The catastrophic effects of groundwater intensive exploitation and Megadrought on aquifers in Central Chile: Global change impact projections in water resources based on groundwater balance modeling.

Central Chile is undergoing its most severe drought since 2010, affecting ecosystems, water supply, agriculture, and industrial uses. The government's short-term measures, such as increasing groundwater extraction (by 383 % from 1997 to 2022), are exacerbating the situation, leading to long-term hydrological deterioration. The objective of this research is to establish the main processes driving the water table depth evolution within Central Chile over the period 1979-2023. This is done by conducting groundwater balances on five major hydrological basins of Central Chile. For the Megadrought (MD) period (2010-2022), the groundwater level depths reflect not only the recharge variability but, especially, the forcing trend of groundwater withdrawals: they represent 35 % and 65 %, respectively, of the total phreatic level drawdown. This result underlines the dominant role played by groundwater withdrawals in the current delicate state of Central Chile's groundwater resources, while revealing that drought is a new complex phenomenon to deal with, in the midterm, to revert the current water resource trend in Central Chile. Our study moreover presents the impact of climate change in the basin in the framework of six different groundwater withdrawal scenarios. In the worst case (i.e., RCP8.5), the aquifer recharge decreases 18 % with respect to 1979-1997, which is the period assumed to be unaffected by the impact of MD and withdrawals. Such a reduction may be irrelevant in the dynamics of the aquifer system if the current extraction rate does not change. The estimated recovery time needed to reach aquifer conditions equal to those of the unaffected period is approximately 50 years.

Artificial recharge by means of careo channels versus natural aquifer recharge in a semi-arid, high-mountain watershed (Sierra Nevada, Spain).

The acequias de careo are ancestral water channels excavated during the early Al-Andalus period (8th-10th centuries), which are used to recharge aquifers in the watersheds of the Sierra Nevada mountain range (Southeastern Spain). The water channels are maintained by local communities, and their main function is collecting snowmelt, but also runoff from rainfall from the headwaters of river basins and distributing it throughout the upper parts of the slopes. This method of aquifer artificial recharge extends the availability of water resources in the lowlands of the river basins during the dry season when there is almost no precipitation and water demand is higher. This study investigates the contribution of the careo channels in the watershed of Bérchules concerning the total aquifer recharge during the 2014-2015 hydrological year. Several channels were gauged, and the runoff data were compared with those obtained from a semi-distributed hydrological model applied to the same hydrological basin. The natural infiltration of meteoric waters accounted for 52% of the total recharge, while the remaining 48% corresponded to water transported and infiltrated by the careo channels. In other words, the careo recharge system enhances by 92% the natural recharge to the aquifer. Our results demonstrate the importance of this ancestral and efficient channel system for recharging slope aquifers developed in hard rocks. The acequias de careo are nature-based solutions for increasing water resources availability that have contributed to a prosperous life in the Sierra Nevada. Its long history (>1200 years) suggests that the system has remarkable resilience properties, which have allowed adaptation and permance for centuries in drastically changing climatic and socioeconomic conditions. This recharge system could also be applied to -or inspire similar adaptation measures in- semi-arid mountain areas around the world where it may help in mitigating climate change effects.

Isotopic content in high mountain karst aquifers as a proxy for climate change impact in Mediterranean zones: The Port del Comte karst aquifer (SE Pyrenees, Catalonia, Spain).

The objective of this work is to characterize the impact of climate change in the karst aquifer of the Port del Comte Massif (PCM). Six regional climate models (RCMs) from CLYM'PY Project are used to analyse the magnitude and trends of changes on precipitation and temperature (RCP4.5 and RCP8.5 scenarios) and how these changes propagate through the hydrogeological system as groundwater resources availability and the associated water isotopic content. The study uses the RCMs climate change forcings as input data to a combination of (1) a semi-distributed hydrological model for simulating the hydrodynamical response of the aquifer, and (2) a lumped parameter model for simulating the isotopic content in groundwater at the outlet of the aquifer. A mean decrease of 2.6% and 1.9% in yearly precipitation and a mean increase of 1.9 and 3.1 °C in average temperature is expected in PCM at the end of the 21st century in the RCP4.5 and RCP8.5 scenarios, respectively. This climate signal entering the hydrogeological system results in a mean decrease in recharge of 3.9% and 0.5% from rainfall and of 59.3% and 76.1% from snowmelt, and a decrease of 7.6% and 4.5% in total system discharge, but also generates an isotopic enrichment in groundwater discharge (δ18OGW) of 0.50‰ and 0.84‰, respectively. Moreover, from a long-term (2010-2100) perspective, the mean trend in δ18OGW is 0.7‰/100 yr and 1.2‰/100 yr for RCP4.5 and RCP8.5, respectively, resulting in easily measurable annual lapse rates with the current analytical methods.

Evaluation of natural background levels of high mountain karst aquifers in complex hydrogeological settings. A Gaussian mixture model approach in the Port del Comte (SE, Pyrenees) case study.

The hydrogeological processes driving the hydrochemical composition of groundwater in the alpine pristine aquifer system of the Port del Comte Massif (PCM) are characterized through the multivariate statistical techniques Principal Component Analysis (PCA) and Gaussian Mixture Models (GMM) in the framework of Compositional Data (CoDa) analysis. Also, the groundwater Natural Background Levels (NBLs) for NO3 and SO4 and Cl are evaluated, which are specially important for indicating the occurrence of groundwater contamination derived from the anthropic activities conducted in the PCM. The different hydrogeochemical facies found in the aquifer system of the PCM comprises low mineralized Ca-HCO3 water for the main Eocene karst aquifer, and Ca-SO4 and highly mineralized NaCl water types in the minor aquifers discharging from the PCM. The NBL values of SO4, Cl and NO3 obtained for the main karst aquifer are 14.33, 4.06 and 6.55 mg/L, respectively. These values are 35, 3 and 1.2 times lower than the respective official NBLs values that were determined by the water administration to be compared with in the case of conducting a pollution assessment characterization in the main karst aquifer. Official overestimation of NBLs can put important groundwater resources in the PCM at risk.

Snowmelt as a determinant factor in the hydrogeological behaviour of high mountain karst aquifers: The Garcés karst system, Central Pyrenees (Spain).

Time series of environmental tracers (groundwater stable isotope composition, electrical conductivity and temperature) and concentration breakthrough curves of artificial tracers (uranine, eosine, amino-G and naphtionate) have been analyzed to characterize fast preferential and slow matrix in-transit recharge flows in the Paleocene-Eocene limestone aquifer of the Ordesa and Monte Perdido National Park, an alpine karst system drained by a water table cave, a rare hydrological feature in high mountain karst systems with similar characteristics. Snowmelt favors the areal recharge of the system. This process is reflected in the large proportion of groundwater flowing through the connected porosity structure of the karst aquifer, which amounts the 75% of the total system water discharge. From the perspective of water resources recovery, the water capacity of the fissured-porous zone (matrix) represents 99% of the total karst system storage. The volume associated to the karst conduits is very small. The estimated mean travel times are 9 days for conduits and 475 days for connected porosity. These short travel times reveal high vulnerability of the karst system to pollutants in broad sense and a great impact of climate change on the associated water resources.

Hydrogeochemical, isotopic and geophysical characterization of saline lake systems in semiarid regions: The Salada de Chiprana Lake, Northeastern Spain.

Most of the athalassic saline and hypersaline lakes are located in arid and semiarid regions where water availability drives the hydrological dynamics of the lake itself and the associated ecosystems. This is the case of the Salada de Chiprana Lake, in the Ebro River basin (Spain). It is the only athalassic permanent hypersaline lake in Western Europe, and where rare and endangered bacterial mats exist. This work presents a robust hydrogeological conceptual model for the lake system. The model evaluates the contribution of groundwater discharge to the whole water budget and explains the hydrological behaviour of the lake system. The lake behaves as a flow-through system rather than a closed basin. About 40% of total water outflow from the lake occurs as groundwater, whereas evaporation accounts for the remaining 60%. The surface water inflows are variable, but the groundwater contribution seems almost constant, amounting to 13% of the average total water inflow and contributing 1.9% of salt income. The high water salinity of the lake is controlled by evaporation, by saline water inflows from irrigation return flows, and the by groundwater outflows. The role of groundwater should be taken into account when drafting the water and land planning, once the conditions for the conservation of the algal mats are defined. A major contribution of this study is the water balance in the Salada de Chiprana Lake, which is consistent with a robust hydrogeological conceptual model defined upon scarce hydrogeological, hydrochemical and isotopic data in the local context as conditioned by the regional behaviour. The water balance is a key tool to help to correctly manage this unique athalassic saline lake, and the approach used here can be extrapolated to other similar ecosystems around the world.

Contribution of isotopic research techniques to characterize high-mountain-Mediterranean karst aquifers: The Port del Comte (Eastern Pyrenees) aquifer.

Water resources in high mountain karst aquifers are usually characterized by high rainfall, recharge and discharge that lead to the sustainability of the downstream ecosystems. Nevertheless, these hydrological systems are vulnerable to the global change impact. The mean transit time (MTT) is a key parameter to describe the behavior of these hydrologic systems and also to assess their vulnerability. This work is focused on estimating MTT by using environmental tracers in the framework of high-mountain karst systems with a very thick unsaturated zone (USZ). To this end, it is adapted to alpine zones a methodology that combines a semi-distributed rainfall-runoff model to estimate recharge time series, and a lumped-parameter model to obtain ΜΤΤ. The methodology has been applied to the Port del Comte Massif (PCM) hydrological system (Southeastern Pyrenees, NE Spain), a karst aquifer system with an overlying 1000 m thick USZ. Six catchment areas corresponding to most important springs of the system are considered. The obtained results show that hydrologically the behavior of the system can be described by an exponential flow model (EM), with MTT ranging between 1.9 and 2.9 years. These ΜΤΤ values are shorter than those obtained by considering a constant recharge rate along time, which is the easiest and most applied aquifer recharge hypothesis when estimating ΜΤΤ through lumped-parameter models.

Groundwater dynamics in a hydrologically-modified alpine watershed from an ancient managed recharge system (Sierra Nevada National Park, Southern Spain): Insights from hydrogeochemical and isotopic information.

In many of the alpine watersheds of Sierra Nevada (Southern Spain) exists an ancient network of dug canals that collect, transport and facilitate the recharge the snowmelt in the underlying aquifer during the spring season. This practice, known as careos, in the lower part of the watersheds supply drinking water as spring discharge during the dry season. To study how this managed recharge technique modifies the natural response of these basins this work focuses on characterizing the hydrological behavior of one of the sites, the Berchules watershed. The mechanisms for mineralization of groundwater are based on geochemical processes such as evapo-concentration in the soil layer and silicate mineral weathering due to dissolved CO2 originated from both soil biogenic processes and the atmosphere. Groundwater presents a main hydrogeochemical calcium­magnesium-bicarbonate type facies, which is associated to groundwater flowing through the upper weathered silicates and quickly drained through springs located in the uplands and in the intermediate altitude catchment zone. Additionally, in the lower part of the basin some springs discharge mineralized groundwater with a sodium-calcium-bicarbonate composition associated to regional groundwater flow. In natural conditions, this hydrogeological system behaves as a sloping aquifer, occurring recharge between 1400 and 2500 m a.s.l. The springs discharge groundwater with an isotopic content and temperature in coherence with the local rainfall isotopic and thermal atmospheric altitudinal lines. Nevertheless, once the careo recharge begins the affected springs reveal the fingerprint of the concentrated recharge system by blurring the fingerprint of both the isotopic and thermal altitudinal dependence in the springs discharge. This validates the previous conceptual model and supports average recharge values of 141 ±â€¯140 mm/yr and total average water resources of 181 ±â€¯111 mm/yr which include a 40% increase in the study period due to the effect of the acequias de careo.

Combination of lumped hydrological and remote-sensing models to evaluate water resources in a semi-arid high altitude ungauged watershed of Sierra Nevada (Southern Spain).

Assessing water resources in high mountain semi-arid zones is essential to be able to manage and plan the use of these resources downstream where they are used. However, it is not easy to manage an unknown resource, a situation that is common in the vast majority of high mountain hydrological basins. In the present work, the discharge flow in an ungauged basin is estimated using the hydrological parameters of an HBV (Hydrologiska Byråns Vattenbalansavdelning) model calibrated in a "neighboring gauged basin". The results of the hydrological simulation obtained in terms of average annual discharge are validated using the VI-ETo model. This model relates a simple hydrological balance to the discharge of the basin with the evaporation of the vegetal cover of the soil, and this to the SAVI index, which is obtained remotely by means of satellite images. The results of the modeling for both basins underscore the role of the underground discharge in the total discharge of the hydrological system. This is the result of the deglaciation process suffered by the high mountain areas of the Mediterranean arc. This process increases the infiltration capacity of the terrain, the recharge and therefore the discharge of the aquifers that make up the glacial and periglacial sediments that remain exposed on the surface as witnesses of what was the last glaciation.

Correlation of the seasonal isotopic amplitude of precipitation with annual evaporation and altitude in alpine regions.

The time series of stable water isotope composition relative to IAEA-GNIP meteorological stations located in alpine zones are analyzed in order to study how the amplitude of the seasonal isotopic composition of precipitation (Aδ) varies along a vertical transect. A clear relationship between Aδ and local evaporation is obtained, with slopes of -0.87 ‰/100mm/yr and -7.3 ‰/100mm/yr for Aδ(18)O and Aδ(2)H, respectively. When all sampling points of the vertical transect receive the same moisture sources, then a linear relationship between Aδ and elevation is obtained, with vertical gradients of 0.16 ‰/100mm/yr and 1.46 ‰/100mm/yr forAδ(18)O and Aδ(2)H, respectively.

Isotopic and hydrogeochemical characterization of high-altitude karst aquifers in complex geological settings. The Ordesa and Monte Perdido National Park (Northern Spain) case study.

The Ordesa and Monte Perdido National Park, located in the Southern Pyrenees, constitutes the highest karst system in Western Europe. No previous studies regarding its geochemical and isotopic groundwater characterization are available in this area. This work presents the results of field and sampling campaigns carried out between July 2007 and September 2013. The groundwater presents high calcium bicarbonate contents due to the occurrence of upper Cretaceous and lower Paleocene-Eocene carbonate materials in the studied area. Other relevant processes include dissolution of anhydrite and/or gypsum and incongruent dissolution of Mg-limestone and dolomite. The water stable isotopes (δ(18)O, δ(2)H) show that the oceanic fronts from the Atlantic Ocean are responsible for the high levels of precipitation. In autumn, winter, and spring, a deuterium excess is found in the recharge water, which could be related to local atmospheric transport of low-altitude snow sublimation vapour and its later condensation on the snow surface at higher altitude, where recharge is mostly produced. The recharge zones are mainly between 2500m and 3200ma.s.l. The tritium content of the water suggests short groundwater transit times. The isotopic composition of dissolved sulphate points to the existence of regional fluxes mixed with local discharge in some of the springs. This work highlights the major role played by the altitude difference between the recharge and discharge zones in controlling the chemistry and the vertical variability of the isotopic composition in high-altitude karst aquifers.

Obstrucción intestinal aguda por bezoar en un paciente diabético tipo 2 con neuropatía / Acute intestinal obstruction caused by bezoar in a patient with type 2 diabetes and neuropathy

Un bezoar es una masa o concreción de material ingerido que se acumula en el estómago, desde donde puede pasar al resto del tracto intestinal. Son poco frecuentes, siendo el más común el fitobezoar. Éste se ha relacionado con la cirugía gástrica y con procesos que alteran la motilidad intestinal, como la gastroparesia diabética o la neuropatía alcohólica. En la mayoría de los casos se descubren de forma casual, y más raramente por la presencia de complicaciones asociadas. Presentamos el caso de un paciente con antecedentes de diabetes tipo 2 e ingesta crónica de alcohol, que presentó un cuadro obstructivo intestinal agudo causado por dos bezoares(AU)

A bezoar is a mass or concretion of ingested material which accumulates in the stomach, from it can progress into the rest of gastrointestinal tract. Bezoars are unusual, being the phytobezoar the most common. Phytobezoar shave been associated with gastric surgery and other pathologies that can alter intestinal motility, as diabetes gastroparesis or alcoholic neuropathy. In most cases they are found incidentally or, more rarely, they are discovered by associated complications. We report the case of a patient with type 2 diabetes and chronic alcoholism that presented an acute intestinal obstruction caused by two bezoars(AU)

Diagnóstico diferencial entre osteomielitis de pie y artropatía de Charcot aguda / Differential diagnosis between foot osteomyelitis and acute Charcot arthropathy

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Serum albumin as indicator of clinical evolution in patients on parenteral nutrition. Multivariate study.

BACKGROUND AND AIMS: The aim of this study is to establish whether serum albumin concentration at the beginning of parenteral nutrition is related to morbidity and mortality. METHODS: In this cohort study spanning four years, a number of patients were classified into twelve groups, depending on their clinical status at the beginning of parenteral nutrition. Their serum albumin concentration and other clinical parameters were then measured and twelve multiple logistic regression models were thus generated in order to model the relationship between initial albumin concentration and risk of morbidity/mortality. RESULTS: 1953 (84%) of the 2321 patients studied were hypoalbuminemic. In six models, this condition was associated with a significant increase in the risk of nosocomial infection. However, no model could be associated to significant risk of renal failure, and only patients with previous hepatopathy were at risk for hepatic failure. In seven models, there was a significant increase in mortality. CONCLUSIONS: Serum albumin concentration at the beginning of parenteral nutrition is related to mortality and morbidity associated with nosocomial infection in some groups of the study.

[Remission of invasive sinusal and pulmonary aspergillosis with liposomal amphotericin B in a patient with chronic lymphatic leukemia following failure with conventional amphotericin]. / Resolución de una aspergilosis invasiva sinusal y pulmonar con anfotericina B liposómica en un paciente con leucemia linfática crónica tras fracaso de la anfotericina convencional.

Invasive aspergillosis is a severe complication in the immunocompromised patient. Despite antifungal treatment the mortality rate is higher than 90% if the immunity deficiency is not corrected. The use and dosage of conventional amphotericin B (deoxycholate-suspended formulation) is limited by its toxicity, especially nephrotoxicity. To reduce these untoward effects, amphotericin B has been formulated in liposomes. Better tolerance and lower nephrotoxicity in the liposomal formulations allow higher doses to be given safely, even in the presence of renal failure. Liposomal encapsulated amphotericin B (LAmB) is a safe and effective alternative to conventional formulations for antifungal therapy. We present a case of a 60-year-old man affected by chronic lymphocytic leukaemia. In the course of his disease and after chemotherapy treatment, he presented an invasive aspergillosis of the lung and paransal sinuses. The rhino-sinusal lesion had progressed despite surgical debridement and treatment with amphotericin B in a dosage of 50 mg per day. Moreover, renal impairment caused by conventional amphotericin was detected. Then, LAmB was started at a dose of 150 mg per day. Treatment with LAmB has resulted in clinical recovery and radiologic ressolution.