Are workers on board vessels involved with chemicals from treated ballast water sufficiently protected? - A decadal perspective and risk assessment

Ballast Water Managements Systems (BWMS) installed on vessels may use Active Substances (AS) to inactivate organisms. This paper provides new insights in the global issue of noxious Disinfection By-Products (DBP) produced with primarily oxidant-based BWMS, and the risk assessment for workers, including port State control officers, while performing tasks on a vessel that involve exposure to treated ballast water. The Joint Group of Experts on the Scientific Aspects of Marine Environmental Protection - Ballast Water Working Group (GESAMP-BWWG) plays a role in the certification process of BWMS that make use of AS evaluating potential negative effects. All BWMS that passed GESAMP-BWWG Final Approval until mid 2019 were analyzed providing an overview of chemicals in the treated ballast water before and after neutralization. The ballast tank cleaning scenario, the sampling scenario, and the ballast tank inspection scenario all showed elevated human health risks using the Derived Minimal Effect Levels approach. The most critical exposure occurs in the ballast tank cleaning scenario through the inhalation of volatile DBP, such as tribromomethane. This substance may cause acute effects such as headache, dizziness and also has carcinogenic properties. The two risk reducing options available in the GESAMP-BWWG Tier 2 calculations were compared, one being mitigation measures such as protective gloves and coveralls, the other option is taking into account a time correction factor. The results showed that the trihalomethanes in air are most problematic, however, there is a possibility that the calculated values may be overestimated as generally worst case assumptions were used.

River toxicity assessment using molecular biosensors: Heavy metal contamination in the Turag-Balu-Buriganga river systems, Dhaka, Bangladesh

Pollution in rapidly urbanising cities and in delta systems is a serious problem that blights the lives and livelihoods of millions of people, damaging and restricting potable water supply and supplies to industry (Whitehead et al, 2015, 2018). Employing new technology based on luminescent molecular biosensors, the toxicity in the rivers around Dhaka in Bangladesh, namely the Turag, Tongi, Balu and Buriganga, has been assessed. Samples taken at 36 sites during medium and low flow conditions and during the Bishwa Ijtema Festival revealed high levels of cell toxicity, as well as high concentrations of metals, particularly aluminium, cadmium, chromium, iron, zinc, lithium, selenium and nickel. Chemical analysis also revealed low dissolved oxygen levels and anoxic conditions in the rivers at certain sites. The bacterial molecular biosensors were demonstrated to be fast, with results in 30 min, robust and a highly sensitive method for the assessment of water toxicity in the field. Furthermore, the biosensor toxicity analysis correlated with the metals data, and a multivariate regression relationship was developed relating toxicity to key metals, such a selenium, zinc and chromium. The resulting model has been validated against split samples and the Bishwa Ijtema Festival data. The combination of modelling and the molecular biosensor technology provides a new approach to detecting and managing pollution in urban river systems.

Substrate Supporting Disc Method for Confirmed Detection of Total Coliforms and E. coli in all Foods: Collaborative Study

The Coli Complete® substrate supporting disc (SSD) method for simultaneous confirmed total coliform count and Escherichia coli determination in all foods was compared with AOAC most probable number (MPN) methods, 966.23 and 966.24. Twenty-nine laboratories participated in this collaborative study in which 6 food types were analyzed. Four food types, raw ground beef, pork sausage, raw liquid milk, and nut meats, were naturally contaminated with coliform bacteria. Two foods, dry egg and fresh frozen vegetables, were seeded with coliforms. Three food types, ground beef, raw liquid milk, and pork sausage, were naturally contaminated with E. coli. Although pork sausage was naturally contaminated, the level was very low (<10/50 g); therefore, additional E. coli were inoculated into 1 lot of this food type. Three food types, nut meats, dry egg, and fresh frozen vegetables, were inoculated with E. coli. For naturally contaminated samples, duplicate determinations were made on 3 separate lots for each food type. For inoculated samples, low, medium, and high contamination levels plus uninoculated control samples were examined in duplicate. Data were analyzed separately for total coliform bacteria and for E. coli. Mean log MPN counts were determined by the SSD method and the appropriate AOAC MPN method. Results were then analyzed for repeatability, reproducibility, and mean log MPN statistical equivalence. Results were statistically equivalent for all total coliform levels in all food types except frozen vegetable and raw nut meat uninoculated control samples and 1 lot of pork sausage where the SSD method produced statistically significant greater numbers. For the E. coli determinations, results were statistically equivalent across all samples and all levels for each food type. The SSD method has been adopted first action by AOAC International for confirmed detection of total coliforms and E. coli in all foods.

Is human health sufficiently protected from chemicals discharged with treated ballast water from vessels worldwide? - A decadal perspective and risk assessment

Ballast water managements systems (BWMS) installed on vessels may use active substances to inactivate organisms. This paper provides new insights in the global issue of noxious disinfection by-products (DBP) discharge with ballast water, and the related risk assessment for human health. The GESAMP ballast water working group plays a role in the certification process of BWMS that make use of active substances evaluating potential negative effects. We analyzed all BWMS that passed GESAMP final approval over a decade until 2017 providing an overview of chemicals in the discharged ballast water generated by BWMS. We used these data to calculate the chemical load humans may be exposed to for two different commercial ports (Koper, Slovenia and Hamburg, Germany). None of the chemicals in this study reached levels of concern that would indicate a risk for humans after exposure to chemicals present in the discharged ballast water. Nevertheless, although this exposure only adds to a lesser degree to the overall exposure to disinfection by-products, some chemicals, such as tribromomethane, have carcinogenic properties. In case studies we show which chemicals have the largest contribution to the aggregated exposure of humans. We note that tribromomethane, despite its low bio-concentration factor (BCF), may accumulate in fat, when fish are continuously exposed to DBPs during low-level chlorination. Since this figure would give a higher value for the internal dose for tribromomethane from seafood consumption than the current BCF in the GISIS database, the calculated value may underestimate the contribution of tribromomethane, and possibly also other DBPs.

Epidemiology of rare diseases detected by newborn screening in the Czech Republic

OBJECTIVES

Presymptomatic detection of patients with rare diseases (RD), defined by a population frequency less than 1 : 2,000, is the task of newborn screening (NBS). In the Czech Republic (CZ), currently eighteen RD are screened: phenylketonuria/hyperphenylalaninemia (PKU/HPA), congenital hypothyroidism (CH), congenital adrenal hyperplasia (CAH), cystic fibrosis (CF), medium chain acyl-CoA dehydrogenase deficiency (MCADD), long chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD), very long chain acyl-CoA dehydrogenase deficiency (VLCADD), carnitine palmitoyl transferase I and II deficiency (CPTID, CPTIID), carnitine-acylcarnitine translocase deficiency (CACTD), maple syrup urine disease (MSUD), glutaric aciduria type I (GA I), isovaleryl-CoA dehydrogenase deficiency (IVA), argininemia (ARG), citrullinemia (CIT), biotinidase deficiency (BTD), cystathionine beta-synthase-deficient homocystinuria (CBSD HCU), and methylenetetrahydrofolate reductase deficiency homocystinuria (MTHFRD HCU). The aim was to analyze the prevalence of RD screened by NBS in CZ.

METHODS

We examined the NBS programme in CZ from 1 January 2010 to 31 December 2017, which covered 888,891 neonates. Dried blood spots were primarily analyzed using fluorescence immuno-assay, tandem mass spectrometry and fluorimetry.

RESULTS

The overall prevalence of RD among the neonate cohort was 1 : 1,043. Individually, 1 : 2,877 for CH, 1 : 5,521 for PKU/HPA, 1 : 6,536 for CF (1 : 5,887 including false negative patients), 1 : 12,520 for CAH, 1 : 22,222 for MCADD, 1 : 80,808 for LCHADD, 1 : 177,778 for GA I, 1 : 177,778 for IVA, 1 : 222,223 for VLCADD, 1 : 296,297 for MSUD, 1 : 8,638 for BTD, and 1 : 181,396 for CBSD HCU.

CONCLUSIONS

The observed prevalence of RD, based on NBS, corresponds to that expected, more precisely it was higher for BTD and lower for MSUD, IVA, CBSD HCU, MCADD and VLCADD. Early detection of rare diseases by means of NBS is an effective secondary prevention tool.

Introducing a soil universal model method (SUMM) and its application for qualitative and quantitative determination of poly(ethylene), poly(styrene), poly(vinyl chloride) and poly(ethylene terephthalate) microplastics in a model soil

Methods for analysis of microplastic in soils are still being developed. In this study, we evaluated the potential of a soil universal model method (SUMM) based on thermogravimetry (TGA) for the identification and quantification of microplastics in standard loamy sand. Blank and spiked soils (with amounts of one of four microplastic types) were analyzed by TGA. For each sample, thermal mass losses (TML) in 10 °C intervals were extracted and used for further analysis. To explain and demonstrate the principles of SUMM, two scenarios were discussed. The first refers to a rare situation in which an uncontaminated blank of investigated soil is available and TML of spiked and blank soils are subtracted. The results showed that the investigated microplastics degraded in characteristic temperature areas and differences between spiked and blank soils were proportional to the microplastics concentrations. The second scenario reflects the more common situation where the blank is not available and needs to be replaced by the previously developed interrelationships representing soil universal models. The models were consequently subtracted from measured TML. Sparse principal component analysis (sPCA) identified 8 of 14 modeled differences between measured TMLs and the universal model as meaningful for microplastics discrimination. Calibrating various microplastics concentrations with the first principal component extracted from sPCA resulted in linear fits and limits of detection in between environmentally relevant microplastics concentrations. Even if such an approach using calculated standards still has limitations, the SUMM shows a certain potential for a fast pre-screening method for analysis of microplastics in soils.

Effervescent agents in acute esophageal food impaction

Acute esophageal food impaction (AEFI) occurs frequently. Few data are published describing the use of effervescent agents (EAs) for treatment of AEFI. We aimed to evaluate the effectiveness, cost, and safety of EAs in the treatment of AEFI. We retrospectively identified patients aged 18 years and older who were seen in the emergency department of 2 hospitals in 1 metropolitan area from January 1, 2011, through April 4, 2016, who had a clinical diagnosis of AEFI. We collected and analyzed data on outcomes and cost associated with the use of EAs, glucagon, and no pharmacologic therapy. During the study period, 239 patients with AEFI met the inclusion criteria. Of the 45 patients who received EA monotherapy, 25 (55.6%) responded successfully, compared with 11 of 62 (17.7%) who received glucagon monotherapy (P < .001) and 16 of 93 (17.2%) who had no therapy (P < .001). Ten of 39 patients (25.6%) who were given both glucagon and EA responded successfully. The other 177 patients had endoscopy, which was successful in all cases. Median hospitalization charges for patients who responded successfully to EA alone were $1,136, compared with $2,602 for responders to glucagon alone (P < .001) and $1,194 for those who cleared their bolus spontaneously (P < .001). All patients who received EA monotherapy had lower median hospitalization costs ($2,384) than all patients who received glucagon monotherapy ($9,289; P = .03) and all patients who received neither ($8,386; P = .02). Effervescent agents are a safe, effective, and cost-saving initial strategy in the treatment of acute esophageal food impaction.

Application of TruGraf v1: A Novel Molecular Biomarker for Managing Kidney Transplant Recipients With Stable Renal Function

TruGraf v1 is a laboratory-developed DNA microarray-based gene expression blood test to enable proactive noninvasive serial assessment of kidney transplant recipients with stable renal function. It has been previously validated in patients identified as Transplant eXcellence (TX: stable serum creatinine, normal biopsy results, indicative of immune quiescence), and not-TX (renal dysfunction and/or rejection on biopsy results). TruGraf v1 is intended for use in subjects with stable renal function to measure the immune status as an alternative to invasive, expensive, and risky surveillance biopsies.

MATERIALS AND METHODS

In this study, simultaneous blood tests and clinical assessments were performed in 192 patients from 7 transplant centers to evaluate TruGraf v1. The molecular testing laboratory was blinded to renal function and biopsy results.

RESULTS

Overall, TruGraf v1 accuracy (concordance between TruGraf v1 result and clinical and/or histologic assessment) was 74% (142/192), and a result of TX was accurate in 116 of 125 (93%). The negative predictive value for TruGraf v1 was 90%, with a sensitivity 74% and specificity of 73%. Results did not significantly differ in patients with a biopsy-confirmed diagnosis vs those without a biopsy.

CONCLUSIONS

TruGraf v1 can potentially support a clinical decision enabling unnecessary surveillance biopsies with high confidence, making it an invaluable addition to the transplant physician's tool kit for managing patients. TruGraf v1 testing can potentially avoid painful and risky invasive biopsies, reduce health care costs, and enable frequent assessment of patients with stable renal function to confirm the presence of immune quiescence in the peripheral blood.

Investigator Assessment of the Utility of the TruGraf Molecular Diagnostic Test in Clinical Practice

BACKGROUND

TruGraf v1 is a well-validated DNA microarray-based test that analyzes blood gene expression profiles as an indicator of immune status in kidney transplant recipients with stable renal function.

METHODS

In this study, investigators assessed clinical utility of the TruGraf test in patient management. In a retrospective study, simultaneous blood tests and clinical assessments were performed in 192 patients at 7 transplant centers, and in a prospective observational study they were performed in 45 subjects at 5 transplant centers.

RESULTS

When queried regarding whether or not the TruGraf test result impacted their decision regarding patient management, in 168 of 192 (87.5%) cases the investigator responded affirmatively. The prospective study indicated that TruGraf results supported physicians' decisions on patient management 87% (39/45) of the time, and in 93% of cases physicians indicated that they would use serial TruGraf testing in future patient management. A total of 21 of 39 (54%) reported results confirmed their decision that no intervention was needed, and 17 of 39 (44%) reported that results specifically informed them that a decision not to perform a surveillance biopsy was correct.

CONCLUSIONS

TruGraf is the first and only noninvasive test to be evaluated for clinical utility in determining rejection status of patients with stable renal function and shows promise of providing support for clinical decisions to avoid unnecessary surveillance biopsies with a high degree of confidence. TruGraf is an invaluable addition to the transplant physician's tool kit for managing patient health by avoiding painful and invasive biopsies, reducing health care costs, and enabling frequent assessment of patients with stable renal function to confirm immune quiescence.

Neonatal screening in the Czech Republic: increased prevalence of selected diseases in low birthweight neonates

Neonates with low birthweight (LBW) represent a vulnerable population. This retrospective study analyzed the birth frequency of diseases detected by neonatal screening (NBS) in normal and LBW neonates in the Czech Republic. Between years 2002 and 2016, the number of screened disorders in the Czech Republic gradually increased from two to 13. Prevalence of screened diseases was calculated for cohorts ranging from 777,100 to 1,277,283 neonates stratified by birthweight. Odds ratio of the association of LBW with each disease was calculated and statistical significance was evaluated using the chi-square test or Fisher's exact test, as appropriate. Three diseases were associated with higher risk of prevalence in LBW neonates, namely congenital hypothyroidism (OR 2.50, CI 1.92; 3.25), cystic fibrosis (OR 2.44, CI 1.51; 3.94), and long chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD) (OR 7.74, CI 2.18; 27.42).Conclusion: Although the underlying mechanisms are not well understood, results can be hypothesized that LBW (respectively prematurity) may lead to the secondary and often transitory hypothyroidism while cystic fibrosis and LCHADD may manifest already prenatally and result into preterm birth and LBW. What is Known: • The percentage of low birthweight (LBW) neonates in the Czech Republic has been increasing. • Previously published studies reported positive association between LBW and congenital hypothyroidism and cystic fibrosis. What is New: • The association between LCHADD and LBW has not yet been described. • LBW can be the first manifestation of cystic fibrosis and LCHADD.