Fitness consequences and ancestry loss in the Apennine brown bear after a simulated genetic rescue intervention.

Reduction in population size, with its predicted effects on population fitness, is the most alarming anthropogenic impact on endangered species. By introducing compatible individuals, genetic rescue (GR) is a promising but debated approach for reducing the genetic load unmasked by inbreeding and for restoring the fitness of declining populations. Although GR can improve genetic diversity and fitness, it can also produce loss of ancestry, hampering local adaptation, or replace with introduced variants the unique genetic pools evolved in endemic groups. We used forward genetic simulations based on empirical genomic data to assess fitness benefits and loss of ancestry risks of GR in the Apennine brown bear (Ursus arctos marsicanus). There are approximately 50 individuals of this isolated subspecies, and they have lower genetic diversity and higher inbreeding than other European brown bears, and GR has been suggested to reduce extinction risks. We compared 10 GR scenarios in which the number and genetic characteristics of migrants varied with a non-GR scenario of simple demographic increase due to nongenetic factors. The introduction of 5 individuals of higher fitness or lower levels of deleterious mutations than the target Apennine brown bear from a larger European brown bear population produced a rapid 10-20% increase in fitness in the subspecies and up to 22.4% loss of ancestry over 30 generations. Without a contemporary demographic increase, fitness started to decline again after a few generations. Doubling the population size without GR gradually increased fitness to a comparable level, but without losing ancestry, thus resulting in the best strategy for the Apennine brown bear conservation. Our results highlight the importance for management of endangered species of realistic forward simulations grounded in empirical whole-genome data.

Consecuencias en la aptitud y pérdida de ascendencia del oso pardo de los Apeninos después de un rescate genético simulado Resumen La reducción del tamaño poblacional, con los previsibles efectos sobre su aptitud, es el impacto antropogénico más alarmante sobre las especies amenazadas. Mediante la introducción de individuos compatibles, el rescate genético (RG) es una estrategia prometedora para reducir la carga genética revelada por la endogamia y restaurar la aptitud de las poblaciones en declive, aunque todavía se debate la eficiencia de esta. Aunque el RG puede mejorar la diversidad genética y la aptitud, también puede producir pérdida de ascendencia, lo que puede dificultar la adaptación local, o sustituir con variantes introducidas por los migrantes los acervos genéticos únicos que han evolucionado en grupos endémicos. En este trabajo realizamos simulaciones genéticas a futuro basadas en datos genómicos empíricos para evaluar los beneficios del RG en términos de aptitud y los riesgos de la pérdida de ascendencia en el oso pardo de los Apeninos (Ursus arctos marsicanus). Quedan aproximadamente 50 individuos de esta subespecie aislada que cuentan con una menor diversidad genética y un mayor nivel de endogamia comparado con otros osos pardos europeos y se ha sugerido que el RG podria reducir el riesgo de extinción de esta población. Comparamos 10 escenarios de RG en los que variaban el número y las características genéticas de los osos migrantes con un escenario sin RG con aumento demográfico causado por factores no genéticos. La introducción de 5 individuos procedentes de una población europea de oso pardo con mayor aptitud o niveles menores de mutaciones deletéreas que el oso pardo de los Apeninos produjo un rápido aumento de la aptitud del 10-20% en la subespecie y hasta un 22.4% de pérdida de ascendencia durante 30 generaciones. En las simulaciones sin un aumento demográfico, la aptitud empezó a disminuir de nuevo después de unas pocas generaciones. La duplicación del tamaño de la población sin RG aumentó gradualmente la aptitud hasta un nivel comparable al de algunos escenarios de RG, pero sin pérdida de ascendencia, por lo que parece ser la mejor estrategia para la conservación del oso pardo de los Apeninos. Nuestros resultados resaltan la importancia que tienen las simulaciones realistas a futuro basadas en datos empíricos del genoma completo para la gestión de especies amenazadas.

Cerebrospinal fluid transcripts may predict shunt surgery responses in normal pressure hydrocephalus.

Molecular biomarkers for neurodegenerative diseases are critical for advancing diagnosis and therapy. Normal pressure hydrocephalus (NPH) is a neurological disorder characterized by progressive neurodegeneration, gait impairment, urinary incontinence and cognitive decline. In contrast to most other neurodegenerative disorders, NPH symptoms can be improved by the placement of a ventricular shunt that drains excess CSF. A major challenge in NPH management is the identification of patients who benefit from shunt surgery. Here, we perform genome-wide RNA sequencing of extracellular vesicles in CSF of 42 NPH patients, and we identify genes and pathways whose expression levels correlate with gait, urinary or cognitive symptom improvement after shunt surgery. We describe a machine learning algorithm trained on these gene expression profiles to predict shunt surgery response with high accuracy. The transcriptomic signatures we identified may have important implications for improving NPH diagnosis and treatment and for understanding disease aetiology.

Outcomes of lung and liver transplantation after simultaneous recovery using abdominal normothermic regional perfusion in donors after the circulatory determination of death versus donors after brain death.

Normothermic regional perfusion (NRP) in controlled donation after the circulatory determination of death (cDCD) is a growing preservation technique for abdominal organs that coexists with the rapid recovery of lungs. We aimed to describe the outcomes of lung transplantation (LuTx) and liver transplantation (LiTx) when both grafts are simultaneously recovered from cDCD donors using NRP and compare them with grafts recovered from donation after brain death (DBD) donors. All LuTx and LiTx meeting these criteria during January 2015 to December 2020 in Spain were included in the study. Simultaneous recovery of lungs and livers was undertaken in 227 (17%) donors after cDCD with NRP and 1879 (21%) DBD donors (P < .001). Primary graft dysfunction grade-3 within the first 72 hours was similar in both LuTx groups (14.7% cDCD vs. 10.5% DBD; P = .139). LuTx survival at 1 and 3 years was 79.9% and 66.4% in cDCD vs. 81.9% and 69.7% in DBD (P = .403). The incidence of primary nonfunction and ischemic cholangiopathy was similar in both LiTx groups. Graft survival at 1 and 3 years was 89.7% and 80.8% in cDCD vs. 88.2% and 82.1% in DBD LiTx (P = .669). In conclusion, the simultaneous rapid recovery of lungs and preservation of abdominal organs with NRP in cDCD donors is feasible and offers similar outcomes in both LuTx and LiTx recipients to transplants using DBD grafts.

Examining the Role of Histaminergic, Orexinergic, and Cannabinergic Systems in Redox Regulation in Gastric Adenocarcinoma.

Histaminergic, orexinergic, and cannabinoid systems play a role in both physiologic and oncogenic mechanisms in digestive tissues. These three systems are important mediators of tumor transformation, as they are associated with redox alterations, which are key aspects in oncological disorders. The three systems are known to promote alterations in the gastric epithelium through intracellular signaling pathways, such as oxidative phosphorylation, mitochondrial dysfunction, and increased Akt, which might promote tumorigenesis. Histamine promotes cell transformation through redox-mediated alterations in the cell cycle, DNA repair, and immunological response. The increase in histamine and oxidative stress generates angiogenic and metastatic signals through the VEGF receptor and H2R-cAMP-PKA pathway. Immunosuppression in the presence of histamine and ROS is linked to a decrease in dendritic and myeloid cells in gastric tissue. These effects are counteracted by histamine receptor antagonists, such as cimetidine. Regarding orexins, overexpression of the Orexin 1 Receptor (OX1R) induces tumor regression through the activation of MAPK-dependent caspases and src-tyrosine. OX1R agonists are candidates for the treatment of gastric cancer by stimulating apoptosis and adhesive interactions. Lastly, cannabinoid type 2 (CB2) receptor agonists increase ROS, leading to the activation of apoptotic pathways. In contrast, cannabinoid type 1 (CB1) receptor agonists decrease ROS formation and inflammation in gastric tumors exposed to cisplatin. Overall, the repercussion of ROS modulation through these three systems on tumor activity in gastric cancer depends on intracellular and/or nuclear signals associated with proliferation, metastasis, angiogenesis, and cell death. Here, we review the role of these modulatory systems and redox alterations in gastric cancer.

Lung transplantation for interstitial lung disease in idiopathic inflammatory myositis: A cohort study.

In patients with interstitial lung disease (ILD) complicating classical or amyopathic idiopathic inflammatory myopathy (IIM), lung transplantation outcomes might be affected by the disease and treatments. Here, our objective was to assess survival and prognostic factors in lung transplant recipients with IIM-ILD. We retrospectively reviewed data for 64 patients who underwent lung transplantation between 2009 and 2021 at 19 European centers. Patient survival was the primary outcome. At transplantation, the median age was 53 [46-59] years, 35 (55%) patients were male, 31 (48%) had classical IIM, 25 (39%) had rapidly progressive ILD, and 21 (33%) were in a high-priority transplant allocation program. Survival rates after 1, 3, and 5 years were 78%, 73%, and 70%, respectively. During follow-up (median, 33 [7-63] months), 23% of patients developed chronic lung allograft dysfunction. Compared to amyopathic IIM, classical IIM was characterized by longer disease duration, higher-intensity immunosuppression before transplantation, and significantly worse posttransplantation survival. Five (8%) patients had a clinical IIM relapse, with mild manifestations. No patient experienced ILD recurrence in the allograft. Posttransplantation survival in IIM-ILD was similar to that in international all-cause-transplantation registries. The main factor associated with worse survival was a history of muscle involvement (classical IIM). In lung transplant recipients with idiopathic inflammatory myopathy, survival was similar to that in all-cause transplantation and was worse in patients with muscle involvement compared to those with the amyopathic disease.

Double-Lung Transplantation in a Patient with Pulmonary Type B Niemann-Pick Disease: A Valid Treatment Option.

Niemann-Pick disease is a rare autosomal recessive disease characterized by an abnormal intracellular lipid accumulation. Type B is later in onset and a less severe form of the disease, so affected people may survive in adulthood. Storage of sphingomyelin in pulmonary macrophages can lead to interstitial lung disease. There are very few published cases of lung transplantation in patients with Niemann-Pick disease, all of them described in the last 2 years. We present here one case of a 57-year-old man successfully treated with a double-lung transplant.

Lung transplantation from controlled donation after circulatory death using simultaneous abdominal normothermic regional perfusion: A single center experience.

Despite the benefits of abdominal normothermic regional perfusion (A-NRP) for abdominal grafts in controlled donation after circulatory death (cDCD), there is limited information on the effect of A-NRP on the quality of the cDCD lungs. We aimed to study the effect of A-NRP in lungs obtained from cDCD and its impact on recipients´ outcomes. This is a study comparing outcomes of lung transplants (LT) from cDCD donors (September 2014 to December 2021) obtained using A-NRP as the abdominal preservation method. As controls, all lung recipients transplanted from donors after brain death (DBD) were considered. The primary outcomes were lung recipient 3-month, 1-year, and 5-year survival. A total of 269 LT were performed (60 cDCD and 209 DBD). There was no difference in survival at 3 months (98.3% cDCD vs. 93.7% DBD), 1 year (90.9% vs. 87.2%), and 5 years (68.7% vs. 69%). LT from the cDCD group had a higher rate of primary graft dysfunction grade 3 at 72 h (10% vs. 3.4%; p <  .001). This is the largest experience ever reported with the use of A-NRP combined with lung retrieval in cDCD donors. This combined method is safe for lung grafts presenting short-term survival outcomes equivalent to those transplanted through DBD.

An integrative water quality evaluation in two surface water bodies from a tropical agricultural region in Cartago, Costa Rica.

A monitoring study was carried out in two micro-catchments in the Reventazón basin, in Northern Cartago, Costa Rica; pesticide occurrence and water quality were analyzed. Twelve pesticides were detected, five insecticides (chlorpyrifos, carbofuran, cypermethrin, imidacloprid, and oxamyl), four fungicides (carbendazim, imazalil, metalaxyl, and thiabendazole), and three herbicides (diuron, linuron, and terbutryn); eight of them presented risk quotients RQ >1, which implies a high risk for the environment. The water quality evaluation included fourteen physicochemical and microbiological parameters, out of which thermotolerant coliforms, nitrate, and total phosphorus exceeded a selected threshold value in every sample. Five metals were also included in the evaluation, Pb was the most frequent, followed by few detections of Cd, Cu, and Cr. Four water quality indexes (WQIs) were applied, two of them, the CCME WQI, based on physicochemical parameters, and the BMWP-CR WQI, based on benthic macroinvertebrate recount adapted to Costa Rican species, categorized all the sampling points as "bad" and "very bad" quality. This work of monitoring is important in the Latin American region, where there is a lack of information for regulation improvement and management decisions. These results showed poor management of the micro-catchments in this agricultural rural area.

Evaluation of Two Different CMV-Immunoglobulin Regimens for Combined CMV Prophylaxis in High-Risk Patients following Lung Transplant.

BACKGROUND: The clinical benefits of the common off-label use of cytomegalovirus (CMV)-specific immunoglobulin (CMV-Ig) combined with antivirals in organ transplantation have not been previously assessed. The objective was to compare the risk of CMV infection and other post-transplantation outcomes between two CMV-Ig prophylaxis regimens in lung transplant recipients; Methods: Retrospective study of 124 donor CMV positive/recipient negative (D+/R-) patients receiving preventive ganciclovir/valganciclovir for 12 months, of whom 62 received adjunctive CMV-Ig as per label indication (short regimen [SR-Ig]; i.e., 7 doses over 2.5 months) and were compared to 62 who received an extended off-label regimen (ER-Ig) consisting of 17 doses over one year after transplantation. RESULTS: The incidence of CMV infection or disease, acute rejection, chronic lung allograft dysfunction, and survival did not differ between the two CMV-Ig schedules. Although the time to the first CMV infection after transplantation was shorter in the ER-Ig than in the SR-Ig adjunctive group (log-rank: p = 0.002), the risk was independently predicted by antiviral cessation (odds ratio = 3.74; 95% confidence interval = 1.04-13.51; p = 0.030), whereas the CMV-Ig schedule had no effect. CONCLUSIONS: Extending the adjunctive CMV-Ig prophylaxis beyond the manufacturer's recommendations up to one year does not confer additional clinical benefits regarding lung post-transplantation outcomes.

Decálogo en ginecología y obstetricia / Decalogue in Gynecology and Obstetrics

Resumen La temática en salud de la mujer toca demasiados aspectos, desde el nacimiento hasta la senectud. Hay ciertas afecciones que están relacionadas con el sexo biológico, pero también con problemas de sexualidad, desigualdad social y muchos tipos de violencia. Por ello se requiere analizar y adaptar la información en materia de salud, para implementar acciones hacia la población objetivo. Si bien en primera instancia la atención médica involucra la salud física, se han vuelto equiparables la salud mental y la social. Con el enfoque en este grupo de riesgo, se integran lineamientos prácticos, normas e información científica actualizada, para explicar las principales medidas que debe tomar cualquier mujer en todo el curso de su vida, y con ello mantener un estado de salud satisfactorio, buscar atención oportuna en ginecología y obstetricia, ademís de poder definir el plan de seguimiento médico personalizado. Se presentan herramientas prácticas mediante la exposición de un decálogo, denominados mandamientos, que sirven tanto para el médico como para la paciente, a fin de favorecer el bienestar físico, mental y social; sin perder la connotación de los distintos grupos etarios, así como lo alusivo a la función reproductiva y el ciclo gestacional.

Abstract The subject of women's health touches too many aspects, from birth to old age. There are certain conditions that are related to biological sex, but also to problems of sexuality, social inequality, and many types of violence. Therefore, it is necessary to analyze and adapt the information on health, to implement actions towards the target population. Although at first instance medical care involves physical health, mental and social health have become comparable. Focusing on this risk group, practical guidelines, standards and updated scientific information are integrated to explain the main measures that any woman should take throughout her life, and thereby maintain a satisfactory state of health, seek care in Gynecology and Obstetrics, in addition to being able to define the personalized medical follow-up plan. Practical tools are presented through the exposition of a decalogue, called commandments, which serve both the doctor and the patient, in order to promote physical, mental and social well-being; without losing the connotation of the different age groups, as well as the allusion to the reproductive function and the gestational cycle.

Usefulness of the COVID-GRAM and CURB-65 scores for predicting severity in patients with COVID-19.

AIM: The aim of this study was to determine the usefulness of COVID-GRAM and CURB-65 scores as predictors of the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Caucasian patients. METHODS: This was a retrospective observational study including all adults with SARS-CoV-2 infection admitted to Hospital Universitario Marqués de Valdecilla from February to May 2020. Patients were stratified according to COVID-GRAM and CURB-65 scores as being at low-medium or high risk of critical illness. Univariate analysis, multivariate logistic regression models, receiver operating characteristic curve, and area under the curve (AUC) were calculated. RESULTS: A total of 523 patients were included (51.8% male, 48.2% female; mean age 65.63 years (standard deviation 17.89 years)), of whom 110 (21%) presented a critical illness (intensive care unit admission 10.3%, 30-day mortality 13.8%). According to the COVID-GRAM score, 122 (23.33%) patients were classified as high risk; 197 (37.7%) presented a CURB-65 score ≥2. A significantly greater proportion of patients with critical illness had a high COVID-GRAM score (64.5% vs 30.5%; P < 0.001). The COVID-GRAM score emerged as an independent predictor of critical illness (odds ratio 9.40, 95% confidence interval 5.51-16.04; P < 0.001), with an AUC of 0.779. A high COVID-GRAM score showed an AUC of 0.88 for the prediction of 30-day mortality, while a CURB-65 ≥2 showed an AUC of 0.83. CONCLUSIONS: The COVID-GRAM score may be a useful tool for evaluating the risk of critical illness in Caucasian patients with SARS-CoV-2 infection. The CURB-65 score could be considered as an alternative.

Methylprednisolone in adults hospitalized with COVID-19 pneumonia : An open-label randomized trial (GLUCOCOVID).

PURPOSE: To determine whether a 6-day course of methylprednisolone (MP) improves outcome in patients with severe SARS-CoV­2 (Corona Virus Disease 2019 [COVID-19]). METHODS: The study was a multicentric open-label trial of COVID-19 patients who were aged ≥ 18 years, receiving oxygen without mechanical ventilation, and with evidence of systemic inflammatory response who were assigned to standard of care (SOC) or SOC plus intravenous MP (40 mg bid for 3 days followed by 20 mg bid for 3 days). The primary outcome was a composite of death, admission to the intensive care unit, or requirement for noninvasive ventilation. Both intention-to-treat (ITT) and per protocol (PP) analyses were performed. RESULTS: A total of 91 patients were screened, and 64 were randomized (mean age70 ± 12 years). In the ITT analysis, 14 of 29 patients (48%) in the SOC group and 14 of 35 (40%) in the MP group suffered the composite endpoint (40% versus 20% in patients under 72 years and 67% versus 48% in those over 72 years; p = 0.25). In the PP analysis, patients on MP had a significantly lower risk of experiencing the composite endpoint (age-adjusted risk ratio 0.42; 95% confidence interval, CI 0.20-0.89; p = 0.043). CONCLUSION: The planned sample size was not achieved, and our results should therefore be interpreted with caution. The use of MP had no significant effect on the primary endpoint in ITT analysis; however, the PP analysis showed a beneficial effect due to MP, which consistent with other published trials support the use of glucocorticoids in severe cases of COVID-19.

Pharmaceuticals in farms and surrounding surface water bodies: Hazard and ecotoxicity in a swine production area in Costa Rica.

The presence of pharmaceuticals in the environment is known to have multiple origins; livestock activities comprise one scarcely studied source, both globally and specially in Latin-America. This work aims to study the occurrence of pharmaceuticals in wastewater from swine farms and their surrounding surface waters, in a highland livestock production area of Costa Rica. The monitoring of 70 pharmaceutical active compounds resulted in the detection of 10 molecules in farm wastewater (influents and effluents of the on-farm treatment system), including compounds of animal and human use. A 57% of effluents showed high hazard (ΣHQ > 1), mainly due to the compounds risperidone, ketoprofen, ibuprofen and naproxen. Additionally, ecotoxicological tests with Daphnia magna and Microtox classified at least 21% of the effluents as very toxic (10 < TU ≤ 100); likewise, 86% of effluents exhibited germination index (GI) inhibition values over 90% for Lactuca sativa. Seven molecules were detected in surface water, six of them of human use (1,7-dimethylxanthine, caffeine, cephalexin, carbamazepine, gemfibrozil, ibuprofen) and one (acetaminophen) of dual (human and veterinary) use; nonetheless, most of the detections were found in sampling points closer to human settlements than animal farms. Considering the set of molecules and their distribution, the livestock influence on surface water seems minimal in comparison with the urban influence. Only 16% of surface water samples showed high risk, mainly due to ibuprofen, gemfibrozil and caffeine; similarly, 45% samples presented GI inhibition >20% (no toxicity was determined towards Daphnia magna or Microtox). These findings in surface water suggest an incipient environmental risk in the area.

Pesticide occurrence and water quality assessment from an agriculturally influenced Latin-American tropical region.

A monitoring study was carried out in three agriculturally influenced microcatchments in Costa Rica during 2012-2014, for pesticides and water quality parameters. A total of 42 pesticides were analyzed, detecting the following in water samples: two herbicides (oxyfluorfen, diuron), four insecticides (carbofuran, chlorpyrifos, oxamyl, ethion), and two fungicides (thiabendazole, carbendazim); while in sediment samples only the insecticides, chlorpyrifos and cypermethrin were found. Water quality was also assessed by the Canadian Council of Ministers of the Environment Water Quality Index and the National Sanitation Water Quality Index, the first one classified most of the sampling point as marginal and poor quality while the second one classified most of them as good quality, the most affected parameters were nitrate, phosphorous, suspended solids and organic matter content. The results suggest that the water quality in the microcatchments seems to be affected by the nearby agricultural and urban activities in the region.

COVID-19 in lung transplant recipients: A multicenter study.

This study describes the clinical presentation, treatment, and outcomes of SARS-CoV-2 infection in lung transplant recipients (LTRs). This is a multicenter, retrospective study of all adult LTRs with confirmed SARS-CoV-2 infection from March 4 until April 28, 2020 in six Spanish reference hospitals for lung transplantation. Clinical and radiological data, treatment characteristics, and outcomes were reviewed. Forty-four cases were identified in that period. The median time from transplantation was 4.2 (interquartile range: 1.11-7.3) years. Chest radiography showed acute parenchymal abnormalities in 32 (73%) cases. Hydroxychloroquine was prescribed in 41 (93%), lopinavir/ritonavir (LPV/r) in 14 (32%), and tocilizumab in 19 (43%) patients. There was a strong interaction between tacrolimus and LPV/r in all cases. Thirty-seven (84%) patients required some degree of respiratory support and/or oxygen therapy, and 13 (30%) were admitted to intermediate or intensive critical care units. Seventeen (39%) patients had died and 20 (45%) had been discharged at the time of the last follow-up. Deceased patients had a worse respiratory status and chest X-ray on admission and presented with higher D-dimer, interleukin-6, and lactate dehydrogenase levels. In this multicenter LTR cohort, SARS-CoV-2 presented with high mortality. Additionally, the severity of disease on presentation predicted subsequent mortality.

Occurrence of pharmaceuticals, hazard assessment and ecotoxicological evaluation of wastewater treatment plants in Costa Rica.

The continuous release of pharmaceuticals from WWTP effluents to freshwater is a matter of concern, due to their potential effects on non-target organisms. The occurrence of pharmaceuticals in WWTPs and their associated hazard have been scarcely studied in Latin American countries. This study aimed at monitoring for the first time the occurrence of 70 pharmaceutical active compounds (PhACs) in WWTPs across Costa Rica; the application of the hazard quotient (HQ) approach coupled to ecotoxicological determinations permitted to identify the hazard posed by specific pharmaceuticals and toxicity of the effluents, respectively. Thirty-three PhACs were found, with 1,7-dimethylxanthine, caffeine, acetaminophen, ibuprofen, naproxen, ketoprofen and gemfibrozil being the most frequently detected (influents/effluents). HQ for specific pharmaceuticals revealed 24 compounds with high/medium hazard in influents, while the amount only decreased to 21 in effluents. The top HQ values were obtained for risperidone, lovastatin, diphenhydramine and fluoxetine (influent/effluent samples), plus caffeine (influent) and trimethoprim (effluent). Likewise, the estimation of overall hazard in WWTP samples (sum of individual HQ, ∑HQ) demonstrated that every influent and 96% of the effluents presented high hazard towards aquatic organisms. Ecotoxicological analysis (Daphnia magna, Lactuca sativa and Microtox test) revealed that 16.7% of the effluents presented toxicity towards all benchmark organisms; the phytotoxicity was particularly frequent, as inhibition values ≥20% in the germination index for L. sativa were obtained for all the effluents. The ∑HQ approach estimated the highest hazard in urban wastewater, while the ecotoxicological results showed the highest toxicity in hospital and landfill wastewater. Likewise, ecotoxicological results and ∑HQ values showed a rather poor correlation; instead, better correlations were obtained between ecotoxicological parameters and HQ values for some individual pharmaceuticals such as cephalexin and diphenhydramine. Findings from this study provide novel information on the occurrence of pharmaceuticals and the performance of WWTPs in the tropical region of Central America.

Classification of maternal morbidity and mortality using an organic dysfunction scale. / Clasificación de morbilidad y mortalidad materna mediante una escala de disfunción orgánica.

BACKGROUND: The patient with high-risk pregnancy and organic dysfunction is called "critically ill" or "near miss" by the World Health Organization (WHO), generally requiring an intensive care unit (ICU) to avoid death. The WHO establishes its identification through the maternal severity index (MSI). However, this index and other rating scales only detect very high mortality, and not all categories. In order to fully assess the obstetric patient, taking into account different models, gestational parameters, the spectrum of maternal morbidity and treatment, a new scale is proposed to correctly detect and classify maternal morbidity and mortality. OBJECTIVE: To classify maternal morbidity and mortality using an organic dysfunction scale. METHOD: Diagnostic and prognostic test validation study. Selection of 80 obstetric patients admitted to the ICU, in a period of 1 year. Scale application by 5 phases: scoring system, detection of multi-organ dysfunction syndrome (MODS), validation of diagnostic test compared to MSI; morbidity and mortality classification. Association, reproducibility and validity tests are performed to determine reliability. RESULTS: 2596 observations were made. The tests support detecting MODS (t Student, P < 0.01) and favor the utility of the scale (sensibility 93%, specificity 65%). The correlation coefficient of the scoring system is positive (0.5274), having >12 points (>50%) emits the highest risk. CONCLUSIONS: The new scale adequately detects the MODS and allows an objective classification of the degree of maternal morbidity and mortality.

INTRODUCCIÓN: La paciente con embarazo de alto riesgo y disfunción orgánica se denomina «críticamente enferma¼ o «near miss¼ por la Organización Mundial de la Salud (OMS), y generalmente requiere ingreso en la unidad de cuidados intensivos (UCI) para evitar su muerte. La OMS establece su identificación mediante el índice de severidad materna (ISM). Sin embargo, este índice y las demás escalas de valoración solo detectan mortalidad muy alta, y no todas las categorías. Con el fin de valorar integralmente a la paciente obstétrica, tomando en cuenta diferentes modelos, parámetros gestacionales, espectro de morbilidad materna y tratamientos, se propone una nueva escala que permita detectar y clasificar correctamente la morbilidad y la mortalidad maternas. OBJETIVO: Clasificar la morbilidad y la mortalidad maternas mediante una escala de disfunción orgánica. MÉTODO: Estudio de validación de prueba diagnóstica y pronóstica. Selección de 80 pacientes obstétricas con ingreso a UCI, en un periodo de 1 año. Aplicación de la escala por cinco fases: sistema de puntuación, detección del síndrome de disfunción multiorgánica (SDMO), validación de prueba diagnóstica comparada con ISM, clasificación de morbilidad y mortalidad. Se realizan pruebas de asociación, reproducibilidad y validez para determinar la confiabilidad. RESULTADOS: Se hicieron 2596 observaciones. Las pruebas avalan detectar SDMO (t de Student, P < 0.01) y favorecen la utilidad de la escala (sensibilidad del 93% y especificidad del 65%). El coeficiente de correlación del sistema de puntuación es positivo (0.5274); tener >12 puntos (>50%) indica el mayor riesgo. CONCLUSIONES: La nueva escala detecta adecuadamente el SDMO y permite clasificar de manera objetiva el grado de morbilidad y la mortalidad materna.