Bioaccumulation and fate of pharmaceuticals in a Mediterranean coastal lagoon: Temporal variation and impact of a flash flood event.

Coastal ecosystems are particularly vulnerable to terrestrial inputs from human-impacted areas. The prevalence of wastewater treatment plants, unable to remove contaminants such as pharmaceuticals (PhACs), leads to their continuous input into the marine environment. In this paper, the seasonal occurrence of PhACs in a semi-confined coastal lagoon (the Mar Menor, south-eastern Spain) was studied during 2018 and 2019 by evaluating their presence in seawater and sediments, and their bioaccumulation in aquatic organisms. Temporal variation in the contamination levels was evaluated by comparison to a previous study carried out between 2010 and 2011 before the cessation of permanent discharges of treated wastewater into the lagoon. The impact of a flash flood event (September 2019) on PhACs pollution was also assessed. A total of seven compounds (out of 69 PhACs analysed) were found in seawater during 2018-2019, with a limited detection frequency (<33%) and concentrations (up to 11 ng/L of clarithromycin). Only carbamazepine was found in sediments (ND-1.2 ng/g dw), suggesting an improved environmental quality in comparison to 2010-2011 (when 24 and 13 compounds were detected in seawater and sediments, respectively). However, the biomonitoring of fish and molluscs showed a still remarkable accumulation of analgesic/anti-inflammatory drugs, lipid regulators, psychiatric drugs and ß-blocking agents, albeit not higher than in 2010. The flash flood event from 2019 increased the prevalence of PhACs in the lagoon, compared to the 2018-2019 sampling campaigns, especially in the upper water layer. After the flash flood the antibiotics clarithromycin and sulfapyridine yielded the highest concentrations ever reported in the lagoon (297 and 145 ng/L, respectively), alongside azithromycin in 2011 (155 ng/L). Flash flood events associated with sewer overflows and soil mobilisation, which are expected to increase under climate change scenarios, should be considered when assessing the risks posed by pharmaceuticals to vulnerable aquatic ecosystems in the coastal areas.

A holistic assessment of the sources, prevalence, and distribution of bisphenol A and analogues in water, sediments, biota and plastic litter of the Ebro Delta (Spain).

Bisphenol A (BPA) is one of the main ubiquitous compounds released from plastics in the environment. This compound, considered an endocrine disruptor, poses a risk to aquatic wildlife and human population, being included in multiple environmental monitoring programmes. Following the regulations restricting BPA use in the last years, BPA-like chemicals have been produced and used as BPA substitutes. However, they are not commonly included in monitoring programs yet and their presence is thus misrepresented, despite showing similar endocrine disrupting potential. In this work, an analytical method for analysing bisphenol A and five of its analogues (Bisphenol S, B, F, AF and Tetrabromobisphenol A) is described, validated for water (riverine, sea and wastewater), sediment, and biota (fish and biofilm) and applied to monitor their presence in the Ebro River Delta (NE Spain). In addition, plastic litter was also collected to evaluate their role as potential source of bisphenols. All compounds except BPF were detected in the analysed samples. Wastewater treatment plants (WWTPs) were discarded as major sources of BPs into the natural aquatic environment, as no BPs were detected in treated effluents. Indeed, the high levels of BPs in the natural environment could be related with direct discharge of raw wastewater from small rural population nucleus. The analysis of riverine plastic leachates yielded 4 out of the 6 BPs analysed, strengthening the hypothesis that plastic debris are also a source of BPs in the natural environment. Whereas Bisphenol S and BPA were detected in water and, to a limited extent, in biota, less polar analogues (mainly BPAF and TBBPA) were not found in any of the water samples. Instead, these hydrophobic BPs were found in fish tissues and biofilm, pointing out plastics and microplastics as their possible vectors. Finally, biofilm demonstrated its potential as sentinel of chemical contamination in freshwater environment.

Hydrocarbon exposure effect on energetic metabolism and immune response in Crassostrea virginica.

Crassostrea virginica was exposed to different light crude oil levels to assess the effect on transcriptomic response and metabolic rate. The exposure time was 21 days, and levels of 100 and 200 µg/L were used, including a control. The most significant difference among treatments was the overexpression of several genes associated with energy production, reactive oxygen species (ROS) regulation, immune system response, and inflammatory response. Also, a hydrocarbon concentration-related pattern was identified in ROS regulation, with a gene expression ratio near 1.8:1 between 200 and 100 µg/L treatments. Statistical analysis showed no interaction effect for metabolic rate; however, significant differences were found for oil concentration and time factors, with a higher oxygen consumption at 200 µg/L. Our findings provide novel information about the metabolic response of C. virginica during hydrocarbons exposure. In addition, our results point out which biological processes should be investigated as targets for searching bioindicators.

Zero valent iron nanoparticles and organic fertilizer assisted phytoremediation in a mining soil: Arsenic and mercury accumulation and effects on the antioxidative system of Medicago sativa L.

Zero valent iron nanoparticles (nZVI) attract interest given their effectiveness in soil remediation. However, little attention has been given to their impacts on plants. Likewise, although fertilizers are commonly used to enhance phytoremediation, their effects on As mobilization, resulting in potential toxic effects, require further study. In this context, we examined the impact of As and Hg accumulation on the antioxidative system of Medicago sativa grown in a soil amended with organic fertilizer and/or nZVI. The experiment consisted of 60 pots. Plants were pre-grown and transferred to pots, which were withdrawn along time for monitoring purposes. As and Hg were monitored in the soil-plant system, and parameters related to oxidative stress, photosynthetic pigments, and non-protein thiol compounds (NPTs) were measured. In general, the application of nZVI immobilized As in soil and increased Hg accumulation in the plant, although it surprisingly decreased oxidative stress. Plants in nZVI-treated soil also showed an increase in NPT content in roots. In contrast, the application of the fertilizer mobilized As, thereby improving bioaccumulation factors. However, when combining fertilizer with nZVI, the As accumulation is mitigated. This observation reveals that simultaneous amendments are a promising approach for soil stabilization and the phytomanagement of As/Hg-polluted soils.

Antegrade endoscopic dilatation as an alternative approach to primary obstructive megaureter. / Dilatación endoscópica anterograda como abordaje alternativo del megauréter obstructivo primario.

OBJECTIVES: Congenital primary obstructive megaureter (POM) is caused by ureterovesical junction stenosis, reduced peristalsis, and the resulting dilatation. Even though ureteral re-implantation remains the current gold standard technique, retrograde dilatation is considered as an effective therapeutic alternative with good results and growing proponents - to the extent it has become the technique of choice in some healthcare facilities. The objective was to present an alternative approach for treatment purposes. MATERIALS AND METHODS: This is the case of a 5-month-old infant with POM and pyonephrosis requiring nephrostomy and intravenous antibiotic therapy. Endoscopic dilatation was carried out by means of a percutaneous drainage in an antegrade fashion and did not require cystoscopy. RESULTS: The procedure was uneventful. During follow-up, ureterohydronephrosis decreased, while ureteral dilatation persisted to a lesser extent with an adequate peristalsis and absence of secondary VUR. The patient has had no symptoms after an 11-month follow-up. CONCLUSIONS: POM antegrade dilatation is an effective alternative in selected patients as it makes the pathology disappear.

OBJETIVOS: El megauréter obstructivo primario congénito (MOP) se produce por la estenosis de la unión ureterovesical, disminución en la peristalsis y su consecuente dilatación. Aunque actualmente el gold standard para el tratamiento de esta entidad sigue siendo el reimplante ureteral, la dilatación retrógrada se considera una alternativa terapéutica eficaz con buenos resultados y que está ganando cada vez más adeptos, siendo en algunos centros la técnica de elección. El objetivo es presentar una alternativa de abordaje para su tratamiento. MATERIAL Y METODOS: Se presenta el caso de un lactante de 5 meses con MOP afecto de pionefrosis que precisa nefrostomía y antibioterapia endovenosa. La dilatación endoscópica se realizó a través del drenaje percutáneo de manera anterógrada sin necesidad de cistoscopia. RESULTADOS: El procedimiento se llevó a cabo sin incidencias. En el seguimiento se apreció una disminución de la ureterohidronefrosis, persistiendo la dilatación del uréter en menor grado con adecuada peristalsis y la ausencia de RVU secundario. Tras 11 meses de seguimiento, permanece asintomático. CONCLUSIONES: La dilatación anterógrada del MOP es una alternativa efectiva en pacientes seleccionados que permite la resolución de la patología.

A mechanism for improved talc pleurodesis via foam delivery.

Talcum powder is recognized as the leading drug for pleurodesis, a treatment of choice for malignant pleural effusions. Recently, it was shown that hydrogel foam delivery systems significantly enhanced the number of adhesions between the chest wall and the lung in a New Zealand rabbit model due to the sol-gel transition. However, many questions still remain regarding the cause of improved efficacy, such as: (1) Would only hydrogel foams improve the efficacy of talc pleurodesis? (2) Is it possible to achieve the same efficacy of hydrogels using non-hydrogel foams? 3) What are the physicochemical properties that can be correlated to the efficacy of talc pleurodesis? In this study, we use non-hydrogel foam formulations to determine the efficacy of pleurodesis. Foam stability and rheology of the formulations were correlated to adhesion formation. The results clearly suggest a correlation of pleurodesis efficacy to the viscosity and modulus of the foam delivery system.

Time-Frequency Analysis of Cardiovascular Variability during an Orthostatic Stress by Complete EMD.

Diverse analysis techniques have been used to comprehend the regulation by the autonomic nervous system (ANS) of the cardiovascular system when a human being faces a stressor. Recently, however, the complete ensemble empirical mode decomposition (EMD) with adaptive noise (CEEMDAN) allows analyzing nonstationary signals in a nonlinear and time- variant way. Consequently, CEEMDAN may provide a means to obtain clues about ANS regulation in health and disease. In this study, we analyze the average Hilbert-Huang spectrum (HHS) of cardiovascular variability signals by CEEMDAN during a head-up tilt test (HUTT) in 12 healthy female subjects and 18 orthostatic intolerance female patients. Beat-to-beat intervals (BBI) as well as systolic (SYS) blood pressure variability time series were analyzed. In addition, instantaneous amplitudes and frequencies of specific intrinsic mode functions (IMF) were investigated separately to define the influence of the disease on ANS regulation. Female groups demonstrated statistical differences in the high-frequency band of BBI but higher differences for the high and low-frequency bands of SYS from the mechanical transition of HUTT.Clinical Relevance- A relevant outcome of the study is the average HHS of healthy female subjects along HUTT. This HHS may be used as reference to help diagnose OI when HHS of the cardiovascular variability signals of any subject deviates from the normal course.

A new scenario in metastatic renal cell carcinoma: a SOG-GU consensus.

BACKGROUND: This article describes and compares approved targeted therapies and the newer immunotherapy agents. MATERIALS AND METHODS: This article especially performs an in-depth review of currently available data for tivozanib, explaining its mechanism of action, its safety profile and its role as an efficacy drug in the management of renal cancer. RESULTS: Despite the fact that the treatment of advanced RCC has been dramatically modified in recent years, durable remissions are scarce and it remains a lethal disease. For first- and second-line therapy, there is now growing evidence to guide the selection of the appropriate treatment. CONCLUSIONS: Several TKIs are standard of care at different settings. Among those approved TKIs, tivozanib has similar efficacy than others with a better safety profile. The use of prognostic factors is critical to the selection of optimal therapy.

Anaphylaxis at school. Are we prepared? Could we improve?

INTRODUCTION AND OBJECTIVES: Food allergy is a highly prevalent disorder. Anaphylaxis is the most serious consequence, and reactions often occur in schools. In the event of anaphylactic reaction prompt treatment is key and should be initiated by school personnel. The aim of this study was to assess the level of knowledge of the management of anaphylaxis, and to determine if it improves after a training session among school staff. MATERIALS AND METHODS: Descriptive study carried out by means of a pre-and post-training questionnaire completed by participants before and after a training session held at the school. Data from the same participants before and after the educational session were compared using McNemar's test. RESULTS: Three schools were enrolled (with a total of 38 children with food allergy) and 53 participants (85% teachers, 15% canteen staff) were trained. In the pre-training surveys, 83% said they had a Student's Allergic Reaction Management Plan, 56% had met with parents, 83% recognised some symptoms of allergic reaction but only 41% recognised anaphylaxis, 16% knew when to use adrenaline, 15% knew how to use it and 19% knew how to act after administering it. In the post-training questionnaires, 100% were satisfied and believed they had improved their knowledge, 93% recognised anaphylaxis and 95% the treatment of choice. CONCLUSIONS: Prior to the intervention their knowledge was insufficient, but it improved considerably after simple training. It also increased the confidence of the staff, which will be decisive when responding to an anaphylactic reaction. We believe that a compulsory training programme should be implemented universally in all schools.

Fe3O4@Au nanoparticles-based magnetoplatform for the HMGA maize endogenous gene electrochemical genosensing.

This work addresses a technological advance applied to the construction of a magnetogenoassay with electrochemical transduction for the maize taxon-specific (HMGA gene) detection using gold-coated magnetic nanoparticles as nanosized platform. Superparamagnetic core-shell Fe3O4@Au nanoparticles (10.4 ±â€¯1.7 nm) were used to assemble the genoassay through the covalent immobilization of HMGA DNA probes onto carboxylated self-assembled monolayers at the nanoparticles surface. A hybridization reaction using sandwich format was selected to prevent inefficient hybridization connected with stable secondary DNA structures using also fluorescein isothiocyanate as DNA signaling tag. The labelling of the hybridization reaction with enzymes allowed the chronoamperometric measurement of the peroxidase activity linked to the nanoplatform located on gold surface. Using this electrochemical magnetogenoassay a linear concentration range from 0.5 to 5 nM and a LOD of 90 pM with a RSD <1.2% was calculated. Certified maize was evaluated without further purification after PCR amplification. This work highlights the efficacy of the electrochemical magnetogenoassay for the HMGA detection, showing its potential as alternative procedure for the verification of the compliance of the legislation.

Tuberculosis vaccine candidates based on mycobacterial cell envelope components.

Even after decades searching for a new and more effective vaccine against tuberculosis, the scientific community is still pursuing this goal due to the complexity of its causative agent, Mycobacterium tuberculosis (Mtb). Mtb is a microorganism with a robust variety of survival mechanisms that allow it to remain in the host for years. The structure and nature of the Mtb envelope play a leading role in its resistance and survival. Mtb has a perfect machinery that allows it to modulate the immune response in its favor and to adapt to the host's environmental conditions in order to remain alive until the moment to reactivate its normal growing state. Mtb cell envelope protein, carbohydrate and lipid components have been the subject of interest for developing new vaccines because most of them are responsible for the pathogenicity and virulence of the bacteria. Many indirect evidences, mainly derived from the use of monoclonal antibodies, support the potential protective role of Mtb envelope components. Subunit and DNA vaccines, lipid extracts, liposomes and membrane vesicle formulations are some examples of technologies used, with encouraging results, to evaluate the potential of these antigens in the protective response against Mtb.

[Registry of perioperative cardiac arrests in a clinical hospital in the period 2006-2017]. / Registro de paro cardiorrespiratorio perioperatorio en un hospital universitario en el período 2006-2017.

BACKGROUND: Perioperative cardiac arrest (PCA) is a rare but important event in the operating room. AIM: To describe PCA events at a Clinical Hospital in Santiago, Chile. MATERIAL AND METHODS: Registry of PCA that occurred in the operating room (OR) and during procedures not carried out in the OR between September 2006 and November 2017. Precipitating events, type of anesthesia and results of resuscitation maneuvers were described. RESULTS: Eighty events (five outside of the OR) during 170,431 surgical procedures were recorded, resulting in an incidence of 4.4 events per 10,000 interventions. Hypotension/hypoperfusion was the most frequently found preexisting condition (42.5%). The main cause was the presence of preoperative complications (57.5%). Nineteen cases (23.8%) were attributable to anesthesia, with an incidence of 1.11 per 10,000 anesthetic procedures. Survival rate at hospital discharge was 52.5%. The figure for PCA caused by anesthesia was 84.2%. CONCLUSIONS: The incidence of PCA and its survival is similar to that reported abroad. In general, PCA has a better prognosis than other types of cardiac arrest, especially if it has an anesthetic cause.

Transcriptomic response of the Crassostrea virginica gonad after exposure to a water-accommodation fraction of hydrocarbons and the potential implications in reproduction.

The Crassostrea virginica oyster has biological and economic importance in the Gulf of Mexico, an area with a high extraction and production of hydrocarbons. Exposure to hydrocarbons affects the reproductive processes in bivalves. In C. virginica, the effect of hydrocarbons on the gonad of the undifferentiated organism has not been evaluated to determine the possible damage during the maturation process. To evaluate this effect, RNA-seq data was generated from C. virginica gonads exposed to a 200 µg/L of hydrocarbons at different exposure times (7, 14 and 21 days) and a control treatment (without hydrocarbons). The analysis of the gonad transcriptome showed the negative effect of hydrocarbons on maturation, with a sub-expression of 22 genes involved in different stages of this process. Additionally, genes in the immune system were down-regulated, which may indicate that exposure to hydrocarbons causes immunosuppression in bivalves. A group of oxidative stress genes was also reduced. These data contribute to a better understanding of the effect of hydrocarbons on the reproductive process in bivalves and, at the same time, allow us to identify possible biomarkers associated with hydrocarbon contamination in the gonad of C. virginica.

Registro de paro cardiorrespiratorio perioperatorio en un hospital universitario en el período 2006-2017 / Registry of perioperative cardiac arrests in a clinical hospital in the period 2006-2017

Background: Perioperative cardiac arrest (PCA) is a rare but important event in the operating room. Aim: To describe PCA events at a Clinical Hospital in Santiago, Chile. Material and Methods: Registry of PCA that occurred in the operating room (OR) and during procedures not carried out in the OR between September 2006 and November 2017. Precipitating events, type of anesthesia and results of resuscitation maneuvers were described. Results: Eighty events (five outside of the OR) during 170,431 surgical procedures were recorded, resulting in an incidence of 4.4 events per 10,000 interventions. Hypotension/hypoperfusion was the most frequently found preexisting condition (42.5%). The main cause was the presence of preoperative complications (57.5%). Nineteen cases (23.8%) were attributable to anesthesia, with an incidence of 1.11 per 10,000 anesthetic procedures. Survival rate at hospital discharge was 52.5%. The figure for PCA caused by anesthesia was 84.2%. Conclusions: The incidence of PCA and its survival is similar to that reported abroad. In general, PCA has a better prognosis than other types of cardiac arrest, especially if it has an anesthetic cause.

Retrospective study of foreign body-associated pathology in stranded cetaceans, Canary Islands (2000-2015).

Marine pollution, overrepresented by plastic, is a growing concern worldwide. However, there is little knowledge on occurrence and detrimental impacts of marine debris in cetaceans. To partially fill in this gap of knowledge, we aimed to investigate the occurrence and pathologies associated with foreign bodies (FBs) in a large cohort of cetaceans (n = 465) stranded in the Canary Islands. The Canary Islands shelter the greatest cetacean biodiversity in Europe, with up to 30 different species, of which nine are regularly present year around. We found at least one ingested FB in 36 out of 465 (7.74%) studied cetaceans, involving 15 different species, including eight out of the nine (80%) cetacean species present year-round in the Canary Islands. Risso's dolphin was the species most affected, followed by sperm whale, beaked whale and mysticetes. Plastic FB were the most common item found (80.56%). FB was directly associated with death in 13/36 (36.11%) animals. Poor body condition and deep diving behavior were found to be risk factors for FB ingestion, whereas the adult age was a protective factor. To the authors knowledge this is the first study that use statistical analysis to investigate risk and protective factors for FB ingestion. This study also provides insights of the potential impact caused by ingested FBs on the animal's health and mortality. This knowledge is critical to better understand and assess the impact of FB in cetaceans setting the scientific basis for prospective impact monitoring and future conservation policies.

Confiabilidad interevaluador de la prueba video head impulse test en estudiantes de primer año de la generación 2016 de la Escuela de Fonoaudiología de la Universidad de Valparaíso Casa Central / Inter-rater reliability of the video head impulse test in students from the School of Speech and Language therapist of the University of Valparaiso main campus class 2016

RESUMEN Introducción: El video head impulse test es un método rápido, no invasivo y cómodo para evaluar el reflejo vestíbulo ocular, el cual está siendo utilizado con mayor frecuencia en la evaluación de pacientes con alteraciones del equilibrio. Sin embargo, en Chile se evidencia una falta de estudios relacionados a la confiabilidad interevaluador de dicha prueba. Objetivo: Determinar el nivel de concordancia de los resultados de la eficiencia del reflejo vestíbulo ocular de los canales semicirculares horizontales, obtenidos mediante la aplicación de la prueba video head impulse test, por parte de 3 evaluadores. Material y método: Estudio cuantitativo, correlacional, no experimental transversal descriptivo, con muestreo no probabilístico, de participación voluntaria. La prueba video head impulse test fue aplicada por 3 examinadores a 30 estudiantes que cumplieron con los criterios de inclusión. Resultados: El método de Bland y Altman mostró gran concordancia en las mediciones realizadas entre los 3 examinadores. La correlación intraclase para la ganancia del canal semicircular horizontal derecho e izquierdo fue de 0,85 y 0,91 respectivamente y de 0,75 para el valor de asimetría. Conclusión: El estudio mostró una confiabilidad interevaluador adecuada de la prueba video head impulse test para la evaluación de los canales semicirculares horizontales.

ABSTRACT Introduction: The video head impulse test is a rapid, non-invasive and comfortable method for the evaluation of the vestibulo-ocular reflex that is being used more often in the evaluation of patients with balance disorders. In Chile there is a lack of studies related to the inter-rater reliability for this test. Aim: To determine the level of agreement on the results for the vestibulo-ocular reflex of the horizontal semicircular canals obtained by the execution of the video head impulse test by 3 raters. Material and method: Quantitative, correlational, non-experimental, cross-sectional descriptive study with a type of non-probability sampling with voluntary participation. The video head impulse test was applied by 3 raters to 30 students who fulfilled the inclusion criteria. Results: The Bland-Altman method demonstrated good agreement in the measurements made between the 3 raters. The inter-rater reliability for the gain of the left and right horizontal semicircular canals was 0.85 and 0.91 respectively and 0.75 for the asymmetry value. Conclusion: The study showed an adequate inter-rater reliability for the video head impulse test in the evaluation of the horizontal semicircular canals.

Complicaciones de traqueostomía en pacientes pediátricos: revisión de la literatura / Complications of tracheostomy in pediatric patients: literature review

RESUMEN Las indicaciones de traqueostomía en niños han cambiado considerablemente en los últimos años, así como el perfil epidemiológico de los pacientes y la morbimortalidad de este procedimiento. Las complicaciones de este procedimiento pueden ser clasificadas en intraoperatorias, inmediatas y tardías. La mortalidad global en pacientes pediátricos llevados a traqueostomía oscila entre el 13% y 19%. Sin embargo, menos del 5% es directamente atribuible a la cirugía. La presente revisión abarcará las complicaciones más frecuentes asociadas a traqueostomía pediátrica con recomendaciones en su prevención y manejo.

ABSTRACT Indications of tracheostomy in children have changed considerably in recent years, as well as the epidemiological profile of patients, and morbidity and mortality related to this procedure. Complications of pediatric tracheostomy can be classified into intraoperative, immediate and late. Overall mortality in pediatric patients with tracheostomy ranges from 13% to 19%. However, less than 5% is directly attributable to tracheostomy. This review will cover the most frequent complications associated with pediatric tracheostomy with recommendations for its prevention and management.