[Seizures in the emergency service: the clinical and therapeutic characteristics of 122 patients]. / Crisis en urgencias: una vista a las características clínicas y terapéuticas a través de 122 pacientes.

INTRODUCTION: Epileptic seizures are a common cause of admission in emergency services at hospitals. Performing the correct diagnosis can be difficult, and deciding when and which anti-seizure medication (ASM) to prescribe is critical. Our objective is to detail the characteristics of patients treated in a medium-sized hospital for this reason. PATIENTS AND METHODS: A retrospective observational study was performed, including all the adult patients treated by the emergency service of the Lucus Augusti University Hospital between January 2022 and January 2023 with a diagnosis of epileptic seizure on discharge. The study recorded their demographic variables, history, whether it was their first seizure, the number of seizures, whether an anti-seizure medication was administered and which one, the diagnosis, the tests performed, and whether the patient was referred to the neurology service. RESULTS: A total of 122 patients were diagnosed with epileptic seizures in the emergency service. 50.8% of the patients were women. The mean age was 69.8 years. Neurological assessment was requested for 47.6%. 50.8% presented their first seizure. No diagnosis was performed in 46% of the cases, of which only 10 were evaluated by the neurology service. The most common etiology was vascular. An electroencephalogram was performed on 41.8%. Levetiracetam was practically the only drug administered when the neurology department was not consulted. CONCLUSIONS: Early evaluation of patients with their first seizure in the emergency service by a neurological specialist is crucial for the diagnosis of epilepsy. The same anti-seizure medication is almost always prescribed when no cross-consultation takes place.

TITLE: Crisis en urgencias: una vista a las características clínicas y terapéuticas a través de 122 pacientes.Introducción. Las crisis epilépticas son un motivo frecuente de consulta en los servicios de urgencias hospitalarias. Llegar al diagnóstico correcto puede ser complejo, y es fundamental decidir cuándo y qué medicamento anticrisis (MAC) pautar. Nuestro objetivo es detallar las características de los pacientes que consultaron por este motivo en un hospital mediano. Pacientes y métodos. Estudio observacional retrospectivo de todos los pacientes mayores de edad que consultaron en el servicio de urgencias del Hospital Universitario Lucus Augusti entre enero de 2022 y enero de 2023 con diagnóstico al alta de crisis epiléptica. Se registraron variables demográficas, los antecedentes, si era una primera crisis, el número de éstas, si se inició un MAC y cuál, el diagnóstico, qué pruebas se realizaron y si se interconsultó con la guardia de neurología. Resultados. Se diagnosticó a 122 pacientes de crisis epilépticas en urgencias. El 50,8% eran mujeres. La media de edad fue de 69,8 años. Se solicitó valoración por neurología en un 47,6%. El 50,8% presentó una primera crisis. No se llegó al diagnóstico en un 46% de los casos, de los cuales sólo 10 fueron valorados por neurología. La etiología más frecuente fue la vascular. Se realizó un electroencefalograma en un 41,8%. El levetiracetam fue prácticamente el único fármaco utilizado cuando no se consultó con neurología. Conclusiones. La valoración precoz de los pacientes con una primera crisis en urgencias por un especialista en neurología es determinante para el diagnóstico de epilepsia. Cuando no se interconsulta, casi siempre se pauta el mismo MAC.

Improvement of the Pour Plate Method by Separate Sterilization of Agar and Other Medium Components and Reduction of the Agar Concentration.

Although the pour plate method is widely employed in microbiological quality control, it has certain drawbacks, including having to melt the culture medium before seeding. In this study, the preparation of the culture medium was modified by using a lower concentration of agar (10 g/L), which was separated from the nutrients during sterilization. The new protocol was assessed in media frequently used in microbiological quality control of food, cosmetics, and pharmaceutical products, with tryptic soy agar (TSA), Sabouraud 4% dextrose agar (SDA), and violet red bile glucose agar (VRBG). In comparison with the conventionally produced media, the modifications significantly improved the growth of Saccharomyces cerevisiae in SDA, Staphylococcus aureus, Salmonella enterica subsp. enterica serovar Typhimurium, and Candida albicans in TSA and Escherichia coli ATCC 8739 and ATCC 25922 and S. Typhimurium in VRBG. The modified VRBG was also more selective for Pseudomonas aeruginosa. Regarding physicochemical properties, a significantly lower pH was observed in TSA and VRBG and lower strength values in TSA. Sterilizing agar separately from the other components of the medium and reducing the agar concentration to 10 g/L can improve microorganism growth and enhance the selectivity of differential media in the pour plate method. These modifications could facilitate the automation of this culture technique. IMPORTANCE In the era of rapid microbiological methods, there is a need to improve long-established culture techniques. Drawbacks of the pour plate method include having to melt each medium separately before seeding. For this technique, we demonstrate that separating the agar from the other components of commonly used media during sterilization and reducing the agar concentration to 10 g/L can enhance microbial growth. The new protocol could have advantages in routine laboratory practice because less agar is required and the same molten agar suspension can be used to prepare different media. Moreover, these modifications could facilitate the automation of the pour plate method.

Effects of concurrent exercise on health-related quality of life in middle-aged women.

OBJECTIVE: This study aimed to evaluate the influence of a 16-week concurrent exercise program on health-related quality of life in middle-aged women. METHODS: A total of 150 middle-aged women from the FLAMENCO project (age range 45-60 years) were randomized into a counseling (n = 75) or an exercise (n = 75) group. The exercise group followed a 16-week (3 days/week, 60 min/session) concurrent exercise program (aerobic + resistance training). The counseling group attended conferences on a healthy lifestyle. Participants' health-related quality of life was assessed with the EuroQol plus, a visual analog scale and the 36-item Short Form Health Survey (SF-36), where greater values indicate a better health-related quality of life. RESULTS: The visual analog scale increased by 9.0% in the exercise group, whereas it only increased by 3.5% in the counseling group (p = 0.040). The SF-36 physical function, physical role, bodily pain, vitality and emotional role increased by 5.5%, 11.3%, 10.8%, 9.6% and 8.9%, respectively, in the exercise group, whereas these only increased by 0.6%, decreased by 0.7% and increased by 1.4%, 3.8% and 0.6% in the counseling group (all p < 0.05). CONCLUSIONS: Our results suggest that a 16-week concurrent exercise program adapted for midlife women improved their health-related quality of life. CLINICALTRIALS.GOV IDENTIFIER: NCT02358109. Date of registration: 05/02/2015.

Improving echographic monitoring of hemodynamics in critically ill patients: Validation of right cardiac output measurements through the modified subcostal window.

OBJECTIVE: We aimed to assess the usefulness of using the right ventricle outflow tract (RVOT) velocity-time integral (VTI) for echocardiographic monitoring of cardiac output compared to the gold standard, the VTI along the left ventricle outflow tract (LVOT). DESIGN: Prospective observational study. SETTING: A tertiary intensive care unit. PATIENTS: 100 consecutive patients. INTERVENTIONS: echocardiographic monitoring in critically ill patients. MAIN VARIABLES OF INTEREST: We used intraclass correlation coefficients (ICC) to compare echocardiographic measurements of LVOT VTI through apical window with RVOT VTI through the parasternal and modified subcostal windows and to assess interobserver reproducibility. Preplanned post hoc analyses compared the ICC between ventilated and nonventilated patients. RESULTS: At the time of echocardiography, 44 (44%) patients were mechanically ventilated and 28 (28%) were receiving vasoactive drugs. Good-quality measurements were obtained through the parasternal short-axis and/or apical views in 81 (81%) patients and in 100 (100%) patients through the subcostal window. Consistency with LVOT VTI was moderate for RVOT VTI measured from the modified subcostal view (ICC 0.727; 95%CI: 0.62-0.808) and for RVOT VTI measured from the transthoracic view (0.715; 95%CI: 0.59-0.807). CONCLUSIONS: Measurements of RVOT VTI are moderately consistent with measurements of LVOT VTI. Adding the modified subcostal window allows monitoring RVOT VTI in all the patients of this selected cohort, even those under mechanical ventilation.

The use of anthropometrical variables for detection of homeostatic measurement assessment-insulin resistance (HOMA-IR) in female participants of a physical exercise program.

BACKGROUND: The Homeostatic Measurement Assessment-Insulin Resistance (HOMA-IR) is a recognized and validated method which uses the levels of fasting glucose in blood and insulin of patients to evaluate the insulin resistance. AIMS: The purpose of the present study was to assess the cut-off values for anthropological variables to identify the (HOMA-IR) index in female participants of a physical exercise program. In addition, the association and prediction of insulin resistance by anthropological variables was studied. METHODS: A total of 143 participants (45.64 ± 13.17 years) volunteered for this study. Clinical data were collected by means of a self-reported questionnaire. Body weight and BMI were assessed by bioelectrical impedance analysis and skinfold thickness was taken using a caliper. Girths were assessed with a flexible metallic tape measures and finally, the HOMA-IR was calculated by the formula as follows: fasting plasma insulin ((µU/ml) x fasting plasma glucose (mmol/L). RESULTS: The outcomes of the study indicated that the AUC of anthropometrical variables for identifying HOMA-IR are reflected primarily in weight, waist-to-hip ratio, waist-to-thigh ratio, subscapular skinfold thickness, abdominal skinfold thickness, hip circumference, chest circumference, upper arm muscular girths (tensed and relaxed) (all, p ≤ 0.001), triceps skinfold thickness (p 109 cm (specificity: 99.2  waist circumference > 116 cm (specificity: 99.2 %) and abdomen skinfold < 8.8 (specificity: 97.6 %), predict the HOMA-IR in 35.29 %, 29.41 %, 23.53 % and 23.53 %, respectively. CONCLUSION: The present empirical study demonstrates that hip, chest and waist circumference on the one hand, and abdomen skinfold on the other hand are markers that are relevant to the identification of HOMA-IR index in females (Tab. 3, Ref. 33). Text in PDF www.elis.sk Keywords: insulin resistance, anthropometry, cut-off value, women, HOMA-IR.

Association of objectively measured physical fitness with health-related quality of life of mid-life women: the FLAMENCO project.

OBJECTIVES: This study aimed to explore the association of physical fitness with health-related quality of life (HRQoL) in mid-life women and to examine the potential independent association of physical fitness components with the physical and mental components from the 36-Item Short-Form Health Survey (SF-36) in this population. METHODS: This cross-sectional study comprised 183 mid-life women from southern Spain who participated in the FLAMENCO project. Body composition was measured through an impedanciometer, a stadiometer, and dual-energy X-ray absorptiometry. Physical fitness was objectively measured with the Senior Fitness Test battery (cardiorespiratory fitness, flexibility, and dynamic balance/agility) plus handgrip strength (muscle strength). The SF-36 questionnaire was used to assess HRQoL of the participants. RESULTS: All the physical fitness components were associated with the SF-36 physical function (all p < 0.05) except for lower-body flexibility. The rest of the physical fitness components showed associations with most of the SF-36 dimensions (all p < 0.05). Dynamic balance/agility and upper-body flexibility were independently associated with the SF-36 physical component scale, explaining 15% and 17% of the SF-36 physical component scale, respectively. Any physical fitness component showed independent associations with the SF-36 mental component scale. CONCLUSIONS: Greater physical fitness levels are associated with better HRQoL of mid-life women. Dynamic balance/agility and upper-body flexibility were the strongest independent physical fitness components associated with the SF-36 physical component scale.

Nitrite inhibition of microalgae induced by the competition between microalgae and nitrifying bacteria.

Outdoor microalgae cultivation systems treating anaerobic membrane bioreactor (AnMBR) effluents usually present ammonium oxidising bacteria (AOB) competition with microalgae for ammonium uptake, which can cause nitrite accumulation. In literature, nitrite effects over microalgae have shown controversial results. The present study evaluates the nitrite inhibition role in a microalgae-nitrifying bacteria culture. For this purpose, pilot- and lab-scale assays were carried out. During the continuous outdoor operation of the membrane photobioreactor (MPBR) plant, biomass retention time (BRT) of 2 d favoured AOB activity, which caused nitrite accumulation. This nitrite was confirmed to inhibit microalgae performance. Specifically, continuous 5-d lab-scale assays showed a reduction in the nitrogen recovery efficiency by 32, 42 and 80% when nitrite concentration in the culture accounted for 5, 10 and 20 mg N·L-1, respectively. On the contrary, short 30-min exposure to nitrite showed no significant differences in the photosynthetic activity of microalgae under nitrite concentrations of 0, 5, 10 and 20 mg N·L-1. On the other hand, when the MPBR plant was operated at 2.5-d BRT, the nitrite concentration was reduced to negligible values due to increasing activity of microalgae and nitrite oxidising bacteria (NOB). This allowed obtaining maximum MPBR performance; i.e. nitrogen recovery rate (NRR) and biomass productivity of 19.7 ± 3.3 mg N·L-1·d-1 and 139 ± 35 mg VSS·L-1·d-1, respectively; while nitrification rate (NOxR) reached the lowest value (13.5 ± 3.4 mg N·L-1·d-1). Long BRT of 4.5 d favoured NOB growth, avoiding nitrite inhibition. However, it implied a decrease in microalgae growth and the accumulation of nitrate in the MPBR effluent. Hence, it seems that optimum BRT has to be within the range 2-4.5 d in order to favour microalgae growth with respect to AOB and NOB.

[Diaphragmatic pacemaker dysfunction and utility of diaphragmatic ultrasonography]. / Disfunción de marcapasos diafragmático y utilidad de la ecografía diafragmática.

Patients with spinal cord injuries above the C5 vertebrae have a high risk of respiratory complications, and complete spinal cord injures can require support with mechanical ventilation. In selected patients, implantation of a diaphragmatic pacemaker offers the possibility of breathing without mechanical support and reduces respiratory complications, increasing the patient's independence. Ultrasonography is a simple and non-invasive technique that may be useful in the differential diagnosis of thoracic diseases. We present the case of a patient with a traumatic cervical spinal cord injury, who underwent diaphragmatic pacemaker implantation. The use of ultrasound allowed rapid and reliable diagnosis of device malfunction. M-mode diaphragmatic ultrasonography is a simple and non-invasive technique that can be incorporated into routine clinical practice to diagnose diaphragm movement disorders.

Author Correction: Computer keyboard interaction as an indicator of early Parkinson's disease.

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Electrochemical degradation of 5-FU using a flow reactor with BDD electrode: Comparison of two electrochemical systems.

In this study, the electrochemical degradation process of 5-fluorouracil (5-FU) in aqueous media was performed using a continuous flow reactor in an undivided cell (system I), and in a divided cell with a cationic membrane (Nafion® 424) (system II). In system I, 75% of 5-FU degradation was achieved (50 mg L-1) with a applied current density japp = 150 A m-2, volumetric flow rate qv = 13 L h-1, after 6 h of electrolysis (kapp = 0.004 min-1). The removal efficiency of 5-FU was higher (95%) when the concentration was 5 mg L-1 under the same conditions. Nitrates (22% of initial amount of N), fluorides (27%) and ammonium (10%) were quantified after 6 h of electrolysis. System II, 77% of 5-FU degradation was achieved (50 mg L-1) after 6 h of electrolysis (kapp = 0.004 min-1). The degradation rate of 5-FU was complete when the concentration was 5 mg L-1 under the same conditions. Nitrates (29% of initial amount of N), fluorides (25%) and ammonium (5%) were quantified after 6 h of electrolysis. In addition, the main organic byproducts identified by mass spectroscopy were aliphatic compound with carbonyl and carboxyl functionalities. Due to, the mineralization of 5-FU with acceptable efficiency of 88% found in system II (japp of 200 A m-2), this system seems to be more promising in the cytostatic drug removal. Moreover the efficiency of 5-FU removal in diluted solutions is better in system II than in system I.

The JAK2 pathway is activated in idiopathic pulmonary fibrosis.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is the most rapidly progressive and fatal fibrotic disorder, with no curative therapies. The signal transducer and activator of transcription 3 (STAT3) protein is activated in lung fibroblasts and alveolar type II cells (ATII), thereby contributing to lung fibrosis in IPF. Although activation of Janus kinase 2 (JAK2) has been implicated in proliferative disorders, its role in IPF is unknown. The aim of this study was to analyze JAK2 activation in IPF, and to determine whether JAK2/STAT3 inhibition is a potential therapeutic strategy for this disease. METHODS AND RESULTS: JAK2/p-JAK2 and STAT3/pSTAT3 expression was evaluated using quantitative real time-PCR, western blotting, and immunohistochemistry. Compared to human healthy lung tissue (n = 10) both proteins were upregulated in the lung tissue of IPF patients (n = 12). Stimulating primary ATII and lung fibroblasts with transforming growth factor beta 1 or interleukin (IL)-6/IL-13 activated JAK2 and STAT3, inducing epithelial to mesenchymal and fibroblast to myofibroblast transitions. Dual p-JAK2/p-STAT3 inhibition with JSI-124 or silencing of JAK2 and STAT3 genes suppressed ATII and the fibroblast to myofibroblast transition, with greater effects than the sum of those obtained using JAK2 or STAT3 inhibitors individually. Dual rather than single inhibition was also more effective for inhibiting fibroblast migration, preventing increases in fibroblast senescence and Bcl-2 expression, and ameliorating impaired autophagy. In rats administered JSI-124, a dual inhibitor of p-JAK2/p-STAT3, at a dose of 1 mg/kg/day, bleomycin-induced lung fibrosis was reduced and collagen deposition in the lung was inhibited, as were JAK2 and STAT3 activation and several markers of fibrosis, autophagy, senescence, and anti-apoptosis. CONCLUSIONS: JAK2 and STAT3 are activated in IPF, and their dual inhibition may be an attractive strategy for treating this disease.