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.

Are bottled mineral waters and groundwater for human supply different?

Increasingly, bottled natural mineral water (NMW) is proposed as a healthy and safe alternative to supply water. However, tap supply water often comes from aquifers (TGW), even from the same aquifers as NMW, sharing the exact formation mechanisms and mineralization processes. Therefore, it is hypothesized that NMW and TGW cannot be distinguished. The chemical composition of TGW and NMW samples in Spain has been compared using five criteria: expert judgment, hydrochemistry, legal regulations, statistical analysis, and machine learning (ML). Hydrochemical criteria included all the NMW samples in the TGW group, as did the legal criterion, whereas classical statistical analysis could not find significant differences between the two groups. Although experts could correctly differentiate a small subsample of both types of water with an accuracy of 0.67, ML-based classification with Extreme Gradient Boosting yielded a balanced accuracy of 0.92 on an extremely imbalanced data set. Shapley Additive Explanations (SHAP) analysis identified pH, SiO2, E, K+, Ca2+, K+/Na+ and NO3- as the most relevant variables for water type discrimination. The overall consistency and generalization ability of the ML classifier has been proven by the spatial distribution of hits and misses, where the few cases of indistinguishable waters seem to be related to proximity to nature reserves (i.e., land use) more than to geological characteristics. Therefore, it can be concluded that NMW and TGW are indeed different and that only ML could find the hidden structure in the chemical data that determines the differences. This structure originates in how the market and consumers decide which water is ultimately bottled. The results can help on future choices of TGW and NMW in a context of water scarcity.

Tratamiento de 2 pacientes con prurito acuagénico con ciclos de terapia combinada UVA/UVB de banda estrecha una vez por año / Treatment of 2 Patients With Aquagenic Pruritus With UVA/Narrow Band UVB Combined Therapy Once a Year

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Protección de la salud mental en la emergencia social: reflexiones y orientaciones para profesionales de la salud mental / Mental health protection in the social emergency: reflections and guidelines for mental health workers

Las situaciones de emergencias y desastres causan sufrimiento y aumentan los problemas de salud mental de las poblaciones afectadas. Existen publicaciones nacionales e internacionales que entregan estrategias y orientaciones para proteger la salud mental de la población en estas situaciones. El estallido social ocurrido en Chile en octubre de 2019 presenta algunas particularidades que hacen necesario revisar conceptos y utilizarlos de manera pragmática para que los profesionales de salud podamos colaborar no sólo en la disminución del malestar y secuelas de eventos que han movilizado afectivamente a todo un país, sino que también como herramientas para lidiar con la ansiedad propia. En el artículo se propone el término de Emergencia Social para definir de manera más precisa el fenómeno. Se plantea la importancia de identificar y combatir la Ansiedad Persecutoria como mecanismo que promueve la polarización violenta a nivel individual y colectivo. Por último, se mencionan algunas recomendaciones generales respecto a las estrategias para proteger la salud mental de la población y recomendaciones específicas respecto del rol de los profesionales de salud mental en situaciones de emergencia.

Neoplasias benignas de vesicula biliar, un paradigma nacional / Benign neoplasms of gallbladder, a national paradigm

INTRODUCCION: En Chile, la indicación quirúrgica más frecuente corresponde a patología vesicular biliar, donde es posible encontrar tumores benignos y malignos, de morfología similar, lo que dificulta el diagnóstico diferencial. OBJETIVO: Caracterizar los hallazgos anatomopatológicos referentes a lesiones tumorales benignas de vesícula encontradas por colecistectomía. MATERIAL Y METODOS: Estudio observacional analítico, se analizaron retrospectivamente 5.699 biopsias correspondientes a todas las vesículas recibidas en Laboratorio de Anatomía Patológica de Concepción (LAP) durante los años 1998 y 2007. Estudio extrapolable al total de población chilena colecistectomizada anualmente con un 95 por ciento de confiabilidad y 80 por ciento de poder (p=0.05). RESULTADOS: 4.730 (83 por ciento) correspondieron a mujeres, conrelación hombre/mujer de 1: 4.9 (p<0.001). 279 vesículas presentaron lesiones tumorales benignas (4.9 por ciento). Las lesiones predominantes fueron las pseudotumorales (92.8 por ciento). La alteración más frecuente correspondió a pólipo (45.8 por ciento), en su mayoría de colesterol (53.1 por ciento) y múltiples (86.7 por ciento); seguido por la hiperplasia adenomiomatosa (41.2 por ciento). Dentro de los tumores epiteliales solo se encontraron adenomas (6 por ciento), manifestándose en su totalidad como pólipo acompañado en un 47 por ciento de displasia y en solo un caso de carcinoma in situ. De las lesiones de aspecto polipoídeo, la mayoría fueron lesiones pseudotumorales (87.1 por ciento), seguidas por adenomas (10.4 por ciento) y un 2.5 por ciento de cáncer. CONCLUSIONES: Destacan la baja frecuencia de lesiones tumorales benignas en el grupo estudiado, con incidencias menores a las internacionales para pólipos e hiperplasia adenomiomatosa, pero más altas que las reportadas para adenomas. La aparición de cáncer manifestado como pólipo de pequeño tamaño suma importancia al diagnóstico diferencial de estas lesiones en dicha localización.

BACKGROUND: In Chile, the most common surgical indication is the pathology of the gallbladder, where is likely to find benign and malignant lesions of similar morphology, making it difficult the differential diagnosis. OBJETIVE: To characterize the anatomo pathological findings of benign lesions of the gallbladder encountered by cholecystectomy. MATERIAL AND METHODS: Observational analytic study, 5.699 biopsies were hindsightanalyzed for all the gallbladders received at the Pathology Laboratory of Concepción (LAP) from 1998 to 2007. The study can be extrapolated to all the chilean cholecystectomized population with a reliability of 95 percent and 80 percent of power (p=0.05). RESULTS: 4,730 (83 percent) were women with a male/female ratio of 1: 4.9 (p<0.001). 279 gallbladders showed benign tumoral lesions (4.9 percent). The pseudotumoral lesions were predominant (92.8 percent). The most frequent alteration was polyp (45.8 percent), mostly of cholesterol (53.1 percent) and multiple (86.7 percent), followed by adenomatous hyperplasia (41.2 percent). Within the epithelial tumors, only adenomas were found (6 percent), expressed entirety as polyps, 47 percent with accompanying dysplasia and in just a case of carcinoma in situ. Of the polypoid lesions, most were pseudotumoral (87.1 percent), followed by adenomas (10.4 percent) and 2.5 percent of cancer. CONCLUTIONS: It is highlighting the low frequency of benign tumoral lesions in the studied group, with lower incidences than internationaly reported for polyps and adenomatous hyperplasia, but higher for adenomas. The emergence of cancer manifested as polyp greats the importance to the differential diagnosis of these injuries in that location.

[Traumatic rupture of thoracic aorta and non operative treatment of concomitant splenic lesion. Case report]. / Ruptura traumática de la aorta torácica y tratamiento no-operatorio de lesión esplénica concomitante. Caso clínico.

We report a 26 years old male that suffered a motorcycle accident resulting in a traumatic aortic rupture and splenic laceration. He was subjected to a surgical repair of the aortic lesion under complete heparinization. The splenic rupture was non operatively managed successfully.

[Massive epistaxis associated with trauma. An indication for superselective angiography and embolization. Clinical case]. / Epistaxis masiva asociada a trauma: una indicación de angiografía y embolización superselectiva. Caso clínico.

We report a 23 years old male admitted to the hospital after a fall from a great altitude with severe trauma. During the second week of hospitalization he presented a severe nosebleed that did not respond to conventional tamponade. A selective angiography was performed and the branches of the internal maxillary artery were embolized in two occasions, stopping the bleeding. The patient was discharged from the hospital after 71 days of hospitalization.

[Non operative treatment of liver and spleen trauma. Clinical experience]. / Tratamiento no operatorio de traumatismos de hígado y bazo. Experiencia clínica.

BACKGROUND: There is a tendency towards conservative behaviours in the treatment of blunt abdominal trauma. AIM: To perform a retrospective analysis of the results of conservative management of liver and spleen trauma. PATIENTS AND METHODS: Clinical charts of 21 patients with traumatic lesions of liver or spleen that were not operated, seen between 1991 and 1996, were reviewed. Severity of trauma was assessed according to the Abbreviated injury scale of 1985 and CAT scan lesions were scored according to scale proposed by the American Association of Trauma Surgery. RESULTS: Mean age of patients was 33.4 years old and 17 were male. Twelve patients had liver trauma, that had a mean severity index of 20.1. According to abdominal CAT scan, two patients had grade II lesions, 8 had grade III lesions and 2 had grade IV lesions. Two patients required transfusions and all had a successful recovery. Nine patients had spleen trauma, with a severity score of 24.4. Three patients required transfusions and one was subjected to a splenectomy. Mean hospital stay was 17.8 days for patients with liver trauma and 16 days for patients with spleen trauma. CONCLUSIONS: Non operative management of liver and spleen trauma is feasible and safe in a selected group of patients, independent of the degree of injury and hemoperitoneum.

Síndrome de Guillain Barre: crónico o recurrente / Guillain Barre syndrome: chronic or recurrent

En agosto de 1993, ingresó a la unidad de cuidados intensivos del Instituto Hondureño de Seguridad Social, una paciente femenina de 6.5 años de edad con cuadro de parálisis fláccida ascendente progresiva (Sindrome de Guillaín Barre) que afectó musculos de la respiración, recibiendo apoyo ventilatorio y medidas de sostén, su cuadro remitió hasta la recuperación completa. Un año después es reintegrada con igual cuadro recibiendo al igual que en la ocasión anterior apoyo ventilatorio y manejo de sostén, agregándose esta vez esteroides sistémicos, siendo de nuevo satisfactoria su evolución. El síndrome de Guillain Barré, es una patología poco frecuente y menos frecuente aún son los casos crónicos recurrentes, presentamos una revisión de su epidemiología, cuadro clínico, criterios diagnósticos y su manejo

[Blunt trauma of the liver: treatment and results in 45 patients]. / Traumatismo hepático cerrado: tratamiento y resultados en 45 pacientes.

We report a retrospective analysis of 45 patients (41 male) aged between 14 and 57 years, with a blunt liver trauma seen between 1984 and 1993. Sixty two percent had complex liver lesions and 73% extraabdominal injuries. Peritoneal lavage and abdominal ultrasound appeared as useful diagnosis tools. Five patients were not operated and had a satisfactory evolution. Among operated patients, liver lesions were corrected with simple measures in 60%, hepatotomy in 7.5% and resection in 17.5%. As additional measures, tamponade was used in 4, resuscitation thoracotomy in 4, porto caval shunt in 2 and Marimoto balloon in 1. Eighteen percent of patients died and 32% had postoperative complications.

[Late splenic rupture: a risk of conservative treatment]. / Rotura tardía del bazo: un riesgo del tratamiento conservador.

We report a 33 year old male admitted after a traffic accident with a painful abdomen and an open ankle fracture. An abdominal CAT scan showed a splenic laceration and free ascites. A conservative treatment was decided considering that the patient was hemodynamically stabilized. Seven days later, the patient appeared hypotense and with severe pain and was operated. During surgical intervention, a massive hemoperitoneum due to splenic bleeding from the spleen was found and a splenectomy was performed. Postoperative outcome was uneventful. The therapeutic approach to splenic traumatism ranges from splenectomy to medical treatment. The report case is an example of a complication of this later approach.

[Usefulness of magnetic resonance imaging in the diagnosis of diaphragmatic rupture in 3 cases]. / Utilidad de la resonancia magnética en el diagnóstico de ruptura diafragmática en 3 casos.

We report three male patients in whom the diagnosis of diaphragmatic rupture was raised. Conventional X ray examination showed an unilateal bulging of the diaphragmatic dome in two and the association of basal atelectasis in the third. Magnetic resonance imaging confirmed the diagnosis of diaphragmatic rupture in all. The diaphragmatic rupture was repaired surgically in two patients and the other was managed medically.

[Traumatic pancreatic pseudocyst, 2 cases]. / Pseudoquiste traumatico del pancreas en dos casos.

Two patients with traumatic pancreatic pseudocyst are presented. One patient was treated with percutaneous drainage and the other was operated on to perform a cystoenterostomy. Both patients recovered successfully. Diagnosis and treatment of this condition is discussed.