A pilot study of alternative substrates in the critically Ill subject using a ketogenic feed.

Bioenergetic failure caused by impaired utilisation of glucose and fatty acids contributes to organ dysfunction across multiple tissues in critical illness. Ketone bodies may form an alternative substrate source, but the feasibility and safety of inducing a ketogenic state in physiologically unstable patients is not known. Twenty-nine mechanically ventilated adults with multi-organ failure managed on intensive care units were randomised (Ketogenic n = 14, Control n = 15) into a two-centre pilot open-label trial of ketogenic versus standard enteral feeding. The primary endpoints were assessment of feasibility and safety, recruitment and retention rates and achievement of ketosis and glucose control. Ketogenic feeding was feasible, safe, well tolerated and resulted in ketosis in all patients in the intervention group, with a refusal rate of 4.1% and 82.8% retention. Patients who received ketogenic feeding had fewer hypoglycaemic events (0.0% vs. 1.6%), required less exogenous international units of insulin (0 (Interquartile range 0-16) vs.78 (Interquartile range 0-412) but had slightly more daily episodes of diarrhoea (53.5% vs. 42.9%) over the trial period. Ketogenic feeding was feasible and may be an intervention for addressing bioenergetic failure in critically ill patients. Clinical Trials.gov registration: NCT04101071.

Arsenic burden in e-waste recycling workers - A cross-sectional study at the Agbogbloshie e-waste recycling site, Ghana.

The export of e-waste from industrialized to developing countries has led to the formation of a large-scale informal e-waste recycling sector in Accra, Ghana. During recycling processes, workers are exposed to several hazardous substances, such as heavy metals. As a common component of e-waste, inorganic arsenic can be released during e-waste recycling processes. The aim of this study was to assess the exposure to inorganic arsenic species in e-waste workers compared to a control group. N = 84 e-waste workers and n = 94 control subjects were included in this analysis. Inorganic arsenic species were determined in urine samples using HPLC-ICP-MS. E-waste workers showed higher median concentrations of As(III), As(V), MMA, DMA and the sum of inorganic arsenic in comparison to the control group. More than 80% of the e-waste workers exceeded the acceptable concentration (14 µg/L), which was significantly higher in comparison to the control group (70%). The tolerable concentration (40 µg/L) was exceeded in 17.2% of the participants, meaning a statistically relevant risk of developing cancer due to arsenic exposure throughout their (working) life. In conclusion, the exposure to inorganic arsenic is not only a problem of informal e-waste recycling, but a major public health concern that needs further investigation.

Health Consequences for E-Waste Workers and Bystanders-A Comparative Cross-Sectional Study.

Informal e-waste recycling is associated with several health hazards. Thus far, the main focus of research in the e-waste sector has been to assess the exposure site, such as the burden of heavy metals or organic pollutants. The aim of this study was to comprehensively assess the health consequences associated with informal e-waste recycling. A questionnaire-based assessment regarding occupational information, medical history, and current symptoms and complaints was carried out with a group of n = 84 e-waste workers and compared to a control cohort of n = 94 bystanders at the e-waste recycling site Agbogbloshie. E-waste workers suffered significantly more from work-related injuries, back pain, and red itchy eyes in comparison to the control group. In addition, regular drug use was more common in e-waste workers (25% vs. 6.4%). Both groups showed a noticeable high use of pain killers (all workers 79%). The higher frequency of symptoms in the e-waste group can be explained by the specific recycling tasks, such as burning or dismantling. However, the report also indicates that adverse health effects apply frequently to the control group. Occupational safety trainings and the provision of personal protection equipment are needed for all workers.