Microplastic distribution in different tissues of small pelagic fish of the Northeast Atlantic Ocean

The accumulation of microplastics (MP) by marine species of ecological and commercial interest represents a major concern, particularly for those present in human diet. This study analysed the accumulation of MP in three species of coastal pelagic fish with high commercial value, European sardine (Sardina pilchardus), European anchovy (Engraulis encrasicolus) and horse mackerel (Trachurus trachurus), collected along the Western coast of the Iberian Peninsula. The gastrointestinal tract (GT), gills and muscle were analysed and a total of 504 particles were observed. MP were found in all target tissues of the studied species. Horse mackerel exhibited significantly higher concentrations of microplastics in GT compared to other tissues. On the other hand, anchovies and sardines had significantly lower microplastic concentrations in their muscle tissue. The accumulation of microplastics in the gills showed a significant difference between species, with anchovy having significantly higher concentrations compared to horse mackerel. Horse mackerel had the highest percentage of individuals with microplastics in their GT (92 %), followed by sardine (75 %) and anchovy (50 %). Horse mackerel was also the species that registered the highest percentage of individuals with particles in the muscle (63 %), followed by anchovy (40 %) and finally sardine (39 %). MP in the gills of European sardines and anchovies were similar to those found in water samples. The majority of MP found measured <0.5 mm and were blue fibers. Furthermore, the presence of MP in the GT showed a weak and moderated significant negative correlation with the Fulton Condition Index in horse mackerel and European sardine. Our study confirms the ubiquitous extent of MP contamination in the ocean and provides baseline evidence of MP tissue distribution in three small pelagic fish species with distinct feeding behaviour, while correlating this with the presence of MP in water. Importantly, the results of this study contribute to improve the understanding of biological partitioning of MP in open sea fish species with high commercial relevance, and the potential deleterious effects of our increasingly MP contaminated world.

First evidence of microplastic ingestion in the ocean giant sunfish (Mola mola)

Mola mola is the largest teleost inhabiting our ocean and the presence of microplastics (MP) in this flagship species was, before this study, never described. Thus, this investigation focused on analysing MP ingestion in 53 ocean giant sunfish in the Northeast Atlantic Ocean. A total of 116 MP were found in 79% of the specimens, with a median of 1 MP.ind-1, ranging from 0 to 11 MP.ind-1. Seasonal differences were observed, with more fibers registered in specimens caught in autumn. Among the different size classes observed, the smallest category (<300 μm) was the most frequent (43%). Blue (43%) was the most prevalent color, followed by green (29%) and black (10%). The majority of fragments were styrene acrylic copolymer (53%), while most fibers were rayon (78%). These findings emphasize that the ocean sunfish population crossing the southern waters of Portugal is exposed to microplastic pollution and highlight the need for effective management policies to address plastic pollution in marine ecosystems.

Assessing microplastic exposure of the Critically Endangered Mediterranean monk seal (Monachus monachus) on a remote oceanic island

Microplastics (<5 mm) are a ubiquitous marine pollutant which are highly bioavailable to marine organisms across all trophic levels. Marine predators are especially vulnerable to microplastic pollution through direct and indirect ingestion (e.g., trophic transfer) due to their high trophic position. In particular, oceanic islands are more susceptible to plastic accumulation, increasing the relative number of microplastics in the environment that are available for consumption. The dynamics of microplastic accumulation in marine predators inhabiting remote islands, however, is sparsely documented. Here we describe microplastic exposure in the Critically Endangered Mediterranean monk seal (Monachus monachus) from the Madeira archipelago (Northeast Atlantic) using scat-based analysis. Microplastics were recovered from 18 scat samples collected between 2014-2021 and were characterized to the polymer level using Fourier-Transform Infrared (u-FTIR) spectroscopy. A total of 390 microplastic particles were recovered, ranging between 0.2-8.6 particles g^-1 dry weight (mean 1.84 ± 2.14 particles g^-1) consisting mainly of fragments (69 %) of various sizes and polymer composition (e.g., PE, PET, PS). Microplastic prevalence (100 % of samples analysed) was higher than what has been previously recorded using scat-based analysis in other pinniped species. Our results suggest that the levels of microplastic pollution in the coastal food-web in the Madeira archipelago are relatively high, placing higher-trophic level organisms at increased risk of microplastic consumption, including humans. This study provides the first insights into microplastic exposure to Madeira's monk seals that may contribute to future management decisions for the species and their long-term survival.

Gadolinium ecotoxicity is enhanced in a warmer and acidified changing ocean as shown by the surf clam Spisula solida through a multibiomarker approach

Humans have exhaustively combusted fossil fuels, and released pollutants into the environment, at continuously faster rates resulting in global average temperature increase and seawater pH decrease. Climate change is forecasted to exacerbate the effects of pollutants such as the emergent rare earth elements. Therefore, the objective of this study was to assess the combined effects of rising temperature (Δ = + 4 °C) and decreasing pH (Δ = - 0.4 pH units) on the bioaccumulation and elimination of gadolinium (Gd) in the bioindicator bivalve species Spisula solida (Surf clam). We exposed surf clams to 10 µg L^-1 of GdCl₃ for seven days, under warming, acidification, and their combination, followed by a depuration phase lasting for another 7 days and investigated the Gd bioaccumulation and oxidative stress-related responses after 1, 3 and 7 days of exposure and the elimination phase. Gadolinium accumulated after just one day with values reaching the highest after 7 days. Gadolinium was not eliminated after 7 days, and elimination is further hampered under climate change scenarios. Warming and acidification, and their interaction did not significantly impact Gd concentration. However, there was a significant interaction on clam's biochemical response. The augmented total antioxidant capacity and lipid peroxidation values show that the significant impacts of Gd on the oxidative stress response are enhanced under warming while the increased superoxide dismutase and catalase values demonstrate the combined impact of Gd, warming & acidification. Ultimately, lipid damage was greater in clams exposed to warming & Gd, which emphasizes the enhanced toxic effects of Gd in a changing ocean.

Single and combined ecotoxicological effects of ocean warming, acidification and lanthanum exposure on the surf clam (Spisula solida)

Lanthanum (La) is one of the most abundant emergent rare earth elements. Its release into the environment is enhanced by its use in various industrial applications. In the aquatic environment, emerging contaminants are one of the stressors with the ability to compromise the fitness of its inhabitants. Warming and acidification can also affect their resilience and are another consequence of the growing human footprint on the planet. However, from information gathered in the literature, a study on the effects of ocean warming, acidification, and their interaction with La was never carried out. To diminish this gap of knowledge, we explored the effects, combined and as single stressors, of ocean warming, acidification, and La (15 μg L^-1) accumulation and elimination on the surf clam (Spisula solida). Specimens were exposed for 7 days and depurated for an additional 7-day period. Furthermore, a robust set of membrane-associated, protein, and antioxidant enzymes and non-enzymatic biomarkers (LPO, HSP, Ub, SOD, CAT, GPx, GST, TAC) were quantified. Lanthanum was bioaccumulated after just one day of exposure, in both control and climate change scenarios. A 7-day depuration phase was insufficient to achieve control values and in a warming scenario, La elimination was more efficient. Biochemical response was triggered, as highlighted by enhanced SOD, CAT, GST, and TAC levels, however as lipoperoxidation was observed it was insufficient to detoxify La and avoid damage. The HSP was largely inhibited in La treatments combined with warming and acidification. Concomitantly, lipoperoxidation was highest in clams exposed to La, warming, and acidification combined. The results highlight the toxic effects of La on this bivalve species and its enhanced potential in a changing world.

Improved methodology for microplastic extraction from gastrointestinal tracts of fat fish species

Potassium hydroxide (KOH) digestion protocols are currently applied to separate microplastics from biological samples, allowing efficient digestion with minor degradation of polymers in a time- and cost-effective way. For biota samples with high-fat content, KOH reacts with triglycerides generating an overlying soap layer, making difficult the digestion and solubilization and subsequent microplastics extraction. Here we studied the addition of Tween-20 in different concentrations to evaluate the effect on the soap layer of post-digested samples. Addition of 10 % of Tween-20 presented higher flow rate during filtration, being set as optimal value. Incorporation of Tween-20 in the extraction procedure increased recovery rates of LDPE, PC and PET and appears to have a protective effect on PC and PET degradation. Tween-20 did not interfere in FTIR spectrum of polymers available in the marine environment. Being low-toxic, makes addition of Tween-20 a simple and economical way to optimize KOH digestion protocols for microplastics extraction.

Lanthanum and Gadolinium availability in aquatic mediums: New insights to ecotoxicology and environmental studies

Studies dealing with Rare Earth Elements (REE) ecotoxicological behavior are scattered and with potential conflicting results. Climate change impacts on aquatic biota and is known to modify contaminants toxicokinetic. Nevertheless, the current knowledge on the potential interactions between climate change and REE is virtually non-existent. Therefore, we focus our research on La and Gd as representatives of Light and Heavy REE that also are of great environmental concern. Experiments on different mediums (fresh-, brackish- and seawater) were designed to run at present-day and near-future conditions (T°=+4 °C, pH=△-0.4). Sampling was taken at different time scales from minutes to hours for one day. The main challenge was to evaluate the availability of La and Gd under environmental conditions closely related to climate changes scenarios. Furthermore, this study will contribute to the baseline knowledge by which future research towards understanding REE patterns and toxicity will build upon. Lanthanum and Gd behave differently with salinity. Temperature also affects the availability of dissolved La in freshwater. On the other hand, pH reduction causes the decrease of Gd in freshwater. In this medium, concentrations reduce sharply, presumably due to sorption processes or precipitates. In the brackish water experiment only the dissolved La levels in the Warming (T°=+4 °C) and Warming & Acidification (T°=+4 °C, pH=△0.4) diminished significantly through time. Dissolved La and Gd levels in seawater were relatively constant with time. The speciation of both elements is also of great relevance for ecotoxicological experiments. The trivalent free ions (La3+ and Gd3+) were the most common species in the trials. However, as ionic strength increases, the availability of other complexes rose, which should be subject of great attention for upcoming ecotoxicological studies.

Rare earth elements biomonitoring using the mussel Mytilus galloprovincialis in the Portuguese coast: Seasonal variations

Increased Rare earth elements (REE) usage culminates in discharges into the environment. Mussels have been chosen as models in biomonitoring, hence, REE concentrations in Mytilus galloprovincialis from six locations on the Portuguese coast were accessed to determine natural concentrations and possible linkage to local ecosystem characteristics and temporal variations, by determining them in distinct seasons (autumn and spring). Samples from Porto Brandão (located on the south bank of the Tagus estuary) exhibited the highest REE concentrations, while mussels from Aljezur (the southernmost point on the Portuguese coast) exhibited the lowest, in both seasons. Overall, ∑REE concentration was greater in the spring. LREE enrichment relative to HREE occurs and a negative Ce and Eu anomaly was observed. This study constitutes the first assessment of REE composition on this model species in the Portuguese coast, in two distinct seasons and contributes to a better understanding of REE uptake for future biomonitoring studies.

Differential tissue accumulation in the invasive Manila clam, Ruditapes philippinarum, under two environmentally relevant lanthanum concentrations

Among the environmental emerging concern rare earth elements, lanthanum (La) is one of the most common and reactive. Lanthanum is widely used in numerous modern technologies and applications, and its intense usage results in increasing discharges into the environment, with potentially deleterious consequences to earthlings. Therefore, we exposed the important food resource and powerful monitoring tool Manila clam to two environmentally relevant concentrations of La (0.3 µg L^-1 and 0.9 µg L^-1) for 6 days, through water, to assess the bioaccumulation pattern in the gills, digestive gland, and remaining body. The La bioaccumulation was measured after 1 (T1), 2 (T2), and 6 (T6) days of exposure. Lanthanum was bioaccumulated after 2 days, and the levels increased in all tissues in a dose-dependent manner. When exposed to 0.3 µg L^-1, the enrichment factor pattern was gills > body > digestive gland. However, when exposed to 0.9 µg L^-1, the pattern appears to change to gills > digestive gland > body. Tissue portioning appears to be linked with exposed concentration: In higher exposure levels, digestive gland seems to gain importance, probably associated with detoxification mechanisms. Here, we describe for the first time La bioaccumulation in these different tissues in a bivalve species. Future studies dealing with the bioaccumulation and availability of La should connect them with additional water parameters (such as temperature, pH, and major cations).

Microplastics in fishes from an estuary (Minho River) ending into the NE Atlantic Ocean

Wild fish (Cyprinus carpio, Mugil cephalus, Platichthys flesus) from an estuary of the NE Atlantic coast were investigated for plastic contamination (N = 128). From the 1289 particles recovered from fish samples, 883 were plastics. Among these, 84% were fibres and 97% were microplastics. Thirty-six polymers were identified. The number of microplastics (mean ± SD) per individual fish (MP/fish) was 8 ± 6 in C. carpio, 10 ± 9 in M. cephalus and 2 ± 2 in P. flesus. The means of MP/fish per body site were 6 ± 7 in gastrointestinal tract, 0.5 ± 1.1 in gills, 0.3 ± 0.7 in liver and 0.6 ± 1.2 in muscle samples. A few large fibres in liver (≤ 4841 μm) and muscle (≤ 5810 μm) samples were found. The results evidence the existence of high fish contamination by microplastics and reinforce the need of further research on plastic pollution in estuaries.

Expression of spindle assembly checkpoint proteins BubR1 and Mad2 expression as potential biomarkers of malignant transformation of oral leukoplakia: an observational cohort study

Background

The Spindle Assembly Checkpoint (SAC) is a surveillance mechanism essential to ensure the accuracy of chromosome segregation during mitosis. Our aim was to evaluate the expression of SAC proteins in oral carcinogenesis, and to assess their potential in predicting malignant transformation of oral leukoplakia.

Material and Methods

We analysed the immunoexpression of BubR1, Mad2, Bub3, and Spindly proteins in 64 oral biopsies from 52 oral leukoplakias and 12 normal tissues. Univariate and multivariate analysis were performed to evaluate predictive factors for malignant transformation (MT).

Results

We observed that BubR1 and Mad2 were more highly expressed in high dysplasia grade lesions than in low grade or normal tissues (P<0.05). High expression of Spindly was significantly correlated with a high Ki-67 score (P=0.004). Six (11.5%) oral leukoplakias underwent malignant transformation. In univariate analysis, the binary dysplasia grade (high grade) (P<0.001) was associated with a higher risk of malignant transformation as well as high BubR1 (P<0.001) and high Mad2 (P=0.013) expression. In multivariate analysis, high expression of BubR1 and Mad2 when combined showed an increased risk for malignant transformation (P=0.013; HR of 4.6, 95% CI of 1.4-15.1).

Conclusions

Our findings reveal that BubR1 and Mad2 were associated with an increased risk for malignant transformation independently of histological grade and could be potential and useful predictive risk markers of malignant transformation in oral leukoplakias.

Key words:BubR1, Mad2, Spindly, Bub3, Oral Leukoplakia, epithelial dysplasia, Oral squamous cell carcinoma.

Antipsychotics use in dementia: How safe are they?

Introduction

Antipsychotics are frequently used for managing psychiatric and behavioral symptoms of dementia. However, it’s an off-label resource which remains controversial due to significant safety concerns in the elderly population, namely increasing cardiovascular adverse effects.

Objectives

To access antipsychotic safety and potential risks when used in dementia.

Methods

A non-systematic review was carefully conducted on PubMed using the following keywords: “dementia”, “antipsychotics” and “safety.” We selected clinical trials, meta-analysis, randomized controlled trials published in the last 10 years.

Results

A total of 43 articles was obtained, of which 22 were excluded because they didn’t meet our inclusion criteria. Regarding atypical antipsychotics, one study found an incidence of severe events in 23,7% of patients and a OR=2.5 for cerebrovascular side effects. Quetiapine was suspended midway given it had a higher incidence of adverse effects compared to others. There weren’t any significant statistic differences concerning serious events between classes of antipsychotics(p<0,01). No study was found comparing typical and atypical antipsychotics safety in dementia.

Conclusions

Overall, we can conclude that antipsychotics pose a risk of serious adverse effects when used in elderly patients, namely cerebrovascular events. Among atypical antipsychotics, quetiapine, used frequently for controlling neuropsychiatric symptoms in these patients appears a higher risk for severe adverse events compared with other drugs. Their use should be restricted after there aren’t any other options available. New protocols could be developed to control these symptoms, for example, environmental measures before resorting to antipsychotics.

An observational retrospective study of odontogenic cyst´s and tumours over an 18-year period in a Portuguese population according to the new WHO Head and Neck Tumour classification

Background

Odontogenic cysts and tumours of the jaws represent one of the most prevalent groups of oral-maxillofacial lesions. We aimed to evaluate the clinical and pathological characteristics of a cohort of odontogenic cysts (OC) and odontogenic tumours (OT) of the jaws in a Portuguese population.

Material and Methods

This observational retrospective study analysed patients diagnosed with either an OC or OT of the jaws at a central hospital of Oporto, Portugal, between 1988 and 2006. Data collected from patients’ files included demographic, clinical, radiological and histopathological information. Recurrence was evaluated using univariate and multivariate analysis.

Results

The sample consisted of 397 patients, 231 males (58.2%) and 166 females (41.8%), with a mean-age of 36.7±17 years. Twenty-seven patients (6.8%) presented with more than one lesion providing a total of 433 lesions. There were 396 (91.5%) OC, mostly represented by radicular cysts (n=257;59.4%), dentigerous cysts (n=79;18.2%), or odontogenic keratocysts (n=50;11.5%). There were 37 (8.5%) OT, mostly represented by ameloblastomas (n=16;3.7%), and odontomas (n=9;2.1%). The most common initial clinical manifestation was swelling (n=224;51.7%). Recurrence was observed in 30 cases (6.9%), mostly in ameloblastomas (n=6;37.5%) and odontogenic keratocysts (n=12;24%). In the multivariate analysis the diagnosis classification of the lesion was the only independent and significant variable related with the recurrence (P=0.04).

Conclusions

Radicular cysts were the most commonly occurring type of OC and ameloblastomas the most commonly occurring OT. Amelobastomas and odontogenic keratocysts were the lesions with the highest rates of recurrence. This large sample provides useful information about the frequency profile and characteristics of OC and OT over a period of 18 years, allowing valuable comparison with data from other countries.

Key words:Odontogenic cysts and tumours, radicular cyst, dentigerous cyst, odontogenic keratocyst, ameloblastoma, recurrence.

Echocardiographic but not clinical response to CRT is an independent predictor of a better survival free from arrhythmic events

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac resynchronization therapy (CRT) is of proven benefit in heart failure patients, improving mortality and reducing hospital admissions. There is however uncertainty if the arrhythmic risk is reduced in responders.

Purpose

We aimed to assess if patients with a CRT implanted for primary prevention had less arrhythmic episodes if they responded to this therapy and if echocardiographic and clinical responses to CRT differ regarding the occurrence of ventricular arrhythmias.

Methods

We prospectively enrolled patients that underwent CRT implant for primary prevention according to ESC guidelines. Patients were classified as responders if they fulfilled one of four criteria (echocardiographic or clinical) at six months after implant: a 5% absolute improvement in LV ejection fraction (LVEF), a 15% improvement in LVEF, a 15% decrease in LV end-diastolic volume or a decrease in NYHA class. During follow-up with device interrogation, arrhythmic ventricular events (AVE) were classified as appropriate ICD therapies or sustained ventricular tachycardia either occurring in ICD monitoring zones or undetected by the device due to a slower rare, but clinically documented. All patients were further classified according to type of pacing, biventricular or LV only. Demographic characteristics of patients were also assessed.

Results

We enrolled 73 patients, 58 (79.5%) male, median age of 72 (65-77) years. Median LVEF was 28 (22-35) % (p = 0.95 between groups), ischemic etiology in 36 (46.6%, p = 1.00). The two groups with and without AVE did not differ significantly regarding clinical, echocardiographic, and electrocardiographic characteristics (table). CRT echocardiographic response criteria were met by 50 (68.5%) of patients and clinical criteria by 53 (72.6%) patients. AVE occurred in 15 (20.5%) patients. In univariate regression analysis, echocardiographic response was associated with reduced AVE (OR 0,14; p = 0,005). Clinical response to CRT was not associated with AVE (p = 0.07). LV only pacing was associated with a higher probability of AVE (OR 5.1; p = 0.038). In Cox regression multivariate analysis, response to CRT was the only independent predictor of better survival free from AVE (HR 0.28;CI 95%, p = 0.044) and LV only pacing was not associated with more episodes of ventricular arrhythmias (p = 0.17). Conclusions: Echocardiographic, but not clinical response to CRT therapy, is the only independent predictor of a higher survival free from arrhythmic events. In spite controversies regarding the arrhythmogenic role of LV pacing, this was not associated with higher ventricular arrhythmic events. Abstract Figure.

Warming enhances lanthanum accumulation and toxicity promoting cellular damage in glass eels (Anguilla anguilla)

Cumulative and continuing human emissions of greenhouse gases to the atmosphere are causing ocean warming. Rising temperature is a major threat to aquatic organisms and may affect physiological responses, such as acid-base balance, often compromising species fitness and survival. It is also expected that warming may influence the availability and toxicological effects of pollutants, including Rare Earth Elements. These are contaminants of environmental emerging concern with great economic interest. This group comprises yttrium, scandium and lanthanides, being Lanthanum (La) one of the most common. The European eel (Anguilla anguilla) is critically endangered and constitutes a delicacy in South East Asia and Europe, being subject to an increasing demand on a global scale. Considering the vulnerability of early life stages to contaminants, we exposed glass eels to 1.5 μg L^-1 of La for five days, plus five days of depuration, under a present-day temperature and warming scenarios (△T = +4 °C). The aim of this study was to assess the bioaccumulation, elimination and specific biochemical enzymatic endpoints in glass eels (Anguilla anguilla) tissues, under warming and La. Overall, our results showed that the accumulation and toxicity of La were enhanced with increasing temperature. The accumulation was higher in the viscera, followed by the head, and ultimately the body. Elimination was less effective under warming. Exposure to La did not impact acetylcholinesterase activity. Moreover, lipid peroxidation peaked after five days under the combined exposure of La and warming. The expression of heat shock proteins was majorly suppressed in glass eels exposed to La, at both tested temperatures. This result suggests that, when exposed to La, glass eels were unable to efficiently prevent cellular damage, with a particularly dramatic setup in a near-future scenario. Further studies are needed towards a better understanding of the effects of lanthanum in a changing world.

Consumption of ultra-processed foods on free sugar intake of Portuguese infants: The Upper Project

Background

The dietary share of ultra-processed foods (UPF) has been associated with low diet quality, including high content of free sugar, mainly in adults' populations. We aim to assess the influence of UPF consumption on free sugar intake of Portuguese infants.

Methods

Cross-sectional representative study including 573 infants (6-23 months old) who participated in the 2015-2016 National Food, Nutrition and Physical Activity Survey. Dietary intake was collected by two non-consecutive food diaries (time interval 8-15 days). Food items were classified according food processing degree by the NOVA system. Total energy intake and percentage provided by each NOVA food groups as well as the free sugar content of the overall diet were assessed. Mean free sugar intake was evaluated across quintiles (Q) of UPF consumption by linear regression adjusted for socioeconomic covariates.

Results

Mean energy intake was 935 kcal/day, in which 49.1% was derived from unprocessed/minimally processed foods, 7.2% from processed culinary ingredients, 7.0% from processed foods and 36.6% from UPF. The mean dietary share of UPF ranged from 12.5% (Q1) to 65.5% (Q5) of total energy. Within UPF, infant formulas (19.3%), milk-based drinks (6.7%) and sweet snacks (4.8%) contributed the most to energy intake. Mean free sugar intake in the overall diet accounted for 8.1% of total energy intake, in which 92.5% came from UPF. As the UPF consumption increased, the dietary content of free sugar increased significantly (β = 0.77; p &lt; 0.001). Contribution of free sugar in total energy intake raised from 2.9% to 12.7%, representing an increment of 338% from the lower to the upper quintile of the dietary share of UPF.

Conclusions

Portuguese infants had an important intake of free sugar. Nearly all of this intake came from UPF, which calls for public health efforts to avoid UPF consumption by this population group.

Funding

FAPESP 2018/07391-9, 2019/05972-7 (MCR), 2016/14302-7 (FR); POCI-01-0145-FEDER-032090.

Key messages

Ultra-processed foods contributed with 36.6% of total energy intake and 92.5% of free sugar in the diets of Portuguese infants. As the ultra-processed foods consumption increased, the dietary content of free sugar increased significantly from 2.9% (Q1) to 12.7% (Q5), representing an increment of 338%.

Microplastics in wastewater: microfiber emissions from common household laundry

Microplastics are widely recognized as a category of emergent pollutants that can cause complex ecotoxicological effects. Synthetic fibers released during the washing of textiles are a relevant source of microplastics, which reach aquatic ecosystems from sewer discharges, even when there is retention in wastewater treatment plants. In this paper, we determined microfiber emissions from washing of textiles in a domestic environment, by collecting wastewater from washings of a mix of clothing from a household of 4 people. It is the first time the characterization of microplastic emission from textiles washing is performed in real household conditions. Results estimated an average emission rate of 18,000,000 synthetic microfibers for a reference load of 6 kg of synthetic fibers. Only 7% of the synthetic fibers found were larger than 500 μm in length, 40% were between 100 and 500 μm, and 53% were between 50 and 100 μm.

Four of five tuberculosis patients experience catastrophic costs related to TB diagnosis and care in Timor-Leste

SETTING: Seventeen health care facilities that report to the national tuberculosis (TB) programme in Timor-Leste. Participants were TB patients.OBJECTIVE: To determine the proportion of TB patients who experienced catastrophic costs due to their TB diagnosis and care, and the magnitude and composition of these costs.DESIGN: This was a cross-sectional health facility-based survey, conducted in 17 DOTS centres between October 2016 and March 2017. TB patients were interviewed by trained nurses using a standardised questionnaire.RESULTS: Among the 457 TB patients who participated (response rate 96.6%), the median age was 32 years; 39.2% were from the capital, Dili. The patient was the main income earner in 26.3% of households. Annual individual and household incomes before and after TB diagnosis decreased by respectively 30.4% and 31.1%. Using a cut-off of 20% of annual household income, 83.0% of patients experienced catastrophic costs related to their TB diagnosis and care. Income loss and nutritional supplementation accounted for respectively 40.7% and 37.9% of these costs.CONCLUSION: Four of five TB patients in Timor-Leste experienced catastrophic costs related to TB diagnosis and care. Financial and social protection to mitigate against these costs are urgently needed, in addition to universal health coverage.

P1393Prolonged atrial electrical conduction as a predictor of atrial fibrillation after atrioventricular nodal reentrant tachycardia ablation

BACKGROUND

Patients (pts) with atrioventricular nodal reentrant tachycardia (AVNRT) have a higher incidence of atrial fibrillation (AF) during follow-up. Conventional risk factors can play a role in AF development, however atrial electrical conduction properties may be implicated in AF pathogenesis.

AIMS

to evaluate atrial conduction times and assess its effect on AF development during follow-up.

METHODS

We studied AVNRT pts who performed EPS and catheter ablation of the slow pathway between 2013 and 2016 in a single center. Pts with AF or valvular disease were excluded. We evaluated duration of symptoms due to AVNRT, conventional risk factors for AF (age, gender, obesity, hypertension, diabetes and structural heart disease (SHD)), left atrium (LA) enlargement and electrophysiologic study (EPS) time intervals related with atrial electrical conduction properties. We measured the time interval between: (1) the beginning of the P wave on the ECG to the A deflection in His-bundle electrogram (P-AHis); (2) the beginning of the P wave to the mid-distal coronary sinus (CS) atrial electrogram (P-CS) and (3) the beginning of the P wave to the H deflection in His-bundle electrogram (P-HHis).

RESULTS

Fifty-two pts were evaluated during a median follow-up of 63 months (IQR 51-69): 22% male, median age 55 years (IQR 42-67). AF occurred in 9 patients (17%) (39 cases per 1000 person-years). Patients with AF were older (67 vs 53 years, p= 0.005) and had more frequently LA enlargement (33% vs 7%, p= 0.024) but they did not differ in hypertension, obesity, diabetes, SHD and duration of symptoms. EPS measured intervals P-AHis and P-HHis interval were not different between the groups (26.0 vs 22.8 ms, p = 0.89 and 151 vs 106 ms, p= 0.56, respectively) but P-CS were prolonged in patients with AF (70 vs 55 ms, p = 0.02) (figure 1). Univariate logistic analysis for AF is presented in table 1. There was no interaction between P-CS and LA enlargement (p = 0.87). In multiavariate analysis, only P-CS was independently associated with AF (table).

CONCLUSIONS

In this group of patients with AVNRT, P-CS, but not other atrial conduction intervals, was independently associated with AF development. The possible role of LA electrical conduction impairment in AVNRT pts for AF development needs further studies.

Univariate and multivariate analysis Univariate analysis Multivariate analysis OR 95% CI p-value OR 95% CI p-value Age (years) 1.10 1.02-1.19 0.016 1.10 1.00-1.21 0.051 LA enlargement 7.00 1.10-44.71 0.040 3.42 0.41-28.03 0.255 P-CS 1.07 1.021.14 0.013 1.06 1.01-1.12 0.044 OR Odds ratio. CI: confidence interval

Abstract Figure. Box-plot for the studied intervals

P518Inappropriate shocks in atrial fibrillation patients: are they really deleterious?

Introduction

Data suggest inappropriate defibrillator shocks are associated with a higher risk of all-cause mortality, particularly those delivered for atrial fibrillation (AF). However, the impact of inappropriate shocks has not been studied specifically in a population with AF.

Aims

to determine if AF-triggered inappropriate shocks are associated with long- term mortality in patients with AF and defibrillators implanted for primary prevention.

Methods

Retrospective single-center study. We analyzed all patients with defibrillators implanted for primary prevention in whom AF was diagnosed until the end of 2017. The cause of inappropriate shocks was evaluated by analysis of the stored intracardiac electrogram. Basal characteristics, cardiovascular risk factors, left ventricle ejection fraction, heart failure etiology (ischemic and non-ischemic), kidney function (creatinine) and medication were evaluated. Death was assessed during the follow-up.

Results

We studied 177 patients [median age 66 years (IQR 59-71); 82% male], with defibrillators and AF. AF was diagnosed before defibrillator implantation in 131 patients (74%) and after the implantation in the remaining 46 (26%). Inappropriate shocks occurred in 31 patients and 24 (14%) were caused by AF with rapid ventricular response: 13 patients with previously diagnosed AF and 11 with new-onset AF. During a median follow-up of 65 (IQR: 36-104) months, 74 patients died. Multivariate Cox-regression analysis demonstrated inappropriate shocks caused by AF were not independently related with death (adjusted HR 0.53; CI 0.23-1.23, p = 0.14). Kaplan-Meier survival curve demonstrated patients with AF-triggered inappropriate shocks had a better survival comparing to those with AF but without inappropriate shocks (logrank, p = 0.03) (figure).

Conclusions

In this group of AF patients, inappropriate shocks caused by AF did not increase the risk of death. Instead, these patients had a better survival comparing to those with AF but no shocks, probably due to a re-evaluation of the patient´s status and subsequent closer medical monitoring, strictly control of symptoms and optimization of drug treatment. These results demonstrate that inappropriate shocks are probably not deleterious per si through a direct mechanism.

Abstract Figure. Kaplan-Meier survival curve

Microplastics in wild fish from North East Atlantic Ocean and its potential for causing neurotoxic effects, lipid oxidative damage, and human health risks associated with ingestion exposure

Microplastics (MP) pollution has received increased attention over the last few years. However, while the number of studies documentating the ingestion of microplastics by fish has increased, fewer studies have addressed the toxicological effects derived from the ingestion of these small items in wild conditions. Here, MP contamination and effect biomarkers were investigated in three commercially important fish species from the North East Atlantic Ocean. From the 150 analysed fish (50 per species), 49 % had MP. In fish from the 3 species, MP in the gastrointestinal tract, gills and dorsal muscle were found. Fish with MP had significantly (p ≤ 0.05) higher lipid peroxidation levels in the brain, gills and dorsal muscle, and increased brain acetylcholinesterase activity than fish where no MP were found. These results suggest lipid oxidative damage in gills and muscle, and neurotoxicity through lipid oxidative damage and acetylcholinesterase induction in relation to MP and/or MP-associated chemicals exposure. From the 150 fish analysed, 32 % had MP in dorsal muscle, with a total mean (± SD) of 0.054 ± 0.099 MP items/g. Based on this mean and on EFSA recommendation for fish consumption by adults or the general population, human consumers of Dicentrachus labrax, Trachurus trachurus, Scomber colias may intake 842 MP items/year from fish consumption only. Based on the mean of MP in fish muscle and data (EUMOFA, NOAA) of fish consumption per capita in selected European and American countries, the estimated intake of microplastics through fish consumption ranged from 518 to 3078 MP items/year/capita. Considering that fish consumption is only one of the routes of human exposure to microplastics, this study and others in the literature emphasize the need for more research, risk assessment and adoption of measures to minimize human exposure to these particles. Thus, MP pollution and its effects should be further investigated and addressed according to the WHO 'One Health' approach.

Burden of disease associated with dietary exposure to carcinogenic aflatoxins in Portugal using human biomonitoring approach

Human biomonitoring is an important tool to assess human exposure to chemicals, contributing to describe trends of exposure over time and to identify population groups that could be under risk. Aflatoxins are genotoxic and carcinogenic food contaminants causing hepatocellular carcinoma, the third leading cause of cancer deaths worldwide. In Portugal, scarce data are available regarding exposure to aflatoxins and no previous study used human biomonitoring data to comprehensively characterize the associated burden of disease. 24 h urine and first-morning urine paired samples were collected by 94 participants and were analyzed by liquid chromatography-tandem mass spectrometry for the quantitative determination of aflatoxins (B₁, B₂, G₁, G₂ and M₁). Deterministic and probabilistic models were developed to assess the Portuguese exposure to aflatoxins and to estimate the health impact of this exposure, estimating the attributed Disability-Adjusted Life Years (DALYs). Aflatoxins were detected in a maximum of 13% (AFB₁), 16% (AFB₂), 1% (AFG₁), 2% (AFG₂) and 19% (AFM₁) of the urine samples. Data obtained through the probabilistic approach revealed an estimated mean probable daily intake of 13.43 ng/kg body weight per day resulting in 0.13 extra cases of hepatocellular carcinoma, corresponding to mean annual DALYs of 172.8 for the Portuguese population (10291027 inhabitants). The present study generated for the first time and within a human biomonitoring study, reliable and crucial data to characterize the burden associated to the exposure to aflatoxins of the Portuguese population. The obtained results constitute an imperative support to risk managers in the establishment of preventive policy measures that contribute to ensure public health protection.

Atopic Dermatitis Host and Environment Model: Revisiting Therapeutic Options

Summary

Atopic Dermatitis affects both children and adults and is a serious health concern in many countries. AD is a complex disease with host and environmental factors underlying its pathology. Its treatment is multidimensional reflecting the diverse nature of its triggers and includes emollients, topical steroids and calcineurin inhibitors among others. Immunological dysfunction can be addressed broadly with systemic immunosupressors and specifically with monoclonal antibodies. Dupilumab, which targets IL-4 and IL-13 was granted approval for treatment of moderate-to-severe AD. Biologics targeting IgE/Th2 pathways may have its role in patients with overlapping AD and asthma. Psychological distress can exacerbate symptoms and is associated with increased severity of AD. Environmental triggers, such as, allergens can be addressed in selected cases with allergic immunotherapy. In this paper, we discuss AD treatment and propose a new step-by-step approach aiming at maintaining disease control and improving quality of life.

Poverty eradication and food security through agriculture in Africa: Rethinking objectives and entry points

Agriculture in Africa is expected to meet the dual objectives of providing food and helping people to escape poverty. African agriculture is dominated by smallholdings and donors generally target their agricultural support at the smallholder sector. The expectation is that if the gap between actual and potential yields can be closed, smallholders will grow sufficient crops to feed their families, with a surplus to sell, thus meeting food security needs and bringing in an income to move them out of poverty. In practice, this is often not possible. While technologies already exist that can raise smallholder farmers' yields 3 or 4 times, even under rainfed conditions, the small size of land available to them limits how much can be grown and the per capita income from agriculture is insufficient to allow people to move above the current World Bank-defined poverty line of US$1.90 per day. We link this finding with farmer typologies to further explain that there are large differences between individual farming households themselves in terms of their investment incentives and capability to benefit from field-level technologies that are aimed at increasing farm productivity. We argue for more differentiated policies for agricultural development in Africa and suggest that policymakers should be much more aware of the heterogeneity of farms and target interventions accordingly. It is important to understand where and for whom agriculture will have the main purpose of ensuring food and nutritional security and where and for whom there is the potential for significant increases in incomes and a contribution to wider economic growth. Let us recognize the distinctiveness of these targets and underlying target groups and work towards solutions that address the underlying needs.

Burden of disease attributable to exposure to aflatoxins in Portugal using Human biomonitoring data

Key messages

Portuguese population is exposed to aflatoxins, chemical food contaminants that may be harmful (carcinogenic, immunotoxic, mutagenic, teratogenic, hepatotoxic) to humans. Human biomonitoring studies provide realistic data on internal exposure at individual level, contributing to a more accurate estimation of the burden derived from this exposure.

Risk assessment of Portuguese population to multiple mycotoxins: the human biomonitoring approach

Key messages

Portuguese population is exposed to mycotoxins, chemical food contaminants that may be harmful (carcinogenic, immunotoxic, mutagenic, teratogenic, hepatotoxic) for human health. Human biomonitoring studies provide realistic data on internal exposure at individual level, allowing a more accurate knowledge of the determinants of exposure to these contaminants.

P3563The influence of circadian patterand obstructive sleep apnean of blood pressure in nocturnal arrhythmias in hypertensive patients

Introduction

There is growing evidence suggesting hypertension is related to the occurrence of arrhythmias. When occurring predominantly during the night, two potential entities commonly present in hypertensive patients could be related with increased arrhythmogenesis: (1) the lack of normal nocturnal dipping of blood pressure (BP) (non-dipping pattern of hypertension) or (2) obstructive sleep apnea (OSA). Thus, nocturnal arrhythmias (NAs) can identify hypertensive patients with OSA and/or non-dipping pattern, both related with adverse outcomes.

Aims

To determine if NAs are related with non-dipping hypertension, OSA or both.

Methods

We studied hypertensive patients who performed ambulatory blood pressure monitoring (ABPM) and also polysomnography and 24-hour Holter monitoring. Non-dipping pattern was considered when nocturnal BP reduction was inferior to 10%. Based on Holter monitoring, NAs were present when atrial fibrillation, frequent premature atrial contractions (PACs) (>30 PACs/hour), runs of >4 consecutive PACs, frequent premature ventricular contractions (PVCs) (>30PVCs/hour) or runs of >4 consecutive PVCs were present predominantly during sleeping hours. During polyssonography, apnoea/hypopnoea index (AHI) and oxygen saturation (SaO2) were analysed. Moderate to severe OSA was considered when AHI >15.

Results

We studied 104 patients [median age 62 (54–70) years, 65% male): 42 (40%) had moderate to severe OSA (median AHI=11 (6–26), mean SaO2=94% (92–95)] and 64 (61%) were non-dippers. NAs occurred in 18 patients (17%) and they were independently associated with AHI (Odds Ratio (OR) for a one unit increase 1.04, 95% confidence interval (CI) 1.01–1.07, p=0.03) but not with SaO2 (OR 0.96, CI 0.78–1.19, p=0.73) nor non-dipping pattern (OR 1.23, CI 0.38–3.98, p=0.72). No interaction was found between OSA and non-dipping hypertension (p=0.35). In patients with dipping pattern (n=40), AHI was higher in NAs patients comparing with no NAs patients (median AHI 29 versus 10, p=0.04), while in those with non-dipping pattern (n=64), AHI was not statistically different between patients with and without NAs (21 versus 11, p=0.12) (figure).

Figure 1

Conclusion

In this population of hypertensive patients, the presence of NAs was associated with OSA severity (i.e AHI), but not with the non-dipping pattern of hypertension. The importance of obstructive events in arrhythmogenesis seemed to be more pronounced in dipping patients, suggesting the abnormal high blood pressure during the night may also have some impact on NAs in non-dipping patients. Overall, our results suggest that OSA screening should be considered when nocturnal arrhythmias are detected in hypertensive patients, but ABPM should not be forgotten since multiple mechanisms can be involved in nocturnal arrhythmogenesis.

P3795Should we also screen for obstructive sleep apnea in patients presenting with excessive supraventricular ectopic activity?

Background

It is recommended to consider obstructive sleep apnoea (OSA) screening in atrial fibrillation (AF) patients with risk factors, due to the strong evidence of an association between these two entities. Excessive supraventricular ectopic activity (ESVEA) has been proposed to be a risk factor for AF. However, strong evidence between ESVEA and OSA has not been established.

Objective

We aimed to determine if ESVEA is associated with moderate to severe OSA since its treatment may prevent AF.

Methods

We studied patients who performed polysomnography and 24-hour Holter monitoring. Patients with atrial fibrillation were excluded. ESVEA was defined as more than 30 PACs per hour (frequent PACs) or runs of >4 consecutive PACs. The circadian pattern of PACs was also evaluated. Sleeping hours were used to define “nocturnal”. Moderate to severe OSA was defined when polyssonography demonstrated a apnoea/hypopnoea index (AHI) >15. We examined the association between ESVEA and moderate to severe OSA during wakefulness and sleep.

Results

We studied 290 patients [median age 65 (55–72) years, 62% males, body mass index (BMI) 30 (27–34)]. 112 (38%) had moderate to severe OSA. Median AHI was 11 (5–24) and mean oxygen saturation was 94% (92–95). Median PACs was 35 (9–117) and 29 patients (10%) had frequent PACs. Runs of >4PACs occurred in 114 patients (39%). Forty-three patients (15%) had predominant nocturnal PACs and 42 (14%) had nocturnal runs of PACs. Multivariate logistic regression analysis demonstrated only nocturnal PACs were associated with moderate to severe OSA (p=0.027) (table 1).

Multivariate logistic regression Odds Ratio 95% Confidence Interval p-value Male gender 4.49 2.48–8.17 <0.001 Body mass index (kg/m2) 1.09 1.03–1.15 0.002 Nocturnal PACs 4.12 1.17–14.46 0.027 Variables not included in the model: age, number of PACs/h, frequent PACs (>30 PAcs/hour), runs of PACs (>4 consecutive PACs), nocturnal frequent PACs and nocturnal runs of PACs.

Conclusion

OSA screening in patients presenting with nocturnal PACs should be routinely considered, especially in male and obese. Treating moderate to severe OSA patients with CPAP has a potential benefit in preventing ESVEA and consequently AF.

Food intake and high-sensitivity C-reactive protein levels in adolescents

BACKGROUND AND AIMS

Diet comprises factors with anti and pro-inflammatory potential that can contribute to modulate obesity-induced inflammation. We aimed to assess the association between food intake and high-sensitivity C-reactive protein (hsCRP) levels in adolescents.

METHODS AND RESULTS

A cross-sectional analysis of 991 adolescents aged 13 years old was conducted as part of the EPITeen cohort, Porto, Portugal. Food intake was assessed by a food frequency questionnaire and thirteen food groups were defined. Anthropometric assessment was performed and serum hsCRP was measured in a fasting blood sample. hsCRP concentrations above the 75th percentile were considered high. Logistic regression was fitted to estimate the association between the intake frequency of the food groups and hsCRP, stratified by BMI and adjusted for sex, parental education and total energy intake. Median (25-75th percentiles) hsCRP concentrations increased with increasing values of BMI [normal weight: 0.20 (0.10-0.50); overweight: 0.40 (0.20-0.80); obese: 1.10 (0.40-2.15) mg/l, p < 0.001]. After adjustment for sex, parental education and total energy intake, no statistically significant associations were found amongst normal weight and overweight participants. However, among obese individuals, having as reference the first frequency category (<1 per day), a higher frequency of vegetables/legumes intake showed a decreased odds of high hsCRP levels (OR: 0.10, 95%CI 0.03-0.38, 1-3 per day; and OR: 0.14, 95%CI 0.04-0.52, >3 per day).

CONCLUSION

Among participants with obesity-induced higher hsCRP levels, a higher frequency of vegetable/legume intake was inversely related to hsCRP.

Accumulation, elimination and neuro-oxidative damage under lanthanum exposure in glass eels (Anguilla anguilla)

Rare earth elements (REEs) comprise elements from lanthanum to lutetium that together with yttrium and scandium are emergent contaminants of critical importance for numerous groundbreaking environmental technologies. Transfer to aquatic ecosystems is expected to increase, however, little information is known about their potential impacts in marine biota. Considering the endangered conservation status of the European eel (Anguilla anguilla) and the vulnerability of early fish life stages to contaminants, we exposed glass eels, through water, to an environmentally relevant concentration (120 ng.L^-1) of lanthanum (La) for 7 days (plus 7 days of depuration). The aim was to study the accumulation and elimination of La in eel's body and subsequent quantification of acetylcholinesterase (AchE), lipid peroxidation and antioxidant enzymatic machinery. Accumulation peaked after 72 h-exposure to La, decreasing afterwards, even in continuous exposure. Accumulation was higher in the viscera, followed by the skinless body and ultimately in the head, possibly as a protective mechanism to cope with La neurotoxicity. A significant increase in AChE activity was observed in La-exposed glass eels, suggesting that La³⁺ may inhibit the binding of acetylcholine. A depression in lipid peroxidation was registered under La exposure, possibly indicating that La³⁺ may play physiological activities and functions as a free radical scavenger. Catalase activity was significantly inhibited in La-exposed glass eels after 72 h, indicating that the availability of La may induce physiological impairment. The quantification of Glutathione S-Transferase activity revealed no differences between control and La-exposed organisms. Further investigation is needed towards understanding the biological effects of REEs.

Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update

BACKGROUND

Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007.

METHODS

SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey.

RESULTS

The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with updated evidence and their best clinical judgment in individual cases.

Expression of iron-related proteins in feline and canine mammary gland reveals unexpected accumulation of iron

Dysregulation of cellular iron homeostasis in human breast cancer is reflected by the altered expression of regulatory proteins. The expressions of iron-related proteins in the mammary glands of cats and dogs have not been assessed. We evaluated the expressions of ferritin, ferroportin, hepcidin and transferrin receptor 1 in benign and malignant mammary gland lesions in cats and dogs. Iron deposition was detected using Perls' Prussian blue staining. We found no major differences in the expression of iron-related proteins between benign and malignant mammary gland lesions in either cats or dogs; however, these species exhibited accumulation of iron in benign lesions. Our findings provide an explanation for the absence of higher iron requirements by tumor cells in these animals. Further investigation of local iron homeostasis in cats and dogs and differences in their physiology compared to human breast cancer is required.