Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine

OBJECTIVE: To compare two widely used drug treatments for people with aggression or agitation due to mental illness. DESIGN: Pragmatic, randomised clinical trial. SETTING: Three psychiatric emergency rooms in Rio de Janeiro, Brazil. SUBJECTS: 301 aggressive or agitated people. INTERVENTIONS: Open treatment with intramuscular midazolam or intramuscular haloperidol plus promethazine. MAIN OUTCOME MEASURES: Patients tranquil or sedated at 20 minutes. Secondary outcomes: patients tranquil or asleep by 40, 60, and 120 minutes; restrained or given extra drugs within 2 hours; severe adverse events; another episode of agitation or aggression; needing extra visits from doctor during first 24 hours; overall antipsychotic load in first 24 hours; and not discharged by two weeks

Characterization of ESBL-producing Escherichia spp. and report of an mcr-1 colistin-resistance Escherichia fergusonni strain from minced meat in Pamplona, Colombia

[EN] Foods of animal origin are increasingly considered a source of extended spectrum β-lactamase (ESBL) producing bacteria which can disseminate throughout the food chain and become a health concern for humans. This work aimed to evaluate the occurrence of ESBL-producing Escherichia coli in 100 retail minced meat samples taken in markets in Pamplona, Colombia. A total of 19 ESBL-producing isolates were obtained, 18 identified as E. coli and one as E. fergusonii. Fifteen isolates (78.9 %) carried blaCTX-M and blaTEM genes, one (5.2 %) blaSHV and blaTEM genes, one isolate (5.2 %) carried blaCTX-M and one (5.2 %) blaSHV alone. The majority of CTX-M-positive E. coli isolates carried the blaCTX-M-15 gene (13 isolates), being the blaCTX-M-9, blaCTX-M-2, and blaCTX-M-8 (one isolate each) also detected. Two SHV-positive isolates presented the blaSHV-5 and blaSHV-12 allele. The isolate identified as E. fergusonii was positive for blaCTX-M-65 gene and mcr-1 gene. Sixteen isolates (84.2 %) belonged to phylogroups A and B1 and grouped together in the phylogenetic tree obtained by MLST; phylogroups E and F were also detected. Transfer of ESBL resistance was demonstrated for the E. fergusonii isolate. Whole genome sequencing of this isolate revealed the presence of plasmids carrying additional resistance genes. This investigation showed the high prevalence of ESBL-producing E. coli in retail samples of minced meat. Also, the isolation of a strain of E. fergusonii is an additional concern, as some resistance genes are located in mobile elements, which can be transmitted to other bacteria. These evidences support the increasing public health concern considering the spreading of resistance genes through the food chain.S

Effect of surgical treatment on the cellular immune response of gastric cancer patients

Patients with gastric cancer have a variety of immunological abnormalities. In the present study the lymphocytes and their subsets were determined in the peripheral blood of patients with gastric cancer (N = 41) both before and after surgical treatment. The percent of helper/inducer CD4 T cells (43.6 ± 8.9) was not different after tumor resection (43.6 ± 8.2). The percent of the cytotoxic CD8+ T cell population decreased significantly, whether patients were treated surgically (27.2 ± 5.8%, N = 20) or not (27.3 ± 7.3%, N = 20) compared to individuals with inflammatory disease (30.9 ± 7.5%) or to healthy individuals (33.2 ± 7.6%). The CD4/CD8 ratio consequently increased in the group of cancer patients. The peripheral blood lymphocytes of gastric cancer patients showed reduced responsiveness to mitogens. The defective blastogenic response of the lymphocytes was not associated with the production of transforming growth factor beta (TGF-ß) since the patients with cancer had reduced production of TGF-ß1 (269 ± 239 pg/ml, N = 20) in comparison to the normal individuals (884 ± 175 pg/ml, N = 20). These results indicate that the immune response of gastric cancer patients was not significantly modified by surgical treatment when evaluated four weeks after surgery and that the immunosuppression observed was not due to an increase in TGF-ß1 production by peripheral leukocytes.33934

Beneficial effects of the ethanol extract of Caesalpinia pyramidalis on the inflammatory response and abdominal hyperalgesia in rats with acute pancreatitis

AbstractEthnopharmacological relevanceCaesalpinia pyramidalis Tul. (Fabaceae) is a plant found in the Northeast of Brazil that is popularly used to treat inflammation. Acute pancreatitis (AP) is an inflammatory disease for which abdominal pain is a relevant symptom. As there is no specific therapy for AP, we investigated the effect of the ethanol extract from the inner bark of C. pyramidalis (EECp) on the AP induced by common bile duct obstruction (CBDO) in rats.Material and methodsAP was induced in male Wistar rats (200–250g, n=6–8) through laparotomy and subsequent CBDO. Animals were euthanized after 6 (G6h) or 24h (G24h) of induction. In the G6h protocol, animals were pretreated with EECp (100–400mg/kg, p.o.) or vehicle (Tween 80; 0.2%) 1h before CBDO or sham surgery. For the G24h protocol, rats were pretreated with EECp (400mg/kg, 1h before CBDO or 1h before and 12h after CBDO) or vehicle. The following parameters were measured: inflammatory/oxidative (myeloperoxidase activity and malondialdehyde formation in the pancreas and lung, leukocyte counts in the blood and serum nitrate/nitrite), enzymatic (serum amylase and lipase levels) and nociceptive (abdominal hyperalgesia).ResultsInduction of AP by CBDO significantly increased all the parameters evaluated in both G6h and G24h protocols when compared with the respective sham group. In the G6h protocol, the EECp pretreatment (400mg/kg) significantly reduced all these parameters, besides completely inhibiting abdominal hyperalgesia. The same profile of reduction was observed from two administrations of EECp in the G24h protocol, while one single dose of EECp was able to significantly reduce pancreatic MDA, serum lipase levels, leukocyte counts in the blood and abdominal hyperalgesia without affecting the other parameters in the G24h protocol. Furthermore, rutin was found in the EECp.ConclusionsOur results demonstrated that EECp decreases inflammation, lipoperoxidation and hyperalgesia in CBDO-induced AP, making it of interest in future approaches to treat this condition

Mechanical behaviour of wood T-joints. Experimental and numerical investigation

Results of a double-shear single-dowel wood connection tested under monotonic quasi-static compression loading are presented and discussed in this paper. The wood used in this study was a pine wood, namely the Pinus pinaster species, which is one of the most important Portuguese species. Each connection (specimen) consists of three wood members: a centre member, loaded in compression along the parallel-tograin direction and two simply supported side members, loaded along the perpendicular-to-grain direction (Tconnection). The load transfer between wood members was assured by means of a steel dowel, which is representative of the most common joining technique applied for structural details in wooden structures. The complete load-slip behaviour of the joint is obtained until failure. In particular, the values of the stiffness, the ultimate loads and the ductility were evaluated. Additionally, this investigation proposed non-linear 3D finite element models to simulate the T-joint behaviour. The interaction between the dowel and the wood members was simulated using contact finite elements. A plasticity model, based on Hill’s criterion, was used to simulate the joint ductility and cohesive damage modelling was applied to simulate the brittle failure modes (splitting) observed in the side members of the joint. The simulation procedure allowed a satisfactory description of the non-linear behaviour of the T-joint including the collapse prediction

Mining for peaks in lc-hrms datasets using finnee - a case study with exhaled breath condensates from healthy, asthmatic, and copd patients

This work was financially supported by the projects: (i) UID/ EQU/00511/2019 - Laboratory for Process Engineering, Environment, Biotechnology and Energy − LEPABE funded by national funds through FCT/MCTES (PIDDAC); (ii) POCI-01-0145-FEDER-029702 and POCI-01-0145-FEDER031297 funded by FEDER funds through COMPETE2020 − Programa Operacional Competitividade e Internacionalizaca̧ õ (POCI) and by national funds (PIDDAC) through FCT/ MCTES; (iii) AstraZeneca − Projecto OLDER (CEDOC/ 2015/59); (iv) iNOVA4Health - UID/Multi/04462/2013, financially supported by FCT/Ministerio da Educação e Ciência, and co-funded by FEDER under the PT2020 Partnership Agreement.Separation techniques hyphenated to high-resolution mass spectrometry are essential in untargeted metabolomic analyses. Due to the complexity and size of the resulting data, analysts rely on computer-assisted tools to mine for features that may represent a chromatographic signal. However, this step remains problematic, and a high number of false positives are often obtained. This work reports a novel approach where each step is carefully controlled to decrease the likelihood of errors. Datasets are first corrected for baseline drift and background noise before the MS scans are converted from profile to centroid. A new alignment strategy that includes purity control is introduced, and features are quantified using the original data with scans recorded as profile, not the extracted features. All the algorithms used in this work are part of the Finnee Matlab toolbox that is freely available. The approach was validated using metabolites in exhaled breath condensates to differentiate individuals diagnosed with asthma from patients with chronic obstructive pulmonary disease. With this new pipeline, twice as many markers were found with Finnee in comparison to XCMS-online, and nearly 50% more than with MS-Dial, two of the most popular freeware for untargeted metabolomics analysis.publishersversionpublishe

Energy Conditions in f(G)f(G) Modified Gravity with Non-minimal Coupling to Matter

In this paper we study a model of modified gravity with non-minimal coupling between a general function of the Gauss-Bonnet invariant, $f(G)$, and matter Lagrangian from the point of view of the energy conditions. Such model has been introduced in Ref. [21] for description of early inflation and late-time cosmic acceleration. We present the suitable energy conditions for the above mentioned model and then, we use the estimated values of the Hubble, deceleration and jerk parameters to apply the obtained energy conditions to the specific class of modified Gauss-Bonnet models.Comment: 12 pages, no figur, Accepted for publication in Astrophysics and Space Scienc

Cross-Correlation Studies with CMB Polarization Maps

The free-electron population during the reionized epoch rescatters CMB temperature quadrupole and generates a now well-known polarization signal at large angular scales. While this contribution has been detected in the temperature-polarization cross power spectrum measured with WMAP data, due to the large cosmic variance associated with anisotropy measurements at tens of degree angular scales only limited information related to reionization, such as the optical depth to electron scattering, can be extracted. The inhomogeneities in the free-electron population lead to an additional secondary polarization anisotropy contribution at arcminute scales. While the fluctuation amplitude, relative to dominant primordial fluctuations, is small, we suggest that a cross-correlation between arcminute scale CMB polarization data and a tracer field of the high redshift universe, such as through fluctuations captured by the 21 cm neutral Hydrogen background or those in the infrared background related to first proto-galaxies, may allow one to study additional details related to reionization. For this purpose, we discuss an optimized higher order correlation measurement, in the form of a three-point function, including information from large angular scale CMB temperature anisotropies in addition to arcminute scale polarization signal related to inhomogeneous reionization. We suggest that the proposed bispectrum can be measured with a substantial signal-to-noise ratio and does not require all-sky maps of CMB polarization or that of the tracer field. A measurement such as the one proposed may allow one to establish the epoch when CMB polarization related to reionization is generated and to address if the universe was reionized once or twice.Comment: 13 pages, 7 figures; Version in press with Phys. Rev.

An audit of uncertainty in multi-scale cardiac electrophysiology models

Models of electrical activation and recovery in cardiac cells and tissue have become valuable research tools, and are beginning to be used in safety-critical applications including guidance for clinical procedures and for drug safety assessment. As a consequence, there is an urgent need for a more detailed and quantitative understanding of the ways that uncertainty and variability influence model predictions. In this paper, we review the sources of uncertainty in these models at different spatial scales, discuss how uncertainties are communicated across scales, and begin to assess their relative importance. We conclude by highlighting important challenges that continue to face the cardiac modelling community, identifying open questions, and making recommendations for future studies. This article is part of the theme issue ‘Uncertainty quantification in cardiac and cardiovascular modelling and simulation’

A prediction algorithm for drug response in patients with mesial temporal lobe epilepsy based on clinical and genetic information

FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOMesial temporal lobe epilepsy is the most common form of adult epilepsy in surgical series. Currently, the only characteristic used to predict poor response to clinical treatment in this syndrome is the presence of hippocampal sclerosis. Single nucleotide121FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOFAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO2013/07559-