Potential human health hazard due to bioavailable heavy metal exposure via consumption of plants with ethnobotanical usage at the largest chromite mine of India.

Usage of native plant species for traditional medicine or nutritional supplement is a popular practice among various cultures. But consumption of plants growing on polluted soil can cause serious human health hazard due to bioaccumulation of toxic heavy metals. Present study deals with the ecological and human health impact of heavy metals, in six native plant species with ethnobotanical significance growing at the largest chromite mine of India. Exchangeable, oxidizable, reducible and residual fractions of the metals in plant rhizosphere were analyzed. Only 2-6% of total Cr (270-330 mg/kg) and Ni (150-190 mg/kg) at the mining site is bioavailable. Cd showed highest bioavailability (~ 60%) in mining site posing very high ecological risk (1055-5291) followed by Ni (1297-2124) and Cr (309-1105). The heavy metals in the shoot of the targeted plants were about 0.7 to 80 times higher than the standard limit as per Indian statutory body. The total hazard quotient (THQ) by the consumption of plants growing in mining region was very high (> 1) and varied from 2.6 to 5.9 in adult and 0.6-1.3 in children, while in non-mining region the THQ of same plants indicates low risk (< 1). This study indicates THQ (adult) in the order of, Euphorbia hirta (5.9) > Calotropis procera (4.9) > Argemone mexicana (3.6) > Vernonia cinerea (3.5) > Pteridium latiusculum (3.4) > Tridax procumbens (2.6) through consumption pathway growing in mine soil. This study concludes that consumption of plants growing in heavy metal polluted soil should be avoided due to their potential health hazard.

Consensus recommendations for essential vascular care in low- and middle-income countries.

OBJECTIVE: Many low- and middle-income countries (LMICs) are ill equipped to care for the large and growing burden of vascular conditions. We aimed to develop essential vascular care recommendations that would be feasible for implementation at nearly every setting worldwide, regardless of national income. METHODS: The normative Delphi method was used to achieve consensus on essential vascular care resources among 27 experts in multiple areas of vascular care and public health as well as with experience in LMIC health care. Five anonymous, iterative rounds of survey with controlled feedback and a statistical response were used to reach consensus on essential vascular care resources. RESULTS: The matrices provide recommendations for 92 vascular care resources at each of the four levels of care in most LMICs, comprising primary health centers and first-level, referral, and tertiary hospitals. The recommendations include essential and desirable resources and encompass the following categories: screening, counseling, and evaluation; diagnostics; medical care; surgical care; equipment and supplies; and medications. CONCLUSIONS: The resources recommended have the potential to improve the ability of LMIC health care systems to respond to the large and growing burden of vascular conditions. Many of these resources can be provided with thoughtful planning and organization, without significant increases in cost. However, the resources must be incorporated into a framework that includes surveillance of vascular conditions, monitoring and evaluation of vascular capacity and care, a well functioning prehospital and interhospital transport system, and vascular training for existing and future health care providers.

Dynamic article: composite antropyloric valve and gracilis muscle transposition for total anorectal reconstruction: a preliminary report.

BACKGROUND: Technique and functional outcomes of anorectal reconstruction using an antropyloric graft have been reported previously. This technique had reasonable initial outcomes but lacked voluntary function. OBJECTIVE: We hereby report the initial results of patients who underwent gracilis muscle wrapping around the perineally transposed antropyloric valve in an attempt to improve voluntary fecal control. SETTING: This study was conducted at a single tertiary care institution. PATIENTS: Eight adult patients (7 men and 1 woman) with a median age of 38 years (range, 19-51 years) underwent this procedure. Seven patients already had anorectal reconstruction with a transposed antropyloric valve, and 1 patient with severely damaged anal sphincter complex underwent single-stage composite antropylorus transposition with a gracilis muscle wrap. MAIN OUTCOME MEASURES: The primary outcome measures were anatomical integrity and functional status of the composite graft in the perineum. RESULTS: No operative mortality or serious procedure-related morbidity occurred in any patient. The median postoperative resting pressure was 29 mmHg (range, 22-38 mmHg) and squeeze pressure was 72.5 mmHg (range, 45-267 mmHg). There was a significant improvement in the squeeze pressure following surgery (p = 0.039). Also, the St. Mark's incontinence scores significantly improved in all patients and varied between 7 and 9 (p = 0.003). The ability to defer defecation and the reduced frequency of leakage accidents were the prime reasons for improved postgraciloplasty outcomes in these patients. On personal interviews, all patients who underwent this procedure were satisfied with the results of their surgery. LIMITATIONS: A longer follow-up with a larger sample size is required. Quality-of-life data have not been evaluated in this study. CONCLUSIONS: Gracilis muscle wrapping around a perineally transposed antropyloric valve is possible and improves the voluntary control and overall functional outcomes in a select group of patients with end-stage fecal incontinence requiring anal replacement (Supplemental Digital Content 1, http://links.lww.com/DCR/A173).