Human inhalation exposure assessment of the airborne microplastics from indoor deposited dusts during winter in Dhaka, Bangladesh.

Microplastic (MP) contamination has become a concern due to its ubiquitous presence. Recent studies have found MPs to be present in multiple human organs. This study was carried out to evaluate the presence and characterize MPs in indoor dust deposition. Deposited dust was collected from fifteen households in Dhaka city. The samples underwent quantification of MPs using stereomicroscopy. Fourier Transform Infrared (FTIR) spectroscopy was performed to understand the polymer composition. MPs of the size group ranging from 50 to 250 µm were the most dominant. The deposition rates varied from 7.52 × 10³ MPs/m2/day to 66.29 × 10³ MPs/m2/day, with the mean deposition rate being 34 × 10³ MPs/m2/day. Notably, the number of occupants and the height of the sampling location above the ground level were found to influence the deposition rates. Various polymers, including polyester (PET), polyethylene (PE), Nylon, and polypropylene (PP), were identified. The estimated mean inhalation exposure was 2986 ± 1035 MPs/kg-BW/day. This work highlights the need for additional research to explore indoor microplastic deposition and its potential effect on human health in the densely inhabited and severely polluted megapolis of Dhaka, Bangladesh.

Artificial Intelligence Tools in Pediatric Urology: A Comprehensive Review of Recent Advances.

Artificial intelligence (AI) is providing novel answers to long-standing clinical problems, and it is quickly changing pediatric urology. This thorough analysis focuses on current developments in AI technologies that improve pediatric urology diagnosis, treatment planning, and surgery results. Deep learning algorithms help detect problems with previously unheard-of precision in disorders including hydronephrosis, pyeloplasty, and vesicoureteral reflux, where AI-powered prediction models have demonstrated promising outcomes in boosting diagnostic accuracy. AI-enhanced image processing methods have significantly improved the quality and interpretation of medical images. Examples of these methods are deep-learning-based segmentation and contrast limited adaptive histogram equalization (CLAHE). These methods guarantee higher precision in the identification and classification of pediatric urological disorders, and AI-driven ground truth construction approaches aid in the standardization of and improvement in training data, resulting in more resilient and consistent segmentation models. AI is being used for surgical support as well. AI-assisted navigation devices help with difficult operations like pyeloplasty by decreasing complications and increasing surgical accuracy. AI also helps with long-term patient monitoring, predictive analytics, and customized treatment strategies, all of which improve results for younger patients. However, there are practical, ethical, and legal issues with AI integration in pediatric urology that need to be carefully navigated. To close knowledge gaps, more investigation is required, especially in the areas of AI-driven surgical methods and standardized ground truth datasets for pediatric radiologic image segmentation. In the end, AI has the potential to completely transform pediatric urology by enhancing patient care, increasing the effectiveness of treatments, and spurring more advancements in this exciting area.

Elemental Characterization of Ambient Particulate Matter for a Globally Distributed Monitoring Network: Methodology and Implications.

Global ground-level measurements of elements in ambient particulate matter (PM) can provide valuable information to understand the distribution of dust and trace elements, assess health impacts, and investigate emission sources. We use X-ray fluorescence spectroscopy to characterize the elemental composition of PM samples collected from 27 globally distributed sites in the Surface PARTiculate mAtter Network (SPARTAN) over 2019-2023. Consistent protocols are applied to collect all samples and analyze them at one central laboratory, which facilitates comparison across different sites. Multiple quality assurance measures are performed, including applying reference materials that resemble typical PM samples, acceptance testing, and routine quality control. Method detection limits and uncertainties are estimated. Concentrations of dust and trace element oxides (TEO) are determined from the elemental dataset. In addition to sites in arid regions, a moderately high mean dust concentration (6 µg/m3) in PM2.5 is also found in Dhaka (Bangladesh) along with a high average TEO level (6 µg/m3). High carcinogenic risk (>1 cancer case per 100000 adults) from airborne arsenic is observed in Dhaka (Bangladesh), Kanpur (India), and Hanoi (Vietnam). Industries of informal lead-acid battery and e-waste recycling as well as coal-fired brick kilns likely contribute to the elevated trace element concentrations found in Dhaka.

Disaster after disaster: the outbreak of infectious diseases in Pakistan in the wake of 2022 floods.

In June 2022, Pakistan witnessed catastrophic floods, affecting millions of people. The ensuing epidemics of cholera, cryptosporidiosis, rotavirus infections, generalized diarrhoea, typhoid and paratyphoid fevers, as well as the frequency of vector-borne diseases including malaria and dengue fever, are studied in this investigation. It also explores the latest outbreak of poliomyelitis and the frequency of respiratory diseases such COVID-19, diphtheria, and tuberculosis, as well as how floods have contributed to skin and eye problems. The report also describes the obstacles governments must overcome in order to manage these health emergencies and offers possible solutions for reducing the effects of ongoing and anticipated epidemics. This flood emphasizes the pressing need for international action and acts as an alarming indicator of the significant impact of climate change. It emphasizes how crucial it is to have effective flood response and preparation strategies in developing nations that are vulnerable to natural disasters.

A reflection of Africa's cardiac surgery capacity to manage congenital heart defects: a perspective.

Congenital heart defects (CHDs) are birth abnormalities that may drastically alter the structure and functionality of the heart. For 70% of infants with congenital disorders to survive or maintain a better quality of life, surgery is necessary. Over 500 000 of the 1.5 million CHD cases reported annually, or 1% of all live births, occur in Africa, according to the WHO. A surmounted 90% of these patients are from Africa, and as a consequence, 300 000 infants die annually as a result of poor care or difficulty accessing adequate healthcare. However, the high prevalence of CHDs, precipitated by a plethora of aetiologies worldwide, is particularly pronounced in Africa due to maternal infectious diseases like syphilis and rubella amongst the pregnant populace. In low- and middle-income countries, especially in Africa, where foreign missions and organizations care for the majority of complicated cardiac surgical patients, access to secure and affordable cardiac surgical therapy is a substantial issue. Interventions for CHDs are very expensive in Africa as many of the continent's domiciles possess low expenditures and funding, thereby cannot afford the costs indicated by associated surgical treatments. Access to management and healthcare for CHDs is further hampered by a lack of trained surgical personnel, specialized tools, infrastructure, and diagnostic facilities in Africa.

Recent Advancements in Epidural Etanercept for Pain Management in Radiculopathy: A Literature Review.

The most common etiology of low back and neck pain is associated with spinal cord pathologies. Regardless of origin, low back and neck pain are some of the most common causes of disability worldwide. Mechanical compression due to spinal cord diseases, such as degenerative disc disorders, can lead to radiculopathy, which manifests as numbness or tingling and can progress to loss of muscle function. Conservative management, such as physical therapy, has not been proven effective in treating radiculopathy, and surgical treatments have more risks than benefits for most patients. Epidural disease-modifying medications, such as Etanercept, have been recently explored due to their minimal invasiveness and direct effects on inhibiting tumor necrosis factor-α (TNF-α). Therefore, this literature review aims to evaluate epidural Etanercept's effect on radiculopathy caused by degenerative disc diseases. Epidural Etanercept has been shown to improve radiculopathy in patients with lumbar disc degeneration, spinal stenosis, and sciatica. Further research is needed to compare the effectiveness of Etanercept with commonly used treatments such as steroids and analgesia.

The Potential Role of Etanercept in the Management of Post-stroke Pain: A Literature Review.

Strokes are the second leading cause of death and disability worldwide. The brain injury resulting from stroke produces a persistent neuroinflammatory response in the brain, resulting in a spectrum of neurologic dysfunction affecting stroke survivors chronically, also known as post-stroke pain. Excess production of tumor necrosis factor alpha (TNF alpha) in the cerebrospinal fluid (CSF) of stroke survivors has been implicated in post-stroke pain. Therefore, this literature review aims to assess and review the role of perispinal etanercept in the management of post-stroke pain. Several studies have shown statistically significant evidence that etanercept, a TNF alpha inhibitor, can reduce symptoms present in post-stroke syndrome by targeting the excess TNF alpha produced in the CSF. Studies have also shown improvements in not only post-stroke pain but also in traumatic brain injury and dementia. Further research is needed to explore the effects of TNF alpha on stroke prognosis and determine the optimal frequency and duration of etanercept treatment for post-stroke pain.

Sonographic Characteristics and Pathology Correlation of Breast Imaging Reporting and Data System (BI-RADS) Category 4 Lesions.

INTRODUCTION: The Breast Imaging-Reporting and Database System (BI-RADS) category 4 is designated for breast lumps that do not display the typical features of malignancy but still raise enough suspicion to warrant a recommendation for a biopsy, as malignancy cannot be ruled out through imaging alone. The main objective of this study was to investigate the sonographic characteristics and pathology correlation of BI-RADS 4 breast lesions and determine the positive predictive rate of BI-RADS 4 lesions in diagnosing breast cancer, using histopathology as the gold standard. METHODS: This was a cross-sectional study conducted at the Department of Radiology, Aga Khan University Hospital in Karachi, spanning from May 2021 to August 2022, with a duration of 15 months. The study focused on female patients over the age of 18 who presented with suspicious breast lesions on ultrasound. Both mammography and ultrasound-guided core needle biopsy were performed on these patients, followed by a detailed histopathological evaluation of the biopsy specimens. To calculate the positive predictive value (PPV), true positive cases were identified through both histopathology and ultrasonography. RESULTS: A total of 227 cases were categorized as BI-RADS 4 lesions, with the patients' mean age being 47.8 ± 14.3 years (range: 17 - 88). Among the biopsied lesions, 101 cases were confirmed to be true positive for breast malignancies, resulting in a PPV for malignancy of 44.9%. Conversely, there were 124 false positive cases out of the 227 BI-RADS 4 category lesions (54.63%). The primary indication for presentation was a breast lump, and out of the 101 confirmed malignant cases, 70 (69.3%) were associated with malignancy. CONCLUSION: BI-RADS 4 can be utilized to assess suspicious breast lumps; however, for more reliable results and to avoid false negatives, histopathological confirmation should complement the imaging findings.

Risk assessment and evaluation of heavy metals concentrations in blood samples of plastic industry workers in Dhaka, Bangladesh.

To assess the potential health risk caused by heavy metals twenty-six blood samples were collected from plastic industry workers based on ages and smoking status in Dhaka, Bangladesh. Heavy metals were analyzed with an atomic absorption spectrometer. The mean concentrations of Lead (Pb), Cadmium (Cd), Nickel (Ni), and Zinc (Zn) found in blood samples of the exposed workers were 32.78 ± 9.47, 1.08 ± 0.47, 1.42 ± 1.01, and 9.08 ± 1.95 µgL-1, respectively. The average heavy metal concentrations in blood samples of smoking workers show a narrow range of fluctuation than that of non-smoking workers. A review of different age groups of industry workers shows the workers between the ages of 26 and 40 are more likely to contaminated with Pb (35.90 ± 8.06 µgL-1) and Ni (1.61 ± 1.31 µgL-1). The higher level of Cd (1.26 ± 0.46 µgL-1) and Zn (9.91 ± 2.80 µgL-1) was found in >40 years old workers. The mean concentration in indoor dust samples of different industrial subsections reported as 40.27 ± 10.33, 3.24 ± 0.83, 18.08 ± 3.61, and 103.64 ± 8.16 mg kg-1 for Pb, Cd, Ni, and Zn, respectively. Exposed workers have relatively less critical health implications concluded from the average daily intake (ADI), hazard quotient (HQs), and hazard index (HI) values. The HI values of Pb, Cd, Ni, and Zn were reported as 2.0 × 10-2, 4.64 × 10-4, 1.62 × 10-3, and 5.49 × 10-4, respectively, which have imparted minimal risks (as HI < 1) to the health of the workers. The cancer risks of Pb, Cd, and Ni were reported as 1.46 × 10-10, 1.77 × 10-9, and 1.31 × 10-9, respectively lower than the threshold values. Therefore, the result divulged a potentially lower cancer risk compared to EPA limit value of 1 × 10-6 to 1 × 10-4 for exposed industrial workers.

Choroidal detachment with exudative retinal detachment following Ahmed valve implantation in Sturge-Weber syndrome.

Ahmed glaucoma valve implant appears to be a relatively useful drainage device in eyes with glaucoma secondary to Sturge-Weber syndrome (SWS). However, early postoperative choroidal and exudative retinal detachment may occur from a rapid expansion of the choroidal hemangioma with effusion of fluid into the suprachoroidal and subretinal spaces. We report the case of a ten-year-old boy who had SWS with choroidal haemangioma and secondary glaucoma. He had Ahmed glaucoma valve implantation on account of the secondary glaucoma which had been refractory to both conventional medical and surgical managements. He developed choroidal and exudative retinal detachment postoperatively. However, he responded to conservative treatment and further surgical management was not required. Ahmed glaucoma valve in the treatment of glaucoma secondary to SWS is useful, but the risk of choroidal effusion with exudative retinal detachment is still present. Surgeons should be alert to this likely complication and be prepared for prompt management.

Comparative efficiency of wheat straw and sugarcane bagasse biochar reduces the cadmium bioavailability to spinach and enhances the microbial activity in contaminated soil.

Biochar is considered a novel soil amendment for cadmium (Cd) stabilization in contaminated soils. A pot experiment was conducted to examine the efficiency of wheat straw and sugarcane bagasse induced biochar on Cd mobility in soil and its bioavailability to spinach in contaminated soil. Soil pH, Cd contents in plant tissues and microbial biomass were examined. Results showed that Cd was significantly decreased by 30.95% and 20.83% with wheat straw and sugarcane bagasse biochar at 2% application rate respectively, relative to the control. Similarly, Cd contents were decreased in plants shoots by 15.41 and 14.33%, while in roots by 48.3 and 35.54%, when wheat straw and sugarcane biochar were added at 2% application rate respectively. Moreover, soil microbial biomass was significantly increased with the application of all biochar types and their applications rates. Finally, wheat straw biochar at 2% application rate can be considered as an effective approach for Cd stabilization in contaminated soils.

Effective Role of Biochar, Zeolite and Steel Slag on Leaching Behavior of Cd and Its Fractionations in Soil Column Study.

Remediation of cadmium (Cd) from contaminated soils is considered a complicated task of environmental safety. A column leaching experiment was planned to estimate the influence of biochar (BC), zeolite (ZE) and steel slag (SL) at 1.5% and 3% application rate on Cd leaching behavior and chemical fractionation in contaminated soil. A sequential extraction procedure, the European Community Bureau of Reference (BCR), Toxicity Characteristic Leaching Procedure (TCLP) and NH4NO3 were performed after leaching was completed. The soluble portion of Cd was decreased by 36.3%, 18.4% and 28.7% and Cd contents in leachate were decreased by 44.8%, 30% and 31.3% after BC, ZE and SL addition at 3% rate, respectively over control soil. The greater reduction in TCLP extractable Cd was observed by 29.6% with BC and 22.4% with ZE and 25.7% with SL at 3% application rate. Overall, biochar can be considered an efficient soil amendment to reduce Cd leaching as well as increased its stabilization within soil profile.

Technical Varieties of Ross Procedure: A Case Series.

Replacement of aortic valve with the pulmonary autograft is carried out through the Ross procedure due to its potential for growth, durability in pediatric population, and absence of anticoagulation. This case series reports the postoperative outcome of two technical variations of Ross procedure in eight patients who underwent surgery from January 2007 to December 2016. The dominant valvular hemodynamic indication was aortic regurgitation. The techniques employed for Ross procedure included free standing root replacement in six patients and modified root replacement with autograft stabilisation using Dacron interposition graft in two patients. Right ventricular outflow tract (RVOT) conduit reconstruction was achieved by utilisation of Contegra bio prosthesis in four patients; and use of manually constructed valved conduit comprising of PTFE (polytetrafluoroethelene) membrane and bovine pericardial tube in remaining four patients. There was no mortality and no re-intervention. The technical varieties of Ross procedure offer freedom from need of anti-coagulation, mortality, and RVOT conduit failure in younger adults.

Comparison of Upper Limb Translocated Femoral Vein and Prosthetic Arteriovenous Bridge Grafts.

Introduction Native veins are an ideal option for dialysis in a patient with chronic kidney disease (CKD) as compared to a prosthetic graft. Femoral vein (FV) translocation to the upper arm is also an alternative to a prosthetic graft as reported in the literature when all options of using the native veins of the arms are exhausted. Thus, we aimed to compare the patency of the upper limb translocated FV arteriovenous fistula (AVF) with a prosthetic arteriovenous bridge graft (AVBG). Methods It is a retrospective cohort study that was conducted in the Department of Vascular Surgery, Aga Khan University Hospital. It included adult patients who underwent either upper arm translocation of FV or prosthetic AVBG using the consecutive purposive sampling technique. There were a total of 10 patients who underwent FV translocation AVF and 20 patients who had AVBG in the upper arms. Results A total of 30 patients were included in the study. Of these 30 patients, 10 underwent FV translocation AVF and the remaining 20 had AVBG. There was a significant difference in the mean operating time of the two surgeries. The mean operating time in FV translocation was 223 (± 41.5) minutes and in those with AVBG, the mean operating time was 100 (±26.5) (p= <0.001). There was no significant difference in the total length of hospital stay in both procedures performed. The primary patency rate for FV translocation was 90% and 95% in AVBG (p=1.00). Ten percent of FV translocation had a primary failure rate compared with that of AVBG, which was 5% (p=1.00). The mean follow-up period was 61 weeks in the FV translocation group and 64 weeks in the AVG group. Conclusion There was no significant difference in both groups in terms of patency, length of hospital stay, and fewer complications were observed in the FV translocation group as compared with the AVBG group.

Cadmium Immobilization Potential of Rice Straw-Derived Biochar, Zeolite and Rock Phosphate: Extraction Techniques and Adsorption Mechanism.

Heavy metal contamination in agricultural soils has become a serious environmental concern due to their generally high mobility and toxic effects on plants and food security. An incubation study was conducted to assess the effectiveness of biochar (BC), zeolite (ZE) and rock phosphate (RP) stabilizers on the immobilization of cadmium (Cd) in contaminated soils. Various extraction techniques were carried out: a sequential extraction procedure, the European Community Bureau of Reference (BCR), the toxicity characteristics leaching procedure (TCLP) and extraction with ammonium nitrate. In addition, Cd adsorption by these materials was observed using Langmuir and Freundlich isotherms. The results showed that with an increase in soil pH the exchangeable fraction of Cd in soil was significantly reduced by 28%-29.4%, 9%-13% and 4%-14% for BC, ZE, and RP, respectively. According to the Langmuir adsorption isotherm, BC-amended soil showed a higher adsorption capacity (Qm) of Cd from 8.38 to 19.85 mg g-1. Overall, BC offered better results when compared to other amendments.

Molecular characterization and multidisciplinary management of Gerbich hemolytic disease of the newborn.

Gerbich (Ge) antigens are high frequency red cell antigens expressed on glycophorin C (GYPC) and glycophorin D. Hemolytic disease of the fetus and newborn (HDFN) due to Gerbich antibody is rare and presents a clinical challenge, as Gerbich negative blood is scarce. We report a case of HDFN due to maternal Ge3 negative phenotype and anti-Ge3 alloimmunization, successfully managed by transfusion of maternal blood. Molecular testing revealed that the mother has homozygous deletion of exon 3 of GYPC, the father is homozygous wildtype for GYPC, and the infant is obligate heterozygote expressing Ge3.

Comparative efficiency of rice husk-derived biochar (RHB) and steel slag (SS) on cadmium (Cd) mobility and its uptake by Chinese cabbage in highly contaminated soil.

Cadmium (Cd) contamination in red soil has been considered as a severe threat due to its toxic effects on plants and food security. This study aims to evaluate the comparative efficiency of rice husk-derived biochar (RHB) and steel slag (SS) metal stabilizer on decreasing Cd mobility and bioavailability to Chinese cabbage grown on acidic contaminated red soil. Several extraction techniques: a sequential extraction procedure, the European Community Bureau of Reference, toxicity characteristics leaching procedure, ammonium nitrate, and simple bioaccessibility extraction test were used to measure Cd mobility after amelioration of the investigated soil. The results indicated that application of stabilizer significantly increased soil chemical properties including soil pH, cation exchange capacity, nutrients, and organic matter. The soluble portion of Cd in soil was significantly decreased by 17.6-31.2% and 7.8-11.7% for RHB and SS at 1.5% and 3% application rate, respectively. Moreover, Cd bioaccessibility was significantly declined by 37.08% with RHB and 11.3% with SS at 3% rate. Inlcorporation of RHB at 3% can effectively immobilize Cd and thereby, reduce its phytoavailability to cabbage in Cd-contaminated soil to mitigate food security risks.

Giant retrocardiac foregut duplication cyst presenting with left atrial compression and palpitations.

A 35-year-old man presented with a 3-month history of palpitations and shortness of breath. An ECG showed premature atrial contractions and episodes of supraventricular tachycardia. A subsequent echocardiogram showed a retrocardiac cystic mass that was compressing the left atrium. A CT scan confirmed these findings by showing a large left-sided posterior mediastinal cyst compressing the left atrium and pulmonary veins. The cyst was successfully excised from the retrocardiac position via left thoracotomy after which there was complete resolution of the palpitations. Histopathology showed it to be a mediastinal cyst, most likely a foregut duplication of the enterogenic variant. This is an extremely unusual case of foregut duplication cyst presenting with compression of the left atrium and pulmonary veins leading to atrial arrhythmias.

Rare Presentation of a Posterior Mediastinal Cystic Schwannoma as a Large Pleural Effusion.

A 46-year-old man presented with shortness of breath and recurrent, left-sided pleural effusions. A computed tomography (CT) scan of the chest showed a large, left-sided pleural effusion with a mass in the posterior mediastinum. A pleural tap showed lymphocytic exudate. The biopsy of the mass was inconclusive. A left posterolateral thoracotomy was performed, which showed a large posterior mediastinal mass adherent to the left lung. The mass was completely excised and the histopathology proved it to be giant predominantly cystic schwannoma. The pleural effusion resolved after tumor resection.