Occurrence of antibiotics and bacterial resistance in wastewater and sea water from the Antarctic

The potential presence of introduced antibiotics in the aquatic environment is a hot topic of concern, particularly in the Antarctic, a highly vulnerable area protected under the Madrid protocol. The increasing presence of human population, especially during summer, might led to the appearance of pharmaceuticals in wastewater. The previous discovery of Escherichia coli strains resistant to antibiotics in sea water and wastewater collected in King George Island motivated our investigation on antibiotics occurrence in these samples. The application of a multi-residue LCMS/MS method for 20 antibiotics, revealed the presence of 8 compounds in treated wastewater, mainly the quinolones ciprofloxacin and norfloxacin (92% and 54% of the samples analyzed, average concentrations 0.89 μg/L and 0.75 μg/L, respectively) and the macrolides azithromycin and clarithromycin (15% positive samples, and average concentrations near 0.4 μg/L), and erythromycin (38% positive samples, average concentration 0.003 μg/L). Metronidazole and clindamycin were found in one sample, at 0.17 and 0.1 μg/L, respectively; and trimethoprim in two samples, at 0.001 μg/L. Analysis of sea water collected near the outfall of the wastewater discharges also showed the sporadic presence of 3 antibiotics (ciprofloxacin, clindamycin, trimethoprim) at low ng/L level, illustrating the impact of pharmaceuticals consumption and the poor removal of these compounds in conventional WWTPs. The most widespread antibiotic in sea water was ciprofloxacin, which was found in 15 out of 34 sea water samples analyzed, at concentrations ranging from 4 to 218 ng/L. Bacteria resistance was observed for some antibiotics identified in the samples (e.g. trimetropim and nalidixic acid –a first generation quinolone). However, resistance to some groups of antibiotics could not be correlated to their presence in the water samples due to analytical limitations (penicillins, tetraciclines). On the contrary, for some groups of antibiotics detected in samples (macrolides), the antibacterial activity against E. Coli was not investigated because these antibiotics do not include this bacterial species in their spectrum of activity. Our preliminary data demonstrate that antibiotics occurrence in the Antarctic aquatic environment is an issue that needs to be properly addressed. Periodical monitoring of water samples and the implementation of additional treatments in the WWTPs are recommended as a first step to prevent potential problems related to the presence of antibiotics and other emerging contaminants in the near future in Antarctica

Cádmio presente no sangue e a sua relação com o consumo de tabaco numa população de trabalhadores de um hospital

Exposure to cadmium is a public health problem due to the broad exposure to this toxic substance among the general population. The main sources of exposure are both tobacco consumption and tobacco smoke.The aim of this study was to determine the blood cadmium concentration in an employee population drawn from our hospital and its association with tobacco consumption.The exposure questionnaire PESA® was administered to 395 employees. Blood cadmium was measured by electrothermal atomization atomic absorption spectrometry.The median blood cadmium concentration was 0.29 μg/L. The median cadmium of current smokers (0.83 μg/L) was the highest, while that for ex-smokers (0.31 μg/L) was also higher than that for those who had never smoked. Among the smokers, an association was observed between the concentration of blood cadmium and the number of cigarettes inhaled.The group of ex-smokers showed an association with the number of cigarettes they had consumed and a negative correlation between the elapsed time between quitting smoking and the concentration of blood cadmium.In never smokers, there was a difference between the concentration of cadmium in those who were passive smokers (0.24 μg/L) and those who were not (0.20 μg/L).The concentration of cadmium in blood is related to the tobacco consumption. Further studies are needed to confirm the finding of higher concentrations of cadmium in passive smokers.La exposición de la población general al cadmio es un problema de salud pública, siendo las principales fuentes tanto el consumo de tabaco como la exposición al humo del mismo.El objetivo de este trabajo fue determinar la concentración de cadmio en sangre en una población laboral hospitalaria y su asociación con el consumo de tabaco.Se administró el cuestionario PESA® a 395 sujetos. El cadmio en sangre se midió por espectrometría de absorción atómica con atomización electrotérmica.La mediana de cadmio en sangre fue 0,29 μg/L. La mediana de cadmio de los fumadores (0,83 μg/L) fue la más elevada y la de los exfumadores (0,31 μg/L) fue a su vez más elevada que la de aquellos que nunca habían fumado (0,21 μg/L). Dentro del grupo de fumadores, se observó una asociación entre la concentración de cadmio y el número de cigarrillos inhalados.En el grupo de exfumadores se observó una asociación con el número de cigarrillos que habían consumido y una correlación negativa entre el tiempo transcurrido desde el abandono del hábito tabáquico y la concentración de cadmio en sangre.Dentro del grupo de los que nunca habían fumado, se observó una diferencia entre la concentración de cadmio de los fumadores pasivos (0,24 μg/L) y los que no lo eran (0,20 μg/L).La concentración de cadmio en sangre se relacionó con el consumo de tabaco. Son necesarios más estudios para confirmar el hallazgo de concentraciones de cadmio más elevadas en los fumadores pasivos.A exposição da população em geral ao cádmio é um problema de saúde pública, sendo as principais fontes o consumo de tabaco e a exposição ambiental ao fumo do mesmo. Este trabalho teve como objetivo determinar a concentração de cádmio no sangue numa população de trabalhadores de um hospital e a sua associação com o consumo de tabaco. Aplicou-se um questionário PESA® a 395 indivíduos. O cádmio no sangue mediu-se por espectrometria de absorção atómica com atomização eletrotérmica. A mediana de cádmio no sangue foi 0,29 μg/L. A mediana de cádmio nos fumadores (0,83 μg/L) foi a mais elevada e a dos ex-fumadores (0,31 μg/L) foi superior à dos indivíduos que nunca tinham fumado (0,21 μg/L). Dentro do grupo de fumadores, observou-se uma associação entre a concentração de cádmio e o número de cigarros fumados. No grupo de ex-fumadores observou-se uma associação com o número de cigarros que tinham consumido e uma correlação negativa entre o tempo decorrido desde o abandono do hábito tabágico e a concentração de cádmio no sangue. Dentro do grupo de pessoas que nunca tinham fumado, observou-se uma diferença entre a concentração de cádmio nos fumadores passivos (0,24 μg/L) em relação àqueles que não o eram (0,20 μg/L). A concentração de cádmio no sangue está relacionada com o consumo de tabaco. São necessários mais estudos para confirmar a existência de concentrações mais altas de cádmio no sangue de fumadores passivos

Mortality and other adverse outcomes in patients with type 2 diabetes mellitus admitted for COVID-19 in association with glucose-lowering drugs: a nationwide cohort study

Background: Limited evidence exists on the role of glucose-lowering drugs in patients with COVID-19. Our main objective was to examine the association between in-hospital death and each routine at-home glucose-lowering drug both individually and in combination with metformin in patients with type 2 diabetes mellitus admitted for COVID-19. We also evaluated their association with the composite outcome of the need for ICU admission, invasive and non-invasive mechanical ventilation, or in-hospital death as well as on the development of in-hospital complications and a long-time hospital stay. Methods: We selected all patients with type 2 diabetes mellitus in the Spanish Society of Internal Medicine's registry of COVID-19 patients (SEMI-COVID-19 Registry). It is an ongoing, observational, multicenter, nationwide cohort of patients admitted for COVID-19 in Spain from March 1, 2020. Each glucose-lowering drug user was matched with a user of other glucose-lowering drugs in a 1:1 manner by propensity scores. In order to assess the adequacy of propensity score matching, we used the standardized mean difference found in patient characteristics after matching. There was considered to be a significant imbalance in the group if a standardized mean difference > 10% was found. To evaluate the association between treatment and study outcomes, both conditional logit and mixed effect logistic regressions were used when the sample size was ≥ 100. Results: A total of 2666 patients were found in the SEMI-COVID-19 Registry, 1297 on glucose-lowering drugs in monotherapy and 465 in combination with metformin. After propensity matching, 249 patients on metformin, 105 on dipeptidyl peptidase-4 inhibitors, 129 on insulin, 127 on metformin/dipeptidyl peptidase-4 inhibitors, 34 on metformin/sodium-glucose cotransporter 2 inhibitor, and 67 on metformin/insulin were selected. No at-home glucose-lowering drugs showed a significant association with in-hospital death; the composite outcome of the need of intensive care unit admission, mechanical ventilation, or in-hospital death; in-hospital complications; or long-time hospital stays. Conclusions: In patients with type 2 diabetes mellitus admitted for COVID-19, at-home glucose-lowering drugs showed no significant association with mortality and adverse outcomes. Given the close relationship between diabetes and COVID-19 and the limited evidence on the role of glucose-lowering drugs, prospective studies are needed

Effectiveness and safety of first-generation protease inhibitors in clinical practice: Hepatitis C virus patients with advanced fibrosis

AIM: To evaluates the effectiveness and safety of the first generation, NS3/4A protease inhibitors (PIs) in clinical practice against chronic C virus, especially in patients with advanced fibrosis. METHODS: Prospective study and non-experimental analysis of a multicentre cohort of 38 Spanish hospitals that includes patients with chronic hepatitis C genotype 1, treatment-nai¨ve (TN) or treatment-experienced (TE), who underwent triple therapy with the first generation NS3/4A protease inhibitors, boceprevir (BOC) and telaprevir (TVR), in combination with pegylated interferon and ribavirin. The patients were treatment in routine practice settings. Data on the study population and on adverse clinical and virologic effects were compiled during the treatment period and during follow up. RESULTS: One thousand and fifty seven patients were included, 405 (38%) were treated with BOC and 652 (62%) with TVR. Of this total, 30% (n = 319) were TN and the remaining were TE: 28% (n = 298) relapsers, 12% (n = 123) partial responders (PR), 25% (n = 260) null-responders (NR) and for 5% (n = 57) with prior response unknown. The rate of sustained virologic response (SVR) by intention-to-treatment (ITT) was greater in those treated with TVR (65%) than in those treated with BOC (52%) (P < 0.0001), whereas by modified intention-to-treatment (mITT) no were found significant differences. By degree of fibrosis, 56% of patients were F4 and the highest SVR rates were recorded in the non-F4 patients, both TN and TE. In the analysis by groups, the TN patients treated with TVR by ITT showed a higher SVR (P = 0.005). However, by mITT there were no significant differences between BOC and TVR. In the multivariate analysis by mITT, the significant SVR factors were relapsers, IL28B CC and non-F4; the type of treatment (BOC or TVR) was not significant. The lowest SVR values were presented by the F4-NR patients, treated with BOC (46%) or with TVR (45%). 28% of the patients interrupted the treatment, mainly by non-viral response (51%): this outcome was more frequent in the TE than in the TN patients (57% vs 40%, P = 0.01). With respect to severe haematological disorders, neutropaenia was more likely to affect the patients treated with BOC (33% vs 20%, P = 0.0001), and thrombocytopaenia and anaemia, the F4 patients (P = 0.000, P = 0.025, respectively). CONCLUSION: In a real clinical practice setting with a high proportion of patients with advanced fibrosis, effectiveness of first-generation PIs was high except for NR patients, with similar SVR rates being achieved by BOC and TVR