Effects of tourist flows on antibiotic resistance in wastewater of a Greek island.

AIM: Antibiotic resistance in wastewaters reflects the clinical resistome. This study aimed at investigating whether changes in the population size and composition in the popular tourist destination of Zakynthos island are associated with differentiation in the antibiotic resistance of environmental micro-organisms isolated from wastewater. METHODS AND RESULTS: The resistance profiles of four species (Escherichia coli, Staphylococcus sp., Pseudomonas sp. and Enterococcus sp.) were studied in 124 raw and treated municipal wastewaters from November 2015 to August 2016. Isolates were tested against their susceptibility to several antibiotics of different antimicrobial categories. Data concerning the alteration in the population size and composition, due to the tourist mobility, were collected and logistic regression models were used to examine the relationships between antimicrobial resistance and population changes. The decrease in resistance of E. coli to amoxicillin-clavulanate, of enterococci to norfloxacin and ampicillin, and of pseudomonads to almost all antibiotics tested was associated with population increase due to tourist flows. In contrast, the presence of tourists was linked to an increase in quinupristin-dalfopristin resistant enterococci. Resistance of staphylococci did not change during the tourist period. CONCLUSION: Changes in population composition in touristic areas are reflected in antibiotic resistance of environmental bacteria in wastewater. SIGNIFICANCE AND IMPACT OF THE STUDY: In touristic areas, where people carrying different resistomes are merged, medication should be adapted accordingly.

Cadmium versus copper toxicity: insights from an integrated dissection of protein synthesis pathway in the digestive glands of mussel Mytilus galloprovincialis.

The main purpose of this study was to investigate the impact of metal-mediated stress on the protein-synthesis pathway in mussels. To this end, mussels (Mytilus galloprovincialis) underwent a 15 days exposure to 100 µg/L Cu(2+) or Cd(2+). Both metals, in particular Cd(2+), accumulated in mussel digestive glands and generated a specific status of oxidative-stress. Exposure of mussels to each metal resulted in 40% decrease of the tRNA-aminoacylation efficiency, at the end of exposure. Cu(2+) also caused a progressive loss in the capability of 40S-ribosomal subunits to form 48S pre-initiation complex, which reached 34% of the control at the end of exposure. Other steps of translation underwent less pronounced, but measurable damages. Mussels exposed to Cd(2+) for 5 days presented a similar pattern of translational dysfunctions in digestive glands, but during the following days of exposure the ribosomal efficiency was gradually restored. Meanwhile, metallothionein levels significantly increased, suggesting that upon Cd(2+)-mediated stress the protein-synthesizing activity was reorganized both quantitatively and qualitatively. Conclusively, Cd(2+) and Cu(2+) affect translation at several levels. However, the pattern of translational responses differs, largely depending on the capability of each metal to affect cytotoxic pathways in the tissues, such as induction of antioxidant defense and specific repair mechanisms.

Anthelmintics residues in raw milk. Assessing intake by a children population.

Anthelmintics, such as benzimidazoles and probenzimidazoles, are veterinary drugs used against endoparasites in food producing animals. A number of these drugs are considered responsible for embryotoxicity and teratogenicity. The residue levels of Albendazole, Febantel, Fenbendazole, Mebendazole and some of their metabolites (Albendazole sulphoxide, Albendazole sulphone, Fenbendazole sulfone) were assessed in 123 (42 goat, 69 sheep, 12 bovine) raw milk samples collected from all farms throughout Southern Greece. Sample analysis was performed by HPLC with Diode Array Detector. A high percentage (27.6%) of the samples examined was found to be positive for the investigated compounds. In 14 samples (11.4%), the residues' concentration exceeded the established Maximum Residue Limits. Estimated Daily Intakes were calculated for a population of 723 children aged 10-12 years. Data on milk consumption were obtained by personal interview through a 7-day food frequency questionnaire. The maximum Estimated Daily Intakes for the anthelmintic residues, concerning raw milk, did not exceed the current Acceptable Daily Intake.

Periodic limb movement during sleep and chronic obstructive pulmonary disease.

The aim of this work was to study whether chronic obstructive pulmonary disease (COPD) subjects exhibited periodic limb movement (PLMs) during sleep. A retrospective case control study was conducted in the referral sleep disorders laboratory in the University of Patras in southwest Greece. A sample of 23 COPD subjects was compared with 14 severe obstructive sleep apnea (OSA) subjects and 18 periodic limb movement disorder (PLMD) subjects. The PLM Index (PLMI) and PLMs Arousal Index (PLMAI) in COPD subjects differ (p<0.05) from severe OSA patients. The PLMAI differ (p < 0.05) between COPD and PLMD subjects. Spearman's correlation showed a positive statistical significant correlation between PLMI and PLMAI in the entire population and in COPD subjects. There was no statistical significant correlation between sleep-related symptoms and the occurrence of PLMs disorder in COPD patients. In our study, PLMs with associated arousals are often seen in COPD subjects. Further prospective studies will be necessary to clarify the mechanisms whereby the reduction in PLMs in COPD patients improved their sleep and quality of life.

Sleep apnea syndrome in a referral population in Greece: influence of social factors.

OBJECTIVE: The aim of this work was to study whether social factors are risk factors for obstructive sleep apnea (OSA). A second objective was to investigate gender differences in relation to referral to a sleep laboratory for sleep-related breathing symptoms. STUDY DESIGN: A retrospective cross-sectional study was conducted in the referral sleep disorders laboratory in the tertiary University Hospital in Patras in southwest Greece. A sample of 362 subjects originated from this geographic region was screened for social characteristics, i.e., marital status, occupation, and education. RESULTS: The apnea hypopnea index (AHI) was approximately three times as high in men as in women (p < 0.05). Snoring was reported to be a symptom by 76.6% of males and 75% of females. Excessive daytime sleepiness (EDS) was reported by 25.5% of males and 15% of females. Arousals during sleep were reported by 5.7% of men and 10% of women. The ratio of subjects with concomitant disorders or symptoms did not differ between sexes (p > 0.05). The influence of age, body mass index (BMI), gender, smoking, and social characteristics on AHI was examined by multinomial logistic regression. The following factors remained independent risk factors for the presence of moderate to severe OSA (i.e., AHI > 15/h compared with AHI < 5): (1) Gender: the odds ratio (OR) of males to females was 6.23 (CI = 1.89-20.5). (2) Obesity: the OR of subjects with BMI >30.5 kg/m(2) in comparison to those with lower BMI was 3.83 (CI = 1.86-7.86). (3) Marital status: The OR of married subjects to singles was 2.30 (CI = 1.01-5.32). (4) Occupational status: The OR of subjects outside the work force was 3.85 (CI = 1.16-12.74) and that of the self-employed was 1.70 (CI = 0.70-4.10) compared to a reference group of clerks/employees. CONCLUSION: In our study factors associated with the presence of sleep apnea include gender (men), obesity, marriage, and self-employment or being outside the work force.

Rainwater harvesting, quality assessment and utilization in Kefalonia Island, Greece.

The quality of harvested rainwater which is used for domestic and drinking purposes in the northern area of Kefalonia Island in SW Greece and the factors affecting it were assessed through 3-year surveillance. In 12 seasonal samplings, 156 rainwater and 144 ground- or mixed water samples were collected from ferroconcrete storage tanks (300-1000 m3 capacity), which are adjacent to cement-paved catchment areas (600-3000 m2). Common anions and major cations as well as the metals Fe, Mn, Cd, Pb, Cu, Cr, Ni and Zn were tested. The presence of three major groups of organic compounds, polycyclic aromatic hydrocarbons (PAHs), organochloride pesticides (OCPs) and volatile organic compounds (VOCs), was screened by common analytical techniques. All of the rainwater samples were within the guidelines for chemical parameters established by the 98/93/EU directive. As far as microbiological quality is concerned, total coliforms, Escherichia coli and enterococci were detected in 80.3%, 40.9% and 28.8% of the rainwater samples, respectively, although they were found in low concentrations. Chemical and microbiological parameters showed seasonal fluctuations. Principal component analysis revealed that microbiological parameters were affected mainly by the cleanness level of catchment areas, while chemical parameters were influenced by the sea proximity and human activities. Disinfection should be applied into the tanker trucks which distribute the water to the consumers and not into the big storage tanks in order to avoid by-products formation. Due to the lack of fluoride in rainwater samples, the consumers must become aware of the fact that the supplementation of this element is needed.

Comparative typing of Pseudomonas species isolated from the aquatic environment in Greece by SDS-PAGE and RAPD analysis.

AIMS: Three broadly used typing methods were employed in order to assess and compare the identification and classification of environmental Pseudomonas strains. The reproducibility, typeability and discriminatory power of the methods were also compared to evaluate their application. Finally, the potential impact on public health of the isolates is to be discussed. METHODS AND RESULTS: Pseudomonas strains (160) isolated from the aquatic environment in Greece and identified by a rapid identification commercially available system (API20NE), were subjected to whole-cell protein electrophoresis (Sodium dodecyl sulfate-polyacrylamide gel electrophoresis) and Randomly Amplified Polymorphic DNAs (RAPD) using two 10-mer primers. In general, the obtained results were in agreement. Twenty isolates that could not be identified by the API20NE system were classified by the other methods. CONCLUSIONS: Rapid identification systems may serve only for a first rough identification of environmental Pseudomonads. In order to acquire further information, so that conclusions about their role in the ecosystem and human health could be drawn, other phenotypic or genotypic methods have to be applied. SIGNIFICANCE AND IMPACT OF STUDY: It is important, from a public health point of view, to monitor the identities of environmental Pseudomonas isolates using specific methods due to their ubiquity, heterogeneity and their pathogenicity, either established or potential.

Increased levels of albumin in bronchial washing fluid of patients with bronchial carcinoma. Could albumin be considered as a tumor marker?

BACKGROUND: The aim of this study was to evaluate the significance of albumin in bronchial washing fluid (BWF) and its relationship to three tumor markers (CEA, CA 19-9 and NSE). METHODS: Serum and BWF samples were collected in a group of 60 patients. Albumin and tumor markers in the BWF and serum of three groups: a control group (CG), a chronic bronchitis group (CBG) and a lung cancer group (CaG), were analyzed in a prospective cross-sectional study. The diagnostic yields of the tests in each environment (serum and BWF) were evaluated by using as cutoff points the values of the corresponding 90th percentile of CG and CBG taken together. RESULTS: A significant difference in albumin level (p < 0.001) was noted in the BWF of patients with cancer compared with the other two groups. In addition, a significant difference in CEA level (p < 0.001) was observed in the serum of cancer patients compared with the other two groups. The cutoff values for CEA in serum and albumin in BWF were 2.20 ng/mL and 2.00 g/dL, respectively. The areas under the corresponding ROC curves were 93% and 97%. Combination of CEA-serum and albumin-BWF by logistic regression analysis increased their diagnostic value. CONCLUSION: Measurement of albumin levels in BWF could be a useful additional diagnostic tool to differentiate malignant from non-malignant lung diseases. Moreover, the combined measurement of CEA in serum and albumin in BWF could be of aid in the follow-up of lung cancer patients.

Organochlorine pesticide residues in human breast milk from southwest Greece: associations with weekly food consumption patterns of mothers.

Breast milk samples were collected from 112 mothers who resided in southwest Greece during the years 1995-1997. The following chemicals, which were present in some of the milk samples, were quantified by gas chromatography: residues of lindane (i.e., alpha-hexachlorocyclohexane [BHC], beta-BHC, gamma-BHC), delta-BHC, 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (p,p-DDE), 1,1-dichloro-2,2-bis(p-chlorophenyl)ethane (p,p'-DDD, and 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (p,p'-DDT). With the assistance of a qualified dietitian, the mothers also completed a 7-d food-frequency questionnaire and provided additional personal information (e.g., educational level, profession, previous or present residence, use of pesticides, treatment of dermal scabies). Concentrations of gamma-BHC (i.e., lindane) were present in 57.1% of the samples (mean concentration = 0.58 microg/l [whole milk], range = nondetectable to 10.86 microg/l). Concentrations of alpha-BHC, beta-BHC, delta-BHC, p,p'-DDD, and p,p'-DDT were detected in 16%, 39.3%, 11.6%, 41%, and 55.3% of the samples, respectively. Moreover, p,p'-DDE, which was detected in all samples, ranged from 0.33 to 278 microg/l. Typically, the amounts of gamma-BHC and sigma-DDTs in breast milk were below the established acceptable daily intake value. Nonetheless, 3 of the 112 samples contained concentrations of sigma-DDT derivatives that exceeded the acceptable daily intake value established by the World Health Organisation in 1987. Concentrations of insecticides in breast milk were affected by dietary habits. Some women who consumed 7 (or more) portions of fresh vegetables per week had gamma-BHC concentrations in whole milk that exceeded 0.15 microg/l (odds ratio = 1.23 [95% confidence interval = 1.05, 1.44]; p = .006). The concentrations of DDT derivatives were associated with the portions of fish, chicken, fruits, milk, and potatoes consumed each week.

Plasma retinol and tocopherol levels in greek elderly population from an urban and a rural area: associations with the dietary habits.

Data on plasma concentrations of retinol and alpha-tocopherol in elderly (over 65 years) living in the Mediterranean countries are sparse. In the current study, plasma retinol and alpha-tocopherol concentrations were determined in 200 healthy subjects (82 men and 112 women) residing in an urban and in a rural area in South Western Greece. High prevalence of low plasma retinol concentration was observed for both sexes in each area. The 16.7% of males in urban and 25.4% in rural area had plasma retinol levels below 0.3 mg/l. The corresponding values for female subjects were 26% and 20.3%. Plasma alpha-tocopherol was found to be within normal range in the rural area (only one male had plasma alpha-tocopherol below 5 mg/l) while in the urban area 68.3% of men and 62% of women had plasma alpha-tocopherol values below 5 mg/l. Differences in dietary habits between subjects living in the rural and in the urban area were revealed through a weekly food frequency questionnaire. This could partly explain the difference in alpha-tocopherol concentrations between the two areas. The results of this study revealed high risk of vitamin A and E deficiency and suggests that the health care system in Greece should pay more attention on the social and health status of its elderly population.

Trace metals in scalp hair of Greek agricultural workers.

In order to determine "base-line" values of hair metal concentrations in unpolluted, non-industrial areas of Greece, a random sample of 144 agricultural workers (75 males and 69 females) was selected from the Civil Registry of communities of southwest Greece. All subjects were at least 50 years old and had lived in the same community for at least 10 years prior to the investigation. Bulk hair samples were collected and washed with non-ionic detergent and ultrasonic cleaning. Concentrations of six metals (Cd, Pb, Cr, Ni, Zn and Cu) were determined by flameless AAS after wet-digestion. Arithmetic means of concentrations of Cd, Pb, Cr, Ni, Zn and Cu were 0.31, 4.40, 0.85, 0.73, 182.50 and 10.48 micrograms g-1, respectively, for males, and 0.19, 3.84, 1.19, 0.73, 187.60 and 10.61 micrograms g-1 respectively, for females. Statistically significant (p less than 0.05) sex differences were observed for cadmium and nickel. High positive correlations were observed between lead, chromium and copper. High negative correlations were observed between cadmium and zinc. Factor analysis showed that lead, chromium and copper were associated with the first factor. The results are discussed and compared with those observed in other parts of the world.

Possible health effects of high manganese concentration in drinking water.

Three areas in the same region of northwest Peloponnesos, Greece, that had varying concentrations of manganese (Mn) in drinking water were selected for study. The Mn concentrations in areas A, B, and C were 3.6-14.6 micrograms/l, 81.6-252.6 micrograms/l, and 1 800-2 300 micrograms/l, respectively. A random sample (62 in area A, 49 in area B, and 77 in area C) of males and females who were at least 50 y of age were submitted to a thorough neurological examination and their whole-blood Mn and hair Mn concentrations were determined. Although all areas were similar with respect to social and dietary characteristics, significant differences were observed for prevalence of chronic manganese poisoning (CMnP) symptoms and hair Mn concentration. The means (both sexes) of neurological scores were 2.7, 3.9, and 5.2, respectively, for areas A, B, and C (Kruskal-Wallis, chi 2 = 6.44, 2 df, p less than .05 for males; chi 2 = 7.8, 2 df, p less than .05 for females). Hair Mn concentrations were also significantly different, the means for which were 3.51, 4.49, and 10.99 micrograms/g dry weight, respectively (both sexes [p less than .001 for each sex separately]). These results indicate that progressive increases of Mn concentration in drinking water are associated with progressively higher prevalences of neurological signs of CMnP and Mn concentration in hair of older persons.