Thermoplasmatales and sulfur-oxidizing bacteria dominate the microbial community at the surface water of a CO2-rich hydrothermal spring located in Tenorio Volcano National Park, Costa Rica.

Here we report the chemical and microbial characterization of the surface water of a CO2-rich hydrothermal vent known in Costa Rica as Borbollones, located at Tenorio Volcano National Park. The Borbollones showed a temperature surrounding 60 °C, a pH of 2.4 and the gas released has a composition of ~ 97% CO2, ~ 0.07% H2S, ~ 2.3% N2 and ~ 0.12% CH4. Other chemical species such as sulfate and iron were found at high levels with respect to typical fresh water bodies. Analysis by 16S rRNA gene metabarcoding revealed that in Borbollones predominates an archaeon from the order Thermoplasmatales and one bacterium from the genus Sulfurimonas. Other sulfur- (genera Thiomonas, Acidithiobacillus, Sulfuriferula, and Sulfuricurvum) and iron-oxidizing bacteria (genera Sideroxydans, Gallionella, and Ferrovum) were identified. Our results show that CO2-influenced surface water of Borbollones contains microorganisms that are usually found in acid rock drainage environments or sulfur-rich hydrothermal vents. To our knowledge, this is the first microbiological characterization of a CO2-dominated hydrothermal spring from Central America and expands our understanding of those extreme ecosystems.

A Biphasic Presentation of Diffuse Large B-cell Lymphoma Metastasis to the Hypothalamus-pituitary Axis: A Case Report and Literature Review.

The Hypothalamus-Pituitary axis (HPA) is a rare location for metastasis of non-Hodgkin's lymphoma. Lymphomas constitute less than 0.5% of reported HPA metastasis. This case is unique in that, in addition to the noted panhypopituitarism; initial diagnostics demonstrated marked hyponatremia, consistent with syndrome of inappropriate antidiuretic hormone (SIADH), which was subsequently complicated by sudden diabetes insipidus (DI), suggesting hypothalamic/stalk infiltration. Despite low sensitivity, CSF cytology/flow cytometry may serve as a less invasive diagnostic measure. Treatment includes systemic chemotherapy with agents that cross the blood-brain barrier. Surgical resection alone or associated radiotherapy did not show an increase in survival. The prognosis remains poor.

Endocrine Shades of Silicone Fillers: A Case of Calcitriol-mediated Hypercalcemia.

Background: The inflammatory reaction of foreign body granulomas (FBG) may be so vast that it leads to severe systemic effects. Case report: A 42-year-old woman was referred to the ED with severe recurrent symptomatic hypercalcemia associated with worsening kidney function. She had presented multiple times with similar complaints. Severe hypercalcemia (13.8 mg/dL) was noted, with appropriately low PTH, elevated PTHrP, low 25-hydroxyvitamin D, and normal 1,25-dihydroxyvitamin D levels. She admitted having significant subcutaneous silicone filler injections in the hips six years prior. Admission workup revealed a normal 25-hydroxyvitamin D, but a marked elevation of 1,25-dihydroxyvitamin D (138 pg/mL). Whole-body PET-CT demonstrated moderate 2-18F-fluoro-2-deoxy-d-glucose (FDG) uptake within the subcutaneous adipose tissue of the lateral aspects of the gluteal regions. She was diagnosed with silicone filler injection-induced hypercalcemia, secondary to granulomatous inflammation. Her calcium level normalized a month after the initiation of prednisone. Discussion: FBG may occur years after filler injection. In rare cases, a significant granulomatous immune response leads to uncontrolled production of calcitriol. Pro-inflammatory cytokines can also upregulate PTHrP expression in macrophages, further contributing to hypercalcemia. Treatment focuses on general hypercalcemia management and FBG remission, most effectively achieved with anti-inflammatory corticosteroid doses. Nevertheless, further studies are needed to evaluate its long-term treatment efficacy. Conclusion: Granulomatous inflammation from silicone filler injection can cause hypercalcemia by uncontrolled production of calcitriol and increased PTHrP production by macrophages and giant cells.

Formación de grado en cuidados paliativos en las universidades de la Comunidad Autónoma de Madrid. Estudio descriptivo / Palliative care degree training at universities in the Autonomous Community of Madrid. A descriptive study

Introducción: En vista del desarrollo que se está produciendo en cuidados paliativos y las recomendaciones formativas llevadas a cabo por distintos planes estratégicos internacionales, nacionales y autonómicos, la Asociación Madrileña de Cuidados Paliativos (AMCP) realizó este estudio con el objetivo de definir la situación actual de la formación en cuidados paliativos en la Comunidad de Madrid en los grados de medicina, enfermería, psicología y trabajo social. Material y métodos: Para ello, se elaboró un cuestionario con los datos considerados relevantes según la evidencia, que fue enviado a las diferentes universidades para su cumplimentación durante el año 2021. En el caso de no obtener respuesta, la información se completó por parte del equipo investigador revisando las guías docentes oficiales.Resultados: A partir de los datos obtenidos provenientes de 46 grados universitarios analizados, encontramos que la formación específica en cuidados paliativos se encuentra en el 71,7 % de las universidades. En el 69,7 % de estas, esta formación no se imparte en una asignatura independiente; la media de ECTS (European Credit Transfer and Accumulation System) atribuidos a esta formación es de 3. En más de la mitad de estudios no hay prácticas obligatorias y los talleres o seminarios solo se encuentran en el 39,5 % de los planes formativos. El seminario más frecuente es el de “Malas noticias” en todos los estudios. Los temas más tratados son el “Abordaje emocional de paciente y familia”, seguido por el “Manejo de síntomas” y los “Aspectos éticos”. Conclusión: La formación en cuidados paliativos se hace presente cada vez más frecuentemente en las universidades madrileñas, habitualmente como parte de otras asignaturas. Los talleres, seminarios y las prácticas obligatorias son escasos. Los profesores son sobre todo titulares y sin formación específica. Hay que seguir trabajando para alcanzar los estándares marcados por las sociedades científicas respecto a formación. (AU)

Introduction: In view of the development that is taking place in the field of palliative care and the training recommendations given by different international, national and regional strategic plans, the Madrilenian Association of Palliative Care (AMCP) carried out this study with the aim of defining the current situation of training in palliative care within the medicine, nursing, psychology and social work degrees taught at universities in the Community of Madrid. Material and methods: To this end, a questionnaire was drawn up with the data considered relevant according to the evidence, which was sent to the different universities to be completed during the year 2021. If no response was received, the information was completed by the research team by reviewing the relevant official teaching guides. Results: From the data obtained from all 46 university degrees analysed, we found that specific training in palliative care is found in 71.7 % of universities. In 69.7 % of these, palliative care is not taught as an independent subject matter; the average number of ECTS (European Credit Transfer and Accumulation System) attributed to this training is 3. In more than 50 % of cases there are no compulsory internships, and workshops or seminars are only found in 39.5 % of the curricula. The most frequently taught seminar is “Breaking bad news”. The most frequently covered topics are “Emotional support of patients and their families”, followed by “Symptom management” and “Ethical aspects”. Conclusion: Training in palliative care is increasingly present in Madrid universities, usually as part of other subjects. Workshops, seminars, and compulsory internships are scarce. Teachers are mostly tenured, without specific training. We must continue working to achieve the standards set by scientific societies regarding training. (AU)

Acuaroid nematodes in the common kestrel (Falco tinnunculus) in the south of Spain.

The prevalence, intensity and abundance of acuaroid nematodes were determined in the common kestrel (Falco tinnunculus) in Andalusia, Spain. Acuaroid nematodes were present in 26/41 (63.4%) of birds examined. The most common species belonged to the genus Synhimantus subgenus Synhimantus (56%): S. (S.) laticeps (36.5%), S. (S.) robertdollfusi (24.3%) and a single specimen of a third, unknown, Synhimantus (S.) spp., unlike any other described previously (2.4%). Other species identified were Synhimantus (Dispharynx) spp. (2.4%), S. (D.) nasuta (4.8%), Desportesius spinulatus (9.7%) and Skrjabinoclava spp. (2.4%). This is the first record of these three species in F. tinnunculus, but the latter two are considered to be accidental parasites in birds of prey.

[Validation of the Life-Support Preferences Questionnaire (LSPQ) for its use in Spain]. / Validación del Cuestionario de Preferencias de Soporte Vital (LSPQ) para su uso en la población española.

OBJECTIVE: To validate the Life-Support Preferences Questionnaire (LSPQ) for its use in Spain. DESIGN: Three-stage study: a) translation and linguistic adaptation; b) evaluation of its validity; and c) validation of its psychometric properties. SETTING: Nine primary care nursing clinics and 2 university classes in Granada, Spain. PARTICIPANTS: Patients who were of age and were first- or second-year university students, without any cognitive deterioration. MAIN MEASUREMENTS: The equivalence of the translation and the original was checked by bilingual people; its linguistic and grammatical standard was appraised by experts in Spanish. The validity of the questionnaire was evaluated by 15 judges-experts and 20 patients; linguistic complexity (Szigriszt index); stability in time (McNemar test); internal consistency (Cronbach's alpha). RESULTS: a) 2 bilingual people did a translation that was reviewed by 6 experts in Spanish. After alterations suggested by the experts, the bilingual people ratified its equivalence with the original; b) 15 experts affirmed that each item was a good indicator of care preferences at the end of life; c) 20 users confirmed the acceptability and comprehensibility of the questionnaire; d) reliability: 299 participants out of the 369 initially selected filled in the questionnaire; and e) its stability was 0.92; and its internal consistency, 0.85. CONCLUSION: The LSPQ questionnaire in Spanish (LSPQ-e) is a reliable tool, designed to help patients to clarify their care and treatment preferences at the end of their lives.

Validación del Cuestionario de Preferencias de Soporte Vital (LSPQ) para su uso en la población española / Validation of the life-support preferences questionnaire (LSPQ) for its use in Spain

Objetivo. Validar el Cuestionario de Preferencias de Soporte Vital (LSPQ ) para su uso en población española. Diseño. Estudio realizado en tres fases: a) traducción y adaptación idiomática; b) evaluación de su validez, y c) validación de sus propiedades psicométricas. Emplazamiento. El estudio se ha llevado a cabo en 9 consultas de enfermería de atención primaria y en 2 aulas universitarias de Granada. Participantes. Se incluyeron pacientes mayores de edad y estudiantes universitarios de primer y segundo cursos, sin deterioro cognitivo. Mediciones principales. Equivalencia de la traducción con el original verificada por bilingües. Corrección lingüística y gramatical evaluada por expertos en lengua española. Validez del cuestionario evaluada por 15 jueces-expertos y 20 pacientes. Complejidad lingüística (índice de Szigriszt). Estabilidad temporal (test de McNemar). Consistencia interna (alfa de Cronbach). Resultados. a) 2 personas bilingües realizaron una traducción que fue revisada por 6 expertos en lengua española. Tras las modificaciones que sugirieron, las personas bilingües aseguraron su equivalencia con el original; b) 15 expertos afirmaron que cada ítem era buen indicador de las preferencias de cuidado al final de la vida; c) 20 usuarios confirmaron la aceptabilidad y comprensibilidad del cuestionario; d) en relación con la fiabilidad, completaron el cuestionario 299 participantes (de los 369 inicialmente seleccionados), y e) la estabilidad del cuestionario es de 0,92 y su consistencia interna de 0,85. Conclusión. El cuestionario LSPQ en español (LSPQ-e) es una herramienta fiable diseñada para ayudar a los pacientes a clarificar sus preferencias de cuidado y tratamiento al final de la vida

Objective. To validate the Life-Support Preferences Questionnaire (LSPQ) for its use in Spain. Design. Three-stage study: a) translation and linguistic adaptation; b) evaluation of its validity; and c) validation of its psychometric properties. Setting. Nine primary care nursing clinics and 2 university classes in Granada, Spain. Participants. Patients who were of age and were first- or second-year university students, without any cognitive deterioration. Main measurements. The equivalence of the translation and the original was checked by bilingual people; its linguistic and grammatical standard was appraised by experts in Spanish. The validity of the questionnaire was evaluated by 15 judges-experts and 20 patients; linguistic complexity (Szigriszt index); stability in time (McNemar test); internal consistency (Cronbach's alpha). Results. a) 2 bilingual people did a translation that was reviewed by 6 experts in Spanish. After alterations suggested by the experts, the bilingual people ratified its equivalence with the original; b) 15 experts affirmed that each item was a good indicator of care preferences at the end of life; c) 20 users confirmed the acceptability and comprehensibility of the questionnaire; d) reliability: 299 participants out of the 369 initially selected filled in the questionnaire; and e) its stability was 0.92; and its internal consistency, 0.85. Conclusion. The LSPQ questionnaire in Spanish (LSPQ-e) is a reliable tool, designed to help patients to clarify their care and treatment preferences at the end of their lives