The role of environmental trace element toxicants on autism: A medical biogeochemistry perspective.

Since genetic factors alone cannot explain most cases of Autism, the environmental factors are worth investigating as they play an essential role in the development of some cases of Autism. This research is a review paper that aims to clarify the role of the macro elements (MEs), Trace elements (TEs) and ultra-trace elements (UTEs) on human health if they are greater or less than the normal range. Aluminium (Al), cadmium Cd), lead (Pb), chromium (Cr), zinc (Zn), copper (Cu), nickel (Ni), arsenic (As), mercury (Hg), manganese (Mn), and iron (Fe) have been reviewed. Exposure to toxicants has a chemical effect that may ultimately lead to autism spectrum disorder (ASD). The Cr, As and Al are found in high concentrations in the blood of an autistic child when compared to normal child reference values. The toxic metals, particularly aluminium, are primarily responsible for difficulties in socialization and language skills disabilities. Zinc and copper are important elements in regulating the gene expression of metallothioneins (MTs), and zinc deficiency may be a risk factor for ASD pathogenesis. Autistics frequently have zinc deficiency combined with copper excess; as part of the treatment protocol, it is critical to monitor zinc and copper levels in autistic people, particularly those with zinc deficiency. Zinc deficiency is linked to epileptic seizures, which are common in autistic patients. Higher serum manganese and copper significantly characterize people who have ASD. Autistic children have significantly decreased lead and cadmium in urine, whereas they have significantly higher urine Cr. A higher level of As and Hg was found in the ASD individual's blood.

Development of new computational machine learning models for longitudinal dispersion coefficient determination: case study of natural streams, United States.

Natural streams longitudinal dispersion coefficient (Kx) is an essential indicator for pollutants transport and its determination is very important. Kx is influenced by several parameters, including river hydraulic geometry, sediment properties, and other morphological characteristics, and thus its calculation is a highly complex engineering problem. In this research, three relatively explored machine learning (ML) models, including Random Forest (RF), Gradient Boosting Decision Tree (GTB), and XGboost-Grid, were proposed for the Kx determination. The modeling scheme on building the prediction matrix was adopted from the well-established literature. Several input combinations were tested for better predictability performance for the Kx. The modeling performance was tested based on the data division for the training and testing (70-30% and 80-20%). Based on the attained modeling results, XGboost-Grid reported the best prediction results over the training and testing phase compared to RF and GTB models. The development of the newly established machine learning model revealed an excellent computed-aided technology for the Kx simulation.

Prediction of sediment heavy metal at the Australian Bays using newly developed hybrid artificial intelligence models.

Hybrid artificial intelligence (AI) models are developed for sediment lead (Pb) prediction in two Bays (i.e., Bramble (BB) and Deception (DB)) stations, Australia. A feature selection (FS) algorithm called extreme gradient boosting (XGBoost) is proposed to abstract the correlated input parameters for the Pb prediction and validated against principal component of analysis (PCA), recursive feature elimination (RFE), and the genetic algorithm (GA). XGBoost model is applied using a grid search strategy (Grid-XGBoost) for predicting Pb and validated against the commonly used AI models, artificial neural network (ANN) and support vector machine (SVM). The input parameter selection approaches redimensioned the 21 parameters into 9-5 parameters without losing their learned information over the models' training phase. At the BB station, the mean absolute percentage error (MAPE) values (0.06, 0.32, 0.34, and 0.33) were achieved for the XGBoost-SVM, XGBoost-ANN, XGBoost-Grid-XGBoost, and Grid-XGBoost models, respectively. At the DB station, the lowest MAPE values, 0.25 and 0.24, were attained for the XGBoost-Grid-XGBoost and Grid-XGBoost models, respectively. Overall, the proposed hybrid AI models provided a reliable and robust computer aid technology for sediment Pb prediction that contribute to the best knowledge of environmental pollution monitoring and assessment.

Survival advantage with para aortic lymphadenectomy in peri-ampullary cancer: A retrospective cohort study.

BACKGROUND: Metastatic para aortic lymph nodes (PALN) in patients with peri ampullary cancer entail poor prognosis. Role of curative surgery in these patients remains debatable. The objective of the current study was to evaluate outcome after extended pancreaticoduodenectomy (PD) in patients with and without positive PALN. METHODS: We reviewed 65 patients who underwent extended PD with PALN removal between 2011 and 2014. Patients were divided into two groups; those with positive PALN and those without. Patients were sub classified for pancreatic and non-pancreatic cancer. Outcome was determined based on median and estimated 3 year overall survival. RESULTS: Median age was 57 (32-85) years. PALN were involved in 15 (23%) patients. Overall 3 year survival for patients with and without positive PALN was 60% and 54% (P = 0.7). Significant difference in survival was present between patients with pancreatic cancer and positive PALN [9 (3-12) months] versus non-pancreatic cancers with positive PALN [17.5 (13-38) months] (P = 0.02). Four out of five patients with pancreatic cancer and positive PALN had survival >6 months and 3 out of these 5 patients were alive at the last follow up. CONCLUSION: Curative surgery may benefit some patients with pancreatic cancer and positive PALN and should be considered selectively.

Short Term Donor Outcomes After Hepatectomy in Living Donor Liver Transplantation.

OBJECTIVE: To determine the outcome of living-donor liver transplant (LDLT) donors from the first liver transplant program in Pakistan. STUDY DESIGN: Cohort study. PLACE AND DURATION OF STUDY: Shifa International Hospital, Islamabad, from April 2012 to August 2014. METHODOLOGY: A total of 100 live donors who underwent hepatectomy were included. Demographics, etiologies, graft characteristics and operative variables were retrospectively assessed. Outcome was assessed based on morbidity and mortality. RESULTS: Median donor age was 28 (17 - 45) years and median body mass index (BMI) was 24 kg/m2 (15 - 36). Male to female ratio was 1.5:1. Hepatitis B and C were the most common underlying etiologies and accounted for 79/100 (79%) of LDLT's. Overall, 93/100 (93%) donors donated a right lobe graft. Median estimated graft weight to recipient body weight (GW/BW) ratio was 1.03 (0.78 - 2). Standard arterial anatomy was present in 56% donors. The 90-day morbidity was 13/100 (13%) and overall morbidity was 17/100 (17%). Bile leak was encountered in 3 (3%) patients. There was no donor mortality. CONCLUSION: Acceptable short-term donor outcomes were achieved in an LDLT program in Pakistan with careful donor selection and planning.

Is pancreaticodoudenectomy with vascular resection a safe procedure in developing country? Early outcomes and review of national literature.

INTRODUCTION: Safety of extended lymphadenectomy (EL) ± vascular resection in patients undergoing pancreaticoduodenectomy (PD) in resource limited settings is not well established. The objective of this study was to report outcomes of PD resection with EL ± vascular resection from Pakistan and review national literature. METHODS: Data of patients who underwent PD between 2011 and 2014 was reviewed. A total of 66 patients were included in the study. Primary outcome was 90 day morbidity and mortality. Secondary objective was 2 year overall survival. RESULTS: Median age was 57 (32-82) years. Majority patients had locally advanced (pT3/T4) tumors and nodal involvement i.e. 44 (71%) and 42 (67.8%). Mean number of excised lymph nodes and positive lymph nodes was 28.2 ± 12.8 (range 3-62) and 4.8 ± 6.9 (range 0-27) respectively. There were 13 vascular resections including 3 arterial resections. Overall 90 day morbidity was 31.8% and mortality was 3%. No difference in complication rate was observed in patients who did and did not undergo vascular resection i.e. 18% versus 34.5% (P = 0.1). Similarly, median survival was 11 (3-24) months and 11 (1-36) months and not significantly different (P = 0.5). CONCLUSION: In developing countries, extended lymphadenectomy with vascular resection can be safely performed with pancreaticoduodenectomy in specialized hepatobiliary units.

The travails of setting up a living donor liver transplant program: Experience from Pakistan and lessons learned.

Living donor liver transplantation (LDLT) is the only treatment option for patients with end-stage liver disease (ESLD) where cadaveric donors are not available. In developing countries, the inception of LDLT programs remains a challenge. The first successful liver transplantation program in Pakistan started transplantation in 2012. The objective of this study was to report outcomes of 100 LDLT recipients in a developing country and to highlight the challenges encountered by a new LDLT program in a resource-limited setting. We retrospectively reviewed recipients who underwent LDLT between April 2012 and August 2014. Demographics, etiology, graft characteristics, and operative variables were assessed. Outcome was assessed on the basis of morbidity and mortality. All complications of ≥ 3 on the Clavien-Dindo grading system were included as morbidity. Estimated 1-year survival was calculated using Kaplan-Meier curves, and a Log-rank test was used to determine the significance. Outcomes between the first 50 LDLTs (group 1) and latter 50 LDLTs (group 2) were also compared. Median age was 46.5 (0.5-72) years, whereas the median MELD score was 15.5 (7-37). The male to female ratio was 4:1. ESLD secondary to hepatitis C virus was the most common indication (73% patients). There were 52 (52%) significant (≥ grade 3) complications. The most common morbidities were bile leaks in 9 (9%) and biliary strictures in 14 (14%) patients. Overall mortality in patients who underwent LDLT for ESLD was 10.6%. Estimated 1-year survival was 87%. Patients who underwent transplantation in the latter period had a significantly lower overall complication rate (36% versus 68%; P = 0.01). Comparable outcomes can be achieved in a new LDLT program in a developing country. Outcomes improve as experience increases.

Comparison of once a day rifaximin to twice a day dosage in the prevention of recurrence of hepatic encephalopathy in patients with chronic liver disease.

BACKGROUND: Rifaximin has been used for prevention of recurrence of hepatic encephalopathy in twice a day dosage. The drug is expensive and lower dising may be possible. OBJECTIVE: To determine the efficacy of rifaximin once a day dose in the prevention of hepatic encephalopathy (HE) in patients with liver cirrhosis as compared with twice daily dose of rifaximin. METHODS: This Randomized control trial was carried out at the Department of Gastroenterology and Hepatology, Shifa International Hospital, Islamabad, Pakistan from November 2012 to February 2014. Patients with known chronic liver disease with at least one episode of HE in the past were randomized to group A (rifaximin 550 mg OD) and group B (rifaximin 550 mg BD), after fulfilling the inclusion criteria. Each patient was followed for 6 months for any episode of HE. Patients in each group were identified for any breakthrough episode of encephalopathy during this period. Data were analyzed using SPSS version 16. Chi-squared test and t-test were applied where required to determine the significant difference between the two groups. RESULTS: There were a total of 306 patients: 128 patients in Group A while 178 in group B. Majority of patients (75.81%) had hepatitis C virus with mean age of 52.30 ± 9.92, MELD score 13.58 ± 8.3, and 55.22% were in Child-Pugh B. Eighty-one patients had an episode of HE during the study period. There were 27 patients in group A and 54 patients in group B with breakthrough episode of HE (P = 0.088). CONCLUSION: This study suggests that there is no significant difference in rifaximin once a day or twice daily dose in preventing HE.

Assessment of sulfurous springs in the west of Iraq for balneotherapy, drinking, irrigation and aquaculture purposes.

This research deals with the sulfurous spring waters flow along the course of the Euphrates River in western Iraq in the area extended between Haqlaniya and Hit within the Al-Anbar governorate. Eleven springs (3 in Haqlanya, 4 in Kubaysa and 4 in Hit) have been addressed for the purpose of water evaluation for balneology, drinking, irrigation and aquaculture (fish farming). In order to meet the objectives of this research, all springs were sampled and analyzed for the total dissolved solid, electrical conductivity, pH, temperature, major cations (Ca(2+), Mg(2+), Na(+) and K(+)), major anions (SO(4)(2-), Cl(-), HCO(3)(-) and CO(3)(2-)), minor anions (PO(4)(3-)and NO(3)(-)) as well as the trace elements that included Pb, Zn, Cd, Ni, Fe, Mn, Cu, Br, F, Ba, B, Sr, Al, As, Cr, Hg and Se. The International Standards of World Health Organization are used for assessing the water quality. The results revealed that the springs belong to the tepid springs of 27-30 °C and classified as hypothermal to the thermal springs. Lithochemistry and geochemical processes clearly affected the water chemistry. The hydrogeochemical processes are responsible for the element enrichment in water by the chemical dissolution of carbonate and gypsum and evaporation as well. The results of the study indicate the possibility of using spring water for therapeutic purposes, but not allowed for drinking and aquaculture (fish farming), except those free of H(2)S gas. On the other hand, it can be used for irrigation with risk. However, soil type as well as proper selection of plants should be taken into consideration.

Validaty of Siriraj Stroke Scoring.

OBJECTIVE: To study the sensitivity and specificity of Siriraj Stroke Scoring (SSS) and to validate the accuracy of SSS in acute supratentorial stroke syndromes. DESIGN: Noninterventional descriptive study. PLACE AND DURATION OF STUDY: Department of Neurology, Pakistan Institute Of Medical Sciences, Islamabad, and Department of Medicine, Federal Government Services Hospital, Islamabad, from July to December 2000 and February to July 2002, respectively. SUBJECTS AND METHODS: One hundred (100) consecutive cases of acute supratentorial strokes were studied in accordance with SSS and sensitivity and specificity of SSS for supratentorial infarction and haemorrhage was tested against the computerised brain scanning (CT) as a gold standard. Siriraj Stroke Scoring was applied. Patients with subarachnoid haemorrhage and transient ischemic attacks were excluded from the study. The findings were recorded, compared and statistically analyzed. RESULTS: Out of 100 patients 45 were male and 55 female with mean age of 59 years. Sixty-two patients had hypertension, 36 patients had one or more atheroma markers (diabetes, coronary artery disease and claudication). Mean diastolic blood pressure was 98 mmHg with range of 60-140 mmHg and mean systolic blood pressure of 163 mmHg with the range of 90-240 mmHg. Forty-eight patients had cerebral infarction, 36 had cerebral hemorrhage while 16 were borderline cases on the basis of Siriraj stroke scoring. CT brain showed 56 and 39 patients had cerebral infarction and haemorrhage respectively while 5 of CT scans were normal. The sensitivity and specificity of SSS for cerebral infarction was 71 and 85 respectively and for intracerebral haemorrhage, it was 73 and 90 respectively. The positive predictive values of SSS for cerebral infarction and haemorrhage were 87% and 83 respectively. CONCLUSION: The siriraj stroke scoring system is a valid and specific scoring system for the diagnosis of acute supratentorial stroke and intracerebral haemorrhage.