Evaluación de riesgo por arsénico, en bajas concentraciones, para trabajadores agrícolas de Cartago, Costa Rica

Introduction: Arsenic, an element that can be harmful to human health, is abundant in the environment. It was among the first substances recognized as carcinogenic, and its presence in water is common in Latin America. Its levels in water sources are relevant for decision-making and sanitary control. This study is the first in Latin America with a mathematical model of the risk and burden of disease. Objective: To evaluate the exposure to low levels of arsenic in agricultural workers in a Costa Rican basin with this new technique. Methods: We sampled arsenic in three points along the Purires River, Cartago, between September 2011 and August 2012. We used “censored value” estimates; risk assessment with quadratic exponential models and Monte Carlo simulations to determine the risk of cancer, for agricultural workers, by type and route of exposure during irrigation. Results: Concentrations did not differ by site, but were higher in the dry season. The risk level and burden of disease were not acceptable. Disease burden is a more rigorous indicator than the individual calculation of probability of occurrence. Our estimated risk level is low compared to other studies outside the region, but not comparable to previous work in Latin America, which used a different method. Conclusion: A decade ago, in the Purires basin, arsenic concentrations were higher in the dry season and the risk level and burden of disease were not acceptable.Introducción: El arsénico, elemento que puede ser nocivo para la salud humana, es abundante en el ambiente. Fue una de las primeras sustancias reconocidas como cancerígenas y su presencia en el agua es común en América Latina. Sus niveles en fuentes de agua son relevantes para la toma de decisiones y control sanitario. Este estudio es el primero en América Latina con un modelo matemático de riesgo y carga de enfermedad. Objetivo: Evaluar la exposición a niveles bajos de arsénico en trabajadores agrícolas, de una cuenca costarricense, con esta nueva técnica. Métodos: Muestreamos arsénico en tres puntos a lo largo del río Purires, Cartago, entre septiembre de 2011 y agosto de 2012. Usamos estimaciones de “valor censurado”; evaluación de riesgos con modelos exponenciales cuadráticos y simulaciones de Monte Carlo para determinar el riesgo de cáncer, según tipo y vía de exposición durante el riego, para trabajadores agrícolas. Resultados: Las concentraciones no difirieron por sitio, pero fueron mayores en la época seca. El nivel de riesgo y la carga de enfermedad no fueron aceptables. La carga de enfermedad es un indicador más riguroso que el cálculo individual de probabilidad. Nuestro nivel de riesgo estimado es bajo en comparación con estudios hechos fuera de la región, pero no es comparable con trabajos anteriores en América Latina, basados en un método diferente. Conclusión: Hace una década, en la cuenca Purires, las concentraciones de arsénico eran más altas en la época seca y el nivel de riesgo y la carga de enfermedad no eran aceptables

Draft Genome Sequence of an Escherichia coli Strain Harboring blaCTX-M-115, blaCMY-2, Aminoglycoside, Tetracycline, and Sulfonamide Resistance Genes, Isolated from a Costa Rican Wastewater Treatment Plant

We report the draft genome sequence of the multidrug-resistant Escherichia coli strain PTA A1517-5, isolated from a wastewater treatment plant in Costa Rica. The genome consists of 4,927,375 bp with a GC content of 50.57% and a total of 4,853 genes. This strain harbors blaCTX-M-115, blaCMY-2, aminoglycoside, tetracycline, and sulfonamide resistance genes.Universidad de Costa Rica/[]/UCR/Costa RicaServicio Nacional de Salud Animal/[]/SENASA/Costa RicaMinisterio de Agricultura y Ganadería/[]//Costa RicaCentro Nacional de Alta Tecnología/[]/CeNAT/Costa RicaUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto de Investigaciones en Salud (INISA

Características físicas, químicas y microbiológicas del agua subterránea en Los Chiles, Costa Rica, y su asociación con el uso del suelo

“Physical, chemical, and microbiological characteristics of groundwater in Los Chiles, Costa Rica, and its association with land use”. Introduction: Los Chiles has one of the lowest Social Progress Indexes in Costa Rica. The inhabitants drink untreated groundwater from an aquifer across the Nicaragua-Costa Rica border. Objective: To characterize water quality and possible associations with land use. Methods: We collected six water samples from wells during the dry and rainy seasons in 2019 and applied standard tests. Results: Grasslands and bare ground cover larger areas than other land uses. The water is calcic-bicarbonate type, and its physical-chemical values are acceptable, we did not detect Escherichia coli in any sample, while we only detected fecal coliforms in La Trocha. Conclusion: If treated to eliminate coliforms and protected from other effects of human activity, this water will be optimal for human consumption.Introducción: Los Chiles tiene uno de los índices de progreso social más bajos de Costa Rica. Los habitantes beben agua subterránea no tratada de un acuífero que atraviesa la frontera entre Nicaragua y Costa Rica. Objetivo: Caracterizar la calidad del agua y posibles asociaciones con el uso de la tierra. Métodos: Recolectamos seis muestras de agua de pozos durante las temporadas seca y lluviosa en 2019 y aplicamos pruebas estándar. Resultados: Los pastizales y el suelo descubierto cubren áreas más grandes que otros usos del suelo. El agua es del tipo calcio-bicarbonato, y sus valores físico-químicos son aceptables, no detectamos Escherichia coli en ninguna muestra, mientras que coliformes fecales sólo en La Trocha. Conclusión: Si se trata para eliminar los coliformes y se protege de otros efectos de la actividad humana, esta fuente será óptima para el consumo humano

Evaluation of climatic seasonal influence on the quality of water for human consumption in a San José (Costa Rica) supply system, 2017-2018

Objetivo: Analizar el estado y la influencia de la variabilidad climática en la calidad del agua de un sistema de abastecimiento para consumo humano en San José, Costa Rica, captado en cuatro microcuencas del cantón Vásquez de Coronado, en el periodo 2017-2018, para brindar recomendaciones al operador y promover la protección de la población abastecida Métodos: Estudio descriptivo de los parámetros de calidad básicos de agua para consumo humano (Escherichia coli, coliformes fecales, turbidez, conductividad, pH, color, temperatura y cloro residual). Los análisis se realizaron siguiendo el Standard Methods for the Examination of Water and Wastewater. Se delimitaron las zonas de captación utilizando sistemas de información geográfica. Se utilizó estadística descriptiva e inferencial para describir la calidad del agua y su variabilidad espacial y estacional. Resultados: La concentración de coliformes fecales en el agua superficial fue > 103 NMP/100 mL y la turbidez >5 UTN en el 76% de las muestras. En la red de distribución se encontraron concentraciones de clororesidual y turbidez (>5 UTN) por encima de los límites recomendados para agua de consumo humano . Se encontró diferencias significativas en todos los parámetros básicos de calidad de agua entre las distintas zonas de captación (p<0,05 en todos los casos), asícomo entre épocas climáticas por zona de captación. Conclusión: Estos resultados indican que se estáutilizando agua de calidad inadecuada para uso y consumo humano, por lo cual se recomienda unmonitoreo intensivo y sectorizado de las fuentes paralocalizar puntos de contaminación.Objective: Analyze the water quality and the influence of the climatic variability in supply system for the human consume in San José, Costa Rica, in four catchment areas in Vasquez of Coronado in the period 2017-2018 to give recommendations to the operator and promote the protection of the supplied population. Methods: Descriptive study of the basic parameters of the drinking water (Escherichia coli, fecal coliforms, turbidity, conductivity, pH, color, temperature, and residual chlorine). The analyses were done following Standard Methods for the examination of Water and Wastewater. The catchment areas were delimited using geographic information systems (GIS). Descriptive and inferential statistic was used to describe the water quality, spatial and seasonal variability. Results: The concentration of fecal coliforms in the catchment areas was >10 3 NMP/100 mL and the turbidity >5 UTN in 76% of the samples. In the distribution system were found concentrations of the residual chlorine and turbidity (>5 UTN) above according to recommended limits for drinking water in the country. The results showed significant differences in all of the basic parameters of the water quality between catchment areas (p<0, 05 in all cases) and between climatic periods for catchment areas. Conclusion: These results indicate that water of inadequate quality is being used for human use and consumption, for which reason intensive and sectorized source monitoring is recommended to locate contamination points.UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto de Investigaciones en Salud (INISA)UCR::Vicerrectoría de Docencia::Salud::Facultad de MicrobiologíaUCR::Vicerrectoría de Docencia::Salud::Facultad de Medicina::Escuela de Tecnologías en Salu

Contaminación del agua del río Durazno, Costa Rica: más allá del índice holandés de calidad del agua

ABSTRACT. “Pollution of the Durazno River water, Costa Rica: beyond the Dutch water quality index”. Introduction: The micro-basin of the Durazno River in Costa Rica is a source of water for human consumption, but is suspected of microbiological pollution from several land uses. Objective: To assess the water quality of the Durazno micro-basin from the physicochemical, microbiological and antibiotics points of view. Methods: We used the Dutch Water Quality index; Standard Methods for the Examination of Water and Wastewater; and solid-phase extraction and ultra-high performance liquid chromatography coupled to tandem mass spectrometry. Results: While physicochemical parameters indicated an adequate water quality, microbiologically this water is not acceptable for human consumption. The water has Doxycycline and Cefotaxime, possibly of agricultural origin. This is the first report of Cefotaxime in water from Costa Rica. The Dutch index fails to take into account microbiological parameters that are also important. Conclusion: The Durazno River does not meet the standards for human water consumption and the Dutch index needs to be complemented with microbiological parameters.    RESUMEN. Introducción: La microcuenca del río Durazno en Costa Rica es fuente de agua para consumo humano, pero se sospecha de contaminación microbiológica por varios usos del suelo. Objetivo: Evaluar la calidad del agua de la microcuenca del Durazno desde el punto de vista fisicoquímico, microbiológico y antibiótico. Métodos: Utilizamos el índice holandés de calidad del agua; Métodos Estándar para el Examen de Agua y Aguas Residuales; y extracción en fase sólida y cromatografía líquida de ultra alta resolución con espectrometría de masas en tándem. Resultados: Si bien los parámetros fisicoquímicos indicaron una calidad de agua adecuada, microbiológicamente esta agua no es aceptable para el consumo humano. El agua tiene doxiciclina y cefotaxima, posiblemente de origen agrícola. Este es el primer reporte de Cefotaxima en agua de Costa Rica. El índice holandés no tiene en cuenta parámetros microbiológicos que también son importantes. Conclusión: El río Durazno no cumple con los estándares para consumo humano de agua y el índice holandés necesita ser complementado con parámetros microbiológicos

Contaminación del agua del río Durazno, Costa Rica: más allá del índice holandés de calidad del agua

RESUMEN. Introducción: La microcuenca del río Durazno en Costa Rica es fuente de agua para consumo humano, pero se sospecha de contaminación microbiológica por varios usos del suelo. Objetivo: Evaluar la calidad del agua de la microcuenca del Durazno desde el punto de vista fisicoquímico, microbiológico y antibiótico. Métodos: Utilizamos el índice holandés de calidad del agua; Métodos Estándar para el Examen de Agua y Aguas Residuales; y extracción en fase sólida y cromatografía líquida de ultra alta resolución con espectrometría de masas en tándem. Resultados: Si bien los parámetros fisicoquímicos indicaron una calidad de agua adecuada, microbiológicamente esta agua no es aceptable para el consumo humano. El agua tiene doxiciclina y cefotaxima, posiblemente de origen agrícola. Este es el primer reporte de Cefotaxima en agua de Costa Rica. El índice holandés no tiene en cuenta parámetros microbiológicos que también son importantes. Conclusión: El río Durazno no cumple con los estándares para consumo humano de agua y el índice holandés necesita ser complementado con parámetros microbiológicos

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

Impacts of the Tropical Pacific/Indian Oceans on the Seasonal Cycle of the West African Monsoon

The current consensus is that drought has developed in the Sahel during the second half of the twentieth century as a result of remote effects of oceanic anomalies amplified by local land–atmosphere interactions. This paper focuses on the impacts of oceanic anomalies upon West African climate and specifically aims to identify those from SST anomalies in the Pacific/Indian Oceans during spring and summer seasons, when they were significant. Idealized sensitivity experiments are performed with four atmospheric general circulation models (AGCMs). The prescribed SST patterns used in the AGCMs are based on the leading mode of covariability between SST anomalies over the Pacific/Indian Oceans and summer rainfall over West Africa. The results show that such oceanic anomalies in the Pacific/Indian Ocean lead to a northward shift of an anomalous dry belt from the Gulf of Guinea to the Sahel as the season advances. In the Sahel, the magnitude of rainfall anomalies is comparable to that obtained by other authors using SST anomalies confined to the proximity of the Atlantic Ocean. The mechanism connecting the Pacific/Indian SST anomalies with West African rainfall has a strong seasonal cycle. In spring (May and June), anomalous subsidence develops over both the Maritime Continent and the equatorial Atlantic in response to the enhanced equatorial heating. Precipitation increases over continental West Africa in association with stronger zonal convergence of moisture. In addition, precipitation decreases over the Gulf of Guinea. During the monsoon peak (July and August), the SST anomalies move westward over the equatorial Pacific and the two regions where subsidence occurred earlier in the seasons merge over West Africa. The monsoon weakens and rainfall decreases over the Sahel, especially in August.Peer reviewe

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research