Nummular headache responsive to anti-calcitonin gene-related peptide monoclonal antibodies in a patient with migraine.

BACKGROUND: Nummular headache (NH) is defined by the presence of localized pain circumscribed to a round or elliptical area of the scalp, with a well-defined contour and a diameter of 1-6 cm. Although some evidence supports a peripheral mechanism, its etiopathogenesis remains unclear. CASE: We report the case of a 64-year-old man with high-frequency episodic migraine who has used topiramate, beta-blockers, flunarizine, and amitriptyline without effect. In the last 8 years he also had continuous pain in an oval area of the scalp, consistent with NH. Triptans were ineffective for this new pain, and preventive therapy with gabapentin and onabotulinumtoxinA in the painful area had no effect. NH remitted when the patient received monthly treatment with subcutaneous galcanezumab for his migraine. CONCLUSIONS: Monoclonal antibodies against calcitonin gene-related peptide (CGRP), in particular galcanezumab, might be an effective therapy in some patients with NH. CGRP may have a role in the etiopathogenesis of this headache, which warrants further investigation.

Treatment satisfaction with calcitonin gene-related peptide monoclonal antibodies as a new patient-reported outcome measure: A real-life experience in migraine.

BACKGROUND: To evaluate treatment satisfaction with galcanezumab as a patient-reported outcome measure (PROM) in migraine. METHODS: Patients with ≥8 headache days/month that had failed at ≥3 medications were included. Demographic and medical history were collected. Patient´s satisfaction (effectiveness, safety, convenience, and global satisfaction [GS]) was assessed by the Treatment Satisfaction Questionnaire for Medication version 1.4 (TSQM-1.4©). RESULTS: We included 30 patients with migraine (76.7% chronic migraine). After 12 weeks of galcanezumab treatment, median monthly headache days (MHDs) decreased 11.5 (IQR 14.0) and median monthly migraine days (MMDs) 9.0 (IQR 7.5); at 24 weeks, the change was 15.0 (IQR 12.0) and 8.0 days (IQR 6.0). HIT-6 score decreased from 68.0 (IQR 7.5) to 54.0 (IQR 9.5) at 12 weeks (p < .001) and to 52.0 (IQR12.0) at 24 weeks (p < .001) and MIDAS from 60.0 (IQR 62.7) to 25.5 (IQR 41.2, p = .004) and 7.0 (IQR 18.5, p < .001), respectively. TSQM-1.4© at 12 weeks was higher compared to other preventive therapy in effectiveness (80.6/50.4, p < .001), convenience (83.3/66.7, p = .001), and GS (78.6/50.0, p < .001). These rates of satisfaction were similar at 24 weeks of galcanezumab treatment. Reductions in HIT-6 (r = -.444, p = .014), MIDAS (r = -.423, p = .020), MMDs (r = -.515, p = .004), and MHDs (r = -.477, p = .008) were associated significantly with GS at 12 weeks. This correlation was significantly associated with changes in HIT-6 and MHDs at 24 weeks. CONCLUSIONS: The results of this study suggest that migraine patients receiving galcanezumab are significantly more satisfied compared to other preventive therapies, associating treatment GS with meaningful reductions in frequency, impact, and disability caused by migraine.

Emergency severity level-3 patient flow based on point-of-care testing improves patient outcomes.

BACKGROUND: Overcrowding of the Emergency Department is rapidly becoming a global challenge and a major source of concern for emergency physicians. The desire to improve Emergency Department throughput requires novel approaches to patient flow. MATERIALS AND METHODS: We conducted a prospective and cluster-randomized study, to evaluate the impact in patient outcomes of a new patient flow based on Point-of-Care Testing (POCT). A total of 380 Emergency Severity Level-3 patients were enrolled and studied in two different groups, interventional arm (laboratory analyses performed on POCT analyzers implemented in the Emergency Department) or control arm (central laboratory). The primary outcome was the Emergency Department length of stay. Secondary outcome included the time to first medical intervention, the laboratory turnaround time and the time to disposition decision. Readmission within the 7 days after discharge was also calculated. RESULTS: Length of stay significantly decreased by 88.50 min (from 247.00 to 158.50), time to disposition decision by 89.00 min (from 192.00 to 103.00) and laboratory turnaround time by 67.11 min (from 89.84 to 22.73) in the POCT group. No increase in readmission was found. CONCLUSION: Our strategy based on POCT represents a good approach to optimize patient flow in the Emergency Department and it should be seen as a starting point for further studies focusing on improving throughput.

Interaction of Caffeic Acid with SDS Micellar Aggregates.

Micellar systems consisting of a surfactant and an additive such as an organic salt or an acid usually self-organize as a series of worm-like micelles that ultimately form a micellar network. The nature of the additive influences micellar structure and properties such as aggregate lifetime. For ionic surfactants such as sodium dodecyl sulfate (SDS), CMC decreases with increasing temperature to a minimum in the low-temperature region beyond which it exhibits the opposite trend. The presence of additives in a surfactant micellar system also modifies monomer interactions in aggregates, thereby altering CMC and conductance. Because the standard deviation of ß was always lower than 10%, its slight decrease with increasing temperature was not significant. However, the absolute value of Gibbs free enthalpy, a thermodynamic potential that can be used to calculate the maximum of reversible work, increased with increasing temperature and caffeic acid concentration. Micellization in the presence of caffeic acid was an endothermic process, which was entropically controlled. The enthalpy and enthropy positive values resulted from melting of "icebergs" or "flickering clusters" around the surfactant, leading to increased packing of hydrocarbon chains within the micellar core in a non-random manner. This can be possibly explained by caffeic acid governing the 3D matrix structure of water around the micellar aggregates. The fact that both enthalpy and entropy were positive testifies to the importance of hydrophobic interactions as a major driving force for micellization. Micellar systems allow the service life of some products to be extended without the need to increase the amounts of post-harvest storage preservatives used. If a surfactant is not an allowed ingredient or food additive, carefully washing it off before the product is consumed can avoid any associated risks. In this work, we examined the influence of temperature and SDS concentration on the properties of SDS⁻caffeic acid micellar systems. Micellar properties can be modified with various additives to develop new uses for micelles. This allows smaller amounts of additives to be used without detracting from their benefits.

Determination of kinetic bioconcentration in mussels after short term exposure to polycyclic aromatic hydrocarbons.

The kinetic bioconcentration of N-heterocyclic aromatic hydrocarbons and polycyclic aromatic hydrocarbons in mussels (Mytilus galloprovincialis) after short waterborne exposure was studied. Benzo[a]pyrene (BaP), its analogue azaarene 10-azabenzo[a]pyrene (AzaBaP), and their mixture (Mix), were selected to monitor the changes in water concentrations over three days. Decay of both PAHs concentrations in water after 24 h of waterborne exposure to mussels at levels of 10 and 100 µg/L follows a first order kinetic with half-lives of 4-5 h, with residual levels of PAHs below 7%. While steady-state scenarios are well studied, there is a lack of information of what happens under non-steady-state conditions, the main purpose of our paper. A synergistic bioconcentration of the mixture was found (around 800 in the mix vs. around 400 for individual PAHs at 100 µg/L of waterborne exposure). It could be explained by the following reasons. The most polar AzaBaP does not compete with the most non-polar BaP for the same tissue compartments. Whereas BaP aggregate in hydrophobic areas, AzaBaP can also do in hydrophilic areas. Moreover, a chance for complex formation between them by charge-transfer stabilization mechanisms could make possible a higher bioaccumulation as a mixture. Instead, toxicological results suggest an additive behaviour in the mixture performance, dominated by BaP, which is the key PAH controlling phase I metabolization in mussels, since is approx. three times more toxic. These experiments provide useful indications for a rapid assessment of PAHs kinetic bioconcentration in mussels.

Redispersion and Self-Assembly of C60 Fullerene in Water and Toluene.

This work aims at assessing the influence of two different solvents, bidistilled water and toluene, on dispersions of carbon-based engineered nanomaterials, namely, fullerenes, and their self-assembly behavior. The obtained self-assembled carbon-based materials were characterized using UV-vis spectrophotometry and transmission electron microscopy techniques. The results obtained were unexpected when toluene was used for dispersing fullerene C60, with the formation of two different types of self-assembled structures: fullerene C60 nanowhiskers (FNWs) and a type of quasispherical nanostructure. The FNWs ranged between 1 and 6 µm in length, whereas the quasispherical fullerene C60 nanoaggregates ranged between 10 and 50 nm in diameter. Aggregates obtained in toluene showed a well-formed crystal structure. When using water, the obtained aggregates were amorphous and showed a no well-defined shape. Their sizes ranged between 20 and 40 nm for nanosized structures and between 0.4 and 4.8 µm for micron-sized self-aggregates.

Oxidative stress and histological changes following exposure to diamond nanoparticles in the freshwater Asian clam Corbicula fluminea (Müller, 1774).

Recently, the scientific community became aware of the potential ability of nanoparticles to cause toxicity in living organisms. Therefore, many of the implications for aquatic ecosystems and its effects on living organisms are still to be evaluated and fully understood. In this study, the toxicity of nanodiamonds (NDs) was assessed in the freshwater bivalve (Corbicula fluminea) following exposure to different nominal concentrations of NDs (0.01, 0.1, 1, and 10 mg l(-1)) throughout 14 days. The NDs were characterized (gravimetry, pH, zeta potential, electron microscopy, and atomic force microscopy) confirming manufacturer information and showing NDs with a size of 4-6 nm. Oxidative stress enzymes activities (glutathione-S-transferase, catalase) and lipid peroxidation were determined. The results show a trend to increase in GST activities after seven days of exposure in bivalves exposed to NDs concentrations (>0.1 mg l(-1)), while for catalase a significant increase was found in bivalves exposed from 0.01 to 1.0 mg l(-1) following an exposure of 14 days. The histological analysis revealed alterations in digestive gland cells, such as vacuolization and thickening. The lipid peroxidation showed a trend to increase for the different tested NDs concentrations which is compatible with the observed cellular damage.

The role of a multimodality imaging approach in diagnosis and stratification of aborted sudden cardiac death.

A 34-year-old man was admitted after an episode of aborted sudden cardiac death. The initial investigation including electrocardiogram, chest x-ray, transthoracic echocardiogram, and biomarkers were normal. Although coronary angiography showed nonsevere stenosis, optical coherence tomography revealed severe obstruction in the artery with a layered appearance of the vessel wall; it was consistent with the presence of mural thrombus.

Myopericarditis with predominantly right ventricular involvement with normal B-type natriuretic peptide and cardiac tamponade as the initial manifestation of systemic lupus erythematosus.

A previously healthy young man presented with a 12-hour history of sudden dyspnea and severe chest pain at rest. Initial findings of physical examination, electrocardiogram and chest radiography showed typical pericarditis and clinical instability. Echocardiogram revealed small pericardial effusion with right ventricle dilatation. The patient was admitted in the ICU; a new echocardiogram revealed moderate pericardial effusion and diagnosis of pericarditis complicated with acute cardiac tamponade was established. The patient transiently improved after pericardial window. In the following hours, the diagnosis of myocarditis with predominantly right ventricular involvement (MPRVI) with severe right heart failure was supported by clinical, chest radiography and echocardiogram data, despite normal B-type natriuretic peptide. On day 2, cardiac troponin I detection was observed. By day 3, B-type natriuretic peptide in the range of ventricular dysfunction was identified. Cardiovascular magnetic resonance findings supported the diagnosis of MPRVI. A systematic MEDLINE/PubMed from 1993 to 2013 does not identify any cases of MPRVI related to systemic lupus erythematosus. Simultaneous acute MPRVI with normal B-type natriuretic peptide and acute cardiac tamponade heralding the diagnosis of systemic lupus erythematosus, to the best of our knowledge, has not been previously described.

Stability study of Iprodione in alkaline media in the presence of humic acids.

The influence of humic aggregates in water solution upon the chemical stability of Iprodione has been investigated under basic conditions. Taking into account that an important part of soils are colloids, the possibility of its presence implies that soil composition and its structure will play an important role in the stability of this pesticide. A kinetic model was applied to this system and the kinetic coefficients were obtained. An inhibition upon the alkaline hydrolysis of Iprodione (2-fold) was observed and it was rationalized in terms of the micellar pseudophase model. These results have been compared with the corresponding ones in the same natural colloidal aggregates in the presence of other pesticides.

Degradation of carbofuran and carbofuran-derivatives in presence of humic substances under basic conditions.

The influence of humic aggregates in water solution upon the chemical stability of carbofuran (CF) and the carbofuran-derivatives, 3-hydroxy-carbofuran (HCF) and 3-keto-carbofuran (KCF), has been investigated in basic media. An inhibition upon the basic hydrolysis of 3-hydroxy-carbofuran and 3-keto-carbofuran (≈ 1.7 and ≈ 1.5-fold, respectively) was observed and it was rationalized in terms of the micellar pseudophase model. Nevertheless, non-significant effect upon the carbofuran stability was found in the presence of humic substances. These behaviors have been compared with the corresponding ones in other synthetic colloidal aggregates.

Degradation of carbofuran derivatives in restricted water environments: basic hydrolysis in AOT-based microemulsions.

The effect of sodium bis(2-ethylhexyl)sulfosuccinate/isooctane/water microemulsions on the stability of 2,2-dimethyl-2,3-dihydro-1-benzofuran-7-yl methylcarbamate (carbofuran, CF), 3-hydroxy-2,3-dihydro-2,2-dimethylbenzofuran-7-yl methylcarbamate (3-hydroxycarbofuran, HCF) and 3-keto-2,3-dihydro-2,2-dimethylbenzofuran-7-yl methylcarbamate (3-ketocarbofuran, KCF) in basic media has been studied. The presence of these microheterogeneous media implies a large basic hydrolysis of CF and HCF on increasing surfactant concentration and, also, on increasing water content in the microemulsion. The hydrolysis rate constants are approximately 2- and 10-fold higher than those in pure water for HCF and CF, respectively. In contrast, a steep descent in the rate of decomposition for KCF was observed. These behaviours can be ascribed to the presence of CF derivatives both in the hydrophilic phase and in the lipophilic phase, while the hydroxyl ions are only restricted to the water pool of the microemulsion (hydrophilic phase). The kinetic rate constants for the basic hydrolysis in AOT-based microemulsions have been obtained on the basis of a pseudophase model. Taking into account that an important part of soils are colloids, the possibility of the presence of restricted water environments implies that soil composition and its structure will play an important role in the stability of these carbamates. In fact, we observed that the presence of these restricted aqueous media in the environment, in particular in watersheds and in wastewaters, could reduce significantly the half-life of these pesticides (33% and 91% for HCF and CF, respectively).

Levetiracetam plasma level monitoring during pregnancy, delivery, and postpartum: clinical and outcome implications.

Variations in the plasma concentration of levetiracetam during pregnancy and postpartum were prospectively monitored in five women to investigate their potential implications in epilepsy management and child outcome. Under unchanged levetiracetam dosages, the mean concentrations of levetiracetam during the third trimester were 62% of the baseline late (12 month) postpartum levels, but only 47% of the baseline early postpartum (2 month) levetiracetam levels. In dual therapy with lamotrigine, baseline late postpartum levetiracetam clearance was 63.2%, whereas in early postpartum it was 45% of the maximal second-trimester clearance. However, the number of seizures remained unchanged once lamotrigine dose was increased. No woman had adverse effects during the puerperium. The mean umbilical cord/maternal plasma concentration ratio was 1.21. None of the newborns had malformations, with the anthropometric data being normal for their gestational age. The decline in gestational levetiracetam plasma concentration does not seem to be hazardous, but differs according to whether early or late postpartum levels are chosen as baseline levels.

Valoración del riesgo psicosocial en las enfermeras de nefrología de los hospitales de Sevilla / Evaluation of the psychosocial risk in nephrology nurses in hospitals in seville

El objetivo general de este trabajo fue realizar una evaluación psicosocial del personal de enfermería de las unidades de nefrología de los hospitales “Virgen del Rocío” y “Virgen Macarena” de Sevilla, siendo los objetivos específicos del estudio describir la situación de este grupo en cuanto a clima laboral, tipo de conflictos del grupo, gestión de los conflictos, relación con el mando inmediato y bases de poder, acoso laboral y comparación entre las unidades de ambas instituciones. El estudio se realizó evaluando 66 encuestas contestadas por el personal de enfermería de los servicios de nefrología, de ambos hospitales. Las conclusiones obtenidas fueron las siguientes: 1. El clima laboral es una mezcla entre clima de apoyo y reglas.2. El tipo de conflicto que predomina en la organización es de tareas sobre el afectivo.3. El estilo de gestión para solucionar los conflictos es el deintegración.4. Las bases de poder están divididas entre formales e informales y el mando no es autoritario.5. El acoso laboral es casi inexistente, siendo éste sobre la función laboral del trabajador, lo que provoca muy baja incidencia somática en el individuo.6. Las diferencias halladas entre las dos unidades no son significativas

The general aim of this work was to conduct a psychosocial assessment of nursing staff in the nephrology units of the hospitals Virgen del Rocío and Virgen Macarena in Seville, the specific aims of the study being to describe the situation of this group as regards the working environment, type of group conflicts, conflict management, relations with immediate superiors and power bases, harassment and comparison between the units in the two hospitals. The study was carried out by assessing 66 surveys to which nephrology service nursing staff in both hospitals had responded. The conclusions obtained were as follows: 1. The working environment is a mixture of support and rules.2. The predominating type of conflict in the organization relates to tasks rather than emotional. 3. The management style to resolve conflicts is integration.4. The power bases are divided between formal and informal and command is not authoritarian.5. Harassment is almost non-existent, and is directed at the employee’s work, which causes a very low somatic incidence on the individual.6. The differences found between the two units are not significant

Estrógenos y enfermedad de Alzheimer: bases, promesas y realidades / Estrogens and Alzheimer disease: fundamentals, promises and truths

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