Emerging Contaminants in the Northeast Andean Foothills of Amazonia: The Case of Study of the City of Tena, Napo, Ecuador.

This work is a study on the occurrence of emerging pollutants in the northeast Ecuadorian Amazon. Emerging contaminants (ECs)-caffeine, triclosan, estradiol, acetaminophen, nicotine, and ibuprofen-were quantified by gas chromatography-mass spectrometry in rivers and streams of the Amazon basin near the city of Tena, Ecuador. For that, a total of 16 natural water samples were taken in 8 locations. Sampling sites included areas impacted by discharges from inefficient sewage networks in urban areas, wastes from fish farming and non-functional landfill, a stream with few threats, tap water, and treated sewage. Caffeine was found in the 38% of the samples studied while trimethoprim and acetaminophen had an occurrence of 13%. Caffeine was detected at two sites receiving untreated sewage and one site receiving treated sewage with mean concentrations that ranged between 19 and 31.5 µg L-1. Acetaminophen (50.4 µg L-1) and trimethoprim (2 µg L-1) were only detected in the river receiving treated sewage effluent. This is the first assessment of emerging contaminants in the upper Ecuadorian Amazon basin, and our observations highlight the need for better sewage treatment and water quality monitoring in Amazonian cities.

A Novel and Practical Method of Performing Atrioventricular Nodal Ablation via a Superior Approach in Patients with Refractory Atrial Fibrillation Undergoing Cardiac Resynchronization Device Implantation.

Atrioventricular node (AVN) ablation is a strategy to manage patients with drug-refractory atrial fibrillation (AF) and heart failure in whom cardiac resynchronization therapy (CRT) device implantation has been prescribed. This study describes a practical method to perform these two procedures using the same surgical site. Twenty-seven patients were indicated for AVN ablation and concurrent CRT device implantation while presenting with AF and rapid ventricular response (RVR) refractory to medical therapy. After placement of the right and left ventricular leads, a third puncture was made in the axillary vein to obtain access to perform the ablation. After hand-injecting contrast media through a RAMP™ (Abbott Laboratories, Chicago, IL, USA) sheath positioned in the right atrial cavity, the anatomical area corresponding to the AVN was identified using fluoroscopy cine runs obtained in the right anterior oblique and left anterior oblique projections. The adequate site for ablation was confirmed by the bipolar recording of a His-bundle deflection at the tip of the ablation catheter. Radiofrequency energy was delivered to achieve complete heart block. Subsequently, device implant was completed. The method was successfully applied in 27 consecutive cases, achieving permanent complete heart block in all patients. The mean radiofrequency time to achieve heart block was 110 seconds ± 43 seconds. The average procedural time including AVN ablation and device implant was 87 minutes ± 21 minutes. The images obtained with the hand-injected contrast media provided adequate information to readily identify the anatomical area corresponding to the AVN with 100% accuracy. This study suggests that ablation of the AVN can be safely and effectively accomplished via a superior approach in patients undergoing a CRT device implant.