Biomarcadores de exposición a plaguicidas / Occupational pesticide exposure and their association with effect biomarkers

La exposición a plaguicidas, durante todas las etapas de su uso, puede tener efectos adversos en la salud y el medio ambiente. Estos efectos no siempre están relacionados con lesiones inmediatas y aparentes, sino que pueden tardar incluso años en manifestarse. La utilización de biomarcadores en estudios epidemiológicos, como son las evaluaciones de daño genético, permiten la detección temprana de un riesgo incrementado de desarrollar diversas patologías, definiendo estados de prepatogénesis, como neoplasias, problemas reproductivos, malformaciones y enfermedades cardiovasculares. Los estudios de biomonitoreo en poblaciones agrícolas publicados desde la década de los años 70 indican resultados muy diversos, dada la amplia variedad de biomarcadores citogenéticos analizados y la heterogeneidad de las poblaciones incluidas en dichos estudios. En etapas previas de esta investigación se han descripto factores personales y contextuales vinculados con la exposición a plaguicidas entre trabajadores agrícolas, diseñado escalas de exposición a plaguicidas y descripto condiciones de salud percibida por agroaplicadores terrestres de la Provincia de Córdoba. Este trabajo presenta biomarcadores de daño citogenético, aportando nuevos elementos para la detección de grupos de riesgo, la comprensión de la red causal de las patologías asociadas a tales exposiciones y proponer herramientas preventivas. (AU)

Exposure to pesticides, during all stages of use, may have adverse effects on health and the environment. These effects are not always related to immediate and apparent injuries, but may even take years to manifest. The use of biomarkers in epidemiological studies, such as evaluations of genetic damage, allow the early detection of an increased risk of developing various pathologies, defining states of prepathogenesis, such as neoplasms, problems Reproductive, malformations and cardiovascular diseases. Biomonitoring Studies in agricultural populations published since the decade of the years 70 indicate very different results, given the wide variety of cytogenetic biomarkers analyzed and the heterogeneity of the populations included in these studies. In previous stages of this research have described personal and contextual factors linked to pesticide exposure among agricultural workers, designed scales of exposure to pesticides and described health conditions perceived by agrochemicals applicators of the province of Cordoba. This paper presents biomarkers of cytogenetic damage, providing new elements for the detection of risk groups, understanding the causal network of pathologies associated with such exhibits and proposing preventive tools. (AU)

Caracterización nutricional del paciente con síndrome metabólico: resultados preliminares / Nutritional characterization of the patient with metabolic syndrome: preliminary results

INTRODUCCIÓN: El síndrome metabólico (SM) es una entidad clínica con alteraciones vasculares y metabólicas que predisponen a la enfermedad cardiovascular (ECV). El estado nutricional es un factor predominante en la evolución del SM y el riesgo de ECV. OBJETIVO: Analizar el estado nutricional a través de indicadores antropométricos y alimentarios en pacientes con SM. MÉTODOS: Estudio observacional, de corte transversal. Participaron 41 personas de ambos sexos (20 hombres y 21 mujeres), entre 30 y 60 años, que asistieron a consulta ambulatoria del Servicio de Cardiología y Clínica Médica de la Clínica Universitaria Reina Fabiola (CURF) y del Servicio de Cardiología No Invasiva del Hospital Nacional de Clínicas (HNC), durante el periodo 2015-2016. Se realizó toma de indicadores antropométricos para determinar el estado nutricional (índice de masa corporal o IMC), circunferencia de cintura (CC), presión arterial sistólica (PAS) y diastólica (PAD). Las variables alimentarias incluidas fueron valor calórico total (VET), consumo de colesterol (CCol) y consumo de sodio (CS). El estudio cuenta con la aprobación del Comité de Ética del CURF y HNC. Para estimar el VET, el consumo de colesterol y de sodio se utilizó el programa informático Interfood v.1.3. El análisis de los datos se llevó a cabo con el programa InfoStat. Para analizar si existían diferencias por sexo, se utilizó el test de Wilcoxon para variables continuas y Kruskal Wallis para las categóricas. RESULTADOS: El 93% de los pacientes presentaron exceso de peso (el 61% con IMC superior a 30kg/mts2). En relación a CC, el 75% de las mujeres y 86% de hombres presentaron riesgo cardiovascular muy aumentado. La media de PAS fue 131,18±18,96 mmHg y la de PAD fue 79,88±12,29 mmHg. El VET fue 2828,45±1255,42 Kcal, el consumo promedio de colesterol fue 380,09±191mg y el de sodio fue 2072,26±1195,44 mg, siendo estas ingestas superiores a las recomendadas. Al analizar las comparaciones por sexo, no se encontraron diferencias estadísticamente significativas para las variables en estudio. CONCLUSIÓN: Estos resultados preliminares resaltan el perfil de riesgo para el desarrollo de ECV de los pacientes con SM. Se necesita continuar profundizando el estudio de estas poblaciones, para aportar evidencia que contribuya a la promoción de hábitos saludables y la prevención de patologías crónicas vinculadas a la alimentación y nutrición. (AU)

INTRODUCTION: the metabolic syndrome (MetS) is a clinical entity with vascular and metabolic alterations that predispose a cardiovascular disease (CVD). Nutritional status is a predominant factor in the evolution of MetS and risk of CVD. Objetive: Analyze the nutritional status through of anthropometric and food indicators in patients with MetS. METHODS: Observational studie, crosssectional. 41 people of both sex participated (20 man and 21 woman), among 30 and 60 years old, who attended outpatient consultation of Cardiology Service and Medical Clinic of Reina Fabiola University Clinic (RFUC) and Non-Inavasive Cardiology Service of National Hospital of Clinics (NHC), during the period 2015-2016. Anthropometric measure were taken to determine nutritional status, body mass index or (BMI), waist circumference (WC), systolic and diastolic blood pressure (SBP) (DBP). Included food variables were total energy value (TEV), cholesterol intake (ColC) and sodium intake (SC). The study has the approval Ethics Committee of RFUC and NHC. To estimate TEV, cholesterol and sodium intake was used computer program Interfood v.1.3. The analysis of the data was carried out with the InfoStat program. To analyze if there differences by sex, the Wilcoxon test for continuous variables and Kruskal Wallis for categorical variables were used. RESULTS: 93% of the patients presented overweight (61% with BMI higher 30 kg/m2). In relation WC, 75% of the women and 86% of men showed highly increased cardiovascular risk. The mean of BSP was 131,18±18,96 mmHg and SBP was 79,88±12,29 mmHg. The TEV was 2828,45±1255,42 Kcal, average intake of cholesterol was 380,09±191mg and the sodium was 2072,26±1195,44 mg, being these higher intakes to those recommended. When analyzing comparisons by sex, no statistically significant differences were found for the variables in study. CONCLUSIONS: these preliminary results highlight the risk profile for the development of CVD of the patients with MetS. It is necessary to continue to deepen the study of these populations, to provide evidence that contributes to the promotion of healthy habits and the prevention of chronic diseases linked to food and nutrition.

Psycho-oncological support for breast cancer patients: A brief overview of breast cancer services certification schemes and national health policies in Europe.

Psycho-oncology addresses the psychological, social, behavioural, and ethical aspects of cancer. Identification and proper management of the patients' psychosocial needs, as well as the needs of their caregivers and family are essential for a person-centred concept of breast cancer care. The aim of this overview is to describe how psychosocial support in breast cancer is incorporated in cancer-related policy documents, such as national cancer plans and breast cancer care certification schemes.

Presence, characteristics and equity of access to breast cancer screening programmes in 27 European countries in 2010 and 2014. Results from an international survey.

The European Union Council Recommendation of 2 December 2003 on cancer screening suggests the implementation of organised, population-based breast cancer screening programmes based on mammography every other year for women aged 50 to 69years, ensuring equal access to screening, taking into account potential needs for targeting particular socioeconomic groups. A European survey on coverage and participation, and key organisational and policy characteristics of the programmes, targeting years 2010 and 2014, was undertaken in 2014. Overall, 27 countries contributed to this survey, 26 of the 28 European Union member states (92.9%) plus Norway. In 2014, 25 countries reported an ongoing population-based programme, one country reported a pilot programme and another was planning a pilot. In eight countries, the target age range was broader than that proposed by the Council Recommendation, and in three countries the full range was not covered. Fifteen countries reported not reaching some vulnerable populations, such as immigrants, prisoners and people without health insurance, while 22 reported that participation was periodically monitored by socioeconomic variables (e.g. age and territory). Organised, population-based breast cancer screening programmes based on routine mammograms are in place in most EU member states. However, there are still differences in the way screening programmes are implemented, and participation by vulnerable populations should be encouraged.

Allium cepa as a biomonitor of ochratoxin A toxicity and genotoxicity.

Ochratoxin A (OTA) is a toxin produced by Aspergillus and Penicillum moulds. Since OTA has not yet been evaluated in plant systems, this paper focused on describing the controversial effect OTA in an Allium root test model, which has known sensitivity to genotoxins and could be useful in toxin screening. Analyses of root growth and the root meristematic zone in response to OTA treatment were undertaken. The results show OTA toxicity to root growth at a concentration of 10 ug.ml(-1) associated with inhibition of proliferation activity. Cytological changes observed in the Allium chromosome aberrations assay, at a concentration of 5.0 ug.ml(-1), showed that OTA was able to induce genotoxicity at the chromosome level. These results indicate that plants cells (Allium cepa) are very sensitive to the mycotoxin OTA, as observed at the highest concentration. Under these conditions, OTA produced toxicity and cytogenetic injury. Evidence in vitro and in vivo indicates that OTA can induce damage at the DNA level.

Fumonisins in foods from Cordoba (Argentina), presence and genotoxicity.

Fumonisins B(1), B(2)yB(3) (FB(1), FB(2)yFB(3)), are a group of toxins produced by different mold species, Fusarium moniliforme and Fusarium proliferatum being the most important ones. Its compounds were tested in chromosome aberrations (CA), sister chromatid exchange (SCE), and micronucleus (MN) in human lymphocytes, and, in Allium cepa (onion), the chromosomal aberrations (CA) assay was used. Moreover, the presence of fumonisins and their producer moulds was determined in different food substrata in Cordoba city, Argentina. Cytogenetic studies using FB(1), FB(2) and FB(3) levels gave positive results for the higher concentrations (5 and 10mug/g) with FB(1). As regards the cytogenetic aspect of FB(1), we found an increase in the incidence of genetic damage measured by chromosomal aberrations, sister chromatid exchange, micronuclei and chromosomal aberrations in Allium cepa. These results indicate that human lymphocytes cells and plants cells (Allium cepa) have a very sensitive cellular response to the mycotoxin fumonisin B(1) as observed at the highest concentrations.

[Surveillance of infections in chronic hemodialysis patients]. / Surveillance des infections chez les hémodialysés chroniques en centre.

OBJECTIVE: To confirm rates of infections from a previous survey in chronic hemodialysis patients; to get information about incidents and manipulations of vascular access-site, number and reasons of hospitalisation; to asses a relationship between the frequency of vascular access-site infections (VASI) and quality of care during the procedures of vascular access-site use. DESIGN: Prospective, multicenter survey performed from February 2000 to January 2001, including all patients underwent chronic hemodialysis in 5 participating centers. Standardized definitions used and different clinical and biological risk factors recorded. RESULTS: 429 patients for a total of 4273 dialysis months (DM) were enrolled. 245 infections in 164 infected patients were reported. The overall rate was 5.73 infections per 100 DM (18 VASI, 25 bacteraemia, 84 respiratory, 29 urinary tract, 1 endocarditis and 88 other infections). 50% of infections were microbiologically documented. 19 of 21 antibiotics resistant microorganisms were meticillin resistant Staphylococcus aureus. Compared to the incidence rate of fistula (0.05 per 1000 days of follow-up) or prosthesis related VASI (0.11), the incidence rate of catheter related VASI (0.65) was significantly higher. Poor hygiene and duration of catheter use were the significant risk factors for VASI showed by logistic analysis regression. VASI and bacteraemia occurred more frequently after incident or manipulation of the vascular access-site. The decrease of VASI between the 2 periods of survey was significantly higher in centers having reduced the catheter use and implemented written protocols. CONCLUSIONS: This second period of surveillance has confirmed the frequency of infections rate in chronic hemodialysis patients and particularly bacteraemia and VASI. This study has allowed to establish risk factors for infections and showed that VASI in hemodialysis are related to factors in part preventable.

Adenosine and hemodialysis in humans.

BACKGROUND: Infections and hypotension are serious complications that develop during hemodialysis (HD) treatment. Adenosine (ADO), a strong hypotensive and immunosuppressive agent, may participate in these two HD complications, because high concentrations of ADO metabolites are found in dialyzed human plasma. ADO, which is released by endothelial cells, is quickly transformed into inosine (INO) by plasmatic ADO deaminase (ADA) and mononuclear cell ADO deaminase (MCADA). In plasma, the degradation of ADO into INO and its uptake by red blood cells (RBC) are both very rapid, resulting in the short half-life of ADO in blood. METHODS: Using liquid chromatography, we evaluated ADO and INO plasma concentrations before and after HD session. RESULTS: Before the HD session, ADO and INO plasma concentrations were higher in hemodialyzed patients than in controls and in peritoneally dialyzed patients. At the end of the HD session, ADO plasma concentration was increased. ADO plasma concentration for the undialyzed patients was in the same range as that of the controls. Before HD, ADA activity was higher in hemodialyzed patients (559 +/- 349 IU) than in controls (219 +/- 48 IU), and the activity rose during the session (665 +/- 135 IU). ADA activity in the undialyzed patients (222 +/- 80 IU) was in the same range as that of the controls (219 +/- 48 IU). Before the HD session, the MCADA activity (247 +/- 144 IU) was lower than in controls (624 +/- 99 IU). HD did not modify ADO RBC uptake. ADO inhibited mononuclear cell proliferation and interferon-gamma production in humans. Finally, as much as 50 microM INO does not inhibit ADO uptake by RBC and does not modify ADA and MCADA activities. CONCLUSIONS: These data indicate that chronic HD inhibited MCADA activity and increased ADO plasma concentration. Both high ADO plasma concentration and low MCADA activity may be involved in dialysis-induced immune system failure and thereby favor infectious diseases.

[Viral hepatitis C and membranoproliferative glomerulonephritis in a renal transplant patient]. / Hépatite virale C et glomérulonéphrite membranoproliférative chez une transplantée rénale.

We report the case of a 36 year-old-patient, hemodialyzed for idiopathic membranous glomerulonephritis, who suffers from type I membranoproliferative glomerulonephritis five years after a successful kidney transplantation. Etiologic evaluation evidenced chronic viral hepatitis C complicated by type III cryoglobulinemia. If hepatitis C induced membranoproliferative glomerulonephritis has yet been described among non transplanted patients, it is at our knowledge, the first observation in a renal transplant recipient.

Sister-chromatid exchange (SCE) among individuals chronically exposed to arsenic in drinking water.

A study was carried out on human subjects of various ages and backgrounds who had been drinking water containing more than 0.13 mg/l (0.13 ppm) arsenic for a period of at least 20 years. The main aim was not only to correlate the frequency of sister-chromatid exchanges in the lymphocytes with the amount of arsenic in water and urine but also to correlate the frequency of SCE with sex and age. In addition, family background regarding skin alterations or other arsenic-related symptoms was explored, so that individual health conditions could be assessed. External factors such as exposure to other chemical or contaminating agents (pesticides, battery manufacturing plants, foundries) were also taken into consideration. The data on sister-chromatid exchanges (282 exposed and 155 control individuals) showed that arsenic at concentrations used by our population (0.13 mg/l) induced a significantly elevated response. Other health effects of arsenic at these concentrations were found, e.g., hyperkeratosis, melanosis, actinic keratosis, basal cell carcinoma.

The effect of lead on Allium cepa L.

The effect of lead on Allium cepa L. at concentrations of 0.1, 1.0, 10, 50, 100 and 200 ppm were studied. Analysis focused on root growth, frequency of mitosis in a meristematic zone, and chromosomal aberrations. It was observed that lead reduces root growth and the frequency of mitotic cells in meristematic zones, and increases the frequency of aberrant cells. The intensity of the effects is a function of lead concentration.

Cytogenetic study of persons occupationally exposed to ethylene oxide.

Ten persons occupationally exposed to ethylene oxide (EO), used in the sterilization of medical instruments, were studied at a hospital. The estimated concentration to which they were exposed was 60-69 ppm, TWA. Peripheral blood samples from 10 workers and 10 controls of the same age and sex were taken to determine the frequency of sister-chromatid exchanges (SCE) and chromosomal aberrations (CA). The mean frequencies of SCE/cell (X = S) were 13.27 for the exposed workers and 6.05 for controls. Chromosome aberration frequencies in exposed individuals were significantly increased compared with controls. A significant relationship between the frequencies of SCE and CA and EO exposure was demonstrated. Blood chemistry parameters such as urea, creatinine, uric acid, lactic dehydrogenase, glutamic oxaloacetic and pyruvic transaminases, luteinizing gonadotropin and follicle stimulating gonadotropin and thyrotropin were also measured and found to be within the normal range.

Study of sperm characteristics in persons occupationally exposed to lead.

The sperm characteristics of 38 male workers exposed to lead in a battery factory were studied. Sperm analysis was performed after 4 days of sexual abstinence. Parameters analyzed were: volume, sperm count, motility, and morphology. Exposure levels were estimated by measuring the concentration of lead and delta-aminolevulinic acid in the serum. Based on blood lead levels, the tested individuals were divided in three groups: A (12), B (11), and C (15). Significant levels of asthenospermia and teratospermia were found in exposed workers when compared with unexposed controls. Long-term exposure to lead may lead to changes in sperm characteristics and function.

Study of reproductive function in persons occupationally exposed to 2,4-dichlorophenoxyacetic acid (2,4-D).

We studied the reproductive function of 32 male farm sprayers who were exposed to 2,4-D. Sperm analysis was made after 4 days of sexual inactivity. Parameters analyzed were volume, sperm count, mobility and morphology. Exposure level was estimated by measuring the concentration of 2,4-D in the urine. Significant levels of asthenospermia, necrospermia and teratospermia were found in exposed workers compared with unexposed controls. Over time, asthenospermia and necrospermia diminished but the abnormal spermatozoa (teratospermia) continued.