Impact of leather industries on fluoride dynamics in groundwater around a tannery cluster in South India.

The aim of this study was to investigate the controls of leather industries on fluoride contamination in and around a tannery cluster in Vaniyambadi. Hydrochemical analysis, mineral saturation indices and statistical methods were used to evaluate the intervening factors that controls the contamination processes. Fluoride in groundwater is exceeded the WHO guideline value (1.5 mg/L), in 62 % of the samples, mostly with Na-HCO3 and Na-Cl type of water. Results of the principal component analysis grouped Na, F, HCO3 and NO3 under component 1. This result was in agreement with the cross plot indicating high positive correlation between F and Na (r (2)  = 0.87), HCO3 (r (2)  = 0.84) and NO3 (r (2)  = 0.55). Fluorite (CaF2) and Halite (NaCl) was undersaturated, while calcite (CaCO3) was oversaturated for all the samples. This suggest more dissolution of F-rich minerals under the active supports of Na. Bivariate plots of Na versus Cl and Na + K versus HCO3 showed a combined origin of Na from tannery effluent as well as silicate weathering. Two major clusters, based on the Na, HCO3 and F concentration showed that groundwater is affected by tanneries and silicate weathering. Fluoride concentration in 38 % of samples (n = 5) have significantly affected by the high Na concentration from tanneries.

Assessment of fluoride contamination in groundwater as precursor for electrocoagulation.

The Present study was conducted in January 2010, in order to assess the fluoride contamination in the Thirupathur Taluk. The major objective of this study was to locate the vulnerable areas in terms of fluoride contamination. The range of fluoride concentration varied between .26 and 2.75 mg/L. 60 % of the samples were above the permissible limit. Good correlation was observed between pH, Na, HCO(3), CO(3) TDS and NO(3). A negative correlation showed by Ca and K. The results show that Geochemistry of these ions controls the Fluoride concentration in the study area. All the samples exceeded the permissible limit of F was characterized by Na-HCO(3) type of water. A fairly good correlation between F and NO(3) suggest an anthropogenic input of F, mainly from the agricultural fields. Spatial distribution map of Fluoride shows very high concentration in the SW part of the study area.

Appraisal of heavy metals in groundwater in Chennai city using a HPI model.

Heavy metal contamination in Chennai city was evaluated using a heavy metal pollution index (HPI) model in conjunction with the spatial distribution maps. Metals such as Cd, Cr, Cu, Pb and Zn in the groundwater were determined using standard methods and the resultant data was utilized in the development of a HPI model. The metal concentrations showed a dominance in the order of Zn > Cu > Cr > Pb > Cd respectively. About 14.3 % of the samples (n = 2), exhibited high HPI (>38) and the highest value, HPI = 97.55, has been recorded from Thiruvanmiyur area. Statistical analysis revealed a positive correlation between metals such as Cd and Cr (r = 0.606), Cd and Cu (r = 0.601), Cr and Cu (r = 0.464) and Pb and Zn (r = 0.416), suggested their common origin. The spatial distribution maps of heavy metals and the HPI suggested that the SW region, especially Adyar and Thiruvanmiyur regions are highly contaminated with the metals. Industrialisation and improper waste dumping were identified as the major cause for the accumulation of metals in the groundwater of Chennai city.

Analysis on COVID-19 Infection Spread Rate during Relief Schemes Using Graph Theory and Deep Learning.

The novel coronavirus 2019 (COVID-19) disease is a pandemic which affects thousands of people throughout the world. It has rapidly spread throughout India since the first case in India was reported on 30 January 2020. The official report says that totally 4, 11,773 cases are positive, 2, 28,307 recovered, and the country reported 12,948 deaths as of 21 June 2020. Vaccination is the only way to prevent the spreading of COVID-19 disease. Due to various reasons, there is vaccine hesitancy across many people. Hence, the Indian government has the solution to avoid the spread of the disease by instructing their citizens to maintain social distancing, wearing masks, avoiding crowds, and cleaning your hands. Moreover, lots of poverty cases are reported due to social distancing, and hence, both the center government and the respective state governments decide to issue relief funds to all its citizens. The government is unable to maintain social distancing during the relief schemes as the population is huge and available support staffs are less. In this paper, the proposed algorithm makes use of graph theory to schedule the timing of the relief funds so that with the available support staff, the government would able to implement its relief scheme while maintaining social distancing. Furthermore, we have used LSTM deep learning model to predict the spread rate and analyze the daily positive COVID cases.

Grounding a natural background level for fluoride in a potentially contaminated crystalline aquifer in south India.

Fluoride contamination is one of the most alarming issues for those countries that depend on groundwater drinking water supply. A careful examination of the hydrogeochemical conditions and routine monitoring of fluoride level are therefore quintessential. Estimation of natural background level (NBL) of fluoride becomes significant information for assessing the current and future contamination episodes. Vellore District in Tamil Nadu is a hard rock terrain known for its F-rich groundwater. In this study, we attempted to form a benchmark for fluoride using hydrochemical pre-selection (based on TDS and NO3) and cumulative probability plots (CPP). Principle components analysis is (PCA) applied to evaluate the corresponding factor grouping of the total of 68 samples, which is later mapped using geostatistical tool in ArcGIS. From the CPP, we derived the NBL of F as 0.75 mg/L. This value is compared with the observed concentration in each sample and they were spatially plotted based on the NBL. Resultant plot suggests that W-NW part of the study area has exceeded and E-EW regions are below the NBL of F. Spatial variation of the factor scores also supported this observation. Grounding an NBL and extending it to other parts of the potential contaminated aquifers are highly recommended for better understanding and management of the water supply systems.

Cellular infiltrate of the jejunum after re-introduction of dietary gluten in children with treated coeliac disease.

Jejunal lamina propria plasma cells and eosinophils and intraepithelial lymphocytes were raised in coeliac children on gluten-containing diets, but only intraepithelial lymphocytes were increased in patients on gluten-free diets. In contrast, lamina propria lymphocytes were reduced in children with coeliad disease on gluten-containing diets but were normal in paitents on gluten-free diets. In children with coeliac disease who were studied serially, lamina propria plasma cells and eosinophils and intraepithelial lymphocytes increased, and lamina propria lymphocytes decreased, within three months of the reintroduction of gluten to the diet. These observations are essentially similar to those made in the adult form of the disease and suggest that more than one type of immunological reaction is involved in the pathogenesis of the jejunal lesion.

Immunological phenomena in the jejunum and serum after reintroduction of dietary gluten in children with treated coeliac disease.

Jejunal mucosal immunoglobulin-containing cells of all three major classes (IgA, IgM, IgG) were increased in coeliac children on gluten-containing diets but only IgM cell numbers were raised in those on gluten-free diets. Patients with subtotal villous atrophy had greater numbers of immunoglobulin-containing cells than patients with normal mucosa. In previously treated patients studied before and after three months on a gluten-containing diet ther was an increase in all three classes of cell, IgM containing cells showing the greatest proportional rise. Basement membrane staining with anti-IgA serum occurred in coeliacs and was most intense in untreated patients. Apart from one patient with very low levels of serum IgA, serum immunoglobulins did not differ from normal. However, after reintroduction of gluten to the diet a significant fall in serum IgM concentrations occurred compared with levels in the same patients while on gluten-free diets. It seems probable that both IgA and IgM systems are important in the immunopathogenesis of the small intestinal lesion of childhood coeliac disease.

Does CagA contribute to ulcer pathogenesis in a developing country, such as Sudan?

BACKGROUND AND OBJECTIVE: In Western populations, peptic ulcer disease is closely associated with Helicobacter pylori (H. pylori) strains expressing the CagA antigen. In Africa the prevalence of H. pylori infection and peptic ulcer disease is high, although information regarding potential virulence factors is lacking. This study examines the prevalence of antibodies to CagA both in African patients with dyspepsia who are undergoing gastroscopy, and in asymptomatic healthy African volunteers. METHODS: Eighty two consecutive patients (median age 34 years, range 15-73 years), attending for gastroscopy were studied, of whom 78 (95.1%) were subsequently found to be Helicobacter positive. Three antral biopsies were obtained from each patient and 5 ml of blood was taken for determination of CagA seropositivity using western blot analysis. CagA seropositivity was also determined in 65 H. pylori positive healthy volunteers (median age 30 years, range 18-70 years), with no symptoms or previous history of gastroduodenal disease. RESULTS: Of the 78 H. pylori positive patients, CagA seropositivity was present in all 22 patients with active peptic ulcer disease (100%), in eight of nine patients with duodenitis (89%), in 15 of 19 patients with macroscopic gastritis (78.9%), and in 24 of 28 patients with a normal endoscopy (85.7%). On histological assessment, 46 patients had chronic active gastritis, 29 patients had gastritis with atrophy and three patients had intestinal metaplasia. CagA seropositivity rates were 84.7%, 93% and 100%, respectively, for these groups. In the 89 healthy volunteers studied, 57 of the 65 H. pylori positive subjects (87.7%) were seropositive for the CagA protein. CONCLUSIONS: As in Western countries, CagA seropositivity in this African population was closely related to endoscopic gastroduodenal disease, and to the presence of more advanced histological lesions in the antrum. However, there was also a high prevalence of CagA seropositivity in asymptomatic healthy individuals, suggesting that factors other than CagA predominate in ulcer pathogenesis in this population.

Effect of partial versus complete plantar fasciotomy on the windlass mechanism.

Eight adult below-knee cadaver specimens were placed in a testing machine and loaded to 350 newtons according to a strict protocol. Arch height and length measurements were obtained in each specimen with the toes resting on the foot plate, dorsiflexed to 30 degrees, and maximally dorsiflexed manually. The plantar fascia was then divided from medial to lateral in one-quarter increments, and the effect on arch height and length measurements was assessed using the same loading protocol. A consistent decrease in the arch-supporting function on sequential sectioning of the plantar fascia was encountered. A less consistent decrease in the arch-supporting function was reflected by the increase in the height of the arch with sequential sectioning of the plantar fascia. The study demonstrates that partial plantar fasciotomy decreases the arch-supporting function of the plantar fascia in addition to weakening the structure. Strict surgical indications for this type of procedure should be maintained.

Lack of association of MYO9B genetic variants with coeliac disease in a British cohort.

BACKGROUND AND AIMS: Development of coeliac disease involves an interaction between environmental factors (especially dietary wheat, rye, and barley antigens) and genetic factors (there is strong inherited disease susceptibility). The known human leucocyte antigen (HLA)-DQ2 and -DQ8 association explains only a minority of disease heritability. A recent study in the Dutch population suggested that genetic variation in the 3' region of myosin IXB (MYO9B) predisposes to coeliac disease. MYO9B is a Rho family GTPase activating protein involved in epithelial cell cytoskeletal organisation. MYO9B is hypothesised to influence intestinal permeability and hence intestinal antigen presentation. METHODS: Four single nucleotide polymorphisms were chosen to tag all common haplotypes of the MYO9B 3' haplotype block (exons 15-27). We genotyped 375 coeliac disease cases and 1366 controls (371 healthy and 995 population based). All individuals were of White UK Caucasian ethnicity. RESULTS: UK healthy control and population control allele frequencies were similar for all MYO9B variants. Case control analysis showed no significant association of any variant or haplotype with coeliac disease. CONCLUSIONS: Genetic variation in MYO9B does not have a major effect on coeliac disease susceptibility in the UK population. Differences between populations, a weaker effect size than originally described, or possibly a type I error in the Dutch study might explain these findings.

Is the xylose test still a worth-while investigation?

In a retrospective survey the results of a D-xylose absorption test have been assessed in relation to jejunal morphology and final diagnosis in 152 adult patients with various types of gastrointestinal disease. Neither urine excretion rates nor serum concentrations alone provide an adequate separation between patients with definite mucosal lesions and those without evidence of gut disease or with other types of gastrointestinal pathology.It is suggested that when a jejunal biopsy can readily be performed the xylose test serves little useful purpose in routine practice and can be positively misleading. It may still be useful as a screening test for referral for jejunal biopsy, provided that strict criteria of normality are applied.

Pulse oximetry saturation levels during routine unsedated diagnostic upper gastrointestinal endoscopy.

BACKGROUND: Diagnostic procedures account for over 90% of all upper gastrointestinal endoscopies. Pulse oximetry saturation (SpO2) levels were assessed in patients attending for routine unsedated diagnostic gastroscopy to identify factors associated with oxygen desaturation. METHODS: Three hundred and thirty unsedated patients were monitored with continuous pulse oximetry. A further 154 patients who requested sedation prior to endoscopy were studied as a positive control group. RESULTS: SpO2 levels were lower in sedated compared to unsedated patients (P < 0.0001). Six unsedated patients (2%) desaturated to 90% or less during endoscopy compared to 32 sedated patients (21%) (P < 0.0001). SpO2 levels in unsedated patients were not related to patient sex, age, cigarette smoking, endoscope diameter, basal SpO2 levels or duration of endoscopy. In contrast, examination of the pharyngeal area and epiglottis (P = 0.0002) and a longer intubation time (P = 0.0002) were associated with lower SpO2 levels. The lowest SpO2 level recorded during unsedated endoscopy was 88%. CONCLUSION: Pulse oximetry is not a prerequisite to performing routine unsedated diagnostic gastroscopy in patients without severe systemic disease.

The cellular infiltrate of the jejunum in adult coeliac disease and dermatitis herpetiformis following the reintroduction of dietary gluten.

The cellular infiltrate of the jejunal mucosa has been studied in patients with both treated and untreated adult coeliac disease and dermatitis herpetiformis and serially in treated patients before and after the reintroduction of gluten to the diet. In adult coeliac disease and dermatitis herpetiformis the jejunal mucosa showed similar abnormalities of the cellular infiltrate which was characterized by an increase in intraepithelial lymphocytes and lamina propria plasma cells and eosinophils, with the greatest numbers of cells occurring in untreated patients. At 24-48 hours following a single 25-g gluten challenge there was an increase in lamina propria plasma cells, lymphocytes and eosinophils and intraepithelial lymphocytes. This rise was sustained after seven days on a gluten-containing diet for all of these cell groups except lamina propria lymphocytes. These responses were essentially similar in both adult coeliac disease and in those dermatitis herpetiformis patients who had jejunal lesions before treatment. In dermatitis herpetiformis patients with normal jejunal morphology on a normal diet there was an upward trend in lamina propria plasma cells and intraepithelial lymphocytes within one to three weeks of taking extra dietary gluten. These results are compatible with the view that more than one immunological mechanism may be responsible for the pathogenesis of the jejunal lesion of coeliac disease and dermatitis herpetiformis.

Misoprostol in the prevention of gastroduodenal damage in rheumatology.

Patients receiving non-steroidal anti-inflammatory drugs (NSAIDs) are at an increased risk of gastroduodenal erosions, ulcers, and the associated complications of haemorrhage, perforation, and death. Many NSAID associated ulcers that bleed or perforate have been asymptomatic until the time of presentation and conversely many patients with dyspepsia do not have ulcers. Symptoms are a poor guide to the presence of an ulcer. During continued treatment with NSAIDs misoprostol is the best choice for NSAID induced gastroduodenal damage; it achieves higher rates of healing than other drugs in these circumstances. Misoprostol is superior to other drugs in the prevention of gastric damage but misoprostol and H2 antagonists are of similar benefit in the duodenum. Prophylactic studies have all used endoscopic damage as an endpoint, and much larger studies will be needed to show an effect of misoprostol on the incidence of ulcer complications. There are no clear guidelines as to which patients should receive prophylactic treatment with misoprostol but those particularly at risk of ulcer complications--that is, those with previous peptic ulceration, the elderly, medically unfit, patients receiving large doses of NSAIDs, and those patients receiving steroids in addition to NSAIDs--should be considered.

Case report: tuberculous colitis mimicking Crohn's disease.

Although intestinal tuberculosis is rare in this country, increasing numbers of patients are now being seen, particularly in the immigrant population. We present the history of a lady who had acute diarrhoea and in whom the radiological and endoscopic findings looked very similar to those seen in Crohn's disease. The radiological presentation included widespread aphthous ulceration, a feature that has rarely been reported in tuberculous colitis.

The incidence of joint involvement with adjacent osteomyelitis in pediatric patients.

Sixty-six patients admitted to our institution over an 8-year period with the diagnosis of osteomyelitis were analyzed to determine the incidence of adjacent joint involvement. Patients with osteomyelitis of the hand, foot, spine, and extraarticular pelvis were excluded from this study. The average age was 5.8 years (range, 1 month to 17 years). Forty-two percent of our patients who had osteomyelitis had evidence of adjacent joint involvement (either septic or nonseptic). One third of our patients had evidence of septic joint involvement. The most commonly involved joint was the knee. There was no difference in the incidence of adjacent joint involvement in those patients who were younger than 18 months compared with the incidence in older children. Our study suggests that the incidence of adjacent joint involvement in children who have osteomyelitis is higher than that suggested in the literature. We believe that careful evaluation of the adjacent joint should be an important part of the evaluation of any child who has osteomyelitis.

The microvillus in adult jejunal mucosa--an electron microscopic study.

The increase in surface area contributed by microvilli per square unit mucosal surface area in the jejunal villus, i.e. amplification factor, has been studied in four normal adults and three adults with treated coeliac disease. Villi were split into three regions, photomicrographs of microvilli were taken from each region and the microvillus amplification factor calculated. The mid-villus region contributed a significantly greater microvillus amplification factor than either the low or upper regions in all patients studied. In addition surface cell heights were greatest in the low- and mid-villus regions. This suggests that the enterocytes in the mid-villus region are best adapted for absorption, and that the enterocytes in the upper-villus regions are undergoing an ageing process.

Food antibodies in patients with dermatitis herpetiformis and adult coeliac disease - relationship to jejunal morphology.

Serum antibodies to a variety of dietary proteins were investigated in 26 patients with adult coeliac disease (ACD, 14 untreated and 17 treated with a gluten-free diet) and 38 patients with dermatitis herpetiformis (DH) with varying small bowel abnormalities. The incidence of one or more positive tests was highest in untreated ACD (73.4%) and DH with subtotal villous atrophy (57.4%). This incidence fell with morphological improvement, being 56.4% in treated ACD patients with partial villous atrophy (PVA), and 33.4% in DH with PVA, and 0% in DH with normal biopsies. The height of the serum antibody titre also fell with morphological improvement. These results show that there is an abnormally high incidence of dietary antibodies in patients with DH, and this correlates with the degree of small bowel damage.