Aspectos logísticos y sanitarios de la atención a migrantes. La experiencia española en la operación EUNAVFOR MED SOPHIA / Logistic and sanitary aspects of attention to migrants. The Spanish experience in the EUNAVFOR MED SOPHIA operation

Actualmente, somos testigos en Europa del mayor número de desplazamientos de los que se tienen constancia en la historia, a consecuencia de la persecución, los conflictos armados, la violencia o la inestabilidad económica y social reinante en Oriente Medio y en numerosos países africanos y de Asia Meridional. Estos hechos junto a la proximidad a las costas europeas han hecho que en los últimos tiempos la ruta del Mediterráneo Central se haya convertido en la más utilizada por los migrantes para alcanzar Europa. La magnitud en cifras de este fenómeno ha llegado a ser tan elevada junto con el importante número de vidas que se han perdido en la mar han hecho que la comunidad internacional ha reaccionado de forma contundente poniendo en marcha la OPERACIÓN EUNAVFOR MED SOPHIA. El objetivo del presente artículo es proporcionar conocimientos sobre esta realidad que supone la inmigración a través de rutas marítimas, los aspectos logísticos y médicos relacionados con la atención y asistencia a migrantes a bordo de los buques de la Armada Española y revisar la bibliografía publicada sobre el tema

Currently, we are witnesses in Europe of the greatest number of displacements recorded in history, as a result of persecution, armed conflicts, violence or the economic and social instability prevailing in the Middle East and in many African countries and South Asia. These facts, together with the proximity to the European coasts have meant that in recent times the Central Mediterranean route has become the most used by migrants to reach Europe. The magnitude of this phenomenon has become so high, that together with the important number of lives that have been lost at sea, have caused that the international community reacts mightly launching the OPERATION EUNAVFOR MED SOPHIA. The objective of this article is to provide knowledge on this reality that involves immigration through maritime routes, logistics and medical aspects related to the care and assistance to migrants on board of the Spanish Navy vessels, and review the published literature on the theme

Association between clean intermittent catheterization and urinary tract infection in infants and toddlers with spina bifida.

INTRODUCTION: The primary goal of urologic management in children with spina bifida is to reduce the risk of urinary tract infection (UTI) and associated renal injury. While clean intermittent catheterization (CIC) has been the mainstay of treatment, recent studies have suggested that this approach is not without risk. The objective of this study was to examine the association between alternative bladder management strategies and UTI in infants and toddlers with spina bifida. METHODS: A retrospective cohort study was conducted on spina bifida patients, aged 0-3 years, seen in a multidisciplinary spinal defects clinic between 2008 and 2013. Inclusion criteria included: a primary diagnosis of meningocele, myelomeningocele, or lipomyelomeningocele. Patients were excluded if they had: <1 year of follow-up, urologic surgery prior to initial evaluation, or incomplete data for analysis. Bivariate analyses were performed using Chi-squared or Fisher's exact tests. Multivariate analyses were performed using logistic regression. RESULTS: A total of 107 patients meeting study criteria were identified. The majority of patients had lumbar lesions (74.8%) and ventriculoperitoneal (VP) shunts (72.9%). Initial bladder management was by CIC in 39.3% of patients and spontaneous voiding in 60.8% of patients. Median age at follow-up was 2.5 years. During the study period, 23.4% of patients switched from spontaneous voiding to CIC. Patients managed with CIC were more likely to have UTIs at final follow-up than those managed with voiding (35.7% vs. 18.5%; P = 0.045). Patients with vesicoureteral reflux (VUR) were also more likely to have UTIs (54.5% vs. 17.9%; P = 0.015). Patients who switched from spontaneous voiding to CIC over the study period were more likely to be evaluated with urodynamics (72.0% vs. 31.8%; P < 0.0001) than those managed with voiding alone. Patients who switched to CIC were also more likely to have VUR (16% vs. 0%; P = 0.09) and UTIs (24% vs. 15%; P = 0.06) than those managed with voiding alone; however, these differences were not statistically significant. CONCLUSIONS: In the present series, infants and toddlers with spina bifida who were initially managed with spontaneous voiding had a lower risk of UTI than those managed with CIC. Patients who switched to CIC after a period of initial observation with voiding did not have a significantly different risk of UTI compared with those managed with CIC alone. These findings suggest that early initiation of CIC may not be warranted in all infants with spina bifida. Further studies are needed to more clearly define optimal indications for initiation of CIC in these patients.

In-depth neuropharmacokinetic analysis of antipsychotics based on a novel approach to estimate unbound target-site concentration in CNS regions: link to spatial receptor occupancy.

The current study provides a novel in-depth assessment of the extent of antipsychotic drugs transport across the blood-brain barrier (BBB) into various brain regions, as well as across the blood-spinal cord barrier (BSCB) and the blood-cerebrospinal fluid barrier (BCSFB). This is combined with an estimation of cellular barrier transport and a systematic evaluation of nonspecific brain tissue binding. The study is based on the new Combinatory Mapping Approach (CMA), here further developed for the assessment of unbound drug neuropharmacokinetics in regions of interest (ROI), referred as CMA-ROI. We show that differences exist between regions in both BBB transport and in brain tissue binding. The most dramatic spatial differences in BBB transport were found for the P-glycoprotein substrates risperidone (5.4-fold) and paliperidone (4-fold). A higher level of transporter-mediated protection was observed in the cerebellum compared with other brain regions with a more pronounced efflux for quetiapine, risperidone and paliperidone. The highest BBB penetration was documented in the frontal cortex, striatum and hippocampus (haloperidol, olanzapine), indicating potential influx mechanisms. BSCB transport was in general characterized by more efficient efflux compared with the brain regions. Regional tissue binding was significantly different for haloperidol, clozapine, risperidone and quetiapine (maximally 1.9-fold). Spatial differences in local unbound concentrations were found to significantly influence cortical 5-HT2A receptor occupancy for risperidone and olanzapine. In conclusion, the observed regional differences in BBB penetration may potentially be important factors contributing to variations in therapeutic effect and side effect profiles among antipsychotic drugs.

Metal release from contaminated estuarine sediment under pH changes in the marine environment.

The contaminant release from estuarine sediment due to pH changes was investigated using a modified CEN/TS 14429 pH-dependence leaching test. The test is performed in the range of pH values of 0-14 using deionised water and seawater as leaching solutions. The experimental conditions mimic different circumstances of the marine environment due to the global acidification, carbon dioxide (CO2) leakages from carbon capture and sequestration technologies, and accidental chemical spills in seawater. Leaching test results using seawater as leaching solution show a better neutralisation capacity giving slightly lower metal leaching concentrations than when using deionised water. The contaminated sediment shows a low base-neutralisation capacity (BNCpH 12 = -0.44 eq/kg for deionised water and BNCpH 12 = -1.38 eq/kg for seawater) but a high acid-neutralisation capacity when using deionised water (ANCpH 4 = 3.58 eq/kg) and seawater (ANCpH 4 = 3.97 eq/kg). Experimental results are modelled with the Visual MINTEQ geochemical software to predict metal release from sediment using both leaching liquids. Surface adsorption to iron- and aluminium-(hydr)oxides was applied for all studied elements. The consideration of the metal-organic matter binding through the NICA-Donnan model and Stockholm Humic Model for lead and copper, respectively, improves the former metal release prediction. Modelled curves can be useful for the environmental impact assessment of seawater acidification due to its match with the experimental values.

Hollow fiber liquid-phase microextraction and determination of nonsteroidal anti-inflammatories by capillary electrophoresis and sulfonamides by HPLC in human urine.

In this paper two applications of three-phase HF-LPME for the determination of pharmaceuticals in human urine are proposed: a capillary electrophoresis with a photodiode array detection method for the analysis of seven nonsteroidal anti-inflammatory drugs (NSAIDs) and a high-performance liquid chromatographic with photo diode array and fluorescence detection method for the determination of four sulfonamides and their corresponding N(4)-acetyl-metabolites. Q3/2 Accurel® polypropylene hollow fibers were used for both procedures. Dihexyl ether was used as the supported liquid membrane for the determination of anti-inflammatories and 1-octanol for sulfonamides. An aqueous solution (pH 12) was used in both procedures as the acceptor phase and as the donor phase an aqueous solution (pH 2), and a 2 M Na(2)SO(4) aqueous solution (pH 4) was used for the determination of the anti-inflammatories and sulfonamides. The detection limits obtained were between 0.25 (naproxen) and 0.86 ng/mL (aceclofenac) for the determination of anti-inflammatories and 7 × 10(-4) (sulfamethoxazole) and 0.048 ng/mL (N(4)-acetyl-sulfamethazine) for sulfonamides. The method was successfully applied to the determination of the analytes in human urine.

Evaluation through column leaching tests of metal release from contaminated estuarine sediment subject to CO2 leakages from Carbon Capture and Storage sites.

The pH change and the release of organic matter and metals from sediment, due to the potential CO(2) acidified seawater leakages from a CCS (Carbon Capture and Storage) site are presented. Column leaching test is used to simulate a scenario where a flow of acidified seawater is in contact with recent contaminated sediment. The behavior of pH, dissolved organic carbon (DOC) and metals As, Cd, Cr, Cu, Ni, Pb, Zn, with liquid to solid (L/S) ratio and pH is analyzed. A stepwise strategy using empirical expressions and a geochemical model was conducted to fit experimental release concentrations. Despite the neutralization capacity of the seawater-carbonate rich sediment system, important acidification and releases are expected at local scale at lower pH. The obtained results would be relevant as a line of evidence input of CCS risk assessment, in an International context where strategies to mitigate the climate change would be applied.

Potential influence of CO2 release from a carbon capture storage site on release of trace metals from marine sediment.

One of the main risks of CCS (Carbon Capture and Storage) is CO(2) leakage from a storage site. The influence of CO(2) leakage on trace metals leaching from contaminated marine sediment in a potential storage area (Northern Spain) is addressed using standardized leaching tests. The influence of the pH of the leaching solution on the leachates is evaluated using deionized water, natural seawater and acidified seawater at pH = 5, 6 and 7, obtained by CO(2) bubbling. Equilibrium leaching tests (EN 12457) were performed at different liquid-solid ratios and the results of ANC/BNC leaching test (CEN/TS 15364) were modeled using Visual Minteq. Equilibrium tests gave values of the final pH for all seawater leachates between 7 and 8 due to the high acid neutralization capacity of the sediment. Combining leaching test results and geochemical modeling provided insight in the mechanisms and prediction of trace metals leaching in acidified seawater environment.

Enzymatic-microwave assisted extraction and high-performance liquid chromatography-mass spectrometry for the determination of selected veterinary antibiotics in fish and mussel samples.

A new method based on enzymatic-microwave assisted extraction prior to high performance liquid chromatography (HPLC) has been developed for the determination of 11 antibiotics (drugs) and the main metabolites of five of them in fish tissue and mussel samples. The analysed compounds were sulfadiazine (SDI), N(4)-acetylsulfadiazine (NDI), sulfamethazine (SMZ), N(4)-acetylsulfamethazine (NMZ), sulfamerazine (SMR), N(4)-acetylsulfamerazine (NMR), sulfamethoxazole (SMX), trimetroprim (TMP), amoxicillin (AMX), amoxicilloic acid (AMA), ampicillin (AMP), ampicilloic acid (APA), chloramphenicol (CLF), thiamphenicol (TIF), oxytetracycline (OXT) and chlortetracycline (CLT). The main factors affecting the extraction efficiency were optimized in tissue of hake (Merluccius merluccius), anchovy (Engraulis encrasicolus), mussel (Mytilus sp.) and wedge sole (Solea solea). The microwave extraction was carried out using an extraction time of 5 min with 5 mL of water at 50W and posterior clean up with dichloromethane. High-performance liquid chromatography (HPLC)-mass spectrometry was used for the determination of the antibiotics. The separation of the analysed compounds was conducted by means of a Phenomenex® Gemini C(18) (150 mm × 4.6mm I.D., particle size 5 µm) analytical column with LiChroCART® LiChrospher® C(18) (4 mm × 4 mm, particle size 5 µm) guard-column. Analysed drugs were determined using formic acid 0.1% in water and acetonitrile in gradient elution mode as mobile phase. Under the optimal conditions, the average recoveries of all the analysed drugs were in the range 70-100%. The proposed method was applied to samples obtained from Mediterranean sea and also evaluated by a laboratory assay consisting in the determination of the targeted analytes in samples of Cyprinus carpio that had been previously administered the antibiotics.

[Long term outcome following 26 surgical ampullectomies]. / Résultat à long terme de 26 ampullectomies chirurgicales.

BACKGROUND: Pancreaticoduodenectomy (PD) is the standard surgical treatment for malignant ampullomas but is still associated with a mortality and morbidity still ranging from 0 to 10% and from 15 to 40%, respectively. Ampullectomy is an alternative to PD for benign ampulloma or, in high-risk patients, for invasive carcinoma. The aim of this study was to report early and long term results of surgical ampullectomy for presumed benign ampullomas. PATIENTS AND METHODS: From 1981 to 2004, 26 patients from two institutions underwent surgical ampullectomy. Of the 26 patients, 8 had familial adenomatous polyposis (FAP). Surgical ampullectomy was indicated on a multisciplinary basis. RESULTS: Final pathological examination revealed 15 adenomas, 4 in situ adenocarcinomas, 2 endocrine tumors, and 5 other benign lesions. There was no postoperative mortality. Specific morbidity was 8% (N=2). Mean follow-up was 86+/-70 months (range: 3-204). Actuarial overall 5-year survival was 92%. There were 4 local recurrences (none in patients with FAP). Four patients died during follow-up (including 3 from initial disease). CONCLUSION: Ampullectomy is a good alternative to PD in case of benign or non-invasive malignant ampullary lesion, including in selected cases of FAP.

Substrate discrimination by cholapod anion receptors: geometric effects and the "affinity-selectivity principle".

Cholapod anion receptors can achieve high affinities while maintaining compatibility with nonpolar media. Previously they have been shown to transport anions across cell and vesicle membranes. In the present work, the scope of the architecture is expanded and structure-selectivity relationships are investigated. Eight new receptors have been synthesized, with up to six H-bond donor centers. Using Cram's extraction method, these compounds plus five known examples have been tested for binding to seven monovalent anions (tetraethylammonium salts, wet chloroform as solvent). Association constants in excess of 10(10) M(-1) have been measured for several pairings. Selectivities vary with receptor geometry, as expected. More remarkably, they also depend on receptor strength: more powerful receptors show a wider range of binding free energies, and therefore a greater spread of Ka(X-)/Ka(Y-). This "affinity-selectivity" effect can be derived from empirical relationships for H-bond strengths, and could prove widely operative in supramolecular chemistry.

Differentially-protected steroidal triamines; scaffolds with potential for medicinal, supramolecular, and combinatorial chemistry.

Cholic acid 2a has been converted into two new orthogonally-protected triamino scaffolds, 13 and 14. The synthesis proceeds via the bis-Boc-NH-substituted azide 10, for which an improved preparation is described. After removal of the Boc groups, the two axial amines are differentiated through a novel monoprotection employing 1-(2-nitrobenzenesulfonyloxy)-benzotriazole 29. Regioselectivity of > or 50 : 1 is achieved, presumably reflecting an exceptional sensitivity to steric hindrance. Protection of the remaining amino group as Boc or Alloc gives the scaffolds in approximately 40% overall yield from cholic acid. Scaffold 13 has been sequentially deprotected and derivatised with N-carbamoyl amino acids, to give a model for tripodal peptide libraries.

Steroidal ureas as enantioselective receptors for an N-acetyl alpha-amino carboxylate.

[reaction: see text] Cholic acid has been elaborated into three regioisomeric bis-carbamoylureas, which have been investigated as enantioselective receptors for N-acetyl phenylalanine. L/D selectivities, peaking at 5:1, have been determined by a sensitive and rapid MS-based extraction method that should be generalizable to related systems.

An extraction-based assay for neutral anionophores: the measurement of high binding constants to steroidal receptors in a nonpolar solvent.

The extraction-based protocol for measuring binding constants, developed by Cram and co-workers, has been extended for use with anionic substrates. The method is especially useful for high-affinity receptors, allowing very high binding constants to be measured in nonpolar solvents. Distribution constants K(d) between chloroform and water have been obtained for tetraethylammonium chloride and bromide, thus calibrating the method for these two substrates. Application to steroidal podands 5-9 has confirmed the ability of electron-withdrawing groups to enhance hydrogen-bond donor capabilities. Binding constants of approximately 3 x 10(7) M(-1) have been measured for the most powerful receptor 7. An X-ray crystal structure of 15, the methyl ester analogue of 7, reveals a well-defined binding site preorganised for anion recognition.

Facilitated phospholipid flip-flop using synthetic steroid-derived translocases.

Cholate esters with phenylurea groups at the 7alpha- and 12alpha-positions are highly effective promoters of phosphatidylcholine translocation across vesicle and cell membranes. The urea groups are essential for strong binding of the highly polar phosphate portion of the phosphocholine headgroup and apparently cannot be replaced by simple amide, alcohol, or amine moieties. NMR and UV studies show that these synthetic translocases have very weak affinity for phosphatidylethanolamine and phosphatidylserine.

[Crohn's disease and small intestine adenocarcinoma]. / Maladie de Crohn et adénocarcinome du grêle.

INTRODUCTION: The relationship between digestive neoplasia and Crohn's disease remains debated but several cases of carcinoma have been reported in the past 10 years. EXEGESIS: We report two cases of intestinal adenocarcinoma found in young people. Patients were asymptomatic during 15 years after the diagnosis of inflammatory bowel disease and presented a sudden occlusive syndrome. Carcinoma was observed incidentally at gross examination, and histopathological study showed dysplasia adjacent to neoplasia. Despite adequate surgical resection, death occurred quickly. CONCLUSION: Crohn's carcinoma should be suspected in patients with long-standing disease, poor symptomatology, and stenosis. Intestinoscopy surveillance remains illusory because inflammatory stenosis is often present and infiltrative neoplasia is invisible. Thus, it is important to be vigilant in this clinical presentation.

Intraductal papillary or mucinous tumors (IPMT) of the pancreas: report of a case series and review of the literature.

OBJECTIVE: Despite a better understanding of these conditions, intraductal papillary or mucinous tumors (IPMT) of the pancreas still present difficulty relating to the predictive factors of malignancy and the risk of relapse after surgical resection. The aim of this study was to report on our experience and to compare it to previously published cases. METHODS: We studied retrospectively 26 patients (mean age 60.3 yr) presenting with IPMT. Of the 26 patients, 19 had surgical resection and seven did not. The main clinical feature was acute pancreatitis occurring in 38% of the patients. Segmental pancreatectomy was performed in all the cases. At pathological assessment of resection margins, tumor resection was considered as complete in 17 cases. Margins exhibited benign mucinous involvement, and resection was considered to be incomplete in one multifocal case and in one case with diffuse spread of the tumor. RESULTS: A total of 11 tumors were benign and five were malignant. Carcinomas were invasive in four cases (two invading the pancreatic parenchyma, one the duodenum, and one the peripancreatic nodes) and in situ in one case. Malignancy was not diagnosed preoperatively except when invasion was evident (duodenal spread). Although main pancreatic duct type and obstructive jaundice appeared as suggestive features for the risk of malignancy, no reliable preoperative predictive factors for malignancy could be identified as regarding to clinical parameters, biological examinations, carcinoembryonic antigen or CA19-9 levels in serum or in pure pancreatic juice, imaging, and cytological methods. Within 40.8 months mean follow-up after surgery (range 2-96 months), three patients (16%), two with malignant and one with benign tumor, had tumor relapse after respectively 7, 27, and 14 months. Margins were positive without malignant features in the two malignant cases and negative in the other case. Tumor relapse was malignant with diffuse spreading in the three cases, and the patients died within 34 months after surgical resection. CONCLUSIONS: Our series and the review of the literature indicate that preoperative indicators of malignancy in IPMT are still lacking. Concerning resection margins, complete tumor resection is usually possible by segmental pancreatectomy. Malignant relapses are not exceptional. Incomplete resection and diffuse or multifocal tumor represent poor prognostic factors. Total pancreatectomy should be considered in such cases.