Emotional intelligence abilities of caregivers of patients with acquired brain injury and cognitive impairment: are they related to overload or resilience?

Introduction: Acquired brain injury entails stressful situations of emotional complexity. Objective: To evaluate possible relationship among emotional intelligence, emotional status, resilience, and burden sensation of caregivers of patients with cognitive-behavioral impairment due to acquired brain injury in isolation circumstances because of COVID-19 pandemic. Material and methods: An observational descriptive cross-sectional study of prevalence was designed with a sample of 17 caregivers of patients with cognitive-behavioral impairment due to acquired brain injury. Main outcome measures: Caregiver Burden Interview, the 10-item Connor-Davidson Resilience Scale, Emotional Health, the Trait Meta-Mood Scale and the Positive and Negative Affect Schedule. Results: The median age of the 17 caregivers was 47.5 years, 71% of women had a median care-time of 3.5 years, and 65% of the total sample were spouses of the patients. 70% of the patients were affected by stroke (hemorrhagic or ischemic cause). 59% of the caregivers presented a low level of emotional attention and emotional clarity, and 47 %, low emotional repair ability. 82% of them did not report overload, 53% showed low resilience level. Emotional intelligence showed strong correlation with resilience and mental health of caregivers. All of them were positively correlated with daily positive emotions and negatively correlated with negative emotions and overload. Conclusions: Emotional intelligence, resilience, and mental health of caregivers are strongly correlated. All of them increase positive emotions and reduce negative emotions and overload.

Introducción: el daño cerebral adquirido crea situaciones estresantes y de gran complejidad emocional. Objetivo: evaluar relación entre inteligencia emocional, resiliencia, estado emocional y sobrecarga de los cuidadores de pacientes con daño cerebral adquirido y afectación cognitivo-conductual en circunstancias de aislamiento por pandemia COVID-19. Materiales y métodos: estudio observacional descriptivo transversal de prevalencia. Participantes: 17 cuidadores de pacientes con daño cerebral adquirido y afectación cognitivo- conductual. Principales medidas: Cuestionario sobre Carga del Cuidador, Medida de Resiliencia Connor- Davidson, Cuestionario de Salud Emocional, Escala Trait Meta-Mood y Escala de Afecto Positivo y Negativo. Resultados: mediana de edad 47,5 años, 71% mujeres, mediana de tiempo siendo cuidador 3,5 años y 65% de la muestra eran cónyuges. El 70% de los pacientes habían sufrido un ictus y el principal deterioro cognitivo de ellos, referido por familiares, fue el déficit de memoria. El 59% de los cuidadores presentó bajo nivel de atención emocional y claridad emocional, y el 47%, baja capacidad de reparación emocional. El 82% no informó sobrecarga, el 53% mostró un bajo nivel de resiliencia y un afecto positivo en el mes previo ligeramente más alto que el afecto negativo. La inteligencia emocional mostró una fuerte correlación con la resiliencia y la salud mental. Además, estas tres variables correlacionaron positivamente con las emociones positivas y negativamente con las negativas y la sobrecarga. Conclusiones: Inteligencia emocional, resiliencia y salud mental están fuertemente correlacionadas. Las tres aumentan las emociones positivas y reducen las negativas y la sobrecarga. La sobrecarga asocia peor resiliencia, reparación emocional y salud mental.

[Sedation-analgesia protocol for the injection of botulinum toxin A in cerebral palsy]. / Protocolo sedoanalgésico para la infiltración de toxina botulínica A en parálisis cerebral.

OBJECTIVE: To evaluate the impact of the sedation-analgesia technique on the pain experienced by the patient. METHODS: This cross-sectional study was conducted on consecutive patients with cerebral palsy (CP) who underwent infiltration with botulinum toxin A (BoTNA). The patients were divided into 4 different groups according to the analgesic strategy assigned: Group I, without sedation or topical anaesthetic cream; Group II, inhalation of nitrous oxide; Group III, deep intravenous sedation; and Group IV, light sedation with benzodiazepines. Pain was assessed with different scales depending on patient age. Parents were asked to rate their satisfaction with their child's comfort by using a 5-point Likert-type scale. The primary end-point was the proportion of patients that experienced a pain level equal or lower than 2, according to pain scales, in the different study groups. RESULTS: Of the 124 patients included in the study, 56 (45.2%) experienced a pain level ≤2. In the Group III a significantly greater proportion of patients were classified with a pain level score ≤2, P<.001, as compared with all the study groups, respectively. The BoTNA injection was guided by ultrasonography in 109 (87.9%) patients, and by palpation in 15 (12.1%). CONCLUSION: The results of this study suggested that, in patients with CP treated with BoTNA injections, the sedation-analgesic strategy had a significant impact on the pain experienced by the subject. Selecting an appropriate analgesic strategy is crucial for reducing the stress associated with the administration of BoTNA injections in children with CP.

Extrinsic bronchial obstruction caused by scoliosis.

STUDY DESIGN: A case report. OBJECTIVE: To emphasize the importance of monitoring the breathing capacity in patients with moderate to severe scoliosis, even in adulthood. SUMMARY OF BACKGROUND DATA: Diseases that disturb the structure of the chest wall affect the function of the respiratory pump. Restrictive respiratory pattern is caused by severe scoliosis. However, scoliosis may provoke obstructive changes due to compression of the airways. It can be a direct compression because of imprinting of vertebral bodies, or an indirect one, due to rotation forces. METHODS.: We have collected data from the patients' clinical history and have reviewed similar published cases. CASE PRESENTATION: a white female, with frequent respiratory tract infections during her childhood. She was diagnosed as having 55° right T5-T11 scoliosis. At age of 26, an increase of her pulmonary symptoms appeared with difficulty to expel mucus and medium efforts dyspnea. A computed axial tomographic scan showed T8 vertebral body pushing against the right intermediate bronchus. A bronchoscopy found a decrease in the bronchial area, with near contact between the walls. Lung function test: 41% forced vital capacity (FVC), 43% forced expiratory volume in 1 second (FEV1), and 91 FEV1/FVC1. The patient underwent surgical correction using rods and pedicle screws; she had improvement of symptoms, image tests, and pulmonary function (70% FVC, 71% FEV1, and 101 FEV1/FVC). CONCLUSION: Increased frequency and severity of respiratory tract infections, difficulty in expelling mucus and dyspnea are warning signs of compromised airways. Spirometry tests and image tests such as computed axial tomography and bronchoscopy are essential for diagnosis. Surgical approach may be the treatment of choice.