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This work evaluates the effect of agricultural plastic waste (APW) in two particle sizes, microplastic and film debris, and subjected to a pre-treatment by exposure to UV-C, in the development of the vermicomposting process. Eisenia fetida health status and metabolic response and the vermicompost quality and enzymatic activity were determined. The environmental significant of this study is mainly related to how can affect plastic presence (depending on plastic type, size and/or if it is partially degraded) not only to this biological process of organic waste degradation, but also to the vermicompost characteristics, since these organic materials will be reintroduced in the environment as organic amendments and/or fertilizers in agriculture. The plastic presence induced a significant negative effect in survival and body weight of E. fetida with an average decrease of 10% and 15%, respectively, and differences on the characteristics of the vermicomposts obtained, mainly related with NPK content. Although the plastic proportion tested (1.25% f. w.) did not induce acute toxicity in worms, effects of oxidative stress were found. Thus, the exposure of E. fetida to AWP with smaller size or pre-treated with UV seemed to induce a biochemical response, but the mechanism of oxidative stress response did not seem to be dependent on the size or shape of plastic fragments or pre-treated plastic.
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Estiércol , Oligoquetos , Animales , Microplásticos/metabolismo , Oligoquetos/metabolismo , Plásticos/toxicidad , Plásticos/metabolismo , Suelo/química , AgriculturaRESUMEN
OBJECTIVE: Healthcare systems have been put under intense pressure by the COVID-19 pandemic, although some studies have shown a decline in hospital admissions for cardiovascular and cerebrovascular diseases during the first and second wave of the pandemic. In addition, studies analyzing gender and procedural differences are scarce. The present study aimed to determine the impact of the pandemic on hospital admissions for acute myocardial infarction (AMI) and cerebrovascular disease (CVD) in Andalusia (Spain) and analyzed differences by gender and by percutaneous coronary interventions performed. PATIENTS AND METHODS: An interrupted time series analysis of AMI and CVD hospital admissions in Andalusia (Spain) was carried out to measure the impact of the COVID-19 outbreak. AMI and CVD cases admitted daily in public hospitals of Andalusia between January 2018 and December 2020 were included. RESULTS: During the pandemic, significant reductions in AMI [-19%; 95% confidence interval (CI): (-29%, -9%), p<0.001] and CVD [-17%; 95% CI: (-26%, -9%); p<0.01] in daily hospital admissions were observed. Differences were also produced according to the diagnosis (ST-Elevation Myocardial Infarction, Non-ST-Elevation Myocardial Infarction, other AMI and stroke), with a greater reduction in females for AMI and in males for CVD. Although there were more percutaneous coronary interventions during the pandemic, no significant reductions were observed. CONCLUSIONS: A decline in AMI and CVD daily hospital admissions during the first and second wave of COVID-19 pandemic was noted. Gender differences were observed, but no clear impact was observed in percutaneous interventions.
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COVID-19 , Infarto del Miocardio , Intervención Coronaria Percutánea , Accidente Cerebrovascular , Masculino , Femenino , Humanos , COVID-19/epidemiología , Vasos Coronarios , Análisis de Series de Tiempo Interrumpido , España/epidemiología , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/diagnósticoRESUMEN
La dispensación es el servicio más demandado e importante dentro de las labores que realiza el farmacéutico, en su día a día, en la farmacia comunitaria. El objetivo de la dispensación es garantizar el acceso del paciente al medicamento de manera adecuada y controlada. En dicho proceso, el farmacéutico comunitario tiene la obligación, como profesional de la salud, de participar de forma activa y comprometida en la detección de posibles errores de medicación o relacionados con la misma. El Grupo de Trabajo de Seguridad del Paciente de SEFAC ha elaborado, como comienzo de una serie de futuros proyectos, unos listados de verificación y decálogos de buenas prácticas sobre medicamentos formulados en forma de parches transdérmicos, comprimidos bucodispersables o formas de liberación modificada. Con esta iniciativa se pretende, mediante una entrevista previa con el paciente y el uso de estas herramientas, minimizar en la medida de lo posible, los errores o problemas que puedan surgir con dichos medicamentos velando finalmente por la seguridad del paciente. A lo largo del 2023 se espera comenzar un pilotaje en farmacias comunitarias colaboradoras con el Grupo de Trabajo de Seguridad del paciente de SEFAC y así poder recoger y notificar los resultados que se obtengan (AU)
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Humanos , Seguridad del Paciente , Errores de Medicación/prevención & control , Servicios Comunitarios de Farmacia , Lista de Verificación , Optimización de ProcesosRESUMEN
Although the use of composts derived from anaerobic digestates as soil amendments is likely to increase in the future, there is little information concerning the fate of their C and N compounds after their incorporation into soil. This work assesses C and N concentrations and the associated changes in δ15N and δ13C during the composting processes of cattle and pig slurry anaerobic digestates. In addition, the compost effect on C and N fractions and plant uptake were studied during a six-month pot experiment with rosemary plants. The results did not show δ13C and δ15N isotopic discrimination during composting, indicating a previous stabilization of cattle manure and pig slurry during the anaerobic digestion. This fact was also confirmed by the low C losses during the composting processes (1.2-fold and 1.05-fold for the composting piles with cattle and pig slurry anaerobic digestates, respectively). After soil addition, the composts augmented N values (from 0.41 g kg-1 to around 0.56 g kg-1 in low dose and 0.68 g kg-1 in high dose compost amended soils) and δ15N soil values (increases in the range of 50%-156%), but showed only slight differences in C and δ13C values compared to unfertilised control and inorganic fertilized soils. Moreover, the rosemary leaves of the plants grown on the compost amended soils presented higher N and δ15N abundance than control and inorganic fertilized plants. We conclude that δ15N abundance of anaerobic digestate composts is useful to discern its N uptake and could thus be a useful tool to detect whether organic or mineral fertiliser types were used for agricultural production.
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Compostaje , Suelo , Porcinos , Animales , Bovinos , Anaerobiosis , Agricultura/métodos , EstiércolRESUMEN
Olive mill wastewater (OMW) resulting from the olive oil extraction process is usually disposed of in evaporation ponds where it concentrates generating a sludge that pollutes the ponds nearby area. In this study, four bio-treatments were applied for the in-situ bioremediation and valorization of OMW sludge: Landfarming, phytoremediation, composting and vermicomposting. In all cases, the OMW sludge was added with organic residues (mushroom compost, rabbit manure, and chicken manure). The bio-treatments were carried out in duplicate, inoculated and non-inoculated, to determine the effect of a specialized fungal consortium (Aspergillus ochraceus H2 and Scedosporium apiospermum H16) on the efficacy of the bio-treatments. The evaluation of chemical parameters, toxicity, and functional microbial biodiversity revealed that the four techniques depleted the toxicity and favored the stimulation of functional microbiota. Landfarming and phytoremediation allowed the decontamination and improvement of soils. Composting and vermicomposting also offered high-quality products of agronomic interest. Inoculation improved the bioremediation effectiveness. Biological treatments are effective for the safe recovery of contaminated OMW sludge into high-quality services and products.
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Olea , Aguas del Alcantarillado , Animales , Residuos Industriales/análisis , Estiércol , Olea/química , Aceite de Oliva , Estanques , Conejos , Aguas del Alcantarillado/microbiología , Eliminación de Residuos Líquidos/métodos , Aguas ResidualesRESUMEN
The agri-food industry is at the centre of the circular economy, since the co-composting of its residual flows allows their management and adds value producing fertilisers. In this work, six composting piles were prepared combining agri-food sludge (AS), different fresh vegetable wastes (pepper waste (P), tomato waste (T), and leek waste (L), and, as bulking agents, vine shoot pruning (VS), garlic stalks (GS) and avocado leaves (AL)). Classical physico-chemical and chemical determinations and advanced instrumental methods (excitation-emission fluorescence (EEM) and gravimetric (TG, DTG and DTA) techniques) were used and compared to assess organic matter evolution and evaluate the quality of the composts obtained. The thermal profiles of the composting processes were viable to show the stabilization of the agri-food sludge with the different materials tested in the mixtures, reaching adequate levels of stabilization of organic matter. Preferential degradation of peptides and proteins was observed by fluorescence. This seemed to induce a limitation in the biodegradation of the remaining organic matter, indicating that these biomolecules are key in composting dynamics, acting as limiting components during the process. The results from thermogravimetric analysis indicated the degradation of labile compounds (e.g., carbohydrates and proteins), the most recalcitrant material becoming predominant at the maturity stage of the composting process. The rise in the thermogravimetric parameter R2 was associated with the increase in the concentration of more refracting compounds, which need more energy for their decomposition.
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Compostaje , Fertilizantes , Residuos Industriales/análisis , Péptidos , SueloRESUMEN
El empiema pleural es una infección localizada en la que se produce acumulación de pus en el espacio pleural. La mayoría de los empiemas se deben a una infección pleural consecutiva a neumonía, pero con frecuencia un derrame no infeccioso puede contaminarse por una ejecución no adecuada de los procedimientos y una técnica no estéril durante una punción o drenaje quirúrgico. El empiema pleural debido a la bacteriemia por Salmonella spp. no tifoidea, es una infección localizada rara que generalmente se asocia con inmunodeficiencia subyacente, anemia de células falciformes, enfermedad pulmonar o pleural previa, y cáncer de pulmón. Se presenta el caso de un varón de 76 años de edad que al poco tiempo de practicarle una biopsia renal, comienza con regular estado general, dificultad respiratoria y fiebre, diagnosticándose empiema pleural por Salmonella spp. La mayoría de los casos descritos de empiema pleural por Salmonella spp, son en pacientes con inmunidad comprometida, factores predisponentes o enfermedad pleuropulmonar previa, siendo raros los casos en pacientes no inmunocomprometidos o en pacientes que carecen de otros factores de riesgo conocidos. (AU)
Pleural empyema is a localized infection with collection of pus in the pleural space. Most empyema is due to a pleural infection secondary to pneumonia, but often a non-infectious effusion can be contaminated by poor performance of the procedures and a non-sterile technique during a surgical puncture or drainage. Pleural empyema due to nontyphoidal Salmonella spp. bacteremia is a rare localized infection that is usually associated with underlying immunodeficiency, sickle cell anemia, previous lung or pleural disease, and lung cancer. We present the case of a 76-year-old man who, shortly after performing a renal biopsy, he started with worsening overall status, respiratory distress and fever, so the patient was diagnosed with pleural empyema due to Salmonella spp. Most of cases described of pleural empyema due to Salmonella spp. are in immunocompromised patients, predisposing factors or previous pleuropulmonary disease, with rare cases in non-immunocompromised patients or patients lacking other known risk factors. (AU)
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Humanos , Masculino , Anciano , Drenaje , Empiema Pleural , SalmonellaRESUMEN
During the last two decades, the method most widely used to manage olive mill wastewater (OMW) derived from olive oil production has been its disposal in evaporation ponds. Long-term storage of OMW leads to the accumulation of toxic sediments (OMWS) rich in recalcitrant compounds with phytotoxic and antimicrobial properties, which limit their use for agronomic purpose. The aim of this study was to compare the effect of two in situ bioremediation strategies (composting and a combination of composting followed by vermicomposting) to remove the potential toxicity of the sediments derived from long-term stored OMW. The results obtained showed that the composting method assisted with the earthworms enhanced the depletion of phenolic compounds and OMWS ecotoxicity more than composting, especially during the maturation stage. Moreover, vermicomposting was more effective in the reduction of the OMWS salinity. However, a pre-composting process to the OMWS is necessary prior to vermicomposting to provide the suitable conditions for earthworms survival and activity. Furthermore, the final compost showed a phytostimulating effect. Therefore, these in situ bioremediation strategies can be considered potential tools for decontamination and recovery of long-term stored OMWS in evaporation ponds, which currently poses an unsolved environmental problem.
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Compostaje , Olea , Biodegradación Ambiental , Residuos Industriales/análisis , Aceite de Oliva , Estanques , Eliminación de Residuos Líquidos , Aguas ResidualesRESUMEN
Dalbavancina es un agente antibacteriano perteneciente al grupo de los lipoglicopéptidos semisintéticos de larga vida media, con gran actividad sobre microorganismos grampositivos y con un perfil de efectos adversos aceptable. Hasta la fecha, ha sido autorizada para el tratamiento de infecciones de piel y tejidos blandos en adultos, sin indicación en infecciones de hueso y articulaciones.La mayoría de los casos de infección protésica articular descritos en la literatura con dalbavancina en tratamiento prolongado, han sido durante un periodo no superior a 4 semanas.Se describen una serie de casos de infección osteoarticular de material protésico tratados de forma prolongada y como rescate con dalbavancina. (AU)
Dalbavancin is an antibacterial agent that belongs to the group of semi-synthetic lipoglicopeptides of long half-life, with great activity in gram-positive microorganisms and with an acceptable adverse effects profile. To date, it has been authorized for the treatment of skin and soft tissue infections in adults, with no indication of bone and joint infections.Most cases of joint prosthetic infection described in the literature with dalbavancin in prolonged treatment have been for a period not exceeding 4 weeks.A series of cases of prosthetic joint infection treated for a long time and as salvage with dalbavancin are described. (AU)
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Humanos , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/terapia , Prótesis Articulares , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , StaphylococcusAsunto(s)
Antibacterianos/uso terapéutico , Linezolid/uso terapéutico , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Teicoplanina/análogos & derivados , Adulto , Desbridamiento , Quimioterapia Combinada , Femenino , Prótesis de Cadera/microbiología , Humanos , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/cirugía , Reoperación , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/cirugía , Staphylococcus epidermidis/aislamiento & purificación , Teicoplanina/uso terapéuticoRESUMEN
Survival models have been extensively used to analyse time-until-event data. There is a range of extended models that incorporate different aspects, such as overdispersion/frailty, mixtures, and flexible response functions through semi-parametric models. In this work, we show how a useful tool to assess goodness-of-fit, the half-normal plot of residuals with a simulated envelope, implemented in the hnp package in R, can be used on a location-scale modelling context. We fitted a range of survival models to time-until-event data, where the event was an insect predator attacking a larva in a biological control experiment. We started with the Weibull model and then fitted the exponentiated-Weibull location-scale model with regressors both for the location and scale parameters. We performed variable selection for each model and, by producing half-normal plots with simulated envelopes for the deviance residuals of the model fits, we found that the exponentiated-Weibull fitted the data better. We then included a random effect in the exponentiated-Weibull model to accommodate correlated observations. Finally, we discuss possible implications of the results found in the case study.
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The objective of this work was to study the possibilities to manage and recycle dog faeces (DF) using biological processes, using two approaches: composting (C) and anaerobic digestion (AD). Thus, different experiments have been carried out: i) two laboratory/pilot scale experiments (self-heating and composting tests) and one, on a commercial scale; ii) two AD experiments. In both approaches, municipal waste such as the organic fraction of municipal solid waste (OMSW) and urban pruning waste (GW) were used as co-substrates. The results obtained regarding the optimization of the composting process indicated that the best strategy was the use of a 1:2 ratio of DF, a 1:4 ratio of OMSW, and a 1:4 ratio of GW, according to the thermal parameters studied (temperature and cumulative quadratic exothermic index (EXI2)), and the quality of the compost obtained. A potentially limiting factor of the process was the high salinity of the DF waste. In addition, AD experiments were performed on DF, OMSW, and GW wastes in controlled anaerobic systems at a laboratory scale. In these experiments, the biogas production obtained was 229â¯mL biogas/g total solids for the DF residue, 248â¯mL biogas/g total solids for GW, and 263â¯mL biogas/g total solids for OMSW. The co-digestion yields a clear improvement in the efficiency of the process against the use of a single residue, increasing the production of biogas by up to 27% with respect to that of the DF waste alone during the first 25 days of AD. The results obtained with these procedures have shown the possibilities to add value to this waste in an urban context where the circular economy represents an increasingly favourable scenario, including the generation of fertilisers and/or energy at a local scale, provided that the collection of dog faeces is optimized.
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Compostaje , Eliminación de Residuos , Anaerobiosis , Animales , Biocombustibles , Reactores Biológicos , Perros , Heces , Metano , Residuos SólidosRESUMEN
The aim of this study was to evaluate the effect of considering different composting times on compost quality before the end of the bio-oxidative phase and after the maturation and storage phases. This study may provide useful information to optimize the composting process and increase the economic feasibility of the technology and its adoption without decreasing the quality of the end-product. In this study, three composts were prepared using chicken meat processing wastes mixed with urban tree trimmings, serving as a bulking agent, to evaluate the effect of reducing the durations of the bio-oxidative phase and the maturity stage on the different physico-chemical properties. Specifically, we evaluate water-soluble organic matter transformations by using excitation-emission matrix (EEM) fluorescence spectroscopy. The obtained results have shown that a composting time of 35â¯days combined with eight turnings was efficient for achieving the standard process control parameters for agro-industrial waste composting in the studied conditions and allowed for the production of stable and mature compost that is suitable for agricultural use.
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Compostaje , Agricultura , Animales , Pollos , Residuos Industriales , SueloRESUMEN
In the Mediterranean countries, there is an increasing production of date palm wastes (Phoenix dactylifera L.), not only due to the raising production of date palm fruits, but also derived from the maintenance of urban and peri-urban green areas, especially in those affected by red palm weevil (Rhynchophorus ferrugineus). The management of this increasing volume of green wastes usually concludes with a controlled disposal that implies an important loss of resources, in terms of organic matter, nutrients and energy. In addition, the rise of wastewater generation and the incentive of the wastewater treatment processes have derived in an increase of the amount of the sludge produced, which makes difficult its management. This work studies the feasibility of co-composting palm wastes with sludge from the urban and agri-food sectors as alternative treatment to manage these organic waste streams and to obtain added-value compost. For this, four mixtures (P1, P2, P3 and P4) were prepared using as main component palm leave waste (PL) mixed with different types of sludge. In the piles P1, P2 and P3, sewage sludge (SS) was used as co-composting agent, while agri-food sludge (AS) was used in P4. Throughout composting, the thermal profile of the composting piles was assessed, as were physical, chemical, physico-chemical and maturity parameters. In addition, the changes in water-soluble organic matter were assessed using chemical analytical methods and the excitation-emission matrix (EEM) fluorescence spectroscopy. The results obtained showed the viability of the co-composting process to obtain end-products with adequate maturity degree and physical characteristics for their potential use as substrates, except for the salt contents that can limit their use in some agricultural sectors.
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Compostaje , Phoeniceae , Aguas del Alcantarillado , Agricultura , Biomasa , SueloRESUMEN
Gas-permeable membranes coupled with low-rate aeration is useful to recover ammonia (NH4+) from livestock effluents. In this study, the role of inorganic carbon (bicarbonate, HCO3-) to enhance the N recovery process was evaluated using synthetic effluents with various NH4+ to HCO3- molar ratios of 0.5, 1.0, 1.5 and 2.0. The study also evaluated the effect of increased organic matter on the NH4+ recovery using humic acids (3000-6000â¯mgâ¯L-1), and the N recovery from high-strength swine manure. The release of hydroxide from the HCO3- with aeration increased the wastewater pH and promoted gaseous ammonia formation and membrane uptake. At the same time, the recovery of gaseous ammonia (NH3) through the membrane acidified the wastewater. Therefore, an abundant inorganic carbon supply in balance with the NH4+ is needed for a successful operation of the technology. NH4+ removal efficiencies >96% were obtained with NH4+ to HCO3- ratios ≤1. However, higher molar ratios inhibited the N recovery process resulting in lower efficiencies (<65%). Fortunately, most swine manures contain ample supply of endogenous inorganic carbon and the process can be used to more economically recover the ammonia using the natural inorganic carbon instead of expensive alkali chemicals. In 4 days, the recovered NH4+ from swine manure contained 48,000â¯mgâ¯L-1. Finally, it was found the process was not inhibited by the increasing levels of organic matter in the wastewater evaluated.
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Nitrógeno/química , Eliminación de Residuos Líquidos/métodos , Aguas Residuales/química , Amoníaco/química , Animales , Carbono/química , Estiércol , Membranas Artificiales , PorcinosRESUMEN
The banana moth Opogona sacchari (Bojer) (Lepidoptera: Tineidae) is a polyphagous pest that can cause serious damage, in particular to banana crops in southern Brazil. The insect is a quarantine pest in several countries, including Argentina, the main consumer market for bananas from southern Brazil. Little information is available about the biology and ecology of this moth, such as a suitable diet for laboratory rearing. In order to provide support for integrated pest management of the pest, this study furnished data for selecting two diets suitable for continuous laboratory rearing of O. sacchari, one based on dried beans, wheat germ, soy bran, brewer's yeast, and casein and another diet with wheat germ and casein as protein sources. With both diets, the viability of the egg-adult period exceeded 68%, with fertility over 338 eggs per female. A corrected biotic potential analysis gave similar values for the two diets.
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Alimentación Animal , Entomología/métodos , Mariposas Nocturnas/crecimiento & desarrollo , Animales , Caseínas , Fabaceae , Femenino , Larva/crecimiento & desarrollo , Saccharomyces cerevisiae , Glycine max , TriticumRESUMEN
This work evaluates several co-composting scenarios based on the use of Arundo donax biomass (AD) as bulking agent for the co-composting of sewage sludge (MS) and agri-food sludge (AS), to manage these organic wastes and to produce balanced organic fertilizers by optimizing the process. For this, six piles were prepared in commercial composting conditions, using AD in a range of 40%-80% (on a dry weight basis). Physico-chemical and chemical parameters and the thermal behaviour were evaluated during the process, as were the physical and chemical parameters of the final composts. The proportion of AD in the mixtures has a significant effect on the development of the thermophilic stage of composting, showing the piles with higher proportion of AD a quicker organic matter degradation. In addition, the evolution of the thermal indices R1 and R2 was different depending on the origin of the sludge used, indicating an increase in the relative concentration of more recalcitrant materials in the piles prepared with AS. The estimation of the global warming potential showed that the use of higher proportion of AD in the composting mixture may be a strategy to mitigate the emission of greenhouse gases during the composting process. Moreover, the end-products obtained had an additional marketable value, with a balanced nutrient content and a good degree of maturity, which indicates the viability of the composting process as a method for the stabilization of these organic wastes.
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Dermatología , Enfermedades de la Piel/psicología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
One method for controlling the Asian citrus psyllid (ACP) Diaphorina citri Kuwayama, the vector of the putative causal agent of Huanglongbing, uses the parasitoid Tamarixia radiata (Waterston). However, the general intensive use of insecticides has reduced the numbers of this parasitoid. This study evaluated the effect of the residual action of 24 insecticides on T. radiata and also determined the differential toxicity of insecticides to D. citri and T. radiata, using three bioassays. In the first, when adults of the parasitoid were exposed to residues of the 24 insecticides, ten were considered short-life (class 1), six slightly persistent (class 2), five moderately persistent (class 3), and three insecticides were considered persistent (class 4), under the IOBC/WPRS classification system. The second bioassay evaluated the sublethal concentrations of the persistent insecticides (formetanate, dimethoate, spinosad). Increasing the concentrations of the insecticides increased the number that were classified as persistent. In the third bioassay, evaluation of the differential toxicity of eight insecticides to the ACP and the parasitoid showed that chlorpyrifos and bifenthrin were more harmful to T. radiata. Therefore, these two insecticides are not recommended for application at the time of parasitoid release. Cypermethrin, imidacloprid, and dimethoate caused higher mortality of D. citri and are most often recommended in IPM programs. The choice of an insecticide for the control of citrus pests must be made with care, aiming to preserve the natural enemies in the ecosystem, and thereby contribute to the success of biological control.
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Hemípteros/parasitología , Himenópteros/efectos de los fármacos , Insecticidas/toxicidad , Animales , Agentes de Control Biológico , Carbamatos , Cloropirifos , Dimetoato , Neonicotinoides , Nitrocompuestos , PiretrinasRESUMEN
The use of hydroxychloroquine (HCQ) in Primary Sjögren's Syndrome (pSS) has been assessed in different studies over the last years, with conflicting results regarding its efficacy in sicca syndrome and extraglandular manifestations (EGM). The goal of this study was to compare the incidence rate of EGM in pSS patients with and without HCQ therapy.We performed a multicenter retrospective study, including patients with pSS (European classification criteria) with at least 1 year of follow-up. Subjects with concomitant fibromyalgia, autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis were excluded. Demographics and pSS characteristics were recorded. The EGM were defined by EULAR-SS disease activity index (ESSDAI). Patients were divided into two groups according to their use or not of HCQ therapy. We evaluated the use of HCQ and its relationship to EGM. HCQ therapy was defined as the continuous use of the drug for at least 3 months. A descriptive analysis of demographics and pSS characteristics was performed. We compared the incidence of EGM between groups defined by HCQ therapy using chi2 test or Fisher's exact test. A total of 221 patients were included (97.3% women), mean age, 55.7 years (SD 14). Mean age at diagnosis, 48.8 years (SD 15); median disease duration, 60 months (IQR 35-84). One hundred and seventy patients (77%) received HCQ. About half of the patients had at least one EGM during the course of the disease, 20% of them developed an EGM before the onset of the sicca syndrome and 26% simultaneously with dryness symptom. Overall, EGM were less frequent in those on HCQ therapy (36.5% vs 63.5%, p < 0.001). Considering each EGM individually, the following manifestations were more frequent in the non-treated group: arthritis (p < 0.001), fatigue (p < 0.001), purpura (p = 0.01), Raynaud phenomenon (p = 0.003), and hypergammaglobulinemia (p = 0.006). Immunosuppressive treatment was indicated on 28 patients (12.7%), 13 of which were receiving also HCQ. The first reason for those treatments was the presence of arthritis in 12/28 patients (42.8%), and the drug used in all the cases was methotrexate. Only three patients required immunosuppressive therapy with cyclophosphamide, due to the presence of glomerulonephritis, vasculitis, and interstitial lung disease. None of the patients received biologic therapy. The lower incidence of EGM was observed in patients on HCQ therapy supports its efficacy in pSS. However, further large scale prospective studies are needed to confirm these findings.