Exposure assessment of nitrate and phenol derivatives in Tehran's water distribution system

The presence of organic and inorganic contaminants in drinking water is a global concern. Nitrate and phenol derivatives are examples of pollutants that could be of anthropogenic origin. They are associated with numerous health risks, underscoring the importance of monitoring their presence in drinking water. This study aimed to measure nitrate and phenol derivatives, including 2,4-Dichlorophenol (2,4-DCP), Pentachlorophenol (PCP), 2,4,5-Trichlorophenol (2,4,5-TCP), 2-Chlorophenol (2-CP), 4-Chlorophenol (4-CP), and phenol, in Tehran's water distribution system (WDS). The pollutants in Tehran's WDS were significantly and positively correlated with precipitation. The Hazard Quotient (HQ) and the Excess Lifetime Cancer Risk (ELCR) of the detected pollutants were estimated. The results showed that the regional mean of nitrate and PCP in Tehran's WDS were 35.58±8.71mg L-1 and 76.14±16.93 ng L-1 lower than the guideline values of 50 mg L-1 and 1000 ng L-1, respectively. Some districts exhibited nitrate concentration exceeding the allowable limit by a factor of 1.2 to 2.3. Consequently, the nitrate intake in some districts constituted approximately 50% of the reference dose. While PCP as a phenol derivative with more health concerns was identified in Tehran's WDS, the likelihood of its health effects was determined to be negligible.

Human biomonitoring and reference values of urinary 1-hydroxypyrene among Iranian adults population

Polycyclic aromatic hydrocarbons (PAHs) are one of the most important environmental pollutants. Urinary concentrations of 1-hydropyren metabolites of PAHs have been used as biomarkers of these chemicals' exposure in humans. This cross-sectional study was conducted on 468 healthy Iranian adults over 25 years old and non-smokers in six provinces who were selected based on the clustering method. Fasting urine sampling and body composition and demographic measurements were performed. Urine samples were analyzed by GC-MS. The analysis included descriptive statistics and analytical statistics using multiple linear regression by Python software. 1-Hydroxypyrene was found in 100% of samples, and the mean (Reference Value 95%) concentration of 1-hydroxypyrene was 6.12 (RV 95%: 20) μg/L and 5.95 (21) μg/gcrt. There was a direct relationship between the amount of body composition (body fat, visceral fat), BMI, and age with the urinary concentrations of 1-hydropyren metabolites, and this relationship was significant for BMI with urinary concentrations of 1-hydropyren metabolites (P = 0.045). The amount of 1-hydroxypyrene in healthy Iranian adults has been higher than in similar studies in other countries. These results provide helpful information regarding the exposure of Iranian adults to 1-hydroxypyrene, and these data can be used to supplement the national reference values of human biomonitoring for the interpretation of biomonitoring results.

In Commemoration of Dr. Bijan Sadrizadeh, a Prominent Physician and Expert in the Field of Public Health in Iran and Around the World

In line with the commemoration of the scientists who played a significant role in advancing knowledge and providing services to the country, it is imperative to publish their biographies so that their lives and achievements are recorded in the history of the country and serve as an example for future generations. Dr. Bijan Sadrizadeh, a physician and a public health specialist, undertook many valuable activities, particularly in the field of public health in Iran and the world during more than 60 years of great services, including the promotion of public health in the Islamic Republic of Iran, the development of I.R. Iran's international collaborations in the field of public health, and the development of research programs in the field of neglected tropical diseases and the eradication of polio in the world. He served the country in many high-level executive capacities, including three periods as deputy Minister of Health. In addition to several years of full-time employment in the World Health Organization (WHO), Dr. Sadrizadeh also served on the WHO Executive Board and was a member of numerous scientific and advisory committees. In reviewing his life, great determination, devotion, believing in primary health care and universal health coverage and a deep sense of responsibility are visible and can be an inspiration and a model for all.

Quantitative microbial risk assessment of enteroviruses in raw-eatable vegetables irrigated by wastewater: examining different scenarios of washing

Due to the increasing water crisis, the reuse of wastewater deserves attention as a method to reduce the pressure of the water crisis, especially in developing countries. The application of health risk assessment models is a way to estimate disease burdens associated with crop irrigation by wastewater effluents. In this study, a quantitative microbial risk assessment (QMRA) with probabilistic Monte-Carlo simulation was used to estimate the annual risk of enteroviruses (EVs) infection and disease burden for consumers of effluent-irrigated raw vegetables in Tehran, the capital of Iran. Wastewater effluent samples were collected over two seasons: summer and winter. EVs were analyzed in three stages, concentration and separation, cell culture, and real-time PCR (RT-PCR). A questionnaire was used to determine the dominant patterns of vegetable washing by consumers. There were 4 vegetable washing steps: wiping away mud (A), rinsing (B), using detergents (C), using disinfectants (D). 5 patterns of washing were examined in the laboratory and the concentration of enteroviruses was measured in every pattern. pattern 1: just wiping away mud (A), pattern 2: wiping away mud and rinsing (AB), pattern 3: wiping away mud by using detergents and rinsing (ABCB), pattern 4: wiping away mud by using disinfectants and rinsing (ABDB), and pattern 5: wiping away mud by using detergents and disinfectants and rinsing (ABCBDB). For washing pattern 1, pattern 2, and pattern 3, the estimated annual infection risk of EVs was estimated to be 5.6 × 10^-1, 3.6 × 10^-1, 1.7 × 10^-1 (risk/per.day), and burden of disease was calculated as 3 × 10^-2, 2 × 10^-2, and 9 × 10^-3 (burden/year), respectively. The results showed that if vegetables are washed according to method 5, the microbial risk will be minimized and the excess prevalence of viral infections will be eliminated.

Effect of dilution factor on the isolation of Helicobacter pylori from municipal wastewater using culture technique

Background and Objectives

Isolating Helicobacter pylori (H. pylori) from wastewater and culturing it using a conventional method has always been a controversial issue because the bacterium converts into a coccoid form when exposed to an unfavourable environment like wastewater. To clarify the cultivability behaviour of the bacterium in fresh wastewater samples, the effect of municipal wastewater dilation on the cultivation of the bacterium using a conventional method was examined.

Materials and Methods

Several dilutions of wastewater samples were inoculated with fresh H. pylori suspension (with McFarland's dilution 0.5) to examine the dilution effect of wastewater on the bacterium isolation.

Results

The H. pylori growth was found to be possible for a dilution factor from 1/10⁶ to 1/10⁷ of raw wastewater. In higher dilution factors the growth of fungi was dominant and could prevent the isolation of the bacterium.

Conclusion

The optimized technique could be applied in future studies for increasing the chance of H. pylori isolation from fresh wastewater environments.

Comparison of the Toxic Effects of Pristine and Photocatalytically Used TiO2 Nanoparticles in Mice

TiO₂ nanoparticles used in the photocatalytic degradation of pollutants in water treatment processes undergo physiochemical changes; therefore, their toxicological effects may be potentially different from those of the pristine nanoparticles. This study compared the toxic effects of exposure to pristine and photocatalytically used TiO₂ nanoparticles in mice. To obtain used TiO₂, the nanoparticles were used for photocatalytic degradation of a model pollutant under UV irradiation several times. Two groups of mice were exposed to pristine (PT group) and photocatalytically used TiO₂ (UT group) at three different concentrations (5-20 mg/m³) using whole-body exposure chambers (2 h/day, 5 days/weeks, 4 weeks). Exposure to both pristine and used TiO₂ increased the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphate (ALP), lactate dehydrogenase (LDH), C-reactive protein (CRP), and creatine kinase (CK-MB) significantly. Both exposed groups showed higher levels of WBC, lymphocytes, platelets, hematocrits, hemoglobin, and mean corpuscular volume (MCV) and lower levels of RBC and mean corpuscular hemoglobin concentration (MCHC) in a concentration-dependent manner. In all analyses, there were small non-significant differences between the PT and UT groups. More pathological changes were observed in the lung, kidney, and brain of the UT group, while the PT group showed more pathological effects in the liver and heart. The histological observations indicated that damage was mostly in the form of vascular endothelial injury. These two types of TiO₂ may activate different pathways to promote adverse effects. Further studies are required to evaluate and distinguish the mechanisms through which pristine and used TiO₂ induce toxicity.

Assessment of burden of disease induced by exposure to heavy metals through drinking water at national and subnational levels in Iran, 2019

The burden of disease attributable to exposure to heavy metals via drinking water in Iran (2019) was assessed at the national and regional levels. The non-carcinogenic risk, carcinogenic risk, and attributable burden of disease of heavy metals in drinking water were estimated in terms of hazard quotient (HQ), incremental lifetime cancer risk (ILCR), and disability-adjusted life year (DALY), respectively. The average drinking water concentrations of arsenic (As), cadmium (Cd), chromium (Cr), lead (Pb), mercury (Hg), and nickel (Ni) in Iran were determined to be 2.3, 0.4, 12.1, 2.5, 0.7, and 19.7 μg/L, respectively, which were much lower than the standard values. The total average HQs of heavy metals in drinking water in the entire country, rural, and urban communities were 0.48, 0.65 and 0.45, respectively. At the national level, the average ILCRs of heavy metal in the entire country were in the following order: 1.06 × 10^-4 for As, 5.89 × 10^-5 for Cd, 2.05 × 10^-5 for Cr, and 3.76 × 10^-7 for Pb. The cancer cases, deaths, death rate (per 100,000 people), DALYs, and DALY rate (per 100,000 people) attributed to exposure to heavy metals in drinking water at the national level were estimated to be 213 (95% uncertainty interval: 180 to 254), 87 (73-104), 0.11 (0.09-0.13), 4642 (3793-5489), and 5.81 (4.75-6.87), respectively. The contributions of exposure to As, Cd, Cr, and Pb in the attributable burden of disease were 14.7%, 65.7%, 19.3%, and 0.2%, respectively. The regional distribution of the total attributable DALY rate for all heavy metals was as follows: Region 5> Region 4> Region 1> Region 3> Region 2. The investigation and improvement of relatively high exceedance of As levels in drinking water from the standard value, especially in Regions 5 and 3 as well as biomonitoring of heavy metals throughout the country were recommended.

Paramedical staff's knowledge, attitude, and performance about nosocomial infection controls at hospitals: A cross-sectional survey in Iran

BACKGROUND

Nosocomial infections usually occur 48 hours after admission to the hospital or up to 72 hours after discharge from the hospital. They lead to an increase in mortality and health costs. The purpose of this study is to measure the knowledge, attitude, and performance of paramedical staff about nosocomial infection control.

MATERIALS AND METHODS

This cross-sectional study was conducted in Tehran hospitals in 2019. A valid and reliable questionnaire was used to collect data. The questionnaires were distributed among 405 randomly selected paramedical staff at 25 hospitals in Tehran. The data were analyzed using SPSS18.

RESULTS

The mean scores of paramedical staff's knowledge, attitude, and performance in terms of nosocomial infection control were 11.2 ± 2.2 (good), 21.7 ± 3.7 (good), and 49.2 ± 9.4 (good) respectively. A statistically significant relationship was obtained between paramedical staff's work experience and type of hospital and their knowledge, attitude, and performance in terms of nosocomial infection control (P <0.05). In addition, a statistically significant relationship was found between gender, age, education, and, employment type and nosocomial infection control performance (P <0.05).

CONCLUSIONS

The knowledge, attitude, and performance of paramedical staff about nosocomial infections in Tehran hospitals were good. Education, continuous supervision, and provision of the necessary equipment are needed for improving the paramedical staff's knowledge, attitude, and performance in terms of nosocomial infections.

Correction to: Evaluation of iron and manganese removal effectiveness by treatment plant modules based on water pollution index; a comprehensive approach

[This corrects the article DOI: 10.1007/s40201-021-00665-2.].

Evaluation of iron and manganese removal effectiveness by treatment plant modules based on water pollution index; a comprehensive approach

Groundwater is a viable alternative when access to surface water resources is limited. Iron and manganese are known ions in soil and naturally in groundwater sources. However, human activities also are responsible. To identifying the best module for removing manganese and iron in the water treatment plant (WTP) of Mazandaran, 516 samples were taken from raw and treated water. The concentration of manganese, iron, was measured by atomic absorption spectrophotometry, and turbidity was used with the nephelometry method. The water pollution index (WPI) was applied for categorizing the status of pollution in treated water. The effect of seasonal temperature and backwashing (At flow rates of 3.5, 9.2, and 15.3 m h-1) on the sand filter efficiency was also investigated. The highest concentrations of manganese, iron, and turbidity in raw water were 0.744, 6.70 mg L-1, and 41.8 NTU, and in treated water were 0.67, 1.09 mg L-1, and 5.58 NTU, respectively. The mean concentration of manganese and iron in raw and treated water were 0.24 ± 0.1, 0.93 ± 0.91, 0.105 ± 0.06 and 0.18 ± 0.14 mg L-1 respectively. The WPI statuses in drinking water were excellent for manganese and iron in 95.74 and 53.88 % of the samples and very poor in 1.16 and 12.01 % of the samples, respectively, and its classification for drinking water for manganese and iron was excellent ˃ good ˃ extremely polluted ˃ polluted and the concentration of iron was more than manganese in treated water. The study of temperature's effect on sand filters showed that the removal efficiency in warm seasons was higher than in cold seasons. Also, the turbulence in the backwash with the 9.2 m h^- 1 rates, is lesser than other speeds, and in this flow, after 270 s, the turbidity decreases to less than 10 NTU. Spearman correlation comparison showed that the parameters amounts after filtration decreased significantly (p ≤ 0.0001) in comparison to raw water. The results showed that module #1 that used open-aeration and chlorine as oxidations, was most effective in removing iron and manganese. In the end, the WTP couldn't diminish the parameters completely and need subsidiary units.

Isolation, identification and reviewing the health effect of HPC bacteria in household point-of-use (PoU) water treatment devices: a case study, Ahvaz, Iran

In Ahwaz, a city in west southern Iran, the majority of households are using Point of Use (PoU) water treatment units. The heterotrophic plate count (HPC) bacteria were isolated from these units while they were mounted on water distribution system in order to determine the variations in HPC and diversity of the bacterial population using polymerase chain reaction (PCR). Results showed that bacterial population regrowth in PoU units could increase HPC exceeding the limit of the 500 CFU/mL in outlet water. In around 70% of the input water samples, the HPC was less than 500 CFU/ml with a mean of 226.7 (CI 95%: 28.1-425.3). HPC in output treated water samples had an increasing trend from the start of the unit operation with a mean of 2416.4 (CI 95%: 1074.9-3757.9). Out of 49 detected bacterial strains, 20 strains were Gram-negative and 29 Gram-positive. Bacillus was the most frequent genes detected in inlet and outlet water samples. Most of the identified bacterial strains were opportunistic pathogens potentially dangerous for immunocompromised population. HPC population in PoU units significantly can be increased during a one-month period of operation, so replacement of the filters must be done regularly.

Iranian population exposures to heavy metals, PAHs, and pesticides and their intake routes: a study protocol of a national population health survey

Cancer is the second leading cause of death in the world and the third leading cause of death in Iran. It has been proven that numerous cancer cases are caused by exposure to environmental pollutants. There is a public health concern regarding an increase in exposure to carcinogens across Iran through different sources (air, food, and water) and a lack of research to address this issue. This study aims to gather data on exposure to heavy metals, polycyclic aromatic hydrocarbons (PAHs), and pesticides and their intake routes during the implementation of a national population health survey. This is a cross-sectional study of environmental pollutants in Iran, with a stratified multi-stage random sampling method, which led to 660 nationally representative samples in 132 clusters in three sequential parts. The first will be questionnaires to obtain demographics, assets, food records, air quality, and food frequency. The second will be physical measurements, including anthropometric and body composition. The third will be lab assessments that measure 26 types of environmental pollutants (7 heavy metals, 16 PAHs, and 3 pesticides) in urine, inhaled air, and consumed food and water of the population under study using ICP-MS and GS-MS devices. The results of this study will inform policymakers and the general population regarding the level of threat and will provide evidence for the development of interventional and observatory plans on the reduction of exposures to these pollutants. It could also be used to develop local standards to control contaminants through the three exposure routes. This study protocol will obtain data needed for policymakers to set surveillance systems for these pollutants at the national and provincial level to address the public concerns regarding the contamination of food, air, and water.

A systematic review and meta-analysis of human biomonitoring studies on exposure to environmental pollutants in Iran

Population exposure to environmental contaminants can be precisely observed through human biomonitoring studies. The present study aimed to systematically review all the biomonitoring studies conducted in Iran on some selected carcinogen environmental pollutants. In this systematic review study, 11 carcinogen agents were selected including arsenic, cadmium, chromium, nickel, lindane, benzene, trichloroethylene (TCE), pentachlorophenol (PCP), radon-222, radium-224, - 226, - 228, and tobacco smoke. The Web of Science, PubMed, and Scopus databases were searched for peer-reviewed articles published in English. After several screening steps, data were extracted from the studies. Meta-analyses (a random-effect model using the DerSimonian-Laired method) were performed only for the biomarkers with more than three eligible articles, including cadmium in blood and breast milk, and arsenic in breast milk. Methodological quality of the studies was assessed using the Newcastle-Ottawa Quality Assessment Scale adapted for cross-sectional studies. Of the 610 articles found in the database search, 30 studies were eligible for qualitative review, and 13 were included in the meta-analysis (cadmium in blood (n = 3), cadmium in breast milk (n = 6), and arsenic in breast milk (n = 4)). The overall pooled average concentrations (95% CI) of cadmium in blood, cadmium in breast milk, and arsenic in breast milk were 0.11 (95% CI: 0.08, 0.14), 5.38 (95% CI: 3.60, 6.96), and 1.42 (95% CI: 1.02, 1.81) µg/L, respectively. These values were compared with the biomarker concentrations in other countries and health-based guideline values. This study showed that there is a need for comprehensive action plans to reduce the exposure of general population to these environmental contaminants.

A comprehensive systematic review of photocatalytic degradation of pesticides using nano TiO2

This study has systematically reviewed all of the research articles about the photocatalytic degradation of pesticides using titanium dioxide (TiO₂) nanoparticles (NPs) and ultraviolet (UV) irradiation. Online databases were searched for peer-reviewed research articles and conference proceedings published during 2009-2019, and ultimately 112 eligible articles were included in the review. Fifty-three active ingredients of pesticides and one mixture had been investigated, most of them were organophosphorus (22%), followed by triazine derivatives (11%), chloropyridines (9%), and organochlorines (9%). Sixteen types of TiO₂ with an average photodegradation efficiency of 71% were determined. Based on the type of pesticide and experimental conditions such as irradiation time, the complete photodegradation had been observed. The removal of each group of pesticides has been sufficiently discussed in the article. Effect of experimental conditions on photocatalytic activity has been investigated using linear and polynomial regressions. The strategies to reduce the required energy for this process, doping TiO₂ with metal and non-metal agents, innovative reactor designs, etc., were also discussed. In conclusion, TiO₂ NPs have been successful for degradation of pesticides. Future direction for research incorporates developing and application of heterogeneous doped and immobilized titania having optimized characteristics such as surface area, reactive centers, recombination rate, and phase, and capable to photo-degrade low levels of pesticides residues under solar light in an efficient full-scale size.

Subnational exposure to secondhand smoke in Iran from 1990 to 2013: a systematic review

Every year, almost eight million people die from tobacco-related diseases, among which around 1.2 million die from secondhand smoke (SHS) exposure. Generally, it is estimated that SHS constituents generated in the interval between puffs are approximately 3 times more toxic than those produced at the moment of puffing. There is no risk-free level of SHS exposure, and even brief exposure can be harmful to health. The aim of this study was to assess SHS exposure and its trend in the different provinces of Iran from 1990 to 2013. To collect available data on SHS exposure, a systematic review was performed. We searched international and national databases using a combination of Medical Subject Headings (MeSH) and relevant text words in the titles, abstracts, and/or keywords. Also, the data in national surveys were gathered. The frequency of exposure in different provinces as well as age, sex, and rural/urban areas were extracted. Afterwards, modeling was done to estimate SHS exposure from the smoking data. According to our findings, SHS exposure was more prevalent among young people. Moreover, this exposure was greater in rural areas as compared to urban areas. A national study on 13-15-year-old individuals showed the highest exposure occurred outdoors. In addition, a declining trend was observed on SHS exposure over time. It seems that attention to the importance of SHS exposure in researches in Iran dates back to 2001, and gradually, especially in recent years, further studies have been conducted on SHS exposure.

Isolation and characterization of a multidrug-resistant Clostridioides difficile toxinotype V from municipal wastewater treatment plant

PURPOSE

Wastewater treatment plant (WWTP) is regarded as a potential source for transmission of Clostridioides difficile from urban areas into the surface water, through feces of human and animals. The aim of this study was to screen and characterize the C. difficile bacteria in inlet and outlet wastewater of different WWTPs in Tehran, Iran.

METHODS

Totally, 72 samples were collected from three different WWTPs (inlet site and outlet sites) during a year. C. difficile was isolated and characterized in terms of toxins, toxinotype, resistance profile and genes, and colonization factors using PCR.

RESULTS

One C. difficile toxinotype V was isolated from the outlet samples. The isolate was susceptible to vancomycin but resistant to metronidazole, tetracycline, ciprofloxacin, and moxifloxacin using MIC Test Strips. The isolated C. difficile was toxigenic (tcdA, tcdB, cdtA, cdtB positive and CPE positive) and had tcdC-A genotype. No mutations were found in fliC and fliD. The slpA sequence type was 078 - 01. The C. difficile was positive for tetM, int, but negative for vanA, nim, and tndX genes. Mutations were not observed in gyrA and gyrB genes.

CONCLUSIONS

This study provided evidence of presence of a multidrug-resistant C. difficile toxinotype V in one of the municipal WWTP. The transmission of such isolate to the environment and reuse of treated wastewater by human pose a threat to human health and dissemination of antibiotic resistant bacteria which are untreatable.

Tehran environmental and neurodevelopmental disorders (TEND) cohort study: Phase I, feasibility assessment

PURPOSE

To advance knowledge about childhood neurodevelopmental disorders and study their environmental determinants, we conducted a study in Tehran, Iran to assess the feasibility of prospective birth cohort study.

METHODS

We evaluated participation of pregnant women, feasibility of sampling biological material, and health care services availability in Tehran in four steps: (1) first trimester of pregnancy; (2) third trimester of pregnancy; (3) at delivery; and (4) two to three months after delivery. We collected related data through questionnaires, also various biological samples were obtained from mothers (blood, urine, milk and nails-hands and feet) and newborns (umbilical cord blood, meconium, and urine samples) from February 2016 to October 2017.

RESULTS

overall 838 eligible pregnant women were approached. The participation rate was 206(25%) in our study and about 185(90%) of subjects were recruited in hospitals. Out of 206 participants in the first trimester, blood, urine, hand nail, and foot nail samples were collected from 206(100%),193(93%), 205(99%), and 205(99%), respectively. These values dropped to 65(54%), 83(69%), 84(70%), and 84(70%) for the remaining participants 120(58%) in the third trimester, respectively. Also, we gathered milk samples from 125(60%) of mothers at two to three months after delivery.

CONCLUSION

Our findings suggest that hospitals were better places for recruitment of subjects in a birth cohort in Tehran. We further concluded that birth cohort study recruitment can be improved by choosing appropriate gestational ages. Obtaining the newborn's urine, meconium, and umbilical cord blood were challenging procedures and require good collaboration between hospital staff and researchers.

Optimizing the performance of conventional water treatment system using quantitative microbial risk assessment, Tehran, Iran

The performance of conventional drinking water treatment plants (WTPs) can be improved using quantitative microbial risk assessment (QMRA). A QMRA study on Cryptosporidium using actual pathogen density was conducted to examine the performance of Jalaliyeh WTP in Tehran, Iran. The infection risk and the burden of disease attributed to the parasite presence in finished water were estimated incorporating physical and chemical log reduction values (LRVs), using stochastic modeling and disinfection profiling. The risk and burden of disease were compared with health-based targets, i.e. one case of infection per 10,000 people or 10^-6 DALYs per person per year. The parasite's LRVs were 2.31 and 0.034 log provided by physico-chemical treatment and disinfection processes, respectively. The mean of estimated risk (111 cases per 10⁴ people per year) and the burden of disease (11.7 DALYs per 10⁶ people per year) both exceeded the targets. To control the excess risk, three QMRA-based disinfection scenarios were examined including: (1) employing chlorine dioxide (ClO₂) instead of chlorine (2) ozonation with a concentration of 0.75 mg/L (Ct = 22.5 min mg/L) and (3) UV irradiation with a dose of 10 mJ/cm². The LRV of parasite may be increased to 3.0, 5.1 and 4.9 log by employing ClO₂, ozonation and UV irradiation, respectively. The use of ozone or UV as alternative disinfectants, could enhance the disinfection efficacy and provide sufficient additional treatment against the excess risk of parasite. QMRA could make it easier applying appropriate improvement to conventional WTPs in order to increase the system performance in terms of health-based measures.

Association Among Sources Exposure of Cadmium in the Adult Non-smoking General Population of Tehran

Acute and chronic exposure to cadmium can cause numerous health effects including poisoning, as well as, bone, liver, and kidney diseases. Cadmium competes with iron absorption in blood and can induce anemia. Cadmium body burden can be measured through urine and blood samples. Urine reflects chronic and blood indicates recent and cumulative exposures to cadmium. Dietary is considered as the main source of exposure to cadmium in non-smoking general population. The study was conducted to determine cadmium level in blood, urine, and in diet of 120 non-smoking adults in Tehran. Dietary components and consumption pattern of participants estimated by a food frequency questionnaire. Next, the correlation investigated between them. Moreover, serum ferritin measured as a marker of iron storage in blood to determine its association with cadmium. The prediction of cadmium fate in the body is determined by toxicokinetic models. This study tried to evaluate one of these models' validity which is developed to predict urinary cadmium from dietary. Afterwards, the predicted urinary compared with the measured urinary cadmium. The correlation coefficient between dietary and blood cadmium equaled 0.66 which was statically significant, but the correlation between dietary and urinary cadmium was minimal and not statically significant (p > 0.05). An inverse and negative correlation was found between serum ferritin and blood cadmium. The mean predicted urinary cadmium calculated by the model was 2.5-fold higher than the measured value in the total population. Results of the present study revealed that blood cadmium reflected mainly acute exposure. There was no correlation between chronic and acute exposures to cadmium. The low serum ferritin level increased cadmium amount in blood. Moreover, the mean predicted urinary cadmium by the model was greater than the measured value. It can because of characteristics of populations and type of dietary exposure. Thus, it is suggested that the model coefficients are determined in each society based on their characteristics.

Developing environmental health indicators [EHIs] for Iran based on the causal effect model

Background

Environmental health monitoring and its effects on health are very important in health systems. Relationship between environment and health can be done by simplifying data in understandable indicators for people and policy-makers. The present study presents the general framework for formulating environmental health quality index for Iran.

Methods

This study was implemented through expert panel at two levels: indicator domain determination and domain specific variables selection. Domain specific variables were selected based on the Driving force-Pressure-State-Exposure-Effect-Action (DPSEEA) framework from the list of national and international variables.

Results

Seven environmental health issues [air quality, drinking water, sewage disposal, food, radiation management and housing and human settlements] were determined, and three variables were selected for air quality, 8 variables for water quality, 5 variables for sanitation, 1 variable for food quality, 3 variables for housing and human settlements, 4 variables for solid waste management and 3 variables for radiation management.

Conclusions

Environmental health indicators determination based on the causal effect model leads to a better understanding of the relationship between the environment and health by simplifying data in an understandable format for public and improves prioritization of policy-making in the environmental health. In this study, environmental health indicators for Iran were proposed.

Chemical composition of PM10 and its effect on in vitro hemolysis of human red blood cells (RBCs): a comparison study during dust storm and inversion

PURPOSE

This study aimed to investigate chemical composition of PM₁₀ (particulate matter with aerodynamic diameter ≤ 10 μm) during dust storm and inversion in Tehran and hemolysis effects.

METHODS

PM₁₀ was sampled in Tehran, Iran, during dust storm and inversion conditions. Water soluble ions (F¯, Cl¯, NO₂¯, NO₃¯, SO₄¯², Na⁺, K⁺, NH₄ ⁺, Ca⁺², Mg⁺²) and elements (Al, Ba, Cd, Co, Cr, Cu, Fe, Li, Mn, Mo, Ni, Pb, Se, Sn, Sr, V, Zn, Pt, Rh, Pd, As and Si) were analyzed by ion chromatograph (IC) and inductively coupled plasma optical emission spectrometer (ICP-OES), respectively. Hemolysis was examined as in vitro at PM₁₀ concentrations of 50-300 μg/ml.

RESULTS

Daily average of PM₁₀ concentrations in dusty and inversion days were 348.40 and 220.54 μg/m³, respectively. Most prevalence ionic components were NO₃¯, Cl¯, SO₄¯² and Ca⁺² during dust storm and SO₄¯², NO₃¯, Cl¯ and NH₄ ⁺ during inversion. Si, Fe and Al had the maximum values in both conditions. Particles associated with both conditions induced hemolytic responses. PM₁₀ from dusty day showed a higher hemolysis percent (10.24 ± 4.67%) than inversion (9.08 ± 5.47%), but this difference was not significant (p = 0.32). Hemolytic effects were significantly intensified by increased PM concentrations (p < 0.001) in a dose-response manner.

CONCLUSIONS

As the results, chemical composition of sampled particles from inversion days and dust storm was different from each other. Hemolytic effects of particles during dust storm were more than inversion days. However, this difference was not statistically significant.

Correction to: Chemical composition of PM10 and its effect on in vitro hemolysis

[This corrects the article DOI: 10.1007/s40201-018-00327-w.].

Investigation and Comparison of In Vitro Genotoxic Potency of PM10 Collected in Rural and Urban Sites at Tehran in Different Metrological Conditions and Different Seasons

The particulate matter has become a serious health problem in some large cities in the world. These particles are a complex mixture of chemical compounds which change based on location and time and, consequently, can cause different health-related effects. The exact mechanism of the effect of these particles is not yet known for certain. However, it seems that numerous mechanisms through the production of ROS and, eventually, DNA destruction, which are related to a wide range of diseases, are among the causes of particles' health-related effects. The present study is aimed to evaluate and compare the genotoxicity potential of particles collected in Tehran, Iran, in urban and rural regions during spring and autumn as well as dusty and inversion conditions. These effects were examined using the comet assay on human pulmonary epithelial cells (A549). Results showed that all the particles had the potential for genotoxicity at the concentration used in this study (75,150 and 300 μg/ml). Moreover, DNA destruction changed with season, site, and even dusty and inversion atmospheric conditions. These changes mostly belonged to urban particles. In general, urban particles in autumn and, specifically, on days with inversion had higher genotoxicity (p < 0.01). Difference was observed between dusty and regular days so that regular days were more potent (p < 0.05). A strong correlation was observed between the effects of most PAH compounds and other metals such as Cr, Co, Cd, Mn, As, and also SO₄, which were mostly the result of combustion in vehicle engines in urban regions. No difference was observed for rural particles at different conditions and seasons.

Dr. Hossein Malekafzali: A Pioneer in Iran's Health Evolution and Development

Dr Malekafzali, an elite biostatistics professor at Tehran University of Medical Sciences, in his more than 50 years of glorious service, has played a crucial role in creation of fundamental evolution in public health, reproductive health and development of applied research in Iran. He has left lasting activities in administrative positions such as health and research deputies, health minister consultant, director of health faculty and director of health research institutes. He published several books and articles on statistics, epidemiology and public health. This article is a review of his worthy and interesting activities in the country's health, research and education.

Correction to: Investigation and Comparison of In Vitro Genotoxic Potency of PM10 Collected in Rural and Urban Sites at Tehran in Different Metrological Conditions and Different Seasons

The original version of this article unfortunately contained a mistake. Figure 6 caption should be "The light microscopic image (a) and transmission electron microscopic image (b) of A549 cell after 24 h of exposure to PM10 (150 μg/ml).

Antibiotics in urban wastewater and rivers of Tehran, Iran: Consumption, mass load, occurrence, and ecological risk

The continuous discharge of antibiotic pharmaceuticals from incomplete wastewater treatment processes into receiving water bodies has become a matter of both scientific and public concern as antibiotics may exert adverse influences on non-target organisms. In this study, the occurrence of seven most commonly prescribed antibiotics belonging to four therapeutic classes of β-lactams, cephalosporins, macrolides, and fluoroquinolones were investigated in the effluent of two wastewater treatment plants (WWTPs) and two river waters: Firozabad Ditch (receiving effluent) and Kan River (not receiving effluent) in Tehran, Iran. In 2016, average consumption rate of target antibiotics in Tehran province was evaluated based on Anatomical Therapeutic chemical (ATC)/Defined Daily Dose (DDD) system and reported as DDD/1000 inh/day. The highest consumption rate was for amoxicillin (128017.6 mg/1000 inhabitants/day), whereas it remained lower for other compounds (amoxicillin > cefixime > azithromycin > ciprofloxacin > cephalexin > erythromycin > penicillin). Ciprofloxacin (79.62 mg/1000 inh/d) and cephalexin (209.51 mg/inh/d) with highest mass loads were evaluated in the influent of WWTP A and WWTP B, respectively. Ciprofloxacin (24.87 mg/1000 inh/d) and cefixime (90.45 mg/1000 inh/d) were the highest evaluated mass loads in the effluent of Ekbatan wastewater treatment plant (WWTP A) and Tehran Southern wastewater treatment plant (WWTP B), respectively. The calculated risk quotients showed that six out of seven target antibiotics posed a high risk to algae (M. aeruginosa and P. subcapitata) and bacteria (P. putida) in the effluent of WWTPs and the rivers wherein amoxicillin and penicillin posed a higher risk than other antibiotics occurring due to their lowest PNEC.

Short-term effects of ambient air pollution and cardiovascular events in Shiraz, Iran, 2009 to 2015

Air pollution and dust storms are associated with increased cardiovascular hospital admissions. The aim of this study was to investigate the association between short-term exposure to ambient air pollutants and CVD (cardiovascular disease) events in a long-term observational period. The study included the events of cardiovascular diseases (namely coronary artery disease, ischemic heart disease, myocardial infarction, and pneumo thrombo embolism) within the population of Shiraz, from March 21, 2009 to March 20, 2015. Also, each patient's demographics were recorded. Main meteorological variables and five ambient pollutants (CO, O₃, SO₂, NO₂, and PM₁₀) were recorded. Statistical analysis was performed using linear regression (GLM) and a generalized additive model (GAM) estimating Poisson distribution and adjusted for the main risk factors and ambient meteorological variables. A mild prevalence (51.5%) of coronary artery disease (CAD) was registered in 6425 events. In GLM analysis, we observed an association among the pollutants with the coronary artery disease hospital admissions which was in the order of CO, NO₂, and PM₁₀. The highest association of each pollutant with hospital admission was observed as PM₁₀ at lag 4 (RR = 1.08; 95% CI 1.02, 1.14 and p < 0.05), NO₂ at lag 0 (RR = 1.22; 95% CI 1.00, 1.48), and CO at lag 0 (RR = 1.52 95% CI = (1.16, 1.99)). However, on dusty days, there were significantly higher numbers of referrals of cardiovascular patients (mean = 7.54 ± 4.44 and p = 0.002,) than on non-dusty days. According to these data, dust storms and some types of pollutants in the air are responsible for more admissions to hospitals for cardiovascular problems.

Endotoxin removal from aqueous solutions with dimethylamine-functionalized graphene oxide: Modeling study and optimization of adsorption parameters

Novel graphene oxide (GO)-based adsorbent embedded with epichlorohydrin (ECH) as a coupling agent and dimethylamine (DMA) as a ligand (GO-ECH-DMA) were prepared and employed for endotoxin removal from aqueous solutions. The physicochemical properties of nanocomposite were fully characterized. The model attributed to batch adsorption process was optimized employing response surface methodology (RSM) via various parameters such as pH, GO-ECH-DMA dosage, and contact time and endotoxin concentration. The p-value with low probability (<0.00001), determination coefficient (R²=0.99) and the non-significant lack of fit (p > 0.05) showed a quadratic model with a good fit with experimental terms. The synergistic effects of the linear term of contact time and GO-ECH-DMA dosage on endotoxin removal were significant. The optimum condition for endotoxin removal was obtained at pH of 5.52, GO-ECH-DMA dosage of 21 mgL^-1, contact time of 56 min and endotoxin concentration of 51.3 endotoxin units per milliliter (EUmL^-1). The equilibrium was the better explained by Langmuir isotherm with the maximum monolayer adsorption capacity of 121.47 EUmg-1, while the kinetics of the endotoxin adsorption process was followed by the pseudo-second-order model. The adsorbent could be recycled with NaOH. The possible mechanisms of endotoxin adsorption were proposed by hydrogen-bonding, π-π stacking, and electrostatic interaction.

An in vitro method to evaluate hemolysis of human red blood cells (RBCs) treated by airborne particulate matter (PM10)

Air pollutants are capable to enter bloodstream through the nose, mouth, skin and the digestive tract. Hemolysis is the premature destruction of red blood cells (RBCs) membranes. This can affect metabolism of RBCs and reduce cell life. Each of these adverse effects could lead to anemia, jaundice and other pathological conditions. Hemolysis can induce by the mineral components adsorbed on the particles. The aim of this study was to evaluate hemolysis of RBCs treated by airborne PM₁₀ (PM with aerodynamic diameter ≤ 10 μm) in vitro. Study had two main stages including sampling and preparation of PM₁₀ suspension, and hemolysis test. Particle samples were collected by means of a high-volume sampler on fiberglass filters. The PM₁₀ was extracted through dry ultrasonic method. Blood sample was incubated by PM₁₀ at concentrations 50-300 μg/mL for 3 h. Hemolysis percent was assessed through measurement of Hemoglobin concentration in test samples and total blood hemoglobin (TBH) sample by the cyanmethemoglobin method. Analysis of variance (ANOVA) and Tukey post-hoc test were applied to compare mean values of hemolysis percent between different PM concentrations. Method used in current study is suggested for investigation of toxic effects of airborne particle matter (PM₁, PM_2.5 and PM₁₀) on human RBCs.

Comparative investigation of argon and argon/oxygen plasma performance for Perchloroethylene (PCE) removal from aqueous solution: optimization and kinetic study

PURPOSE

The aim of this study is evaluation of the perchloroethylene degradation from aqueous solutions by non-thermal plasma produced in dielectric barrier discharge reactor in two different scenarios: first plasma generated with 225 cc/min mixture of oxygen and argon flow (12% gas ratio of O2/Ar), and in the second scenario plasma generated with 225 cc/min of pure argon gas.

METHODS

Design studies were performed using response surface methodology and central composite design. All experiments with the selected levels of independent parameters including the initial concentration of perchloroethylene (5-100 mg/L), voltage (20-5 kv) and contact time (15-180 s) was implemented, and 29 tests were proposed by using response surface methodology and central composite design was performed in two experimental scenarios.

RESULTS

Results showed that the Pseudo first-order kinetics coefficient of perchloroethylene degradation in the mixture of oxygen and argon and pure argon scenario under the optimum conditions were 0.024 and 0.016 S-1 respectively. Results conveyed that in order to achieve the highest removal efficiency (100%), the values of contact time, perchloroethylene concentration and voltage variables were predicted 169.55 s, 74.3 mg/l, 18.86 kv respectively in mixture of oxygen and argon scenario and also were predicted 203 s, 85.22 mg/l, 20.39 kv respectively in pure argon scenario.

CONCLUSIONS

In the recent study dielectric barrier discharge was an efficient method for perchloroethylene removal with both oxygen an argon mixture and pure argon as input gas. Both input voltage and reaction time has positive effect on perchloroethylene removal; but initial perchloroethylene concentration has negative effect on perchloroethylene removal. Comparison of two plasma scenarios with different input gas shown that plasma generated by mixture of oxygen and argon gas was more powerful and had higher removal efficiency and degradation kinetics than the plasma generated by pure argon gas.

An in vitro method to survey DNA methylation in peripheral blood mononuclear cells (PBMCs) treated by airborne particulate matter (PM10)

The International Agency for Research on Cancer (IARC) has defined outdoor air pollution and PM as the human carcinogen (Group 1), which mainly cause an increased risk of lung cancer. Scientists have considered epigenetic modifications as a possible mechanism to deal with adverse effects of air pollution. This study aimed to compare the effect of airborne PM₁₀ (PM with aerodynamic diameter ≤10 μm) on in vitro global methylation in human peripheral blood mononuclear cells (PBMCs). PM₁₀ was sampled in metropolitan Tehran, the capital of Iran. PBMCs were extracted from whole blood of healthy males and treated with PM₁₀ suspension at concentrations of 50–300 μg/mL for 4 h. Untreated cells were used as the negative control. Genomic DNA was extracted from each sample using the DNA blood mini kit according to the manufacturer’s instruction. Moreover, 5-methylsytosine (%5-mC) and 5-hydroxymethylcytosine (%5-hmC) were measured by the enzyme-linked immunosorbent assay (ELISA) method. %5-mC and %5-hmC in each sample was compared with negative control and reported as difference %5-mC and %5-hmC.

Setting research priorities to achieve long-term health targets in Iran

Background

In 2015, it was estimated that the burden of disease in Iran comprised of 19 million disability-adjusted life years (DALYs), 74% of which were due to non-communicable diseases (NCDs). The observed leading causes of death were cardiovascular diseases (41.9%), neoplasms (14.9%), and road traffic injuries (7.4%). Even so, the health research investment in Iran continues to remain limited. This study aims to identify national health research priorities in Iran for the next five years to assist the efficient use of resources towards achieving the long-term health targets.

Methods

Adapting the Child Health and Nutrition Research Initiative (CHNRI) method, this study engaged 48 prominent Iranian academic leaders in the areas related to Iran’s long-term health targets, a group of research funders and policy makers, and 68 stakeholders from the wider society. 128 proposed research questions were scored independently using a set of five criteria: feasibility, impact on health, impact on economy, capacity building, and equity.

Findings

The top-10 priorities were focused on the research questions relating to: health insurance system reforms to improve equity; integration of NCDs prevention strategy into primary health care; cost-effective population-level interventions for NCDs and road traffic injury prevention; tailoring medical qualifications; epidemiological assessment of NCDs by geographic areas; equality in the distribution of health resources and services; current and future common health problems in Iran’s elderly and strategies to reduce their economic burden; the status of antibiotic resistance in Iran and strategies to promote rational use of antibiotics; the health impacts of water crisis; and research to replace the physician-centered health system with a team-based one.

Conclusions

These findings highlight consensus amongst various prominent Iranian researchers and stakeholders over the research priorities that require investment to generate information and knowledge relevant to the national health targets and policies. The exercise should assist in addressing the knowledge gaps to support both the National General Health Policies by 2025 and the health targets of the United Nations’ Sustainable Development Goals by 2030.

Association between apparent temperature and acute coronary syndrome admission in Rasht, Iran

Objective

Our objective was to assess the relations between apparent temperature and incidence of acute coronary syndrome (ACS) in Rasht, Iran.

Methods

We used a time-series analysis to investigate the relationship between apparent temperature and hospital admission from 2005 to 2014. Distributed lag non-linear models were used to estimate the association between ACS hospitalisation and apparent temperature. To examine the high-temperature effect on ACS hospital admission, the relative risk of ACS hospital admission associated with high temperature, the 99th percentile of temperature (34.7°C) compared with the 75th percentile of temperature (26.9°C), was calculated. To assess the cold effect on ACS hospital admission, the relative risk of ACS hospital admission associated with cold temperature, the first percentile of temperature (-0.2°C) compared with the 25th percentile of temperature (8.2°C), was evaluated.

Results

The cumulative effect of hot exposure on ACS admissions was statistically significant, with a relative risk of 2.04 (95% CI 1.06 to 4.16). The cumulative effect of cold temperature on ACS admissions was found to be non-significant. The highest risk of ACS admission in women was in 38°C (RR, 2.03, 95%  CI 1.04 to 4.18). The effect of hot temperature on ACS admission occurred immediately (lag 0) (RR, 1.09, 95%  CI 1.001 to 1.19).

Conclusions

The high apparent temperature is correlated with a higher ACS admission especially on the same day. These findings may have implications for developing intervention strategies to reduce and prevent temperature-related morbidity especially in the elderly.

Highly antibiotic-resistant Clostridium difficile isolates from Iranian patients

AIMS

Little is known about the resistance rate and susceptibility profile of Clostridium difficile isolates in Iran. Therefore, the aim of present study is to assess the rate of drug-resistant C. difficile.

METHODS AND RESULTS

During a 6-year period, four hospitals submitted 735 stool specimens from patients suspected for C. difficile infections to the anaerobic bacteriology laboratory. The 46 C. difficile isolates were subjected to disc diffusion and minimum inhibitory concentration (MIC) Test Strips. All isolates were susceptible to vancomycin (VAN) while the highly resistant phenotypes of metronidazole (MTZ) (67·4%), moxifloxacin (78·3%), ciprofloxacin (69·5%) and tetracycline (82·6%) were observed. Of more concern, 67·3% of C. difficile isolates displayed multidrug-resistant phenotypes. More than half of the isolates (n = 27, 58·6%) were coresistant to ciprofloxacin and moxifloxacin. The MIC90 of VAN was ≤2 mg l^-1 , whereas this value for MTZ, ciprofloxacin, moxifloxacin and tetracycline was higher than the resistance breakpoints. According to the comparison of interpretive categories for two tests, the categorical agreement was less than 90% for VAN, ciprofloxacin and tetracycline.

CONCLUSIONS

The disc diffusion method can be used to detect the isolates with reduced susceptibility to MTZ or moxifloxacin. The high rate of resistance to fluoroquinolones highlights the possibility of the emergence of hypervirulent strains in our settings.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study provides data regarding the high level of resistance against multiple antibiotics except VAN.

Assessment of Environmental Health Research Centers in Iran due to knowledge production and utilization

BACKGROUND

Knowledge production in environmental health promotion is one of the most important goals at the national level and establishing environmental health research centers (EHRCs) is one of the main strategies that will lead to achieving this goal. In this study, we are going to present the results of knowledge production and research performance evaluation of EHRCs in Iran.

METHODS

In this cross sectional study, a specific check list has been used to assess Knowledge production and utilization through annual evaluations undertaken by research centers in Iran. This article has the results of the 4-year evaluation (2011-2014).

RESULTS

The total number of EHRCs under the supervision of universities of medical sciences (UMS) is 34. The number of faculty members at these centers is 291 and the total approved projects by research council of UMS during 2011-2014, were 538. The number of published article increased from 282 in 2011 to 709 in 2014. During this period, the number of citations to EHRCs' articles was 4488 in Scopus database. The number of EHRCs' articles which have been referred in text books were 39. The proportion of published articles per academic member in environmental health has been 1.8 per year.

CONCLUSION

Based on research performance evaluation, knowledge production and research is desirable in EHRCs, but research utilization to health environmental promotion is still inadequate and should be assessed by qualitative evaluation.

The Effects of Apparent Temperature on Cardiovascular Mortality Using a Distributed Lag Nonlinear Model Analysis: 2005 to 2014

The relationship between apparent temperature and cardiovascular disease (CVD) mortality was studied in Rasht, Iran, from 2005 to 2014. The effects of apparent temperature on CVD mortality were investigated using the distributed lag nonlinear model. Data on all types of cardiovascular mortality cases according to the International Classification of Diseases were collected from the only cardiovascular hospital in Rasht, and the meteorological variables were obtained from Rasht Meteorological Center during the period of study. Our findings showed that low temperatures had significant impacts on CVD mortality, and a reverse J-shaped temperature-mortality relationship was found. Moreover, immediate effects of hot temperatures on CVD mortality with the strongest effects on the same day but delayed effects of cold temperature was observed. This study showed that exposure to both hot and cold apparent temperatures was associated with increased cardiovascular mortality in Rasht.

Carcinogenic and non-carcinogenic risk assessments of arsenic contamination in drinking water of Ardabil city in the Northwest of Iran

Based on the environmental health assessment framework of the United State Environmental Protection Agency, a quantitative health risk assessment of arsenic in contaminated drinking water in a city in the northwest of Iran has been carried out. In the exposure assessment step, arsenic concentrations in drinking water were determined during four seasons. In addition, the water ingestion rate for different age groups in this region was determined. The concentration of arsenic in 163 collected samples from different locations during four seasons ranged from 0 to 99 μg L^-1. Furthermore, a high percentage of the samples manifested higher levels than the permissible limit of 10 μg L^-1. The total daily water intake rates of four age groups 1 to <2 (group 1), 2 to <6 (group 2), 6 to <16 (group 3), and ≥16 years (group 4) were estimated as 0.86, 1.49, 2.00, and 2.33 L day^-1, respectively. Calculating the lifetime average daily dose of arsenic indicated that adults (group 4) had the highest and children (group 1) had the lowest daily intake of arsenic in their entire life. The results of risk characteristic showed that the order of excess lifetime cancer risk via arsenic exposure in the four groups was 4 > 3 > 2 > 1. The estimated risks for all age groups were higher than the acceptable range (1E-6 to 1E-4). The hazard quotient values for all of the classified groups were lower than the recommended limit values (<1), but it cannot be concluded that potential non-carcinogenicity risks are non-existent since the possible exposure to arsenic via food and skin may also pose the risk.

Occurrence and fate of most prescribed antibiotics in different water environments of Tehran, Iran

The presence of most prescribed antibiotic compounds from four therapeutic classes (β-lactam, cephalosporins, macrolides, fluoroquinolones) were studied at two full-scale WWTPs, two rivers, thirteen groundwater resources, and five water treatment plants in Tehran. Analytical methodology was based on high performance liquid chromatography/tandem mass spectrometry after solid-phase extraction. Samples were collected at 33 sample locations on three sampling periods over four months from June to August 2016. None of the target antibiotics were detected in groundwater resources and water treatment plants, while seven out of nine target antibiotics were analyzed in two studied river waters as well as the influent and effluent of wastewater treatment plants at concentrations ranging from <LOQ to 926.32ng/L. Ciprofloxacin predominated in all analyzed influent (552.6-796.2ng/L) and effluent (127-248.7ng/L) samples of WWTP A, whereas cephalosporins including cephalexin (523.3-977.7ng/L) and cefixime (278.65 to 422.1ng/L) were the most abundant detected antibiotics in the influent and effluent of WWTP B. Aqueous phase removal efficiencies were assessed and ranged from 339.83% to 100% for the seven detected antibiotics. "Negative removals" were observed for erythromycin, azithromycin, and cefixime due to the deconjugation of conjugated metabolites via biological transformation in the studied WWTPs. From a statistical point of view, significant differences (p<0.05) were observed in the concentrations of cefixime, cephalexin, azithromycin, and erythromycin in the effluent of both studied WWTPs. Ciprofloxacin and cephalexin were the most abundant detected antibiotics in the two studied river waters. Statistical results revealed that there were significant differences in the concentrations of ciprofloxacin, azithromycin, and erythromycin (p<0.05) in Firozabad ditch (receiving WWTP effluent) and Kan River (non-receiving WWTP effluent) which demonstrated that WWTPs discharges could be an important source of antibiotics being released in water bodies.

What do we know about exposure of Iranians to cadmium? Findings from a systematic review

Cadmium is an important environmental contaminant. High consumption of chemical fertilizers and industrial activities in recent decades has caused people to be worried about exposure to cadmium. There is no policy for environmental and biological monitoring of exposure to cadmium in the general population in Iran. This study was aimed to review cadmium content in consuming foods and biological samples in Iran, systematically. We developed a comprehensive search strategy and used it to search on Web of Science, Scopus, Science Direct, and Scientific Information Database until 28 December 2016. The totals of 285 articles were identified and finally 31 original papers were selected. Cadmium contamination was found in Iranian food groups such as rice, cereal and legumes, canned tuna fish, vegetables, fruit juice, and egg. This study showed that cadmium amount in 75% of the consumed rice samples (domestic and imported) was higher than the maximum limits approved by institute of standards and industrial research of Iran. Lettuce samples in Yazd were recorded the highest concentration of cadmium compared to other studies. In addition, high amount of cadmium was observed in the blood of the general population. Regarding the cadmium contamination in food and blood samples in Iran, policies must be adopted to reduce exposure to cadmium through different matrices as much as possible.

Haloacetic acids degradation by an efficient Ferrate/UV process: Byproduct analysis, kinetic study, and application of response surface methodology for modeling and optimization

Haloacetic acids (HAAs) after trihalomethanes are the second main group of chlorination byproducts. In this study, decomposition of the two most common HAAs in drinking water was studied by an advanced oxidation process using a combination of Ferrate [Fe(VI)] and UV irradiation. The decomposition rate was measured, and the byproducts formed during the process and the mass balances were also analyzed. HAAs were quantified by GC-ECD, and the final products including acetate and chloride ions were measured by ion chromatography (IC). A central composite design was used for the experimental design, and the effect of four variables including the initial HAA concentration, pH, Fe(VI) dosage, and contact time were investigated by response surface methodology (RSM). Dichloroacetic acid decomposed more easily than TCAA. Results show that when TCAA and DCAA were studied individually, the degradation rates were 0.0179 and 0.0632 min^-1, respectively. When the HAAs were simultaneously placed in the reactor, the decomposition rates of both TCAA and DCAA decreased dramatically. In this case their decomposition rate constants decreased by 67% and 49%, respectively. In the mixture, the decomposition rate of DCAA was 2.5 times higher than that of TCAA. In summary, Fe(VI)/UV process can be used as a promising treatment option for the decomposition of recalcitrant organic pollutants such as HAAs, and RSM can be used for modeling and optimizing the process.

Estimating national dioxins and furans emissions, major sources, intake doses, and temporal trends in Iran from 1990-2010

BACKGROUND

Polychlorinated dibenzo-p-dioxins (PCDD) and dibenzofurans (PCDFs) are highly toxic persistent organic pollutants (POPs), which can cause various health outcomes, such as cancer. As a part of the National and Sub-national Burden of Disease Study (NASBOD), we aimed to estimate dioxins and furans national emissions, identify their main sources, estimate daily intake doses, and assess their trend from 1990-2010 in Iran.

METHODS

The Toolkit for Identification and Quantification of Releases of Dioxins, Furans and Other Unintentional POPs, which is developed by the United Nations Environment Programme (UNEP 2013), was used to estimate the emissions of PCDD/PCDFs from several sources into the air, water, land, residue, and other products. The daily intake doses were estimated using a linear regression of estimated emissions by UNEP Toolkit and average intake doses in other countries. Finally, the trend of PCDD/PCDFs emissions and daily intake doses were explored from 1990-2010.

RESULTS

The total emissions were estimated as 960 g Toxic Equivalents (g TEQ) for 1990 and 1957 g TEQ for 2010 (18.2 and 26.8 g TEQ per million capita, respectively). The estimations suggest that albeit contribution of open burning to PCDD/PCDFs emissions has been declining from 1990 to 2010, it remained the major source of emissions in Iran contributing to about 45.8% out of total emissions in 1990 to 35.7% in 2010. We further found that PCDD/PCDFs are mostly emitted into the ambient air, followed by residue, land, products, and water. The daily intake doses were estimated to be 3.1 and 5.4 pg TEQ/kg bw/day for 1990 and 2010, respectively. We estimated an increasing trend for PCDD/PCDFs emissions and intake doses in Iran from 1990-2010.

CONCLUSIONS

The high levels of emissions, intake doses, and their increasing trend in Iran may pose a substantial health risk to the Iranian population. Further studies with more rigorous methods are recommended but this should not circumvent taking appropriate policy actions against these pollutants. Currently, Iran has no standard for dioxins and furans. Adaptation of the World Health Organization recommended guidelines might be an appropriate starting point to control dioxins and furans emissions.

Ambient temperature and cardiovascular mortality: a systematic review and meta-analysis

INTRODUCTION

Our study aims at identifying and quantifying the relationship between the cold and heat exposure and the risk of cardiovascular mortality through a systematic review and meta-analysis.

MATERIAL AND METHODS

A systematic review and meta-analysis were conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Peer-reviewed studies about the temperature and cardiovascular mortality were retrieved in the MEDLINE, Web of Science, and Scopus databases from January 2000 up to the end of 2015. The pooled effect sizes of short-term effect were calculated for the heat exposure and cold exposure separately. Also, we assessed the dose-response relationship of temperature-cardiovascular mortality by a change in units of latitudes, longitude, lag days and annual mean temperature by meta-regression.

RESULT

After screening the titles, abstracts and full texts, a total of 26 articles were included in the meta-analysis. The risk of cardiovascular mortality increased by 5% (RR, 1.055; 95% CI [1.050-1.060]) for the cold exposure and 1.3% (RR, 1.013; 95% CI [1.011-1.015]) for the heat exposure. The short-term effects of cold and heat exposure on the risk of cardiovascular mortality in males were 3.8% (RR, 1.038; 95% CI [1.034-1.043]) and 1.1%( RR, 1.011; 95% CI [1.009-1.013]) respectively. Moreover, the effects of cold and heat exposure on risk of cardiovascular mortality in females were 4.1% (RR, 1.041; 95% CI [1.037-1.045]) and 1.4% (RR, 1.014; 95% CI [1.011-1.017]) respectively. In the elderly, it was at an 8.1% increase and a 6% increase in the heat and cold exposure, respectively. The greatest risk of cardiovascular mortality in cold temperature was in the 14 lag days (RR, 1.09; 95% CI [1.07-1.010]) and in hot temperatures in the seven lag days (RR, 1.14; 95% CI [1.09-1.17]). The significant dose-response relationship of latitude and longitude in cold exposure with cardiovascular mortality was found. The results showed that the risk of cardiovascular mortality increased with each degree increased significantly in latitude and longitude in cold exposure (0.2%, 95% CI [0.006-0.035]) and (0.07%, 95% CI [0.0003-0.014]) respectively. The risk of cardiovascular mortality increased with each degree increase in latitude in heat exposure (0.07%, 95% CI [0.0008-0.124]).

CONCLUSION

Our findings indicate that the increase and decrease in ambient temperature had a relationship with the cardiovascular mortality. To prevent the temperature- related mortality, persons with cardiovascular disease and the elderly should be targeted. The review has been registered with PROSPERO (registration number CRD42016037673).

Statistical analysis of arsenic contamination in drinking water in a city of Iran and its modeling using GIS

In this research, probable arsenic contamination in drinking water in the city of Ardabil was studied in 163 samples during four seasons. In each season, sampling was carried out randomly in the study area. Results were analyzed statistically applying SPSS 19 software, and the data was also modeled by Arc GIS 10.1 software. The maximum permissible arsenic concentration in drinking water defined by the World Health Organization and Iranian national standard is 10 μg/L. Statistical analysis showed 75, 88, 47, and 69% of samples in autumn, winter, spring, and summer, respectively, had concentrations higher than the national standard. The mean concentrations of arsenic in autumn, winter, spring, and summer were 19.89, 15.9, 10.87, and 14.6 μg/L, respectively, and the overall average in all samples through the year was 15.32 μg/L. Although GIS outputs indicated that the concentration distribution profiles changed in four consecutive seasons, variance analysis of the results showed that statistically there is no significant difference in arsenic levels in four seasons.