Emergency contraception and risk habits in a university population.

OBJECTIVE: The aim of our study was to determine the self-reported prevalence of use of emergency contraception (EC), identify factors associated with EC use, and measure the prevalence in university students of pregnancy and abortion among users and non-users of EC. METHODS: A cross-sectional descriptive study of university students using a self-administered questionnaire was carried out in 2016. The main dependent variable was EC use at any time. Independent variables included sociodemographic factors and factors related to harmful habits and sexual behaviour. RESULTS: The study sample consisted of 1309 students (median age 20 years). Forty per cent of participants reported using EC; condom failure was given as the main reason. Variables associated with EC use in both men and women were illegal drug consumption and having had more than 10 sexual partners. In women, other factors associated with EC use were age at first coitus and non-centrist political views. The prevalence of pregnancy was 6.5% and the prevalence of voluntary abortion was 2.9%. This prevalence was similar for men and women and for EC users and non-users. CONCLUSION: EC use in university students was more likely in those who experienced contraceptive failure or used no contraception. There were differences between men and women. Those at higher risk of unplanned pregnancy were more likely to report EC use, which may explain why there was no difference in the rates of unwanted pregnancies between EC users and non-users.

The power of solid supports in multiphase and droplet-based microfluidics: towards clinical applications.

Multiphase and droplet microfluidic systems are growing in relevance in bioanalytical-related fields, especially due to the increased sensitivity, faster reaction times and lower sample/reagent consumption of many of its derived bioassays. Often applied to homogeneous (liquid/liquid) reactions, innovative strategies for the implementation of heterogeneous (typically solid/liquid) processes have recently been proposed. These involve, for example, the extraction and purification of target analytes from complex matrices or the implementation of multi-step protocols requiring efficient washing steps. To achieve this, solid supports such as functionalized particles (micro or nanometric) presenting different physical properties (e.g. magnetic, optical or others) are used for the binding of specific entities. The manipulation of such supports with different microfluidic principles has both led to the miniaturization of existing biomedical protocols and the development of completely new strategies for diagnostics and research. In this review, multiphase and droplet-based microfluidic systems using solid suspensions are presented and discussed with a particular focus on: i) working principles and technological developments of the manipulation strategies and ii) applications, critically discussing the level of maturity of these systems, which can range from initial proofs of concept to real clinical validations.

A simple and low-cost chip bonding solution for high pressure, high temperature and biological applications.

The sealing of microfluidic devices remains a complex and time-consuming process requiring specific equipment and protocols: a universal method is thus highly desirable. We propose here the use of a commercially available sealing tape as a robust, versatile, reversible solution, compatible with cell and molecular biology protocols, and requiring only the application of manually achievable pressures. The performance of the seal was tested with regards to the most commonly used chip materials. For most materials, the bonding resisted 5 bars at room temperature and 1 bar at 95 °C. This method should find numerous uses, ranging from fast prototyping in the laboratory to implementation in low technology environments or industrial production.

Optimization of a microwave-assisted extraction method for the analysis of polychlorinated biphenyls in ash samples.

An alternative method for the extraction of polychlorinated biphenyls (PCBs) in ash samples, which is less time and solvent consuming than Soxhlet extraction, is presented. A study was carried out to evaluate the possibilities of microwave-assisted extraction (MAE) to determine exactly which parameters affect the efficiency of the process, since direct extrapolation of extraction conditions for PCBs in other solid matrices, failed when applied to coplanar congeners in ash samples. Influence of the organic solvent on the yield of the extraction was first evaluated using two ash samples with different percentages of carbon. Once the extraction solvent was fixed, the effects of solvent volume, extraction temperature and extraction time were investigated using an experimental design. It was found that the volume of organic solvent played a more important role in the extraction efficiency than the other factors. In the optimal conditions microwave extractions were performed at 110 degrees C. for 10 min and using 30 ml of toluene. Recoveries higher than 80% were obtained for all the highly chlorinated congeners. including coplanar species, in a spiked ash sample containing a relatively high concentration of carbon. The proposed method was also applied to the determination of PCBs in a reference material of urban dust. Recoveries were similar to those obtained for spiked ash samples.

Selective determination of polychlorinated biphenyls in waste oils using liquid-liquid partition followed by headspace solid-phase microextraction and gas chromatography with atomic emission detection.

A procedure for the determination of the total content of polychlorinated biphenyls (PCBs) in industrial oil samples using gas chromatography coupled to atomic emission detection (GC-AED) is presented. Analytes were extracted from the samples using dimethylsulfoxide (DMSO), this extract was diluted with water, and PCBs were concentrated on a PDMS-DVB solid-phase microextraction (SPME) fibre using the headspace (HS) mode. Fibres were thermally desorbed for 3 min in the splitless injection port of the GC-AED system. Influence of liquid-liquid extraction conditions on the performance of the analytical procedure is presented and the need of a sample oxidation step, previous to the extraction of the PCBs with DMSO, discussed. Working under optimal conditions, quantification limits from 0.5 to 1 microg/g (total PCBs content) were obtained for several Aroclor mixtures in transformer oil samples. The repeatability of the whole sample preparation procedure (liquid-liquid partition followed by headspace SPME and GC-AED determination) ranged from 4 to 7%.

Rapid determination of butyltin species in water samples by multicapillary gas chromatography with atomic emission detection following headspace solid-phase microextraction.

A procedure for the rapid determination of mono-, di- and tributyltin in water samples is described. The analytes are simultaneously ethylated and concentrated on a solid-phase microextraction fibre placed in the headspace over the sample for 2 min. The ethylated species are then separated and selectively quantified in only 90 s using a multicapillary gas chromatography column combined with atomic emission detection. The influence of blank signals and sampling conditions on the sensitivity of the method is described. Detection limits of 1-5 ng/l and relative standard deviations of 6-10% at concentrations of 20 ng/l were obtained.

Determination of polychlorinated biphenyl compounds in indoor air samples.

A simple procedure for the determination of six non-coplanar polychlorinated biphenyls (PCBs) in medium volumes of indoor air is described. Samples are forced at 6 m3/h through a device consisting of a quartz filter connected to the end of a conventional solid-phase extraction cartridge containing 60 mg of functionalized styrene-divinylbenzene. PCBs retained on the sorbent are directly eluted with 2 ml of hexane. Those associated to airborne particulate matter are microwave extracted in 10 min using 15 ml hexane-acetone (1:1). The proposed procedure is favorably compared to the use of polyurethane cylinders for the concentration of PCBs in terms of solvent consumption and rapidity of the desorption step. Furthermore, the functionalized sorbent showed higher breakthrough volumes than Amberlite XAD-2 for PCBs in gas phase. Quantification limits between 2 and 40 pg/m3 were obtained for six PCBs (from di- to heptachlorobiphenyls) using GC-electron-capture detection.

Application of matrix solid-phase dispersion to the determination of polychlorinated biphenyls in fat by gas chromatography with electron-capture and mass spectrometric detection.

A one-step extraction-purification method for the determination of polychlorinated biphenyls (CBs) in fat samples was developed. Matrix solid-phase dispersion using different combinations of normal phase sorbents and elution solvents was evaluated, in terms of extraction yield and lipids removal efficiency, for the isolation of CBs from butter, chicken and beef fat. Under optimal conditions, 0.5 g of sample was dried with anhydrous sodium sulphate, dispersed on 1.5 g of Florisil and transferred to the top of a polyethylene solid-phase extraction cartridge which already contain 5 g of Florisil. Non-coplanar CBs were quantitatively eluted with 15 ml of n-hexane. The lipid percentage in this extract remained below 0.06% of the sample mass. As coplanar congeners show a higher affinity for Florisil, 20 ml of hexane-dichloromethane (90:10) were necessary for the quantitative recovery of coplanar and non-coplanar CBs. The potential of the procedure to fractionate non-coplanar and coplanar congeners is discussed. After extract evaporation to 0.2 ml, quantification limits of 0.4 ng of each CB per g of fat were achieved, using gas chromatography with tandem MS or electron-capture detection (ECD).

Optimization of a microwave-assisted derivatization-extraction procedure for the determination of chlorophenols in ash samples.

A procedure for the determination of 17 chlorophenolic compounds in ash samples obtained from the incineration of waste materials is described. Analytes were simultaneously derivatized with acetic anhydride in presence of triethylamine (TEA), and extracted from the sample in a mixture of n-hexane acetone using a microwave system equipped with closed extraction vessels. Influence of five experimental parameters (volume of TEA and acetic anhydride, extraction time and temperature, as well as the volume of n-hexane acetone) on the yield of the derivatization-extraction procedure was systematically studied using a uniform experimental design at four levels, followed by a conventional factorial design at two levels. Under optimal extraction conditions, recoveries from 72 to 94% were obtained for a spiked ash sample with a carbon content of 8.7%. Quantification limits of the proposed procedure ranged from 2 to 5 ng/g using GC-MS as detection technique. The proposed method was applied to the determination of chlorophenols in three ash samples obtained from different incineration plants. Total chlorophenol contents of 423 and 135 ng/g were found in two of these samples.

Epidemiology of invasive streptococcus pneumoniae infections in children in Spain, 1996-1998.

BACKGROUND: Streptococcus pneumoniae is a significant cause of meningitis and septicemia in early infancy, being associated to a high case-fatality rates and serious sequelae. OBJECTIVE: To investigate the burden of invasive disease caused by S. pneumoniae in Valencia, Spain, during a three-year period (1996-1998). METHODS: Hospital-based prospective active surveillance program for invasive bacterial diseases in children < or = 15 years of age in Valencia, from December 1, 1995 to January 1999. RESULTS: A total of 94 cases of invasive pneumococcal disease were detected in patients < or = 15 years of age. The overall annual incidence of invasive pneumococcal disease was 4.6/100,000 persons, < or = 15 years of age. The incidence of invasive disease and meningitis was higher among children younger than 2 years of age (16.8 and 3.8, respectively). Serotypes 19, 14 and 6 accounted for 83% of the isolates. CONCLUSIONS: The age distribution of invasive pneumococcal disease and meningitis shows a peak in the first two years of life and a decline thereafter. Serotypes 19, 14 and 6 are those primarily responsible for invasive pneumococcal disease in children of this region of Spain.

Impact of non-routine vaccination on the incidence of invasive Haemophilus influenzae type b (Hib) disease: experience in the autonomous region of Valencia, Spain.

OBJECTIVE: This study assessed the impact of non-routine vaccination against invasive Haemophilus influenzae (Hib)disease before the introduction of universal childhood Hib vaccination. METHODS: Data were obtained from a prospective surveillance program for invasive bacterial diseases in children <15 years of age that was begun in the Autonomous Region of Valencia on 1 December 1995. RESULTS: An incidence of 15.5 cases of invasive Hib disease per 100,000 children <5 years of age was reported in the first year of the surveillance program (from 1 December 1995 to 30 November 1996), when Hib vaccination coverage was estimated to be 32.5%. An increase in vaccination coverage to 44% in the second year (1 December 1996 to 30 November 1997) was associated with a reduction in disease incidence to 3.3 cases per 100,000. After the initiation of universal vaccination in December 1998, only two cases were reported. The effectiveness of non-routine vaccination was 71% in 1997. CONCLUSIONS: These results show that before the introduction of routine childhood Hib vaccination, widespread use of the vaccine can dramatically reduce the occurrence of invasive Hib disease.

Antibiotics for preventing recurrent urinary tract infection in non-pregnant women.

BACKGROUND: Urinary tract infection (UTI) is a common health care problem. Recurrent UTI (RUTI) in healthy non-pregnant women is defined as three or more episodes of UTI during a twelve month period. Long-term antibiotics have been proposed as a prevention strategy for RUTI. OBJECTIVES: To determine the efficacy (during and after) and safety of prophylactic antibiotics used to prevent uncomplicated RUTI in adult non-pregnant women. SEARCH STRATEGY: We searched MEDLINE (1966-April 2004), EMBASE (1980-January 2003), Cochrane Central Register of Controlled Trials( in The Cochrane Library Issue 1, 2004) and reference lists of retrieved articles SELECTION CRITERIA: Any published randomised controlled trial where antibiotics were used as prophylactic therapy in RUTI. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) with 95% confidence intervals (CI). MAIN RESULTS: Nineteen studies involving 1120 women were eligible for inclusion. Antibiotic versus antibiotic (10 trials, 430 women): During active prophylaxis the rate range of microbiological recurrence patient-year (MRPY) was 0 to 0.9 person-year in the antibiotic group against 0.8 to 3.6 with placebo. The RR of having one microbiological recurrence (MR) was 0.21 (95% CI 0.13 to 0.34), favouring antibiotic and the NNT was 1.85. For clinical recurrences (CRPY) the RR was 0.15 (95% CI 0.08 to 0.28). The NNT was 1.85. The RR of having one MR after prophylaxis was 0.82 (95% CI 0.44 to 1.53). The RR for severe side effects was 1.58 (95% CI 0.47 to 5.28) and for other side effects the RR was 1.78 (CI 1.06 to 3.00) favouring placebo. Side effects included vaginal and oral candidiasis and gastrointestinal symptoms. Antibiotic versus antibiotic (eight trials, 513 women): These trials were not pooled. Weekly pefloxacin was more effective than monthly. The RR for MR was 0.31(95% CI 0.19 to 0.52). There was no significant difference in MR between continuous daily and postcoital ciprofloxacin. REVIEWERS' CONCLUSIONS: Continuous antibiotic prophylaxis for 6-12 months reduced the rate of UTI during prophylaxis when compared to placebo. After prophylaxis two studies showed nodifference between groups. There were more adverse events in the antibiotic group. One RCT compared postcoital versus continuous daily ciprofloxacin and found no significant difference in rates of UTIs, suggesting that postcoital treatment could be offered to woman who have UTI associated with sexual intercourse.

[Hypertensive encephalopathy: contribution of magnetic resonance]. / Encefalopatía hipertensiva: aportación de la resonancia magnética.

We report a patient with hypertensive encephalopathy and we analyze his clinical and neurological imaging peculiarities. Computed tomography showed hypodense corticosubcortical lesions, whereas magnetic resonance scan disclosed extensive, wholly reversible enhanced signal lesions due to cerebral edema.

[Haemophilus influenza type b invasive disease in the Community of Valencia. Study Group on Invasive Diseases]. / Enfermedad invasora por Haemophilus influenzae tipo b en la Comunidad Valenciana. Group de Estudio de Enfermedades Invasoras.

The objective of this study was to estimate the incidence of systemic Haemophilus influenzae type b (Hib) disease in the Valencian Community, Spain, and to study the microbiological characteristics of the strains. Prospective, active surveillance of children in the Valencian Community. Data were obtained from microbiology laboratories and paediatricians. A case was considered when a child younger than 15 years of age had clinical invasive disease and a Haemophilus influenzae (Hi) was isolated from a normally sterile site, or when a positive capsular antigen was identified with a compatible Gram strain. In the first year of surveillance, starting on December 1, 24 cases were identified. Of the 20 strains studied in our laboratory, 19 were serotype b and one non typable. 75% of the strains were beta-lactamase positive. Meningitis was the most frequent clinical presentation. All children were less than five, and 51.2% were less than one year of age. The mortality was 8.3%. For unvaccinated children less than 5 years the estimated incidence of invasive disease was 18.2/100,000 and of meningitis 14.0/100,000. The incidence of Hib invasive disease in unvaccinated children justifies the universal Hib vaccine programme in the Valencian Community.

[Study of non-participation in the breast cancer screening program in the city of Valencia (Spain)]. / Estudio de la no participación en el programa de prevención de cáncer de mama en la ciudad de Valencia.

AIM: To determine the reasons for non-participation of women in a breast cancer screening program. METHODS: We performed an observational, cross-sectional study in women who were invited to participate in the breast cancer screening program in the city of Valencia and who failed to attend. The women were interviewed in their homes through a questionnaire consisting of 25 questions grouped as follows: knowledge of the program, reasons for nonparticipation, attitudes or beliefs and characteristics of the interviewees (socioeconomic and educational variables and age). A descriptive analysis was performed. Differences in the characteristics of women were evaluated through bivariate analysis. Multivariate analysis was performed through logistic regression. RESULTS: A total of 783 addresses were used, 411 questionnaires were completed and 361 were analyzed. The 50 questionnaires used in the pilot study were excluded because, as a consequence of this study, the questionnaire had been modified. Most of the women (93.4%) (CI: 90.3-95.7) remembered having an appointment. The main reason for not attending was being screened in another health service in 48.8% (CI: 43.6-53.9), followed by various personal reasons in 16.1% (CI: 12.3-19.9) and inability to keep the appointment at the specified time in 15.5% (CI: 11.8-19.2). Comparison of women in the middle and upper social classes with those in the lower classes revealed important differences. Middle and upper class women had a higher probability of knowing about the program and of being on hormone replacement therapy (HRT) and the most frequent reason for non-attendance was attendance at another program run by another health service. In lower class women the reasons for non-attendance were fear, not believing the program to be important to health and inability to keep the appointment at the specified time. In the multivariate analysis, the variables that entered the model were HRT, social class and education. Thus, middle or upper class women undergoing HRT and with secondary or higher education had a higher probability of being screened. CONCLUSIONS: The profile of non-participating women belongs on the one hand to those in the middle or upper social classes, undergoing HRT and being screened by other health services and, on the other, to a group of women of low social class, whose reason for non-participation is fear and timetable difficulties.

[Epidemiology of Haemophilus influenzae type b, Neisseria meningitidis, and Streptococcus pneumoniae in children in the Valencia Community, Spain. Acute diseases study group]. / Epidemiología de la meningitis producida por Haemophilus influenzae tipo b, Neisseria meningitidis y Streptococcus pneumoniae en niños de la Comunidad Valenciana, España. Grupo de Estudio de Enfermedades Invasoras.

OBJECTIVE: To asses the incidence of Haemophilus influenzae type b (Hib), Neisseria meningitidis and Streptococcus pneumoniae meningitis in children of de Valencian Community (VC), Spain, and to describe the microbiologic characteristics. MATERIAL AND METHODS: Prospective surveillance system with paediatrician and microbiologist participation of all public hospitals of the VC. Cases are children less than 15 with clinical meningitis and with isolation of Hib, N. meningitidis or S. pneumoniae from CSF of blood. RESULTS: From 1st December 1995 to 30th November 1996, 51 cases were declared, 33.3% were Hib, 49.0% N. meningitidis and 17.7% S. pneumoniae. The annual incidence of meningitis was 7.6 cases/100,000 < 15 years, 20.5/100,000 < 5 years and 56.2/100,000 < 1 year. 84.3% of the cases occurred in children younger than 5. S. pneumoniae had the highest mortality. CONCLUSIONS: Hib is a frequent cause of meningitis in spite of that one third of children are vaccinated. 43% of the N. meningitidis isolated in meningitis are serogroup C. S. pneumoniae meningitis are more frequent in children less than one, and has a high mortality rate.

[Ulegyria and epilepsy]. / Ulegiria y epilepsia.

Ulegyria is a derangement of the architecture of the cerebral cortex characterised by the presence of multiple small cerebral convolutions. It is caused by hypoxic-ischaemic damage of these convolutions in the perinatal period. This differentiates it from polimcrogyria which is due to damage during the period of late neuronal migration or early postmigration. The clinical findings vary from cases with hardly any symptoms to more severe forms which show psychomotor retardation, convulsive crises and/or motor defects. We describe the case of a 21-year-old patient who suffered anoxia during delivery, with a very low Apgar score, who presented with epileptic crises in childhood (motor foci which became generalized) with good anticonvulsant control. On examination, there was a slight mental handicap. On magnetic resonance an uligyric area was seen in the occipital cortex. High resolution magnetic resonance allows the diagnosis of this type of change in the cerebral cortex in the living patient since the differences between grey and white matter can be distinguished better than with computerized tomography.

[Pseudotumor cerebri secondary to cerebral venous defects not identified by magnetic resonance]. / Pseudotumor cerebri secundario a defectos de drenaje venoso cerebral no identificados mediante resonancia magnética.

Pseudotumour cerebri is the name of a syndrome characterized by headache and papilloedema, with normal cerebral CT/MR studies and CSF with a high pressure and normal laboratory findings. We describe four patients who fulfilled the diagnostic criteria of this condition (including normal 0.5T MR studies). They all had cerebral angiograms showing minor abnormalities localized to the level of the superior longitudinal sinus. All improved on treatment with anticoagulants and steroids. In view of these findings we consider that in cases of pseudotumour cerebri without a clear aetiological factor, an angio MR study should be done, or if this technique is not available, a cerebral angiogram should be done, to exclude cerebral venous drainage defects.

[Isolated hemi-ataxia as a sign of mesencephalic lacunar infarction]. / Hemiataxia aislada como manifestación de infarto lacunar mesencefálico.

INTRODUCTION: Lesions of the dento-rubro-thalamo-cortical pathway may cause homolateral or contralateral hemiataxia, depending on whether they are found above or below the decussation which occurs at the level of the inferior colliculus. Most mesencephalic infarctions causing hemiataxia also show oculomotor involvement with nuclear or fascicular lesions of the third cranial nerves. This was not seen in the case we report. CLINICAL CASE: We describe the case of a diabetic patient with a permanent right appendicular hemiataxia, without oculomotor involvement, caused by a lacunar infarct shown on MR imaging which was situated in the antero-external part of the left superior mesencephalum. CONCLUSIONS: This case helps to clarify the topography of the thalamic radiations of the mesencephalic calotte, including the decussated superior dento-rubro-thalamic pathway to the red nucleus. Involvement of this, situated in the mesencephalic lateral vascular territory causes contralateral hemiataxia.