Impact of a Community Pharmacy Pharmacotherapy Follow-up (PTF) service in patients using opioid analgesic.

The use of prescribed major opioid analgesics (fentanyl, tapentadol, morphine and oxycodone and combinations) for non-cancer chronic pain is fraught with risks that may generate Negative Medicine Outcomes (NMO). Among the factors associated with these risks, those related to the patient's characteristics and aberrant behavior, the treatment conditions, and the prescription health settings should be evaluated with the aim of minimizing unsafety during the health care process. The present study addresses, from a community pharmacy, the analysis of Drug Related Problems (DRP) and Negative Medicine Outcomes (NMO) in patients using these major opioid analgesics while it aims to demonstrate the role of pharmaceutical care interventions in promoting safety during the use of these molecules. A three step Pharmacotherapeutic Follow-up (PFT) protocol was designed to prevent, detect, and solve DRP and NMO associated with the use of opioid analgesics. 74.6% of the patients used opioid analgesics to treat musculoskeletal pain. Polypharmacy with benzodiazepines (61.9%); antidepressants (57.1%) and antiepileptics (30.2%) was detected in patients using these opioids. The Morisky-Green Adherence test revealed that 30.2% were nonadherent. It was observed, with statistical significance, that in all patients (63), the impact of the 14-week PFT supervised by the community pharmacist achieved an overall reduction in the prevalence of DRP and NMO. While the reduction in the number of DRPs reached 66.7%. Community pharmacies are a strategic point to promote and implement effective opioid stewardship due to both their central role in healthcare services and frequent interaction with patients.

Real world data on outcomes of anti-CD38 antibody treated, including triple class refractory, patients with multiple myeloma: a multi-institutional report from the Canadian Myeloma Research Group (CMRG) Database.

Multiple myeloma (MM) remains incurable despite the availability of novel agents. This multi-center retrospective cohort study used the Canadian Myeloma Research Group Database to describe real-world outcomes of patients withanti-CD38 monoclonal antibody (mAb) refractory MM subsequently treated with standard of care (SoC) regimens. Patients with triple class refractory (TCR) disease (refractory to a proteasome inhibitor, immunomodulatory drug, and anti-CD38 mAb) were examined as a distinct cohort. Overall, 663 patients had disease progression on anti-CD38 mAb therapy, 466 received further treatment (346 with SoC regimens were included, 120 with investigational agents on clinical trial and were excluded). The median age at initiation of subsequent SoC therapy of 67.9 (range 39.6-89.6) years with a median of 3 prior lines (range 1-9). The median PFS and OS from the start of subsequent therapy was 4.6 (95% CI 4.1-5.6) months and 13.3 (95% CI 10.6-16.6) months, respectively. The median PFS and OS of patients with TCR disease (n = 199) was 4.4 (95% CI 3.6-5.3) months and 10.5 (95% CI 8.5-13.8) months. Our results reinforce that real-world patients with relapsed MM, particularly those with TCR disease, have dismal outcomes. There remains an urgent unmet need for the development of and access to effective therapeutics for these patients.

[Evaluation of the application of hyaluronic acid in postoperative arthroscopy patients with grade II-III gonarthrosis using the WOMAC scale]. / Evaluación en la aplicación de ácido hialurónico en pacientes postoperados de artroscopía con gonartrosis grado II-III mediante la escala de womac.

INTRODUCTION: gonarthrosis is a degenerative disease, whose loss of cartilage causes changes in the adjacent bone and its response produces deformations and attempts at regeneration. In 1934 Meyer and Palmer isolated bovine vitreous humor, a polysaccharide called hyaluronic acid, which has the property of visco-elasticity. Today, multiple procedures performed in orthopedics are known, in order to limit the degenerative process that this entails. OBJECTIVE: to know the use and efficacy of hyaluronic acid in the patient requiring knee arthroscopy, evaluating the evolution of the patient using the WOMAC scale; as well as the ideal time of application of hyaluronic acid in this study group. MATERIAL AND METHODS: clinical, non-randomized, prospective, analytical trial. 48 patients from 45 to 60 years of age, divided into 3 groups with a diagnosis of gonarthrosis grade II-III, who underwent arthroscopy with subsequent hyaluronic acid application, were evaluated; in the postoperative period (group 1), one month after the postoperative period (group 2) and without application (group 3) in a period from September 2015 to June 2016 at the ISSSTE Hospital "Dr. Darío Fernández Fierro". RESULTS: the treatment showed differences in patients regarding reduction of pain and stiffness; and improvement in functional capacity. CONCLUSION: despite, there are no conclusive results if the treatment is better than the other, certain data suggests that using hyaluronic acid in the postoperative improves rigidity and function, however, it was not statistically significant.

INTRODUCCIÓN: la gonartrosis es una enfermedad degenerativa, cuya pérdida de cartílago origina cambios en el hueso adyacente y su respuesta produce deformaciones e intentos de regeneración. En 1934 Meyer y Palmer aislaron el humor vítreo bovino, polisacárido denominado ácido hialurónico, que tiene la propiedad de visco elasticidad. Hoy en día se conocen múltiples procedimientos realizados en ortopedia, con la finalidad de limitar el proceso degenerativo que este conlleva. OBJETIVO: conocer el uso y la eficacia del ácido hialurónico, en el paciente que requiere artroscopía de rodilla, valorando la evolución del paciente mediante escala de WOMAC; así como el tiempo ideal de aplicación del ácido hialurónico en este grupo de estudio. MATERIAL Y MÉTODOS: ensayo clínico, no aleatorizado longitudinal, prospectivo, analítico. Se valoraron 48 pacientes de 45 a 60 años de edad, divididos en tres grupos con diagnóstico de gonartrosis grado II-III, en quienes se realizaron artroscopía con posterior aplicación ácido hialurónico; en el transquirúrgico (grupo 1), al mes del postquirúrgico (grupo 2) y sin aplicación (grupo 3) en un período de Septiembre de 2015 a Junio de 2016 en el Hospital del ISSSTE "Dr. Darío Fernández Fierro". RESULTADOS: el tratamiento mostró diferencias en los pacientes en cuanto a reducción de dolor y rigidez; y mejoría en capacidad funcional. CONCLUSIÓN: a pesar de que no es concluyente si algún tratamiento es mejor que otro, ciertos datos sugieren que el utilizar ácido hialurónico en el transquirúrgico mejora la rigidez y la función, sin embargo, no logró ser estadísticamente significativo.

Momentum-independent magnetic excitation continuum in the honeycomb iridate H3LiIr2O6.

Understanding the interplay between the inherent disorder and the correlated fluctuating-spin ground state is a key element in the search for quantum spin liquids. H3LiIr2O6 is considered to be a spin liquid that is proximate to the Kitaev-limit quantum spin liquid. Its ground state shows no magnetic order or spin freezing as expected for the spin liquid state. However, hydrogen zero-point motion and stacking faults are known to be present. The resulting bond disorder has been invoked to explain the existence of unexpected low-energy spin excitations, although data interpretation remains challenging. Here, we use resonant X-ray spectroscopies to map the collective excitations in H3LiIr2O6 and characterize its magnetic state. In the low-temperature correlated state, we reveal a broad bandwidth of magnetic excitations. The central energy and the high-energy tail of the continuum are consistent with expectations for dominant ferromagnetic Kitaev interactions between dynamically fluctuating spins. Furthermore, the absence of a momentum dependence to these excitations are consistent with disorder-induced broken translational invariance. Our low-energy data and the energy and width of the crystal field excitations support an interpretation of H3LiIr2O6 as a disordered topological spin liquid in close proximity to bond-disordered versions of the Kitaev quantum spin liquid.

Improvement of the optical, photocatalytic and antibacterial properties of ZnO semiconductor nanoparticles using different pepper aqueous extracts.

Peppers are fruits that grow on plants of the genus Capsicum and are popular for their use in gastronomy as a condiment and for their anti-inflammatory and anti-cancer properties due to their phytocompounds such as flavonoids, polyphenols, or alkaloids. Semiconductor zinc oxide (ZnO) nanoparticles (NPs) were synthesized using a green approach employing natural aqueous extracts of several varieties of peppers (jalapeño, morita, and ghost). The obtained NPs were characterized by different techniques, and their photocatalytic and antibacterial activity was studied. The signal at 620 cm-1 in the FTIR spectra belonging to the Zn-O bond, the appearance of the main peaks of a hexagonal wurtzite structure in the XRD pattern, and the characteristic signals in the UV-Vis spectra confirm the correct formation of ZnO NPs. The photocatalytic activity was analyzed against Methylene Blue (MB), Rhodamine B (RB), and Methyl Orange (MO) under UV and sunlight. All syntheses were able to degrade more than 93% of the pollutants under UV light. Antibacterial assays were performed against gram-positive and gram-negative bacteria. All syntheses exhibited antibacterial activity against all bacteria and maximum growth inhibition against Bacillus subtilis. The prominent results demonstrate that natural aqueous extracts obtained from peppers can be used to synthesize ZnO NPs with photocatalytic and biomedical applications.

Variables influyentes en los niveles de 25(OH)D total y libre en población sana / Influencing variables on total and free 25(OH)D levels in healthy population

Introducción La vitamina D ejerce un papel fundamental en la homeostasis del calcio y el metabolismo óseo. Procede, mayoritariamente, de la síntesis cutánea, por acción de la luz solar. Así, variaciones en la exposición a esta radiación modifican sus niveles séricos. Estudiamos dos analitos diferentes de vitamina D en población sana española, y la influencia de la estacionalidad, el clima y la latitud en sus estatus. Métodos Estudio descriptivo, transversal. Se incluyeron 206 donantes de sangre de Burgos y Valencia de 18-60 años durante marzo-abril y octubre-noviembre de 2018. Se analizaron las concentraciones séricas de 25-hidroxicolecalciferol (25(OH)D) total y libre. Resultados Las concentraciones medias de 25(OH)D total y libre tras el verano en Burgos fueron: 24,31 ± 5,25 ng/mL y 5,01 ± 1,25 pg/mL; y en Valencia: 25,99 ± 6,87 ng/mL y 8,97 ± 2,82 pg/mL. Tras el invierno, los resultados en Burgos fueron: 17,66 ± 5,04 ng/mL y 4,08 ± 0,66 pg/mL, y en Valencia: 21,38 ± 3,77 ng/mL y 7,23 ± 2,44 pg/mL. Los cambios estacionales resultaron estadísticamente significativos para los dos componentes estudiados, tanto de manera global como en ambas poblaciones por separado. Las diferencias poblacionales en los niveles de 25(OH)D total y libre resultaron estadísticamente significativas, excepto en 25(OH)D total tras el verano (24,07 ng/mL vs. 26,03 ng/mL; p = 0,408). La latitud también demostró ser un factor influyente en las concentraciones de ambos analitos, en verano e invierno. Conclusiones Nuestro estudio refleja niveles de vitamina D más bajos de lo esperable tratándose de población sana española. Se demuestra la influencia de la estacionalidad, el clima y la latitud en los niveles de 25(OH)D total y 25(OH)D libre (AU)

Introduction Vitamin D plays a fundamental role in calcium homeostasis and bone metabolism. It mainly comes from cutaneous synthesis through the action of sunlight. Therefore, variations in exposure to this radiation modify serum levels. We studied two different analytes of vitamin D in the healthy Spanish population and the influence of seasonality, climate, and latitude on its levels. Methods This work is a cross-sectional, descriptive study. A total of 206 blood donors from Burgos and Valencia between 18-60 years of age were recruited during March-April and October-November 2018. Total and free serum 25-hydroxycholecalciferol (25(OH)D) were analyzed. Results After summer, total and free serum 25(OH)D medium levels were 24.31 ± 5.25 ng/mL and 5.01 ± 1.25 pg/mL in Burgos and 25.99 ± 6.87 ng/mL and 8.97 ± 2.82 pg/mL in Valencia. After winter, they were 17.66 ± 5.04 ng/mL and 4.08 ± 0.66 ng/mL in Burgos and 21.38 ± 3.77 ng/mL and 7.23 ± 2.44 ng/mL in Valencia. The seasonal changes were statistically significant for both components studied both in the sample as a whole and in the separate populations. The differences found between the two populations in total and free 25(OH)D levels were statistically significant except for total 25(OH)D after summer (24.07 ng/mL vs. 26.03 ng/mL; p = 0.408). Latitude was also shown to be a factor that influences concentrations of both analytes in summer and winter. Conclusions Our study shows lower vitamin D levels than expected for a healthy Spanish population. Seasonality, climate, and latitude were demonstrated to influence total and free 25(OH)D levels (AU)

Exploration of robustness indicators using adaptive responses to short-term feed restriction in suckling primiparous beef cows.

Animal robustness is a complex trait of importance for livestock production systems and genetic selection. Phenotyping is essential for evaluation of the adaptation of different genotypes to changing environments. This study tested an experimental framework to induce marked deviations in the adaptive responses of suckling beef cows and to identify relevant indicators of responses to characterise individual differences in the robustness of cows. The production and metabolic responses of primiparous suckling Charolais cows to two periods of feed restriction (FR, 50% of their net energy requirements) of different durations were monitored. After calving, 13 cows (aged 39 ±â€¯2 months, BW of 680 ±â€¯42 kg at calving) had ad libitum access to a diet composed of hay and supplemented with concentrate to meet their energy and protein requirements. Starting at 54 ±â€¯6 days postcalving, the cows underwent two periods of FR: 4 days of FR (FR4), which was followed by 17 days of ad libitum intake to study the recovery from FR4, and 10 days of FR (FR10), which was followed by 18 days of ad libitum intake to study the recovery from FR10. The milk yield (MY), BW, body condition score and plasma non-esterified fatty acid (NEFA), ß-hydroxybutyrate, glucose and urea concentrations were measured before, during and after each FR. Among all measured variables, the MY and NEFA concentrations showed the most significant changes in response to FR. A functional data analysis approach was applied to the MY and NEFA data to model the adaptive responses and extract quantifiable indicators of deviation and recovery. Linear correlations (P < 0.03-0.07) between FR4 and FR10 were found for some indicators describing MY and NEFA levels before and after FR. The overall repeatability of MY and NEFA responses between both FR accounted for 46% based on quartile analysis performed on average responses. Moreover, the variance in both the MY and NEFA variables did not differ significantly between FR4 and FR10, despite a trend for higher variances in FR10. Altogether, (1) the calculated variables derived from the functional data analysis of the time patterns of the MY and NEFA accounted for the differences in the cow responses to FR, and (2) the animal responses appeared to show concordance between FR4 and FR10. In conclusion, short-term FR is a relevant framework for studying productive and metabolic adaptive responses in suckling cows and allows the identification of potential robustness indicators.

Influencing variables on total and free 25(OH)D levels in healthy population.

INTRODUCTION: Vitamin D plays a fundamental role in calcium homeostasis and bone metabolism. It mainly comes from cutaneous synthesis through the action of sunlight. Therefore, variations in exposure to this radiation modify serum levels. We studied two different analytes of vitamin D in the healthy Spanish population and the influence of seasonality, climate, and latitude on its levels. METHODS: This work is a cross-sectional, descriptive study. A total of 206 blood donors from Burgos and Valencia between 18-60 years of age were recruited during March-April and October-November 2018. Total and free serum 25-hydroxycholecalciferol (25(OH)D) were analyzed. RESULTS: After summer, total and free serum 25(OH)D medium levels were 24.31 ±â€¯5.25 ng/mL and 5.01 ±â€¯1.25 pg/mL in Burgos and 25.99 ±â€¯6.87 ng/mL and 8.97 ±â€¯2.82 pg/mL in Valencia. After winter, they were 17.66 ±â€¯5.04 ng/mL and 4.08 ±â€¯0.66 ng/mL in Burgos and 21.38 ±â€¯3.77 ng/mL and 7.23 ±â€¯2.44 ng/mL in Valencia. The seasonal changes were statistically significant for both components studied both in the sample as a whole and in the separate populations. The differences found between the two populations in total and free 25(OH)D levels were statistically significant except for total 25(OH)D after summer (24.07 ng/mL vs. 26.03 ng/mL; p = .408). Latitude was also shown to be a factor that influences concentrations of both analytes in summer and winter. CONCLUSIONS: Our study shows lower vitamin D levels than expected for a healthy Spanish population. Seasonality, climate, and latitude were demonstrated to influence total and free 25(OH)D levels.

Robot-assisted simple prostatectomy versus open simple prostatectomy: a single-center comparison.

PURPOSE: Open simple prostatectomy (OSP) is a standard surgical technique for patients with benign prostatic hyperplasia with prostate size larger than 80 ml. As a minimally invasive approach, robot-assisted simple prostatectomy (RASP) emerged as a feasible surgical alternative. Currently, there are no definite recommendations for the standard use of RASP. Therefore, we aimed at investigating various clinical outcomes comparing RASP with OSP. METHODS: In this retrospective single-center study, we evaluated clinical data from 103 RASP and 31 OSP patients. Both cohorts were compared regarding different clinical characteristics with and without propensity score matching. To detect independent predictive factors for clinical outcomes, multivariate logistic regression analysis was performed. RESULTS: Robot-assisted simple prostatectomy patients demonstrated a lower estimated blood loss and need for postoperative blood transfusions as well as less postoperative complications. OSP had a shorter operative time (125 min vs. 182 min) longer hospital stay (11 days vs. 9 days) and longer time to catheter removal (8 days vs. 6 days). In the multivariate analysis, RASP was identified as an independent predictor for longer operative time, lower estimated blood loss, shorter length of hospital stay, shorter time to catheter removal, less postoperative complications and blood transfusions. CONCLUSION: Robot-assisted simple prostatectomy is a safe alternative to OSP with less perioperative and postoperative morbidity. Whether OSP (shorter operative time) or RASP (shorter length of hospital stay) has a more favorable economic impact depends on the particular conditions of different health care systems. Further prospective comparative research is warranted to define the value of RASP in the current surgical management of benign prostatic hyperplasia.

Double crush syndrome: Epidemiology, diagnosis, and treatment results.

BACKGROUND: Double Crush Syndrome (DCS) is a clinical condition that involves multiple compression sites along a single peripheral nerve. The present study aims to describe the epidemiology of DCS and surgical results. METHODS: A retrospective observational analytic study included patients with clinical diagnosis of cervical radiculopathy and carpal tunnel syndrome who underwent surgery between January 2009 and January 2019. General demographic characteristics were noted, and 3 groups were distinguished: spinal surgery, carpal tunnel release, and bimodal decompression (BD); statistical differences were analyzed between them. RESULTS: The sample comprised 32 patients. DCS prevalence was 10.29%. Mean age at presentation was 59.25±10.98 years. There was female predominance (75%). Paresthesia was the main symptom (65.6%). Post-surgical results of BD showed significant improvement in sensory nerve conduction velocity, motor nerve conduction velocity (both P=0.008), and disability on Douleur Neuropathique 4 questions, Neck Disability Index, and Boston Carpal Tunnel Questionnaire (P=0.001, 0.004, 0.008, respectively). CONCLUSIONS: Diagnosis and management of DCS are a challenge. It is necessary to determine the site with maximal compression and risk of complications to decide on treatment. If first-line surgery is adequate, proximal and distal symptomatology can be improved. To maximize success, we recommend BD, according to the present results.

Lidar observations of large-amplitude mountain waves in the stratosphere above Tierra del Fuego, Argentina.

Large-amplitude internal gravity waves were observed using Rayleigh lidar temperature soundings above Rio Grande, Argentina ([Formula: see text], [Formula: see text]), in the period 16-23 June 2018. Temperature perturbations in the upper stratosphere amounted to 80 K peak-to-peak and potential energy densities exceeded 400 J/kg. The measured amplitudes and phase alignments agree well with operational analyses and short-term forecasts of the Integrated Forecasting System (IFS) of the European Centre for Medium-Range Weather Forecasts (ECMWF), implying that these quasi-steady gravity waves resulted from the airflow across the Andes. We estimate gravity wave momentum fluxes larger than 100 mPa applying independent methods to both lidar data and IFS model data. These mountain waves deposited momentum at the inner edge of the polar night jet and led to a long-lasting deceleration of the stratospheric flow. The accumulated mountain wave drag affected the stratospheric circulation several thousand kilometers downstream. In the 2018 austral winter, mountain wave events of this magnitude contributed more than 30% of the total potential energy density, signifying their importance by perturbing the stratospheric polar vortex.

CAR-T: luces y sombras / CAR-T: lights and shades

La terapia celular adoptiva está revolucionando el panorama de la terapéutica actual. La gestión de los medicamentos CAR-T supone un reto para el sistema nacional de salud (SNS), pues se trata de medicamentos complejos de un elevado impacto sanitario. En esta línea, la elaboración de protocolos fármaco-clínicos con criterios claramente definidos ayudará a un correcto posicionamiento y selección de los pacientes candidatos a estas terapias. Así mismo, la administración de estos fármacos debe realizarse en centros previamente seleccionados y cualificados para tal fin, garantizando la equidad en el acceso. Por otro lado, es prioritario un abordaje multidisciplinar de todos los pacientes que sean tratados con las terapias CAR-T. Finalmente es fundamental la evaluación y el registro constante de resultados, los cuales contribuirán a determinar el beneficio real de la terapia, reclamando la necesidad de precios equitativos para garantizar la sostenibilidad del SNS y el acceso a los pacientes previamente seleccionados

Adoptive cell therapy is revolutionizing the current therapeutic landscape. The management of CAR-T drugs is a challenge for The National Health System (NHS), as they are complex drugs with high impact on health. This way, the development of clinical pharmaceutical protocols with clearly defined criteria, will help in correct positioning and selection of patients candidates for these therapies. Likewise, administration of these drugs must be carried out in centers previously selected and qualified for this purpose, guaranteeing equity of access. On the other hand, a multidisciplinary approach of all patients treated with CAR-T therapies is a priority. Finally, the assessment and the constant result recording are essencial, since they will contribute to determining the real benefit of these therapies, claiming the need for equitable prices, guaranteeing the sustainability of the NHS and the access of previously selected patients to them

Digestibility contributes to between-animal variation in feed efficiency in beef cows.

Residual feed intake (RFI) is an alternative measure of feed efficiency (FE) and is calculated as the difference between actual and expected feed intake. The biological mechanisms underlying animal-to-animal variation in FE are not well understood. The aim of this study was to investigate the digestive ability of beef cows selected for RFI divergence as heifers, using two contrasted diets. Fifteen 4-year-old beef cows were selected from a total of 69 heifers based on their RFI following the feedlot test. The selected heifers were ranked into high-RFI (+ 1.02 ± 0.28, n = 8) and low-RFI (-0.73 ± 0.28, n = 7), and a digestibility trial was performed after their first lactation. Both RFI groups were offered two different diets: 100% hay or a fattening diet which consisted of a DM basis of 67% whole-plant maize silage and 33% high starch concentrates over four experimental periods (two per diet). A diet effect was observed on feed intake and apparent digestibility, whereas no diet × RFI interaction was detected (P > 0.05). Intake and apparent digestibility were higher in cows fed the fattening diet than in those fed the hay diet (P < 0.0001). DM intake (DMI) and organic matter apparent digestibility (OMd) were repeatable and positively correlated between the two subsequent periods of measurements. For the hay and fattening diets, the repeatability between periods was r = 0.71 and r = 0.73 for DMI and r = 0.87 and r = 0.48 for OMd, respectively. Moreover, both intake (r = 0.55) and OMd (r = 0.54) were positively correlated (P < 0.05) between the hay and fattening diets. Significant differences between beef cows selected for divergence in RFI as heifers were observed for digestive traits (P < 0.05), DM and organic matter (OM) apparent digestibility being higher for low-RFI cows. Overall, this study showed that apparent digestibility contributes to between-animal variation in FE in beef cows.

Organochlorine pesticides air monitoring near a historical lindane production site in Spain.

The landfilling and dumping of persistent organic pollutants (POPs) and other persistent hazardous chemicals, such as hexachlorocyclohexane (HCH) isomers can have significantly adverse environmental consequences and cause contamination in soil, water, and atmosphere systems. Approximately 115,000 t of HCH wastes were generated by INQUINOSA Factory located in Sabiñánigo (Aragón, Spain) from 1975 to 1992, and were mainly dumped at Bailín and Sardas landfills. Under the frame of the project plan approved by the Government of Aragón, remediation and containment measures were implemented at the derelict production facility and landfill sites. To protect and assess the local environment, the concentrations of HCH isomers, pentachlorobenzene (PeCB) and hexachlorobenzene (HCB) in air were periodically monitored in the Sardas landfills and surroundings by passive sampling devices. The influence of meteorological parameters was evaluated, showing positive correlations between temperature and HCH and HCB concentrations. The highest HCH levels were detected in Sardas landfill and INQUINOSA Factory sites. PeCB values were statistically higher in Sardas landfill than in Sabiñánigo urban core, nevertheless, HCB concentrations were similar in both sampling points. Statistically positive correlations were found among HCH isomers in all sampling points, showing a major common source. The chlorobenzenes also correlated positively with each other. The α-/γ-HCH ratios were calculated (1.46 ±â€¯1.25; mean ±â€¯S.D.), corroborating that concentrations detected were mainly originated from the historical production, storage and waste disposal of technical HCH.

[Incidence, trend and municipal distribution of tobacco-associated tumours in the Health Area of León: 1997-2014]. / Incidencia, tendencia y distribución municipal de los tumores asociados al tabaco en el Área de Salud de León: 1997-2014.

OBJECTIVE: For cancer incidence, tobacco use is one of the main avoidable risk factors.The aim of this study is to describe the frequency, trend and geographical distribution of the incidence of tobacco-associated tumours in the León Health Area, Spain. MATERIAL AND METHODS: An observational, descriptive study was carried out on tumours of Hospital Registry of Tumours of the University Hospital Complex of León between 1997 and 2014. León Health Area residents, associated with smoking were included. Gross and adjusted rates were calculated and adjusted for triennials. For the analysis of spatial distribution, municipal relative hazards were smoothed by adjusting the Besag, York, and Mollié model and for their posterior probabilities for relative hazards to be higher than 1, using Bayesian methods. RESULTS: A total of 7,103 cases were included. Crude incidence rates rose from 116.4 (1997-1999) to 228.0 (2012-2014) per 100,000 men, and from 19.8 (1997-1999) to 44.5 (2012-2014) per 100,000 women. The adjusted rates for the European population also increased from 116.2 (1997-1999) to 136.9 (2012-2014) per 100,000 men, and from 11 (1997-1999) to 24.5 (2012-2014) per 100,000 women. In the south and centre of the province, there were municipalities with high relative hazards, several of them higher than 2 with posterior probabilities of 1. CONCLUSIONS: Tumours associated with tobacco increased in the triennial studied, especially in women. The different geographical distribution can be used as a tool to prevent tobacco consumption in the areas involved.

Non-Typhi, non-Paratyphi Salmonella-related hospitalisations in Spain: trends, clinical aspects, risk factors for worse prognosis and hospital costs.

This study reviews non-typhoid Salmonella (NTS)-related hospitalisations at National level in Spain between 2010 and 2015. NTS hospitalisations were obtained from the National Registry of Hospitalisations. A descriptive analysis of the hospitalisations was performed, including hospitalisation rates (HR) and case-fatality rates (CFR%) calculation. For those with NTS as Main Diagnosis logistic regression were used to estimate the relationship between the different factors and death outcome. 21,660 registered NTS-related hospitalisations were described (88.8% with Salmonella coded as Main Diagnosis). Average HR2010-2015 was 7.7 (range, 7.3 to 8.1) hospitalisations/100,000 population. Those with NTS infections as Secondary Diagnosis were on average (p < 0.001) older (47.9 vs. 36.5 years), presented worse Charlson Comorbidity Index (2.1 vs. 1.2), higher CFR% (4.8% vs. 0.7%), spent more days hospitalised (15.1 vs. 5.8 days), and generated more costs (6173 vs. 4272 euros/per hospitalisation) than those with NTS as Main Diagnosis. For those with NTS as Main Diagnosis increased risk of death was related to being > 64 years old (OR = 20.99; p < 0.001); presenting septicaemia (OR = 15.82; p < 0.001) or localised infections (OR = 3.98; p = 0.061); Charlson Comorbidity Index > 3 (OR = 4.57; p < 0.001); a non-HIV co-infection (OR = 1.80; p = 0.013); other risk factors (OR = 5.70; p < 0.001); bowel perforation (OR = 70.30; p < 0.001); or acute renal failure (OR = 1.95; p = 0.001). In those with Salmonella as Main Diagnosis, among all complications, bowel perforation presented the strongest association with death outcome. Clinical practice guidelines can help to identify patients at risk of bowel perforation to reduce the fatality of the disease.

HCH air levels derived from Bailín dumpsite dismantling (Sabiñánigo, Spain).

Remediation and management of dumpsites is a worldwide problem that must be addressed to protect human health and the environment. Aragon Government long-term objective is the control of air quality related to landfills used to dump organochlorine waste. The present study evaluated the influence of dismantling works performed in Bailín landfill, an hexachlorocyclohexane (1,2,3,4,5,6-hexaclorohexane; HCH) dumpsite located in the city of Sabiñánigo, Spain. A total of 65,000 t of HCH solid waste and 342,000 t of polluted soil were transferred to a new cell with additional isolating measures going beyond the Spanish legal requirements. To evaluate influence of excavation of the old cell, transfer of waste and the state once the works in Bailín area had finished, levels of α-, ß-, γ-, δ- and ɛ- HCH isomers were analyzed in 112 air samples obtained from summer 2014 to autumn 2016 by using passive air samplers. Results showed that: i) the existence of the old landfill and/or the works performed during its dismantling were a source of HCH air contamination, ii) old landfill represented an HCH source even after dismantling work was completed, iii) other sources, tentatively associated to Sardas dumpsite and HCH production site (INQUINOSA Factory) were identified in the surroundings, where management should be addressed. Data comparison reflected a heavier contamination caused by the production, storage, and waste disposal than the corresponding to application of lindane and/or technical HCH in Spain. Meteorological dependence (temperature, solar radiation and relative humidity), α-/γ-HCH ratios and isomer profiles of HCH air concentrations were evaluated for temporal trends and geographic distribution.