Occurrence and risk evaluation of endocrine-disrupting chemicals in wastewater and surface water of Lahore, Pakistan.

The current study highlights the occurrence, spatial distribution, and risk assessment of 16 endocrine-disrupting chemicals (EDCs) including their transformation products (TPs) in the wastewater and surface water of Lahore, Pakistan, using solid-phase extraction followed by liquid chromatography-mass spectrometry and gas chromatography-mass spectrometry. The parent EDCs include bisphenol A (BPA), triclosan (TCS), triclocarban (TCC), estrone (E1), estradiol (E2), estriol (E3), ethinylestradiol (EE2), 4-n-octylphenol (4n-OP), and 4-n-nonylphenol (4n-NP). The TPs include two TPs each of BPA, TCC, and estrogens along with a TP of TCS. Most EDCs showed 100% detection frequency in the wastewater with highest median concentration of 1310 ng/L for E3. In the surface water, the highest median concentration was, however, observed for BPA (54.6 ng/L). Spatial variations in terms of sum of concentration due to all EDCs and their TPs were observed at different sampling points which suggest contamination due to industrial waste from nearby industrial estate. Risk evaluation in terms of risk quotient (RQ) and estradiol equivalent factor (EEQ) showed that most of EDCs and their TPs could pose high risk and estrogenicity to the surrounding environment. From the results of the current study, it is observed that the environment of Pakistan is deteriorating and is potential risk for endocrine disruption. It is, therefore, recommended to take stringent measures to make it sustainable for current as well as for future generations.

Tenofovir alafenamide associated fatal lactic acidosis in an autologous hematopoietic stem cell transplant recipient.

Fatal lactic acidosis has been reported while on the treatment with Nucleoside/nucleotide analogues (NA) for the treatment of hepatitis B, C and HIV. No cases of such a complication have been reported in hematopoietic stem cell transplant (HSCT) recipients. We present a 65-year male who underwent autologous HSCT for the treatment of multiple myeloma. Prior to transplant he was started on single agent tenofovir alafenamide (TAF) for treatment of resolved hepatitis B infection. He presented few weeks later with severe lactic acidosis. Other causes of lactic acidosis were excluded. The patient died of multi-organ failure despite stopping TAF and aggressive supportive care. The case demonstrates the need for increased awareness of this potential complication of NA treatment in the course of transplantation.

Optical coherence tomography assisted retinal nerve fibre layer thickness profile in high myopia.

INTRODUCTION: To evaluate the association of high myopia with retinal nerve fibre layer (RNFL) thickness by Fourier domain optical coherence tomography (FD OCT). MATERIALS AND METHODS: Fifty highly myopic eyes (25 patients) and forty emmetropic eyes (20 Normal subject) were randomly selected after excluding concomitant ophthalmic disorder and RNFL thickness measured using the Fourier domain optical coherence tomography (FD OCT). RESULTS: The overall mean RNFL thickness in the myopic groups and control were 87.89 µm and 111.64 µm respectively. The mean retinal nerve fibre thickness was significantly less in myopic eyes as compared to control group (p =0.0001). Retinal nerve fibre layer thickness shows topographic double hump pattern in both the groups (myopes and emmetropes). CONCLUSION: Retinal nerve fibre thickness was significantly less in myopic eyes as compared to emmetropic eyes. The retinal nerve fibre layer thinning in high myopes may be confused with open angle glaucoma, a disease also prevalent in high myopes. There is therefore a need to have retinal nerve fibre layer thickness normogram for high myopes of a given population group to avoid wrong interpretation.