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Despite the fact that the first red tide reported on the coasts of the Iberian Peninsula was due to Lingulodinium polyedra , knowledge about their frequency and, particularly, about the environmental conditions contributing to bloom initiation is still scarce. For this reason, L. polyedra bloom episodes were observed and studied in three Galician rias during the summer season based on the 1993-2008 record database period; additionally, samples were collected in summer 2008. Proliferations of L. polyedra occurred in the rias of Ares and Barqueiro in June and August, respectively, while in the Ria of Coruña, they persisted from the end of June to early September. Red tides developed when the surface temperature reached 17 °C, with "seasonal thermal window" conditions, and when salinities were ≥30, i.e., an "optimal salinity window"; when these parameters were lower than these thresholds, cyst germination decreased. A cyst transport mechanism from sediments to the surface must also exist; this mechanism was found to be natural (tidal currents) in the ria of Barqueiro or anthropogenic (dredging) in the rias of Ares and Coruña. Surface temperatures during summer were usually favorable for cyst germination (85 to 100%) during the 1993-2008 period; however, water temperatures below 10 m depth only rarely reached the 17 °C threshold (2 to 18%). During this 16-year period, dredging activities could explain 71% (Coruña) and 44% (Ares) of the recorded bloom events. When a bloom episode developed in early summer, favorable conditions did not lead to a new red tide, probably due to the lag period required by cysts for germination. Moreover, blooms did not develop when high densities of diatoms (>1,000,000 cells·L -1 ) remained in the water column as a result of summer upwelling pulses occurring in specific years. The temperature-sediment disturbance pattern found in this study provides a useful tool for the prevention of eventual risks resulting from red tides of this dinoflagellate., Competing Interests: The authors declare no conflicts of interest.

Introduction: Although alcohol cessation is the only effective treatment for alcohol-related liver disease, few data exist concerning its influence on the risk of hepatocellular carcinoma (HCC). We aimed to evaluate the effect of alcohol abstinence on the incidence of HCC in patients with alcohol-related cirrhosis., Methods: We studied 727 patients with alcohol-related cirrhosis (247 with compensated disease and 480 with previous decompensation) who were included in a surveillance program for the early detection of HCC and prospectively followed. Baseline clinical and biological parameters and alcohol consumption during follow-up were recorded. Abstinence was defined as the absence of any alcohol use., Results: During follow-up (median 54 months), 354 patients (48.7%) remained abstinent and 104 developed HCC (2.3 per 100 person-years). Factors independently associated with the risk of HCC among patients with previous decompensation were age, male gender, and aspartate aminotransferase, whereas abstinence was not linked to a reduced risk (hazard ratio 0.95; 95% confidence interval 0.59-1.52). However, among patients without previous decompensation, prothrombin activity and abstinence were independently associated with the risk of HCC. Abstinent patients had a significant decrease in the risk of developing tumor (hazard ratio 0.35; 95% confidence interval 0.13-0.94). These results did not change after applying a competing risk analysis where death and liver transplantation were considered as competing events., Discussion: Alcohol abstinence reduced the risk of HCC in patients with alcohol-related cirrhosis, but only in those without a history of decompensated disease. This finding emphasizes the need for an early diagnosis of alcohol-related liver disease and for implementing strategies leading to an increase in the rate of achieving and maintaining abstinence among this population., (Copyright © 2021 by The American College of Gastroenterology.)

Background and Objectives: There are limited information on outcome, complications and treatments of critically ill COVID-19 patients requiring admission to an intensive care unit (ICU). The aim of this study is to describe the clinical ICU course, treatments used, complications and outcomes, of critically ill COVID-19 patients admitted in seven ICU in Galicia region during the 2020 March-April pandemic peak., Methods: Between March 21 and April 19, 2020, we evaluated critically ill COVID-19 patients admitted to the ICU of Anesthesia of seven hospitals in Galicia, northwestern Spain. Outcome, complications, and treatments were monitored until May 6, 2020, the final date of follow-up., Results: A total of 97 critically ill COVID-19 patients were included. During ICU stay, mechanical ventilation became necessary in 80 (82.5%) patients, and tracheostomy in 22 (22.7%) patients. Prone position was used frequently in both intubated (67.5%) and awake (27.8%) patients. Medications consisted of antivirals agents (92.7%), corticosteroids (93.8%), tocilizumab (57.7%), and intermediate or high doses of anticoagulants (83.5%). The most frequent complications were ICU-acquired infection (52.6%), thrombosis events (16.5%), and reintubation (9.3%). After a median follow-up of 42 (34-45) days, 15 patients (15.5%) deceased, 73 patients (75.2%) had been discharged from ICU, and nine patients (9.3%) were still in the ICU., Conclusions: A high proportion of our critically ill COVID-19 patients required mechanical ventilation, prone positioning, antiviral medication, corticosteroids, and anticoagulants. ICU complications were frequent, mainly infections and thrombotic events. We had a relatively low mortality of 15,5%., (Copyright © 2020 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Chronic obstructive pulmonary disease (COPD) is the fourth cause of death in western countries. Its final stage has clearly been forgotten by medical research in recent years. There exists consensus regarding the need to integrate palliative care in assisting these patients, but the difficulty in establishing a prognosis for the disease, establishing limits for life support measures, the lack of information about the disease's natural course and ignorance as to the most effective health-care structure for these patients' palliative treatment may be responsible for their late inclusion or non-inclusion in specific programmes. The main purpose of this work is to find out the natural background of patients with stage IV COPD and the main prognostic factors that influence these patients' survival., Methods/design: Prospective observational study of a home patient cohort with stage IV COPD sent from Neumology consultations and Palliative Care Unit in La Paz Hospital in Madrid and Primary Care Health Centres in the area to the palliative care home support team. The goal is to study socio-demographic variables, prognosis, nutritional status, use of health resources, perceived quality of life, functionality, main symptomatology, use and effectiveness of opioids, adherence to treatment, prognostic information regarding the disease, information given by professionals, advance directives, social backup requirements and overburden level of the main caregiver., Discussion: The HOLD study is a project aimed at finding out the prognostic factors and evolution of the disease COPD in its most advanced stage. The final goal is to improve the health and quality of life, in a personalised, integral way up to end of life and explore and foster communication with patients, as well as their participation and collaboration in decision-taking. The HOLD study can help us better understand what these patients' real palliative and care needs are, in order to more efficiently organise their treatment at end of life.

Phytoplankton is a sentinel of marine ecosystem change. Composed by many species with different life-history strategies, it rapidly responds to environment changes. An analysis of the abundance of 54 phytoplankton species in Galicia (NW Spain) between 1989 and 2008 to determine the main components of temporal variability in relation to climate and upwelling showed that most of this variability was stochastic, as seasonality and long term trends contributed to relatively small fractions of the series. In general, trends appeared as non linear, and species clustered in 4 groups according to the trend pattern but there was no defined pattern for diatoms, dinoflagellates or other groups. While, in general, total abundance increased, no clear trend was found for 23 species, 14 species decreased, 4 species increased during the early 1990s, and only 13 species showed a general increase through the series. In contrast, series of local environmental conditions (temperature, stratification, nutrients) and climate-related variables (atmospheric pressure indices, upwelling winds) showed a high fraction of their variability in deterministic seasonality and trends. As a result, each species responded independently to environmental and climate variability, measured by generalized additive models. Most species showed a positive relationship with nutrient concentrations but only a few showed a direct relationship with stratification and upwelling. Climate variables had only measurable effects on some species but no common response emerged. Because its adaptation to frequent disturbances, phytoplankton communities in upwelling ecosystems appear less sensitive to changes in regional climate than other communities characterized by short and well defined productive periods., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Nonlinear methods have been applied to the analysis of biological signals. Complexity analysis of glucose time series may be a useful tool for the study of the initial phases of glucoregulatory dysfunction. This observational, cross-sectional study was performed in patients with essential hypertension. Glucose complexity was measured with detrended fluctuation analysis (DFA), and glucose variability was measured by the mean amplitudes of glycemic excursion (MAGE). We included 91 patients with a mean age of 59 ± 10 years. We found significant correlations for the number of metabolic syndrome (MS)-defining criteria with DFA (r = 0.233, P = .026) and MAGE (r = 0.396, P < .0001). DFA differed significantly between patients who complied with MS and those who did not (1.44 vs. 1.39, P = .018). The MAGE (f = 5.3, P = .006), diastolic blood pressures (f = 4.1, P = .018), and homeostasis model assessment indices (f = 4.2, P = .018) differed between the DFA tertiles. Multivariate analysis revealed that the only independent determinants of the DFA values were MAGE (β coefficient = 0.002, 95% confidence interval: 0.001-0.004, P = .001) and abdominal circumference (β coefficient = 0.002, 95% confidence interval: 0.000015-0.004, P = .048). In our population, DFA was associated with MS and a number of MS criteria. Complexity analysis seemed to be capable of detecting differences in variables that are arguably related to the risk of the development of type 2 diabetes., (Copyright © 2014 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.)

Behçet's disease is an inflammatory multisystemic chronic disease that progresses by outbreaks. It is more common in Asia and countries in the eastern Mediterranean basin (Silk Route). In Spain the prevalence is between 5 and 10 cases per 100,000 inhabitants. It is a difficult disease to diagnose because of the multiple and varied clinical manifestations, and because there are not pathognomonic laboratory tests available. The delay in the diagnosis, which is frequent in countries of low prevalence like Spain, increases the morbidity and the mortality of patients with Behçtis disease.

Using a decision-making and treatment checklist developed to facilitate the at-home palliative sedation process, we assessed the incidence and efficacy of palliative sedation for end-of-life cancer patients with intractable symptoms who died at home. We retrospectively reviewed the medical records of 370 patients who were followed by a palliative home care team. Twenty-nine of 245 patients (12%) who died at home had received palliative sedation. The mean age of the patients who received palliative sedation was 58 +/- 17 years, and the mean age of the patients who did not receive palliative sedation was 69 +/- 15 years (p = 0.002). No other differences were detected between patients who did or did not receive palliative sedation. The most common indications for palliative sedation were delirium (62%) and dyspnea (14%). Twenty-seven patients (93%) received midazolam for palliative sedation (final mean dose of 74 mg), and two (7%) received levomepromazine (final mean dose of 125 mg). The mean time between palliative sedation initiation and time of death was 2.6 days. In 13 of the cases (45%), the palliative sedation decision was made with the patient and his or her family members, and in another 13 patients (45%), the palliative sedation decision was made only with the patient's family members. We concluded that palliative sedation may be used safely and efficaciously to treat dying cancer patients with refractory symptoms at home.

Objective: To investigate glycemic dynamics and its relation with mortality in critically ill patients. We searched for differences in complexity of the glycemic profile between survivors and nonsurvivors in patients admitted to a multidisciplinary intensive care unit., Design: Prospective, observational study, convenience sample., Settings: Multidisciplinary intensive care unit of a teaching hospital in Madrid, Spain., Patients: A convenience sample of 42 patients, aged 29 to 86 yrs, admitted to an intensive care unit with an Acute Physiology and Chronic Health Evaluation II score of >or=14 and with an anticipated intensive care unit stay of >72 hrs., Interventions: A continuous glucose monitoring system was used to measure subcutaneous interstitial fluid glucose levels every 5 mins for 48 hrs during the first days of intensive care unit stay. A 24-hr period (n = 288 measurements) was used as time series for complexity analysis of the glycemic profile., Measurements: Complexity of the glycemic profile was evaluated by means of detrended fluctuation analysis. Other conventional measurements of variability (range, sd, and Mean Amplitude of Glycemic Excursions) were also calculated., Main Results: Ten patients died during their intensive care unit stay. Glycemic profile was significantly more complex (lower detrended fluctuation analysis) in survivors (mean detrended fluctuation analysis, 1.49; 95% confidence interval, 1.44-1.53) than in nonsurvivors (1.60; 95% confidence interval, 1.52-1.68). This difference persisted after accounting for the presence of diabetes. In a logistic regression model, the odds ratio for death was 2.18 for every 0.1 change in detrended fluctuation analysis.Age, gender, Simplified Acute Physiologic Score 3 or Acute Physiologic and Chronic Health Evaluation II scores failed to explain differences in survivorship. Conventional variability measurements did not differ between survivors and nonsurvivors., Conclusions: Complexity of the glycemic profile of critically ill patients varies significantly between survivors and nonsurvivors. Loss of complexity in glycemia time series, evaluated by detrended fluctuation analysis, is associated with higher mortality.

The social losses arising from the Prestige oil spill exceed the compensation granted under the IOPC (International Oil Pollution Compensation) system, with losses estimated at 15 times more than the applicable limit of compensations. This is far above the level of costs for which those responsible for hydrocarbons spills are liable. The highest market losses correspond to sectors of extraction, elaboration and commercialisation of seafood. However, damages to non-commercial natural resources could constitute an outstanding group of losses for which further primary data are needed: these losses would only be compensable under the current system by means of a refund for cleaning and restoration costs. Results show that, in Europe, the responsibility for oil spills in maritime transport is limited and unclear. The consequence of this is net social losses from recurrent oil spills and internationally accepted incentives for risky strategies in the marine transport of hydrocarbons.

Background and Objective: Describe the evolution of prescription opioids from 2002 to 2006 in Primary Health Care Area 2 and 5 in the Madrid Community and its referral hospitals (University Hospitals of la Princesa and La Paz)., Materials and Methods: A retrospective observational study of prescriptions made by calculating defined daily doses per million inhabitants., Results: In Primary Care, transdermal fentanyl (78.39% of the total in 2006 in area 2 and 76.69% in the area 5) is the opioid prescribed most on the third step on the WHO analgesic ladder. This is followed by buprenofin (12.30% and 13.23%) and morphine (6.94% and 8.45%). As for the second step, tramadol is the most prescribed opioid with 85.12% and 83.56% of total consumption. We see a growth in consumption in the third step that goes from a defined daily doses per one million inhabitants of 897.67 in 2003 in area 5 and 1056.42 in area 2 to 1490.15 and 1601.48, respectively in 2006 and the second step goes from 1545.25 and 1629.94 in 2003 to 1904.70 and 1730.66 in both areas in 2006. In the hospitals analyzed, there is a similar progression, with a gradual increase in the use of fentanyl and a trend towards reduction in the consumption of morphine., Conclusions: Our data reflect the increase in consumption of opioids, despite declining morphine. It is noteworthy that transdermal fentanyl is the opioid prescribed most.

Plankton samples (20-350 microm and >350 microm) collected at three transects along the Galician coast (NW Spain) were analysed for individual aliphatic and aromatic hydrocarbons by GC-MS. Sample collection was performed in April-July 2003, after the Prestige oil spill (November 2002), to determine whether the hydrocarbons released into the water column as a consequence of the spill were accumulated by the planktonic communities during the subsequent spring and early summer blooms. Surface sediments were also collected to assess the presence of the spilled oil, removed from the water column by downward particle transport. Plankton concentrations of PAHs (Sigma14 parent components) were in the range of 25-898 ng g(-1)dw, the highest values being close to coastal urban areas. However, the individual distributions were highly dominated by alkyl naphthalenes and phenanthrenes, paralleling those in the water dissolved fraction. The detailed study of petrogenic molecular markers (e.g. steranes and triterpanes, and methyl phenanthrenes and dibenzothiophenes) showed the occurrence of background petrogenic pollution but not related with the Prestige oil, with the possible exception of the station off Costa da Morte in May 2003, heavily oiled after the accident. The dominant northerly wind conditions during the spring and early summer 2003, which prevented the arrival of fresh oil spilled from the wreck, together with the heavy nature of the fuel oil, which was barely dispersed in seawater, and the large variability of planktonic cycles, could be the factors hiding the acute accumulation of the spilled hydrocarbons. Then, with the above exception, the concentrations of PAHs found in the collected samples, mostly deriving from chronic pollution, can be considered as the reference values for the region.

Chlorophyll, primary production, zooplankton biomass and the species composition of phytoplankton and zooplankton were studied in 2003, after the Prestige shipwreck. The information obtained was compared to previous data series available for the area affected by the spill. A large data series on plankton variables for the N-NW Spanish coast existed, and therefore a realistic evaluation of the effects by comparison with the range of natural variability could be carried out. We emphasized the evaluation of impact during the spring bloom, the first important biological event after the spill. Some minor changes were observed occasionally, but they did not show any clear pattern and were more related to the natural variability of the ecosystem than to effect of the spill. Plankton community structure did not undergo any changes. Only a few species were more abundant during spring 2003 than in previous years. No significant changes were detected in the planktonic community during productive periods, such as the spring bloom and the summer blooms related to intrusions of East North Atlantic Central Waters. The lack of evidence of the effects of the spill on planktonic communities is discussed in terms of the characteristics of the fuel, the high dynamics of the water masses, the biological mechanisms through which the fuel from the surface waters is transferred to the sea floor and, particularly, the influence of the natural variability by means of large and meso-scale hydrographic processes in the area under study. At the present time it is not possible to determine any minor effects the spill may have had on the plankton owing to the great variability of the planktonic cycles and the short-term impact of the oil from the Prestige on the pelagic system.

Objective: In certain physiologic systems, disease is associated with a loss of complexity in system's output. We test the hypothesis that, in critically ill patients, there is an inverse relation between the complexity of the temperature curve and the clinical status. We also consider whether complexity analysis of the temperature curve may have prognostic value., Design: Prospective, observational study., Setting: Intensive care unit of a general hospital in Madrid, Spain., Patients: Twenty-four successive patients admitted in the intensive care unit with multiple organ failure., Interventions: Skin temperature was measured every 10 mins from inclusion in the study until discharge or death (median length of stay 18.8 days, interquartile range 86)., Measurements: From the temperature time series, hourly approximate entropy measurements were obtained. Clinical status was evaluated using the Sequential Organ Failure Assessment (SOFA) score., Main Results: A significant inverse relationship between approximate entropy and the attributed SOFA score was observed in 89% of the patients considered. Both mean and minimum approximate entropy were significantly lower in patients who died than in patients who survived (mean approximate entropy, 0.47 vs. 0.61; minimum approximate entropy, 0.24 vs. 0.40; in both cases p < .001). To evaluate the prognostic value of both mean and minimum approximate entropy, we fitted logistic regression models against survival. An increase in 0.1 units in minimum or mean approximate entropy increased 15.4- and 18.5-fold the odds of surviving, respectively., Conclusions: The clinical status of patients suffering multiple organ failure is inversely correlated to the complexity of the temperature curve expressed as approximate entropy. Reduced complexity has dismal prognostic implications. Its assessment is noninvasive and inexpensive and allows for real-time continuous monitoring of clinical status.

In our Neuropsychiatric dispensary in Galicia, all 3,000 consultations from June 1997 to May 1998 were summed up. We serve a population of 125,000 living in a semi-rural district dependent on a strong industrialised city with car, ship and fishing industry. Of all consulting people, 50% of the 1,000 new ones were unemployed, and 25% of the 2,000 who came for check-ups. In the group under 25 years of age not having had their first job, main findings were anxiety, stress migraine, schizoid outbreaks and self-referring delusion. In the group of young people with unstable jobs, we often found depression, phobias, anorexia/bulimia, low back pain and functional digestive disorders. Age groups 35-50 showed depression patterns, hypochondriac symptoms, low back pain and delusion outbreaks. Those over 50 years old often came from reorganised companies, and showed hypochondriac or psychosomatic sickness, or they applied for retirement or sickness benefits.