Estimating density limits for walking pedestrians keeping a safe interpersonal distancing.

With people trying to keep a safe distance from others due to the COVID-19 outbreak, the way in which pedestrians walk has completely changed since the pandemic broke out1,2. In this work, laboratory experiments demonstrate the effect of several variables-such as the pedestrian density, the walking speed and the prescribed safety distance-on the interpersonal distance established when people move within relatively dense crowds. Notably, we observe that the density should not be higher than 0.16 pedestrians per square meter (around 6 m2 per pedestrian) in order to guarantee an interpersonal distance of 1 m. Although the extrapolation of our findings to other more realistic scenarios is not straightforward, they can be used as a first approach to establish density restrictions in urban and architectonic spaces based on scientific evidence.

Pedestrian evacuation simulation in the presence of an obstacle using self-propelled spherocylinders.

We explore the role that the obstacle position plays in the evacuation time of agents when leaving a room. To this end, we simulate a system of nonsymmetric spherocylinders that have a prescribed desired velocity and angular orientation. In this way, we reproduce the nonmonotonous dependence of the pedestrian flow rate on the obstacle distance to the door. For short distances, the obstacle delays the evacuation because the exit size is effectively reduced; i.e., the distance between the obstacle and the wall is smaller than the door width. By increasing the obstacle distance to the door, clogging is reduced leading to an optimal obstacle position (maximum flow rate) in agreement with results reported in numerical simulations of pedestrian evacuations and granular flows. For further locations, however, a counterintuitive behavior occurs as the flow rate values fall again below the one corresponding to the case without obstacle. Analyzing the head-times distribution, we evidence that this new feature is not linked to the formation of clogs, but is caused by a reduction of the efficiency of the agent's instantaneous flow rate when the exit is not blocked.

[Clinical and radiological diagnosis of neurocysticercosis: a case report]. / Diagnóstico clínico-radiológico de neurocisticercosis: a propósito de un caso.

BACKGROUND: Neurocysticercosis is the most frequent parasitic disease of the central nervous system and the first cause of acquired epilepsy in endemic areas. Our aim in is to use clinical and radiological criteria to orientate diagnosis where there is suspicion of neurocysticercosis, presenting a clinical case as an example. MATERIALS AND METHODS: We present the case of a 43 year old woman of Bolivian origin, who came to accidents and emergencies after suffering a generalized convulsive crisis, witnessed by relatives of the patient. RESULTS: A cranial computerized axial tomography was taken, which together with her clinical history led to suspicion of neurocysticercosis. She was admitted to the neurosurgery department for completion of the study, which confirmed the diagnosis of suspicion. She received treatment with albendazol and corticoids, with a good evolution. CONCLUSIONS: Neurocysticercosis is an emergent pathology in developed countries, due to the increase of immigration from endemic areas, mainly from Latin America. Epilepsy is the most frequent clinical expression, but presentation can vary greatly. A high degree of suspicion is necessary in order to be able to diagnose this disease.

Diagnóstico clínico-radiológico de neurocisticercosis: a propósito de un caso / Clinical and radiological diagnosis of neurocysticercosis: A case report

Introducción. La neurocisticercosis es la enfermedadparasitaria más frecuente del sistema nervioso centraly la primera causa de epilepsia de inicio tardío en lasáreas endémicas. Nuestro objetivo con este trabajo esorientar a través de los criterios clínicos y radiológicosel diagnóstico de sospecha de esta enfermedad, presentandoun caso clínico.Materiales y métodos. Presentamos el caso de una mujerde 43 años, natural de Bolivia, que acudió al Serviciode Urgencias tras presentar una crisis convulsivageneralizada, presenciada por familiares de la paciente.Resultados. Se realizó una tomografía axial computarizadacraneal, que permitió junto con su historia clínicasospechar una neurocisticercosis. Se ingresó enneurocirugía para completar el estudio, que confirmóel diagnóstico de sospecha, y recibió tratamiento conalbendazol y corticoides, con buena evolución.Conclusiones. La neurocisticercosis es una patologíaemergente en países desarrollados, debido al aumentode la inmigración desde áreas endémicas, principalmentede América Latina. La epilepsia es la expresiónclínica más frecuente, pero la presentación es muyvariable. Un alto grado de sospecha es necesario parapoder diagnosticar esta enfermedad (AU)

Background. Neurocysticercosis is the most frequentparasitic disease of the central nervous system and thefirst cause of acquired epilepsy in endemic areas. Ouraim with this paper is to use clinical and radiologicalcriteria to orientate diagnosis where there is suspicionof neurocysticercosis, presenting a clinical case as anexample.Materials and methods. We present the case of a 43year old woman of Bolivian origin, who came to accidentsand emergencies after suffering a generalizedconvulsive crisis, witnessed by relatives of the patient.Results. A cranial computerized axial tomography wastaken, which together with her clinical history led tosuspicion of neurocysticercosis. She was admitted tothe neurosurgery department for completion of the study,which confirmed the diagnosis of suspicion. She receivedtreatment with albendazol and corticoids, witha good evolution.Conclusions. Neurocysticercosis is an emergent pathologyin developed countries, due to the increaseof immigration from endemic areas, mainly from LatinAmerica. Epilepsy is the most frequent clinical expression,but presentation can vary greatly. A high degree ofsuspicion is necessary in order to be able to diagnosethis disease (AU)

Agresión sexual / Sexual assault

Los delitos contra la agresión sexual constituyenuno de los temas de mayor interés en el momento actualy en diferentes campos sociales (judicial, médico,policial, criminológico...). La importancia radica en lafrecuencia de los mismos y las repercusiones legales,físicas y psicológicas que conllevan.Debido a ello es importante tener clara la pauta deactuación en urgencias frente a tales delitos, siendo minuciosoen la realización del informe ginecológico y enla toma de muestras, ofertando profilaxis de enfermedadesde transmisión sexual y embarazos no deseados yprestando apoyo psicológico(AU)

Offences involving sexual assault are an issue ofthe greatest current interest in different social fields(legal, medical, police, criminological…). They are significantdue to their frequency and to the legal, physicaland psychological repercussions involved.It is therefore important to clearly understand thepattern of action in Accidents and Emergencies facingsuch cases. Great detail is required in the gynaecologicalreport and the taking of samples, prophylaxes forsexually transmitted diseases and unwanted pregnanciesmust be given and psychological support provided(AU)

[Sexual assault]. / Agresión sexual.

Offences involving sexual assault are an issue of the greatest current interest in different social fields (legal, medical, police, criminological...). They are significant due to their frequency and to the legal, physical and psychological repercussions involved. It is therefore important to clearly understand the pattern of action in Accidents and Emergencies facing such cases. Great detail is required in the gynaecological report and the taking of samples, prophylaxes for sexually transmitted diseases and unwanted pregnancies must be given and psychological support provided.

Adult celiac disease and hypertransaminasemia.

OBJECTIVE: to determine the incidence of hypertransaminasemia in adult patients with celiac disease with or without relevant chronic liver disease, and to evaluate the response after a gluten-free diet. PATIENTS AND METHODS: retrospective study of 20 cases of adult celiac disease (> 14 years old at diagnosis). Patients were included in the study if they fulfilled the revised EPSGAN criteria. If laboratory tests of liver function revealed alterations, hepatitis B and C viral serology, thyroid hormones, and use of alcohol and drugs were investigated, and liver ultrasound scans were done. Liver biopsy and endoscopic retrograde cholangiopancreatography were done only in patients for whom these studies were considered necessary. RESULTS: ten patients had hypertransaminasemia (50%), ascribed to benzodiazepine use in 1 patient, chronic HCV hepatitis in 1, and celiac disease in 8. In all of these last patients except 1 (benzodiazepine use), laboratory values returned to normal after 4-10 months on a gluten-free diet. CONCLUSIONS: celiac disease was frequently associated with hypertransaminasemia. In most patients transaminase levels returned to normal within 1 year after dietary gluten intake was restricted. If alterations in laboratory values persist, other causes that may be related (e.g., autoimmunity or tumors) or unrelated to celiac disease (e.g., virus) must be ruled out.

Enfermedad celíaca del adulto e hipertransaminasemia / Adult celiac disease and hypertransaminasemia

OBJETIVO: determinar la incidencia de hipertransaminasemia con hepatopatía crónica relevante o no en la celiaquía del adulto y la respuesta a la restricción del gluten. PACIENTES Y MÉTODO: estudio retrospectivo de 20 casos de celiaquía del adulto (> 14 años al diagnóstico). Incluyéndose en el estudio los casos que cumplen los criterios revisados de la ESPGAN. Se realizó analítica hepática y en caso de alteración; serología Vírica B y C, -hormonas tiro¡deas, exclusión de tóxicos (alcohol y fármacos) y ecografía hepática a todos los pacientes. Biopsia hepática y colangiografía retrógrada endoscópica únicamente en los casos que se -cree indicado. RESULTADOS: se detectan diez casos (50 por ciento) de hipertransarninasemia; un caso por benzodiacepinas; otro por hepatitis crónica por el virus C de la hepatitis; ocho casos secundarios a la celiaquía, de los cuales en siete (77,7 por ciento, excluido el caso por benzodiacepinas) se normaliza la analítica en un plazo de 4-10 meses de dieta sin gluten. CONCLUSIONES: 1) La asociación celiaquía e hipertransaminasemia es un fenómeno muy frecuente. 2) En la mayoría de los casos hay normalización tras restricción del gluten de la dieta en un periodo menor de un año. 3) En el caso de persistencia de alteración analítica hay que descartar otras causas independientes de la celiaquía (virus...) o relacionadas con ella (autoinmunidad, tumor..) (AU)

[Validation of the Ottawa ankle rules for the efficient utilization of radiographies in acute lesions of the ankle]. / Validación de las reglas del tobillo de Ottawa para el uso eficiente de radiografías en las lesiones agudas de tobillo.

OBJECTIVE: To test the validity of Ottawa ankle rules (OAR) in our field. To test the agreement physician/nurse in the assessment of the patient with acute ankle injuries. DESIGN: Observational, with application of rules and prospective outcome measurement. SETTING: Hospital emergency departments. PARTICIPANTS: Adults who attended at the emergency department, suffering from a secondary ankle pain to a traumatic injury, from 1st March to 30th September, 1997. MEASUREMENTS AND MAIN RESULTS: Physicians who participated applied the OAR to the patients and asked for a control radiograph, independently from the result of rules application. 100 patients were valued by a physician and a nurse in order to measure the agreement level. Data from 564 patients were recorded, getting a global sensitivity of the OAR of 97.3% (95% CI 89.7-99.5); specificity of 33.3% (95% CI 29.5-37.3). The positive predictive value was of 15.6 (95% CI 12.4-19.3). Thanks to the application of the rules radiography would reduce by 29.5%. 74 (13.1%) patients suffered form fracture: 48 (8.5%), of the maleolar zone and 26 (4.6%) of the midfoot zone. Attending to the OAR criteria, radiographs wouldn't be necessary in two cases of fracture. CONCLUSIONS: We consider the OAR clinically valuable and useful in our field. They can help to work on the basis of uniform criteria when decisions must be taken and to use properly sanitary resources. Triage nurses can apply them.

[Idiopathic spontaneous pneumothorax: treatment by small-caliber catheter aspiration compared to drainage through a chest tube]. / Neumotórax espontáneo idiopático: tratamiento basado en la aspiración con catéter fino frente a drenaje torácico.

BACKGROUND: Several options are available for treating patients with a first episode of primary spontaneous pneumothorax (ISP). The aim of this study was to compare the efficacy of two treatment alternatives: puncture-aspiration (PA) using a small caliber catheter, and pleural drainage through a chest tube (DCT). PATIENTS AND METHODS: We compared a current series of 91 patients treated with PA with a retrospective series of 216 patients treated with DCT. PA was performed by emergency room physicians and DCT was performed by chest surgeons. Patients were followed for a period of 24 months. RESULTS: The immediate efficacy of PA was superior to DCT (86.7% versus 76%, p < 0.05). The proportion of recurrences after each treatment was similar (23% and 17%, respectively, NS). Duration of hospital stay was shorter for PA-treated patients (24 h) than for DCT-treated patients (138 h) (p < 0.05). The efficacy of the two procedures 24 months later was similar (63.7% and 62.9%, respectively, NS), and the cost of PA was three times less than that of DCT. CONCLUSIONS: PA is as effective a treatment procedure as DCT. PA is simple enough for emergency room physicians to perform correctly. Inconvenience to the patient, cost to the health care system, and time of hospital stay are all significantly less with PA.

[Arteriovenous malformation of the superior mesenteric artery with secondary portal hypertension]. / Malformación arteriovenosa de la mesentérica superior con hiperaflujo e hipertensión portal secundaria.

The case of a 60-year-old patient who was repeatedly admitted for ascitic decompensation secondary to hyperflow portal hypertension provoked by congenital arteriovenous malformation of the superior mesenteric artery is presented. Diagnosis was performed by arteriography. Surgical treatment was conducted with total resection of the malformation thereby achieving complete resolution and normalization of portal pressure. The literature is reviewed and the pathophysiologic mechanism as well as the clinical manifestations, diagnosis and treatment are discussed.