Analysis of the socio-ecological drivers of the recreational use of temporary streams and rivers.

The undervaluation of the ecosystem services that temporary waterways provide to human wellbeing is one of the most important threats for the conservation and management of these ecosystems. Recreational services might be particularly undervalued in temporary waterways, as there is some evidence that social perceptions and attitudes towards rivers and streams may depend on their flow permanency. The objective of this study was to determine if the recreational use (here considered as an indicator of social perceptions) of temporary waterways differs from the recreational use of perennial waterways. We analysed the recreational use of temporary and perennial waterways in a Mediterranean basin using geotagged photographs (with temporal and spatial-coordinate metadata) that were uploaded during the period 2003 -2020 on the outdoor recreational website Wikiloc, as well as on Google Earth. The observed recreational activity in each type of waterway was compared with the expected activity, estimated from the proportion of temporary and perennial waterways in the basin, considering the accessibility from both paved and unpaved roads, proximity to populations and flow permanency were significant drivers of recreational activities associated with waterways, thus confirming our two hypotheses of a negative bias towards temporary waterways.This is the first study of our knowledge reporting evidence on the role of flow permanency on the social perception towards waterways. The undervaluation of temporary waterways is one of their major threats, and we must activity design and implement management actions to change this social perception from educational activities at schools to restoration actions.

Nature-based solutions in the urban context: terminology, classification and scoring for urban challenges and ecosystem services.

The concept of Nature-Based Solutions (NBS) has emerged to foster sustainable development by transversally addressing social, economic, and environmental urban challenges. However, there is still a considerable lack of agreement on the conceptualization of NBS, especially concerning typologies, nomenclature, and performance assessments in terms of ecosystem services (ES) and urban challenges (UC). Therefore, this article consolidates the knowledge from 4 European projects to set a path for a common understanding of NBS and thus, facilitate their mainstreaming. To do so, firstly, we performed elicitation workshops to develop an integrative list of NBS, based on the identification of overlaps among NBS from different projects. The terminologies were formalized via web-based surveys. Secondly, the NBS were clustered, following a conceptual hierarchical classification. Thirdly, we developed an integrative assessment of NBS performance (ES and UC) based on the qualitative evaluations from each project. Afterwards, we run a PCA and calculated the evenness index to explore patterns among NBS. The main conceptual advancement resides in providing a list of 32 NBS and putting forward two novel NBS categories: NBS units (NBSu) that are stand-alone green technologies or green urban spaces, which can be combined with other solutions (nature-based or not); NBS interventions (NBSi) that refer to the act of intervening in existing ecosystems and in NBSu, by applying techniques to support natural processes. The statistical analysis suggests that NBSu are more versatile than NBSi in terms of UC and ES. Moreover, the results of the integrative assessment of NBS performance suggest a greater agreement concerning the role of NBS in addressing environmental UC, cultural and regulating ES than regarding socio-economic UC and supporting and provision ES. Finally, the 'green factor' and the replication of non-intensive practices occurring in nature seem to be key criteria for practitioners to identify a particular solution as an NBS.

A guideline to frame stressor effects in freshwater ecosystems.

Environmental policies fall short in protecting freshwater ecosystems, which are heavily threatened by human pressures and their associated stressors. One reason is that stressor effects depend on the context in which they occur and it is difficult to extrapolate patterns to predict the effect of stressors without these being contextualized in a general frame. This study aims at improving existing decision-making frameworks such as the DPSIR approach (Driver-Pressure-State-Impact-Response) or ERA (Environmental Risk Assessment) in the context of stressors. Here, we delve into stressor-impact relationships in freshwater ecosystems and develop a guideline which includes key characteristics such as stressor type, stressor duration, location, the natural levels of environmental variables to which each ecosystem is used to, among others. This guideline is intended to be useful in a wide range of ecosystem conditions and stressors. Incorporating these guidelines may favor the comparability of scientific results and may lead to a substantial advancement in the efficacy of diagnosis and predictive approaches of impacts.

Management actions to mitigate the occurrence of pharmaceuticals in river networks in a global change context.

Human consumption of pharmaceuticals leads to high concentrations of pharmaceuticals in wastewater, which is usually not or insufficiently collected and treated before release into freshwater ecosystems. There, pharmaceuticals may pose a threat to aquatic biota. Unfortunately, occurrence data of pharmaceuticals in freshwaters at the global scale is scarce and unevenly distributed, thus preventing the identification of hotspots, the prediction of the impact of Global Change (particularly streamflow and population changes) on their occurrence, and the design of appropriate mitigation actions. Here, we use diclofenac (DCL) as a typical pharmaceutical contaminant, and a global model of DCL chemical fate based on wastewater sanitation, population density and hydrology to estimate current concentrations in the river network, the impact of future changes in runoff and population, and potential mitigation actions in line with the Sustainable Development Goals. Our model is calibrated against measurements available in the literature. We estimate that 2.74 ± 0.63% of global river network length has DCL concentrations exceeding the proposed EU Watch list limit (100 ng L-1). Furthermore, many rivers downstream from highly populated areas show values beyond 1000 ng L-1, particularly those associated to megacities in Asia lacking sufficient wastewater treatment. This situation will worsen with Global Change, as streamflow changes and human population growth will increase the proportion of the river network above 100 ng L-1 up to 3.10 ± 0.72%. Given this background, we assessed feasible source and end-of-pipe mitigation actions, including per capita consumption reduction through eco-directed sustainable prescribing (EDSP), the implementation of the United Nations Sustainable Development Goal (SDG) 6 of halving the proportion of population without access to safely managed sanitation services, and improvement of wastewater treatment plants up to the Swiss standards. Among the considered end-of-pipe mitigation actions, implementation of SDG 6 was the most effective, reducing the proportion of the river network above 100 ng L-1 down to 2.95 ± 0.68%. However, EDSP brought this proportion down to 2.80 ± 0.64%. Overall, our findings indicate that the sole implementation of technological improvements will be insufficient to prevent the expected increase in pharmaceuticals concentration, and that technological solution need to be combined with source mitigation actions.

Nutrient attenuation dynamics in effluent dominated watercourses.

In-stream attenuation of dissolved and particulate forms of carbon, nitrogen and phosphorus are a crucial ecosystem service, especially in watercourses downstream of chemical pollution point-sources (i.e. wastewater treatment plants). Most chemical-fate models assume that attenuation is directly proportional to the concentration of available dissolved organic carbon, and inorganic nitrogen and phosphorus compounds in watercourses, but there are multiple evidences of saturation and even inhibition of attenuation at higher concentrations. Our current comprehension of nutrient attenuation kinetics in streams remains a limiting factor for the development and calibration of predictive models of the chemical fate of these compounds in rivers, thus hindering the development and implementation of more effective regulatory strategies. Here, we assessed the in-stream attenuation of dissolved organic carbon, inorganic nitrogen (NH4+, NO2-, NO3-) and phosphorus (PO43-) compounds at increasing concentrations of these compounds, and analyzed the interaction between attenuation kinetics and biofilm structure and function. Specifically, the net balances of these compounds were assessed in artificial streams exposed to eight treatments following the gradient of WWTP contribution to the river flow (0, 14, 29, 43, 58, 72, 86, and 100% of WWTP effluent water). Results indicate that biological in-stream attenuation by a given biofilm of an effluent dominated watercourse might be saturated if exposed for short periods to high nutrient concentrations such as during combined sewer overflow events, but that communities can adapt if exposed long enough to high concentrations, therefore avoiding or at least minimizing saturation. More attention should be therefore given to the management of effluent-dominated watercourses, as reductions in the temporal variability of the discharged wastewater by WWTP might enhance attenuation and thus reduce water quality issues downstream.

Peripheral levels of brain-derived neurotrophic factor and S100B in neuropsychiatric systemic lupus erythematous.

BACKGROUND: The aim of this study was to investigate serum S100B and brain-derived neurotrophic factor (BDNF) in systemic lupus erythematous (SLE) patients, with and without neuropsychiatric (NP) manifestation activity. METHODS: We assessed 47 SLE patients and 20 selected healthy individuals. Disease activity was assessed according to the SLE disease activity index (SLEDAI). Serum BDNF and S100B were measured by enzyme-linked immunosorbent assay. RESULTS: Serum S100B protein was significantly higher in SLE patients. BDNF levels were significantly decreased in active SLE, when compared with inactive SLE, but not when compared with controls. S100B was clearly higher in the NPSLE group, when compared with the non-NPSLE or control groups. Receiver operating characteristic analysis of S100B revealed an area under the curve of 0.706 that discriminated NPSLE patients with peripheral polyneuropathy. CONCLUSIONS: Our findings reinforce the use of serum S100B as a biomarker in SLE, particularly for NPSLE. Moreover, we found a strong association between serum S100B and peripheral neuropathy, indicating a specific utility for this biomarker in SLE that warrants clinical investigation.

Fate of organic microcontaminants in wastewater treatment and river systems: An uncertainty assessment in view of sampling strategy, and compound consumption rate and degradability.

The growing awareness of the relevance of organic microcontaminants on the environment has led to a growing number of studies on attenuation of these compounds in wastewater treatment plants (WWTP) and rivers. However, the effects of the sampling strategies (frequency and duration of composite samples) on the attenuation estimates are largely unknown. Our goal was to assess how frequency and duration of composite samples influence uncertainty of the attenuation estimates in WWTPs and rivers. Furthermore, we also assessed how compound consumption rate and degradability influence uncertainty. The assessment was conducted through simulating the integrated wastewater system of Puigcerdà (NE Iberian Peninsula) using a sewer pattern generator and a coupled model of WWTP and river. Results showed that the sampling strategy is especially critical at the influent of WWTP, particularly when the number of toilet flushes containing the compound of interest is small (≤100 toilet flushes with compound day-1), and less critical at the effluent of the WWTP and in the river due to the mixing effects of the WWTP. For example, at the WWTP, when evaluating a compound that is present in 50 pulses·d-1 using a sampling frequency of 15-min to collect a 24-h composite sample, the attenuation uncertainty can range from 94% (0% degradability) to 9% (90% degradability). The estimation of attenuation in rivers is less critical than in WWTPs, as the attenuation uncertainty was lower than 10% for all evaluated scenarios. Interestingly, the errors in the estimates of attenuation are usually lower than those of loads for most sampling strategies and compound characteristics (e.g. consumption and degradability), although the opposite occurs for compounds with low consumption and inappropriate sampling strategies at the WWTP. Hence, when designing a sampling campaign, one should consider the influence of compounds' consumption and degradability as well as the desired level of accuracy in attenuation estimations.

Eclampsia como manifestación clínica de enfermedad trofoblástica gestacional: reporte de caso / Eclampsia as clinical presentation of gestational trophoblastic disease: case report

Introducción: La eclampsia es una complicación severa y poco frecuente del embarazo, apareciendo generalmente luego de las 34 semanas de edad gestacional. El diagnóstico de preeclampsia antes de las 20 semanas de edad gestacional se asocia con patología del trofoblasto. Presentación del caso: Paciente femenina de 18 años, 3 embarazos, 0 partos, 2 abortos, cursando embarazo de 14 semanas de edad gestacional, consulta por haber presentado síndrome convulsivo con crisis generalizadas de tipo tónico-clónicas y amaurosis posterior. Se sospecha síndrome de hipertensión endocraneana y se solicita resonancia magnética de encéfalo, que muestra múltiples lesiones córtico-subcorticales, sugiriendo síndrome de encefalopatía posterior reversible. Una ecografía obstétrica informa placenta aumentada de tamaño con múltiples imágenes econegativas con aspecto de panal de abeja, oligohidroamnios y feto con latidos positivos, sin anomalías anatómicas. La gonadotrofina coriónica humana fue de 11538440 U/L. Evoluciona con compromiso de conciencia y tres episodios de convulsión generalizada de tipo tónico-clónica con mala respuesta a diazepam y adecuada respuesta a sulfato de magnesio. Se pesquisa crisis hipertensiva y proteinuria de 24 horas de 8 gramos. Se decide interrupción del embarazo y manejo en Unidad de Paciente Crítico. Legrado aspirativo sin incidentes. La biopsia indica mola hidatidiforme parcial con feto sin malformaciones externas. Evolución favorable con negativización de gonadotrofina coriónica humana en controles posteriores. Discusión: El desarrollo de eclampsia antes de las 20 semanas es anecdótico con pocos casos reportados y su aparición debe hacer sospechar una patología del trofoblasto.

Introduction: Preeclampsia is a severe complication of pregnancy, usually appearing after 34 weeks of gestational age. The diagnosis of preeclampsia before 20 weeks of gestational age is associated with trophoblastic disease. Case report: Female patient, 18 years old, 3 pregnancies, 0 deliveries, 2 abortions, 14 weeks pregnant. Presents with generalized tonicclonic seizures and amaurosis. Clinical evaluation compatible with intracranial hypertension síndrome and magnetic resonance imaging of the brain is requested, showing multiple cortico-subcortical lesions, suggesting posterior reversible encephalopathy syndrome. Ultrasound evaluation informs increased size placenta, multiple echo-negativa images with honeycomb disposition, oligohydramnios and present fetal heartbeats. No fetal anatomic abnormalities. Human chorionic gonadotrophin level was 11538440 U/L. Clinical presentation evolves with impaired conscousness and three generalized tonic-clonic crisis, showing poor response to intravenous diazepam and appropriate response to magnesium sulfate. Hypertensive crisis develops and the result of 24 hour proteinuria is 8 grams. Due to mater nal risk pregnancy was interrupted and uterine aspirage was performed. Patient was managed in the Intensive Care Unit. Biopsy informed partial hydatidiform mole and fetus with no anatomical abnormalities. Clinical evolution was positive and human chorionic gonadotrophin level below detection during follow-up. Discussion: Development of eclapsia before 20 weeks of gestational age is anecdotal with few reported cases and could be indicative of gestational trophoblastic disease.

Attenuation of pharmaceuticals and their transformation products in a wastewater treatment plant and its receiving river ecosystem.

Pharmaceuticals are designed to improve human and animal health, but may also be a threat to freshwater ecosystems, particularly after receiving urban or wastewater treatment plant (WWTP) effluents. Knowledge on the fate and attenuation of pharmaceuticals in engineered and natural ecosystems is rather fragmented, and comparable methods are needed to facilitate the comprehension of those processes amongst systems. In this study the dynamics of 8 pharmaceuticals (acetaminophen, sulfapyridine, sulfamethoxazole, carbamazepine, venlafaxine, ibuprofen, diclofenac, diazepam) and 11 of their transformation products were investigated in a WWTP and the associated receiving river ecosystem. During 3 days, concentrations of these compounds were quantified at the influents, effluents, and wastage of the WWTP, and at different distances downstream the effluent at the river. Attenuation (net balance between removal and release from and to the water column) was estimated in both engineered and natural systems using a comparable model-based approach by considering different uncertainty sources (e.g. chemical analysis, sampling, and flow measurements). Results showed that pharmaceuticals load reduction was higher in the WWTP, but attenuation efficiencies (as half-life times) were higher in the river. In particular, the load of only 5 out of the 19 pharmaceuticals was reduced by more than 90% at the WWTP, while the rest were only partially or non-attenuated (or released) and discharged into the receiving river. At the river, only the load of ibuprofen was reduced by more than 50% (out of the 6 parent compounds present in the river), while partial and non-attenuation (or release) was observed for some of their transformation products. Linkages in the routing of some pharmaceuticals (venlafaxine, carbamazepine, ibuprofen and diclofenac) and their corresponding transformation products were also identified at both WWTP and river. Finally, the followed procedure showed that dynamic attenuation in the coupled WWTP-river system could be successfully predicted with simple first order attenuation kinetics for most modeled compounds.

Placing ecosystem services at the heart of urban water systems management.

Current approaches have failed to deliver a truly integrated management of the different elements of the urban water system, such as freshwater ecosystems, drinking water treatment plants, distribution networks, sewer systems and wastewater treatment plants. Because the different parts of urban water have not been well integrated, poor decisions have been made for society in general, leading to the misuse of water resources, the degradation of freshwater ecosystems and increased overall treatment costs. Some attempts to solve environmental issues have adopted the ecosystem services concept in a more integrated approach, however this has rarely strayed far away from pure policy, and has made little impact in on-the-ground operational matters. Here, we present an improved decision-making framework to integrate the management of urban water systems. This framework uses the ecosystem service concept in a practical way to make a better use of both financial and water resources, while continuing to preserve the environment.

Nutrients versus emerging contaminants-Or a dynamic match between subsidy and stress effects on stream biofilms.

Freshwater ecosystems are threatened by multiple anthropogenic stressors, which might be differentiated into two types: those that reduce biological activity at all concentrations (toxic contaminants), and those that subsidize biological activity at low concentrations and reduce it at high concentrations (assimilable contaminants). When occurring in mixtures, these contaminants can have either antagonistic, neutral or synergistic effects; but little is known on their joint effects. We assessed the interaction effects of a mixture of assimilable and toxic contaminants on stream biofilms in a manipulative experiment using artificial streams, and following a factorial design with three nutrient levels (low, medium or high) and either presence or absence of a mixture of emerging contaminants (ciprofloxacin, erythromycin, diclofenac, methylparaben, and sulfamethoxazole). We measured biofilm biomass, basal fluorescence, gross primary production and community respiration. Our initial hypotheses were that biofilm biomass and activity would: increase with medium nutrient concentrations (subsidy effect), but decrease with high nutrient concentrations (stress effect) (i); decrease with emerging contaminants, with the minimum decrease at medium nutrient concentrations (antagonistic interaction between nutrients subsidy and stress by emerging contaminants) and the maximum decrease at high nutrient concentrations (synergistic interaction between nutrients and emerging contaminants stress) (ii). All the measured variables responded linearly to the available nutrients, with no toxic effect at high nutrient concentrations. Emerging contaminants only caused weak toxic effects in some of the measured variables, and only after 3-4 weeks of exposure. Therefore, only antagonistic interactions were observed between nutrients and emerging contaminants, as medium and high nutrient concentrations partly compensated the harmful effects of emerging contaminants during the first weeks of the experiment. Our results show that contaminants with a subsidy effect can alleviate the effects of toxic contaminants, and that long-term experiments are required to detect stress effects of emerging contaminants at environmentally relevant concentrations.

Determination of a broad spectrum of pharmaceuticals and endocrine disruptors in biofilm from a waste water treatment plant-impacted river.

Wastewater treatment plants (WWTPs) are one of the main sources of pharmaceuticals and endocrine disrupting compounds in freshwater ecosystems, and several studies have reported bioaccumulation of these compounds in different organisms in those ecosystems. River biofilms are exceptional indicators of pollution, but very few studies have focused on the accumulation of these emerging contaminants. The objectives of this study were first to develop an efficient analytical methodology for the simultaneous analysis of 44 pharmaceuticals and 13 endocrine disrupting compounds in biofilm, and second, to assess persistence, distribution, and bioaccumulation of these contaminants in natural biofilms inhabiting a WWTP-impacted river. The method is based on pressurized liquid extraction, purification by solid-phase extraction, and analysis by ultra performance liquid chromatography coupled to a mass spectrometer (UPLC-MS/MS) in tandem. Recoveries for pharmaceuticals were 31-137%, and for endocrine disruptors 32-93%. Method detection limits for endocrine disruptors were in the range of 0.2-2.4 ng g(-1), and for pharmaceuticals, 0.07-6.7 ng g(-1). A total of five endocrine disruptors and seven pharmaceuticals were detected in field samples at concentrations up to 100 ng g(-1).

Balancing the health benefits and environmental risks of pharmaceuticals: Diclofenac as an example.

Pharmaceuticals are designed to improve human and animal health, but even the most beneficial pharmaceuticals might raise some questions concerning the consequences of exposure to non-target organisms. To illustrate this situation and using diclofenac as a case-study, we analyze global consumption and occurrence data to identify hot spots of consumption without occurrence data, review the scientific literature on the harmful environmental effects to determine whether the observed concentrations in freshwater are of environmental concern, summarize the current pharmaceutical and environmental policies to highlight policy gaps, and suggest a series of research and policy recommendations, which can be summarized as follows: we need to improve the current knowledge on occurrence in freshwaters to properly implement environmental policies (i), diclofenac might pose a risk to non-target organisms in freshwater (ii); the harmful effects that some pharmaceuticals may have on the environment are not always addressed by environmental policies (iii).

Sensitivity analysis of a sediment dynamics model applied in a Mediterranean river basin: global change and management implications.

Climate change and land-use change are major factors influencing sediment dynamics. Models can be used to better understand sediment production and retention by the landscape, although their interpretation is limited by large uncertainties, including model parameter uncertainties. The uncertainties related to parameter selection may be significant and need to be quantified to improve model interpretation for watershed management. In this study, we performed a sensitivity analysis of the InVEST (Integrated Valuation of Environmental Services and Tradeoffs) sediment retention model in order to determine which model parameters had the greatest influence on model outputs, and therefore require special attention during calibration. The estimation of the sediment loads in this model is based on the Universal Soil Loss Equation (USLE). The sensitivity analysis was performed in the Llobregat basin (NE Iberian Peninsula) for exported and retained sediment, which support two different ecosystem service benefits (avoided reservoir sedimentation and improved water quality). Our analysis identified the model parameters related to the natural environment as the most influential for sediment export and retention. Accordingly, small changes in variables such as the magnitude and frequency of extreme rainfall events could cause major changes in sediment dynamics, demonstrating the sensitivity of these dynamics to climate change in Mediterranean basins. Parameters directly related to human activities and decisions (such as cover management factor, C) were also influential, especially for sediment exported. The importance of these human-related parameters in the sediment export process suggests that mitigation measures have the potential to at least partially ameliorate climate-change driven changes in sediment exportation.

Development of an extraction and purification method for the determination of multi-class pharmaceuticals and endocrine disruptors in freshwater invertebrates.

Aquatic organisms from freshwater ecosystems impacted by waste water treatment plant (WWTP) effluents are constantly exposed to constant concentrations of pharmaceuticals, endocrine disruptors and related compounds, among other anthropogenic contaminants. Macroinvertebrates inhabiting freshwater ecosystems might be useful bioindicators of exposure to contaminants, since their lives are long enough to bioaccumulate, but at the same time may integrate short-term changes in the environment. However, studies about potential bioaccumulation of emerging contaminants in these organisms are very scarce. The objectives of this study were to develop an analytical methodology for the analysis of 41 pharmaceuticals and 21 endocrine disruptors in freshwater invertebrates. In addition, bioaccumulation of these contaminants in three macroinvertebrate taxa inhabiting a waste water treatment plant -impacted river was evaluated. The method for the simultaneous extraction of both families of compounds is based on sonication, purification via removal of phospholipids, and analysis by ultra performance liquid chromatography coupled to a mass spectrometer (UPLC-MS/MS) in tandem. Recoveries for pharmaceuticals were 34-125%, and for endocrine disruptors were 48-117%. Method detection limits (MDLs) for EDCs were in the range of 0.080-2.4 ng g(-1), and for pharmaceuticals, 0.060-4.3 ng g(-1). These pollutants were detected in water samples taken downstream the waste water treatment plant effluent at concentrations up to 572 ng L(-1). Two non-esteroidal anti-inflammatory drugs, diclofenac and ibuprofen, and four endocrine disruptors - estrone, bisphenol A, TBEP, and nonylphenol - were detected in at least one macroinvertebrate taxa in concentrations up to 183 ng g(-1) (dry weight). An isobaric interference was identified during the analysis of diclofenac in Hydropsyche samples, which was successfully discriminated via accurate mass determination by TFC-LTQ Orbitrap.

Frecuencia de colonización por Estreptococo grupo B en embarazadas de 35 a 37 semanas en el Hospital Materno-Infantil San Pablo / Frequency of group B Streptococcus colonization in 35 to 37 weeks pregnant women in the San Pablo Maternal-Child Hospital

La colonización del Estreptococo grupo B en la embarazada está relacionada a patologías perinatales, constituyéndose en una causa muy importante de morbi-mortalidad neonatal. De manera a reducir dicha morbi-mortalidad, el Centro de Control y Prevención de Enfermedades Infecciosas de Estados Unidos desarrolló una estrategia que consiste en realizar el cultivo de muestra tanto vaginal como ano-rectal de todas las mujeres entre 35 y 37 semanas de gestación. El objetivo de este trabajo fue determinar la frecuencia de colonización por Estreptococo β hemolítico grupo B en mujeres gestantes entre las 35-37 semanas de embarazo que concurrieron al Hospital Materno-Infantil San Pablo, Centro de Salud Nº 5, desde abril del 2010 a agosto del 2011. Se realizó un estudio con diseño observacional descriptivo de corte transverso. Las muestras fueron tomadas mediante hisopado de introito vaginal y ano-rectal, colocadas en medio de transporte Stuart y remitidas al Instituto de Investigaciones en Ciencias de la Salud para el cultivo en agar sangre, previo enriquecimiento en caldo Todd Hewitt. La identificación bacteriana se realizó mediante pruebas bioquímicas convencionales y la confirmación mediante aglutinación con látex. La frecuencia de colonización obtenida fue relativamente alta, de 23,6%. Los resultados de este estudio permiten dimensionar la problemática en nuestro país y evidenciar la necesidad de la implementación de un programa a nivel nacional para la detección del Estreptococo grupo B de forma rutinaria en las embarazadas. De esta manera, se podrá disminuir la morbi-mortalidad perinatal y materna con la administración oportuna del tratamiento profiláctico.

Embarazo Tubárico Asociado a Teratoma de Ovario, Hallazgos Ecográficos y Laparoscopicos: Reporte de un Caso / Tubal Pregnancy Asociated with oVarian Teratoma, Ecographic and Laparoscopic Findings: Case Report

RESUMEN Mujer de 28 años con retraso menstrual de 15 días. Examen físico: dolor en ambas fosas ilíacas, escaso sangrado, fondos de saco laterales dolorosos no abombados y fondo de saco de Douglas (FSD) levemente doloroso. Se realizaron 3 ecografías diferentes. Observamos la evolución del embarazo ectópico desde la típica imagen ecográfica redondeada con saco en su interior hasta la imagen heterogénea (hemática) que resultó ser un aborto tubárico por laparoscopia y biopsia. Hubo correlación con el BHCG en descenso. La búsqueda bibliográfica no encontró descripciones de asociaciones iguales al caso descrito.

ABSTRACT We report a case of a 28 year old woman with 15 days menstrual delay, abdominal pain and small bleeding. During physical examination, we found no pain in lateral pouches and slight pain in pouch of Douglas. Three different vaginal ultrasounds were perfomed by 3 professionals. We saw ultrasonographic evolution of an ectopic pregnancy from typical image with a sac within it to heterogeneous image (blood). Laparoscopy and biopsy confirm these findings. BHCG correlates with them, showing descendent levels. Bibliographic search didn’t find similar cases to our patient.

Construcción y validación inicial de un cuestionario para medir calidad de vida en pacientes esquizofrénicos / Construction and preliminary validation of a questionnaire to assess quality of life in schizophrenic patients

La consideración de la calidad de vida subjetiva de los pacientes se ha transformado progresivamente en uno de los aspectos críticos en la evaluación de programas de rehabilitación psiquiátrica. Objetivos: Construir un instrumento específico para evaluar calidad de vida en pacientes con esquizofrenia y determinar sus principales características psicométricas. Pacientes y Método: El estudio fue realizado en varias etapas. Primero se construyó un listado con 65 tópicos que emergieron de una revisión de la literatura relevante. Posteriormente, la lista fue modificada de acuerdo con las sugerencias de 15 expertos y de la observación de 10 pacientes, a quienes se les hizo un seguimiento durante un mes. A continuación, se construyó un cuestionario con reactivos tipo diferencial semántico destinados a medir aquellos aspectos que emergieron como los más relevantes en las etapas anteriores. Finalmente, se aplicó el cuestionario a una muestra de 200 pacientes atendidos en servicios públicos de salud y se determinaron las principales características psicométricas del instrumento. Resultados: La validación inicial del instrumento se realizó a través de un análisis factorial exploratorio que arrojó los siguientes factores: adaptación al entorno, bienestar general, intercambio afectivo, autoeficacia, atención psiquiátrica, hogar y familia, vida amorosa, situación económica y emancipación del hogar. La confiabilidad del cuestionario, medida con el coeficiente de Crombach, fue de 0,89 para la prueba total y varió entre 0,51 y 0,83 para los factores. Conclusión: El instrumento es apropiado para evaluar calidad de vida subjetiva en pacientes esquizofrénicos. Se entregan normas para su interpretación.

Background: The measurement of subjective quality of life in schizophrenic patients has become increasingly one of the critical tasks when assessing the effectiveness of psychiatric rehabilitation programs. Aims: To develop a specific questionnaire to evaluate subjective quality of life in schizophrenic patients and to asses its main psychometric properties. Patients and Method: The study was conducted in several stages. First, a list of the 65 most relevant quality of life-related topics was extracted from the relevant literature. The list was then modified according to the suggestions of 15 experts and to the results of the observation of 10 patients, who were followed up for a month. Next, a questionnaire was build using semantic differential items for each of the selected topics. Finally, the questionnaire was administered to 200 patients attending to public health services in Chile and its major psychometric properties were assessed. Results: An exploratory factor analysis conducted to evaluate the preliminary validity of the questionnaire revealed a 9 dimensions solution: adaptation to the environment, subjective well being, affective intercourse, self-efficacy, psychiatric attention, home and family, sentimental life, financial situation, and emancipation from home. The reliability, assessed by Cronbach 's alpha, was 0.89 for the entire questionnaire and varied from 0.51 and 0.83 for the factors. Conclusion: The questionnaire is appropriate to assess subjective quality of life schizophrenic patients. Normative scores and interpretation criteria are provided.