Background: Medical residents must sustain acute sleep deprivation, which can lead to nonfatal and fatal consequences in hospitals due to cognitive decline. Anodal transcranial direct current stimulation (a-tDCS) is a safe noninvasive neuromodulation technique that can induce depolarization of neurons. Previous studies in pilots have shown benefits against fatigue increasing wakefulness and cognitive performance. However, the effects of a-tDCS on cognition in acute sleep deprived healthcare workers remains unknown. Purpose: To evaluate cognitive changes in sleep deprived medical residents after one session of a-tDCS. Methods: Open clinical test-re-test study including 13 medical residents with acute sleep deprivation. Subjects received 1 session of bifrontal a-tDCS (2mAx20min), anodal over the left dorsolateral prefrontal region. Pre-and-post treatment subjects were tested with Beck anxiety inventory, Beck depression and HVLT tests, Rey´s and Taylor´s figures, Trail Making A/B, Stroop, Aleatory Digit retention test (WAIS), Digits and symbols and MoCA tests. Post-intervention was added the Executive functions and Frontal Lobes Neuropsychological Battery (BANFE2) test and changing the Taylor figure for Reyfigure. Results: Twelve medical residents were analyzed; 8 men and 4 women, 29.5 (+/-2.2) years mean age. All had a mean of 21.6 (+/-1.3) hours of sleep deprivation. There were no serious adverse events. We found statistically significant difference in Rey´s/Taylor´s figures (p=0.002), Trail Making Test (p=0.005), WAIS IV symbols (p=0.003), Word Stroop (p=0.021). BANFE-2 showed that the main affected area was the orbito-medial prefrontal region. Conclusion: a-tDCS appears safe and improves working memory, attention, response time and distractors elimination in acute sleep deprived medical residents.
Background: Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis worldwide. Lymphocytes and neutrophils are associated with systemic inflammation and production of proinflammatory mediators. GBS, as an autoimmune disease, elicits an upregulation in inflammatory and metabolic pathways, with increased production of lymphocytes and neutrophils. Serum markers such as the neutrophil-lymphocyte (NLR) and leuko-glycemic (LGR) ratios have been studied for the severity and prognosis of non-neurological disorders. Methods: A cross-sectional study from a prospective cohort of patients with GBS was conducted, from January 2018 to February 2021. Comparison between patients with or without ventilatory support was performed with student´s t test or Mann-Whitney U test based on distribution. Chi-square for was used for categorical variables, Fisher´s exact test was applied when necessary. A logistic regression analysis was performed. Results: One hundred and twenty-three patients were included. Logistic regression analysis demonstrated NLI to be an independent factor for mechanical ventilation in GBS, but not for LGI and OR 2.0, respectively. Both LGI and NLI demonstrated a high performance for ventilatory support prediction, with 0.70 and 0.81, respectively. Best cut-off values, according to Youden index, are for LGI 1.12 (sensitivity 0.70, specificity 0.40) and for NLI 3.59 (sensitivity 0.78, specificity 0.33). Conclusions: Despite the wide use of the EGRIS scale in estimating respiratory insufficiency in patients with GBS, we portray a new and easy to obtain laboratory tool that can further help non-neurologists and other clinicians to predict the risk for ventilatory support.
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