Las comunidades meiobentónicas en playas arenosas expuestas de la costa gallega (NO España), seis meses después del vertido de fuel del Prestige: importancia de los hidrocarburos aromáticos policíclicos (HAPs

The effect of polycyclic aromatic hydrocarbons (PAHs) on Galician sandy beach ecosystems, six months after the Prestige oil spill, was evaluated using the meiobenthos at a higher taxon level as an indicator. Meiobenthos community structure, environmental variables and sediment PAH content from six affected exposed beaches were studied and compared with three reference sites. They were also compared with data from polluted beaches obtained during the first days of the spill. Significant amounts of PAHs were found in affected beach sediments and both univariate and multivariate analyses showed differences between affected and reference beaches. Correlation analyses between PAH content and the meiobenthos community structure showed that 1,2-dimethylnaphthalene (C2-NAPH) and 1-methylphenanthrene (C-PHEN) affected both the community structure and the abundance of the main taxa. These two PAHs seem to be responsible for the low meiofauna density values, which suggests that there is a relationship between the oil spill and the differences between affected and reference localities– Este trabajo tiene como objetivo evaluar el efecto de los hidrocarburos aromáticos policíclicos (HAPs) en playas arenosas gallegas, seis meses después del vertido de fuel producido por el Prestige, utilizando el meiobentos a nivel de los grandes grupos zoológicos. Para llevar a cabo esta evaluación la comunidad meiobentónica, variables ambientales y el contenido en HAPs del sedimento fueron estudiados en seis playas intermareales afectadas y comparados con tres localidades de referencia. También fueron comparados con datos de playas contaminadas obtenidos durante los primeros días del derrame. Considerables cantidades de HAPs fueron encontradas en los sedimentos de las playas afectadas y tanto los análisis univariantes como los multivariantes indicaron diferencias entre las playas afectadas y las de referencia. Los análisis de correlación entre el contenido en HAPs y la estructura de la comunidad meiobentónica indicaron que el 1, 2-dimetilnaftaleno (C2-NAPH) y el 1-metilfenantreno (C-PHEN) jugaban un papel importante tanto en la estructura de la comunidad como en la abundancia de los principales taxones. Estos dos HAPs parecieron ser los responsables de las bajas densidades de meiofauna, corroborando la relación entre el vertido de fuel y las diferencias entre las localidades afectadas y de referenciaThis research was supported by the Ministerio de Ciencia y Tecnología (Programa Nacional: Acción urgente Prestige-Recursos Naturales)S

Estudio preliminar del efecto del fuel sobre la meiofauna de algunas playas gallegas, en los primeros días de la marea negra del Prestige

Con el objetivo de obtener una primera evaluación urgente del efecto de la marea negra provocada por el Prestige, hemos estudiado la meiofauna de varias playas gallegas en los días siguientes al accidente. Como parámetros poblacionales para el estudio de dichas comunidades hemos considerado la abundancia, la densidad, la heterogeneidad faunística y el índice Nematodos/Copépodos Harpacticoideos. En ninguna de las playas la meiofauna se vió totalmente eliminada. La densidad oscila entre 4 individuos/100 cc (Malpica) y 663 individuos/100 cc. (Lira) y la heterogeneidad faunística entre 2 taxones (Baldaio) y 8 taxones (Lariño, Lira). Las comunidades están dominadas por los Nematodos, los Copépodos Harpacticoideos o por una combinación de diferentes taxones

List of Medicines to Avoid in Primary Care Health and Their Application In Polymedicated Patients

[Resumen] Introduction: La alta prevalencia del uso de medicación inadecuada y sus importantes consecuencias para la salud requieren herramientas específicas y ágiles que ayuden a detectarla y evitarla. Objetivo de este trabajo fue elaborar un listado de medicamentos a evitar en AP y aplicarlo en pacientes polimedicados de un servicio asistencial de Atención Primaria (AP). Métodos: En la Base de datos del Consejo General de Colegios Oficiales de Farmacéuticos español (BOT-Plus) se comprobó el estado y disponibilidad de cada uno de los 93 medicamentos del Listado Prescrire 2019. Se elaboró el Listado de medicamentos a evitar en AP con aquellos que estaban comercializados en España y se excluyeron los que no estaban financiados y los de uso exclusivo hospitalario. 2 2 Con el listado de medicamentos a evitar en AP se hizo un análisis retrospectivo de todos (N=262) los informes de prescripción de polimedicados >10 medicamentos del año 2017 en un servicio asistencial de AP (5 centros de salud). Se realizó análisis de frecuencias, medidas de tendencia central y dispersión; se estimaron (IC 95%) y se utilizó X o exacta de Fisher para determinar la asociación entre variables y análisis de regresión logística. Resultados: Se observó una prevalencia de polimedicados de 1,2%, con una media de edad de 71,7 ± 12,4 años y una media de prescripciones de 12 ±1,7 medicamentos. El listado de medicamentos a evitar en AP incluyó 45 principios activos. Los fármacos a evitar más usados han sido: duloxetina, sitagliptina y olmesartán. El 50,4% de los polimedicados tenían al menos un medicamento a evitar y una edad media de 68,5±11,8 años. El sexo fue un factor de riesgo de prescripción inadecuada, el hecho de ser mujer incrementa con un OR=1,8 (IC 95%=1,3-3,0) la probabilidad de medicamentos a evitar. Conclusiones: Un alto porcentaje de pacientes polimedicados tienen prescripto al menos un medicamento a evitar. El listado de medicamentos a evitar en AP es una herramienta útil para identificar la medicación inadecuada y para uso de los profesionales de AP.[Abstract] Introduction: The high prevalence of inappropriate medication use and its important health consequences for health require specific and agile tools to detect and avoid it. The objective of this work was to elaborate a list of medications to avoid in Primary Care and to apply it on the polymedicated patients of a Primary Care assistance service. Methods: In the Database of the Spanish General Council of Official Associations of Pharmacists (BOT-Plus) the status and availability of each of the 93 MAE of the Prescrire 2019 List was checked. The list of medications to be avoided in Primary Care was drawn up with those that were marketed in Spain and excluded those that were not financed and those for exclusive hospital use. With the list of medicines to avoid in Primary Care, a retrospective analysis was made of all the prescription reports of polimedicated >10 medications for 2017 in a Primary Care services (N=262) in 5 health centers. Frequency analysis, central tendency measures and dispersion were carried out; they were estimated [CI: 95%] and X or Fisher’s exact was used to determine the association between variables and logistic regression analysis. Results: A prevalence of polymedicated drugs of 1.2% was observed, with a mean age of 71.7 years (DT± 12.4) and a mean prescription of 12 drugs (DT±1.7). The list of medications to be avoided in PC included 45 active ingredients. The 50.4% of the polymedicated had at least one drug to avoid and an average age of 68.5 years (DT±11.8). Sex was a risk factor for inappropriate prescription, the fact of being a woman increases with an OR=1.8 (IC95%=1, 3-3.0) the probability of having some medicines to avoid. The most commonly used drugs to avoid were: duloxetine, sitagliptin and olmesartan. Conclusions: A high percentage of polymedicated patients are prescribed at least one drug to avoid. The Primary Care medication avoidance list is a useful tool for identifying inappropriate medication and for the use by Primary Care professionals

Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain

Background Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. Methods A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. Results Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5-11.8) vs 3.4 years (IQR 0.4-9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5-8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. Conclusions MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients

Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain

Background Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. Methods A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. Results Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5–11.8) vs 3.4 years (IQR 0.4–9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5–8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. Conclusions MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients

Kairos study protocol: a multidisciplinary approach to the study of school timing and its effects on health, well-being and students’ performance

Recent evidence from chronobiology, chssronomedicine and chronopsychology shows that the organisation of social time (e.g., school schedules) generally does not respect biological time. This raises concerns about the impact of the constant mismatch between students’ social and internal body clocks on their health, well-being and academic performance. The present paper describes a protocol used to investigate the problem of (de) synchronisation of biological times (chronotypes) in childhood and youth in relation to school times. It studies the effects of student chronotype vs. school schedule matches/mismatches on health behaviours (e.g., how many hours students sleep, when they sleep, eat, do physical activity, spend time outdoors in daylight) and learning (verbal expression, spatial structuring, operations) and whether alert-fatigue levels mediate this effect alignments/misalignments on learning (verbal expression, spatial structuring, operations) and their mediation by alert-fatigue levels. The novelty of our protocol lies in its multidisciplinary and mixed methodology approach to a relevant and complex issue. It draws on up-to-date knowledge from the areas of biology, medicine, psychology, pedagogy and sociology. The methods employed include a varied repertoire of techniques from hormonal analysis (cortisol and melatonin), continuous activity and light monitoring, self-registration of food intake, sleep timings, exercise and exposure to screens, alongside with systematic application of cognitive performance tests (e.g., memory, reasoning, calculation, attention) and self-reported well-being. This comprehensive and interdisciplinary protocol should support evidence-based education policy measures related to school time organisation. Appropriate and healthier school timetables will contribute to social change, healthier students and with more efficient learning. The results of studies using a similar methodology in other countries would ensure replication and comparability of results and contribute to knowledge to support policy making

Evaluación a los dos meses del alta hospitalaria tras la primera ola de COVID-19: presencia de síntomas persistentes

Introduction: a series of symptoms have been reported after COVID-19, which have been encompassed in the so-named “postCOVID syndrome”. PostCOVID syndrome is a heterogeneous disorder with an uncertain pathophysiology. The aim of this study is to describe the characteristics and frequence of symptoms after COVID-19 discharge and to analyze the possible implicated factors. Methods: this is an observational propective study with COVID-19 patients hospitalized from March to April 2020. Patients were assessed in an outpatient clinic two months after discharge, and serological, radiological and laboratory workup was conducted. Previous medical history, length of stay (LOS) and intensive care unit (ICU) admission were recorded. Persistent symptons (PS) were defined as those appearing after the acute infection and present at follow-up. Results: 74 patients were included. Mean age was 66±13 years, and 54.4% patients were men. Six (8.1%) patients needed ICU admission, and median LOS was 8 (6-12) days. Forty (54.8%) patients presented PS, the most frequent being fatigue and dyspnea (20.3% each). 77% patients presented laboratory abnormalities but just in 11 cases (15.1%) were they severe. Ten (13.5%) had radiological abnormalities. 71 (95.9%) had positive IgG serology. There were no differences between patients with and without PS regarding previous medical history or acute infection course. PS patients had a higher heart rate 83 (75-93) vs 76 65-85) bpm; p=0.038) at assessment. Conclusion: symptoms and laboratory abnormalities are frequent two months after COVID-19, although usually mild. No predictors were found for the presence of PS, but larger studies are needed to ascertain this aseverationIntroducción: se han notificado tras el alta por COVID-19 una serie de síntomas englobados dentro del llamado “síndrome post-COVID”, un cuadro heterogéneo cuya fisiopatología es incierta. Nuestro objetivo es describir las características y frecuencia de síntomas tras el alta y analizar los posibles factores relacionados. Métodos: estudio observacional prospectivo con pacientes ingresados por COVID-19 durante marzo-abril de 2020. Se evaluó en consulta a los dos meses tras el alta con valoración clínica, analítica, serología y radiografía de tórax. Se recogieron los antecedentes, la estancia hospitalaria y la necesidad de UCI. Se definieron síntomas persistentes (SP) como síntomas que aparecieron desde la infección aguda y que se mantenían al seguimiento. Resultados: se revisaron 74 pacientes. La edad media fue 66±13 años, siendo un 51,4% hombres. Seis (8,1%) ingresaron en UCI, y la mediana de estancia fue 8 (6-12) días. Cuarenta (54,8%) presentaron SP, siendo los más frecuentes astenia y disnea (20,3% ambos). Un 77% tenía alteraciones analíticas pero solo en 11 (15,1%) fueron relevantes. Diez (13,5%) presentaban alteraciones radiológicas y 71 (95,9%) tenían IgG positiva. No hubo diferencias entre los pacientes con y sin SP en sus antecedentes o evolución hospitalaria. Los pacientes con SP estaban más taquicárdicos [83 (75-93) lpm vs 76 (65-85) lpm; p=0,038], no existiendo diferencias significativas en el resto de variables. Conclusión: al seguimiento tras la COVID-19 es frecuente la presencia de síntomas o alteraciones analíticas, aunque no suelen traducir gravedad. No encontramos variables que predijeran la presencia de los mismos, pero sería interesante analizar cohortes más amplia

Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain

Background Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. Methods A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. Results Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5–11.8) vs 3.4 years (IQR 0.4–9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5–8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. Conclusions MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients