Synthetic microfiber emissions from denim industrial washing processes: An overlooked microplastic source within the manufacturing process of blue jeans.

In recent years, domestic laundry has been recognized as a relevant source of microfiber (MF) pollution to aquatic environments. Nevertheless, the MF emissions from industrial washing processes in real world scenarios have not been quantified. The aim of this study was to quantify the MF emissions from 3 industrial washing processes (rinse wash, acid wash and enzymatic wash) commonly employed in the manufacturing process of blue jeans. The blue jeans were characterized by ATR-FT-IR, SEM and TGA to study the morphology, the polymer chemical identity and the proportion of synthetic and natural fibers, respectively. The MF emissions were quantified as the MF mass and number emitted per washed jean. All the industrial washing processes released a majority of synthetic MF. The enzymatic wash produced the highest amount of MF, with 1423 MF per gram of fabric (MF/g) equivalent to 381.7 MF grams per gram of fabric (MF g/g), followed by the acid wash with 253 MF/g equivalent to 142.7 MF g/g and lastly the rinse wash with 133 MF/g equivalent to 62.3 MF g/g. Statistically significant differences between the MF sizes for all washing processes were found when evaluating the emissions by MF/g, however, the previous trend was not found for MF g/g. Moreover, the total MF emissions of an industrial washing process of a pair of blue jeans during its manufacture process are up to 10.95 times higher than the reported domestic washing estimates performed by the consumer available in the published literature. We demonstrate that studying industrial washing procedures of textile garments will improve the accuracy of the current estimates of MF emissions available in published reports, which will ultimately aid in the development of regulations for MF emissions at an industrial level.

Octogenarios: ¿demasiado ancianos para revascularización miocárdica quirúrgica? / Octogenarians: Too old for surgical myocardial revascularization?

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Genetic basis of familial dilated cardiomyopathy patients undergoing heart transplantation.

BACKGROUND: Dilated cardiomyopathy (DCM) is the most frequent cause of heart transplantation (HTx). The genetic basis of DCM among patients undergoing HTx has been poorly characterized. We sought to determine the genetic basis of familial DCM HTx and to establish the yield of modern next generation sequencing (NGS) technologies in this setting. METHODS: Fifty-two heart-transplanted patients due to familial DCM underwent NGS genetic evaluation with a panel of 126 genes related to cardiac conditions (59 associated with DCM). Genetic variants were initially classified as pathogenic mutations or as variants of uncertain significance (VUS). Final pathogenicity status was determined by familial cosegregation studies. RESULTS: Initially, 24 pathogenic mutations were found in 21 patients (40%); 25 patients (48%) carried 19 VUS and 6 (12%) did not show any genetic variant. Familial evaluation of 220 relatives from 36 of the 46 families with genetic variants confirmed pathogenicity in 14 patients and allowed reclassification of VUS as pathogenic in 17 patients, and as non-pathogenic in 3 cases. At the end of the study, the DCM-causing mutation was identified in 38 patients (73%) and 5 patients (10%) harbored only VUS. No genetic variants were identified in 9 cases (17%). CONCLUSIONS: The genetic spectrum of familial DCM patients undergoing HTx is heterogeneous and involves multiple genes. NGS technology plus detailed familial studies allow identification of causative mutations in the vast majority of familial DCM cases. Detailed familial studies remain critical to determine the pathogenicity of underlying genetic defects in a substantial number of cases.

Costes sanitarios y no sanitarios de personas que padecen insuficiencia cardiaca crónica sintomática en España / Health care and nonhealth care costs in the treatment of patients with symptomatic chronic heart failure in spain

Introducción y objetivos La insuficiencia cardiaca crónica es una enfermedad con elevada mortalidad y consumidora de recursos sanitarios y sociales. El objetivo del estudio es cuantificar la utilización de los recursos sanitarios y no sanitarios e identificar variables que ayuden a explicar la variabilidad de su coste en España.MétodosEstudio multicéntrico, prospectivo y observacional con 12 meses de seguimiento. Se incluyó a 374 pacientes con insuficiencia cardiaca sintomática de consultas específicas de cardiología, y se recogió información sobre características socioeconómicas de pacientes y cuidadores, estado de salud, recursos sanitarios y cuidados profesionales y no profesionales. Los recursos empleados en el cuidado de la salud se valoraron monetariamente, diferenciando entre clases funcionales.ResultadosEl coste total estimado durante ese año osciló entre 12.995 y 18.220 euros, dependiendo del escenario elegido (año base, 2010). La mayor partida fue para los cuidados no profesionales (59,1-69,8% del coste total), seguido del gasto sanitario (26,7-37,4%) y los cuidados profesionales (3,5%). Dentro de los costes sanitarios, el coste hospitalario tuvo el mayor peso, seguido de la medicación. Hubo diferencias estadísticamente significativas en los costes totales entre los pacientes en clase funcional II y los de clases III - IV . La insuficiencia cardiaca es una enfermedad que requiere la movilización de un importante volumen de recursos. La partida más importante del gasto es la del cuidado informal del paciente. Tanto el gasto sanitario como el no sanitario son mayores en la población con enfermedad más avanzada

Introduction and objectives: Chronic heart failure is associated with high mortality and utilization of health care and social resources. The objective of this study was to quantify the use of health care and nonhealth care resources and identify variables that help to explain variability in their costs in Spain.MethodsThis prospective, multicenter, observational study with a 12-month follow-up period included 374 patients with symptomatic heart failure recruited from specialized cardiology clinics. Information was collected on the socioeconomic characteristics of patients and caregivers, health status, health care resources, and professional and nonprofessional caregiving. The monetary cost of the resources used in caring for the health of these patients was evaluated, differentiating among functional classes.ResultsThe estimated total cost for the 1-year follow-up ranged from Euros 12 995 to Euros 18 220, depending on the scenario chosen (base year, 2010). The largest cost item was informal caregiving (59.1%-69.8% of the total cost), followed by health care costs (26.7%- 37.4%), and professional care (3.5%). Of the total health care costs, the largest item corresponded to hospital costs, followed by medication. Total costs differed significantly between patients in functional class II and those in classes III or IV.ConclusionsHeart failure is a disease that requires the mobilization of a considerable amount of resources. The largest item corresponds to informal care. Both health care and nonhealth care costs are higher in the population with more advanced disease (AU)

Health care and nonhealth care costs in the treatment of patients with symptomatic chronic heart failure in Spain.

INTRODUCTION AND OBJECTIVES: Chronic heart failure is associated with high mortality and utilization of health care and social resources. The objective of this study was to quantify the use of health care and nonhealth care resources and identify variables that help to explain variability in their costs in Spain. METHODS: This prospective, multicenter, observational study with a 12-month follow-up period included 374 patients with symptomatic heart failure recruited from specialized cardiology clinics. Information was collected on the socioeconomic characteristics of patients and caregivers, health status, health care resources, and professional and nonprofessional caregiving. The monetary cost of the resources used in caring for the health of these patients was evaluated, differentiating among functional classes. RESULTS: The estimated total cost for the 1-year follow-up ranged from € 12,995 to € 18,220, depending on the scenario chosen (base year, 2010). The largest cost item was informal caregiving (59.1%-69.8% of the total cost), followed by health care costs (26.7%- 37.4%), and professional care (3.5%). Of the total health care costs, the largest item corresponded to hospital costs, followed by medication. Total costs differed significantly between patients in functional class II and those in classes III or IV. CONCLUSIONS: Heart failure is a disease that requires the mobilization of a considerable amount of resources. The largest item corresponds to informal care. Both health care and nonhealth care costs are higher in the population with more advanced disease.

Cor triatriatum asociado con síndrome de Wolff-Parkinson-White / Cor Triatriatum Associated with Wolff-ParkinsonWhite Syndrome

El síndrome de Wolff-Parkinson-White ha sido relacionado con diversas anomalías anatómicas. Sin embargo, su asociación con el cor triatriatum no ha sido previamente establecida. Presentamos el caso de una paciente de 34 años con episodios paroxísticos de palpitaciones y datos electrocardiográficos de preexcitación ventricular, en la que se documentó la presencia de un cor triatriatum no obstructivo durante la valoración ecográfica previa a la realización de ablación con radiofrecuencia (AU)

Desenvolvimento urbano e acidentes de trânsito: Porto Alegre, RS, 1970-1989 / Urban development and traffic accidents: Porto Alegre, RS, 1970-1989

Os acidentes de trânsito representam uma das principais causas de mortes no conjunto das capitais brasileiras. Buscou-se relacionar os mesmos como problema de saúde pública com o desenvolvimetno urbano de Porto Alegre no período de 1970 a 1988...

Sídrome uretral, infecçöes urinárias recorrentes e uretrotomia interna / Urethral syndrome appellant urinary tract infections and internal urethromia

Dentre as afecçöes do trato urinário baixo no sexo feminino, a infecçäo urinária recorrente e a síndrome uretral, cujo quadro é semelhante a suas manifestaçöes, porém com uma cultura negativa ou, às vezes, pequienas alteraçöes no sedimento urinário, säo uma patologia freqüente em clínicas especializadas. Säo apresentados pacientes acometidos por estas patologias, métodos de diagnóstico, tratamento clínico e cirúrgico e evoluçäo pós-tratamento no último trênio. A conduta diante das patologias citadas é, até o momento, uma conduta discutida e divergente entre os estudiosos