Lithium levels and lifestyle in patients with bipolar disorder: a new tool for self-management.

BACKGROUND: Patients should get actively involved in the management of their illness. The aim of this study was to assess the influence of lifestyle factors, including sleep, diet, and physical activity, on lithium levels in patients with bipolar disorder. METHODS: A multicenter study was performed. In total, 157 lithium measurements were done biweekly in a sample of 65 patients (35 women) over 6 weeks. Lifestyle, based on total sleep hours and physical activity, was assessed by actigraphy. Diet was evaluated using the Mediterranean Lifestyle Index (Medlife). RESULTS: 35.4% of patients had a normal weight. The mean Medlife score was 14.5 (± 2.5) (moderate-good adherence to Mediterranean diet). BMI, daily dose of lithium and intensity of physical activity had a combined effect on lithium levels, after adjustment for other variables. Patients who practiced intense physical exercise, who took lower doses and had a higher BMI exhibited lower levels of lithium. CONCLUSIONS: Higher physical activity and BMI contribute to lower lithium levels. Patients should be made aware of these relationships to improve their perception of control and self-management. Lifestyle-based interventions contribute to establishing a more personalized medicine.

Neuroinvasive disease due to West Nile virus: Clinical and imaging findings associated with a re-emerging pathogen.

The West Nile virus (WNV) is an arbovirus than can infect human beings and cause severe neuroinvasive disease. Taking the outbreak that occurred in Spain in 2020 as a reference, this article reviews the clinical and imaging findings for neuroinvasive disease due to WNV. We collected demographic, clinical, laboratory, and imaging (CT and MRI) variables for 30 patients with WNV infection diagnosed at our center. The main clinical findings were fever, headache, and altered levels of consciousness. Neuroimaging studies, especially MRI, are very useful in the diagnosis and follow-up of these patients. The most common imaging findings were foci of increased signal intensity in the thalamus and brainstem in T2-weighted sequences; we illustrate these findings in cases from our hospital.

Enfermedad neuroinvasiva por el virus del Nilo Occidental: características clínicas y en neuroimagen de un patógeno reemergente / Neuroinvasive disease due to West Nile virus: clinical and imaging findings associated with a re-emerging pathogen

El virus del Nilo Occidental es un arbovirus que puede infectar al ser humano y causar una enfermedad neuroinvasiva grave. Tomando como referencia el brote que tuvo lugar en España en 2020, se ha realizado una revisión clínica y de neuroimagen de dicha patología. Para ello, se han recogido datos demográficos, clínicos, analíticos y pruebas de imagen (tomografía computarizada y resonancia magnética) de 30 pacientes diagnosticados de infección por virus del Nilo Occidental en nuestro centro. Las principales manifestaciones clínicas fueron fiebre, cefalea y alteración del nivel de conciencia. Los estudios de neuroimagen, especialmente la resonancia, son de gran importancia para el diagnóstico y seguimiento. Los hallazgos más frecuentes fueron focos de aumento de señal en T2 en el tálamo y tronco del encéfalo, que ilustramos en esta revisión con casos de nuestro centro hospitalario.(AU)

The West Nile virus (WNV) is an arbovirus than can infect human beings and cause severe neuroinvasive disease. Taking the outbreak that occurred in Spain in 2020 as a reference, this article reviews the clinical and imaging findings for neuroinvasive disease due to WNV. We collected demographic, clinical, laboratory, and imaging (CT and MRI) variables for 30 patients with WNV infection diagnosed at our center. The main clinical findings were fever, headache, and altered levels of consciousness. Neuroimaging studies, especially MRI, are very useful in the diagnosis and follow-up of these patients. The most common imaging findings were foci of increased signal intensity in the thalamus and brainstem in T2-weighted sequences; we illustrate these findings in cases from our hospital.(AU)

[Introduction of an anticholinesterase drug in the context of myasthenia, in a severe asthmatic patient]. / Introduction d'un anticholinestérasique dans le contexte d'une myasthénie, chez une patiente asthmatique sévère.

Association of asthma with myasthenia gravis presents a twofold peculiarity. First, as dyspnea characterizes both conditions, diagnostic orientation is difficult. Second, from a therapeutic standpoint, the initiation of anticholinesterase treatment requires a multidisciplinary approach due to possible contraindication for asthma. We report on the case of a patient monitored for severe asthma and treated with biotherapy, and also monitored for myasthenia gravis, and treated with anticholinesterase.

Neuroinvasive disease due to West Nile virus: clinical and imaging findings associated with a re-emerging pathogen. / Enfermedad neuroinvasiva por el virus del Nilo Occidental: características clínicas y en neuroimagen de un patógeno reemergente.

The West Nile virus (WNV) is an arbovirus than can infect human beings and cause severe neuroinvasive disease. Taking the outbreak that occurred in Spain in 2020 as a reference, this article reviews the clinical and imaging findings for neuroinvasive disease due to WNV. We collected demographic, clinical, laboratory, and imaging (CT and MRI) variables for 30 patients with WNV infection diagnosed at our center. The main clinical findings were fever, headache, and altered levels of consciousness. Neuroimaging studies, especially MRI, are very useful in the diagnosis and follow-up of these patients. The most common imaging findings were foci of increased signal intensity in the thalamus and brainstem in T2-weighted sequences; we illustrate these findings in cases from our hospital.

A Novel Computerized Cognitive Stress Test to Detect Mild Cognitive Impairment.

BACKGROUND: The Loewenstein Acevedo Scales of Semantic Interference and Learning (LASSI-L) is a novel and increasingly employed instrument that has outperformed widely used cognitive measures as an early correlate of elevated brain amyloid and neurodegeneration in prodromal Alzheimer's Disease (AD). The LASSI-L has distinguished those with amnestic mild cognitive impairment (aMCI) and high amyloid load from aMCI attributable to other non-AD conditions. The authors designed and implemented a web-based brief computerized version of the instrument, the LASSI-BC, to improve standardized administration, facilitate scoring accuracy, real-time data entry, and increase the accessibility of the measure. OBJECTIVE: The psychometric properties and clinical utility of the brief computerized version of the LASSI-L was evaluated, together with its ability to differentiate older adults who are cognitively normal (CN) from those with amnestic Mild Cognitive Impairment (aMCI). METHODS: After undergoing a comprehensive uniform clinical and neuropsychological evaluation using traditional measures, older adults were classified as cognitively normal or diagnosed with aMCI. All participants were administered the LASSI-BC, a computerized version of the LASSI-L. Test-retest and discriminant validity was assessed for each LASSI-BC subscale. RESULTS: LASSI-BC subscales demonstrated high test-retest reliability, and discriminant validity was attained. CONCLUSIONS: The LASSI-BC, a brief computerized version of the LASSI-L is a valid and useful cognitive tool for the detection of aMCI among older adults.

Loss of vision in a patient with major burn injury, including a review of the literature.

Vision loss is a rare complication due to decreased blood flow through the optic nerve, which has been described in certain groups of postoperative patients and as a major complication in polytraumatisms that need massive fluid resuscitation. However it has rarely been described in burned patients. We describe a patient with ischemic optic neuropathy (ION) as a major burn injury complication, focusing on his massive fluid resuscitation and hospital course and comparing it with previous case reports related to burn injuries in the literature. A 37-year-old male was admitted to the Burn Care Unit with an 85% total body surface burn injury caused by high temperature water vapour with traces of caustic soda. He underwent escharotomies the day of admission and sequential enzymatic and surgical debridement. An ophthalmological follow-up was conducted, with no fundoscopy alterations, and ION and vision loss was subsequently diagnosed. ION is an uncommon and currently irreversible condition, prevention therefore being the principal objective. Thus, minimization of risk factors such as anaemia, significant blood loss and massive fluid resuscitation, is advisable.

La perte de vision est une complication rare liée à un bas débit sanguin destiné au nerf optique, décrite en particulier en post opératoire et dans le cadre de polytraumatismes, après remplissage massif. Elle est toutefois peu décrite chez les brûlés. Nous décrivons ici une neuropathie optique ischémique compliquant une brûlure sévère. Nous nous attachons au remplissage massif initial et au séjour hospitalier et le comparons aux cas similaires préalablement rapportés. Un homme de 37 ans est admis pour une brûlure sur 85% SCT par ébouillantement d'eau additionnée de soude caustique (ça sent l'accident agro- alimentaire, NDRLF). Des incisions de décharge ont été initialement nécessaires puis le patient a bénéficié d'un débridement enzymatique. Une névrite optique ischémique, à fond d'oeil normal, a été mise en évidence. Cette complication, rare mais irréversible, doit donc être prévenue, en minimisant les facteurs de risque que sont l'anémie, l'hémorragie massive et le surremplissage.

Characteristics of a Diverse Cohort of Stroke Patients with SARS-CoV-2 and Outcome by Sex.

BACKGROUND AND PURPOSE: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is associated with stroke. The role of sex on stroke outcome has not been investigated. To objective of this paper is to describe the characteristics of a diverse cohort of acute stroke patients with COVID-19 disease and determine the role of sex on outcome. METHODS: This is a retrospective study of patients with acute stroke and SARS-CoV-2 infection admitted between March 15 to May 15, 2020 to one of the six participating comprehensive stroke centers. Baseline characteristics, stroke subtype, workup, treatment and outcome are presented as total number and percentage or median and interquartile range. Outcome at discharge was determined by the modified Rankin Scale Score (mRS). Variables and outcomes were compared for males and females using univariate and multivariate analysis. RESULTS: The study included 83 patients, 47% of which were Black, 28% Hispanics/Latinos, and 16% whites. Median age was 64 years. Approximately 89% had at least one preexisting vascular risk factor (VRF). The most common complications were respiratory failure (59%) and septic shock (34%). Compared with females, a higher proportion of males experienced severe SARS-CoV-2 symptoms requiring ICU hospitalization (73% vs. 49%; p = 0.04). When divided by stroke subtype, there were 77% ischemic, 19% intracerebral hemorrhage and 3% subarachnoid hemorrhage. The most common ischemic stroke etiologies were cryptogenic (39%) and cardioembolic (27%). Compared with females, males had higher mortality (38% vs. 13%; p = 0.02) and were less likely to be discharged home (12% vs. 33%; p = 0.04). After adjustment for age, race/ethnicity, and number of VRFs, mRS was higher in males than in females (OR = 1.47, 95% CI = 1.03-2.09). CONCLUSION: In this cohort of SARS-CoV-2 stroke patients, most had clinical evidence of coronavirus infection on admission and preexisting VRFs. Severe in-hospital complications and worse outcomes after ischemic strokes were higher in males, than females.

[Syncytial intramedullary meningioma associated with cervical syringomyelia]. / Meningioma sincitial intramedular asociado a siringomielia cervical.

TITLE: Meningioma sincitial intramedular asociado a siringomielia cervical.

The immune status against tetanus and diphtheria in healthcare workers in Catalonia.

The objective was to investigate the immune status against tetanus and diphtheria of healthcare workers in Catalonia. A cross-sectional multicentre study was conducted in seven health centres. Blood samples were obtained, and demographic and clinical variables collected. 509 health workers were included. The prevalence of protective antibodies against tetanus was 94.7% (95% CI: 92.3-96.4) overall and 85.1% (95% CI: 74.5-92.0) in workers aged ≥55 years. The prevalence of protective antibodies against diphtheria was 68.6% (95% CI: 64.3-72.5%) overall and 29.7% (95% CI: 19.9-41.6) in workers aged ≥55 years. Protection against tetanus in healthcare workers is high, but should be improved in workers aged ≥55 years. Protection against diphtheria has improved in healthcare workers over the past decade (68.6% vs 46.5%) but should be improved in all ages, especially in workers aged ≥55 years.

Fixed-bed column system for Cd2+ uptake from aqueous solution by sodium- and thiourea-modified clinoptilolite-rich tuff.

Two kinds of clinoptilolite-rich tuffs from the state of Sonora (Mexico), previously treated with NaCl solution and then modified with thiourea, were investigated to remove Cd2+ from aqueous solution in a fixed-bed column system. Experiments were conducted with a 30 mg L-1 Cd2+ solution at a pH value of 5 and three-bed heights of sodium- and thiourea-modified clinoptilolite-rich tuffs. The experimental data were examined with the bed depth service time model (BDST), the Thomas model, and a mass balance approach. According to the BDST model, the dynamic sorption capacity (No) for the thiourea-modified clinoptilolite-rich tuff was 0.0357 Kg L-1. This value corresponded to 1.2 times higher than that for sodium-modified clinoptilolite-rich tuff (0.0287 Kg L-1). The experimental data obtained for sodium- modified clinoptilolite-rich tuff (ZSGNa) with 3 cm of bed height, fitted to the Thomas model, with R2 = 0.9679 and Cd sorption capacity of 35.4 mg g-1, while for the thiourea-modified clinoptilolite-rich tuff (ZSGThio) with 4.5 cm of bed height, was 36.52 mg g-1 with R2 = 0.9368. The parameters calculated with the mass balance model describe a favourable process where the system with ZSGThio (6 cm bed height) had the best performance for sorption capacity up to the breakthrough point, qb = 22.35 mg g-1. The zeolite modified with thiourea exhibited higher capacity in Cd2+ removal than the one modified with NaCl, in the column with 6 cm of bed height. To investigate the mechanisms of removal of Cd2+ by the modified zeolites, Na⁺ was measured to determine the milliequivalents of cadmium removed.

[Isolated paralysis of the hypoglossal nerve due to atlanto-occipital joint cysts]. / Paralisis aislada del nervio hipogloso ocasionada por quistes occipitoatloideos.

TITLE: Paralisis aislada del nervio hipogloso ocasionada por quistes occipitoatloideos.

Effects of peanut drying and blanching on Salmonella spp.

In order to evaluate the behavior of Salmonella during peanut drying and blanching, a study was conducted with Runner type peanuts. Samples of raw in-shell or unblanched peanuts were inoculated by spraying with a pool of five Salmonella serotypes isolated from the peanut supply chain (Miami, Muenster, Yoruba, Javiana and Glostrup). The in-shell peanuts were submitted to drying at 35 and 40 °C up to 18 h. After this time, the Salmonella counts went down ca. 2.0 log MPN/g at 35 and 40 °C. According to the Weibull model the time needed to achieve Salmonella 3-log reduction (T3d) and 5-log reduction (T5d) on the in-shell peanuts would be ca. 49 and 117 h at 35 °C and 35 and 79 h at 40 °C, respectively. The results showed that there was no statistical difference (p > .05) between either of the temperatures employed in the process. The blanching process was performed in two steps: pre-roasting (step 1) and skin removal (step 2). Reduction of up to 2.1 log MPN/g was observed after blanching at 100 °C/15 min plus 15 s of air impact. The skin removal process did not result in recontamination of the final sample. The Weibull model predicted 3- and 5-log reductions of Salmonella in 37.0 and 68.9 min for blanching at 95 °C, and in 39.1 and 114.9 min at 100 °C. The results demonstrated that drying and blanching processes did not generate large reductions of Salmonella in the peanut samples. Thus, the product resulting from these steps may be a possible source of cross-contamination for the processing plant and the final product.

[Nuclear paralysis of the oculomotor nerve within the context of traumatic brain injury]. / Paralisis nuclear del III par craneal en el contexto de un traumatismo craneoencefalico.

TITLE: Paralisis nuclear del III par craneal en el contexto de un traumatismo craneoencefalico.

Susceptibilidad genética del síndrome de Gilbert en población valenciana; eficiencia del test de ayuno / Genetic susceptibility to Gilbert's syndrome in a valencian population; efficacy of the fasting test

El estudio de la correlación entre el genotipo y el fenotipo: ¿éxito o fracaso? Objetivo. Describir la distribución poblacional de la variante UGT1A1*28 (código de variante genética rs8175347) localizada en el promotor del gen UGT1A1 y correlacionar sus genotipos con los resultados de la prueba de ayuno, así como su relación con la alteración bioquímica propia del síndrome de Gilbert (SG) en población valenciana. Pacientes y métodos. Estudiamos la prevalencia de los genotipos (TA)6/6 (TA)6/7 y (TA)7/7 de la variante deletérea rs8175347, en 144 pacientes con hiperbilirrubinemia, de los cuales 38 habían sido sometidos previamente a la prueba del ayuno para realizar el diagnóstico de SG, y en 150 individuos control. Analizando la región genómica de la caja TATA del promotor del gen UGT1A1 mediante secuenciación Sanger, se estableció la correlación de los genotipos rs8175347 con los resultados del test del ayuno y con las alteraciones bioquímicas de los pacientes. Resultados. La frecuencia de heterocigosidad del alelo (TA)7 en población control fue 32% y ascendió al 87,59% entre pacientes con sospecha de SG. La frecuencia del genotipo TA7/7 fue del 81,94% entre los pacientes, frente a un 11,33% en controles. La prueba de ayuno mostró un 15,79% de falsos negativos y un 5,26% de falsos positivos. Conclusiones. La elevada frecuencia del alelo (TA)7 entre individuos de población control valenciana, casi el doble del 5% descrito en individuos control europeos, corrobora la elevada frecuencia del SG descrita en población española, sin observarse diferencias significativas entre extremos geográficos del país. La eficacia y fiabilidad de la prueba del ayuno para el diagnóstico del SG es cuestionable (AU)

Ojective. To describe the populational distribution of the UGT1A1*28 variant (genetic variant code rs8175347) located in the promotor of the UGT gene and correlate its genotypes with the results of the fasting test, as well as its relationship with the biochemical disorder of Gilbert's syndrome (GS) in a Valencian population. Patients and methods. We studied the prevalence of the genotypes (TA)6/6 (TA)6/7 and (TA)7/7 of the deleterious variant rs8175347 in 144 patients with hyperbilirubinemia, 38 of whom had previously undergone the fasting test to diagnose GS, and in 150 control patients. By analysing the genomic region of the TATA box of the UGT1A1 gene promotor using Sanger sequencing, we established the correlation between the rs8175347 genotypes and the fasting test results and with the patients’ biochemical disorders. Results. The rate of heterozygosity of allele (TA)7 in the control population was 32% and increased to 87.59% among the patients with suspected GS. The rate of genotype TA7/7 was 81.94% among the patients with hyperbilirubinemia, compared with 11.33% in the control patients. The fasting test showed a 15.79% rate of false negatives and a 5.26% rate of false positives. Conclusions. The high frequency of allele (TA)7 among the Valencian control population, almost double the 5% reported for European control patients, confirms the high rate of GS reported in the Spanish population, without observing significant differences between the geographical ends of the country. The efficacy and reliability of the fasting test for the diagnosis of GS is questionable (AU)