There is limited information on the course of recovery and long-term outcome of people with prolonged disorders of consciousness (PDOC). To determine long-term outcomes (mortality, recovery of consciousness, disability, functioning, and independence) in people with PDOC after early intensive neurorehabilitation (EIN) within a novel nationwide PDOC care pathway. Prospective cohort study with 2-year follow-up. All people with PDOC admitted to EIN at a single rehabilitation center in the Netherlands were screened for inclusion. Baseline measurements of level of consciousness (CRS-R), disability (DRS), and functioning (FIM) were collected at rehabilitation admission, and follow-up was at 14, 28, 40, 52 and 104 weeks post admission. Of 129 participants included (mean age 38.1 years, SD 16.4), 33 (26%) patients died, and 80 (62%) regained consciousness within the 2-year follow-up. From them, 56 (43%) regained consciousness during 14 weeks of EIN, 14 (11%) within 6 months after admission, and 10 (8%) between 6- and 24-month follow-up. Mean level of disability and functioning significantly increased over time, with the largest improvement between 14- and 28-week post admission. Amongst responders who regained consciousness, the proportion of participants functioning independently (FIM total score ≥78) increased from 4% (3/78) at 14 weeks to 41% (25/61) at 2-year follow-up. Improvement of level of consciousness, disability, and functioning in people with PDOC occurs beyond the early stages of specialized neurorehabilitation until 2 years post injury, despite substantial mortality. These results highlight the need for specialized care for people with PDOC during the first 2 years after their injury, which focuses on both functional recovery and personalized decision-making. International Clinical Trial registry Platform (ICTRP) of the World Health Organization (WHO): NL-OMON23779.
Background The principle of double effect is often invoked to interpret clinical intentions in palliative sedation (PS), considering that intended effect may differ from foreseen effect. Despite clarifications, intentions concerning patient consciousness remain ambiguous. Moreover, little is known about how non-palliative care specialists understand and apply these intentions. Methods This study aims to explore physicians' intentions regarding PS, with a particular focus on the relationship between their intentions and patients' consciousness. This qualitative study is based on twelve semi-structured interviews with physicians from a university hospital in France. The methodology combined hierarchical evocation, clinical vignettes, and semi-structured interviews. Results The study reveals considerable heterogeneity in physicians' intentions regarding patient unconsciousness. The distinction between intended and foreseen effects was often poorly understood. References to the doctrine of double effect were rare, whereas the principle of proportionality was more frequently acknowledged. Conclusion This study reveals important discrepancies between specialized frameworks and the conceptual models of clinical reasoning. We particularly highlighted the inadequacy of the principle of double effect to enable an explicit evaluation of the ethical significance of induced unconsciousness and proposed a more integrated approach to palliative sedation, grounded in contemporary evidence, and proportionality.
This paper explores the fundamental challenges of machine consciousness in the era of Physical AI, where Large Language Models (LLMs) are integrated with humanoid platforms. While current systems like 'Ameca' exhibit sophisticated conversational abilities, they remain ungrounded discursive constructs operating within the realm of 'spoken speech' (parole parlée)-linguistic patterns detached from lived experience. Drawing on phenomenology and developmental psychology, this study argues that authentic self-consciousness is not an internal property of an isolated agent but a relational quality emerging from the Aida (a Japanese concept referring to the relational 'in-between' that emerges between interacting agents). To address the symbol grounding problem, this research proposes the paradigm of 'Aidification.' Through a phenomenological analysis of bodily origins, we trace the constitution of the 'Me' through a developmental trajectory from the hands-initially experienced as visible instruments of action-to the face, which remains phenomenologically inaccessible to the self and thus requires the 'gaze of the Other' as the essential catalyst for self-objectification. Within this framework, language is reconceptualized as a 'cane for thought' that enables 'speaking speech' (parole parlante)-a creative act of meaning-generation anchored in the human 'felt sense.' Ultimately, Aidification reconceptualizes the AI robot as a dynamic participant in a shared intersubjective world rather than a solitary processor. By shifting the locus of cognition to the interactional field, we envision a 'symbiotic intelligence' that flourishes between humans and machines. This grounded intelligence does not merely simulate life but actively participates in the continuous co-creation of a shared reality, ensuring that the future of robotics is deeply rooted in the intersubjective fabric of human existence.
Many children experience agitation and altered consciousness during early acquired brain injury (ABI) recovery, requiring multidisciplinary collaboration across the care pathway. However, limited research evidence and variability in management approaches compromise the provision of standardised, best practice care. This study aimed to co-design and pilot a targeted, evidence-informed implementation intervention to improve inpatient care for children with ABI experiencing altered consciousness and agitation. An Advisory Group was established, comprising 10 clinicians and one parent with lived experience of paediatric ABI (pABI). An evidence-informed, experience-based co-design (E2CD) process was followed and involved 'understanding' current evidence, clinical practice and lived experience perspectives using a scoping review, clinician survey, audit and qualitative interviews (Phase 1); 'refining' this understanding in the local context (Phase 2); 'prioritising' evidence-practice gaps (Phase 3); 'co-designing' resources (Phase 4); and 'implementing and evaluating' the resources through pilot testing (Phase 5). The 'In This Together' micro-learning videos were developed, comprising five 'bite-sized' videos that provide trauma-informed information and tips on managing agitation, uncertainty and transitions in care. The videos aim to support a shared understanding of these topics among clinicians and families and seek to provide families with knowledge and strategies to empower them during their child's care. Pilot testing with clinicians in the local setting indicated that the videos are acceptable, appropriate and feasible. This study highlights the value of partnership with key stakeholders throughout the research process and resulted in the development of micro-learning videos that meaningfully address their needs and have a greater chance of clinical implementation and sustainability.
Structured tracheostomy decannulation pathways specifically tailored to patients with prolonged disorders of consciousness (pDoC) after brain injury remain limited. We aimed to describe a stepwise decannulation pathway and evaluate its feasibility and safety in this population. We retrospectively reviewed consecutive tracheostomized patients with pDoC after brain injury admitted to a single rehabilitation center. The pathway integrated flexible laryngoscopy for assessment of airway patency and secretion burden using the Murray Secretion Scale (MSS), assessment of airway protection using the Semi-quantitative Cough Strength Score (SCSS), and a monitored 48-h capping trial. The primary outcomes were feasibility (decannulation rate), early safety (reintubation or transfer to the ICU within 48 h), and short-term safety (reintubation within 3 months). Secondary outcomes included time from referral to decannulation, airway findings, and MSS grades on flexible laryngoscopy, SCSS score, and reasons for non-decannulation. Among 61 included patients, 35 (57.4%) were successfully decannulated. No patient required reintubation or transfer to the ICU within 48 h after decannulation. One patient underwent reintubation approximately 1 month later because of severe liver failure rather than airway compromise. The mean time to decannulation was 19.8 ± 8.2 days. Airway lesions were identified in 54 patients (88.5%), and 31 (50.8%) had MSS ≥ 2. Twelve patients (19.7%) had SCSS < 3. The main barriers to decannulation were airway stenosis ≥50%, uncontrolled secretion burden, inadequate cough-mediated airway protection, and worsening pulmonary infection during capping. In this single-center retrospective study, the stepwise decannulation pathway appeared feasible and was associated with favorable short-term safety outcomes in patients with pDoC after brain injury. The pathway may provide a structured framework for decannulation decision-making in this population. Further prospective, multicenter studies are needed to validate these findings.
The World Health Organization's 2019 recognition in ICD-11 that chronic primary pain constitutes a disease in its own right demands novel conceptual frameworks. Current models focusing on peripheral and central sensitization, while valuable, may describe downstream manifestations rather than primary etiology. We hypothesize that chronic pain may arise from disruption of bioelectromagnetic coherence at the interface where consciousness and neural tissue interact-upstream of the cytokine cascades, neuroinflammation, central sensitization, and epigenetic modifications typically studied as pain mechanisms. Convergent lines of evidence support this hypothesis: (1) thalamocortical dysrhythmia documented in chronic pain patients via magnetoencephalography, with therapeutic correction producing pain relief; (2) heart rate variability abnormalities and reduced cardiac coherence consistently found in chronic pain populations; (3) photobiomodulation efficacy in randomized controlled trials suggesting electromagnetic etiology; (4) mitochondrial bioenergetic dysfunction preceding inflammatory cascades; (5) ultra-weak photon emission alterations correlating with disease states; and (6) circadian rhythm disruption patterns in chronic pain conditions. This framework positions inflammatory cascades, glial activation, and central sensitization as potential downstream consequences of bioelectromagnetic disruption rather than primary causes. The hypothesis generates falsifiable predictions and suggests novel therapeutic approaches targeting electromagnetic coherence restoration.
Although auditory sensory stimulation has been widely used in clinical occupational therapy practice for DOC, there is significant heterogeneity in specific implementation protocols. However, none of these studies have focused specifically on exploring the familiar voice of subject's own name (FV SON) vs. unfamiliar voice of subject's own name (UFV SON) calling. Functional near-infrared spectroscopy (fNIRS) has shown great potential in the clinical assessment of DOC, as it features both high portability and relatively high spatial resolution. This study used fNIRS to investigate the real-time cortical activation elicited by auditory sensory stimulation through FV SON and UFV SON in patients with DOC, aiming to provide meaningful guidance for clinical occupational therapy and treatment evaluation. A total of 64 participants with DOC were recruited for this study. FNIRS was used to detected blood oxygen signals during FV SON and UFV SON in the subjects. Statistical analyses were performed for intra-group differences and the relationships between fNIRS metrics and the scores of the CRS-R. Participants with DOC under UFV SON stimulation exhibited deactivation in the Left Dorsolateral Pre-frontal Cortex (DLPFC-L). However, compared with the rest state (RS), participants with DOC under FV SON stimulation did not show deactivation in the DLPFC-L. Compared with the UFV SON stimulation, the peak value of participants with DOC under FV SON stimulation was greater in the DLPFC-L. However, compared with the FV SON stimulation, the peak value of participants with DOC under UFV SON stimulation was greater for the TC-L. Compared with the UFV SON stimulation, the initial slope of participants with DOC under FV SON stimulation was greater for PreM & SMC-L. Under FV SON stimulation, the peak values of the DLPFC-L and TC-L were positively correlated with the CRS-R VFS score. Under UFV SON stimulation, the peak value of the TC-L was positively correlated with the CRS-R total score, CRS-R VFS score and CRS-R AS score; the peak value of the PMC-L was positively correlated with the CRS-R total score, CRS-R AFC score and CRS-R VFS score; and the peak value of the Broca-L was positively correlated with the CRS-R total score, CRS-R VFS score and CRS-R AS score. Under UFV SON stimulation, the initial slope of the DLPFC-L was positively correlated with the CRS-R AFC score. In conclusion, DOC patients show distinct cortical activation patterns under familiar vs. unfamiliar SON calling stimulation. This study is helpful for guiding auditory stimulation strategies or personalized rehabilitation in DOC. These conclusions warrant further validation in future larger, multicenter studies, multimodal neuroimaging, studies, and intervention-based studies. [ChiCTR2300074202].
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Hemispherotomy is a surgical intervention for severe drug-resistant epilepsy that fully disconnects the lesional brain hemisphere from the rest of the nervous system. This creates a rare opportunity to explore whether consciousness can be sustained without external input. The default-mode network, linked to introspective mental activity, is considered a necessary, though not sufficient, condition for consciousness. In this prospective case-control study, resting-state functional MRI data from 26 individuals post-hemispherotomy and 24 healthy controls were analysed. Default-mode network activity was assessed using seed-to-voxel correlations based on the peak activity in the precuneus of controls, delineated by group independent component analysis. In connected hemispheres, typical default-mode network patterns were preserved and did not differ significantly from controls. Isolated hemispheres also showed preserved positive default-mode network connectivity, though negative connectivity was significantly reduced compared to controls. In two patients with both pre- and post-surgical scans, the individual default-mode network remained detectable but was divided between the isolated and connected hemispheres. These findings suggest that default-mode network activity persists in isolated hemispheres, meeting a necessary condition for consciousness. However, the presence of default-mode network activity alone does not confirm conscious awareness, encouraging further investigation into the neural correlates of consciousness in isolated hemispheres.
Breathing, beyond its metabolic role, has been increasingly implicated in shaping perception, attention, and aspects of cognitive processing. Here, we propose the Rhythmic Embodied Perception (REP) Framework, a multi-level framework linking body and brain to explain how respiration structures conscious experience. At the neurophysiological level, slow respiratory cycles modulate cortical oscillations via cross-frequency coupling, biasing excitability patterns across frontoparietal and occipital networks. At the perceptual-phenomenological level, these oscillatory dynamics create transient pause states-low-excitability phases of alpha/theta activity-during which sensory input is most likely to reach awareness. Respiration rhythmically gates these windows, coordinating perceptual clarity and attentional receptivity. At the regulatory-attentional level, volitional breath control stabilizes oscillatory and perceptual dynamics by entraining neuromodulatory networks such as the locus coeruleus-noradrenaline system, extending pause duration, and enhancing attentional stability. The REP Framework yields concrete, testable predictions: for example, respiratory phase should modulate phase-dependent sensory detection, and slow-paced breathing should strengthen respiration-cortex coupling and improve attentional continuity. Conceptually, this framework unifies evidence from neuroscience, theories of discrete perception, and yogic models of prana, grounding ancient accounts of pulsative attention in contemporary neural dynamics. Practically, it positions respiration as a trainable lever for shaping perceptual and attentional rhythms, offering an experimentally tractable route to probe the embodied mechanisms of consciousness. By highlighting the rhythmic interplay of breath, brain, and perception, the REP Framework provides a novel, integrative perspective on how bodily rhythms structure conscious experience, with implications for cognitive neuroscience, contemplative practice, and therapeutic interventions.
Representationalism is the theory that our conscious perception of the world is mediated by mental representations, rather than being a direct encounter with reality. In this article, we define representations in terms of a unified theory of long-term memory that incorporates both its explicit and implicit divisions. Apart from these integrative features, the theory offers the possibility for reconciling perspectives in neuroscience and the philosophy of mind. We address various areas of debate, focusing on concepts such as consciousness, intentionality, emergence, and qualia. We draw the following conclusions based on our framework applied to representational systems. First, conscious experience results from the retrieval of the contents of explicit memory representations from short-term memory. Regarding intentionality, the strong link between intentionality and memory representations allows us to define intentionality, capturing both the "what is it" and "what it is like" aspects. Finally, notions referring to the subjective experiential content of consciousness, such as emergence and "qualia", are integral to all conscious experience, reflecting memory-emotion interactions realized in neuro-affective networks. Ultimately, we conclude that concepts from the philosophy of mind can be harmonized, in a non-reductionist way, with neurocognitive theories that define memory representations as multilevel networks of large-scale brain systems.
The paramedian thalamic artery has four types of anatomical variants, among which type IIb is commonly referred to as the artery of Percheron (AOP). Occlusion of this artery typically results in bilateral paramedian thalamic infarction, with variable involvement of the rostral midbrain. We report a case of acute ischemic stroke caused by AOP occlusion, which is a rare complication of a neurointerventional procedure. A 51-year-old male underwent stent placement due to severe stenosis with dissection of the V4 segment of the left vertebral artery. After the procedure, he presented with classic symptoms of AOP infarction, including acute altered consciousness and memory impairment. Magnetic resonance imaging (MRI) revealed bilateral paramedian thalamic and rostral midbrain infarction. He was diagnosed with an acute ischemic stroke caused by AOP occlusion and achieved a favorable outcome with symptomatic therapy, supportive care, and rehabilitation. This case underscores that in patients who have stenosis with dissection undergoing neurointerventional procedures, heightened vigilance is required for the complication of distal embolization, and distal blood flow should be repeatedly assessed. When neurological deficits, such as altered consciousness, arise after the procedure, the possibility of AOP infarction should be considered, especially in patients with an anatomical variant of this artery. Timely MRI and treatments such as intravenous thrombolysis and endovascular therapy should be performed.
Drug-facilitated sexual assault (DFSA) is a type of drug-facilitated crime defined as a form of sexual violence against an individual incapacitated or unconscious due to the effects of psychoactive substances. These substances alter the victim's level of consciousness, judgment, and/or memory. This study aimed to develop and validate a quantitative LC-MS/MS method for psychoactive substances and biotransformation products with detection limits suitable for DFSA investigations. The scope was based on ANSI/ASB Standard 121 guidelines (2021). Urine samples were submitted to enzymatic hydrolysis, followed by liquid-liquid extraction. An aliquot of urine underwent protein precipitation with acetonitrile. After agitation, centrifugation, and evaporation of solvent, samples were resuspended with mobile phase and injected into LC-MS/MS system. The method was validated according to ANSI/ASB Standard 036 recommendations, with quantification limits of 0.5 to 50 ng/mL and linearity of 0.5 to 750 ng/mL. Bias and imprecision were better than 14.3% and 14.8%, respectively, and matrix effect ranging from -72.9% to 21.5%. No evidence of carryover and interference was observed. All substances were stable at 10 °C for 24 hours and recovery results were better than 5.2%. In total, 42 samples from sexual assault victims were analyzed, with at least one substance detected in 26 samples. Ethanol was the most predominant substance, followed by 11-nor-9-carboxy-Δ-9-tetrahydrocannabinol and cocaine. A sensitive method was developed and validated to quantify psychoactive substances in urine, with low limits of detection and quantification, adequate linearity, bias, imprecision, and successfully applied to the analysis of authentic urine samples.
Meditation offers a tractable model for probing altered states of consciousness, yet consistent physiological markers remain elusive. This study characterized within-subject autonomic and respiratory modulation across pre-meditation, during-meditation, and post-meditation states in trained Rajyoga practitioners using multiscale heart rate variability (HRV) metrics and HRV-respiration coupling. Sex-stratified analyses were presented exploratorily to summarize state-dependent effects. A single-lead electrocardiogram (ECG) was recorded from 55 Rajyoga practitioners (31 male, 24 female) during three consecutive 10-min states: pre-meditation, during meditation, and post-meditation. After artifact correction, 27 HRV indices spanning time-domain, frequency-domain, and non-linear dynamics, including multiscale entropy (MSE 1-20), were computed in Kubios HRV Scientific. State-dependent effects were tested using Friedman tests with Bonferroni-adjusted post-hoc contrasts, and cardiorespiratory coupling was assessed through correlations between respiration frequency and low-frequency (LF) and high-frequency (HF) HRV powers. Meditation was associated with robust state-dependent modulation. Time-domain indices and frequency-domain powers increased during meditation with partial post-session recovery, while selected non-linear features shifted significantly. Respiration frequency was reduced, and HRV-respiration coupling was strengthened, consistent with increased parasympathetic engagement. Exploratory sex-stratified summaries indicated potential differences in effect magnitudes that warrant confirmation in studies powered for interaction testing. These findings identify a reproducible physiological signature of the meditative state by integrating HRV magnitude, complexity, and cardiorespiratory coupling. The results support the usefulness of multiscale cardiorespiratory analysis as an operational marker of altered consciousness induced by Rajyoga meditation.
The autonomic imbalance can negatively affect left ventricular (LV) remodeling following a myocardial infarction (MI). Ganglionated plexi (GP) play a crucial role in autonomic nervous system imbalance. Cardiac sympathetic afferent denervation (CSAD) has been shown to have beneficial effects in addressing this imbalance. This study aimed to evaluate the effects of the ablation of cardiac sympathetic sensory neurons on LV remodeling. Resiniferatoxin (RTX), a neurotoxic transient receptor potential vanilloid (TRPV1) antagonist, was used to achieve it. A total of 31 beagle dogs were randomly assigned to three groups: MI group (n = 12), CSAD group (MI with CSAD; n = 10), and Control group (sham surgery without CSAD; n = 9). In the CSAD group, RTX was injected into the anterior right ganglionated plexi (ARGP) only once. After a 4-week follow-up period, CSAD treatment resulted in a significant decrease in left stellate ganglion (LSG) activity, improved LSG remodeling, reduced LV dilation, and improved LV function. Furthermore, CSAD treatment significantly attenuated LV remodeling in post-MI LV tissue. The treatment also showed positive effects on high-sensitivity C-reactive protein (hs-CRP), norepinephrine (NE), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and Neuropeptide Y (NPY) levels. In conscious dogs with healed MI, CSAD led to a reduction in cardiac sympathetic tone and an improvement in ventricular remodeling. This suggests that targeting cardiac sympathetic sensory neurons through CSAD may have therapeutic benefits in managing LV remodeling after MI.
Delayed emergence from anesthesia is a frequent challenge in surgical settings. Common etiologies include residual drug effects, metabolic derangements, or neurological insults. We report a case of a 55-year-old woman who underwent an elective six-hour lumbar laminectomy and cervical implantation surgery. Despite an uneventful intraoperative course and routine neuromuscular blockade reversal, the patient exhibited somnolence and ventilatory failure after reversal and extubation. Arterial blood gas (ABG) analysis revealed severe respiratory acidosis. The patient required re-intubation and controlled mechanical ventilation to facilitate carbon dioxide (CO₂) washout. Following normalization of arterial partial pressure of carbon dioxide (PaCO₂), the patient regained consciousness and was successfully extubated the following morning. This case highlights the importance of monitoring ventilation adequacy in the transition from controlled to spontaneous respiration following long-duration surgeries. Importantly, normal intraoperative end-tidal CO₂ values should not be considered reassuring in high-risk patients, as significant arterial hypercapnia may remain undetected.
This review systematically summarizes the sources and quality control standards of muscone, with particular emphasis on elucidating its neuroprotective mechanisms in cerebral ischemic injury and current research advancements in its investigation and clinical applications. Stroke is a prevalent cerebrovascular disorder caused by insufficient blood supply or occlusion of cerebral vessels, characterized by a high occurrence rate, mortality, and disability rates, profoundly impacting the quality of life of patients and their families. Musk, as the primary drug for "inducing resuscitation and restoring consciousness," is traditionally used to treat febrile coma and stroke with phlegm syncope. Modern pharmacological studies have revealed that its core active component, muscone, exhibits significant neuroprotective properties. Through searching keywords including "musk," "muscone," "cerebral ischemia," "stroke," "cerebral stroke," " ischemic stroke," "apoplexy," "Ischemia-reperfusion injury," "protection mechanism," and "neuroprotection," relevant Chinese and English literature published between 1982 and 2025 was collected from databases such as Web of Science, PubMed, Elsevier, and China National Knowledge Infrastructure (CNKI). The following types of literature were excluded: non-peerreviewed articles, low-quality studies, publications with unclear research objectives, duplicate publications, editorials, and conference abstracts. A rigorous screening and data extraction process was conducted for review articles and experimental studies within the valid research scope. The quality and relevance of each study's objectives were comprehensively evaluated to significantly enhance the verifiability of conclusions. It has been demonstrated that muscone exhibits multi-dimensional mechanisms of action in both animal models of stroke and cellular experiments: (1) inhibition of excitotoxicity via modulation of glutamate metabolic pathways; (2) suppression of neuronal apoptosis through activation of the PI3K/Akt signaling pathway; (3) exertion of anti-inflammatory effects by regulating the NF- κB/NLRP3 inflammasome; (4) scavenging of oxygen free radicals and enhancement of antioxidant enzyme activity; (5) promotion of neurogenesis through stimulation of neural stem cell proliferation and differentiation; and (6) protection of blood-brain barrier integrity via maintenance of tight junction protein expression. Muscone exhibits remarkable neuroprotective efficacy against cerebral ischemic injury. Mechanistic studies on its neuroprotective effects may provide a multi-target paradigm for the development of novel neuroprotective agents, demonstrating profound translational value in the field of stroke therapy.
Antimicrobial resistance (AMR) represents a global threat that affects all populations and ecosystems equally, partly driven by the massive and improper use of antibiotics since their discovery in the 20th century. While microorganisms' ability to develop resistance is a natural adaptation mechanism, human practices have dramatically accelerated this process, compromising the therapeutic efficacy of these drugs and generating health, economic, and political consequences on a global scale. In this context, the "responsible use of antimicrobials" emphasizes the commitment, shared responsibility, and conscious action of all actors involved in the life cycle of these medications, as part of an urgent and sustained systemic response to this crisis. This narrative review explores the impact of AMR in Latin America and Argentina, the use of antimicrobials in animal health, and its impact on the environment, proposing various strategies for change. This document serves as a compelling call to action, recognizing the ubiquitous involvement of all stakeholders -the community (including the environment) and the healthcare sector- as both contributors to and potential mitigators of AMR. Ensuring a future where antimicrobials remain effective tools for human, animal, and environmental health is a collective mission for all. La resistencia a los antimicrobianos (RAM) constituye una amenaza global que afecta a todas las poblaciones y ecosistemas por igual, impulsada en parte por el uso masivo e inadecuado de antibióticos desde su descubrimiento en el siglo XX. Aunque la capacidad de los microorganismos para desarrollar resistencia es un mecanismo natural de adaptación, las prácticas humanas han acelerado dramáticamente este proceso, comprometiendo la eficacia terapéutica de estos fármacos y generando consecuencias sanitarias, económicas y políticas a escala planetaria. En este contexto, el "uso responsable de antimicrobianos" enfatiza el compromiso, la corresponsabilidad y la acción consciente de todos los actores involucrados en la cadena de vida de estos medicamentos, como parte de una respuesta cultural urgente y sostenida frente a esta crisis. En esta revisión narrativa se explora el impacto de la RAM en Argentina, el uso de antimicrobianos en salud animal y su impacto en el ambiente proponiendo diferentes estrategias para el cambio. Este documento es una convocatoria a la acción de todos como parte de un problema, la RAM, y parte de la solución, en la comunidad, en el ámbito de la salud o en el medioambiente. Asegurar un futuro donde los antimicrobianos sigan siendo herramientas eficaces para la salud humana, animal y ambiental es una misión de todos para todos.
Delirium is a frequent and serious complication in critically ill patients and associated with adverse outcomes. Automated pupillometry has emerged as a potential diagnostic tool for the detection of delirium. However, pupillometric parameters are also influenced by pain, potentially confounding their relationship to delirium. The aim of this study was to evaluate the association between automated pupillometry parameters and delirium in patients with high risk of pain (surgical patients) admitted to intensive care units (ICU). This prospective multicenter observational study included adult surgical patients admitted to an ICU between April 2023 and August 2025. Delirium was assessed every 6 h after admission using CAM-ICU. Automated pupillometry together with pain intensity scores (VAS, CPOT, BPS) were performed concurrent with CAM-ICU. To account for repeated measurements within individual patients, a generalized linear mixed-effects model (GLMM) with patient as a random effect was used to evaluate the association between pupillometric parameters and diagnosed delirium. Forty-nine patients were included, yielding 417 measurements, of which 48 (12%) were done in patients who were simultaneously CAM-ICU positive. Among pupillometric variables, only average pupillary latency (LAT avg) was significantly shorter in patients with delirium (p = 0.01). In the mixed-effects model adjusted for sedation depth, level of consciousness, and pain intensity, LAT avg. was independently associated with delirium (OR 1.55 per 0.01; 95% CI 1.13-2.13; p = 0.007). In surgical ICU patients, shortened pupillary light reflex latency is associated with delirium. Automated pupillometry may serve as a useful tool for detection of delirium in this population. https://clinicaltrials.gov/study/ Identifier: NCT05811208.