[Time in therapeutic range and incidence of warfarin complications in a 20-year retrospective cohort]. / Tiempo en rango terapéutico e incidencia de complicaciones por warfarina en una cohorte retrospectiva de 20 años.

OBJECTIVE: To characterize the time in therapeutic range (TTR) and estimate the incidence rate of complications (PTIRc) in adults with warfarin protocol. DESIGN: Retrospective cohort based on medical records of patients older than 18years, between 1996 and 2016 and followed for at least three months. SITE: Hematology unit of a Venezuelan specialized cardiovascular center. PARTICIPANTS: Electronic health record. MAIN MEASUREMENTS: TTR and PTIRc. The variables were sex, functional illiteracy, occupation, International Normalized Ratio (INR) and follow-up time, which were analyzed with TTR and PTIRc using binomial logistic and Poisson regression models, respectively. RESULTS: 2,770 patients were followed up for a total of 1,201,380 days, 42.3% had a TTR<65% and 3.5% had INR 2.5-3.5. 61.8% had complications. PTIRc was 6.84/100 person-months (95%CI: 6.56-7.15). TTR<65% showed significant adjusted OR with functional illiteracy and INR 2.5-3.5, while for higher PTIRc a significant RR was found in the two factors mentioned, shorter follow-up time, TTR<65% and in women. CONCLUSIONS: Despite new anticoagulant treatments, warfarin is useful. As follow-up time increased, control was better and the rate of occurrence of complications decreased; however, the conditions that showed lower TTR and higher rate of occurrence of complications require a thorough review of follow-up especially in patients with functional illiteracy.

Microenvironment Eradication of Hepatitis C: A Novel Treatment Paradigm.

OBJECTIVES: Prisons are major reservoirs of hepatitis C virus (HCV) in which a therapeutic approach has been particularly difficult so far. Our aim was to create a permanent program of HCV elimination in a prison based on a "test and treat" strategy. METHODS: This open-label clinical trial was conducted in the Spanish prison "El Dueso" between May 2016 and July 2017. Viremic patients were treated with a ledipasvir-sofosbuvir regimen (8-12 weeks) according to the 2015 Spanish Guidelines. A teleconsultation program was established to follow-up patients from the hospital. Non-responders were submitted for a phylogenetic analysis and offered retreatment. An evaluation of new cases of HCV infection was performed every 6 months and upon release in all inmates. RESULTS: 847 (99.5%) inmates accepted to participate. HCV antibodies were present in 110 (13.0%) and 86 (10.2%) had detectable viremia. Most of them were genotype 1 or 3 (82.6%) and had

Trace element contents in fine particulate matter (PM2.5) in urban school microenvironments near a contaminated beach with mine tailings, Chañaral, Chile.

Air quality in schools is an important public health issue because children spend a considerable part of their daily life in classrooms. Particulate size and chemical composition has been associated with negative health effects. We studied levels of trace element concentrations in fine particulate matter (PM2.5) in indoor versus outdoor school settings from six schools in Chañaral, a coastal city with a beach severely polluted with mine tailings. Concentrations of trace elements were measured on two consecutive days during the summer and winter of 2012 and 2013 and determined using X-ray fluorescence. Source apportionment and element enrichment were measured using principal components analysis and enrichment factors. Trace elements were higher in indoor school spaces, especially in classrooms compared with outdoor environments. The most abundant elements were Na, Cl, S, Ca, Fe, K, Mn, Ti, and Si, associated with earth's crust. Conversely, an extremely high enrichment factor was determined for Cu, Zn, Ni and Cr; heavy metals associated with systemic and carcinogenic risk effects, whose probably origin sources are industrial and mining activities. These results suggest that the main source of trace elements in PM2.5 from these school microenvironments is a mixture of dust contaminated with mine tailings and marine aerosols. Policymakers should prioritize environmental management changes to minimize further environmental damage and its direct impact on the health of children exposed.

The burden of cardiovascular morbidity in a European Mediterranean population with multimorbidity: a cross-sectional study.

BACKGROUND: Cardiovascular diseases are highly represented in multimorbidity patterns. Nevertheless, few studies have analysed the burden of these diseases in the population with multimorbidity. The objective of this study was to identify and describe the cardiovascular diseases among the patients with multimorbidity. METHODS: We designed a cross-sectional study in patients ≥19 years old assigned to 251 primary health care centres in Catalonia, Spain. The main outcome was cardiovascular morbidity burden, defined as the presence of one or more of 24 chronic cardiovascular diseases in multimorbid patients (≥2 chronic conditions). Two groups were defined, with and without multimorbidity; the multimorbidity group was further divided into cardiovascular and non-cardiovascular subgroups. The secondary outcomes were: modifiable major cardiovascular risk factors (smoking, hypertension, hypercholesterolaemia, diabetes) and cardiovascular risk score (REGICOR, Registre Gironí del Cor). Other variables analysed were: sex, age (19-24, 25-44, 45-64, 65-79, and 80+ years), number of chronic diseases, urban setting, active toxic habits (smoking and alcohol), physical parameters and laboratory tests. RESULTS: A total of 1,749,710 individuals were included (mean age, 47.4 years [SD: 17.8]; 50.7 % women), of which nearly half (46.8 %) had multimorbidity (95 % CI: 46.9-47.1). In patients with multimorbidity,, the cardiovascular burden was 54.1 % of morbidity (95 % CI: 54.0-54.2) and the four most prevalent cardiovascular diseases were uncomplicated hypertension (75.3 %), varicose veins of leg (20.6 %), "other" heart disease (10.5 %) and atrial fibrillation/flutter (6.7 %). In the cardiovascular morbidity subgroup, 38.2 % had more than one cardiovascular disease. The most prevalent duet and triplet combinations were uncomplicated hypertension & lipid disorder (38.8 %) and uncomplicated hypertension & lipid disorder & non-insulin dependent diabetes (11.3 %), respectively. By age groups, the same duet was the most prevalent in patients aged 45-80 years and in men aged 25-44 years. In women aged 19-44, varicose veins of leg & anxiety disorder/anxiety was the most prevalent; in men aged 19-24, it was uncomplicated hypertension & obesity. Patients with multimorbidity showed a higher cardiovascular risk profile than the non-multimorbidity group. CONCLUSIONS: More than 50 % percent of patients with multimorbidity had cardiovascular diseases, the most frequent being hypertension. The presence of cardiovascular risk factors and the cardiovascular risk profile were higher in the multimorbidity group than the non-multimorbidity group. Hypertension, diabetes and dyslipidaemia constituted the most prevalent multimorbidity pattern.

Conformance contrast testing between rates of pulmonary tuberculosis in Ecuadorian border areas.

OBJECTIVE: To estimate rates of cases of respiratory symptomatic subjects and the incidence rate of pulmonary tuberculosis in two border areas of Ecuador, and contrast them with official figures. MATERIALS AND METHODS: Cross-sectional survey in the southeastern (SEBA), and the Andean southern Ecuadorian border areas (ASBA), which were conducted, respectively, in 1 598 and 2 419 persons aged over 15 years recruited over periods of three weeks. In identified respiratory symptomatic cases, a sputum sample was taken for smear testing. The results (odds ratios and their respective 95% confidence intervals), were compared with local and national official figures using maximum likelihood contrasts. RESULTS: The rates of respiratory symptomatic subjects (7.7% and 5.9% in the SEBA, and ASBA, respectively) and of pulmonary tuberculosis (cumulative incidence rates of 125 and 140 per 100 000 inhabitants, in the same order) were significantly greater than the official figures (of 0.98 and 0.99% for respiratory symptomatic subjects in the SEBA and ASBA, respectively; and of 38.23 per 100 000 inhabitants for pulmonary tuberculosis in Ecuador as a whole) (p<0.001). CONCLUSION: It is necessary to reinforce both active case finding for respiratory symptomatic subject cases, and epidemiological surveillance of pulmonary tuberculosis in Ecuadorian border regions.

The Use of a Natural Polysaccharide Extracted from the Prickly Pear Cactus (Opuntia ficus indica) as an Additive for Textile Dyeing.

The art of dyeing fabrics is one of the oldest human activities. In order to improve the fastness properties of dyeing products, various additives are added to optimize the uniformity of fibers and surfaces and improve dye distribution. Unfortunately, these additives can be harmful and very often are not biodegradable. This article reports on the possibility of using a natural additive for dyeing textiles: a polysaccharide extracted from the prickly pear cactus (Opuntia ficus indica). One type of fabric was tested, silk, with different colors. Several samples were prepared and dyed for each color, adding the same additives but also a commercial chemical aid for one of them and the mucilage of Opuntia for another. The fastness of the applied dyes was evaluated by washing at different temperatures with a common liquid detergent. All samples were analyzed before and after washing with a colorimeter to evaluate the color changes. The results of the analyses reported and compared indicate the potential of prickly pear mucilage as an additive for dyeing silk, which is easily accessible, safe, and sustainable compared to other commonly used additives.

Sociodemographic factors associated with the success or failure of anti-tuberculosis treatment in the Chiapas Highlands, Mexico, 2019-2022.

OBJECTIVE: To estimate the incidence rate of tuberculosis (TB) in the Highlands (Tsotsil-Tseltal) region of Chiapas and to analyze sociodemographic factors that might influence the success of anti-TB treatment from the period of January 2019 to June 2022. METHODS: Retrospective study in which the TB databases of the National Epidemiological Surveillance System (SINAVE) were analyzed. TB incidence rates were calculated based on the number of registered TB cases and estimated annual populations. The success-failure of anti-TB treatment was analyzed according to sociodemographic indicators, degree of concentration of indigenous population of the municipality of residence and admission to SINAVE. RESULTS: Two hundred thirty-three cases were analyzed. The variables associated to a lower success rate of treatment against TB were: living in a municipality with high-very high concentration of indigenous population, being indigenous, having a primary school education or lower, and agricultural occupation. The number of TB diagnosed from 2020-2022 and the incidence rates from 2020-2021 decreased significantly compared to 2019. CONCLUSIONS: It is necessary to strengthen the follow-up of TB cases in the region, mainly in areas with high-very high indigenous concentration, in people with low levels of education and engaged in agricultural work.

[Recommendations of the Spanish Pancreatic Club on the diagnosis and treatment of chronic pancreatitis: part 2 (treatment)]. / Recomendaciones del Club Español Pancreático para el diagnóstico y tratamiento de la pancreatitis crónica: parte 2 (tratamiento).

Chronic pancreatitis (CP) is a complex disease with a wide spectrum of clinical manifestations ranging from asymptomatic disease to disabling forms or serious complications. The management of CP frequently differs among geographical areas and even among centers. These differences are due to the scarcity of high-quality studies and clinical practice guidelines that focus on the diagnosis and treatment of this disease. The aim of the Spanish Pancreatic Club was to create evidence-based recommendations for the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts in this disease. These experts were selected on the basis of their clinical and research experience in CP. A list of questions was drawn up and each question was then reviewed by two panelists. These questions were then used to produce a draft, which was discussed in a face-to-face meeting with all the participants. Levels of evidence were based on the classification of the Oxford Centre for Evidence-Based Medicine. In the second part of the consensus process, recommendations were established for the management of pain, pseudocysts, biliary and duodenal stenosis, pancreatic fistula and ascites, left portal hypertension, diabetes mellitus, exocrine pancreatic insufficiency, and nutritional support in CP.

[Recommendations of the Spanish Pancreatic Club on the diagnosis and treatment of chronic pancreatitis: part 1 (diagnosis)]. / Recomendaciones del Club Español Pancreático para el diagnóstico y tratamiento de la pancreatitis crónica: parte 1 (diagnóstico).

Chronic pancreatitis (CP) is a relatively uncommon, complex and highly heterogeneous disease. There is no clear pattern applicable to the initial stages of CP, which hampers its early diagnosis. Some of the complications of CP, especially chronic pain, can be difficult to manage. There is wide variation in the diagnosis and treatment of CP and its complications among centers and health professionals. The Spanish Pancreatic Club has developed a consensus document on the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts in this disease. A list of questions was drawn up. Each question was reviewed by two experts. These questions were then used to produce a draft, which was discussed in a face-to-face meeting with all the participants. The first part of the consensus document focusses on the diagnosis of CP and its complications.

Research Priorities for Precision Medicine in NAFLD.

NAFLD is a multisystem condition and the leading cause of chronic liver disease globally. There are no approved NAFLD-specific dugs. To advance in the prevention and treatment of NAFLD, there is a clear need to better understand the pathophysiology and genetic and environmental risk factors, identify subphenotypes, and develop personalized and precision medicine. In this review, we discuss the main NAFLD research priorities, with a particular focus on socioeconomic factors, interindividual variations, limitations of current NAFLD clinical trials, multidisciplinary models of care, and novel approaches in the management of patients with NAFLD.

Interleukin-10-mediated heme oxygenase 1-induced underlying mechanism in inflammatory down-regulation by norfloxacin in cirrhosis.

UNLABELLED: Patients with cirrhosis receiving norfloxacin show a restored inflammatory balance that likely prevents clinical complications derived from an excessive proinflammatory response to bacterial product challenges. This study sought to investigate associated inflammatory control mechanisms established in patients with cirrhosis receiving norfloxacin. A total of 62 patients with cirrhosis and ascites in different clinical conditions were considered. Blood samples were collected and intracellular and serum norfloxacin were measured. Inflammatory mediators were evaluated at messenger RNA and protein levels. Neutrophils from all patients were cultured with lipopolysaccharide (LPS) and anti-interleukin-10 (anti-IL-10) monoclonal antibody in different conditions. IL-10 and heme oxygenase-1 (HO-1) were up-regulated in patients receiving norfloxacin and correlated with norfloxacin in a concentration-dependent manner, whereas proinflammatory inducible nitric oxide synthase, cyclooxygenase-2, and nuclear factor-κB behaved inversely. Higher IL-10 levels correlated with lower white blood cell count and higher mean arterial pressure. No correlations were found between IL-10 and disease clinical scores or liver function markers in blood. Neutrophilic in vitro assays showed that the effect of LPS on proinflammatory mediator levels in the presence of norfloxacin was abrogated by significantly increasing IL-10 and HO-1 expression. After stimulation with LPS plus anti-IL-10, proinflammatory mediators were dramatically increased in patients receiving norfloxacin, and increasing intracellular norfloxacin concentrations did not decrease the expression levels of these proinflammatory molecules. Unblocking IL-10 restored proinflammatory mediator and HO-1 expression to previously observed levels in response to LPS stimulation. CONCLUSION: Although the described association does not necessarily mean causality, an IL-10-mediated HO-1-induced anti-inflammatory mechanism is present in patients with cirrhosis receiving norfloxacin, that is directly associated with cell-modulating events in these patients.

Quantification of blue carbon stocks associated with Posidonia oceanica seagrass meadows in Corsica (NW Mediterranean).

In the last decades, the increasing necessity to reduce atmospheric carbon dioxide (CO2) concentrations has intensified interest in quantifying the capacity of coastal ecosystems to sequester carbon, referred to commonly as 'Blue Carbon' (BC). Among coastal habitats, seagrass meadows are considered as natural carbon sinks due to their capacity to store large amounts of carbon in their sediments over long periods of time. However, the spatial heterogeneity of carbon stocks in seagrass sediments needs to be better understood to improve the accuracy of BC assessments, particularly where there is high environmental variability. In the Mediterranean, Posidonia oceanica (L.) Delile constitutes extensive meadows considered as long-term carbon sinks due to the development of an exceptional structure known as 'matte', reaching several meters in height, which can be preserved over millennia. In order to specify the role of P. oceanica meadows in climate change mitigation, an estimate of carbon stocks has been conducted along the eastern coast of Corsica (NW Mediterranean). The approach is mainly based on the biogeochemical analysis of 39 sediment cores. Organic carbon (Corg; 327 ± 150 t ha-1, mean ± SE) and inorganic carbon stocks (Cinorg; 245 ± 45 t ha-1) show a high variability related to water depth, matrix (sandy vs rocky substrate) or the depositional environment (coastal vs estuary). The isotopic signature (δ13C) revealed a substantial contribution of allochthonous inputs of organic matter (macroalgae and sestonic sources) mainly in estuarine environment and shallow areas. The carbon stocks in the first 250 cm of matte (average thickness) were estimated at 5.6-14.0 million t Corg (study site) and 14.6-36.9 million t Corg (Corsica), corresponding to 11.6-29.2 and 30.4-76.8 years of CO2 emissions from the population of Corsica.

The role of inputs of marine wrack and carrion in sandy-beach ecosystems: a global review.

Sandy beaches are iconic interfaces that functionally link the ocean with the land via the flow of organic matter from the sea. These cross-ecosystem fluxes often comprise uprooted seagrass and dislodged macroalgae that can form substantial accumulations of detritus, termed 'wrack', on sandy beaches. In addition, the tissue of the carcasses of marine animals that regularly wash up on beaches form a rich food source ('carrion') for a diversity of scavenging animals. Here, we provide a global review of how wrack and carrion provide spatial subsidies that shape the structure and functioning of sandy-beach ecosystems (sandy beaches and adjacent surf zones), which typically have little in situ primary production. We also examine the spatial scaling of the influence of these processes across the broader land- and seascape, and identify key gaps in our knowledge to guide future research directions and priorities. Large quantities of detrital kelp and seagrass can flow into sandy-beach ecosystems, where microbial decomposers and animals process it. The rates of wrack supply and its retention are influenced by the oceanographic processes that transport it, the geomorphology and landscape context of the recipient beaches, and the condition, life history and morphological characteristics of the macrophyte taxa that are the ultimate source of wrack. When retained in beach ecosystems, wrack often creates hotspots of microbial metabolism, secondary productivity, biodiversity, and nutrient remineralization. Nutrients are produced during wrack breakdown, and these can return to coastal waters in surface flows (swash) and aquifers discharging into the subtidal surf. Beach-cast kelp often plays a key trophic role, being an abundant and preferred food source for mobile, semi-aquatic invertebrates that channel imported algal matter to predatory invertebrates, fish, and birds. The role of beach-cast marine carrion is likely to be underestimated, as it can be consumed rapidly by highly mobile scavengers (e.g. foxes, coyotes, raptors, vultures). These consumers become important vectors in transferring marine productivity inland, thereby linking marine and terrestrial ecosystems. Whilst deposits of organic matter on sandy-beach ecosystems underpin a range of ecosystem functions and services, they can be at variance with aesthetic perceptions resulting in widespread activities, such as 'beach cleaning and grooming'. This practice diminishes the energetic base of food webs, intertidal fauna, and biodiversity. Global declines in seagrass beds and kelp forests (linked to global warming) are predicted to cause substantial reductions in the amounts of marine organic matter reaching many beach ecosystems, likely causing flow-on effects for food webs and biodiversity. Similarly, future sea-level rise and increased storm frequency are likely to alter profoundly the physical attributes of beaches, which in turn can change the rates at which beaches retain and process the influxes of wrack and animal carcasses. Conservation of the multi-faceted ecosystem services that sandy beaches provide will increasingly need to encompass a greater societal appreciation and the safeguarding of ecological functions reliant on beach-cast organic matter on innumerable ocean shores worldwide.

Influence of fluid therapy on the prognosis of acute pancreatitis: a prospective cohort study.

OBJECTIVES: Although aggressive fluid therapy during the first days of hospitalization is recommended by most guidelines and reviews on acute pancreatitis (AP), this recommendation is not supported by any direct evidence. We aimed to evaluate the association between the amount of fluid administered during the initial 24 h of hospitalization and the incidence of organ failure (OF), local complications, and mortality. METHODS: This was a prospective cohort study. We included consecutive adult patients admitted with AP. Local complications and OF were defined according to the Atlanta Classification. Persistent OF was defined as OF of >48-h duration. Patients were divided into three groups according to the amount of fluid administered during the initial 24 h: group A: <3.1 l (less than the first quartile), group B: 3.1-4.1 l (between the first and third quartiles), and group C: >4.1 l (more than the third quartile). RESULTS: A total of 247 patients were analyzed. Administration of >4.1 l during the initial 24 h was significantly and independently associated with persistent OF, acute collections, respiratory insufficiency, and renal insufficiency. Administration of <3.1 l during the initial 24 h was not associated with OF, local complications, or mortality. Patients who received between 3.1 and 4.1 l during the initial 24 h had an excellent outcome. CONCLUSIONS: In our study, administration of a small amount of fluid during the initial 24 h was not associated with a poor outcome. The need for a great amount of fluid during the initial 24 h was associated with a poor outcome; therefore, this group of patients must be carefully monitored.

Bacterial DNA translocation is associated with systemic circulatory abnormalities and intrahepatic endothelial dysfunction in patients with cirrhosis.

UNLABELLED: Presence of bacterial DNA in noninfected patients with cirrhosis and ascites is associated with a marked inflammatory response including activation of the inducible form of nitric oxide synthase and release of nitric oxide, similar to that observed in patients with spontaneous bacterial peritonitis. Although presence of bacterial DNA is associated with an impaired prognosis, no information is available regarding its hemodynamic consequences. Systemic and hepatic hemodynamics before and after a liquid test meal were assessed in a series of 75 noninfected patients with cirrhosis (55 with ascites). Bacterial DNA was measured by polymerase chain reaction. Bacterial DNA was detected only in patients with ascites. Clinical data and liver function were similar in ascitic patients with presence (n = 21) or absence of bacterial DNA (n = 34). Bacterial-DNA(+) patients had significantly lower mean arterial pressure (P = 0.002) and systemic vascular resistance (P = 0.03) than bacterial-DNA(-) patients. Cardiac output, cardiopulmonary pressures, hepatic venous pressure gradient (HVPG), and hepatic blood flow were similar in both groups. Thirty minutes after the test meal, in response to increased blood flow caused by postprandial hyperemia, there was a significantly greater increase in HVPG and impaired hepatic vasorelaxation in bacterial-DNA(+) as compared with bacterial-DNA(-) patients, which indicates hepatic endothelial dysfunction. Indeed, the increase in HVPG after the test meal significantly correlated with serum bacterial DNA concentration. CONCLUSION: Presence of bacterial DNA, a marker of bacterial translocation, is associated with aggravation of peripheral vasodilation and with worsening of intrahepatic endothelial dysfunction.

Peritoneal macrophage priming in cirrhosis is related to ERK phosphorylation and IL-6 secretion.

BACKGROUND: Bacterial infections are common complications arising in patients with cirrhosis and ascites. Translocation of bacterial DNA is a dynamic process that is associated with an increased inflammatory response and a poor prognosis in this setting. The aim of this study was to study whether peritoneal macrophages remain in a chronic primed status to allow a rapid response to subsequent events of bacterial translocation. PATIENTS AND METHODS: Peritoneal monocyte-derived macrophages were isolated from 25 patients with cirrhosis and non-infected ascites and compared with donor's blood monocytes. Activation cell-surface markers were screened using flow-cytometry, and the phosphorylation state of ERK 1/2, p38 MAP Kinase, PKB/Akt and transcription factors c-Jun and p65 NFκB were evaluated using Western blot. Synthesis of tumour necrosis factor alpha, interleukin 6 (IL-6) and interleukin-10 (IL-10) at baseline and in response to bacterial stimuli was evaluated using ELISA. RESULTS: A high expression of CD54, CD86 and HLA-DR at baseline was displayed by peritoneal macrophages. Increased phosphorylated levels of ERK1/2, protein kinase B (PKB) and c-Jun, together with IL-6 production, were observed in peritoneal macrophages at baseline compared with donors' blood monocytes. A positive correlation was established between basal IL-6 levels and extracellular signal-regulated kinase (ERK) phosphorylation in peritoneal macrophages from patients with cirrhosis (r=0·9; P=0·005). Addition of lipopolysaccharide induced higher phosphorylation levels of all studied signalling intermediates than synthetic-oligodeoxydinucleotides, but similar end-stage p65 NFκB. CONCLUSIONS: A sustained immune response is present in ascitic fluid of cirrhotic patients, even in the temporal absence of bacterial antigens. This would facilitate a fast response, probably controlled by IL-6, against repeated bacterial-DNA translocation or in liver chronic inflammation.

Pulmonary tuberculosis infection among workers in the informal public transport sector in Lima, Peru.

BACKGROUND: Because a strong association was observed between pulmonary tuberculosis (TB) and the use of public transport, increasing with duration of journey, a study was carried out to assess infection by Mycobacterium tuberculosis and working conditions among workers in this sector. METHODS: A cross-sectional study was conducted between June and September 2008. A total of 104 workers from two public transport minibus ('combi') cooperatives covering marginal areas of the Ate-Vitarte district in Lima were interviewed. Demographic and occupational details were collected as well as prior family and personal history of TB and BCG vaccination. The tuberculin skin test (TST) was administered to each study subject and an induration of ≥ 10 mm was considered positive. Statistical analysis was based on logistic models, ORs and their 95% CIs. RESULTS: TST results were obtained for 70.2% (n=73), of whom 76.6% (n=56) were positive. Positivity was significantly associated with those who had worked for more than 2 years (crude OR 11.04; 95% CI 3.17 to 38.43) and more than 60 h/week (crude OR 9.8; 95% CI 2.85 to 33.72). These associations remained significant in a multivariate model as well. CONCLUSION: The association observed between years of working and weekly work burden among minibus workers suggests an occupational risk in service jobs in low-income countries with high TB prevalence. Consequently, other types of users are at increased risk for TB infection, with a causal relationship between effect and duration of exposure.

[Treatment of refractory hepatic encephalopathy associated with insertion of a transjugular intrahepatic portosystemic shunt through new endovascular techniques: a case report]. / Tratamiento de la encefalopatía hepática resistente asociada a la creación de una derivación percutánea portosistémica intrahepática mediante nuevas técnicas endovasculares: a propósito de un caso clínico.

Insertion of a transjugular intrahepatic portosystemic shunt (TIPS) is an increasingly used treatment in the management of the complications of portal hypertension. However, one of the complications of this technique is refractory or recurrent hepatic encephalopathy, which poses a difficult clinical problem. We report the case of a patient who underwent TIPS insertion to control bleeding due to esophageal varices. The patient subsequently developed refractory hepatic encephalopathy, requiring reduction of the caliber of the shunt.

Sizing the carbon sink associated with Posidonia oceanica seagrass meadows using very high-resolution seismic reflection imaging.

Among blue carbon ecosystems, seagrass meadows have been highlighted for their contribution to the ocean carbon cycle and climate change mitigation derived from their capacity to store large amounts of carbon over long periods of time in their sediments. Most of the available estimates of carbon stocks beneath seagrass meadows are based on the analysis of short sediment cores in very limited numbers. In this study, high-resolution seismic reflection techniques were applied to obtain an accurate estimate of the potential size of the organic deposit underlying the meadows of the Mediterranean seagrass Posidonia oceanica (known as 'matte'). Seismic profiles were collected over 1380 km of the eastern continental shelf of Corsica (France, Mediterranean Sea) to perform a large-scale inventory of the carbon stock stored in sediments. The seismic data were ground-truthed by sampling sediment cores and using calibrated seismo-acoustic surveys. The data interpolation map highlighted a strong spatial heterogeneity of the matte thickness. The height of the matte at the site was estimated at 251.9 cm, being maximum in shallow waters (10-20 m depth), near river mouths and lagoon outlets, where the thickness reached up to 867 cm. Radiocarbon dates revealed the presence of seagrass meadows since the mid-Holocene (7000-9000 cal yr BP). Through the top meter of soil, the matte age was estimated at 1656 ± 528 cal yr BP. The accretion rate showed a high variability resulting from the interplay of multiple factors. Based on the surface area occupied by the meadows, the average matte thickness underneath them and the carbon content, the matte volume and total Corg stock were estimated at 403.5 ± 49.4 million m3 and 15.6 ± 2.2 million t Corg, respectively. These results confirm the need for the application of large-scale methods to estimate the size of the carbon sink associated with seagrass meadows worldwide.