Novel flame retardants detected in marine plastic litter in coastal areas in Central Chile.

Flame retardants (FRs) are released throughout the plastic life cycle, potentially impacting the environment, biodiversity, and human health. This study analyzed novel flame retardants (NFR) in marine plastic litter (MPL) from six coastal areas in central Chile in November 2017. Target chemicals (n = 19) were analyzed using ultrasonic extraction with hexane, gas chromatography, and mass spectrometry (GC-MS). From all nineteen NFRs analyzed, only ten (53 %) were routinely detected. BTBPE (1,2-bis(2,4,6-tribromophenoxy) ethane) showed the highest concentrations at the Bellavista site (618 to 424,000 pg g-1), and HBB (Hexabromobiphenyl), banned since 1970, was detected in Coliumo (2630 to 13,700 pg g-1). These results show emerging transport patterns and underscore the critical need for enhanced waste management practices for MPL in coastal regions to prevent adverse impacts on marine biodiversity.

Marine litter pollution in a subantarctic beach of the Strait of Magellan, Punta Arenas, Chile.

This study assessed the presence of marine litter along the beach of the city of Punta Arenas, Chile. The sampling period coincided with the COVID-19 pandemic. A total of 239 plastic waste items were identified out of a total of 638 litter items. The Clean Coast Index reported within this study ranged from Clean (CCI 2-5) to Extremely dirty (CCI >20), especially near the port. The majority of litter items has been classified as originating from varied origins, as it is not possible to pinpoint a precise origin in most items. The results indicate that the predominant plastic litter in Punta Arenas is PVC. The results are discussed in relation to the sources and composition of the residues, the morpho dynamics of the coast, and the CCI is compared with other locations around the globe.

Occurrence of marine plastic litter and plasticizers from touristic beaches of Arauco Gulf in Central Chile.

Marine plastic litter (MPL) was collected from beaches (n = 3) of the Arauco Gulf in central Chile in spring 2021 and summer 2022. MPL was analyzed for physical and chemical characteristics, and plasticizers were also screened using FTIR-ATR. Three hundred seventeen plastic items with an accumulated weight of 226.8 g were found. MPL densities ranged from 0.4 to 17.1 items m-2. Significant differences (p < 0.05) between seasons were observed for Arauco and Maule beaches, being ∼ten times higher in summer compared to spring. Solid pieces were the predominant shape, macroplastics were the most abundant (>2.5 cm), and white and blue colors were dominant. Polypropylene (52 %) and polyethylene (31 %) were the predominant polymers. Plasticizers (n = 3) were detected in the MPL in the study area (dioctyl phthalate, polybutene, and alpha-methylstyrene) for the first time. This study contributes new information related to MPL in coastal areas of central Chile and their chemical composition.

A Pioneer Tool to Reduce Restrictive Practices toward People with Intellectual and Developmental Disabilities.

Reducing restrictive practices toward individuals with intellectual and developmental disabilities is a globally recognized imperative and human rights priority. This paper presents a novel tool called LibRe for assessing and reducing restrictive practices. This tool involved an instrumental multistage design and collaboration between professionals, individuals with disabilities, family members, and experts from different fields. It addresses diverse restrictive practices in five key domains: physical or mechanical, chemical or pharmacological, structural, relational, and practices related to contexts and supports. It addresses practices that are pertinent to the Spanish context and that existing tools have not covered. Embedded as a step within an organizational approach, LibRe fosters organizational transformation and provides resources to achieve outcomes within reduction plans for restrictive practices. In total, 156 teams comprising 585 professionals, 64 people with disabilities, and 44 family members responded to the tool. In terms of evidence for internal structure validity, the oblique five-factor model exhibited an adequate fit through confirmatory factor analysis, along with satisfactory reliability indices, according to ordinal alpha and omega. Users positively appraised the tool's usefulness and identified its strengths and challenges. Although further research is needed, preliminary evidence frames LibRe as a useful resource for practice and research.

How to Assess Oral Narrative Skills of Children and Adolescents with Intellectual Disabilities: A Systematic Review.

Children and adolescents with intellectual disabilities (ID) often encounter difficulties with narrative skills. Yet, there is a lack of research focusing on how to assess these skills in this population. This study offers an overview of the tools used for assessing oral narrative skills in children and adolescents with ID, addressing key questions about common assessment tools, their characteristics, and reported evidence. A systematic review was conducted of the literature published between 2010 and 2023 in the PsycINFO, ERIC, Education, and Psychology databases. An initial 1176 studies were reviewed by abstract, of which 485 were read in full text, leading to the selection and analysis of 22 studies. Most of the identified tools involve analyzing language samples obtained using wordless picture story books. Three common tools are emphasized. Studies have primarily identified inter-rater reliability and test-criterion evidence for validity. The main tools and their characteristics are discussed in depth to aid readers in discerning suitable options for research or practical applications. The importance of reporting diverse sources of evidence for validity and reliability within this population is highlighted.

A Myeloid-Specific Lack of IL-4Rα Prevents the Development of Alternatively Activated Macrophages and Enhances Immunity to Experimental Cysticercosis.

To determine the role that the IL-4/IL13 receptor plays in the development of alternatively activated macrophages (AAM or M2) and their role in the regulation of immunity to the extraintestinal phase of the helminth parasite Taenia crassiceps, we followed the infection in a mouse strain lacking the IL-4Rα gene (IL-4Rα-/-) and in the macrophage/neutrophil-specific IL-4Rα-deficient mouse strain (LysMcreIL-4Rα-/lox or cre/LoxP). While 100% of T. crassiceps-infected IL-4Rα+/+ (WT) mice harbored large parasite loads, more than 50% of th eIL-4Rα-/- mice resolved the infection. Approximately 88% of the LysMcreIL-4Rα-/lox mice displayed a sterilizing immunity to the infection. The remaining few infected cre/LoxP mice displayed the lowest number of larvae in their peritoneal cavity. The inability of the WT mice to control the infection was associated with antigen-specific Th2-type responses with higher levels of IgG1, IL-4, IL-13, and total IgE, reduced NO production, and increased arginase activity. In contrast, IL-4Rα-/- semi-resistant mice showed a Th1/Th2 combined response. Furthermore, macrophages from the WT mice displayed higher transcripts for Arginase-1 and RELM-α, as well as increased expression of PD-L2 with robust suppressive activity over anti-CD3/CD28 stimulated T cells; all of these features are associated with the AAM or M2 macrophage phenotype. In contrast, both the IL-4Rα-/- and LysMcreIL-4Rα-/lox mice did not fully develop AAM or display suppressive activity over CD3/CD28 stimulated T cells, reducing PDL2 expression. Additionally, T-CD8+ but no T-CD4+ cells showed a suppressive phenotype with increased Tim-3 and PD1 expression in WT and IL-4Rα-/-, which were absent in T. crassiceps-infected LysMcreIL-4Rα-/lox mice. These findings demonstrate a critical role for the IL-4 signaling pathway in sustaining AAM and its suppressive activity during cysticercosis, suggesting a pivotal role for AAM in favoring susceptibility to T. crassiceps infection. Thus, the absence of these suppressor cells is one of the leading mechanisms to control experimental cysticercosis successfully.

Análisis del patrón de consumo de psicotropos y drogas de abuso en el hospital de Pontevedra durante el año 2016 / Analysis of the pattern of psichotropic and drug abuse in Pontevedra hospital during 2016

Estudio descriptivo retrospectivo de las intoxicaciones agudas por psicofármacos y/o drogas de abuso atendidas en el servicio de urgencias del hospital de Pontevedra durante el año 2016 con el fin de conocer el tipo de intoxicación, su intencionalidad, cronología, agentes tóxicos implicados, antecedentes de los pacientes, manifestaciones clínicas presentadas, evolución y tratamiento administrado. Se realizó la prueba cualitativa Drug-Clip Test 10 (A. Menarini Diagnostics) en orina. Se confirmaron 831 resultados positivos (1% de las urgencias anuales). Las intoxicaciones por benzodiazepinas fueron las más frecuentes (617 casos), principalmente en mujeres, seguidas de la detección de cannabis (318 casos), mayormente en hombres. Predominaron los síntomas neurológicos (44%), antecedentes psiquiátricos (43%) y el tratamiento inespecífico (82%). La intencionalidad autolítica fue del 22% y la mortalidad del 0,8%. Concluimos que la sobreprescripción de benzodiazepinas está aumentando su accesibilidad, causando un incremento de las intoxicaciones agudas y los intentos autolíticos por estos fármacos

Retrospective descriptive study of acute intoxications by psychotropic substances and/or abuse drugs at the emergency department of Pontevedra Hospital during the year 2016 performed to know the type of intoxication, its intention, chronology, toxic agents involved, previous patient history, clinical manifestations presented, evolution and treatment administered. The Drug-Clip test 10 (A. Menarini diagnostics) was tested in urine. Results. 831 positive cases were confirmed (1% of the overall annual emergencies). Benzodiazepine intoxications were the most frequent (617 cases), mainly in women, followed by cannabis detections (318 cases), mostly in males. Neurological symptoms (44%), psychiatric antecedents (43%) and unspecific treatment (82%) predominated. Autolytic Intentionality was 22% and mortality 0.8%. Conclusion. Over-prescription of benzodiazepines makes easier its accessibility, causing an increase in the acute intoxications and the autolytic attempts by these drugs

Evaluación de prevalencia de pacientes con necesidades paliativas en las plantas de hospitalización de agudos de oncología y medicina interna en 2 hospitales de tercer nivel de la Comunidad de Madrid / Evaluating the prevalence of patients with palliative needs in acute oncology and internal medicine hospitalization wards at two third-level hospitals in the Community of Madrid

Introducción: Los cuidados paliativos se demuestran útiles y eficientes en los pacientes que presentan dichas necesidades, pero es escasa aún la implementación de estos en el ars médica diaria de los médicos sin formación específica. El instrumento NECPAL (Instrumento para la Identificación de Personas en Situación de Enfermedad Crónica Avanzada y Necesidad de Atención Paliativa en Servicios de Salud y Sociales) se ha demostrado útil para identificar a estos pacientes y ayudar a la toma de decisiones. El objetivo principal de este estudio es conocer la prevalencia de pacientes con necesidades paliativas y si se produjo adecuación de medicina paliativa al alta en los pacientes NECPAL positivos. Material y métodos: Estudio observacional, retrospectivo, de cohortes, de pacientes hospitalizados en un periodo de 3 meses en las plantas de Medicina Interna y Oncología de 2 hospitales de tercer nivel, con la recogida de variables demográficas, identificación de necesidades paliativas y complejidad. Resultados: La prevalencia de pacientes con necesidades paliativas es alta (90 %) y de ellos cumplen criterios de complejidad el 32 % de los pacientes oncológicos y el 20 % de los no oncológicos. Pese a ello, el abordaje de las necesidades paliativas solo se produjo en el 18 % de los pacientes oncológicos y en el 18 % de los no oncológicos. La mortalidad de los pacientes identificados como NECPAL positivos a 12 meses fue del 96 % en los oncológicos y del 57 % en los no oncológicos. Conclusión: Pese a la alta prevalencia de pacientes con necesidades de cuidados paliativos en las plantas de hospitalización de Medicina Interna y Oncología y la alta mortalidad en el año siguiente a dicha hospitalización, la planificación de la atención es escasa. (AU)

Introduction: Palliative care has been shown to be useful and efficient in patients who present these needs, but its implementation in the daily medical practice of doctors without specific training is still scarce. The NECPAL instrument (Instrument for the Identification of People in a Situation of Advanced Chronic Illness and Need for Palliative Care in Health and Social Services) has been shown to be useful in identifying these patients and in helping decision-making. The main objective of this study was to determine the prevalence of patients with palliative needs, and whether there was adequacy of palliative measures at discharge in NECPAL-positive patients. Material and methods: An observational, retrospective, cohort study of patients hospitalized over a period of 3 months at the Internal Medicine and Oncology wards of two tertiary hospitals, with collection of demographic variables, and identification of palliative needs and complexity. Results: The prevalence of patients with palliative needs (90 %) and meeting complexity criteria is 32 % of cancer patients and 20 % of non-cancer patients. Despite this, addressing palliative needs only occurred in 18 % of cancer patients and 18 % of non-cancer patients. The mortality rate of patients identified as NECPAL-positive at 12 months was 96 % in cancer patients and 57 % in non-cancer patients. Conclusion: Despite a high prevalence of patients with palliative care needs in internal medicine and oncology hospitalization wards, and a high mortality rate in the year following said hospitalization, care planning is scarce. (AU)

La importancia del estudio histológico e inmunohistoquímico en el diagnóstico de la enfermedad grave por citomegalovirus con carga viral indetectable / The importance of the histological and immunohistochemical evaluation for diagnosis of serious cytomegalovirus disease without detectable iral load

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Desorden bronquiolar primario de difícil diagnóstico / Primary bronchiolar disorder difficult to diagnose

Se presenta una paciente de sexo femenino de 25 años de edad, domiciliada en Santiago del Estero, que ingresa por Servicio de Urgencias del Hospital Padilla de Tucumán el 10/01/14. Refiere disnea grado 2-3 MRC de 10 días de evolución aproximadamente; las 48 horas previas al ingreso presentó fiebre (> 38°C) y compromiso del estado general. Consultó primero en su provincia, donde fue medicada con cronopen balsámico (ampicilna, dipirona, guaifenesina) intramuscular por 6 días, sin evolución favorable

Procalcitonina y proteína C reactiva como marcadores precoces de infección intraabdominal postoperatoria en pacientes operados de cáncer gastrointestinal / Procalcitonin and C-reactive protein as early indicators of postoperative intra-abdominal infection after surgery for gastrointestinal cancer

OBJETIVO: Evaluar la asociación entre niveles séricos de procalcitonina (PCT) y proteína C reactiva (PCR), en los 3 primeros días de postoperatorio, y la aparición de infección intraabdominal postoperatoria. MÉTODO: Estudio observacional prospectivo que incluye a 67 pacientes intervenidos quirúrgicamente de cáncer colorrectal, gástrico y pancreático. Los niveles séricos de PCT y PCR se midieron antes de la cirugía y a las 24, 48 y 72 h de la misma. Se registraron los valores de PCT y PCR, así como su fiabilidad para la detección de infección intraabdominal postoperatoria. RESULTADOS: La incidencia de infección intraabdominal postoperatoria fue de 13,4%. Los valores de PCR a las 72 h, los valores de PCT a las 24, 48 y 72 h y el cociente entre el valor de PCR a las 72 h y el valor de PCR a las 48 h (PCR D3/PCR D2) se asociaron significativamente con la aparición de infección intraabdominal postoperatoria. La sensibilidad más alta correspondió al valor de PCT a las 72 h (88,9%); la especificidad más alta y el valor predictivo positivo (VPP) más alto, al cociente PCR D3/PCR D2 (96,49 y 71,4%, respectivamente); el valor predictivo negativo (VPN) más alto, al valor de PCT a las 72 h y a las 24 h (97,7 y 96%, respectivamente). CONCLUSIÓN: Los valores de PCT se asocian significativamente con la aparición de infección intraabdominal postoperatoria en los 3 primeros días de postoperatorio. Su sensibilidad y VPP son bajos, pero su VPN es alto, incluso a las 24 h de la cirugía

AIM: to evaluate the association between serum levels of procalcitonin and C-reactive protein, on the first 3 postoperative days, and the appearance of postoperative intra-abdominal infection. METHOD: Prospective observational study including 67 patients operated on for colo-rectal, gastric and pancreatic cancer. Serum levels of procalcitonin and C-reactive protein were analyzed before surgery and daily until the third postoperative day. Values of procalcitonin (PCT) and C-reactive protein (CRP) were recorded as well as their accuracy for detection of postoperative intra-abdominal infection (PIAI). RESULTS: The incidence of postoperative intra-abdominal infection was 13.4%. CRP serum levels at 72 h, PCT serum levels at 24, 48 and 72 h and the ratio between serum levels of CRP at 72 hours and serum levels of CRP at 48 hours (CRP D3/CRP D2) were significantly associated with the appearance of postoperative intra-abdominal infection. The highest sensitivity corresponded to PCT at 72 hours (88.9%); the highest specificity and positive predictive value corresponded to the ratio CRP D3/CRP D2 (96.49% and 71.4%, respectively); the highest negative predictive value to procalcitonin at 72 h and 24 h. CONCLUSIONS: Serum levels of PCT are significantly associated with the appearance of postoperative intra-abdominal infection. Sensitivity and predictive positive values are low, but negative predictive value is high, even at 24 h after surgery

Hallazgos clínicos y de laboratorio presentes en mujeres adolescentes embarazadas residentes en Costa Rica y con al menos dos consultas de control prenatal en el Hospital Calderón Guardia del 10 de mayo al 21 de mayo del 2010 / Clinical and laboratory findings in pregnant teenagers present resident in Costa Rica and with at least two antenatal care visits in the Calderon Guardia Hospital May 10 to May 21, 2010

El presente es un estudio descriptivo observacional de cincuenta y tres expedientes de pacientes de la clínica de adolescentes del Hospital Calderón Guardia de donde se obtuvieron datos de hemoglobina, hematocrito, peso, talla y otros, con el fin de determinar la frecuencia de anemia y los patrones de ganancia pero adecuados e inadecuados. Menos del 10 porciento de las pacientes presentaron anemia y aproximadamente la mitad tuvieron una inadecuada ganancia de peso y de estas la gran mayoría por pobre ganancia de peso. No se encontró una alta incidencia de anemia en esta población sin embargo en las que si presentaron se encontraba asociada a un bajo peso para la edad gestacional, lo cual concuerda en la literatura existente. En cuanto a la ganancia de peso se obtuvieron resultados que demuestran que en las adolescentes embarazadas la presencia de una inadecuada ganancia de peso es frecuente por lo que se debe tener en cuenta como factores asociados a este cuando se trabaja en el área de salud...

Estenosis de uretra en la mujer. Diagnóstico morfo-funcional y tratamiento / Urethral stricture in women. Morphofunctional diagnosis and treatment

OBJETIVO: El objetivo del presente artículo es la descripción del diagnóstico de la obstrucción infravesical en la mujer y el tratamiento de la estenosis uretral como causa de la misma.MÉTODO: Se realizó una revisión bibliográfica en la base de datos de Medline (PubMed) de los artículos publicados sobre el diagnóstico de la obstrucción infravesical en la mujer y el tratamiento de la estenosis uretral en el periodo 1989-2009.RESULTADOS: La prevalencia de obstrucción en la mujer varía en la literatura entre el 2,7 y el 23%. El patrón de referencia para su diagnóstico es el estudio videourodinámico. El 78% de las obstrucciones son de carácter funcional y sólo un 6,8 % son secundarias a la estenosis uretral. La estenosis afecta comúnmente al meato uretral y el tercio distal de la uretra, y la causa más frecuente es la iatrogénica, secundaria a cirugía de la incontinencia, dilataciones uretrales y la cateterización traumática. El tratamiento de la estenosis de uretra dependerá de la localización y longitud de la estenosis, la longitud de la uretra sana proximal, la integridad del cuello vesical y la coexistencia de incontinencia. El fracaso repetido de técnicas no invasivas y la presencia de defectos parciales o totales de uretra serán subsidiarias de técnicas de reconstrucción uretral mediante colgajos o injertos, aunque la técnica de elección es motivo de controversia.CONCLUSIÓN: El diagnóstico de la obstrucción infravesical en la mujer está limitado por la ausencia de parámetros urodinámicos claramente definidos. La estenosis uretral es una causa infrecuente de obstrucción cuyo tratamiento puede constituir un desafio terapéutico. La recidiva precoz de la estenosis debería ser motivo para considerar la reconstrucción quirúrgica precoz. Los colgajos vaginales constituyen la base de las reconstrucciones uretrales. La cicatrización vulvar extensa pueden hacer necesaria la utilización de injertos(AU)

OBJECTIVES: The objective of this article is to describe the diagnosis of bladder outlet obstruction in women and the treatment of urethral stricture as a cause thereofMETHOD: A bibliographic review was performed in the Medline (PubMed) data base on articles published on the diagnosis of bladder outlet obstruction in women and the treatment of urethral stricture in the 1989-2009 period.RESULTS: The prevalence of obstruction in women varies between 2.7% and 23% in the literature. The gold standard for diagnosis is the videourodynamic study. 78% of obstructions are functional, and only 6.8% are secondary to urethral stricture. Stricture commonly affects the urethral meatus and the distal third of the urethra, the most frequent cause being yatrogenic, secondary to surgery for incontinence, urethral dilations and traumatic catheterisation. The treatment of urethral stricture will depend on the location and length of the stricture, the length of the healthy proximal urethra, bladder neck integrity and the coexistence of incontinence. The repeat failure of non-invasive techniques and the presence of partial or total urethra defects will be subsidiary to urethral reconstruction techniques by means of flaps or grafts, although the technique of choice is still controversial.CONCLUSION: The diagnosis of bladder outlet obstruction in women is limited by the absence of clearly defined urodynamic parameters. Urethral stricture is an infrequent cause of obstruction, the treatment of which may constitute a therapeutic challenge. Early stricture relapse may constitute grounds for considering early surgical reconstruction. Vaginal flaps are the cornerstone of urethral reconstructions. Extensive vulvar scarring may require the use of grafts(AU)