Iraqi experts consensus on the management of relapsing remitting multiple sclerosis in adults.

OBJECTIVE: In Iraq, a lack of evidence-based management protocols for diagnosing, treating, and managing multiple sclerosis (MS) poses risks of suboptimal outcomes and clinical practice variability and potential harm to the patients. This study aimed to develop consensus recommendations regarding the diagnosis and management of MS in Iraq, specifically focusing on treatment-naïve patients, suboptimal responders, and women of childbearing age during preconception, pregnancy planning, and lactation.A survey was conducted to collect feedback from a panel of ten key opinion leaders (KOLs), who evaluated and discussed the statements to determine agreement levels. The mini-Delphi method was employed to establish a consensus on the management recommendations, and a meeting was held to analyze the responses and ensure that the recommendations were based on current evidence and followed a consensus-driven approach. RESULTS: The Revised McDonald Criteria is recommended for MS diagnosis, which includes evidence of dissemination of disease characteristics in space and time. Disease activity and progression can be monitored using relapses, MRI activity, and short-term disability progression. Experts suggest initiating treatment at diagnosis using higher efficacy medications, such as cladribine, ocrelizumab, natalizumab, or rituximab, for patients with high disease activity after careful risk stratification. Injectable interferon preparations have a tolerable risk profile but have drawbacks, such as the route and frequency of administration. Overall, disease-modifying therapies (DMTs) have shown efficacy in reducing relapse rates and short-term disability. CONCLUSION: This article presents expert panel recommendations for managing MS in Iraq, taking into account international guidelines, medication updates, and local resources. However, practical questions remain regarding the real-world use of disease-modifying therapies (DMTs). Personalizing treatment based on disease severity, prognosis, and individual risk factors while adhering to guidelines is crucial. A collaborative approach between healthcare providers and patients, considering individual preferences, is vital for achieving treatment goals.

Seasonal and spatial variation of Yamuna River water quality in Delhi, India.

Yamuna river pollution has been extensively studied with regard to some selected parameters in five locations at Palla, Nizamuddin Midstream, Nizamuddin Quarter Stream, Agra Canal Midstream, and Agra Canal Quarter Stream in Delhi, India. Seasonal and location-wise variation of pollutants namely dissolve oxygen (DO), biochemical oxygen demand (BOD), chemical oxygen demand (COD), total Kjeldahl nitrogen (TKN), ammonia (AMM), total coliform and fecal coliform were studied for 6 years during the period of 2000-2005. The study results revealed the lowest level of pollution during monsoon. The statistical analysis revealed a positive correlation between DO, BOD, COD, TKN, and AMM.

Trihalomethane formation potential in treated water supplies in urban metro city.

Trihalomethane (THM) formation potential (TFP) is very useful test to assess the level of the formation of trihalomethanes in worst case scenario. Organics in water have the potential to generate harmful disinfection by-products (DBPs) such as THMs, as a result of their reaction with disinfectant chlorine used in drinking water. DBPs are increasingly recognized as cancerous agents. TFP of postchlorinated treated water were investigated at six water treatment plants (WTPs) in Delhi City (India). The present paper presents the current trends of TFP so that prevention and control measures can be initiated by the regulating agencies responsible for drinking water supply. Liquid-liquid extraction method, followed by qualitative and quantitative estimation by gas chromatograph equipped with electron capture detector, had been used for the determination of THMs in water samples collected at the outlet just before supplying to the consumers during 2000-2007. The TFP values from 2004 onward of all WTPs did not exceed the WHO guideline value of

Anemia and iron deficiency in rural Bangladeshi pregnant women living in areas of high and low iron in groundwater.

BACKGROUND: Recent studies found a low rate of iron deficiency in Bangladeshi non-pregnant and non-lactating women. This was attributed to high iron concentrations in drinking water. However, there are limited data on iron deficiency among pregnant women in Bangladesh. OBJECTIVES: Our aim was to investigate the prevalence of anemia, iron deficiency, and iron deficiency anemia (IDA) among rural pregnant women and explore the association of groundwater iron concentration with anemia and iron deficiency in this group. METHODS: This study used data from a baseline assessment of an intervention study on rural pregnant women (n = 522), gestational age ≤20 wk, living in areas of low and high iron in groundwater. RESULTS: Overall, 34.7% of the pregnant women had anemia, 27% had iron deficiency, and 13.4% had IDA. Prevalence of anemia, iron deficiency, and IDA among the pregnant women living in low-groundwater-iron areas was significantly higher than among the pregnant women from high-groundwater-iron areas. The odds of iron deficiency were significantly lower among pregnant women in the higher quartiles of daily iron intake from drinking water. CONCLUSIONS: This study found a differential prevalence of anemia and iron deficiency among pregnant women living in areas of high and low groundwater iron. Iron status was independently associated with daily iron intake from drinking water. However, a significant proportion of the anemia could not be attributed to iron deficiency. Further research to identify other nutritional and non-nutritional contributors to anemia in Bangladesh is needed to formulate effective prevention and control programs for anemia.

Seasonal variation of trihalomethane formation potential in treated water supplies of Delhi City (India).

The main goal in using chlorine as water disinfectant is to protect the water in the distribution systems against microbial contamination and to prevent and control re-growth of microorganisms in the water distribution system. Organics in water have the potential to generate harmful disinfection by-products (DBPs) such as trihalomethanes (THMs) as a result of their reaction with chlorine. DBPs are increasingly recognized as cancerous agents. Residual chlorine concentration, temperature and pH are the major factors that influence the rate and degree of THMs formation. Trihalomethanes formation potential (TFP) is very useful test to assess the level of the formation of trihalomethanes. Seasonal variations of TFP of post chlorinated treated water were investigated at six water treatment plants (WTPs) in Delhi City (India).The post chlorinated treated water samples from Bhagirathi, Sonia Vihar, Wazirabad, Nangloi, Okhla, and Haiderpur WTPs were collected just at the outlet before water supply to the consumers. The investigation was based on an intensive bi-monthly sampling program, undertaken from May 2007 to March 2008. Correlation among TFP, residual chlorine, temperature and pH, and their variation throughout the year is also discussed in this paper.