Registro ACESUR: atención de pacientes adultos con crisis epilépticas en servicios de urgencias: diferencias entre primer episodio y recurrencia

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

A review of boiling and convective heat transfer with nanofluids

Nanofluids have evoked immense interest from researchers of multi-disciplines from around the globe due to their fascinating thermophysical properties and numerous potential benefits and applications in important fields such as microelectronics, microfluidics, transportation, and biomedical. However, there are many controversies and inconsistencies in reported arguments and experimental results on various thermal characteristics such as effective thermal conductivity, convective heat transfer coefficient and boiling heat transfer rate of nanofluids. As of today, researchers have mostly focused on anomalous thermal conductivity of nanofluids. Although investigations on boiling, droplet spreading, and convective heat transfer are very important in order to exploit nanofluids as the next generation coolants, considerably less efforts have been made on these major features of nanofluids. In this paper, these important cooling features--boiling, spreading, and convective heat transfers of nanofluids are presented together with exhaustive review of research and development made in these areas of nanofluids.Nanofluids Boiling Heat transfer coefficient Critical heat flux Nanoparticles Superheat Reynolds number

Thermophysical Properties of Ionic Liquid Dicyanamide (DCA) Nanosystems.

International audienceIoNanofluids have emerged as a possible alternative to current engineering fluids for heat transfer applications, namely in small volume heat exchangers and micro-channels. Thermal conductivity and density play a crucial role for the chemical plant design of green processes. Existing data are very scarce and inaccurate, mostly affected by impurities and the presence of water in the ionic liquids.In the present paper, we report new data on the thermal conductivity and density of 1-n-butyl-3-methyl-imidazolium dicyanamide ([C4mim][dca]), 1-ethyl-3-methyl-imidazolium dicyanamide ([C2mim][dca]) and 1-butyl-1-methyl-pyrrolidinium dicyanamide ([C4mpyr][dca]) at temperatures between (293 and 343) K at p = 0.1 MPa and IoNanofluids based on them with MWCNTs (multi-walled carbon nanotubes), in order to understand the effect of adding nanomaterials to a ionic liquid matrix and its modification of the heat transfer mechanism. Discussion about the effect of the cation, its side alkyl chain, head group and anion structure in the properties studied concluded that it is essential to understand better the mechanism of heat transfer in these systems, namely the role played by the interface ionic liquid (cation and anion)-nanoparticle, whatever molecular shape they have. Current theories used to calculate the thermal conductivity enhancement are insufficient to predict its value and variation with volume fraction of the nanomaterial