Arsenic and fluoride in groundwater triggering a high risk: Probabilistic results using Monte Carlo Simulation and Species Sensitivity Distribution

The widespread presence of arsenic (As) and fluoride (F-) in groundwater poses substantial risks to human health on a global scale. These elements have been identified as the most prevalent geogenic contaminants in groundwater in northern Mexico. Consequently, this study aimed to evaluate the human health and ecological risks associated with the content of As and F- in the Meoqui-Delicias aquifer, which is in one of Mexico's most emblematic irrigation districts. Concentrations of As and F- were measured in 38 groundwater samples using ICP-MS and ion chromatography, respectively. Overall, these elements showed a similar trend across the aquifer, revealing a positive correlation between them and pH. The concentration of As and F- in the groundwater ranged from 5.3 μg/L to 303 μg/L and from 0.5 mg/L to 8.8 mg/L, respectively. Additionally, the levels of As and F- surpassed the established national standards for safe drinking water in 92% and 97% of samples, respectively. Given that groundwater is used for both agricultural purposes and human activities, this study also assessed the associated human health and ecological risks posed by these elements using Monte Carlo simulation and Species Sensitivity Distribution. The findings disclosed a significant noncarcinogenic health risk associated with exposure to As and F-, as well as an unacceptable carcinogenic health risk to As through water consumption for both adults and children. Furthermore, a high ecological risk to aquatic species was identified for F- and high to medium risks for As in the sampling sites. Therefore, the findings in this study provide valuable information for Mexican authorities and international organizations (e.g., WHO) about the adverse effects that any exposure without treatment to groundwater from this region represents for human health.

Application of ecotoxicological tools to evaluate the quality status of mangroves under restoration in the Yucatán Peninsula, Mexico

Ecotoxicological tools, namely biomarkers and bioassays, may provide insights on the ecological quality status of mangroves under restoration. We investigated how 1) physicochemical parameters and water bioassays using Artemia franciscana; and 2) quantification of sublethal (osmoregulatory capacity, biochemical, and oxidative stress) and individual biomarkers (density, length-weight relationship [LWR], parasitic prevalence) in the sentinel fiddler crab Minuca rapax, can improve restoration indicators in mangroves from the Yucatán Peninsula, Southern Gulf of Mexico. We showed that water quality was improved with restoration, but still presented toxicity. Regarding sublethal biomarkers, M rapax from restored areas lower osmotic regulatory capacity, higher oxidative stress, and showed lipid peroxidation. As to the individual biomarkers, the density, LWR, and the prevalence of parasites in M. rapax was higher in restored areas. The use of bioassays/biomarkers were useful as early warning indicators to better assess the health of mangroves under restoration.

FlowSOM clustering - A novel pattern recognition approach for water research: Application to a hyper-arid coastal aquifer system

Monitoring and understanding of water resources have become essential in designing effective and sustainable management strategies to overcome the growing water quality challenges. In this context, the utilization of unsupervised learning techniques for evaluating environmental tracers has facilitated the exploration of sources and dynamics of groundwater systems through pattern recognition. However, conventional techniques may overlook spatial and temporal non-linearities present in water research data. This paper introduces the adaptation of FlowSOM, a pioneering approach that combines self-organizing maps (SOM) and minimal spanning trees (MST), with the fast-greedy network clustering algorithm to unravel intricate relationships within multivariate water quality datasets. By capturing connections within the data, this ensemble tool enhances clustering and pattern recognition. Applied to the complex water quality context of the hyper-arid transboundary Caplina/Concordia coastal aquifer system (Peru/Chile), the FlowSOM network and clustering yielded compelling results in pattern recognition of the aquifer salinization. Analyzing 143 groundwater samples across eight variables, including major ions, the approach supports the identification of distinct clusters and connections between them. Three primary sources of salinization were identified: river percolation, slow lateral aquitard recharge, and seawater intrusion. The analysis demonstrated the superiority of FlowSOM clustering over traditional techniques in the case study, producing clusters that align more closely with the actual hydrogeochemical pattern. The outcomes broaden the utilization of multivariate analysis in water research, presenting a comprehensive approach to support the understanding of groundwater systems.

Occurrence, ecological and health risk assessment of phthalates in a polluted urban river used for agricultural land irrigation in central Mexico

The escalating global concern on phthalate esters (PAEs) stems from their status as emerging contaminants, marked by their toxicity and their potential to harm both the environment and human health. Consequently, this study aimed to evaluate the occurrence, spatial distribution, and ecological and health risks associated with PAEs in the Atoyac River, an urban waterway in central Mexico that receives untreated and poorly treated urban and industrial wastewater. Of the 14 PAEs analyzed in surface water samples collected along the river mainstream, nine were detected and quantified by GC-MS. The concentration of each detected PAE ranged from non-detected values to 25.7 μg L-1. Di (2-ethylhexyl) phthalate (DEHP) and di-n-hexyl phthalate (DnHP) were detected in all sampling sites, with concentrations ranging from 8.1 to 19.4 μg L-1 and from 6.3 to 15.6 μg L-1, respectively. The cumulative Σ9PAEs concentrations reached up to 81.1 μg L-1 and 96.0 μg L-1 in sites downstream to high-tech industrial parks, pinpointing industrial wastewater as the primary source of PAEs. Given that the river water is stored in a reservoir and used for cropland irrigation, this study also assessed the ecological and human health risks posed by PAEs. The findings disclosed a high ecological risk to aquatic organisms exposed to di-n-octyl phthalate (DOP), dicyclohexyl phthalate (DCHP), benzyl butyl phthalate (BBP), DEHP, and DnHP. Additionally, a high carcinogenic (CR > 10-4) and noncarcinogenic (HQ > 10) risk for the DEHP exposure through ingestion of crops irrigated with river water was identified for both children and adults. These data on PAEs provide valuable insights for the Mexican government's future strategies in regulating these pollutants in water bodies, thereby minimizing the environmental and human health risks that they pose.

Nitrate prediction in groundwater of data scarce regions: The futuristic fresh-water management outlook

Nitrate contamination in groundwater poses a significant threat to water quality and public health, especially in regions with limited data availability. This study addresses this challenge by employing machine learning (ML) techniques to predict nitrate (NO3--N) concentrations in Mexico's groundwater. Four ML algorithms-Extreme Gradient Boosting (XGB), Boosted Regression Trees (BRT), Random Forest (RF), and Support Vector Machines (SVM)-were executed to model NO3--N concentrations across the country. Despite data limitations, the ML models achieved robust predictive performances. XGB and BRT algorithms demonstrated superior accuracy (0.80 and 0.78, respectively). Notably, this was achieved using ∼10 times less information than previous large-scale assessments. The novelty lies in the first-ever implementation of the 'Support Points-based Split Approach' during data pre-processing. The models considered initially 68 covariates and identified 13-19 significant predictors of NO3--N concentration spanning from climate, geomorphology, soil, hydrogeology, and human factors. Rainfall, elevation, and slope emerged as key predictors. A validation incorporated nationwide waste disposal sites, yielding an encouraging correlation. Spatial risk mapping unveiled significant pollution hotspots across Mexico. Regions with elevated NO3--N concentrations (>10 mg/L) were identified, particularly in the north-central and northeast parts of the country, associated with agricultural and industrial activities. Approximately 21 million people, accounting for 10 % of Mexico's population, are potentially exposed to elevated NO3--N levels in groundwater. Moreover, the NO3--N hotspots align with reported NO3--N health implications such as gastric and colorectal cancer. This study not only demonstrates the potential of ML in data-scarce regions but also offers actionable insights for policy and management strategies. Our research underscores the urgency of implementing sustainable agricultural practices and comprehensive domestic waste management measures to mitigate NO3--N contamination. Moreover, it advocates for the establishment of effective policies based on real-time monitoring and collaboration among stakeholders.

Worldwide risk assessment of phthalates and bisphenol A in humans: The need for updating guidelines

Phthalates and bisphenol A (BPA) are compounds widely used as raw materials in the production of plastics, making them ubiquitous in our daily lives. This results in widespread human exposure and human health hazards. Although efforts have been conducted to evaluate the risk of these compounds in diverse regions around the world, data scattering may mask important trends that could be useful for updating current guidelines and regulations. This study offers a comprehensive global assessment of human exposure levels to these chemicals, considering dietary and nondietary ingestion, and evaluates the associated risk. Overall, the exposure daily intake (EDI) values of phthalates and BPA reported worldwide ranged from 1.11 × 10-7 to 3 700 µg kg bw-1 d-1 and from 3.00 × 10-5 to 6.56 µg kg bw-1 d-1, respectively. Nevertheless, the dose-additive effect of phthalates has been shown to increase the EDI up to 5 100 µg kg bw-1 d-1, representing a high risk in terms of noncarcinogenic (HQ) and carcinogenic (CR) effects. The worldwide HQ values of phthalates and BPA ranged from 2.25 × 10-7 to 3.66 and from 2.74 × 10-7 to 9.72 × 10-2, respectively. Meanwhile, a significant number of studies exhibit high CR values for benzyl butyl phthalate (BBP) and di(2-ethylhexyl) phthalate (DEHP). Moreover, DEHP has shown the highest maximum mean CR values for humans in numerous studies, up to 179-fold higher than BBP. Despite mounting evidence of the harmful effects of these chemicals at low-dose exposure on animals and humans, most regulations have not been updated. Thus, this article emphasizes the need for updating guidelines and public policies considering compelling evidence for the adverse effects of low-dose exposure, and it cautions against the use of alternative plasticizers as substitutes for phthalates and BPA because of the significant gaps in their safety.

Adsorptive removal of ciprofloxacin and sulfamethoxazole from aqueous matrices using sawdust and plastic waste-derived biochar: A sustainable fight against antibiotic resistance

We produced carbon-negative biochar from the pyrolysis of sawdust biomass alone (SB) and from the co-pyrolysis of sawdust and plastic waste (SPB). The co-pyrolysis approach in this study was driven by several hypothetical factors, such as increased porosity, surface chemistry, stability, as well as waste management. We applied pyrolyzed and co-pyrolyzed biochars for the removal of ciprofloxacin (CFX) and sulfamethoxazole (SMX). Due to its more alkaline and amorphous nature, SB showed better removal efficiencies compared to SPB. The maximum removals of CFX and SMX with SB were observed as ∼95% and >95%, respectively whereas with SPB were 58.8%, and 34.9%, respectively. The primary mechanisms involved in the adsorption process were H-bonding, electrostatic and π-π electron donor-acceptor interactions. Homogenously and heterogeneously driven adsorption of both antibiotics followed the pseudo-second-order kinetic model, implying electron sharing/transfer (chemisorption) mediated adsorption. The work is highly pertinent in the context of emerging concerns related to drivers that promote antimicrobial resistance.

A systematic review on metal contamination due to mining activities in the Amazon basin and associated environmental hazards

Metal contamination associated with mining activities has been considered one of the main environmental pollution problems in the Amazon region. Understanding the levels of metal contamination from mining activities requires a good understanding of background metal concentrations, which may vary notably according to the geology/lithology characteristics of the region, soil type, and predominant biogeochemical processes. This review assessed 50 papers and reports published between 1989 and 2020 describing environmental concentrations of different metals and metalloids (As, Hg, Mn, Fe, Cd, Cu, Cr, Pb, Ni, and Zn) in water and sediments of mining and non-mining areas in five geographic regions of the Amazon basin. Metal enrichment caused by mining activities was calculated and exposure concentrations were compared with sediment and water quality standards set for the protection of aquatic life. Significant enrichments of Cd, Cu, Cr, Fe, Hg, Mn, Ni and Zn were observed in mining areas in both sediment and water. Regarding background levels in the different geographic regions, the highest prevalence of metal enrichment (i.e., concentrations 10 to 100-fold higher than mean background values) in sediment samples was found for Fe (100% of samples), Ni (90%), and Mn (69%). For water, high prevalence of metal enrichment occurred for Zn, Mn, and Fe (100% of samples), and for Hg (86%). Hg, Fe, Pb, Cu, Cd, Ni and Zn exceeded water and/or sediment quality standards in a significant number of samples in the proximity of mining areas. This study indicates that mining activities significantly contribute to water and sediment contamination across the Amazon basin, posing hazards for freshwater ecosystems and potentially having human health implications.

Influence of PFDA on the nutrient removal from wastewater by hydrogels containing microalgae-bacteria

PFAS have demonstrated to affect some aerobic microorganisms applied for wastewater treatment. This study evaluated the nutrient removal of three types of hydrogels containing a consortium of microalgae-bacteria (HB), activated carbon (HC), or both (HBC) in presence of perfluorodecanoic acid (PFDA). The nutrients evaluated were ammonium nitrogen (NH₄-N), nitrate nitrogen (NO₃-N), phosphate (PO₄), and chemical oxygen demand (COD). Fluorine (F^-) concentration and the integrity of HB exposed to PFDA were also determined at the end of experiments to understand the potential sorption and effects of PFDA on hydrogel. The results indicated that the presence of PFDA did affect the nitrification process, 13% and 36% to HB and HBC, respectively. Mass balance confirmed negative impact of PFDA on nitrogen consumption in HB (-31.37%). However, NH₄-N was removed by all types of hydrogels in a range of 61-79%, while PO₄ was mainly removed by hydrogels containing activated carbon (AC), 37.5% and 29.2% for HC and HBC, respectively. The removal of both NH₄ and PO₄, was mainly attributed to sorption processes in hydrogels, which was enhanced by the presence of AC. PFDA was also adsorbed in hydrogels, decreasing its concentration between 18% and 28% from wastewater, and up to 39% using HC. Regarding COD concentration, this increased overtime but was not related to hydrogel structure, since Transmission Electron Microscopy imaging revealed that their structure was preserved in presence of PFDA. COD increasement could be attributed to soluble algal products as well as to PVA leaching from hydrogels. In general, the presence of AC in hydrogels can contribute to mitigate the toxic effect of PFDA over microorganisms involved in biological nutrient removal, and hydrogels can be a technique to partially remove this contaminant from aqueous matrices.

Seawater intrusion pattern recognition supported by unsupervised learning: A systematic review and application

Seawater intrusion is among the world's leading causes of groundwater contamination, as salty water can affect potable water access, food production, and ecosystem functions. To explore such contamination sources, multivariate analysis supported by unsupervised learning tools has been used for decades to aid in water resource pattern recognition, clustering, and water quality data variability characterization. This study proposes a systematic review of these techniques applied for supporting seawater intrusion identification based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and subsequent bibliometric analysis of 102 coastal hydrogeological studies. The most relevant identified methods, including principal components analysis (PCA), hierarchical clustering analysis, K-means clustering, and self-organizing maps, are explained and applied to a case study. Although 74 % of the studies that applied dimensional reduction methods, such as PCA, associated most of the database variance with the salinization process, 77 % of the studies that applied clustering methods associated at least one water sample cluster with the influence of seawater intrusion. Based on the review and a practical demonstration using the open-source R software platform, recommendations are made regarding data preprocessing, research opportunities, and publishing information necessary to replicate and validate the studies.

Hydrochemical controls on arsenic contamination and its health risks in the Comarca Lagunera region (Mexico): Implications of the scientific evidence for public health policy

Nearly half of the world's urban population depends on aquifers for drinking water. These are increasingly vulnerable to pollution and overexploitation. Besides anthropogenic sources, pollutants such as arsenic (As) are also geogenic and their concentrations have, in some cases, been increased by groundwater pumping. Almost 40 % of Mexico's population relies on groundwater for drinking water purposes; much the aquifers in semi-arid and arid central and northern Mexico is contaminated by As. These are agricultural regions where irrigation water is primarily provided from intenstive pumping of the aquifers leading to long-standing declines in the water table. The focus of this study is the main aquifer within the Comarca Lagunera region in Northern Mexico. Although the scientific evidence demonstrates that health effects are associated with long-term exposure to elevated As concentrations, this knowledge has not yielded effective groundwater development and public health policy. A multidisciplinary approach - including the evaluation of geochemistry, human health risk and development and public health policy - was used to provide a current account of these links. The dissolved As concentrations measured exceeded the corresponding World Health Organization guideline for drinking water in 90 % of the sampled wells; for the population drinking this water, the estimated probability of presenting non-carcinogenic health effects was >90 %, and the lifetime risk of developing cancer ranged from 0.5 to 61 cases in 10,000 children and 0.2 to 33 cases in 10,000 adults. The results suggest that insufficient policy responses are due to a complex and dysfunctional groundwater governance framework that compromises the economic, social and environmental sustainability of this region. These findings may valuable to other regions with similar settings that need to design and enact better informed, science-based policies that recognize the value of a more sustainable use of groundwater resources and a healthier population.

Groundwater contamination pathways of phthalates and bisphenol A: origin, characteristics, transport, and fate - A review

Phthalic acid esters (PAEs) or phthalates and bisphenol A (BPA) are emerging organic contaminants (EOCs) that may harm biota and human health. Humans can be exposed to these contaminants by drinking water consumption from water sources such as groundwater. Before their presence in aquifer systems, phthalates and BPA can be found in many matrices due to anthropogenic activities, which result in long-term transport to groundwater reservoirs by different mechanisms and reaction processes. The worldwide occurrence of phthalates and BPA concentrations in groundwater have ranged from 0.1 × 10^-3 to 3 203.33 µg L^-1 and from 0.09 × 10^-3 to 228.04 µg L^-1, respectively. Therefore, the aim of this review is to describe the groundwater contamination pathways of phthalates and BPA from the main environmental sources to groundwater. Overall, this article provides an overview that integrates phthalate and BPA environmental cycling, from their origin to human reception via groundwater consumption. Additionally, in this review, the readers can use the information provided as a principal basis for existing policy ratification and for governments to develop legislation that may incorporate these endocrine disrupting compounds (EDCs) as priority contaminants. Indeed, this may trigger the enactment of regulatory guidelines and public policies that help to reduce the exposure of these EDCs in humans by drinking water consumption.

Occurrence of emerging organic contaminants and endocrine disruptors in different water compartments in Mexico - A review

This review compiles the studies (2007-2021) regarding the occurrence of emerging organic contaminants (EOCs) and endocrine disruptors (EDs) in wastewater, surface water and groundwater in Mexico. A total of 174 compounds were detected, including pharmaceuticals, hormones, plasticizers, personal care products, sweeteners, drugs, and pesticides considered as EDs. The levels of EOCs and EDs varied from ng/L to 140 mg/L, depending on the compound, location, and compartment. Raw wastewater was the most studied matrix, showing a greater abundance and number of detected compounds. Nevertheless, surface waters showed high concentrations of bisphenol-A, butylbenzil-phthalate, triclosan, pentachlorophenol, and the hormones estrone, 17 α-ethinylestradiol, and 17 β-estradiol, which exceeded the thresholds set by international guidelines. Concentrations of 17 α-ethinylestradiol and triclosan exceeding the above-mentioned limits were reported in groundwater. Cropland irrigation with raw wastewater was the principal activity introducing EOCs and EDs into groundwater. The groundwater abundance of EOCs was considerably lesser than that of wastewater, highlighting the attenuation capacity of soils/aquifers during wastewater infiltration. However, carbamazepine and N,N-diethyl-meta-toluamide showed higher concentrations in groundwater than those in wastewater, suggesting their accumulation/concentration in soils/pore-waters. Although the contamination of water resources represents one of the most environmental concerns in Mexico, this review brings to light the lack of studies on the occurrence of EOCs in Mexican waters, which is important for public health policies and for developing legislations that incorporates EOCs as priority contaminants in national water quality guidelines. Consequently, the development of legislations will support regulatory compliance for wastewater and drinking water, reducing the human exposure.

Acquired insights from the long-term surveillance of SARS-CoV-2 RNA for COVID-19 monitoring: The case of Monterrey Metropolitan Area (Mexico)

Wastewater-based epidemiology offers a time- and cost-effective way to monitor SARS-CoV-2 spread in communities and therefore represents a complement to clinical testing. WBE applicability has been demonstrated in a number of cases over short-term periods as a method for tracking the prevalence of SARS-CoV-2 and an early-warning tool for predicting outbreaks in the population. This study reports SARS-CoV-2 viral loads from wastewater treatment plants (WWTPs) and hospitals over a 6-month period (June to December 2020). Results show that the overall range of viral load in positive tested samples was between 1.2 × 10³ and 3.5 × 10⁶ gene copies/l, unveiling that secondary-treated wastewaters mirrored the viral load of influents. The interpretation suggests that the viral titers found in three out of four WWTPs were associated to clinical COVID-19 surveillance indicators preceding 2-7 days the rise of reported clinical cases. The median wastewater detection rate of SARS-CoV-2 was one out of 14,300 reported new cases. Preliminary model estimates of prevalence ranged from 0.02 to 4.6% for the studied period. This comprehensive statistical and epidemiological analysis demonstrates that the applied wastewater-based approach to COVID-19 surveillance is in general consistent and feasible, although there is room for improvements.

Pharmaceuticals and personal care products in water streams: Occurrence, detection, and removal by electrochemical advanced oxidation processes

Pharmaceutical and personal care products (PPCPs) are part of the emerging contaminants (ECs) in the environment due to their known or suspected adverse effects in aquatic and terrestrial organisms, as well as in human health. Presence of PPCPs in aquatic and terrestrial ecosystems has been mainly attributed to the effluents of wastewater treatment plants (WWTPs). Although several PPCPs have been detected in wastewater, their removal from wastewater via biological processes is limited. Removal of PPCPs depends on their chemical structure, concentration, solubility, and technology used to treat the wastewater. Electrochemical Advanced Oxidation Processes (EAOPs) are some of the most sought-after methods for dealing with organic pollutants in water including PPCPs, due to generation of strong oxidants such as •OH, H₂O₂ and O₃^- by using directly or indirectly electrochemical technology. This review is focused on the removal of main PPCPs via EAOPs such as, anodic oxidation, electro-Fenton, photoelectron-Fenton, solar photoelectron-Fenton, photoelectrocatalysis and sonoelectrochemical processes. Although more than 40 PPCPs have been identified through different analytical approaches, antibiotics, anti-inflammatory and antifungal are the main categories of PPCPs detected in different water matrices. Application of EAOPs has been centered in the removal of antibiotics and analgesics of high consumption by using model media, e.g. Na₂SO_4. Photoelectrocatalysis and Electro-Fenton processes have been the most versatile EAOPs applied for PPCPs removal under a wide range of operating conditions and a variety of electrodes. Although EAOPs have gained significant scientific interest due to their effectiveness, low environmental impact, and simplicity, further research about the removal of PPCPs and their by-products under realistic concentrations and media is needed. Moreover, mid-, and long-term experiments that evaluate EAOPs performance will provide knowledge about key parameters that allow these technologies to be scaled and reduce the potential risk of PPCPs in aquatic and terrestrial ecosystem.

Influence of wastewater type in the effects caused by titanium dioxide nanoparticles in the removal of macronutrients by activated sludge

The imminent arrival of nanoparticles (NPs) to the wastewater treatment plants (WWTP) brings concern about their effects, which can be related to the wastewater composition. In this work, the effects of titanium dioxide (TiO₂) NPs in the removal of carbon, nitrogen, and phosphorus by activated sludge bioreactors during the treatment of synthetic, raw, and filtered wastewaters were evaluated. Floc size, compaction of sludge, and morphological interactions between sludge and NPs were also determined. The main effect of TiO₂ NPs was the inhibition of up to 22% in the removal of ammonia nitrogen for all types of wastewaters. This effect is strong dependent on combined factors of TiO₂ NPs concentration and content of organic matter and ammonia in wastewater. The removal of dissolved organic carbon was affected by TiO₂ NPs in lower level (up to 6%) than nitrogen removal for all types of wastewaters. Conversely to adverse effects, the removals of orthophosphate in the presence of TiO₂ NPs were improved by 34%, 16%, and 55% for synthetic, raw, and filtered wastewater, respectively. Compaction of the sludge was also enhanced as the concentrations of NPs increased without alterations in the floc size for all types of wastewaters. Based on TEM and STEM imaging, the main interaction between TiO₂ NPs and the activated sludge flocs was the adsorption of NPs on cell membrane. This means that NPs can be attached to cell membrane during aerobic wastewater treatment, and potentially disrupt this membrane. The effects of TiO₂ NPs on macronutrient removal clearly depended on wastewater characteristics; hence, the use of realistic media is highly encouraged for ecotoxicological experiments involving NPs.

Mapping salinization and trace element abundance (including As and other metalloids) in the groundwater of north-central Mexico using a double-clustering approach

This study aimed to determine the reliability of the double-clustering method to understand the spatial association and distribution of major and minor constituents in the groundwater of an arid endorheic basin in central Mexico (Comarca Lagunera Region). The results of the double-clustering approach were compared with well-known spatial statistics such as spatial autocorrelations (Moran index) and the local indicator of spatial association (LISA). Fifty-five groundwater samples were collected from diverse wells within the basin, and the major ions, metalloids, and trace elements were determined. Overall, the double-clustering analysis was an effective tool for identifying lithogenic/anthropogenic processes occurring in the basin and for establishing zones with high or low abundance of major ions and trace elements, even where processes affecting the groundwater quality were spatially dispersed. Although 89% of the samples showed As higher than the threshold value of 10 μg/L proposed by the World Health Organization for drinking water, both the double-clustering and LISA analyses identified As hotspots in the alluvial aquifer, where the extraction of deeper and warmer groundwater might promote the concomitant release of the metalloids As, Sb, and Ge and the trace elements V and W. Similarly, both statistical analyses identified mountainous sectors where the weathering of silicates and carbonates plays a key role in the abundance of HCO₃^-, Ga, and Ba. However, the LISA analysis failed to identify hotspots of carbonate-derived elements such as Ca, Mg, Sr, and U and silicate-derived elements such as Ca, Mg, K, Sr, Rb, Cs, Pb, Ni, and Y. Otherwise, the double-clustering analysis clearly defined high- and low-concentration zones for all these elements in the study region. Unlike the LISA analysis, the double-clustering approach was also successful in determining alluvial areas with high concentrations of Si and Ti and areas where the concentrations of Na, Cl^-, SO₄^2-, NO₃^-, B, Li, Cu, Re, and Se in groundwater were elevated, increasing the groundwater salinity. Overall, this study demonstrated that the double-clustering is an easy-to-apply approach, capable of visualizing disperse zones where specific anthropogenic processes may threaten the groundwater quality.

Impact of admitting diagnosis on survival from in-hospital cardiac arrest

Background

In-hospital cardiac arrest (IHCA) has an incidence of approximately 200,000 adults per year in the United States. Most events occur in patients without known heart disease. The majority of IHCA data is heterogenous from registries, pooled databases, and insurance claims. We sought to examine single-center data from our institution over a 5-year period.

Purpose

Does the category of admitting diagnosis impact the outcome of IHCA? We hypothesized that patients with cardiac admitting diagnoses would have higher rates of survival to discharge and discharge home due to an increased amount of shockable (ventricular) rhythms.

Methods

All IHCA events over 5 years were identified, and 1,105 charts were examined. Charts with missing information were excluded. Admitting diagnoses were reviewed and categorized by organ system. If there were multiple categories, the most causative was chosen. If equally causative, the most severe was chosen. Charts were organized by survival and sorted by the organ system of the admitting diagnosis. Categories with <10 patients were excluded from analysis. The primary outcome was survival to discharge. Secondary outcomes were initial rhythm, immediate survival, and discharge disposition. Initial rhythms were classified as asystole, pulseless electrical activity (PEA), and ventricular (ventricular tachycardia and fibrillation).

Results

Patients with a cardiac category of admitting diagnosis (Table 1) had the highest rate of IHCA (29.68%) while hematologic had the lowest (1.45%). Immediate survival and survival to discharge respectively were highest for transplant patients (85.71%, 32.14%) and lowest for vascular (37.5%, 12.5%). The initial rhythm was predominantly PEA across all groups. Patients with cardiac and pulmonary diagnoses had higher rates of ventricular rhythms than asystole, which was reversed in the other groups. Discharge disposition (Table 2) home was highest for transplant (55.56%), cancer (52%), and cardiac (49.35%). Cardiac patients were nearly as likely to be discharged to an inpatient facility (45.46%). Pulmonary and gastrointestinal patients were most likely to be discharged to a long-term acute care hospital (28.89% and 28.57%, respectively). Neurologic patients were all, and trauma patients were mostly, discharged to inpatient facilities.

Conclusion(s)

In keeping with established data, cardiac patients were most likely to suffer an IHCA and had more ventricular rhythms than the other groups. However, their initial rhythm was predominantly PEA, they had the third-highest survival to discharge, and were predominantly discharged home. Transplant and trauma patients surprisingly had the highest survival to discharge while gastrointestinal and infectious patients had the lowest. The data presented herein can serve as a guide for clinicians to better predict survival to discharge and disposition for their patients who suffer an IHCA.

Funding Acknowledgement

Type of funding sources: None.

Determining nitrate and sulfate pollution sources and transformations in a coastal aquifer impacted by seawater intrusion-A multi-isotopic approach combined with self-organizing maps and a Bayesian mixing model

Over the past few decades, the La Paz aquifer system in Baja California Sur, Mexico, has been under severe pressure due to overexploitation for urban water supply and agriculture; this has caused seawater intrusion and deterioration in groundwater quality. Previous studies on the La Paz aquifer have focused mainly on seawater intrusion, resulting in limited information on nitrate and sulfate pollution. Therefore, pollution sources have not yet been identified sufficiently. In this study, an approach combining hydrochemical tools, multi-isotopes (δ²H_H2O, δ¹⁸O_H2O, δ¹⁵N_NO3, δ¹⁸O_NO3, δ³⁴S_SO4, δ¹⁸O_SO4), and a Bayesian isotope mixing model was used to estimate the contribution of different nitrate and sulfate sources to groundwater. Results from the MixSIAR model revealed that seawater intrusion and soil-derived sulfates were the predominant sources of groundwater sulfate, with contributions of ~43.0% (UI₉₀ = 0.29) and ~42.0% (UI₉₀ = 0.38), respectively. Similarly, soil organic nitrogen (~81.5%, UI₉₀ = 0.41) and urban sewage (~12.1%, UI₉₀ = 0.25) were the primary contributors of nitrate pollution in groundwater. The dominant biogeochemical transformation for NO₃^- was nitrification. Denitrification and sulfate reduction were discarded due to the aerobic conditions in the study area. These results indicate that dual-isotope sulfate analysis combined with MixSIAR models is a powerful tool for estimating the contributions of sulfate sources (including seawater-derived sulfate) in the groundwater of coastal aquifer systems affected by seawater intrusion.

Does Alumina-Refining Waste Increase the Nutrient Level in Tropical Mesotrophic Floodplain Lakes?

Several floodplain lakes of the Orinoco River have been impacted by alkaline alumina-refining waste including red mud, a by-product from the Bayer process. Some of these impacted lakes have undergone algal overgrowth, which has been detected due to the unusual green color of water and the dissolved oxygen oversaturation. Thus, we conducted sampling campaigns in impacted and non-impacted lakes to measure the concentration of nitrogen (N) and phosphorous (P) in water to detect any change in the nutrient levels. Despite the content of N and P in red mud is low, our findings suggest that N is released from red mud accumulated in bed sediments to the water column in the impacted lakes, increasing the content of total N. However, the total P concentrations in impacted lakes were not affected from their background values probably due to the strong adsorptive behavior of P onto red mud minerals.

A review of the current environmental status and human health implications of one of the most polluted rivers of Mexico: The Atoyac River, Puebla

For more than 4 decades, the Atoyac River in central Mexico has been subjected to anthropogenic stresses driven by the urban and industrial wastewater discharges, as well as leachates coming from intensive peri-urban agricultural practices. This review provides an overview of the levels of organic, inorganic and microbiological contaminants found during the past 10 years in waters and bed sediments of the Atoyac system, and the implication of this pollution over the human health. Overall, the Atoyac waters present high loads of nutrients, BOD₅, COD, TDS and trace elements (Al, Fe, Zn, Pb, Cr, Cu). The bacteriological pollution is extremely high; with total coliform values of up to 10¹² MPN/100 mL. Anthropogenic organics such as PAHs, PCBs and organophosphate and organochlorine pesticides have been also found in river waters. Although pharmaceuticals have not been surveyed in a broad range, considerable concentrations of Triclosan, Naproxen and Diclofenac have been detected in river waters. Regarding sediments, anoxic conditions promote the precipitation/enrichment of sulfides and associated trace elements (As, Fe, Mo, Pb, Zn, Cu, Cr). Microplastics in sediments included films (25.9%), fragments (22.2%), fibers (14.8%) and pellets (11.1%). Fibers from the textile industry were found to accumulate in the aquatic biota of the Valsequillo reservoir. Quality indexes demonstrated that waters and sediments in the Puebla City are the most contaminated. The water of this zone reached the classification of strongly contaminated, whereas the sediments showed the most accumulation/enrichment of major and trace elements of the riverine zones. The main pathologies found in humans were gastrointestinal diseases, whereas children living in vulnerable zones showed elevated levels of cancer biomarkers. Studies have indicated a high risk of suffering cancerous diseases in children that consume contaminated groundwater and high risks for developing non-cancerous diseases in adults working with river-irrigated soils and children consuming milk with high content of river-derived Arsenic.

POS1218 SAFETY AND EFFICACY OF ANAKINRA IN SEVERE SARS-COV2 INFECTION (COVID19) AT A TERTIARY HOSPITAL

Background:

SARS-CoV-2 virus is a novel coronavirus that causes COVID-19 disease, which in its most severe form produces life-threatening atypical pneumonia and ARDS. Coronaviruses induce dysregulation of the immune system resulting in a cytokine storm syndrome with activation of the macrophage mediated mainly by IL-1 and IL-6. Although there is no specific treatment to date, researchers have explored novel approaches through targeting both IL-6 and IL-1. Anakinra is a recombinant human IL-1 receptor antagonist that prevents IL-1β and IL-1α binding and therefore blocks signal transduction. Its high bioavailability, rapid action, relatively short half-life and good safety profile make it a promising drug.

Objectives:

Analyse the experience of administering Anakinra for severe forms of COVID19 in patients hospitalised at a tertiary hospital.

Methods:

Retrospective single-center study in which all patients admitted for COVID-19 and treated with Anakinra from April 1st to the end of the 1st wave (July 2020) were included. Medical records were reviewed to collect demographic, clinical and lab test data, using Brescia-COVID respiratory severity scale, SaFi, CRP, Ferritin, LDH and lymphocytes. Variables were assessed at baseline, 72h and 7 days after treatment initiation. Descriptive statistical analysis was performed, including a sub-analysis of patients who received anakinra as the only biological treatment.

Results:

54 patients were included, of which 37 male (68.5%) with a median age of 69.5 years (36-94). Comorbidities were lung disease 14 pts (25.9%), cardiovascular disease 39 pts (72.2%), Diabetes Mellitus 11 pts (20.4%), kidney disease and rheumatic disease each in 6 pts (11.1%), and immunosuppression 13 pts (24.1%). Each patient received a mean of 4.85 doses of anakinra (± 3.96). Other therapies included low-dose steroids (70.3%); high-dose steroids: 1mg/kg (87%), bolus (24%), Tocilizumab (57.4%), Infliximab (24.1%), Lopinavir/Ritonavir (48%), Hydroxychloroquine (94.4%), and Azithromycin (79.6%). Mortality was 22% overall, 75% due to COVID19, 8.3% due to infectious complications and 16.7% due to non-infectious complications. In the group receiving Anakinra as only biological drug, mortality accounted for 17.9% of patients, 75% due to COVID19 and 25% to non-infectious complications. No adverse effects related to anakinra were observed.

General group (n=54)Group receiving anakinra as only biological drug (n=23)PBaselineAfter 72hAfter 7dBaselineAfter 72hAfter 7dBrescia-COVID1.65 (0.95)1.63 (1.13)1.73 (1.19)1.09 (0.8)0.91 (0.88)1.09 (0.8)Mean(SD)Values:Values:Values:Values:Values:Values:NS0: 11.1%0: 16.7%0: 7.9 %0: 26.1%0: 39.1%0: 8.7 %1: 31.5%1: 27.8%1: 52.6%1: 47.8%1: 34.8%1: 82.6%2: 42.6%2: 38.9%2: 18.4%2: 21.7%2: 21.7%2: 8.7%3: 53.7%3: 7.4%3: 7.9%3:4.34%3: 4.34%3: 0%4: 3.7%4: 9.3%4: 13.2%4: 0%4: 0%4: 0%SaFi222.60 (115.2)240.51 (117.6)250.95 (102.6)306.35 (124.7)316.04 (129.8)300.36 (135.4)NSMean (SD)Values:Values:Values:Values:Values:Values:>300:>300:>300:>300:>300:>300:25.9%24.5 %34.2 %56,52%52.2 %45.46 %201-299201-299:201-299:201-299:201-299:201-299:: 14.8%26.4%34.2%17.39%21.7%27.27%<201:<201:<201:<201:<201:<201:59.3%49%31.6%26.1%26.1%27.27%Lymphocytes, 10^3/microLMean (SD)1.07 (1.5)5.16 (3.05)1.15 (2.49)0.88 (0.56)1.25 (0.79)1.15. (2.4)NSFerritine,ng/mlMean (SD)1098.4 (944.8)1080.23 (873.9)1069.19 (989.42)1112.76 (621.80)903.25 (385.49)704.14 (261.86)NSC-reactive protein, mg/LMean (SD)38.78 (37.58)21.46 (20.17)7 (6)50 (6.38)34.67 (23.3)19.96 (28.92)NSLDH, U/LMean (SD)387.64 (163.1)394.98 (209.32)374.26 (157.63)326.38 (111.66)308 (116.59)355 (151.96)NSRespiratory improvement*N/A20.37%51.85%N/A30.43%69.5%.007Lab test improvement**N/A51.85%77.78%N/A60.87%78.2%NS

* SaFi normalised or increased 100 mmHg or more

** Improvement of 2 or more analytic variables

Conclusion:

Anakinra in severe SARS-CoV-2 infection offers respiratory improvement and partial lab tests improvement. No adverse effects were observed.

Acknowledgements:

We wish to acknowledge Puerta de Hierro Majadahonda COVID19 task force and all the patients and staff affected by the pandemic.

Disclosure of Interests:

None declared

Estimation of nitrate pollution sources and transformations in groundwater of an intensive livestock-agricultural area (Comarca Lagunera), combining major ions, stable isotopes and MixSIAR model

The identification of nitrate (NO₃^-) sources and biogeochemical transformations is critical for understanding the different nitrogen (N) pathways, and thus, for controlling diffuse pollution in groundwater affected by livestock and agricultural activities. This study combines chemical data, including environmental isotopes (δ²H_H2O, δ¹⁸O_H2O, δ¹⁵N_NO3, and δ¹⁸O_NO3), with land use/land cover data and a Bayesian isotope mixing model, with the aim of reducing the uncertainty when estimating the contributions of different pollution sources. Sampling was taken from 53 groundwater sites in Comarca Lagunera, northern Mexico, during 2018. The results revealed that the NO₃^- (as N) concentration ranged from 0.01 to 109 mg/L, with more than 32% of the sites exceeding the safe limit for drinking water quality established by the World Health Organization (10 mg/L). Moreover, according to the groundwater flow path, different biogeochemical transformations were observed throughout the study area: microbial nitrification was dominant in the groundwater recharge areas with elevated NO₃^- concentrations; in the transition zones a mixing of different transformations, such as nitrification, denitrification, and/or volatilization, were identified, associated to moderate NO₃^- concentrations; whereas in the discharge area the main process affecting NO₃^- concentrations was denitrification, resulting in low NO₃^- concentrations. The results of the MixSIAR isotope mixing model revealed that the application of manure from concentrated animal-feeding operations (∼48%) and urban sewage (∼43%) were the primary contributors of NO₃^- pollution, whereas synthetic fertilizers (∼5%), soil organic nitrogen (∼4%), and atmospheric deposition played a less important role. Finally, an estimation of an uncertainty index (UI90) of the isotope mixing results indicated that the uncertainties associated with atmospheric deposition and NO₃^--fertilizers were the lowest (0.05 and 0.07, respectively), while those associated with manure and sewage were the highest (0.24 and 0.20, respectively).

Temporal and spatial variability of heavy metals in bottom sediments and the aquatic macrophyte Paspalum repens of the Orinoco River floodplain lagoons impacted by industrial activities

This study investigated the water parameters and the levels of several heavy metals in leaves and roots of the aquatic macrophyte Paspalum repens and in bed sediments of one unpolluted lagoon and two polluted lagoons of the Orinoco River floodplain to know the impact of the alumina refining wastes on these ecosystems. The sampling was performed during four hydrological periods, covering one hydrological year. Chemical parameters in water (pH, conductivity, and total dissolved solids) and the levels of Al, Pb, Cr, and Cu in sediments were the highest in Macanillal (LMaca) lagoon, whereas sediments of Punta Cuchillo (LPC) lagoon also had elevated concentrations of Al and Fe in comparison with Las Aruhacas (LArh) lagoon (unpolluted lagoon). Chemical parameters in waters returned almost to natural values during high water stage because of the huge inundation of the Orinoco River during the high discharge periods. The solid/liquid discharges of industrial effluents over these systems also affected the grain size distribution of sediments in the lagoons. In all the studied lagoons, the distribution of elements in leaves of P. repens was in the order K ≥ Cr > Ca > Mg > Al > Fe > Mn > Cu > Pb, whereas Al was found to be the more abundant element in roots. The high abundance of Cr in P. repens was related with the high Cr accumulation potential shown by aquatic macrophytes. Despite this, the concentration of elements in P. repens did not show differences between the plants collected in the polluted lagoons versus the plants collected in the unpolluted lagoon. This suggests that P. repens is unsuitable for bio-monitoring studies of heavy metals in these aquatic environments impacted by alkaline residues.

Tracking nitrate and sulfate sources in groundwater of an urbanized valley using a multi-tracer approach combined with a Bayesian isotope mixing model

Over the past decades, groundwater quality has deteriorated worldwide by nitrate pollution due to the intensive use of fertilizers in agriculture, release of untreated urban sewage and industrial wastewater, and atmospheric deposition. Likewise, groundwater is increasingly polluted by sulfate due to the release of domestic, municipal and industrial wastewaters, as well as through geothermal processes, seawater intrusion, atmospheric deposition, mineral dissolution, and acid rain. The urbanized and industrialized Monterrey valley has a long record of elevated nitrate and sulfate concentrations in groundwater with multiple potential pollution sources. This study aimed to track different sources and transformation processes of nitrate and sulfate pollution in Monterrey using a suite of chemical and isotopic tracers (δ²H-H₂O, δ¹⁸O-H₂O, δ¹⁵N-NO₃, δ¹⁸O-NO₃ δ³⁴S-SO₄, δ¹⁸O-SO₄) combined with a probability isotope mixing model. Soil nitrogen and sewage were found to be the most important nitrate sources, while atmospheric deposition, marine evaporites and sewage were the most prominent sulfate sources. However, the concentrations of nitrate and sulfate were controlled by denitrification and sulfate reduction processes in the transition and discharge zones. The approach followed in this study is useful for establishing effective pollution management strategies in contaminated aquifers.

Dynamics of major and trace elements during seawater intrusion in a coastal sedimentary aquifer impacted by anthropogenic activities

This study analyzed the dynamics of major ions and trace elements along the groundwater flow path of the coastal sedimentary Todos Santos aquifer in Baja California Sur, Mexico, moderately impacted by anthropogenic activities. The results indicate that the elements Ca²⁺, Mg²⁺, Ba²⁺, Sr²⁺ and Li⁺ are mobilized from the aquifer matrix during seawater intrusion, whereas the alkali-elements Na⁺, K⁺ and Rb⁺ are removed from solution, possibly due to cationic exchange process. The anions HCO^3- and SO₄^2- and the elements I and B are mobilized due to carbonate mineral weathering, whereas dissolved silica and the halides Br^- and F^- behave conservatively during salinization. Groundwater NO₃^- is provided by sewage infiltration. Regarding trace elements behavior, we identify three groups: i) elements that are mobilized during saline intrusion (Fe, Co, V, Se, Re), ii) elements revealing low or no mobilization (Mo, Ni, Cr, Ta, W) and iii) elements that show an undefined tendency (U, As, Ge, Sb, Cu, Mn). The U and NO₃^- levels in groundwater should be considered carefully because several wells have concentrations close to the permissible levels. This study may be useful as reference for knowing the possible effect of salinization in coastal aquifers under sea level rise scenarios driven by climate change.

The application of a haemorrhage assessment tool in evaluating control of bleeding in a pilot trauma haemorrhage trial

OBJECTIVES

To determine whether it was feasible to use a haemorrhage assessment tool (HAT) within a trauma trial and whether the data obtained could differentiate patients who had achieved haemostasis.

BACKGROUND

Major haemorrhage is one of the leading causes of death worldwide, affecting 40% of trauma patients. Clinical trials evaluating haemostatic interventions often use transfusion outcomes as a primary endpoint. Transfusion is highly dependent on local practice, limiting its reliability as a robust, transferable endpoint.

METHODS

A five-point HAT questionnaire was applied to participants enrolled into the EFIT-1 trial. This RCT evaluated the feasibility of administering a 6 g fibrinogen concentrate to patients with severe trauma haemorrhage.

RESULTS

Of participants, 98% completed a HAT; 75% participants had 'achieved haemostasis' at the time of tool completion, as determined by clinical acumen alone. HAT scores were able to differentiate which participants required transfusion after 3 h. Of participants, 56% were transfused red blood cells when they scored 0-2, compared to 17% with HAT scores between 3 and 5.

CONCLUSION

This study has confirmed the feasibility of using a HAT during the emergency care of patients suffering trauma haemorrhage, and future studies should be conducted to determine its value as an endpoint in haemostasis studies.

Heavy Metal Enrichment Factors in Fluvial Sediments of an Amazonian Basin Impacted by Gold Mining

Artisanal and small-scale gold mining (ASGM) has been performed in the southern Ecuadorian Amazon since the colonial period. However, its effects on fluvial systems have been poorly investigated. Thus, in order to calculate the normalized enrichment factors (NEF) of several heavy metals in fluvial sediments of the Zamora River basin (Ecuadorian Amazon), we analyzed bottom sediments along ASGM-affected and unaffected river sections. The results indicated that sediments of the Congüime River have NEF between 2.2 and 2.3 for Cu (moderate contamination) and higher than 3 for Mn, Zn, Pb, and Hg (severe contamination). Similarly, a severe contamination is also observed in the lower Nangaritza River, due to sediments of this sector have NEF > 3 for Zn, Pb, and Hg. Bottom sediments from the Nambija and Zamora rivers showed a severe contamination with Hg (NEF > 3), suggesting the existence of ASGM activities in the upper Zamora River basin.

Survey of 218 organic contaminants in groundwater derived from the world's largest untreated wastewater irrigation system: Mezquital Valley, Mexico

The Mezquital Valley system is the world's oldest and largest example with regard to use of untreated wastewater for agricultural irrigation. Because of the artificial high recharge associated with the Mezquital Valley aquifers, groundwater is extracted for human consumption, and there are plans to use this groundwater as a water resource for Mexico City. Thus, this study analyzed 218 organic micro-contaminants in wastewater, springs, and groundwater from Mezquital Valley. Five volatile organic compounds (VOCs) and nine semi-volatile organic compounds (SVOCs) were detected in the wastewater used for irrigation. Only two SVOCs [bis-2-(ethylhexyl) phthalate and dibutyl phthalate] were detected in all the wastewater canals and groundwater sources, whereas no VOCs were detected in groundwater and springs. Of the 118 pharmaceutically active compounds (PhACs) and 7 reproductive hormones measured, 65 PhACs and 3 hormones were detected in the wastewater. Of these, metformin, caffeine, and acetaminophen account for almost sixty percent of the total PhACs in wastewater. Nevertheless, 23 PhACs were detected in groundwater sources, where the majority of these compounds have low detection frequencies. The PhACs sulfamethoxazole, N,N-diethyl-meta-toluamide, carbamazepine, and benzoylecgonine (primary cocaine metabolite) were frequently detected in groundwater, suggesting that although the soils act as a filter adsorbing and degrading the majority of the organic pollutant content in wastewater, these PhACs still reach the aquifer. Therefore, the presence of these PhACs, together with the high levels of the endocrine disruptor bis-2-(ethylhexyl) phthalate, indicate that water sources derived from the recharge of the studied aquifers may pose a risk to consumer health.

Assessment of major ions and trace elements in groundwater supplied to the Monterrey metropolitan area, Nuevo León, Mexico

The Monterrey metropolitan area (MMA) is the third greatest urban area and the second largest economic city of Mexico. More than four million people living in this megacity use groundwater for drinking, industrial and household purposes. Thus, major ion and trace element content were assessed in order to investigate the main hydrochemical properties of groundwater and determine if groundwater of the area poses a threat to the MMA population. Hierarchical cluster analysis using all the groundwater chemical data showed five groups of water. The first two groups were classified as recharge waters (Ca-HCO₃) coming from the foothills of mountain belts. The third group was also of Ca-HCO₃ water type flowing through lutites and limestones. Transition zone waters of group four (Ca-HCO₃-SO₄) flow through the valley of Monterrey, whereas discharge waters of group 5 (Ca-SO₄) were found toward the north and northeast of the MMA. Principal component analysis performed in groundwater data indicates four principal components (PCs). PC1 included major ions Si, Co, Se, and Zn, suggesting that these are derived by rock weathering. Other trace elements such as As, Mo, Mn, and U are coupled in PC2 because they show redox-sensitive properties. PC3 indicates that Pb and Cu could be the less mobile elements in groundwater. Although groundwater supplied to MMA showed a high-quality, high mineralized waters of group 5 have NO₃^- concentrations higher than the maximum value proposed by international guidelines and SO₄^2-, NO₃^-, and total dissolved solid concentrations higher than the maximum levels allowed by the Mexican normative.

Manganese and Mercury Levels in Water, Sediments, and Children Living Near Gold-Mining Areas of the Nangaritza River Basin, Ecuadorian Amazon

Artisanal and small-scale gold-mining activities performed in mountain areas of the Southern Ecuadorian Amazon have incorporated several heavy metals into the aquatic systems, thus increasing the risk of exposure in populations living in adjacent zones. Therefore, the objective of this study was to evaluate the contamination levels of mercury (Hg) and manganese (Mn) in several rivers of the Nangaritza River basin and assess the exposure in school-aged children residing near the gold-mining zones. River water and sediment samples were collected from a highly contaminated (HEx) and a moderately contaminated (MEx) zones. Hair Mn (MnH) and urinary Hg (HgU) levels were determined in school-aged children living in both zones. High concentrations of dissolved Mn were found in river waters of the HEx zone (between 2660 and 3990 µg l(-1)); however, Hg levels, in general, were lower than the detection limit (DL; <1.0 µg l(-1)). Similarly, Mn levels in sediments were also increased (3090 to 4086 µg g(-1)). Median values of MnH in children of the HEx and MEx zones were 5.5 and 3.4 µg g(-1), respectively, whereas the median values of HgU concentrations in children living in the HEx and MEx zones were 4.4 and 0.62 µg g-creat(-1), respectively. Statistically significant differences were observed between both biomarkers in children from the HEx and MEx zones. In addition, boys presented significantly greater MnH levels in both zones. The greater MnH values were found in children living in alluvial areas, whereas children living in the high mountain areas, where some ore-processing plants are located close to or inside houses and schools, had the greater HgU concentrations. In summary, the data reported in this paper highlights that artisanal and small-scale gold-mining activities can not only produce mercurial contamination, that can also release other heavy metals (such as Mn) that may pose a risk to human health.

Costs and quality of life associated with acute upper gastrointestinal bleeding in the UK: cohort analysis of patients in a cluster randomised trial

OBJECTIVES

Data on costs associated with acute upper gastrointestinal bleeding (AUGIB) are scarce. We provide estimates of UK healthcare costs, indirect costs and health-related quality of life (HRQoL) for patients presenting to hospital with AUGIB.

SETTING

Six UK university hospitals with >20 AUGIB admissions per month, >400 adult beds, 24 h endoscopy, and on-site access to intensive care and surgery.

PARTICIPANTS

936 patients aged ≥18 years, admitted with AUGIB, and enrolled between August 2012 and March 2013 in the TRIGGER trial of AUGIB comparing restrictive versus liberal red blood cell (RBC) transfusion thresholds.

PRIMARY AND SECONDARY OUTCOME MEASURES

Healthcare resource use during hospitalisation and postdischarge up to 28  days, unpaid informal care, time away from paid employment and HRQoL using the EuroQol EQ-5D at 28  days were measured prospectively. National unit costs were used to value resource use. Initial in-hospital treatment costs were upscaled to a UK level.

RESULTS

Mean initial in-hospital costs were £2458 (SE=£216) per patient. Inpatient bed days, endoscopy and RBC transfusions were key cost drivers. Postdischarge healthcare costs were £391 (£44) per patient. One-third of patients received unpaid informal care and the quarter in paid employment required time away from work. Mean HRQoL for survivors was 0.74. Annual initial inhospital treatment cost for all AUGIB cases in the UK was estimated to be £155.5 million, with exploratory analyses of the incremental costs of treating hospitalised patients developing AUGIB generating figures of between £143 million and £168 million.

CONCLUSIONS

AUGIB is a large burden for UK hospitals with inpatient stay, endoscopy and RBC transfusions as the main cost drivers. It is anticipated that this work will enable quantification of the impact of cost reduction strategies in AUGIB and will inform economic analyses of novel or existing interventions for AUGIB.

TRIAL REGISTRATION NUMBER

ISRCTN85757829 and NCT02105532.

Temporal distribution of heavy metal concentrations in oysters Crassostrea rhizophorae from the central Venezuelan coast

The oyster Crassostrea rhizophorae is a bivalve abundant in Venezuelan estuaries and consumed by local populations. No known values have been reported on trace metals in oysters from the central Venezuelan coast. We report the concentrations of Al, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, Sr, V and Zn in the soft parts of C. rhizophorae, which were collected bimonthly between March 2008 and March 2009, at two sampling areas from the Central Venezuelan Coast: Buche estuary and Mochima estuary. Our results show that for each metal there is a similar temporal variation pattern. The concentrations of the heavy metals reported in this work are useful as reliable baselines and can be used for comparison in future environment studies. Concentrations in C. rhizophorae from the Buche estuary can be interpreted to be high on a global scale for Cd, Cu, Ni and Mn, indicating atypically raised bioavailabilities.

Slow gallbladder emptying reverts to normal but small intestinal transit of a physiological meal remains slow in celiac patients during gluten-free diet

BACKGROUND

Alterations of small intestinal transit and gallbladder (GB) motility have been reported in celiac disease (CD) in studies involving, in most cases, non-physiological experimental conditions and artificial stimuli to motility. Our aims were to quantitate non-invasively small intestinal transit time and GB emptying during administration of a physiological and palatable solid meal, and to assess the effect of gluten-free diet (GFD).

METHODS

We simultaneously measured mouth-to-cecum transit time (MCTT) using a validated H(2) breath test, and GB motility using ultrasonography. We studied CD patients before (n = 19) and during (n = 14) GFD, and healthy volunteers (n = 24) following administration of a physiological solid meal (Kcal 539).

KEY RESULTS

Mouth-to-cecum transit time was more prolonged in CD (mean ± SEM: 235 ± 96 min) than in controls (169 ± 65 min, P = 0.0039). The GB fasting volume and postprandial residual volume were significantly higher in CD than in controls, and GB emptying constant was slower in CD than in controls. During GFD, GB emptying reverted to normal, but MCTT remained unchanged (229 ± 69 min) and more prolonged in CD than in controls (P = 0.0139). During GFD, duodenal infiltration with lymphocytes and mast cells persisted higher than that in controls, and the number of mast cells lying in proximity of nervous endings did not change.

CONCLUSIONS & INFERENCES

Slow postprandial MCTT in response to a physiological meal does not revert to normal during GFD, an effect mirroring incomplete histopathologic recovery.

[Descriptive epidemiological study of the diagnosis of detrusor overactivity in urodynamic units in Spain]

OBJECTIVE

To know the relative weight of the diagnosis of detrusor overactivity (DO) in the Urodynamic Units of Spain and relate the prevalence of the overactive bladder (OB) syndrome.

MATERIAL AND METHOD

An epidemiological, descriptive, retrospective, multicenter, national study conducted according to registered data in 47 Urodynamic Units covering the Spanish geographic area in the different areas of health distributed among the regional communities. These data inform about the health care received by 35% of the Spanish population. Urodynamic diagnoses and related variables, recorded during 2007 and 2008, were collected.

RESULTS

A mean of 346.45 (SD=304.03) and 349.72 (SD=296.49) urodynamics studies per care unit were performed in women during 2007 and 2008, respectively and 181.20 (SD=212.71) and 195.68 (SD=257.58) in men. The relative weight of the diagnosis of non-neurogenic DO in women per unit was 31.39% and 35.28%, in 2007 and 2008, and in men was 21.06% and 20.43%. The diagnostic capacity of DO was 19.28 new cases per 100,000 inhabitants/year. The diagnosis of non-neurogenic DO in the woman accounts for one third of all the urodynamic/year diagnoses and more than half of the diagnoses of DO. In men, DO accounts for 25% of the diagnoses, the most frequent one being that associated with benign prostatic hyperplasia, followed by that of neurogenic cause. Approximately half of the DO diagnoses in children correspond to non-neurogenic DO.

CONCLUSIONS

The differences between the capacity of diagnosis of DO (ratio per 100,000 inhabitants) is far from many of the estimations of the prevalence of OB (relationship %). The doubt may exist about whether part of this quota is secondary and not-idiopathic, given the large difference between the frequency of OB and the capacity of diagnosis of DO.

[Corneal tumor secondary to trichiasis]

A rare lesion of secondary amyloidosis of the cornea caused by trichiasis is reported. A 33-year-old Asian woman presented with progressive decrease of visual acuity of the right eye evolving over several years, combined with the growth of a lower budding, gelatinous, pink corneal mass located next to an inferior lid trichiasis. The treatment consisted of eyelid surgery for trichiasis, followed by ablation of the corneal lesion by anterior keratectomy. After 14 months of follow-up, no recurrence was observed. Visual acuity is 9/10 P3 without correction. Pathological examination of the mass revealed secondary corneal amyloidosis, AL type (light chains), rarely reported in the literature (18 cases). No other organ involvement by amyloidosis was identified. Corneal amyloidosis is a rare complication of trichiasis. To avoid recurrence, this anomaly should be recognized as the cause and should be treated prior to removal of the corneal lesion.

Amazonia through time: Andean uplift, climate change, landscape evolution, and biodiversity

The Amazonian rainforest is arguably the most species-rich terrestrial ecosystem in the world, yet the timing of the origin and evolutionary causes of this diversity are a matter of debate. We review the geologic and phylogenetic evidence from Amazonia and compare it with uplift records from the Andes. This uplift and its effect on regional climate fundamentally changed the Amazonian landscape by reconfiguring drainage patterns and creating a vast influx of sediments into the basin. On this "Andean" substrate, a region-wide edaphic mosaic developed that became extremely rich in species, particularly in Western Amazonia. We show that Andean uplift was crucial for the evolution of Amazonian landscapes and ecosystems, and that current biodiversity patterns are rooted deep in the pre-Quaternary.