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Red howler monkeys swung from the cables of a footbridge and screeched in the jungle. Herons, snowy egrets, brown pelicans and parakeets darted across the coffee-coloured water and soared over our heads. The river is known as a destination for whitewater rafting. Fishers motoring from the opposite direction gave warnings to Romero about what lay ahead. Romero, a solid man with black-framed spectacles and a pink camouflage shirt, scanned the river and pointed straight ahead. Near the opposite bank, about metres away, three pairs of grey ears flicked, and beady eyes darted above the water line. One raised a gigantic, bulbous head and opened its mouth, exposing a sharp set of canines. You might not expect to encounter wild hippopotamuses, the huge, semiaquatic mammal native to sub-Saharan Africa, in the rivers — and ponds, swamps, lakes, forests and roads — of rural Colombia. Decades ago, Escobar spent part of his vast fortune assembling a menagerie of exotic animals, including elephants, giraffes, zebras, ostriches and kangaroos, at his hacienda outside Doradal, a town about 10 miles west of the Magdalena. Afterward, the hacienda sank into ruin. In , the government seized the property and eventually transferred most of the animals to domestic zoos. But several hippos — most sources say three females and one male — were considered too dangerous to move. The hippos multiplied. Once they reach maturity, female hippos can produce a calf every 18 months, and they can give birth 25 times during a lifespan of 40 to 50 years. Males cast out of the herd by the dominant male migrated elsewhere, started their own herds and took over new territory. As of late , the official government count was Colombian biologists recently predicted that by , if nothing is done to control their breeding, the population will grow to as many as 1, In Africa, hippos are thought to kill about people a year, making them among the most dangerous animals to humans, according to the BBC and other sources. And while, for now, violent encounters in Colombia have been limited, unsettling incidents are increasing. The beasts have attacked farmers and destroyed crops. Last year, a car struck and killed a hippo crossing a highway. Hippos tend to spend daytime hours in the water and move around land at night, adding to a menacing sense of danger striking in the dark. The animal munched on fruit that had fallen from trees before shuffling off to nearby fields. Although nobody was hurt, the incident was widely covered in the Colombian media, increasing pressure on the authorities to do something. The danger is hardly limited to people. For example, a single hippo produces up to 9kg of faeces a day. In Africa, the dung long provided nutrients for fish populations in rivers and lakes, but in recent years, perhaps as a consequence of warming temperatures, water-intensive agriculture and increasing drought, the dung has accumulated to toxic levels in stagnating pools, killing off the same aquatic life that once benefited from it. Experts fear the same thing could happen in Colombia. And competition for food and space could displace otters, West Indian manatees, capybaras and turtles. This bizarre problem is compelling Colombian conservationists to search for unusual solutions, which is one reason I found myself with Mira on the Magdalena, staking out unsuspecting hippos. The procedure, an invasive surgical castration, is medically complicated, expensive and sometimes dangerous for hippos, as well as for the people performing it. After successfully piloting the programme last year, the team sterilised seven hippos in three months — a considerable achievement, but short of the estimated 40 castrations a year that they believe will be necessary to control the population. As we circled the hippos, Romero, the boatman, kept a judicious distance. Mira and I had come, during a hiatus in the castrations, to see for ourselves the growth of the population, but viewing hippos in the wild can be risky. Half an hour into our excursion, the boat engine abruptly died. Romero yanked on the pull cord. The motor responded with a sputter. He yanked again — nothing. With mounting frustration, and sweat pouring down his face, the boatman tugged and pulled the rope. Meanwhile, we drifted towards the hippo pod. The creatures turned toward us, watching. Wilson returned the stare. The drug baron installed a runway, a villa, heliports, aircraft hangars, horse stables, 27 artificial lakes, a dinosaur theme park and a bull ring. He also hired a staff of more than 1, people to run the hacienda. Many more, including the hippos, were procured from other dealers and possibly zoos. Escobar was picky about his animals. Just keeping them fed is a tremendous amount of work. In the early 80s, crowds stood in line for hours in the heat at the hacienda gates, waiting to board electric vehicles and bounce over the property past elephants, ostriches and other wild beasts. Five years after that, an unwitting courier carried a bomb on to a Colombian airliner, which blew up mid-flight, killing all people on board. Rightwing death squads known as autodefensas formed an alliance with drug cartels — offering the cartel members protection in return for a cut of their profits — and declared war on the Revolutionary Armed Forces of Colombia Farc , a Marxist guerrilla group, and its sympathisers. Puerto Triunfo became a centre of the violence, with many people kidnapped and murdered during the late 80s and 90s. After Escobar was shot dead and his property abandoned, the hippos survived on their own, eating the grass, fruits and other plants. Over the years, the population established new pods beyond the hacienda. Reports trickled in that the animals were trampling farmland, attacking cattle and menacing fishing boats. One of his first initiatives was to seek advice from wildlife experts in South Africa, who visited Doradal to investigate. But it took an hour for the tranquilliser to have an effect, by which time the animal had returned to the water. A military helicopter then transported the unconscious beast in a cage back to the hacienda. To contain the hippos, Cornare tried cordoning off the hacienda with bushes, barbed wire and electric fences, but the animals kept finding escape routes. The agency approached zoos in India, the Philippines, Ecuador and other countries about adopting the animals, but the plan was criticised by the Hippo Specialist Group of the International Union for Conservation of Nature IUCN , a Switzerland-based committee of biologists and animal conservationists. Staffers also tried chemically castrating the animals with darts, a procedure used successfully in zoos around the world. But hippos require multiple shots, months apart from each other over two years, and it proved impossible to tag and track the free-ranging animals that had received the first dose. Inside the park near Doradal, they surgically castrated a dozen juvenile hippos, which are more docile and easier to manoeuvre than adults. But that still left an adult population scattered across the Magdalena Basin. The hippos, on seeing us, moved closer to the shore. The population in this lake, where the animals spend the daylight hours, had reached about 50 — the densest concentration outside the park, and became the initial target of the new surgical castration campaign. The team uses a trail of carrots, cabbages and fruit to lure hippos into the enclosure; a spring-trap door then slams shut. Once lured, the animals are shot with tranquilliser darts, allowing the scientists to castrate them where they rest. Cornare observers conduct spot checks every evening, and if they encounter a trapped hippo, they quickly summon the surgical team to the scene. A lejandro Mira got the call to assist in his first surgical castration of a hippo last October. In the predawn darkness last year, Mira arrived at the lakeshore to confront a kg male — relatively junior-sized — pacing inside the enclosure. Then the group waited outside. Mira had castrated many horses, dogs and cats, but this was different from the usual neutering. To verify that the hippo was in a deep state of unconsciousness, a team member tickled his ears. The team donned surgical scrubs and raised a canvas tent to shield themselves and the animal from the rising sun. Then they swabbed the hippo with sterile wipes and inserted intravenous drips — antibiotics, anti-inflammatories and anaesthetics — into the veins on his ears and tongue. Administering the anaesthetic is a dangerous part of the procedure. For unclear reasons, hippos, like other marine mammals, are highly sensitive to sedation and, in zoos, have sometimes had fatal reactions. Because they are retractable and can reside as deep as 40cm inside the body, they can be difficult to find. Buitrago made a 6cm incision, cutting with difficulty through thick skin and layers of fat. Mira knelt beside her, handing her surgical instruments. The vet snipped them off, sutured the wound and sewed the incision shut. As the animal slept, the team hurriedly removed the equipment and exited the corral, monitoring the hippo until it returned to consciousness and shambled through the gate and into the lake. From darting to awakening, the procedure had lasted seven hours. Still, they were confident it would recover well. Throughout the autumn of , the Cornare team refined the procedure to as close to a science as possible. Then, in December, Mira and his colleagues faced a male hippo weighing almost kg, among the largest they had encountered. With a final heave, they raised the animal just enough to slide the canvas sheet beneath his bulk. You have to go much deeper and really use your hands. The operation on the big hippo was a success. By April, however, the veterinary team was back in the field, and had castrated three more hippos. But the sentiment for a hardline solution is growing. Indeed, many hippo experts around the world agree. The caretaker had notified Cornare that a hippo had moved into a pond behind the property, and Mira had been called to assess the situation. Reports like these have become more common in the last couple of years, Mira told me. We drove up the long driveway to a Spanish colonial-style villa where Escobar is reported to have lived in the 70s while hunting for a ranch. The caretaker, a young woman named Flor Daza, led us to the back garden. Mira said the animal was probably a young male who had been cast out of a herd by the dominant male and forced to live on his own. In this beleaguered part of the country, which has suffered decades of violence, turmoil and civil war, many people see the hippos as a potential economic lifeline. A high arch stands at the entrance, topped by a replica of the single-engine Piper Super Cub plane that Escobar first used to fly cocaine to landing strips in the US. Those looking for more menacing mementoes could take their pick from display cases filled with replica pistols and AKs. In fact, business was booming. Despite a recognition among Colombian officials that the hippos will have to be managed, whether by a culling programme, wide-scale sterilisation, targeted translocation or some combination, even in the best of circumstances Colombians are likely to have to live with a vestigial hippo population. Of 3, invasive animal species introduced by humans into new, unsuitable biomes around the world, few have been eradicated. Whether the intruders are Burmese pythons imported by exotic pet collectors and abandoned in the Florida Everglades, or lionfish from the Indo-Pacific eating up crustaceans, snappers, groupers and other aquatic animals along the East Coast and Gulf of Mexico, or giant African land snails devouring native plants across Asia and Latin America, there is no realistic way to turn back the clock. Colombians may have no choice but to make their peace with this reality. This article was first published in the Smithsonian Magazine. By Joshua Hammer. View image in fullscreen. One Swedish zoo, seven escaped chimpanzees. Read more. Reuse this content. Most viewed.
Antineoplastic drugs (AD) are potentially carcinogenic and/or reprotoxic molecules. Healthcare professionals are increasingly exposed to these.
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Official websites use. Share sensitive information only on official, secure websites. Correspondence to Dr Mireille Canal-Raffin; mireille. Healthcare professionals are increasingly exposed to these drugs and can be potentially contaminated by them. Internal contamination of professionals is a key concern for occupational physicians in the assessment and management of occupational risks in healthcare settings. Objectives of this study are to report AD internal contamination rate in nursing staff and to identify factors associated with internal contamination. The target population is nurses practicing in one of the fifteen selected care departments where at least one of the five studied AD is handled 5-fluorouracil, cyclophosphamide, doxorubicin, ifosfamide, methotrexate. The trial will be conducted with the following steps: 1 development of analytical methods to quantify AD urine biomarkers, 2 study of the workplace and organization around AD in each care department transport and handling, professional practices, personal and collective protection equipments available 3 development of a self-questionnaire detailing professional activities during the day of inclusion, 4 nurses inclusion urine samples and self-questionnaire collection , 5 urine assays, 6 data analysis. The results will be submitted to peer-reviewed journals and reported at suitable national and international meetings. For reliable detection and to reduce the number of misclassifications as uncontaminated, the analytical methods used will to be specific, highly sensitive, will use isotopic internal standard to normalise urine matrix effect and the antineoplastic drugs AD urine stability during storage will be studied. The data from the self-questionnaires coupled with the results of the urine assays will serve to identify factors associated with internal contamination. This study will only assess the internal contamination of nurses and the environmental contamination of working surface will be performed separately in an other study. The number of cancer cases is constantly increasing worldwide and consequently, the administration of antineoplastic drugs ADs is more and more widespread. More than ADs are currently marketed. Thirty-eight ADs have been evaluated by IARC: 13 are classified as a human carcinogens group 1 , 11 as probably carcinogen group 2A , 7 may be carcinogenic group 2B and 7 are not classifiable for human carcinogenicity group 3. The reported reprotoxic effects are: spontaneous abortions, 7—13 fetal malformations, 6 14—17 decreased fertility, 13 18 19 risk of uterine growth retardation and prematurity. Surface sampling is a useful tool in order to identify sources of environmental contamination, to help in the implementation of corrective measures, to verify the effectiveness of the surface decontamination process and to insure a monitoring of these surfaces. Surface sampling is complementary to biomonitoring, which is the best approach to measure internal contamination, that is, AD detection in urines of exposed healthcare professionals. Indeed, unlike metrology of surface contamination, biomonitoring allows to take into account at the level of each individual, all exposure pathways respiratory, dermal and oral , the wearing or not of the protective equipment, the effectiveness of the type of protective equipment, gestures and professional practices, personal hygiene and quantities handled. Several analytical methods have been published for surface metrology of AD 24—28 and for AD urine biomonitoring. The limit of detection LOD value in urine, for six of them, is from 0. In the absence of reference biological value for occupational AD exposure, the long-term effects of occupational low-intensity exposure to these CMR products should lead to a reduction in exposures to the lowest possible level. Above reported internal contamination, data show that preventive measures are not currently sufficiently controlled, confirmed by Graeve et al. Very little current data are available on the internal contamination of French healthcare professionals exposed to AD. The protocol detailed in this paper, aims to collect data on AD internal contamination in nurses and understand factors associated with this contamination. This rate will be described globally and then stratified by care department. The secondary objectives are: 1 to describe for each studied AD the rate of internal contamination among the nurses in the study, and the concentrations associated with this contamination; 2 to identify factors associated with internal contamination in this study exposure characteristics and use of protective equipments by nurses. As a result, some less exposing tasks may cause higher workers contamination level than more exposing tasks. Indeed, Fransman et al , 37 highlight levels of external hand contamination higher for tasks such as washing treated patients, removing bed sheets and handling urine of treated patients compared with drug preparation and toilet cleaning tasks. Collected data from the self-questionnaire administered to nurses concerning AD handling the day of inclusion the day of urine sample collection. Collected data from the self-questionnaire administered to nurses concerning take care modalities of AD-treated patients the day of inclusion the day of urine sample collection. The exclusion criteria are: 1 be a student nurse; 2 be treated with one of the five studied AD or have been treated with any in the year prior to the day of study participation and 3 have at home a person treated with one of the five studied AD, in the month before the day of study participation. AD urine biomarkers will be the AD themselves with the exception of 5-fluorouracil, which is not detectable in urine. For this molecule, its urinary metabolite, alfa-fluoro-beta-alanine FBAL , will be assayed to assess internal contamination. Two methods have been already validated 33 but the limit of quantification LOQ will be improved. Two other methods are developed for this study for the determination of 5-fluorouracil metabolite FBAL 35 and doxorubicin urine biomarkers. For each AD, isotopic internal standard is added in each urine sample to normalise urine matrix effect. A hygienist of the occupational medicine department will observe the activities around AD in each selected care department at the end of the urine sample and self-questionnaire collection. Collective and individual protection equipment available in each department as well as the professional practices observed will be reported in this study of the workplace. A description of the complete organisation around AD and excreta of treated patients within each care department will also be carried out: AD reception in the department, administration to patients, disposal of waste. All these observations will be collected and reported in a standardised way for each care department. A self-questionnaire is built, in the light of literature data, concerning work tasks potentially exposing, risk perception. During this pilot study, a draft version was pretested on a small group of nurses. When it was necessary, questions were changed according to the feedback of the nurses. A final version was elaborated and will be used in this study. The aim of this self-questionnaire is to collect several data: sociodemographic and occupational data table 3 , data concerning AD handling on the day of inclusion table 1 , data concerning take care modalities of AD-treated patient table 2 and PPE worn the day of inclusion table 4. Level perception on AD exposing tasks, AD handling risks, the individual protective equipments, the action to be taken in AD accidental exposure cases. For each task listed in tables 1 and 2 , the influence of the questionnaire on the nurse practices on the day of participation and for the future is asked. For each task listed in tables 1 and 2 , PPEs table 4 that the nurse wears the day of inclusion are asked. Each nurse from the selected healthcare departments will receive a briefing note prior to inclusion and will be invited to participate in an information meeting about this study. At the end of the meeting, a kit containing the polypropylene pots to collect urine samples, the self-questionnaire and the participation consent form will be given to each volunteer. During the meeting, the nurse will be asked to collect their urine samples after several days of work. The time of the third sampling was chosen to take into account a delayed absorption by the cutaneous way as indicated by Hirst et al. Urine samples collection time. A document gathering the date and times of urine samples will be attached to the samples. At the same time, nurses will complete a self-questionnaire concerning their professional activity throughout the AD handling day. The self-questionnaire is a paper document with a detachable flap. This part will be sent by mail return postage paid envelopes to the coordinating centre, which will monitor the completed data and the other part will be kept by the nurse. After urine sample reception by the laboratory, the latter will immediately informs the coordinating centre of this reception. The coordinating centre will contact the nurses within 7 days if the self-questionnaire has not been received yet, limiting possible loss of data. Moreover, in case of missing or discordant data, each subject will be contacted by a member of the coordinating centre to complete the self-questionnaire. For each urine sample, four extraction methods followed by a validated analytical method will be performed. Moreover, urine creatinine will be analysed for each urine sample to account for dilution. Participant will be considered as contaminated when at least one of the five studied AD, is detected in at least one of the three collected urine samples. The rate of internal contamination will be calculated by reporting the number of contaminated subjects by at least one of the studied AD to the total number of subjects included and will be expressed as a percentage. This proportion will be estimated globally then detailed by molecule and department. The extent of the concentration levels achieved will also be described for each sampling time and each drug. The statistical analysis will include a global descriptive analysis of collected data from the self-administered questionnaire. Then factors associated with internal contamination of nurses will be studied using a multivariate logistic regression model. Interactions and confounders will be sought and tested throughout the modelling. The primary endpoint will be the absence or presence of internal AD contamination for each nurse. It will be determined in the light of AD urine assays results. A subject will be considered contaminated if at least one of the five AD is detected in at least one of the three urine samples. Descriptions of the studied population from the self-questionnaire data: 1 sociodemographic data; 2 occupational data; 3 AD handling data and 4 take care modalities of treated patients by studied AD. This description will be stratified by centre and by department stratification conditioned by the number of participants. Following these descriptions, the factors, described above, associated with internal contamination of nurses will be studied. The main objective is to estimate the rate of nurse internal AD contamination in two hospitals. Thus, no sample size calculation will be made for the main criterion since it will be estimated from the total eligible population. Given the total number of nurses working in the 11 selected care departments to participate in the study, nurses are potentially eligible. With this participation rate, the number of recruited subjects expected for this study will be about subjects. The research question and the protocol have been developed by a multidisciplinary team and an analysis of the workplace. As indicated in step 3 of the study protocol, a pilot study was previously conducted, in a healthcare unit of Bordeaux university hospital during which a draft version of a self-questionnaire was developed and pretested on a small group of nurses and modify according to their feedback. Representative workers of hospital personnel, managers of the two hospitals, health managers will be informed of the study. Each nurse from the selected care departments will receive a briefing note prior to inclusion and will be invited to participate in an information meeting about this study. The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international conferences or workshops. AV and MCR wrote the manuscript with the contributions of others authors for each work packages. All authors read and approved the final manuscript. We apologized Pr Nicholas Moore for his proofreading. Funding: This work represents independent research. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. BMJ Open. Find articles by Antoine Villa. Find articles by Mathieu Molimard. Find articles by Emmanuelle Bignon. Find articles by Magali Rouyer. Find articles by Simone Mathoulin-Pelissier. Find articles by Isabelle Baldi. Find articles by Catherine Verdun-Esquer. Find articles by Mireille Canal-Raffin. No commercial re-use. See rights and permissions. Published by BMJ. Open in a new tab. Performed tasks: Direct contact with treated patients help to wash, handling of treated patient Handling of treated patient excreta vomit, urine, faeces, expectoration, soiled sheets Participation in cleaning chemotherapy treatment room Cleaning room of treated patient Cleaning sanitary facilities of treated patient Insertion or removal of an urinary catheter Change of drape or bed repair of a treated patient Deposit of treated patient excreta in bin Bin evacuation. General collected data from the self-questionnaire administered to nurses. Provenance and peer review: Not commissioned; externally peer reviewed. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Day of AD handling Work schedule the previous 7 days. Hour of the beginning Hour of the end. Perception of each participant on the department activity. Patient treatment on the day of participation. Direct contact with treated patients help to wash, handling of treated patient Handling of treated patient excreta vomit, urine, faeces, expectoration, soiled sheets Participation in cleaning chemotherapy treatment room Cleaning room of treated patient Cleaning sanitary facilities of treated patient Insertion or removal of an urinary catheter Change of drape or bed repair of a treated patient Deposit of treated patient excreta in bin Bin evacuation. Sex Month and year of birth Pregnancy Smoking Onychophagia. Hat Plasticised apron Short sleeve gown Long sleeve gown. Protective eyewear Visor. Performed procedure of hand washing after gloves removal gloves used after AD handling. Nothing Hand sanitizer use Wash of hands with water only Wash of hands with water and soap.
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