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INTRODUCTION: There are many variables to be considered in the withdrawal of treatment for epileptic seizures, which requires a risk-benefit assessment. PATIENTS AND METHODS: A retrospective study of patients in a neuropaediatric practice who required the reintroduction of treatment for epilepsy after its initial withdrawal, and who continue to receive anti-seizure drugs. RESULTS: Twenty-three of 57 children whose treatment was withdrawn are currently being administered the treatment as a monotherapy. Attempts at withdrawal were made with 17 patients, with a mean seizure-free period of 26 months; range: 8-47 months (excluding one patient who never stopped presenting seizures). Mean age at the time of the last known data: 16 years; range: 7-28 years. Average time until the first seizure after withdrawal: 12 months; range: 1-82 months. Seizures persist despite the current treatment administered in eight cases. Two or three attempts to withdraw treatment were made in six patients, with a mean seizure-free period of 28.6 months; range: 22-48 months. Mean age at the time of the last known data: 18.68 years; range: 13-37 years. Average time until the first seizure after withdrawal: 8.2 months; range: 1-30 months. They presented seizures after treatment four was reintroduced. 52% of the patients presented seizures while receiving the drug, which was discontinued. The treatment was withdrawn in cases meeting criteria for persistent seizures: three refractory epilepsies, five symptomatic focal epilepsies, four cases with intellectual disability, five adolescent-onset epilepsies, and failures in previous withdrawal in 23 cases and 30 attempts. CONCLUSION: The decision to withdraw treatment must be personalised, and consider the risk of relapse, taking into account efficacy and tolerability, and behaviour and neurodevelopment in particular.

TITLE: Retirada y reintroducción del tratamiento farmacológico de la epilepsia en pacientes pediátricos. Nuestra experiencia.Introducción. Existen muchas variables que se deben considerar en la retirada del tratamiento anticrisis epilépticas, que precisa una evaluación riesgo-beneficio. Pacientes y métodos. Estudio retrospectivo en pacientes de una consulta de neuropediatría que precisaron reintroducir el tratamiento de la epilepsia tras su retirada inicial y continúan con fármacos anticrisis epilépticas. Resultados. De 57 niños a quienes se les retiró el tratamiento, 23 lo llevan actualmente, todos en monoterapia. En 17 se realizó un intento de retirada, con tiempo medio previo sin crisis de 26 meses; rango: 8-47 meses (excluido uno que nunca dejó de presentarlas). Edad media en el momento de los últimos datos conocidos: 16 años; rango: 7-28 años. Tiempo medio hasta nueva crisis tras retirada: 12 meses; rango: 1-82 meses. En ocho casos persisten crisis pese al tratamiento actual. En seis se realizaron 2-3 intentos, con un tiempo medio previo sin crisis de 28,6 meses; rango: 22-48 meses. Edad media en el momento de los últimos datos conocidos: 18,68 años; rango: 13-37 años. Tiempo medio hasta nueva crisis tras retirada: 8,2 meses; rango: 1-30 meses. Presentaron crisis una vez reintroducido el tratamiento cuatro. Había presentado crisis recibiendo el fármaco que se suspendió, el 52%. Se retiró el tratamiento a casos con criterios de persistencia de crisis: tres epilepsias refractarias, cinco focales sintomáticas, cuatro con discapacidad intelectual, cinco epilepsias de inicio en la adolescencia, y en 23 casos y 30 intentos fallidos en la retirada previa. Conclusión. La decisión de retirada debe ser individualizada, conociendo el riesgo de recaída, atendiendo a la eficacia y la tolerabilidad, especialmente el comportamiento y el neurodesarrollo.

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The field of carbocatalysis, often portrayed by paradigmatic graphitic carbonaceous structures, has become a booming topic tailored for multiple applications. To this end, a new metal-free carbocatalyst has been constructed from simple prebiotic monomers such as cyanamide and glyoxal. The resulting material shows an excellent performance as photocatalyst for H2 production and CO2 valorization, thus unveiling its real value to tackle sustainable goals. The unique oxygen-rich carbonaceous structure has been characterized in detail, which is consistent with a graphitic layered network. The described performance in two major societal concerns along with a facile preparation from C1/C2 platforms, makes this type of overlooked oxynitride carbocatalysts promising for real-life environmental endeavors.

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OBJECTIVE: There is early evidence about Valproic acid (VPA) antiviral effect. Our aim was to investigate the incidence and severity of SARS-CoV-2 infection in VPA users as compared with the general population. MATERIAL AND METHODS: A case-control study nested within a cohort, carried out between March 1 and December 17, 2020. Retrospectively, we identified confirmed SARS-CoV-2 infection patients exposed to VPA in our health department (defined as case). We ascertained VPA regimen (all the time (AT) (292 days) or at least 20% of the study period (notAT) (≥58 days) and if VPA levels were in therapeutic range (ATR) (50-100mcg/mL) in the last 24 months. We calculated the cumulative incidence of SARS-CoV-2 infection and hospital admission in the cases, comparing it with the general unexposed VPA population (controls). RESULTS: During the study period, 6183 PCR+ were detected among 281,035 inhabitants, of these, 746 were hospitalized. 691 patients were on VPA notAT and 628 (90.1%) AT. The indication for VPA use was epilepsy in 54.9%. The incidence of PCR+ was 1.736% (OR 0.785 (95%CI 0.443-1.390) and 1.910% (OR 0.865 (95%CI 0.488-1.533), on VPA notAT and VPA AT patients, respectively vs. 2.201% in people without VPA regimen. Those patients with VPA ATR had a lower risk of PCR + (OR 0.233 (95%CI 0.057-0.951) notAT; OR 0.218 (95%CI 0.053-0.890) AT). Hospital admission incidence was lower in patient on VPA (OR was 0.543 (95% CI 0.076-3.871). CONCLUSION: Patients with VPA within the therapeutic range had a reduction of SARS-Cov-2 infection incidence greater than 75%. There is a downward trend in the risk of COVID-19 admission by SARS-CoV-2 in patients on VPA therapy. These findings warrant further investigation.

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A new method to investigate disorder in ice films is proposed and applied to acetylene ice. It is based on a quantitative analysis of the infrared spectrum data, which includes: the Brendel-Bormann model for the material's dielectric function; molecular vibration modes calculated by density functional theory (DFT); a monomer-dimer model for amorphous ice; and a peak-shape analysis through Levenberg-Marquardt nonlinear regression. Acetylene ice films with different degrees of disorder were investigated with the proposed method. The results provide an estimate of the degree of disorder in the films and indicate the possibility of existence of a second amorphous phase of acetylene ice grown at temperatures of about 15 K and then annealed. This phase would be similar to the high-density amorphous phase observed for water ice. The infrared data in this work is compared with those from the literature for acetylene gas, acetylene film, and acetylene aerosol. A qualitative analysis reveals differences in the degree of disorder in each system and points to a crystallinity limit for acetylene ice film; that is, the crystalline acetylene film has a higher degree of intrinsic disorder than the crystalline acetylene aerosol.

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BACKGROUND AND AIMS: In recent years, scientific interest in triglyceride-rich lipoproteins (TRL) and remnant cholesterol has increased, focusing on the evidence that these lipoproteins are a causal factor for developing atherosclerotic cardiovascular disease (ASCVD). Furthermore, a high remnant concentration (>38 mg/dL) has been associated with several non-cardiovascular risks. We aimed in this study to describe the percentile distribution of remnant cholesterol. Additionally, we evaluated the association between remnant cholesterol plasma concentration and epidemiologically relevant cardio-metabolic outcomes such as hypertension, type 2 diabetes (T2D), and ASCVD. METHODS: We analyzed data from 9,591 adults from the National Survey of Health and Nutrition (ENSANUT) 2018 with fasting blood samples and complete medical history questionnaires. We built multivariate models to evaluate the association between chronic diseases and blood remnant concentration. To compare our 2018-sub-sample against a population reference, we used the NHANES (2005-2014) publicly available datasets by ethnicity. RESULTS: Remnants were independently associated with cardiovascular risk, diabetes, hypertension, obesity, and metabolic syndrome. For all outcomes, the blood remnant concentration was a stronger predictor than LDL. At all deciles, the blood remnant concentration was higher in ENSANUT-2018. CONCLUSIONS: A remnant blood concentration above 38 mg/dL was highly prevalent among Mexicans. Remnants were significantly associated with a higher risk of diabetes, hypertension, obesity, and cardiovascular risk. This association occurred independently of other lipid markers.

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The reverse anomeric effect is usually associated with the equatorial preference of nitrogen substituents at the anomeric center. Once postulated as another anomeric effect with explanations ranging from electrostatic interactions to delocalization effects, it is now firmly considered to be essentially steric in nature. Through an extensive research on aryl imines from 2-amino-2-deoxyaldoses, spanning nearly two decades, we realized that such substances often show an anomalous anomeric behavior that cannot easily be rationalized on the basis of purely steric grounds. The apparent preference, or stabilization, of the ß-anomer takes place to an extent that not only neutralizes but also overcomes the normal anomeric effect. Calculations indicate that there is no stereoelectronic effect opposing the anomeric effect, resulting from the repulsion between electron lone pairs on the imine nitrogen and the endocyclic oxygen. Such data and compelling structural evidence unravel why the exoanomeric effect is largely inhibited. We are now confident, as witnessed by 2-iminoaldoses, that elimination of the exo-anomeric effect in the α-anomer is due to the formation of an intramolecular hydrogen bond between the anomeric hydroxyl and the iminic nitrogen, thereby accounting for a true electronic effect. In addition, discrete solvation may help justify the observed preference for the ß-anomer.

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Although postpartum Ca supplementation strategies are often employed to prevent subclinical hypocalcemia in dairy cows, these strategies have produced a mix of beneficial, neutral, and detrimental results when assessing milk yield and subsequent disease outcomes. Because the mechanisms underlying these differing results are unknown, our objectives were to determine how common postpartum Ca supplementation strategies affect blood Ca concentrations and parathyroid hormone (PTH). We conducted a randomized controlled trial with 74 multiparous dairy cows on a commercial dairy in central New York. Cows were assigned to 1 of 4 supplementation groups immediately after calving: (1) control (CON; no Ca supplementation, n = 15); (2) conventional oral Ca supplementation (BOL-C; 43 g of oral Ca bolus administered immediately after calving and 24 h later, n = 17); (3) delayed oral Ca supplementation (BOL-D; 43 g of oral Ca bolus administered 48 and 72 h after calving, n = 15); or (4) subcutaneous infusion (SQ; 500 mL of 23% Ca borogluconate infused subcutaneously once immediately after calving, n = 15). Blood samples were collected immediately after calving (0 h) and at 8, 16, 24, 32, 40, 48, 56, 64, 72, 80, 88, 96, 120, and 168 h postpartum for a total of 15 blood samples per cow. Cows were excluded if administered Ca, via any route, by farm employees or if they died or were sold within 96 h following parturition, which left 62 cows for analysis. Linear mixed models, accounting for repeated measures, were created to analyze changes in serum total Ca (tCa) and PTH over the first 168 h after parturition and assess differences between supplementation groups. Serum tCa and PTH concentrations were not different at the time of calving among supplementation groups. There was a supplementation group by hour postcalving interaction for mean tCa concentration in which SQ cows had reduced tCa concentrations from 32 to 64 h compared with CON cows, 32 to 96 h compared with BOL-C cows, and 40 to 64 h compared with BOL-D cows. Mean PTH concentration did not differ among supplementation groups across 168 h after enrollment and was 158.1 pmol/L (95% confidence interval [CI] = 148.2 to 168.0) for CON cows, 164.0 pmol/L (95% CI = 154.9 to 173.1) for BOL-C cows, 158.7 pmol/L (95% CI = 149.2 to 168.1) for BOL-D cows, and 153.2 pmol/L (95% CI = 143.6 to 162.8) for SQ cows. Our findings suggest that although serum tCa does not differ between cows that receive conventional or delayed oral Ca bolus supplementation at calving and cows that receive no supplemental Ca, subcutaneous infusion of Ca at calving reduces serum tCa for a substantial period between 32 and 64 h postsupplementation. However, as PTH concentrations did not differ among groups across 168 h postpartum, the mechanism by which tCa is reduced remains unclear.

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Objective: We aimed to determine the prevalence of self-reported swallowing difficulty (dysphagia) among older Colombians and to explore the factors associated with this condition. Methods: This study presents a secondary analysis of the SABE-Colombia survey, a crosssectional study of community-dwelling older adults. The dependent variable was self reported swallowing difficulty, assessed through the question: "How often do you have difficulty or discomfort swallowing?" Descriptive and bivariate analyses of the sample were performed, followed by multivariate analysis, adjusting for confounding variables. Results: The final sample included 19 004 older Colombians, whose mean age was 69 years (56% women). The overall prevalence of swallowing difficulty was 12.2%. In the multivariate analysis, significant associations were observed between swallowing difficulty and several factors, including male sex (OR 1.14, 95%CI 1.03 ­ 1.26), age > 80 years (OR 1.26, 95%CI 1.08 ­ 1.47), dependence in activities of daily living (OR 1.62, 95%CI 1.23 ­ 2.13), cognitive impairment (OR 1.49, 95%CI 1.30 ­ 1.70), depressive symptoms (OR 1.38, 95%CI 1.15 ­ 1.65), sarcopenia (OR 1.32, 95%CI 1.02 ­ 1.69), malnutrition (OR 1.35, 95%CI 1.23 ­ 1.49), and osteoarticular disease (OR 1.18, 95%CI 1.07 ­ 1.38). Conclusion: There was a high prevalence of swallowing difficulty among older community-dwelling Colombians. Our results showed a strong correlation between swallowing difficulty and risk factors such as cognitive impairment, depressive symptoms, osteoarticular disease, and dependence in activities of daily living, but not with malnutrition or sarcopenia. (AU)

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Microplastics are a complex mix of chemicals containing polymers and certain plastic additives such as bisphenols and phthalates. These particles are porous materials that can also sorb contaminants from their surroundings, and leach chemicals from the particle under certain circumstances. Aquatic animals can ingest microplastic particles, which mostly bioaccumulate in the gastrointestinal tract of animals. In terms of dietary exposure, small animals consumed whole such as mussels, contribute more to the dietary intake of microplastic particles. Plastic additives and contaminants are not chemically bound to the polymers, and certain processing methods or cooking processes result in the release of these chemicals that leach from the plastic particles, leaving them more available for absorption when ingested. Analytical methods are crucial for a better understanding of the occurrence of plastic additives and contaminants in aquatic products, and to know certain circumstances and treatments that influence human exposure. This study uses an MSPD-HPLC methodology for the simultaneous determination of 9 analytes (BPA, BPF, BPS, DEP, DBP, DEHP, DDD, DDT, and DDE) analyzing, for the first time, the occurrence of these chemicals in raw, steamed and canned mussels of two different harvesting areas (Atlantic and the Mediterranean), becoming one of the most efficient methodologies for determining the presence of these analytes in very complex food matrices, able to define the changes in cooking and processing activities. The results showed that the heat and pressure treatment could influence the migration of plastic additives from microplastic particles present in mussels to the cooking liquids.

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OBJECTIVES: Immunisation against preventable diseases as meningitis is crucial from a public health perspective to face challenges posed by these infections. Nurses hold a great responsibility for these programs, which highlights the importance of understanding their preferences and needs to improve the success of campaigns. This study aimed to investigate nurses' preferences regarding Meningococcus A, C, W, and Y (MenACWY) conjugate vaccines commercialised in Spain. STUDY DESIGN: A national-level discrete choice experiment (DCE) was conducted. METHODS: A literature review and a focus group informed the DCE design. Six attributes were included: pharmaceutical form, coadministration evidence, shelf-life, package contents, single-doses per package, and package volume. Conditional logit models quantified preferences and relative importance (RI). RESULTS: Thirty experienced primary care nurses participated in this study. Evidence of coadministration with other vaccines was the most important attribute (RI = 43.78%), followed by package size (RI = 22.17%), pharmaceutical form (RI = 19.07%), and package content (RI = 11.80%). There was a preference for evidence of coadministration with routine vaccines (odds ratio [OR] = 2.579, 95% confidence interval [95%CI] = 2.210-3.002), smaller volumes (OR = 1.494, 95%CI = 1.264-1.767), liquid formulations (OR = 1.283, 95%CI = 1.108-1.486) and package contents including only vial/s (OR = 1.283, 95%CI = 1.108-1.486). No statistical evidence was found for the remaining attributes. CONCLUSIONS: Evidence of coadministration with routine vaccines, easy-to-store packages, and fully liquid formulations were drivers of nurses' preferences regarding MenACWY conjugate vaccines. These findings provide valuable insights for decision-makers to optimize current campaigns.

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OBJECTIVE: The aim of this study was to perform a systematic review of the usefulness of suPAR as a prognostic marker in non-critical COVID-19 patients. MATERIALS AND METHODS: We carried out a literature search in MEDLINE, Embase, and Web of Science using the following keywords: ("soluble urokinase receptor" OR "urokinase plasminogen activator receptor" OR "suPAR" OR "soluble uPAR" OR "soluble uPA receptor") AND ("COVID-19" OR "SARS-CoV-2"). We included observational studies (descriptive or analytic) that measured plasma suPAR on COVID-19 patients 18 years old or older, with non-critical disease at the beginning of the study. RESULTS: After screening and eligibility assessment, a total of 16 articles were included in the review. Most studies that measured mean differences found that suPAR levels were higher in patients with worse outcomes. The studies that measured diagnostic accuracy concluded that suPAR was highly sensitive and moderately specific to predicting bad outcomes. Studies that performed a survival analysis found that patients with high suPAR levels were more at risk of bad outcomes. Most of the studies included in this review were performed before extensive vaccination and omicron wave. CONCLUSIONS: COVID-19 patients with moderate initial disease and elevated suPAR levels are more at risk of poor outcomes. Larger prospective clinical trials are needed to confirm the results obtained in this review.

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OBJECTIVE: The purpose was to analyze age-standardized trends in diabetes mortality rates (DMR) from 1998 to 2022, stratified by sex and Mexican state, and the effects attributable to age, period, and cohort by sex. STUDY DESIGN: Joinpoint regression and age-period-cohort effect analysis. METHODS: Based on the tenth revision of the International Classification of Diseases, E11, E12, E13, and E14 codes of the death certificate, a daily record of mortality was extracted from the death certificate attributable to diabetes as the main cause. From 1998 to 2022, sexes and ages (≥20 years) were used to calculate the crude mortality rates and standardized at the national and Mexican state levels. Additionally, the age-period-cohort model was used to examine age, period, and cohort effects. RESULTS: From 1998 to 2005, the age-adjusted DMR increased by 3.6% (95% confidence interval [CI]: 2.7, 4.5) for the total population, as shown by the joinpoint regression analysis at a national level; from 2017 to 2020, it increased by 7.4% (95% CI: 0.6, 14.8). The DMR with the highest increase during the study period came mainly from states in the country's southeastern region, 2.3% to 3.7% per year. The net age and period effects showed that mortality increased with advancing age and with going time, respectively; and the net cohort effect revealed that mortality increased in more recent birth cohorts, mainly in men Rate Ratio (RR) = 2.37 (95% CI: 2.29, 2.46) vs RR = 1.13 (95% CI: 1.09, 1.17). CONCLUSION: The DMR increased among older age groups. The period effect showed that mortality increased over time. Furthermore, the cohort effect showed that mortality increased in more recent birth cohorts, especially among men.

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