Long-term ongoing impact of arsenic contamination on the environmental compartments of a former mining-metallurgy area.

Arsenic and mercury are potentially toxic elements of concern for soil, surficial and ground waters, and sediments. In this work various geochemical and hydrogeological tools were used to study a paradigmatic case of the combined effects of the abandonment of Hg- and As-rich waste on these environmental compartments. Continuous weathering of over 40years has promoted As and Hg soil pollution (thousands of ppm) in the surroundings of a former Hg mining-metallurgy site and affected the water quality of a nearby river and shallow groundwater. In particular, the high availability of As both in soils and waste was identified as one of the main determinants of contaminant distribution, whereas the impact of Hg was found to be minor, which is explained by lower mobility. Furthermore, potential additional sources of pollution (coal mining, high natural backgrounds, etc.) discharging into the study river were revealed less significant than the contaminants generated in the Hg-mining area. The transport and deposition of pollutants within the water cycle has also affected several kilometres downstream of the release areas and the chemistry of stream sediments. Overall, the environmental compartments studies held considerable concentrations of Hg and As, as remarkably revealed by the average contaminant load released in the river (several tons of As per year) and the accumulation of toxic elements in sediments (enrichment factors of As and Hg above 35).

Sources of mercury in groundwater and soils of west Gijón (Asturias, NW Spain).

This work aimed to determine the cause of the presence of high concentrations of mercury in several springs that exhibit a low concentration of metals in the bedrocks of their recharge areas in Gijón, NW Spain and the extent of this contamination. On the basis of geological mapping, different lithological substrata were analysed at the regional scale with the objective of establishing the base level of mercury in natural soils. The mercury content was simultaneously analysed in several water samples, and the following parameters were also determined: major anions and cations, As, Pb, δ(34)S, and δ(18)OSO4. The soils of the recharge area of the springs exhibited Hg concentrations that were higher than the base level established for sandstone at the regional level, and four of the total number of springs analysed exhibited Hg concentrations higher than 1 µg/l. In addition, the sulphate concentration exceeded the values that this type of aquifer shows in other parts of the region. A comparison between the regionally geochemical background of soils and mercury concentration in springs and soils of the study area did not exhibit a direct relationship, suggesting an anthropogenic and timely origin (most likely from industrial emissions) for this metal. The δ(34)S and δ(18)OSO4 values of dissolved sulphate from the springs with a higher Hg concentration also indicate an anthropogenic origin.

[Analysis of the results of treatment of obesity in the hospital outpatient department]. / Análisis de los resultados del tratamiento de la obesidad en consultas externas de un hospital.

The results obtained in the treatment of obesity in the out patient department of the Nutrition Unit of "La Paz" hospital during the first 6 years of experience were analyzed. To this end, different aspects of the treatment of obesity were studied in a successive manner. The first approach prospectively compared the results obtained with individual or group health care education (HCE); with no statistically significant differences being found. Before analyzing the results obtained with the different treatments, one notes a high rate of abandonment (65%). One sees that the global weight lost is statistically significant (7%). The amount of weight los differs depending on the degree of obesity (measured by the Body Mass Index): grade I and II obesities lost the same percentage of weight (7%), grade III lost 8% and grade IV is the grade that loses the most, 12%. Keeping in mind the treatment modality used, the results are as follows: both the diet alone and the diet in association with health care education in a group, achieve a weight loss of 7%, modified fasting yields 6%, adding drugs to the diet achieves a loss of 11% and the most effective is bariatric surgery with a loss of 18%.

[Evaluation of the cost of home enteral nutrition in relation to different access routes]. / Evaluación del coste de la nutrición enteral domiciliaria con relación a diferentes vías de acceso.

UNLABELLED: When home enteral nutrition is needed, there is still, despite the undisputed increase in the quality of life that can be achieved with a Percutaneous Endoscopic Gastrostomy (PEG), a reservation in its use because this technique and its maintenance is considered to be very costly. We aim to assess the true cost of home enteral nutrition using the oral route, a nasogastric tube, and PEG. PATIENTS AND METHODS: The data of 65 patients who required home enteral nutrition during 1996, were analyzed retrospectively. The access route was a nasogastric tube in 20 cases, 18 patients had PEG, and 27 candidates used an oral route. The average age was 56 years. 50% were men and 50% were women. The most common diagnoses that led to the indication were oropharyngeal-maxillofacial neoplasms and neurological disorders. In all cases the material and formula used was assessed, as were the associated complications and the cost of the at home enteral nutrition. RESULTS: The average duration of the treatment was 175 +/- 128 days, and this was similar in all three groups. The average formula/day cost was slightly higher in the patients using the oral access route. The average total day cost and the average material/day cost was slightly higher in patients with a PEG. Patients with a PEG presented fewer complications than those with a nasogastric tube. The cost derived from possible complications must be higher in the nasogastric tube group, especially considering the repeated tube changes due to obstruction or loss. CONCLUSIONS: The cost of home enteral nutrition is slightly lower if one uses a nasogastric tube. The greater incidence of complications that were mild but required a tube change, in this case a nasogastric tube, suggests higher indirect costs. The oral route is associated with the need for special formulae that are more expensive.

[Results of nutritional treatment of anorexia nervosa: our experience (1989-1995)]. / Resultado del tratamiento nutricional de la anorexia nervosa: nuestra experiencia (1989-1995).

With the alm of evaluating the nutritional treatment of anorexia nervosa (AN) in our center, evolutive data were collected, as well as anthropometric and biochemical parameters, of out out patient department (OPD) as well as of our hospital admissions (HA) which took place between 1989-91 (period A) and between 1992-95 (period B). 79 cases of HA were included (5 men, 31 women), with a duration of hospitalization of 36.96 +/- 22.02 days, with the reason for release most often (86.84%) being reaching the agreed upon weight, and 124 cases of OPD (12 men and 112 women), who were followed for 11.53 +/- 12.13 months achieving a final release rate of 14.14%. The nutritional status (NS) of the HA patients upon admission was most often sever caloric malnutrition (CM) (64.55%), and upon release this was moderate CM (60.75%), while in the OPD the moderate CM was most frequent at the initial visit and at the last visit registered. The anthropometric parameter which was most affected, was the triceps fold (TF), followed by the wight (W). The biochemical abnormalities were few, with hypercholesterolemia and ferropenia being notable. The nutritional treatment in the OPD required the addition of dietary supplements in 31% of the cases, and of psycho-medication in 43%. In the HA cases, only 6 patients reached the agreed upon wight with a free oral diet, and 35 patients required dietary supplements, 20 needed mixed therapy (enteral nutrition and supplements), and 17 cases required enteral nutrition through a naso-gastric tube. Significant multivariant models are presented which find independent associations for the probability of release (lower age upon diagnosis, male, lower income, absence of bulimia's, no need for dietary supplements), of amenorrhoea (worse NS, absence of vomiting), and for the HA time (more interventionist treatment, lower weight, lower age). The comparison between periods, shows an initial contact of the patients with AN with our OPD, with a better nutritional status y recent years, as well as a better nutritional result, a greater tendency towards the use of enteral nutrition, and a shorter time of HA.

Thyroid autoimmune disorders in patients with chronic hepatitis C before and during interferon-alpha therapy.

BACKGROUND AND AIMS: Hepatitis C virus is involved in the induction of autoimmunity and interferon can also induce hepatic and non-hepatic autoimmune reactions. This study assessed the prevalence of thyroid autoantibodies and autoimmune thyroid disorders in patients with chronic hepatitis C before and during interferon therapy. PATIENTS AND METHODS: We studied prospectively 207 patients positive for anti-HCV and viral RNA. One hundred and forty-four of them received a therapeutic trial of one year with interferon-alpha. Free thyroxine, TSH and autoantibodies to thyroglobulin and thyroid microsomes were systematically tested at entry and at weeks 12 and 24 in both untreated and treated patients. RESULTS: Sixteen of the 207 patients (7.7%) had thyroid dysfunction, including positive antithyroid antibodies in 14 (6.7%) and hypothyroidism in 10 (4.8%) prior to interferon therapy. In addition, during pretreatment evaluation one patient developed clinical hyperthyroidism after transient subclinical hypothyroidism and another had subclinical hyperthyroidism. Prevalences of positive antithyroid antibodies and hypothyroidism were significantly higher in women (14.7 and 10.5%, respectively, vs 0% in men, P < 0.01) and were directly associated with increasing age (P < 0.01). The incidence of thyroid dysfunction was also significantly higher in patients with other autoantibodies such as anti-nuclear (ANA) (P < 0.01). A trial with interferon was initiated in 144 patients and 8 of 142 (5.6%) without previous thyroid abnormalities developed thyroid dysfunction, including positive antithyroid antibodies in 7 (4.9%) and hypothyroidism in 4 (2.8%) with a prevalence again significantly higher in women (12.7 and 8.3%, respectively, vs 1% in men, P < 0.01) and also directly related to increasing age (P < 0.01). An association was found between the development of thyroid dysfunction during interferon therapy and the presence of other autoantibodies, including ANA, anti-DNA and anti-Sjögren's antibodies (P < 0.01), as well as with the induction of autoimmune hepatitis and Sjögren's syndrome (P < 0.01 and < 0.05 respectively). Thyroid abnormalities were reversed in all patients when interferon therapy was discontinued. CONCLUSIONS: No significant association was found between chronic hepatitis C and the presence of thyroid autoimmunity in female patients. On the contrary, interferon therapy induced antithyroid autoantibodies and thyroid dysfunction de novo in patients with chronic hepatitis C without pre-existing thyroid abnormalities. Thyroid dysfunction secondary to interferon was reversible after discontinuation of therapy.