First-Principles Identification of Single Photon Emitters Based on Carbon Clusters in Hexagonal Boron Nitride.

A recent study associates carbon with single photon emitters (SPEs) in hexagonal boron nitride (h-BN). This observation, together with the high mobility of carbon in h-BN, suggests the existence of SPEs based on carbon clusters. Here, by means of density functional theory calculations, we studied clusters of substitutional carbon atoms up to tetramers in h-BN. Two different conformations of neutral carbon trimers have zero-point line energies and shifts of the phonon sideband compatible with typical photoluminescence spectra. Moreover, some conformations of two small C clusters next to each other result in photoluminescence spectra similar to those found in the experiments. We also showed that vacancies are unable to reproduce the typical features of the phonon sideband observed in most measurements because of the large spectral weight of low-energy breathing modes, ubiquitous in such defects.

Survival and neurological status after out-of-hospital cardiac arrest in the pediatric population in Andalusia.

OBJECTIVE: Little is known about the evolution and long-term neurological status of pediatric patients who survive out-of-hospital cardiac arrest. Our aim is to describe long-term survival and neurological status. DESIGN: Retrospective observational study, based on the Andalusian Register of out-of-hospital Cardiac Arrest. SETTING: Pre-hospital Care. PATIENTS: The study included patients aged 0-15 years between January 2008 and December 2012. INTERVENTIONS: Patients follow up. VARIABLES: Prehospital and hospital care variables were analyzed and one-year follow-up was performed, along with a specific follow-up of survivors in June 2014. RESULTS: Of 5069 patients included in the register, 125 (2.5%) were aged ≤15 years. Cardiac arrest was witnessed in 52.8% of cases and resuscitation was performed in 65.6%. The initial rhythm was shockable in 7 (5.2%) cases. Nearly half (48.8%) the patients reached the hospital alive, of whom 20% did so while receiving resuscitation maneuvers. Only 9 (7.2%) patients survived to hospital discharge; 5 showed ad integrum recovery and 4 showed significant neurological impairment. The 5 patients with complete recovery continued their long-term situation. The remaining 4 patients, although slight improvement, were maintained in situation of neurological disability. CONCLUSIONS: Survival after out-of-hospital cardiac arrest in pediatric patients was low. The long-term prognosis of survivors with good neurological recovery remains, although improvement in the rest was minimal.

Transethnic meta-analysis suggests genetic variation in the HEME pathway influences potassium response in patients treated with hydrochlorothiazide.

Hypokalemia is a recognized adverse effect of thiazide diuretic treatment. This phenomenon, which may impair insulin secretion, has been suggested to be a reason for the adverse effects on glucose metabolism associated with thiazide diuretic treatment of hypertension. However, the mechanisms underlying thiazide diuretic-induced hypokalemia are not well understood. In an effort to identify genes or genomic regions associated with potassium response to hydrochlorothiazide, without a priori knowledge of biologic effects, we performed a genome-wide association study and a multiethnic meta-analysis in 718 European- and African-American hypertensive participants from two different pharmacogenetic studies. Single-nucleotide polymorphisms rs10845697 (Bayes factor=5.560) on chromosome 12, near to the HEME binding protein 1 gene, and rs11135740 (Bayes factor=5.258) on chromosome 8, near to the Mitoferrin-1 gene, reached genome-wide association study significance (Bayes factor >5). These results, if replicated, suggest a novel mechanism involving effects of genes in the HEME pathway influencing hydrochlorothiazide-induced renal potassium loss.

Recommendations in dispatcher-assisted bystander resuscitation from emergency call center.

Dispatch-assisted bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest has been shown as an effective measure to improve the survival of this process. The development of a unified protocol for all dispatch centers of the different emergency medical services can be a first step towards this goal in our environment. The process of developing a recommendations document and the realization of posters of dispatch-assisted cardiopulmonary resuscitation, agreed by different actors and promoted by the Spanish Resuscitation Council, is presented.

Genome-wide association analyses suggest NELL1 influences adverse metabolic response to HCTZ in African Americans.

Hydrochlorothiazide (HCTZ) is one of the most widely prescribed antihypertensive medications. Although it is well known that HCTZ is associated with hyperglycemia and hypertriglyceridemia, the mechanisms underlying these adverse effects are not well understood. We performed a genome-wide association study and meta-analysis of the change in fasting plasma glucose and triglycerides in response to HCTZ from two different clinical trials: the Pharmacogenomic Evaluation of Antihypertensive Responses and the Genetic Epidemiology of Responses to Antihypertensive studies. Two single-nucleotide polymorphisms (rs12279250 and rs4319515 (r(2)=0.73)), located at 11p15.1 in the NELL1 gene, achieved genome-wide significance for association with change in fasting plasma triglycerides in African Americans, whereby each variant allele was associated with a 28 mg dl(-1) increase in the change in triglycerides. NELL1 encodes a cytoplasmic protein that contains epidermal growth factor-like repeats and has been shown to represses adipogenic differentiation. These findings may represent a novel mechanism underlying HCTZ-induced adverse metabolic effects.

Association of KCNJ1 variation with change in fasting glucose and new onset diabetes during HCTZ treatment.

Thiazide-induced potassium loss may contribute to new onset diabetes (NOD). KCNJ1 encodes a potassium channel and one study observed that a KCNJ1 single-nucleotide polymorphism (SNP) was associated with changes in fasting glucose (FG) during hydrochlorothiazide (HCTZ) treatment. We used linear regression to test association of KCNJ1 SNPs and haplotypes with FG changes during HCTZ treatment in the Pharmacogenomic Evaluation of Antihypertensive Responses (PEAR) study. We used logistic regression to test association of KCNJ1 variation with NOD in HCTZ-treated patients from the International Verapamil SR Trandolapril Study (INVEST). Multivariate regression analyses were performed by race/ethnicity with false discovery rate (FDR) correction. In PEAR blacks, a KCNJ1 SNP was associated with increased FG during HCTZ treatment (beta=8.47, P(FDR)=0.009). KCNJ1 SNPs and haplotypes were associated with NOD risk in all INVEST race/ethnic groups (strongest association: odds ratio 2.14 (1.31-3.53), P(FDR)=0.03). Our findings support that KCNJ1 variation is associated with HCTZ-induced dysglycemia and NOD.

Fluorescent aluminium indicators derived from substituted coumarins.

Metalfluorechromic indicators, containing the o,o'-di-hydroxyazo group, have been prepared from a number of coumarin derivatives. The dye obtained from 4-methylumbelliferone reacts with 0.2-10 ppm of aluminium at pH 4-5 to give a pink fluorescence with an excitation peak at 540 mmu and an emission peak at 590 mmu.

Plants used in Guatemala for the treatment of dermatophytic infections. 2. Evaluation of antifungal activity of seven American plants.

From 52 plants screened for antifungal activity, 26 (50%) were active against dermatophytes. This paper reports further evaluation of seven American plants against four pathogenic fungi (Aspergillus flavus, Epidermophyton floccosum, Microsporum gypseum and Trichophyton rubrum), the part showing most activity, the best solvent and, in three cases, the minimal inhibitory concentration (MIC) against the fungus in pure culture. Antifungal activity was confirmed in all of the plants, but not all parts; the most active parts were the bark and leaves. The most active species were Byrsonima crassifolia, Cassia grandis, Gliricidia sepium and Malpighia glabra. Diphysa robinioides, Rhizophora mangle and Cassia occidentalis were less active. The most susceptible fungi were E. floccosum and T. rubrum; A. flavus was not susceptible. Ethanol was usually the best solvent and the MIC of C. grandis, C. occidentalis and D. robinioides was 50 micrograms/ml.

[Leptospirosis in children in Ciego de Avila Province, Cuba]. / Leptospirosis en niños de la Provincia de Ciego de Avila, Cuba.

The morbidity of leptospirosis among children from Ciego de Avila Province was investigated from 1982 to 1995, and 253 cases were diagnosed. Isolated cases prevailed over those occurring in outbreaks. The 10-14 age group was predominant, followed by the 5-9 age group. According to sex, it was more frequently found in males than in females. One death occurred during this period. There was an increase of cases from July to August and October, and November showed a higher incidence of cases. Fever, headache and myalgia were the symptoms and signs more frequently reported, and 92% of cases showed no icterus. Acute fever, leptospirosis and viral meningoencephalitis were the presumptive diagnoses most frequently made. Possible sources of infection involving a larger number of cases were contact with low terrains and bathing in rivers, ponds and lakes. Regarding diagnosis, 162 cases were diagnosed by the microagglutination test and 91 by the hemolytic test. Canicola, australis and pomona were the serogroups more frequently detected by the microagglutination test.

[Assessment of the nutritional status of elderly patients treated at a home-hospital unit]. / Evaluación del estado nutricional de los pacientes mayores atendidos en una unidad de hospitalización a domicilio.

GOALS: To establish the nutritional status of our elderly patients, assess the usefulness of the various anthropometric and biochemical parameters as markers of malnutrition and to determine which of the variables studied have the greatest correlation with malnutrition. SCOPE: Home Hospital Unit of the Arnau de Vilanova Teaching Hospital in Lerida. PATIENTS: 57 patients > or = 60 years. Mean admission to our unit: 12.1 days. VARIABLES: Age, sex, groups by treatment complexity, associated pathology, diagnosis, reason for admission, duration of stay in hospital, surgery performed, complications during the stay at the Home Hospital Unit, weight, height, PCT, AC, BMI, albumin, haemoglobin and RTL. RESULTS: Patients of great age present lower levels of serum albumin (p < 0.005), total proteins (p < 0.001), transferrin (p < 0.03), haemoglobin (p < 0.02) and RTL (p < 0.04) than "younger" elderly patients. Serum albumin and haemoglobin are lower in patients in a complicated post-surgical condition (p < 0.04 and p < 0.02, respectively) and this group is the one with the longest stays (p < 0.001). Those patients with hypoalbuminaemia (74.1%) present lower PCT and RTL (p < 0.02) and a longer stay in hospital (p < 0.01) than those with normal levels of albumin in blood. Patients with anaemia (63.3%) present a lower RTL (p < 0.01) and a greater hospitalization time than those without anaemia. Total proteins (p < 0.0001), albumin (p < 0.004), transferrin (p < 0.003) and RTL (p < 0.005) correlate negatively with age. Albumin (p < 0.001), haemoglobin (p < 0.006) and RTL (p < 0.0001) present a negative correlation with length of hospital stay. CONCLUSION: The prevalence of global malnutrition is high (51% moderate-severe). The nutritional status worsens with age. The length of hospitalization increases gradually with age, with deteriation in the nutritional status and with complexity of the treatment provided.

[Emergency tracheobronchoscopy in children with burns]. / Trachéo-bronchoscopie en urgence chez les enfants brûlés.

Smoke inhalation affects the upper airways and lung parenchyma, causing the burn victims' death rate to increase substantially. Early diagnosis is hard to obtain, as clinical signs of complications will be delayed. However, both improved chances for survival and a lower incidence of sequelae depend on how soon treatment is initiated. The smoke inhalation syndrome suspectacle from the case history cannot be confirmed without due paraclinical investigations. The authors retrace their experience with 42 children hospitalized at the Hôpital Trousseau Burn Unit. They stress the importance of emergy ENT endoscopic assessment for obtaining the diagnostic and therapeutic data necessary for taking adequate measures.

Supervivencia y estado neurológico de la parada cardiaca extrahospitalaria en edad pediátrica en Andalucía / Survival and neurological status after out-of-hospital cardiac arrest in the pediatric population in Andalusia

OBJETIVO: No existe demasiada información sobre la evolución y estado neurológico a largo plazo de los pacientes en edad pediátrica que sobreviven a una parada cardiaca extrahospitalaria. Nuestro objetivo es describir la supervivencia y estado neurológico de estos pacientes a largo plazo. DISEÑO: Estudio observacional retrospectivo. Basado en el Registro Andaluz de Parada Cardiaca Extrahospitalaria. ÁMBITO: Atención Prehospitalaria. PACIENTES: Entre 0 y 15 años atendidos entre enero de 2008 y diciembre de 2012 por Parada Cardiaca Extrahospitalaria. Intervenciones: Seguimiento de pacientes. Variables: Se incluyen variables de la atención prehospitalaria, hospitalaria y del seguimiento al año y un seguimiento específico de los supervivientes en junio de 2014. RESULTADOS: Se incluyeron en el registro un total de 5069 pacientes de los que 125(2.5%) tenían 15 o menos años. La parada fue presenciada en el 52.8% de los casos y hubo reanimación previa en 65.6%. El ritmo inicial fue desfibrilable en 7 (5.2%) casos. Un 48.8% de los pacientes llegó al hospital aunque un 20% lo hizo en situación de reanimación en curso. De los 9 (7.2%) pacientes que sobrevivieron al alta hospitalaria, 5 de ellos lo hicieron con recuperación ad integrum y 4 con grave deterioro neurológico. Los 5 pacientes con recuperación completa mantuvieron su situación a largo plazo. Los 4 pacientes restantes, aunque con discreta mejoría, se mantuvieron en situación de discapacidad neurológica. CONCLUSIONES: La supervivencia de la parada cardiaca extrahospitalaria en edad pediátrica es baja. El pronóstico a largo plazo de los pacientes con buena recuperación neurológica desde el inicio se mantiene, aunque la mejoría en el resto es mínima

OBJECTIVE: Little is known about the evolution and long-term neurological status of pediatric patients who survive out-of-hospital cardiac arrest. Our aim is to describe long-term survival and neurological status. DESIGN: Retrospective observational study, based on the Andalusian Register of out-of-hospital Cardiac Arrest. SETTING: Pre-hospital Care. PATIENTS: The study included patients aged 0-15 years between January 2008 and December 2012. Interventions: Patients follow up. Variables: Prehospital and hospital care variables were analyzed and one-year follow-up was performed, along with a specific follow-up of survivors in June 2014. RESULTS: Of 5069 patients included in the register, 125 (2.5%) were aged less or equal15 years. Cardiac arrest was witnessed in 52.8% of cases and resuscitation was performed in 65.6%. The initial rhythm was shockable in 7 (5.2%) cases. Nearly half (48.8%) the patients reached the hospital alive, of whom 20% did so while receiving resuscitation maneuvers. Only 9 (7.2%) patients survived to hospital discharge; 5 showed ad integrum recovery and 4 showed significant neurological impairment. The 5 patients with complete recovery continued their long-term situation. The remaining 4 patients, although slight improvement, were maintained in situation of neurological disability. CONCLUSIONS: Survival after out-of-hospital cardiac arrest in pediatric patients was low. The long-term prognosis of survivors with good neurological recovery remains, although improvement in the rest was minimal

Comentario sobre «Supervivencia y pronóstico neurológico en paradas cardiorrespiratorias extrahospitalarias por ritmos desfibrilables tratadas con hipotermia terapéutica moderada» / Comment on: "Survival and neurological outcome in out-of-hospital cardiac arrests due to shockable rhythms treated with mild therapeutic hypothermia"

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Comentario al artículo original. Unidades de soporte vital básico y avanzado en España: análisis de la situación actual / S. Ballesteros / Coment on the original article. Basic and advanced life support units in Spain: analysis and current situations

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[Outbreak of leptospirosis, predominantly meningoencephalitic, among children in the municipality of Morón]. / Brote de leptospirosis en niños con predomino meningoencefálico, en el municipio Morón.

A description is made of a leptospirosis outbreak in children who bathed in the Cimarron Channel in Morón. Ciego de Avila. The outbreak started on September 25 and ended on October 20, 1986. Six cases were reported, of which four had meningoencephalic appearance. Ages ranged from 8 to 13 years. Fever, cephalalgia, arthralgia and myalgia were the most common signs and symptoms in the confirmed cases. All the patients were positive to Canicola serogroup. The results of a survey on 12 dogs in the zone surrounding the Cimarron Channel suggest that they were the reservoir which contaminated the Channel waters.

[Appropriateness admissions to the Department of Internal Medicine of the Hospital de Santa Luzia (Elvas) evaluated by the AEP (Appropriateness Evaluation Protocol)]. / Adequação dos internamentos num Serviço de Medicina. Aplicação da escala AEP (Appropriateness Evaluation Protocol).

The authors analyse the appropriateness admissions to the Internal Medicine ward of the Hospital de Santa Luzia (Elvas). A retrospective study was performed during 6 months of 2001, using the Appropriateness Evaluation Protocol (AEP). Non-appropriateness admissions were found in 19% (CI95%: 16-22), and this group of patients had less mean age (63 + 16 vs 69 + 16; p <0.01), and less mean days of admission (7.1 + 6 vs 9.3 + 7; p <0.01) than group with appropriateness admissions. Appropriateness admissions were mainly found in patients admitted from the emergency room (86% vs 49%; p <0.001). Most of patients with non-appropriate admissions were admitted to undergo diagnostic tests (44%; CI95%: 35-53), or to be referred to other medical centres for specialized study and/or treatment (12%; CI95%: 6-18).

[Cryptosporidiosis in children with acute diarrhea from Ciego de Avila province, Cuba]. / Criptosporidiosis en niños con diarrea aguda de la provincia de Ciego de Avila, Cuba.

An epidemiological and clinical study of criptosporidiosis in children from Ciego de Avila province was carried out from 1987 to 1994. During this period 14,895 children with acute diarrhea were studied. Cryptosporidium sp. oocysts were found in the feces of 1,256 (8.4%) of them. Isolated cases prevailed over outbreaks, being the incidence rate proportional in both urban and rural areas. Seventy nine point seven per cent of infected children were less one year old, predominating the age group 6-11 months old. No influence of seasons on the occurrence of the parasitose was observed. The most frequently detected symptoms and signs were diarrhea, vomits and loss of weight. The main epidemiological factors were: 81.0% of ill children drank water directly from the aqueduct, 12.8% lived in overcrowded conditions, 11.0% had animals and 10.7% attended nursery schools.