:  The persistence of Giardia, Cryptosporidium, Rotavirus, and Adenovirus in samples of raw and treated sewage collected monthly in 2010 at the Biological Wastewater Treatment Plant of Ribeirão Preto, SP, Brazil, was analyzed. The USEPA Method 1623 was used to detect and quantify Giardia and Cryptosporidium. An enzyme immunoassay was carried out to test Rotavirus and Adenovirus antigen optical density (Rotascreen® and Adenoscreen®). The results show a significant decrease in the concentrations of Giardia, Rotavirus and Adenovirus (P < 0.05) and a trend of decreasing Cryptosporidium densities, without statistical significance. Giardia concentrations ranged from 120 to 2,200 cysts/L in raw sewage and from 0.45 to 3.5 cysts/L in treated sewage. Cryptosporidium concentration ranged from undetectable to 28.9 oocysts/L in raw sewage and undetectable to 1.05 oocysts/L in treated sewage. Rotavirus presented absorbance values that ranged from 1.17 ± 0.81 in raw sewage to 0.46 ± 0.32 in treated sewage. Adenovirus, in turn, presented absorbance values of 0.64 ± 0.20 in raw sewage and of 0.45 ± 0.04 in treated sewage. There was no significant seasonal tendency observed in the distribution of protozoa (oo)cysts and in the viral antigen density in the monthly sewage samples during 2010 (P > 0.05). Even though these pathogenic agents decreased after treatment, the remaining loads observed in treated sewage can reach the watercourses receiving it. Giardia, Cryptosporidium, Rotavirus, and Adenovirus are pathogens with very low infectious doses, representing a public health risk especially for vulnerable groups, such as children living near these watercourses and homeless people using this water for various purposes. Studies addressing the environmental persistence of opportunistic pathogens in watercourses are hugely important in the public health sphere, especially in developing countries, where economic, social, cultural, and environmental factors still persist that are favorable to population's exposure to diarrhea-causing agents.

Mixture of metals and herbicides in rivers may pose relevant risks for the health of surrounding communities. Humans may be exposed to river pollution through intake of contaminated water and fish, as well as irrigated agricultural products. The aim of this study was to assess the human health risks of environmental exposure to metals and herbicides through water and fish intake in the Pardo River. Metals (Al, As, Be, Cd, Cr, Cu, Pb, Mn, Hg, Ni, Tl, Sn, V, and Zn) were analyzed in river water and in edible fish. Herbicides (ametryn, atrazine, diuron, hexazinone, simazine, and tebuthiuron) were analyzed in river water. Seasonal variances were also studied. Aluminum, Cd, Cu, Mn, Pb, and Zn levels in river water were higher than the USEPA benchmarks. Non-carcinogenic risks due to pollutants mixture exposure were above the limit, and carcinogenic risks of As exposure were >10 in the sampling points during the rainy season. Metal levels in fish were lower than the Brazilian legislation and do not pose a threat to public health. Herbicides were detected in four sampling points, with atrazine concentrations (range 0.16-0.32 μg/L) below the Brazilian standard (2.0 μg/L), but above the European Union standard (0.1 μg/L). Considering the water supply needs of cities located in the Pardo River Basin and the persistence of metals and herbicides, the present study indicated that there was a seasonal influence on non-carcinogenic and carcinogenic risks to human health, especially in the rainy season. Studies for water treatment plants implantation should consider the risks of exposure to persistent substances, in order to protect the population.

ResumoAs doenças de veiculação hídrica causadas por protozoários oportunistas re-emergiram como relevantes problemas de saúde pública nos últimos anos, apesar dos avanços tecnológicos nos processos de tratamento de água. Nesse marco, Cryptosporidium e Giardia são agentes que apresentam (oo)cistos resistentes ao tratamento convencional de água e se caracterizam por causar sérias morbidades em indivíduos imunocomprometidos. No Brasil, o controle de Cryptosporidium e Giardia em água por técnicas específicas e sensíveis ainda está pouco difundido. O presente estudo visou analisar criticamente as evidências científicas sobre a contaminação da água de abastecimento público por Cryptosporidium e Giardia. Realizou-se uma revisão sistemática da literatura produzida entre 2001 e 2011 nas bases de dados PUBMED e LILACS. A partir dos resultados obtidos, verificou-se uma distribuição cosmopolita desses parasitas disseminados em diferentes fontes de água tratada, representando um potencial risco para a saúde pública e um desafio para a vigilância ambiental, considerando a especificidade e alto custo das técnicas analíticas reconhecidas internacionalmente para análise desses patógenos em água. Palavras-chave:Cryptosporidium. Giardia. Água Potável. AbstractWater-borne diseases caused by opportunistic protozoa re-emerged as an important public health problem in recent years, despite technological advances in water treatment processes. In this context, agents such as Cryptosporidium and Giardia produce (oo)cysts resistant to conventional water treatment and can cause serious cases of morbidity in immunocompromised individuals. In Brazil, water control by specific and sensitive techniques aimed at detecting Cryptosporidium and Giardia still is not widespread. The aim of this study was to do a critical analysis of the scientific evidence on the contamination of public water supplies by Cryptosporidium and Giardia. We did a systematic review of the literature produced from 2001 to 2011 in PUBMED and LILACS databases. From the results, we find a cosmopolitan distribution of these parasites in different sources of treated water, representing a risk to public health and a challenge for environmental monitoring, considering the specificity and high cost of internationally recognized analytical techniques for identifying these pathogens in water. Keywords

This study's objective was to analyze Brazilian and international scientific evidence on the reasons people store medication at home and the disposal methods used. This systematic literature review includes studies published from 2001 to 2016 and indexed in PubMed, Lilacs and Elsevier's Scopus Database, using the following key words: Disposal of medicines in household, Disposal of drugs expired, Residential expired drugs, Management of expired medications in household. Thirty-three studies were selected after applying inclusion and exclusion criteria. The studies reveal that the main reasons people keep a stock of medicines at home include the possibility of future use, leftovers from previous treatments, and self-medication. Inappropriate disposal methods prevail, such as throwing medicines in the household trash or flushing them into the sewer. Some countries have adopted programs to educate on proper storage and disposal of medicines, though only one study describes a national program guiding these practices that is free of charge. Evidence shows there is a need to implement public policies intended to provide guidance on the proper storage and disposal of medicines at home.

Latin America, Africa, and Asia present wide dissemination and high prevalence rates of waterborne parasitic diseases, which is a strong indicative of the fragility of public sanitation systems. In this context, parasitological analyses represent extremely relevant instruments. Several parasite diagnosis methods exist, among which Ritchie's method (1948) stands out. This method uses formaldehyde and ether, two reagents of toxicological importance that can cause damages to environmental and occupational health. The present study aimed to compare Ritchie's method modified by Régis Anécimo, without use of solvents, with the traditional Ritchie's method, routinely used for helminth and protozoa diagnosing in Brazil. Some changes were introduced in the modified method, such as controlled increase of water temperature used after stool dilution and substitution of formaldehyde and ether by a neutral detergent before material centrifugation for observation of parasites. In examined samples by both methods, multiple infections were commonly observed; the modified method presented a similar sensitivity to identify the parasites. The development of analytic diagnosis methods that minimize the use of chemical products like ether and formaldehyde represents an important tool to prevent occupational diseases among exposed professionals, as well as to preserve environmental quality through the use of clean techniques.

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Contamination by metals and microbiological agents in hemodialysis water can cause clinical intercurrences in hemodialysis patients. Evaluating and assuring minimum levels of contamination from metals and microorganisms in hemodialysis water can improve patient safety. The objective of this study was to assess hemodialysis water quality in a major tertiary hospital in Brazil and investigate the relationship between hemodialysis water quality and clinical intercurrences in hemodialysis patients. A prospective-observational cohort study for evaluation of water quality parameters and clinical intercurrences present by patients (n = 52) were performed from May 2014 to April 2015. Mixed linear regression models and binary regression models were fitted for water quality parameters and patients' clinical parameters. The increase in the levels of copper and nitrate in hemodialysis water was significant (p < 0.05) to explain anemia. Bone pain was related to age, sex (female), and hemodialysis treatment duration (years). Hypotensive episodes were related to serum sodium decrease. Aluminum in hemodialysis water was present in an average concentration higher than the permitted threshold (15.35 ± 14.53 μg/L). Cadmium, total coliforms, Escherichia coli, and endotoxins in hemodialysis water were not detected and the heterotrophic bacteria count was below the reference limit. These parameters' concentrations varied during the study, evidencing the need for continuous monitoring.

Located in the southeast of Brazil, the Pardo River Basin has a large population and an economy focused on agriculture, with a strong predominance of the sugarcane agro-industry. The purpose of the study was to assess the water quality of the Pardo River Basin under a multivariate approach using limnological parameters, metal concentrations, and indicator bacteria. Nine sampling campaigns were performed during both the dry and rainy seasons. Element concentrations were determined by inductively coupled plasma spectrometry (ICP-MS, Perkin Elmer Elan 6000). A battery of test to determine limnological parameters was performed (in situ). Total coliforms and Escherichia coli were detected and quantified using Defined Substrate Technology Colilert and multiple tube dilutions. Principal component analysis and hierarchical cluster analysis were used as multivariate exploratory analysis. In general, the results suggest the influence of rain, possible sewage discharges into the watercourse, and the input of organic matter in some sampling points in both seasons, besides the absence of riparian vegetation in much of the Pardo River. The likely influence of industrial activities that do not have great prominence in the region was supported by temporal/spatial assessment of Cr and V. The water quality monitoring of Pardo River is an important tool for environmental management, and its continuity is indicated to obtain a consistent series of systematic data and thereby support concretely the actions of planning and controlling the use of water from the Pardo River and soil around them.