Antimicrobial susceptibility of cinnamon and red and common thyme essential oils and their main constituent compounds against Streptococcus suis.

Streptococcus suis is an emerging zoonotic pathogen causing different diseases, in both humans and pigs. Generally, the control of this pathogen is based on antimicrobial therapy, but the development of bacterial resistance has led one to look for new options. In this sense, the essential oils (EOs) constitute a promising alternative. The activity of cinnamon, common thyme and red thyme EOs and their main active compounds (cinnamaldehyde and thymol) against S. suis isolates from pigs (n = 50) and humans (n = 6) was determined by the broth microdilution method. MIC50-90, MBC50-90 and the bactericidal index (BI) (minimal bactericidal concentration (MBC)/minimal inhibitory concentration (MIC)) were calculated. Also, the time-kill curve of each product against the S. suis P1/7 European reference strain was determined. No differences in the MIC or MBC values were observed between all the tested products, which suggest a homogeneous behaviour of S. suis, independently of their origin, organ of isolation or resistance profile. All the products showed a concentration-dependent and time-dependent killing activity and achieved the virtual eradication of S. suis at supra-inhibitory concentrations within the first 5 min of exposure, except cinnamaldehyde that showed only bacteriostatic effect. It suggests that these products could be utilized as antimicrobials in veterinary medicine for the control of this zoonotic pathogen.

Acclimation of microorganisms for an efficient production of volatile fatty acids and biogas from mezcal vinasses in a dark fermentation process.

Mezcal is an alcoholic artisanal drink made from agave plants in Mexico. Its production causes the generation of wastewater called vinasses, which are highly polluting residues due to its concentration of organic matter as chemical oxygen demand (COD) (35,000-122,000 mg/L) and acidity (pH < 4). Due to their organic content, these residues can be used in dark fermentation to obtain biogas, which is rich in hydrogen. In this work, the acclimation of inoculum by means of a dark fermentation process, in the presence of toxic compounds from mezcal vinasses was studied. The strategy of increasing the initial concentration of vinasse in each treatment cycle in a sequencing batch reactor (SBR) reactor was applied. It was possible to obtain a maximum biogas production of 984 ± 187 mL/L, from vinasses (18,367 ± 1,200 mg COD/L), with an organic matter removal efficiency of 20 ± 1%. A maximum generation of volatile fatty acids (VFA) of 980 ± 538 mg/L equivalent to a production of 74 ± 21% of the influent concentration and removal rate of organic matter of 1,125 ± 234 mg COD/L d-1 equivalent to a removal efficiency of 20 ± 4% was obtained from vinasses with a concentration of 19,648 ± 1,702 mg COD/L.

Azo dyes decolorization under high alkalinity and salinity conditions by Halomonas sp. in batch and packed bed reactor.

Biodecolorization and biodegradation of azo dyes are a challenge due to their recalcitrance and the characteristics of textile effluents. This study presents the use of Halomonas sp. in the decolorization of azo dyes Reactive Black 5 (RB5), Remazol Brilliant Violet 5R (RV5), and Reactive Orange 16 (RO16) under high alkalinity and salinity conditions. Firstly, the effect of air supply, pH, salinity and dye concentration was evaluated. Halomonas sp. was able to remove above 84% of all dyes in a wide range of pH (6-11) and salt concentrations (2-10%). The decolorization efficiency of RB5, RV5, and RO16 was found to be ≥ 90% after 24, 13 and 3 h, respectively, at 50 mg L-1 of dyes. The process was monitored by HPLC-DAD, finding a reduction of dyes along the time. Further, Halomonas sp. was immobilized in volcanic rocks and used in a packed bed reactor for 72 days, achieving a removal rate of 3.48, 5.73, and 8.52 mg L-1 h-1, for RB5, RV5 and RO16, respectively, at 11.8 h. The study has confirmed the potential of Halomonas sp. to decolorize azo dyes under high salinity and alkalinity conditions and opened a scope for future research in the treatment of textile effluents.

Combined effect of conventional antimicrobials with essential oils and their main components against resistant Streptococcus suis strains.

Streptococcus suis is a major swine pathogen. Different strategies to reduce the antimicrobial resistance to conventional antimicrobials (AMBs) have been proposed, including the combined use with essential oils (EOs). The objective of this work was to evaluate the effectiveness of the combination of cinnamon, oregano, common thyme and red thyme EOs and their main components (cinnamaldehyde, carvacrol and thymol) with conventional AMBs (oxytetracycline, trimethoprim-sulfamethoxazole, gentamicin and penicillin) against field resistant S. suis strains. The checkerboard method was used to assess the interaction, by the fractional inhibitory concentration index (FICindex ) determination. All the AMBs showed synergistic (FICindex  ≤ 0·5) or additive (0·5 < FICindex  ≤ 1) effect with at least one of the four essential oils. In general, the combination of the AMBs with the EOs showed better results than combination the AMBs with the main components, although no antagonist effects were detected in any case. The results obtained would support the combined use of AMBs agents with EOs for the treatment of S. suis. SIGNIFICANCE AND IMPACT OF THE STUDY: Streptococcus suis is an important pig pathogen and a zoonosis. Control is based on antimicrobials; however, there is pressure to reduce the use of antimicrobials and new products or combination therapies are of considerable interest. We have evaluated the combined interaction of four essential oils or their main components with conventional antimicrobials against resistant S. suis strains. A positive interaction between gentamicin and oxytetracycline with cinnamon, oregano or thyme was observed, suggesting that a combination of conventional antimicrobials with EOs is a promising alternative for the control of S. suis infections.

Do pharmaceuticals bioaccumulate in marine molluscs and fish from a coastal lagoon?

The bioaccumulation of 20 pharmaceuticals in cockle (Cerastodema glaucum), noble pen shell (Pinna nobilis), sea snail (Murex trunculus), golden grey mullet (Liza aurata) and black goby (Gobius niger) was evaluated, considering their distribution throughout the Mar Menor lagoon and their variations in spring and autumn 2010. The analytical procedure was adapted for the different matrices as being sensitive and reproducible. Eighteen out of the 20 compounds analysed were found at low ngg(-1) in these species throughout the lagoon. Hydrochlorothiazide and carbamazepine were detected in all species considered. The bioaccumulation of pharmaceuticals was heterogeneous in the lagoon, with a higher number of pharmaceuticals being detected in fish (18) than in wild molluscs (8), particularly in golden grey mullet muscle (16). В-blockers and psychiatric drugs were preferentially bioccumulated in fish and hydrochlorothiazide was also confirmed in caged clams. The higher detection frequency and concentrations found in golden grey mullet suggested that mugilids could be used as an indicator of contamination by pharmaceuticals in coastal areas. To the best of our knowledge, this is the first study that shows data about hydrochlorothiazide, levamisole and codeine in wild marine biota.

Chemometrics quality assessment of wastewater treatment plant effluents using physicochemical parameters and UV absorption measurements.

Chemometric techniques like Principal Component Analysis (PCA) and Partial Least Squares Regression (PLS) are used to explore, analyze and model relationships among different water quality parameters in wastewater treatment plants (WWTP). Different data sets generated by laboratory analysis and by an automatic multi-parametric monitoring system with a new designed optical device have been investigated for temporal variations on water quality parameters measured in the water influent and effluent of a WWTP over different time scales. The obtained results allowed the discovery of the more important relationships among the monitored parameters and of their cyclic dependence on time (daily, monthly and annual cycles) and on different plant management procedures. This study intended also the modeling and prediction of concentrations of several water components and parameters, especially relevant for water quality assessment, such as Dissolved Organic Matter (DOM), Total Organic Carbon (TOC) nitrate, detergent, and phenol concentrations. PLS models were built to correlate target concentrations of these constituents with UV spectra measured in samples collected at (1) laboratory conditions (in synthetic water mixtures); and at (2) WWTP conditions (in real water samples from the plant). Using synthetic water mixtures, specific wavelengths were selected with the aim to establish simple and reliable prediction models, which gave good relative predictions with errors of around 3-4% for nitrates, detergent and phenols concentrations and of around 15% for the DOM in external validation. In the case of nitrate and TOC concentrations modeling in real water samples from the effluent of the WWTP using the reduced spectral data set, results were also promising with low prediction errors (less than 20%).

Pharmaceuticals in biota in the aquatic environment: analytical methods and environmental implications.

The presence of pharmaceuticals in the aquatic environment is an ever-increasing issue of concern as they are specifically designed to target specific metabolic and molecular pathways in organisms, and they may have the potential for unintended effects on nontarget species. Information on the presence of pharmaceuticals in biota is still scarce, but the scientific literature on the subject has established the possibility of bioaccumulation in exposed aquatic organisms through other environmental compartments. However, few studies have correlated both bioaccumulation of pharmaceutical compounds and the consequent effects. Analytical methodology to detect pharmaceuticals at trace quantities in biota has advanced significantly in the last few years. Nonetheless, there are still unresolved analytical challenges associated with the complexity of biological matrices, which require exhaustive extraction and purification steps, and highly sensitive and selective detection techniques. This review presents the trends in the analysis of pharmaceuticals in aquatic organisms in the last decade, recent data about the occurrence of these compounds in natural biota, and the environmental implications that chronic exposure could have on aquatic wildlife.

Phenotypic and genotypic antibiotic resistance patterns in Salmonella Typhimurium and its monophasic variant from pigs in southern Spain.

The high incidence of human salmonellosis and multi-drug resistant (MDR) strains of Salmonella Typhimurium (ST) is of concern to global public and animal health. Our research, by means of the broth microdilution method, evaluated the Minimum Inhibitory Concentration (MIC) distribution of 12 antimicrobials against a collection of 73 ST and mST and S. typhimurium monophasic variant 4,[5],12:i:- (mST) isolates from slaughtered pigs reared in extensive systems in southern Spain, and also 12 resistance-associated genes or antimicrobial resistance (AMR) determinants using qPCR. Our data revealed that 98.6% of strains were MDR, with resistance to cephalothin/tetracycline/sulfamethoxazole-trimethoprim/ampicillin/chloramphenicol being the most common pattern (55.6%). Regarding AMR determinants, the most significantly (p < 0.05) genes detected by qPCR were sul1 and aadA2 (89% of strains positive), aadA1 and dfrA12 (87.7%), and blaTEM and tet(B) (86.3% and 84.9%, respectively). Up to date information on ST antimicrobial resistance patterns is essential for epidemiological surveillance programs to support animal and public health. The high number of MDR isolates and variability regarding resistance determinants revealed in this study highlights the role of animals reared in extensive systems as a source of resistant Salmonella strains.

Consensus document for multimodal intraoperatory neurophisiological monitoring in neurosurgical procedures. Basic fundamentals. / Documento de consenso para la monitorización neurofisiológica intraoperatoria multimodal en procedimientos neuroquirúrgicos. Fundamentos básicos.

The present work aims to establish a guide to action, agreed by anaesthesiologists and neurophysiologists alike, to perform effective intraoperative neurophysiological monitoring for procedures presenting a risk of functional neurological injury, and neurosurgical procedures. The first section discusses the main techniques currently used for intraoperative neurophysiological monitoring. The second exposes the anaesthetic and non-anaesthetic factors that are likely to affect the electrical records of the nervous system structures. This section is followed by an analysis detailing the adverse effects associated with the most common techniques and their use. Finally, the last section describes a series of guidelines to be followed upon the various intraoperative clinical events.

Salmonella Indiana as a cause of abortion in ewes: Genetic diversity and resistance patterns.

Salmonella enterica subspecies enterica Indiana, a food-borne serovar uncommon in most countries, was responsible for an outbreak of abortion in a flock of Lacaune dairy ewes in southern Spain. Drinking water and feedstuff samples were analysed in an attempt to determine the source of the infection. Pigeons (Columba livia) and turtledoves (Streptopelia turtur) in close contact with the ewes were captured and examined for the bacterium. Seventeen S. Indiana strains were isolated from the ewes and wild birds and the genetic similarity among them analysed by Pulsed Field Gel Electrophoresis (PFGE) after the digestion of their genomic DNA with the restriction enzyme XbaI. The results suggest the wild birds might be responsible for the outbreak in the ewes. The strains recovered were fully susceptible to 15 out of the 16 antimicrobial agents tested: ampicillin, amoxycillin clavulanate, cephalothin, ceftriaxone, gentamicin, neomycin, streptomycin, tetracycline, ciprofloxacin, enrofloxacin, sulphonamides, trimethoprim-sulphamethoxazole, apramycin, colistin and chloramphenicol. Differences in the resistance pattern to nalidixic acid were observed; 11 strains (64.7%) were nalidixic acid resistant (R-Nx) and 6 (35.3%) sensitive (S-Nx). Among the R-Nx strains, a substitution of Gly to Cys at position 81 (Gly81àCys) of the gyrA gene in 10 strains isolated from wild birds and ovine foetuses, and of Asp to Tyr at position 87 (Asp87àTyr) in one strain isolated from ewe faeces, were revealed by sequencing the gene. To control the outbreak, enrofloxacin treatment was administered for 5 days. The same therapy was used to prevent infection during following gestation cycles, administering the antimicrobial agent at presentation and over 4 weeks before birth. Anti-bird meshes and closed drinking and feeding troughs were also installed to prevent further contact of the ewes with wild birds.

Contaminants of emerging concern in freshwater fish from four Spanish Rivers.

This study investigated the occurrence of 135 contaminants of emerging concern (CECs) - pharmaceuticals, pesticides, a set of endocrine disrupting compounds (EDCs) (parabens, bisphenols, hormones, triazoles, organophosphorus flame retardants and triclosan), UV-filters, perfluoroalkyl substances (PFASs) and halogenated flame retardants (HFRs) - in 59 fish samples, collected in 2010 in 4 Spanish Rivers (Guadalquivir, Júcar, Ebro and Llobregat). Of the 135 CECs, 76 including 8 pharmaceuticals, 25 pesticides, 10 EDCs, 5 UV-filters, 15 PFASs and 13 HFRs were detected. Pharmaceuticals were the less frequently found and at lower concentrations. Pesticides, EDCs, UV-filters, PFASs and HFRs were detected more frequently (>50% of the samples). The maximum concentrations were 15 ng/g dry weight (dw) for pharmaceuticals (diclofenac), 840 ng/g dw for pesticides (chlorpyrifos), 224 ng/g dw for EDCs (bisphenol A), 242 ng/g dw for UV-filters (EHMC), 1738 ng/g dw for PFASs (PFHxA) and 64 ng/g dw for HFRs (Dec 602). The contaminants detected in fish are commonly detected also in sediments. In light of current knowledge, the risk assessment revealed that there was no risk for humans related to the exposure to CECs via freshwater fish consumption. However, results provide detailed information on the mixtures of CECs accumulated that would be very useful to identify their effects on aquatic biota.

Seroprevalence and risk factors of exposure to caprine arthritis-encephalitis virus in southern Spain.

The aim of the present transversal descriptive study was to determine the exposure and risk factors associated with caprine arthritis-encephalitis virus (CAEV) in southern Spain. A total of 3,312 serum samples were collected from goat belonging to three different breeds coming from 48 flocks located in different geographic areas from southern Spain. In addition, health and productive parameters were surveyed during the visit to the herds. Serum samples were analysed by INgezim Maedi Screening (Ingenasa®) ELISA kit. The total percentage of herds exposed to CAEV was 87.71% (CI95 78.42-97.00). A total of 733 goats were seropositive with overall seroprevalence of 23.22% (CI95 21.78-24.65). The intraherd seroprevalence was 20.82%±24.07. Multivariate logistic regression showed significant association between CAEV and the next variables: (i) herd size (P<0.0001; OR: 2.07; CI95: 1.73-2.50), (ii) kidding area (P<0.0020; OR: 1.38; CI95: 1.13-1.69), (iii) cleaning and disinfection program (P<0.0067; OR: 1.90; CI95: 1.43-2.53), (iv) natural mating (P<0.0026; OR: 2.22; CI95: 1.73-2.86) and (v) multiparous (P<0.0001; OR: 2.90; CI95: 2.17-3.87). The results indicate a widespread of CAEV infection in goat herds in southern Spain, being herd size, existence of kidding area, absence of cleaning and disinfection program, natural mating and multiparous goats risk factors for the exposure to CAEV.

Determination of a broad spectrum of pharmaceuticals and endocrine disruptors in biofilm from a waste water treatment plant-impacted river.

Wastewater treatment plants (WWTPs) are one of the main sources of pharmaceuticals and endocrine disrupting compounds in freshwater ecosystems, and several studies have reported bioaccumulation of these compounds in different organisms in those ecosystems. River biofilms are exceptional indicators of pollution, but very few studies have focused on the accumulation of these emerging contaminants. The objectives of this study were first to develop an efficient analytical methodology for the simultaneous analysis of 44 pharmaceuticals and 13 endocrine disrupting compounds in biofilm, and second, to assess persistence, distribution, and bioaccumulation of these contaminants in natural biofilms inhabiting a WWTP-impacted river. The method is based on pressurized liquid extraction, purification by solid-phase extraction, and analysis by ultra performance liquid chromatography coupled to a mass spectrometer (UPLC-MS/MS) in tandem. Recoveries for pharmaceuticals were 31-137%, and for endocrine disruptors 32-93%. Method detection limits for endocrine disruptors were in the range of 0.2-2.4 ng g(-1), and for pharmaceuticals, 0.07-6.7 ng g(-1). A total of five endocrine disruptors and seven pharmaceuticals were detected in field samples at concentrations up to 100 ng g(-1).

Bioaccumulation and bioconcentration of carbamazepine and other pharmaceuticals in fish under field and controlled laboratory experiments. Evidences of carbamazepine metabolization by fish.

There is a growing interest in evaluating the presence of pharmaceutical residues and their metabolites in aquatic biota. In this study, twenty pharmaceuticals, including carbamazepine (CBZ) and two metabolites, were analyzed in homogenates of two fish species (Gambusia affinis and Jenynsia multidentata) captured in polluted areas of the Suquía River (Córdoba, Argentina). The twenty target pharmaceuticals were found in G. affinis, while only fifteen were detected in J. multidentata. We observed a noticeable difference in the accumulation pattern of both fish species, suggesting different pathways for the bioaccumulation of polar pharmaceuticals in each fish. In order to investigate uptake and tissue distribution of pharmaceuticals, a detailed study was performed under controlled laboratory conditions in J. multidentata, exposed to CBZ. CBZ and two of its metabolites (carbamazepine-10,11-epoxide - CBZ-EP and 2-hydroxycarbamazepine - 2-OH-CBZ) were monitored in five organs of fish under laboratory exposure. To our knowledge, this is the first report on the presence of CBZ and its metabolite 2-OH-CBZ in gills, intestine, liver, brain and muscle of fish, while the metabolite carbamazepine-10,11-epoxide (CBZ-EP) was detected in gills and muscle. A ratio CBZ-EP/CBZ close to 0.1 suggests that gills and muscle of J. multidentata could metabolize CBZ through the CBZ-EP pathway. Our results reinforce the need of analyzing multiple species to account for the environmental impact of pollutants, negating the simplification of a single, "representative model" during ecotoxicological biomonitoring. To our knowledge, the biotransformation of CBZ to its metabolites (CBZ-EP, 2-OH-CBZ) in fish, under controlled laboratory in vivo exposures, is reported for the first time.

PO-04 - A new genetic risk score for predicting venous thromboembolic events in cancer patients receiving chemotherapy.

BACKGROUND: Venous thromboembolism (VTE) is one of the major causes of cancer-associated mortality. Risk for developing VTE increases when in chemotherapy, mainly in the outpatient setting. Current risk scores for predicting chemotherapy-associated VTE have low/moderate discrimination capacity. These models use clinical parameters. ThromboinCode (TiC) is a new tool for VTE risk prediction using an algorithm that combines a genetic risk score (GRS) with subject's VTE clinical risk parameters (cancer type and cancer disease status "CDS", included). AIMS: To evaluate whether TiC predicts better the risk for chemotherapy-associated VTE than Khorana score. METHODS: A prospective, observational study including 251 patients with locally advanced or metastatic cancer (colon, stomach, pancreas and lung) receiving systemic outpatient chemotherapy. Patients are followed-up for 6 months. Three predictive models were compared: a) Khorana score; b) Khorana score plus CDS and c) TiC. Genetic variants included in TiC are FVL, PT, F5 rs118203906 and rs118203905, F12 rs1801020, F13 rs5985, SERPINC1 rs121909548, SERPINEA10 rs2232698 and A1 blood group rs8176719, rs7853989, rs8176743, rs8176750. Clinical risk factors in TiC are age, sex, family history of VTE, BMI, smoking, diabetes, type of cancer and CDS. Prediction capacity of each model was assessed in terms of the discrimination (area under the receiver operating characteristic curve, AUC). RESULTS: The incidence of VTE at 6 months was 23.11%. Korana score had an AUC of 0.550 (95% CI 0.485-0.613, p=0.2162), sensitivity 64.41, specificity 46.56, positive likelihood ratio of 1.21, negative likelihood ratio of 0.76. Khorana score+CDS prediction model had an AUC of 0.609 (95% CI 0.545-0.670, p=0.008), sensitivity 70.69, specificity 50.53, positive likelihood ratio of 1.25, negative likelihood ratio of 0.67. Discrimination increased significantly with TiC (AUC: 0.70; 95% CI 0.636 - 0.753, p<0.0001), sensitivity 79.31, specificity 55.44, positive likelihood ratio of 1.78, negative likelihood ratio of 0.37. The discrimination with TiC was significantly higher than with the other two predictive models (p<0.05). CONCLUSIONS: We conclude that TiC predicts chemotherapy-associated VTE risk significantly better than Khorana score with CDS.

Evaluation of the effectiveness of the Pastormaster method for disinfection of legionella in a hospital water distribution system.

The Pastormaster method consists of heating the water of hospital distribution systems at a specific point to a sufficient temperature for a minimum amount of time to eradicate legionella. The object of this study was to evaluate the effectiveness of the Pastormaster method for legionella disinfection in a hospital environment. A two-phase procedure was performed: hydraulic optimization of the water supply circuit, and implementation of the Pastormaster method. Water samples were taken at 10 representative points in the hospital hot-water system and cultured microbiologically. Other physical and chemical measurements were also determined. Implementation of the Pastormaster method and correction of the deficiencies identified during a hydraulic system audit confirmed the absence of legionella in the hospital water distribution system. The combination of implementation of the Pastormaster method and conduction of a hydraulic audit designed to identify and remedy any possible problems in water circulation is effective in minimizing the risk of legionella contamination in hospital water distribution systems.

Multi-residue method for the analysis of pharmaceuticals and some of their metabolites in bivalves.

A fast, simple and robust method has been developed for the simultaneous determination of 23 pharmaceuticals (including some major metabolites) in bivalve mollusks. The analytes belong to eight different therapeutic groups: antibiotics, psychiatric drugs, analgesics/anti-inflammatories, tranquilizer, calcium channel blockers, diuretic, and prostatic hyperplasia. The method is based on pressurized liquid extraction (PLE) followed by solid phase extraction clean-up (SPE), and ultra performance liquid chromatography-triple quadrupole mass spectrometry (UHPL-MS/MS) for the identification and quantification of the target analytes. It has been developed and validated in three different species of bivalves: Crassostrea gigas (Pacific oyster), Mytilus galloprovincialis (Mediterranean mussel), and Chamelea gallina (striped venus clam). The majority of the compounds were extracted with a recovery between 40 and 115%. The developed analytical method allowed the determination of the compounds in the lower ng/g concentration levels. The relative standard deviation was under 12% for the intra-day and 20% inter-day analyses, respectively. Finally, the method was applied to oyster, clam and mussel samples collected from the Ebro delta, Spain. The most ubiquitous compounds detected were the psychiatric drug venlanfaxine and the antibiotic azithromycin, with the highest concentrations found in mussel (2.7ng/g dw) and oyster (3.0ng/g dw), respectively. To the best of our knowledge, this is the first time that azithromycin has been reported in environmental samples of marine biota.

Development of an extraction and purification method for the determination of multi-class pharmaceuticals and endocrine disruptors in freshwater invertebrates.

Aquatic organisms from freshwater ecosystems impacted by waste water treatment plant (WWTP) effluents are constantly exposed to constant concentrations of pharmaceuticals, endocrine disruptors and related compounds, among other anthropogenic contaminants. Macroinvertebrates inhabiting freshwater ecosystems might be useful bioindicators of exposure to contaminants, since their lives are long enough to bioaccumulate, but at the same time may integrate short-term changes in the environment. However, studies about potential bioaccumulation of emerging contaminants in these organisms are very scarce. The objectives of this study were to develop an analytical methodology for the analysis of 41 pharmaceuticals and 21 endocrine disruptors in freshwater invertebrates. In addition, bioaccumulation of these contaminants in three macroinvertebrate taxa inhabiting a waste water treatment plant -impacted river was evaluated. The method for the simultaneous extraction of both families of compounds is based on sonication, purification via removal of phospholipids, and analysis by ultra performance liquid chromatography coupled to a mass spectrometer (UPLC-MS/MS) in tandem. Recoveries for pharmaceuticals were 34-125%, and for endocrine disruptors were 48-117%. Method detection limits (MDLs) for EDCs were in the range of 0.080-2.4 ng g(-1), and for pharmaceuticals, 0.060-4.3 ng g(-1). These pollutants were detected in water samples taken downstream the waste water treatment plant effluent at concentrations up to 572 ng L(-1). Two non-esteroidal anti-inflammatory drugs, diclofenac and ibuprofen, and four endocrine disruptors - estrone, bisphenol A, TBEP, and nonylphenol - were detected in at least one macroinvertebrate taxa in concentrations up to 183 ng g(-1) (dry weight). An isobaric interference was identified during the analysis of diclofenac in Hydropsyche samples, which was successfully discriminated via accurate mass determination by TFC-LTQ Orbitrap.

Potassium imbalance in the coronary care unit.

Alterations in serum potassium levels are not uncommon in this era of wide use of diuretics, potassium supplements, and potassium-sparing drugs. Familiarity with the characteristic electrocardiographic changes related to abnormal serum levels of potassium is necessary in the care of patients in intensive care units.