[Cryptogenic new-onset super-refractory status epilepticus following SARS-CoV-2 vaccination. A case report]. / Estado epiléptico superrefractario de nueva aparición criptógeno tras vacunación contra el SARS-CoV-2. A propósito de un caso.

INTRODUCTION: New-onset super-refractory status epilepticus (NOSRSE) is a neurological emergency characterised by the development of status epilepticus in a patient without epilepsy or any known prior neurological disease and with no clear structural, toxic or metabolic cause, which recurs after 24 hours of induced coma. The most common identifiable cause is inflammatory-autoimmune. Consequently, we present a case of NOSRSE related to SARS-CoV-2 vaccination as an opportunity to investigate the dysimmune origin of this pathology. CASE REPORT: We report the case of a 40-year-old male who presented at the emergency department with fever and headache with no clear source of infection. His personal history included bacterial meningitis in childhood without any sequelae and protein S deficiency without treatment at the time, as well as vaccination with ChAdOx1 nCoV-19 21 days earlier. He was initially diagnosed with a urinary tract infection and treated with cefuroxime. Two days later, he was taken back to the emergency department with confusional symptoms and tonic-clonic seizures. He did not respond to midazolam and finally required sedation and orotracheal intubation for refractory status epilepticus. While in hospital, he required a number of lines of antiepileptic drugs, ketamine, a ketogenic diet, immunotherapy and plasmapheresis in order to successfully limit NOSRSE. The aetiological study offered normal results for serology, antineuronal antibodies in serum and cerebrospinal fluid, transthoracic echocardiography, testicular ultrasound and computed tomographic angiography. Only the control MRI scan showed a diffuse and bilateral alteration of the right hemispheric cortex and thalamic pulvinar as the only finding. CONCLUSION: It is crucial to report suspected adverse reactions associated with SARS-CoV-2 vaccination, thereby allowing continued monitoring of the risk/benefit ratio of vaccination.

TITLE: Estado epiléptico superrefractario de nueva aparición criptógeno tras vacunación contra el SARS-CoV-2. A propósito de un caso.Introducción. El estado epiléptico superrefractario de nueva aparición (NOSRSE) es una emergencia neurológica caracterizada por el desarrollo de estado epiléptico en un paciente sin epilepsia ni enfermedad neurológica previa conocida y sin clara causa estructural, tóxica o metabólica, que recurre tras 24 horas del coma inducido. La causa identificable más frecuente es la inflamatoria-autoinmune. En consecuencia, planteamos un caso de NOSRSE relacionado con la vacunación para el SARS-CoV-2 como una oportunidad de indagar el origen disinmune de esta patología. Caso clínico. Varón de 40 años que acude al servicio de urgencias refiriendo fiebre y cefalea sin claro foco infeccioso. Entre sus antecedentes personales destacamos una meningitis bacteriana en la infancia sin secuelas y un déficit de proteína S sin tratamiento en ese momento, así como vacunación con ChAdOx1 nCoV-19 21 días antes. Fue inicialmente diagnosticado de infección del tracto urinario y tratado con cefuroxima. Dos días después, se le llevó de nuevo a urgencias con cuadro confusional y crisis tonicoclónicas, sin respuesta al midazolam, y requirió finalmente sedación e intubación orotraqueal por estado epiléptico refractario. Durante su ingreso requirió múltiples líneas de antiepilépticos, quetamina, dieta cetógena, inmunoterapia y plasmaféresis para conseguir limitar el NOSRSE. El estudio etiológico ofrecía normalidad de los resultados de serología, anticuerpos antineuronales en el suero y líquido cefalorraquídeo, ecocardiografía transtorácica, ecografía testicular y angiotomografía computarizada. Únicamente la resonancia magnética de control mostró una alteración difusa y bilateral de la corteza hemisférica y pulvinar talámica derecha como único hallazgo. Conclusión. Es crucial notificar las sospechas de reacciones adversas asociadas a la vacunación frente al SARS-CoV-2, permitiendo así una supervisión continuada de la relación riesgo/beneficio de ésta.

Estado epiléptico superrefractario de nueva aparición criptógeno tras vacunación contra el SARS-CoV-2. A propósito de un caso / Cryptogenic new-onset super-refractory status epilepticus following SARS-CoV-2 vaccination. A case report

Introduction: New-onset super-refractory status epilepticus (NOSRSE) is a neurological emergency characterised by the development of status epilepticus in a patient without epilepsy or any known prior neurological disease and with no clear structural, toxic or metabolic cause, which recurs after 24 hours of induced coma. The most common identifiable cause is inflammatory-autoimmune. Consequently, we present a case of NOSRSE related to SARS-CoV-2 vaccination as an opportunity to investigate the dysimmune origin of this pathology. Case report: We report the case of a 40-year-old male who presented at the emergency department with fever and headache with no clear source of infection. His personal history included bacterial meningitis in childhood without any sequelae and protein S deficiency without treatment at the time, as well as vaccination with ChAdOx1 nCoV-19 21 days earlier. He was initially diagnosed with a urinary tract infection and treated with cefuroxime. Two days later, he was taken back to the emergency department with confusional symptoms and tonic-clonic seizures. He did not respond to midazolam and finally required sedation and orotracheal intubation for refractory status epilepticus. While in hospital, he required a number of lines of antiepileptic drugs, ketamine, a ketogenic diet, immunotherapy and plasmapheresis in order to successfully limit NOSRSE. The aetiological study offered normal results for serology, antineuronal antibodies in serum and cerebrospinal fluid, transthoracic echocardiography, testicular ultrasound and computed tomographic angiography. Only the control MRI scan showed a diffuse and bilateral alteration of the right hemispheric cortex and thalamic pulvinar as the only finding. Conclusion: It is crucial to report suspected adverse reactions associated with SARS-CoV-2 vaccination, thereby allowing continued monitoring of the risk/benefit ratio of vaccination.(AU)

Introducción: El estado epiléptico superrefractario de nueva aparición (NOSRSE) es una emergencia neurológica caracterizada por el desarrollo de estado epiléptico en un paciente sin epilepsia ni enfermedad neurológica previa conocida y sin clara causa estructural, tóxica o metabólica, que recurre tras 24 horas del coma inducido. La causa identificable más frecuente es la inflamatoria-autoinmune. En consecuencia, planteamos un caso de NOSRSE relacionado con la vacunación para el SARS-CoV-2 como una oportunidad de indagar el origen disinmune de esta patología. Caso clínico: Varón de 40 años que acude al servicio de urgencias refiriendo fiebre y cefalea sin claro foco infeccioso. Entre sus antecedentes personales destacamos una meningitis bacteriana en la infancia sin secuelas y un déficit de proteína S sin tratamiento en ese momento, así como vacunación con ChAdOx1 nCoV-19 21 días antes. Fue inicialmente diagnosticado de infección del tracto urinario y tratado con cefuroxima. Dos días después, se le llevó de nuevo a urgencias con cuadro confusional y crisis tonicoclónicas, sin respuesta al midazolam, y requirió finalmente sedación e intubación orotraqueal por estado epiléptico refractario. Durante su ingreso requirió múltiples líneas de antiepilépticos, quetamina, dieta cetógena, inmunoterapia y plasmaféresis para conseguir limitar el NOSRSE. El estudio etiológico ofrecía normalidad de los resultados de serología, anticuerpos antineuronales en el suero y líquido cefalorraquídeo, ecocardiografía transtorácica, ecografía testicular y angiotomografía computarizada. Únicamente la resonancia magnética de control mostró una alteración difusa y bilateral de la corteza hemisférica y pulvinar talámica derecha como único hallazgo. Conclusión: Es crucial notificar las sospechas de reacciones adversas asociadas a la vacunación frente al SARS-CoV-2, permitiendo así una supervisión continuada de la relación riesgo/beneficio de ésta.(AU)

Analysis of headache management in Andalusia.

INTRODUCTION AND OBJECTIVE: Headache is a frequent reason for consultation between primary care physicians, emergency services physicians, and neurology specialists; however, it is not always well managed. The Andalusian Society of Neurology's Headache Study Group (SANCE) aimed to analyse headache management at different levels of care. MATERIAL AND METHODS: We conducted a descriptive cross-sectional study with data gathered through a retrospective survey in July 2019. Participants completed a series of structured questionnaires on different social and work-related variables from 4 different groups of healthcare professionals (primary care [PC], emergency departments, neurology departments, headache units). RESULTS: A total of 204 healthcare professionals completed the survey: 35 emergency department physicians, 113 PC physicians, 37 general neurologists, and 19 neurologists specialising in headache. Eighty-five percent of PC physicians reported prescribing preventive drugs, which were maintained for at least 6 months (59%), with flunarizine and amitriptyline being the most commonly used. Most patients attended at neurology consultations (65%) are referred by PC physicians, with changes in the headache pattern being the main reason for referral (74%). Healthcare professionals across all levels of care showed great interest in headache and in receiving training in headache management (97% of PC physicians, 100% of emergency services physicians, 100% of general neurologists). CONCLUSIONS: Migraine sparks great interest among healthcare professionals from different levels of care. Our results also reveal a lack of resources for headache management, which is reflected in the long waiting times. Other means of bilateral communication between different levels of care should be explored (eg, e-mail).

Terapia farmacológica en la prevención secundaria del ictus isquémico en los muy ancianos: ¿ha mejorado en las últimas décadas? / Pharmacological therapy in the secondary prevention of ischemic stroke in the oldest-old patients: has it improved in recent decades?

Introduction Population aging has caused an increase in strokes in very elderly patients (VEP). We assess how secondary prevention of ischemic stroke has changed in VEP in recent decades. Method Retrospective study of discharges due to ischemic stroke in the Virgen Macarena, Virgen del Rocio and Valme hospitals in Seville (Spain), during the periods 1999–2001, 2014−16 and 2019−2020. VEP were considered those with ≥80 years. Result We studied 1806 patients, 349 (19.3%) were VEP. Over the years, VEPs have doubled (13.5% vs. 25.9% and 28% p = 0.0001) and age has increased (83.3 ± 3 vs. 84.1 ± 3 vs. 85.2 ± 4 p = 0.001). Comparing the periods, the VEPs have more hypertension (69.9% vs. 84.8% vs. 84.6%; p = 0.0001) and dyslipidemia (12% vs. 41.7% vs. 52.3%; p = 0.0001) and have prescribed more antihypertensives (69.1% vs. 86.7% vs. 92.3%; p = 0.0001), statins (5.3% vs. 78% vs. 81.5%; p = 0.0001) and anticoagulants (16.5% vs. 19.4% vs. 53.1%; p = 0.001), increasing the number of antihypertensives (1 ± 0.9 vs. 1.6 ± 0, 9 vs. 1.9 ± 0.8 drugs p = 0.0001), and high-intensity statins (2.3% vs. 42.7 vs. 69.2% p = 0.0001). Comparing the VEPs with the younger ones, there were no differences in antihypertensive treatment in any period, there were differences in antithrombotic treatment in the first period, and with statins the differences were maintained until the end. Conclusions In the last 20 years the number of VEPs has doubled, exceeding a quarter of the discharges. Although there is improvement in secondary stroke prevention in VEPs, there is room for improvement (AU)

Introducción El envejecimiento poblacional ha provocado un aumento de los ictus en los pacientes muy ancianos (PMA). Valoramos cómo ha cambiado la prevención secundaria del ictus isquémico en PMA en las últimas décadas. Método Estudio retrospectivo de las altas por ictus isquémico en los hospitales Virgen Macarena, Virgen del Rocío y Virgen de Valme de Sevilla (España), durante los períodos 1999-2001, 2014-2016 y 2019-2020. Se consideró PMA ≥ 80 años. Resultado Estudiamos a 1.806 pacientes, de los cuales 349 (19,3%) eran PMA. Con los años se han duplicado los PMA (13,5% vs. 25,9% y 28%; p = 0,0001) y aumentado la edad (83,3 ± 3 vs. 84,1 ± 3 vs. 85,2 ± 4; p = 0,001). Comparando los períodos, los PMA tienen más hipertensión (69,9 vs. 84,8% vs. 84,6%; p = 0,0001) y dislipidemia (12 vs. 41,7% vs. 52,3%; p = 0,0001) y tienen prescritos más antihipertensivos (69,1% vs. 86,7% vs. 92,3%; p = 0,0001), estatinas (5,3% vs. 78% vs. 81,5%; p = 0,0001) y anticoagulantes (16,5% vs. 19,4% vs. 53,1%; p = 0,001); también ha aumentado el número de antihipertensivos (1 ± 0,9 vs. 1,6 ± 0,9 vs. 1,9 ± 0,8 fármacos; p = 0,0001) y de estatinas de alta intensidad (2,3% vs. 42,7% vs. 69,2%; p = 0,0001). Comparando los PMA con pacientes más jóvenes, no hubo diferencias en el tratamiento antihipertensivo en ningún período, aunque sí hubo diferencias en el tratamiento antitrombótico en el primer período y con las estatinas las diferencias se mantuvieron hasta el final. Conclusiones En los últimos 20 años el número de PMA se ha duplicado y supera la cuarta parte de las altas. Aunque existe mejoría en la prevención secundaria del ictus en los PMA, existe margen de mejora (AU)

Pharmacological therapy in the secondary prevention of ischemic stroke in the oldest-old patients: has it improved in recent decades?

INTRODUCTION: Population aging has caused an increase in strokes in very elderly patients (VEP). We assess how secondary prevention of ischemic stroke has changed in VEP in recent decades. METHOD: Retrospective study of discharges due to ischemic stroke in the Virgen Macarena, Virgen del Rocio and Valme hospitals in Seville (Spain), during the periods 1999-2001, 2014-16 and 2019-2020. VEP were considered those with ≥80 years. RESULT: We studied 1806 patients, 349 (19.3%) were VEP. Over the years, VEPs have doubled (13.5% vs. 25.9% and 28% p = 0.0001) and age has increased (83.3 ±â€¯3 vs. 84.1 ±â€¯3 vs. 85.2 ±â€¯4 p = 0.001). Comparing the periods, the VEPs have more hypertension (69.9% vs. 84.8% vs. 84.6%; p = 0.0001) and dyslipidemia (12% vs. 41.7% vs. 52.3%; p = 0.0001) and have prescribed more antihypertensives (69.1% vs. 86.7% vs. 92.3%; p = 0.0001), statins (5.3% vs. 78% vs. 81.5%; p = 0.0001) and anticoagulants (16.5% vs. 19.4% vs. 53.1%; p = 0.001), increasing the number of antihypertensives (1 ±â€¯0.9 vs. 1.6 ±â€¯0, 9 vs. 1.9 ±â€¯0.8 drugs p = 0.0001), and high-intensity statins (2.3% vs. 42.7 vs. 69.2% p = 0.0001). Comparing the VEPs with the younger ones, there were no differences in antihypertensive treatment in any period, there were differences in antithrombotic treatment in the first period, and with statins the differences were maintained until the end. CONCLUSIONS: In the last 20 years the number of VEPs has doubled, exceeding a quarter of the discharges. Although there is improvement in secondary stroke prevention in VEPs, there is room for improvement.

Tendencias en el uso de estatinas tras un ictus isquémico. ¿Hemos cambiado nuestra práctica clínica? / Trends in the use of statins after ischaemic stroke: Have clinical practices changed?

Introducción: El papel de las estatinas tras el ictus isquémico cambió con la publicación del estudio SPARCL en 2006. Nos planteamos valorar cómo ha influido en la prescripción de estatinas en esta población.MétodoEstudio retrospectivo de las altas por ictus isquémico en los hospitales Virgen Macarena, Virgen del Rocío y Valme de Sevilla durante dos periodos: 1999-2001 y 2014-2016.ResultadoIncluimos 1.575 pacientes, 661 (42%) mujeres, edad media 69 (± 10) años. Comparando los dos períodos, los pacientes del grupo post-SPARCL tienen mayor edad (68 ± 10 vs. 71 ± 11, p = 0,0001), mayor proporción de mujeres y mayor frecuencia de dislipidemia, hipertensión y diabetes. Al alta se utilizaron estatinas en el 18,7% frente al 86,9% (p = 0,0001), y estatinas de alta intensidad en el 11,1% frente al 54,4% (p = 0,0001), respectivamente. En ambos períodos la atorvastatina fue la estatina más recetada (80 mg, 6% vs. 42,7%; 40 mg, 5,1% vs. 11,1%). En el primer grupo, el uso de estatinas y de estatinas de alta intensidad se correlacionó con la hipercolesterolemia, y de forma inversa con la edad. En el segundo grupo, el uso de estatinas se correlacionó con la hipertensión y la hipercolesterolemia, y el de estatinas de alta intensidad, con la cardiopatía isquémica y, de forma inversa, con la edad.ConclusiónExiste un cambio evidente en la prescripción de estatinas al alta en pacientes con ictus isquémico. No obstante, muchos pacientes siguen infratratados y es preciso optimizar su uso. (AU)

Introduction: The role of statins after ischaemic stroke changed with the publication of the SPARCL study in 2006. We analyse how this has influenced the prescription of statins in this patient population.MethodsWe conducted a retrospective study of patients discharged with ischaemic stroke at the Virgen Macarena, Virgen del Rocío, and Valme hospitals in Seville (Spain) over two periods: 1999-2001 and 2014-2016.ResultsThe study included 1575 patients: 661 (42%) were women and mean age (standard deviation) was 69 (10) years. Patients from the later period are older (68 [10] vs 71 [11]; P = .0001); include a higher proportion of women; and present higher rates of dyslipidaemia, hypertension, and diabetes. At discharge, statins were used in 18.7% of patients (vs 86.9% in the first period; P = .0001), with high-intensity statins prescribed in 11.1% of cases (vs 54.4%; P = .0001). In both periods, atorvastatin was the most commonly prescribed statin (80 mg: 6% vs 42.7%; 40 mg: 5.1% vs 11.1%). In the first period, the use of statins and high-intensity statins was correlated with hypercholesterolaemia, and inversely correlated with age. In the second period, statin use was correlated with hypertension and hypercholesterolaemia, and high-intensity statin use was correlated with ischaemic heart disease and inversely correlated with age.ConclusionThere has been a clear change in the prescription of statins to patients with ischaemic stroke at discharge. However, many patients remain undertreated and the use of these drugs needs to be optimised. (AU)

Trends in the use of statins after ischaemic stroke: Have clinical practices changed?

INTRODUCTION: The role of statins after ischaemic stroke changed with the publication of the SPARCL study in 2006. We analyse how this has influenced the prescription of statins in this patient population. METHODS: We conducted a retrospective study of patients discharged with ischaemic stroke at the Virgen Macarena, Virgen del Rocío, and Valme hospitals in Seville (Spain) over two periods: 1999-2001 and 2014-2016. RESULTS: The study included 1575 patients: 661 (42%) were women and mean age (standard deviation) was 69 (10) years. Patients from the later period are older (68 [10] vs 71 [11]; P = .0001); include a higher proportion of women; and present higher rates of dyslipidaemia, hypertension, and diabetes. At discharge, statins were used in 18.7% of patients (vs 86.9% in the first period; P = .0001), with high-intensity statins prescribed in 11.1% of cases (vs 54.4%; P = .0001). In both periods, atorvastatin was the most commonly prescribed statin (80 mg: 6% vs 42.7%; 40 mg: 5.1% vs 11.1%). In the first period, the use of statins and high-intensity statins was correlated with hypercholesterolaemia, and inversely correlated with age. In the second period, statin use was correlated with hypertension and hypercholesterolaemia, and high-intensity statin use was correlated with ischaemic heart disease and inversely correlated with age. CONCLUSION: There has been a clear change in the prescription of statins to patients with ischaemic stroke at discharge. However, many patients remain undertreated and the use of these drugs needs to be optimised.

Trends in the use of statins after ischaemic stroke: Have clinical practices changed? / Tendencias en el uso de estatinas tras un ictus isquémico. ¿Hemos cambiado nuestra práctica clínica?

INTRODUCTION: The role of statins after ischaemic stroke changed with the publication of the SPARCL study in 2006. We analyse how this has influenced the prescription of statins in this patient population. METHODS: We conducted a retrospective study of patients discharged with ischaemic stroke at the Virgen Macarena, Virgen del Rocío, and Valme hospitals in Seville (Spain) over two periods: 1999-2001 and 2014-2016. RESULTS: The study included 1575 patients: 661 (42%) were women and mean age (standard deviation) was 69 (10) years. Patients from the later period are older (68 [10] vs 71 [11]; P=.0001); include a higher proportion of women; and present higher rates of dyslipidaemia, hypertension, and diabetes. At discharge, statins were used in 18.7% of patients (vs 86.9% in the first period; P=.0001), with high-intensity statins prescribed in 11.1% of cases (vs 54.4%; P=.0001). In both periods, atorvastatin was the most commonly prescribed statin (80mg: 6% vs 42.7%; 40mg: 5.1% vs 11.1%). In the first period, the use of statins and high-intensity statins was correlated with hypercholesterolaemia, and inversely correlated with age. In the second period, statin use was correlated with hypertension and hypercholesterolaemia, and high-intensity statin use was correlated with ischaemic heart disease and inversely correlated with age. CONCLUSION: There has been a clear change in the prescription of statins to patients with ischaemic stroke at discharge. However, many patients remain undertreated and the use of these drugs needs to be optimised.

Impact of SARS-CoV-2 infection on neurodegenerative and neuropsychiatric diseases: a delayed pandemic? / Influencia de la infección SARS-CoV-2 sobre enfermedades neurodegenerativas y neuropsiquiátricas: ¿una pandemia demorada?

INTRODUCTION: SARS-CoV-2 was first detected in December 2019 in the Chinese city of Wuhan and has since spread across the world. At present, the virus has infected over 1.7 million people and caused over 100 000 deaths worldwide. Research is currently focused on understanding the acute infection and developing effective treatment strategies. In view of the magnitude of the epidemic, we conducted a speculative review of possible medium- and long-term neurological consequences of SARS-CoV-2 infection, with particular emphasis on neurodegenerative and neuropsychiatric diseases of neuroinflammatory origin, based on the available evidence on neurological symptoms of acute SARS-CoV-2 infection. DEVELOPMENT: We systematically reviewed the available evidence about the pathogenic mechanisms of SARS-CoV-2 infection, the immediate and lasting effects of the cytokine storm on the central nervous system, and the consequences of neuroinflammation for the central nervous system. CONCLUSIONS: SARS-CoV-2 is a neuroinvasive virus capable of triggering a cytokine storm, with persistent effects in specific populations. Although our hypothesis is highly speculative, the impact of SARS-CoV-2 infection on the onset and progression of neurodegenerative and neuropsychiatric diseases of neuroinflammatory origin should be regarded as the potential cause of a delayed pandemic that may have a major public health impact in the medium to long term. Cognitive and neuropsychological function should be closely monitored in COVID-19 survivors.

Will neurological care change over the next 5 years due to the COVID-19 pandemic? Key informant consensus survey. / ¿Va a cambiar la neurología tras la pandemia de COVID-19 en los próximos 5 años? Estudio de enfoque mediante informadores clave.

INTRODUCTION: The COVID-19 pandemic will give rise to long-term changes in neurological care, which are not easily predictable. MATERIAL AND METHODS: A key informant survey was used to enquire about the changes expected in the specialty over the next 5 years. The survey was completed by heads of neurology departments with broad knowledge of the situation, having been active during the pandemic. RESULTS: Despite a low level of consensus between participants, there was strong (85%) and moderate consensus (70%) about certain subjects, mainly the increase in precautions to be taken, the use of telemedicine and teleconsultations, the reduction of care provided in in-person consultations to avoid the presence of large numbers of people in waiting rooms, the development of remote training solutions, and the changes in monitoring visits during clinical trials. There was consensus that there would be no changes to the indication of complementary testing or neurological examination. CONCLUSION: The key informant survey identified the foreseeable changes in neurological care after the pandemic.

Knowing Patients Better After a Stroke and Secondary Prevention.

The habits and lifestyles are the fundamental factors in the control of cardiovascular risk. Patients who have had a cerebrovascular accident (CVA) have a high risk of having a new event with similar characteristics. The exponentially growing success, penetration and adherence of the new communication technologies, based on applications (APPs), allows to use them to obtain information and influence the risk factors. We propose that empowering patients in their disease can make a more efficient management of it. For this reason, we designed and developed a system which integrates a mobile application and a web application. This system also makes use of peripheral devices to monitor patients and allow the automatic acquisition of information to enable the characterization of this kind of patients in relation to habits and lifestyle. At the same time, the system can also empower these patients with their disease to do secondary prevention.

Las demandas por conducta suicida a los servicios de urgencias prehospitalarios de Málaga: características y factores asociados / Calls due to suicidal behaviour made to the prehospital, emergency department in Málaga: characteristics and associated factors

Fundamento: El comportamiento suicida, mortal y no mortal, se ha convertido en un problema grave de salud pública en muchos países. El objetivo de este estudio es describir las características diferenciales de las llamadas al Centro Coordinador de Urgencias y Emergencias de la provincia de Málaga por conducta suicida, frente a las llamadas por problemas físicos o psiquiátricos. Material y métodos: Esta investigación consiste en un estudio observacional retrospectivo de las demandas registradas en la base de datos de la Empresa Pública de Emergencias Sanitarias durante un año. Las comparaciones y análisis de regresión logística multivariante se realizaron respecto a la edad y sexo de los demandantes y respecto a las siguientes características de las demandas: horas del día, días laborables o festivos, meses del año y trimestres, número de recursos movilizados y tipos de resolución. Resultados: Los análisis se realizaron sobre un total de 163.331 llamadas. 1.380 fueron por conducta suicida (0,8%), 9.951 por motivos psiquiátricos (6,1%) y 152.000 por motivos físicos (93%). Las llamadas por conducta suicida fueron realizadas preferentemente por mujeres jóvenes, que solicitan atención durante la tarde y la noche, requiriendo traslado al hospital y la movilización de más de un recurso sanitario. Las demandas por suicidio consumado las realizaron más frecuentemente varones en edades más avanzadas. En el primer trimestre del año se dan más demandas por ideación que por amenaza/intento, mientras que en el tercer trimestre ocurre lo contrario. Conclusión: Los resultados indicaron características diferenciales de las llamadas por conducta suicida potencialmente relevantes para la prevención del suicidio (AU)

Background: Suicidal behaviour (fatal and non-fatal) has become a serious public health problem in many countries. The aim of the study was to describe the differential characteristics of emergency calls due to suicidal behaviour made to the Emergency Coordinating Centre (CCUE) in the province of Málaga, in comparison with calls due to physical or psychiatric problems. Methods: Retrospective observational study of the calls recorded in the database of the Public Company for Emergency Health during one year. Multivariate logistic regression analyses were carried out including age, gender and the following variables related with the demand: hours of the day, type of day (working days or bank holidays), months of the year and trimesters, number of resources mobilized and types of resolution. Results: The analyses were carried out on 163,331 calls, of which 1,380 calls were due to suicidal behaviour (0.8%), 9,951 for psychiatric reasons (6.1%) and 152,000 for physical reasons (93%). The emergency calls for suicidal behaviour were mainly made by females, between 31-60 years, in the evening and at night, and required transfer to hospital and more than one mobilized resource. Calls due to completed suicide were more frequently made by older men. Calls due to suicidal tendencies predominated over those due to attempted or threatened suicide during the first trimester of the year, while the opposite was the case during the third trimester. Conclusions: The results indicated differential characteristics of suicide calls that are potentially relevant for prevention in spite of the limitations of the present study (AU)

[Calls due to suicidal behaviour made to the prehospital, emergency department in Málaga: characteristics and associated factors]. / Las demandas por conducta suicida a los servicios de urgencias prehospitalarios de Málaga: características y factores asociados.

BACKGROUND: Suicidal behaviour (fatal and non-fatal) has become a serious public health problem in many countries. The aim of the study was to describe the differential characteristics of emergency calls due to suicidal behaviour made to the Emergency Coordinating Centre (CCUE) in the province of Málaga, in comparison with calls due to physical or psychiatric problems. METHODS: Retrospective observational study of the calls recorded in the database of the Public Company for Emergency Health during one year. Multivariate logistic regression analyses were carried out including age, gender and the following variables related with the demand: hours of the day, type of day (working days or bank holidays), months of the year and trimesters, number of resources mobilized and types of resolution. RESULTS: The analyses were carried out on 163,331 calls, of which 1,380 calls were due to suicidal behaviour (0.8%), 9,951 for psychiatric reasons (6.1%) and 152,000 for physical reasons (93%). The emergency calls for suicidal behaviour were mainly made by females, between 31-60 years, in the evening and at night, and required transfer to hospital and more than one mobilized resource. Calls due to completed suicide were more frequently made by older men. Calls due to suicidal tendencies predominated over those due to attempted or threatened suicide during the first trimester of the year, while the opposite was the case during the third trimester. CONCLUSIONS: The results indicated differential characteristics of suicide calls that are potentially relevant for prevention in spite of the limitations of the present study.

Power Analysis of the Basilar Membrane in the Cochlea by Mechanical Resonance / Análisis de Potencia de la Membrana Basilar en la Cóclea por Resonancia Mecánica

Abstract: This paper presents the power analysis to the mechanical model of the basilar membrane in the cochlea as a system of forced damped harmonic oscillators without lateral coupling proposed by Lesser and Berkeley. The Lagrange's equation for dissipative mechanical systems and the energy method are used to obtain the general equation of the system. Next a solution by complex exponential is proposed using the resonance analysis considering only excitations of pure tones to obtain the equation of displacement, and with its derived the equation of velocity. The power in the system is the multiplication between the equations of the velocity and the excitation force. Finally the equation of the average power in the system is obtained. This new solution has the advantage of determining the relationship between the excitation frequency of the system and the position along the basilar membrane where the average power is maximum. This implies that the distance where there is maximum transfer of energy between the wave propagating in the perilymph and the mechanical displacement of the basilar membrane on the hair cells in the organ of Corti is known. The power analysis is successfully compared with the two-dimensional model of the cochlea developed by Neely using finite differences and with the experimental results of Békésy. In both experiments are used the same mechanical parameters of the basilar membrane and the same set of frequencies of evaluation proposed in the original papers in order to compare the different methodologies.

Resumen: En este artículo se presenta el análisis de potencia del modelo mecánico de la membrana basilar en la cóclea como un sistema de osciladores armónicos forzados amortiguados sin acoplamiento lateral propuesto por Lesser y Berkeley. Se usa la ecuación de Lagrange para sistemas mecánicos disipativos y el método de energías para obtener la ecuación general del sistema. A continuación se propone su solución en forma exponencial compleja usando el análisis por resonancia considerando únicamente excitaciones de tonos puros obteniendo la ecuación del desplaza miento, y a partir de su derivada la ecuación de la velocidad. Posteriormente se determina la ecuación de potencia mediante el producto entre las ecuaciones de la velocidad y la fuerza de excitación. Por último se obtiene la ecua ción de la potencia promedio en el sistema. Esta nueva solución tiene la ventaja de determinar la relación entre la frecuencia de excitación del sistema y la posición a lo largo de la membrana basilar donde la potencia promedio es máxima, con lo cual se conoce la distancia donde se genera la máxima transferencia de energía entre la onda que se propaga en la perilinfa y el desplazamiento mecánico de la membrana basilar sobre los cilios en el órgano de Corti. El análisis de potencia se compara satisfactoriamente con el modelo en dos dimensiones por diferencias finitas de la cóclea desarrollado por Neely y con los resultados experimentales obtenidos por Békésy. En ambos experimentos se usan los mismos parámetros mecánicos de la membrana basilar y el mismo conjunto de frecuencias de evaluación propuestos en los trabajos originales con el objetivo de comparar las diferentes metodologías.

Solution Using Lagrange's Equation to the Model of Cochlear Micromechanics / Solución del modelo de la micromecánica de la cóclea usando la ecuación de Lagrange

Abstract In this paper a new solution to micromechanical model of the cochlea developed by Neely and Kim is presented using Lagrange's equation. This solution has the advantage over previous methodologies to provide a mathematical model for the displacement exercised on the outer hair cells in the organ of Corti that only depends of the mechanical characteristics in the system and the value of the excitation frequency in the inner ear. For the evaluation of this new model the parameters developed by Ku are used and is considers that the amplitude of the excitation frequency is normalized. The model developed is satisfactorily compared with the impedance method and its numerical solution proposed by Neely and Kim, the state space analysis developed by Elliot, Ku and Lineton and the physiological measurements taken from Békésy.

Resumen En este trabajo se presenta una nueva solución utilizando la ecuación de Lagrange al modelo micromecánico de la cóclea desarrollado por Neely y Kim. Esta solución tiene la ventaja respecto a las ya existentes de proporcionar un modelo matemático del desplazamiento ejercido a los cilios en el órgano de Corti que sólo depende de las características mecánicas del sistema y del valor de la frecuencia de excitación en el oído interno. Para su evaluación se utilizan los parámetros desarrollados por Ku y se considera que la amplitud de la frecuencia de excitación está normalizada. El modelo desarrollado se compara satisfactoriamente con el método de impedancias y su solución numérica propuesta por Neely y Kim, el método de análisis de espacio estado desarrollado por Elliot, Ku y Lineton y con las mediciones fisiológicas realizadas por Békésy.

Mobile platform for treatment of stroke: A case study of tele-assistance.

This article presents the technological solution of a tele-assistance process for stroke patients in acute phase in the Seville metropolitan area. The main objective of this process is to reduce time from symptom onset to treatment of acute phase stroke patients by means of telemedicine, regarding mobility between an intensive care unit ambulance and an expert center and activating the pre-hospital care phase. The technological platform covering the process has been defined following an interoperability model based on standards and with a focus on service-oriented architecture focus. Messaging definition has been designed according to the reference model of the CEN/ISO 13606, messages content follows the structure of archetypes. An XDS-b (Cross-Enterprise Document Sharing-b) transaction messaging has been designed according to Integrating the Healthcare Enterprise profile for archetype notifications and update enquiries.This research has been performed by a multidisciplinary group. The Virgen del Rocío University Hospital acts as Reference Hospital and the Public Company for Healthcare as mobility surroundings.

[Tight control of blood pressure after ischemic stroke is associated with nocturnal hypotension episodes]. / El control estricto de la presion arterial tras un ictus isquemico se asocia con la aparicion de episodios de hipotension nocturna.

AIM: To evaluate whether a tighter blood pressure (BP) control in patients with recent ischemic stroke is associated with the presence of nocturnal hypotension (NHP) episodes. PATIENTS AND METHODS: We included one hundred consecutive patients who had been discharged for ischemic stroke in the previous six months. To evaluate adequacy of BP control in these patients office BP and 24-h ambulatory BP monitoring values were used. RESULTS: We studied 63 males and 37 females; mean age was 69 ± 11 years. Sixty-eight lacunar and 32 non-lacunar strokes were included. Episodes of NHP were observed in 59 patients. Clinical hypertension was present in 34 patients. An abnormal pattern of circadian rhythm of BP was present in 72 subjects. Only 18 patients had BP within normal limits. Episodes of NHP were more frequent in subjects with good BP control versus patients with bad BP control: 88.8% and 52.4 % respectively (p = 0.007). The presence of NHP episodes was also inversely related to number of BP parameters altered (p = 0.001). CONCLUSIONS: Tight control of BP after ischemic stroke is associated with a high frequency of NHP episodes. It is likely that aggressively lowering BP levels within the normal range after an ischemic stroke may be not beneficial, particularly in elderly patients.

TITLE: El control estricto de la presion arterial tras un ictus isquemico se asocia con la aparicion de episodios de hipotension nocturna.Objetivo. Evaluar si un control mas estricto de la presion arterial (PA) en pacientes con ictus isquemico reciente se asocia con la presencia de episodios de hipotension nocturna (HPN). Pacientes y metodos. Se incluyeron 100 pacientes consecutivos que habian sido dados de alta por ictus isquemico en los seis meses previos. Para evaluar el buen control de la PA en estos pacientes, se utilizaron valores de la PA en consulta y monitorizacion ambulatoria de la PA de 24 horas. Resultados. Se estudiaron 63 varones y 37 mujeres; la media de edad fue de 69 ± 11 años. Se incluyeron 68 ictus lacunares y 32 no lacunares. Se observaron episodios de HPN en 59 pacientes. La hipertension clinica estuvo presente en 34 pacientes. Un patron anormal del ritmo circadiano de la PA estaba presente en 72 sujetos. Solo 18 pacientes tenian la PA dentro de limites normales. Los episodios de HPN fueron mas frecuentes en los pacientes con buen control de la PA en comparacion con los pacientes con mal control: 88,8% y 52,4%, respectivamente (p = 0,007). La presencia de episodios de HPN tambien estaba inversamente relacionada con el numero de parametros de PA alterados (p = 0,001). Conclusiones. El control estricto de la PA tras un ictus isquemico se asocia con una alta frecuencia de episodios de HPN. Es probable que una reduccion intensiva de los niveles de la PA dentro del rango de la normalidad tras un ictus isquemico pueda no ser beneficiosa, en particular en los pacientes ancianos.