Quantification of Major Inorganic Contaminants in a Mediterranean Coastal Lagoon with a Large Dystrophic Crisis.

In August 2021, the Mar Menor, a saltwater lagoon located in the Region of Murcia (Spain), suffered a tragic environmental episode of dystrophic crisis and anoxia. The appearance of numerous dead fish in different areas of the lagoon over the course of days put all the authorities and the population of the area on alert. This paper shows a case study of what happened in the lagoon in terms of the presence of the most common inorganic pollutants. Measurements of the concentration of nitrogen species, phosphates and main heavy metals were carried out at different sampling sites in the Mar Menor from May 2021 to November 2022. Chemical analyses were carried out for each of the species under study. These analyses provide valuable information about the dystrophic crisis caused by a classic eutrophication process that began with the excessive nutrient input into the Mar Menor. Ion chromatography and Inductively Coupled Plasma Mass Spectrometry (ICP-MS) were used as instrumentation for the quantification of these samples. The species whose values were greatly increased after the tragic episode described above were nitrates. The concentration varied significantly at the different sampling sites throughout the study. On the last sampling date, decreased concentrations of all the species were measured at each of the sampling sites, coinciding with the apparent good state of the lagoon.

Accompaniment of minors during health care procedures.

In clinical practice, it is not rare to encounter situations in which parents and families are asked to leave the child alone with the health care team in rooms full of devices throughout the performance of procedures, which at times may give rise not only to conflicts but, more importantly, emotional sequelae in children or adolescents. We conducted a narrative review of the literature by searching the digital library of the public health care system of Andalusia for articles concerning the experiences of health care professionals and families with the accompaniment of paediatric patients during health care procedures. We restricted the search to studies published in Spanish or English and conducted in humans. The review evinced the need to humanise care in order to improve care quality. The need to accompany minors is supported by the evidence from works that have analysed the factors involved in the persistence of these behaviours and attitudes in both professionals and parents. We consider it necessary to develop institutional policies and appoint mediators to compile the statements of different national and international societies, taking into account legal aspects but, above all, the pertinent values from a health care ethics perspective, and in pursuit of the best interests of the child.

Bio-Monitoring of Metal(loid)s Pollution in Dry Riverbeds Affected by Mining Activity.

The aim of this study was to evaluate the most abundant native plants that could be used as a bio-monitor of metal(loid) concentration in dry riverbeds affected by mining activities. Three plants species and their respective rhizospheric soils were sampled from the El Beal (Piptatherum miliaceum, 15 samples), La Carrasquilla (Foeniculum vulgare, 10 samples), and Ponce (Dittrichia viscosa, 12 samples) dry riverbeds from the mining district of Cartegena-La Unión (SE Spain). There is scanty bibliography of the capacity of these species to be used as bio-monitors in the dry riverbeds. Plants categorized as a bio-monitor were established according to the bioaccumulation factor (BF), mobility ratio (MR), and linear correlations between metal(loid) concentrations in plants tissues (root or stem)-rhizospheric soils. The rhizospheric soils were highly contaminated for As, Cd, Pb, and Zn (Cf ≥ 6), and moderately contaminated for Mn (1 ≤ Cf < 3). Piptatherum miliaceum presented on Cd similar mean concentrations on rhizospheric soil and root, BF = 1.07, with a strong correlation soil-root (r = 0.61, p = 0.02). Therefore, of the three species with the capacity to grow in the area, Piptatherum miliaceum showed characteristics to be considered as a bio-monitor for Cd, with a BF > 1, and a positive-significant correlation between the rhizospheric soil and roots.

Acompañamiento a los menores durante los procedimientos asistenciales / Accompaniment of minors during health care procedures

En la práctica clínica no es infrecuente observar situaciones en las cuales se invita a los progenitores y la familia a dejar a los menores en soledad junto al equipo asistencial en estancias repletas de tecnología durante la realización de procedimientos, dando lugar en ocasiones a conflictos, pero sobre todo con consecuencias emocionales en los niños o adolescentes.Se ha realizado una revisión narrativa de la literatura mediante búsqueda bibliográfica en la biblioteca virtual del sistema sanitario público de Andalucía, siendo los criterios de inclusión utilizados, estudios que conciernen a las experiencias de profesionales sanitarios y familiares sobre el acompañamiento de la población pediátrica en los procedimientos asistenciales. El resultado de la búsqueda se limitó a trabajos en humanos en español e inglés.Esta revisión pone de manifiesto la necesidad de humanizar la asistencia sanitaria para mejorar la calidad de la atención. Se justifica la necesidad de acompañamiento de los menores, a través de trabajos que han analizado los factores que intervienen en la permanencia de estas conductas y actitudes tanto por profesionales como padres. Se recomienda la necesidad de políticas institucionales y figuras mediadoras que recojan las declaraciones de algunas sociedades nacionales e internacionales teniendo en cuenta aspectos legales, pero sobre todo los valores en juego desde una ética del cuidado y búsqueda del interés superior del menor.(AU)

In clinical practice, it is not rare to encounter situations in which parents and families are asked to leave the child alone with the health care team in rooms full of devices throughout the performance of procedures, which at times may give rise not only to conflicts but, more importantly, emotional sequelae in children or adolescents.We conducted a narrative review of the literature by searching the digital library of the public health care system of Andalusia for articles concerning the experiences of health care professionals and families with the accompaniment of paediatric patients during health care procedures. We restricted the search to studies published in Spanish or English and conducted in humans.The review evinced the need to humanise care in order to improve care quality. The need to accompany minors is supported by the evidence from works that have analysed the factors involved in the persistence of these behaviours and attitudes in both professionals and parents. We consider it necessary to develop institutional policies and appoint mediators to compile the statements of different national and international societies, taking into account legal aspects but, above all, the pertinent values from a health care ethics perspective, and in pursuit of the best interests of the child.(AU)

Dissectional Orientation: Morphological Variations of Teres Minor Muscle and its Nerve Supply

SUMMARY: The teres minor is one of the rotator cuff muscles that comprise the superior margin of the quadrangular space. Quadrangular space syndrome (QSS) refers to the entrapment or compression of the axillary nerve and the posterior humeral circumflex artery in the quadrangular space, often caused by injuries, dislocation of the shoulder joint, etc. Patients who fail the primary conservative treatments and have persistent symptoms and no pain relief for at least six months would be considered for surgical interventions for QSS. This cadaveric study of 17 cadavers (males: 9 and females: 8) was conducted in the Gross Anatomy Laboratory at the Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University. The cadavers were preserved in a 10 % formaldehyde solution and obtained ethical approval by the ethical commission of the Siriraj Institutional Review Board. The morphology of the teres minor muscle-tendon junction, the bifurcation type of the axillary nerve, and the length and number of the terminal branches of the nerve to the teres minor were documented. Specimens with quadrangular space contents and surrounding muscles that had been destroyed were excluded from the study. The results showed that 47.06 % of the specimens had type A bifurcation, 47.06 % had type B bifurcation, and the remaining 5.88 % had type C bifurcation. It was observed that 58.82 % had nonclassic muscle-tendon morphology, while 41.18 % were classic. The average length of the terminal branches of the nerve to the teres minor in males was 1.13 cm, with the majority having two branches. For females, many showed one terminal branch with an average length of 0.97 cm. Understanding the differences in anatomical variations can allow for a personalized treatment plan prior to quadrangular space syndrome surgical procedures and improve the recovery of postsurgical interventions for patients.

El músculo redondo menor es uno de los músculos del manguito rotador que comprende el margen superior del espacio cuadrangular. El síndrome del espacio cuadrangular (QSS) se refiere al atrapamiento o compresión del nervio axilar y la arteria circunfleja humeral posterior en el espacio cuadrangular, a menudo causado por lesiones, dislocación de la articulación humeral, entre otros. En los pacientes en los que fracasan los tratamientos conservadores primarios y presentan síntomas persistentes y ningún alivio del dolor durante al menos seis meses se considerarían para intervenciones quirúrgicas para QSS. Este estudio cadavérico de 17 cadáveres (hombres: 9 y mujeres: 8) se llevó a cabo en el Laboratorio de Anatomía Macroscópica del Departamento de Anatomía de la Facultad de Medicina del Hospital Siriraj de la Universidad Mahidol. Los cadáveres se conservaron en una solución de formaldehído al 10 % y obtuvieron la aprobación ética de la comisión ética de la Junta de Revisión Institucional de Siriraj. Se documentó la morfología de la unión músculo-tendón del músculo redondo menor, el tipo de bifurcación del nervio axilar y la longitud y el número de las ramas terminales del nervio para el músculo redondo menor. Se excluyeron del estudio los especímenes con contenido de espacios cuadrangulares y músculos circundantes que habían sido destruidos. Los resultados mostraron que el 47,06 % de los especímenes presentó bifurcación tipo A, el 47,06 % una bifurcación tipo B y el 5,88 % restante una bifurcación tipo C. Se observó que el 58,82 % presentaba una morfología músculo-tendinosa no clásica, mientras que el 41,18 % era clásica. La longitud pmedia de los ramos terminales del nervio hasta el músculo redondo menor en los hombres era de 1,13 cm, y la mayoría tenía dos ramos. En el caso de las mujeres, mostraron un ramo terminal con una longitud promedio de 0,97 cm. Comprender las diferencias en las variaciones anatómicas puede permitir un plan de tratamiento personalizado antes de los procedimientos quirúrgicos del síndrome del espacio cuadrangular y mejorar la recupe- ración de las intervenciones posquirúrgicas de los pacientes.

Evaluación de aspectos clínicos relacionados con la amputación de miembros inferiores en personas que viven con diabetes mellitus tipo 2 en México / Evaluation of clinical aspects related to lower limb amputation among individuals living with type 2 diabetes mellitus in Mexico

RESUMEN Introducción: La diabetes continúa siendo una de las principales causas de discapacidad y muerte en la población mundial. Alrededor del 25% de las personas con diabetes desarrollarán una úlcera en alguno de sus miembros pélvicos inferiores. Objetivo: El presente estudio evalúa los aspectos clínicos relacionados con la amputación del miembro inferior pélvico en una cohorte de pacientes con diabetes mellitus. Métodos: Estudio retrospectivo, transversal, realizado en colaboración entre el Instituto Mexicano del Seguro Social y la Facultad de Farmacia de la Universidad Autónoma del Estado de Morelos, implicó una revisión de expedientes de pacientes con diabetes mellitus tipo 2 en el Hospital General Regional "Ignacio García Téllez". Se seleccionaron 100 expedientes clínicos y Electrónicos basados en criterios de inclusión, que incluían edad mayor de 18 años, afiliación en el sitio del estudio, evolución de la diabetes de al menos 10 años, tratamiento farmacológico para la diabetes y diagnóstico de pie diabético con curación completa o amputación como resultado. Los análisis estadísticos se realizaron mediante STATA y se obtuvo aprobación ética. Resultados: Los pacientes con un control glucémico óptimo cuantificando sus niveles de glucosa en ayunas (<130 mg/dl) así como sus valores de hemoglobina glicosilada (< 7%) tuvieron una menor frecuencia de amputaciones (p˂0,001; Chi2) en comparación con aquellos pacientes sin un control glucémico adecuado. Conclusión: Se encontró que ser hombre, valores de hemoglobina glucosilada superiores al 7% y valores promedio de glucosa en ayunas superiores a 130 mg/L aumentan la probabilidad de presentar una amputación de extremidad inferior.

ABSTRACT Introduction: Diabetes continues to be a leading cause of disability and death in the world's population. About 25% of people with diabetes will develop an ulcer in one of their lower pelvic limbs. Objective: The present study evaluates the clinical aspects related to lower pelvic limb amputation in a cohort of patients with diabetes mellitus. Lazarte Echegaray Hospital during the period 2017-2020. Methods: Retrospective, cross-sectional study, conducted in collaboration between the Mexican Institute of Social Security and the School of Pharmacy of the Autonomous University of Morelos State, involved a review of records of patients with type 2 diabetes mellitus at the Regional General Hospital "Ignacio García Téllez". One hundred clinical and electronic records were selected based on inclusion criteria, which included age over 18 years, affiliation at the study site, diabetes evolution of at least 10 years, pharmacological treatment for diabetes and diagnosis of diabetic foot with complete healing or amputation as an outcome. Statistical analyses were performed using STATA and ethical approval was obtained. Results: Patients with optimal glycemic control by quantifying their fasting glucose levels (<130 mg/dl) as well as their glycated hemoglobin values (< 7%) had a lower frequency of amputations (p˂0.001; Chi2) compared to those patients without adequate glycemic control. Conclusion: Being male, glycosylated hemoglobin values greater than 7% and mean fasting glucose values greater than 130 mg/L were found to increase the likelihood of having a lower extremity amputation.

Measuring Marine Biotoxins in a Hypersaline Coastal Lagoon.

Marine biotoxins have posed a persistent problem along various coasts for many years. Coastal lagoons are ecosystems prone to phytoplankton blooms when altered by eutrophication. The Mar Menor is the largest hypersaline coastal lagoon in Europe. Sixteen marine toxins, including lipophilic toxins, yessotoxins, and domoic acid (DA), in seawater samples from the Mar Menor coastal lagoon were measured in one year. Only DA was detected in the range of 44.9-173.8 ng L-1. Environmental stressors and mechanisms controlling the presence of DA in the lagoon are discussed. As an enrichment and clean-up method, we employed solid phase extraction to filter and acidify 75 mL of the sample, followed by pre-concentration through a C18 SPE cartridge. The analytes were recovered in aqueous solutions and directly injected into the liquid chromatography system (LC-MS), which was equipped with a C18 column. The system operated in gradient mode, and we used tandem mass spectrometry (MS/MS) with a triple quadrupole (QqQ) in the multiple reaction monitoring mode (MRM) for analysis. The absence of matrix effects was checked and the limits of detection for most toxins were low, ranging from 0.05 to 91.2 ng L-1, depending on the compound. To validate the measurements, we performed recovery studies, falling in the range of 74-122%, with an intraday precision below 14.9% RSD.

Long-term sediment records reveal over three thousand years of heavy metal inputs in the Mar Menor coastal lagoon (SE Spain).

The Mar Menor lagoon combined high biological production and environmental quality, making it an important economic engine. However, the pressure of human activities put its ecological integrity at risk, the oldest environmental impact being mining activity recorded since Roman times, about 3500 years ago, reaching its maximum intensity in the 20th century, contributing heavy metals to the lagoon sediments for almost 30 centuries. This work reviews the spatiotemporal evolution of the main heavy metals in this coastal lagoon using data from 272 surface sediment samples obtained during the last 40 years and two deep cores covering the total history of the lagoon (c. 6500 yrs BP), so as their incidence in the lagoon trophic web. The observed patterns in sedimentation, sediment characteristics and heavy metal content respond to the complex interaction, sometimes synergistic and sometimes opposing, between climatic conditions, biological production and human activities, with mining being mainly responsible for Pb, Zn and Cd inputs and port activities for Cu. High Fe/Al, Ti/Al and Zr/Al ratios identify periods of mining activity, while periods of arid climatic conditions and deforestation that increase erosion processes in the drainage basin and silt concentration in the lagoon sediments are determined by high Zr/Rb and, to a lesser extent, Zr/Al and Si/Al ratios. After the cessation of direct discharges into the lagoon in the 1950s, the recent evolution of heavy metals concentration and its spatial redistribution would be determined by hydrographic and biogeochemical processes, solubility of different elements, and coastal works in harbours and on beaches. The bioconcentration factor decreases along the trophic levels of the food web, suggesting that the lagoon ecosystem provides an important service by retaining heavy metals in the sediment, largely preventing their bioavailability, but actions involving resuspension or changes in sediment conditions would pose a risk to organisms.

Phenology of scyphozoan jellyfish species in a eutrophication and climate change context.

The uprising interest in gelatinous zooplankton populations must cope with a lack of robust time series of direct abundance observations in most of the ecosystems because of the difficulties in sampling small, fragile organisms, and of the dismissal of jellyfish as a nuisance. Most of the hypotheses about their dynamics are built on a few species and ecosystems and extended to the whole group, but the blooms are registered mainly for the members of the Class Scyphozoa that dwell in temperate, shallow waters. Within the scyphozoans, our knowledge about their phenology relies mainly on laboratory experiences. Here we present a long-term analysis of the phenology and life cycle of three scyphozoan species in an ecosystem affected by eutrophication in a climate change context. We have found that the phenology is directed by temperature, but not modified by different thermal and ecological regimes.

Dissolved organic matter distribution in the water column and sediment pore water in a highly anthropized coastal lagoon (Mar Menor, Spain): Characteristics, sources, and benthic fluxes.

Coastal lagoons are among the most productive and biodiverse systems in the world and are important sentinels of climate change. The Mar Menor is one of the largest coastal lagoons in the Mediterranean, providing a variety of ecosystem services and resources to the community. However, in recent decades this lagoon has suffered drastic changes and degradation caused by human activities. We analyzed the concentration of dissolved organic carbon (DOC) and the optical properties of dissolved organic matter (DOM) in the water column and sediment pore water during the summer and winter of 2018 and during eighteen months from 2016 to 2018. Overall, we found that the composition of DOM is mainly related to and enhanced by anthropogenic activities and microbial metabolism. DOM enters the lagoon via urban and agricultural runoff, drainage systems, and wastewater treatment plants. Additionally, strong microbial metabolism in sediments leads to differences in DOM composition between water and sediments. In the water column, humic-like components accounted for 71 % of the total DOM, while protein-like compounds were most abundant in sediment pore water. We observed a strong seasonal variability associated with precipitation and the system collapse in 2016 (phytoplankton bloom), which resulted in the death of 80 % of macrophytes. The sediments act as a source of DOM to the overlying water, likely due to relatively high organic matter content and intense microbial activity, primarily through anaerobic pathways. Benthic fluxes of DOC ranged from 5.24 to 33.30 mmol m-2 d-1, being higher in winter than summer 2018 and decreasing from north to south, likely related to lower residence time in the northern basin, groundwater discharge and accumulation of organic matter from the dead meadows. We estimate a net flux of DOC from the Mar Menor toward the Mediterranean Sea of 1.57 × 107 mol yr-1.

El saber hacer de la Indicación Farmacéutica, hacia una farmacia asistencial / The know-how of the Minor Ailments Service, towards a clinical pharmacy

Servicio de Indicación farmacéutica (SIF) es el Servicio Profesional Farmacéutico Asistencial (SPFA) prestado ante la consulta de un PS concreto, para un paciente o cuidador que llega a la farmacia solicitando el remedio más adecuado para el mismo. Es una de las actividades de mayor peso en nuestra profesión. Cuando el farmacéutico comunitario comienza a trabajar la IF de manera protocolizada y siguiendo la metodología, se establece el Servicio de Indicación Farmacéutica. El Estudio Indica+Pro comenzó en 2020 y finaliza este año. Lleva mas de 20.500 registros.Un ejemplo a seguir, son algunas de las experiencias de compañeros del grupo de trabajo de IF que podemos leer en el artículo "Factores y estrategias en la implantación del Servicio de Indicación Farmacéutica en Farmacia Comunitaria" publicado en este mismo número. Es una farmacia comprometida con sus pacientes donde todo el equipo trabaja de forma coordinada y lleva un número sorprendente de registros en el Estudio Indica+Pro. (AU)

The impact of chemical pollution on the European eel (Anguilla anguilla) from a Mediterranean hypersaline coastal lagoon.

The European eel (Anguilla anguilla) is a critically endangered species. The impact of environmental contamination on this species has been highlighted as contributing to the decline in recruitment. The Mar Menor hypersaline coastal lagoon (SE Spain) is one of the most productive fisheries of European eel in Europe, making it a critical habitat for species conservation. The present study aimed to provide an initial overview of the impact of organic chemical contaminants on the European eel and the potential sublethal effects of chemical pollution on pre-migrating eels in this hypersaline habitat. We investigated muscle bioaccumulation of main persistent and hazardous organic contaminants (including some current-use pesticides) and genotoxicity, neurotoxicity, and xenobiotic detoxification system responses. The findings show that lagoon eels were exposed to high levels of legacy organochlorine contaminants, recently banned pesticides (chlorpyrifos), and some emerging chemicals. Some individuals surpassed the maximum levels of CBs authorized by the European Commission for human consumption. In this species, residuals of chlorpyrifos, pendimethalin, and chlorthal dimethyl have been reported for the first time. This field study provides relevant data to stock management and human health consumption and provides the first biomarker responses in European eel under permanent hypersaline conditions. Furthermore, the high frequency of micronuclei in peripheral erythrocytes of lagoon eels indicates sublethal genotoxic effects on the organism. Overall, the European eels growing and maturing in the Mar Menor lagoon are exposed to toxic and carcinogenic chemicals. The lack of seafood safety regulations for human consumption for some legacy chemicals that were measured in high concentrations in our study requires special action. Further biomonitoring and research are recommended to protect the animal, public, and environmental health.

Ley Trans, liberum arbitrium / Transgender law, liberum arbitrium

La nueva ley sobre la igualdad de las personas trans y la garantía de derechos de las personas LGTBI (Ley 4/2023, de 28 de febrero) ha sido una ley discutida y criticada por algunos grupos de profesionales de la medicina que atienden a la población infantil. Las críticas desde el ámbito médico y pediátrico se pueden hacer siempre ante cualquier ley que consideremos que afecta a los derechos sanitarios de los menores. Lo que sucede es que algunas de esas críticas son sobre aspectos que no se recogen en la ley. En el siguiente artículo analizaremos lo que dice la ley, lo que dicen algunas asociaciones de profesionales y lo que dice la legislación sobre los derechos sanitarios del menor, con el fin de contribuir al debate de esos controvertidos aspectos de la ley (AU)

The new law on the equality of trans people and the guarantee of rights of LGTBI people (Law 4/2023, February 28th) has been discussed by some groups of medical professionals that have shown their disagreement.In relation to any law, criticism can be made from the medical or pediatric field; whenever it affects the rights of minors. However, criticisms, if they exist, should be made about what the law says, not about other aspects.In the following article we will analyze what the law says, what some professional associations say and what the legislation says about the health rights of minors, in order to contribute to the debate on these controversial aspects of the law. (AU)

Whose waters, whose nutrients? Knowledge, uncertainty, and controversy over eutrophication in the Mar Menor.

This work explores the role of knowledge claims and uncertainty in the public dispute over the causes and solutions to nonpoint-driven overfertilization of the Mar Menor lagoon (Spain). Drawing on relational uncertainty theory, we combine the analysis of narratives and of uncertainty. Our results show two increasingly polarized narratives that deviate in the causes for nutrient enrichment and the type of solutions seen as effective, all of which relate to contested visions on agricultural sustainability. Several interconnected uncertainties are mobilized to dispute the centrality of agriculture as a driver for eutrophication and to confront strategies that may hamper productivity. Yet, both narratives rest on a logic of dissent that strongly relies on divergent knowledge to provide legitimacy, ultimately reinforcing contestation. Transforming the ongoing polarization dynamics may require different inter- and transdisciplinary approaches that focus on sharing rather than assigning responsibility and that unpack rather than disregard existing uncertainties.

Bioaccumulation and fate of pharmaceuticals in a Mediterranean coastal lagoon: Temporal variation and impact of a flash flood event.

Coastal ecosystems are particularly vulnerable to terrestrial inputs from human-impacted areas. The prevalence of wastewater treatment plants, unable to remove contaminants such as pharmaceuticals (PhACs), leads to their continuous input into the marine environment. In this paper, the seasonal occurrence of PhACs in a semi-confined coastal lagoon (the Mar Menor, south-eastern Spain) was studied during 2018 and 2019 by evaluating their presence in seawater and sediments, and their bioaccumulation in aquatic organisms. Temporal variation in the contamination levels was evaluated by comparison to a previous study carried out between 2010 and 2011 before the cessation of permanent discharges of treated wastewater into the lagoon. The impact of a flash flood event (September 2019) on PhACs pollution was also assessed. A total of seven compounds (out of 69 PhACs analysed) were found in seawater during 2018-2019, with a limited detection frequency (<33%) and concentrations (up to 11 ng/L of clarithromycin). Only carbamazepine was found in sediments (ND-1.2 ng/g dw), suggesting an improved environmental quality in comparison to 2010-2011 (when 24 and 13 compounds were detected in seawater and sediments, respectively). However, the biomonitoring of fish and molluscs showed a still remarkable accumulation of analgesic/anti-inflammatory drugs, lipid regulators, psychiatric drugs and ß-blocking agents, albeit not higher than in 2010. The flash flood event from 2019 increased the prevalence of PhACs in the lagoon, compared to the 2018-2019 sampling campaigns, especially in the upper water layer. After the flash flood the antibiotics clarithromycin and sulfapyridine yielded the highest concentrations ever reported in the lagoon (297 and 145 ng/L, respectively), alongside azithromycin in 2011 (155 ng/L). Flash flood events associated with sewer overflows and soil mobilisation, which are expected to increase under climate change scenarios, should be considered when assessing the risks posed by pharmaceuticals to vulnerable aquatic ecosystems in the coastal areas.

Evaluación de la madurez del menor en el ámbito sanitario: la perspectiva de padres y pediatras / Assessment of the maturity of the minor in the health field: the perspective of parents and pediatricians

Introducción: el modelo de respeto a la autonomía y de participación progresiva en el contexto pediátrico requiere que el pediatra que atiende al paciente menor sea capaz de evaluar y decidir si este presenta suficiente madurez y es competente para tomar una decisión sanitaria, o en qué grado participa en la misma. El objetivo es determinar la correlación entre la valoración de la madurez del menor realizada por parte de pediatras y de padres de forma subjetiva, con la realizada mediante una prueba objetiva, la Escala de Valoración de la Madurez de Lleida, MadurTest. Material y métodos: estudio prospectivo, observacional y transversal; 199 adolescentes de entre 12 y 16 años, con patología aguda y crónica. Se evaluó la madurez de los pacientes con la escala MadurTest, y los pediatras y los padres valoraron la madurez del menor con preguntas de la escala Likert para madurez. Resultados: la media de la puntuación de MadurTest fue de 6,39, presentando las niñas un nivel de madurez superior a los niños en la mayoría de las franjas de edad. La valoración de madurez por parte de los pediatras fue de 3,18 de media y por parte de los padres de 3,18. No se observa correlación entre la puntuación obtenida en el MadurTest con la valoración por parte de los profesionales ni por parte de los padres. No obstante, se observa una correlación entre las valoraciones efectuadas por los padres y los profesionales (r = 0,73; p <0,00001). Conclusiones: la madurez de los menores valorada de forma subjetiva por pediatras y padres no se correlaciona con la madurez evaluada de forma objetiva mediante el test MadurTest (AU)

Introduction: the model of respect for autonomy and progressive participation in the pediatric context requires that attending pediatricians be able to assess minor maturity, and decide the degree of participation. The objective of this study is to determine the correlation between the assessment made subjectively by paediatricians and parents, with the maturity of the minor carried out by means of an objective test, the Lleida Maturity Assessment Scale, MadurTest.Material and methods: prospective, observational and cross-sectional study. 199 adolescents between 12 and 16 years old, affected by acute and chronic pathology. The maturity of the patients was evaluated with the MadurTest scale and pediatricians and parents assessed the maturity of the minor in the form of the Likert maturity scale.Results: the mean of the MadurTest score is 6.39, girls present a higher level of maturity than boys in most age groups. The maturity assessment by pediatricians is 3.18 on average and by parents 3.18. No correlation is observed between the score obtained with the MadurTest and the assessment by professionals or by parents. However, a correlation is observed between the assessments made by parents and professionals (r = 0.73, p <0.00001)Conclusions: the maturity of minors assessed subjectively by paediatricians and parents does not correlate with the maturity assessed objectively using the MadurTest. (AU)

Spatial distribution and pollution evaluation in dry riverbeds affected by mine tailings.

The objective of this study was to evaluate the level of pollution, sources and potential risk of heavy metals (Zn, Cu, Mn, Cd, Cr, Ni, Fe and Pb) and arsenic (As) in four dry riverbeds affected by mine tailing, which drain into one of the biggest coastal lagoon of Europe (Mar Menor). El Beal, La Carrasquilla, Las Matildes and Ponce dry riverbeds sediments were sampled along its course (20, 18, 13, 19 samples were collected, respectively), and total/soluble metal(loid)s, water soluble ions, nitrogen, and organic/inorganic carbon contents were analyzed. Spatial distribution, principal component analysis (PCA), hierarchical cluster analysis (HCA), contamination factor (Cf), pollution load index (PLI) and potential ecological risk index (RI) were used to identify the possible sources of metal(loid)s and to assess the sediment pollution status. The results showed that the mean total concentrations of As, Cu, Cd, Mn, Zn and Pb exceeded the natural background levels of the study area, with the highest values located close to the mining areas. Correlation and cluster analysis identified that Cd and Zn were associated mainly with anthropogenic activities for all riverbeds, while Cr and Ni come from parent. PLI graded the four riverbeds as contaminated by heavy metals, while RI manifested that 100% of samples located in El Beal, La Carrasquilla and Las Matildes had a significantly high ecological risk. Therefore, this study suggests that mine wastes are the main source of metal(loids) contamination in the dry riverbeds, which results can be used to design actions and measures to reduce the environmental impact of metal(loid)s in the Mar Menor coastal lagoon.

Woodchip bioreactors for saline leachates denitrification can mitigate agricultural impacts in mediterranean areas: The Campo de Cartagena-Mar Menor environmental issue.

Leachates from intensive agriculture containing high nitrate have been identified as a major cause of the severe eutrophication crisis that impacts Mar Menor (SE Spain), the largest hypersaline coastal lagoon in the Mediterranean basin. A best management practice for removing NO3--N is denitrifying bioreactors. This is the first study to assess the efficiency of citrus woodchips bioreactors in treating agricultural leachates that flow to the Mar Menor via surface discharges. Denitrification capacity, woodchip degradation (by weight loss), formation of potentially harmful compounds, and greenhouse gas (GHG) emissions were assessed. Three bioreactors (6 m × 0.98 m x 1.2 m) filled with citrus woodchips (3 m3 d-1 per bioreactor) through which the untreated ditch water over 1.5 years. Bioreactors were operated at 8 h, 16 h, and 24 h hydraulic residence time respectively, in each bioreactor. The main characteristics of the ditch water were: pH ≈ 7.5-8.0, electrical conductivity ≈ 5-8 dS m-1, dissolved organic carbon ≈6-10 mg L-1, and NO3--N ≈ 22-45 mg L-1. Bioreactors were highly efficient in reducing NO3--N. The average RNO3 in effluents was for the complete experimental period 8 g N m-3 d-1, 10.9 g N m-3 d-1, and 12.6 g N m-3 d-1 for 8, 16 and 24 h residence time, respectively. Nitrate reduction efficiency was modulated by seasonal changes in temperature, with an increasing efficiency in warmer periods (maximum ≈ 85-90% for all hydraulic residence time) and decreasing in colder ones (minimum ≈ 12%, 23% and 41% for hydraulic residence time 8, 16 and 24 h respectively). Woodchips degradation was greatest during the first six months (average ≈ 29% weight loss) in the material above the water level, attributable to aerobic mineralization of the organic carbon, while weight loss was ≈11% in woodchip media continuously below the water level. Dissolved organic carbon, sulfide, ammonium, and soluble phosphorus concentrations in the effluents were mostly low, although some peaks in concentrations occurred. Design consideration must be taken to avoid environmental impacts due to the occasional presence of harmful compounds in the effluents.

Assessing the effectiveness of potential best management practices for science-informed decision support at the watershed scale: The case of the Mar Menor coastal lagoon, Spain.

Coastal lagoons are ecosystems of high environmental importance but are quite vulnerable to human activities. The continuous inflow of pollutant loads can trigger negative impacts on the ecological status of these water bodies, which is contrary to the European Green Deal. One example is the Mar Menor coastal lagoon in Spain, which has experienced significant environmental degradation in recent years due to excessive external nutrient input, especially from non-point source (NPS) pollution. Mar Menor is one of the largest coastal lagoons of the Mediterranean region and a site of great ecological and socio-economic value. In this study, the highly anthropogenic and complex watershed of Mar Menor, known as Campo de Cartagena (1244 km2), was modelled with the Soil and Water Assessment Tool (SWAT) to analyse potential options for recovery of this unique system. The model was used to simulate several best management practices (BMP) proposed by recent Mar Menor regulations, such as vegetative filter strips, shoreline buffers, contour farming, removal of illegal agriculture, crop rotation management, waterway vegetation restoration, fertiliser management and greenhouse rainwater harvesting. Sixteen scenarios of individual and combined BMPs were analysed in this study. We found that, as individual measures, vegetative filter strips and contour farming were most effective in nutrient reduction: approximately 30 % for total nitrogen (TN) and 40 % for total phosphorus (TP). Moreover, waterway vegetation restoration showed the highest sediment (S) reduction at approximately 20 %. However, the combination of BMPs demonstrated clear synergistic effects, reducing S export by 38 %, TN by 67 %, and TP by 75 %. Selecting the most appropriate BMPs to be implemented at a watershed scale requires a holistic approach considering effectiveness in reducing NPS pollution loads and BMP implementation costs. Thus, we have demonstrated a way forward for enabling science-informed decision-making when choosing strategies to control NPS contamination at the watershed scale.

The effectiveness and safety of cranial nerve block in migraine: a critical review / A eficácia e segurança do bloqueio de nervos cranianos na enxaqueca: uma revisão crítica

Cranial nerve blocks (CNBs) have been used for the acute and preventive treatment of a variety of headaches, including migraine. The effectiveness of CNBs in migraine is usually observed beyond the duration of the nerve block, possibly due to central pain modulation. The most used target is the greater occipital nerve. Other commonly targeted nerves are the lesser occipital nerve and various branches of the trigeminal nerve, including the supratrochlear, supraorbital, and auriculotemporal nerves. CNBs are generally safe and well-tolerated procedures that can be performed in either emergency or outpatient settings. There is currently no guideline standardizing CNBs in migraine. In clinical practice, as well as the few published studies, the results are encouraging, justifying further studies in the area. In the present study we critically review the literature about the safety and efficacy of CNBs in the treatment of migraine attacks and in the preventive treatment of migraine.

Bloqueios de nervos cranianos (BNCs) têm sido usados ​​para o tratamento agudo e preventivo de uma variedade de dores de cabeça, incluindo enxaqueca. A eficácia dos BNC na enxaqueca é geralmente observada além da duração do bloqueio nervoso, possivelmente devido à modulação central da dor. O alvo mais utilizado é o nervo occipital maior. Outros nervos comumente alvo são o nervo occipital menor e vários ramos do nervo trigêmeo, incluindo os nervos supratroclear, supraorbital e auriculotemporal. Os CNBs são geralmente procedimentos seguros e bem tolerados que podem ser realizados em ambientes de emergência ou ambulatoriais. Atualmente não há nenhuma diretriz padronizando BNCs na enxaqueca. Na prática clínica, assim como nos poucos estudos publicados, os resultados são animadores, justificando novos estudos na área. No presente estudo revisamos criticamente a literatura sobre a segurança e eficácia dos BNC no tratamento de crises de enxaqueca e no tratamento preventivo da enxaqueca.