HEAVY METALS BIOACCUMULATION AND RISK ESTIMATION IN EDIBLE FRESHWATER FISH FROM PEDROSO RESERVOIR (MAYABEQUE, CUBA)

International audienceThis work is a validation of the second step of a heavy metal monitoring procedure in Cuba fluvial ecosystems. Concentrations of seven heavy metals were measured by ICP-MS in water samples collected from the Pedroso reservoir (Mayabeque province, Cuba) and its main tributaries, as well as in edible muscle of three locally consumed fish species: Oreochromis spp., Tinca tinca and Clarias gariepinus. The results show a high concentration of Pb in areas near a paint factory (85.5 μg/L), an asphalt factory and a high traffic area (345.8 μg/L). Metal content (in mg/kg ww) in fish fillet ranged as follows: Cr (0.01-0.58), Co (0.01-0.58), Cu (0.23-88.16), Zn (4.9-29.9), As (0.01-0.86), Cd (0.02-2.93) and Pb (0.01-1.23). According to Cuban regulations, concentrations of Cd in muscle are not safe in 37.5 to 44.0 % of the studied fishes, while Pb is high in 14.0 to 20.0 %. Non-carcinogenic risk (HI) is present when daily intake is above 81 g/day. Carcinogenic risk (ELCR) is calculated to be 5.8 × 10-4 according to the US-EPA methodology. Fishermen families are the most sensitive population sector. Local authorities were informed and different measures were taken to avoid polluted fish consumption and the reduction of pollutant sources. Palabras clave: metales pesados, agua, peces, bioacumulación, seguridad alimentaria, Cuba

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)