RESUMEN
WHAT IS KNOWN AND OBJECTIVE: Medication is the main treatment option for patients with chronic atrial fibrillation. However, medication can have negative effects. We aimed to detect negative outcomes associated with medication that led to patients with chronic atrial fibrillation presenting themselves to hospital emergency departments. We assessed the severity of those outcomes and comment on whether they could have been avoided. METHODS: This descriptive, cross-sectional study included all patients with chronic atrial fibrillation who attended the emergency department of our tertiary hospital. We used the Dader method to identify and evaluate the negative outcomes associated with medication through interviews with patients and scrutiny of the clinical charts. RESULTS AND DISCUSSION: Of the 198 eligible patients who presented at the emergency department, 134 (67·7%) did so because of negative outcomes associated with medication (41% related to necessity, 32·1% to effectiveness and 26·9% to safety); 67·9% of those negative outcomes could have been avoided. In terms of severity, 6·7% were mild, 31·3% moderate, 51·5% severe and 10·4% fatal. The Anatomical Therapeutic Chemical Classification anatomical group most frequently associated with negative outcomes was the cardiovascular system, followed by blood/blood-forming organs. WHAT IS NEW AND CONCLUSION: A high percentage of patients with chronic atrial fibrillation presenting at hospital emergency departments had negative outcomes associated with medication. Some led to deaths. More than half of these were severe, and most could have been avoided.
Asunto(s)
Fibrilación Atrial/tratamiento farmacológico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Estudios Transversales , Femenino , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Índice de Severidad de la EnfermedadRESUMEN
Phytostabilization aims to immobilize soil contaminants using higher plants. The accumulation of trace elements in Populus alba leaves was monitored for 12 years after a mine spill. Concentrations of As and Pb significantly decreased, while concentrations of Cd and Zn did not significantly over time. Soil concentrations extracted by CaCl2 were measured by ICP-OES and results of As and Pb were below the detection limit. Long-term biomonitoring of soil contamination using poplar leaves was proven to be better suited for the study of trace elements. Plants suitable for phytostabilization must also be able to survive and reproduce in contaminated soils. Concentrations of trace elements were also measured in P. alba fruiting catkins to determine the effect on its reproduction potential. Cadmium and Zn were found to accumulate in fruiting catkins, with the transfer coefficient for Cd significantly greater than Zn. It is possible for trace elements to translocate to seed, which presents a concern for seed germination, establishment and colonization. We conclude that white poplar is a suitable tree for long-term monitoring of soil contaminated with Cd and Zn, and for phytostabilization in riparian habitats, although some caution should be taken with the possible effects on the food web. Supplemental materials are available for this article. Go to the publisher's online edition of International Journal of Phytoremediation to view the supplemental file.
Asunto(s)
Monitoreo del Ambiente/métodos , Populus/metabolismo , Contaminantes del Suelo/metabolismo , Oligoelementos/metabolismo , Arsénico/análisis , Arsénico/metabolismo , Biodegradación Ambiental , Transporte Biológico , Cadmio/análisis , Cadmio/metabolismo , Contaminación Ambiental , Frutas/crecimiento & desarrollo , Frutas/metabolismo , Frutas/fisiología , Plomo/análisis , Plomo/metabolismo , Minería , Hojas de la Planta/crecimiento & desarrollo , Hojas de la Planta/metabolismo , Hojas de la Planta/fisiología , Populus/crecimiento & desarrollo , Populus/fisiología , Reproducción , Suelo/química , Contaminantes del Suelo/análisis , Oligoelementos/análisis , Árboles , Zinc/análisis , Zinc/metabolismoRESUMEN
The financial sustainability of public health systems (PHS) is currently threatened by population growth, increased prevalence of chronic conditions and disabilities, inequality in access and use of resources, zero cost delivery and global economic crisis. The emergency department (ED) is one for which demand is highest--without relation to the health model--because disease becomes established in disadvantaged socio-demographic areas and inequalities, hyperconsumption and decision making more closely linked to the user are maintained. The medical device of ED is a multiple one and its diverse product lines make it difficult to measure. This review discusses the need to deploy measurement tools in ED, where there are high direct costs--primarily structural--and other variables related to the activity, where the marginal cost is higher than the average and there is no economy of scale in such interventions. The possible mechanisms of private copayment in financing the supply of EDs are also studied, showing their advantages and disadvantages, with the conclusion that they are not recommendable--due to their scarce fund raising and deterrent capacity, which is why fundamental strategic changes in the management of these resources are needed.
Asunto(s)
Servicio de Urgencia en Hospital/economía , Servicio de Urgencia en Hospital/normas , Servicio de Urgencia en Hospital/organización & administración , Humanos , Justicia SocialRESUMEN
públicos (SSP) está amenazada por el crecimientopoblacional, la mayor prevalencia de procesos crónicosy discapacidades, la inequidad residual en el acceso yutilización de los recursos, el coste nulo en la prestacióny la crisis económica mundial.Los servicios de Urgencias y Emergencias (SUE)son uno de los más demandados sin relación con elmodelo de salud porque la enfermedad asienta enáreas sociodemográficas menos favorecidas, se mantieneninequidad, hiperconsumo y capacidad de decisiónmás ligada al usuario. El producto sanitario de los SUEes múltiple y con líneas de producción diversas quedificultan su medición. En esta revisión se analiza lanecesidad de implantar herramientas de medida en losSUE, donde existen altos costes directos fundamentalmenteestructurales y otros variables relacionadoscon la actividad, donde el coste marginal es superior almedio y sin economía de escala en estas intervenciones.Se estudian, asimismo, los posibles mecanismos decoparticipación privada en la financiación de la ofertade los SUE, se muestran sus ventajas e inconvenientesy se concluye que no son recomendables por su escasacapacidad recaudadora y disuasoria por lo queson necesarios cambios estratégicos fundamentales enla gestión de estos recursos(AU)
The financial sustainability of public health systems(PHS) is currently threatened by populationgrowth, increased prevalence of chronic conditions anddisabilities, inequality in access and use of resources,zero cost delivery and global economic crisis.The emergency department (ED) is one for whichdemand is highest without relation to the health model because disease becomes established in disadvantagedsocio-demographic areas and inequalities, hyperconsumptionand decision making more closely linkedto the user are maintained. The medical device of EDis a multiple one and its diverse product lines make itdifficult to measure.This review discusses the need to deploy measurementtools in ED, where there are high direct costs primarily structural and other variables related tothe activity, where the marginal cost is higher than theaverage and there is no economy of scale in such interventions.The possible mechanisms of private copaymentin financing the supply of EDs are also studied,showing their advantages and disadvantages, with theconclusion that they are not recommendable due totheir scarce fund raising and deterrent capacity, whichis why fundamental strategic changes in the managementof these resources are needed(AU)
Asunto(s)
Humanos , Medicina de Emergencia/economía , Medicina de Desastres/economía , Manejo de Atención al Paciente/organización & administración , Equidad en el Acceso a los Servicios de Salud , Accesibilidad a los Servicios de Salud , 34002RESUMEN
Pasture established on polluted soil may pose a risk to grazing livestock creating a requirement for mechanical management which may affect biodiversity and expend energy. The risk associated with managing pasture by grazing horses (non-edible livestock) is being assessed in the Guadiamar Valley (SW Spain), where soils are polluted with trace elements following a major pollution incident. Soil pollution does not affect biomass production or floristic composition of pasture, although both variables influence trace element accumulation in herbage. Element concentrations in herbage are below maximum tolerable limits for horses. Faecal analysis showed regulated absorption of essential elements, while non-essential elements seemed preferentially excreted. Elemental content of horse hair did not differ in animals from polluted and control pastures. If pastures are managed by grazing, periodic monitoring is recommended in view of the long-term chronic trace element exposure in these systems.
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Heces/química , Cabello/química , Caballos , Metales Pesados/análisis , Plantas/química , Contaminantes del Suelo/análisis , Crianza de Animales Domésticos/métodos , Animales , Biomasa , Modelos Lineales , Análisis de Componente Principal , Estaciones del Año , EspañaRESUMEN
The Domingo Rubio tidal channel (Palos de la Frontera, Huelva, Spain) is an estuary located in the mouth of the Tinto River. The estuary is affected by different sources of pollution (waters of the Tinto River, contaminated with trace elements from the Iberian Pyrite belt, and effluent from the Huelva chemical industrial area). Soil and the most frequent plant species were collected in 2004 and 2006 at six different locations on the estuary. In general, N-Kjedahl, Total Organic Carbon values, salinity and contamination (total trace elements up to 1,000 mg kg(-1) As, 6 mg kg(-1) Cd, 2,500 mg kg(-1) Cu, 1,900 mg kg(-1) Pb and 1,300 mg kg(-1) Zn) tended to increase downstream of the tidal channel. Soil biochemical properties were not negatively affected either by the high salinity or by trace element contamination. Despite the high values of the trace elements, analysed plant samples showed that Cu was the only metal that could be a serious risk for the food chain.
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Contaminantes Atmosféricos/análisis , Contaminantes Atmosféricos/farmacocinética , Plantas/metabolismo , Contaminantes del Suelo/análisis , Contaminantes del Suelo/farmacocinética , Arsénico/análisis , Arsénico/farmacocinética , Disponibilidad Biológica , Monitoreo del Ambiente , Estuarios , Metales Pesados/análisis , Metales Pesados/farmacocinética , Estaciones del Año , Suelo/química , Microbiología del Suelo , España , Especificidad de la Especie , Espectrofotometría Atómica , Oligoelementos/análisis , Oligoelementos/farmacocinéticaRESUMEN
In this study, the effect of a partial substitution of peat for compost on the growth and nutrition of a native shrub (Pistacia lentiscus L.) was tested. Composts were prepared from pruning and municipal solid wastes or pruning waste and sewage sludge. For preparing growing media each compost was added at a rate of 40%, fresh pine bark at 20% or 40% and peat at 20%, 40% or 60%. Aqueous extracts from the substrates did not impair germination of cress (germination bioassay). In relation to plants growing in peat-based substrate (used as a control), plants of the compost-based substrates reached better growth and nutrition, especially when using the sewage sludge-based compost, and the P uptake was notably enhanced. The concentrations of trace elements were far lower than the ranges considered phytotoxic for vascular plants. Detrimental effect derived from using fresh pine bark was not observed.
Asunto(s)
Pistacia/metabolismo , Eliminación de Residuos/métodos , Eliminación de Residuos Líquidos/métodos , Bioensayo , Biomasa , Modelos Estadísticos , Pinus , Hojas de la Planta/metabolismo , Raíces de Plantas/metabolismo , Aguas del Alcantarillado , Suelo , Oligoelementos/análisisRESUMEN
The Aznalcóllar accident (28th April 1998) occurred because the collapse of the tailing-dam dike of the Aznalcóllar-Los Frailes mines. Soils were affected by a slurry of acidic water loaded with trace elements, finely divided metal sulphides, and materials used in the refining /floating process. Studies carried out before and after the soil restoration activities (sludge removal, amending, tilling, and afforestation) showed severe trace-element contamination (mainly As, Cd, Cu, Pb, Tl and Zn) in the superficial layer of the sludge-affected soils. Despite Hg being an important component of the Los Frailes ore and therefore of the contaminant sludge, data on Hg content of sludge-affected soils are scarce and sometimes controversial. The aim of this study was to determine the effect of the spill and of restoration measures on the Hg content of soils and how this related to other elements. Concentration of Hg immediately after the spill was 8-fold above background (0.061+/-0.012 mg kg(-1); mean+/-SD) at the surface (0-5 cm) and 3-4-fold greater in deeper layers (0-20; 0-50 cm). After the remediation measures, mean values of Hg and other elements (As, Cd, Cu, Pb and Zn) were very variable and remained above background values. These anomalies are due to the sludge left on the soil surface or buried during restoration operations, resulting in an irregular distribution of trace elements. The highest values for the less mobile elements (up to 176 mg kg(-1) As, 2.36 mg kg(-1) Hg and 1556 mg kg(-1) Pb) were observed in the area 1 km downstream of the tailings dam.
Asunto(s)
Mercurio/análisis , Minería , Aguas del Alcantarillado/análisis , Contaminantes del Suelo/análisis , Análisis de Componente Principal , España , Espectrofotometría AtómicaRESUMEN
OBJECTIVE: To evaluate the long-term stability of International Classification of Diseases-10th revision bipolar affective disorder (BD) in multiple settings. METHOD: A total of 34 368 patients received psychiatric care in the catchment area of a Spanish hospital (1992-2004). The analyzed sample included patients aged > or =18 years who were assessed on > or =10 occasions and received a diagnosis of BD at least once (n = 1153; 71,543 assessments). Prospective and retrospective consistencies and the proportion of subjects who received a BD diagnosis in > or =75% of assessments were calculated. Factors related to diagnostic shift were analyzed with traditional statistical methods and Markov's models. RESULTS: Thirty per cent of patients received a BD diagnosis in the first assessment and 38% in the last assessment. Prospective and retrospective consistencies were 49% and 38%. Twenty-three per cent of patients received a BD diagnosis during > or =75% of the assessments. CONCLUSION: There was a high prevalence of misdiagnosis and diagnostic shift from other psychiatric disorders to BD. Temporal consistency was lower than in other studies.
Asunto(s)
Trastorno Bipolar/diagnóstico , Pautas de la Práctica en Medicina , Adolescente , Adulto , Trastorno Bipolar/psicología , Estudios de Cohortes , Diagnóstico Diferencial , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Estudios ProspectivosRESUMEN
Thallium is a scarce, highly toxic element. There are several investigations that report Tl accumulation in plants of the family Brassicaceae. These plants could pose a risk in areas where Tl is present at higher concentrations than normal soils. The present study reports analyses of two wild Brassicaceae, Hirschfeldia incana and Diplotaxis catholica, growing spontaneously at five sampling sites moderately polluted with Tl and other trace elements in the Green Corridor of the Guadiamar river, Seville, S. Spain. In general, trace element content was unremarkable in all part plants, despite the concentrations present in soil. Thallium was the only element whose concentration in both plant species was above normal for plants (maximum values of 5.00 mgkg(-1) in H. incana flowers). There were significant positive correlations between total Tl in soil and Tl in both plant species. Transfer Coefficients (TC) for all elements were, in general, <1 for both species, except for Tl in flowers and fruits at some sites. The highest Enrichment Factor (EF) was found for Tl in H. incana fruits (EF = 607) and D. catholica flowers (EF = 321). H. incana was studied in a previous growing season (2004) in the same area, although the rainfall was 3 times more than in the year of the present study (2005), giving a maximum Tl content of 46.5 mgkg(-1) in H. incana flowers. The data presented here show that Tl content of plants growing in semi-arid conditions can be significantly influenced by precipitation. In dry years, plant Tl accumulation may be significantly reduced.
Asunto(s)
Brassicaceae/química , Contaminantes del Suelo/análisis , Suelo/análisis , Talio/análisis , Oligoelementos/análisis , Brassicaceae/crecimiento & desarrollo , Brassicaceae/metabolismo , Monitoreo del Ambiente/métodos , Flores/química , Flores/metabolismo , Metales Pesados/análisis , Lluvia , Contaminación del Agua/análisisRESUMEN
Objetivo: Describir los problemas relacionados con los medicamentosen pacientes ingresados en el área de observación deurgencias y evitabilidad.Método: Estudio descriptivo transversal, aleatorizado en elárea de observación del servicio de urgencias general de un hospitalde tercer nivel durante 3 meses en 125 pacientes para detectarproblemas relacionados con los medicamentos (PRM). Se usó elmétodo Dáder adaptado a hospital.Resultados: Se obtuvo un promedio de 0,94 PRM por paciente.Los PRM principales (PRMp) supusieron el 50% del total dePRM. El 69,50% de los PRM fueron evitables. El 44% moderados,38% leves y 18%, resultaron graves. El 54,4% de los pacientes estudiadosingresaron, de los cuales el 25% fueron originados por unPRMp, esto equivale al 50% de todos los pacientes con PRMp.Conclusiones: Una parte importante de los pacientes queingresan en el área de observación lo hace como consecuencia deun PRM
Objective: The therapeutic armamentarium of developedcountries has experienced a great advance; however, increaseddrug therapy not only provides benefits, as the inappropriate useof drugs results in relevant consequences for patients.Method: A 3-month, descriptive, cross-sectional, randomizedstudy in 125 patients seen at the emergency department observationarea of a third-level hospital to identify drug-related problems(DRPs). A hospital adaptation of Dader's method was used.Results: A mean of 0.94 DRPs per patient was obtained.Major DRPs (mDRPs) represented 50% of all DRPs; 69.50% ofDRPs were avoidable; 44% were moderate, 38% mild, and 18%serious; 54.4% of patients were admitted to hospital, which originatedin a mDRP in 25% of cases - this represents 50% of allpatients with a mDRP.Conclusions: A significant portion of patients admitted to theobservation area present there as a result of a DRP
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Humanos , Utilización de Medicamentos/estadística & datos numéricos , /epidemiología , Sistemas de Registro de Reacción Adversa a Medicamentos/organización & administración , Epidemiología Descriptiva , Servicio de Urgencia en Hospital/estadística & datos numéricosRESUMEN
In this paper, we surveyed the concentration of nine trace elements (As, Cd, Cu, Fe, Mn, Ni, Pb, Tl and Zn) in bermudagrass (Cynodon dactylon) 3 years after the mine spill in Aznalcóllar (south Spain). The results were compared with those that had been obtained for the same species in a previous study, 18 months after the accident. Three types of soil condition were determined: i) unaffected soils (UN, control); ii) cleaned up and amended soils (A, amended); and (iii) non-amended soils, inaccessible to the clean-up and remediation operations (NA, non-amended). The trace element concentrations in the plants were lower than those reported in the first sampling for both washed (plant tissues) and unwashed plants (as consumed by herbivores). Apart from Cd, trace elements concentrations (plant tissues) were similar in the A and the UN soils. In the NA soils, the Cd, Fe, Mn, Zn and Pb levels in unwashed plants were excessive for animal consumption. This wild grass seems to be suitable as a soil stabilizer for spill affected soils and as a biomonitor for soil pollution by some trace elements (As, Cu and Zn); however, its potential for phytoextraction is negligible.
Asunto(s)
Cynodon/crecimiento & desarrollo , Monitoreo del Ambiente/métodos , Minería , Contaminantes del Suelo/análisis , Oligoelementos/análisis , Biodegradación Ambiental , Cynodon/metabolismo , Minería/normas , EspañaRESUMEN
The collapse of a pyrite-mining, tailing dam on 1998 contaminated an area of 4286 ha along the Agrio and Guadiamar river valleys in southern Spain. Over 2700 ha of the Doñana marshes, an important wintering area for wetland European birds, were contaminated. This study reports analyses of the tubers of Scirpus maritimus (an important food for greylag geese, Anser anser) collected in 2000 in the "Entremuros" (spill-affected area) and in nearby unaffected Doñana marshes (control areas). In the spill-affected area mean tuber tissue concentrations of Cd (0.25 mg kg-1) and Zn (61 mg kg-1) were greater than in those tubers from the control area (0.02 mg kg-1 for Cd, and 22 mg kg-1 for Zn); values of Cd and Zn in "Entremuros" (samples collected two years after the mine spill) were much smaller than those reported only a few months after the accident. Trace elements (As, Fe, Mn and Tl, and to a lesser extent Cd and Pb) showed a preferential accumulation in the outer skin of tubers. Surprisingly, concentrations of As and Fe were greater in tubers from some marsh sites not affected by the mine-spill than in tubers from the "Entremuros". We suggest that relic river channels within the Doñana marshes may be contaminated by trace elements from historic mining activities. An exhaustive study of macrophytes and other plant species in this area is recommended to identify potential risks to wildlife.
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Arsénico/análisis , Cadmio/análisis , Cyperaceae/química , Contaminantes del Suelo/análisis , Contaminación Química del Agua/análisis , Animales , Arsénico/efectos adversos , Cadmio/efectos adversos , Desastres , Monitoreo del Ambiente , Plomo/efectos adversos , Plomo/análisis , Minería , Medición de Riesgo , Contaminantes del Suelo/efectos adversos , España , Oligoelementos/efectos adversos , Oligoelementos/análisis , Contaminación Química del Agua/efectos adversosRESUMEN
The failure of a tailing pond dam at the Aznalcóllar pyrite mine (SW Spain) in April 1998 released a toxic spill affecting approximately 4300 ha along the Agrio and Guadiamar valleys. Two years later, we have studied yield and concentration of mineral nutrients and trace elements in sunflower plants grown in the spill-affected soil, and in an adjacent unaffected soil as comparison. The study has been carried out in plants at seedling (V4) and mature (R8) stages. Shoot and root biomass of sunflower seedlings was significantly smaller in the affected soil than in the unaffected soil, but there was no significant difference at the mature stage. Oil production was greater in the spill-affected plants. We have not detected any 'fertilising' effect caused by the acid waters of the spill on the main nutrient (N, P and Ca) acquisition, as documented in 1998 for sunflower plants flooded by the spill. Sunflower plants growing in the spill-affected soil reached adequate levels of nutrients. None of the trace elements measured-As, Cd, Cu, Pb and Tl-reached levels either phytotoxic or toxic for humans or animals in seeds and the above-ground part of the spill-affected plants. We evaluate the potential use of sunflower plants for phytoremediation. The potential for phytoextraction is very low; however, it may be used for soil conservation. The production of oil (usable for industrial purposes) may add some value to this crop.
Asunto(s)
Helianthus/crecimiento & desarrollo , Metales Pesados/farmacocinética , Minería , Contaminantes del Suelo/efectos adversos , Oligoelementos/farmacocinética , Biodegradación Ambiental , Biomasa , Calcio/farmacocinética , Contaminación Ambiental/prevención & control , Helianthus/química , Hierro , Nitrógeno/farmacocinética , Fósforo/farmacocinética , SulfurosRESUMEN
The collapse of the tailing dam in the Aznalcóllar pyrite mine (SW Spain) occurred in April 1998 and affected approximately 4300 ha along the Agrio and Guadiamar valleys. An urgent soil cleaning up and remediation programme was started just after the accident. Eighteen months later, mineral nutrients and trace elements concentration in soil and two wild grasses--Cynodon dactylon and Sorghum halepense--have been studied. Three types of conditions are distinguished: (a) unaffected soils (control); (b) cleaned up and remediated soils (remediated); and (c) sludge-covered soils left in a fenced plot (non-remediated). As, Cd, Cu and Pb in grasses reached toxic levels for the food web in the non-remediated plot, while on remediated soils only Cd reached a toxic level in grass tissues. However, Pb and, to a lesser extent As and Fe, reached also toxic levels in unwashed plants (as they would be ingested by animals) in remediated soils. Both native grasses seem tolerant of trace elements pollution and suitable for stabilisation of spill-affected soils.
Asunto(s)
Metales Pesados/análisis , Minería , Poaceae/química , Contaminantes del Suelo/análisis , Monitoreo del Ambiente , Residuos Peligrosos , Metales Pesados/farmacocinética , Contaminantes del Suelo/farmacocinética , EspañaRESUMEN
El abuso y dependencia del alcohol son, con mucha diferencia, los trastornos más comunes relacionados con las sustancias. Las terapias que se centran en las razones por las cuales una persona bebe son mucho más efectivas que aquellas que giran en torno a cuestiones psicodinámicas más vagas. El núcleo es siempre la situación en la cual el paciente bebe, la motivación y las posibles vías alternativas para hacer frente a estas situaciones. El Acamprosato puede ser de utilidad en el control del ansia de alcohol (AU)
Asunto(s)
Adulto , Femenino , Masculino , Humanos , Terapia Combinada/métodos , Terapia Combinada/psicología , Consumo de Bebidas Alcohólicas/psicología , Consumo de Bebidas Alcohólicas/terapia , Psicoterapia/métodos , Terapia Familiar/métodos , Recurrencia , Psicoterapia de Grupo/métodos , Alcoholismo/psicología , Alcoholismo/tratamiento farmacológico , Disulfiram/administración & dosificación , Naltrexona/administración & dosificación , Trastornos Relacionados con Sustancias/psicología , Psicoterapia/organización & administración , Psicoterapia/tendencias , Receptores de GABA , Síndrome de Abstinencia a Sustancias/tratamiento farmacológico , Síndrome de Abstinencia a Sustancias/psicología , Ensayos Clínicos Controlados como Asunto/métodos , Placebos/administración & dosificaciónRESUMEN
El Eritema multiforme es una dermatosis aguda, reaccional, de naturaleza inmunológica que aparece como respuesta a múltiples causas, fundamentalmente infecciosas y farmacológicas. Existe una forma minor, con sus variedades eritematopapulosa y vesiculoampollosa, y otra forma major, también denominada Síndrome de Stevens-Johnson. Desde sus primeras descripciones hasta nuestros días ambos procesos han sido considerados alternativamente entidades independientes o distintas facetas de una misma enfermedad. La tendencia actual es considerarlas, de nuevo, enfermedades diferentes. Los autores presentan un caso de Eritema multiforme minor que consideran de interés por la disparidad de criterios existentes con respecto a su ubicación como entidad clínica, asociado o no al Síndrome de Stevens-Johnson (AU)
Asunto(s)
Femenino , Preescolar , Humanos , Eritema Multiforme/diagnóstico , Eritema Multiforme/etiología , Eritema Multiforme/patologíaRESUMEN
Total heavy metal concentrations were determined in soil samples of seven selected areas along the Guadiamar river valley affected by the toxic flood, after removal of the deposited sludge. Mean total concentrations of nine elements (As, Au, Bi, Cd, Cu, Pb, Sb, Tl and Zn) out of the 23 (As, Au, Ba, Be, Bi, Cd, Co, Cr, Cu, In, Mn, Mo, Ni, Pb, Sb, Sc, Sn, Th, Tl, U, V, Y and Zn) analysed were higher in sludge-covered soils than in unaffected soils. Mean values of total As, Au, Pb, Sb, Tl and Zn in sludge-affected soils were higher than the upper limits for normal soils world-wide. Mean concentrations of Bi, Cd and Cu were within these ranges, although some individual values exceeded the upper limits. In all sampling areas, severe heavy metal pollution was observed in the superficial layers (0-20 cm) of most of the affected soils, which decreased downward in the soil profile. Generally, in soils with more than 25% of clay, concentration of heavy metals below the 20-cm depth decreased to values close to those of the background level of the Guadiamar valley soils, while in coarser soils, heavy metal pollution penetrated below this depth, being noticeable down to a depth of at least 50-80 cm.