Very-high-frequency oscillations in the main peak of a magnetar giant flare.

Magnetars are strongly magnetized, isolated neutron stars1-3 with magnetic fields up to around 1015 gauss, luminosities of approximately 1031-1036 ergs per second and rotation periods of about 0.3-12.0 s. Very energetic giant flares from galactic magnetars (peak luminosities of 1044-1047 ergs per second, lasting approximately 0.1 s) have been detected in hard X-rays and soft γ-rays4, and only one has been detected from outside our galaxy5. During such giant flares, quasi-periodic oscillations (QPOs) with low (less than 150 hertz) and high (greater than 500 hertz) frequencies have been observed6-9, but their statistical significance has been questioned10. High-frequency QPOs have been seen only during the tail phase of the flare9. Here we report the observation of two broad QPOs at approximately 2,132 hertz and 4,250 hertz in the main peak of a giant γ-ray flare11 in the direction of the NGC 253 galaxy12-17, disappearing after 3.5 milliseconds. The flare was detected on 15 April 2020 by the Atmosphere-Space Interactions Monitor instrument18,19 aboard the International Space Station, which was the only instrument that recorded the main burst phase (0.8-3.2 milliseconds) in the full energy range (50 × 103 to 40 × 106 electronvolts) without suffering from saturation effects such as deadtime and pile-up. Along with sudden spectral variations, these extremely high-frequency oscillations in the burst peak are a crucial component that will aid our understanding of magnetar giant flares.

Meta-análisis sobre la eficacia de la estrategia de monoterapia con inhibidores de la proteasa potenciados en pacientes VIH+ / Meta-analysis of the effectiveness of the strategy of monotherapy with boosted protease inhibitors in HIV+ patients

Introducción El objetivo del presente trabajo es analizar la evidencia disponible sobre la eficacia de la estrategia de inducción mantenimiento con inhibidores de proteasa potenciados con ritonavir en pacientes adultos VIH respecto al tratamiento convencional. Métodos Se realizó un meta-análisis de ensayos aleatorizados y controlados en pacientes VIH para comparar la eficacia de una estrategia de monoterapia con inhibidores de proteasa potenciados frente al tratamiento antirretroviral convencional. La búsqueda bibliográfica se realizó en PubMed, EMBASE (septiembre 1999–septiembre 2009) y en resúmenes de congresos de los últimos 5 años. Se calcularon los Odds Ratio del fracaso terapéutico y sus intervalos de confianza del 95%. Para combinar los resultados de los estudios individuales seleccionados, se empleó un modelo de efectos fijos basado en el método de Mantel-Haenszel o de efectos aleatorios, en función de que exista o no heterogeneidad en los resultados. Resultados Se localizaron inicialmente un total de 1.510 publicaciones, de las que solo 8 estudios cumplieron los criterios de inclusión en el meta-análisis. El Odds Ratio combinado de los 8 estudios es de 1,39 (IC 95% 1,02–1,90) a favor del grupo de tratamiento con tratamiento antirretroviral convencional, pero con un intervalo de confianza cercano a los límites de la no significación estadística. Conclusión Los resultados del análisis de eficacia combinado en el meta-análisis no encuentran diferencias significativas entre la estrategia convencional y la monoterapia. Esta estrategia se considera recomendable (nivel A de evidencia) en pacientes sin historia de fracaso previo a inhibidores de la proteasa, con carga viral plasmática indetectable y signos o síntomas de toxicidad por análogos de nucleósidos/nucleótidos (AU)

Introduction The objective of this study is to analyse the available evidence regarding the effectiveness of the strategy of induction maintenance with boosted protease inhibitors with ritonavir in adult HIV patients as compared to conventional treatment. Methods We performed a meta-analysis of randomised controlled trials in HIV patients to compare the efficacy of a monotherapy strategy of boosted protease inhibitors as compared with conventional antiretroviral therapy. The literature search was conducted in PubMed, EMBASE (September 1999–September 2009) and in conference abstracts of the last 5 years. The Odds Ratio of treatment failure and their 95% confidence intervals were calculated. To combine the results of individual studies selected, a fixed effects model based on the Mantel-Haenszel method or random effects was used, depending on whether or not the results were heterogeneous. Results Initially a total of 1510 publications were found, of which just 8 studies met the criteria for inclusion in the meta-analysis. The combined Odds Ratio of the 8 studies is 1.39 (95% CI 1.02–1.90) for the treatment group with conventional antiretroviral treatment, but with a confidence interval close to the limits of statistical non-significance. Conclusion The results of the combined effectiveness analysis in the meta-analysis found no significant differences between the conventional strategy and monotherapy. This strategy is considered recommended (level A evidence) in patients with no history of previous failure of protease inhibitor, with undetectable plasma viral load and signs or symptoms of nucleoside/nucleotide toxicity (AU)

[Meta-analysis of the effectiveness of the strategy of monotherapy with boosted protease inhibitors in HIV+ patients]. / Meta-análisis sobre la eficacia de la estrategia de monoterapia con inhibidores de la proteasa potenciados en pacientes VIH+

INTRODUCTION: The objective of this study is to analyse the available evidence regarding the effectiveness of the strategy of induction maintenance with boosted protease inhibitors with ritonavir in adult HIV patients as compared to conventional treatment. METHODS: We performed a meta-analysis of randomised controlled trials in HIV patients to compare the efficacy of a monotherapy strategy of boosted protease inhibitors as compared with conventional antiretroviral therapy. The literature search was conducted in PubMed, EMBASE (September 1999-September 2009) and in conference abstracts of the last 5 years. The Odds Ratio of treatment failure and their 95% confidence intervals were calculated. To combine the results of individual studies selected, a fixed effects model based on the Mantel-Haenszel method or random effects was used, depending on whether or not the results were heterogeneous. RESULTS: Initially a total of 1510 publications were found, of which just 8 studies met the criteria for inclusion in the meta-analysis. The combined Odds Ratio of the 8 studies is 1.39 (95% CI 1.02-1.90) for the treatment group with conventional antiretroviral treatment, but with a confidence interval close to the limits of statistical non-significance. CONCLUSION: The results of the combined effectiveness analysis in the meta-analysis found no significant differences between the conventional strategy and monotherapy. This strategy is considered recommended (level A evidence) in patients with no history of previous failure of protease inhibitor, with undetectable plasma viral load and signs or symptoms of nucleoside/nucleotide toxicity.

[Vitamins stability in parenteral nutrition]. / Estabilidad de vitaminas en nutrición parenteral.

OBJECTIVE: Some decades ago, several studies were published describing vitamins degradation in parenteral nutrition (PN) and their catalysis by oligoelements such as copper. Thus, the practice of administering oligoelements and vitamins every other day and adding them the same day of PN was implemented. Today, in many Spanish hospitals these recommendations are still being followed although currently different products, type of containers, and ways of administration are used. The purpose of this review is to determine whether combined administration of vitamins and oligoelements with PN is recommended and how many days they remain stable while refrigerated under the current conditions of preparation and administration of PN. SETTING: We have reviewed the articles on vitamins stability in PN published after 1990. RESULTS: The results are controversial with vitamin A, although "all-in-one" administration and photo-protection remarkably decrease its degradation and there seems to be no difference between adding the vitamin before its administration and doing so previously. Vitamin E is stable with photo-protection for 3-7 days under refrigeration plus one additional day at room temperature if multilayered bags are used. Thiamine is stable if bisulfites-free amino acids solutions are used. CONCLUSIONS: We conclude that vitamins and oligoelements may be administered together and PN be prepared before use if "all-in-one" photo-protected multilayered bags and bisulfite-free amino acids solutions are used.

Estabilidad de vitaminas en nutrición parenteral / Vitamins stability in parenteral nutrition

Objetivo: Hace algunas décadas se publicaron varios estudios describiendo la degradación de vitaminas en nutrición parenteral (NP) y su catalización por oligoelementos tales como el cobre. Por ello se instauró la práctica de administrar oligoelementos y vitaminas a días alternos y aditivarlos el mismo día de la administración. Todavía muchos hospitales españoles siguen estas recomendaciones aunque actualmente se utilizan productos, tipo de material del envase y formas de administración distintas de las de entonces. El objetivo de esta revisión es determinar si en las condiciones actuales de preparación y administración de NP sería recomendable la administración conjunta de vitaminas y oligoelementos y cuantos días serían estables en refrigeración antes de su administración. Ámbito: Se han revisado los artículos sobre estabilidad de vitaminas en NP publicados posteriormente a 1990. Resultados: Con la vitamina A hay resultados contradictorios pero la administración "todo en uno" y la fotoprotección disminuyen considerablemente su degradación y parece que no existen diferencias entre añadir la vitamina antes de su administración o hacerlo con anterioridad. La vitamina E se muestra estable con fotoprotección durante 3-7 días en refrigeración más un día a temperatura ambiente. La vitamina C es estable junto a oligoelementos en bolsas multicapa por 2-7 días en refrigeración más un día a temperatura ambiente. La tiamina es estable si se utilizan soluciones de aminoácidos que no contengan bisulfitos. Conclusiones: Se concluye que se pueden administrar conjuntamente vitaminas y oligoelementos y preparar la NP con anterioridad a su administración cuando se utiliza NP "todo en uno", bolsas multicapa, soluciones de aminoácidos sin bisulfitos y fotoprotección (AU)

Objective: Some decades ago, several studies were published describing vitamins degradation in parenteral nutrition (PN) and their catalysis by oligoelements such as copper. Thus, the practice of administering oligoelements and vitamins every other day and adding them the same day of PN was implemented. Today, in many Spanish hospitals these recommendations are still being followed although currently different products, type of containers, and ways of administration are used. The purpose of this review is to determine whether combined administration of vitamins and oligoelements with PN is recommended and how many days they remain stable while refrigerated under the current conditions of preparation and administration of PN. Setting: We have reviewed the articles on vitamins stability in PN published after 1990. Results: The results are controversial with vitamin A, although "all-in-one" administration and photo-protection remarkably decrease its degradation and there seems to be no difference between adding the vitamin before its administration and doing so previously. Vitamin E is stable with photo-protection for 3-7 days under refrigeration plus one additional day at room temperature if multilayered bags are used. Thiamine is stable if bisulfites-free amino acids solutions are used. Conclusions: We conclude that vitamins and oligoelements may be administered together and PN be prepared before use if "all-in-one" photo-protected multilayered bags and bisulfite-free amino acids solutions are used (AU)

Estudio de los trastornos de personalidad y de la utilización de servicios en la población clínica atendida en la red de salud mental de un sector sanitario / Study of personality disorders and the use of services in the clinical population attended in the mental health network of a community area

Introducción. Los trastornos de personalidad (TP) constituyen un problema clínico y asistencial creciente. En España los estudios de los TP y de la utilización de servicios de salud mental (SM) en población clínica son escasos. Sin embargo, estos datos son necesarios para planificar la asistencia de los TP. Método. Se han estudiado todos los pacientes atendidos durante 1 año en el conjunto de los servicios psiquiátricos (n=2.701) y por separado en los servicios hospitalarios (n=193) y ambulatorios (n=2.649). Se han incluido todos los pacientes diagnosticados de TP mediante entrevista clínica (criterios DSM-IV-TR). Se han investigado variables demográficas, clínicas y uso de servicios de SM. Resultados. La proporción de TP en el conjunto de la población atendida fue del 11% (intervalo de confianza [IC] del 95%: 9,8-12,2) y en los servicios hospitalarios y ambulatorios del 17,6% (IC 95%: 12,9-23,6) y 10,3% (IC 95%: 9,2-11,5), respectivamente. Los TP más representados fueron el límite (25,7%), el histriónico (24%) y el obsesivo-compulsivo (6,4%), y el 19,6% fueron TP no especificado. Los TP hicieron una utilización importante de los recursos de salud mental (hospitalarios, ambulatorios y urgencias). Los trastornos del estado de ánimo, de ansiedad y por consumo de sustancias fueron los más comórbidos en el eje I. Conclusiones. El estudio de los TP atendidos en los servicios de SM de un distrito sanitario mediante evaluación clínica es un instrumento económico, sencillo y reproducible para planificar la asistencia de los TP (AU)

Introduction. Personality disorders (PD) are a growing clinical and health care problem. In Spain, the studies of PD and utilization of the Mental Health Services(MHS) in the clinical population are scant. However, these data are necessary in the planning of MHS for PD. Method. We studied all the patients attended throughout one year in all the psychiatric departments (n=2701), and separately in the inpatient (n=193) and outpatient (n=2649) psychiatric services. All the patients diagnosed with PD by clinical interview (DSM-IV-TR criteria) were included. Demographic and clinical variables as well as use of MHS were studied. Results. The proportion of PD in the population attended was 11% (95% CI: 9.8%-12.2%) and in the inpatient and outpatient psychiatric services 17.6% (95% CI: 12.9%-23.6%) and 10.3% (95% CI: 9.2%-11.5%), respectively. The most representative PD were borderline (25.7%), histrionic (24%) and obsessive-compulsive (6.4%) and 19.6% were not otherwise specified PD. PD accounted for an extensive use of mental health resources (inpatient, outpatient and emergency units). The most comorbid conditions in axis I were affective, anxiety and substance-related disorders. Conclusions. The study of PD attended in the MHS in a community area by means of clinical evaluation is an economical instrument, which is easily applied and replicated in planning of MHS for PD (AU)

Study of personality disorders and the use of services in the clinical population attended in the mental health network of a community area.

INTRODUCTION: Personality disorders (PD) are a growing clinical and health care problem. In Spain, the studies of PD and utilization of the Mental Health Services (MHS) in the clinical population are scant. However, these data are necessary in the planning of MHS for PD. METHOD: We studied all the patients attended throughout one year in all the psychiatric departments (n=2701), and separately in the inpatient (n=193) and outpatient (n=2649) psychiatric services. All the patients diagnosed with PD by clinical interview (DSM-IV-TR criteria) were included. Demographic and clinical variables as well as use of MHS were studied. RESULTS: The proportion of PD in the population attended was 11% (95% CI: 9.8%-12.2%) and in the inpatient and outpatient psychiatric services 17.6% (95% CI: 12.9%- 23.6%) and 10.3% (95% CI: 9.2%-11.5%), respectively. The most representative PD were borderline (25.7%), histrionic (24%) and obsessive-compulsive (6.4%) and 19.6% were not otherwise specified PD. PD accounted for an extensive use of mental health resources (inpatient, outpatient and emergency units). The most comorbid conditions in axis I were affective, anxiety and substance-related disorders. CONCLUSIONS: The study of PD attended in the MHS in a community area by means of clinical evaluation is an economical instrument, which is easily applied and replicated in planning of MHS for PD.