Plasticlusters: A marine litter microhabitat in a marina of Tunisia, N Africa.

Plastic debris is a significant and rapidly developing ecological issue in coastal marine ecosystems, especially in areas where it accumulates. This study introduces "plasticlusters", a new form of floating debris agglomeration found in the Yasmine Hammamet marina (Tunisia, North-Africa), loosely attached to pontoon ropes around the water surface level. The analysis of two samples revealed that they were formed primarily by average 2.11 mm polystyrene fragments, 3.43 mm fibers, 104 mm polypropylene and polyethylene sheets, and 122 mm decomposing seagrass leaves. They were inhabited by several taxa, including at least 2 cryptogenic and 5 non-indigenous species (NIS). Unlike other plastic formations, plasticlusters provide a novel and potentially temporal microhabitat to fouling assemblages due to their loose and unconsolidated structure which, combined with marinas being NIS hubs, could enhance NIS dispersion. The results of this study raise concerns about the combined ecological effects of debris accumulation and biocontamination inside marinas.

Evaluation of the incorporation of an IOTA-ADNEX model in the discrimination of adnexal masses in our third-level hospital centre, taking into account the menopausal status of patients. Five years of experience / Evaluación de la incorporación del IOTA-ADNEX model en la discriminación de las masas anexiales en nuestro centro hospitalario de tercer nivel teniendo en cuenta el estado menopáusico en la predicción de malignidad. Cinco años de experiencia

Objective: The objectives were to estimate the performance of the IOTA-ADNEX model test after its incorporation into the ultrasound tests of our third-grade hospital gynecology service, as well as to assess whether its capacity of accuracy is modified when taking into account the patient's menopausal status. Methods: A cross-sectional study was conducted to clinically evaluate the diagnostic performance of the IOTA-ADNEX model test, which was performed between January 2016 and December 2021. The study included 573 women with an adnexal injury who underwent surgical excision within 180 days after ultrasound diagnosis and histological confirmation (gold standard). After the ultrasound exam, the injuries were classified using the ADNEX model. The study estimated the area under the receiver-operating-characteristics curve (AUC) of the ADNEX model for classifying between benign and malignant adnexal masses and compared the performance by menopausal state. Sensitivity and specificity were determined for different cut-off points. Results: Out of the 573 women, 183 (31.9%) had a malignant tumor. The AUC of the ADNEX model for differentiating between benign and malignant adnexal masses at the time of ultrasound examination was 0.92 and the best malignancy threshold, detected by Youden index, was 22.5%. At this cut-off, the sensitivity of the ADNEX model was 91.8% and the specificity was 76.4%. However, it varies according to menopausal status: in the group of pre-menopausal patient, sensitivity was 86.1% (95% CI, 85.4%–86.8%) and specificity was 81.3% (95% CI, 85.4%–86.8%). In the postmenopausal group, sensitivity was 96.1% (95% CI, 95.6%–96.7%) and specificity was 68.5% (95% CI, 68.1%–68.8%)...(AU)

Objetivo: Los objetivos eran estimar el rendimiento del test IOTA ADNEX model después de su incorporación en el estudio ecográfico en nuestro servicio de ginecología, en un hospital de tercer nivel, así como evaluar si su capacidad de precisión se modifica al tener en cuenta el estado menopáusico de la paciente. Método: Se llevó a cabo un estudio transversal para evaluar clínicamente el rendimiento diagnóstico del test IOTA ADNEX model, el cual se realizó entre enero de 2016 y diciembre de 2021. El estudio incluyó a 573 mujeres con una lesión anexial que se sometieron a tratamiento quirúrgico en un plazo de 180 días después del diagnóstico por ecografía y confirmación histológica (gold standard). Después de realizar la ecografía, las lesiones fueron clasificadas utilizando el modelo ADNEX. El estudio estimó el área bajo la curva (AUC) del modelo ADNEX para diferenciar entre masas anexiales benignas y malignas, y se comparó el rendimiento según el estado menopáusico. Se determinó la sensibilidad y la especificidad para diferentes puntos de corte. Resultados: De las 573 mujeres, 183 (31,9%) tenían un tumor maligno. El AUC del modelo ADNEX para diferenciar entre masas anexiales benignas y malignas en el momento del examen ecográfico fue de 0,92 y el umbral de malignidad óptimo, detectado por el índice de Youden, fue del 22,5%. Con este punto de corte, la sensibilidad (SE) del modelo ADNEX fue del 91,8% y la especificidad (SP) fue del 76,4%. Sin embargo, esto varía según el estado menopáusico: en el grupo de pacientes premenopáusicas, la sensibilidad fue del 86,1% (IC del 95%: 85,4-86,8%) y la especificidad fue del 813% (IC del 95%: 85,4-86,8%). En el grupo de pacientes posmenopáusicas, la sensibilidad fue del 96,1% (IC del 95%: 95,6-96,7%) y la especificidad fue del 68,5% (IC del 95%: 68,1-68,8%)...(AU)

Facilitation of macrofaunal assemblages in marinas by the habitat-forming invader Amathia verticillata (Bryozoa: Gymnolaemata) across a spatiotemporal scale.

Widespread habitat-forming invaders inhabiting marinas, such as the spaghetti bryozoan Amathia verticillata, allow exploring facilitation processes across spatiotemporal contexts. Here we investigate the role of this bryozoan as habitat for native and exotic macrofaunal assemblages across different ecoregions of Western Mediterranean and East Atlantic coasts, and a monthly variation over a year. While only 7 (all peracarid crustaceans) of the 54 associated species were NIS, they dominated macrofaunal assemblages in terms of abundance, raising the potential for invasional meltdown. NIS richness and community structure differed among marinas but not among ecoregions, highlighting the importance of marina singularities in modulating facilitation at spatial scale. Despite facilitation did not depend on bryozoan abundance fluctuations, it was affected by its deciduous pattern, peaking in summer and disappearing in late winter. Monitoring A. verticillata in marinas, especially in summer periods, may improve the detection and management of multiple associated NIS.

Frailty as a predictor of clinical problems and events that require elderly patients with heart failure to use health resources.

BACKGROUND: The clinical management of elderly patients with heart failure (HF) is not firmly established. Decision-making should be individualized depending on the biological deterioration of each patient, from aggressive management to a palliative approach. Frailty can serve as the basis for this comprehensive individualized management. Our objective was to evaluate the importance of the main clinical problems, as well as the events that required the use of health resources, based the degree of frailty, in elderly patients with HF. METHODS AND RESULTS: Retrospective observational cohort study. Frailty was defined according to the deficit accumulation construct. A total of 546 patients hospitalized for acute HF were included. The median age (Q1-Q3) was 82 (78-86) years. A total of 454 patients (83%) showed some degree of frailty: 221 (48.7%) mild, 207 (45.6%) moderate and 26 (5.7%) advanced. There was a significant tendency towards polypharmacy from no to severe frailty. Hospital events were recorded for 4 (1-6) patients with mild frailty, 4 (2-6) patients with moderate frailty and 2 ((1-4) patients with advanced frailty (p = 0.045). A total of 204 patients (37.4%) died during follow-up. The median time to death was 11.4 (4-16.8), 6.7 (3.3-11.6), 6.5 (3.4-12.2) and 4.1 (0.8-7.7) months for patients with no, mild, moderate, or advanced frailty, respectively (p = 0.006). CONCLUSIONS: Frailty due to deficit accumulation is a good predictor of clinical problems and events that require the use of health resources; therefore, it can serve as a basis for the management of HF in the elderly.

Efficacy of Human Papillomavirus Vaccination 4 Years After Conization for High-Grade Cervical Neoplasia.

OBJECTIVE: The aim of the study was to estimate human papillomavirus (HPV) vaccination efficacy in reducing recurrence risk within 4 years after conization for high-grade cervical neoplasia. MATERIALS AND METHODS: From January 2012 to June 2015, we performed a longitudinal, observational study (case-series study) on patients diagnosed with cervical intraepithelial neoplasia 2-3 neoplasia. Efficacy was estimated by a 95% CI of the relative risk, relative risk reduction, attributable risk, and number needed to treat. Parametric and nonparametric tests were used as appropriate to compare 160 vaccinated with 171 nonvaccinated patients. To estimate the hazard ratio of the vaccinated status, patients were subjected to multivariable analyses based on the Cox proportional hazard model. To compare recurrence-free survival, a Kaplan-Meier model and a log-rank test were applied. RESULTS: The overall recurrence was 9.4% in the nonvaccinated and 2.5% in the vaccinated group (p = .009). Vaccination was associated with a significant decrease in the relative risk (73.5%, 95% CI = 21.8%-90.9%) with a mean number needed to treat of 14 patients per relapse prevented. Although positive conization margins were related to the highest recurrence risk, not being vaccinated independently increased this risk 3.5-fold in a 4-year follow-up (p = .025). Cumulative recurrence-free rates differed significantly between both groups (log-rank test: p = .009). CONCLUSIONS: Our study corroborates the benefits of HPV vaccination, recommends a closer and longer follow-up in nonvaccinated women, and offers a 4-year prognosis for patients undergoing conization for high-grade cervical lesions.

Bryozoa from deep-sea habitats of the northern Gulf of Cádiz (Northeastern Atlantic).

This study examines material collected in the northern part of the Gulf of Cádiz, in the Northeastern Atlantic Ocean, between the Iberian Peninsula and northern Africa, at 300-1200 m depth, within the Site of Community Importance "Volcanes de fango del Golfo de Cádiz" (Mud volcanoes of the Gulf of Cádiz, ESZZ-12002). Several previous studies were carried out in the Iberian Peninsula and Moroccan area (shallow and deep waters), recording ca. 300 bryozoan species from the Gulf of Cádiz. In the present study a total of 40 bryozoan taxa were identified, including two species new to science-Antropora gemarita n. sp. and Microporella funbio n. sp.-and three new records for the area.

Three species of Reteporella (Bryozoa: Cheilostomata) in a diapiric and mud volcano field of the Gulf of Cádiz, with the description of Reteporella victori n. sp.

Diapirs and mud volcanoes (MVs) are formed by the migration and extrusion of fluids and mud to the seafloor, respectively. In the Gulf of Cádiz there are ca. 60 MVs and several diapirs with different environmental conditions and seepage activity. Previous studies, mainly on MVs, have demonstrated that the invertebrate fauna associated with these seafloor structures can be very diverse, including chemosymbiotic species, mostly mollusks and frenulate polychaetes, as well as vulnerable suspension feeders, such as cold-water corals and sponges, among others. Previous studies of the bryozoan fauna in this area have recorded species belonging to 28 families. One of these families is Phidoloporidae, which comprises 27 genera worldwide, including the common Rhynchozoon, Reteporellina, and Reteporella. In the present study, two species belonging to Reteporella are redescribed, and a new species is described from diapirs and MVs on the shelf and slope of the Gulf of Cádiz. The samples were collected during several oceanographic expeditions carried out by the Instituto Español de Oceanografia. This genus is well represented in the NE Atlantic Ocean and the Mediterranean Sea, and our study extends its occurrence on MVs and diapirs fields of the Gulf of Cádiz.

Empatía médica en residentes del Instituto Guatemalteco de Seguridad Social -IGSS- / Medical empathy in residents of the Guatemalan Institute of Social Security -IGSS-

OBJETIVO: Determinar los niveles de empatía médica en los residentes del Instituto Guatemalteco de Seguridad Social -IGSS-, de julio a agosto 2016. POBLACIÓN Y MÉTODOS: Estudio descriptivo, realizado con 158 residentes, mediante la Escala de Empatía Médica de Jefferson. RESULTADOS: Características Sociodemográfcas: 80 (51%) residentes de sexo masculino , con edad promedio de 28 años (± 2); 105 (66%) católicos y 140 (87% ) solteros. Características académicas: Únicamente 10 (6.33%) no se encuentran realizando su primera opción de especialidad médica; 76 (48.10%) repitieron algun año durante el pregrado, la mayor proporción de residentes se encontró en cirugía (18.9%). Con relación a la empatía médica se observó que únicamente 17 (10.7% ) (IC95%: 12- 31) presentaron un nivel alto de empatía. Se evidenció asociación entre este nivel y el sexo masculino (X2 4.62; RR 2.73 (IC95% 1.06-7.03) P=0.045. CONCLUSIONES: La especialidad médica con mayor proporción de residentes es cirugía; del total de los encuestados únicamente diez no se encuentran realizando su primera opción de posgrado. Cuatro de cada diez repitieron algún año durante su pregrado. Una minoría de los encuestados evidenció nivel alto de empatía; las especialidades en las que se encuentran los niveles de empatía más altos son: medicina física y rehabilitación y pediatría. Los residentes del sexo masculino presentan 2.73 veces más probabilidad de tener un nivel de empatía catalogado como alto según el Test de Jefferson en comparación a las residentes de sexo femenino. (AU)

OBJECTIVE: To determine the levels of medical empathy in the residents of the Guatemalan Social Security Institute -IGSS-, from July to August 2016. POPULATION AND METHODS: Descriptive study, conducted with 158 residents, using the Jefferson Medical Empathy Scale. RESULTS: Sociodemographic characteristics: 80 (51%) male residents, with an average age of 28 years (± 2); 105 (66%) Catholics and 140 (87%) single. Academic characteristics: Only 10 (6.33%) are not making their first choice of medical specialty; 76 (48.10%) repeated some year during undergraduate, the highest proportion of residents was found in surgery (18.9%). Regarding medical empathy, it was observed that only 17 (10.7%) (95% CI: 12-31) presented a high level of empathy. An association was found between this level and the male sex (X2 4.62; RR 2.73 (95% CI 1.06-7.03) P = 0.045. CONCLUSIONS: The medical specialty with the highest proportion of residents is surgery; of the total of those surveyed, only ten were not found doing their first graduate option Four out of ten repeated some year during their undergraduate A minority of respondents showed high level of empathy, the specialties in which the highest levels of empathy are found are: physical medicine and rehabilitation and pediatrics Male residents are 2.73 times more likely to have a level of empathy classified as high according to the Jefferson Test compared to female residents

Prácticas familiares en el cuidado de los menores de la zona rural de Sopetrán, Antioquia / Family practices in the care of children from the rural areas of Sopetrán, Antioquia / Práticas familiares no cuidado dos menores da zona rural de Sopetrán, Antioquia

Objetivo: determinar la aplicación de prácticas familiares clave de la estrategia de atención integral a las enfermedades prevalentes en la infancia, por parte de los padres de niños inscritos en hogares del Instituto Colombiano de Bienestar Familiar, en la zona rural del municipio de Sopetrán, Antioquia, en 2014. Metodología: estudio descriptivo, transversal. La fuente primaria fue el universo de padres o cuidadores. Resultados: participaron 79 padres o cuidadores de nueve Hogares comunitarios de ocho veredas del municipio. En promedio, las madres tenían 28 años y los padres 32. El 74.7% de las familias fue de estrato socioeconómico nivel uno; la frecuencia de familias de tipo nuclear fue del 48%. Las verduras, los vegetales, los lácteos, las calabazas y las zanahorias fueron los alimentos menos consumidos por los menores. El 54.4% de las familias obtiene el agua de nacimiento y el 21.5% no le realiza tratamiento antes de consumirla. El 5.1% deposita excretas a campo abierto. El 15.2% y el 35.4% desconocen los signos de peligro que ponen en riesgo la vida del menor por infección respiratoria y por enfermedad diarreica aguda, respectivamente. En el 89.9% de los casos las madres se encargan del cuidado de los menores, con poca o nula participación del padre. Conclusión: los padres desconocen las prácticas clave relacionadas con la identificación temprana de signos de alarma de enfermedades prevalentes en la infancia. Además, el derecho al agua potable y saneamiento básico no es una realidad para todas las familias participantes. Adicionalmente, muchas no hierven el agua para consumirla, lo que podría incrementar algunas enfermedades prevalentes.

Objective: To determine to what extent the parents of children participating in the Colombian Institute for Family Wellbeing community homes implemented key family practices as a part of integrated management of childhood illness in the rural areas of Sopetrán, Antioquia in 2014. Methodology: cross-sectional descriptive study. The main source was the universe of parents or caregivers. Results: Seventy-nine parents or caregivers participated from nine community wellbeing homes in eight rural communities. The average age of mothers and fathers was 28 and 32, respectively. Of all families, 74.7% belonged to the lowest socioeconomic strata, and 48% of families were nuclear families. Vegetables, dairy products, pumpkins, and carrots were the least consumed foods by children. Over half of families (54.4%) get water from springs, 21.5% do not treat the water before drinking it, and 5.1% still practice open defecation. In fact, 15.2% and 35.4% remain unaware of the warning signs of infant respiratory infection and acute diarrhea, respectively. In 89.9% of cases, mothers care for children with little or no help from fathers. Conclusion: Parents are unaware of the key practices related to the early identification of warning signs in diseases common to children. In addition, not all participating families have access to treated drinking water and basic sanitary conditions. Lastly, many families do not boil water prior to drinking it, which could increase the prevalence of certain diseases.

Objetivo: determinar a aplicação de práticas familiares chave da estratégia de atenção integral às doenças prevalentes na infância, por parte dos pais de crianças inscritas nos lares do Instituto Colombiano de Bienestar Familiar, na zona rural do município de Sopetrán, Antioquia, em 2014. Metodologia: estudo descritivo, transversal. A fonte primária foi o universo de pais ou cuidadores. Resultados: participaram 79 pais ou cuidadores de nove Lares comunitários de oito bairros rurais do município. Em média, as mães tinham 28 anos e os pais 32. 74.7% das famílias foi de estrato socioeconômico nível um; a frequência de famílias de tipo nuclear foi de 48%. As verduras, os vegetais, os lácteos, as abóbora e as cenouras foram os alimentos menos consumidos pelos menores. 54.4% das famílias obtém a água de nascimento e 21.5% não se realiza tratamento antes de consumir. 5.1% deposita resíduos a campo aberto. 15.2% e o 35.4% desconhecem os signos de perigo que colocam em risco a vida do menor por infecção respiratória e por doença diarreica aguda, respectivamente. Em 89.9% dos casos as mães se encarregam do cuidado dos menores, com pouca ou nula participação do pai. Conclusão: os padres desconhecem as práticas chave relacionadas com a identificação precoce de signos de alarme de doenças prevalentes na infância. Ademais, o direito à água potável e saneamento básico não é uma realidade para todas as famílias participantes. Adicionalmente, muitas não fervem a água para consumir, o que poderia aumentar algumas doenças prevalentes.

Vacunación frente al cáncer de cérvix en mujeres fuera de los programas de vacunación sistemática, con o sin infección por el virus del papiloma humano o lesión cervical. Encuesta de opinión y recomendaciones / Vaccination against cervical cancer in women outside of routine immunization programs, with or without infection by the human papilloma virus or cervical lesions. Opinion survey and recommendations

Las vacunas frente al cáncer de cérvix se han implementado, en un amplio número de países del mundo, dentro de los programas de vacunación sistemática. Asimismo se ha recomendado la vacunación de rescate en adolescentes y mujeres jóvenes. Desde la perspectiva de salud pública, la vacunación rutinaria en mujeres de mayor edad no se plantea por motivos de coste-efectividad. En estos casos son el médico y la paciente los que, de forma individualizada, deben decidir sobre la vacunación. Una encuesta de opinión dirigida a ginecólogos españoles que desarrollan su actividad asistencial en el ámbito de la patología cervical y colposcopia evidencia que, incluso en este colectivo, hay un relativo desconocimiento sobre aspectos importantes de la vacuna frente al cáncer de cérvix en mujeres fuera de los programas de vacunación sistemática, con o sin infección por el virus del papiloma humano (VPH) o lesión cervical. Además se constata la demanda de mayor información y poder disponer de recomendaciones específicas acerca de este tema. En el presente artículo se revisan las evidencias sobre la infección VPH y el riesgo de cáncer de cérvix a lo largo de la vida, la eficacia de las vacunas en relación con la edad o tras el tratamiento de lesiones cervicales, y la perspectiva del médico y de la mujer. Finalmente se presentan unas recomendaciones, a modo de guía clínica, sobre la vacunación en mujeres fuera de los programas de vacunación sistemática, con o sin infección o lesión cervical (AU)

Vaccines against cervical cancer have been implemented in a wide number of countries around the world as part of systematic vaccination programmes. In addition, rescue vaccination has been recommended for teenagers and young women. From a Public Health perspective, routine vaccination in older women is not proposed for reasons of cost-effectiveness. In these cases, the physician and the patient must decide about the suitability of vaccination in each individual. An opinion poll of Spanish gynaecologists rendering health-care services in the area of cervical pathologies and colposcopy has shown that, even among this group, there is relative lack of knowledge about important aspects of the vaccine against cervical cancer in women outside systematic vaccination programmes, with or without HPV infection or cervical lesions. In addition, the demand for greater information has been confirmed, as has the wish for specific recommendations on this topic. The present article reviews the evidence on HPV infection and the lifelong risk of cervical cancer, the efficacy of vaccines with respect to age or after the treatment of cervical lesions and the perspectives of physicians and women. Finally, some recommendations are made by way of clinical guidance for the vaccination of women outside systematic vaccination programmes, with or without infection or cervical lesion (AU)

The biodiversity of the Mediterranean Sea: estimates, patterns, and threats.

The Mediterranean Sea is a marine biodiversity hot spot. Here we combined an extensive literature analysis with expert opinions to update publicly available estimates of major taxa in this marine ecosystem and to revise and update several species lists. We also assessed overall spatial and temporal patterns of species diversity and identified major changes and threats. Our results listed approximately 17,000 marine species occurring in the Mediterranean Sea. However, our estimates of marine diversity are still incomplete as yet-undescribed species will be added in the future. Diversity for microbes is substantially underestimated, and the deep-sea areas and portions of the southern and eastern region are still poorly known. In addition, the invasion of alien species is a crucial factor that will continue to change the biodiversity of the Mediterranean, mainly in its eastern basin that can spread rapidly northwards and westwards due to the warming of the Mediterranean Sea. Spatial patterns showed a general decrease in biodiversity from northwestern to southeastern regions following a gradient of production, with some exceptions and caution due to gaps in our knowledge of the biota along the southern and eastern rims. Biodiversity was also generally higher in coastal areas and continental shelves, and decreases with depth. Temporal trends indicated that overexploitation and habitat loss have been the main human drivers of historical changes in biodiversity. At present, habitat loss and degradation, followed by fishing impacts, pollution, climate change, eutrophication, and the establishment of alien species are the most important threats and affect the greatest number of taxonomic groups. All these impacts are expected to grow in importance in the future, especially climate change and habitat degradation. The spatial identification of hot spots highlighted the ecological importance of most of the western Mediterranean shelves (and in particular, the Strait of Gibraltar and the adjacent Alboran Sea), western African coast, the Adriatic, and the Aegean Sea, which show high concentrations of endangered, threatened, or vulnerable species. The Levantine Basin, severely impacted by the invasion of species, is endangered as well. This abstract has been translated to other languages (File S1).