Manejo de la primera crisis epiléptica y del status en urgencias

First epileptic seizure is a common reason for attending the emergency department. Its management is focused on diagnosis of the episode and on identification and treatment of the underlying cause. Occasionally, anti-epileptic treatment will be required. However, when the seizure is prolonged - a condition known as status epilepticus - it becomes a life-threatening process and requires immediate treatment. In this article, general advice and guidelines for the management of seizures and of sta

Characteristics of Pump Performance in Major Irrigated Areas of California

Well pump tests (12,876) in three Central California groundwater basins were characterized and described according to their spatial distribution. The average overall pumping plant efficiency (wire-water, not including column losses and velocity head) was about 56%. Characteristics such as drawdown, total dynamic heads, kW, and flow rate vary greatly between pumps within and between sub-basins. This is the first well pump characterization of its type in California, although irrigation pump tests have been conducted for over 70 years in California. This paper provides a summary of the spatial variation of well pump performance and characteristics

Modelización Térmica de Discos de Freno Ferroviarios.

En el presente proyecto se ha inicializado una actividad de capacitación en cálculos termo-mecánicos con el objetivo de tener una herramienta que permita dimensionar el sistema de freno de fricción en bogie, concretamente en cuanto a número de discos y su material (fundición o acero). En primer lugar, se estudia el planteamiento del problema general, analizando los datos disponibles para su resolución. Posteriormente, se elige una metodología de cálculo desacoplado, empleando tres modelos en Abaqus que interactúan entre sí para transmitir los resultados: modelo de dinámica de fluidos computacional (CFD), modelo térmico y modelo mecánico. Para cada modelo, se expone una descripción detallada que incluye los siguientes puntos: marco teórico, geometría empleada, condiciones del modelo, parámetros de cálculo y salida de resultados. El modelo CFD se emplea para obtener los coeficientes de transferencia de calor por convección, conociendo el flujo de calor que se disipa al aire cuando el disco está a una determinada temperatura y gira a una determinada velocidad de rotación. A continuación, se realiza el modelo térmico para calcular la distribución de temperaturas en el sistema de frenado, con el objeto de determinar la capacidad de disipación de calor del disco de freno. Con los resultados térmicos del análisis, mediante el tercer modelo, se estudia el estado de tensión creado por los gradientes de temperatura, se superpone al estado inicial de precarga del conjunto eje-rueda-discos y se comprueba la resistencia mecánica del disco de freno. Una vez definidos los modelos de cálculo del problema, para automatizar el tratamiento de resultados, se han creado herramientas de post-proceso: dos script de obtención de ficheros de resultados en código Python y una macro de Excel en código Visual Basic. Finalmente, se ha aplicado la metodología en los vehículos Oaris y Civity, realizando un cálculo termo-mecánico de los discos de freno montados en rueda. Los resultados obtenidos se han comparado con informes de cálculos previos proporcionados por los proveedores, concluyendo que a pesar de observarse algunas diferencias, la metodología desarrollada es válida siempre y cuando se disponga de las características de los materiales

A comprehensive overview on Kratom

Kratom (Mitragyna speciosa Korth) is a tropical tree, indigenous to South East Asia. Historically, the plant is locally used as a stimulant, a remedy in traditional medicine and in social context. Imported to Western countries, Kratom is classified as a novel psychoactive substance (NPS). A systematic review of the literature on Mitragyna speciosa and its main constituents was carried by our international multidisciplinary group. Results were qualitatively analysed in three main areas of interest: in-vitro and preclinical data on pharmacology and behavioral effects, laboratoristic techniques for identification/characterization, epidemiological/toxicological reports on humans. At present, there is no systematic data on the prevalence of Kratom use in all the native countries, but it seems to be considerable. In South-East Asia, Kratom, even if banned, might be still considered a better option than other illicit drugs, an alternative opioid treatment, a “natural” remedy with no real social stigma attached to its consumption. In parallel, this ethno-drug seems to be popular in Western countries, largely unregulated, easily available on the Internet. Kratom pharmacology appears to be complex, with many alkaloids involved. The subjective effects in humans are very peculiar and seem to be dose-dependent, ranging from psycho-stimulant to sedative-narcotic. Available data on Kratom suggest caution: this psychoactive plant could exhibit a serious harmful potential. Kratom use seems to be associated with drug dependency, development of withdrawal symptoms, craving, serious adverse effects and life-threatening effects in a multidrug-intoxicating scenario. On the other hand, its anxyiolitic, antidepressant and analgesic properties deserve to be further studied

Acoustic evaluation of modular greenery noise barriers

Green noise barriers have become an alternative means of reducing urban traffic noise. In this paper, the acoustic performance of a modular greenery noise barrier is evaluated. In situ measurements of noise reflection were performed using an experimental prototype to estimate the sound absorption coefficients. These coefficients were found to have values of approximately 0.7, higher than those previously found in laboratory measurements for a similar system with a lower vegetation density. The obtained values were input into software for predicting environmental noise to analyse the expected performance of such barriers, particularly in the case of a pair of parallel barriers. A comparison with the results for reflective barriers indicates a significant improvement in sound attenuation of up to 4 dBA. The values are similar and even superior to results reported by other authors regarding the effectiveness of absorptive treatments applied to parallel barriers, and furthermore, the proposed barriers offer an aesthetic element for environmental integration.Peer ReviewedPostprint (published version

Profiling the vendors of COVID‐19 related product on the Darknet: An observational study

Background In a time of unprecedented global change, the COVID-19 pandemic has led to a surge in demand of COVID-19 vaccines and related certifications. Mainly due to supply shortages, counterfeit vaccines, fake documentation, and alleged cures to illegal portfolios, have been offered on darkweb marketplaces (DWMs) with important public health consequences. We aimed to profile key DWMs and vendors by presenting some in-depth case studies. Methods A non-systematic search for COVID-19 products was performed across 118 DWMs. Levels of activity, credibility, content, COVID-19 product listings, privacy protocols were among the features retrieved. Open web fora and other open web sources were also considered for further analysis of both functional and non functional DWMs. Collected data refers to the period between January 2020 and October 2021. Results A total of 42 relevant listings sold by 24 vendors across eight DWMs were identified. Four of these markets were active and well-established at the time of the study with good levels of credibility. COVID-19 products were listed alongside other marketplace content. Vendors had a trusted profile, communicated in English language and accepted payments in cryptocurrencies (Monero or Bitcoin). Their geographical location included the USA, Asia and Europe. While COVID-19 related goods were mostly available for regional supply, other listings were also shipped worldwide. Interpretation Findings emerging from this study rise important questions about the health safety of certain DWMs activities and encourage the development of targeted interventions to overcome such new and rapidly expanding public health threats. Funding CovSaf, National Research centre on Privacy, Harm Reduction and Adversarial Influence Online (REPHRAIN), Commonwealth Fund

Paresia poscrítica durante estudios de monitorización de vídeo-EEG

To know the frequency of Todd s paralysis during the video EEG monitoring studies, to investigate in its pathophysiology, and to confirm its value to localise the epileptic focus. PATIENTS AND METHODS: We reviewed 114 monitoring studies, in 102 patients. RESULTS: Sixty patients had epileptic seizures. An obvious paresis was noted in four seizures of two patients (3 and 1, respectively). Both patients had frontal epilepsy. During the paralysis, in the first patient the EEG showed ictal discharges on the contralateral centrotemporal area. In the second patient, the EEG demonstrated slow waves in the contralateral frontal region. The ictal onset was contralateral to the paresis in all cases. No patient with pseudoseizures had paralysis. CONCLUSIONS: Postconvulsive paralysis are not frequent in video EEG monitoring studies. However, if present it points out to a contralateral seizure onset. In our series it happened in patients with frontal seizures. The EEG may help to clarify if it correspond to a true postictal phenomenon or to a ictal paralysis

Changes in the heart rate variability in patients with obstructive sleep apnea and its response to acute CPAP treatment

Obstructive Sleep Apnea (OSA) is a major risk factor for cardiovascular disease. The goal of this study was to demonstrate whether the use of CPAP produces significant changes in the heart rate or in the heart rate variability of patients with OSA in the first night of treatment and whether gender and obesity play a role in these differences. METHODS: Single-center transversal study including patients with severe OSA corrected with CPAP. Only patients with total correction after CPAP were included. Patients underwent two sleep studies on consecutive nights: the first night a basal study, and the second with CPAP. We also analyzed the heart rate changes and their relationship with CPAP treatment, sleep stages, sex and body mass index. Twenty-minute segments of the ECG were selected from the sleep periods of REM, no-REM and awake. Heart rate (HR) and heart rate variability (HRV) were studied by comparing the R-R interval in the different conditions. We also compared samples from the basal study and CPAP nights. RESULTS: 39 patients (15 females, 24 males) were studied. The mean age was 50.67 years old, the mean AHI was 48.54, and mean body mass index was 33.41 kg/m(2) (31.83 males, 35.95 females). Our results showed that HRV (SDNN) decreased after the use of CPAP during the first night of treatment, especially in non-REM sleep. Gender and obesity did not have any influence on our results. CONCLUSIONS: These findings support that cardiac variability improves as an acute effect, independently of gender or weight, in the first night of CPAP use in severe OSA patients, supporting the idea of continuous use and emphasizing that noncompliance of CPAP treatment should be avoided even if it is just once

A global strategy for the conservation and use of apple genetic resources

Publishe