Internal and external adenomyosis phenotypes: ultrasound features and association with clinical outcomes.

STUDY QUESTION: What are the sonographic and clinical findings in women diagnosed with external and internal adenomyosis by ultrasound? SUMMARY ANSWER: Patients with external and internal adenomyosis phenotypes, diagnosed by ultrasound, present differences in sonographic features of the disease and demographic characteristics including age, parity, and association with deep endometriosis (DE) and leiomyomas. WHAT IS KNOWN ALREADY: Two different phenotypes of adenomyosis have been described based on the anatomical location of adenomyotic lesions in the myometrium, suggesting that adenomyosis affecting the inner myometrium and that affecting the external myometrial layer may have distinct origins. STUDY DESIGN, SIZE, DURATION: A cross-sectional study including 505 patients with a sonographic diagnosis of adenomyosis was performed between January 2021 and December 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women sonographically diagnosed with adenomyosis in a tertiary referral hospital that serves as a national reference center for endometriosis were included over a 2-year period. Patients were divided into two groups (internal and external adenomyosis) according to the myometrial layer affected by adenomyosis. We compared sonographic and clinical outcomes including a multivariate analysis between the two groups. MAIN RESULTS AND THE ROLE OF CHANCE: According to ultrasound findings, 353 (69.9%) patients presented with internal adenomyosis, while 152 (30.1%) presented with external adenomyosis. Women with internal adenomyosis were significantly older and less frequently nulliparous compared to those with external adenomyosis. Sonographically, internal adenomyosis appeared diffusely, it had a greater number of adenomyosis features, it presented a globular morphology of the uterus more frequently, and it coexisted with leiomyomas more frequently, compared to external adenomyosis. Conversely, the presence of translesional vascularity and associated DE were more common among the external adenomyosis group. No significant differences were found between internal and external adenomyosis groups regarding pain, heavy menstrual bleeding, spotting, or infertility. In the multivariate analysis, nulliparity, the presence of leiomyomas, and the presence of DE were independently associated with adenomyosis phenotypes (the presence of DE and nulliparity increased the risk of external adenomyosis, whereas the presence of leiomyomas was a risk factor for internal adenomyosis). Considering the impact of hormonal treatment, we found that the number of ultrasound adenomyosis criteria was significantly greater in patients without hormonal treatment. Non-treated patients more commonly presented dysmenorrhea or bleeding-associated pain and heavy menstrual bleeding than women on hormonal treatment, although there were no significant differences according to adenomyosis phenotypes. LIMITATIONS, REASONS FOR CAUTION: As the population was selected from the Endometriosis Unit of a tertiary center, there may be patient selection bias, given the high prevalence of individuals with associated endometriosis, previous endometriosis-related surgery, and/or receiving hormonal treatment. WIDER IMPLICATIONS OF THE FINDINGS: Transvaginal ultrasound is the most available and cost-effective tool for the diagnosis of adenomyosis. Adenomyosis phenotypes based on ultrasound findings may be key in achieving an accurate diagnosis and in decision-making regarding the most adequate therapeutic strategy for the management of patients with adenomyosis. Determination of the sonographic features associated with symptoms could help in the evaluation of treatment response. STUDY FUNDING/COMPETING INTEREST(S): No funding was obtained for this study and there are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: N/A.

Actualización del abordaje de la endometriosis / Update in endometriosis work-up and treatment

El creciente compromiso con la salud ginecológica ha puesto de manifiesto la necesidad de actualizar el abordaje de la endometriosis, por lo que se ha querido llevar a cabo una revisión exhaustiva de la literatura científica con el fin de recopilar los últimos avances relevantes en su asistencia sanitaria. En este sentido, se llevó a cabo un congreso de ginecología el 30 de septiembre y 1 de octubre que convocó a diversos expertos para revisar aspectos clínicos, farmacológicos y vanguardistas. La revisión destaca los criterios directos, indirectos y soft markers que determinan la presencia de endometriosis durante la exploración, así como las pautas adecuadas para el diagnóstico mediante pruebas de imagen. Además, analiza la importancia de realizar un diagnóstico completo y detallado en pacientes que presenten síntomas de la enfermedad. Por otra parte, resalta los avances en el tratamiento de esta enfermedad, haciendo especial énfasis en los beneficios de la N-acetil cisteína. Finalmente, estudia el papel de la cirugía, destacando sus ventajas, pero señalando que la endometriosis no debe ser siempre asociada a la operación, ya que esta puede conllevar numerosas complicaciones.(AU)

The growing commitment to gynecological health has highlighted the need to update the approach to endometriosis. Therefore, a comprehensive review of the scientific literature has been carried out to gather the latest relevant advances in its healthcare. In this regard, a gynecology congress was held on September 30 and October 1, bringing together various experts to review clinical, pharmacological, and cutting-edge aspects. The review emphasizes the direct, indirect, and soft markers that determine the presence of endometriosis during examination, as well as the appropriate guidelines for diagnosis through imaging tests. Furthermore, it discusses the importance of conducting a complete and detailed diagnosis in patients exhibiting symptoms of the disease. Additionally, it highlights advancements in the treatment of this condition, with a particular emphasis on the benefits of N-acetyl cysteine. Finally, it explores the role of surgery, emphasizing its advantages but pointing out that endometriosis should not always be associated with surgery since it can entail numerous complications.(AU)

Remediation of pesticides in commercial farm soils by solarization and ozonation techniques.

Soil contamination by pesticides is a growing environmental problem. Even though nowadays numerous soil remediation technologies are available, most of them have not been tested at field scale. This study attempts to demonstrate the efficiency of solarization-ozonation techniques for the removal of twelve pesticides at full scale. Initial solarization and ozonation trials were conducted in plots located in a greenhouse using freshly and aged contaminated soils under controlled pilot conditions. The combination of solarization and ozonation treatment was efficient for all the studied pesticides both in freshly and in aged contaminated soils, being the lower degradation values found for the second type. This low removal suggests that the increase of pesticides' adsorption on soil resulting from ageing decreases their availability. Once the essays were carried out at pilot scale, the solarization-ozonation applicability was evaluated in a commercial farm soil. This trial was carried out in a greenhouse whose soil had previously been contaminated with some of the pesticides studied. A significant degradation (53.8%) was observed after 40 days of treatment. Pesticides' main metabolites were identified during the different remediation experiments. In addition, the cost of the combined solarization and ozonation technology was evaluated. Finally, our results suggest that this combination of techniques could be considered a promising technology to degrade pesticides in soil.

Istmocele y fertilidad: revisión de la literatura a propósito de un caso / Isthmocele and fertility: A case report and review of the literature

Una de las complicaciones que puede derivarse de una cesárea es el istmocele. En muchos casos este será asintomático y puede pasar desapercibido, pero en ocasiones da lugar a sintomatología, como por ejemplo sangrado uterino anómalo, infertilidad secundaria, o bien problemas en un futuro embarazo, como acretismo placentario o rotura uterina. Existe a día de hoy mucha controversia sobre el diagnóstico de esta entidad y su posible tratamiento. La motivación de este estudio es presentar una breve revisión de la literatura a raíz de un caso clínico sobre una paciente con istmocele e infertilidad secundaria.(AU)

One of the complications that can result from a caesarean section is isthmocele. In many cases, it will be asymptomatic and can go unnoticed, but sometimes it leads to symptoms such as abnormal uterine bleeding, secondary infertility, or problems in a future pregnancy such as placental accreta or uterine rupture. There is currently much controversy about the diagnosis of this entity and its possible treatment. The aim of the present study is to present a brief review of the literature based on a case report of a patient with isthmocele and secondary infertility.(AU)

Transvaginal ultrasound for diagnosis of deep endometriosis involving uterosacral ligaments, torus uterinus and posterior vaginal fornix: prospective study.

OBJECTIVE: To evaluate the accuracy of transvaginal ultrasound (TVS) in diagnosing deep endometriosis (DE) involving the uterosacral ligaments (USLs), torus uterinus (TU) or posterior vaginal fornix (PVF) in women with suspected endometriosis scheduled for laparoscopic surgery. METHODS: In this prospective study, consecutive women with clinically suspected pelvic endometriosis who were scheduled for laparoscopic surgery were invited to participate. TVS was performed before surgery. TVS findings were compared with those obtained at laparoscopy and confirmed histologically. The accuracy of TVS for diagnosing DE involving the USLs, TU or PVF was assessed. Additionally, the association of DE involving the USLs, TU or PVF on TVS with symptoms and with DE affecting other pelvic locations was assessed. RESULTS: In total, 172 patients were included. The global sensitivity and specificity of TVS in diagnosing DE affecting the USLs, TU and/or PVF were 92% and 87%, respectively. For DE involving the USLs, the accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio and negative likelihood ratio of TVS were 89.5%, 96.6%, 82.1%, 85.0%, 95.8%, 5.41 and 0.04, respectively; the respective values for DE involving the TU were 86.6%, 83.9%, 89.4%, 89.0%, 84.4%, 7.92 and 0.18, and the respective values for DE involving the PVF were 93.6%, 87.0%, 94.6%, 71.4%, 97.9%, 16.20 and 0.14. Logistic regression analysis showed a significant association between DE affecting the USLs, TU and/or PVF and DE affecting the rectosigmoid (odds ratio, 5.43; P < 0.001). Dyschezia was associated strongly with DE involving the USLs, TU and PVF, while dysmenorrhea was associated significantly with DE involving the TU. CONCLUSION: TVS has high accuracy, sensitivity, specificity, PPV and NPV for the detection of DE involving the USLs, TU and PVF in women with suspected endometriosis scheduled for laparoscopic surgery. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Interacting Proteins, Polymorphisms and the Susceptibility of Animals to SARS-CoV-2.

COVID-19, caused by SARS-CoV-2, is a world-wide problem for the human population. It is known that some animal species, such as mink, can become infected and transmit the virus. However, the susceptibility of most animals is not known. Here, we review the use of sequence analysis of the proteins which are known to interact with SARS-CoV-2 as a way to estimate an animal's susceptibility. Although most such work concentrates on the angiotensin-converting enzyme 2 receptor (ACE2), here TMPRSS2 (Transmembrane Serine Protease 2), neuropilin-1 and furin are also considered. Polymorphisms, especially ones which are known to alter viral/host interactions are also discussed. Analysis of ACE2 and TMPRSS2 protein sequences across species suggests this approach may be of some utility in predicting susceptibility; however, this analysis fails to highlight some susceptible animals such as mink. However, combined with observational data which emerges over time about which animals actually become infected, this may, in the future, be a useful tool to assist the management of risks associated with human/animal contact and support conservation and animal welfare measures.

Clinical findings, neurological manifestations and survival of dogs with insulinoma: 116 cases (2009-2020).

OBJECTIVES: To review the clinical findings and outcome in dogs diagnosed with insulinoma, and to assess which factors are predictors of overall survival. Additionally, to describe the neurological manifestations of this population and their correlation with survival. MATERIALS AND METHODS: Retrospective multicentric study of canine insulinoma cases (2009 to 2020). Signalment, clinical history, neurological examination, diagnostic findings, treatment and outcome were obtained from clinical records. Univariate and multivariate analyses were used to compare the overall survival. RESULTS: One hundred and sixteen cases were included. Median duration of clinical signs before presentation was 1.5 months. The most common presenting clinical signs were weakness (59.5%), epileptic seizures (33.6%) and changes in consciousness or behaviour (27.6%). Three dogs were suspected to have paroxysmal dyskinesia. Thirty-two dogs had an abnormal neurological examination, most commonly showing obtundation (28.1%), decreased withdrawal reflexes (21.9%) and absent menace response (18.8%). Overall survival for dogs undergoing surgery (20 months) was significantly longer than in medically treated (8 months; adjusted hazard ratio: 0.33; 95% confidence interval: 0.18, 0.59). Presence of metastases was the only other variable associated with prognosis (adjusted hazard ratio 1.72; 95% confidence interval: 1.02, 2.91). CLINICAL SIGNIFICANCE: Clinical signs of canine insulinoma are vague and non-specific. Weakness, epileptic seizures and changes in mentation or behaviour were the most commonly reported. Obtunded mentation and forebrain neurolocalisation were the main neurological manifestations. Dogs undergoing surgery had a longer overall survival compared to medically treated cases, and dogs with metastasis had a shorter overall survival regardless of treatment modality. Abnormalities in the neurological examination did not correlate with prognosis.

Bowel preparation prior to transvaginal ultrasound improves detection of rectosigmoid deep infiltrating endometriosis and is well tolerated: prospective study of women with suspected endometriosis without surgical criteria.

OBJECTIVES: To analyze the effect of bowel preparation prior to transvaginal ultrasound (TVS) examination on the detection of bowel involvement and the description of rectosigmoid nodules of deep infiltrating endometriosis (DIE), and to evaluate patient tolerance of bowel preparation. METHODS: This was a prospective study of paired data obtained between September 2015 and March 2016 from a cohort of women referred, on suspicion of DIE but without surgical criteria, to the endometriosis unit of a tertiary university hospital. In all patients, the wall of the rectum and lower sigmoid colon was evaluated by two TVS examinations: the first was performed without bowel preparation and the second was done after the patient had followed a 3-day low-residue diet and received two 250-mL enemas, one the night before TVS and the second 1-3 h before the examination. The presence of adhesions, number and size of rectosigmoid nodules, deepest layer of the rectum affected, percentage of the circumference of the bowel affected and distance from the most caudal part of the bowel nodule to the anal verge were determined. Patient tolerance to bowel preparation was assessed using a 5-point Likert scale, in which 1 represented 'very well tolerated' and 5 represented 'very poorly tolerated'. RESULTS: The mean ± SD age of the 110 patients included in the study was 36.8 ± 5.07 years. As many as 55% of those identified during the first examination (TVS alone) as having adhesions were identified at the second examination (TVS with prior bowel preparation) as having rectosigmoid nodules, and 22 additional nodules were observed on TVS following bowel preparation. These newly detected rectosigmoid nodules, initially assessed mainly as adhesions, were smaller and more superficial compared with the nodules detected on TVS alone, or located in the anterior sigmoid wall. Patient tolerance overall to bowel preparation scored a mean of 1.81 on the 5-point Likert scale. CONCLUSIONS: Bowel preparation is well tolerated by patients. When bowel preparation is performed before TVS, the detection of small and superficial nodules and those in the anterior sigmoid wall is improved, allowing more detailed description of these nodules in patients with suspected endometriosis. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Feasibility, tolerability, and safety of hysterosalpingo-foam sonography (hyfosy). multicenter, prospective Spanish study.

OBJECTIVE: To determine the feasibility,tolerability, and safety of the ultrasound assessment of tubal patency using foam as contrast. METHODS: This was a prospective multicenter study of 915 infertile nulliparous women scheduled for sonohysterosalpingography with foam instillation (HYFOSY) for tubal patency testing as a part of the fertility workup. Clinical and sonographic data were recorded into a web-shared database. Tubal patency, cervical catheterization, pain during the procedure and post-procedural complications were collected. Patients reported discomfort or pain experienced during the procedure with a visual analogue scale (VAS) score. RESULTS: Nine hundred fifteen women were included in the final analysis. Median age was 34 (range, 21-45) years and median body mass index was 23 (range, 16-41) kg/m2. Of 839 women, only 8(0.95 %) cases were abandoned due to impossibility of introducing the intracervical catheter. Most of the cervical os were easily cannulated with either paediatric nasogastric probes or special catheter for intrauterine insemination / sonohysterosalpingography 688/914(75.3 %). With a median instillation of 4 mL (range 1-16) of foam, both tubes were identified in 649/875 (70.9 %) patients, while unilateral patency was observed in 190/875 (20.8 %). Only 36/875 (3.9 %) of the women had bilateral tubal obstruction. The median VAS score for perception of pain during HyFoSy examination was 2 (range 0-10), and only 17 (1.9 %) of women reported severe pain (VAS ≥ 7). Pain was unrelated to tubal patency or tubal blockage. Unexpectedly, difficult cervical catheterizations that needed tenaculum, were more likely associated with mild pain during procedure [nasogastric probe group 176/289 (70.9 %) vs. insemination catheter group 166/399 (41.6 %) vs. tenaculum group 190/218(87.2 %) p < 0.001]. Finally, among 915 patients, we only noticed 3 (0.32 %) complications of the technique: two vasovagal episodes and a mild urinary infection. CONCLUSION: HYFOSY is a feasible, well-tolerated and safe technique for the evaluation of tubal patency in infertile women.

La maestra de educación física en los libros de texto de primaria / The Teacher of Physical Education in Primary Textbooks

El objetivo del presente estudio es analizar cómo se representa a la maestra de educación física en los libros de texto de esta área, en la etapa de Educación Primaria. Se realiza un estudio cuantitativo que muestra un número elevado de maestras con respecto al maestro de educación física, principalmente en el primer ciclo de Primaria y otro cualitativo, a través del análisis de contenido, identificando un tratamiento estereotipado en cuanto a las características físicas de la docente, al representar a una maestra eminentemente joven, de raza blanca, delgada, con ropa deportiva y sin discapacidad. Pero a la vez, aparece un tratamiento más abierto y participativo en cuanto al rol representado, ya que la maestra de educación física aparece en la zona periférica de la imagen, con actitud activa, en un espacio no necesariamente deportivo, sin complementos docentes, que imparte contenidos relacionados con la gestión del grupo-clase y los juegos

The objective of the present study is to analyse how the physical education teacher is represented in the textbooks of this area, in the Primary Education stage. A quantitative study is carried out showing a high number of teachers with respect to the physical education teacher, mainly in the first cycle of Primary Education and a qualitative one, through content analysis, identifying a stereotyped treatment of the physical characteristics of the teacher, by representing a teacher eminently young, white, thin, wearing sports clothes and without disabilities. But at the same time, a more open and participative treatment appears in relation to the role represented, since the physical education teacher appears in the peripheral area of the image, with an active attitude, in a space not necessarily sports, without teaching complements, that Imparts content related to group-class management and games

Tumour-to-Tumour Metastasis Phenomenon: Metastatic Prostatic Adenocarcinoma within an Anaplastic Oligodendroglioma in the Brain of a Dog.

A 10-year-old entire male French bulldog was presented following clusters of generalized tonic-clonic epileptic seizures. Neurolocalization was consistent with a lesion in the left forebrain. Magnetic resonance imaging of the brain revealed a large, ill-defined, intra-axial, space-occupying lesion at the level of the left temporal and parietal lobes, causing marked compression of the adjacent parenchyma. Computed tomography of the thorax and abdomen was consistent with disseminated metastatic disease. The dog was humanely destroyed and subjected to necropsy examination. Histological examination of the brain revealed a metastasis of prostatic carcinoma within an anaplastic oligodendroglioma in the left forebrain. To the author's knowledge, this is the first report describing clinical, imaging and histopathological features of an intracranial tumour-to-tumour metastasis in the brain of a dog.

Mesophilic and thermophilic anaerobic co-digestion of winery wastewater sludge and wine lees: An integrated approach for sustainable wine production.

In this work, winery wastes generated by a cellar producing approximately 300,000 hL of wine per year was monitored for a period of one year. On average, 196 L of wastewater, 0.1 kg of waste activated sludge (dry matter) and 1.6 kg of wine lees were produced per hectoliter of wine produced. Different winery wastes, deriving from different production steps, namely waste activated sludge from wastewater treatment and wine lees, were co-treated using an anaerobic digestion process. Testing was conducted on a pilot scale for both mesophilic and thermophilic conditions. The process was stable for a long period at 37 °C, with an average biogas production of 0.386 m3/kg CODfed. On the other hand, for thermophilic conditions, volatile fatty acids accumulated in the reactor and the process failed after one hydraulic retention time (23 days). In order to fix the biological process, trace elements (iron, cobalt and nickel) were added to the feed of the thermophilic reactor. Metals augmentation improved process stability and yields at 55 °C. The pH ranged between 7.8 and 8.0, and specific gas production was 0.450 m3/kg CODfed, which corresponded to dry matter and COD removals of 34% and 88%, respectively. Although the observed performances in terms of biogas production were good, the thermophilic process exhibited some limitations related to both the necessity of metals addition and the worse dewaterability properties. In fact, while the mesophilic digestates reached a good dewatering quality via the addition of 6.5 g of polymer per kg of dry matter, the required dosage for the thermophilic sludge was greater than 10 g/kg of dry matter.

Postpartum two- and three-dimensional ultrasound evaluation of anal sphincter complex in women with obstetric anal sphincter injury.

OBJECTIVE: To compare the sensitivity and specificity of two- (2D) and three- (3D) dimensional transperineal ultrasound (TPUS) and 3D endovaginal ultrasound (EVUS) with the gold standard 3D endoanal ultrasound (EAUS) in detecting residual defects after primary repair of obstetric anal sphincter injuries (OASIS). METHODS: External (EAS) and internal (IAS) anal sphincters were evaluated by the four ultrasound modalities in women with repaired OASIS. 2D-TPUS was evaluated in real-time, whereas 3D-TPUS, 3D-EVUS and 3D-EAUS volumes were evaluated offline by six blinded readers. The presence/absence of any tear in EAS or IAS was recorded and defects were scored according to the Starck system. Sensitivity, specificity and predictive values were calculated, using 3D-EAUS as reference standard. Inter- and intraobserver analyses were performed for all 3D imaging modalities. Association between patients' symptoms (Wexner score) and ultrasound findings (Starck score) was calculated. RESULTS: Images from 55 patients were analyzed. Compared with findings on 3D-EAUS, the agreement for EAS evaluation was poor for 3D-EVUS (κ = 0.01), fair for 2D-TPUS (κ = 0.30) and good for 3D-TPUS (κ = 0.73). The agreement for IAS evaluation was moderate for both 3D-EVUS (κ = 0.41) and 2D-TPUS (κ = 0.52) and good for 3D-TPUS (κ = 0.66). Good intraobserver (3D-EAUS, κ = 0.73; 3D-TPUS, κ = 0.78) and interobserver (3D-EAUS, κ = 0.68; 3D-TPUS, κ = 0.60) agreement was reported. Significant association between Starck and Wexner scores was found only for 3D-EAUS (Spearman's rho = 0.277, P = 0.04). CONCLUSIONS: 2D-TPUS and 3D-EVUS are not accurate modalities for the assessment of anal sphincters after repair of OASIS. 3D-TPUS shows good agreement with the gold standard 3D-EAUS and a high sensitivity in detecting residual defects. It, thus, has potential as a screening tool after primary repair of OASIS. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Estudio Regional de Incidentes Derivados de la Atención (ERIDA) en Urgencias / Regional Study of Patient Safety Incidents (ERIDA) in the Emergency Services

OBJETIVO: Evaluar los incidentes de seguridad del paciente en los servicios de urgencias de nuestra región. MATERIAL Y MÉTODO. Estudio observacional en todos los servicios de urgencias hospitalarios del Servicio Murciano de Salud. Tras muestreo aleatorio sistemático, se recogieron datos durante la asistencia y una semana después por encuesta telefónica. La recogida de información se realizó tras formación previa, por trabajadores de cada servicio, siguiendo la metodología del Estudio Nacional sobre los Eventos Adversos ligados a la hospitalización –ENEAS– y el Estudio sobre Eventos Adversos en Urgencias –EVADUR–. Resultados. Se tomó una muestra de 393 casos, proporcional a las asistencias de cada hospital. En 10 casos (3,1%) el motivo de consulta fue un incidente de seguridad previo. En 47 pacientes (11,9%; 8,7-15,1%) se ha detectado al menos un incidente. En 3 casos ha habido 2 (total 50 incidentes). Respecto al impacto, el 51% de los incidentes causaron daño al paciente. Los eventos más frecuentes fueron la necesidad de repetir visita (9 casos) y el mal manejo del dolor (8 casos). En 24 casos (51,1%) la atención sanitaria no se vio afectada, en 3 casos requirió una prueba adicional, en 11 casos requirió nueva consulta y en 2 motivó el ingreso. Los factores causales más frecuentes están relacionados con la medicación (14) y los cuidados (12). El 60% se han considerado evitables. Conclusiones. Se ha obtenido una tasa de incidentes en Urgencias representativa de toda la comunidad autónoma. La inferencia de los resultados a la población significa que 12 de cada 100 pacientes atendidos en Urgencias tendrán un evento adverso, de los cuales 7 serán evitables

OBJECTIVE: Evaluate the patient safety incidents that occur in the emergency departments of our region. MATEIRAL AND METHOD: Observational study conducted in all the hospital emergency departments in the Regional Health Service of Murcia. After systematic random sampling, data were collected during care and a week later by telephone survey. Health professionals of each service were trained and collected the information, following the methodology of the National Study of Adverse Events Related to Hospitalization -ENEAS- and the Adverse Events Related to Spanish Hospital Emergency Department Care -EVADUR-. RESULTS: A total of 393 samples were collected, proportional to the cases treated in each hospital. In 10 cases (3.1%) the complaint was a previous safety incident. At least one incident was detected in 47 patients (11.95%; 8.7 to 15.1%). In 3 cases there were 2 incidents, bringing the number of incidents to 50. Regarding the impact, the 51% of incidents caused harm to the PATIENTS: The effects more frequent in patients were the need for repeat visits (9 cases), and mismanagement of pain (8 cases). In 24 cases (51.1%) health care was not affected, although 3 cases required an additional test, 11 cases required further consultation, and led to hospitalisation in 2 cases. The most frequent causal factors of these incidents were medication (14) and care (12). The incidents were considered preventable in 60% of cases. CONCLUSIONS: A rate of incidents in the emergency departments, representative of the region, has been obtained. The implications of the results for the population means that 12 out of every 100 patients treated in emergency departments have an adverse event, and 7 of these are avoidable (AU)

[Regional Study of Patient Safety Incidents (ERIDA) in the Emergency Services]. / Estudio Regional de Incidentes Derivados de la Atención (ERIDA) en Urgencias.

OBJECTIVE: Evaluate the patient safety incidents that occur in the emergency departments of our region. MATERIAL AND METHOD: Observational study conducted in all the hospital emergency departments in the Regional Health Service of Murcia. After systematic random sampling, data were collected during care and a week later by telephone survey. Health professionals of each service were trained and collected the information, following the methodology of the National Study of Adverse Events Related to Hospitalization -ENEAS- and the Adverse Events Related to Spanish Hospital Emergency Department Care -EVADUR-. RESULTS: A total of 393 samples were collected, proportional to the cases treated in each hospital. In 10 cases (3.1%) the complaint was a previous safety incident. At least one incident was detected in 47 patients (11.95%; 8.7 to 15.1%). In 3 cases there were 2 incidents, bringing the number of incidents to 50. Regarding the impact, the 51% of incidents caused harm to the patients. The effects more frequent in patients were the need for repeat visits (9 cases), and mismanagement of pain (8 cases). In 24 cases (51.1%) health care was not affected, although 3 cases required an additional test, 11 cases required further consultation, and led to hospitalisation in 2 cases. The most frequent causal factors of these incidents were medication (14) and care (12). The incidents were considered preventable in 60% of cases. CONCLUSIONS: A rate of incidents in the emergency departments, representative of the region, has been obtained. The implications of the results for the population means that 12 out of every 100 patients treated in emergency departments have an adverse event, and 7 of these are avoidable.

Growth of tropical tree species and absorption of copper in soil artificially contaminated.

Reclamation of copper contaminated sites using forest species may be an efficient alternative to reduce the negative impact. The aim of this study was to quantify the growth and evaluate the quality of seedlings of native species at different doses of copper in the soil. The experimental design was completely randomized, with seven replications in a factorial arrangement (3×9), using three indigenous species of plants (Anadenanthera macrocarpa, Mimosa scabrella and Apuleia leiocarpa) and nine doses of copper in the soil (0, 60, 120, 180, 240, 300, 360, 420 and 480 mg kg-1).The experiment was carried out in a greenhouse which the seedlings were grown for 180 days. The experimental units were plastic pots of 125 cm3 filled with Oxisol. The results indicated that the levels of copper applied to the soil decreased the quality of seedlings and growth of Apuleia leiocarpato a lesser extent compared with Mimosa scabrella and Anadenanthera macrocarpa. Anadenanthera macrocarpa was the forest species that resulted in the lowest copper translocation from roots to shoots. In addition, the Apuleia leiocarpa exhibited high resistance and tolerance for copper in the soil and also, it is highlighted an ability for copper phytoremediation.

La incontinencia urinaria en consultas de ginecología. ¿Todas las mujeres con síntomas desean tratarse? / Urinary incontinence in gynaecological consultations. Do all women with symptoms wish to be treated?

Objetivo: Determinar la prevalencia y gravedad de los síntomas de incontinencia urinaria (IU) en mujeres que acuden a consultas de atención primaria de ginecología, así como la proporción con síntomas de IU que desean ser estudiadas y tratadas. Materiales y métodos: Estudio multicéntrico, observacional, descriptivo transversal en mujeres que consultaron por cualquier motivo (excepto IU, embarazo y puerperio), a 8 consultas especializadas en salud sexual y reproductiva de las 4 provincias catalanas. Se utilizó el cuestionario ICQ-UI-SF para la detección de los síntomas de IU. A las mujeres con síntomas de IU (ICI-Q-SF > 0) se les preguntó si deseaban recibir atención específica por su problema de IU. A las que contestaron que no se les preguntó por qué. Resultados: Se incluyeron 2.840 mujeres, de las cuales un 41,8% afirmó tener pérdidas de orina, sobre todo sintomatología leve o moderada. Un 53,62% de las mujeres con IU respondió que no deseaba ser tratadas: un 75% con sintomatología leve, un 45% moderada y solo un 16% y un 5% con sintomatología grave o muy grave, respectivamente. Un 53% de mujeres no deseaba tratamiento porque la IU no era un problema importante para ellas. Conclusiones: Casi la mitad de las mujeres que acuden a una consulta especializada en salud sexual y reproductiva por cualquier motivo refieren síntomas de IU, sobre todo leve y moderada. Más de la mitad de las pacientes con síntomas de IU no desean iniciar un proceso de diagnóstico y tratamiento de su problema. La severidad de los síntomas se asocia a la voluntad de ser tratadas

Objective: To determine the prevalence and symptom severity of urinary incontinence (UI) in women who attend primary care gynaecological consultations, as well as the proportion of women with UI symptoms who wish to be studied and treated. Materials and methods: A multicentre, observational, descriptive cross-sectional study was conducted of women who visit the 8 specialised consultations for sexual and reproductive health (SRH) in the 4 Catalan provinces for any reason (except UI, pregnancy and postpartum). We employed the ICQ-UI-SF questionnaire to detect UI symptoms. Women with UI symptoms (ICI-Q-SF > 0) were asked whether they wanted specific care for their UI problem. Those who answered 'no' were asked why. Results: The study included 2840 women, 41.8% of whom reported urine losses, especially mild to moderate symptoms. Some 53.62% of the women with UI responded that they did not wish to be treated. Of these, 75% had mild symptoms, 45% had moderate symptoms, and only 16% and 5% had severe or very severe symptoms, respectively. Fifty-three percent of the women did not want treatment because the UI was not a significant problem for them. Conclusions: Almost half of the women who attended a specialised consultation for SRH for any reason reported UI symptoms, especially mild and moderate. More than half of the patients with UI symptoms did not want to start a diagnostic and treatment process for their problem. Symptom severity is associated with the willingness to be treated

Growth of tropical tree species and absorption of copper in soil artificially contaminated

Abstract Reclamation of copper contaminated sites using forest species may be an efficient alternative to reduce the negative impact. The aim of this study was to quantify the growth and evaluate the quality of seedlings of native species at different doses of copper in the soil. The experimental design was completely randomized, with seven replications in a factorial arrangement (3×9), using three indigenous species of plants (Anadenanthera macrocarpa, Mimosa scabrella and Apuleia leiocarpa) and nine doses of copper in the soil (0, 60, 120, 180, 240, 300, 360, 420 and 480 mg kg1).The experiment was carried out in a greenhouse which the seedlings were grown for 180 days. The experimental units were plastic pots of 125 cm3 filled with Oxisol. The results indicated that the levels of copper applied to the soil decreased the quality of seedlings and growth of Apuleia leiocarpato a lesser extent compared with Mimosa scabrella and Anadenanthera macrocarpa. Anadenanthera macrocarpa was the forest species that resulted in the lowest copper translocation from roots to shoots. In addition, the Apuleia leiocarpa exhibited high resistance and tolerance for copper in the soil and also, it is highlighted an ability for copper phytoremediation.

Resumo A recuperação de áreas contaminadas com cobre utilizando espécies florestais pode ser uma alternativa eficiente para reduzir o impacto negativo deste elemento nestas áreas. O objetivo deste estudo foi quantificar o crescimento e avaliar a qualidade de mudas de espécies nativas em diferentes doses de cobre no solo. O delineamento experimental foi inteiramente casualizado, com sete repetições, em um esquema fatorial (3×9), utilizando-se três espécies nativas de plantas (Anadenanthera macrocarpa, Mimosa scabrella e Apuleia leiocarpa) e nove doses de cobre no solo (0, 60, 120, 180, 240, 300, 360, 420 e 480 mg kg1). O experimento foi realizado em casa de vegetação, onde as plantas foram cultivadas por 180 dias. As unidades experimentais foram vasos de plástico de 125 cm3, preenchidos com Latossolo Vermelho distrófico. Os resultados indicaram que o nível de cobre aplicado ao solo reduziu a qualidade de plântulas e crescimento de Apuleia leiocarpa para um menor grau comparado com bracatinga e angico. Anadenanthera macrocarpa foi a espécie florestal que apresentou menor translocação de cobre a parte aérea das mudas. Além disso, a Apuleia leiocarpa exibiu elevada tolerância para o cobre no solo e também destaca-se mostrando uma capacidade para fitoremediação de áreas contaminadas com cobre.

Growth of tropical tree species and absorption of copper in soil artificially contaminated / Crescimento de espécies arbóreas tropicais e absorção de cobre em solo artificialmente contaminado

Abstract Reclamation of copper contaminated sites using forest species may be an efficient alternative to reduce the negative impact. The aim of this study was to quantify the growth and evaluate the quality of seedlings of native species at different doses of copper in the soil. The experimental design was completely randomized, with seven replications in a factorial arrangement (3×9), using three indigenous species of plants (Anadenanthera macrocarpa, Mimosa scabrella and Apuleia leiocarpa) and nine doses of copper in the soil (0, 60, 120, 180, 240, 300, 360, 420 and 480 mg kg–1).The experiment was carried out in a greenhouse which the seedlings were grown for 180 days. The experimental units were plastic pots of 125 cm3 filled with Oxisol. The results indicated that the levels of copper applied to the soil decreased the quality of seedlings and growth of Apuleia leiocarpato a lesser extent compared with Mimosa scabrella and Anadenanthera macrocarpa. Anadenanthera macrocarpa was the forest species that resulted in the lowest copper translocation from roots to shoots. In addition, the Apuleia leiocarpa exhibited high resistance and tolerance for copper in the soil and also, it is highlighted an ability for copper phytoremediation.

Resumo A recuperação de áreas contaminadas com cobre utilizando espécies florestais pode ser uma alternativa eficiente para reduzir o impacto negativo deste elemento nestas áreas. O objetivo deste estudo foi quantificar o crescimento e avaliar a qualidade de mudas de espécies nativas em diferentes doses de cobre no solo. O delineamento experimental foi inteiramente casualizado, com sete repetições, em um esquema fatorial (3×9), utilizando-se três espécies nativas de plantas (Anadenanthera macrocarpa, Mimosa scabrella e Apuleia leiocarpa) e nove doses de cobre no solo (0, 60, 120, 180, 240, 300, 360, 420 e 480 mg kg–1). O experimento foi realizado em casa de vegetação, onde as plantas foram cultivadas por 180 dias. As unidades experimentais foram vasos de plástico de 125 cm3, preenchidos com Latossolo Vermelho distrófico. Os resultados indicaram que o nível de cobre aplicado ao solo reduziu a qualidade de plântulas e crescimento de Apuleia leiocarpa para um menor grau comparado com bracatinga e angico. Anadenanthera macrocarpa foi a espécie florestal que apresentou menor translocação de cobre a parte aérea das mudas. Além disso, a Apuleia leiocarpa exibiu elevada tolerância para o cobre no solo e também destaca-se mostrando uma capacidade para fitoremediação de áreas contaminadas com cobre.