Source specific sedimentary response towards the differential anthropogenic impacts in terms of potentially toxic elements in an urban river

To investigate the interplay between varying anthropogenic activities and sediment dynamics in an urban river (Turag, Bangladesh), this study involved 37-sediment samples from 11 different sections of the river. Neutron activation analysis and atomic absorption spectrometry were utilized to quantify the concentrations of 14 metal(oid)s (Al, Ti, Co, Fe, As, Cd, Cr, Cu, Fe, Hg, Mn, Ni, Pb, Zn). This study revealed significant toxic metal trends, with Principal coordinate analysis explaining 62.91 % of the variance from upstream to downstream. The largest RSDs for Zn(287 %), Mn(120 %), and Cd(323 %) implies an irregular regional distribution throughout the river. The UNMIX-model and PMF-model were utilized to identify potential sources of metal(oid)s in sediments. ∼63.65-66.7 % of metal(oid)s in sediments originated from anthropogenic sources, while remaining attributed to natural sources in both models. Strikingly, all measured metal(oid)s' concentrations surpassed the threshold effect level, with Zn and Ni exceeding probable effect levels when compared to SQGs.

Elevated levels of environmental radioactivity in fluvial sediment: origin and health risk assessment

To study the geogenic processes of naturally occurring radioactive materials' (NORMs') distribution, a transboundary Himalayan river (Punarbhaba) is chosen due to its trivial anthropogenic impacts. In explaining the genesis of radionuclides, transition elements (Sc, Ti, V, and Fe), rare-earth-elements (REEs: La, Eu, Ce, Yb, Sm, and Lu), Ta, Hf, Th, and U were analysed in 30 riverbed sediments collected from the Bangladeshi portion of the river. Elemental abundances and NORMs' activity were measured by neutron activation analysis and HPGe-gamma-spectrometry, respectively. Averagen=30 radioactivity concentrations of 226Ra (68.4 Bq kg-1), 232Th (85.7 Bq kg-1), and 40K (918 Bq kg-1) were 2.0-2.3-fold higher, which show elevated results compared to the corresponding world mean values. Additionally, mean-REE abundances were 1.02-1.38-times higher than those of crustal origin. Elevated (relative to earth-crust) ratios of Th/U (=3.95 ± 1.84) and 232Th/40K and statistical demonstrations invoke Th-dominant heavy minerals, indicating the role of kaolinite clay mineral abundance/granitic presence. However, Th/Yb, La/V, Hf/Sc, and Th/Sc ratios reveal the presence of felsic abundances, hydrodynamic sorting, and recycling of sedimentary minerals. Geo-environmental indices demonstrated the enrichment of chemical elements in heavy minerals, whereas radiological indices presented ionizing radiation concerns, e.g., the average absorbed-gamma-dose rate (123.1 nGy h-1) was 2.24-fold higher compared to the threshold value which might cause chronic health impacts depending on the degree of exposure. The mean excess lifetime cancer risk value for carcinogen exposure was 5.29 × 10-4 S v-1, which is ∼2-times greater than the suggested threshold. Therefore, plausible extraction of heavy minerals and using residues as building materials can alleviate the two-reconciling problems: (1) radiological risk management and (2) fluvial navigability.

Using unsupervised machine learning models to drive groundwater chemistry and associated health risks in Indo-Bangla Sundarban region

Groundwater is an essential resource in the Sundarban regions of India and Bangladesh, but its quality is deteriorating due to anthropogenic impacts. However, the integrated factors affecting groundwater chemistry, source distribution, and health risk are poorly understood along the Indo-Bangla coastal border. The goal of this study is to assess groundwater chemistry, associated driving factors, source contributions, and potential non-carcinogenic health risks (PN-CHR) using unsupervised machine learning models such as a self-organizing map (SOM), positive matrix factorization (PMF), ion ratios, and Monte Carlo simulation. For the Sundarban part of Bangladesh, the SOM clustering approach yielded six clusters, while it yielded five for the Indian Sundarbans. The SOM results showed high correlations among Ca2+, Mg2+, and K+, indicating a common origin. In the Bangladesh Sundarbans, mixed water predominated in all clusters except for cluster 3, whereas in the Indian Sundarbans, Cl--Na+ and mixed water dominated in clusters 1 and 2, and both water types dominated the remaining clusters. Coupling of SOM, PMF, and ionic ratios identified rock weathering as a driving factor for groundwater chemistry. Clusters 1 and 3 were found to be influenced by mineral dissolution and geogenic inputs (overall contribution of 47.7%), while agricultural and industrial effluents dominated clusters 4 and 5 (contribution of 52.7%) in the Bangladesh Sundarbans. Industrial effluents and agricultural activities were associated with clusters 3, 4, and 5 (contributions of 29.5% and 25.4%, respectively) and geogenic sources (contributions of 23 and 22.1% in clusters 1 and 2) in Indian Sundarbans. The probabilistic health risk assessment showed that NO3- poses a higher PN-CHR risk to human health than F- and As, and that potential risk to children is more evident in the Bangladesh Sundarban area than in the Indian Sundarbans. Local authorities must take urgent action to control NO3- emissions in the Indo-Bangla Sundarbans region.

Differential impact of COVID-19 on mental health and burnout

BACKGROUND

There may be differential impact of the COVID-19 pandemic on mental health and burnout rates of healthcare professionals (HCPs) performing different roles.

AIMS

To examine mental health and burnout rates, and possible drivers for any disparities between professional roles.

METHODS

In this cohort study, online surveys were distributed to HCPs in July-September 2020 (baseline) and re-sent 4 months later (follow-up; December 2020) assessing for probable major depressive disorder (MDD), generalized anxiety disorder (GAD), insomnia, mental well-being and burnout (emotional exhaustion and depersonalization). Separate logistic regression models (at both phases) compared the risk of outcomes between roles: healthcare assistants (HCAs), nurses and midwives (nurses), allied health professionals (AHPs) and doctors (reference group). Separate linear regression models were also developed relating the change in scores to professional role.

RESULTS

At baseline (n = 1537), nurses had a 1.9-fold and 2.5-fold increased risk of MDD and insomnia, respectively. AHPs had a 1.7-fold and 1.4-fold increased risk of MDD and emotional exhaustion, respectively. At follow-up (n = 736), the disproportionate risk between doctors and others worsened: nurses and HCAs were at 3.7-fold and 3.6-fold increased risk of insomnia, respectively. Nurses also had a significantly increased risk of MDD, GAD, poor mental well-being and burnout. Nurses also had significantly worsened anxiety, mental well-being and burnout scores over time, relative to doctors.

CONCLUSIONS

Nurses and AHPs had excess risk of adverse mental health and burnout during the pandemic, and this difference worsened over time (in nurses especially). Our findings support adoption of targeted strategies accounting for different HCP roles.

WaterHyacinth: A comprehensive image dataset of various Water hyacinth species from different regions of Bangladesh

The "WaterHyacinth" dataset, a recently gathered collection of images featuring four distinct species of Water hyacinth from different regions of Bangladesh, is presented in this article. There are four different classifications: Lemna minor, Eichhornia crassipes, Monochoria korsakowii, and Pistia stratiotes. The collection consists of 1790 original images and in addition 4050 augmented photos of Water hyacinth species. Every original picture was captured with the appropriate background and in sufficient natural light. Every image was correctly placed in its corresponding subfolder, providing optimal use of the pictures by various machine learning and deep learning models. Researchers could make major progress in agriculture, environmental monitoring, aquatic science, and remote sensing domains by utilizing this enormous dataset and various machine learning and deep learning approaches. In addition to opening opportunities for significant developments in these domains, it offers an essential asset for further study.

Fractionation of environmental radioactivity in road dust from a megacity: external and internal health risks

Naturally occurring radioactive materials (NORMs: 232Th, 226Ra, 40K) can reach our respiratory system by breathing of road dust which can cause severe health risks. Targeting the pioneering consideration of health risks from the NORMs in road dust, this work reveals the radioactivity abundances of NORMs in road dust from a megacity (Dhaka) of a developing country (Bangladesh). Bulk chemical compositions of U, Th, and K obtained from neutron activation analysis were converted to the equivalent radioactivities. Radioactivity concentrations of 226Ra, 232Th, and 40K in road dust ranged from 60-106, 110-159, and 488-709 Bq kg-1 with an average of 84.4 ± 13.1, 126 ± 11, and 549 ± 48 Bq kg-1, respectively. Estimated 226Ra, 232Th, and 40K radioactivities were, respectively, 1.7-3.0-, 3.7-5.3-, and 1.2-1.8-folds greater than the affiliated world average values. Mechanistic pathway of NORMs' enrichment and fractionation relative to the major origin (pedosphere) were evaluated concerning the water logging, relative solubility-controlled leaching and translocation, climatic conditions, and aerodynamic fractionations (dry and wet atmospheric depositions). Computation of customary radiological risk indices invokes health risks. Noticing the ingress of NOMR-holding dust into the human respiratory system along with the associated ionizing radiations, the computed radiological indices represent only the least probable health hazards. Nevertheless, in real situations, α-particles from the radioactive decay products of 232Th and 238U can create acute radiation damages of respiratory system. Policymakers should emphasize on limiting the dust particle evolution, and public awareness is required to alleviate the health risks.

Fluvial responses towards the tannery effluent: Tracing the anthropogenic foot-prints

Tannery-effluent is one of the top-ranked hazardous waste which is generally discharged into the river. To study the fluvial response toward the tannery-effluents and to trace anthropogenic foot-prints in the fluvial-system, a suite of systematically collected sediment and water samples were analyzed for radioactive (226Ra, 232Th, and 40K) and non-radioactive elements (Al, Ti, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Cd, Sb, Hg, and Pb). Neutron activation analysis and atomic absorption spectroscopy were used for elemental analysis, whereas HPGe-gamma-detector was used for measuring the primordial-radionuclides. Ranges of Cr-abundances in sediment and water were 63-4373 μg.g-1 and 15.6-52.2 μg.L-1, respectively which were ∼4-14 times higher than the geological background. Radioactivity concentrations of 226Ra, 232Th, and 40K ranged from 17.7-48.5, 36.1-81.6, and 687-1041 Bq.kg-1, respectively which were significantly depleted in effluent discharge point. Hence, primordial-radionuclides were used as natural tracers for tracing anthropogenic foot-prints which were explained in terms of dilution effect, redox environment and differential geo-environmental events/characteristics. From statistical-approaches and geochemical reasoning, elemental sources and responses in fluvial system were explored. Surprisingly, ecological & radiological risks were reduced while sediment quality guideline-based ecotoxicity & water-mediated health risks were increased by the incorporation of tannery effluents. This study describes the sedimentary response toward the received tannery effluents which is particularly explored by the primordial radionuclides.

Receptor model-based source-specific health risks of toxic metal(loid)s in coal basin-induced agricultural soil in northwest Bangladesh

Toxic metal(loid)s (TMLs) in agricultural soils cause detrimental effects on ecosystem and human health. Therefore, source-specific health risk apportionment is very crucial for the prevention and control of TMLs in agricultural soils. In this study, 149 surface soil samples were taken from a coal mining region in northwest Bangladesh and analyzed for 12 TMLs (Pb, Cd, Ni, Cr, Mn, Fe, Co, Zn, Cu, As, Se, and Hg). Positive matrix factorization (PMF) and absolute principal component score-multiple linear regression (APCS-MLR) receptor models were employed to quantify the pollution sources of soil TMLs. Both models identified five possible sources of pollution: agrochemical practice, industrial emissions, coal-power-plant, geogenic source, and atmospheric deposition, while the contribution rates of each source were calculated as 28.2%, 17.2%, 19.3%, 19% and 16.3% in APCS-MLR, 22.2%, 13.4%, 24.3%, 15.1% and 25.1% in PMF, respectively. Agrochemical practice was the major source of non-carcinogenic risk (NCR) (adults: 32.37%, children: 31.54%), while atmospheric deposition was the highest source of carcinogenic risk (CR) (adults: 48.83%, children: 50.11%). NCR and CR values for adults were slightly higher than for children. However, the trends in NCR and CR between children and adults were similar. As a result, among the sources of pollution, agrochemical practices and atmospheric deposition have been identified as the primary sources of soil TMLs, so prevention and control strategies should be applied primarily for these pollution sources in order to protect human health.

Radiation exposure and health concerns associated with the environmental geochemistry of relatively higher radioactivity in a fresh water basin

This study was carried out on a negligible anthropogenically impacted Indo-Bangla transboundary river basin (Atrai, Bangladesh) to elicit radionuclides' and elemental distributions. Thirty sediment samples were collected from the Bangladesh portion of the river, and instrumental neutron activation analysis and HPGe γ-Spectrometry techniques were used to determine environmental radionuclides (e.g., 232Th, 226Ra, 40K) and associated elemental concentrations, respectively. Metal concentrations (Sc, V, Fe, Eu, Sm, La, Yb, Ce, Lu, Ta, Hf) were determined to comprehend the genesis of greater radioactivity. Recognizing the mean concentration of absorbed gamma dose rate (158.7 hGyh-1) is 2.88-times more than the recommended value (55 hGyh-1) that describes ionizing radiation concerns regarding potential health risks to the surrounding communities and the houses of native residents, which are constructed by Atrai river sediment. This work will assist relevant policymakers in exploring valuable heavy minerals and provide information regarding radiological health risks from a fluvial system.

Perception and legacy of soil chromium and lead contamination in an operational small-scale coal mining community

Operational small-scale coal mining (OSCM) is one of the most significant sources of chromium (Cr) and lead (Pb) pollution in Bangladesh. Attempts to minimize or lessen the use of Cr and Pb in OSCM have shown unsatisfactory results, mainly because they need to address the sociotechnical complexity of pollution concerns in OSCM. This research adopts a multidisciplinary, sociotechnical approach to addressing Cr and Pb problems, coupling soil sampling for Cr and Pb with questionnaires of miners' and inhabitants' perceptions of pollution and its distribution. The study was undertaken in the Barapukuria coal basin in northwest Bangladesh. Except for mining areas (average of 49.80 ± 27.25 mg/kg), Cr levels in soils exceeded the world average in the periphery (73.34 ± 24.39 mg/kg, ~ 1.2 times) and residential areas (88.85 ± 35.87 mg/kg, 1.5 times the world standard of 59.5 mg/kg). Pb levels in soils exceeded national and global averages in mining (53.56 ± 37.62 mg/kg, ~ 1.9 times), periphery (35.05 ± 21.77 mg/kg, ~ 1.3 times), and residential areas (32.14 ± 26.59 mg/kg, ~ 1.2 times) when compared to Bangladesh and global standards of 20 and 27 mg/kg. Pb levels were highest in mining areas, while Cr concentrations were highest in residential areas. The questionnaire findings indicated that miners and inhabitants did not correctly assume that the highest levels of Cr and Pb pollution would be found in these areas. Among all respondents, 54% are unaware of the health impacts of prolonged Cr and Pb exposure. They face respiratory problems (38.6%), skin diseases (32.7%), and other health issues. A large number of people (66.6%) agreed with the fact that Cr and Pb contamination has an impact on drinking water. Cr and Pb pollution has caused 40% crop loss and a 36% decrease in productivity in the agricultural sector. However, respondents underestimated the level of Cr pollution in mining areas, and most assumed that only individuals working directly with mines were impacted by the Cr and Pb content. Participants also rated the reduction of Cr and Pb contamination as of low importance. There is less awareness of Cr and Pb pollution among miners and inhabitants. Sincere efforts to reduce Cr and Pb pollution will likely be met with extra attention and hostility.

Receptor model-based source tracing and risk assessment of elements in sediment of a transboundary Himalayan River

This study utilized surface sediments from a potentially less polluted transboundary Himalayan River (Brahmaputra: China-India-Bangladesh) to investigate the abundance of 15 geochemically and ecologically significant elements and to predict their sources and ecological consequences. INAA was applied to determine the elemental concentrations. The average abundances (μg.g-1) of Rb (94.20), Cs (4.49), Th (20.31), & U (2.73) were 1.12-2.26 folds elevated than shale. Environmental indices disclosed a pollution status ranging from "uncontaminated to moderately contaminated," with minimal Rb, U, and Th enrichment in the downstream zone. Consensus-based sediment quality guideline (SQG) threshold values suggested that only Cr (60% samples > TEL) may impose rare biological effects. Ecological risk indices suggested "minor to no" possible eco-toxicological risks for the accounted elements (Cr, Co, Mn, Zn, Sb, & As). The positive matrix factorization (PMF) model predicated the predominance of geogenic or crustal contributions (∼72.69%) for Al, K, Na, Ti, Co, Zn, Ba, Cs, As, Rb, Th, & U derived from elemental fractionations, mineral weathering, and bio-geo-chemical mobilization. The relative contributions of anthropogenic sources (∼27.31%; such as the construction of roads, settlement expansion, litter disposal, municipal waste discharge, mining activities, agricultural encroachment, etc.) on elemental distribution were significantly lower. The abundance of Cr and Mn was mainly influenced by anthropogenic sources. This study demonstrated the effectiveness of utilizing geo-environmental guidelines and receptor models in discriminating the natural & anthropogenic origins of metals in the complex riverine sediments of a less anthropogenically affected river.

Heavy metals in popularly sold branded cigarettes in Bangladesh and associated health hazards from inhalation exposure

Tobacco products are widely recognized as a major contributor to death. Cigarette smoke contains several toxic chemicals including heavy metals particulate causing high health risks. However, limited information has been available on the health risks associated with the heavy metals in cigarettes commonly sold in the Bangladeshi market. This study evaluated the concentrations and potential health risks posed by ten concerned heavy metals in ten widely consumed cigarette brands in Bangladesh using an atomic absorption spectrometer. The concentration (mg/kg) ranges of heavy metals Pb, Cd, Cr, As, Co, Ni, Mn, Fe, Cu, and Zn vary between 0.46-1.05, 0.55-1.03, 0.80-1.2, 0.22-0.40, 0.46-0.78, 2.59-3.03, 436.8-762.7, 115.8-184.4, 146.6-217.7, and 34.0-42.7, respectively. We assume that the heavy metals content among cigarette brands is varied due to the differences in the source of tobacco they use for cigarette preparation. The carcinogenic risks posed by heavy metals follow the order of Cr > Co > Cd > As > Ni > Pb, while the non-carcinogenic risks for Cu, Zn, Fe, and Mn were greater than unity (HQ > 1), except for Fe. The existence of toxic heavy metals in cigarette tobacco may thus introduce noticeable non-carcinogenic and carcinogenic health impacts accompanying inhalation exposure. This study provides the first comprehensive report so far on heavy metal concentration and associated health risks in branded cigarettes commonly sold in Bangladesh. Hence, this data and the information provided can serve as a baseline as well as a reference for future research and have potential implications for policy and legislation in Bangladesh.

Human exposures to multiple water sources in the southwestern coastal region of Bangladesh: water quality, pollution sources, and preliminary health risks appraisals

The coastal areas of Bangladesh have poor accessibility to fresh drinking water and the groundwater is not suitable for drinking, cooking, and other domestic uses due to high levels of salinity and potentially toxic elements. The current study focuses on understanding of the distribution of some physicochemical parameters (temperature, pH, EC, TDS, and salinity) and chemical elements (Fe, Mn, Zn, Ca, Mg, Na, K, Cu, Co, Pb, As, Cr, Cd, and Ni) with health perspective in drinking water from the southwestern coastal area of Bangladesh. The physicochemical properties of the water samples were examined with a multiparameter meter, while the elemental concentrations were analyzed using atomic absorption spectrometer. Water quality index (WQI) and irrigation indices were utilized to determine the drinking water quality and irrigation feasibility, respectively, whereas hazard quotients (HQs) and hazard index (HI) were used to assess the probable pathways and the associated potential risks to human health. The concentrations of some toxic elements in measured samples were relatively higher compared to drinking water guidelines, indicating that ground and surface water are not apt for drinking and/or domestic uses. The multivariate statistical approaches linked the source of the pollutants in the studied water body mostly to the geogenic origin including saline water intrusion. WQI values ranged from 18 to 430, reflecting excellent to unsuitable categories of water quality. The assessment of human health risks due to exposure to contaminated water demonstrated both carcinogenic and non-carcinogenic health risks in the exposed residents of the study area. Therefore, appropriate long-term coastal area management strategies should be adopted in the study region for environmental sustainability. The findings of this research will be supportive in understanding the actual situation of fresh drinking water in the area for policymakers, planners, and environmentalists to take effective necessary measures to ensure safe drinking water in the study area.

When I say … burnout

In the world of wellness, 'burnout' might as well be a God term. But what do we really mean when we say, "I'm burned out." And is this one little word enough?

Propofol-induced myoclonus during maintenance of anaesthesia

Myoclonus is a known side effect of propofol and can interfere with surgery and possibly precipitate patient injury. Here, we report a 23-year-old patient undergoing an L5 osteoblastoma resection with a predominantly propofol-based anaesthetic who developed intra-operative myoclonus. Other adjuncts included ketamine, lidocaine and fentanyl infusions. The myoclonus did not improve after deepening the anaesthetic with propofol, opioid boluses or discontinuation of the lidocaine infusion. The myoclonus ceased after reducing the propofol infusion and increasing the ketamine and opioid infusions. The remainder of the intra-operative course was uneventful. This report details our intra-operative management of propofol-induced cortical reflex myoclonus and discusses our institution's experience with treating this phenomenon.

Evaluation of Heavy Metal Contamination in Soil Samples around Rampal, Bangladesh

Rising soil pollution has recently emerged as a significant global issue as a result of increased industrialization, urbanization, and inadequate waste management. In Rampal Upazila, soil contamination with heavy metals resulted in a significant deterioration of quality of life and life expectancy, so the study's goal is to appraise the level of heavy metal contamination in soil samples. Inductively coupled plasma-optical emission spectrometry was used to identify 13 heavy metals (Al, Na, Cr, Co, Cu, Fe, Mg, Mn, Ni, Pb, Ca, Zn, and K) from 17 soil samples that were collected at random from Rampal. Enrichment factor (EF), geo-accumulation index (I_geo), contamination factor (CF), pollution load index, elemental fractionation, and potential ecological risk analysis were used to evaluate the level of pollution and sources of metal. The average concentration of heavy metals implies that they are below in the permissible limit except for Pb. Environmental indices also showed the same result for Pb. The ecological risk index (RI) for six elements-Mn, Zn, Cr, Fe, Cu, and Pb-is 26.575. For investigating the behavior and origin of elements, multivariate statistical analysis was also applied. From the EF, Na, Cr, Fe, and Mg are in the anthropogenic region, and Al, Co, Cu, Mn, Ni, Ca, K, and Zn are minorly polluted, but Pb is highly contaminated in the Rampal area. The geo-accumulation index exhibits that Pb is slightly contaminated but others are not, while CF shows no contamination in this region. From the ecological RI, the value which is below 150 is called uncontaminated, which indicates that our studied area is ecologically free. There are various classifications of heavy metal contamination in the study area. Therefore, regular monitoring of soil pollution is required, and the public awareness needs to be raised to ensure a safe environment.

Risk assessment and source apportionment for metals in sediments of Kaptai Lake in Bangladesh using individual and synergistic indices and a receptor model

Metal enrichment in lake sediments originating from multiple sources can threaten both the aquatic ecosystem and human health. Therefore, assessment of the eco-environmental risks and potential sources of metals in the sediments is essential for effective lake management. Here, we analyzed the sediment metal contents of Kaptai Lake, the largest lake in Bangladesh for the first time with this study. The results indicated that only Cr and Ni contents among the metals studied exceeded the probable effect concentrations (PEC) at 25.42 % and 55.93 % of the sampling stations, respectively. All metals at most sampling stations showed low contamination and low ecological risk based on the individual indices (geoaccumulation index, contamination factor, ecological risk factor, enrichment factor and modified hazard quotient). There was no significant risk from the combined metals in the sediments of the lake according to the synergistic indices (toxic risk index, Nemerow risk index, ecological risk index, Nemerow pollution index and pollution load index). Organic matter and silt were significant sediment parameters that favored the accumulation of Cr, Fe, Cu, Pb and Mn. In the absolute principle component scores-multiple linear regression model (APCS-MLR), five potential sources of metals were identified in the sediments: Zn, Mn, Co and Cd mainly from natural sources and to a lesser extent from agricultural and aquacultural activities, Ni, Cr and Fe from parent materials, Pb and Cu mainly from natural sources and to a lesser extent from vehicle emissions, Hg and U from lithogenic sources, and As from natural sources. This study will improve our knowledge of the sedimentary metal contents of Kaptai Lake and provide helpful information for developing effective lake management and pollution control strategies.

Metal(loid)s in tap-water from schools in central Bangladesh (Mirpur): Source apportionment, water quality, and health risks appraisals

Considering the health risks originating from the exposure of metal(loid)s in tap-water and the concomitant vulnerability of school-going students, 25 composite tap water samples from different schools and colleges of central Bangladesh (Mirpur, Dhaka) were analyzed by atomic absorption spectroscopic technique. Elemental abundances of Na, Mg, K, Ca, Cr, Mn, Fe, Co, Ni, Zn, As, Cd, and Pb in the studied tap water samples varied from 4520 to 62250, 2760-29580, 210-3000, 15780-78130, 1.54-5.32, 7.00-196, 2.00-450, 0.04-1.45, 8.23-24.4, 0.10-813, 0.10-10.5, 0.002-0.212, and 1.55-15.8 μgL^-1, respectively. Dissolved metal(loid)s' concentrations were mostly within the national and international threshold values with few exceptions which were also consistent with the entropy-based water quality assessment. Multivariate statistical approaches demonstrated that hydro-geochemical processes like water-rock interactions mostly govern the major elemental (Na, Mg, K, Ca) compositions in tap water. However, anthropogenic processes typically control the trace elemental compositions where supply pipeline scaling was identified as the major source. Cluster analysis on sampling sites separated two groups of schools and colleges depending on their establishment years where tap water from older schools and colleges possesses relatively higher levels of metal(loid)s. Hence, gradual pipeline scaling on a temporal scale augmented the metal(loid)s' concentrations in tap-water. In terms of non-carcinogenic health risks estimation, studied tap-water seems to be safe, whereas elemental abundances of Pb and As can cause carcinogenic risks to school-going people. However, progressive deterioration of water quality by pipeline scaling will be supposed to cause significant health risks in the future, for which preventative measures should be adopted.

Indexical and statistical approaches to investigate the integrated origins of elements in the sediment of Teesta River, Bangladesh: sediment quality and ecological risk assessment

This study investigates ecological consequences from the combined provenance (natural and manmade) of fifteen metal(oid)s (Na, Al, K, Ti, Cr, Mn, Co, Zn, As, Rb, Sb, Cs, Ba, Th, and U) from a major Indo-Bangla transboundary river (Teesta). Instrumental neutron activation analysis has been performed to calculate the elemental concentration for a total of thirty sediment samples which accumulated from the upper, middle and downstream section of the Teesta River. In comparison with the crustal origin Rb, Th, and U were 1.5-2.8 times elevated. Elements from upstream and midstream sediments showed greater spatial variability than those from downstream sediments in terms of Na, Rb, Sb, Th, and U. Statistical approaches suggested the dominance of geogenic sources (Na, K, Al, Ti, Co, and Ba) of elements over anthropogenic sources (Cr and Zn). Alkali feldspar and aluminosilicates release lithophilic minerals into the sediments under the redox condition (U/Th = 0.18). Site-specific ecotoxicological indices advocated that some specific locations are highly hazardous relative to Cr and Zn. From SQG-based guidelines, Cr showed higher potential toxicity in some upstream locations relative to Zn, Mn, and As. In order to attain the knowledge limitation of northern transboundary rivers from Bangladesh, this study of origin and relative environmental impact will be beneficial for policy makers.

A177 RISK OF VENOUS THROMBOEMBOLISM IN COVID-19 PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED MATCHED COHORT STUDY

Background

Venous thromboembolism (VTE), is associated with significant morbidity and mortality. Inflammation increases the risk of VTE, and it is a well-recognised complication of both inflammatory bowel disease (IBD) and COVID-19.

Purpose

To compare the risk of VTE among individuals with and without IBD following a positive COVID-19 test.

Method

Using health administrative data from Ontario, Canada we conducted a retrospective matched cohort study.All Ontario residents with a positive SARS-CoV-2 PCR test between January 1,2020 and December 30,2021 who had been diagnosed with IBD prior to their COVID-19 infection (identified using a validated algorithm) were matched to 5 individuals without IBD based on year of birth, sex, mean neighbourhood income quintile, date of positive COVID-19 test, and rural/urban residence. Individuals with a cancer diagnosis in the 5 years prior to their first COVID-19 positive test were excluded. Individuals were followed from positive COVID-19 PCR test until VTE event, death, migration out of Ontario or March 31, 2022.VTEs were identified from emergency department or hospitalization data using ICD-10 codes. Incidence rate of VTEs among individuals with IBD were assessed at 1, 6 and 12 months. Proportional cause-specific hazards models compared the risk of VTEs in people with and without IBD, treating death as a competing risk and controlling for vaccination status (2^nd dose ≥14 days prior to positive COVID-19 test) and a history of VTE (VTE in the 5 years prior to infection).

Result(s)

There were 4293 people with IBD (44% Crohn’s disease, mean age ±SD 46.1±17.2 y) matched to 20,207 with out IBD (mean age 45.3±16.8 y) with a positive SARS-CoV-2 PCR test. Within 1 month of a positive COVID-19 test, the crude incidence rate of VTE in individuals with IBD was 4.77(95%CI, 4.75-4.80) per 100,000 person-days compared to 8.25(95%CI, 8.20-8.30) per 100,000 among people without IBD.Within 6 months, these rates were 1.86(95%CI, 1.86-1.87) and 2.12(95%CI, 2.11-2.12) per 100,000 person-days among people with and without IBD, respectivley. Within 12 months, these rates were 1.59(95% CI, 1.58-1.59) and 1.42(95% CI, 1.42-1.42) per 100,000 person-days among people with and without IBD, respectively.After adjusting for vaccination status and history of VTE there was no difference in the risk of VTE for people with and without IBD (HR 1.08, 95%CI, 0.64 to 1.83).

Conclusion(s)

IBD patients with COVID-19 were not more likely to experience a VTE infection compared with the general popluation. The risk of VTE was highest soon after COVID-19 and declined thereafter.

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Disclosure of Interest

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A114 UNIFIED MAGNIFYING ENDOSCOPIC CLASSIFICATION (UMEC) FOR GASTROINTESTINAL LESIONS: A NORTH AMERICAN EDUCATION STUDY

Background

Magnification endoscopy and magnification narrow-band imaging are image enhanced endoscopy technologies that may allow for the diagnosis of advanced neoplasia in the GI tract on the basis of imaging characteristics. Recently, the Unified Magnifying Endoscopic Classification (UMEC) has been developed, which unified the criteria for the esophagus, stomach, and colon. UMEC divides optical diagnosis into one of the three categories: non-neoplastic, intramucosal neoplasia, and deep submucosal invasive cancer.

Purpose

The objective of this study is to educate North American endoscopists on the use of the UMEC schema, and to ascertain performance of the UMEC framework among North American endoscopists.

Method

Using UMEC, five North American endoscopists (>1000 procedures) without prior training in magnifying endoscopy independently diagnosed previously collected endoscopic image set of the esophagus, stomach, and colon. The endoscopists were trained on the use of UMEC via an eleven-minute training video with exemplars of each element of UMEC from esophagus, stomach, and colon. All endoscopists were blinded to white-light and non-magnifying NBI findings as well as histopathological diagnosis. The diagnostic performance of UMEC was assessed while using the gold standard histopathology as a reference.

Result(s)

A total of 299 gastrointestinal lesions (77 esophagus, 92 stomach, and 130 colon) were assessed using UMEC. For esophageal squamous cell carcinoma, the sensitivity, specificity, and accuracy for all 5 endoscopists ranged from 65.2% (95% CI: 50.9–77.9) to 87.0% (95% CI: 75.3–94.6), 77.4% (95% CI: 60.9–89.6) to 96.8% (95% CI: 86.8–99.8), and 75.3% to 87.0%, respectively. For gastric adenocarcinoma, the sensitivity, specificity, and accuracy for all 5 endoscopists ranged from 94.9% (95% CI: 85.0–99.1) to 100%, 52.9% (95% CI: 39.4–66.2) to 92.2% (95% CI: 82.7–97.5), and 73.3% to 93.3%, respectively. For colorectal adenocarcinoma, the sensitivity, specificity, and accuracy for all 5 endoscopists ranged from 76.2% (95% CI: 62.0–87.3) to 83.3% (95% CI: 70.3–92.5), 89.7% (95% CI: 82.1–94.9) to 97.7% (95% CI: 93.1–99.6), and 86.8% to 90.7%, respectively.

Image

Conclusion(s)

UMEC is a simple and practical classification that can be used to introduce and educate endoscopists to magnification narrow-band imaging and optical diagnosis.

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CAG

Disclosure of Interest

M. R. A. Fujiyoshi Grant / Research support from: 2022 CAG/AbbVie Education Research Grant, Y. Fujiyoshi: None Declared, N. Gimpaya: None Declared, R. Bechara: None Declared, T. Jeyalingam: None Declared, N. Calo: None Declared, N. Forbes: None Declared, R. Khan: None Declared, M. Atalla: None Declared, A. Toshimori: None Declared, Y. Shimamura: None Declared, M. Tanabe: None Declared, J. Mosko: None Declared, H. Inoue: None Declared, S. Grover: None Declared

A128 GLOBAL TRENDS IN TRAINING AND CREDENTIALING GUIDELINES FOR GASTROINTESTINAL (GI) ENDOSCOPY: A SYSTEMATIC REVIEW

Background

Credentialing in GI endoscopy is not a universally standardized process. National guidelines may provide a framework for local training, however in certain settings, training committees set minimal competency requirements that must be met before a clinician can be accredited to practice independently. There is a paucity of literature assessing the inter-societal and geographic variability in guidelines and training requirements in endoscopy.

Purpose

To systematically review the available credentialing guidelines proposed by different GI endoscopy societies and affiliated training committees internationally.

Method

We conducted a systematic review according to the PRISMA guidelines. A comprehensive literature search was performed for credentialing guidelines for GI endoscopy from inception until January 2022. Two reviewers screened and one reviewer abstracted data using a pre-defined data collection form.

Result(s)

From the 653 records obtained from our search, 20 credentialing guidelines from 12 different GI societies were ultimately included in the review. These guidelines encompassed the following procedures and outlined the following key-performance indicators; a) Colonoscopy: the recommended minimum number of procedures performed ranged from 150-275 with a minimum cecal intubation and adenoma detection rate of 85-90% and 20-30% respectively; b) EGD: the minimum number of procedures prior to credentialing ranged from 130-1000, the minimum duodenal intubation rate ranged from 95-100%, and the range for minimum number of upper GI bleeds managed was 20-45 (in addition to other procedural KPIs); c) ERCP: the recommended minimum number of procedures prior to credentialing ranged from 100-300 cases with a minimum selective duct cannulation rate of 80-90%. Guidelines for flexible sigmoidoscopy, EUS and capsule endoscopy were also obtained.

Image

Conclusion(s)

There is a general concordance amongst the various international GI societies with regards to minimum procedural volume and performance in key procedural tasks prior to credentialing, however the use of validated education assessment tools was lacking in the majority of guidelines. Additional KPI’s need to be explored for less routinely performed procedures such as EUS and capsule endoscopy.

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None

Disclosure of Interest

None Declared

A119 DEVELOPMENT AND EVALUATION OF LOW-COST GEL POLYPS FOR POLYPECTOMY SKILLS TRAINING IN NOVICE ENDOSCOPISTS

Background

Polypectomy is an essential skill for endoscopists to acquire. As polyps are encountered ad hoc during colonoscopies, exposure to polypectomy in clinical training may vary. There is a need to deliver a curriculum that standardizes exposure to polypectomy while remaining cost-effective for endoscopy programs worldwide.

Purpose

To develop low-cost simulated polyps that can be incorporated into endoscopic training programs, and to evaluate their perceived realism and useability for polypectomy training.

Method

We designed 3D molds based on the Paris classification, a validated rubric for polyp morphology. The polyps are depicted in Figure 1. Using low-cost materials, we created gel-based polyps compatible with physical colonic simulators. Current versions of the polyps were finalized based on visual realism and durability. Expert (performed >1000 procedures) and novice (<25 procedures) endoscopists were invited to perform simulated polypectomies and evaluate the realism of the polyps. Using a 7-point Likert scale (“strongly disagree” to “strongly agree”), we administered a survey adapted from the Direct Observed Polypectomy Skills (DOPyS) checklist to evaluate the polyps on practicality of design and useability for training. Additionally, the simulator’s resemblance to human polypectomy was assessed through a scale with 1 indicating “low resemblance” and 7 indicating “high resemblance”. The ease of identifying morphology was also evaluated, with 1 indicating “difficult” and 7 indicating “easy”.

Result(s)

The survey was completed by 11 expert endoscopists and 10 novices. The median score submitted by experts on the polyps’ useability in training the technique for mobilization of the polyp was 7 (IQR 6-7). Experts rated the simulator’s practicality in teaching cold snare or electrocautery techniques with a median score of 6 (IQR 6-7). Lastly, the ability of the simulator to develop skills in identifying and treating the residual polyp was assessed by expert endoscopists, giving it a median score of 6 (IQR 6-7). The simulators were tested on similarity to human polypectomy, with the median score of expert groups being 5 (IQR 5-6), and novice groups being 6 (IQR 6-6). Both groups were asked to rate if morphology could be identified using the simulator; the median score of expert groups being 6 (IQR 6-7), and 6.5 for novice endoscopists (IQR 5-7).

Image

Conclusion(s)

The development of simulated polyps with differing morphologies using low-cost and common materials with high realism is feasible. These polyps may potentially be integrated into different endoscopic training programs.

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None

Disclosure of Interest

A. Zhao: None Declared, N. Gimpaya: None Declared, J. Lisondra: None Declared, R. Fujiyoshi: None Declared, Y. Fujiyoshi: None Declared, R. Khan Grant / Research support from: Rishad Khan has received research grants from AbbVie (2018) and Ferring Pharmaceuticals (2019) and research funding from Pendopharm (2019). , D. Tham: None Declared, M. Scaffidi: None Declared, R. Bansal: None Declared, C. Walsh: None Declared, S. Grover Shareholder of: Samir C. Grover has equity in Volo Healthcare., Grant / Research support from: Samir C. Grover has received research grants and personal fees from AbbVie and Ferring Pharmaceuticals, personal fees from Takeda, education grants from Janssen.

A115 THE PERFORMANCE OF NATURAL LANGUAGE PROCESSING IN INTERPRETING COLONOSCOPY REPORTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background

Screening colonoscopy is integral in the effort to identify and remove potentially cancerous lesions. Important quality indicators include the adenoma detection rate and more recently, the sessile/serrated adenoma detection rate. Natural language processing (NLP) is a computer-based linguistic technique that leverages artificial intelligence to abstract meaningful information from text. This tool carries the potential to automate the task of analyzing large volumes of colonoscopy and pathology reports to generate data on key performance metrics.

Purpose

The aim of this study is to systematically review the available literature on the performance of NLP in identifying the presence of an adenoma or a sessile/serrated adenoma in colonoscopy reports.

Method

We performed a systematic review and meta-analysis according to PRISMA recommendations. A comprehensive literature query was conducted on MEDLINE, EMBASE, CINAHL, and CDSR, through July 2022. Studies were included if they evaluated the performance of NLP in extracting data from colonoscopy reports. Our primary outcome was the performance of NLP models in correctly identifying an adenoma reported in a colonoscopy report. Two authors independently screened studies and abstracted data using an a priori designed data collection form. We pooled the sensitivity and specificity of our primary outcome using a univariate analysis first, followed by a bivariate analysis. Using the open-source package ‘mada’ which is written in R, we generated a summary estimate and a summary receiver operating characteristic curve.

Result(s)

From the 1030 unique studies obtained from our literature search, 13 studies met the inclusion criteria. Eligible studies were used for our meta-analysis. In the univariate analysis, the pooled sensitivity and specificity for detecting an adenoma by the NLP systems was 0.978 (95% CI 0.938-0.992) and 0.997 (95% CI 0.984-0.999), respectively. Similarly, in univariate analysis, the pooled sensitivity and specificity for detecting a sessile/serrated adenoma by the NLP systems was 0.984 (95% CI 0.929-0.996) and 1.0 (95% CI 0.998-1.000), respectively. In the bivariate analysis, the summary estimates for the sensitivity and specificity of the NLP system in detecting an adenoma were 0.973 (95% CI 0.929-0.990) and 0.992 (95%CI 0.978-0.997) respectively. For detecting a sessile/serrated adenoma, the summary estimates for sensitivity and specificity were 0.964 (95% CI 0.895-0.988) and 0.998 (95% CI 0.995-0.999) respectively.

Conclusion(s)

NLP models have excellent performance in extracting quality metric data from colonoscopy reports. Based on the available literature, we suggest integration of NLP in quality improvement efforts in colonoscopy.

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None

Disclosure of Interest

None Declared

A117 VALIDITY EVIDENCE FOR ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY COMPETENCY ASSESSMENT TOOLS: A SYSTEMATIC REVIEW

Background

Assessment of competence in endoscopic retrograde cholangiopancreatography (ERCP) is essential to ensure trainees possess the skills needed for independent practice. Traditionally, ERCP training has used the apprenticeship model, whereby novices learn skills under the supervision of an expert. A growing focus on procedural quality, however, has supported the implementation of competency-based medical education models which require documentation of a trainee’s competence for independent practice. Observational assessment tools with strong evidence of validity are critical to this process. Validity evidence supporting ERCP observational assessment tools has not been systematically evaluated.

Purpose

To conduct a systematic review of ERCP assessment tools and identify tools with strong evidence of validity using a unified validity evidence framework

Method

We conducted a systematic search using electronic databases and hand-searching from inception until August 2021 for studies evaluating observational assessment tools of ERCP performance. We used a unified validity framework to characterize validity evidence from five sources: content, response process, internal structure, relations to other variables, and consequences. Each domain was assigned a score of 0-3 (maximum score 15). We assessed educational utility and methodological quality using the Accreditation Council for Graduate Medical Education framework and the Medical Education Research Quality Instrument, respectively.

Result(s)

From 2769 records, we included 17 studies evaluating 7 assessment tools. Five tools were studied for clinical ERCP, one on simulated ERCP, and one on simulated and clinical ERCP. Validity evidence scores ranged from 2-12. The Bethesda ERCP Skills Assessment Tool (BESAT), ERCP Direct Observation of Procedural Skills Tool (ERCP DOPS), and The Endoscopic Ultrasound (EUS) and ERCP Skills Assessment Tool (TEESAT) had the strongest validity evidence with scores of 10, 12, and 11, respectively. Regarding educational utility, most tools were easy to use and interpret, and required minimal additional resources. Overall methodological quality was strong, with scores ranging from 10-12.5 (maximum 13.5).

Conclusion(s)

The BESAT, ERCP DOPS, and TEESAT have strong validity evidence compared to other assessments. Integrating tools into training may help drive learners’ development and support competency decision-making.

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CAG

Disclosure of Interest

None Declared

Corrigendum to “Development of a fabricated first-flush rainwater harvested technology to meet up the freshwater scarcity in a South Asian megacity, Dhaka, Bangladesh” [Heliyon 9 (1) (January 2023) Article e13027]

[This corrects the article DOI: 10.1016/j.heliyon.2023.e13027.].

Distribution, sources, and pollution levels of toxic metal(loid)s in an urban river (Ichamati), Bangladesh using SOM and PMF modeling with GIS tool

Indexical assessment coupled with a self-organizing map (SOM) and positive matrix factorization (PMF) modeling of toxic metal(loid)s in sediment and water of the aquatic environment provides valuable information from the environmental management perspective. However, in northwest Bangladesh, indexical and modeling assessments of toxic metal(loid)s in surface water and sediment are still rare. Toxic metal(loid)s were measured in sediment and surface water from an urban polluted river (Ichamati) in northwest Bangladesh using an atomic absorption spectrophotometer to assess distribution, pollution levels, sources, and potential environmental risks to the aquatic environment. The mean concentrations (mg/kg) of metal(loid)s in water are as follows: Fe (871) > Mn (382) > Cr (72.4) > Zn (34.2) > Co (20.8) > Pb (17.6) > Ni (16.7) > Ag (14.9) > As (9.0) > Cu (5.63) > Cd (2.65), while in sediment, the concentration follows the order, Fe (18,725) > Mn (551) > Zn (213) > Cu (47.6) > Cr (30.2) > Ni (24.2) > Pb (23.8) > Co (9.61) > As (8.23) > Cd (0.80) > Ag (0.60). All metal concentrations were within standard guideline values except for Cr and Pb for water and Cd, Zn, Cu, Pb, and As for sediment. The outcomes of eco-environmental indices, including contamination and enrichment factors and geo-accumulation index, differed spatially, indicating that most of the sediment sites were moderately to highly polluted by Cd, Zn, and As. Cd and Zn content can trigger ecological risks. The positive matrix factorization (PMF) model recognized three probable sources of sediment, i.e., natural source (49.39%), industrial pollution (19.72%), and agricultural source (30.92%), and three possible sources of water, i.e., geogenic source (45.41%), industrial pollution (22.88%), and industrial point source (31.72%), respectively. SOM analysis identified four spatial patterns, e.g., Fe-Mn-Ag, Cd-Cu, Cr-Pb-As-Ni, and Zn-Co in water and three patterns, e.g., Mn-Co-Ni-Cr, Cd-Cu-Pb-Zn, and As-Fe-Ag in sediment. The spatial distribution of entropy water quality index values shows that the southwestern area possesses "poor" quality water. Overall, the levels of metal(loid) pollution in the investigated river surpassed a critical threshold, which might have serious consequences for the river's aquatic biota and human health in the long run.

1251 FRAILTY PREVALENCE AND RISK OF SARCOPENIA IN OLDER HEART FAILURE (HF) INPATIENTS

Introduction

Both frailty and HF are common in the elderly population. Elderly HF patients have an increased risk of frailty and elderly frail patients are at a higher risk of developing HF. Frailty is an independent predictor of mortality in cardiovascular disease. Sarcopenia (defined as decreased muscle mass and muscle strength and/or performance) is also prevalent in HF patients and may progress to cardiac cachexia. HF may induce sarcopenia and sarcopenia may contribute to the poor prognosis of HF.

Aims

Methods

A cross-sectional, retrospective analysis of consecutive patients, 60 years and over, admitted with HF to a UK hospital. Data was manually extracted from anonymized electronic records. The Rockwood Clinical Frailty Scale (CFS) was used for assessment for frailty and the SARC-F tool was used for screening for sarcopenia. Patients with medical history of HF but did not present with decompensated HF were excluded. Also, patients with incomplete data were excluded. The IBM SPSS 28 statistical package was used for statistical analysis. Descriptive statistics and risk estimates were calculated.

Results

163 patients were analysed; 82 males and 81 females. The mean age was 81.4 years (SD 9.69). 71.5 % of patients were frail while 28.5 % were non-frail. The risk of sarcopenia was 10.9 times greater in the frail than in the non-frail patients (OR = 10.9; 95% C.I 4.85 – 24.67). There was a lower risk of sarcopenia in male patients than in the female patients (OR =0.45; 95% C.I 0.22 – 0.94).

Conclusions

Frailty is prevalent in older heart failure inpatients. It significantly increases the risk of sarcopenia in these patients. Women are at higher risk of sarcopenia than men. More research is needed into frailty and sarcopenia in.

1242 CO-MORBIDITY, FRAILTY AND EJECTION FRACTION IN OLDER HEART FAILURE INPATIENTS

Introduction

Co-morbidities and frailty are common in older heart failure patients. The aim of this study is to explore the relationship between co-morbidity, frailty and ejection fraction (EF) in older heart failure inpatients

Methods

A cross-sectional, observational, retrospective analysis of consecutive patients aged 60 years and over who were admitted with heart failure in a UK hospital. Patients with incomplete data were excluded. The Carlson’s comorbidity index (CCI) was used to compute comorbidity and the Rockwood Clinical Frailty Scale (CFS) was used to measure frailty. The EF was calculated as the midpoint of the ranges measured by echocardiography. IBM SPSS 28 software was used for statistical analysis. Descriptive statistics were used to measure baseline characteristics and Pearson’s correlation coefficient and linear regression were used to calculate correlation.

Results and discussion

101 patients were analysed; 48 males and 53 females. Mean age was 81.2 years(SD 9.98). Mean CCI was 6.97(SD 1.63) and mean CFS was 5.09(SD 1.14). There was statistically significant positive correlation between CCI and CFS (r= 0.232; p= .01). There was statistically significant inverse correlation between CCI and EF (r= -.277; p=. 005). When taking into account the level of frailty the correlation between CCI and EF was much stronger in non-frail than in frail patients (r= -.612; p=. 035 and r= -.216; p= .047 respectively). There was no correlation between CFS and EF (r= .095; p=.26). This was not surprising as HFpEF is the most common type of HF in the elderly. HFpEF patients are more likely to have more comorbidities and to be more frail compared to HFrEF patients.

Conclusion

There was a positive correlation between multi-morbidity and frailty in older inpatients admitted with heart failure. There was statistically significant inverse correlation between CCI and ejection fraction but there was no correlation between frailty and ejection.

Facile acid fermentation extraction of silkworm pupae oil and evaluation of its physical and chemical properties for utilization as edible oil

Considering the increasing demand for edible oil in recent times, their price in the world market is becoming skyrocketing. In this research, we produced cost-effective edible oil from desilked silkworm pupae (Bombyx mori) applying a facile acid fermentation process, for the first time. The extraction was performed using two different types of organic acids, 3% of each acetic and citric acid. The yield of the extracted oil was 3.52 ± 0.23% from fresh silkworm pupae. The produced oil was then characterized physically and chemically to know its suitability to be used as edible oil. The oil was found with a low peroxide and acid value of 4.82 meq/kg and 1.35 mg KOH/g oil, respectively, and comprised of different fatty acids, in which palmitic acid (32.04%) and oleic acid (34.62%) were in large portions among the total fatty acids. Additionally, the extracted oil included linoleic, α-linolenic, and dihomo-gamma-linolenic acid which have health benefits. The oil was rich with minerals such as Iron, Sodium, Potassium, Calcium, Magnesium, Zinc, and Phosphorus with a negligible concentration of toxic elements such as Manganese, Cobalt, Nickel, Copper, Lead, Cadmium, Chromium, Arsenic, and Silver, indicating a good nutritive value of the extracted oil. Overall, the outcomes of all the characterizations showed that the extracted oil could be used as good edible oil and the corresponding acid fermentation extraction process has the potential to be used as an effective oil extraction method for silkworm pupae.

Natural and anthropogenic contributions to the elemental compositions and subsequent ecological consequences of a transboundary river's sediments (Punarbhaba, Bangladesh)

An anthropogenically less affected transboundary river (Punarbhaba, Bangladesh) was studied to detect associated risks from the combined origin(s) of geochemically and toxicologically significant elements in benthic sediments. A total of 30 river bed sediments were analyzed by instrumental neutron activation analysis targeting the 15 chemical elements viz., Na, Al, K, Ti, Cr, Mn, Co, Zn, As, Rb, Sb, Cs, Ba, Th, and U. Among the estimated elements, the mean abundances (μg/g) of Rb (136), Sb (0.66), Cs (6.66), Th (14.6), and U (3.92) were 1.4-1.7 times higher than the crustal origin. These elements are primarily responsible for the contaminated state of the Punarbhaba River. The studied area is 'moderately polluted' (I_geo: 2.01 to 0.02) and possesses 'minor enrichment' (EF: 1.98 to 0.48) in terms of the measured elements. The output of statistical analyses projected that the studied elements are geochemically fractionated in an oxidizing environment (U/Th = 0.44) and mostly originated from felsic sources, thus confirming the mineral is comprised of aluminosilicates and alkali feldspar. However, SQGs-based and ecological risk indices invoked minor (Cr: 6.67%) to no potential ecotoxicological threats for Cr, Mn, Co, Zn, As, and Sb. Nonetheless, altered distribution patterns caused by geogenic activities increased Cr and Zn in the environment which may cause toxicity (Cr: 22-53%, Zn: 35-70%), and pose potential ecological risks, specifically in upstream locations (P-2, P-3, P-5). Further, this study broadened the perspective of sediment deposition from fractionation, fluvial transportation, and weathering events beyond the industrial disintegration of elements, which will aid researchers and policymakers to comprehend combined risks from suspended sediments.

Knowledge, attitude and practices regarding dengue and its vector among medical practitioners in Malakand region, Pakistan

Abstract Dengue fever (DF) is increasingly recognized as one of the world’s major mosquito borne diseases and causes significant morbidity and mortality in tropical and subtropical countries. Dengue fever is endemic in most part of Pakistan and continues to be a public health concern. Knowledge, attitude and practices can play an important role in management of the disease. Current study was aimed to determine the level of knowledge, attitude and practices regarding dengue fever among health practitioners, to study the level of knowledge and attitude with preventive practices for dengue fever. A cross sectional study was carried out in medical practitioners of the four districts of Malakand region during October to November 2019. A pre-structured questionnaire was used to collect data from medical practitioners. Data was analyzed using Graph Pad version 5. Significant value was considered when less than 0.05 (at 95% confidence of interval). The results revealed that most of participants have seen dengue vector (62%), the media being the most quoted source of information. Nearly 81.2% participants were aware from transmission of dengue fever is by mosquito bite. Practices based upon preventive measures were found to be predominantly focused towards prevention of mosquito bites rather than elimination of breeding places. Although the knowledge regarding DF and mosquito control measure was quite high among the medical practitioners but this knowledge was not put into practice. Further studies are required to aware the people about dengue and its vector in order to get prevention and control.

Cross sections and calculated yields of some radionuclides of yttrium, strontium and rubidium formed in proton-induced reactions on enriched strontium-86: possibility of production of 85gSr, 83Rb and 82mRb in no-carrier-added form

Cross sections of the 86Sr(p,3n)84mY, 86Sr(p,αn)82mRb, and 86Sr(p,x)85gSr reactions were measured from their respective thresholds up to 16.2 MeV and from 23.0 to 44.1 MeV at FZJ, and from 14.3 to 24.5 MeV at LBNL, using 96.4% enriched 86SrCO3 as target material. Thin targets prepared by sedimentation were irradiated with protons in a stacked-form, and the induced radioactivity was measured by high-resolution γ-ray spectrometry. Nuclear model calculations based on the code TALYS reproduced our experimental cross section data well. From the excitation functions, the integral yields of the above three radionuclides were calculated. The yield of 85gSr via the natSr(n,γ) process was also measured using the TRIGA Mark-II reactor at AERE, Savar. A comparison of the reactor and cyclotron production of carrier-added 85gSr is given. The production possibilities of the three investigated radionuclides in no-carrier-added forms at a 30 MeV cyclotron via new routes are discussed.

Reconciling the geogenic and non-crustal origins of elements in an Indo-Bangla transboundary river, Atrai: Pollution status, sediment quality, and preliminary risk assessment

This study has been conducted on an anthropogenically less influenced transboundary river (Atrai: Indo-Bangladesh) to comprehend the inherent geochemistry and identify potential elemental sources. In doing so, across the Bangladeshi portion, 30 river-bed samples were culled and studied by neutron activation analysis to quantify the abundances of 15 geochemically and toxicologically significant elementals (Na, Al, K, Ti, Cr, Mn, Co, Zn, As, Rb, Sb, Cs, Ba, Th, and U). The results revealed that the mean concentrations (μg/g) of Rb (154.6), Cs (7.53), Th (20.90), and U (4.88) were 1.5-2.0 times higher than crustal values. Besides, geo-environmental indices revealed 'uncontaminated to moderately contaminated' pollution status with minor enrichment or contamination for Rb, Th, Sb, U, and Cs, relatively concentrated in the mid-to-downstream zone possessed geogenic and non-crustal origins. The positive matrix factorization and other statistical approaches revealed predominant geogenic enrichment of Na, K, Al, Ti, Zn, Cs, Rb, As, Th, and U from differential mineralogical compositions via weathering, elemental fractionations, and biogeochemical mobilization. Contrariwise, several anthropogenic sources (for Cr, Sb, Co, Mn, Th) were also ascertained in the vicinity of Atari River. However, sediment characterization based on SQG threshold values manifested that Cr and Mn possess rare biological effects on local aquatic organisms. Nevertheless, SQGs-based and ecological risk indices invoked minor to no potential ecotoxicological intimidations for the considered metal(oid)s (Cr, Mn, Co, Zn, As, and Sb). Hence, this study manifested the usefulness of a less anthropogenically affected river to reckon geogenic and non-crustal elemental origins in the compounded riverine sediment.

Environmental geochemistry of higher radioactivity in a transboundary Himalayan river sediment (Brahmaputra, Bangladesh): potential radiation exposure and health risks

This study of a downstream segment (Brahmaputra, Bangladesh) of one of the longest transboundary (China-India-Bangladesh) Himalayan rivers reveals elevated radioactivity compared to other freshwater basins across the world. Naturally occurring radioactive nuclides (²²⁶Ra, ²³²Th, and ⁴⁰K) and metal contents (transition metals, Fe, Ti, Sc, and V; rare earth elements, La, Ce, Eu, Sm, Dy, Yb, and Lu; high field strength elements, Ta and Hf; and actinides, Th and U) in thirty sediment samples were measured by HPGe γ-spectrophotometry and research reactor-based neutron activation analysis, respectively. We systematically investigated the mechanism of the deposition of higher radioactivity concentrations and rare earth elements (REEs) associated with heavy minerals (HMs) and photomicrograph-based mineralogical analysis. The results show that total REEs (∑REE) and Ta, Hf, U, and Th are generally 1.5- to 3.0-fold elevated compared to crustal values associated with -δEu and -δCe anomalies, suggesting a felsic source provenance. The enrichment of light REEs (×1.5 upper continental crust (UCC)) and Th (×1.9 UCC), besides Th/U (=7.74 ± 2.35) and ²³²Th/⁴⁰K ratios, along with the micrographic and statistical approaches, revealed the elevated presence of HMs. Fluvial suspended sedimentary transportation (from upstream) followed by mineralogical recycling and sorting enriched the HM depositions in this basin. Bivariate plots, including La/Th-Hf, La/Th-Th/Yb, and La/V-Th/Yb, revealed significant contributions of felsic source rock compared to mafic sources. The assessment of radiological hazards demonstrates ionizing-radiation-associated health risks to the local residents and people inhabiting houses made from Brahmaputra River sediments (as construction material).

P-658 NLRP3 Inflammasome and polycystic ovarian syndrome – a possible novel association

Study question

Is NLRP3 inflammasome expression in subcutaneous adipose tissue (SAT) and peripheral blood monocytes upregulated in women with polycystic ovarian syndrome (PCOS) compared to healthy controls?

Summary answer

NLRP3 expression was upregulated in subcutaneous adipose tissue but not in peripheral blood mononuclear cells (PBMCs) of women with PCOS compared to controls.

What is known already

Emerging evidence strongly suggests that PCOS is a chronic inflammatory condition. Inflammasomes are multiprotein complexes, which act as intracellular regulators of inflammation. It is now well established that NLRP3 inflammasome plays a central role in obesity-induced inflammation and insulin resistance. Given the close link between obesity and PCOS, it is plausible to hypothesize that the NLRP3 inflammasome may play a role in PCOS-related chronic inflammation and insulin resistance. This hypothesis has never been investigated before.

Study design, size, duration

This lab-based study involved reproductive age women (age 18–45years; BMI≤40kg/m2) who were diagnosed with PCOS (n = 24) according to the Rotterdam criteria. A healthy control group of non-PCOS women (n = 13) of similar age and BMI was included. Ethics approval was obtained, and all participants signed a written, informed consent. SAT biopsies were obtained during routine gynaecological surgery through the abdominal skin incision. Blood samples were obtained during surgery or during clinic visits.

Participants/materials, setting, methods

Blood samples were processed to separate plasma and to isolate peripheral blood mononuclear cells (PBMCs). SAT and PBMCs were analysed using qPCR and Western Blot (WB) to measure the relative gene and protein expression levels of NLRP3, CYP17, Caspase-1, IL-1β and IL-18 in both groups. ELISA was used to measure concentrations of Caspase-1, IL-1β and IL-18 in the plasma.

Main results and the role of chance

NLRP3 gene expression in SAT was significantly (p = 0.038) higher in PCOS women (2.08±3.5 (n = 12)) compared to controls (0.77±2.9 (n = 8)). Both groups were matched for age (PCOS, 29.4±3.7 vs controls, 30.3±4.0) and BMI (PCOS, 25.4±3.2 vs controls, 26.9±4.3). CYP17 expression was significantly (p = 0.001) higher in PCOS women (4.8±0.1) versus controls (1.5±1.6). There was a moderate positive correlation (r²=0.576, P &lt; 0.05) between SAT NLRP3 and CYP17 expressions.

NLRP3 gene expression in PBMCs were not significantly (p &lt; 0.05) different between non-obese PCOS (-2.64±1.55 (n = 4)), obese PCOS (-2.847±1.85 (n = 8)) and non-PCOS women (0.000±2.67 (n = 5)).

Using WB in PBMCs, NLRP3 band had a mean molecular weight of 72.59±5.43kDa with no significant difference between groups, with a trend towards higher levels in PCOS. Using ELISA in PBMCs, NLRP3 levels were not significantly (p = 0.3) different between PCOS (1.53±1.32pg/ml (n = 12)) vs controls (1.03±0.583 (n = 5)).

Gene expression levels of Caspase-1, IL-1b and IL-18 in PBMCs were not significantly (P &gt; 0.05) different between groups.

Plasma IL-1β levels were significantly (p &lt; 0.05) higher in PCOS (51.64±91.00ng/ml) vs. controls (0.47±0.93ng/ml). Plasma IL-18 concentrations were not significantly different between PCOS (3.79±0.53μg/ml) vs. controls (4.08±0.21μg/ml).

Limitations, reasons for caution

One limitation of this study is the lack of data on the protein expression of NLRP3 in the adipose tissue. There was also no data on other inflammasome components in the SAT analysis e.g. Caspase-1. However, all these data were available for the PBMCs.

Wider implications of the findings

The novel and interesting finding of an increase in NLRP3 in adipose tissue of PCOS women suggests that this inflammasome may play a central role in this common condition. Our study may therefore pave the way to further research to help understand the role of inflammation in PCOS

Trial registration number

N/A

970 FRAILTY IS INVERSELY CORRELATED WITH SERUM ALBUMIN IN ACUTE HIP FRACTURE

Introduction

Frailty and sarcopenia have been shown to significantly increase the risk of falls, traumatic hip fractures and all-cause mortality in the elderly. The assessment of frailty using a validated clinical frailty scale such as that proposed by Rockwood et al., therefore, continues to remain an important step in determining post-operative prognosis in patients undergoing hip fracture surgery. The purpose of this study was to examine the relationship between frailty and serum albumin—an independent biochemical predictor of survival in hip fracture patients (1).

Method

This retrospective cross-sectional study analysed 190 patients, aged above 60 years, admitted to Queen’s Hospital Burton (QHB) between the 1st January and 28th December 2019 with a newly diagnosed hip fracture. Pre-operative serum albumin levels (g/L) and Rockwood clinical frailty scores (rCFS) were recorded from electronic medical records (EMR). Using the SPSS 27 statistical package, Pearson’s correlation co-efficient and linear regression analysis were carried out using these variables.

Results

A total of 190 patients were included in the study (57 male, 133 female). Mean patient age was 82.2 ± 8.47 years. More than 50% of patients had a Rockwood CFS ≥5. Mean serum albumin (g/L) was 37.3 ± 6.56. A statistically significant inverse correlation was demonstrated between pre-operative serum albumin levels and Rockwood CFS (r = −0.243, p &lt; 0.001).

Conclusion

This study showed how serum albumin, a negative acute phase reactant and marker of chronic malnutrition, is inversely associated with frailty in hip fracture patients and the important role of Rockwood CFS and pre-operative serum albumin levels in the prognostication of hip fractures in the elderly. References 1) Bohl D, Shen M, Hannon C, Fillingham Y, Darrith B, Della Valle C. Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture. Journal of Bone and Joint Surgery. 2017;99(24):2110–2,118.

975 RELATIONSHIP BETWEEN HAND GRIP STRENGTH (HGS) AND 10 YEAR PROBABILITY OF MAJOR OSTEOPOROTIC FRACTURES IN OLDER

Introduction

HGS has been shown to be associated with adverse outcomes in a wide range of conditions. It has also been found to be associated with bone mineral density and is inversely associated with risk of osteoporotic fractures. The aim of this study was to determine the association between HGS and 10 year probability of sustaining a major osteoporotic fractures in older inpatient and to evaluate the effect of gender on this association.

Method

This was a cross-sectional, observational analysis of older patients admitted into hospital between September and November 2021. HGS was measured in these patients using the JAMAR hydraulic hand held dynamometer. The Southampton protocol was used. The FRAX UK tool (without BMD) was used to calculate 10 year probability of major osteoporotic fractures. Patients were included if they were 60 years and above. Younger patients were excluded as were stroke patients. Patients with incomplete data were excluded from analysis. The SPSS 27 package was used for statistical analysis. Baseline characteristics were calculated using descriptive statistics. Pearson’s correlation coefficient and linear regression were used to calculate correlation.

Results

104 patients were analysed—41 males and 63 females. Mean age was 83 years (SD 8.2). Grip strength was inversely correlated with FRAX UK in predicting 10 year probability of major osteoporotic fractures in all patients, male patients and female patients (r = −0.452; p &lt; 0.001, r = −0.351; p = 0.02 and r = −0.271; p = 0.03 respectively).

Conclusion

Grip strength is negatively associated with increased probability of major osteoporotic fractures in older inpatients. Reference(s) Ma Y, Fu L, Jia L, et al. Muscle strength rather than muscle mass is associated with osteoporosis in older Chinese adults. J Formos Med Assoc. 2018;117(2):101–108. doi:10.1016/j.jfma.2017.03.004

974 ASSOCIATION BETWEEN NOTTINGHAM HIP FRACTURE SCORE AND FRAILTY IN ELDERLY ACUTE HIP FRACTURE PATIENTS

Introduction

Nottingham Hip Fracture Score (NHFS) is a well validated risk stratification tool that has been shown to predict 30 day mortality in elderly patients with acute hip fractures. A lot of older patients that sustain hip fractures are frail. The Rockwood Clinical Frailty Scale (CFS) has been validated as a tool to screen for frailty in acutely ill patients and has been shown to predict outcomes in acutely ill elderly patients. The aim of this study was to determine if there is any correlation between the NHFS and CFS in elderly patients with acute hip fractures and to evaluate the effect of gender on this correlation.

Method

A retrospective, cross-sectional analysis was carried out on patients admitted with acute hip fractures between January and December 2019 in a single centre trauma and orthopaedic unit. Data was extracted from anonymized electronic patient records. Patients were included if they were 60 years and above; those less than 60 were excluded. Patients with missing data were excluded from analysis. NHFS and CFS were calculated in these patients. SPSS 27 IBM software was used for statistical analysis. Baseline characteristics were calculated using descriptive statistics and spearman’s correlation co-efficient and linear regression were used to determine correlation.

Results

A total of 268 patients were analysed—65 males and 202 females. Mean age was 83 years (SD 8.5). There was statistically significant positive correlation between NHFS and CFS in all patients, male patients and female patients (r = 0.589; p &lt; 0.001, r = 0.603; p &lt; 0.001, and r = 0.599; p &lt; 0.001 respectively).

Conclusion

NHFS is positively correlated with CFS in elderly acute hip fracture patients. Reference(s) Doherty W.J, Stubbs T.A et al. Prediction of Postoperative Outcomes Following Hip Fracture Surgery: Independent Validation and Recalibration of the Nottingham Hip Fracture Score. Journal of the American Medical Directors Association;22(3):663–669.e2.

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.

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.