Reinvigorating aza-Michael reactions under ionic liquid catalysis: a greener approach.

Cholinium α-amino carboxylates, which debuted in the ionic liquid arena over a decade ago, exhibit superior stability and suitable physical properties relative to other RTILs. Although synthetic pursuits in such media, leveraging their dual role as solvents and catalysts, have been scarce so far, we herein illustrate their catalytic advantage in aza-Michael reactions in terms of low loading, acceleration and improved yields with respect to conventional conditions and other imidazolium-based ILs. These highly structured salts most likely act through multiple and cooperative non-covalent interactions. These mechanistic features have also been investigated through high-level computational analyses as well.

Schistosoma haematobium infection and morbidity risk factors for pre-school age children in western Angola: A knowledge, attitudes and practices survey.

BACKGROUND: Urogenital schistosomiasis is one of the most prevalent parasitic diseases in sub-Saharan Africa. It is a poverty-related disease conditioned by behavioural practices. METHODS: Our objective is to evaluate the awareness, mindset and habits about urogenital schistosomiasis in the community of Cubal (Angola), as well as its association with infection and urinary tract morbidity in pre-school age children. A cross-sectional study of knowledge, attitudes and practices at home was conducted between February and May 2022 with 250 participants. RESULTS: Overall, 93.6% of those surveyed had some prior knowledge about schistosomiasis and, among all the symptoms associated with this disease, blood in the urine was the best known (54.4%). Nevertheless, 57.6% obtained a medium knowledge score. Regarding attitude, the majority of respondents had a high attitude score (79.2%) with 96.0% willing to participate in mass drug administration campaigns. Laundry in the river was the most common risk practice (61.2%) and 55.2% out of the total were classified with a low practice score. CONCLUSION: Low knowledge about symptoms and transmission by caregivers was the outstanding risk factor for infection in pre-school age children (OR = 16.93, 95%CI: 3.93-72.82), and lack of knowledge that avoiding entering the river prevents schistosomiasis was the main risk factor for morbidity in PSAC (OR = 8.14, 95%CI: 1.14-58.25).

Exploring the Potential of Alternative Materials in Concrete Mixtures: Effect of Copper Slag on Mechanical Properties and Carbonation Resistance.

In this study, the effect on the flowability, compressive strength, absorption, sorptivity, and carbonation resistance of concrete with different copper slag (CS) replacement ratios was investigated. For this research, four concrete mixes with different percentages of CS were made (0%, 10%, 20%, and 30% of CS as replacement of cement by volume). In addition, the microstructure was analyzed by X-ray diffraction (XRD), scanning electron microscope (SEM), and thermogravimetric analysis (TG-DTG). The results shows that the incorporation of CS reduces the workability and compressive strength of the mixtures, being more significant in concrete with 30% CS. The carbonation depth of concrete with CS increases monotonically with increasing CS. In addition, the compressive strength of the carbonated (20% and 30% CS) concretes show a loss of compressive strength at 90 days of exposure when compared to their water-cured counterparts. The use of low percentages of CS does not generate a decrease in workability and its mechanical effect is not significant at prolonged ages, so the use of this waste as SCM in percentages close to 10% is a viable alternative to the sustainability of concrete and the management of this residue.

Can an individualized adherence education program delivered by nurses improve therapeutic adherence in elderly people with acute myocardial infarction?: A randomized controlled study.

BACKGROUND: The ageing of the population is leading to an increase in the number of elderly patients with acute myocardial infarction. These patients are at higher risk for complications and poor medication adherence, which in turn are associated with higher healthcare resource expenditures. Nursing programmes might help to improve adherence in these complex patients. OBJECTIVE: The objective of this study was to assess the impact of a nursing intervention on therapeutic adherence in elderly patients after myocardial infarction compared to a control group. DESIGN: A single-blind, randomized controlled trial. SETTINGS: Heart disease institute of a tertiary care hospital. PARTICIPANTS: Patients aged ≥75 years with myocardial infarction undergoing percutaneous coronary intervention. METHODS: A comprehensive geriatric assessment was performed during the admission in all patients (N=143). Patients were randomly allocated to a nursing intervention group (n=68) or a usual care group (n=75). In patients from the intervention group, a nursing intervention programme was performed 3 months after admission based on education support and patient monitoring to improve therapeutic adherence. The main outcome measured was 12-months therapeutic adherence, as defined by a combination of measurement tools (Morisky-Green and Hayness-Sacket scales, attendance at visits and withdrawal of medication from the pharmacy). Therapeutic adherence was assessed by nurses blinded to the assignment group. RESULTS: The mean age was 82.2 years. The proportion of comorbidities was significant (diabetes mellitus 51/143 (35.7%), hypertension 110/143 (76.9%), prior stroke 22/143 (15.4%)). Likewise, the proportion of geriatric syndromes was noticeable (frailty 26/143 (18.2%), risk of malnutrition 38/143 (26.6%), cognitive impairment 28/143 (19.6%)). Most patients (92.3%) had a low educational level. A total of 119 patients achieved 12-month assessment adherence. Among these patients, the proportions of adherence were as follows: Morisky-Green test: 76/119 (63.9%), Haynes-Sackett test 99/119 (83.2%), medical visits compliance 95/119 (79.8%), and correct acquisition of drugs in the pharmacy 74/119 (62.2%). A total of 42/119 patients (35.3%) were adherent as defined by the combination of the 4 measures. Therapeutic adherence at 12 months was achieved in a significantly higher proportion of patients from the nursing intervention group (51.9% vs 21.5%, p<0.001). CONCLUSION: A significant proportion of elderly patients with myocardial infarction were non-adherent at 12 months. The proportion of adherent patients was highly variable according to the different tools used. A structured nursing intervention was independently associated with a higher adherence rate, as assessed by a multidimensional measurement, in this subset of complex high-risk elderly patients with myocardial infarction. TRIAL REGISTRATION: Registered with www.clinicaltrials.gov (NCT04662762).

Hierarchy of the main factors predicting the decision to go to the doctor in a general population sample: A factorial survey design.

OBJECTIVE: To obtain a hierarchy of the main factors that predict the decision to go to the doctor when symptoms are not yet linked to a specific disease. METHOD: 64 representative vignettes, combinations of nine factors, were presented to 168 adults between 28-60 years of age. RESULTS: Multilevel multiple regression models were used to rank the main factors predicting urgency to see a doctor in order of importance: the interference of symptoms in daily activities (B = -1.29; p < .001), fear (B = -0.96; p < .001), pain (B = -0.90; p < .001), access to medical care (B = -0.64; p < .001) and confidence in the doctor (B = -0.27; <.05). Moreover, gender (B = 0.56; p < .05) and educational level (B =-0.31; p < .05) explained part of the interindividual variation in the daily symptoms' interference. CONCLUSION: When a specific disease has not yet been diagnosed, daily symptoms' interference is the factor that most strongly increases the urgency to visit a doctor, especially among men and among people with a higher level of education. PRACTICE IMPLICATIONS: To reduce delay, generic health prevention campaigns should place more emphasis on possible interference in daily activities than on the meaning of symptoms for health.

Frailty in elderly patients undergoing primary percutaneous coronary intervention.

BACKGROUND: The prevalence of frailty, cognitive impairment and disability and its prognostic impact in patients with myocardial infarction undergoing primary percutaneous coronary intervention is unknown. AIMS: The aim of this study was to assess the prevalence of frailty and other ageing-related variables and their association with inhospital mortality in consecutive elderly ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention in a tertiary care hospital. METHODS: We prospectively included patients aged 75 years or older with STEMI undergoing primary percutaneous coronary intervention. The nursing team provided pre-discharge, standardised questionnaires and tests to each patient to study the presence of frailty (FRAIL scale), comorbidity (Charlson index), disability (Barthel test, Lawton-Brody index), nutritional risk (MNA-SF test) and cognitive status (Pfeiffer test). The association between ageing-related variables and mortality was assessed by binary logistic regression. RESULTS: A total of 259 patients were included with a mean age of 82.6±6 years, 57.9% men. A total of 51 patients (19.7%) were frail, 26 presented with moderate or severe disability (10%), and 82 were at risk of malnutrition (31.7%). Frailty was associated with a higher prevalence of diabetes, hypertension and previous stroke, and a higher inhospital mortality (21.6% vs. 3.4%; P<0.001). After adjusting for potential confounders, this association remained significant (odds ratio 3.96; 95% confidence interval 1.16-13.56; P=0.028). CONCLUSION: A not negligible proportion of elderly patients with STEMI fulfilled the frailty criteria. Frailty was independently associated with mortality. A very simple, feasible geriatric assessment by trained nurses can contribute to predict mortality.

New pathogenic variant in the FGF10 gene in the agenesis of lacrimal and salivary gland syndrome: Ophthalmological and genetic study.

Aplasia/agenesis of lacrimal and salivary glands is a rare congenital defect that has been associated with disturbances in fibroblast growth factor 10 (FGF10). It can present with symptoms of congenital lacrimal obstruction, dry eye, and dry mouth. We report the ophthalmological and genetic study of a 19-year-old woman and her relatives suffering from this syndrome. A new probably pathogenic variant is described in the FGF10 gene.

Carriage of One or Two FMR1 Premutation Alleles Seems to Have No Effect on Illness Severity in a FXTAS Female with an Autozygous FMR1 Premutation Allele.

Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late-onset neurodegenerative disorder that occurs in FMR1 premutation carriers. The prevalence of FMR1 premutation carriers in the general population is relatively high, and although rare, a premutation in both X chromosomes may occur in females inheriting a premutation allele from each of both parent carriers. Here, we report the first female with an autozygous (homozygous by descendent) FMR1 premutation allele, who fulfills neurological and radiological FXTAS findings/criteria. Molecular characterization included CGG repeat length, AGG interruption pattern, FMR1 messenger RNA (mRNA), fragile X mental retardation protein (FMRP) level quantification, and single-nucleotide polymorphism (SNP) microarray. Neuroradiological assessment of 3-T magnetic resonance imaging and neurological and cognitive/neuropsychological evaluations were performed. Neurological and neuroradiological examination of the female with the same FMR1 allele in the premutation range (77 CGGs) demonstrated FXTAS features. Further familial evaluation showed a similar neuropsychiatric profile, with impairments in cognitive flexibility and visuospatial function, mainly. A unique family with an autozygous FMR1 premutation female is presented. Neurological/cognitive and neuroradiological examinations revealed FXTAS-specific findings in the female with the autozygous FMR1 premutation allele. The consistent molecular and cognitive/psychiatric phenotype in family members suggests that carrying one or two FMR1 premutation alleles has no effect on illness severity.

Chronic stress and calcium oxalate stone disease: influence on blood cortisol and urine composition.

OBJECTIVE: To evaluate the influence of chronic stress (CS) on urine composition of calcium oxalate (CaOx) stone patients and controls. METHODS: This case-control study enrolled 128 patients during a period of 20 months. The cases were CaOx stone formers with a recent stone episode. Controls were matched by sex and age. Dimensions of CS were evaluated in cases and controls by validated self-report questionnaires measuring stressful life events, perceived stress, anxiety, depression, burnout, and satisfaction with life. Blood and urine samples were collected to determine cortisol levels and urinary composition. RESULTS: More relations between CS dimensions and blood and urine parameters were observed in cases than in controls. In cases, the blood cortisol level was related positively with the number of stressful life events (P = .03), intensity of these events (P = .04), and anxiety (P = .04). In addition, urinary magnesium (P = .03) and pyrophosphate (P = .05) levels were positively related with satisfaction with life and burnout, respectively. In contrast, urinary magnesium levels were negatively related with perceived stress (P = .01), anxiety (P = .016), and depression (P = .03). In controls, the number of stressful life events and the intensity of stressful life events was related positively with magnesium (P = .06, P = .02) levels and negatively with blood cortisol levels (P = .03, P = .004). CONCLUSION: Based on the variation between cases and controls in relations between CS dimensions and biochemical parameters, we hypothesize that CS may trigger a differential biological response in CaOx stone formers and controls, which in turn may promote or protect against CaOx stone formation.

Multivariable discriminant analysis for the differential diagnosis of microcytic anemia.

Introduction. Iron deficiency anemia and thalassemia are the most common causes of microcytic anemia. Powerful statistical computer programming enables sensitive discriminant analyses to aid in the diagnosis. We aimed at investigating the performance of the multiple discriminant analysis (MDA) to the differential diagnosis of microcytic anemia. Methods. The training group was composed of 200 ß -thalassemia carriers, 65 α -thalassemia carriers, 170 iron deficiency anemia (IDA), and 45 mixed cases of thalassemia and acute phase response or iron deficiency. A set of potential predictor parameters that could detect differences among groups were selected: Red Blood Cells (RBC), hemoglobin (Hb), mean cell volume (MCV), mean cell hemoglobin (MCH), and RBC distribution width (RDW). The functions obtained with MDA analysis were applied to a set of 628 consecutive patients with microcytic anemia. Results. For classifying patients into two groups (genetic anemia and acquired anemia), only one function was needed; 87.9% ß -thalassemia carriers, and 83.3% α -thalassemia carriers, and 72.1% in the mixed group were correctly classified. Conclusion. Linear discriminant functions based on hemogram data can aid in differentiating between IDA and thalassemia, so samples can be efficiently selected for further analysis to confirm the presence of genetic anemia.

Chronic stress and calcium oxalate stone disease: is it a potential recurrence risk factor?

Chronic emotional stress is associated with increased cortisol release and metabolism disorders. However, few studies have evaluated the influence of chronic stress on calcium oxalate (CaOx) stone disease and its recurrence. A total of 128 patients were enrolled in this case-control study over a period of 20 months. All patients were CaOx stone formers with a recent stone episode (<3 months); 31 were first-time stone formers (FS) and 33 recurrent stone formers (RS). Dimensions of chronic stress were evaluated with self-reported validated questionnaires measuring stressful life events, perceived stress, anxiety, depression, burnout and satisfaction with life. An ad hoc self-reporting questionnaire was designed to evaluate stress-related specifically to stone episodes. Blood and urine samples were collected to determine cortisol levels and urinary composition. In addition, epidemiological data, socioeconomic information, diet and incidences of metabolic syndrome (MS) were reported. Overall, no significant differences were observed in the scores of cases and controls on any of the questionnaires dealing with stress. The number (p < 0.001) and the intensity (p < 0.001) of perceived stressful life events were higher in RS than in FS, but there were no differences between the two groups in other dimensions of stress. RS had higher glucose (p = 0.08), uric acid (p = 0.02), blood cortisol (p = 0.01), and urine calcium levels (p = 0.01) than FS. RS also had lower economic levels (p = 0.02) and more frequent incidences of MS (p = 0.07) than FS. Although no differences were observed in cases and controls among any dimension of chronic stress, the number and intensity of stressful life events were higher in RS than in FS. These differences correlate with variations in blood and urinary levels and with metabolic disorders, indicating an association between chronic stress and risk of recurrent CaOx stone formation.

Cardiac biomarkers and exercise duration and intensity during a cycle-touring event.

OBJECTIVE: To determine the influence of age, training status, race time, and exercise intensity on the appearance of cardiac biomarkers after a cycle-touring event. DESIGN: Pre-post exercise measurements. SETTING: University of Zaragoza, Zaragoza, Spain. PARTICIPANTS: Ninety-one amateur cyclists. INTERVENTION: The 2005 Quebrantahuesos cycle-touring event (distance: 206 km; altitude difference: 3800 m). MAIN OUTCOME MEASURES: Cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) were measured the day before and immediately after the race. Heart rate (HR) monitoring was performed on 55 cyclists during the race to evaluate exercise intensity. RESULTS: cTnI and NT-pro-BNP were significantly elevated immediately post race, with 43% of participants exhibiting cTnI levels greater than 0.04 microg/L and 65% of the participants measuring NT-pro-BNP levels greater than 125 ng/L. The cTnI increase was significantly associated with mean exercise intensity HR (r = 0.36, P < 0.01) but was not associated with age, training status, or race time. The increase in NT-pro-BNP correlated with race time (r = 0.40, P < 0.001) and training status (r = -0.36, P < 0.001) but was not associated with age or exercise intensity HR measures. CONCLUSIONS: These results suggest that, in part, exercise intensity (HR) is responsible for the cTnI increase and that race time is responsible for the increase in NT-pro-BNP. Future standardized endurance exercise trials are recommended to further elucidate the potentially differential effects of training status, exercise time, and intensity on post-exercise increases in cTnI and NT-pro-BNP.

Effects of posttraining damage to the pedunculopontine tegmental nucleus on conditioned stimulus transfer in two-way active avoidance in rats.

The effects of posttraining excitotoxic lesions of the pedunculopontine tegmental nucleus (PPTg) on two-way active avoidance after changing the conditioned stimulus (CS) used during prelesion training were examined. Prelesion training was carried out with either a tone or a light as the CS, and this CS was changed during postlesion training. Replacing the tone with a light reduced the performance of control and lesioned rats, but the degree of reduction was higher in the latter. Replacing the light with a tone had slight detrimental effects in lesioned rats but not in controls. Thus, posttraining PPTg lesions slowed down the reacquisition of shuttle-box avoidance under conditions of CS transfer, an effect that may be attributable to disruption of attention and/or gating of sensory stimuli.