The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Development of a UPLC-MS/MS method for the determination of ten anticancer drugs in hospital and urban wastewaters, and its application for the screening of human metabolites assisted by information-dependent acquisition tool (IDA) in sewage samples

In the present work, the development, optimization, and validation (including a whole stability study) of a fast, reliable, and comprehensive method for the analysis of ten anticancer drugs in hospital and urban wastewater is described. Extraction of these pharmaceutical compounds was performed using automated off-line solid-phase extraction followed by their determination by ultra-performance liquid chromatography coupled to a triple quadrupole–linear ion trap mass spectrometer. Target compounds include nine cytotoxic agents: cyclophosphamide, ifosfamide, docetaxel, paclitaxel, etoposide, vincristine, tamoxifen, methotrexate, and azathioprine; and the cytotoxic quinolone, ciprofloxacin. Method detection limits (MDL) ranged from 0.8 to 24 ng/L. Levels found of cytostatic agents in the hospital and wastewater influents did not differ significantly, and therefore, hospitals cannot be considered as the primary source of this type of contaminants. All the target compounds were detected in at least one of the influent samples analyzed: Ciprofloxacin, cyclophosphamide, tamoxifen, and azathioprine were found in most of them and achieving maximum levels of 14.725, 0.201, 0.133, and 0.188 μg/L, respectively. The rest of target cancer drugs were less frequently detected and at values ranging between MDL and 0.406 μg/L. Furthermore, a feasible, useful, and advantageous approach based on information acquisition tool (information-dependent acquisition) was used for the screening of human metabolites in hospital effluents, where the hydroxy tamoxifen, endoxifen, and carboxyphosphamide were detected.This study has been co-financed by the Spanish Ministry of Economy and Competitiveness, and the European Union through the European Regional Development Fund (FEDER), through the national research projects (CTQ2010-21776-C02-02, DEGRAPHARMAC), the European projects (FP7-ENV-2011-ECO-INNOVATION, ENDETECH), and The Catalan Agency for Administration of University and Research Grants (AGAUR, 2009 CTP 00034, MBRMed). This work was partly supported by the Generalitat de Catalunya (Consolidated Research Group: Water and Soil Quality Unit 2009-SGR-965). The authors would further like to thank the Consorci de la Costa Brava, the members of Castell d`Aro WWTP, TRARGISA S.A. (Tractament de Residus i d'Aigües Residuals del Sistema de Girona), and Jose Vicente Bon in charge of Green Office from CHGUV (Consorcio Hospital General Universitario de Valencia). Prof. Barceló acknowledges King Saud University for his visiting professorship.Peer reviewe

An integrative biological effects assessment of a mine discharge into a Norwegian fjord using field transplanted mussels

acceptedVersio

An integrative biological effects assessment of a mine discharge into a Norwegian fjord using field transplanted mussels

acceptedVersio

Occurrence of common pollutants and pharmaceuticals in hospital effluents

This chapter summarizes the current knowledge on the occurrence of common pollutants and pharmaceuticals in hospital effluents. These common pollutants include a myriad of biological, inorganic and organic pollutants. Daily and weekly concentration variability is presented for many of the covered pollutants. Particular attention is given to heavy metals (gadolinium and platinum) and pharmaceuticals commonly used in hospitals. For pharmaceuticals, the prevalent therapeutic categories are presented and are found to be dependent on the type of healthcare facility â\u80\u93 general hospital, specialized hospitals, wards, and units