Occurrence of pharmaceutically active compounds during 1-year period in wastewaters from four wastewater treatment plants in Seville (Spain)

Several pharmaceutically active compounds have been monitored during 1-year period in influent and effluent wastewater from wastewater treatment plants (WWTPs) to evaluate their temporal evolution and removal from wastewater and to know which variables have influence in their removal rates. Pharmaceutical compounds monitored were four antiinflammatory drugs (diclofenac, ibuprofen, ketoprofen and naproxen), an antiepileptic drug (carbamazepine) and a nervous stimulant (caffeine). All of the pharmaceutically active compounds monitored, except diclofenac, were detected in influent and effluent wastewater. Mean concentrations measured in influent wastewater were 6.17, 0.48, 93.6, 1.83 and 5.41 microg/L for caffeine, carbamazepine, ibuprofen, ketoprofen and naproxen, respectively. Mean concentrations measured in effluent wastewater were 2.02, 0.56, 8.20, 0.84 and 2.10 microg/L for caffeine, carbamazepine, ibuprofen, ketoprofen and naproxen, respectively. Mean removal rates of the pharmaceuticals varied from 8.1% (carbamazepine) to 87.5% (ibuprofen). The existence of relationships between the concentrations of the pharmaceutical compounds, their removal rates, the characterization parameters of influent wastewaters and the WWTP control design parameters has been studied by means of statistical analysis (correlation and principal component analysis). With both statistical analyses, high correlations were obtained between the concentration of the pharmaceutical compounds and the characterization parameters of influent wastewaters; and between the removal rates of the pharmaceutical compounds, the removal rates of the characterization parameters of influent wastewaters and the WWTP hydraulic retention times. Principal component analysis showed the existence of two main components accounting for 76% of the total variability.

Limitation of the concentration of organic pollutants in sewage sludge for agricultural purposes: A case study in South Spain

In 2000, the EU published the third draft of a future sludge directive entitled "Working document on sludge" where limit values for some organic compounds, including di-(2-ethyhexyl)phthalate (DEHP), sum of nonylphenol (NP), nonyphenol mono-(NP1EO) and diethoxylates (NP2EO), seven polychlorinated biphenyl congeners (PCB), polycyclic aromatic hydrocarbons (PAH) and linear alkylbenzene sulphonates (LAS), are fixed. In the present work, the monitoring of these organic compounds in sludge samples from four wastewater treatment plants (WWTPs) is reported. All WWTPs use anaerobic biological stabilization of sludge. The highest concentration levels were found for LAS, NPE and DEHP, in this order, with, in general, anaerobically-digested dehydrated sludge and compost samples being the most contaminated samples. DEHP, NPE, LAS and PAH were found at concentration levels above the limit values fixed in the third draft of the future EU sludge directive in the 44%, 88%, 13% and 6% of the analyzed anaerobically-digested dehydrated sludge and compost samples.

Sewage sludge applied to agricultural soil: Ecotoxicological effects on representative soil organisms

Application of sewage sludge to agricultural lands is a current practice in EU. European legislation permits its use when concentrations of metals in soil do not increase above the maximum permissible limits. In order to assess the fate and the effects on representative soil organisms of sewage sludge amendments on agricultural lands, a soil microcosm (multi-species soil system-MS3) experiment was performed. The MS3 columns were filled with spiked soil at three different doses: 30, 60 and 120tha(-1) fresh wt. Seed plants (Triticum aestivum, Vicia sativa and Brassica rapa) and earthworms (Eisenia fetida) were introduced into the systems. After a 21-d exposure period, a statistically significant increase for Cd, Cu, Zn and Hg concentrations was found for the soils treated with the highest application rate. Dose-related increase was observed for nickel concentrations in leachates. Plants and earthworm metal body burden offer much more information than metal concentrations and help to understand the potential for metal accumulation. Bioaccumulation factor (BAF(plant-soil)) presented a different behavior among species and large differences for BAF(earthworm-soil), from control or sewage-amended soil, for Cd and Hg were found. B. rapa seed germination was reduced. Statistically significant decrease in fresh biomass was observed for T. aestivum and V. sativa at the highest application rate, whereas B. rapa biomass decreased at any application rate. Enzymatic activities (dehydrogenase and phosphatase) as well as respiration rate on soil microorganisms were enlarged.

Observational study of continuous spinal anesthesia with the catheter-over-needle technique for cesarean delivery

BACKGROUND

Few studies have assessed the efficacy and safety of continuous spinal anesthesia in obstetrics, although placement of a catheter in the intrathecal space theoretically offers advantages in these patients.

METHODS

Ninety-two women scheduled for elective cesarean delivery using continuous spinal anesthesia with the catheter-over-needle technique (22- or 24-gauge Spinocath) were included in the study. The doses of local anesthetic used, hemodynamic variables, use of ephedrine and other drugs, and incidence of complications such as technical failure and postdural puncture headache (PDPH) were recorded.

RESULTS

The mean (+/-SD) dose of hyperbaric bupivacaine used was 8.2+/-1.8 mg. The incidence of hypotension was 30% and the mean total dose of ephedrine was 4+/-7 mg. The continuous spinal anesthetic technique failed in 18 women (20%). The overall incidence of post-dural-puncture headache was 29%; 18% of patients with post-dural-puncture headache required a blood patch.

CONCLUSIONS

Compared to previous reports, the incidence of block failure and PDPH in this study was unacceptably high and therefore the risks of the technique appear to outweigh the advantages of continuous spinal anesthesia in obstetric practice.

Skin testing and drug provocation in the diagnosis of nonimmediate reactions to aminopenicillins in children

BACKGROUND

Nonimmediate allergic reactions (NIR) to aminopenicillin include several entities, the most common of which are urticaria-like and maculopapular exanthemas.

AIMS OF THE STUDY

To evaluate a group of children who developed one or more episodes of skin reactions suggestive of NIR after aminopenicillin administration.

METHODS

The inclusion criteria required negative immediate skin tests and absence of specific IgE antibodies to different penicillins. Intradermal and patch tests were carried out with delayed readings and, if negative, a drug-provocation test including a full therapeutic course of the drug was given. Two different groups were compared: A) children with positive skin testing or a positive drug-provocation test and B) children with negative skin testing and good tolerance after a drug-provocation test.

RESULTS

Group A was composed of 20 patients. Positive intradermal/patch tests were found in one patient and in the remaining 19, a positive response to a drug-provocation test confirmed the diagnosis. Group B (the control group) consisted of 19 patients with similar symptoms after aminopenicillin intake but good tolerance. No differences in age, dose or number of previous treatments were observed between the groups. The clinical entities were also similar in both groups.

CONCLUSIONS

Reproducible nonimmediate skin reactions to aminopenicillins may occur in children in spite of negative skin testing. The value of this diagnostic procedure seems to be limited in this type of reaction, with drug-provocation tests (DPT) being a reasonable and safe alternative if the diagnosis has to be confirmed.

Sequential extraction of metals from mixed and digested sludge from aerobic WWTPs sited in the south of Spain

The content of heavy metals is the major limitation to the application of sewage sludge in soil. However, assessment of the pollution by total metal determination does not reveal the true environmental impact. It is necessary to apply sequential extraction techniques to obtain suitable information about their bioavailability or toxicity. In this paper, sequential extraction of metals from sludge before and after aerobic digestion was applied to sludge from five WWTPs in southern Spain to obtain information about the influence of the digestion treatment in the concentration of the metals. The percentage of each metal as residual, oxidizable, reducible and exchangeable form was calculated. For this purpose, sludge samples were collected from two different points of the plants, namely, sludge from the mixture (primary and secondary sludge) tank (mixed sludge, MS) and the digested-dewatered sludge (final sludge, FS). Heavy metals, Al, Cd, Co, Cr, Cu, Fe, Hg, Mn, Mo, Ni, Pb, Ti and Zn, were extracted following the sequential extraction scheme proposed by the Standards, Measurements and Testing Programme of the European Commission and determined by inductively-coupled plasma atomic emission spectrometry. The total concentration of heavy metals in the measured sludge samples did not exceed the limits set out by European legislation and were mainly associated with the two less-available fractions (27-28% as oxidizable metal and 44-50% as residual metal). However, metals as Co (64% in MS and 52% in FS samples), Mn (82% in MS and 79% in FS), Ni (32% in MS and 26% in FS) and Zn (79% in MS and 62% in FS) were present at important percentages as available forms. In addition, results showed a clear increase of the concentration of metals after sludge treatment in the proportion of two less-available fractions (oxidizable and residual metal).

The Catalan Healthcare Intercultural Mediation Training Project of “la Caixa” Social and Cultural Outreach Projects

Known by many different names-culture broker, community interpreter, medical interpreter, and communication facilitator-the intercultural mediator has as a primary task the facilitation of communication and the therapeutic relationship in the presence of linguistic and/or cultural difference. The Immigration Plan of “la Caixa” Social and Cultural Outreach Projects has undertaken an ambitious project to train all of the cultural mediators in Spain, including both those currently working and those newly entering the field, to meet existing needs. In the first phase of the project, the training was developed in Catalunya, in collaboration with the the Catalan Department of Health, executed by the Psychiatry Department of the Vall d'Hebron University Hospital (Autonomous University of Barcelona) and certified by the Health Studies Institute of the Department of Health. Drawing from the four years experience of the NGO SURT and the Department of Psychiatry of the Vall d'Hebron University Hospital, the program provides 200 hours of theoretical and 1200 hours of practical training. 50 currently employed intercultural mediators and 30 novices are being trained. In subsequent phases the training will be adapted to needs of other autonomous regions of Spain. Modules include medical anthropology, Western biomedicine, community health, linguistic interpretation, cultural competence, professional identity, and ethics. Small group supervision provides a supportive environment to facilitate the application of theory to practice. Finally, high quality training materials were developed specifically for the course. Preliminary evaluations of the project are positive despite some unanticipated complications.

Improving long-term outcomes after liver transplantation in children

The objective was to review the current state of knowledge and recommend future research directions related to long-term outcomes for pediatric liver transplant recipients. A 1-day Clinical Research Workshop on Improving Long-Term Outcomes for Pediatric Liver Transplant Recipients was held on February 12, 2007, in Washington, DC. The speaker topics were germane to research priorities delineated in the chapters on Pediatric Liver Diseases and on Liver Transplantation in the Trans-NIH Action Plan for Liver Disease Research. Issues that compromise long-term well-being and survival but are amenable to existing and new research efforts were presented and discussed. Areas of research that further enhanced the research priorities in the Action Plan for Liver Disease Research included collection of longitudinal data to define emerging trends of clinical challenges; identification of risk factors associated with long-term immunosuppression complications; development of tolerance-inducing regimens; definition of biomarkers that reflect the level of clinical immunosuppression; development of instruments for the measurement of health wellness; identification of risk factors that impede growth and intellectual development before and after liver transplantation and identification of barriers and facilitators that impact nonadherence and transition of care for adolescents.

Changes in digestive enzymes through developmental and molt stages in the spiny lobster, Panulirus argus

Changes in major digestive enzymes through developmental and molt stages were studied for the spiny lobster Panulirus argus. There were significant positive relationships between specific activity of trypsin and amylase enzymes and lobster size, whereas esterase and lipase specific activities decreased as lobsters aged. No relationship was found between amylase/trypsin ratio and lobster size. Positive trends were found, however, for trypsin/lipase and amylase/lipase ratios. Results suggest that changes in enzyme activity respond to the lobsters' physiological needs for particular dietary components although multivariate analysis suggested that enzyme activities could be not totally independent of diet. On the other hand, the pattern of changes of major enzyme activities through molt cycle was similar for most enzymes studied. Following molt, trypsin, chymotrypsin, amylase, and lipase activities gradually increased to maximal levels at late intermolt (C4) and premolt (D). There were no variations in the electrophoretic pattern of digestive enzymes through developmental and molt stages and thus, it is demonstrated that regulation is exerted quantitatively rather than qualitatively. Further studies on the effect of other intrinsic and extrinsic factors on digestive enzyme activities are needed to fully understand digestive abilities and regulation mechanisms in spiny lobsters.

Hydrolysis under high hydrostatic pressure as a means to reduce the binding of beta-lactoglobulin to immunoglobulin E from human sera

Cows' milk allergy is the most frequent food allergy in children, and beta-lactoglobulin (beta-Lg) is a major allergen. Milk-based hypoallergenic ingredients are manufactured by enzymatic hydrolysis, a process that could be improved by the application of high-pressure treatments. This study showed that the treatment of beta-Lg dissolved in buffer with chymotrypsin and trypsin under high pressure for relatively short times accelerated proteolysis by leading to a rapid removal of the intact protein. The rapid proteolysis of the beta-Lg substrate under pressure led to the production, in 20 min, of hydrolysates with lower immunoglobulin (Ig) G binding than those produced in 8 h (chymotrypsin) or 48 h (trypsin) at atmospheric pressure. However, those hydrolysates retained some residual IgE-binding properties that could be traced to the preferential release, during the initial stages of proteolysis, of peptides containing IgE epitopes, such as (Val-41-Lys-60), (Leu-149-Ile-162), and (Ser-21-Arg-40). The formation of these fragments was favored when proteolysis was conducted under high pressure due to the preferential hydrolysis of Arg-40 and Arg-148 by trypsin, and Tyr-42 and Leu-149 by chymotrypsin, all located at the dimer interface of beta-Lg or very close to it. Although our results do not support that trypsin and chymotrypsin under high pressure selectively address the allergenic regions of beta-Lg, it is possible to select the conditions that quickly produce hydrolysates with reduced potential allergenicity that could be used in hypoallergenic foods.

[Maternal satisfaction with the quality of epidural analgesia for pain relief in labor]

OBJECTIVE

To measure patient satisfaction with epidural analgesia in labor and to analyze the sociodemographic characteristics of the obstetric population treated in our hospital.

MATERIAL AND METHODS

We administered an anonymous questionnaire in July and December 2003 to all patients who received epidural analgesia during labor to obtain information on the intensity of pain before analgesia and the efficacy of this procedure.

RESULTS

A total of 1067 questionnaires were returned. Of the patients who responded to the questionnaire, 91.3% were satisfied with the process of epidural anesthesia, 93.8% stated that they would recommend the technique used in our hospital, and 94% responded that they would request the technique again in our hospital. Spanish nationals accounted for 74.8% of the surveyed patients; the remaining 25.2% were from other countries-mainly from Central and South America (18% of the total). Before administration of epidural analgesia, 23.3% of Spanish primiparas defined labor pain as severe compared to 40.7% of foreign primiparas (P<.001). Of the multiparas, 212% of Spanish patients described the pain as severe compared to 40.4% of foreign women (P<.001).

CONCLUSIONS

The overall level of satisfaction with the process of epidural analgesia is very high and was not influenced by sociodemographic factors. Labor pain is perceived as being more intense by non-Spanish women.

Oral desensitization in children with cow's milk allergy

INTRODUCTION

Current treatment of food allergies consists of the elimination of the offending food from the diet. Desensitization or tolerance induction can be an alternative for those children who have not achieved tolerance spontaneously. We propose a cow's milk desensitization protocol carried out in an outpatient setting over a 9-10 week period.

PATIENTS AND METHOD

Eighteen children older than 4 years with cow's milk protein allergy confirmed by open oral challenge with milk underwent a desensitization protocol beginning with 0.05 mL of cow's milk, reaching 1 mL on the first day, and increasing the dosage weekly until a dose of 200-250 mL of milk taken once a day was tolerated.

RESULTS

By the end of the desensitization protocol, 16 of the 18 patients tolerated 200-250 mL of cow's milk in a single daily dose. The median length of the process was 14 weeks (interquartile range, 11-17 weeks). One patient withdrew due to recurrent symptoms with 2 mL and another reached a tolerance of 40 mL of milk a day. During the program, 11 children (68.75%) presented symptoms that were generally mild but which increased the length of the protocol. At the time of writing, the 16 patients who completed the program continue to tolerate milk, 13 of them for more than a year.

CONCLUSIONS

Tolerance of cow's milk was achieved in 16 out of 18 patients who took part in this study. One patient only tolerated 40 mL, which prevents the risk of reactions caused by the inadvertent intake of the food substance; 1 patient is still on a milk-free diet. We believe this cow's milk desensitization protocol to be effective and reasonably safe.

Optimization and validation of a new method for analysis of linear alkylbenzene sulfonates in sewage sludge by liquid chromatography after microwave-assisted extraction

A new approach has been developed for the monitoring of linear alkylbenzene sulfonates (LAS) (C10-C13) in sewage sludge. It is based on microwave-assisted extraction (MAE) prior to high performance liquid chromatography coupled with diode array (HPLC-DAD) and fluorescence (HPLC-FL) detectors. Column Zorbax XDB-C8, 150 mm x 4.6 mm i.d., 5 microm particle size was used as well as acetonitrile-water containing 0.1 M NaClO4 (65:35) and isocratic elution. Compounds were isocratically eluted over 6 min runtime at a flow rate of 1 mL min(-1). Since polar interferences are eluted between 0 and 2 min, they do not interfere in the analysis. The column was thermostated at a temperature of 25 degrees C. For the determination of LAS, DAD-UV (lambda(ex) = 225 nm) and fluorescence (lambda(ex) = 225 nm, lambda(em) = 295 nm) detectors were employed. The main factors affecting the extraction efficiency (extractant volume, microwave power and irradiation time) were optimized using a compost sludge. The detection limit for total LAS in the sludge was < 5 mg kg(-1). The extraction of C10-C13 homologues is carried out by using an extraction time of 10 min and 5 mL of methanol; whereas Soxhlet needs a 12 h extraction. The method did not require clean-up or preconcentration steps. Concentration levels of LAS were between 13,037 mg kg(-1) for digested sludge and 2492 mg kg(-1) for compost sludge.

Occurrence and risk assessment of pharmaceutically active compounds in wastewater treatment plants. A case study: Seville city (Spain)

The occurrence of four anti-inflammatory drugs (diclofenac, ibuprofen, ketoprofen and naproxen), an antiepileptic drug (carbamazepine) and a nervous stimulant (caffeine) in influent and effluent samples from four wastewater treatment plants (WWTPs) in Seville was evaluated. Removal rates in the WWTPs and risk assessment of the pharmaceutically active compounds have been studied. Analytical determination was carried out by high performance liquid chromatography (HPLC) with diode array (DAD) and fluorescence (Fl) detectors after sample clean up and concentration by solid phase extraction. All pharmaceutically active compounds, except diclofenac, were detected not only in wastewater influents but also in wastewater effluents. Mean concentrations of caffeine, carbamazepine, ketoprofen and naproxen ranged between 0.28-11.44 microg l(-1) and 0.21-2.62 microg l(-1) in influent and effluent wastewater, respectively. Ibuprofen was present in the highest concentrations in the range 12.13-373.11 microg l(-1) and 0.78-48.24 microg l(-1) in influent and effluent wastewater, respectively. Removal rates of the pharmaceuticals ranged between 6 and 98%. Risk quotients, expressed as ratios between the measured environmental concentration (MEC) and the predicted no effect concentrations (PNEC) were higher than 1 for ibuprofen and naproxen in influent wastewater and for ibuprofen in effluent wastewater.

Simultaneous sonication-assisted extraction, and determination by gas chromatography–mass spectrometry, of di-(2-ethylhexyl)phthalate, nonylphenol, nonylphenol ethoxylates and polychlorinated biphenyls in sludge from wastewater treatment plants

Di-(2-ethyl-hexyl)phthalate (DEHP), nonylphenol, nonylphenol mono- and diethoxylates (NPEs) and polychlorinated biphenyls (PCBs) are organic pollutants in sewage sludge which have to be monitored in the European Union according to a future Sludge Directive. In the present work, an analytical method for the simultaneous extraction and determination of DEHP, NPEs and PCBs is proposed for the routine analysis of these compounds in sludge from wastewater treatment plants. All the compounds were simultaneously extracted by sonication with hexane and analysed by gas chromatography-mass spectrometry (GC-MS) in electronic impact mode. Recoveries achieved were 105% for DEHP, 61.4-88.6% for NPEs and 55.8-108.3% for PCBs with relative standard deviation bellow 10%. Limits of quantification were 65 microg kg(-1) for DEHP, from 630 to 2504 microg kg(-1) for NPEs and from 5.4 to 10.6 microg kg(-1) for PCBs in dried sludge. The applicability of the proposed method was evaluated by the determination of these compounds in sludge from wastewater treatment plants in Seville (South Spain).

Clinical heterogeneity of recessive ataxia in the Mexican population

Approximately 75% of Indo-European patients with recessive ataxia are homozygous for frataxin gene (FXN) mutations and have either typical or atypical Friedreich ataxia (FRDA). Our previous analysis of 134 Mexican Mestizo recessive ataxia patients showed that FRDA is relatively uncommon in the Mexican population (10.4%). This article reports the evaluation of the phenotypes of these patients. Over half of the patients with clinical diagnostic criteria for FRDA did not carry FXN mutations, constituting a "FRDA-like" phenotypic subgroup. Analysis of non-FRDA patients revealed a subgroup with early onset recessive cerebellar ataxia and cognitive deficit. These two phenotypic subgroups accounted for approximately 60% of all patients, indicating that the cause for recessive ataxia in the Mexican population is distinct from other populations and remains largely unknown.