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Background: Individual extracerebral organ dysfunction is common after severe traumatic brain injury (TBI) and impacts outcomes. However, multiorgan failure (MOF) has received less attention in patients with isolated TBI. Our objective was to analyze the risk factors associated with the development of MOF and its impact in clinical outcomes in patients with TBI. Methods: This was an observational, prospective, multicenter study using data from a nationwide registry that currently includes 52 intensive care units (ICUs) in Spain (RETRAUCI). Isolated significant TBI was defined as Abbreviated Injury Scale (AIS) ≥ 3 in the head area with no AIS ≥ 3 in any other anatomical area. Multiorgan failure was defined using the Sequential-related Organ Failure Assessment as the alteration of two or more organs with a score of ≥ 3. We analyzed the contribution of MOF to crude and adjusted mortality (age and AIS head) by using logistic regression analysis. A multiple logistic regression analysis was performed to analyze the risk factors associated with the development of MOF in patients with isolated TBI. Results: A total of 9790 patients with trauma were admitted to the participating ICUs. Of them, 2964 (30.2%) had AIS head ≥ 3 and no AIS ≥ 3 in any other anatomical area, and these patients constituted the study cohort. Mean age was 54.7 (19.5) years, 76% of patients were men, and ground-level falls were the main mechanism of injury (49.1%). In-hospital mortality was 22.2%. Up to 185 patients with TBI (6.2%) developed MOF during their ICU stay. Crude and adjusted (age and AIS head) mortality was higher in patients who developed MOF (odds ratio 6.28 [95% confidence interval 4.58–8.60] and odds ratio 5.20 [95% confidence interval 3.53–7.45]), respectively. The logistic regression analysis showed that age, hemodynamic instability, the need of packed red blood cells concentrates in the initial 24 h, the severity of brain injury, and the need for invasive neuromonitoring were significantly associated with MOF development. Conclusions: MOF occurred in 6.2% of patients with TBI admitted to the ICU and was associated with increased mortality. MOF was associated with age, hemodynamic instability, the need of packed red blood cells concentrates in the initial 24 h, the severity of brain injury, and the need for invasive neuromonitoring. [ABSTRACT FROM AUTHOR]

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Abstract: In semiarid regions, reclaimed water can be an important source of emerging pollutants in groundwater. In Gran Canaria Island, reclaimed water irrigation has been practiced for over thirty years and currently represents 8% of water resources. The aim of this study was to monitor contaminants of emerging concern and priority substances (2008/105/EC) in a volcanic aquifer in the NE of Gran Canaria where the Bandama Golf Course has been sprinkled with reclaimed water since 1976. Reclaimed water and groundwater were monitoring quarterly from July 2009 to May 2010. Only 43% of the 183 pollutants analysed were detected: 42 pharmaceuticals, 20 pesticides, 12 polyaromatic hydrocarbons, 2 volatile organic compounds and 2 flame retardants. The most frequent compounds were caffeine, nicotine, chlorpyrifos ethyl, fluorene, phenanthrene and pyrene. Concentrations were always below 50ngL−1, although some pharmaceuticals and one pesticide, cholrpyrifos ethyl, were occasionally detected at higher concentrations. This priority substance for surface water exceeded the maximum threshold (0.1μgL−1) for pesticide concentration in groundwater (2006/118/EC). Sorption and degradation processes in soil account for more compounds being detected in reclaimed water than in groundwater, and that some contaminants were always detected in reclaimed water, but never in groundwater (flufenamic acid, propyphenazone, terbutryn and diazinon). Furthermore, erythromycin was always detected in reclaimed water (exceeding occasionally 0.1μgL−1), and was detected only once in groundwater. In contrast, some compounds (phenylephrine, nifuroxazide and miconazole) never detected in reclaimed water, were always detected in groundwater. This fact and the same concentration range detected for the groups, regardless of the water origin, indicated alternative contaminant sources (septic tanks, agricultural practices and sewerage breaks). The widespread detection of high adsorption potential compounds, and the independence of concentration with origin and depths, indicates the existence of preferential flows phenomena as potential contamination route in volcanic fractured materials. [Copyright &y& Elsevier]

The province of Jaén counts with four natural parks, numerous rivers, reservoirs and wetlands; moreover, it is probably the region with higher olive oil production in the world, which makes this zone a proper target to be studied based on the European Water Framework Directive 2000/60/CE. The aim of this survey is to monitor a total number of 373 compounds belonging to different families (pesticides, PAHs, nitrosamines, drugs of abuse, pharmaceuticals and life-style compounds) in surface waters located at different points of the province of Jaén. Among these compounds some priority organic substances (regulated by the EU Directive 2008/105/EC) and pollutants of emerging concern (not regulated yet) can be found. A liquid chromatography electrospray time-of-flight mass spectrometry (LC-TOFMS) method covering 340 compounds was developed and applied, together with a gas chromatography triple-quadrupole mass spectrometry (GC-MS/MS) method which enabled the analysis of 63 organic contaminants (30 of these compounds are analyzed by LC-TOFMS as well). From April 2009 to November 2010 a total of 83 surface water samples were collected (rivers, reservoirs and wetlands). In this period numerous organic contaminants were detected, most of them at the ng L(-1) level. The most frequently priority substances found were chlorpyrifos ethyl, diuron and hexachlorobenzene. Within the other groups, the most frequently detected compounds were: terbuthylazine, oxyfluorfen, desethyl terbuthylazine, diphenylamine (pesticide family); fluorene, phenanthrene, pyrene (PAHs group), codeine, paracetamol (pharmaceuticals compounds) and caffeine, nicotine (life-style compounds). As is could be expected, the total concentration of emerging contaminants is distinctly larger than that of priority pollutants, highlighting the importance of continuing with the study of their presence, fate and effects in aquatic environments. However, concentration levels (at the ng per liter level) are low in general for both kinds of contaminants which minimizes the possible harmful effect on the environment., (Copyright © 2014 Elsevier B.V. All rights reserved.)

In Spain, although more than 50% of urban wastewaters are currently being treated, only half of them are subjected to biological treatments and only 3% undergo advanced treatment technologies. Consequently, the application of more exhaustive wastewater treatment protocols, including the use of new and improved technologies, the application of wider and integrated quality control and water reuse strategies are a priority. We have used as a reference, the European Water Framework Directive (WFD; Directive 2000/60/CE), which establishes a framework for Community action in the field of water policy, setting a list of priority compounds to be monitored in water in order to evaluate their levels. The aim of the present study is to develop and validate a multi-residue method for the analysis of 57 multi-class organic contaminants in wastewater samples using gas chromatography coupled to triple quadrupole mass spectrometry and apply it to evaluate the presence of such compounds in different wastewater treatment plants. The proposed method is based on a sample treatment using liquid-liquid extraction with n-hexane followed by identification, confirmation and quantitation with gas chromatography tandem mass spectrometry using a triple quadrupole analyzer operating in the selected reaction monitoring mode. Three MS/MS transitions were selected for unambiguous confirmation of the target chemicals. The method was validated at two different concentration levels (15 and 150 ng L(-1)) obtaining recovery rates in the range 70-110% in most cases. The limits of quantitation obtained for most of the compounds tested were in the low nanogram per liter range (below 3 ng L(-1) in all cases). Treated and untreated effluent wastewater samples of different origin (industrial, coastal and urban) provided by several sewage treatment plants (STPs) located throughout Spain were tested. Results so far showed that most of the samples assayed did not contain large amount of these contaminants. Hexachlorobenzene was found to be the more frequently detected contaminant in the studied samples, although at levels below 5 μg L(-1)., (Copyright © 2013 Elsevier B.V. All rights reserved.)

The presence of 170 pharmaceuticals, personal care products, priority substances according to the 2008/105EU Directive and four metals (Cd, Ni, Hg, Pb) have been investigated at the Llobregat delta, south of Barcelona (Spain). In the area, reclaimed water is destined to satisfy environmental uses, irrigation and the construction of a hydraulic barrier against seawater intrusion in the deep aquifer of the delta. A monitoring survey was undertaken of water samples from a tertiary wastewater treatment plant (Depurbaix), treated waste water with an additional treatment of ultrafiltration, reverse osmosis, and UV disinfection (WWATP, for the hydraulic barrier injection). Groundwater samples from the aquifer receiving recharge were also investigated. The pharmaceutical group of substances was detected in sampled waters at concentrations rarely exceeding a few microg/L, among the compounds Caffeine, Nicotine and Galaxolide (musk fragrance) were found to be present in more than 60% of the samples. Diuron was the only priority substance detected. The four metals were always present in a variable concentration. After the WWATP treatment the majority of analytes are removed from tertiary treated wastewater or their concentration is reduced below 0.1 microg/L. Monitoring revealed a widespread occurrence of analysed compounds in groundwater. Among them Codeine (analgesic), Ibuprofen (anti-inflammatory), Iopamidol, Iopromide (contrast agent) and Paraxanthine (metabolite of caffeine) have only been detected in groundwater, and are not present in water currently being injected in the deep aquifer.