Seizures in the Emergency Department: clinical and diagnostic data from a series of 153 patients.

INTRODUCTION: Seizures are a frequent reason for admission to emergency departments and require early, precise diagnosis and treatment. The objective of this study was to describe the clinical and prognostic characteristics of a series of patients with seizures attended at our hospital's emergency department. METHODS: We performed a retrospective, observational study of all patients with seizures who were admitted to our hospital's emergency department and attended by the on-call neurology service between February and August 2017. RESULTS: We included 153 patients, representing 9.9% of all neurological emergency department admissions. The median age was 58 years, 52.3% of patients were women, and 51% had history of epilepsy. Onset was focal in 82.4% of cases, and the most frequent aetiology was cerebrovascular disease (24.2%). Twelve patients (7.8%) developed status epilepticus, which was associated with higher scores on the ADAN scale (P < .001) and with history of refractory epilepsy (P = .002). The in-hospital mortality rate was 3.7%, and in-hospital mortality was associated with older age (P = .049) and status epilepticus (P = .018). Eighty percent of patients with no history of epilepsy were diagnosed with epilepsy at the emergency department; all started treatment. The kappa coefficient for epilepsy diagnosis in the emergency department compared to diagnosis after one year of follow-up by the epilepsy unit was 0.45 (diagnosis was modified in 20% of patients). CONCLUSIONS: Seizures are a frequent neurological emergency with potential complications and considerable morbidity and mortality rates. In patients with no known history of epilepsy, the condition may be diagnosed in the emergency department, but follow-up at specialised epilepsy units is recommended.

Red flags in patients with hereditary transthyretin amyloidosis at diagnosis in a non-endemic area of Spain.

INTRODUCTION: Hereditary transthyretin (hATTR) amyloidosis with polyneuropathy is a rare multisystemic disease characterised by onset during adulthood and associated with poor prognosis if untreated. A set of signs and symptoms, commonly known as "red flags," have been proposed to assist in early detection of the disease; presence of red flags may suggest underlying hATTR amyloidosis in patients with progressive sensorimotor polyneuropathy. MATERIAL AND METHODS: We analysed the frequency of red flags at the time of diagnosis in 30 patients with hATTR amyloidosis in a non-endemic area of Spain; onset was late in the majority of patients. RESULTS: The frequencies of the red flags were as follows: bilateral carpal tunnel syndrome in 15 patients (50%), early autonomic dysfunction in 17 (56%), gastrointestinal problems in 14 (46.6%), unexplained weight loss in 8 (26.6%), heart disease in 12 (40%), asymptomatic cardiac findings in 13 (43.3%), kidney disease in one (3.3%), vitreous opacities in none, family history of neuropathy in 21 (70%), family history of heart disease in 15 (50%), and family history of gastrointestinal problems in 3 (10%). All patients presented at least one red flag at diagnosis, with a median of 4 red flags. CONCLUSION: Red flags were common at the time of diagnosis, even in patients with late-onset hATTR amyloidosis. Presence of red flags in a patient with symmetrical sensorimotor polyneuropathy should serve as a warning sign, and lead to targeted diagnosis to rule out hATTR amyloidosis, independently of age of onset.

Increased severity in SARS-CoV-2 infection of minorities in Spain.

OBJECTIVE: With the global spread of COVID-19, studies in the US and UK have shown that certain communities have been strongly impacted by COVID-19 in terms of incidence and mortality. The objective of the study was to determine social determinants of health among COVID-19 patients hospitalized in the two major cities of Spain. METHODS: A multicenter retrospective case series study was performed collecting administrative databases of all COVID-19 patients ≥18 years belonging to two centers in Madrid and two in Barcelona (Spain) collecting data from 1st March to 15th April 2020. Variables obtained age, gender, birthplace and residence ZIP code. From ZIP code we obtained per capita income of the area. Predictors of the outcomes were explored through generalized linear mixed-effects models, using center as random effect. RESULTS: There were 5,235 patients included in the analysis. After multivariable analysis adjusted by age, sex, per capita income, population density, hospital experience, center and hospital saturation, patients born in Latin American countries were found to have an increase in ICU admission rates (OR 1.56 [1.13-2.15], p<0.01) but no differences were found in the same model regarding mortality (OR 1.35 [0.95-1.92], p=0.09). CONCLUSIONS: COVID-19 severity varies widely, not only depending on biological but also socio-economic factors. With the emerging evidence that this subset of population is at higher risk of poorer outcomes, targeted public health strategies and studies are needed.

Red flags in patients with hereditary transthyretin amyloidosis at diagnosis in a non-endemic area of Spain. / «Red flags¼ en pacientes con polineuropatía amiloidótica familiar relacionada con transtiretina (hATTR) en el momento del diagnóstico en un área no endémica de España.

INTRODUCTION: Hereditary transthyretin (hATTR) amyloidosis with polyneuropathy is a rare multisystemic disease characterised by onset during adulthood and associated with poor prognosis if untreated. A set of signs and symptoms, commonly known as "red flags," have been proposed to assist in early detection of the disease; presence of red flags may suggest underlying hATTR amyloidosis in patients with progressive sensorimotor polyneuropathy. MATERIAL AND METHODS: We analysed the frequency of red flags at the time of diagnosis in 30 patients with hATTR amyloidosis in a non-endemic area of Spain; onset was late in the majority of patients. RESULTS: The frequencies of the red flags were as follows: bilateral carpal tunnel syndrome in 15 patients (50%), early autonomic dysfunction in 17 (56%), gastrointestinal problems in 14 (46.6%), unexplained weight loss in 8 (26.6%), heart disease in 12 (40%), asymptomatic cardiac findings in 13 (43.3%), kidney disease in one (3.3%), vitreous opacities in none, family history of neuropathy in 21 (70%), family history of heart disease in 15 (50%), and family history of gastrointestinal problems in 3 (10%). All patients presented at least one red flag at diagnosis, with a median of 4 red flags. CONCLUSION: Red flags were common at the time of diagnosis, even in patients with late-onset hATTR amyloidosis. Presence of red flags in a patient with symmetrical sensorimotor polyneuropathy should serve as a warning sign, and lead to targeted diagnosis to rule out hATTR amyloidosis, independently of age of onset.

Seizures in the Emergency Department: Clinical and diagnostic data from a series of 153 patients. / Crisis epilépticas en urgencias: aspectos clínicos y diagnósticos de una serie de 153 pacientes.

INTRODUCTION: Seizures are a frequent reason for admission to emergency departments and require early, precise diagnosis and treatment. The objective of this study was to describe the clinical and prognostic characteristics of a series of patients with seizures attended at our hospital's emergency department. METHODS: We performed a retrospective, observational study of all patients with seizures who were admitted to our hospital's emergency department and attended by the on-call neurology service between February and August 2017. RESULTS: We included 153 patients, representing 9.9% of all neurological emergency department admissions. The median age was 58 years, 52.3% of patients were women, and 51% had history of epilepsy. Onset was focal in 82.4% of cases, and the most frequent aetiology was cerebrovascular disease (24.2%). Twelve patients (7.8%) developed status epilepticus, which was associated with higher scores on the ADAN scale (P<.001) and with history of refractory epilepsy (P=.002). The in-hospital mortality rate was 3.7%, and in-hospital mortality was associated with older age (P=.049) and status epilepticus (P=.018). Eighty percent of patients with no history of epilepsy were diagnosed with epilepsy at the emergency department; all started treatment. The kappa coefficient for epilepsy diagnosis in the emergency department compared to diagnosis after one year of follow-up by the epilepsy unit was .45 (diagnosis was modified in 20% of patients). CONCLUSIONS: Seizures are a frequent neurological emergency with potential complications and considerable morbidity and mortality rates. In patients with no known history of epilepsy, the condition may be diagnosed in the emergency department, but follow-up at specialised epilepsy units is recommended.

[Impact of Spanish Public Health Measures on Emergency Visits and COVID- 19 diagnosed cases during the pandemic in Madrid].

OBJECTIVE: Changes in Public Health recommendations may have changed the number of emergency visits and COVID-19 diagnosed cases in an Emergency Department in Madrid. METHODS: This retrospective case series study included all consecutive patients in a tertiary and urban ED in Madrid from 1st to 31st March. The sample was divided: NonCOVID-19, Non-investigated COVID-19, Possible COVID-19, Probable COVID-19, Confirmed COVID-19. Differences between public health periods were tested by ANOVA for each cohort, and by ANCOVA including the number of PCR tests (%) as covariate. RESULTS: A total of 7,163 (4,071 Non-COVID-19, 563 Non-investigated COVID-19, 870 Possible, 648 Probable and 1,011 Confirmed COVID-19) cases were included. Public Health measurements applied during each period showed a clear effect on the case proportion for the five cohorts. CONCLUSIONS: The variability of case definitions and diagnostic test criteria may have impact on the number of emergency visits and COVID-19 diagnosed cases in Emergency Department.

Mortality of women with ductal carcinoma in situ of the breast: a population-based study from the Girona province, Spain (1994-2013).

PURPOSE: We aim to comprehensively describe the incidence and mortality trends of ductal carcinoma in situ (DCIS) in the Girona province, Spain (1994-2013) and to estimate the all-cause mortality excess risk of diagnosed women. METHODS: Age-standardized rates of DCIS were estimated between 1994 and 2013. Standard mortality ratios (SMR) and absolute excess mortality were calculated overall and by tumor and patient characteristics. A sensitivity analysis was conducted excluding cases with a subsequent invasive breast cancer (sIBC). RESULTS: Of the 641 women included, 56 died (follow-up time: 8.4 person-years). Between 1994 and 2013, a significant increase in incidence and decrease in mortality was identified among women aged between 50 and 69 years old. Neoplasms and circulatory system disease were the most common causes of death. No excess risk of death was found overall, except for women aged < 50 years (SMR = 3.44, 95% CI 1.85; 6.40) and those with a sIBC (SMR = 2.51, 95% CI 1.26; 5.02), risk that lessened when cases with sIBC were excluded. Patients with sIBC also showed an excess risk (SMR = 2.29, 95% CI 1.03; 5.10). CONCLUSIONS: Among women aged 50-69 years old, incidence of DCIS has significantly increased yet mortality has decreased. Overall, the all-cause mortality risk of women diagnosed with DCIS remains similar to that of the general population except for women diagnosed before age 50 and those with sIBC, who showed a significant increased risk. Differential management of these patients should be considered.

Impact of climate change environmental conditions on the resilience of different formulations of the biocontrol agent Candida sake CPA-1 on grapes.

Biocontrol agents have become components of integrated crop protection systems for controlling economically important fungal pathogens. Candida sake CPA-1 is a biocontrol agent of fungal pathogens of fruits, both pre- and post-harvest. While the efficacy of different formulations have been examined previously, few studies have considered the resilience of different formulations under changing climatic conditions of elevated temperature, drought stress and increased atmospheric CO2 . This study examined the effect of (a) temperature × RH × elevated CO2 (400 vs 1000 ppm) on the temporal establishment and viability of two dry and one liquid C. sake CPA-1 formulations on grape berry surfaces; (b) temperature stress (25 vs 35°C); and (c) elevated CO2 levels. Results indicated that temperature, RH and CO2 concentration influenced the establishment and viability of the formulations but there was no significant difference between formulations. For the combined three-component factors, increased temperature (35°C) and lower RH (40%) reduced the viable populations on grapes. The interaction with elevated CO2 improved the establishment of viable populations of the formulations tested. Viable populations greater than Log 4 CFUs per g were recovered from the grape surfaces suggesting that these had conserved resilience for control of Botrytis rot in grapes. SIGNIFICANCE AND IMPACT OF THE STUDY: The interaction between environmental factors that are expected to occur in response to climate change (CC) will have a significant impact on food security and availability. Little information exists on how elevated temperature, drought stress and increased CO2 will have on the efficacy of biocontrol agents. The impact of these factors on the viability of different formulations of the biocontrol yeast Candida sake on the surface of grapes berries was evaluated for the first time. Such knowledge is critical for projecting the efficacy of biocontrol under climate change conditions and to identify formulations that have the necessary resilience to perform under CC conditions.

The Internal Medicine Subinternship--Now More Important than Ever: A Joint CDIM-APDIM Position Paper.

For decades, the internal medicine (IM) subinternship has served as a critical interface between undergraduate and graduate medical education. As such, the vast majority of U.S. medical schools offer this rotation to help students prepare for post-graduate training. Historically an experiential rotation, a formal curriculum with specific learning objectives was eventually developed for this course in 2002. Since then, graduate medical education (GME) has changed significantly with the regulation of duty hours, adoption of competency-based education, and development of training milestones and entrustable professional activities. In response to these and many other changes to residency training and medical practice, in 2010, the Association of Program Directors in Internal Medicine (APDIM) surveyed its members-with input from the Clerkship Directors in Internal Medicine (CDIM) Subinternship Task Force-to determine which core skills program directors expected from new medical school graduates. The results of that survey helped to inform a joint CDIM-APDIM committee's decision to re-evaluate the goals of the IM subinternship in an effort to enhance the transition from medical school to residency. This joint committee defined the minimum expectations of what constitutes an IM subinternship rotation, proposed recommended skills for IM subinterns, and discussed challenges and future directions for this crucial course.

Predicting results of daily-practice cystoscopies.

OBJECTIVE: Our objective was to elaborate a predictive model of bladder cancer, in an unselected clinical population submitted to cystoscopy. MATERIALS AND METHODS: We recruited consecutive patients that underwent cystoscopy due to suspicion of bladder cancer or surveillance of a previously diagnosed bladder cancer. Urine cytology and a BTA-stat® (BTA) test were carried out for all patients. To avoid an assessment bias, the BTA-tests, cytologies and cystoscopies were conducted in a blinded fashion. We used logistic regression to predict cystoscopy results from cytology, BTA-test and clinical variables. RESULTS: From August 2011 to July 2012, we recruited 244 patients and 237 were valid for analysis. Newly diagnosed and surveillance cases were 13% and 87% respectively. Cytology and BTA-test sensitivities were 57.9% (CI 95: 42.2-72.1) and 63.2% (CI 95: 47.3-76.6) with specificities of 84.4% (CI 95: 78.7-88.8) and 82.9% (CI 95: 77.1-87.5). The predictive model included the BTA-test, cytology, time since previous tumour, and treatment with mitomicin or BGC during the last three months. The model predictive accuracy (AUC) was .85 (.78-.92), and dropped to 0.79 when excluding the BTA-test (P=.026). For the surveillance of bladder cancer, a 10% threshold on the model predicted probabilities resulted in an overall negative predictive value of 95.7%, and 95.0% in low grade tumours. CONCLUSION: In a cost containment environment, our prediction model could be used to space out cystoscopies in patients with previous, low grade tumours, resulting in a more efficient use of resources in the healthcare system.

Elevated CD8 T cell responses in type 1 diabetes patients to a 13 amino acid coeliac-active peptide from α-gliadin.

Some type 1 diabetes (T1D) patients have been reported to exhibit T cell reactivity to wheat gluten. We tested the hypothesis that this T cell reactivity could be abolished by using prolyl-endopeptidase (PEP), an enzyme that cleaves peptide bonds after proline. Peripheral blood mononuclear cells (PBMCs) were isolated from T1D patients and healthy controls. PBMCs were stimulated with a peptic-tryptic digest of wheat gluten; a peptic-tryptic-PEP digest of wheat gluten; and a 13 amino acid peptide from wheat gluten. Fluorescent-labelled antibodies to CD3, CD4 and CD8 cell marker proteins were utilized to determine proliferative responses of CD3, CD4 and CD8 T cells. There were no significant differences in proliferative responses of CD3 or CD4 T cells to the wheat gluten antigens. A significantly higher proportion of CD8(+) T cells from T1D patients proliferated in the presence of the 13 amino acid peptide than when challenged with the peptic-tryptic or the peptic-tryptic-PEP digests of wheat gluten. PEP treatment had no significant effect on CD8 T cell reactivity to the peptic-trytic digest of wheat gluten. Our results suggest that wheat gluten-derived peptides, containing ≤ 13 amino acids, may evoke T cell responses in T1D patients.

Synthesis, characterization and electrochemical properties of iron-zirconia solid solution nanoparticles prepared using a sol-gel technique.

The range of compositions and temperatures at which single-phase tetragonal and monoclinic Fe-containing zirconia nanoparticles are stable is reported. Both types of iron-doped zirconia particles were synthesized by annealing dried gels FexZr1-xO2, with nominal compositions in the range 0 ≤ x ≤ 0.15, over the range of temperatures between 400 °C and 1300 °C. Monophasic crystalline specimens of Fe-ZrO2 solid solutions were characterized by different techniques including X-ray powder diffraction (XRD), infrared and Raman spectroscopies (IR and Raman), and transmission electron microscopy (TEM). Energy gaps were estimated from diffuse reflectance ultraviolet-visible spectra (DRUV-Vis) and compared with those obtained from electrochemical data. Upon increasing the amount of iron in both types of iron-containing zirconia-based structures the energy gaps slightly lowered. The electrochemical properties of those solid solutions obtained using the voltammetry of microparticles (VPM) technique indicated the presence of a small portion of iron as Fe(2+) in both types of crystalline Fe-doped ZrO2. Electrochemical data suggest that the monoclinic solid solutions provide a particularly high accessibility for promoting catalytic processes such as electrochemical oxygen reduction.

Analytical and mineralogical studies of ore and impurities from a chromite mineral using X-ray analysis, electrochemical and microscopy techniques.

A wide analytical study of South African chromite ore, material with high interest in ceramic industry, has been carried out. With this purpose, an accurate chemical identification and mineralogical characterization of the mineral and the gangue have been performed using X-ray fluorescence (XRF), voltammetry, X-ray diffraction (XRD), light microscopy (LM), and scanning electron microscopy (SEM/EDX). The elemental composition of the sample (ore and gangue) has been obtained by XRF. The voltammetric analysis has allowed to demonstrate that iron in the sample was as Fe(II). The main compound of the chromite ore was a spinel (magnesiochromite ferroan), identified by XRD from the sample, which constitutes the chromite ore. This technique has also been useful to characterize some silicates as impurities in the chromite ore sample. Light microscopy has allowed the detection of the spinel and the identification of a silicate impurity (chrome chlorite), by means of their colouration. On the other hand, the other silicate impurity was identified as labradorite by means of X-ray microscopy by SEM/EDX. Finally, a strategy was developed to calculate the composition of each mineral in the unknown sample. The obtained results were: chromite spinel 82.89%, chlorite 12.79% and labradorite 4.32%.

Diaphragmatic rupture: a frequently missed injury in blunt thoracoabdominal trauma patients.

In the US and Western Europe, trauma is the fourth most common cause of death and the leading cause of death in the population less than 45 years of age [Mullinix and Foley, J Comput Assist Tomogr 28(Suppl 1):S20-S27, 2004]. Diaphragmatic injuries occur in 0.8 to 8% of patients after blunt trauma (Gray H, The muscles of the thorax. Anatomy of the human body. Lea & Febiger, Philadelphia, 1918) and may be a predictor of severity of injury in the blunt trauma patient [Worthy et al., Radiology 194(3):885-888, 1995]. The clinical diagnosis of diaphragmatic rupture (DR) is difficult and is missed in anywhere from 7 to 66% of patients [Cantwell, Radiology 238(2):752-753, 2006]. The accurate diagnosis and prognosis of this pathology depend on a complete knowledge of the clinical and radiological presentation. Computed tomography is the imaging modality of choice in the assessment of patients with clinical or radiographic findings suggestive of DR.

H-point standard addition method applied to solid-state stripping voltammetry: quantitation of lead and tin in archaeological glazes.

A solid-state electrochemical application of the H-point standard addition method to the quantification of two depositable metals A and B, which produce strongly overlapped stripping peaks, is described. The method is based on the mechanical transference of mixtures of the solid sample plus a selected compound, of a reference depositable metal R, and of known amounts of a reference material containing A or B, to paraffin-impregnated graphite electrodes. After a reductive deposition step, voltammograms recorded for those modified electrodes immersed into a suitable electrolyte produce stripping peaks for the oxidation of all of the metals deposited. Measurement of the currents at selected potentials in overlapping peaks corresponding to the stripping of A and B permits the quantitation of these metals in the solid sample, while avoiding matrix effects. The method was applied to the simultaneous determination of Pb and Sn in archaeological glazes using PbCO(3) and SnO(2) as standards and ZnO as a reference material.

[Effectiveness of self-measurement of blood pressure in patients with hypertension: the Dioampa study]. / Efectividad de la automedición de la presión arterial en pacientes hipertensos: estudio Dioampa.

OBJECTIVE: To evaluate the effectiveness of self-measurement of blood pressure (SMBP) in controlling hypertension. DESIGN: Randomized, controlled, pragmatic, open study. The unit of randomization was the basic health care unit (BCU), consisting of 1 physician and 1 nurse. All BCUs were randomized to the control group (usual clinical practice, n=94) or to the intervention group (n=86). SETTING: Primary care BCUs throughout Spain. PARTICIPANTS: Patients with poorly controlled essential hypertension, defined as systolic blood pressure > or = 140 or diastolic blood pressure > or = 90 mm Hg. INTERVENTIONS: The patients were given an OMRON HEM-705CP automatic blood pressure monitor on two occasions, for use during 15 days at weeks 6 and 14. Blood pressure was recorded at each visit (baseline, 6, 8, 14, 16, and 24 weeks). Main outcome measures. MAIN OUTCOME VARIABLE: control of blood pressure, considered systolic/diastolic blood pressure <140/90 mm Hg (130/85 in patients with diabetes). RESULTS: 180 BCUs serving 1325 patients (622 in the intervention group, 703 in the control group) participated. Baseline characteristics were similar in both groups. Immediately after the first period of SMBP (week 8) the proportion of patients whose blood pressure was well controlled was 7.6% higher in the intervention group than in the control group (P=.01). After the second period of SMBP (week 16) the difference between groups decreased to 4.1% (P=.27). At the end of the study the difference was 4.9% (P=.19). CONCLUSIONS: Self-measurement of blood pressure was effective in controlling blood pressure in the short term, but its effects faded over time.

Manejo percutáneo de las colecciones pancréaticas que complican pancreatitis agudas de causa infrecunte / Percutaneous drainage of peripancreatic collections following acute pancreatitis of unusual origin

Objetivo: Evaluar la efectividad del drenaje percutáneo de las colecciones complicando pancreatitis agudas (PA) de causa enfrecuente. Material y método: Se evaluron 131 pacientes con pancreatitis aguda complicada con colecciones líquidas que fueron evacuados mediante drenaje percutáneo. Del todo de esta serie 19 pacientes sufrieron PA por causas infrecuentes. Los indicaciones para el drenaje guiado por imágenes fueron la presencia de dolor, obstrucción de la vía biliar o digestiva, y sepsis. Los catéteres fueron removidos cuando existió mejoría clínica del paciente con desaparición del dolor, normalización de las enzimas pancreáticas en sangre, ausencia de fístula en el sinograma y un volumen de drenaje menor a 10 ml cada 24 horas. Resultados: Las colecciones pancreáticas complicando pancreatitis de causa infrecuente fueron resueltas con drenaje percutáneo en 15 de los 19 pacientes (79 por ciento). No hubo complicaciones relacionadas con el procedimiento. Cuatro pacientes murieron: falla multiorgánica, 3 pacientes; embolismo pulmonar, 1 paciente. Conclusión: El resultado de los drenajes percutáneos en pacientes con PA de causa infrecuente medida como la resolución de las colecciones pancreáticas fue similar a los del resto de la serie. El manejo percutáneo de las colecciones pancráticas complicando pancreatitis de causa infrecuente fue un procedimiento eficáz para su resolución. La severidad de la pancreatitis más que la causa aparece como el factor determinante de la duración del drenaje y su resultado

Electrochemical identification of flavonoid dyes in solid work of art samples by abrasive voltammetry at paraffin-impregnated graphite electrodes.

An electrochemical method for identifying flavonoid-type dyes in microsamples from works of art is reported. Square wave voltammograms of natural insoluble dyestuffs based on flavonoid structure dragoon's blood, weld, old fustic, gamboge, Brazilwood and logwood (Campeche wood) attached to paraffin-impregnated graphite electrodes in contact with 0.25M HAc+0.25M NaAc aqueous buffer display characteristic peaks in the potential region between +0.85 and -0.85V versus AgCl/Ag. Sequential experiments in contact with 0.05M AlCl(3) and 0.05M Na(2)MoO(4) plus HAc/NaAc and 0.05M H(3)BO(3)+0.10M NaOH solutions also provide dye-characteristic signals allowing for an unambiguous identification of each one of the pigments. Individual pigments were satisfactorily identified in mixtures of pigments and real samples from textile pieces found in Castellfort (Valencian Region, Spain) attributed to the 15th century production of local textile workshops.

Standard addition method applied to solid-state stripping voltammetry: determination of zirconium in minerals and ceramic materials.

An application of the standard addition method to stripping voltammetry of solid materials immobilized in inert electrodes is described. The method allows the determination of the mass fraction of a depositable metal M in a material on addition of known amounts of a standard material containing M to a mixture of that material and a reference compound of a second depositable metal, R. After a reductive deposition step, voltammograms recorded for those modified electrodes immersed in a suitable electrolyte produce stripping peaks for the oxidation of the deposits of M and R. If no intermetallic effects appear the quotients between the peak areas and the peak currents for the stripping oxidation of M and R vary linearly with the mass ratio of the added standard and the reference compound, thus providing an electrochemical method for determining the amount of M in the sample. The method has been applied to the determination of Zr in minerals, ceramic frits, and pigments, using ZnO as reference material and ZrO(2) as the standard.