Potentially toxic elemental contamination in Wainivesi River, Fiji impacted by gold-mining activities using chemometric tools and SOM analysis

Potentially toxic element (PTE) contamination in Wainivesi River, Fiji triggered by gold-mining activities is a major public health concern deserving attention. However, chemometric approaches and pattern recognition of PTEs in surface water and sediment are yet hardly studied in Pacific Island countries like Fijian urban River. In this study, twenty-four sediment and eight water sampling sites from the Wainivesi River, Fiji were explored to evaluate the spatial pattern, eco-environmental pollution, and source apportionment of PTEs. This analysis was done using an integrated approach of self-organizing map (SOM), principle component analysis (PCA), hierarchical cluster analysis (HCA), and indexical approaches. The PTE average concentration is decreasing in the order of Fe > Pb > Zn > Ni > Cr > Cu > Mn > Co > Cd for water and Fe > Zn > Pb > Mn > Cr > Ni > Cu > Co > Cd for sediment, respectively. Outcomes of eco-environmental indices including contamination and enrichment factors, and geo-accumulation index differed spatially indicated that majority of the sediment sites were highly polluted by Zn, Cd, and Ni. Cd and Ni contents can cause both ecological and human health risks. According to PCA, both mixed sources (geogenic and anthropogenic such as mine wastes discharge and farming activities) of PTEs for water and sediment were identified in the study area. The SOM analysis identified three spatial patterns, e.g., Cr-Co-Zn-Mn, Fe-Cd, and Ni-Pb-Cu in water and Zn-Cd-Cu-Mn, Cr-Ni and Fe, Co-Pb in sediment. Spatial distribution of entropy water quality index (EWQI) values depicted that northern and northwestern areas possess "poor" to "extremely poor" quality water. The entropy weights indicated Zn, Cd, and Cu as the major pollutants in deteriorating the water quality. This finding provides a baseline database with eco-environmental and health risk measures for the Wainivesi river contamination.

Mechanism of arsenic enrichment and mobilization in groundwater from southeastern Bangladesh: Water quality and preliminary health risks assessment

To understand the mechanistic pathway of arsenic (As) enrichment and mobilization in groundwater (southeastern Bangladesh) and to evaluate the water quality as well as associated health risks, a suite of systematically collected groundwater samples (depth: 17-61 m) were analyzed. Arsenic concentrations (μg L^-1) in the groundwater samples were ranged from 6 to 581 with a mean value of 199 which is significantly higher than the recommended values. The assessment of water quality using entropy water quality index and irrigation water quality indices revealed that the groundwater in the studied region was not recommended for drinking and irrigation, respectively with few exceptions. Dominant water types in the studied area were Ca-Mg-HCO_3, Na-HCO₃, and Na-Cl types. Various forms of water-rock interactions, leaching of evaporates, and the confined nature of the aquifer mostly control the hydro-chemical parameters. Fe/Mn bound As are likely to be released in the aquifer through the dissolution of carbonate minerals of Fe/Mn while the higher degree of water-rock interaction and probable oxidation of organic materials helped to elevate As concentration. The probable longer residence time of groundwater guided by topographic slope and the neighboring clayey aquitard govern the As mobilization in the aquifer. Probabilistic health risk assessment revealed that groundwaters from the studied area can cause both non-carcinogenic and carcinogenic health risks.

Pre-tracheal Ectopic Thymoma: A diagnostic challenge in Endobronchial Ultrasound-guided Transbronchial Needle Aspiration cytology

Ectopic thymomas (ETs) are rare thymic neoplasms that arise from atypical anatomical sites¹ and present a diagnostic challenge for clinicians as they can be mistaken for other pathological entities on fine needle aspiration (FNA) cytology.² Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) sampling of mediastinal and para-tracheal lymph nodes is commonly performed to diagnose and stage lung malignancies. International literature search of thymic lesions diagnosed on EBUS-TBNA yielded only four cases although none in an ectopic location. In this report we describe a case of a patient who presented with an ectopic thymoma that was diagnosed by EBUS-TBNA from a station 4R location. Subsequent histology confirmed the diagnosis and subtyped as well as staged the tumour. We discuss the role of cytology in the diagnosis of this rare tumour from an unusual site, the potential pitfalls and highlight the importance of considering ET as a differential diagnosis in the context of unexplained mediastinal lymphadenopathy.

Road dust-driven elemental distribution in megacity Dhaka, Bangladesh: environmental, ecological, and human health risks assessment

Road dust, which reflects ambient air quality, receives various pollutants including toxic metal(oid)s from several natural and/or anthropogenic sources. This manuscript reports a comprehensive evaluation of the levels of seventeen metal(oid)s in road dust of a megacity (Dhaka, Bangladesh). Different evaluation approaches were implemented including statistical analysis and GIS mapping, besides environmental, ecological, and human health risk indices. From 30 sampling sites, representative samples were collected, which were analyzed by neutron activation analysis. The average concentrations (± SD) of Na, Mg, Al, Sc, Ti, V, Cr, Mn, Fe, Co, Zn, As, Rb, Sb, Cs, Ba, and W were 11,738 ± 560 µg g^-1, 12,410 ± 1249 µg g^-1, 62,127 ± 5937 µg g^-1, 8.89 ± 0.47 µg g^-1, 5224 ± 1244 µg g^-1, 66 ± 8 µg g^-1, 66.7 ± 6.9 µg g^-1, 547 ± 110 µg g^-1, 25,150 ± 1723 µg g^-1, 8.39 ± 0.65 µg g^-1, 125 ± 17 µg g^-1, 3.63 ± 0.56 µg g^-1, 87 ± 9 µg g^-1, 0.75 ± 0.28 µg g^-1, 4.40 ± 0.48 µg g^-1, 397 ± 87 µg g^-1, and 3.82 ± 1.77 µg g^-1, respectively. The distance-based redundancy analysis showed that the northern region was enriched with Na, Mn, Al, Fe, Zn, and Rb, while the southern region was enriched with Fe, Al, Ti, Cr, and Mg. The GIS mapping shows hot spots of Sc, Cr, Zn, and Cs were observed mostly in heavy traffic areas. Significant positive correlations of Fe-Sc, Al-Mg, V-Mg, V-Al, Cs-Rb, Cs-Sc, Rb-Sc, As-Na, and Cs-Rb invoked their inter-dependency and persistence in road dust. Depending on a set of environmental and ecological index-based calculation, the degree of metal(oid) pollution followed the descending order as W > Sb > Zn > Cr > As > Ti > Sc > V, while no pollution was recorded by Mn, Fe, Al, Rb, Cs, Co, and Ba. Importantly, the total hazard index values for adults and children were higher than unity, indicating potential non-carcinogenic health risks from exposure of road dust. Furthermore, the total carcinogenic risks from Cr and As through ingestion and dermal contact exceeded the standard guideline values. The implementation of different evaluation approaches strengthens the findings of metal(oid) source apportionment.

A104 PATIENT AND PUBLIC INVOLVEMENT (PPIN) IN IBD RESEARCH - A SCOPING REVIEW

Background

Over the past 10 years, interest in patient and public involvement (PPIn) in research has grown. Several arguments support the engagement of patients as partners in the research process. Patients with lived experience of a condition can offer their knowledge to study design as experience-based experts, helping researchers incorporate patient-pertinent outcomes. PPIn has also been shown to boost patient enrolment and retention in clinical trials. Benefits, challenges, and best practices of PPIn have been examined in other fields. However, to date, no study has examined PPIn in inflammatory bowel disease (IBD) research. Many factors amenable to research involvement may impact IBD patients’ quality of life, including disease morbidity, complications, and efficacy/side effects of therapy.

Aims

This review aims to characterize methods of PPIn in IBD research and highlight themes relating to best practices, benefits, and challenges.

Methods

We ran a systematic search on MEDLINE, EMBASE, and Cochrane for all IBD research studies in which IBD patients were involved in the research process. PPIn included but was not limited to patient input in one of the following 3 stages: Study Design (prioritization of research topics, outcome selection, study tool development), Study Execution (recruitment, data collection & analysis), and Dissemination of Research. After abstract and full-text screening, 14 studies were selected.

Results

Patients were recruited for PPIn through IBD and patient organizations (7/14), outpatient clinics (4/14), tertiary care sites (2/14), and pre-existing patient advisory groups (1/14). The majority of studies (11/14) engaged patients in the development of study materials, which included a physical activity intervention for stoma patients, an IBD pregnancy decision aid, and a quality of life questionnaire. Two studies interviewed patients to determine comprehensibility of survey items and guide revisions. One study involved patients in data analysis and manuscript development. Most consultations were open-ended, including focus groups (8/14) and semi-structured interviews (3/14). According to study authors, PPIn helps guide IBD research priorities by focusing on patient-relevant issues. Authors also cited the role of PPIn in designing patient-friendly study tools. One challenge reported by 2 studies was that PPIn requires patients to have access to high-quality information and requires a significant time commitment, which may contribute to demographic biases.

Conclusions

The majority of IBD studies engaged patients in an open-ended format and were engaged in study design, particularly in developing study materials. Authors recommend continuous involvement of patients throughout the research process to address their research priorities.

Funding Agencies

None

A140 INTEROBSERVER RELIABILITY OF THE PARIS CLASSIFICATION FOR SUPERFICIAL GASTROINTESTINAL TRACT NEOPLASMS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background

The Paris classification is an international classification system that characterizes the morphology of superficial gastrointestinal tract neoplasms. Given its ability to predict the risk of submucosal invasion, this tool plays an important role in the preliminary endoscopic assessment of early gastrointestinal neoplastic lesions. Despite its international prevalence, there are no pooled reliability analyses to assess agreement amongst endoscopists using this classification system.

Aims

To systematically review and meta-analyze the interobserver reliability (IOR) of the Paris classification system.

Methods

We conducted a systematic review and meta-analysis according to the PRISMA recommendations. A comprehensive literature query was conducted on biomedical databases through December 2020. Studies were included if they quantitively evaluated the IOR of the Paris classification with at least 5 endoscopists participating in the study cohort. Two authors independently screened studies and abstracted data using an a priori designed data collection form. We pooled the results of studies which provided IOR with kappa statistics and confidence intervals using DerSimonian and Laird random effects models. Risk of bias was independently assessed by two study authors using the Guidelines for Reporting Reliability and Agreement Studies (GRRAS) tool.

Results

From an initial 1541 studies, 5 were included in the qualitative review and 3 reported data that allowed for a quantitative analysis of the primary outcome, representing a total of 28 endoscopists. All three of these studies were high quality. The IOR for the Paris classification amongst all endoscopists was 0.541 (95% CI, 0.466–0.617). There was no significant improvement (p=0.551) in the IOR of the Paris classification system following an educational training intervention (pre-education pooled kappa, 0.498; 95% CI, 0.429–0.567 compared to post-education pooled kappa, 0.530; 95% CI, 0.451–0.608).

Conclusions

Interobserver reliability of the Paris classification is moderate with no significant improvement following educational intervention.

Funding Agencies

None

A257 PANCREATIC CANCER TREATMENT AND END OF LIFE OUTCOMES: A POPULATION BASED COHORT STUDY

Background

Patients with pancreatic cancer face challenging decisions regarding treatment choices following their diagnosis and often lack data on end-of-life (EOL) outcomes. Without the available information, older patients may be undertreated, dying earlier than they would have with treatment, while others may be overtreated and exposed to aggressive measures with harmful side effects.

Aims

To describe survival and EOL outcomes among pancreatic cancer patients based on index cancer treatment, disease stage, and patient characteristics.

Methods

We conducted a population based cohort study in Ontario, Canada of patients who died from April 2010 to December 2017 and were diagnosed with pancreatic cancer prior to death. We used administrative databases to collect data on demographics, baseline health status, treatments, and outcomes. The primary exposure was index cancer treatment (no treatment, radiation, chemotherapy alone, surgery alone, and surgery with chemotherapy). The primary outcomes were mortality, health care encounters per 30 days in the last six months of life, and palliative care visits per 30 days within the last six months of life. Secondary outcomes were location of death (institution vs. community), hospitalization within the last 30 days of life, and receipt of chemotherapy within the last 30 days of life. We estimated the association between the exposure and outcomes using multivariable models, adjusting for demographics, comorbidities, and cancer stage. Hazard ratios, adjusted mean differences, and odds ratios were reported with 95% confidence intervals.

Results

Our cohort included 9950 adults with a median age at diagnosis of 78. 56% received no index treatment, 5% underwent radiation, 27% underwent chemotherapy alone, 7% underwent surgery alone, and 6% underwent surgery and chemotherapy. In the multivariable regression (Table and Figure), radiation, chemotherapy alone, surgery alone, and surgery with chemotherapy were all associated with decreased mortality and fewer healthcare encounters. All groups except radiation were associated with fewer palliative care visits. All treatment groups were associated with lower odds of institutional death and hospitalization within the last 30 days of life, and higher odds of chemotherapy within the last 30 days of life.

Conclusions

Our data, the first to provide EOL outcome estimates based on index cancer treatment, can help patients make initial treatment decisions after a diagnosis of pancreatic cancer.

Multivariable regression analyses predicting primary and secondary outcomes

Funding Agencies

CIHR

A32 DEVELOPMENT AND VALIDATION OF THE TORONTO UPPER GASTROINTESTINAL CLEANING SCORE

Background

High quality esophagogastroduodenoscopy (EGD) depends on the ability to appropriately visualize upper gastrointestinal (GI) mucosa pathology. Evaluation can be limited by the presence of mucus, foam, bubbles and solid materials. Currently, there is no standardized method to assess mucosal visualization for use in clinical or research settings.

Aims

To develop and establish the content validity of the Toronto Upper Gastrointestinal Cleaning Score (TUGCS) and evaluate its interrater reliability.

Methods

An international panel of endoscopy experts rated potential items and their associated anchors for importance as indicators of adequacy of mucosal visualization during EGD. The survey utilized a Likert scale (1 (strongly disagree) to 5 (strongly agree)). The Delphi process was repeated until consensus was reached. Consensus was defined priori as ≥80% of experts in a given round scoring ≥4 on all survey items. To assess content validity, 48 EGD procedures were evaluated in real-time by two endoscopist reviewers using the TUGCS at a single institution. The interrater agreement between assessments was calculated for TUGCS total scores using intraclass correlation coefficient, one-way random effects model (ICC 1,1).

Results

Fourteen experts agreed to be part of the Delphi panel. An anatomical framework representing the upper GI mucosa and anchors for each mucosal portion representing various levels of visibility was generated through systematic review. Three survey rounds, with response rates of 100%, 100% and 71% respectively, achieved consensus. The final TUGCS includes four anatomical areas (fundus, body, antrum, duodenum) and mucosal visualization anchors ranging from 0 to 3 (Figure 1). TUGCS was used to assess foregut cleaning in 48 procedures (Table 1). The mean TUGCS for staff and trainee were 8.1 (±2.4) and 8.1 (±2.6), respectively. The ICC was 0.78 (95% confidence interval 0.62–0.88) indicating good reliability.

Conclusions

We developed and generated content validity evidence for the TUGCS through rigorous Delphi methodology, reflective of practice across different centres. Planned as future research is a video survey distributed to endoscopists internationally to further validate the TUGCS to create a tool that may be used to judge mucosal visualization for EGD in research and clinical settings.

Funding Agencies

None

A89 PERCEPTIONS OF NON-TECHNICAL SKILLS IN GASTROINTESTINAL ENDOSCOPY: A THEMATIC ANALYSIS OF FOUR FOCUS GROUPS

Background

Nontechnical skills (NTS), which involve an individual’s cognitive, attitudinal, and social skills that supplement task expertise, are an essential component in the practice of gastrointestinal endoscopy. There is a growing body of literature that highlights the association between these skills and patient outcomes. To date, however, these skills have not been adequately defined within the context of gastrointestinal endoscopy.

Aims

To define the domain and corresponding characteristics of NTS in GI endoscopy.

Methods

We conducted a qualitative study at a tertiary-care academic center in Toronto, Ontario. Specifically, we held four focus groups with physician endoscopists, nurses who work in an endoscopy unit, and patients who have had previous endoscopies, in order to ascertain their input on the role of NTS in gastrointestinal endoscopy. The three groups were interviewed independently and there was one focus group of both physicians and nurses that was used for validation of our initial thematic framework. Data from the focus groups was collected using a combination of field notes and discussion transcriptions. Three authors independently generated codes from these data. Using these codes, a thematic network analysis was used to identify emerging themes. The primary outcome of this study was the development of a cohesive thematic network of NTS in endoscopy, including their characteristics and examples.

Results

The four focus groups included a total of 34 participants, including 15 physician endoscopists, 15 nurses, and 4 patients. Using thematic network analysis, we identified six dimensions of NTS using the first three focus groups: communication; professionalism; teamwork; leadership; decision-making; and situational awareness. Additional topics related to the practice and evaluation of NTS were identified. In particular, there is a degree of subjectivity in the appraisal of NTS due to the nuances among individual practice, aside from egregious errors of NTS (e.g. unprofessional behaviours). The use of video recordings was suggested as a way to capture signs of good NTS, such as appropriate levels of calmness during procedures and attention to patient comfort. Finally, patient involvement can be useful for evaluating communication and professionalism based on patient comprehension and the nature of the therapeutic relationship.

Conclusions

Our findings provide the first cohesive framework of NTS in gastrointestinal endoscopy that is anchored in real world experiences with relevant stakeholders – physicians, nurses, and patients. Future research should consolidate these findings into an assessment tool for NTS in order to evaluate and provide feedback to endoscopists who are both in training and in practice.

Funding Agencies

CAG

A25 CRITICAL APPRAISAL OF GI ENDOSCOPY CLINICAL PRACTICE GUIDELINES DURING THE COVID-19 PANDEMIC

Background

Clinical Practice Guidelines (CPGs) are integral during a pandemic, offering guidance to clinicians through uncertainty. Existing literature has established that the need for rapid publication of CPGs during previous infectious disease outbreaks resulted in less rigorous guidelines. CPGs were rapidly developed since the onset of the pandemic in December 2019, providing guidance in gastrointestinal (GI) endoscopy, an area where COVID-19 may pose risk of transmission.

Aims

To evaluate the quality of GI endoscopy guidelines developed during the COVID-19 pandemic and to compare these with (a) endoscopy CPGs developed prior to the pandemic; (b) CPGs for other endoscopic topics unrelated to COVID-19; and, (c) non-endoscopic CPGs published during the pandemic.

Methods

We systematically searched Medline, Embase and Scopus for CPGs published by GI societies from January 1, 2018 to December 31, 2020. A grey literature search was conducted. Two authors screened full-texts. In this interim analysis, CPGs were grouped based on publication year: before 2020, or 2020. Endoscopy CPGs published in 2020 were categorized as COVID or non-COVID related. Two authors independently assessed the CPGs using the AGREE II tool, consisting of six domains for evaluating guidelines. A domain score of 60 was set as a threshold to indicate good quality.

Results

There were 70 endoscopy guidelines and 27 CPGs focused on other GI topics. The mean overall scores were 69% (±12%) for endoscopy CPGs published before 2020 (n=28), and 51% (±23%) for CPGs published in 2020 (n=42). For individual AGREE II domains, mean scores for pre-2020 CPGs ranged from 33.11 (±17.39) in Applicability to 81.55 (±10.37) in Clarity of Presentation. For CPGs published during COVID-19, mean domain scores ranged from 34.18 (±10.52) in Applicability to 75.26 (±13.85) in Clarity of Presentation. 21 of 42 CPGs published in 2020 were related to COVID. Mean overall scores were 35% (±20%) for COVID-related CPGs and 67% (±13%) for non-COVID-19 CPGs. For COVID-19 CPGs, scores ranged from 27.88 (±20.31) in Rigour of Development to 69.58 (±10.81) in Scope and Purpose. For non-COVID CPGs, the scores ranged from 37.30 (±8.93) in Applicability to 84.52 (±5.93) in Clarity of Presentation.

Conclusions

The difference in overall scores between COVID-19 endoscopy CPGs and non-COVID endoscopy CPGs may suggest that the urgency to disseminate COVID-19 information decreased CPG quality or completeness of reporting. This interim analysis is limited by the lack of distinction between peer-reviewed CPGs and non-peer reviewed recommendations. Given the importance of CPGs in clinical decision making, it is important to ensure that the rapid development of guidelines does not compromise quality and rigour.

Funding Agencies

None

A99 PHARMACEUTICAL INDUSTRY FUNDING TO GASTROINTESTINAL PATIENT ADVOCACY ORGANIZATIONS

Background

Patient advocacy organizations (PAOs) are not-for-profit organizations that aim to support families and individuals afflicted by illnesses. PAOs play a significant role in guiding health policy, providing education to patients, lobbying, and supporting research. Previous studies have demonstrated that PAOs may receive financial payments from pharmaceutical and medical device manufacturers. This may create a risk of conflict of interest.

Aims

To assess the prevalence and transparency of financial donations from industry to gastrointestinal patient advocacy groups based in the United States (US).

Methods

We conducted a cross-sectional study to determine the prevalence of industry donations to PAOs. Data was extracted from the Kaiser Health News (KHN) Database, a database that tracked payments from pharmaceutical companies to PAOs in 2015. After an initial list of 1215 PAOs was obtained from the database, authors extracted the annual revenues, websites and mission statements for each PAO. Authors individually screened each organization’s mission statement and website to determine whether their primary scope of focus included gastroenterology. A final list of 11 PAOs with annual revenues surpassing $500,000 USD was included for descriptive analysis. From this list, the annual reports and websites of each group were reviewed to determine the extent of transparency of PAOs disclosing financial relationships with industry sponsors. The primary outcome of our study was the total amount of funding that each PAO received from pharmaceutical companies. The secondary outcome was the self-reported amount of funding stated on each PAO’s website and annual report.

Results

From our analysis of 11 PAOs, 9 (81%) organizations received payments from pharmaceutical companies. The median dollar value of donations received was $31,052 USD (IQR=$25 to $302,550). The total dollar value of donations received was $4,059,433 USD. Across the 9 PAOs that received donations, 5 (56%) organizations disclosed a financial relationship with a pharmaceutical company on their website and 2 (22%) disclosed the value of industry donations within a range. No group specified an exact amount of funding received.

Conclusions

Our results demonstrate that a majority of US based gastrointestinal PAOs receive funding from pharmaceutical companies. Furthermore, our results show that many PAOs that receive industry funding do not disclose this amount on their website or annual reports. Given their role in providing patient centered support, it is important for PAOs to disclose financial relationships with industry so as to not produce a conflict of interest.

Funding Agencies

None

Multivariate statistics and entropy theory for irrigation water quality and entropy-weighted index development in a subtropical urban river, Bangladesh

Currently, a well-developed combination of irrigation water quality index (IWQIs) and entropy water quality index (EWQIs) for surface water appraisal in a polluted subtropical urban river is very scarce in the literature. To close this gap, we developed IWQIs by establishing statistics-based weights of variables recommended by FAO 29 standard value using the National Sanitation Foundation Water Quality Index (NSFWQI) compared with the proposed EWQIs based on information entropy in the Dhaleshwari River, Bangladesh. Fifty surface water samples were collected from five sampling locations during the dry and wet seasons and analyzed for sixteen variables. Principal component analysis (PCA), factor analysis (FA), Moran's spatial autocorrelation, and random forest (RF) model were employed in the datasets. Weights were allocated for primary variables to compute IWQI-1, 2 and EWQI-1, 2, respectively. The resultant IWQIs showed a similar trend with EWQIs and revealed poor to good quality water, with IWQI-1 for the dry season and IWQI-2 for the wet season is further suggested. The entropy theory recognized that Mg²⁺, Cr, TDS, and Cl^- for the dry season and Cd, Cr, Cl-, and SO₄^2- for the wet season are the major contaminants that affect irrigation water quality. The primary input variables were lessened to ultimately shortlisted ten variables, which revealed good performance in demonstrating water quality status since weights have come effectively from PCA than FA. The results of the RF model depict NO₃^-, Mg²⁺, and Cr as the most predominant variables influencing surface water quality. A significant dispersed pattern was detected for IWQImin-3 in the wet season (Moran's I>0). Overall, both IWQIs and EWQIs will generate water quality control cost-effective, completely objective to establish a scientific basis of sustainable water management in the study basin.

Massive perinatal left ventricle infarction treated with tissue plasminogen activator: No ECMO - A case report

Neonatal myocardial infarction due to coronary thrombus is a rare cause of acute heart failure and is associated with high morbidity and mortality. We present a rare case of a full-term newborn who developed coronary artery thrombus treated with intracoronary recombinant tissue plasminogen activator infusion while undergoing therapeutic hypothermia. Also, we describe a unique treatment strategy to support systemic circulation sparing the patient from neonatal extracorporeal membrane oxygenation and its complications. Neonatal myocardial infarction should be suspected and ruled out in sick newborns.

Preliminary assessment of heavy metals in surface water and sediment in Nakuvadra-Rakiraki River, Fiji using indexical and chemometric approaches

River water and sediment embody environmental characteristics that give valuable environmental management information. However, indexical and chemometric appraisal of heavy metals (HMs) in river water and sediment is very scarce in Island countries including Fiji. In this research, forty-five sediment and fifteen water samples from the Nakuvadra-Rakiraki River, Fiji were analyzed for appraising spatial distribution, pollution, and source identification of selected heavy metals (HMs) using the coupling tools of self-organizing map (SOM), compositional data analysis (CDA), and sediment and water quality indices. The mean concentration of HMs increased in the order of Cd < Co < Pb < Cu < Zn < Ni < Cr < Mn < Fe for sediment and Cd < Pb < Cu < Ni < Zn < Co < Cr < Fe < Mn for water, respectively. The outcomes of the enrichment factor, geo-accumulation index and contamination factor index varied spatially and most of the sediment samples were polluted by Pb, Mn, and Cu. The potential ecological risk recognized Cd, and Pb as ecological and public health risks to the surrounding communities. Based on SOM and CDA, three potential sources (e.g., point, nonpoint and lithological sources) of HMs for sediment and two sources (e.g., geogenic and human-induced sources) of HMs for water were identified. The spatial patterns of EWQI values revealed that the northern and northeast zones of the studied area possess a high degree of water pollution. The entropy weight indicated Ni and Cd as the main pollutants degrading the water quality. This study gives a baseline dataset for combined eco-environmental measures for the river's water and sediment pollution as well as contributes to an inclusive appraisal of HMs contamination in global rivers.

Prevalence of cestodes infection among school children of urban parts of Lower Dir district, Pakistan

Tapeworms of zoonotic importance have been described as a leading public health problem. Current research was aim to assess the prevalence of tapeworms among 5-12years school children residing in district Lower Dir, Pakistan from January 2019-December 2019. The wet mount preparation in saline/iodine/methods were used for stool examination. Data was analyzed using appropriate descriptive, static methods. Of the 400 children studied 71.7% were infected with one or more species of intestinal parasites. Single infection of cestode species was found in 69 individuals with 17.2% prevalence and multiple parasitic infections were identified in 19.7% (n=79/400) individuals. The multiple infection were comprised as 10% (n=40) double, 6.75% (n=27) triple and 3% (n=12) quadruple. A total of 9 species of helminths and one species of protozoan infection. Among the helminths Ascaris lumbricoides was the most prevalent 33.1% (n=95), Taenia saginata 22.6% (n=65), hookworm 19.8% (n=57), Hymenolepis nana 18.8% (n=54), Enterobius vermicularis and Hymenolepis diminuta 1.39% (n=4each), Trichuris trichura 1.04% (n=3), Toxocara spp 0.69% (n=2) and Schistosoma japonicum 0.34% (n=1) were reported. One protozoan species was Cryptosporidium spp 0.69% (n=2) in current study. In case of A.lumbricoides, hookworm, E.vermicularis, T.trichura, T.saginata, H.nana and H.diminuta the male children of below 8 years of age were highly infected. Other infections are reported in the same prevalence with slight difference if any. We conclude that there is a need for mass scale campaigns to create awareness regarding health and hygiene in children and the need for development of effective poverty control programs because deworming alone is not adequate to control parasitic infections.

Potentially toxic elements in street dust from an urban city of a developing country: ecological and probabilistic health risks assessment

Anthropogenic activities in and around the urban highways followed by aerodynamic processing generate street dusts, which can cause adverse health effects through different exposure pathways. Hence, considering the high degree of industrialization, concomitant unplanned urbanization, and rapid demographic augmentation, street dust samples from an urban city (Gazipur, Bangladesh) were investigated in terms of potentially toxic elements (using ICP-MS) to evaluate their ecological and health risks. Mean concentrations (± SD) of lead (Pb), copper (Cu), chromium (Cr), cadmium (Cd), zinc (Zn), nickel (Ni), and arsenic (As) in the analyzed air-dried samples were 40.9 ± 13.6, 44.9 ± 15.4, 83.3 ± 19.0, 9.1 ± 5.4, 239.1 ± 34.7, 33.5 ± 10.4, and 2.1 ± 0.8 mg/kg, respectively with heterogeneous distribution which were 0.2 (As) to 82.7 (Cd) times higher than the available internationally recommended limits. Element-specific environmental indices revealed that contamination levels followed the descending order as Cd > Zn > Cu > Pb > Cr > Ni > As, whereas individual ecological risks followed the descending order as Cd > Cu > Pb > Ni > Zn > Cr > As. Sampling site-specific composite indices indicated that sampling sites with high loadings of traffic, population, industrialization, and urbanization were mostly polluted. Multivariate statistical approaches also deduced the similar origins of the studied elements. In terms of the investigated elements, the study site possessed high potential ecological risks, although non-carcinogenic and carcinogenic risks through different pathway's exposures seem insignificant, where children are more vulnerable than adults.

Water resources pollution associated with risks of heavy metals from Vatukoula Goldmine region, Fiji

Although mining is essential for human economic development, is amongst the most polluting anthropogenic sources that influence seriously in water resources. Thus, understanding the presence and concentration of heavy metals in water and sediment in the vicinity of mines is important for the sustainability of the ecosystem. In this work, a multidisciplinary approach was developed to characterize the contamination level, source apportionment, co-existence, and degree of ecological and human health risks of HMs on water resources in the Vatukoula Goldmine region (VGR), Fiji. The outcomes suggested significant contamination by Cd (range: 0.01-0.95 g/L), Pb (range: 0.03-0.53 g/L), and Mn (range: 0.01-3.66 g/L) in water samples surpassed the level set by Fiji and international laws, whereas higher concentration of Cd (range: 2.60-23.16 mg/kg), Pb (range: 28.50-200.90 mg/kg) and Zn (range: 36.50-196.66 mg/kg) were detected in sediment samples. Lead demonstrated a strong significant co-existence network with other metals (e.g., Mn, Ni). Source apportionment recognized four source patterns (Cd, Pb, Ni, and Mn) for water and (Cr, Cd-Pb, Mn, and Zn) for sediment which was further confirmed by principal component analysis. The mine inputs source mainly contributed to Cd (66.07%) for water, while mineral processing mostly contributed to Zn (76.10%) for sediment. High non-carcinogenic (>1) and carcinogenic (>10^-4) health risks, particularly in children, are related to the elevated Cd, Pb and Cr contents from the VGR. Uncertainty analysis demonstrates that the 90th quantile of Cd led to higher carcinogenic risk. Pollution indices disclosed a moderate to extremely contamination status mainly along the Toko dam which poses high ecological risks identified by index calculation. However, sediment quality indicators based on probable effect levels showed that there was a 75% of likelihood that the concentrations of Cd and Pb adjacent to the VGR have a severe toxic impact on aquatic lives.

Placental Swab in Supporting Diagnosis of Vertical Transmission in SARS-CoV-2 Positive Mothers

Aims To review the evidence regarding the possibility of fetal vertical transmission in COVID-19 positive pregnant mothers by diagnosing through placental swabs. Methods The search terms 'pregnant COVID-19 positive mothers', 'fetal vertical transmission' and 'placental swabs' were used. 20 papers were selected. Results 183 COVID-19 positive pregnant women were identified whose 184 placentas and 185 neonates were also analysed by RT-PCR or immunohistochemistry and/or in situ hybridization for the presence of SARS-CoV-2 (one case of monochorionic diamniotic twins and one case of dichorionic diamniotic twins). 183 liveborn neonates were successfully delivered primarily via caesarean section (99%). 2 mothers did not deliver liveborn infants due to severe preeclampsia resulting in a termination of pregnancy and a miscarriage, both occurring in the second trimester. 9 neonates tested positive for SARS-CoV-2 (5%). We report no neonatal mortality after live birth and no maternal mortality. 17 placentas tested positive for SARS-CoV-2 out of a total of 184 tested (9%). Of these 17, 7 cases of SARS-CoV-2 were identified in the maternal, neonatal and placental tissue. Conclusion There is no concrete evidence of vertical transmission occurring between mother and infant. We propose further research investigating the effects of COVID-19 on pregnant women by using RT-PCR to test the mother, placenta, vaginal fluid, breast milk and infant for SARS-CoV-2 at various stages of transmission.

Morphology of the entering and exiting nerve as a differentiating feature of benign from malignant peripheral nerve sheath tumours of the brachial plexus

OBJECTIVE

To identify if morphology of the entering and exiting nerve involved by a nerve sheath tumour in the brachial plexus can help differentiate between benign (B) and malignant (M) peripheral nerve sheath tumours (PNSTs).

MATERIALS AND METHODS

Retrospective review of 85 patients with histologically confirmed primary PNSTs of the brachial plexus over a 12.5-year period. Clinical data and all available MRI studies were independently evaluated by 2 consultant musculoskeletal radiologists blinded to the final histopathological diagnosis assessing for maximal lesion dimension, visibility and morphology of the entering and exiting nerve, and other well-documented features of PNSTs.

RESULTS

The study included 47 males and 38 females with mean age 46.7 years (range, 8-81 years). There were 73 BPNSTs and 12 MPNSTs. The entering nerve was not identified in 5 (7%), was normal in 17 (23%), was tapered in 38 (52%) and showed lobular enlargement in 13 (18%) BPNSTs compared with 0 (0%), 0 (0%), 2 (17%) and 10 (83%) MPNSTs respectively. The exiting nerve was not identified in 5 (7%), was normal in 20 (27%), was tapered in 42 (58%) and showed lobular enlargement in 6 (8%) BPNSTs compared with 4 (33%), 0 (0%), 2 (17%) and 6 (50%) MPNSTs respectively. Increasing tumour size, entering and exiting nerve morphology and suspected MRI diagnosis were statistically significant differentiators between BPNST and MPNST (p < 0.001). IOC for nerve status was poor to fair but improved to good if normal/tapered appearance were considered together with improved specificity of 81-91% for BPNST and sensitivity of 75-83%.

CONCLUSIONS

Morphology of the adjacent nerve is a useful additional MRI feature for distinguishing BPNST from MPNST of the brachial plexus.