Urinary Arsenic Speciation in Children and Pregnant Women from Spain

Inorganic arsenic (i-As) is a non-threshold human carcinogen that has been associated with several adverse health outcomes. Exposure to i-As is of particular concern among pregnant women, infants and children, as they are specifically vulnerable to the adverse health effects of i-As, and in utero and early-life exposure, even low to moderate levels of i-As, may have a marked effect throughout the lifespan. Ion chromatography-mass spectrometry detection (IC-ICP-MS) was used to analyse urinary arsenic speciation, as an exposure biomarker, in samples of 4-year-old children with relatively low-level arsenic exposure living in different regions in Spain including Asturias, Gipuzkoa, Sabadell and Valencia. The profile of arsenic metabolites in urine was also determined in samples taken during pregnancy (1st trimester) and in the children from Valencia of 7 years old. The median of the main arsenic species found in the 4-year-old children was 9.71 lg/l (arsenobetaine—AsB), 3.97 lg/l (dimethylarsinic acid—DMA), 0.44 lg/l (monomethylarsonic acid—MMA) and 0.35 lg/l (i-As). Statistically significant differences were found in urinary AsB, MMA and i-As according to the study regions in the 4-year-old, and also in DMA among pregnant women and their children. Spearman’s correlation coefficient among urinary arsenic metabolites was calculated, and, in general, a strong methylation capacity to methylate i-As to MMA was observed

Serum levels of PCDDs, PCDFs and dl-PCBs in general population residing far and near from an urban waste treatment plant under construction in Gipuzkoa, Basque Country (Spain)

This research focused on investigating the basal serum concentrations of polychlorinated dibenzo-p-dioxins, dibenzofurans (PCDD/Fs) and dioxin-like polychlorinated biphenyls (dl-PCBs) in the general population residing in two urban-industrial zones near and far from an energy recovery plant under construction in Gipuzkoa, Basque Country (Spain). The study used a cross-sectional design and included 227 participants who were randomly selected from municipal censuses in both areas. The participants were stratified based on age (ranging from 18 to 70 years) and sex. Serum samples were collected from the participants and analysed following the established protocol to measure the concentrations of PCDD/Fs and dl-PCBs. The study used multiple linear regression models to assess the impact of various sociodemographic variables, lifestyle factors, reproductive history, and diet on the variability of the measured compounds in the participants' serum. The median total toxicity equivalent (TEQ) in serum, was 10.58 pg WHO-TEQ2005 g-1 lipid. Serum PCDD levels were lower in the population residing in the "far" zone than the "near" zone. Age was positively associated with both PCDD/F and dl-PCB levels, indicating that older participants had higher concentrations of these compounds in their serum. This finding might be attributed to cumulative exposure over time. In terms of sex differences, women exhibited lower levels of dl-PCBs compared to men. Among lifestyle factors, smokers showed lower levels of dl-PCBs compared to non-smokers. Furthermore, daily alcohol consumption was significantly associated with higher serum levels of these compounds, with daily drinkers showing higher levels than non-drinkers. Consumption of local poultry was associated with significantly higher serum levels and oil consumption with low levels of PCDD/Fs.This research, conducted between 2017 and 2019 before the operation of the Energy Recovery plant, was funded through a public tender (017/11-HH-ZE) by the Gipuzkoa Provincial Council. However, the funding source did not play any part in the study's design, data collection and analysis, or the interpretation and writing of the manuscript.Peer reviewe

Characterization of PCDD/F and dl-PCB levels in air in Gipuzkoa (Basque Country, Spain)

This research examines the levels and trends of pollutants, specifically 17 congeners of PCDD/Fs and 12 dl-PCBs, in the air measured in the province of Gipuzkoa (Basque Country, Spain). The study used PCDD/Fs, dl-PCB, and the sum of dioxin-like compounds as separate response variables. A total of 113 air samples were collected and analyzed using the method described in the European Standard (EN-1948:2006) from two industrial areas. The results were analyzed using non-parametric test to assess the variability of these pollutants based on different factors (year, season and day of the week) and General Linear Models to assess the weight of each factor. The study found that the toxic equivalents (TEQs) for PCDD/Fs were 12.29 fg TEQm-3 and for dl-PCBs were 1.63 fg TEQm-3, which were in a similar range or lower than those observed in other national and international studies in industrial areas. The results showed temporal variations, with higher levels of PCDD/Fs in autumn-winter than in spring-summer and higher levels of PCDD/Fs and dl-PCBs during weekdays than on weekends. The industrial area where the energy recovery plant (ERP) will be located had higher levels of air pollutants due to the presence of two PCDD/Fs emitting industries nearby, as indicated by the Spanish Registry of Polluting Emission Sources. Both industrial areas showed similar profiles of PCDD/Fs and dl-PCBs, with the PCDD/F profiles dominated by OCDD, 1,2,3,4,6,7,8-HpCDD, and 1,2,3,4,6,7,8-HpCDF in terms of concentrations and 1,2,3,7,8-PeCDD, 2,3,4,7,8-PeCDF, and 2,3,7,8-TCDD in terms of TEQs. The dl-PCB profiles were dominated by PCB 118, PCB 105, and PCB 77 in terms of concentrations and PCB 126 in terms of TEQs. The findings of this study can serve as an indicator of the potential impact of ERP on the health of the resident population and the environment.This research, conducted between 2017 and 2019 before the operation of the Energy Recovery plant, was funded through a public tender (017/11-HH-ZE) by the Gipuzkoa Provincial Council. However, the funding source did not play any part in the study's design, data collection and analysis, or the interpretation and writing of the manuscript.Peer reviewe

Influence of genetic polymorphisms on arsenic methylation efficiency during pregnancy: Evidence from a Spanish birth cohort

Background: Inorganic arsenic (iAs) is a widespread toxic metalloid. It is well-known that iAs metabolism and its toxicity are mediated by polymorphisms in AS3MT and other genes. However, studies during pregnancy are scarce. We aimed to examine the role of genetic polymorphisms in AS3MT, GSTO2, N6AMT1, MTHFR, MTR, FTCD, CBS, and FOLH1 in iAs methylation efficiency during pregnancy. Methods: The study included 541 pregnant participants from the INMA (Environment and Childhood) Spanish cohort. Using high-performance liquid chromatography coupled to inductively coupled plasma-tandem mass, we measured arsenic (iAs and the metabolites monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA)) in urine samples collected during the first trimester. iAs methylation efficiency was determined based on relative concentrations of the As metabolites in urine (%MMA, %DMA, and %iAs). Thirty-two single nucleotide polymorphisms (SNPs) in nine genes were determined in maternal DNA; AS3MT haplotypes were inferred. We assessed the association between genotypes/haplotypes and maternal As methylation efficiency using multivariate linear regression models. Results: The median %MMA and %DMA were 5.3 %, and 89 %, respectively. Ancestral alleles of AS3MT SNPs (rs3740393, rs3740390, rs11191453, and rs11191454) were significantly associated with higher %MMA, %iAs, and lower %DMA. Pregnant participants with zero copies of the GGCTTCAC AS3MT haplotype presented a higher %MMA. Statistically significant associations were also found for the FOLH1 SNP rs202676 (β 0.89 95%CI: 0.24, 1.55 for carriers of the G allele vs. the A allele). Conclusions: Our study shows that ancestral alleles in AS3MT polymorphisms were associated with lower As methylation efficiency in early pregnancy and suggests that FOLH1 also plays a role in As methylation efficiency. These results support the hypothesis that As metabolism is multigenic, being a key element for identifying susceptible populations

Identification of CRF66_BF, a New HIV-1 Circulating Recombinant Form of South American Origin

Circulating recombinant forms (CRFs) are important components of the HIV-1 pandemic. Among 110 reported in the literature, 17 are BF1 intersubtype recombinant, most of which are of South American origin. Among these, all 5 identified in the Southern Cone and neighboring countries, except Brazil, derive from a common recombinant ancestor related to CRF12_BF, which circulates widely in Argentina, as deduced from coincident breakpoints and clustering in phylogenetic trees. In a HIV-1 molecular epidemiological study in Spain, we identified a phylogenetic cluster of 20 samples from 3 separate regions which were of F1 subsubtype, related to the Brazilian strain, in protease-reverse transcriptase (Pr-RT) and of subtype B in integrase. Remarkably, 14 individuals from this cluster (designated BF9) were Paraguayans and only 4 were native Spaniards. HIV-1 transmission was predominantly heterosexual, except for a subcluster of 6 individuals, 5 of which were men who have sex with men. Ten additional database sequences, from Argentina (n = 4), Spain (n = 3), Paraguay (n = 1), Brazil (n = 1), and Italy (n = 1), branched within the BF9 cluster. To determine whether it represents a new CRF, near full-length genome (NFLG) sequences were obtained for 6 viruses from 3 Spanish regions. Bootscan analyses showed a coincident BF1 recombinant structure, with 5 breakpoints, located in p17 gag , integrase, gp120, gp41-rev overlap, and nef, which was identical to that of two BF1 recombinant viruses from Paraguay previously sequenced in NFLGs. Interestingly, none of the breakpoints coincided with those of CRF12_BF. In a maximum likelihood phylogenetic tree, all 8 NFLG sequences grouped in a strongly supported clade segregating from previously identified CRFs and from the CRF12_BF "family" clade. These results allow us to identify a new HIV-1 CRF, designated CRF66_BF. Through a Bayesian coalescent analysis, the most recent common ancestor of CRF66_BF was estimated around 1984 in South America, either in Paraguay or Argentina. Among Pr-RT sequences obtained by us from HIV-1-infected Paraguayans living in Spain, 14 (20.9%) of 67 were of CRF66_BF, suggesting that CRF66_BF may be one of the major HIV-1 genetic forms circulating in Paraguay. CRF66_BF is the first reported non-Brazilian South American HIV-1 CRF_BF unrelated to CRF12_BF.This work was funded through Acción Estratégica en Salud Intramural (AESI), Instituto de Salud Carlos III, projects PI16CIII/00033 and PI19CIII/00042; Red de Investigación en SIDA (RIS), Instituto de Salud Carlos III, Subdirección General de Evaluación y Fondo Europeo de Desarrollo Regional (FEDER), Plan Nacional I+D+I, project RD16ISCIII/0002/0004; and scientific agreements with Consellería de Sanidade, Government of Galicia (MVI 1004/16) and Osakidetza-Servicio Vasco de Salud, Government of Basque Country (MVI 1001/16).S

Prenatal Metals Exposure and pre-adolescents’ Emotional and Behavioral Problems

Emotional and behavioral problems during childhood raise the risk of subsequent developmental of mental disorders. Our aim was to study the association between maternal metal and trace element concentrations during gestation and these problems in 9 year-old children. The study sample comprised Spanish mother-child pairs in the INMA project (n = 1003). Metals and trace elements (As, Cd, Co, Cu, Mo, Ni, Pb, Sb, Se, Tl and Zn) were measured in urine samples collected during pregnancy. Inorganic As metabolites were speciated in a subsample (n = 729). Emotional and behavioral problems were assessed using the Child Behavior Checklist (CBCL) composed of three scales: internalizing, externalizing and total problems. Sociodemographic, dietary and exposure to other environmental pollutants were obtained through questionnaires. Single nucleotide polymorphisms in brain- and metabolism-related genes APOE, BDNF, GSTP1, and PON1 were determined in cord blood. Multivariate negative binomial models were used. The interaction with sex and genotypes was evaluated including interaction terms. A multi-element analysis was carried out by a principal component analysis. Higher concentrations of Cu, monomethylarsonic acid, and Pb during pregnancy were associated with an increased incidence ratio risk (IRR) between 4.6 and 7.5% for internalizing and externalizing problems for all three CBCL scales in the children. Increasing Mo, Ni and Co concentrations were associated with higher IRR for internalizing problems (up to 8%), and Cd for externalizing problems (6.7%). Modifications by sex and genotypes were found for several associations. Multi-element analysis associated multiple metals and trace elements (Ni, Cu, Se, Cd and Pb) with higher internalizing problems.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. We are grateful to all the participants and their families for taking part in this study. We also appreciate the generous contribution in the study of all INMA members. A full roster of the INMA Project researchers can be found at http://www.proyectoinma.org/presentacion-inma/listado-investigadores/en_listado-investigadores.html. This study was supported by grants from Spanish government through the Ministry of Universities under the grant CAS21/00008 and grant for the requalification of the Spanish University, financed by the European Union, NextGeneration EU, Instituto de Salud Carlos III [FIS-FEDER: 13/1944, 16/1288, 17/00663 and 19/1338; FIS-FSE: 17/00260; Miguel Servet-FSE: MSII20/0006, FIS-PI06/0867, FIS-PI09/00090, CPII18/00018], CIBERESP, Department of Health of the Basque Government (2005111093, 2009111069, 2013111089, 2015111065), Generalitat Valenciana [BEST/2020/059, AICO/2020/285 and CIAICO/2021/132] and the Provincial Government of Gipuzkoa (DFG06/002, DFG08/001 and DFG15/221 and DFG 89/17). We also acknowledge support from the Spanish Ministry of Science and Innovation and the State Research Agency through the “Centro de Excelencia Severo Ochoa 2019–2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program.Peer reviewe

Imported malaria in Spain (2009-2016) : results from the +REDIVI Collaborative Network

Imported malaria is a frequent diagnosis in travellers and migrants. The objective of this study was to describe the epidemiological and clinical characteristics of patients diagnosed with imported malaria within a Spanish collaborative network registering imported diseases (+REDIVI). In addition, the possible association between malaria and type of case, gender, age or area of exposure was explored. Cases of imported malaria were identified among all cases registered in the +REDIVI database during the period October 2009-October 2016. Demographic, epidemiological and clinical characteristics were analysed. In total, 11,816 cases of imported infectious diseases were registered in +REDIVI's database between October 2009 and October 2016. Immigrants seen for the first time after migration accounted for 60.2% of cases, 21.0% of patients were travellers, and 18.8% were travellers/immigrants visiting friends and relatives (VFRs). There were 850 cases of malaria (850/11,816, 7.2%). Malaria was significantly more frequent in men than in women (56.8% vs 43.2%) and in VFR-immigrants (52.6%) as compared to travellers (21.3%), immigrants (20.7%) and VFR-travellers (5.4%) (p < 0.001). Although this data was not available for most patients with malaria, only a minority (29/217, 13.4%) mentioned correct anti-malarial prophylaxis. Sub-Saharan Africa was found to be the most common region of acquisition of malaria. Most common reason for consultation after travel was a febrile syndrome although an important proportion of immigrants were asymptomatic and presented only for health screening (27.3%). Around 5% of travellers presented with severe malaria. The most prevalent species of Plasmodium diagnosed was Plasmodium falciparum (81.5%). Malaria due to Plasmodium ovale/Plasmodium vivax was frequent among travellers (17%) and nearly 5% of all malaria cases in immigrants were caused by Plasmodium malariae. Malaria was among the five most frequent diagnoses registered in +REDIVI's database. Some significant differences were found in the distribution of malaria according to gender, type of case, species. Among all malaria cases, the most frequent diagnosis was P. falciparum infection in VFR-immigrant men

Tratamiento fisioterápico en la prevención del infarto agudo de miocardio

Objetivos: el principal objetivo de esta revisión es saber cómo se podría intervenir por medio de la fisioterapia, para conseguir así prevenir las enfermedades cardiovasculares. Como objetivos secundarios, se encuentran verificar la infrautilización de la rehabilitación cardíaca, exclusivamente en España y aumentar la información de la evidencia de las modalidades del ejercicio físico, para modificar los factores de riesgo principales. Métodos: se ha intentado buscar todo tipo de estudios, revisiones sistemáticas, estudios randomizados/aleatorios controlados, estudios de intervención etc, pero se ha centrado en estudios de revisión sistemática, tras excluir los estudios que no obtenían los criterios de elegibilidad y la media-baja calidad de valoración de cada artículo, se han escogido 13 artículos de revisión sistemática. Resultados: Uso de la rehabilitación cardíaca como beneficio para reducir las mortalidades y mejorar la calidad de vida de los pacientes con enfermedad cardiovascular. El efecto beneficioso del ejercicio, para modificar los factores de riesgo principales afectados en las enfermedades cardiovasculares. La infrautilización de la rehabilitación cardíaca sobre todo en Europa y concretamente en España, a pesar del beneficio que conlleva. El efecto del ejercicio, relacionado con el reempleo, aspectos psicológicos y en pacientes ancianos. Discusión: Las limitaciones de esta revisión bibliográfica son: La búsqueda realizada, está limitada en dos bases de datos (Pubmed y Science Direct) en inglés y en descriptores de palabras es español (Decs). Se han escogido un mayor número artículos en una base de datos (Sciencedirect) en comparación con (Pubmed), gracias a la variedad de los idiomas. (Español) La elección de los artículos, se ha realizado por medio de una persona, empleando para ello sus criterios subjetivos. Lograr artículos con la mayor calidad posible ha sido una intención, que ha acortado el número de los mismos, considerablemente. Conclusión: se ha demostrado que la rehabilitación cardíaca aporta beneficios en las enfermedades cardiovasculares, reduciendo la presión arterial, el colesterol, la obesidad…, mejora la calidad de vida sobre todo en ancianos, los aspectos psicológicos, el reempleo, la mortalidad, pero la infrautilización y los factores de costes limitan que los pacientes puedan realizar estos programas.Objectives: The main objective of this review is to know how they could take action through physical therapy, to achieve and prevent cardiovascular disease. As secondary objectives are to verify the underutilization of cardiac rehabilitation, only in Spain and further information of the evidence of the modalities of exercise, to modify the main risk factors. Methods: We have tried all types of studies, systematic reviews, randomized / randomized controlled etc, but has focused on systematic review studies, after excluding the studies that did not get the eligibility criteria and lower-middle quality assessment of each article, 13 articles have been selected for systematic review. Results: Using benefit cardiac rehabilitation as to reduce mortality and improve the quality of life of patients with cardiovascular. The beneficial effect of exercise, to modify the risk factors most affected in cardiovascular diseases. The under utilization of cardiac rehabilitation especially in Europe and specifically in Spain, despite its benefit. The effect of exercise, related to the re-employment, and psychological aspects in older patients. Discussion: The limitations of this bibliografic review are: Our search is limited in two databases (PubMed and Science Direct) in English and Spanish words in (DECS). Were chosen more items in a database (Sciencedirect) compared to (Pubmed), due to the variety of languages. (Spanish) The choice of the articles was performed by a person, employing their subjective criteria. Articles achieve the highest possible quality has been an intention, which shortened the number thereof considerably. Conclusion: it has been shown that cardiac rehabilitation brings benefits in cardiovascular disease, reducing blood pressure, cholesterol, obesity ..., improves the quality of life especially in the elderly, the psychological, reemployment, mortality, but the underutilization and cost factors limit patients to make these programs.Graduado o Graduada en Fisioterapia por la Universidad Pública de NavarraFisioterapian Graduatua Nafarroako Unibertsitate Publikoa