Treeline displacement may affect lake dissolved organic matter processing at high latitudes and altitudes.

Climate change induced shifts in treeline position, both towards higher altitudes and latitudes induce changes in soil organic matter. Eventually, soil organic matter is transported to alpine and subarctic lakes with yet unknown consequences for dissolved organic matter (DOM) diversity and processing. Here, we experimentally investigate the consequences of treeline shifts by amending subarctic and temperate alpine lake water with soil-derived DOM from above and below the treeline. We use ultra-high resolution mass spectrometry (FT-ICR MS) to track molecular DOM diversity (i.e., chemodiversity), estimate DOM decay and measure bacterial growth efficiency. In both lakes, soil-derived DOM from below the treeline increases lake DOM chemodiversity mainly through the enrichment with polyphenolic and highly unsaturated compounds. These compositional changes are associated with reductions in bulk and compound-level DOM reactivity and reduced bacterial growth efficiency. Our results suggest that treeline advancement has the potential to enrich a large number of lake ecosystems with less biodegradable DOM, affecting bacterial community function and potentially altering the biogeochemical cycling of carbon in lakes at high latitudes and altitudes.

El pediatra de Atención Primaria y la anafilaxia / The primary care pediatrician and anaphylaxis

La anafilaxia es una reacción alérgica grave de instauración rápida y potencialmente mortal. El diagnóstico de anafilaxia es clínico y debe realizarse de manera precoz. Aparece en las 2 primeras horas tras exposición al alérgeno, en los primeros 30 minutos en alergia alimentaria y más precozmente con medicamentos intravenosos o picaduras de himenópteros. Los síntomas cutáneos suelen ser los primeros en manifestarse y están presentes en la mayoría de los casos, más de un 80%. Pueden ser leves o transitorios e incluso no estar presentes en un 18% de los casos. Si se afecta el sistema cardiocirculatorio estaríamos ante un shock anafiláctico. La causa más frecuente en Pediatría son los alimentos. Existen cofactores cuya presencia aumenta la probabilidad de anafilaxia; los más importantes son: el ejercicio, los fármacos, la fiebre y el estrés. El tratamiento de elección es la adrenalina intramuscular. Tanto los padres como los niños deben saber identificar los signos y/o síntomas del inicio de la anafilaxia para instaurar el tratamiento pautado en el plan de acción escrito.

Anaphylaxis is a severe, rapid and potentially fatal allergic reaction. The diagnosis of anaphylaxis is clinical and must be early. It appears in the first 2 hours after exposure to the allergen, in the first 30 minutes in food allergy and earlier with intravenous drugs or hymenoptera stings. Cutaneous symptoms are generally the first to appear and are present in most cases, more than 80%. They may be mild or transitory, or absent in 18% of cases. If the cardio-circulatory system is affected, an anaphylactic shock occurs. The most frequent cause in pediatrics is nutrition. There are several cofactors whose presence increases the likelihood of anaphylaxis; the most important are: exercise, medication, fever and stress. The treatment of choice is intramuscular adrenaline. Parents and children should be able to identify the signs and/or symptoms of anaphylaxis in order to implement the treatment prescribed in the written action plan. (AU)

Seasonal Variation in Detection of Haemosporidia in a Bird Community: A Comparison of Nested PCR and Microscopy.

In a 2-yr study on prevalence of Haemosporidia in an avian community in Ithaca, New York, USA, we tested the hypothesis that apparent seasonal variation in prevalence is influenced by the detection protocol. We confirmed a higher detection of Haemosporidia using a molecular diagnosis technique (PCR) than by microscopy; this further increased when the PCR test was triplicated. Microscopic examination and PCR techniques have different specificity and sensitivity and therefore different probabilities of detecting hemoparasites. Birds with chronic infections or sampled during winter often have very low parasitemia, and such infections may be missed by microscopy but detected by PCR. Haemosporidian prevalence was higher during the breeding season than during the nonbreeding season regardless of the method used. Detection of Leucocytozoon spp. infection from blood smears using microscopy was challenging.

Changes in the levels of free sialic acid during ex vivo lung perfusion do not correlate with pulmonary function. Experimental model.

BACKGROUND: Ex vivo lung perfusion (EVLP) constitutes a tool with great research potential due to its advantages over in vivo and in vitro models. Despite its important contribution to lung reconditioning, this technique has the disadvantage of incurring high costs and can induce pulmonary endothelial injury through perfusion and ventilation. The pulmonary endothelium is made up of endothelial glycocalyx (EG), a coating of proteoglycans (PG) on the luminal surface. PGs are glycoproteins linked to terminal sialic acids (Sia) that can affect homeostasis with responses leading to edema formation. This study evaluated the effect of two ex vivo perfusion solutions on lung function and endothelial injury. METHODS: We divided ten landrace swine into two groups and subjected them to EVLP for 120 min: Group I (n = 5) was perfused with Steen® solution, and Group II (n = 5) was perfused with low-potassium dextran-albumin solution. Ventilatory mechanics, histology, gravimetry, and sialic acid concentrations were evaluated. RESULTS: Both groups showed changes in pulmonary vascular resistance and ventilatory mechanics (p < 0.05, Student's t-test). In addition, the lung injury severity score was better in Group I than in Group II (p < 0.05, Mann-Whitney U); and both groups exhibited a significant increase in Sia concentrations in the perfusate (p < 0.05 t-Student) and Sia immunohistochemical expression. CONCLUSIONS: Sia, as a product of EG disruption during EVLP, was found in all samples obtained in the system; however, the changes in its concentration showed no apparent correlation with lung function.

Are Purple Finches (Haemorhous purpureus) the Next Host for a Mycoplasmal Conjunctivitis Epidemic?

Ever since 1994, when the bacterial pathogen Mycoplasma gallisepticum jumped from poultry to wild birds, it has been assumed that the primary host species of this pathogen in wild North American birds was the house finch (Haemorhous mexicanus), in which disease prevalence was higher than in any other bird species. Here we tested two hypotheses to explain a recent increase in disease prevalence in purple finches (Haemorhous purpureus) around Ithaca, New York. Hypothesis 1 is that, as M. gallisepticum evolved and became more virulent, it has also become better adapted to other finches. If this is correct, early isolates of M. gallisepticum should cause less-severe eye lesions in purple finches than in house finches, while more-recent isolates should cause eye lesions of similar severity in the two species. Hypothesis 2 is that, as house finch abundance declined following the M. gallisepticum epidemic, purple finches around Ithaca increased in abundance relative to house finches and purple finches are thus more frequently exposed to M. gallisepticum-infected house finches. This would then lead to an increase in M. gallisepticum prevalence in purple finches. Following an experimental infection with an early and a more-recent M. gallisepticum isolate, eye lesions in purple finches were more severe than in house finches. This did not a support Hypothesis 1; similarly, an analysis of Project Feeder Watch data collected around Ithaca did not show differences in changes in purple and house finches' abundance since 2006, a result which does not support Hypothesis 2. We conclude that purple finch populations will, unlike those of house finches, not suffer a severe decline because of a M. gallisepticum epidemic.

¿Son los pinzones purpúreos (Haemorhous purpureus) los próximos huéspedes de una epidemia de conjuntivitis por micoplasma? Desde el año 1994, cuando el patógeno bacteriano Mycoplasma gallisepticum saltó de las aves comerciales a las aves silvestres, se ha supuesto que la principal especie huésped de este patógeno en las aves silvestres de América del Norte era el pinzón mexicano (Haemorhous mexicanus), en el que la prevalencia de la enfermedad era mayor que en cualquier otra especie aviar. En este estudio se analizaron dos hipótesis para explicar un aumento reciente en la prevalencia de la enfermedad en los pinzones purpúreos (Haemorhous purpureus) alrededor de Ithaca, en Nueva York. La hipótesis 1 es que, a medida que M. gallisepticum evolucionó y se volvió más virulento, también se adaptó mejor a otros pinzones. Si esto es correcto, los aislamientos tempranos de M. gallisepticum deberían causar lesiones oculares menos graves en los pinzones purpúreos que en los pinzones mexicanos, mientras que los aislamientos más recientes deberían causar lesiones oculares de gravedad similar en las dos especies. La hipótesis 2 es que, a medida que la abundancia de pinzones mexicanos disminuyó después de la epidemia de M. gallisepticum, los pinzones purpúreos alrededor de Ithaca aumentaron en abundancia en relación con los pinzones mexicanos y, por lo tanto, los pinzones morados están expuestos con mayor frecuencia a los pinzones caseros infectados con M. gallisepticum. Esto conduciría a un aumento de la prevalencia de M. gallisepticum en los pinzones purpúreos. Después de una infección experimental con un aislamiento temprano y uno más reciente de M. gallisepticum, las lesiones oculares en los pinzones purpúreos fueron más graves que en los pinzones mexicanos. Esto no apoyó la Hipótesis 1; de manera similar, un análisis de los datos del Proyecto Feeder Watch recopilados alrededor de Ithaca no mostró diferencias en los cambios de la abundancia de pinzones purpúreos y mexicanos desde 2006, un resultado que no respalda la Hipótesis 2. Se concluye que las poblaciones de pinzones purpúreos, a diferencia de las de los pinzones mexicanos, no sufrieron un declive severo a causa de una epidemia de M. gallisepticum.

CHANGES IN TISSUE TROPISM OF MYCOPLASMA GALLISEPTICUM FOLLOWING HOST JUMP.

Mycoplasma gallisepticum, a pathogen of worldwide economic importance in poultry, is recovered in chickens, especially from the respiratory tract. Some strains, however, are specialized to other tissues and because it jumps from poultry to wild birds, the new strains also cause severe conjunctivitis in new hosts. Nevertheless, most studies of M. gallisepticum in wild birds use choanal swabs or combine choanal and conjunctival swabs to quantify bacterial load. Because the clinical signs associated with M. gallisepticum infection differ markedly between poultry and House Finches (Haemorhous mexicanus), we compared the bacterial load in choanal and conjunctival samples following experimental inoculation of House Finches with M. gallisepticum isolates originating from poultry or from House Finches. This allowed us to test two hypotheses: M. gallisepticum changed tissue tropism, or M. gallisepticum simply expanded its within-host niche. By comparing bacterial loads from choanal and conjunctival swabs in birds inoculated with one of a suite of M. gallisepticum isolates, we found support for hypothesis 2. The choanal loads in House Finches did not differ between isolates, while the conjunctival loads of birds inoculated with poultry isolates were lower than in birds inoculated with House Finch isolates. When measuring the bacterial load of M. gallisepticum in birds, it is important to sample and analyze separately choanal and conjunctival swabs, as quantifying bacterial loads in pooled samples may not provide reliable information on differences in virulence.

THE EFFECT OF DEXAMETHASONE ON HEMATOLOGIC PROFILES, HEMOSPORIDIAN INFECTION, AND SPLENIC HISTOLOGY IN HOUSE FINCHES (HAEMORHOUS MEXICANUS).

Research on host response to infectious disease often involves pharmacological induction of immunosuppression, frequently through administration of dexamethasone. Reports on the effect of dexamethasone in birds are largely restricted to poultry and pigeons. This study describes changes in white blood cell (WBC) differentials, hemoparasite counts, splenic histology, and splenic CD3 immunoreactivity in House Finches (Haemorhous mexicanus). Experimental group birds (n=9) were treated with a daily intramuscular injection of 25 µg of dexamethasone for 8 d; a control group (n=9) received daily saline solution. Smears were made with blood collected immediately before the first dose (day 0) and on d 4, 8, and 9, and stained with modified Wright. The WBC differential counts were performed by three blinded observers, parasite counts by two blinded observers, and histology by one blinded observer. Dexamethasone-treated birds experienced relative heterophilia and lymphopenia on d 4 (P=0.008); heterophilia was also present at d 8 (P=0.018). Hemosporidian counts were significantly increased in dexamethasone-treated birds on d 4 and 8 (P=0.048 and P=0.031, respectively). In contrast with control birds, all dexamethasone-treated birds lacked histologically apparent splenic lymphoid follicles (P<0.001). No significant difference was observed in splenic CD3 immunoreactivity between groups. Our results indicate that dexamethasone has an effect on the hematologic profile of House Finches and suggest that it may be a useful method to induce immunosuppression in this species.

A cell-based ELISA as surrogate of virus neutralization assay for RBD SARS-CoV-2 specific antibodies.

SARS-CoV-2, the cause of the COVID-19 pandemic, has provoked a global crisis and death of millions of people. Several serological assays to determine the quality of the immune response against SARS-CoV-2 and the efficacy of vaccines have been developed, among them the gold standard conventional virus neutralization assays. However, these tests are time consuming, require biosafety level 3 (BSL3), and are low throughput and expensive. This has motivated the development of alternative methods, including molecular inhibition assays. Herein, we present a safe cell-based ELISA-virus neutralization test (cbE-VNT) as a surrogate for the conventional viral neutralization assays that detects the inhibition of SARS-CoV-2 RBD binding to ACE2-bearing cells independently of species. Our test shows a very good correlation with the conventional and molecular neutralization assays and achieves 100% specificity and 95% sensitivity. cbE-VNT is cost-effective, fast and enables a large-scale serological evaluation that can be performed in a BSL2 laboratory, allowing its use in pre-clinical and clinical investigations.

Transmission cluster of COVID-19 cases from Uruguay: emergence and spreading of a novel SARS-CoV-2 ORF6 deletion.

BACKGROUND: Evolutionary changes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) include indels in non-structural, structural, and accessory open reading frames (ORFs) or genes. OBJECTIVES: We track indels in accessory ORFs to infer evolutionary gene patterns and epidemiological links between outbreaks. METHODS: Genomes from Coronavirus disease 2019 (COVID-19) case-patients were Illumina sequenced using ARTIC_V3. The assembled genomes were analysed to detect substitutions and indels. FINDINGS: We reported the emergence and spread of a unique 4-nucleotide deletion in the accessory ORF6, an interesting gene with immune modulation activity. The deletion in ORF6 removes one repeat unit of a two 4-nucleotide repeat, which shows that directly repeated sequences in the SARS-CoV-2 genome are associated with indels, even outside the context of extended repeat regions. The 4-nucleotide deletion produces a frameshifting change that results in a protein with two inserted amino acids, increasing the coding information of this accessory ORF. Epidemiological and genomic data indicate that the deletion variant has a single common ancestor and was initially detected in a health care outbreak and later in other COVID-19 cases, establishing a transmission cluster in the Uruguayan population. MAIN CONCLUSIONS: Our findings provide evidence for the origin and spread of deletion variants and emphasise indels' importance in epidemiological studies, including differentiating consecutive outbreaks occurring in the same health facility.

Transmission cluster of COVID-19 cases from Uruguay: emergence and spreading of a novel SARS-CoV-2 ORF6 deletion

BACKGROUND Evolutionary changes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) include indels in non-structural, structural, and accessory open reading frames (ORFs) or genes. OBJECTIVES We track indels in accessory ORFs to infer evolutionary gene patterns and epidemiological links between outbreaks. METHODS Genomes from Coronavirus disease 2019 (COVID-19) case-patients were Illumina sequenced using ARTIC_V3. The assembled genomes were analysed to detect substitutions and indels. FINDINGS We reported the emergence and spread of a unique 4-nucleotide deletion in the accessory ORF6, an interesting gene with immune modulation activity. The deletion in ORF6 removes one repeat unit of a two 4-nucleotide repeat, which shows that directly repeated sequences in the SARS-CoV-2 genome are associated with indels, even outside the context of extended repeat regions. The 4-nucleotide deletion produces a frameshifting change that results in a protein with two inserted amino acids, increasing the coding information of this accessory ORF. Epidemiological and genomic data indicate that the deletion variant has a single common ancestor and was initially detected in a health care outbreak and later in other COVID-19 cases, establishing a transmission cluster in the Uruguayan population. MAIN CONCLUSIONS Our findings provide evidence for the origin and spread of deletion variants and emphasise indels' importance in epidemiological studies, including differentiating consecutive outbreaks occurring in the same health facility.

Complex interactions between bacteria and haemosporidia in coinfected hosts: An experiment.

Hosts are typically coinfected by multiple parasite species whose interactions might be synergetic or antagonistic, producing unpredictable physiological and pathological impacts on the host. This study shows the interaction between Plasmodium spp. and Leucocytozoon spp. in birds experimentally infected or not infected with Mycoplasma gallisepticum.In 1994, the bacterium Mycoplasma gallisepticum jumped from poultry to wild birds in which it caused a major epidemic in North America. Birds infected with M. gallisepticum show conjunctivitis as well as increased levels of corticosterone.Malaria and other haemosporidia are widespread in birds, and chronic infections become apparent with the detectable presence of the parasite in peripheral blood in response to elevated levels of natural or experimental corticosterone levels.Knowing the immunosuppressive effect of corticosterone on the avian immune system, we tested the hypothesis that chronic infections of Plasmodium spp. and Leucocytozoon spp. in house finches would respond to experimental inoculation with M. gallisepticum as corticosterone levels are known to increase following inoculation. Plasmodium spp. infection intensity increased within days of M. gallisepticum inoculation as shown both by the appearance of infected erythrocytes and by the increase in the number and the intensity of positive PCR tests. Leucocytozoon spp. infection intensity increased when Plasmodium spp. infection intensity increased, but not in response to M. gallisepticum inoculation. Leucocytozoon spp. and Plasmodium spp. seemed to compete in the host as shown by a negative correlation between the changes in their PCR score when both pathogens were present in the same individual.Host responses to coinfection with multiple pathogens measured by the hematocrit and white blood cell count depended on the haemosporidian community composition. Host investment in the leukocyte response was higher in the single-haemosporidia-infected groups when birds were infected with M. gallisepticum.A trade-off was observed between the immune control of the chronic infection (Plasmodium spp./Leucocytozoon spp.) and the immune response to the novel bacterial infection (M. gallisepticum).

Ectoparasitism during an avian disease outbreak: An experiment with Mycoplasma-infected house finches and ticks.

Hosts are typically co-parasitized by multiple species. Parasites can benefit or suffer from the presence of other parasites, which can reduce or increase the overall virulence due to competition or facilitation. Outcomes of new multi-parasite systems are seldom predictable. In 1994 the bacterium Mycoplasma gallisepticum jumped from poultry to songbirds in which it caused an epidemic throughout North America. Songbirds are often parasitized by hard ticks, and can act as reservoirs for tick-borne pathogens. We tested the hypothesis that Mycoplasma infection in house finches influences North America's most important tick vector Ixodes scapularis, by affecting the tick's feeding success, detachment behaviour and survival to the next stage. Most ticks detached during the daylight hours irrespective of the bird's disease status and time since infestation. Birds incrementally invested in anti-tick resistance mechanisms over the course of the experiment; this investment was made earlier in the Mycoplasma-infected birds. At higher tick densities, the feeding success on birds with more severe conjunctivitis was lower than in the uninfected birds. Throughout the experiment we found positive density dependent effects on the tick's feeding success. More diseased hosts suffered more from the tick infestations, as shown by reduced haematocrits. Three Mycoplasma-infected birds died during the weeks following the experiment, although all birds were kept in optimal housing conditions. Mycoplasma made the bird a less accessible and valuable host for ticks, which is an example of ecological interference. Therefore, Mycoplasma has the potential to ultimately reduce transmission outcomes of tick-borne pathogens via songbird hosts.

Desenlaces maternos y neonatales relacionados con edad materna avanzada / Maternal and neonatal outcomes in advanced maternal age

Resumen OBJETIVO: Describir los desenlaces maternos y perinatales en embarazadas de edad avanzada. MATERIALES Y MÉTODOS: Estudio de dos cohortes, prospectivo y retrospectivo efectuado con base en la información de expedientes clínicos de pacientes atendidas en el Complexo Hospitalario Universitario de Ourense entre 2017 y 2018. Se establecieron dos cohortes: la cohorte A con edad mayor o igual a 40 años y la cohorte B con edad menor de 40 años. Se realizaron pruebas paramétricas y no paramétricas para determinar la asociación potencial entre las variables de estudio (χ2, t de Student, U de Mann-Whitney). RESULTADOS: Las pacientes de la cohorte A (n = 207) tuvieron significación estadística: índice de masa corporal mayor al inicio del embarazo (p = 0.028), mayor cantidad de embarazos previos (p = 0.001), a expensas de mayor cantidad de abortos (p < 0.001), estados hipertensivos del embarazo (p = 0.03), prematurez (p = 0.009), retraso en el crecimiento intrauterino (p = 0.006), macrosomía fetal (p = 0.04), inducciones (p < 0.001), cesáreas programadas o intraparto y hemorragia posparto (p = 0.001). No se encontraron diferencias en la paridad, amenorrea al parto, diabetes pregestacional-gestacional, peso fetal medio, Apgar, pH de la arteria umbilical y cantidad de recién nacidos con requerimiento de ingreso a la unidad de Neonatología. CONCLUSIONES: La edad materna avanzada es un factor de riesgo importante de morbilidad materna y perinatal. La mayor tasa de complicaciones descritas refleja la importancia del control exhaustivo del embarazo y vigilancia periparto minuciosa.

Abstract OBJECTIVE: To describe the maternal and perinatal results in pregnant women with advanced age. MATERIALS AND METHODS: A cohort study was conducted with prospective follow-up and retrospective data collection of the Clinical History of the University Hospital Complex of Ourense between 2017 and 2018. Two cohorts were established, cohort A with age greater than and equal to 40 years and the cohort B with age under 40 years. Parametric and non-parametric tests were performed to determine the potential association between the study variables (Chi-Square, Student's T, Mann-Whitney U). RESULTS: The cohort A patients (n = 207) presented with statistical significance: body mass index higher at the beginning of pregnancy (p = 0.028), higher number of previous pregnancies (p = 0.001), but at the expense of a higher number of abortions (p <0.001), hypertensive states of pregnancy (p = 0.03), prematurity (p = 0.009), intrauterine growth retardation (p = 0.006), fetal macrosomia (p = 0.04), inductions (p < 0.001), of both scheduled and intrapartum caesarean sections and postpartum hemorrhage (p = 0.001). No differences were found in parity, amenorrhea at delivery, pregestational / gestational diabetes, mean fetal weight, Apgar score, umbilical artery pH and number of newborns who required admission to the Neonatal Unit. CONCLUSIONS: Advanced maternal age is an important risk factor for maternal and perinatal morbidity. The higher rate of complications described reflects the importance of thorough pregnancy control and careful peripartum surveillance.

[Depression and burden in the caretaking of elderly]. / Depresión y sobrecarga en el cuidado de personas mayores.

OBJECTIVE: Informal care affects the quality of life and emotional health. Objective: To analyze the relationship between burden and depression in caregivers measured by Zarit's Scale and GHQ-28 and the global functional deterioration of the elderly measured by OARS-MFAQ. METHODS: Descriptive observational cross-sectional study in Primary Health Care at Ourense city. 104 people (>65 years old) and their caregivers were interviewed. Descriptive analysis and logistic regression were used to analyze the characteristics that increase the probability to suffer burden and depression. RESULTS: 82.7% of caregivers were women with an average age of 63.64 years (95% CI: 61.05-66.23) and 10.3% were over 80 years old. 32.2% had an overload, associated with taking care of younger people (p=0.043), being a couple of an elder (p=0.003) being older (p=0.031) and the risk of depression which were all found as factors associated with burden, measured by GHQ (p<0.001). Having good perception of the vision (p=0.038), rejecting the use of a cane (p=0.002) or wheelchair (p=0.015) were also associated with factors contributing to burden. CONCLUSIONS: Informal caregivers are women around their sixties, and although they do not feel overburdened for caring, they have depression, more likely the more severe the burden is, and it is related with the perception of economic deficiencies for the caring.

OBJETIVO: Los cuidados informales afectan a la calidad de vida y a la salud emocional. El objetivo de este trabajo fue analizar la relación entre la carga y la depresión en los cuidadores/as medida con Escala de Zarit y GHQ-28 y el deterioro funcional global del anciano medido mediante OARS-MFAQ. METODOS: Estudio transversal descriptivo por entrevistas a 104 personas mayores de 65 años y sus cuidadores/as informales en la ciudad de Ourense. Se realizó un análisis descriptivo y una regresión logística de las variables que influyen en la depresión y la sobrecarga por cuidar ancianos. RESULTADOS: El 82,7% de cuidadores/as eran mujeres con edad media de 63,64 años (IC 95%: 61,05-66,23) y el 10,3% mayor de 80 años. El 32,2% presentaba sobrecarga encontrándose como factores asociados a la misma, cuidar de ancianos más jóvenes (p=0,043), ser pareja del anciano (p=0,003), tener mayor edad (p=0,031) y el riesgo de depresión medida con GHQ (p<0,001). Tener buena percepción de la visión (p=0,038), rechazar el uso de bastón (p=0,002) o silla de ruedas (p=0,015) también se asoció con la sobrecarga. CONCLUSIONES: Las cuidadoras informales son mujeres en torno a 60 años. Aunque no sientan sobrecarga por cuidar, tienen depresión, que es más probable cuanto más severa es la carga y esta se relaciona con la percepción de carencias económicas básicas para el cuidado.

Depresión y sobrecarga en el cuidado de personas mayores / Depression and burden in the caretaking of elderly

OBJETIVO: Los cuidados informales afectan a la calidad de vida y a la salud emocional. El objetivo de este trabajo fue analizar la relación entre la carga y la depresión en los cuidadores/as medida con Escala de Zarit y GHQ-28 y el deterioro funcional global del anciano medido mediante OARS-MFAQ. MÉTODOS: Estudio transversal descriptivo por entrevistas a 104 personas mayores de 65 años y sus cuidadores/as informales en la ciudad de Ourense. Se realizó un análisis descriptivo y una regresión logística de las variables que influyen en la depresión y la sobrecarga por cuidar ancianos. RESULTADOS: El 82,7% de cuidadores/as eran mujeres con edad media de 63,64 años (IC 95%: 61,05-66,23) y el 10,3% mayor de 80 años. El 32,2% presentaba sobrecarga encontrándose como factores asociados a la misma, cuidar de ancianos más jóvenes (p=0,043), ser pareja del anciano (p=0,003), tener mayor edad (p=0,031) y el riesgo de depresión medida con GHQ (p<0,001). Tener buena percepción de la visión (p=0,038), rechazar el uso de bastón (p=0,002) o silla de ruedas (p=0,015) también se asoció con la sobrecarga. CONCLUSIONES: Las cuidadoras informales son mujeres en torno a 60 años. Aunque no sientan sobrecarga por cuidar, tienen depresión, que es más probable cuanto más severa es la carga y esta se relaciona con la percepción de carencias económicas básicas para el cuidado

OBJECTIVE: Informal care affects the quality of life and emotional health. Objective: To analyze the relationship between burden and depression in caregivers measured by Zarit's Scale and GHQ-28 and the global functional deterioration of the elderly measured by OARS-MFAQ. METHODS: Descriptive observational cross-sectional study in Primary Health Care at Ourense city. 104 people (>65 years old) and their caregivers were interviewed. Descriptive analysis and logistic regression were used to analyze the characteristics that increase the probability to suffer burden and depression. RESULTS: 82.7% of caregivers were women with an average age of 63.64 years (95% CI: 61.05-66.23) and 10.3% were over 80 years old. 32.2% had an overload, associated with taking care of younger people (p=0.043), being a couple of an elder (p=0.003) being older (p=0.031) and the risk of depression which were all found as factors associated with burden, measured by GHQ (p<0.001). Having good perception of the vision (p=0.038), rejecting the use of a cane (p=0.002) or wheelchair (p=0.015) were also associated with factors contributing to burden. CONCLUSIONS: Informal caregivers are women around their sixties, and although they do not feel overburdened for caring, they have depression, more likely the more severe the burden is, and it is related with the perception of economic deficiencies for the caring

Morbilidad y mortalidad a largo plazo en mujeres con antecedente de desprendimiento prematuro de placenta normoinserta / Long-term morbidity and mortality in women with a history of premature placental abruption normoinserta

Resumen OBJETIVOS: Analizar las consecuencias a largo plazo del desprendimiento prematuro de placenta normoinserta, principalmente la incidencia de enfermedad cardiovascular y secundariamente otras causas de morbilidad y mortalidad (diabetes, neoplasias o trastornos psiquiátricos). MATERIALES Y MÉTODOS: Estudio de casos y controles, con recolección retrospectiva de datos de pacientes embarazadas que acudieron al Complexo Hospitalario Universitario de Ourense entre 1996 y 2008. El criterio de inclusión en el grupo casos fue el antecedente de desprendimiento prematuro de placenta normoinserta. El grupo control lo integraron pacientes con parto anterior y posterior al grupo de casos y que no habían sufrido desprendimiento de placenta. Las historias clínicas se analizaron mediante la recolección de datos de la "gestación índice" y se realizó el seguimiento a largo plazo para establecer el diagnóstico de hipertensión arterial, diabetes mellitus, enfermedad cardiovascular, neoplasias o alteraciones psiquiátricas. Para el análisis estadístico se requirió el programa SPSS15.0. Se consideró estadísticamente significativo el valor de p < 0.05. RESULTADOS: Se estudiaron 198 mujeres: 66 en el grupo de casos y 132 en el grupo control. Durante el seguimiento (15.8 ± 3.58 años), la incidencia de diabetes mellitus y dislipidemia fue mayor en el grupo de casos, pero sin significación estadística. No se encontraron diferencias en la incidencia de hipertensión arterial, síndrome metabólico, enfermedad cardiovascular ni trastorno ansioso-depresivo. En el grupo de casos se encontró una alta tasa de enfermedad neoplásica. CONCLUSIONES: No existe relación entre desprendimiento prematuro de placenta y enfermedad cardiovascular. Se carece de una explicación que justifique la alta tasa de patología tumoral en este grupo de pacientes.

Abstract OBJECTIVE: To analyze if women with a history of premature placental abruption have a long-term increase in morbidity and mortality. MATERIALS AND METHODS: Case-control study with retrospective data collection of pregnant women from the Hospital University Complex of Ourense between 1996 and 2008. The criteria for inclusion in the case group were the history of placental abruption. The control group was constituted by the women with previous and subsequent delivery to the case group and who had not presented placental abruption. The clinical histories were analyzed with data collection of the index pregnancy and a long-term follow-up was carried out to detect the subsequent diagnosis of arterial hypertension, diabetes mellitus, cardiovascular disease, as well as neoplastic and psychiatric pathology. The statistical study was carried out using the SPSS15.0 computer program. Values of p < 0,05 were considered significant results. RESULTS: A total of 198 women were studied, of which 66 belong to the case group and 132 to the control group. In the follow-up period (15,8±3,58 years) the incidence of diabetes mellitus and dyslipidemia was higher in the case group, but without statistical significance. No differences were found in the incidence of hypertension, metabolic syndrome, cardiovascular disease or anxiety-depressive illness. In the case group, a high rate of oncological pathology was found. CONCLUSIONS: We found no relationship between the history of placental abruption and cardiovascular disease. We lack an explanation that justifies the high rate of tumor pathology in this group of women.

A Second Order Multi-Stencil Fast Marching Method with a Non-Constant Local Cost Model.

The Fast Marching method is widely employed in several fields of image processing. Some years ago a Multi-Stencil version (MSFM) was introduced to improve its accuracy by solving the equation for a set of stencils and choosing the best solution at each considered node. The following work proposes a modified numerical scheme for MSFM to take into account the variation of the local cost, which has proven to be second order. The influence of the stencil set choice on the algorithm outcome with respect to stencil orthogonality and axis swapping is also explored, where stencils are taken from neighborhoods of varying radius. The experimental results show that the proposed schemes improve the accuracy of their original counterparts, and that the use of permutation-invariant stencil sets provides robustness against shifted vector coordinates in the stencil set.

Influence of propofol dose and blood components on duration of electrical seizures in electroconvulsive therapy / Influência da dose de propofol e dos componentes sanguíneos na duração das convulsões elétricas em eletroconvulsoterapia

Abstract Background and objectives: Propofol is commonly employed as a hypnotic agent to perform electroconvulsive therapy, but it exhibits also anticonvulsant properties. The main objective was to study the effect of the weight-adjusted dose of propofol on duration of the electrical seizure. Secondary objectives were to study the effect of absolute dose of propofol on duration of electrical seizure, the effect of both absolute and weight-adjusted doses on values of bispectral index, and the influence of blood chemistry on anticonvulsant effect. Methods: After approval of the Institutional Review Board, a retrospective chart review was performed of all patients who underwent at least one electroconvulsive therapy session. Multiple lineal regression analysis adjusted for potential confounders was employed to explore the effect of propofol dosage on values of bispectral index and on duration of seizure; bivariate correlation analyses were previously performed to identify variables fulfilling confounding criteria, specifically values of Spearman's rho >0.10. Results of regression analysis were expressed as B coefficient with its 95% confident interval. Results: 76 patients received 631 acute phase sessions. Propofol showed a statistically significant negative effect on duration of seizure (specifically a reduction of 4.081 s for every mg.kg−1 of propofol; CI95%: −7906 to −0.255, p = 0.037) but not on bispectral index values. Slight anemia and hypoalbuminemia were very infrequent conditions, and the anticonvulsant effect was not influenced by these parameters. Conclusions: Propofol weight-adjusted dose is negatively related to duration of seizures. It should be carefully titrated when employed to perform electroconvulsive therapy.

Resumo Justificativa e objetivos: O propofol é comumente usado como agente hipnótico na terapia eletroconvulsiva, mas apresenta também propriedades anticonvulsivantes. O objetivo principal foi avaliar o efeito da dose de propofol ajustada ao peso na duração da convulsão elétrica. Os objetivos secundários foram avaliar o efeito da dose total de propofol na duração da convulsão elétrica, o efeito da dose tanto total quanto ajustada ao peso nos valores do índice bispectral e a influência da bioquímica do sangue no efeito anticonvulsivante. Métodos: Após aprovação do Comitê de Ética em Pesquisa, foi feita uma revisão retrospectiva dos prontuários de todos os pacientes que fizeram pelo menos uma sessão de eletroconvulsoterapia. Análise de regressão linear múltipla ajustada para potenciais confundidores foi feita para explorar o efeito da dosagem de propofol sobre os valores do índice bispectral e a duração da convulsão; análises de correlação bivariada foram previamente feitas para identificar as variáveis que atendem aos critérios de confusão, especificamente valores de r de Spearman > 0,10. Os resultados da análise de regressão foram expressos como coeficiente B com intervalo de confiança de 95%. Resultados: Setenta e seis pacientes receberam 631 sessões de fase aguda. Propofol mostrou um efeito negativo estatisticamente significativo sobre a duração da convulsão (especificamente uma redução de 4,081 segundos para cada mg.kg−1 de propofol; IC de 95%: -7906 para -0,255, p = 0,037), mas não para os valores do índice bispectral. Anemia leve e hipoalbuminemia foram condições muito raras e o efeito anticonvulsivante não foi influenciado por esses parâmetros. Conclusões: A dose de propofol ajustada ao peso está negativamente relacionada com a duração das crises convulsivas, deve ser cuidadosamente titulada quando usada na terapia eletroconvulsiva.

[Influence of propofol dose and blood components on duration of electrical seizures in electroconvulsive therapy]. / Influência da dose de propofol e dos componentes sanguíneos na duração das convulsões elétricas em eletroconvulsoterapia.

BACKGROUND AND OBJECTIVES: Propofol is commonly employed as a hypnotic agent to perform electroconvulsive therapy, but it exhibits also anticonvulsant properties. The main objective was to study the effect of the weight-adjusted dose of propofol on duration of the electrical seizure. Secondary objectives were to study the effect of absolute dose of propofol on duration of electrical seizure, the effect of both absolute and weight-adjusted doses on values of bispectral index, and the influence of blood chemistry on anticonvulsant effect. METHODS: After approval of the Institutional Review Board, a retrospective chart review was performed of all patients who underwent at least one electroconvulsive therapy session. Multiple lineal regression analysis adjusted for potential confounders was employed to explore the effect of propofol dosage on values of bispectral index and on duration of seizure; bivariate correlation analyses were previously performed to identify variables fulfilling confounding criteria, specifically values of Spearman's rho >0.10. Results of regression analysis were expressed as B coefficient with its 95% confident interval. RESULTS: 76 patients received 631 acute phase sessions. Propofol showed a statistically significant negative effect on duration of seizure (specifically a reduction of 4.081s for every mg.kg-1 of propofol; CI95%: -7906 to -0.255, p=0.037) but not on bispectral index values. Slight anemia and hypoalbuminemia were very infrequent conditions, and the anticonvulsant effect was not influenced by these parameters. CONCLUSIONS: Propofol weight-adjusted dose is negatively related to duration of seizures. It should be carefully titrated when employed to perform electroconvulsive therapy.

[Incidence of hypophosphatemia in not critically ill patients with enteral feeding]. / Incidencia de hipofosfatemia en pacientes ingresados no críticos con nutrición enteral.

BACKGROUND: Up to 30-40% of the patients starting artificial nutritional support develop hypophosphatemia. In general, patients with mild and moderate hypophosphatemia do not have symptoms, but severe hypophosphatemia is the hallmark of refeeding syndrome. AIM: To determine the incidence of hypophosphatemia in not critically ill patients receiving enteral feeding. MATERIAL AND METHODS: Prospective study. We assessed during seven days 181 not critically ill patients started on enteral artificial nutrition support during seven days. RESULTS: 51.9% of the patients were considered to be at risk of developing refeeding syndrome (United Kingdom National Institute for Health and Clinical Excellence criteria). The incidence of hypophosphatemia was 31.5%, but only 1.1% of the patients developed severe hypophosphatemia. Older age and lower plasma proteins were significantly associated with hypophosphatemia. CONCLUSION: The incidence of severe hypophosphatemia in our study is low, so we can't offer robust conclusions about the risk of hypophosphatemia in the type of patients receiving enteral nutrition.

INTRODUCCIÓN: se ha descrito una incidencia de hipofosfatemia en pacientes con soporte nutricional especializado (SNE) de hasta el 30-40%. La hipofosfatemia leve y la moderada son generalmente asintomáticas, mientras que la severa es el hecho fundamental del síndrome de realimentación. OBJETIVO: evaluar la incidencia y gravedad de la hipofosfatemia en pacientes hospitalizados no críticos con nutrición enteral (NE).MATERIAL Y MÉTODOS: se diseñó un estudio observacional y prospectivo en condiciones de práctica clínica habitual. Se recogieron datos clínicos, antropométricos y analíticos de 181 pacientes a los que se les inició nutrición enteral. El seguimiento fue de siete días.RESULTADOS: el 51,9% de los pacientes estaban en riesgo de desarrollar síndrome de realimentación según las guías del United Kingdom National Institute for Health and Clinical Excellence (NICE). La incidencia de hipofosfatemia fue del 31,5% y la de la hipofosfatemia severa, del 1,1%. De todos los parámetros clínicos, antropométricos y analíticos analizados, solo la edad y unas proteínas séricas más bajas se correlacionaron de forma estadísticamente significativa con el aumento en la incidencia de hipofosfatemia. CONCLUSIÓN: la incidencia de hipofosfatemia grave en nuestra serie es muy baja, lo que hace imposible extraer conclusiones específicas para este grupo de pacientes.