Harmonizing analytical chemistry and clinical epidemiology for human biomonitoring studies. A case-study of plastic product chemicals in urine.

There is an interdisciplinary interface between analytical chemistry and epidemiology studies with respect to the design, execution, and analysis of environmental epidemiology cohorts and studies. Extracting meaningful results linking chemical exposure to human health outcomes begins at study design and spans the entire workflow. Here we discuss analytical experimental design from an exposure science perspective, and propose a reporting checklist for the design of human biomonitoring studies. We explain key analytical chemistry concepts of blanks and limits of reporting and present a case series of plastic product chemical exposure in prenatal urine specimens from the Barwon Infant Study.

Integrated chemical exposure assessment of coastal green turtle foraging grounds on the Great Barrier Reef.

The Great Barrier Reef receives run-off from 424,000 km2 catchment area across coastal Queensland, incorporating diffuse agricultural run-off, and run-off point sources of land-based chemical pollutants from urban and industrial development. Marine biota, such as green turtles (Chelonia mydas), are exposed to these diverse chemical mixtures in their natural environments, and the long term effects on turtle and ecosystem health remain unknown. This study was part of a larger multi-disciplinary project characterising anthropogenic chemical exposures from the marine environment and turtle health. The aim of this study was to screen for a wide range of anthropogenic chemical pollutants present in the external and internal environment of green turtles, using a combination of traditional targeted chemical analyses, non-target suspect screening, and effect-based bioassay methods, while employing a case-control study design. A combination of passive (water) and grab (water, sediment) samples were investigated. Three known green turtle foraging sites were selected for sampling: two coastal 'case' sites influenced primarily by urban/industrial and agricultural activities, respectively; and a remote, offshore 'control' site. Water and sediment samples from each of the three sampling locations showed differences in chemical pollutant profiles that reflected the dominant land uses in the adjacent catchment. Targeted mass spectrometric analysis for a range of pesticides, industrial chemicals, pharmaceuticals and personal care products found the greatest detection frequency and highest concentrations in coastal samples, compared to the control. Non-target screening analysis of water showed clear differentiation in chemical profile of the urban/industrial site. In-vitro assays of sediment samples from the control site had lowest induction, compared to coastal locations, as expected. Here we present evidence that turtles foraging in coastal areas are exposed to a range of anthropogenic pollutants derived from the adjacent coastal catchment areas.

Concentrations of phthalates and DINCH metabolites in pooled urine from Queensland, Australia.

Dialkyl phthalate esters (phthalates) are ubiquitous chemicals used extensively as plasticizers, solvents and adhesives in a range of industrial and consumer products. 1,2-Cyclohexane dicarboxylic acid, diisononyl ester (DINCH) is a phthalate alternative introduced due to a more favourable toxicological profile, but exposure is largely uncharacterised. The aim of this study was to provide the first assessment of exposure to phthalates and DINCH in the general Australian population. De-identified urine specimens stratified by age and sex were obtained from a community-based pathology laboratory and pooled (n=24 pools of 100). Concentrations of free and total species were measured using online solid phase extraction isotope dilution high performance liquid chromatography tandem mass spectrometry. Concentrations ranged from 2.4 to 71.9ng/mL for metabolites of di(2-ethylhexyl)phthalate, and from <0.5 to 775ng/mL for all other metabolites. Our data suggest that phthalate metabolites concentrations in Australia were at least two times higher than in the United States and Germany; and may be related to legislative differences among countries. DINCH metabolite concentrations were comparatively low and consistent with the limited data available. Ongoing biomonitoring among the general Australian population may help assess temporal trends in exposure and assess the effectiveness of actions aimed at reducing exposures.

Determination of nicotine in mushrooms by various GC/MS- and LC/MS-based methods.

Due to the basic properties of nicotine, it is not easily integrated into commonly used multiresidue methods. The present work investigates the application of two commonly employed multiresidue methods-the QuEChERS method and the ethyl acetate method-for determining nicotine in mushrooms. Both methods are employed in a modified form and an unmodified form: the former to address the special properties of nicotine and the latter, combined with the use of isotopically labelled nicotine, to compensate for poor recoveries. The QuEChERS-based methods were followed by liquid chromatography-time-of-flight mass spectrometry and those based on ethyl acetate extraction were followed by gas chromatography-triple quadrupole-mass spectrometry. All methods were validated according to European guidelines (document no. SANCO/10684/2009). Recovery studies performed on mushroom spiked at 10 and 100 µg kg(-1) yielded average recoveries in the range 80-110% with relative standard deviation (RSD) values below 9%. The linearity of the response over two orders of magnitude was demonstrated (r(2) > 0.995) for all of the determination techniques employed. The limits of detection and quantification obtained were in the 0.7 and 10 µg kg(-1) range, depending on the technique, and thus below the maximum residue level established for this toxic alkaloid by current EU legislation. Good repeatability and reproducibility were obtained in terms of the RSD of the analytical methods (0.4-13.2%). The modified QuEChERS method was tested in a proficiency test on nicotine in dried mushrooms obtaining good results. The methods were successfully applied to 20 real samples.

[Comparative study of two enteral feeding formulas in hospitalized elders: casein versus soybean protein]. / Estudio comparativo de dos dietas enterales en ancianos hospitalizados: proteína de soja frente a proteína caseína.

OBJECTIVES: To compare the incidence of gastrointestinal side effects of two enteral feeding formulas with changes in the origin of protein (casein and isolated soy protein) in hospitalised elderly patients. METHOD: A cross sectional survey was done among a sample of elderly patients carrying nasogastric tube admitted to the Reina Sofia General Hospital (Murcia) during a period of 6 months. A formula based on casein or soybean protein was randomly assigned. The variables studied were: age, sex, cause for indication of EN, duration of the EN and maximum amount of EN administered per day. Nutritional status at admission and discharge, mortality and gastrointestinal side effects (diarrhoea, constipation, vomits or regurgitation) were also collected. Statistical analyses were performed with the Student's T and chi 2 tests, with a significance of 95%. RESULTS: Sample conformed by 50 patients over 65 years (48% casein, 52% soybean) without statistically significant differences in age nor cause of indication of the EN. Either there were no differences in the nutritional status at the admission and discharge in both groups. Significant differences were observed in the incidence of diarrhoea (C: 45.83%, S: 7.69%, p = 0.009) and vomits (C: 41.66%, S: 15.38%, p = 0.05). CONCLUSIONS: A significant reduction in the incidence of gastrointestinal complications, a reduction in the incidence of ulcers by pressure and less mortality occurred on the group that took formula based on the soybean protein. The individualized nutritional evaluation must be performed routinely when the patient is admitted to the hospital for detection and treatment of early signs of malnutrition.

Extrinsic ileal occlusion secondary to appendiceal mucocele of unusual size.

Appendiceal mucocele due to papilar cystadenoma is a rare condition, characterized by a diffuse swelling, a distension of the lumen secondary to accumulation of mucoid substance and occasional mucinous intraperitoneal deposits. It is often asymptomatic (approximately 25%) and is found incidentally during abdominal imaging studies or surgical exploration. Pre-operative recognition is difficult but very important because of the possibility of rupture during surgery with the development of pseudomyxoma peritonei. A case of benign mucocele presenting acutely as an occlusive syndrome is reported. The surgical treatment consisted of an appendicectomy with partial caecectomy. The clinicopathological and imaging diagnostic features of this pathological entity, as well as the main therapeutic approaches suggested in the literature, are commented on.

Spontaneous retroperitoneal hemorrhage from adrenal artery aneurysm.

Spontaneous adrenal hemorrhage is a very rare but serious disorder of the adrenal gland that can require emergent treatment. We report on a 42-year-old man who underwent selective angiography for diagnosis and treatment of retroperitoneal hemorrhage from small adrenal artery aneurysm. This case gives further details about the value of transluminal artery embolization in the management of visceral aneurysm rupture.

El impacto de la demencia del anciano sobre su cuidador y factores de la carga asociada al hecho de cuidar / The impact of dementia on the main caregiver and factors of burder associated to caring

Introducción: la alta prevalencia de la demenciay su carácter crónico son responsablesde un alto coste humano, económico y social. Elpropósito de este estudio fue valorar el desgasteque produce el cuidado de pacientes con demenciay examinar las características de sus cuidadoresprincipales.Material y método: se realizó un estudiotransversal sobre una muestra de cuidadores ypacientes con demencia ingresados en el hospitalUSP San Carlos (Murcia) durante un períodode 6 meses. Se utilizó un cuestionario que recogíadiversos datos, repartidos en cuatro apartados:A/Datos sociodemográficos del paciente condemencia.B/Datos sociodemográficos del familiar-cuidador.C/Opiniones y actitudes de los allegados depacientes con demencia.D/Indice de esfuerzo del cuidador (IEC).Se realizó un estudio de factores asociadossobre algunas decisiones en la enfermedad delpaciente. El análisis de influencia de las distintasvariables consideradas se ha hecho mediantemodelo de regresión logística. La fuerza de esaasociación se interpretó mediante el cálculo dela odds-ratio.Resultados: un total de 80 pacientes (20hombres y 60 mujeres con edad media de 82,4años) y sus cuidadores (27% hombres y 73 %mujeres) fueron incluidos. La elección del cuidadorprincipal se realizó tras consenso entre todoslos familiares disponibles en sólo 28 casos(35%). En cuanto a los problemas descritos porlos cuidadores, el principal es el esfuerzo físicopara el 43%. También los enfrentamientos entrefamiliares (25%) y la pérdida de vida propia(23%) son considerados inconvenientes importantesde esta situación. Para el futuro, el 93%de los encuestados piensa que la carga económicaserá insoportable y expresan la necesidadde más apoyos institucionales. La mayoría reconocióque la muerte del enfermo sería una liberación,y que se acepta la adopción de medidasagresivas para el enfermo que el cuidador no desearíapara sí en la misma situación. La puntuaciónmedia del test IEC fue 9,28. De acuerdo conesta escala, el 75% de los cuidadores se encontrabanbajo un alto o muy alto grado de estrés(IEC > 7). El mayor grado de carga del cuidadorestaba relacionado de forma estadísticamentesignificativa con un mayor deterioro físico y mentaldel enfermo.Conclusiones: nuestros resultados reproducenlos de estudios previos y reflejan la necesidadde mejorar los servicios ofertados a los enfermoscon demencia y sus cuidadores e intensificarla participación de los profesionales sanitarios

Introduction: The high prevalence and chronic evolution of dementia are responsible for a major social, financial and human cost. Family members are the first-line caregivers for demented elderly patients living at home in our country. Giving care to a demented patient has an important impact on the mood, quality-of-life and physicaland psychological health of family aids. The purpose of this study wes to explore the barden of caring for home-based patients with dementia in our community and to examine the characteristics of theirprimary caregivers.Material and methods: In order to determine the factors that exhaust caregivers, a cross sectional survey was done among a sample of demented patients and their caregivers who were admitted at the USP San Carlos Hospital (Murcia) during a period of 6 months. The study employed a self-recording questioneaire form whichcollected different data included in four sections:A/Sociodemographic data of the patient. B/Sociodemographic data of the family primarycaregiver. C/Carers’ opinions, attitudes and emotionalresponses of relatives of patients with dementia.D/Strain level of care provider. It was measuredby means of the 13-items Caregiver Burden Scale.A logistic regression analysis was performed to identify caregiver characteristics and to examine the effects of different factors associated with caregiver strain. The power of that association wes measured by the odds-ratio.Results: A total of 80 patients (20 men, 60 women, average age 82.4 years) and their 80 informelcaregivers (27% men, 73% women) were included. The selection of the prime caregiver wes “considered natural” in 48 cases (60%) and chosen after a consensus or agreement between the potential caregivers in 28 cases (35%). About the problems perceived by the caregivers, themain one is the physical effort for 43%. Also,confrontations among the relatives (25%) and the loosing of the own time (23%) are described as serious inconveniences of caring. For the future, 93% of the participants thinks that the economic charge will be unsupportable and they expressed the need for more institutional help. The largest part of carers in this study recognised th at they would be “liberated” by the die of the patient, but the factors analysed (such as age, sex or patient functional status) were not related tothis variable. Aggressive life-sustaining treatmentsare better accepted for their relatives than for themselves. Average score of CBS was 9.28. According to this scale, 75% of caregivers were found under high or even extremely high level of stress (CBS > 7). Level of perceived burden correlated significantly with the physical and mental deterioration of the patient.Conclusions: Our results reproduce previous findings and suggest that females (wife or daughter) are typically found to be the primary caregiver when a family member falis ill. The mejority of caregivers presented a high level of stress, correlated wilh patient’s health problems. The results document the great need for servicesamong families and the need for enhancement ofquality of care and negotiated partnership betweenfamilies and professionals

Pericardial tamponade as initial presentation of papillary thyroid carcinoma.

We herein describe a 19-year-old woman who presented with pericardial effusion that resulted in heart tamponade. The clinicopathological study revealed papillary carcinoma of the thyroid metastasized to the heart. Although malignant pericardial effusion is a known complication of thyroid cancer, it is rarely the first manifestation and shows a relatively favourable prognosis despite widespread metastases if adequate treatment is given.

El cuidador del paciente con demencia: aplicación del test Índice del Esfuerzo del Cuidador / Caregivers of dementia patients: application of the Caregiver Burden Scale

Introducción: un número creciente de ancianos con demencia es atendido en nuestros hospitales por miembros de su familia. En estas condiciones, la prolongación de los cuidados puede favorecer la aparición de una carga excesiva para los allegados y llevar al fracaso de la atención familiar. El objetivo de este estudio ha sido establecer la posible aplicación de un índice del esfuerzo del cuidador (Caregiver Burden Scale) para valorar la carga entre cuidadores de personas con demencia en el ámbito hospitalario. Pacientes y método: se evaluó a los ancianos con demencia ingresados en nuestro hospital y las características de sus cuidadores principales, mayoritariamente familiares directos. Los cuidadores profesionales fueron excluidos. El grado de esfuerzo fue medido con la Escala de Carga del Cuidador. Se utilizó un modelo de regresión logística para determinar la influencia de diferentes factores sobre el agotamiento del cuidador. Resultados: un total de 80 pacientes (20 varones y 60 mujeres; edad media, 82,4 años) y sus 80 familiares-cuidadores (27 por ciento varones, 73 por ciento mujeres) fueron incluidos en el estudio. La puntuación media del test fue de 9,28. De acuerdo con esta escala, el 75 por ciento de los cuidadores se encontraba bajo un alto o muy alto grado de estrés. El mayor grado de carga estaba relacionado de forma estadísticamente significativa con alteraciones físicas (molestias musculares) y mentales (ansiedad) en el cuidador principal. Conclusiones: nuestros resultados coinciden con los de estudios anteriores e indican que el test Caregiver Burden Scale puede ser empleado como un instrumento sencillo y fácil de aplicar para identificar el exceso de carga entre los cuidadores-familiares de nuestros pacientes. Este simple índice puede ser de utilidad en el ámbito hospitalario en cualquier evaluación que examine las relaciones de cuidado y dependencia. El grado de esfuerzo experimentado estaba relacionado de forma estadísticamente significativa con la salud del cuidador principal, aunque no con una mayor demanda de atención médica (AU)

Valoración del grado de conocimientos y experienciaen nutrición artificial entre los especialistasen medicina intensiva de la Región de Murcia / Evaluation of intensivit´s knowledge and experience in artificial nutrition in the Murcia region (Spain)

Objetivos. El conocimiento de la nutrición artificial es un apartado obligatorio en la formación de los especialistas en medicina intensiva por su importancia en el tratamiento del paciente crítico. En el presente estudio se pretende valorar la formación recibida y el grado de conocimientos adquiridos entre los intensivistas de nuestra área. Métodos. Se llevó a cabo una encuesta en tiempo real entre los intensivistas de cinco hospitales de nuestra región. La encuesta constaba de 29 ítems, divida en tres apartados: formación, conocimientos generales y conocimientos en el paciente crítico. Resultados. Se recogieron 52 encuestas (38 especialistas y 14 médicos residentes, o MIR).De ellos, un 83 por ciento había recibido formación sobre el tema durante el período MIR, pero el 66 por ciento la consideraba insuficiente. Esta opinión era significativamente mayor (p < 0,05) en el grupo MIR. Un 66 por ciento de los encuestados adecuaba las dietas a las características del paciente, pero sólo conocían y manejaban "toda" la gama de productos de cada tipo de nutrición un 25 por ciento en el caso de las dietas orales, un 22 por ciento en el de la nutrición enteral y un 36 por ciento en el de la nutrición parenteral. La nota media (desviación estándar [DE]) en el conocimiento de nutrición en el paciente crítico fue de 6,19 (1,80), significativamente mayor (p < 0,05) en los especialistas que en los MIR. Conclusiones. La formación en nutrición se recibe fundamentalmente en el período MIR, aunque en general se considera que es insuficiente. La mayoría de los profesionales utiliza correctamente las dietas existentes. Por último, el grado de conocimientos es medio, y es significativamente mayor en los profesionales con más experiencia (AU)

Colangitis supurada, sepsis grave y absceso hepático en paciente con enfermedad litiásica hepática / Acute suppurative colangitis, severe sepsis and liver abscess in a patient with intrahepatic stones

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Sipple's syndrome presenting acutely as severe heart failure.

We describe the case of a 56-year-old man who developed acute hypertension leading to cardiac insufficiency, arrhythmia, severe heart failure and death. The autopsy revealed Sipple's syndrome (multiple endocrine neoplasia syndrome type IIa) and catecholamine-induced cardiomyopathy. This man had received a false diagnosis of primary hypertension 1 year before. The prime objective of this report is to call attention to the necessity of an in depth diagnosis of labile and paroxysmal hypertension. The clinical diagnostic features of phaeochromocytoma as well as the main therapeutic approaches suggested in the literature are commented on.

[Evolution of the nutritional status of patients with HIV-AIDS. Effects of socioeconomic situation and dietetic counseling]. / Evolución del estado nutricional de pacientes VIH-SIDA. Efecto de su situación socio-económica y del consejo dietético.

OBJECTIVES: To know HIV-AIDS patient's nutritional status in different infection's condition and their relation with the socioeconomic situation and, in that case, the nutritional condition improvement through the dietetic advice appropriated for each patient. METHODS: Prospective study of 79 patients with HIV-AIDS diagnostic in any illness's condition and recopilation of anthropometrics and biochemical variables. At the beginning of the study we got data about socioeconomic situation of patient with a scale of 1 to 5 points each variable and an score top of 35. In the survivors we checked, after dietetic advice, the variables at 6 and 12 months by sanitary personal (physician and nurse) who weren't implicated in direct assistance. The study was analyzed by Student "T" for matched data and the simple correlation test. RESULTS: We have objectivated a lost of initial weight over their habitual's with a progressive impairment in different stage of evolution that weren't modified by dietetic advice. We didn't observed significant variations in the biochemical variables included in advances states and in parameters which are usually affected in malnutrition. In the analysis of relation between nutritional condition and socioeconomic factors, it was estimated a lesser score, that was statistically significative, in patients who had a work, family situation and an affective upset positive. CONCLUSIONS: The results obtained induce to think that the nutritional advices appropriated for each patient are not related, in our series, with progressive deterioration of anthropometrics variables, neither biochemical parameters fluctuations at 6, 12 months of follow-up. The patient's socioeconomic situation is not influenced by nutritional condition except for the work, affectivity and family environment.