We diagnosed 11 Guillain–Barré syndrome (GBS) cases among 71,904 COVID patients attended at 61 Spanish emergency departments (EDs) during the 2‐month pandemic peak. The relative frequency of GBS ...among ED patients was higher in COVID (0.15‰) than non‐COVID (0.02‰) patients (odds ratio OR = 6.30, 95% confidence interval CI = 3.18–12.5), as was the standardized incidence (9.44 and 0.69 cases/100,000 inhabitant‐years, respectively, OR = 13.5, 95% CI = 9.87–18.4). Regarding clinical characteristics, olfactory–gustatory disorders were more frequent in COVID‐GBS than non‐COVID–GBS (OR = 27.59, 95% CI = 1.296–587) and COVID–non‐GBS (OR = 7.875, 95% CI = 1.587–39.09) patients. Although COVID‐GBS patients were more frequently admitted to intensive care, mortality was not increased versus control groups. Our results suggest SARS‐CoV‐2 could be another viral infection causing GBS. ANN NEUROL 2021;89:598–603
Mesospheric Green emissions from excited Oxygen in Sprite Tops (ghosts) are infrequent and faint greenish transient luminous events that remain for hundreds of milliseconds on top of certain ...energetic sprites. The main hypothesis to explain this glow persistence is the long lifetime of excited atomic oxygen at 557.73 nm, a well-known emission line in aurora and airglow. However, due to the lack of spectroscopic campaigns to analyse such events to date, the species involved in the process can not yet be identified. Here we report observational results showing the temporal evolution of a ghost spectrum between 500 nm and 600 nm. Besides weak -but certain- traces of excited atomic oxygen, our results show four main contributors related to the slow decay of the glow: atomic iron and nickel, molecular nitrogen and ionic molecular oxygen. Additionally, we are able to identify traces of atomic sodium, and ionic silicon, these observations being consistent with previous direct measurements of density profiles of meteoric metals in the mesosphere and lower thermosphere. This finding calls for an upgrade of current air plasma kinetic understanding under the influence of transient luminous events.
Nutrition is a modifiable factor potentially related to aging. Milk and other dairy products may contribute to the prevention of physical and cognitive impairment. We conducted a systematic review to ...investigate the effectiveness of dairy product intake for preventing cognitive decline, sarcopenia, and frailty in the elderly population. A systematic search for publications in electronic databases MEDLINE via PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews from 2009 to 2018 identified observational and interventional studies in English and Spanish that tested the relation between dairy product consumption and cognitive decline, sarcopenia, and frailty in community-dwelling older people. We assessed the participants, the type of exposure or intervention, the outcomes, and the quality of evidence. We screened a total of 661 records and included 6 studies (5 observational prospective cohort studies and 1 randomized controlled trial). Regarding cognitive impairment, the relation cannot be firmly established. Consumption of milk at midlife may be negatively associated with verbal memory performance. In older women, high intakes of dairy desserts and ice cream were associated with cognitive decline. On the other hand, 1 study demonstrated a significant inverse relation between dairy intake and development of Alzheimer disease among older Japanese subjects. The consumption of dairy products by older people may reduce the risk of frailty, especially with high consumption of low-fat milk and yogurt, and may also reduce the risk of sarcopenia by improving skeletal muscle mass through the addition of nutrient-rich dairy proteins (ricotta cheese) to the habitual diet. Despite the scarcity of evidence on the topic, our systematic review shows that there are some positive effects of dairy products on frailty and sarcopenia, whereas studies concerning cognitive decline have contradictory findings.
Background Teledermoscopy involves the use of dermoscopic images for remote consultation and decision-making in skin cancer screening. Objective We sought to analyze the potential benefits gained ...from the addition of dermoscopic images to an internet-based skin cancer screening system. Methods A randomized clinical trial assessed the diagnostic performance and cost-effectiveness of clinical teleconsultations (CTC) and clinical with dermoscopic teleconsultations. Results A total of 454 patients were enrolled in the trial (nCTC = 226, nclinical with dermoscopic teleconsultation = 228). Teledermoscopy improved sensitivity and specificity (92.86% and 96.24%, respectively) compared with CTC (86.57% and 72.33%, respectively). Correct decisions were made in 94.30% of patients through clinical with dermoscopic teleconsultations and in 79.20% in CTC ( P < .001). The only variable associated with an increased likelihood of correct diagnosis was management using teledermoscopy (odds ratio 4.04; 95% confidence interval 2.02-8.09; P < .0001). The cost-effectiveness analysis showed teledermoscopy as the dominant strategy, with a lower cost-effectiveness ratio (65.13 vs 80.84). Limitations Potentially, a limitation is the establishment of an experienced dermatologist as the gold standard for the in-person evaluation. Conclusions The addition of dermoscopic images significantly improves the results of an internet-based skin cancer screening system, compared with screening systems based on clinical images alone.
Surgical menopause causes a sharp drop in estrogen levels in middle‐aged women, thus preventing the gradual physiological adaptation that is characteristic of the perimenopause. Previous studies ...suggest that surgical menopause might increase the risk of dementia later in life. In addition, the transition to motherhood entails long‐lasting endocrine and neuronal adaptations. We compared differences in whole‐brain cortical volume between women who reached menopause by surgery and a group of women who reached spontaneous non‐surgical menopause and determined whether these cortical differences were influenced by previous childbearing. Using surface‐based neuroimaging techniques, we investigated cortical volume differences in 201 middle‐aged women (134 women who experienced non‐surgical menopause, 78 of whom were parous women; and 67 women who experienced surgical menopause, 39 of whom were parous women). We found significant atrophy in the frontal and temporal regions in women who experienced surgical menopause. Nulliparous women with surgical menopause showed significant lower cortical volume in the left temporal gyrus extending to the medial temporal lobe cortex, as well as in the precuneus bilaterally compared to parous women with surgical menopause; whereas our results revealed no significant differences between parous women with surgical menopause and both parous and nulliparous women who reached a non‐surgical menopause. Furthermore, in the surgical menopause group, we found a negative correlation between cortical volume and age at first pregnancy in the temporal lobe. Our study suggests that the long‐term brain remodeling of parity may mitigate the neural impact of the sudden drop in estrogen levels that characterizes surgical menopause.
Premenopausal bilateral oophorectomy prevents women from undergoing the physiological adaptations of perimenopause provoking brain changes that increase the risk of dementia later in life. Preoperative childbearing may mitigate such oophorectomy‐related brain changes. Adaptive changes related to motherhood are crucial in coping with not experiencing the transition of menopause.
Aims
Benzodiazepines have been used as safe anxiolytic drugs for decades and some authors have suggested they could be an alternative for morphine for treating acute cardiogenic pulmonary oedema ...(ACPE). We compared the efficacy and safety of midazolam and morphine in patients with ACPE.
Methods and results
A randomized, multicentre, open‐label, blinded endpoint clinical trial was performed in seven Spanish emergency departments (EDs). Patients >18 years old clinically diagnosed with ACPE and with dyspnoea and anxiety were randomized (1:1) at ED arrival to receive either intravenous midazolam or morphine. Efficacy was assessed by in‐hospital all‐cause mortality (primary endpoint). Safety was assessed through serious adverse event (SAE) reporting, and the composite endpoint included 30‐day mortality and SAE. Analyses were made on an intention‐to‐treat basis. The trial was stopped early after a planned interim analysis by the safety monitoring committee. At that time, 111 patients had been randomized: 55 to midazolam and 56 to morphine. There were no significant differences in the primary endpoint (in‐hospital mortality for midazolam vs. morphine 12.7% vs. 17.9%; risk ratioRR 0.71, 95% confidence interval CI 0.29–1.74; p = 0.60). SAE were less common with midazolam versus morphine (18.2% vs. 42.9%; RR 0.42, 95% CI 0.22–0.80; p = 0.007), as were the composite endpoint (23.6% vs. 44.6%; RR 0.53, 95% CI 0.30–0.92; p = 0.03).
Conclusion
Although the number of patients was too small to draw final conclusions and there were no significant differences in mortality between midazolam and morphine, a significantly higher rate of SAEs was found in the morphine group.
There were no significant differences in mortality between morphine and midazolam but the rate of serious adverse events was significantly higher in the morphine group, although the number of patients was too small to draw final conclusions.
An integrated interpretation of the late Paleozoic structural and geochronological record of the Iberian Massif is presented and discussed under the perspective of a Gondwana-Laurussia collision ...giving way to the Variscan orogen. Compressional and extensional structures developed during the building of the Variscan orogenic crust of Iberia are linked together into major tectonic events operating at lithosphere scale. A review of the tectonometamorphic and magmatic evolution of the Iberian Massif reveals backs and forths in the overall convergence between Gondwana and Laurussia during the amalgamation of Pangea in late Paleozoic times. Stages dominated by lithosphere compression are characterized by subduction, both oceanic and continental, development of magmatic arcs, (over- and under-) thrusting of continental lithosphere, and folding. Variscan convergence resulted in the eventual transference of a large allochthonous set of peri-Gondwanan terranes, the Iberian Allochthon, onto the Gondwana mainland. The Iberian Allochthon bears the imprint of previous interaction between Gondwana and Laurussia, including their juxtaposition after the closure of the Rheic Ocean in Lower Devonian times. Stages governed by lithosphere extension are featured by the opening of two short-lived oceanic basins that dissected previous Variscan orogenic crust, first in the Lower-Middle Devonian, following the closure of the Rheic Ocean, and then in the early Carboniferous, following the emplacement of the peri-Gondwanan allochthon. An additional, major intra-orogenic extensional event in the early-middle Carboniferous dismembered the Iberian Allochthon into individual thrust stacks separated by extensional faults and domes. Lateral tectonics played an important role through the Variscan orogenesis, especially during the creation of new tectonic blocks separated by intracontinental strike-slip shear zones in the late stages of continental convergence.
Scope
Hypercholesterolemia increases the risk of mortality in type 2 diabetes mellitus (T2DM), especially in the late‐stage. Consumption of bioactive compounds as functional ingredients would help ...achieve therapeutic goals for cholesterolemia. Silicon has demonstrated a hypocholesterolemic effect and the ability to reduce fat digestion. However, it is unclear whether silicon exerts such effect in late‐stage T2DM (LD) and the intestinal mechanisms involved.
Methods and results
Three groups of eight rats were included: early‐stage T2DM control (ED), LD, and the LD group treated with silicon (LD‐Si) once the rats were diabetic. Morphological alterations of the duodenal mucosa, and levels of markers involve in cholesterol absorption and excretion, beside cholesterolemia, and fecal excretion were assayed. Silicon included as a functional ingredient significantly reduces cholesterolemia in part due to: 1) reducing cholesterol intestinal absorption by decreasing the absorptive area and Acetyl‐Coenzyme A acetyltransferase‐2 (ACAT2) levels; and 2) increasing cholesterol excretion to the lumen by induction of the liver X receptor (LXR) and consequent increase of adenosine triphosphate‐binding cassette transporter (ABCG5/8).
Conclusions
These results provide insight into the intestinal molecular mechanisms by which silicon reduces cholesterolemia and highlights the efficacy of the consumption of silicon‐enriched functional foods in late‐stage T2DM.
Duodenal mucosa in early‐stage type 2 diabetes mellitus (ED), late‐stage type 2 diabetes mellitus injected with streptozotocin‐nicotinamide (STZ/NAD) (LD) and treated‐silicon LD (LD‐Si) groups. Silicon partially reversed LD group alterations: decreased absorptive area and acyl‐Coenzyme A:cholesterol acyltransferase 2 (ACAT2) levels, and increased levels of member 5 and 8 of the ATP‐binding cassette G (ABCG5/8) induced by liver X receptor (LXR).
(1) Background: There are conflicting results on whether weight loss after bariatric surgery (BS) might be associated with quality of life (QoL)/depressive symptomatology. We aim to determine whether ...BS outcomes are associated with QoL/depressive symptomatology in studied patients at the 8-year follow-up after BS, as well as their relationship with different serum proteins and miRNAs. (2) Methods: A total of 53 patients with class III obesity who underwent BS, and then classified into “good responders” and “non-responders” depending on the percentage of excess weight lost (%EWL) 8 years after BS (%EWL ≥ 50% and %EWL < 50%, respectively), were included. Basal serum miRNAs and different proteins were analysed, and patients completed tests to evaluate QoL/depressive symptomatology at 8 years after BS. (3) Results: The good responders group showed higher scores on SF-36 scales of physical functioning, role functioning—physical, role functioning—emotional, body pain and global general health compared with the non-responders. The expression of hsa-miR-101-3p, hsa-miR-15a-5p, hsa-miR-29c-3p, hsa-miR-144-3p and hsa-miR-19b-3p were lower in non-responders. Hsa-miR-19b-3p was the variable associated with the response to BS in a logistic regression model. (4) Conclusions: The mental health of patients after BS is limited by the success of the intervention. In addition, the expression of basal serum miRNAs related to depression/anxiety could predict the success of BS.
Background
Heart failure is one of the most pressing current public health concerns. However, in Spain there is a lack of population data. We aimed to examine thirteen‐year nationwide trends in heart ...failure hospitalization, in‐hospital mortality and 30‐day readmission rates in Spain.
Methods
We conducted a retrospective observational study of patients discharged with the principal diagnosis of heart failure from The National Health System’ acute hospitals during 2003‐2015. The source of the data was the Minimum Basic Data Set. Temporal trends were modelled using Poisson regression analysis. The risk‐standardized in‐hospital mortality ratio was calculated using a multilevel risk adjustment logistic regression model.
Results
A total of 1 254 830 episodes of heart failure were selected. Throughout 2003‐2015, the number of hospital discharges with principal diagnosis of heart failure increased by 61%. Discharge rates weighted by age and sex increased during the period incidence rate ratio (IRR): 1.03; 95% confidence interval (95% CI): 1.03‐1.03; P < .001), although this increase was motivated by the increase in older age groups (≥75 years old). The crude mortality rate diminished (IRR: 0.99; 95% CI: 0.98‐1, P < .001), but 30‐day readmission rate increased (IRR: 1.05; 95% CI: 1.04‐1.06; P < .001). The risk‐standardized in‐hospital mortality ratio did not change throughout the study period (IRR: 0.997; 95% CI: 0.992‐1; P = .32).
Conclusions
From 2003 to 2015, heart failure admission rates increased significantly in Spain as a consequence of the sustained increase of hospitalization in the population ≥75 years. 30‐day readmission rates increased, but the risk‐standardized in‐hospital mortality ratio did not significantly change for the same period.
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