Arsenic levels in immigrant children from countries at risk of consuming arsenic polluted water compared to children from Barcelona

Arsenic is a highly toxic element that pollutes groundwater, being a major environmental problem worldwide, especially in the Bengal Basin. About 40% of patients in our outpatient clinics come from those countries, and there is no published data about their arsenic exposure. This study compares arsenic exposure between immigrant and native children. A total of 114 children (57 natives, 57 immigrants), aged 2 months to 16 years, were recruited and sociodemographic and environmental exposure data were recorded. Total arsenic in urine, hair, and nails and arsenic-speciated compounds in urine were determined. We did not find significant differences in total and inorganic arsenic levels in urine and hair, but in organic arsenic monomethylarsenic acid (MMA) and dimethylarsinous acid (DMA) in urine and in total arsenic in nails. However, these values were not in the toxic range. There were significant differences between longer than 5 years exposure and less than 5 years exposure (consumption of water from tube wells), with respect to inorganic and organic MMA arsenic in urine and total arsenic in nails. There was partial correlation between the duration of exposure and inorganic arsenic levels in urine. Immigrant children have higher arsenic levels than native children, but they are not toxic. At present, there is no need for specific arsenic screening or follow-up in immigrant children recently arrived in Spain from exposure high-risk countries.

Ethanol cytotoxic effect on trophoblast cells

Prenatal ethanol exposure may cause both, altered fetal neurodevelopment and impaired placental function. These disturbances can lead to growth retardation, which is one of the most prevalent features in Fetal Alcohol Syndrome (FAS). It is not known whether there is a specific pattern of cytotoxicity caused by ethanol that can be extrapolated to other cell types. The aim of this study was to determine the cytotoxic effects caused by sustained exposure of trophoblast cells to ethanol. The cytotoxic effect of sustained exposure to standard doses of ethanol on an in vitro human trophoblast cell line, JEG3, was examined. Viable cell count by exclusion method, total protein concentration, lactate dehydrogenase (LDH) activity and activation of apoptotic markers (P-H2AX, caspase-3 and PARP-1) were determined. Sustained exposure to ethanol decreased viable cell count and total protein concentration. LDH activity did not increased in exposed cells but apoptotic markers were detected. In addition, there was a dose-dependent relationship between ethanol concentration and apoptotic pathways activation. Sustained ethanol exposure causes cellular cytotoxicity by apoptotic pathways induction as a result of DNA damage. This apoptotic induction may partially explain the altered function of placental cells and the damage previously detected in other tissues.

[Alternative biological materials to detect prenatal exposure to drugs of abuse in the third trimester of pregnancy]

INTRODUCTION

Detection of prenatal drug abuse exposure is essential to ensure an appropriate monitoring of affected children. A maternal questionnaire is not an efficient screening tool. The usefulness of maternal hair and meconium as biological materials to assess this exposure has been described in last few years. The aim of this study was to compare both these alternative biological materials for prenatal drug exposure detection in the third trimester of pregnancy, in order to assess its use as a screening tool.

PATIENTS AND METHODS

Between January and March 2010, samples of maternal hair and meconium from 107 mother-infant dyads were collected in Can Misses Hospital, Ibiza. The presence of opiates, cocaine, cannabis, and amphetamines, was determined in both materials, using standard chromatographic techniques.

RESULTS

Maternal hair analysis showed a 15.9% positivity for drugs of abuse (17 cases): 11 cannabis, 7 cocaine, 1 cannabis and ecstasy, and 1 cannabis and cocaine. Only one mother reported cannabis consumption and another one, cocaine. Of the 7 cocaine positive cases in hair, 6 were confirmed in meconium analysis, while of 11 cannabis positive cases, only 3 were confirmed in meconium. Two different consumer profiles were defined: cocaine consumers and cannabis consumers (with only 2 cases of multiple drug use). The highest level of cocaine ever published was detected (1.582ng/g) in one case.

DISCUSSION

This study reveals a high prevalence of drug abuse in this cohort during pregnancy. Improved screening methods may optimize prevention and monitoring of exposed infants. Maternal hair seems to be more sensitive than meconium to detect prenatal exposure to cannabis during the third trimester, so it might become a good screening tool.

[Drugs of abuse acute intoxication in paediatric emergencies]

Documented cases show that acute drugs of abuse intoxication in children usually is the Fritz clinical evidence of a chronic exposure. Published clinical reports of drugs of abuse acute poisonings in children are reviewed, above all those with an underlying chronic exposure to the same or another substance. Biological matrices and exposure biomarkers useful in toxicology analysis in Paediatrics are reviewed. In toxicology, biomarkers refer to original parental substances and its metabolites and matrices refer to body substances where biomarkers are detected. In these matrices acute and chronic (previous days, weeks or months) exposures can be detected. Hair analysis has become the gold standard of drugs of abuse chronic exposure. Recommendation includes to confirm previous chronic exposure to drugs of abuse by hair analysis of children and their parents. This protocol must be applied in all cases with suspicion of acute drugs of abuse intoxication, parental consumption and/or children living in a risk environment.

Attempt to normalize simulated exhaled nitric oxide according to ventilatory settings

BACKGROUND

Simulated exhaled nitric oxide (eNO) depends on ventilatory settings used in different experimental conditions.

OBJECTIVES

To normalize the simulated minute exhaled nitric oxide according to different ventilatory settings.

WORKING HYPOTHESIS

Different ventilatory settings influence the concentrations of exhaled nitric oxide and these results can be normalized. METHODOLOGY AND STUDY DESIGN: We used a rubber lung model (50 ml) with an orifice through which a 3 mm endotracheal tube was introduced. The NO, which simulated that of endogenous production, was delivered through the base of the lung using a unidirectional rotameter and obtaining a concentration of around 25 ppb. The sample of gas was recorded through a 6 F arterial catheter introduced into the endotracheal tube to its tip. The ventilator used was a Babylog 8000. Air delivered was compressed and filtered and had an NO content of under 0.3 ppb. The NO level assessed was the plateau value given by the software of the Sievers NOA apparatus. Each experiment involved sampling during 1 min, three times. Normalization was done using a multiple cubic regression formula.

RESULTS

An increase in respiratory frequency or in peak of inspiratory pressure were accompanied by a decrease in eNO (ppb). Minute volume was adjusted for the percentage of leakage given by the ventilator. Normalization was obtained analyzing 518 respirations with different ventilatory settings. The coefficient of variation fell from 15.5% to 0.27%. Validation of the normalization formula was performed in other three groups (320, 372, and 372 respirations) with different simulated NO concentrations (25, 16, and 50 ppb), resulting in reduction of the coefficient of variation from 42.7% to 9.3%, from 42.3% to 10.6% and from 45.2% to 9.6%, respectively.

CONCLUSIONS

Normalization of simulated minute eNO according to ventilatory settings is possible using the equipment and experimental set-up reported. Extrapolation to patients is not possible without constraints.

Prenatal exposure to arecoline (areca nut alkaloid) and birth outcomes

The betel nut is commonly used as a drug by Asian populations. A high prevalence of adverse pregnancy outcomes has been reported in women who chewed betel quid during gestation. The hypothesis that chronic exposure of the fetus to arecoline (the principal alkaloid of the areca nut) is the cause was investigated in a clinical observational study on six newborns from Asian mothers who chewed betel nut during pregnancy.

Concentrations and determinants of NO2 in homes of Ashford, UK and Barcelona and Menorca, Spain

This study examined indoor nitrogen dioxide (NO2) concentrations in Ashford, Kent (UK), Menorca Island and Barcelona city (Spain) and the contribution of their most important indoor determinants (e.g. gas combustion appliances and cigarette smoking). The homes examined (n = 1421) were those from infants recruited for the Asthma Multicentre Infants Cohort Study, which aimed to assess, using a standard protocol, the effects of pre- and post-natal environmental exposures in the inception of atopy and asthma. Indoor NO2 was measured using passive filter badges placed on a living room wall of the homes for between 7 and 15 days. Homes in the three centers had significantly different concentrations of indoor NO2, with those in Barcelona showing the highest levels (median NO2 levels: 5.79, 6.06 and 23.87 p.p.b. in Ashford, Menorca and Barcelona, respectively). Multiple regression analysis showed that the principal indoor determinants of NO2 concentrations in the three cohorts were the heating/cooking fuel used in the house (gas fire increased average NO2 concentrations by 1.27-fold and gas cooker by 2.13 times), parental cigarette smoking and season of measurement. Those variables significantly related to indoor NO(2) accounted for 23, 14 and 39% of the variation in indoor NO2 concentration in Ashford, Barcelona and Menorca, respectively. In all the cohorts combined, 52% of the variation could be explained in this way. Although outdoor NO2 was not measured concurrently, its additional contribution was estimated. In conclusion, despite differences in indoor NO2 mean concentrations probably reflecting different outdoor NO2 level, home factors affecting indoor NO2 values and their specific contributions were constant across the three cohorts.

PRACTICAL IMPLICATIONS

This study found that principal determinants associated to indoor NO2 in three different sites of Europe: Ashford (UK), Barcelona and Menorca (Spain) were the energy source present in the home and cigarette smoking, despite these areas presented different climates, levels of outdoor contamination, housing characteristics and ventilation behavior. It is suggested that interventions in homes of these three centers will need to address principally cigarette smoking and gas combustion appliances. These latter factors require institutional intervention, while cigarette smoking mainly require personal changes.

Development and validation of a liquid chromatography-mass spectrometry assay for the determination of opiates and cocaine in meconium

A procedure based on liquid chromatography-mass spectrometry (LC-MS) is described for determination of 6-monoacetylmorphine, morphine, morphine-3-glucuronide, morphine-6-glucuronide, codeine, cocaine, benzoylecgonine and cocaethylene in meconium using nalorfine as the internal standard. The analytes are initially extracted from the matrix by methanol (6-monoacetylmorphine, morphine, codeine, cocaine, benzoylecgonine and cocaethylene) or 0.01 M ammonium hydrogen carbonate buffer (morphine-3-glucuronide, morphine-6-glucuronide). Subsequently a solid-phase extraction with Bondelut Certify columns (6-monoacetylmorphine, morphine, codeine, cocaine, benzoylecgonine and cocaethylene) or ethyl solid-phase extraction columns (morphine-3-glucuronide, morphine-6-glucuronide) was applied. Chromatography was performed on a C(8) reversed-phase column using a gradient of acetic acid 1%-acetonitrile as a mobile phase. Analytes were determined in LC-MS single ion monitoring mode with atmospheric pressure ionisation-electrospray (ESI) interface. The method was validated in the range 0.005-1.00 microg/g using 1 g of meconium per assay and applied to analysis of meconium in newborns to assess fetal exposure to opiates and cocaine.

[Profile of the hospital case mix of the immigrant population in Barcelona, Spain]

OBJECTIVE

Although the immigrant population in cities such as Barcelona has tripled in the last five years, until now the impact of this group on the health system has not been rigorously evaluated. The aim of this study was to compare hospital resource utilization among the immigrant population with that among the native population through case mix, demographic characteristics and hospital day use. MATERIAL AMD METHODS: We analyzed 15,057 discharges from Hospital del Mar in Barcelona in 2000. This hospital attends 60% of admissions from the Ciutat Vella district. In 2000, 21% of the population of this district were immigrants. Socio-demographic patient characteristics and case mix were compared between the immigrant and the native population. Hospital resource use was compared according to age, case mix (diagnosis related groups) and seriousness (severity, complications and comorbidities) of the events requiring medical care.

RESULTS

The case mix of the immigrant population differed from that of the autochthonous population due to pronounced ge differences and a higher fertility rate. Thirty-three percent of immigrant admissions were for deliveries. The mean cost of discharge of immigrants from low-income countries was 30% lower than that for the remaining discharges. After adjusting for age, case mix and severity, length of stay among the immigrant population was significantly shorter. A 5% reduction was found after adjusting for case mix and a 10% reduction was found when all the factors were considered.

CONCLUSIONS

Case mix differences are due to age and socio-cultural factors. Immigrants are rejuvenating the ageing native population and the role of gynecology-obstetrics and pediatrics needs to be increased. The finding that resource use per discharge is lower among immigrants from low-income countries contradicts the expectation that lower socioeconomic status leads to higher hospital resource use intensity. Therefore, new hypotheses and analyses that explain this situation should be put forward.

The spanish version of the paediatric asthma quality of life questionnaire (PAQLQ): metric characteristics and equivalence with the original version

The Paediatric Asthma Quality of Life Questionnaire (PAQLQ), developed by Juniper et al., assesses the impact of asthma on children's daily life. It contains 23 items, covering three dimensions: symptoms, activities limitation and emotional function.

AIMS

To develop an equivalent Spanish version of the PAQLQ, and to assess its measurement characteristics.

METHODS

The forward and back-translation method was used for the adaptation. A longitudinal study (assessments at the 1st and 5th weeks), with patients from the emergency and outpatient departments of three Spanish hospitals, was designed to test the properties of the new adapted version. At each visit, a trained interviewer administered the PAQLQ, a Global Index of Change and a General Health Perception scale. The Peak Expiratory Flow Rate (PEFR) was also recorded daily, together with symptoms, during the prior week.

RESULTS

Ninety-nine patients (66.7% males, 42.4% suffering an exacerbation, mean age of 11.3 years) with the following types of asthma were evaluated: mild intermittent (31.3%), mild persistent (36.4%), moderate persistent (29.3%) and severe persistent (3%). At the 1st visit, the mean pre-bronchodilator %PEFR was 87.3%. The Cronbach's alpha ranged from 0.86 to 0.95. As expected, correlations between the PAQLQ scores, and the Asthma Control Score (0.53-0.67), the General Health Perception (0.34-0.55), and the %PEFR (0.44-0.55) were moderate. The PAQLQ scores remained unchanged in stable patients while increased significantly in those showing improvements.

CONCLUSIONS

After a standard cross-cultural adaptation process, the Spanish version of the PAQLQ has shown to be equivalent to the original, with similar internal consistency reliability, validity and sensitivity to clinical changes.

Maternal atopy and parity

BACKGROUND

Family size and high birth order were related to the prevalence of hayfever and positive skin prick test. However, this association may be explained by maternal atopy. We examined the relationship between maternal atopy and the number of offspring in three European cohorts of pregnant women.

METHODS

The mothers and their children (n = 1487) were recruited for the Asthma Multi-centre Infants Cohort Study (AMICS). The three concurrent cohorts (Ashford, Kent (UK); Menorca island (Spain) and Barcelona city (Spain) followed the same research protocol. Maternal and paternal atopy was identified by skin prick tests at different times at the three centres.

RESULTS

Maternal atopy was inversely related to the number of offspring, an association which occurred in each of the three cohorts and remained when atopy was defined separately for individual allergens (a positive response to testing with either Der p 1 or grass pollen) and which was not confounded by maternal age, smoking nor social class (the adjusted odds ratios were 0.71, 0.79 and 0.26 for increasing number of offspring, P = 0.002). Neither maternal asthma (P = 0.43) nor paternal atopy (P = 0.58) were associated with the number of offspring. Maternal atopy was not related to reproductive outcomes.

CONCLUSIONS

The association between maternal atopy and parity challenges the role of family size on child atopy, which should be studied in other populations.

Cord serum cotinine as a biomarker of fetal exposure to cigarette smoke at the end of pregnancy

This study investigated the association between biomarkers of fetal exposure to cigarette smoke at the end of pregnancy, cotinine in cord serum and in maternal and newborn urine samples, and quantitative measurement of smoking intake and exposure evaluated by maternal self-reported questionnaire. Study subjects were 429 mothers and their newborns from a hospital in Barcelona, Spain. A questionnaire including smoking habits was completed in the third trimester of pregnancy and on the day of delivery. Cotinine concentration in cord serum was associated with daily exposure to nicotine in nonsmokers and with daily nicotine intake in smokers. The geometric mean of cotinine concentration in cord serum statistically discriminated between newborns from nonexposed and exposed nonsmoking mothers, and between these two classes and smokers, and furthermore was able to differentiate levels of exposure to tobacco smoke and levels of intake stratified in tertiles. Urinary cotinine levels in newborns from nonsmoking mothers exposed to more than 4 mg nicotine daily were statistically different from levels in two other categories of exposure. Cotinine concentration in urine from newborns and from mothers did not differentiate between exposure and nonexposure to environmental tobacco smoke (ETS) in nonsmoking mothers. Cord serum cotinine appeared to be the most adequate biomarker of fetal exposure to smoking at the end of pregnancy, distinguishing not only active smoking from passive smoking, but also exposure to ETS from nonexposure.

Prevalence of asthma-related symptoms and bronchial responsiveness to exercise in children aged 13-14 yrs in Barcelona, Spain

It is not clear whether asymptomatic bronchial responsiveness is a risk factor for development of asthma. A cross-sectional study was conducted to determine the prevalence of asthma among schoolchildren from Barcelona (Spain). The association between respiratory symptoms and bronchial responsiveness to exercise was examined. For this study 3,033 schoolchildren aged 13-14 yrs were studied from the general population. Participants answered a respiratory questionnaire and a self-reporting video-questionnaire. A total of 2,842 children underwent bronchial responsiveness testing by exercise challenge. The study was part of the International Study of Asthma and Allergies in Childhood (ISAAC) project. The prevalence of "current asthma" (recent wheezing and bronchial responsiveness to exercise) was 4% and the prevalence of "wheezing only" 10%. A fall in peak expiratory flow rate (PEFR) > or = 15% after exercise testing was found in 324 (11%) children, 29 (9%) of whom presented clinical symptoms of asthma. Bronchial responsiveness to exercise was significantly associated with all items of the asthma questionnaire. The prevalence of asthma-related symptoms in this inner-city area was lower than frequently reported rates in other countries, although the prevalence of exercise-induced bronchoconstriction was relatively high, and threefold greater than in a geographical area in the vicinity of Barcelona. These findings are consistent with the current view that asthma-related symptoms and bronchial responsiveness to exercise have different meanings in a community survey, and that local environmental factors could influence the prevalence of bronchial responsiveness.

[Hepatitis B at an open institution for the mentally retarded. Immunogenic effect of a recombinant anti-hepatitis-B vaccine]

The diffusion of hepatitis B virus was investigated in an open institution for mentally retarded patients, where 24 patients with Down's syndrome (DS) and 94 with other types of mental retardation (OMR) were being cared for. The immunogenic response to a recombinant vaccine intramuscularly injected to the deltoid muscle at a dosage of 20 mcg in the months 0, 1 and 6 was also evaluated. Seropositivity for some hepatitis B serum marker was found in 19.4% of patients (12.5% of those with DS and 21.2% of those with OMR). HBsAg was found in 8.3% of patients with DS and in 4.2% of those with OMR. The seroconversion to antiHBs induced by the vaccine 8 months after the first dose was found in 72.3% of DS and in 100% of OMR. The poor immunogenic response in DS was attributed to age, as in patients younger than 20 years it was 91.6% while in those over that age it was only 33.3%. It was concluded that in open institutions for mentally retarded patients there is a risk of hepatitis B infection, also shown in closed institutions, and that recombinant hepatitis B vaccine is highly immunogenic in this population, although it has been found that in patients with DS the age has a very marked negative influence on the response to the vaccine.