[A multicentre epilepsy registry in Mexico]. / Registro multicéntrico de epilepsia en México.

INTRODUCTION: The National Epilepsy Registry in Mexico was carried out, from March 2021 to December 2022, in public hospitals of the Priority Epilepsy Program 'PPE', with the aim of describing the current situation in our pediatric and adult population. PATIENTS AND METHODS: Observational, cross-sectional, multicenter study. We used a database, according to classifications of the International League Against Epilepsy (ILAE) 2017. Patients of all ages were included, with a diagnosis of epilepsy according to the practical clinical definition ILAE 2014. RESULTS: We registered 10,852 patients, 5,495 men (50.6%) and 5,357 women (49.4%). Family history of epilepsy in 1,714 patients (15.8%), febrile seizures in 987 (9.1%). Type of seizure: 5,542 (51.1%) presented focal onset, of which 1,889 (34.1%) evolved to bilateral tonic-clonic seizures; generalized onset 4,861 (44.8%), unknown 33 (3.1%) and unclassified 115 (1.1%). Almost half had unknown etiology and 40% were structural, of which hypoxic ischemic encephalopathy was the most frequent (21.6%) and neurocysticercosis was 1%. Comorbidities appeared in 6,326 patients (58.3%). Anti-seizure medications (ASM) were used in 96.4% patients, mainly valproate. Status epilepticus was found in 1,383 patients (12.7%) and drug-resistant epilepsy in 18.9%. Paraclinical studies: 79.3% with at least one electroencephalogram and 76.9% with a neuroimaging study. Epilepsy surgery occurred in 275 patients (2.5%). CONCLUSIONS: Despite the efforts of the Pan American Health Organization in its Strategy and Action Plan on epilepsy, diagnostic technologies and ASM supply are still lagging behind.

TITLE: Registro multicéntrico de epilepsia en México.Introducción. Se realizó el Registro Nacional de Epilepsia en México, de marzo de 2021 a diciembre de 2022, en hospitales del sector público del Programa Prioritario de Epilepsia, para conocer la situación actual en población pediátrica y adulta. Pacientes y métodos. Es un estudio observacional, transversal y multicéntrico. Se utilizó una base de datos, acorde con las clasificaciones de la Liga Internacional Contra la Epilepsia (ILAE) de 2017. Se incluyó a pacientes de todas las edades, con diagnóstico de epilepsia según la definición clínica práctica de la ILAE de 2014. Resultados. Se registró a 10.852 pacientes, 5.495 hombres (50,6%) y 5.357 mujeres (49,4%). Había antecedente familiar de epilepsia en 1.714 pacientes (15,8%) y crisis febriles en 987 (9,1%). Los tipos de crisis eran: 5.542 (51,1%) de inicio focal, de las que 1.889 (34,1%) evolucionaban a bilateral tonicoclónica; 4.861 (44,8%) de inicio generalizado; 33 (3,1%) de inicio desconocido; y 115 (1,1%) no clasificadas. Casi la mitad tuvo etiología desconocida y el 40% fueron estructurales; de ellas, la encefalopatía hipóxico-isquémica fue la más frecuente (21,6%) y la neurocisticercosis fue el 1%. Las comorbilidades aparecieron en 6.326 pacientes (58,3%). El 96,4% fueron tratados con fármacos anticrisis epilépticas (FACE), principalmente ácido valproico. El estado epiléptico se encontró en 1.383 pacientes (12,7%), y la farmacorresistencia, en 18,9%. Respecto a los estudios paraclínicos, al 79,3% se le realizó al menos un electroencefalograma, y al 76,9%, un estudio de neuroimagen. Se realizó cirugía de epilepsia a 275 pacientes (2,5%). Conclusiones. A pesar del esfuerzo de la Organización Panamericana de la Salud en su Estrategia y Plan de Acción sobre la Epilepsia, las tecnologías diagnósticas y el abasto de los FACE aún se encuentran rezagados.

SARS-CoV-2 induces mitochondrial dysfunction and cell death by oxidative stress/inflammation in leukocytes of COVID-19 patients.

The inflammation and activation of the immune system induced by SARS-CoV-2 are mediated by a pro-oxidant microenvironment that can induce cytotoxic effects that enhance tissue damage, favoring organic deterioration. We investigated whether the induction of oxidative stress and inflammation by COVID-19 infection could inhibit mitochondrial function and cause cellular damage in leukocytes. We evaluated levels of oxidative/inflammation markers and their correlation with mitochondrial function and leukocyte cell death in COVID-19 patients at two moments: viremia and severe sepsis with multi-organ failure. COVID-19 induces increased oxidative stress and inflammation markers that activate cellular damage processes. In the viremia stage, an increase in peroxide, nitric oxide, carbonylated proteins, and IL-6 was observed, which was correlated with a marked inhibition of mitochondrial function, decreased cell viability, early apoptosis, necrosis, and leukocytes-reactivity. The severe sepsis stage with multi-organ failure also showed a further increase in levels of peroxide, carbonylated proteins, and IL-6, with a slight decrease in nitric oxide. This oxidative process and inflammation were correlated with less inhibition of mitochondrial function, decreased cell viability and an increase in late apoptosis, and morphology changes evidencing damage in the leukocytes. SARS-CoV-2 induced damage promotes levels of oxidative stress and inflammation markers and mitochondrial dysfunction that potentiate morphological changes and cell death in leukocytes. These processes explain the rapid changes in the immune system, and that present an initial over-activation and early massive death due to SARS-CoV-2 infection, promoting endothelial-alveolar damage that would cause multi-organ failure, sustained by oxidative stress and inflammation.

Fluctuation-induced current from freestanding graphene.

At room temperature, micron-sized sheets of freestanding graphene are in constant motion, even in the presence of an applied bias voltage. We quantify the out-of-plane movement by collecting the displacement current using a nearby small-area metal electrode and present an Ito-Langevin model for the motion coupled to a circuit containing diodes. Numerical simulations show that the system reaches thermal equilibrium and the average rates of heat and work provided by stochastic thermodynamics tend quickly to zero. However, there is power dissipated by the load resistor, and its time average is exactly equal to the power supplied by the thermal bath. The exact power formula is similar to Nyquist's noise power formula, except that the rate of change of diode resistance significantly boosts the output power, and the movement of the graphene shifts the power spectrum to lower frequencies. We have calculated the equilibrium average of the power by asymptotic and numerical methods. Excellent agreement is found between experiment and theory.

Bifurcation analysis and phase diagram of a spin-string model with buckled states.

We analyze a one-dimensional spin-string model, in which string oscillators are linearly coupled to their two nearest neighbors and to Ising spins representing internal degrees of freedom. String-spin coupling induces a long-range ferromagnetic interaction among spins that competes with a spin-spin antiferromagnetic coupling. As a consequence, the complex phase diagram of the system exhibits different flat rippled and buckled states, with first or second order transition lines between states. This complexity translates to the two-dimensional version of the model, whose numerical solution has been recently used to explain qualitatively the rippled to buckled transition observed in scanning tunneling microscopy experiments with suspended graphene sheets. Here we describe in detail the phase diagram of the simpler one-dimensional model and phase stability using bifurcation theory. This gives additional insight into the physical mechanisms underlying the different phases and the behavior observed in experiments.

Genetic Relationships and Spatial Genetic Structure Among Populations of Rhodnius prolixus (Hemiptera: Reduviidae) in Colombia and Venezuela Based on Mitochondrial Cytochrome-b Sequences.

One hundred twenty Rhodnius prolixus (Stal) (Hemiptera: Reduviidae) specimens from 6 Colombian Departments and 1 Venezuelan State had 594-bp of the mitochondrial cytochrome-b gene sequenced to improve the understanding of evolutionary processes that shape the main vector of Chagas disease. The levels of genetic diversity for this species were low-medium with reference to other bugs. The genetic heterogeneity among the populations was very limited which means there has been extensive gene flow and/or very recent split processes. The overall sample as well as some individual populations showed evidence of recent population expansions (with the exception of Arauca, which yielded evidence of a bottleneck for a mismatch distribution). This expansion (11,000 or 2000-25,000 year ago depending of two procedures employed) coincides with the ending of the last intense glacial conditions during the Pleistocene and the beginning of the Holocene that had a warmer and wetter climate. Some of our autocorrelation analyses (AIDA and Genetic Landscape Interpolation Analysis) indicated local patches of high genetic similarity but no globally significant spatial structure. We did show an original haplotype distributed throughout the entirety of the geographical area studied.

Optimising non-invasive mechanical ventilation: Which unit should care for these patients? A cohort study.

BACKGROUND: Use of noninvasive ventilation (NIV) has extended beyond intensive care units (ICUs), becoming usual practice in emergency departments (EDs) and general wards. OBJECTIVE: To analyse the relationship between nursing care and NIV outcome in different hospital units. DESIGN AND SETTINGS: Three university hospitals and one community hospital participated in a prospective observational cohort study. PARTICIPANTS: Ten units participated: 4 ICUs (1 surgical, 3 medical-surgical), 3 recovery (1 postsurgical, 2 EDs, 3 general wards). METHOD: Treatment success/failure, interface intolerance and complications were evaluated according to patient characteristics, nursing care provided, and procedures used. Complications analysed included bronchoaspiration, pneumothorax, skin lesions, inability to manage secretions, eye irritations, deteriorating level of consciousness, gastric distension, and excessive air losses around the mask. RESULTS: Of 387 patients, 194 (50.1%) were treated in ICU, 121 (31.3%) in ED, 38 (9.8%) postsurgery, and 34 (8.8%) in general wards. Regression analysis, adjusted for APACHE score and NIV indication, showed 3.3 times greater risk of NIV failure (95% CI [1.2-9.2]) in a university-hospital ICU with <50 NIV cases/year, compared to a community hospital ICU. In ICUs and general wards, NIV was suspended in 12% of patients due to interface intolerance. Acute-on-chronic lung diseases (ACLD) had lower risk of NIV failure (OR 0.2 [95% CI 0.06-0.69]) and lack of humidification was not associated with treatment failure (OR 0.2 [95% CI 0.1-0.4]). Poor secretion management was linked to pneumonia (OR 2.5 [95% CI 1.1-5.9]) and early weaning/extubation (OR 3.3 [95% CI 1.2-8.9]). Interface intolerance was associated with conventional ICU ventilators (OR 4.4 [95% CI 2.1-9.2]) and nasal skin lesions with excessive air losses (OR 2.4 [95% CI 1.1-5.3]), especially with oronasal masks (OR 3.5 [95% CI 1.1-11.3]). CONCLUSIONS: Acute respiratory failure patients with pneumonia admitted to general wards had increased interface intolerance and NIV failure. Rotating mask types could improve NIV success in any unit administering this therapy.

[Implementation of a best practice guideline for the prevention of falls: Perception among hospitalized patients and its caregivers]. / Implantación de una guía de buenas prácticas para la prevención de caídas: percepción de los pacientes hospitalizados y sus cuidadores.

OBJECTIVE: To analyze the influence that the implementation of a fall prevention Best Practice Guideline (BPG) could have on the perception of patients and their caregivers about the utility of the activities implemented, about the care provided during admission and the adherence (the level of follow-up) to the recommendations received at discharge. MATERIAL AND METHOD: Design. Quasi-experimental study. Patients >65 years admitted≥48h to the Medical Area of the General Hospital of Albacete. SAMPLE: 104 subjects (consecutive sampling January-March 2013). Experimental group (EG). Patients admitted to BPG implementation units. Control group (CG). Usual care units. VARIABLES: Sociodemographic characteristics; previous and during admission falls, cognitive status (Pfeiffer); independence in daily life activities (ADLs); satisfaction with care and information provided, utility perceived, adherence to recommendations at discharge. DATA SOURCES: Interview and clinical history. Statistical analysis (SPSS 15.0). Descriptive and bivariant. Relative Risk. CI95%. RESULTS: 104 patients, EG 46.2% (48) and CG 53.8% (56). Women 51.9%, average age 79.9 years (s.d.=7.8). Pfeiffer 4,3 (s.d.=3.7). Previous falls 31.1%. In process, 1 fall in each group. There were statistically significant differences between EG/CG: age, cognitive status and independence in ADLs. In the EG was higher the percentage of perception about the usefulness of the recommendations to prevent falls (P<.001), greater adherence to them (P=0.0002), and to be very or quite satisfied with the information (P<.00004) and care received (P=.002). CONCLUSION: To implement recommendations according to an Evidence-based BPG to prevent falls in older people has shown, in users and caregivers, greater satisfaction, better perception of its usefulness and greater adherence to the recommendations.

Five-year experience of tele-ophthalmology for diabetic retinopathy screening in a rural population. / Análisis de un programa de teleoftalmología para el cribado de retinopatía diabética en área rural tras cinco años.

OBJECTIVE: To identify the prevalence and risk factors of diabetic retinopathy (DR) among rural inhabitants included in a tele-ophthalmology program. To analyse diagnostic accuracy among primary care physicians, concordance with ophthalmologists, and financial savings. MATERIAL AND METHODS: An observational randomised study was conducted on 394 patients included in a tele-ophthalmology program (from January 2010 to January 2015). An analysis was performed on the clinical characteristics, DR findings in retinography images, and correspondence between the request for a second interpretation by an ophthalmologist, and previously established criteria for it: presence of moderate to severe DR, vision loss, poor image quality and/or intraocular pressure >22mmHg. Statistical analysis was performed using the SPSS program (Student t and χ(2) tests). RESULTS: DR prevalence was 12.1%. Patients with glycosylated haemoglobin values >7.68% or those treated with a combination of insulin and oral antidiabetic drugs showed a higher risk of DR (P<.05). 43.3% of patients correctly referred to ophthalmologists showed moderate to severe DR. Unnecessary referrals to specialists were improved from 91.7% in 2010 to 98.6% in 2014. It is estimated that the program has made a total saving of €152,550.45. CONCLUSIONS: Tele-ophthalmology programs are a useful tool in DR screening. Primary care physicians are able to distinguish patients who need specialist care, avoiding unnecessary referrals to ophthalmologists, and saving costs.

[The prevalence of obesity and metabolic syndrome in paediatric patients with epilepsy treated in monotherapy with valproic acid]. / Prevalencia de obesidad y sindrome metabolico en pacientes pediatricos con epilepsia tratados en monoterapia con acido valproico.

INTRODUCTION: Valproic acid (VPA) is a useful antiepileptic drug for controlling different types of epilepsy. It has several side effects and is associated to increased body weight, as well as metabolic and endocrine disorders, including metabolic syndrome. AIM: To determine the prevalence of obesity and metabolic syndrome among paediatric patients with epilepsy treated in monotherapy with VPA. PATIENTS AND METHODS: The study was cross-sectional, observational and analytical. A sample of patients treated with VPA between 2010-2014 were studied and the body mass index (BMI), abdominal perimeter, arterial blood pressure, glucose, triglycerides and high density lipoproteins (HDL) were studied in search of obesity and metabolic syndrome. Obesity was defined as a BMI above the 95th percentile, and metabolic syndrome was considered if at least three of the following criteria were fulfilled: abdominal perimeter above the 90th percentile, systolic arterial pressure above the 90th percentile, triglycerides above 110 mg/dL and HDL below 40 mg/dL. RESULTS: A total of 47 patients with a mean age of 10.1 ± 4 years were studied; 51.06% were males. Eight (17%) of them developed obesity and, of those, two (25%) had metabolic syndrome. Three patients went on to become overweight (6%). Statistically significant differences were observed in the mean age in comparison to the BMI groups, where the obese patients were adolescents (ANOVA, p = 0.0001) and those who took more VPA per day were the obese (ANOVA, p = 0.024). CONCLUSIONS: Patients treated with VPA who become obese may go on to develop metabolic syndrome. They require careful monitoring and, if they are seen to put on weight, withdrawal of the drug should be considered.

TITLE: Prevalencia de obesidad y sindrome metabolico en pacientes pediatricos con epilepsia tratados en monoterapia con acido valproico.Introduccion. El acido valproico (VPA) es un antiepileptico util para controlar diferentes tipos de epilepsia. Tiene efectos colaterales y se asocia a incremento del peso corporal y a alteraciones metabolicas y endocrinas, entre ellas sindrome metabolico. Objetivo. Conocer la prevalencia de la obesidad y el sindrome metabolico en pacientes pediatricos con epilepsia tratados en monoterapia con VPA. Pacientes y metodos. Estudio transversal, observacional, analitico. Se estudiaron pacientes tratados con VPA entre 2010-2014, y se midio el indice de masa corporal (IMC), el perimetro abdominal, la presion arterial, la glucosa, los trigliceridos y las lipoproteinas de alta densidad (HDL), en busqueda de obesidad y sindrome metabolico. La obesidad se definio con un IMC mayor del percentil 95; el sindrome metabolico, con al menos tres de los siguientes criterios: perimetro abdominal mayor del percentil 90, presion arterial sistemica mayor del percentil 90, trigliceridos mayores de 110 mg/dL y HDL menor de 40 mg/dL. Resultados. Se estudiaron 47 pacientes con una edad media de 10,1 ± 4 años; el 51,06% eran varones. Ocho (17%) desarrollaron obesidad y, de ellos, dos (25%), sindrome metabolico. Tres pacientes desarrollaron sobrepeso (6%). Observamos diferencias estadisticamente significativas de media de edad comparados con los grupos de IMC, donde los pacientes obesos eran adolescentes (ANOVA; p = 0,0001), y aquellos que tomaban mas VPA al dia eran los obesos (ANOVA; p = 0,024). Conclusiones. Los pacientes tratados con VPA que se convierten en obesos pueden desarrollar sindrome metabolico. Requieren una monitorizacion cuidadosa y, ante la presencia de ganancia de peso, se debera valorar la retirada del farmaco.

Molecular phylogenetics of the white-lipped peccary (Tayassu pecari) did not confirm morphological subspecies in northwestern South America.

We sequenced the mitochondrial DNA (mtDNA) control region of 59 peccaries (44 white-lipped peccaries, Tayassu pecari, and 15 collared peccaries, Pecari tajacu). We also genotyped 3 DNA microsatellites from 78 white-lipped peccaries representing the 4 putative morphological subspecies (i.e., spiradens, aequatoris, pecari, and albirostris) present in northwestern South America (i.e., Colombia, Ecuador, Peru, and Bolivia). Our results showed: 1) the estimated diversity of the mtDNA control region in the T. pecari population was extremely high, whereas the average genetic diversity for the microsatellites was medium to high and similar to that observed in European pig breeds; 2) there was no significant genetic heterogeneity among the quoted putative morphological subspecies at the mitochondrial marker, but we did detect significant (although relatively small) genetic heterogeneity using microsatellites, indicating that T. pecari albirostris is a uniquely differentiated group; and 3) the phylogenetic mtDNA trees showed that haplotypes were intermixed independent of their "a priori" subspecies classification. In addition, the microsatellite assignation analyses yielded low percentages of well-classified individuals when the analysis considered the geographic morphology of the subspecies. Thus, the molecular results do not support the putative morphological subspecies of T. pecari in northwestern South America. Finally, our results did not detect clear historical demographic changes using the mtDNA control region sequences. These genetic results are discussed in the context of the ecological and social characteristics of T. pecari.

[Pharmaceutical intervention in duration of antimicrobial treatment at hospital ambit]. / Actuación farmacéutica en el control de la duración del tratamiento con antimicrobianos en el ámbito hospitalario.

OBJECTIVE: To estimate the acceptance of the pharmaceutical intervention in controlling duration of antimicrobial therapy and to evaluate their impact on optimizing the treatment. METHODS: Prospective observational study for two years in a General University Hospital. For the patients record, we followed non critical adult patients with antibiotic treatment. When the duration of antimicrobial treatment not complied with established criteria for each antibiotic and pathology, there was a communication with the physician, at which is recommended to assess the need for continue treatment. The acceptance of pharmaceutical intervention was collected and afterwards we analyzed the impact of this work by antimicrobial consumption and incidence of Clostridium difficile. RESULTS: . In 122 patients the pharmacist made a pharmaceutical intervention due to prolonged antibiotic treatment. The most prevalent antibiotics were ß-lactams, specifically meropenem. The intravenous administration was more frequent. In 77 cases it was decided to recommend the suspension of treatment, we conducted an orally prospective intervention at 70.15 % and the rest of interventions were written. Acceptance was 65.95 % and 65.00%, respectively. During the study period, the DDD of the antimicrobials decreased by 8.89% and expenditure on antimicrobials one 40.12%. The incidence of C. difficile was stable. CONCLUSIONS: . In a hospital, a pharmaceutical counselling program on the duration of antimicrobial therapy is well accepted by the prescriber physician, but it must be improved. The route of information does not affect the degree of acceptance. These actions could involve a reduction of antimicrobial consumption.

Analysis of the genetic variability and structure of Ochlerotatus taeniorhynchus (Diptera: Culicidae) populations from the Colombian Atlantic coast on the basis of random amplified polymorphic DNA markers.

Ochlerotatus taeniorhynchus (Diptera: Culicidae) is a mosquito, which is an efficient vector of the virus causing epidemic-epizootic Venezuelan equine encephalitis in Colombia. This study used 9 random amplified polymorphic DNA (RAPD) markers to analyze the mosquito's genetic variability and genetic structure of 122 specimens in 7 populations from the Colombian Atlantic coast. Assuming that all loci were in Hardy-Weinberg equilibrium, diversity statistics and analyses were performed. The average number of amplified fragments for each primer was 8.3, and the size of these fragments ranged from 350 to 3600 bp. The expected average heterozygosity was 0.358 ± 0.103. The genetic heterogeneity among the populations studied was small (GST = 0.05 ± 0.01); meanwhile, the gene flow estimates (Nm = 7.32 ± 1.35) were high. In an identical way, the Nei's genetic distances obtained yielded very small values amongst the populations that were studied in this Colombian region. Furthermore, a spatial autocorrelation analysis with Moran's I index revealed a very weak, or inexistent, spatial genetic structure among these populations. The comparison of these results with those performed for other markers (isoenzymes and microsatellites) in populations of this same mosquito from the Colombian Atlantic coast was discussed. The results of our RAPD analysis showed scarce genetic differentiation among the mosquito populations on the Colombian Atlantic coast, which was probably determined by high gene flow levels.

Kovacs effect in the one-dimensional Ising model: a linear response analysis.

We analyze the so-called Kovacs effect in the one-dimensional Ising model with Glauber dynamics. We consider small enough temperature jumps, for which a linear response theory has been recently derived. Within this theory, the Kovacs hump is directly related to the monotonic relaxation function of the energy. The analytical results are compared with extensive Monte Carlo simulations, and an excellent agreement is found. Remarkably, the position of the maximum in the Kovacs hump depends on the fact that the true asymptotic behavior of the relaxation function is different from the stretched exponential describing the relevant part of the relaxation at low temperatures.