Lipophilic Shellfish Poisoning Toxins in Marine Invertebrates from the Galician Coast.

For the purpose of assessing human health exposure, it is necessary to characterize the toxins present in a given area and their potential impact on commercial species. The goal of this research study was: (1) to screen the prevalence and concentrations of lipophilic toxins in nine groups of marine invertebrates in the northwest Iberian Peninsula; (2) to evaluate the validity of wild mussels (Mytilus galloprovincialis) as sentinel organisms for the toxicity in non-bivalve invertebrates from the same area. The screening of multiple lipophilic toxins in 1150 samples has allowed reporting for the first time the presence of 13-desmethyl spirolide C, pinnatoxin G, okadaic acid, and dinophysistoxins 2 in a variety of non-traditional vectors. In general, these two emerging toxins showed the highest prevalence (12.5-75%) in most of the groups studied. Maximum levels for 13-desmethyl spirolide C and pinnatoxin G were found in the bivalves Magallana gigas (21 µg kg-1) and Tellina donacina (63 µg kg-1), respectively. However, mean concentrations for the bivalve group were shallow (2-6 µg kg-1). Okadaic acid and dinophysistoxin 2 with lower prevalence (1.6-44.4%) showed, on the contrary, very high concentration values in specific species of crustaceans and polychaetes (334 and 235 µg kg--1, respectively), to which special attention should be paid. Statistical data analyses showed that mussels could be considered good biological indicators for the toxicities of certain groups in a particular area, with correlations between 0.710 (for echinoderms) and 0.838 (for crustaceans). Polychaetes could be an exception, but further extensive surveys would be needed to draw definitive conclusions.

Nefritis como debut lúpico en el embarazo: reporte de dos casos y revisión de la literatura / Nephritis as a lupic debut in pregnancy: report of two cases and review of the literature

ANTECEDENTES: El lupus eritematoso sistémico es una enfermedad autoinmunitaria multisistémica que afecta principalmente a mujeres en edad fértil. La nefritis lúpica es la manifestación clínica más frecuente durante la gestación y constituye un factor de riesgo para la pérdida del embarazo, en especial en pacientes con insuficiencia renal. Además, presenta mayor riesgo de pérdida fetal, restricción del crecimiento intrauterino e hipertensión. CASOS CLÍNICOS: El primer caso se trata de una gestante de 28 + 2 semanas con daño renal grave y anticuerpos anti-DNA en título elevado. En el segundo caso destaca el debut con sintomatología de dificultad respiratoria y edemas como manifestaciones clínicas de nefropatía lúpica tipo V a las 23 semanas de gestación. En ambas pacientes destaca la prematuridad como complicación perinatal, así como el crecimiento intrauterino retardado en el primer caso. Por último, se describen los resultados clínico-analíticos tras el inicio terapéutico específico en ambos casos. CONCLUSIONES: El diagnóstico diferencial del debut de nefritis lúpica durante la gestación continúa siendo un desafío, a pesar de los avances en cuanto a marcadores angiogénicos. La valoración clínica continúa siendo la piedra angular de este proceso diagnóstico y de sus implicaciones en cuanto a complicaciones del embarazo actuales y futuras.

BACKGROUND: Systemic lupus erythematosus is a multisystem autoimmune disease that mainly affects women of childbearing age. Lupus nephritis represents the most frequent clinical manifestation in pregnancy, constituting a risk factor for pregnancy loss, especially in patients with kidney damage. It also has a higher risk of fetal loss, intrauterine growth restriction, and gestational hypertension. CLINICAL CASES: The first case is a 28 + 2-week pregnant woman with severe kidney damage and high-titles anti-DNA antibodies. In the second case, we highlight the debut with symptoms of respiratory distress and edema as clinical manifestations of type V lupus nephropathy in a 23-week gestation. In both cases, prematurity stands out as a perinatal complication, as well as delayed intrauterine growth in the former. Finally, the clinical-analytical results are described, after the specific therapeutic initiation in both cases. CONCLUSIONS: The differential diagnosis of the onset of lupus nephritis during pregnancy continues to be a challenge, despite the advances in angiogenic markers; clinical assessment continues to be the cornerstone of this diagnostic process and its implications for current and future pregnancy complications.

Diagnóstico posnatal de hematoma de cordón umbilical: reporte de un caso / Postnatal diagnosis of umbilical cord hematoma: case report

ANTECEDENTES: El hematoma espontáneo del cordón umbilical es una complicación rara del embarazo que representa una causa grave de morbilidad y mortalidad fetal. Se han descrito numerosos factores de riesgo, pero aún se desconoce su etiología exacta. CASO CLÍNICO: Mujer de 28 años, en su octava gestación, que consultó en urgencias por disminución de los movimientos fetales de varias horas de evolución tras una caída accidental traumática. La monitorización fetal mostró un patrón cardiotocográfico no tranquilizador, con disminución de la variabilidad y sin aceleraciones. Se realizó una cesárea urgente, sin complicaciones, con el nacimiento de un varón vivo de 4560 g, con Apgar 8/10/10 y pH de sangre de cordón umbilical 7.08, que precisó ingreso en la unidad de neonatología por hallazgo de un soplo cardíaco. Tras el alumbramiento se objetivó una gran colección hemática en el cordón umbilical. MÉTODO: Se aplicó una estrategia de búsqueda sistemática en Medline, PubMed y Cochrane de todos los artículos en inglés y español que tuvieran como palabras clave "Umbilical", "Cordón" y "Hematoma". RESULTADOS: Se encontraron 13 publicaciones de 15 casos de hematoma del cordón umbilical en los años 2008-2020. Se realizó una revisión sistemática de los informes de casos descritos en los últimos 12 años en la literatura para evaluar la epidemiología, los factores predisponentes, los resultados potenciales, el diagnóstico prenatal y el manejo clínico. CONCLUSIONES: Debido a la rareza de esta afección, se deben informar todos los casos nuevos de hematoma del cordón umbilical para mejorar el conocimiento de los factores predisponentes, el diagnóstico prenatal y el manejo clínico.

BACKGROUND: Spontaneous umbilical cord hematoma is a rare complication of pregnancy which represents a serious cause of fetal morbidity and mortality. There are many risk factors, but the exact etiology is still unknown. CASE REPORT: 28-year-old woman, eighth gestation, who consulted due to decreased fetal movements of several hours of evolution after traumatic accidental fall. Fetal monitoring showed a non-reassuring cardiotocographic pattern, with decreased fetal variability, without accelerations. An emergency cesarean section was performed without complications, with the birth of a living male weighing 4560 grams, with an 8/10/10 Apgar test, and an arterial pH of the umbilical cord 7.08, which required admission to the neonatology unit. After delivery, a large blood collection was observed in the umbilical cord. METHOD: A systematic search strategy was applied to several electronic bibliographic databases: Medline, PubMed and Cochrane. Key words used were "Umbilical", "Cord", "Hematoma". RESULTS: 13 publications of 15 cases of umbilical cord hematoma were reported in the years 2008-2020. A systematic review of the reports of cases, described in the last twelve years in the literature was carried out to evaluate the epidemiology, predisposing factors, potential results, prenatal diagnosis and clinical management of this phenomenon. CONCLUSIONS: Due to the rarity of this condition, every new case of umbilical cord hematoma should be reported in order to improve the knowledge of predisposing factors, prenatal diagnosis, and clinical management.

Distribución de morfina y opioides / CURRENT STATUS AND DISTRIBUTION OF MORPHINE AND OPIOIDS

La liberación del uso terapéutico de los opioides se ha hecho cada vez mas frecuente como una propuesta para mejorar la distribución de éstos en las instituciones de salud pública y privadas con el fin de garantizar su alcance a población que cursa con dolor. A pesar de esto, aún no se logra una distribución homogénea de estos recursos en la población requirente. El objetivo de este trabajo es dar a conocer el panorama actual de los opioides en México y algunos países sudamericanos.

The release of therapeutic opioid use is mentioned with increasing frequency as a proposal to improve their tion in Public and Private Health Care Institutions, in order to scope opioids to population who needs them. Although this, homogeneous distribution of opioids is not achieved. The aim of this paper is to present the current panorama of opioids in Mexico and Latin American countries

Outcome of Recipients of Hematopoietic Stem Cell Transplants Who Require Intensive Care Unit Support: A Single Institution Experience.

Admission to the intensive care unit (ICU) of a patient who has been grafted with hematopoietic stem cells is a serious event, but the role of the ICU in this setting remains controversial. Data were analyzed from patients who underwent autologous or allogeneic bone marrow transplantation at the Centro de Hematología y Medicina Interna de Puebla, México, between May 1993 and October 2014. In total, 339 patients were grafted: 150 autografts and 189 allografts; 68 of the grafted patients (20%) were admitted to the ICU after transplantation: 27% of the allografted and 11% of the autografted patients (p = 0.2). Two of 17 autografted patients (12%) and 5 of 51 allografted patients (10%) survived. All patients who required insertion of an endotracheal tube died, whereas 7 of 11 patients without invasive mechanical ventilation survived (p = 0.001). Only 10% of the grafted patients survived their stay in the ICU; this figure is lower than those reported from other centers and may reflect several facts, varying from the quality of the ICU support to ICU admission criteria to the initial management of all the grafts in an outpatient setting, which could somehow delay the arrival of patients to the hospital.

Identification of alkyl-methoxypyrazines as the malodorous compounds in water supplies from Northwest Spain.

A study of organic compounds which caused several odor problems in water supplies from NW Spain was carried out. Sour dish-cloths, potato bin and musty were the main descriptors associated with these events. Closed loop stripping analysis combined with sensory-GC and GC/MS detection was used. The compound producing the initial odor event was 3,5-dimethyl-2-methoxypyrazine, identified for the first time as the compound responsible for odor incidents in finished water. Concentration levels were up to 300 ng/L in the effluent from an activated sludge wastewater treatment plant (WWTP) and 3 ng/L in finished water. 3-isobutyl-2-methoxypyrazine and other alkyl methoxypyrazines were the compounds responsible for the odor events that occurred several months later. Concentration levels in the mg/L range were measured in the activated sludge of a WWTP.

Infarto agudo de miocardio y gestación / Acute myocardial infarction and pregnancy

Es raro que el infarto agudo de miocardio se presente en mujeres en edad reproductiva y, por tanto, durante el embarazo. Suele conllevar un gran aumento en la mortalidad materno-fetal, ya que además del riesgo por el infarto en sí, el embarazo dificulta su diagnóstico y tratamiento. Presentamos un caso de una gestante que, desde las 5 semanas de embarazo, presentó varios episodios de infarto

Acute myocardial infarction is rare in women of reproductive age and consequently is uncommon during pregnancy. However, when this event does occur, the risk of maternal-fetal mortality is greatly increased, since, in addition to the risk posed by the myocardial infarction, pregnancy hinders diagnosis and treatment. We report the case of a pregnant women who, from week 5 of pregnancy, showed several episodes of infarction