Sewage analysis as an alternative tool for assessing drug of abuse and new psychoactive substances in Tunisia.

Many studies attest to the pollution of wastewaters by organic molecules including drug of abuse (DAs) residues and new psychoactive substances (NPS) at trace levels. The occurrence of these emerging micropollutants in influent wastewaters (IWW) from three Tunisian Wastewater Treatment Plants (WWTPs) was assessed. Influent wastewater composite samples (24 h) were collected over 7 consecutive days in November 2019. The determination and quantification of 11 drug of abuse or their metabolites was performed by the application of an optimized multi-residue method liquid chromatography tandem mass spectrometry (LC-MS/MS). MDMA, THC and the cocaine metabolite benzoyl ecgonine were the most detected substances across the three investigated sewage plants. A new wastewater-based epidemiology (WBE) approach was applied in this study to estimate illicit drug consumption. This innovative approach was used to calculate and to assess collective drug consumption of illicit drug at a community level, based on the concentration of selected illicit substances and their major metabolites in influent wastewater. The average MDMA consumption found in the selected cities ranged between 35,8-1531,1 mg day- 1/1000 inhabitants and increased during the weekends. Cocaine consumption varied from 24.5 to 179.8 mg day- 1/1000 inhabitants. Complementary qualitative investigation of new psychoactive substances was monitored for the first time for an African country, examining the occurrence of 33 NPS in wastewaters samples. Out of 33 totals screened NPS across all sampling sites, 16 were tentatively identified with this approach. The 16 detected NPS covered most of the representative and used molecules of different NPS classes; including synthetic opioids, synthetic cathinones, amphetamines derivatives and synthetic cannabinoids.

Contrasting cardiovascular mortality trends in Eastern Mediterranean populations: Contributions from risk factor changes and treatments.

BACKGROUND: Middle income countries are facing an epidemic of non-communicable diseases, especially coronary heart disease (CHD). We used a validated CHD mortality model (IMPACT) to explain recent trends in Tunisia, Syria, the occupied Palestinian territory (oPt) and Turkey. METHODS: Data on populations, mortality, patient numbers, treatments and risk factor trends from national and local surveys in each country were collated over two time points (1995-97; 2006-09); integrated and analysed using the IMPACT model. RESULTS: Risk factor trends: Smoking prevalence was high in men, persisting in Syria but decreasing in Tunisia, oPt and Turkey. BMI rose by 1-2 kg/m(2) and diabetes prevalence increased by 40%-50%. Mean systolic blood pressure and cholesterol levels increased in Tunisia and Syria. Mortality trends: Age-standardised CHD mortality rates rose by 20% in Tunisia and 62% in Syria. Much of this increase (79% and 72% respectively) was attributed to adverse trends in major risk factors, occurring despite some improvements in treatment uptake. CHD mortality rates fell by 17% in oPt and by 25% in Turkey, with risk factor changes accounting for around 46% and 30% of this reduction respectively. Increased uptake of community treatments (drug treatments for chronic angina, heart failure, hypertension and secondary prevention after a cardiac event) accounted for most of the remainder. DISCUSSION: CHD death rates are rising in Tunisia and Syria, whilst oPt and Turkey demonstrate clear falls, reflecting improvements in major risk factors with contributions from medical treatments. However, smoking prevalence remains very high in men; obesity and diabetes levels are rising dramatically.