Telehealth Opportunities in the COVID-19 Pandemic Early Days: What Happened, Did Not Happen, Should Have Happened, and Must Happen in the Near Future?

The objective of this communication is to offer a better understanding of the value of telemedicine in health care, particularly its role in creating opportunities for continuity of care to patients in a complex and novel setting as were the circumstances of the early COVID-19 pandemic times. Crisis time is also a time for opportunities. With regard to telehealth, all players (providers, staff, and patients) should be informed about its benefits and should also become familiar with the use of the various telehealth options and this will only be achieved through large information campaigns necessary enriched by local teaching and training programs in both public and private institutions. The final aim is to launch the debate and foster ideas useful throughout the pandemic. This article covers the experiences of physicians as well as health professionals in the Iberian Peninsula (Spain and Portugal), to provide a clearer idea of what has happened and how we can improve it with the possibilities provided by telemedicine, while at the same time to put in evidence that public health systems need to be rethought to provide solutions to situations such as that we are experiencing.

House sparrow biomarkers as lead pollution bioindicators. Evaluation of dose and exposition length on hematological and oxidative stress parameters.

House sparrows (Passer domesticus) have been proposed as a key ecological indicator of urban pollution. Remarkably, we lack knowledge about the physiological effects of lead on this bird species. Therefore, this study was aimed to evaluate the effect of Pb on several physiological parameters in house sparrows exposed to environmental Pb concentrations. In a first experiment, birds were exposed to Pb sub-lethal doses (from 1.3 to 14.0 µg of Pb/g animal/day) during 5 days, which resulted in a dose response increase of blood Pb levels and decrease of blood ALAD activity. However, at the higher doses tested (> 7 µg of Pb/g animal/day) the blood ALAD activity inhibition (~82%) remained constant. Hematocrit and hemoglobin were significantly reduced only at the highest-doses, and the stress indicator, heterophils to lymphocyte (H/L) ratio, did not show apparent changes. In a second experiment, house sparrows were exposed to Pb in drinking water (12.3 ppm) during either 15 or 30 days. Pb concentration used in this study was enough to produce blood lead levels equivalents to those found recently in house sparrows inhabiting urban areas, reduced blood ALAD activity and inversion of the H/L ratio. Decreasing blood ALAD activities were correlated with increasing blood Pb levels. In addition, Pb exposure produced modification in the levels of hepatic antioxidant enzymes, increased GST activity and decreased CAT activity, without lipid peroxidation. In conclusion, our results suggest that blood ALAD activity is a reliable and sensitive biomarker for environmental Pb exposure in house sparrows, additionally chronic exposure produce physiological stress (H/L inversion) and small changes in antioxidant enzyme activity. Finally, this specie could be considered a bioindicator for monitoring the urban Pb contamination.

Degradation of indomethacin in river water under stress and non-stress laboratory conditions: degradation products, long-term evolution and adsorption to sediment.

The pharmaceutical compound indomethacin is not totally removed in wastewater treatment plants, whose effluents flow into aquatic environments; concentrations in the 0.1-100ng/L range are commonly found in surface waters, and its fate is unknown. Here, biological, photochemical and thermal degradation assays were conducted under stress and non-stress conditions to estimate its degradation rate in river water and establish its degradation products over time. The results revealed that direct sunlight irradiation promoted the complete degradation of indomethacin (2µg/L) in less than 6hr, but indomethacin was detected over a period of 4months when water was kept under the natural day-night cycle and the exposure to sunlight was partially limited, as occurs inside a body of water. The biological degradation in water was negligible, while the hydrolysis at pH7.8 was slow. Residues were monitored by ultra-pressure liquid chromatography/quadrupole time-of-flight/mass spectrometry after solid-phase extraction, and six degradation products were found; their structures were proposed based on the molecular formulae and fragmentation observed in high-resolution tandem mass spectra. 4-Chlorobenzoic and 2-acetamido-5-methoxybenzoic acids were the long-term transformation products, persisting for at least 30weeks in water kept under non-stress conditions. Furthermore, the degradation in the presence of sediment was also monitored over time, with some differences being noted. The adsorption coefficients of indomethacin and degradation products on river sediment were calculated; long-term degradation products did not have significant adsorption to sediment.

Near-Infrared Spectroscopy Procedure for Online Determination of Sodium and Potassium Content in Low-Salt Cured Hams.

This paper reports the development of a near-infrared spectroscopy (NIRS) calibration procedure for the determination of sodium and potassium content in cured ham samples. Sliced samples of hams treated with different salts in different percentages were included in the study. Calibration models developed using partial least squares regression were cross-validated and predictive models were tested using the samples of cured ham with low sodium content. The results showed that the developed NIRS procedure is capable of directly measuring the potassium content of packaged dry-cured ham slices with low sodium content with a fitting accuracy of 91.44%, and that it can indirectly determine the sodium content by applying a correction factor to the values obtained for potassium. The prediction error between the calculated and actual sodium values determined using inductively coupled plasma atomic emission spectrophotometry (ICP-AES) was 0.004%, and this confirms that the NIRS procedure is a viable option for the determination of sodium and potassium content in this type of sample.

A quantitative on-line analysis of salt in cured ham by near-infrared spectroscopy and chemometrics.

In this work, non-invasive near-infrared spectroscopy (NIRS) combined with chemometrics was evaluated as a possible online analytical technique to categorize pieces of cured ham on the industrial production line based on their maximum sodium content. Stifle muscle was selected for the development of the NIRS prediction models because it is the one with the highest sodium content and the easiest in terms of accessibility for spectral measurement. In the study, samples with varying thicknesses were taken. The suitability of this method is demonstrated when a 5 mm sample is used for the construction of the model, obtaining the best fit with an R2cv of 92% and a prediction error of 0.11% sodium that coincides with the error of the reference method. In conclusion, a method is proposed for the direct determination of sodium content on the production line which allows the different pieces of ham to be quickly categorized according to their salt content.

Combination of liquid scintillation counting and passive sampling strategy for the determination of ¹³¹I in air and application to estimate the inhalation dose to the staff of a nuclear medicine service.

(131)I, commonly used in nuclear medicine, can be incorporated into the human body in a variety of chemical and physical forms. This study describes a sensitive method for the determination of (131)I concentration and its application to the estimation of the amount of airborne (131)I inhaled by staff workers of a Nuclear Medicine Department. Our method uses passive sampling with charcoal canisters followed by liquid scintillation counting, a very sensitive technique for the determination of low concentrations of airborne (131)I. We have studied the effects caused on the measured (131)I concentration in air by both, the doses administered to the patients and the distance of sampling canisters to the patient. We have found a direct relationship between the amount of (131)I activity administered and the airborne (131)I activity concentration. We have estimated the contribution of inhaled (131)I to the effective dose received by staff, finding differences between physicians and non-physician personnel. However, the measured exposure was quite low in both cases, thus suggesting that there is no need to introduce additional safety measures to the current ones.

[Significance of free perigastric fluid detected by echoendoscopy in patients with gastric cancer]. / Significado del líquido libre perigástrico identificado por ecoendoscopia en pacientes con cáncer gástrico.

OBJECTIVES: To determine the diagnostic value of free perigastric fluid identified by echoendoscopy in patients with gastric cancer and to establish the factors related to the presence of peritoneal carcinomatosis in these patients. MATERIAL AND METHODS: We retrospectively included 100 patients with a histological diagnosis of gastric adenocarcinoma referred for echoendoscopy. A positive result was defined as the echoendoscopic identification of free perigastric fluid. This result was compared with the final study based on exploratory laparoscopy-laparotomy. The histological and endoscopic characteristics were compared with the final result. RESULTS: Free perigastric fluid was found in 21 patients (21%). Among these, 15 (71%) showed peritoneal carcinomatosis, confirmed by laparoscopy (12 patients) or echoendoscopy-guided fine-needle-aspiration biopsy (three patients). In seven of the 79 patients (8%) not showing the presence of ascites, peritoneal implants were identified by exploratory laparoscopy-laparotomy. The sensitivity, specificity, positive predictive value and diagnostic accuracy of free fluid in the diagnosis of carcinomatosis was 68%, 92%, 71%, 91% and 87%, respectively. No histologic or endoscopic factors related to the malignancy of echoendoscopically-detected fluid were identified. CONCLUSION: In patients with gastric cancer, free perigastric fluid identified by echoendoscopy is an important predictive factor of peritoneal carcinomatosis and may have significant implications in the management of these patients.

Post-discharge follow-up of patients with COVID-19: A Brazilian experience.

Objective: The objective of this study is to evaluate post-acute symptoms in patients with confirmed severe and critical coronavirus disease 2019 infections. Methods: We evaluated patients with confirmed severe and critical coronavirus disease 2019 infections. Post-acute symptoms were defined as symptoms persisting 4 weeks after the onset of the symptoms and classified as pulmonary, muscular, hematologic, neuropsychiatric, renal, and dermatological. Results: We recovered data from 565 patients (43.7% female) with a mean age of 61.1 years. In 18.2%, at least one hospital readmission was necessary and 11.1% died. In 62.6%, there was at least one persistent symptom, and 28.8% had more than one. Among associated factors, obesity, intensive care support, and mechanical ventilation were related to persistent symptoms. Conclusion: The most prevalent symptoms were pulmonary and neuropsychiatric sequelae, as reported in previous studies. This finding underscores the severity of the coronavirus disease 2019 infection and the need for follow-up after recovery from the initial illness. Obese patients, those requiring mechanical ventilation, female patients, and increased hospital length are at greater chance of having persistent symptoms.

Carney triad: A case report, characteristics and literature review of this rare entity.

INTRODUCTION AND IMPORTANCE: Carney triad is a rare entity of unknown etiology, characterized by the association of tumors with low incidence such as: gastric leiomyosarcoma, pulmonary chondroma and extra-adrenal paraganglioma. We show a case of Carney triad diagnosed in our center that has some different characteristics to the typical presentation of this patology, and a review of the literature. CASE PRESENTATION: We present the case of a 47-year-old men who was admitted to our hospital for upper gastrointestinal bleeding and anemia. The patient was diagnosed of gastric GIST (gastrointestinal stromal tumor), pulmonary nodule and retroperitoneal nodule close to iliac bifurcation. A review of his medical history revealed that he had undergone surgery at 18-year-old for gastric leiomiosarcoma, subtotal gastrectomy performed with gastroenteric anastomosis type Billroth II. The patient underwent total gastrectomy with a end-lateral esophago-jejune mechanical anastomosis and retroperitoneal tumor was also excised. Pathological result confirmed gastric GIST, and extra-adrenal paraganglioma. CLINICAL DISCUSSION: We review the available literature to determinate the characteristics and the most appropriate management for this syndrome. The trend is surgical treatment of gastric GIST and paraganglioma, preferred conservative treatment in pulmonary chondroma. It is under discussion whether gastric tumors Carney syndrome is considered GIST, because the Carney triad lesions in stomach are different clinically, pathologically, and etiologically from GIST of stomach. CONCLUSION: Carney's triad is a low prevalence entity, with a limited number of publications, so the presentation of the syndrome may be different from the presentation described in the literature.

Evaluation by NIRS technology of curing process of ham with low sodium content.

NIR spectroscopy combined with chemometric methods has been used to develop a prediction models of the most influential parameters in curing process of two types of hams (140 hams) using different salting techniques, lean hams salted on a tray and fatty hams in a tub, in which sodium is partially replaced. Spectral data were examined by principal component analysis and cross-validated calibration equations were developed using partial-least squares regression. Calibration errors for each parameter, obtained from cross validation (RMSECV), were similar to those obtained by reference method. For lean and fatty hams the RMSECV values were: Moisture 0.78% and 0.80; Fat 2.5 and 1.2%; Protein 0.7 and 1.7%; water activity 0.008 and 0.006; Proteolysis Index 1.6 and 1.7%; Sodium 0.11 and 0.10%; and Potassium 0.04 and 0.10. Results allow the prediction of the parameters involved in ham curing process, demonstrating the viability of the proposed method for the control and monitoring of the different stages until obtaining the final product.

Esterase isoenzymes and insecticide resistance in Frankliniella occidentalis populations from the south-east region of Spain.

BACKGROUND: Frankliniella occidentalis (Pergande) is among the most important crop pests in the south-east region of Spain; its increasing resistance to insecticides constitutes a serious problem, and understanding the mechanisms involved is therefore of great interest. To this end, F. occidentalis populations, collected from the field at different locations in south-east Spain, were studied in terms of total esterase activity and esterase isoenzyme pattern. RESULTS: Individual thrips extracts were analysed by native polyacrylamide gel electrophoresis (PAGE) and stained for esterase activity with the model substrate alpha-naphthyl acetate. Significant correlations were found between resistance to the insecticides acrinathrin and methiocarb and the presence of a group of three intensely stained bands, named Triplet A. For each individual thrips extract, total esterase activity towards the substrates alpha-naphthyl acetate and alpha-naphthyl butyrate was also measured in a microplate reader. Insects possessing Triplet A showed a significantly higher alpha-naphthyl acetate specific activity and alpha-naphthyl acetate/alpha-naphthyl butyrate activity ratio. This observation allowed a reliable classification of susceptible or resistant insects either by PAGE analysis or by total esterase activity determination. CONCLUSION: The PAGE and microplate assays described can be used as a monitoring technique for detecting acrinathrin- and methiocarb-resistant individuals among F. occidentalis field populations.

Assessing the influence of temperature on NIRS prediction models for the determination of sodium content in dry-cured ham slices.

Temperature fluctuations are a key factor in the development of prediction models using near infrared spectroscopy (NIRS). In the present study, this influence has been investigated and a methodology has been proposed to reduce the effect of sample temperature on NIRS model prediction of the sodium content in dry-cured ham slices. Spectra were taken directly from the slices using a remote measurement probe (for non-contact analysis) at three different temperature ranges: -12 °C to -5°C, -5°C to 10 °C and 10 °C to 20 °C. Local and global temperature compensation methods were established. Partial-least squares (PLS) regression was used as a chemometrics tool to perform the calibrations. The results showed that local models were sensitive to changes in temperature, while a global temperature model using sample spectra over the entire temperature range showed good prediction ability, reducing the error caused by temperature fluctuations to acceptable levels for practical applications.

Forced and long-term degradation assays of tenoxicam, piroxicam and meloxicam in river water. Degradation products and adsorption to sediment.

The fate of the pharmaceutical drugs tenoxicam, piroxicam and meloxicam in river water is evaluated here for first time. So, biological, photochemical and thermal degradation assays have been conducted to estimate their degradation rates and know their degradation products. Results indicated that the direct sunlight irradiation, without any protection, promoted a fast degradation of the oxicams while the chemical reactions in solution were less important. The biological degradation in water was negligible except for tenoxicam in whose case its influence was scarce. When the exposition of river water to sunlight was partially limited and kept under the natural day-night cycle, as occurs inside a body of water, tenoxicam, piroxicam and meloxicam (at 2 µg L-1) were detected during a period of 15, 27 and 45 days, respectively. Residues were monitored by ultra-pressure liquid chromatography/quadrupole time-of-flight/mass spectrometry after solid-phase extraction and several degradation products were found (10 for tenoxicam, 9 for piroxicam and 7 for meloxicam) and monitored over time. Their structures were proposed from the molecular formulae and fragmentation observed in high-resolution tandem mass spectra; the nature of the transformation products found in the long-term resulted to be very variable for each oxicam. Furthermore, the degradation in presence of river sediment was also monitored over time, with some differences being noted; the adsorption coefficients of the compounds on sediment were calculated, meloxicam exhibited a higher sorption capacity. The ecotoxicity of the different compounds in aquatic ecosystems was predicted, too.

Photochemical, thermal, biological and long-term degradation of celecoxib in river water. Degradation products and adsorption to sediment.

Celecoxib is an anti-inflammatory drug with antibacterial activity whose fate in surface water is unknown. Thus, some assays have been conducted under forced biological, photochemical and thermal conditions, and non-forced conditions, to establish its persistence and degradation products in river water. The results suggest that celecoxib dissolved in river water is not biologically degraded while it is minimally altered after its exposure to sunlight or high temperature (70°C). Only the irradiation at 254nm promotes its complete degradation. Celecoxib is degraded about 3%, in 36 weeks, when water was kept at room temperature and the exposure to sunlight was partially limited as it happens inside a body of water. Residues were monitored by ultra-pressure liquid chromatography/quadrupole time-of-flight/mass spectrometry after solid-phase extraction; eleven degradation products were detected and the structures of nine of them were unequivocally proposed from the molecular formulae and fragmentation observed in high-resolution tandem mass spectra. The long-term transformation products under non-forced conditions were 4-[5-(4-methylphenyl)-3-(trifluoromethyl)-1H-pyrazol-1-yl]benzenesulfonic acid, 4-[1-(4-sulfoaminephenyl)-3-(trifluoromethyl)-1H-pyrazol-5-yl]benzoic acid and a hydroxylated derivative. The degradation over time in presence of sediment was monitored, being slightly higher, about 4%. The adsorption equilibrium constants of celecoxib and degradation products on river sediment were estimated.

[Serological diagnosis of atrophic gastritis with a combination of pepsinogen I and II, gastrin-17 and anti-Helicobacter pylori antibodies]. / Diagnóstico serológico de gastritis atrófica con una combinación de pepsinógeno I y II, gastrina-17 y anticuerpos anti-Helicobacter pylori.

OBJECTIVE: Noninvasive diagnosis of atrophic gastritis would help to identify individuals at increased risk of gastric carcinoma. In the present study, we evaluated the utility of a serological panel combining pepsinogen I and II, gastrin-17, and anti-Helicobacter pylori antibodies (Gastropanel) as a screening method for atrophic gastritis. PATIENTS AND METHODS: The serological panel was evaluated in 56 patients divided in two groups: group 1 consisted of 47 patients with uninvestigated dyspepsia and group 2 was composed of nine consecutive patients with gastric carcinoma. In all patients, we performed endoscopy with biopsies of the gastric antrum and body. Levels of pepsinogen I and II, gastrin-17, and anti-H. pylori antibodies were determined through a specific EIA test (Biohit plc, Helsinki, Finland) in fasting serum samples. RESULTS: Atrophic gastritis was significantly more frequent in patients with gastric carcinoma than in those with dyspepsia (56 vs 6%; p = 0.0015). Agreement between the Gastropanel and gastric histology was good (kappa = 0.68). The sensitivity and specificity of the Gastropanel in the diagnosis of atrophic gastritis was 87.5% and 100%, respectively. However, the Gastropanel would not have detected four of the nine cases of gastric carcinoma, since these tumors arose in stomachs with nonatrophic mucosa. CONCLUSIONS: Gastropanel is a useful noninvasive method for the diagnosis of atrophic gastritis. However, its utility as a screening method is limited by cases of gastric carcinoma that arise in stomachs without atrophic mucosa.

On-line prediction of sodium content in vacuum packed dry-cured ham slices by non-invasive near infrared spectroscopy.

In the present study, non-invasive near infrared spectroscopy (NIRS) was evaluated as a potential on-line analytical technique to predict the sodium content in dry-cured ham slices. Samples of 310 packages were scanned by applying a remote fibre-optic probe to the surface of the slices, at different temperatures, with no previous manipulation. The sodium content of the meat samples was determined by a reference method based on Inductively Coupled Plasma Atomic Emission Spectrophotometry (ICP-AES) after chemical digestion. Partial least squares (PLS) regression was used as a chemometrics method to perform the calibrations. The models yielded acceptable results with cross validation correlation coefficients (R2CV) determined 86.2-90.2%. The prediction capacity reached in the external validation was 3.63, with a standard prediction error of 0.12% Na. These results show that NIR measurements could be implemented on the packaging line of dry-cured ham slices to provide accurate and relevant information about the sodium content of each packaged products.

Persistence of alprazolam in river water according to forced and non-forced degradation assays: adsorption to sediment and long-term degradation products.

Alprazolam is a pharmaceutical compound that it is detected in surface waters. Some degradation studies in aqueous solutions and pharmaceutical products are available, but there is no reliable information about its stability in river water. Here, assays have been conducted under forced biological, photochemical, and thermal conditions, and under non-forced conditions, to estimate the fate of alprazolam in river water and know its degradation products. The forced assays indicated that the biological and photochemical degradation of alprazolam was negligible; heating at 70°C for a long time barely affected it. The degradation of alprazolam in river water at 100 µg/L was about 5% after 36 weeks, keeping the water under a natural day-night cycle at room temperature and limiting partially the exposure to sunlight as happens inside a body of water; no change in concentration was observed when the monitoring was performed at 2 µg/L. The results suggest the persistence of alprazolam in surface water and a possible accumulation over time. Residues were monitored by ultra-pressure liquid chromatography/quadrupole time-of-flight/mass spectrometry after solid-phase extraction; nine degradation products were found and the structures for most of them were proposed from the molecular formulae and fragmentation observed in high-resolution tandem mass spectra. (5-chloro-2-(3-methyl-4H-1,2,4-triazol-4-yl)phenyl)(phenyl)methanol was the main long-term transformation product in conditions that simulate those in a mass of water. The degradation rate in presence of sediment was equally very low under non-forced conditions; adsorption coefficients of alprazolam and major degradation products were calculated. Copyright © 2016 John Wiley & Sons, Ltd.

Vitellogenin polypeptide levels in one susceptible and one cadmium-resistant strain of Oncopeltus fasciatus (Heteroptera: Lygaeidae), and its role in cadmium resistance.

The heavy metal Cd has recently been shown to have endocrine disrupting activity in different vertebrate species. In the insect Oncopeltus fasciatus, Cd exposure delays ovarian maturation and inhibits vitellogenesis, probably through a reduction in vitellogenin (Vg) polypeptide synthesis. An O. fasciatus strain was selected in the laboratory for Cd resistance with gradually increasing Cd concentrations for 50 generations. Cd-selected (OCdR) insects were 2.7-2.3 times more resistant to chronic exposure to Cd than susceptible (OS) insects. OCdR females showed increased (up to 90%) Vg polypeptide levels in hemolymph. Vg polypeptide synthesis was equally decreased in OCdR and OS females after acute Cd exposure, indicating that resistance in the OCdR strain was not due to a reduced sensitivity of the target of Cd. Vg polypeptide concentrations and ovarian maturation in acutely exposed OCdR females, however, were equal to those of control OS females. OCdR females chronically exposed to Cd showed a 30% decrease in Vg polypeptide concentrations, relative to control OS females. It is concluded that increased Vg polypeptide levels play an important role in resistance to the toxic effects of Cd on reproduction in the OCdR strain, and that this novel Cd resistance mechanism has the potential to evolve in vertebrate species in which Cd inhibits Vg synthesis by disruption of the endocrine system.