Detection of pharmaceutically active compounds in the rivers and tap water of the Madrid Region (Spain) and potential ecotoxicological risk

Concentrations of pharmaceutically active compounds (PhACs) in the order of ng L(-1) to μg L(-1) have been reported worldwide in waste, fluvial and even drinking water, raising concern about the efficacy of the currently employed waste water treatments in the elimination of this kind of compounds. Despite ranking 29th in terms of population, Spain is currently the 8th country on pharmaceutical prescription with an expense of 14×10(9) euros in 2008. In this context, the aim of this study was to determine the presence of 33 pharmaceutically active compounds in specific points of the main rivers of the Madrid Region (MR) as well as tap water samples from the metropolitan area of Madrid. Additionally, a screening level risk characterization by means of the Hazard Quotient (HQ) method was applied. A total of 25 pharmaceutical compounds and metabolites were detected in the 10 sampling points downstream the outlet of the major STPs of the MR. The highest concentrations were detected for the anticonvulsant carbamazepine and the stimulant caffeine. Concentrations for most of the analyzed compounds exceed levels previously reported in the literature. Moreover, we report the highest concentration of the cytostatic ifosfamide, detected for the first time in Spain in surface water. Preliminary risk characterization shows that a total of 16 compounds represent at least a low potential hazard based on their scored HQs, with five of them present in a concentration that exceeds the predicted no effect concentration (PNEC). Toxic Units calculation indicates that for all the selected sampling points high hazard is anticipated from the presence of the analyzed compounds in the measured concentrations (TUs>10). Caffeine and cotinine were detected in all (10) the analyzed tap water samples. Carbamazepine and nicotine were detected in six and venlafaxine in two samples. No studies venlafaxine in drinking water have been reported. These results clearly pinpoint the need for water quality monitoring and research in urban rivers, as well as the need for improved water treatment techniques able to eliminate this kind of compounds from the effluent waters as well as from drinking water sources.

Mycobacterium abscessus infection in transplant recipients

BACKGROUND

Mycobacterium abscessus is a ubiquitous, rapidly growing mycobacterium that colonizes organic surfaces. It is a potential pathogen, especially in immunosuppressed patients, including transplant recipients in whom disease can range from localized cutaneous lesions to disseminated infections. The purpose of this study was to describe the 12-year impact from January 1997 to December 2009 of M. abscessus infection among solid organ and bone marrow transplantations performed in adults and children.

METHODS

Information was obtained from the database of our Microbiology Department concerning samples, culture methods, and in vitro susceptibility testing. Isolates were classified as contaminants (C), colonization (CL), or disease (D) following standard criteria. We reviewed the medical records of affected subjects.

RESULTS

M abscessus was isolated in 76 patients (28 C, 18 CL, and 30 D), including 11 recipients, namely 8 (73%) classified as disease displaying 1 bone marrow case and solid organ cases--4 (50%) pulmonary (2 after cystic fibrosis), 2 renal, and 1 heart transplant patients. All were adults. The localization of infection showed 2 disseminated cases, both of whom shows cutaneous primary lesions, and 6 localized in 3 cases cutaneous and in 3, respiratory.

CONCLUSION

Diseases caused by M abscessus have increased in the last 5 years, possibly due to the greater number of transplants and the more focused search for the lesions. Most isolates were from lung cases, especially those with infections prior to transplantation. Respiratory and cutaneous samples were predominant, with skin lesions being an important site of primary symptom previous to dissemination of infection. Although the optimal regimen remains undefined, a favorable outcome depended mainly on a rapid diagnosis and inception of treatment following susceptibility test results.

Utility of geriatric assessment tools to identify 85-years old subjects with vitamin D deficiency

OBJECTIVES

To calculate the prevalence of hypovitaminosis D in subjects aged 85 years old and to study the relationship between some common geriatric evaluation scales and vitamin D status.

DESIGN

Prospective cohort study.

SETTING

A community-based study.

PARTICIPANTS

312 subjects aged 85 years old.

MEASUREMENTS

Geriatric assessment was based on comorbidity, functional status according to the Barthel Index (BI) and Lawton Index (LI), cognitive status measured by the Spanish version of the Mini-Mental State Examination (MEC), nutritional risk according to the Mini Nutritional Assessment (MNA), and gait using the Tinetti Gait Scale. Serum 25(OH)D concentrations were used to assess vitamin D status. Hypovitaminosis D was considered as < 25 ng/ml and deficiency < 11 ng/ml.

RESULTS

Mean serum 25(OH)D level was 28 ± 30 ng/ml. The prevalence of hypovitaminosis D was 52.5% (38.1% insufficiency and 14.4% deficiency). Men had higher levels than women (32.2 ± 44 vs. 25.2 ± 25 ng/ml; p=0.04). The bivariate analyses identified an association between MNA scores and hypovitaminosis D, and showed that females ande participants with poor BI, Tinetti and MNA scores were associated with deficiency. Logistic regression analysis confirmed a significant association between poor MNA scores and both hypovitaminosis D (p < 0.04, OR 1.066, 95% CI 1.002-1.135) and vitamin D deficiency (p < 0.0001, OR 1.192, 95% CI 1.099-1.293).

CONCLUSIONS

More than half the population aged 85 years has a vitamin D deficit and 14.4% show a deficiency. A lower score on the MNA scale is associated with a greater likelihood of having lower vitamin D serum values.

Analysis of the presence of cardiovascular and analgesic/anti-inflammatory/antipyretic pharmaceuticals in river- and drinking-water of the Madrid Region in Spain

Interest in the presence of pharmaceuticals in wastewater, in the water of our rivers and, to a lesser extent, in our drinking water, has been growing in recent decades. Many of these substances, currently classified as "emerging pollutants", are biologically active compounds and continuously released in effluents. As sewage treatment plants (STPs) are not adequately equipped to eliminate all of these substances completely, some are discharged directly into rivers. In Spain, as in most of its neighbouring countries, there is an elevated use of pharmaceuticals for the treatment of cardiovascular diseases (which are extremely prevalent among the older adult population) and anti-inflammatory medications, which are obtainable over the counter without a medical prescription. This study therefore sought to determine to what degree pharmaceuticals with the highest regional prescription and/or use rates, such as cardiovascular and analgesic/anti-inflammatory/antipyretic medications, were present in the principal rivers (Jarama, Manzanares, Guadarrama, Henares and Tagus) and tap-water samples of the Madrid Region (MR). Samples were taken downstream the discharge of 10 of the most important region's STPs and the most frequently used drugs in the region were analysed for. Of the 24 drugs analysed, 21 were detected at concentrations ranging from 2 ng L⁻¹ to 18 μg L⁻¹. The highest drug concentrations corresponded to ibuprofen, diclofenac, naproxen, atenolol, frusemide (furosemide), gemfibrozil and hydrochlorthiazide, and in most cases exceeded the amounts reported in the scientific literature. No traces of these groups of pharmaceuticals were detected in the drinking water analysed. On the basis of the high concentrations detected, we believe that an environmental surveillance system should be implemented to assess the continuous discharge of these pharmaceuticals and their possible ecotoxicological effects. At the same time, efforts to raise the awareness of the public about responsible use and the proper disposal of such substances at purpose-designated collection points should be increased. Furthermore sewage treatment processes should be suitably adapted to increase the rates of removal of these drugs.

Highly efficient Brønsted acidic ionic liquid-based catalysts for biodiesel synthesis from vegetable oils

Biodiesel has been produced by transesterification of canola oil with methanol in the presence of highly Brønsted acidic ionic liquids based on 1-benzyl-1H-benzimidazole, and the effect of reaction temperature, type and amount of catalyst, molar ratio and reaction time investigated. The results show that the 4B ionic liquid has the highest catalytic activity and best recyclability under the optimised reaction conditions. Thus, this ionic liquid is able to catalyze the transesterification of canola oil to its methyl esters in 5 h with yields of more than 95%. Density functional calculations (B3LYP), using the 6-311G basis set, have been performed to have a better understanding on the reactivity of these catalysts. The catalytic activity of 4B for the transesterification of other vegetable oils and alcohols has also been studied.

Fasting and postprandial adiponectin alterations anticipate NEFA and TNF-α changes in prepubertal obese children

BACKGROUND AND AIMS

It has been suggested that adipokine changes might precede changes in plasma non-esterified fatty acids and other obesity metabolic biomarkers. The aim of the present study was to evaluate changes in fasting and postprandial plasma levels of adiponectin, non-esterified fatty acids, and tumor necrosis factor-alpha in prepubertal obese children and age-matched normal-weight children.

METHODS AND RESULTS

Fifty-four children of prepubertal age (34 obese, comprising 23 males and 11 females, and 20 normal-weight comprising 11 males and 9 females) were studied. A standard 438 kcal breakfast was given to both groups. Baseline measurements included anthropometry and plasma lipids. The following parameters were determined in plasma before and after breakfast: glucose, insulin, and C-peptide at baseline and 2h and non-esterified fatty acids, adiponectin, and tumor necrosis factor-alpha at baseline and 1, 2, and 3h. Fasting plasma non-esterified fatty acid levels were lower in the obese versus normal-weight children (P=0.021). Both at baseline and postprandially, plasma adiponectin levels were lower in the obese versus normal-weight children (P<0.001). A trend was observed (P=0.06) that levels of tumor necrosis factor-alpha were lower in the obese versus normal-weight children. Adiponectin was inversely associated with insulin in the obese children after adjustment for BMI and sex (r=-0.401, P=0.025).

CONCLUSION

At prepubertal age, obese children show lower fasting and postprandial plasma adiponectin levels in comparison to normal-weight children, whereas non-esterified fatty acids and tumor necrosis factor-alpha were not yet increased. Therefore, adiponectin appears to be a good marker of early metabolic alterations associated with childhood obesity.

[Education on nutrition: from the university to specialized care]

The 7th Abbott-SENPE Forum is structured facing the new regulations of the European Space of High Education regarding the studies on Nutrition in the different degrees (Medicine, Pharmacology, Nutrition, Nursing) and post-doctoral education. A multi-professional and multidisciplinary discussion on the current situation of university education on nutrition, and its capabilities and limitations, is carried out. The value of the role of continuous medical education, the inhouse training programme, masters, and of scientific societies is also assessed. It is concluded that there is a need to urge academic authorities, the National Commission of Medical Specialties, the persons in charge of continuous medical education, and scientific societies of the importance of the studies relating to nutrition, feeding, and dietetics at both pre-graduate and post-graduate educational levels, and to implement and develop these studies in their areas of influence.

[Neurovascular intervention in the acute phase of cerebral infarction]

BACKGROUND AND PURPOSE

Endovascular therapies in acute ischaemic stroke may offer benefits to patients that are not eligible for standard use of intravenous tissue activator plasminogen (iv t-PA) or when this is not effective. Our aim is to present the initial experience in with endovascular techniques in the Community of Madrid.

METHODS

We present data from our registry of acute ischaemic strokes treated with endovascular re-perfusion therapies in five University Hospitals in Madrid (Spain) during the period 2005-2009. We recorded demographic data, vascular risk factors, risk severity with the NIHSS (National Institute of Health Stroke Scale), endovascular techniques, complications and mortality rates. Functional outcome and neurological disability at 90 days was defined by the modified Rankin scale (mRs).

RESULTS

A total of 41 patients were treated with endovascular therapies. Mean age was 58.6 ± 19.9, and 56.1% were males. Of those 22 patients had an anterior circulation stroke and 19 had a posterior circulation stroke. Baseline NIHSS score was: median, 17 [range, 2-34]; 7 patients had previously received iv t-PA. The following endovascular techniques were performed: mechanical disruption (26 patients), intra-arterial infusion of t-PA (26 patients), angioplasty and stenting (5 patients), mechanical use of MERCI device (3 patients). Partial or total re-canalization was achieved in 32 patients (78%). Only one patient had a symptomatic cerebral haemorrhage. Three months after stroke, 53.6% of the patients were independent (mRs ≤ 2) and overall mortality rate was 19.5%.

CONCLUSIONS

Acute ischaemic stroke is a potentially treatable medical emergency within the first hours after the onset of symptoms. Stroke endovascular procedures constitute an alternative for patients with iv t-PA exclusion criteria or when this is not effective.

Identification of single nucleotide polymorphisms in the bovine solute carrier family 11 member 1 (SLC11A1) gene and their association with infection by Mycobacterium avium subspecies paratuberculosis

Johne's disease is a chronic enteritis caused by Mycobacterium avium ssp. paratuberculosis (MAP) that causes substantial financial losses for the cattle industry. Susceptibility to MAP infection is reported to be determined in part by genetic factors, so marker-assisted selection could help to obtain bovine populations that are increasingly resistant to MAP infection. Solute carrier family 11 member 1 (SLC11A1) was adjudged to be a potential candidate gene because of its role in innate immunity, its involvement in susceptibility to numerous intracellular infections, and its previous association with bovine MAP infection. The objectives of this study were to carry out an exhaustive process of discovery and compilation of polymorphisms in SLC11A1 gene, and to perform a population-based genetic association study to test its implication in susceptibility to MAP infection in cattle. In all, 57 single nucleotide polymorphisms (SNP) were detected, 25 of which are newly described in Bos taurus. Twenty-four SNP and two 3'-untranslated region polymorphisms, previously analyzed, were selected for a subsequent association study in 558 European Holstein-Friesian animals. The SNP c.1067C>G and c.1157-91A>T and a haplotype formed by these 2 SNP yielded significant association with susceptibility to MAP infection. The c.1067C>G is a nonsynonymous SNP that causes an amino acid change in codon 356 from proline to alanine (P356A) that could alter SLC11A1 protein function. This association study supports the involvement of SLC11A1 gene in susceptibility to MAP infection in cattle. Our results suggest that SNP c.1067C>G may be a potential causal variant, although functional studies are needed to assure this point.