The concentrations of Cd, Cr, Cu, Hg, Mn, Ni, Pb, Sn, and Zn were determined in breast milk of women living in Conceição das Alagoas, Minas Gerais, Brazil. The potential relationships between metal levels in samples of breast milk, drinking water, and soils collected in the study area were also established. Metal levels in breast milk, except Cr, were lower in comparison to WHO reference concentrations. Zinc was the predominant element in breast milk and drinking water samples, with a median level of 46.2 and 82.2 μg · L(-1), respectively. Soils presented a different pattern of metal concentrations with respect to those found in breast milk and drinking water, Chromium showed the highest median levels (148 mg · kg(-1)), while a certain predominance of Zn and Cu was also observed (47.0 and 43.0 mg · kg(-1), respectively). Similar profiles were observed when comparing metal concentrations in drinking water and breast milk (chi-square χ(2) = 14.36; p < 0.05). In contrast, breast milk-soil and drinking water-soil metal concentration profiles showed significant differences (χ(2) = 635.05 and χ(2) = 721.78, respectively; p < 0.05). These results indicate that drinking water is an important exposure pathway for metals to newborns through breast milk. Further studies should be aimed at assessing the body burdens of metals in that population and at evaluating the potential relationships in the concentrations in biological and environmental matrices as well as at estimating the contribution of dietary intake of metals. In addition, the presence of other chemical pollutants in breast milk should be also studied in order to assess the combined newborn exposure to other contaminants.

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.

There is a growing need for strategic assessment of environmental conditions in river basins around the world. In spite of the considerable water resources, Brazil has been suffering from water quality decrease in recent years. Pardo River runs through Minas Gerais and São Paulo, two of the most economically important states in Brazil, and is being currently promoted as a future drinking water source. This study aimed at integrating three different tools to conduct a hydromorphological assessment focused on the spatial complexity, connectivity, and dynamism of the Pardo River, Brazil. Twelve sampling stretches were evaluated in four sampling campaigns, in dry and rainy seasons. In each stretch, permanent preservation areas (PPAs), hydromorphological integrity by rapid assessment protocol (RAP), and physicochemical parameters were qualified. The kappa coefficient was used to assess statistical agreement among monitoring tools. The PPA analysis showed that in all stretches, the vegetation was modified. RAP results revealed environmental deterioration in stretches located near human activities and less variability of substrates available for aquatic fauna and sediment deposition as well. Low values for dissolved oxygen in the river mouth were noted in the rainy season. Electrical conductivity was higher in stretches near sugarcane crops. The poor agreement (k<0.35) between the RAP and physicochemical parameters indicates that the tools generate different and complementary information, while they are not replaceable. Potential changes of the hydromorphological characteristics and variations in physicochemical indicators must be related to extensive PPA modification.

Introduction: Emergent and re-emergent waterborne protozoans have become a worldwide public health problem, especially among vulnerable groups. Methods: This cross-sectional study evaluated 17 HIV-infected children and their families. Results: A high (76.5%) percentage of parasite-infected children was observed, even among children with CD4 + T-cell counts of >200 cells/mm 3 . Giardia spp., Cryptosporidium spp. and Cyclospora spp. were observed in 41.2% of these children. Low income, poor hygiene practices, and co-infection in domestic, peridomestic and scholastic environments were signifi cant sources of these intestinal infections. Conclusions: Early diagnosis, timely treatment, and socio-educational interventions may improve the health conditions of this vulnerable population.

na pessoa do Prof. Dr. José Abrão Cardeal da Costa, chefe da Unidade de Diálise, que generosamente abriu suas portas para a execução deste projeto de pesquisa. À Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes), pela bolsa concedida. À minha querida orientadora, Profa. Dra. Susana Segura-Muñoz, por me guiar na concepção e execução deste trabalho, por sempre estar de braços abertos como orientadora, mãe e amiga, pessoa que levarei para sempre no coração. Ao meu esposo Adriano, pelo amor e paciência, por lidar com minhas angústias sempre com muito zelo, e por sua valiosa contribuição nas análises estatísticas. À minha irmã Adriana, por abrir sua casa com muito amor e me acolher durante todo o doutorado. À toda a minha família, que sempre me apoiou e incentivou. À biomédica Tânia Maria Beltramini Trevilato, do Laboratório de Pediatria, Setor de Metais do HCFMRP/USP, que desde sempre me auxiliou nas análises de metais, e acolheu com muito amor e carinho em todos os momentos. Ao biomédico Marcos e às aprimorandas Aline e Camila do Laboratório de Pediatria, Setor de Metais do HCFMRP/USP, pela receptividade e contribuição na padronização da técnica de análise de alumínio em sangue. Ao Prof. Dr. José Abrão Cardeal da Costa, chefe da Unidade de Diálise do HCFMRP/USP, pela disponibilidade, por sua extrema simpatia e pelas preciosas contribuições no Exame de Qualificação. À Profa. Dra. Luciana Kusumota da EERP/USP, pelo auxílio na revisão dos questionários e pelas preciosas contribuições no Exame de Qualificação.