Time of the day and season distribution among stroke code subtypes: differences between ischemic stroke, intracranial hemorrhage, and stroke mimic.

Background: Circadian variations in the timing of the onset of stroke symptoms have been described, showing a morning excess of cardiovascular risk. To date, no differences have been found between stroke subtype and time distribution throughout the day. The present study aims to compare the seasonal and circadian rhythm of symptoms onset in ischemic, hemorrhagic, and stroke mimic patients. Methods: This study was conducted prospectively at a hospital and involved a cohort of stroke alert patients from 2018 to 2021. Stroke subtypes were classified as ischemic stroke, intracerebral hemorrhage (ICH), transient ischemic attack (TIA), and stroke mimic. Clinical variables were recorded, and each patient was assigned to a 4-h interval of the day according to the time of onset of symptoms; unwitnessed stroke patients were analyzed separately. Seasonal changes in stroke distribution were analyzed at 3-month intervals. Results: A total of 2,348 patients were included in this analysis (ischemic 67%, ICH 13%, mimic 16%, and TIA 3%). Regardless of stroke subtype, most of the patients were distributed between 08-12 h and 12-16 h. Significant differences were found in the time distribution depending on stroke subtype, with ICH predominating in the 4-8 h period (dawn), most of which were hypertensive, TIA in the 12-16 h period (afternoon), and stroke mimic in the 20 h period (evening). The ischemic stroke was evenly distributed throughout the different periods of the day. There were no differences in the seasonal pattern between different stroke subtypes, with winter being the one that accumulated the most cases. Conclusion: The present study showed different circadian patterns of stroke subtypes, with a predominance of ICH at dawn and stroke mimic in the afternoon. The stroke circadian rhythm resembles previous studies, with a higher incidence in the morning and a second peak in the afternoon.

Systematics and phylogeography of bats of the genus Rhynchonycteris (Chiroptera: Emballonuridae): Integrating molecular phylogenetics, ecological niche modeling and morphometric data.

Rhynchonycteris is a monotypic genus of Embalonurid bats, whose geographic distribution extends from southern Mexico to tropical regions of the South American continent, including Trinidad and Tobago. Although species that have a wide geographic distribution are frequently revealed to be polytypic, to date, no study has evaluated the taxonomic status of populations of Rhynchonycteris naso. Thus, the aim of this study is to address the patterns of phylogeographic structure and taxonomic subdivision of R. naso using molecular phylogenetics, morphometric data and ecological niche modeling. Phylogenetic results recovered using the genes COI, Cytb, Chd1, Dby, and Usp9x, supported the monophyly of the genus Rhynchonycteris, in addition, a deep phylogeographic structure was revealed by the mitochondrial gene COI for the populations of Belize and Panama in comparison to those of South America. The PCA, and the linear morphometry indicated an apparent differentiation between the cis-Andean and trans-Andean populations. Furthermore, according to the skull morphology, at least two morphotypes were identified. Ecological niche modeling projections in the present have shown that the Andean cordillera acts as a climatic barrier between these two populations, with the depression of Yaracuy (Northwest Venezuela) being the only putative climatically suitable path that could communicate these two populations. On the other hand, projections for the last glacial maximum showed a drastic decrease in climatically suitable areas for the species, suggesting that cycles of lower temperatures played an important role in the separation of these populations.

Assessing Impact of Household Intervention on Indoor Air Quality and Health of Children with Asthma in the US-Mexico Border: A Pilot Study.

Few studies have investigated household interventions to enhance indoor air quality (IAQ) and health outcomes in relatively low-income communities. This study aims to examine the impact of the combined intervention with asthma education and air purifier on IAQ and health outcomes in the US-Mexico border area. An intervention study conducted in McAllen, Texas, between June and November 2019 included 16 households having children with asthma. The particulate matter (PM2.5) levels were monitored in the bedroom, kitchen, and living room to measure the IAQ for 7 days before and after the intervention, respectively. Multiple surveys were applied to evaluate changes in children's health outcomes. The mean PM2.5 levels in each place were significantly improved. Overall, they significantly decreased by 1.91 µg/m3 on average (p < 0.05). All surveys showed better health outcomes; particularly, quality of life for children was significantly improved (p < 0.05). This pilot study suggests that the combined household intervention might improve IAQ in households and health outcomes for children with asthma and reduce health disparities in low-income communities. Future large-scale studies are needed to verify the effectiveness of this household intervention to improve IAQ and asthma management.

Indoor Air Quality in Passivhaus Dwellings: A Literature Review.

Indoor air quality (IAQ) is a critical consideration in airtight buildings that depend on mechanical ventilation, such as those constructed to the Passivhaus standard. While previous reviews of IAQ on Passivhaus-certified buildings foccused on offices, this study examines residential buildings. A summary of data collection methods and pollutant concentrations is presented, followed by a critical discussion of the impact of Passivhaus design strategies on IAQ. This review indicates that IAQ in Passivhaus-certified dwellings is generally better than in conventional homes, but both occupant behaviour and pollution from outdoor sources play a significant role in indoor concentrations. Moreover, there are differences in data collection and reporting methods. Many of the available studies depend on short-term IAQ monitoring of less than two weeks, making it difficult to determine the longer impact of housing design on IAQ and occupants' well-being. There is also a lack of studies from non-European countries. Future research should focus on investigating associations between IAQ and Passivhaus design strategies in hot and humid climates, where evidence is particularly lacking. Further effort is also required to investigate potential links between occupant's perception of IAQ and physical exposure to indoor pollution. Finally, the lack of homogeneous monitoring and reporting methods for IAQ studies needs to be addressed.

Mortality in heart failure with atrial fibrillation: Role of digoxin and diuretics.

BACKGROUND: The impact of atrial fibrillation (AF) on mortality of patients with heart failure (HF) has been established. Nevertheless, the effect of some factors in mortality, such as digoxin or diuretic use, remains controversial. This study aims at assessing mortality in community-dwelling patients with stable HF related to AF and determines the relation of these drugs with prognosis. MATERIALS AND METHODS: Community-based cohort study of HF patients diagnosed between January 2010 and December 2014 attended at any one of the 279 primary healthcare centres of the Catalan Institute of Health (Spain). Follow-up ended on December 31, 2015, and the main outcome was mortality for all causes. The effect of clinical and demographic characteristics on survival was assessed by Cox proportional hazards model. RESULTS: A total of 13 334 HF patients were included. Mean age was 78.7 years (SD 10.1), and 36.8% had AF. Mean follow-up was 26.9 months (SD 14.0). At the end of the study, 25.8% patients had died, and mortality was higher when AF was present (28.8% vs 24.1%, P < 0.001, respectively). Multivariate model confirmed the higher risk of death for AF patients (HR 1.10 95%, CI 1.02-1.19). Digoxin and diuretics were not associated with higher mortality in AF patients (HR 1.04 95% CI 0.92-1.18 and HR 1.04 95% CI 0.85-1.26, respectively). CONCLUSIONS: An excess of mortality in HF patients with AF was found in a large retrospective community-based cohort. Digoxin and diuretics did not affect mortality in HF patients with AF.