Hydrological modelling and evolution of lakes and playa-lakes in southern Spain constrained by geology, human management and climate change.

The hydrological functioning of wetlands in S Spain is poorly understood. We perform a 22-years hydrological modelling of seven playa-lakes located in a semi-arid region of southern Spain, including dry and wet periods. To do that, we applied a hydrological balance model to reconstruct past lake water levels. In addition, we investigated the hydrochemistry of the water, the basin bathymetry, and the geological setting of the watersheds, acquiring new lithology and active structures data. Once the models were constrained, scenarios considering increases on temperature and human management were implemented, and discussed. The water balance is simplified to precipitation (water input) and basin discharge (evapotranspiration), as the lakes are disconnected from groundwater because of the low-permeability substrate. In addition, unlike in previous studies, we add overflows to the modelling. The results of the model agree with actual lake water monitoring data (R2 > 0.8). We observed that the hydroperiods of some of these lakes vary from permanent lakes to ephemeral, depending strongly on the basin bathymetry. Lakes with steeply margins show longer hydroperiods, whilst it is shorter for low-lying floor playa-lakes. In addition, we observed that steeply lake margins respond to active faults and/or lithological changes. To forecast the effects of climate change on the lake hydroperiods, we applied a 1 °C increase in average temperature in our hydrological modelling. The hydroperiod is significantly reduced for ephemeral playa-lakes, whilst is barely affected in permanent lakes. Moreover, we detected the high sensitivity of ephemeral playa-lakes to the anthropogenic management, including siltation, plant colonization and changes watershed surface.

Control of trace metal distribution and variability in an interdunal wetland.

Trace elements are serious pollutants in the natural environment and are of increasing concern due to the adverse effects at global scale. To refine the current understanding of trace metal distribution and variability in natural environments, concentrations of dissolved trace metals (Ag, Al, As, B, Ba, Be, Co, Cr, Cd, Cu, Fe, Hg, Mo, Ni, Pb, Sb, Se, Th,Tl, U, V, Mn, Zn), major ions, inorganic nutrients (NO3, PO4), TOC and stable isotopes of water were determined in water samples from rainwater, seven piezometers and a pond in the coastal Doñana wetland during four sampling campaigns between 2017 and 2019. Results show clear evaporation signatures of stable isotopes in the pond but not in the groundwater. Hydrochemical analyses yield significant, systematic changes in groundwater trace metal and nutrient composition along the flowpath from the dune belt to the pond, controlled by organic matter in the sediments. Whereas major ions reached maximum concentrations in the pond due to evapoconcentration, most trace metals showed highest concentrations at sites with lower redox levels, except for B, As and U, which showed very high concentrations in the pond. Cu, Zn, Ni, Sb and Tl yielded higher median concentrations in rainwater than in most of the groundwater points and in case of Cu and Zn higher even than in surface water which points to an atmospheric input source of these elements. Temporal variability of trace metals was related to lower hydraulic heads after an elongated dry period which led to lower redox levels and higher concentrations of most of the trace elements whereas major ions showed more constant concentration levels. This is of special concern regarding climate change and the predicted higher frequency of prolonged dry periods, which could modify the natural hydrochemical patterns in undisturbed wetlands systems.

Análisis y mejora de la adherencia terapéutica en una farmacia comunitaria de Ourense / Analysis and improvement of therapeutic adherence in a community pharmacy in Ourense

Objetivos: evaluar la adherencia terapéutica de pacientes con patologías prevalentes, identificandofactores relacionados. Cuantificar la mejora en la adherencia conseguida mediante servicios profesionalesfarmacéuticos (SPF). Comprobar la satisfacción con el servicio.Métodos: diseño: 1ª fase: estudio monocéntrico, descriptivo, longitudinal, realizado entre 18/3y 10/4/2019. 2ª fase: estudio cuasiexperimental sin grupo control, con intervención educativa y SPF,revisión del uso de la medicación (RUM) y sistemas personalizados de dosificación (SPD), octubre-noviembre/2019.Sujetos: pacientes mayores de edad con dislipemia, hipertensión o diabetes, que acudieron a lafarmacia y aceptaron participar. Para la 2ª fase se seleccionaron pacientes que resultaron no adherentesen la 1ª.Variables: adherencia (medida con el test Morisky-Green), satisfacción con el servicio. Variables demográficas.Resultados: 1ª fase: 101 pacientes, media de edad de 69 años. 50,5% hombres. La proporción deno adherentes fue del 55,4%. 40 (71,4%) olvidan alguna vez tomar sus medicamentos. La adherenciano resultó relacionada con sexo, edad, acompañamiento, número de patologías o nivel de estudios(p>0,05).2ª fase: RUM: el porcentaje de no adherentes disminuyó al 67%. SPD: 9 de los 10 pacientes resultaron adherentes al final del estudio. 1 paciente resultó no adherente por olvidar esporádicamente algunatoma.El 100% de las encuestas de satisfacción dio como resultado “muy satisfechos”, continuarían visitando la farmacia y la recomendarían.Conclusiones: la adherencia terapéutica resulto baja, menor del 50%. No se encontró relación con losfactores analizados. (AU)

Manejo terapéutico de aspergilosis invasiva en paciente trasplantado e isavuconazol como nueva alternativa antifúngica / Therapeutic management of invasive aspergillosis in a transplant patient and isavuconazole as a new antifungal alternative

Las infecciones oportunistas en pacientes sometidos a trasplante de órgano sólido (TOS) son una causa de morbimortalidad muy importante. Entre ellas las infecciones fúngicas, aunque menos frecuentes, destacan por su alta mortalidad. Una de las infecciones por hongos más usual es la ocasionada por Aspergillus. El tratamiento de elección de aspergilosis invasiva en un paciente con TOS es voriconazol.Presentamos el caso de un paciente inmunodeprimido tras trasplante renal con cuadro de sepsis grave de origen respiratorio en probable contexto de una aspergilosis invasiva. El interés del caso radica en la intervención farmacéutica en el complejo manejo farmacológico del paciente a lo largo de su estancia en la Unidad de Críticos y en la terapia antimicrobiana satisfactoria con isavuconazol, un nuevo antifúngico. (AU)

Opportunistic infections in patients undergoing solid organ transplantation (TOS) are a very important cause of morbidity and mortality. Among them, fungal infections, stand out for their higher mortality. One of the most frequent fungal infections is caused by Aspergillus. There are more than 150 species of Aspergillus, being Aspergillus fumigatus the most common agent of invasive fungal infections in human. Gold standard treatment for invasive aspergillosis in a patient with TOS is voriconazole.We present the case of a kidney transplanted and immunocompromised patient with severe sepsis of respiratory origin in context of invasive aspergillosis. Interest of this case lies on the multiple pharmaceutical interventions in the patient’s complex pharmacological management throughout his stay in the critics unit and satisfactory treat-ment with isavuconazole, a new antifungal. (AU)

Sordera súbita idiopática. Entidad poco conocida en atención primaria / Idiopathic sudden deafness. A poorly known entity in primary care

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Erythema multiforme induced by tramadol: an allergy assessment

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Evaluación de la aplicabilidad del léxico BI-RADS(R) de la resonancia magnética para la interpretación de la mamografía digital con contraste / Evaluation of the applicability of BI-RADS(R) MRI for the interpretation of contrast-enhanced digital mammography

OBJETIVO: Se plantea comprobar la utilidad del léxico BI-RADS(R) de la resonancia magnética de la mama (RMM) para la descripción morfológica y la categorización de las imágenes obtenidas mediante mamografía digital con realce de contraste (CESM) en comparación con el diagnóstico final. MATERIAL Y MÉTODOS: Se incluyeron pacientes con lesiones de mama palpables o que necesitaban una aclaración de anormalidades previamente identificadas por otra técnica de diagnóstico por imagen, o una evaluación complementaria de parénquima mamario heterogéneamente denso. Tres radiólogos evaluaron de forma independiente las lesiones de mama estudiadas por CESM utilizando una plantilla que contenía los descriptores morfológicos cualitativos del léxico BI-RADS(R) de la RMM. En una segunda etapa, otros dos radiólogos experimentados proporcionaron una opinión consensuada sobre casos discrepantes. Los lectores también proporcionaron una clasificación en la escala BI-RADS(R) de 1 a 5 para cada una de las lesiones, tanto benignas como malignas. Todos los resultados se compararon con el estado real de la enfermedad (estándar de referencia apropiado para el tipo de lesión) y la significación estadística fue evaluada mediante la prueba de χ2. RESULTADOS: El estudio incluyó 218 lesiones benignas y 426 malignas. Hubo un alto acuerdo interobservador entre los tres radiólogos (valor de kappa de Fleiss-Cohen=0,805; IC al 95% 0,728-0,837). De forma similar a lo que se ha descrito para la RMM, la evaluación de los descriptores morfológicos de las lesiones que dan efecto de masa mostró que las lesiones malignas tienden a presentar una forma irregular, con bordes espiculados o mal definidos y un patrón de realce intenso y heterogéneo (p <0,001). Sin embargo, a diferencia de la RMM, el patrón de realce en anillo no se puede describir como un criterio independiente de malignidad con esta técnica. Con respecto a las lesiones que no dan efecto de masa, el único descriptor significativo fue la intensidad de la captación del medio de contraste (p <0,05). La aplicación global del léxico BI-RADS(R) de la RMM para CESM permitió la clasificación adecuada del 85% de las categorías benignas (BI-RADS 1 y lesiones BI-RADS 2 y 3) y el 93% de las lesiones malignas (BI-RADS 4-5), que son valores similares a los descritos para RMM. CONCLUSIONES: Los descriptores morfológicos del léxico BI-RADS(R) de la RMM se pueden aplicar al análisis morfológico de lesiones de mama estudiadas por CESM. Las discrepancias parciales en la interpretación no influyeron en la puntuación final de BI-RADS(R), lo que permite una buena diferenciación de las lesiones benignas y malignas

OBJECTIVE: To determine the usefulness of BI-RADS(R) MRI for the morphological description and categorization of images obtained with contrast-enhanced digital mammography in comparison with the final diagnosis. MATERIAL AND METHODS: We included patients who had palpable breast lesions, those who needed clarification regarding abnormalities identified with another imaging technique, and those which needed a complementary evaluation of heterogeneously dense breast parenchyma. Three radiologists working independently used a template with the BI-RADS(R) MRI qualitative descriptors to evaluate the breast lesions studied with contrast-enhanced digital mammography. In a second phase, two other experienced radiologists reached a consensus about discrepant interpretations. Readers also classified each lesion (both benign and malignant lesions) on the BI-RADS(R) scale (1 - 5). All the results were compared with the real state of disease (determined by the appropriate gold standard for each type of lesion), and the statistical significance was assessed with the chi-square test. RESULTS: A total of 218 benign lesions and 426 malignant lesions were included. The interobserver agreement among the three radiologists was high (Fleiss-Cohen kappa=0.805; 95% CI: 0.728-0.837). Similarly to what has been reported about breast MRI, on contrast-enhanced digital mammography, malignant lesions with mass effect tended to have an irregular shape with spiculated or ill-defined margins and a pattern of intense and heterogeneous enhancement (p <0.001). Nevertheless, unlike on breast MRI, ring enhancement was not an independent criterion of malignancy on contrast-enhanced digital mammography. For lesions without a mass effect, the only significant descriptor was the intensity of contrast material uptake (p <0.05). Applying the BI-RADS(R) MRI material to contrast-enhanced digital mammography images enabled the correct classification of 85% of lesions in the benign categories (BI-RADS 1 and BI-RADS 2 and 3 lesions) and of 93% of the lesions in the malignant categories (BI-RADS 4-5); these values are similar to those reported for breast MRI. CONCLUSIONS: The morphological descriptors used in BI-RADS(R) MRI can be applied to the morphological analysis of breast lesions studied with contrast-enhanced digital mammography. The partial discrepancies in the interpretation did not influence the final BI-RADS(R) score, and the score enabled good differentiation between benign and malignant lesions

Evaluation of the applicability of BI-RADS® MRI for the interpretation of contrast-enhanced digital mammography. / Evaluación de la aplicabilidad del léxico BI-RADS® de la resonancia magnética para la interpretación de la mamografía digital con contraste.

OBJECTIVE: To determine the usefulness of BI-RADS® MRI for the morphological description and categorization of images obtained with contrast-enhanced digital mammography in comparison with the final diagnosis. MATERIAL AND METHODS: We included patients who had palpable breast lesions, those who needed clarification regarding abnormalities identified with another imaging technique, and those which needed a complementary evaluation of heterogeneously dense breast parenchyma. Three radiologists working independently used a template with the BI-RADS® MRI qualitative descriptors to evaluate the breast lesions studied with contrast-enhanced digital mammography. In a second phase, two other experienced radiologists reached a consensus about discrepant interpretations. Readers also classified each lesion (both benign and malignant lesions) on the BI-RADS® scale (1 - 5). All the results were compared with the real state of disease (determined by the appropriate gold standard for each type of lesion), and the statistical significance was assessed with the chi-square test. RESULTS: A total of 218 benign lesions and 426 malignant lesions were included. The interobserver agreement among the three radiologists was high (Fleiss-Cohen kappa=0.805; 95% CI: 0.728-0.837). Similarly to what has been reported about breast MRI, on contrast-enhanced digital mammography, malignant lesions with mass effect tended to have an irregular shape with spiculated or ill-defined margins and a pattern of intense and heterogeneous enhancement (p <0.001). Nevertheless, unlike on breast MRI, ring enhancement was not an independent criterion of malignancy on contrast-enhanced digital mammography. For lesions without a mass effect, the only significant descriptor was the intensity of contrast material uptake (p <0.05). Applying the BI-RADS® MRI material to contrast-enhanced digital mammography images enabled the correct classification of 85% of lesions in the benign categories (BI-RADS 1 and BI-RADS 2 and 3 lesions) and of 93% of the lesions in the malignant categories (BI-RADS 4-5); these values are similar to those reported for breast MRI. CONCLUSIONS: The morphological descriptors used in BI-RADS® MRI can be applied to the morphological analysis of breast lesions studied with contrast-enhanced digital mammography. The partial discrepancies in the interpretation did not influence the final BI-RADS® score, and the score enabled good differentiation between benign and malignant lesions.

Heterogeneous Predisposing Factors and Etiology of Edema of the Uvula in a Spanish Population.

BACKGROUND AND OBJECTIVE: Edema of the uvula (EU) may appear in isolation or in association with clinical manifestations such as urticaria, angioedema, and anaphylaxis. EU may lead to upper airway obstruction, provoking obstructive respiratory distress and asphyxia. Objective: We sought to investigate the etiology of and predisposing factors for EU in a large population of patients referred to an outpatient clinic. METHODS: In this 3-year follow-up cohort study, 171 patients presenting with EU were identified and classified as having isolated EU or nonisolated EU. The etiology of each patient's condition was studied, and possible predisposing factors were recorded. An allergology work-up and a statistical study (bivariate/multivariate analyses) were performed. RESULTS: The predisposing factors for both groups of EU patients were found to be different. The etiology of the problem was identified for most patients; allergy to Anisakis simplex was the most common cause in both groups. Nonsteroidal anti-inflammatory drugs and antibiotics were also found to be triggers in both groups. CONCLUSIONS: Isolated EU was associated with snoring, an elongated uvula, and having experienced previous episodes of EU. We found no associations between groups of EU patients and gender, obesity, smoking, alcohol consumption, personal and family history of atopy, and obstructive sleep apnea. Allergy to A simplex was the most commonly recorded cause.

Role of creatine kinase as an allergen in immediate selective allergy to pork meat

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Actin as a possible cross-reactive allergen between fish and poultry

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Heterogeneous predisposing factors and etiology of edema of the uvula in a Spanish population

BACKGROUND: Edema of the uvula (EU) may appear in isolation or in association with clinical manifestations such as urticaria, angioedema, and anaphylaxis. EU may lead to upper airway obstruction, provoking obstructive respiratory distress and asphyxia. OBJECTIVE: We sought to investigate the etiology of and predisposing factors for EU in a large population of patients referred to an outpatient clinic. METHODS: In this 3-year follow-up cohort study, 171 patients presenting with EU were identified and classified as having isolated EU or nonisolated EU. The etiology of each patient's condition was studied, and possible predisposing factors were recorded. An allergology work-up and a statistical study (bivariate/multivariate analyses) were performed. RESULTS: The predisposing factors for both groups of EU patients were found to be different. The etiology of the problem was identified for most patients; allergy to Anisakis simplex was the most common cause in both groups. Nonsteroidal anti-inflammatory drugs and antibiotics were also found to be triggers in both groups. CONCLUSIONS: Isolated EU was associated with snoring, an elongated uvula, and having experienced previous episodes of EU. We found no associations between groups of EU patients and gender, obesity, smoking, alcohol consumption, personal and family history of atopy, and obstructive sleep apnea. Allergy to A simplex was the most commonly recorded cause

INTRODUCCIÓN: El edema de úvula (EU) puede aparecer aislado o en asociación con otras manifestaciones clínicas, tales como urticaria, angioedema o anafilaxia. En cualquier caso, puede provocar una obstrucción de la vía aérea superior que a veces puede ser grave. OBJETIVO: Intentamos investigar la etiología y los factores predisponentes del EU de una gran población de pacientes derivados a nuestras consultas. MÉTODOS: En este estudio de cohortes de 3 años de seguimiento, se valoraron 171 pacientes que presentaban EU, clasificándose como EU aislado o EU no aislado. Se estudió la etiología de la condición clínica de cada paciente y se registraron los posibles factores predisponentes en cada caso, a través de un estudio alergológico y estadístico, con el fin de comprobar una asociación significativa entre ellos. RESULTADOS: Se encontró que los factores predisponentes para ambos grupos de pacientes eran diferentes. Una etiología fue identificada para la mayoría de los casos, siendo la alergia a Anisakis simplex la causa más común para ambos grupos. Los fármacos antiinflamatorios no esteroideos y los antibióticos también fueron identificados como etiologías para ambos grupos. CONCLUSIONES: Encontramos que el EU aislado se asoció con roncopatía, úvula elongada y haber sufrido episodios previos de EU. No se demostró asociación entre ambos grupos de pacientes con el sexo, obesidad, tabaquismo, hábito enólico, atopia personal y familiar o apnea obstructiva del sueño. La alergia a A. simplex fue la causa más frecuentemente demostrada