Telemedicina y epilepsia: experiencia asistencial de un centro de referencia nacional durante la pandemia de COVID-19 / Telemedicine and epilepsy: healthcare experience of a national reference center during the COVID-19 pandemic

Introducción: El mundo entero está afrontando la pandemia por COVID-19 causada por el SARS-CoV-2. Los sistemas de salud nacionales están sometidos a niveles de sobrecarga sin precedentes. En nuestro centro se inició de forma temprana la asistencia a través de telemedicina. Pacientes y métodos: Es un estudio descriptivo y retrospectivo para evaluar la utilidad de la telemedicina durante el confinamiento en nuestro centro. Se incluyó a los pacientes con diagnóstico clínico de epilepsia, con dos asistencias a través de telemedicina, que tuvieran seguimiento durante al menos seis meses durante la situación de normalidad previa a la pandemia por COVID-19 y dos consultas presenciales durante ese mismo período. Resultados: Se incluyó a 115 pacientes. La media de edad fue de 29 años, el 53% fueron varones, el 52,2% con epilepsia focal, el 58,3% de etiología estructural y el 57,4% presentaba epilepsia de difícil control. La media de crisis preconfinamiento fue de 9,73/mes y de 6,54/mes durante el confinamiento. El número de pacientes libres de crisis fue mayor al final del confinamiento respecto a la fase preconfinamiento, 54 frente a 45/115. Conclusiones: La telemedicina es una estrategia de mucha utilidad en la monitorización de la evolución, el control evolutivo y los cambios terapéuticos en pacientes epilépticos a corto y medio plazo. La reducción de la frecuencia de crisis puede mantenerse a medio plazo, no sólo a corto plazo como se corroboró en estudios previos. La telemedicina permite acceder a prácticamente la totalidad de los pacientes y realizar un seguimiento más cercano.(AU)

Introduction: Countries worldwide are having to cope with the COVID-19 pandemic caused by SARS-CoV-2. The burden on their national health systems is currently at unprecedented levels. Telemedicine care was initiated at an early stage in our centre. Patients and methods: We conducted a descriptive and retrospective study to evaluate the usefulness of telemedicine during lockdown in our centre. Patients included in the study had a clinical diagnosis of epilepsy, with two visits via telemedicine, who had been followed up for at least six months during the normal situation prior to the COVID-19 pandemic and two face-to-face consultations during the same period. Results: A total of 115 patients were included. The average age was 29 years, 53% were males, 52.2% had focal epilepsy, 58.3% with a structural causation and 57.4% had difficult-to-treat epilepsy. The mean number of seizures prior to lockdown was 9.73/month and 6.54/month during lockdown. The number of patients who were seizure-free when lockdown ended was higher than that observed in the phase before it began: 54 versus 45 out of 115. Conclusions: Telemedicine is a very useful strategy for monitoring the course, progress and therapeutic changes in epileptic patients in the short and medium term. The reduction in the seizure frequency can be sustained in the medium term, not only in the short term as corroborated in previous studies. Telemedicine allows access to virtually all patients and closer monitoring.(AU)

[Telemedicine and epilepsy: healthcare experience of a national reference center during the COVID-19 pandemic]. / Telemedicina y epilepsia: experiencia asistencial de un centro de referencia nacional durante la pandemia de COVID-19.

INTRODUCTION: Countries worldwide are having to cope with the COVID-19 pandemic caused by SARS-CoV-2. The burden on their national health systems is currently at unprecedented levels. Telemedicine care was initiated at an early stage in our centre. PATIENTS AND METHODS: We conducted a descriptive and retrospective study to evaluate the usefulness of telemedicine during lockdown in our centre. Patients included in the study had a clinical diagnosis of epilepsy, with two visits via telemedicine, who had been followed up for at least six months during the normal situation prior to the COVID-19 pandemic and two face-to-face consultations during the same period. RESULTS: A total of 115 patients were included. The average age was 29 years, 53% were males, 52.2% had focal epilepsy, 58.3% with a structural causation and 57.4% had difficult-to-treat epilepsy. The mean number of seizures prior to lockdown was 9.73/month and 6.54/month during lockdown. The number of patients who were seizure-free when lockdown ended was higher than that observed in the phase before it began: 54 versus 45 out of 115. CONCLUSIONS: Telemedicine is a very useful strategy for monitoring the course, progress and therapeutic changes in epileptic patients in the short and medium term. The reduction in the seizure frequency can be sustained in the medium term, not only in the short term as corroborated in previous studies. Telemedicine allows access to virtually all patients and closer monitoring.

TITLE: Telemedicina y epilepsia: experiencia asistencial de un centro de referencia nacional durante la pandemia de COVID-19.Introducción. El mundo entero está afrontando la pandemia por COVID-19 causada por el SARS-CoV-2. Los sistemas de salud nacionales están sometidos a niveles de sobrecarga sin precedentes. En nuestro centro se inició de forma temprana la asistencia a través de telemedicina. Pacientes y métodos. Es un estudio descriptivo y retrospectivo para evaluar la utilidad de la telemedicina durante el confinamiento en nuestro centro. Se incluyó a los pacientes con diagnóstico clínico de epilepsia, con dos asistencias a través de telemedicina, que tuvieran seguimiento durante al menos seis meses durante la situación de normalidad previa a la pandemia por COVID-19 y dos consultas presenciales durante ese mismo período. Resultados. Se incluyó a 115 pacientes. La media de edad fue de 29 años, el 53% fueron varones, el 52,2% con epilepsia focal, el 58,3% de etiología estructural y el 57,4% presentaba epilepsia de difícil control. La media de crisis preconfinamiento fue de 9,73/mes y de 6,54/mes durante el confinamiento. El número de pacientes libres de crisis fue mayor al final del confinamiento respecto a la fase preconfinamiento, 54 frente a 45/115. Conclusiones. La telemedicina es una estrategia de mucha utilidad en la monitorización de la evolución, el control evolutivo y los cambios terapéuticos en pacientes epilépticos a corto y medio plazo. La reducción de la frecuencia de crisis puede mantenerse a medio plazo, no sólo a corto plazo como se corroboró en estudios previos. La telemedicina permite acceder a prácticamente la totalidad de los pacientes y realizar un seguimiento más cercano.

Antidepresivos en la tercera edad / Antidepressants in the elderly

La depresión en el anciano es una enfermedad frecuente, compleja y cambiante. Además sufren con más frecuencia recaídas y requieren cursos más largos de tratamiento. Es un reto su abordaje habida cuenta de otros factores concurrentes que complican su tratamiento además de la propia peculiaridad de la psicopatología. Es importante tener un esquema básico de los antidepresivos que nos ayude desde la atención primaria a tratar con garantías esta enfermedad tan frecuente. No hay ningún fármaco libre de problemas y hay que conocer las características de los mismos para poder realizar la elección más adecuada dependiendo de la eficacia, seguridad y tolerabilidad (AU)

Depression in the elderly is a changing, difficult and common disorder. At this age, there are more relapses and more long-life treatment is required. The pharmacology approach is a challenge because of concurrent factors that make their treatment more difficult. It is very important to have a basic antidepressant scheme, in order to help treat this disorder with efficiency and success from Primary Care. There are no drugs without side effects, and their characteristics have to be known in order to make the right selection depending on effectiveness, safety and tolerance (AU)

[Antidepressants in the elderly]. / Antidepresivos en la tercera edad.

Depression in the elderly is a changing, difficult and common disorder. At this age, there are more relapses and more long-life treatment is required. The pharmacology approach is a challenge because of concurrent factors that make their treatment more difficult. It is very important to have a basic antidepressant scheme, in order to help treat this disorder with efficiency and success from Primary Care. There are no drugs without side effects, and their characteristics have to be known in order to make the right selection depending on effectiveness, safety and tolerance.

Femtosecond laser writing of multifunctional optical waveguides in a Nd:YVO4 + KTP hybrid system.

We report on the fabrication of optical channel waveguides supporting both visible and IR TE and TM confinement in a hybrid system composed of a Nd:YVO4 laser gain medium glued to a potassium titanyl phosphate (KTP) nonlinear crystal. The microphotoluminescence and second harmonic confocal images of the fabricated waveguides have revealed that the laser and nonlinear properties of the constituent crystals have not been deteriorated because of the waveguide inscription. The resulting structures emerge as promising candidates for the development of multifrequency waveguide lasers.

Wavelength tuning of femtosecond pulses generated in nonlinear crystals by using diffractive lenses.

We demonstrate that diffractive lenses (DLs) can be used as a simple method to tune the central wavelength of femtosecond pulses generated from second-order nonlinear optical processes in birefringent crystals. The wavelength tunability is achieved by changing the relative distance between the nonlinear crystal and the DL, which acts in a focusing configuration. Besides the many practical applications of the so-generated pulses, the proposed method might be extended to other wavelength ranges by demonstrated similar effects on other nonlinear processes, such as high-order harmonic generation.

Photoionization with orbital angular momentum beams.

Intense laser ionization expands Einstein's photoelectric effect rules giving a wealth of phenomena widely studied over the last decades. In all cases, so far, photons were assumed to carry one unit of angular momentum. However it is now clear that photons can possess extra angular momentum, the orbital angular momentum (OAM), related to their spatial profile. We show a complete description of photoionization by OAM photons, including new selection rules involving more than one unit of angular momentum. We explore theoretically the interaction of a single electron atom located at the center of an intense ultraviolet beam bearing OAM, envisaging new scenarios for quantum optics.

Femtosecond-laser-written, stress-induced Nd:YVO4 waveguides preserving fluorescence and Raman gain.

We report the formation of optical waveguides in the self-Raman Nd:YVO(4) laser crystal by femtosecond laser inscription. The confocal fluorescence and Raman images have revealed that the waveguide is constituted by a locally compressed area in which the original fluorescence and Raman gains of the Nd:YVO(4) system are preserved. Thus the obtained structures emerge as promising candidates for highly efficient self-Raman integrated laser sources.

Thermally resistant waveguides fabricated in Nd:YAG ceramics by crossing femtosecond damage filaments.

We report on femtosecond laser writing of channel waveguides in Nd(3+) ion doped YAG ceramics by multiple inscriptions of damage filaments. Waveguiding between filaments was found to resist annealing temperatures as high as 1500 degrees C. Microluminescence imaging experiments have been carried out to elucidate the potential application of the obtained waveguides as integrated laser sources as well as to elucidate the waveguiding mechanisms.

The usefulness of post-genomics tools for characterization of the amine cross-talk in mammalian cells.

Evidence is growing in favour of a relationship between cancer and chronic inflammation, and particularly of the role of a polyamine and histamine metabolic interplay involved in these physiopathological problems, which are indeed highly complex biological systems. Decodification of the complex inter- and intra-cellular signalling mechanisms that control these effects is not an easy task, which must be helped by systems biology technologies, including new tools for location and integration of database-stored information and predictive mathematical models, as well as functional genomics and other experimental molecular approaches necessary for hypothesis validation. We review the state of the art and present our latest efforts in this area, focused on the amine metabolism field.

Saturation of ablation channels micro-machined in fused silica with many femtosecond laser pulses.

We investigate the effect of saturation in the propagation of ablation channels performed in fused silica with many incident femtosecond pulses and laser fluence slightly above the ultrafast ablation threshold. A 110 fs Ti:Sapphire laser system is used in the experiments and the results are compared with theoretical predictions performed with a numerical model developed by the authors. Diffraction of the incoming pulses at the entrance of the channel as well as reflections at the walls of the channel play a crucial role in the progress of the crater as it is shown by means of the numerical results. The effect of the pulse duration in the shape of the ablation channel is also investigated.

Integrated-grating-induced control of second-harmonic beams in frequency-doubling crystals.

We report a novel type of integrated nonlinear photonic device for controlling the generation of several second-harmonic beams. Two-dimensional diffraction gratings are recorded with femtosecond laser pulses at the entrance surface of a frequency-doubling crystal. This periodic spatial modulation of the material surface induces noncollinear propagation of the fundamental input signal in the crystal. By slightly changing the angle of incidence of the seed beam, collinear and noncollinear phase matching can be achieved between different diffraction orders, in this way allowing the efficient generation of several second-harmonic beams.

Laparoscopic bowel injury in an animal model: monocyte migration and apoptosis.

BACKGROUND: Unrecognized laparoscopic bowel injury has a delayed and covert presentation. Differences in monocyte migration and apoptosis between laparoscopic and open bowel injury were determined. METHODS: For this study, 24 rabbits were divided into laparoscopic (n = 9) and open surgical (n = 9) bowel injury groups and a control group (n = 6) without bowel injury. Bowel injury was created using monopolar electrocautery. The animals were killed 1 day, 1 week, and 2 weeks after surgery. Monocyte migration assay was performed across a modified Boyden chamber. Apoptosis was assessed by DNA fluorescent stain H-33342. RESULTS: In laparoscopy, monocyte apoptosis was decreased (p < 0.001), and migration was increased (p < 0.05), as compared with the open group. Apoptosis increased over time in both study groups, and was higher than in the control group (p < 0.001). Migration was decreased in both study groups as compared with the control group (p < 0.05) CONCLUSIONS: These results suggest decreased immune system priming with laparoscopic bowel injury, which may contribute to the masking of relevant signs and symptoms of peritonitis.

Efficacy and morbidity of therapeutic renal embolization in the spectrum of urologic disease.

PURPOSE: We report the largest series of renal embolizations performed for a variety of indications. PATIENTS AND METHODS: A retrospective analysis was performed on embolizations performed in our institution from 1997 to 2002 encompassing 36 patients who underwent 44 procedures. RESULTS: Embolization was successful on the first attempt in 87% of the patients. A second embolization was performed in four of the five unsuccessful cases, three successfully, increasing the success rate to 95%. The mean postoperative narcotic use was 27.2 mg of morphine equivalent, and 10 mg or less was required by 45% of the patients. In the 14 patients who had not also undergone a surgical procedure, the mean narcotic use was 21 mg, and 64% required 10 mg or less. Only 15% of the patients developed fever, which resolved within 2 days in all cases. Leukocytosis was seen in 47%. Follow-up creatinine and hypertension information was available in 16 and 18 patients, respectively. After a mean follow-up of 269 days, only one patient had a clinically significant rise in the creatinine concentration. After a mean follow-up of 496 days, two patients had new-onset hypertension. There was no statistically significant difference in the success rate, narcotic use, complications, creatinine concentrations, or the likelihood of fever, leukocytosis, or hypertension according to the indication for embolization or the agent used. Use of a microcatheter was associated with less parenchymal loss, and decreased parenchymal loss was associated with a significant reduction of narcotic use. CONCLUSIONS: Renal embolization is a highly effective and well-tolerated procedure in a variety of urologic conditions. The indications and material used did not have a significant effect on the outcome. Reducing parenchymal loss can significantly reduce morbidity.

Photochemical instability of CdSe nanocrystals coated by hydrophilic thiols.

The photochemical instability of CdSe nanocrystals coated by hydrophilic thiols was studied nondestructively and systematically in water. The results revealed that the photochemical instability of the nanocrystals actually included three distinguishable processes, namely the photocatalytic oxidation of the thiol ligands on the surface of nanocrystals, the photooxidation of the nanocrystals, and the precipitation of the nanocrystals. At first, the thiol ligands on the surface of a nanocrystal were gradually photocatalytically oxidized using the CdSe nanocrystal core as the photocatalyst. This photocatalytic oxidation process was observed as a zero-order reaction in terms of the concentration of the free thiols in the solution. The photogenerated holes in a nanocrystal were trapped onto the thiol ligands bound on the surface of the nanocrystal, which initiated the photooxidation of the ligands and protected the nanocrystal from any photooxidation. After nearly all of the thiol ligands on the surface of the nanocrystals were converted into disulfides, the system underwent several different pathways. If the disulfides were soluble in water, then all of the disulfides fell into the solution at the end of this initial process, and the nanocrystals precipitated out of the solution without much variation over their size and size distribution. When the disulfides were insoluble in water, they likely formed a micelle-like structure around the nanocrystal core and kept it soluble in the solution. In this case, the nanocrystals only precipitated after severe oxidation, which took a long period of time. If the system contained excess free thiol ligands, they replaced the photochemically generated disulfides and maintained the stability and solubility of the nanocrystals. The initiation stage of the photooxidation of CdSe nanocrystals themselves increased as the thickness and packing density of the ligand shell increased. This was explained by considering the ligand shell on the surface of a nanocrystal as the diffusion barrier of the oxygen species from the bulk solution into the interface between the nanocrystal and the surface ligands. Experimental results clearly indicated that the initiation stage of the photooxidation was not caused by the chemical oxidation of the system kept in air under dark conditions or the hydrolysis of the cadmium-thiol bonds on the surface of the nanocrystals, both of which were magnitudes slower than the photocatalytic oxidation of the surface ligands if they occurred at all. The results described in this contribution have already been applied for designing new types of thiol ligands which dramatically improved the photochemical stability of CdSe nanocrystals with a ligand shell that is as thin as approximately 1 nm.

Client satisfaction and quality of health care in rural Bangladesh.

OBJECTIVE: To assess user expectations and degree of client satisfaction and quality of health care provided in rural Bangladesh. METHODS: A total of 1913 persons chosen by systematic random sampling were successfully interviewed immediately after having received care in government health facilities. FINDINGS: The most powerful predictor for client satisfaction with the government services was provider behaviour, especially respect and politeness. For patients this aspect was much more important than the technical competence of the provider. Furthermore, a reduction in waiting time (on average to 30 min) was more important to clients than a prolongation of the quite short (from a medical standpoint) consultation time (on average 2 min, 22 sec), with 75% of clients being satisfied. Waiting time, which was about double at outreach services than that at fixed services, was the only element with which users of outreach services were dissatisfied. CONCLUSIONS: This study underscores that client satisfaction is determined by the cultural background of the people. It shows the dilemma that, though optimally care should be capable of meeting both medical and psychosocial needs, in reality care that meets all medical needs may fail to meet the client's emotional or social needs. Conversely, care that meets psychosocial needs may leave the clients medically at risk. It seems important that developing countries promoting client-oriented health services should carry out more in-depth research on the determinants of client satisfaction in the respective culture.

Breakdown of stabilization of atoms interacting with intense, high-frequency laser pulses

An analysis of the influence of the magnetic field of an intense, high-frequency laser pulse on the stabilization of an atomic system is presented. We demonstrate that at relatively modest intensities the magnetic field can significantly alter the dynamics of the system. In particular, a breakdown of stabilization occurs, thereby restricting the intensity regime in which the atom is relatively stable against ionization. Counterpropagating pulses do not negate the detrimental effects of the magnetic field. We compare our quantum mechanical results with classical Monte Carlo simulations.