Contamination assessment and potential sources of heavy metals and other elements in sediments of a basin impacted by 500 years of mining in central Mexico.

Since the middle of the 1500 s, mining has been active in central Mexico. Total estimates for low-grade piles and mine tailing materials in the Guanajuato mining district (GMD) are in the range of 150 million tons, covering an area of 15 to 20 km2. GMD is located in the Guanajuato River sub-basin (GRB), which is part of one of the largest basins in Mexico (Lerma-Santiago). Previous studies on the GRB found unusually high concentrations of heavy metals in mining tailings and sediments. Geochemical and statistical methods were used here to determine the sediment's origin, background values, degree of contamination, and toxicity through different contamination indices. This analysis shows that Cu, Co, As, Sb, and Hg are higher than they are in the upper continental crust (UCC) overbank sediments without human and mining influence, because of the ore deposits and rock weathering in GRB. Geochemistry results in stream sediments show anomalies, where Hg, Cu, Zn, As, and Pb are higher than UCC because those heavy metals and trace elements (HMT) have been influenced by human activities and mineral recovery (smelting, amalgamation, cyanidation). The distribution of high concentrations of HMTs and contamination indices occur in the main channel of the Guanajuato River and downstream of the city of Guanajuato. Statistical analyses (cluster and principal component analysis) reveal relationships between Cr, Ni, Cu, and Pb, which are primarily of natural origin, related to rocks of the upper basin. The middle and lower basins are distinctive in their associations between As, Sb, Zn, Pb, and Hg. Additionally, it is recognized that the origins of Pb, Zn, and Hg are geogenic and anthropogenic. This study demonstrates how crucial it is to understand the geochemistry of various HMT sources, with both natural and anthropogenic contributions (stream sediments and rocks), in order to calculate a more realistic background in a basin with both natural anomalies and anthropogenic contamination. The basin is a regional aquifer recharge area, so the new geochemical data are important for improving basin environmental management.

How Aromatic Are Molecular Nanorings? The Case of a Six-Porphyrin Nanoring*.

Large conjugated rings with persistent currents are novel promising structures in molecular-scale electronics. A six-porphyrin nanoring structure that allegedly sustained an aromatic ring current involving 78π electrons was recently synthesized. We provide here compelling evidence that this molecule is not aromatic, contrary to what was inferred from the analysis of 1 H-NMR data and computational calculations that suffer from large delocalization errors. The main reason behind the absence of an aromatic ring current in these nanorings is the low delocalization in the transition from the porphyrins to the bridging butadiyne linkers, which disrupts the overall conjugated circuit. These results highlight the importance of choosing a suitable computational method to study large conjugated molecules and the appropriate aromaticity descriptors to identify the part of the molecule responsible for the loss of aromaticity.

Energetics and diffusion of liquid water and hydrated ions through nanopores in graphene: ab initio molecular dynamics simulation.

The energetics and diffusion of water molecules and hydrated ions (Na+, Cl-) passing through nanopores in graphene are addressed by dispersion-corrected density functional theory calculations and ab initio molecular dynamics (MD) simulations. Pores of about 0.8 nm in diameter with different pore-edge passivations, with (H) and (O, H) atoms, were considered. Our MD simulations show a water flux through the hydroxylated pores of about one H2O molecule every three picoseconds, in close agreement with recent experiments that estimated a water flux of three molecules per picosecond through pores of ∼1 nm. We also find that both pores are effective in blocking hydrated Na+ and Cl- ions with large energy barriers, ranging from 12 to 15 eV. In addition, pore passivation with O atoms would increase the water transport through hydroxylated pores, due to the formation of hydrogen bonds with nearby water molecules, which is not observed in the hydrogenated pores.

Influence of construction materials on the natural mummification process: case study of the municipal pantheon of Santa Paula, Guanajuato, Mexico.

The process of natural or spontaneous mummification has been observed for more than a hundred years in various Mexican pantheons. The construction materials used in the niches of the pantheons generate particular microenvironmental conditions that promote the preservation of organic materials. The construction materials (mining adobe, brick and stone material) that make up the three series of the municipal pantheon of Santa Paula were studied and analyzed using X-ray Diffraction, X-ray Fluorescence and petrographic analysis techniques. At the same time, the mechanical and physical properties of the materials were determined, as well as the relative humidity and temperature within the niches. The results indicate that the geochemistry, distribution and percentage of said materials inside of the niches created exceptional microclimatic conditions that favored the conservation of the bodies. With this contribution we intend to advance the understanding of the influence that construction materials had on the process of natural mummification.

Efficient arsenic removal from water using iron-impregnated low-temperature biochar derived from henequen fibers: performance, mechanism, and LCA analysis.

The present study aims to investigate the low-energy consumption and high-efficiency removal of arsenic from aqueous solutions. The designed adsorbent Fe/TBC was synthesized by impregnating iron on torrefaction henequen fibers. Isothermal adsorption experiments indicated maximum adsorption capacities of 7.30 mg/g and 8.98 mg/g for arsenic(V) at 25.0 °C and 40.0 °C, respectively. The interference testing showed that elevated levels of pH, HCO3- concentration, and humic acid content in the solution could inhibit the adsorption of arsenic by Fe/TBC. Characterization of the adsorbent before and after adsorption using FTIR and SEM-EDS techniques confirmed arsenic adsorption mechanisms, including pore filling, electrostatic interaction, surface complexation, and H-bond adhesion. Column experiments were conducted to treat arsenic-spiked water and natural groundwater, with effective treatment volumes of 550 mL and 8792 mL, respectively. Lastly, the life cycle assessment (LCA) using OpenLCA 2.0.3 software was performed to treat 1 m3 of natural groundwater as the functional unit. The results indicated relatively significant environmental impacts during the Fe/TBC synthesis stage. The global warming potential resulting from the entire life cycle process was determined to be 0.8 kg CO2-eq. The results from batch and column experiments, regeneration studies, and LCA analysis indicate that Fe/TBC could be a promising adsorbent for arsenic(V).

Ankle and Pantalar Arthrodesis: End-Stage Salvage in Cavus Foot.

Bony alignment is the primary goal in foot and ankle reconstruction of the cavovarus foot. This condition presents as a malalignment causing a medial overload of the ankle articular surface and lateral overload of the hindfoot, midfoot, and forefoot. A painful gait associated with articular degeneration of the numerous joints can lead to a chronic and rigid arthrosis of joints, warranting arthrodesis of the affected joints accordingly.

Neurologic Conditions Associated with Cavus Foot Deformity.

The cavus foot deformity is an often less understood deformity within the spectrum of foot and ankle conditions. The hallmark concern is the possibility of an underlying neurologic or neuromuscular disorder. Although a proportion of these deformities are idiopathic, a significant majority do correlate with an underlying disorder. The appropriate evaluation of this deformity, in coordination within the multidisciplinary scope of health care, allows for a timely diagnosis and understanding of the patient's condition. We provide an abbreviated survey of possible underlying etiologies for the patient with the cavus foot deformity as a reference to the foot and ankle surgeon.

Magnetic parameters as proxies for anthropogenic pollution in water reservoir sediments from Mexico: An interdisciplinary approach.

We assess the element pollution level of water reservoir sediments using environmental magnetism techniques as a novel approach. Although "La Purísima" Water Reservoir is an important source for multiple activities (e.g. recreational, fishing and agricultural) in Guanajuato state, it has been receiving for the last centuries a high load of pollutants by mining extraction, urbanization and land-use change from the Guanajuato Hydrological Basin. The analyses of environmental magnetism, geochemistry, X-ray energy dispersive spectroscopy, scanning electron microscopy and multivariate methods were applied to study sediments from the reservoir and basin. Accordingly, they indicate the presence of iron oxides (magnetite and hematite) and iron sulfides (pyrite and greigite), which evidences relevant differences in particle size and concentration within the water reservoir (median mass-specific magnetic susceptibility χ = 23.2 × 10-8 m3/kg), as well as with respect to the river basin sediments (median χ = 88.8 × 10-8 m3/kg). The highest enrichment factor EF values (median values of EF = 2-10 for As, Co, Ba, Cu, Cd, Ni and EF > 20 for S) are mainly associated with historical mining activities that have led to an enrichment of potentially toxic elements on these water reservoir sediments. We propose the use of concentration and grain size dependent magnetic parameters, i.e. χ, remanent magnetizations and anhysteretic ratios ARM/SIRM and χARM/χ, as proxies for Ba, Co, Cr, Ni, P and Pb pollution in these river and water reservoir sediments. Such parameters allow to evaluate this sedimentary environment, and similar ones, through useful and convenient proxies.

[Care of adult patients with epileptic seizure in emergency departments (ACESUR Registry). Differences according to age ≥75 years]. / Atención de pacientes adultos con crisis epilépticas en servicios de urgencias (Registro ACESUR). Diferencias en función de la edad ≥75 años.

OBJECTIVES: To determine whether there are differences in the profile and in the care of adult patients with epileptic seizures in emergency department according to age ≥75 years, and if this is independently associated with results in the emergency department and 30 days after discharge. MATERIAL AND METHODS: ACESUR is a multicentre, prospective, observational cohort multipurpose register that was carried out in 2017. The distribution of the variables corresponding to the clinical presentation and care according to age ≥75 years were compared. Subsequently, logistic regression models were performed with the objective of evaluating the effect of age ≥75 years on the outcome variables. RESULTS: A total of 541 (81.5%) cases younger than 75 years were analysed compared to 123 adult patients (18.5%) of ≥75 years or more. In the group of long-lived it was observed significantly greater probability of dependence, co-morbidity, polypharmacy, a previous visit to the hospital emergency department, arrived by ambulance, first seizures and a symptomatic aetiopathogenic classification. In the multivariate analysis, after adjusting for the above variables, it is observed that age >75 years is associated independently with a higher incidence of specific supplementary tests (OR: 2.31; 95% CI: 1.21-4.44), but not pharmacological intervention (OR: 1.63; 95% CI: 0.96-2.80), or hospitalisation or extended stay in emergency departments (OR: 1.56; 95% CI: 0.94-2.59). On adjusting for all previous variables, age >75 years is associated with lower incidence of adverse events at 30 days (OR: 0.43; 95% CI: 0.25-0.77). CONCLUSIONS: In the ACESUR Registry, differences in clinical presentation and in the care of patients with seizures in emergency departments were identified when comparing those patients >75 years with those <75 years. Age ≥75 years is not independently associated with a higher incidence of intervention in emergency departments, or with more adverse outcomes at 30 days after discharge.

Differences in emergency department care of adults with a first epileptic seizure versus a recurrent seizure: a study of the ACESUR (Acute Epileptic Seizures in the Emergency Department) registr. / Registro ACESUR: atención de pacientes adultos con crisis epilépticas en servicios de urgencias: diferencias entre primer episodio y recurrencia.

OBJECTIVES: To describe the characteristics of care received by patients who come to the emergency department with a first epileptic seizure versus a recurrent seizure in a patient with diagnosed epileps. MATERIAL AND METHODS: ACESUR (Acute Epileptic Seizures in the Emergency Department) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling on even days in February and July 2017 and on odd days in April and October 2017. Patients were aged 18 years or older and had an emergency department diagnosis of epileptic seizure. We recorded clinical variables and details related to care given during each patient's visit, including whether the event was a first or recurrent seizure. RESULTS: A total of 664 patients attended by 18 Spanish emergency departments were entered into the ACESUR registry. Two hundred twenty-nine (34.5%) were first seizures and 435 (65.5%) were recurrences. Patients who were attended for first seizures were older, consulted for a wider variety of reasons, and were transported in ambulances (P<.001, all comparisons). Care received differed between patients with first seizures versus recurrent seizures. Specific complementary testing was more likely in patients with first seizures (adjusted odds ratio [aOR], 13.94; 95% CI, 29-26.7; P<.001), and they were more often hospitalized or stayed longer in the emergency department, (aOR, 1.69; 95% CI, 1.11-2.58; P=.015). Pharmacologic treatment did not differ between the groups, either in the acute phase or for prevention (aOR, 1.40; 95% CI, 0.94-2.09; P=.096). Antiepileptic drugs were given to 100 patients (43.7%) after a first seizure and were restarted or changed in 142 patients with recurrent seizure (32.6%). CONCLUSION: The clinical characteristics of adults attended for a first epileptic seizure differ from those of patients with diagnosed epilepsy who were attended for recurrent seizures in Spain. The care received also differs.

OBJETIVO: Describir las características y la atención recibida de pacientes adultos que consultan por crisis epiléptica (CE) en los servicios de urgencias hospitalarios (SUH), diferenciando entre primera crisis y recurrencia en epiléptico conocido. METODO: ACESUR es un registro observacional de cohortes multipropósito, prospectivo y multicéntrico con un muestreo sistemático, los días pares de febrero y julio alternando con los impares de abril y octubre de 2017. Se incluyeron pacientes 18 años con diagnóstico de CE en los SUH. Se recogieron variables clínico-asistenciales de la visita índice de pacientes, distinguiendo entre primera CE y recurrencia en epiléptico. RESULTADOS: El registro ACESUR recogió a 664 pacientes procedentes de 18 SUH españoles, 229 (34,5%) con primera CE y 435 (65,5%) con CE recurrentes. Los pacientes con primera CE fueron de mayor edad (p < 0,001), presentaron motivos de consulta distintos (p < 0,001) y requirieron más traslados en ambulancia (p < 0,001). La atención recibida en el SUH fue diferente, en pacientes con primera CE se solicitó con mayor probabilidad una prueba complementaria específica (OR ajustada = 13,94; IC95%:7,29-26,7; p < 0,001) y se necesitó mayor hospitalización o estancia prolongada en el SUH (OR ajustada = 1,69; IC95%:1,11-2,58; p = 0,015). No hubo diferencias en cuanto al tratamiento farmacológico en fase aguda ni preventivo (OR ajustada = 1,40; IC95%:0,94-2,09; p = 0,096). Se inició tratamiento con fármacos antiepiépticos (FAE) en 100 pacientes (43,7%) tras primera CE y se reinició o modificó añadiendo nuevo FAE en 142 pacientes (32,6%) con CE recurrentes. CONCLUSIONES: Las características clínicas y la atención recibida de pacientes adultos con primera CE en SUH en España difieren de las recurrencias en epiléptico conocido.

Adults discharged after an epileptic seizure: a model of 30-day risk for adverse outcomes. / Modelo de riesgo a 30 días en los pacientes adultos con crisis epiléptica dados de alta de urgencias (RACESUR).

OBJECTIVES: To develop a risk model to predict adverse outcomes within 30 days of discharge in adults attended by hospital emergency departments for an epileptic seizure. METHODS: ACESUR (Acute Epileptic Seizures in the Emergency Department) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling. We made follow-up telephone calls to registered patients 30 days after discharge. Clinical variables for the index visit were extracted from the register and variables at 30 days were collected by telephone. The main outcome variable was the occurrence of any adverse outcome (seizure recurrence, emergency department revisit, hospitalization, or death) within 30 days of discharge. RESULTS: Of the patients from the ACESUR registry discharged from 18 hospitals, we included 489 (74%) with complete follow-up information. The median (interquartile range) age was de 48 (34-66) years. One hundred forty-four patients (29.4%) experienced an adverse outcome within 30 days of discharge. Factors included in the ACESUR risk model were generalized nonconvulsive tonic-clonic epileptic seizure as the reason for the index visit (odds ratio [OR], 2.42; 95% CI, 1.49-3.90; P<.001), ongoing use of 3 or more medications (OR, 1.98; 95% CI, 1.28-3.07; P=.002), and an emergency visit for any reason in the 6 months prior to the index event (OR, 2.34; 95% CI, 1.47-3.70; P<.001). Each factor contributed 1 point to the risk score. A score of 3 was associated with a 62.2% risk of an adverse outcome within 30 days, a score of 2 was associated with a 38.5% risk, a score of 1 with a 25.9% risk, and a score of 0 with a 10.9% risk. The area under the curve receiver operating characteristic curve was 0.72 (95% CI, 0.675-0.772; P=.025). CONCLUSION: The ACESUR risk model may provide a useful score for identifying patients at high risk of an adverse outcome within 30 days of emergency department discharge after an epileptic seizure.

OBJETIVO: Diseñar un modelo de riesgo para predecir resultado adverso a los 30 días del alta en pacientes adultos atendidos por crisis epiléptica en servicios de urgencias hospitalarios (SUH). METODO: ACESUR fue un registro observacional de cohortes multipropósito, prospectivo, multicéntrico, con muestreo sistemático y con seguimiento telefónico a 30 días. La variable principal fue la presencia de algún resultado adverso (recurrencia de crisis, revisita al SUH, hospitalización o fallecimiento) a 30 días del alta del SUH. RESULTADOS: Se incluyeron 489 (74%) pacientes de 48 años de mediana (RIC 34-66), dados de alta de 18 SUH con datos de seguimiento. Ciento cuarenta y cuatro (29,4%) presentaron algún resultado adverso a 30 días del alta del SUH. El Modelo RACESUR incluyó la presencia de crisis epiléptica no convulsiva generalizada tónico-clónica como motivo de consulta (OR 2,42; IC 95% 1,49-3,90; p < 0,001), consumo habitual de $ 3 fármacos (OR 1,98; IC 95% 1,28- 3,07; p = 0,002) y visita al SUH en el semestre anterior por cualquier causa (OR 2,34; IC 95% 1,7-3,70; p < 0,001). Cada ítem vale 1 punto. El riesgo de padecer un resultado adverso a 30 días fue de un 62,2% con 3 puntos, 38,5% con 2, 25,9% con 1 y 10,9% con 0 puntos. El área bajo la curva del modelo fue de 0,72 (IC 95% 0,675-0,772; p = 0,025). CONCLUSIONES: El Modelo RACESUR podría ser una herramienta pronóstico de utilidad para identificar al paciente adulto con crisis epiléptica y alto riesgo de presentar resultado adverso a los 30 días del alta de urgencias.

Capacidad del qSOFA1-lactato para predecir mortalidad a 30 días en los pacientes atendidos por infección en urgencias / Ability of qSOFA1-lactate to predict 30-day mortality in patients seen for infection in the Emergency Department

Objetivo. Evaluar y comparar la capacidad del lactato y del quick Sepsis-related Organ Failure Assessment (qSOFA) para predecir mortalidad a 30 días en los pacientes que acuden al servicio de urgencias (SU) por un episodio de sospecha de infección.Método. Estudio observacional de cohortes, multicéntrico, prospectivo. Se incluyó por oportunidad a pacientes ≥18 años atendidos por sospecha de infección en 71 SU españoles del 01/10/2019 al 31/03/2020. Se analizó la capacidad predictiva con el área bajo la curva (ABC) de la característica operativa del receptor (COR) y los valores de sensibilidad (Se), especificidad (Es), valor predictivo positivo (VPP) y negativo (VPN). Resultados. Se incluyeron 4.439 pacientes con edad media de 67 (DE:18) años, 2.648 (59,7%) fueron hombres y fallecieron a los 30 días 459 (10,3%). Para la mortalidad a 30 días el ABC-COR obtenida con el modelo qSOFA=1 más lactato 2 mmol/l fue de 0,66 (IC 95%: 0,63-0,69) con una Se:68%, Es:70% y VPN:92%, mientras que qSOFA=1 obtuvo ABC-COR de 0,52 (IC 9%: 0,49-0,55) con una Se:42%, Es:64% y VPN:90%.Conclusiones. Para predecir mortalidad a los 30 días en los pacientes que acuden al SU por un episodio de infección, el modelo qSOFA=1 + lactato≥2 mmol/L mejora significativamente el poder predictivo conseguido de forma individual por qSOFA1 y llega a ser muy similiar al de qSOFA≥2 (AU)

Objectives. To evaluate lactate and the Quick Sepsis-Related Organ Failure Assessment (qSOFA) and compare their ability to predict 30-day mortality in patients treated for infection in emergency departments (ED). Methods. Prospective multicenter observational cohort study. We enrolled a convenience sample of patients aged 18 years or older attended in 71 Spanish ED from October 1, 2019, to March 31, 2020. Each model’s predictive power was analyzed with the area under the receiver operating characteristic curve (AUC), and its values of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative (NPV). Results. A total of 4439 patients with a mean (SD) age of 18 years were studied; 2648 (59.7%) were men and 459 (10.3%) died within 30 days. For 30-day mortality, the AUC-COR obtained with the qSOFA = 1 model plus 2 mmol/l lactate was 0.66 (95% CI, 0.63-0.69) with Se: 68%, Es: 70% and NPV:92%, while qSOFA = 1 obtained AUC-COR of 0.52 (95% CI, 0.49-0.55) with a Se:42%, Es:64% and NPV:90%. Conclusions. To predict 30-day mortality in patients presenting to the ED due to an episode of infection, the qSOFA =1 + lactate≥2 mmol/L model significantly improves the predictive power achieved individually by qSOFA1 and becomes very similar to qSOFA≥2 (AU)

Costs and epidemiological changes of chronic diseases: implications and challenges for health systems.

BACKGROUND: The need to integrate economic and epidemiological aspects in the clinical perspective leads to a proposal for the analysis of health disparities and to an evaluation of the health services and of the new challenges which are now being faced by health system reforms in middle income countries. OBJECTIVE: To identify the epidemiological changes, the demand for health services and economic burden from chronic diseases (diabetes and hypertension) in a middle income county. METHODS: We conducted longitudinal analyses of costs and epidemiological changes for diabetes and hypertension in the Mexican health system. The study population included both the insured and uninsured populations. The cost-evaluation method was used, based on the instrumentation and consensus techniques. To estimate the epidemiological changes and financial consequences for 2014-2016, six models were constructed according to the Box-Jenkins technique, using confidence intervals of 95%, and the Box-Pierce test. RESULTS: Regarding epidemiological changes expected in both diseases for 2014 vs. 2016, an increase is expected, although results predict a greater increase for diabetes, 8-12% in all three studied institutions, (p < .05). Indeed, in the case of diabetes, the increase was 41469 cases for uninsured population (SSA) and 65737 for the insured population (IMSS and ISSSTE). On hypertension cases the increase was 38109 for uninsured vs 62895 for insured. Costs in US$ ranged from $699 to $748 for annual case management per patient in the case of diabetes, and from $485 to $622 in patients with hypertension. Comparing financial consequences of health services required by insured and uninsured populations, the greater increase (23%) will be for the insured population (p < .05). The financial requirements of both diseases will amount to 19.5% of the total budget for the uninsured and 12.5% for the insured population. CONCLUSIONS: If the risk factors and the different health care models remain as they currently are, the economic impact of expected epidemiological changes on the social security system will be particularly strong. Another relevant challenge is the appearance of internal competition in the use and allocation of financial resources with programs for other chronic and infectious diseases.

Registro ACESUR: atención de pacientes adultos con crisis epilépticas en servicios de urgencias: diferencias entre primer episodio y recurrencia / Differences in emergency department care of adults with a first epileptic seizure versus a recurrent seizure: a study of the ACESUR (Acute Epileptic Seizures in the Emergency Department) registry

Objetivo: Describir las características y la atención recibida de pacientes adultos que consultan por crisis epiléptica (CE) en los servicios de urgencias hospitalarios (SUH), diferenciando entre primera crisis y recurrencia en epiléptico conocido. Método: ACESUR es un registro observacional de cohortes multipropósito, prospectivo y multicéntrico con un muestreo sistemático, los días pares de febrero y julio alternando con los impares de abril y octubre de 2017. Se incluyeron pacientes 18 años con diagnóstico de CE en los SUH. Se recogieron variables clínico-asistenciales de la visita índice de pacientes, distinguiendo entre primera CE y recurrencia en epiléptico. Resultados: El registro ACESUR recogió a 664 pacientes procedentes de 18 SUH españoles, 229 (34,5%) con primera CE y 435 (65,5%) con CE recurrentes. Los pacientes con primera CE fueron de mayor edad (p < 0,001), presentaron motivos de consulta distintos (p < 0,001) y requirieron más traslados en ambulancia (p < 0,001). La atención recibida en el SUH fue diferente, en pacientes con primera CE se solicitó con mayor probabilidad una prueba complementaria específica (OR ajustada = 13,94; IC95%:7,29-26,7; p < 0,001) y se necesitó mayor hospitalización o estancia prolongada en el SUH (OR ajustada = 1,69; IC95%:1,11-2,58; p = 0,015). No hubo diferencias en cuanto al tratamiento farmacológico en fase aguda ni preventivo (OR ajustada = 1,40; IC95%:0,94-2,09; p = 0,096). Se inició tratamiento con fármacos antiepiépticos (FAE) en 100 pacientes (43,7%) tras primera CE y se reinició o modificó añadiendo nuevo FAE en 142 pacientes (32,6%) con CE recurrentes. Conclusiones: Las características clínicas y la atención recibida de pacientes adultos con primera CE en SUH en España difieren de las recurrencias en epiléptico conocido

Objective: To describe the characteristics of care received by patients who come to the emergency department with a first epileptic seizure versus a recurrent seizure in a patient with diagnosed epilepsy. Methods: ACESUR (Acute Epileptic Seizures in the Emergency Department) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling on even days in February and July 2017 and on odd days in April and October 2017. Patients were aged 18 years or older and had an emergency department diagnosis of epileptic seizure. We recorded clinical variables and details related to care given during each patient's visit, including whether the event was a first or recurrent seizure. Results: A total of 664 patients attended by 18 Spanish emergency departments were entered into the ACESUR registry. Two hundred twenty-nine (34.5%) were first seizures and 435 (65.5%) were recurrences. Patients who were attended for first seizures were older, consulted for a wider variety of reasons, and were transported in ambulances (P<.001, all comparisons). Care received differed between patients with first seizures versus recurrent seizures. Specific complementary testing was more likely in patients with first seizures (adjusted odds ratio [aOR], 13.94; 95% CI, 29-26.7; P<.001), and they were more often hospitalized or stayed longer in the emergency department, (aOR, 1.69; 95% CI, 1.11-2.58; P=.015). Pharmacologic treatment did not differ between the groups, either in the acute phase or for prevention (aOR, 1.40; 95% CI, 0.94-2.09; P=.096). Antiepileptic drugs were given to 100 patients (43.7%) after a first seizure and were restarted or changed in 142 patients with recurrent seizure (32.6%). Conclusions: The clinical characteristics of adults attended for a first epileptic seizure differ from those of patients with diagnosed epilepsy who were attended for recurrent seizures in Spain. The care received also differs

Modelo de riesgo a 30 días en los pacientes adultos con crisis epiléptica dados de alta de urgencias (RACESUR) / Adults discharged after an epileptic seizure: a model of 30-day risk for adverse outcomes

Objetivo: Diseñar un modelo de riesgo para predecir resultado adverso a los 30 días del alta en pacientes adultos atendidos por crisis epiléptica en servicios de urgencias hospitalarios (SUH). Metodología: ACESUR fue un registro observacional de cohortes multipropósito, prospectivo, multicéntrico, con muestreo sistemático y con seguimiento telefónico a 30 días. La variable principal fue la presencia de algún resultado adverso (recurrencia de crisis, revisita al SUH, hospitalización o fallecimiento) a 30 días del alta del SUH. Resultados: Se incluyeron 489 (74%) pacientes de 48 años de mediana (RIC 34-66), dados de alta de 18 SUH con datos de seguimiento. Ciento cuarenta y cuatro (29,4%) presentaron algún resultado adverso a 30 días del alta del SUH. El Modelo RACESUR incluyó la presencia de crisis epiléptica no convulsiva generalizada tónico-clónica como motivo de consulta (OR 2,42; IC 95% 1,49-3,90; p < 0,001), consumo habitual de $ 3 fármacos (OR 1,98; IC 95% 1,283,07; p = 0,002) y visita al SUH en el semestre anterior por cualquier causa (OR 2,34; IC 95% 1,7-3,70; p < 0,001). Cada ítem vale 1 punto. El riesgo de padecer un resultado adverso a 30 días fue de un 62,2% con 3 puntos, 38,5% con 2, 25,9% con 1 y 10,9% con 0 puntos. El área bajo la curva del modelo fue de 0,72 (IC 95% 0,675-0,772; p = 0,025). Conclusiones: El Modelo RACESUR podría ser una herramienta pronóstico de utilidad para identificar al paciente adulto con crisis epiléptica y alto riesgo de presentar resultado adverso a los 30 días del alta de urgencias

Objective: To develop a risk model to predict adverse outcomes within 30 days of discharge in adults attended by hospital emergency departments for an epileptic seizure. Methods: ACESUR (Acute Epileptic Seizures in the Emergency Department) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling. We made follow-up telephone calls to registered patients 30 days after discharge. Clinical variables for the index visit were extracted from the register and variables at 30 days were collected by telephone. The main outcome variable was the occurrence of any adverse outcome (seizure recurrence, emergency department revisit, hospitalization, or death) within 30 days of discharge. Results: Of the patients from the ACESUR registry discharged from 18 hospitals, we included 489 (74%) with complete follow-up information. The median (interquartile range) age was de 48 (34-66) years. One hundred forty-four patients (29.4%) experienced an adverse outcome within 30 days of discharge. Factors included in the ACESUR risk model were generalized nonconvulsive tonic-clonic epileptic seizure as the reason for the index visit (odds ratio [OR], 2.42; 95% CI, 1.49-3.90; P<.001), ongoing use of 3 or more medications (OR, 1.98; 95% CI, 1.28-3.07; P=.002), and an emergency visit for any reason in the 6 months prior to the index event (OR, 2.34; 95% CI, 1.47-3.70; P<.001). Each factor contributed 1 point to the risk score. A score of 3 was associated with a 62.2% risk of an adverse outcome within 30 days, a score of 2 was associated with a 38.5% risk, a score of 1 with a 25.9% risk, and a score of 0 with a 10.9% risk. The area under the curve receiver operating characteristic curve was 0.72 (95% CI, 0.675-0.772; P=.025). Conclusion: The ACESUR risk model may provide a useful score for identifying patients at high risk of an adverse outcome within 30 days of emergency department discharge after an epileptic seizure

Adecuación y efecto del tratamiento antiepiléptico preventivo tras una primera crisis epiléptica a los 30 días del alta / Adequacy and effect of preventive antiepileptic treatment after a first epileptic seizure 30 days after discharge from hospital emergency departments: the ACESUR registry

Objetivo. Evaluar la adecuación y el efecto del tratamiento antiepiléptico preventivo en pacientes adultos con una primera crisis epiléptica en cuanto a resultados adversos a los 30 días del alta del servicio de urgencias hospitalario (SUH). Pacientes y métodos. ACESUR fue un registro observacional de cohortes multipropósito, prospectivo y multicéntrico con un muestreo sistemático. Se realizó seguimiento telefónico a los 30 días. Se recogieron variables clínicas en la visita índice y de resultado en seguimiento. La variable principal fue "tratamiento preventivo adecuado según indicaciones", y la de resultado, "algún resultado adverso" (recurrencia de crisis epiléptica, revisita a SUH, hospitalización o muerte) a los 30 días del alta de urgencias. Se realizó un modelo de regresión logística para aislar el efecto del tratamiento preventivo adecuado. Resultados. Se incluyó a 151 (22,7%) pacientes con una media de 55 años con primera crisis epiléptica, dados de alta de 18 SUH con datos de seguimiento. El tratamiento preventivo se consideró adecuado en 128 (84,8%) pacientes. Cuarenta y un (27,2%) pacientes presentaron algún resultado adverso a los 30 días del alta. Tras la regresión logística, el tratamiento preventivo adecuado al alta del SUH ejerce un efecto protector sobre la variable "algún resultado adverso a 30 días". Conclusiones. En el registro ACESUR, el tratamiento preventivo fue adecuado en la mayoría de los pacientes y su efecto resultó, de forma independiente, protector a los 30 días. Por tanto, el tratamiento preventivo adecuado podría mejorar los resultados a corto plazo de pacientes adultos dados de alta con una primera crisis epiléptica del SUH

Aim. To evaluate the adequacy and effect of preventive antiepileptic treatment in adult patients with the first epileptic seizure in adverse outcomes at 30 days after discharge from the hospital emergency department (HED). Patients and methods. ACESUR was an observational registry of multipurpose, prospective and multicentric cohorts with a systematic sampling. Phone follow-up was done at 30 days. Clinical variables were collected in the index visit and the follow-up result. The main variable was "adequate preventive treatment according to indications" and the result of "some adverse outcome" (recurrence of epileptic seizure, revisits to HED, hospitalization or death) 30 days after discharge from HED. A logistic regression model was used to isolate the effect of adequate preventive treatment. Results. 151 (22.7%) patients with a mean age of 55 years old were included with first epileptic seizure discharged from 18 HED with follow-up data. Preventive treatment was considered adequate in 128 (84.8%) patients. 41 (27.2%) patients presented some adverse outcome 30 days after discharge. After the logistic regression, the appropriate preventive treatment to the discharge of the HED exerts a protective effect on the variable "some adverse outcome to 30 days". Conclusions. In the ACESUR registry, preventive treatment was adequate for most patients and its effect was independent protective at 30 days. Therefore, adequate preventive treatment could improve the short-term results of adult patients discharged with the first epileptic seizure of the HED