Stroke mimic diagnoses presenting to a hyperacute stroke unit.

Stroke services have been centralised in several countries in recent years. Diagnosing acute stroke is challenging and a high proportion of patients admitted to stroke units are diagnosed as a non-stroke condition (stroke mimics). This study aims to describe the stroke mimic patient group, including their impact on stroke services. We analysed routine clinical data from 2,305 consecutive admissions to a stroke unit at St George's Hospital, London. Mimic groupings were derived from 335 individual codes into 17 groupings. From 2,305 admissions, 555 stroke mimic diagnoses were identified (24.2%) and 72% of stroke mimics had at least one stroke risk factor. Common mimic diagnoses were headache, seizure and syncope. Medically unexplained symptoms and decompensation of underlying conditions were also common. Median length of stay was 1 day; a diagnosis of dementia (p=0.028) or needing MRI (p=0.006) was associated with a longer stay. Despite emergency department assessment by specialist clinicians and computed tomography brain, one in four suspected stroke patients admitted to hospital had a non-stroke diagnosis. Stroke mimics represent a heterogeneous patient group with significant impacts on stroke services. Co-location of stroke and acute neurology services may offer advantages where service reorganisation is being considered

Small Vessel Disease in the Heart and Brain: Current Knowledge, Unmet Therapeutic Need and Future Directions

No abstract available

The association of neutrophil-lymphocyte ratio and lymphocyte-monocyte ratio with 3-month clinical outcome after mechanical thrombectomy following stroke

Background and aim Neutrophil-lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR) are associated with clinical outcomes in malignancy, cardiovascular disease and stroke. Here we investigate their association with outcome after acute ischaemic stroke treated by mechanical thrombectomy (MT). Methods Patients were selected using audit data for MT for acute anterior circulation ischaemic stroke at a UK centre from May 2016–July 2017. Clinical and laboratory data including neutrophil, lymphocyte and monocyte count tested before and 24 h after MT were collected. Poor functional outcome was defined as modified Rankin Scale (mRS) of 3–6 at 3 months. Multivariable logistic regression analyses were performed to explore the relationship of NLR and LMR with functional outcome. Results One hundred twenty-one patients (mean age 66.4 ± 16.7, 52% female) were included. Higher NLR (adjusted OR 0.022, 95% CI, 0.009–0.34, p = 0.001) and lower LMR (adjusted OR − 0.093, 95% CI (− 0.175)−(− 0.012), p = 0.025) at 24-h post-MT were significantly associated with poorer functional outcome when controlling for age, baseline NIHSS score, infarct size, presence of good collateral supply, recanalisation and symptomatic intracranial haemorrhage on multivariate logistic regression. Admission NLR or LMR were not significant predictors of mRS at 3 months. The optimal cut-off values of NLR and LMR at 24-h post-MT that best discriminated poor outcome were 5.5 (80% sensitivity and 60% specificity) and 2.0 (80% sensitivity and 50% specificity), respectively on receiver operating characteristic curve analysis. Conclusion NLR and LMR tested at 24 h after ictus or intervention may predict 3-month functional outcome

Ophthalmic adverse drug reactions to systemic drugs: a systematic review

PURPOSE: To perform a comprehensive and systematic review regarding ophthalmic adverse drug reactions (ADRs) to systemic drugs to: (i) systematically summarize existing evidence, (ii) identify areas, ophthalmic ADRs or drugs that lacked systematization or assessment (namely drugs with original studies characterizing specific ophthalmic ADRs but without causality assessment nor without meta-analysis). METHODS: Systematic review of several electronic databases (last search 1/7/2012): Medline, SCOPUS, ISI web of knowledge, ISI Conference Proceedings, International Pharmaceutical Abstracts and Google scholar. Search query included: eye, ocular, ophthalmic, ophthalmology, adverse and reaction. Inclusion criteria were: (i) Primary purpose was to assess an ophthalmic ADR to a systemic medication; (ii) Patient evaluation performed by an ophthalmologist; (iii) Studies that specified diagnostic criteria for an ocular ADR. Different types of studies were included and analyzed separately. Two independent reviewers assessed eligibility criteria, extracted data and evaluated risk of bias. RESULTS: From 562 studies found, 32 were included (1 systematic review to sildenafil, 11 narrative reviews, 1 trial, 1 prospective study, 6 transversal studies, 6 spontaneous reports and 6 case series). Drugs frequently involved included amiodarone, sildenafil, hydroxychloroquine and biphosphonates. Frequent ophthalmic ADRs included: keratopathy, dry eye and retinopathy. CONCLUSIONS: To increase evidence about ophthalmic ADRs, there is a need for performing specific systematic reviews, applying strictly the World Health Organization's (WHO) definition of ADR and WHO causality assessment of ADRs. Some ophthalmic ADRs may be frequent, but require ophthalmological examination; therefore, ophthalmologists' education and protocols of collaboration between other specialties whenever they prescribe high-risk drugs are suggestions for the future

Psychogenic Nonepileptic Seizures in Adolescence: Case Report

Psychogenic non-epileptic seizures are a functional neurological disorder characterized by transient alterations in sensory-motor control and a lack of response to external stimulus, resembling epileptic seizures, but with distinctive semiologic features supported by no ictal activity on electroencephalogram. Since psychogenic non-epileptic seizures can mimic epileptic seizures, children and adolescents with this presentation are usually seen by neurologists. Early diagnosis and intervention with a multidisciplinary approach, including neurology and pedopsychiatry, are critical for limiting unnecessary medical investigations and needless antiepileptic drugs, ascertaining psychiatric comorbidities, and improving treatment adherence and prognosis. We report the case of a 12-year-old female with several admissions to a neuropediatric inpatient unit with a diagnosis of psychogenic non-epileptic seizures to discuss neurologic and psychiatric assessments, delivery of diagnoses, and planning of outpatient management of this disorder in adolescents.info:eu-repo/semantics/publishedVersio

New Functionalized Macroparticles for Environmentally Sustainable Biofilm Control in Water Systems

Reverse osmosis (RO) depends on biocidal agents to control the operating costs associated to biofouling, although this implies the discharge of undesired chemicals into the aquatic environment. Therefore, a system providing pre-treated water free of biocides arises as an interesting solution to minimize the discharge of chemicals while enhancing RO filtration performance by inactivating bacteria that could form biofilms on the membrane system. This work proposes a pretreatment approach based on the immobilization of an industrially used antimicrobial agent (benzalkonium chloride-BAC) into millimetric aluminum oxide particles with prior surface activation with DA-dopamine. The antimicrobial efficacy of the functionalized particles was assessed against Escherichia coli planktonic cells through culturability and cell membrane integrity analysis. The results showed total inactivation of bacterial cells within five min for the highest particle concentration and 100% of cell membrane damage after 15 min for all concentrations. When reusing the same particles, a higher contact time was needed to reach the total inactivation, possibly due to partial blocking of immobilized biocide by dead bacteria adhering to the particles and to the residual leaching of biocide. The overall results support the use of Al2O3-DA-BAC particles as antimicrobial agents for sustainable biocidal applications in continuous water treatment systems

InfectionCMA: A Cell MicroArray Approach for Efficient Biomarker Screening in In Vitro Infection Assays

The recently emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has forced the scientific community to acquire knowledge in real-time, when total lockdowns and the interruption of flights severely limited access to reagents as the global pandemic became established. This unique reality made researchers aware of the importance of designing efficient in vitro set-ups to evaluate infectious kinetics. Here, we propose a histology-based method to evaluate infection kinetics grounded in cell microarray (CMA) construction, immunocytochemistry and in situ hybridization techniques. We demonstrate that the chip-like organization of the InfectionCMA has several advantages, allowing side-by-side comparisons between diverse cell lines, infection time points, and biomarker expression and cytolocalization evaluation in the same slide. In addition, this methodology has the potential to be easily adapted for drug screening. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Funding text 1: Funding: The Portuguese Foundation for Science and Technology (FCT) funded this project through the Research4COVID19 projects 109_596696487 and RESEARCH COVID-19 projects Ref. 510. FCT also financed the Ph.D. grant to R.J.P. (SFRH/BD/145217/2019) and M.N. (2020.04720.BD). i3S is supported by FEDER–Fundo Europeu de Desenvolvimento Regional funds through the COMPETE 2020–Operational Program for Competitiveness and Internationalization (POCI), Portugal 2020, and by Portuguese funds through FCT/Ministério da Ciência, Tecnologia e Inovação in the framework of the project ‘Institute for Research and Innovation in Health Sciences’ (POCI-01-0145-FEDER-007274).; Funding text 2: The Portuguese Foundation for Science and Technology (FCT) funded this project through the Research4COVID19 projects 109_596696487 and RESEARCH COVID-19 projects Ref. 510. FCT also financed the Ph.D. grant to R.J.P. (SFRH/BD/145217/2019) and M.N. (2020.04720.BD). i3S is supported by FEDER?Fundo Europeu de Desenvolvimento Regional funds through the COMPETE 2020?Operational Program for Competitiveness and Internationalization (POCI), Portugal 2020, and by Portuguese funds through FCT/Minist?rio da Ci?ncia, Tecnologia e Inova??o in the framework of the project ?Institute for Research and Innovation in Health Sciences? (POCI-01-0145-FEDER-007274)

Combined use of O3/H2O2 and O3/Mn2+ in flotation of dairy wastewater

This work investigated the degradation of organic matter present in synthetic dairy wastewater by the combination of ozonation (ozone (O 3 )/hydrogen peroxide (H 2 O 2 )) and catalytic ozonation (ozone (O 3 )/manganese (Mn 2+ )) associated with dispersed air flotation process. The effect of independent factors such as O 3 concentration, pH and H 2 O 2 and Mn 2+ concentration was evaluated. For the flotation/O 3 /H 2 O 2 treatment, the significant variables (p ≤ 0.05) were: O 3 concentration (linear and quadratic effect), H 2 O 2 concentration linear and quadratic effect, pH values (linear and quadratic effect) and interaction O3 concentration versus pH. For catalytic ozonation, it was observed that the significant variable was the linear effect of O 3 concentration. According to the desirability function, it was concluded that the optimal condition for the treatment of flotation/O 3 /H 2 O 2 can be obtained in acidic solution using O3 concentrations greater than 42.9 mg L -1 combined with higher concentrations of H 2 O 2 to 1071.5 mg L -1 . On other hand, at pH values higher than 9.0, the addition of O3 may be neglected when using higher concentrations than 1071.5 mg L -1 of H 2 O 2 . For flotation/ozonation catalyzed by Mn 2+ , it was observed that metal addition did not affect treatment, resulting in an optimum condition: 53.8 mg L -1 of O 3 and pH 3.6

Bearing My Heart: The Role of Extracellular Matrix on Cardiac Development, Homeostasis, and Injury Response

The extracellular matrix (ECM) is an essential component of the heart that imparts fundamental cellular processes during organ development and homeostasis. Most cardiovascular diseases involve severe remodeling of the ECM, culminating in the formation of fibrotic tissue that is deleterious to organ function. Treatment schemes effective at managing fibrosis and promoting physiological ECM repair are not yet in reach. Of note, the composition of the cardiac ECM changes significantly in a short period after birth, concurrent with the loss of the regenerative capacity of the heart. This highlights the importance of understanding ECM composition and function headed for the development of more efficient therapies. In this review, we explore the impact of ECM alterations, throughout heart ontogeny and disease, on cardiac cells and debate available approaches to deeper insights on cell–ECM interactions, toward the design of new regenerative therapies.This work was funded by the European Regional Development Fund (ERDF) through COMPETE 2020, Portugal 2020, and by the FCT (Fundação para a Ciência e Tecnologia) (POCI-01-0145-FEDER-030985) and by the FCT/Ministério da Ciência, Tecnologia e Inovação in the framework of individual funding (CEECINST/00091/2018) to DN