A multidisciplinary study of human exposure to arsenic and other trace elements.

Arsenic (As) is a carcinogenic agent that is present in varying levels in environmental matrices including water and food. Long term As exposure can lead to skin lesions, peripheral neuropathy, diabetes, renal system effects and cardiovascular diseases. Bio-monitoring of human urine, toenail, serum and cerebrospinal fluid was carried out in this thesis to assess the exposure to arsenic and other trace elements. A multidisciplinary approach based on Inductively Coupled Plasma Mass Spectrometry (ICP-MS), HPLC-ICP-MS and Proton-Nuclear Magnetic Resonance Spectroscopy (1H-NMR) in conjunction with a questionnaire based survey was employed. The impact of rice consumption (a well-known vector of arsenic in the general population) on human urinary As levels was assessed. Results obtained show that the Bangladeshi (UK-B) community in the United Kingdom, who consume ca. 30-fold more rice than the white Caucasians (UK-C), are exposed to a higher level of arsenic. ICP-MS and HPLC-ICP-MS revealed a significant increase in dimethylarsinic acid (DMA) and inorganic arsenic (iAs) species in UK-B compared to UK-C, while cationic compounds were lower in UK-B than in UK-C. DMA and iAs levels in the Bangladeshis were positively correlated to rice consumption. Rice is likely to be responsible for the increase in levels of DMA and iAs in urine of UK-B. The link between this and the disproportional occurrence of diabetes and cardiovascular diseases (CVD) in UK-B needs to be investigated. Another important finding of this study is that the DMA to monomethyl arsenic (MA) ratio, which is often used as an indication of arsenic methylation capacity, should be applied with caution in populations consuming large quantities of rice because variation in the quantity and type of rice eaten may alter the urinary DMA levels and thereby the DMA/MA ratio. Urinary arsenic, selenium, copper and zinc were monitored for a group of Bangladeshis, Pakistanis, Indians and Caucasians living in the UK. The most striking finding was the increase in urinary copper in the UK-B group compared to other ethnicities and to reference values reported for the general UK population. Among the possible reasons for this could include dietary exposure via ethnic food consumption or a change in copper metabolism in the Bangladeshis. High serum copper levels have been correlated to CVD in the US population. In this context, further work is recommended to investigate if there is a relationship between urinary copper and the disproportionately high incidence of CVD in UK Bangladeshis. An approach based on 1H-NMR was used to detect changes in human urinary metabolomic profile as a function of As exposure through different routes. For this, the urine of UK-B, UK-C and a group residing in Bangladesh (BD-B) were monitored. The effects of other factors were explored, including arsenic urinary profile, chewing pan, ethnicity, rice consumption, selenium and diabetes. The three populations show distinctive metabolomic profiles. Urinary arsenic speciation was used in evaluating the effects of arsenic on the metabolomic profile for the UK group. This revealed that the %DMA positively correlates to %N,N-dymethylglycine, %alanine and %betaine. Comparative analysis of the 1H NMR spectra revealed that the BD-B urinary profiles were depleted in the number and quantity of metabolites. Visible signs of lower protein intake and undernourishment emerged from the urinary metabolomic profile of BD-B including a 2.5 decrease in creatinine levels compared to UK-B. Urinary creatinine and the metabolomic profile provide evidence for undernourishment in the BD-B population group that was not evident from previous studies on dietary protein intake in this population performed using food frequency questionnaires. Public health officials might consider also using bio-monitoring studies for nutrient intake rather than solely relying on estimations from food frequency questionnaires. The results reveal the complexity of the subject and pave the way for future studies, highlighting the need for awareness about diet and other specific confounding factors. Multiple Sclerosis (MS) is considered a multifactorial disease and its cause remains unknown. A case-control study on a MS cluster from the volcanic region of Mt. Etna (a natural emitter of geogenic trace elements in the environment) was undertaken. Urine and toenails were monitored for trace elements along with food consumption and life-style habits. Levels of a range of trace elements were reported for the first time for a population living in the Mt. Etna region. No significant differences were found in trace element levels in urine and toenails of MS patients and controls. However, urinary levels of nickel, manganese and selenium were higher than those reported in the literature for the general population from Italy, Germany and the UK. These findings and observations might suggest a role for nickel in the pathology of MS. However, larger studies on the possible role of nickel on MS, and trace elements in general, should be performed. Cerebrospinal fluid (CSF) and some serum from MS patients and controls from the Mt. Etna region were also monitored in this study using ICP-MS. There were significant differences in the trace elemental profile of CSF of MS volunteers and controls, including an increase in arsenic and zinc in the CSF of MS patients. Lead, aluminium, cadmium and molybdenum were significantly increased in the CSF of MS patients as well. In contrast, selenium was lower in MS patients compared to controls. The enrichment of certain trace elements in the CSF of MS patients could be the result of an impairment of the blood brain barrier and tight junction disruption due to MS and its progression, resulting in serum protein leakage and trace elements across the blood–brain barrier. Studies are necessary in the future to identify the chemical species present in the CSF and also determine their role in biological processes including their harmful effects on the brain.Marie Curie Actions Contract No: MRTN-CT-2006-03542

European Food Safety Authority open access tools to estimate dietary exposure to food chemicals.

The European Food Safety Authority (EFSA) has developed a suite of open access tools to estimate dietary exposure to food-borne chemical hazards. The tools are tailored to several regulatory domains within EFSA's remit (e.g. food and feed additives, pesticide residues, contaminants and food enzymes) and are intended for use by EFSA experts, industry applicants of regulatory product dossiers, researchers or any stakeholder with an interest in estimating dietary exposure using European food consumption data. The majority of the tools are based on FoodEx2, EFSA's food classification and description system as well as the EFSA Comprehensive European food consumption database. This paper provides an overview of these open access tools, the regulatory framework in which they were developed as well as data sources used

HIV infection with viro-immunological dissociation in a patient with polycystic kidney disease: Candidate for transplantation?

Here we describe the case of a HIV-infected patient with polycystic kidney disease and end stage renal diseases not transplantable due to the persistence of a CD4 count <200 notwithstanding a good virological response to highly active antiretroviral therapy and suggest that such limitation to kidney transplantation in such as cases might be bypassed

El comportamiento del consumidor de películas en la era digital actual

El presente trabajo de investigación tiene como objetivo principal estudiar las motivaciones que influyen sobre la toma de decisiones de compra de los consumidores sobre el visionado de películas en salas de cine y por Internet para determinar si el cine llegará a la obsolescencia e inevitable desaparición

A Case of Epididymo-orchitis after intravesical bacille Calmette-Guérin therapy for superficial bladder carcinoma in a patient with latent tuberculosis infection

Background: Intravesical instillation of bacille Calmette-Guérin (BCG) has been established as efficient therapy for superficial bladder carcinoma. Overall, intravesical BCG is well tolerated and results in complications of less than 5 %. However, adverse effects such as granulomatous prostatitis, pneumonitis, hepatitis, sepsis, and hypersensitivity reactions may occur. The reported rate for tuberculous orchitis after BCG intravesical therapy is 0.4 %. Findings: We report a case of monolateral tuberculous orchitis occurring one month after the second course of intravescical instillation of bacille Calmette-Guérin in a patient with proven superficial bladder carcinoma and latent tuberculosis infection. Conclusions: In our opinion intravesical instillation of BCG should be considered on an individual patient basis, with full patient disclosure of the potentially significant risks. A screening with an intradermal Mantoux before starting the first cycle of BCG instillation should be recommended and isoniazid would be indicated as the treatment for latent tuberculosis infection

Fever with spontaneous gingival bleeding: A diagnostic challenge

A previously healthy 4-year-old girl was admitted to our institution with fever and painless spontaneous gingival bleeding, persisting over a week, without evident lesions or trauma. She was born in Italy and had always lived in Palermo. She had never travelled internationally. Lab oratory testing showed a negative swab test for Sars-CoV2 and a tri linear pancytopenia with neutropenia (0.6 × 103/mm3), lymphopenia (1.17 × 103/mm3), thrombocytopenia (115 × 103/mm3) and anemia (Hb 7.1 g/dL, RBC 3.48 × 103/mm3, Hct 21.2%, RDW-CV 23.4%, RDW SD 51,6 fL). Other laboratory findings showed hyponatremia (130 mmol/dL), hypocalcemia (8.7 mmol/dL), hypoalbuminemia (3.5 g/dL), increase of LDH (267 IU/L), C-reactive protein (1.64 mg/dL) and alka line phosphatase levels (190 IU/L). On physical examination she appeared in pain, pale, with hyperemic pharynx without plaque or pu rulent secretion and hypertrophic bleeding gingiva (see Fig. 1). There was notable cervical lymphadenopathy, hepatomegaly (1 cm below the costal margin), and splenomegaly (3 cm below the costal margin). An abdominal ultrasound showed an enlarged spleen (15.6 × 6.6 cm) and ascites. Additional history revealed the diagnosis of visceral leishmaniasis, treated with six doses of Amphotericin B liposomal (administered for first 5 days plus one dose on the 10th day) seven months earlier. A subsequent leishmania polymerase chain reaction (PCR) assay on blood and gingival brush confirmed the diagnosis of a leishmaniasis relapse. A comprehensive immunological evaluation including an HIV test excluded any primary or acquired immunodeficiency disease. Treatment with amphotericin B was administered over 10 days, leading to a full recovery. Visceral leishmaniasis caused by Leishmania infantum is endemic in the Mediterranean region. Mucocutaneus lesions are extremely rare with this species and usually affect immunosuppressed patients. In children leishmaniasis relapse with atypical mucosal involvement represent a rarity. Clinical follow up and periodic PCR tests (performed at 3-6-9-12 months after treatment) should be considered for early recognition of a relapse

Malaria and the heart: Two rare case reports of plasmodium falciparum-associated pericarditis

Malaria is one of the most important parasitic diseases in the world, causing significant mortality and morbidity in the tropical regions1 . Although symptoms can range from a mild fever to severe complicated forms, there are limited published data on cardiac involvement of malaria and only a few studies have been carried out regarding cardiac function in severe malaria2–3. Cardiac involvement in the course of malaria ranges from severe forms with hypatension, shock, circulatory collapse and impaired haemodynamic function, to mild disorders documented by Electrocardiogram (ECG) and echocardiography4–6. Pericardial involvement in malaria is a very rare event7–8. We report here two cases of falciparum malaria complicated with pericardial effusion

Thromboembolic Events in Patients with Influenza: A Scoping Review

Introduction: Influenza is an acute respiratory infection that usually causes a short-term and self-limiting illness. However, in high-risk populations, this can lead to several complications, with an increase in mortality. Aside from the well-known extrapulmonary complications, several studies have investigated the relationship between influenza and acute cardio and cerebrovascular events. Reviews of the thromboembolic complications associated with influenza are lacking. Objectives: the study aims to conduct a scoping review to analyze the epidemiological and clinical characteristics of patients suffering from influenza and thromboembolic complications. Materials and methods: A computerized search of historical published cases using PubMed and the terms "influenza" or "flu" and "thrombosis", "embolism", "thromboembolism", "stroke", or "infarct" for the last twenty-five years was conducted. Only articles reporting detailed data on patients with thromboembolic complications of laboratory-confirmed influenza were considered eligible for inclusion in the scoping review. Results: Fifty-eight cases with laboratory documented influenza A or B and a related intravascular thrombosis were retrieved. Their characteristics were analyzed along with those of a patient who motivated our search. The localizations of thromboembolic events were pulmonary embolism 21/58 (36.2%), DVT 12/58 (20.6%), DVT and pulmonary embolism 3/58 (5.1%), acute ischemic stroke 11/58 (18.9%), arterial thrombosis 4/58 (6.8%), and acute myocardial infarction 5/58 (8.6%). Discussion: Our findings are important in clarifying which thromboembolic complications are more frequent in adults and children with influenza. Symptoms of pulmonary embolism and influenza can be very similar, so a careful clinical evaluation is required for proper patient management, possible instrumental deepening, and appropriate pharmacological interventions, especially for patients with respiratory failure

Rickettsiales in Italy

: There is no updated information on the spread of Rickettsiales in Italy. The purpose of our study is to take stock of the situation on Rickettsiales in Italy by focusing attention on the species identified by molecular methods in humans, in bloodsucking arthropods that could potentially attack humans, and in animals, possible hosts of these Rickettsiales. A computerized search without language restriction was conducted using PubMed updated as of December 31, 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was followed. Overall, 36 species of microorganisms belonging to Rickettsiales were found. The only species identified in human tissues were Anaplasma phagocytophilum,Rickettsia conorii, R. conorii subsp. israelensis, R. monacensis, R. massiliae, and R. slovaca. Microorganisms transmissible by bloodsucking arthropods could cause humans pathologies not yet well characterized. It should become routine to study the pathogens present in ticks that have bitten a man and at the same time that molecular studies for the search for Rickettsiales can be performed routinely in people who have suffered bites from bloodsucking arthropods

Molecular epidemiology of astrovirus infection in Italian children with gastroenteritis.

A 1-year study involving 157 gastroenteritis samples was conducted to investigate the role of human astrovirus, (HAstV) as a cause of gastroenteritis in Italian children aged < 2 years. The overall incidence of HAstV was 3.1%. Most cases occurred between March and May, and four of the five isolates were of the HAstV-1 type, the other being HAstV-3. Analysis of genetic variability showed that the three HAstV-1 isolates collected in 2000 clustered together, but separately from the 1999 isolate. The results indicated that HAstV should be considered as a potential diarrhoeal pathogen in Italian children. © 2004 Copyright by the European Society of Clinical Microbiology and Infectious Disease