Obstructive jaundice of a parasitic etiology

We present the case of a patient with colic pain in the epigastrium and right hypochondrium, which was accompanied by choluria and acholia and slightly elevated levels of bilirubin and eosinophilia. Abdominal echography and magnetic resonance imaging identified a biliary obstruction and endoscopic retrograde cholangiopancreatography was used to extract 3 adult worms identified as Fasciola hepatica. This case highlights the need to consider the suspicion of biliary obstruction caused by Fasciola hepatica in the presence of obstructive jaundice, with or without eosinophilia

Bioaccumulation of inorganic elements in dreissena polymorpha from the Ebro river, Spain: could zebra mussels be used as a bioindicator of the impact of human activities?

Dreissena polymorpha is among the top 100 most harmful invasive species in aquatic habitats. European Directive 2013/39/UE establishes Environmental Quality Standards for biota because it has been demonstrated that pollutants bioaccumulate in aquatic organisms. This study evaluated bioaccumulation of inorganic elements in the soft tissues of D. polymorpha in order to assess the usefulness of zebra mussels as a bioindicator of contaminant presence in super fi cial waters. Concentrations of 66 elements were measured in order to evaluate their relation- ship with nearby anthropogenic activity and to the values recommended by Environmental Quality Standards for biota. Bivalves were col- lected from four sample points along the Ebro River Basin (Spain), where diverse human activities are carried out. Zebra mussels accumulate toxins in soft tissue during their life cycle, including Al, Cr, Fe, Hg, Pb, Th, Cd and U. The highest levels of accumulation corresponded to elements associated with human activity in the area, showing the impact of anthropogenic actions on biota. D. polymorpha not only supplies information about current water quality but also acts as a witness of past water quality by bioconcentrating toxic elements present in the environment and providing relevant results about historical water contamination. In conclusion, D. polymorpha is a harmful and dangerous invasive species, but its pervasiveness means that it can be used as a bioindicator to assess current and past presence of elements in water

Damping of long-wavelength collective excitations in quasi-onedimensional Fermi liquids

The imaginary part of the exchange-correlation kernel in the longitudinal current-current response function of a quasi-onedimensional Fermi liquid is evaluated by an approximate decoupling in the equation of motion for the current density, which accounts for processes of excitation of two particle-hole pairs. The two-pair spectrum determines the intrinsic damping rate of long-wavelength collective density fluctuations, which is calculated and contrasted with a result previously obtained for a clean Luttinger liquid.Comment: 9 pages, no figures, Physica B in pres

Using Pareto optimality to explore the topology and dynamics of the human connectome.

Graph theory has provided a key mathematical framework to analyse the architecture of human brain networks. This architecture embodies an inherently complex relationship between connection topology, the spatial arrangement of network elements, and the resulting network cost and functional performance. An exploration of these interacting factors and driving forces may reveal salient network features that are critically important for shaping and constraining the brain's topological organization and its evolvability. Several studies have pointed to an economic balance between network cost and network efficiency with networks organized in an 'economical' small-world favouring high communication efficiency at a low wiring cost. In this study, we define and explore a network morphospace in order to characterize different aspects of communication efficiency in human brain networks. Using a multi-objective evolutionary approach that approximates a Pareto-optimal set within the morphospace, we investigate the capacity of anatomical brain networks to evolve towards topologies that exhibit optimal information processing features while preserving network cost. This approach allows us to investigate network topologies that emerge under specific selection pressures, thus providing some insight into the selectional forces that may have shaped the network architecture of existing human brains

Amebas de vida libre en aguas residuales y fangos: Su papel como reservorio natural de bacterias potencialmente patógenas

Las amebas de vida libre (AVL) son protozoos ubicuos, presentes en suelos y en ecosistemas acuáticos naturales y artificiales. Participan en los procesos de depuración desarrollados en las Estaciones Depuradoras de Aguas Residuales (EDAR), convirtiéndolas en un nicho ecológico idóneo para la proliferación de AVL, que las colonizan e instauran en ellas su hábitat, ya que se alimentan de bacterias presentes en el medio. Los procesos de depuración biológica no están diseñados con el fin de eliminar la contaminación microbiológica, aunque ayudan a reducir algunas poblaciones bacterianas. Hasta la fecha, sólo algunas especies y géneros de AVL han sido descritos como patógenos, pero todas ellas suponen un riesgo como reservorio de bacterias patógenas. Su forma quística, les confiere resistencia frente a las condiciones adversas y desinfectantes comunes, permitiéndoles superar los procesos de depuración y potabilización y colonizar sistemas artificiales de agua. En este trabajo, se estudió la presencia de AVL en aguas y fangos de 5 EDAR que vierten sus aguas a la cuenca del Ebro, analizando un total de 20 puntos de muestreo. Para ello, se llevó a cabo el aislamiento AVL y la posterior identificación de género y especie, así como de las bacterias endosimbiontes, mediante la reacción en cadena de la polimerasa (PCR). De las 41 amebas aisladas en el 85 % de las muestras, 21 fueron identificadas genéticamente. Trece de ellas, pertenecieron al género Acanthamoeba spp., 6 a Naegleria spp. y 2 se identificaron como Vermamoeba vermiformis. El 53,66 % de las AVL albergaba en su interior Mycobacterium spp., el 29,27 % Legionella pneumophila y el 14,63 % Pseudomonas spp. Free-living amoebae (FLA) are ubiquitous protozoa, present in soils and in natural and artificial aquatic ecosystems. They take part in the purification processes that take place in Wastewater Treatment Plants (WWTPs), thereby turning these plants into ecological niches suitable for proliferation of FLAs, which they colonize and in which they establish their habitat, since they feed on bacteria present in the environment. Biological purification processes are not designed to remove microbiological contamination, although they help to reduce some microbial populations. At present only some genera and species of FLAs have been described as pathogenic, but all of them pose a risk as reservoirs of pathogenic bacteria. Their cystic stage gives them resistance to adverse conditions and common disinfectants, allowing them to withstand water purification processes and colonize artificial water systems. The presence of FLAs in waters and sludges from 5 WWTPs that discharge their waters into the Ebro river basin has been studied in this work. To this end, a total of 20 sample points were analysed by isolating the FLAs and subsequently identifying their genus and species. The same was done for endosymbiotic bacteria, by Polymerase Chain Reaction (PCR). Out of 41 FLAs that were isolated in 85 % of the samples, 21 were genetically identified. Thirteen belonged to the genus Acanthamoeba spp., 6 to Naegleria spp. and 2 were identified as Vermamoeba vermiformis. 53.66 % of FLAs hosted Mycobacterium spp., 29.27 % Legionella pneumophila, and 14.63 % Pseudomonas spp

Health and science-related disinformation on COVID-19: A content analysis of hoaxes identified by fact-checkers in Spain

A massive "infodemic" developed in parallel with the global COVID-19 pandemic and contributed to public misinformation at a time when access to quality information was crucial. This research aimed to analyze the science and health-related hoaxes that were spread during the pandemic with the objectives of (1) identifying the characteristics of the form and content of such false information, and the platforms used to spread them, and (2) formulating a typology that can be used to classify the different types of hoaxes according to their connection with scientific information. The study was conducted by analyzing the content of hoaxes which were debunked by the three main fact-checking organizations in Spain in the three months following WHO¿s announcement of the pandemic (N = 533). The results indicated that science and health content played a prominent role in shaping the spread of these hoaxes during the pandemic. The most common hoaxes on science and health involved information on scientific research or health management, used text, were based on deception, used real sources, were international in scope, and were spread through social networks. Based on the analysis, we proposed a system for classifying science and health-related hoaxes, and identified four types according to their connection to scientific knowledge: ¿hasty¿ science, decontextualized science, badly interpreted science, and falsehood without a scientific basis

El gen tpi como herramienta en los estudios epidemiolo´gicos de la giardiosis

Giardia duodenalis es un protozoo que causa infección en humanos y animales, que se puede transmitir por vía hídrica, de persona a persona o por contacto con animales, siendo una de las infecciones intestinales más frecuentes en nuestro país, por lo que supone una preocupación de Salud Pública. Su estudio epidemiológico, requiere la caracterización molecular de los parásitos, utilizando genes con gran variabilidad como el que codifica la triosafosfatoisomerasa (tpi) y analizando la homología entre aislamientos. El objetivo del trabajo es establecer el criterio de identidad que permita la comparación epidemiológica de los aislamientos de Giardia. Se recogieron 2-3 muestras de heces en días alternos, de 26 pacientes con giardiosis. Tras la extracción de ADN, se amplificaron por técnicas de PCR, un fragmento del gen tpi y un fragmento del gen de la beta-giardina (bg), que se utilizó como comparación. Los fragmentos obtenidos fueron secuenciados y las secuencias analizadas con los programas BioEdit y DnaSP v.5.0. Las secuencias del gen tpi mostraron una elevada divergencia, con valores de diversidad ¿ entre 0 y 0, 21219. La aparición de picos múltiples en el cromatograma, indicaron la presencia de varios clones en la misma muestra. Las diferencias entre aislamientos del mismo paciente fueron iguales o mayores que las encontradas para el conjunto de todas las muestras. La variabilidad del gen tpi no permite establecer unos criterios de identidad, necesarios para la identificación de aislamientos. Las infecciones mixtas intragenotipo ocurren de una forma muy frecuente, sugiriendo una implicación de la vía ambiental como principal fuente de transmisión o una variación genética muy elevada. Giardia duodenalis is a protozoon that causes infection in humans and animals. It can be transmitted by contaminated water, from person to person or by contact with animals; it being the cause one of the most common intestinal infections in our country, so it is a public health concern. The epidemiological study thereof requires the molecular characterization of parasites, using genes with great variability, such as the one that codes triosephosphate isomerase (tpi), and analizing the homology between isolates. The purpose of this work is to establish the identity criterion for epidemiological comparison of Giardia isolates. 2-3 stool samples were collected in alternate days from 26 patients with giardiasis. After DNA extraction, a fragment of the tpi gene and a fragment of the beta-giardin (bg) gene-used for comparison purposes-were amplified by means of PCR techniques. The obtained fragments were sequenced and the sequences analyzed with the BioEdit and DnaSP v.5.0 software. The tpi gene sequences showed a high divergence, with values of diversity ¿ ranging from 0 to 0.21219. The appearance of multiple peaks in the chromatogram points to the presence of various clones in the same sample. The differences between isolates from the same patient where equal or higher than those found for the collection of all samples. The variability of the tpi gene does not allow identity criteria to be established, which are necessary for isolate identification. Mixed intragenotype infections occur very frequently, which suggests the environmental path is the principal path of transmission and/or there is very high genetic variability

Mentiras contagiosas. Guía para esquivar la desinformación en salud

Internet y las redes sociales han democratizado la comunicación de contenidos sobre salud y han multiplicado la difusión pública de informaciones relacionadas con ese tema. Muchas de las informaciones sanitarias proceden de fuentes acreditadas y son plenamente solventes, lo que permite a la ciudadanía acceder fácilmente a información de calidad que promueve comportamientos responsables. Sin embargo, al mismo tiempo, en las redes circulan cada vez más contenidos sobre salud de procedencia desconocida y fiabilidad dudosa. Buena parte de esos mensajes son, de hecho, intencionadamente engañosos. Las redes, en definitiva, son una moneda de dos caras: dan acceso a contenidos sanitarios de calidad, pero exponen asimismo a la ciudadanía a diversos riesgos. Esta guía pretende desarrollar y divulgar pautas que sirvan para contrarrestar el fenómeno de la desinformación en materia de salud

A multi-stakeholder multicriteria decision analysis for the reimbursement of orphan drugs (FinMHU-MCDA study)

Background: Patient access to orphan medicinal products (OMPs) is limited and varies between countries, reimbursement decisions on OMPs are complex, and there is a need for more transparent processes to know which criteria should be considered to inform these decisions. This study aimed to determine the most relevant criteria for the reimbursement of OMPs in Spain, from a multi-stakeholder perspective, and using multicriteria decision analysis (MCDA). Methods: An MCDA was developed in 3 phases and included 28 stakeholders closely related to the field of rare diseases (6 physicians, 5 hospital pharmacists, 7 health economists, 4 patient representatives and 6 members from national and regional health authorities). Initially [phase A], a bibliographic review was conducted to identify the potential reimbursement criteria. Then, a reduced advisory board (8 members) proposed, selected, and defined the final list of criteria that could be relevant for reimbursement. A discrete choice experiment (DCE) [phase B] was developed to determine the relevance and relative importance weight of such criteria according to the stakeholders’ preferences by choosing between pairs of hypothetical financing scenarios. A multinomial logit model was fitted to analyze the DCE responses. Finally [phase C], the advisory board review the results using a deliberative process. Results: Thirteen criteria were selected, related to 4 dimensions: patient population, disease, treatment, and economic evaluation. Nine criteria were deemed relevant for decision-making and associated with a higher relative importance: Health-related quality of life (HRQL) (23.53%), treatment efficacy (14.64%), availability of treatment alternatives (13.51%), disease severity (12.62%), avoided costs (11.21%), age of target population (7.75%), safety (seriousness of adverse events) (4.72%), quality of evidence (3.82%) and size of target population (3.12%). The remaining criteria had a < 3% relative importance: economic burden of disease (2.50%), cost of treatment (1.73%), cost-effectiveness (0.83%) and safety (frequency of adverse events) (0.03%). Conclusion: The reimbursement of OMPs in Spain should be determined by its effect on patient’s HRQL, the extent of its therapeutic benefit from efficacy and the availability of other therapeutic options. Furthermore, the severity of the rare disease should also influence the decision along with the potential of the treatment to avoid associated costs