Assessment of seasonal and annual patterns in phosphorus content in a monitored catchment through a partitioning approach based on hydrometeorological data.

High amounts of phosphorus (P) in rivers come mainly from two sources: fertilizers washed off from agricultural and urban areas by runoff water (non-point sources) and urban and industrial development which are translated in P discharges from wastewater treatment plants (WWTP). This work analyses the content of P in water for nearly 40 years inquiring into the origin of the sources, based on the hypothesis of runoff generation from the detection of river streamflow increases during the P contribution episode and the previous precipitation. For this purpose, the Guadaira River, which is located in the South of Spain and has a drainage surface of 1524 km2, was selected. In this watershed agricultural land use converges with numerous human activities resulting in high pressures on water quality. We found 40% of the P contribution episodes found seem to come from the runoff generated after the heaviest rainfall events, which normally occur between November and May. The remaining 60% of the P contribution episodes were found to be linked to point sources, which become more relevant from June to September, reaching the highest concentration values (6-17 mg/L). The results highlight that the target phosphate concentration value of 0.34 mg PO4/L imposed by the national legislation for a good state following the Water Framework Directive 2000/60/EC is exceeded by 96% of the measurements during the period from 1981 to 2022. On a monthly basis, PO4 loads showed a linear relationship with river streamflow (R2 = 0.94). However, on field measurements scale, a potential relationship between both variables was found, which changed according to the improvement in the wastewater treatment and facilities for 1982-1994, 1995-2017 and 2018-2022. In these three periods, different significant decreasing trends of the P content were found, mainly marked by the setup of each individual WWTP.

The relationship between overweight and education revisited: a test of the selection hypothesis based on adolescents' educational aspirations.

OBJECTIVES: This paper examines the selection mechanism underlying the association between overweight/obesity and educational aspirations of adolescents. STUDY DESIGN: This is a cross-sectional study based on a survey conducted in secondary schools in Spain in 2016. METHODS: We estimate linear probability models to determine the association between adolescents' body mass index (BMI) and their expectations to obtain a university degree, as well as their school choices representing the most usual path towards higher studies. To address the potential endogeneity of BMI, we use the instrumental variables (IV) method. Additionally, we account for potential unobserved heterogeneity by including school fixed-effects and a wide set of individual and family characteristics in our analysis. RESULTS: Our results indicate that adolescents with a higher BMI have lower expectations to obtain a university degree and are less likely to enrol in high school with the intention to pursue higher education in the future. The estimated effect is quite sizable and statistically significant only for girls. We estimate that a five-unit increase in BMI (e.g., the change between healthy weight and overweight) reduces girls' expectations to complete higher education by 19 percentage points and odds of enrolling in high school (vs. vocational training) by 21 percentage points. CONCLUSIONS: We provide empirical evidence supporting the selection hypothesis behind the relationship between BMI and adolescents' educational aspirations. That is, unhealthy weight in adolescence is associated with poorer aspirations for further education. Lower educational aspirations during adolescence can lead to lower academic achievement, which in turn, may result in poorer health, labour market outcomes, and well-being during adulthood.

Impact of outdoor air pollution on severity and mortality in COVID-19 pneumonia.

The relationship between exposure to air pollution and the severity of coronavirus disease 2019 (COVID-19) pneumonia and other outcomes is poorly understood. Beyond age and comorbidity, risk factors for adverse outcomes including death have been poorly studied. The main objective of our study was to examine the relationship between exposure to outdoor air pollution and the risk of death in patients with COVID-19 pneumonia using individual-level data. The secondary objective was to investigate the impact of air pollutants on gas exchange and systemic inflammation in this disease. This cohort study included 1548 patients hospitalised for COVID-19 pneumonia between February and May 2020 in one of four hospitals. Local agencies supplied daily data on environmental air pollutants (PM10, PM2.5, O3, NO2, NO and NOX) and meteorological conditions (temperature and humidity) in the year before hospital admission (from January 2019 to December 2019). Daily exposure to pollution and meteorological conditions by individual postcode of residence was estimated using geospatial Bayesian generalised additive models. The influence of air pollution on pneumonia severity was studied using generalised additive models which included: age, sex, Charlson comorbidity index, hospital, average income, air temperature and humidity, and exposure to each pollutant. Additionally, generalised additive models were generated for exploring the effect of air pollution on C-reactive protein (CRP) level and SpO2/FiO2 at admission. According to our results, both risk of COVID-19 death and CRP level increased significantly with median exposure to PM10, NO2, NO and NOX, while higher exposure to NO2, NO and NOX was associated with lower SpO2/FiO2 ratios. In conclusion, after controlling for socioeconomic, demographic and health-related variables, we found evidence of a significant positive relationship between air pollution and mortality in patients hospitalised for COVID-19 pneumonia. Additionally, inflammation (CRP) and gas exchange (SpO2/FiO2) in these patients were significantly related to exposure to air pollution.

Three-year efficacy of switching to dolutegravir plus lamivudine: A real-world study.

BACKGROUND: Dolutegravir (DTG) plus lamivudine (3TC) has proven highly efficacious as a switching strategy in virologically suppressed people with HIV (PWH). As this strategy was introduced relatively recently, real-world, long-term durability studies are lacking. METHODS: We performed a retrospective review of treatment-experienced patients who started DTG + 3TC in a cohort of PWH. HIV-RNA <50 copies/mL was analysed at 144 weeks in an intention-to-treat (ITT) analysis (missing = failure) and a per-protocol (PP) analysis (patients with missing data or changes for reasons other than virological failure were excluded). RESULTS: The study population comprised 358 PWH (19% women). Median age and time with HIV infection were 51.7 and 13.4 years, respectively. The median number of previous antiretroviral combinations was three. Previous virological failure was reported in 27.1% of patients, and the M184V resistance mutation was detected in 17 patients. At 144 weeks, the percentage of individuals with HIV-RNA <50 copies/mL was 77.4% (277/358) in the ITT analysis and 95.5% (277/290) in the PP analysis. A total of 68 participants were excluded from the PP analysis (data missing, 25, discontinuation due to toxicity, 19; other, 16; death, 8). Two people with virological failure selected resistance-associated mutations (M184V and M184V + R263K). HIV-RNA remained undetectable in 17 patients with a previous history of the M184V mutation. CONCLUSION: Our results confirm the real-world, long-term efficacy, tolerability and high genetic barrier of DTG + 3TC in treatment-experienced PWH. Although scarce, mutations causing resistance to nucleosides and integrase can emerge.

Experiences of water immersion during childbirth: a qualitative thematic synthesis.

BACKGROUND: The increasing demand for childbirth care based on physiological principles has led official bodies to encourage health centers to provide evidence-based care aimed at promoting women's participation in informed decision-making and avoiding excessive medical intervention during childbirth. One of the goals is to reduce pain and find alternative measures to epidural anesthesia to enhance women's autonomy and well-being during childbirth. Currently, water immersion is used as a non-pharmacological method for pain relief. This review aimed to identify and synthesize evidence on women's and midwives' experiences, values, and preferences regarding water immersion during childbirth. METHODS: A systematic review and thematic synthesis of qualitative evidence were conducted. Databases were searched and references were checked according to specific criteria. Studies that used qualitative data collection and analysis methods to examine the opinions of women or midwives in the hospital setting were included. Non-qualitative studies, mixed-methods studies that did not separately report qualitative results, and studies in languages other than English or Spanish were excluded. The Critical Appraisal Skills Program Qualitative Research Checklist was used to assess study quality, and results were synthesized using thematic synthesis. RESULTS: Thirteen studies met the inclusion criteria and were included in this review. The qualitative studies yielded three key themes: 1) reasons identified by women and midwives for choosing a water birth, 2) benefits experienced in water births, and 3) barriers and facilitators of water immersion during childbirth. CONCLUSIONS: The evidence from qualitative studies indicates that women report benefits associated with water birth. From the perspective of midwives, ensuring safe water births requires adequate resources, midwives training, and rigorous standardized protocols to ensure that all pregnant women can safely opt for water immersion during childbirth with satisfactory results.

Reconstrucción mamaria inmediata prepectoral / Immediate prepectoral breast reconstruction

Introducción. La reconstrucción mamaria inmediata con implantes prepectorales permite realizar la mastectomía oncológica con un resultado estético en un solo tiempo quirúrgico y con menor morbilidad del área dadora. Las indicaciones son precisas, en directa relación con las condiciones de la mastectomía. Material y métodos. Se presentan 83 pacientes en el período comprendido entre febrero de 2020 a febrero de 2022 con mastectomías uni- y bilaterales, con conservación del complejo areola-pezón los cuales fueron injertados en 7 casos. La incisión en surco submamario se realizó en 60 casos, radiada externa en 8 casos, vertical en 8 casos y 7 casos con patrón de reducción en el Instituto Oncológico Alexander Fleming. Los criterios de exclusión que utilizamos son tumores mamarios a menos de 1 cm del complejo areola pezón y tumores localmente avanzados. Resultados. En total se realizaron 98 mastectomías, de las cuales 86 fueron terapéuticas y 12 profilácticas por mutaciones genéticas. La extracción de ganglios se realizó por una incisión axilar, excepto en el patrón de reducción donde se realizó a través de la incisión de la mastectomía. En 42 pacientes se utilizaron implantes anatómicos y en 56 casos redondos texturizados. El seguimiento de las pacientes fue a 25 meses. Conclusión. La reconstrucción mamaria prepectoral lleva a la reconstrucción de la mama en el mismo espacio con una baja morbilidad y resultado natural. Las indicaciones para esta técnica deben ser muy precisas para lograr obtener los resultados deseados. En nuestra experiencia, la reconstrucción mamaria inmediata con implante directo es una técnica segura y reproducible, con excelentes resultados en pacientes en las que está debidamente indicada la técnica, con una baja tasa de complicaciones y disminución en el tiempo de tratamiento y de recuperación.

Introduction. Immediate breast reconstruction with pre pectoral implants allows to perform oncologic mastectomy with an aesthetic result in a single surgical time and with less morbidity of the donor area. The indications are precise and directly related to the conditions of the mastectomy. Material and methods. We present 83 patients in the period from February 2020 to February 2022 with uni and bilateral mastectomies, with preservation of the nipple-areola complex which was grafted in 7 cases. The incision in the submammary sulcus was performed in 60 cases, external radiated in 8 cases, vertical in 8 cases and 7 with reduction pattern at the Alexander Fleming Oncological Institute. The exclusion criteria we used are breast tumors less than 1 cm from the nipple areola complex and locally advanced tumors. Results. A total of 98 mastectomies were performed, of which 86 were therapeutic and 12 prophylactic for genetic mutations. Node removal was performed through an axillary incision, except in the reduction pattern where it was performed through the mastectomy incision. Anatomical implants were used in 42 patients and textured round implants in 56 cases. The follow-up of the patients was 25 months. Conclusion. Pre pectoral breast reconstruction leads to reconstruction of the breast in the same space with low morbidity and natural results. The indications for this technique must be very precise to achieve the desired results. In our experience, immediate breast reconstruction with direct implant is a safe and reproductible technique, with excellent results in patients in whom the technique is properly indicated, with a low rate of complications and decrease in treatment and recovery time.

Real-life analysis on safety and efficacy of asciminib for ponatinib pretreated patients with chronic myeloid leukemia.

Failure of second-generation tyrosine kinase inhibitors (2GTKI) is a challenging situation in patients with chronic myeloid leukemia (CML). Asciminib, recently approved by the US Federal Drug Administration, has demonstrated in clinical trials a good efficacy and safety profile after failure of 2GTKI. However, no study has specifically addressed response rates to asciminib in ponatinib pretreated patients (PPT). Here, we present data on responses to asciminib from 52 patients in clinical practice, 20 of them (38%) with prior ponatinib exposure. We analyzed retrospectively responses and toxicities under asciminib and compared results between PPT and non-PPT patients.After a median follow-up of 30 months, 34 patients (65%) switched to asciminib due to intolerance and 18 (35%) due to resistance to prior TKIs. Forty-six patients (88%) had received at least 3 prior TKIs. Regarding responses, complete cytogenetic response was achieved or maintained in 74% and 53% for non-PPT and PPT patients, respectively. Deeper responses such as major molecular response and molecular response 4.5 were achieved in 65% and 19% in non-PPT versus 32% and 11% in PPT, respectively. Two patients (4%) harbored the T315I mutation, both PPT.In terms of toxicities, non-PPT displayed 22% grade 3-4 TEAE versus 20% in PPT. Four patients (20% of PPT) suffered from cross-intolerance with asciminib as they did under ponatinib.Our data supports asciminib as a promising alternative in resistant and intolerant non-PPT patients, as well as in intolerant PPT patients; the resistant PPT subset remains as a challenging group in need of further therapeutic options.

Implantación del servicio de indicación farmacéutica (SIF). Proyecto INDICA PRO. Provincia de Alicante. Resultados de 9 farmacias / Implementation of the pharmaceutical indication service (SIF). INDICA PRO Project. Province of Alicante. Results from 9 pharmacies

JUSTIFICACIÓN: las farmacias comunitarias (FC) disponen de una plataforma (SEFAC e_XPERT), un protocolo (PASITAMAE) y criterios de derivación consensuados por sociedades científicas en 31 síntomas menores (SM), permitiendo instaurar un SIF (INDICA PRO).OBJETIVOS: -Registrar al paciente en el SIF indicando el SM, realizando seguimiento. -Indicar opción más adecuada para resolver el SM (OTC, tratamiento no farmacológico…) o si es necesario derivación al médico.-Medir prevalencia de SM no consensuados.MATERIAL Y MÉTODO: Programa SEFAC e_XPERT, Libro SM y criterios de derivación SEFAC.RESULTADOS: durante el año 2021, 15 farmacéuticos de 9 farmacias de la provincia de Alicante, realizamos 2147 registros pertenecientes a 1302 pacientes (862 mujeres y 440 hombres). Media de edad 57 años (DE±17,6). El 27,53 % de los registros pertenecen a SM no consensuados siendo la astenia con 44 registros (2,05 %), sequedad de piel (18 registros ;0,84 %) y el tapón de cerumen (14 registros; 0,65 %) los que presentan más prevalencia. Los resultados obtenidos para los registros que pertenecen a SM con criterios de derivación consensuados son los siguientes: •Respiratorios; 254 registros (11,83 %)•Congestión nasal; 80 (3,73 %)•Síndrome catarral y gripal; 83 (3,87 %)• Tos; 91(4,24 %)•Dolor; 368 (17,14 %)•Cefalea; 28 (1,3 %) •Dolor articular y de espalda; 252 (11,74 %)•Dolor de garganta; 61 (2,84 %)•Dolor dentario; 27 (7,34 %)•Digestivos; 263 (12,25 %)•Acidez/pirosis; 71 (3,31 %)•Diarrea; 69 (3,21 %)•Estreñimiento; 70 (3,26 %)• Flatulencia; 43 (2 %) •Vómitos; 10 (0,47 %)•Dermatológico; 354 (16,49 %)•Acné; 12 (0,56 %)•Aftas; 36 (1,68 %)•Dermatitis; 118 (5,5 %) •Heridas cutáneas; 35 (1,63 %)•Herpes labial; 32 (1,49 %)•Hiperhidrosis; 6 (0,28 %) (AU)

Biomonitoring bisphenols, parabens, and benzophenones in breast milk from a human milk bank in Southern Spain.

BACKGROUND: Human breast milk is considered the optimal source of nutrition for infants. Milk from breast milk banks offers an alternative to infant formulas for vulnerable hospitalized neonates most likely to benefit from exclusive human milk feeding. However, breast milk can also be a source of exposure to environmental contaminants, including endocrine-disrupting chemicals (EDCs). AIM: To evaluate concentrations of phenolic EDCs, including bisphenols, parabens (PBs), and benzophenones (BPs), in samples from a human milk bank in Granada, Southern Spain and to explore sociodemographic, reproductive, and lifestyle factors related to their concentrations in the milk. METHODS: Concentrations of three bisphenols [bisphenol A (BPA), bisphenol F (BPF), and bisphenol S (BPS)], four PBs [methyl- (MeP), ethyl- (EtP), propyl- (n-PrP), and butyl-paraben (n-BuP)], and six BPs [BP-1, BP-2, BP-3, BP-6, BP-8, and 4-hydroxy-BP] were determined in milk samples from 83 donors. Information on potential explanatory variables was gathered using the milk bank donor form and an ad hoc questionnaire. Multiple linear and logistic regression models were fitted. RESULTS: Detectable concentrations were found of at least one of the analyzed compounds in all donor breast milk samples and at least five compounds in one-fifth of them. The most frequently detected compounds were MeP (90.5%), BP-3 (75.0%), EtP (51.2%), n-PrP (46.4%), and BPA (41.7%). Median concentrations ranged between <0.10 ng/mL (n-PrP, n-BuP, BP-1) and 0.59 ng/mL (BP-3). No sample contained detectable concentrations of BPF, BPS, or most BPs (BP-2, BP-6, BP-8, and 4- hydroxy-BP). Breast milk phenol concentrations were associated with parity, the utilization of deodorants, mouthwash, skin care products, and cosmetics, and the intake of nutritional supplements. CONCLUSIONS: Results reveal the widespread presence of BPA, PBs, and BP-3 in donor breast milk samples, highlighting the need for preventive measures to enhance the benefits of breast milk from milk banks and from breastfeeding women in general.

Bioactive pectic polysaccharides from bay tree pruning waste: Sequential subcritical water extraction and application in active food packaging.

The potential isolation of bio-active polysaccharides from bay tree pruning waste was studied using sequential subcritical water extraction using different time-temperature combinations. The extracted polysaccharides were highly enriched in pectins while preserving their high molecular mass (10-100 kDa), presenting ideal properties for its application as additive in food packaging. Pectin-enriched chitosan films were prepared, improving the optical properties (≥95% UV-light barrier capacity), antioxidant capacity (˃95% radical scavenging activity) and water vapor permeability (≤14 g·Pa-1·s-1·m-1·10-7) in comparison with neat chitosan-based films. Furthermore, the antimicrobial activity of chitosan was maintained in the hybrid films. Addition of 10% of pectins improved mechanical properties, increasing the Young's modulus 12%, and the stress resistance in 51%. The application of pectin-rich fractions from bay tree pruning waste as an additive in active food packaging applications, with triple action as antioxidant, barrier, and antimicrobial has been demonstrated.

A RAC-GEF network critical for early intestinal tumourigenesis.

RAC1 activity is critical for intestinal homeostasis, and is required for hyperproliferation driven by loss of the tumour suppressor gene Apc in the murine intestine. To avoid the impact of direct targeting upon homeostasis, we reasoned that indirect targeting of RAC1 via RAC-GEFs might be effective. Transcriptional profiling of Apc deficient intestinal tissue identified Vav3 and Tiam1 as key targets. Deletion of these indicated that while TIAM1 deficiency could suppress Apc-driven hyperproliferation, it had no impact upon tumourigenesis, while VAV3 deficiency had no effect. Intriguingly, deletion of either gene resulted in upregulation of Vav2, with subsequent targeting of all three (Vav2-/- Vav3-/- Tiam1-/-), profoundly suppressing hyperproliferation, tumourigenesis and RAC1 activity, without impacting normal homeostasis. Critically, the observed RAC-GEF dependency was negated by oncogenic KRAS mutation. Together, these data demonstrate that while targeting RAC-GEF molecules may have therapeutic impact at early stages, this benefit may be lost in late stage disease.

[Helicobacter pylori infection in the HIV + population: a comorbidity to think about]. / Infección por Helicobacter pylori en la población VIH+: una comorbilidad en la que pensar.

OBJECTIVE: Gastrointestinal disorders are frequent in HIV+. Helicobacter pylori may be an underdiagnosed cause. METHODS: Patients with HIV and H. pylori were described since January 1998 up to December 2017. RESULTS: A total de 132 patients were included. The most frequent symptom was dyspepsia. 88.5% had chronic atrophic gastritis. Eradication was achieved in 102 (77.3%). Healing was more frequent with quadruple regimen (p=0.004) and in the youngest (p=0.041). CONCLUSIONS: H. pylori infection could be responsible for nonspecific digestive manifestations in HIV + patients.

Tentorial Incision vs. Retraction of the Tentorial Edge during the Subtemporal Approach: Anatomical Comparison in Cadaveric Dissections and Retrospective Clinical Case Series.

Objective The aim of this study was to compare tentorial incision (group A) versus retraction and tack up suture (group B) of the tentorial edge during the subtemporal approach for surgery in the high basilar region. Design 24 cadaveric dissections and 4 clinical cases of aneurysms of the high basilar region are presented. Assessment included visibility and operability afforded by either tentorial incision creating a dural flap (group A) or retraction of the tentorial edge and tethering with a suture (group B). Four patients, two with superior cerebellar artery aneurysms and two with proximal posterior cerebral artery aneurysms were treated with each approach. Results In the quantitative evaluations, we found no significant difference in the exposure of the posterior cerebral, superior cerebellar, and perforant arteries as well as surgical working area provided by either approach. However, tentorial incision allowed a significantly greater exposure of the basilar artery and the fourth cranial nerve (both p < 0.001). Concerning operability, tentorial incision provided no objective advantage for direct clipping of the high basilar region (groups A vs. B, p > 0.05). Subjectively, clipping of the high basilar segment was feasible using tentorial tethering only. Conclusion Retraction of the free edge of the tentorium downward by tethering with a suture is simple and fast method for exposure of aneurysms in the high basilar region when the pathology does not require a proximal control. In our data the rather more invasive and time consuming tentorial incision provided an additional objectified advantage only for placement of a proximal temporary clip.

Regulation of adult hippocampal neurogenesis exerted by sexual, cognitive and physical activity: An update.

In 1962, Joseph Altman described that the brain generates neurons after the postnatal period, and this continues throughout your life (Altman, 1962). This was a breakthrough in the neuroscience field because before this the accepted paradigm was that the brain only generated neurons during the embryonal development. This discovery has been controversial ever since, especially since one of the areas of the brain with neurogenic properties is the hippocampus, which is the area involved in memory storage and neurodegenerative processes. The adult hippocampal neurogenesis modulates in response to different environmental factors. In this article, we review how exercise and cognitive and sexual activity can regulate the generation of new neurons in the hippocampal in an adult brain and the impact of these new neurons in the brain circuitry.

Effect of the administration of a probiotic with a combination of Lactobacillus and Bifidobacterium strains on antibiotic-associated diarrhea.

OBJECTIVE: The aim of this study is to analyze the effect, safety and tolerability of a specific probiotic combination of Lactobacillus and Bifidobacterium strains (Pearls IC©) on antibiotic associated diarrhea due to amoxicillin-clavulanic acid treatment. METHODS: Pilot, unicentric, randomized, double-blind, parallel group, placebo-controlled study (probiotic vs. placebo for 30 days). Target population: Adult patients, both sexes treated with amoxicillin-clavulanic acid (850mg / 125mg every 8h /orally) for 7 days who attended the Emergency Department (Dexeus Hospital, Barcelona) between January and April of 2018 with prior signed informed consent with a follow up at 30 days. Variables: The differences between day 0 and day 30 of the number of daily stools and duration of diarrhea were evaluated; Stool consistency according to Bristol Stool Form, Quality of intestinal life. Subjective evaluation and evaluation of adverse effects of the product through a specifically designed questionnaire. RESULTS: Thirty-six subjects were included (18 per group) 25 females and 11 males, average age of 38.5 years (range 19-65 years). Pearls IC© delayed between 4 and 5 days the appearance of the diarrheic episode vs. placebo (p <0.001). The results of the quality of life assessment showed an improvement at the end of the 30 days period but without difference vs placebo. The results of the subjective assessment were in favor of the probiotic with higher rate of like responses than placebo. CONCLUSIONS: Pearls IC© demonstrated its beneficial effect on antibiotic associated diarrhea by delaying the onset of diarrhea and showed a tendency to decrease the number of daily stools vs. placebo.

Manifestaciones dermatológicas en kwashiorkor: reporte de caso y revisión de la literatura / Dermatological manifestations in kwashiorkor: case report and review of literature

RESUMEN Objetivo: presentar un reporte de caso y revisión de la literatura de una paciente diagnosticada con Kwashiorkor, por sus manifestaciones dermatológicas y clínicas. Métodos: se valora en el servicio de Urgencias a una lactante menor, femenina, de 4 meses de edad, con un cuadro de aproximadamente 15 días de lesiones asintomáticas, que se inician en miembros inferiores con posterior diseminación a tronco, miembros superiores y cara. La madre refiere alimentación exclusiva con avena desde el mes de vida. Resultados: se realizó un manejo interdisciplinario, con los servicios de Pediatría, Nutrición y Dermatología con adecuada evolución clínica de la paciente, observando importante mejoría del cuadro cutáneo, a los pocos días de su estancia hospitalaria. Conclusiones: aunque no es una patología muy frecuente hoy en día, sigue sucediendo en países en vía de desarrollo y desarrollados, por lo que es importante siempre tenerla como diagnóstico diferencial para un abordaje adecuado y educar a los padres y cuidadores.

SUMMARY Objective: wepresent a case report and review of the literature of a patient, diagnosed with Kwashiorkor due to its dermatological and clinical manifestations. Methods: a 4-month-old female infant was evaluated in the Emergency department for approximately 15 days of asymptomatic lesionsthat began in the lower limbs with subsequent dissemination to the trunk, upper limbs and face. The mother refers a diet since four months of age only with oats, denies maternal lactation. Results: an interdisciplinary management was carried out, with the Pediatric service, Nutrition and Dermatology with adequate clinical evolution of the patient, observing an important improvement of the cutaneous lesions, after a few days in the hospital. Conclusions: although it is not a very frequent pathology, it is still happening in developing countries and developed, so it is important to always have it as a differential diagnosis for an adequate approach and always educate parents and caregivers.

Vagino-rectal colonization and maternal-neonatal transmission of Enterobacteriaceae producing extended-spectrum ß-lactamases or carbapenemases: a cross-sectional study.

This study sought to determine the prevalence and risk factors for colonization with extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-E) and carbapenemase-producing Enterobacteriaceae (CPE) in 815 mothers and 800 newborns using a cross-sectional design; 59 women and 13 neonates were colonized by ESBL-E (prevalence (95% confidence interval): 6.7% (5.2-8.7) and 1.6 (0.7-2.5), respectively). No CPE were found. The most frequent ESBL-E were CTX-M-14 and SHV-12. Vertical transmission occurred in 14% of colonized mothers. The risk factors for colonization were, in mothers: complications in previous pregnancies, more than one urinary tract infection, non-Caucasian ethnicity, and frequently having the main meal outside home; in newborns: colonized mother and vaginal delivery.

Inverse association for diagnosis of Alzheimer's disease subsequent to both melanoma and non-melanoma skin cancers in a large, urban, single-centre, Midwestern US patient population.

BACKGROUND: Although literature demonstrates a decreased risk of Alzheimer's disease (AD) in individuals with various cancers, including squamous cell cancers (SCC) and basal cell cancers (BCC) comprising non-melanoma skin cancers (NMSC), there is a paucity of literature to substantiate an association between malignant melanoma (MM) and AD. OBJECTIVE: The aim of this study was to determine whether an association exists between MM and AD as well as for NMSC and AD. METHODS: A large urban, Midwestern, US, single-centre, medical record (EMR) data repository was searched between January 2001 and December 2015, to identify all patients at age ≥60 and <89 years with a clinic follow-up of at least 1 year and no diagnosis for AD, MM or NMSC at the time of the study entry. Data collected included age, gender, race and duration of follow-up. MM and NMSC were detected by ICD-9 codes and ICD-10 codes. Incident diagnosis of AD was also detected by ICD-9 and ICD-10 codes. Logistic regression analysis was utilized to obtain crude and adjusted odds ratios (ORs). RESULTS: Data for a total of 82 925 patients with known race and gender and were detected. After adjusting for confounding factors (race, gender, age, cerebrovascular disease, peripheral vascular disease and diabetes), there was a significant decreased risk of subsequent AD in patients with MM (OR: 0.39; 95% CI: 0.16-0.96; P = 0.042) as well as in patients with BCC (OR: 0.18; 95% CI: 0.08-0.45; P < 0.0001) and for patients with SCC (OR: 0.08; 95% CI: 0.01-0.56; P = 0.013). CONCLUSION: These findings add to the growing body of evidence for a decreased risk of AD in patients with various cancers and highlight the need for ongoing research to elucidate both neurologic and biologic mechanisms that may underlie this apparent inverse association.

PCR evaluation of selected vector-borne pathogens in dogs with pericardial effusion.

OBJECTIVES: To investigate evidence for selected vector-borne pathogen infections in dogs with pericardial effusion living in a Mediterranean area in which several canine vector-borne diseases are endemic. MATERIALS AND METHODS: Archived EDTA blood (n=68) and pericardial fluid samples (n=58) from dogs with pericardial effusion (n=68) were included. Dogs without pericardial effusion examined for other reasons were included as controls (n=60). Pericardial effusion was classified as neoplastic in 40 dogs, idiopathic in 23 dogs and of unknown aetiology in 5 dogs. Real-time PCR was performed for Leishmania infantum, Ehrlichia/Anaplasma species, Hepatozoon canis, Babesia species, Rickettsia species and Bartonella species, and sequencing of PCR products from positive samples was used to confirm species specificity. RESULTS: Vector-borne pathogens were found in 18 dogs: 16 of 68 dogs with pericardial effusion (23·5%) and two of 60 control dogs (3·3%). Positive dogs demonstrated DNA of Leishmania infantum (n=7), Anaplasma platys (n=2, one dog coinfected with Leishmania infantum), Babesia canis (n=5), Babesia gibsoni (n=3) and Hepatozoon canis (n=2). Vector-borne pathogens were more commonly detected among dogs with pericardial effusion than controls (P=0·001). There was no relationship between aetiology of the pericardial effusion and evidence of vector-borne pathogens (P=0·932). CLINICAL SIGNIFICANCE: Vector-borne pathogens are often detected in dogs with pericardial effusion and require further investigation, especially in dogs with idiopathic pericardial effusion. PCR can provide additional information about the potential role of vector-borne pathogens in dogs with pericardial effusion living in endemic areas.

Young athletes' health knowledge system: Qualitative analysis of health learning processes in adolescent sportspersons.

Recognized side effects on health associated with sports participation in youth include overtraining, doping, and exposure to harassment and violence. Many of these effects originate in contexts where young athletes are beginning to make decisions about their sports practices on their own. This study sets out to explore knowledge and reasoning about health among adolescent athletes and to describe how health knowledge management structures are associated with different social systems. Qualitative data were collected from focus groups involving 65 young Swedish athletes aged 16-17 years. The participants' knowledge and reasoning about health were examined using a deductive thematic analysis, categories from Bloom's taxonomy of educational objectives, and Luhmann's social systems theory. The meaning of health was found to have a dynamic character for the young athletes, associated with constantly striving to satisfy immediate needs and fulfill short-time life goals. The athletes' thinking about health was associated with a pragmatic "health-as-a-resource" perspective, characterized by group self-comparisons, rapid cognitive processing, and opportunistic substitutions. They expressed a particular interest in experiential learning and personally relevant procedural knowledge, and they perceived that their factual knowledge about health was saturated. The results of this study add emphasis to the importance of involving adolescent sportspersons in the development of health education programs and contextualizing the programs to the athletes' specific age and social environment.