Study of trace metal contamination and ecological risk assessment in the sediments of a tropical river estuary, Southwestern India

The present study aims to assess the extent of trace metal pollution in the sediments of Sita-Swarna estuary, west coast of India, and investigate their possible ecological risk on the aquatic environment. The sediment cores were analyzed for sand, silt, clay, organic carbon, and trace metals (Al, Fe, Mn, As, Cd, Co, Zn, Pb, Ni, Cr, and Cu) at 2-cm intervals. The study revealed that sediments have deposited in relatively violent to very violent hydrodynamic energy conditions. Factor analysis indicated that the metal distribution is mainly controlled by Fe–Mn oxyhydroxides and organic carbon. Further, the geochemical approach, pollution indices, and statistical evaluation revealed moderate pollution in the catchment. From an ecotoxicological perspective, the estimated risk index (RI) value was found to less than 150, indicating low risk for aquatic life. Thus, this baseline study would help to adopt strategies in pollution control and protect the fragile marine environment.

Hemorrhagic Transformation Following Childhood Cardioembolic Stroke Is Not Increased in Anticoagulated Patients

Objective: To characterize the risk of hemorrhagic transformation following cardioembolic stroke in childhood, and whether anticoagulation impacts that risk. Methods: Ninety-five children (1 month-18 years) with cardioembolic arterial ischemic stroke between January 1, 2009, and December 31, 2019, at 2 institutions were identified for retrospective chart review. Neuroimaging was reviewed to assess for hemorrhagic transformation. Results: There were 11 cases of hemorrhagic transformation; 8 occurred within 2 days of stroke diagnosis. Risk of hemorrhagic transformation did not differ in patients with and without anticoagulation use (15% vs 9%, estimated risk difference 5%; CI –9%, 19%). Stroke size did not predict hemorrhagic transformation (OR 1.004, 95% CI 0.997, 1.010). Risk of hemorrhagic transformation was higher in strokes that occurred in the inpatient compared with the outpatient setting (16% vs 6%). Conclusion: Hemorrhagic transformation occurred in 11% of pediatric cardioembolic ischemic stroke, usually within 2 days of stroke diagnosis, and was not associated with anticoagulation or stroke size.

Risk of airway fire with the use of KTP laser and high flow humidified oxygen delivery in a laryngeal surgery model

Airway surgery presents a unique environment for operating room fire to occur. This study aims to explore the factors of combustion when using KTP laser with high flow oxygen in an ex-vivo model. The variables tested were varying tissue type, tissue condition, oxygen concentration, laser setting, and smoke evacuation in a stainless-steel model. Outcome measures were time of lasing to the first spark and/or flame. A multivariate Cox proportional hazard model was used to determine the risk of spark and flame across the different risk factors. For every 10% increase in oxygen concentration above 60% the risk of flame increased by a factor of 2.3. Continuous laser setting at 2.6 W increased the risk by a factor of 72.8. The risk of lasing adipose tissue is 7.3 times higher than that of muscle. Charred tissue increases the risk of flame by a factor of 92.8. Flame occurred without a preceding spark 93.6% of the time. Using KTP laser in the pulsed mode with low wattages, minimising lasing time, reducing the oxygen concentration and avoiding lasing adipose or charred tissue produce a relatively low estimated risk of spark or flame.

Prevalence of Pharmaceuticals in Surface Water Samples in Ghana

Pharmaceuticals, among the emerging contaminants, are pseudopersistent and recently of serious concern due to universal use, toxicity, and resistance development at low concentrations. This study was aimed at assessing the prevalence and risk of eight pharmaceuticals in surface water used for vegetable irrigation in Ghana’s Kumasi and Sunyani metropolises, which are influenced by hospitals, sewage treatment facilities, and market effluents. Samples were concentrated via solid-phase extraction (SPE) while liquid chromatography was used to identify and quantify the analytes. Ibuprofen, acetaminophen, and diclofenac were the detected analgesics in this study, with concentrations stretching from below detection limit (not detected) to 319.0 ng/L, while amoxicillin, trimethoprim, and cefuroxime were the detected antibiotics with a concentration range of no detection to 840.0 ng/L. Based on the available long-term data, an environmental risk assessment was conducted. Because of the presence of ibuprofen, the lowest trophic level and fish were shown to be at risk. The estimated risk quotient values for antibiotics resistance were above 1 for all the antibiotics investigated in surface water impacted by the wastewater of hospitals and pharmaceutical companies’ except surface water impacted by sewage treatment plants (STPs) and market wastewater. The existence of these pharmaceuticals in surface water does not only point to a general concern for the environment but also a potential health risk on humans and other lives as a result of their impact on drinking water and vegetable production in Ghana.

Estimation of metformin and other sugar reducing therapy influence on the outcomes in patients with acute coronary syndrome and diabetes mellitus type II

Aim. To study the influence of hypoglycemic therapy on hospital and long-term prognosis in patients with acute coronary syndrome (ACS) and diabetes type 2.Methods. The study included 63 patients with ACS and type 2 diabetes. All patients had a clinical examination, assessment of mortality risk and myocardial infarction on GRACE scale (Global Registry of Acute Coronary Events) and TIMI (Thrombolisis In Myocardial Infarction) in-hospital and six months after hospitalization.Results. Metformin is associated with a lower estimated risk of in-hospital mortality and within 6 months after discharge in patients with acute coronary syndrome on the background of type 2 diabetes and with less risk of adverse cardiovascular events within 14 days of their occurrence in patients with unstable angina pectoris on the background of diabetes. High daily doses of metformin have also been associated with a decrease in the estimated risk of in-hospital mortality and within 6 months after discharge in patients with ACS associated with diabetes. The inverse association between the daily dosage of metformin and the presence of angina pectoris in patients with ACS and diabetes type 2 indicates a protective effect of metformin high daily dosages in relation to the risk of complications within six months after the discharge from hospital.Conclusion. One of the important aspects of ACS treatment, along with effective therapy, is the impact on concomitant risk factors, including blood glucose control. The main groups of hypoglycemic drugs have currently been identified; their effect on cardiovascular events, long-term effects and long-term prognosis are being investigated.

At Which Mean Glandular Dose Does the Benefit of Breast Cancer Deaths Averted Equal the Risk of Lives Lost to Screening From Radiation-induced Malignancy for Mammography With and Without Tomosynthesis?

Objective To estimate benefit-to-radiation-risk mean glandular dose (MGD) equivalence values for screening mammography, defined as the yearly MGD (over a 10-year period) at which the estimated benefit of mammography in terms of deaths averted equals the estimated risk of lives lost to screening due to radiation exposure (a benefit-to-risk ratio of 1). Methods Benefit-to-risk ratios were calculated as the ratio of breast cancer deaths averted and lives lost to screening over 10-year intervals starting at age 40 for mammography and tomosynthesis using previously published methodology. The MGD values at which estimated benefit equals risk were tabulated. Results The MGD values at which benefit-to-risk equivalence points were met for digital screening mammography are 63 milligray (mGy) (ages 40–49), 88 mGy (ages 50–59), 176 mGy (ages 60–69), and 336 mGy (ages 70–79). The MGD values that met benefit-to-risk equivalence for screening tomosynthesis plus digital mammography or synthetic mammography are 80 mGy (ages 40–49), 111 mGy (ages 50–59), 224 mGy (ages 60–69), and 427 mGy (ages 70–79). Conclusion Cutoff MGD values at which the estimated benefit from screening equals the estimated risk are well above standard screening MGD exposures. Care is necessary to ensure that threshold values are not exceeded during a screening exam, particularly for women ages 40–49 years old when using digital mammography plus tomosynthesis (due to an approximate doubling of dose per exam that will more readily exceed cutoff MGD values) and when many additional views are obtained.

Management of cardiovascular disease using an mHealth tool: a randomized clinical trial

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death and morbidity worldwide. This randomized controlled, single-center, open-label trial tested the impact of a mobile health (mHealth) service tool optimized for ASCVD patient care. Patients with clinical ASCVD were enrolled and randomly assigned to the intervention or control group. Participants in the intervention group were provided with a smartphone application named HEART4U, while a dedicated interface integrated into the electronic healthcare record system was provided to the treating physicians. A total of 666 patients with ASCVD were enrolled, with 333 patients in each group. The estimated baseline 10-year risk of cardiovascular disease was 9.5% and 10.8% in the intervention and control groups, respectively, as assessed by the pooled cohort risk equations. The primary study endpoint was the change in the estimated risk at six months. The estimated risk increased by 1.3% and 1.1%, respectively, which did not differ significantly (P = 0.821). None of the secondary study endpoints showed significant differences between the groups. A post-hoc subgroup analysis showed the benefit was greater if a participant in the intervention group accessed the application more frequently. The present study demonstrated no significant benefits associated with the use of the mHealth tool in terms of the predefined study endpoints in stable patients with ASCVD. However, it also suggested that motivating patients to use the mHealth tool more frequently may lead to greater clinical benefit. Better design with a positive user experience needs to be considered for developing future mHealth tools for ASCVD patient care.Trial Registration: ClinicalTrials.gov NCT03392259

Impact of Co-occurring Mental Disorders and Chronic Physical Illnesses on Frequency of Emergency Department Use and Hospitalization for Mental Health Reasons

Background: Patients with mental disorders (MD) are at high risk for a wide range of chronic physical illnesses (CPI), often resulting in greater use of acute care services. This study estimated risk of emergency department (ED) use and hospitalization for mental health (MH) reasons among 678 patients with MD and CPI compared to 1,999 patients with MD only.Methods: Patients visiting one of six Quebec (Canada) ED for MH reasons and at onset of a MD in 2014–15 (index year) were included. Negative binomial models comparing the two groups estimated risk of ED use and hospitalization at 12-month follow-up to index ED visit, controlling for clinical, sociodemographic, and service use variables.Results: Patients with MD, more severe overall clinical conditions and those who received more intensive specialized MH care had higher risks of frequent ED use and hospitalization. Continuity of medical care protected against both ED use and hospitalization, while general practitioner (GP) consultations protected against hospitalization only. Patients aged 65+ had lower risk of ED use, whereas risk of hospitalization was higher for the 45–64- vs. 12–24-year age groups, and for men vs. women.Conclusion: Strategies including assertive community treatment, intensive case management, integrated co-occurring treatment, home treatment, and shared care may improve adequacy of care for patients with MD-CPI, as well as those with MD only whose clinical profiles were severe. Prevention and outreach strategies may also be promoted, especially among men and older age groups.

Thromboembolic and hemorrhagic risks after vaccination against SARS-CoV-2: a systematic review and meta-analysis of randomized controlled trials

Background Thromboembolic and bleeding events after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are major public concerns leading to vaccine hesitancy. Due to low incidence, an individual randomized controlled trial (RCT) is underpowered to determine whether SARS-CoV-2 vaccines increase the risks of thromboembolism and hemorrhage. Methods We performed a literature search using PubMed, EMBASE, Cochrane, medRxiv databases, and reference lists of relevant articles to identify RCTs that reported thromboembolic, hemorrhagic events, and thromboembolism/hemorrhage-related death after SARS-CoV-2 vaccination. The primary aim of this systematic review and meta-analysis was to estimate the pooled thromboembolic risk related to SARS-CoV-2 vaccines compared to placebo. The secondary outcomes included estimating the risks of arterial thromboembolism (ATE), venous thromboembolisms (VTE), hemorrhage, thrombocytopenia, and thromboembolism/hemorrhage-related death. Results Eight RCTs of 4 vaccine platforms comprised of 195,196 participants were retrieved. SARS-CoV-2 vaccines were not associated with an increased risk of overall thromboembolism (risk ratio [RR], 1.14; 95% CI [confidence interval], 0.61–2.14; I2 = 35%), ATE (RR, 0.97; 95% CI, 0.46–2.06; I2 = 21%), VTE (RR, 1.47; 95% CI, 0.72–2.99; I2 = 0%), hemorrhage (RR, 0.97; 95% CI, 0.35–2.68; I2 = 0), and thromboembolism/hemorrhage-related death (RR, 0.53; 95% CI, 0.16–1.79; I2 = 0). Compared to the baseline estimated risk of these outcomes in participants administered placebos, the risk differences with vaccines were very small and not statistically significant. These findings were consistent in the subgroup analysis across 4 vaccine platforms. Conclusion Vaccines against SARS-CoV-2 are not associated with an increased risk of thromboembolism, hemorrhage, and thromboembolism/hemorrhage-related death.