Zooplankton exposure to microplastic contamination in a estuarine plume-influenced region, in Northeast Brazil.

This work describes the spatio-temporal distribution of suspected plastic and microplastic (MP) particles in estuarine plumes and analyzes the microplastic/zooplankton ratio. Subsurface hauls with a conical-cylindrical net were deployed in the coastal area of Tamandare (Pernambuco, Brazil), covering the plume of two rivers and a bay adjacent to coral reefs. A total of 2079 suspected plastic particles were detected, mostly fibers and fragments (>60%). Organic matter digestion was made using a 30% hydrogen peroxide solution, of which approximately 50% of suspected particles were validated as MPs. The average MP abundance was significantly higher during the high rainfall season (53.8 ± 89.6 and 18.8 ± 32.3 particles/m³, respectively), with higher values registered in the plume area (108.9 ± 158.5 and 44.6 ± 55.5 particles/m³). Polymer identification using FT-IR confirmed that suspected particles were mainly polypropylene, polyamide, and polyurethane. These results confirm the hypothesis of a temporal transport variation of MPs from the river to the coastal environments, particularly since the plume influences debris input. Eleven animal phyla were identified, and the subclass Copepoda was predominant (90%), particularly the nauplius stage (70%). Over 70% of verified MPs range between 20 and 2000 µm, equivalent to the most common size of zooplanktonic organisms. Results support that coastal areas near estuarine plumes are exposed to microplastic contamination, affecting species dependent on zooplankton in marine coastal food webs.

Polytetrafluoroethylene versus polypropylene mesh during laparoscopic totally extraperitoneal (TEP) repair of inguinal hernia: short- and long-term results of a double-blind clinical randomized controlled trial.

PURPOSE: Aim of the study is to compare macroporous (> 1 mm2) polytetrafluoroethylene mesh (LP-PTFE) versus microporous (< 1 mm2) polypropylene mesh (SP-PPL) in terms of postoperative acute and chronic discomfort and pain, difficulty in mesh handling and long-term recurrence rate. METHODS: Fifty-two patients with bilateral hernia were enrolled in this double-blind randomized controlled trial (NCT02023203). Each hernia, in the same patient, was randomized to implant LP-PTFE or SP-PPL mesh during totally extraperitoneal laparoscopic hernia repair. Patients were followed at 7 days, 1, 3, 6, 12 and 60 months after surgery. Visual analog scale (VAS) score was employed to evaluate the outcomes. Student's t test was used in case of normally distributed continuous variables, while the nonparametric Mann-Whitney U test was used in case of not normally distributed variables. Chi square test was used for analysis of categorical variables. RESULTS: Median VAS discomfort score with SP-PPL was significantly higher than LP-PTFE at 1 and 3 months after surgery (p = 0.003 in both cases). LP-PTFE showed significantly lower median score than SP-PPL at 7 days after surgery (p = 0.025) regarding pain at movement. Testicular pain was lower in case of LP-PTFE than SP-PPL at 7 days, 1 and 3 months after surgery (p = 0.005, p = 0.004 and p = 0.004, respectively). LP-PTFE was significantly more difficult to handle (p = 0.001). At 60 months, one recurrence was observed in the LP-PTFE group (p = 1.0000). CONCLUSIONS: LP-PTFE has less postoperative discomfort and pain up to 3 months after surgery, without differences after that period, although it shows more difficulty in handling and recurrences occur even if not statistically significant.

Glycaemic target attainment in people with Type 2 diabetes treated with insulin glargine/lixisenatide fixed-ratio combination: a post hoc analysis of the LixiLan-O and LixiLan-L trials.

AIMS: Both fasting (FPG) and postprandial plasma glucose (PPG) contribute to HbA1c levels. We investigated the relationship between achievement of American Diabetes Association (ADA) and American Association of Clinical Endocrinologists (AACE) recommended FPG and/or PPG targets and glycaemic efficacy outcomes in two trials. METHODS: In this post hoc analysis, data from participants with Type 2 diabetes in the phase 3 LixiLan-O (NCT02058147) and LixiLan-L (NCT02058160) trials were evaluated to compare the relationship between achievement of society-recommended FPG and/or PPG targets and efficacy (HbA1c change, HbA1c goal attainment, weight change) and safety outcomes in the treatment groups. RESULTS: Across treatment arms, iGlarLixi achieved the highest proportion of participants meeting both ADA- and AACE-recommended FPG and PPG targets at study end in both trials. A higher proportion of participants in the iGlarLixi (fixed-ratio combination of insulin glargine and lixisenatide) vs. insulin glargine alone or lixisenatide alone treatment arms achieved HbA1c goals (P < 0.001 for overall comparisons), irrespective of ADA- or AACE-defined targets. Hypoglycaemia rates [any, documented symptomatic (plasma glucose ≤ 3.9 mmol/l), and clinically important (plasma glucose < 3.0 mmol/l)] were low across all groups. Participants treated with iGlarLixi tended to show weight loss or less weight gain compared with participants receiving insulin glargine alone. No differences were observed in average daily basal insulin dose at week 30 between the two treatment arms or across the different FPG and PPG target groups. CONCLUSION: Insulin glargine and lixisenatide as a fixed-ratio combination resulted in more participants reaching both FPG and PPG targets, leading to better HbA1c target attainment.

Advanced-stage mycosis fungoides: role of the signal transducer and activator of transcription 3, nuclear factor-κB and nuclear factor of activated T cells pathways.

BACKGROUND: The malignant mechanisms that control the development of cutaneous T-cell lymphoma (CTCL) are beginning to be identified. Recent evidence suggests that disturbances in specific intracellular signalling pathways, such as RAS-mitogen-activated protein kinase, T-cell receptor (TCR)-phospholipase C gamma 1 (PLCG1)-nuclear factor of activated T cells (NFAT) and Janus kinase (JAK)-signal transducer and activator of transcription (STAT), may play an essential role in the pathogenesis of CTCL. OBJECTIVES: To investigate the mechanisms controlling disease development and progression in mycosis fungoides (MF), the most common form of CTCL. METHODS: We collected 100 samples that were submitted for diagnosis of, or a second opinion regarding, MF between 2001 and 2018, 80% of which were in the early clinical stages of the disease. Formalin-fixed paraffin-embedded tissues were used for histological review and to measure the expression by immunohistochemistry of surrogate markers of activation of the TCR-PLCG1-NFAT, JAK-STAT and NF-κB pathways. Folliculotropism and large-cell transformation were also examined. RESULTS: NFAT and nuclear factor kappa B (NF-κB) markers showed a comparable activation status in early and advanced stages, while STAT3 activation was more frequent in advanced stages and was associated with large-cell transformation. Consistently with this observation, STAT3 activation occurred in parallel with MF progression in two initially MF-negative cases. A significant association of NFAT with NF-κB markers was also found, reflecting a common mechanism of activation in the two pathways. Genomic studies identified nine mutations in seven genes known to play a potential role in tumorigenesis in T-cell leukaemia/lymphoma, including PLCG1, JAK3 and STAT3, which underlies the activation of these key cell-survival pathways. A higher mutational allele frequency was detected in advanced stages. CONCLUSIONS: Our results show that STAT3 is activated in advanced cases and is associated with large-cell transformation, while the activation of NFAT and NF-κB is maintained throughout the disease. These findings could have important diagnostic and therapeutic implications. What's already known about this topic? Mycosis fungoides is characterized by a clonal expansion of T cells in the skin. The mechanisms controlling disease development and progression are not fully understood. What does this study add? An association of the nuclear factor of activated T cells and nuclear factor kappa B pathways was found, which could reflect a common mechanism of activation. These pathways were activated in early and advanced stages at the same level. Signal transducer and activator of transcription 3 activation was associated with large-cell transformation and was more frequent in advanced stages. A genomic analysis of cutaneous T-cell lymphoma-associated genes was performed. Nine mutations were detected. What is the translational message? These results could have important implications for the treatment of MF in the near future.

A micro-Raman and X-ray study of erupted submarine pyroclasts from El Hierro (Spain) and its' astrobiological implications.

The pumice volcanic samples could have possible connections to the evolution of life and give us insight about their bio-geochemical processes related. In this regard, the samples from the volcanic eruption from La Restinga (El Hierro, Spain) in 2011 have been mainly studied by means of Raman spectroscopy. The research also includes analysis of XRD, Scanning Electron Microscopy and Optical Microscopy to support the Raman analysis. The results show that the Raman methods and mineral analyses are in strong agreement with the results obtained from other authors and techniques. The internal white foamy core (WFC) of the studied pumice samples shows amorphous silica, Fe-oxides, Ti-oxides, quartz, certain sulfates, carbonates, zeolites and organics. On the other hand, the external part (dark crust - DC) of these samples mainly presents primary-sequence mineralogy combined with some secondary alteration minerals such as olivine, feldspar, pyroxene, amorphous silica, and Fe-oxide. Raman spectroscopy detected other minerals not yet reported on these samples like barite, celestine and lepidocrocite. Also, the different chemometric and calibration methods for Raman spectroscopy in elemental composition, mineral classification and structural characterization has been successfully applied. From the astrobiological perspective, the research was also complemented with comparisons to other similar samples from terrestrial analogs. The main consideration was taking into account the proposed hypothesis regarding the potential behavior of the pumice as a substrate for the evolution of life. Furthermore, the detailed analysis from La Restinga eruption is coherent with the mineral phases and processes discussed from previous literature. The white internal part fulfills the conditions to work as an organic reservoir, confirmed by the detection of organic matter and selected minerals that could be used as energy sources for bacterial communities. The external layers of the samples work as a shielding layer to protect the organics from decay in extreme conditions. Finally, here we have demonstrated that the characteristics and advantages of Raman spectroscopy could help to assess and understand the possible biogenicity and alteration processes of any geological sample to be found on Mars.

Esophagocardioplasty, vagotomy-antrectomy and Roux-en-Y gastrojejunostomy: indication in cases with severe esophageal motor disfunction.

Almost 10% of patients with Crest syndrome associated with severe gastroesophageal reflux and 5-10% of patients with failed cardiomyotomy for achalasia present with cardial or distal esophageal organic stricture. Some of these cases are poor risk patients for surgery and therefore the surgeon must offer a safe procedure with low morbimortality, keeping in mind the pathophysiological motor pattern of these patients.In order to treat the stricture to improve the esophageal transit we treated patients with esophagocardioplasty associated with vagotomy-antrectomy and Roux-en-Y gastrojejunostomy, thereby avoiding the potential acid or biliary reflux in poor risk patients in whom esophagectomy would be a very deleterious procedure. All four patients had a good postoperative evolution and late control demonstrated good esophagogastric transit with no postoperative esophagitis.

Microplastics in coastal sediments from Southern Portuguese shelf waters.

Microplastics are well-documented pollutants in the marine environment that result from fragmentation of larger plastic items. Due to their long chemical chains, they can remain in the environment for long periods of time. It is estimated that the vast majority (80%) of marine litter derives from land sources and that 70% will sink and remain at the bottom of the ocean. Microplastics that result from fragmentation of larger pieces of plastic are common to be found in beaches and in the water surface. The most common microplastics are pellets, fragments and fibres. This work provides original data of the presence of microplastics in coastal sediments from Southern Portuguese shelf waters, reporting on microplastic concentration and polymer types. Microplastic particles were found in nearly 56% of sediment samples, accounting a total of 31 particles in 27 samples. The vast majority were microfibers (25), identified as rayon fibres, and fragments (6) identified as polypropylene, through infrared spectroscopy (µ-FTIR). The concentration and polymer type data is consistent with other relevant studies and reports worldwide.

A multistrategic approach in the development of sourdough bread targeted towards blood pressure reduction.

Rising prevalence of hypertension is pushing food industry towards the development of innovative food products with antihypertensive effects. The aim was to study the effect of reduced sodium content and 21% addition of wholemeal wheat sourdough (produced by Lactobacillus brevis CECT 8183 and protease) on proximate composition, γ-aminobutyric acid (GABA) and peptide content of wheat bread. Angiotensin converting enzyme I (ACE) inhibitory and antioxidant activities were also evaluated. Sodium replacement by potassium salt did not affect chemical composition and biological activities of bread. In contrast, GABA and peptides <3 kDa contents in sourdough bread (SDB) were 7 and 3 times higher, respectively, than the observed in control. ACE inhibitory and antioxidant activities of the peptide fraction < 3 kDa from SDB was 1.7 and 2.6-3.0 times higher than control. Therefore, the combination of reduced sodium content with enriched concentrations of bioactive compounds in bread making may provide interesting perspectives for development of innovative breads towards blood pressure reduction.

High-pressure improves enzymatic proteolysis and the release of peptides with angiotensin I converting enzyme inhibitory and antioxidant activities from lentil proteins.

Angiotensin I converting enzyme (ACE) inhibitory and antioxidant peptides are receiving attention due to their beneficial effects in the prevention/treatment of hypertension. The objective was to explore the effect of high hydrostatic pressure (HP) on proteolysis by different proteases and the release of bioactive peptides from lentil proteins. Pressurisation (100-300 MPa) enhanced the hydrolytic efficiency of Protamex, Savinase and Corolase 7089 compared to Alcalase. Proteolysis at 300 MPa led to a complete degradation of lentil proteins and increased peptide (<3 kDa) concentration by all enzymes. Proteolysis at 300 MPa by Savinase gave rise to lentil hydrolysates (S300) with the highest ACE-inhibitory and antioxidant activities that were retained upon in vitro gastrointestinal digestion. The peptides responsible for the multifunctional properties of S300 hydrolysate were identified as different fragments from storage proteins and the allergen Len c 1. These results support the potential of HP as a technology for the cost-effective production of bioactive peptides from lentil proteins during enzymatic proteolysis.

Uso de recuperador de sangre durante la artroplastía de rodilla / Cell saver use during knee arthroplasty

Antecedentes: La gonartrosis es una patología degenerativa que limita de forma importante la funcionalidad de una persona. Se recurre al manejo quirúrgico cuando el paciente presenta una limitación funcional importante así como dolor intenso. La artroplastía de rodilla es una de las cirugías con mejores resultados funcionales en pacientes con esta patología, pero dentro de sus limitaciones está la posibilidad de un sangrado importante y, por consiguiente, la necesidad de hemotransfundir al paciente. El objetivo de este estudio fue evaluar la necesidad de hemotransfundir a los pacientes operados de artroplastía de rodilla que utilizaron recuperador sanguíneo en el postoperatorio y las diferencias entre los costos del recuperador sanguíneo y la transfusión clásica. Métodos: Estudio retrospectivo, transversal y retrolectivo de 300 expedientes de pacientes operados en el Hospital Ángeles de Querétaro de artroplastía de rodilla que utilizaron recuperador sanguíneo que requirieron hemotransfusión alogénica entre Octubre 2001 y Junio 2013. Resultados: De las 246 rodillas operadas, solamente tres requirieron hemotransfusión alogénica. Ninguna complicación/infección con el uso de recuperador sanguíneo. La edad promedio de los pacientes fue de 67.1 ± 9.78 años con un predominio femenino siendo éstos 141 (60.5%) en comparación con 92 (39.5%) masculinos. La sangre recolectada vía recuperador sanguíneo varió de 150 a 1,225 ml con un promedio de 318 ± 100.6 ml, la cual fue retransfundida a cada paciente. Conclusiones: El uso de recapturador sanguíneo en pacientes postoperados de artroplastía de rodilla disminuye de forma importante la necesidad de hemotransfusión alogénica.

Backgound: Gonarthrosis is a degenerative condition that importantly limits an individual's performance. Surgical treatment is used in patients with important functional limitation and severe pain. Knee arthroplasty is one of the surgeries with the best functional results in patients with this condition. However, its limitations include the risk of heavy bleeding and the resulting need for blood transfusion. The objective of this study was to assess the need for blood transfusion in patients undergoing knee arthroplasy in whom the cell saver was used postoperatively and find out the cost differences between the cell saver and standard blood transfusion. Methods: Retrospective, cross-sectional, retrolective trial including 300 records of patients who underwent knee arthroplasty at Hospital Ángeles Querétaro that included the use of the cell saver and allogeneic blood transfusion from October 2001 to June 2013. Results: Only 3 of the 246 operated knees required allogeneic blood transfusion. There were no complications/infections resulting from the use of the cell saver. Mean age of patients was 67.1 ± 9.78 years; females were predominant, as they were 141 (60.5%), compared to 92 (39.5%) males. The blood collected with the cell saver ranged from 150 to 1,225 ml with a mean of 318 ± 100.6 ml and was retransfused to each patient. Conclusions: Cell saver use in patients subjected to knee arthroplasty importantly decreases the need for allogeneic blood transfusion.

Evidence of microplastics in samples of zooplankton from Portuguese coastal waters.

Records of high concentrations of plastic and microplastic marine debris floating in the ocean have led to investigate the presence of microplastics in samples of zooplankton from Portuguese coastal waters. Zooplankton samples collected at four offshore sites, in surveys conducted between 2002 and 2008, with three different sampling methods, were used in this preliminary study. A total of 152 samples were processed and microplastics were identified in 93 of them, corresponding to 61% of the total. Costa Vicentina, followed by Lisboa, were the regions with higher microplastic concentrations (0.036 and 0.033 no. m⁻³) and abundances (0.07 and 0.06 cm³ m⁻³), respectively. Microplastic: zooplankton ratios were also higher in these two regions, which is probably related to the proximity of densely populated areas and inputs from the Tejo and Sado river estuaries. Microplastics polymers were identified using Micro Fourier Transformed Infrared Spectroscopy (µ-FTIR), as polyethylene (PE), polypropylene (PP) and polyacrylates (PA). The present work is the first report on the composition of microplastic particles collected with plankton nets in Portuguese coastal waters. Plankton surveys from regular monitoring campaigns conducted worldwide may be used to monitor plastic particles in the oceans and constitute an important and low cost tool to address marine litter within the scope of the Marine Strategy Framework Directive (2008/56/EC).

[Risk Factors and extraneurological complications of stroke patients]. / Factores de riesgo y complicaciones extraneurológicas de pacientes internados por Accidente Cerebrovascular en el Hospital Nacional de Clínicas de Córdoba.

INTRODUCTION: Stroke is the third leading cause of death globally , act on modifiable risk factors is now the best prevention strategy. Medical complications are common in patients hospitalized for stroke , the valuation of income NIHSS , is associated with the final result in terms of duration of hospitalization, survival and discharge location. OBJETIVE: Determining risk factors ( RF) in patients hospitalized for stroke in Hospital Nacional de Clinicas de Córdoba (HNC) and characterize neurological complications NIHSS relative to income. MATERIAL AND METHODS: Prospective study of patients admitted to the Service of Neurology at HNC diagnosed with the first of September , 2010 to December 30, 2012 , we applied the admission NIHSS scale. Were determined cerebrovascular risk factors , we evaluated neurological complications during hospitalization. RESULTS: The total number of patients admitted for stroke was 200 , with 168 ischemic stroke ( 84%) and hemorrhagic stroke 32 (16 % ) . The FR Hypertension was the most frequent ( 83.5 %), over 40% had 3 or more FR for stroke. Had complications : 32 % of patients , the respiratory infection was the most frequent (14.5 % ). Patients with NIHSS greater than 10 points had a higher rate of complications. CONCLUSION: The multiple RF control is an effective strategy to decrease the incidence of stroke . Prevention of medical complications enable better patient care and reduce morbidity associated with stroke.

El Accidente cerebro vascular (ACV) constituye la tercera causa de muerte a nivel mundial; actuar sobre los factores de riesgo modificables constituye hoy la mejor estrategia de prevención. Las complicaciones médicas son frecuentes en los pacientes internados por ACV; la valoración del NIHSS de ingreso, está asociado al resultado final en términos de duración de internación, supervivencia y ubicación al alta. Objetivo. Determinar los factores de riesgo (FR) en pacientes internados por ACV en el HNC de Córdoba y caracterizar las complicaciones no neurológicas en relación al NIHSS de ingreso. Material y métodos. Estudio prospectivo de pacientes internados en el HNC con diagnóstico de ACV del primero de septiembre de 2010 al 30 de diciembre de 2012, se aplicó la escala de NIHSS al ingreso. Se determinaron los factores de riesgo cerebrovasculares; se evaluaron las complicaciones no neurológicas durante la internación. Resultados. El total de pacientes ingresados por ACV fue de 200, con ACV isquémico 168 (84%) y ACV hemorrágico 32(16%). La Hipertensión Arterial fue el FR más frecuente (83,5%); más del 40% tenía 3 o más FR para ACV. Tuvieron complicaciones: 32% de los pacientes, la Infección respiratoria fue la más frecuente (14.5%)Pacientes con NIHSS superior a 10 puntos presentaron mayor porcentaje de complicaciones. Conclusión. El control de FR múltiples constituye una estrategia efectiva para disminuir la incidencia de ACV. La prevención de las complicaciones médicas permiten un mejor cuidado del paciente y reducen la morbilidad relacionada al ACV.

Factores de riesgo y complicaciones extraneurológicas de pacientes internados por Accidente Cerebrovascular en el Hospital Nacional de Clínicas de Córdoba / [Risk Factors and extraneurological complications of stroke patients].

INTRODUCTION: Stroke is the third leading cause of death globally , act on modifiable risk factors is now the best prevention strategy. Medical complications are common in patients hospitalized for stroke , the valuation of income NIHSS , is associated with the final result in terms of duration of hospitalization, survival and discharge location. OBJETIVE: Determining risk factors ( RF) in patients hospitalized for stroke in Hospital Nacional de Clinicas de Córdoba (HNC) and characterize neurological complications NIHSS relative to income. MATERIAL AND METHODS: Prospective study of patients admitted to the Service of Neurology at HNC diagnosed with the first of September , 2010 to December 30, 2012 , we applied the admission NIHSS scale. Were determined cerebrovascular risk factors , we evaluated neurological complications during hospitalization. RESULTS: The total number of patients admitted for stroke was 200 , with 168 ischemic stroke ( 84

) and hemorrhagic stroke 32 (16

) . The FR Hypertension was the most frequent ( 83.5

had 3 or more FR for stroke. Had complications : 32

of patients , the respiratory infection was the most frequent (14.5

). Patients with NIHSS greater than 10 points had a higher rate of complications. CONCLUSION: The multiple RF control is an effective strategy to decrease the incidence of stroke . Prevention of medical complications enable better patient care and reduce morbidity associated with stroke.

Temporal influence on foraging strategies, territoriality and nomadic tendencies of Snail Kite, Rosthramus sociabilis (Viellot, 1817) in an urban Neotropical wetland / Temporalidade e estratégias de forrageamento, territorialidade e deslocamento do gavião-caramujeiro Rosthramus sociabilis (Viellot, 1817) em uma área urbana úmida Neotropical

The foraging, territoriality and displacement of the Snail Kite were studied over 232 hours of observations in an urban lake during the dry and wet seasons. The temperature and rainfall variations were used to correlate with predation rates and the correlation coefficients were 0,39 and 0,34, respectively. Snail Kites spent more time foraging during the wet than the dry season when perching is more frequently recorded. The higher predation in the wet season can be explained by the higher abundance of apple snails and the energy demand for reproduction. In the wet season, the territories were smaller and the conspecific conflicts decreased as prey were more available. However, due to the lack of food in the dry season, intra-specific conflicts and expansion of male territories were observed and the female and immatures were expelled from their foraging area to another location. In this way, site tenacity of Snail Kites should be interpreted in relation to the variations on food and dominance gradients according to the temporal changes (time) and foraging sites (space).

Foram estudados os comportamentos territoriais e de forrageio do gavião-caramujeiro em uma lagoa urbana durante as estações seca e chuvosa. Observaram-se esses comportamentos durante 232 horas, sendo a amostragem divida em períodos matutino e vespertino. A maior atividade de forrageio foi observada durante o período matutino. Os principais itens predados foram espécimes do gênero Pomacea spp. No entanto, durante o período de seca, os gaviões-caramujeiros também predaram caranguejos. Essas aves exibiram diferentes estratégias de forrageamento e territorialidade durante as diferentes estações. Os gaviões-caramujeiros dispenderam maior tempo de forrageamento durante a estação chuvosa e maior tempo pousados, durante a estação seca. A expansão/contração dos territórios realizados pelos machos é dependente da disponibilidade de alimento, que varia durante as estações: a) estação seca (pouco alimento): conflitos agonísticos intraespecíficos, seguidos de expansão dos territórios; b) estação chuvosa: conflitos agonísticos decresceram à medida que a oferta de alimento aumentou e, consequentemente, houve redução do tamanho dos territórios. Desse modo, conclui-se que os padrões de movimentação para forragear e estabelecer territórios são altamente dependentes da distribuição de recursos no espaço e no tempo, e estão também associados ao comportamento social, por meio de dominância dos machos.

Use of antifungal agents in pediatric and adult high-risk areas.

The purpose of this investigation was to describe the characteristics of the use of systemic antifungal agents (AFAs) and to evaluate their appropriateness of use. A prospective drug-utilisation study was conducted in intensive-care areas: haematology-oncology services and transplant units. Data were collected in three periods over 9 months. The required sample size was determined to be 113 patients (margin of error ±7%, 95% confidence interval [CI]), assuming a variability of 50%. Two different investigator groups evaluated the appropriateness of use separately; Cohen's Kappa index was used to calculate the degree of agreement between groups. A total of 114 patients we included, of which 62 (54.4%) were children. A total of 150 prescriptions were administered; fluconazole was the most frequently prescribed (38%), followed by liposomal amphotericin B (22.7%) and caspofungin (18.7%). The indications were: (1) pre-emptive treatment of Candida in non-neutropaenic critically ill patients (35.1%), (2) treatment of systemic fungal infection (24.6%), (3) prophylaxis for systemic fungal infection (SFI) in immunocompromised patients (16.7%), (4) prophylaxis of SFI in transplant recipients (12.3%), (5) prophylaxis of SFI in preterm infants (5.3%), (6) treatment of SFI in neonates (6.1%). The Kappa index showed a substantial agreement (Kappa = 0.73). The indications were considered to be inappropriate in 71 (47.3%) episodes. The indications or dosages were inappropriate in 79 cases (52.7%). The indications, dosages or duration of treatment were inappropriate in 83 cases (55.3%). We conclude that AFAs are prescribed for a significant number of inappropriate indications.

Organic pollutants in microplastics from two beaches of the Portuguese coast.

Microplastics pose a threat to coastal environments due to their capacity to adsorb persistent organic pollutants (POPs). These particles (less than 5 mm in size) are potentially dangerous to marine species due to magnification risk over the food chain. Samples were collected from two Portuguese beaches and sorted in four classes to relate the adsorption capacity of pollutants with color and age. Polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs) and DDTs were analysed on pellets through gas chromatography mass spectrometry (GC-MS), and types of plastic were identified using Fourier transformed infra-red spectroscopy (micro-FTIR). Microplastics were mostly polyethylene and polypropylene. Regarding sizes, some fibres ranged from 1 to 5 µm in diameter and were 500 µm in length. The majority of samples collected had sizes above 200 µm. Black pellets, unlike aged pellets, had the highest concentrations of POPs except for PAHs in Fonte da Telha beach. PAHs with higher concentrations were pyrene, phenantrene, chrysene and fluoranthene. Higher concentrations of PCBs were found for congeners 18, 31, 138 and 187. Further investigation is necessary to understand the relationship between plastic degradation and adsorption for different pollutants.

[Foreign body management. Combined bronchoscopy in a Paediatric Pulmonology Unit]. / Tratamiento del cuerpo extraño intrabronquial. Broncoscopia combinada en Neumología Infantil.

The foreign body (FB) aspiration is a significant of morbidity and mortality in childhood. The severity of the acute obstruction of the upper airway and the complications that the FB creates in the lower airway requires early diagnosis and treatment. Classically, the FB is removed with a rigid bronchoscope, with general anaesthesia, by surgeons. Nowadays, there are publications on removing FB with flexible bronchoscopy. There is now discussion on which is the best instrument, rigid or flexible bronchoscope. Flexible bronchoscopy is a minimal invasive procedure that allows the diagnosis to be made and locate the FB, which can only be removed in selected cases. Therefore, authors believe that FB removal is more effective with rigid bronchoscopy. It guarantees patient safety and the success of the procedure. However, both, flexible and rigid bronchoscopes are complementary, so their combined use is the most appropriate choice. We report the management of five cases of FB in paediatric patients with a combined procedure using flexible and rigid bronchoscopy.

Effect of flour extraction rate and baking on thiamine and riboflavin content and antioxidant capacity of traditional rye bread.

The effect of rye flour extraction rates and baking on thiamine and riboflavin content, and antioxidant capacity of traditional rye bread were studied and compared with white wheat flour. The content of thiamine was higher (10.9%) in rye dough formulated with dark rye flour (F-100%; extraction rate of 100%) than in rye dough formulated with brown rye flour (F-92%; extraction rate of 92%) that was similar to dough made with wheat flour. The riboflavin content in rye dough made from flour F-100% was also higher (16%) than in dough formulated with flour F-92%, and both provided larger riboflavin content than wheat dough. Baking led to reductions in thiamine of 56% for wheat bread and of 20% for both rye breads; however, this process caused only a 10% decrease in riboflavin for wheat bread and a 30% decrease for rye breads. Trolox equivalent antioxidant capacity, peroxyl radical scavenging capacity, DPPH radical scavenging activity, and Folin-Ciocalteu reducing capacity were higher in rye than in wheat dough and bread. Baking process produced slight changes in antioxidant activity, except for Superoxide Dismutase-like activity where a sharp decrease was observed. Our findings showed that rye breads are an important source of B vitamins and rye breads formulated with dark and brown flours showed better antioxidant properties than wheat bread. Therefore, rye breads should be more widely recommended in human nutrition.

Pramlintide in the treatment of diabetes.

Diabetes treatment has traditionally focused on correcting insulin deficiency with exogenous insulin and oral agents designed to enhance insulin secretion or insulin sensitivity in peripheral tissues. The more recent view of diabetes as a disease that affects multiple hormones in addition to insulin has led to the development of new therapies more broadly aimed at restoring glucose homeostasis by correcting abnormalities in additional glucoregulatory hormones. Pramlintide, a synthetic analogue of the beta-cell hormone amylin, regulates the appearance of glucose in the circulation following meals through several mechanisms of action: slowing gastric emptying, preventing inappropriate postprandial secretion of glucagon and increasing satiety. Long-term studies have demonstrated that pramlintide improves postprandial glucose fluctuations and A1C while reducing insulin dose and body weight. This combination of benefits associated with pramlintide makes it an attractive new treatment option for patients with diabetes. Clinical Trial Registry Numbers: 137-155 open-label clinical trial: NCT00108004 (Pramlintide long-term, placebo-controlled clinical trials were completed prior to the requirement for NCT registry).

Morbidity of laparoscopic surgery for complicated appendicitis: an international study.

BACKGROUND: Although laparoscopic appendectomy has some advantages over open appendectomy, some reports do show more postoperative intraabdominal abscesses. METHODS: A retrospective review of complicated appendicitis managed surgically by eight surgical groups from six countries was undertaken. Among 3,433 patients with appendicitis, 1,017 (29.5%) had complicated appendicitis, which included perforated or gangrenous appendicitis with or without localized or disseminated peritonitis. There were 74 preoperative abscesses (7.4%) and 5 small bowel obstructions. RESULTS: One patient died. There were 29 postoperative intraabdominal abscesses (2.8%) and 112 mostly minor complications. Conversion to laparotomy was necessary for 28 patients (2.7%). The surgical time ranged from 32 to 132 min (mean, 62 min), and the hospital stay ranged from 1 to 18 days (mean, 3.5 days). CONCLUSIONS: The morbidity rates, particularly for intraabdominal abscesses, were less for laparoscopic appendectomy in complicated appendicitis than those reported in the literature for open appendectomy, whereas operating times and hospital stays were similar.