Twin lossy mode resonance on a single D-shaped optical fiber.

This Letter presents the fabrication of dual lossy mode resonance (LMR) refractometers based on titanium dioxide (TiO2) and tin oxide (SnO2) thin films deposited on a single side-polished D-shaped optical fiber. For the first time, to the best of our knowledge, two independent LMRs are obtained in the same D-shaped optical fiber, by using a step-shaped nanostructure consisting of a first section of TiO2 with a thickness of 120 nm and a second section with a thickness of 140 nm (120 nm of TiO2 and 20 nm of SnO2). Each section is responsible for generating a first-order LMR with TM-polarized light (LMRTM). TiO2 is deposited by atomic layer deposition and SnO2 by electron-beam deposition. The theoretical results show that the depth of each of the resonances of the dual LMR depends on the length of the corresponding section. Two experimental devices were fabricated with sections of different lengths, and their sensitivities were studied, achieving values ∼4000nm/refractiveindexunit (RIU) with a maximum of 4506 nm/RIU for values of the SRI between 1.3327 and 1.3485.

Variability of assay methods for total and free PSA after WHO standardization.

The variability of total PSA (tPSA) and free PSA (fPSA) results among commercial assays has been suggested to be decreased by calibration to World Health Organization (WHO) reference materials. To characterize the current situation, it is necessary to know its impact in the critical cutoffs used in clinical practice. In the present study, we tested 167 samples with tPSA concentrations of 0 to 20 µg/L using seven PSA and six fPSA commercial assays, including Access, ARCHITECT i2000, ADVIA Centaur XP, IMMULITE 2000, Elecsys, and Lumipulse G1200, in which we only measured tPSA. tPSA and fPSA were measured in Access using the Hybritech and WHO calibrators. Passing-Bablok analysis was performed for PSA, and percentage of fPSA with the Hybritech-calibrated access comparison assay. For tPSA, relative differences were more than 10 % at 0.2 µg/L for ARCHITECT i2000, and at a critical concentration of 3, 4, and 10 µg/L, the relative difference was exceeded by ADVIA Centaur XP and WHO-calibrated Access. For percent fPSA, at a critical concentration of 10 %, the 10 % relative difference limit was exceeded by IMMULITE 2000 assay. At a critical concentration of 20 and 25 %, ADVIA Centaur XP, ARCHITECT i2000, and IMMULITE 2000 assays exceeded the 10 % relative difference limit. We have shown significant discordances between assays included in this study despite advances in standardization conducted in the last years. Further harmonization efforts are required in order to obtain a complete clinical concordance.

[The emergency department short stay unit and the hospital at home as alternatives to standard inpatient hospitalisation]. / La unidad de corta estancia de urgencias y la hospitalización a domicilio como alternativas a la hospitalización convencional.

The emergency short stay unit (ESSU) is a support unit for the accident and emergency services and a clear alternative to the conventional hospitalisation of patients needing urgent care, who are affected by the re-aggravation of certain chronic diseases (whether seasonal o not) or by moderate short-evolution pathologies. Hospitalisation at home is one alternative making it possible to undertake the care and treatment characteristic of a hospital in the home of the patient, with greater comfort and intimacy. The origin of the patient might be the conventional hospital, the emergency service or ESSU. A suitable selection of patients is essential in both alternatives to conventional hospitalisation, using strict criteria that are both clinical and socio-family in nature. Their correct use assures a significant saving in stays in conventional hospital units, a reduction of the average stay in hospital medical and surgical services and less pressure on the accident and emergency service, since they increase the availability of beds both for programmed admission and for urgent admission in conventional hospitalisation and thus improve patient outflow in the accident and emergency service.

La unidad de corta estancia de urgencias y la hospitalización a domicilio como alternativas a la hospitalización convencional / The emergency department short stay unit and the hospital at home as alternatives to standard inpatient hospitalisation

La unidad de corta estancia de urgencias (UCEU)es una unidad de soporte del servicio de urgencias yuna alternativa clara a la hospitalización convencionalde pacientes con requerimiento de atención urgente yque están afectados de algunas enfermedades crónicasreagudizadas (estacionales o no) o de patologías degravedad leve-moderada de corta evolución. La hospitalizacióna domicilio (HaD) es una alternativa asistencialque permite realizar en el domicilio del enfermolos cuidados y tratamientos propios del hospital, conmayor comodidad e intimidad para éste, y el origen delpaciente puede ser tanto la hospitalización convencional,como el servicio de urgencias o la UCEU. En ambasalternativas a la hospitalización convencional, es clavela selección adecuada de los pacientes, mediante criteriosestrictos tanto clínicos como sociofamiliares. Sucorrecto uso asegura un significativo ahorro de estanciasen las unidades de hospitalización convencional,una reducción de la estancia media en los serviciosmédicos y quirúrgicos hospitalarios y una menor presiónde urgencias, ya que aumenta la disponibilidad decamas tanto para el ingreso programado como para elingreso urgente en hospitalización convencional y mejora,por tanto, el drenaje del servicio de urgencias(AU)

The emergency short stay unit (ESSU) is a supportunit for the accident and emergency services and aclear alternative to the conventional hospitalisationof patients needing urgent care, who are affected bythe re-aggravation of certain chronic diseases (whetherseasonal o not) or by moderate short-evolutionpathologies. Hospitalisation at home is one alternativemaking it possible to undertake the care and treatmentcharacteristic of a hospital in the home of the patient,with greater comfort and intimacy. The origin of thepatient might be the conventional hospital, the emergencyservice or ESSU. A suitable selection of patientsis essential in both alternatives to conventional hospitalisation,using strict criteria that are both clinical andsocio-family in nature. Their correct use assures a significantsaving in stays in conventional hospital units,a reduction of the average stay in hospital medical andsurgical services and less pressure on the accident andemergency service, since they increase the availabilityof beds both for programmed admission and for urgentadmission in conventional hospitalisation and thus improvepatient outflow in the accident and emergencyservice(AU)

[Homocysteine related vitamins and lifestyles in the elderly people: The SENECA study]. / Homocisteína, vitaminas relacionadas y estilos de vida en personas de edad avanzada: estudio SENECA.

The SENECA study started in 1988 and consisted of a random age- and sex-stratified sample of inhabitants of 19 European towns. A total of 2.100 elderly people were finally able to be included in the study. The present study includes results for total plasma homocysteine (tHcy) and the related vitamins folate, B12 and B6. Other style factors as alcohol consumption or smoking have been also evaluated. The lowest values for tHcy corresponded to Mediterranean countries (Portugal, Spain, and Greece), compared to central or northern european countries (Netherland or Belgium (differences higher than 4 micromol/l). In addition, an interesting north-south gradient is observed, with the lowest values for tHcy corresponding to Betanzos (Spain), 12.38 micromol/l followed by both centers in Portugal, whereas the highest concentrations are found in Maki (Poland), 21.92 pmol/I and Culemborg (Netherlands), 20.41 mircromol/l. The mean tHcy concentration for all the European centers was 15.98 micromol/l. Effect of sex has been also evaluated: those countries with the lowest tHcy concentration (i.e. Spain or Portugal) show significant (p < 0.01) higher tHcy concentration in men vs women, whereas these differences by sex are not observed in countries with the highest tHcy values. The effect of "aging" within the same individuals after ten years of follow up was also evaluated: a significant difference was observed for the same individuals in the 10-years period. Plasma folic acid was compared to tHcy values, resulting also in marked differences between north and southern countries. Plasma vitamin B12 also shows a close pattern. Either plasma folate or vitamin B12 were shown as strong predictors of tHcy. This effect was not observed for plasma vitamin B6. Total alcohol intake was positively and significantly (p < 0.01) correlated with tHcy ("no" intake corresponded with the lowest tHcy, 14.3 micromol/l vs "high" intake-over 30 g/d-with the highest tHcy, 17 micromol/l). The type of alcoholic beverage was also evaluated: wine and spirits drinkers showed positively significant (p < 0.005) correlation whereas beer intake was not significantly associated. Smoking was also analysed: "never" smokers had the lowest tHcy concentration (13.82 +/- 0.20 micromol/1) vs "current" smokers (16.64 +/- 0.35 pmol/1), a significant difference (p < 0.05).

[The oncology patient in emergencies. Epidemiological data]. / Enfoque global del enfermo oncológico en urgencias. Datos epidemiológicos.

Oncology patients do not form a large proportion within the overall figures of an emergency service, but their clinical characteristics mean that attending to them is often complex. The elaboration of a complete clinical history, specifying the characteristics and stage of the tumoural disease, is a basic weapon for taking decisions when an emergency arises. According to the data from our centre, oncology patients account for 5% of the total of emergency cases. The most frequent type of tumour that we deal with is pulmonary, followed by breast and colon. It is often the case that these patients come to the emergency department several times in the same month and pain is the most frequent reason for consultation, although it is normal for them to mention several causes on each occasion. In a high percentage of cases the reason for the consultation is related to the disease itself, but on as many as 35% of occasions it is an intercurrent pathology. The index of admissions is high (around 50%), especially if the patient has come for a reason related to the disease. In global terms, they account for 14% of total admissions from emergencies.

Enfoque global del enfermo oncológico en urgencias. Datos epidemiológicos / The oncology patient in emergencies. Epidemiological data

Los pacientes oncológicos no representan un gran volumen dentro del global de un servicio de urgencias, pero sus características clínicas hacen que su atención sea a menudo compleja. La realización de una historia clínica completa, en la que se especifiquen las características y estadio de la enfermedad tumoral, es un arma fundamental para la toma de decisiones en el momento urgente. Según datos de nuestro centro, los enfermos oncológicos representan un 5% del total de las urgencias. El tipo de tumor que más frecuentemente atendemos es el pulmonar, seguido del de mama y colon. Es frecuente que estos enfermos acudan a urgencias varias veces en un mismo mes y el motivo de consulta más frecuente es el dolor, aunque es habitual que comenten varias causas en cada ocasión. En un alto porcentaje de casos la causa de su consulta está relacionada con la propia enfermedad pero hasta en un 35% de las ocasiones es una patología intercurrente. El índice de ingresos es elevado (alrededor del 50%) y especialmente si el paciente ha acudido por un motivo relacionado con la enfermedad. En global suponen un 14% del total de ingresos desde urgencias (AU)

Oncology patients do not form a large proportion within the overall figures of an emergency service, but their clinical characteristics mean that attending to them is often complex. The elaboration of a complete clinical history, specifying the characteristics and stage of the tumoural disease, is a basic weapon for taking decisions when an emergency arises. According to the data from our centre, oncology patients account for 5% of the total of emergency cases. The most frequent type of tumour that we deal with is pulmonary, followed by breast and colon. It is often the case that these patients come to the emergency department several times in the same month and pain is the most frequent reason for consultation, although it is normal for them to mention several causes on each occasion. In a high percentage of cases the reason for the consultation is related to the disease itself, but on as many as 35% of occasions it is an intercurrent pathology. The index of admissions is high (around 50%), especially if the patient has come for a reason related to the disease. In global terms, they account for 14% of total admissions from emergencies (AU)

[Appropriateness of emergency hospital admissions]. / Adecuación de los ingresos hospitalarios urgentes.

INTRODUCTION: The aim of this work is to know the proportion of inadequate urgent admissions in a general hospital. MATERIAL AND METHODS: A retrospective and descriptive study of patients admitted during 1,999 was performed. The Appropriatness Evaluation Protocol (AEP) was used in order to evaluate the appropriatness of the admissions. RESULTS: Eighteen admissions (4.5%) were inadecuated. There was a higher proportion of inappropriate admission (IA) when the physician responsible of the admission was a medical specialist (internal medicine, hematology or nephrology): odds ratio 5.3 in opposite to emergency physicians (p < 0.03). CONCLUSIONS: There was a low proportion of inadequate admissions (4.5%) and the risk of inappropriatness of the admission was major when it was ordered by a medical specialist.

Adecuación de los ingresos hospitalarios urgentes / Appropriateness of the emergent hospitalary admissions

Objetivo: Estudio realizado para conocer el porcentaje de ingresos inapropiados urgentes de un hospital general. Material y métodos: Estudio descriptivo retrospectivo de los pacientes ingresados durante 1.999 mediante aplicación del Appropriateness Evaluation Protocol (AEP) para valorar la adecuación del ingreso. Resultados: Dieciocho pacientes (4,5 per cent) ingresaron de forma inapropiada. Hubo mayor riesgo de ingreso inadecuado por los especialistas médicos (internista de guardia, hematólogo o nefrólogo): odds ratio frente a ingreso por médico de Urgencias de 5,3 (p<0,03). Conclusiones: Destaca una bajo porcentaje de ingresos inadecuados (4,5 per cent). Existe mayor riesgo cuando el médico responsable del ingreso pertenece a una especialidad médica. (AU)

[Acarbose-induced acute hepatitis. Report of two events in the same patient]. / Hepatitis aguda por acarbosa. Descripción de 2 episodios en una misma paciente.

A 57-year-old woman with non-insulin-dependent diabetes mellitus and inadequate glycemic control was prescribed acarbose (100 mg 3 times daily). Two months later she presented with acute hepatitis (ALT 2,300 IU/l). Other causes of liver damage were excluded. Three months after acarbose had been discontinued, all results of laboratory tests returned to normal values. Three years later the patient was given acarbose again. Acarbose (100 mg three times daily) had been added to glibenclamide (15 mg daily) 2 weeks before she presented with acute hepatitis (ALT 2,778 IU/l). Acarbose was stopped and the results of liver tests returned to normal within 2 months. Of the eight cases of acarbose-associated hepatotoxicity previously reported, five (as well as the two presented herein) were Spanish. The latency period, from the start of drug therapy to the onset of liver injury, was relatively long (> 2 months). We suggest that acarbose be included in the list of drugs which may induce acute hepatitis.

[Exclusion causes to thrombolytic treatment in myocardial infarction]. / Causas de exclusión de tratamiento trombolítico en el infarto de miocardio.

BACKGROUND: Only one third of patients who have suffered a myocardial infarction can benefit from thrombolytic treatment in the daily clinic practice. The aim of this study is to know the percentage of patients who were treated in a General Hospital and the main exclusion causes to receive thrombolytic treatment. METHODS: A descriptive study in patients with infarction who were admitted to the Critical Care Unit of a 550 beds Hospital between September-95 and August-96. RESULTS: 188 patients were admitted with suspicion of myocardial infarction. The 50.53% of them received thrombolytic treatment. The main exclusion causes to receive this treatment were: delay of the patient (18.10%), normal ECG or descended ST (16.50%), contraindications (8%), patient's refusal to receive treatment (0.53%) an uncertain indication of therapy (6.40%). CONCLUSIONS: A high percentage of patients received thrombolytic therapy, maybe because these drugs can be used until 12 hours the infarction and they haven't limit of age.

[Delayed thrombolytic administration in myocardial infarction;]. / Demora en la administración de trombolíticos en el infarto de miocardio.

BACKGROUND: The aim of the study is to know whether the patients with acute myocardial infarction (AMI) who consulted an extrahospitalary physician before the hospital arrival delayed their admission to the critical care unit (CCU), and whether their probability to receive early thrombolytic therapy was smaller than that of the patients who cam directly to hospital. PATIENTS AND METHODS: A descriptive study in patients with AMI was performed during 1995. The following variables were studied: age, sex, town of residence, previous AMI, consultation to an extrahospitalary physician, delay time in the admission to the CCU, and whether thrombolytic treatment was performed. Comparison of proportions, Student-Fisher t-test, or Mann-Whitney U-test were used, according to the case. A multiple logistic regression was used to study the independent effect of the previous consult to an extrahospitalary physician on the chance for early thrombolytic treatment. RESULTS: A hundred and eighteen patients (79.7% males) were studied. The mean age was 63 years-old. Nine point five per cent of the patients had suffered a previous AMI and 54.2% received thrombolytic treatment. Delay to hospital arrival was the main exclusion reason to receive this treatment. The mean age of patients who consulted an extrahospitalary physician (n = 69) was 5 years older, their hospital arrival were 100 min later (difference of medians) (p < 0.001), were admitted to the CCU 124 min later (p < 0.02) and ran a higher risk to arrive to CCU after 3 hours from the onset of symptoms (odds ratio [OR]: 3.3; confidence interval [IC] 95%: 1.2 to 9.2) than those who cam directly to hospital. CONCLUSIONS: The patients with AMI who consult an extrahospitalary physician delay their admission to the CCU and have a less chance to receive early thrombolytic therapy in the first 3 hours of evolution.

[Cardiopulmonary resuscitation in a general hospital]. / Reanimación cardiopulmonar en un hospital general.

The study presents a plan that is based on transferring the survival chain philosophy in hospital environments that directs the modern cardiopulmonary revival (CPR). The plan is based on an alarm system, starting the basic CPR by the nurse that identifies the sudden death, the fast arrival of the intensive care doctor, a nurse supervisor (who carries the defibrillator monitor to the scene) and the doctor responsible for the patient. During the first two years of performance (June 1993 to June 1995) 99 cases occurred with 73 confirmed stoppages. In 95% of the cases the alarm was tended in less than 5 minutes. Twenty one patients (33%) recovered their pulse and seven (11%) were sent home with a good brain recovery. The authors believe that appliances like the one introduced are useful in order to achieve efficient results in the CPR within the hospital.

Regulation of the herpes simplex virus latency-associated transcripts during establishment of latency in sensory neurons in vitro.

The temporal appearance of the major latency-associated transcript (LAT) of herpes simplex virus, type-1 (HSV-1) was examined in sensory neuronal cultures during the establishment of either a latent or a lytic infection. Under conditions that result in the establishment of a latent infection, a significant delay in LAT accumulation was observed. The delay in the appearance of LAT was reflected in both a reduced number of LAT-positive neurons detected by in situ hybridizations and by low levels of the major 2-kb LAT detected by Northern blot analysis at early times compared to later in the latent infection. The percentage of LAT-positive neurons shown by in situ hybridizations and the relative abundance of the major LAT by Northern blot analysis increased markedly by 14 days after inoculation with virus. In addition to the major LAT, a spliced 1.5-kb LAT species was detected in Northern blot analysis after establishment of latency in the neuronal cultures, similar to observations in vivo. In contrast to the latent infection, under conditions that produced lytic infections in the neuronal cultures, LAT and HSV-1-specific antigens were detected in the majority of neurons 24 hr after inoculation with virus. These results indicate that LAT expression during the establishment of latency is regulated differently than during the lytic infection: LAT expression appears to be inhibited initially during the establishment of latency, whereas LAT is readily expressed during the lytic infection.