Deleterious effects of mercury contamination on immunocompetence, liver function and egg volume in an antarctic seabird.

Mercury (Hg) is a globally important pollutant that can negatively impact metabolic, endocrine and immune systems of marine biota. Seabirds are long-lived marine top predators and hence are at risk of bioaccumulating high Hg concentrations from their prey. Here, we measured blood total mercury (THg) concentrations and relationships with physiology and breeding parameters of breeding brown skuas (Stercorarius antarcticus) (n = 49 individuals) at Esperanza/Hope Bay, Antarctic Peninsula. Mean blood THg concentrations were similar in males and females despite the differences in body size and breeding roles, but differed between study years. Immune markers (hematocrit, Immunoglobulin Y [IgY] and albumin) were negatively correlated with blood THg concentrations, which likely indicates a disruptive effect of Hg on immunity. Alanine aminotransferase (GPT) activity, reflecting liver dysfunction, was positively associated with blood THg. Additionally, triacylglycerol and albumin differed between our study years, but did not correlate with Hg levels, and so were more likely to reflect changes in diet and nutritional status rather than Hg contamination. Egg volume correlated negatively with blood THg concentrations. Our study provides new insights into the sublethal effects of Hg contamination on immunity, liver function and breeding parameters in seabirds. In this Antarctic species, exposure to sublethal Hg concentrations reflects the short-term risks which could make individuals more susceptible to environmental stressors, including ongoing climatic changes.

[Appropriateness of antimicrobial prescriptions in the emergency department of a tertiary hospital]. / Adecuación de las prescripciones antimicrobianas realizadas en el área de urgencias de un hospital de tercer nivel.

OBJECTIVE: Antibiotics are widely prescribed in the Emergency Department (ED), representing 26-62% of outpatient antibiotic prescriptions. Around 40% of antibiotic prescriptions in hospitalized patients are inappropriate or unnecessary. The aim of the study was to assess the appropriateness of antibiotic prescriptions according to local empirical antibiotic treatment guidelines, in the ED of a tertiary hospital. METHODS: Observational, retrospective study including patients attending the ED in November 2016, with an antibiotic prescription, excluding those from residents. RESULTS: A total of 676 patients were included, 57.1% women, mean age 47.4 ± 21.2 years. Patient's diagnoses were 27.2% urinary tract infections (UTI), 24.1% lower respiratory tract infections, 15.4% skin and soft tissue infections (SSTI), 13.8% upper respiratory tract infections, 11.8% oral infections, 2.7% genital/sexually transmitted infections, 1.6% gastrointestinal infections, 0.3% ocular infections and 3.1% other. The most prescribed antibiotic families were: 44.1% penicillins, 21.3% fluoroquinolones. The most prescribed antibiotics were: fosfomycin trometamol in UTI (32.1%), levofloxacin in lower respiratory tract (46.2%) and amoxicillin/clavulanate in oral infections (71.6%), SSTI (62.5%) and upper respiratory tract (46.6%). In 56.8% (384) of the prescriptions antibiotics were indicated. An appropriated antibiotic was selected in 62% (238) of the prescriptions. Appropriated dosage and duration were selected in 82.8% (197) and 45.4% (108) of the prescriptions, respectively. CONCLUSIONS: Appropriateness of antibiotic prescriptions was low, mainly due to an overuse of antibiotics when not indicated, broad spectrum and incorrect treatment duration. These data reinforce the need to enhance adherence to local empirical antibiotic treatment guidelines by developing an antimicrobial stewardship program in the ED.

[Bortezomib as an alternative in the treatment of patients with malignant gammopathy]. / Bortezomib como alternativa en el tratamiento de pacientes con gammapatías malignas.

OBJECTIVE: To describe the use of bortezomib in a district hospital as an alternative in the treatment of malignant gammopathy. METHODS: A retrospective analysis was carried out on patients treated with bortezomib in our hospital between November 2005 and October 2007. The patients' medical histories were used to obtain data regarding diagnosis, treatments prior to bortezomib, date of the last disease progression, number of bortezomib courses, response to bortezomib, overall and event free survival. RESULTS: 47% of the patients studied were male (5/12). The median age was 67, (age range between 40 and 81). The main diagnosis was multiple myeloma on its own or associated with plasmocytoma. Bortezomib initiation coincided with the last disease progression in 83% of patients (10/12). 50% of the patients completed 7-8 courses of bortezomib. Response was seen in 58% of the patients (7/12), partial response in 33% of them (4/12) and complete response in 25% (3/12). The most common adverse reactions were neuropathy and gastrointestinal toxicity which required treatment to be discontinued in 50% of cases. CONCLUSIONS: According to the results obtained, bortezomib is a good alternative in the treatment of malignant gammopathy, above all in the case of plasmocytomas.