Determinación de arsénico en cabello de poblaciones expuestas en Matehuala, San Luis Potosí, México

"La problemática de contaminación en agua por disolución de arseniatos de calcio en Matehuala, San Luis Potosí, México, ha sido propuesta como la más alta en el mundo a pH cercanos al neutro. No obstante, antes de este estudio, no se habían realizado esfuerzos por determinar la concentración de arsénico en la población. Lo anterior, probablemente debido a que los aprovechamientos hídricos contaminados no son utilizados para beber agua. Sin embargo, si se usan, eventualmente, para la irrigación de cultivos de traspatio, actividades pecuarias y recreativas. Derivado de estas prácticas, existen entonces rutas potenciales de entrada de arsénico al cuerpo humano y a la cadena alimenticia, lo que representa un riesgo por contacto e ingesta de arsénico a través del consumo de alimentos cultivados en suelos contaminados y/o de animales alimentados con forrajes cultivados en suelos enriquecidos con arsénico que, además, pudieran beber agua en abrevaderos contaminados. Por lo anterior, el objetivo de este trabajo fue determinar la concentración de arsénico en cabello de poblaciones expuestas, con la finalidad de utilizarlo como biomarcador de exposición, para determinar si, en su caso, la población presenta acumulación de arsénico en concentraciones consideradas peligrosas para el humano de acuerdo al valor guía de la Agencia para Sustancias Toxicas y Registro de Enfermedades (ATSDR, por sus siglas en inglés) de 1 mg/kg. Además, se buscó explicar el posible origen de la exposición por las vías oral, de inhalación y dérmica. Para lo anterior se recolectaron 78 muestras de cabello de habitantes de poblaciones expuestas (Matehuala y Cerrito Blanco) y no expuestas (Encarnación de Arriba y Encarnación de Abajo) y se les determinó la concentración de arsénico en el mismo previa digestión ácida. Adicionalmente, también se recolectaron muestras de agua para beber y muestras de agua de uso doméstico con la finalidad de excluir su posible aportación a la exposición de arsénico en los habitantes del lugar. Por último, se recolectó información sobre la edad, el género, el tiempo de residencia de los habitantes en el sitio, los usos que le dan al agua, la práctica de actividades agropecuarias y hábitos alimenticios. Se encontró presencia de arsénico en cabello de individuos expuestos.""The contamination by calcium arsenate dissolution (at pH close to neutral) in Matehuala waters, in San Luis Potosi, Mexico, has been proposed as the highest in the world. Despite this, no efforts had been undertaken to determine the concentration of arsenic in Matehuala population previously. The cause of this fact is probably that arsenic contaminated water in the area is not in a drinking source; however, it is reported that this water is eventually used for crop irrigation, livestock, and recreational activities. Derived from these practices, there are, therefore, potential routes of arsenic intake into the human body and the food chain, representing a risk for arsenic contact and ingestion. The main sources of arsenic intake became, then, the crop plants grown in contaminated soil and / or animals fedded with arsenic contaminated food and/or water. Therefore, the aim of this study was to identify the concentration of arsenic in hair of the Matehuala exposed population, in order to use it as a biomarker of arsenic exposure. This biomarker can be used as an indicator of arsenic accumulation or exposure permitting to determine if the population is exposure to arsenic values considered as dangerous to human according to the Agency for Toxic Substances and Disease Registry (ATSDR) guide value (1 mg / kg). In addition, this research intent to explain the probable origin of the oral, inhalation and dermal exposure.To accomplish this objective, 78 hair samples, from supposedly exposed individuals from Matehuala and Cerrito Blanco population and from unexposed individuals from Encarnación de abajo y Encarnación de arriba, were collected and analyzed to determine arsenic concentration. The samples were treated by acid digestion and arsenic concentration was determined by Flow Injection Analysis coupled with Atomic Absortion Spectrometry (FIAS-AA). In addition, drinking and domestic water samples were collected in order to determine the possible water contribution to the arsenic exposure in local residents. Finally, information about life conditions (age, gender, residence time, water uses and eating habits, among others) of the inhabitans of the region was collected.In the supposedly exposed individuals from Matehuala, and Cerrito Blanco population, the arsenic concentrations values in hair were higher than the background (assumed as the value of the unexposured individuals) and the ATSDR guide value.

Uso da metabolómica ecológica como ferramenta complementar para o estudo da saúde integral dos ecossistemas

The planet's ecosystems show symptoms that clearly warn us that resilience processes are no longer as efficient; they are in decline as a result of of various human activities that alter their physical, chemical and biological components and their interrelationships. Therefore, this rapid deterioration calls for more appropriate environmental monitoring, increasingly intensifying the need for indicators that are more operational in nature. One of the limitations that arise when monitoring an ecosystem is that there are no tools for detecting and revealing potentially harmful changes in its functional capabilities early on. However, the holistic approach of the so-called omics sciences (genomics, transcriptomics, metabolomics), especially metabolomics, could be an important tool for generating data to access the metacognition of the concept of ecological vulnerability and its importance in monitoring an ecosystem. The basis of metabolomics is the monitoring of phenotypic variability in response to environmental changes (biotic and biotic interactions), which permits a better analysis of the different response capabilities provided by the phenotypic plasticity of each species, thus allowing the metabolic patway that is associated with this plasticity, to be determined. The metabolic responses of species are essential to monitoring ecosystems. This approach shows great potential for obtaining not only individual data on organisms but also networks of data on the metabolic behavior of populations or ecosystems in a spatial and temporal manner, which makes it a very interesting tool for monitoring ecosystems.Los ecosistemas del planeta presentan síntomas que nos advierten claramente que los procesos de resiliencia ya no son tan eficientes; están en declive, como consecuencia de diversas actividades humanas que alteran sus componentes físicos, químicos, biológicos y sus interrelaciones. Por lo tanto, este rápido deterioro requiere de una monitorización ambiental más adecuada, intensificando la necesidad de indicadores que sean más operativos. Una de las limitantes que se presenta al momento de monitorear un ecosistema es que no se cuenta con herramientas que evidencien y detecten tempranamente cambios potencialmente dañinos en las capacidades funcionales del mismo. Sin embargo, el enfoque holístico de las llamadas ciencias ómicas (genómica, transcriptómica, metabolómica), en especial metabólomica, podría ser una importante herramienta que permita generar datos para acceder a la metacognición del concepto de vulnerabilidad ecológica y su importancia al momento de monitorear un ecosistema. La base de la metabolómica es el monitoreo de la variabilidad fenotípica en respuesta a los cambios ambientales (interacciones bióticas y abióticas), proporcionando un mejor análisis de las diferentes capacidades de respuesta conferidas por la plasticidad fenotípica de cada especie, permitiendo así, determinar el metabolismo que está involucrado en esta plasticidad. Las respuestas metabólicas de las especies son determinantes al momento de monitorear un ecosistema. Esta aproximación tiene un gran potencial para establecer no solo datos individuales de un organismo, sino redes de datos del comportamiento metabólico de poblaciones, o ecosistemas de manera espacial y temporal convirtiéndola en una herramienta muy interesante para monitorear un ecosistema.Os ecossistemas do planeta apresentam sintomas que nos alertam claramente para a falta de eficiência dos processos de resiliência; estão em declínio, em consequência das diversas atividades humanas, que alteram os seus componentes físicos, químicos, biológicos e as suas inter-relações. Portanto, a rápida degradação requer um acompanhamento ambiental adequado, intensificando a necessidade de indicadores que sejam mais operacionais. Uma das limitações que surge na monitorização de um ecossistema, é o facto das ferramentas de medição não anteciparem as alterações potencialmente nocivas às capacidades funcionais do mesmo. Porém, o enfoque holístico das chamadas ciências Ómicas (Genómica, Transcritómica, Metabolómica), em especial a metabómica, pode constituir uma ferramenta importante, que permita gerar dados para aceder à metacognição do conceito de vulnerabilidade ecológica e a sua importância, no momento de monitorar um ecossistema. A base da metabómica é o acompanhamento da variabilidade fenotípica, em resposta às alterações ambientais (interações bióticas e abióticas) proporcionando uma melhor análise das diferentes capacidades de resposta, conferida pela plasticidade fenotípica de cada espécie, permitindo assim, determinar o metabolismo que está envolvido na plasticidade. As respostas metabólicas das espécies são determinantes no momento de monitorar um ecossistema. Esta abordagem tem o grande potencial de estabelecer, não apenas dados individuais de um organismo, mas redes de dados do comportamento metabólico de populações ou ecossistemas de maneira espacial e temporal, tornando-a uma ferramenta altamente sugestiva para monitorar um ecossistema

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Uso da metabolómica ecológica como ferramenta complementar para o estudo da saúde integral dos ecossistemas

The planet's ecosystems show symptoms that clearly warn us that resilience processes are no longer as efficient; they are in decline as a result of of various human activities that alter their physical, chemical and biological components and their interrelationships. Therefore, this rapid deterioration calls for more appropriate environmental monitoring, increasingly intensifying the need for indicators that are more operational in nature. One of the limitations that arise when monitoring an ecosystem is that there are no tools for detecting and revealing potentially harmful changes in its functional capabilities early on. However, the holistic approach of the so-called omics sciences (genomics, transcriptomics, metabolomics), especially metabolomics, could be an important tool for generating data to access the metacognition of the concept of ecological vulnerability and its importance in monitoring an ecosystem. The basis of metabolomics is the monitoring of phenotypic variability in response to environmental changes (biotic and biotic interactions), which permits a better analysis of the different response capabilities provided by the phenotypic plasticity of each species, thus allowing the metabolic patway that is associated with this plasticity, to be determined. The metabolic responses of species are essential to monitoring ecosystems. This approach shows great potential for obtaining not only individual data on organisms but also networks of data on the metabolic behavior of populations or ecosystems in a spatial and temporal manner, which makes it a very interesting tool for monitoring ecosystems.Los ecosistemas del planeta presentan síntomas que nos advierten claramente que los procesos de resiliencia ya no son tan eficientes; están en declive, como consecuencia de diversas actividades humanas que alteran sus componentes físicos, químicos, biológicos y sus interrelaciones. Por lo tanto, este rápido deterioro requiere de una monitorización ambiental más adecuada, intensificando la necesidad de indicadores que sean más operativos. Una de las limitantes que se presenta al momento de monitorear un ecosistema es que no se cuenta con herramientas que evidencien y detecten tempranamente cambios potencialmente dañinos en las capacidades funcionales del mismo. Sin embargo, el enfoque holístico de las llamadas ciencias ómicas (genómica, transcriptómica, metabolómica), en especial metabólomica, podría ser una importante herramienta que permita generar datos para acceder a la metacognición del concepto de vulnerabilidad ecológica y su importancia al momento de monitorear un ecosistema. La base de la metabolómica es el monitoreo de la variabilidad fenotípica en respuesta a los cambios ambientales (interacciones bióticas y abióticas), proporcionando un mejor análisis de las diferentes capacidades de respuesta conferidas por la plasticidad fenotípica de cada especie, permitiendo así, determinar el metabolismo que está involucrado en esta plasticidad. Las respuestas metabólicas de las especies son determinantes al momento de monitorear un ecosistema. Esta aproximación tiene un gran potencial para establecer no solo datos individuales de un organismo, sino redes de datos del comportamiento metabólico de poblaciones, o ecosistemas de manera espacial y temporal convirtiéndola en una herramienta muy interesante para monitorear un ecosistema.Os ecossistemas do planeta apresentam sintomas que nos alertam claramente para a falta de eficiência dos processos de resiliência; estão em declínio, em consequência das diversas atividades humanas, que alteram os seus componentes físicos, químicos, biológicos e as suas inter-relações. Portanto, a rápida degradação requer um acompanhamento ambiental adequado, intensificando a necessidade de indicadores que sejam mais operacionais. Uma das limitações que surge na monitorização de um ecossistema, é o facto das ferramentas de medição não anteciparem as alterações potencialmente nocivas às capacidades funcionais do mesmo. Porém, o enfoque holístico das chamadas ciências Ómicas (Genómica, Transcritómica, Metabolómica), em especial a metabómica, pode constituir uma ferramenta importante, que permita gerar dados para aceder à metacognição do conceito de vulnerabilidade ecológica e a sua importância, no momento de monitorar um ecossistema. A base da metabómica é o acompanhamento da variabilidade fenotípica, em resposta às alterações ambientais (interações bióticas e abióticas) proporcionando uma melhor análise das diferentes capacidades de resposta, conferida pela plasticidade fenotípica de cada espécie, permitindo assim, determinar o metabolismo que está envolvido na plasticidade. As respostas metabólicas das espécies são determinantes no momento de monitorar um ecossistema. Esta abordagem tem o grande potencial de estabelecer, não apenas dados individuais de um organismo, mas redes de dados do comportamento metabólico de populações ou ecossistemas de maneira espacial e temporal, tornando-a uma ferramenta altamente sugestiva para monitorar um ecossistema

Trasplante hepático: proceso asistencial integrado. 2ª ed

Publicado en la página web de la Consejería de Salud: www.juntadeandalucia.es/salud (Consejería de Salud / Profesionales / Nuestro Compromiso por la Calidad / Procesos Asistenciales Integrados)YesConjunto de actividades secuenciales para el tratamiento médico-quirúrgico al paciente afecto de una enfermedad hepática crónica avanzada o aguda irreversible, que es evaluado e incluido en lista de espera para sustituir su hígado enfermo por un hígado sano, parcial o totalmente, procedente de un donante cádaver o un donante vivo y, posteriormente, ser seguido de manera continua, con el objetivo de normalizar la función hepática y mejorar su calidad de vida

Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis—The ESCAPE Study

International audienceBackground: Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment.Methods: We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome.Results: Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects.Conclusion: L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective

Role of age and comorbidities in mortality of patients with infective endocarditis.

The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups: A total of 3120 patients with IE (1327  There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in th