Investigating the impacts of heavy metal(loid)s on ecology and human health in the lower basin of Hungary's Danube River: A Python and Monte Carlo simulation-based study.

This study aimed to determine the environmental and health risks of the heavy metal levels in the Danube River in Hungary. The metals, including Fe, Mn, Zn, Cu, Ni, Cr, Pb, and As, were measured in the period from 2013 to 2019. The Spearman correlation and heatmap cluster analysis were utilized to determine the origin of pollution and the factors that control surface water quality. Several indices, such as the heavy metal pollution index (HPI), metal index (MI), hazard quotient oral and dermal (HQ), hazard index oral and dermal (HI), and carcinogenic risk (CR), were conducted to evaluate the potential risks for the environment and human health. The values of the HPI were between the range of 15 < HPI < 30, which indicated moderate pollution; however, the MI results showed high pollution in Dunaföldvár and Hercegszántó cities. The ecological risk (RI < 30) and HI values (< 1) showed low environmental risks and non-carcinogenic impacts of the existing metals, either on adults or children. The mean CR value of oral arsenic was 2.2E-04 and 2.5E-04 during April-September and October-March, respectively, indicating that children were the most vulnerable to arsenic-carcinogenic oral effects. While lead's CR oral values for children during April-September exceeded the threshold of 1.0E-04, chromium's oral and dermal CR values for both adults and children were 2.08E-04, 6.11E-04, 1.97E-04, and 5.82E-04 during April-September and October-March, respectively. These results demonstrate the potential carcinogenic risks related to chromium exposure within the two pathways in Hungary and highlight the need for effective measures to mitigate these risks.

Oral Anticoagulation and Adverse Outcomes after Ischemic Stroke in Heart Failure Patients without Atrial Fibrillation.

BACKGROUND: The safety and effectiveness of oral anticoagulation (OAC) after an ischemic stroke in older patients with heart failure (HF) without atrial fibrillation remains uncertain. METHODS: Utilizing Get With The Guidelines Stroke national clinical registry data linked to Medicare claims from 2009-2014, we assessed the outcomes of eligible patients with a history of HF who were initiated on OAC during a hospitalization for an acute ischemic stroke. The cumulative incidences of adverse events were calculated using Kaplan-Meier curves and adjusted Cox proportional hazard ratios were compared between patients discharged on or off OAC. RESULTS: A total of 8,261 patients from 1,370 sites were discharged alive after an acute ischemic stroke and met eligibility criteria. Of those, 747 (9.0%) were initiated on OAC.  Patients on OAC were younger (77.2±8.0 vs. 80.5±8.9 years, p<0.01). After adjustment for clinical covariates, the likelihood of 1 year mortality was higher in those on OAC (aHR: 1.22, 95% CI 1.05-1.41, p<0.01), while no significant differences were noted for ICH (aHR: 1.34, 95% CI 0.69-2.59, p=0.38) and recurrent ischemic stroke (aHR: 0.78, 95% CI 0.54-1.15, p = 0.21).  The likelihood of all-cause bleeding (aHR: 1.59, 95% CI 1.29-1.96, p<0.01) and all-cause re-hospitalization (aHR: 1.14, 95% CI 1.02-1.27, p = 0.02) was higher for those on OAC. CONCLUSION: Initiation of OAC after an ischemic stroke in older patients with HF in the absence of atrial fibrillation is associated with death, bleeding and re-hospitalization without an associated reduction in recurrent ischemic stroke. If validated, these findings raise caution for prescribing OAC to such patients.

Association Between Exclusive Breastfeeding and Infant Health Outcomes in Pakistan.

PURPOSE: The infant mortality rate in Pakistan is one of the highest in the world with most cases attributed to diarrheal or respiratory diseases. Exclusive breastfeeding for the first 6 months of life is recommended by the World Health Organization to achieve optimal growth and health, however, in Pakistan the rate of exclusive breastfeeding by mothers is <40%. The aim of this study was to investigate the relationship of exclusive breastfeeding, diarrhea, acute respiratory infections and fever among infants under the age of 6 months. DESIGN AND METHODS: The cross-sectional study analyzed secondary data from the 2017-18 Pakistan Demographic and Health-Survey. The sampling frame for the current study consisted of last-born children who were under the age of 6 months. The study sample consisted of 1033 infants under the age of 6 months. RESULTS: The prevalence of exclusive breastfeeding was 53.6%. Compared to infants who were not breastfed exclusively, infants who were had lower odds of diarrhea, acute respiratory infection, and fever. The observed association was independent of potential confounders. CONCLUSIONS: Exclusive breastfeeding reduces the odds of childhood illnesses. Plausible explanations for the observed association may be related to human milk's contents including necessary nutrients to fulfill an infant's needs within first months of life. Additionally, continued exposure to breastfeeding also reduces exposure to other contaminated foods to ensure adequate nutrition for the infant. PRACTICE IMPLICATIONS: The findings have important implications for educating families and healthcare providers about the benefits of exclusive breastfeeding for optimal child health outcomes.