Hydrogeochemical appraisal, sources, quality and potential health risk assessment in Holocene and Pleistocene aquifers in Bangladesh.

This study integrated hydrochemical analysis, isotopic analysis, the integrated water quality index (IWQI), and the health risk assessment model to analyze hydrochemical characteristics, quality, and nitrate health risks in a typical agricultural and industrial (i.e., Holocene and Pleistocene) simultaneously affected by anthropogenic activities, as well as to explore the recharge mechanisms of the groundwater. The shallow groundwater is mainly Ca-HCO3- and deep groundwater is mainly Na-HCO3- types. In shallow and intermediate aquifers (Holocene), rainfall recharge is seen, but in deep aquifers (Holocene) and the Madhupur tract (Pleistocene), there is no evidence of recent recharge from the stable isotopic (δ2H‰ and δ18O‰) composition of groundwater. Anthropogenic sources significantly impacted the groundwater chemistry of shallow and intermediate aquifers more than geogenic sources. Most metalloids, and metals (As, and Cr, Fe, Ni, Pb, and Mn) and NO3- exceed the WHO-2011 and BD acceptable limit from shallow and intermediate groundwater. PCA analysis revealed the contamination of shallow and intermediate aquifers by metalloids, metals and from various anthropogenic activities. Based on the IWQI, HPI, HEI, and DC, groundwater samples from shallow and intermediate aquifers are unsuitable for oral consumption. The NPI shows that the metalloids, and metals are responsible for groundwater pollution in a descending order of As > Fe > Pb > Ni > Cr > Mn. Health risk assessment indicates oral and dermal consumption of contaminated water from shallow and intermediate aquifers can pose carcinogenic and non-carcinogenic health risks for both the adults and the children. The HQ and HI values of shallow and intermediate groundwater indicates higher non-carcinogenic risk. Carcinogenic risk through oral and dermal consumption follows an order of As > Ni > Cr > Pb and Ni > Cr > As > Pb, respectively. Compared to adults, children are more susceptible to both carcinogenic and non-carcinogenic risks. Potential threats to the health of people living in the study region need immediate attention from the public, government, and the scientific community.

Immunogenicity and safety of SARS-CoV-2 recombinant protein subunit vaccine (IndoVac) adjuvanted with alum and CpG 1018 in Indonesian adults: A phase 3, randomized, active-controlled, multicenter trial.

BACKGROUND: Bio Farma has developed a recombinant protein subunit vaccine (IndoVac) that is indicated for active immunization in population of all ages. This article reported the results of the phase 3 immunogenicity and safety study in Indonesian adults aged 18 years and above. METHODS: We conducted a randomized, active-controlled, multicenter, prospective intervention study to evaluate the immunogenicity and safety of IndoVac in adults aged 18 years and above. Participants who were SARS-CoV-2 vaccine-naïve received two doses of either IndoVac or control (Covovax) with 28 days interval between doses and were followed up until 12 months after complete vaccination. RESULTS: A total of 4050 participants were enrolled from June to August 2022 and received at least one dose of vaccine. The geometric mean ratio (GMR) of neutralizing antibody at 14 days after the second dose was 1.01 (95 % confidence interval (CI) 0.89-1.16), which met the WHO non-inferiority criteria for immunobridging (95 % CI lower bound > 0.67). The antibody levels were maintained through 12 months after the second dose. The incidence rate of adverse events (AEs) were 27.95 % in IndoVac group and 32.15 % in Covovax group with mostly mild intensity (27.70 %). The most reported solicited AEs were pain (14.69 %) followed by myalgia (7.48 %) and fatigue (6.77 %). Unsolicited AEs varied, with each of the incidence rate under 5 %. There were no serious AEs assessed as possibly, probably, or likely related to vaccine. CONCLUSIONS: IndoVac in adults showed favourable safety profile and elicited non-inferior immune response to Covovax. (ClinicalTrials.gov: NCT05433285, Indonesian Clinical Research Registry: INA-R5752S9).

Single Anastomosis Duodeno-Ileal Bypass (SADI) as a Second Step After Failed Sleeve Gastrectomy:Systematic Review and Meta-analysis

Purpose@#Our aim in this study is to assess single anastomosis duodeno-ileal bypass (SADI) as a salvage procedure following sleeve gastrectomy (SG), examining its technical feasibility, outcomes, and potential complications. @*Materials and Methods@#A systematic review and meta-analysis were conducted, drawing data from PubMed, Medline, and the Cochrane library. The analysis encompassed 14 studies, involving 1,066 patients. We evaluated operative time, comorbidity resolution (hypertension, dyslipidemia, diabetes), post-operative diarrhea incidence, excess weight loss (EWL) at six, twelve, and twenty-four months, and post-operative leak rates. @*Results@#SADI as a salvage procedure following SG yielded positive outcomes. Mean operative time was 125.98 minutes (95% CI 102.50–149.46, I 2 =99%). Importantly, SADI led to comorbidity resolution in a notable proportion of cases: hypertension in 48% (95% CI 38–57%, I 2 =44%), dyslipidemia in 55% (95% CI 40–69%, I 2 =30%), and diabetes in 63% (95% CI 53–72%, I 2 =30%) of patients. Post-operative diarrhea incidence was relatively low at 2% (95% CI 1–9%, I 2 =75%).In terms of weight loss, SADI patients exhibited substantial EWL: 47.73% (95% CI 37.86–57.61, I 2 =95%) at six months, 59.39% (95% CI 51.18–67.61, I 2 =95%) at twelve months, and 23.84% (95% CI 5.76–41.92, I 2 =100%). At twenty-four months. Furthermore, post-operative leak rate was relatively low, reported in only 1% (95% CI 0–5%, I 2 =80%) of cases. @*Conclusion@#SADI as a salvage procedure post-SG demonstrates technical feasibility and marked effectiveness. It offers substantial comorbidity resolution, significant weight loss, and low post-operative complication rates, notably post-operative leaks. Further research should investigate the long-term impact of SADI on patient nutritional status to facilitate its broader adoption.