose is associated with risk of ectopic atrial rhythm.

Quetiapine overdose is commonly associated with coma, respiratory depression, hypotension, tachycardia, and QTc interval prolongation on the electrocardiogram.

La sobredosis aguda de quetiapina se asocia con riesgo de ritmo auricular ectópico / [Acute quetiapine overdose is associated with risk of ectopic atrial rhythm]

La sobredosis de quetiapina se asocia comúnmente con coma, depresión respiratoria, hipotensión, taquicardia y prolongación del intervalo QTc en el electrocardiograma. Aunque se ha establecido el efecto arritmogénico de los antipsicóticos sobre la arritmia ventricular, aún no se conoce bien su papel en las arritmias auriculares, específicamente las causadas por un ritmo auricular ectópico (RAE). Nuestro objetivo es presentar un caso y revisión sobre la asociación entre quetiapina y RAE. Los datos se obtuvieron de las historias clínicas y de la búsqueda bibliográfica en PubMed. Presentamos el caso de una mujer de 57 años que acudió a urgencias tras una sobredosis de quetiapina con una RAE de nuevo diagnóstico que revirtió horas después. Esta asociación puede deberse al mayor riesgo de quetiapina de bloqueo de los receptores muscarínicos cardíacos que puede provocar anomalías en la conducción. Debido a la posibilidad de degeneración a otras alteraciones del ritmo más graves, la implantación de marcapasos y el aumento de la mortalidad, existe la necesidad de una mayor conciencia de esta correlación. (AU)

Quetiapine overdose is commonly associated with coma, respiratory depression, hypotension, tachycardia, and QTc interval prolongation on the electrocardiogram. Although the arrhythmogenic effect of antipsychotics on ventricular arrhythmia has been established, their role in atrial arrhythmias is still not quite understood, specifically the ones caused by an ectopic atrial rhythm (EAR). We aim to present a case and review on the association between Quetiapine and EAR. Data were obtained from clinical records and bibliographic research on PubMed. We present the case of a 57-year-old woman brought to the emergency room after a Quetiapine overdose with a newly diagnosed EAR that reverted hours later. This association may be due to Quetiapine’s increased risk of cardiac muscarinic receptors blockade that can lead to conduction abnormalities. Because of the possibility of degeneration to other more serious rhythm alterations, pacemaker implementation and increased mortality, there is a need for greater awareness of this correlation. (AU)

Experiences with remote communication in adult intensive care units during the COVID-19 pandemic: a systematic review protocol.

OBJECTIVE: The objective of this review is to explore the lived experiences of critically ill adults, their families, or health care professionals with remote communication in intensive care units (ICUs) during the COVID-19 pandemic. INTRODUCTION: Family visiting restrictions in ICUs during the COVID-19 pandemic imposed significant challenges to communication between critically ill adults, their families, and the health care team. Evidence shows that several communication strategies were developed and implemented in ICUs during the COVID-19 pandemic to promote family engagement; however, the experiences of critically ill adults, their families, and health care professionals with these strategies are scattered across primary qualitative studies. INCLUSION CRITERIA: This review will consider qualitative studies that include critically ill adults, their families, or health care professionals, focusing on their experiences with remote communication strategies in ICUs during the COVID-19 pandemic. METHODS: This review will be conducted in accordance with JBI methodology. The search strategy will aim to locate both published and unpublished qualitative studies in English, Spanish, and Portuguese. Studies published after January 2020 will be included. Study selection, critical appraisal, and data extraction will be performed independently by 2 reviewers. Data will be presented in narrative format and synthesized using the JBI meta-aggregation process. A ConQual Summary of Findings will be presented. REVIEW REGISTRATION: PROSPERO CRD42022383603.

What do we know about pseudodementia?

Depression and dementia can lead to generalised cognitive and memory dysfunction. Thus, differentiating these disorders is important and challenging. Pseudodementia is a term used clinically to describe symptoms that resemble dementia but are caused by other conditions (most frequently depression), rather than being recognised as an official diagnosis. Pseudodementia is characterised by a cognitive impairment that mimics dementia but which does not have its origin in neurological degeneration, deriving instead from functional psychiatric conditions. This condition is more commonly observed in older adults (particularly those over the age of 50 or 60 years), and its risk factors overlap with those for depression. Pseudodementia is essentially characterised by deficits in memory, executive function and speech and, therefore, can easily be confused with dementia, although there are aspects that allow its differentiation. Diagnosing pseudodementia can be difficult, especially as there is significant overlap between its symptoms and those of other conditions. However, it is important to recognise characteristic aspects of this disorder, as its correct identification is essential for proper treatment.

Climate variability effects on eutrophication of groundwater, lakes, rivers, and coastal waters in the Netherlands.

Many aquatic ecosystems in densely populated delta areas worldwide are under stress from overexploitation and pollution. Global population growth will lead to further increasing pressures in the coming decades, while climate change may amplify the consequences for chemical and ecological water quality. In this study, we explored the effects of climatic variability on eutrophication of groundwater, streams, rivers, lakes, estuaries, and marine waters in the Netherlands. We exploited the relatively dense monitoring information from the Dutch part of the Rhine-Meuse delta to evaluate the water quality response on climatic variability, in combination with anthropogenic pressures. Our results show that water quality of all water systems in the Netherlands is affected by climate variability in several ways: 1) through the process of global climate change (mainly temperature and sea level rise), 2) through changes Atlantic ocean circulation patterns (more southwestern winds), 3) through changes in continental precipitation and river discharge fluctuations, and 4) through local climatic fluctuations. The impact of climate variability propagates through the hydrological system 'from catchment to coast'. The fluctuations in water quality induced by climatic variability shown in this study give a preview for the potential effects of climate change.

Velocidade do alcance em tarefas de atenção e memória: validação do teste como marcador funcional na população geriátrica / Attainment speed in attention and memory tasks: test validation as a functional indicator in the geriatric population

OBJETIVO: Validar a velocidade do alcance durante tarefas de atenção e memória como um indicador funcional na população geriátrica. MÉTODOS: Idosos institucionalizados residentes em 4 instituições no centro de Portugal foram caraterizados quanto ao seu perfil funcional, constando as seguintes variáveis: (i) cognição; (ii) independência nas atividades da básicas da vida diária (AVD); (iii) independência nas atividades instrumentais da vida diária (AIVD); (iii) força de preensão, (iv) diagnóstico de depressão; (v) função sensório-motora membro superior; (vi) funções executivas. Os vários instrumentos foram submetidos a um processo de linking com a Classificação Internacional de Funcionalidade e Saúde (CIF). A amostra foi dividida em quatro grupos funcionais considerando os valores abaixo e superiores à média da velocidade de alcance em tarefas de atenção (Grupo 1 - G1, Grupo 2 - G2) e a velocidade de alcance em tarefas de memória (Grupo 3 - G3, Grupo 4 - G4). A caraterização dos grupos de amostra foi realizada utilizando medidas de estatística descritiva dos qualificadores da CIF e a diferença entre grupos (G1/G2 e G3/G4) foi testada utilizando testes t para amostras independentes. RESULTADOS: Os resultados mostraram diferenças significativas entre grupos de baixo e elevado perfil nos testes de alcance (p<0.05), identificando as seguintes áreas prioritárias de intervenção em idosos institucionalizados: d6. Vida doméstica, d1. Aprendizagem e aplicação de conhecimento, d4. Mobilidade, d5. Autocuidados e d8. Áreas significativas da vida. Idosos com velocidade no teste de alcance em tarefas de atenção <0.06m/s ou com valores <0.07m/s no teste de alcance em tarefas de memória tendem a apresentar uma incapacidade moderada a grave em áreas como a Mobilidade e os Autocuidados e uma incapacidade grave a completa na participação de tarefas da Vida Doméstica. CONCLUSÃO: Este estudo foi um importante contributo para a validação da velocidade do alcance (um teste para a função do membro superior) durante tarefas de atenção e memória como um indicador funcional, possibilitando a avaliação funcional de um largo espectro de idosos, incluindo os não ambulantes.

AIM: To validate the reaching speed during attention and memory tasks as a functional indicator in the geriatric population. METHODS: Institutionalized elderly living in 4 Portuguese institutions were characterized by their functional profile, with the following variables: (i) cognition; (ii) independence in basic daily living activities; (iii) independence in instrumental activities of daily living; (iii) grip strength, (iv) diagnosis of depression; (v) upper limb sensorimotor function; (vi) executive functions. All these instruments underwent a linking process with the International Classification of Functioning and Health. The sample was divided into four functional groups considering the values below and above the mean range of reaching speed in attention tasks (Group 1 - G1, Group 2 - G2) and the range of RS in memory tasks (Group 3 - G3, Group 4 - G4). Characterization of the sample groups was performed using descriptive statistical measures of the ICF qualifiers and the difference between groups (G1 / G2 and G3 / G4) was tested using t-tests for independent samples. RESULTS: The results showed significant differences between low- and high-profile groups in RS tasks (p <0.05), identifying the following priority intervention areas in institutionalized elderly: d6. Domestic life, d1. Learning and knowledge application, d4. Mobility, d5. Self-care and d8. Significant areas of life. Older adults with reaching speed in attention tasks <0.06m/s or <0.07m/s in memory tasks tend to have moderate to severe disability in Mobility and Self-Care and severe/complete inability to participate in Household tasks. CONCLUSION: This study was an important contribution to the validation of reaching speed (a test for upper limb function) during attention and memory tasks as a functional indicator, enabling elderly functional evaluation in a large spectrum, including non-ambulate elderly people.