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Early detection of ST-segment elevation myocardial infarction (STEMI) on the prehospital electrocardiogram (ECG) improves patient outcomes. Current software algorithms optimize sensitivity but have a high false-positive rate. The authors propose an algorithm to improve the specificity of STEMI diagnosis in the prehospital setting.
Methods:
A dataset of prehospital ECGs with verified outcomes was used to validate an algorithm to identify true and false-positive software interpretations of STEMI. Four criteria implicated in prior research to differentiate STEMI true positives were applied: heart rate <130, QRS <100, verification of ST-segment elevation, and absence of artifact. The test characteristics were calculated and regression analysis was used to examine the association between the number of criteria included and test characteristics.
Results:
There were 44,611 cases available. Of these, 1,193 were identified as STEMI by the software interpretation. Applying all four criteria had the highest positive likelihood ratio of 353 (95% CI, 201-595) and specificity of 99.96% (95% CI, 99.93-99.98), but the lowest sensitivity (14%; 95% CI, 11-17) and worst negative likelihood ratio (0.86; 95% CI, 0.84-0.89). There was a strong correlation between increased positive likelihood ratio (r2 = 0.90) and specificity (r2 = 0.85) with increasing number of criteria.
Conclusions:
Prehospital ECGs with a high probability of true STEMI can be accurately identified using these four criteria: heart rate <130, QRS <100, verification of ST-segment elevation, and absence of artifact. Applying these criteria to prehospital ECGs with software interpretations of STEMI could decrease false-positive field activations, while also reducing the need to rely on transmission for physician over-read. This can have significant clinical and quality implications for Emergency Medical Services (EMS) systems.
Relapse prevention during early stages after psychosis onset is a key factor for long term outcome. While factors associated with first relapse have been widely studied, factors associated with subsequent relapses are poorly described.
Objectives
To determine predictive factors of first and subsequent relapses among patients recruited from a cohort of PAFIP Early Intervention Program.
Material and methods
We analyzed socio-demographic and clinical data of a cohort of 393 first episode psychosis (FEP) patients that were recruited since February 2001 to May 2011. Of these, 341 achieved clinical remission and were, therefore, considered to be at risk of relapse. They were followed-up for 3 years. A wide range of potential factors were included as possible predictors of relapse. Test univariate, analysis logistics of regression, regression of Cox and analysis of survival of Kaplan-Meier were carried out.
Results
Poor adherence to medication was the main predictor associated to first relapse (ExpB: 2.979; P < 0.001). After the first relapse, only 56 patients (33.9%) underwent a second relapse, being the diagnosis (ExpB: 1.975; P = 0.074), the age of onset, (ExpB: 1.078; P = 0.003) and a low level of positive symptomatology (ExpB: 0.863; P = 0.03) the predictors of associated with a second relapse.
Conclusions
After a FEP, non-adherence to medication is the main predictor of first relapse. Second and subsequent relapses relate with non-modifiable factors such as age of onset or schizophrenia diagnosis. This subgroup of patients could have greater predisposition to relapse related with the severity of the disease itself.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Previous research on the prevalence of medical disorders among adults with dual diagnosis (DD) has been inconclusive.
Objectives
The purpose of this study was to assess dual diagnosis and medical co-morbidity at the Brief Psychiatric Inpatient Unit of Marqués de Valdecilla Hospital, Santander in the period from January 2014 until March 2015.
Methods
Ninety-three patients were admitted at our hospital from December 2014 until March 2015. The simple was analyzed retrospectively. Sixty-two of the patients (66.7%) met criteria for Dual Diagnosis. We collected socio-demographic variables, drug abuse, mental pathology, and treatment received.
Results
The mean age of the sample was 42.95 years (± 14 DS) with a male:female ratio of 1.8:1 (no significant differences by gender). Hypertension was more prevalent among patients without dual pathology (22.5%). Patients with dual diagnosis presented hypertension less likely (6.5%) (P < 0.005). This can be explained by the fact that patients without dual diagnosis had a higher mean age (47 years) than patients with dual diagnosis (42 years). We did not found statistically significant differences between both groups respect to diabetes mellitus, vascular brain disease, HIV and dyslipidemia.
Conclusions
Hypertension was less likely to appear among patients with dual pathology admitted to an ultra brief psychiatry unit. This could be explained for an earlier mean age at admission among these patients.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Alcohol consumption represents a significant factor for mortality in the world: 6.3% in men and 1.1% in women. Alcohol use disorder is also very common: 5.4% in men and 1.5% in women. Despite its high frequency and the seriousness of this disorder, only 8% of all alcohol-dependents are ever treated. One potentially interesting treatment option is oriented toward reducing alcohol intake.
Aims
To describe one case who has improved his alcohol consumption after starting treatment with nalmefene, an opioid receptor antagonist related to naltrexone.
Methods
A 35-year-old male with alcohol use disorder since 2001 came to our consult in November 2015. He was in trouble with his family and he had a liver failure. We offer a new treatment option with nalmefene 18 mg to reduce alcohol consumption.
Results
Before to start nalmefene he drank 21 drinks/week. Six-month later, he decreased alcohol intake until 5 drinks/week with better family relationship and liver function. After starting nalmefene he complained of nausea, so we recommend to take the middle of the pill for next 7 days. After this time he returned to take one pill with good tolerance and no more side effects or withdrawal syndrome.
Conclusions
Nalmefene appears to be effective and safe in reducing heavy drinking and in preventing alcohol withdrawal syndrome due to its opioid receptor antagonism. This case suggests nalmefene is a potential option to help patients, who do not want or cannot get the abstinence, in reducing their alcohol consumption.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Functioning of patients with delusional disorder may be impaired, particularly if the delusional thinking is chronic rather than episodic. They refuse to characterize their beliefs as false and view opposing views with surprise, if not hostility and disdain, dismissing or ignoring them, and continuing their struggle to find resolution or restitution for the wrongs they have endured or the illnesses from which they suffer. They typically reject and often resent the suggestion that they are mentally compromised. They are a difficult group to engage clinically, often refusing to meet with a clinician about their delusions and/or to take medication. The first-line treatment of delusional disorder is antipsychotic medication rather than other clinical interventions. Patients with the disorder often reject psychiatric treatment, it is particularly important that medication be prescribed in the context of a therapeutic relationship that includes support, education, encouragement of healthier pursuits, and discouragement of damaging, delusion-inspired actions.
Methods
We describe a case of a 55-year-old woman with a delusional disorder that was diagnosed 4 years before. The supervision of the right take of the treatment was not possible and the intensity of behavioral disturbances increased. Then we started the treatment with long-acting injectable aripiprazole.
Results
Within the 4 months following the start of treatment, her mental state improved by attenuation of psychotic symptoms.
Conclusions
Long-acting aripiprazole could be an effective tool for treatment of psychotic symptoms in patients with no insight and difficulties to check the proper treatment take.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Antidepressant treatment, although it is effective to improve the manifestations of major depression, may also induce or exacerbate some symptoms of sexual dysfunction. Symptoms such as decreased libido, anorgasmia, delayed ejaculation, erection difficulty or dyspareunia, affect the quality of life of the subject who suffers and the self-esteem, can lead to lack of adherence to treatment and in accordingly, the relapse of depressive symptoms. Serotonergic antidepressants are frequently associated with the onset of sexual dysfunction in sexually active patients exceeding 70%. Clinicians underestimate the actual incidence of dysfunction as the technical specifications of drugs show lower levels than 25% and spontaneous reports of patients do not exceed 20-40%.
Aims
Vortioxetina is a reuptake inhibitor of serotonin (5-HT) and is also an agonist of the 5-HT1A partial agonist 5-HT1B and an antagonist of 5-HT3, 5-HT1D and 5-HT7. Apparently, this molecule at doses of between 5 and 15 mg is safe and effective and does not cause sexual dysfunction. It is a well-tolerated and safe, with low incidence of sexual dysfunction.
Methods
To evaluate the action we have evaluated sexual dysfunction in patients with major depression before receiving treatment vortioxetina (whether state or not previously treated with other antidepressants) and at 2, 6 and 12 months after starting treatment with the drug. So we’ve used the SALSex scale (Scale for measuring sexual dysfunction secondary to psychotropic drugs).
Results
The results of this study are still being analyzed.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The first five years after the onset of a first episode of psychosis (FEP) are crucial for long term outcome. In this period, the risk of relapse is particularly high. Consequences of relapse include an increased risk of neurotoxicity, chronicity, hospitalization, decreased response to treatment, increased economic burden and functional impairment.
Objectives
To discern the influence of cannabis on relapse as it may contribute to adopt specific measures in patients during early stages of the illness.
Material and methods
PAFIP is an early intervention program for patients with a FEP. Between January 2005 and January 2011, 163 patients were recruited for this study. They were followed-up during 3 years at intervals of three months. The sample was divided into three groups: (1) those non-cannabis users neither before the FEP nor during follow-up (nn), (2) consumers before the FEP and during follow-up (ss) and (3) consumers before the FEP that gave up consumption during follow-up (sn).
Results
No statistically significant differences between the three groups were observed but a trend (P = 0.057) towards a more enduring survival in Group 3 (sn). (Kaplan–Meier curve and detailed Log Rank Test results will be included in the final poster).
Conclusions
Cannabis has a detrimental effect on schizophrenia. The interruption of its use could contribute to improve the outcome of the disease, as the results of our study suggest.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
As consumer-directed care programmes become increasingly common in aged care provision, there is a heightened requirement for literature summarising the experience and perspectives of recipients. We conducted rapid evidence reviews on two components of consumer experience of home- and community-based aged care: (a) drivers of choice when looking for a service (Question 1 (Q1)); and (b) perceptions of quality of services (Question 2 (Q2)). We systematically searched MEDLINE and EMBASE databases, and conducted manual (non-systematic) searches of primary and grey literature (e.g. government reports) across CINAHL, Scopus, PsychINFO, and Web of Science, Trove and OpenGrey databases. Articles deemed eligible after abstract/full-text screening subsequently underwent risk-of-bias assessment to ensure their quality. The final included studies (Q1: N = 21; Q2: N = 19) comprised both quantitative and qualitative articles, which highlighted that consumer choices of services are driven by a combination of: desire for flexibility in service provision; optimising mobility; need for personal assistance, security and safety, interaction, and social/leisure activities; and to target and address previously unmet needs. Similarly, consumer perspectives of quality include control and autonomy, interpersonal interactions, flexibility of choice, and safety and affordability. Our reviews suggest that future model development should take into account consumers’ freedom to choose services in a flexible manner, and the value they place on interpersonal relationships and social interaction.
Thousands of new asteroids are discovered every year and the rate of discovery is by far larger than the determination rate of their physical properties. In 2015 a group of researchers and students of several Mexican institutions have established an observational program to study asteroids photometrically. The program, named Mexican Asteroid Photometry Campaign, is aiming to derive rotation periods of asteroids based on optical photometric observations. Since then four campaigns have been carried out. The results obtained throughout these campaigns, as well as future work, are presented.
We present photometric observations of (4055) Magellan, (143404) 2003 BD44, 2014 JO25 and (3122) Florence, four potentially hazardous Near Earth Asteroids (NEAs). The data were taken near their approaches to Earth by 3 observatories participating in the Mexican Asteroid Photometry Campaign (CMFA). The results obtained: light curves, spin rates, amplitudes and errors, are in general agreement with those obtained by others. During the day of a NEAs maximum approach to our planet, its light curve may present significant changes. In the spin rate, however, only minute changes are observed. 2014 JO25 is briefly discussed in this regard.
We derive and assess the sharpness of analytic upper bounds for the instantaneous growth rate and finite-time amplification of palinstrophy in solutions of the two-dimensional incompressible Navier–Stokes equations. A family of optimal solenoidal fields parametrized by initial values for the Reynolds number $Re$ and palinstrophy ${\mathcal{P}}$ which maximize $\text{d}{\mathcal{P}}/\text{d}t$ is constructed by numerically solving suitable optimization problems for a wide range of $Re$ and ${\mathcal{P}}$, providing numerical evidence for the sharpness of the analytic estimate $\text{d}{\mathcal{P}}/\text{d}t\leqslant (a+b\sqrt{\ln Re+c}){\mathcal{P}}^{3/2}$ with respect to both $Re$ and ${\mathcal{P}}$. This family of instantaneously optimal fields is then used as initial data in fully resolved direct numerical simulations, and the time evolution of different relevant norms is carefully monitored as the palinstrophy is transiently amplified before decaying. The peak values of the palinstrophy produced by these initial data, i.e. $\sup _{t>0}{\mathcal{P}}(t)$, are observed to scale with the magnitude of the initial palinstrophy ${\mathcal{P}}(0)$ in accord with the corresponding a priori estimate. Implications of these findings for the question of finite-time singularity formation in the three-dimensional incompressible Navier–Stokes equation are discussed.
Paediatric hospital-associated venous thromboembolism is a leading quality and safety concern at children’s hospitals.
Objective
The aim of this study was to determine risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation.
Methods
We conducted a retrospective, case–control study of children admitted to the cardiovascular intensive care unit at Johns Hopkins All Children’s Hospital (St. Petersburg, Florida, United States of America) from 2006 to 2013. Hospital-associated venous thromboembolism cases were identified based on ICD-9 discharge codes and validated using radiological record review. We randomly selected two contemporaneous cardiovascular intensive care unit controls without hospital-associated venous thromboembolism for each hospital-associated venous thromboembolism case, and limited the study population to patients who had undergone cardiothoracic surgery or therapeutic cardiac catheterisation. Odds ratios and 95% confidence intervals for associations between putative risk factors and hospital-associated venous thromboembolism were determined using univariate and multivariate logistic regression.
Results
Among 2718 admissions to the cardiovascular intensive care unit during the study period, 65 met the criteria for hospital-associated venous thromboembolism (occurrence rate, 2%). Restriction to cases and controls having undergone the procedures of interest yielded a final study population of 57 hospital-associated venous thromboembolism cases and 76 controls. In a multiple logistic regression model, major infection (odds ratio=5.77, 95% confidence interval=1.06–31.4), age ⩽1 year (odds ratio=6.75, 95% confidence interval=1.13–160), and central venous catheterisation (odds ratio=7.36, 95% confidence interval=1.13–47.8) were found to be statistically significant independent risk factors for hospital-associated venous thromboembolism in these children. Patients with all three factors had a markedly increased post-test probability of having hospital-associated venous thromboembolism.
Conclusion
Major infection, infancy, and central venous catheterisation are independent risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or cardiac catheter-based intervention, which, in combination, define a high-risk group for hospital-associated venous thromboembolism.
The Recorrido Arqueológico de Coixtlahuaca (RAC) presents period-by-period settlement pattern maps for the valley of Coixtlahuaca in the northern Mixteca Alta. The RAC project made improvements in full-coverage survey methods. We identify limitations and suggest that similar projects in the future need to resolve several management and budget problems. The survey revealed two periods of heavy occupation, 700–300 BC and AD 1200–1520, separated by a long period of lower population. Archaeological and historical data indicate that during the AD 1200–1520 period, and probably earlier, small landholders organized in strong communities managed an intensive agroecosystem, investing in landesque capital. Urbanization was impressive, yet cities were aggregations of communities and barrios. Today local citizens pose questions about how the large prehispanic population could have organized and sustained itself; these questions coincide with anthropological interest in collective agency, property, landesque capital, and collapse.
Coeliac disease (CD) is an immune-mediated enteropathy resulting from exposure to gluten in genetically predisposed individuals. Gluten proteins are partially digested by human proteases generating immunogenic peptides that cause inflammation in patients carrying HLA-DQ2 and DQ8 genes. Although intestinal dysbiosis has been associated with patients with CD, bacterial metabolism of gluten has not been studied in depth thus far. The aim of this study was to analyse the metabolic activity of intestinal bacteria associated with gluten intake in healthy individuals, CD patients and first-degree relatives of CD patients. Faecal samples belonging to twenty-two untreated CD patients, twenty treated CD patients, sixteen healthy volunteers on normal diet, eleven healthy volunteers on gluten-free diet (GFD), seventy-one relatives of CD patients on normal diet and sixty-nine relatives on GFD were tested for several proteolytic activities, cultivable bacteria involved in gluten metabolism, SCFA and the amount of gluten in faeces. We detected faecal peptidasic activity against the gluten-derived peptide 33-mer. CD patients showed differences in faecal glutenasic activity (FGA), faecal tryptic activity (FTA), SCFA and faecal gluten content with respect to healthy volunteers. Alterations in specific bacterial groups metabolising gluten such as Clostridium or Lactobacillus were reported in CD patients. Relatives showed similar parameters to CD patients (SCFA) and healthy volunteers (FTA and FGA). Our data support the fact that commensal microbial activity is an important factor in the metabolism of gluten proteins and that this activity is altered in CD patients.
Exoplanetary transit observations were carried out for the first time with all the three telescopes at the San Pedro Mártir National Astronomical Observatory in Baja California, Mexico.
We present preliminary results on WASP-39 and WASP-43, two Hot Jupiters known for the presence of a highly-inflated radius. Using the defocused photometry technique, we observed these systems, achieving photometric precision of ± 3–5mmag peak-to-valley. The preliminary fit of their lightcurves shows physical and orbital parameters consistent with published results.
The composition and diversity of parasite communities and intestinal components, as well as infra-community structure, were assessed in eels Anguilla anguilla, from Mar Menor, a permanent Mediterranean hypersaline coastal lagoon. Data were used to determine whether this helminth community differs in composition and structure from that of eels in lagoons with lower salinity regimes and higher freshwater inputs. A total prevalence of 93% was detected. Specifically, parasites were identified as Deropristis inflata, Bucephalus anguillae, Contracaecum sp., Anguillicoloides crassus and two plerocercoid larvae belonging to the order Proteocephalidae, the marine species representing 91% of the isolated helminths. In the total community, digenetic trematodes were the dominant group of helminths, and D. inflata, an eel specialist, dominated both the component community and the infra-community. Richness and diversity were low but similar to those reported in other saline lagoons, and maximum species per eel did not exceed four. At the infra-community level, higher abundance than in other brackish or marine Mediterranean environments was detected. The findings provide further evidence of the similarity in composition and structure of helminth communities in eels from various Mediterranean coastal lagoons. Moreover, salinity-dependent specificities are well supported and reflect the life history of individual eels.
The present work describes a patent applied for registration at the IMPI (Instituto Mexicano de la Propiedad Industrial) of a production process of zeolite X using as raw materials alum sludges issued from drinking water treatment plants. Sludge sample was collected in a water drinking plant located northern Mexico City. The sample was dried and then physicochemical and microbiological analyses were carried out (metal content, main oxides content, mineralogical analysis, helminth eggs content, fecal coliforms). In accordance with its characterization, two main steps of the zeolites production process were performed: 1) alkaline fusion of alum sludge-NaOH mixture for increasing the dissolved precursor’s content and 2) alkaline hydrothermal treatment. Spherical particles of zeolite X were identified by SEM and XRD respectively. The best synthesized zeolite showed a CEC=2.11 meq/g, value being similar to the data reported for clinoptilolite (the most commonly zeolite used for water treatment in the removal of heavy metals). Thus, the synthesized zeolite X in this work can be used for the same purpose.