Ecotoxicological endpoints, are they useful tools to support ecological status assessment in strongly modified water bodies?

Although man-made reservoirs represent an important water supply source in countries where water scarcity has become a problem, little work has been done on the evaluation of their ecological status. Taking this in account, the general aim of this study was to assess the usefulness of ecotoxicological endpoints in the potential ecological status characterization of water reservoirs, with the purpose of their possible integration in evaluation programs developed under the Water Framework Directive (WFD). To achieve this purpose, a group of bioassays were selected to evaluate both water and sediment compartments at the Alqueva reservoir (the biggest from the Iberian Peninsula), with representative species from different taxonomic and functional groups: Vibrio fischeri, Thamnocephalus platyurus, Daphnia magna and Heterocypris incongruens. The ecotoxicological assessment showed that sublethal endpoints (e.g., luminescence, growth or reproduction), would be more useful and sensitive to identify toxicity patterns in this type of water body. In general, the results from this ecotoxicological toolbox agreed with the potential ecological status established according to the WFD, which indicates that the bioassays complement the ecological assessment. Furthermore, the use of an ecotoxicological approach can be extremely useful, especially in cases where the biotic indices are difficult to establish, such as in man-made reservoirs. However, when pollutant concentrations are very low, and/or when nutrients and organic matter concentrations are high, the two approaches do not fit, requiring further research to determine which organisms are more sensitive and the best biotic indices to use under those conditions.

Occurrence and potential risk of currently used pesticides in sediments of the Alqueva reservoir (Guadiana Basin)

The evaluation of sediments, concerning to pesticides, constitutes an important step for the understanding of the principal sources of contamination of the surface water. Hence, the purpose of this study was to evaluate for the first time the occurrence, distribution and risk of pesticides in sediments of the Alqueva reservoir, the largest reservoir in the Europe. For this purpose, the occurrence of 22 pesticides and some of their degradation products was determined in surficial sediments of the Alqueva reservoir. To assess the potential risk on ecosystem, the measured concentrations of pesticides were compared with regulatory and toxicological benchmarks. Of the 22 pesticides analysed, only 8 were detected. Diuron was the pesticide detected in greater concentration, followed by terbuthylazine and chlortoluron. The sediments most polluted by pesticides were from Lucefécit, constituted totally by fine particles (<0.063 mm) and with high values of organic matter, and are located nearby large agricultural fields. The risk assessment allowed us to conclude that the sediments from the Alqueva reservoir presented low risk, concerning to pesticides, for the various communities that integrate the aquatic ecosystems. However, some of the compounds detected present a high potential for bioaccumulation that may lead to their bioamplification in the trophic chain, reaching concentrations higher than their acceptable daily intake, putting, in this way the populations at risk.

Public perception of dermatologists and comparison with other medical specialties: results from a national survey

BACKGROUND

The public's perception of dermatologists in the United States is unknown.

OBJECTIVE

We sought to determine the US public's perception of how dermatologists spend time professionally and to compare the public's perception of dermatologists with physicians from other medical specialties.

METHODS

We administered a telephone survey to the US public using the validated random digit dialing method.

RESULTS

We made 2353 telephone calls to randomly selected active numbers from 10 US area codes. A total of 800 adults (34%) completed the telephone survey. Overall, 46% of participants perceived that dermatologists spend a majority of their time managing skin cancer. Of respondents, 27% perceived that dermatologists spend a majority of their time performing cosmetic procedures. Compared with dermatologists, primary care physicians were perceived to have a more critical profession by 63% of participants, a more difficult job by 54% of respondents, and work longer hours by 92% of those surveyed. Similar findings were observed when dermatologists were compared with cardiologists. The public perceived dermatologists to earn more than primary care physicians but less than cardiologists or plastic surgeons.

LIMITATIONS

Potential differences may exist between responders and nonresponders.

CONCLUSIONS

Educational efforts are necessary to better inform public understanding and perception of dermatologists' expertise.

Risk assessment of pesticides detected in surface water of the Alqueva reservoir (Guadiana basin, southern of Portugal)

The purpose of this study was to evaluate the potential impact of the pesticides detected in the Alqueva reservoir (Guadiana Basin, South Iberian Peninsula) on the aquatic organisms belonging to this ecosystem. For this purpose, the occurrence and risk assessment of 25 pesticides and of a number of their degradation products were determined in the Alqueva surface waters. The areas (sampling stations) most polluted by pesticides were Sra. Ajuda, Lucefecit and Álamos in the northern and in the middle portions of the reservoir, respectively. The aquatic risk assessment revealed that from the various compounds analysed terbuthylazine, chlorfenvinphos and diazinon presented non-acceptable risk when maximum concentrations were used as the measured environmental concentrations (MEC). The locations that had more samples with risk quotients higher than 1 (high risk) were Sra. Ajuda followed by Lucefécit. The use of risk assessment allowed us to conclude that, despite that the pesticides' concentrations in the water column fulfil the European environmental quality standards, a number of the compounds show a high ecotoxicological risk for the aquatic organisms in the Alqueva ecosystem. The results thereby demonstrate that to have an efficient risk management process, the regulatory authorities of each country must consider an integrative chemical and ecotoxicological approach.

Integrated environmental assessment of freshwater sediments: a chemical and ecotoxicological approach at the Alqueva reservoir

In order to study the pollution of an aquatic ecosystem, it is necessary to analyze not only the levels of chemical pollutants in water, but also those accumulated in the sediment matrix, as well as to assess its ecotoxicological status. The Alqueva reservoir, the largest artificial lake in Europe, was chosen as case study as it constitutes the most important water supply source in southern Portugal. It is located in the Guadiana River Basin, in a semi-arid region with high levels of water scarcity and where agriculture is one of the main activities. The evaluation of sediments comprised: (1) physical and chemical analysis (grain size, pH, organic matter, nitrogen, phosphorus); (2) potentially toxic trace elements (Cu, As, Pb, Cr, Cd, Zn and Ni); and (3) ecotoxicological evaluation with Vibrio fischeri, Thamnocephalus platyurus, Daphnia magna, and Heterocypris incongruens. Total trace element concentrations indicated that As, Cd, and Pb surpassed the Canadian levels for the protection of aquatic life, in most of Alqueva's sites. The results of the toxicity assessment showed that some locations induced acute and chronic toxicity in the species used. Further, the H. incongruens was the most sensitive species as far as the contamination found in the sediment is concerned, followed by the bacteria V. fischeri. This integrative approach, together with the water column quality assessment, allowed a comprehensive evaluation of the environmental quality of this strongly modified water body and will allow the implementation of remediation strategies to obtain a good ecological potential as proposed in the Water Framework Directive.

Spatial and temporal variability of the water and sediments quality in the Alqueva reservoir (Guadiana Basin; southern Portugal)

The purpose of this work was to evaluate the dynamic of the water quality from the Alqueva reservoir (Guadiana River Basin, Portugal) and identify the most important parameters that influence its ecological and chemical status. The results could indicate preventive and/or remediation actions that are necessary to improve its quality and status. Water and sediment samples were collected between 2011 and 2012, at five sampling stations, and analyzed for: (i) water - pH, temperature, dissolved oxygen, electrical conductivity, chloride, total phosphorus, total nitrogen, ammonium, nitrate, nitrite, biochemical and chemical oxygen demand, total Fe, Mn, and As; and (ii) sediments - pH, electrical conductivity, organic matter, total nitrogen, total phosphorus, major and trace elements. The results from the water column showed that the organic descriptors exceeded the Portuguese guideline values for water quality for multiple uses at most of the sampling stations. As for nutrients, Ajuda is the station where the concentrations of the total nitrogen and total phosphorus exceeded the guideline values in most months. Ammonium achieved concentrations above the allowed, during the study, in all locations. Trace elements were more abundant in the sediments, surpassing the maximum levels for the protection of aquatic life for As, Cd and Pb, at Alcarrache, Lucefécit and Álamos, respectively. The use of multivariate analysis showed that the major parameters that explained the water quality variability were the nutrients in the water column, and trace elements in the sediments. Comparing the results from this study with results obtained since 2006, we can observe an obvious increment of the organic descriptors and nutrients in the water body. Further, several parameters and observations indicate an increase of the eutrophication process. So, it is urgent to develop preventive actions and remediation processes to stop the degradation so as to improve the quality of the water in this reservoir.

Coronary artery disease in patients with psoriasis referred for coronary angiography

Patients with psoriasis may have an increased risk of cardiovascular disease and myocardial infarction. The aim of this study was to investigate whether psoriasis is associated with an increased prevalence of coronary artery disease (CAD) independent of established cardiovascular risk factors in patients undergoing coronary angiography. A retrospective cohort analysis was performed by linking records of all patients undergoing coronary angiography from 2004 through 2009 with dermatology medical records. From an overall cohort of 9,473 patients, we identified 204 patients (2.2%) with psoriasis before coronary angiography. Patients with psoriasis had higher body mass index (31.3 ± 8.1 vs 29.3 ± 7.1 kg/m(2), p <0.001) but the prevalence of other risk factors was similar. Median duration of psoriasis before cardiac catheterization was 8 years (interquartile range 2 to 24). Patients with psoriasis were more likely to have CAD (84.3% vs 75.7%, p = 0.005) at coronary angiography. After adjusting for established cardiovascular risk factors, psoriasis was independently associated with presence of angiographically confirmed CAD (adjusted odds ratio 1.8, 95% confidence interval 1.2 to 2.8, p = 0.006). In patients with psoriasis, duration of psoriasis >8 years was also independently associated with angiographically confirmed CAD after adjusting for established cardiovascular risk factors (adjusted odds ratio 3.5, 95% confidence interval 1.3 to 9.6, p = 0.02). In conclusion, patients with psoriasis and especially those with psoriasis for >8 years have a higher prevalence of CAD than patients without psoriasis undergoing coronary angiography.

Practice models and challenges in teledermatology: a study of collective experiences from teledermatologists

BACKGROUND

Despite increasing practice of teledermatology in the U.S., teledermatology practice models and real-world challenges are rarely studied.

METHODS

The primary objective was to examine teledermatology practice models and shared challenges among teledermatologists in California, focusing on practice operations, reimbursement considerations, barriers to sustainability, and incentives. We conducted in-depth interviews with teledermatologists that practiced store-and-forward or live-interactive teledermatology from January 1, 2007 through March 30, 2011 in California.

RESULTS

Seventeen teledermatologists from academia, private practice, health maintenance organizations, and county settings participated in the study. Among them, 76% practiced store-and-forward only, 6% practiced live-interactive only, and 18% practiced both modalities. Only 29% received structured training in teledermatology. The average number of years practicing teledermatology was 4.29 years (SD±2.81). Approximately 47% of teledermatologists served at least one Federally Qualified Health Center. Over 75% of patients seen via teledermatology were at or below 200% federal poverty level and usually lived in rural regions without dermatologist access. Practice challenges were identified in the following areas. Teledermatologists faced delays in reimbursements and non-reimbursement of teledermatology services. The primary reason for operational inefficiency was poor image quality and/or inadequate history. Costly and inefficient software platforms and lack of communication with referring providers also presented barriers.

CONCLUSION

Teledermatology enables underserved populations to access specialty care. Improvements in reimbursement mechanisms, efficient technology platforms, communication with referring providers, and teledermatology training are necessary to support sustainable practices.

[Clinical aspects and endoscopic management of gastrointestinal bleeding from Dieulafoy's lesion]

OBJECTIVE

the aim of the study was to assess the incidence, clinical presentation, location, and response to endoscopic therapy of gastrointestinal bleeding from Dieulafoy's lesion.

MATERIAL AND METHOD

ALL consecutive episodes of gastrointestinal bleeding due to Dieulafoy's lesion seen between 2000 and 2006 were retrospectively reviewed. All main clinical and endoscopic data were collected: type and effectiveness of endoscopic therapy, rebleeding, complications, and mortality during hospitalization.

RESULTS

WE found 41 patients, 26 males and 15 females, median age of 71.19 years. Dieulafoy's lesion accounted for 1.55% of all gastrointestinal bleeding episodes during the study period. The incidence of Dieulafoy's lesion was 2.2 cases/100.000 inhabitants/year. Active bleeding at endoscopy was present in 85.36%, and comorbidity in 92.68%. The stomach was the most frequent location (60.97%), followed by duodenum (29.26%). Endoscopic therapy achieved initial hemostasis in all cases. Three patients (7.31%) initially treated with epinephrine injection showed rebleeding and properly responded to a second session of endoscopic therapy. No surgery was needed. The mortality rate during hospitalization was 4.87%.

CONCLUSIONS

Dieulafoy's lesion is an uncommon, but potentially severe cause of gastrointestinal bleeding. It may be found in any location within the gastrointestinal tract. Endoscopic therapy is effective and safe. Injected epinephrine alone is associated with a higher risk of rebleeding.

[Droxicam-induced hepatitis. Description of 3 new cases and review of the literature]

Three new cases of cholestatic hepatitis caused by droxicam are described, along with a revision of the other eight cases published to date. Itching, asthenia, and jaundice were the most common symptoms. Average age was 62.8 years (range: 45-82 years), and the median time of exposition was 22.7 days (range: 5-50 days). Biochemistry of the liver showed primarily cholestasis and in 4/11 cases hypereosinophilia. Two patients presented elevated levels of cholesterol and triglycerides which disappeared within the month. Clinical manifestations persisted in one patient for eight weeks after the cessation of treatment. The three patients presented in the present series presented alteration in the biochemistry of the liver two months after initiation. Liver biopsy in three patients showed centrozonal cholestasis associated with portal inflammatory activity and presence of granulomas consistent with toxic hepatitis.

Ascites adenosine deaminase activity is decreased in tuberculous ascites with low protein content

The value of adenosine deaminase activity (ADA) in ascitic fluid was examined in 12 patients with confirmed peritoneal tuberculosis and compared with that of 96 patients with ascites of other different etiologies as an age-matched control group, to determine the diagnostic value of the ADA activity in tuberculous ascites. The mean adenosine deaminase activity (ADA) value in ascitic fluid of the tuberculous peritonitis group was 47.9 +/- 21.9 IU/L and in the control group 9.6 +/- 5 U/L (mean +/- SD); p less than 0.01. A different method than that usually reported in tuberculous peritonitis was used for ascites ADA estimation. The best sensitivity and specificity was obtained when greater than 32 U/L was used as a cutoff point. The ascites ADA activity correlated with the ascites total protein concentration in the tuberculosis group (r = 0.842). Our findings confirm other results and support the ADA activity determination in ascitic fluid as a useful noninvasive screening test in the diagnosis of peritoneal tuberculosis in endemic areas or in high risk patients. However, false-negative results may occur in those patients in which ascites total protein concentration is low.

Localized phlegmonous gastritis: endoscopic view

A case of localized phlegmonous gastritis is reported. Features of this condition and the diagnostic and therapeutic usefulness of endoscopy are briefly considered.