Experience of primary care nurses applying nurse-led management of patients with acute minor illnesses.

AIM: The aim of this study is to determine the experience of primary health care nurses regarding the application of nurse-led management in patients with acute minor illnesses. BACKGROUND: Nursing leadership of care for acute minor illnesses is a new challenge faced by nurses in Spain. DESIGN: Qualitative, hermeneutical, interpretive phenomenological approach is used. The Consolidated criteria for reporting qualitative research guidelines were applied. METHODS: Twenty primary care nurses participated; three focus group discussions and nine semi-structured interviews were conducted between November 2019 and October 2020. All the focus group discussions and interviews were recorded, transcribed verbatim and analysed using content analysis. RESULTS: Seven main themes emerged from the focus group discussions and interviews: concept, perception of the other actors, practice, history and social context, competencies, training, and legality. CONCLUSION: The study shows the diversity and complexity of nurses' experience when applying nurse-led management in acute minor illnesses. This work has helped to show the gaps perceived by nurses, including the lack of training in the treatment of conditions historically attended by physicians, the lack of definition of the legal framework and the limitations on nurse prescribing. It also highlighted the power of the nursing profession in terms of autonomy, competencies and role expansion.

Influence of Age and Cardiovascular Risk Factors in Vestibular Neuritis: Retrospective Cohort Study.

To analyze the influence of age and cardiovascular risk factors (CVRFs) in the evolution of vestibular neuritis (VN). METHODS: Retrospective cohort study. VN-diagnosed patients were included and divided into two groups: those with and without CVRFs. We analyzed the mean vestibular-ocular reflex (VOR) gain, measured through the video head impulse test (vHIT) at the diagnosis and one-year follow-up. We conducted a factorial analysis of variance (ANOVA) to evaluate the effect of age, sex, and CVRFs in the mean VOR gain. RESULTS: Sixty-three VN-diagnosed patients were included. There were no statistically significant differences in the mean VOR gain between both groups. However, in the subgroup analysis, there were statistically significant differences when comparing the mean VOR gain at the one-year follow-up between the group over 55 years of age 0.77 ± 0.20 and the group under 55 years 0.87 ± 0.15 (p = 0.036). Additionally, the factorial ANOVA demonstrated a significant main effect of age group on the mean VOR gain at the one-year follow-up (p = 0.018), and it also found a significant interaction between the factors of gender, age group, HTN (p = 0.043). CONCLUSIONS: CVRFs do not independently affect the mean VOR gain in VN patients' follow-ups. However, age significantly impacts VOR gain in VN and could be modulated by gender and hypertension.

Use of Skull Vibration-Induced Nystagmus in the Follow-up of Patients With Ménière Disease Treated With Intratympanic Gentamicin.

OBJECTIVES: Ménière disease (MD) is an idiopathic disorder that affects hearing and inner ear balance. Intratympanic gentamicin (ITG) is recognized as an effective treatment for uncontrolled MD characterized by persistent vertigo attacks despite therapy. The video head impulse test (vHIT) and skull vibration-induced nystagmus (SVIN) are validated. METHODS: for evaluating vestibular function. A progressive linear relationship has been identified between the slow-phase velocity (SPV) of SVIN determined using a 100-Hz skull vibrator and the gain difference (healthy ear/affected ear) measured by vHIT. The aim of this study was to ascertain whether the SPV of SVIN was associated with the recovery of vestibular function following ITG treatment. Consequently, we sought to determine whether SVIN could predict the onset of new vertigo attacks in patients with MD who were treated with ITG. METHODS: A prospective longitudinal case-control study was conducted. Several variables were recorded post-ITG and throughout the follow-up period, followed by statistical analyses. Two groups were compared: patients who experienced vertigo attacks 6 months after ITG and those who did not. RESULTS: The sample comprised 88 patients diagnosed with MD who underwent ITG treatment. Of the 18 patients who experienced recurring vertigo attacks, 15 demonstrated gain recovery in the affected ear. However, all 18 patients exhibited a decrease in the SPV of SVIN. CONCLUSION: The SPV of SVIN may be more sensitive than vHIT in identifying the recovery of vestibular function following ITG administration. To our knowledge, this is the first study to illustrate the link between a reduction in SPV and the likelihood of vertigo episodes in patients with MD who have been treated with ITG.

Factors Impacting the Use or Rejection of Hearing Aids-A Systematic Review and Meta-Analysis.

PURPOSE: To examine the prevalence of adherence to hearing aids and determine their rejection causes. METHODS: This study was conducted according to the Preferred Reporting terms for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed an electronic search using PubMed, BVS, and Embase. RESULTS: 21 studies that met the inclusion criteria were selected. They analyzed a total of 12,696 individuals. We observed that the most common causes for positive adherence to hearing aid use included having a higher degree of hearing loss, patients being aware of their condition, and requiring the device in their daily life. The most common causes for rejection were the lack of perceived benefits or discomfort with the use of the device. The results from the meta-analysis show a prevalence of patients who used their hearing aid of 0.623 (95% CI 0.531, 0.714). Both groups are highly heterogeneous (I2 = 99.31% in each group, p < 0.05). CONCLUSIONS: A significant proportion of patients (38%) do not use their hearing aid devices. Homogeneous multicenter studies using the same methodology are needed to analyze the causes of rejection of hearing aids.

Vértigo posicional paroxístico benigno y enfermedad de Menière: análisis retrospectivo / Benign paroxysmal positional vertigo and Menière's disease: retrospective analysis

Introducción y objetivo: El Vértigo Posicional Paroxístico Benigno (VPPB) es más frecuente dentro del subgrupo de pacientes con Enfermedad de Menière (EM). El presente estudio tiene como objetivo describir las características clínicas tanto del VPPB como de la EM cuando se encuentran asociados. Método: Realizamos un análisis retrospectivo de 22 pacientes con EM diagnosticados de VPPB entre el 1999 y el 2021 en el Complejo Asistencial Universitario de Salamanca. Se recogieron variables clínicas, tanto de las características del VPPB como de la EM. Resultados: En nuestra base de datos, el 66,66 % de los 22 pacientes eran mujeres con una edad media de 59,33 años. El canal semicircular afecto con más frecuencia fue el posterior derecho. En cuanto al VPPB, un 19% se trata de VPPB multicanal, en casi la mitad (47,62%) se tuvieron que realizar más de tres maniobras para solucionarlo y tardó más de un mes en resolverse en más de la mitad (57,14%). Por otro lado, la EM era bilateral en el 19% de los pacientes, con un tiempo de evolución desde el diagnóstico de más de tres años en el 71,42%. Un tercio de los pacientes había presentado más de 10 crisis en los últimos seis meses, y fluctuación en la audición. En base a estos resultados, parece que los pacientes con EM avanzada tienen más probabilidades de presentar VPPB y con peor resultado en su tratamiento. Conclusión: La aparición conjunta del VPPB y la EM podría afectar al pronóstico de ambas patologías por separado. (AU)

Introuction and objective: Benign Paroxysmal Positional Vertigo (BPPV) is more frequent within the subgroup of patients with Menière's Disease (MD). The present study aims to describe the clinical characteristics of both BPPV and MD, when they are associated. Method: We carried out a retrospective analysis of 22 patients with MD diagnosed with BPPV between 1999 and 2021 at the University Assistance Complex of Salamanca. Clinical variables were collected, both from the characteristics of BPPV and MD. Results: In our database, 66.66% of the 22 patients were women with a mean age of 59.33 years. The most frequently affected semicircular canal was the posterior right. Regarding BPPV, 19% are multichannel BPPV, in almost half (47.62%) more than three maneuvers had to be performed to solve it and it took more than a month to resolve it in more than half (57.14%). On the other hand, MD was bilateral in 19% of patients, with a time since diagnosis of more than three years in 71.42%. A third of the patients had presented more than 10 crises in the last six months, and fluctuation in hearing. Based on these results, it appears that patients with advanced MD are more likely to have BPPV and have a worse treatment outcome. Conclusion: The joint appearance of BPPV and MD could affect the prognosis of both pathologies separately. (AU)

Early Diagnosis of Central Disorders Mimicking Horizontal Canal Cupulolithiasis.

BACKGROUND: Horizontal Canal Cupulolithiasis (hc-BPPV-cu) can mimic a pathology of central origin, so a careful examination is essential to prevent misdiagnosis. METHODS: Retrospective cross-sectional cohort study of 45 patients suffering from suspected hc-BPPV-cu. We recorded whether patients first presented through an ENT Emergency Department (ED) or through an Outpatient Otolaryngology Clinic (OC). RESULTS: We found statistically significant differences (p < 0.05) between the OC versus the ED in relation to the time between symptom onset and first assessment (79.7 vs. 3.6 days, respectively), the number of therapeutic maneuvers (one maneuver in 62.5% vs. 75.9%, and more than one in 25.1% vs. 13.7%), and multi-canal BPPV rate (43.8% vs. 3.4%). hc-BPPV-cu did not resolve in 2 patients (12.5%) from the OC and in 3 (10.3%) from de ED, all of which showed central pathology. DISCUSSION: There are no prior studies that analyze the approach to hc-BPPV-cu in the ED. The benefits of early specialist input are early identification of central positional nystagmus, a decrease in symptom duration, reduced number of therapeutic maneuvers required for symptom resolution, and lower rates of iatrogenic multi-canal BPPV. CONCLUSION: A comprehensive approach to hc-BPPV-cu in the ED allows both more effective treatment and early identification of central disorder mimics.

Impacto de la enfermedad de pequeño vaso en la inestabilidad del anciano. Estudio descriptivo transversal / Vestibular Pathology and Instability in the Elderly and its Relationship with Small Vessel Disease. Cross-Sectional Descriptive Study

Introducción y objetivo: La elevada prevalencia de mareo e inestabilidad en los ancianos, su complejo diagnóstico e importantes consecuencias (caídas y lesiones derivadas) constituyen un grave problema sanitario. El presente estudio tiene como objetivo principal determinar si existe relación entre dichos síntomas y la presencia de enfermedad de pequeño vaso. Secundariamente intentaremos describir las causas más frecuentes de mareo e inestabilidad en los pacientes ancianos. Método: Se realiza un estudio descriptivo transversal con 214 pacientes mayores de 70 años remitidos por vértigo, mareo o inestabilidad. Se valoran los diagnósticos más frecuentes y se comparan tres grupos: 1) Patología vestibular periférica, 2) mareo o inestabilidad de causa desconocida y 3) grupo de control. Para ello se utiliza la escala de Fazekas que determina la magnitud de las lesiones de sustancia blanca por imágenes de resonancia magnética. Resultados: El vértigo posicional paroxístico benigno fue el diagnóstico más frecuente (17,3%), seguido de la enfermedad de Ménière (15%). Un 20% de los pacientes fueron clasificados como origen desconocido o multifactorial. La enfermedad de pequeño vaso se encontró con mayor frecuencia en el grupo con mareo de causas desconocidas (p=0,034). Conclusiones: se reafirma la asociación entre las lesiones de sustancia blanca, sugerentes de enfermedad de pequeño vaso, y la mayor aparición de mareo e inestabilidad en los ancianos; siendo la prevalencia de la enfermedad mucho menor en el grupo de control que en aquellos con mareo de causa desconocida. Asimismo, se determina que el vértigo posicional paroxístico benigno es el diagnóstico más frecuente de mareo e inestabilidad en el anciano. (AU)

Short-Term Mortality in Patients with Heart Failure at the End-of-Life Stages: Hades Study.

Background: Information regarding short-term vital prognosis in patients with heart failure at advanced stages of the disease is scarce. Objective: To develop a three-month mortality predictive model for patients with advanced heart failure. Methods: Prospective observational study carried out in primary care and a convalescence community facility. Heart failure patients either New York Heart Association (NYHA) III with at least two HF hospitalizations during the previous six months or NYHA IV with/without previous recent hospitalization were included in the study. Multivariable predictive models using Cox regression were performed. Results: Of 271 patients included, 55 (20.3%) died during the first three months of follow-up. Mean age was 84.2 years (SD 8.3) and 59.8% were women. Predictive model including NT-proBNP had a C-index of 0.78 (95% CI 0.71; 0.85) and identified male gender, low body mass index, high potassium and NT-proBNP levels, and moderate-to-severe dependence for daily living activities (Barthel index < 40) as risk factors of mortality. In the model without NT-proBNP, C index was 0.72 (95% CI 0.64; 0.79) and, in addition to gender, body mass index, low Barthel index, and severe reductions in glomerular filtration rate showed the highest predictive hazard ratios for short-term mortality. Conclusions: In addition to age, male gender, potassium levels, low body mass index, and low glomerular filtration, dependence for activities of daily living add strong power to predict mortality at three months in patients with advanced heart failure.

Skull Vibration-Induced Nystagmus and High Frequency Ocular Vestibular-Evoked Myogenic Potentials in Superior Canal Dehiscence.

BACKGROUND: Although diagnostic criteria have been established for superior canal dehiscence syndrome, cases in which the diagnosis is not easy are frequent. On those occasions, some tests such as vibration-induced nystagmus or vestibular-evoked myogenic potentials can offer invaluable help due to their high sensitivity and specificity. METHODS: We studied 30 patients showing superior canal dehiscence or "near-dehiscence" in a CT scan. Skull vibration-induced nystagmus and high frequency ocular vestibular-evoked myogenic potentials are performed in each patient. The aim of the study is to determine how useful both tests are for detection of superior canal dehiscence or near-dehiscence. RESULTS: Of the 60 temporal bones studied, no dehiscence was the result in 22, near-dehiscence in 17 and a definite finding in 21. In 10/30 patients, there was no SVIN (Skull vibration induced nystagmus) during otoneurological testing, while in 6/30, induced nystagmus was mainly horizontal, and in 14/30 there was vertical up-beating. All patients had a positive oVEMP (Ocular vestibular evoked myiogenic potentials) at 0.5 kHz in both ears and the HFoVEMP (High frequency ocular vestibular evoked myiogenic potentials) response was positive in 25/60 (41.6%) of the ears studied and in 19/30 of the patients evaluated (in 6 it was positive in both ears). Up-beat SVIN will point to a SCD (Superior Canal Dehiscence) mainly when HFoVEMP are present, and when this is negative there is a high probability that it is not a SCD. CONCLUSIONS: When SVIN and HFoVEMP results are added (or combined), they not only improve the possibilities of detecting SCD, but also the affected side.

Hearing loss in vestibular schwannoma

Introducción y objetivo: La hipoacusia es uno de los síntomas más frecuentes en el debut de un schwannoma vestibular (SV). El objetivo de este estudio es analizar la pérdida auditiva en pacientes con SV y determinar en qué medida se relaciona con el tamaño tumoral. Método: Se lleva a cabo un estudio retrospectivo observacional en 291 pacientes diagnosticados de SV entre 1995 y 2017 en el servicio de Otorrinolaringología y Cirugía Cervicofacial del Hospital Clínico Universitario de Salamanca analizándose diferentes datos pre y postoperatorios de los pacientes así como hallazgos radiológicos y quirúrgicos.Resultados: El síntoma más frecuente de consulta es la hipoacusia unilateral progresiva (31.6%). La asociación entre el tamaño del SV y la hipoacusia no es estadísticamente significativa (p=0.099).Conclusiones: La pérdida auditiva producida por un SV no es patrimonio de ningún estadio, aunque las pérdidas severas y profundas son más indicativas de neurinomas grados III-IV, y ante una pérdida auditiva leve o audición normal tendremos con más probabilidad un neurinoma grado I-II. (AU)

The most common reason for consultation in patients suffering from Vestibular Schwannoma (VS) is progressive hearing loss. The main objective of this study is analyzing the hearing loss in patients with VS and determining the extent to which the tumor grade and the hearing loss are related. Methods: An observational retrospective study was conducted with a sample of 291 patients diag-nosed with VS between 1995 and 2017 in the Department of Otorhinolaryngology and Head and Neck Surgery of the Tertiary Care Primary Center of Salamanca. We analyzed preoperative and postoperative data from patients with VS as well as radiological and surgical findings. Results: The most common reason for consultation at diagnosis was progressive unilateral hearing loss (31.6%). The relationship between the size of the VS and hearing loss in the patients who reported progressive unilateral hearing loss as a reason for consultation was not statistically significant (p=0.099). Conclusion: The most common reason for consultation in VS is progressive unilateral hearing loss. The hearing loss caused by VS does not have a statistically significant association with any tumor grade, although severe and profound hearing loss is more commonly associated with grade III-IV neurinomas, whereas mild hearing loss or normal hearing are more likely in grade I-II tumors. (AU)

Employment and working conditions of nurses: where and how health inequalities have increased during the COVID-19 pandemic?

BACKGROUND: Nurses and midwives play a critical role in the provision of care and the optimization of health services resources worldwide, which is particularly relevant during the current COVID-19 pandemic. However, they can only provide quality services if their work environment provides adequate conditions to support them. Today the employment and working conditions of many nurses worldwide are precarious, and the current pandemic has prompted more visibility to the vulnerability to health-damaging factors of nurses' globally. This desk review explores how employment relations, and employment and working conditions may be negatively affecting the health of nurses in countries such as Brazil, Croatia, India, Ireland, Italy, México, Nepal, Spain, and the United Kingdom. MAIN BODY: Nurses' health is influenced by the broader social, economic, and political system and the redistribution of power relations that creates new policies regarding the labour market and the welfare state. The vulnerability faced by nurses is heightened by gender inequalities, in addition to social class, ethnicity/race (and caste), age and migrant status, that are inequality axes that explain why nurses' workers, and often their families, are exposed to multiple risks and/or poorer health. Before the COVID-19 pandemic, informalization of nurses' employment and working conditions were unfair and harmed their health. During COVID-19 pandemic, there is evidence that the employment and working conditions of nurses are associated to poor physical and mental health. CONCLUSION: The protection of nurses' health is paramount. International and national enforceable standards are needed, along with economic and health policies designed to substantially improve employment and working conditions for nurses and work-life balance. More knowledge is needed to understand the pathways and mechanisms on how precariousness might affect nurses' health and monitor the progress towards nurses' health equity.

Reduced solvent and reagent amounts: effect on carbonyl dinitrophenylhydrazone measurements at low concentrations.

This work aims to advance towards a more affordable laboratory procedure for sample treatment to determine carbonyl compounds by derivatization with 2,4-dinitrophenylhydrazine (DNPH). The proposal is based on reducing the amount of DNPH and solvents. A simple addition of standard carbonyls in a solution containing DNPH to prepare hydrazone standards is described and evaluated. Tedious recrystallization steps are avoided. Formaldehyde, acetaldehyde, acetone, tolualdehyde and hexanal, as carbonyl models, were quantified using a DNPH concentration of 400 µg mL-1 and 3.8 mM H2SO4 and by keeping for 24 hours at room temperature. Analytical coefficients of variation between 10 and 25% were found from the analysis of blanks under intermediate conditions (two different devices, very different concentrations of DNPH and analysis on two days). From these values of relative standard deviations and background levels, quantification limits were estimated between 15 and 40 ng mL-1. The reduction of reagent amounts allows the operator to better control the background levels in the use of DNPH, as well as making the method more cost-effective and easy to use. In short, it leads to a more sustainable adaptation of the classical method. The versatility in analytical application was tested to estimate the levels of formaldehyde, acetaldehyde and acetone in very different types of environmental samples. In particular, outdoor and indoor samples were collected in filters and impregnated cartridges, respectively. Moreover, tars in 2-propanol and particulate matter from gasification processes were also tested.

Molecular characterization of novel Ehrlichia genotypes in Ixodes auritulus from Uruguay.

Ehrlichia are small intracellular Gram-negative bacteria transmitted by ticks. These microorganisms cause ehrlichiosis, a complex of life-threatening emerging zoonoses and diseases of global veterinary relevance. The aim of this study was to investigate the presence of Ehrlichia in free-living Ixodes auritulus collected in Uruguay. Ticks were collected from vegetation in five localities from the southeast and northeast of the country between 2014 and 2017. Detection of Ehrlichia DNA was performed in pools of adults or nymphs grouped according to the collection site and date. A total of 1,548 I. auritulus ticks were collected in four of the five locations sampled. Fragments of three loci (16S rRNA, dsb and groEL) were obtained by PCR, and phylogenies inferred using Bayesian inference analysis for each gene independently. DNA of Ehrlichia spp. was found in 15 out of 42 tick pools. Based on the topology of the phylogenetic trees, our sequences represent two novel genotypes for the genus named as Ehrlichia sp. Serrana and Ehrlichia sp. Laguna Negra. Both genotypes were closely related to Ehrlichia sp. Magellanica, a species detected in Ixodes uriae and Magellanic penguins. Considering that all stages of I. auritulus and I. uriae are parasites of birds, their phylogenetic relationships, and common eco-epidemiological profiles, it is reasonable to state that these genotypes of Ehrlichia spp. may represent a natural group likely associated with birds. Our results constitute the first characterization of Ehrlichia spp. in Uruguay. Future studies on birds reported as hosts for I. auritulus are needed to further understand the epidemiological cycles of both Ehrlichia genotypes in the country. Finally, I. auritulus does not feed on humans, so the two Ehrlichia species reported herein might have no implications in human health.

Neuromuscular involvement in COVID-19 critically ill patients.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has a high incidence of intensive care admittance due to the severe acute respiratory syndrome (SARS). Intensive care unit (ICU)-acquired weakness (ICUAW) is a common complication of ICU patients consisting of symmetric and generalised weakness. The aim of this study was to determine the presence of myopathy, neuropathy or both in ICU patients affected by COVID-19 and whether ICUAW associated with COVID-19 differs from other aetiologies. METHODS: Twelve SARS CoV-2 positive patients referred with the suspicion of critical illness myopathy (CIM) or polyneuropathy (CIP) were included between March and May 2020. Nerve conduction and concentric needle electromyography were performed in all patients while admitted to the hospital. Muscle biopsies were obtained in three patients. RESULTS: Four patients presented signs of a sensory-motor axonal polyneuropathy and seven patients showed signs of myopathy. One muscle biopsy showed scattered necrotic and regenerative fibres without inflammatory signs. The other two biopsies showed non-specific myopathic findings. CONCLUSIONS: We have not found any distinctive features in the studies of the ICU patients affected by SARS-CoV-2 infection. SIGNIFICANCE: Further studies are needed to determine whether COVID-19-related CIM/CIP has different features from other aetiologies. Neurophysiological studies are essential in the diagnosis of these patients.

Characterization of organic aerosol at a rural site influenced by olive waste biomass burning.

Biomass burning is a major air pollution problem all around the world. However, the identification and quantification of its contribution to ambient aerosol levels is a difficult task due to the generalized lack of observations of molecular markers. This paper presents the results of a yearlong study of organic constituents of the atmospheric aerosol at a rural site in southern Spain (Villanueva del Arzobispo, Jaén). Sampling was performed for PM10 and PM2.5, and a total of 116 and 115 samples, respectively, were collected and analyzed by GC/MS, quantifying 77 organic compounds. Higher levels of organic pollutants were recorded from November to March, coinciding with the cold season when domestic combustion is a common practice in rural areas. This jointly with adverse meteorological conditions, e.g. strong atmospheric stability, produced severe pollution episodes with high PMx ambient levels. High daily concentrations of tracers were reached, up to 26 ng m-3 for B(a)P and 6065 ng m-3 for levoglucosan in PM2.5, supporting that biomass burning is a major source of pollution at rural areas. A multivariate statistical study based on factor and cluster analysis, was applied to the data set with the aim to distinguish sources of organic compounds. The main resulting sources were related with biomass combustion, secondary organic aerosol (SOA), biogenic emissions, lubricating oil and soil organic components. A preliminary organic source profile for olive wastes burning was evaluated, based on cluster results, showing anhydrosacharides and xylitol are the main emitted compounds, accounting for more than 85% of the quantified compounds. Other source compounds were fatty acids, diacids, aliphatics, sugars, sugar alcohols, PAHs and quinones.

Linear Scleroderma and Primary Sclerosing Cholangitis: An Undescribed Association.

Linear scleroderma (LS) is clinically characterized by the presence of sclerotic areas of skin, which develop in a linear pattern. Primary sclerosing cholangitis is a cholestatic disorder that can lead to end-stage liver disease. We present, for the first time in English literature, the case of a patient suffering from both the diseases. This highlights the fact that, even though LS has conventionally been considered to be a form of localized scleroderma, this does not necessarily imply that it is an exclusively cutaneous disease.

Organic Analysis of Environmental Samples Using Liquid Chromatography with Diode Array and Fluorescence Detectors: An Overview.

This overview is focused to provide an useful guide of the families of organic pollutants that can be determined by liquid chromatography operating in reverse phase and ultraviolet/fluorescence detection. Eight families have been classified as the main groups to be considered: carbonyls, carboxyls, aromatics, phenols, phthalates, isocyanates, pesticides and emerging. The references have been selected based on analytical methods used in the environmental field, including both the well-established procedures and those more recently developed.

Treatment of Elephantiasis Nostras Verrucosa with CO2 Laser.

Elephantiasis nostras verrucosa (ENV) is the most severe form of chronic non-filarial lymphedema that leads to disfiguration of body parts. Multiple topical and surgical treatments have been typically used with high relapse rates and local complications. In this context, CO2 laser emerges as a new well-tolerated and effective treatment option. We report two cases of long-term evolution of elephantiasis nostras verrucosa recalcitrant to topical therapy and successfully treated with CO2 laser. Both of them were septuagenarians with personal history of obesity and suffered from lower extremities edema due to heart failure in one case, and due to chronic venous insufficiency in the other. We describe the procedure, the results and the advisable maintenance for preventing recurrence in this difficult to treat and chronic condition.

Calidad de vida relacionada a la salud en personas con VIH y factores asociados / Quality of life related to health in people with HIV and associated factors / Qualidade de vida relacionada à saúde em pessoas com HIV e fatores associados

Introducción: aunque existe una mejoría significativa en la sobrevida consecuencia del impacto del tratamiento antirretroviral (TARV), numerosos estudios demuestran que existe una afectación de la calidad de vida relacionada a la salud (CVRS) en personas con virus de inmunodeficiencia humana (VIH). Objetivo: evaluar CVRS en personas con VIH y variables socio-demográficas y clínicas asociados, con énfasis en la adherencia al TARV. Método: estudio transversal de una muestra no probabilística de personas con VIH, mayores de 18 años, recibiendo TARV, asistidas en el subsector público en un período de 24 meses. Se aplicó la encuesta MOS-HIV SF30 (CVRS). Se aplicó el cuestionario SMAQ para evaluar adherencia. Resultados: se incluyeron 101 personas. El cuestionario MOS-HIV SF30 mostró fiabilidad y buena consistencia interna. El score global de CVRS fue 71,71±17,76. Fue peor el score global y en algunas dimensiones en pacientes con carga viral indetectable: funcionamiento físico, p=0,016; energía/fatiga, p=0,008; calidad de vida percibida, p=0,025. En mujeres el score fue peor en dolor, p=0,034; funcionamiento físico, p=0,006; funcionamiento social, p=0,031; salud mental, p=0,040. El score fue significativamente mejor en algunos dominios entre adherentes (salud general percibida, p=0,027; funcionamiento social, p=0,030); en varones gay/bisexuales (dolor, p=0,025; actividad diaria, p=0,028); entre quienes tuvieron relaciones sexuales en el último mes (salud general percibida, p=0,011). Conclusiones: el score global de CVRS fue bueno a pesar de ser una población con múltiples vulnerabilidades. Si bien la adherencia se relacionó a mejor percepción de CVRS en algunos dominios, no tuvo impacto en el score global. La carga viral indetectable no fue predictor de mejor CVRS, lo que reafirma que los parámetros biológicos aislados no dan cuenta de la complejidad de la salud percibida.

Introduction: in spite of there being a meaningful improvement in the survival of individuals as a consequence of antiretroviral therapy (ART), several studies have shown it affects the health-related quality of life of HIV infected people. Objective: to assess the health-related quality of life (HRQoL) of HIV infected people, as well as social and demographic variables, associated clinical findings, in particular in the adherence to antiretroviral therapy (ART). Method: transversal study of a non-probabilistic sample of HIV infected people, older than 18years old, undergoing antiretroviral therapy (ART), who were seen in the public sub-sector during a 24 month period. The MOS-HIV SF30 (HRQoL) questionnaire survey was applied. The SMAQ questionnaire was applied to assess adherence. Results: 101 patients were included in the study. The MOS-HIV SF30 (HRQoL) questionnaire evidenced reliability and a good internal consistency. Global HRQoL score was 71.71±17.76. Global score was worse and in a few dimensions, in patients with an undetectable viral load the following was found: physical activity: p=0.016; energy/fatigue: p=0.008; perceived quality of life: p=0.025. Score for women was worse for pain: p=0.034; physical activity: p=0.006; social performance: p=0.031; mental health: p=0.040. The score was meaningfully better in a few domains among those who adhered to it (general health condition perceived p=0.027; social performance: p=0.030), in gay/bisexual boys (pain: p=0.025; daily activity: p=0.028); among those who had sex in the last month (general health condition perceived: p=0.011). Conclusions: the Global HRQoL score was good despite it being a population comprising multiple vulnerabilities. In spite of adherence being associated to a better perception of the HRQoL in a few domains, it had no impact on the global score. Undetectable viral load was no predictor of the HRQoL, what reinforces the idea that isolated biological parameters do not account for the complexity of perceived health condition.

Introdução: embora exista uma significativa melhoria na sobrevida, consequência do impacto do tratamento antirretroviral (TARV), numerosos estudos demostram que a qualidade de vida relacionada à saúde (QVRS) em pessoas com VIH é afetada. Objetivo: avaliar QVRS em pessoas com VIH e as variáveis sócio demográficas e clínicas associadas, com ênfase na adesão ao TARV. Método. Estudo transversal de uma amostra não probabilística de pessoas com VIH, maiores de 18 anos, recebendo TARV, atendidas no subsetor público em um período de 24 meses. Foram utilizados os questionários MOS-HIV SF30 para QVRS e SMAQ para avaliar a adesão ao tratamento. Resultados: foram incluídas 101 pessoas. O questionário MOS-HIV SF30 mostrou fiabilidade e boa consistência interna. O score global de QVRS foi 71,71±17,76. O score global e em algumas dimensões foi pior em pacientes com carga viral indetectável: funcionamento físico, p=0,016; energia/fadiga, p=0,008; qualidade de vida percebida, p=0,025. Nas mulheres o score foi pior em dor, p=0,034; funcionamento físico, p=0,006; funcionamento social, p=0,031; saúde mental, p=0,040. O score foi significativamente melhor em alguns domínios entre os aderentes (saúde general percebida, p=0,027; funcionamento social, p=0,030); em homens gay/bissexuais (dor, p=0,025; atividade diária, p=0,028); entre os que tiveram relações sexuais no último mês (saúde general percebida, p=0,011). Conclusões: o score global de QVRS foi bom apesar de ser uma população com múltiplas vulnerabilidades. Embora a adesão ao tratamento estivesse relacionada a uma melhor percepção da QVRS em alguns domínios, não teve impacto no score global. A carga viral indetectável não foi preditor de melhor QVRS, o que confirma que os parâmetros biológicos isolados não explicam a complexidade da percepção de saúde.

Validating Analytical Protocols to Determine Selected Pesticides and PCBs Using Routine Samples.

This study aims at providing recommendations concerning the validation of analytical protocols by using routine samples. It is intended to provide a case-study on how to validate the analytical methods in different environmental matrices. In order to analyze the selected compounds (pesticides and polychlorinated biphenyls) in two different environmental matrices, the current work has performed and validated two analytical procedures by GC-MS. A description is given of the validation of the two protocols by the analysis of more than 30 samples of water and sediments collected along nine months. The present work also scopes the uncertainty associated with both analytical protocols. In detail, uncertainty of water sample was performed through a conventional approach. However, for the sediments matrices, the estimation of proportional/constant bias is also included due to its inhomogeneity. Results for the sediment matrix are reliable, showing a range 25-35% of analytical variability associated with intermediate conditions. The analytical methodology for the water matrix determines the selected compounds with acceptable recoveries and the combined uncertainty ranges between 20 and 30%. Analyzing routine samples is rarely applied to assess trueness of novel analytical methods and up to now this methodology was not focused on organochlorine compounds in environmental matrices.