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Resumen Introduccion Las crisis epilepticas son un motivo de ingreso frecuente en urgencias y requieren una actuacion diagnostico-terapeutica precoz y precisa. Nuestro objetivo fue describir las caracteristicas clinico-evolutivas de una serie de pacientes con crisis epilepticas atendidos en urgencias. Metodos Estudio observacional retrospectivo de todos los pacientes con crisis epilepticas que ingresaron en urgencias y fueron atendidos por neurologia de guardia, de febrero a agosto de 2017. Resultados Se incluyeron 153 pacientes, correspondientes al 9,9% del total de urgencias neurologicas. La mediana de edad fue de 58 anos, el 52,3% fueron mujeres y el 51% tenia antecedente de epilepsia. El 82,4% de las crisis tuvo un inicio focal y la etiologia mas frecuente fue la enfermedad cerebrovascular (24,2%). Doce pacientes se complicaron con estatus epileptico (7,8%), lo que se relaciono con mayor puntuacion en la escala ADAN (p Conclusiones Las crisis epilepticas constituyen una urgencia neurologica frecuente, con potenciales complicaciones y una morbimortalidad relevante. En pacientes sin epilepsia conocida es apropiado realizar el diagnostico de epilepsia en urgencias, pero es recomendable un seguimiento posterior en consultas especializadas.

Resumen Introduccion El tiempo de actuacion medica es uno de los factores pronosticos modificables mas importantes en el estatus epileptico. La epilepsia parcial continua (EPC) es un tipo de estatus epileptico con duracion muy variable, en ocasiones prolongada. Nuestro objetivo fue analizar la relacion entre el tiempo de evolucion de la EPC y su pronostico. Metodos Estudio observacional prospectivo de todos los pacientes con EPC que ingresaron en un hospital terciario en el periodo comprendido del 01/09/2017 al 01/09/2018. Resultados Se incluyeron 10 pacientes con EPC, 9 mujeres, con una mediana de edad de 74 anos. La etiologia mas frecuente fue la enfermedad cerebrovascular (n = 6). El inicio de la EPC fue extrahospitalario en 5 pacientes, siendo la mediana del tiempo hasta el ingreso hospitalario 4 h. En la serie global, la mediana del tiempo hasta el inicio del tratamiento fue 12,3 h. La mediana del tiempo hasta el control desde el inicio del tratamiento fue 30 h, y presento una correlacion positiva alta con el tiempo hasta el inicio del tratamiento (rho Spearman 0,88). Seis pacientes presentaban hiperglucemia al inicio del episodio, y esta asocio una correlacion positiva con el tiempo hasta el control desde el inicio del tratamiento (rho Spearman: 0,71). Los 6 pacientes con hiperglucemia tenian una lesion cerebral que justificaba el origen de la EPC. Conclusiones Identificamos un retraso en diferentes fases del manejo de la EPC, lo que se relaciono con una mayor duracion del episodio. La glucemia tambien se relaciono con la duracion del episodio, con un papel probablemente mas desencadenante que etiologico.

The Supporting Information is available free of charge at https://pubs.acs.org/doi/10.1021/acs.jafc.2c08855., Avocado fruit growth and development, unlike that of other fruits, is characterized by the accumulation of oil and C7 sugars (in most fruits, the carbohydrates that prevail are C6). There are five essential carbohydrates which constitute 98% of the total content of soluble sugars in this fruit; these are fructose, glucose, sucrose, D-mannoheptulose, and perseitol, which together with quinic acid and chlorogenic acid have been the analytes under study in this work. After applying an efficient extraction procedure, a novel methodology based on hydrophilic interaction liquid chromatography coupled to mass spectrometry was applied to determine the levels of these seven substances in tissues exocarp, seed, and mesocarp from avocado fruits of two different varieties scarcely studied, Bacon and Fuerte, at three different ripening stages. Quantitative characterization of the selected tissues was performed, and the inter-tissue distribution of metabolites was described. For both varieties, D-mannoheptulose was the major component in the mesocarp and exocarp, whereas perseitol was predominant in the seed, followed by sucrose and D-mannoheptulose. Sucrose was found to be more abundant in seed tissues, with much lower concentrations in avocado mesocarp and exocarp. Quinic acid showed a predominance in the exocarp, and chlorogenic acid was exclusively determined in exocarp samples., Universidad de Granada / CBUA, Ministry of Science and Innovation (PID2021-128508OB-I00 and PID2019- 109566RB-I00, FEDER/Junta de Andalucía-Consejería de Transformación Económica, Industria, Conocimiento y Universidades, Proyecto P20_0026, FEDER/Junta de Andalucía-Consejería de Economía y Conocimiento, Proyecto B-AGR-416-UGR18, Spanish Government (FPU19/00700), UE-NextGenerationUE

Resilience can be defined as the capacity to overcome stressful situations, such as menopausal transition. Female sexual dysfunction is a problem that prevents women from experiencing satisfaction from sexual activity. In this study, we assessed resilience, sexual function, and quality of life among a sample of mid-aged Spanish menopausal women.This cross-sectional study was performed in 101 symptomatic menopausal women. Participants filled out the 14-item Wagnild and Young Resilience Scale, the 19-item Female Sexual Function Index (FSFI), the 16-item Cervantes-SF form, and a sociodemographic questionnaire.Resilience scores were significantly higher among women with high sexual function scores (FSFI26), with a 14-item Wagnild and Young Resilience Scale total valuation of 86 [80-94] versus 74 [66-79.50] (P0.001). Sexual function was significantly worse in the low resilience subgroup of participants, with an FSFI total score of 18.90 [14.10-24] versus 29.40 [24.60-33] in the mid-high resilience one (P0.001). Menopauserelated quality of life was significantly worse among low resilient women, with a Cervantes-SF total score of 42.50 [34.17-56.70] versus 30.80 [20.80-44.90] in the mid-high resilience one (P = 0.004).In our sample, resilience was related to sexual health. Higher resilience scores seem to be linked to a better quality of life during the menopausal transition.

The aim of this study is to analyze the efficacy of the dual trigger (human chorionic gonadotropin (hCG) + GnRH agonists) compared to the conventional trigger (hCG) in terms of oocyte retrieval (number and oocyte maturity), fertilization rate or number of embryos with two pronuclei, number of high-quality embryos, number of transferred embryos, number of cryopreserved embryos, implantation rate, positive β-hCG rate, ongoing pregnancy rate, abortion rate, and live birth rate.This search performed in this systematic review included all literature published in the PubMed database of studies on controlled ovarian stimulation with dual trigger compared with conventional trigger. The meta-analysis included clinical trials and prospective cohort studies.Statistically significant differences between groups (dual trigger vs. hCG trigger) in terms of number of oocytes retrieved and live birth rate favored the dual trigger protocol. No statistically significant differences were found in the other studied variables. A tend favoring the dual trigger protocol was observed in all studied parameters.Dual trigger seems to be more effective in GnRH antagonist cycles in terms of embryo and pregnancy outcome.

When the recipient of the product is relatively distant from the production area, it is necessary to use cold storage and controlled humidity to transport the avocado fruits. One of the main advantages of local avocado consumption lies on the possibility of prolonging on-tree maturation; this could foreseeably modify the metabolic profile of the fruit which arrives to the consumer. In this work, the effect of prolonged on tree maturation (during different time intervals) on the final composition of avocado fruit (at edible ripeness) was evaluated and compared with the impact of the same periods after prolonged cold storage. The quantitative evolution of nine bioactive metabolites (7 phenolic compounds, pantothenic and abscisic acids) over 40 days (10-days intervals) was studied by using a solid-liquid extraction protocol and a LC-MS methodology. The results were discussed both considering the quantitative evolution of each individual compound and the sum of all of them., Universidad de Granada/CBUA

BACKGROUND Timing in status epilepticus (SE) attention is probably the most relevant modifiable prognostic factor and may influence SE duration and prognosis. We aimed to describe the precise relationship between management timing, duration, and prognosis of SE. METHODS Observational longitudinal prospective study on a cohort of all patients diagnosed with SE admitted to our tertiary hospital from September 2017 to August 2019, with a 3-month follow-up. Univariate and multivariable analyses were performed to identify clinical and timing variables associated with SE duration and prognosis. RESULTS Eighty-three SE affecting 76 patients were included. Median age was 73 years, 61.4% were women, median baseline modified Rankin Scale (mRS) was 2, and 55.4% had prior epilepsy. In the out-of-hospital group (n = 50), median time to emergencies was 1.3 h and to hospital admission 2.8 h. In the global series, median time to neurologist was 4.3 h, and median time to therapy initiation was 4.5 h. These four times positively correlated with SE duration (all Spearman's rho coefficient >0.5, all p

Perinatal transmission of HIV has dramatically decreased in high-income countries in the last few years with current rates below 1%, but it still occurs in high-risk situations, mainly pregnant women with late diagnosis of infection, poor antiretroviral adherence and a high viral load (VL). In these high-risk situations, many providers recommend combined neonatal prophylaxis (CNP). Our aim was to evaluate the safety and toxicity of CNP in infants deemed at high-risk of HIV infection among mother-infant pairs in the Madrid Cohort.Prospective, multicenter, observational cohort study between years 2000 and 2019. The subgroup of newborns on CNP and their mothers were retrospectively selected (cohort A) and compared with those who received monotherapy with zidovudine (cohort B). Infants with monotherapy were classified according to treatment regimes in long (6 weeks) and short (4 weeks) course.We identified 227 newborns (33.3% preterm and 7 sets of twins) with CNP. A maternal diagnosis of HIV-1 infection was established during the current pregnancy in 72 cases (36.4%) and intrapartum or postpartum in 31 cases (15.7%). Most infants received triple combination antiretroviral therapy (65.6%; n = 149). The perinatal transmission rate in cohort A was 3.5% (95% confidence interval: 1.13%-5.92%). Infants from cohort A developed anemia (26.1% vs. 19.4%, P = 0.14) and neutropenia more frequently at 50-120 days (21.4% vs. 10.9%, P0.01), without significant differences in grade 3 and 4 anemia or neutropenia between the two cohorts. There were no differences in increased alanine aminotransferase. Neutropenia was more common in the long zidovudine regimes.Our findings provide further evidence of the safety of CNP in infants with high-risk of HIV-1 perinatal transmission.

Objective: to assess the capacity of the PET/CT to predict pulmonary function deterioration and increased mortality risk in patients with idiopathic interstitial pneumonia (IIP) and to establish a possible SUVmax cutoff which identifies these patients. Material and methods: retrospective study between January 2007-December 2020. Inclusion criteria: patients > 18 years of age, diagnosed with IIP by PET/CT and pulmonary function test, with less than 6 months’ difference between the two tests. A study was made of the outcome variables associated with the PET/CT, the pulmonary function test measured at 2 stages (initially at the time of the PET/CT and at the end of follow-up), the mortality risk (using the GAP index) and the relationship between them all. Other variables of interest observed were age, sex, department requesting the PET/CT, indication, and the presence of lung cancer (LC). The statistical analysis was performed using the SPSS program. Results: 39 patients were analysed: 34 males (87%), with an age of 75 ± 8 years (mean ± DS). The mean ± SD of the SUVmax was 2.57 ± 1.17, with a statistically insignificant difference (p = 0.670) between patients with and without lung cancer. LC was confirmed in 21 cases (54%). There is a small inverse correlation between the SUVmax and the initial and final predicted FVC% (r= -0.154, r= -0.252), together with a medium correlation for the initial and final predicted DLCO% (r= -0.523, r= -0.514). The mean ± SD of the GAP index was 3.77 ± 1.08. There is a medium correlation between the SUVmax and the mortality risk of stages I and II (r = 0.468). By means of ROC curve analysis, an SUVmax of 2.2 was established to predict the fall of the FVC below 80%, of 1.9 to predict the fall of the DLCO below 60%, and of 2.15 to predict the progression from GAP stage I to II in mortality risk. Conclusions: There is an inverse correlation between the SUVmax and the pulmonary function, together with a direct relationship between the SUVmax and the mortality risk.

Background: Our aim in this study was to investigate if Hip index (HI) improves the identification of cardiovascular risk (CVR) beyond that achieved with either the waist-to-height ratio (WHtR) or body mass index (BMI)-adjusted waist circumference (A body shape index [ABSI]) in the Spanish Caucasian population. Methods: Three thousand eight hundred forty-four subjects (1754 males, response rate 75.8%) were included. Anthropometric indices (AIs) included were HI, ABSI, and WHtR. CVR was estimated using the Framingham, Systematic COronary Risk Evaluation (SCORE), and American College of Cardiology/American Heart Association (ACC/AHA) charts. Areas under the receiver operating characteristic curve (AUC) were obtained to evaluate the performance of AIs in detecting CVR. We also estimated the AIs' standardized Z-scores and compared them against the CVR. Results: AUC demonstrated that the best AI in males to estimate higher CVR according to Framingham and ACC/AHA charts was WHtR. In females, WHtR also achieved good performance and showed higher prediction capacity than the other AIs. After transforming to Z-scores, ABSI was the best linear predictor for CVR according to SCORE and ACC/AHA, although WHtR also proved to be good. HI did not associate with the measures of CVR. Conclusions: HI does not predict high CVR in the Spanish Caucasian Population. However, ABSI is directly and linearly related to high CVR, with a higher performance than WHtR when standardized and evaluated as a linear predictor.

Food adulteration is an age-old issue and a concomitant phenomenon of the global food market. The assessment of food authenticity constitutes a powerful tool to mitigate this problem and protect the global interest. However, the increasing refinement of fraudulent practices requires a continuous update and enhancement of the analytical methodologies. In this context, the so-called “metabolomic approaches” are currently offering high chances in food authentication. These strategies commonly apply advanced analytical technologies together with chemometric tools to analyze a large number of samples with minimal time consumption and to identify useful biomarkers of food authenticity. In the current contribution, after contextualizing the chapter, the general workflow (and each one of its successive steps) for the application of metabolomic approaches in the field of food authentication and traceability is described. Likewise, interesting examples to illustrate the application of metabolomic strategies for the authentication of different kinds of foodstuffs are given. Particular attention is paid to some recent relevant reports (not intending to typify an exhaustive review or reaching a complete coverage of a particular food category), as well as the main future challenges and perspectives.

Timing in the management of nonconvulsive status epilepticus (NCSE) seems to be one of the most important modifiable prognostic factors. We aimed to determine the precise relationship between timing in NCSE management and its outcome.We performed a cross-sectional study in which clinical data were prospectively obtained from all consecutive adults with NCSE admitted to our hospital from 2014 to 2016. Univariate and multivariable regression analyses were performed to identify clinical and timing variables associated with NCSE prognosis.Among 38 NCSE cases, 59.9% were women, and 39.5% had prior epilepsy history. The median time to treatment (TTT) initiation and the median time to assessment by a neurologist (TTN) were 5h, and the median time to first electroencephalography assessment was 18.5h; in the cases with out-of-hospital onset (n=24), the median time to hospital (TTH) arrival was 2.8h. The median time to NCSE control (TTC) was 16.5h, and it positively correlated with both the TTH (Spearman's rho: 0.439) and the TTT (Spearman's rho: 0.683). In the multivariable regression analyses, the TTC was extended 1.7h for each hour of hospital arrival delay (p=0.01) and 2.7h for each hour of treatment delay (p0.001). Recognition delay was more common in the episodes with in-hospital onset, which also had longer TTN and TTC, and increased morbidity.There were pervasive delays in all phases of NCSE management. Delays in hospital arrival or treatment initiation may result in prolonged TTC. Recognition of in-hospital episodes may be more delayed, which may lead to poorer prognosis in these cases.

Introduction Given the wide heterogeneity of common variable immunodeficiency (CVID), several groups have proposed clinical and immunological classifications to better define follow-up and prognostic algorithms. The present study aims to validate recent clinical and laboratory algorithms, based on different combinations of CVID biomarkers, to provide more personalized treatment and follow-up strategies. Methods We analysed clinical and immunological features of 80 patients with suspected or diagnosed CVID, in two reference centres of Portugal and Spain. Clinical manifestations were categorized into clinical phenotyping proposed by Chapel et al. [ 1 ] that included cytopenia; polyclonal lymphocytic infiltration; unexplained enteropathy; and no disease-related complications. Results 76% of patients in our cohort entered one of the four categories of clinical phenotyping, without overlap (cytopenia; polyclonal lymphocytic infiltration; unexplained enteropathy; and no disease-related complications). The most prominent phenotype was “cytopenia” (40%) followed by “polyclonal lymphocytic infiltration” (19%). The remaining 24% patients of our cohort had overlap of 2 clinical phenotypes (cytopenia and unexplained enteropathy mainly). A delay of CVID diagnosis in more than 6 years presented 3.7-fold higher risk of developing lymphoproliferation and/or malignancy (p Conclusions The phenotypic and genetic study is crucial for an adequate clinical orientation of CVID patients. In these two independent cohorts of patients, classification based in clinical and laboratory algorithms, provides more personalized treatment and follow-up strategies.

INTRODUCTION Seizures are a frequent reason for admission to emergency departments and require early, precise diagnosis and treatment. The objective of this study was to describe the clinical and prognostic characteristics of a series of patients with seizures attended at our hospital's emergency department. METHODS We performed a retrospective, observational study of all patients with seizures who were admitted to our hospital's emergency department and attended by the on-call neurology service between February and August 2017. RESULTS We included 153 patients, representing 9.9% of all neurological emergency department admissions. The median age was 58 years, 52.3% of patients were women, and 51% had history of epilepsy. Onset was focal in 82.4% of cases, and the most frequent aetiology was cerebrovascular disease (24.2%). Twelve patients (7.8%) developed status epilepticus, which was associated with higher scores on the ADAN scale (P

Patients' education is the most relevant contributor to patient self-management of epilepsy. We aimed to assess the acquisition of knowledge after a semi-structured interview.We performed a quasi-experimental prospective study with a cohort of patients with epilepsy admitted for prolonged video electroencephalogram (VEEG). We measured patients' baseline knowledge with a 10-item true-false test (test A). Then, a qualified nurse carried out a semi-structured interview. We measured acquired knowledge with another 10-item true-false exam (test B), prior to VEEG discharge and after a 3- to 5-month follow-up, and we compared the difference between the scores in test A and test B. Finally, we conducted a satisfaction and suitability survey on the interview at follow-up.Thirty-two patients participated, half were women. Their median age was 39.5, and the median length of schooling was 14 years. The median time since epilepsy onset was 13 years, 75% had suffered tonic-clonic seizures. The median score on test A was 7, while the median score on test B was 8.5 (p 0.001) both at VEEG discharge and after follow-up. After the interview, 84.4% of participants reported that they were very satisfied with the information received; 87.5% stated that they had not previously heard about SUDEP (sudden unexpected dead in epilepsy); and 93.8% considered it important to receive detailed information about SUDEP.Patient education through a semi-structured comprehensive interview improves knowledge of patients with epilepsy about their disease. The calm atmosphere and the qualified nursing working at VEEG units make them an appropriate setting for talking about epilepsy and its risks, including SUDEP.

To develop and validate an epilepsy-specific scale for comprehensive functional assessment of patients with epilepsy, named Epidaily.The multidisciplinary research group created through brainstorming a list of 47 items to explore the cognitive, social, basic and instrumental functionality of the patient. A group of epilepsy experts independent of the research group evaluated the suitability of all the items, which then were selected and reviewed by the research group to conform the Epidaily scale. On a sample of 102 patients, a reliability analysis was performed, as well as a validation one using as reference scale the score on the Activities of Daily Living Questionnaire (ADLQ), which evaluates basic and instrumental functionality.Epidaily consisted of 10 items distributed in four dimensions, with a possible score from 0 to 100 (perfect functionality). Inter-observer reliability was excellent, with an intraclass correlation coefficient of 0.98 (95% confidence interval 0.97-0.99). Criterion validity was demonstrated by the high positive correlation of the Epidaily score with the ADLQ score (Spearman's rho coefficient 0.85, p 0.001). Significant relation was found between ADLQ and Epidaily in the linear regression analysis (p 001), which reported that Epidaily explains 85.5% of the variability of ADLQ (R-squared 0.85). Discriminant validity was also proved, as Epidaily allowed to classify epilepsy severity based on Cramer et al epilepsy severity classification. The median time to obtain the Epidaily score was 5 min (interquartile range 4-6).Epidaily is a brief and versatile scale, with excellent inter-observer reliability, which has been validated for comprehensive functional assessment of patients with epilepsy.

AimTo determine the association of body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtr) and Body Shape Index (ABSI) with high cardiovascular risk (CVR), as well as to determine whether how strong are these relationships.Material and methodsA cross-sectional study was carried out in Spanish Caucasian adults. 3,456 subjects completed the study, 45.78% males, aged < 65 years and non-diabetic subjects. Anthropometric/biochemical variables were measured. We determined ABSI based on WC adjusted for height and weight. High CVR was defined as ≥ 20% according to the Framingham chart, ≥ 5% with the SCORE chart, and ≥ 7.5% with the ACC/AHA guide. Areas under the receiver operating characteristic curves (AUCs) were estimated for each anthropometric measure.ResultsMost significant AUCs in males were: WHtr and ABSI for Framingham ≥ 20% and SCORE ≥ 5%. Also significant were WHtr, WC and ABSI for ACCA/AHA ≥ 7.5%. On the other hand, most significant AUCs in females were: WHtr and WC for Framingham ≥ 20%; and WHtr and WHR for SCORE ≥ 5%, WHtr, and WC for ACC/AHA guide ≥ 7.5%.ConclusionsOverall, the best anthropometric index identifying Spanish males and females who are at high risk for CV events is WHtr. ABSI was also found to be a good anthropometric index to predict high CVR in Spanish males according to FR, SCORE and ACC/AHA charts. For Spanish females, WC is a good anthropometric index according to FR and ACC/AHA guide, while WHR is better according to SCORE.

Background and objectives: Resilience is a dynamic process that implies positive adaptation to adversity, and it is tested in stressful situations. In this study we compared resilience and menopause-related quality of life in women with and without a history of gynaecological cancer. Methods: A cross-sectional study was conducted with a total of 293 participants, all of them menopausal women: 80 cancer survivors and 213 without a history of cancer. Participants completed the 14-item Wagnild and Young Resilience Scale (WYRS-14) and the 16-item short form Cervantes (Cervantes-SF-16) questionnaire (on which a lower score indicates a higher menopause-related quality of life), and sociodemographic data were collected. Results: Resilience was significantly higher in the cancer survivors than in the menopausal women without a history of cancer: their total WYRS-14 scores were 86 points [72.25–90.00] and 80 points [69.80–88], respectively. Quality of life for cancer survivors was significantly worse than for women without a history of cancer: their total Cervantes-SF-16 scores were 45.01 [27.19–58.34] and 32.37 [20.00–44.80], respectively. Among the cancer survivors, women with a high resilience score had a better quality of life than those with a low resilience score: the groups’ respective scores on the Cervantes-SF-16 total score were 35.98 [25.84–53.00] and 64.59 [51.81–76.68]. Conclusions: A history of cancer significantly affected women's menopause-related quality of life. Cancer had an impact on resilience. Highly resilient menopausal women with a history of gynaecological cancer had a better menopause-related quality of life than less resilient women with a history of gynaecological cancer.