Yessotoxins in Mollusks of the Galician Coast from 2014 to 2022: Variability, Biotransformation, and Resistance to Alkaline Hydrolysis.

The presence of yessotoxins (YTXs) was analyzed in 10,757 samples of Galician bivalves from 2014 to 2022. Only YTX and 45-OH YTX were found. YTX was detected in 31% of the samples, while 45-OH YTX was found in 11.6% of them. Among the samples containing YTX, 45-OH YTX was detected in 37.3% of cases. The maximum recorded levels were 1.4 and 0.16 mg of YTX-equivalentsg-1, for YTX and 45-OH YTX, respectively, which are well below the regulatory limit of the European Union. The YTX and 45-OH YTX toxicities in the raw extracts and extracts subjected to alkaline hydrolysis were strongly and linearly related. Due to the lack of homo-YTX in Galician samples, the effect of alkaline hydrolysis on homo-YTX and 45OH-Homo-YTX was only checked in 23 additional samples, observing no negative effect but a high correlation between raw and hydrolyzed extracts. Hydrolyzed samples can be used instead of raw ones to carry out YTXs determinations in monitoring systems, which may increase the efficiency of those systems where okadaic acid episodes are very frequent and therefore a higher number of hydrolyzed samples are routinely analyzed. The presence of YTX in the studied bivalves varied with the species, with mussels and cockles having the highest percentages of YTX-detected samples. The presence of 45-OH YTX was clearly related to YTX and was detected only in mussels and cockles. Wild populations of mussels contained proportionally more 45-OH YTX than those that were raft-cultured. Spatially, toxin toxicities varied across the sampling area, with higher levels in raft-cultured mussels except those of Ría de Arousa. Ría de Ares (ARE) was the most affected geographical area, although in other northern locations, lower toxin levels were detected. Seasonally, YTX and 45-OH YTX toxicities showed similar patterns, with higher levels in late summer and autumn but lower toxicities of the 45-OH toxin in August. The relationship between the two toxins also varied seasonally, in general with a minimum proportion of 45-OH YTX in July-August but with different maximum levels for raft-cultured and wild mussel populations. Interannually, the average toxicities of YTX decreased from 2014 to 2017 and newly increased from 2018 to 2021, but decreased slightly in 2022. The relationship between 45-OH YTX and YTX also varied over the years, but neither a clear trend nor a similar trend for wild and raft mussels was observed.

Jóvenes y educación superior en el Cono Sur de América

(analítico) Con la finalidad de conocer la experiencia de ser joven hoy en la educación superior en Argentina, Chile o Uruguay, se realiza un análisis temático a 54 artículos de los últimos tres años en WoS, Scopus y Scielo. Por intermedio de un trabajo inductivo y reflexivo, se identifican patrones comunes en las fuentes de análisis, que permiten identificar siete temas que dan cuenta de una transición: ampliación de cobertura, pero sin inclusión; facilidad al ingreso, pero con incertidumbre al egreso; cambios en los roles de género, pero manteniéndose el machismo; valoración de la salud, pero con conductas de riesgo; preocupación por los otros, pero con individualismo; valoración del movimiento estudiantil, pero con cambios en sus manifestaciones y tránsito de lo presencial a lo virtual, acelerado por covid-19.

(analytical) In order to know the experience of being young today in higher education in Argentina, Chile or Uruguay, a Thematic Analysis is carried out on 54 articles from the last three years in WoS, Scopus and Scielo. Through inductive and reflective work, common patterns are identified in the sources of analysis, which allow the identification of seven themes that account for a transition: expansion of coverage, but without inclusion; ease upon admission, but with uncertainty upon discharge; changes in gender roles, but maintaining machismo; health assessment, but with risk behaviors; concern for others, but with individualism; appreciation of the student movement, but with changes in its manifestations and transition from face-to-face to virtual, accelerated by COVID-19.

(analítico) Para conhecer a experiência de ser jovem hoje na educação superior na Argentina, Chile ou Uruguai, realiza-se uma Análise Temática de 54 artigos dos últimos três anos em WoS, Scopus e Scielo. Através de um trabalho indutivo e reflexivo, identificam-se padrões comuns nas fontes de análise, que permitem identificar sete temas que dão conta de uma transição: ampliação da cobertura, mas sem inclusão; facilidade na admissão, mas com incerteza na alta; mudanças nos papéis de gênero, mas mantendo o machismo; avaliação de saúde, mas com comportamentos de risco; preocupação com os outros, mas com individualismo; valorização do movimento estudantil, mas com mudanças em suas manifestações e transição do presencial para o virtual, acelerada pela Covid-19.

Influence of an armrest support on handgrip strength in different arm and shoulder flexion angles in overhead postures.

A study was undertaken in which the handgrip strength in three arm positions above the shoulder was measured to compare handgrip strength when arm support is used and when it is not used. Grip forces were generated in pairs of flexion angles, corresponding to shoulder and elbow at 90°-90°, 135°-45° and 160°-20°. Thirty-two participants completed the present study; 23 men and nine women with a median age of 23.1 (SD ±3.6) years. A manual handgrip dynamometer (0-90 kg) and an adjustable angle arm support (AAAS) were used during the data collection. Two-way analysis of variance (ANOVA) for repeated measurements indicates a significant effect of the AAAS factor on the handgrip strength, as well as on the AAAS × angle interaction. However, there is no significant effect of the angle factor on the AAAS × angle interaction.

Twenty-Five Years of PSP Toxicity in Galician (NW Spain) Bivalves: Spatial, Temporal, and Interspecific Variations.

Twenty-five years of paralytic shellfish poisoning (PSP) toxicity in Galician bivalves have been studied. PSP was detected in 4785 out of 73,740 samples of the commercially important bivalve species analyzed from 1995 to 2020. Its general prevalence in the area was 6.5%. Only 1.6% of all samples tested were over the regulatory limit (incidence). The maximum level of PSP in the area, 40,800 µg STX 2HCl-eq kg-1, was recorded in raft mussels from Bueu (PON-II, Pontevedra) in December 2005. The highest maximum PSP values were found in mussels, which were mostly affected by Gymnodinium catenatum, but not those of prevalence and incidence which were recorded in clams, mostly affected by Alexandrium. Average levels in mussels were higher than in any other studied species. Spatially, in general, the prevalence, incidence, maximum, and average PSP toxicity during episodes tend to decrease from south to northeast, but some hot points with high levels can be identified. PCA analysis separates the southern rías, associated to G. catenatum blooms, from the middle and northern ones, associated to Alexandrium blooms. Along the year, two main peaks of the four variables are observed, the first one in late autumn-winter and the other in summer, the summer peak being much more important for the infaunal species than for raft mussels. In the seasonal pattern obtained by time series analysis of the average PSP toxicity, the autumn-winter peak was only maintained (and very reduced) in the southern rías, indicating that this peak is seasonally much less important than the summer peak. The observed seasonality is expected based on the timing of the blooms of the two PSP-producing phytoplankton groups present in the area. Over the 25 years of monitoring, large differences in PSP toxicity have been observed. Apart from some special years, an ascending trend in prevalence and incidence seems to be present from 2011 to 2020. No trend seems to exist during the same period for average or maximum toxicity.

Neurosífilis con neuropatía óptica y auditiva simultáneas en un paciente VIH positivo / Neurosyphilis with simultaneous optic and auditive involvement in an HIV-positive patient

Introducción: a partir del año 2000, los médicos han asistido a un retorno de la sífilis vinculado a prácticas sexuales no protegidas y con parejas múltiples, en especial entre hombres que tienen sexo con hombres. La coinfección Treponema pallidum/virus de la inmunodeficiencia humana (VIH) modifica tanto la historia natural de la sífilis, incrementando la incidencia de neurosífilis temprana, como la respuesta al tratamiento con penicilina. Métodos: un paciente varón, peruano, de 36 años, seropositivo para VIH, consulta por dis-minución de la agudeza visual en ojo derecho, pérdida de la audición, tinnitus, mareos y vértigo. Refería antecedentes de sífilis en los 2 años previos. Resultados: el examen oftalmológico efectuado al paciente mostró células en el segmento anterior del ojo derecho. El fondo de ojo reveló la existencia de inflamación del nervio óptico asociada con panuveítis. En base a los hallazgos clínicos, los valores de VDRL en suero y líquido cefalorraquídeo (LCR) se diagnosticó neurosífilis (NS) con neuritis óptica, panuveítis y otosífilis en un paciente coinfectado por VIH. El paciente fue tratado con penicilina G sódica intravenosa, 4 millones de UI cada 4 horas, durante 2 semanas con buena respuesta clínica. Discusión: el compromiso de los pares craneales óptico y auditivo puede representar la manifestación de una NS temprana, en especial, en el contexto de un paciente VIH positivo. De acuerdo con nuestro conocimiento, este sería el segundo caso publicado de compromiso simultáneo del nervio óptico y del aparato vestíbulo-coclear en un paciente con NS.

Introduction: from the 2000s, the physicians experienced a return of syphilis, which may be related to unrestricted sexual behaviour with unprotected contact between multiple partners, especially in men who have sex with men. Concurrent infection with human immunodeficiency virus (HIV) alters the natural history of syphilis by increasing the frequency of early neurosyphilis and the response to penicillin. Methods: a 36-year-old Peruvian man, seropositive for HIV infection, was admitted to the hospital with decreased visual acuity in his right eye, hearing loss, tinnitus, buzzing, and vertigo. He referred history of syphilis in the previous two years. Results: oph-thalmological examination was performed. Ocular anterior segment examination of the right eye showed cells. Fundoscopy revealed swelling of the right optic disc with panuveitis. Diagnosis of neurosyphilis (NS) with optic and ear neuritis, and concurrent HIV infection was made, based on the clinical manifestations and serum and cerebrospinal VDRL titers. The patient was treated with intravenous penicillin (four million units every four hours for two weeks) with an excellent clinical response. Discussion: simultaneous optic and auditive cranial nerve involvement can manifest early neurosyphilis (NS) and HIV coinfection. This is the second report to describe the simultaneous occurrence of syphilitic optic neuritis with vestibulocochlear nerve involvement.

Spirolides in Bivalve Mollusk of the Galician (NW Spain) Coast: Interspecific, Spatial, Temporal Variation and Presence of an Isomer of 13-Desmethyl Spirolide C.

Spirolides are cyclic imines whose risks to human health have not been sufficiently evaluated. To determine the possible impact of these compounds in Galicia (NW Spain), their presence and concentration in bivalve mollusk were studied from 2014 to 2021. Only 13-desmethyl spirolide C (13desmSPXC) and an isomer have been detected, and always at low concentrations. Mussel, Mytilus galloprovincialis, was the species which accumulated more spirolides, but the presence of its isomer was nearly restricted to cockle, Cerastoderma edule, and two clam species, Venerupis corrugata and Polititapes rhomboides. On average, the highest 13desmSPXC levels were found in autumn-winter, while those of its isomer were recorded in spring-summer. Both compounds showed decreasing trends during the study period. Geographically, the concentration tends to decrease from the southern to the north-eastern locations, but temporal variability predominates over spatial variability.

Ramsay-Hunt syndrome: Report of two cases with identification of the varicella zoster virus genome in cerebrospinal fluid / Síndrome de Ramsay-Hunt: a propósito de dos casos en que se identificó el genoma del virus de la varicela-zóster en líquido cefalorraquídeo

Like other alpha-herpesviruses, the varicella-zoster virus (VZV) remains latent in the neural ganglia following the primary varicella infection. The reactivation of the VZV in the dorsal root ganglia results in herpes zoster. Herpes zoster eruption is characterized by localized cutaneous lesions and neuralgic pain mostly in older and immunocompromised persons, especially those living with the human immunodeficiency virus (HIV). The most commonly reported complications include VZV pneumonia, meningitis, encephalitis, and hepatitis. Several neurologic syndromes have been described associated with herpes zoster localized in cranial areas including peripheral nerve palsies and the Ramsay-Hunt syndrome, which has a varied clinical presentation and is the second most common cause of peripheral facial paralysis. Facial paralysis in this syndrome occurs in 60 to 90% of cases and it may precede or appear after the cutaneous lesions with a worse prognosis than idiopathic Bell paralysis. Here we present two cases of herpes zoster from the geniculate ganglia with peripheral facial paralysis that appeared simultaneously with vesicular herpetic otic lesions (multimetameric Ramsay-Hunt syndrome). In the two cases, amplifiable varicella-zoster viral DNA was found in the cerebrospinal fluid by RT-PCR Multiplex.

Como los otros herpesvirus alfa, el virus de la varicela-zóster (VZV) permanece en estado de latencia en los ganglios neurales después de la infección primaria (varicela). La reactivación de una infección latente por VZV en los ganglios de la raíz dorsal, produce el herpes zóster. La erupción que este provoca se caracteriza por lesiones cutáneas metaméricas que se acompañan de dolor neurítico y comprometen con mayor frecuencia a ancianos y sujetos inmunocomprometidos, en especial, aquellos infectados con el virus de la inmunodeficiencia humana (HIV). Las complicaciones que se observan en esta población de pacientes incluyen neumonía, hepatitis y compromiso del sistema nervioso central (meningitis y encefalitis). Varios síndromes clínicos se asocian con el herpes zóster de localización craneal, incluida la parálisis facial periférica y el síndrome de Ramsay-Hunt, el cual constituye la segunda causa de parálisis facial periférica y tiene una gran variedad de presentaciones clínicas. La parálisis facial se presenta en 60 a 90 % de los casos de síndrome de Ramsay-Hunt, puede preceder o aparecer después de las lesiones cutáneas y tiene peor pronóstico que la parálisis de Bell. Se describen aquí dos casos de herpes zóster del ganglio geniculado, con parálisis facial periférica que coincidió con la aparición de las lesiones cutáneas vesiculosas en el conducto auditivo externo y el pabellón auricular (síndrome de Ramsay-Hunt multimetamérico). En ambos casos, se identificó el genoma del VZV mediante PCR en el líquido cefalorraquídeo (LCR).

Síndrome de Ramsay-Hunt: a propósito de dos casos en que se identificó el genoma del virus de la varicela-zóster en líquido cefalorraquídeo / Ramsay-Hunt syndrome: Report of two cases with identification of the varicella zoster virus genome in cerebrospinal fluid

Resumen | Como los otros herpesvirus alfa, el virus de la varicela-zóster (VZV) permanece en estado de latencia en los ganglios neurales después de la infección primaria (varicela). La reactivación de una infección latente por VZV en los ganglios de la raíz dorsal, produce el herpes zóster. La erupción que este provoca se caracteriza por lesiones cutáneas metaméricas que se acompañan de dolor neurítico y comprometen con mayor frecuencia a ancianos y sujetos inmunocomprometidos, en especial, aquellos infectados con el virus de la inmunodeficiencia humana (HIV). Las complicaciones que se observan en esta población de pacientes incluyen neumonía, hepatitis y compromiso del sistema nervioso central (meningitis y encefalitis). Varios síndromes clínicos se asocian con el herpes zóster de localización craneal, incluida la parálisis facial periférica y el síndrome de Ramsay-Hunt, el cual constituye la segunda causa de parálisis facial periférica y tiene una gran variedad de presentaciones clínicas. La parálisis facial se presenta en 60 a 90 % de los casos de síndrome de Ramsay-Hunt, puede preceder o aparecer después de las lesiones cutáneas y tiene peor pronóstico que la parálisis de Bell. Se describen aquí dos casos de herpes zóster del ganglio geniculado, con parálisis facial periférica que coincidió con la aparición de las lesiones cutáneas vesiculosas en el conducto auditivo externo y el pabellón auricular (síndrome de Ramsay-Hunt multimetamérico). En ambos casos, se identificó el genoma del VZV mediante PCR en el líquido cefalorraquídeo (LCR).

Abstract | Like other alpha-herpesviruses, the varicella-zoster virus (VZV) remains latent in the neural ganglia following the primary varicella infection. The reactivation of the VZV in the dorsal root ganglia results in herpes zoster. Herpes zoster eruption is characterized by localized cutaneous lesions and neuralgic pain mostly in older and immunocompromised persons, especially those living with the human immunodeficiency virus (HIV). The most commonly reported complications include VZV pneumonia, meningitis, encephalitis, and hepatitis. Several neurologic syndromes have been described associated with herpes zoster localized in cranial areas including peripheral nerve palsies and the Ramsay-Hunt syndrome, which has a varied clinical presentation and is the second most common cause of peripheral facial paralysis. Facial paralysis in this syndrome occurs in 60 to 90% of cases and it may precede or appear after the cutaneous lesions with a worse prognosis than idiopathic Bell paralysis. Here we present two cases of herpes zoster from the geniculate ganglia with peripheral facial paralysis that appeared simultaneously with vesicular herpetic otic lesions (multimetameric Ramsay-Hunt syndrome). In the two cases, amplifiable varicella-zoster viral DNA was found in the cerebrospinal fluid by RT-PCR Multiplex.

Piomiositis, artritis séptica y osteomielitis aguda porStaphylococcus aureus meticilino resistente de la comunidad enpaciente pediátrico / Pyomyositis, septic arthritis and acute osteomyelitis due tocommunity methicillin-resistant Staphylococcus aureus in apediatric patient

Las infecciones osteoarticulares y musculoesqueléticas son patologías infecciosas relativamente infrecuentes en la infancia, afectando generalmente a varones y menores de 5 años. Países desarrollados reportan una incidencia anual de osteomielitis de 10 a 80/100.000 niños y de 4 casos/100.000 niños para artritis séptica. En países tropicales, la piomiositis tiene una incidencia de un caso por cada 2.000 habitantes. El Staphylococcus aureus es el principal agente causal. En la infancia la vía más común del legada del germen a la articulación es la hematógena. Hasta en un 30% de niños coexisten osteomielitis aguda y artritis séptica. Se presenta el caso de preescolar masculino de 3años, quien posterior a aplastamiento de miembro inferior izquierdo, presenta aumento de volumen, dolor y limitación para la marcha, asociándose 9 días después fiebre de 39.5°C,acudiendo al Hospital Universitario de Caracas. La anamnesis, evaluación clínica y estudios paraclínicos fueron sugestivos depiomiositis de muslo izquierdo, osteomielitis de fémur izquierdo y artritis séptica de rodilla izquierda. Se indica antibioticoterapiacon cobertura para Staphylococcus aureus (ciprofloxacina y clindamicina). Se realizó artrotomía evacuadora y limpieza quirúrgica de estructuras afectadas. El cultivo reportó Staphylococcus aureus sensible a ciprofloxacina, gentamicina, linezolid, rifampicina, trimetropin/sulfametoxazol; resistentea clindamicina, eritromicina, oxacilina, por lo que se omitióclindamicina y se indicó trimetropin/sulfametoxazol. Cumplió21 días de tratamiento intravenoso, observándose evolución satisfactoria por lo que se decidió egreso, dando continuidad con tratamiento vía oral por cuatro semanas y seguimiento interdisciplinario. El abordaje oportuno y adecuado de estas patologías disminuye el riesgo de desarrollar complicaciones(AU)

Osteoarticular and musculoskeletal infections are relatively rare infectious diseases in childhood, generally affecting men and children under 5 years of age. Developed countries report an annual incidence of osteomyelitis of 10 to 80 / 100,000 children and 4 cases / 100,000 children for septicarthritis. In tropical countries, pyomyositis has an incidence of one case for every 2,000 inhabitants. Staphylococcus aureusis the main causative agent. In childhood the most commonroute of arrival of the germ to the joint is hematogenous.Up to 30% of children coexist acute osteomyelitis and septic arthritis. We present the case of a 3-year-old male preschoolerwho, after crushing his left lower limb, presented an increasein volume, pain, and limited gait, and was associated witha fever of 39.5 ° C 9 days later, going to the University Hospital of Caracas. the anamnesis, clinical evaluation and paraclinical studies were suggestive of pyomyositis of the leftthigh, osteomyelitis of the left femur and septic arthritis of the left knee. Antibiotic therapy with coverage for Staphylococcus aureus (ciprofloxacin and clindamycin) is indicated. Evacuating arthrotomy and surgical cleaning of affected structures were performed. The culture reported Staphylococcus aureus sensitiveto ciprofloxacin, gentamicin, linezolid, rifampin, trimetropin /sulfamethoxazole; resistant to clindamycin, erythromycin,oxacillin, therefore clindamycin was omitted and trimetropin /sulfamethoxazole was indicated. He completed 21 days ofintravenous treatment, observing satisfactory evolution so hisdis charge was decided, continuing with oral treatment for four weeks and interdisciplinary follow-up. The timely and adequate approach to these pathologies reduces the risk of developing complications(AU)

Twenty-Five Years of Domoic Acid Monitoring in Galicia (NW Spain): Spatial, Temporal and Interspecific Variations.

Prevalence, impact on shellfish resources and interspecific, spatial, and temporal variabilities of domoic acid (DA) in bivalves from Galicia (NW Spain) have been studied based on more than 25 years of monitoring data. The maximum prevalence (samples in which DA was detected) (100%) and incidence (samples with DA levels above the regulatory limit) (97.4%) were recorded in Pecten maximus, and the minimum ones in Mytilus galloprovincialis (12.6 and 1.1%, respectively). The maximum DA concentrations were 663.9 mg kg-1 in P. maximus and 316 mg kg-1 in Venerupis corrugata. After excluding scallop P. maximusdata, DA was found (prevalence) in 13.3% of bivalve samples, with 1.3% being over the regulatory limit. In general, the prevalence of this toxin decreased towards the North but not the magnitude of its episodes. The seasonal distribution was characterized by two maxima, in spring and autumn, with the later decreasing in intensity towards the north. DA levels decreased slightly over the studied period, although this decreasing trend was not linear. A cyclic pattern was observed in the interannual variability, with cycles of 4 and 11 years. Intoxication and detoxification rates were slower than those expected from laboratory experiments, suggesting the supply of DA during these phases plays an important role.

Paralytic Shellfish Poisoning (PSP) in Mussels from the Eastern Cantabrian Sea: Toxicity, Toxin Profile, and Co-Occurrence with Cyclic Imines.

In the late autumn of 2018 and 2019, some samples taken by the official monitoring systems of Cantabria and the Basque Country were found to be paralytic shellfish poisoning (PSP)-positive using a mouse bioassay. To confirm the presence of PSP toxins and to obtain their profile, these samples were analyzed using an optimized version of the Official Method AOAC 2005.06 and using LC-MS/MS (HILIC). The presence of some PSP toxins (PSTs) in that geographical area (~600 km of coast) was confirmed for the first time. The estimated toxicities ranged from 170 to 983 µg STXdiHCl eq.·kg-1 for the AOAC 2005.06 method and from 150 to 1094 µg STXdiHCl eq.·kg-1 for the LC-MS/MS method, with a good correlation between both methods (r2 = 0.94). Most samples contained STX, GTX2,3, and GTX1,4, and some also had NEO and dcGTX2. All of the PSP-positive samples also contained gymnodimine A, with the concentrations of the two groups of toxins being significantly correlated. The PSP toxin profiles suggest that a species of the genus Alexandrium was likely the causative agent. The presence of gymnodimine A suggests that A. ostenfeldii could be involved, but the contribution of a mixture of Alexandrium species cannot be ruled out.

Morphologic Variations in the Circle of Willis as a Risk Factor for Aneurysm Rupture in the Anterior and Posterior Communicating Arteries.

BACKGROUND: Intracranial aneurysms are acquired abnormal vascular dilations. The most dangerous complication of a cerebral aneurysm is its rupture, with a high rate of mortality. This study aimed to determine whether there is an association between anatomic variations in the circle of Willis and ruptured aneurysms in the anterior and posterior communicating arteries. METHODS: A cross-sectional study of adult patients with a diagnosis of intracranial aneurysm was carried out between March 2015 and March 2019. The patients were divided into groups of ruptured or unruptured aneurysm in the anterior and posterior communicating arteries. RESULTS: A total of 132 patients with anterior and posterior communicating artery aneurysms were included. The presence of anatomic variation in the circle of Willis presented a statistically significant association with ruptured aneurysms (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.11-4.65; P = 0.024). There was a statistically significant difference between the presence of nonspherical aneurysm and rupture (OR, 6.9; 95% CI, 3.12-15.48; P < 0.0001). Multivariate logistic regression observed smoking (OR, 2.4; 95% CI, 1.01-5.9; P = 0.4), anterior complex variations (OR, 2.68; 95% CI, 1.01-7.18; P < 0.04), and nonspherical morphology (OR, 4.7; 95% CI, 1.93-11.45; P = 0.001) presented a statistically significant association with the rupture. CONCLUSIONS: Our results suggest that the studied variations of the circle of Willis and nonspherical morphology, in addition to playing a role in the development of cerebral aneurysms, may contribute to their rupture.

Endonasal Endoscopic Pituitary Adenoma Resection in light of the COVID-19 Pandemic: A Technical Report

Introduction The endoscopic endonasal transsphenoidal approach (EETA) is routinely used to treat sellar and suprasellar tumors. It provides safe and direct access to tumors in these locations, with wide visualization of anatomical landmarks and great surgical results. With the COVID-19 pandemic, despite the high risk of transmission involved, various surgical procedures cannot be postponed due to their emergency. Case Report A 62-year-old female presented in the previous two months with headaches, followed by bilateral severe visual loss. In 2016, she was submitted to subtotal resection of a non-secretorymacroadenoma. Because of the progressive visual deficits, the EETA was used to the resect the pituitary adenoma. Technical Note We developed a low-cost adaptation to the surgical fields, covering the patient's head and superior trunk with a regular surgicalmicroscope bag with a tiny slit to enable the endoscope and surgical instruments to enter the nose, thus protecting the personnel in the operating room from the aerosolization of particles. This makes surgery safer for the surgical team and for the patient. Conclusion In view of the lack of literature on this subject, except for some reports of experiences from some services around the world, we describe the way we have adjusted the EETA in the context of the COVID-19 pandemic.

Fibroblast growth factor 21 is associated with increased serum total antioxidant capacity and oxidized lipoproteins in humans with different stages of chronic kidney disease.

Background and aims: Oxidative stress (OS) induces the production of fibroblast growth factor 21 (FGF21). Previous data have revealed that FGF21 protects cells from OS injury and death, making it a potential therapeutic option for many diseases with increased OS. However, the association of this growth factor with OS markers in humans with chronic kidney disease (CKD) remains unknown. This study aims to evaluate the association of serum FGF21 with serum total antioxidant capacity (TAC) and oxidized low-density lipoproteins (OxLDL) in subjects in different stages of kidney disease. Methods: This is a cross-sectional study that included 382 subjects with different stages of CKD, irrespective of type 2 diabetes (T2D) diagnosis. Associations of serum FGF21 with OxLDL, TAC, sex, age, body mass index (BMI), fasting plasma glucose, estimated glomerular filtration rate (eGFR), T2D, and smoking, were evaluated through bivariate and partial correlation analyses. Independent associations of these variables with serum FGF21 were evaluated using multiple linear regression analysis. Results: Serum FGF21 was significantly and positively correlated with age (r = 0.236), TAC (lnTAC) (r = 0.217), and negatively correlated with eGFR (r = -0.429) and male sex (r = -0.102). After controlling by age, sex, BMI, T2D, smoking, and eGFR; both TAC and OxLDL were positively correlated with FGF21 (r = 0.117 and 0.158 respectively, p < 0.05). Using multiple linear regression analysis, eGFR, male sex, T2D, OxLDL, and TAC were independently associated with serum FGF21 (STDß = -0.475, 0.162, -0.153, 0.142 and 0.136 respectively; p < 0.05 for all) adjusted for age, BMI, smoking, and fasting plasma glucose. Conclusion: A positive association between serum FGF21 and OS has been found independently of renal function in humans. Results from the present study provide novel information for deeper understanding of the role of FGF21 in OS in humans with CKD and T2D; mechanistic studies to explain the association of serum FGF21 with oxidative stress in CKD are needed.

Diversity and regional distribution of harmful algal events along the Atlantic margin of Europe.

The IOC-ICES-PICES Harmful Algal Event Database (HAEDAT) was used to describe the diversity and spatiotemporal distribution of harmful algal events along the Atlantic margin of Europe from 1987 - 2018. The majority of events recorded are caused by Diarrhetic Shellfish Toxins (DSTs). These events are recorded annually over a wide geographic area from southern Spain to northern Scotland and Iceland, and are responsible for annual closures of many shellfish harvesting areas. The dominant causative dinoflagellates, members of the morphospecies 'Dinophysis acuminata complex' and D. acuta, are common in the waters of the majority of countries affected. There are regional differences in the causative species associated with PST events; the coasts of Spain and Portugal with the dinoflagellates Alexandrium minutum and Gymnodinium catenatum, north west France/south west England/south Ireland with A. minutum, and Scotland/Faroe Islands/Iceland with A. catenella. This can influence the duration and spatial scale of PST events as well as the toxicity of shellfish. The diatom Pseudo-nitzschia australis is the most widespread Domoic Acid (DA) producer, with records coming from Spain, Portugal, France, Ireland and the UK. Amnesic Shellfish Toxins (ASTs) have caused prolonged closures for the scallop fishing industry due to the slow depuration rate of DA. Amendments to EU shellfish hygiene regulations introduced between 2002 and 2005 facilitated end-product testing and sale of adductor muscle. This reduced the impact of ASTs on the scallop fishing industry and thus the number of recorded HAEDAT events. Azaspiracids (AZAs) are the most recent toxin group responsible for events to be characterised in the ICES area. Events associated with AZAs have a discrete distribution with the majority recorded along the west coast of Ireland. Ciguatera Poisoning (CP) has been an emerging issue in the Canary Islands and Madeira since 2004. The majority of aquaculture and wild fish mortality events are associated with blooms of the dinoflagellate Karenia mikimotoi and raphidophyte Heterosigma akashiwo. Such fish killing events occur infrequently yet can cause significant mortalities. Interannual variability was observed in the annual number of HAEDAT areas with events associated with individual shellfish toxin groups. HABs represent a continued risk for the aquaculture industry along the Atlantic margin of Europe and should be accounted for when considering expansion of the industry or operational shifts to offshore areas.

Gymnodimine A in mollusks from the north Atlantic Coast of Spain: Prevalence, concentration, and relationship with spirolides.

Gymnodimine A has been found in mollusks obtained along the whole northern coast of Spain from April 2017 to December 2019. This is the first time that this toxin is detected in mollusks from the Atlantic coast of Europe. The prevalence of the toxin was, in general, low, being detected on average in approximately 6% of the obtained samples (122 out of 1900). The concentrations recorded were also, in general, low, with a median of 1.3 µg kg-1, and a maximum value of 23.93 µg kg-1. The maxima of prevalence and concentration were not geographically coincident, taking place the first at the easternmost part of the sampled area and the second at the westernmost part. In most cases (>94%), gymnodimine A and 13-desmethyl spirolide C were concurrently detected, suggesting that Alexandrium ostenfeldii could be the responsible producer species. The existence of cases in which gymnodimine A was detected alone suggests also that a Karenia species could also be involved. The geographical heterogeneity of the distribution suggests that blooms of the producer species are mostly local. Not all bivalves are equally affected, clams being less affected than mussels, oysters, and razor clams. Due to their relatively low toxicity, and their low prevalence and concentration, it seems that these toxins do not pose an important risk for the mollusk consumers in the area.