Mercury Exposure and Toxicological Consequences in Fish and Fish-Eating Wildlife from Anthropogenic Activity in Latin America.

Despite the risk of significant adverse toxicological effects of Hg to humans and wildlife, Hg use in anthropogenic activities, and artisanal small-scale gold mining (ASGM) in particular, is widespread throughout Latin America. However, there are few research and monitoring studies of Hg toxicity in fish and fish-eating wildlife in Latin America compared to North America. In the present paper, we reviewed the literature from published articles and reports and summarized and assessed data on Hg in fish from 10 391 individuals and 192 species sampled across Latin America. We compared fish Hg levels with toxicity reference values (TRVs) for fish and dietary TRVs for fish-eating wildlife. We determined that fish, piscivorous birds, and other wildlife are at risk of Hg toxicity. We observed a large disparity in data quantity between North and Latin America, and identified regions requiring further investigation. In particular, future biomonitoring and research should focus on exposure of wildlife to Hg in Peru, Chile, Uruguay, the eastern and northern regions of Brazil, Venezuela, Ecuador, and Colombia. We also discuss Hg risk assessment methodological issues and recommend that future evaluations of Hg risk to wildlife must collect key physiological variables, including age, body size, and ideally Hg-to-Se molar ratios. Integr Environ Assess Manag 2021;17:13-26. © 2020 Environment and Climate Change Canada. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Cardiovascular Outcomes in Young Adulthood in a Population-Based Very Low Birth Weight Cohort.

OBJECTIVES: To assess differences in left heart structure and function, and endothelial function in a national cohort of very low birth weight (VLBW) young adults and term-born controls. STUDY DESIGN: The New Zealand VLBW study is a prospective, population-based, longitudinal cohort study which included all infants born <1500 g in 1986. The VLBW cohort (n = 229; 71% of survivors) and term-born controls (n = 100), were assessed at age 26-30 years. Measures of left heart structure and function were evaluated by echocardiography, vascular function was assessed using blood pressure, reactive hyperemia index, and arterioventricular coupling by calculating left ventricular (LV) and arterial elastance. RESULTS: Compared with controls, those born VLBW had smaller LVs, even when indexed for body surface area (mean LV mass, 89.7 ± 19.3 g/m2 vs 95.0 ± 22.3 g/m2 [P = .03]; LV end-diastolic volume, 58.3 ± 10.9 mL/m2 vs 62.4 ± 12.4 mL/m2 [P = .002]; and LV end-systolic volume, 20.8 ± 4.9 mL/m2 vs 22.6 ± 5.8 mL/m2 [P = .004]). VLBW participants had lower stroke volume (median, 37.2 mL/m2 [IQR, 33-42 mL/m2] vs median, 40.1 mL/m2 [IQR, 34-45 mL/m2]; P = .0059) and cardiac output (mean, 4.8 ± 1.2 L/min vs 5.1 ± 1.4 L/min; P = .03), but there was no difference in ejection fraction. The VLBW group had higher LV elastance (3.37 ± 0.88 mm Hg/mL vs 2.86 ± 0.75 mm Hg/mL; P < .0001) and arterial elastance (1.84 ± 0.4 vs 1.6 ± 0.4; P < .0001) and lower reactive hyperemia index (0.605 ± 0.28 vs 0.688 ± 0.31; P = .041). These measures were influenced by birth weight and sex, but we found limited associations with other perinatal factors. CONCLUSIONS: Being born preterm and VLBW is associated with differences in cardiovascular structure and function in adulthood. This population may be more vulnerable to cardiovascular pathology as they age. TRIAL REGISTRATION: Australian Clinical Trials Registry ACTRN12612000995875.

Mercury in Forage Fish from Mexico and Central America: Implications for Fish-Eating Birds.

Mercury (Hg) is a global contaminant of aquatic food chains. Aquatic birds, such as the osprey (Pandion haliaetus), with migratory populations breeding in Canada and the northern United States and wintering in the Central and South America, can be exposed to mercury on both the breeding and wintering ranges. We examined Hg levels in 14 fish taxa from 24 osprey wintering sites identified from satellite telemetry. Our main goal was to determine whether fish species that feature in the diet of overwintering and resident fish-eating birds reached toxicity thresholds for Hg. Mean Hg levels in fish whole carcasses ranged from a high of 0.18 µg g(-1) (wet weight) in Scomberomorus sierra to a low of 0.009 µg g(-1) in Catostomidae. Average Hg levels were within published toxicity threshold values in forage fish for only two sites in Mexico (Puerto Vallarta and San Blas Estuary), and all were marine species, such as mackerel (Scomberomorus sierra), sea catfish (Ariopus spp.), and sardinas species (Centropomus spp.). Except for one sample from Nicaragua, sea catfish from Puerto Morazan, none of the fish from sites in Central America had Hg levels which exceeded the thresholds. Nonmetric multidimensional scaling revealed geographical differences in Hg levels with significant pairwise differences between sites along the Pacific Ocean (Mexico) versus the Bay of Campeche, partly due to differences in species composition of sampled fish (and species distributions). Hg increased with trophic level, as assessed by nitrogen stable isotope ratios (δ(15)N but not δ(13)C), in freshwater and marine, but not estuarine, environments. Hg concentrations in forage fish do not account for the elevated Hg reported for many osprey populations on the breeding grounds, thus primary sources of contamination appear to be in the north.

Risk stratification in the setting of non-ST elevation acute coronary syndromes 1999-2007

It is unclear if clinician risk stratification has changed with time. The aim of this study was to assess the temporal change in the concordance between patient presenting risk and the intensity of evidence-based therapies received for non-ST-segment elevation acute coronary syndromes over a 9-year period. Data from 3,562 patients with non-ST-segment elevation acute coronary syndromes enrolled in the Australian and New Zealand population of the Global Registry of Acute Coronary Events (GRACE) from 1999 to 2007 were analyzed. Patients were stratified to risk groups on the basis of the GRACE risk score for in-hospital mortality. Main outcome measures included in-hospital use of widely accepted evidence-based medications, investigations, and procedures. Invasive management was consistently higher in low-risk patients than in intermediate- or high-risk patients (coronary angiography 66.7% vs 63.5% vs 35.3%, p <0.001; percutaneous coronary intervention 31.1% vs 22.0% vs 12.9%, p <0.001). Absolute rates of angiography and percutaneous coronary intervention in the high-risk group remained 24% and 15% lower compared to the low-risk group in the most recent time period (2005 to 2007). In-hospital use of thienopyridine, low-molecular weight heparin, and glycoprotein IIb/IIIa inhibitors showed a similar inverse relation with risk. Prescription of aspirin, â blockers, statins, and angiotensin receptor blockers was inversely related to risk before 2004, although this inverse relation was no longer present in the most recent time period (2005 to 2007). Only in-hospital use of unfractionated heparin showed use concordant with patient risk status. In conclusion, despite an overall increase in the uptake of evidence-based therapies, most investigations and treatments are not targeted on the basis of patient risk. Clinician risk stratification remains suboptimal compared to objective measures of patient risk.

Invasive pneumococcal infections in children with sickle cell disease in the era of penicillin prophylaxis, antibiotic resistance, and 23-valent pneumococcal polysaccharide vaccination.

Rates and severity of pneumococcal infections in children with sickle cell disease were examined before licensure of pneumococcal-conjugated vaccine (PVC). Rates of peak invasive infection rates in 1-year-old children with hemoglobin SS and mortality in those 0 to 10 years of age were 36.5 to 63.4 and 1.4 to 2.8 per 1000 person-years, respectively (>10 and 100 times as frequent as in the general population). Overall, 71% of serotyped isolates (n=80) were PVC serotypes and 71% of nonvaccine serotype strains were penicillin-sensitive. Clinical presentation in children with hemoglobin SS (n=71; more with hypotension) and hemoglobin SC (n=18; more with acute chest syndrome, otitis media) differed. Penicillin nonsusceptibility (38% of isolates) varied between geographic study sites. Penicillin prophylaxis appeared less effective against intermediate and resistant strains. Of all infected children, meningitis developed in 20% and 15% died (hemoglobin SS, n=15 and 11; hemoglobin SC, n=1 each). Factors associated with death included age >4 years (58%), serotype 19F, and not being followed by a hematologist (42% each). The pneumococcal-polysaccharide vaccine was 80.4% effective within 3 years after vaccination (95% CI, 39.7, 93.6). Children with sickle cell disease of all ages may benefit from PVC boosted with polysaccharide vaccination.

Six-month multicenter study on invasive infections due to group B streptococci in Argentina.

There is little information about invasive infections by group B streptococci (GBS) and their antimicrobial susceptibilities in Latin America. We performed a prospective multicenter study to determine the serotype distribution and the antimicrobial susceptibility of GBS in Argentina. We identified 58 cases, but only 44 had sufficient data to be evaluated. Eight early-, four late-, and one fatal late, late-onset neonatal infections due to GBS were found. A total of 31 patients were adults with bacteremia, skin and soft tissue infections, osteomyelitis, arthritis, meningitis, abdominal infections, and renal abscess. Serotype III was prevalent in late-onset neonatal disease, and several serotypes (Ia/c, III, Ia, and II) were involved in early-onset neonatal infections. Serotypes II, Ia/c, III, and IV were commonly found in adults, with serotype II prevalent in younger adults (18 to 69 years old) and serotype Ia/c prevalent in elderly adults (>70 years old). The mortality rate attributable to GBS infections was 10.8%. All GBS were susceptible to penicillin and ceftriaxone. Resistance to clindamycin (1.7%), erythromycin (5.2%), azithromycin (5.2%), minocycline (69%), and tetracycline (72.4%), to high levels of kanamycin and amikacin (1.7%), and to intermediately high levels of gentamicin (1.7%) was observed. The bifunctional enzyme AAC6'-APH2" was detected in the isolate resistant to aminoglycosides, and other genetic determinants were identified in other resistant isolates: tetM and tetO in tetracycline-resistant streptococci and mefA and ermTR for efflux-mediated and inducible macrolide-lincosamide-streptogramin B-resistant streptococci, respectively. For clinical purposes and rapid and easy detection of high-level aminoglycoside-resistant GBS, a screening method that used 1,000- micro g kanamycin disks is proposed.