Assessment of hypertension association with arsenic exposure from food and drinking water in Bihar, India.

Epidemiological studies have associated chronic exposure to arsenic (As) from drinking water with increased risk of hypertension. However, evidence of an association between As exposure from food and hypertension risks is sparse. To quantify the association between daily As intake from both food (rice, wheat and potatoes) and drinking water (Aswater) along with total exposure (Astotal) and hypertension risks in a study population in Bihar, India, we conducted an individual level cross-sectional analysis between 2017 and 2019 involving 150 participants. Arsenic intake variables and three indicators of hypertension risks (general hypertension, low-density lipoprotein (LDL) and high-density lipoprotein (HDL)) were derived, and any relationship was quantified using a series of crude and multivariable log-linear or logistic regression models. The prevalence of general hypertension was 40% for the studied population. The median level of HDL was 45 mg/dL while median value of LDL was 114 mg/dL. Apart from a marginally significant positive relationship between As intake from rice and the changes of LDL (p-value = 0.032), no significant positive association between As intake and hypertension risks could be ascertained. In fact, Astotal was found to be associated with lower risks of general hypertension and higher levels of HDL (p-value = 0.020 and 0.010 respectively) whilst general hypertension was marginally associated with lower Aswater (p-value = 0.043). Due to limitations regarding study design and residual confounding, all observed marginal associations should be treated with caution.

Achieving Sustainable Development Goal for Clean Water in India: Influence of Natural and Anthropogenic Factors on Groundwater Microbial Pollution.

Worldwide, >2 billion people (~1/3 world population), mostly living in economically stressed areas of Africa and South Asia, still do not have access to basic sanitation, and ~1 billion still practice open defecation. Water pollution due to open defecation may primarily be linked to economy, and other factors such as social and hygiene practices, land use and hydrogeological parameters could also have sufficient influence. The present study describes the effect of human development index (HDI, 2001-2015) and economic development (NL, 1992-2013) on groundwater microbial pollution (FC, 2002-2017) across India. Economic development pattern suggested discernable inverse relationship with FC in most areas, although areas with inferior water quality, improper human practices were found to outweigh economic development. Vulnerability modelling, using these data, along with measured FC in groundwater-sourced drinking water locations (n = 235) demonstrated the heterogeneity of FC distribution potential in areas of homogenous economy, social practices, and land use. High-resolution numerical modelling of the advective transport of the hypothetical FC particles in the aquifers, suggest up to ~24 times faster movement of pollutants under irrigation-induced pumping regimes. Hence, the results of our study highlight and quantify the potential pitfalls that are possible hindrance for achieving the United Nations sustainable development goal, despite social and economic development, across the spatial scales.

Elevated risk of stillbirth in males: systematic review and meta-analysis of more than 30 million births.

BACKGROUND: Stillbirth rates have changed little over the last decade, and a high proportion of cases are unexplained. This meta-analysis examined whether there are inequalities in stillbirth risks according to sex. METHODS: A systematic review of the literature was conducted, and data were obtained on more than 30 million birth outcomes reported in observational studies. The pooled relative risk of stillbirth was estimated using random-effects models. RESULTS: The crude mean rate (stillbirths/1,000 total births) was 6.23 for males and 5.74 for females. The pooled relative risk was 1.10 (95% confidence interval (CI): 1.07-1.13). The attributable fraction in the whole population was 4.2% (95% CI: 3.70-4.63), and the attributable fraction among male fetuses was 7.8% (95% CI: 7.0-8.66). Study populations from countries with known sex-biased sex selection issues had anomalous stillbirth sex ratios and higher overall stillbirth risks than other countries, reflecting increased mortality among females. CONCLUSIONS: Risk of stillbirth in males is elevated by about 10%. The population-attributable risk is comparable to smoking and equates to approximately 100,000 stillbirths per year globally. The pattern is consistent across countries of varying incomes. Given current difficulties in reducing stillbirth rates, work to understand the causes of excess male risk is warranted. We recommend that stillbirths are routinely recorded by sex. This will also assist in exposing prenatal sex selection as elevated or equal risks of stillbirth in females would be readily apparent and could therefore be used to trigger investigation.

Pond-derived organic carbon driving changes in arsenic hazard found in Asian groundwaters.

Microbially mediated reductive processes involving the oxidation of labile organic carbon are widely considered to be critical to the release of arsenic into shallow groundwaters in South and Southeast Asia. In areas where there is significant pumping of groundwater for irrigation the involvement of surface-derived organic carbon drawn down from ponds into the underlying aquifers has been proposed but remains highly controversial. Here we present isotopic data from two sites with contrasting groundwater pumping histories that unequivocally demonstrate the ingress of surface pond-derived organic carbon into arsenic-containing groundwaters. We show that pond-derived organic carbon is transported to depths of up to 50 m even in an arsenic-contaminated aquifer in Cambodia thought to be minimally disturbed by groundwater pumping. In contrast, in the extensively exploited groundwaters of West Bengal, we show that pond-derived organic carbon is transported in shallow groundwater to greater depths, in excess of 100 m in the aquifer. Intensive pumping of groundwaters may potentially drive secular increases in the groundwater arsenic hazard in this region by increasing the contribution of bioavailable pond-derived dissolved organic carbon drawn into these aquifer systems and transporting it to greater depths than would operate under natural flow conditions.

Baseline distribution of petroleum hydrocarbon contamination in the marine environment around the coastline of Qatar.

Levels of organic contaminants (TPHs, PAHs) were simultaneously determined in both abiotic (sediments, seawater) and biotic (Pinctada radiata oysters) samples at four sites along the coastline of Qatar (Arabian Gulf) in 2017-2018. TPHs and PAHs were more frequently detected in oyster tissues than sediment and seawater samples collected from the same areas. While levels of TPHs and PAHs in seawater and sediments were lower than previous local studies and worldwide studies, PAHs levels observed in pearl oyster tissue (25.9-2240 µg/kg) were relatively higher than in previous studies in Qatar. In general, eight PAHs compounds were detected in oyster tissue, with benzo(a)pyrene displaying the highest concentration. The coast of Qatar could be affected by seasonal patterns of pollutants, where TPHs and PAHs levels increased in winter compared to summer. These results provide key information on the use of the pearl oyster as a bioindicator species and Qatar's marine environment.

Determination of bioavailable arsenic threshold and validation of modeled permissible total arsenic in paddy soil using machine learning.

Minimizing arsenic intake from food consumption is a key aspect of the public health response in arsenic (As)-contaminated regions. In many of these regions, rice is the predominant staple food. Here, we present a validated maximum allowable concentration of total As in paddy soil and provide the first derivation of a maximum allowable soil concentration for bioavailable As. We have previously used meta-analysis to predict the maximum allowable total As in soil based on decision tree (DT) and logistic regression (LR) models. The models were defined using the maximum tolerable concentration (MTC) of As in rice grains as per the codex recommendation. In the present study, we validated these models using three test data sets derived from purposely collected field data. The DT model performed better than the LR in terms of accuracy and Matthews correlation coefficient (MCC). Therefore, the DT estimated maximum allowable total As in paddy soil of 14 mg kg-1 could confidently be used as an appropriate guideline value. We further used the purposely collected field data to predict the concentration of bioavailable As in the paddy soil with the help of random forest (RF), gradient boosting machine (GBM), and LR models. The category of grain As (MTC) was considered as the dependent variable; bioavailable As (BAs), total As (TAs), pH, organic carbon (OC), available phosphorus (AvP), and available iron (AvFe) were the predictor variables. LR performed better than RF and GBM in terms of accuracy, sensitivity, specificity, kappa, precision, log loss, F1score, and MCC. From the better-performing LR model, bioavailable As (BAs), TAs, AvFe, and OC were significant variables for grain As. From the partial dependence plots (PDP) and individual conditional expectation (ICE) of the LR model, 5.70 mg kg-1 was estimated to be the limit for BAs in soil.

Chronic Exposure to Drinking Water Arsenic and Gallbladder Cancer Risk: Preliminary Evidence from Endemic Regions of India.

BACKGROUND: Evidence linking arsenic in drinking water to digestive tract cancers is limited. We evaluated the association between arsenic levels in groundwater and gallbladder cancer risk in a case-control study (2019-2021) of long-term residents (≥10years) in two arsenic-impacted and high gallbladder cancer risk states of India-Assam and Bihar. METHODS: We recruited men and women aged 30 to 69 years from hospitals (73.4% women), with newly diagnosed, biopsy-confirmed gallbladder cancer (N = 214) and unrelated controls frequency-matched for 5-year age, sex, and state (N = 166). Long-term residential history, lifestyle factors, family history, socio-demographics, and physical measurements were collected. Average-weighted arsenic concentration (AwAC) was extrapolated from district-level groundwater monitoring data (2017-2018) and residential history. We evaluated gallbladder cancer risk for tertiles of AwAC (µg/L) in multivariable logistic regression models adjusted for important confounders [Range: 0-448.39; median (interquartile range), T1-0.45 (0.0-1.19); T2-3.75 (2.83-7.38); T3-17.6 (12.34-20.54)]. RESULTS: We observed a dose-response increase in gallbladder cancer risk based on AwAC tertiles [OR = 2.00 (95% confidence interval, 1.05-3.79) and 2.43 (1.30-4.54); Ptrend = 0.007]. Participants in the highest AwAC tertile consumed more tubewell water (67.7% vs. 27.9%) and reported more sediments (37.9% vs. 18.7%) with unsatisfactory color, odor, and taste (49.2% vs. 25.0%) than those in the lowest tertile. CONCLUSIONS: These findings suggest chronic arsenic exposure in drinking water at low-moderate levels may be a potential risk factor for gallbladder cancer. IMPACT: Risk factors for gallbladder cancer, a lethal digestive tract cancer, are not fully understood. Data from arsenic-endemic regions of India, with a high incidence of gallbladder cancer, may offer unique insights. Tackling 'arsenic pollution' may help reduce the burden of several health outcomes.

Household and community systems for groundwater remediation in Bihar, India: Arsenic and inorganic contaminant removal, controls and implications for remediation selection.

The presence of arsenic (As) and other inorganic contaminants in groundwater is a key public health issue in India and many other parts of the world. Whilst a broad range of remediation technologies exist, performance can be highly variable, and appropriate selection and management of remediation approaches remains challenging. Here, we have identified and tested the performance of a range of small-scale remediation technologies (e.g. sand filters, multi-stage filtration and reverse osmosis (RO)-based systems; n = 38) which have been implemented in Bihar, India. We have undertaken spot-assessments of system performance under typical operating conditions in household and non-household (e.g. community, hospital, hostel/hotel) settings. The removal of As and other inorganic contaminants varied widely (ranging from ~0-100%), with some solutes generally more challenging to remove than others. We have evaluated the relative importance of technology type (e.g. RO-based versus non-RO systems), implementation setting (e.g. household versus non-household) and source water geochemistry (particularly concentrations and ratios of As, Fe, P, Si and Ca), as potential controls on remediation effectiveness. Source water composition, particularly the ratio ([Fe] - 1.8[P])/[As], is a statistically significant control on As removal (p < 0.01), with higher ratios associated with higher removal, regardless of technology type (under the site-specific conditions observed). This ratio provides a theoretical input which could be used to identify the extent to which natural groundwater composition may be geochemically compatible with higher levels of As removal. In Bihar, we illustrate how this ratio could be used to identify spatial patterns in theoretical geochemical compatibility for As removal, and to identify where additional Fe may theoretically facilitate improved remediation. This geochemical approach could be used to inform optimal selection of groundwater remediation approaches, when considered alongside other important considerations (e.g. technical, managerial and socio-economic) known to impact the effective implementation and sustainability of successful groundwater remediation approaches.

Varietal differences influence arsenic and lead contamination of rice grown in mining impacted agricultural fields of Zamfara State, Nigeria.

In Zamfara state, Nigeria, rice is cultivated in fields contaminated with Pb (lead) from artisanal and illicit mining activities. Rice grown in such contaminated agricultural areas risks not only Pb contamination but also contamination from other toxic elements, like arsenic (As); co-contamination of Pb and As in rice cultivated in mining impacted areas has been previously reported and rice is a hyperaccumulator of As. A field study was conducted with ten different commonly-cultivated Nigerian rice varieties in the mining-impacted farmlands of Dareta village, Zamfara State. The aim was to determine the optimal rice variety for cultivation on these contaminated farmlands; an optimal variety would have the lowest contaminant concentrations and highest essential elements concentrations in the rice grains. A total of 300 paired soil and rice plants were collected. The mean As and Pb concentrations in paddy soils were 0.91 ± 0.82 mg kg-1 and 288.5 ± 464.2 mg kg-1, respectively. Mean As (30.4 ± 15.1 µg kg-1) content in rice grains was an order of magnitude lower than the Codex recommendation of 200 µg kg-1 (for milled rice) while the Pb content in all the rice varieties (overall mean of 743 ± 327 µg kg-1) was approximately four times higher than the Codex recommendation of 200 µg kg-1. Contrary to previous studies, a negative correlation was observed between As and Pb in rice grains across all the varieties. Rice variety Bisalayi was the variety with the lowest Pb transfer factor (TF = 0.08), but the average Pb concentration in rice grain was still above the Codex recommendation. Bisalayi also had the highest TF for iron. Variety ART_15, which had the lowest As uptake (TF = 0.10), had the highest TF for essential elements (magnesium, potassium, manganese, zinc, and copper). In areas of Pb contamination, Bisalayi rice may therefore be a suitable variety to choose for cultivation.

Association of Perfluorooctanoic Acid (PFOA) and Perfluorooctane Sulfonate (PFOS) with age of puberty among children living near a chemical plant.

Animal studies suggest that perfluorocarbons (PFCs) may alter sexual maturation. Relationships of human PFC exposure with puberty are not clear. We conducted a cross-sectional study to investigate whether perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) were associated with indicators of sexual maturation in a 2005-2006 survey of residents with PFOA water contamination from the Mid-Ohio Valley. Participants were 3076 boys and 2931 girls aged 8-18 years. They were classified as having reached puberty based on either hormone levels (total >50 ng/dL and free >5 pg/mL testosterone in boys and estradiol >20 pg/mL in girls) or onset of menarche. We estimated the odds of having reached puberty classified by these criteria and the fitted median age of reaching puberty in relation to serum PFOA and PFOS concentrations measured when puberty status was assigned. For boys, there was a relationship of reduced odds of reached puberty (raised testosterone) with increasing PFOS (delay of 190 days between the highest and lowest quartile). For girls, higher concentrations of PFOA or PFOS were associated with reduced odds of postmenarche (130 and 138 days of delay, respectively). In conclusion, our study showed a later age of puberty in this population correlated with PFC concentrations.

Outcome of COVID-19 in Solid Organ Malignancies: Experience From a Tertiary Cancer Center in Eastern India.

PURPOSE: The COVID-19 pandemic has imposed a unique challenge to oncology patients. Outcome data on COVID-19 in patients with cancer from the Indian subcontinent are scarce in the literature. We aimed to evaluate the outcome of patients with COVID-19 on active systemic anticancer therapy. MATERIALS AND METHODS: This is a retrospective study of patients with solid organ malignancies undergoing systemic therapy with a diagnosis of COVID-19 between March 2020 and February 2021. COVID-19 was diagnosed if a reverse transcriptase polymerase chain reaction assay from oropharyngeal or nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2. The objectives were to evaluate the outcome of COVID-19 and factors predicting the outcome. RESULTS: A total of 145 patients were included with a median age of 58 years (range, 20-81 years). Treatment was curative in 60 (42%) patients. Of all symptomatic cases (n = 88, 61%), 50 had mild, 27 had moderate and 19 had severe COVID-19-related symptoms as per WHO criteria. Fifty (34%) patients required hospitalization with a median duration of hospital stay of 12 days (range, 4-25 days); five patients required intensive care unit admission. The rest were treated with home isolation and did not require further hospitalization. Twenty-two (15%) patients died, and the risk of death was significantly associated with severity of symptoms (odds ratio, 91.3; 95% CI, 9.1 to 919.5, P = .0001) but not with any other clinical factors. Drug holiday was given to 63 (44%) patients with a median duration of 25 days (range, 7-88 days). The median duration to reverse transcriptase polymerase chain reaction-negative was 16 days (range, 7-62 days). CONCLUSION: COVD-19-related death rate was 15% among patients with solid organ malignancies. The severity of the symptoms was related to mortality. The majority of patients with mild symptoms were treated at home isolation.

Bioaccessibility and speciation of arsenic in children's diets and health risk assessment of an endemic area in Bangladesh.

This study determines the bioaccessibility of toxic and carcinogenic arsenic (As) in composite food samples and evaluates potential exposure from food intake in Bangladesh children. Total As (tAs), inorganic As (iAs) and bioaccessible As (BAs) in food composite samples consumed by children were compared between an exposed and a control group (based on As in drinking water). Total As concentrations in composite food samples of children exposed to mean As level of 331 µg/l in drinking and cooking water ranged from 586 to 1975 µg/kg, dry weight over 76-90 µg/kg in the unexposed group. Average iAs in food composites was 73.9% (range: 49.3-90.8%). The fraction of BAs using gastric and gastrointestinal phases was 91 ± 13% and 98 ± 11%, respectively. Daily intake of iAs in the exposed group ranged from 0.41 to 6.38 µg per kg body weight (BW), which was much higher than the unexposed group (0.08-0.15 µg per kg BW). High iAs content and BAs in composite food samples indicated the elevated risk to exposed children. Further research should include both adults and children using larger sample size to determine overall As exposure from food intake in Bangladesh, attention must be given to lowering of As in food.

Impact of Covid-19 Lockdown on Availability of Drinking Water in the Arsenic-Affected Ganges River Basin.

The 2020 COVID-19 pandemic has not only resulted in immense loss of human life, but it also rampaged across the global economy and socio-cultural structure. Worldwide, countries imposed stringent mass quarantine and lockdowns to curb the transmission of the pathogen. While the efficacy of such lockdown is debatable, several reports suggest that the reduced human activities provided an inadvertent benefit by briefly improving air and water quality. India observed a 68-days long, nation-wide, stringent lockdown between 24 March and 31 May 2020. Here, we delineate the impact of the lockdown on groundwater and river sourced drinking water sustainability in the arsenic polluted Ganges river basin of India, which is regarded as one of the largest and most polluted river basins in the world. Using groundwater arsenic measurements from drinking water wells and water quality data from river monitoring stations, we have studied ~700 km stretches of the middle and lower reaches of the As (arsenic)-polluted parts of the river for pre-lockdown (January-March 2020), syn-lockdown (April-May), and post-lockdown periods (June-July). We provide the extent of As pollution-free groundwater vis-à-vis river water and examine alleviation from lockdown as an opportunity for sustainable drinking water sources. The overall decrease of biochemical oxygen demand (BOD) and chemical oxygen demand (COD) concentrations and increase of pH suggests a general improvement in Ganges water quality during the lockdown in contrast to pre-and-post lockdown periods, potentially caused by reduced effluent. We also demonstrate that land use (agricultural/industrial) and land cover (urban-periurban/rural) in the vicinity of the river reaches seems to have a strong influence on river pollutants. The observations provide a cautious optimistic scenario for potentially developing sustainable drinking water sources in the arsenic-affected Ganges river basin in the future by using these observations as the basis of proper scientifically prudent, spatially adaptive strategies, and technological interventions.

Arsenic exposure from food exceeds that from drinking water in endemic area of Bihar, India.

Extensive evidence of elevated arsenic (As) in the food-chain, mainly rice, wheat and vegetables exists. Nevertheless, the importance of exposure from food towards total As exposure and associated health risks in areas with natural occurring As in drinking water is still often neglected, and accordingly mitigations are largely focused on drinking water only. In this study, the contribution of food over drinking water to overall As exposure was estimated for As exposed populations in Bihar, India. Increased lifetime cancer risk was predicted using probabilistic methods with input parameters based on detailed dietary assessment and estimation of As in drinking water, cooked rice, wheat flour and potato collected from 91 households covering 19 villages. Median total exposure was 0.83 µg/kgBW/day (5th and 95th percentiles were 0.21 and 11.1 µg/kgBW/day) and contribution of food (median = 49%) to overall exposure was almost equal to that from drinking water (median = 51%). More importantly and contrary to previous studies, food was found to contribute more than drinking water to As exposure, even when drinking water As was above the WHO provisional guide value of 10 µg/L. Median and 95th percentile excess lifetime cancer risks from food intake were 1.89 × 10-4 and 7.32 × 10-4 respectively when drinking water As was below 10 µg/L and 4.00 × 10-4 and 1.83 × 10-3 respectively when drinking water As was above 10 µg/L. Our results emphasise the importance of food related exposure in As-endemic areas, and, perhaps surprisingly, particularly in areas with high As concentrations in drinking water - this being partly ascribed to increases in food As due to cooking in high As water. These findings are timely to stress the importance of removing As from the food chain and not just drinking water in endemic areas.

Comparison of drinking water, raw rice and cooking of rice as arsenic exposure routes in three contrasting areas of West Bengal, India.

Remediation aimed at reducing human exposure to groundwater arsenic in West Bengal, one of the regions most impacted by this environmental hazard, are currently largely focussed on reducing arsenic in drinking water. Rice and cooking of rice, however, have also been identified as important or potentially important exposure routes. Quantifying the relative importance of these exposure routes is critically required to inform the prioritisation and selection of remediation strategies. The aim of our study, therefore, was to determine the relative contributions of drinking water, rice and cooking of rice to human exposure in three contrasting areas of West Bengal with different overall levels of exposure to arsenic, viz. high (Bhawangola-I Block, Murshidibad District), moderate (Chakdha Block, Nadia District) and low (Khejuri-I Block, Midnapur District). Arsenic exposure from water was highly variable, median exposures being 0.02 µg/kg/d (Midnapur), 0.77 µg/kg/d (Nadia) and 2.03 µg/kg/d (Murshidabad). In contrast arsenic exposure from cooked rice was relatively uniform, with median exposures being 0.30 µg/kg/d (Midnapur), 0.50 µg/kg/d (Nadia) and 0.84 µg/kg/d (Murshidabad). Cooking rice typically resulted in arsenic exposures of lower magnitude, indeed in Midnapur, median exposure from cooking was slightly negative. Water was the dominant route of exposure in Murshidabad, both water and rice were major exposure routes in Nadia, whereas rice was the dominant exposure route in Midnapur. Notwithstanding the differences in balance of exposure routes, median excess lifetime cancer risk for all the blocks were found to exceed the USEPA regulatory threshold target cancer risk level of 10(-4)-10(-6). The difference in balance of exposure routes indicate a difference in balance of remediation approaches in the three districts.

Corrections: Xu, L.; Mondal, D.; Polya, D.A. Positive Association of Cardiovascular Disease (CVD) with Chronic Exposure to Drinking Water Arsenic (As) at Concentrations below the WHO Provisional Guideline Value: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2020, 17, 2536.

In our recently published meta-analysis, due to an oversight, we treated urinary As concentration data reported by Tsinovoi et al [...].

Positive Association of Cardiovascular Disease (CVD) with Chronic Exposure to Drinking Water Arsenic (As) at Concentrations below the WHO Provisional Guideline Value: A Systematic Review and Meta-Analysis.

To the best of our knowledge, a dose-response meta-analysis of the relationship between cardiovascular disease (CVD) and arsenic (As) exposure at drinking water As concentrations lower than the WHO provisional guideline value (10 µg/L) has not been published yet. We conducted a systematic review and meta-analyses to estimate the pooled association between the relative risk of each CVD endpoint and low-level As concentration in drinking water both linearly and non-linearly using a random effects dose-response model. In this study, a significant positive association was found between the risks of most CVD outcomes and drinking water As concentration for both linear and non-linear models (p-value for trend < 0.05). Using the preferred linear model, we found significant increased risks of coronary heart disease (CHD) mortality and CVD mortality as well as combined fatal and non-fatal CHD, CVD, carotid atherosclerosis disease and hypertension in those exposed to drinking water with an As concentration of 10 µg/L compared to the referent (drinking water As concentration of 1 µg/L) population. Notwithstanding limitations included, the observed significant increased risks of CVD endpoints arising from As concentrations in drinking water between 1 µg/L and the 10 µg/L suggests further lowering of this guideline value should be considered.

Association of low-level inorganic arsenic exposure from rice with age-standardized mortality risk of cardiovascular disease (CVD) in England and Wales.

Adverse health outcomes, including death from cardiovascular disease (CVD), arising from chronic exposure to inorganic arsenic (iAs) are well documented. Consumption of rice is a major iAs exposure route for over 3 billion people, however, there is still a lack of epidemiological evidence demonstrating the association between iAs exposure from rice intake and CVD risks. We explored this potential association through an ecological study using data at local authority level across England and Wales. Local authority level daily per capita iAs exposure from rice (E-iAsing,rice) was estimated using ethnicity as a proxy for class of rice consumption. A series of linear and non-linear models were applied to estimate the association between E-iAsing,rice and CVD age-standardized mortality rate (ASMR), using Akaike's Information Criterion as the principle model selection criterion. When adjusted for significant confounders, notably smoking prevalence, education level, employment rate, overweight percentage, PM2.5, female percentage and medical and care establishments, the preferred non-linear model indicated that CVD risks increased with iAs exposure from rice at exposures above 0.3 µg/person/day. Also, the best-fitted linear model indicated that CVD ASMR in the highest quartile of iAs exposure (0.375-2.71 µg/person/day) was 1.06 (1.02, 1.11; p-trend <0.001) times higher than that in the lowest quartile (<0.265 µg/person/day). Notwithstanding the well-known limitations of ecological studies, this study further suggests exposure to iAs, including from rice intake, as a potentially important confounder for studies of the factors controlling CVD risks.

Perspective of Oncology Patients During COVID-19 Pandemic: A Prospective Observational Study From India.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has imposed a unique challenge to oncology patients and their treatment. There is no study related to the patients' preference for systemic therapy during this pandemic. We have conducted a prospective study to analyze that aspect. METHODS: All consecutive patients who visited during the lockdown period from April 1-10, 2020, for systemic chemotherapy were included in the study for a questionnaire-based survey to evaluate the willingness to continue chemotherapy during this pandemic and factors influencing the decisions. RESULTS: A total of 302 patients were included (median age, 56 years; range, 21-77 years). Most common sites of cancer were breast (n = 114), lung (n = 44), ovary (n = 34), and colon (n = 20). Home address was within the city for 125 patients (42%), outside the city for 138 (46%), and outside the state for 37 (12%). Treatment was curative in 150 patients and palliative in 152. Educational status was primary and above for 231 patients and no formal schooling for 71. A total of 203 patients wanted to continue chemotherapy, 40 wanted to defer, and 56 wanted the physician to decide. Knowledge about COVID-19 strongly correlated with intent of treatment (P = .01), disease status (P = .02), knowledge about immunosuppression (P < .001), home location (P = .02), and education status (P = .003). The worry about catching SARS-CoV-2 was high in those with controlled disease (P = .06) and knowledge about immunosuppression (P = .02). Worry about disease progression was more with palliative intent (P < .001). CONCLUSION: This study shows that oncology patients in our country are more worried about disease progression than the SARS-CoV-2 and wish to continue chemotherapy during this pandemic. The treatment guidelines in the COVID-19 scenario should incorporate patients' perspectives.

Arsenic in Peruvian rice cultivated in the major rice growing region of Tumbes river basin.

Arsenic (As) exposure from surface and groundwater in Peru is being recognised as a potential threat but there are limited studies on As in the food-chain and none on As in Peruvian rice. In this study, we have determined the As content in rice cultivated in the Tumbes river basin located in the northern province of Peru, an area known for extensive rice cultivation. We collected rice and soil samples from agricultural fields, soil was collected using grid sampling technique while rice was collected from the heaps of harvested crop placed across the fields. The average total As concentration in rice was 167.94 ±â€¯71 µg kg-1 (n = 29; range 68.39-345.31 µg kg-1). While the rice As levels were not highly elevated, the As content of few samples (n = 7) greater than 200 µg kg-1 could contribute negatively to human health upon chronic exposure. Average concentration of As in soil was 8.63 ±â€¯7.8 mg kg-1 (n = 30) and soil to grain transfer factor was 0.025 ±â€¯0.018 for 12 matched samples. Compared to our previous pilot study in 2006 (samples collected from the same agricultural fields but not from exact locations) there was a 41% decrease in As soil concentration in this study. Rice samples collected in 2006 (n = 5) had a mean concentration of 420 ±â€¯109 µg kg-1. Our data provides a baseline of rice grain As concentrations in Peruvian province of Tumbes and warrants further studies on factors affecting uptake of As by the rice varieties cultivated in Peru and any potential human health risks.