Application of machine learning and multivariate approaches for assessing microplastic pollution and its associated risks in the urban outdoor environment of Bangladesh.

Microplastics (MPs) are an emerging global concern due to severe toxicological risks for ecosystems and public health. Therefore, this is the first study in Bangladesh to assess MP pollution and its associated risks for ecosystems and human health in the outdoor urban environment using machine learning and multivariate approaches. The occurrences of MPs in the urban road dust were 52.76 ± 20.24 particles/g with high diversity, where fiber shape (77%), 0.1-0.5 mm size MPs (75%), blue color (26%), and low-density polyethylene (24%) polymer was the dominating MPs category. Pollution load index value (1.28-4.42), showed severe pollution by MPs. Additionally, the contamination factor (1.00-5.02), and Nemerow pollution index (1.38-5.02), indicate moderate to severe MP pollution. The identified polymers based on calculated potential ecological risk (2248.52 ± 1792.79) and polymer hazard index (814.04 ± 346.15) showed very high and high risks, respectively. The occurrences of MPs could effectively be predicted by random forest, and support random vector machine, where EC, salinity, pH, OC, and texture classes were the influencing parameters. Considering the human health aspect, children and adults could be acutely exposed to 19259.68 and 5777.90 MP particles/ year via oral ingestion. Monte-Carlo-based polymers associated cancer risk assessment results indicate moderate risk and high risk for adults and children, respectively, where children were more vulnerable than adults for MP pollution risks. Overall assessment mentioned that Dhaka was the most polluted division among the other divisions.

Removal of hazardous textile dye from simulated wastewater by municipal organic solid waste charcoal using machine learning approaches: Kinetics, isotherm, and thermodynamics.

This study focuses on the probable use of municipal organic solid waste charcoal (MOSWC) as an adsorbent for Methyl orange (MO) adsorption. The prepared MOSWC is characterized by FE-SEM and FT-IR. Batch adsorption experiments were conducted with the influencing of different operational conditions namely time of contact (1-180 min), adsorbate concentration (60-140 mg/L), adsorbent dose (1-5 g/L), pH (3-11), and temperature (25-60 °C). The high coefficient value (R2 = 0.96) of the process optimization model suggests that this model was significant, where pH and adsorbent dose expressively stimulus adsorption efficiency including 40.11 mg/g at pH (3), MO concentration (100 mg/L), and MOSWC dose (1 g/L). Furthermore, the machine learning approaches (ANN and BB-RSM) revealed a good association between the tested and projected values. The highest monolayer adsorption capacity of MO was 90.909 mg/g. Pseudo-second-order was the well-suited kinetics, where Langmuir isotherm could explain better for equilibrium adsorption data. Thermodynamic study shows MO adsorption is favourable, exothermic, and spontaneous. Finally, this study indicates that MOSWC could be a potential candidate for the adsorption of MO from wastewater.

Black carbon derived PET plastic bottle waste and rice straw for sorption of Acid Red 27 dye: Machine learning approaches, kinetics, isotherm and thermodynamic studies.

This study focuses on the probable use of PET waste black carbon (PETWBC) and rice straw black carbon (RSBC) as an adsorbent for Acid Red 27 (AR 27) adsorption. The prepared adsorbent is characterized by FE-SEM and FT-IR. Batch adsorption experiments were conducted with the influencing of different operational conditions namely time of contact (1-180 min), AR 27 concentration (5-70 mg/L), adsorbent dose (0.5-20 g/L), pH (2-10), and temperature (25-60°C). High coefficient value [PETWBC (R2 = 0.94), and RSBC (R2 = 0.97)] of process optimization model suggesting that this model was significant, where pH and adsorbent dose expressively stimulus removal efficiency including 99.88, and 99.89% for PETWBC, and RSBC at pH (2). Furthermore, the machine learning approaches (ANN and BB-RSM) revealed a good association between the tested and projected value. Pseudo-second-order was the well-suited kinetics, where Freundlich isotherm could explain better equilibrium adsorption data. Thermodynamic study shows AR 27 adsorption is favourable, endothermic, and spontaneous. Environmental friendliness properties are confirmed by desorption studies and satisfactory results also attain from real wastewater experiments. Finally, this study indicates that PETWBC and RSBC could be potential candidates for the adsorption of AR 27 from wastewater.

Receptor model-based sources and risks appraisal of potentially toxic elements in the urban soils of Bangladesh.

Rapid urbanization and industrial development have prompted potentially toxic elements (PTEs) in urban soil in Bangladesh, which is a great concern for ecological and public health matters. The present study explored the receptor-based sources, probable human health and ecological risks of PTEs (As, Cd, Pb, Cr, Ni, and Cu) in the urban soil of the Jashore district, Bangladesh. The USEPA modified method 3050B and atomic absorption spectrophotometers were used to digest and evaluate the PTEs concentration in 71 soil samples collected from eleven different land use areas, respectively. The concentration ranges of As, Cd, Pb, Cr, Ni, and Cu in the studied soils were 1.8-18.09, 0.1-3.58, 0.4-113.26, 0.9-72.09, 2.1-68.23, and 3.82-212.57 mg/kg, respectively. The contamination factor (CF), pollution load index (PLI), and enrichment factor (EF) were applied to evaluate the ecological risk posed by PTEs in soils. Soil quality evaluation indices showed that Cd was a great contributor to soil pollution. The PLI values range was 0.48-2.82, indicating base levels to continuous soil degradation. The positive matrix factorization (PMF) model showed that As (50.3 %), Cd (38.8 %), Cu (64.7 %), Pb (81.8 %) and Ni (47.2 %) were derived from industrial sources and mixed anthropogenic sources, while Cr (78.1 %) from natural sources. The highest contamination was found in the metal workshop, followed by the industrial area, and brick filed site. Soil from all land use types revealed moderate to high ecological risk after evaluating probable ecological risks, and the descending order of single metal potential ecological risk was Cd > As > Pb > Cu > Ni > Cr. Ingestion was the primary route of exposure to potentially toxic elements for both adults and children from the study area soil. The overall non-cancer risk to human health is caused by PTEs for children (HI=0.65 ± 0.1) and adults (HI=0.09 ± 0.03) under USEPA safe limit (HI>1), while the cancer risks from exclusively ingesting As through soil were 2.10E-03 and 2.74E-04 for children and adults, respectively, exceeding the USEPA acceptable standard (>1E-04).

Human health risk ​and receptor model-oriented sources of heavy metal pollution in commonly consume vegetable and fish species of high Ganges river floodplain agro-ecological area, Bangladesh.

This study was intended to assess heavy metal contents and sources in commonly consumed vegetables and fish collected from the Jashore district of Bangladesh and to evaluate the probable human health risks via the ingesting of those vegetables and fish species. A total of 130 vegetable and fish samples were analyzed for As, Mn, Cu, Cr, Ni, and Pb concentration by an atomic absorption spectrophotometer. Metals and metalloids like As, Pb, and Cr in vegetable species were greater than the maximum allowable concentration (MAC), while Pb and cu in fish species exceeded the MAC. Pollution evaluation index values were ranges from 0.40-10.35 and 1.53-2.78 for vegetable and fish species, respectively, indicating light to serious pollution. Lactuca sativa followed by Cucurbita moschata, Amaranthus gangeticus for vegetables and Channa punctate, Oreochromis mossambicus, followed by Dendrobranchiata for fish are the most contaminated food items. The positive matrix factorization model showed that As (81.9%), Ni (48%), Cr (49.6%), Mn (46%), Pb (44.3%), and Cu (44.4%) for vegetable species and As (86.9%), Ni (90.5%), Mn (67.6%), Pb (65.3%), Cr (57%) and Cu (46.2%) for fish species were resulting from agrochemical, atmospheric emission, irrigation, contaminated feed, and mixed sources. The self-organizing map and principle component analysis indicates three spatial patterns e.g., As-Mn-Cu, Pb-Cr, and Ni in vegetables and As-Mn-Cr, Cu-Ni, and Pb in fish samples. The THQ values for single elements were less than 1 (except As for vegetables and Pb for fish species) for all food items but the HI values for all of the vegetables (2.18E+00 to 2.04E+01) and fish (1.07E+00 to 9.39E+00) samples were exceeded the USEPA acceptable risk level (HI > 1E+00). While the cancer risks only induced by As for all vegetables and fish species, which exceeded the USEPA safe level (TCR>1E-04). Sensitivity analysis indicates that metal concentration was the most responsible factor for carcinogenic risk.

Arsenic, iron, and manganese in groundwater and its associated human health risk assessment in the rural area of Jashore, Bangladesh.

This study investigated groundwater pollution and potential human health risks from arsenic, iron, and manganese in the rural area of Jashore, Bangladesh. Study results show that the mean value of groundwater pH is 7.25 ± 0.31, with a mean conductivity of 633.94 ± 327.41 µs/cm, while about 73, 97, and 91% of groundwater samples exceeded the Bangladesh drinking water standard limits for As, Fe, and Mn, respectively. Groundwater pollution evaluation indices, including the heavy metal pollution index, the heavy metal evaluation index, the degree of contamination, and the Nemerow pollution index, show that approximately 97, 82, 100, and 100% of samples are in the high degree of pollution category, respectively. Spatial distribution exhibited that the study area is highly exposed to As (73%), Fe (82%), and Mn (46%). In the case of non-carcinogenic health risk via oral exposure, about 94% of samples suggest a high category of risk for infants, and 97% of samples are found to be at high risk for children and adults. The carcinogenic risk of arsenic via an oral exposure pathway suggests that approximately 97% of the samples are found to be at high risk for infants, and all of the samples are at high risk for both adults and children.

Human health risk assessment of elevated and variable iron and manganese intake with arsenic-safe groundwater in Jashore, Bangladesh.

Groundwater through hand-operated tubewell (a type of water well) tapping is the main source of drinking water in Bangladesh. This study investigated iron and manganese concentration in groundwater across Jashore district-one of the worst arsenic contaminated area in Bangladesh. One working tubewell that had been tested previously for arsenic and marked safe (green) was selected from each unions of the district. Results revealed that approximately 73% and 87% of groundwater samples exceeded the limits for iron and manganese in Bangladesh drinking water, respectively. Additionally, spatial distribution of iron and manganese indicate that only 5% of the total surface area of groundwater is covered by safe level of iron and manganese. Human health risk due to ingestion of iron and manganese through drinking water was evaluated using hazard quotients (HQ) for adults and children. The result of the health risk assessment revealed that the non-carcinogenic health risks due to ingestion of iron (HQ up to 1.446 for adults and 0.590 for children) and manganese (HQ up to 2.459 for adults and 1.004 for children) contaminated groundwater are much higher among adults than children. On the basis of occurrences, spatial distribution and health risk assessment results, the area can be categorized as a high-risk zone for iron and manganese-related problems and needs special attention in order to protect public health of local residents.

Significance of Pulmonary Hypertension in Hypertrophic Cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is the most prevalent hereditary cardiac disease characterized by the presence of left ventricular and/or septal hypertrophy in the absence of other underlying cardiac disorders. Patients of HCM have a broad range of clinical presentation from being asymptomatic to severely ill condition requires hospitalization and urgent management. Broadly, HCM is classified in two variants: obstructive and nonobstructive. The mainstay of diagnosis is through echocardiography. As HCM chiefly affect the left heart, pulmonary hypertension (PH) is an expected complication of this disease. Though the existence of PH in HCM is known for a long time, its clinical significance, underlying mechanism, and prognostic impact in HCM have been revealed by few recent studies. Specifically, studies have shown increased events of thromboembolism, atrial fibrillation, and heart failure in patients with HCM and PH. These studies elucidated the underlying mechanism of PH in HCM--a rise of pressure in the precapillary and postcapillary pulmonary vasculature. In addition to left ventricular involvement, studies have shown right ventricular involvement and the association of left and right ventricular dysfunction in these patients. Further, it has been shown that surgical intervention to reduce septal thickness improves survival in pharmacotherapy nonresponders and the presence of PH does not increase mortality in these patients. We present a comprehensive review exploring the prevalence, underlying mechanisms, and impact of PH on HCM.

Sodium Glucose Co-transporter 2 Inhibitors and Heart Failure.

Sodium-glucose co-transporter 2 (SGLT2) receptors are primarily located in the proximal convoluted tubule of the nephron. These receptors are responsible for almost 90% to 95% of tubular reabsorption of the glucose in the nephron. In patients with diabetes mellitus, due to upregulation of SGLT2 receptors, glucose reabsorption is further increased. The Food and Drug Administration approved SGLT2 inhibitors, such as canagliflozin, empagliflozin, dapagliflozin, and ertugliflozin, for the treatment of type 2 diabetes. In addition to their positive effect on blood glucose, additional cardioprotective and renoprotective functions have been demonstrated in major trials such as EMPA-REG OUTCOME, CANVAS, DECLARE-TIMI-58, and CREDENCE. Unlike other antihyperglycemic drugs, reduction in hospitalization for heart failure (HF) was also seen as a class effect with this group, mechanisms of which are probably multifactorial. Subgroup analysis from these major trials indicated a reduction in progression of nephropathy and HF readmission with SGLT2 inhibitors. Although this unique property of canagliflozin was further analyzed in the CREDENCE trial, similar trials for empagliflozin (EMPERIAL-Reduced and EMPERIAL-Preserved) and dapagliflozin (DAPA-HF) are currently underway. Recently released phase III results from DAPA-HF trial indicate that dapagliflozin shows significant reduction in death due to cardiovascular causes and hospitalization in HF compared with the placebo, in both diabetics and nondiabetics. In this review article, the authors attempt to explore the possible underlying molecular mechanisms and data from existing trials pertaining to the HF related outcomes associated with SGLT2 inhibitors.

Cardiovascular Toxicities of Immune Checkpoint Inhibitors: JACC Review Topic of the Week.

Immune checkpoint inhibitors (ICIs) have been an important therapeutic advance in the field of cancer medicine, resulting in a significant improvement in survival of patients with advanced malignancies. Recent reports provided greater insights into the incidence of cardiovascular adverse events (CVAEs) with ICI use. Myocarditis is the most common CVAE associated with ICI. Pericardial diseases, Takotsubo syndrome, arrhythmias, and vasculitis constitute other significant AEs. Physicians should be aware of these infrequent, but potentially fatal toxicities associated with ICIs as their therapeutic use becomes widespread with a myriad of approvals by the U.S. Food and Drug Administration. Management involves prompt administration of high-dose corticosteroids and discontinuation of ICIs in severe myocarditis. This review summarizes the most updated evidence on epidemiology, pathophysiological mechanisms, and management strategies of various CVAEs associated with ICIs. Highlights from recent guidelines published by National Comprehensive Cancer Network on ICI-related CV toxicities have also been incorporated.

Peculiar mechanical complication of myocardial infarction.

A 58-year-old man presented to the chest pain unit with crescendo angina over 24 hours and worsening dyspnoea of 10 hours duration. He was a known diabetic and hypertensive on regular treatment for 10 years and a habitual smoker with over 15 pack-years smoking duration. Examination revealed a profusely diaphoretic and dyspnoeic (respiratory rate of 45/min) individual with a blood pressure of 100/60 mm Hg and heart rate of 124 beats/min. He was hypoxic and his oxygen saturation in the ambient air was 64%. His jugular venous pressure was elevated with a prominent V wave. Cardiovascular examination revealed a harsh grade IV/VI systolic murmur over the lower left parasternal border. There were bilateral extensive crepitations heard over the lung fields. ECG on admission revealed presence of Q wave and ST elevation in leads II and III, aVF with ST depression in I and aVL. X-ray chest showed normal cardiac shadow and features of grade III pulmonary venous hypertension. Transthoracic echocardiography is shown in figure 1.Figure 1Transthoracic echocardiogram short axis view at mid cavity level, 2D (A) and colour Doppler (B) image. QUESTION: What is the most likely diagnosis?A. Left ventricular (LV) true aneurysmB. LV pseudoaneurysmC. LV pseudo-pseudoaneurysmD. Ventricular septal rupture (VSR)E. LV free wall rupture.

Fourteen-year-old boy with decreased appetite and pedal swelling.

CLINICAL INTRODUCTION: A 14-year-old boy presented with history of decreased appetite and bilateral swelling of feet for 6 months. He did not give any associated history of orthopnoea or paroxysmal nocturnal dyspnoea. He was born by a normal delivery after a non-consanguineous marriage. He had an unremarkable birth and childhood health history. There was no family history of significant cardiovascular illness or sudden death. Clinical examination showed an average built boy with elevated jugular venous pressure with prominent v wave and bilateral pitting pedal oedema. Cardiovascular examination showed normal first (S1) and second (S2) heart sounds and a short early systolic murmur over tricuspid region. Other systems examination was remarkable for soft tender hepatomegaly.ECG showed sinus rhythm with tall, peaked p waves. Chest X-ray revealed enlargement along the right cardiac border. Transthoracic echocardiographic images are shown in figure 1A (apical four-chamber view) and figure 1B (tricuspid inflow Doppler). There was no colour Doppler evidence of interatrial shunt.heartjnl;105/5/405/F1F1F1Figure 1(A) Transthoracic echocardiographic apical four-chamber view. (B) Tricuspid inflow continuous wave Doppler image. QUESTION: What is the most likely diagnosis of his condition? Endomyocardial fibrosis (EMF)Ebstein's anomalyArrhythmogenic right ventricular dysplasia (ARVD)Idiopathic dilatation of right atriumRestrictive cardiomyopathy.

Effectiveness and Safety of Inclisiran, A Novel Long-Acting RNA Therapeutic Inhibitor of Proprotein Convertase Subtilisin/Kexin 9.

Low-density cholesterol (LDL-C) has a causal association with coronary artery disease and acute coronary syndromes (ACS). Statins have been found to reduce LDL-C, and many randomized trials have documented the significant role of statins in prevention and treatment of ACS. Treatment with statin therapy is associated with few shortcomings. A healthy percentage of patients initiated on statin, discontinue it within a year of initiation predominantly because of its daily dosing schedule. There is considerable variability in treatment response to statins and in some percentage of patients with high risk for ACS, satins are not enough to help reach the LDL-C goal necessitating the development of alternate LDL-C lowering therapies. Inclisiran a small interfering ribonucleic acid molecule inhibitor is helpful in sustained reduction of LDL-C. A single dose can decrease LDL-C for around 6 months, showed promising results in the phase II trials. In conclusion, here we reviewed the possibilities of Inclisiran as LDL-C reducing therapy and compared with currently available newer nonstatin LDL-C lowering therapies.

Dengue fever with encephalitis: a rare phenomenon.

The clinical profile and presentation of patients with dengue fever may differ from asymptomatic infection to the dreadful complications like dengue shock syndrome. However, neurological complications are very rare. Dengue encephalitis occurs by a direct involvement of central nervous system by the dengue virus which is an extremely rare complication. A 33-year-old man presented with fever, vomiting and severe headache. He had one episode of generalised tonic-clonic seizure followed by an altered sensorium on the day of admission to the hospital. The diagnosis of dengue fever was confirmed by dengue serology (IgM) and (NS1) antigen assay. MRI brain was suggestive of encephalitis. Thus, the patient was treated symptomatically and discharged in stable condition with minimal neurological deficit.

Criss-cross heart: Transthoracic echocardiographic features.

OBJECTIVE: To study the echocardiographic features of criss-cross heart (CCH), a congenital cardiac anomaly characterized by crossed ventricular inflow streams, in Indian patients. METHODS: In this retrospective observational study, all pediatric echocardiograms performed in a single tertiary care institution in South India over a three-year period were scrutinized for a diagnosis of CCH. Demographic, clinical and echocardiographic data were collected from patients' medical records and echocardiographic database. Crossed ventricular inflow streams was identified when there was inability to visualize both atrio-ventricular valves in a single imaging plane in cardiac four chamber view. RESULTS: CCH was diagnosed in five patients from 10,500 pediatric echocardiographic studies. The age at diagnosis ranged from one month to 8 years. Cyanosis was present in all but one of the five cases. Crossed ventricular inflow streams was present by definition in all cases, whereas superior-inferior ventricular relationship was present in only three cases. All cases were associated with ventricular septal defects. Atrio-ventricular discordance was seen in three cases and concordance in two. Ventriculo-arterial discordance was seen in three cases, concordance in one and double outlet right ventricle in one. Three cases had pulmonary stenosis and the other two had pulmonary arterial hypertension. Straddling of AV valve was observed in four cases and hypoplastic aortic arch in one case. CONCLUSION: CCH is an extremely rare congenital cardiac anomaly. Superior-inferior ventricular relationship often co-exists with CCH, but is not necessarily present in all cases. CCH requires early diagnosis because of its common association with diverse cardiac anomalies.