Highlights - Lineal accelerator based radiosurgery for treatment of central nervous system arteriovenous malformations achieve high rates of obliteration, inversely proportional to the grade of the ...arteriovenous malformation - Previous embolization does not alter the results in terms of obliteration in the treatment of arteriovenous malformations with lineal accelerator based radiosurgery - Several variables are predictive of obliteration, post-treatment hemorrhage and symptomatic radiation-induced changes, but no single factor has been found to predict the neurological outcome at 3 years.
•An increase of the displacement of the wall was found in ruptured aneurysms and ICH treated with EVD.•Increased wall displacement in low shear areas of the aneurysm is strongly related to rebleeding ...phenomena after EVD placement.•Lowering ICP procedures behaves differently in ruptured and unruptured aneurysms making different risk profiles.
The treatment of hydrocephalus using external ventricular drainage (EVD) seems to favour rebleeding of an untreated ruptured aneurysm. FSI studies are valuable to study this environment.
From December 2014 to December 2017, 61 patients with SAH required EVD due to hydrocephalus, 6 patients had aneurysm rebleeding after the procedure. Two controls for each case was included. DSA studies were used for fluid–structure interaction simulations using two scenarios high ICP (5332 Pa) and low ICP (133 Pa).
Maximum displacement of the wall in HICP was 0.34 mm and 0.26 mm in rebleeding and no rebleeding cases respectively, after EVD (LICP), it was 0.36 mm and 0.27 mm. The difference after implantation of EVD (HICP-LICP) had an average of 0.01567 mm and 0.00683 mm in rebleeding and no rebleeding cases (p = 0.05). This measure in low shear areas of the aneurysm was 0.026 and 0.0065 mm in rebleeding and no rebleeding cases (p = 0.01).
Effective stress in the HICP was 4.77 MPa and 3.26 MPa in rebleeding and no rebleeding cases (p = 0.25). In LICP condition, this measure was 2.28 MPa and 1.42 MPa respectively (p = 0.33). TAWSS had no significant differences in the conditions of HICP and LICP.
Changes after EVD placement includes an increase in the wall displacement with greater differences over low shear areas, this had a strong association with rebleeding.
To determine the differences by age-dependent categories in the clinical profile, presentation, management, and short-term outcomes of patients with laboratory-confirmed COVID-19 admitted to a ...Spanish Emergency Department (ED).
Secondary analysis of COVID-19_URG-HCSC registry. We included all consecutive patients with laboratory-confirmed COVID-19 admitted to the ED of the University Hospital Clinico San Carlos (Madrid, Spain). The population was divided into six age groups. Demographic, baseline and acute clinical data, and in-hospital and 30-day outcomes were collected.
1379 confirmed COVID-19 cases (mean age 62 (SD 18) years old; 53.5% male) were included (18.1% < 45 years; 17.8% 45-54 years; 17.9% 55-64 years; 17.2% 65-74 years; 17.0% 75-84 years; and 11.9% ≥ 85 years). A statistically significant association was found between demographic, comorbidity, clinical, radiographic, analytical, and therapeutic variables and short-term results according to age-dependent categories. There were less COVID-specific symptoms and more atypical symptoms among older people. Age was a prognostic factor for hospital admission (aOR = 1.04; 95% CI 1.02-1.05) and in-hospital (aOR = 1.08; 95% CI 1.05-1.10) and 30-day mortality (aOR = 1.07; 95% CI 1.04-1.09), and was associated with not being admitted to intensive care (aOR = 0.95; 95% CI 0.93-0.98).
Older age is associated with less COVID-specific symptoms and more atypical symptoms, and poor short-term outcomes. Age has independent prognostic value and may help in shared decision-making in patients with confirmed COVID-19 infection.
Resumen Objetivo Identificar factores predictores de hiperfrecuentación en Atención Primaria (AP) en una muestra de pacientes hiperfrecuentadores (HF) en servicios de urgencias hospitalarios (SUH). ...Diseño Estudio observacional retrospectivo multicéntrico. Participantes Se seleccionaron pacientes mayores de 14 años HF en el SUH entre el 1 de enero y el 31 de diciembre de 2013. Emplazamiento: se reclutaron pacientes atendidos en los SUH de 17 hospitales públicos de la Comunidad de Madrid. Método Se recogieron variables relativas a la visita índice del SUH. Se analizó la muestra en función de ser o no HF en AP. Se considera HF al paciente que realizó al menos 10 visitas en cada nivel asistencial durante un año. Resultados Se incluyeron 1.284 pacientes HF en SUH. Se analizaron 423 (32,9%) HF en AP con 16 visitas (RIC 12-25) frente a 861 (67,1%) pacientes no HF en AP con 4 visitas (RIC 2-6). Factores independientes predictores de HF en AP fueron la edad > 65 años (OR: 1,51; IC 95%: 1,07-2,13; p = 0,019), el deterioro cognitivo (OR: 1,63; IC 95%: 1,01-2,65; p = 0,049), el número de fármacos ≥3 (OR: 1,56; IC 95%: 1,06-2,30; p = 0,025) y vivir en la comunidad frente a vivir institucionalizado o en la calle (OR: 3,05; IC 95%: 1,14-8,16; p = 0,026). Conclusiones En una muestra de pacientes HF en los SUH, el hecho de ser mayor de 65 años, tomar 3 o más fármacos, presentar deterioro cognitivo y vivir en la comunidad se consideran factores predictores de ser HF también en AP.
Patients older than 65 years are increasingly attended in the Emergency Department (ED). This means that internists working in ED are responsible for improving their geriatric training. The frail ...elders are the one who have the higher probability to suffer an adverse event. The detection of this profile is very important for making a decision in ED. A possible geriatric emergency model would be the one that screens frailty among all patients older than 65 years old in ED by nurses, and, in those triaged as of high risk, a geriatric assessment must be done by a geriatric trained doctor or nurse. All this information will be helpful for the final location and discharge follow-up plan.
To assess whether dementia is an independent predictor of death after a hospital emergency department (ED) visit by older adults with or without a COVID-19 diagnosis during the first pandemic wave.
...We used data from the EDEN-Covid (Emergency Department and Elderly Needs during Covid) cohort formed by all patients ≥65 years seen in 52 Spanish EDs from March 30 to April 5, 2020. The association of prior history of dementia with mortality at 30, 180 and 365 d was evaluated in the overall sample and according to a COVID-19 or non COVID diagnosis.
We included 9,770 patients aged 78.7 ± 8.3 years, 51.1% men, 1513 (15.5%) subjects with prior history of dementia and 3055 (31.3%) with COVID-19 diagnosis. 1399 patients (14.3%) died at 30 d, 2008 (20.6%) at 180 days and 2456 (25.1%) at 365 d. The adjusted Hazard Ratio (aHR) for age, sex, comorbidity, disability and diagnosis for death associated with dementia were 1.16 (95% CI 1.01-1.34) at 30 d; 1.15 at 180 d (95% CI 1.03-1.30) and 1.19 at 365 d (95% CI 1.07-1.32), p < .001. In patients with COVID-19, the aHR were 1.26 (95% CI: 1.04-1.52) at 30 days; 1.29 at 180 d (95% CI: 1.09-1.53) and 1.35 at 365 d (95% CI: 1.15-1.58).
Dementia in older adults attending Spanish EDs during the first pandemic wave was independently associated with 30-, 180- and 365-day mortality. This impact was lower when adjusted for age, sex, comorbidity and disability, and was greater in patients diagnosed with COVID-19.
The elderly population frequently consults the emergency department (ED). This population could have greater use of EDs and hospital health resources. The EDEN cohort of patients aged 65 years or ...older visiting the ED allowed this association to be investigated. To analyse the association between healthcare resource use and the characteristics of patients over 65 years of age who consult hospital EDs. We performed an analysis of the EDEN cohort, a retrospective, analytical, and multipurpose registry that includes patients over 65 years of age who consulted in 52 Spanish EDs. The impact of age, sex, and characteristics of ageing on the following outcomes was studied: need for hospital admission (primary outcome) and need for observation, stay in the ED > 12 h, prolonged hospital stay > 7 days, need for intensive care unit (ICU) and return to the ED at 30 days related to the index visit (secondary outcomes). The association was analysed by calculating the adjusted odds ratios (aOR) and their 95% confidence intervals (CI), using a logistic regression model. A total of 25,557 patients with a mean age of 78.3 years were analysed, 45% were males. Of note was the presence of comorbidity, a Charlson index ≥ 3 (33%), and polypharmacy (66%). Observation in the ED was required by 26%, 25.4% were admitted to the hospital, and 0.9% were admitted to the ICU. The ED stay was > 12 h in 12.5% and hospital stay > 7 days in 13.5% of cases. There was a progressive increase in healthcare resource use based on age, with an aOR for the need for observation of 2.189 (95% CI 2.038-2.352), ED stay > 12 h 2.136 (95% CI 1.942-2.349) and hospital admission 2.579 (95% CI 2.399-2.772) in the group ≥ 85 years old. Most of the characteristics inherent to ageing (cognitive impairment, falls in the previous 6 months, polypharmacy, functional dependence, and comorbidity) were associated with significant increases in the use of healthcare resources, except for ICU admission, which was less in all the variables studied. Age and the characteristics inherent to ageing are associated with greater use of structural healthcare resources.The elderly population frequently consults the emergency department (ED). This population could have greater use of EDs and hospital health resources. The EDEN cohort of patients aged 65 years or older visiting the ED allowed this association to be investigated. To analyse the association between healthcare resource use and the characteristics of patients over 65 years of age who consult hospital EDs. We performed an analysis of the EDEN cohort, a retrospective, analytical, and multipurpose registry that includes patients over 65 years of age who consulted in 52 Spanish EDs. The impact of age, sex, and characteristics of ageing on the following outcomes was studied: need for hospital admission (primary outcome) and need for observation, stay in the ED > 12 h, prolonged hospital stay > 7 days, need for intensive care unit (ICU) and return to the ED at 30 days related to the index visit (secondary outcomes). The association was analysed by calculating the adjusted odds ratios (aOR) and their 95% confidence intervals (CI), using a logistic regression model. A total of 25,557 patients with a mean age of 78.3 years were analysed, 45% were males. Of note was the presence of comorbidity, a Charlson index ≥ 3 (33%), and polypharmacy (66%). Observation in the ED was required by 26%, 25.4% were admitted to the hospital, and 0.9% were admitted to the ICU. The ED stay was > 12 h in 12.5% and hospital stay > 7 days in 13.5% of cases. There was a progressive increase in healthcare resource use based on age, with an aOR for the need for observation of 2.189 (95% CI 2.038-2.352), ED stay > 12 h 2.136 (95% CI 1.942-2.349) and hospital admission 2.579 (95% CI 2.399-2.772) in the group ≥ 85 years old. Most of the characteristics inherent to ageing (cognitive impairment, falls in the previous 6 months, polypharmacy, functional dependence, and comorbidity) were associated with significant increases in the use of healthcare resources, except for ICU admission, which was less in all the variables studied. Age and the characteristics inherent to ageing are associated with greater use of structural healthcare resources.
Drug facilitated crimes by “burundanga” or scopolamine Fernández Alonso, Cesáreo; Descalzo Casado, Elena; Quintela Jorge, Oscar ...
Spanish Journal of Legal Medicine,
April-June 2022, 2022-04-00, Volume:
48, Issue:
2
Journal Article
Peer reviewed
Burundanga or potion with scopolamine is a substance that has gained great notoriety in cases of drug facilitated crimes (DFC). San Carlos Clinical Hospital (SCCH) has a clinical practice guide in ...suspected DFC. The toxicological analysis (TA) is carried out at the National Institute of Toxicology and Forensic Sciences (INTCF) in Madrid.
To analyze cases of suspicion of DFC due to scopolamine in SCCH.
Retrospective observational study of cases registered as possible SQ in the HCSC with scopolamine identified in the toxicological analysis (TA) between March 2015 and 2021.
In only 1 of 292 (0.3%) records in the SCCH were identified scopolamine (128, ng / mL) in urine using liquid chromatography techniques coupled with mass spectrometry. A 34-year-old man was referred to the emergency room for anticholinergic symptoms, referring to a crime against property.
Scopolamine is a substance identified in an exceptional way in cases of suspected SQ in SCCH.
La Burundanga o brebaje con escopolamina ha acaparado gran notoriedad en los casos de sumisión química (SQ). El Hospital Clínico San Carlos (HCSC) dispone de una guía de práctica clínica ante la sospecha de SQ. El análisis toxicológico (AT) se realiza en el Instituto Nacional de Toxicología y Ciencias Forenses (INTCF) de Madrid.
Analizar casos de sospecha de SQ en el HCSC con detección de la escopolamina en el AT.
Estudio observacional retrospectivo de casos registrados como posible SQ en el HCSC con presencia de la escopolamina identificada en el AT entre marzo de 2015 y de 2021.
En solo 1 de 292 (0,3%) registros en el HCSC se identificó escopolamina (128,ng/mL) en orina mediante técnicas de cromatografía de líquidos acoplada a espectrometría de masas. Un varón de 34 años fue atendido en Urgencias por síntomas anticolinérgicos refiriendo delito contra la propiedad.
La escopolamina es una sustancia identificada de manera excepcional en casos de sospecha de SQ en el HCSC.
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