Design organization and clinical processes around patient characteristics: Evidence from a multiple case study of Hemophilia.

Background: There is growing evidence of the relevance of designing organization of care around patient characteristics; this is especially true in the case of complex chronic diseases.Purpose: The goal of the paper - that focuses on the analysis of the clinical condition hemophilia in three different centers - is to address two different research questions:1. How can we define, within the same clinical condition, different patient profiles homogeneous in terms of intensity of service required (e.g. number of visits or diagnostics)? 2. What are the conditions to re-organize care around these patient profiles in a multidisciplinary and coordinated manner?Research design: The authors have used a multiple case study approach combining both qualitative and quantitative methodologies; in particularly the semi-structured interviews and the direct observation were aimed to map the process in order to come up with an estimate of the cost of the full cycle of care.Study sample: The research methodology has been applied consistently in three different centers. The selection of the structures has been based on two main different criteria: (i) high standards regarding both organizational and clinical aspects and (ii) willingness from management, nurses and physicians to provide data.Results: The study clearly shows that different patient profiles - within the same clinical condition - trigger a different set of diagnostic and therapeutic activities. It is, thus, important considering patient characteristics in the development and implementation of clinical pathways and this will imply relevant differences in terms of organizational and economic impact.Conclusions: These process-based analyses are very much critical especially if we want to move to a bundled and integrated payment system but, as shown by this study itself, require a lot of time and efforts since our healthcare information systems are still fragmented and vertically designed.

Sublethal effects induced by different plastic nano-sized particles in Daphnia magna at environmentally relevant concentrations.

A growing number of studies have reported the toxic effects of nanoplastics (NPs) on organisms. However, the focus of these studies has almost exclusively been on the use of polystyrene (PS) nanospheres. Herein, we aim to evaluate the sublethal effects on Daphnia magna juveniles of three different NP polymers: PS-NPs with an average size of 200 nm, polyethylene [PE] NPs and polyvinyl chloride [PVC] NPs with a size distribution between 50 and 350 nm and a comparable mean size. For each polymer, five environmentally relevant concentrations were tested (from 2.5 to 250 µg/L) for an exposure time of 48 h. NP effects were assessed at the biochemical level by investigating the amount of reactive oxygen species (ROS) and the activity of the antioxidant enzyme catalase (CAT) and at the behavioral level by evaluating the swimming behavior (distance moved). Our results highlight that exposure to PVC-NPs can have sublethal effects on Daphnia magna at the biochemical and behavioral levels. The potential role of particle size on the measured effects cannot be excluded as PVC and PE showed a wider size range distribution than PS, with particles displaying sizes from 50 to 350 nm. However, we infer that the chemical structure of PVC, which differs from that of PE of the same range size, concurs to explain the observed effects. Consequently, as PS seems not to be the most hazardous polymer, we suggest that the use of data on PS toxicity alone can lead to an underestimation of NP hazards.

Whole mitochondrial and chloroplast genome sequencing of Tunisian date palm cultivars: diversity and evolutionary relationships.

BACKGROUND: Date palm (Phoenix dactylifera L.) is the most widespread crop in arid and semi-arid regions and has great traditional and socioeconomic importance, with its fruit well-known for its high nutritional and health value. However, the genetic variation of date palm cultivars is often neglected. The advent of high-throughput sequencing has made possible the resequencing of whole organelle (mitochondria and chloroplast) genomes to explore the genetic diversity and phylogenetic relationships of cultivated plants with unprecedented detail. RESULTS: Whole organelle genomes of 171 Tunisian accessions (135 females and 36 males) were sequenced. Targeted bioinformatics pipelines were used to identify date palm haplotypes and genome variants, aiming to provide variant annotation and investigate patterns of evolutionary relationship. Our results revealed the existence of unique haplotypes, identified by 45 chloroplastic and 156 mitochondrial SNPs. Estimation of the effect of these SNPs on genes functions was predicted in silico. CONCLUSIONS: The results of this study have important implications, in the light of ongoing environmental changes, for the conservation and sustainable use of the genetic resources of date palm cultivars in Tunisia, where monoculture threatens biodiversity leading to genetic erosion. These data will be useful for breeding and genetic improvement programs of the date palm through selective cross-breeding.

Glacier foreland insect uptake synthetic compounds: an emerging environmental concern.

Pesticides, synthetic fragrances and polycyclic aromatic hydrocarbons contaminated two glacier-fed streams (Amola, Mandrone) and one spring (Grostè) in the Italian Alps. Ten compounds (chlorpyrifos (CPY), chlorpyrifos-methyl (CPY-m), galaxolide (HHCB), tonalide (AHTN), fluorene (Flu), phenanthrene (Phen), anthracene (Ant), fluoranthene (Fl), pyrene (Pyr), benzo[a]anthracene (BaA)) accumulated in aquatic larvae of chironomids (Diamesa steinboecki, D. latitarsis, D. bertrami, D. tonsa, D. zernyi, Pseudokiefferiella parva, Orthocladiinae) and tipulids. Their tissue concentrations (detected by gas chromatography coupled with mass spectrometry) ranged from 1.1 ± 0.1 ng/g d.w. (= dry weight) (CPY-m in D. tonsa from Amola) to 68.0 ± 9.1 ng/g d.w. (Pyr in D. steinboecki from Mandrone). HHCB, AHTN, and CPY, with one exception, were accumulated by all aquatic insects. Six compounds (CPY, CPY-m, HHCB, AHTN, Fl, Pyr) also contaminated carabids (Nebria germarii, N. castanea, N. jockischii) predating adults of merolimnic insects. Their tissue concentrations ranged from 1.1 ± 0.3 ng/g d.w. (CPY-m in N. germarii from Mandrone) to 84.6 ± 0.3 ng/g d.w. (HHCB in N. castanea from Grostè). HHCB and AHTN were accumulated by all Nebria species. Intersite and interspecies differences were observed, which might be attributed to different environmental contamination levels. There was a stronger similarity between species from the same site than among the same species from different sites, suggesting that uptake is not species specific. At all sites, the concentration of xenobiotics was higher in larvae than in water and comparable or higher in carabids than in larvae from the same site, suggesting trophic transfer by emerging aquatic insects to their riparian predators.

A database with frailty, functional and inertial gait metrics for the research of fall causes in older adults.

The GSTRIDE database contains information of the health status assessment of 163 elderly adults. We provide socio-demographic data, functional and frailty variables, and the outcomes from tests commonly performed for the evaluation of elder people. The database contains gait parameters estimated from the measurements of an Inertial Measurement Unit (IMU) placed on the foot of volunteers. These parameters include the total walking distance, the number of strides and multiple spatio-temporal gait parameters, such as stride length, stride time, speed, foot angles and clearance, among others. The main processed database is stored, apart from MS Excel, in CSV format to ensure their usability. The database is complemented with the raw IMU recordings in TXT format, in order to let researchers test other algorithms of gait analysis. We include the Python programming codes as a base to reproduce or modify them. The database stores data to study the frailty-related parameters that distinguish faller and non-faller populations, and analyze the gait-related parameters in the frail subjects, which are essential topics for the elderly.

Assessing falls in the elderly population using G-STRIDE foot-mounted inertial sensor.

Falls are one of the main concerns in the elderly population due to their high prevalence and associated consequences. Guidelines for the management of the elder with falls are comprised of multidimensional assessments, especially gait and balance. Daily clinical practice needs for timely, effortless, and precise tools to assess gait. This work presents the clinical validation of the G-STRIDE system, a 6-axis inertial measurement unit (IMU) with onboard processing algorithms, that allows the calculation of walking-related metrics correlated with clinical markers of fall risk. A cross-sectional case-control study was conducted with 163 participants (falls and non-falls groups). All volunteers were assessed with clinical scales and conducted a 15-min walking test at a self-selected pace while wearing the G-STRIDE. G-STRIDE is a low-cost solution to facilitate the transfer to society and clinical evaluations. It is open hardware and flexible and, thus, has the advantage of providing runtime data processing. Walking descriptors were derived from the device, and a correlation analysis was conducted between walking and clinical variables. G-STRIDE allowed measuring walking parameters in non-restricted walking conditions (e.g. hallway). Walking parameters statistically discriminate between falls and non-falls groups. We found good/excellent estimation accuracy (ICC = 0.885; [Formula: see text]) for walking speed, showing good/excellent correlation between gait speed and several clinical variables. G-STRIDE can calculate walking-related metrics that allow for discrimination between falls and non-falls groups, which correlates with clinical indicators of fall risk. A preliminary fall-risk assessment based on the walking parameters was found to improve the Timed Up and Go test in the identification of fallers.

Occurrence, sources, and ecological risks of polycyclic aromatic hydrocarbons (PAHs) in the Amazon river.

The Amazon is the largest river by discharge volume and one of the most biodiverse biomes in the world. Lately, there has been a rapid increase of the urban population in the region, which has been translated into a growing emission of organic contaminants such as polycyclic aromatic hydrocarbons (PAHs) into surface water bodies. This study provides the most comprehensive evaluation of the PAH contamination levels in surface waters of the Amazon basin. We investigated the occurrence and potential sources of 16 priority PAHs and characterised their risks for freshwater ecosystems. For this, we took 40 water samples from different sites along the Brazilian part of the Amazon River, including three major tributaries, and smaller rivers crossing the main urban areas. The results of this study show that PAHs are widespread contaminants in rivers of the Brazilian Amazon. The sum of the total concentration of the 16 priority PAHs reached values of 134 ng L-1 in the Amazon River, and 163 ng L-1 near densely populated areas. On the other hand, the total PAH concentration was generally lower in the monitored tributaries. In most samples, the contamination pattern was dominated by high molecular weight PAHs, suggesting a major contribution of pyrogenic sources, although petrogenic contamination was also present in some locations near urban areas. We assessed ecological risks posed by PAH mixtures using a hazard index. The results indicated that PAH contamination is not likely to pose direct toxic effects for Amazonian freshwater organisms, however continued monitoring is recommended near densely populated areas.

Bioconcentration and cellular effects of emerging contaminants in sponges from Maldivian coral reefs: A managing tool for sustainable tourism.

Tourism is the main income source for the Maldives, but concurrently, it represents a growing threat to its marine ecosystem. Here, we monitored the bioaccumulation of 15 emerging contaminants (ECs) in the Maldivian reef sponges Spheciospongia vagabunda collected in two resort islands (Athuruga and Thudufushi, Ari Atoll) and an inhabited island (Magoodhoo, Faafu Atoll), and we analysed their impact on different sponge cellular stress biomarkers. Caffeine and the insect repellent DEET were detected in sponges of all the islands, whereas the antibiotic erythromycin and the UV filter 4-methylbenzylidene camphor were found in resort islands only. Although concentrations were approximately a few ng/g d.w., we quantified various induced cellular effects, in particular an increase of the levels of the enzyme glutathione S-transferase involved in cell detoxification. Our results highlight the importance to increase awareness on ECs pollution, promoting the use of more environmental friendly products to achieving the sustainable development goals.

Silent Contamination: The State of the Art, Knowledge Gaps, and a Preliminary Risk Assessment of Tire Particles in Urban Parks.

Tire particles (TPs) are one of the main emission sources of micro- and nano-plastics into the environment. Although most TPs are deposited in the soil or in the sediments of freshwater and although they have been demonstrated to accumulate in organisms, most research has focused on the toxicity of leachate, neglecting the potential effects of particles and their ecotoxicological impact on the environment. In addition, studies have focused on the impact on aquatic systems and there are many gaps in the biological and ecotoxicological information on the possible harmful effects of the particles on edaphic fauna, despite the soil ecosystem becoming a large plastic sink. The aim of the present study is to review the environmental contamination of TPs, paying particular attention to the composition and degradation of tires (I), transport and deposition in different environments, especially in soil (II), the toxicological effects on edaphic fauna (III), potential markers and detection in environmental samples for monitoring (IV), preliminary risk characterization, using Forlanini Urban Park, Milan (Italy), as an example of an urban park (V), and risk mitigation measures as possible future proposals for sustainability (VI).

Integrated Exposure and Algal Ecotoxicological Assessments of Effluents from Secondary and Advanced-Tertiary Wastewater-Treatment Plants.

The great concern over the environmental impact of wastewaters has led to the designing of advanced treatment processes to upgrade conventional treatment plants and achieve a significant reduction of contaminants in receiving waters. In the present study we combined chemical and ecotoxicological analyses, aiming to evaluate the reduction of toxicity effects associated with the removal of micropollutants and to define the contribution of the detected compounds to the overall toxicity of the mixtures in a series of wastewater effluents collected from a secondary treatment (OUT 2) and from a tertiary activated carbon treatment (OUT 3) plant. The target compounds were selected after a screening procedure among pharmaceuticals, musk fragrances, and trace metals. The classical algal growth inhibition test was conducted on the original effluent samples and on different fractions obtained by solid-phase extraction (SPE) treatment. A good accordance was found between the removal of toxicity (30%-80%) and organic compounds (70%-80%) after the tertiary treatment, suggesting its high efficiency to improve the wastewater quality. The discrepancy between the contribution to the overall toxicity of the nonadsorbable compounds (i.e., inorganic or very polar organic compounds) as experimentally measured by the SPE bioassays (18%-76%) and calculated by the concentration addition approach (>97%) could be mitigated by including the bioavailability correction in metal-toxicity modeling of wastewater mixtures. For the organic compounds, the toxic equivalency method enabled us to quantify the portion of toxicity explained by the detected chemicals in both OUT 2 (82%-104%) and OUT 3 (5%-57%), validating the selection of the target molecules. The applied integrating approach could be implemented by the inclusion of both additional target chemicals and toxicity endpoints. Environ Toxicol Chem 2022;41:2404-2419. © 2022 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

A database of physical therapy exercises with variability of execution collected by wearable sensors.

This document introduces the PHYTMO database, which contains data from physical therapies recorded with inertial sensors, including information from an optical reference system. PHYTMO includes the recording of 30 volunteers, aged between 20 and 70 years old. A total amount of 6 exercises and 3 gait variations were recorded. The volunteers performed two series with a minimum of 8 repetitions in each one. PHYTMO includes magneto-inertial data, together with a highly accurate location and orientation in the 3D space provided by the optical system. The files were stored in CSV format to ensure its usability. The aim of this dataset is the availability of data for two main purposes: the analysis of techniques for the identification and evaluation of exercises using inertial sensors and the validation of inertial sensor-based algorithms for human motion monitoring. Furthermore, the database stores enough data to apply Machine Learning-based algorithms. The participants' age range is large enough to establish age-based metrics for the exercises evaluation or the study of differences in motions between different groups.

Nanoplastics: Status and Knowledge Gaps in the Finalization of Environmental Risk Assessments.

Nanoplastics (NPs) are particles ranging in size between 1 and 1000 nm, and they are a form of environmental contaminant of great ecotoxicological concern. Although NPs are widespread across ecosystems, they have only recently garnered growing attention from both the scientific community and regulatory bodies. The present study reviews scientific literature related to the exposure and effects of NPs and identifies research gaps that impede the finalization of related environmental risk assessments (ERAs). Approximately 80 articles published between 2012 and 2021 were considered. Very few studies (eight articles) focused on the presence of NPs in biotic matrices, whereas the majority of the studies (62 articles) assessed the lethal and sublethal effects of NPs on aquatic and terrestrial organisms. Whilst many studies focused on nude NPs, only a few considered their association with different aggregates. Amongst NPs, the effects of polystyrene are the most extensively reported to date. Moreover, the effects of NPs on aquatic organisms are better characterized than those on terrestrial organisms. NP concentrations detected in water were close to or even higher than the sublethal levels for organisms. An ERA framework specifically tailored to NPs is proposed.

Ecological risk assessment of pesticides in urban streams of the Brazilian Amazon.

The use of pesticides in households and peri-urban areas of the Amazon has increased notably during the last years. Yet, the presence of these contaminants in Amazonian freshwater ecosystems remains unexplored. Here, we assessed the exposure to 18 pesticides and 5 transformation products in the Amazon River and in the urban streams of Manaus, Santarém, Macapá, and Belém (Brazil). Pesticide concentrations were analyzed by liquid and gas chromatography methods. Ecological risks were assessed following a two-tiered approach. First, hazard quotients and an overall hazard index were calculated using toxicity data for standard test species of primary producers, invertebrates, and fish. Second, the pesticides showing moderate-to-high ecological risks in the first tier were evaluated using Species Sensitivity Distributions (SSDs). Our study shows that pesticides are widespread in urban and peri-urban areas of the Brazilian Amazon. The frequency of detection was higher in urban streams than in the Amazon River, with some samples taken in Manaus, Santarém, and Belém containing up to 8 compounds. Most pesticides were measured at relatively low concentrations (ng L-1), except for malathion, carbendazim and the bulk concentration of chlorpyrifos, which were monitored at concentrations above 100 ng L-1. Based on the first-tier assessment, we found moderate-to-high risks for freshwater invertebrates for malathion, chlorpyrifos, and chlorpyrifos-methyl, and moderate risks for malathion to fish. The risk assessment performed with SSDs indicated high risks of malathion and chlorpyrifos-methyl in urban areas, with up to 15% and 5% of invertebrate species potentially affected, respectively. The bulk concentrations of chlorpyrifos resulted in high risks in some urban areas (14-22% of species affected) and in areas of the main river (32-44%) impacted by agriculture. We conclude that pesticide residues may contribute to a biodiversity impact in the Amazon and should be further monitored in urban and peri-urban areas, particularly after heavy rainfall events.

Use of the Species Sensitivity Distribution Approach to Derive Ecological Threshold of Toxicological Concern (eco-TTC) for Pesticides.

The species sensitivity distribution (SSD) calculates the hazardous concentration at which 5% of species (HC5) will be potentially affected. For many compounds, HC5 values are unavailable impeding the derivation of SSD curves. Through a detailed bibliographic survey, we selected HC5 values (from acute toxicity tests) for freshwater aquatic species and 129 pesticides. The statistical distribution and variability of the HC5 values within the chemical classes were evaluated. Insecticides are the most toxic compounds in the aquatic communities (HC5 = 1.4 × 10-3 µmol L-1), followed by herbicides (HC5 = 3.3 × 10-2 µmol L-1) and fungicides (HC5 = 7.8 µmol L-1). Subsequently, the specificity of the mode of action (MoA) of pesticides on freshwater aquatic communities was investigated by calculating the ratio between the estimated baseline toxicity for aquatic communities and the HC5 experimental values gathered from the literature. Moreover, we proposed and validated a scheme to derive the ecological thresholds of toxicological concern (eco-TTC) of pesticides for which data on their effects on aquatic communities are not available. We proposed eco-TTCs for different classes of insecticides, herbicides, and fungicides with a specific MoA, and three eco-TTCs for those chemicals with unavailable MoA. We consider the proposed approach and eco-TTC values useful for risk management purposes.

Sulfoxaflor and nutritional deficiency synergistically reduce survival and fecundity in bumblebees.

A range of anthropogenic factors are causing unprecedented bee declines. Among these drivers the usage of pesticides is believed to be crucial. While the use of key bee-harming insecticides, such as the neonicotinoids, has been reduced by regulatory authorities, novel, less studied substances have occupied their market niche. Understanding the threat of these chemicals to bees is, therefore, crucial to their conservation. Here we focus on sulfoxaflor, a novel insecticide, targeting the same neural receptor as the neonicotinoids. In stark contrast to the growing concerns around its negative impacts on bee health, a recent assessment has resulted in the extension of its authorisations across the USA. However, such assessments may underestimate risks by overlooking interactive impacts of multiple stressors. Here we investigated co-occurring, lethal and sublethal risks of sulfoxaflor and a dietary stress for bumblebees (Bombus terrestris), a key pollinator. Specifically, we employed a novel microcolony design, where, for the first time in bees, pesticide exposure mimicked natural degradation. We orally exposed workers to sulfoxaflor and a sugar-deficient diet in a fully factorial design. Field realistic, worst-case sulfoxaflor exposure caused a sharp increase in bee mortality. At sublethal concentrations, sulfoxaflor negatively affected bee fecundity, but not survival. Nutritional stress reduced bee fecundity and synergistically or additively aggravated impacts of sulfoxaflor on bee survival, egg laying and larval production. Our data show that non-mitigated label uses of sulfoxaflor may have major, yet severely neglected effects on bumblebee health, which may be exacerbated by nutritional stress. By unravelling mechanistic interactions of synergistic risks, our study highlights the need to overcome inherent limitations of Environmental Risk Assessment schemes, which, being based on a "single stressor paradigm", may fail to inform policymakers of the real risks of pesticide use.

Pharmaceuticals and other urban contaminants threaten Amazonian freshwater ecosystems.

Urban areas in the Brazilian Amazon have grown at an unprecedented rate during the last years. About 90% of the wastewater produced by these urban areas are discharged untreated into Amazonian freshwater ecosystems, constituting a potential environmental pathway for pharmaceuticals and other chemicals consumed by modern societies (e.g. psychostimulants, personal-care products, hormones). The distribution of these chemicals into the Amazon River and their potential risks for freshwater biodiversity have not been evaluated so far. Here, we show the results of the largest chemical monitoring campaign conducted in the Amazon region. We assessed exposure patterns for 43 pharmaceuticals and other urban contaminants in 40 sampling sites distributed along the Amazon River, three major tributaries (Negro, Tapajós and Tocantins Rivers), and four large cities of the Brazilian Amazon (Manaus, Santarém, Macapá, Belém). We assessed risks for freshwater biodiversity using species sensitivity distributions and mixture toxicity approaches. We found that urban areas constitute important hot-spots for chemical contamination, with mixtures containing up to 40 different compounds and exposure concentrations reaching the world's maxima for some of them. We show that chemical pollution can result in long-term effects for up to 50-80% of aquatic species next to urban areas. Moreover, we identified several ubiquitous compounds which can be used as tracers of anthropogenic pressure in the Amazon basin. We conclude that the chemical burden created by urbanization significantly contributes to a biodiversity loss in the region and should be further controlled.

Burkholderia thailandensis E264 as a promising safe rhamnolipids' producer towards a sustainable valorization of grape marcs and olive mill pomace.

Within the circular economy framework, our study aims to assess the rhamnolipid production from winery and olive oil residues as low-cost carbon sources by nonpathogenic strains. After evaluating various agricultural residues from those two sectors, Burkholderia thailandensis E264 was found to use the raw soluble fraction of nonfermented (white) grape marcs (NF), as the sole carbon and energy source, and simultaneously, reducing the surface tension to around 35 mN/m. Interestingly, this strain showed a rhamnolipid production up to 1070 mg/L (13.37 mg/g of NF), with a higher purity, on those grape marcs, predominately Rha-Rha C14-C14, in MSM medium. On olive oil residues, the rhamnolipid yield of using olive mill pomace (OMP) at 2% (w/v) was around 300 mg/L (15 mg/g of OMP) with a similar CMC of 500 mg/L. To the best of our knowledge, our study indicated for the first time that a nonpathogenic bacterium is able to produce long-chain rhamnolipids in MSM medium supplemented with winery residues, as sole carbon and energy source. KEY POINTS: • Winery and olive oil residues are used for producing long-chain rhamnolipids (RLs). • Both higher RL yields and purity were obtained on nonfermented grape marcs as substrates. • Long-chain RLs revealed stabilities over a wide range of pH, temperatures, and salinities.

Control glicémico perioperatorio / Perioperatory glycemic control

Diabetes is the most common endocrinopathy, in 2014, 8.6% of the population suffered from diabetes, and it was responsible for at least 3.7 million deaths per year. It is estimated that by that by 2050 more than 30% of the population will have this disease. In cardiovascular surgery, it is described that 5.2% of patients are undiagnosed diabetics and this rises to 10% -28% in non-cardiac surgeries. The adverse results are markedly high in those patients with poor glycemic control including an increase of more than 50% in mortality, as well as an increase in respiratory infections, surgical site infection, urinary infection, heart attack and acute kidney injury among others. During the preoperative period of patients with diabetes, it is important to review glycemic control and its current treatment, in addition to providing the patient instructions on how to adjust medications. Intraoperatively, any condition that leads to an uncontrolled increase in surgical stress must be controlled, since this in turn generates hyperglycemia. Knowledge of insulins, their pharmacology and schedules is essential to maintain blood glucose intraoperatively in normal ranges. Different practical algorithms are proposed for the correct and safe management of hyperglycemia in the perioperative period. All care should be continued in the postoperative period defining the continuity of the insulin therapies established and the postoperative care of the patient.

La diabetes es la endocrinopatía más común, en 2014, el 8,6% de la población padecía diabetes siendo responsable de 3,7 millones de muertes por año. Se estima que para el 2050 más del 30% de la población tendrá diabetes. En cirugía cardiovascular el 5,2% de los pacientes son diabéticos no diagnosticados, cifra que aumenta hasta 10%-28% en cirugías no cardíacas. Los resultados adversos son marcadamente elevados en aquellos pacientes con mal control incluyendo un aumento del 50% en la mortalidad, así mismo, incremento de infecciones respiratorias, infección del sitio quirúrgico, infección urinaria, infarto agudo de miocardio y lesión renal aguda, entre otros. Durante el preoperatorio de pacientes con diabetes, es importante revisar el control glucémico y su tratamiento, además de proporcionar al paciente instrucciones por escrito sobre cómo ajustarlo. En el intraoperatorio se debe controlar cualquier condición que lleve a un aumento del estrés quirúrgico pues este a su vez genera hiperglucemia. Es fundamental el conocimiento de las insulinas, su farmacología y esquemas para mantener glucemias en el intraoperatorio en rangos normales. Se proponen diferentes algoritmos prácticos para el correcto y seguro manejo de la hiperglucemia en el perioperatorio. La atención debe continuarse en el posoperatorio definiendo continuidad de terapias insulínicas instauradas y el adecuado cuidado del paciente.

First record of emerging contaminants in sponges of an inhabited island in the Maldives.

In the Maldivian islands, the lack of sewage wastewater treatment and an improper landfill enhance the potential hazard of emerging contaminants, including pharmaceuticals and personal care products. In order to analyze the occurrence of emerging contaminants in the marine biota, sponges were collected in two coral reef areas of Magoodhoo island (Faafu), one near the landfill and the other furthest from the island. Caffeine, fluoxetine and norfluoxetine were detected only in the proximity of the landfill, with caffeine showing the highest concentration (28.4 ng/g d.w.), followed by fluoxetine (6.00 ng/g d.w.). Norfluoxetine was below the limit of quantification of 10 ng/g d.w. Nitro xylene, N,N-Diethyl-meta-toluamide and galaxolide were found in both areas, with concentrations of 3.51/6.11/8.54 and

Behavioural and biochemical alterations by chlorpyrifos in aquatic insects: an emerging environmental concern for pristine Alpine habitats.

This study aimed to assess how different concentrations of the insecticide chlorpyrifos (1.1, 5.24, 11, 52.4, 110, 262, 524 and 1100 ng L-1) affect the swimming behaviour of Diamesa zernyi larvae following exposure. A video tracking system was employed to analyse two swimming traits (total distance moved and average speed) of the larvae simultaneously after 3 days of exposure to the pesticide at 2 °C. The behavioural results were also interpreted according to biochemical responses to oxidative stress (OS) induced by chlorpyrifos, based on malondialdehyde (MDA) and protein carbonyl (PCC) content. Both distance and speed significantly decreased after 72 h of exposure to chlorpyrifos concentrations of ≥ 110 ng L-1, under which significant OS was detected as lipid peroxidation (level of MDA) and protein carbonylation (level of carbonyl). Analysis of altered swimming behaviour, along with MDA and carbonyl content, indicated that ≥ 110 ng L-1 contamination levels of the insecticide cause the organism to reallocate energy normally used for locomotor activity to repair cell damage, which might explain the strong impairment to locomotor performance. Locomotor performance is an ecologically relevant trait for elucidating the population dynamics of key species, with disturbance to this trait having long-term negative impacts on population and community structure. Therefore, chlorpyrifos insecticides represent a serious ecological risk for mountain aquatic species based on the detrimental effects observed in the current study, as the tested concentrations were those at which the insecticide is found in many Alpine rivers of Italy.